Health care reform and financial crisis in the Netherlands

Over the past decade, many health care systems across the Global North have implemented elements of market mechanisms while also dealing with the consequences of the financial crisis. Although effects of these two developments have been researched separately, their combined impact on the governance of health care organizations has received less attention. The aim of this study is to understand how health care reforms and the financial crisis together shaped new roles and interactions within health care. The Netherlands - where dynamics between health care organizations and their financial stakeholders (i.e., banks and health insurers) were particularly impacted - provides an illustrative case. Through semi-structured interviews, additional document analysis and insights from institutional change theory, we show how banks intensified relationship management, increased demands on loan applications and shifted financial risks onto health care organizations, while health insurers tightened up their monitoring and accountability practices towards health care organizations. In return, health care organizations were urged to rearrange their operations and become more risk-minded. They became increasingly dependent on banks and health insurers for their existence. Moreover, with this study, we show how institutional arenas come about through both the long-term efforts of institutional agents and unpredictable implications of economic and societal crises.</p

BIM : a methodology to transform business processes into software systems

This manuscript proposes a guiding methodology to obtain a software system that supports the execution of the business processes existing within an organization. The methodology promotes the usage of business process reference models and intends to reduce the implementation time of the software systems. The methodology assumes four distinct phases and several abstraction levels and is applicable both when developing systems from scratch or in re-engineering contexts. The methodology embodies a special phase to handle the diversity of the business processes of an organization. By tailoring process reference models and by considering the characteristics of a specific organization, a proper set of business processes is derived for that organization. Then, we can obtain a suitable information system and implement its automatable parts in a software solution that can run on top of open source software frameworks. We also present four new supporting concepts to the methodology, and a summarized execution of it

Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes.

ObjectivesThe objective of this review was to summarize and appraise evidence on functional electrical stimulation (FES) cycling exercise after spinal cord injury (SCI), in order to inform the development of evidence-based clinical practice guidelines.MethodsPubMed, the Cochrane Central Register of Controlled Trials, EMBASE, SPORTDiscus, and CINAHL were searched up to April 2021 to identify FES cycling exercise intervention studies including adults with SCI. In order to capture the widest array of evidence available, any outcome measure employed in such studies was considered eligible. Two independent reviewers conducted study eligibility screening, data extraction, and quality appraisal using Cochranes' Risk of Bias or Downs and Black tools. Each study was designated as a Level 1, 2, 3 or 4 study, dependent on study design and quality appraisal scores. The certainty of the evidence for each outcome was assessed using GRADE ratings ('High', 'Moderate', 'Low', or 'Very low').ResultsNinety-two studies met the eligibility criteria, comprising 999 adults with SCI representing all age, sex, time since injury, lesion level and lesion completeness strata. For muscle health (e.g., muscle mass, fiber type composition), significant improvements were found in 3 out of 4 Level 1-2 studies, and 27 out of 32 Level 3-4 studies (GRADE rating: 'High'). Although lacking Level 1-2 studies, significant improvements were also found in nearly all of 35 Level 3-4 studies on power output and aerobic fitness (e.g., peak power and oxygen uptake during an FES cycling test) (GRADE ratings: 'Low').ConclusionCurrent evidence indicates that FES cycling exercise improves lower-body muscle health of adults with SCI, and may increase power output and aerobic fitness. The evidence summarized and appraised in this review can inform the development of the first international, evidence-based clinical practice guidelines for the use of FES cycling exercise in clinical and community settings of adults with SCI. Registration review protocol: CRD42018108940 (PROSPERO)

Universal distribution of transparencies in highly conductive Nb/AlOx_x/Nb junctions

We report the observation of the universal distribution of transparencies, predicted by Schep and Bauer [Phys. Rev. Lett. {\bf 78}, 3015 (1997)] for dirty sharp interfaces, in uniform Nb/AlO$_x$/Nb junctions with high specific conductance ($10^8$ Ohm$^{-1}$cm$^{-2}$). Experiments used the BCS density of states in superconducting niobium for transparency distribution probing. Experimental results for both the dc $I-V$ curves at magnetic-field-suppressed supercurrent and the Josephson critical current in zero magnetic field coincide remarkably well with calculations based on the multimode theory of multiple Andreev reflections and the Schep-Bauer distribution.Comment: 4 pages, 4 figures, references adde

Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels

Objective: To investigate the effects of low-intensity wheelchair training on wheelchair-specific fitness, wheelchair skill performance and physical activity levels in inactive people with long-term spinal cord injury. Design: Randomized controlled trial. Participants: Inactive manual wheelchair users with spinal cord injury for at least 10 years (n = 29), allocated to exercise (n = 14) or no exercise. Methods: The 16-week training consisted of wheelchair treadmill-propulsion at 30-40% heart rate reserve or equivalent in terms of rate of perceived exertion, twice a week, for 30 min per session. Wheelchair-specific fitness was determined as the highest 5-s power output over 15-m overground wheelchair sprinting (P5-15m), isometric push-force, submaximal fitness and peak aerobic work capacity. Skill was determined as performance time, ability and strain scores over a wheelchair circuit. Activity was determined using a questionnaire and an odometer. Results: Significant training effects appeared only in P5-15m (exercise vs control: mean +2.0 W vs -0.7 W, p = 0.017, ru=0.65). Conclusion: The low-intensity wheelchair training appeared insufficient for substantial effects in the sample of inactive people with long-term spinal cord injury, presumably in part owing to a too-low exercise frequency. Effective yet feasible and sustainable training, as well as other physical activity programmes remain to be developed for inactive people with long-term spinal cord injury. Key words: activities of daily living; paraplegia; physical activity; physical fitness; spinal cord injuries; tetraplegia; rehabilitation; wheelchairs

Subharmonic Shapiro steps and assisted tunneling in superconducting point contacts

We analyze the current in a superconducting point contact of arbitrary transmission in the presence of a microwave radiation. The interplay between the ac Josephson current and the microwave signal gives rise to Shapiro steps at voltages V = (m/n) \hbar \omega_r/2e, where n,m are integer numbers and \omega_r is the radiation frequency. The subharmonic steps (n different from 1) are a consequence of the ocurrence of multiple Andreev reflections (MAR) and provide an unambiguous signature of the peculiar ac Josephson effect at high transmission. Moreover, the dc current exhibits a rich subgap structure due to photon-assisted MARs.Comment: Revtex, 4 pages, 4 figure

Resistively-shunted superconducting quantum point contacts

We have studied the Josephson dynamics of resistively-shunted ballistic superconducting quantum point contacts at finite temperatures and arbitrary number of conducting modes. Compared to the classical Josephson dynamics of tunnel junctions, dynamics of quantum point contacts exhibits several new features associated with temporal fluctuations of the Josephson potential caused by fluctuations in the occupation of the current-carrying Andreev levels.Comment: 5 pages, RevTex, 3 postscript figures include

Full Counting Statistics of Multiple Andreev Reflections in incoherent diffusive superconducting junctions

We present a theory for the full distribution of current fluctuations in incoherent diffusive superconducting junctions, subjected to a voltage bias. This theory of full counting statistics of incoherent multiple Andreev reflections is valid for arbitrary applied voltage. We present a detailed discussion of the properties of the first four cumulants as well as the low and high voltage regimes of the full counting statistics. The work is an extension of the results of Pilgram and the author, Phys. Rev. Lett. 94, 086806 (2005).Comment: Included in special issue Spin Physics of Superconducting heterostructures of Applied Physics A: Materials Science & Processin