A model for store handling : potential for efficiency improvement

In retail stores, handling of products typically forms the largest share of the operational costs. The handling activities are mainly the stacking of the products on the shelves. While the impact of these costs on the profitability of a store is substantial, there are no models available of the different drivers influencing store handling. In this paper, a study of the shelf stacking process is presented. First, a conceptual model based on warehouse operations is derived. It is shown that handling costs are non-linear with the number of consumer units stacked. Secondly, by means of a motion and time study, data has been collected in four grocery stores of two different European retail companies. The model clearly demonstrates the impact of the most important drivers for handling efficiency: case pack size, number of case packs stacked simultaneously, and the stacking regime. Efficiency gains of 8-49% by changing the driver parameter value are identified. Based on the presented insights both retail companies have decided to structurally change their current operations

The human eye-movement response to maintained surface galvanic vestibular stimulation

Contains fulltext : 141356.pdf (publisher's version ) (Closed access

Performance of BRCA1/2 mutation prediction models in male breast cancer patients

To establish whether existing mutation prediction models can identify which male breast cancer (MBC) patients should be offered BRCA1 and BRCA2 diagnostic DNA screening, we compared the performance of BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm), BRCAPRO (BRCA probability) and the Myriad prevalence table ("Myriad"). These models were evaluated using the family data of 307 Dutch MBC probands tested for BRCA1/2, 58 (19%) of whom were carriers. We compared the numbers of observed vs predicted carriers and assessed the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) for each model. BOADICEA predicted the total number of BRCA1/2 mutation carriers quite accurately (observed/predicted ratio: 0.94). When a cut-off of 10% and 20% prior probability was used, BRCAPRO showed a non-significant better performance (observed/predicted ratio BOADICEA: 0.81, 95% confidence interval [CI]: [0.60-1.09] and 0.79, 95% CI: [0.57-1.09], vs. BRCAPRO: 1.02, 95% CI: [0.75-1.38] and 0.94, 95% CI: [0.68-1.31], respectively). Myriad underestimated the number of carriers in up to 69% of the cases. BRCAPRO showed a non-significant, higher AUC than BOADICEA (0.798 vs 0.776). Myriad showed a significantly lower AUC (0.671). BRCAPRO and BOADICEA can efficiently identify MBC patients as BRCA1/2 mutation carriers. Besides their general applicability, these tools will be of particular value in countries with limited healthcare resources

Rapid exome sequencing as a first-tier test in neonates with suspected genetic disorder:results of a prospective multicenter clinical utility study in the Netherlands

The introduction of rapid exome sequencing (rES) for critically ill neonates admitted to the neonatal intensive care unit has made it possible to impact clinical decision-making. Unbiased prospective studies to quantify the impact of rES over routine genetic testing are, however, scarce. We performed a clinical utility study to compare rES to conventional genetic diagnostic workup for critically ill neonates with suspected genetic disorders. In a multicenter prospective parallel cohort study involving five Dutch NICUs, we performed rES in parallel to routine genetic testing for 60 neonates with a suspected genetic disorder and monitored diagnostic yield and the time to diagnosis. To assess the economic impact of rES, healthcare resource use was collected for all neonates. rES detected more conclusive genetic diagnoses than routine genetic testing (20% vs. 10%, respectively), in a significantly shorter time to diagnosis (15 days (95% CI 10–20) vs. 59 days (95% CI 23–98, p &lt; 0.001)). Moreover, rES reduced genetic diagnostic costs by 1.5% (€85 per neonate). Conclusion: Our findings demonstrate the clinical utility of rES for critically ill neonates based on increased diagnostic yield, shorter time to diagnosis, and net healthcare savings. Our observations warrant the widespread implementation of rES as first-tier genetic test in critically ill neonates with disorders of suspected genetic origin.What is Known:• Rapid exome sequencing (rES) enables diagnosing rare genetic disorders in a fast and reliable manner, but retrospective studies with neonates admitted to the neonatal intensive care unit (NICU) indicated that genetic disorders are likely underdiagnosed as rES is not routinely used.• Scenario modeling for implementation of rES for neonates with presumed genetic disorders indicated an expected increase in costs associated with genetic testing.What is New:• This unique prospective national clinical utility study of rES in a NICU setting shows that rES obtained more and faster diagnoses than conventional genetic tests.• Implementation of rES as replacement for all other genetic tests does not increase healthcare costs but in fact leads to a reduction in healthcare costs.</p

A model for store handling : potential for efficiency improvement

In retail stores, handling of products typically forms the largest share of the operational costs. The handling activities are mainly the stacking of the products on the shelves. While the impact of these costs on the profitability of a store is substantial, there are no models available of the different drivers influencing store handling. In this paper, a study of the shelf stacking process is presented. First, a conceptual model based on warehouse operations is derived. It is shown that handling costs are non-linear with the number of consumer units stacked. Secondly, by means of a motion and time study, data has been collected in four grocery stores of two different European retail companies. The model clearly demonstrates the impact of the most important drivers for handling efficiency: case pack size, number of case packs stacked simultaneously, and the stacking regime. Efficiency gains of 8-49% by changing the driver parameter value are identified. Based on the presented insights both retail companies have decided to structurally change their current operations

[CHEK2-mutation in Dutch breast cancer families: expanding genetic testing for breast cancer]

Item does not contain fulltext- In the majority of breast cancer families, DNA testing does not show BRCA1 or BRCA2 mutations and the genetic cause of breast cancer remains unexplained. - Routine testing for the CHEK2*1100delC mutation has recently been introduced in breast cancer families in the Netherlands. - The 1100delC mutation in the CHEK2-gene may explain the occurrence of breast cancer in about 5% of non-BRCA1/2 families in the Netherlands. - In the general population the CHEK2*1100delC mutation confers a slightly increased breast cancer risk, but in a familial breast cancer setting this risk is between 35-55% for first degree female carriers. - Female breast cancer patients with the CHEK2*1100delC mutation are at increased risk of contralateral breast cancer and may have a less favourable prognosis. - Female heterozygous CHEK2*1100delC mutation carriers are offered annual mammography and specialist breast surveillance between the ages of 35-60 years.- Prospective research in CHEK2-positive families is essential in order to develop more specific treatment and screening strategies

Prevalence of hyperventilation in patients with asthma

OBJECTIVE: Asthma is frequently accompanied by dysfunctional breathing of which hyperventilation has been recognized as a subtype. The prevalence of hyperventilation in stable asthma has been scantily studied using blood gas analysis. Hence, a reliable estimate of its prevalence is lacking. It is unknown whether the Nijmegen Questionnaire (NQ) is a useful screening tool for hyperventilation in asthma. Therefore, the primary aim of this study was to determine the prevalence of hyperventilation in a large sample of patients with asthma in a stable state of disease. Secondary aims were to compare the clinical characteristics between patients with and without hyperventilation, and, to examine the concurrent validity of the NQ to detect hypocapnia in patients with asthma. METHODS: A real-world, observational, multicenter study was conducted. Capillary blood gas analysis was performed in adults with a confirmed diagnosis of stable asthma. A subset of patients completed the NQ. RESULTS: A blood gas analysis was obtained in 1006 patients. In 17% of the patients an acute hyperventilation was found, and in another 23% a chronic hyperventilation was uncovered. Patients with a chronic hyperventilation blood gas were more often female, were younger and had a better spirometric outcomes. The NQ appeared not to correlate with PCO2. CONCLUSION: Hyperventilation is common in patients with stable asthma. Chronic hyperventilation is more often found in females of younger age and with the best spirometric outcomes compared to patients without hyperventilation. The NQ is not a suitable screening tool for the presence of hyperventilation in stable asthmatics

Segmentation of malignant lesions in 3D breast ultrasound using a depth-dependent model

Purpose: Automated 3D breast ultrasound (ABUS) has been proposed as a complementary screening modality to mammography for early detection of breast cancers. To facilitate the interpretation of ABUS images, automated diagnosis and detection techniques are being developed, in which malignant lesion segmentation plays an important role. However, automated segmentation of cancer in ABUS is challenging since lesion edges might not be well defined. In this study, the authors aim at developing an automated segmentation method for malignant lesions in ABUS that is robust to ill-defined cancer edges and posterior shadowing. Methods: A segmentation method using depth-guided dynamic programming based on spiral scanning is proposed. The method automatically adjusts aggressiveness of the segmentation according to the position of the voxels relative to the lesion center

Improved cancer detection in automated breast ultrasound by radiologists using Computer Aided Detection

Contains fulltext : 173113.pdf (publisher's version ) (Closed access)OBJECTIVE: To investigate the effect of dedicated Computer Aided Detection (CAD) software for automated breast ultrasound (ABUS) on the performance of radiologists screening for breast cancer. METHODS: 90 ABUS views of 90 patients were randomly selected from a multi-institutional archive of cases collected between 2010 and 2013. This dataset included normal cases (n=40) with >1year of follow up, benign (n=30) lesions that were either biopsied or remained stable, and malignant lesions (n=20). Six readers evaluated all cases with and without CAD in two sessions. CAD-software included conventional CAD-marks and an intelligent minimum intensity projection of the breast tissue. Readers reported using a likelihood-of-malignancy scale from 0 to 100. Alternative free-response ROC analysis was used to measure the performance. RESULTS: Without CAD, the average area-under-the-curve (AUC) of the readers was 0.77 and significantly improved with CAD to 0.84 (p=0.001). Sensitivity of all readers improved (range 5.2-10.6%) by using CAD but specificity decreased in four out of six readers (range 1.4-5.7%). No significant difference was observed in the AUC between experienced radiologists and residents both with and without CAD. CONCLUSIONS: Dedicated CAD-software for ABUS has the potential to improve the cancer detection rates of radiologists screening for breast cancer