Phil Jones Associates (United Kingdom)

Abstract When assessing the cleanliness of industrial hydraulic fluids, current procedures focus on particles above 4 µm in size. However, the use of more sophisticated techniques has confirmed that substantial numbers of much smaller particles can be formed in use — mainly by high‐temperature degradation processes.The paper outlines the mechanisms for fine particle generation and procedures for their measurement and control. Significant quantities can adversely affect fluid surface‐active properties and hinder the operation of system components.The effect of flow electrification or applied electrical fields to assist filtration is also discussed. The paper suggests that residual charge could stabilise particle dispersions, assist the depletion of dispersed anti‐foam particles and affect foam stability.An extension of the ISO 4406 cleanliness code to quantify the presence of fine particulate is recommended as is the need for further work to investigate the limits that should be placed on their presence in different applications. Copyright © 2015 John Wiley & Sons, Ltd.

Objectives: While mortality following acute myocardial infarction (AMI) has decreased over time, subsequent hospitalizations due to unstable angina (UA) and coronary revascularization (CR) continue to be a great source of burden both from a patient’s and a societal perspective. It is unknown, however, how AMI patients who experience these additional readmissions value their health and what the associated costs are, beyond the hospitalization itself. Methods: From TRIUMPH, a 24-center observational AMI registry, we identified patients readmitted for unstable angina (UA) or unplanned CR ≥1 month following index AMI discharge. Propensity matching was used to compare (1) patients who were vs. were not readmitted for UA and (2) patients who were vs. were not readmitted for CR. We examined one-year quality-adjusted life-years (QALYs) using the EQ-5D measurements at 1, 6 and 12 months, as well as post-discharge costs (office visits, cardiac rehabilitation and cardiovascular readmissions, excluding costs for the UA/CR event). Confidence intervals were calculated via bootstrap analysis. Results: A total of 140 (4.26%) were readmitted for UA and 112 (3.41%) patients underwent CR after their AMI. Unadjusted mean 1-year QALYs for UA and non-UA patients were 0.743 and 0.821 [propensity-matched difference -0.076 (95% CI -0.100, -0.042)]. Unadjusted mean 1-year QALYs for CR and non-CR patients were 0.798 and 0.828 [propensity-matched difference -0.032 (95% CI -0.063, -0.003]. Mean differences in costs were $8009 (95% CI $3997, $14229) for UA vs. non-UA patients and $4498 (95% CI $4046, $4966) for CR vs. non-CR patients. Cardiovascular rehospitalizations contributed most to these costs (Table) . Conclusion: In this study, over the year following AMI, patients experiencing UA or unplanned coronary revascularization were challenged in maintaining their health status as compared with those not experiencing the respective event and had significantly higher health care costs.

A fundamental aspect of the UK Programme of Decommissioning and Waste Management is the desire of the Nuclear Decommissioning Authority to achieve more for less. This requires the use of ‘incentives’ and target-cost arrangements. This paper examines the role and use of the NEC3 Engineering and Construction Contract and the Institution of Chemical Engineers Burgundy-Book conditions of contract. Questions are now arising about how incentives-based contracts/target-cost contracts actually work in practice. How do they provide an incentive and allocate the risk of cost/time overrun? What are the problems that are leading to disputes? These questions are addressed, as well as exploring the specific areas that contracting parties should now consider before signing up to an incentives-based or target-cost contract. The paper concludes by examining the desire in the industry to use ‘hybrid contracts’ that incorporate elements of fixed price, or longer-term target plus fee (for workstreams or sites where analysis of risks is required or where work needs to be better understood and characterised).