A solution approach for deriving alternative fuel station infrastructure requirements

When an alternative fuel is introduced, the infrastructure through which that fuel is made available to the market is often underdeveloped. Transportation service providers relying on such infrastructures are unlikely to adopt alternative fuel vehicles as it may impose long detours for refueling. In this paper, we design and apply a new solution approach to derive minimum infrastructure requirements, in terms of the number of alternative fuel stations. The effectiveness of our approach is demonstrated by applying it to the case of introducing liquefied natural gas (LNG) as a transportation fuel in The Netherlands. From this case, we learn that, depending on the driving range of the LNG trucks and the size of area on which those trucks operate, a minimum of 5-12 LNG fuel stations is necessary to render LNG trucks economically and environmentally beneficial

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Lines of curvature for polyp detection in virtual colonoscopy

Computer-aided diagnosis (CAD) is a helpful addition to laborious visual inspection for preselection of suspected colonic polyps in virtual colonoscopy. Most of the previous work on automatic polyp detection makes use of indicators based on the scalar curvature of the colon wall and can result in many false-positive detections. Our work tries to reduce the number of false-positive detections in the preselection of polyp candidates. Polyp surface shape can be characterized and visualized using lines of curvature. In this paper, we describe techniques for generating and rendering lines of curvature on surfaces and we show that these lines can be used as part of a polyp detection approach. We have adapted existing approaches on explicit triangular surface meshes, and developed a new algorithm on implicit surfaces embedded in 3D volume data. The visualization of shaded colonic surfaces can be enhanced by rendering the derived lines of curvature on these surfaces. Features strongly correlated with true-positive detections were calculated on lines of curvature and used for the polyp candidate selection. We studied the performance of these features on 5 data sets that included 331 pre-detected candidates, of which 50 sites were true polyps. The winding angle had a significant discriminating power for true-positive detections, which was demonstrated by a Wilcoxon rank sum test with p < 0.001. The median winding angle and inter-quartile range (IQR) for true polyps were 7.817 and 6.770 - 9.288 compared to 2.954 and 1.995 - 3.749 for false-positive detection

Classifying CT Image Data Into Material Fractions by a Scale and Rotation Invariant Edge Model

Abstract—A fully automated method is presented to classify 3-D CT data into material fractions. An analytical scale-invariant description relating the data value to derivatives around Gaussian blurred step edges—arch model—is applied to uniquely combine robustness to noise, global signal fluctuations, anisotropic scale, noncubic voxels, and ease of use via a straightforward segmentation of 3-D CT images through material fractions. Projection of noisy data value and derivatives onto the arch yields a robust alternative to the standard computed Gaussian derivatives. This results in a superior precision of the method. The arch-model parameters are derived from a small, but over-determined, set of measurements (data values and derivatives) along a path following the gradient uphill and downhill starting at an edge voxel. The model is first used to identify the expected values of the two pure materials (named and) and thereby classify the boundary. Second, the model is used to approximate the underlying noisefree material fractions for each noisy measurement. An iso-surface of constant material fraction accurately delineates the material boundary in the presence of noise and global signal fluctuations. This approach enables straightforward segmentation of 3-D CT images into objects of interest for computer-aided diagnosis and offers an easy tool for the design of otherwise complicated transfer functions in high-quality visualizations. The method is applied to segment a tooth volume for visualization and digital cleansing for virtual colonoscopy. Index Terms—Anisotropic Gaussian point spread function (PSF), object segmentation, partial volume effect (PVE), transfer function for visualization, voxel classification. I

Lines of Curvature for Polyp Detection in Virtual Colonoscopy

Abstract — Computer-aided diagnosis (CAD) is a helpful addition to laborious visual inspection for preselection of suspected colonic polyps in virtual colonoscopy. Most of the previous work on automatic polyp detection makes use of indicators based on the scalar curvature of the colon wall and can result in many false-positive detections. Our work tries to reduce the number of false-positive detections in the preselection of polyp candidates. Polyp surface shape can be characterized and visualized using lines of curvature. In this paper, we describe techniques for generating and rendering lines of curvature on surfaces and we show that these lines can be used as part of a polyp detection approach. We have adapted existing approaches on explicit triangular surface meshes, and developed a new algorithm on implicit surfaces embedded in 3D volume data. The visualization of shaded colonic surfaces can be enhanced by rendering the derived lines of curvature on these surfaces. Features strongly correlated with true-positive detections were calculated on lines of curvature and used for the polyp candidate selection. We studied the performance of these features on 5 data sets that included 331 pre-detected candidates, of which 50 sites were true polyps. The winding angle had a significant discriminating power for true-positive detections, which was demonstrated by a Wilcoxon rank sum test with p &lt; 0.001. The median winding angle and inter-quartile range (IQR) for true polyps were 7.817 and 6.770 − 9.288 compared to 2.954 and 1.995 − 3.749 for false-positive detections. Index Terms—Medical visualization, virtual colonoscopy, polyp detection, line of curvature, implicit surface.

Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Objective. To study the safety and efficacy of microtransesophageal echocardiography (micro-TEE) and TEE during percutaneous atrial septal defect (ASD) and patent foramen ovale (PFO) closure. Background. TEE has proven to be safe during ASD and PFO closure under general anaesthesia. Micro-TEE makes it possible to perform these procedures under local anaesthesia. We are the first to describe the safety and efficacy of micro-TEE for percutaneous closure. Methods. All consecutive patients who underwent ASD and PFO closure between 2013 and 2018 were included. The periprocedural complications were registered. Residual shunts were diagnosed using transthoracic contrast echocardiography (TTCE). All data were compared between the use of TEE or micro-TEE within the ASD and PFO groups separately. Results. In total, 82 patients underwent ASD closure, 46 patients (49.1 ± 15.0 years) with TEE and 36 patients (47.8 ± 12.1 years) using micro-TEE guidance. Median device diameter was, respectively, 26 mm (range 10–40 mm) and 27 mm (range 10–35 mm). PFO closure was performed in 120 patients, 55 patients (48.6 ± 9.2 years, median device diameter 25 mm, range 23–35 mm) with TEE and 65 patients (mean age 51.0 ± 11.8 years, median device diameter 27 mm, range 23–35 mm) using micro-TEE. There were no major periprocedural complications, especially no device embolizations within all groups. Six months after closure, there was no significant difference in left-to-right shunt after ASD closure and no significant difference in right-to-left shunt after PFO closure using TEE or micro-TEE. Conclusion. Micro-TEE guidance without general anaesthesia during percutaneous ASD and PFO closure is as safe as TEE, without a significant difference in the residual shunt rate after closure