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This study examines measurement invariance of student perceptions of teaching quality collected in five countries: Indonesia (n students = 6,331), the Netherlands (n students = 6,738), South Africa (n students = 3,422), South Korea (n students = 6,997) and Spain (n students = 4,676). The administered questionnaire was the My Teacher Questionnaire (MTQ). Student perceived teachers' teaching quality was estimated using the partial credit model (PCM). Tests for differential item functioning (DIF) were used to assess measurement invariance. Furthermore, if DIF was found, it was explored whether an application of a quasi-international calibration, which estimates country-unique parameters for DIF items, can provide more valid estimates for between-country comparisons. Results indicate the absence of non-uniform DIF, but presence of uniform DIF among most items. This suggests that direct comparisons of raw mean or sum scores between countries is not advisable. Details of the set of invariant items are provided. Furthermore, results suggest that the quasi-international calibration is promising, but also that this approach needs further exploration in the context of student perceptions of teaching quality.

Effective teaching is a key factor in educational effectiveness and improvement. To facilitate the knowledge exchange regarding effective teaching in secondary education internationally, there has been a growing interest in using classroom observation measures. However, little is known regarding the comparability of observation measures across various national contexts (measurement invariance). Consequently, comparing effective teaching behaviour across contexts is compromised by issues of construct and measurement equivalence. In the present study, we investigated measurement invariance of the International Comparative Analysis of Learning and Teaching (ICALT) for measuring teaching behaviour across various national contexts including the Netherlands, South Korea, South Africa, Indonesia, Hong Kong-China, and Pakistan. Results showed that ICALT indicates full strict invariance in four out of the six countries, which provides a possibility to compare teaching behaviour in the Netherlands, South Korea, South Africa, and Indonesia. South Korea indicated the highest quality of teaching behaviour, while Indonesia indicated the lowest.

Differentiated instruction is considered to be an important teaching quality domain to address the needs of individual students in daily classroom practices. However, little is known about whether differentiated instruction is empirically distinguishable from other teaching quality domains in different national contexts. Additionally, little is known about how the complex skill of differentiated instruction compares with other teaching quality domains across national contexts. To gain empirical insight in differentiated instruction and other related teaching quality domains, cross-cultural comparisons provide valuable insights. In this study, teacher classroom practices of two high-performing educational systems, The Netherlands and South Korea, were observed focusing on differentiated instruction and other related teaching quality domains using an existing observation instrument. Variable-centred and person-centred approaches were applied to analyze the data. The study provides evidence that differentiated instruction can be viewed as a distinct domain of teaching quality in both national contexts, while at the same time being related to other teaching domains. In both countries, differentiated instruction was the most difficult domain of teaching quality. However, differential relationships between teaching quality domains were visible across teacher profiles and across countries.

The main aim of this study was to adjust the Questionnaire on the Experience and Evaluation of Work (QEEW) in order to measure stress causes and stress responses of beginning secondary school teachers in the Netherlands. First, the suitability of the original QEEW stress scales for use in the beginning teachers (BTs) context was investigated using a sample of 356 beginning teachers from 52 different secondary school locations in the Netherlands. Confirmatory Factor Analyses, Principal Component Analyses and Mokken scaling item reduction was applied to create high concise and precise scales. Hereafter, based on the teacher stress literature, additional teacher specific stress items were added, resulting in the adjusted version of the measure, the Questionnaire on the Experience and Evaluation of Work -- Beginning Teachers (QEEW-BT, study 1). To cross-validate the results and to examine the internal consistency and validity of the adjusted instrument a different sample of 143 beginning teachers from 61 different secondary school locations in the Netherlands was used (study 2). The present findings provide adequate support that the QEEW-BT is a reliable and valid instrument to measure stress causes and responses for beginning secondary school teachers in the Netherlands.

This explorative study adopts a regional perspective on understanding differences in observable teaching quality by describing regional levels in teaching quality for specific regions and by examining the contribution of schools' regional characteristics on effective teaching behaviour of 1,945 beginning teachers in secondary education. Beginning teachers working in schools located in regions of population decline have better basic teaching skills than beginning teachers working elsewhere. Multilevel analyses reveal that within the Randstad region, adaptive instruction skills are weaker in very urban areas. Schools' changing student numbers influence the quality of adaptive instruction skills and teaching learning strategies. These findings indicate that differences in teaching quality become visible at lower regional levels and are of interest because these effects on student outcomes might not be captured in national figures. This approach adds to existing literature and is useful to tailor current professionalization programmes for beginning teachers to specific regional contexts.

In this study, the relationships between beginning teachers' perceived stress causes, stress responses, observed teaching behaviour and attrition is investigated employing structural equation modelling (SEM). A total of 143 BTs were surveyed using the Questionnaire on the Experience and Evaluation of Work-BTs (QEEW-BT). Teaching behaviour was observed using the ICALT observation instrument. Results show that BTs' perceived negative pupil aspects relate positively to the stress responses perceived tension, discontent and negative emotions. Negative emotions, in turn, are negatively associated with observed teaching behaviour. This study also shows that discontent positively relates to attrition. Additionally, this study provides important cues to improve professional support programmes for BTs.

Although effective teaching behaviour is central for pupil outcomes, the extent to which pre-service teachers behave effectively in the classroom and how their behaviour relates to pupils' engagement remain unanswered. The present study aims to validate a theoretical model linking effective pre-service teaching behaviour and pupil's engagement, incorporating the role of context and teacher characteristics. The study included a sample of 264 pre-service teachers from 64 secondary schools throughout the Netherlands. Pre-service teachers were observed using the International Comparative Analysis of Learning and Teaching to measure effective teaching behaviour and pupils' engagement. We used multilevel modelling to account for the hierarchical structure in the data. Results show that the quality of teaching behaviour of pre-service teachers is below that of experienced teachers. Class size and (partly) teacher gender explain differences in the quality of teaching behaviour. All domains of teaching behaviour are related to pupil engagement, with classroom management and clarity of instruction showing the strongest relationships with academic engagement compared to the other domains. The results make it plausible to approximate minimum standards for the assessment of pre-service teachers based upon a normative criterion based on the impact on pupils' academic engagement.

Six observation scales for measuring the skills of teachers and 1 scale for measuring student engagement, assessed in South Korea and The Netherlands, are sufficiently reliable and offer sufficient predictive value for student engagement. A multigroup confirmatory factor analysis shows that the factor loadings and intercepts of the scales are the same, within acceptable boundaries, in both countries. Therefore, we can compare the average scores of teachers in both countries in a reliable and valid way. The 289 Dutch teachers score significantly better on "creating a safe and stimulating learning climate" and "intensive and activating teaching" and almost significantly on "efficient classroom management". We find no significant differences in "clear and structured instruction". The 375 South Korean teachers perform significantly better than the Dutch teachers on "teaching learning strategies" and almost significantly on "differentiating instruction". Furthermore, we find better student engagement in South Korea.

Observations and student perceptions are recognised as important tools for examining teaching behaviour, but little is known about whether both perspectives share similar construct representations and how both perspectives link with student academic outcomes. The present study compared the construct representation of preservice teachers' teaching behaviour as perceived by trained teacher observers and students. It also examined the predictive power of both measures of teaching behaviour for student academic engagement. The theoretical framework of teaching behaviour used in this study is based on evidence-based research derived from empirical teacher effectiveness research. The study was part of a national project that included 2164 students and 108 teachers in The Netherlands. Results suggest that, although observations and student perceptions of teaching behaviour shared similar theoretical considerations, the construct representations seemed to differ to some extent. Furthermore, although both perspectives are significant predictors of student academic engagement, student perceptions appeared to be more predictive of their perceived academic engagement than observations. Implications for research on learning environments and teacher education are discussed.

The teaching profession faces a shortage as well as a decline of teaching skills. A possible way to mitigate this is to implement evidence-based induction arrangements. Seventy-one schools with 338 beginning secondary education teachers were randomly allocated to an experimental or a control group. The experimental schools used induction arrangements; the authors measured the effects of these arrangements by using repeated lesson observations and by comparing the rates at which beginners in the control and experimental groups left the teaching profession. Three years later, 14% of the control group and 12% of the experimental group had left. Leaving the profession could be explained by a lack of certification and low initial teaching skill levels. The experimental group exhibited greater improvement in teaching skills compared to the control group. Workload reduction influenced the skill level negatively, and coaching and observing had a strong positive influence on the skill level in Year 3.

In this study, the path of influence of support programmes for beginning teachers (BTs) is examined. Longitudinal relationships between self-efficacy and stress causes experienced by BTs and their job tension and discontent are investigated. Differential effects are explored in the relationships between the perceived psychological variables for induction and non-induction groups, after a period of three years. A total of 62 secondary schools and 338 BTs, in the Netherlands, were randomly selected to two context conditions. In the experimental condition, an induction arrangement was provided to the BTs. The remaining schools and BTs followed their regular (induction) arrangements. Results show that school and class efficacy are negatively related to job tension and job discontent. Stress causes were positively related to job tension and discontent. The link between classroom self-efficacy and stress outcomes is much stronger in the induction group. For school self-efficacy, however, the link is weaker in the induction groups. Implications of the findings for practice and theory are discussed.

Teacher learning is essential to the teaching profession, because it has been strongly linked to improved teaching practices and teacher quality. The source for teacher learning is initial teacher education, a crucial phase in the learning-to-teach continuum. To gain insight into this influential period for student teachers' long-term professional lives, this exploratory study investigates student teachers' participation in learning activities and explores whether it is connected to their own effective teaching behaviours in a school-based teacher education setting for secondary education in the Netherlands. The results indicate that student teachers vary in their self-reported learning and that this learning relates positively to observations of their effective teaching behaviour. These findings have several implications for teacher education programmes that aim to enhance the likelihood that their student teachers will become career-long learning professionals.

The present study examines the development of a measure tapping students' perceptions of (pre-service) teachers' teaching behaviour to explore the practical value of such a measure in teacher education and teacher professional development programs. From a sample of 1,635 students of 91 pre-service teachers teaching in secondary education in The Netherlands, random subsamples of 809 students of 45 teachers and of 826 students of 46 teachers were used for analyses. Classical test analyses were used as a preliminary approach prior to utilizing Rasch modelling to the data. Additionally, multilevel analyses were used to examine the predictive validity of the measure on student academic engagement as an external criterion. Results revealed that a shortened and representative measure of teachers' behaviour meets the requirements of the Rasch model sufficiently. In addition, the predictive quality of the shortened measure was confirmed. Implications of findings for research and educational practices were discussed.

Career-long teacher learning is essential to the teaching profession because it is strongly connected with teacher quality and practices. Student teachers in the first stage of their career-long learning continuum, however, vary in the extent to which they participate in learning activities. This study explores the relationship between beliefs about learning and teaching and participation in learning activities among student teachers, in a school-based teacher education setting for secondary education in the Netherlands. The results indicate that student teachers vary in their beliefs. Structural equation modelling analysis shows that pupil-oriented beliefs are positively related to self-reported participation in learning activities; no relationship emerges between subject matter-oriented beliefs and learning. A cluster analysis reveals two distinct belief profiles, and the findings confirm the relationship to participation in learning activities. Implications for teacher education programmes intended to enhance the chances that their student teachers will become pupil-oriented, career-long learning professionals are discussed.

This study examined the (1) effects of a supportive program (i.e., induction arrangement) on beginning teachers' (BTs') psychological processes after a period of 1 year and (2) psychological paths of influence of the arrangement. Participants (56 Dutch secondary schools with 143 BTs) were randomly allocated to two conditions. Experimental schools provided a carefully developed and implemented induction arrangement to their BTs. Control schools followed their regular (induction) arrangements. BTs perceived stress causes, self-efficacy, and job strain were measured with a pre-test post-test design. Condition effects were examined by means of independent sample t tests. The perception of the provided support was measured, and its psychological path of influence was investigated by conducting standard multiple regression analyses. BTs in the experimental condition indicated that they (1) received more support, (2) experienced fewer stress causes (i.e., lack of learning opportunities and lack of regulating possibilities), and (3) experienced more self-efficacy in the classroom at the end of the school year. Furthermore, fewer BTs left the experimental schools after 1 year. Reducing BTs' workload and supporting their professional development are the most influential induction arrangement elements provided in this study. Providing carefully developed and implemented induction arrangements may soften the harshness of the context in which BTs operate, by decreasing their perceived stress causes and increasing their level of self-efficacy in the classroom. This, in turn, could positively affect BTs' decision to stay in the teaching profession and might, therefore, add to a solution to the teacher shortage problem.

As algorithms play an increasingly important role in public organizations, we see a rise in the number of public sector data scientists. Even though the relevance and risks of algorithms in the public sector are broadly discussed, our current academic knowledge of public sector data scientists and their work is limited. To develop an understanding of their work practices, data scientists have been studied in two Dutch government organizations. In a core period of 5 months per organization, I conducted in-depth qualitative research into the work of the data scientists, their role in the organization, and their relationship with other actors at two regulatory agencies in the Netherlands. The analysis shows that data scientists integrate Silicon Valley and engineering, domain, as well as political–administrative logics in their work practices. Thus, the work of the data scientists is hybrid. However, even though the organizational contexts are very similar, hybrid work takes very different forms both across organizations and over time. This dynamic hybridity is linked to different algorithmization processes and outcomes in the two organizations. The results suggest that hybridity in public sector data scientists' work should be adapted to organizational and technological aspects of transformation processes and aspired outcomes. [ABSTRACT FROM AUTHOR]

Induction arrangements are implemented in schools all over the world to support beginning teachers (BTs) (novices) in gradually growing into their profession. The aim of this study is to gain more insight into two key psychological processes involved in the work of a qualified beginning teacher, namely perceived stress and self-efficacy. This unfolding is necessary to find a path of influence to lead the way to meaningful support interventions. Support in the form of induction arrangements is hypothesised to decrease perceived stress and to increase self-efficacy and, thus, decrease stress outcomes. To test our hypotheses 30 BTs and their school-based educators, working in 13 different schools, were surveyed. The analyses revealed that stress causes and stress outcomes are indeed interrelated and that self-efficacy affects this relationship in a mediating way. However, besides decreasing a beginning teachers' perceived lack of learning opportunities, no other influences of induction arrangements were obtained. Implications and suggestions for future research are discussed. (Contains 1 figure and 9 tables.)

This study shows that professional identity should not be viewed as a composed variable with a uniform structure. Based on the literature and previous research, we view teachers' job satisfaction, self-efficacy, occupational commitment and change in the level of motivation as indicators of teachers' professional identity. Using two-step cluster analysis, three distinct professional identity profiles have empirically been identified, based on data of 1214 teachers working in secondary education in the Netherlands. These profiles differed significantly regarding the indicators of teachers' professional identity. Teachers belonging to the found profiles did not significantly differ in their amount of experience. (Contains 5 tables and 1 figure.)

Administered two intelligence batteries and a computer-assisted elementary cognitive test battery to 474 second-generation migrant and 747 majority-group students, aged 6 to 12 years, in the Netherlands. Findings suggest that performance differences between these groups are better predicted by a cultural complexity ("c") factor than by cognitive "g." (SLD)

Granting credit involves certain risks and thus financial institutions try to minimize them using various methods. The aim of this article is to develop a method of selecting borrowers' characteristics for credit risk assessment. The article uses non-genetic algorithms (such as CFS, ReliefF or Lasso), that perform calculations for all features, with only financial institutions granting the loan selecting the significant features to be assessed. The Holland and NSGA II genetic algorithms also begin with all features and gradually reduce their number in the consequent iterations without compromising the accuracy of feature selection. Only the GAAM genetic algorithm gives the lender the ability to choose the number of features entered into the calculations. During the operation, this algorithm increases the accuracy of feature selection by reducing their number. This significantly shortens the time to analyse loan application while maintaining acceptable accuracy, which results in making the right decision quickly. The features selected by the algorithms are additionally classified by the LDA classifier to demonstrate the correct selection of features by a given algorithm compared to the benchmark, which is the actual percentage of credits granted and then repaid. [ABSTRACT FROM AUTHOR]

The need to transform mental health care toward person-centered, recovery-based, and network-oriented care is recognized worldwide. Open Dialogue (OD) is seen as a hopeful approach in the context of this transformation and is introduced in countries around the globe. Five Dutch mental health care organizations spread over the Netherlands introduced the Peer-supported Open Dialogue (POD) approach, which adds an explicit role of peer-support workers to the OD approach. It appeared that (P) OD-trained professionals face issues in introducing the (P)OD approach in existing MHC settings. One of the reasons, which is the focus of this study, may be that they encounter difficulties in explaining to non-(P)OD-trained professionals what (P)OD entails. The main objective of this study is to provide guidance to and contribute to making (P)OD better understandable for non- (P)OD-trained professionals. In this study, we used a qualitative design and conducted 23 semi-structured interviews with POD-trained professionals with various backgrounds, to cultivate a rich understanding of which aspects could contribute to a better understanding of POD for non-POD-trained professionals. We used a hybrid approach to analyze the data, meaning that the technique of both inductive and deductive thematic analyses has been applied. From these analyses, six aspects emerged that could give guidance to and contribute to making (P)OD more understandable for non-(P)ODtrained professionals: (1) Experiencing (P)OD by attending treatment network sessions, (2) a coherent and profound narrative about (P)OD, (3) adjusting terminology to better fit the context, such as the two terms "principles" and "responsibility" in this study, (4) the order in which (P)OD elements are introduced in the narrative, (5) bringing the elements "presence," "reflecting," and "expertise by experience" more to the foreground, and (6) conceptualizing the main elements in a "talking paper." A better understanding of (P)OD might be one of the building blocks for improving (P)OD adoption in existing MHC practices, which are on their way toward person-centered, recovery-based, and network-oriented care. [ABSTRACT FROM AUTHOR]

Objectives: It is currently thought that most-but not all-individuals infected with SARS-CoV-2 develop symptoms, but the infectious period starts on average 2 days before the first overt symptoms appear. It is estimated that pre- and asymptomatic individuals are responsible for more than half of all transmissions. By detecting infected individuals before they have overt symptoms, wearable devices could potentially and significantly reduce the proportion of transmissions by pre-symptomatic individuals. Using laboratory-confirmed SARS-CoV-2 infections (detected via serology tests [to determine if there are antibodies against the SARS-CoV-2 in the blood] or SARS-CoV-2 infection tests such as polymerase chain reaction [PCR] or antigen tests) as the gold standard, we will determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the following two algorithms to detect first time SARS-CoV-2 infection including early or asymptomatic infection: • The algorithm using Ava bracelet data when coupled with self-reported Daily Symptom Diary data (Wearable + Symptom Data Algo; experimental condition) • The algorithm using self-reported Daily Symptom Diary data alone (Symptom Only Algo; control condition) In addition, we will determine which of the two algorithms has superior performance characteristics for detecting SARS-CoV-2 infection including early or asymptomatic infection as confirmed by SARS-CoV-2 virus testing.Trial Design: The trial is a randomized, single-blinded, two-period, two-sequence crossover trial. The study will start with an initial learning phase (maximum of 3 months), followed by period 1 (3 months) and period 2 (3 months). Subjects entering the study at the end of the recruitment period may directly start with period 1 and will not be part of the learning phase. Each subject will undergo the experimental condition (the Wearable + Symptom Data Algo) in either period 1 or period 2 and the control condition (Symptom Only Algo) in the other period. The order will be randomly assigned, resulting in subjects being allocated 1:1 to either sequence 1 (experimental condition first) or sequence 2 (control condition first). Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence.Participants: The trial will be conducted in the Netherlands. A target of 20,000 subjects will be enrolled. Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence. This results in approximately 6500 normal-risk individuals and 3500 high-risk individuals per sequence. Subjects will be recruited from previously studied cohorts as well as via public campaigns and social media. All data for this study will be collected remotely through the Ava COVID-RED app, the Ava bracelet, surveys in the COVID-RED web portal and self-sampling serology and PCR kits. More information on the study can be found in www.covid-red.eu . During recruitment, subjects will be invited to visit the COVID-RED web portal. After successfully completing the enrolment questionnaire, meeting eligibility criteria and indicating interest in joining the study, subjects will receive the subject information sheet and informed consent form. Subjects can enrol in COVID-RED if they comply with the following inclusion and exclusion criteria: Inclusion criteria: • Resident of the Netherlands • At least 18 years old • Informed consent provided (electronic) • Willing to adhere to the study procedures described in the protocol • Must have a smartphone that runs at least Android 8.0 or iOS 13.0 operating systems and is active for the duration of the study (in the case of a change of mobile number, the study team should be notified) • Be able to read, understand and write Dutch Exclusion criteria: • Previous positive SARS-CoV-2 test result (confirmed either through PCR/antigen or antibody tests; self-reported) • Current suspected (e.g. waiting for test result) COVID-19 infection or symptoms of a COVID-19 infection (self-reported) • Participating in any other COVID-19 clinical drug, vaccine or medical device trial (self-reported) • Electronic implanted device (such as a pacemaker; self-reported) • Pregnant at the time of informed consent (self-reported) • Suffering from cholinergic urticaria (per the Ava bracelet's user manual; self-reported) • Staff involved in the management or conduct of this study INTERVENTION AND COMPARATOR: All subjects will be instructed to complete the Daily Symptom Diary in the Ava COVID-RED app daily, wear their Ava bracelet each night and synchronize it with the app each day for the entire period of study participation. Provided with wearable sensor and/or self-reported symptom data within the last 24 h, the Ava COVID-RED app's underlying algorithms will provide subjects with a real-time indicator of their overall health and well-being. Subjects will see one of three messages, notifying them that no seeming deviations in symptoms and/or physiological parameters have been detected; some changes in symptoms and/or physiological parameters have been detected and they should self-isolate; or alerting them that deviations in their symptoms and/or physiological parameters could be suggestive of a potential COVID-19 infection and to seek additional testing. We will assess the intraperson performance of the algorithms in the experimental condition (Wearable + Symptom Data Algo) and control conditions (Symptom Only Algo). Note that both algorithms will also instruct to seek testing when any SARS-CoV-2 symptoms are reported in line with those defined by the Dutch national institute for public health and the environment 'Rijksinstituut voor Volksgezondheid en Milieu' (RIVM) guidelines.Main Outcomes: The trial will evaluate the use and performance of the Ava COVID-RED app and Ava bracelet, which uses sensors to measure breathing rate, pulse rate, skin temperature and heart rate variability for the purpose of early and asymptomatic detection and monitoring of SARS-CoV-2 in general and high-risk populations. Using laboratory-confirmed SARS-CoV-2 infections (detected via serology tests, PCR tests and/or antigen tests) as the gold standard, we will determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the following two algorithms to detect first-time SARS-CoV-2 infection including early or asymptomatic infection: the algorithm using Ava bracelet data when coupled with the self-reported Daily Symptom Diary data and the algorithm using self-reported Daily Symptom Diary data alone. In addition, we will determine which of the two algorithms has superior performance characteristics for detecting SARS-CoV-2 infection including early or asymptomatic infection as confirmed by SARS-CoV-2 virus testing. The protocol contains an additional twenty secondary and exploratory objectives which address, among others, infection incidence rates, health resource utilization, symptoms reported by SARS-CoV-2-infected participants and the rate of breakthrough and asymptomatic SARS-CoV-2 infections among individuals vaccinated against COVID-19. PCR or antigen testing will occur when the subject receives a notification from the algorithm to seek additional testing. Subjects will be advised to get tested via the national testing programme and report the testing result in the Ava COVID-RED app and a survey. If they cannot obtain a test via the national testing programme, they will receive a nasal swab self-sampling kit at home, and the sample will be tested by PCR in a trial-affiliated laboratory. In addition, all subjects will be asked to take a capillary blood sample at home at baseline (between month 0 and 3.5 months after the start of subject recruitment), at the end of the learning phase (month 3; note that this sampling moment is skipped if a subject entered the study at the end of the recruitment period), period 1 (month 6) and period 2 (month 9). These samples will be used for SARS-CoV-2-specific antibody testing in a trial-affiliated laboratory, differentiating between antibodies resulting from a natural infection and antibodies resulting from COVID-19 vaccination (as vaccination will gradually be rolled out during the trial period). Baseline samples will only be analysed if the sample collected at the end of the learning phase is positive, or if the subject entered the study at the end of the recruitment period, and samples collected at the end of period 1 will only be analysed if the sample collected at the end of period 2 is positive. When subjects obtain a positive PCR/antigen or serology test result during the study, they will continue to be in the study but will be moved into a so-called COVID-positive mode in the Ava COVID-RED app. This means that they will no longer receive recommendations from the algorithms but can still contribute and track symptom and bracelet data. The primary analysis of the main objective will be executed using the data collected in period 2 (months 6 through 9). Within this period, serology tests (before and after period 2) and PCR/antigen tests (taken based on recommendations by the algorithms) will be used to determine if a subject was infected with SARS-CoV-2 or not. Within this same time period, it will be determined if the algorithms gave any recommendations for testing. The agreement between these quantities will be used to evaluate the performance of the algorithms and how these compare between the study conditions.Randomization: All eligible subjects will be randomized using a stratified block randomization approach with an allocation ratio of 1:1 to one of two sequences (experimental condition followed by control condition or control condition followed by experimental condition). Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence, resulting in approximately equal numbers of high-risk and normal-risk individuals between the sequences.Blinding (masking): In this study, subjects will be blinded to the study condition and randomization sequence. Relevant study staff and the device manufacturer will be aware of the assigned sequence. The subject will wear the Ava bracelet and complete the Daily Symptom Diary in the Ava COVID-RED app for the full duration of the study, and they will not know if the feedback they receive about their potential infection status will only be based on the data they entered in the Daily Symptom Diary within the Ava COVID-RED app or based on both the data from the Daily Symptom Diary and the Ava bracelet.Numbers To Be Randomized (sample Size): A total of 20,000 subjects will be recruited and randomized 1:1 to either sequence 1 (experimental condition followed by control condition) or sequence 2 (control condition followed by experimental condition), taking into account their risk level. This results in approximately 6500 normal-risk and 3500 high-risk individuals per sequence.Trial Status: Protocol version: 3.0, dated May 3, 2021. Start of recruitment: February 19, 2021. End of recruitment: June 3, 2021. End of follow-up (estimated): November 2021 TRIAL REGISTRATION: The Netherlands Trial Register on the 18th of February, 2021 with number NL9320 ( https://www.trialregister.nl/trial/9320 ) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol. [ABSTRACT FROM AUTHOR]

In hearing research, pupillometry is an established method of studying listening effort. The focus of this study was to evaluate several pupil measures extracted from the Task-Evoked Pupil Responses (TEPRs) in speech-in-noise test. A range of analysis approaches was applied to extract these pupil measures, namely (a) pupil peak dilation (PPD); (b) mean pupil dilation (MPD); (c) index of pupillary activity; (d) growth curve analysis (GCA); and (e) principal component analysis (PCA). The effect of signal-to-noise ratio (SNR; Data Set A: –20 dB, –10 dB, +5 dB SNR) and luminance (Data Set B: 0.1 cd/m2, 360 cd/m2) on the TEPRs were investigated. Data Sets A and B were recorded during a speech-in-noise test and included TEPRs from 33 and 27 normal-hearing native Dutch speakers, respectively. The main results were as follows: (a) A significant effect of SNR was revealed for all pupil measures extracted in the time domain (PPD, MPD, GCA, PCA); (b) Two time series analysis approaches (GCA, PCA) provided modeled temporal profiles of TEPRs (GCA); and time windows spanning subtasks performed in a speech-in-noise test (PCA); and (c) All pupil measures revealed a significant effect of luminance. In conclusion, multiple pupil measures showed similar effects of SNR, suggesting that effort may be reflected in multiple aspects of TEPR. Moreover, a direct analysis of the pupil time course seems to provide a more holistic view of TEPRs, yet further research is needed to understand and interpret its measures. Further research is also required to find pupil measures less sensitive to changes in luminance. [ABSTRACT FROM AUTHOR]

Background: Treatment and rehabilitation protocol for hip arthroplasty differs between Germany and the Netherlands. The Dutch system promotes fast-track surgery whereas in Germany conventional care is provided with a longer hospital stay including rehabilitation. Clinical outcome, patient satisfaction and costs in both treatment protocols were compared in a prospective setup. Material and methods: This prospective cohort study included patients allocated for primary THA in 3 German and 1 Dutch hospital in the border region. Patient-reported outcome scores (PROMS) were measured pre- and postoperatively at 6 and 12 months including the Oxford Hip Score, SF12 survey, visual analogue scale for satisfaction and pain. Length of hospitalisation and availability of postoperative rehabilitation were recorded. In addition, a total cost estimation was calculated using health insurers data. Results: A total of 360 consecutive patients were included; 175 THA in Germany compared to 185 THA in the Netherlands. No cross-border healthcare was encountered in both cohorts. Mean length of hospitalisation was 11.3 (range 6–23) days in Germany, compared to 4.4 (range 3–25) days in the Netherlands. In Germany 92% of the patients was discharged with inpatient (72%) or outpatient (20%) rehabilitation, compared to 21% with only inpatient rehabilitation in the Netherlands. No significant differences were measured regarding the PROMS and patient satisfaction between both countries. Due to profound differences in health care financing only a global cost estimation could be made and no major differences were encountered. Conclusion: Germany and the Netherlands both offer highly protocolled care for THA with comparable functional outcome and patient satisfaction with treatment after 12 months. Despite the length of hospitalisation in Germany is significantly longer including a more intensive rehabilitation programme, no significant differences were recorded regarding functional outcome nor patient satisfaction compared to fast-track surgery performed in the Netherlands. [ABSTRACT FROM AUTHOR]

Research shows that effective teaching behavior is important for students' learning and outcomes, and scholars have developed various instruments for measuring effective teaching behavior domains. Although student assessments are frequently used for evaluating teaching behavior, they are mainly in Likert-scale or categorical forms, which precludes students from freely expressing their perceptions of teaching. Drawing on an open-ended questionnaire from large-scale student surveys, this study uses a machine learning tool aiming to extract teaching behavior topics from large-scale students' open-ended answers and to test the convergent validity of the outcomes by comparing them with theory-driven manual coding outcomes based on expert judgments. We applied a latent Dirichlet allocation (LDA) topic modeling analysis, together with a visualization tool (LDAvis), to qualitative data collected from 173,858 secondary education students in the Netherlands. This data-driven machine learning analysis yielded eight topics of teaching behavior domains: Clear explanation, Student-centered supportive learning climate, Lesson variety, Likable characteristics of the teacher, Evoking interest, Monitoring understanding, Inclusiveness and equity, Lesson objectives and formative assessment. In addition, we subjected 864 randomly selected student responses from the same dataset to manual coding, and performed theory-driven content analysis, which resulted in nine teaching behavior domains and 19 sub-domains. Results suggest that the relation between machine learning and human analysis is complementary. By comparing the bottom-up (machine learning analysis) and top-down (content analysis), we found that the proposed topic modeling approach reveals unique domains of teaching behavior, and confirmed the validity of the topic modeling outcomes evident from the overlapping topics. • LDA topic modeling and LDAvis are used to analyze students' open-ended answers. • Machine-based analyses extracted eight data-driven topics. • Machine-based bottom-up analysis is compared with top-down content analysis. • LDA topic modeling to analyze big data of student answers is easy and practical. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore how actors in the offshore wind farm decommissioning supply chain collaborate to manage collective uncertainties—external supply chain uncertainties shared among several supply chain actors. Semi-structured expert interviews with ten companies active in five different segments of the decommissioning supply chain in the Netherlands, Germany, and Belgium are conducted. Businesses currently utilize collaborative communication, information sharing, and joint knowledge creation to mitigate the adverse effects of collective uncertainties. However, collaboration is severely impeded by the presence of barriers such as intellectual property or the lack of resources. Nevertheless, opportunities to lower these hurdles and improve collaboration across the supply chain exist. This study contributes to the literature on collective uncertainties and supply chain collaboration in offshore wind decommissioning. Additionally, this paper provides practitioner-oriented insights to leverage supply chain collaboration in dealing with the decommissioning challenge. • Identifies collective uncertainties in the offshore wind farm decommissioning chain. • High uncertainty impedes decommissioning planning and preparation. • Several collaboration practices help in managing uncertainty. • Barriers to supply chain collaboration exist. • Finds a need for regulation and that uncertainty trickles down the supply chain. [ABSTRACT FROM AUTHOR]

A number of pension schemes in the Netherlands are considering reducing members' accrued rights and benefits. This article argues that the incorporation into Dutch domestic law of a strict interpretation of the European Directive has something to do with that. The article looks at whether the best intentions of the legislation have therefore contributed to an unexpected outcome, and considers whether this might spell the demise of compulsory participation in Dutch pension schemes. [ABSTRACT FROM AUTHOR]

On June 19th. 1999 the joint ministers of education of the EU countries issued a statement which has become known as the Bologna Declaration. Although the declaration itself was only one and a half page long, its impact on the educational landscape of Europe is generally seen as enormous, because it contained a blue-print for one unified EU-wide educational system based on "the Anglo-Saxon model". So with some justification, the Bologna Treaty has been presented as the beginning of a new phase in the history of European integration. In this article I argue, however, that this picture of a "brand new start" in Bologna is completely misleading as far as the Netherlands are concerned. The continuities in Dutch educational policies before and after the Bologna Declaration are far more striking than its discontinuities. In the first part of the article I go into the Bologna Declaration and its accompanying policy statements, like the Paris and the Lisbon Declarations. I argue that the economic definitions of higher education in these EU-policy statements are basically the same as the definitions followed by the (neo-liberal) World Trade Organsation (WTO) and the General Agreement of Trade and Tariffs (GATT) - and GATS - the General Agreement of Trade in Services - in particular. I also argue that this line of policy basically endangers democratic control over higher education. In the second part of this article I go into the anticipation of the neo-liberal conception of higher education in the Netherlands. Beginning in the early 1980's successive Dutch governments had already embarked on a policy course, in which higher education was basically seen and handled primarily in economic terms and was seen in its function for the 'knowledge economy'. This conception can be traced to socalled 'New Public Management' policy. I analyze these continuities concentrating on: 1. the representation of (higher) education as a 'product' like any other; 2. the representation of educational institutions as "enterprises" like any other, fundamentally obeying to the economies of scale; 3. the transformation of all notions of academic "quality" into quantifiable "output" indicators; and 4. the central importance of managerial control mechanisms. The aricle agues that the general relevance of the 'Dutch model' for other EU-countries lies in the fact that the the Dutch case broadly foreshadows what will happen to other EU-countries when Bologna polices will be put into practice. [ABSTRACT FROM AUTHOR]

The inheritance of extreme resistance to PVY ( Ry sto) by a single dominant locus was confirmed by obtaining a 1:1 segregation ratio in a virus inoculation test with 28 resistant ( Ryry) to 29 susceptible ( ryry) anther culture-derived dihaploid lines (2 n=2 x=24) from cv. “Assia” (2 n=4 x=48) having extreme resistance derived from Solanum stoloniferum in simplex constitution ( Ryryryry). Twelve Ry sto markers selected in AFLP assays using bulked segregant analysis were applied to 106 tested potato cultivars from Germany, The Netherlands and Poland and 19 potato cultivars were identified by these markers as extremely resistant to PVY in alignment with phenotypic data. The locus for extreme resistance ( Ry sto) to PVY was mapped on chromosome XII co-segregating with the SSR marker STM0003. The utility of anther-culture derived dihaploid potatoes for genetic marker development was demonstrated. Marker transferability from diploids to tetraploids provides an optimistic potential for marker-assisted selection in potato breeding programs. [ABSTRACT FROM AUTHOR]

Acculturative strategies and cognitive acculturation were studied among 118 Dutch migrant children (age: 7-12 years). Both an exploratory factor analysis and a Linear Logistic Test Model analysis provided evidence for the bipolar unidimensionality of Berry's four acculturation strategies; integration constituted one pole and assimilation, separation, and marginalization the other. Integration was by far the most popular strategy. Cognitive performance was measured by the Snijders-Oomen Nonverbal Intelligence Test, school report measures, and a computer-assisted choice reaction-time measure. A good fit was found for a structural model that postulated cognitive acculturation as the latent variable linking background measures (i.e. acculturation strategy, second language usage, age, and gender) to the cognitive measures. Relationships between background variables and cognitive performance were stronger in the first than in the second generation. Both older children and children who favour an integration strategy showed a higher degree of cognitive acculturation. Cette etude analyse les strategies d'acculturation et l'acculturation cognitive chez 118 enfants immigrants neerlandais (age: 7-12 ans). Une analyse factorielle exploratoire et une analyse par le Linear Logistic Test Model appuient l'unidimensionnalite bipolaire des quatre strategies d'acculturation proposees par Berry; l'integration constitue l'un des poles tandis que l'assimilation, la separation et la marginalisation constituent l'autre pole. L'integration represente la strategie qui est de loin la plus populaire. La performance cognitive est mesuree par le test d'intelligence non verbale Snijders-Oomen, par des mesures de performance scolaire et par une mesure de temps de choix dans une tache assistee par ordinateur. Les donnees correspondent bien a un modele structural selon lequel l'acculturation cognitive serait la variable latente reliant les mesures de base (i.e. strategie d'acculturation, utilisation d'une langue seconde, age et sexe) et les mesures cognitives. Les relations entre les variables de base et la performance cognitive sont plus fortes chez le premiere que chez la deuxieme generation d'immigrants. Les enfants plus ages et les enfants qui favorisent une strategie d'integration montrent un plus fort degre d'acculturation cognitive. [ABSTRACT FROM AUTHOR]

Simple Summary: To define a healthy animal in an experimental setting or to differentiate and backup a diagnosis in cattle practice, reference intervals (RIs) in haematology diagnostics are necessary. The RIs in calves for blood cell counts, such as platelets and white blood cells, differ from RIs in adult cattle and are not widely studied. Blood results from dairy calves in the Netherlands were used to study the variation in platelet counts in young calves and to calculate an RI for platelet and white blood cell counts. In new-born calves up to six days of age, platelet counts were lower than in calves older than five days. From six days of age until 60 days of age we propose an RI platelet count of 287–1372 × 109/L and for the first 60 days of life an RI for leukocyte count of 4.0–18.9 × 109/L. Platelet and leukocyte count reference intervals (RIs) for cattle differ by age and while adult RIs are known, RIs for calves are studied less. The aims of this observational study are to evaluate variation of platelet counts of Holstein Friesian calves over the first 14 days of life and to propose RIs for platelet and leukocyte counts of Holstein Friesian calves aged 0–60 days. In a longitudinal study, 19 calves were blood sampled 17 times, in the first 14 days of their lives. Blood was collected in a citrate blood tube and platelet counts were determined. We assessed the course of platelet counts. In a field study, 457 healthy calves were blood sampled once. Blood was collected in an EDTA blood tube and platelet and leukocyte counts were determined. The RIs were calculated by the 2.5 and 97.5 percentiles. Platelet counts started to increase 24 h after birth (mean platelet count 381 × 109/L ± 138 × 109/L) and stabilized after five days (mean platelet count 642 × 109/L ± 265 × 109/L). In calves up to six days of age, platelet counts were lower than in calves older than five days. In conclusion, the RIs of platelet and leukocyte counts in calves were wider in range than the RIs for adult cattle, therefore, calf specific RIs for platelet and leukocyte counts should be used. From 6 until 60 days of age, we propose an RI for platelet counts of 287–1372 × 109/L and for the first 60 days of life an RI for leukocyte counts of 4.0–18.9 × 109/L. [ABSTRACT FROM AUTHOR]

Water tables are strictly controlled throughout much of the Netherlands. Higher water tables could permit the restoration of wetland ecosystems. Deriving benefits from this requires the spatial matching of physical planning, eco-hydrological processes, and economic activities. This paper reports on a study combining spatial analysis and disciplinary integration to assess management strategies for the Vecht river basin in the Netherlands. The paper addresses two research questions. How can the information generated by spatial models be condensed into performance indicators for the evaluation of strategies? How can spatial information be retained in the evaluation, and does this lead to different rankings and/or insights? Procedures for the construction of performance indicators for three criteria ? net present value, environmental quality and spatial equity ? are presented. The evaluation concludes that recreation and higher water tables provide a means for restoration, recouping of costs, and stimulating regional incomes. Maintenance of spatial detail led to different insights, and in particular indicated uncertainty about this conclusion. [ABSTRACT FROM AUTHOR]

This ex post facto prospective study investigated whether symptoms of posttraumatic stress disorder (PTSD) are associated with increased physical health problems, while controlling for base-rates of symptoms and individual differences in neuroticism. Dutch army soldiers completed standardized questionnaires before they were deployed to Iraq (n = 479), and about 5 months (n = 382; 80%) and 15 months (n = 331; 69%) after their return home. PTSD-symptoms were evaluated by questionnaires and clinical interviews. The results showed that, on average, participants with PTSD at 5 months reported increased physical problems after deployment. PTSD-symptoms at 5 months predicted coexisting physical symptoms, after controlling for demographic variables, military factors, injury sustained on deployment, war-zone exposure on deployment, baseline physical problems, baseline PTSD-symptoms, and neuroticism. PTSD-symptoms at 5 months also predicted physical problems at 15 months, while controlling for physical symptoms at 5 months. The results suggest that posttraumatic stress contributes to physical symptoms. Clinicians are advised to be attentive to PTSD when individuals present with physical symptoms, and to pay attention to physical symptoms in patients diagnosed with PTSD. [ABSTRACT FROM AUTHOR]

Microplastics are both pervasive in the marine environment and highly detrimental to it. In this study, we investigate the abundance, distribution, and characteristics of microplastics in surface waters on a transect spanning 6 major ocean current regions in the Atlantic Ocean from Scheveningen (the Netherlands) to Montevideo (Uruguay). 50 surface trawls were completed with a manta net (mesh 500 μm, cod 333 μm) and particles were analyzed in the laboratory including polymer type identification with ATR-FTIR spectroscopy. An overall abundance of 0.011 ± 0.017 items/m 3 was found with a significant correlation between microplastic abundance and distance to coast. The dominant polymer types were HD-PE (63.5 %) and PP (28.3 %), shape was fragments (88.6 %), and color was white (59.1 %). We conclude that this study's findings reaffirm the widespread presence of microplastic pollution in the Atlantic Ocean, contributing data from consistently under-sampled regions such as the South Atlantic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands., Aims: To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations., Methods: A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response., Results: Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95% CI 0.66-1.03], and OR = 1.5 [95% CI 0.92-2.45]), respectively., Linking Evidence to Action: Two large RCTs demonstrated that a preventive nurse-led care program can preserve daily functioning in the oldest-old population. Older people with few comorbidities and higher self-rated health had a higher likelihood of a positive outcome. Unraveling the characteristics associated with a successful response provides important information for further refining and targeting an intervention to obtain maximum effectiveness. More effort is needed to modify interventions for the oldest-old with multiple morbidities and low levels of education., (© 2017 Sigma Theta Tau International.)

Aims: The reported rate of stent thrombosis (ST) after drug-eluting stent (DES) implantation varies among registries. To investigate differences in baseline characteristics and clinical outcome in European and Japanese all-comers registries, we performed a pooled analysis of patient-level data., Methods and Results: The j-Cypher registry (JC) is a multicentre observational study conducted in Japan, including 12,824 patients undergoing SES implantation. From the Bern-Rotterdam registry (BR) enrolled at two academic hospitals in Switzerland and the Netherlands, 3,823 patients with SES were included in the current analysis. Patients in BR were younger, more frequently smokers and presented more frequently with ST-elevation myocardial infarction (MI). Conversely, JC patients more frequently had diabetes and hypertension. At five years, the definite ST rate was significantly lower in JC than BR (JC 1.6% vs. BR 3.3%, p<0.001), while the unadjusted mortality tended to be lower in BR than in JC (BR 13.2% vs. JC 14.4%, log-rank p=0.052). After adjustment, the j-Cypher registry was associated with a significantly lower risk of all-cause mortality (HR 0.56, 95% CI: 0.49-0.64) as well as definite stent thrombosis (HR 0.46, 95% CI: 0.35-0.61)., Conclusions: The baseline characteristics of the two large registries were different. After statistical adjustment, JC was associated with lower mortality and ST.

Aims: Newer-generation everolimus-eluting stents (EES) have been shown to improve clinical outcomes compared with early-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in patients undergoing percutaneous coronary intervention (PCI). Whether this benefit is maintained among patients with saphenous vein graft (SVG) disease remains controversial., Methods and Results: We assessed cumulative incidence rates (CIR) per 100 patient years after inverse probability of treatment weighting to compare clinical outcomes. The pre-specified primary endpoint was the composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR). Out of 12,339 consecutively treated patients, 288 patients (5.7%) underwent PCI of at least one SVG lesion with EES (n=127), SES (n=103) or PES (n=58). Up to four years, CIR of the primary endpoint were 58.7 for EES, 45.2 for SES and 45.6 for PES with similar adjusted risks between groups (EES vs. SES; HR 0.94, 95% CI: 0.55-1.60, EES vs. PES; HR 1.07, 95% CI: 0.60-1.91). Adjusted risks showed no significant differences between stent types for cardiac death, MI and TVR., Conclusions: Among patients undergoing PCI for SVG lesions, newer-generation EES have similar safety and efficacy to early-generation SES and PES during long-term follow-up to four years.

Objective: Somatoform disorders (SDs) are characterized by chronic multiple functional somatic (FS) symptoms. It has been suggested that infections may be triggers for FS symptoms to occur, pointing to the immune system as a pathogenic factor in their development. The current study aimed to compare the prevalence of infections (i.e., infection load) in the history of patients with SDs with that of matched controls., Methods: Samples (n = 185) were identified in the Psychiatric Case Register Middle Netherlands and the Julius General Practitioners Network. Patients with an SD diagnosis in the Psychiatric Case Register Middle Netherlands were compared with matched persons without somatoform complaints (controls) on their infection load in two periods before the date of the psychiatric diagnosis or a matched date for the controls (i.e., the total period for which data were available and a 3-year period). Infection load was defined as the total number of infections documented in the Julius General Practitioners Network., Results: Patients with SD had significantly more infections than did controls in both periods (total period: mean [standard error] = 0.87 [0.10] versus 0.51 [0.06], z = -3.08, p = .002; 3-year period: 3.44 [0.47] versus 2.15 [0.50], z = -2.91, p = .004)., Conclusions: Results show that patients with SD have a higher infection load preceding their diagnosis as compared with matched controls, implicating that infection load may indeed predispose for developing FS symptoms. These findings emphasize the importance of further research on immunological mechanisms in FS symptoms. Limitations of the study are discussed.

Fatigue is a common complaint among adolescents. We investigated the course of fatigue in females during the transition from adolescence to young adulthood and examined psychological, immunological, and life style risk factors for development of fatigue and chronic fatigue syndrome (CFS)-related symptoms. Six hundred and thirty-three healthy females (age 14.63±1.37 years) filled out questionnaires measuring fatigue severity, depressive symptoms, anxiety, chronic fatigue syndrome (CFS)-related symptoms, sleep features, and life style characteristics at baseline and 4½ years thereafter. Of 64 participants LPS- and CD2CD28-induced cytokine data at baseline were available. The best predictor of fatigue in young adulthood was previous fatigue severity. In participants who were non-fatigued during adolescence and who experienced a notable increase in fatigue, fatigue development was preceded by emotional problems and CFS-related complaints during adolescence. Increases as well as decreases in fatigue severity were accompanied by respectively increase and decrease in depressive symptoms and anxiety, suggesting that these symptoms cluster and co-vary over time. Higher interferon (IFN)-γ, higher IFN-γ/interleukin (IL)-4 ratio, lower tumor necrosis factor-α and lower IL-10 at baseline were related to fatigue severity at follow up. The rise in total number of CFS-related symptoms at follow up was predicted by anxiety and decreased physical activity during adolescence. Sleep and substance use were associated with fatigue severity and anxiety and depression. In conclusion, vulnerability to develop fatigue and associated symptoms in young adulthood can to a certain extent be identified already years before the manifestation of complaints., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome of patients treated by percutaneous coronary intervention (PCI) using drug-eluting stents. Patients were stratified according to BMI as normal (<25 kg/m(2)), overweight (25 to 30 kg/m(2)), or obese (>30 kg/m(2)). At 5-year follow-up all-cause death, myocardial infarction, clinically justified target vessel revascularization (TVR), and definite stent thrombosis were assessed. A complete dataset was available in 7,427 patients, of which 45%, 22%, and 33% were classified according to BMI as overweight, obese, and normal, respectively. Mean age of patients was significantly older in those with a normal BMI (p <0.05). Incidence of diabetes mellitus, hypertension, and dyslipidemia increased as BMI increased (p <0.05). Significantly higher rates of TVR (15.3% vs 12.8%, p = 0.02) and early stent thrombosis (1.5% vs 0.9%, p = 0.04) were observed in the obese compared to the normal BMI group. No significant difference among the 3 BMI groups was observed for the composite of death/myocardial infarction/TVR or for definite stent thrombosis at 5 years, whereas the normal BMI group was at higher risk for all-cause death at 5 years (obese vs normal BMI, hazard ratio 0.74, confidence interval 0.53 to 0.99, p = 0.05; overweight vs normal BMI, hazard ratio 0.73, confidence interval 0.59 to 0.94, p = 0.01) in the multivariate Cox proportional hazard model. Age resulted in a linearly dependent covariate with BMI in the all-cause 5-year mortality multivariate model (p = 0.001). In conclusion, the "obesity paradox" observed in 5-year all-cause mortality could be explained by the higher rate of elderly patients in the normal BMI group and the existence of colinearity between BMI and age. However, obese patients had a higher rate of TVR and early stent thrombosis and a higher rate of other risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to investigate the stability of fatigue in adolescents and to explore whether psychological, somatic, and lifestyle factors are involved in the onset and persistence of fatigue during adolescence., Methods: In this longitudinal study, a total of 653 adolescent girls (aged 14.40 +/- 1.45 years) who previously participated in an epidemiological study filled out questionnaires 6 (T2) and 12 (T3) months after the initial assessment (T1). Fatigue severity, depression, anxiety, and chronic fatigue syndrome-related symptoms were assessed. We determined the prevalence of severely fatigued cases at T2 and T3 and evaluated whether persistently fatigued participants initially differed from nonfatigued participants and participants with transient fatigue. We examined which factors predicted the development of new-onset fatigue and investigated whether changes in fatigue covaried with changes in other complaints and changes in lifestyle., Results: Of all participants who were severely fatigued at T1, 25.7% were persistently fatigued throughout the study. Persistently fatigued participants had higher levels of depression and anxiety at the beginning of the study, were less physically active, and slept shorter. New-onset fatigue was predicted by depression, less physical activity, and more nightlife activities. Interestingly, new onset was not predicted by initial levels of fatigue. Persistently fatigued participants did not differ in initial fatigue severity from short-term fatigued patients. A decrease in fatigue severity was associated with a decrease in depression, anxiety, and chronic fatigue syndrome-related symptoms and, to a lesser extent, with an increase in physical activity and sleep duration., Conclusions: The stability of severe fatigue among adolescents is substantial. The involvement in the onset and persistence of fatigue suggests that both preventive and therapeutic strategies with respect to fatigue treatment in adolescents should concentrate on emotional well-being. Moreover, adolescents at risk should be stimulated to spend more time on physical activities and to sleep longer.

Objectives: The current study examined the extent to which symptom improvement and full return to work occurs among clinically burnt-out employees and what the influence of concurring sleep problems is with respect to health recovery., Methods: Fifty-nine burnt-out employees on extended sick leave assessed their symptoms for 2 weeks using an electronic diary. After 6 months, the measurements were repeated. Symptom levels were compared with those of a healthy reference group that was assessed only once., Results: After 6 months, all burnout symptoms had decreased significantly, and full return to work was achieved by 37% of the burnt-out individuals. The symptom levels at 6 months of follow-up among those who had fully returned to work were similar to healthy levels and significantly lower than the levels of those still on sick leave. The persons who benefited poorly from sleep at baseline had higher exhaustion levels at follow-up than those who benefited from sleep. Trouble falling asleep and less refreshing sleep at baseline hampered eventual full work resumption., Conclusions: The results show that a significant number of clinically burnt-out employees is able to recover in a 6-month period and that sleep plays an important role both in symptom improvement and in return to work.

Burnout is generally defined as a state of severe exhaustion. So far, research has predominantly focused on relatively mild burnout in employees able to work despite their complaints. This study examines energy depletion in clinical burnout (e.g., the severest cases on extended sick leave) by comparing the diurnal patterns of fatigue and exhaustion with those of healthy individuals. Sixty clinically burned-out and 40 healthy participants kept an electronic diary for 14 days, 7 times a day, yielding a total of 8,116 diary entries. This study shows that burned-out individuals typically suffer continuously from a severe fatigue throughout the day. The resulting flattened diurnal cycles mark a stable exhaustion that is uncommon in healthy persons. The current results provide novel support for the existence of severe energy erosion in clinical burnout.