Measuring and Interpreting Trends in the Division of Labour in the Netherlands

This paper introduces indicators about the division of labour to measure and interpret recent trends in the structure of employment in the Netherlands. Changes in the division of labour occur at three different levels: the level of the individual worker, the level of the industry and the spatial level. At each level the organisation of work is determined by an equilibrium of forces that glue tasks together or unbundle them. Communication costs are the main force for clustering or gluing together tasks; comparative advantage stimulates unbundling and specialisation. The estimates suggest that on average the Netherlands has witnessed unbundling in the period 1996-2005, which implies that advantages of specialisation have increased. These developments explain to a considerable extent changes in the structure of employment. Especially at the spatial level it explains a substantial part of the increase in offshoring tasks abroad.technological change, tasks, division of labour, the Netherlands

Max and the knight: how a therapeutic story provided a connection point for child, family, school, human service agencies and community

OBJECTIVES: We developed an outcome indicator based on the finding that complications often prolong the patient's hospital stay. A higher percentage of patients with an unexpectedly long length of stay (UL-LOS) compared to the national average may indicate shortcomings in patient safety. We explored the utility of the UL-LOS indicator. SETTING: We used data of 61 Dutch hospitals. In total these hospitals had 1 400 000 clinical discharges in 2011. PARTICIPANTS: The indicator is based on the percentage of patients with a prolonged length of stay of more than 50% of the expected length of stay and calculated among survivors. INTERVENTIONS: No interventions were made. OUTCOME MEASURES: The outcome measures were the variability of the indicator across hospitals, the stability over time, the correlation between the UL-LOS and standardised mortality and the influence on the indicator of hospitals that did have problems discharging their patients to other health services such as nursing homes. RESULTS: In order to compare hospitals properly the expected length of stay was computed based on comparison with benchmark populations. The standardisation was based on patients' age, primary diagnosis and main procedure. The UL-LOS indicator showed considerable variability between the Dutch hospitals: from 8.6% to 20.1% in 2011. The outcomes had relatively small CIs since they were based on large numbers of patients. The stability of the indicator over time was quite high. The indicator had a significant positive correlation with the standardised mortality (r=0.44 (p0.05)). CONCLUSIONS: The UL-LOS indicator is a useful addition to other patient safety indicators by revealing variation between hospitals and areas of possible patient safety improvement

Toward an Integrated Competence-based System Supporting Lifelong Learning and Employability: Concepts, Model, and Challenges

Miao, Y., Van der Klink, M., Boon, J., Sloep, P. B., & Koper, R. (2009). Toward an Integrated Competence-based System Supporting Lifelong Learning and Employability: Concepts, Model, and Challenges. In M. Spaniol, Q. Li, R. Klamma & R. W. H. Lau (Eds.), Proceedings of the 8th International Conference Advances in Web Based Learning - ICWL 2009 (pp. 265-276). August, 19-21, 2009, Aachen, Germany. Lecture Notes in Computer Science 5686; Berlin, Heidelberg: Springer-Verlag.Efficient and effective lifelong learning requires that people can make informed decisions about their continuous personal development in the different stages of their lives. In this paper we state that lifelong learners need to be characterized as decision-makers. In order to improve the quality of their decisions we propose the development of an integrated lifelong learning and employment support system, which traces learners’ competence development and provides a decision support environment. An abstract conceptual model has been developed and the main design ideas have been documented using Z notation. Moreover, we analyzed the main technical challenges for the realization of the target system: competence information fusion, decision analysis models, spatial indexing structures and browsing structures and visualization of competence related information objects.The work on this publication has been sponsored by the TENCompetence Integrated Project that is funded by the European Commission's 6th Framework Programme, priority IST/Technology Enhanced Learning. Contract 027087 [http://www.tencompetence.org

The role of parental investments for cognitive and noncognitive skill formation : evidence for the first 11 years of life

This paper examines the impact of parental investments on the development of cognitive, mental and emotional skills during childhood using data from a longitudinal study, the Mannheim Study of Children at Risk, starting at birth. Our work offers three important innovations. First, we use reliable measures of the child’s cognitive, mental and emotional skills as well as accurate measures of parental investment. Second, we estimate latent factor models to account for unobserved characteristics of children. Third, we examine the skill development for girls and boys separately, as well as for children who were born with either organic or psychosocial risk. We find a decreasing impact of parental investments on cognitive and mental skills, while emotional skills seem to be unaffected by parental investment throughout childhood. Thus, initial inequality persists during childhood. Since families are the main sources of education during the first years of life, our results have important implications for the quality of the parent-child relationship

The influence of T cell development on pathogen specificity and autoreactivity

T cells orchestrate adaptive immune responses upon activation. T cell activation requires sufficiently strong binding of T cell receptors on their surface to short peptides derived from foreign proteins bound to protein products of the major histocompatibility (MHC) gene products, which are displayed on the surface of antigen presenting cells. T cells can also interact with peptide-MHC complexes, where the peptide is derived from host (self) proteins. A diverse repertoire of relatively self-tolerant T cell receptors is selected in the thymus. We study a model, computationally and analytically, to describe how thymic selection shapes the repertoire of T cell receptors, such that T cell receptor recognition of pathogenic peptides is both specific and degenerate. We also discuss the escape probability of autoimmune T cells from the thymus.Comment: 12 pages, 7 figure

Direct medical costs of adverse events in Dutch hospitals

Background: Various international studies have shown that a substantial number of patients suffer from injuries or even die as a result of care delivered in hospitals. The occurrence of injuries among patients caused by health care management in Dutch hospitals has never been studied systematically. Therefore, an epidemiological study was initiated to determine the incidence, type and impact of adverse events among discharged and deceased patients in Dutch hospitals. Methods/Design: Three stage retrospective patient record review study in 21 hospitals of 8400 patient records of discharged or deceased patients in 2004. The records were reviewed by trained nurses and physicians between August 2005 and October 2006. In addition to the determination of presence, the degree of preventability, and causes of adverse events, also location, timing, classification, and most responsible specialty of the adverse events were measured. Moreover, patient and admission characteristics and the quality of the patient records were recorded. Discussion: In this paper we report on the design of the retrospective patient record study on the occurrence of adverse events in Dutch hospitals. Attention is paid to the strengths and limitations of the study design. Furthermore, alterations made in the original research protocol in comparison with former international studies are described in detail.