Shape Memory Alloy Reinforced Concrete Frames Vulnerable to Strong Vertical Excitations

Reinforced concrete (RC) framed buildings dissipate the seismic energy through yielding of the reinforcing bars. This yielding jeopardizes the serviceability of these buildings as it results in residual lateral deformations. Superelastic shape memory alloys (SMAs) can recover inelastic strains by stress removal. This paper extends previous research by the authors that optimized the use of SMA bars in RC frames considering the horizontal seismic excitation by addressing the effect of the vertical seismic excitation. A steel RC six-storey building designed according to current seismic standards is considered as case study. Five different earthquake records with strong vertical components are selected for the nonlinear dynamic analysis. The results were used to evaluate the effect of the vertical excitation on the optimum locations of SMA bars

Detection of contaminant plumes released from landfills

International audienceContaminant leaks released from landfills are a significant threat to groundwater quality. The groundwater detection monitoring systems installed in the vicinity of such facilities are vital. In this study the detection probability of a contaminant plume released from a landfill has been investigated by means of both a simulation and an analytical model for both homogeneous and heterogeneous aquifer conditions. The results of the two models are compared for homogeneous aquifer conditions to illustrate the errors that might be encountered with the simulation model. For heterogeneous aquifer conditions contaminant transport is modelled by an analytical model using effective (macro) dispersivities. The results of the analysis show that the simulation model gives the concentration values correctly over most of the plume length for homogeneous aquifer conditions, and that the detection probability of a contaminant plume at given monitoring well locations match quite well. For heterogeneous aquifer conditions the approximating analytical model based on effective (macro) dispersivities yields the average concentration distribution satisfactorily. However, it is insufficient in monitoring system design since the discrepancy between the detection probabilities of contaminant plumes at given monitoring well locations computed by the two models is significant, particularly with high dispersivity and heterogeneity

A decision analysis approach for optimal groundwater monitoring system design under uncertainty

International audienceGroundwater contamination is the degradation of the natural quality of groundwater as a result of human activity. Landfills are one of the most common human activities threatening the groundwater quality. The objective of the monitoring systems is to detect the contaminant plumes before reaching the regulatory compliance boundary in order to prevent the severe risk to both society and groundwater quality, and also to enable cost-effective counter measures in case of a failure. The detection monitoring problem typically has a multi-objective nature. A multi-objective decision model (called MONIDAM) which links a classic decision analysis approach with a stochastic simulation model is applied to determine the optimal groundwater monitoring system given uncertainties due to the hydrogeological conditions and contaminant source characteristics. A Monte Carlo approach is used to incorporate uncertainties. Hydraulic conductivity and the leak location are the random inputs of the simulation model. The design objectives considered in the model are: (1) maximizing the detection probability, (2) minimizing the contaminated area and, (3) minimize the total cost of the monitoring system. The results show that the monitoring systems located close to the source are optimal except for the cases with very high unit installation and sampling cost and/or very cheap unit remediation cost

COVID-19 Outbreak: Effect of an Educational Intervention Based on Health Belief Model on Nursing Students' Awareness and Health Beliefs at Najran University, Kingdom of Saudi Arabia

This study aimed to investigate the effect of an educational intervention based on the health belief model (HBM) about COVID-19 on nursing  students' awareness and health beliefs. A true-experimental research design was conducted at nursing college, Najran University, KSA. A  comprehensive sampling was followed to include all female students at the colleges (164 students). The sample was divided randomly into  intervention (82) and control group (82). The educational intervention was designed and conducted based on the HBM through four sequential phases: assessment, planning, implementation, and evaluation. The current study results indicated no statistically significant differences between intervention and control groups concerning their demographic characteristic, awareness, and health beliefs before intervention. After intervention, significant differences (p< 0.05) were observed between intervention and control groups in their awareness and all HBM constructs regarding COVID19. There were positive, statistically significant correlations (P< 0.05) between participants' total HBM score and their total awareness score. This study concluded that HBM is effective in increasing nursing students' awareness regarding COVID-19. It also increases their perceived  susceptibility, severity, and benefits. Besides, it may increase their self-efficacy to overcome perceived barriers to practice protective and preventive actions while dealing with COVID-19. Keywords: Awareness, COVID-19, Health belief model, Nursing students, Saudi Arabia   Cette étude visait à étudier l'effet d'une intervention éducative basée sur le modèle de croyance en santé (HBM) à propos du COVID-19 sur la sensibilisation des étudiants en soins infirmiers et leurs croyances en matière de santé. Une conception de recherche véritablement expérimentale a été menée au collège d'infirmières de l'Université de Najran, en Arabie Saoudite. Un échantillonnage complet a été suivi pour inclure toutes les étudiantes des collèges (164 étudiantes). L'échantillon a été divisé au hasard en groupe d'intervention (82) et groupe témoin (82). L'intervention éducative a été conçue et menée sur la base du HBM à travers quatre phases séquentielles: évaluation, planification, mise en oeuvre et évaluation. Les résultats de l'étude actuelle n'ont indiqué aucune différence statistiquement significative entre les groupes d'intervention et de contrôle concernant leurs caractéristiques démographiques, leur sensibilisation et leurs croyances en matière de santé avant l'intervention. Aprèsl'intervention, des  différences significatives (p <0,05) ont été observées entre les groupes d'intervention et de contrôle dans leur connaissance et tutes les constructions HBM concernant COVID19. Il y avait des corrélations positives et statistiquement significatives (P <0,05) entre le score HBM total des participants et leur score total de sensibilisation. Cette étude a conclu que HBM est efficace pour sensibiliser les étudiants en sciences infirmières au COVID-19. Cela augmente également leur sensibilité, leur gravité et leurs avantages perçus. En outre, cela peut augmenter leur efficacité personnelle pour surmonter les obstacles perçus à la pratique d'actions de protection et de prévention tout en traitant le COVID-19. Mots-clés: Sensibilisation, COVID-19, modèle de croyance en matière de santé, étudiants en sciences infirmières, Arabie saoudit

Cap-Assisted Technique versus Conventional Methods for Esophageal Food Bolus Extraction: A Comparative Study

Background/Aims Food bolus impaction is the most common form of esophageal foreign body impaction observed in adults. Clinical guidelines recommend using the push technique or retrieval methods in such cases. The push technique can cause injuries in certain clinical situations. Notably, conventional retrieval methods are time and effort consuming. Cap-assisted endoscopic extraction of an impacted food bolus is an easy and effective technique; however, more data are needed for its validation. This study compared the capassisted extraction technique with conventional methods. Methods This prospective observational multicenter study compared the success and en bloc removal rates, total procedure time, and adverse events in both techniques.. Results The study included 303 patients who underwent food bolus extraction. The push technique was used in 87 patients (28.7%) and a retrieval procedure in 216 patients (71.3%). Cap-assisted extraction was performed in 106 patients and retrieval using conventional methods in 110 patients. The cap-assisted technique was associated with a higher rate of en bloc removal (80.2% vs. 15%, p<0.01), shorter procedure time (6.9±3.5 min vs. 15.7±4.1 min, p<0.001), and fewer adverse events (0/106 vs. 9/110, p<0.001). Conclusions Cap-assisted extraction showed no adverse events, higher efficacy, and a shorter procedure time compared with conventional retrieval procedures

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p&lt;00001), age 70 years or older versus younger than 70 years (230 [165-322], p&lt;00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p&lt;00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised