Teachers’ motives for learning in networks:costs, rewards and community interest

Background: This paper discusses teachers’ perspectives on learning networks and their motives for participating in these networks. Although it is widely held that teachers’ learning may be developed through learning networks, not all teachers participate in such networks. Purpose: The theme of reciprocity, central to studies in the area of learning in networks, is often approached from a rational exchange perspective. This study attempts to extend this approach with reference to the concept of symbolic interactionism. The study was guided by the following research question: What is the relationship between teachers’ perceptions of learning networks and their motives for participation or non-participation in these networks? Design and methods: In order to address this research question, semi-structured interviews among 25 teachers in secondary education in the Netherlands were carried out. The semi-structured interviews consisted of three parts: background information, perspectives on learning networks and personal experiences with those networks. Data were analysed qualitatively and analyses consisted of within-case analysis, and cross-case analysis of interview fragments. Three themes were considered: (1) perspectives on learning networks, (2) motives for participation perceived as rational exchange, (3) motives for participation perceived as related to social order. Findings: The findings are presented around these three themes. Each theme is discussed in relation to relevant aspects from the literature. Findings indicated that teachers perceived learning networks to be organised both within-school and outside school, and mostly focused around specific content knowledge. Reasons for participation or non-participation were related to rational costs and rewards (such as time, technology, self-efficacy); in symbolic motives (such as joy, sharing and mutual understanding), and also in a sense of meaning that resulted from networking activities. Conclusions: We conclude that, in addition to social exchange motives, the data suggest that symbolic aspects of communication and interaction play an important role in considerations for participation in learning networks. This may be described in terms of four ‘types’ of networking teachers: the Community focused networking teacher, the Locally focused networking teacher, the Not-yet-networking teacher, and the Non-networking teacher. It is hoped that these exploratory findings could be helpful in supporting the development of learning networks for all teachers.</p

Parents' perceptions of secondary school students' motivation and well-being before and during the COVID-19 lockdown: The moderating role of student characteristics

During the COVID-19 lockdown of spring 2020, Dutch children were being homeschooled. We examined how parents’ (n = 470) perceptions of secondary school students’ (Mage = 14.23 years) need satisfaction, academic motivation and well-being differed before the lockdown (assessed retrospectively) and during the lockdown. Furthermore, we examined the differential impact of the lockdown for different groups of children based on parental educational level, academic track, gender and special educational needs (SEN). Results indicated that students’ motivation and well-being as perceived by parents decreased during the lockdown and this could be explained by decreases in need satisfaction. Most student characteristics did not moderate the effects of the lockdown, except for SEN. The lockdown effects were less negative for children with SEN, especially gifted children and children with behavioural disabilities, than for children without SEN. Results are discussed with regard to their practical implications after the lockdown and for future lockdowns

Development of a clinical prediction model for an international normalised ratio ≥ 4·5 in hospitalised patients using vitamin K antagonists

Vitamin K antagonists (VKAs) used for the prevention and treatment of thromboembolic disease, increase the risk of bleeding complications. We developed and validated a model to predict the risk of an international normalised ratio (INR) ≥ 4·5 during a hospital stay. Adult patients admitted to a tertiary hospital and treated with VKAs between 2006 and 2010 were analysed. Bleeding risk was operationalised as an INR value ≥4·5. Multivariable logistic regression analysis was used to assess the association between potential predictors and an INR ≥ 4·5 and validated in an independent cohort of patients from the same hospital between 2011 and 2014. We identified 8996 admissions of patients treated with VKAs, of which 1507 (17%) involved an INR ≥ 4·5. The final model included the following predictors: gender, age, concomitant medication and several biochemical parameters. Temporal validation showed a c statistic of 0·71. We developed and validated a clinical prediction model for an INR ≥ 4·5 in VKA-treated patients admitted to our hospital. The model includes factors that are collected during routine care and are extractable from electronic patient records, enabling easy use of this model to predict an increased bleeding risk in clinical practice

Antithrombotic stewardship: A multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation

_Introduction:_ Antithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation. _Methods and analysis:_ In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective. _Ethics and dissemination:_ This protocol was approved by the Medical Ethical Committee of the Erasmus University Medical Center. The findings of the study will be disseminated through peer-reviewed journals and presented at relevant conferences

The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines

Background: Anticoagulant therapy is associated with a high risk of complications. Adherence to anticoagulant therapy protocols may lower this risk but adherence is often suboptimal. The introduction of a multidisciplinary antithrombotic team may improve adherence to anticoagulant guidelines among physicians. Objective: To determine the efect of hospital-based multidisciplinary antithrombotic stewardship on adherence to anticoagulant guidelines among prescribing physicians. Setting This prospective non-randomised before-and-after study was conducted in patients hospitalized between October 2015 and December 2017 and treated with anticoagulant therapy. Method: A multidisciplinary antithrombotic team focusing on education, medication reviews, drafting of local anticoagulant therapy protocols, patient counseling and medication reconciliation at admission and discharge was implemented in two Dutch hospitals. Main outcome measure Primary outcome was the proportion of the admitted patients in which the prescribing physician did adhere to the anticoagulant guidelines. Results: The study comprised 1886 patients, of which 941 patients were included in the usual care period and 945 patients in the intervention period. Multivariable logistic regression analysis indicated that adherence was observed signifcantly more often during the intervention period (adjusted odds ratio [ORadj] 1.58, 95% confdence interval [95% CI] 1.21–2.05). Detailed analysis identifed that the signifcantly higher overall adherence in the intervention period was attributed to dosing of LMWHs (odds ratio [OR] 1.58, 95% CI 1.16–2.14). Conclusion: This study shows that introduction of a multidisciplinary antithrombotic stewardship leads to a signifcantly higher overall adherence to anticoagulant guidelines among prescribing physicians, mainly based on the improvement of dosing of low-molecular-weight-heparins

A study on prevalence and determinants of ototoxicity during treatment of childhood cancer (SOUND): protocol for a prospective study

Background: Some children with central nervous system (CNS) and solid tumors are at risk to develop ototoxicity during treatment. Up to now, several risk factors have been identified that may contribute to ototoxicity, such as platinum derivates, cranial irradiation, and brain surgery. Comedication, like antibiotics and diuretics, is known to enhance ototoxicity, but their independent influence has not been investigated in childhood cancer patients. Recommendations for hearing loss screening are missing or vary highly across treatment protocols. Additionally, adherence to existing screening guidelines is not always optimal. Currently, knowledge is lacking on the prevalence of ototoxicity. Objective: The aim of the Study on Prevalence and Determinants of Ototoxicity During Treatment of Childhood Cancer (SOUND) is to determine the feasibility of audiological testing and to determine the prevalence and determinants of ototoxicity during treatment for childhood cancer in a national cohort of patients with solid and CNS tumors.Methods: The SOUND study is a prospective cohort study in the national childhood cancer center in the Netherlands. The study aims to include all children aged 0 to 19 years with a newly diagnosed CNS or solid tumor. Part of these patients will get audiological examination as part of their standard of care (stratum 1). Patients in which audiological examination is not the standard of care will be invited for inclusion in stratum 2. Age-dependent audiological assessments will be pursued before the start of treatment and within 3 months after the end of treatment. Apart from hearing loss, we will investigate the feasibility to screen patients for tinnitus and vertigo prevalence after cancer treatment. This study will also determine the independent contribution of antibiotics and diuretics on ototoxicity. Results: This study was approved by the Medical Research Ethics Committee Utrecht (Identifier 20-417/M). Currently, we are in the process of recruitment for this study. Conclusions: The SOUND study will raise awareness about the presence of ototoxicity during the treatment of children with CNS or solid tumors. It will give insight into the prevalence and independent clinical and cotreatment-related determinants of ototoxicity. This is important for the identification of future high-risk patients. Thereby, the study will provide a basis for the selection of patients who will benefit from innovative otoprotective intervention trials during childhood cancer treatment that are currently being prepared.Analysis and Stochastic

Differences in collagen prolyl 4-hydroxylase assembly between two Caenorhabditis nematode species despite high amino acid sequence identity of the enzyme subunits

The collagen prolyl 4-hydroxylases (P4Hs) are essential for proper extracellular matrix formation in multicellular organisms. The vertebrate enzymes are &#945;2&#946;2 tetramers, in which the &#946; subunits are identical to protein disulfide isomerase (PDI). Unique P4H forms have been shown to assemble from the &lt;i&gt;Caenorhabditis&lt;/i&gt; &lt;i&gt;elegans&lt;/i&gt; catalytic &#945; subunit isoforms PHY-1 and PHY-2 and the &#946; subunit PDI-2. A mixed PHY-1/PHY-2/(PDI-2)&lt;sub&gt;2&lt;/sub&gt; tetramer is the major form, while PHY-1/PDI- 2 and PHY-2/PDI-2 dimers are also assembled but less efficiently. Cloning and characterization of the orthologous subunits from the closely related nematode &lt;i&gt;Caenorhabditis&lt;/i&gt; &lt;i&gt;briggsae&lt;/i&gt; revealed distinct differences in the assembly of active P4H forms in spite of the extremely high amino acid sequence identity (92-97%) between the &lt;i&gt;C. briggsae&lt;/i&gt; and &lt;i&gt;C. elegans&lt;/i&gt; subunits. In addition to a PHY-1/PHY-2(PDI-2)&lt;sub&gt;2&lt;/sub&gt; tetramer and a PHY-1/PDI-2 dimer, an active (PHY- 2)&lt;sub&gt;2&lt;/sub&gt;(PDI-2)&lt;sub&gt;2&lt;/sub&gt; tetramer was formed in &lt;i&gt;C. briggsae&lt;/i&gt; instead of a PHY-2/PDI-2 dimer. Site-directed mutagenesis studies and generation of inter-species hybrid polypeptides showed that the N-terminal halves of the &lt;i&gt;Caenorhabditis&lt;/i&gt; PHY-2 polypeptides determine their assembly properties. Genetic disruption of &lt;i&gt;C. briggsae phy-1&lt;/i&gt; (&lt;i&gt;Cb-dpy-18&lt;/i&gt;) via a &lt;i&gt;Mos1&lt;/i&gt; insertion resulted a small (short) phenotype that is less severe than the dumpy (short and fat) phenotype of the corresponding &lt;i&gt;C. elegans&lt;/i&gt; mutants (&lt;i&gt;Ce-dpy-18&lt;/i&gt;). &lt;i&gt;C. briggsae&lt;/i&gt; &lt;i&gt;phy-2&lt;/i&gt; RNA interference produced no visible phenotype in the wild type nematodes but produced a severe dumpy phenotype and larval arrest in &lt;i&gt;phy-1&lt;/i&gt; mutants. Genetic complementation of the &lt;i&gt;C. briggsae&lt;/i&gt; and &lt;i&gt;C. elegans&lt;/i&gt; &lt;i&gt;phy-1&lt;/i&gt; mutants was achieved by injection of a wild type &lt;i&gt;phy-1&lt;/i&gt; gene from either species

Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization

Background Although the benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety. No previous studies investigated the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes. The primary aim of this study was to compare the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. Methods and findings A prospective, multicenter before-after intervention study was conducted in two Dutch hospitals. Adult patients hospitalized between October 2015 and December 2017 treated with anticoagulant therapy were included. The primary aim was to estimate the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. The intervention was the implementation of a multidisciplinary antithrombotic team focusing on education, medication reviews by pharmacists, implementing of local anticoagulant therapy guidelines based on national guidelines, patient counselling and medication reconciliation at admission and discharge. The primary endpoint was analysed using segmented linear regression. We obtained data for 1,886 patients: 941 patients were included in the usual care period and 945 patients in the intervention period. The S-team study showed that implementation of a multidisciplinary antithrombotic team over time significantly reduced the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs (-1.83% (-2.58% to -1.08%) per 2 month period). Conclusions This study shows that implementation of a multidisciplinary antithrombotic team over time significantly reduces the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs

TCERG1L allelic variation is associated with cisplatin-induced hearing loss in childhood cancer, a PanCareLIFE study.

In children with cancer, the heterogeneity in ototoxicity occurrence after similar treatment suggests a role for genetic susceptibility. Using a genome-wide association study (GWAS) approach, we identified a genetic variant in TCERG1L (rs893507) to be associated with hearing loss in 390 non-cranial irradiated, cisplatin-treated children with cancer. These results were replicated in two independent, similarly treated cohorts (n = 192 and 188, respectively) (combined cohort: P = 5.3 × 10-10, OR 3.11, 95% CI 2.2-4.5). Modulating TCERG1L expression in cultured human cells revealed significantly altered cellular responses to cisplatin-induced cytokine secretion and toxicity. These results contribute to insights into the genetic and pathophysiological basis of cisplatin-induced ototoxicity