PARTIAL SYSTEMS\u27 ANALYSIS OF TRAFFIC NOISE REDUCTION IN TARIK AL JADIDAH, BEIRUT

Traffic noise is considered one of the main pollutants in an urban space and has multiple side effects regarding the physical and mental health of the human being. Tarik Al Jadidah, one of the most densely populated neighborhoods in Beirut City- Lebanon, is selected as urban area for a project-based initiative and the focal point of different studies in BAU Urban Lab. The area suffers from various urban problems, but prominently traffic noise that highly damages the urban residents\u27 quality of life due to its high levels of traffic noise that surpasses the World Health Organization (WHO) guidelines. BAU Urban Lab, an interdisciplinary platform for innovation and knowledge exchange that integrates education with research has led a workshop entitled “System Modelling for Urban Health and Well-Being” held at BAU, Faculty of Architecture - Design and Built Environment. The paper proposes that Vester Sensitivity Model can be considered as a supportive decision-making tool responsible for finding the most effective variables related to Traffic Noise Reduction. The main aim of this paper is to identify the key variables affecting traffic noise reduction system through detecting the variables’ reciprocal impacts using Vester Sensitivity Model. It also depicted that the most influencing variables are those related to social, institutional, infrastructure, and resource flows of the city rather than its fixed physical infrastructure

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Influence of Polymer Processing on the Double Electrical Percolation Threshold in PLA/PCL/GNP Nanocomposites

For the first time, the double electrical percolation threshold was obtained in polylactide (PLA)/polycaprolactone (PCL)/graphene nanoplatelet (GNP) composite systems, prepared by compression moulding and fused filament fabrication (FFF). Using scanning electron microscopy (SEM) and atomic force microscopy (AFM), the localisation of the GNP, as well as the morphology of PLA and PCL phases, were evaluated and correlated with the electrical conductivity results estimated by the four-point probe method electrical measurements. The solvent extraction method was used to confirm and quantify the co-continuity in these samples. At 10 wt.% of the GNP, compression-moulded samples possessed a wide co-continuity range, varying from PLA55/PCL45 to PLA70/PCL30. The best electrical conductivity results were found for compression-moulded and 3D-printed PLA65/PCL35/GNP that have the fully co-continuous structure, based on the experimental and theoretical findings. This composite owns the highest storage modulus and complex viscosity at low angular frequency range, according to the melt shear rheology. Moreover, it exhibited the highest char formation and polymers degrees of crystallinity after the thermal investigation by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC), respectively. The effect of the GNP content, compression moulding time, and multiple twin-screw extrusion blending steps on the co-continuity were also evaluated. The results showed that increasing the GNP content decreased the continuity of the polymer phases. Therefore, this work concluded that polymer processing methods impact the electrical percolation threshold and that the 3D printing of polymer composites entails higher electrical resistance as compared to compression moulding

Polymer processing influence on the double electrical percolation threshold in PLA/PCL/GNP nanocomposites

International audienceConductive fillers such as graphene are able to increase the electrical conductivity in polymer composite systems. Beyond a certain concentration called the electrical percolation threshold, graphene particles can form interconnected 3D percolated network and thus leading to a sudden rise in the conductivity of the composites [1].In this context, this work aims to highlight for the first time the differences in terms of the microstructure of polymer blend composite systems based on polylactic acid (PLA 2003D, Nature Works) and polycaprolactone (PCL CapaTM 6800 , Perstorp) that are filled with 10 wt.% of graphene nanoplatelets (GNP-Grade M5, XG Sciences) and their influence on the electrical properties. The polymer composites were prepared using the melt blending technique via a mini twin-screw extruder. The polymer proportions were varied (the percentage of PLA was increased from 30 wt.% to 80 wt.% in the polymer total weight percentage). 3D printing and compression moulding techniques were used to manufacture the samples for the conductivity tests and the microstructural analysis by scanning electron microscopy (SEM). The SEM image (Figure 1.a) is related to PLA30/PCL70/10 wt.% GNP compression moulded composite in which the PLA nodules (brighter phase) are dispersed in the PCL (darker phase) that contains all the GNPs. The same sea-island morphology was obatined for the 3D printed sample. And from the electrical conductivity measurement tests, this formulation showed inferior electrical performance as compared to PLA60/PCL40/10 wt.% GNP composite (Figure 1.b). The latter possesses superior conductivity due to the presence of a co-continuous structure of PLA and PCL phases in addition to the selective localization of the graphene in the PCL phase. This phenomenon is related to the existence of a double percolation threshold that exists in the case of immiscible polymer blend composites which contain filler whose preference is to one polymer phase rather than the other [2].References[1] Marsden, A.J.; Papageorgiou, D.G.; Valles, C.; Liscio, A.; Palermo, V.; Bissett, M.A.; Young, R.J.; Kinloch, I.A.; Electrical percolation in graphene-polymer composites. 2D Materials 2018, 5, 1-34.[2] Zhang, K.; Yu, H.O.; Shi, Y.D.; Chen, Y.F.; Zeng, J.B.; Guo, J.; Wang, B.; Guo, Z.; Wang, M.; Morphological regulation improved electrical conductivity and electromagnetic interference shielding in poly(L-lactide)/poly(ε-caprolactone)/carbon nanotube nanocomposites via constructing stereocomplex crystallites. Journal of Materials Chemistry C 2017, 5, 2807-2817

Polymer nanocomposites from the flame retardancy viewpoint: A comprehensive classification of nanoparticle performance using the flame retardancy index

International audienc

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial

Importance: It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia. Objective: To describe baseline characteristics of participants enrolled and randomized in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate whether qualification by stress imaging or nonimaging exercise tolerance test (ETT) influenced risk profiles. Design, Setting, and Participants: The ISCHEMIA trial recruited patients with SIHD with moderate or severe ischemia on stress testing. Blinded coronary computed tomography angiography was performed in most participants and reviewed by a core laboratory to exclude left main stenosis of at least 50% or no obstructive coronary artery disease (CAD) (<50% for imaging stress test and <70% for ETT). The study included 341 enrolling sites (320 randomizing) in 38 countries and patients with SIHD and moderate or severe ischemia on stress testing. Data presented were extracted on December 17, 2018. Main Outcomes and Measures: Enrolled, excluded, and randomized participants' baseline characteristics. No clinical outcomes are reported. Results: A total of 8518 patients were enrolled, and 5179 were randomized. Common reasons for exclusion were core laboratory determination of insufficient ischemia, unprotected left main stenosis of at least 50%, or no stenosis that met study obstructive CAD criteria on study coronary computed tomography angiography. Randomized participants had a median age of 64 years, with 1168 women (22.6%), 1726 nonwhite participants (33.7%), 748 Hispanic participants (15.5%), 2122 with diabetes (41.0%), and 4643 with a history of angina (89.7%). Among the 3909 participants randomized after stress imaging, core laboratory assessment of ischemia severity (in 3901 participants) was severe in 1748 (44.8%), moderate in 1600 (41.0%), mild in 317 (8.1%) and none or uninterpretable in 236 (6.0%), Among the 1270 participants who were randomized after nonimaging ETT, core laboratory determination of ischemia severity (in 1266 participants) was severe (an eligibility criterion) in 1051 (83.0%), moderate in 101 (8.0%), mild in 34 (2.7%) and none or uninterpretable in 80 (6.3%). Among the 3912 of 5179 randomized participants who underwent coronary computed tomography angiography, 79.0% had multivessel CAD (n = 2679 of 3390) and 86.8% had left anterior descending (LAD) stenosis (n = 3190 of 3677) (proximal in 46.8% [n = 1749 of 3739]). Participants undergoing ETT had greater frequency of 3-vessel CAD, LAD, and proximal LAD stenosis than participants undergoing stress imaging. Conclusions and Relevance: The ISCHEMIA trial randomized an SIHD population with moderate or severe ischemia on stress testing, of whom most had multivessel CAD

Baseline characteristics and risk profiles of participants in the ISCHEMIA randomized clinical trial

Importance It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia. Objective To describe baseline characteristics of participants enrolled and randomized in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate whether qualification by stress imaging or nonimaging exercise tolerance test (ETT) influenced risk profiles. Design, Setting, and Participants The ISCHEMIA trial recruited patients with SIHD with moderate or severe ischemia on stress testing. Blinded coronary computed tomography angiography was performed in most participants and reviewed by a core laboratory to exclude left main stenosis of at least 50% or no obstructive coronary artery disease (CAD) (<50% for imaging stress test and <70% for ETT). The study included 341 enrolling sites (320 randomizing) in 38 countries and patients with SIHD and moderate or severe ischemia on stress testing. Data presented were extracted on December 17, 2018. Main Outcomes and Measures Enrolled, excluded, and randomized participants’ baseline characteristics. No clinical outcomes are reported. Results A total of 8518 patients were enrolled, and 5179 were randomized. Common reasons for exclusion were core laboratory determination of insufficient ischemia, unprotected left main stenosis of at least 50%, or no stenosis that met study obstructive CAD criteria on study coronary computed tomography angiography. Randomized participants had a median age of 64 years, with 1168 women (22.6%), 1726 nonwhite participants (33.7%), 748 Hispanic participants (15.5%), 2122 with diabetes (41.0%), and 4643 with a history of angina (89.7%). Among the 3909 participants randomized after stress imaging, core laboratory assessment of ischemia severity (in 3901 participants) was severe in 1748 (44.8%), moderate in 1600 (41.0%), mild in 317 (8.1%) and none or uninterpretable in 236 (6.0%), Among the 1270 participants who were randomized after nonimaging ETT, core laboratory determination of ischemia severity (in 1266 participants) was severe (an eligibility criterion) in 1051 (83.0%), moderate in 101 (8.0%), mild in 34 (2.7%) and none or uninterpretable in 80 (6.3%). Among the 3912 of 5179 randomized participants who underwent coronary computed tomography angiography, 79.0% had multivessel CAD (n = 2679 of 3390) and 86.8% had left anterior descending (LAD) stenosis (n = 3190 of 3677) (proximal in 46.8% [n = 1749 of 3739]). Participants undergoing ETT had greater frequency of 3-vessel CAD, LAD, and proximal LAD stenosis than participants undergoing stress imaging. Conclusions and Relevance The ISCHEMIA trial randomized an SIHD population with moderate or severe ischemia on stress testing, of whom most had multivessel CAD. Trial Registration ClinicalTrials.gov Identifier: NCT0147152

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction