Critical decision making in surgical necrotizing enterocolitis (NEC) is highly complex and hard to capture in decision rules due to case-specificity and high mortality risk. In this choice experiment, we aimed to identify the implicit weight of decision factors towards future decision support, and to assess potential differences between specialties or centers. Thirty-five hypothetical surgical NEC scenarios with different factor levels were evaluated by neonatal care experts of all Dutch neonatal care centers in an online environment, where a recommendation for surgery or comfort care was requested. We conducted choice analysis by constructing a binary logistic regression model according to behavioral artificial intelligence technology (BAIT). We demonstrated how BAIT can analyze the implicit weight of factors in the complex and critical decision for surgery or comfort care for (surgical) NEC. The findings reflect Dutch expertise, but the technique can be expanded internationally. After validation, our choice model/BAIT may function as decision aid. Volume 11 - 2023 | https://doi.org/10.3389/fped.2023.1122188 This article is part of the Research TopicArtificial Intelligence and Machine Learning in Pediatric SurgeryView all 6 articles Background: Critical decision making in surgical necrotizing enterocolitis (NEC) is highly complex and hard to capture in decision rules due to case-specificity and high mortality risk we aimed to identify the implicit weight of decision factors towards future decision support and to assess potential differences between specialties or centers Methods: Thirty-five hypothetical surgical NEC scenarios with different factor levels were evaluated by neonatal care experts of all Dutch neonatal care centers in an online environment where a recommendation for surgery or comfort care was requested We conducted choice analysis by constructing a binary logistic regression model according to behavioral artificial intelligence technology (BAIT) Results: Out of 109 invited neonatal care experts 16 pediatric surgeons and one neonatology physician assistant Cerebral ultrasound (Relative importance = 20% 95% CI = 3.39–4.86) was the most important factor in the decision surgery versus comfort care in surgical NEC nationwide and for all specialties and centers Pediatric surgeons more often recommended surgery compared to neonatologists (62% vs hemodynamics and parental preferences were significant decision factors (p < 0.05) growth since birth (p = 0.25) and estimated parental capacities (p = 0.06) had no significance in nationwide nor subgroup analyses Conclusion: We demonstrated how BAIT can analyze the implicit weight of factors in the complex and critical decision for surgery or comfort care for (surgical) NEC but the technique can be expanded internationally our choice model/BAIT may function as decision aid In both pilot studies BAIT provided insight into implicit decision trade-offs In the present paper we will illustrate the use of this technique in cases of NEC on a nationwide and multicenter scale as it may function as an important future adjunct in moral medical decision making The aim of the current study is to identify, interpret and further elucidate the implicit weights of decision factors in a national context and to identify possible between-group variations that contribute to critical decision making, in the context of one of the most difficult decisions in medicine: surgery versus comfort care for a critically ill preterm neonate with surgical NEC (18, 19) This may offer future decision support and educational insights to evaluate decision making and improve collaboration between stakeholders we assessed decision making in surgical NEC nationwide (the Netherlands) and subsequently focused on the differences between neonatologists and pediatric surgeons between neonatal centers and between more and less experienced physicians In a previous pilot study, we have developed a decision-analysis tool for NEC based on BAIT (7) which was employed on a larger scale for the current study The BAIT technique comprises four steps: (1) definition of the expert decision and relevant factors; (2) determination of choice model structure; (3) design and execution of the choice experiment; (4) results analysis The study was approved by the University Medical Center Groningen (UMCG) Ethical Board (METc 2020/310) and all methods were carried out in accordance with relevant guidelines and regulations an expert group of two senior neonatologists and two senior pediatric surgeons defined the medical decision as follows: “to advise parents to proceed to surgery or to initiate comfort care (palliative care resulting in death) for a critically ill infant with confirmed NEC and clear indication for surgery This indication is a given fact for the sake of this experiment and is in daily practice always discussed within the multidisciplinary team treating the child (neonatologist pediatric surgeon and pediatric anesthetist) and can consist of intestinal perforation confirmed by abdominal imaging and/or clinical deterioration despite maximum active conservative treatment” This description captures the actual clinical situation as closely as possible The same expert group subsequently identified fourteen presumably relevant factors in the decision and their ranges (Table 1) Certain factor levels were purposely formulated in a subjective fashion rather than based on instrumental measurements (e.g. cerebral ultrasound “good prognosis” rather than “no intraventricular hemorrhage”) This served two goals: (1) experts usually form a personal conclusion (good/intermediate/weak) for certain decision factors based on multiple clinical/objective inputs so this resembles the clinical situation as closely as possible and; (2) we specifically aimed to capture subjective morality in our study Constraining factor combinations in real life were specified for exclusion from the scenarios presented in the choice experiment as they will not occur in real-life cases Excluded combinations were: (1) a gestational age of 24 or 26 weeks with a birth weight of 1,500 g; (2) gestational age of 30 weeks with a birth weight of 500 or 650 g; (3) no complications since birth in combination with poor lung function and/or poor neurodevelopmental prognosis from cerebral ultrasound Predetermined decision factors and their ranges within the predefined levels Second, the choice model structure was defined. We opted for a binary logistic regression model, because of the positive and intuitive results achieved in our pilot study (7) the weight of factors was modelled linearly (e.g. a positive linear impact of increasing gestational age towards the decision to operate) Third, the choice experiment was designed and executed. This consisted of scenarios mimicking real-life cases of surgical NEC patients, where a hypothetical yes/no choice should be made by the participating expert based on the provided factors (Figure 1) Efficient design techniques by Ngene software (version 1.2.1 ChoiceMetrics) ensured that the maximum amount of information regarding factor weights was obtained with each completed scenario This entailed that a total of 35 scenarios were created for each participant the first two scenarios were extremes (i.e. functioning as a form of positive and negative control for general NEC expertise Subsequent scenario order was randomized for each participant Example of a choice scenario as completed by participants pediatric surgeons and physician assistants of all tertiary neonatal care centers in the Netherlands were invited to participate to allow representation of all Dutch care providers with expertise and involvement in NEC care Participants were invited through e-mail to complete the experiment in an online application (WEM No-Code Platform) particularly for the type of choices made in experimental conditions with difficult trade-offs Example of an assessment generated by the nationwide choice model stating that the probability that a randomly sampled expert from the expert group would recommend to perform surgery on a patient with this profile equals 95% Color coding highlights which factors had a positive or negative contribution to the assessment The relative importance (RI) was determined as follows: for each factor the estimated weight is multiplied by the range of the factor (theoretical maximum effect of the factor) RI is then defined as the percentage contribution of each factor to the total theoretical maximum effect summed over all factors To establish between-group significance of the difference in importance weights we computed the standard error of the difference based on the standard errors of the weights and subsequently conducted standard t-tests Between-group difference in the frequency to advise surgery or comfort care was assessed by the Chi2-test We divided the participant—reported work experience subgroups in: less experienced (0–5 years) moderately experienced (5–15 years) and highly experienced (>15 years) physicians We invited 109 neonatal care experts, including 88 neonatologists and 21 pediatric surgeons. The choice experiment was completed by 45 neonatologists, 16 pediatric surgeons and one neonatology physician assistant. This amounted to a total of 62 participants out of 109 invitees (response rate 57%) (Table 2) Fourteen (23%) participants were excluded from subgroup analyses because they opted to omit occupational information: three from the specialty subanalysis six from the center subanalysis and five from the work experience subanalysis Factor weights for nationwide choice analysis and for the subgroup of neonatologists and pediatric surgeons are displayed in Table 3 Model fit of the estimated nationwide model was calculated at a McFadden’s ρ2 value of 0.27 The mean absolute deviation was 5.8% indicating that on average the predicted probability (percentage) of a recommendation to operate by the model was 5.8% higher or lower than the observed percentage of experts choosing for operation in the choice experiment eleven had significant impact on the decision growth since birth (p = 0.25) and estimated parental capacities (p = 0.06) did not significantly affect the decision in the nationwide model Estimated linear weight (beta coefficient) of each factor per level of the nationwide analysis and the neonatologist and pediatric surgeon subgroups Relative importance (RI) of decision factors RI determined by: betacoefficient×factorrangeSUM(allbetacoefficients×allfactorranges) **Significant difference (p < 0.01) based on standard error of the difference between beta coefficients The McFadden’s ρ2 of the neonatologist group (n = 44) and the pediatric surgeon (n = 14) group were 0.26 and 0.37, respectively. Table 3 depicts choices and regression analysis outcomes of neonatologists and pediatric surgeons pediatric surgeons were somewhat more inclined to advice surgery when compared to neonatologists (62% vs Cerebral ultrasound had the greatest RI for both neonatologists and pediatric surgeons (RI 21% Hemodynamics was the sole factor that differed significantly in impact on the decision between the two professions [RI 10% (neonatologists) vs RI of factors is displayed in Figure 4 for the four neonatal care centers with the most participants: center A (n = 17) center C (n = 7) and center D (n = 7) Other centers had participant numbers of <7 for subanalysis resulting in limited value for additional analyses The frequency of recommendation for surgery varied significantly between centers with 53% in center A 58% in center C and 57% in center D (p = 0.03) Interpretation of cerebral ultrasound was the factor with most impact on the decision in all four centers birth weight (RI = 16%) had an equal impact on the decision as cerebral ultrasound (RI = 16%) Four factors consistently had a significant effect in per-center regression analysis of all centers congenital comorbidity and parental preferences Factors with no significant impact on the decision in all four centers were sex growth since birth and estimated parental capacities (A) per center and (B) per work experience RI determined by: betacoefficientxfactorrangeSUM(allbetacoefficients×allfactorranges) *Significant difference (p < 0.05) based on standard error of the difference between beta coefficients Subgroup analysis for years of working experience as a specialist is displayed in Table 4 The overall trend for all groups was more scenario answers in favor of surgery with 398 (57%) answers in the 0–5 years 476 (62%) answers in the 5–15 years and 289 (55%) answers in the >15 years work experience group Comparing the linear weight of decision factors between the groups there was only a significant difference in cerebral ultrasound between 5 and 15 and >15 years experience groups (beta coefficient 1.72 vs course pre-NEC was not a significant factor in the decision for the 0–5 years work experience group (p = 0.09) whereas it was for the other two groups (5–15 years p = 0.02; >15 years p = 0.047) cerebral oxygenation was not significant in the >15 years group (p = 0.18) while in the 0–5 years experience (p = 0.02) and 5–15 years experience (p = 0.001) groups it was Estimated linear weight of the work experience subgroup analysis divided in three groups: 0–5 years (group 1) 5–15 years (group 2) and >15 years (group 3) of working experience as a neonatologist or pediatric surgeon we applied choice analysis techniques to identify analyze and codify the weight of factors in the decision for comfort care or surgery in a critically ill neonate with surgical NEC both over the nationwide analysis and subanalyses cerebral ultrasound was the factor with most impact on the decision birth weight and gestational age were the second and third most important decision factors for neonatologists whereas for pediatric surgeons these were hemodynamics and congenital comorbidity Factors of significant impact in all centers were cerebral ultrasound hemodynamics and parental preferences and the maximum difference in number of recommendations for surgery between centers was 10 percentage points with a mean absolute deviation of 5.8% the dominant weight of cerebral ultrasound and also the large impact of birth weight and gestational age may reflect the perceived importance of long-term neurodevelopmental function the recommendation for NEC surgery becomes much less desirable for participants due to the long-term cognitive and functional prognosis after surgery the findings possibly simulate a transition between the less and more experienced specialists: younger specialists focus more on more recently implemented monitor parameters (cerebral oxygenation) whereas more experienced specialists rely more on their clinical view (clinical course prior to NEC) this relative lack of experience with this technique might also have influenced results due to certain participants blunting its relevance in the decision Dutch experts in (neonatal) health care settings have a relatively harmonious set of medical expertise to be tailored to a medical decision in a child’s best interest our study reflects that the desire of parents for treatment more accurately represents the perspectives for future care of an infant than our subjective estimation of parental capacities The BAIT decision-analysis tool enabled us to capture the expertise of a nationwide panel of neonatal and pediatric surgical specialists It clearly provided insights into factors affecting their choices regarding one of the most difficult decisions in neonatology A limitation is that captured factors are considered important by Dutch physicians and may not be generalizable considering different ethical circumstances and attitudes surrounding the decision may exist worldwide it should be considered that our technique provides decision transparency but does not dictate which choice is “the best” in this nuanced critical decision this methodology can be applied to identify decision factor weights internationally or for parents a more elaborate European or worldwide choice experiment could offer insight into factors that influence this decision in other countries thereby shedding a light on the possible differences between countries and cultures choice analysis may be utilized to educate us about the weight of factors in medical decision making and reflect upon them Our methodology exposed between-group differences and showed that Dutch neonatal care experts have a generally harmonious set of medical expertise norms and values in critical decision making in surgical NEC the model may serve as a decision aid for neonatologists pediatric surgeons and parents of patients The raw data supporting the conclusions of this article will be made available by the authors The studies involving human participants were reviewed and approved by University Medical Center Groningen (UMCG) Ethical Board (METc 2020/310) The patients/participants provided their written informed consent to participate in this study All authors contributed to the study conception and design Design of the data collection instrument was performed by AB analysis and interpretation was performed by OV The first draft of the manuscript was written by OV and all authors commented on previous versions of the manuscript All authors contributed to the article and approved the submitted version Financial support for this study was provided in part by a grant from the European Research Council (ERC-Consolidator Grant BEHAVE The funding agreement ensured the authors' independence in designing the study Financial support for publication of this study was provided by the For Wis(h)dom Foundation (Project 9 Maeckelberghe (associate professor in bioethics and research ethics the Netherlands) for her guidance in ethical considerations and critical revision of our manuscript The authors declare the following potential conflict of interest: AB and CC are associated with Councyl (the latter two as cofounders) a Delft University of Technology spin-off that develops and commercializes the behavioral artificial intelligence technology (BAIT) that is presented in this article JH and EK declare that no funding was received and that there are no competing interests All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher Explainable artificial intelligence for safe intraoperative decision support Artificial intelligence and surgical decision-making A scoping review of clinical decision support tools that generate new 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necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology Received: 12 December 2022; Accepted: 31 January 2023;Published: 28 February 2023 © 2023 van Varsseveld, ten Broeke, Chorus, Heyning, Kooi and Hulscher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Otis C. van Varsseveld by5jLnZhbi52YXJzc2V2ZWxkQHVtY2cubmw= Specialty Section: This article was submitted to Pediatric Surgery a section of the journal Frontiers in Pediatrics Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish By LAURA WILLIAMSON FOR MAILONLINE Updated: 08:27 BST The blue sign welcoming you to Varsseveld is written in Korean This might strike you as more than a little strange – after all But Varsseveld, just north of the German border and home to 6,000 people, has one claim to fame. It is the birthplace of Guus Hiddink, the 62-year-old coach who took South Korea to the semi-finals of the 2002 World Cup and is to become the interim manager of Chelsea Former glory: The former museum (Guuseum) shine to local hero Guus Hiddink before it was replaced by the ruins of rubble.. Varsseveld would be your average Dutch village a school and a smattering of small shops at its centre a couple of windmills on the outskirts and more than a few bicycles a collection of Guus-themed memorabilia showcased by the coach's brother and local restaurateur Jacques Westerhoff after South Korea's success in 2002 eager to see the house where Hiddink was born in November 1946 and the ground where he first played competitive football But you'll be disappointed if you come to Varsseveld expecting to load your suitcase with Guus magnets perhaps stopping for a quick flick through one of the 16 biographies written about Hiddink after his World Cup success or to have your photo taken with the cardboard cut-out of the great man himself It closed in 2005 when the Koreans lost interest and Hiddink moved on to new challenges first with the Australia national team and PSV Eindhoven and then Russia How dare they close something so vital to the international football community You can still see the semi-detached house with the painted shutters where Hiddink and his five brothers grew up used to play football in the garden of the family home where the Hiddinks lived until Guus was 12 Hiddink's father was part of the Resistance during the Second World War and helped Jews escape from occupied Holland He also received a certificate from President Eisenhower thanking him for his help in smuggling Allied pilots out of the country The award is reprinted in Guus Hiddink's autobiography which can be purchased from a Varsseveld bookshop Sportsmail's Laura Williamson stands disappointment outside what used to be the once-famous Guuseum The village is the home of amateur side SC Varsseveld whose pitch is the other side of the railway line less than a mile from Hiddink's first home started his career there before joining Dutch side De Graafschap in 1967 Karel and Arnold - also played there and his father represented Varsseveld until he was 43 is keen to show me around the new clubhouse Rangers and Nottingham Forest in the trophy cabinet Maybe Hiddink will arrange a friendly if he continues in the job beyond May You get the impression we are the latest in a long line of tourists to traipse around the ground and smile and nod at the pictures of Hiddink as a youngster Green grass of home: Local referee Joop Knikkink reflects on Guus Hiddink with great pride at the Dutchman's hometown club SC Varsseveld There is pride in Knikkink's voice when he says: 'Guus is a good good coach.' Hiddink may have sold his home here preferring the bright lights of Eindhoven and Amsterdam but most people in Varsseveld are proud to speak about the local boy made good When I asked for a telephone directory in Varsseveld library the librarian smiled and turned straight to the page with surnames beginning with 'H' Yet some people in the village have had enough of people asking about 'Lucky Guus' and could not care less about the furore his name has sparked in a certain part of west London Man on a mission: Will Chelsea fans flock to Hiddink's hometown if he resurrects their season 'We're Guus Hiddink-ed out,' said the female manager of Die Ploeg a restaurant in the village centre that sponsors SC Varsseveld then the Russians and now you English will be turning up on our doorstep.' We had been told Die Ploeg had memorabilia from the Guuseum but we were to be disappointed again All traces of Hiddink vanished when the restaurant was re-decorated six months ago bearing fistfuls of euros and eager for a snap of anything connected with Guus They brought their own bottles of water and sat in the corner drinking them Will Blues fans be flocking to Varsseveld in their thousands if Hiddink can resurrect Chelsea's season or bring Champions League glory to Stamford Bridge They should be starting a 'Bring back the Guuseum' campaign Surely Roman Abramovich has the money to fund the return of a once-popular football gem The Mail on Sunday & Metro Media Group (BRAIN) — Spinov8 is no longer the North American distributor for special-needs bike brand Van Raam after seven years Because it was a single brand distributor for Van Raam which manufactures its bikes in Varsseveld will sell directly to North American dealers said Spinov8 Operations Director Tiffany Ovalles The split resulted from financial growth concerns and failing to reach agreement on terms and conditions during the past two years noting that shipping costs rose to almost $15,000 per container The decision to end the partnership came last week Van Raam did not respond to requests for comment "I even went and visited them in February to have a private presentation and to personally explain that we needed to find a new path forward The margins we were getting were basically that of a dealer," Ovalles said Spinov8 had about a dozen North American dealers and it contacted them to finalize outstanding business Ovalles said Spinov8's four employees will transition to Bike-On Bike-On co-owner and CEO Dan Pellett said Van Raam wanted a one-brand distributor and believes Spinov8 delivered the expertise it sought. "They didn't want to go into business with someone that was shipping multiple products because they wanted a focused group," Pellett said I think the last two or three years have felt like five years Because we really did work hard with these dealers So it's very unfortunate for us to see that hard work kind of go unnoticed We did not want our relationship to end with Van Raam this way We wanted to keep partnering with them in a way that was agreeable to both parties because the bikes simply are life changing." Van Raam has focused on special-needs cycles exclusively for about 30 years Each model also is available with a pedal-assist option Download the 2019 Industry Directory Read the 2021 Sales Training Guide IntroductionThe secondary treatment of sewage is a large and energy intensive process involving a biological digestion followed by a settlement of the solids created by the bioreaction The membrane bioreactor takes the place of the whole secondary stage – and does it better It is a device for the biological oxidation of the organic material dissolved in sewage and the separation from the resultant slurry of a relatively clean liquid (it will also largely do away with tertiary liquid/solid separation) The excess solids created by the oxidation process can then be easily removed for subsequent treatment and is rapidly becoming the best available technology (BAT) for waste water treatment The sludge settlement stage of the conventional secondary process is a fairly slow one so the removal of the clear liquid from the slurry is a better option and quite commonly to those of ultrafiltration A major advantage of the MBR system is that it can operate at a much higher solids concentration in the bioreactor than that of a conventional activated sludge plant The MBR plant can work effectively at MLSS (mixed liquor suspended solids) concentrations typically in the range 8000 to 12,000 mg/l (or 0.8 to 1.2%) and has been demonstrated successfully at up to 3% whereas conventional activated sludge plants work at about 2000 to 3000 mg/l This higher slurry concentration permits effective removal not only of dissolved organic material but also of residual particulate solids This high sludge concentration capability enables an MBR system to deal effectively with strong industrial wastes and factories are seeking to close their water cycles The MBR is a comparatively recent development (it is not mentioned as such even in the second edition of Keith Scott's “Handbook of Industrial Membranes”) although it has been in use in wastewater treatment for a number of years It was first developed to commercial use in the USA in the late 1970s and in Japan in the early 1980s There are now well over 1000 MBRs in use (if not 2000) although a significant number of these are only of pilot scale The cost of an MBR plant for secondary processing is still higher than that for a conventional plant the life cycle cost differential will soon disappear and the process advantages should lead to rapid uptake of the MBR system by the waste water treatment industry The smaller footprint of an MBR plant will make it much more attractive for construction in developed urban areas The membrane bioreactor systemThe membrane bioreactor in its present embodiments constitutes a complete plant for the treatment of sewage once the large floating materials and the suspended grit have been removed A normal sewage treatment works would have a primary settlement stage after screening and grit removal but the ability of the MBR to deal with high solids loadings means that some of the primary settlement can be left to the MBR The basic MBR consists of two processing steps – a bioreactor in which aerobic bacteria digest organic material in the presence of dissolved oxygen in which relatively pure water separates from the suspension of organic matter and bacteria These two units may be set up to run in succession (i.e the liquid flows first through the bioreactor where it is held for as long as necessary for the reaction to be completed and then through the membrane separation stage) with a recycle of some of the separated sludge to the bioreactor the membranes are suspended in the slurry in the bioreactor which is appropriately partitioned to achieve the correct air flow with the surplus sludge withdrawn from the base of the bioreactor at a rate to give the required sludge retention time (and independent of the water offtake rate) This is then termed a submerged (or immersed) MBR Membrane formatTwo main formats are used for the membrane material welded in pairs around a panel for each pair hanging vertically and parallel to other such cartridges on either side of it Between the membrane sheets and the support panel are spacer sheets that allow the permeate to run from the inside of the membrane to a withdrawal nozzle at the top of the cartridge Liquid flow is from the outside in to the centre of the cartridge uses bundles of hollow fibres to form the membrane module with liquid flow from the outside of the fibres in to their centres The bottom end of the fibre is sealed shut and the top end together with all of the other fibres is sealed through an end cap into a permeate offtake chamber is perfectly capable of resisting the relatively low transmembrane pressures entailed in MBR operation but several manufacturers advertise their use of reinforced fibres Either of these formats can be used for submerged or sidestream operation with liquid flow from inside the tubes outwards into a permeate collection chamber These membranes operate in through-flow mode with separated sludge collecting inside the tubes and having to be backwashed out at regular intervals while the flat sheet and hollow fibre membranes operate in an approximation to cross-flow with the solids flushed away from the membrane surface by an air-scour operation A fourth format has the membranes in the shape of circular discs mounted on a horizontal shaft The whole array is submerged in the activated sludge suspension Permeate flow is from the outside of the double-sheet discs and in to the central shaft which is hollow to provide permeate offtake flow air scouring is used to remove solids from the vicinity of the membrane surface This may be the same as the air flow used to activate the solid suspension or (and especially in sidestream arrangements) the two gas injection systems are quite separate The disassociation of bioreaction from sludge settlement means that the bioreactor can be much smaller than in the case of conventional activated sludge processes This enables the skid mounting of MBR systems for easier installation Most membrane filtration processes require quite a high transmembrane pressure in order to produce an acceptable permeate flow rate the membrane bioreactor operates with a low differential or by the hydrostatic head of a deep bioreactor tank or by a low level of pressurisation of this tank The MBR mainly operates by ultrafiltration but some microfiltration membranes are now used as allowed by the degree of separation required An MBR is capable of removing suspended solids to levels of below 5 ppm and BOD to below 10 ppm (and much better in some cases) which figures are comfortably below the current 20/30 requirements for marine and watercourse discharges By careful choice of membranes a membrane bioreactor system can retain chlorine resistant pathogens such as Cryptosporidium and Giardia The longer sludge retention times permit the reduction of molecules difficult to biodegrade With proper system design nitrogen and phosphorus contents can also be significantly reduced The membrane bioreactor has lent itself very well to the “municipal” waste water treatment business with very large companies (as well as municipalities) taking an increasing part the operators of treatment works tend not to be the suppliers of the equipment used in them Rather is this done at two further levels: contractors engaged to build the works and specify the contained equipment and then the specialist manufacturers of the equipment as appropriate The MBR business can thus be found among the waste water equipment suppliers either the specialist builders of waste treatment equipment who have acquired membrane technology (possibly by buying a membrane specialist company) who have developed an expertise in waste water treatment The earliest developers were Zenon in Canada and Kubota in Japan closely followed by Wehrle Werk in Germany There are now around 30 manufacturers of MBR systems world-wide of which the largest include Zenon (now part of GE Water Technologies) Kubota (which has several licensees around the world) USFilter (now part of Siemens – which puts two of the largest manufacturers under the umbrellas of massive corporations) The numbers of installations are variously quoted presumably from different times of writing but it seems likely that Zenon has several hundred reference plants and Mitsubishi Rayon over 700 (the latter two mostly in Japan) The largest MBR plant (at the time this article is being written – which may well be exceeded very shortly) is the Brightwater plant which will treat a waste water flow of 495,000 m3/day (495 megalitres per day) when it starts up in 2010/2011 The MBR plant for Brightwater will be supplied by GE Zenon DevelopmentsIn the long history of waste water treatment (over 110 years) the membrane bioreactor is quite a recent invention is still in a period of intense development Three key areas of system investigation can be identified: the nature of the membrane coupled with operating energy consumption air/gas handling and the bioreaction itself By the standards of most membrane processes they have a low transmembrane pressure differential in operation (and Development will continue to find membranes with lower cut points (i.e retaining finer solids) but without an increase in working pressure drop One of the disadvantages of the MBR system is a relatively high energy consumption per unit of liquid throughput and the energy required to drive the permeate through the membrane is a significant component of the total consumption so higher pressure drops will be unacceptable The gas flow through an MBR has two purposes – to dissolve oxygen in the suspending liquid and so feed the aerobic bacteria in the bioreactor and to scour the surfaces of the membranes to keep them free of solid deposits Design developments will continue to maximise the efficiency of both of these gas flows – with a reduction in energy consumption Perhaps the most exciting development in the MBR system would be its conversion from an aerobic process to anaerobic operation Conventional activated sludge plants are looking at anaerobic operation with a great deal of interest because of its potential ability to treat whole sewage in one process and at the same time generate (in the form of methane) sufficient fuel to drive the whole works with some over to deliver to the electric power supply grid (It is estimated that the energy content of a typical sewage inflow is about five times the energy required to run the treatment works so the current processes are clearly some way from being energy efficient.) Anaerobic operation of an MBR system would obviously need a change in the gas feed as well as operation at higher temperatures but the increased production of biogas would be a major advantage These developments have all concerned the MBR system itself in its application as a sewage and industrial waste treatment process a great number of other biological processes that might benefit from the continuous extraction of the liquid phase during the reaction and developments of the system to suit other processes entirely can be expected Free access to this content is for qualifying individuals only Corporate and institutional access requires an appropriate license or subscription For more information contact institutions@markallengroup.com Keeping my grandfather’s stories of freedom I’m worried that my generation is forgetting the importance of Remembrance Day As we move further away from World Wars I and II I fear the sacrifice of Canadian soldiers and veterans will soon become meaningless With fewer veterans around to share their personal memories it’s becoming increasingly important to make sure their firsthand stories are documented and shared Not everyone is fortunate enough to have grown up with a parent or grandparent who fought in one of the World Wars—wars that gained us the freedoms we have today I grew up with a front-row seat view to what WWII was like through the eyes of someone who lived through it himself: my grandfather From storming the beaches on D-Day to the liberation of Holland to even finding a hidden family of Dutch Jews beneath the floorboards of a farmhouse my grandfather was among the men and women who selflessly defended their country and the rights and freedoms of others My late grandfather was one of the few Jewish soldiers in the British Army since told to Historica Canada’s Memory Project reminds me and readers alike of his generation’s courage Whenever my mother asked if he wanted to attend Remembrance Day ceremonies at Nathan Phillips Square in Toronto Despite his refusal to talk about his experiences it was a moment in time that defined him as a young man and characterized the rest of his life You’d only need to walk a few steps through the door of my grandparents’ apartment to know my grandfather was a war veteran and keepsakes from his time spent in the 4th/7th Royal Dragoon Guards of the British Army I remember taking his beret to school once for show-and-tell I was certain he was going to call in a security team to ensure I brought it back in one piece For someone who didn’t like talking about the war the thought alone of losing a piece of it seemed to devastate him he worried it would end before he got a chance to enlist he’d read the local newspaper in Middlesbrough England to learn about the British army’s progress This is going to be over before I can serve!”  There was no doubt in his mind that enlisting was the right thing to do he became a member of his platoon’s tank crew as a driver and a gunner One of his most poignant memories was of an experience that took place in a small Dutch village called Varsseveld during the liberation of Holland my grandfather recounted the story in an interview for the Memory Project “Everything got quiet and I noticed a little kid tugging at the sleeves of the infantry as they walked by […] I jumped out of the tank and I walked over and the kid shook me I thought he was asking for gum or chocolate stamps on the floor that was covered in straw and up popped the trap door They’d been living under the floorboards for I don’t know how long […] she made me kneel down and blessed me for saving her.” my grandfather tried to find the family he’d discovered in that barn so many years ago my grandfather did a little of his own digging and learned that one of the brothers had immigrated to Burlington the man didn’t want anyone to know where he was He even anglicized his Jewish-sounding name out of fear that what happened to the Dutch Jews would happen again Even when my grandfather tried to reach out to him over the phone the gentleman was quick to hang up—reluctant to reminisce about the past This man’s ongoing fear of anti-Semitism startled my grandfather He believed enough time had passed that there was no longer any real need to worry would be saddened to discover the oppressive anti-Semitic acts that have taken place in communities around the world The people of the “greatest generation” fought too long and too hard to resist various forms of oppression for their efforts to be forgotten If we fail to remember the stories of those who experienced World Wars I and II and the evils our ancestors fought against we’re doomed to re-live similar prejudice and hatred Knowing and learning from stories like my grandfather’s has made a remarkable difference for my own understanding of what happened during the War Efforts to collect similar stories can serve future generations and strengthen their connections to the past There are hundreds of veterans with stories like my grandfather’s and many never get the opportunity to share them with younger generations These stories prove how valuable veterans’ memories are for sustaining the meaning of Remembrance Day and keeping the important roles of those before us alive don’t just buy a poppy to honour a veteran Spend a few minutes asking those veterans about their service defending our country We might not all have close relatives to share their stories of the past with us we play an important role: to carry on their legacy so that we may never forget All final editorial decisions are made by the Editor(s) in Chief and/or the Managing Editor. Authors should not be contacted, targeted, or harassed under any circumstances. If you have any grievances with this article, please direct your comments to journal_editors@ams.queensu.ca and website in this browser for the next time I comment Please use the form below to subscribe to Campus Catch-Up the new twice-weekly newsletter from the editors at The Queen’s Journal the national anthems of Poland and South Korea blared across the Busan World Cup Stadium But the heated atmosphere in the stands was not due simply to the weather.There was the usual pre-match anticipation Though Korea had qualified for more World Cup tournaments than any other Asian nation — five — it had not won a single match in the globe’s most popular sporting tourney no host nation had ever failed to make it beyond the first round of the tournament If Korea failed to win a match and failed to make it past stage one a gigantic banner was hoisted among the Korean fans the first foreign manager of a Korean World Cup squad did exactly that In a game attended by President Kim Dae-jung Korea scored a convincing 2-0 victory.From then on the team Hiddink had coached could do no wrong The previously unheralded South Korean side swept from victory to victory in a fairy-tale rush unseating three European powerhouses in the process Not only had Korea beaten a losing streak that went all the way back to 1953 a delirious possibility that the country might go all the way to the finals Millions of Koreans hit the streets to cheer on the team the serious-looking 55-year-old Dutchman — who was photographed during matches often with his chin on his fist — became the most celebrated foreign national in the nation.From Varsseveld to Seoul Born in 1946 Hiddink started his football career in the youth team of his hometown in the Netherlands he — and the club — were playing in Holland’s top league He retired as a player in 1981 and made the transition from doing to teaching in 1983 as an assistant manager at the famous PSV Eindhoven then became manager of the Dutch national side in 1995 where his no-nonsense leadership became apparent He united a team noted for internal squabbling he moved on to the management of superstar team Real Madrid but there his blunt speaking and lack of league success saw him given the boot a year later another opportunity beckoned on the far side of the world Though Japan had been expected to win exclusive rights to hold the first World Cup in Asia in 2002 underdog South Korea had come up with a brilliant international PR campaign “The Rightful Choice” made the case that Korea had — given its previous World Cup appearances — a better right to host the tournament than Japan A compromise was reached and FIFA allowed the first-ever bi-national co-hosting of the event “The Rightful Choice” had been the brainchild of PR executives Bill Rylance and Brian Matthews of Merit Burson-Marsteller; clearly foreign skill sets had been successful in winning the hosting rights Korea’s Football Association wanted to harness overseas expertise directly to the national side Hiddink was invited to coach Team Korea for a trial-by-fire in the summer of 2002.Guus takes commandThe early days were not encouraging There was the inevitable suspicion of the outsider though he maintained an ambience of quiet confidence Local reporters and camera crews took to following him around even filming him at restaurants as he discussed formations and tactics He was criticized for not taking his duties seriously when his girlfriend joined him.Worst of all Korea’s showing in matches prior to the World Cup were not encouraging The squad suffered 5-0 thrashings at the feet of both France and the Czech Republic in 2001 proved unable even to beat football also-rans Cuba and Canada Four months before the finals got underway there were calls for Hiddink’s upcoming dismissal.But on the pitch Hiddink had been making significant changes He ditched the seniority system that plagued Korean football promoting young players to the team if they had the fitness and the talent One of those he brought up would become South Korea’s most famous international football export (Park would later be pictured leaping into Hiddink’s arms after scoring during the World Cup.) One plus to the number of junior players he recruited to the team was that his boys were not tired out from a long season of club football as was the case with some of the European teams Hiddink also bought along his own conditioning coach who tuned the young players to a peak of fitness the team had tightly bonded and was fully familiar with the midfield- and winger-heavy formation Hiddink favored.The Dutchman’s early lack of popularity evaporated after that first win against Poland the press that had been (at best) ambivalent about Hiddink it is a credit to the generosity of the Korean fans — the exuberant “Red Devils” — that the manager would become as popular a figure as any of his star players.After Poland In a tense match that was partly overshadowed by the then-recent deaths of two schoolgirls in a road accident with Korea-based U.S troops — an issue that would explode onto the streets at the end of the year — the score was 1-1 Korea overcame highly favored Portugal 1-0 meaning the team was through to the knockout stage Korea — a nation where club football draws little interest — was going football crazy of Koreans donned the red national strip and flooded the streets of cities to watch their team’s games on giant LED screens set up overlooking plazas and intersections Questions were raised to FIFA about the legal status of these screens showing live matches but as an extraordinary carnival atmosphere gripped the nation For a while it is safe to say that many of the Koreans who gathered in public to watch the matches barely understood the offside rule it was clear that something remarkable was happening in South Korea Prominent members of the international football press corps would be quoted as saying how more exciting the ambience was in Korea than in Japan To the astonishment of global football aficionados and pundits Korea beat Italy 2-1 in extra time in what was arguably the tournament’s most exciting match Next it was Spain’s turn — the European nation went down at the last minute in a penalty shootout making Korea the first Asian team ever to advance to a World Cup semifinal.It could not continue: Korea’s winning streak was bought to a halt by eventual champions Germany Korea played Turkey in a third-place playoff that was (again) overshadowed by politics — North Korean gunboats sank a South Korean patrol vessel on the morning of the game a brilliant result for a nation that had appeared in five World Cup finals without winning a single match.At the conclusion of the Turkey game the celebrations were as happy and as good-natured as they would have been if Korea had won and Asia’s first World Cup came to a close.Hiddink the heroIn the wake of Team Korea’s remarkable showing A press corps who had previously been critical were now worshipful The manager’s trademark goal-scoring celebration — a circle and raise of his fist from waist height — was widely copied by Koreans of all ages He was favorably compared to Hendrik Hamel the Dutch sailor marooned in Joseon between 1653-1666 who wrote the first detailed account of Korea ever to be published in Europe.Hiddink was made an honorary Korean citizen and given cash bonuses free flights for life on the national airline and a holiday home on Jeju Island The city of Gwangju renamed their football stadium in his honor VIPs — including the newly minted mayor of Seoul an ambitious former businessman named Lee Myung-bak — queued up to shower him with honors to soak up the glory by being photographed alongside him An economic research institute penned a scholarly study on how the “Hiddink Effect” could be applied to business And Korean travel agencies arranged for Korea tour groups to visit Hiddink’s sleepy hometown in the rural Netherlands He returned to PSV Eindhoven — but he did take with him local stars Park Ji-sung and Lee Young-pyo And given that he was now seen as one of the world’s most successful managers of national football teams — in 2002 he was named FIFA’s Manager of the Year — he was subsequently retained by Australia as well as by English and Russian clubs.Though Guus Hiddink no longer maintains his connection with this nation’s team he remains an icon of that remarkable World Cup summer of 2002 a summer when Korean footballers and football fans astonished — and charmed — the world.Andrew Salmon is a reporter and the author of three works on modern Korean history _ ``U.S 1866 — the Present,’’ ``To the Last Round: The Epic British Stand on the Imjin River Black Snow: Britain and Australia in the Korean War 1950.’’Recommended Contents For YouTaboola 후원링크 Informationen på denna sida är avsedd för journalister press och media.Klicka ja för att komma till nyhetsrummet Klickar du nej kommer du tillbaka till mynewsdesk.com 2017 dedicated to digital transformation and record amount of investments (Varsseveld the Netherlands) Varsseveld-based Kramp Groep B.V which can be seen in the 2017 annual report published today Kramp saw its revenue rise to 790 million euro and reported a net profit of 50 million euro "With sales growth of 7.2% and a growth in net profit of 9% Kramp Groep can report on yet another successful year The ambitious goals we set ourselves have been achieved and we are well on our way to reaching the revenue target of 1 billion euro by 2020 We want to properly fulfill our aim to be the essential partner for our customers and suppliers The central theme of this annual report is "digital transformation" Eddie Perdok continues: "It is important for Kramp to be constantly adapting our strategy and developing our skills to make ourselves even more flexible Experience and knowledge are essential factors in the digital transformation process we are investing in knowledge and expertise in the field of digitisation and E-business." Kramp invested a record amount of almost 50 million euro There has been a drive towards expansion and modernisation in the warehouses in the Netherlands as well as a structural investment in the "Digital Commerce & Technology" (DC&T) organisation A total of 36 million euro is budgeted for investments for 2018 The structural investment in DC&T will be increased to 15 million euro per year the main emphasis of the investment is on logistics processes such as additional developments to the new systems in Germany and the Netherlands Kramp is investing time and energy in partnerships with suppliers In addition to the existing collaborations with tractor manufacturers AGCO and SDF a partnership with John Deere was entered into in 2017 for the German market the John Deere dealers get access to a huge range of technical parts in the sector The sales results are clear evidence that the John Deere dealers in Germany are very satisfied with the complementary range of parts from Kramp The digital transformation set in motion by Kramp in 2017 will continue in 2018 creating opportunities for all parties in the agricultural ecosystem Kramp wants to play an essential role in this "We want to strengthen our collaboration with suppliers but I am convinced that we at Kramp are on the right path and that we will be properly prepared to handle the digital challenges together" The complete annual report can be found at Kramp's website. Kramp grundades 1951 i Johan Kramps garage i Varsseveld i Nederländerna och har sedan dess vuxit till att bli Europas ledande grossist inom reservdelar och tillbehör till lantbruksbranschen Vårt mål är att underlätta för våra återförsäljare att driva sina verksamheter och att göra allt för att lantbrukare ska kunna jobba på Kramp gick samman med det nordiska företaget Grene 2013 och sedan 2017 går hela bolaget under namnet Kramp När du väljer att skapa ett konto och följa ett nyhetsrum kommer dina personuppgifter behandlas av oss och av ägaren av nyhetsrummet för att du ska kunna motta nyheter och uppdateringar enligt dina bevakningsinställningar För att läsa mer om detta, var vänlig läs vår Integritetspolicy som berör vår behandling av dina personuppgifter, och Integritetspolicy för Contacts som berör behandlingen av dina personuppgifter från ägaren av nyhetsrummet du följer Vänligen notera att våra Användarvillkor gäller alla våra tjänster Du kan dra tillbaka ditt samtycke när som helst genom att avregistrera dig eller genom att ta bort ditt konto Вы используете блокировщик рекламы в вашем браузере В этом случае Вы не сможете пользоваться всеми функциональными возможностями нашего сайта и его отдельными страницами который мы используем для отображения видеоконтента активированный блокировщик рекламы может вызывать проблемы с загрузкой сайта и корректным его отображением чтобы получить возможность использовать наш сайт в полной мере внесите Dynamo.kiev.ua в «белый список» вашего блокировщика что любые попытки обсуждения этого и других решений редакции сайта немедленно влекут за собой ограничение по п.2.9 правил сайта Today the world was gifted with several famous people closely linked to football: Vladimir Veremeyev (1948) - former footballer who played as a midfielder and forward He defended the colors of "Zvezda" and Kyiv "Dynamo." Six-time champion and three-time holder of the USSR Cup Holder of the Cup Winners' Cup and UEFA Super Cup in 1975 He played 26 matches for the USSR national team Vladimir Greber (1911-1965) - former footballer who played as a midfielder He was considered a master of penalty execution He defended the colors of Kyiv and Dnipropetrovsk "Dynamo." One of the few footballers who played for Kyiv in both pre-war and post-war squads Joe Cole (1981) - former English midfielder A product of "West Ham." Cole also had a successful career at London "Chelsea." At one point Joe spent a season at French "Lille," where he played on loan He participated in the England national team games during the World Cups in 2002 as well as at the European Championship 2004 Known as a successful mentor for several top European clubs and several national teams Hiddink has won 14 club trophies with his teams and has led the Korean national team and the Netherlands national team to prize-winning places in World Cup and European Championship tournaments It is worth noting that in Guus Hiddink's homeland there was a museum named after the coach "Guuseum" Стать участником фан-зоны Нажимая на кнопку, вы соглашаетесь с условиями членства в фан-зоне конвертировать карму в шурики Устанавливайте наше приложение и всегда оставайтесь в курсе футбольных новостей