HAN University of Applied Sciences

Background The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years. Methods A working group ( n = 43 members) conducted a literature search spanning 2019–2024 using the keywords “Global Leadership Initiative on Malnutrition or GLIM.” Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus. Results More than 400 scientific reports were published in peer‐reviewed journals, forming the basis of 10 systematic reviews, some including meta‐analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5‐year update. Conclusion Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

The concept of climate justice extends traditional environmentalism by emphasizing the social dimensions of environmental issues. Recently, it has gained much attention due to the growing impacts of climate change, especially on vulnerable communities that contribute minimally to global emissions. Based on the need for research in this field, this paper reports on a study that examined how higher education institutions (HEIs) are integrating climate justice into education, based on a literature review and a set of case studies. These cases highlight actions undertaken by various HEIs to incorporate climate justice into education across the globe. Based on the increasing number of publications, the findings show a growing research interest in the topic and reveal that some countries such as the US, the UK, China, Australia, and Germany have a visible presence in the literature. It also provides a wide range of perspectives on educational practices in climate justice, including real-world examples of courses implemented in HEIs. The findings reveal that HEIs have significant potential to address climate justice in their educational programs, which may help to transform students’ values and actions despite challenges.

Purpose: To translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) to Dutch for the Belgian and Dutch populations, and to investigate its measurement properties in the general population and physiotherapists. Methods: The adaptation followed established guidelines. Content validity, internal consistency, test-retest reliability (intraclass correlation coefficient), floor and ceiling effects, minimal detectable change (MDC), construct validity, and structural validity were assessed in physiotherapists and the general population. The modified Fear-Avoidance Beliefs Questionnaire (mFABQ) investigated the Back-PAQ's convergent validity, and Confirmatory Factor Analysis evaluated structural validity. Discriminant validity was assessed between physiotherapists and the general population. Results: Two hundred and sixty participants (mean age: 29 ± 13.3) completed the initial survey and 147 completed the test-retest survey. All Back-PAQ versions (34-item, 20-item, and 10-item) demonstrated good internal consistency, good to excellent test-retest reliability. Moderate correlations with the mFABQ (p < 0.001) and adequate discriminant validity between physiotherapists and the general population supported robust construct validity. The Back-PAQ 10 exhibited a good model fit and enables meaningful sub-score comparisons. Conclusions: This collaboration produced a validated Dutch Back-PAQ suitable for use in both the Netherlands and Belgium. All versions demonstrated robust measurement properties, supporting their use in clinical and research settings assessing unhelpful beliefs in back pain management. h IMPLICATIONS FOR REHABILITATION • The Dutch Back Pain Attitudes Questionnaire (Back-PAQ) exhibits strong measurement properties, supporting its application in both clinical practice and research contexts. • The Dutch translation of the Back-PAQ demonstrates good to excellent reliability and construct validity, making it suitable for health-care practitioners to assess recovery-impeding beliefs about back pain within the general population. • The factor structure of the 10-item version of the Back-PAQ 10 has been further analysed using a Confirmatory Factor Analysis, facilitating a practical comparison of its sub-score outcomes in a clinical setting.

This approach offers a structured method for organizations to develop and articulate their ethical frameworks, particularly in areas where legal guidance is limited or nonexistent. Problem: This study investigates establishing core values in a legal vacuum, where research, design, or implementation of an invention or innovation is feasible but lacks regulations. We leverage Large Language Models (LLMs) to analyze codes of conduct from 1000 organizations (profit and not-for-profit) to identify core values. Metrics such as accuracy, bias, completeness, consistency, and relevance are used to validate the performance of LLMs in this context. From 493 non-profit organizations and companies on the Fortune 500 list, a total of 8646 core values including variations across 89 sectors were found. Using accuracy, bias, completeness, consistency and relevance as metrics for evaluating result from the LMMs, the number of core values is reduced to 362. The research employs a ten-step decision-making process to guide ethical decision-making when clear rules, laws, or regulations are absent. The framework presents how objectivity can be maintained without losing personal values. This research contributes to understanding how core values are established and applied in the absence of formal regulations.

Purpose Many elite road-race cyclists have low areal bone mineral density (aBMD) as previously shown by dual-energy X-ray absorptiometry (DXA). However, aBMD provides limited insight into bone quality. Therefore, this cross-sectional study aimed to assess volumetric BMD (vBMD), bone microarchitecture, and bone strength in elite road-race cyclists using high-resolution peripheral computed tomography (HR-pQCT), along with aBMD measured by DXA. Methods Twenty female elite (Tier 3/ 4) road-race cyclists (21 ± 2 y; BMI 20.8 ± 1.6 kg/m ² ) had DXA scans at the hip, lumbar spine, and total body to assess aBMD, and HR-pQCT scans at the distal radius and tibia to assess vBMD, bone microarchitecture, and failure load. Z -scores were calculated for all outcomes, with Z -scores <-1 considered as low or impaired. The risk of low energy availability was assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). Results Low aBMD was observed in 20%, 25%, 35%, and 10% of the participants at the hip, femoral neck, lumbar spine, and total body, respectively. Low total vBMD was present in 45% and 40% at the distal radius and tibia, respectively. With regard to bone microarchitecture, the tibial cortical area and tibial cortical thickness were low in 40% and 60% of the participants, respectively, and number and thickness of trabeculae at the tibia were low in 40% and 30% of the participants. The impairments were less pronounced at the distal radius. Failure load was low in 15% (radius) and 20% (tibia) of the participants. Conclusions Along with low aBMD, a substantial proportion of female elite cyclists had impaired bone microarchitecture, mainly characterized by a low cortical area and thickness and low trabecular number and thickness, especially at the distal tibia.

This paper presents a case study from the Center for International Research (CIBR) at HAN International School of Business, which has employed a systematic change management approach to transition toward sustainability. The objective of this paper is to clarify this process through the introduction of a six-step framework named TRANSITION and it reflects particularly the involvement of the research team in the process. Based on this framework, the center first aligns its direction with the strategic plan of the university, emphasizing the imperative to prioritize sustainability in its research agenda. Second, the research team conducts an inventory of existing knowledge and expertise, grouping efforts, and assessing individual progress. Third, the team develops a shared vision by defining the research team’s domain as transitioning toward sustainability. Subsequently, the team establishes four distinct research lines and integrates both short-term and long-term goals. Lastly, it is vital for researchers to embrace these changes, thereby enhancing the skills of certain researchers and transferring knowledge to colleagues and the community. This paper introduces the TRANSITION framework developed at CIBR to realign the research center toward sustainability.

Objectives The adoption and subsequent implementation of telemonitoring across university hospital settings is a challenging task. This study provides insight into the perceived value of using a nationwide network to support scaling up telemonitoring in university hospitals. Methods A qualitative approach was used to evaluate the role of the National eHealth network ‘Citrien eHealth programme Implementation and Upscaling (Citrien-2)’. In phase 1, an inventory questionnaire was used to identify successes and lessons learnt. Phase 2 consisted of a semi-structured group interview to develop a deeper understanding about the potential value of the network. Subsequently, we conducted a qualitative content analysis and results were organised into key themes of the non-adoption, abandonment, scale-up, spread and sustainability framework. Results In total, 20 participants responded to our questionnaire, and 7 participants participated in our semistructured group interview. Qualitative analysis revealed 28 themes. The network’s key value is the collaboration and structured approach it promotes. This serves as a foundation for exchanging ideas, identifying both temporary and sustainable funding, and establishing a robust stakeholder position, all of which serve to act as a catalyst for implementation and scaling up of telemonitoring. Discussion Our findings align with known barriers to digital innovation, such as funding and legal issues. Our study shows the value of a nationwide network in overcoming these barriers. Conclusions The Citrien-2 nationwide network contributes to scaling up telemonitoring across university settings. Therefore, we recommend that governments and their funding agencies recognise and embrace the power of these nationwide networks in scaling up digital initiatives.

Higher education institutions are challenged to educate students for an uncertain future. Adaptive expertise (AE) is needed to thrive in an uncertain future: the ability to respond successfully to altered situations and changing circumstances. Work-based learning (WBL) environments would allow students to develop AE. However, knowledge about how WBL contributes to AE development in higher education is scarce. This paper reports on a realist review to understand and explain how, why and in what circumstances WBL leads to AE development. Three narratives illustrate how working in challenging conditions, interacting with others and stimulating a willingness to learn were associated with AE development through WBL as a result of shifts in perspective and thinking. Five work-based learning elements for AE development were identified: integrative challenging contexts, reflective practice, interacting with others, guidance and learner characteristics. Future research should focus on how working in challenging situations, interactions with others and guidance interact to stimulate AE development in different types of WBL environments.

Both supervisors and students play an active role in facilitating workplace learning in healthcare placements. In workplace learning, affordances, referring to the opportunities for learning in the workplace, and agency, referring to the willingness and ability to engage with affordances, are central concepts. To fully utilize the potential of workplace learning, crucial is the extent to which supervisors and students interactively and intentionally engage with affordances for learning in placements. In current literature, the concepts of supervisor agency and student agency are studied individually, but limited understanding exists of how supervisors and students interactively manifest agency in workplace learning. This single case study characterizes agency in supervisors’ and students’ interacting strategies throughout a twenty-week placement. The study focuses on interacting strategies of two supervisors and one student in a revalidation centre, in the context of a student-physiotherapist’s bachelor program in Dutch University of Applied Sciences. Data were collected through observations and interviews. Three strategies of supervisors were identified to elucidate agency in workplace learning: (1) demonstration, (2) stimulated participation and (3) entrustment. Correspondingly, students used three interacting strategies: (1) learner stance, (2) negotiated participation and (3) independency. Agency in workplace learning is manifested as continuous alternations in these supervisors’ and students’ interacting strategies, highlighting the interactive nature of agency in workplace learning. The study contributes by providing insight into the real-life mechanisms of facilitating workplace learning, where interacting strategies of supervisors and students reveal the full learning potential of workplace learning.

The share of internationally mobile students has risen exponentially for the last two decades until the disruptive COVID-19 period, leading to a more diverse and multipolar network structure. However, the COVID-19 pandemic has caused restrictions across the globe. This systematic review aims to explore how COVID-19 has affected the magnitude, flows, and direction of internationally mobile students. A total of 57 studies, retrieved from several databases after extensive search, were analyzed regarding the dimensions of size, flow, direction, and pattern in international student mobility during the pandemic. The review suggests that following the pandemic, international student mobility was still dominated by the top-tier countries due to their swift actions and incremental policies, while some other countries gained visibility for international students and attracted more international students owing to students’ safety concerns and revised international student policies of the countries. Further, students’ study abroad decisions from source countries seemed to be shaped by the policies and regulations implemented during the pandemic, the political environment of the destination country, and personal concerns about safety and getting the most out of the study abroad experience. These factors reshaped the directional flow of international student mobility and study modality, particularly concerning regionalization and digital transformation for higher education institutions.

Internationalization, global citizenship, and sustainable development are key themes in modern higher education. Internationalization aims to develop intercultural competence as a component of global citizenship education to enable people from different backgrounds to work together to achieve sustainable development goals. We examine internationalization at home through an undergraduate intercultural virtual collaboration course between a business school at an applied sciences university in the Netherlands and a global business program at an international liberal arts university in Japan. During the course, students work virtually in diverse teams on a business case project while also completing individual and teamwork tasks designed to develop intercultural competence. Students select a multinational firm providing consumer products in both the Netherlands and Japan and compare the firm’s approach and communication regarding reducing plastic waste associated with their products in each country. We employ the Participatory Action Research approach to analyse the effectiveness of the course and identify potential improvements. In this chapter, we investigate the students’ personal learning goals and achievements, their perceptions of culture as a challenge to work in a diverse team, and how they learn to navigate these cultural challenges to achieve their shared goals. We find that effective communication is a significant challenge for students in their teamwork. The understanding of the role of silence as non-verbal communication differs substantially between students from cultures with high context (Japan) and low context (the Netherlands) communications styles. Furthermore, differing cultural values regarding team harmony affect students’ willingness to engage in open discussion. Well-structured intercultural learning experiences support students’ ability to overcome these challenges and develop their intercultural competence.

Background Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. Methods A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. Results A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. Conclusion The aim of this article is to summarize and enhance physiotherapists’ essential knowledge of the differential diagnosis and management of patients with DCM.

Aim To assess the impact of a person-centred culturally sensitive approach in primary care on the recognition and discussion of mental distress in refugee youth. Background Refugee minors are at risk for mental health problems. Timely recognition and treatment prevent deterioration. Primary care is the first point of contact where these problems could be discussed. However, primary care staff struggle to discuss mental health with refugees. Guided by the needs of refugees and professionals we developed and implemented the Empowerment intervention, consisting of a training, guidance and interprofessional collaboration in four general practices in the Netherlands. Methods This mixed-method study consisted of a quantitative cohort study and semi-structured interviews. The intervention was implemented in a stepped wedge design. Patient records of refugee youth and controls were analysed descriptively regarding number of contacts, mental health conversations, and diagnosis, before and after the start of the intervention. Semi-structured interviews on experiences were held with refugee parents, general practitioners, primary care mental health nurses, and other participants in the local collaboration groups. Findings: A total of 152 refugees were included. Discussions about mental health were significantly less often held with refugees than with controls (16 versus 38 discussions/1000 patient-years) but increased substantially, and relatively more than in the control group, to 47 discussions/1000 patient-years (compared to 71 in the controls) after the implementation of the programme. The intervention was much appreciated by all involved, and professionals in GP felt more able to provide person-centred culturally sensitive care. Conclusion Person-centred culturally sensitive care in general practice, including an introductory meeting with refugees, in combination with interprofessional collaboration, indeed results in more discussions of mental health problems with refugee minors in general practice. Such an approach is assessed positively by all involved and is therefore recommended for broader implementation and assessment.

Purpose To identify, summarize, and synthesize barriers and facilitators associated with interprofessional education (IPE) for work-focused healthcare professionals such as occupational physicians, social insurance physicians, and labor experts, to inform and stimulate interprofessional collaborative practice within the field of work-focused healthcare. Methods An integrative review was conducted to identify studies that report on IPE for work-focused healthcare professionals. Eight databases (APA PsycInfo, CINAHL, Cochrane, Embase, ERIC, Google Scholar, PubMed, Web of Science) were searched until March 2024. Reference lists of included articles were screened. Inclusion criteria were a description of an IPE activity of which at least one group of participants were work-focused healthcare professionals (in training). Barriers and facilitators were structured using the framework of Measurement Instruments for Determinants of Innovation (MIDI). Results From 6123 studies, seven were included. Barriers and facilitators were identified for each level of the MIDI framework. For example, at the level of characteristics of the IPE activity, involvement of skilled educators and reflection opportunities facilitated IPE. At the level of characteristics of IPE participants, role misunderstanding and lack of interaction hindered IPE. At the level of the organizational context, connection to work practice facilitated IPE. At the level of socio-political context, lack of support from external organizations hindered IPE. Conclusion Insights from this review can inform future IPE development. It is recommended that IPE is integrated in a learning continuum, is connected to daily practice, and includes reflection possibilities and training for interprofessional competencies.

Older people value their independence and prefer to live in an environment they are familiar with and can benefit substantially from vital communities. The objective of this study is to examine the theorised contribution of vital communities to successful ageing in place, as increasing numbers of older people in western societies, are living longer independently at home, while their need for support gradually increases. A modified Delphi study was conducted and consisted of two stages. In the first stage, we conducted two panel discussions in order to develop statements representing the theorised contribution of the features of vital communities to the key themes of ageing in place. This was followed by the second stage which had three online Delphi rounds, and which aimed to reach a consensus among 126 international experts concerning the theorised contribution. The findings of this study showed a consensus among the experts about aspects that show the positive contribution with regard to the aim of vital communities (quality of life, belonging), and all the key themes of ageing in place (place, technology, social networks, support, personal characteristics). However, experts nuanced the theorised contribution of the mechanisms and typical characteristics of vital communities and the key theme of technology. According to the experts, whether technology contribute depends on the skills of older people and the type of technology. The findings of this study imply that vital communities could facilitate older people to age in place for as long as possible, while maintaining their quality of life.