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When studying abroad, international exchange students generally establish a new social network abroad. However, how international exchange students develop their social networks over time remains a blind spot in academic literature. In this article, we analyze the initial formation and development of such networks among six Dutch Erasmus+ students. Using homophily theory, we focus on the factors that enable and restrain initial social network formation and interaction patterns. We relied on a longitudinal qualitative approach, whereby we repeatedly interviewed these six students over time. Our findings reveal the importance of three main contexts in the initial social network formation of Erasmus+ students, namely the premobility phase, the living place, and the social space. These findings provide insights for practitioners on which contexts to focus on when developing strategies to foster the integration of international exchange students at host institutions.

In recent years, it has been well established that study abroad participation is a socially selective process. Today, scholars generally focus on single social markers, often using cross-sectional data. In this article, we instead adopt an intersectional and longitudinal approach to improve our understanding of the development of social selectivity in study abroad, with a particular focus on the intersection between socioeconomic background and gender. Our analyses are based on the Learning Conditions and Student Orientations (N = 49,931), a representative survey of German higher education students, and covers the period 1994 to 2016. Our analyses indicate that social selectivity in German study abroad programs increased in 2003 and remained stable afterward, which can be partly explained by differences in cultural, economic, and social capital. Finally, our analysis suggests that cultural capital also explains the gender imbalance in study abroad programmes.

Abstract Purpose To identify key components and variations in family-centered care practices. Methods A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate. Results The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6–8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness. Conclusions This study emphasizes the need to prioritize healthcare providers’ mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.

Abstract Background Bereaved relatives of intensive care unit (ICU) patients are at increased risk of psychological complaints. Aftercare might help them cope with processing the ICU admission and their loved one’s death. There is little (qualitative) evidence on how bereaved relatives experience aftercare. Also, the COVID-19 pandemic likely impacted aftercare provision. We aim to examine how many relatives in Dutch ICUs received aftercare before and during the pandemic and to qualitatively describe their experiences and needs regarding aftercare. Methods A mixed-methods study among relatives of patients who died in an ICU before or during the COVID-19 pandemic. Bereaved relatives in six ICUs completed a questionnaire (n = 90), including two items on aftercare. These were analyzed using descriptive statistics and Chi-squared tests. Subsequently, both relatives that received and relatives that did not receive aftercare were interviewed about their experiences and needs regarding aftercare. The interviews were thematically analyzed. Results After the passing of a loved one, 44% of the relatives were asked by a healthcare professional from the hospital how they were doing, and 26% had had a follow-up conversation. Both happened more often during the first wave of the pandemic than during the second wave or before the pandemic. The most common reason for not having had a follow-up conversation was not knowing about this option (44%), followed by not feeling a need (26%). Regarding the latter, interviewed relatives explained that this would not revive their loved one or that they had already discussed everything they wanted. Relatives who wanted a follow-up conversation, wanted this because this would help them realize the severity of their loved one’s illness, to exchange personal experiences, and/or to thank the ICU team. Those with a follow-up conversation said that they had reviewed the medical course of the admission and/or discussed their (mental) well-being. Conclusions ICU healthcare professionals may play a vital role in addressing aftercare needs by asking relatives how they are doing in the weeks following the death of their loved one and offering them a follow-up conversation with an ICU physician. We recommend to include aftercare for bereaved relatives in ICU guidelines.

Abstract Background In the intensive care unit (ICU) relatives play a crucial role as surrogate decision-makers, since most patients cannot communicate due to their illness and treatment. Their level of involvement in decision-making can affect their psychological well-being. During the COVID-19 pandemic, relatives’ involvement probably changed. We aim to investigate relatives’ involvement in decision-making in the ICU before and during the pandemic and their experiences and preferences in this regard. Methods A mixed-methods study among relatives of ICU patients admitted to an ICU before or during the COVID-19 pandemic. Relatives in six ICUs completed a questionnaire (n = 329), including two items on decision-making. These were analysed using descriptive statistics and logistic regression analyses. Subsequently, relatives (n = 24) were interviewed about their experiences and preferences regarding decision-making. Thematic analysis was used for analysing the qualitative data. Results Nearly 55% of the relatives indicated they were at least occasionally asked to be involved in important treatment decisions and of these relatives 97.1% reported to have had enough time to discuss questions and concerns when important decisions were to be made. During the first COVID-19 wave relatives were significantly less likely to be involved in decision-making compared to relatives from pre-COVID-19. The interviews showed that involvement varied from being informed about an already made decision to deliberation about the best treatment option. Preferences for involvement also varied, with some relatives preferring no involvement due to a perceived lack of expertise and others preferring an active role as the patient’s advocate. Discussing a patient’s quality of life was appreciated by relatives, and according to relatives healthcare professionals also found this valuable. In some cases the preferred and actual involvement was in discordance, preferring either a larger or a smaller role. Conclusions As treatment alignment with a patient’s values and preferences and accordance between preferred and actual involvement in decision-making is very important, we suggest that the treatment decision-making process should start with discussions about a patient’s quality of life, followed by tailoring the process to relatives’ preferences as much as possible. Healthcare professionals should be aware of relatives’ heterogeneous and possibly changing preferences regarding the decision-making process.

Abstract Background In this case series abomasitis as a consequence of halofuginone intoxication is suspected. Case presentation Seven Belgian-Blue calves with complaints of anorexia and weight loss were presented to an university clinic. Ultrasonography showed thickening and edema of the abomasal wall in all cases, suggesting abomasitis. Abomasitis was confirmed on necropsy in three cases. Retrospective analysis clarified the uptake of an overdose of halofuginone lactate (348–421 µg/kg/day). Four animals fully recovered after removal of halofuginone lactate administration, therapy for comorbidities (pneumonia, diarrhoea) and supportive therapy. Conclusion To the authors’ knowledge, this case series is the first report associating halofuginone lactate use with abomasitis. This was suspected after clinical improvement of four of the presented animals after terminating the administration of a high dose of halofuginone lactate, and exclusion of other possible causes. Underlying mechanisms are still unclear.

Many papers on international student mobility have analysed different macro factors influencing the decision making of international students. However, only a limited number of studies have considered the role of language distance on international educational choices. This paper aims to fill that gap by identifying the role of language proximity in international degree seeking student flows among 21 countries of the European Economic Area in the years 2005, 2010 and 2015. Our gravity models reveal a statistically significant influence of language proximity on student flows within these 21 countries. We argue that language proximity simplifies academic, cultural and socio-economic integration of international students in the destination country and as a result makes the process of their adaptation to a new environment easier and smoother. Future research should expand on the mechanisms of that influence.

Abstract Research on international student migration has been burgeoning, leading to a more nuanced understanding of international students whose experiences were, for many years, conceptualised in a rather limited way. In this paper, we aim to advance understanding of the diversity and complexity of student migrants’ experiences, by proposing a new interpretive framework, developed through narrative enquiry. Based on an in-depth narrative analysis of 41 “biographical encounters” with student migrants in Portugal, we illustrate the potential of biographical approaches in highlighting students’ subjectivities, and the complex interplay of diverse factors that shape migration processes. A migration “profile” was assigned to each narrative, capable of representing its leitmotif. This biographical approach to student migration provides a more nuanced understanding of how student migration emerges in time, thus offering a methodological approach that does justice to the diversity of student migration trajectories and may enhance the empirical examination of their experiences.

Abstract In this paper, we analyze the relationship between development and outgoing international student mobility (ISM) for the years 2003–2018 using data from UNESCO. Starting from migration transition theory, we expect that development and outgoing migration follows an inverted U-shape due to changes in capabilities and aspirations of populations. As predicted, we find that outgoing ISM also follows this pattern. Probing deeper into this finding, we investigated whether students from countries of different levels of development favor different destination countries, focusing on destination countries’ academic ranking, GDP per capita, and linguistic and colonial ties. We find that these destination country characteristics indeed have different effects for students from origin countries with different stages of development, and that these effects cannot simply be reduced to a dichotomy between developed/developing countries. Together, the findings highlight the nonlinearity of ISM processes. In turn this opens up new avenues of research regarding the diversity of international student populations.

The overrepresentation of female students in study abroad programmes across the Western world represents one of the major gaps in scientific research on study abroad. In this paper, I explore possible theoretical and empirical explanations, drawing on Personal Investment Theory and investigating study abroad motivations and decisions of a nationally representative sample of higher education students in the Netherlands between 2006 and 2015. The analyses specifically focus on the role of parents, academic self-concept and perceived goals in female and male students decision-making process to participate in study abroad programmes. The results reveal that maternal educational attainment level potentially plays a crucial role in explaining the decision-making process of both male and female students, as well as in explaining the overrepresentation of female students. The findings indicate that female students whose mothers have a medium educational attainment level are more likely to study abroad for exploration motives, whereas female students with lower educated mothers are more motivated by professional development purposes. As such, the results suggest mothers might motivate their daughters to study abroad in order to achieve intergenerational social mobility. Together, the presented findings offer fresh theoretical and empirical explanations of the gender gap in study abroad. Furthermore, the generated insights open up new directions for future research, indicating particularly the potential of social reproduction theories for explaining the gender gap in study abroad.

For a long time, internationalisation strategies of higher education institutions across the world focused on international student mobility. However, international student mobility is a socially selective process, whereby students from lower socio-economic backgrounds are less likely to participate. Consequently, in recent years 'internationalisation for all', 'inclusive internationalisation' and 'internationalisation at home' have become prominent terms in internationalisation strategies, aiming to provide internationalisation activities to all students, including those who remain at home. To our surprise, however, existing scholarship today did not investigate whether offering a broader array of internationalisation activities also reaches the objectives of such new internationalisation strategies, namely to reach a broader group of students, including those from traditionally disadvantaged backgrounds. To this end, in this paper, we investigate the likelihood of different (social) groups to participate in different internationalisation activities, both at home and abroad, through an online survey conducted in 2019 at three institutions in Belgium and the Netherlands (n = 2567). Our findings clearly indicate that the social composition of student populations needs to be taken into account when designing internationalisation strategies. Our results indicate that simply broadening the type of activities is not sufficient, as students from lower socio-economic backgrounds showed to be less likely to participate in any internationalisation activity. Overall, the findings suggest that inclusive internationalisation might best be reached through integrating internationalisation into the formal curriculum, in order to circumvent the barriers that might exist to participate in activities outside of the formal study schedule.

The academic literature on the determinants of international student mobility so far has largely ignored the influence of romantic relationships and study motivation in the development of aspirations to participate in temporary learning experiences in another country. However, young adults might take considerations about investments in individual development (via academic training and thus study motivation) and romantic relationships into account in their decision-making process. Consequently, we apply a life-course perspective analyzing the relationships between having a romantic partner, study motivation, and aspirations to participate in an international exchange program among first-year university students, based on a survey conducted among 603 freshmen in Brussels. As female students are more likely to participate in student exchanges compared with male students, we pay special attention to gender differences. Our results show that a romantic relationship is negatively correlated with aspirations to participate in an international student exchange among female students. In contrast, intrinsic academic motivation is significantly associated with such aspirations among female and male students. Overall, our findings indicate the need for the consideration of different life-course domains in academic studies on international student mobility.

This note discusses a class activity that was developed for first-year bachelor students in sociology to understand homogamy theory. Taught in a "classical" deductive way, this theory proved to be difficult to remember and describe on the examination. Starting from inductive learning, and more specifically, (structured) inquiry-guided learning, the aim of the exercise was to transcend passive learning, making students gradually discover the different components of the theory themselves, practicing their sociological imagination. Overall, students evaluated the exercise positively, and they performed much better on the examination.

Abstract Shortage of nurses on the ICU is not a new phenomenon, but has been exacerbated by the COVID-19 pandemic. The underlying reasons are relatively well-recognized, and include excessive workload, moral distress, and perception of inappropriate care, leading to burnout and increased intent to leave, setting up a vicious circle whereby fewer nurses result in increased pressure and stress on those remaining. Nursing shortages impact patient care and quality-of-work life for all ICU staff and efforts should be made by management, nurse leaders, and ICU clinicians to understand and ameliorate the factors that lead nurses to leave. Here, we highlight 10 broad areas that ICU clinicians should be aware of that may improve quality of work-life and thus potentially help with critical care nurse retention.

Patients with severe COVID-19 develop acute respiratory distress syndrome (ARDS) that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that complement component 5a (C5a), through its cellular receptor C5aR1, has potent proinflammatory actions and plays immunopathological roles in inflammatory diseases, we investigated whether the C5a/C5aR1 pathway could be involved in COVID-19 pathophysiology. C5a/C5aR1 signaling increased locally in the lung, especially in neutrophils of critically ill patients with COVID-19 compared with patients with influenza infection, as well as in the lung tissue of K18-hACE2 Tg mice (Tg mice) infected with SARS-CoV-2. Genetic and pharmacological inhibition of C5aR1 signaling ameliorated lung immunopathology in Tg-infected mice. Mechanistically, we found that C5aR1 signaling drives neutrophil extracellular traps-dependent (NETs-dependent) immunopathology. These data confirm the immunopathological role of C5a/C5aR1 signaling in COVID-19 and indicate that antagonists of C5aR1 could be useful for COVID-19 treatment.

The welfare aspects of intra-European migration remain an important and controversial topic of academic and political debates. These discussions touch upon the classical ‘welfare magnet’ or ‘welfare tourism’ hypothesis. Transcending the politicised concept of ‘benefit tourism’, our paper examines how welfare-state considerations in relation to migration decisions vary across the life course. Relying on micro-level qualitative research focusing on Spanish intra-EU movers, the paper probes deeper into how individuals perceive welfare systems, analysing the subtle and nuanced meanings of different aspects of the welfare for their migration decisions. We focus more specifically on welfare provisions in terms of health care, compulsory education, child support and other care responsibilities, unemployment and pensions and retirement. Our research indicates that, in studies on the migration–welfare nexus, it is necessary to move beyond the current narrow focus on the welfare magnet hypothesis and to examine how diverse welfare arrangements continuously and dynamically set the context for migration decisions at various stages of an individual’s life. The results of our research show how features of the Spanish welfare system, in comparison to those of potential destination countries, might act as both a trigger and/or a barrier to migration. As such, we get a ‘thicker description’ of the role which welfare might play in shaping individuals’ eventual migratory aspirations and decisions.

Here, the authors profile the respiratory microbiome of COVID-19 patients and link clinical practices, such as mechanical ventilation, with vast changes in the microbiota. In the lungs, oral bacteria are found physically associated with proinflammatory immune cells, thus possibly contributing to exacerbated immune responses in severe disease

COVID-19 is characterised by a broad spectrum of clinical and pathological features. Natural killer (NK) cells play an important role in innate immune responses to viral infections. Here, we analysed the phenotype and activity of NK cells in the blood of COVID-19 patients using flow cytometry, single-cell RNA-sequencing (scRNA-seq), and a cytotoxic killing assay. In the plasma of patients, we quantified the main cytokines and chemokines. Our cohort comprises COVID-19 patients hospitalised in a low-care ward unit (WARD), patients with severe COVID-19 disease symptoms hospitalised in intensive care units (ICU), and post-COVID-19 patients, who were discharged from hospital six weeks earlier. NK cells from hospitalised COVID-19 patients displayed an activated phenotype with substantial differences between WARD and ICU patients and the timing when samples were taken post-onset of symptoms. While NK cells from COVID-19 patients at an early stage of infection showed increased expression of the cytotoxic molecules perforin and granzyme A and B, NK cells from patients at later stages of COVID-19 presented enhanced levels of IFN-γ and TNF-α which were measured ex vivo in the absence of usual in vitro stimulation. These activated NK cells were phenotyped as CD49a+CD69a+CD107a+ cells, and their emergence in patients correlated to the number of neutrophils, and plasma IL-15, a key cytokine in NK cell activation. Despite lower amounts of cytotoxic molecules in NK cells of patients with severe symptoms, majority of COVID-19 patients displayed a normal cytotoxic killing of Raji tumour target cells. In vitro stimulation of patients blood cells by IL-12+IL-18 revealed a defective IFN-γ production in NK cells of ICU patients only, indicative of an exhausted phenotype. ScRNA-seq revealed, predominantly in patients with severe COVID-19 disease symptoms, the emergence of an NK cell subset with a platelet gene signature that we identified by flow and imaging cytometry as aggregates of NK cells with CD42a+CD62P+ activated platelets. Post-COVID-19 patients show slow recovery of NK cell frequencies and phenotype. Our study points to substantial changes in NK cell phenotype during COVID-19 disease and forms a basis to explore the contribution of platelet-NK cell aggregates to antiviral immunity against SARS-CoV-2 and disease pathology.

The host immune response plays a critical role in the immunopathology of SARS-CoV2. Here the authors combine a systems biology approach to implicate monocytes as key drivers of cytokine storm and disturbed neutrophil activation in COVID-19 disease severity.

Summary: Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 (ACE2) receptor, a critical component of the kallikrein-kinin system. Its dysregulation may lead to increased vascular permeability and release of inflammatory chemokines. Interactions between the kallikrein-kinin and the coagulation system might further contribute to thromboembolic complications in COVID-19. Methods: In this observational study, we measured plasma and tissue kallikrein hydrolytic activity, levels of kinin peptides, and myeloperoxidase (MPO)-DNA complexes as a biomarker for neutrophil extracellular traps (NETs), in bronchoalveolar lavage (BAL) fluid from patients with and without COVID-19. Findings: In BAL fluid from patients with severe COVID-19 (n = 21, of which 19 were mechanically ventilated), we observed higher tissue kallikrein activity (18·2 pM [1·2-1535·0], median [range], n = 9 vs 3·8 [0·0-22·0], n = 11; p = 0·030), higher levels of the kinin peptide bradykinin-(1-5) (89·6 [0·0-2425·0], n = 21 vs 0·0 [0·0-374·0], n = 19, p = 0·001), and higher levels of MPO-DNA complexes (699·0 ng/mL [66·0-142621·0], n = 21 vs 70·5 [9·9-960·0], n = 19, p < 0·001) compared to patients without COVID-19. Interpretation: Our observations support the hypothesis that dysregulation of the kallikrein-kinin system might occur in mechanically ventilated patients with severe pulmonary disease, which might help to explain the clinical presentation of patients with severe COVID-19 developing pulmonary oedema and thromboembolic complications. Therefore, targeting the kallikrein-kinin system should be further explored as a potential treatment option for patients with severe COVID-19. Funding: Research Foundation-Flanders (G0G4720N, 1843418N), KU Leuven COVID research fund.

Background Immune checkpoint inhibitor (ICI)-related pneumonitis is the most frequent fatal immune-related adverse event associated with programmed cell death protein-1/programmed death ligand-1 blockade. The pathophysiology however remains largely unknown, owing to limited and contradictory findings in existing literature pointing at either T-helper 1 or T-helper 17-mediated autoimmunity. In this study, we aimed to gain novel insights into the mechanisms of ICI-related pneumonitis, thereby identifying potential therapeutic targets.Methods In this prospective observational study, single-cell RNA and T-cell receptor sequencing was performed on bronchoalveolar lavage fluid of 11 patients with ICI-related pneumonitis and 6 demographically-matched patients with cancer without ICI-related pneumonitis. Single-cell transcriptomic immunophenotyping and cell fate mapping coupled to T-cell receptor repertoire analyses were performed.Results We observed enrichment of both CD4+ and CD8+ T cells in ICI-pneumonitis bronchoalveolar lavage fluid. The CD4+ T-cell compartment showed an increase of pathogenic T-helper 17.1 cells, characterized by high co-expression of TBX21 (encoding T-bet) and RORC (ROR-γ), IFN-G (IFN-γ), IL-17A, CSF2 (GM-CSF), and cytotoxicity genes. Type 1 regulatory T cells and naïve-like CD4+ T cells were also enriched. Within the CD8+ T-cell compartment, mainly effector memory T cells were increased. Correspondingly, myeloid cells in ICI-pneumonitis bronchoalveolar lavage fluid were relatively depleted of anti-inflammatory resident alveolar macrophages while pro-inflammatory ‘M1-like’ monocytes (expressing TNF, IL-1B, IL-6, IL-23A, and GM-CSF receptor CSF2RA, CSF2RB) were enriched compared with control samples. Importantly, a feedforward loop, in which GM-CSF production by pathogenic T-helper 17.1 cells promotes tissue inflammation and IL-23 production by pro-inflammatory monocytes and vice versa, has been well characterized in multiple autoimmune disorders but has never been identified in ICI-related pneumonitis.Conclusions Using single-cell transcriptomics, we identified accumulation of pathogenic T-helper 17.1 cells in ICI-pneumonitis bronchoalveolar lavage fluid—a phenotype explaining previous divergent findings on T-helper 1 versus T-helper 17 involvement in ICI-pneumonitis—,putatively engaging in detrimental crosstalk with pro-inflammatory ‘M1-like’ monocytes. This finding yields several novel potential therapeutic targets for the treatment of ICI-pneumonitis. Most notably repurposing anti-IL-23 merits further research as a potential efficacious and safe treatment for ICI-pneumonitis.

Introduction A substantial proportion of intensive care unit (ICU) survivors develop psychological impairments after ICU treatment, part of the postintensive care syndrome, resulting in a decreased quality of life. Recent data suggest that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients is feasible and safe, improves satisfaction with ICU aftercare, and might improve psychological sequelae. In the present trial, we firstly aim to determine whether ICU-VR is effective in mitigating post-traumatic stress disorder (PTSD)-related symptoms and secondly to determine the optimal timing for initiation with ICU-VR.Methods and analysis This international, multicentre, randomised controlled trial will be conducted in 10 hospitals. Between December 2021 and April 2023, we aim to include 300 patients who have been admitted to the ICU ≥72 hours and were mechanically ventilated ≥24 hours. Patients will be followed for 12 consecutive months. Patients will be randomised in a 1:1:1 ratio to the early ICU-VR group, the late ICU-VR group, or the usual care group. All patients will receive usual care, including a mandatory ICU follow-up clinic visit 3 months after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR within 2 weeks after ICU discharge. Patients in the late VR group will receive ICU-VR during the post-ICU follow-up visit. The primary objective is to assess the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to determine optimal timing for ICU-VR, to assess the effects on anxiety-related and depression-related symptoms and health-related quality of life, and to assess patient satisfaction with ICU aftercare and perspectives on ICU-VR.Ethics and dissemination The Medical Ethics Committee United, Nieuwegein, the Netherlands, approved this study and local approval was obtained from each participating centre (NL78555.100.21). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals.Trial registration number NL9812.

Abstract Psoroptic mange is a common disease of livestock, caused by Psoroptes ovis. Compared to Holstein–Friesian (HF) cattle, the Belgian Blue (BB) cattle breed is highly susceptible to the infestation. However, the mechanism for this difference is still unclear. To determine the factors responsible for this breed susceptibility, the immune response to P. ovis was studied in experimentally infested BB and HF cattle, using clinical signs, histology, immunohistochemical profiling and gene expression analysis of skin biopsies. The mite numbers and lesion area of BB cattle were greater than in HF during the whole study period. Significant influxes of eosinophils in the epidermis and dermis were detected in comparison with the pre-infestation samples in both breeds, with significantly higher eosinophils in BB at 6 weeks post infestation (wpi). Mast cell numbers were unaffected at all stages of infestation in HF, but were significantly elevated relative to pre-infestation in BB cattle at 2 and 6 wpi. The more pronounced cutaneous eosinophilia and higher IL-4 levels at 6 wpi in BB cattle suggest that a Th2-type immune response is underlying the higher susceptibility of the BB breed. In naturally infested BB cattle, development of the psoroptic mange lesions and eosinophils and CD3+ T cell areas were severely depressed after anti-inflammatory treatment with dexamethasone. Together, these results suggest that a stronger Th2-type immune response to P. ovis causes the skin lesions in psoroptic mange in BB cattle and that local anti-inflammatory treatment could potentially be an alternative to control the pathology caused by this parasite.

When used for the evaluation of drug efficacy against Psoroptes ovis, the diagnostic performance of different sampling strategies for a mite count reduction test (MCRT) remains unclear. In the present study, a novel simulation framework was constructed that accounted for relevant biological features of P. ovis infestations in cattle and that was parameterized with field data from 16 farms (154 animals). Second, this framework was applied to explore the impact of study specific factors (number of animals, number of sampled lesions, and number of scrapings per lesion) and biological factors (mite infestation intensity and size of lesions) on the diagnostic performance of MCRT. Its outcome provided a basis to determine the diagnostic performance of MCRT when it was applied according to the World Association for the Advancement in Veterinary Parasitology (WAAVP) and the European Medicine Agency (EMA) guidelines, and to formulate recommendations to ensure a good diagnostic performance of the MCRT. For both guidelines, the MCRT allowed to correctly detect (power 80%) reduced and normal efficacy when the therapeutic efficacy was

Abstract Background When a patient is approaching death in the intensive care unit (ICU), patients’ relatives must make a rapid transition from focusing on their beloved one’s recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is to develop and implement a multicomponent bereavement support intervention for relatives of deceased ICU patients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression and posttraumatic stress in bereaved relatives. Methods The study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in the Netherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in 2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities and evidence-based practices, a nurse-led intervention will be developed and implemented during the study period. This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, will serve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200 relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety, depression and posttraumatic stress. Differences between the baseline and follow-up measurements will be calculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, risk profiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted. Discussion The newly developed intervention has the potential to improve the bereavement process of the relatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression, anxiety and posttraumatic stress, might decrease. Trial registration Netherlands Trial Register Registered on 27/07/2019 as NL 7875, www.trialregister.nl

Abstract Background Psoroptic mange is an important disease in Belgian Blue cattle. Treatment failure of macrocyclic lactones against Psoroptes ovis has been reported, but clear evidence of in vivo resistance is lacking. This study assessed the efficacy of macrocyclic lactone products on 16 beef farms in Belgium and the Netherlands in vivo and in vitro. Methods On each farm a group of animals (n = 7–14) with psoroptic mange was treated with two subcutaneous injections of a macrocyclic lactone product with 7–10 days interval (15 farms) or a single injection with a long-acting macrocyclic lactone (1 farm). In vivo efficacy was assessed by the reduction in mite counts, clinical index (proportion of the body surface affected by lesions), the proportion of the animals with negative mite counts after the first treatment round and the number of treatment rounds needed to obtain zero mites counts in all animals. A mite population was categorized as sensitive when the mite count reduction after the first treatment round > 95% and the lower limit of the uncertainty interval > 90%. Resistance was detected when both parameters were below their threshold and suspected when one parameter was too low. In vitro knockdown and mortality were evaluated in a contact test. Results The proportion of the animals with negative mite counts after the first treatment round varied from 0 to 80%. All farms needed two or more treatments rounds to obtain zero mite counts on all animals. Clinical index only started to reduce after the second treatment round. Mite populations from three farms were categorized as sensitive, one as suspected resistant and 12 as resistant. No correlation was found between in vitro lethal dose 50 and knockdown dose 50 values and in vivo efficacy parameters. Conclusions Unambiguous treatment failure was detected on 12 out of 16 farms, confirming the presence of macrocyclic lactone resistance on Belgian Blue beef farms. In vitro parameters could not discriminate the farms based on their in vivo sensitivity. The mean reduction in mite counts and the lower limit of the confidence interval are proposed as parameters to identify acaricide resistance.

Introduction Anxiety is common in critically ill patients and has likely become more prevalent in the recent decade due to the imperative of the recent Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients (PADIS) to use low levels of sedation and strive for wakefulness. However, management of anxiety has not been included in the PADIS guidelines, and there is lack of evidence to treat it in spite of its growing importance. Administration of sedative and analgesic medication is often chosen to reduce anxiety, especially when associated with agitation. Sedatives are associated with prolonged mechanical ventilation, delirium and muscle wasting and are therefore preferably minimised. Previous studies have suggested positive effects of music interventions on anxiety in the critically ill. Therefore, we aim to study the effect of music intervention on anxiety in adult critically ill patients.Methods and design A multicentre randomised controlled trial was designed to study the effect of a music intervention on the level of anxiety experienced by adult patients admitted to the intensive care unit (ICU). One hundred and four patients will be included in three centres in the Netherlands. Patient recruitment started on 24-08-2020 and is ongoing in three hospitals. The primary outcome is self-reported anxiety measured on the visual analogue scale. Secondary outcomes include anxiety measured using the six-item State-Trait Anxiety Inventory, sleep quality, agitation and sedation level, medication requirement, pain, delirium, complications, time spend on mechanical ventilation, physical parameters and ICU memory and experience.Ethics and dissemination The Medical Ethics Review Board of Erasmus MC University Medical Centre Rotterdam, The Netherlands, has approved this protocol. The study is being conducted in accordance with the Declaration of Helsinki. Results of this trial will be published in peer-reviewed scientific journals and conference presentations.Trial registration number NCT04796389.

Many host-countries have liberalised migration policies to facilitate the transition of international students to the local labour market as they are seen as economic agents who increase global competitiveness and integrate easily. However, how migration and educational policies at the regional and national levels emerge, are negotiated and become implemented, and how they contradict other policies, remains little-known. This special issue aims to address that gap. This introductory paper offers an analytical framework for studying policies of international student mobility that addresses four critical dimensions: discourses, contexts, agents and temporalities before offering some key avenues for future research.