Characterization and Assessment of Tensile Behavior of Carbon Nanofibers Enhanced Ultra-High Performance Concrete

Second only to water, concrete is the world’s most consumed material, not surprisingly, concrete contributes to around 8% of global carbon emissions (Gagg, 2014). This motivates researchers to advance in cementitious material and explore possible breakthroughs in an attempt to further improve and optimize the limited available resources. One recent breakthrough in cementitious materials is Ultra High-Performance Concrete (UHPC). UHPC is an advanced class of concrete and cementitious materials that exhibits high mechanical and durability performance. These properties are achievable using packing density theory which optimizes the gradation of granular materials. In other words, UHPC depends on enhanced microstructure, accompanied by a low water/cement ratio and fiber reinforcement to achieve superior overall performance and durability. UHPC typically consists of cement, silica fume, sand, and a fine supplementary material including -but not limited to- fly ash or slag cement. The robustness and popularity of UHPC in different fields has pushed the interest of stakeholders to explore the UHPC tensile capabilities and behaviors. Evidently, there has been a growth in UHPC tensile research. The literature lacks any set of extensive data with variable fiber dosage.In this study, extensive data is examined and commented on. This study is examining a commercial material named CeEntek which consists of sand, cement, water, carbon nanofiber, and superplasticizer. This study’s comprehensive goal is to assess and characterize the tensile behavior of a nanofiber enhanced UHPC. Another goal of the study is to document the post-cracking tensile behavior of the material. It dictates the future usage of the material as there are two anticipated failure behaviors: failure after gradual strain hardening or failure after crack localization. The first behavior would provide warnings at peak loads which is favorable in general concrete elements design. With the variable fiber percentage in the experimental program, extensive data is generated helping in a better understanding of the tensile behavior of UHPC. To achieve the mentioned goals, an experimental program was set. The experimental investigation consisted of tests on prims, cylinders, and dog-bone-shaped specimens with varying steel fiber content. Four-point bending, direct tension, and compression tests were carried out according to ASTM specifications and extensive data on their compressive, tensile, and flexural behavior were recorded and analyzed

Evaluation of Laparoscopic Sphincter Saving Surgery in Management of Rectal Cancer

Background: Sphincter-saving surgery for rectal carcinoma (RC) has been classically performed by open surgery. Laparoscopic restorative proctectomy (LRP) has been evolved for the same purpose, but its benefits are controversial representing an enigma in the choice of management of RC.Objective: The aim of this study was to evaluate the feasibility, adequacy, safety, short- and long-term outcomes of LRP.Patients and methods: This was a prospective observational study included 35 patients suffering from middle and distal third RC admitted electively to Sohag University Hospital and Colorectal Unit in Ain Shams University. Patients were evaluated and analysed regarding efficacy of LRP, length of stay and different risk factors for post-operative complications.Results: Regarding operative outcomes the mean operative time was 189 minutes, and mean operative blood loss was 95.4 mL, while operative complications happened in 8.5%. Post-operatively, complications happened in 22.9%. The mean post-operative hospital stay was 4.2 ± 1.4 days. Higher American Society of Anesthesiologists (ASA) risk scoring and advanced pathological stage proved to be independent risk factors responsible for complications. During follow-up, local recurrence was evident in 5.7% and distant recurrence developed in further 5.7%. Disease-free survival rate was 80.02 %, and overall survival rate was 91.3% for stage II and 83.3% for stage III. Conclusion: LRP can be done safely reflecting adequacy of the procedure with a comparable complication rate and long-term outcomes to conventional surgery, which makes it a good alternative to conventional technique

Bone Height Changes of the Mandibular Edentulous Ridge in Screw Retained Versus Telescopic Restorations for Completely Edentulous Patients

AIM: This study was established to evaluate the amount of bone height changes in the posterior mandibular area of edentulous patients receiving screw-retained prostheses versus removable telescopic implant overdentures.MATERIAL AND METHODS: Every patient received four inter-foraminal implants regarding the mandibular arch and four anterior implants for the maxillary arch, computer guided surgical guides were planned for the insertion of the implants accurately with a flapless technique. Panoramic radiographs were made immediately, six months and twelve months after the prostheses` use proportional area and vertical measurements were applied to determine changes in the bone height of the posterior mandibular edentulous area.RESULTS: After twelve months, a statistically non-significant amount of bone resorption was reported for both groups.CONCLUSION: Up to the limitations of this study both treatment options the screw retained and telescopic overdenture can be used for rehabilitation of completely edentulous patients. These cases must be followed for a longer period to have a definite answer regarding their efficiency in the long run

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

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

Modeling System to Support the Determination of the Return on Investment (ROI) for PPP projects in Egypt

Public authorities and governments in many nations ensure to assign the operations management of existing PPP projects and for financing new projects to the private sector. This approach adds a lot of benefits for all parties. These benefits included risks’ mitigation, cost savings regarding governmental expenditures, service enhancement, employment opportunities, and improvement in economic indices. This approach called public-private partnership (PPP) (Yescombe, 2007). Due to their complexity, nature and their long duration, PPP projects are usually more difficult to implement than other procurement models. Previous research studies on several PPP projects indicated that a number of problems exist in the calculations of the project’ returns. Additionally, it is explicit that there is a need for an objective, reliable and practical returns’ assessment model for PPP projects with regards to the different factors that might affect theses estimated returns. The required model will help decision makers and investors to assess the revenues of PPP projects at their early stages. To apply PPP projects in Egypt successfully, one of the fundamental requirements is to perform and implement a comprehensive analysis of Return on Investment (ROI), to do such analysis; it should include the factors affecting the ROI relating the projects’ influences such as; financial, legal, political, social . . . etc. According to the World Bank report, the private financial participation in Egypt has accounted $219,229.82 Million in the period from 1990 to 2000. This figure has increased to$998,667.36 Million in 2015 (World Bank ,2016)

Association between the Angiotensinogen (AGT) gene (M235T) polymorphism and Essential Hypertension in Egyptian patients

The pathogenesis of essential hypertension (EH) is affected by genetic and environmental factors. Mutations in hypertension-related genes can affect blood pressure (BP) via alteration of salt and water reabsorption by the nephron. The genes of the renin-angiotensin system (RAS) have been extensively studied because of the well documented role of this system in the control of BP. It has been previously shown that angiotensinogen (AGT) gene polymorphism could be associated with increased risk of EH. The current study evaluated the frequency of AGT (M235T) polymorphism in relation to EH in a group of Egyptian population. The study population included 83 hypertensive patients and 60 age and sex matched healthy control subjects. Restriction fragment length polymorphism-Polymerase chain reaction (RFLP-PCR) was used for the analysis of M235T polymorphism of AGT genes in peripheral blood samples of all patients and controls. The results revealed that there was a positive risk of developing EH when having the T allele whether in homozygous or heterozygous state. It was concluded that there was an association between AGT (M235T) gene polymorphism and the risk of developing EH

Structure and function of the aortic and pulmonary outflows in a patient, 12 years after Nikaidoh operation, A cautionary Note

Background: Nikaidoh translocation operation is increasingly being used for patients with TGA, VSD and LVOTO. The early results of this operation are excellent and possibly better than the Rastelli repair. However, the long-term results remain inadequately defined. Methods and results: Detailed follow up data of a patient, 12 years after Nikaidoh operation, using computerized image analysis are reported. The patient complained of chest pain on exertion. Imaging showed severe dilatation of the non-coronary sinus of the aortic root, compressing the RVOT and pulmonary artery branches resulting in RV dilatation. The dilated aortic sinus showed marked pulsatility with expansion during systole and diastole. As the child was symptomatic, with a risk of aneurysm rupture, excision was performed. This complication is thought to be due to interruption of the innervation of the root as well as cutting vasa vasorum. Conclusion: Nikaidoh operation is a viable solution for the repair of TGA, VSD, PS. Dilatation of the neo-aortic root should be carefully followed and causes of the dilatation investigated