Minimally invasive pancreatic surgery:A stepwise nationwide introduction

Thijs de Rooij doet onderzoek naar de landelijke introductie van minimaal-invasieve alvleesklierchirurgie. Hij richt zich met name op de alvleesklierstaartresectie en de pancreatoduodenectomie, twee procedures die met name uitgevoerd worden voor de behandeling van alvleesklierkanker. Hij bekijkt of een laparoscopische of robot-geassisteerde benadering voor dit type chirurgie van toegevoegde waarde zijn. In eerste instantie rolt hij onder intensieve begeleiding landelijke introductieprogramma’s uit en bekijkt hij of deze introductie veilig is verlopen. Hierna worden de uitkomsten vergeleken met de conventionele ‘open’ benadering voor alvleesklierchirurgie. Hij analyseert voornamelijk de operatieve uitkomsten, complicaties, opnameduur, kwaliteit van leven en kosten, onder andere in landelijke gerandomiseerd gecontroleerde studies

Explaining quantity implicatures

We give derivations of two formal models of Gricean Quantity implicature and strong exhaustivity in bidirectional optimality theory and in a signalling games framework. We show that, under a unifying model based on signalling games, these interpretative strategies are game-theoretic equilibria when the speaker is known to be respectively minimally and maximally expert in the matter at hand. That is, in this framework the optimal strategy for communication depends on the degree of knowledge the speaker is known to have concerning the question she is answering. In addition, and most importantly, we give a game-theoretic characterisation of the interpretation rule Grice (formalising Quantity implicature), showing that under natural conditions this interpretation rule occurs in the unique equilibrium play of the signalling game

Stratigraphy and palaeoceanography of a topography-controlled contourite drift in the Pen Duick area, southern Gulf of Cádiz

The northern part of the Gulf of Cádiz has and still is receiving a lot of attention from the scientific community due to (amongst others) the recent IODP Expedition 339. In contrast, its southern part, or the Moroccan margin has received far less attention, although mud volcanoes, diapiric ridges and cold-water corals are present in this region. The El Arraiche mud volcano field is characterized by a compressive regime creating several ridges and assisting the migration of hydrocarbon fluids towards the seabed surface. This study presents seismic and multibeam evidence for the existence of a contourite drift at water depths between 550 and 650 meters along the southwestern flank of the Pen Duick Escarpment and Gemini Mud Volcano, within the El Arraiche Mud Volcano field. From the onset of the Quaternary, when the escarpment started to lift and the local mud volcanism initiated, contouritic deposition was initiated as well at the foot of both topographic obstacles. Initially, fairly low-velocity bottom currents gave rise to sheeted drift deposits, affected by the uplift of the escarpment or mud extrusion. From the Middle Pleistocene onwards, separated mounded drift deposits were formed due to intensified bottom currents. An Antarctic Intermediate Water origin is inferred as driving mechanism for the drift development, although glacial conditions are not yet well constrained. The influence of Mediterranean Outflow Water (MOW) cannot be substantiated here. Moreover, the changes recorded within this contourite drift differ from the MOW-dominated contourite depositional system in the northern Gulf of Cádiz, as drift deposits only occur as early as the base of the Quaternary (compared to the Early Pliocene for the north) and mounded drift deposits only occur from the Middle Pleistocene onwards (compared to the Early Pleistocene). Cold-water coral mounds have been observed within and on top of the sedimentary sequence at the foot of the Pen Duick Escarpment. This implies that environmental conditions in which cold-water corals thrive were not necessarily restricted to the top of the Pen Duick Escarpment

Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education.

A 71-year-old man presenting with hip osteoarthritis, with a complex range of comorbidities was referred by his general practitioner to CHAIN (Cycling against Hip PAIN), a 6 week programme developed to aid self-management of hip osteoarthritis through exercise, education and advice, as defined by the National Institute for Health and Care Excellence (NICE) guidelines. Significant improvements were seen in Oxford hip score, the Hip disability and Osteoarthritis Outcome Score (HOOS) - function score, sit-to-stand test, timed up and go test, pain scores and hip flexion. There was also a weight loss of 2.1 kg. The man reported 'an amazing difference' in his affected hip and leg, and improved fitness. Many clinicians would have questioned the man's suitability for the programme due to his coexisting medical conditions. This case study shows that patients may be much more able than we think to achieve significant improvement with exercise