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Practical Winery
58-D Paul Drive, San Rafael, CA 94903-2054
phone:415/479-5819 · fax:415/492-9325
This article is from the July/August 2005 issue of Practical Winery & Vineyard Magazine. Order current or back issues here.

BY Henry Work
Plumpjack Winery (Oakville, CA) offered premium Cabernet Sauvignon in bottles sealed with screwcaps in the late 1990s. Since then, PlumpJack’s continued success has opened a lot of eyes, and the premium wine industry has begun to consider use of screwcaps.

Another winery shifting to screwcaps is Hogue Cellars (Prosser, WA). David Forsyth (director of winemaking) stated in June 2004 (after completing a 2 1/2-year closure study), “Bottling our wines with screwcaps will yield tremendous benefits: elimination of cork taint, consistent and appropriate ageing, lower SO2 levels at bottling, and greater ease in opening bottles.”

Screwcaps, however, are not new. Threaded aluminum ROTE (Roll-on, tamper-evident) or ROPP (Roll-on, pilfer-proof) closures were introduced in the 1960s. Researchers at Dow Chemical in 1933 discovered polyvinylidene chloride, the main material in the liner-seal that is in contact with wine, subsequently branded as “Saran” and “Saranex” (Saran sandwiched between layers of polyethlylene or polyethylene-vinylacetate). When a tin/saran liner is used, it is the tin layer that creates a barrier to oxygen ingress.

Wineries such as E&J Gallo (Modesto, CA) have been producing wines with screwcap in their economy and beverage categories for more than 30 years, notes Mary Wagner, chief technical officer.

“In Finland, Norway, Sweden, and Switzerland, wine under screwcap has been popular for more than 30 years,” reports George Thomson (Crown Cork/United Closures & Plastics [UCP] in the United Kingdom).

With an increasing demand for screwcaps, more suppliers are entering the marketplace. This report will examine quality control factors and standards for the three critical legs in screwcap usage: screwcap suppliers and manufacturers, critical factors in glass bottles, and screwcap application at bottling.

Suppliers / Manufacturers
of screwcaps

Pechiney (now Alcan Packaging), with its Stelvin brand, was one of the first suppliers to offer a long skirt (30mm x 60 mm) screwcap for premium wines. Scott Laboratories offers the Alplast brand. More recent entries are Cork Supply USA with SAVin from Metal Closures Group in South Africa, Oeneo Closures (formerly Sabaté) with the S-Cap, G-3 Enterprises (exclusive U.S. manufacturer of Royal 90™), Richard’s Packaging (representing Crown Cork/UCP), Alcoa, Auscap (Australia), and the Guala Closures Group.

Some of these suppliers are divisions of larger international closure groups, while others contract to have screwcaps made to their specifications. In most cases, the fabrication plants are already making closures for other food and beverage industries and abide by, or utilize, several quality control certifications.

Certifications include ISO-9000 (certified by the International Organization for Standardization), HACCP (Hazard Analysis and Critical Control Point) typically used for food and food product production, American FDA compliance, and European regulations, including those applicable to the use of heavy metals. Ask your supplier for current confirmation of these certifications.

“Closure liners must comply with U.S. FDA CFR 21 reg. 177.1210 and the internal coatings must comply with U.S. FDA CFR 21 reg. 175.300,” explains George Crochiere, Crochiere & Associates, packaging consultants, (Pepperell, MA). “Compliance does not guarantee good flavor, sealing, or barrier properties.”

While certifications and compliance activities are not an iron-clad guarantee against defects, they certainly minimize problems. Many winemakers agree with the assessment of Aron Hess, executive winemaker at Rex Hill, (Newburg, OR), who suggests that the few problems he has experienced have generally not been the fault of the cap manufacturer.

“Wineries should only obtain closures from manufacturers who produce screwcaps under statistical process control,” notes Thomson (Crown Cork/UCP).

Manufacturing of screwcaps
“The manufacturing of aluminum screwcaps starts with the coating or painting process,” says Crochiere. “The flat aluminum sheet has a total of two to five individual coatings applied to the inside and outside. The coatings provide corrosion protection, lubricity for manufacturing and removal torques, improved adhesion for the inks, and decorative color.

“The aluminum is cut into discs and drawn into the closure shape. Depending on the cap and process, this is accomplished in one to three operations; the result is a cap shell with smooth sides.

“If the cap is to have decoration or a logo applied, this is done next with inks and a clear protective varnish. In this process, each cap is handled, registered, and printed individually whereas short screwcaps (used on beer or water) are typically printed during the coating process.

“The last metal operation trims the cap to its specified length, applies the knurling and liner-retaining feature, and makes the cuts for the pilfer-band bridges (breakaway feature).

“The final manufacturing process is insertion of a liner; these are either provided as cut discs or as a roll of material that is cut in the insertion process.

“The screwcap manufacturer conducts quality checks at each stage of this process. Final quality control process should include but not be limited to: closure application, sealing, pilferband operation, removal torques, correct liner material, and coating and ink application, color, placement and adhesion.”

Seal manufacturing processes
and shipping

The actual sealing discs, and their layered materials, are normally made by companies other than the cap manufacturer. The seal material is made by a combination of extrusion, co-extrusion and/or lamination processes. The material is shipped to the cap manufacturer either in sheets, which the cap manufacturer cuts to size as they are inserted into the cap, or as pre-cut discs to save on shipping and scrap costs.

It is important to understand the potential areas for contamination in the supply chain of screwcaps and liners. As noted, the seals are normally manufactured in different plants from where the screwcap is made.

Trucks and containers carry all sorts of products and chemicals (some of them volatile), which could be absorbed by the plastics. Again, as part of the cap manufacturing process, inspection of incoming raw materials should be part of the quality control process. (More on this in the “Bottling line application” section below.)

Sealing material options / selection
“Seals are made to provide a compromise of resilient softness for sealing properties and barrier properties,” says Crochiere, “to minimize oxygen ingress, carbonation loss, loss of volatiles and flavor neutrality; typically these are opposing properties for polymers. Seals are made in three different ways; formed in place PVC, single material discs, and multi-layer discs of resilient cushion layers and barrier material layers.”

“The oxygen transmission rate for Saranex is only slightly greater than tin-saran or aluminum-saran,” says Jim Peck, G-3 Enterprises (Modesto, CA).

“Each sealant material and configuration has its own sealing, flavor, and barrier properties,” adds Crochiere. “Changes in closure and/or liner supply should be carefully evaluated. In addition to the sealant material, the closing conditions also affect the barrier properties as different closing conditions can increase the length and reliability of the seal on the bottle.

“Based on work started in the beer industry in 1982, the sealant industry has developed barrier materials and techniques to evaluate them under commercial conditions for oxygen ingress, carbonation loss, and the ingress of TCA, TeCA, and other undesirable contaminants. The methods are now being used for wine packaging.

“An oxygen permeability coefficient will tell you how many micro-grams of oxygen permeate through a given package component per day. Combined with the volume of the package, an ingress rate in ppb of total package oxygen per day for a closure/liner type, closing condition and bottle size can be determined. These units are the same as those used to measure oxygen levels at filling and can be added together to determine the total oxygen in the package from filling and ingress over time. Versions of this test are also used to evaluate the performance of closures when exposed to abuses like warehouse stacking, transportation, temperature changes, or impact on the closure.”

“Another term for oxygen permeability coefficient is oxygen transmission rate, which would include not only permeation but any micro-leakage,” notes Jim Peck.

“When selecting a new closure and liner, a comparison of oxygen ingress coefficients or rates to existing closure types will help predict the shelf-life and development of the wine with the new closure,” adds Crochiere. “In addition, comparison of TCA or TeCA barrier properties can minimize the risk of cellar or transportation contamination. Typically, the better the barrier properties, the higher the cost.

“A chart of oxygen permeability coefficients for some typical wine closures is in Table I. These numbers have been generated from numerous tests over the past seven years and should only be used as an indication of what is possible.”

The choice between Saran/Tin or Saranex seals generally reflects the winemakers’ decision on whether to seal the bottle completely for a short-lived wine, such as Sauvignon Blanc, Riesling, or Pinot Grigio, or to allow some permeability, for ageing red wines. However, both Patrick Pickett, (winemaker for Pepi, Oakville, CA), and Aron Hess, have observed relatively little difference in the actual taste of wines using either of these two seal types with whites or reds.

“It is a huge debate on how much oxygen,” says Thomson (Crown Cork/UCP). “The technology is available; unfortunately Crown Cork/UCP does not have a fix on the quantities required over time.”

Wineries using screwcaps are trying to get a “fix” on the right amount of oxygen for their various wines. Hogue uses the Saranex seal for both red and white wines, while John Conover (general manager at Plump Jack Winery), reports using the Saran/Tin seal for their reds, and some of their white wines. All of which suggests that the Saran seal for whites and Saranex seal for reds guideline can have many exceptions.

Inspecting screwcaps
Your supplier should have an inspection procedure for all incoming products from its manufacturers. This should provide a second line of defense against possible manufacturing errors. All suppliers contacted for this report did have a receiving inspection procedure in place. These include checks for the cap artwork and colors, that the correct seal-disc has been properly inserted, and that the packaging integrity has been maintained. If you are using a new supplier, it would be worthwhile to ask what checks are included in their receiving inspection.

The distributor’s inspection procedures should also include: inspection of the packaging for damage (especially crushed contents, but also rips and tears); any odd odors; sample inspection of the caps to ensure they conform to size, thickness, skirt length, and style; sampling of the seals to ensure they are the correct type and inserted correctly (since the layers in the saran/tin-type seals are not symmetrical, they must be inserted with the saran side to face the wine); proper printing, and embossing. Colors should match between the top and skirt (they are printed separately), and should match the customer’s specifications. Break points (bridge line) must be properly perforated; and general cleanliness of the caps and their packaging must be assured.

Screwcaps and glass bottles
Not all screwcaps are compatible with all styles of glass bottles, and vice-versa. The bottle finish design and corresponding neck diameter must be compatible with the screwcap and closing equipment. Cap manufacturers and distributors want to inspect a bottle sample the winery proposes to use to make sure their cap will fit properly, or can supply design specifications for a glass manufacturer. Aron Hess emphasizes: “Screwcap manufacturers who do not insist on matching their cap to a specific bottle/finish tend to supply more problematical caps.”

This problem was echoed by another winemaker, Tony Bish (Sacred Hill Wines in Hawke’s Bay, New Zealand), who received a shipment of bottles with a slightly elliptical neck, some outside the range of specifications. The screwcap would not fully descend onto the bottle. The capping head would come down and impact the closure and tighten onto the bottle, resulting in many broken bridges on the cap, compromising the tamper-proofing aspects. The caps did seal correctly, but the result was unsatisfactory due to sharp edges where bridges were broken and unsightly appearance.

A different brand of screwcap worked better, because the caps had a slightly wider skirt to allow more caps to fully seat on the bottle-neck before the capping head was applied. Also, the inside surface of the caps was smoother and the reduced friction allowed caps to seat better. However, since the bottles were out-of-round due to forming irregularities, even this did not fully correct the problem.

The Sacred Hill problem was only solved by disgorging some bottles and re-bottling in new bottles within specifications. Given the tight tolerances required for a proper seal and tamper-proofing, all screwcap suppliers and winemakers recommend that great effort be taken to ensure that the screwcap and glass bottle styles be absolutely compatible.

“Richards Packaging has had several experiences with matching of bottle and closure,” reports Bob Boord. “The Glass Packaging Institute (GPI) provides neck finish specifications, but many small deviations have crept into bottle neck finishes over the years. In addition, molds wear. The result is that constant attention needs to be given to the proper matching up of neck finishes on bottles with the closure specifications.

“In one situation, a customer used seven different glass bottles. Analysis found that there were seven variations of the GPI neck finish, and some of those deviations were serious. In another situation, a glass manufacturer built new neck finish inserts, but the new specifications changed the fit of the closure on the bottle.

“Manufacturers of bottles and closures do not communicate well with each other, so it becomes important for the winery-buyer and the distributor salesperson to work together to provide bottle samples to the closure manufacturer for testing to assure good fit. Whenever a new bottle is introduced or existing bottle molds are rebuilt or modified, samples of all cavities should be sent to the screwcap manufacturer for analysis.”

The actual sealing of the screwcap is achieved at the top of the outside rim radius of the glass bottle. Therefore, this rim must be smooth and correctly curved. The glass thread must start a specified distance below this rim to accommodate the seal.

“The holding power of the cap is achieved by the threads, while the pilfer-band locks the cap in place,” explains Crochiere. In addition to the proper surfacing at the top edge, the thread and pilfer band ridge below the thread tolerances are relatively tight, thus the need for coordinating the bottle and cap specifications.

Bottling line application
Prior to and at bottling, a number of inspections and checks must be made. Most of the caps are packaged bulk in plastic bags and shipped in cardboard boxes. The boxes must not show any evidence of being crushed, which could dent or deform the caps; nor should the plastic be ripped or torn, in order to keep the caps clean and protect them from odors. Clean, dry storage in the winery is essential.

“Bottles should be inspected for straight and concentric necks in addition to dimensional checks to insure that the sealing area, threads, pilfer step and neck comply with specifications,” says Crochiere. “Bottles should also be inspected for manufacturing imperfections or damage (glass flash or slivers at the mold-parting lines) that could result in unacceptable performance of the screwcap sealing system. Don’t forget to check for cleanliness and off-odors in the bottles and cases.”

Alignment of the capper is absolutely critical. Kristi Koford (winemaker at Napa Wine Company, Oakville, CA), notes that one screwcap manufacturer insists on inspecting the head set-up for first-time users. She appreciates this service since they have previously experienced a brand that wouldn’t seat on the bottles and then jammed the capping machinery.

The capper is a complex piece of machinery with a precisely-shaped head (pressure block) and several sets of rollers designed to mold the screwcap in a specific manner. Precision springs apply a pressure of around 400 lbs. force (28.12kgf/cm2) to the pressure block. This squeezes and forms the screwcap on the bottle’s top sealing edge, forming the seal. This part of the sealing is referred to as a reform or redraw. The capper should be set to the particular screwcap manufacturer’s settings.

Wineries should consult with Alcoa, Zalkin, Silgan, Arol, Bertolaso or other capper manufacturers to determine top pressure in a capper.

“There are three general types/ shapes of pressure blocks,” explains Crochiere: “1) a flat surface that produces a top seal only, 2) a partial or slight curved block that produces a slight corner seal, and 3) a full reform that draws or wraps the closure and liner around the top of the glass and seals 1.5 to 2.0 mm down the outside of the bottle.”
The rollers that form the threads need to be exactly aligned and moving at a speed that will allow them to be inserted and released at the proper time.

Steve Rasmussen (owner of S.L.O. Bottling Services), notes that the capper head needs to move slow enough in order to allow these rollers to accurately form the threads. If speed is essential, more heads should be installed.

The second set of rollers simultaneously crimps (undertucks) the aluminum closure under the pilfer ring and smooths the skirt to complete the seal and hold the cap in place. The head and screwcap manufacturers recommend specific pressures for each of these sets of rollers.

Another important factor is the head space to allow for wine expansion without creating excessive internal pressure in the sealed bottle. Generally, screwcap manufacturers suggest around 2% of the wine volume. This fill level should be checked periodically throughout the bottling process.

As more winemakers become familiar with using screwcaps, one current debate is on sparging with either nitrogen or CO2 prior to cap placement, to displace any oxygen. Some winemakers and bottling line companies use nitrogen gas, while others are using liquid nitrogen. Patrick Pickett (Pepi Wines), uses liquid nitrogen that requires little time to displace the oxygen.

“The total packaging oxygen (TPO) exposure to the wine is the sum of the oxygen pickup during transfer to the filler,” explains Crochiere, “pickup as the wine is being filled into the bottle, the oxygen added from the head space, and the oxygen ingress through the package (closure) during the life of the product. Typically the two largest contributors are the head space and the ingress.”

Figure I illustrates the amount of oxygen added to the filled product as a function of volume of head space. The chart shows two relationships, one with a complete flush as with liquid nitrogen, the other with no flush.

“If you use inert gas,” adds Crochiere, “the head space flush will not be as thorough due to air turbulence and allowed time. When using liquid nitrogen, there should be excess added so that bottles are sealed with 10 to 15 psi nitrogen pressure.
“Selection of the sealing liner and optimum reform will minimize ingress as illustrated by the oxygen permeability coefficients and ingress rates in Table I. The use of inert gas to flush the empty bottle before filling (with or without alternating vacuum) would optimize the filling line for minimum oxygen pickup.”

David Wright, production manager for Pacific Wine Partners (Gonzales, CA), uses CO2 which, being heavier, displaces oxygen. Hogue Cellar’s quality supervisor, Mei Yeung, notes that because screwcaps allow for relatively large head space, when compared to cork closures, the use of nitrogen, carbon dioxide, or argon is necessary to remove the oxygen from that space. Hogue uses liquid nitrogen. On the bottling line, the gas (regardless of type), is delivered just after filling and before cap application.

Quality control of the caps does vary. Jose Mendez, the bottling line supervisor for Ultima Mobile Bottling, has, on occasion, seen a difference in skirt lengths of 1 to 2 millimeters. The longer ones can block the cap feed. He also watches for the seal discs falling out of caps as they move through the cap feeding system.

After bottling, case storage is recommended at no more than three pallets high, in order to prevent excessive compression on the caps. PlumpJack Winery solves the problem by shipping bottles horizontally in six-bottle wooden boxes. Hogue Cellars stores screwcapped wine without pallets four-cases high for even distribution of vertical forces.

Testing on bottling line
As a basic method to ensure that bottles are properly sealed, most suppliers recommend periodic testing of the torque required to remove a screwcap. Several supply a torque tester to accurately and easily perform this test. Frequency of this testing is up to the winery, although one bottle, every one to two hours per capper being used, is a commonly mentioned standard.

Wright suggests that the torque specifications should be in the range of 5 to 15 inch-pounds. The test is conducted with two twists. The initial twist breaks the seal and should be on the higher side of the range. The second breaks the aluminum “bridges” connecting the threaded portion to the lower skirt, and should be no less than the lower number in the range. (Normally the wine consumer would unseal and break the “bridges” with one motion.)

A pressure test is used by Wright to test the seal. This consists of injecting CO2, to apply pressure into the bottle via a threaded needle, while the bottle is under water. As the pressure is increased, an operator watches for bubbles escaping from under the cap. Normally the cap should hold a minimum of 20 lbs/in2 of pressure for still wines. Wright emphasizes, “This is an important test as the internal pressure in the head space of a bottle can vary drastically due to elevation and temperature changes.”

“The Secure Seal Test (pressure test) injects any pressurized gas at a controlled rate into the bottle via a threaded piercing needle,” says Crochiere. “The specification of 150 psi is for carbonated soft drinks, beers should hold about 100 psi, still products like wine only need a closure that holds 40 to 50 psi. This is the force required to compress the liner material and allow the air to vent. A closure that is applied incorrectly can leak at very low pressures.”

Several companies supply testing equipment for these checks. Contact your screwcap supplier or these testing equipment suppliers: Secure Pak or Dillon.

Additionally, a bottling line worker should make a visual inspection of the caps; noting the smoothness of the threads, any deformation or bulges at the top, and a clean crimp line. When the top of the cap is removed, it should separate cleanly at the “bridges,” with no torn or sharp edges to cut the opener’s fingers.

“Inspection should also include the coatings and inks — the more decorated the cap, the more likely there will be paint and ink dust generated in the screwcap hopper,” adds Crochiere. “This can be unsightly, but more important, the dust will collect inside the caps and contaminate the wine. In addition, check for coating lifting at the cut edges of the pilfer bridges and the bottom of the cap. Dark color caps show scratches much more than light color caps as the exposed aluminum makes a sharp contrast.”

QC issues for further research
In 1999, Peter Godden and colleagues at the Australian Wine Research Institute (AWRI) undertook an extensive research project on closures for wine bottles — including the use of corks, synthetic corks, and screwcaps. One result of their testing was that screwcaps showed the least reduction in free SO2 of all closures tested.2

Having noted a similar maintenance of SO2 levels by screwcaps, several winemakers interviewed for this article including Shaun Richardson, vice president and winemaker at Clos Pegase (Calistoga, CA), are looking into the possibility of reducing the SO2 level at bottling.

However, the AWRI closure research project also indicated, through sensory testing, that the screwcap closure had the highest “reduced” aroma. It was described as “struck flint” or rubbery.1 The authors reporting the study subsequently note that, after 36 months in the bottle, the same wine sealed with the corks also exhibited similar aromas. Further exploration of the causes and/or relation between the SO2 levels and reduced aromas issues will be required.

Perhaps associated with this reduction are the yet-to-be totally defined differences in permeability of sealing materials in discs of various screwcap brands. While Conover indicated that he does not want breathability with the PlumpJack Cabernets and hence uses the Saran/Tin seal, Richardson uses the Saran/Tin for the Clos Pegase Sauvignon Blanc wines, and Saranex disc seals for the Chardonnay, in order to allow some oxygenation during ageing. The jury appears to still be out on the issues of seals and wine type, with more experimentation and experience necessary.

Screwcaps have a history of use in many industries. They are relatively new as a premium wine closure, but have a long history of use with low-priced wines. The technology and materials are well-tested and appear to be suitable for wine. If winemakers make sure their caps and glass are compatible, are cautious with new suppliers, and test frequently with the first bottlings, screwcaps should have a positive impact on wine, by providing, as Patrick Pickett notes, “consistency bottle to bottle.”

  1. Francis, L., J. Field, M. Gishen, A. Coulter, P. Valente, K. Lattey, P. Høj, E. Robinson, P. Godden. (2003, August). “The AWRI closure trial: sensory evaluation data 36 months after bottling.” Australian & New Zealand Grapegrower & Winemaker, 475, 59–64.
  2. Godden, P., L. Francis, J. Field, M. Gishen, A. Coulter, P. Valente, P. Høj, E. Robinson. (2001, September). “Results of an AWRI trial investigating the technical performance of various types of wine closure: Part II – Wine composition up to 20 months post-bottling.” Australian Grapegrower & Winemaker, 452, 89–98


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Bleeding moving heavy

My periods are started 1st July and finished 3rd July. Yesterday I had bleeding after moving heavy objects then I checked pregnancy test at home with pregnancy kit. Results are negative. I want to know what happened. Can u suggest me what should be done.?
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Dr. Devjani Das (Ganguly)
Gynecologist 16 yrs exp Kolkata
Were your periods due on 1st July, and was the bleeding and duration of the period normal, ie like your usual periods? Are you on any contraceptive pills? Missing pills can cause breakthrough bleeding. If your periods a generally regular & monthly, I would advise you to observe the bleeding pattern this month, and wait and see what happens in your next period. If you miss your next period at the expected time, please see a gynaecologist. Irregular bleeds may result from hormonal fluctuations in the body, though early pregnancy problems may also cause them.
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The National Theatre

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The National Theatre is the most important and representative theatre of the Czech Republic.

In The National Theatre you can see top opera and ballet performances.

The National Theatre was built from the desire of the Czech people for national independence. Its building was financed from the collections on which participated broad masses of the people as well as important donators (including the nobility and the emperor himself). The theatre foundation ceremonial on 16th May 1868 became a national celebration.

The theatre was opened in 1881. In the same year the theatre burned down, and this tragic event caused a huge wave of new collections to support the restoration of the theatre. The National Theatre was reopened in 1883 by the opera Libuse by Bedrich Smetana and since then it has been serving as a place of Czech national identity and as a flagship of the Czech culture to these days.

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Pharaohs, Cantonese and the Gang of Four

In this week's World in Words podcast: why did British band Gang of Four name themselves after China's notorious cultural revolutionaries? Also, was Hosni Mubarak Egypt's last pharaoh? Or is that just a cute turn of phrase? And is Cantonese, once the lingua franca of Chinatowns around the world., imperiled by the steady march of Mandarin?

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Time: Friday, 18 November 2016 12:00-14:00
Place: PRIO, Hausmanns gate 3, Oslo

Artificial Police Agents: Looking Awry

We now live in a world saturated with artificial agency, even though it is difficult to identify the agents.

Police intelligence is increasingly supported by big data analytics and machine learning, e.g. in the form of crime mapping and new types of criminal profiling.

This generates new issues around opacity and transparency that are key to the safety and security of individual citizens.

In this talk, Mireille Hildebrandt will discuss the implications for privacy, non-discrimination and the presumption of innocence as well as the methodological pitfalls that plague the employment of computational optimization. Though the latter term is less intuitive than 'machine learning', it may be time to acknowledge that 'learning' can also be a misleadning term that diverts attention from the invisible backend of technical systems that are employed. Such systems profile presort individuals which may lead to further scrutiny and monitoring.

As this part of investigations does remain hidden and does not fall within the scope of the presumption of innocence, it reconfigures the institutional landscape of the Rule of Law. Hildebrandt's argument will be that we must learn to 'look awry' at the input, the output and the computational operations of artificial agency, scrutinizing their claims to objectivity and truth without demonizing their employment.

Mireille Hildebrandt

Mireille Hildebrandt is a Research Professor at the research group for Law, Science, Technology and Society (LSTS) at Vrije Universiteit Brussels. She holds a PhD in the philosophy of criminal law from Erasmus University Rotterdam, and a law degree from Leiden University. Hildebrandt also holds the (parttime) chair of Smart Environments, Data Protection and the Rule of Law at the Institute for Computing and Information Sciences (iCIS) at Radboud University, Nijmegen.

12:00 – 12:15Welcome (Dariusz Kloza)
12:15 – 13:00Keynote: Mireille Hildebrandt
13:00 – 13:20Discussants (Kristoffer Lidén & Mareile Kaufmann)
13:20 – 14:00Open discussion with the audience

This seminar is organised in the framework of the LASIE (Large Scale Information Exploitation of forensic data) project, in association with the Nordic Centre for Security Technology and Societal Values (NordSTEVA).

A light lunch will be served from 11:30 onwards. Welcome!


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Call for Applications Now Open for 2016-2017 Pacific Security Scholars

Annual program provides the next generation of policymakers in the Pacific with a global platform to share their insights and analysis on contemporary security issues
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Foreign Policy

Honolulu - Hawaii - US

HONOLULU - Aug. 5, 2015 - PRLog -- The Pacific Islands Society believes that the combined challenges of geographical remoteness, limited finances and environmental vulnerabilities place Pacific Island Countries (PICs) at the fore of political relevance. Despite such constraints, Island nations have a great potential to develop innovative solutions to shared challenges. Their capacity to impact international policy just needs to be strengthened.

Growing concerns surrounding traditional and nontraditional security threats (e.g., maritime security and climate change) have shifted greater focus to the valuable contributions PICs can make in tackling global challenges. Although small, PICs are at the nexus of global powers on the periphery of the Pacific Rim amidst delicate power balances. Being at the frontline of addressing major security issues, the experience and perspective of PICs becomes definitive of how future generations will tackle issues like immigration, climate change, and natural disasters. The problem therefore is not the relevance of PICs. Rather, it is the need for broader opportunities to educate, empower and support the next generation of experts on the problems that they will ultimately inherit.

In recent years we have seen a greater effort in PIC representation and leadership in forums such as the UN Small Island Developing States (SIDS); COP21 Paris Climate Change Conference and regional and global disarmament efforts. Following the success of its inaugural class, the Pacific Islands Society wants to ensure PICs active engagement in these discussions not only continues, but expands in order to ensure the growth of Pacific Islands security policy experts. The Pacific Islands Society is therefore very excited to invite young professionals, postgraduate and research students from the Pacific region to participate the in 2016-2017 Pacific Security Scholars Program.

Leading experts and professionals actively involved in some of the highest levels of multilateral diplomacy will serve as mentors, providing one-to-one support and an exclusive insight into the intricacies of public diplomacy. Selected scholars will in turn have the opportunity to contribute their thoughts and policy recommendations on a global platform by submitting regular articles and opinion pieces for publication on the Pacific Islands Society website.

Lora Vaoileti, a member of the inaugural class says ‘the program gave me figurative pass to access regional experts on the Pacific. This helped me to build a picture of the broad challenges that our region faces. Along the way, I came to understand how willing many are to share their thoughts and discuss the issues with young leaders. And, I found these engagements to be both heartening and enlightening. Given the challenges of climate change as a risk-multiplier across our region, I believe that the timing of the Pacific Security Scholars Program is critical. Through the program, the Pacific Islands Society (PacSoc) offers a unique balance of mentorship, structure, networks, and generous insight to young leaders.’

The Pacific Islands Society is now accepting applications for the 2016-2017 Pacific Security Scholars Program. Students from the following countries, territories, prefectures, and states are encourage to apply: Fiji, Tonga, Papua New Guinea, Samoa, Vanuatu, Kiribati, Nauru, Solomon Islands, New Zealand, Federated States of Micronesia, Palau, Niue, Republic of Marshall Islands, Tuvalu, French Polynesia, New Caledonia, American Samoa, Tokelau, Guam, Timor-Leste, Wallis and Futuna, Hawai`i, Okinawa, and the Northern Mariana Islands.

If interested, please send an expression of interest, C.V., and two recommendations to: vicepresident@islandssociety.org. When submitting, please paste the requested items in the body of the email rather than as attached documents. Applications will remain open until October 1st, 2015 or until the five Pacific Security Scholars are chosen.

About the Pacific Islands Society

The Pacific Islands Society is an independent, non-partisan, non-governmental organization that develops and implements projects that inspire and empower Pacific islanders around the world. These projects are currently organized around two main themes: community projects and next generation leaders. PacSoc's community projects center on nine issue areas, including charity, conservation, democracy, disaster relief, education, equality, health, innovation, and sustainability. PacSoc's next generation leader projects support artists, athletes, chefs, incubators, musicians, policymakers, storytellers, and Ttechnologists. the Emerging Science and Technology Policy Centre partners with ´the Pacific Islands Society partners on the Pacific Security Scholars program.

Website: www.islandssociety.org

Eddie Walsh
Source:Pacific Islands Society
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Tags:Call For Applications, Foreign Policy, Security, Defense, Pacific
Industry:Defense, Non-profit
Location:Honolulu - Hawaii - United States
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House of Commons

The Register of Members' Financial Interests: Part 1
As at 13th October 2014

BAKER, Norman (Lewes)

2. Remunerated employment, office, profession etc

Ongoing income from royalties for publication of book entitled ‘The Strange Death of David Kelly’. Payments from Methuen Publishing Ltd, now of 35 Hospital Fields Rd, York YO5 4DZ:

Received £833.16 on 15 November 2013. Hours: no additional hours . (Registered 25 November 2013)

Received £263.74 on 19 March 2014. Hours: no additional hours . (Registered 19 March 2014)

11. Miscellaneous

I advanced a sum of money to help finance the release of an album by The Reform Club, a band of which I am a member. (Registered 23 August 2013)

Prepared 16th October 2014


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Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Gladwin of Clee: Clause 10 of the Bill seeks to put into statute part of the ACAS recommendations that have been used for a number of years. The Code of Practice: Disciplinary Practice etc (1977) states that, "Disciplinary procedures should", and lists a number of issues. The one to which I want to draw attention is (g), which states,

My concern with these amendments is that they seek to restrict that right. Amendment No. 262, as the noble Baroness explained, seeks to insert the words,

    "who is a full time paid official of a union". Amendment No. 263 further restricts it by saying that if the company recognises a union, then the full-time paid official must be employed by that trade union. Amendments Nos. 264 and 265 seek to take away the possibility of other employees representing someone who is in the middle of either a grievance procedure or a disciplinary procedure.

An employee who is subject to a disciplinary procedure or is pursuing a grievance will need the most effective representation that he or she can obtain, particularly if it is a disciplinary issue where his or her livelihood is at stake. It is not necessarily a full-time paid official who will be the best person to represent that employee. In my experience it is often the local branch secretary or a lay official of the trade union who is far better equipped to represent an employee who is subject to a disciplinary procedure.

Many trade unions have very few full-time paid officials. They depend upon their lay elected officials to represent their membership when they go through either disciplinary or grievance procedures. Also, speed is important, particularly if it is a disciplinary process. I am bound to say that the availability of full-time officials is sometimes not immediate and so one has to

16 Jun 1999 : Column 327

rely upon lay officials. There are circumstances where neither a fellow worker nor a full-time official would be the most appropriate person to represent an employee who was subject to disciplinary action or who was pursuing a grievance.

I can think of a number of circumstances, which are quite usual these days, where a manufacturer has a number of contractors on site who are there virtually permanently. The employee is often not represented, but he wants speedy assistance and will often go to the shop steward, the convenor, of the host site.

My objection to the amendments is that they restrain the right of an employee to be accompanied and represented at disciplinary and grievance procedures.

Lord Tebbit: I find myself in the slightly odd position of having to agree with an amendment put forward by the Liberal Benches. However, we have had a few concessions from the Government Front Bench, which makes it a kind of holiday, so we may as well double it. I support the sentiment behind Amendment No. 261, although I have some concerns about it.

I recollect saying when I was a lay official in my trade union, in a moment of irritation when we came to consideration of the minutes of the previous meeting which had been provided by the employer's secretariat, that the minutes of a meeting should represent the lies which were actually told and not the lies which people subsequently wished they had told. I carried that thinking through to my days as a Minister. I would frequently insist, before people left my office after a difficult meeting at which we thought conclusions had been reached, that the conclusions should be written down in an aide memoire, and that we should all read them and agree that that is what we thought we had agreed before the meeting finally broke up. It is important for the avoidance of unnecessary future disputes.

Amendment No. 261 only refers to a written record of the hearing, and it might be implied that Parliament did not intend it to cover an electronic recording of the hearing. I should like to hear from the Minister whether that is likely. I have always found that lawyers say that if you include one bit of detail, there is an implication that the other bits, which might have been there but were not, are specifically excluded.

I also agree with the intention behind the other amendments, but I hope that they cannot be held to exclude a lay member of a union accompanying the person who is the subject of the disciplinary action.

I am still a member of the British Airline Pilots' Union. That union has very few paid officials. Most of the work is done, and done in my view much better, by lay members. I would not want to see in the legislation a situation whereby they were not allowed to represent and support a member who is appearing in disciplinary proceedings.

As I listened to noble Lords, it went through my mind that we should thank the Lord that the Government are not putting into law the marriage service. My goodness; just imagine the length of the schedules, the

16 Jun 1999 : Column 328

amendments and the discussions as to the meanings! Indeed, it has worked rather well on the whole, and I do not think it would have worked any better if it had had 75 pages of legal jargon stuck on the end of it; nor will the Bill.

Lord McCarthy: It may be working very well, but it is being used less and less.

I hope that the Government will accept Amendment No. 261. As the noble Lord, Lord Meston, stated, frequently there is no agreed record of tribunal proceedings and no right of the representative of the employee to compile an independent record. The noble Lord, Lord Gladwin, read from a 1976 document, but that does not state that an individual worker has a right to a representative and that that representative has a right to write, nor is it found in a more recent publication, the employment handbook of ACAS. Most people with any real experience and feel for this subject would never deny the right of a worker to have a representative, nor would they deny the right of that representative to write and give their account. Perhaps the authors of these handbooks assumed that it was a natural thing. It is time that it was put into the law, and I hope that the Government will do that today.

Baroness Gardner of Parkes : I have sat for 20 years in an industrial tribunal. In theory, I agree that it is a good idea that the representative should take a note. I agree with the noble Lord, Lord Meston, that it would be helpful to the tribunal to have those notes.

However, a major problem is that if someone is slowly and laboriously scribbling away it will inhibit the proceedings and the flow and interchange. The noble Baroness, Lady Miller, suggested a tape recording which could later be transcribed. That is a good idea. In a number of hearings, verbatim reports have been prepared from tape recordings and there has been no argument about it. Where, however, people have different notes, very often those notes do not agree.

In my capacity as chairman of a charity, a case was brought against the charity which was very interesting because it was a very different experience from sitting and hearing cases. In that instance the employee flatly refused to sign any text of any meeting that we produced. She was very much a loner and refused to have anyone with her. We asked her to sign the note to say not that she agreed with it but that it was a correct record of the meeting. She would not sign anything because someone had told her not to sign anything. It was an impossible situation.

The most difficult situation occurs before commencement of the disciplinary or grievance procedure, for example when someone is called in for a general discussion about their affairs and is asked if they would like to bring someone with them. They automatically think that it must be really serious. Very often, what begins as a consultation between the two parties progresses to either a grievance or a disciplinary procedure. In those circumstances the meeting should be suspended and the resources that are set out here should

16 Jun 1999 : Column 329

be offered. The transition between a general discussion on employment and the formal procedure is not fully covered in the Bill.

No matter how much detail you put down to cover these things, they never quite work in the way intended. Although every detail is here, there will still be something which will be defective. I would be worried about people taking notes in such a slow and laborious way because it would hold up proceedings. That is why I was hoping that there might be some agreement for having tape recordings, which could be transcribed later.

Lord Wedderburn of Charlton: Underneath many of the comments made by Members of the Committee is the question whether there must be a grievance or disciplinary procedure. As I understand it, the Bill does not go that far. Nevertheless, because we discussed this last year during the proceedings on the previous Bill on dispute resolution, the noble Lord, Lord Meston, will know that there is authority in the courts. I believe that the latest effusion was in 1995. However, it is possible that the Minister has some other authority or that he wants to get rid of it. I have in mind the case of Goold v. McConnell. According to the head-note, the Employment Appeal Tribunal held that the authority was,

    "an implied term in a contract of employment that the employers will reasonably and promptly afford a reasonable opportunity to their employees to obtain redress of any grievance". There are also remarks about disciplinary procedures, but the case is not concerned with them directly. However, if that be right and, if, in a general sense, there is an implied term that the employee has a right to a grievance procedure, it is likely that the courts will go a little further. Indeed, at the end, the judgment says:

    "The breach [of the contract] is the failure to provide or operate a proper procedure", and that was a continuing breach. There is talk about proper procedure and, obviously, in the next case one might predict that the nature of a proper procedure would be looked at by the court and that questions such as keeping a record would have some impact in that respect. I can imagine a case where a number of the elements of a grievance procedure addressed today might be taken further as a matter of implication in the contract of employment.

I am neither advocating nor speaking against this at the moment. I simply ask the question: will the new Bill operate side by side in the perspective of the Government, and indeed of other noble Lords who have spoken, with a set of clauses which assume that there is some kind of grievance procedure? Perhaps I may express an opinion and say that I do not believe that that is the most sensible way to proceed. We would perhaps have fewer clauses and paragraphs if we had a short section in the Bill which stated that there should be such procedures. Of course, that is a personal view, which the Government may well have considered and rejected. However, if they had rejected it, did they want in any way to obstruct the precedents, which are now bound to follow the Goold case of 1995?

Next Section Back to Table of Contents Lords Hansard Home Page


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Airdate: Oct 13, 2009
Scientist: Dr. Ron Fearing

KSC Biomimicry - Gecko Adhesion

KSC Biomimicry - Gecko Adhesion
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RF: “So one of the really fascinating things we’ve found in the last few years is how do geckos stick to walls; the fundamental reason behind this turns out to be a universal thing.”

It’s the sort of thing that could lead to a new kind of superhero. I’m Jim Metzner, and this is the Pulse of the Planet. UC Berkeley engineer Ron Fearing develops materials with special characteristics, and he does this by paying close attention to the natural world. Well, it turns out that geckos have the unique ability to climb walls, not by having sticky stuff on their feet, but by utilizing a natural principle of attraction that’s only recently been recognized by scientists. Ron Fearing explains.

RF: “When you bring two very small things in contact, they’re attracted to each other. Basically, there’s instantaneous motion of the electrons and the atoms, and they cause two things to be attracted to each other. If you stick your finger on a desk, unless there’s something sticky on there, you don’t really notice that you’re being attracted to the table. Well, that’s because you can’t sense it. It’s such a small force.”

Now, multiply that force by millions, and you could climb a wall like Spiderman. Or Gecko-man.

RF: “The secret behind the gecko adhesion is that rather than making just a single contact with a few nanonewtons of force, they have millions or hundreds of millions of contacts simultaneously. So, if you looked at detail at the end of a gecko toe, there would be tens of thousands of fibers on that toe, and on each fiber there would be up to a thousand nanofibers on the end of that fiber. And you can imagine millions of these contacts. And each one of these contacts makes a very small amount of adhesive force, but you have so many of them that they combine together; you get real significant forces you can really feel.”

Ron Fearing is one of the scientists participating in the Kids’ Science Challenge, our nationwide competition for third to sixth graders, made possible by the National Science Foundation. You’ve been listening to Pulse of the Planet. I’m Jim Metzner.


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The Falcons of Fire and Ice

By: Karen Maitland

Date Released

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The Falcons of Fire and Ice by Karen Maitland, author of the hugely popular Company of Liars, is a powerful historical thriller which takes you right back to the darkest corners of the 16th century. Intelligently written and meticulously researched, it is a real treat for all fans of CJ Sansom and Umberto Eco's The Name of the Rose.
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Karen Maitland travelled and worked in many parts of the United Kingdom before finally settling in the beautiful medieval city of Lincoln. She is the author of The White Room, Company of Liars, The Owl Killersand The Gallows Curse. The latter three titles are available as Penguin paperbacks.
Publication Date:
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etiology of shock

Philip C Spinella
Preventable deaths after injury must be reduced to improve outcomes for trauma patients. The elimination of preventable deaths after injury has been documented by the 75th US Army Ranger Regiment. Therefore, zero preventable deaths after injury is an achievable goal. Trauma is the most common cause of death between the ages of 1-46 and is the most common cause of life-years lost, before 75 years of age, compared to all other etiologies. Traumatic Hemorrhagic Shock (THS) is the leading cause of death that is preventable after injury, accounting for potentially 17,000 preventable deaths per year in the US...
March 22, 2017: Journal of Trauma and Acute Care Surgery
Rudy J Castellani, Gruschenka Mojica-Sanchez, Gary Schwartzbauer, David S Hersh
The pathophysiology of acute-on-chronic subdural hematoma (ACSDH) is complex and incompletely understood. Evidence to date indicates that the overall process is initiated by rotational force with movement of the brain inside the skull, which exerts tensile strain and rupture of bridging veins, leading in turn to acute hemorrhage in the subdural potential space. This is followed by the proliferation of mesenchymal elements with angiogenesis and inflammation, which in turn becomes a substrate for repeated hemorrhage and expansion of the lesion...
March 18, 2017: American Journal of Forensic Medicine and Pathology
Eric Siddall, Minesh Khatri, Jai Radhakrishnan
In various human diseases, an increase in capillary permeability to proteins leads to the loss of protein-rich fluid from the intravascular to the interstitial space. Although sepsis is the disease most commonly associated with this phenomenon, many other diseases can lead to a "sepsis-like" syndrome with manifestations of diffuse pitting edema, exudative serous cavity effusions, noncardiogenic pulmonary edema, hypotension, and, in some cases, hypovolemic shock with multiple-organ failure. The term capillary leak syndrome has been used to describe this constellation of disease manifestations associated with an increased capillary permeability to proteins...
March 16, 2017: Kidney International
Fen Hu, Zhenhai Hui, Wei Wei, Jianyu Yang, Ziyuan Chen, Bu Guo, Fulin Xing, Xinzheng Zhang, Leiting Pan, Jingjun Xu
Rheumatoid arthritis (RA) is a chronic and systemic autoimmune-disease with complex and unclear etiology. Hypotonicity of synovial fluid is a typical characteristic of RA, which may play pivotal roles in RA pathogenesis. In this work, we studied the responses of RA synovial fibroblasts to hypotonic stress in vitro and further explored the underlying mechanisms. Data showed that hyposmotic solutions significantly triggered increases in cytosolic calcium concentration ([Ca(2+)]c) of synoviocytes. Subsequently, it caused rapid release of ATP, as well as remarkable production of intracellular reactive oxygen species (ROS)...
March 6, 2017: Biochemical and Biophysical Research Communications
Antonio Gutiérrez-Pizarraya, Marc Leone, Jose Garnacho-Montero, Claude Martin, Ignacio Martin-Loeches
BACKGROUND: There is a concern to conduct de-escalation in very sick patients. AIMS: To determine if de-escalation is feasible in ICU settings. METHODS: We performed a metaanalysis of published studies conducted comparing de-escalation (defined by withdrawal of at least one antimicrobial empirically prescribed, switch to a new antimicrobial with narrower spectrum and withdrawal of at least one antimicrobial plus change of another drug to a new one with narrower spectrum) in non-immunocompromised patients with sepsis admitted to ICU...
April 2017: Expert Review of Clinical Pharmacology
Brian B Gowen, Brady T Hickerson
A growing number of bunyaviruses are known to cause viral hemorrhagic fever (VHF), a severe febrile illness which can progress to hypovolemic shock and multi-organ failure and is characterized by hematologic abnormalities and vascular leak. At present, there are no approved vaccines or antiviral therapies to effectively prevent or treat VHF caused by pathogenic bunyaviruses. Advances in the modeling of bunyaviral infections have facilitated efforts towards the development of novel post-exposure prophylactic and therapeutic countermeasures, several of which may some day be approved for human use...
March 2017: Journal of Microbiology / the Microbiological Society of Korea
Cansu Alyeşil, Nurettin Özgür Doğan, İbrahim Ulaş Özturan, Seda Güney
BACKGROUND: Distributive shock is a hyperdynamic process resulting from excessive vasodilatation. Impaired blood flow causes inadequate tissue perfusion, which can lead to end-organ damage. Although the most common etiology is septic shock, anaphylactic and other etiologies should be considered. CASE REPORT: We report the case of a 30-year-old female who presented to the emergency department with nonspecific symptoms and hypotension after a viral upper respiratory infection...
February 18, 2017: Journal of Emergency Medicine
Kimie Oedorf, Danielle E Day, Yotam Lior, Victor Novack, Leon D Sanchez, Richard E Wolfe, Hans Kirkegaard, Nathan I Shapiro, Daniel J Henning
INTRODUCTION: Lactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. Whether a serum lactate provides similar prognostic value across diseases is not fully elucidated. This study assesses the prognostic value of serum lactate in ED patients with and without infection to both report and compare relative predictive value across etiologies. METHODS: We conducted a prospective, observational study of ED patients displaying abnormal vital signs (AVS) (heart rate ≥130 bpm, respiratory rate ≥24 bpm, shock index ≥1, and/or systolic blood pressure <90 mmHg)...
February 2017: Western Journal of Emergency Medicine
Kayla Johnson, Joanna L Stollings, E Wesley Ely
OBJECTIVES: A 30-year-old patient presented with hallucinations and profound shock. He was initially misdiagnosed as having severe sepsis; once ingestions were considered, he was diagnosed as potentially having arsenic toxicity. SUMMARY: The clinical story reveals many instructional lessons that could aid in the evaluation and management of future patients. This man presented with large amounts of blue crystals around his nose and lips from inhaling and eating boric acid (an ant poison) so he could, as he put it, kill the ants "pouring into my mouth and nose and up into my brain...
February 2017: Southern Medical Journal
Kyu-Hwan Park, Chan-Hee Lee, Byung Chun Jung, Yongkeun Cho, Myung Hwan Bae, Yoon-Nyun Kim, Hyoung-Seob Park, Seongwook Han, Young Soo Lee, Dae-Woo Hyun, Jun Kim, Dae Kyeong Kim, Tae-Jun Cha, Dong-Gu Shin
BACKGROUND AND OBJECTIVES: This study was performed to describe clinical characteristics of patients with left ventriculars (LV) dysfunction and implantable cardioverter-defibrillator (ICD), and to evaluate the effect of ICD therapy on survival in Yeongnam province of Korea. SUBJECTS AND METHODS: From a community-based device registry (9 centers, Yeongnam province, from November 1999 to September 2012), 146 patients with LV dysfunction and an ICD implanted for primary or secondary prophylaxis, were analyzed...
January 2017: Korean Circulation Journal
Lukasz A Myc, Jonathan G Stine, Rinita Chakrapani, Alexandra Kadl, Curtis K Argo
AIM: To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholamine-refractory septic shock. METHODS: We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents...
January 18, 2017: World Journal of Hepatology
Jiajia Liu, Conor Bell, Vagia Campbell, Julian DeBacker, Erik Tamberg, Christie Lee, Sangeeta Mehta
INTRODUCTION: Noninvasive ventilation (NIV) is commonly used as first-line therapy for immunocompromised patients with acute respiratory failure. However, it may not be appropriate for all patients, as failure of NIV and delayed endotracheal intubation (ETI) may increase mortality. We report our center's experience and outcomes for patients with active hematologic malignancy (HM) treated with NIV. METHODS: We conducted a retrospective study of consecutive patients with HM who were admitted to the intensive care unit (ICU) of Mount Sinai Hospital for acute respiratory failure between January 1, 2010, and May 31, 2015, and were initially treated with NIV...
January 1, 2017: Journal of Intensive Care Medicine
Brian T Kalish
Hypotension is a common problem in neonates with complex underlying pathophysiology. Although treatment of low blood pressure is common, clinicians must use all available information to target neonates with compromised perfusion. Pharmacotherapy should be tailored to the specific physiologic perturbations of the individual neonate. Dopamine is the most commonly utilized agent and may be the most appropriate agent for septic shock with low diastolic blood pressure. However, alternative therapies should be considered for other etiologies of hypotension, including milrinone and vasopressin for persistent pulmonary hypertension of the newborn and dobutamine for patent ductus arteriosus...
January 1, 2017: Neonatal Network: NN
Silvia D Visonà, Gaetano Thiene, Savina Mannarino, Giulia Corana, Antonio Osculati, Annalisa Angelini, Stefania Rizzo
Noncompaction cardiomyopathy is a rare disorder, often associated with cardiac and noncardiac malformations. Hirschsprung's disease, a well-known aganglionosis, is associated with congenital heart diseases and has been reported to be due to impairment migration and differentiation of neural crest cells. Here, we present an 8-month-old male infant who died for cardiogenic shock after surgical resection of the involved bowel segment. The child was affected by both noncompaction cardiomyopathy and Hirschsprung's disease, two entities which can share a common neural crest-derived etiology...
March 2017: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Supreeth Nekkanti, Vijay C, Sujana Theja Js, RaviShankar R, Sumit Raj
INTRODUCTION: Simultaneous bilateral fractures of the neck of femur is rare. Hypocalcemia, epilepsy, osteoporosis and electrical injuries are known to cause similar injuries. CASE REPORT: We report a case of a 43-year-old male who sustained an electrical shock injury following which he fell from a height of around 4 feet. Radiological studies confirmed bilateral transcervical neck of femur fracture. Laboratory investigations revealed the patient had extremely low levels of vitamin D (11...
July 2016: Journal of Orthopaedic Case Reports
Johan Holmén, Jacob Hollenberg, Andreas Claesson, Maria Jiménez Herrera, Youcef Azeli, Johan Herlitz, Christer Axelsson
INTRODUCTION: Mortality after out of hospital cardiac arrest (OHCA) is high and a shockable rhythm is a key predictor of survival. A concomitant need for repeated shocks appears to be associated with less favorable outcome. AIM: To, among patients found in ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) describe: (a) factors associated with 30-day survival with emphasis on the number of defibrillatory shocks delivered; (b) the distribution of and the characteristics of patients in relation to the number of defibrillatory shocks that were delivered...
January 18, 2017: Resuscitation
Esmaeil Mortaz, Ian M Adcock, Atefhe Abedini, Arda Kiani, Mehdi Kazempour-Dizaji, Masoud Movassaghi, Johan Garssen
Sarcoidosis is a granulomatous disorder of unknown etiology. Infection, genetic factors, autoimmunity and an aberrant innate immune system have been explored as potential causes of sarcoidosis. The etiology of sarcoidosis remains unknown, and it is thought that it might be caused by an infectious agent in a genetically predisposed, susceptible host. Inflammation results from recognition of evolutionarily conserved structures of pathogens (Pathogen-associated molecular patterns, PAMPs) and/or from reaction to tissue damage associated patterns (DAMPs) through recognition by a limited number of germ line-encoded pattern recognition receptors (PRRs)...
January 17, 2017: European Journal of Pharmacology
Viki Kumar, Jaspinder Kaur, Pallavi Pothuri, Sahiba Bandagi
BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder of unknown etiology which can present at any age with symptoms of mucocutaneous, musculoskeletal, renal, central nervous system, and nonspecific clinical pictures making the disease a "master of mimicry". CASE REPORT A 53-year-old female, who was recently diagnosed with SLE, presented with right-sided sharp and electric shock-like facial pain starting at the side of her right nostril and traveling down the naso-labial fold and then back to the angle of the jaw, mostly in the region of V2-V3 distribution with no radiation beyond trigeminal distribution...
January 12, 2017: American Journal of Case Reports
Stine Maarbjerg, Giulia Di Stefano, Lars Bendtsen, Giorgio Cruccu
Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk...
January 1, 2017: Cephalalgia: An International Journal of Headache
Arun L Jayaraman, Daniel Cormican, Pranav Shah, Harish Ramakrishna
Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation...
January 2017: Annals of Cardiac Anaesthesia
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