Excellence in higher education: educational preferences of honours students in the Netherlands

This paper researches excellence in higher education by looking into honours programmes (HPs) in Dutch higher education. HPs are selective and aimed at the brightest students, offering them a more challenging – often extra-curricular – study experience. Based on a survey (n=259) at Dutch universities, our study identifies three types of honours students: task-committed, above-average ability, and creative. We asked each group how their ideal HP looks like. Task-committed students are interested in disciplinary HPs that have a student-centred approach. The above-average ability students demand a highly selective and small-scale HP that admits only the brightest students. Moreover, they prefer a HP that is isolated from regular study programmes. Creative students are interested in a variety of disciplinary subjects, not offered in regular curricula, often requiring substantial amounts of extra time and effort. The differences in preferred configurations of HPs have policy implications for universities interested in introducing excellence educatio

Facilitating practice-led co-innovation for the improvement in animal welfare

Using the egg-laying-hen sector as a case study, the European Union-funded ‘Hennovation’ thematic network has been testing mechanisms to enable practice-led innovation through the establishment of 19 innovation networks of farmers and within the laying-hen processing industry, supported by existing science and market-driven actors. These networks were facilitated to proactively search for, share and use new ideas to improve hen welfare, efficiency and sustainability. This article provides insights into the tools used, including a framework for the facilitation of practice-led collaborative innovation processes. This framework was developed through participatory action research to monitor network performance and self-reflection by facilitators. Practice-led innovation processes are network specific and evolve as the actors within the network come together to share common problems, experiment with possible solutions and learn. The participatory and iterative nature of this process leads to uncertainty in process and end results. This raises methodological challenges in the management of such processes and requires a flexible and adaptive management approach focusing on learning and reflection. </jats:p

Cost-Effectiveness and Cost Utility of Treatment of Attention-Deficit/Hyperactivity Disorder:A Systematic Review

Objectives: This systematic review provides an overview of full economic evaluations of attention-deficit/hyperactivity disorder (ADHD) treatments, evaluates their outcomes, and highlights gaps in the literature. Data Sources: Electronic databases were searched for full economic evaluations of ADHD treatments for children, adolescents, or adults published in English or Dutch. Results: Twenty-nine studies met the inclusion criteria. Almost all studies that compared medication or psychosocial treatment to no treatment, placebo, or care as usual indicated that medication and psychosocial treatment were cost-effective compared to the control group. Stimulant treatment appeared to be cost-effective for the treatment of ADHD in children and adolescents. Only few studies focus on treatments in adults and psychosocial treatments and the number of studies with long time horizons and without industry funding is limited. Conclusions: Despite the rising interest in cost-effectiveness, this systematic review shows that more cost-effectiveness research of higher quality is warranted to aid in the optimal use of available treatments and resources for individuals with ADHD. Specifically, more studies should focus on treatments in adults and psychosocial treatments, and more studies with long time horizons and without industry funding are warranted. Nevertheless, we can conclude that treating ADHD is generally cost-effective compared to no treatment

Improving automatic delineation for head and neck organs at risk by Deep Learning Contouring

INTRODUCTION: Adequate head and neck (HN) organ-at-risk (OAR) delineation is crucial for HN radiotherapy and for investigating the relationships between radiation dose to OARs and radiation-induced side effects. The automatic contouring algorithms that are currently in clinical use, such as atlas-based contouring (ABAS), leave room for improvement. The aim of this study was to use a comprehensive evaluation methodology to investigate the performance of HN OAR auto-contouring when using deep learning contouring (DLC), compared to ABAS. METHODS: The DLC neural network was trained on 589 HN cancer patients. DLC was compared to ABAS by providing each method with an independent validation cohort of 104 patients, which had also been manually contoured. For each of the 22 OAR contours - glandular, upper digestive tract and central nervous system (CNS)-related structures - the dice similarity coefficient (DICE), and absolute mean and max dose differences (|Δmean-dose| and |Δmax-dose|) performance measures were obtained. For a subset of 7 OARs, an evaluation of contouring time, inter-observer variation and subjective judgement was performed. RESULTS: DLC resulted in equal or significantly improved quantitative performance measures in 19 out of 22 OARs, compared to the ABAS (DICE/|Δmean dose|/|Δmax dose|: 0.59/4.2/4.1 Gy (ABAS); 0.74/1.1/0.8 Gy (DLC)). The improvements were mainly for the glandular and upper digestive tract OARs. DLC significantly reduced the delineation time for the inexperienced observer. The subjective evaluation showed that DLC contours were more often preferable to the ABAS contours overall, were considered to be more precise, and more often confused with manual contours. Manual contours still outperformed both DLC and ABAS; however, DLC results were within or bordering the inter-observer variability for the manual edited contours in this cohort. CONCLUSION: The DLC, trained on a large HN cancer patient cohort, outperformed the ABAS for the majority of HN OARs

A participatory, farmer-led approach to changing practices around antimicrobial use on UK farms

Farmer-led, participatory approaches are being increasingly employed in agricultural research with promising results. This study aimed to understand how a participatory approach based on the Danish Stable Schools could help to achieve practical, farmer-led changes that reduced reliance on antimicrobials in the UK. Five facilitated Farmer Action Groups comprising 30 dairy farms across South West England met on farm at regular intervals between 2016 – 2018 and worked collaboratively within their groups to discuss how to reduce antimicrobial use. Qualitative data from group discussions and individual semi-structured interviews were collected and analysed using thematic analysis to explore how the approach helped farmers address and deal with changes to their on-farm practices. Facilitator-guided reviews of antimicrobial use and benchmarking were carried out on each farm to assess any change in usage and help farmers review their practices. The pattern of antimicrobial use changed over the 2 years of the study with 21 participating farms reducing their use of highest priority critically important antibiotics (6 farms were not using any of these critical medicines from the outset). Thirty practical action plans were co-developed by the groups with an average implementation rate of 54.3% within a year. All assessed farms implemented 1 recommendation, and many were still ongoing at the end of the study. Farmers particularly valued the peer-to-peer learning during farm walks. Farmers reported how facilitated discussions and action planning as a peer group had empowered them to change practices. Participants identified knowledge gaps during the project, particularly on highest priority critically important antibiotics where they were not getting information from their veterinarians. The study demonstrated that facilitation has a valuable role to play in participatory approaches beyond moderating discussion; facilitators encouraged knowledge mobilization within the groups and were participants in the research as well. Facilitated, farmer-led, participatory approaches that mobilize different forms of knowledge and encourage peer learning are a promising way of helping farmers to adapt and develop responsible practices

Diagnostic yield of targeted next generation sequencing in 2002 Dutch cardiomyopathy patients

BACKGROUND: Next-generation sequencing (NGS) is increasingly used for clinical evaluation of cardiomyopathy patients as it allows for simultaneous screening of multiple cardiomyopathy-associated genes. Adding copy number variant (CNV) analysis of NGS data is not routine yet and may contribute to the diagnostic yield. OBJECTIVES: Determine the diagnostic yield of our targeted NGS gene panel in routine clinical diagnostics of Dutch cardiomyopathy patients and explore the impact of exon CNVs on diagnostic yield. METHODS: Patients (N = 2002) referred for clinical genetic analysis underwent diagnostic testing of 55-61 genes associated with cardiomyopathies. Samples were analyzed and evaluated for single nucleotide variants (SNVs), indels and CNVs. CNVs identified in the NGS data and suspected of being pathogenic based on type, size and location were confirmed by additional molecular tests. RESULTS: A (likely) pathogenic (L)P variant was detected in 22.7% of patients, including 3 with CNVs and 25 where a variant was identified in a gene currently not associated with the patient's cardiomyopathy subtype. Only 15 out of 2002 patients (0.8%) were found to carry two (L)P variants. CONCLUSION: The yield of routine clinical diagnostics of cardiomyopathies was relatively low when compared to literature. This is likely due to the fact that our study reports the outcome of patients in daily routine diagnostics, therefore also including patients not fully fulfilling (subtype specific) cardiomyopathy criteria. This may also explain why (L)P variants were identified in genes not associated with the reported subtype. The added value of CNV analysis was shown to be limited but not negligible

Construction of Transgenic Plasmodium berghei as a Model for Evaluation of Blood-Stage Vaccine Candidate of Plasmodium falciparum Chimeric Protein 2.9

BACKGROUND:The function of the 19 kDa C-terminal region of the merozoite surface protein 1 (MSP1-19) expressed by Plasmodium has been demonstrated to be conserved across distantly related Plasmodium species. The green fluorescent protein (GFP) is a reporter protein that has been widely used because it can be easily detected in living organisms by fluorescence microscopy and flow cytometry. METHODOLOGY AND RESULTS:In this study, we used gene targeting to generate transgenic P. berghei (Pb) parasites (designated as PfMSP1-19Pb) that express the MSP1-19 of P. falciparum (Pf) and the GFP reporter protein simultaneously. The replacement of the PbMSP1-19 locus by PfMSP1-19 was verified by PCR and Southern analysis. The expression of the chimeric PbfMSP-1 and the GFP was verified by Western blot and fluorescence microscopy, respectively. Moreover, GFP-expressing transgenic parasites in blood stages can be readily differentiated from other blood cells using flow cytometry. A comparison of growth rates between wild-type and the PfMSP1-19Pb transgenic parasite indicated that the replacement of the MSP1-19 region and the expression of the GFP protein were not deleterious to the transgenic parasites. We used this transgenic mouse parasite as a murine model to evaluate the protective efficacy in vivo of specific IgG elicited by a PfCP-2.9 malaria vaccine that contains the PfMSP1-19. The BALB/c mice passively transferred with purified rabbit IgG to the PfCP-2.9 survived a lethal challenge of the PfMSP1-19Pb transgenic murine parasites, but not the wild-type P. berghei whereas the control mice passively transferred with purified IgG obtained from adjuvant only-immunized rabbits were vulnerable to both transgenic and wild-type infections. CONCLUSIONS:We generated a transgenic P. berghei line that expresses PfMSP1-19 and the GFP reporter gene simultaneously. The availability of this parasite line provides a murine model to evaluate the protective efficacy in vivo of anti-MSP1-19 antibodies, including, potentially, those elicited by the PfCP-2.9 malaria vaccine in human volunteers

Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020:A fetuses-at-risk approach

OBJECTIVE: To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.DESIGN: Population-based, multi-country study.SETTING: National data systems in 15 high- and middle-income countries.POPULATION: Live births and stillbirths.METHODS: A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation.MAIN OUTCOME MEASURES: Gestation-specific stillbirth rates and risks according to size at birth.RESULTS: The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed.CONCLUSIONS: Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.</p