A comparative study of the effects of particle grading and compaction effort on the strength and stiffness of earth building materials at different humidity levels

This paper presents an investigation of the mechanical properties of three different earth building materials manufactured by compacting two soils with distinct particle size distributions under two markedly different efforts. Multiple samples of each material have been equalised either inside a climatic chamber at different humidity levels or oven-dried, before being subjected to shearing inside a triaxial cell to measure the corresponding levels of strength and stiffness. Triaxial shearing has been performed under different levels of radial stress to investigate the effect of material confinement inside thick walls. Consistent with previous research, the study has indicated that strength and stiffness increase as ambient humidity reduces and degree of saturation decreases, though the actual variation of these properties strongly depends on the dry density and clay content of the material. Most importantly, particle grading has emerged as a key material parameter, whose impact on earth building has often been overlooked. Particle grading appears to influence strength and stiffness even more than compaction effort, dry density and average particle size, which are usually quoted as the most important variables for the design of earth building materials

Earth stabilisation via carbonate precipitation by plant-derived urease for building applications

Raw (unfired) earth represents a sustainable and efficient alternative to traditional construction materials but its dissemination into building practice has been hindered by a relatively high vulnerability to water erosion. Enzyme induced carbonate precipitation (EICP) can improve the durability of earth materials without using traditional chemical binders such as cement and lime. EICP utilises the urease enzyme to catalyse the hydrolysis of urea, which produces carbonate ions that react with the calcium ions dissolved in the pore water, thus resulting in the precipitation of calcium carbonate. The calcium carbonate fills the soil voids and binds particles together, which reduces water permeability and increases material strength. The urease enzyme is a hexameric protein that is found in the tissues of many common plants. This work proposes a low-cost and simple stabilisation technology that makes use of crude urease enzyme extracted from soybeans. This technology is applied to the stabilisation of compacted earth, whose properties are then assessed via unconfined compression, moisture buffering and durability tests. The findings suggest a noticeable improvement of material strength and durability, though further investigation is necessary to increase the competitiveness of EICP stabilisation against standard techniques using cement and lime

Factors affecting adherence to guidelines for antithrombotic therapy in elderly patients with atrial fibrillation admitted to internal medicine wards

Current guidelines for ischemic stroke prevention in atrial fibrillation or flutter (AFF) recommend Vitamin K antagonists (VKAs) for patients at high-intermediate risk and aspirin for those at intermediate-low risk. The cost-effectiveness of these treatments was demonstrated also in elderly patients. However, there are several reports that emphasize the underuse of pharmacological prophylaxis of cardio-embolism in patients with AFF in different health care settings. AIMS: To evaluate the adherence to current guidelines on cardio-embolic prophylaxis in elderly (> 65 years old) patients admitted with an established diagnosis of AFF to the Italian internal medicine wards participating in REPOSI registry, a project on polypathologies/polytherapies stemming from the collaboration between the Italian Society of Internal Medicine and the Mario Negri Institute of Pharmacological Research; to investigate whether or not hospitalization had an impact on guidelines adherence; to test the role of possible modifiers of VKAs prescription. METHODS: We retrospectively analyzed registry data collected from January to December 2008 and assessed the prevalence of patients with AFF at admission and the prevalence of risk factors for cardio-embolism. After stratifying the patients according to their CHADS(2) score the percentage of appropriateness of antithrombotic therapy prescription was evaluated both at admission and at discharge. Univariable and multivariable logistic regression models were employed to verify whether or not socio-demographic (age >80years, living alone) and clinical features (previous or recent bleeding, cranio-facial trauma, cancer, dementia) modified the frequency and modalities of antithrombotic drugs prescription at admission and discharge. RESULTS: Among the 1332 REPOSI patients, 247 were admitted with AFF. At admission, CHADS(2) score was ≥ 2 in 68.4% of patients, at discharge in 75.9%. Among patients with AFF 26.5% at admission and 32.8% at discharge were not on any antithrombotic therapy, and 43.7% at admission and 40.9% at discharge were not taking an appropriate therapy according to the CHADS(2) score. The higher the level of cardio-embolic risk the higher was the percentage of antiplatelet- but not of VKAs-treated patients. At admission or at discharge, both at univariable and at multivariable logistic regression, only an age >80 years and a diagnosis of cancer, previous or active, had a statistically significant negative effect on VKAs prescription. Moreover, only a positive history of bleeding events (past or present) was independently associated to no VKA prescription at discharge in patients who were on VKA therapy at admission. If heparin was considered as an appropriate therapy for patients with indication for VKAs, the percentage of patients admitted or discharged on appropriate therapy became respectively 43.7% and 53.4%. CONCLUSION: Among elderly patients admitted with a diagnosis of AFF to internal medicine wards, an appropriate antithrombotic prophylaxis was taken by less than 50%, with an underuse of VKAs prescription independently of the level of cardio-embolic risk. Hospitalization did not improve the adherence to guideline

Morning Blood Pressure Surge, Dipping, and Risk of Coronary Events in Elderly Treated Hypertensive Patients

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European Hernia Society guidelines on management of rectus diastasis

Rectus diastasis; Hernia; GuidelinesDiástasis del recto; Hernia; PautasDiàstasi del recte; Hèrnia; PautesBackground The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. Method The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. Results Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. Conclusion RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested

An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure.

Purpose To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest. Methods Systematic review of PubMed and Scopus from 2010 onwards. Studies included both open (OS) and laparoscopic (LS). The primary outcome was incidence of IH 12 months after index procedure, secondary outcomes were the study features and their influence on reported proportion of IH. Random effects models were used to calculate pooled proportions. Meta-regression models were performed to explore heterogeneity. Results Ninetyone studies were included reporting 6473 IH. The pooled proportions of IH for OS were 0.35 (95% CI 0.27–0.44) I2 0% in midline laparotomies and 0.02 (95% CI 0.00–0.07), I2 52% for off-midline. In case of LS the pooled proportion of IH for midline extraction sites were 0.10 (95% CI 0.07–0.16), I2 58% and 0.04 (95% CI 0.03–0.06), I2 86% in case of off-midline. In Port-site IH was 0.02 (95% CI 0.01–0.04), I2 82%, and for single incision surgery (SILS) of 0.06—95% CI 0.02–0.15, I2 81%. In case of stoma reversal sites was 0.20 (95% CI 0.16–0.24). Conclusion Midline laparotomies and stoma reversal sites are at high risk for IH and should be considered in research of preventive strategies of closure. After laparoscopic approach IH happens mainly by extraction sites incisions specially midline and also represent an important area of analysis.3102 K

Transition from Secondary school CLIL to EMI at University: Initial evidence from research in Italy

Through vocabulary tests, interviews with students and recordings of classes/lectures, we measured students' English vocabulary knowledge against the vocabulary in the teachers' talk, the nature of classroom interaction in the two settings and the students' approaches to their learning in general and their in-class listening strategies in particular. In this way we aimed to identify the challenges students faced in English-medium education in the secondary and tertiary educational phases

Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review.

Purpose Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. Methods A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines. Results Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the ‘small bites’ suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. Conclusion Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.pre-print146 K