Properties of Modified Warm-Mix Asphalt Mixtures Containing Different Percentages of Reclaimed Asphalt Pavement

The Rapid reduction of energy resources and the escalated effects of global warming have created a strong motivation to find some new techniques in the field of paving construction. Adopting new technologies, such as warm-mix asphalt (WMA) or the recycling process of asphalt can be very helpful for the economy and have a significant impact on the environmental footprint. Thus, this research aimed to study the mechanical and durable characteristics of modified WMA mixtures using (1.0%, 1.5%, and 2.0%) Sasobit REDUX®, (0.3%, 0.4%, and 0.5%) Aspha-Min®, and (0.07%, 0.1%, and 0.125) ZycoTherm® additives corresponding to three percentages of reclaimed asphalt pavement (RAP) (20%, 40%, and 60%). Three mixing temperatures have been conducted in this study to generate WMA mixtures at (135 °C, 125 °C, and 115 °C) corresponding to three compacting temperatures (125 °C, 115 °C, and 105 °C). The mechanical properties of the developed WMA mixtures have been evaluated using the Superpave volumetric properties (air voids, voids filled with asphalt, and voids in mineral aggregate), while the durable properties have been investigated using the resilient modulus test (MR) at 25 °C, resilient modulus ratio (RMR), and Hamburg wheel-track test in terms of permanent deformation, moisture susceptibility, and rutting resistance. To make the WMA mixtures accept high quantities of RAP (>25%), an insignificant increase in the amounts of WMA additives was needed to produce mixtures carrying sustainability labels. Results indicated that all the used additives had pushed the WMA mixtures to achieve considerable mechanical properties, whereas the best properties for the WMA mixtures containing 0%, 20%, 40%, and 60% of RAP have been achieved by mixing with (1.0% Sasobit REDUX® @ 125 °C), (1.0% Sasobit REDUX® or 0.3% Aspha-Min® @ 135 °C), (1.5% Sasobit REDUX® @ 125 °C), and (2.0% Sasobit REDUX® or 0.5% Aspha-Min® @ 135 °C), respectively. On another hand, the best durable properties have been achieved by mixing the mentioned WMA mixtures containing 0%, 20%, 40%, and 60% of RAP with 0.07%, 0.07%, 0.1%, and 0.125% of ZycoTherm® at 153 °C, respectively. Using such additives in the recycled WMA mixtures made it possible to activate waste recycling in the paving industry

Antibacterial resistance and their genetic location in MRSA isolated in Kuwait hospitals, 1994-2004

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of serious infections in hospitals and in the community worldwide. In this study, MRSA isolated from patients in Kuwait hospitals were analyzed for resistance trends and the genetic location of their resistance determinants. METHODS: Between April 1994 and December 2004, 5644 MRSA isolates obtained from different clinical samples were studied for resistance to antibacterial agents according to guidelines from the National Committee for Clinical Laboratory Standards and the British Society for Antimicrobial Chemotherapy. The genetic location of their resistance determinants was determined by curing and transfer experiments. RESULTS: They were resistant to aminoglycosides, erythromycin, tetracycline, trimethoprim, fusidic acid, ciprofloxacin, chloramphenicol, rifampicin, mupirocin, cadmium acetate, mercuric chloride, propamidine isethionate and ethidium bromide but susceptible to vancomycin, teicoplanin and linezolid. The proportion of the isolates resistant to erythromycin, ciprofloxacin and fusidic acid increased during the study period. In contrast, the proportion of isolates resistant to gentamicin, tetracycline, chloramphenicol and trimethoprim declined. High-level mupirocin resistance increased rapidly from 1996 to 1999 and then declined. They contained plasmids of 1.9, 2.8, 3.0, 4.4, 27 and 38 kilobases. Genetic studies revealed that they carried plasmid-borne resistance to high-level mupirocin resistance (38 kb), chloramphenicol (2.8 – 4.4 kb), erythromycin (2.8–3.0 kb) and cadmium acetate, mercuric chloride, propamidine isethionate and ethidium bromide (27 kb) and chromosomal location for methicillin, the aminoglycosides, tetracycline, fusidic acid, ciprofloxacin and trimethoprim resistance. Thus, the 27 kb plasmids had resistance phenotypes similar to plasmids reported in MRSA isolates in South East Asia. CONCLUSION: The prevalence of resistance to erythromycin, ciprofloxacin, high-level mupirocin and fusidic acid increased whereas the proportion of isolates resistant to gentamicin, tetracycline, chloramphenicol and trimethoprim declined during the study period. They contained 27-kb plasmids encoding resistance to cadmium acetate, mercuric chloride, propamidine isethionate and ethidium bromide similar to plasmids isolated in MRSA from South East Asia. Molecular typing of these isolates will clarify their relationship to MRSA from South East Asia

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is indispensable in everyday surgical practice. Despite this, as an invasive procedure, it has its own mortality and morbidity, the most feared of which is periduodenal perforations. Our experience with ERCP related periduodenal perforations and its treatment strategies are presented. Additionally, a rarely encountered subtype is highlighted.MethodsPatients who underwent ERCP and sustained a periduodenal perforation between August 2008 and October 2011 were reviewed.ResultsDuring the period from August 2008 to October 2011, 597 ERCP procedures were performed in our hospital. Ten of these patients (3 male, 7 female) had a perforation. The mean patient age was 56.6 years. During the procedure, injury was suspected in four patients; it passed unnoticed in the remaining six. The decision to operate or follow a conservative policy was based on a combination of clinical and radiological findings. Operative intervention was required in three patients, with one mortality, while conservative treatment was followed in the remaining seven. A laparotomy was performed early in two patients whereas it was performed after an initial period of conservative treatment in one. The presence of periduodenal fluid collection, contrast extravasation or free intraperitoneal air were decisive factors for performing laparotomy.ConclusionsERCP-related periduodenal perforations include different categories. Certain types require operative repair while others should be treated conservatively. The choice of the management approach should be individualised, depending on the clinical picture and radiological findings. Although rare, these are potentially serious complications that may end fatally. Early recognition and appropriate intervention is the only way to avert a fatal outcome.</jats:sec