Micromechanical Modeling of High-Strain Thin-Ply Composites

This paper presents a micromechanical analysis for the elastic and viscoelastic behavior of high-strain thin-ply composites. The modeling approach is based on unit cell homogenization. The geometry of the internal weave architecture and ply configuration is characterized via micrographic analysis and explicitly modeled in the unit cell. The composites are modeled as Kirchhoff plates and the homogenization analysis computes the effective relaxation ABD matrix represented by Prony series using the elastic and viscoelastic properties of the constituent fiber and matrix. The formulation of the micromechanical model and numerical implementation d. Composite laminates with 3-ply and 4-ply configurations are studied

Complement Therapeutics in Autoimmune Disease

Many autoimmune diseases are characterized by generation of autoantibodies that bind to host proteins or deposit within tissues as a component of immune complexes. The autoantibodies can activate the complement system, which can mediate tissue damage and trigger systemic inflammation. Complement inhibitory drugs may, therefore, be beneficial across a large number of different autoimmune diseases. Many new anti-complement drugs that target specific activation mechanisms or downstream activation fragments are in development. Based on the shared pathophysiology of autoimmune diseases, some of these complement inhibitory drugs may provide benefit across multiple different diseases. In some antibody-mediated autoimmune diseases, however, unique features of the autoantibodies, the target antigens, or the affected tissues may make it advantageous to block individual components or pathways of the complement system. This paper reviews the evidence that complement is involved in various autoimmune diseases, as well as the studies that have examined whether or not complement inhibitors are effective for treating these diseases

Medical Guide System

Currently, getting access to emergency services and consumer health services requires calling a knowledgeable person on the regular phone or using different self-care techniques for illnesses without consulting a doctor. We are improving and expanding new channels of personal communication to facilitate interaction between emergency users and the emergency service system. Given the widespread use of smart devices in our society, we are developing a web application called "Quick Health" for emergency management, with the main feature of answering a question asked by another party or evaluating a given answer, as well as posting a problem and exchanging ideas with others. Our goal is to define a platform that is totally usable by everyone, regardless of their technological or linguistic proficiency. This paper's main goal is to clarify how to adapt traditional applications to modern web applications by taking into account not only web technologies but also social networking behavior. Keywords - Healthcare Emergency System: Medical Guidance; User Interaction; Web Applications &nbsp

A Continuous Quality Improvement Intervention to Improve Antenatal HIV Care Testing in Rural South Africa: Evaluation of Implementation in a Real-World Setting

BACKGROUND: We evaluated continuous quality improvement (CQI) targeting antenatal HIV care quality in rural South Africa using a stepped-wedge cluster-randomised controlled trial (Management and Optimisation of Nutrition, Antenatal, Reproductive, Child health, MONARCH) and an embedded process evaluation. Here, we present results of the process evaluation examining determinants of CQI practice and 'normalisation.' METHODS: A team of CQI mentors supported public-sector health workers in seven primary care clinics to (1) identify root causes of poor HIV viral load (VL) monitoring among pregnant women living with HIV and repeat HIV testing among pregnant women not living with HIV, and (2) design and iteratively test their own solutions. We used a mixed methods evaluation with field notes from CQI mentors ('dose' and 'reach' of CQI, causes of poor HIV care testing rates, implemented change ideas); patient medical records (HIV care testing by clinic and time step); and semi-structured interviews with available health workers. We analysed field notes andsemi-structured interviews for determinants of CQI implementation and 'normalisation' using Normalisation Process Theory (NPT) and Tailored Implementation of Chronic Diseases (TICD) frameworks. RESULTS: All interviewed health workers found the CQI mentors and methodology helpful for quality improvement. Total administered 'dose' was higher than planned but 'reach' was limited by resource constraints, particularly staffing shortages. Simple workable improvements to identified root causes were implemented, such as a patient tracking notebook and results filing system. VL monitoring improved over time, but not repeat HIV testing. Besides resource constraints, gaps in knowledge of guidelines, lack of leadership, poor clinical documentation, and data quality gaps reduced CQI implementation fidelity and normalisation. CONCLUSION: While CQI holds promise, we identified several health system challenges. Priorities for policy makers include improving staffing and strategies to improve clinical documentation. Additional support with implementing clinical guidelines and improving routine data quality are needed. Normalising CQI may be challenging without concurrent health system improvements

Home-based intervention to test and start (HITS) protocol : a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

Abstract: To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - microincentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women..

CD4+ T-cell count at antiretroviral therapy initiation in the "treat all" era in rural South Africa: an interrupted time series analysis

BACKGROUND: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). METHODS: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults ≥16 years old attending 17 public sector primary care services in rural South Africa between July 2014 and March 2019. RESULTS: Among 20,599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval, CI, 308.6 to 325.6)-one to eight months prior to UTT-to 421.0 cells/μL (95% CI 413.0 to 429.0) one to twelve months after UTT, including an immediate increase of 124.2 cells/μL (95% CI 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI 381.8 to 397.1) 13 to 30 months after UTT, but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (-118.2 cells/μL, 95% CI -125.5 to -111.0) throughout the study. CONCLUSIONS: Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in HIV infection, particularly among men

The Magnitude, Clinical Presentation and Consequences of Patients with Burn Injuries Admitted to Tertiary Care Hospital, Kurunegala, Sri Lanka: A Prospective Analysis

This prospective analysis is based on clinical forensic examinations and clinical case records of the victims who sustained burns and were admitted during a one-year period since 2017. Of the 90 patients (34 children and 56 adults), 54 % were male with ages ranging from 1 month to 80 years. Males below the age of 20 years (48 %) were highly vulnerable. Education status revealed that most of the patients have an education level below O/L representing 52 % (Ordinary Level/ O/L is similar to the General Certificate of Secondary Education/ GCSE in Cambridge Education System in United Kingdom) and the majority were married (52%). Scalds were seen in 52 %, while flame burns in 28 % cases. Most of the incidents had taken place at home (92%). Burn injuries were most frequently observed on upper extremities (47 %) and the majority were of first degree in nature. Furthermore, this study revealed that 57 % recovered without any complications, while 34 % resulted in scarring or disfigurement. It was highlighted that children are the most vulnerable to in sustaining burns, especially with hot water in domestic settings. The study recommends increasing awareness among parents/guardians regarding safe handling of hot water to minimize such incidents

Findings from home-based HIV testing and facilitated linkage after scale-up of test and treat in rural South Africa: young people still missing

Objectives: The aim of the study was to estimate rates of linkage to HIV care and antiretroviral treatment (ART) initiation after the introduction of home‐based HIV counselling and testing (HBHCT) and telephone‐facilitated support for linkage in rural South Africa. / Methods: A population‐based prospective cohort study was carried out in KwaZulu Natal, South Africa. All residents aged ≥ 15 years were eligible for HBHCT. Those who tested positive and were not in care were referred for ART at one of 11 public‐sector clinics. Individuals who did not attend the clinic within 2 weeks were sent a short message service (SMS) reminder; those who had not attended after a further 2 weeks were telephoned by a nurse counsellor, to discuss concerns and encourage linkage. Kaplan–Meier methods were used to estimate the proportion of newly diagnosed individuals linking to care and initiating ART. / Results: Among 38 827 individuals visited, 26% accepted HBHCT. Uptake was higher in women than in men (30% versus 20%, respectively), but similar in people aged < 30 years and ≥ 30 years (28% versus 26%, respectively). A total of 784 (8%) tested HIV positive, of whom 427 (54%) were newly diagnosed. Within 6 months, 31% of women and 18% of men < 30 years old had linked to care, and 29% and 16%, respectively, had started ART. Among those ≥ 30 years, 41% of women and 38% of men had linked to care within 6 months, and 41% and 35%, respectively, had started ART. / Conclusions: Despite facilitated linkage, rates of timely linkage to care and ART initiation after HBHCT were very low, particularly among young men. Innovations are needed to provide effective HIV care and prevention interventions to young people, and thus maximize the benefits of universal test and treat

Low intensity harvesting of natural rubber: A financial perspective

Cultivation of rubber is a long term investment with about 30 years of rotational age. Harvesting is considered to be the most important operation in rubber plantations since it determines not only the productivity but also economic life of the tree. It requires high level of skill and also contributes to ca. 45% of the cost of production (COP) in Sri Lanka.Economical lifespan of the tree ends when the consumable bark of the tree is over by tapping. Therefore, any increase in bark consumption rate shortens the economical lifespan. There are records on 16 year lifespan in some estates. Previous studies revealed that in plantations, ca. 38% of the total harvesters are unskilled and in some estates, it has been as high as 89%. On average this results in a yield loss of ca. 118 kg per hectare per year. This situation aggravated with poor daily outturn of harvesters and increased COP. The nature of this profession does not attract young people for latex harvesting. With that only about 17% of the harvesters have been below 30 years of age. Low intensity harvesting systems facilitate to reduce the COP through the reduction of the cost of tapping and also reduce the harvester requirement in rubber plantations. In addition, LIH systems with shorter tapping cuts may eliminate the skill factor of harvesters to some extent. Hence, LIH system would be a practical solution to the problems associated with skilled worker shortage in latex harvesting. Moreover, considerable financial benefits are expected with reducing of bark consumption and associated increase in economic lifespan of trees. For base panel harvesting, two extended LIH systems (i.e. harvesting a half spiral of the tree in once four days and harvesting a quarter spiral of the tree once in three days) are available. Those were reviewed in this study on monetary terms.In the application of S/2 d4 and S/4 d3, the overall production cost (COP) has been reduced by Rs. 17.40 and Rs. 16.24, respectively from the value of the traditional S/2 d2 system. Increased daily wage of harvesters were observed in LIH systems with that the highest income, Rs. 833.99 was recorded in S/2 d4 system showing 36.30% increase over S/2 d2 system. Harvester‟s income under S/4 d3 system was Rs. 719.00 per day and Rs. 107.13 higher than that of S/2 d2 system. With the lowest COP observed, highest net income (i.e. Rs. 367,022.37) per hectare per year was recorded in S/2 d4 and it was shown to be 12.49% increase over the net income of S/2 d2 system. Net annual income observed per hectare in S/4 d3 system was Rs. 355,861.95 with 9.07% increase over the traditional S/2 d2 system.With the observed bark consumption in three harvesting systems (i.e. S/2 d2, S/2 d4 and S/4 d3) tested base panels of rubber trees could be harvested for 24, 40 and 54 years; hence the trees could be kept for 30, 46 and 60 years, respectively with initial six year immature phase. Extension of tree lifespan results in improved mature:immature ratio providing higher level of revenue area in an estate