Belgian Government Research Articles

Status of the MINERVA cryomodules and associated cryogenic system (MYRRHA phase 1)

MYRRHA at SCK CEN in Mol/Belgium will be a pre-industrial large-scale Accelerator Driven System for unparalleled research opportunities in spent nuclear fuel, nuclear medicine, and fundamental and applied physics. In 2018 the Belgian government released funding for MYRRHA’s first phase, MINERVA, for a staged implementation and operation. It covers the design, construction, and commissioning of the continuous-wave superconducting RF proton linac up to 100 MeV, as well as dedicated user target stations. The MINERVA proton linac will accommodate 30 identical cryomodules to boost the beam energy delivered by the normal-conducting frontend from 16.6 MeV to 100 MeV. Each cryomodule will contain two superconducting RF single-spoke cavities immersed in a superfluid Helium bath at 2 K. The design and architecture of the associated cryogenic system is derived from the stringent linac reliability requirements imposed by the future subcritical nuclear reactor. We present the architecture, design, and development status of the MINERVA cryomodules and associated cryogenic system towards the implementation phase of the project as part of a collaboration between ACS, CEA/DSBT, IJCLab, and SCK CEN. We also provide an overview of the initial outcomes of cryogenic and RF tests for the prototype MINERVA cryomodule, which are still ongoing at IJCLab.

Large-scale real-world data on a multidisciplinary approach to spinal cord stimulation for persistent spinal pain syndromes: first evaluation of the Neuro-Pain® nationwide screening and follow-up interactive register.

Spinal cord stimulation is a common treatment option for neuropathic pain conditions. Despite its extensive use and multiple technological evolutions, long term efficacy of spinal cord stimulation is debated. Most studies on spinal cord stimulation include a rather limited number of patients and/or follow-ups over a limited period. Therefore, there is an urgent need for real-world, long-term data. In 2018, the Belgian government initiated a nationwide secure platform for the follow-up of all new and existing spinal cord stimulation therapies. This is a unique approach used worldwide. Four years after the start of centralized recording, the first global extraction of data was performed. Herein, we present the findings, detailing the different steps in the centralized procedure, as well as the observed patient and treatment characteristics. Furthermore, we identified dropouts during the screening process, the reasons behind discontinuation, and the evolution of key indicators during the trial period. In addition, we obtained the first insights into the evolution of the clinical impact of permanent implants on the overall functioning and quality of life of patients in the long-term. Although these findings are the results of the first data extraction, some interesting conclusions can be drawn. The long-term outcomes of neuromodulation are complex and subject to many variables. Future data extraction will allow us to identify these confounding factors and the early predictors of success. In addition, we will propose further optimization of the current process.

'Integrated antenatal care pathway':  a regional experience in Belgium (Flanders).

In a 2019 publication, the KCE (the Federal Knowledge Center, an independent research institution providing scientific advice on health care as requested by the Belgian government) proposes to monitor all pregnant women in Belgium through an “Integrated Antenatal Care pathway”. The baseline care needs to be expanded in case of high medical risk or psychosocial vulnerability.
 This advice addressed some new aspects: the extension of the classic clinical (medical) follow-up with Individual Counseling Consultation (ICC) sessions, sessions for Birth Preparation and Parenthood Education (BPPE). The pregnant woman chooses one health care provider as coordinator. The coordinator draws up an individual care plan and, if necessary, extends the standard counseling (general practitioner, gynecologist, midwife, physiotherapist and regional child guidance services) to a social worker, mental health care professionals and other specialists. The coordinator organizes Multidisciplinary Antenatal Consultation (MAO) if needed. Holistic view on patientcare and shared decision making are keypoints.
 In the East Flemish Brabant region, the execution of such an integrated care pathway was started following this advice and has been implemented since late 2021 under coordination of vzw De Bakermat, a center of expertise in Maternity care.
 The Bakermat previously also set up a pilot project called 'Kort in Kraamkliniek' (KIK), a postnatal care pathway, to reduce the length of postnatal hospital stays in the region, also upon request by the government. Similarly, seamless transition of the transmural care was crucial for the patient.
 The development of the integrated antenatal care pathway was a challenging, complex process of co-creation, involving a large number of partners in the region from the start. The region spanned across the entire ""Plexus"" hospital network covering 585,000 inhabitants, consisting of three regional and one supra-regional (university) hospital. Collaboration occurred across lines and trans-disciplinary. Existing organizations with local initiatives of integrated care and well-being were involved, in light of their shared vision and expertise. Therefore, the project did not only create a care pathway but also a strong interconnectedness between all partners involved!
 The project resulted in uniformity and greater clarity for caregiver and care recipient. One follow-up schedule was created and all patient info was centralized. At the beginning of each pregnancy, there is a screening for psychosocial vulnerability, through a scientifically validated tool (Born In Belgium, antenatal screening of vulnerability). Red flags for referral from primary to secondary care were listed to maximize the use of additional expertise.
 Electronic data sharing in a joint patient file is complex and will be further developed.
 The quality of the project is continuously monitored through a set of indicators coordinated by the Academic Center for General Practice of the KULeuven. Regular training sessions are organized by and for all project partners. Meanwhile, the regional coordination and adjustment of the project in the future is embedded in and provided by the center of expertise for maternity care.
 

Optimization of the (pharmacotherapeutic) treatment and care of the diabetes type 2 patient in Belgium through multidisciplinary collaboration between general practitioner and community pharmacist

Introduction: Diabetes type 2 is a chronic condition that can lead to devastating micro-and/or macrovascular complications in the long term when not treated properly. This causes decreased health-related quality of life and an increased risk for morbidity and mortality. Despite safe and effective drugs, there are major challenges in the treatment of diabetes type 2: (1) medication adherence, (2) optimizing pharmacotherapy, (3) non-pharmacotherapy related care (e.g.;eyecare, cardiovascular risk, footcare…). It is clear that the care for these patients can no longer be treated monodisciplinary and that it requires a level of care from the community pharmacists (CP) that goes beyond usual dispensing. The added value of a multidisciplinary collaboration between the CP and general practitioners (GP) lies in a combination of knowledge and competences and joint responsibility.
 Policy Context And Objective: In 2018, the Royal Association of Pharmacists in Antwerpen (KAVA) and Domus Medica have developed a quality improving program (QIP) in the context of Medical-Pharmaceutical Concertation (MPC). MPC is an initiative from the Belgian Government for Health Insurance (RIZIV) to promote the rational prescribing and dispensing of medication and the safe use of medication in general and provides financial incentives to GP and CP to organize local MPC-projects, based on a QIP. A local MPC-project starts with a ‘kick-off meeting’, to make agreements of the rational use of medication. Most of the time, different cases are discussed in small interprofessional groups. After this meeting, the agreements are subsequently implemented into practice and can be evaluated with quality indicators. 
 This specific QIP focusses on five modules: (1) the pathogenesis of different forms of diabetes, diagnosis, complications and non-pharmacological treatment, (2) Guidelines / medication groups - Treatment of comorbidities and reimbursement criteria, (3) case studies of different patient with heart failure, renal insufficiency, overweight, (4) Care pathways and adherence to therapy, and (5) the safe use of antidiabetics during Ramadan for a specific population.
 Target Population: MPC targets the GP and CP with mutual diabetes type 2 patients. 
 Highlights: KAVA and Domus Medica strongly believe in this initiative. Currently 17 local MPC-projects have been organized in which 102 CP and 122 GP participated. The 4 most important topics of these MPC-projects are:
 •lifestyle intervention, comorbidities and pharmacotherapy
 •Overview and objective of care pathways and organizing good use medication (GGG) interview by CP & feedback to GP
 •Adherence 
 Conclusion: A MPC is a promising service to support evidence-based practice for optimizing treatment of diabetes patients through constructive collaboration between GP and CP. There was a particular need for good information about the treatment options for diabetes, comorbidities and lifestyle. A second point of attention was the care pathways, which are clearly insufficiently known, let alone implemented. There is certainly a strong will in the local MFO projects to work on compliance, as evidenced by the many indicators around the GGG. Unfortunately, we have no insight into whether these have been effectively worked out in practice and further research is necessary to analyze the impact.

Dementia coaching: the missing link in primary care

Introduction: Each Belgian township has inhabitants who suffer from dementia and this prevalence will continue to rise. Not only Belgium but also other European countries are facing this increase.
 In Belgium, on average 70% of people with dementia are living and receiving care at home.
 Policy Context And Objective: There are many services available for people with dementia. The organization of these services is however, highly fragmented and difficult to navigate. Additionally, the multidisciplinary integration and coordination is limited.
 In 2015, the Belgian government approved a plan called “Integrated Care for a better health”, which led to the development of 12 pilot projects that aim to provide high quality care and support to patients through the implementation of different actions. One of these actions in the Waasland regional project aims to target the challenges as described above through the dementia coaching approach. This approach was developed and implemented bottom-up since 2019, with the input of informal caregivers and the Alzheimer’s patient organization.
 Subsequently, in 2021 a similar approach was developed for people with Parkinson’s disease.
 Target Population: The action targets people who are diagnosed with dementia, as well as their informal caregivers in the Waasland region. In October 2022, already 216 families have received guidance from one of the regional dementia coaches.
 Highlights: The dementia coaching approach is a unique initiative that targets coordination of care across organizations. It aims to be the “missing link” through a multidisciplinary coaching team of both self-employed coaches and coaches employed by the different regional health care organizations. Their main task is to assist in navigating the regional health systems and organizations, by house and/ or telephone calls.
 The regional hospital is an additional partner of the project alongside the primary care organizations.
 The approach aims to improve the perceived quality of care as well as patient empowerment. The project is continuously evaluated and improved based on its user experiences. The coaches need to follow a mandatory training and participate in peer reviews to ensure that they share a quality-based vision and approach.
 Since dementia coaching receives state funding for the pay of the coaches, it allows the approach to be offered without additional costs for its users. This improves accessibility of care.
 
 Transferability And Conclusion: The dementia coaching approach is already being implemented for people with Parkinson’s disease. The approach shows possibilities to be transferred to other target populations as well (e.g. other chronic diseases) and could be useful for people with comorbidities. This option is currently being explored.
 Additionally, the approach has the potential to be implemented in other regions and/or countries that are willing to add this missing link.
 Key words: pilot projects – co-creation – dementia – chronic disease - integrated care
 

Aqueous Solution-Gel Deposition of Copper-Based Photo-Electrodes for Multipurpose Photo-Electrochemical Systems

Efficient valorization of solar energy is expected to contribute significantly to a sustainable supply of energy and fuel sources, as well as the reduction of atmospheric pollution. To this end, photo-electrochemical systems show encouraging potential by converting light into chemical energy. These devices rely on semiconducting photoanodes and/or -cathodes that absorb light efficiently and generate electron-hole pairs with sufficient energy for initiating redox reactions. Several copper-based oxides exhibit appropriate band edges for both photo-electrochemical water splitting and CO2 reduction [1]. This, in combination with their bandgap values, low toxicity, and earth-abundance, has recently increased the attention for copper-based photo-electrodes for multipurpose photo-electrochemical systems. Substantial photocorrosion of CuO and Cu2O is the main issue restricting their application as functional photo-electrodes. In contrast, copper-based ternary oxides are found to be significantly less susceptible to photocorrosion. The citrate-based aqueous solution-gel method has proven to be a versatile approach for the formulation of stable aqueous metal ion precursor solutions, and the subsequent synthesis of (doped) multi-metal oxides by this method has been demonstrated numerously. [2,3] Still, due to the flexible redox chemistry of copper, the solution-gel synthesis of phase-pure copper-based ternary oxides remains challenging. This work describes the synthesis of copper-based photo-electrode materials by focusing on copper ferrite (CFO), copper tungstate (CWO), copper niobate (CNO), and copper bismuth oxide (CBO). The formulation of the respective precursor solutions is described, and their thermal decomposition is investigated. Thin-film photo-electrodes are deposited on transparent conductive substrates by spin coating. The phase purity of the resulting copper-based oxides is determined by X-ray diffraction and Raman spectroscopy. Using UV-Vis spectroscopy, the optical bandgap of the oxide semiconductors is calculated. Furthermore, the photo-electrodes are subjected to linear sweep voltammetry in dark and under illumination to evaluate their photo-electrochemical performance. [1] Wang et al. “Insights into the development of Cu-based photocathodes for carbon dioxide conversion” Green Chem. (2021) 23, 3207[2] Van den Rul et al. “Aqueous Solution-Based Synthesis of Nanostructured Metal Oxides” in “Handbook of Nanoceramics and Their Based Nanodevices” (2009) Ed. T-Y Tseng and H. S. Nalwa[3] Marchal et al. “Precursor Design Strategies for the Low-Temperature Synthesis of Functional Oxides: It’s All in the Chemistry” Chem. Eur. J. (2020) 26, 9070 This work has received funding from the Belgian federal government through the ETF project T-REX and from the VLAIO network “Flanders Innovation & Entrepreneurship” through the Catalisti Moonshot project SYN-CAT. Part of this work was financially supported by TNO in the framework of the “Energy Conversion and Storage” Early Research Program.

Does organizational change trigger civil servant proactivity? The impact of past changes experienced

ABSTRACTCivil servants are increasingly expected to behave proactively at work, being confronted with workplace changes that require increased autonomy and responsibility. However, proactivity is a resource-intense behaviour that may become increasingly difficult in a demanding work context characterized by frequent change. We examine the impact of organizational change on civil servant proactivity, taking into account civil servants’ past change experiences. Analysis of two survey waves in a Belgian government agency reveal that civil servants who experienced many changes in the past behave less proactively in response to new changes compared to their colleagues who only experienced few past changes.

The discursive construction of a news event: Access and legitimation in the media framing of an escalated anti-asylum protest in Belgium

Abstract In October 2019, the Belgian government announced the opening of an asylum center in a former retirement home, leading to civic and political protest that escalated into arson. We examine the construction of the events before, on, and after the arson by analyzing 135 articles from Flemish newspapers, the public broadcaster’s news website, and alternative media between October 25 and November 30, 2019 using qualitative content analysis. Our analysis emphasizes journalists’ role as gatekeepers, deciding which actors get access and legitimation in media coverage. Focus is on the dynamic process of how events become discursively constructed through the interventions of journalists and their sources attempting to gain primary definer status. Our analysis confirms that institutional sources remain more likely to achieve primary definer status in legacy news media. Alternative media perform similar discursive interventions as legacy news media but utilize them to provide access and legitimacy to different actors and standpoints. In the first days of news coverage, in particular, the narratives developed in right-leaning alternative media seemed to spread in legacy news media. In the following days, governmental actors and experts, through their interventions in legacy news media, were able to steer the discourse in a different direction.

“Encore Merci de Votre Collaboration et Bravo!” Albert Van Buylaere, a Belgian Intelligence Agent during World War II

Although World War II intelligence and action services are an important research topic in current Belgian intelligence studies, researchers until recently never focused solely on the Benoît network in their studies. However, this organization was of vital importance for the successful transmission of the intelligence that had been gathered by the Belgian government and State Security in London. One of Benoît’s key members was Albert Van Buylaere who was considered “brilliant” by his superiors. This article gives an overview of his motives and actions and gives a first impression of why he was so sought after by various intelligence agencies during the Cold War. After a brief discussion on the organization and activities of this network and the main events around it, the focus will shift to his activities.

Evaluating achieving tobacco control targets in Belgium using modelled projections

Abstract Background Tobacco use in Belgium remains a key public health concern with an estimated 15% of adults reporting daily tobacco use in 2018. In 2022, the Belgian government launched the “Interfederal Strategy 2022-2028 for a Smoke-free Generation.” The strategy outlines a number of targets for reducing daily tobacco use among adults 15+ years and young adults 15-24 years. We evaluate the feasibility of achieving these targets given current daily smoking trajectories at a national and regional level. Methods We modelled time trends of smoking in Belgium based on repeated cross-sectional data taken from the nationally representative Belgian Health Interview Survey. We applied a Bayesian inference model, the integrated nested Laplace approximation, to obtain a time series of daily tobacco use for adults by age, sex, and region of Belgium from 1997 to 2018. We then projected this model to 2070 using population projections from the Belgian Federal Planning bureau for population distributions. We compared trajectories with targets from the Interfederal Strategy to assess whether they are likely to be achieved. Results The national target of reducing daily smoking among adults 15+ years to 10% by 2028 and 5% by 2040 will not be achieved on current trajectories. Wallonia has the highest level of people smoking daily and is projected to miss the targets by the largest margin. Flanders is expected to reach the 10% threshold by 2032. The target for reduction of prevalence of daily smoking among youth 15-24 years to 6% by 2028 will not be achieved before 2040. Smoking among the youngest age group (15-24 years) is decreasing rapidly with prevalence of daily smoking in that age group projected to be < 2% in Flanders by 2059. Conclusions No region of Belgium is expected to achieve targets for reduction in daily smoking given current trajectories. Tobacco control policies in the country should be re-assessed, targeted and intensified. Key messages • The Belgian national target of 5% daily smoking prevalence in adults by 2040 will not be achieved. • Differences in smoking trajectories in Belgium exist by age and region; tobacco control policies should be targeted.

STRENGTHENING COASTAL DEFENCE WITH ARTIFICIAL DUNES

The Belgian coast is primarily sandy and is locally subject to erosion (Deronde, 2004). Traditionally, erosion was counteracted using hard engineering structures like groynes, seawalls and sea dikes. Nowadays, the Belgian government uses a different strategy by adopting a more soft and dynamic approach where possible. Many ‘soft’ managing activities at the Belgian coast are carried out in the form of regular and routine sand nourishments to cope for future flooding risks and coastal erosion (Houthuys, 2012). This method gives room to a new approach for coastal management where the natural elements and processes facilitate the development of new engineered dune areas at locations where traditional dike structures currently protect the hinterland. In the context of climate change and strict requirements for water safety, these hard to adapt engineering structures will not resist future flood events and more innovative solutions like dune in front of a dike principles to deal with rising sea level are receiving considerable attention. As a result, concepts are worked out in which traditional sea dikes are reinforced with newly created dune systems, offering a high level of protection of coastal infrastructure and at the same time offering a more natural appearance and higher ecological and socio economical values. In the framework of the SARCC project, one pilot site is realized in Raversijde. Besides the coastal defense function of the artificial dune, a second benefit is achieved: mitigating the nuisance, created by aeolian sand transport and preventing roads and tram tracks at the dike crest to be buried in sand.

The impact of policy interventions to promote the uptake of biosimilar medicines in Belgium: a nationwide interrupted time series analysis

BackgroundThe Belgian government has taken several measures to increase the uptake of biosimilars in past years. However, no formal evaluation of the impact of these measures has been made yet. This study aimed to investigate the impact of the implemented measures on biosimilar uptake.MethodsAn interrupted time series analysis was performed using an autoregressive integrated moving average (ARIMA) model with the Box-Jenkins method. All data were expressed as defined daily doses (DDD) per month/quarter and obtained from the Belgian National Institute for Health and Disability Insurance (NIHDI). Three molecules were included in the analysis: etanercept (ambulatory), filgrastim (hospital), and epoetin (hospital). A significance level of 5% was used for all analyses.ResultsIn the ambulatory care, the effect of a financial prescriber incentive of 2019 was investigated. After this intervention, 44.504 (95% CI −61.61 to −14.812; P < 0.001) fewer etanercept biosimilar DDDs were dispensed monthly than expected in the absence of the intervention. Two interventions were modelled for biosimilars in the hospital setting. The first intervention of 2016 includes prescription targets for biosimilars and monitoring of hospitals on adequate tendering. The second intervention involves an information campaign on biosimilars. After the first intervention, a small decrease in quarterly epoetin biosimilar uptake of 449.820 DDD (95% CI −880.113 to −19.527; P = 0.05) was observed. The second intervention led to a larger increase in quarterly epoetin biosimilar uptake of 2733.692 DDD (95% CI 1648.648–3818.736; P < 0.001). For filgrastim, 1809.833 DDD (95% CI 1354.797–2264.869; P < 0.001) more biosimilars were dispensed immediately after the first intervention and 151.639 DDD (95% CI −203.128 to −100.150; P < 0.001) fewer biosimilars each quarter after the first intervention. An immediate and sustained increase of 700.932 DDD (95% CI 180.536–1221.328; P = 0.016) in quarterly biosimilar volume was observed after the second intervention. All other parameter estimates were not statistically significant.ConclusionsThe results of this study suggest that the impact of past policy interventions to increase the uptake of biosimilars has been variable and limited. A holistic policy framework is required to develop a competitive and sustainable off-patent biologicals market in Belgium.

Well‐being during COVID‐19‐related first lockdown: Relationship with autobiographical memory and experiential diversity

AbstractIn March 2020, the Belgian government ordered a complete lockdown as an attempt to decrease the progression of the COVID‐19. The aim of the present study was to examine lockdown‐related changes in psycho‐affective states as well as their relations with experiential diversity and autobiographical memory. A total of 186 Belgian citizens completed an online survey assessing lockdown‐related changes in various dimensions: work, leisure activities, affective state, sleep quality, fatigue, and autobiographical memory. Results revealed that well‐being during the lockdown was related to changes in experiential diversity and to the richness of participants' memories. Moreover, the content and the phenomenology of memories were more negative when memories pertained to the lockdown situation. These findings provide new evidence that mental well‐being of Belgian citizens during the first lockdown was related to how pandemic‐related sanitary constraints affected the diversity of activities that they could undertake.

To Catch a Dictator: The Pursuit and Trial of Hissène Habré by Reed Brody

Reviewed by: To Catch a Dictator: The Pursuit and Trial of Hissène Habré by Reed Brody Naomi Roht-Arriaza (bio) Reed Brody, To Catch a Dictator: The Pursuit and Trial of Hissène Habré (Columbia University Press 2022), ISBN 9780231202589, 296 pages. When the verdict was announced in a Dakar courtroom in May 2016, it marked the culmination of a decades-long effort to bring Chad’s former dictator, Hissène Habré, to justice for crimes against humanity. It was also the first time that domestic courts located outside the country where the crimes took place brought a former head of state to justice for international crimes. The remarkable saga of the Habré case is told in a recent book by Reed Brody, former counsel at Human Rights Watch (HRW) and a key actor in supporting, guiding, and backing the case over many years. The book is required reading for anyone interested in international justice or human rights, but it’s also a moving meditation on the effect of North-South power dynamics on activists, the personal toll on those involved of continuing to fight, and all the ways in which the stars must align for justice to prevail. Habré ruled Chad from 1982 to 1990. According to one of the first truth commissions, established after his overthrow, he killed at least 40,000 people, tortured thousands, razed villages, and attacked ethnic groups he perceived as potential opponents. He was supported in this by the US Reagan administration, which saw him as a bulwark against Libyan leader Mohamar Qaddafi, and by the French. Eventually, he was removed in a coup, and took up a gilded exile in Senegal, helped by the millions he stole from the Chadian treasury. Brody tells the story of Habré’s misrule succinctly, but most of the book focuses on his victims and their almost forty-year struggle for justice. He writes chronologically about the investigation and trial, focusing on major incidents, twists and turns, and the strategic decisions (good and bad) that drove the process. I. EVERYTHINGEVERYWHERE ALL AT ONCE One of the takeaways from the book involves the need for those seeking justice to look everywhere, and to play multilevel chess. Dictators and war criminals have huge advantages of money, contacts, and powerful networks to protect them. To fight back, advocates and victims must use all the avenues they can simultaneously and sequentially. This insight isn’t unique to the team pursuing Habré: the efforts to bring Augusto Pinochet to justice in the 1990s spanned not only Spain and the United Kingdom (as well as Chile, of course), but also Belgium, Argentina, France, and other possible forums.1 As both Brody and Chadian lawyer for the victims Jacqueline Moudeïna (in a foreword) note, the precedent of Pinochet’s arrest in London, and its positive impact on both prosecutions in Chile and on efforts to use universal [End Page 335] jurisdiction against despots elsewhere, were important to the Chadians as they considered their strategy. But more than any previous efforts, the Habré case drew on a wealth of international and regional forums and strategically combined them. When it looked like the Senegalese government would expel Habré, putting him beyond the reach of justice, lawyers for the victims went to the UN Committee on Torture to pressure Senegal to honor its “extradite or prosecute” commitments under the Convention Against Torture.2 When Senegal refused to act on a Belgian request to extradite Habré for trial in Belgium or to try him in Senegal, they convinced the Belgian government to complain to the International Court of Justice (ICJ). The ICJ’s subsequent decision was a huge win for human rights advocates, establishing that the extradite or prosecute provisions of the Torture Convention (and other human rights, anti-terrorist act, and anti-corruption treaties) could not be indefinitely ignored or delayed.3 The African Union (AU) eventually became a key political actor in creating the Extraordinary African Chambers (EAC) that convicted Habré. Brody’s book, written for a general audience, doesn’t detail the legal background, structure, and operations of the court that eventually tried and convicted Habré. But it’s worth pausing a moment to...

Hydrogen fuel and the Belgian transport sector: A critical assessment from an environmental and sustainable development perspective

This study provides an in-depth analysis of the potential role of hydrogen (H2) in the Belgian transport sector in the context of sustainable and environmentally friendly growth. This paper starts by examining the energy-climate roadmap and the emission mitigation programme defined by the Belgian federal government in the context of environmental sustainability. Then, the Belgian situation is critically evaluated in light of the needs for H2 fuel in the transport sector, as well as issues about a roadmap on environmental considerations for a sustainable future, while preserving the country's economic stakes. There are several key advances in this direction, especially as H2 is seen as one of the best viable options for sustained development, unlike other possibilities. This paper also highlights some limitations that make it difficult to accelerate the transition to a sustainable H2 energy future. Although there are many interests in favour of an advanced and non-polluting transport system, there are differing views on the approach to be taken in political decision-making at national level. Therefore, this study will help public authorities to better integrate environmental and sustainability issues in the context of a transition to a comprehensive hydrogen economy in the current transport sector.

Verification of Education Credentials on European Blockchain Services Infrastructure (EBSI): Action Research in a Cross-Border Use Case between Belgium and Italy

The European Blockchain Services Infrastructure (EBSI) is a major policy initiative of the EU and European Blockchain Partnership, to leverage blockchain to create cross-border services for public administrations, businesses, citizens, and their ecosystems, to verify information and increase trust in services. The EBSI aims to provide a secure and interoperable system infrastructure, utilizing new digital technologies such as digital wallets, verifiable credentials, and decentralized identifiers. These technologies are expected to change the way government services are organized between citizens and service providers. This article presents empirical findings from a cross-border pilot that was the first case to utilize this new blockchain infrastructure, and which tested the institutional, technical, and user-specific requirements for wider adoption. The pilot tested and assessed the verification of education credentials through the EBSI blockchain in a cross-border setting between a Belgian and an Italian university. The research was based on action research with the ICT units of the participating universities, wallet solution providers, the Belgian government, and EBSI officials. The findings highlight the following as key challenges for the wider adoption of the EBSI and verification credential use case: (1) onboarding of the EBSI ecosystem governance, (2) issuance of EBSI-compliant digital wallets and data schemes for transcript validation, (3) interoperability issues concerning digital identity systems.

Belgian Tax Procedures Reformed with Focus on International Tax Matters

As part of the Belgian government’s plan to fight tax and social fraud, legislation was approved to provide the Belgian tax authorities with a much broader toolset for investigating taxpayers. The main pillar of this legislation is the extension of the standard tax assessment, investigation and retention periods. The extended statute of limitations – which applies to both income taxes and VAT – seems to focus on cross-border transactions in particular.

Digital adaptability competency for healthcare professionals: a modified explorative e-Delphi study

AimTo establish items of the digital adaptability competency for healthcare professionals. BackgroundWhile the application and deployment of eHealth has continued at a rapid pace, healthcare professionals are expected to keep up and join the digital evolution. The implementation of eHealth requires a change in the healthcare professionals’ competencies of which the ability to adapt to technological change is fundamental. There’s more needed than just ICT skills, overall competencies to be digitally adaptable between patientcare and the use of eHealth are needed. Today, a distinct and relevant list of items for healthcare professionals related to the competency of digital adaptability is missing. DesignAn exploratory modified e-Delphi study. MethodsThis study was conducted in Flanders, Belgium. An expert group (n = 12) consisting of 2 policymakers of the Belgian federal government, 3 eHealth managers of large organizations in the Belgian healthcare sector, 1 nurse, 1 midwife, 2 health service users and 3 researchers specialized in eHealth research.Through a literature review an initial list of items was developed, consisting of 67 statements. A two-round Delphi survey was performed where experts could rate the relevance of each item. The third round comprised an online meeting, where the expert group discussed the remaining items until agreement was reached to retain, modify, or eliminate the item. ResultsIn round 1, eleven items were included to the final document. In round 2, ten items were included. In round 3, the panel unanimously agreed to add six items, one item was modified into two separate items. In total, 29 items were included in the final document. ConclusionsThe rather abstract concept of digital adaptability is now transformed into a more pragmatic concept of 29 items, reflecting the practical competencies of healthcare professionals necessary to be digital adaptable.

Non-invasive prenatal testing for everybody or contingent screening?

To compare the advantages and disadvantages of two main implementation strategies for non-invasive prenatal testing (NIPT) for the detection of trisomies 21, 13 and 18 in public healthcare settings. These concern NIPT as a first-tier screening test for all pregnant women, or NIPT contingent on an increased risk first-trimester combined test (FCT) result. Comparison based on (un)published data and literature. Despite the lower prevalence of trisomies in the low-risk population, data show that the positive predictive value (PPV) and detection-miscarriage ratio of first-tier NIPT are comparable to NIPT used as contingency test. Advantages of NIPT as a first-tier test compared to FCT with contingent NIPT are that there is no time-window for testing, sensitivity is higher, fewer women need follow-up testing (PPV of NIPT is higher than PPV of FCT), less anxiety for pregnant women and partners. When given the choice, pregnant women prefer first-tier NIPT. Although contingency testing still seems to be the cheaper option, the differences in costs are becoming increasingly smaller and might soon disappear. We argue that NIPT should preferably be offered as a first-tier test for the detection of fetal aneuploidies for all pregnant women, provided that women are supported to make informed decisions. This article is protected by copyright. All rights reserved.

Lumumba in the Arts

Lumumba in the Arts