The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

Aims: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. Methods: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. Results: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59–3.87), large for gestational age (OR 3.99, 95% CI 2.40–6.63), fetal malformation (OR 2.66, 95% CI 1.00–7.18), and respiratory distress (OR 4.33, 95% CI 1.33–14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00–2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04–3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02–2.27) and obesity (OR 1.62, 95% CI 1.04–2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21–2.33 for obese; OR 1.38 95% CI 1.03–1.87 for overweight). Conclusions: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity

On the fracture behaviour of thin-walled SFRC roof elements

The paper presents an experimental and a numerical investigation on precast, prestressed reinforced concrete (RC) and steel fibre reinforced concrete (SFRC) roof elements. The element investigated has a complex geometry, because it is characterized by a thin-walled open cross-section and a long span. In order to reduce the total weight of the traditional RC element and favour an industrialized production process, the structure can be made of fibre reinforced concrete. This composite presents a significant toughness after cracking that can substitute the diffused reinforcement made of common steel-welded meshes, conserving the longitudinal prestressed reinforcement. The mechanical characterization of SFRC material has found recently a shared design approach that starts with the identification of the uniaxial tension constitutive law obtained from a standardized bent notched specimen. Nevertheless, for defined casting procedures of the structure, like in prefabrication, the identification of the uniaxial tension constitutive law can be performed by a four point bending tests on suitable unnotched specimens, able to take into account the effective fibre orientation in the structure and the real nominal thickness of the critical portion of the element. The latter two different experimental test procedures (on notched or unnotched specimens) lead to significant differences in the tension softening response. For this reason SFRC tension softening relations, coming from the previously mentioned experimental tests are analyzed in this paper in order to evaluate their effects on the structural response of this large-scale roof element. The results of the experimental tests on the roof element presented in this paper show that second-order effects drastically anticipated the achievement of the longitudinal bending moment resistance calculated following the beam theory and neglecting transverse equilibrium and in plane cross section deformation. Two numerical models are proposed in this paper to evaluate second-order effects in the resistance assessment of the precast structure. The first one is based on a Plane Section Approach (PSA), while the second one is based on a Non-linear Finite Element Analysis (NLFEA). Both second-order effect and uniaxial tension constitutive relationship roles are examined in relation to the global response of the structure up to failure. The final remarks, coming from a careful comparison between experimental and numerical results, highlight that the failure is mainly led by a structural behaviour, because second-order effects prevail on non-linear response of SFRC materials adopted

Total and excess bed occupancy by age, specialty and insulin use for nearly one million diabetes patients discharged from all English Acute Hospitals

To investigate total diabetes bed occupancy and prolonged inpatient length of stay (LOS) in all English Acute Hospitals, we analysed hospital episode statistics (HES) discharge data for all English Acute Hospitals over 4 years for ICD10 discharge codes of E10 (‘insulin-dependent diabetes’) or E11 (‘non-insulin dependent diabetes’) by age-band (18–60, 61–75 and >75 years) and specialties. We matched these data to control discharges without these codes. There were 943,613 diabetes discharges (6,508,668 bed days) and 10,724,414 matched controls. Mean diabetes LOS increased with age for each specialty and both E10 and E11 codes, but excess diabetes LOS decreased with age. Excess diabetes LOS was <1.0 days in most groups and highest (1.2 days) in insulin-dependent surgical patients under 60 years old, where 19.7% of bed days were excess. A similar pattern was seen for 76,570 diabetes inpatients with key cardiac or surgical conditions. Excess bed occupancy due to prolonged mean LOS accounted for 325,033 bed days under general medical and surgical codes. There were 25,525 discharges with diabetic ketoacidosis (126,495 bed days) in these 4 years. Excess diabetes LOS is concentrated in younger age groups. Excess bed occupancy due to prolonged LOS in medical and surgical inpatients is three times greater than bed occupancy due to diabetic ketoacidosis. Strategies to reduce excess diabetes bed occupancy should emphasize reducing inpatient LOS in younger inpatients