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There is a significant risk for ongoing and treatment-resistant courses of hepatitis E virus (HEV) infection in patients after solid organ transplantation. The aim of this study was to identify risk factors for the development of hepatitis E, including the dietary habits of patients. We conducted a retrospective single-center study with 59 adult kidney and combined kidney transplant recipients who were diagnosed with HEV infection between 2013 and 2020. The outcomes of HEV infections were analyzed during a median follow-up of 4.3 years. Patients were compared with a control cohort of 251 transplant patients with elevated liver enzymes but without evidence of an HEV infection. Patients’ alimentary exposures during the time before disease onset or diagnosis were assessed. Previous intense immunosuppression, especially treatment with high-dose steroids and rituximab, was a significant risk factor to acquire hepatitis E after solid organ transplantation. Only 11 out of 59 (18.6%) patients reached remission without further ribavirin (RBV) treatment. A total of 48 patients were treated with RBV, of which 19 patients (39.6%) had either viral rebounds after the end of treatment or did not reach viral clearance at all. Higher age (>60 years) and a BMI ≤ 20 kg/m2 were risk factors for RBV treatment failure. Deterioration in kidney function with a drop in eGFR (p = 0.046) and a rise in proteinuria was more common in patients with persistent hepatitis E viremia. HEV infection was associated with the consumption of undercooked pork or pork products prior to infection. Patients also reported processing raw meat with bare hands at home more frequently than the controls. Overall, we showed that the intensity of immunosuppression, higher age, a low BMI and the consumption of undercooked pork meat correlated with the development of hepatitis E.

Women of childbearing age show increased fertility after kidney transplantation. Of concern, preeclampsia, preterm delivery, and allograft dysfunction contribute to maternal and perinatal morbidity and mortality. We performed a retrospective single-center study, including 40 women with post-transplant pregnancies after single or combined pancreas–kidney transplantation between 2003 and 2019. Outcomes of kidney function up to 24 months after the end of pregnancy were compared with a matched-pair cohort of 40 transplanted patients without pregnancies. With a maternal survival rate of 100%, 39 out of 46 pregnancies ended up with a live-born baby. The eGFR slopes to the end of 24 months follow-up showed mean eGFR declines in both groups (−5.4 ± 14.3 mL/min in pregnant versus −7.6 ± 14.1 mL/min in controls). We identified 18 women with adverse pregnancy events, defined as preeclampsia with severe end-organ dysfunction. An impaired hyperfiltration during pregnancy was a significant risk contributor for both adverse pregnancy events (p < 0.05) and deterioration of kidney function (p < 0.01). In addition, a declining renal allograft function in the year before pregnancy was a negative predictor of worsening allograft function after 24 months of follow-up. No increased frequency of de novo donor-specific antibodies after delivery could be detected. Overall, pregnancies in women after kidney transplantation showed good allograft and maternal outcomes.

Use of head-mounted displays (HMDs) and hand-held displays (HHDs) may affect the effectiveness of stability control mechanisms and impair resistance to falls. This study aimed to examine whether the ability to control stability during locomotion is diminished while using HMDs and HHDs. Fourteen healthy adults (21–46 years) were assessed under single-task (no display) and dual-task (spatial 2-n-back presented on the HMD or the HHD) conditions while performing various locomotor tasks. An optical motion capture system and two force plates were used to assess locomotor stability using an inverted pendulum model. For perturbed standing, 57% of the participants were not able to maintain stability by counter-rotation actions when using either display, compared to the single-task condition. Furthermore, around 80% of participants (dual-task) compared to 50% (single-task) showed a negative margin of stability (i.e., an unstable body configuration) during recovery for perturbed walking due to a diminished ability to increase their base of support effectively. However, no evidence was found for HMDs or HHDs affecting stability during unperturbed locomotion. In conclusion, additional cognitive resources required for dual-tasking, using either display, are suggested to result in delayed response execution for perturbed standing and walking, consequently diminishing participants’ ability to use stability control mechanisms effectively and increasing the risk of falls.

Microscopic hematuria is a common feature of patients with Alport syndrome, a familial nephropathy due to mutations in COL4A3, COL4A4 or COL4A5. These genes encode for α3, α4, and α5 type IV collagen polypeptide chains (collagen IV α345), crucial for the structural component of the glomerular basement membrane. Even patients with mild phenotype, namely isolated microhematuria (X-linked females with thin basement membrane on electron microscopy or heterozygous carriers of COL4A3 or COL4A4 mutations), can potentially progress to proteinuria and to end-stage renal disease. Recent pedigree analyses provided evidence for digenic inheritance of Alport syndrome by concomitant mutations in COL4A3/COL4A4 or COL4A4/COL4A5. We describe a Caucasian family with concomitant COL4A3 and COL4A5 mutations, consisting of a novel c.4484A>G COL4A3 (p.Gln1495Arg) mutation and a previously reported c.1871G>A COL4A5 (p.Gly624Asp) mutation. Our segregation analysis raises the possibility that Alport syndrome resembles also digenic inheritance by COL4A3/COL4A5.

Human factors and ergonomics (HFE) is challenged by machine and system safety under digital transformation calling for sound solutions suitable for application at the shop floor level. HFE challenges will arise with future human-system interactions referring to dynamics in task design, digitised interaction interfaces, and work system entities interwoven in networks. Work system design, i.e. enclosing operator work task, workplace, equipment and environment, seems promising, especially with prevention through design early in construction of today and tomorrow machinery and technical installations. The Human Factors Group of the ISSA Section Machine and System Safety compiled some design requirements and recommendations available in the given context. The Scientific Symposium is likely to support collection of HFE knowledge available, discussion with HFE experts potentially interested and suggestions for research required to increase HFE contributions to machine and system safety in digital transformation. Contributions from, discussions and cooperation with those interested in HFE and objectives presented are always welcome.

Future work processes in digital transformation include dynamics in task design, digitised interfaces, and work system components interwoven in process chains and networks. This causes challenges for design according to human factors and ergonomics (HFE) and occupational safety and health (OSH) since it goes beyond anthropometry and biomechanics and calls for work system design and compatibility with human information processing. The Human Factors group of the International Prevention Section of the ISSA on Machine and System Safety is compiling HFE design requirements and solutions from international literature and standards at an internet platform to foster machinery and system safety. The platform structure for the Human Factors group is geared to the concept of work system design and already introduces work behavioural issues, work place issues, and work equipment issues. A given sample requirement for interaction interface design illustrates how good practice referring to HFE contributes to machinery and system safety. Compilation of HFE design requirements in the context of digital transformation is a cumbersome endeavour. While some HFE design requirements are available, others lack specifications for application at the shop floor level. Systematic research along work system design could result in differential design requirements regarding human-system interaction under conditions for work equipment, work place and work environment imposed by the work task.

Obstacle avoidance is one of the skills required in coping with challenging situations encountered during walking. This study examined adaptation in gait stability and its interlimb transfer in a virtual obstacle avoidance task. Twelve young adults walked on a treadmill while wearing a virtual reality headset with their body state represented in the virtual environment. At random times, but always at foot touchdown, 50 virtual obstacles of constant size appeared 0.8 m in front of the participant requiring a step over with the right leg. Early, mid and late adaptation phases were investigated by pooling data from trials 1-3, 24-26 and 48-50. One left-leg obstacle appearing after 50 right-leg trials was used to investigate interlimb transfer. Toe clearance and the anteroposterior margin of stability (MoS) at foot touchdown were calculated for the stepping leg. Toe clearance decreased over repeated practice between early and late phases from 0.13 ± 0.05 m to 0.09 ± 0.04 m (mean ± SD, p

Occupational safety and health (OSH) is active at all levels of the hierarchy of controls to prevent accidents associated with slips, trips and falls (STF). Training programs related to STF prevention are increasingly supported by virtual reality (VR) techniques. A review revealed a wide range of applications in practical and scientific areas. Trainings for operational practice vary regarding objectives, target groups, application contexts, media, and effectiveness, if available. Trainings in scientific studies are well designed for specific purposes at hand, but not suitable for direct application in operational practice. Research is required to bridge the gap. An investigation on gait stability and control in a VR-based obstacle avoidance training scenario has been conducted to contribute to developments in STF prevention. Initial results indicated a high level of presence and no evidence for detrimental effects on body and gait stability through application of VR techniques. This provides a sound basis for analysis of other data still required and for guiding similar and subsequent studies along knowledge gained by training programs available.

Kritische Ereignisse in verfahrenstechnischen Anlagen konnen mit schwerwiegenden Konsequenzen fur das Unternehmen, die Beschaftigten, die (unmittelbare) Bevolkerung und die Umwelt verbunden sein. Ergonomisch schlecht gestaltete Alarmsysteme und ein unzureichendes Alarmmanagement trugen vorliegenden Untersuchungsberichten zufolge mitunter zu deren Entstehen bei. In einem Forschungsprojekt wurden daher Alarmsysteme und Alarmmanagements in Leitwarten unterschiedlicher Branchen mithilfe einer rechnergestutzten Checkliste untersucht. Zur Datenerhebung wurden verschiedene Methoden, wie Beobachtung, Sichtprufung, Schalldruckpegelmessungen, Befragung von Leitwartenoperateuren und Fuhrungskraften sowie Dokumentenprufung, angewandt. Die Ergebnisse zeigen Unterschiede in der Gestaltungsgute der untersuchten Alarmsysteme und der Alarmmanagements. In allen untersuchten Leitwarten liesen sich Gestaltungsdefizite ausmachen. Viele Anforderungen und Empfehlungen an die ergonomische Gestaltung aus Normen, Leitlinien und Fachliteratur waren in den Leitwarten nicht umgesetzt. Die Ergebnisse weisen auf Losungsansatze hin, die zu einem hoheren Niveau der ergonomischen Gestaltungsqualitat beitragen konnen. Praktische Relevanz Alarmsystem und Alarmmanagement sind bedeutende Elemente im Sicherheitskonzept von verfahrenstechnischen Anlagen. Ergonomisch gut gestaltete Systeme tragen zur Aufrechterhaltung des sicheren Zustandes einer Anlage bei, wahrend Gestaltungsdefizite bei der Entstehung, Entwicklung und der Schwere von Vorfallen eine wichtige Rolle spielen konnen. Die vorliegende Untersuchung zeigt, dass jedes der untersuchten Systeme Gestaltungsdefizite und Verletzungen von ergonomischen und normativen Vorgaben aufwies. Die Ergebnisse lassen ferner Ansatze fur verbesserte Gestaltungslosungen erkennen, um einen hoheren Sicherheitsstandard zu erreichen.

Human–robot collaboration (HRC) is characterized by a spatiotemporal overlap between the workspaces of the human and the robot and has become a viable option in manufacturing and other industries. However, for companies considering employing HRC it remains unclear how best to configure such a setup, because empirical evidence on human factors requirements remains inconclusive. As robots execute movements at high levels of automation, they adapt their speed and movement path to situational demands. This study therefore experimentally investigated the effects of movement speed and path predictability of an industrial collaborating robot on the human operator. Participants completed tasks together with a robot in an industrial workplace simulated in virtual reality. A lower level of predictability was associated with a loss in task performance, while faster movements resulted in higher-rated values for task load and anxiety, indicating demands on the operator exceeding the optimum. Implications for productivity and safety and possible advancements in HRC workplaces are discussed.

The Human-System Interaction (HSI) approach focuses on analysis, design, and evaluation of work systems for humans to interact with technical systems ergonomically designed for human use. An initial framework is developed for human factors and ergonomics (HFE) design requirements with regard to occupational safety and health (OSH). The framework refers to concept, criteria and intended user populations in work systems design. Some future work systems in industry 4.0 and cyber-physical systems call for emphasising human information processing with interchange of information variable and dynamic in quantity, quality and time. Taking into account new solutions and challenges in digital manufacturing, selected requirements, explanations, examples and references should inform manufacturers and health and safety experts at the shop floor level about HFE and OSH. Information presented at an internet platform, should assist in how to integrate these factors into construction of machinery or other technical installations, in workplace, equipment and software design and for practical use in HSI.

In future work systems, humans may interact with scalable industrial robots. In a virtual reality simulation study, human mental workload effects were analyzed in human-robot interactions (HRI) with variations in design requirements regarding human factors and ergonomics (HFE) as well as occupational safety and health (OSH). Each of 20 participants performed his/her own task while interacting with two virtual robots in a manufacturing environment. Results on task performance indicated relative lower human mental workload when robots acted on lower level of robot autonomy (lower LORA) and the human operator was informed about upcoming HRI by multi-modal signaling (Information Aid ‘on’). However, this pattern of workload reflected in performance measures, was not reflected in mental workload ratings. Hence, compensational adjustments in operator performance were assumed. It was concluded, that a combination of less autonomous robots and multi-modal feedback result in relatively less operator distraction from task performance and, thus, less impairment in operator workload. HFE and OSH may improve when HRI is audio-visually indicated and robot activities are adapted to human operator task requirements (low LORA). Therefore, results have the potential to inform future design of HRI regarding HFE and OSH at different workplaces in industry and services.

The aim of the project is to develop and evaluate a training environment for the prevention of falls with the help of an application in virtual reality (VR). The participants of our study walk on a treadmill with fall protection while immersing into a virtual scenario where they should cross virtual obstacles. Potential parameters reflecting the plasticity of the neuromotor system are investigated in order to search for possible learning effects and their stabilization. In addition, it will be determined how many perturbations (i.e. obstacles) are necessary to establish a learning process. The results will be used to check the experimental setup and to prepare a main study for the development of a training program that helps preventing slip, trip, and fall (STF) accidents using a VR environment. So far two pilot measurements have been completed and parameters that may indicate learning effects were calculated. Initial results do not reveal clear learning effects, however, they inform about relevant adjustments for setting up systematic investigations and provide important details about strategies for data acquisition and analysis.

A study dealing with human factors and ergonomics in the design of alarm systems and alarm management in the process industries was conducted at 15 workplaces for control room operators across different branches of industry in Germany. The results show that none of the systems under investigation fulfilled all the design recommendations derived from relevant literature, guidelines or standards. Thus, the results indicate an increased risk potential for incidents. Need for action to improve alarm systems and alarm management has, inter alia, been found particularly necessary with regard to alarm prioritization, consideration of operator performance limits, instructions on alarm handling and system support, continuous improvement processes as well as systematic training concepts and operator training concerning the alarm system and alarm handling. Results also suggest that there is still a lack of design improvements, as has already been documented in former research reports on critical incidents.

With future work systems becoming more interactive, dynamic, and flexible, occupational safety and health (OSH) calls for prospective assessments of hazards and risks to facilitate prevention through design. German river locks for inland waterways will be composed of standardised objects representing a high level of OSH. A research project aimed at conducting risk assessments of river locks of the future; early in their planning stage, with standardised objects and referring to different EU Directives addressing safety and health at work. About 150 work scenarios across operational states and variations in river lock standardisation have been compiled and supplemented for instructing risk assessments. They also conveyed design requirements for setting up dynamic virtual reality (VR) planning models in future contexts of use. Initial feedback about VR simulation use for scenario-based risk assessments is positive and a design review suggested minor adjustments before risk assessments can be conducted that should facilitate OSH improvements and templates for future assessments. The project motivates applications in similar contexts.

The International Social Security Association (ISSA) Section for Prevention of Occupational Risks in Machine and System Safety established a working group on Human Factors, Ergonomics and Safe Machines for reviewing, selecting and presenting design requirements and recommendations according to occupational safety and health (OSH) and human factors and ergonomics (HFE). An internet platform will inform, motivate and support machinery manufacturers, users and OSH experts to apply OSH and HFE when constructing, risk assessing, setting-up and operating machinery. Concepts like hierarchy of controls and work system design guide along relevant issues. Besides traditional approaches a special emphasis is given to smart manufacturing calling for design solutions for human-system interaction according to OSH and HFE.

BACKGROUND Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) DNA in serum and/or liver in HBsAg-negative patients. We investigated the prevalence of OBI in large chronic haemodialysis (CHD) and kidney transplant recipients (KTxR) cohorts, including determination of HBV DNA in peripheral blood mononuclear cells (PBMCs). METHODS HBV DNA was determined in both serum and PBMCs in 417 CHD patients, 417 KTxR, 20 HBsAg-positive non-CHD non-KTx patients (positive controls) and 40 HBsAg-negative healthy subjects (negative controls). RESULTS Chronic haemodialysis group: two of 376 patients were HBsAg-positive. The 374 HBsAg-negative patients tested negative for HBV DNA in both serum and PBMCs. KTxR group: 14 of 417 patients were HBsAg-positive. One of 403 HBsAg-negative patients tested positive for HBV DNA in serum but not in PBMCs. Positive controls: six of 20 patients were under antiviral therapy and had negative HBV DNA in both serum and PBMCs. In 11 of 14 remaining patients, HBV DNA was detected in serum and in both serum and PBMCs in 3 patients. Negative controls: All 34 patients were anti-HBc-negative and HBV DNA-negative in both serum and PBMCs. In the long term, the only case of anti-HBc-negative OBI lost anti-HBs 5 years after inclusion in the study and showed HBV reactivation with HBsAg re-seroconversion. CONCLUSIONS We found nil prevalence of OBI in CHD patients and a very low prevalence (

Interactions between humans and system components of future work systems may be driven by digitalization, connectivity and agility. Though the design of future systems is not yet known or is not yet available or accessible, it would be desirable to ensure occupational safety and health (OSH) in early stages of development and design. It would also be helpful to learn about potential hazards and risks and prevent them before using work systems across their future life cycle. Since knowledge, experience and imagination might not be sufficient to predict human-system interactions (HSI) it should be possible to apply modeling and simulation such as virtual reality (VR) to overcome some of the challenges in analysis, design and evaluation of future work systems. Similar seems to be true for work systems too dangerous, too complex, or too resource demanding to investigate in reality. The concept on safety and usability through applications in virtual environments (SUTAVE) facilitates effective prevention through design in OSH to be addressed by means of innovative technology. Studies have been conducted to improve OSH in HSI supported by VR simulation; i.e. (a) risk assessments in planning stage, (b) task, interaction and information design in human robot interaction, (c) usability evaluation of safety measures in contexts of use, (d) near misses and course of events in accident investigations, (e) safety concept development. The results are encouraging to face future challenges in HSI as long as its design is taken into account early on and according to human factors and ergonomics principles.

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection diagnosed in immunocompromized patients. After solid organ transplantation, early infection has decreased as a result of effective prophylaxis, but late infections and even outbreaks caused by interpatient transmission of pneumocystis by air are present in the SOT community. Different risk factors for PJP have been described and several indications for PJP prophylaxis have to be considered by clinicians in patients even years after transplantation. Diagnosis of PJP is confirmed by microscopy and immunofluorescence staining of bronchial fluid but PCR as well as serum s-D-Glucan analysis have become increasingly valuable diagnostic tools. Treatment of choice is Trimethoprim/sulfamethoxazole and early treatment improves prognosis. However, mortality of PJP in solid organ transplant patients is still high and many aspects including the optimal management of immunosuppression during PJP treatment require further investigations.

This paper reports results of a study dealing with the ergonomic design quality of the alarm system and alarm management in 15 process control systems from different sectors of industrial production. Based on available guidelines and ergonomic evidence, a checklist was designed and applied to these systems to test for compliance with these guidelines. The results show that there is a great deal of non-compliance with the requirements, leading to severe impairments of process safety. The main areas of design deficiencies have been found in the lack of prioritization of alarms, a lack of action guides in the presentation of alarms, lack of continuous improvement of the alarm system, a lack of systematic training concepts and training of alarm handling. Feeding back the results to the companies involved clearly showed that they were looking for help in dealing with these problems.

In the past, poorly designed alarm systems and inadequate alarm management contributed to the emergence of critical events with partially serious consequences. Based on the experience gained from these incidents, guidelines were created with recommendations for the design of alarm systems and alarm management. A comprehensive checklist has been developed to analyze the current design quality of alarm systems and alarm management and has been used in various control rooms across different branches of industry in Germany. Using the checklist, design deficiencies can be identified and action needs can be derived. So far, the results also show systematic differences in the application of the checklist between individual assessors and between groups of assessors.

Trimethoprim/sulfamethoxazole (TMP/SMX) is considered first-line therapy for pneumocystis jiroveci pneumonia (PCP) in renal transplant patients. Alternatives have not been formally studied. Clindamycin–primaquine (C–P) is effective in HIV-associated PCP, but data in renal transplant patients are lacking. Retrospective cohort study of 57 consecutive renal transplant patients who developed PCP and were treated with C–P (n = 23) or TMP/SMX (n = 34). A non-significantly higher failure rate was observed in patients on C–P due to lack of efficacy (30.4 versus 20.6 %, p = 0.545). The difference was more pronounced in severe PCP (60 versus 37.5 %, p = 0.611) and a significantly lower efficacy of C–P was seen when used as salvage therapy. The two patients who had received C–P after not responding to TMP/SMX failed this regimen, but all seven patients who had failed initial treatment with C–P and had been switched to TMP/SMX were cured (p = 0.028). No treatment-limiting adverse reactions were reported for patients on C–P while six patients (17.6 %) on TMP/SMX developed possibly related treatment-limiting toxicity (p = 0.071). However, in only two patients adverse events were definitely related to TMP/SMX (5.9 %). Clindamycin–primaquine appears to be safe and well tolerated for treating PCP in renal transplant patients but is probably less effective than TMP/SMX, the standard regimen. However, our data indicates that C–P represents an acceptable alternative for patients with contraindications or treatment emergent toxicities during TMP/SMX use. Notably, TMP/SMX was also acceptably tolerated in most patients. TMP/SMX remains an effective salvage regimen in case of C–P failure.

Renal transplant recipients (RTR) are considered at high risk for influenza-associated complications due to immunosuppression. The efficacy of standard influenza vaccination in RTRs is unclear. Hence, we evaluated activation of the adaptive immunity by the pandemic influenza A(H1N1) 2009 (A(H1N1)pdm09) vaccine in RTRs as compared to healthy controls. To determine cross-reactivity and/or bystander activation, seasonal trivalent influenza vaccine and tetanus/diphteria toxoid (TT/DT) vaccine-specific T cells along with allospecific T cells were quantified before and after A(H1N1)pdm09 vaccination. Vaccination-induced alloimmunity was additionally determined by quantifying serum creatinine and proinflammatory protein IP-10. Contrary to healthy controls, RTRs required a booster vaccination to achieve seroconversion (13.3 % day 21; 90 % day 90). In contrast to humoral immunity, sufficient A(H1N1)pdm09-specific T-cell responses were mounted in RTRs already after the first immunization with a magnitude comparable with healthy controls. Interestingly, vaccination simultaneously boosted T cells reacting to seasonal flu but not to TT/DT, suggesting cross-activation. No alloimmune effects were recorded. In conclusion, protective antibody responses required booster vaccination. However, sufficient cellular immunity is established already after the first vaccination, demonstrating differential kinetics of humoral and cellular immunity.