Collaborative Use of DEM and FEM for Brick Joint Splitting in Strong Earthquake Ground Motion

Masonry structures constructed about one hundred and fifty years ago, in the era of the opening of Japan, have been recognized as industrial heritages. Many of them are masonry warehouses made of brick or stone walls framed by wood members. In this research, a two-story warehouse in Tomioka city, a mortar jointed brick masonry with wooden frame reinforcements, was studied for strong earthquake ground motion. Several vibration modes were identified by micro-tremor observations and excitation tests. The three-dimensional FE overall model was constructed and tuned for the distinctive vibration modes. Two DEM local models, one for bending at the center bottom of the wall treated by plane strain, and the other for shear at the upper corner of the wall by plane stress, were constructed to evaluate brick joint splitting. For both models, dynamic displacement response obtained by the three- dimensional FEM were specified at their peripheries via periphery blocks. At the center bottom of the wall, horizontally developing joint splitting in the section was evaluated. At the upper corners, obliquely proceeding joint splitting on the wall was evaluated. In these analyses, the specified displacements were calculated by the FE model for intact brick walls, regardless of the degrading status of the walls. Although this assumption will have to be justified, the results of DEM were consistent with the reported summary of past earthquake damages

Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery

While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized general anesthetic decrease the duration of recovery following outpatient nasal surgery. At a tertiary care university hospital, healthy adult subjects scheduled for outpatient nasal surgery were randomly assigned to receive bilateral infraorbital injections with either 0.5% bupivacaine (Group IOB) or normal saline (Group NS) using an intraoral technique immediately following induction of general anesthesia. All subjects underwent a standardized general anesthetic regimen and were transported to the recovery room following tracheal extubation. The primary outcome was the duration of recovery (minutes) from recovery room admission until actual discharge to home. Secondary outcomes included average and worst pain scores, nausea and vomiting, and supplemental opioid requirements. Forty patients were enrolled. A statistically significant difference in mean [SD] recovery room duration was not observed between Groups IOB and NS (131 [61] min vs 133 [58] min, respectively; P = 0.77). Subjects in Group IOB did experience a reduction in average pain on a 0–100 mm scale (mean [95% confidence interval]) compared to Group NS (−11 [−21 to 0], P = 0.047), but no other comparison of secondary outcomes was statistically significant. When added to a standardized general anesthetic, bilateral IOB do not decrease actual time to discharge following outpatient nasal surgery despite a beneficial effect on postoperative pain

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS