People with multiple sclerosis (pwMS) report many different visual complaints, but not all of them are well understood. Decline in visual, visuoperceptual and cognitive functions do occur in pwMS, ...but it is unclear to what extend those help us understand visual complaints. The purpose of this cross-sectional study was to explore the relation between visual complaints and decline in visual, visuoperceptual and cognitive functions, to optimize care for pwMS. Visual, visuoperceptual and cognitive functions of 68 pwMS with visual complaints and 37 pwMS with no or minimal visual complaints were assessed. The frequency of functional decline was compared between the two groups and correlations were calculated between visual complaints and the assessed functions. Decline in several functions occurred more frequently in pwMS with visual complaints. Visual complaints may be an indication of declined visual or cognitive functioning. However, as most correlations were not significant or weak, we cannot infer that visual complaints are directly related to functions. The relationship may be indirect and more complex. Future research could focus on the overarching cognitive capacity that may contribute to visual complaints. Further research into these and other explanations for visual complaints could help us to provide appropriate care for pwMS.
To determine the incidence of visual impairment (VI) caused by retinopathy of prematurity (ROP) and concomitant disabilities in preterm neonates born between 2000 and 2009 in the Netherlands.
Data ...were retrieved from the Dutch institutes for the visually impaired. They were compared with similar Dutch studies conducted in 1975-1987, 1986-1994 and 1994-2000.
Records of 42 infants with VI due to ROP were included. A gradual decrease of gestational age and birthweight but an increase of duration of artificial ventilation, supplemental oxygen administration, bronchopulmonary dysplasia, developmental delay and behavioural abnormalities was found. Compared with the previous study (1994-2000), significantly fewer children were visually impaired due to ROP (1.84 per 100,000 live births/year vs 3.93 per 100,000 live births/year, p=0.000), the incidence of complete blindness decreased from 27.5% to 7.1% (p < 0.05) and more children were treated (66.7% vs 56.9%, NS). The incidence of concomitant disabilities was high and did not differ greatly from the previous study.
This was a retrospective study showing a significant decrease in VI due to ROP in the Netherlands. Changes in neonatal care practices did not result in a decrease in the incidence of concomitant disabilities. More children were treated for ROP, but 33% were not treated.
To compare the effectiveness of two 45 degrees photographic fields per eye in the screening for diabetic retinopathy with the routine ophthalmologist's examination and to study the effectiveness of ...visual acuity measurement in the detection of diabetic macular edema.
Type 1 and 2 diabetic patients without a known history of more than minimal retinopathy (n = 469) had a routine examination by an ophthalmologist, including visual acuity measurement, indirect retinoscopy, and biomicroscopy. At the same time, two-field nonstereoscopic retinal photographs were made of both eyes and assessed in a masked fashion by a retinal specialist. The results were compared.
The prevalence was 4.3% for vision-threatening retinopathy and 24% for any retinopathy. The sensitivity of two-field photography in identifying diabetic patients with sight-threatening retinopathy was 95% (specificity 99%) and sensitivity for detecting any retinopathy was 83% (specificity 88%). The percentage of referrals to an ophthalmologist was 6.2%. All patients with macular edema detected by biomicroscopy were classified as having vision-threatening retinopathy on the photographs.
Two-field retinal photography is a promising alternative to the routine ophthalmologist's examination in the screening for diabetic retinopathy. Visual acuity measurement is not a sensitive tool for the detection of macular edema. Screening for diabetic retinopathy using two-field retinal photography is feasible in a primary care setting and can substantially lower the number of ophthalmic referrals.
Supernovae and their remnants are a central problem in astrophysics due to their role in the stellar evolution and nuclear synthesis. A supernova’s explosion is driven by a blast wave causing the ...development of Rayleigh–Taylor and Richtmyer–Meshkov instabilities and leading to intensive interfacial mixing of materials of a progenitor star. Rayleigh–Taylor and Richtmyer–Meshkov mixing breaks spherical symmetry of a star and provides conditions for synthesis of heavy mass elements in addition to light mass elements synthesized in the star before its explosion. By focusing on hydrodynamic aspects of the problem, we apply group theory analysis to identify the properties of Rayleigh–Taylor and Richtmyer–Meshkov dynamics with variable acceleration, discover subdiffusive character of the blast wave-induced interfacial mixing, and reveal the mechanism of energy accumulation and transport at small scales in supernovae.
Introduction
Appendicectomy may reduce relapses and need for medication in patients with ulcerative colitis, but long‐term prospective data are lacking. This study aimed to analyse the effect of ...appendicectomy in patients with refractory ulcerative colitis.
Methods
In this prospective multicentre cohort series, all consecutive patients with refractory ulcerative colitis referred for proctocolectomy between November 2012 and June 2015 were counselled to undergo laparoscopic appendicectomy instead. The primary endpoint was clinical response (reduction of at least 3 points in the partial Mayo score) at 12 months and long‐term follow‐up. Secondary endpoints included endoscopic remission (endoscopic Mayo score of 1 or less), failure (colectomy or start of experimental medication), and changes in Inflammatory Bowel Disease Questionnaire (IBDQ) (range 32–224), EQ‐5D™ and EORTC‐QLQ‐C30‐QL scores.
Results
A total of 28 patients (13 women; median age 40·5 years) underwent appendicectomy. The mean baseline IBDQ score was 127·0, the EQ‐5D™ score was 0·65, and the EORTC‐QLQ‐C30‐QL score was 41·1. At 12 months, 13 patients had a clinical response, five were in endoscopic remission, and nine required a colectomy (6 patients) or started new experimental medical therapy (3). IBDQ, EQ‐5D™ and EORTC‐QLQ‐C30‐QL scores improved to 167·1 (P < 0·001), 0·80 (P = 0·003) and 61·0 (P < 0·001) respectively. After a median of 3·7 (range 2·3–5·2) years, a further four patients required a colectomy (2) or new experimental medical therapy (2). Thirteen patients had a clinical response and seven were in endoscopic remission. The improvement in IBDQ, EQ‐5D™ and the EORTC‐QLQ‐C30‐QL scores remained stable over time.
Conclusion
Appendicectomy resulted in a clinical response in nearly half of patients with refractory ulcerative colitis and a substantial proportion were in endoscopic remission. Elective appendicectomy should be considered before proctocolectomy in patients with therapy‐refractory ulcerative colitis.
Antecedentes
La apendicectomía puede reducir las recaídas y la necesidad de medicación en pacientes con colitis ulcerosa (ulcerative colitis, UC), sin embargo, faltan datos a largo plazo obtenidos de forma prospectiva. El objetivo de este estudio fue analizar el efecto de la apendicectomía en pacientes con UC refractarios al tratamiento.
Métodos
En esta serie prospectiva de cohortes multicéntrica, a todos los pacientes consecutivos con UC refractaria remitidos para proctocolectomía entre noviembre de 2012 y junio de 2015 se les recomendó en su lugar someterse a una apendicectomía laparoscópica. El criterio de valoración principal fue la respuesta clínica (disminución de ≥ 3 puntos del sistema de puntuación parcial de Mayo que varía de 0 a 9) a los 12 meses y en el seguimiento a largo plazo. Los criterios de valoración secundarios incluyeron la remisión endoscópica (puntuación endoscópica de Mayo ≤ 1), fracaso (colectomía o inicio de medicación experimental) y cambios en el IBDQ (rango 32‐224), EQ‐5D y EORTC‐QLQ‐C30‐QL.
Resultados
En total, 28 pacientes (13 mujeres, mediana de edad 40,5) se sometieron a una apendicectomía. El IBDQ de referencia promedio fue de 127,0; el EQ‐5D 0,65 y el EORTC‐QLQ‐C30‐QL 41,1. A los 12 meses, 13 pacientes presentaban una respuesta clínica, cinco estaban en remisión endoscópica y nueve precisaron colectomía (n = 6) o un nuevo tratamiento médico experimental (n = 3). El IBDQ, EQ‐5D y EORTC‐QLQ‐C30‐QL mejoraron a 167,1 (P < 0,001); 0,80 (P = 0,003) y 61,0 (P < 0,001) respectivamente. Después de una mediana de 3,7 años (rango 2,3‐5,2), otros cuatro pacientes requirieron una colectomía (n = 2) o un nuevo tratamiento médico experimental (n = 2). Trece pacientes presentaron respuesta clínica y siete se encontraban en remisión endoscópica. La mejora del IBDQ, el EQ‐5D y el EORTC‐QLQ‐C30‐QL se mantuvo estable a lo largo del tiempo.
Conclusión
La apendicectomía consiguió una respuesta clínica en casi la mitad de los pacientes con UC refractaria. La apendicectomía electiva debería ser considerada antes que la proctocolectomía en pacientes con UC refractaria al tratamiento.
Appendicectomy may reduce relapses and need for medication in patients with ulcerative colitis, but long‐term prospective data are lacking. In this study, appendicectomy resulted in a clinical response in 13 of 28 patients with therapy‐refractory ulcerative colitis and a substantial proportion were in endoscopic remission. Elective appendicectomy should therefore be considered before proctocolectomy in these patients.
Has promise
Transportation is not always organised efficiently, which causes unnecessary costs and CO2 emissions. Vendor-managed inventory (VMI) has been suggested as a form of cooperation that can reduce ...economic and environmental impacts of transportation and consequently improve eco-efficiency of the supply chain. Establishing viable forms of VMI cooperation requires a fair distribution of the cooperation's economic benefits. Cooperative game theory (CGT) research is used to fairly allocate both benefits and costs. However, the environmental contribution of partners has often been ignored in the benefit allocation. In this study, the Shapley value (a commonly used CGT method) is used to share the monetary gains in a way that reflects the partners' contributions to cost and emissions savings. The method is applied to evaluate the allocation of economic and environmental benefits of vendor-managed inventory between cooperating supermarket chains in the Netherlands. The findings show that there is a set of eco-efficient solutions resulting in lower costs and CO2 emissions compared to the current situation. For each of the eco-efficient solutions, the relative importance of saving costs and of saving emissions was quantified, and based on the importance weights, a cost allocation was found. For all partners that contribute to saving both cost and CO2 emissions, this approach results in cost savings, and therefore, the approach can be considered fair. Also, this approach helps to stimulate long-term eco-efficient forms of cooperation.
•Vendor-managed inventory can improve eco-efficiency in supply chains.•A green inventory routing model is used to quantify cooperative benefits.•With the Shapley value, benefits are allocated based on costs and emissions.•Costs and emissions are dependent on location and demand characteristics.
•We assess benefits of cooperation in temperature controlled transportation.•An Inventory Routing Problem is applied to compare different forms of cooperation.•Joint Route Planning cooperation can ...reduce both costs and emissions substantially.•Vendor Managed Inventory results in a trade-off between cost and emissions.•There is a trade-off between emissions and average product age in VMI cooperation.
Inefficient road transportation causes unnecessary costs and polluting emissions. This problem is even more severe in refrigerated transportation, in which temperature control is used to guarantee the quality of the products. Organizing logistics cooperatively can help decrease both the environmental and the economic impacts. In Joint Route Planning (JRP) cooperation, suppliers and customers jointly optimize routing decisions so that cost and emissions are minimized. Vendor Managed Inventory (VMI) cooperation extends JRP cooperation by optimizing routing and inventory planning decisions simultaneously. However, in addition to their economic advantages, VMI and JRP may also yield environmental benefits. To test this assertion, we perform a case study on cooperation between a number of supermarket chains in the Netherlands. The data of this case study are analyzed to quantify both the economic and environmental benefits of implementing cooperation via JRP and VMI, using vehicle routing and an inventory routing models. We found that JRP cooperation can substantially reduce cost and emissions compared with uncooperative routing. In addition, VMI cooperation can further reduce cost and emissions, but minimizing cost and minimizing emissions no longer result in the same solution and there is a trade-off to be made.
Background
High perianal fistulas require sphincter‐preserving surgery because of the risk of faecal incontinence. The ligation of the intersphincteric fistula tract (LIFT) procedure preserves anal ...sphincter function and is an alternative to the endorectal advancement flap (AF). The aim of this study was to evaluate outcomes of these procedures in patients with cryptoglandular and Crohn's perianal fistulas.
Methods
A systematic literature search was performed using MEDLINE, Embase and the Cochrane Library. All RCTs, cohort studies and case series (more than 5 patients) describing one or both techniques were included. Main outcomes were overall success rate, recurrence and incontinence following either technique. A proportional meta‐analysis was performed using a random‐effects model.
Results
Some 30 studies comprising 1295 patients were included (AF, 797; LIFT, 498). For cryptoglandular fistula (1098 patients), there was no significant difference between AF and LIFT for weighted overall success (74·6 (95 per cent c.i. 65·6 to 83·7) versus 69·1 (53·9 to 84·3) per cent respectively) and recurrence (25·6 (4·7 to 46·4) versus 21·9 (14·8 to 29·0) per cent) rates. For Crohn's perianal fistula (64 patients), no significant differences were observed between AF and LIFT for overall success rate (61 (45 to 76) versus 53 per cent respectively), but data on recurrence were limited. Incontinence rates were significantly higher after AF compared with LIFT (7·8 (3·3 to 12·4) versus 1·6 (0·4 to 2·8) per cent).
Conclusion
Overall success and recurrence rates were not significantly different between the AF and LIFT procedure, but continence was better preserved after LIFT.
This systematic review and meta‐analysis, including 1295 patients in 30 studies, suggested that, for cryptoglandular fistula, overall success and recurrence rates after the advancement flap and ligation of the intersphincteric fistula tract (LIFT) procedure are comparable. In Crohn's fistula, overall success rates after the two procedures were also comparable, although data were limited and no study reported recurrence rates after the LIFT procedure. For both indications, continence seems to be preserved better after the LIFT procedure.
Treatment of high perianal fistulas
Inefficient road transportation causes unnecessary costs and emissions. This problem is even more severe in fresh food transportation, where temperature control is used to guarantee product quality. ...On a route with multiple stops, the quality of the transported products could be negatively influenced by the door openings and consequent temperature fluctuations. In this study, we quantify the effects of multi-stop transportation on food quality. To realistically model and quantify food quality, we develop a time-and temperature-dependent kinetic model for a vehicle routing problem. The proposed extensions of the vehicle routing problem enable quantification of quality decay on a route. The model is illustrated using a case study of cooperative routing, and our results show that longer, multi-stop routes can negatively influence food quality, especially for products delivered later in the route, and when the products are very temperature-sensitive and the outside temperature is high. Minimising quality loss results in multiple routes with fewer stops per route, whereas minimising costs or emissions results in longer routes. By adjusting driving speed, unloading rate, cooling rate, and by setting a quality threshold level, the negative quality consequences of multi-stop routes can be mitigated.
Display omitted
•We develop the quality driven vehicle routing problem for fresh food logistics.•We apply the model to a retail case of cooperative cold chains.•Our model can be used to find decay minimising strategies on a route.•Quality constraints can be used to guarantee product quality for all clients.•To quantify quality decay, the Arrhenius equation is inserted in a routing model.
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