Online Voting Advice Applications (VAAs) are survey-like instruments that help citizens to shape their political preferences and compare them with those of political parties. Especially in ...multi-party democracies, their increasing popularity indicates that VAAs play an important role in opinion formation for citizens, as well as in the public debate prior to elections. Hence, the objectivity and transparency of VAAs are crucial. In the design of VAAs, many choices have to be made. Extant research in survey methodology shows that the seemingly arbitrary choice to word questions positively (e.g., 'The city council should allow cars into the city centre') or negatively ('The city council should ban cars from the city centre') systematically affects the answers. This asymmetry in answers is in line with work on negativity bias in other areas of linguistics and psychology. Building on these findings, this study investigated whether question polarity also affects the answers to VAA statements. In a field experiment (N = 31,112) during the Dutch municipal elections we analysed the effects of polarity for 16 out of 30 VAA statements with a large variety of linguistic contrasts. Analyses show a significant effect of question wording for questions containing a wide range of implicit negations (such as 'forbid' vs. 'allow'), as well as for questions with explicit negations (e.g., 'not'). These effects of question polarity are found especially for VAA users with lower levels of political sophistication. As these citizens are an important target group for Voting Advice Applications, this stresses the need for VAA builders to be sensitive to wording choices when designing VAAs. This study is the first to show such consistent wording effects not only for political attitude questions with implicit negations in VAAs, but also for political questions containing explicit negations.
In patients with aneurysmal subarachnoid haemorrhage, short-term antifibrinolytic therapy with tranexamic acid has been shown to reduce the risk of rebleeding. However, whether this treatment ...improves clinical outcome is unclear. We investigated whether ultra-early, short-term treatment with tranexamic acid improves clinical outcome at 6 months.
In this multicentre prospective, randomised, controlled, open-label trial with masked outcome assessment, adult patients with spontaneous CT-proven subarachnoid haemorrhage in eight treatment centres and 16 referring hospitals in the Netherlands were randomly assigned to treatment with tranexamic acid in addition to care as usual (tranexamic acid group) or care as usual only (control group). Tranexamic acid was started immediately after diagnosis in the presenting hospital (1 g bolus, followed by continuous infusion of 1 g every 8 h, terminated immediately before aneurysm treatment, or 24 h after start of the medication, whichever came first). The primary endpoint was clinical outcome at 6 months, assessed by the modified Rankin Scale, dichotomised into a good (0–3) or poor (4–6) clinical outcome. Both primary and safety analyses were according to intention to treat. This trial is registered at ClinicalTrials.gov, NCT02684812.
Between July 24, 2013, and July 29, 2019, we enrolled 955 patients; 480 patients were randomly assigned to tranexamic acid and 475 patients to the control group. In the intention-to-treat analysis, good clinical outcome was observed in 287 (60%) of 475 patients in the tranexamic acid group, and 300 (64%) of 470 patients in the control group (treatment centre adjusted odds ratio 0·86, 95% CI 0·66–1·12). Rebleeding after randomisation and before aneurysm treatment occurred in 49 (10%) patients in the tranexamic acid and in 66 (14%) patients in the control group (odds ratio 0·71, 95% CI 0·48–1·04). Other serious adverse events were comparable between groups.
In patients with CT-proven subarachnoid haemorrhage, presumably caused by a ruptured aneurysm, ultra-early, short-term tranexamic acid treatment did not improve clinical outcome at 6 months, as measured by the modified Rankin Scale.
Fonds NutsOhra.
In response to heart failure (HF), the heart reacts by repressing adult genes and expressing fetal genes, thereby returning to a more fetal-like gene profile. To identify genes involved in this ...process, we carried out transcriptional analysis on murine hearts at different stages of development and on hearts from adult mice with HF. Our screen identified
, encoding for 5-oxoprolinase, a member of the γ-glutamyl cycle that functions by scavenging 5-oxoproline. OPLAH depletion occurred as a result of cardiac injury, leading to elevated 5-oxoproline and oxidative stress, whereas OPLAH overexpression improved cardiac function after ischemic injury. In HF patients, we observed elevated plasma 5-oxoproline, which was associated with a worse clinical outcome. Understanding and modulating fetal-like genes in the failing heart may lead to potential diagnostic, prognostic, and therapeutic options in HF.
Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that ...requires the integration of knowledge and skills from several competency domains.
To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice.
We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses.
The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001).
This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice.
Voting Advice Applications (VAAs) provide voting recommendations to millions of people. As these voting recommendations are based on users' answers to attitude questions, the framing of these ...questions can have far-reaching consequences. The current study reports on a field experiment in which the framing of the header above VAA statements (N = 17) was manipulated (condition 1: no header; condition 2: a right-wing header, e.g., finance; condition 3: a left-wing header, e.g., nature and environment). Visitors of a VAA developed for Utrecht, the fourth largest municipality in the Netherlands, were randomly guided to one of the versions of the tool in which the header type was varied. Results (based on Nrespondents = 27,404) show that providing a header (left-wing or right-wing) leads to more left-wing answers as compared a condition where there is no header above the attitude statement. This effect, however, is only observed for respondents with lower levels of political sophistication.
Voting Advice Applications (VAAs) are Web tools that are used to inform increasing numbers of voters during elections. This increasing usage indicates that VAAs fulfill voters' needs, but what these ...needs are is unknown. Previous research has shown that such tools are primarily used by young males and highly educated citizens. This suggests that VAAs are generally used by citizens who are already well-informed about politics and may not need the assistance of a VAA to make voting decisions. To analyze the functions that VAAs have for their users, this study utilizes unique user data from a popular Dutch VAA to identify different user types according to their cognitive characteristics and motivations. A latent class analysis (LCA) resulted in three distinct user types that vary in efficacy, vote certainty, and interest: doubters, checkers, and seekers. Each group uses the VAA for different reasons at different points in time. Seekers' use of VAAs increases as Election Day approaches; less efficacious and less certain voters are more likely to use the tool to become informed.
Previous research shows effects of the advice from voting advice applications (VAAs) on party choice. These effects could be spurious because common antecedent factors like prior voting, a voter's ...prior issue positions and election campaign news may explain both party choice and the opinions someone reports to the VAA, and hence the voting advice obtained from the VAA. Often VAAs will advise users to opt for parties that they were already likely to vote for, based on antecedent factors. Here, three-wave panel surveys and media content data for the Dutch national election campaigns of 2010 and 2012 are employed. In spite of spurious correlations resulting from common antecedent factors, genuine VAA effects show up, especially for doubting voters. Party change based on positive VAA-advice for a party is least likely (a) for voters who already have an abundance of antecedent factors in favour of that party anyway, and (b) for those without a single antecedent factor in favour of that party. Genuine VAA effects imply that VAAs make it less easy for political parties to neglect each other's owned issues, because VAAs weigh issues equally for each party.
Relapse is a major cause of treatment failure in children with acute myeloid leukemia (AML). The prognosis of children with relapsed AML is poor. Population-based data for this patient group are ...scarce. The aim of this study was to gain insight into the outcome of Dutch pediatric patients with relapsed AML by describing trends in survival against the background of first-line treatment protocols: ANLL-97 and AML 15 (1998–2009) versus DB AML-01 and NOPHO-DBH-AML-2012 (2010–2018).
We retrospectively analyzed outcome and clinical data of all pediatric patients (<18 years) with AML relapse in the Netherlands who were initially diagnosed between 1998 and 2018. Overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan–Meier method. Kaplan-Meier curves and log-rank tests were used to compare survival probabilities of various subgroups.
Cumulative incidence of relapse was 38%. Overall, 5-year OS after first relapse was 32% and increased from 23% in 1998‐2009 to 51% in 2010–2018 (P = 0.001). The overall 5-year EFS was 26% and increased from 21% in 1998‐2009 to 33% in 2010–2018 (P = 0.02). In addition to diagnostic period, late relapse (>1 year) was an independent favorable prognostic factor of (event-free) survival.
Survival of Dutch pediatric patients with relapsed AML has improved significantly between 1998 and 2018, but remains dismal. Treatment during the period 2010–2018 and late relapse were favorable prognostic factors for OS and EFS.
•Survival of Dutch pediatric patients with relapsed AML has improved.•Overall and event-free survival increased significantly from 1998–2009 to 2010–2018.•Treatment during 2010–2018 was a favorable prognostic factor for survival.
Bottleneck of the validation and evaluation of analysis and verification tools for distributed systems is the shortage of benchmark problems. Specifically designed benchmark problems are typically ...artificial, rare, and small, and it is difficult to guarantee challenging properties of realistic benchmarks. This paper shows how to systematically construct arbitrarily complex Petri Nets with guaranteed safety properties. Key to our construction is a top-down parallel decomposition based on lightweight assumption commitment specifications. We will illustrate how a specific strategy for design choices, which may well be automated, leads to benchmarks that grow exponentially with the number of its parallel components, and that are very difficult to verify. In particular, we will report numbers from a systematic sequence of concrete corresponding verification attempts using today's leading verification technology.
This study examined the intergenerational transmission of religiosity within Muslim immigrant families who live in the Netherlands, a rather secular society. We studied whether transmission of ...religiosity within immigrant families is influenced by warm family relations on the one hand, and integration into the host country on the other hand. Two analyses were carried out on a nationally representative sample of Turkish and Moroccan first- and second-generation immigrants aged 15–45, in the Netherlands. The findings support the hypotheses to some extent: warm family ties are found to facilitate religious transmission but transmission is stronger when parents have different national backgrounds. A stronger transmission is found within families that are stronger embedded in religious communities; however there are large differences between men and women. Our research shows that the influence of parental religiosity cannot be ignored in the study of immigrants’ religiosity.
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