In tourism and recreation management it is still common practice to apply traditional input-output (IO) economic impact models, despite their well-known limitations. In this study the authors analyse the usefulness of applying a non-linear input-output (NLIO) model, in which price-induced input substitution is accounted for. For large changes in final demand, a NLIO model is more useful than a traditional IO model, leading to higher or lower impacts. For small changes in final demand input substitution is less likely. In that case the application of the NLIO may lead to the same results as a traditional IO model. To analyse changes of subsidies, a traditional IO model is not an option. A more flexible model, such as the NLIO, is required. The NLIO model forces researchers to make choices about capacity constraints, factor mobility and the substitution elasticity, which can be difficult but create flexibility and allow for more realism.
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Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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Purpose: The increasing number of cancer survivors has heightened demands on hospital-based follow-up care resources. To address this, involving general practitioners (GPs) in oncological follow-up is proposed. This study explores secondary care providers’ views on integrating GPs into follow-up care for curatively treated breast and colorectal cancer survivors. Methods: A qualitative exploratory study was conducted using semi-structured interviews with Dutch medical specialists and nurse practitioners. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis by two independent researchers. Results: Fifteen medical specialists and nine nurse practitioners participated. They identified barriers such as re-referral delays, inexperience to perform structured follow-up, and worries about the lack of oncological knowledge among GPs. Benefits included the GPs’ accessibility and their contextual knowledge. For future organization, they emphasized the need for hospital logistics changes, formal GP training, sufficient case-load, proper staffing, remuneration, and time allocation. They suggested that formal GP involvement should initially be implemented for frail older patients and for prevalent cancer types. Conclusions: The interviewed Dutch secondary care providers generally supported formal involvement of primary care in cancer follow-up. A well-organized shared-care model with defined roles and clear coordination, supported by individual patients, was considered essential. This approach requires logistics adaptation, resources, and training for GPs. Implications for cancer survivors: Integrating oncological follow-up into routine primary care through a shared-care model may lead to personalized, effective, and efficient care for survivors because of their long-term relationships with GPs.
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In tourism management, traditional input-output models are often applied to calculate economic impacts, including employment impacts. These models imply that increases in output are translated into proportional increases in labour, indicating constant labour productivity. In non-linear input- output (NLIO) models, final demand changes lead to substitution. This causes changes in labour productivity, even though one unit of labour ceteris paribus still produces the same output. Final demand changes can, however, also lead to employees working longer, harder and/or more efficiently. The goal of this article is to include this type of 'real' labour productivity change into an NLIO model. To do this, the authors introduce factor augmenting technical change (FATC) and a differentiation between core and peripheral labour. An NLIO model with and without FATC is used to calculate the regional economic impacts of a 10% final demand increase in tourism in the province of Zeeland in the Netherlands. Accounting for real productivity changes leads to smaller increase in the use of labour, as productivity increases allow output to be produced using fewer inputs.
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Background: A highly promoted opportunity for optimizing healthcare services is to expand the role of nonphysician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to nonphysicians and identify drivers for and barriers to reallocation. Methods: A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results: A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions: Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.
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Biopolymeren vormen een potentieel interessant alternatief voor conventioneel op olie gebaseerde polymeren, omdat zij geen fossiele grondstoffen gebruiken voor de productie. Daarentegen is het productie procedé afhankelijk van energie en toevoegmiddelen die weer bijdragen aan het verbruik van energie en de emissie van onder andere broeikasgassen en zijn de grondstoffen van belang, zoals het gebruik van reststromen uit de afvalverwerking of andere biomaterialen. Binnen het project Circulaire Biopolymeren Waardeketens zijn meerdere productiemethoden bestudeerd om polyhydroxyalkanoaten (PHAs) te maken uit organische reststromen: GFT en afvalwaterslib, een bijproduct uit de afvalwaterzuivering. Productie en extractie van PHAs kan middels diverse routes. In het project zijn meerdere extractieroutes bestudeerd betreffende hun mogelijkheden. Als onderdeel van het project is een levenscyclusanalyse (LCA) gedaan om de milieu-impact van de productie van de biopolymeren in kaart te brengen.
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Diet related non-communicable diseases (NCDs), as well as micronutrient deficiencies, are of widespread and growing importance to public health. Authorities are developing programs to improve nutrient intakes via foods. To estimate the potential health andeconomic impact of these programs there is a wide variety of models. The aim of this review is to evaluate existing models to estimate the health and/or economic impact of nutrition interventions with a focus on reducing salt and sugar intake andincreasing vitamin D, iron, and folate/folic acid intake. The protocol of this systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016050873). The final search was conducted onPubMed and Scopus electronic databases and search strings were developed for salt/sodium, sugar, vitamin D, iron, and folic acid intake. Predefined criteria related to scientific quality, applicability, and funding/interest were used to evaluate the publications. In total 122 publications were included for a critical appraisal: 45 for salt/sodium, 61 for sugar, 4 for vitamin D, 9 for folic acid, and 3 for iron. The complexity of modelling the health and economic impact of nutrition interventions is dependent on the purpose and data availability. Although most of the models have the potential to provide projections of future impact, the methodological challenges are considerable. There is a substantial need for more guidance and standardization for future modelling, to compare results ofdifferent studies and draw conclusions about the health and economic impact of nutrition interventions.
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Paper presented at the International Sustainability Transitions conference 2018 (12-14 june) Manchester, UK. The Dutch agrifood regime is grinding to a halt. International economic pressures force Dutch farmers to further scale up and intensify their businesses, while food scandals and calamities as well as many and varied negative environmental impacts have led to an all-time low societal acceptance of the agrifood regime as well as a host of legislative measures to stifle further growth. Such a situation, in which regime pressures increasingly undermine the regime, represents a strong call for transition of the Dutch agrifood system.At the same time, new business models emerge: new players arrive, new logistical pathways come to the fore and innovative consumer and farmer relationships – food co-operatives – are forged. In a sense, the transition is already under way (cf. Hermans et al., 2010), with new business models forming an important backbone. However, the way forward is still a matter of great uncertainty and controversy: How do new business models relate to reconfiguring the Dutch agrifood system? We explore the hypothesis that different transition pathways put specific demands on the role of new business models. We studied various new business models in the Dutch agrifood system and their relations to three different transition pathways. Our research combines future exploration (backcasting) and analysis of new business models. In this research, we approach this question from two angles. First, we introduce a transition-oriented business model concept, in order to effectively link new business models to transition. Then we shortly touch upon the transition pathway typology introduced by Geels et al. (2016) and describe three different transition pathways for the Dutch agrifood system. We report on XX business models in each of these transition pathways. The paper ends with a discussion of the role of business models for different types of transition pathways.
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New Dutch agrifood business models are emerging in response to economic, social and ecological pressures: new players arrive, new logistical pathways come to the fore and innovative consumer and farmer relationships – food coöperatives – are forged. How do new business models relate to reconfiguring the Dutch agrifood system? Our research combines future exploration (backcasting) and analysis of new business models. We developed three agrifood transition scenarios with various groups of stakeholders. For each scenario, we then analysed a specific, representative business model to explore the different roles of business models in agrifood transition. Business models in the “Added value in and with the countryside” already exist and occupy a niche in the market. However, a breakthrough of these business models require large-scale institutional and behavioural change. Business models in the “New products, specific markets” exist but are rare. They usually concern high-value specialist products that could result in widespread market change, but might require little institutional change. The “Sustainable production methods” most resembles the current system. Some associated business models become successful, but they have difficulty distinguishing themselves from conventional produce, which raises questions about whether business models are able to drive a transition in this direction. Thus, our results lend credence to the hypothesis that different transition pathways offer specific potential for and requirements of new business models.
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Despite the efforts of governments and firms, the construction industry is trailing other industries in labour productivity. Construction companies are interested in increasing their labour productivity, particularly when demand grows and construction firms cope with labour shortages. Off-site construction has proved to be a favourable policy to increase labour productivity. However, a complete understanding of the factors affecting construction labour productivity is lacking, and it is unclear which factors are influenced by off-site construction. This study developed a conceptual model describing how 15 factors influence the construction process and make a difference in labour productivity between off-site and on-site construction. The conceptual model shows that all 15 factors affect labour productivity in three ways: through direct effects, indirect effects and causal loops. The model is a starting point for further research to determine the impact of off-site construction on labour productivity.
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