Comparison Between Finite Element Predictions and Results from Dynamic Centrifuge Tests on Tilting Gravity Wall Retaining Dry Sand

An analytical model is developed to analyze the seismic response of gravity walls retaining and founded on dry sand, with special emphasis on tilting behavior. A well verified two-dimensional finite element code is used for this purpose. The analytical model is verified comparing predictions to results from three dynamic centrifuge tests, with satisfactory agreement. Moreover, sensitivity analyses are carried out for one of the centrifuge test conditions to understand how the results would change if the boundary conditions and rotational stiffness of the wall were changed

PRACTICES OF SAFETY DESIGN OF SAUDI RESIDENTIAL BUILDINGS

The number of fires reported by the General Civil Defense Administration (GCDA) in Saudi Arabia indicates that fire is a major hazard in residential buildings, accounting for the highest percentage of buildings burnt. It seems that building designers and engineers do not give much considerations to the risk of fire in many of types of buildings. A considerable insight at safety measures in the design of buildings is therefore required. Architects and engineers play the most significant role assuring safety in the design of buildings. Although they know that designing for safety is vitally important, it is not clear yet how to go about establishing, incorporating and enforcing safety measures in buildings. The most readily available information is the safety instructions for different types of buildings provided by the GCDA. The objective of this paper is to present the results of a field assessment conducted to study the current safety practices in the design stage of residential buildings in Saudi Arabia and to identify common deficiencies in safety design. It also presents a systematic safety compliance checklist based on existing local safety instructions and international safety codes and standards. The checklist use is intended to ensure compliance with minimal safety requirements in the design stage of residential buildings

Multidisciplinary Collaboration In Emergency Medical Services

Healthcare is the delivery of care and service to the patient; therefore, it is important to relate this care delivery and/or service to patient outcomes. Outcomes can be seen from two perspectives: positive, in which the service/care provided resulted in improvement to the patient\u27s well-being, and negative, in which the service/care provided did not meet the patient\u27s needs and requirements, resulting in no improvement or a deterioration in the patient\u27s well-being. The latter is often referred to as an adverse event, and its impact can be both short-term (through exacerbation of a condition or further injury) and long-term (in which the patient\u27s confidence and trust in the healthcare system have been affected). High-quality patient care is our goal, and an improvement in patient outcomes is what we aim to achieve. The very model of EMS in the UK is multi-disciplinary, consisting of different professions in primary and secondary care. A profession can be defined as a vocation founded on specialized educational training. The purpose of the profession is to apply the training and knowledge to an area of need, and it has a code of ethics for its members. The current modernization of the NHS, with changes in the role of primary care, has blurred the boundaries of professional practice. Some professions in EMS are autonomous in nature, with direct access to patients and their diagnosis and treatment. An example of this would be a paramedic. Others may have a dependent role with indirect patient contact. An example of this would be a veterinary nurse working in the helo-vet service. Each profession has its own professional identity and values, and there is potential scope for adverse outcomes if conflict with patient management and/or need occurs between professions. With today\u27s focus on inter-professional care between professions and patient healthcare having a direct relationship to professional practice, now is the time to examine multi-disciplinary interventions between professions in EMS and their impact on patient care and outcomes. Emergency medical services (EMS) are an essential part of any healthcare system. Efficient and timely patient care is paramount at the scene of a medical or trauma incident, and in many cases, the quality of patient outcomes depends on the speed and efficiency with which care is delivered. This paper will focus on the different elements and complex relationships that occur between the primary services (ambulance, helo-vet, and first response) and the potential impact that these can have on the overall patient care and outcome. By the very nature of their jobs, healthcare is a collaboration between professionals from a wide variety of disciplines, each of whom brings a different body of knowledge and perspective to the care of the patient. The complexity of healthcare needs often surpasses the skills of one profession; patient needs can be wide-ranging and diverse. EMS is a unique healthcare system in that it provides immediate care to a patient and then an avenue in which to further transport and access further care. Often in the hospital setting, there is a multi-disciplinary approach to care; however, in many cases, in the pre-hospital setting, this can be disjointed and occur between different service plans and the handover of patient care. This paper will conclude by considering the potential impact of changes to multi-disciplinary clinical governance and the potential for standardizing educational outcomes between professions to improve overall patient care and experience in the pre-hospital setting

Estimating a threshold price for CO2 emissions of buildings to improve their energy performance level. Case study of a new Spanish home

Energy consumption in homes produces CO2. In many countries, building regulations are being set to enable energy efficiency performance levels to be issued. In Spain, there is a regulated procedure to certify the energy performance of buildings according to their CO2 emissions. Consequently, some software tools have been design to simulate buildings and to obtain their energy consumption and CO2 emissions. In this paper the investment, maintenance and energy consumption costs are calculated for different energy performance levels and for various climatic zones, in a single-family home. According to the results, more energy efficient buildings imply higher construction and maintenance costs, which are not compensated by lower energy costs. Therefore, under current conditions, economic criteria do not support the improvement of the energy efficiency of a dwelling. 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Predictive Value of POSSUM and ACPGBI Scoring in Mortality and Morbidity of Colorectal Resection: A Case–Control Study

Contains fulltext : 97239.pdf (publisher's version ) (Open Access)BACKGROUND: Preoperative risk prediction to assess mortality and morbidity may be helpful to surgical decision making. The aim of this study was to compare mortality and morbidity of colorectal resections performed in a tertiary referral center with mortality and morbidity as predicted with physiological and operative score for enumeration of mortality and morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), and colorectal POSSUM (CR-POSSUM). The second aim of this study was to analyze the accuracy of different POSSUM scores in surgery performed for malignancy, inflammatory bowel diseases, and diverticulitis. POSSUM scoring was also evaluated in colorectal resection in acute vs. elective setting. In procedures performed for malignancy, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) score was assessed in the same way for comparison. METHODS: POSSUM, P-POSSUM, and CR-POSSUM predictor equations for mortality were applied in a retrospective case-control study to 734 patients who had undergone colorectal resection. The total group was assessed first. Second, the predictive value of outcome after surgery was assessed for malignancy (n = 386), inflammatory bowel diseases (n = 113), diverticulitis (n = 91), and other indications, e.g., trauma, endometriosis, volvulus, or ischemia (n = 144). Third, all subgroups were assessed in relation to the setting in which surgery was performed: acute or elective. In patients with malignancy, the ACPGBI score was calculated as well. In all groups, receiver operating characteristic (ROC) curves were constructed. RESULTS: POSSUM, P-POSSUM, and CR-POSSUM have a significant predictive value for outcome after colorectal surgery. Within the total population as well as in all four subgroups, there is no difference in the area under the curve between the POSSUM, P-POSSUM, and CR-POSSUM scores. In the subgroup analysis, smallest areas under the ROC curve are seen in operations performed for malignancy, which is significantly worse than for diverticulitis and in operations performed for other indications. For elective procedures, P-POSSUM and CR-POSSUM predict outcome significantly worse in patients operated for carcinoma than in patients with diverticulitis. In acute surgical interventions, CR-POSSUM predicts mortality better in diverticulitis than in patients operated for other indications. The ACPGBI score has a larger area under the curve than any of the POSSUM scores. Morbidity as predicted by POSSUM is most accurate in procedures for diverticulitis and worst when the indication is malignancy. CONCLUSION: The POSSUM scores predict outcome significantly better than can be expected by chance alone. Regarding the indication for surgery, each POSSUM score predicts outcome in patients operated for diverticulitis or other indications more accurately than for malignancy. The ACPGBI score is found to be superior to the various POSSUM scores in patients who have (elective) resection of colorectal malignancy

A simple and reproducible scoring system for EGFR in colorectal cancer: application to prognosis and prediction of response to preoperative brachytherapy

The aim of this study was to determine the predictive and prognostic value of epidermal growth factor receptor (EGFR) expression in rectal cancers treated with preoperative high-dose rate brachytherapy and in mismatch-repair (MMR)-proficient colorectal cancers (CRCs), respectively. We validate the use of receiver operating characteristic (ROC) curve analysis to select cutoff scores for EGFR overexpression for the end points studied. Immunohistochemistry (IHC) for EGFR was performed on 82 rectal tumour biopsies and 1197 MMR-proficient CRCs using a tissue microarray. Immunoreactivity was scored as the percentage of positive tumour cells by three pathologists and the inter-observer reliability was assessed. ROC curve-derived cutoffs were used to analyse the association of EGFR overexpression, tumour response and several clinicopathological features including survival. The scoring method was found to be reproducible in rectal cancer biopsies and CRCs. The selected cutoff scores from ROC curve analysis for each clinicopathological feature were highly consistent among pathologists. EGFR overexpression was associated with response to radiotherapy (P-value <0.001) and with worse survival time (P-value <0.001). In multivariate analysis, EGFR overexpression was independently associated with adverse prognosis (P-value <0.001). Epidermal growth factor receptor is a predictive marker of response to preoperative radiotherapy and an independent adverse prognostic factor CRC

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Vocabulary Acquisition via Extensive Input

The current research explores vocabulary acquisition via extensive input in the L2. The first study reported here was conducted in the Saudi EFL context, where intensive reading is the prominent approach. The treatment used an extensive reading design in which participants were offered a wide range of graded readers at different levels to read from. The second study was carried out on Arab students studying in the UK. The aim of this study was to determine the relative vocabulary acquisition from extensive reading vs. extensive listening. The third study was based on a corpus of 8'4 graded read~rs from the Oxford Bookworms series. It is a replication ofNation and Wang's (1999) study into vocabulary coverage. The objective of this study was to examine potential opportunities for vocabulary learning available in those graded readers. All ofthe three studies were conducted with quantitative measurements, such as the VLT, PET, TOEFL, a word knowledge scale, and a questionnaire. The results of the first study demonstrated that extensive reading had positive effects on the participants' vocabulary knowledge, reading comprehension, reading speed, and attitudes towards reading in the L2. The findings ofthe second study showed that both extensive reading and listening coUld lead to incidental vocabulary learning. However, these gains are very small. The study also indicated that reading may be more advantageous than listening in terms ofvocabulary gains. Finally, the corpus-based study revealed that graded readers are a suitable means of helping learners encounter new as well as old vocabulary; even if they read less than one graded reader a week. The study also demonstrated that reading more texts at different levels would enable learners to meet words quite frequently.EThOS - Electronic Theses Online ServiceGBUnited Kingdo