Managed Competition Reform in the Netherlandsand its Lessons for Canada

This article provides an economic and legal perspective on the managed competition reforms within the Netherlands. After an examination of the rationale and the main features of the reforms, a number of problems and dilemmas that were encountered during the implementation process will be highlighted. The authors conclude that although the logic of the managed competition model is appealing, its implementation is quite complicated and requires a strong government with a continued commitment to set and enforce the rules of competition. If these preconditions are not met, the prospects of a successful introduction of managed competition are bleak. Despite its different health care system, Canada may benefit from the Dutch reform experience, especially if the trend towards decentralization of health planning and funding continues. In particular, the need for an adequate definition of entitlement to health care will become more pronounced

Risk of Infection with Leishmania spp. in the Canine Population in the Netherlands

<p/> <p>The dog is the main reservoir of <it>Leishmania infantum</it>, the causative agent of visceral leishmaniasis (VL) in humans in Southern Europe. In order to identify the risk of dogs from a <it>Leishmania </it>non-endemic area traveling to a <it>Leishmania</it>-endemic area becoming infected and the risk of transmitting infection to humans in non-endemic areas an investigation was performed, in which the results of a questionnaire were combined with the results of a serologic survey.</p> <p>The questionnaire was sent to 1478 at random chosen families in the Netherlands. Of the 59.0% responders 28.0% had one or more dogs and 4.8% of these dogs had visited Southern Europe during the summer period of that year. On a total population of 1,200,000 dogs in the Netherlands, this means that each year some 58,000 dogs are at risk of being exposed to a <it>Leishmania </it>infection in Southern Europe.</p> <p>During the period 1990–1992 blood was collected for serology in 1911 dogs presented to the Utrecht University Clinic because of clinical problems not related to leishmaniasis, of which 434 had been in Southern Europe in the foregoing years. None was serologically positive. From these data it can be deduced that the highest chance to obtain leishmaniasis during a vacation in Southern Europe is mathematically less than 1/434 or less than 0.23%. Serology was also performed during the period 1989–1993 in 597 dogs that had been in Southern Europe and were suspected of leishmaniasis. Titers were positive in 145 of these samples. Sixty-four of these dogs were born in the Mediterranean and had been imported into the Netherlands. Excluding these imported dogs, it was calculated that at least 0.027% of the 58,000 dogs yearly taken to Southern Europe during holidays become infected with Leishmania. In order to establish the risk of disease transmission for people in close contact with an infected dog, serum samples of owners and house mates of 37 dogs with leishmaniasis were tested. All 112 sera tested negative. It was concluded that the risk to get leishmaniasis was between 0.027% and 0.23% for the dog when taken to Southern Europe during vacation, and that the risk for owners in non-endemic areas to get leishmaniasis from an infected dog is minimal.</p

Effets de différentes fréquences annuelles de stimulation éthylénique sur les paramètres agrophysiologiques et de sensibilité à l’encoche sèche d’Hevea brasiliensis au sud-est de la Côte d’Ivoire:Cas des clones PB 235 et PB 260 de la classe ..

Titre complet ici: Effets de différentes fréquences annuelles de stimulation éthylénique sur les paramètres agrophysiologiques et de sensibilité à l’encoche sèche d’Hevea brasiliensis au sud-est de la Côte d’Ivoire : cas des clones PB 235 et PB 260 de la classe d’activité métabolique rapideLa stimulation hormonale de la production de caoutchouc abusive et inadaptée réduit considérablementla productivité de l’hévéa. Pour prévenir cette contrainte, une étude des régimes annuels de stimulationpermettant aux clones PB 235 et PB 260 d’Hevea brasiliensis, à métabolisme actif, d’exprimer au mieux leurspotentialités, a été entreprise au sud-est de la Côte d’Ivoire. Les hévéas, plantés à 510 arbres/ha selon undispositif complètement randomisé, ont été saignés en S/2 d4 et stimulés à l’Ethéphon aux fréquences annuellesde 0, 1, 2, 4, 6, 8, 13 et 26. Les paramètres mesurés ont été la production de caoutchouc, la croissanceisodiamétrique, le profil physiologique et la sensibilité à l’encoche sèche des arbres. Les résultats ont révéléque la stimulation a une influence sur la production, la croissance isodiamétrique et les paramètresphysiologiques des clones PB 235 et PB 260. La teneur en saccharose du latex a été un paramètre déterminantde la réponse à cette stimulation puisqu’elle a participé de l’amélioration de la productivité et surtout del’amoindrissement du stress pouvant susciter la fatigue physiologique, voire l’encoche sèche. La sensibilité à cesyndrome est une caractéristique intrinsèque de ces clones. Pour exprimer au mieux leurs potentialités, lesfréquences annuelles de stimulation respectives de 1 et 2 sont adaptées aux PB 235 et PB 260.Mots clés : Hevea brasiliensis, demi-spirale descendante, stimulation hormonale, croissance isodiamétrique,profil physiologique, encoche sèche, Côte d’Ivoire

Atom--Molecule Coherence in a Bose-Einstein Condensate

Coherent coupling between atoms and molecules in a Bose-Einstein condensate (BEC) has been observed. Oscillations between atomic and molecular states were excited by sudden changes in the magnetic field near a Feshbach resonance and persisted for many periods of the oscillation. The oscillation frequency was measured over a large range of magnetic fields and is in excellent quantitative agreement with the energy difference between the colliding atom threshold energy and the energy of the bound molecular state. This agreement indicates that we have created a quantum superposition of atoms and diatomic molecules, which are chemically different species.Comment: 7 pages, 6 figure

Rapid sympathetic cooling to Fermi degeneracy on a chip

Neutral fermions present new opportunities for testing many-body condensed matter systems, realizing precision atom interferometry, producing ultra-cold molecules, and investigating fundamental forces. However, since their first observation, quantum degenerate Fermi gases (DFGs) have continued to be challenging to produce, and have been realized in only a handful of laboratories. In this Letter, we report the production of a DFG using a simple apparatus based on a microfabricated magnetic trap. Similar approaches applied to Bose-Einstein Condensation (BEC) of 87Rb have accelerated evaporative cooling and eliminated the need for multiple vacuum chambers. We demonstrate sympathetic cooling for the first time in a microtrap, and cool 40K to Fermi degeneracy in just six seconds -- faster than has been possible in conventional magnetic traps. To understand our sympathetic cooling trajectory, we measure the temperature dependence of the 40K-87Rb cross-section and observe its Ramsauer-Townsend reduction.Comment: 5 pages, 4 figures (v3: new collision data, improved atom number calibration, revised text, improved figures.

Coherent spinor dynamics in a spin-1 Bose condensate

Collisions in a thermal gas are perceived as random or incoherent as a consequence of the large numbers of initial and final quantum states accessible to the system. In a quantum gas, e.g. a Bose-Einstein condensate or a degenerate Fermi gas, the phase space accessible to low energy collisions is so restricted that collisions be-come coherent and reversible. Here, we report the observation of coherent spin-changing collisions in a gas of spin-1 bosons. Starting with condensates occupying two spin states, a condensate in the third spin state is coherently and reversibly created by atomic collisions. The observed dynamics are analogous to Josephson oscillations in weakly connected superconductors and represent a type of matter-wave four-wave mixing. The spin-dependent scattering length is determined from these oscillations to be -1.45(18) Bohr. Finally, we demonstrate coherent control of the evolution of the system by applying differential phase shifts to the spin states using magnetic fields.Comment: 19 pages, 3 figure

The BINGO project: VII. Cosmological forecasts from 21 cm intensity mapping

Context. The 21 cm line of neutral hydrogen (HI) opens a new avenue in our exploration of the structure and evolution of the Universe. It provides complementary data to the current large-scale structure (LSS) observations with different systematics, and thus it will be used to improve our understanding of the Icold dark matter (ICDM) model. This will ultimately constrain our cosmological models, attack unresolved tensions, and test our cosmological paradigm. Among several radio cosmological surveys designed to measure this line, BINGO is a single-dish telescope mainly designed to detect baryon acoustic oscillations (BAOs) at low redshifts (0.127 < z < 0.449). Aims. Our goal is to assess the fiducial BINGO setup and its capabilities of constraining the cosmological parameters, and to analyze the effect of different instrument configurations. Methods. We used the 21 cm angular power spectra to extract cosmological information about the HI signal and the Fisher matrix formalism to study BINGO's projected constraining power. Results. We used the Phase 1 fiducial configuration of the BINGO telescope to perform our cosmological forecasts. In addition, we investigated the impact of several instrumental setups, taking into account some instrumental systematics, and different cosmological models. Combining BINGO with Planck temperature and polarization data, the projected constraint improves from a 13% and 25% precision measurement at the 68% confidence level with Planck only to 1% and 3% for the Hubble constant and the dark energy (DE) equation of state (EoS), respectively, within the wCDM model. Assuming a Chevallier- Polarski- Linder (CPL) parameterization, the EoS parameters have standard deviations given by w0 = 0.30 and wa = 1.2, which are improvements on the order of 30% with respect to Planck alone. We also compared BINGO's fiducial forecast with future SKA measurements and found that, although it will not provide competitive constraints on the DE EoS, significant information about HI distribution can be acquired. We can access information about the HI density and bias, obtaining 8.5% and 6% precision, respectively, assuming they vary with redshift at three independent bins. BINGO can also help constrain alternative models, such as interacting dark energy and modified gravity models, improving the cosmological constraints significantly. Conclusions. The fiducial BINGO configuration will be able to extract significant cosmological information from the HI distribution and provide constraints competitive with current and future cosmological surveys. It will also help in understanding the HI physics and systematic effects

ONCOR: design of the Dutch cardio-oncology registry

Background: The relative new subspecialty ‘cardio-oncology’ was established to meet the growing demand for an interdisciplinary approach to the management of cancer therapy–related cardiovascular adverse events. In recent years, specialised cardio-oncology services have been implemented worldwide, which all strive to improve the cardiovascular health of cancer patients. However, limited data are currently available on the outcomes and experiences of these specialised services, and optimal strategies for cardio-oncological care have not been established. / Aim: The ONCOR registry has been created for prospective data collection and evaluation of cardio-oncological care in daily practice. / Methods: Dutch hospitals using a standardised cardio-oncology care pathway are included in this national, multicentre, observational cohort study. All patients visiting these cardio-oncology services are eligible for study inclusion. Data collection at baseline consists of the (planned) cancer treatment and the cardiovascular risk profile, which are used to estimate the cardiotoxic risk. Information regarding invasive and noninvasive tests is collected during the time patients receive cardio-oncological care. Outcome data consist of the incidence of cardiovascular complications and major adverse cardiac events, and the impact of these events on the oncological treatment. / Discussion: Outcomes of the ONCOR registry may aid in gaining more insight into the incidence of cancer therapy–related cardiovascular complications. The registry facilitates research on mechanisms of cardiovascular complications and on diagnostic, prognostic and therapeutic strategies. In addition, it provides a platform for future (interventional) studies. Centres with cardio-oncology services that are interested in contributing to the ONCOR registry are hereby invited to participate