Behavior of steel reinforced concrete panels subjected to direct tension

Cracking of massive concrete structures like offshore and nuclear power plants structures is an important issue in designing and maintaining such structures. The low tensile strength of concrete can destroy the structural aesthetics and expose steel reinforcements to severe environmental conditions, leading to corrosion of reinforcement and other deterioration. -- The present research investigation ultimately aims to investigate the general behavior of steel-reinforced normal- and high-strength concrete panels subjected to uniaxial and biaxial direct tension loading taking into consideration the effect of the set of parameters that have the most significant effect on the cracking response. This investigation includes experimental, theoretical, and numerical modeling phases for the cracking response. -- The experimental study incorporates the effect of some important parameters such as the concrete strength, bar diameter, bar spacing, concrete cover, and reinforcement ratio on the cracking response of concrete panels. To conduct the current experimental investigation, a special test setup was designed and fabricated. The loading system was equipped to make it possible to simultaneously apply loads in both directions. Results of the experimental work will be presented in terms of cracking behavior (cracking load, crack spacing, crack width, and crack pattern and the mode of failure), stresses and strains in concrete and steel reinforcement before and after cracking. -- Compared with NSC panels, HSC panels showed lower strains and greater tension stiffening response at a given load level thanks to the corresponding improvement of the bond between the reinforcing steel bars and the high strength concrete matrix. The panels tested under biaxial loading conditions showed lower concrete tensile strength and tension stiffening response, compared with the panels subjected to uniaxial loading conditions. This reduction in the tensile strength of concrete panels subjected to biaxial loading was found to be equal to 5% - 15%. The reduction of the tension stiffening contribution of concrete between cracks due to applying the axial into biaxial direction became more significant as the reinforcing bar diameter was increased. -- An analytical study was conducted to study the bond characteristics between concrete and steel reinforcing bars. Also, a practical and new analytical model, which is capable of predicting the crack spacing of orthogonally reinforced concrete plate panels, was developed. Afterwards, this study developed a model for evaluating crack widths for thick reinforced concrete plates subjected to in-plane axial loading. The calculation procedure was supported by an evaluation of existing test data. -- Finally, the nonlinear analysis of reinforced concrete plates using the damage plasticity model was performed. The tension stiffening model developed in this study was implemented to simulate the cracking response of the concrete. The numerical results show reasonable accuracy in predicting the behavior of steel-reinforced concrete panels

Umbilical cord drainage versus intraumbilical cord oxytocin injection in management of third stage of labour

Background: Postpartum hemorrhage is an important cause of maternal morbidity and mortality. Considerable difference of opinion exist regarding the optimal approach to the management of the 3rd stage of labour, practice varies between countries &between units. Objectives: To evaluate the effectiveness of intra umbilical vein injection of oxytocin and umbilical cord driange in shortening the duration of third stage of labour. Patient and Methods: In this randomized controlled study, 100 women were enrolled in this study they divided into three groups. (Group 1 ,N =30 )received 20 units of oxytocin diluted in 20 ml 0.9% saline solution injected in the umbilical vein after clamping.(Group 2, N = 34) placental cord drainage.(Group 3, N= 36) with no intervention. The primary outcome was mean duration of third stage of labor. Results: The third stage of labor was significantly shorter in group 1 and 2 as compared to group 3. Groups 1 shorten the duration of third stage of labor by 3 min. and group 2 shorten the duration of third stage of labor by 4.27 min.There were no reports of need for manual removal of placenta or retained placenta. Conclusion: The use of intraumbilical injection of oxytocin and placental cord drainage in the third stage of labor significantly reduced the duration of the third stage

Outcome of patients with visceral leishmaniasis in Diyala province

Background: Visceral leishmaniasis is the second largest parasitic killer in the world after malaria. Objective: The outcome of patient with visceral leishmaniasis in hospital samples depending on spot test for diagnosis. Patients and Methods: This study was conducted in Al-Batool Teaching Hospital in Baqubah- Diyala province, during the period from January 2015 to December 2015. Thirty five collecting cases were suspected to have visceral leishmaniasis. History was taken regarding residence, gender, age, animal contact, blood group type. Clinical examination and investigation were done using complete blood count, abdominal ultrasound and spot test. Results: In this study, thirty-five children were diagnosed as visceral leishmaniasis. It is found more among males (60%) than females (40%), more common in spring and winter, than in summer and autumn; which was (48.5%, 31%, 14% and 0.05%) respectively. High percentage recorded among patient with type (A) and (B) blood group, and less in (AB) and (O) (57%,22%,5%,14%) respectively also infection in rural area (71%) more than in urban (29%). Regarding the site of infection, organomegaly was (57%), splenomegaly (14%), hepatomegaly (17%), hepatosplenomegaly (26%) no-organomegaly(43%). All patients were anemic (43%), mild anemia (10 mg% and less) and (57%) severe anemia (7mg% and less). The percentage of duration of fever was 17%2 weeks. Conclusion: Visceral leishmaniasis is a common in patients live in rural areas that have contact with animals (Dog, fox and jackals)

Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment

AbstractBackgroundThe improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation [PCE]) is untested.ObjectivesThis study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle–brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) levels, and family history (FH) of ASCVD to the PCE in participants of MESA (Multi-Ethnic Study of Atherosclerosis).MethodsThe PCE was calibrated (cPCE) and used for this analysis. The Cox proportional hazards survival model, Harrell’s C statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease–related death, or fatal or nonfatal stroke.ResultsOf 6,814 MESA participants not prescribed statins at baseline, 5,185 had complete data and were included in this analysis. Their mean age was 61 years; 53.1% were women, 9.8% had diabetes, and 13.6% were current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC score, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC score modestly improved the Harrell’s C statistic (0.74 vs. 0.76; p = 0.04); ABI, hsCRP levels, and FH produced no improvement in Harrell’s C statistic when added to the cPCE.ConclusionsCAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers

The role of liquid ink transport in the direct placement of quantum dot emitters onto sub-micrometer antennas by dip-pen nanolithography

Dip‐pen nanolithography (DPN) is used to precisely position core/thick‐shell (“giant”) quantum dots (gQDs; ≥10 nm in diameter) exclusively on top of silicon nanodisk antennas (≈500 nm diameter pillars with a height of ≈200 nm), resulting in periodic arrays of hybrid nanostructures and demonstrating a facile integration strategy toward next‐generation quantum light sources. A three‐step reading‐inking‐writing approach is employed, where atomic force microscopy (AFM) images of the pre‐patterned substrate topography are used as maps to direct accurate placement of nanocrystals. The DPN “ink” comprises gQDs suspended in a non‐aqueous carrier solvent, o‐dichlorobenzene. Systematic analyses of factors influencing deposition rate for this non‐conventional DPN ink are described for flat substrates and used to establish the conditions required to achieve small (sub‐500 nm) feature sizes, namely: dwell time, ink‐substrate contact angle and ink volume. Finally, it is shown that the rate of solvent transport controls the feature size in which gQDs are found on the substrate, but also that the number and consistency of nanocrystals deposited depends on the stability of the gQD suspension. Overall, the results lay the groundwork for expanded use of nanocrystal liquid inks and DPN for fabrication of multi‐component nanostructures that are challenging to create using traditional lithographic techniques.F.D. and J.W. contributed equally to this work. F.D. was supported by postdoctoral funding of the Center for Integrated Nanotechnologies (CINT), an Office of Science (OS) Nanoscale Science Research Center (NSRC) and User Facility operated for the U.S. Department of Energy (DOE) by Los Alamos National Laboratory (LANL; Contract No. DE-AC52-06NA25396) and Sandia National Laboratories (Contract No. DE-NA-0003525), and the work was performed in large part at CINT and contributed to CINT User Project, C2013B0048. J.W., P.A.S., S.M., M.T., and J.A.H. acknowledge LANL Directed Research and Development Funds. C.J.S. is a CINT-funded technical specialist. M.R.B. was funded by an LANL Director's Postdoctoral Fellowship, and A.M.D. by a Single Investigator Small Group Research Grant (2009LANL1096), Division of Materials Science and Engineering (MSE), Office of Basic Energy Sciences (OBES), OS, DOE. Los Alamos National Laboratory, an affirmative action equal opportunity employer, is operated by Los Alamos National Security, LLC, for the National Nuclear Security Administration of the DOE under Contract No. DE-AC52-06NA25396. (Center for Integrated Nanotechnologies (CINT), an Office of Science (OS) Nanoscale Science Research Center (NSRC); DE-AC52-06NA25396 - U.S. Department of Energy (DOE); DE-NA-0003525 - U.S. Department of Energy (DOE); C2013B0048 - CINT User Project; LANL Directed Research and Development Funds; CINT; LANL Director's Postdoctoral Fellowship; 2009LANL1096 - Single Investigator Small Group Research Grant, Division of Materials Science and Engineering (MSE), Office of Basic Energy Sciences (OBES), OS, DOE; DE-AC52-06NA25396 - National Nuclear Security Administration of the DOE)Accepted manuscrip

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Genetic analyses of the electrocardiographic QT interval and its components identify additional loci and pathways

The QT interval is an electrocardiographic measure representing the sum of ventricular depolarization and repolarization, estimated by QRS duration and JT interval, respectively. QT interval abnormalities are associated with potentially fatal ventricular arrhythmia. Using genome-wide multi-ancestry analyses (>250,000 individuals) we identify 177, 156 and 121 independent loci for QT, JT and QRS, respectively, including a male-specific X-chromosome locus. Using gene-based rare-variant methods, we identify associations with Mendelian disease genes. Enrichments are observed in established pathways for QT and JT, and previously unreported genes indicated in insulin-receptor signalling and cardiac energy metabolism. In contrast for QRS, connective tissue components and processes for cell growth and extracellular matrix interactions are significantly enriched. We demonstrate polygenic risk score associations with atrial fibrillation, conduction disease and sudden cardiac death. Prioritization of druggable genes highlight potential therapeutic targets for arrhythmia. Together, these results substantially advance our understanding of the genetic architecture of ventricular depolarization and repolarization

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely