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This paper presents the methodology for the construction of the KNMI'23 national climate scenarios for the Netherlands. We have developed six scenarios, that cover a substantial part of the uncertainty in CMIP6 projections of future climate change in the region. Different sources of uncertainty are disentangled as much as possible, partly by means of a storyline approach. Uncertainty in future emissions is covered by making scenarios conditional on different SSP scenarios (SSP1‐2.6, SSP2‐4.5, and SSP5‐8.5). For each SSP scenario and time horizon (2050, 2100, 2150), we determine a global warming level based on the median of the constrained estimates of climate sensitivity from IPCC AR6. The remaining climate model uncertainty of the regional climate response at these warming levels is covered by two storylines, which are designed with a focus on the annual and seasonal mean precipitation response (a dry‐trending and wet‐trending variant for each SSP). This choice was motivated by the importance of future water management to society. For users with specific interests we provide means how to account for the impact of the uncertainty in climate sensitivity. Since CMIP6 GCM data do not provide the required spatial detail for impact modeling, we reconstruct the CMIP6 responses by resampling internal variability in a GCM‐RCM initial‐condition ensemble. The resulting climate scenarios form a detailed storyline of plausible future climates in the Netherlands. The data can be used for impact calculations and assessments by stakeholders, and will be used to inform policy making in different sectors of Dutch society. Plain Language Summary: To prepare society for the effects of future climate change, we need to know what the future climate will be like. In this paper we explain the method that is used to construct six different scenarios that describe possible future climates of the Netherlands. The scenarios make assumptions about future greenhouse gas emissions, and are based on the outcomes of climate models that simulate the response of the climate to these emissions. The KNMI'23 climate scenarios show that strongly reducing global emissions strongly reduces the expected changes in the climate of the Netherlands. In the scenario in which global emissions continue to rise until 2080, Dutch society will have to adapt to a much stronger increases in heat and precipitation extremes, increased risks of droughts with low river discharge in summer, and increased risk of flooding due to high river discharges in winter. In the coming years the climate scenario data will be used to evaluate what needs to be done to keep the country a safe place for people to live in and to thrive in, under changing climate conditions. Key Points: We present a methodology for the construction of regional climate scenarios using a storyline approach to partition uncertaintyResults from CMIP6 are reconstructed with a GCM‐RCM initial condition ensemble to produce high‐resolution scenario data for end‐usersSix scenario variants cover emission uncertainty (high, moderate, low) and uncertainty in the regional response (dry‐trending, wet‐trending) [ABSTRACT FROM AUTHOR]

Background: The role of patient participation and representation during crises, such as the COVID‐19 pandemic, has been under‐researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID‐19 pandemic. Methods: The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands. Results: We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision‐making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision‐making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered. Conclusions: The struggle for patient representation during pandemic decision‐making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision‐making offer lessons for future representation activities. However, adaptations to the crisis decision‐making structure are also needed to enable patient representatives to play their role. Patient Contribution: We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co‐authored this paper. [ABSTRACT FROM AUTHOR]

Flood defences are often situated in public spaces and are mostly multi‐functional, multi‐financed and multi‐managed. Cooperation in flood defence asset management is important because roles and responsibilities are fragmented within and between organisations. This complex context calls for mutual understanding from responsible role‐holders. Research has shown that serious games are instrumental to reflect situations in which technical and social complexity both play a role. Serious games motivate participants to learn and to change the way they learn. This paper presents the development, application, and results of a serious game 'Dike Dilemmas Under Pressure' that aims to create better mutual understanding between actors in flood defence asset management. The game was played with 67 professionals that fulfil a diversity of roles related to flood defence asset management in the Netherlands. The analysis of the results in this paper clearly shows different preferred cooperative attitudes between different groups of role‐holders and indicates potential misperceptions. The game participants were enthusiastic about the insights gained. They indicated that it helped them to recognise the broad variety of asset management dilemmas and become aware of their own cooperative attitudes and those of their colleagues towards dealing with these dilemmas. Future application of the game is recommended to monitor the cooperative attitudes of professionals in flood defence and to support the development of teams. [ABSTRACT FROM AUTHOR]

Flood defences are in practice often multi‐used, multi‐managed and multi‐financed. Flood defence asset management contains technical, organizational and spatial complex issues involving multiple organizations. In the literature, little attention has been given to the conditions for successful cooperation between organizations in flood defence asset management. This paper elaborates on this aspect of mature asset management from a practical point of view. Although the importance of a fit‐for‐purpose cooperation seems trivial, practice shows that the shape of cooperation is often the coincidental result of implicit or ad‐hoc choices and is not deliberately designed. This paper reports on empirical data gathered in a case consisting of five different situations related to collaboration in flood defence management. The management context consists of three main tasks: performance assessment, reinforcement and daily management, and three decision levels: strategic, tactical and operational, resulting in nine different management environments and related interfaces. For effectively achieving desired outcomes, the shape of cooperation has to be explicitly chosen dependent on the complexity of content and organizational context, and relevant external circumstances: situational cooperation. [ABSTRACT FROM AUTHOR]

Background: Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. Methods: Using Q‐methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow‐up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by‐person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. Results: Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision‐making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. Conclusions: Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. Patient or Public Contribution: An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications. [ABSTRACT FROM AUTHOR]

Long baseline bistatic radar systems herald enhanced sensitivity and metric accuracy for space objects in geosynchronous orbits and beyond. Radio telescopes are ideal participants in such a system; in particular, they often feature large apertures with low‐noise temperatures and have stable, synchronised clocks. Pairing radio telescopes with high‐power radars creates new methodologies for Space Domain Awareness. This paper describes long baseline bistatic measurements using the Millstone Hill Radar in the USA, the Tracking and Imaging Radar in Germany, multiple receivers of the enhanced multi‐element remotely linked interferometer network array in the United Kingdom, and the Westerbork Synthesis Radio Telescope in the Netherlands. The authors, a Research Task Group formed by the NATO Science and Technology Organisation Sensors and Electronic Technology Panel (SET‐293), performed novel bistatic and monostatic radar imaging experiments with real on‐orbit tumbling rocket bodies. These experiments on tumbling objects at near‐geosynchronous orbits highlight successful demonstrations of advanced bistatic Doppler characterisation across diverse imaging geometries. Specialised Doppler processing on tumbling targets, such as the Doppler superpulse algorithm, enables high‐fidelity rotation period estimation and determination of minimum target size. [ABSTRACT FROM AUTHOR]

Climatic changes can cause unpredictability in flood regimes that traditional flood risk management (FRM) approaches may struggle with. Therefore, flood resilience is seen as a supplementation to these approaches, putting a larger emphasis on flood acceptance and minimising consequences. An (emergent) group contributing towards flood resilience is civil society. This paper examines how civil society contributions can be furthered and guided in the Netherlands as well as exploring potential limitations in doing so. To achieve this, England is used as a good practice example due to a more developed and defined role for civil society being present here. Data were collected on both actual (England and the Netherlands) and potential (The Netherlands) civil society contributions. These were compared to identify potential avenues for Dutch civil society contributions to flood resilience that can be further investigated. The research shows that the most promising avenues are improving advocacy from citizens, improving local flood awareness and developing relationships between FRM authorities and existing citizen groups that can be harnessed and mobilised to support flood resilience. Additionally, the research also provides insights into potential limitations for transferring resilience approaches from one context to another beyond the cases discussed in this publication. [ABSTRACT FROM AUTHOR]

Sea level rise (SLR) will affect water levels and increase flood risk in river deltas. To adapt river deltas to SLR, various strategies can be followed. Many urbanised river deltas already have flood protection in place. Continuing a protection strategy under an increasing SLR, would mean higher embankments along the coast and rivers and possibly closing off the river mouths from the sea. However, closing of rivers will hamper the river flow. How to adapt river deltas and enabling rivers to discharge into the sea is a challenging question. This paper assesses impacts of SLR on flood risks in the Rhine‐Meuse Delta in the Netherlands in case the current protection strategy is continued and explores two alternative protection strategies: (1) a closed system with pumps and discharge sluices and (2) an open system in which rivers are diverted to less densely populated areas. The second alternative results in a more flexible river delta, which can accommodate larger SLR. The paper shows that a systems approach and using quantitative assessments of the implications of strategies is possible. This is needed to further assess the adaptation options, so we can anticipate and adapt when needed and avoid regret of decisions. [ABSTRACT FROM AUTHOR]

Aim: To investigate spoken language comprehension (SLC), single‐word comprehension (SWC), functional communication development, and their determinants, in children with cerebral palsy. Method: This was a prospective cohort study in the Netherlands spanning 2 years 6 months. The main outcomes were SLC and SWC, assessed by the Computer‐Based instrument for Low motor Language Testing (C‐BiLLT) and the Peabody Picture Vocabulary Test‐III‐NL (PPVT‐III‐NL) respectively; and functional communication, measured by a subscale of the Focus on the Outcomes of Communication Under Six‐34 (FOCUS‐34). Linear mixed models were used to determine developmental trajectories, which were compared with norm and reference data. Potential determinants, for example intellectual functions, speech production, functional communication level (classified with the Communication Function Classification System, CFCS), and functional mobility, were added to assess their effects. Results: Children with cerebral palsy (n = 188; mean age 59 months, range 17–110) were monitored for 2 years 6 months. Developmental trajectories for SLC (C‐BiLLT) and SWC (PPVT‐III‐NL) were nonlinear; those for functional communication (FOCUS‐34) were linear. Compared with norm and reference groups, significantly delayed SLC, SWC, and functional communication development were found. Determinants for SLC and SWC were intellectual functions and functional communication level (CFCS); and for functional communication development (FOCUS‐34), speech production and arm–hand functioning. Interpretation: Children with cerebral palsy showed delayed SLC, SWC, and functional communication development compared with norm and reference groups. Remarkably, functional mobility was not associated with the development of SLC, SWC, or functional communication. What this paper adds: Children with cerebral palsy have delayed spoken language comprehension (SLC), single‐word comprehension (SWC), and functional communication development, compared to norm and reference data.Determinants for SLC and SWC development are intellectual functions and functional communication level.Determinants for functional communication development are speech production and arm–hand functioning.Functional mobility is not associated with SLC, SWC, or functional communication. What this paper adds: Children with cerebral palsy have delayed spoken language comprehension (SLC), single‐word comprehension (SWC), and functional communication development, compared to norm and reference data.Determinants for SLC and SWC development are intellectual functions and functional communication level.Determinants for functional communication development are speech production and arm–hand functioning.Functional mobility is not associated with SLC, SWC, or functional communication. Video Podcast: https://youtu.be/x09Tac7tsz0 [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate the nurses' experiences with the Nursing Crisis Meetings and to identify nurses' needs regarding the future governance structure. Design: Qualitative study. Methods: Two focus groups were conducted in February 2022 with participants of the Nursing Crisis Meetings (N = 15). We used thematic analysis to describe themes. Results: We identified five themes: opportunity to speak up, call for nursing leadership, call for control over practice and autonomy, development of a governance infrastructure and development of the professional nurse role. Conclusion: Nurses experienced the Nursing Crisis Meetings to be a positive and empowering infrastructure, which facilitates the unique opportunity to speak up and share experiences and concerns. This new infrastructure is a promising strategy to engage nurses during a pandemic and to build on a professional governance structure. Impact: This paper highlights the need for nurses to speak up and be engaged during the COVID‐19 pandemic and gives a practical example of how to put this infrastructure into practice. [ABSTRACT FROM AUTHOR]

This paper examines the effect of hiring migrants on firms' imports using a rich employer–employee dataset from the Netherlands for 2010–17. We use an instrumental variables strategy, and find that firms that employ migrants from a high‐income country are more likely to import from that country. Our benchmark specification indicates that a one standard deviation increase in the share of migrant workers from a certain country raises their employer's probability of importing from those workers' origin country by 6.6 percentage points, explaining half of the average probability of importing from a given country. This result is robust to a battery of sensitivity checks, and the effects are driven largely by migrants working in trade intermediaries that import final goods and inputs. Our results suggest that migrants help to erode informational barriers and enable their employers to source goods from abroad. This paper is part of the Economica 100 Series. Economica, the LSE "house journal" is now 100 years old. To commemorate this achievement, we are publishing 100 papers by former students, as well as current and former faculty. Aksel Erbahar graduated from the LSE in 2010 with an MSc in Economics. [ABSTRACT FROM AUTHOR]

Global reanalyzes like ERA5 accurately capture atmospheric processes at spatial scales of O(10) $\mathcal{O}(10)$ km or larger. By downscaling ERA5 with large‐eddy simulation (LES), LES can provide details about processes at spatio‐temporal scales down to meters and seconds. Here, we present an open‐source Python package named the "Large‐eddy simulation and Single‐column model—Large‐Scale Dynamics," or (LS)2D in short, designed to simplify the downscaling of ERA5 with doubly‐periodic LES. A validation with observations, for several sensitivity experiments consisting of month‐long LESs over Cabauw (the Netherlands), demonstrates both its usefulness and limitations. The day‐to‐day variability in the weather is well captured by (LS)2D and LES, but the setup under‐performs in conditions with broken or near overcast clouds. As a novel application of this modeling system, we used (LS)2D to study surface solar irradiance variability, as this quantity directly links land‐surface processes, turbulent transport, and clouds, to radiation. At a horizontal resolution of 25 m, the setup reproduces satisfactorily the solar irradiance variability down to a timescale of seconds. This demonstrates that the coupled LES‐ERA5 setup is a useful tool that can provide details on the physics of turbulence and clouds, but can only improve on its host reanalysis when applied to meteorological suitable conditions. Plain Language Summary: Modern global weather models are accurate in predicting atmospheric processes at scales of around 10 km or larger, but are less good at predicting smaller scale processes, like for example, the interaction between solar radiation, individual clouds, and the resulting clouds shadows that are cast onto the land surface. High spatio‐temporal resolution research models are able to capture these smaller scale processes, but require a coupling to a weather model to account for the day‐to‐day variability in our weather. In this paper, we present a framework to couple large to small scale models, and demonstrate both the benefits and challenges of using this coupled model setup. The coupled setup excels in capturing the aforementioned high frequency interactions between small clouds and surface solar radiation. However, the chaotic nature of broken to overcast clouds is proven difficult to represent. The coupled model setup is published as open‐source code, and is therefore freely available to the research community. Key Points: We developed an open‐source Python package named (LS)2D, designed to downscale the ERA5 reanalysis with turbulence and cloud‐resolving large‐eddy simulation (LESs)One month long experiments with (LS)2D and MicroHH over the Netherlands demonstrate both the skill and limitations of the coupled setupCapturing high‐frequency interactions between clouds and surface solar irradiance requires high resolution (O $\mathcal{O}$(10) m) LES [ABSTRACT FROM AUTHOR]

Plastic pollution in aquatic ecosystems is a growing threat to ecosystem health and human livelihood. Recent studies show that the majority of environmental plastics accumulate within river systems for years, decades and potentially even longer. Long‐term and system‐scale observations are key to improve the understanding of transport and retention dynamics, to identify sources and sinks, and to assess potential risks. The goal of this study was to quantify and explain the variation in floating plastic transport in the Rhine‐Meuse delta, using a novel 1‐year observational data set. We found a strong positive correlations between floating plastic transport and discharge. During peak discharge events, plastic transport was found up to six times higher than under normal conditions. Plastic transport varied up to a factor four along the Rhine and Meuse rivers, which is hypothesized to be related to the complex river network, locations of urban areas, and tidal dynamics. Altogether, our findings demonstrate the important role of hydrology as driving force of plastic transport dynamics. Our study emphasizes the need for exploring other factors that may explain the spatiotemporal variation in floating plastic transport. The world's most polluted rivers are connected to the ocean through complex deltas. Providing reliable observations and data‐driven insights in the transport and dynamics are key to optimize plastic pollution prevention and reduction strategies. With our paper we aim to contribute to both advancing the fundamental understanding of plastic transport dynamics, and the establishment of long‐term and harmonized data collection at the river basin scale. Plain Language Summary: Plastic pollution in rivers and oceans harms ecosystems and human livelihoods. Especially large plastic items (>0.5 cm) can be mistaken for food by animals, damage ships, and block waterways. Knowing how much plastic is floating through rivers is important for policy‐makers to reduce plastic pollution in the environment. In our study, we measured floating plastic pollution in the Rhine and the Meuse, two large European rivers that flow into the ocean in the Netherlands. From January to December 2021, a team of students and volunteers counted plastic items floating in the rivers from bridges. We found that more plastic was counted when the river flow was higher. The highest amount of plastic was measured during two flood events, when parts of the land next to the rivers were flooded. We think that more plastic leaks into the river when streets, riverbanks, and floodplains are under water. We hope that our study can help to better predict how much plastic flows through other big rivers around the world. Only when we know how big the plastic problem is, we can successfully solve it. Key Points: Plastic pollution is a global environmental challenge, but poorly understood and quantified due to a lack of reliable observationsRiver plastic transport increases significantly during discharge during peak eventsHydrology plays a crucial role in the transport and retention dynamics, and the spatiotemporal variation of floating plastic transport [ABSTRACT FROM AUTHOR]

In this paper, we report on a wind observation method based on the movement of hot‐air balloons (HABs). A quality assessment was carried out by comparing against wind observations at the meteorological tower of Cabauw in the Netherlands during May–September 2018, and the obtained standard deviations in error were σu=0.65ms−1$$ {\sigma}_u=0.65\;{\mathrm{ms}}^{-1} $$ and σv=0.69ms−1$$ {\sigma}_v=0.69\;{\mathrm{ms}}^{-1} $$ for the measured zonal and meridional wind components, respectively. Subsequent comparison against short‐term forecasts of the HARMONIE‐AROME model showed a standard deviation of 2.5 ms−1 for the wind vector difference. From the HAB observation set, a case was selected with a rapidly changing wind field belonging to a small intensifying depression. The HAB wind observation was applied in data assimilation as a proof of principle for a single‐observation experiment. It is shown that in a complex baroclinic situation, the model state is slightly improved. [ABSTRACT FROM AUTHOR]

Copyright of Papers in Regional Science is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rain‐induced leading‐edge erosion (LEE) of wind turbine blades (WTBs) is associated with high repair and maintenance costs. The effects of LEE can be triggered in less than 1 to 2 years for some wind turbine sites, whereas it may take several years for others. In addition, the growth of erosion may also differ for different blades and turbines operating at the same site. Hence, LEE is a site‐ and turbine‐specific problem. In this paper, we propose a probabilistic long‐term framework for assessing site‐specific lifetime of a WTB coating system. Case studies are presented for 1.5 and 10 MW wind turbines, where geographic bubble charts for the leading‐edge lifetime and number of repairs expected over the blade's service life are established for 31 sites in the Netherlands. The proposed framework efficiently captures the effects of spatial and orographic features of the sites and wind turbine specifications on LEE calculations. For instance, the erosion is highest at the coastal sites and for sites located at higher altitudes. In addition, erosion is faster for turbines associated with higher tip speeds, and the effects are critical for such sites where the exceedance probability for rated wind conditions are high. The study will aid in the development of efficient operation and maintenance strategies for wind farms. [ABSTRACT FROM AUTHOR]

Because national governments have limited power to regulate the conditions of production abroad, voluntary certification schemes have come to play a significant role in transnational regulation of many global supply chains, particularly in the food sector, where multiple regulatory issues are in play and different certification schemes compete. However, we still know relatively little about the political‐economic factors that shape the construction of certified citrus markets for these competing standards. Based on an original dataset from a comparative survey of US and Dutch importers, this paper investigates factors that shape the construction of certification markets for citrus, focusing on the construction of markets for different kinds of certification schemes including Fair Trade, Organic, and GlobalGAP certification. The paper investigates from a comparative perspective whether the construction of markets differs across the US and Dutch political economies. The results show both the enduring effects of national political economies and the importance of global value chain dynamics. Across competing schemes, the industry‐sponsored business‐to‐business certification systems have outcompeted consumer‐facing label systems. [ABSTRACT FROM AUTHOR]

During early summer 2019, the Netherlands experienced an outbreak of the exotic oak processionary caterpillar. The vast number of caterpillars, which live in large nests on oak trees before they turn into moths, possess thousands of small, barbed hairs (setae) that are disseminated with the wind. The hairs cause a range of primarily dermatologic problems. However, Dutch ophthalmologists started reporting patients with ophthalmologic complaints caused by the penetrating hairs of the oak processionary caterpillar. This paper focuses on the ophthalmologic complications caused by the caterpillar hairs. We collected a series of four cases with reports ranging from a corneal erosion with hairs lodged into the cornea, to a sterile endophthalmitis in which hairs were found in the vitreous. A literature review for similar cases was performed using the PubMed and Embase database. Together with the Dutch Ophthalmic Society (Nederlands Oogheelkundig Gezelschap, NOG), a national survey was issued to determine the scale of this new problem. This showed that oak processionary caterpillar related complaints are primarily limited to the south of the Netherlands. Suggested ophthalmic treatment guidelines are presented. With the next summer at the doorstep, and limited preventative measures against the caterpillar hairs, we expect a new wave of ophthalmologic complaints coming year as well. [ABSTRACT FROM AUTHOR]

Most atmospheric models consider radiative transfer only in the vertical direction (1D), as 3D radiative transfer calculations are too costly. Thereby, horizontal transfer of radiation is omitted, resulting in incorrect surface radiation fields. The horizontal spreading of diffuse radiation results in darker cloud shadows, whereas it increases the surface radiation in clear sky patches (cloud enhancement). In this study, we developed a simple method to account for the horizontal transfer of diffuse radiation. We spatially filter the surface diffuse radiation field with a Gaussian filter, which is conceptually simple and computationally efficient. We applied the filtering to the results of Large‐Eddy Simulations for two summer days in Cabauw, the Netherlands, on which shallow cumulus clouds formed during the day. We obtained the optimal filter size by matching the simulation results with detailed high‐quality observations (1 Hz). Without the filtering, cloud enhancements are not captured, and the probability distribution of global radiation is unimodal, whereas the observed distribution is bimodal. After filtering, the probability distribution of global radiation is bimodal and cloud enhancements are simulated, in line with the observations. We found that small changes in the filter width do not strongly influence the results. Furthermore, we showed that the width of the filter can be parameterized as a linear function of for example, the cloud cover. Hence, this work presents a proof‐of‐concept for our method to come to more realistic surface irradiances by filtering diffuse radiation at the surface. Plain Language Summary: The pattern of radiation at the surface is characterized by the presence of cloud shadows and peaks in the radiation caused by scattering of light by clouds. The amount of solar radiation that reaches the Earth's surface determines how much energy is produced by solar panels and how much heat and moisture is supplied to the clouds, thus it influences how the clouds develop. Existing models neglect the scattering of radiation in the horizontal direction, therefore the high peaks in the radiation are not modeled. In this paper, we show for 2 days with shallow cumulus clouds how we can include the effect of the horizontal propagation of radiation. We redistribute the radiation at the surface, and we compare our model results with measurements. After the redistribution, the high peaks in radiation are modeled. In general, we get a good match between the observed and modeled radiation distribution. We show that the redistribution can be made a function of the clouds in the model. Hence, this work presents a proof‐of‐concept for our method to come to more realistic surface radiation, without complex calculations. Key Points: We correct simulations of shallow cumulus cloud days with 1D radiative transfer for the 3D radiative effects in a post‐processing stepThe probability distributions of diffuse and global radiation closely match the observations after filtering the surface diffuse radiationThe filter size can be parameterized as a linear function of one or multiple cloud variables, resulting in a minimal computational overhead [ABSTRACT FROM AUTHOR]

Background: In the management of epidemics, like COVID‐19, trade‐offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision‐making. Methods: From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID‐19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed. Results: Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations. Conclusions: This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience. Patient or Public Contribution: No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate. [ABSTRACT FROM AUTHOR]

Copyright of Papers in Regional Science is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pharmacogenomics (PGx) relates to the study of genetic factors determining variability in drug response. Implementing PGx testing in paediatric patients can enhance drug safety, helping to improve drug efficacy or reduce the risk of toxicity. Despite its clinical relevance, the implementation of PGx testing in paediatric practice to date has been variable and limited. As with most paediatric pharmacological studies, there are well‐recognised barriers to obtaining high‐quality PGx evidence, particularly when patient numbers may be small, and off‐label or unlicensed prescribing remains widespread. Furthermore, trials enrolling small numbers of children can rarely, in isolation, provide sufficient PGx evidence to change clinical practice, so extrapolation from larger PGx studies in adult patients, where scientifically sound, is essential. This review paper discusses the relevance of PGx to paediatrics and considers implementation strategies from a child health perspective. Examples are provided from Canada, the Netherlands and the UK, with consideration of the different healthcare systems and their distinct approaches to implementation, followed by future recommendations based on these cumulative experiences. Improving the evidence base demonstrating the clinical utility and cost‐effectiveness of paediatric PGx testing will be critical to drive implementation forwards. International, interdisciplinary collaborations will enhance paediatric data collation, interpretation and evidence curation, while also supporting dedicated paediatric PGx educational initiatives. PGx consortia and paediatric clinical research networks will continue to play a central role in the streamlined development of effective PGx implementation strategies to help optimise paediatric pharmacotherapy. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, all women aged 30–60 years are invited to participate in the national cervical cancer screening programme, which is aimed at early detection and treatment of precancerous lesions. One fourth of the Dutch population has a migration background, with Turkish and Moroccan immigrants being the largest immigrant populations. Turkish‐ and Moroccan‐Dutch women show lower screening participation rates and a higher incidence of cervical cancer, compared to native Dutch women. Since current information materials are not tailored to these women's needs, we developed a short culturally sensitive educational video to facilitate informed decision‐making for cervical cancer screening among Turkish‐ and Moroccan‐Dutch women. This article describes the development process of this video and the lessons learned. Methods: Using the Entertainment–Education communication strategy, we collaborated with an interdisciplinary team of Turkish‐ and Moroccan‐Dutch women, researchers, public health experts, and creative media professionals. We developed the video following the different stages of the Media Mapping model: Orientation, Crystallization, Design/Production, Implementation, and Dissemination. Each stage is described in the paper. Results: The video was developed in Moroccan‐Arabic, ‐Berber and Turkish, and emphasized three main themes: (1) more certainty about having cervical (pre)cancer and the possibility to prevent treatment, surgery, or premature death, and because of this, being there for the children, (2) according to the Islam, a woman should take good care of her health, and (3) anxiety, shame, and privacy. Conclusions: A short culturally sensitive educational video, delivered as part of a larger intervention together with the current information brochure, was developed based on theory and grounded in the needs of Turkish‐ and Moroccan‐Dutch women. The value and effectiveness of this intervention to facilitate informed cervical cancer screening decisions are evaluated in a randomised controlled trial. Patient or Public Contribution: We collaborated with Turkish‐ and Moroccan‐Dutch women during the development process of a short culturally sensitive educational video. Turkish‐ and Moroccan‐Dutch women were also invited to watch the raw footage to verify whether the content and presentation matched their needs and requirements. [ABSTRACT FROM AUTHOR]

Both England and the Netherlands have seen efforts to liberalise their audit markets for local government in recent decades. According to economic theory, these should benefit buyers as increased competition produces lower prices and improved quality. Increasing the number of competing audit firms in markets traditionally dominated by few large firms is widely seen as a key ingredient to this process. However, liberalisation has taken different paths in England, compared to the Netherlands. In England, a national‐level collaborative purchasing arrangement has seen a small number of large firms competing, whilst in the Netherlands, a free market has led to the withdrawal by Big‐4 firms and rapidly growing market share by mid‐tier and small firms. In this paper, we analyse contrasting market developments in local public audit in England and the Netherlands and accordingly analyse the underlying factors through applying an established framework for market analysis from industrial economics, Porter's five forces framework, together with an institutional logics approach to further understand the factors involved. We find the Porter framework a useful tool to identify structural differences between markets but one that requires further analysis to explain underlying dynamics, which in the case of Dutch and English local public audit markets is effectively provided by the use of concepts from institutional logics including a historical contingency analysis. [ABSTRACT FROM AUTHOR]

In this paper, we revisit this well‐established linear relationship of person‐organisation, demands‐abilities, and needs‐supply fit with job satisfaction, commitment, and OCBs, and propose that this relationship may be linear for affective work outcomes but curvilinear for behavioural ones. We test this idea in a two‐wave sample of 212 employees, with measures taken 4 weeks apart. The results support the idea that the relationship between fit and behavioural outcomes can, indeed, be curvilinear. Overall, this study contributes to a better understanding of the nature of the relationship between fit and work outcomes by challenging the long‐held 'more fit is better' logic that pervades much of the PE fit research to date. [ABSTRACT FROM AUTHOR]

Background: Community engagement is seen as key to citizen‐centred and sustainable healthcare systems as involving citizens in the designing, implementation and improvement of services and policies is thought to tailor these more closely to communities' own needs and experiences. Organizations have struggled to reach out to and involve disadvantaged citizens. This paper examines how if, why, and when low‐income citizens wish to be involved. Methods: For this qualitative realist case‐study, 19 interviews (one dyad) were held with (20) low‐income citizens in two Dutch municipalities. Additionally, the results were discussed with a reference panel consisting of professionals and citizens to enrich the results and to ensure the results had face validity. Results: The results showed four different ways in which low‐income citizens wished to be involved: (a) in a practical/volunteer way; (b) as a buddy; (c) as a lay expert; (d) not involved at all. The factors affecting citizens' interest and capacity to participate include citizens' own experiences of the services they access and their personal situations, e.g. their mental or physical health, extent of financial crisis, family situation, home environment. None of the interviewees was currently involved, but all had ideas for improving health(care) services and policies. Citizens' experiences of the services they accessed acted as a motivator for some to be involved as they wanted to ensure others would not have the same struggles, while for others their own needs and an apathetic system remained too high a barrier. To enable involvement, citizens need continued support for their own health(care) and financial situation, better communication and accessibility from services, practical support (e.g., training and bus passes) and recognition for their input (e.g., monetary compensation). Conclusion: The study shows that citizens' experiences of the services they accessed influenced if and how they wanted to be involved with health and care services. Despite the fact that all participants had shared solid ideas for improving services and policies, they were hindered by a bureaucratic, impersonal and inaccessible system. Organizations seem to underestimate the required investments to reach out to low‐income citizens and the support required to ensure their involvement. Patient and Public Involvement (PPI) in Study: Citizens as well as PPI organizations were members of the reference panel who helped formulate the research questions and recruitment strategy. The local reference panel also helped to interpret and refine the initial findings. [ABSTRACT FROM AUTHOR]

Extended producer responsibility (EPR) is a proposed policy approach to promoting the circular economy (CE) within the European Union. This research used a policy Delphi to explore perspectives on improving EPR policies to further contribute to the CE goals of the Netherlands. Both the potential improvement and critical reflections discussed by CE and EPR experts and practitioners from this study contribute to a more detailed understanding of the future governance of CE practices. We present various activities to improve EPR and insights from Delphi participants that emerged from the study. This paper shows that whilst actors agree, in essence, that there is a need for modifying EPR, what the specific changes to the form are and to whom the new responsibilities apply is contested. [ABSTRACT FROM AUTHOR]

Background: To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim: This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods: Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results: Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion: The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution: European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey. [ABSTRACT FROM AUTHOR]

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Aim: To determine neurocognitive performance and behavioural problems in children with Panayiotopoulos syndrome.Method: All 18 children (10 females, 8 males; mean age 4y 7mo; SD 1y 10mo) diagnosed with Panayiotopoulos syndrome at the Kempenhaeghe Epilepsy Center in the Netherlands between 2010 and 2017 were analysed retrospectively. All underwent a neuropsychological/behavioural assessment, an academic assessment, and a 24-hour electroencephalogram.Results: Mean full-scale IQ (93.5; range 76-123; p=0.04) and performance IQ (93.2; range 76-126; p=0.04) were within the normal range, although significantly lower compared to the normative mean. Verbal IQ (96.3; range 76-118) and processing speed (96.1; range 74-114) were not significantly lower. Simple auditory/visual reaction times, visual attention, visual-motor integration, and verbal memory were significantly lower compared to normative values. On average, patients with Panayiotopoulos syndrome were 8 months behind in arithmetic speed and 11 months behind in reading speed for the number of months in school. Behavioural questionnaires revealed significantly higher scores on reported internalizing behavioural problems.Interpretation: Children with Panayiotopoulos syndrome demonstrated diffuse cognitive dysfunction in full-scale IQ, performance IQ, visual attention, visual-motor integration, and verbal memory. A high incidence of internalizing behavioural problems was reported. This strongly suggests neuropsychological and behavioural comorbidity in children with Panayiotopoulos syndrome.What This Paper Adds: Children with Panayiotopoulos syndrome are at risk for cognitive deficits in various cognitive domains. Children with Panayiotopoulos syndrome are also prone to internalizing behavioural problems. Mild-to-severe academic underachievement was present in more than half of the children with Panayiotopoulos syndrome. [ABSTRACT FROM AUTHOR]

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Abstarct: Purpose: Children with Down syndrome (DS) more often have strabismus, refractive errors, accommodative lags and reduced visual acuity (VA) than typically developing children. In this study, we compare the effects of bifocal glasses with those of unifocal glasses in children with DS. Changes in angle of strabismus, accommodation and refractive error were analysed in this paper. Methods: In a multicentre randomized controlled trial, 119 children with DS, aged 2–16, were randomly allocated for bifocal or unifocal glasses (with full correction of refractive error in cycloplegia). The 15 centres, all in the Netherlands, followed the participants for 1 year. Changes in refractive error, accommodative accuracy, strabismus, binocularity and stereopsis were compared across 4 subsequent visits. Results: Refractive errors and accommodative errors showed no significant change throughout the course of our study in either intervention group. The manifest angle of strabismus, however, reduced significantly in the bifocal group. This improvement was observed shortly after the children received their new correction (~6 weeks) (linear regression: t = 3.652, p < 0.001) and remained present in the final measurements after 1 year (linear regression: t = 3.604, p < 0.001). The percentage of children with positive binocularity and stereo tests showed no significant differences between the groups. Conclusion: Bifocals with full correction of refractive error reduce the manifest angle of strabismus within a few weeks. No effects on accommodation, refractive error, stereopsis and binocularity occurred over the course of 1 year. [ABSTRACT FROM AUTHOR]

Citizen‐science thermometer measurements have the potential to provide information about surface air temperature fields on scales smaller than is typically quantified by the official monitoring network. As such, national meteorological services are becoming increasingly interested in these measurements as a possible source of data for use in weather monitoring or forecasting. However, in order for the information to be used, biases in the data need to be assessed. The most important source of bias is the potential overheating of the thermometer due to inadequate shielding or exposure. Previous research has indicated that information about the nature of the instrument and its exposure is important for correcting this bias. However, in the majority of cases this information is unavailable for amateur stations. In this paper a statistical correction for short wave radiation bias is developed for the air temperature data recorded at 159 Weather Observations Website (WOW) stations across the Netherlands during the period 2015–2016. Generalized additive mixed modelling (GAMM) is used to quantify and correct for short wave radiation bias in the hourly measurements using a background temperature field generated from the official 34 automatic weather stations along with satellite‐derived short wave radiation estimates. It is demonstrated that the corrected WOW data add local detail to the hourly temperature field, which may provide a useful source of data to supplement official measurements. [ABSTRACT FROM AUTHOR]

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The life of a refugee is hard. We show how Maslow's theory of motivation can be utilized to better understand the situation of refugees in the Netherlands. Our aim is to formulate guidelines for the authorities in terms of logistical support. From a methodological position, we motivate the use of critical systems thinking to be used in wicked problems. The popular account of Maslow's work undermines key aspects from the original work, namely, preconditions for need satisfaction and the role of information. As we analysed stories told by refugees, it is these lesser known aspects of his theory that provided most insights. Freedom in host countries is gained on different levels. Contrasting Maslow's view, we propose that freedom is an "end" and hierarchical. Without information, the refugee cannot experience freedom. Because the stories of the refugees follow Maslow's needs hierarchy, we argue that information provided should be according to this hierarchy. [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]

Background: Patient‐directed knowledge tools such as patient versions of guidelines and patient decision aids are increasingly developed to facilitate shared decision making. In this paper, we report how consensus was reached within the Netherlands on quality criteria for development, content and governance of these tools. Method: A 12‐month development and consensus study. The consortium worked on four work packages: (a) reviewing existing criteria; (b) drafting the quality criteria; (c) safe‐guarding the acceptability and feasibility of the draft criteria by participatory research in on‐going tool development projects; and (d) gaining formal support from national stakeholders on the quality criteria. Results: We reached consensus on a 8‐step guidance; describing minimal quality criteria for (a) the team composition; (b) setting the scope; (c) identifying needs; (d) the content and format; (e) testing the draft; (f) finalizing and approval; (g) dissemination and application, and (h) ownership and revision. The participants of the on‐going tool development projects were positive about the quality criteria in general, but divided as to the degree of detail. Whereas some expressed a clear desire for procedural standards, others felt that it would be sufficient to provide only general directions. Despite the different views as to the degree of detail, consensus was reached in three stakeholder meetings. Discussion: We successfully collaborated with all stakeholders and achieved formal support from national stakeholders on a set of minimum criteria for the development process, content and governance of patient‐directed knowledge tools. [ABSTRACT FROM AUTHOR]

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This paper studies unobserved heterogeneity in hedonic price models, arising from missing property and locational characteristics. Specifically, commercial real estate is very heterogeneous, and data on detailed property characteristics are often lacking. We show that adding mutually independent property random effects to a hedonic price model results in more precise out‐of‐sample price predictions, both for commercial multifamily housing in Los Angeles and owner‐occupied single‐family housing in Heemstede, the Netherlands. The standard hedonic price model does not take advantage of the fact that some properties sell more than once. We subsequently show that adding spatial random effects leads to an additional increase in prediction accuracy. The increase is highest for properties without prior sales. [ABSTRACT FROM AUTHOR]

Introduction: Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. Methods: We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision‐making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. Results: A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self‐awareness; (5) consideration skills; (6) self‐efficacy; (7) emotional distress; and (8) experienced time. We developed the 20‐item ReadySDM to retrospectively measure these elements in an oncological setting. Conclusion: We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM. The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. Patient or Public Contribution: Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire. [ABSTRACT FROM AUTHOR]

The Wound‐QoL assesses the impact of chronic wounds on patients' health‐related quality of life (HRQoL). A 17‐item and a shortened 14‐item version are available. The Wound‐QoL‐17 has been validated for multiple languages. For the Wound‐QoL‐14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound‐QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound‐QoL versions for the overall sample and, if feasible, country‐wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound‐QoL‐17 (Cronbach's α: 0.820–0.933) and Wound‐QoL‐14 (0.779–0.925). Test–retest reliability was moderate to good (intraclass correlation coefficient: 0.618–0.808). For Wound‐QoL‐17 and Wound‐QoL‐14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = −0.371; r = −0.388) and wound size (r = 0.381; r = 0.383). Country‐wise results were similar. Both Wound‐QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound‐QoL‐14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long‐term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end‐of‐life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. Research Design and Objective: An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. Findings: Thirty‐eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. Discussion and Implications: International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. Patient or Public Contribution: PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript. [ABSTRACT FROM AUTHOR]

The present paper addresses two crafting strategies employees may display in different life domains in order to attain desired outcomes. On the one hand, job crafting is targeted at increasing social and structural job resources and challenging job demands. On the other hand, leisure crafting is the proactive pursuit of leisure activities targeted at goal setting, human connection, learning, and personal development. We hypothesized that job crafting relates positively to employee work engagement and meaning-making, especially when occupational role salience is high. Furthermore, we hypothesized that leisure crafting relates positively to meaning-making, especially when job crafting opportunities are low. Using a sample of 105 Dutch employees and a weekly survey with three measurements, we found support for most of our hypotheses. All job crafting dimensions related positively to work engagement when occupational role salience was high. Also, increasing structural resources related positively to meaning-making when occupational role salience was high. Leisure crafting related positively to meaning-making when job crafting opportunities were low. We discuss directions for future research on work and leisure, and suggest how employees and organizations may benefit by encouraging job and leisure crafting. Practitioner points Employees can proactively build their own work engagement using job crafting, especially when they view their work as a source of personal satisfaction and development., In workplaces where opportunities to craft are low, employees could focus on their leisure time as a source of meaning and self-reflection., Managers can empower and coach employees to proactively seek growth and self-fulfilment both at work and outside work, via job crafting and leisure crafting., Organizations and managers should encourage employees to flourish not only at work but also during leisure time, communicating that work and leisure are two life domains that can help and complement each other. [ABSTRACT FROM AUTHOR]

Traditionally, governmental authorities in the Netherlands have a strong focus on the construction and maintenance of flood defences, such as dikes and dams. The last decades, however, there has been a growing awareness of the importance of spatial planning for flood risk management. With the arrival of the Floods Directive (2007), it is likely that even more attention will be paid to sustainable spatial planning to reduce flood risks. From an institutional perspective, this paper explores the way in which the Netherlands is now attempting to further integrate water management and spatial planning in the preparation of its first Flood Risk Management Plans. The current internal policy debate centres around five important issues concerning the required measures, instruments, rules, governance styles and time perspectives. Maintaining its strong, engineering-based water management tradition, and at the same time institutionalising a framework for a more holistic flood risk management that comprises not only rules and regulations for probability reduction but also for impact reduction through sustainable spatial planning turns out to be a challenging task. The recently established national Delta Commissioner (2012) could be an important stimulus for the further integration and innovation of water management and spatial planning. [ABSTRACT FROM AUTHOR]

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Resistance exercise training is effective to counteract the adverse effects of androgen deprivation therapy (ADT) on body composition, muscle mass and leg strength in prostate cancer patients (PCa). However, it is unknown whether these effects can be autonomously maintained after cessation of the supervised program. Sixty‐eight PCa patients on ADT were included. The exercise intervention group (EX, n = 37) performed 20 weeks of supervised resistance exercise training. Thereafter, patients were advised to autonomously continue exercise training. The control group (CON, n = 31) only received usual care. Outcome measures were compared between baseline and after 1 year. Changes during the intervention (baseline vs. 20 weeks) and follow‐up period (20 weeks vs. 1 year) were descriptively explored. In EX, 83% reported to have continued exercise training themselves. After 1 year, fat mass gains were attenuated in EX compared to CON (1.2 ± 2.6 and 2.8 ± 1.9 kg, respectively; time × treatment effect p = 0.032). The fat percentage increased, and lean mass and quadriceps muscle cross‐sectional area decreased over time, with no differences between groups (overall 1.6 ± 2.1%, −0.7 ± 2.3 kg and −2.2 ± 2.9 cm2, respectively; time effects, all p < 0.05). For muscle strength, an increase of ∼5% in EX was observed, significantly different from the ∼10% decrease in CON (p < 0.001). Subsequent analyses showed that the initial exercise training‐obtained gains in lean mass, muscle mass and strength in EX compared to CON, declined during the follow‐up period. In conclusion, PCa patients on ADT are not capable to autonomously maintain the exercise‐obtained gains of a 20‐week supervised training program over a subsequent 1‐year period. Highlights: ADT for prostate cancer results in many side effects, including muscle mass lossA supervised resistance exercise training program can counteract many side effectsAfter cessation of the supervised program, exercise benefits are not effectively preservedMore focus on sustainability of exercise programs during ADT is required [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the epilepsy phenotype in a large international cohort of patients with KBG syndrome and to study a possible genotype–phenotype correlation. Methods: We collected data on patients with ANKRD11 variants by contacting University Medical Centers in the Netherlands, an international network of collaborating clinicians, and study groups who previously published about KBG syndrome. All patients with a likely pathogenic or pathogenic ANKRD11 variant were included in our patient cohort and categorized into an "epilepsy group" or "non‐epilepsy group". Additionally, we included previously reported patients with (likely) pathogenic ANKRD11 variants and epilepsy from the literature. Results: We included 75 patients with KBG syndrome of whom 26 had epilepsy. Those with epilepsy more often had moderate to severe intellectual disability (42.3% vs 9.1%, RR 4.6 [95% CI 1.7–13.1]). Seizure onset in patients with KBG syndrome occurred at a median age of 4 years (range 12 months – 20 years), and the majority had generalized onset seizures (57.7%) with tonic–clonic seizures being most common (23.1%). The epilepsy type was mostly classified as generalized (42.9%) or combined generalized and focal (42.9%), not fulfilling the criteria of an electroclinical syndrome diagnosis. Half of the epilepsy patients (50.0%) were seizure free on anti‐seizure medication (ASM) for at least 1 year at the time of last assessment, but 26.9% of patients had drug‐resistant epilepsy (failure of ≥2 ASM). No genotype–phenotype correlation could be identified for the presence of epilepsy or epilepsy characteristics. Significance: Epilepsy in KBG syndrome most often presents as a generalized or combined focal and generalized type. No distinctive epilepsy syndrome could be identified. Patients with KBG syndrome and epilepsy had a significantly poorer neurodevelopmental outcome compared with those without epilepsy. Clinicians should consider KBG syndrome as a causal etiology of epilepsy and be aware of the poorer neurodevelopmental outcome in individuals with epilepsy. [ABSTRACT FROM AUTHOR]

Aims: When relying on clinical assessment alone, an estimated 22% of acute heart failure (AHF) patients are missed, so clinical guidelines recommend the use of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) for AHF diagnosis. Since publication of these guidelines, there has been poor uptake of NT‐proBNP testing in part due to concerns over excessive false positive referrals resulting from the low specificity of a single 'rule‐out' threshold of <300 pg/mL. Low specificity can be mitigated by the addition of age‐specific 'rule‐in' NT‐proBNP thresholds. Methods and results: A theoretical hybrid decision tree/semi‐Markov model was developed, combining global trial and audit data to evaluate the cost‐effectiveness of NT‐proBNP testing using age‐specific rule‐in/rule‐out (RI/RO) thresholds, compared with NT‐proBNP RO only and with clinical decision alone (CDA). Cost‐effectiveness was measured as the incremental cost per quality‐adjusted life year (QALY) gained and incremental net health benefit. In the base case, using UK‐specific inputs, NT‐proBNP RI/RO was associated with both greater QALYs and lower costs than CDA. At a willingness‐to‐pay threshold of £20 000/QALY, NT‐proBNP RO was also cost‐effective compared with CDA [incremental cost‐effectiveness ratio (ICER) of £8322/QALY], but not cost‐effective vs. RI/RO (ICER of £64 518/QALY). Overall, NT‐proBNP RI/RO was the most cost‐effective strategy. Sensitivity and scenario analyses were undertaken; the conclusions were not impacted by plausible variations in parameters, and similar conclusions were obtained for the Netherlands and Spain. Conclusions: An NT‐proBNP strategy that combines an RO threshold with age‐specific RI thresholds provides a cost‐effective alternative to the currently recommended NT‐proBNP RO only strategy, achieving greater diagnostic specificity with minimal reduction in sensitivity and thus reducing unnecessary echocardiograms and hospital admissions. [ABSTRACT FROM AUTHOR]

Introduction: Vulvar lichen sclerosus (VLS) occurs in at least one in 900 girls. There is limited knowledge as to what extent the disease persists in adulthood and what the repercussions in adulthood may be. The aim of this study is to evaluate the long‐term consequences of VLS diagnosed in childhood or adolescence. Material and methods: The population of females histologically diagnosed with VLS in childhood or adolescence in the Netherlands between 1991 and 2015 was identified through the national pathology database. Histological specimens were retrieved and re‐evaluated. Potential participants for whom the diagnosis was reconfirmed and who are now adults, were then traced and surveyed. Descriptive statistics were calculated and compared with the literature. Main outcome measures are the demographics of the cohort, their scores on standardized quality of life (QoL) and sexuality questionnaires and answers to additional questions regarding patients' experience with the disease. The questionnaires used were the Dermatology Life Quality Index (DLQI), the Skindex‐29, the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale‐Revised (FSDS‐R). Secondary outcome measures include obstetric history and histological features found in the original tissue specimens. Results: A total of 81 women participated, median age 29.0 years, median follow‐up from childhood diagnosis 19.5 years. Both QoL and sexuality were somewhat affected in 51.9% of cases. Less than half (45%) reported having regular check‐ups. Forty‐five (56%) reported symptoms within the past year; of those with symptoms, 14 (31%) were not under surveillance. Cesarean section rate (14.5%) was comparable to the general population, and there were more high‐grade obstetric anal sphincter injuries with vaginal deliveries than expected. Sixteen respondents (20%) were not aware of the childhood diagnosis prior to this study. Conclusions: Symptoms due to VLS are reported by most adults diagnosed as juveniles. QoL and sexuality are affected and correlate to recent symptoms. VLS as a juvenile does not preclude a vaginal delivery. Women diagnosed with VLS in childhood or adolescence are often lost to follow‐up. [ABSTRACT FROM AUTHOR]