Aggregated dynamic demand equations for specialistic-outpatient medical care:(Estimated from a time-series of cross-sections)

In this paper a dynamic model is presented which describes the development of the demand for specialistic medical care in The Netherlands, during the period 1960-1972. The "regionally correlated, time-wise auto-regressive" model is consistently estimated from a time-series of cross-sections, using a modified Aitken estimator. The dependent variables are the number of publicly insured patients referred from general care to specialistic care, and the amount of care consumed per patient referred. As independent variables we took demographic factors, the supply of different levels of medical care and the insurance system. The estimation results show a.o. important substitution possibilities between general and specialistic care, and a significant influence of supply and supply-related variables on the demand for specialistic care.</p

Are tearful individuals perceived as less competent? Probably not

What are the social signals of emotional tears? This question has fascinated scholars ever since Darwin. Studies have suggested several interpersonal effects of emotional tears. A recent study by Van de Ven, Meijs, and Vingerhoets (2017) presented evidence in three studies that tearful individuals are perceived as warmer, but also less competent than their non-tearful counterparts. However, the competence effect was relatively small, and a recent replication failed to find such an effect in two different populations while the warmth effect was replicated (Zickfeld &amp; Schubert, 2018). This questions the generalizability of the effect of tears on perceived competence. To test whether individuals expressing emotional tears are really perceived as less competent and what boundary conditions such an effect might have, we specified a decision tree of three different studies in which we test differences between the original reference study and the replication. We replicated previous findings of the perceived (in)competence in Study 1 (n = 531) but observed a considerably smaller non-significant effect when proceeding to Study 2 (n = 471), which increased the number of stimuli. The earlier and now repeated replication failure can therefore likely be attributed to an increased variation in stimulus material. We conclude that there is not enough evidence to argue that one social outcome of tears signals a relative lack of competence as the effect seems to depend on the specific stimuli used.info:eu-repo/semantics/acceptedVersio

Labour not land constrains agricultural production and food self-sufficiency in maize-based smallholder farming systems in Mozambique

Despite abundant land and favourable climatic conditions, Mozambique remains food insecure. We investigated the diversity, constraints and opportunities to increase smallholder productivity and achieve food self-sufficiency in maize-based farming systems in two Posts in central Mozambique. We identified four farm types in each village based on cultivated area and labour. Farm type 1 cultivated relatively large areas, owned cattle and hired in labour. Farm type 2 cultivated moderate areas and both hired in and hired out labour. Farms of type 3a and 3b cultivated the smallest areas. Farm type 3a shared labour while Farm type 3b only hired out labour. For each farm type, we calculated land and labour productivities of maize, sunflower and sesame and assessed maize self-sufficiency. Access to labour during weeding was the main constraint. The hiring out of labour by small farms caused severe reductions in both land and labour productivity. Yield reductions on these farms were due to delayed weeding in own fields. In one Post, Farm type 3b was not maize self-sufficient. Labour quality was probably impaired by excess alcohol consumption among the poorer farmers (both men and women). Our results showed that production can be increased based on current agricultural practices. Farmers did not cultivate all of their land, suggesting that lack of labour constrained intensification by smallholder farmers

Case finding of mild cognitive impairment and dementia and subsequent care; results of a cluster RCT in primary care

Purpose Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. Methods In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≤ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Results Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3 (138/326) of persons in the intervention, and in 30.5 (98/321) in the control group (estimated difference GEE: 10.8, OR: 1.51, 95-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25), there were no differences in mental health between the intervention and control group. Conclusions We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. Trial Registration Nederlands Trial Register NTR3389 © 2016 van den Dungen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

R&D partnership portfolios and the inflow of technological knowledge

This article links research on parallel search and joint R&D to contribute a portfolio perspective to the study of knowledge flows within interfirm R&D partnerships. In a longitudinal analysis of firms engaged in R&D partnerships relating to information technology between 1975 and 1999, we show that the size of a firm's R&D partnership portfolio and its share of novel partners both have an inverted U-shaped effect on the inflow of technological knowledge from the firm's R&D partners. We also show how these direct effects vary as a function of the level of technological uncertainty within the portfolio

Managing digital coordination of design: emerging hybrid practices in an institutionalized project setting

What happens when digital coordination practices are introduced into the institutionalized setting of an engineering project? This question is addressed through an interpretive study that examines how a shared digital model becomes used in the late design stages of a major station refurbishment project. The paper contributes by mobilizing the idea of ‘hybrid practices’ to understand the diverse patterns of activity that emerge to manage digital coordination of design. It articulates how engineering and architecture professions develop different relationships with the shared model; the design team negotiates paper-based practices across organizational boundaries; and diverse practitioners probe the potential and limitations of the digital infrastructure. While different software packages and tools have become linked together into an integrated digital infrastructure, these emerging hybrid practices contrast with the interactions anticipated in practice and policy guidance and presenting new opportunities and challenges for managing project delivery. The study has implications for researchers working in the growing field of empirical work on engineering project organizations as it shows the importance of considering, and suggests new ways to theorise, the introduction of digital coordination practices into these institutionalized settings

Virtual Resection: A New Tool for Preparing for Nephron-Sparing Surgery in Wilms Tumor Patients

Nephron-sparing surgery (NSS) in Wilms tumor (WT) patients is a surgically challenging procedure used in highly selective cases only. Virtual resections can be used for preoperative planning of NSS to estimate the remnant renal volume (RRV) and to virtually mimic radical tumor resection. In this single-center evaluation study, virtual resection for NSS planning and the user experience were evaluated. Virtual resection was performed in nine WT patient cases by two pediatric surgeons and one pediatric urologist. Pre- and postoperative MRI scans were used for 3D visualization. The virtual RRV was acquired after performing virtual resection and a questionnaire was used to assess the ease of use. The actual RRV was derived from the postoperative 3D visualization and compared with the derived virtual RRV. Virtual resection resulted in virtual RRVs that matched nearly perfectly with the actual RRVs. According to the questionnaire, virtual resection appeared to be straightforward and was not considered to be difficult. This study demonstrated the potential of virtual resection as a new planning tool to estimate the RRV after NSS in WT patients. Future research should further evaluate the clinical relevance of virtual resection by relating it to surgical outcome