In the Netherlands acute care organisations are overstretched and overcrowded. The acute care networks involve different organisations, including Emergency Departments (EDs), General Practice... Show moreIn the Netherlands acute care organisations are overstretched and overcrowded. The acute care networks involve different organisations, including Emergency Departments (EDs), General Practice Cooperatives (GPCs), ambulance services, acute mental health services, and home care and nursing home organisations. Crowding gives rise to major problems in healthcare and is caused by a combination of factors. As the general population continues to age, so too does the burden on the shrinking working force. Another factor is the suboptimal use of acute care, as a relatively high proportion of acute care use goes to patients presenting problems that are considered to have low urgency. Furthermore, the large number of acute care organisations involved increases the fragmentation caused by healthcare providers working independently and with too little communication, which stands in the way of effective cooperation. Due to the large number of organisations involved, there are multiple entrance and exit routes for patients in acute care organisations. Effective communication and coordination between all stakeholders at different levels of an organizational structure is crucial to providing high quality acute care.The main objective of this thesis is to find clues how and where acute care in the Netherlands can be improved at all integration levels. Insight into the various mechanisms should enable us to maintain accessibility of acute care for all citizens in the future. Show less
There is an increasing amount of attention on EU and its Member States contributions to implementation of two landmark agreements: the Paris Climate Agreement and the UN Agenda 2030 with... Show moreThere is an increasing amount of attention on EU and its Member States contributions to implementation of two landmark agreements: the Paris Climate Agreement and the UN Agenda 2030 with Sustainable Development Goals (SDGs). Absent from the current literature is an analysis of the political effect of legal competences on coordination between EU and Member State actors. Legal competences will become increasingly important for transformative sustainability policies. By using different case studies focusing on alternative fuel policies, ‘Team EU’ in climate negotiations and SDG implementation, this dissertation attempts to explore the potential of including legal competences as independent variables explaining coordination of EU and Member State actors. The findings nuance some of the theories in which the role of EU Treaties is often neglected. The dissertation also shows, however, that the legal competences are sometimes not used habitually unless clear examples of behaviours ‘contrary to the Treaty-logic’ or ‘contrary to sustainable development objectives’. The dissertation not only serves academic integrative purposes. There is increased societal attention for legal avenues to influence political decision-making. As an example, the Dutch ‘Urgenda’ case demonstrate that Courts can be responsive to the argument that Member States’ policies are ‘unlawful’ to avoid dangerous climate change. Show less
This work provides a typologically oriented description of clause linkage strategies in Ket, a highly endangered language spoken in Central Siberia. It is now the only surviving member of the... Show moreThis work provides a typologically oriented description of clause linkage strategies in Ket, a highly endangered language spoken in Central Siberia. It is now the only surviving member of the Yeniseian language family with the last remaining speakers residing in the north of Russia’s Krasnoyarsk province. Although Ket can be said to have a rather long history of studies, there are issues that still lack a comprehensive and coherent account in the existing literature on the language, issues of clause linkage being one of them. The present study seeks to change the situation by providing a unified description of strategies used to code various clause-linking relations, including coordinative relations, complement relations, adverbial relations and relative relations. The theoretical background of the present study is based on the general framework developed within the functional-typological approach. It incorporates all the advances made during the last decades with respect to Ketology and the study of clause linkage typology to ensure its descriptive and typological value. Show less
In the chronic stage of Complex Regional Pain Syndrome (CRPS), motor disturbances are common and cause significant disability. The motor dysfunction of CRPS is a poorly understood phenomenon that... Show moreIn the chronic stage of Complex Regional Pain Syndrome (CRPS), motor disturbances are common and cause significant disability. The motor dysfunction of CRPS is a poorly understood phenomenon that is characterized predominantly by a decrease or loss of voluntary muscle control. This thesis aims to obtain a better understanding of the pathophysiology underpinning the motor dysfunction of CRPS by examining the potential roles of decreased inhibition of the motor system, changes in sensory processing and problems in sensory-motor integration. In specific, characteristics of muscle activity recordings are scrutinized in order to determine whether the loss of voluntary motor control and abnormal postures in CRPS exhibit characteristics of dystonia that are associated with reduced inhibition of the motor system (i.e., excessive muscle activation and enhanced mirror activity). The potential role of impaired processing of proprioceptive information related to wrist orientation and force production is examined, as well as the involuntary and voluntary (sensory-)motor interactions between the affected and unaffected arm. Furthermore, a systematic review of the literature on the motor consequences of experimental pain in healthy humans is presented in order to gain insight into the potential role of pain-related processes in the motor and sensory and motor disturbances of CRPS. Show less
Witte, P.B. de; Werner, S.; Braak, L.M. ter; Veeger, H.E.J.; Nelissen, R.G.H.H.; Groot, J.H. de 2014
This dissertation explores the effects of the Treaty of Lisbon (ToL) on the coherence of the external representation of the European Union (EU) in the field of Common Foreign and Security Policy ... Show moreThis dissertation explores the effects of the Treaty of Lisbon (ToL) on the coherence of the external representation of the European Union (EU) in the field of Common Foreign and Security Policy (CFSP) at two main UN bodies, i.e., the UN General Assembly (UNGA) and the Security Council (UNSC). It theorizes EU representation into a principal-agent relationship and assesses the developments of the EU delegation relationship since the adoption of the ToL. In both contexts the EU and its entire membership are considered a collective principal while the actors that play the role of the agent(s) have been different through different historical periods. A mixed approach is adopted to combine both quantitative and qualitative methods to detect the pre- and post-Lisbon coherence variation in EU representation. At the UNGA, EU representation coherence is measured in terms of EU voting cohesion. At the UNSC, some descriptive statistics are first presented to describe and summarize the voting behaviour of the EU member states sitting on the UNSC, based on which the cases of Iraq and Libya are selected for further investigation. Subsequently, the coherence of the EU__s representation during these two conflicts __ both horizontal and vertical __ is examined and compared by looking at the coordination mechanisms and articulation consistency of the EU and its member states. The empirical evidence suggests that EU representation coherence, in general, has increased in parallel with the developments of the CFSP over time. The reformed delegation structure introduced by the ToL, however, has not yet contributed to greater EU representation coherence at the UN. Whereas the ToL offers an opportunity to strengthen agent capabilities and control mechanisms, coherent EU representation appears to be unlikely in the near future, if the remaining agency problems are left unaddressed. Especially it depends on the genuine willingness of EU member states to overcome diverging preferences and support common EU positions. Only until their declaratory commitments lead to real cooperation can the Union truly stand united and speak coherently on foreign affairs. Of equal importance is the demand for closer coordination among different EU institutions for the sake of consistent and complementary representation. Time is still needed for EU representatives, namely the President of the European Council, the Commission President and the refashioned High Representative __ the External Action Service under her authority as well __ to develop into fully-fledged agents with more autonomy and clearer delimitation of representation competences. Show less
This work contributes to the field of coordination, in particular to Reo, by improving existing approaches to execute synchronisation models in three major ways. First, this work supports decoupled... Show moreThis work contributes to the field of coordination, in particular to Reo, by improving existing approaches to execute synchronisation models in three major ways. First, this work supports decoupled execution and lightweight reconfiguration. We developed a prototype Dreams engine to test our distributed protocol, using an actor library for the Scala language. Reconfiguration of a small part of the system is independent of the execution or behaviour of unrelated parts of the same system. Second, Dreams outperforms previous Reo engines by using constraint satisfaction techniques. In each round of the execution of the Dreams framework, descriptions of the behaviour of all building blocks are combined and a coordination pattern for the current round is chosen using constraint satisfaction techniques. This approach requiring less time than previous attempts that collect all patterns before selecting one. Third, our work improves scalability by identifying synchronous regions. We statically discover regions of the coordination layer that can execute independently, thus achieving a truly decoupled execution of connectors. Consequently, the constraint problem representing the behaviour at each round is smaller and more easily solved. Show less
In the last years, there has been a growing interest for distributed systems both in computer science and in society. The most popular and biggest distributed system in the world is the Internet. A... Show moreIn the last years, there has been a growing interest for distributed systems both in computer science and in society. The most popular and biggest distributed system in the world is the Internet. A distributed system is a collection of independent computers that appears to its users as a single coherent system. These computers are connected to each other through a network. On each of these computers there is at least one (software) component that needs to communicate with other components on remote computers to achieve some goal. Components can consist of processes, databases, applications, etc. These components are not only distributed among the several computers of a network but they also run in parallel. Therefore, distributed systems need appropriate theory and infrastructures for the coordination of its concurrently running components. In this thesis we present MoCha, a novel coordination framework. MoCha allows dynamic reconfiguration of connections among the components in a system, a property that is very useful and even crucial in systems where the components themselves are mobile. Furthermore, MoCha provides exogenous coordination. This makes it possible to coordinate components from the 'outside' (exogenous), and thus, change a distributed system's behavior without having to change its components. Show less
Since the inception of programming, composition of algorithms has served as the driving force behind software composition. The models and techniques that have emerged out of this focus do not... Show moreSince the inception of programming, composition of algorithms has served as the driving force behind software composition. The models and techniques that have emerged out of this focus do not adequately meet our modern requirements, such as third-party composition of black-box components, or dynamic composition of the behavior of independent distributed subsystems and services. Decades of theoretical and practical work in the field of concurrency has culminated in substantial experience with various aspects of interaction and protocols. Curiously, however, interaction has not been considered as a first-class concept in a constructive model of computation. I believe the inadequacy of our contemporary composition techniques and our neglect to treat interaction as a first-class concept are intertwined. In this lecture, I describe some of my work and ideas on a compositional model for construction of complex systems out of simpler parts, using interaction as the only first-class concept. Show less
