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In language classrooms, listening is considered a problematic skill for various reasons. The uncontrollable nature of speech's speed of delivery plays a major role in these issues. Tight teacher control over the audio input creates even more unfavorable conditions for listeners to sufficiently absorb input. This study explores the positive effects of self-regulating the audio on listening comprehension problems of foreign language (FL) listeners. Thirty Flemish secondary school English as a Foreign Language (EFL) learners in Belgium participated in a quasi-experimental design in which the control group (N = 16) worked in pairs and listened to the audio input twice, while the experiment group (N = 14), also working in pairs, had the option to regulate the audio input. Despite having a common listening proficiency level (A2), a qualitative analysis reveals that there are prominent differences in the significance and frequency of listening comprehension problems between pairs with and without the self-regulation option. By documenting the listening problems students experience and self-regulation's effect on them, the current study illustrates the possible benefits of more autonomy for listeners and suggests new insights into listening education from linguistic and pedagogical perspectives.

Recent studies in the field of language education policy (LEP) have emphasized the agency of educators in language policy implementation, which considerably influences the policy outcome. These studies, however, often focus on LEP measures for newcomers or ethnic minority students, and on the language used for instruction as the main LEP indicator. This study adopts an educational effectiveness framework in order to provide a more comprehensive view of the LEP measures that school teams deploy. By means of a multiple case study in six mainstream primary schools in Flanders (Belgium), it examines how language education policies are enacted in local school contexts. Focus group interviews were conducted with both teachers and school management teams. The results reveal conflicts between the official LEP and the interpretations of what LEP is and should be according to school team members, and between management team members and teachers within the same school. The rationale for the schools' enacted LEP, too, is built up from different argumentations that are not necessarily consistent with each other. The combination of these dynamics results in LEPs that either display none, one or -- in one case only -- both dimensions of what can be called an effective or strategic LEP. This study helps to understand how future policies can respond to local needs. By zooming in on local policy implementation, we were able to identify the difficulties that school teams struggle most with when implementing their LEPs.

This study reports on the development and validation of a video-based instrument to assess early childhood education (ECE) teachers’ professional vision (PV) of language-stimulation (LS) interactions. PV refers to noticing and reasoning about key classroom interactions, a skill that can be trained and distinguishes experts from novices. The instrument targets the PV of three language-stimulation (LS) strategies: language input (LI), opportunities for language production (OLP), and feedback (FB). The instrument measures noticing through comparative judgement (CJ) and reasoning through multiple-choice items. Construct validity was assessed using the AERA framework, using three samples: a sample of professionals (n = 22), a pre-service teachers’ sample (n = 107), and a mixed sample with in- and pre-service teachers (n = 6). Reliability and validity were confirmed, with strong reliability scores for the CJ aggregated “master” rank orders (SRR: 0.827–0.866). Think-aloud procedures demonstrated that respondents’ decisions during CJ were mainly based on LS-relevant video features. Decisions unrelated to LS require further study. Multiple-choice reasoning items were developed from professionals’ open-ended feedback. Pre-service teacher reasoning scores showed no significant predictors. Using real classroom videos, this instrument provides an ecologically valid, scalable tool for assessing teachers’ professional vision of LS interactions. This validated instrument offers a foundation for professional development programs aimed at addressing the theory–practice gap in early language education.

Transfer of in vitro-produced (IVP) equine embryos is associated with a higher incidence of monozygotic multiple pregnancies, but this remains a rarity. The outcome of monozygotic twin gestation is poor, and good management techniques are lacking. In addition, hydrops conditions are exceptional in horses, with hydroallantois occurring more frequently than hydramnion. Most hydrops conditions will lead to compromise or death of the foal and mare. A 6-year-old multiparous standardbred recipient mare, 332 days pregnant, diagnosed with a monozygotic twin and hydrops with a dead co-twin, gave birth with an assisted vaginal delivery. The dead foal, previously determined at 9 months by ultrasound, turned out to have the dimensions and hair corresponding to an 8-month-old foal. The other foal was born alive and considered healthy and normal-sized for its age. Both mare and foal were discharged from the clinic one week after parturition. This report is the first to describe the birth of a healthy foal born from a monozygotic twin pregnancy in the presence of hydrops, following transfer of a single IVP equine embryo. In addition, it is rare to find a non-macerated, non-mummified dead co-twin after fetal death at 8 months together with a healthy full-term foal.

It is vital to understand the listening problems students face in a foreign language (FL) classroom. In the current study, students were provided with options to identify these problems. Twenty-eight A1 level Turkish secondary school students worked in pairs and had autonomy to control the audio while listening. While dialogic exchanges illustrated articulated listening comprehension problems in a natural and observable way, self-control data enabled the researcher to observe how students chose to operate the input after encountering such difficulties. Students mostly experienced problems related to process, listener, affect, and input, followed by social- and task-related problems. The most frequent problems were mental translation, inability to chunk streams of speech and difficulty keeping pace with the delivery. In terms of self-controlling the input, students operated the audio mainly to check understanding and catch up with the speed of speech. With the help of these valuable data, the current study aims to highlight the possible benefits of peer interaction by portraying how students experienced and shared the mental, affective, and social processes involved in listening.

This study investigates the differential effects of a task-based inside-school intervention and an outside-school project intervention on the development of speaking skills of 56 beginner second language (L2)-learners. The study extends previous research by looking at development across multiple occasions instead of two (i.e., a pretest and posttest), and by assessing speaking development by means of a non-intrusive task eliciting an informal conversation, rather than a formal test. To measure students' development of Dutch speaking skills, syntactic complexity, lexical diversity, accuracy, fluency, and communicative effectiveness were assessed. Multilevel analyses revealed differential effects for both interventions. The task-based intervention inside school led to significant positive development of communicative effectiveness and syntactic complexity measured by length and subordination, but also to more breakdowns in fluency. The outside-school project intervention, however, did not result in any significant speaking development. The findings demonstrate the learning potential of a task-based inside-school intervention for developing various aspects of informal speaking skills, except for fluency. From a methodological perspective, this study illustrates the complexity of test and measure selection when assessing L2 speaking development.

Background Long-term use of antidepressant drugs (AD), much longer than recommended by guidelines, in nursing homes (NH) is common. NH home residents may have a relatively higher risk of adverse events. Moreover, in an NH setting nursing staff and relatives are intensively involved in the decision-making process. In many countries, General Practitioners’ (GPs) provide care for residents in NHs. Little is known about GPs’ perspectives on discontinuation of long-term AD in NH residents.Objectives To explore GPs’ views of discontinuing long-term AD in NH residents.Methods An exploratory qualitative study, with semi-structured interviews, was conducted with a purposive sample of 20 Belgian GPs. Interviews, conducted over six months in 2019, were analysed by thematic analysis.Results Twenty interviews were conducted until data saturation. The first theme, ‘reluctance to rock the boat: not worth taking the risk’, describes that GPs perceive discontinuation as an unpredictable risk without clear benefits. GPs’ main concern was the risk of destabilising the fragile balance in an older patient. Second, ‘it takes at least three to tango’, captures the unspoken alliance between GPs, nursing staff and relatives and suggests that agreement of at least these three partners is required. The third, ‘Opening the door: triggers to discontinue’, points to severe health problems and dementia as strong facilitators for discontinuation.Conclusion Discontinuation of long-term AD in NHs is a complex process for GPs. More evidence and attention to the role nursing staff and relatives play are needed to better guide the discontinuation of AD in older NH patients.

A remarkable and unexpected increase in the photopolymerization efficiency of an acrylic resin by a bisacylphosphine oxide photoinitiator was observed when an optical brightener was present in the medium. High values for the maximal rates of photopolymerization were obtained by RT‐FTIR at 365 nm under a very low irradiance of 1 mW/cm2. Fluorescence studies revealed that the quenching process occurs through singlet‐singlet energy transfer between the first singlet excited state of the optical brightener and the ground state photoinitiator. This mechanism acts as an additional pathway for the excitation of the photoinitiator, thereby increasing the total amount of initiating radicals. Using the Förster resonance energy transfer model, we calculated the relative efficiency of the photosensitization process with respect to the direct excitation efficiency of the photoinitiator. The results demonstrate that the photosensitization process can be predicted, paving the way for further improvements in photoinitiating systems. [ABSTRACT FROM AUTHOR]

Simple Summary: A 6-year-old multiparous standardbred recipient mare was presented at 9 months of gestation with a monozygotic twin foal with hydrops and a dead co-twin. Careful monitoring until 332 days of pregnancy resulted in the birth of one healthy, normal-sized foal accompanied with a non-macerated, non-mummified dead co-twin, diagnosed and corresponding to an 8-month-old fetus. This report outlines the clinical progression, treatment, positive outcome and prognosis of this compromised pregnancy. Transfer of in vitro-produced (IVP) equine embryos is associated with a higher incidence of monozygotic multiple pregnancies, but this remains a rarity. The outcome of monozygotic twin gestation is poor, and good management techniques are lacking. In addition, hydrops conditions are exceptional in horses, with hydroallantois occurring more frequently than hydramnion. Most hydrops conditions will lead to compromise or death of the foal and mare. A 6-year-old multiparous standardbred recipient mare, 332 days pregnant, diagnosed with a monozygotic twin and hydrops with a dead co-twin, gave birth with an assisted vaginal delivery. The dead foal, previously determined at 9 months by ultrasound, turned out to have the dimensions and hair corresponding to an 8-month-old foal. The other foal was born alive and considered healthy and normal-sized for its age. Both mare and foal were discharged from the clinic one week after parturition. This report is the first to describe the birth of a healthy foal born from a monozygotic twin pregnancy in the presence of hydrops, following transfer of a single IVP equine embryo. In addition, it is rare to find a non-macerated, non-mummified dead co-twin after fetal death at 8 months together with a healthy full-term foal. [ABSTRACT FROM AUTHOR]

School-based language policies (SLP) are expected to have a positive effect on student achievement. To date, few studies have empirically examined the impact of such policies on student outcomes. This study investigates to what extent SLPs are related to pupils' reading performance from an educational effectiveness perspective. In addition, the study investigates whether SLPs have differential effects for pupils at risk of underachievement. Data from a cross-sectional study involving 3,000 pupils in the first, third, and sixth grades of 28 elementary schools in Flanders, the northern Dutch-speaking part of Belgium, were analyzed using multivariate multilevel modeling. Results indicate that one SLP component, team reflective capacity for language instruction, positively affects students' decoding skills in reading. No differential effects for low- versus high-risk pupils were found.

Background: It is found that assigning students to a lower track during secondary education negatively affects their academic performance. As an explanation, it is often mentioned that an anti-school culture in lower tracks undermines students' effort and involvement. Aims: This study assessed whether going to a lower track affects student engagement. For if an anti-school culture is to blame for limiting lower track students' performance, lower track assignment should reduce engagement. Sample: A sample of a longitudinal cohort study during secondary education in Flanders (northern Belgium) was used to describe development in engagement with n = 5,417 students in 46 schools. Four tracks were investigated across four school years. Method: Two main methodological challenges were present in this study, different student intake in each track and many students changing from a higher to lower track over time. Accordingly, we used inverse probability treatment weights with marginal structural mean models to account for different student intake and track changes. A comparison was made per pair of tracks that are hierarchically consecutive by matching students who were comparable across these tracks. Accordingly, there were three pairwise comparisons. Results: It was never found that being continuously in lower track negatively affects engagement. Only for one pairwise comparison, there was evidence that students who changed from the higher to lower track had lower engagement. Conclusions: We rejected the hypothesis that lower tracks negatively affect student engagement. This makes the anti-school culture as an explanation for lower track assignment negatively affecting academic performance implausible.

Introduction Acute mechanical thrombectomy is the preferred treatment for large vessel occlusion related stroke. Histopathological research on the obtained occlusive embolic thrombus may provide information regarding the etiology and pathology of the lesion to predict prognosis and propose possible future acute ischemic stroke therapy. Methods A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion related stroke and underwent mechanical thrombectomy were included in the study. The obtained thrombus materials were subjected to standard histopathological examination. Based on histological criteria they were considered fresh (1 day old). Patients were followed for two years for documentation of all-cause mortality. Results Thrombi were classified as fresh in 40 patients (53%) and as older in 35 patients (47%). Univariate Cox regression analysis showed that thrombus age, National Institutes of Health Stroke Scale at hospital admission and patient age were associated with long-term mortality (p

Background Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Most antidepressants are prescribed by general practitioners (GPs) but it remains unclear why they do not discontinue long-term use. Aim To explore GPs’ views and experiences of discontinuing long-term antidepressants, barriers and facilitators of discontinuation and required support. Design and setting Qualitative study in Belgian GPs. Method 20 semi-structured face-to-face interviews with GPs. Interviews were analysed thematically. Results The first theme, ‘Success stories’ describes three strong motivators to discontinue antidepressants: patient health issues, patient requests and a new positive life event. Second, not all GPs consider long-term antidepressant use a ‘problem’ as they perceive antidepressants as effective and safe. GPs’ main concern is the risk of relapse. Third, GPs foresee that discontinuation of antidepressants is not an easy and straightforward process. GPs weigh up whether they have the necessary skills and whether it is worth the effort to start this process. Conclusion Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs, especially in the absence of a facilitating life-event or patient demand. The absence of a compelling need for discontinuation and fear of relapse of symptoms in a stable patient are important barriers for GPs when considering discontinuation. In order to increase GPs’ motivation to discontinue long-term antidepressants, more emphasis on the futility of the actual effect and on potential harms related to long-term use is needed.KEY POINTS Current awareness: Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Main statements: • Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs. • More emphasis on the futility of the actual effect of antidepressants and on potential harms related to long-term use is needed.

Governmental education policies provide vague, general confines in which local actors have to design concrete policies tailored to their needs. Such policies rely on the local capacities of schools for implementing them. Recently, qualitative studies reveal that a great deal of variation in policy enactment should be attributed to school contextual variables. This study adds to these findings by examining to what extent school contextual variables influence the implementation of one type of education policy in Flemish schools: school-based language policies (SLP). It combines quantitative survey data from 28 primary schools with focus group interviews in a subsample of six schools in order to verify whether and why the school context affects the implementation of SLP. Results confirm that school context does affect implementation. Particularly, the ethnic composition of the student population is one of the main motivations for school teams to implement an SLP, and this is often associated with a deficit perspective.

Percutaneous coronary interventions in saphenous vein grafts can pose a variety of challenges, such as severely calcified lesions. If these lesions are nondilatable, lithotripsy can arguably be a proper tool for lesion preparation. We present a case in which a nondilatable, calcified saphenous vein graft was successfully treated using Shockwave lithotripsy. (Level of Difficulty: Intermediate.)

Introduction Allergic asthma is a common but heterogeneous chronic inflammatory lung disease characterized by type 2 airway inflammation and bronchial hyperreactivity (1). Asthma patients experience symptoms such as wheezing, shortness [...], Allergic asthma is mediated by Th2 responses to inhaled allergens. Although previous experiments indicated that Notch signaling activates expression of the key Th2 transcription factor Gata3, it remains controversial how Notch promotes allergic airway inflammation. Here we show that T cell-specific Notch deficiency in mice prevented house dust mite-driven eosinophilic airway inflammation and significantly reduced Th2 cytokine production, serum IgE levels, and airway hyperreactivity. However, transgenic Gata3 overexpression in Notch-deficient T cells only partially rescued this phenotype. We found that Notch signaling was not required for T cell proliferation or Th2 polarization. Instead, Notch-deficient in vitro-polarized Th2 cells showed reduced accumulation in the lungs upon in vivo transfer and allergen challenge, as Notch-deficient Th2 cells were retained in the lung-draining lymph nodes. Transcriptome analyses and sequential adoptive transfer experiments revealed that while Notch-deficient lymph node Th2 cells established competence for lung migration, they failed to upregulate sphingosine-1-phosphate receptor 1 (S1PR1) and its critical upstream transcriptional activator Kruppel-like factor 2 (KLF2). As this KLF2/S1PR1 axis represents the essential cell-intrinsic regulator of T cell lymph node egress, we conclude that the druggable Notch signaling pathway licenses the Th2 response in allergic airway inflammation via promoting lymph node egress.

Background The COVID-19 pandemic is likely to influence psychological health of pregnant and postpartum women. Methods We conducted a non-concurrent cross-sectional study among 1145 women living in the Dutch-speaking part of Belgium, 541 pregnant and 604 postpartum women. We measured psychological health with the Whooley questions, Generalized Anxiety Disorder 2-item (GAD-2) and the Edinburgh Postnatal Depression Scale (EPDS) and compared the scores of pregnant and postpartum women before and during the COVID-19 pandemic. Results No differences were observed in the Whooley, GAD-2 or EPDS scores among pregnant women. The postpartum total GAD-2 scores before vs during the pandemic showed significant differences. Controlling for confounders, we observed a small main positive effect of having an infant during time of COVID-19 (F(1.13) = 5.06, p.025, d.27). The effect was significantly larger for women with (a history of) perinatal psychological problems (F(1.12) = 51.44, p < .001, d.82). Emotional support was significantly related to GAD-2 scores of postpartum women during the pandemic (F(1.90) = 35.54, p < .001). Postpartum women reported significant higher effects of the pandemic on their behavior compared to pregnant women (p.034). Conclusion The COVID-19 pandemic seems to have a positive effect on postpartum women during the first year postpartum, in particular for women with (a history of) perinatal psychological problems and for those women who experienced emotional support. The findings suggest that less external stimuli caused by lockdown restrictions might have a positive effect on postpartum women’s emotional wellbeing. The sample consisted of white, educated women in a relationship and information regarding the extent of exposure to adverse COVID-19 consequences was lacking. We relied on self-selection and self-report. The postpartum pandemic sample was small.

In a cell-based non-invasive prenatal test (cbNIPT), intact circulating trophoblasts (CTs) are isolated from maternal blood for subsequent genetic analysis. Enrichment of these CTs from maternal blood is the most challenging step in the cbNIPT workflow. This study aims to assess the suitability of the filtration-based Metacell® technology to enrich CTs from maternal blood at week 10 to 13 of gestation. The Metacell® technology is a novel size-based enrichment technology that combines blood filtration through 8 μm pores with an in vitro culture method. Three protocols were evaluated. First, 8 mL or 16 mL of maternal blood was filtered and subsequently cultured in vitro on the separation membrane for 3 days in RPMI 1640. In addition, 16 mL of maternal blood was filtered, and immediately processed without further culturing. Y-chromosome-specific qPCR or STR analysis was performed to evaluate the enrichment of CTs. A total of 44 samples from pregnant women, out of which 26 were carrying a male fetus, were processed. Although five enriched male fetus samples show detectable male DNA quantities, it cannot be excluded that the obtained positive signal is caused by cell-free fetal DNA sticking to the Metacell® separation membrane. In conclusion, the Metacell® technology, tested as described, is not suitable for consistent enrichment of CTs.

Objective. In TAVR, area sizing is used for balloon-expandable (BE) valves, whereas self-expanding valves are sized to annulus perimeter. For BE valves, this seems illogical: these frames force a circular shape even on an ellipsoid annulus. This can potentially lead to relative undersizing when area sizing is being applied. We developed a perimeter-based sizing algorithm to evaluate the safety and feasibility of perimeter sizing for the Myval BE valve. Methods. In this prospective single-center study, 60 patients with severe aortic stenosis treated with the Myval BE valve were included. Perimeter sizing was used with limited oversizing of 3.7% ± 1.3% compared to the annulus perimeter. After TAVR, clinical outcomes were evaluated at 30 days and 1 year. An echocardiographic follow-up took place at 30 days. Results. At 30 days, the need for PPI and stroke occurred in 2% and 3% of the patients, respectively. Moreover, cardiac death and moderate-severe PVL were absent. At 1-year, cardiac death and stroke were observed in 3% and 8% of the patients, respectively. In 33.3% of the patients, a larger valve size was implanted compared to the valve size calculated by area sizing. Conclusions. Perimeter sizing with the Myval BE valve leads to substantial use of larger valve sizes and favorable clinical outcomes, with low PPI and the absence of significant PVL. A randomized controlled trial is being planned to prove the superiority of this alternative sizing method.

University entrance language tests are often administered under the assumption that even if language proficiency does not determine academic success, a certain proficiency level is still required. Nevertheless, little research has focused on how well L2 students cope with the linguistic demands of their studies in the first months after passing an entrance test. Even fewer studies have taken a longitudinal perspective. Set in Flanders, Belgium, this study examines the opinions and experiences of 24 university staff members and 31 international L2 students, of whom 20 were tracked longitudinally. Attention is also given to test/retest results, academic score sheets, and class recordings. To investigate the validity of inferences made on the basis of L2 students' scores, Kane's (2013) Interpretation/Use Argument approach is adopted, and principles from political philosophy are applied to investigate whether a policy that discriminates among students based on language test results can be considered just. It is concluded that the receptive language requirements of university studies exceed the expected B2 level and that the Flemish entrance tests include language tasks that are of little importance for first-year students. Furthermore, some of the students who failed the entrance test actually managed quite well in their studies -- a result that entails broad implications concerning validation and justice even outside the study's localized setting.