Need For More Insight Research Articles

Minority Stress, Substance Use, and Resilience: Examining Long-Term Sobriety in the LGBTQ Community

ABSTRACT The cumulative stress of living with stigmatized social identities is thought to contribute to disparities in substance use outcomes. Thus, it is important to understand how LGBTQ individuals adapt to and elude poor health outcomes. The present study addressed the need for more insight into factors associated with recovery from SUDs among LGBTQ individuals. Thematic analysis was used to analyze data from in-depth interviews with 16 gender and sexual minorities in long-term recovery, with sobriety times ranging from 2 to 24 years (M = 5.68, SD = 5.27). Five major themes emerged from the participants’ narratives about factors that facilitated their paths to recovery: (a) addressing the interconnectedness of mental health, (b) seeking professional support, (c) seeking social support, (d) forming new habits and healthy coping skills, and (e) finding a sober, LGBTQ identity. The narratives convey the value of integrated and specialized mental health treatment as well as identity-affirming and recovery-facilitative spaces and relationships.

Stakeholders’ perspectives on informed decision-making for migrant women in CC prevention programs

Abstract Background This study gathered the perspectives of stakeholders regarding participation in cervical cancer (CC) screening and human papilloma virus (HPV) vaccination among migrant women in the Netherlands. Considering their perspectives by developing interventions that are tailored to migrant women’s information needs regarding CC screening and HPV vaccination will support informed decision-making. Methods In total five focus group discussions were held with community leaders, healthcare professionals and communication experts separately. The focus group discussions were transcribed verbatim in Dutch, and analyzed thematically according to the Grounded Theory. Results The analysis resulted in six themes. The first theme describes the existing views and misconceptions regarding CC (screening) and HPV vaccination in the target population according to the stakeholders. The second theme is about the current approach of informing about these health programs, and its belonging barriers. Theme three dives into the differences within the target population, such as generations and level of language. Theme four describes the conditions to which interventions should adhere. In theme five and six suggestions for interventions were introduced, focused on the target population and their (social) network respectively. Conclusions The results of this study showed that stakeholders are willing to play a role to support informed decision-making regarding CC (screening) and HPV vaccination among migrant women, but they need more training to support. Community leaders express a need for training to gather more medical knowledge of CC and its prevention programs. Healthcare professionals expressed a need for more insight into the practical, cultural, religious and emotional aspects that play a role within this target population. Communication experts emphasize the need for customized information materials and a more district-oriented approach. Key messages • Stakeholders operating at different levels are willing to play a role in increasing informed decision-making regarding CC screening and HPV vaccination. • Migrant women’s (social) network need more training and support to be able to provide tailored information regarding CC screening and HPV vaccination.

Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test.

The therapist-facilitative interpersonal skills (FIS) has shown to predict therapy outcomes, demonstrating that high FIS therapists are more effective than low FIS therapists. There is a need for more insight into the variability in strengths and weaknesses in therapist skills. This study investigates whether a revised and extended FIS-scoring leads to more differentiation in measuring therapists'interpersonal skills. Furthermore, we explorative examine whether subgroups of therapists can be distinguished in terms of differences in their interpersonal responses. Using secondary data analysis, 93 therapists were exposed to seven FIS-clips. Responses of therapists using the original and the extended FIS scoring were rated. Three factors were found on the extended FIS scoring distinguishing supportive, expressive, and persuasive interpersonal responses of therapists. A latent profile analysis enlightened the presence of six subgroups of therapists. Using the revised and extended FIS-scoring contributes to our understanding of the role of interpersonal skills in the therapeutic setting by unraveling the question what works for whom.

Is it harmful or helpful? Examining the causes and consequences of generative AI usage among university students

While the discussion on generative artificial intelligence, such as ChatGPT, is making waves in academia and the popular press, there is a need for more insight into the use of ChatGPT among students and the potential harmful or beneficial consequences associated with its usage. Using samples from two studies, the current research examined the causes and consequences of ChatGPT usage among university students. Study 1 developed and validated an eight-item scale to measure ChatGPT usage by conducting a survey among university students (N = 165). Study 2 used a three-wave time-lagged design to collect data from university students (N = 494) to further validate the scale and test the study’s hypotheses. Study 2 also examined the effects of academic workload, academic time pressure, sensitivity to rewards, and sensitivity to quality on ChatGPT usage. Study 2 further examined the effects of ChatGPT usage on students’ levels of procrastination, memory loss, and academic performance. Study 1 provided evidence for the validity and reliability of the ChatGPT usage scale. Furthermore, study 2 revealed that when students faced higher academic workload and time pressure, they were more likely to use ChatGPT. In contrast, students who were sensitive to rewards were less likely to use ChatGPT. Not surprisingly, use of ChatGPT was likely to develop tendencies for procrastination and memory loss and dampen the students’ academic performance. Finally, academic workload, time pressure, and sensitivity to rewards had indirect effects on students’ outcomes through ChatGPT usage.

Serving students with disabilities in K-12 online learning: daily practices of special educators during the COVID-19 pandemic

Online and distance education strategies offer a path for closing opportunity gaps for students with disabilities because of digital technologies’ flexibility and capacity for differentiation, but fully online schooling does always guarantee an inclusive education. The COVID-19-induced shift to remote learning highlighted the need for more insight into inclusive practices for students with disabilities in online contexts, especially at the K-12 levels. The present study describes special education teachers’ online teaching practices with students with disabilities and the necessary conditions for special educator use of technology in K-12 remote learning. Using in-depth interview (N = 2 0) and survey data with special educators teaching during the COVID-19 pandemic, findings highlight specific strategies special educators use to differentiate instruction as well as innovations in hybrid content experiences and home-school partnerships across K-12 schooling. The practices of special educators teaching in online environments provide insights into how all educators can support learners with or without disabilities in K-12 distance education settings.

Beyond transformational leadership in nursing: A qualitative study on rebel nurse leadership-as-practice.

Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses' experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between "bad" and "good" rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for "good" rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.

Women’s perspectives on disrespect and abuse experiences during childbirth in a teaching hospital in Southwest Ethiopia: a qualitative study

There is evidence that women in Ethiopia often face disrespect and abuse in health care facilities during childbirth. Disrespect and abuse (D&A) violate women’s right to dignified, respectful health care and decrease their trust in health care facilities. There is a need for more insight into women’s perspectives on D&A during childbirth in different contexts. Therefore, this study aimed to explore women’s perspectives on D&A during childbirth in a teaching hospital in South-West Ethiopia. A qualitative study was conducted from November 2017 to February 2018 using in-depth interviews and focus group discussions. Postnatal women were purposively chosen and scheduled for interviews six weeks postpartum. Data saturation occurred once 32 women were interviewed, and four focus group discussions were conducted. A thematic analysis method was used to analyse the data using MAXQDA qualitative analysis software. Three main themes emerged from the data: disrespect and abuse, its contributors, and perceived consequences. The subthemes of D&A include neglected care, non-consented care, physical abuse, lack of privacy, loss of autonomy, objectification, lack of companionship, and verbal abuse. The subthemes of contributors include health care provider-related, health care system-related, and women-related contributors. The subthemes of perceived consequences include the fear of using health care facilities. Women in Ethiopia experienced D&A. Health system factors, such as the teaching environment and scarcity of supplies, contribute the most to the identified D&A. Therefore, providers, administrators, training institutions, and researchers must collaborate to address these health system factors to reduce disrespect and abuse during childbirth in teaching hospitals.

Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer

BackgroundThere is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists’ and patients’ views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy.MethodsSemi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software.ResultsTaken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients’ unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more.ConclusionsIntegrating oncologists’ and patients’ views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate – tailored – information-provision, leading ultimately to patient-centered care lying at the heart of medicine.

Failure modelling of glass plates in biaxial loading: using flaw-size based weakest-link systems

Experimental strength tests are performed on two series of nominally equal plate specimens of annealed soda-lime glass subjected to either ring-on-ring or ball-on-ring bending. The Weibull effective area which represents a fictitious surface area exposed to uniform tension is calculated using closed-form solutions. Finite-size weakest-link systems are implemented numerically in a computationally intensive procedure for random sampling of plates extracted from a virtual jumbo pane whose surface area contains a set of stochastic Griffith flaws. A non-linear finite element analysis is conducted to compute the bending stresses. The glass surface condition is represented in different flaw-size concepts that depend on a truncated exponentially decaying flaw-size distribution. Stress corrosion effects are modelled by implementation of subcritical crack growth. The effective ball contacting radius is determined in a numerical computation. The results show that surface size effects in glass are not only a matter of strength-scaling, as also the shape of the distribution changes. While the lowest strength value, as per the major in-plane principal stress at the recorded fracture origin, in the respective data sets is very similar, the strongest specimen observed in ball-on-ring testing is over 70% stronger than the correspondingly strongest specimen observed in ring-on-ring bending. The Shift function is used to make visual comparisons of the difference in quantiles in the observed data sets. Use of an ordinary Weibull distribution leads to non-conservative strength predictions on smaller effective areas, and to too low strength predictions than are viable for glass design on larger areas. The numerical implementation of finite-size weakest-link systems can produce better predictions for the strength-scaling compared to a Weibull distribution, in particular when the flaw-size concept is modified to include a doubly stochastic flaw-size distribution or a random noise added to each subdivided region of the discretized surface area. The simulated ball-on-ring fracture origins exhibit greater spread from the centre point than otherwise observed in laboratory tests. It is indicated that the chosen representation of surface condition may not be accurate enough for the modelling of all fracture origins in the ball-on-ring setup even though acceptable results are obtained with the ring-on-ring model. There is a need for more insight into the surface condition of glass which can be conducive to the development of flaw-size based weakest-link modelling.

What Were You Thinking? Medical Students’ Metacognition and Perceptions of Self-Regulated Learning

Phenomenon As a component of self-regulated learning, metacognition is gaining attention in the medical education research community. Metacognition, simply put, is thinking about one’s thinking. Having a metacognitive habit of mind is essential for healthcare professionals. This study identified the metacognitive competencies of medical students as they completed a conceptual learning task, and provided insight into students’ perceptions of self-regulated learning in their curriculum. Approach: Eleven third-year medical students from a Dutch University were purposively sampled to participate in this qualitative study. The study design included a think-aloud assignment followed by a semi-structured interview. During the assignment, participants were instructed to think aloud while solving questions about medical physiological concepts such as blood flow, pressure, and resistance. Think-aloud data were collected through audiotaping and used to identify participants’ metacognitive competencies. The assignment also served as a prompt for an interview in which participants were questioned about metacognitive knowledge, monitoring, experiences, and perceptions of self-regulated learning in their curriculum. All data were transcribed verbatim and analyzed iteratively using a template analysis. Findings: Students differed in their use of metacognitive skills, with an overall focus on monitoring and, to a lesser extent, on planning and evaluation. Additionally, differences were found in students’ metacognitive knowledge and metacognitive experiences. There was apparent use of inefficient, superficial predictive cues. Regarding perceptions of self-regulated learning skills, some students felt no need to develop such skills as they perceived medical education as an exercise in memorizing facts. Others emphasized the need for more insight into their actual level of knowledge and competence. Insights: Pre-clinical medical students require explicit teaching of metacognitive skills to facilitate self-regulated learning. Educators should aim to integrate metacognition in the everyday discourse of the classroom to foster an environment in which students discuss their own learning. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1889559.

The reciprocal effects of physical activity and happiness in adolescents

BackgroundPositive associations exist between physical activity and happiness in adolescents. However, previous studies have mostly used self-reported measures and cross-sectional designs. There is a need for more insight into the directionality and duration of this association. The current study was the first to investigate whether an increase in physical activity leads to happiness and whether adolescents become more physically active when they are happier. These two effects were studied between (on a day-to-day basis) and within days (on an hour-to-hour basis).MethodsThe study used data from the MyMovez project in which 1484 adolescents between the ages of 8 and 17 years wore an accelerometer on their wrist and answered experience sampling questions on happiness at random moments during the day for several weeks in 2016–2018.ResultsThe preregistered analyses demonstrated an association between physical activity and happiness. More specifically, the number of steps per day predicted the experienced happiness on that day. In addition, a short-term reciprocal effect of physical activity and happiness was observed. Happiness was predicted by the number of steps accumulated in the previous hour and it also predicted the number of steps accumulated in the subsequent hour. However, convincing evidence was found that these effects did not occur in the long-term between days. The number of steps on the previous day did not predict happiness, nor did happiness predict the number of steps of the subsequent day.ConclusionsThis study confirms an association between physical activity and happiness in adolescents and shows that in the short-term, physical activity promotes happiness and vice versa. Therefore, we conclude that physical activity is not only important for the physical health of youth, but also plays an important role in their mental well-being. In addition, this knowledge can be used to further understand the importance of physical activity in adolescents’ health and help in promoting a healthy lifestyle among youth.Trial registrationThe data used are stored at the Data Archiving and Networked Services (https://doi.org/10.17026/dans-zz9-gn44). Hypotheses, study design, sample, data collection procedure, measured variables, and plan of analysis were preregistered on the Open Science Framework (OSF, https://osf.io/5yk7r/).

Governing for sustainability in the Norwegian aquaculture industry

Aquaculture in Norway is expected to grow radically in the years to come. From both the government and from the industry itself, there is a demand for developing policies that can accommodate this intensification in activity. However, the aquaculture industry in Norway is also met with considerable skepticism and resistance. Both NGOs and several researchers have voiced concerns in the media, expressing a need for more insight into this resistance. This article explores the attitudes of local residents and stakeholder groups towards aquaculture through a qualitative field study in a small coastal community. Data shows that attitudes are not necessarily a matter of being for or against aquaculture. The issue at stake is sustainability, as what residents and stakeholder groups want is sustainable aquaculture. However, how the different groups interpreted sustainability differed, both between groups and depending on the circumstances. Our analysis shows that interpretations are embedded in different world-views or orders of worth. In this article, we give empirical insight into the expressed attitudes of various stakeholder groups, discuss the underlying values and indicate possible implications these findings can have for policy-making in the Norwegian coastal zone.

Professional functioning of young adults with congenital coagulation disorders in the Netherlands.

Introduction and AimSuboptimal health‐related quality of life and lowered employment rates found in a previous study in young adults (YA) with congenital coagulation disorders (CCD) in the Netherlands underline the need for more insight into professional functioning of YA with CCD and into determinants of professional functioning.MethodsYoung adults (18‐30 years) with CCD participated in a cross‐sectional study. Professional functioning was assessed with the Work Productivity and Activity Impairment questionnaire (WPAI). Potential determinants were assessed with the Course of Life Questionnaire (CoLQ), Pediatric Quality of Life Inventory Young Adult version (PedsQL_YA), Illness Cognition Questionnaire (ICQ) and Haemophilia Activities List (HAL). Logistic regression analyses were performed in the complete sample of YA with CCD, and in YA men with haemophilia separately, to examine determinants of WPAI outcomes.ResultsNinety‐four YA (77 men; mean age 24.1 years, SD 3.5 and 17 women; mean age 24.5 years, SD 3.8) with CCD (74% haemophilia A/B) participated. 74.5% of YA were paid employed for on average 30 hours per week. Of these, more than a quarter reported work impairment. Older age and a non‐severe type of haemophilia (in the sample of YA men with haemophilia) were associated with successful (paid) employment. No variables were associated with professional functioning (expressed as Presenteeism and Overall work impairment) in patients with CCD or haemophilia.ConclusionThree‐quarters of YA with CCD were successful in finding paid employment. Though absenteeism was low, YA with paid employment needs attention as a considerable part experienced work impairment.

Experiences With Telehealth Followup in Patients With Rheumatoid Arthritis: A Qualitative Interview Study.

To explore the experiences of a patient-reported outcome (PRO)-based telehealth followup from the perspective of patients with rheumatoid arthritis (RA) and their experiences of increasing their active role, and responsibility for disease control in particular. Adopting a strategy of interpretive description, we conducted individual, semistructured interviews with 15 RA patients participating in a telehealth followup. Participants were selected purposively and consecutively from both sexes and with various ages, disease durations, and disease severity. The analysis was inductive, with a constant comparative approach. First, we identified the main themes conveying the participants' experiences. Then we constructed patient typologies to explain different perspectives on the telehealth followup. Five themes covered the participants' experiences: a flexible solution, responsibility, knowledge of RA, communication and involvement, and continuity. Two typologies, the keen patient and the reluctant patient, represented opposite perspectives and preferences regarding the core value of and approach to the telehealth followup. The participants had positive perceptions of the PRO-based telehealth followup and saw it as a flexible and resource-saving solution. They reported disadvantages related to missing face-to-face contact with health professionals. The 2 typologies, the keen and the reluctant patient, help us understand the patients' different needs, wishes, and abilities to take part in telehealth followup. Our findings reveal a need for more insight into how telehealth followup could be integrated in routine clinical practice, paying special attention to how reluctant patients may be supported.

Influence of protein properties and protein modification on biodistribution and tumor uptake of anticancer antibodies, antibody derivatives, and non-Ig scaffolds.

Newly developed protein drugs that target tumor-associated antigens are often modified in order to increase their therapeutic effect, tumor exposure, and safety profile. During the development of protein drugs, molecular imaging is increasingly used to provide additional information on their in vivo behavior. As a result, there are increasing numbers of studies that demonstrate the effect of protein modification on whole body distribution and tumor uptake of protein drugs. However, much still remains unclear about how to interpret obtained biodistribution data correctly. Consequently, there is a need for more insight in the correct way of interpreting preclinical and clinical imaging data. Summarizing the knowledge gained to date may facilitate this interpretation. This review therefore provides an overview of specific protein properties and modifications that can affect biodistribution and tumor uptake of anticancer antibodies, antibody fragments, and nonimmunoglobulin scaffolds. Protein properties that are discussed in this review are molecular size, target interaction, FcRn binding, and charge. Protein modifications that are discussed are radiolabeling, fluorescent labeling drug conjugation, glycosylation, humanization, albumin binding, and polyethylene glycolation.

Improving care for multiproblem families: Context-specific effectiveness of interventions?

An overview of the effectiveness of interventions for multiproblem families (MPF) is lacking, and evidence seems to be context-specific. The aim of this study is to summarize the evidence on this topic in one country, the Netherlands, to better understand the reasons for the heterogeneity of findings. We searched literature published between January 2005 and April 2017. We found 26 Dutch studies of 11 interventions aimed at MPF. Most studies used a pretest-posttest design. The effect sizes of the studies ranged from small to large and varied between interventions, but also between studies of the same intervention. This large variation in effect sizes implies a need for more insight into the components of interventions. A better fit between problems of MPF and intervention components could improve the effectiveness of interventions targeting this population.

Genetic and Toxigenic Variability within Aspergillus flavus Population Isolated from Maize in Two Diverse Environments in Kenya.

Aspergillus flavus is the main producer of carcinogenic aflatoxins in agricultural commodities such as maize. This fungus occurs naturally on crops, and produces aflatoxins when environmental conditions are favorable. The aim of this study is to analyse the genetic variability among 109 A. flavus isolates previously recovered from maize sampled from a known aflatoxin-hotspot (Eastern region, Kenya) and the major maize-growing area in the Rift Valley (Kenya), and to determine their toxigenic potential. DNA analyses of internal transcribed spacer (ITS) regions of ribosomal DNA, partial β-tubulin gene (benA) and calmodulin gene (CaM) sequences were used. The strains were further analyzed for the presence of four aflatoxin-biosynthesis genes in relation to their capability to produce aflatoxins and other metabolites, targeting the regulatory gene aflR and the structural genes aflP, aflD, and aflQ. In addition, the metabolic profile of the fungal strains was unraveled using state-of-the-art LC-MS/MS instrumentation. The three gene-sequence data grouped the isolates into two major clades, A. minisclerotigenes and A. flavus. A. minisclerotigenes was most prevalent in Eastern Kenya, while A. flavus was common in both regions. A. parasiticus was represented by a single isolate collected from Rift Valley. Diversity existed within the A. flavus population, which formed several subclades. An inconsistency in identification of some isolates using the three markers was observed. The calmodulin gene sequences showed wider variation of polymorphisms. The aflatoxin production pattern was not consistent with the presence of aflatoxigenic genes, suggesting an inability of the primers to always detect the genes or presence of genetic mutations. Significant variation was observed in toxin profiles of the isolates. This is the first time that a profound metabolic profiling of A. flavus isolates was done in Kenya. Positive associations were evident for some metabolites, while for others no associations were found and for a few metabolite-pairs negative associations were seen. Additionally, the growth medium influenced the mycotoxin metabolite production. These results confirm the wide variation that exists among the group A. flavus and the need for more insight in clustering the group.

Characteristics and quality of adverse drug reaction reporting among healthcare providers at Rumailah Hospital in Qatar

Introduction: Under-reporting of adverse drug reactions (ADRs) and low-quality reporting are a widespread phenomenon globally.1 There is a need for more insight on the role of pharmacists and other healthcare professionals in ADR reporting. This study primarily aimed to compare the rates, quality, and characteristics of ADR reports received from different healthcare providers in Rumailah Hospital (RH) in Qatar. Methods: A retrospective descriptive analysis of ADR reports submitted by healthcare providers in RH between 1 January 2012 and 1 October 2014 was conducted. Outcome measures included rate of ADR reporting, quality, causality scores as well as characteristics of the reported ADRs. Results: A total of 92 ADR reports were submitted by different healthcare providers, of which 42% were submitted by pharmacists, 38% by physicians, and 9% by nurses. Most of the ADR reports by physicians (66%), nurses (63%) and pharmacists (41%) were judged to be of high quality (grade 2) based on WHO scheme (p>0.05%).2 Sixty percent of the submitted ADR reports were for medications considered ‘possibly’ causing the event according to Naranjo causality score, while 30% were considered probable (p < 0.05%). Most of the ADR reports were type B (54%) and were unpreventable (64%) according to the Medication Appropriateness Index (MAI).3 One hundred percent and 91% of nurses and physicians' ADR reports were for unpreventable events, respectively, while 41% of pharmacists' reports were definitely preventable ADRs (p < 0.05%). Conclusion: ADR reporting in RH was undertaken by different healthcare professionals and was generally of high quality. ADRs reported were often unpreventable. There were differences between characteristics and causality scores of ADR reports between different healthcare professionals.

Teachers’ decision-making: Data based or intuition driven?

Teachers' decisions have an impact on pupils' educational trajectories, yet we know little about their decision-making. This study explored how teachers use data and intuition in the decision process in the case of grade retention. Semi-structured interviews were conducted with 17 primary teachers in Belgium. Results show that teachers use little data that are purposively collected to inform decision-making. Intuitive expertise appeared to be the most important bases of teachers' decisions. These findings stress the need for more insight in teachers' decision-making in general, and in teachers' intuition more specific. Only a full understanding of intuition and its impact on decision-making can help strengthen the positive contribution of expertise while also preventing severe bias.

Conflict between diabetes guidelines and experienced counselling in sports and physical activity. An exploratory study.

According to medical guidelines counselling on sports and physical activity should be part of diabetes treatment. Using an online questionnaire ( n = 181), we explored how people with both type 1 and type 2 diabetes experienced this counselling in the Netherlands. Most respondents were critical, indicating that they did not receive proper guidance or helpful advices. A third of the respondents mentioned that there was hardly any attention for the subject during their treatment. This conflict between guidelines and experiences point towards the need for more insight in critical issues in counselling regarding taking up sports and physical activity (again) after diagnosis.