Op weg naar maatschappelijke kosten-batenanalyses voor preventie en zorg : Themarapport Volksgezondheid Toekomst Verkenning 2014

Een maatschappelijke kosten-batenanalyse (MKBA) biedt een overzicht van de voor- en nadelen van een maatregel, zoals de aanleg van een weg of woonwijk. Door deze voor- en nadelen zoveel mogelijk te kwantificeren en in euro's uit te drukken, geeft een MKBA inzicht in het effect van de maatregel op de welvaart in Nederland. Met die informatie kan een MKBA de politieke besluitvorming ondersteunen en verhelderen. Om de kwaliteit en de vergelijkbaarheid van MKBA's te waarborgen hebben het Centraal Planbureau (CPB) en het Planbureau voor de Leefomgeving (PBL) in 2013 een algemene MKBA-leidraad opgesteld. De ministeries zullen de komende jaren werkwijzers maken, waarin de principes van de algemene leidraad worden geconcretiseerd voor het eigen beleidsterrein. Dit rapport van het RIVM is bedoeld als een eerste stap om te komen tot zo'n werkwijzer voor volksgezondheid en zorg. In het rapport laten we zien wat de consequenties zijn als vanuit de MKBA-methode naar dit terrein wordt gekeken. Een goede MKBA kan ook op het terrein van volksgezondheid en zorg een bijdrage leveren aan de beleidsvoorbereiding en de besluitvorming. Daarvoor moeten nog wel enkele methodologische aspecten nader uitgewerkt en bediscussieerd worden. Belangrijke thema's daarbij zijn: effecten op de verdeling van welvaart tussen groepen mensen, de waarde van gezondheid in euro's, het kwantificeren van arbeidsbaten en het waarderen van toekomstige baten (de 'discontovoet'). In dit rapport signaleert en expliciteert het RIVM de belangrijkste vragen en dilemma's waarop de werkwijzer een antwoord moet geven

Microwave photovoltage and photoresistance effects in ferromagnetic microstrips

We investigate the dc electric response induced by ferromagnetic resonance in ferromagnetic Permalloy (Ni80Fe20) microstrips. The resulting magnetization precession alters the angle of the magnetization with respect to both dc and rf current. Consequently the time averaged anisotropic magnetoresistance (AMR) changes (photoresistance). At the same time the time-dependent AMR oscillation rectifies a part of the rf current and induces a dc voltage (photovoltage). A phenomenological approach to magnetoresistance is used to describe the distinct characteristics of the photoresistance and photovoltage with a consistent formalism, which is found in excellent agreement with experiments performed on in-plane magnetized ferromagnetic microstrips. Application of the microwave photovoltage effect for rf magnetic field sensing is discussed.Comment: 16 pages, 15 figure

Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage

Objectives Countries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU).Design Systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance.Data sources Embase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022.Eligibility criteria Studies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC.Data extraction and synthesis Studies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy’s ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU.Results Of the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU.Conclusions SES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored

Healthcare expenditure prediction with neighbourhood variables:A random forest model

We investigated the additional predictive value of an individual’s neighbourhood (quality and location), and of changes therein on his/her healthcare costs. To this end, we combined several Dutch nationwide data sources from 2003 to 2014, and selected inhabitants who moved in 2010. We used random forest models to predict the area under the curve of the regular healthcare costs of individuals in the years 2011–2014. In our analyses, the quality of the neighbourhood before the move appeared to be quite important in predicting healthcare costs (i.e. importance rank 11 out of 126 socio-demographic and neighbourhood variables; rank 73 out of 261 in the full model with prior expenditure and medication). The predictive performance of the models was evaluated in terms of R2 (or proportion of explained variance) and MAE (mean absolute (prediction) error). The model containing only socio-demographic information improved marginally when neighbourhood was added (R2 +0.8%, MAE −€5). The full model remained the same for the study population (R2 = 48.8%, MAE of €1556) and for subpopulations. These results indicate that only in prediction models in which prior expenditure and utilization cannot or ought not to be used neighbourhood might be an interesting source of information to improve predictive performance

Some Mammal Remains from a Jackson County Cave

Excavation of a trench in the floor of a cave at Springbrook, Jackson County, Iowa, yielded bones of nine species of mammals. At a depth of 19 to 24 inches the jawbone of a porcupine and the upper right canine tooth of a black bear were found. There are no museum records of either species in Iowa. Intermingled with these remains were clam shells and ashes probably left by cave dwelling Indians. Historical literature indicates that the bear probably was extinct in Iowa before the Civil War and the porcupine before the advent of white settlers

From test to rest:Evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

IntroductionThe COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.MethodologyThis retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.ResultsAmong the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.DiscussionOur findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans

Het is niet al goud wat blinkt:Eigen huis, eigen vermogen en eigen bijdragen aan de langdurige zorg

De eigen bijdragen voor langdurige zorg zijn in Nederland in de afgelopen jaren fors gestegen. Nadat sinds de jaren 1990 vooral het inkomen (inclusief dat uit vermogen) bepalend was voor de hoogte van de eigen bijdrage, telt nu ook het vermogen zelf weer mee als mogelijke financieringsbron daarvan. In dit NEA paper bekijken we welke personen meer zijn gaan betalen. Om dat na te gaan, maken we gebruik van een unieke koppeling van gegevens uit verschillende bronnen op individueel niveau. Onze conclusies zijn als volgt: hoewel eigen bijdragen aan de langdurige zorg een aantrekkelijke mogelijkheid lijken voor het inperken van groei in de zorguitgaven, is het niet al goud wat blinkt. Enerzijds komt dat omdat ouderen met een bovenmodaal inkomen veel minder gebruik maken van langdurige zorg vergeleken met ouderen met onder modaal inkomen. Dit betreft zowel zorg zonder verblijf (4 keer minder) als zorg met verblijf (6 keer minder). Daardoor dragen zorggebruikers die minder verdienen en die tot de ‘risicogroepen’ behoren, te weten eenpersoonshuishoudens en huurders, de zwaarste last van de totale uitgaven aan de langdurige zorg. Anderzijds zal de invoering van een extra vermogensbijtelling voor eigen bijdragen aan langdurige zorg vooral zorggebruikers met middeninkomens treffen maar geen hogere inkomensgroepen. De budgettaire opbrengst zal tegenvallen en de solidariteit tussen meer- en minderverdieners zal afnemen

Thermal radiation and near-field energy density of thin metallic films

We study the properties of thermal radiation emitted by a thin dielectric slab, employing the framework of macroscopic fluctuational electrodynamics. Particular emphasis is given to the analytical construction of the required dyadic Green's functions. Based on these, general expressions are derived for both the system's Poynting vector, describing the intensity of propagating radiation, and its energy density, containing contributions from non-propagating modes which dominate the near-field regime. An extensive discussion is then given for thin metal films. It is shown that the radiative intensity is maximized for a certain film thickness, due to Fabry-Perot-like multiple reflections inside the film. The dependence of the near-field energy density on the distance from the film's surface is governed by an interplay of several length scales, and characterized by different exponents in different regimes. In particular, this energy density remains finite even for arbitrarily thin films. This unexpected feature is associated with the film's low-frequency surface plasmon polariton. Our results also serve as reference for current near-field experiments which search for deviations from the macroscopic approach

Quantum Noise and Superluminal Propagation

Causal "superluminal" effects have recently been observed and discussed in various contexts. The question arises whether such effects could be observed with extremely weak pulses, and what would prevent the observation of an "optical tachyon." Aharonov, Reznik, and Stern (ARS) [Phys. Rev. Lett., vol. 81, 2190 (1998)] have argued that quantum noise will preclude the observation of a superluminal group velocity when the pulse consists of one or a few photons. In this paper we reconsider this question both in a general framework and in the specific example, suggested by Chiao, Kozhekin, and Kurizki [Phys. Rev. Lett., vol. 77, 1254 (1996)], of off-resonant, short-pulse propagation in an optical amplifier. We derive in the case of the amplifier a signal-to-noise ratio that is consistent with the general ARS conclusions when we impose their criteria for distinguishing between superluminal propagation and propagation at the speed c. However, results consistent with the semiclassical arguments of CKK are obtained if weaker criteria are imposed, in which case the signal can exceed the noise without being "exponentially large." We show that the quantum fluctuations of the field considered by ARS are closely related to superfluorescence noise. More generally we consider the implications of unitarity for superluminal propagation and quantum noise and study, in addition to the complete and truncated wavepackets considered by ARS, the residual wavepacket formed by their difference. This leads to the conclusion that the noise is mostly luminal and delayed with respect to the superluminal signal. In the limit of a very weak incident signal pulse, the superluminal signal will be dominated by the noise part, and the signal-to-noise ratio will therefore be very small.Comment: 30 pages, 1 figure, eps