Stork (Netherlands)

In 2012, The Netherlands established the so-called “free market experiment”, which allowed providers of dental care to set the prices for their dental services themselves. The introduction of market mechanisms is intended to improve the quality of care and to contribute to cost containment, but increasing health expenditures for citizens have been observed in this context. Using large-volume health insurance claims data and exploiting the 2012 experiment in Dutch dental care, we identified the effects of a liberalization of service prices. Using pooled regression with individual fixed effects, we analyzed changes in utilization patterns of prevention-oriented dental services in response to the experiment as well as the elasticities in demand in response to variations in out-of-pocket (OOP) prices. We found substantial increases in prices and patients’ OOP contributions for dental services following the liberalization with differences in increases between types of services. In response to the experiment, the proportion of treatment sessions containing preventive-oriented services decreased significantly by 3.4% among adults and by 5.3% for children and adolescents. Estimates of short-run price elasticities of demand for different services point towards differences in price sensitivity. One potential explanation for the observed variations in prices and utilization could be different extents of asymmetric information for first-stage and follow-on services. Price liberalization seems to have affected the composition of treatment sessions towards a decreasing use of preventive services, suggesting a shift in the reason for seeing a dental care provider from a regular-preventive perspective to a symptom-based restorative approach.

Abstract Several glass wool insulation sections from a heat-treat furnace showed visible, but only cosmetic discoloration. EDS showed the presence of silicon, aluminum, and oxygen in the nondiscolored region, and these elements are consistent with glass wool. Relatively high levels of chromium and nickel were detected in the discolored area, along with lower amounts of iron, manganese, sodium, calcium, cobalt, and sulfur, in addition to the surrounding glass wool elements. Results of this limited evaluation showed the discoloration was caused by the presence of elevated levels of chromium, nickel, and aluminum. The visual appearance, along with the EDS findings, suggested these elements were present in the form of oxides. These oxides were likely deposited from adjacent structural components of the furnace, which had oxidized during operation.

BackgroundTo explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach.MethodsWe compared expected (based on consumption patterns of a health insurers’ total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006–2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care.ResultsOur findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.ConclusionsUtilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more ‘comprehensive’ integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3246-z) contains supplementary material, which is available to authorized users.

With “inclusive education” in the Dutch school system in mind, a new interdisciplinary counseling was conceptualized. Failing handwriting development in Grade 1 was scrutinized to explore the possibilities of interdisciplinary counseling. The development of two children with dysgraphic handwriting was followed in Grade 1, 2 and 3, and contrasted with the general results of their classmates. Teachers, pediatric physical therapists and psychologist used a combination of hand-writing, literacy and kinematic measures for assessment and interdisciplinary counseling for diagnosis and decisions on treatment for the two children with dysgraphic handwriting development. For handwriting speed and quality, standardized test scores were used, for spelling and reading, measures from the school following system were extracted. A motoric loop-writing task was used to explore non-linguistic motor development. For the two dysgraphic boys, a combination of handwriting assessment, kinematic assessment, and reading and writing capacities seems to be a sound foundation for interdisciplinary counseling. Dyslectic development proved to be easier to differentiate than visual motor learning disorders. The handwriting test we used (BHK), can distinguish dysgraphia in general by low scores on quality, whereas the handwriting speed might be informative for developmental dyslexia. Speed and spelling combinations are distinctive for developmental dyslexia, but not so for visuo-spatial learning disorders (VSLD). Spatial accuracy in a non-linguistic task is also distinctive for dyslexia, especially in first and second grade, while VSLD cannot be distinguished by spatial accuracy in a non-linguistic task. Our conclusion is that, if obvious measures for remediation of dysgraphic development are insufficient, psychological assessment is imperative for defining underlying disorders. Tacit knowledge and practical experience in teachers as well as theoretical and practical knowledge of the pediatric physical therapist, together with solid diagnosis to define constraints for treatment procedures, are needed to start the process of inclusive education in elementary schools.

Technology Update As oil and gas fields mature, production of sand and other reservoir solids can become an increasing and sometimes major impediment to hydrocarbon production and facility operations. These solids can move through the wellbore into process facilities, causing flow assurance problems that affect system integrity, export line transportation, cleaning, and disposal. As operators seek to optimize production from mature assets, solids management is likely to take on additional importance. Sand and solids production can also be a problem on some new wells. To address these issues, Stork Technical Services developed an advanced online desander (AOD) for managing separator solids, providing thermographic determination of sand accumulation, and enabling clean sand discharge to the sea, with no deferred production (Fig. 1). The system has been used successfully in eight deployments on the Hummingbird floating production, storage, and offloading system (FPSO), which supports Centrica’s Chestnut field, operated by Wood Group, in the United Kingdom North Sea. Risks of Sand in Production Vessels The presence of sand in production vessels reduces capacity and affects separation performance, which leads to deteriorating produced water quality and the carry-over of water in the oil phase. If not controlled, the sand can cause a separator to be taken offline and manually cleaned. This exposes facility crew members to process hazards and may damage downstream equipment. Conventional sand management techniques require a shutdown of 10 to 14 days for manual sand removal, resulting in a significant delay and additional expense. Following this, oil-on-sand discharge rules may limit disposal options and compel storage of some or all of the sand. The Online Desanding Technology The desander is designed to allow more operator uptime and to reduce costs, compared with traditional vessel entry cleanout methods. With the new technology, there is no need to shut down production, and the elimination of manual cleaning improves safety. In addition, the technology enables operators to change their approach to planned shutdown periods. Because the system allows a high degree of cleaning to take place before shutdown, the team of technical experts needed for a shutdown can be smaller and planning for it simpler. The system comprises a number of purpose-designed, integrated components including solids extraction, solids separation, and solids conditioning packages. A high-flow jetting unit with a recovered-liquid package recycles the separator water. The system complies with European Union hazardous area safety requirements and can be used in Zone 2 hazardous offshore environments.

Identifying and describing successful diabetes-related (SDR) behaviors from reports by experiential experts to support people with diabetes in applying for and participating effectively in paid work. Data were collected by conducting in-depth interviews with experiential experts with diabetes (N = 47). A comprehensive set of SDR behaviors that can help people with diabetes apply for and participate in paid work. The most important factors were reported to be the ability to anticipate problems in job applications, effective self-management activities to prevent and/or respond to hypoglycemia and hyperglycemia at work, informing relevant others in the workplace, and successfully negotiating with employers about adjustments to work conditions. A set of work-related SDR behaviors was identified. After validation by experiential experts and professionals, these could be translated into recommendations and tested in experiments in self-management programs.

This study was conducted to determine if austempered 4340 steel had different fatigue resistance compared to quench and tempered (Q&T) 4340 steel with an identical hardness of nominally 45 HRC and an identical yield strength of nominally 1340 MPa (194 ksi). Strain-life and stress-life fatigue testing was conducted at room temperature under identical test conditions. The standard array of strain-life and stress-life regression constants was obtained. The two heat treatments produced virtually identical total strain-life curves and fatigue limits at 5 million cycles. However, the two materials exhibited different trends in the elastic and plastic strain regimes. The austempered steel exhibited greater high cycle fatigue (finite) lives than the Q&T samples at comparable elastic strain amplitudes in strain-life fatigue testing and at comparable stress amplitudes in stress-life fatigue testing. However, the Q&T samples exhibited greater low cycle fatigue lives than the austempered samples at comparable plastic strain amplitudes in strain-life testing. Although both materials generally exhibited similar fatigue fracture characteristics, the overload regions of the Q&T samples were composed entirely of dimple rupture, whereas the austempered samples exhibited both dimple rupture and quasicleavage.

The motivation of the investigation is critical pressure loss in cryogenic flexible hoses used for LNG transport in offshore installations. Our main goal is to estimate the friction factor for the turbulent flow in this type of pipes. For this purpose, two-equation turbulence models (k–ε and k–ω) are used in the computations. First, fully developed turbulent flow in a conventional pipe is considered. Simulations are performed to validate the chosen models, boundary conditions and computational grids. Then a new boundary condition is implemented based on the “combined” law of the wall. It enables us to model the effects of roughness (and maintain the right flow behavior for moderate Reynolds numbers). The implemented boundary condition is validated by comparison with experimental data. Next, turbulent flow in periodically corrugated (flexible) pipes is considered. New flow phenomena (such as flow separation) caused by the corrugation are pointed out and the essence of periodically fully developed flow is explained. The friction factor for different values of relative roughness of the fabric is estimated by performing a set of simulations. Finally, the main conclusion is presented: the friction factor in a flexible corrugated pipe is mostly determined by the shape and size of the steel spiral, and not by the type of the fabric which is wrapped around the spiral.

Abstract This article begins with a description of the classes and grades of ductile iron. It discusses the factors affecting the mechanical properties of ductile iron. The article reviews the hardness properties, tensile properties, shear and torsional properties, compressive properties, fatigue properties, fracture toughness, and physical properties of ductile iron and compares them with other cast irons to aid the designer in materials selection. It concludes with information on austempered ductile iron.