Background: In the Netherlands, general practitioners (GPs) play a key role in provider-initiated HIV testing, but opportunities for timely diagnosis are regularly missed. We implemented an educational intervention to improve HIV testing by GPs from 2015 to 2020, and observed a 7% increase in testing in an evaluation using laboratory data. The objective for the current study was to gain a deeper understanding of whether and how practices and perceptions of GPs’ HIV/sexually transmitted infection (STI) testing behaviour changed following the intervention. Methods: We performed a mixed-methods study using questionnaires and semi-structured interviews to assess self-reported changes in HIV/STI testing by participating GPs. Questionnaires were completed by participants at the end of the final educational sessions from 2017 through 2020, and participating GPs were interviewed from January through March 2020. Questionnaire data were analysed descriptively, and open question responses were categorised thematically. Interview data were analysed following thematic analysis methods. Results: In total, 101/103 participants completed questionnaires. Of 65 participants that were included in analyses on the self-reported effect of the programme, forty-seven (72%) reported it had changed their HIV/STI testing, including improved STI consultations, adherence to the STI consultation guideline, more proactive HIV testing, and more extragenital STI testing. Patients’ risk factors, patients’ requests and costs were most important in selecting STI tests ordered. Eight participants were interviewed and 15 themes on improved testing were identified, including improved HIV risk-assessment, more proactive testing for HIV/STI, more focus on HIV indicator conditions and extragenital STI testing, and tools to address HIV during consultations. However, several persistent barriers for optimal HIV/STI testing by GPs were identified, including HIV-related stigma and low perceived risk. Conclusions: Most GPs reported improved HIV/STI knowledge, attitude and testing, but there was a discrepancy between reported changes in HIV testing and observed increases using laboratory data. Our findings highlight challenges in implementation of effective interventions, and in their evaluation. Lessons learned from this intervention may inform follow-up initiatives to keep GPs actively engaged in HIV testing and care, on our way to zero new HIV infections.
While the original definition of replacement focuses on the replacement of the use of animals in science, a more contemporary definition focuses on accelerating the development and use of predictive and robust models, based on the latest science and technologies, to address scientific questions without the use of animals. The transition to animal free innovation is on the political agenda in and outside the European Union. The Beyond Animal Testing Index (BATI) is a benchmarking instrument designed to provide insight into the activities and contributions of research institutes to the transition to animal free innovation. The BATI allows participating organizations to learn from each other and stimulates continuous improvement. The BATI was modelled after the Access to Medicine Index, which benchmarks pharmaceutical companies on their efforts to make medicines widely available in developing countries. A prototype of the BATI was field-tested with three Dutch academic medical centers and two universities in 2020-2021. The field test demonstrated the usability and effectiveness of the BATI as a benchmarking tool. Analyses were performed across five different domains. The participating institutes concluded that the BATI served as an internal as well as an external stimulus to share, learn, and improve institutional strategies towards the transition to animal free innovation. The BATI also identified gaps in the development and implementation of 3R technologies. Hence, the BATI might be a suitable instrument for monitoring the effectiveness of policies. BATI version 1.0 is ready to be used for benchmarking at a larger scale.
Bilingual education has become popular in many countries in the last two decades. It is generally acknowledged that learning a second language (L2) through subject content has a positive impact on students’ L2 learning, but there is less agreement on whether this also applies to learning subject content knowledge in and through L2. This cross-sectional study compared Dutch pre-university mainstream and bilingual education students in grades 7 and 9 on a history knowledge test, taking into consideration the language of instruction and testing. Students were also tested on their motivation to learn and affinity with history, because of the alleged higher motivation bilingual education students bring to the classroom. Multilevel analyses showed that bilingual education students in grade 7 lagged behind in the English part of the test but performed at the same level in the Dutch part. 9th bilingual education graders on the other hand performed significantly better on the knowledge test than 9th mainstream graders in both L2 and L1, thus providing evidence for the non-detrimental effect of bilingual education on the acquisition of subject content knowledge.
Everyone has the right to participate in society to the best of their ability. This right also applies to people with a visual impairment, in combination with a severe or profound intellectual and possibly motor disability (VISPIMD). However, due to their limitations, for their participation these people are often highly dependent on those around them, such as family members andhealthcare professionals. They determine how people with VISPIMD participate and to what extent. To optimize this support, they must have a good understanding of what people with disabilities can still do with their remaining vision.It is currently difficult to gain insight into the visual abilities of people with disabilities, especially those with VISPIMD. As a professional said, "Everything we can think of or develop to assess the functional vision of this vulnerable group will help improve our understanding and thus our ability to support them. Now, we are more or less guessing about what they can see.Moreover, what little we know about their vision is hard to communicate to other professionals”. Therefore, there is a need for methods that can provide insight into the functional vision of people with VISPIMD, in order to predict their options in daily life situations. This is crucial knowledge to ensure that these people can participate in society to their fullest extent.What makes it so difficult to get this insight at the moment? Visual impairments can be caused by a range of eye or brain disorders and can manifest in various ways. While we understand fairly well how low vision affects a person's abilities on relatively simple visual tasks, it is much more difficult to predict this in more complex dynamic everyday situations such asfinding your way or moving around during daily activities. This is because, among other things, conventional ophthalmic tests provide little information about what people can do with their remaining vision in everyday life (i.e., their functional vision).An additional problem in assessing vision in people with intellectual disabilities is that many conventional tests are difficult to perform or are too fatiguing, resulting in either no or the wrong information. In addition to their visual impairment, there is also a very serious intellectual disability (possibly combined with a motor impairment), which makes it even more complex to assesstheir functional vision. Due to the interplay between their visual, intellectual, and motor disabilities, it is almost impossible to determine whether persons are unable to perform an activity because they do not see it, do not notice it, do not understand it, cannot communicate about it, or are not able to move their head towards the stimulus due to motor disabilities.Although an expert professional can make a reasonable estimate of the functional possibilities through long-term and careful observation, the time and correct measurement data are usually lacking to find out the required information. So far, it is insufficiently clear what people with VZEVMB provoke to see and what they see exactly.Our goal with this project is to improve the understanding of the visual capabilities of people with VISPIMD. This then makes it possible to also improve the support for participation of the target group. We want to achieve this goal by developing and, in pilot form, testing a new combination of measurement and analysis methods - primarily based on eye movement registration -to determine the functional vision of people with VISPIMD. Our goal is to systematically determine what someone is responding to (“what”), where it may be (“where”), and how much time that response will take (“when”). When developing methods, we take the possibilities and preferences of the person in question as a starting point in relation to the technological possibilities.Because existing technological methods were originally developed for a different purpose, this partly requires adaptation to the possibilities of the target group.The concrete end product of our pilot will be a manual with an overview of available technological methods (as well as the methods themselves) for assessing functional vision, linked to the specific characteristics of the target group in the cognitive, motor area: 'Given that a client has this (estimated) combination of limitations (cognitive, motor and attention, time in whichsomeone can concentrate), the order of assessments is as follows:' followed by a description of the methods. We will also report on our findings in a workshop for professionals, a Dutch-language article and at least two scientific articles. This project is executed in the line: “I am seen; with all my strengths and limitations”. During the project, we closely collaborate with relevant stakeholders, i.e. the professionals with specific expertise working with the target group, family members of the persons with VISPIMD, and persons experiencing a visual impairment (‘experience experts’).
In the last decade, the automotive industry has seen significant advancements in technology (Advanced Driver Assistance Systems (ADAS) and autonomous vehicles) that presents the opportunity to improve traffic safety, efficiency, and comfort. However, the lack of drivers’ knowledge (such as risks, benefits, capabilities, limitations, and components) and confusion (i.e., multiple systems that have similar but not identical functions with different names) concerning the vehicle technology still prevails and thus, limiting the safety potential. The usual sources (such as the owner’s manual, instructions from a sales representative, online forums, and post-purchase training) do not provide adequate and sustainable knowledge to drivers concerning ADAS. Additionally, existing driving training and examinations focus mainly on unassisted driving and are practically unchanged for 30 years. Therefore, where and how drivers should obtain the necessary skills and knowledge for safely and effectively using ADAS? The proposed KIEM project AMIGO aims to create a training framework for learner drivers by combining classroom, online/virtual, and on-the-road training modules for imparting adequate knowledge and skills (such as risk assessment, handling in safety-critical and take-over transitions, and self-evaluation). AMIGO will also develop an assessment procedure to evaluate the impact of ADAS training on drivers’ skills and knowledge by defining key performance indicators (KPIs) using in-vehicle data, eye-tracking data, and subjective measures. For practical reasons, AMIGO will focus on either lane-keeping assistance (LKA) or adaptive cruise control (ACC) for framework development and testing, depending on the system availability. The insights obtained from this project will serve as a foundation for a subsequent research project, which will expand the AMIGO framework to other ADAS systems (e.g., mandatory ADAS systems in new cars from 2020 onwards) and specific driver target groups, such as the elderly and novice.
“Empowering learners to create a sustainable future” This is the mission of Centre of Expertise Mission-Zero at The Hague University of Applied Sciences (THUAS). The postdoc candidate will expand the existing knowledge on biomimicry, which she teaches and researches, as a strategy to fulfil the mission of Mission-Zero. We know when tackling a design challenge, teams have difficulties sifting through the mass of information they encounter. The candidate aims to recognize the value of systematic biomimicry, leading the way towards the ecosystems services we need tomorrow (Pedersen Zari, 2017). Globally, biomimicry demonstrates strategies contributing to solving global challenges such as Urban Heat Islands (UHI) and human interferences, rethinking how climate and circular challenges are approached. Examples like Eastgate building (Pearce, 2016) have demonstrated successes in the field. While biomimicry offers guidelines and methodology, there is insufficient research on complex problem solving that systems-thinking requires. Our research question: Which factors are needed to help (novice) professionals initiate systems-thinking methods as part of their strategy? A solution should enable them to approach challenges in a systems-thinking manner just like nature does, to regenerate and resume projects. Our focus lies with challenges in two industries with many unsustainable practices and where a sizeable impact is possible: the built environment (Circularity Gap, 2021) and fashion (Joung, 2014). Mission Zero has identified a high demand for Biomimicry in these industries. This critical approach: 1) studies existing biomimetic tools, testing and defining gaps; 2) identifies needs of educators and professionals during and after an inter-disciplinary minor at The Hague University; and, 3) translates findings into shareable best practices through publications of results. Findings will be implemented into tangible engaging tools for educational and professional settings. Knowledge will be inclusive and disseminated to large audiences by focusing on communication through social media and intervention conferences.
