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Loyalty and Multiple Voting Shares in Listed Companies in Belgium:Current Legal Framework and Policy Proposals
No full textIn this article, we analyse the legal framework for loyalty voting shares (LVS) in Belgium and the implications of the EU Directive on Multiple Voting Shares (MVS). We evaluate the limited uptake and practical use of LVS, highlighting their function as a control-enhancing tool for insiders. Based on proposals by a working group within the Belgian Centre for Company Law, we present a policy framework to implement MVS in Belgium, including safeguards for minority shareholders, a 1:20 maximum voting ratio, and the possibility of midstream adoption. We conclude that MVS provide a more flexible and effective governance mechanism than LVS to stimulate long-term ownership and listing activity in Belgium
Van Parkersburg tot Dordrecht: Juridische ontwikkelingen en uitdagingen inzake PFAS
No full textIn deze bijdrage volgen we het juridische PFAS-spoor, van Parkersburg, West Virginia, tot Dordrecht. We beginnen in de Verenigde Staten omdat Nederlandse rechtszaken, onder andere, bouwen op rechtszaken die daar sinds eind jaren negentig door advocaat Rob Bilott worden gevoerd. We lichten toe wat PFAS zijn en waarom PFAS een probleem zijn, en beschrijven enkele juridische ontwikkelingen en uitdagingen in het bestuurs-, civiel en strafrecht
Sensor-Based to Interaction-Based AI Models in Education:The JOINclusion Case Study
No full textThe integration of Artificial Intelligence (AI) in education is reshaping traditional learning environments by enabling personalized learning experiences, enhancing accessibility, and providing data-driven insights into student engagement and performance. However, the rise of AI technologies in educational settings brings complex ethical challenges, including concerns over data privacy, transparency, and equity. This paper explores the dual impact of AI on education, examining both its transformative potential and the ethical issues it presents. It discusses the role of AI models that analyse how students use the learning tools as an alternative to sensor-based approaches, which can address privacy concerns while still offering adaptive, personalized support. Furthermore, this study evaluates frameworks for ethical AI implementation, emphasizing transparency, inclusivity, and trustworthiness to support responsible AI deployment in education. By addressing key ethical considerations and regulatory standards, this paper proposes a path toward data-driven tools that enhance educational outcomes without compromising student autonomy or privacy. The findings underscore the importance of aligning AI innovations with educational values, suggesting that an ethically-centred approach to AI can promote trust and effectiveness in diverse learning contexts
Heart failure and left ventricular ejection fraction:a necessary but imperfect partnership
No full textThe left ventricular ejection fraction (LVEF) is the most commonly used index to assess left ventricular systolic function and guide management in patients with heart failure (HF). This is largely due to the widespread availability of echocardiography, its practicality, rapid scan time, ease of measuring left ventricular (LV) volumes, and its extensive application in both clinical practice and research. Accordingly, a recent joint clinical consensus statement from the Heart Failure Association (HFA) and the Heart Failure Society of America (HFSA) recommends that LVEF be evaluated longitudinally to assess disease trajectory, natural history, and response to treatment in patients with heart failure (6). However, there is little, if any, evidence that serial LVEF assessment improves risk stratification or guides management in HF. Notably, LVEF may not accurately reflect overall cardiac function. While it is commonly used as a measure of systolic function, LVEF does not fully capture the status of the heart. Other parameters-such as diastolic function, ventricular size, valvular function, and right ventricular function-also play important roles in determining patient risk. This paper proposes an alternative strategy, shifting from serial LVEF evaluation to a more comprehensive approach that includes assessment of congestion, right ventricular function, and structural myocardial damage to provide more robust diagnostic and prognostic information
Integrating Environmental Aspects into Health Technology Assessment:A Qualitative Study among Dutch Stakeholders
No full textBackground The Dutch National Health Care Institute (ZIN) advises the Dutch Minister of Health on the basic benefit package using Health Technology Assessment (HTA), focusing on necessity, clinical effectiveness, cost-effectiveness, and feasibility. Despite the huge environmental impact of the healthcare sector, this impact is not taken into consideration. Several methodological approaches to integrate the environmental impact into HTA have been proposed, including information conduit, integrated evaluation, parallel evaluation, and environment-focused evaluation. There is significant uncertainty as to which approach is the most appropriate. Therefore, it is important to understand stakeholders' perspectives on these approaches.Objectives To explore Dutch stakeholders' perspectives on integrating environmental impacts into HTA and assess preferred methods and challenges.Methods A qualitative study using a focus group with members from ZIN (n = 7) and individual interviews (n = 7) with experts in HTA, market access, and reimbursement. Interviews were transcribed and analyzed thematically.Results Stakeholders highlighted the importance of addressing environmental impacts such as pharmaceutical pollution, greenhouse gas emissions, and waste. Integrated and parallel evaluations were preferred, but barriers such as data gaps, methodological complexity, and lack of guidelines were noted.Conclusion Incorporating environmental impacts into HTA is crucial but requires clear guidelines, better data, and stakeholder collaboration to support sustainable healthcare practices
Women's Capabilities and Challenges of Caring for Persons with Disabilities:Experiences from Rural Areas of Andhra Pradesh, India
No full textAdequate support and care are a prerequisite for the full participation and inclusion of persons with disabilities (WHO, 2011). In rural India, it is predominantly the women of the family who offer such care and support. Consequently, their lives are closely linked to the lives of persons with disabilities. It is essential to understand this relationship and consider their experiences when developing strategies to improve the support system. This empirical research undertakes interviews with women caregivers in rural India and uses the capability approach (CA) to analyze their experiences. The results suggest that the prevailing invisibility and negative perceptions of such care work, coupled with the lack of agency of the women caregivers, make the situation unsatisfactory for both the women and the family member with disabilities they are caring for
Hybrid human-AI coaching: experiences of coaches and agents in a customer service environment
No full textMost studies on AI coaching focus on AI as an independent system. Instead, this study examines the implementation of hybrid AI-supported coaching, where an AI-tool supports but does not replace the human coach. We evaluate how coaches and workers experience the implementation of AI-supported coaching, and what factors shape trust and perceived effectiveness. We use an inductive thematic analysis of qualitative interviews with both coaches and workers one month and five months after implementation of the AI-tool. The evaluation focuses on four themes: Two themes refer to the coaches: AI integration and Coaching effectiveness; and two themes refer to the agents: Trust dynamics and Feedback-driven growth. Our findings reveal an initial phase of resistance, linked to concerns about surveillance, followed by growing trust and perceived value due to the tool’s ability to generate feedback that was perceived as more objective, consistent, and more relevant than the traditional subjective feedback of coaches. Although adoption required additional effort, the tool enabled more targeted preparation, precise feedback, and measurable learning outcomes. Transparent use and the active involvement of coaches who build their coaching on the AI-generated data further supported this transition. Trust in the AI-supported coaching was built through ongoing human engagement
Inadequate Oxygen Delivery During Cardiopulmonary Bypass Drives Inflammatory Reaction after Cardiac Surgery
No full textObjectives Systemic inflammatory response syndrome (SIRS) is a common complication following cardiopulmonary bypass (CPB), associated with increased mortality. We assessed the relationship between indexed oxygen delivery (DO(2)i) during CPB and SIRS. Methods We conducted a prospective observational study at 2 institutions. The primary end-point was clinically-defined SIRS 12 hours after surgery. The secondary end-point was a composite outcome comprising death, TIA/stroke, renal replacement therapy, bleeding, mechanical circulatory support, or intensive care unit (ICU) stay >96 hours. The primary analysis modelled DO(2)i in multivariable logistic regression. Linearity was assessed with restricted cubic splines, knot-sensitivity, quintiles, and piecewise fits. The optimal ROC-derived threshold was explored. Patients above and below the threshold were matched 1:1 by propensity score. Structural equation modelling (SEM) assessed mediation between DO(2)i, SIRS, and outcomes. Results Of 1154 patients screened, 908 were analysed; 221 (24.3%) developed SIRS. Median DO(2)i was lower in the SIRS group (274 vs 302 mL/min/m(2), P < .001). DO(2)i was inversely associated with SIRS (aOR 0.798; 95% CI 0.750-0.850, P < .001, per +10 mL/min/m(2)). In the secondary analysis, DO(2)i <= 293 mL/min/m(2) was identified as threshold (sensitivity 62%, specificity 74%). Propensity score matched 390 patient pairs, with higher SIRS incidence in the low-DO(2)i group (33.3% vs 14.4%; P < .001). The composite outcome occurred more frequently in the low-DO(2)i cohort (17.7% vs 8.2%; P < .001). SEM showed mediation by SIRS, accounting for 46.2% of the DO(2)i effect on outcomes (OR 1.052; 95% CI 1.036-1.067; P < .001). Conclusions Low DO(2)i during CPB predicts SIRS and adverse outcomes. Goal-directed perfusion to reduce inflammation warrants evaluation in randomized trials