Prevalence of gastroesophageal reflux in patients who develop pneumonia following percutaneous endoscopic gastrostomy: A 24-hour pH monitoring study

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al, in 1980. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined

Influence of cladding panels on the first period of one-story precast buildings

During the recent severe seismic events, as L’Aquila (2009) and Emilia earthquakes (2012), the collapse of cladding panels system in precast buildings has been frequently observed due to their connection system failure. Such a damage have demonstrated the deficiency of the actual design approach, that considers cladding panels as non-structural elements, neglecting any interaction with the structure under bi-directional and dynamic seismic excitations. This paper investigates the influence of vertical cladding panels on the first vibration period of one-story precast concrete buildings, with floor rigid in its own plane. At this purpose, a bare structural elastic model and an innovative elastic model of the building with cladding system are implemented and a parametric study is performed. The results of the parametric study show a high influence of the panels on the first period of the analyzed buildings, as well as the inadequacy for this typology of buildings of the simplified relationship for computing the fundamental period proposed by some codes. More suitable formulas are proposed to evaluate the first period in a linear static analysis of one-story precast buildings, both in the case of bare buildings and of buildings with cladding system