Introduction: The kinetics of protein oxidation, monitored in breath, and its contribution to the whole body protein status is not well established. Objectives: To analyze protein oxidation in various metabolic conditions we developed/validated a 13C-protein oxidation breath test using low enriched milk proteins. Method/Design: 30 g of naturally labeled 13C-milk proteins were consumed by young healthy volunteers. Breath samples were taken every 10 min and 13CO2 was measured by Isotope Ratio Mass Spectrometry. To calculate the amount of oxidized substrate we used: substrate dose, molecular weight and 13C enrichment of the substrate, number of carbon atoms in a substrate molecule, and estimated CO2-production of the subject based on body surface area. Results: We demonstrated that in 255 min 20% ± 3% (mean ± SD) of the milk protein was oxidized compared to 18% ± 1% of 30 g glucose. Postprandial kinetics of oxidation of whey (rapidly digestible protein) and casein (slowly digestible protein) derived from our breath test were comparable to literature data regarding the kinetics of appearance of amino acids in blood. Oxidation of milk proteins was faster than that of milk lipids (peak oxidation 120 and 290 minutes, respectively). After a 3-day protein restricted diet (~10 g of protein/day) a decrease of 31% ± 18% in milk protein oxidation was observed compared to a normal diet. Conclusions: Protein oxidation, which can be easily monitored in breath, is a significant factor in protein metabolism. With our technique we are able to characterize changes in overall protein oxidation under various meta-bolic conditions such as a protein restricted diet, which could be relevant for defining optimal protein intake under various conditions. Measuring protein oxidation in new-born might be relevant to establish its contribution to the protein status and its age-dependent development.
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BACKGROUND: Total body surface area (TBSA) burned, expressed as percentage is one of the most important aspects of the initial care of a burn victim. It determines whether transfer to a burn centre is necessary as well as the need for, and amount of, intravenous fluid resuscitation. Numerous studies, however, have highlighted inaccuracies in TBSA assessment. Therefore, the differences in burn size estimates between referrers and burn centre's in children and its consequences in terms of transfer and intravenous fluid resuscitation were investigated.METHODS: This study involved two time periods from January 2002 until March 2004 and January 2007 until August 2008. All referred children admitted to a Dutch Burn centre within 24h post burn were eligible. Data were obtained from patient records retrospectively and in part prospectively.RESULTS: A total of 323 and 299 children were included in periods 1 and 2, respectively. Referring physicians overestimated burn size with a factor two (mean difference: 6% TBSA ± 5.5). About one in five children was referred to a burn centre without fulfilling the criteria for referral with regard to burn size (assessed by burn specialists) special localisation or inhalation trauma. Proportions of children receiving intravenous fluid resuscitation regardless of indication increased from 33% to 49% (p<0.01). The received volumes tended to be higher than necessary.CONCLUSIONS: Referring physicians overestimate burn size in children admitted to Dutch burn centres. This has little negative consequences, however, in terms of unindicated transfers to a burn centre or unnecessary fluid resuscitation.
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A local operating theater ventilation device to specifically ventilate the wound area has been developed and investigated. The ventilation device is combined with a blanket which lies over the patient during the operation. Two configurations were studied: Configuration 1 where HEPA-filtered air was supplied around and parallel to the wound area and Configuration 2 where HEPA-filtered air was supplied from the top surface of the blanket, perpendicular to the wound area. A similar approach is investigated in parallel for an instrument table. The objective of the study was to verify the effectiveness of the local device. Prototype solutions developed were studied experimentally (laboratory) and numerically (CFD) in a simplified setup, followed by experimental assessment in a full scale mock-up. Isothermal as well as non-isothermal conditions were analyzed. Particle concentrations obtained in proposed solutions were compared to the concentration without local ventilation. The analysis procedure followed current national guidelines for the assessment of operating theater ventilation systems, which focus on small particles (<10 mm). The results show that the local system can provide better air quality conditions near the wound area compared to a theoretical mixing situation (proof-of-principle). It cannot yet replace the standard unidirectional downflow systems as found for ultraclean operating theater conditions. It does, however, show potential for application in temporary and emergency operating theaters
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An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5-7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5-7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5-7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.
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INTRODUCTION: The aim of this study was to characterize the epidemiology of severe burns in the Netherlands, including trends in burn centre admissions, non burn centre admissions and differences by age.METHODS: Patients with burn-related primary admission in a Dutch centre from 1995 to 2011 were included. Nationwide prospectively collected data were used from three separate historical databases and the uniform Dutch Burn Repository R3 (2009 onwards). General hospital data were derived from the National Hospital Discharge Register. Age and gender-adjusted rates were calculated by direct standardization, using the 2005 population as the reference standard.RESULTS: The annual number of admitted patients increased from 430 in 1995 to 747 in 2011, incidence rates increased from 2.72 to 4.66 per 100,000. Incidence rates were high in young children, aged 0-4 years and doubled from 10.26 to 22.96 per 100,000. Incidence rates in persons from 5 up to 59 increased as well, in older adults (60 years and older) admission rates were stable. Overall burn centre mortality rate was 4.1%, and significantly decreased over time. There was a trend towards admissions of less extensive burns, median total burned surface area (TBSA) decreased from 8% to 4%. Length of stay and length of stay per percent TBSA decreased over time as well.CONCLUSIONS: Data on 9031 patients admitted in a 17-year period showed an increasing incidence rate of burn-related burn centre admissions, with a decreasing TBSA and decreasing in-burn centre mortality. These data are important for prevention and establishment of required burn care capacity.
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Background: Burn scar maturation can take several years but is generally studied shortly after injury. Therefore, we investigated patient-reported scar quality up to 5–7 years post-burn. Methods: Patients with ≤ 20 % total body surface area burned completed the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS 2.0) on the same scar at 3, > 18 months (median 28 months) and 5–7 years (median 63 months) post-burn. Results: Fifty-eight patients (21 children; 37 adults) with a median total body surface area burned (TBSA) of 6.3 % participated. Average patient-reported scar quality (POSAS score) was generally worst at 3 months (median score: 4.2), best at 28 months (median score: 2.2) and intermediate at 63 months post-burn (median score: 3.4) (p < 0.001). Many patients (66 %) reported a median 1.8 point higher (worse) POSAS score at 63 months compared to 28 months post-burn, whereas 14 % reported an identical, and 21 % a lower (better) score. At any assessment, largest differences with normal skin were reported for scar colour. Univariate predictive factors of long-term patient-reported scar quality were scar quality at 3 months (p = 0.002) and 28 months post-burn (p < 0.001), full-thickness burn size (p = 0.033), length of hospital stay (p = 0.003), and number of surgeries (p < 0.001). Conclusion: Two-thirds of patients with burns up to 20 % TBSA scored the quality of their scars worse at 63 months compared to 28 months post-burn. Whether this corresponds to increased dissatisfaction with scars in the long term should be further investigated. These new insights add to the body of knowledge on scar maturation and underscores the importance of discussing patients’ expectations.
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On the basis of a model for energy budgets, which includes the dynamics of stored energy, a model has been proposed for the kinetics of non-metabolized xenobiotic compounds, which may be lipophilic. The surface area coupled uptake is via food and/or water through the aqueous fraction of the animal. The partitioning to non-aqueous structural body mass and to stored materials (i.e. lipids, carbohydrates and proteins) is taken instantaneously. The result is a simple first order kinetics with variable coefficients. The bioconcentration factor has been evaluated. Model predictions have been tested against data from the litera
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Urban water bodies like ponds or canals are commonly assumed to provide effective cooling in hot periods. Some of the evidence that feeds this assertion is based on remote sensing observations at relatively large scales. Such observations generally reveal reduced surface temperatures of water bodies during daytime, relative to their urbanized environment. This is to be expected because of the extremely large heat capacity of water in combination with its ability to transport heat away from the water surface by turbulent mixing. However, this also implies that the cooling of a water body may proceed only slowly, which may result in higher night-time surface temperatures. This can lead to water bodies contributing to night-time urban heat islands. The existence of a surface-air temperature gradient is a necessary, but insufficient condition for water bodies to influence their environment. In order to noticeably affect the atmospheric temperature, the cooler or warmer air near the water surface needs to be transported to the urban surroundings. Furthermore, for humans such effects are generally only relevant if they are present at a height of 1-2 m. This requires the fetch over the water to be sufficiently large, so that the internal boundary layer can grow to these atmospheric levels. Furthermore, since not only temperature but also wind (ventilation), humidity and radiation contribute to the heat load of humans, possible cooling or heating effects need to be considered in terms of physiologically meaningful quantities, such as the Physiological Equivalent Temperature (PET). Taking such considerations into account, it is no surprise that the effect of water bodies on their atmospheric surroundings are generally found to be small or even nearly absent when considering evidence from atmospheric measurements.Although there are indications that proper combinations of shading, evaporation and ventilation interventions around water bodies can help to keep their surroundings cooler during summer, it is virtually unknown how these strategies can be optimally combined in designs to counter urban heat effectively. The ‘Really cooling water bodies in cities’ (REALCOOL) project explores possible cooling effects of such combinations for relatively small urban water bodies (characteristic horizontal dimension up to a few tens of meters, maximum depth 3m). The goal is to create evidence-based design guidelines of cooling urban water environments — design prototypes — meant for application in urban and landscape design practice.This presentation will address the cooling effects of the design prototypes evaluated with micrometeorological simulations. Special attention will be paid to the cooling effects of the water bodies in the designs. These were assessed using ENVI_MET version 4.1.3., which allows the user to choose the intensity of turbulent mixing of the water. Comparisons with observations and results from water temperature simulations with a model that assumes perfectly mixed water (the “Cool Water Tool”, CWT) showed that enhancing the turbulent mixing in ENVI_MET strongly improves water temperature simulations. Three design experiments were implemented in ENVI_MET: Exp1) testbeds, which are spatial reference situations derived from an inventory of common urban water bodies in The Netherlands, characterized by the shape and dimensions of the water body and the type of urban environment; Exp2) testbeds in which the area occupied by the water was replaced with the paving materials or vegetation flanking the water body in the original testbed; Exp3) design options with optimal combinations of shading, evaporation and ventilation. All simulations were performed for the same set of meteorological conditions, representing a typical heatwave day in The Netherlands. The initial water temperature depends on the water depth and was determined from simulations with the CWT, run for the same heatwave day repetitively until a quasi-equilibrium state was reached.Model outcomes from ENVI_MET were evaluated for the normally warmest period during daytime (around 15:00 CET) and the coolest period during night-time (around 5:00 CET) in the summer, using water temperature just below the water surface and using air temperature and PET at a height of 1.5m. The cooling effect is defined as the difference in air temperature and PET, respectively, between the different design experiments. The differences were computed from the spatial averages over two areas: the area directly above the water surface (Exp1, Exp3) or its replacement (Exp2) and the area directly bordering the water (like quays and sidewalks, called “pedestrian area” hereafter).The simulations with ENVI_MET suggest that the cooling effect of small water bodies on the air temperature is quite small and often negligible (Exp1-Exp2). This is also true for the optimized designs (Exp3-Exp2). The presence of the water body in the testbeds reduced the daytime air temperature in the afternoon by at most 0.8°C directly over the water body and 0.6°C in the pedestrian area (Exp1-Exp2). PET was reduced by at most 1.8°C and 1.9°C, respectively. During night-time, there was a very slight warming effect in a majority of cases, of at most 0.3°C in air temperature. Warming effects in terms of PET were even smaller. The optimized designs led to a reduction of water temperature of at best 0.5°C, relative to the reference situations (Exp1-Exp3). Air temperature was reduced by at most 0.8°C, relative to the temperature in original testbeds. The Physiological Equivalent Temperature (PET) could be reduced by as much as 7°C at 15:00 CET, but this difference was mainly due to shading effects of trees, not to the presence of water.We conclude that small urban water bodies like the ones tested here may not be the most relevant adaptation measure to create cooler urban environments. Their size may simply be too small to have meaningful thermal effects in their surroundings, in accordance with micrometeorological theory on the development of internal boundary layers. Only for water bodies that are sufficiently large cooling effects may become noticeable. This is then also true for possible warming effects. However, the openness of urban water bodies and their surroundings allows ventilation and provides room for trees that provide shade. The combination of these aspects which both lead to cooling effects was found to dominate favourable changes in daytime PET in particular.
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From the article: Abstract Since decision management is becoming an integrated part of business process management, more and more decision management implementations are realized. Therefore, organizations search for guidance to design such solutions. Principles are often applied to guide the design of information systems in general. A particular area of interest when designing decision management solutions is compliance. In an earlier published study (Zoet & Smit, 2016) we took a general perspective on principles regarding the design of decision management solutions. In this paper, we re-address our earlier work, yet from a different perspective, the compliance perspective. Thus, we analyzed how the principles can be utilized in the design of compliant decision management solutions. Therefore, the purpose of this paper is to specify, classify, and validate compliance principles. To identify relevant compliance principles, we conducted a three round focus group and three round Delphi Study which led to the identification of eleven compliance principles. These eleven principles can be clustered into four categories: 1) surface structure principles, 2) deep structure principles, 3) organizational structure principles, and 4) physical structure principles. The identified compliance principles provide a framework to take into account when designing information systems, taking into account the risk management and compliance perspective.
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Als na afloop van een brandincident een stoffelijk overschot wordt aangetroffen, is het van belang dat de causaliteit tussen de brand en het overlijden wordt onderzocht. Brand is zeer destructief voor het menselijk lichaam. Dit bemoeilijkt de interpretatie van onderzoeksbevindingen aan een lichaam. Er zijn diverse verschijnselen die tot op zekere hoogte duiden op vitaliteit (de betrokkene was levend) ten tijde van de brand. In dit artikel worden deze verschijnselen tegen het licht gehouden. Op basis van de huidige wetenschappelijke theorieën bestaan er geen verschijnselen die leiden tot de eenduidige conclusie over al dan niet vitale blootstelling. Wel kunnen verschijnselen een vermoeden van vitale blootstelling tot op zekere hoogte ondersteunen. Ontbreken de verschijnselen, dan is het niet mogelijk om een conclusie te trekken; de afwezigheid is geen bewijs van overlijden vóór het ontstaan van de brand. Om in de rechtszaal een uitspraak te kunnen doen over de causaliteit tussen brand en overlijden, wordt het noodzakelijk geacht om de waarde voor de aannemelijkheid van vitale blootstelling per verschijnsel te motiveren.
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