Centre Of Brussels Research Articles

Wood Used in Brussels’ Old Buildings: Origin, Characterisation, and Use (12th–19th Centuries)

Abstract Since 1990 archaeologists, historians and dendrochronologists have worked on 128 sites in the Brussels-Capital Region. In addition to producing a typo-chronological inventory of wooden roof structures (12th–19th centuries), the studies have now extended to finishings and floor coverings, with an increasing focus being placed on the types of wood used. Although oak was the predominant material, especially before the 17th century, the resources used in Brussels and the surrounding villages were local. They came from three wooded areas, cleared or degraded to varying degrees: the Sonian Forest, state-owned forests, and hedgerows. Oak grows rapidly, with wide rings which make dendrochronological dating difficult, although this can be overcome by utilising more comparative data, employing carbon-14 dating, or knowing the historical context. The use of green wood has been confirmed, with unusual felling periods spread over two years. The sinuous profile of the fast-growing oaks was used to cut the knee braces in roofs over knee walls and porticoed wooden structures of monuments, urban housing, and vernacular architecture. Mediocre oak, or even wood from fruit trees, elm, or ash, was used for this kind of architecture. Moreover, from the 17th century onward, species other than oak began to appear in the roof frames of all buildings, especially after the centre of Brussels was bombarded in 1695. The typology of the reconstructed roof frames is the same as that prior to 1695, but a wider variety of woods were used to meet the high demand at the time of reconstruction. This diversity of species is more evident among floorboards, with poplar, elm, Scots pine, fir, and spruce being used. This may have been due to technical reasons, but, in the local context, it would also have been a question of using the precious oak of the Sonian Forest frugally.

Antenatal management and neonatal outcomes of monochorionic twin pregnancies in a tertiary teaching hospital: a 10-year review

Monochorionic (MC) pregnancy is a high risk pregnancy with well-defined specific complications, such as twin-to-twin transfusion syndrome (TTTS) and twin anaemia-polycythaemia sequence (TAPS). Laser photocoagulation (LPC) is an effective treatment for both complications. In the current retrospective study, we determined the incidence of MC pregnancy complications in a tertiary care centre during a 10-year period. Single foetal death (FD) beyond 14 weeks’ gestation was significantly higher when complicated by either TTTS, TAPS or selective foetal growth restriction (21.4%, 16.7% and 9.1% versus 1.6%, p<.001, p=.02 and p=.04, respectively). We also demonstrated that twins’ weight discordance >20% is an independent risk factor for single or double FD after LPC. Consequently, prior to LPC, patients should be counselled that early diagnosis of TTTS, advanced Quintero stages and weight discordances >20% are potential risk factors for FD. Further studies are needed to identify additional risk factors for TTTS and TAPS outcome after LPC. Impact Statement What is already known on this subject? Monochorionic (MC) pregnancy is a high risk pregnancy with well-defined specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anaemia-polycythaemia sequence (TAPS). Laser photocoagulation (LPC) is an effective treatment for both complications. What the results of this study add? The results of the current study determined the incidence of MC pregnancy complications in a tertiary care centre in Brussels, and identified that twins’ weight discordance >20% is an independent risk factor for single or double foetal death after LPC. What the implications are of these findings for clinical practice and/or further research? Prior to laser coagulation, patients should be counselled that early diagnosis of TTTS, Quintero stages 3 or 4 and weight discordances >20% are potential risk factors for foetal demise. Further studies are needed to identify additional risk factors for TTTS and TAPS outcome after LPC.

Malaria in HIV-infected patients in a nonendemic setting.

The impact of HIV infection on malaria is unclear in nonendemic areas. In endemic territories, HIV has been reported to be a risk factor for higher morbidity. Nowadays, as HIV-infected patients travel more, it is important to assess the impact of HIV at the individual level on imported malaria. This retrospective case-control study collected data on HIV-infected patients diagnosed with malaria (2000-2017) and matched them with two controls based on age, sex and ethnicity. Clinical and biological parameters were collected and compared. We identified 47 cases and matched them with 94 controls. Comparing each of the WHO 2014 severity criteria, hyperparasitemia above 10% (P = 0.006; 12.8 versus 1.1%), icterus (P = 0.042; 14.9 versus 4.3%), acute renal failure (P = 0.022; 25.5 versus 9.6%) and bacteraemia (P = 0.014; 6.4 versus 0%) were significantly more present in HIV-infected patients with a trend to more cerebral malaria (12.8 versus 6.4%). HIV- infected patients were hospitalized more frequently and for longer periods. We observed a higher number of severity criteria when CD4 T-cell count was lower, especially below 200 cells/μl. The difference in occurrence of severe malaria disappeared when patients with CD4 T-cell count more than 500 cells/μl and undetectable viral load (n = 9) were compared with controls. De-novo HIV diagnosis was made during the malaria episode in 17% of cases. HIV infection has an impact on the imported malaria profile, although it is unclear whether well controlled HIV-infected patients have a higher risk of severe malaria. HIV-infected patients should be particularly targeted for pretravel advice.

Aktion Reinhardt and Aktion Erntefest

Conference: On November 3d and 4th 2018, the non-profit organization Mémoire d’Auschwitz – Auschwitz Foundation organized an international conference on Aktion Reinhardt and Aktion Erntefest at the Enabel Conference Centre in Brussels.

Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease.

In the recently revised guidelines on the management of thyroid dysfunction during pregnancy, treatment with thyroid hormone (LT4) is not recommended in women without thyroid autoimmunity (TAI) and TSH levels in the range 2.5-4.0 mIU/L, and in a recent study in that particular group of pregnant women, more complications were observed when a treatment with LT4 was given. The objective of the study was therefore to investigate whether variation in thyroid function within the normal (non-pregnant) range in women free of thyroid disease was associated with altered pregnancy outcomes? Cross-sectional data analysis of 1321 pregnant women nested within an ongoing prospective collection of pregnant women's data in a single centre in Brussels, Belgium. Thyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), free T4 (FT4) and ferritin levels were measured and baseline characteristics were recorded. Women taking LT4, with TAI and thyroid function outside the normal non-pregnant range were excluded. Pregnancy outcomes and baseline characteristics were correlated with all TSH and FT4 levels within the normal range and compared between two groups (TSH cut-off < and ≥2.5 mIU/L). Tobacco use was associated with higher serum TSH levels (OR: 1.38; CI 95%: 1.08-1.74); P = 0.009. FT4 levels were inversely correlated with age and BMI (rho = -0.096 and -0.089; P < 0.001 and 0.001 respectively) and positively correlated with ferritin levels (rho = 0.097; P < 0.001). Postpartum haemorrhage (>500 mL) was inversely associated with serum FT4 levels (OR: 0.35; CI 95%: 0.13-0.96); P = 0.040. Also 10% of women free of thyroid disease had serum TSH levels ≥2.5 mIU/L. Variation in thyroid function during the first trimester within the normal (non-pregnant) range in women free of thyroid disease was not associated with altered pregnancy outcomes. These results add evidence to the recommendation against LT4 treatment in pregnant women with high normal TSH levels and without TPO antibodies.

Maternal thyroid parameters in pregnant women with different ethnic backgrounds: Do ethnicity‐specific reference ranges improve the diagnosis of subclinical hypothyroidism?

Guidelines on the management of thyroid dysfunction during pregnancy have recently been updated and, for the diagnosis of subclinical hypothyroidism (SCH), a thyroid-stimulating hormone (TSH) upper reference limit (cut-off) of 4.0mIU/L has been proposed when no institutional values are available. It is also suggested that serum TSH and thyroid autoimmunity (TAI) may be different according to the ethnic background of the women. We therefore determined the prevalence of TAI and SCH in pregnant women with different ethnic backgrounds and, to define SCH, we used different first trimester TSH upper reference cut-offs (institutional, ethnicity-specific, 2.5mIU/L [Endocrine Society] and 4.0mIU/L [American Thyroid Association]). Cross-sectional data analysis of 1683 pregnant women nested within an ongoing prospective database of pregnant women. The study was performed in a single centre in Brussels, Belgium. During the first antenatal visit, thyroid peroxidase antibodies (TPO-abs), TSH and free T4 (FT4) were measured and baseline characteristics recorded. Data from 481 women with sub-Saharan (SaBg; 28.6%), 754 North African (NaBg; 44.8%) and 448 Caucasian (CaBg; 26.6%) backgrounds were analysed. For the calculation of TSH reference ranges, women with TAI, outliers, twin and assisted pregnancies were excluded. The prevalence of TAI was significantly lower in the SaBg group than in NaBg and CaBg groups (3.3% vs 8.6% and 11.1%; P<.001, respectively). Median TSH was significantly lower in SaBg and NaBg groups as compared with the CaBg group (1.3 and 1.4 vs 1.5 mIU/L; P=.006 and .014, respectively). The prevalence of women with SCH was comparable between all groups when 2.5 mIU/L was used as cut-off, but when 4.0mIU/L or the institutional cut-off (3.74mIU/L) was used, it was significantly higher in the CaBg group vs the NaBg group (5.4% vs 2.1% and 7.1% vs 3.3%, P=.008 and .013, respectively). The use of ethnicity-specific cut-offs did not change the prevalence of SCH as compared to the use of institutional cut-offs. However, when these cut-offs were used, the prevalence of SCH reduced by >70% (4.5% instead of 16.7%; P<.001) relative to the 2.5mIU/L cut-off. Pregnant women with a sub-Saharan African background had a lower prevalence of TAI and TSH levels as compared with women from other backgrounds. The use of ethnicity-specific TSH cut-offs in early pregnancy was not more specific for the diagnosis of SCH as compared to the use of the institutional cut-off.

Cultural facilities and urban development: WIELS contemporary art centre and the transformation of a working-class neighbourhood

The opening in 2007 of the first contemporary art centre in Brussels in the lower part of the municipality of Forest, which is characterised by an industrial urban fabric and socioeconomic insecurity, seems to have marked a new era for this neighbourhood. WIELS defines itself as “an international laboratory for the creation and diffusion of contemporary art”. Using a typology based on international literature, the objective of the study is to confront the rationale behind the creation of this cultural institution with the social and spatial transformations which have taken place in the neighbourhood since its establishment. In this article, we attempt to understand how WIELS contributes to urban development through culture. By combining different qualitative methods, it is clear that although WIELS was initially caught in a conflict between property income and openness towards its neighbourhood, certain tangible and discursive elements might prompt us to consider WIELS as one of the components in the formation of a new creative metropolitan centrality.

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Norah A. TerraultFigureDr A. Norah Terrault is a Professor of Medicine and Surgery and Director of the Viral Hepatitis Center at the University of California, San Francisco, USA. She received her MD from the University of Alberta, USA, and completed fellowships at the University of Toronto, Canada, before joining the faculty at the University of California, San Francisco. Her research focuses on the natural history and treatment of viral hepatitis and non-alcoholic fatty liver disease, especially in patients with cirrhosis and liver transplant recipients. She has conducted multiple clinical trials related to preventing and treating chronic hepatitis C and B, and is site PI for the NIH-supported HBV Clinical Research Network (HBRN) and NASH Clinical Research Network. She has authored over 250 peer-reviewed manuscripts, editorials, invited reviews, and chapters and is an Associate Editor for Hepatology and past Deputy Editor for Liver Transplantation. She previously served on the AASLD governing board and is current Councilor on the IASL governing board. Andreas PascherFigureAndreas Pascher is Professor of Surgery and the Deputy Chair of the Department of Visceral and Transplant Surgery as well as the Director of Neuroendocrine Tumor Surgery and the Organ Transplant Programme (liver, pancreas, kidney, Intestine, multivisceral) at the Universitaetsmedizin Berlin-Charité, Germany. He founded the Intestine Rehabilitation and Transplant Programme in 2000. In 2006, he was awarded his PhD and four years later he achieved an MBA in Health Care Management. He has received board certifications in transplant surgery (UEMS – Fellow of the European Board of Surgeons), gastrointestinal surgery and general surgery (incl. endocrine surgery). He has been board member of the European Liver and Intestine Transplantation Association (ELITA) since 2011 and ELITA Secretary from 2012 to 2014. Currently he is a member of the scientific advisory board of the Intestinal Transplant Association (ITA). He has published more than 190 papers and has presented at numerous national and international meetings in the field. Jan P.M. LerutFigureProf. Jan P.M. Lerut, MD, PhD, trained in General Surgery at the Katholieke Universiteit Leuven (KUL), Belgium, the H.Heine University of Dusseldorf, Germany, and at the Université catholique de Louvain (UCL), Belgium. From the very start of his surgical career he was involved in organ transplantation. This interest resulted in a transplantation fellowship at the Universities Paris-Sud – Centre Hépatobiliaire, France, under the lead of Prof. H. Bismuth and Pittsburgh Medical Centre, USA, under the lead of Prof. Th. Starzl. He was Director of the Abdominal Transplant Program at the Inselspital University of Bern, Switzerland, from 1987 to 1991. Currently he is ordinary Professor of Surgery and Director of the Department of Abdominal and Transplantation Surgery as well as Director of the Starzl Abdominal Transplant Unit of the University Hospitals Saint Luc and of the UCL Transplant Centre in Brussels, Belgium. He has served as President of the Belgian Society of Transplantation (BST), as Chairman of the Eurotransplant (ET) Liver Allocation Committee (ELIAC) and as President of the European Society for Organ Transplantation (ESOT). He is member of different councils and learning societies related to surgery and transplantation. He is active in the Euroliver Foundation awareness campaigns for adolescents in relation to organ donation. Under his Presidency of the ELIAC, the MELD system was introduced within the ET Community. His presidency of ESOT was devoted to the broadening of the European transplant community and to the development of a master educational program in the field of transplantation. He is President of the International Liver Transplant Society (ILTS) and Royal Belgian Society of Surgery (RBSS). He has published over 300 peer-reviewed articles, authored 24 books chapters and 24 scientific films. He made more than 600 communications on national and international congresses, most of them devoted to liver transplantation. He recently co-edited the book Regenerative Medicine Applications in Organ Transplantation (Academic press).

Protocol of the PSYCHOTSH study: association between neonatal thyroid stimulating hormone concentration and intellectual, psychomotor and psychosocial development at 4-5 year of age: a retrospective cohort study.

BackgroundSeveral European countries, including Belgium, still suffer from mild iodine deficiency. Thyroid stimulating hormone (TSH) concentration in whole blood measured at birth has been proposed as an indicator of maternal iodine status during the last trimester of pregnancy. It has been shown that mild iodine deficiency during pregnancy may affect the neurodevelopment of the offspring. In several studies, elevated TSH levels at birth were associated with suboptimal cognitive and psychomotor outcomes among young children. This paper describes the protocol of the PSYCHOTSH study aiming to assess the association between neonatal TSH levels and intellectual, psychomotor and psychosocial development of 4–5 year old children. The results could lead to a reassessment of the recommended cut-off levels of 5 > mU/L used for monitoring iodine status of the population.MethodsIn total, 380 Belgian 4–5 year old preschool children from Brussels and Wallonia with a neonatal blood spot TSH concentration between 0 and 15 mU/L are included in the study. For each sex and TSH-interval (0–1, 1–2, 2–3, 3–4, 4–5, 5–6, 6–7, 7–8, 8–9 and 9–15 mU/L), 19 newborns were randomly selected from all newborns screened by the neonatal screening centre in Brussels in 2008–2009. Infants with congenital hypothyroidism, low birth weight and prematurity were excluded from the study. Neonatal TSH concentration was measured by the Autodelphia method in dried blood spots, collected by heel stick on filter paper 3 to 5 days after birth. Cognitive abilities and psychomotor development are assessed using the Wechsler Preschool and Primary Scale of Intelligence - third edition - and the Charlop-Atwell Scale of Motor coordination. Psychosocial development is measured using the Child Behaviour Check List for age 1½ to 5 years old. In addition, several socioeconomic, parental and child confounding factors are assessed.ConclusionsThis study aims to clarify the effect of mild iodine deficiency during pregnancy on the neurodevelopment of the offspring. Therefore, the results may have important implications for future public health recommendations, policies and practices in food supplementation. In addition, the results may have implications for the use of neonatal TSH screening results for monitoring the population iodine status and may lead to the definition of new TSH cut-offs for determination of the severity of iodine status and for practical use in data reporting by neonatal screening centres.

EUtopia? The European Union and the Parlamentarium in Brussels

This paper explores the European Parliament's new visitors' centre in Brussels, the Parlamentarium. It examines how the Parlamentarium and its displays might be related to various conceptions of European Union (EU) territoriality, mediating between an ‘informational’ conception of the EU and one that is grounded in a more traditional idea of place. The paper argues that the Parlamentarium seeks to make sense of the multi-centred, multi-scaled spatial organisation that characterises the EU and that, by promoting the notion of an extensive European cityspace, it attempts to create for the EU a compelling visual and spatial imaginary. In some senses, the Parlamentarium might be seen to take on the functions of the capital city that the EU lacks. The paper also explores a number of contradictions and points of tension within the Parlamentarium, noting that it seems to be a constitutional centre without a constitution, and a place in which meaning appears to be fragmentary and fleeting. Examining the ‘televisual’ aspect of many of the displays, the paper argues that the exhibition both promotes the European ideal of unity in diversity and, simultaneously, casts doubt upon it. The Parlamentarium seeks to act as an agent for the creation of European subjectivity. Whether the type of postmodern imagery that it deploys is sufficient for this task remains open to question.

Chemical submission to commit robbery: A series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels

Between January 17, 2003 and August 29, 2003, the Emergency Department admitted a patient who had been surreptitiously intoxicated and robbed of his valuables every Friday. The first cases were considered anecdotal, but criminal activity was rapidly suspected. The cohort includes 16 male Asian patients aged 28–50 years. All the victims had just arrived in Brussels through one of the main rail station of the town and were admitted via the emergency ambulance service from different locations in the centre of Brussels around the CHU Saint-Pierre Hospital. Haemodynamic parameters upon admission were within normal limits. The Glasgow Coma Scale was equal or higher than 9/15 in 14 of the 16 victims. Toxicology screening obtained in 12 patients revealed the presence of flunitrazepam, which was further quantified at levels ranging from 21 to 75 μg/l. One of the Japanese patients, who returned to Belgium afterwards for professional reasons, was approached by the police and accepted to press charges. This allowed the police to investigate and send undercover agents to the railway station on Friday afternoons and evenings. They found a person who was offering welcome cookies to Asian travellers. He arrived from Amsterdam and returned once his crime was committed.Flunitrazepam is well known as a rape drug. We report a series of victims in whom flunitrazepam was used to facilitate robbery.

Studying urban stratigraphy: Dark Earth and a microstratified sequence on the site of the Court of Hoogstraeten (Brussels, Belgium). Integrating archaeopedology and phytolith analysis

Soil micromorphology has become an important tool in urban archaeology to investigate enigmatic dark, humus-rich, apparently homogeneous units, known as Dark Earth. It has also proven to be of great value to study microstratified sequences (such as floors), allowing a finer grained picture. Phytolith studies have also shown to be of particular interest to investigate archaeological layers, especially where other botanical remains are poorly preserved. The integration of phytolith studies and micromorphology allows understanding of the distribution and orientation patterns of the phytoliths and their relation to other features/fabrics, contributing to a better understanding of taphonomical processes and the identification of different human activities.The aim of the present article is to demonstrate the possibilities of such an integrated approach by the example of the site of the Court of Hoogstraeten, situated near the top of a steep slope, next to the Palace of the Dukes in the centre of Brussels (Belgium). The present article focuses on one complex sequence that includes two levels of Dark Earth and a microstratified sequence.The integrated study demonstrates that the formation of the Dark Earth on the site of the Court of Hoogstraeten results from multiphased processes, whereby various human actions interact with natural phenomena. Among the human activities pasturing, crop growing, manuring and composting have been identified. The microstratified sequence has been identified as a potential floor layer. As such, this approach does not only allow understanding the site formation processes both from homogenised units like Dark Earth, and microstratified ones, but also identification of ancient activities that are rather difficult to interpret based on field data alone.

Initiation of an anal cancer screening in HIV+MSM: results of cytology, biopsy and determination of risk factors

Incidence of anal cancer is increasing and risk of anal cancer is higher in MSM, especially if they are HIV+. European guidelines for treatment of HIV‐infected adults recommend anal cancer screening by digital rectal exam±Pap test with anuscopy if Pap test is abnormal. A systematic anal cancer screening in HIV+MSM with anal cytology (Pap smears) was established in June 2011 in our reference centre in Brussels. If anal cytology was abnormal, high‐resolution anuscopy (HRA) with biopsy was performed. 353 MSM HIV+were screened by anal smears between June 2011 and May 2012. 90% were Caucasians, median age was 44.5 years, 83% were on HAART and 74% had an undetectable viral load, median CD4 was 632/µl and 33% had a nadir CD4&lt;200. Thirty‐three (9.3%) were excluded because of poor quality. Cytology was abnormal in 46% of the 320 remaining patients: high‐grade squamous intraepithelial lesion (HSIL) 3%, low‐grade squamous intraepithelial lesion (LSIL) 24%, atypical squamous cells of undetermined significance (ASC‐US) 16%, and atypical squamous cells / cannot rule out a high‐grade lesion (ASC‐H) 3%. Viral load (VL) was more frequently undetectable (82% vs 64%, p=0.0003) and median duration of HAART was longer (111 vs 61 months, p=0.0145) in patients with normal cytology. 80 HRA with biopsies have been performed. 12.5% were normal, 44% showed anal intraepithelial neoplasia (AIN) 1, 24% AIN 2 and 19% AIN 3. For this analysis, high‐grade AIN (2 and 3) were put together (AIN 2+). Among patients with AIN 2+(n=33), cytology had showed 8 (24%) ASC‐US, 3 (9%) ASC‐H, 19 (57%) LSIL, 3 (9%) HSIL. When patients with normal cytology or normal biopsy and patients with AIN 2+were compared, the only significant risk factor found for AIN 2+was a nadir CD4&lt;100/µl (32% of the patients with AIN 2+vs 14% in patients with normal smear, p=0.0073). Anal precancerous lesions are frequent and at different stages. Among 46% abnormal cytology, 87% had abnormal biopsy including half AIN 2+.Cytology±biopsy is the only way to detect those lesions and should be performed systematically in HIV+MSM. Risk factor for AIN2+was a nadir CD4&lt;100/µl. A normal cytology was associated with an undetectable VL and a longer duration of HAART. Those results provide further argument for early initiation of HAART.

Echocardiography of pulmonary vascular function in asymptomatic carriers ofBMPR2mutations

To the Editors: Pulmonary arterial hypertension (PAH) is a rare, life-threatening dyspnoea–fatigue syndrome, caused by progressive increase in pulmonary vascular resistance (PVR) and eventual right ventricular failure [1]. The heritable form of PAH has been shown to be associated with mutations of the gene encoding the bone morphogenetic protein receptor-2 ( BMPR2 ). Asymptomatic carriers of BMPR2 mutations are at high risk of developing PAH [2]. Careful follow-up of these subjects might help to detect early-stage disease with a more favourable response to targeted therapies. However, there is uncertainty about the optimal screening method. A recent European multicentre study showed that relatives of patients with idiopathic PAH (IPAH) present with an increased prevalence of abnormally high pulmonary artery pressure (PAP) during exercise or during low-oxygen breathing [3]. In that study, measurements of pulmonary vascular function were limited to a systolic PAP (sPAP) estimated from the maximum tricuspid regurgitation velocity (TRV) assessed by Doppler echocardiography. Here, we report on additional measurements performed in one of the participating centres, providing insight into abnormal pulmonary vascular distensibility and hypoxia-induced PVR in healthy BMPR2 carriers. This study was part of a larger multicentre European project, which included 291 relatives of 109 IPAH patients and 191 age-matched controls [3]. The participating PAH centre in Brussels, Belgium, contributed with 35 relatives of 10 index patients with IPAH and 38 healthy controls. The 35 relatives were aged mean±sd 35±14 yrs. The 38 controls were aged mean±sd 36±10 yrs, and matched for sex and body surface area. Five of the asymptomatic relatives and two of the index IPAH patients were carriers …

Operational research: getting it done and making a difference [Editorial

Although The Union has been involved for years with operational research, it is in the last three years that we have collectively tried to think about what we are doing, how we can get the work done and how we can make a difference. In this regard, we have had a strong, enduring, productive and happy partnership with the Medecins Sans Frontieres (MSF) Operational Research Centre in Brussels, with whom we share a joint vision and strategy. It is worthwhile repeating our agreed definition of operational research, which is ‘research into strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness and performance of health systems and programmes so that better care is delivered to patients and communities’.1,2 One of our key strategies is to ensure that we build local capacity in the low- and middle-income countries in which we work. Our operational research courses and their modular structure have been described previously.2,3 Participants who are selected for our courses learn the principles of operational research while they take through a project from design to data collection to analysis, to paper writing and submission to a peer-reviewed journal. Experienced and reliable mentorship is needed and provided for this journey, and we are convinced about the effectiveness of this approach. In the three courses completed to date, we have trained 34 participants (doctors, nurses, paramedical officers, monitoring and evaluation officers) from Asia, Africa and Latin America, and seen 27 of their papers published in a variety of peer-reviewed journals. We have five other courses being implemented, with a total of 60 participants, and are confident that most will achieve their milestones and deliver the goods. We have learnt a lot along the way. We encourage our trained participants to become facilitators, and many have taken up this challenge in our subsequent courses or in courses that they have initiated and implemented locally in their own countries. We have realised the importance of a critical mass of staff, and our decisions about whom to select for our courses are strategic as well as based on merit and potential. We have learnt the meaning of the expression ‘data rich, information poor’. In many programmes or health settings from which our participants come, there is often a mass of data routinely collected over the years which is gathering dust and never used. Many of our research projects are designed around asking pertinent questions about these data sets. This is a win-win situation: the data are turned into useful knowledge, and gradual recognition is given to the concept that such data can provide information about how health care is delivered and can be changed. We have developed a sound understanding of ethics and operational research, and have redesigned our ethics application forms to relate better to retrospective data collection studies. We believe passionately in the published paper as a hard, measurable indicator that a research project has been taken through to completion and is of an acceptable standard.4 Furthermore, if we want our research to influence international or national policy, it has to be published because policy, strategy and guidance statements are increasingly evidence-based. We still have much to learn. ID Rusen summed it up well in an editorial in the International Journal of Tuberculosis and Lung Disease when he stated that ‘we need to do operational research on operational research’.5 We have changed the structure of our courses so that the first two modules on designing a research project and developing an electronic data capture instrument are done back-to-back instead of 2 months apart; we are about to implement this newly designed course, and it should save money and be more efficient. We need a robust, simple system of regularly keeping track of all the people we have trained so that we can measure whether research activities continue long after the trainings have finished. We are working on implementing this. We need to be able to measure in a standardised way whether the research has influenced policy and practice, and guidance on how to do this has just been published.6 What we need to do now is implement this in the field. The seed that we planted back in 2009 has grown into a tree. That tree and its branches continue to grow. However, like all plants, it needs nourishment without which it will wither and die. For operational research, this means international interest, support and funding. Through thick and thin, we must ensure that this happens and that operational research continues to be performed and serves its real purpose of finding health solutions for the poor.

Rethinking Interest Representation in the European Union

In 2004, the European Economic and Social Committee moved out of the grey cement building it had occupied in the old centre of Brussels, a building far removed from the European Union's other institutions. It moved into a modern glass and steel construction, right next to the European Parliament, the Council of Ministers, and the Commission. Did this change of abode represent anything more than the need for more office space after enlargement towards the East? The answer, judging from Stijn Smismans' recent book, is 'yes'. The Economic and Social Committee, constituted of representatives of national employer federations, trade unions, and such other economic groups as farmers and the professions, gives opinions on proposed European legislation. It is one of the original institutions of the European Union, established in 1958, as was the Council of Ministers, the Commission, the Court of Justice, and the Parliament. Since then, a number of similar committees and agency boards have been created.' They resemble the Economic and Social Committee in that they give representatives of national (or pan-European) interest organizations the opportunity to advise on European policy. These committees and agency boards differ from the Economic and Social Committee in that their mandate is far

The Suicide Prevention Policy of a Mental Health Centre

The purpose of this paper is to present the suicide prevention policy implemented by the Mental Health Centre in Brussels. The policy focuses on the quality of the help offered and on the efficacy of the services provided by the network of providers in mental health and social care. Goals of the policy are to optimise the care offered to clients at risk from suicidal behaviour; develop networks to enable follow-up with at-risk patients; lend support to and to share relevant knowledge with other caregivers; advocate suicide prevention issues within local networks; facilitate postvention; participate in regional and (international suicide prevention activities. The policy development started at the end of 1997, as a concerted strategy of all Mental Health Centres in the Flemish region of Belgium. An initial review of the policy recommended the implementation of guidelines, in all the Mental Health Centres, to deal with at-risk patients, improving the networks between inpatient and outpatient care and the co...

Held in the Auditorium 2000 of the Brussels Exhibition Centre in Brussels, Belgium on Friday 1st October 1999 at 17:30 h

Held in the Auditorium 2000 of the Brussels Exhibition Centre in Brussels, Belgium on Friday 1st October 1999 at 17:30 h

Influence of traffic conditions on fuel consumption and emissions: Brussels as a case study

In 1996 on-board measurements were performed on six passenger cars. These tests were executed in the centre of Brussels under various traffic conditions. All vehicles were measured for both fuel consumption and COi emissions. Two were also measured for CO, HC and NO% emissions. The chief emphasis was put on driving in the rush hour and smooth-flowing (on Sundays) traffic. The principal aim was to obtain realistic fuel consumption and exhaust emission values for Brussels. Secondly, to gain an insight into the relationship between consumption and emissions on the one hand and the process of traffic on the other. Furthermore, the measurement results have been used to upgrade an existing microscope traffic model with a fuel consumption module. In the process of designing an intersections and traffic control measures, energy and environmental aspects have to be taken into account if a more sustainable mobility is to be obtained.

Campylobacter meets Helicobacter in Brussels

W orkshops on Cum~ylobatter (VIIth International Workshop on Campylobacter, September 21-22) and on Helicobacter (Vlth Workshop on Gastroduodenal Pathology and Helicobacter, September 2325) were held at the Congress Centre in Brussels in 1993. Just 10 years previously in Brussels at the IInd International Workshop on Campylobacter Infections, Barry Marshall, then of Perth, Australia, reported the isolation and culture of an unusual spiral bacterium from gastric biopsies of patients with gastritis, duodenal and gastric ulcers’. Now Helicobacter pylori (formerly Campylobacter pyloridis then Campylobacter pylori) has stolen the show. Although initial reports of a bacteriological cause of gastritis and peptic ulcers seemed far-fetched to microbiologists, pathologists and gastroenterologists alike, the evidence for the pathological role played by H. pylori in the development of gastritis, ulcers and some types of gastric cancer is now well accepted. During the past 10 years, interest has turned from the study of Campylobacter (a genus containing 14 species, many of which cause self-limiting diarrhoea) to work on H. pylori or on one of the other nine (and increasing) Helicobacter species. This fact was mirrored by the relative numbers of participants in the workshops (87 Campylobacter-only participants, 544 Helicobacter-only participants and 251 for the combined workshops).