Although research into multimodal stance-taking has gained momentum over the past years, the multimodal construction of so-called stacked stances has not yet received systematic attention in the literature. Mocking enactments are a prime example of such complex social actions as they are layered both interactionally and stance-related, and they rely significantly on the use of bodily visual resources, depicting rather than describing events and stances. Using Du Bois\' Stance Triangle as a framework, this study investigates mocking enactments as a case study to unravel the multimodal aspects of layered stance expressions. Drawing on three data sets-music instruction in Dutch, German, and English, spontaneous face-to-face interactions among friends in Dutch, and narrations on past events in Flemish Sign Language (VGT)-this study provides a qualitative exploration of mocking enactments across different communicative settings, languages, and modalities. The study achieves three main objectives: (1) illuminating how enactments are used for mocking, (2) identifying the layers of stance-taking at play, and (3) examining the multimodal construction of mocking enactments. Our analysis reveals various different uses of enactments for mocking. Aside from enacting the target of the mockery, participants can include other characters and viewpoints, highlighting the breadth of the phenomenon under scrutiny. Second, we uncover the layered construction of stance on all axes of the Stance Triangle (evaluation, positioning, and alignment). Third, we find that mocking enactments are embedded in highly evaluative contexts, indexed by the use of bodily visual resources. Interestingly, not all mocking enactments include a multimodally exaggerated depiction, but instead, some merely allude to an absurd hypothetical scenario. Our findings contribute to the growing body of literature on multimodal stance-taking, by showing how a nuanced interpretation of the Stance Triangle can offer a useful framework for analyzing layered stance acts.

BACKGROUND: MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability.
OBJECTIVE: This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands.
METHODS: Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the \"Problem Areas in Diabetes\" (PAID-11) questionnaire (diabetes distress), the \"World Health Organization Well-being Index\" (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the \"Checklist Individual Strength\" (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback.
RESULTS: In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization.
CONCLUSIONS: Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial.

The correct language to refer to someone with a diagnosis of autism spectrum disorder has received a lot of attention in recent years. Studies in English-speaking countries found a main identity-first language (IFL) preference (e.g. autistic person) opposed to a person-first language preference (PFL) (e.g. person with autism) among adults with autism. However, a recent study conducted in a Dutch-speaking country (the Netherlands) reported a PFL preference (Buijsman et al., 2023). The goal of the current study was to gain insights into language preferences in two Dutch-speaking countries and, in contrast to previous studies, give participants the option to indicate not having a specific language preference. In the current study, we asked 414 Dutch-speaking adults with autism, living either in Belgium or the Netherlands, to fill in an online questionnaire about their language preference. We found that over half of the participants had a PFL preference (54%), followed by having no preference (27%). Only 14% of them had an IFL preference, and 5% proposed another term. Having more years of education was identified as a predictor for having an IFL preference when compared to a PFL preference, while being older predicted having no preference compared to a PFL preference. The majority of Dutch-speaking adults with autism showed a PFL preference, which is in contrast to findings from English-speaking countries, but in accord with a recent study conducted in the Netherlands (Buijsman et al., 2023). Implications of this finding for language use are discussed.

John Ohala claimed that the source of sound change may lie in misperceptions which can be replicated in the laboratory. We tested this claim for a historical change of /t/ to /k/ in the coda in the Southern Min dialect of Chaoshan. We conducted a forced-choice segment identification task with CVC syllables in which the final C varied across the segments [p t k ʔ] in addition to a number of further variables, including the V, which ranged across [i u a]. The results from three groups of participants whose native languages have the coda systems /p t k ʔ/ (Zhangquan), /p k ʔ/ (Chaoshan) and /p t k/ (Dutch) indicate that [t] is the least stably perceived segment overall. It is particularly disfavoured when it follows [a], where there is a bias towards [k]. We argue that this finding supports a perceptual account of the historically documented scenario whereby a change from /at/ to /ak/ preceded and triggered a more general merger of /t/ with /k/ in the coda of Chaoshan. While we grant that perceptual sound changes are not the only or even the most common type of sound change, the fact that the perception results are essentially the same across the three language groups lends credibility to Ohala\'s perceptually motivated sound changes.

BACKGROUND: Affordability and accessibility of hospital care are under pressure. Research on hospital care financing focuses primarily on incentives in the financial system outside the hospital. It is notable that little is known about (incentives in) internal funding in hospitals. Therefore, our study focuses on the budget allocation in hospitals: the distribution model. Based on our hypothesis that the reimbursement and distribution models in hospitals might interact, we gain knowledge about-, and insight into, the interaction of different reimbursement and distribution models used in Dutch hospitals, and how they affect the financial output of hospital care.
METHODS: An online survey with 22 questions was conducted among financial senior management as an expert group in 49 Dutch hospitals.
RESULTS: Ultimately, 38 of 49 approached experts fully completed the survey, which amounts to 78% of the hospitals we approached and 60% of all Dutch hospitals. The results on the reimbursement model indicate price * volume with adjusted prices above a maximum cap as the most common dominant contract type. On the internal distribution model, 75-80% of the experts reported incremental budgeting as the dominant budgeting method. Results on the interaction between the reimbursement and the distribution model show that both general and specific changes in contract agreements are only partially incorporated in hospital budgets. In 28 out of 31 hospitals with self-employed medical specialists, a relation is reported between the reimbursement model and the contracts with the Medical Consultant Group(s) in which the medical specialists are united.
CONCLUSIONS: Our results in Dutch setting indicate a limited interaction between the reimbursement model and the distribution model. This lack of congruence between both models might limit the desired effects of incentives in contractual agreements aimed at the financial output. This applies to different reimbursement and distribution models. Further research into the various interactions and incentives, as visualized in our conceptual framework, could result in evidence-based advice for achieving affordable and accessible hospital care.

BACKGROUND: This study surveyed Dutch orthopedic surgeons on the management of cartilage defects in the knee and the adherence to the recently updated Dutch knee cartilage repair consensus statement (DCS).
METHODS: A web-based survey was sent to 192 Dutch knee specialists.
RESULTS: The response rate was 60%. Microfracture, debridement and osteochondral autografts are performed by the majority, 93%, 70% and 27% of respondents, respectively. Complex techniques are used by < 7%. Microfracture is mainly considered in defects 1-2 cm2 (by > 80%) but also in 2-3 cm2 (by > 40%). Concomitant procedures, e.g., malalignment corrections, are performed by 89%. Twenty-one percent of surgeons treat patients aged 40-60 years. Microfracture, debridement and autologous chondrocyte implantation are not considered to be highly affected by age > 40 years by any of the respondents (0-3%). Moreover, for the middle-aged there is a large spread in treatments considered. In case of loose bodies, the majority (84%) only performs refixation in the presence of attached bone.
CONCLUSIONS: Small cartilage defects in ideal patients may be well treated by general orthopedic surgeons. The matter becomes complicated in older patients, or in case of larger defects or malalignment. The current study reveals some knowledge gaps for these more complex patients. Referral to tertiary centers might be indicated, as is stated by the DCS, and this centralization should enhance knee joint preservation. Since the data from present study are subjective, registration of all separate cartilage repair cases should fuel objective analysis of clinical practice and adherence to the DCS in the future.

Negative beliefs and stigmatization of all that is not heterosexual still have an adverse impact on the mental health of the homosexual population in many countries. The purpose of the present study was to comparatively assess how sociocultural differences regarding the level of homosexuality acceptance impact the adult attachment dimensions and emotion regulation strategies among three groups of Iranian and Dutch gay men. A community sample of 124 gay men (40 of Iranians residing in their home country, 41 of Iranians immigrated to the Netherlands and 43 Dutch) participated in the study and completed Revised Adult Attachment Scale (RAAS) and Emotion Regulation Questionnaire (ERQ). MANOVA and follow-up post-hoc Tukey tests were conducted in order to analyze the data. Results demonstrated a noticeable difference in both studied variables, attachment dimensions (close, anxiety, and depend) and emotion regulation strategies (cognitive reappraisal and expressive suppression), among the three groups of participants. As the Iranian (residing in Iran) group showed the greatest levels of anxiety and emotional suppression with the lowest levels of close (convenience of getting intimate to others), depend (trust and depend on others to be availabale when needed) and cognitive reappraisal (ability to alter the emotion caused by an event, before experiencing it by reinterpreting the situation), while the highest levels of depend, close and cognitive reappraisal and the lowest levels of anxiety and emotional suppression were seen in the Dutch group. Finally, Iranian gay immigrants came half way between. This data highlights the role of cultural differences in terms of homosexuality acceptance or stigmatization, in the way gay men exhibit their attachment and manage their emotions either by reappraisal or suppression. Comparative cross-cultural studies are possibly able to open paths to new research on psychological factors of non-heterosexuals in different countries with various cultures and religions.

This paper discusses how the transcription hurdle in dialect corpus building can be cleared. While corpus analysis has strongly gained in popularity in linguistic research, dialect corpora are still relatively scarce. This scarcity can be attributed to several factors, one of which is the challenging nature of transcribing dialects, given a lack of both orthographic norms for many dialects and speech technological tools trained on dialect data. This paper addresses the questions (i) how dialects can be transcribed efficiently and (ii) whether speech technological tools can lighten the transcription work. These questions are tackled using the Southern Dutch dialects (SDDs) as case study, for which the usefulness of automatic speech recognition (ASR), respeaking, and forced alignment is considered. Tests with these tools indicate that dialects still constitute a major speech technological challenge. In the case of the SDDs, the decision was made to use speech technology only for the word-level segmentation of the audio files, as the transcription itself could not be sped up by ASR tools. The discussion does however indicate that the usefulness of ASR and other related tools for a dialect corpus project is strongly determined by the sound quality of the dialect recordings, the availability of statistical dialect-specific models, the degree of linguistic differentiation between the dialects and the standard language, and the goals the transcripts have to serve.

Dutch is a West-Germanic language spoken natively by around 24 million speakers. Although studies on typical Dutch speech sound development have been conducted, norms for phonetic and phonological characteristics of typical development in a large sample with a sufficient age range are lacking.
To give a detailed description of the speech sound development of typically developing Dutch-speaking children from 2 to 7 years.
A total of 1503 typically developing children evenly distributed across the age range of 2;0-6;11 years participated in this normative cross-sectional study. The picture-naming task of the Computer Articulation Instrument (CAI) was used to collect speech samples. Speech development was described in terms of (1) percentage consonants correct-revised (PCC-R) and percentage vowels correct (PVC); (2) consonant, vowel and syllabic structure inventories; (3) degrees of complexity (phonemic feature hierarchy); and (4) phonological processes.
A two-way mixed analysis of variance (ANOVA) confirmed a significant increase in the number of PCC-R and PVC between the ages of 2;0 and 6;11 years (p < 0.001). The consonant inventory was found to be complete at 3;7 years of age for the syllable-initial consonants, with the exception of the voiced fricatives /v/ and /z/, and the liquid /r/. All syllable-final consonants were acquired before age 4;4 years. At age 3;4 years, all children had acquired a complete vowel inventory, and at age 4;7 years they produced most syllable structures correctly, albeit that the syllable structure CCVCC was still developing. All phonological contrasts were produced correctly at 3;8 years of age. Children in the younger age groups used more phonological simplification processes than the older children, and by age 4;4 years, all had disappeared, except for the initial cluster reduction from three to two consonants and the final cluster reduction from two to one consonant.
This paper describes a large normative cross-sectional study of Dutch speech sound development which, in clinical practice, can help Dutch speech-language pathologists to differentiate children with delayed or disordered speech development from typically developing children. What this paper adds What is already known on this subject In recent years many studies have been conducted worldwide to investigate speech sound development in different languages, including several that explored the typical speech sound development of Dutch-speaking children, but none of these latter studies explored both phonetic and phonological progress within a comprehensive age range and a large sample that is representative of the Dutch population. What this study adds to existing knowledge This study serves to fill this gap by providing normative cross-sectional results obtained in 1503 typically developing Dutch-speaking children aged between 2;0 and 6;11 years on informative parameters of speech development: PCC-R and PVC, consonant, vowel and syllabic structure inventories, degrees of complexity (phonemic feature hierarchy), and phonological simplification processes. What are the potential or actual clinical implications of this work? The detailed description of typical Dutch speech sound development provides speech-language pathologists with pertinent information to determine whether a child\'s speech development progresses typically or is delayed or disordered.

Diabetic foot ulceration (DFU) is a common late-stage complication of diabetes with a large impact on health status and quality of life. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients\' views on their well-being. The DFU Scale Short Form (DFS-SF) is a validated disease-specific PROM for measuring health-related quality of life among DFU patients. The Lower Extremity Functional Scale (LEFS) is another PROM that can be used to measure physical functioning in patients with lower extremity disorders. The LEFS is not yet validated for DFU. Both instruments are not validated in the Dutch language. The purpose of this study is to culturally adapt and validate the DFS-SF and LEFS questionnaires for Belgian Dutch-speaking patients with DFU.
This study will be conducted as a monocentre observational cohort study in DFU patients presenting at a hospital-based multidisciplinary diabetic foot clinic. Data will be collected from the medical electronic files and from DFS-SF, LEFS and five-level EuroQol five-dimension questionnaires that will be presented to the patients at defined time points. Reproducibility, internal consistency, floor and ceiling effects, construct validity and responsiveness will be assessed for the DFS-SF and LEFS.
The study protocol has been approved by the Medical Ethics Committee of Onze-Lieve-Vrouw Hospital (Aalst, Belgium). The results of the study will be disseminated through peer-reviewed publications and conference presentations.