Strengthening of damaged low strength concrete beams using PTMS or NSM techniques

This article presents the results of an analytical and experimental study on the performance of rectangular reinforced concrete (RC) beams strengthened using either post-tension metal strapping (PTMS) or side-near surface mounted (SNSM) FRP bars. Four low-strength (15.3 MPa) medium-scale beams were tested in four-point bending in two phases. In Phase I, one control beam was tested up to failure, whereas three beams were tested up to yielding of the main flexural reinforcement. In Phase II, the three pre-cracked beams were strengthened using PTMS or SNSM techniques, and then retested up to failure. The results indicate that the capacity of the pre-cracked PTMS-strengthened beam was only 8 % higher than the control counterpart. Conversely, the SNSM strengthening solution increased the beam capacity by up to 55 %, which is due to additional flexural reinforcement provided by the FRP bars. Moreover, the predictions given by linear cracked sectional analysis and the current ACI guidelines match well the deflection response of the strengthened beams but only up to the yielding load

Tempo de demora intra-hospitalar das síndromes coronárias agudas

TITULO: Tempo de Demora Intra-hospitalar das Síndromes Coronárias Agudas. ENQUADRAMENTO: A doença coronária, por si só, mantém-se no primeiro lugar das causas de morte na União Europeia. O enfarte agudo do miocárdio (EAM) constitui uma importante causa de morbilidade e mortalidade, sobretudo ao nível dos países industrializados, e resulta, habitualmente, de um processo progressivo de aterosclerose coronária. Todos os anos em Portugal ocorrem cerca de 10.000 EAM. Em doentes com enfarte do miocárdio com supradesnivelamento do segmento ST, a reperfusão precoce é o tratamento de eleição. Manter o menor intervalo de tempo desde o início dos sintomas até à reperfusão é realçado nas guidelines atuais como uma prioridade. OBJECTIVOS: Determinar o tempo de demora intra-hospitalar das Síndromes Coronárias Agudas e analisar a influência de determinadas variáveis no tempo de demora intra-hospitalar, como a idade, o sexo, a forma de admissão (proveniência e tipo de transporte), a prioridade do Sistema de Triagem de Manchester (STM), a dor torácica, o tipo de Síndrome Coronária Aguda (SCA) e a Via Verde Coronária (VVC). MÉTODOS: É um estudo quantitativo e transversal. Amostra constituída por 204 indivíduos com diagnóstico médico de SCA, internados na UCIC do CHTV, EPE, no período compreendido de 1 de Janeiro de 2010 a 30 de Setembro de 2010. A recolha de dados teve por base o registo informático do Sistema ALERT®. RESULTADOS: Os doentes são maioritariamente do sexo masculino (70,1%) com uma média de idades de 69,75 anos (dp=12,74). 63,2% são provenientes do domicílio, 34,8% foram referenciados pelo centro de saúde/SUB. A ambulância sem médico e os meios próprios são o tipo de transporte mais utilizado (44,1% e 42,6% respetivamente). 96,1% dos indivíduos apresentaram dor torácica. 49,0% dos indivíduos foi diagnosticado EAM sem Supra-ST, 32,4% dos indivíduos foi diagnosticado EAM com Supra-ST e 18,6% dos indivíduos foi diagnosticado angina instável. O tempo médio de demora pré-hospitalar (DPH) foi de 1043,11 minutos e o tempo médio entre o início da dor torácica e a admissão no Serviço de Urgência (TDH) foi de 1044,13 minutos; o tempo médio entre a admissão e a realização de triagem (DAT) foi de 8,60 minutos; o tempo médio entre a triagem e a realização do eletrocardiograma (DT-ECG) foi de 34,09 minutos; o tempo médio entre a realização do eletrocardiograma e a primeira observação médica (D-ECGMédico) foi de 20,48 minutos; o tempo médio entre a primeira observação médica e a administração da primeira terapêutica (D-Médico-Terapêutica) foi de 20,25 minutos; o tempo médio entre a admissão e a alta/internamento do doente (DIH-SU) foi de 281,91 minutos, com um tempo mínimo de 6 minutos e máximo de 1500 minutos. 64,7% dos indivíduos fizeram o 1.º ECG no SU num tempo superior a 10 minutos e apenas 35,3% dos indivíduos fizeram o 1.º ECG no SU num tempo 10 minutos. 74,5% dos indivíduos foram triados através do fluxograma Dor Torácica, 70,6% dos indivíduos foram triados com a prioridade laranja e 72,7% dos indivíduos do sexo masculino e 70,5% dos indivíduos do sexo feminino entraram pela VVC. Relativamente ao DIH-SU, o tempo médio foi de 126,71 minutos (dp=141,023) nos indivíduos com EAM com Supra-ST, 340,76 minutos (dp=246,71) nos indivíduos com EAM sem Supra-ST e 396,61 minutos (dp=324,50) nos indivíduos com angina instável. CONCLUSÃO: Os indivíduos do sexo masculino têm um tempo de demora intrahospitalar inferior aos indivíduos do sexo feminino (p> 0,05). Os indivíduos do grupo etário <55 anos apresentam melhores valores médios do tempo entre a admissão e a alta/internamento (p> 0,05). Os indivíduos transferidos do domicílio apresentam melhores valores médios no tempo de demora intra-hospitalar que os indivíduos que são referenciados por outra Instituição de Saúde (p> 0,05). Os indivíduos transportados em ambulância com médico apresentam melhores tempos médios de demora intrahospitalar (p< 0,05). Os indivíduos com dor torácica apresentam piores tempos médios de demora intra-hospitalar que os indivíduos sem dor torácica, à exceção do tempo entre a triagem e o ECG (p< 0,05). Os indivíduos com EAM com Supra-ST são os indivíduos que apresentam melhores tempos médios de demora intra-hospitalar (p< 0,001). Os indivíduos que entraram na VVC são os indivíduos que apresentam melhores tempos médios de demora intra-hospitalar (p< 0,001). PALAVRAS-CHAVE: Síndrome coronária aguda, Tempo de demora intra-hospitalar, Triagem de Manchester, Dor torácica, Tipo de SCA, Via Verde Coronária, ECG.ABSTRACT TITLE: In-hospital delay time in Acute Coronary Syndrome FRAMEWORK: Coronary heart disease alone remains in the first cause of death in the European Union. The acute myocardial infarction (AMI) is an important cause of morbidity and mortality, especially at the level of industrialized countries, and usually results of a progressive process of coronary atherosclerosis. Every year in Portugal occur, about 10000 AMI. In patients with ST-segment elevation myocardial infarction, the early reperfusion therapy is the treatment of choice. Keep the shortest time interval from symptom onset to reperfusion is emphasized in current guidelines as a priority. OBJECTIVES: Determining the time delay of thein-hospital management of Acute Coronary Syndromes and analyze the influence of certain variables in the in-hospital delay time, such as age, sex, the form of admission (provenance and type of transport), the priority of the Manchester Triage System, chest pain, the type of Acute Coronary Syndrome (ACS) and VVC. METHODS: It is a quantitative cross-sectional, retrospective study. Sample of 204individuals, with diagnosis of acute coronary syndrome (ACS), hospitalized in the Coronary Care Unit of CHTV, EPE from the period 1 January 2010 to 30 September 2010. Data collection was based on the computer record ALERT ®System. RESULTS: Patients are mostly male (70.1%) with average age of 69,75. 63.2% came from home, 34.8% were referred by a health center. The type of transport used were, ambulance without doctor and by own means (44.1% and 42.6% respectively). 96.1%ofindividuals had chest pain. 49.0% of individuals were diagnosed with Non-STsegment elevation myocardial infarction, 32.4% of individuals were diagnosed with STsegment elevation myocardial infarction and 18.6%of individuals diagnosed unstable angina. The pre-hospital delay time average was 1043.11 minutes and the time of the beginning of chest pain and admission to hospital average was 1044.13 minutes; time average between admission and triage was 8.60 minutes; time between triage and application of ECG averaged 34.09 minutes; time between execution of ECG and the first medical observation averaged 20.48 minutes; time between the first observation and the first medical therapeutic averaged 20.25 minutes. The average time between admission and discharge/hospitalization was 281.91 minutes, with a minimum time of 6 minutes and a maximum of 1500 minutes. 64.7%of individual shad the first ECG in the emergency room at a time over 10 minutes and only 35.3% of individual shad the first ECG in the emergency room at a time 10 minutes. 74.5% of individuals were triaged through the flowchart chest pain, 70.6% of individuals were triaged with the priority orange and 72.7% of males and 70.5% of females entered the VVC. For the time between admission and discharge/hospitalization, the average time was 126.71 minutes (sd = 141.03) in individuals with ST-segment elevation myocardial infarction, 340.76 minutes (sd = 246.71) in individuals with Non-ST-segment elevation myocardial infarction and 396.61 minutes (sd = 324.50) in patients with unstable angina. CONCLUSION: The males have a lower in-hospital delay time than females (p>0.05). Individuals in the age group <55 year shave better average time between admission and discharge/hospitalization (p>0.05). Individuals transferred from home show better average in-hospital delay time than individuals that are referenced by other Health Institutions (p>0.05). Individuals transported by ambulance with a doctor have better average in-hospital delay time (p<0.05). Individuals with chest pain have worse average in-hospital delay time than individuals without chest pain, except for the time between triage and ECG (p <0.05). Individuals with ST-segment elevation myocardial infarction are the individuals with the best average in-hospital delay time (p <0.001). Individuals who entered the VVC are individuals who have better average in-hospital delay time (p <0.001). KEY WORDS: Acute coronary syndrome, in- hospital delay time, Manchester Triage system, chest pain, type of ACS, via verde coronária. Sd= standard deviation

AdaptMap: exploring goat diversity and adaptation

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2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

<p>Abstract</p> <p>Background</p> <p>The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).</p> <p>Methods</p> <p>All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.</p> <p>Results</p> <p>The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.</p> <p>Conclusion</p> <p>These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.</p

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio