Collaboration and competition policy in a market-based hospital system: a case-study from The Netherlands

In the Dutch healthcare system, provider competition is used as a tool to improve efficiency. From a competition policy perspective, little is known about how collaboration among healthcare providers contributes to overall patient welfare, and how a balance is achieved between scale benefits and preventing anticompetitive collusion. This paper examines the ex-post effects of a Dutch case study in which three competing hospitals have collaborated to provide highcomplexity low-volume cancer surgery, an arrangement that tests the limits of permissibility under the Dutch cartel prohibition. Our preliminary empirical research demonstrated only a modest increase in price and travel time for some of the tumour surgeries. Volume analysis showed that the intended centralization of surgical procedures has not been fully realized. Our findings highlight the importance of a comprehensive self-assessment by the collaborating hospitals to ex-ante assess (potential) e

Single-cell analysis of peptide expression and electrophysiology of right parietal neurons involved in male copulation behavior of a simultaneous hermaphrodite

Male copulation is a complex behavior that requires coordinated communication between the nervous system and the peripheral reproductive organs involved in mating. In hermaphroditic animals, such as the freshwater snail Lymnaea stagnalis, this complexity increases since the animal can behave both as male and female. The performance of the sexual role as a male is coordinated via a neuronal communication regulated by many peptidergic neurons, clustered in the cerebral and pedal ganglia and dispersed in the pleural and parietal ganglia. By combining single-cell matrix-assisted laser mass spectrometry with retrograde staining and electrophysiology, we analyzed neuropeptide expression of single neurons of the right parietal ganglion and their axonal projections into the penial nerve. Based on the neuropeptide profile of these neurons, we were able to reconstruct a chemical map of the right parietal ganglion revealing a striking correlation with the earlier electrophysiological and neuroanatomical studies. Neurons can be divided into two main groups: (i) neurons that express heptapeptides and (ii) neurons that do not. The neuronal projection of the different neurons into the penial nerve reveals a pattern where (spontaneous) activity is related to branching pattern. This heterogeneity in both neurochemical anatomy and branching pattern of the parietal neurons reflects the complexity of the peptidergic neurotransmission involved in the regulation of male mating behavior in this simultaneous hermaphrodite

Ultra-sensitive immunoassays using multi-photon-detection in diagnostic proteomics of blood

Multiphoton-detection methods that detect as little as 1000 atoms of 125I-streptavidin increase the sensitivity of immunoassays by 200- to 1000-fold (1 femtogram/mL). Improved background suppression allows 20- to 100-fold improvements in sensitivity for conventional immunoassays (10-50 femtogram/mL). Quantitation of low abundance biomarkers in blood (PSA, TNF, VEGF, IL-1, IL-6, and IL-8), for the first time for complete patient cohorts, indicates that very high analytical sensitivity and new statistical methods are crucial for serum-based diagnostic proteomics