Cost-effectiveness in extracorporeal life support in critically ill adults in the Netherlands

Background: Extracorporeal life support (ECLS) is used to support the cardiorespiratory function in case of severe cardiac and/or respiratory failure in critically ill patients. According to the ELSO guidelines ECLS should be considered when estimated mortality risk approximates 80%. ECLS seems an efficient therapy in terms of survival benefit, but no undisputed evidence is delivered yet. The aim of the study is to assess the health-related quality of life after ECLS treatment and its cost effectiveness. Methods: We will perform a prospective observational cohort study. All adult patients who receive ECLS in the participating centers will be included. Exclusion criteria are patients in whom the ECLS is only used to bridge a procedure (like a high risk percutaneous coronary intervention or surgery) or the absence of informed consent. Data collection includes patient characteristics and data specific for ECLS treatment. Severity of illness and mortality risk is measured as precisely as possible using measurements for the appropriate age group and organ failure. For analyses on survival patients will act as their own control as we compare the actual survival with the estimated mortality on initiation of ECLS if conservative treatment would have been continued. Survivors are asked to complete validated questionnaires on health related quality of life (EQ5D-5 L) and on medical consumption and productivity losses (iMTA/iPCQ) at 6 and 12 months. Also the health related quality of life 1 month prior to ECLS initiation will be obtained by a questionnaire, if needed provided by relatives. With an estimated overall survival of 62% 210 patients need to be recruited to make a statement on cost effectiveness for all ECLS indications. Discussion: If our hypothesis that ECLS treatment is cost-effective is confirmed by this prospective study this could lead to an even broader use of ECLS treatment

Exploring, exploiting and evolving diversity of aquatic ecosystem models: A community perspective

Here, we present a community perspective on how to explore, exploit and evolve the diversity in aquatic ecosystem models. These models play an important role in understanding the functioning of aquatic ecosystems, filling in observation gaps and developing effective strategies for water quality management. In this spirit, numerous models have been developed since the 1970s. We set off to explore model diversity by making an inventory among 42 aquatic ecosystem modellers, by categorizing the resulting set of models and by analysing them for diversity. We then focus on how to exploit model diversity by comparing and combining different aspects of existing models. Finally, we discuss how model diversity came about in the past and could evolve in the future. Throughout our study, we use analogies from biodiversity research to analyse and interpret model diversity. We recommend to make models publicly available through open-source policies, to standardize documentation and technical implementation of models, and to compare models through ensemble modelling and interdisciplinary approaches. We end with our perspective on how the field of aquatic ecosystem modelling might develop in the next 5–10 years. To strive for clarity and to improve readability for non-modellers, we include a glossary

A growth model of the cockle (Cerastoderma edule L.) tested in the Oosterschelde estuary (The Netherlands)

We present an ecophysiological model of the bivalve Cerastoderma edule that simulates individual growth and reproduction under ambient conditions in temperature and food availability in the Oosterschelde estuary, SW Netherlands. The model contains feedback loops in the uptake and metabolism of food and in the partitioning of carbon to the internal state variables: somatic tissue, storage, organic shell matrix and gametes. The model was calibrated for 24 parameters, based on random distributions of parameter values. This procedure includes an estimate of confidence intervals of the output variables. The simulated growth of shell length and animal wet and dry weight reflected the observed values of growth in the field for the period 1993 – 1997. The model is a tool for the integration of ecophysiological knowledge of this species and also for carrying-capacity studies of shellfish culture and for environmental management of populations in estuarine and coastal areas. D 2005 Elsevier B.V. All rights reserved

A Farm Information Model for Development and Configuration of Interoperable ICT Components to support Collaborative Business Processes – a case of late blight protection

Farm enterprises2 The objective of this paper is to describe a farm information model and a proof of concept that demonstrates how a collaborative Business Process for farming can be configured using this farm information model. Knowledge to develop this model and a proof of concept is obtained by case study research focusing on the collaborative Business Processes of spraying and crop protection of potatoes against late blight disease. need to collaborate with numerous actors that are part of Agri-Food Supply Chain Networks (AFSCNs) such as governments, advisory services, contractors, processors, input providers and certification bodies. This collaboration is required to produce food in a more sustainable, safe and transparent manner. To collaborate efficiently and effectively, information needs to be shared within collaborative Business Processes. The information sharing within such collaborative Business Processes should be supported by an ICT infrastructure consisting of interoperable ICT Components. Currently, most of the available ICT Components are not interoperable, hindering data exchange between ICT Components of various vendors. Consequently, this situation is hindering optimization of farm production processes and collaboration in AFSCNs. Therefore, a platform, called FIspace, is being established for multiple domains that support the development and configuration of interoperable ICT Components into a system that is able to support collaborative farm Business Processes. To develop interoperable ICT Components and configure these in an easy and flexible manner to support farm enterprises, a farm information model is, amongst other models, required.The presented farm information reference model is able to describe the relations between a farm enterprise and its collaborators, the Business Processes related to the supporting ICT Components and the data messages for data exchange between ICT Components

IoF2020 - the Internet of Meat : towards applications of Internet of Things in the meat supply chain

To enable all actors in the meat supply chain to monitor, manage and optimise their production process, Internet of Things applications create multiple opportunities. In the IoF2020 project (Internet of Food and Farm 2020), starting early 2017, 11 partners from five countries focus on large-scale implementations of IoT via three use cases in the meat supply chain: pig farm management, poultry chain monitoring and meat transparency and traceability. Farmer’s lack of accessibility to information to monitor their production on a continuous basis will be addressed by installing and integrating IoT sensors for environmental and animal monitoring. In addition, early warning systems will be developed, linking different data-streams to provide valuable feedback to the farmer, as well as information transfer to other stakeholders. Doing so, preventive or corrective actions for diseases, boar taint, bird mortality, feed waste, environment, etc. can be taken. Further, also EPCIS-based tracebility from farm to fork will be enabled, so that consumers receive reliable information on meat origin and quality. The current progress of these three use cases, as well as the planned developments will be presented. By addressing several technological and business challenges, as well as EU-wide dissemination, IoF2020 aims to contribute to the digital revolution in Smart Farming

Effects of genital prolapse surgery on sexuality

OBJECTIVE: A prospective study was performed to evaluate the effects of genital prolapse surgery on sexuality. Additionally we investigated which variables are risk factors for persistence or development of sexual problems after surgery. METHODS: All 82 patients participating in a randomized trial comparing vaginal and abdominal surgical correction of descensus uteri, were asked to complete the Questionnaire for screening Sexual Dysfunctions (QSD) before and at six months and one year after surgery. RESULTS: Sixty-two patients completed the questionnaire. General satisfaction about sexuality was significantly improved after surgery. Of 41 patients who were sexually active both before surgery and at one year after surgery, 28 (68.3%) patients reported sexual problems before surgery. In 13 (46.4%) of these patients, all sexual problems disappeared. Of the 13 patients without sexual problems before surgery, two patients reported de novo sexual problems. The relative risk on disappearance of sexual problems in patients with large cystocele was 1.5 (95% confidence interval 1.1-2.1) times higher than the risk in patients without large cystocele. CONCLUSION: Satisfaction about sexuality increases and the prevalence of sexual problems decreases in patients undergoing surgical correction of descensus uter

A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function

OBJECTIVE: To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function. DESIGN: Randomised trial. SETTING: Three teaching hospitals in The Netherlands. POPULATION: Eighty-two patients undergoing surgical correction of uterine prolapse stages II-IV. METHODS: Participating patients completed the urogenital distress inventory (UDI), before and at six weeks, six months and one year after surgery, to measure discomfort of prolapse and micturition symptoms. Domain scores of the UDI (ranging from 0 to 100, higher scores indicating more discomfort) were compared between groups at all time points. Findings at pelvic examination, number of doctor visits within the first year after surgery because of pelvic floor symptoms and performed or planned surgery of recurrent genital prolapse were also compared. MAIN OUTCOME MEASURE: Domain scores of the UDI at one year after surgery. RESULTS: At one year after surgery, scores on the discomfort/pain domain (mean difference 7.1, 95% confidence interval [CI] 1.1-13.2), overactive bladder domain (mean difference 8.7, 95% CI 0.5-16.9) and obstructive micturition domain (mean difference 10.3, 95% CI 0.6-20.1) of the UDI were significantly higher in the abdominal group than in the vaginal group. Findings at pelvic examination were similar in both groups. Doctor visits because of pelvic floor symptoms were more frequent in the abdominal group than in the vaginal group. Re-operation was performed or planned in 9 of the 41 patients who underwent abdominal surgery and in 1 of the 41 patients who underwent vaginal surgery (odds ratio [OR] = 11.2, 95% CI 1.4-90.0). CONCLUSIONS: Our findings suggest that vaginal hysterectomy with anterior and/or posterior colporraphy is preferable to abdominal sacro-colpopexy with preservation of the uterus as surgical correction in patients with uterine prolapse stages II-I