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Objective: Maladaptive daydreaming (MD) is characterized by vivid, excessive fantasy activity that becomes prioritized over other activities and may result in avoidant coping strategies. Little is known about the relationship between MD and internalized stigma in the neurodivergent sample. The current study aimed to examine emotional dysregulation, escapism and self-perception (self-esteem and internalized stigma) as potential determinants of MD in three groups: adults on the autism spectrum, with ADHD, and both diagnoses ("AuDHD"), including their neurodivergent symptoms (autistic traits, empathizing, ADHD symptoms). Methods: A sample of 293 persons (139 with ADHD, 74 on the autism spectrum, and 80 with both diagnoses) completed self-report scales concerning ADHD symptoms, autism spectrum symptoms, empathizing, self-esteem, daydreaming as escapism, emotional dysregulation, maladaptive daydreaming, and internalized stigma. A correlation analysis was implemented. Additionally, a group comparison and quantile regression for the 25th, 50th, and 75th percentile of maladaptive daydreaming in the three groups were executed. Results: The results showed that internalized stigma, emotional dysregulation, escapism, and self-esteem have significant associations with MD in the neurodiverse sample. The ADHD group achieved the lowest scores in emotional dysregulation, discrimination experience, and social withdrawal. The groups did not vary in MD rates, stereotype endorsement, stigma resistance, nonacceptance of emotional responses, and impulse control difficulties. The AuDHD group achieved higher results than the ASD group only in the ADHD symptoms. Quantile regression revealed differences in the predictors of maladaptive daydreaming in the three groups. ADHD symptoms and self-suppression escapism were significant predictors for the higher levels of MD in persons with singular autism or ADHD diagnosis. Conclusion: The results showed no differences in MD rates, although there were significant variations in predictive features among the three samples. The role of internalized stigma and self-esteem was highlighted in the results as significant associates of MD prevalence. These outcomes expand the current knowledge in the context of maladaptive daydreaming, internalized stigma, self-esteem and emotional dysregulation in a neurodiverse sample and allow for proposing clinical applications and further research directions.

Psychoeducation programs may increase knowledge about stress and help adolescents cope with stress. However, research about the effectiveness of psychoeducation programs about stress for adolescents is limited. The present study aimed to fill this gap by evaluating the effect of a brief school-based universal psychoeducation program about stress, the Stress Lessons, in terms of knowledge and experienced stress. A total of 1613 adolescents (M = 13.41 years) from Dutch secondary schools participated. A cluster randomised controlled design was employed: classes were randomly assigned to an experimental or control condition. The experimental condition received three Stress Lessons between pre- and post-test. The Stress Lessons provided information about stress, how to recognize stress, and how to cope with and prevent stress. Questionnaires were used to assess knowledge about stress as well as experienced stress. Multilevel analyses were conducted to examine the effectiveness of the Stress Lessons and the moderating effect of gender, educational track, and ethnic background. Results showed that knowledge gain was significantly greater in the experimental than in the control condition. Experienced stress did not change due to the Stress Lessons. Moderator analyses revealed a larger effect of the Stress lessons in terms of knowledge about stress for girls compared to boys and for adolescents who followed academic compared to vocational education. Overall, the findings show that a brief psychoeducation program leads to a better understanding of stress. Therefore, it may be useful for schools to implement such programs to enhance adolescents' awareness.

Targeted school-based programs seem to be a promising approach to help adolescents in need. Nevertheless, successful implementation and evaluation of such programs is challenging. However, there is limited knowledge about (overcoming) the challenges of implementation and experimental evaluation of school-based programs. The goal of the present paper is, therefore, to improve future research by describing the challenges encountered and lessons learned during two randomized controlled trials (RCTs) to study the effectiveness of two skills-training programs reducing school or social stress. In this way, we aim to inform others who plan to implement and evaluate such programs in schools using an RCT design. Some of the challenges encountered apply to all effectiveness studies, such as the recruitment and retention of participants; others are more "intervention at school" specific, such as scheduling the programs and assessments. Our experiences show that it is possible to effectively implement and evaluate targeted programs promoting adolescent mental health in secondary schools with RCTs, even during a worldwide health pandemic, but that it requires investing sufficient time in keeping close and regular contact as well as clear communication between the involved parties. Moreover, high levels of flexibility are needed in adjusting scheduled meetings for intervention and research while keeping track of the entire process for each school and individual participant.

The present study aimed to identify overall stress and salient stressors experienced by adolescents from different education tracks and self-perceived ethnic backgrounds. A total of 1489 adolescents (M = 13.40 years; SD = 0.89 years) from nine Dutch secondary schools participated. Self-reported stressors were measured with the adapted version of the Adolescent Stress Questionnaire -- Short. After controlling for age, gender, country of birth, and school classes, results showed that overall stress did not differ for educational track nor for ethnic background subgroups. Adolescents in academic education reported more stress from school-related stressors than adolescents attending vocational education. Adolescents with a mixed ethnic background (i.e., Dutch and another ethnicity) reported more stress regarding school-related stressors than adolescents with a Dutch ethnic background. These differences between adolescents of different educational tracks and ethnic backgrounds have implications for intervention programs targeting specific stressors.

In this study we measured the effect of COIL on intercultural competence development using a quasi-experimental design. Our sample consisted of 108 undergraduate students from two universities, one located in the Netherlands (NL) and one in the United States (US). Students' self-reported intercultural competence was measured using a pre-post survey which included the Cultural Intelligence Scale (CQS) and Multicultural Personality Questionnaire (MPQ). Qualitative data were collected to complement our quantitative findings and to give a deeper insight into the student experience. The data showed a significantly bigger increase in intercultural competence for the US experimental group compared to the US control group, supporting our hypothesis that COIL develops intercultural competence. This difference was not observed for the NL students, possibly due to the NL control group being exposed to other international input during the course.

School closures due to the COVID-19 pandemic raised concerns about increases in educational inequality. We examined the magnitude of the impact of the first school closure for vulnerable student groups in particular. This study was conducted among 886 Grade 3-5 students in the Netherlands in schools serving a high percentage of students from disadvantaged backgrounds. Piecewise growth analyses indicated that the school closures caused discontinuity in students' achievement growth on national standardized tests and led to an average learning loss of 2.47 months in mathematics and 2.35 in reading comprehension, exceeding the duration of the school closure. Findings suggest that school closures contribute to educational inequality and indicate which students may particularly need additional support to overcome the adverse consequences of the lockdowns.

Early Warning Systems (EWS) in higher education accommodate student counsellors by identifying at-risk students and allow them to intervene in a timely manner to prevent student dropout. This study evaluates an EWS that shares student-specific risk information with student counsellors, which was implemented at a large Dutch university. A randomised field experiment was conducted to estimate the effect of EWS-assisted counselling on first-year student dropout and academic performance. The results show that the EWS accurately predicts at-risk students. Yet, EWS-assisted counselling did not reduce dropout, nor improved academic performance. Solving the underlying problem of poor academic performance might require additional actionable feedback and recommended counselling practices.

Purpose: Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood. Method: This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed. Results: Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = 0.04). In the opposite direction, children with a history of stuttering showed more negative affectivity ([beta] = 0.19, 95% CI [0.02, 0.37], p = 0.03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors ([beta] = 0.38, 95% CI [0.03, 0.74], p = 0.04) and higher emotional reactivity ([beta] = 0.53, 95% CI [0.09, 0.89], p = 0.02) at the age of 9 years. Conclusions: Behavior and temperament were associated with stuttering persistency--seemingly as both predictor and consequence--but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered.

Success for All, a multi-tiered school reform program, has its origins in the US and has recently expanded to the Netherlands. Using a multiple case study approach, we investigated similarities and differences in the way struggling readers are supported at two Success for All schools in the US and two in the Netherlands. First- and second-grade teachers and other staff members involved in the implementation of Success for All and the support of struggling readers were interviewed. We concluded that American and Dutch interviewees agreed on the benefits of Success for All for struggling readers, such as the engaging whole-class lessons and the possibility to offer tutoring. Furthermore, in both countries a tension was observed between the scriptedness of Success for All and the need for flexibility in the support of struggling readers. Regarding differences, we observed that both contextual and cultural factors led to variations in the way struggling readers are supported.

Objective: To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. Design: Prospective study. Setting: Sophia Children's Hospital, Rotterdam, the Netherlands. Patients/ Participants: 36 patients with Robin Sequence who were treated between 2011 and 2021. Interventions: Positional therapy and respiratory support. Main Outcome Measure(s): Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). Results: Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from −0.40 to −0.33 to −1.03, respectively. Conclusions: Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 lockdown had profound effects on society and healthcare. Cardiology departments reported declines in chest pain evaluations and acute coronary syndrome (ACS) diagnoses. However, the pattern of chest pain in primary care is not clear yet. This study aims to assess the impact of the COVID-19 lockdown on the number of patients presenting with chest pain in primary care. Methods: Routine primary care data from the Extramural LUMC (Leiden University Medical Center) Academic Network (ELAN) in the Netherlands were used. Chest pain consultations from January 2017 to December 2020 were included. An interrupted time series analysis was performed to compare the incidence rate (IR) of chest pain consultations during the COVID-19 lockdown to the expected IR. Secondary outcomes were the type of consultations, referral proportions, and the IR of registered ACS diagnoses. Results: In total 9,908 chest pain consultations were included. During the COVID-19 lockdown the IR was 6.16 per 1000 person-years while the expected IR was 7.55 (95% CI 7.03–8.12). The immediate effect of the lockdown yielded an incidence rate ratio (IRR) of 0.62 (95% CI 0.50–0.77). A similar decrease was seen for ACS diagnoses (IRR 0.62, 95% CI 0.48–0.79), with no compensatory increase after the lockdown (IRR 1.04, 95% CI 0.89–1.21). Face-to-face consultations shifted to telephone consultations (p < 0.001) and hospital referrals decreased (9.9% vs. 19.0% (p < 0.001)). Conclusions: During the COVID-19 lockdown the number of chest pain consultations and registered ACS diagnoses in primary care decreased significantly. In addition, fewer patients were assessed face-to-face and fewer patients were referred to the hospital. Key Message: During the COVID-19 lockdown, significantly fewer patient consulted their general practitioner for chest pain. Fewer new diagnoses of ACS were registered by general practitioners during the COVID-19 lockdown. It remains unclear whether the number of ACS diagnoses truly decreased or if ACS cases were missed. [ABSTRACT FROM AUTHOR]

In this study, we analyze in-depth interviews conducted with 26 Dutch third-graders as well as interviews with one of each child's parents. The children attended one of six schools, each with a relatively large population of families with a low socioeconomic status, where home-based literacy assignments aimed at increasing children's enjoyment of reading were distributed for a duration of 3 years. The aim of this study is to gain knowledge of distinctive interaction characteristics of child-parent dyads regarding at-home literacy, to learn how these characteristics can help educational professionals and researchers answer to the needs of children and parents when designing and distributing at-home reading assignments. Based on the attitudes towards reading and the skillset of child and parent(s), we distinguished three reader-profiles: (1) Autonomously motivated readers, (2) Incompatible readers, and (3) Generational non-readers. The practical implications of our research are that, to be appealing, at-home reading assignments should be differentiated, nonrepetitive, and concrete, complete, and structured. Prerequisite implications are that both children and parents value regular positive feedback on their at-home literacy activities and that, in approaching parents, it appears to be advisable to take them for what they are: parents, not substitute teachers.

Teacher educators are an occupational group who appear to suffer from an identity crisis. They do not seem to be able to agree on what their role or professional learning needs are. This situation has dire consequences for the next generation of teacher educators who enter the field in the same rather haphazard and ad hoc way as the ones before. This phenomenon might further explain why it has been called the hidden profession with reports of a general lack of professional induction, mentoring and advice. To explore this issue, a study of twenty "accomplished" university-based teacher educators were posed questions, one in particular asked, "what advice would you give beginning teacher educators"? A key finding is the important role a teacher educator plays as a public intellectual and the new skills and knowledges required to fulfil this role in an increasingly complex, multifaceted and digital world.

The concept of open functions was introduced to capture an intended feature of van Eyck's seminal play sculptures -- they do not suggest a specific action. In a recent study, Van der Schaaf, A. L., S. R. Caljouw, and R. Withagen. (2020. "Are Children Attracted to Play Elements with an Open Function?" "Ecological Psychology" 32: 79-94) aimed to determine the degree of openness of Parkour play elements by asking participants what behavior children will mainly perform on them. In the present study, we used this method to determine the degree of openness of traditional play elements (e.g. a slide), van Eyck's play sculptures, and Parkour play elements. In addition, we measured the time participants needed to answer the question of what action children will mainly perform on the different elements. We found that generally the Parkour elements have the highest degree of openness. Interestingly, van Eyck's play elements appeared not to be that open. Moreover, the reaction time proved to be an alternative measure for the degree of openness.

Whereas executive functions are known to be closely tied to successful language processing in children and younger adults, less is known about how age-related decline in these functions affects language processing in elderly adults. Because the abilities to use linguistic context and resolve potential ambiguities such as between an idiom's figurative and literal meaning depend on executive functions, we investigated this issue by examining elderly adults' processing of idioms in context. We recorded event-related potentials of 25 younger (age 18-28) and 25 elderly adults (age 61-74) while they read literal sentences and sentences containing an idiom (e.g., the Dutch idiom "to walk against the lamp," meaning "to get caught"), each preceded by a neutral or predictive context sentence. Participants' use of context was hypothesized to relate to working memory capacity, while their ability to disambiguate idioms was hypothesized to depend on inhibition skills. Both groups showed facilitated processing for idioms compared with literal sentences and for sentences preceded by predictive compared with neutral contexts, indexed by a reduced N400. However, only elderly adults showed an increased P600 for literal but not idiomatic sentences preceded by a predictive context, suggesting that they rely on linguistic context when a sentence's meaning needs to be computed word by word, but not when a large part is retrieved from memory (as in idioms). Our findings suggest that in both younger and elderly adults processing literal sentences requires more cognitive effort than processing idiomatic sentences, and that cognitive aging affects language when processing is effortful.

This study performs a cost-benefit analysis of the implementation of the KiVa anti-bullying program in the Netherlands. Specifically, it addressed whether the expected benefits of KiVa for victims in terms of lifetime income are greater than the costs that are made for implementing the program. The KiVa intervention was examined in a randomized controlled trial in the Netherlands in 2012-2014 in 98 Dutch primary schools (target grades US-level 3-4, 8 to 9 years old). A model-based approach was applied to the effects for the expected income for prevented victims, which is a long-term outcome that can be quantified. The estimated costs and benefits of implementing KiVa were used to estimate the return-on-investment (ROI) that indicated the expected benefits per euro invested. Investing in KiVa in the Netherlands generated an ROI of €4.04-€6.72, indicating that it is good value for money to invest in KiVa. The chosen estimates in this study were deemed conservative; on the cost side, it was assumed that schools maximally implement KiVa (thus, maximum costs), and on the benefit side, only the expected income effect for victims was included to the model. Quantifying and incorporating other outcomes (i.e., depression, anxiety, psychiatric problems, not only for victims but also for bullies, bystanders, parents, teachers) may further increase the ROI for this intervention.

In previous studies, the effects of physically active academic lessons on academic achievement have been shown. Less is known about follow-up effects and the effects for disadvantaged groups. The first aim of this study was to examine 7-9 months follow-up effects of a physically active academic intervention on academic achievement. The second aim was to examine the effects of the 2-year intervention for a subgroup of socially disadvantaged children. A cluster-randomized controlled trial with 499 children (113 socially disadvantaged children) from second- and third-grade classes was conducted. Children's academic achievement was measured before the intervention started, after the first and second intervention year, and 7-9 months after the intervention ended. At the 7-9 months follow-up, the intervention group showed significantly greater gains in math performance in comparison with the control group. No significant follow-up effects were found on language performance. Furthermore, the lessons significantly improved the math and spelling performance of socially disadvantaged children after two intervention years. These children did not benefit more from the lessons than other children. In conclusion, effects of physically active academic lessons on math achievement persist when the lessons are no longer taught, and the lessons are an innovative way to improve the academic achievement of socially disadvantaged children. The findings suggest that physically active academic lessons should be considered for inclusion in school curriculums in order to improve the academic achievement of all children. Trial Registration: This study is registered at www.isrctn.com (No. ISRCTN17021806).

Introduction: Multimorbidity challenges quality and sustainability of healthcare systems. Care groups were introduced in the Netherlands to promote integration of chronic primary care, but it remains unknown to which degree they facilitate this. This study therefore aims to determine whether Dutch general practices perceive themselves to be capable of delivering integrated chronic care and uncover the role of care groups. Methods: We performed a survey study amongst 39 care groups and 65 healthcare providers within general practices (GPs and nurse practitioners). Results: 43% of healthcare providers within general practices are (very) dissatisfied with capabilities for chronic care to patients and 56% do not feel capable of delivering integrated care. Care groups and providers show alignment in their perception of some of the most important facilitators and barriers such as motivation and lack of time, but other factors are valued differently at both levels. Discussion: Our findings show inability of general practices to deliver integrated chronic care despite a health system that is inherently supportive of care integration and point to a mismatch between barriers and facilitators amongst practices and care groups, resulting in providers partly relying on their motivation in accommodating integrated chronic care. Conclusion: General practices are not sufficiently supported by care groups and national policies in delivering integrated chronic care. The identified mismatch between policy and practice warrants redesign of support from care groups to align policies with identified barriers and facilitators at the provider level. [ABSTRACT FROM AUTHOR]

The Merovingian period (5th to 8th cc AD) was a time of demographic, socioeconomic, cultural, and political realignment in Western Europe. Here, we report the whole-genome shotgun sequence data of 30 human skeletal remains from a coastal Late Merovingian site of Koksijde (675 to 750 AD), alongside 18 remains from two Early to Late Medieval sites in present-day Flanders, Belgium. We find two distinct ancestries, one shared with Early Medieval England and the Netherlands, while the other, minor component, reflecting likely continental Gaulish ancestry. Kinship analyses identified no large pedigrees characteristic to elite burials revealing instead a high modularity of distant relationships among individuals of the main ancestry group. In contrast, individuals with >90% Gaulish ancestry had no kinship links among sampled individuals. Evidence for population structure and major differences in the extent of Gaulish ancestry in the main group, including in a mother-daughter pair, suggests ongoing admixture in the community at the time of their burial. The isotopic and genetic evidence combined supports a model by which the burials, representing an established coastal nonelite community, had incorporated migrants from inland populations. The main group of burials at Koksijde shows an abundance of >5 cM long shared allelic intervals with the High Medieval site nearby, implying long-term continuity and suggesting that similarly to Britain, the Early Medieval ancestry shifts left a significant and long-lasting impact on the genetic makeup of the Flemish population. We find substantial allele frequency differences between the two ancestry groups in pigmentation and diet-associated variants, including those linked with lactase persistence, likely reflecting ancestry change rather than local adaptation. [ABSTRACT FROM AUTHOR]

Proponents of dynamic testing have advocated its use as a replacement or addition to conventional tests. This research aimed to investigate the effects of using versus not using a pretest on both the outcome on the posttest and the processes used in solving inductive reasoning tasks in dynamic testing using a graduated prompts training. Sixty-seven 7- to 8-year-old children were assigned to either a group that received a pretest or a group that did not receive a pretest, using a randomized blocking procedure. No significant differences were found between both groups of children on posttest accuracy, process measures, number of hints needed during training, amount of time needed for testing, and the prediction of school related measures. This article concluded that the decision of whether or not a pretest is necessary should be based on the research question to be answered because it does not appear to influence posttest results.

The attention being devoted to teacher educators as professionals and their professional development is unquestionably increasing. Whilst much of that attention is being directed at teacher educators in different countries, international comparisons have been quite rare to date. The research question addressed in this study was: "Do experienced teacher educators from different countries differ in their concerns, professional development activities and developmental goals?" Interviews were conducted with 25 participants from 10 different countries, all of whom were experienced teacher educators. Teacher educators' concerns varied in the course of their careers. During their induction their primary focus tended to be on survival, whereas later on in their careers their concerns became linked to their own professional identity and their students as individuals. Participants from all the participating countries were involved in a range of developmental activities. A large majority was involved in research-related activities which they perceived as an important tool in their professional development. All the participants had plans for their further professional development but sometimes foresaw hindrances to the realisation of those plans, such as a lack of resources and time. The interview data did not provide evidence to suggest clear country-specific differences. In fact, the opposite would appear to be the case: teacher educators from different countries seem to have similar concerns, and their current professional development activities and plans for future development are also quite comparable.

Generating creative ideas in a brainstorm session `is a crucial part of innovation. However, for actual implementation, the most creative ideas must be selected from a pool of ideas. To date, idea selection has remained relatively unexplored and validated instruments to measure idea selection performance are not systematically employed. This study aimed to improve creative idea selection performance in a field study. In this study, an idea pool of 18 ideas was used, and participants had to select the 5 most creative ideas from the idea pool. Right before participants performed the idea selection task, in the experimental condition, a promotion focus and positive affect was induced in combination with a self-affirmation task. Participants in the control condition performed corresponding filler tasks. The selection of the 5 most creative ideas from the idea pool of 18 ideas was performed individually. Participants in the experimental condition selected ideas that were more creative than did participants in the control condition. These findings provide first evidence that the selection of creative ideas can be enhanced through a combined induction of promotion-focus, positive mood and self-affirmation.

Aims: To explore potential areas of low‐value home‐based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home‐based nursing care. Design: A quantitative, cross‐sectional design. Methods: An online survey with questions containing scaled frequencies on five‐point Likert scales and open questions on possible related influencing factors of low‐value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. Results: A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low‐value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're‐use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low‐value care. Conclusion: According to registered nurses and certified nursing assistants, a number of low‐value nursing practices occurred frequently in home‐based nursing care and they experienced multiple factors that influence the provision of low‐value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de‐implementation strategy. Reporting Method: STROBE checklist for cross‐sectional studies. Patient or Public Contribution: No Patient or Public Contribution. Implications for the Profession and/or Patient Care: Nursing care is increasingly shifting towards the home environment.Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low‐value.Reducing low‐value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system. [ABSTRACT FROM AUTHOR]

While physical activity (PA) is understood to promote vascular health, little is known about whether the daily and weekly patterns of PA accumulation associate with vascular health. Accelerometer‐derived (activPAL3) 6‐ or 7‐day stepping was analyzed for 6430 participants in The Maastricht Study (50.4% women; 22.4% Type 2 diabetes mellitus (T2DM)). Multivariable regression models examined associations between stepping metrics (average step count, and time spent slower and faster paced stepping) with arterial stiffness (measured as carotid–femoral pulse wave velocity (cfPWV)), and several indices of microvascular health (heat‐induced skin hyperemia, retinal vessel reactivity and diameter), adjusting for confounders and moderators. PA pattern metrics were added to the regression models to identify associations with vascular health beyond that of stepping metrics. Analyses were stratified by T2DM status if an interaction effect was present. Average step count and time spent faster paced stepping was associated with better vascular health, and the association was stronger in those with compared to those without T2DM. In fully adjusted models a higher step count inter‐daily stability was associated with a higher (worse) cfPWV in those without T2DM (std β = 0.04, p = 0.007) and retinal venular diameter in the whole cohort (std β = 0.07, p = 0.002). A higher within‐day variability in faster paced stepping was associated with a lower (worse) heat‐induced skin hyperemia in those with T2DM (std β = −0.31, p = 0.008). Above and beyond PA volume, the daily and weekly patterns in which PA was accumulated were additionally associated with improved macro‐ and microvascular health, which may have implications for the prevention of vascular disease. [ABSTRACT FROM AUTHOR]

Introduction: As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. Material and methods: This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40–44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. Results: A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72–0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. Conclusions: Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the prognostic value of the neurotrophic tyrosine receptor kinase (NTRK) gene fusions by comparing the survival of patients with NTRK+ tumours with patients without NTRK+ tumours. Methods: We used genomic and clinical registry data from the Center for Personalized Cancer Treatment (CPCT-02) study containing a cohort of cancer patients who were treated in Dutch clinical practice between 2012 and 2020. We performed a propensity score matching analysis, where NTRK+ patients were matched to NTRK− patients in a 1:4 ratio. We subsequently analysed the survival of the matched sample of NTRK+ and NTRK− patients using the Kaplan–Meier method and Cox regression, and performed an analysis of credibility to evaluate the plausibility of our result. Results: Among 3556 patients from the CPCT-02 study with known tumour location, 24 NTRK+ patients were identified. NTRK+ patients were distributed across nine different tumour types: bone/soft tissue, breast, colorectal, head and neck, lung, pancreas, prostate, skin and urinary tract. NTRK fusions involving the NTRK3 gene (46%) and NTRK1 gene (33%) were most common. The survival analysis rendered a hazard ratio (HR) of 1.44 (95% CI 0.81–2.55) for NTRK+ patients. Using the point estimates of three prior studies on the prognostic value of NTRK fusions, our finding that the HR is > 1 was deemed plausible. Conclusions: NTRK+ patients may have an increased risk of death compared with NTRK− patients. When using historic control data to assess the comparative effectiveness of TRK inhibitors, the prognostic value of the NTRK fusion biomarker should therefore be accounted for. [ABSTRACT FROM AUTHOR]

The present study aimed to identify overall stress and salient stressors experienced by adolescents from different education tracks and self-perceived ethnic backgrounds. A total of 1489 adolescents (M = 13.40 years; SD = 0.89 years) from nine Dutch secondary schools participated. Self-reported stressors were measured with the adapted version of the Adolescent Stress Questionnaire – Short. After controlling for age, gender, country of birth, and school classes, results showed that overall stress did not differ for educational track nor for ethnic background subgroups. Adolescents in academic education reported more stress from school-related stressors than adolescents attending vocational education. Adolescents with a mixed ethnic background (i.e., Dutch and another ethnicity) reported more stress regarding school-related stressors than adolescents with a Dutch ethnic background. These differences between adolescents of different educational tracks and ethnic backgrounds have implications for intervention programs targeting specific stressors. [ABSTRACT FROM AUTHOR]

While the right of children to be involved in decisions that concern them has been widely recognised, they are currently barely involved in guideline development in healthcare. This paper aims to explore what a future guideline development system in which children are meaningfully involved might look like and to reflect on the transition required to achieve this. We used a systems innovation perspective, exploring child participation within its systemic context and complexity. To this end, we conducted 24 interviews with various actors, about their ideas on and experiences with child participation in guideline development in the Dutch system (between August 2018 and September 2020), complemented with a scoping review. The current system is characterised by a high‐speed, rigid process that relies heavily on scientific evidence. Children are usually not included or taken seriously. The contours of a system in which children are meaningfully involved would differ markedly: children would be considered capable and taken seriously, and the guideline development process would be flexible, with time for interaction with children and discussion about the implications of their perspectives. We encountered few examples of child participation in guideline development worldwide, and believe our results are indicative of the situation in other Western countries. We propose the following actions: (1) Development of a discussion arena to create a joint vision on the aim of guideline development and subsequently the role of child participation therein. (2) Set up of transition experiments unbound by the current constellation, conducted by front‐runners who are open to children's perspectives. These are essential to clarify pathways towards a future in which the voices of children are meaningfully integrated. It remains to be seen, however, whether there are sufficient actors who feel the necessary urgency for change. [ABSTRACT FROM AUTHOR]

Background: Preventing overweight and improving physical fitness in primary school children is a worldwide challenge, and physically active intervention programs usually come with the cost of academic instruction time. This study aimed to investigate effects of physically active academic lessons on body mass index (BMI) and physical fitness in primary school children. Methods: Dutch children attending second- or third-grade class from 12 primary schools (N = 376; 8.1 ± 0.7 years) were randomly assigned to a 22-week intervention program or to the control group. In addition to measuring BMI before and after the intervention, physical fitness was measured with 5 items of the Eurofit test battery, measuring cardiovascular and muscular fitness. Results: Multilevel analysis showed a significant interaction effect between condition (intervention vs control) and grade (B = -0.47; p < 0.05). For third-grade children, BMI of the intervention group did not change significantly during the intervention period, whereas a significant increase was found in the control group. No significant main or interaction effects were found for cardiovascular or muscular fitness. Conclusions: The current physically active academic lessons had positive effects on BMI in third-grade children, but had no effects on cardiovascular and muscular fitness.

Cognitive flexibility is one of the essential mental abilities underlying creative thinking. Previous findings have shown that cognitive flexibility can be enhanced by schema violations, and it has been suggested that active involvement is needed for schema violations to facilitate cognitive flexibility. The possibility that identification with an actor performing a schema violation (i.e., corepresenting an active schema violation) can enhance cognitive flexibility was investigated in 2 studies. In the first study, under conditions of high or low identification, participants watched an actor preparing a sandwich. The way the actor made the sandwich followed either a schema violation or contained the normal schema of preparing a sandwich. When identification was high, watching a schema-violation-enhanced cognitive flexibility as compared to watching the corresponding normal event. No effect of schema violation occurred under conditions of low identification. As little is known about the neural correlates of schema violations, in the second study the brain activity during schema violations was explored by means of functional Magnetic Resonance Imaging (fMRI). Participants were instructed to identify with an actor and brain activity was measured while participants watched the actor performing a schema violation or the corresponding normal schema. Activity in the temporal parietal junction (TPJ), a brain region that is associated with violation of expectations, was higher in the schema-violation condition than in the normal schema condition. These findings enhance the theoretical understanding of the effects of schema violations and may provide important practical implications in various settings where creative thinking is needed.

Background: Several studies showed that during the pandemic patients have refrained from visiting their general practitioner (GP). This resulted in medical care being delayed, postponed or completely forgone. The provision of low-value care, i.e. care which offers no net benefit for the patient, also could have been affected. We therefore assessed the impact of the COVID-19 restrictions on three types of low-value GP care: 1) imaging for back or knee problems, 2) antibiotics for otitis media acuta (OMA), and 3) repeated opioid prescriptions, without a prior GP visit. Methods: We performed a retrospective cohort study using registration data from GPs part of an academic GP network over the period 2017–2022. The COVID-19 period was defined as the period between April 2020 to December 2021. The periods before (January 2017 to April 2020) and after the COVID-19 period (January 2022 to December 2022) are the pre- and post-restrictions periods. The three clinical practices examined were selected by two practicing GPs from a top 30 of recommendations originating from the Dutch GP guidelines, based on their perceived prevalence and relevance in practice (van Dulmen et al., BMC Primary Care 23:141, 2022). Multilevel Poisson regression models were built to examine changes in the incidence rates (IR) of both registered episodes and episodes receiving low-value treatment. Results: During the COVID-19 restrictions period, the IRs of episodes of all three types of GP care decreased significantly. The IR of episodes of back or knee pain decreased by 12%, OMA episodes by 54% and opioid prescription rate by 13%. Only the IR of OMA episodes remained significantly lower (22%) during the post-restrictions period. The provision of low-value care also changed. The IR of imaging for back or knee pain and low-value prescription of antibiotics for OMA both decreased significantly during the COVID-restrictions period (by 21% and 78%), but only the low-value prescription rate of antibiotics for OMA remained significantly lower (by 63%) during the post-restrictions period. The IR of inappropriately repeated opioid prescriptions remained unchanged over all three periods. Conclusions: This study shows that both the rate of episodes as well as the rate at which low-value care was provided have generally been affected by the COVID-19 restrictions. Furthermore, it shows that the magnitude of the impact of the restrictions varies depending on the type of low-value care. This indicates that deimplementation of low-value care requires tailored (multiple) interventions and may not be achieved through a single disruption or intervention alone. [ABSTRACT FROM AUTHOR]

Aim: Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration. Design: Qualitative study. Methods: Semi‐structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews. Results: Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working. Conclusion: In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals. Impact: The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice. Reporting Method: In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Refugees often suffer from trauma-related psychopathology, specifically posttraumatic stress disorder (PTSD). Negative world assumptions are strongly correlated with the development, course, and severity of PTSD. Objective: This study aimed to investigate whether there are distinct profiles of PTSD and negative world assumptions (NWA) and examine whether trauma load, torture, and gender differentially predict such symptom profiles. Method: In a sample of 225 treatment-seeking refugees who had resettled in the Netherlands, latent profile analysis was used to identify subgroups of patients sharing the same profile of PTSD and NWA symptoms. Predictors of profile membership were analyzed via multinomial logistic regression. Results: A three-profile solution yielded the best model fit: a low PTSD/low NWA profile (23.6%), a high PTSD/high NWA profile (41.8%), and a high PTSD/low NWA profile (34.7%). Participants who reported a higher trauma load, were more likely to be part of the high PTSD/high NWA profile or the high PTSD/low NWA profile in comparison to low PTSD/low NWA profile. Participants who reported having experienced torture were more likely to be part of the high PTSD/high NWA profile in comparison to low PTSD/low NWA profile. Gender did not differentiate between the profiles. Conclusions: This study reveals that among treatment-seeking refugees resettled in the Netherlands, there are distinct profiles of PTSD and NWA. These profiles indicate that PTSD and NWA are not uniformly experienced among refugees, emphasizing the diversity in their psychological responses to trauma. Among individuals experiencing severe PTSD symptoms, a subgroup was identified of individuals who additionally exhibited negative assumptions about themselves, others, and the world. Recognizing this heterogeneity is crucial in both research and clinical practice, particularly in the context of refugee mental health. Directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Simple Summary: The use of imaging, in general and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC), both at initial diagnosis and during the diagnosis of recurrent disease, is increasing. In these patients, palliative systemic therapy is the only (tumor-directed) therapy and, hence, is often immediately initiated. However, delaying therapy until symptoms occur may preserve quality of life and avoid therapy-related toxicity, but the impact on survival of this approach is unknown. Using an online survey sent to all first and last authors of published trials on mPDAC and to medical oncologists of the Dutch Pancreatic Cancer group, this study aimed to gain insight into the current perspectives and clinical decision-making of experts. Overall, 78 of 291 (27%) medical oncologists from 15 countries responded. Two-thirds of respondents (63%) preferred an immediate initiation of chemotherapy following diagnosis. In 3/9 case-vignettes, delayed treatment was favored in specific clinical contexts (i.e., patient with only one small lung metastasis, significant comorbidities, and higher age). Respondents from the Netherlands, as well as medical oncologists with fewer years of experience, more often favored delayed treatment. Although the response rate was limited, in this increasing group of asymptomatic patients with mPDAC, immediate treatment is most often preferred, although in specific clinical contexts (i.e., limited metastatic disease, more comorbidities, and higher age), delaying treatment until symptoms occur is considered. Background: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment option; hence, it is often immediately initiated. However, delaying therapy in asymptomatic palliative patients may preserve quality of life and avoid therapy-related toxicity, but the impact on survival is unknown. This study aimed to gain insight into the current perspectives and clinical decision=making of experts regarding the timing of treatment initiation of patients with asymptomatic mPDAC. Methods: An online survey (13 questions, 9 case-vignettes) was sent to all first and last authors of published clinical trials on mPDAC over the past 10 years and medical oncologists of the Dutch Pancreatic Cancer Group. Inter-rater variability was determined using the Kappa Light test. Differences in the preferred timing of treatment initiation among countries, continents, and years of experience were analyzed using Fisher's exact test. Results: Overall, 78 of 291 (27%) medical oncologists from 15 countries responded (62% from Europe, 23% from North America, and 15% from Asia–Pacific). The majority of respondents (63%) preferred the immediate initiation of chemotherapy following diagnosis. In 3/9 case-vignettes, delayed treatment was favored in specific clinical contexts (i.e., patient with only one small lung metastasis, significant comorbidities, and higher age). A significant degree of inter-rater variability was present within 7/9 case-vignettes. The recommended timing of treatment initiation differed between continents for 2/9 case-vignettes (22%), in 7/9 (77.9%) comparing the Netherlands with other countries, and based on years of experience for 5/9 (56%). Conclusions: Although the response rate was limited, in asymptomatic patients with mPDAC, immediate treatment is most often preferred. Delaying treatment until symptoms occur is considered in patients with limited metastatic disease, more comorbidities, and higher age. [ABSTRACT FROM AUTHOR]

Summary: Invasive alien species represent a multifaceted management problem in terms of threats to biodiversity and ecosystems and their impacts on agriculture and human well-being. Ambrosia artemisiifolia is an invasive alien plant in Europe that affects the human population as its already highly allergenic pollen can interact with air pollutants, resulting in detrimental effects on health. In this context, the invasive beetle Ophraella communa was proposed as a biocontrol agent of A. artemisiifolia , as it feeds on its leaves, leading to a decrease in pollen production. This paper takes advantage of the different co-occurrence classes obtained by the ecological niche models inferred for both of these species based on current and future climatic conditions. We integrate them with spatial data regarding major air pollutants (nitrogen dioxide and fine particulate matter). We couple this information with European human population density data at a narrow territorial scale to infer current and future statistically significant hotspots of health risk. The Netherlands and the UK host the widest hotspots within their national territory for both current (7.09% and 3.54%, respectively) and future (15.04% and 6.70%, respectively) scenarios. Considering the alarming results obtained for some areas, the monitoring and biocontrol of A. artemisiifolia should be applied as a European strategy. [ABSTRACT FROM AUTHOR]

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Background: Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking. Objective: The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills. Methods: Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents (Mage = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants (N = 95 in the experimental group), while the social skills program included N = 165 participants (N = 86 in the experimental group). MANCOVA's were performed. Results: The performance anxiety program had a small effect on reducing adolescents' test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents' coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health. Conclusions: A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents' performance anxiety. Trial registration: International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019). [ABSTRACT FROM AUTHOR]

Background: Choosing Wisely is an international movement that stimulates conversations about unnecessary care. The campaign created five recommendations including a statement that less wound care is sometimes better. Aims: The study aims to evaluate nurses' and physicians' adherence to the Choosing Wisely recommendations for acute wound care in the Netherlands and the barriers and facilitators to improve this. Design: This is a mixed methods study using a survey and interviews. Methods: The survey was completed by 171 nurses and 71 physicians from November 2017 to February 2018. A total of 17 nurses and 6 physicians were interviewed. Results: Awareness of the five recommendations ranged from 62% to 89% for nurses and 46% to 85% for physicians. However, up to 15% of the nurses and 28% of physicians were aware but did not adhere to the recommendations. Barriers to adhering were a lack of knowledge, the work environment and perceptions of patients' preferences. Repeated attention, cost‐consciousness and an open culture facilitated the implementation. Conclusion: Although most nurses and physicians were aware of the recommendations, not all adhered to them. Increasing awareness is not enough for successful implementation. A tailored approach that removes the barriers is necessary, such as increasing knowledge about wounds and changing the work environment. Summary statement: What is already known on this topic? Less wound care is sometimes better: cleaning wounds with tap water only, not bathing wounds, using simple bandages and not using bandages on wounds healing by primary intention leads to better wound care for lower costs.It is unknown to what extent this is known and practiced by nurses and physicians and what barriers and facilitators they experience in practicing this. What this paper adds? Although the majority of nurses and physicians were aware of the Choosing Wisely recommendations for acute wounds, not all adhered to them.Awareness is not always sufficient for successful implementation, which requires a broader approach that targets the barriers. The implications of this paper Implementation of these recommendations can be improved by increasing knowledge about wounds and wound care, changing the work environment, and verifying the patient's presumed preferences regarding wound care. [ABSTRACT FROM AUTHOR]

Estimating added value as an indicator of school effectiveness in the context of educational accountability often occurs using test or examination scores of students. This study investigates the possibilities for using scores of educational positions as an alternative indicator. A number of advantages of a value added indicator based on educational positions of students can be formulated, such as: (a) the societal significance of educational position as output measure; (b) the fact that a single indicator can be estimated for an entire school in a differentiated educational system, where not all schools provide education in all tracks; and (c) the expectation that value added based on educational positions leads to other incentives for schools than value added based on test scores. Empirical analysis of Dutch cohort data (VOCL'99) for secondary education showed considerable differences in effectiveness between schools in the positions of students. Furthermore, differential school effects were found for both socio-economic status and prior achievement. The phenomena of differential school effects for socio-economic status and prior achievement are linked to differences between schools in the kind of tracks in which the schools provide schooling.

A successful transition from kindergarten to 1st grade requires a positive combination of multiple dimensions of child competence. Using latent class analysis, we simultaneously examined the academic skills, work attitude, and social/behavioral competence of a large sample of Dutch kindergarten children to identify profiles of kindergarten competence. We tested the predictive power of the profiles by means of multivariate multilevel analyses with language, arithmetic, and work attitude scores as outcome variables. Research Findings: Five profiles of children with distinctive combinations of skills were identified. The results showed that the profile solution forms a significant basis on which to predict later performance. In particular, children in the 2 profiles with the highest kindergarten competence levels perform significantly better in Grade 1 than children with less advantageous skill sets, an effect that tends to increase in magnitude at the end of Grade 2. Practice or Policy: We suggest a practical validation of these profiles to be used as tools for tailoring learning opportunities in kindergarten according to children's skill sets.

Background: Intravitreal injection (IVI) of antibody biologics is a key treatment approach in ophthalmology. Pharmaceutical compounding and storage of prefilled syringes for IVI must take place without impairing the structure and function of the biologics. This study investigated the effect of withdrawing and storing the therapeutic antibody faricimab (Vabysmo, Roche, Basel, Switzerland) in the Zero Residual silicone oil-free, 0.2-mL syringe (SJJ Solutions, The Hague, the Netherlands). Methods: To assess the effect of syringe withdrawal on faricimab, we compared samples from syringes prepared at day 0 with samples taken directly from faricimab vials. To assess the effect of syringe storage on faricimab, we kept prefilled syringes in the dark at 4 oC for 7, 14, or 37 days and compared samples from these syringes with day 0. We measured protein concentration (with spectrophotometry), stability and integrity (with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), size-exclusion chromatography (SEC), and melting temperature (Tm)), as well as binding of faricimab to its cognate antigens: vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2) (with enzyme-linked immunosorbent assay (ELISA)). Results: Faricimab migrated in line with its expected molecular mass under both reducing and non-reducing conditions for all time points when analyzed with SDS-PAGE, without any sign of degradation products or aggregation. The SEC elution profiles were identical for all time points. There were slight variations in Tm for different time points compared to day 0 but without consistent relationship with storage time. ELISA did not detect differences in VEGF-A or Ang-2 binding between time points, and faricimab did not bind the neonatal Fc receptor. Conclusions: Withdrawal and storage of faricimab in syringes for up to day 37 did not impair the structure and bi-specific binding properties of the therapeutic antibody. [ABSTRACT FROM AUTHOR]

The purpose of our study is to determine a threshold for iodine quantification to distinguish definitely non-enhancing benign renal lesions from potential enhancing masses on portal venous dual-layer spectral computed tomography (CT) to reduce the need for additional multiphase CT. In this single-center retrospective study, patients (≥18 years) scanned between April 2021 and January 2023 following the local renal CT protocol were included. Exclusion criteria were patients without renal lesions, lesions smaller than 10 mm, only fat-containing lesions, abscesses or infarction, follow-up after radiofrequent ablation, wrong scan protocol, or artefacts. Scans were performed on a dual layer detector-based spectral CT (CT 7500, Philips Healthcare, Best, The Netherlands). Iodine concentration (mgI/mL) in renal lesions was determined using spectral data. Analyses were performed for all lesions and for lesions of >30 HU on portal venous CT. Enhancement on multiphase CT (≥20 ΔHU from true unenhanced (TUE) to portal venous phase (PVP) CT) was used as reference standard. To determine thresholds for iodine concentration receiver operating characteristic (ROC) curves, area under the curve (AUC) and 95% confidence intervals were calculated. To obtain thresholds for definite (non-)enhancement, 100% sensitivity with maximum specificity and 100% specificity with maximum sensitivity were noted. Data were measured using one reader. To assess interobserver agreement, a second reader performed measurements on the PVP CT scans. A total of 103 patients (62 years ± 14, 68 men) were included. We measured 328 renal lesions, 56 enhancing lesions (17%) in 38 patients and 272 non-enhancing lesions (83%) in 86 patients. The threshold for non-enhancing lesions was 0.76 mgI/mL or lower (100% sensitivity, 76% specificity). The threshold for a definite enhancing mass was 1.69 mgI/mL or higher (100% specificity, 78% sensitivity). A total of 77% of indeterminate lesions (>30 HU on PVP CT) in our study could be definitely characterized. Renal lesions can be definitively classified as non-enhancing or enhancing on PVP spectral CT using thresholds of 0.76 mgI/mL or 1.69 mgI/mL, respectively, eliminating the need for multiphase imaging. [ABSTRACT FROM AUTHOR]

Background: Group schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster‐C PDs. Individual ST has proven to be effective for Cluster‐C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster‐C PD. Moreover, differences between the specific Cluster‐C PDs (avoidant PD, dependent PD and obsessive‐compulsive PD) were explored. Methods: A multicentre open trial was conducted, including 137 patients with a Cluster‐C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive‐compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster‐C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD‐related beliefs, self‐esteem, self‐ideal discrepancy, schemas and schema modes were assessed at baseline until 2‐year follow‐up with semi‐structured interviews and self‐report measures. Change over time and differences between the specific Cluster‐C PDs were analysed with mixed regression analyses. Results: The outcome measures showed significant improvements for all Cluster‐C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster‐C PDs in severity at baseline, change trajectories and effectiveness of GST. Conclusions: This study demonstrated that GST is a promising treatment for Cluster‐C PDs. The following step is a randomized controlled trial to further document the (cost‐)effectiveness of GST. [ABSTRACT FROM AUTHOR]

Firm growth in creative industries, which are characterized by craftmanship, imagination, artistic quality and innovativeness, is a conundrum. By means of a matched pair case study design of market leaders and followers in seven creative industries in the Netherlands, the present paper seeks to tackle this conundrum. It suggests that for entrepreneurial firms to develop (instead of stagnating or demising), founders need to fit in, or understand the value creation and conversion processes in vigor within their industry. For firms to grow by means of an expansion of their markets, founders need to stand out, or create resource advantages vis a vis other firms in the industry, which could lie in an internationalization or a digitalization vantage. Not despite of, but because of their quality focus, which accrues to reputation advantages and impact, creative firms succeed in growing. Lessons are drawn from how and why firms in creative industries develop and grow. These may contribute to firm growth assessment practices and process theories. [ABSTRACT FROM AUTHOR]

Background: A multitude of diagnostic and predictive algorithms have been designed for COVID-19. However, currently no score can accurately quantify and track day-to-day disease severity in hospitalised patients with COVID-19. We aimed to design such a score to improve pathophysiological insight in COVID-19. Methods: Development of the Severity of COronavirus Disease Assessment (SCODA) score was based on the 4C Mortality score but patient demographic variables that remain constant during admission were excluded. Instead, parameters associated with breathing and oxygenation were added to reflect the daily condition. The SCODA score was subsequently applied to the BEAT-COVID cohort to describe COVID-19 severity over time and to determine the timing of clinical recovery for each patient, an important marker in pathophysiological studies. The BEAT-COVID study included patients with PCR confirmed COVID-19 who were hospitalized between April 2020 and March 2021 in the Leiden University Medical Center, The Netherlands. Results: The SCODA score consists of 6 clinical and 2 routine lab parameters. 191 patients participated in the BEAT-COVID study. Median age was 66, and 74.4% was male. The modal timepoint at which recovery was clinically initiated occurred on days 8 and 24 since symptom onset for non-ICU and ICU-patients, respectively. Conclusions: We developed a daily score which can be used to track disease severity of patients admitted due to COVID-19. This score is useful for improving insight in COVID-19 pathophysiology, its clinical course and to evaluate interventions. In a future stage this score can also be used in other (emerging) infectious respiratory diseases. [ABSTRACT FROM AUTHOR]

This study investigates the possibilities of estimating value added as a performance indicator in senior secondary vocational education. Value added is interesting in this context because it is considered as a reliable tool for comparing the effectiveness of educational institutions. Although value added indicators have been developed since the 1980s for both primary and secondary educations, the research on school effectiveness has largely neglected vocational education because of its complexity. For estimating value added in this study, data concerning almost 90,000 students in Dutch senior secondary vocational education are used. Factors such as ethnicity, living in problematic neighbourhoods and students' prior educational attainment appear to be significant predictors of student outcomes. The results indicate considerable differences in the effectiveness among clusters of training programmes, whereas there are hardly any differences between the educational institutions. Of the total variance among the student outcomes, 14% is related to the training programme clusters. (Contains 3 tables and 3 figures.)

Accountability systems in education generally include indicators of student performance. However, these indicators often differ considerably among the various systems. More and more countries try to include value-added measures, mainly because they do not want to hold schools accountable for differences in their initial intake of students. This study presents a conceptual framework of these value-added measures, resulting in an overview of 5 different types. Using data from Dutch secondary schools, we empirically provide estimates of these different measures. Our analyses show that the correlation between the different types of school effects estimated is rather high, but that the different models implicate different results for individual schools. Based on theoretical considerations, arguments are given to use the following indicators in the value-added accountability models: prior achievement, student-level background characteristics, and compositional characteristics of the student population. (Contains 2 notes and 9 tables.)

This study examines professional development activities for students and teachers in two Dutch professional development schools (PDSs). The PDSs consist of a partnership between the kindergarten classes of the elementary school and accompanying playgroup (with children aged 4-6 and 2.6-4, respectively), a teacher's training college and a research group and educational service agency attempting to improve the effects of early childhood education programmes. The professional development activities encompass the quality of adult-child interaction during instruction and daily routines. All participants learn from each other how to support and challenge children's language and reasoning skills by attending joint courses, observing each other and giving feedback. Rating scales of interactive skills were completed twice during one year by the participants themselves, colleagues and an observer. Also, the participants evaluated the interventions used. Findings indicate that although the subjects became more aware of the importance of adult-child interaction, only kindergarten teachers grew in interactive skills. (Contains 4 figures and 2 tables.)