Rostering at a Dutch Security Firm

The roster planning process at the Dutch security firm NVD was traditionally carried out by hand. A few years NVD was traditionally carried out by hand. A few years ago, because of changing labor laws in the Netherlands, this became practically impossible. We developed a decision support system which has four main modules. The first one checks given rosters for feasibility with respect to the complicated rules of the current Collective Labor Agreement. A second module generates feasible rosters. The third one evaluates each roster with respect to its cost and ergonomic criteria. Finally, the fourth module uses mathematical programming based methods to select high quality rosters. The DSS has received rave reviews from upper management, security employees as well as the planners, who have gained enormous insight into the planning process. The DSS is currently being implemented and will be operational within the near future.decision support systems;information systems;labor;applications;integer;programming;search and surveillance

Cardiac and metabolic effects in patients who present with a multinodular goitre

Twenty-six consecutive patients who presented with clinically euthyroid multinodular goitre were studied for an overnight fasting serum lipid profile and 24 h Holter monitoring. Mean serum TSH was 0.6 +/- 0.4 vs 2.4 +/- 1.3 mU/l (p < 0.0001) and mean TT3 2.4 +/- 0.4 vs 2.0 +/- 0.5 nmol/l (p = 0.009) in patients vs controls (n = 15) while mean FT4 was not different from controls. Total serum HDL, LDL cholesterol and triglycerides were lower in patients but creatinine, ferritin and SHBG levels did not differ between patients and controls. The 24-hour ambulatory continuous ECG recordings did not demonstrate significant differences in mean, minimal and maximal heart rate between the study and the control group. Nocturnal heart rate, measured between 23.00 and 06.00 hours, also showed no differences between the two groups. Atrial fibrillation was absent in both the study and the control group. Premature atrial and ventricular complexes occurred equally frequently in both groups. Comparison of patients with a serum TSH below 0.4 mU/l (n = 11) and patients with a TSH above 0.4 mU/l revealed no differences. In conclusion, in consecutive patients who present with multinodular goitre, effects were found on the lipid profile, but not on the heart. It is argued that in this type of patients, cardiac effects depend on the degree of subclinical hyperthyroidism

Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment

Background: To judge whether an intervention offers value for money, the incremental costs per gained quality-adjusted life-year (QALY) need to be compared with some relevant threshold, which ideally reflects the monetary value of health gains. Literature suggests that this value may depend on the equity context in which health gains are produced, but the value of a QALY in relation to equity considerations has remained largely unexplored. Objective: The objective of this study was to estimate the social marginal willingness to pay (MWTP) for QALY gains in different equity subgroups, using a discrete choice experiment (DCE). Both severity of illness (operationalized as proportional shortfall) and fair innings (operationalized as age) were considered as grounds for differentiating the value of health gains. Methods: We obtained a sample of 1205 respondents, representative of the adult population of the Netherlands. The data was analysed using panel mixed multinomial logit (MMNL) and latent class models. Results: The panel MMNL models showed counterintuitive results, with more severe health states reducing the probability of receiving treatment. The latent class models revealed distinct preference patterns in the data. MWTP per QALY was sensitive to severity of disease among a substantial proportion of th

Rostering at a Dutch Security Firm

The roster planning process at the Dutch security firm NVD was traditionally carried out by hand. A few year

Effect of Pregnancy on eGFR after Kidney Transplantation:A National Cohort Study

BACKGROUND: The effect of pregnancy on the course of estimated glomerular filtration rate (eGFR) is unknown in kidney transplant recipients (KTRs). METHODS: We conducted a nationwide multicenter cohort study in KTRs with pregnancy (>20 weeks) after kidney transplantation (KT). Annual eGFR's after KT until death or graft loss and additional eGFR's before each pregnancy were collected according to protocol. Changes in eGFR slope before and after each pregnancy were analyzed by generalized estimating equations (GEE) multilevel analysis adjusted for transplant vintage. RESULTS: We included 3194 eGFR measurements before and after pregnancy in 109 (55%) KTRs with 1, 78 (40%) with 2 and 10 (5%) with 3 pregnancies after KT. Median follow-up after first delivery post-KT was 14 years (IQR 18 years). Adjusted mean eGFR pre-pregnancy was 59 ml/min/1.73m2 (SEM 1.72; 95% CI 56-63), after first pregnancy 56 ml/min/1.73m2 (SEM 1.70; 95% CI 53-60), after second pregnancy 56 ml/min/1.73m2 (SEM 2.19; 95% CI 51-60) and after third pregnancy 55 ml/min/1.73m2 (SEM 8.63; 95% CI 38-72). Overall eGFR slope after first, second and third pregnancy was not significantly worse than pre-pregnancy (p = 0.28). However, adjusted mean eGFR after first pregnancy was 2.8 ml/min/1.73m (p = 0.08) lower than pre-pregnancy. CONCLUSIONS: First pregnancy has a small, but no significant, effect on eGFR slope in KTR. Midterm hyperfiltration, a marker for renal reserve capacity, was associated with better eGFR and death-censored graft survival. In this KTR cohort with long-term follow-up, no significant effect of pregnancy on kidney function was detected