Managing the Pre- and Post-analytical Phases of the Total Testing Process

For many years, the clinical laboratory's focus on analytical quality has resulted in an error rate of 4-5 sigma, which surpasses most other areas in healthcare. However, greater appreciation of the prevalence of errors in the pre- and post-analytical phases and their potential for patient harm has led to increasing requirements for laboratories to take greater responsibility for activities outside their immediate control. Accreditation bodies such as the Joint Commission International (JCI) and the College of American Pathologists (CAP) now require clear and effective procedures for patient/sample identification and communication of critical results. There are a variety of free on-line resources available to aid in managing the extra-analytical phase and the recent publication of quality indicators and proposed performance levels by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) working group on laboratory errors and patient safety provides particularly useful benchmarking data. Managing the extra-laboratory phase of the total testing cycle is the next challenge for laboratory medicine. By building on its existing quality management expertise, quantitative scientific background and familiarity with information technology, the clinical laboratory is well suited to play a greater role in reducing errors and improving patient safety outside the confines of the laboratory

Evaluation of feet measurements of industrial workers by using a 3D-scan with special regard to foot deformities

Arbeitsschuhe stellen die mit Abstand am häufigsten getragenen Schuhe eines Industriearbeiters dar, weshalb es gerade bei diesen Schuhen wichtig ist, dass eine optimale Passform gewährleistet ist. In der vorliegenden Studie wurden bei 517 männlichen Industriearbeitern mit einer neuartigen Meßmethode, einem 3D-Scanner („Pedus 3D Foot Scanner“, Fa. Human Solutions GmbH), Fußvermessungen durchgeführt. Analog der Fußvermessung erfolgten auch Messungen an den für die Arbeitsschuhherstellung verwendeten Leisten, um einen entsprechenden Vergleich durchführen zu können. Anhand einer Evaluierung der gewonnenen Fußmaße konnte gezeigt werden, dass es mit einem einzigen Modell pro Fußweite und Schuhgröße nicht möglich ist, dem Anspruch gerecht zu werden, jedem Arbeiter optimal passende Sicherheitsschuhe anbieten zu können. Bei einer Vielzahl an Fußmaßen einer Schuhgröße variieren die Maße teils erheblich. Die Fußtypisierung mit Hilfe einer Clusteranalyse ergab, dass zwischen 3 Typen mit unterschiedlicher Ballenbreite, Ballen- bzw. Zehenlänge, Ballenwinkel und Fersenbreite unterschieden werden muss. Der Vergleich dieser Fußtypen mit den im Sicherheitsschuhbau eingesetzten Leisten zeigt die Defizite in der Passform auf. Eine zu große Ballenlänge, ein zu flacher Ballenwinkel und eine zu schmale Ballenbreite engen die Füße im Vorfußbereich ein und behindern das natürliche Abrollverhalten der Füße. Mit einer zusätzlichen klinischen Untersuchung der Füße konnten die Auswirkungen unpassenden Schuhwerks bestätigt werden. Schwielenbildung an der Großzehe bei knapp 50% und an der Kleinzehe bei knapp 30% aller Untersuchten und ein Hallux-valgus-Anteil von über 26% machen einen Zusammenhang mit zu engem Schuhwerk sehr wahrscheinlich. Häufig konnten auch weitere Fußfehlstellungen wie Spreizfüße, Knick-Senkfüße und Hohlfüße nachgewiesen werden. Neben zu engem Schuhwerk zeigten sich auch andere Entstehungsmechanismen bzw. Risikofaktoren für derartige Fehlstellungen. So besteht die Arbeit in großen Industriebetrieben weitgehend aus Arbeit im Stehen, was in Kombination mit zu engem Schuhwerk die Atrophie der Fußlängs- und Quermuskulatur begünstigt. Hinzu kommt, dass weit über die Hälfte aller Arbeiter mit einem BMI von mehr als 25 kg/m2 übergewichtig ist. Um das Entstehen und das Fortschreiten von Fußbeschwerden und Fußfehlstellungen effektiv verhindern zu können, bedarf es sowohl einer Verbesserung der Schuhpassform vor allem im Vorfußbereich als auch einer Optimierung des Arbeitsplatzes hin zu ergonomischeren Bewegungsformen mit häufigeren Gehphasen und rückenschonenderen Haltungsformen.Safety shoes are the most carried shoes of industrial workers. So it is important especially for these shoes to have a perfect fit. In the present study a measurement of feet was carried out in 517 male industrial workers by using a new method of measurement- a 3D-scanner („Pedus 3D Foot Scanner“, Fa. Human Solutions GmbH). Corresponding to the measurement of feet , measurements of the lasts that are used for the production of safety shoes were performed in order to have a possibility of comparison.On the basis of the evaluation of the feet measurements it could be showed, that it is not possible to offer each industrial worker an individual safety shoe with a perfect fit using only a single shoe type per footwidth and footsize. The measurements per category of shoe size diversify partial enormally. Foot typing by means of a cluster analysis showed a need to differ between three types of different ball width, ball- and toe length, angular position of the ball of the foot and heel width. The comparison of these types of feet with the shoe lasts which are used for shaping safety shoes showed a strong deficiency of the fit. A ball length that is too long, an angular position of the ball of the foot that is too flat and a ball width that is too small cramp the feet in the forefoot position and constrict the physical scrolling of the feet. Based on an additionally performed clinical exploration the effects of unfitting shoeware could be confirmed. Keratosis of the great toe in 50% and of the little toe in 30% and a part of more than 26% of hallux valgus in all tested persons point at a cause in unfitting shoeware. Further other foot deformities like splayfeet, skew- and flat feet and high-arched feet could be detected frequently. Among close-fitting shoeware additional reasons and risks for developing these deformities were found. So work in industrial companies has mostly be performed in an upright position which favours in combination with unfitting shoes the atrophy of the long and square muscles of the foot. Additionally, more than half of all tested persons presented themselves overweighted with a body mass index of more than 25 kg/m2. To lower the development and the progression of the disorders und deformities of the feet it needs both an enhancement of the fit of shoes especially in the position of the forefoot and an improvement of the workplace to more ergonomic movements with more possibilities to walk and backsaving positions

Energy neutral neighbourhoods

The building sector accounts for 30% of the total energy consumption worldwide, which has a large potential for improvement in energy demand (OECD/IEA, 2015). In the Netherlands a large part of the building stock are existing houses and that eventually need to be transformed to become energy neutral. The scale of the neighbourhood makes it possible to bring inhabitants, the city and building level together. Not only electricity, heating and cooling demand is considered in this research, also transport is regarded as an important energy consumer of households. Energy demand can be reduced by improving energy performance of the buildings with measures such as insulation. Modern technologies such as electric vehicles and heat pumps, make it possible to move away from petrol and gas, which could decrease the annual energy demand significantly. Most of the current electricity is centrally produced in a power plant. Energy from renewable sources can be produced on‐site. Due to the intermittent character of local renewable energy generation, the stress on the grid could increase (Koch, Girard, & McKoen, 2012). Local grid problems can be prevented by introducing a microgrid (Ustun, Ozansoy, & Zayegh, 2011). A microgrid makes it possible to match distributed energy generation with local demands. The electrification of technologies such as heat pumps and electric vehicles can cause increasing peak demands on the electricity grid. This will result in more interconnection between the heating, transport and electricity sector among other things. Using an integral approach, the relationship between the built environment and energy sector was explored in this research. It was shown that the primary energy demand in the case study neighbourhood in Rotterdam could be reduced with 45% with measures such as strong insulation, heat pumps, solar panels and electric vehicles. In the worst case scenario this would lead to an increase in peak demand of 4.1 times the current situation. By improving the physical design variables in the built environment, this peak demand was reduced with 40%, which is 2.6 times the peak demand of the current situation.Electrical Engineering, Mathematics and Computer ScienceElectrical Sustainable EnergySustainable Energy Technolog

Hepatitis C Virus Quantitation: Optimization of Strategies for Detecting Low-Level Viremia

A long-term assessment of quantitative hepatitis C virus (HCV) testing was performed at the University of Pittsburgh Medical Center. The Quantiplex HCV RNA 2.0 branched-chain DNA (bDNA) assay (Bayer Diagnostics) for hepatitis C viral load determination was used to test 3,471 specimens. bDNA-negative samples were also tested by an in-house qualitative reverse transcriptase (RT)-PCR assay with a measured sensitivity of fewer than 100 HCV genome equivalents per milliliter. Of 1,239 bDNA-negative specimens, 74.1% were negative and 25.9% were positive by RT-PCR, indicating the presence of viremia in a significant proportion of bDNA-negative samples. We discuss the medical and economic implications of these results and propose two alternatives for clinical laboratories to consider in approaching quantitative HCV testing. For laboratories able to perform a sensitive RT-PCR assay for ≤40% of the bDNA test cost, prescreening bDNA requests by RT-PCR may be the most cost-effective approach