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Background: In experimental and clinical studies, volatile anaesthesia has proven to possess cardioprotective properties. However, no randomized controlled trials on the use of isoflurane during the entire cardiac surgical procedure are available. We therefore compared isoflurane-sufentanil vs propofol-sufentanil anaesthesia in patients undergoing coronary artery bypass grafting.Methods: One hundred patients were randomly assigned to receive isoflurane-sufentanil (I) (n = 51) or propofol-sufentanil (P) (n = 49) anaesthesia, aimed at the same hypnotic depth. Postoperative concentrations of cardiac troponin I (cTnI) were followed for 72 h. Secondary outcome variables were length of stay (LOS) in the intensive care unit (ICU) and in hospital, and 30 day and 1 yr mortality and morbidity, defined as acute myocardial infarction, arrhythmias, and cardiac dysfunction. Groups were compared by an on-treatment analysis, using linear mixed models for repeated measures.Results: Eighty-four patients completed the protocol (I: 41 vs P: 43). Postoperative cTnI concentrations increased to a maximum of I: 2.72 ng ml(-1) (1.78-5.85) and P: 2.64 ng ml(-1) (1.67-4.83), but did not differ between groups (P=0.11). LOS in the ICU and in hospital was similar [ICU I: 18 (17.0-21.5) vs P: 19 (17.0-22.0) h; hospital I: 9 (6.5-8.0) vs P: 8 (6.0-9.0) days]. Cardiac morbidity and mortality in hospital and 30 days after surgery did not differ between groups. One year after surgery, two patients had died of non-cardiac causes. No between-group differences in cardiac morbidity were found.Conclusions: In this study, the use of isoflurane-sufentanil in comparison with propofol-sufentanil anaesthesia does not afford additional reduction of postoperative cTnI levels. [ABSTRACT FROM AUTHOR]

Objective: to assess the mode of childbirth and adverse neonatal outcomes in women with a breech presentation with or without an external cephalic version attempt, and to compare the mode of childbirth among women with successful ECV to women with a spontaneous cephalic presentation. Design: prospective matched cohort study. Setting: 25 clusters (hospitals and its referring midwifery practices) in the Netherlands. Data of the Netherlands perinatal registry for the matched cohort. Participants: singleton pregnancies from January 2011 to August 2012 with a fetus in breech presentation and a childbirth from 36 weeks gestation onwards. Spontaneous cephalic presentations (selected from national registry 2009 and 2010) were matched in a 2:1 ratio to cephalic presentations after a successful version attempt. Matching criteria were maternal age, parity, gestational age at childbirth and fetal gender. Main outcomes were mode of childbirth and neonatal outcomes. Measurements and findings: of 1613 women eligible for external cephalic version, 1169 (72.5%) received an ECV attempt. The overall caesarean childbirth rate was significantly lower compared to women who did not receive a version attempt (57% versus 87%; RR 0.66 (0.62-0.70)). Women with a cephalic presentation after ECV compared to women with a spontaneous cephalic presentation had a decreased risk for instrumental vaginal childbirth (RR 0.52 (95% CI 0.29-0.94)) and an increased risk of overall caesarean childbirth (RR 1.7 (95%CI 1.2-2.5)). Key conclusions: women who had a successful ECV are at increased risk for a caesarean childbirth but overall, ECV is an important tool to reduce the caesarean rate. Implication for practice: ECV is an important tool to reduce the caesarean section rates. [ABSTRACT FROM AUTHOR]

Objective: to compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care. Design: retrospective cohort study. Setting: Amsterdam region of the Netherlands. Participants: women with singleton pregnancies who gave birth beyond 37 + 0 weeks gestation in the years 2005 up to 2008 and lived in the catchment area of the neonatal intensive care units of both academic hospitals in Amsterdam. Women with a primary caesarean section or a pregnancy complicated by antepartum death or major congenital anomalies were excluded. For women in the midwife-led care group, a home or hospital birth could be planned. Measurements: analysis of linked data from the national perinatal register, and hospital- and midwifery record data. We assessed (unadjusted) relative risks with confidence intervals. Main outcome measures were incidences of intrapartum and neonatal (<28 days) mortality. Secondary outcomes included incidences of caesarean section and vaginal instrumental delivery. Findings: 53,123 women started labour in primary care and 30,166 women in secondary care. Intrapartum and neonatal mortality rates were 37/53,123 (0.70%o) in the primary care group and 24/ 30,166 (0.80%o) in the secondary care group (relative risk 0.88; 95% CI 0.52-1.46). Women in the primary care group were less likely to deliver by secondary caesarean section (5% versus 16%; RR 0.31; 95% CI 0.30-0.32) or by instrumental delivery (10% versus 13%; RR 0.76; 95% CI 0.73-0.79). Key conclusions: we found a low absolute risk of intrapartum and neonatal mortality, with a comparable risk for women who started labour in primary versus secondary care. The intervention rate was significantly lower in women who started labour in primary care. Implications for practice: these ndings suggest that it is possible to identify a group of women at low risk of complications that can start labour in primary care and have low rates of medical interventions whereas perinatal mortality is low. [ABSTRACT FROM AUTHOR]

Objective: When primary chondrocytes are cultured in monolayer, they undergo dedifferentiation during which they lose their phenotype and their capacity to form cartilage. Dedifferentiation is an obstacle for cell therapy for cartilage degeneration. In this study, we aimed to systemically evaluate the changes in gene expression during dedifferentiation of human articular chondrocytes to identify underlying mechanisms.Methods: RNA was isolated from monolayer-cultured primary human articular chondrocytes at serial passages. Gene expression was analyzed by microarray. Based on the microarray analysis, relevant genes and pathways were identified. Their functions in chondrocyte dedifferentiation were further investigated.Results: In vitro expanded human chondrocytes showed progressive changes in gene expression. Strikingly, an overall decrease in total gene expression was detected, which was both gradual and cumulative. DNA methylation was in part responsible for the expression downregulation of a number of genes. Genes involved in many pathways such as the extracellular-signal-regulated kinase (ERK) and Bone morphogenetic protein (BMP) pathways exhibited significant changes in expression. Inhibition of ERK pathway did not show dramatic effects in counteracting dedifferentiation process. BMP-2 was able to decelerate the dedifferentiation and reinforce the maintenance of chondrocyte phenotype in monolayer culture.Conclusion: Our study not only improves our knowledge of the intricate signaling network regulating maintenance of chondrocyte phenotype, but also contributes to improved chondrocyte expansion and chondrogenic performance for cell therapy. [ABSTRACT FROM AUTHOR]

Although seawater reverse osmosis (SWRO) is currently the only non-thermal desalination process in practical use, its characteristics make it difficult to approach the ideal reversible process. SWRO has a low water recovery (determined by the osmotic pressure) and relatively high energy consumption. A breakthrough in development of SWRO membranes can not be expected; at maximum a recovery of 60% could be obtained with membranes that can stand ultra-high pressures. In our project, an alternative development of desalination is introduced in which the osmotic pressure difference is reduced prior to SWRO with the use of electro-membranes, as in electrodialysis (ED). ED has distinctive and complementary assets when compared to SWRO. ED enables an operation close to the reversible limit, at least to the first extent of the desalination process. ED is an ideal pre-desalination step as: (i) the water recovery is not limited by a driving force (e.g., pressure), (ii) the specific energy consumption is directly proportional to the salt removal, (iii) the process economy allows low ionic fluxes and thus low irreversible losses, (iv) the system can be operated with infinitesimal changes in salinity (a pre-requisite for reversibility), and (v) the pre-treatment efforts can be kept limited. In this paper we compare a hybrid ED-SWRO scheme with state-of-the-art desalination schemes with respect to costs and energy consumption. [ABSTRACT FROM AUTHOR]

Reverse electrodialysis is a conversion technique to obtain electricity from salinity gradients. Over the past few years, the performance of reverse electrodialysis on laboratory scale has improved considerably. In this paper, we discuss the challenges we are still facing concerning the economic and technological feasibility and the developing path of reverse electrodialysis. We focus on the following issues: (i) the development of low-cost membranes, (ii) pre-treatment in relation to stack design and operation, and (iii) the economics of reverse electrodialysis. For membranes, the challenge is to increase availability (>km²/year) at reduced cost (<2 €/m²). The membranes should be manufactured at high speed to meet this challenge. For pre-treatment, a capital-extensive micro-screen filter with 50 µm pores was selected and tested. Such a straightforward pre-treatment is only sufficient given the fact that the reverse electrodialysis stack was redesigned towards a more robust spacer-free system. For the economic feasibility, a 200 kW repetitive unit was designed. The cost price is estimated to be less than 0.08 €/kWh (excluding any subsidy or compensation), comparable with that of wind energy. The feasibility of the technology should be proved with a scaled-up system under practical conditions. The intended pilot facility at the Afsluitdijk (The Netherlands) will be an essential step towards implementation of reverse electrodialysis for power generation. [ABSTRACT FROM AUTHOR]

Abstract: A rapid presence/absence test for Campylobacter in chicken faeces is being evaluated to support the scheduling of highly contaminated broiler flocks as a measure to reduce public health risks [Nauta, M. J., & Havelaar, A. H. (2008). Risk-based standards for Campylobacter in the broiler meat chain. Food Control, 19, 372–381]. Although the presence/absence test is still under development, an example data set of test results is analysed to illustrate the benefit of the detection probability concept. The detection probability of Campylobacter increases with the logarithm of the Campylobacter concentration in faeces according to an S-shaped curve which stretches about 2–3 log units. The detection probability is 50% at a Campylobacter concentration of 7.4×106 cfu/g. The uncertainty in the detection probability is 32% at the most for a 90% confidence interval. This type of information allows for realistic calculations on the Campylobacter status of different food processing paths after splitting. Usable quantitative estimates on detection probability await a data set of test results from a test that is ready for use or has similar properties. [Copyright &y& Elsevier]

Abstract: During the last few years it has become more and more customary for major industries to use FEM simulations during the product creation process. Most of these metal-forming process simulations are based on elastic plastic behaviour of material and use non-deformable tools. For a correct use of FEM simulations in product development stages, it is very important to determine the accuracy of the simulations. For multi-stage processes, it can be more effective not to simulate the total process but only a few stages of the process, with the last stages usually being the most important ones. To start simulations half way the total process calls for information on the semi-finished product. This information is generated by means of measured values in order to decrease the total modeling time and to increase the accuracy. This paper shows a method developed for handling these problems. The method based on a fully automatic measuring device, including a LECO hardness tester. The results of these measurements were used to verify models, including models based on the transformation behaviour of strain-induced martensite. The examples presented are based on products made of a stainless steel called Nanoflex . [Copyright &y& Elsevier]

Abstract: During precision forming of metal parts made of metastable austenitic stainless steels, the relationship between the scatter on the initial parameters like the strip thickness, yield stress, etc. on the product accuracy need to be known. This becomes complex if the material is instable, i.e. martensite forms very easily. The transformation rate depends on the stress state, which is related to friction. It also depends on the temperature, which is related to deformation heat. A greater understanding of these phenomena is obtained by doing a process window study, using design and analysis of computer experiments (DACE). This paper demonstrates how to perform a DACE study on a three-stage metal forming process, using distributed computing. The study focuses on: [•] Hardening due to strain-induced and stress-assisted transformation. [•] The influence of metal forming parameters on the product accuracy. [Copyright &y& Elsevier]

BACKGROUND: Retention of the video capsule is the most significant complication associated with capsule endoscopy (CE). There are limited data on incidence, risk factors, and outcomes of capsule retention. OBJECTIVE: We aimed to determine the incidence of capsule retention and to investigate the causes and clinical outcomes of capsule retention. SETTING: Single tertiary referral medical center. PATIENTS: All patients who underwent CE for suspected small bowel disease from June 2002 to March 2006. METHODS: Retrospective case series. RESULTS: Capsule retention occurred in 1.4% of our patients (14/1000). Eleven patients failed to pass the capsule because of nonsteroidal anti-inflammatory drug (NSAID) enteropathy (diaphragm disease). One patient had capsule retention from an obstructing carcinoid tumor. Metastatic ovarian cancer with invasion of the ileum was the cause of retention in another patient. One patient who did not have surgical removal of the capsule because of loss of follow-up had retention caused by a small-bowel tumor suspicious for carcinoid tumor on CT enterography. All patients remained 'asymptomatic' from the retained capsules. Thirteen patients underwent elective partial small-bowel resection and capsule removal. No deaths were associated with these surgeries. Eleven patients recovered promptly, whereas 2 patients had mild postoperative ileus. LIMITATION: Retrospective study. CONCLUSION: Retention of the capsule endoscope appears to be infrequent. The most common cause is diaphragm disease resulting from NSAIDs in this study population. In most cases, capsule retention is asymptomatic, and it usually leads to surgical removal, which appears safe and also identifies and treats the underlying small-bowel condition. [ABSTRACT FROM AUTHOR]

Albumin induces oxidative stress and cytokine production in proximal tubular cells (PTECs). Albumin-bound fatty acids (FAs) enhance tubulopathic effects of albumin in vivo. We proposed that FA aggravation of albumin-induced oxidative stress in PTECs might be involved. We hypothesized that mitochondria could be a source of such stress. Using a fluorescent probe, we compared reactive oxygen species (ROS) production after exposure of PTECs to bovine serum albumin (BSA) alone or loaded with oleic acid (OA-BSA) (3–30 g/l for 2 h). There was no difference in cellular albumin uptake, but OA-BSA dose-dependently induced more ROS than BSA alone (P<0.001). OA-BSA-induced ROS was significantly alleviated by mitochondrial inhibition, but not by inhibitors of nicotinamide adenine dinucleotide phosphate hydrogenase (NADPH) oxidase, xanthine oxidase, or nitric oxide synthase. Gene expression analysis showed that neither the NADPH oxidase component p22phox nor xanthine oxidase was induced by BSA or OA-BSA. OA-BSA, in contrast to BSA, failed to induce mitochondrial manganese superoxide dismutase 2 (SOD2) expression. OA-BSA showed a greater capacity than BSA to downregulate heme oxygenase-1 mRNA expression and accentuate inflammatory cytokine mRNA and protein. Supplementation of SOD activity with EUK-8 reduced ROS, and interleukin-6 protein expression was suppressed by both mitochondrial inhibition and SOD augmentation. Thus, in PTECs, FAs accentuate albumin-induced oxidative stress and inflammatory cytokine expression via increased mitochondrial ROS, while frustrating protective antioxidant responses.Kidney International (2006) 70, 724–731. doi:10.1038/sj.ki.5001629; published online 12 July 2006 [ABSTRACT FROM AUTHOR]

Abstract: T-cell responses are supposed to be the major immune reactions in broilers infected with Eimeria. The nature of such T-cell responses is influenced by the species of Eimeria involved, age of the host, amount of parasites and the preceding infection history. In young chicks the intestine is still developing in length while the lymphocyte populations in the gut develop and differentiate. In chicks infected at young age the immune response may be different in quality as compared to responses in adults. We investigated the (T-cell) immune responses of young broilers to a primary Eimeria acervulina infection in relation to the number of parasites used for infection. In our experiment we infected one-day-old broilers with a low (5×102 oocysts) and a high (5×104 oocysts) dose of E. acervulina. We used a newly developed species specific real-time PCR to quantify total amount of parasites in the duodenum as the number of oocysts in faeces may not be representative for the exposure of the gut immune system. We characterized T-cell subsets in the duodenum by means of FACS-analyses, lymphocyte proliferation assays with spleen lymphocytes and the mRNA profiles of different cytokines (TGF-β2, -4, IFN-γ, IL-2, -6, -8 and -18) in the duodenum by means of real-time PCR. From day 5 p.i. broilers with a high dose of E. acervulina had a significantly lower body weight than the control group. No increase in CD4+ cells, but a strong increase in CD8+ cells was observed at days 7 and 9 p.i. in the duodenum of broilers infected with a high dose E. acervulina. IL-8 mRNA responses were observed after infection with low and with high infection doses, but no IFN-γ and TGF-β mRNA responses were found in the duodenum. The specific proliferative T-cell responses to a low infectious dose were not significantly different as compared to the control group. In conclusion, based on the kinetics of observed responses a primary infection with a high dose of E. acervulina in one-day-old broilers seems to generate an immune response that shows a peak at the time of oocyst excretion, whereas the immune response to a low dose is less explicit. [Copyright &y& Elsevier]

Studies the physiological effects of elevated plasma corticosterone concentrations in broiler chickens. Effect of corticosterone treatment on body and spleen weight; Effect on antibody formation; Effect on indocyanine green clearance by the liver.

Determines the heterophil/lymphocyte ratio in relation to corticosterone (CS) in stressed chickens. Age of male and female chickens; Discrepancies between microscopic and automated cell counts; Cortisone concentration; Dose-effect of CS treatment concentration in heterophil count; Plasma CS concentrations.

Abstract This research investigated the ablation process of commercial stainless steels with ultrashort pulsed laser. Square hollows were ablated on stainless steel sheets using a picosecond laser with pulse duration of 0.25, 1 and 10 ps, respectively, and fluence ranging from 0.125 J/cm2 to 5 J/cm2. For each setting the surface quality and ablation efficiency were determined by optical microscopy and scanning electron microscopy (SEM). Processing windows producing high quality surfaces at high ablation efficiency were found at a fluence around 0.75 J/cm2 for the two shorter pulse lengths tested. Individual cones and periodic cone-like protrusions were found in the low fluence regime (<0.625 J/cm2) and high fluence regime (>0.875 J/cm2), respectively, both of which make the ablated surface rough. Emphasizing on the individual cones, it is found that the cones are caused by inclusions in the base materials, attributed to a higher fluence threshold required for ceramic-like inclusions. This novel theory explaining the creation mechanism is verified by multiple analysis methods like SEM and energy dispersive X-ray spectroscopy and stop-motion SEM imaging. Highlights • Square hollows were ablated on stainless steel sheets using a picosecond laser. • Inclusions induced cones found in the low fluence regime (<0.625 J/cm2). • Periodic cone-like protrusions formed in the high fluence regime (>0.875 J/cm2). • Stop-motion SEM imaging revealed the formation mechanism of inclusions induced cones.. • The process window is the widest for 0.25 ps pulse and narrows with increasing pulse duration. [ABSTRACT FROM AUTHOR]

This paper concentrates on the effect of the residual stress state during product manufacturing of AISI 420 steel on the final shape of the product. The work includes Finite Element (FE) calculations of the distribution of the residual stresses after metal forming and a heat treatment. The evolution of the residual stress state is predicted employing a creep model which was calibrated through creep experiments ranging between 500 and 700 °C. The creep model is implemented in the FE software together with material specific parameters to simulate a thermal treatment of the product including residual stresses. The complete simulation is validated by a comparison of the predicted shape change with the actual cold-formed and hardened product. An important message of this paper is that, in contrast to what is commonly believed, residual stresses play a crucial role during creep and that a shape change may occur at lower temperatures, i.e. not at higher temperatures and in fact below the transformation temperature in this AISI 420 steel. This surprising conclusion is essential for keeping the shape change during product manufacturing minimal. [ABSTRACT FROM AUTHOR]

Abstract The design of a product component may require complex processing steps such as metal forming followed by a thermal treatment. The thermal treatment may improve the functional performance of the material itself, but may result in rather unwanted changes in the shape of the product. Here it is shown that Finite Element modeling of the various processes can assist in the design of a robust and accurate production process. The modeling approach presented allows a coupling between various complex material models, in such a way that full cold forming and thermal treatment processes are calculated. This coupling of material models is key for the design and concerns the novelty of the proposed approach. Cold forming by deep drawing is calculated whereby planar anisotropy is implemented. The thermal hardening treatment consists of three contributions: creep, thermal expansion and phase transformation. All models are based on experimental data, acquired from tensile and dilatometer tests, and are implemented into the material model either directly or by a simple fit. It is shown that the effects of a complete forming and heat treatment of a cup could be successfully calculated. The predicted cup shape change was compared to experiments, and shows excellent agreement. Graphical abstract Unlabelled Image Highlights • The predictability and accuracy of the shape changes in the product design • Coupling between forming and thermal treatment • Processing steps of forming and thermal treatment are successfully implemented in the Finite Element computer code. [ABSTRACT FROM AUTHOR]

Ion exchange membranes (IEMs) are used for selective transport of ions between two solutions. These solutions are often different in concentration or composition. The membrane resistance (RM) is an important parameter affecting power consumption or power production in electrodialytic processes. In contrast to real applications, often RM is determined while using a standard 0.5M NaCl external solution. It is known that RM increases with decreasing concentration. However, the detailed effect of a salinity gradient present over an IEM on RM was not known, and is studied here using alternating and direct current. NaCl solution concentrations varied from 0.01 to 1.1M. The results show that RM is mainly determined by the lowest external concentration. RM can be considered as two resistors in series i.e. a gel phase (concentration independent) and an ionic solution phase (concentration dependent). The membrane conductivity is limited by the conductivity of the ionic solution when the external concentration, cext<0.3M. The membrane conductivity is limited by the conductivity of the gel phase when cext≥0.3M, then differences of RM are small. A good approximation of experimentally determined RM can be obtained. The internal ion concentration profile is a key factor in modeling RM. [ABSTRACT FROM AUTHOR]

In desalination often multi ionic compositions are encountered. A preferential removal of multivalent ions over monovalent ions can be of interest to prevent scaling in the desalination process. Recently, a novel fractionating electrodialysis stack is described by Zhang et al., 2012 (in Sep. purify. Technol. 88). In the present work a small modification to such a stack was made, to create a current induced ion exchange process, in which no longer desalination occurs. This was done by building a membrane stack in which monovalent-selective ion-exchange membranes and standard grade ion-exchange membranes, with similar charge sign (so either anion or cation exchange groups), were placed alternatingly between an anode and a cathode to form a membrane stack. A proof of principle of the fractioning electrodialysis technology is given. Ternary mixtures, with a divalent-monovalent ion ratio similar to seawater, were used as feed water. For a cation and an anion fractioning stack, maximum fractionations of divalent ions were obtained of approximately 90 and 60%. At higher applied current density, ions can be fractionated to a larger extent than at lower applied current density. For both stacks the water recovery was ~50%. Coulombic efficiency of both processes decrease rapidly after the start of the experiment. This leads to relatively large volumetric energy consumptions. [ABSTRACT FROM AUTHOR]

Abstract: “Testing and scheduling” has been proposed as a strategy for control of Campylobacter in broiler meat. By this strategy, flocks with high numbers of Campylobacter in fecal samples would be diverted away from fresh meat production at the entrance of the broiler meat processing plant. Risk assessment studies suggest that this would effectively decrease human health risks, if these flocks are responsible for the meat products with the highest Campylobacter numbers. To investigate the effect of this control strategy, the numbers of Campylobacter were determined in fecal samples from transport containers, and in cecal and breast meat samples from birds in 62 broiler chicken flocks. Results from direct plating and enrichment were combined by a statistical method that allows the inclusion of censored data. As the implementation of “testing and scheduling” requires a rapid on-site test to detect high numbers of Campylobacter, a lateral flow immuno-assay (LFA) was developed and applied to the fecal samples collected from containers. The Campylobacter prevalence in broiler flocks in the autumn of 2007 was found to be 85.4% by traditional microbiological methods. Campylobacter could be isolated from breast meat samples from 42% of the flocks. There was limited agreement between Campylobacter results for the three types of samples and weak correlation between the quantitative results for fecal or cecal samples and meat samples. Agreement between the results of LFA and traditional methods was poor. These findings do not support the implementation of “testing and scheduling” as a practical control strategy, because of both measurement uncertainties and shortcomings in understanding the dynamics of transmission and survival of Campylobacter in the broiler meat processing plant. The limited correlation between Campylobacter contamination of cecal samples and breast meat samples, as observed in this study, suggests that cecal samples are no good indicator for human exposure to Campylobacter. [Copyright &y& Elsevier]

Abstract: A low-temperature study of the mechanical behaviour of a metastable semi-austenitic stainless steel was carried out. This class of stainless steels is found to show a characteristic hump followed by softening in their stress–strain curves, especially at low temperatures, much like dynamically recrystallizing steels. Experiments are carried out at sub-zero temperatures to examine this phenomenon. Samples are subjected to various metallographic, X-ray and transmission electron microscopy techniques to identify the evolution of the different phases. The presence of an intermediate phase ε-martensite is detected which might cause a softening in the stress–strain behaviour, comparable with the formation in other low stacking fault energy stainless steels. [Copyright &y& Elsevier]

Abstract: Logical models for quantifying occupational risk owing to fall from height developed under the Workgroup Occupational Risk Model (WORM) project are presented. Sixty four logical models quantifying corresponding occupational risks are developed under the WORM project. The overall objective of quantifying occupational risk through detailed logic models in WORM is twofold: First from a qualitative point of view the model helps in identifying the specific factors that contribute to the risk by outlining the sequence of events that constitute an accident, starting from the undertaking of an activity by a worker to the final undesirable consequence. Second, from a quantitative point of view, a logic model allows for the quantitative assessment of the risk of the particular activity to the workers allowing a rational ordering of the various activities on the basis of quantified risk rather than on, the potentially misleading, number of observed accidents. Furthermore, a quantified detailed logical model allows for the assessment of the relevant contribution of the various factors to the risk enabling this way a rational prioritization of the available risk reducing measures. Fall from height models presented in this paper simulate the logical and stochastic interdependences of the various events involved with the occurrence of a fall and its consequences. Fall from heights logical models consist of two main parts (a) the part incorporating the events preceding the fall consisting mainly of fall preventing measures; and (b) the part incorporating events following the fall and consisting mainly of measures mitigating the effects of the falls or otherwise affecting the consequences of a given fall. Three levels of consequence severity are considered; lethal injuries, non-lethal permanent injuries, and recoverable injuries. A generic logical model developed for quantifying occupational risk is specialized to six particular instances corresponding to six different work related ways of falling from a height, namely falls from ladders, scaffolds, roofs and roof openings, holes in the ground, moveable platforms and falls from non-moving vehicles. Safety measures engineered or procedural aimed at preventing the fall, mitigating the impact of a fall and influencing the consequences of a given impact along with the required data for quantification are presented. As an example preliminary quantification results are presented for the risk of a fall from a movable ladder. [Copyright &y& Elsevier]

Abstract: Each year eighty-five people are killed on the job in the Netherlands and 167,000 are injured to the extent that they are at least a day absent from work. Their death and injuries occur during the approximately seven million person years that the Dutch workforce spend on their job. The ministry of Social Affairs and Employment (SZW) has as one of its main tasks to reduce and control occupational risk. Recently it commissioned a project to determine the risk and its causes following the same principles as used in quantified analyses of the third party risks of nuclear and chemical plants. To this end a model has been constructed: the occupational risk model (ORM). With this model authorities, industries and experts can evaluate the occupational risks for individual workers, for companies and for projects. The project has four major parts: assembly and analysis of accident and exposure data, generalisation of these data into a logical risk model, deriving improvement measures and their costs and developing an optimiser that supports cost effective risk reduction strategies. The model is a further development of previous work executed with support of SZW and the European Union, such as IRISK and AVRIM. This paper describes the concepts used in the model and the overall structure. Some of the results are also given. More detail and more results are given in other papers in this conference. [Copyright &y& Elsevier]

Abstract: The Workgroup Occupational Risk Model (WORM) project in the Netherlands is developing a comprehensive set of scenarios to cover the full range of occupational accidents. The objective is to support companies in their risk analysis and prioritization of prevention. This paper describes how the modeling has developed through projects in the chemical industry, to this one in general industry and how this is planned to develop further in the future to model risk prevention in air transport. The core modeling technique is based on the bowtie, with addition of more explicit modeling of the barriers needed for risk control, the tasks needed to ensure provision, use, monitoring and maintenance of the barriers, and the management resources and tasks required to ensure that these barrier life cycle tasks are carried out effectively. The modeling is moving from a static notion of barriers which can fail, to seeing risk control dynamically as (fallible) means for staying within a safe envelope. The paper shows how concepts develop slowly over a series of projects as a core team works continuously together. It concludes with some results of the WORM project and some indications of how the modeling is raising fundamental questions about the conceptualization of system safety, which need future resolution. [Copyright &y& Elsevier]

Summary: Objective: To create, array, and characterize a pooled, high-coverage, genomic library composed of multiple biofilm-forming clinical strains of the opportunistic pathogen, Pseudomonas aeruginosa (PA). Twelve strains were obtained from patients with otorrhea, otitis media, and cystic fibrosis as a resource for investigating: difference in the transcriptomes of planktonic and biofilm envirovars; the size of the PA supragenome and determining the number of virulence genes available at the population level; and the distributed genome hypothesis. Methods: High molecular weight genomic DNAs from 12 clinical PA strains were individually hydrodynamically sheared to produce mean fragment sizes of ∼1.5kb. Equimolar amounts of the 12 sheared genomic DNAs were then pooled and used in the construction of a genomic library with ∼250,000 clones that was arrayed and subjected to quality control analyses. Results: Restriction endonuclease and sequence analyses of 686 clones picked at random from the library demonstrated that >75% of the clones contained inserts larger than 0.5kb with the desired mean insert size of 1.4kb. Thus, this library provides better than 4.5× coverage for each of the genomes from the 12 components clinical PA isolates. Our sequencing effort (∼1 million nucleotides to date) reveals that 13% of the clones present in this library are not represented in the genome of the reference P. aeruginosa strain PA01. Conclusions: Our data suggests that reliance on a single laboratory strain, such as PA01, as being representative of a pathogenic bacterial species will fail to identify many important genes, and that to obtain a complete picture of complex phenomena, including bacterial pathogenesis and the genetics of biofilm development will require characterization of the P. aeruginosa population-based supra-genome. [Copyright &y& Elsevier]

Summary: Objectives: To identify mucin genes in chinchilla middle ear epithelium and characterize complimentary deoxyribonucleic acid (cDNA) sequences to facilitate further investigations into mucin physiology and pathophysiology on a molecular level using the chinchilla model. Methods: Chinchilla mucin gene exploration and cDNA characterization was accomplished using reverse transcriptase-polymerase chain reactions (RT-PCR). Forward and reverse primer pairs were designed using consensus sequences available for human and rodent species. Chinchilla middle ear epithelium was harvested and primary cell cultures (CMEEC) were established. The CMEEC were explored for the expression of chinchilla mucin genes 1, 2, 4 and 5AC (cMuc1, cMuc2, cMuc4 and cMuc5AC). Identified cDNA amplicons for each of these genes was sequenced and homology compared to previously published human and rodent sequences. Results: CMEEC express all four of the mucin genes cMuc1, cMuc2, cMuc4 and cMuc5AC. cDNA amplicons for each of the genes were able to be sequenced with lengths ranging from 66 to 362 base pairs. Each of the chinchilla cDNA sequences expressed significant homology with published human and rodent cDNA for these mucin genes. A cDNA sequence for the housekeeping gene, β-actin, was also identified. Conclusions: Chinchilla middle ear epithelium grown in culture expresses the mucin genes 1, 2, 4 and 5AC, which have been identified as important in mucin regulation in the middle ear. cDNA sequences corresponding to these mucin genes were identified and may serve as important molecular tools in future studies of otitis media using the chinchilla model. [Copyright &y& Elsevier]

Summary: Objective: Epidermodysplasia verruciformis is a skin disease characterized by abnormal susceptibility to human papilloma viruses. Recently four mutations in the Epidermodysplasia verruciformis 1 gene (EVER1, also known as TMC6) have been associated with the disease. Because of the phenotypic similarity between Epidermodysplasia verruciformis and recurrent respiratory papillomatosis, we decided to investigate whether any of these mutations accounts for the susceptibility to human papilloma viruses in subjects with recurrent respiratory papillomatosis (RRP). Methods: Allele-specific PCR and restriction fragment length polymorphisms (RFLPs) were employed for genotyping a cohort of 101 patients with recurrent respiratory papillomatosis. Results: None of these four mutations were found in the studied subjects. Conclusion: The absence of these mutations in RRP patients might indicate that EVER 1 alleles are not associated with susceptibility to RRP, or that other, as yet unidentified, mutations in the Epidermodysplasia verruciformis 1 gene, might account for the susceptibility to RRP. [Copyright &y& Elsevier]

Context: Otitis media (OM) is the most common reason that a child undergoes a general anesthetic, with the total costs of treating this disease exceeding five billion dollars annually. Concerns regarding the development of antibiotic-resistant organisms in response to medical treatment for OM have fueled the demand for surgical intervention. However, reimbursements are decreasing. Non-traditional settings for children requiring bilateral myringotomy and tube (BMT) placement for ear disease have the potential to offer the same degree of patient safety and improved efficiency but at lower cost. Objective: To develop a non-traditional setting for BMT surgery that is safe, cost effective, and well received by patients, families and staff. Design: Prospective design of an outpatient treatment suite (OTS) for BMT placement; prospective evaluation of safety and family satisfaction; analysis of costs. Setting: A 778 bed US urban area level one trauma center and teaching hospital, with a 2160 ft2 electro-convulsive therapy suite that was underutilized and non-revenue generating on Tuesdays and Thursdays. Participants: A design task force of health care providers, administrators and operations personnel; 794 healthy children between the ages of 6 months to 16 years requiring BMT surgery; 100 families of patients. Main outcome measures: Financial comparison was made between the traditional operating room (OR) setting, the outpatient surgery center (SC) and the OTS comparing overhead and indirect costs to run each site. A prospective survey was conducted of 100 consecutive patients undergoing surgery between November 2000 and June 2001. The survey was conducted at the 2 weeks postoperative check and was composed of 18 questions divided into five sections, with a 5-point rating scheme, with one being very poor, and five being very good. Results: Designing a new treatment venue was successful because of teamwork and a willingness to think creatively. The OTS was found to be far more cost-effective than both the main OR and SC for BMTs. The contribution to margin for the SC was US$ 280 per case and for the main OR was US$ 2130 per case. By operating on 794 patients in OTS, the hospital was able to generate additional contribution to margin of US$ 197,100 when compared to the cost of performing these cases in the SC and US$ 1,499,500 when compared to performing all cases in the main OR. No adverse consequences were noted. Patient/Family satisfaction was also rated very high, with an overall rating of 4.85 and markedly reduced time in hospital. Conclusion: Operating rooms (ORs) today are busier than in years past, but revenues barely meet or in some cases fall below expenses due to insurers’ decreased reimbursement. This innovative approach to BMT placement has been shown to be safe and results in excellent family satisfaction, with a substantial contribution to margin. As over one million BMT cases are performed annually in the US, adoption of this approach nationally has the potential to markedly reduce the treatment costs of this common disease. [Copyright &y& Elsevier]

Haemophilus influenzae is one of the most important respiratory pathogens of man. It has been etiologically associated with otitis media, otorrhea, and chronic obstructive pulmonary disease. Identification of new genomic elements will provide novel targets to fight chronic infections caused by this organism. Objective: The new paradigm that chronic infections are caused by bacterial biofilms prompted us to study the relationship between bacterial pathogenicity, biofilm formation and bacterial communal cooperation. To do this, it is essential to determine the virulence gene sets that are involved in the above processes and whether they are present in every bacterial cell or distributed in a “communal gene-pool”, the distributed genome hypothesis (DGH). We designed, constructed and characterized a highly redundant genomic DNA library comprised of the genomes of ten low passage clinical isolates of H. influenzae carrying large numbers of genes that are not present in the laboratory strains of H. influenzae. Methods: Genomic DNA fragments of the ten clinical strains were hydro-dynamically sheared to produce a mean fragment size of 1.5–2.5 kb. The ten sheared DNAs were than pooled and used in the construction of a genomic library with 76 800 clones. Results: Our restriction endonuclease and sequence analyses of 800 clones demonstrate that 75% of the clones carry an insert larger than 0.5 kb. The library has an ∼1.5 kb average insert size, and therefore, better than 4.5× redundancy for each of the genomes of the ten clinical isolates. Our sequencing effort (∼1 million nucleotides to date) reveals that a high percentage of genes (75 clones, 11% of the 686 sequenced clones) present in this library are not represented in the genome of the reference strain H. influenzae Rd. Conclusions: The library, based on the above results, has a better than 4.5× coverage for each of the ten constituent genomes. On the basis of our preliminary sequencing data (∼1 million nucleotides) the library lacks of highly repeated sequences, therefore, the expected genome coverage (4.5×) is not degraded. Using the prevalence of non-Rd like sequences (11%) detected during characterization of the genomic library, we estimated that the library contains DNA sequences equivalent to ∼2 million bp, which are not represented in the reference genome of the H. influenzae Rd strain and that is greater in size than the genome of this reference strain, providing ample targets for innovative drug design. [Copyright &y& Elsevier]