VMBO: Tevredenheid en aansluiting met vervolgonderwijs

Jaarlijks ontvangen ongeveer 100.000 jongeren een VMBO-diploma. Daarmee kanhet VMBO-diploma als een eerste belangrijke mijlpaal in het Nederlandse onderwijsstelselgezien worden. Het VMBO dient dan ook een stevige basis te biedenaan jongeren in hun verdere onderwijsloopbaan. Het voorliggende rapport VMBO:Tevredenheid en aansluiting met vervolgonderwijs, dat in het kader van het 10-jarigjubileum van het VMBO aangeboden wordt, laat de gediplomeerden van het VMBOaan het woord komen.labour market entry and occupational careers;

High expression of ZNF703 independent of amplification indicates worse prognosis in patients with luminal B breast cancer

Peer reviewe

Kartlegging av fysisk aktivitet i to bedrifter

Innledning Utviklingen fra andre verdenskrig og frem til i dag viser en mer stillesittende hverdag. Arbeidsoppgaver som tidligere bestod av mye kroppslig arbeid, er i dag erstattet med maskiner som gjør at arbeidshverdagen blir mindre fysisk krevende. I tillegg har kommunikasjonsverktøy som smarttelefoner og Internett gjort det enklere å drive kommunikasjon, som medfører mer stillesitting på jobb og hjemme og i hverdagen generelt. Metode Kontorister (n=9) og elektrikere (n=5) utgjorde yrkesgruppene som ble testet. Registrering av fysisk aktivitet gikk over tre sammenhengende dager med ni timers arbeidsdag. Det ble brukt aktivitetsmålere (Actigraph GT3X-BT) for å kartlegge aktivitetsnivået, gitt i skritt, energi, intensitet og MET. Forskjellen i fysisk aktivitet (skritt, energi, intensitet og PAL) ble testet ved bruk av en tosidig uavhengig t-test. Signifikansnivået er satt til p<0,05. Resultat Begge bedriftene gjennomførte med 100% tilstedeværelse. Kontoristenes gjennomsnittlige telling av skritt var 10.958, og 14.402 for elektrikerne. Når det gjelder forskjellen i skritt, så vises det ingen signifikant forskjell mellom bedriftene. Prosenten av totaltiden i de forskjellige intensitetssonene hos kontoristene og elektrikerne var henholdsvis 75% mot 59% i hvile, 22% mot 37% i lett og 3% mot 4% i MVPA. I to av de tre intensitetssonene (hvile og lett) er det en forskjell mellom bedriftene, mens i den tredje sonen (MVPA) er det ingen signifikant forskjell. Bedriftene forbrukte henholdsvis 815 mot 852 kcal. Ved oppsummering i PAL-verdier over testperioden viser resultatene ingen signifikant forskjell angående fysisk aktivitetsnivå Konklusjon Basert på hovedfunnene (skritt, intensitet, energi og PAL) er det ingen signifikant forskjell mellom bedriftene i noen av kategoriene for aktivtetsnivå

Disentangling the potential effects of four non-indigenous species on commercially and recreationally used fish stocks in the Baltic Sea-a review

Non-indigenous species (NIS) are on a rise globally. They can pose strong impacts on ecosystems in their non-native range and can therefore be a serious threat to biodiversity. Here, we compile the existing information available regarding the extent to which commercially and recreationally used fish stocks (exploited fish species) are affected by NIS. To do so, we conducted a literature review to summarize the known and presumed impacts of four case study NIS with already known strong effects on the Baltic Sea ecosystem: round goby, Neogobius melanostomus, sea walnut, Mnemiopsis leidyi, mud crab, Rhithropanopeus harrisii, and fishhook water flea, Cercopagis pengoi. We found that round goby, mud crab and fishhook water flea are documented to serve as a new food source for native fish species, while sea walnut and fishhook water flea are supposedly affecting planktivorous fish through resource competition. Round goby is very likely a strong competitor for the benthivore fish community. There are also indications that it feeds on juvenile fish and fish eggs. Generally, our results show that large knowledge gaps exist, while the published impacts on exploited fish species are often solely based on correlations (e.g. decreasing abundances of native species with cooccurring increasing abundances of NIS), regionally restricted studies or expert judgements. In addition, many studies are older and the current population size of the NIS, which is obviously associated with their impact, is unknown. Thus, the majority of described impacts of NIS on commercially and recreationally used fish stocks seems to stem from assumptions. Therefore, more field observations and experimental studies are needed to be able to scientifically evaluate the impact of NIS. Nevertheless, in this review, the available information was summarized, even if they are speculative, and specific knowledge gaps were identified. Moreover, we outline further investigations that are needed to advance our mechanistic understanding of the interactions between NIS and exploited fish species in the Baltic Sea. This knowledge is essential for the sustainable management of aquatic resources and management of NIS of the Baltic Sea

Using stakeholders' experiences to redesign health services for persons living with heart failure: A case study protocol in a Swedish cardiac care setting

Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Introduction: Clinical guidelines promote recognising persons with heart failure (referred to as PWHF) as coproducers of their own care. Coproduction of healthcare—involving PWHF, families and professionals in care processes—aims to promote the best possible health. Still, it is unclear how to coproduce heart failure (HF) care. This study explores whether and how Experience-Based Co-Design (EBCD) involving PWHF, family members and professionals can be undertaken online, in a Swedish cardiac care setting, to codesign improved experiences of HF care. Methods and analysis: In EBCD, stakeholders’ experiences are solicited to redesign healthcare services. First, we will undertake a thematic analysis of field notes from consultations and filmed/audio-recorded interviews with PWHF (n=10–12). This analysis will identify ‘touchpoints’ (emotionally positive/negative events that shape overall service experiences), edited into a ‘trigger film’. Next, a thematic analysis of family members’ (n=10– 12) and professionals’ (n=10–12) interviews will identify key themes mirroring their experiences. Separate feedback events with each stakeholder group will confirm identified touchpoints and key themes and identify areas for HF care improvement. At a joint event, prompted by the ‘trigger film’, stakeholders will agree on one area for HF care improvement. A team including PWHF, family members and professionals, led by an improvement adviser, will then plan, design, implement and evaluate an improvement activity addressing the identified problem area. A deductive thematic analysis of field notes, project documentation and stakeholder focus group interviews, underpinned by MUSIQ, will identify how organisational conditions influence the process. Quantitative measurements, describing the results of the improvement activity, will be integrated with qualitative data to strengthen the case. To reduce resource intensity, we will use online tools during the process. Ethics and dissemination: The Swedish Ethical Review Authority approved the study in May 2021. The results will be disseminated through seminars, conference presentations and publications.publishedVersio

Improving health for people living with heart failure: Focus group study of preconditions for co-production of health and care

Background: Co-production of health and care involving patients, families of patients, and professionals in care processes can create joint learning about how to meet patients’ needs. Although barriers and facilitators to co-production have been examined previously in various health care contexts, the preconditions in Swedish chronic cardiac care contexts are yet to be explored. This study is set in the health system of the Swedish region of Jönköping County and is part of system-wide efforts to promote better health for persons with heart failure (HF). Objective: The objective of this study was to test the usefulness of the Capability, Opportunity, and Motivation Behavior (COM-B) model when assessing the barriers to and facilitators of co-production of health and care perceived by patients with HF, family members of patients with HF, and professionals in a Swedish chronic cardiac care context as a guide for subsequent initiatives. Methods: Data collection involved 1 focus group interview (FGI) with patients with HF (n=5), 1 FGI with family members of patients with HF (n=5), 1 FGI with professionals in primary care (n=7), and 1 FGI with professionals in cardiac care (n=4). In addition, patients with HF kept diaries of their thoughts regarding co-production. Using a deductive approach to content analysis, underpinned by the COM-B model, barriers and facilitators were categorized into capabilities, opportunities, and motivations to co-produce health and care. Results: The participants showed limited understanding of co-production as a practice. They appeared to view it as a privilege to be offered to patients on top of traditional care and rarely as an approach for improving health care processes. The interviews revealed the limited health literacy among patients and the struggle of professionals to convey health information to these patients. Co-production was considered to be more resource-intensive than traditional care. Different expectations of stakeholders’ roles were revealed: professionals expected older patients not to want to co-produce health and care, and all participants expected professionals to be in charge of health care services. The family members’ position involved trying to balance their desire to support their relatives with understanding when, how, and with whom to co-produce. Presumed benefits motivated stakeholders: co-production was recognized to motivate patients to improve self-care. However, the participants recognized that motivation to get involved in health and care decisions varies over time among stakeholders. Conclusions: Co-production can be facilitated by the stakeholders’ motivation. However, varying levels of understanding of co-production, patients’ limited health literacy, unease with power sharing between patients and professionals, and resource constraints are barriers that need to be managed to promote co-produced care and better health for persons living with HF. Further research is warranted to explore how to co-produce health care services with patients with HF and how leaders can facilitate the inevitable cultural change it requires and represents.publishedVersio

An array of highly flexible electrodes with a tailored configuration locked by gelatin during implantation-initial evaluation in cortex cerebri of awake rats.

A major challenge in the field of neural interfaces is to overcome the problem of poor stability of neuronal recordings, which impedes long-term studies of individual neurons in the brain. Conceivably, unstable recordings reflect relative movements between electrode and tissue. To address this challenge, we have developed a new ultra-flexible electrode array and evaluated its performance in awake non-restrained animals

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden

<p>Abstract</p> <p>Background</p> <p>There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.</p> <p>Methods</p> <p>We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.</p> <p>Results</p> <p>Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.</p> <p>Conclusions</p> <p>Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).</p

MicroRNAs in Differentiation of Embryoid Bodies and the Teratoma Subtype of Testicular Cancer

Background: Testicular germ cell tumours (TGCTs) are the most frequent tumour type among young, adult men. TGCTs can be efficiently treated, but metastases of the teratoma subtype, for which there are no circulating biomarkers, represent a challenge. Materials and Methods: Global microRNA expression in teratoma tissue and embryoid bodies was assessed using next-generation sequencing. Levels of microRNAs identified as potential biomarkers were obtained from serum of patients with teratoma and matched healthy men. Results: We identified miR-222-5p, miR-200a-5p, miR-196b-3p and miR-454-5p as biomarker candidates from the tumour tissue and embryoid body screening but the expression of these microRNAs was very low in serum and not statistically different between patients and controls. miR-375-3p was highly expressed, being highest in patients with teratoma (p=0.012) but the levels of expression in serum from these patients and healthy controls overlapped. miR-371a-3p was not expressed in serum from patients with pure teratoma, only in patients with mixed tumours. Conclusion: The microRNA profiles of the teratoma subtype of TGCT and embryoid bodies were obtained and assessed for candidate circulating biomarkers, but none with high sensitivity and specificity for teratoma were identified in our study. We conclude that neither the proposed teratoma marker miR-375-3p nor miR-371a-3p are suitable as circulating teratoma markers.publishedVersio