Organizing Multidisciplinary Care for Children with Neuromuscular Diseases

The Academic Medical Center (AMC) in Amsterdam, The Netherlands, recently opened the `Children's Muscle Center Amsterdam' (CMCA). The CMCA diagnoses and treats children with neuromuscular diseases. These patients require care from a variety of clinicians. Through the establishment of the CMCA, children and their parents will generally visit the hospital only once a year, while previously they visited on average six times a year. This is a major improvement, because the hospital visits are both physically and psychologically demanding for the patients. This article describes how quantitative modelling supports the design and operations of the CMCA. First, an integer linear program is presented that selects which patients to invite for a treatment day and schedules the required combination of consultations, examinations and treatments on one day. Second, the integer linear program is used as input to a simulation to study to estimate the capacity of the CMCA, expressed in the distribution of the number patients that can be seen on one diagnosis day. Finally, a queueing model is formulated to predict the access time distributions based upon the simulation outcomes under various demand scenarios

Organizing multidisciplinary care for children with neuromuscular diseases at the Academic Medical Center, Amsterdam:CASE STUDY

The Academic Medical Center (AMC) in Amsterdam, The Netherlands, recently opened the ‘Children’s Muscle Center Amsterdam’ (CMCA). The CMCA diagnoses and treats children with neuromuscular diseases. The patients with such diseases require care from a variety of clinicians. Through the establishment of the CMCA, children and their parents will generally visit the hospital only once a year, while previously they used to visit on average six times a year. This is a major improvement, because the hospital visits are both physically and psychologically demanding for the patients. This paper describes how quantitative modelling supports the design and operations of the CMCA. First, an integer linear program is presented that selects which patients are to be invited for a treatment day and schedules the required combination of consultations, examinations and treatments on one day. Second, the integer linear program is used as input to a simulation study to estimate the capacity of the CMCA, expressed in terms of the distribution of the number patients that can be seen on one diagnosis day. Finally, a queueing model is formulated to predict the access time distributions based upon the simulation outcomes under various demand scenarios. Its contribution on the case under study is twofold. First, we design highly constrained appointment schedules for multiple patients that require service from multiple disciplines’ resources. Second, we study the effect of the trade-offs between scheduling constraints and access times. As such, the contribution of this case study paper is that it illustrates the value of applying Operations Research techniques in complex healthcare settings, by designing context-specific combinations of mathematical models, thereby improving delivery of the highly-constrained multidisciplinary care

A High Statistics Search for Ultra-High Energy Gamma-Ray Emission from Cygnus X-3 and Hercules X-1

We have carried out a high statistics (2 Billion events) search for ultra-high energy gamma-ray emission from the X-ray binary sources Cygnus X-3 and Hercules X-1. Using data taken with the CASA-MIA detector over a five year period (1990-1995), we find no evidence for steady emission from either source at energies above 115 TeV. The derived upper limits on such emission are more than two orders of magnitude lower than earlier claimed detections. We also find no evidence for neutral particle or gamma-ray emission from either source on time scales of one day and 0.5 hr. For Cygnus X-3, there is no evidence for emission correlated with the 4.8 hr X-ray periodicity or with the occurrence of large radio flares. Unless one postulates that these sources were very active earlier and are now dormant, the limits presented here put into question the earlier results, and highlight the difficulties that possible future experiments will have in detecting gamma-ray signals at ultra-high energies.Comment: 26 LaTeX pages, 16 PostScript figures, uses psfig.sty to be published in Physical Review

Measurements of the ϒ(1S), ϒ(2S), and ϒ(3S) differential cross sections in pp collisions at s=7TeV

Differential cross sections as a function of transverse momentum pTpT are presented for the production of ϒ(nS)ϒ(nS) (n = 1, 2, 3) states decaying into a pair of muons. Data corresponding to an integrated luminosity of 4.9View the MathML sourcefb−1 in pp collisions at View the MathML sources=7TeV were collected with the CMS detector at the LHC. The analysis selects events with dimuon rapidity |y|<1.2|y|<1.2 and dimuon transverse momentum in the range View the MathML source10<pT<100GeV. The measurements show a transition from an exponential to a power-law behavior at View the MathML sourcepT≈20GeV for the three ϒ states. Above that transition, the ϒ(3S)ϒ(3S) spectrum is significantly harder than that of the ϒ(1S)ϒ(1S). The ratios of the ϒ(3S)ϒ(3S) and ϒ(2S)ϒ(2S) differential cross sections to the ϒ(1S)ϒ(1S) cross section show a rise as pTpT increases at low pTpT, then become flatter at higher pTpT

Search for vectorlike charge 2/3 T quarks in proton-proton collisions at root(s)=8 TeV

Peer reviewe

The Influence of Age and Sex on Genetic Associations with Adult Body Size and Shape : A Large-Scale Genome-Wide Interaction Study

Genome-wide association studies (GWAS) have identified more than 100 genetic variants contributing to BMI, a measure of body size, or waist-to-hip ratio (adjusted for BMI, WHRadjBMI), a measure of body shape. Body size and shape change as people grow older and these changes differ substantially between men and women. To systematically screen for age-and/or sex-specific effects of genetic variants on BMI and WHRadjBMI, we performed meta-analyses of 114 studies (up to 320,485 individuals of European descent) with genome-wide chip and/or Metabochip data by the Genetic Investigation of Anthropometric Traits (GIANT) Consortium. Each study tested the association of up to similar to 2.8M SNPs with BMI and WHRadjBMI in four strata (men 50y, women 50y) and summary statistics were combined in stratum-specific meta-analyses. We then screened for variants that showed age-specific effects (G x AGE), sex-specific effects (G x SEX) or age-specific effects that differed between men and women (G x AGE x SEX). For BMI, we identified 15 loci (11 previously established for main effects, four novel) that showed significant (FDR= 50y). No sex-dependent effects were identified for BMI. For WHRadjBMI, we identified 44 loci (27 previously established for main effects, 17 novel) with sex-specific effects, of which 28 showed larger effects in women than in men, five showed larger effects in men than in women, and 11 showed opposite effects between sexes. No age-dependent effects were identified for WHRadjBMI. This is the first genome-wide interaction meta-analysis to report convincing evidence of age-dependent genetic effects on BMI. In addition, we confirm the sex-specificity of genetic effects on WHRadjBMI. These results may providefurther insights into the biology that underlies weight change with age or the sexually dimorphism of body shape.Peer reviewe

Global relative species loss due to first generation biofuel production for the transport sector

The global demand for biofuels in the transport sector may lead to significant biodiversity impacts via multiple human pressures. Biodiversity assessments of biofuels, however, seldom simultaneously address several impact pathways, which can lead to biased comparisons with fossil fuels. The goal of the present study was to quantify the direct influence of habitat loss, water consumption and greenhouse gas (GHG) emissions on potential global species richness loss due to the current production of first‐generation biodiesel from soybean and rapeseed and bioethanol from sugarcane and corn. We found that the global relative species loss due to biofuel production exceeded that of fossil petrol and diesel production in more than 90% of the locations considered. Habitat loss was the dominating stressor with Chinese corn, Brazilian soybean and Brazilian sugarcane having a particularly large biodiversity impact. Spatial variation within countries was high, with 90th percentiles differing by a factor of 9 to 22 between locations. We conclude that displacing fossil fuels with first‐generation biofuels will likely negatively affect global biodiversity, no matter which feedstock is used or where it is produced. Environmental policy may therefore focus on the introduction of other renewable options in the transport sector.JRC.D.5-Food Securit

Surgery in metastatic breast cancer: patients with a favorable profile seem to have the most benefit from surgery

INTRODUCTION About 3-10% of breast cancer patients have distant metastases (Stage IV) at initial presentation; standard treatment (in the Netherlands) of these patients consists of palliative systemic therapy. However, retrospective studies have shown an improved survival in patients who received surgery for their primary tumor. The aim of this study was to assess characteristics associated with surgical treatment and to determine the impact on survival in women with stage IV breast cancer. METHODS A cohort of women with a diagnosis of breast cancer and concomitant distant metastases was retrospectively studied. Patient characteristics, treatment and survival distilled from medical files were evaluated using univariate and multivariable analysis. RESULTS Of 171 patients included in this analysis, 59 underwent surgery. In multivariable analysis lower age, no medication use, lower clinical T-stage and lower grade were associated with receiving surgery. In 21 of the 59 patients (35%) who received surgery it was unknown at the time of surgery that the patient had metastatic disease. Stratified survival analyses showed an association between surgery and improved survival for young patients (HR 0.3; p = 0.02), without comorbidity (HR 0.4; p = 0.002), with no medication use (HR 0.5; p = 0.009), with a small tumor (HR 0.4; p = 0.01), no regional lymph node involvement (HR 0.4; p = 0.01), with positive Estrogen (HR 0.6; p = 0.02) or Progesterone receptor (HR 0.4; p = 0.03) and with only visceral metastases (HR 0.5; p = 0.03). In multivariable analyses, younger patients and patients without comorbidity that received surgery had an increased survival (HR 0.3; p = 0.03 and HR 0.5; p = 0.03, respectively). CONCLUSION This study showed that patients with the most favorable profile receive local surgery and that a survival gain for operated patients was seen in young patients and in patients without comorbidity.Surgical oncolog

Molecular analysis of the mevalonate kinase gene in a cohort of patients with the hyper-IgD and periodic fever syndrome: Its application as a diagnostic tool

Contains fulltext : 19672.pdf (publisher's version ) (Closed access