Steady State Response and Stability of an Elastically Restrained Tapered Beam

An analytical method for the study of the nonlinear forced vibrations and their stabilities of an elastically restrained tapered cantilever beam due to a direct periodic excitation is developed. The method of harmonic balance is used to study the steady state frequency response of the beam system for different values of physical parameters such as the root translational and rotational stiffness and the beam taper ratio. Results are presented for the first three modes of vibration. The stability of the frequency response for some selected values of the physical parameters is investigated, i.e. the regions on the frequency response curves at which the solution may bifurcate and then culminate into chaos. The qualitative features of the solutions are studied and identified using phase plane, Poincare maps and Fast Fourier Transform. The results are presented, discussed and conclusions on the elastically restrained tapered beam nonlinear dynamics are drawn

Properties of tube and fitting scaffold connections under cyclical loads

The standard design procedure for tube and fitting connections assumes that the connections are only subjected to non-cyclical loads. This paper presents the results of experimental tests and theoretical calculations of the moment-rotation capacities of three common connections – sleeve couplers, swivel couplers and right-angled couplers. The results show that under a cyclic side load, such as that occurring by wind loading, looseness affects the capacity of the connections. For all three types of coupler looseness is shown to be relatively high which will reduce the stiffness of the connection under side loads. For sleeve couplers the effects of axial load in the tubes also affects the coupler stiffness and the maximum bending capacity of the joint. This implies that the common European code BS EN 74-1 for the connection should be changed to consider the loss in stiffness and maximum side load capacity under axial loads and looseness which are ignored in the standard. The standard assumption for right-angled and swivel couplers is that the connection can be assumed to be rigid about an axis normal to the plane containing the two tubes being joined. This is shown to be incorrect as the connections are shown to have stiffnesses about this axis which is of a similar order to the stiffnesses about the other axes

Non-Linear Seismic Response of Base-Isolated Frame Structures Using Rubber Bearings

Over the past two decades, much progress has been made in research and application of the base isolation of structures as means of providing earthquake resistance to a structure. However, the trade-off between the extent of acceleration reduction and the response of a base-isolation system has not been given a serious consideration. This work uses a new material constitutive model for rubber bearing base-isolation system, which adopts the technique of real-time structural parameter modification. To achieve this, a finite element modeling and analysis are performed as a comparative study between a conventional totally fixed-base steel frame structure and similar base-isolated structures using rubber-steel bearings. The structures are subjected to the El-Centro, N-S earthquake. In order to include nonlinearity effects, a non-linear hyperviscoelastic material model has been used and linked to ABAQUS software as a user defined material subroutine (i.e., UMAT). Special connector elements are selected from ABAQUS library to connect the rubber bearings to the frame structure and the foundations in order to achieve the required kinematical constraints at the connection points. The model is validated by carrying out a comparative study of the results obtained from the analysis of the presented material model with those obtained by using the existing ABAQUS material models (e.g., Ogden material model). The results show a significance efficiency of using the rubber bearing isolation in order to uncouple the structure from the seismic ground motion. Moreover, it has been proved that the used material model is more effective to capture the behavior of the base-isolated structures expressing a notable reduction in acceleration and an increase in the structural resistance to earthquake excitations

Impact of an Education Training program upon Nurse-Midwives Practices Concerning First Stage of Labor.

Abstract: Background: Delivery by a skilled birth attendant (nurse - midwives ( as an indicator of progress towards reducing maternal mortality worldwide ) the fifth Millennium Development Goal( Aim: The aim of this study is to identify the impact of training education program applied on nurse-midwife practice concerning   care during first stage of labor in labor room. Method: A quasi-experimental design conducted on non-probability (purposive) sample of fifty two nurse- midwives selected during period from 3th August to 10th November 2011. The study is conducted at the four hospital of Ministry of Health (Baghdad health directorate in Al-Karhk and Al-Risafa) sector. The questionnaire form is consisted of three parts which included demographic data, knowledge concerning practice during First stage of labor, practice checklist. Content validity and reliability of the questionnaire determined through a pilot study, descriptive and inferential statistics are used to analyze the data. Results: Results of the study showed that the highest percentage (44.2%) were in age group of 30-39 years, midwifery school graduate and)42.3%( of them had 1-10 years of work experience in midwifery. There were low and moderate means in  most items related to  the practices of nurse-midwives regarding first stage of labor  in pre-test  and assessed as (partial) while there were high mean scores in all items, and assessed Pass in posttest after the implementation of the training education program with high statistical significant. Conclusion: The study found there were low and moderate means in most items related to the practices of nurse-midwives regarding the care during first stage of labor in pre-test and while there were high mean scores in all items, and assessed Pass in posttest after the implementation of the training education program with high statistical significant. Recommendation: establishment of clinical practice standards according to the WHO, development of continuing education programs, establishes a baccalaureate degree program in midwifery.Key words: Nurse- Midwives, program, practice, childbirt

1-(Adamantan-1-ylcarbon­yl)-3-(2,6-difluoro-4-hy­droxy­phen­yl)thio­urea

In the title mol­ecule, C18H20F2N2O2S, the 2,6-difluoro-4-hy­droxy­phenyl ring and the carbonyl­thio­urea group are each essentially planar, with maximum deviations of atoms from their mean planes of 0.0113 (14) and 0.1017 (15) Å, respectively; the dihedral angle between these two planes is 71.03 (6)°. An intra­molecular N—H⋯O hydrogen bond occurs. In the crystal, N—H⋯O and O—H⋯S hydrogen bonds connect the mol­ecules into chains running diagonally across the bc plane. C—H⋯S and C—H⋯F contacts are also observed

A Comparison between Natural Pozzolana and Fly Ash Replacements on the Mechanical Properties of Concrete

This study investigates the effect of Natural Pozzolana (NP) and Fly Ash (FA) substitutes on concrete's mechanical and microstructural properties. Mixes containing 10 - 50 % cement substitute ratios were prepared and tested for flexure and compressive strength after 28 days of curing. Then, qualitative microstructural analysis was performed using Scanning Electron Microscope (SEM). In terms of compressive strength, the mixes containing only 10 % replacement ratios of both NP and FA showed an improvement of 10 % compared to the plain control mix. On the other hand, all mixes containing FA could attain at least a 25 % development in their flexural strength compared to the control mix. The microstructural analysis illustrated that adding FA and NP enhances cement hydration by improving the formation of dense hydration products such as calcium silicate hydrate (C-S-H) and calcium hydroxide (C-H), which are mainly responsible for the performance of the improved mechanical properties of concrete

OP0063 QUANTITATIVE COMPUTED TOMOGRAPHY PREDICTS 10-YEAR MORTALITY IN INTERSTITIAL LUNG DISEASE RELATED TO SYSTEMIC SCLEROSI

Background: Interstitial lung disease (ILD) is the main cause of death in Systemic Sclerosis (SSc). Chest CT is the gold standard in detecting ILD although it is not easy to understand its prognostic value. ILD qualitative assessment is almost worthless. Goh et al. semi quantitative score of ILD extent is related to mortality risk but it is burdened by relevant inter/intra-readers variability. An operator independent algorithm based on voxel-wise analysis proved to identify SSc patients with an increased risk of mortality according to prediction models. Objectives: To verify if quantitative analysis of chest CT (QCT) predict 10 years-mortality in SSc patients. Methods: SSc patients with availability of a chest CT were enrolled in 13 different centers. The CT voxel-wise analysis with a free software (www.horosproject.com) provided QCT indexes: kurtosis, skewness, mean lung attenuation and standard deviation. Patients

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome