Simulation of Autonomic Logistics System (ALS) Sortie Generation

The Air Force needs tools for analysis and evaluation of new logistic operational concepts. The purpose of this research was to conflict a discrete event simulation model of the aircraft sortie generation process to permit what-if analyses of these concepts. The current Air Force logistics operations system is reactive in nature meaning that after the aircraft detects a part failure, the maintenance person must perform fault isolation procedures and then steps are taken to repair or replace the faulty item. The Autonomic Logistics System (ALS) concept changes the reactive process into a proactive one with the employment of technologies such as prognostics and distributed information network. Certain logistics tasks can be handled automatically or autonomously i.e. ordering parts, requesting maintenance specialists, and notifying maintenance control center. The conclusion of this research was that an aircraft equipped with the ALS increased the measures of effectiveness (MOE) like mission capable rate and flying scheduling effectiveness tip to a point. The research indicated that as ALS false alarms grew these MOEs decreased and eventually were worse than the baseline system. However, it is worth noting that this research simulated a worst case false alarm scenario, a part removal and replacement with each false alarm

Immunological Adaptations to Pregnancy in Women with Type 1 Diabetes

Despite adequate glycemic control, pregnancy outcome of women with type 1 diabetes (T1D) is still unfavorable as compared to healthy women. In a rat-model of T1D under normoglycemic conditions, adverse pregnancy outcome was also observed, which was associated with aberrant immunological adaptations to pregnancy. Because similar processes may occur in women with T1D we studied the systemic immune response in non-pregnant and pregnant women with and without T1D. The systemic immune response was assessed by using flow cytometry to evaluate the number and activational status of subpopulations of lymphocytes, Natural Killer cells and monocytes in peripheral blood of non-pregnant and pregnant women with and without T1D. An increased white blood cell count, an increased Th1/Th2 ratio, increased Natural Killer cell expression of CD335 and enhanced activation of intermediate and non-classical monocytes was observed in pregnant women with T1D vs. healthy pregnant women. Also, the pregnancy outcome (i.e. incidence of preterm delivery and macrosomia) of women with T1D was unfavorable as compared to healthy women. This study showed that in T1D, the immunological adaptations to pregnancy are disturbed. In addition to hyperglycemia, these different immunological adaptations may be responsible for the greater frequency of complications in pregnant women with T1D

Structure-Specific Fermentation of Galacto-Oligosaccharides, Isomalto-Oligosaccharides and Isomalto/Malto-Polysaccharides by Infant Fecal Microbiota and Impact on Dendritic Cell Cytokine Responses

SCOPE: Next to galacto-oligosaccharides (GOS), starch-derived isomalto-oligosaccharide preparation (IMO) and isomalto/malto-polysaccharides (IMMP) could potentially be used as prebiotics in infant formulas. However, it remains largely unknown how the specific molecular structures of these non-digestible carbohydrates (NDCs) impact fermentability and immune responses in infants. METHODS AND RESULTS: In vitro fermentation of GOS, IMO and IMMP using infant fecal inoculum of 2- and 8-week-old infants showed that only GOS and IMO were fermented by infant fecal microbiota. The degradation of GOS and IMO coincided with an increase in Bifidobacterium and production of acetate and lactate, which was more pronounced with GOS. Individual isomers with an (1↔1)-linkage or di-substituted reducing terminal glucose residue were more resistant to fermentation. GOS, IMO and IMMP fermentation digesta attenuated cytokine profiles in immature dendritic cells (DCs), but the extent was dependent on the infants age and NDC structure. CONCLUSION: The IMO preparation, containing reducing and non-reducing isomers, showed similar fermentation patterns as GOS in fecal microbiota of 2-week-old infants. Knowledge obtained on the substrate specificities of infant fecal microbiota and the subsequent regulatory effects of GOS, IMO and IMMP on DC responses might contribute to the design of tailored NDC mixtures for infants of different age groups. This article is protected by copyright. All rights reserved

Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651]

<p>Abstract</p> <p>Background</p> <p>Chronic low back pain (LBP) is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW) is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW.</p> <p>The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP.</p> <p>Methods/Design</p> <p>The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands). Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6, and 12 months later. All statistical analysis will be performed according to the intension-to-treat principle.</p> <p>Discussion</p> <p>Usual care of primary and outpatient health services isn't directly aimed at RTW, therefor it is desirable to look for care which is aimed at RTW. Research shows that several occupational interventions in primary care are aimed at RTW. They have shown a significant reduction of sick leave for employee with LBP. If a comparable reduction of sick leave duration of patients with chronic LBP of who attend an outpatient clinic can be achieved, such reductions will be obviously substantial for the Netherlands and will have a considerable impact.</p> <p>Trial registration</p> <p>ISRCTN28478651</p

An representative example of a FACS analysis procedure to evaluate lymphocytes subpopulations.

<p>[A] A forward/sideward (FSC/SSC) scatterplot of all events in which leukocytes were identified. [B] The leukocyte gate was copied to a FSC/SSC scatterplot in which the lymphocytes are identified. [C] These lymphocytes are copied to a SSC/CD3-PerCP scatterplot to distinguish T-lymphocytes (CD3⁺). [D] The lymphocytes are further divided into helper (CD3⁺/CD4⁺) and cytotoxic (CD3^+/CD4⁺; ct) T-cells in a CD3 PerCP/CD4 Alexa 700 scatterplot. [E] A CD3 PerCP/CD25 FITC scatterplot in which CD3⁻ cells were copied to assess the gate for FITC-positivity. [F] This gate for FITC positivity was copied to a CD4 Alexa 700/CD25 FITC scatterplot to identify CD25 positive and negative cells; i.e. effector (CD3⁺/CD4⁺/CD25⁺) and naive helper T-cells (CD3⁺/CD4⁺/CD25⁻). [G] A CD25 FITC/FoxP3 Alexa 647 scatterplot to identify the regulatory T-cell (CD3⁺/CD4⁺/CD25⁺/FoxP3⁺; Treg) positive population.</p

Lymphocyte subpopulations in non-pregnant rats.

<p>[A] The percentages of T-lymphocytes (of the total leukocyte population), the ratio of T-helper cells (Th) and cytotoxic T-cells (Tc), percentages effector T-cells (of Th; Teff), regulatory T-cells (of Th; Treg), NK-cells (of total lymphocyte population) and the ratio of MFI CD161a/NKR-P1b of NK-cells of the three non-pregnant rat-strains. [B] The Th1/Th2-mRNA ratio and mRNA expression of ROR-C of the three non-pregnant rat-strains. Values are expressed as median with range (Q₁–Q₃), mRNA was expressed as Fold Change (2^∧−ΔCT). ‘*’ significant difference, Mann-Whitney U-Test, p<0.05.</p

Monocyte subpopulations in pregnant rats.

<p>Values of day 10 or 18 of pregnancy are recalculated regarding the median values of non-pregnant animals (which was set at 100%) to express (as median (Q₁–Q₃)) pregnancy-induced changes. [A] The adaptations to pregnancy in the ratio non-classical/classical monocytes, [B] the percentage of CD4⁺ classical monocytes, [C] the MFI of CD4 on classical monocytes, [D] the percentage of CD4⁺ non-classical monocytes and [E] the MFI of CD4 on non-classical monocytes of each strain during pregnancy. d10/d18: day 10 or 18 of pregnancy. ∞slope significantly different from zero (Regression-analysis, ANCOVA, p<0.05). *slope significant different between the marked strains (Regression-analysis, ANCOVA, p<0.05).</p

Lymphocyte subpopulations in pregnant rats.

<p>Values of day 10 or 18 of pregnancy are recalculated regarding the median values of non-pregnant animals (which was set at 100%) to express (as median (Q₁–Q₃)) pregnancy-induced changes. [A] The adaptations to pregnancy in percentage of T-lymphocytes, ratio of T-helper cells (Th) and cytotoxic T-cells (Tc), percentages of effector T-cells (Teff), regulatory T-cells (Treg), NK-cells and the ratio of MFI CD161a/NKR-P1b of NK-cells in all three strains during pregnancy. [B] The adaptations to pregnancy of the Th1/Th2-mRNA ratio and ROR-C mRNA expression in all three strains during pregnancy. d10/d18: day 10 or 18 of pregnancy. ∞slope significantly different from zero (Regression-analysis, ANCOVA, p<0.05). *slope significant different between the marked strains (Regression-analysis, ANCOVA, p<0.05).</p