ICT loves agglomeration The urban impacts of ICT in the Netherlands

Information and Communication Technology (ICT) has had an undeniable impact on our society. Some people argue that technology has projected us onto a new wave of social and cultural change. Nevertheless, despite the growth of technology and the social significance of its applications, we have only a poor grasp of its actual impact on the use of physical space. The key question addressed in this paper is therefore: how will ICT influence the spatial-economic patterns of business activities in the Netherlands? In offering answers to this question, the paper develops a conceptual framework that distinguishes two roles of ICT in spatial-economic development: that of a ‘motor’, enhancing productivity and encourages the development of economic sectors, and that of an ‘enabler’ (of e-work, e-commerce and e-business), which may lead households and firms to adopt a different attitude to space requirements. The paper is based on a thorough survey of the current literature on the subject, the results of a recent survey of ICT’s impact on society, and original empirical research into specific factors such as ICT companies’ location preferences and the willingness of knowledge workers to commute. The paper presents an assessment of the usefulness of these concepts in terms of the Dutch situation, both today and in the future. We conclude that Information and Communication Technology has not yet had a marked visible impact on the use of space. To the contrary, despite predictions neither Dutch companies (particularly those in the ICT sector) nor knowledge workers display any unusual degree of mobility at the local or regional s 2perfect substitute for ‘traditional’ behavioural patterns. Nevertheless, there are clear indications that the ‘spatial order’ of the Netherlands is likely to change. Although it is likely that ICT will consolidate underlying spatial patterns, on the regional aggregate changes are occurring within those patterns. While (inner) cities have traditionally been the breeding ground for new ICT companies, this function has now largely been taken over by the outlying city regions, in which multiple clusters of economic activity are emerging: a process of ‘splintering urbanism’. However, despite this regionalized pattern of deconcentration, the traditional city centres continue to fulfil a number of essential functions. These centres remain the meeting places, and the shopping and entertainment centres for businesses and households (the ‘Consumer City’). In the processes of deconcentration and multimodality, ICT should be seen to play an important facilitating and strengthening role. cale. ICT does not function as a 2perfect substitute for ‘traditional’ behavioural patterns. Nevertheless, there are clear indications that the ‘spatial order’ of the Netherlands is likely to change. Although it is likely that ICT will consolidate underlying spatial patterns, on the regional aggregate changes are occurring within those patterns. While (inner) cities have traditionally been the breeding ground for new ICT companies, this function has now largely been taken over by the outlying city regions, in which multiple clusters of economic activity are emerging: a process of ‘splintering urbanism’. However, despite this regionalized pattern of deconcentration, the traditional city centres continue to fulfil a number of essential functions. These centres remain the meeting places, and the shopping and entertainment centres for businesses and households (the ‘Consumer City’). In the processes of deconcentration and multimodality, ICT should be seen to play an important facilitating and strengthening role.

The knowledge economy and Dutch cities

How can cities and metropolitan regions remain prosperous and competitive in a rapidly changing economy? In our paper we argue that ‘the knowledge economy’ offers perspectives for growth and added value creation. The paper clarifies what elements the knowledge economy actually consists of, how it can be measured in statistical indicators, in which regions and cities in the Netherlands the knowledge economy has its most significant imprints and what statistical association there is between these regions and cities and relatively good economic performance of firms. We test two contrasting hypotheses often heard in the international literature. The current embedding of knowledge externalities in endogenous economic growth theory have led to important contributions that stress the urban character knowledge transmission in particular. The reasoning is that if knowledge spillovers and –externalities are important to growth and innovation, they should be more easily identified in cities where many people are concentrated into a relatively small geographic space so that knowledge can be transmitted between them more easily. Much recent research indeed finds a limited extent of spatial spillovers and a large degree of local clustering. Alternatively, a large body of literature on Western spatial configurations of innovation and high-technology firms predominantly stresses the supposed ‘urban field’ character of firm performance: location and agglomeration aspects do not seem to have a systematic impact on the distribution of innovative and growth inducing activities over space. We test the urban hypothesis using spatial econometric modeling techniques. On the one hand, the fact that a distance squared distance weight matrix in spatial lag estimations fits the performance data best in relation to knowledge economy factors indicates that spatial relations are limited and urban fixed. On the other hand, the significance of several spatial regimes though (especially those of the Randstad core region, the so-called intermediate zone and medium-sized cities) indicates that the urban structure related to the knowledge economy and economic performance is not straightforward hierarchical (largest cities are not the relatively most attached to the knowledge economy). Both hypotheses (urban and non-urban) are too extreme to fit the Dutch situation. We also conclude that the locational attributes of the factor ‘knowledge workers’ are much more significantly related to economic growth and added value (in practically all specifications over regimes and spatial lag estimations) than the R&D-based innovation input factor. This questions Dutch policy initiatives that mainly focus on R&D as stimulator of the ‘knowledge economy’.

Survival-Day @ Wiesbaden business school - evaluation of a short-term educational intervention to reduce work-associated health risks during nursing internships of students in health care economics

Background: In 2013 RheinMain University launched its bachelor's degree program Health Care Economics requiring each student to participate in a mandatory two-month nursing internship. A preliminary risk assessment revealed serious risks for both students and patients and had to be addressed by appropriate measures such as mandatory systematic safety training for each student. Methods: A short-term educational intervention named "Survival-Day" was designed to minimize risks related to nursing internships of students. This intervention consists of six 45-min-units with theoretical input (2 units) and hands-on training (4 units) imparting basic knowledge and skills in CPR, hand hygiene and handling of masks and protective gowns, prevention of needle stick injuries, fire protection and firefighting. Performance of CPR was assessed using computerized manikins. Acceptance, necessity and usability were assessed anonymously by standardized written questionnaires after completion of nursing internships. Results: 462 students have completed the Survival-Day until January 2019. CPR performance showed acceptable adherence rates to guideline recommendations (mean 78.8%, SD ±22.6%). The majority of students performed aseptic health care activities (66%), treated patients with multi-resistant pathogens (62%) and disposed sharp instruments such as blood-contaminated needles (76%). According to students' self-reports about these hazardous activities, less than 50% of these students received adequate safety training at nursing facilities. However, no sentinel events such as needle stick injuries or students becoming second victim have been reported. Conclusion: Our study reveals severe discrepancies between legal obligation of nursing facilities to ensure safety instructions for nursing interns and initial training as perceived by this group. Mandatory initial training before conduction of hazardous tasks was mainly covered by our short-term educational intervention (Survival-Day). Regarding responsibility for their students a preliminary safety instruction program like the Survival-Day should be considered for all educational institutions sending students to nursing internships unless mandatory and sufficient safety trainings for nursing interns can be guaranteed by nursing facilities

ICT and Productivity - relations and dynamics in a spatial context

The strong emergence of ICT in the past decades was accompanied by much research on the potential productivity boosting qualities of ICT: high productivity growth was expected. However, empirical evidence on the productivity impact of ICT stayed behind: the Solow paradox. Since then analytical steps were made by using alternative indicators for both ICT adoption and productivity and including longer time periods, distinctions in types of economic activities and adding micro level and firm specific characteristics like size, age, and intensity of innovation. Moreover, ICT was linked to network relations including externalities. These adaptations led to outcomes in favour of a positive relation between the use of ICT and productivity. However, most convincing in this debate was the finding that the effects of ICT on economic performance should be analysed from a perspective which, besides ICT, includes changes in knowledge and organisations. Knowledge is defined here broadly and includes both codified and tacit knowledge. In this paper we focus on the trinity ‘ICT, knowledge and organization’ and add the regional dimension to this. Based on economic literature our hypothesis is that regions where firms increasingly use ICT show a stronger growth of added value and productivity. This positive relationship is, however, co-determined by changes in the broadly defined knowledge level. The use of ICT by firms is analysed at different levels of urbanism in the Netherlands. Most central is the distinction between the metropolitan Randstad, the intermediate zone and the national periphery. By this regional distinction the debate on the centrifugal and centripetal effects of ICT (the death of distance) is included. The empirical measurement as such is based on the low spatial scale of 496 municipalities.

The knowledge economy and Dutch cities

How can cities and metropolitan regions remain prosperous and competitive in a rapidly changing economy? In our paper we argue that 'the knowledge economy' offers perspectives for growth and added value creation. The paper clarifies what elements the knowledge economy actually consists of, how it can be measured in statistical indicators, in which regions and cities in the Netherlands the knowledge economy has its most significant imprints and what statistical association there is between these regions and cities and relatively good economic performance of firms. We test two contrasting hypotheses often heard in the international literature. The current embedding of knowledge externalities in endogenous economic growth theory have led to important contributions that stress the urban character knowledge transmission in particular. The reasoning is that if knowledge spillovers and –externalities are important to growth and innovation, they should be more easily identified in cities where many people are concentrated into a relatively small geographic space so that knowledge can be transmitted between them more easily. Much recent research indeed finds a limited extent of spatial spillovers and a large degree of local clustering. Alternatively, a large body of literature on Western spatial configurations of innovation and high-technology firms predominantly stresses the supposed 'urban field' character of firm performance: location and agglomeration aspects do not seem to have a systematic impact on the distribution of innovative and growth inducing activities over space. We test the urban hypothesis using spatial econometric modeling techniques. On the one hand, the fact that a distance squared distance weight matrix in spatial lag estimations fits the performance data best in relation to knowledge economy factors indicates that spatial relations are limited and urban fixed. On the other hand, the significance of several spatial regimes though (especially those of the Randstad core region, the so-called intermediate zone and medium-sized cities) indicates that the urban structure related to the knowledge economy and economic performance is not straightforward hierarchical (largest cities are not the relatively most attached to the knowledge economy). Both hypotheses (urban and non-urban) are too extreme to fit the Dutch situation. We also conclude that the locational attributes of the factor 'knowledge workers' are much more significantly related to economic growth and added value (in practically all specifications over regimes and spatial lag estimations) than the R&D-based innovation input factor. This questions Dutch policy initiatives that mainly focus on R&D as stimulator of the 'knowledge economy'

ICT loves agglomeration The urban impacts of ICT in the Netherlands

Information and Communication Technology (ICT) has had an undeniable impact on our society. Some people argue that technology has projected us onto a new wave of social and cultural change. Nevertheless, despite the growth of technology and the social significance of its applications, we have only a poor grasp of its actual impact on the use of physical space. The key question addressed in this paper is therefore: how will ICT influence the spatial-economic patterns of business activities in the Netherlands? In offering answers to this question, the paper develops a conceptual framework that distinguishes two roles of ICT in spatial-economic development: that of a ‘motor’, enhancing productivity and encourages the development of economic sectors, and that of an ‘enabler’ (of e-work, e-commerce and e-business), which may lead households and firms to adopt a different attitude to space requirements. The paper is based on a thorough survey of the current literature on the subject, the results of a recent survey of ICT’s impact on society, and original empirical research into specific factors such as ICT companies’ location preferences and the willingness of knowledge workers to commute. The paper presents an assessment of the usefulness of these concepts in terms of the Dutch situation, both today and in the future. We conclude that Information and Communication Technology has not yet had a marked visible impact on the use of space. To the contrary, despite predictions neither Dutch companies (particularly those in the ICT sector) nor knowledge workers display any unusual degree of mobility at the local or regional s 2perfect substitute for ‘traditional’ behavioural patterns. Nevertheless, there are clear indications that the ‘spatial order’ of the Netherlands is likely to change. Although it is likely that ICT will consolidate underlying spatial patterns, on the regional aggregate changes are occurring within those patterns. While (inner) cities have traditionally been the breeding ground for new ICT companies, this function has now largely been taken over by the outlying city regions, in which multiple clusters of economic activity are emerging: a process of ‘splintering urbanism’. However, despite this regionalized pattern of deconcentration, the traditional city centres continue to fulfil a number of essential functions. These centres remain the meeting places, and the shopping and entertainment centres for businesses and households (the ‘Consumer City’). In the processes of deconcentration and multimodality, ICT should be seen to play an important facilitating and strengthening role. cale. ICT does not function as a 2perfect substitute for ‘traditional’ behavioural patterns. Nevertheless, there are clear indications that the ‘spatial order’ of the Netherlands is likely to change. Although it is likely that ICT will consolidate underlying spatial patterns, on the regional aggregate changes are occurring within those patterns. While (inner) cities have traditionally been the breeding ground for new ICT companies, this function has now largely been taken over by the outlying city regions, in which multiple clusters of economic activity are emerging: a process of ‘splintering urbanism’. However, despite this regionalized pattern of deconcentration, the traditional city centres continue to fulfil a number of essential functions. These centres remain the meeting places, and the shopping and entertainment centres for businesses and households (the ‘Consumer City’). In the processes of deconcentration and multimodality, ICT should be seen to play an important facilitating and strengthening role

The role of Homocysteine as a predictor for coronary heart disease

Background and objective: There is an ongoing debate on the role of the cytotoxic aminoacid homocysteine as a causal risk factor for the development of coronary heart disease. Results from multiple case control-studies demonstrate, that there is a strong association between high plasma levels of homoysteine and prevalent coronary heart disease, independent of other classic risk factors. Furthermore, results from interventional studies point out that elevated plasma levels of homocysteine may effectively be lowered by the intake of folic acid and B vitamins. In order to use this information for the construction of a new preventive strategy against coronary heart disease, more information is needed: first, whether homocysteine actually is a causal risk factor with relevant predictive properties and, second, whether by lowering elevated homocysteine plasma concentrations cardiac morbidity can be reduced. Currently in Germany the determination of homocysteine plasma levels is reimbursed for by statutory health insurance in patients with manifest coronary heart disease and in patients at high risk for coronary heart disease but not for screening purposes in asymptomatic low risk populations.Against this background the following assessment sets out to answer four questions: 1. Is an elevated homocysteine plasma concentration a strong, consistent and independent (of other classic risk factors) predictor for coronary heart disease? 2. Does a therapeutic lowering of elevated homoysteine plasma levels reduce the risk of developing coronary events? 3. What is the cost-effectiveness relationship of homocysteine testing for preventive purposes? 4. Are there morally, socially or legally relevant aspects that should be considered when implementing a preventive strategy as outlined above? Methods: In order to answer the first question, a systematic overview of prospective studies and metaanalyses of prospective studies is undertaken. Studies are included that analyse the association of homocysteine plasma levels with future cardiac events in probands without pre-existing coronary heart disease or in population-based samples. To answer the second question, a systematic overview of the literature is prepared, including randomised controlled trials and systematic reviews of randomised controlled trials that determine the effectiveness of homocysteine lowering therapy for the prevention of cardiac events. To answer the third question, economic evaluations of homocysteine testing for preventive purposes are analysed. Methodological quality of all materials is assessed by widely accepted instruments, evidence was summarized qualitatively. Results: For the first question eleven systematic reviews and 33 single studies (prospective cohort studies and nested case control studies) are available. Among the studies there is profound heterogeneity concercing study populations, classification of exposure (homocysteine measurements, units to express “elevation”), outcome definition and measurement, as well as controlling for confounding (qualitatively and quantitatively). Taking these heterogeneities into consideration, metaanalysis of single patient data with controlling for multiple confounders seems to be the only adequate method of summarizing the results of single studies. The only available analysis of this type shows, that in otherwise healthy people homocysteine plasma levels are only a very weak predictor of future cardiac events. The predictive value of the classical risk factors is much stronger. Among the studies that actively exclude patients with pre-existing coronary heart disease, there are no reports of an association between elevated homocysteine plasma levels and future cardiac events. Eleven randomized controlled trials (ten of them reported in one systematic review) are analysed in order to answer the second question. All trials include high risk populations for the development of (further) cardiac events. These studies also present with marked clinical heterogeneity: primarily concerning the average homocysteine plasma levels at baseline, type and mode of outcome measurement and as study duration. Except for one, none of the trials shows a risk reduction for cardiac events by lowering homocysteine plasma levels with folate or B vitamins. These results also hold for predefined subgroups with markedly elevated homocysteine plasma levels. In order to answer the third questions, three economic evaluations (modelling studies) of homocysteine testing are available. All economic models are based on the assumption that lowering homocysteine plasma levels results in risk reduction for cardiac events. Since this assumption is falsified by the results of the interventional studies cited above, there is no evidence left to answer the third question. Morally, socially or legally relevant aspects of homocysteine assessment are currently not being discussed in the scientific literature. Discussion and conclusion: Many currently available pieces of evidence contradict a causal role of homocysteine in the pathogenesis of coronary heart disease. Arguing with the Bradford-Hill criteria at least the criterion of time-sequence (that exposure has to happen before the outcome is measured), the criterion of a strong and consistent association and the criterion of reversibility are not fulfilled. Therefore, homocysteine may, if at all, play a role as a risk indicator but not as risk factor. Furthermore, currently available evidence does not imply that for the prevention of coronary heart disease, knowledge of homocysteine plasma levels provides any information that supersedes the information gathered from the examination of classical risk factors. So, currently for the indication of prevention, there is no evidence that homocysteine testing provides any benefit. Against this background there is also no basis for cost-effectiveness calculations. Further basic research should clarify the discrepant results of case control studies and prospective studies. Maybe there is a third parameter (confounder) associated with homocysteine metabolism as well with coronary heart disease. Further epidemiological research could elucidate the role of elevated homocysteine plasma levels as a risk indicator or prognostic indicator in patients with pre-existing coronary heart disease taking into consideration the classical risk factors

Long-term dynamics of soil solution in Bavarian forests: Is there a recovering from acidification?

Acid deposition has damaged soils in Central Europe and has been a major source of disturbance for forest ecosystems in the last century. Although acid deposition decreased continuously since the 1990s, it is not clear how fast the damaged soils will recover. We have analysed time series of up to 20 years of precipitation, throughfall and soil solution of the top- and subsoil from 15 Level II forest monitoring sites in Bavaria (Germany). These sites represent a broad range of tree species and soil conditions. As indicators of soil acidification, we calculated the Bc/Al ratio (the ratio of the nutrient cations K, Mg and Ca to Al) and the alkalinity. Additionally, we analysed the trends in Al and SO4 concentrations. To evaluate the temporal dynamics, we extracted the trend of the time series using the model-free method Empirical Mode Decomposition. Our first results suggest that recovery from acidification, i.e. decrease of Al and increase of Bc/Al and alkalinity, is neither uniform nor continuous. We attribute the distinct responses to differences in soil properties among the studied sites