An analysis of options for a sustainable Texel

The need to reduce energy consumption and to increase the energy generation from renewable resources is imminent. The community of the Dutch island of Texel has the ambition to be part of this energy transition towards sustainability and has adopted the goal of becoming fully sustainable by the year 2020 [1]. To achieve this, some projects are already taking place and Alliander is assessing the different strategies related to the grid management to maximize the level of energy neutrality with lower investment costs as part of the "Proeftuin Texel" project. This study continues the analysis of the "Proeftuin Texel" to identify the optimal solutions for the creation of a sustainable energy system. The study has two main objectives. The first objective is to calculate the maximum installed capacity of renewable energy sources (RES) technologies by optimizing the use of the current infrastructure; the second is to assess the benefits of energy balancing solutions. These solutions include heat pumps, electrical vehicles, and an energy management system (EMS). Three scenarios are created and the benefits are measured in terms of cost per reduction of CO2 emissions for each scenario. The results from this study could serve as a reference for energy related decisions in Texel and could be adapted to other cases. The three scenarios are composed by the following solutions: the first scenario analyses the maximum capacity of the actual grid to implement PV panels; the second scenario adds wind turbines and alternative solutions for the use of the actual grid; and in the third scenario the electricity consumption is increased by electrifying the residential heating and private transport to add flexibility on the demand side and balance it with the EMS. The results show that the greater benefits are achieved by the second scenario, while the benefits of the first and those of the third (in comparison with the second scenario) are notable lower; consequently their costs per tonne of CO2 reduction are higher. A further analysis shows the effect from each solution of the three scenarios, showing that the lower cost solutions are wind turbines combined with the grid solutions consisting on cable-pooling and the use of the backup installation. From this study it can be concluded that for this case with the given timeframe, a smart design is more effective than a smart grid

C-section on patient with secondary paraplegia resulting from spontaneous spinal epidural hematoma and acquired FXIII deficiency. A case report

Background: Spontaneous spinal epidural hematoma (SSEH) in a pregnant patient is an extremely rare clinical condition and requires emergency surgical evacuation, while termination of pregnancy depends on fetal viability status1 . Etiology includes hemorrhagic diathesis, autoimmune inflammatory vasculitis, anticoagulant therapy, vascular malformations, and tumors. Pregnancy is considered a risk factor for SSEH. Below is a patient with SSEH and acquired FXIII deficiency (FXIII D) as a sole finding. Case report: A 37 year old, gravida 3 para 2, 28 weeks of gestation was transferred to our hospital with symptoms of progressive paraplegia over 72 hours. MRI showed spinal lesion due to spontaneous epidural hematoma, emergency decompression followed with a T1-T5 laminectomy. A hemorrhagic episode required transfusions up to 4 RBCs and 2 FFPs during the laminectomy, neither FXIII nor Tranexamic acid (TXA) was given on that occasion. The neurological examination showed flaccid paraplegia, with sensitive level at T3. Test results showed normal values except in FXIII-A concentration 28% (60-160%). No other major bleeding cause could be determined aside from the FXIII D. Two months later, she had a c-section performed at 36 weeks of gestation. Intravenous plasma-derived FXIII (pdFXIII) concentrate 2500 IU was given preoperatively along with TXA 1g. General anesthesia using propofol for induction and sevorane for maintenance was administered, no muscle relaxants or opioids were necessary. Videolaryngoscopy was used for orotracheal intubation. Bleeding was between normal ranges. There was no need for RBC transfusions. A healthy female baby was born with a 8/9 Apgar score and 2,840 grams. Post-operative FXIII-A level was 69%. Discussion: There are merely a few dozens of pregnant SSEH cases reported in the literature. Regional anesthesia for paraplegic condition is advised as the best technique to prevent autonomic dysreflexia; although general anesthesia seems more appropriate to prevent further spinal complications in patients with hemorrhagic diathesis2 . References: 1. Krishnan P, et al. Neurol India. 2014;62(2):205-7. 2. Jones BP, et al. Can J Anaesth. 2000;47(11):1122-28. Learning points: General anesthesia is an adequate anesthesia technique for paraplegic patients with FXIIID. FXIII should be tested even if coagulation test results are normal, and preoperative pdFXIII administration is probably the best way to prevent severe bleeding as well as TXA in these patients

New method to measure thermal shock resistance in ceramics using a piezo-spectroscopic technique

A new method for assessing the critical temperature in thermally shocked ceramics is proposed. It is based on the measurement of stress relaxation of residual stresses as a consequence of thermal shock. The change in the stress-field is determined by piezo-spectroscopic technique. The technique is described and the results analyzed. The values obtained are compared with those obtained by the conventional method based on strength degradation measured on test pieces quenched at different temperatures. The agreement among the data is very good

Death in the sun: the bioarchaeology of an early post-medieval hospital in Gibraltar

In 2014, during construction work at the ex-Civil Hospital in Gibraltar, excavations led by the Gibraltar Museum revealed a major, previously unknown burial ground containing more than 200 skeletons. We present the historical, archaeological and radiometric dating evidence from the site alongside the results of initial osteological analyses. The data indicate that the burials pertain to an earlier 16th-century Spanish hospice, and therefore stand to offer new insights into the functioning of this early modern hospital and the health and movements of people at a time of incipient globalization

A Case Report of Sandhoff Disease

Sandhoff disease is a rare and severe lysosomal storage disorder representing 7% of GM2 gangliosidoses. Bilateral thalamic involvement has been suggested as a diagnostic marker of Sandhoff disease. A case of an 18-month-old infant admitted for psychomotor regression and drug resistant myoclonic epilepsy is presented. Cerebral CT scan showed bilateral and symmetrical thalamic hyperdensity. MRI revealed that the thalamus was hyperintense on T1-weighted images and hypointense on T2-weighted images with a hypersignal T2 of the white matter. Enzymatic assays objectified a deficiency of both hexosaminidases A and B confirming the diagnosis of Sandhoff disease

Effect of Interfacial Bonds on the Morphology of InAs QDs Grown on GaAs (311) B and (100) Substrates

The morphology and transition thickness (tc) for InAs quantum dots (QDs) grown on GaAs (311) B and (100) substrates were investigated. The morphology varies with the composition of buffer layer and substrate orientation. Andtcdecreased when the thin InGaAs was used as a buffer layer instead of the GaAs layer on (311) B substrates. For InAs/(In)GaAs QDs grown on high miller index surfaces, both the morphology andtccan be influenced by the interfacial bonds configuration. This indicates that buffer layer design with appropriate interfacial bonds provides an approach to adjust the morphologies of QDs grown on high miller surfaces

Will Patients Benefit from Regionalization of Gynecologic Cancer Care?

OBJECTIVE: Patient chances for cure and palliation for a variety of malignancies may be greatly affected by the care provided by a treating hospital. We sought to determine the effect of volume and teaching status on patient outcomes for five gynecologic malignancies: endometrial, cervical, ovarian and vulvar carcinoma and uterine sarcoma. METHODS: The Florida Cancer Data System dataset was queried for all patients undergoing treatment for gynecologic cancers from 1990-2000. RESULTS: Overall, 48,981 patients with gynecologic malignancies were identified. Endometrial tumors were the most common, representing 43.2% of the entire cohort, followed by ovarian cancer (30.9%), cervical cancer (20.8%), vulvar cancer (4.6%), and uterine sarcoma (0.5%). By univariate analysis, although patients treated at high volume centers (HVC) were significantly younger, they benefited from an improved short-term (30-day and/or 90-day) survival for cervical, ovarian and endometrial cancers. Multivariate analysis (MVA), however, failed to demonstrate significant survival benefit for gynecologic cancer patients treated at teaching facilities (TF) or HVC. Significant prognostic factors at presentation by MVA were age over 65 (HR = 2.6, p<0.01), African-American race (HR = 1.36, p<0.01), and advanced stage (regional HR = 2.08, p<0.01; advanced HR = 3.82, p<0.01, respectively). Surgery and use of chemotherapy were each significantly associated with improved survival. CONCLUSION: No difference in patient survival was observed for any gynecologic malignancy based upon treating hospital teaching or volume status. Although instances of improved outcomes may occur, overall further regionalization would not appear to significantly improve patient survival

In-Depth Molecular Characterization of Mycobacterium tuberculosis from New Delhi – Predominance of Drug Resistant Isolates of the ‘Modern’ (TbD1−) Type

BACKGROUND: India has the highest estimated burden of tuberculosis in the world, accounting for 21% of all tuberculosis cases world-wide. However, due to lack of systematic analysis using multiple markers the available information on the genomic diversity of Mycobacterium tuberculosis in India is limited. METHODOLOGY/PRINCIPAL FINDINGS: Thus, 65 M. tuberculosis isolates from New Delhi, India were analyzed by spoligotyping, MIRU-VNTR, large deletion PCR typing and single nucleotide polymorphism analysis (SNP). The Central Asian (CAS) 1 _DELHI sub-lineage was the most prevalent sub-lineage comprising 46.2% (n = 30) of all isolates, with shared-type (ST) 26 being the most dominant genotype comprising 24.6% (n = 16) of all isolates. Other sub-lineages observed were: East-African Indian (EAI)-5 (9.2%, n = 6), EAI6_BGD1 (6.2%, n = 4), EAI3_IND, CAS and T1 with 6.2% each (n = 4 each), Beijing (4.6%, n = 3), CAS2 (3.1%, n = 2), and X1 and X2 with 1 isolate each. Genotyping results from five isolates (7.7%) did not match any existing spoligopatterns, and one isolate, ST124, belonged to an undefined lineage. Twenty-six percent of the isolates belonged to the TbD1+ PGG1 genogroup. SNP analysis of the pncA gene revealed a CAS-lineage specific silent mutation, S65S, which was observed for all CAS-lineage isolates (except two ST26 isolates) and in 1 orphan. Mutations in the pncA gene, conferring resistance to pyrazinamide, were observed in 15.4% of all isolates. Collectively, mutations in the rpoB gene, the katG gene and in both rpoB and katG genes, conferring resistance to rifampicin and isoniazid, respectively, were more frequent in CAS1_DELHI isolates compared to non-CAS_DELHI isolates (OR: 3.1, CI95% [1.11, 8.70], P = 0.045). The increased frequency of drug-resistance could not be linked to the patients' history of previous anti-tuberculosis treatment (OR: 1.156, CI95% [0.40, 3.36], P = 0.79). Fifty-six percent of all new tuberculosis patients had mutations in either the katG gene or the rpoB gene, or in both katG and rpoB genes. CONCLUSION: CAS1_DELHI isolates circulating in New Delhi, India have a high frequency of mutations in the rpoB and katG genes. A silent mutation (S65S) in the pncA gene can be used as a putative genetic marker for CAS-lineage isolates