Multiscale modelling of masonry structures using domain decomposition techniques

This paper describes the application of a domain decomposition technique for multiscale modelling of fracture behaviour in masonry. The use of multiple domains allows for a difference in employed mesh sizes for the macro- and mesoscale. For domains which play a crucial role in the failure process, we apply a mesoscale level meshing, while less critical components can be modelled by a less computationally expensive macroscale mesh. The crack behaviour is modelled by using the GFEM method, while the joint degradation is described using a plasticity based cohesive zone model, with a smooth yield surface. For the purpose of domain decomposition, we propose the use of a FETI method

Multiscale modelling of masonry structures using domain decomposition techniques

This paper describes the application of a domain decomposition technique for multiscale modelling of fracture behaviour in masonry. The use of multiple domains allows for a difference in employed mesh sizes for the macro- and mesoscale. For domains which play a crucial role in the failure process, we apply a mesoscale level meshing, while less critical components can be modelled by a less computationally expensive macroscale mesh. The crack behaviour is modelled by using the GFEM method, while the joint degradation is described using a plasticity based cohesive zone model, with a smooth yield surface. For the purpose of domain decomposition, we propose the use of a FETI method

Resistance against Botrytis cinerea in smooth leaf pruning wounds of tomato does not depend on major disease signalling pathways

In high-tech, heated tomato glasshouses, stem infections caused by Botrytiscinerea usually end up girdling the stem, resulting in plant death and consequently high economic losses. Such infections originate primarily from wounds created during leaf pruning, a common cultural practice in which it is intended to remove leaves completely, resulting in smooth stem wounds. However, hasty leaf pruning often results in numerous petiole stubs accidentally left behind. In this study analysis of disease incidences clearly proved that pruning leaves flush to the stem resulted in absolute resistance of the stem wounds, whereas petiole stubs displayed a high level of susceptibility to B.cinerea. Postponing inoculation of wounds after pruning indicated that development of nearly complete resistance occurs within 48h after deleafing. Monitoring of the wound wetness period showed that drying of the wound surface is not the cause of the decreased susceptibility, contrary to what was commonly believed. Tomato mutants deficient in disease signalling showed altered phenotypes for susceptibility to B.cinerea, indicating that defences against this pathogen in petiole stubs depend on ethylene signalling. Additionally, the decreased susceptibility of mutants deficient in the biosynthesis of jasmonates and abscisic acid suggest an antagonistic effect of these signal molecules. On the other hand, resistance of smooth stem wounds could not be altered by disruption of salicylic acid, ethylene, jasmonate or abscisic acid signalling. This indicates that this remarkable absolute resistance to B.cinerea does not depend on the major disease signalling pathways

Development and implementation of a continuing medical education program on non-alcoholic fatty liver disease for primary care practitioners in Europe

Background: Primary care has a crucial role to play in the prevention, early detection, referral, and risk factor management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NAFLD/NASH). In 2021, a team of European collaborators developed a continuing medical education (CME) program on NAFLD/NASH that consolidates evidence and clinical best practices tailored to the primary care setting. This article reports on the methodology used to design and develop the CME and the results of a feasibility study.Methods: An expert advisory group representing both European specialists and general practitioners supported the design of the CME to be implemented in three European settings (Greece, Spain, and Netherlands). The CME features four training modules and problem-based learning using clinical case studies. The CME was tested regarding feasibility and acceptability among a sample of primary care providers (PCPs) in Greece (n = 28) with measurements occurring before, immediately after, and 1 month following the training. Outcome measures included satisfaction with the CME, changes in PCPs' knowledge, attitudes, confidence, and self-reported clinical practices related to NAFLD/NASH.Results: The CME is available as an open-access e-learning course on the European Society for Primary Care Gastroenterology education platform (1) in English, Greek, Spanish, and Dutch. The feasibility study documented high levels of satisfaction, with 96% of PCPs reporting they were extremely or very satisfied with the overall training. Statistically significant increases in PCPs' confidence in NAFLD/NASH-related clinical practices were documented between the pre- and post-assessments. At the follow-up, 62% of GPs reported that the CME had changed their clinical practices related to NAFLD/NASH to a great extent.Conclusion: This CME intervention developed by experts and tailored to PCPs in European settings may serve as an asset for increasing knowledge, confidence, and practice behaviors related to NAFLD/NASH

Hepatitis C reinfection in former and active injecting drug users in Belgium

Abstract Background There is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium. However, in a recent meta-analysis, the overall HCV reinfection rate was 5.9/100 person-years (PY) among PWID. Accordingly, this study was undertaken to investigate the reinfection rate in former and active PWID who achieved the end of treatment response after direct-acting antiviral (DAA) treatment in Belgium. Methods This observational cross-sectional study recruited individuals with a history of injecting drug use who had achieved the end of treatment response to any DAA treatment between 2015 and 2020. Participants were offered a post-treatment HCV RNA test. Results Eighty-five potential participants were eligible to participate and contacted, of whom 60 participants were enrolled in the study with a median age of 51.0 (IQR 44.3–56.0) years; it was reported that 23.3% continued to inject drugs intravenously after DAA treatment. Liver cirrhosis was present in 12.9%. The majority had genotype 1a (51.7%) or genotype 3 (15.0%) infection. We detected no reinfections in this study population. The total time patients were followed up for reinfection in the study was 78.5 PY (median 1.0 years IQR 0.4–2.0). Conclusion Reinfection after successful treatment with DAA initially appears to be very low in Belgian PWID. Therefore, efforts should be made to screen individuals with persistent risk behaviors for reinfection systematically. In addition, a national HCV registry should be established to accurately define the burden of HCV infection and reinfection in Belgium and support the elimination of viral hepatitis C in Europe. Trial registration clinicaltrials.gov NCT04251572, Registered 5 Feb 2020–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04251572

The hepatitis C cascade of care in the Belgian HIV population: One step closer to elimination

Objectives: The Belgian population of people living with HIV (PLHIV) has unrestricted access to direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection, since 2017. International literature claims that half of the patients remain untreated in high-income countries with unrestricted access to DAA. This study was initiated to provide an overview of the present situation in Belgium and recommendations for HCV care in PLHIV in other regions.Methods: This was a retrospective, multicenter study of PLHIV in Belgium, from January 1, 2007 to December 31, 2018. The HCV cascade of care was examined.Results: Out of 4607 unique PLHIV, 322 (7.0%) tested positive for HCV antibody and HCV RNA positivity was seen in 289 (6.3%). Of those with a proven HCV infection, 207/289 (71.6%) initiated treatment. Of the 171 (82.6%) persons with a sustained virologic response (SVR), 16 (9.4%) subjects were reinfected.Conclusions: We present a care cascade of 4607 PLHIV in Belgium. Treatment initiation and SVR rates were high compared to other regions. Implementation of a national HCV register to track progress and yearly screening, especially in PLHIV with high-risk behavior, remains crucial. Identifying reasons for not initiating treatment is necessary to achieve elimination of HCV in PLHIV by 2030. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases

Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium

Background: Targeted screening for hepatitis C viral (HCV) infection is not yet widely executed in Belgium. When performed in people who use drugs (PWUD), it is mainly focused on those receiving opiate agonist therapy (OAT). We wanted to reach out to a population of difficult to reach PWUD not on centralized OAT, using non-invasive screening as a bridge to re-integration in medical care supported by facilitated referral to a specialist. Methods: This was a prospective, multicenter cohort study in PWUD not enrolled in a centralized OAT program in a community-based facility in Limburg or OAT program in a community-based facility in Antwerp, Belgium, from October 2018 until October 2019. Two study teams recruited participants using an outreach method at 18 different locations. Participants were tested for HCV antibodies (Ab) by finger prick, and risk factors were assessed through a face-to-face questionnaire. Univariate analyses were used to assess the association between HCV Ab and each risk factor separately. A generalized linear mixed model was used to investigate the association between the different risk factors and HCV. Results: In total, 425 PWUD were reached with a mean age of 41.6 +/- 10.8, and 78.8% (335/425) were men. HCV Ab prevalence was 14.8% (63/425). Fifty-six (88.9%) PWUD were referred, of whom 37 (66.1%) were linked to care and tested for HCV RNA. Twenty-nine (78.4%) had a chronic HCV infection. Treatment was initiated in 17 (58.6%) patients. The adjusted odds for HCV Ab were highest in those with unstable housing 6 months before inclusion (p < .001, AOR 8.2 CI 95% 3.2-23.3) and in those who had ever shared paraphernalia for intravenous drug use (p < .001, AOR 6.2 CI 95% 2.5-16.0). Conclusions: An important part tested positive for HCV. Treatment could be started in more than half of the chronically infected referred and tested positive for HCV-RNA. Micro-elimination is necessary to achieve the World Health Organization goals by 2030. However, it remains crucial to screen and link a broader group of PWUD to care than to focus solely on those who inject drugs