Prevalence and determinants of weight misperception among adult females in Basrah city

Association with the other studied characteristics. Conclusions :The study showed that approximately half of the studied females misperceived their body weight. Females tend to perceive their weights accurately as their ages increase. Highest percents of weight misconception are for obese females who misperceived themselves as overweight and then for underweight ones who misperceived their weights as normal. Recommendations: Comprehensive intervention programs for women could be devised to raise self-awareness of their weight status, to overcome weight misperception, and to prevent obesity and its related health risks

Guillain-Barre syndrome associated with COVID-19 infection:A case series

In this communication, we reported a series of six patients presented with Guillain-Barré syndrome that associated with COVID-19 infection, which was confirmed with RT-PCR. Here we discuss the laboratory investigation and case management, as well as clinical presentation and outcome of each case. The current report demonstrated the first case series of COVID-19-associated GBS-cases in Sudan.</p

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Ökad kunskap om sprutbetong ger hållbara tunnlar

QC 20161114</p

Models for analysis of shotcrete on rock exposed to blasting

In underground construction and tunnelling, the strive for a more time-efficient construction process naturally focuses on the possibilities of reducing the times of waiting between stages of construction. The ability to project shotcrete (sprayed concrete) on a rock surface at an early stage after blasting is vital to the safety during construction and function of e.g. a tunnel. A complication arises when the need for further blasting affects the hardening of newly applied shotcrete. If concrete, cast or sprayed, is exposed to vibrations at an early age while still in the process of hardening, damage that threatens the function of the hard concrete may occur. There is little, or no, established knowledge on the subject and there are no guidelines for practical use. It is concluded from previous investigations that shotcrete can withstand high particle velocity vibrations without being seriously damaged. Shotcrete without reinforcement can survive vibration levels as high as 0.5−1 m/s while sections with loss of bond and ejected rock will occur for vibration velocities higher than 1 m/s. The performance of young and hardened shotcrete exposed to high magnitudes of vibration is here investigated to identify safe distances and shotcrete ages for underground and tunnelling construction, using numerical analyses and comparison with measurements and observations. The work focuses on finding correlations between numerical results, measurement results and observations obtained during tunnelling. The outcome will be guidelines for practical use. The project involves development of sophisticated dynamic finite element models for which the collected information and data will be used as input, accomplished by using the finite ele­ment program Abaqus. The models were evaluated and refined through comparisons between calculated and measured data. First, existing simple engineering models were compared and evaluated through calculations and comparisons with existing data. The first model tested is a structural dynamic model that consists of masses and spring elements. The second is a model built up with finite beam elements interconnected with springs. The third is a one-dimensional elastic stress wave model. The stress response in the shotcrete closest to the rock when exposed to P-waves striking perpendicularly to the shotcrete-rock interface was simulated. Results from a non-destructive laboratory experiment were also used to provide test data for the models. The experiment studied P-wave propagation along a concrete bar, with proper­ties similar to rock. Cement based mortar with properties that resembles shotcrete was applied on one end of the bar with a hammer impacting the other. The shape of the stress waves travelling towards the shotcrete was registered using accelerometers positioned along the bar. Due to the inhomogeneous nature of the rock, the stress waves from the blasting attenuate on the way from the point of explosion towards the shotcrete on the rock surface. Material damping for the rock mass is therefore accounted for, estimated from previous in-situ measurements. The vibration resistance of the shotcrete-rock support system depends on the material properties of the shotcrete and here were age-dependent properties varied to investigate the behaviour of young shotcrete subjected to blast loading. The numerical simulations require insertion of realistic material data for shotcrete and rock, such as density and modulus of elasticity. The calculated results were in good correspondence with observations and measurements in-situ, and with the previous numerical modelling results. Compared to the engineering models, using a sophisticated finite element program facilitate modelling of more complex geometries and also provide more detailed results. It was demonstrated that wave propagation through rock towards shotcrete can be modelled using two dimensional elastic finite elements in a dynamic analysis. The models must include the properties of the rock and the accuracy of the material parameters used will greatly affect the results. It will be possible to describe the propagation of the waves through the rock mass, from the centre of the explosion to the reflection at the shotcrete-rock interface. It is acceptable to use elastic material formulations until the material strengths are exceeded, i.e. until the strains are outside the elastic range, which thus indicates material failure. The higher complexity of this type of model, compared to the engineering models, will make it possible to model more sophisticated geometries. Examples of preliminary recommendations for practical use are given and it is demonstrated how the developed models and suggested analytical technique can be used to obtain further detailed limit values.Inom undermarks- och tunnelbyggande leder strävan efter en mer tidseffektiv byggprocess till fokus på möjligheten att reducera väntetiderna mellan byggetapper. Möjligheten att projicera sprutbetong på bergytor i ett tidigt skede efter sprängning är avgörande för säkerheten under konstruktionen av t.ex. en tunnel. En komplikation uppstår när behovet av ytterligare sprängning kan påverka härdningen av nysprutad betong. Om betong, gjuten eller sprutad, utsätts för vibrationer i ett tidigt skede under härdningsprocessen kan skador som hotar funktionen hos den hårdnade betongen uppstå. Kunskapen i ämnet är knapphändig, eller obefintlig, och det finns inga etablerade riktlinjer för praktisk användning. Slutsatsen från tidigare undersökningar visar att sprutbetong kan tåla höga vibrationer (partikelhastigheter) utan att allvarliga skador uppstår. Oarmerad sprutbetong kan vara oskadd efter att ha utsatts för så höga vibrationsnivåer som 0,5–1 m/s medan partier med förlorad vidhäftning till berget kan uppträda vid vibrationshastigheter högre än 1 m/s. Funktionen hos ung och hårdnande sprutbetong som utsätts för höga vibrationsnivåer undersöks här för att identifiera säkra avstånd och sprutbetongåldrar för undermarks- och tunnelbyggande, med hjälp av numeriska analyser och jämförelser med mätningar och observationer. Arbetet fokuserar på att finna samband mellan numeriska resultat, mätresultat och observationer från tunnelbyggande. Det slutliga resultatet kommer att vara riktlinjer för praktisk användning. Projektet omfattar utveckling av sofistikerade dynamiska finita elementmodeller för vilka insamlad information och data kommer att användas som indata för det finita elementprogrammet Abaqus. Modellerna utvärderades och förfinats genom jämförelser mellan beräknade och uppmätta resultat. Först jämfördes befintliga enkla mekaniska, ingenjörsmässiga modeller vilka utvärderades genom beräkningar och jämförelser med befintliga data. Den första modellen är en strukturdynamisk modell bestående av massor och fjäderelement. Den andra är en modell uppbyggd av finita balkelementet sammankopplade med fjädrar. Den tredje är en endimensionell elastisk spänningsvågsmodell. Spänningstillståndet i sprutbetongen närmast berget, utsatt för vinkelrätt inkommande P-vågor simulerades. Resultat från icke-förstörande laborationsprovningar användes också som testdata för modellerna. Experimentellt studerades P-vågsutbredning i en betongbalk med egenskaper likvärdiga med berg. Cementbruk med egenskaper liknande sprutbetong applicerades på balkens ena ände medan en hammare användes i den andra. Formen hos den genererade spänningsvågen som propagerade mot sprutbetongänden registrerades med accelerometrar utplacerade längs balken. På grund av bergets inhomogena karaktär kommer spänningsvågorna från sprängningen att dämpas ut på vägen från detonationspunkten till sprutbetongen på bergytan. Materialdämpningen hos bergmassan måste därför beaktas och kan uppskattas utifrån resultat från fältmätningar. Vibrationståligheten hos förstärkningssystem av sprutbetong och berg beror av materialegenskaperna hos sprutbetongen och i den här studien varierades de åldersberoende egenskaperna för att undersöka beteendet hos nysprutad och hårdnande sprutbetong utsatt för sprängbelastning. De numeriska simuleringarna kräver realistiska materialdata för sprutbetong och berg, som t.ex. densitet och elasticitetsmodul. De beräknade resultaten var i god överensstämmelse med observationer och mätningar i fält plats, och med de tidigare numeriska resultaten. Jämfört med de mekaniska modellerna kan ett sofistikerat finit elementprogram underlätta modellering av mer komplexa geometrier och också ge mer detaljerade resultat. Det visades att vågutbredning genom berg och fram emot sprutbetong kan beskrivas med tvådimensionella elastiska finita element i en dynamisk analys. Modellerna måste beskriva bergets egenskaper och noggrannheten i dessa parametrar kommer att ha stor inverkan på resultaten. Det kommer att vara möjligt att beskriva vågutbredningen genom bergmassan, från detonationspunkten till reflektionen vid bergytan, det vill säga gränssnittet mellan sprutbetong och berg. Det är acceptabelt att använda elastiska materialformuleringar tills materialet elasticitetsgräns överskrids tills töjningar utanför det elastiska området nås, vilket därmed indikerar materialbrott. Den högre komplexiteten hos den här typen av modell, jämfört med de mekaniska modellerna, kommer att göra det möjligt att analysera mer komplexa tunnelgeometrier. Exempel på preliminära rekommendationer för praktiskt bruk ges och det visas hur de utvecklade modellerna och den föreslagna analysmetodiken kan användas för att fastställa ytterligare detaljerade gränsvärden.QC 2012042

Models for analysis of young cast and sprayed concrete subjected to impact-type loads

The strive for a time-efficient construction process naturally put focus on the possibility of reducing the time of waiting between stages of construction, thereby minimizing the construction cost. If recently placed concrete, cast or sprayed, is exposed to impact vibrations at an early age while still in the process of hardening, damage that threatens the function of the hard concrete may occur. A waiting time when the concrete remains undisturbed, or a safe distance to the vibration source, is therefore needed. However, there is little, or no, fully proven knowledge of the length of this distance or time and there are no established guidelines for practical use. Therefore, conservative vibration limits are used for young and hardening concrete exposed to vibrations from e.g. blasting. As a first step in the dynamic analysis of a structure, the dynamic loads should always be identified and characterized. Here it is concluded that impact-type loads are the most dangerous of possible dynamic loads on young and hardening concrete. Shotcrete (sprayed concrete) on hard rock exposed to blasting and cast laboratory specimens subjected to direct mechanical impact loads have been investigated using finite element models based on the same analysis principles. Stress wave propagation is described in the same way whether it is through hard rock towards a shotcrete lining or through an element of young concrete. However, the failure modes differ for the two cases where shotcrete usually is damaged through loss of bond, partly or over larger sections that may result in shotcrete downfall. Cracking in shotcrete due to vibrations only is unusual and has not been observed during previous in situ tests. The study of shotcrete is included to demonstrate the need of specialized guidelines for cases other than for mass concrete, i.e. structural elements or concrete volumes with large dimensions in all directions. Within this project, work on evaluating and proposing analytical models are made in several steps, first with a focus on describing the behaviour of shotcrete on hard rock. It is demonstrated that wave propagation through rock towards shotcrete can be described using two-dimensional elastic finite element models in a dynamic analysis. The models must include the material properties of the rock and the accuracy of these parameters will greatly affect the results. It is possible to follow the propagation of stress waves through the rock mass, from the centre of blasting to the reflection at the shotcrete-rock interface. It is acceptable to use elastic material formulations until the strains are outside the elastic range, which thus indicates imminent material failure. The higher complexity of this type of model, compared with mechanical models using mass and spring elements, makes it possible to analyse more sophisticated geometries. Comparisons are made between numerical results and measurements from experiments in mining tunnels with ejected rock mass and shotcrete bond failure, and with measurements made during blasting for tunnel construction where rock and shotcrete remained intact. The calculated results are in good correspondence with the in situ observations and measurements, and with previous numerical modelling results. Examples of preliminary recommendations for practical use are given and it is demonstrated how the developed models and suggested analytical technique can be used for further detailed investigations. The modelling concept has also been used for analysis of impact loaded beams and concrete prisms modelled with 3D solid elements. As a first analysis step, an elastic material model was used to validate laboratory experiments with hammer-loaded concrete beams. The laboratory beam remained un-cracked during the experiments, and thus it was possible to achieve a good agreement using a linear elastic material model for fully hardened concrete. The model was further developed to enable modelling of cracked specimens. For verification of the numerical results, earlier laboratory experiments with hammer impacted smaller prisms of young concrete were chosen. A comparison between results showed that the laboratory tests can be reproduced numerically and those free vibration modes and natural frequencies of the test prisms contributed to the strain concentrations that gave cracking at high loads. Furthermore, it was investigated how a test prism modified with notches at the middle section would behave during laboratory testing. Calculated results showed that all cracking would be concentrated to one crack with a width equal to the sum of the multiple cracks that develop in un-notched prisms. In laboratory testing, the modified prism will provide a more reliable indication of when the critical load level is reached. This project has been interdisciplinary, combining structural dynamics, finite element modelling, concrete material technology, construction technology and rock support technology. It is a continuation from previous investigations of the effect on young shotcrete from blasting vibrations but this perspective has been widened to also include young, cast concrete. The outcome is a recommendation for how dynamic analysis of young concrete, cast and sprayed, can be carried out with an accurate description of the effect from impact-type loads. The type of numerical models presented and evaluated will provide an important tool for the work towards guidelines for practical use in civil engineering and concrete construction work. Some recommendations on safe distances and concrete ages are given, for newly cast concrete elements or mass concrete and for newly sprayed shotcrete on hard rock.QC 20150529</p

Laboratory simulation of blasting induced bond failure between rock and shotcrete

QC 20161114</p

Modelleringsverktyg hittar sprickor

QC 20161114</p