Design and construction of stadium tiers – a case study of R. Premadasa Stadium, Sri Lanka

The R.Premadasa International Stadium which is one of the largest stadiums in the country and the only ground in Colombo with flood lights was one of the venues for the tenth ICC Cricket World Cup 2011. The ground which had 15,000 seating capacity was refurbished and reconstructed to increase the seating capacity to 35,000. Under this massive construction project almost buildings around the ground was added with structures to increase the seating capacity and also the existing roof was replaced with a new steel roof. Even the project was very large the time duration given for the design and the completion of construction was only one year. Since the main aim was to increase the seating capacity priority was given to design and construction of stadium tiers and the supporting arrangement. There were many shortcomings with the existed stadium tiers as they were the pre-stressed double “T” sections. Speed of construction and cost effectiveness could not be achieved with them. Precise formwork system and limited area of casting beds were the main problems encountered with casting. Also there was a major problem of water leaking through the brickwork at the edge of the tier connection. In order to overcome the above problems, a new system was identified, analyzed, designed and constructed. Compared with in-situ tiers the new pre-cast system had great advantages in both time and cost. The shape was modified and the weight per unit was limited to overcome the above problems and for the ease of handling. The paper will discuss the types of stadium tiers, design and construction aspects and both advantages and disadvantages. With all these efforts the hosting of World Cup Cricket Matches in R. Premadasa Stadium became a reality

Real-world efficacy of direct acting antiviral therapies in patients with HIV/HCV

The advent of direct-acting antiviral (DAA) therapies has dramatically transformed HCV treatment, with most recent trials demonstrating high efficacy rates (>90%) across all genotypes and special populations, including patients with HIV/HCV coinfection. The efficacy rates of HCV treatment are nearly identical between patients with HCV monofection and patients with HIV/HCV coinfection; however, there are limited studies to compare real-world efficacy with efficacy observed in clinical trials. Using a database from HIV clinics across the United States (US), we identified 432 patients with HIV/HCV coinfection who completed DAA therapy from January 1, 2014 to March 31, 2017 and were assessed for efficacy. Efficacy was evaluated as sustained virologic response (SVR) 12 weeks after DAA completion; furthermore, factors associated with achieving SVR12 were identified. In this analysis, we found DAA therapies to be effective, with 94% of the patients achieving SVR12 and 6% experiencing virologic failure. Baseline variables, including older age, HCV viral load <800K IU/ML, FIB-4 score <1.45, absence of depression, diabetes, substance abuse, and use of DAA regimens without ribavirin were significant predictors of achieving SVR12. Patients with fewer comorbidities, better liver health, and lower HCV viral loads at baseline were more likely to achieve treatment success. Our results were consistent with other real-world studies, supporting the use of HCV therapy in HIV/HCV coinfected patients

MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates

Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4 + cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001). Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4 + cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates