De ware eenvoud vinden : het Oude Testament als object van wetenschap en als bron van inspiratie

Rede uitgesproken bij de aanvaarding van het ambt van hoogleraar Oude Testament aan de Theologische Universiteit van de Protestantse Kerk in Nederland op 3 november 2006 te Kampen

Costs of ownership of ready-to-administer pre-filled sterilized syringes in a Dutch hospital:A cost minimization analysis

Objectives: Preparation errors occur frequently during conventional multiple step preparation of parenteral drugs at the bedside, causing potential adverse drug events (ADEs), which can be a burden to the patient and involves high costs for the national healthcare system. The use of ready-to-administer (RTA) pre-filled sterilized syringes (PFSS) produced by the hospital pharmacy can prevent a significant part of preparation errors and reduces the risk of bacteremia due to contamination of the intravenous fluid. This research aims to compare the total cost of the conventional preparation methods (CPM) with the PFSS method. Methods: In the analysis, costs related to the preparation of the drugs, bacteremia due to contamination, ADEs as a result of medication errors and wastage of syringes were taken into account. Annual costs in a general Dutch hospital were consistently calculated. Three scenarios were investigated: (i) all preparations CPM (864.246 administrations per year); (ii) all preparations as PFSS; and (iii) 200.000 PFSS and the remaining part CPM (reflecting a transition state as currently present). Deterministic and probabilistic analyses are performed. Results: The first scenario shows higher annual costs at € 10.862.609 compared to the second scenario. The current situation (third scenario) already shows savings of € 2.420.545 compared to the old situation (first scenario). Sensitivity analyses revealed that cost savings of PFSS were mainly the result of decreased risks of medication errors and contamination of intravenous fluids. Extrapolating these results nationwide indicates potential savings over € 300 million if only PFSS were used Conclusions: The use of PFSS prepared at the hospital pharmacy yielded cost-savings compared to conventional preparation at the bedside in the Dutch hospital

Macroeconomic Crisis and Individual Firm Performance: The Mexican Experience

This paper considers financial, operational, solvency, and performance ratios, in order to detect when there were balance sheets’ variations related to the 1994 Mexican currency crisis. Quarterly results for 88 non-financial Mexican companies that survived the crisis are used, and tests for structural change are performed. Findings show that generally firms’ balance sheets deteriorated between the fourth quarters of 1993 and 1995, which points the possibility of corporate roots of the macroeconomic crisis. Although in most cases firms’ balance sheets improved after the crisis, the recovery was partial and gradual, and overall this episode was prejudicial even for surviving companies

Optimalisasi Pemberdayaan Masyarakat Desa Melalui Sinergi Program PUAP Dengan Desa Mandiri Pangan

Program pemberdayaan masyarakat yang bertujuan untuk mengentaskan kemiskinan di pedesaan pada prinsipnya memiliki banyak persamaan. Hal ini terlihat pada program PUAP dan Demapan. Adapun persamaannya antara lain : sama-sama berbasis desa, dilaksanakan oleh kelompok masyarakat, mendapatkan modal USAha pertanian dan non pertanian, terbentuknya lembaga keuangan mikro ditingkat desa, dan dibimbing oleh penyuluh dan tenaga pendamping. Dalam pelaksanaannya program tersebut masih banyak mengalami permasalahan dan untuk mengatasinya diperlukan koordinasi dengan cara mensinergikan program PUAP dengan Demapan. Sinergi dan integritasi kedua program mencakup beberapa aspek, yaitu : (1) diawali dengan sinergi data, pemilihan desa penerima program; (2) penataan internal kelembagaan program; (3) pemantapan pengembangan infrastruktur dengan sasaran akselerasi pengentasan kemiskinan; dan (4) antisipasi implementasi sinergi kedua program di lapangan. Dengan mengoptimalkan empat aspek tersebut, diharapkan akselerasi pembangunan pertanian dan ekonomi desa yang mengarah pada pengentasan kemiskinan dapat diwujudkan

Compactness properties of operator multipliers

We continue the study of multidimensional operator multipliers initiated in [arXiv:math/0701645]. We introduce the notion of the symbol of an operator multiplier. We characterise completely compact operator multipliers in terms of their symbol as well as in terms of approximation by finite rank multipliers. We give sufficient conditions for the sets of compact and completely compact multipliers to coincide and characterise the cases where an operator multiplier in the minimal tensor product of two C*-algebras is automatically compact. We give a description of multilinear modular completely compact completely bounded maps defined on the direct product of finitely many copies of the C*-algebra of compact operators in terms of tensor products, generalising results of Saar

Modeling the transboundary risk of feed ingredients contaminated with porcine epidemic diarrhea virus

Citation: Dee, S., Neill, C., Singrey, A., Clement, T., Cochrane, R., Jones, C., . . . Nelson, E. (2016). Modeling the transboundary risk of feed ingredients contaminated with porcine epidemic diarrhea virus. Bmc Veterinary Research, 12, 12. doi:10.1186/s12917-016-0674-zBackground: This study describes a model developed to evaluate the transboundary risk of PEDV-contaminated swine feed ingredients and the effect of two mitigation strategies during a simulated transport event from China to the US. Results: Ingredients imported to the USA from China, including organic & conventional soybeans and meal, lysine hydrochloride, D-L methionine, tryptophan, Vitamins A, D & E, choline, carriers (rice hulls, corn cobs) and feed grade tetracycline, were inoculated with PEDV. Control ingredients, and treatments (ingredients plus a liquid antimicrobial (SalCURB, Kemin Industries (LA) or a 2 % custom medium chain fatty acid blend (MCFA)) were tested. The model ran for 37 days, simulating transport of cargo from Beijing, China to Des Moines, IA, US from December 23, 2012 to January 28, 2013. To mimic conditions on land and sea, historical temperature and percent relative humidity (% RH) data were programmed into an environmental chamber which stored all containers. To evaluate PEDV viability over time, ingredients were organized into 1 of 4 batches of samples, each batch representing a specific segment of transport. Batch 1 (segment 1) simulated transport of contaminated ingredients from manufacturing plants in Beijing (day 1 post-contamination (PC)). Batch 2 (segments 1 and 2) simulated manufacturing and delivery to Shanghai, including time in Anquing terminal awaiting shipment (days 1-8 PC). Batch 3 (segments 1, 2 and 3) represented time in China, the crossing of the Pacific and entry to the US at the San Francisco, CA terminal (day 1-27 PC). Batch 4 (segments 1-4) represented the previous events, including transport to Des Moines, IA (days 1-37 PC). Across control (non-treated) ingredients, viable PEDV was detected in soybean meal (organic and conventional), Vitamin D, lysine hydrochloride and choline chloride. In contrast, viable PEDV was not detected in any samples treated with LA or MCFA. Conclusions: These results demonstrate the ability of PEDV to survive in a subset of feed ingredients using a model simulating shipment from China to the US. This is proof of concept suggesting that contaminated feed ingredients could serve as transboundary risk factors for PEDV, along with the identification of effective mitigation options

Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives

INTRODUCTION: We compared the effects of mechanical ventilation with a lower tidal volume (V(T)) strategy versus those of greater V(T) in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives. METHODS: This is a secondary analysis of a previously conducted before/after intervention study, which consisting of feedback and education on lung protective mechanical ventilation using lower V(T). We evaluated the effects of this intervention on medication prescriptions from days 0 to 28 after admission to our multidisciplinary intensive care unit. RESULTS: Medication prescriptions in 23 patients before and 38 patients after intervention were studied. Of these patients, 10 (44%) and 15 (40%) suffered from ALI/ARDS. The V(T) of ALI/ARDS patients declined from 9.7 ml/kg predicted body weight (PBW) before to 7.8 ml/kg PBW after the intervention (P = 0.007). For patients who did not have ALI/ARDS there was a trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBW (P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither the proportion of patients receiving opioids or sedatives, or prescriptions at individual time points differed between pre-intervention and post-intervention. Also, there were no statistically significant differences in doses of sedatives and opioids. Findings were no different between non-ALI/ARDS patients and ALI/ARDS patients. CONCLUSION: Concerns regarding sedation requirements with use of lower V(T) are unfounded and should not preclude its use in patients with ALI/ARD

Transposition of the tendon of the M. tibialis posterior as an effective operative treatment of a drop foot

Objective. To evaluate the results of transposition of the tendon of the M. tibialis posterior in patients with a drop foot. Design. Descriptive, retrospective and follow-up investigation. Methods. Surgical treatment was carried out in 12 patients with a drop foot (9 women and 3 men, with an average age of 37 years) in the period 1986-1998. The aetiology of the drop foot was a traumatic or iatrogenic lesion of the peroneal nerve or sciatic nerve in 9 patients and in 3 patients spina bifida occulta, leprosy and a herniation of a lumbar disc respectively. None of the patients had important comorbidity. Treatment consisted of lengthening the Achilles tendon according to Huckstep, transposition of the tibial posterior tendon in two tails to the dorsomedial and dorsolateral side of the foot, and six weeks of immobilisation in plaster of Paris. Results. The postoperative period was without complications. The treatment improved the heel-toe steppage gait in all patients. None of the 10 patients who had used an orthosis preoperatively still used it at the time of the follow up. Fifty per cent of the patients acquired a dorsiflexion of the foot of more than 0°. The results were in accordance with those in the literature. Conclusion. Transposition of the tibial posterior tendon is a worthwhile alternative for those patients with a drop foot (and without important comorbidity) who cannot walk satisfactorily with an ankle-foot orthosis.</p