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Comparison of cognitive workload between very short answer questions and multiple-choice questions:an eye-tracking experiment
No full textVery short answer questions (VSAQs) have gained attention for their superior psychometric properties compared to multiple-choice questions (MCQs). While VSAQs require knowledge recall, MCQs primarily involve knowledge recognition. This difference in cognitive processes may lead to varying cognitive workloads, defined as the amount of mental processing in working memory. Previous studies have not demonstrated consistent differences, likely due to reliance on self-reported measures. Eye tracking provides objective, process-level indicators of cognitive workload. This study investigated whether answering VSAQs requires a higher cognitive workload than answering MCQs. In a within-subject randomized crossover experiment, sixth-year medical students answered both VSAQs and MCQs. Cognitive workload was measured using screen-based eye tracking, focusing on the number of fixations and revisitations as objective indicators of mental effort. Data were analyzed using mixed-effects models. Thirty-four medical students participated, yielding 1,326 observations, which is the multiplication of the number of students by the number of questions (39 questions). Mixed-effects models showed a significant effect of question type on both workload indicators: VSAQs elicited more fixations and revisitations than MCQs (β_std = 0.30-0.39, p < .001). This effect remained after controlling for accuracy. Incorrect answers were associated with higher workload (β_std = -0.15--0.16, p < .01). Heatmaps confirmed these findings, showing denser fixations on key diagnostic features for VSAQs and on answer options for MCQs. Answering VSAQs imposed a higher cognitive workload than MCQs. The presence of answer options in MCQs may reduce workload by providing unintentional cues, while VSAQs require active retrieval. Eye tracking proved valuable for distinguishing cognitive workload across assessment formats.</p
Trends and associated factors of late-stage HIV diagnosis among heterosexuals in the Netherlands between 2012 and 2022:An analysis of national surveillance data
No full textObjectives:Late-stage HIV diagnoses among heterosexuals remain a problem in Europe, yet little is known about its risk factors. We aimed to identify the trends and factors associated with late-stage HIV diagnosis among heterosexuals in the Netherlands. Methods:We used national HIV surveillance data and included individuals diagnosed between 2012 and 2022, with heterosexual contact as the suspected transmission route. We applied descriptive statistics and logistic regression analyses. Results:Of 1637 HIV diagnoses among heterosexuals, 932 (57%) were late-stage disease. The proportion of late-stage diagnoses was stable during 2012-2022 (range 51-62%). Significant risk factors for late-stage diagnosis were male sex (adjusted odds ratio [AOR] = 1.72; 95% confidence interval [CI] = 1.40-2.13), older age (every 10-year increase: AOR = 1.48; 95% CI = 1.34-1.62), being born in Africa (AOR = 2.21; 95% CI = 1.70-2.88), and Asia (AOR = 2.93; 95% CI = 1.88-4.65). People born in eastern Europe approached significance (AOR = 1.70; 95% CI = 0.97-3.05). Most late-stage diagnoses occurred in hospitals. Conclusions:The proportion of late-stage HIV diagnoses remains high among heterosexuals in the Netherlands. Men; older people; and those born in Africa, Asia, and eastern Europe were associated with late-stage diagnosis.</p
Can risk-rating of incremental premiums improve consumer sorting across coverage options in mandatory health insurance markets?
No full textSeveral mandatory health insurance schemes include some consumer choice of coverage (e.g., in terms of deductible levels). Premiums in these schemes are typically community-rated per insurance plan. While community-rated premiums help achieve objectives of fairness, they can also lead to adverse selection across coverage options. Consequently, consumers may sort inefficiently across these coverage options resulting in forgone welfare gains. This paper aims to explore under what conditions risk rating of incremental premiums for more comprehensive coverage (compared to a basic plan) can improve consumer sorting. In a simulation analysis on Chilean data, results show that under perfect risk adjustment, risk rating of incremental premiums can improve consumer sorting. With imperfect risk adjustment, however, the effects of risk rating on consumer sorting are ambigous as incremental premiums will not just reflect the direct effect of more comprehensive coverage on healthcare spending, but also the under/overcompensation from the (imperfect) risk adjustment system. Moreover, we find that in the presence of imperfect risk adjustment, risk rating improves welfare over community rating but does not fully solve the problem of inefficient sorting
Effects of small airtime rewards linked to unsolicited text messages on uptake of a tuberculosis self-screening app in South Africa:a randomised trial
No full textObjectives The objective of this study was to test whether an airtime reward increased tuberculosis (TB) Check screening uptake. This served as a feasibility study for the planned Phase 2, which aimed to test behavioural messaging to boost take-up of TB testing among users who were advised to get tested by TB Check. Design The study was a randomised controlled trial with a parallel design. Setting This study assessed mHealth support to boost TB testing in high-burden Cape Town clinics. Intervention Patients aged 18 or above with a valid mobile phone number that had been added within the last 5 years were invited by the Western Cape Department of Health and Wellness through unsolicited text messages to screen for TB using TB Check. Participants Patients in the intervention group (n=1250) were additionally offered R15 airtime for completing the screening and participating in the research study. Patients were allocated to the intervention or control group through parallel randomisation with equal group size. Primary outcome measures The primary outcome was the number of TB Check screenings completed within 1week of the SMS invitation being sent. Results Messages were successfully delivered to 616 patients in the control group and 633 patients in the intervention group. Uptake of the invitation by the intended recipients was very low. Eight users in the control group and 20 users in the intervention group initiated a self-screening (1.3% vs 3.2% of delivered messages; 95%CI of difference (0.2 to 3.5)), but only three users in the control group and seven users in the intervention group successfully completed a self-screening (0.49% vs 1.11% of delivered messages; 95%CI of difference (−0.4 to 1.6)). Low delivery of text message invitations (50.0%) and low completion of users who started the screening (35.7%) posed additional challenges. No adverse events were recorded. Conclusions The addition of a small airtime participation reward to unsolicited text message invitations did not appear to be an effective tool to reach targeted individuals in this context. The results of Phase 1 reported here suggested that Phase 2 would not be feasible, so we did not proceed with the planned Phase 2. However, uptake of incentivised self-screening was unexpectedly high among users who were not originally invited (presumably known contacts of the original invitees). Within 5days of the invitations being sent, 1962 unique self-screenings had taken place using the incentive code; only 7 of these users were originally invited. The lessons learnt from this study can help to inform future efforts to promote TB self-screening, mHealth initiatives and attempts to engage with patients via text message.</p
The cost-effectiveness of increasing hepatitis Delta testing for individuals co-infected with HBV and HIV in the Netherlands
No full textObjectives Chronic hepatitis D virus (HDV) infection accelerates liver-related morbidity and mortality in people living with HIV and hepatitis B virus (HBV). In the Netherlands, HDV testing among HIV/HBV-coinfected adults is currently limited. This study evaluates whether a one-time HDV testing strategy for all HIV/HBsAg-positive adults is cost-effective compared with the current limited testing strategy. Methods A Markov model was developed and followed HIV/HBV-coinfected adults through mutually exclusive health states. One-time testing scenario comprised of anti-HDV testing with HDV RNA confirmation, and bulevirtide in combination of interferon therapy for 50% of viremic patients. Clinical and cost inputs were sourced from clinical studies and the Dutch costing manual. Utilities used EQ-5D values for HBV/HDV patients assuming controlled HIV infection. Sensitivity analyses explored parameter uncertainty. Results One-time HDV testing could avert 174 HDV-related deaths, 95 cirrhosis cases, and 111 liver cancer cases per 10,000 individuals with HIV/HBV infection. The intervention yields 0.253 additional quality-adjusted life-years (QALYs) at an incremental cost of €5,026, resulting in an ICER of €19,881/QALY, which is below the Dutch willingness-to-pay threshold of €80,000/QALY. Conclusion One-time HDV testing among HIV/HBV-coinfected adults in the Netherlands appears cost-effective and clinically impactful, supporting routine HDV testing into national HIV/HBV care protocols.</p
Outcomes and management strategies of pregnancies after heart and lung transplantation across Europe
No full textBackground: Literature on pregnancy after heart and/or lung transplantation (heart transplantation (HTx), lung transplantation (LTx), heart lung transplantation (HLTx)) remains sparse. This study assessed short- and long-term outcomes of pregnancies post-thoracic organ transplantation across Europe and analyzed center management of these patients. Methods: European centers provided retrospective data on post-HTx/LTx pregnancies and center strategies for handling transplant recipients with a pregnancy wish. Descriptive statistics and linear regression analysis were used.Results: Forty-two females had 50 pregnancies across 12 European centers. Pregnancy-induced hypertension occurred in 50% (HTx), 28% (LTx), and 20% (HLTx), and preeclampsia in 19%, 16%, and 20%, respectively. Preterm birth (<37 weeks) occurred in 23% (HTx) and 68% (LTx), and birth weight <2,500 g in 8% and 58%, respectively. Live birth rate was 98%. In multivariable analysis, a trend for higher birth weight with higher pre-pregnancy estimated glomerular filtration rate was observed (B 13.3, 95% CI −1.7-28.4, p = 0.08). Graft function remained stable in most patients during and after pregnancy. During follow-up (mean 15 years, range 5-31 post-transplantation), 6/40 mothers (15%) died (1 HTx, 2 LTx, 3 HLTx), with their children aged 0-11 years. No specific physical health problems were mentioned in 29/30 children (age 0-22 years). Physician opinions towards pregnancy differed from reluctant (31%) to positive (69%), with numerous management variations.Conclusions: We show reassuring pregnancy outcomes for post-HTx, LTx, and HLTx patients in an exclusive European cohort, despite high pregnancy complication rates. Graft function and overall maternal survival appear unaffected. We highlight differences in pregnancy management between centers and suggest development of a uniform approach.</p
Introducing an integrated maternity care pathway for women with a history of small-for-gestational-age:Evaluation of its effect on care process and clinical outcomes
No full textIntroduction:This study focusses on the implementation of an integrated care pathway for women with SGA in their obstetric history that pursues value-based healthcare. This study aims to 1) Determine whether the integrated care pathway led to a reduction in the number of antenatal secondary care consultations, as an indicator of care efficacy, and 2) compare clinical outcomes for women with a history of SGA before and after implementation of the integrated care pathway. Methods:Retrospective cohort study including data from pregnant women with a history of SGA within integrated maternity care organisation Annature, 2017–2020. Intervention was an integrated care pathway (2018). Pre- and post-intervention periods were compared assessing prenatal secondary care consultations, place and mode of delivery, and perinatal outcomes. Results:The implementation of the care pathway for pregnant women with a history of SGA led to a reduction in mean number of prenatal secondary care consultations per pregnancy from 11 in 2017–5 in 2020, and fewer inductions of labour (78 (34.2%) vs 127 (26.8%), p = 0.045). Additionally, the number of births in primary care increased (35 (15.4%) vs 136 (28.8%), p < 0.001) with no significant adverse impact on neonatal outcomes in the post-intervention period compared to the pre-intervention period. Conclusion:The implementation of the care pathway for pregnant women with a history of SGA resulted in a reduction in prenatal secondary care consultations and fewer inductions of labour. Additionally, the number of births in primary care increased, with no significant adverse impact on neonatal outcomes in the post-intervention period compared to the pre-intervention period.</p
Blowing Minds:A cross-cultural, longitudinal investigation to unravel the highs and lows of recreational and medicinal cannabis users
No full textCannabis use is widely on the rise for recreational and medicinal purposes, with the latter often aimed at improving mental health and cognition. Simultaneously, the prevalence of cannabis-related health harms, such as cannabis use disorder (CUD), is increasing. Product potency, route of administration, and preexisting mental health symptoms play a role in the effects of cannabis; however, there is limited research on how broader factors, such as local cannabis legislation and perceptions of use, may influence these outcomes. Moreover, knowledge remains sparse regarding the growing population of medicinal users, predominantly using without medical supervision. Altogether, this illustrates the need for ecologically valid ways to investigate individuals and their cannabis usage within real-world settings. Therefore, this longitudinal, cross-cultural online study examines an international sample of regular recreational and medicinal users (aged 18–65) from different cannabis jurisdictions (e.g., the Netherlands, the United States, Brazil, Canada, and regions in Asia and Africa) in their natural environment via their mobile phone. By using the Experience Sampling Method (ESM), alongside a comprehensive battery of cognition and mental health related assessments over a 2-year period, we aim to gain insight into the short- and long-term mental health and cognitive determinants and consequences of cannabis use, and how these interact with broader, contextual factors, such as legislation. This is one of the first cross-cultural studies assessing both positive and negative effects of cannabis longitudinally, examining the full range of effects that cannabis may have on the individual.</p
Entrepreneurial imagination:A pluralistic scoping review of a sprawling literature
No full textEntrepreneurial imagination (EI) lies at the core of entrepreneurship research. Both early and contemporary scholars have emphasized its central role in visualizing and actualizing entrepreneurial opportunities, shaping decision-making, and enabling venture creation. Perhaps because of its salience and significance, EI has been approached from a wide range of definitional, philosophical, theoretical, and methodological perspectives, fostering a conceptually rich yet sprawling and fragmented body of work. Drawing on a scoping literature review of articles published in leading management and entrepreneurship journals, we synthesize the diverse constructs, processes, and conceptualizations associated with EI. We adopt a pluralistic approach, identifying eight distinct theoretical perspectives that have shaped scholars' understanding of EI over time. Rather than seeking to unify these perspectives into a single framework, we provide a multidimensional account of EI that captures its complexity and explore possibilities for cross-pollination as an agenda for future research. By putting complementary and sometimes contrasting perspectives into conversation, especially where they address similar concerns or compensate for each other's limitations, we aim to inspire novel combinations and spark new questions that can meaningfully advance scholarship on EI
'Our body invents a thousand unexpected figures':Michel Serres's philosophy of the body, movement, and sport
No full textMichel Serres (1930-2019) was a French philosopher and historian of science known for his original way of thinking across disciplinary boundaries. Rather than staying within a single field, he continually sought connections between different forms of knowledge. From the 1960s onward, he developed a distinctive philosophy that wove together technological, scientific, and social developments into a revision of what it means to be human. Over the last years, interest in his work has grown, especially because he addresses issues that are highly relevant today: interdisciplinarity, globalization, ecological crisis, and the expanding influence of communication technologies.A striking feature of Serres’s thought is his constant attention to the corporal condition. For him, our bodily existence forms the foundation of how we think, move, and relate to the world. This dissertation explores Serres's corporal condition through three interconnected domains: a philosophy of the body, a philosophy of movement, and an independent philosophy of sport.By applying Serres’s ideas to current challenges such as climate change, urbanization, and digitalization, this study offers a new framework for both the philosophy of sport and medical ethics. It shows how Serres’s focus on the body can inform concrete practices and provide original insights into contemporary problems.<br/