Costs and benefits of an individual learning account (ILA):A simulation analysis for the Netherlands

This study analyses costs and benefits of a public-private funded individual learning account (ILA) for the labour force in the Netherlands. We consider an ILA that is funded by subsidies targeted at low- and medium-educated workers and co-funded by training levies as a share of the wage bill. We simulate two alternative steady-state scenarios about the uptake of resources and increase in training activity, using a lifecycle model of human capital investments. We derive predictions for gross earnings, income inequality and costs (training subsidies and tax deductions) and benefits (tax revenues and fewer unemployment benefits). Our results show how the balance of costs and benefits depends on the interplay between take-up rates, returns to training and the deadweight loss of subsidizing an ILA for the whole labour force. Our model and results contribute to policy trade-offs about the introduction of ILA's to stimulate the resilience of the labour force

Understanding success and failure in innovative Australian resource processing projects

This thesis in concerned with the understanding of success and failure of innovation in resource processing, a sector that is central to the Australian economy. Decline in ore grade, complexity of available ore resources, increases in labour and capital cost, and increased market demand have driven innovation and larger resource processing projects. The outcomes from innovation investment have been disappointing, and not well understood. This thesis aims to understand why so many large resource processing projects fail, and what factors have been critical in other projects that succeed. It proposes a new model for innovation investment, based on public domain data and an outsider view. Five criteria are used in this thesis to classify success and failure of large resource processing projects; that (1) the project and firm made a profit, in failure the project made a loss, (2) the production in the first 36 months of operation is 90% or more of nameplate capacity, while a failure is less than 70%, (3) return on investment is below 105 months, failure above 105 months, average for successful projects is found to be 53 months,. (4) failure sees project and or firm fail, with the plant selling for less than 20% of cost, success sees the project continue to produce at close to capacity, and if sold was value at close to investment, and (5) the successful process is reproduced; in the case of failure it is not. The thesis examines a sample of 67 resource processing projects in Australia initially valued at over $100 million each, over an 18 year interval between 1993 and 2010. The projects totalled$45.3 billion in value with 73% of classified as successful, while 15 projects failed. Four hypotheses are proposed and tested, each respectively relating to one of the following four factors; (1) Firm competence, (2) new process innovation, (3) government involvement in value adding, and (4) information asymmetry and strategic misrepresentation

Barriers in recognising, diagnosing and managing depressive and anxiety disorders as experienced by Family Physicians; a focus group study

BACKGROUND The recognition and treatment of depressive- and anxiety disorders is not always in line with current standards. The results of programs to improve the quality of care, are not encouraging. Perhaps these programs do not match with the problems experienced in family practice. This study aims to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders. METHODS focus group discussions with FPs, qualitative analysis of transcriptions using thematic coding. RESULTS The FPs considered recognising, diagnosing and managing depressive- and anxiety disorders as an important task. They expressed serious doubts about the validity and usefulness of the DSM IV concept of depressive and anxiety disorders in family practice especially because of the high frequency of swift natural recovery. An important barrier was that many patients have difficulties in accepting the diagnosis and treatment with antidepressant drugs. FPs lacked guidance in the assessment of patients' burden. The FPs experienced they had too little time for patient education and counseling. The under capacity of specialised mental health care and its minimal collaboration with FPs were experienced as problematic. Valuable suggestions for solving the problems encountered were made CONCLUSION Next to serious doubts regarding the diagnostic concept of depressive- and anxiety disorders a number of factors were identified which serve as barriers for suitablemental health care by FPs. These doubts and barriers should be taken into account in future research and in the design of interventions to improve mental health care in family practice.This study was co-funded by the International Health Foundation, Utrecht, the Netherlands

Dynamic contact area ratio in shoulder instability: an innovative diagnostic technique measuring interplay of bony lesions

Purpose: The hypothesis of this study is that Dynamic Contact Area Ratio of the humerus and glenoid, measured with CT scans, is significantly reduced in patients with anterior shoulder instability compared to the Dynamic Contact Area Ratio in a control group of people without shoulder instability. Methods: Preoperative CT scans of patients who underwent surgery for anterior shoulder instability were collected. Additionally, the radiologic database was searched for control subjects. Using a validated software tool (Articulis) the CT scans were converted into 3-dimensional models and the amount the joint contact surface during simulated motion was calculated. Results: CT scans of 18 patients and 21 controls were available. The mean Dynamic Contact Area Ratio of patients was 25.2 \ub1 6.7 compared to 30.1 \ub1 5.1 in healthy subjects (p = 0.014). Conclusion: Dynamic Contact Area Ratio was significantly lower in patients with anterior shoulder instability compared to controls, confirming the hypothesis of the study. The findings of this study indicate that calculating the Dynamic Contact Area Ratio based on CT scan images may help surgeons in diagnosing anterior shoulder instability. Level of evidence: III

Assessment of medical students' integrated clinical communication skills: Development of a tailor-made assessment tool

Background Since patient-centered communication is directly connected to clinical performance, it should be integrated with medical knowledge and clinical skills. Therefore, clinical communication skills should be trained and assessed as an integral part of the student’s clinical performance. We were unable to identify a tool, which helps when assessing patient-centered communication skills as an integrated component of medical history taking (‘the integrated medical interview’). Therefore, we decided to design a new tailor-made assessment tool, the BOCC (BeOordeling Communicatie en Consultvoering (Dutch), Assessment of Communication and Consultation (English) to help raters assess students’ integrated clinical communication skills with the emphasis on patient-centred communication combined with the correct medical content. This is a first initiative to develop such a tool, and this paper describes the first steps in this process. Methods We investigated the tool in a group of third-year medical students (n = 672) interviewing simulated patients. Internal structure and internal consistency were assessed. Regression analysis was conducted to investigate the relationship between scores on the instrument and general grading. Applicability to another context was tested in a group of fourth-year medical students (n = 374). Results PCA showed five components (Communication skills, Problem clarification, Specific History, Problem influence and Integration Skills) with various Cronbach’s alpha scores. The component Problem Clarification made the strongest unique contribution to the grade prediction. Applicability was good when investigated in another context. Conclusions The BOCC is designed to help raters assess students’ integrated communication skills. It was assessed on internal structure and internal consistency. This tool is the first step in the assessment of the integrated medical interview and a basis for further investigation to reform it into a true measurement instrument on clinical communication skills.This study was supported by the Radboud University Medical Center Nijmegen (EKO grant)

One-Particle Measurement of the Antiproton Magnetic Moment

\DeclareRobustCommand{\pbar}{\HepAntiParticle{p}{}{}\xspace} \DeclareRobustCommand{\p}{\HepParticle{p}{}{}\xspace} \DeclareRobustCommand{\mup}{$\mu_{p}${}{}\xspace} \DeclareRobustCommand{\mupbar}{\mu_{\pbar}{}{}\xspace} \DeclareRobustCommand{\muN}{$\mu_N${}{}\xspace For the first time a single trapped \pbar is used to measure the \pbar magnetic moment {\bm\mu}_{\pbar}. The moment {\bm\mu}_{\pbar} = \mu_{\pbar} {\bm S}/(\hbar/2) is given in terms of its spin ${\bm S}$ and the nuclear magneton (\muN) by \mu_{\pbar}/\mu_N = -2.792\,845 \pm 0.000\,012. The 4.4 parts per million (ppm) uncertainty is 680 times smaller than previously realized. Comparing to the proton moment measured using the same method and trap electrodes gives \mu_{\pbar}/\mu_p = -1.000\,000 \pm 0.000\,005 to 5 ppm, for a proton moment ${\bm{\mu}}_{p} = \mu_{p} {\bm S}/(\hbar/2)$, consistent with the prediction of the CPT theorem.Comment: 4 pages, 4 figures. arXiv admin note: substantial text overlap with arXiv:1201.303

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial

OBJECTIVE To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. DESIGN 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. SETTING 15 general practices in the eastern part of the Netherlands. PARTICIPANTS Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. INTERVENTIONS A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). OUTCOME MEASURES The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. RESULTS 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). CONCLUSIONS Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. TRIAL REGISTRATION Clinical trials NCT00128765.This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw) and Partners in Care Solutions for COPD (PICASSO). The funding sources had no role in the design, conduct, or reporting of the stud

The value of reasons for encounter in early detection of colorectal cancer

BACKGROUND: Symptoms with a high predictive power for colorectal cancer (CRC) do not exist. OBJECTIVE: To explore the predictive value of patients' reason for encounter (RFE) in the two years prior to the diagnosis of CRC. METHODS: A retrospective nested case-control study using prospectively collected data from electronic records in general practice over 20 years. Matching was done based on age (within two years), gender and practice. The positive likelihood ratios (LR+) and odds ratios (OR) were calculated for RFE between cases and controls in the two years before the index date. RESULTS: We identified 184 CRC cases and matched 366 controls. Six RFEs had significant LR + and ORs for CRC, which may have high predictive power. These RFEs are part of four chapters in the International Classification of Primary Care (ICPC) that include tiredness (significant at 3-6 months prior to the diagnosis; LR+ 2.6 and OR 3.07; and from 0 to 3 months prior to the diagnosis; LR+ 2.0 and OR 2.36), anaemia (significant at three months before diagnosis; LR+ 9.8 and OR 16.54), abdominal pain, rectal bleeding and constipation (significant at 3-6 months before diagnosis; LR+ 3.0 and OR 3.33; 3 months prior to the diagnosis LR+ 8.0 and OR 18.10) and weight loss (significant at three months before diagnosis; LR+ 14.9 and OR 14.53). CONCLUSION: Data capture and organization in ICPC permits study of the predictive value of RFE for CRC in primary care