Alkaline Activation of Hybrid Cements Binders Based on Industrial by-Products

Environmentally friendly building materials are becoming increasingly relevant in civil engineering in view of their contribution toward sustainable development. This research is focused on hybrid geopolymer concrete (geopolymer with ordinary Portland-cement (OPC) additive) with the objective of analysing strength development. In this research, hybrid geopolymer concrete, manufactured using biomass bottom ash, fly ash and production waste from the manufacture of aluminium fluoride (silica gel) with 4 different amounts of OPC (0%, 5%, 10% and 15%) is studied. Each blend is cured at a temperature of 50 0C and the material is tested after 7, 14 and 28 days. X-ray powder diffraction and energy-dispersive X-ray spectroscopy were used as investigation methods. The purpose of research was to study the chemical composition and the strength development in hybrid geopolymer concretemade from OPC and the industrial by-products mentioned above

Roadmap on ferroelectric hafnia- and zirconia-based materials and devices

Ferroelectric hafnium and zirconium oxides have undergone rapid scientific development over the last decade, pushing them to the forefront of ultralow-power electronic systems. Maximizing the potential application in memory devices or supercapacitors of these materials requires a combined effort by the scientific community to address technical limitations, which still hinder their application. Besides their favorable intrinsic material properties, HfO2–ZrO2 materials face challenges regarding their endurance, retention, wake-up effect, and high switching voltages. In this Roadmap, we intend to combine the expertise of chemistry, physics, material, and device engineers from leading experts in the ferroelectrics research community to set the direction of travel for these binary ferroelectric oxides. Here, we present a comprehensive overview of the current state of the art and offer readers an informed perspective of where this field is heading, what challenges need to be addressed, and possible applications and prospects for further development

Multi-performance experimental assessment of autogenous and crystalline admixture-stimulated self-healing in UHPFRCCs : validation and reliability analysis through an inter-laboratory study

The huge benefits brought by the use of Ultra High-Performance Fibre-Reinforced Cementitious Composites (UHPFRCCs) include their high “intrinsic” durability, which is guaranteed by (1) the compact microstructure and (2) the positive interaction between stable multiple-cracking response and autogenous self-healing capability. Hence, self-healing capability must be properly characterized addressing different performances, thus providing all the tools for completely exploiting such large potential. Within this context, the need is clear for a well-established protocol for self-healing characterization. To this end, in the framework of the Cost Action CA15202 SARCOS, six Round Robin Tests involving 30 partners all around Europe were launched addressing different materials, spanning from ordinary concrete to UHPFRCC, and employing different self-healing technologies. In this paper, the tailored experimental methodology is presented and discussed for the specific case of autogenous and crystalline-admixture stimulated healing of UHPFRCC, starting from the comparison of the results from seven different laboratories. The methodology is based on chloride penetration and water permeability tests in cracked disks together with flexural tests on small beams. The latter ones are specifically aimed at assessing the flexural performance recovery of UHPFRCCs, which stands as their signature design “parameter” according to the most recent internationally recognized design approaches. This multi-fold test approach allows to address both inherent durability properties, such as through-crack chloride penetration and apparent water permeability, and more structural/mechanical aspects, such as flexural strength and stiffness.peer-reviewe

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Crack sealing capacity in chloride-rich environments of mortars containing different cement substitutes and crystalline admixtures

This paper presents the results of a preliminary study aimed at assessing the crack sealing capacity in chloride environments of different concrete mixtures, incorporating supplementary cementitious materials as well as self-healing enhancing crystalline admixtures. For each addition, also including pulverized fuel ash and silica fume, different contents were taken into consideration. Cylinder specimens were pre-cracked in splitting up to three different crack-opening ranges, simulating different service conditions, and then exposed to different conditioning environments, also containing different concentrations of sodium chloride and including both permanent immersion and wet/dry cycles. Healing conditioning was performed up to three months and crack sealing was visually inspected and quantified via image analysis procedures, monthly. Optimum dosages of each cement substitute/addition were quantified, also considering, besides the healing capacity, also the fresh state performance and compressive strength development. The good performance of mixes with crystalline admixture even under open-air exposure, as well as of other investigated mixes with reference to crack openings and exposure conditions, paves the way to revise the significance of a serviceability design parameter such as the maximum allowable crack width as a function of the exposure with the concept of a sealable crack width

Recycled Ultra High Performance Concrete (UHPC) as a Way to Reduce the Cement Demand in New UHPC

The work reported in this paper aims at assessing the performance of Recy-cled Ultra High Performance Concrete (R-UHPC), produced using different fractions of recycled aggregates and fines obtained from crushed Ultra High Performance Concrete (UHPC), as a substitute of the both the natural aggre-gates, as customary in recycled aggregate concrete, and of cement. Three dif-ferent (R-UHPC) mixes were designed and manufactured with a reference mix based on natural aggregate and two mixes with the natural aggregate to-tally replaced by recycled UHPC and 30% cement replacement either with recycled UHPC fines or with recycled UHPC aggregates as well, under the assumption of exploiting the paste halo around the recycled interface parti-cles as a binder since it can consist of significant quantity of uh-hydrated cement. The possibility of totally replacing new fibres with recycled ones, reclaimed after UHPC crushing, was also addressed. This supports the cradle-to-cradle approach in life cycle engineering applications. The research con-firmed the effective regeneration of new UHPC based on recycled aggregate obtained from crushed UHPC, attaining the required rheological, mechanical (compressive, flexural strength and toughness) and durability performance (chloride penetration resistance, chloride migration, water capillary suction and resistivity) as well as the capacity to maintain the overall performance upon the recycling process. This work is intended as the first step towards the sustainability assessment of the potential of R-UHPC for new and retro-fit structural applications. The work has been conducted as a follow up of the activities of the H2020 ReSHEALience Project. One key objective of the project was to formulate the concept and experimentally validate the performance of UHPC for struc-tures and infrastructures exposed to extremely aggressive scenarios, employ-ing functionalizing micro- and nano-scale constituents especially added to deliver high durability in the cracked state under extremely aggressive expo-sure conditions”. In this context, the research was conducted to investigate the potential of recycling the UHPCs, developed and validated in previous research and employing them as a partial or even total replacement of natu-ral fine aggregate in the production of a new UHDC