Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: A European study

International audienceBACKGROUND & AIMS:All oral direct acting antivirals (DAA) have been shown to improve the liver function of patients with decompensated cirrhosis but it is presently unknown whether this clinical improvement may lead to the delisting of some patients. The aim of this study was to assess if and which patients can be first inactivated due to clinically improvement and subsequently delisted in a real life setting.METHODS:103 consecutive listed patients without hepatocellular carcinoma were treated with different DAA combinations in 11 European centres between February 2014 and February 2015.RESULTS:The cumulative incidence of inactivated and delisted patients by competing risk analysis was 15.5% and 0% at 24weeks, 27.6% and 10.3% at 48weeks, 33.3% and 19.2% at 60weeks. The 34 patients who were inactivated showed a median improvement of 3.4 points for MELD (delta MELD, p20:HR=0.042; p<0.0001), delta MELD (HR=1.349; p<0.0001) and delta albumin (HR=0.307; p=0.0069) both assessed after 12weeks of DAA therapy.CONCLUSIONS:This study showed that all oral DAAs were able to reverse liver dysfunction and favoured the inactivation and delisting of about one patient out-of-three and one patient out-of-five in 60weeks, respectively. Patients with lower MELD scores had higher chances to be delisted. The longer term benefits of therapy need to be ascertained.LAY SUMMARY:The excellent efficacy and safety profile of the new drugs against Hepatitis C virus, "direct acting antivirals" or DAAs, have made antiviral therapy possible also for patients with advanced liver disease and for those on the waiting list for liver transplantation (LT). This study shows for the first time that the DAAs may lead to a remarkable clinical improvement allowing the delisting of one patient out of 5

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

Ambient Vibration Tests and Modal Analysis of a Six-Story Lightweight Timber Frame Building

 This paper describes the in-situ ambient vibration tests of a lightweight timber frame building, performed in order to obtain its modal properties. Our case study is a six-story lightweight timber frame building in Varberg, Sweden. Five battery-driven wireless data acquisition units with a total of 14 uni-axial accelerometers were used to perform the in-situ measurements. Accelerations along the two horizontal directions were recorded with a duration of approximately 40 minutes. Two different only-output frequency and time domain Operational Modal Analysis (OMA) methods were used to evaluate the dynamic properties of the building. The modal parameters obtained from the in-situ measurements, such as natural frequencies and mode shapes, were compared with the parameters obtained from the Finite Element (FE) model of the structure. To perform a detailed numerical analysis of the light-frame timber building, all lateral-load resisting system components were modelled. The FE model was calibrated in function of the results obtained from the OMA of the building. Based on the obtained results from the calibrated FE model, it was possible to conclude that the non-structural elements have an influence on the global dynamic response of the building

199+325 çelik demiryolu köprüsünün sistem tanımlama çalışmaları ve kalibre sonlu elemanlar modelinin oluşturulması

Ülkemizde bulunan demiryolu köprüleri TCDD tarafından işletilen demiryolu ağlarının en önemli bağlantı ve geçit noktalarını oluşturmakta ve bu köprülerin büyük bir kısmı 100 yılı aşkın süredir hizmet vermektedir. Bu köprüler diğer köprülere kıyasla (karayolu, yolu köprüleri) daha ağır yüklere ve köprünün dinamik özelliklerini değiştirebilen etkilere maruz kalmaktadır. Bu sebeplerden dolayı demiryolu köprülerinin TCDD tarafından rutin olarak gerçekleştirilen bakım ve onarım çalışmaları önem arz etmektedir. TCDD tarafından gerçekleştirilen umumi ve periyodik kontrol yöntemleri, gözleme dayanan ve tekniği uygulayan kişilerin deneyimine bağlı yöntemlerdir. Bu yüzden bu çalışmalarda hata yapma olasılığı fazla olup gizli hasarların tespit edilmesi de güç olmaktadır. Titreşim tabanlı yapı sağlığının izlenmesi yöntemleri gözleme dayalı olarak yapılan demiryolu köprülerinin bakım ve onarım çalışmaları için daha nesnel bir değerlendirme yöntemidir. Bu çalışma Uşak il sınırında bulunan ve TCDD tarafından işletilen 199+325 çelik demiryolu köprüsünün yerinde yapılan deneysel çalışmalar ile modal parametrelerinin tahmin edilmesini ve köprünün referans sayısal modelinin geliştirilmesi çalışmalarını içermektedir. Köprünün dinamik tepkisi 2 farklı ortam sıcaklığında ve ortamsal titreşim koşulları altında 4 farklı deney kurulumu ile ölçülmüştür. Modal parametreler ise 2 farklı sadece-çıktı tabanlı sistem tanımlama yöntemi kullanılarak tahmin edilmiştir. Bunlardan ilki İyileştirilmiş Frekans Tanım Alanında Ayrıştırma (Enhanced Frequency Domain Decomposition, EFDD) ikincisi ise Veri Tabanlı Stokastik Altalan Tanımlama (Data-driven Stochastic Subspace Identification, SSI-DATA) yöntemleridir. İki farklı sıcaklık koşulunda elde edilen sonuçlar, modal parametre tahmin sonuçlarındaki sıcaklık değişiminin etkilerini değerlendirmek için karşılaştırılmıştır. Köprünün başlangıç sonlu elemanlar modeli Matlab tabanlı FEDEASLab sonlu elemanlar programı kullanılarak oluşturulmuş ve deneme-yanılma yöntemi ile kalibrasyonu gerçekleştirilmiştir. Böylece köprünün mevcut durumunu yansıtan referans bir sayısal model oluşturulmuştur. Bu model ileride sonlu elemanlar modeli güncelleme tabanlı hasar tespitinde kullanılabilecektir

System identification work on 199+325 steel railroad bridge and development of its calibrated finite element model

Railroad bridges maintained and operated by the State Raid Road Agency (TCDD) constitute the main passage ways and junction points of the railroad network of the country. Most of these bridges have been under service for more than 100 years. These bridges are exposed to larger service loads as compared to the highway bridges, and are open to external actions leading to changes in their dynamic parameters. Due to these reasons, the railroad bridges must routinely be checked and serviced. The routine checks done by TCDD are based on visual inspection, and highly subjective and dependent on the technician's experience. This increases the chance of making mistakes and missing hidden structural damages. Vibration-based structural health monitoring offers a more objective framework which has the potential to reduce operator dependent nature of the routine checks. This study presents modal parameter estimation studies by in-situ experiments and a developed reference numerical model of the 199+325 steel railway bridge located in Usak. The dynamic response of the bridge was measured in four different test setups and in two different temperature states, and under ambient vibration conditions. Modal parameters of the bridge are estimated using two different output-only system identification methods, namely, Enhanced Frequency Domain Decomposition and Data-driven Stochastic Subspace Identification methods. The identification results obtained under different temperature conditions are compared in assessing the effects of temperature change in identification results. Three dimensional finite element model of the bridge is created using FEDEASLab software. Trial-and-error type model updating study is conducted. Therefore a reference numerical model of the bridge representing its current condition is obtained. This model will be facilitated in the future for damage identification purpose using the sensitivity based finite element modeling updating method

Samband mellan styvhet och ändring av fukthalt i KL-trä vid lågmekanisk belastning : Slutrapport till förstudieprojekt

Korslimmat trä (KL-trä) tillverkas av brädor som limmas ihop korsvis i flera skikt. Skivorna som erhållsanvänds som byggelement, mestadels för väggar och bjälklagselement. Utgångsmaterialet trä tarstår i jämvikt med det omgivande klimatet och kommer därför ändra fuktkvoten. I studien undersöktesen skiva av KL-trä under varierande fuktförhållanden i en klimatkammare hos Linnéuniversitetet.Egenfrekvenser samt fuktkvoten följdes upp och sambandet med klimatet studerades. Det visade sigatt första och tredje uppmätta egenfrekvensen (böjning) visade negativ korrelation med omgivandefukten, den gick upp när fukten minskades (och tvärtom). För andra egenfrekvensen (torsion)däremot visade sig ett mer komplicerat samband. Ett flertal möjliga orsaker presenteras som förklaring. Medverkande organisationer var Linnéuniversitetet som huvudpart samt SödraSkogsägarna och Saab som bidragit som stödfunktionen och bollplank

Changes in eigenfrequencies of CLT elements due to a variation of ambient conditions

Wood is widely used in the construction sector and gaining increased market share. It isinteracting with the surrounding so that its mechanical and geometrical properties (stiffness,strength, swelling, density, …) change with temperature and humidity levels. In a full-scalebuilding, the eigenfrequencies are hence also varying with the climate. In the current paper,results from a preliminary experimental study are presented. A beam made from cross-laminated timber was hanging freely supported inside a climate chamber. Enforced vibrationsfrom a controlled shaker were taken to obtain the eigenfrequencies. With decreasing moisturecontent, the first and third eigenfrequencies were increasing (bending modes) while the secondeigenfrequency was decreasing (torsional mode). A finite element study allowed for checkingwhich parameters is influencing to which degree so that individual changes can be combined

Samband mellan styvhet och ändring av fukthalt i KL-trä vid lågmekanisk belastning : Slutrapport till förstudieprojekt

Korslimmat trä (KL-trä) tillverkas av brädor som limmas ihop korsvis i flera skikt. Skivorna som erhållsanvänds som byggelement, mestadels för väggar och bjälklagselement. Utgångsmaterialet trä tarstår i jämvikt med det omgivande klimatet och kommer därför ändra fuktkvoten. I studien undersöktesen skiva av KL-trä under varierande fuktförhållanden i en klimatkammare hos Linnéuniversitetet.Egenfrekvenser samt fuktkvoten följdes upp och sambandet med klimatet studerades. Det visade sigatt första och tredje uppmätta egenfrekvensen (böjning) visade negativ korrelation med omgivandefukten, den gick upp när fukten minskades (och tvärtom). För andra egenfrekvensen (torsion)däremot visade sig ett mer komplicerat samband. Ett flertal möjliga orsaker presenteras som förklaring. Medverkande organisationer var Linnéuniversitetet som huvudpart samt SödraSkogsägarna och Saab som bidragit som stödfunktionen och bollplank