Expertise Center Vocational Education

Many vocational education and training (VET) students in the Netherlands struggle with the transition from education to the labour market, resulting in high dropout rates. VET institutions are actively seeking effective mechanisms to support their students during this transition. This research explored valuable strategies identified by education professionals to facilitate a sustainable transition from education to the labour market. This study employed a realistic evaluation framework using CIMO-logic (which focuses on the Context, Intervention, Mechanism, Outcome) for analysis in order to gain insight into the processes of change. In total, four cases were studied at two Dutch educational institutions. The research followed an inductive approach using within-case and cross-case analyses. Five key elements were identified: skills and competencies, Self-insight, Self-efficacy, Building a professional network, and bridging education and practice. In school-to-work guidance for VET students, these elements are relevant to consider in guidance programs.

SummaryBackgroundMasculinizing genital gender-affirming surgery (gGAS) for transgender and gender diverse people encompasses a complex, heterogenous, and modular set of procedures. To enable evidence-based decision-making or meta-analysis, a uniformity of outcome research is needed. Currently, this is hindered by non-standardized outcome reporting. This study aims to develop a core outcome set (COS) for research on masculinizing gGAS to address this issue.MethodsAn international, multidisciplinary study steering group was established, consisting of 16 professional experts (PE) and lived experience experts (LEE), to advise on and support the development of this COS. The steering group convened online on 16 June 2022, 28 September 2023, 2 May 2024, and 29 August 2024. Potential outcomes were identified through interviews and focus groups with LEE and a systematic literature review convened up to September 2023. LEE and PE were recruited globally via websites, social platforms, scientific meetings, patient organizations, and posters and invited to participate in three e-Delphi survey rounds. In the first round, participants rated each outcome's importance on a 5-point Likert scale and provided reasoning for their rating. In subsequent rounds, participants re-rated the outcomes using illustrative quotes and rankings based on prior ratings to refine consensus. Pre-defined criteria guided outcome inclusion and exclusion. A final online consensus meeting with LEE and PE finalized the COS.FindingsInitial outcome gathering identified 384 unique outcomes, of which 38 outcomes were selected for the e-Delphi survey rounds. Thirty-two LEE and 52 PE participants, most from Europe, the UK, and the USA, completed all three survey rounds (February, May, and July 2024). Final consensus was reached in September 2024 on including one clinical outcome, three adverse events, and six patient-reported outcomes in the COS for masculinizing gGAS. The core outcomes are sensibility in the neo-phallus, additional surgery, ability to achieve orgasm, sexual well-being, and satisfaction with neo-genital aesthetics. For urethral lengthening, additional core outcomes include neo-urethral fistula, stricture, and the ability to void while standing. For phalloplasty, additional outcomes are flap necrosis and donor site morbidity.InterpretationDeveloping a COS for masculinizing gGAS is a crucial step towards standardized outcome measurement and reporting in clinical research. Implementation could facilitate data comparison, meta-analysis and evidence-based guideline development, ultimately improving personalized surgical care.FundingNone received.

Emotional responses during anterior cruciate ligament (ACL) rehabilitation are described as a 'linear' or 'U-shaped' pattern, indicating not all athletes exhibit the same emotional pattern. Therefore, this study aimed to (1) identify emotional patterns during the early- and mid-stage phases of rehabilitation after ACL reconstruction (ACLR), and (2) investigate differences in patient-specific characteristics among these patterns. Patients completed the Photographic Series of Sports Activities for Anterior Cruciate Ligament Reconstruction (PHOSA-ACLR), and Dutch language short Anterior Cruciate Ligament Return to Sport after Injury scale (short ACL-RSI-NL) preoperatively and 6 weeks, 3 months and 6 months postoperatively. Cluster analysis was conducted to identify groups with similar emotional score patterns over time. Changes in scores between consecutive time points (deltas) were calculated for clustering, after which the optimal number of clusters was determined, and K-means clustering was performed. One hundred and twenty-eight patients completed both surveys at all time points. Patients displayed an 'A-shaped', 'U-shaped' or 'zigzag' pattern. Patients with an A-shaped PHOSA-ACLR pattern were significantly younger than patients with a zigzag pattern (p = 0.01). Recreational athletes who are not in competition less often followed an A-shaped short ACL-RSI-NL pattern (p < 0.002). Patients with an A-shaped short ACL-RSI-NL pattern had significantly higher preoperative scores than patients with a U-shaped (p < 0.001) or zigzag pattern (p < 0.003). Patients with a U-shaped short ACL-RSI-NL pattern had lower scores at six months postoperatively than those with A-shaped or zigzag patterns. Patients' emotions before and after ACLR follow three patterns: 'A-shaped', 'U-shaped', or 'zigzag'. These patterns are significantly related to age (PHOSA-ACLR) and level of sport involvement and preoperative readiness to RTS (short ACL-RSI-NL). Level III.

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a ‘sense of knowing’ is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.

The aim of this cross-sectional study was to identify post-COVID-19 condition (PCC) phenotypes and to investigate the health-related quality of life (HRQoL) and healthcare use per phenotype. We administered a questionnaire to a cohort of PCC patients that included items on socio-demographics, medical characteristics, health symptoms, healthcare use, and the EQ-5D-5L. A principal component analysis (PCA) of PCC symptoms was performed to identify symptom patterns. K-means clustering was used to identify phenotypes. In total, 8630 participants completed the survey. The median number of symptoms was 18, with the top 3 being fatigue, concentration problems, and decreased physical condition. Eight symptom patterns and three phenotypes were identified. Phenotype 1 comprised participants with a lower-than-average number of symptoms, phenotype 2 with an average number of symptoms, and phenotype 3 with a higher-than-average number of symptoms. Compared to participants in phenotypes 1 and 2, those in phenotype 3 consulted significantly more healthcare providers (median 4, 6, and 7, respectively, p < 0.001) and had a significantly worse HRQoL (p < 0.001). In conclusion, number of symptoms rather than type of symptom was the driver in the identification of PCC phenotypes. Experiencing a higher number of symptoms is associated with a lower HRQoL and more healthcare use.

Back pain is the leading cause of years lived with disability worldwide, yet surprisingly, little is known regarding the biology underlying this condition. The impact of genetics is known for chronic back pain: its heritability is estimated to be at least 40%. Large genome-wide association studies have shown that common variation may account for up to 35% of chronic back pain heritability; rare variants may explain a portion of the heritability not explained by common variants. In this study, we performed the first gene-based association analysis of chronic back pain using UK Biobank imputed data including rare variants with moderate imputation quality. We discovered 2 genes, SOX5 and PANX3 , influencing chronic back pain. The SOX5 gene is a well-known back pain gene. The PANX3 gene has not previously been described as having a role in chronic back pain. We showed that the association of PANX3 with chronic back pain is driven by rare noncoding intronic polymorphisms. This result was replicated in an independent sample from UK Biobank and validated using a similar phenotype, dorsalgia, from FinnGen Biobank. We also found that the PANX3 gene is associated with intervertebral disk disorders. We can speculate that a possible mechanism of action of PANX3 on back pain is due to its effect on the intervertebral disks.

Abstract Low voltage distribution grids play an important role in the energy transition—both in generation and demand. In the coming decades the reliability of these grids may deteriorate due to asset ageing. Various maintenance (replacement) strategies are compared in order to mitigate this. For multiple scenarios, it is analysed under which circumstances and when alternative strategies are more profitable than current practice towards managing low voltage assets. Under all scenarios utilities are advised to actively seek collaboration with other utilities and institutions in order to increase efficiency, reduce nuisance, achieve future‐proofness and minimise risks. Also, opportunities for condition‐based approaches exist with the increasing application of distribution automation.

ABSTRACT Working with groups of parents in career development services in secondary schools is rare practice and little researched. This article focuses on the pedagogy applied in one such intervention, “Parents Turn,” supporting family learning and community learning. The secondary analysis of qualitative data collected from parents has been used to evaluate the pedagogy on which the intervention was based. It shows that group work is feasible in a school-based intervention and reflects on some issues to enhance such parent-involved career development services in secondary schools.