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This work is an attempt to answer the question: How to use convex programming in shakedown analysis of structures made of materials with temperature-dependent properties. Based on recently established shakedown theorems and formulations, a dual relationship between upper and lower bounds of the shakedown limit load is found, an algorithmfor shakedown analysis is proposed. While the original problem is neither convex nor concave, the algorithm presented here has the advantage of employing convex programming tools.
An optimization method is developed to describe the mechanical behaviour of the human cancellous bone. The method is based on a mixture theory. A careful observation of the behaviour of the bone material leads to the hypothesis that the bone density is controlled by the principal stress trajectories (Wolff’s law). The basic idea of the developed method is the coupling of a scalar value via an eigenvalue problem to the principal stress trajectories. On the one hand this theory will permit a prediction of the reaction of the biological bone structure after the implantation of a prosthesis, on the other hand it may be useful in engineering optimization problems. An analytical example shows its efficiency.
Limit loads can be calculated with the finite element method (FEM) for any component, defect geometry, and loading. FEM suggests that published long crack limit formulae for axial defects under-estimate the burst pressure for internal surface defects in thick pipes while limit loads are not conservative for deep cracks and for pressure loaded crack-faces. Very deep cracks have a residual strength, which is modelled by a global collapse load. These observations are combined to derive new analytical local and global collapse loads. The global collapse loads are close to FEM limit analyses for all crack dimensions.
In the new European standard for unfired pressure vessels, EN 13445-3, there are two approaches for carrying out a Design-by-Analysis that cover both the stress categorization method (Annex C) and the direct route method (Annex B) for a check against global plastic deformation and against progressive plastic deformation. This paper presents the direct route in the language of limit and shakedown analysis. This approach leads to an optimization problem. Its solution with Finite Element Analysis is demonstrated for mechanical and thermal actions. One observation from the examples is that the so-called 3f (3Sm) criterion fails to be a reliable check against progressive plastic deformation. Precise conditions are given, which greatly restrict the applicability of the 3f criterion.
In: Technical feasibility and reliability of passive safety systems for nuclear power plants. Proceedings of an Advisory Group Meeting held in Jülich, 21-24 November 1994. - Vienna , 1996. - Seite: 43 - 55 IAEA-TECDOC-920 Abstract: It is shown that the difficulty for probabilistic fracture mechanics (PFM) is the general problem of the high reliability of a small population. There is no way around the problem as yet. Therefore what PFM can contribute to the reliability of steel pressure boundaries is demonstrated with the example of a typical reactor pressure vessel and critically discussed. Although no method is distinguishable that could give exact failure probabilities, PFM has several additional chances. Upper limits for failure probability may be obtained together with trends for design and operating conditions. Further, PFM can identify the most sensitive parameters, improved control of which would increase reliability. Thus PFM should play a vital role in the analysis of steel pressure boundaries despite all shortcomings.
The most of conventional methods of air purification use the power of a fan to draw in air and pass it through a filter. The problem of bacterial contamination of inner parts of such a type of air conditioners in some cases draws attention towards alternative air-cleaning systems. Some manufacturers offer to use the ozone's bactericidal and deodorizing effects, but the wide spreading of such systems is restricted by the fact that toxic effects of ozone in respect of human beings are well known. In 2000 Sharp Inc. introduced "Plasma Cluster Ions (PCI)" air purification technology, which uses plasma discharge to generate cluster ions (I 0-14 ). This technology has been developed for those customers that are conscious about health and hygiene. In our experiments, we focused on some principal aspects of plasma-generated ions application - time-dependency and irreversibility of bactericidal action, spatial and kinetic characteristics of emitted cluster particles, their chemical targets in the microbial cells.
A procedure for the evaluation of the failure probability of elastic-plastic thin shell structures is presented. The procedure involves a deterministic limit and shakedown analysis for each probabilistic iteration which is based on the kinematical approach and the use the exact Ilyushin yield surface. Based on a direct definition of the limit state function, the non-linear problems may be efficiently solved by using the First and Second Order Reliabiblity Methods (Form/SORM). This direct approach reduces considerably the necessary knowledge of uncertain technological input data, computing costs and the numerical error. In: Computational plasticity / ed. by Eugenio Onate. Dordrecht: Springer 2007. VII, 265 S. (Computational Methods in Applied Sciences ; 7) (COMPLAS IX. Part 1 . International Center for Numerical Methods in Engineering (CIMNE)). ISBN 978-1-402-06576-7 S. 186-189
Proceedings of the International Conference on Material Theory and Nonlinear Dynamics. MatDyn. Hanoi, Vietnam, Sept. 24-26, 2007, 8 p. In this paper, a method is introduced to determine the limit load of general shells using the finite element method. The method is based on an upper bound limit and shakedown analysis with elastic-perfectly plastic material model. A non-linear constrained optimisation problem is solved by using Newton’s method in conjunction with a penalty method and the Lagrangean dual method. Numerical investigation of a pipe bend subjected to bending moments proves the effectiveness of the algorithm.
7th International Conference on Reliability of Materials and Structures (RELMAS 2008). June 17 - 20, 2008 ; Saint Petersburg, Russia. pp 354-358. Reprint with corrections in red Introduction Analysis of advanced structures working under extreme heavy loading such as nuclear power plants and piping system should take into account the randomness of loading, geometrical and material parameters. The existing reliability are restricted mostly to the elastic working regime, e.g. allowable local stresses. Development of the limit and shakedown reliability-based analysis and design methods, exploiting potential of the shakedown working regime, is highly needed. In this paper the application of a new algorithm of probabilistic limit and shakedown analysis for shell structures is presented, in which the loading and strength of the material as well as the thickness of the shell are considered as random variables. The reliability analysis problems may be efficiently solved by using a system combining the available FE codes, a deterministic limit and shakedown analysis, and the First and Second Order Reliability Methods (FORM/SORM). Non-linear sensitivity analyses are obtained directly from the solution of the deterministic problem without extra computational costs.
The sorption of LPS toxic shock by nanoparticles on base of carbonized vegetable raw materials
(2008)
Immobilization of lactobacillus on high temperature carbonizated vegetable raw material (rice husk, grape stones) increases their physiological activity and the quantity of the antibacterial metabolits, that consequently lead to increase of the antagonistic activity of lactobacillus. It is implies that the use of the nanosorbents for the attachment of the probiotical microorganisms are highly perspective for decision the important problems, such as the probiotical preparations delivery to the right address and their attachment to intestines mucosa with the following detoxication of gastro-intestinal tract and the normalization of it’s microecology. Besides that, thus, the received carbonizated nanoparticles have peculiar properties – ability to sorption of LPS toxical shock and, hence, to the detoxication of LPS.
One of interesting but not well known water properties is related to appearance of highly ordered structures in response to strong electrical field. In 1893 Sir William Armstrong placed a cotton thread between two wine glasses filled with chemically pure water. When high DC voltage was applied between the glasses, a connection consisting of water formed, producing a "water bridge"
The absence of a general method for endotoxin removal from liquid interfaces gives an opportunity to find new methods and materials to overcome this gap. Activated nanostructured carbon is a promising material that showed good adsorption properties due to its vast pore network and high surface area. The aim of this study is to find the adsorption rates for a carboneous material produced at different temperatures, as well as to reveal possible differences between the performance of the material for each of the adsorbates used during the study (hemoglobin, serum albumin and lipopolysaccharide, LPS).
As a deduction from these results, we can conclude that proteins mainly in vitro, denaturate totally at a temperature between 57°C -62°C, and they also affected by NO and different ions types. In which mainly, NO cause earlier protein denaturation, which means that, NO has a destabilizing effect on proteins, and also different ions will alter the protein denaturation in which, some ions will cause earlier protein denaturation while others not.
A melting probe equipped with autofluorescence-based detection system combined with a light scattering unit, and, optionally, with a microarray chip would be ideally suited to probe icy environments like Europa’s ice layer as well as the polar ice layers of Earth and Mars for recent and extinct live.
Bacterial lipopolysaccharides (endotoxins) show strong biological effects at very low concentrations in human beings and many animals when entering the blood stream. These include affecting structure and function of organs and cells, changing metabolic functions, raising body temperature, triggering the coagulation cascade, modifying hemodynamics and causing septic shock. Because of this toxicity, the removal of even minute amounts is essential for safe parenteral administration of drugs and also for septic shock patients' care. The absence of a general method for endotoxin removal from liquid interfaces urgently requires finding new methods and materials to overcome this gap. Nanostructured carbonized plant parts is a promising material that showed good adsorption properties due to its vast pore network and high surface area. The aim of this study was comparative measurement of endotoxin- and blood proteins-related adsorption rate and adsorption capacity for different carboneous materials produced at different temperatures and under different surface modifications. As a main surface modificator, positively cbarged polymer, polyethileneimine (PEl) was used. Activated carbon materials showed good adsorption properties for LPS and some proteins used in the experiments. During the batch experiments, several techniques (dust removal, autoclaving) were used and optimized for improving the material's adsorption behavior. Also, with the results obtained it was possible to differentiate the materials according to their adsorption capacity and kinetic characteristics. Modification of the surface apparently has not affected hemoglobin binding to the adsorbent's surface. Obtained adsorption isotherms can be used as a powerful tool for designing of future column-based setups for blood purification from LPS, which is especially important for septic shock treatment.
Plant physiology and plant stress: Plant physiology will be much more important for human mankind because of yield and cultivation limits of crops determined by their resistance to stress. To assess and counteract various stress factors it is necessary to conduct plant research to gain information and results on plant physiology.
Summary: This paper presents a methodology to study and understand the mechanics of stapled anastomotic behaviors by combining empirical experimentation and finite element analysis. Performance of stapled anastomosis is studied in terms of leakage and numerical results which are compared to in vitro experiments performed on fresh porcine tissue. Results suggest that leaks occur between the tissue and staple legs penetrating through the tissue.
The importance of the availability of stored blood or blood cells, respectively, for urgent transfusion cannot be overestimated. Nowadays, blood storage becomes even more important since blood products are used for epidemiological studies, bio-technical research or banked for transfusion purposes. Thus blood samples must not only be processed, stored, and shipped to preserve their efficacy and safety, but also all parameters of storage must be recorded and reported for Quality Assurance. Therefore, blood banks and clinical research facilities are seeking more accurate, automated means for blood storage and blood processing.
We present the novel concept of a combined drilling and melting probe for subsurface ice research. This probe, named “IceMole”, is currently developed, built, and tested at the FH Aachen University of Applied Sciences’ Astronautical Laboratory. Here, we describe its first prototype design and report the results of its field tests on the Swiss Morteratsch glacier. Although the IceMole design is currently adapted to terrestrial glaciers and ice shields, it may later be modified for the subsurface in-situ investigation of extraterrestrial ice, e.g., on Mars, Europa, and Enceladus. If life exists on those bodies, it may be present in the ice (as life can also be found in the deep ice of Earth).
Tests with palm tree leaves have just started yet and scan data are in the process to be analyzed. The final goal of future project for palm tree gender and species recognition will be to develop optical scanning technology to be applied to date palm tree leaves for in–situ screening purposes. Depending on the software used and the particular requirements of the users the technology potentially shall be able to identify palm tree diseases, palm tree gender, and species of young date palm trees by scanning leaves.
The demand of replacements for inoperable organs exceeds the amount of available organ transplants. Therefore, tissue engineering developed as a multidisciplinary field of research for autologous in-vitro organs. Such three dimensional tissue constructs request the application of a bioreactor. The UREPLACE bioreactor is used to grow cells on tubular collagen scaffolds OPTIMAIX Sponge 1 with a maximal length of 7 cm, in order to culture in vitro an adequate ureter replacement. With a rotating unit, (urothelial) cells can be placed homogeneously on the inner scaffold surface. Furthermore, a stimulation is combined with this bioreactor resulting in an orientation of muscle cells. These culturing methods request a precise control of several parameters and actuators. A combination of a LabBox and the suitable software LabVision is used to set and conduct parameters like rotation angles, velocities, pressures and other important cell culture values. The bioreactor was tested waterproof successfully. Furthermore, the temperature controlling was adjusted to 37 °C and the CO2 - concentration regulated to 5 %. Additionally, the pH step responses of several substances showed a perfect functioning of the designed flow chamber. All used software was tested and remained stable for several days.
The ”IceMole“ is a novel maneuverable subsurface ice probe for clean in-situ analysis and sampling of subsurface ice and subglacial water/brine. It is developed and build at FH Aachen University of Applied Sciences’ Astronautical Laboratory. A first prototype was successfully tested on the Swiss Morteratsch glacier in 2010. Clean sampling is achieved with a hollow ice screw (as it is used in mountaineering) at the tip of the probe. Maneuverability is achieved with a differentially heated melting head. Funded by the German Space Agency (DLR), a consortium led by FH Aachen currently develops a much more advanced IceMole probe, which includes a sophisticated system for obstacle avoidance, target detection, and navigation in the ice. We intend to use this probe for taking clean samples of subglacial brine at the Blood Falls (McMurdo Dry Valleys, East Antarctica) for chemical and microbiological analysis. In our conference contribution, we 1) describe the IceMole design, 2) report the results of the field tests of the first prototype on the Morteratsch glacier, 3) discuss the probe’s potential for the clean in-situ analysis and sampling of subsurface ice and subglacial liquids, and 4) outline the way ahead in the development of this technology.
The carbonized rice husk (CRH) was evaluated for its wound healing activity in rats using excision models. In this study, the influences of CRH on wound healing in rat skin in vivo and cellular behavior of human dermal fibroblasts in vitro were investigated. The obtained results showed that the CRH treatment promoted wound epithelization in rats and exhibited moderate inhibition of cell proliferation in vitro. CRH with lanolin oil treated wounds were found to epithelize faster as compared to controls.
A 3D finite element model of the female pelvic floor for the reconstruction of urinary incontinence
(2014)
Smoothed Finite Element Methods for Nonlinear Solid Mechanics Problems: 2D and 3D Case Studies
(2016)
The Smoothed Finite Element Method (SFEM) is presented as an edge-based and a facebased techniques for 2D and 3D boundary value problems, respectively. SFEMs avoid shortcomings of the standard Finite Element Method (FEM) with lower order elements such as overly stiff behavior, poor stress solution, and locking effects. Based on the idea of averaging spatially the standard strain field of the FEM over so-called smoothing domains SFEM calculates the stiffness matrix for the same number of degrees of freedom (DOFs) as those of the FEM. However, the SFEMs significantly improve accuracy and convergence even for distorted meshes and/or nearly incompressible materials.
Numerical results of the SFEMs for a cardiac tissue membrane (thin plate inflation) and an artery (tension of 3D tube) show clearly their advantageous properties in improving accuracy particularly for the distorted meshes and avoiding shear locking effects.
Recent analysis of scientific data from Cassini and earth-based observations gave evidence for a global ocean under a surrounding solid ice shell on Saturn's moon Enceladus. Images of Enceladus' South Pole showed several fissures in the ice shell with plumes constantly exhausting frozen water particles, building up the E-Ring, one of the outer rings of Saturn. In this southern region of Enceladus, the ice shell is considered to be as thin as 2 km, about an order of magnitude thinner than on the rest of the moon. Under the ice shell, there is a global ocean consisting of liquid water. Scientists are discussing different approaches the possibilities of taking samples of water, i.e. by melting through the ice using a melting probe. FH Aachen UAS developed a prototype of maneuverable melting probe which can navigate through the ice that has already been tested successfully in a terrestrial environment. This means no atmosphere and or ambient pressure, low ice temperatures of around 100 to 150K (near the South Pole) and a very low gravity of 0,114 m/s^2 or 1100 μg. Two of these influencing measures are about to be investigated at FH Aachen UAS in 2017, low ice temperature and low ambient pressure below the triple point of water. Low gravity cannot be easily simulated inside a large experiment chamber, though. Numerical simulations of the melting process at RWTH Aachen however are showing a gravity dependence of melting behavior. Considering this aspect, VIPER provides a link between large-scale experimental simulations at FH Aachen UAS and numerical simulations at RWTH Aachen. To analyze the melting process, about 90 seconds of experiment time in reduced gravity and low ambient pressure is provided by the REXUS rocket. In this time frame, the melting speed and contact force between ice and probes are measured, as well as heating power and a two-dimensional array of ice temperatures. Additionally, visual and infrared cameras are used to observe the melting process.
Electromechanical model of hiPSC-derived ventricular cardiomyocytes cocultured with fibroblasts
(2018)
The CellDrum provides an experimental setup to study the mechanical effects of fibroblasts co-cultured with hiPSC-derived ventricular cardiomyocytes. Multi-scale computational models based on the Finite Element Method are developed. Coupled electrical cardiomyocyte-fibroblast models (cell level) are embedded into reaction-diffusion equations (tissue level) which compute the propagation of the action potential in the cardiac tissue. Electromechanical coupling is realised by an excitation-contraction model (cell level) and the active stress arising during contraction is added to the passive stress in the force balance, which determines the tissue displacement (tissue level). Tissue parameters in the model can be identified experimentally to the specific sample.
In this chapter, the key technologies and the instrumentation required for the subsurface exploration of ocean worlds are discussed. The focus is laid on Jupiter’s moon Europa and Saturn’s moon Enceladus because they have the highest potential for such missions in the near future. The exploration of their oceans requires landing on the surface, penetrating the thick ice shell with an ice-penetrating probe, and probably diving with an underwater vehicle through dozens of kilometers of water to the ocean floor, to have the chance to find life, if it exists. Technologically, such missions are extremely challenging. The required key technologies include power generation, communications, pressure resistance, radiation hardness, corrosion protection, navigation, miniaturization, autonomy, and sterilization and cleaning. Simpler mission concepts involve impactors and penetrators or – in the case of Enceladus – plume-fly-through missions.
Contractile behavior of the gastrocnemius medialis muscle during running in simulated hypogravity
(2021)
Vigorous exercise countermeasures in microgravity can largely attenuate muscular degeneration, albeit the extent of applied loading is key for the extent of muscle wasting. Running on the International Space Station is usually performed with maximum loads of 70% body weight (0.7 g). However, it has not been investigated how the reduced musculoskeletal loading affects muscle and series elastic element dynamics, and thereby force and power generation. Therefore, this study examined the effects of running on the vertical treadmill facility, a ground-based analog, at simulated 0.7 g on gastrocnemius medialis contractile behavior. The results reveal that fascicle−series elastic element behavior differs between simulated hypogravity and 1 g running. Whilst shorter peak series elastic element lengths at simulated 0.7 g appear to be the result of lower muscular and gravitational forces acting on it, increased fascicle lengths and decreased velocities could not be anticipated, but may inform the development of optimized running training in hypogravity. However, whether the alterations in contractile behavior precipitate musculoskeletal degeneration warrants further study.
The international partnership of space agencies has agreed to proceed forward to the Moon sustainably. Activities on the Lunar surface (0.16 g) will allow crewmembers to advance the exploration skills needed when expanding human presence to Mars (0.38 g). Whilst data from actual hypogravity activities are limited to the Apollo missions, simulation studies have indicated that ground reaction forces, mechanical work, muscle activation, and joint angles decrease with declining gravity level. However, these alterations in locomotion biomechanics do not necessarily scale to the gravity level, the reduction in gastrocnemius medialis activation even appears to level off around 0.2 g, while muscle activation pattern remains similar. Thus, it is difficult to predict whether gastrocnemius medialis contractile behavior during running on Moon will basically be the same as on Mars. Therefore, this study investigated lower limb joint kinematics and gastrocnemius medialis behavior during running at 1 g, simulated Martian gravity, and simulated Lunar gravity on the vertical treadmill facility. The results indicate that hypogravity-induced alterations in joint kinematics and contractile behavior still persist between simulated running on the Moon and Mars. This contrasts with the concept of a ceiling effect and should be carefully considered when evaluating exercise prescriptions and the transferability of locomotion practiced in Lunar gravity to Martian gravity.
Microbial diversity studies regarding the aquatic communities that experienced or are experiencing environmental problems are essential for the comprehension of the remediation dynamics. In this pilot study, we present data on the phylogenetic and ecological structure of microorganisms from epipelagic water samples collected in the Small Aral Sea (SAS). The raw data were generated by massive parallel sequencing using the shotgun approach. As expected, most of the identified DNA sequences belonged to Terrabacteria and Actinobacteria (40% and 37% of the total reads, respectively). The occurrence of Deinococcus-Thermus, Armatimonadetes, Chloroflexi in the epipelagic SAS waters was less anticipated. Surprising was also the detection of sequences, which are characteristic for strict anaerobes—Ignavibacteria, hydrogen-oxidizing bacteria, and archaeal methanogenic species. We suppose that the observed very broad range of phylogenetic and ecological features displayed by the SAS reads demonstrates a more intensive mixing of water masses originating from diverse ecological niches of the Aral-Syr Darya River basin than presumed before.
Extension fractures are typical for the deformation under low or no confining pressure. They can be explained by a phenomenological extension strain failure criterion. In the past, a simple empirical criterion for fracture initiation in brittle rock has been developed. In this article, it is shown that the simple extension strain criterion makes unrealistic strength predictions in biaxial compression and tension. To overcome this major limitation, a new extension strain criterion is proposed by adding a weighted principal shear component to the simple criterion. The shear weight is chosen, such that the enriched extension strain criterion represents the same failure surface as the Mohr–Coulomb (MC) criterion. Thus, the MC criterion has been derived as an extension strain criterion predicting extension failure modes, which are unexpected in the classical understanding of the failure of cohesive-frictional materials. In progressive damage of rock, the most likely fracture direction is orthogonal to the maximum extension strain leading to dilatancy. The enriched extension strain criterion is proposed as a threshold surface for crack initiation CI and crack damage CD and as a failure surface at peak stress CP. Different from compressive loading, tensile loading requires only a limited number of critical cracks to cause failure. Therefore, for tensile stresses, the failure criteria must be modified somehow, possibly by a cut-off corresponding to the CI stress. Examples show that the enriched extension strain criterion predicts much lower volumes of damaged rock mass compared to the simple extension strain criterion.
In this work, the effects of carbon sources and culture media on the production and structural properties of bacterial cellulose (BC) synthesized by Medusomyces gisevii have been studied. The culture medium was composed of different initial concentrations of glucose or sucrose dissolved in 0.4% extract of plain green tea. Parameters of the culture media (titratable acidity, substrate conversion degree etc.) were monitored daily for 20 days of cultivation. The BC pellicles produced on different carbon sources were characterized in terms of biomass yield, crystallinity and morphology by field emission scanning electron microscopy (FE-SEM), atomic force microscopy and X-ray diffraction. Our results showed that Medusomyces gisevii had higher BC yields in media with sugar concentrations close to 10 g L−1 after a 18–20 days incubation period. Glucose in general lead to a higher BC yield (173 g L−1) compared to sucrose (163.5 g L−1). The BC crystallinity degree and surface roughness were higher in the samples synthetized from sucrose. Obtained FE-SEM micrographs show that the BC pellicles synthesized in the sucrose media contained densely packed tangles of cellulose fibrils whereas the BC produced in the glucose media displayed rather linear geometry of the BC fibrils without noticeable aggregates.
Background
Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.
Methods
This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.
Results
With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.
Conclusion
Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.