(On)begrensde Technologie

Er zijn voorspellingen gedaan, bijvoorbeeld door het World Economic Forum, dat we aan de vooravond van een ‘vierde industriële revolutie’ staan, die draait om het meer verbonden raken van informatie- en productieprocessen. Als dat zo is, zal dat maatschappelijke gevolgen voor Zuid-Holland en daarmee implicaties voor het beleid van de provincie hebben. De onderzoeksvraag van deze studie is dan ook: “Wat is de maatschappelijke [sociale, economische en ruimtelijke] invloed van nieuwe productie- en informatietechnologieën? En, hoe verandert dat de wijze waarop we als provincie aan de opgaven van de toekomst werken?”. Hiertoe hebben we een literatuurstudie over de potentiële maatschappelijke gevolgen van nieuwe technologie verricht en daarna in interactie met stakeholders en de provincie vier scenario’s ontwikkeld

The effect of audit market structure on audit quality and audit pricing in the private-client market

This study examines whether audit market structure affects audit quality and audit pricing. We analyze two conceptually distinct dimensions of market structure: audit market concentration and client mobility. Focusing on the private-client segment of the Belgian audit market, we compare the pricing and quality effects of market structure between the segment of small and medium-sized (SME) clients and the segment of large clients to test how audit complexity moderates such effects. We find that market concentration impairs price and quality competition in the SME-client segment. Market concentration is unrelated to audit quality in the large-client segment, where we argue that concentration is endogenous to audit complexity. Furthermore, we find that client mobility stimulates price competition in both segments but improves audit quality only in the large-client segment. We interpret our findings as evidence that (a) audit market concentration impairs competition especially when audits have low complexity and that (b) the large-client market segment, characterized by higher audit complexity and higher market concentration, can also be price and quality competitive if clients are sufficiently mobile, and change auditors relatively frequently

Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial

Objective To examine the effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners

Value-Chain Wide Food Waste Management: A Systematic Literature Review

© 2019, Springer Nature Switzerland AG. The agriculture value chain, from farm to fork, has received enormous attention because of its key role in achieving United Nations Global Challenges Goals. Food waste occurs in many different forms and at all stages of the food value chain, it has become a worldwide issue that requires urgent actions. However, the management of food waste has been traditionally segmented and in an isolated manner. This paper reviews existing work that has been done on food waste management in literature by taking a holistic approach, in order to identify the causes of food waste, food waste prevention strategies, and elicit recommendations for future work. A five step systematic literature review has been adopted for a thorough examination of the existing research on the topic and new insights have been obtained. The findings suggest that the main sources of food waste include food overproduction and surplus, food waste caused by processing, logistical inconsistencies, and households. Main food waste prevention strategies have been revealed in this paper include policy solutions, packaging solutions, date-labelling solutions, logistics solutions, changing consumers’ behaviours, and reuse and redistribution solutions. Future research directions such as using value chain models to reduce food waste and forecasting food waste have been identified in this paper. This study makes a contribution to the extant literature in the field of food waste management by discovering main causes of food waste in the value chain and eliciting prevention strategies that can be used to reduce/eliminate relevant food waste

CAMbase – A XML-based bibliographical database on Complementary and Alternative Medicine (CAM)

The term "Complementary and Alternative Medicine (CAM)" covers a variety of approaches to medical theory and practice, which are not commonly accepted by representatives of conventional medicine. In the past two decades, these approaches have been studied in various areas of medicine. Although there appears to be a growing number of scientific publications on CAM, the complete spectrum of complementary therapies still requires more information about published evidence. A majority of these research publications are still not listed in electronic bibliographical databases such as MEDLINE. However, with a growing demand by patients for such therapies, physicians increasingly need an overview of scientific publications on CAM. Bearing this in mind, CAMbase, a bibliographical database on CAM was launched in order to close this gap. It can be accessed online free of charge or additional costs. The user can peruse more than 80,000 records from over 30 journals and periodicals on CAM, which are stored in CAMbase. A special search engine performing syntactical and semantical analysis of textual phrases allows the user quickly to find relevant bibliographical information on CAM. Between August 2003 and July 2006, 43,299 search queries, an average of 38 search queries per day, were registered focussing on CAM topics such as acupuncture, cancer or general safety aspects. Analysis of the requests led to the conclusion that CAMbase is not only used by scientists and researchers but also by physicians and patients who want to find out more about CAM. Closely related to this effort is our aim to establish a modern library center on Complementary Medicine which offers the complete spectrum of a modern digital library including a document delivery-service for physicians, therapists, scientists and researchers

The economic impact of mental healthcare consumption before and after stroke in a cohort of stroke patients in the Netherlands:a record linkage study

BACKGROUND: Post-stroke healthcare consumption is strongly associated with a mental health diagnosis. This study aimed to identify stroke patients who utilised mental healthcare facilities, explored their mental healthcare consumption pre-stroke and post-stroke, and examined possible predictors of costs incurred by mental healthcare consumption post-stroke. METHODS: Three databases were integrated, namely the Maastricht University Medical Centre (MUMC) Medical Administration, the Stroke Registry from the Department of Neurology at MUMC, and the Psychiatric Case Registry South-Limburg. Patients from the MUMC who suffered their first-ever stroke between January 1 2000 and December 31 2004 were included and their records were analysed for mental healthcare consumption from 5 years preceding to 5 years following their stroke (1995-2009). Regression analysis was conducted to identify possible predictors of mental healthcare consumption costs. RESULTS: A total of 1385 patients were included and 357 (25.8%) received services from a mental healthcare facility during the 10-year reference period around their stroke. The costs of mental healthcare usage increased over time and peaked 1 year post-stroke (€7057; 22% of total mental healthcare costs). The number of hospitalisation days and mental healthcare consumption pre-stroke were significant predictors of mental healthcare costs. Explained variances of these models (costs during the 5 years post-stroke: R (2) = 15.5%, costs across a 10 year reference period: R (2) = 4.6%,) were low. CONCLUSION: Stroke patients have a significant level of mental healthcare comorbidity leading to relatively high mental healthcare costs. There is a relationship between stroke and mental healthcare consumption costs, but results concerning the underlying factors responsible for these costs are inconclusive

Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain

BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. METHOD: The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. RESULTS: Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. CONCLUSION: Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience

The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

Background: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Methods. Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. Results: The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 18, 42 13, and 45 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated car

Does the Community-based Combined Meeting Center Support Programme (MCSP) Make the Pathway to Day-care Activities Easier for People Living with Dementia? A Comparison Before and After Implementation of MCSP in Three European Countries

The "pathway to care" concept offers a helpful framework for preparing national dementia plans and strategies and provides a structure to explore the availability and accessibility of timely and effective care for people with dementia and support for their informal carers. Within the framework of the JPND-MEETINGDEM implementation project the pathways to regular day-care activities and the Meeting Centers Support Programme (MCSP), an innovative combined support form for people with dementia and carers, was explored. An exploratory, descriptive, qualitative, cross-country design was applied to investigate the pathways to day care in several regions in four European countries (Italy, Poland, United Kingdom, and the Netherlands). Before implementation of MCSP, of the four countries the United Kingdom had the most structured pathway to post-diagnostic support for people with dementia. MCSP introduction had a positive impact on the pathways to day-care activities in all countries. MCSP filled an important gap in post-diagnostic care, increasing the accessibility to support for both people with dementia and carers. Key elements such as program of activities, target group, and collaboration between healthcare and social services were recognized as success factors. This study shows that MCSP fills (part of) the gap between diagnosis and residential care and can therefore be seen as a pillar of post-diagnostic care and support. Further dissemination of Meeting Centers in Europe may have a multiple impact on the structure of dementia services in European countries and the pathways to day care for people with dementia and their carer(s)

Assessing the ecological risk posed by a recently established invasive alien predator: Harmonia axyridis as a case study

Invasive alien predators are a serious threat to biodiversity worldwide. However, there is no generic method for assessing which local species are most at risk following the invasion of a new predator. The harlequin ladybird, Harmonia axyridis (Pallas) (Coleoptera: Coccinellidae), is an alien in Europe and many other parts of the world where it affects other species of ladybirds through competition for food and intra-guild predation (IGP). Here, we describe a method developed to assess which European ladybird species are most at risk following the invasion of H. axyridis. The three components of the risk assessment are: the likelihood that the assessed native species encounters H. axyridis in the field, the hazard of competition for food, and the IGP hazard. Thirty native European ladybird species were assessed through data obtained from field observations, laboratory experiments and literature reviews. The species that are considered most at risk are found on deciduous trees, have immature stages which are highly vulnerable to IGP by H. axyridis, and are primarily aphidophagous. These species should be the focus of specific studies and possibly conservation actions. The risk assessment method proposed here could be applied to other alien predators which are considered a threat to native species through competition and predation