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Objective The objective of this study was to effectuate a consensus of emergency physicians on minimum requirements for facility, diagnostic, and medical specialist availability as a first step toward minimum operational standards for 24/7 available emergency departments (EDs) in the Netherlands.Patients and methods A two-part e-Delphi through online survey was performed between January 2015 and May 2016, using a panel of 20 experts in emergency medicine. The aim of part I was to reach an agreement on a list of possible ED elements and their definitions. The second part addressed the actual study objective to reach consensus on operational standards. Successive rounds were submitted to the members of the panel online using SurveyMonkey. Results of each survey round were discussed and interpreted in agreement with all authors in preparation for the next round. Reaching consensus, defined as 70% or more agreement or disagreement among the panel, on the level of all items was the endpoint of this study.Results Both parts I and II required five rounds. The dropout rate of the expert panel remained zero. The availability of 52 facilities and diagnostic functionalities and the manner in which 17 medical specialties should be available to every 24/7 ED were agreed upon by the expert panel.Conclusion An expert panel agreed upon minimum operational standards for EDs in the Netherlands. These results are helpful as a first step toward a more widely supported standard for future 24/7 available EDs in the Netherlands and in addition to this other urgent care facilities.

Research and product or process development are two distinct, yet complementary innovation activities. Making use of a specific grant-based policy design that explicitly distinguishes between research projects, development projects, and mixed R & D projects, this study estimates the direct and cross scheme effects on both research and development investments of recipient firms. Positive cross scheme effects can be expected when research and development activities are complementary and financing constraints are more binding for research than for development projects. The results show that while research grants yield positive direct effects on net research spending as well as positive cross effects on development, development grants are less effective for stimulating development expenditures. The positive effect of development grants on overall R & D stems from cross effects of development grants on research expenditures. These results suggest a higher priority for subsidies targeting research projects.

Acute pijn komt vaak voor bij patiënten op de afdeling Spoedeisende Hulp en wordt nog steeds onderbehandeld. Herhaaldelijk meten en documenteren van pijn is essentieel voor adequate pijnbehandeling. De patiënt is richtinggevend in hoeveel analgesie nodig is. Gedurende het diagnostische proces hoort medicamenteuze pijnstilling niet te worden uitgesteld, ook niet in geval van buikpijn. Opioïden hebben een centrale rol in de behandeling van acute pijn; opiofobie is niet gerechtvaardigd. Adequate pijnbestrijding op de SEH dient zowel bij opname in het ziekenhuis als bij ontslag naar huis een effectief vervolg te krijgen.

AIM Our aim was to study the prevalence and characteristics of constipation in children with profound multiple disabilities, as data in this area are scarce. METHOD A cross-sectional observational study was performed in specialized day-care centres and schools in the Netherlands. The study included 152 children (81 males, 71 females; mean age 9y 6mo, SD 4y 6mo). Intellectual disability ranged from moderate (7%) to profound (52%) in all participants who also had severe motor disabilities (83% classified at Gross Motor Function Classification System level V). We collected data on defaecation characteristics, food and fluid intake, and laxative consumption using standardized bowel diaries and interviews. Constipation was defined as (1) scybalous, pebble-like, hard stools in over a quarter of defaecations in combination with a defaecation frequency of less than three times per week during a 2-week study period; (2) large stools palpable on abdominal examination; or (3) laxative use or manual disimpaction of faeces. RESULTS Of the studied population, 57% were constipated and 55% used laxatives, 27% of whom showed symptoms of constipation. Daily intakes of water and fibre were below the required standards in 87% and 53% of participants respectively, without a proven relation to constipation. INTERPRETATION Constipation is a common problem in children with severe disabilities. Laxative use is high but dosing is frequently inadequate to prevent symptoms.

Universities are key players in the successful transition to a knowledge-based economy and society. However, this crucial sector of society needs restructuring if Europe is not to lose out in the global competition in education, research and innovation. To allow a more evidence based process of reforms of higher education, this contribution reviews the trends in performance, funding and governance of European universities. It also brings on board some evidence on support for the reform process. The analysis shows that, while EU universities have improved their quantitative performance on teaching and research, it needs to further improve especially on the quality dimension. The link between governance, funding and performance is not obvious and needs still further data and research. Nevertheless, the preliminary evidence so far seems to suggest that society supports a multitude of university structures, to respond to a heterogeneous set of preferences. This calls for granting universities the space and thrust to develop autonomously their own strategies and structures. Public and private stakeholders should provide the funds for universities to develop their agenda, while holding them accountability for delivering results. Establishing a large, integrated market for higher education and research in Europe, would provide an environment for European universities to develop their comparative advantages, making them stronger players on the world scene.

We analyze strategic interaction in R&D internationalization decisions by two multinational firms competing both abroad and in their home markets and examine different incentives for foreign R&D faced by technology leaders and technology laggards. The model takes into account the impact of local inter-firm R&D spillovers, (non-costless) international intra-firm transfer of knowledge, and the notion that internal R&D increases the effectiveness of incoming spillovers. Greater efficiency of intra-firm transfers and greater spillovers increases the attractiveness of home R&D to the technology leader. The lagging firm in contrast increases the share of foreign R&D as overseas technology sourcing becomes more effective. Greater product market competition encourages the leading firm to engage in foreign R&D to capture a larger share of profits on the foreign market, while laggards concentrate more R&D at home to defend their home market position. The country with a stricter intellectual property rights regime attracts a larger shares of R&D by both leader and laggard. ispartof: DTEW Research Report 0533 pages:1-38 status: published