QMRA in the Drinking Water Distribution System

AbstractA Quantitative Microbial Risk Assessment (QMRA) model was developed for contamination events after mains repairs. The sensitivity analysis showed that the contamination concentration is the most important parameter, next to the pathogen dose response relation. The time of opening valves and of consumption are also important parameters. The event location within the network and the amount of consumption are of smaller importance. Issuing a boil water advice and opening only one valve before “releasing” the entire isolation section are effective measures to reduce the number of infected people per event by a factor of 2 to 4

Atom lithography without laser cooling

Using direct-write atom lithography, Fe nanolines are deposited with a pitch of 186 nm, a full width at half maximum (FWHM) of 50 nm, and a height of up to 6 nm. These values are achieved by relying on geometrical collimation of the atomic beam, thus without using laser collimation techniques. This opens the way for applying direct-write atom lithography to a wide variety of elements.Comment: 7 pages, 11 figure

A Quantitative Chemicals' Mixture Risk Assessment Approach For Contaminants Of Emerging Concern Management In Drinking Water

Uncertainties on occurrence and hazard of mixtures of Contaminants of Emerging Concern (CECs) in drinking water (DW) challenge water utilities and decision makers in prioritizing these compounds in, respectively, interventions for the optimization of DW treatment and DW regulations. Continuous development of quantitative risk assessment procedures addressing adverse effects of CECs supports decision-making regarding mitigation actions in minimizing health risks. We propose a novel, quantitative chemical risk assessment (QCRA) approach for mixtures of CECs in DW. The risks are evaluated with the aid of the benchmark quotient probabilistic distribution and including uncertainties in both (i) exposure assessment using occurrence data of different DW sources and simulating DW treatment by granular activated carbon and (ii) hazard assessment steps. The QCRA was applied to compare risks deriving from the presence of alkylphenols mixtures in tap or bottled DW, and to evaluate how actual DW consumption habits affect health risks

The Spanish society of Parenteral and Enteral Nutrition (SENPE) and its relation with healthcare authorities

Está muy bien documentado en la literatura médica que la desnutrición es un problema común en todos los niveles de atención sanitaria, desde atención primaria a especializada y en centros de atención geriátrica. Este problema no se limita a países con pocos recursos económicos o con limitado desarrollo social y económico. También es un problema universal en Europa. La desnutrición aumenta las cifras de morbilidad, mortalidad, ingresos hospitalarios y duración de la estancia. Estas cifras más elevadas suponen lógicamente un aumento del uso de recursos sanitarios. A pesar de esto, el problema de la desnutrición a menudo puede pasar desapercibido y el paciente no recibir el tratamiento necesario. Este problema requiere la cooperación de múltiples agentes tales como los Gobiernos de los Estados, los profesionales de la salud y los mismos ciudadanos. El VIII Foro de Debate concluye con la necesidad de establecer un claro plan de actuación (a semejanza de la European Alliance for Health Nutrition) y la creación de una plataforma (coalición) que reúna las voces de asociaciones de profesionales sanitarios, instituciones, colegios profesionales, asociaciones de pacientes, industria y entidades aseguradoras. Los fines de esta plataforma consistirán en informar de la extensión del problema, identificar y potenciar líderes que transmitan los fines de esta iniciativa ante las autoridades autonómicas y nacionales, propuesta de soluciones y colaboración en su puesta en marcha y finalmente, evaluación/ control de las acciones desarrolladasIt has been well documented in medical literature that hyponutrition is a common issue at all healthcare levels, from primary to specialized health care, as well as geria - tric healthcare facilities. This problem is not limited to countries with scarce economic resources or limited social development; it is also a universal issue in Europe. Hyponutrition increases the rates of morbidity, mortality, hospital admissions, and hospital stay. These higher figures also represent a higher use of healthcare resources. In spite of this, hyponutrition may often go undetected and the patient may not receive the necessary treatment. This problem requires the cooperation of multiple agents such as the Governments, the healthcare professionals, and the citizens themselves. The VIII Discussion Forum concludes on the need to establish a clear-cut plant for action (similar to the European Alliance for Health Nutrition) and the creation of a platform (coalition) encompassing the voices of healthcare professionals associations, institutions, professional colleges, patients associations, the pharmaceutical companies, and insurance companies. The goals of this platform will be to inform about the extent of this issue, to identity and promote leaders that will convey the aims of this initiative to regional and national healthcare authorities, to present solutions and to collaborate in their implementation, and finally to assess/control the actions take

The clinical response to infliximab in rheumatoid arthritis is in part dependent on pretreatment tumour necrosis factor α expression in the synovium

Objective: To determine whether the heterogeneous clinical response to tumour necrosis factor (TNF)alpha blocking therapy in rheumatoid arthritis (RA) can be predicted by TNF alpha expression in the synovium before initiation of treatment. Methods: Prior to initiation of infliximab treatment, arthroscopic synovial tissue biopsies were obtained from 143 patients with active RA. At week 16, clinical response was evaluated using the 28-joint Disease Activity Score (DAS28). Immunohistochemistry was used to analyse the cell infiltrate as well as the expression of various cytokines, adhesion molecules and growth factors. Stained sections were evaluated by digital image analysis. Student t tests were used to compare responders (decrease in DAS28 >= 1.2) with non-responders (decrease in DAS28 <1.2) and multivariable regression was used to identify the independent predictors of clinical response. Results: Synovial tissue analysis confirmed our hypothesis that the baseline level of TNF alpha expression is a significant predictor of response to TNF alpha blocking therapy. TNF alpha expression in the intimal lining layer and synovial sublining were significantly higher in responders than in non-responders (p = 0.047 and p = 0.008, respectively). The numbers of macrophages, macrophage subsets and T cells (all able to produce TNF alpha) were also significantly higher in responders than in non-responders. The expression of interleukin (IL)1 beta, IL6, IL18, IL10, E-selectin, intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) was not associated with response to anti-TNF alpha treatment. Conclusion: The effects of TNF alpha blockade are in part dependent on synovial TNF alpha expression and infiltration by TNF alpha producing inflammatory cells. Clinical response cannot be predicted completely, indicating involvement of other as yet unknown mechanism

The Dutch secret: how to provide safe drinking water without chlorine in the Netherlands

The Netherlands is one of the few countries where chlorine is not used at all, neither for primary disinfection nor to maintain a residual disinfectant in the distribution network. The Dutch approach that allows production and distribution of drinking water without the use of chlorine while not compromising microbial safety at the tap, can be summarized as follows: &lt;br&gt; 1. Use the best source available, in order of preference:&lt;br&gt; &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;ndash; microbiologically safe groundwater,&lt;br&gt; &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;ndash; surface water with soil passage such as artificial recharge or bank filtration,&lt;br&gt; &amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;ndash; direct treatment of surface water in a multiple barrier treatment;&lt;br&gt; 2. Use a preferred physical process treatment such as sedimentation, filtration and UV-disinfection. If absolutely necessary, also oxidation by means of ozone or peroxide can be used, but chlorine is avoided;&lt;br&gt; 3. Prevent ingress of contamination during distribution;&lt;br&gt; 4. Prevent microbial growth in the distribution system by production and distribution of biologically stable (biostable) water and the use of biostable materials;&lt;br&gt; 5. Monitor for timely detection of any failure of the system to prevent significant health consequences. &lt;br&gt;&lt;br&gt; New developments in safe drinking water in the Netherlands include the adaptation of the Dutch drinking water decree, implementation of quantitative microbial risk assessment (QMRA) by water companies and research into source water quality, drinking water treatment efficacy, safe distribution and biostability of drinking water during distribution and &lt;i&gt;Legionella&lt;/i&gt;. This paper summarizes how the Dutch water companies warrant the safety of the drinking water without chlorine

Activity of high-dose epirubicin combined with gemcitabine in advanced non-small-cell lung cancer: a multicenter phase I and II study

The aim of the study was to evaluate efficacy and tolerance of epirubicin and gemcitabine as first-line chemotherapy in patients with advanced non-small-cell lung cancer. A phase I study was performed with the combination of escalating doses of epirubicin intravenously on day 1 and a fixed dose of gemcitabine on days 1 and 8 of a 21-day cycle. Eighteen patients were included in the phase I part of the study before the maximum tolerated dose was found. Dose-limiting toxicity was febrile neutropenia. The phase II part of the study was continued with epirubicin 100 mg m−2on day 1 and gemcitabine 1125 mg m−2on days 1 and 8 of a 21-day cycle. Forty-three chemotherapy-naive patients were included. The median age of the patients was 60 years (range 26–75). Most patients (74%) were in stage IV. Granulocytopenia CTC grade 4 occurred in 32.5% and thrombocytopenia grade 4 in 11.6% of cycles. Febrile neutropenia occurred in six patients. Non-haematological toxicity was mainly mucositis CTC grade 2 and 3 in 35% of patients. The tumour response rate was 49% (95% confidence interval (CI) 35–63%). The median survival time for the patients was 42 weeks (95% CI 13–69). © 2000 Cancer Research Campaig

The Psychiatric Case Register Middle Netherlands

<p>Abstract</p> <p>Background</p> <p>The Psychiatric Case Register Middle Netherlands (PCR-MN) registers the mental healthcare consumption of over Dutch 760,000 inhabitants in the centre of the Netherlands. In 2010 the follow-up period was over ten years. In this paper we describe the content, aims and research potential of this case register.</p> <p>Description</p> <p>All mental healthcare institutions in the middle-western part of the province of Utrecht participate in the PCR-MN case register. All in- and out-patients treated in these institutions have been included in the database from the period 2000 to 2010. Diagnosis according to DSM-IV on axis I to IV, visits to in- and out-patient clinics and basic demographics are recorded. A major advantage of this register is the possibility to link patients anonymously from the PCR-MN cohort to other databases to analyze relationships with determinants and outcomes, such as somatic healthcare consumption, mortality, and demographics, which further increases the research potential</p> <p>Conclusions</p> <p>The PCR-MN database has a large potential for scientific research because of its size, duration of follow-up and ability to link with additional databases, and is accessible for academic researchers.</p

Doppler-free frequency modulation spectroscopy of atomic erbium in a hollow cathode discharge cell

The erbium atomic system is a promising candidate for an atomic Bose-Einstein condensate of atoms with a non-vanishing orbital angular momentum ($L \neq 0$) of the electronic ground state. In this paper we report on the frequency stabilization of a blue external cavity diode laser system on the 400.91 $nm$ laser cooling transition of atomic erbium. Doppler-free saturation spectroscopy is applied within a hollow cathode discharge tube to the corresponding electronic transition of several of the erbium isotopes. Using the technique of frequency modulation spectroscopy, a zero-crossing error signal is produced to lock the diode laser frequency on the atomic erbium resonance. The latter is taken as a reference laser to which a second main laser system, used for laser cooling of atomic erbium, is frequency stabilized

Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault

Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH