Labour market effects of unemployment accounts: insights from behavioural economics

This paper reconsiders the behavioural effects of replacing the existing unemployment insurance system with unemployment accounts (UAs). Under this alternative system, workers are required to save a fraction of their wage in special accounts whereas the unemployed are allowed to withdraw savings from these accounts. Previous studies argued that such a reform will improve employment incentives considerably and thereby lead to a dramatic decrease in unemployment levels and durations. We show that this expected impact hinges critically on the assumptions on intertemporal choice. Using recent insights from behavioural economics, we demonstrate that the theoretical impact of UAs on unemployment is limited. This study points out that the overall effect of introducing an UA system on labour market behaviour is ambiguous rather than substantially positive.unemployment insurance; unemployment accounts; time preferences; behavioural economics

Multidisciplinary oncology care pathways, evaluation of organisational interventions

In het proefschrift van Van Huizen worden de reorganisatie van multidisciplinaire medische overleggen (MDO’s) en video-confereren (VC) geëvalueerd. Het bleek dat door de invoering van een multidisciplinair eerste-dag spreekuur voor hoofd-hals-kanker en de reorganisatie van het gastro-intestinale oncologische MDO, de efficiëntie van de zorgtrajecten, vooral de wachttijd tot behandeling, verbeterde. Daarnaast bleek dat bij multidisciplinaire behandelingen het informeren van de patiënt extra aandacht verdient en wensen steeds moeten worden meegewogen.Zes verschillende vormen van VC in oncologische netwerken werden geïdentificeerd. De toepassingen van VC varieerde van ad hoc overleg met experts over behandeling van complexe casussen of zeer zeldzame tumoren, tot regulier overleg tussen zorgprofessionals, bijvoorbeeld in de palliatieve zorg. Voordelen van VC voor patiënten waren minder reizen voor diagnostisch onderzoek, betere coördinatie van zorg, betere toegang tot schaarse voorzieningen en behandeling in de eigen regio. Voordelen voor zorgmedewerkers waren optimalisatie van behandelplannen door multidisciplinaire discussies van complexe cases, tegelijkertijd informeren van zorgmedewerkers over wijzigingen in het zorgplan voor individuele patiënten en medische ontwikkelingen, verbeterde zorgcoördinatie en minder reizen.Het reguliere VC-MDO Hoofd-Hals Oncologie tussen een Universitair Medisch Centrum Groningen en haar partner Medisch Centrum Leeuwarden bleek vooral van waarde voor het bespreken van complexe casussen, omdat het andere team er met een ‘frisse blik’ naar keek, en voor het afstemmen van medisch beleid. Voor de aansturing van een zorgtraject bleek er behoefte te zijn aan een ‘real-time dashboard’ betreffende diagnostische procedures en behandelplannen. De meerwaarde van zo’n dashboard zou in toekomstig onderzoek geëvalueerd moeten worden.Van Huizen's dissertation evaluates the reorganisation of multidisciplinary meetings (MDTMs) and video-conferencing (VC). It turned out that introduction of a multidisciplinary first-day consultation for head-and-neck cancer and reorganisation of the gastrointestinal oncological MDTM improved the efficiency of the care pathway, particularly waiting times to start treatment. It was shown that in case of multidisciplinary treatment, extra attention should be paid to informing the patient and that wishes should always be taken into consideration.Six different types of VC in oncology networks were identified. Applications ranged from ad hoc consultation with experts about complex cases or very rare tumours to regular meetings about e.g. palliative care. Benefits for patients were, less travel, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals involved optimised treatment plans through multidisciplinary discussion of complex cases, the ability to inform all healthcare professionals simultaneously on developments in the care of individual patients, enhanced care coordination, less travel and continued medical education.The regular VC-MDTM Head-and-Neck Oncology between Groningen University Medical Centre and its partner Leeuwarden Medical Centre added value in discussing complex cases, because the other team offered a fresh perspective by hearing it ‘as new’ and in in keeping their medical viewpoints aligned.For management of a care pathway, there was a need for real-time information regarding diagnostic procedures and treatment plans in the form of a ‘real time dashboard’. The added value of such a dashboard should evaluated in future research

Make new friends, but keep the old: Methotrexate treatment in psoriasis patients

Psoriasis is a chronic and inflammatory skin disease, with a current prevalence of 1.92% - 3.46% (Western Europe). There are different treatment options for psoriasis: topical therapy, phototherapy, systemic treatment with pills and biological treatment with subcutaneous injections.The aim of this thesis was to study the systemic treatment option methotrexate in psoriasis vulgaris and other dermatological diseases. Due to the low treatment costs of methotrexate, this drug has the ability to keep dermatological healthcare affordable and accessible. Methotrexate was investigated by summarizing the evidence for the off-label use of methotrexate and the dosing of this drug used in psoriasis patients. In this thesis, we also tried to reach international consensus on the dosing regimen of methotrexate, and we investigated the long-term effects of the combination of methotrexate with adalimumab (adalimumab is a better affordable biological since biosimilars are available). In the last part, shared decision making for the systemic treatment decisions in psoriasis was studied

Collagen in Colorectal Cancer – a mass spectrometry analysis –

In the Netherlands colon cancer is the 3rd most frequent cancer type, with annually more than 14,000 new patients, and 5000 patients die. After surgical removal of the primary colon tumor, there is a 30-40% chance of metastasis in the liver. To detect the presence of metastasis as early as possible, the patient has to regularly visit the hospital and receives CT-scans, ultrasounds, or blood tests. This thesis had as goal to find protein fragments (peptides) in urine that are elevated in patients with a liver metastasis. If this is possible,

Instant on-site histology:A clinical translation of HHG microscopy

Pathological tissue examination is of key importance in diagnosing diseases, for example for cancer diagnosis and assessment of complete surgical tumor resections. To date, extracted tissue samples are send to the pathology department and no direct on-site histological feedback on freshly excised tissue is available. Conventional histopathological assessment techniques require tissue processing, which is labor-intensive and time-consuming, taking at least 24 hours. An available technique to provide intraoperative histological feedback is frozen section analysis, however, this requires freezing and staining of the tissue which comes with freezing artefacts and still stakes 15–25 minutes.A promising technique is higher harmonic generation (HHG) microscopy, a laser-based imaging technique that acquires real-time images with a subcellular resolution of fresh unprocessed tissue. HHG microscopy includes third harmonic generation (THG) revealing all tissue interfaces showing cellular and cell nuclear morphology; second harmonic generation (SHG) mainly showing collagen fibers; and multiphoton excited autofluorescence (MPEF) visualizing autofluorescent molecules in cytoplasm as well as elastin fibers. In this thesis we validated a mobile HHG microscope in the clinical for instant on-site histological feedback on freshly excised human tissue, with as main focus lung tissue and diagnosis of lung cancer and interstitial lung disease (ILD). This thesis provides a HHG imaging atlas of both healthy and diseased human lung tissues, by comparing HHG images with corresponding standard histology images for diverse types of tissue samples. We showed that using HHG microscopy the tissue architecture could be revealed. In particular, the extracellular matrix components collagen and elastin could be distinguished by SHG and MPEF, respectively, and various types of cells were identified by THG microscopy. Specifically, the four main types of leukocytes (neutrophils, eosinophils, lymphocytes, macrophages) could be distinguished, and we showed that by using a deep learning network the percentages of different leukocyte types could be estimated. Based on the HHG images, pathologists were able to identify important histological characteristics. For cancer diagnosis this included increased cellularity, cellular pleomorphism, abnormal cell growth patterns, disrupted extracellular matrix, and tumor cell invasion. In ILD specimens, tissue architectural changes were identified, including different stages of fibrosis and inflammation, as well as specific histological ILD hallmarks such as honeycombing, masson bodies and granulomas. Fibrosis and inflammation were also shown to be present in HHG images of lung tissue affected by coronavirus disease (COVID-19).We reported for the first time on the feasibility of a HHG microscope in the clinic in terms of acquisition time, image quality and diagnostic accuracy. The HHG microscope acquires real-time images and is able to provide a first overview image of a biopsy in less than 7 minutes on average. The HHG image quality was according to two pulmonary pathologists sufficient for a malignancy versus non-malignancy diagnosis in 97% of the biopsies. The malignancy versus non-malignancy diagnosis based on HHG images was correct in on average 87%. This agreement is substantial, especially for a first study on assessing HHG images of bronchoscopy biopsies.In this thesis we brought HHG microscopy a step closer towards clinical use. Compared to conventional histology, HHG microscopy is fast, instant digitally available, it can acquire 3D images without the need for tissue slicing, and it enables identification and quantification of various specific histological structures without the need for tissue staining. In conclusion, HHG microscopy is a powerful technique to provide instant on-site histological feedback on fresh unprocessed tissue in the clinic, with a great potential to provide better disease understanding, as well as to improve and speed up the diagnostic workup, potentially resulting in increased diagnostic yield, reduced need for repeated or additional procedures and reduced associated costs and adverse effects for the patient

Risk aversion and job mobility

Job mobility is inherently risky as workers have limited ex ante information about the quality of outside jobs. Using a large longitudinal Dutch dataset, which includes data on risk preferences elicited through an (incentivized) lottery-choice experiment, we examine the relation between risk aversion and job mobility. The evidence shows that risk averse workers are less likely to move to other jobs. The results are stronger for male workers and for workers who hold a permanent contract. Our empirical findings indicate that the negative relation between risk aversion and job mobility is driven by the job acceptance rather than the search effort decision