Shear Behavior of Reinforced Concrete Inverted-T Deep Beam

Contrary to top-loaded deep beams, Inverted-T (IT) deep beams are loaded on ledges at the beam’s bottom chord. The presence of the load near the bottom of the beams creates a tension field in the web at the loading points. An experimental investigation was carried out in which 8 specimens of reinforced concrete IT deep beams were tested and the effect of the following variables was studied: changing the hanger diameter, hanger arrangement in terms of spacing and distribution distance, hanger reinforcement ratio, vertical and horizontal web shear reinforcement diameter, and spacing. In addition, all the tested beams had long ledges extending to the end of the beam. It was concluded that hanger reinforcement diameter and horizontal web shear reinforcement have an insignificant effect on the IT deep beam capacity. While the change in hanger arrangement, vertical web reinforcement, and ledge length has a significant effect on IT deep beam capacity. The maximum spacing of the hanger reinforcement and the minimum hanger reinforcement ratio passing through the load plate length will be studied in the following publication. A finite element model (FEM) was presented to predict the behavior of IT deep beams. The simulation was carried out using the ABAQUS 2017 software program. The results of the numerical model showed good agreement with the experimental program. Analysis using design codes was checked against the experimental data, where the computed beam capacities were compared to those obtained from the test results. The comparison showed a remarkable difference between the predictions using the design codes and the test results. Computation using design codes significantly underestimated the capacities of the beams. Doi: 10.28991/CEJ-2023-09-05-04 Full Text: PD

Behavior of RC Wide Beams under Eccentric Loading

Wide beams are one of the widely used structural elements in RC buildings due to the many special features that characterize them. The main objective of this research is to investigate the behavior of wide shallow beams under the effect of eccentric loading acting along their cross sections. To achieve that, an experimental program that consisted of seven wide beams was conducted. All beams were loaded using two concentrated loads at their middle third where the main parameters considered were: the magnitude of the load eccentricity, the longitudinal spacing between shear reinforcement, and the arrangement of the longitudinal reinforcement. Following that, a finite element analysis was performed where the analytical model used was first verified using the data from the experimental program. The results from both the experimental and analytical programs were in good agreement. Then, the finite element analysis was extended through a parametric study where other variables were studies such as the compressive strength of concrete, the transverse spacing between stirrups and the longitudinal reinforcement ratio. The results showed that the value of the load eccentricity, spacing between shear reinforcement, the arrangement of the main reinforcement along the beam cross section, and the compressive strength of concrete significantly affected the torsional resistance of shallow wide beams. Conclusions and recommendations are presented which can be useful for future researchers. Doi: 10.28991/cej-2021-03091766 Full Text: PD

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

Behavior of Reinforced Concrete Deep Beams with Openings under Vertical Loads Using Strut and Tie Model

This research aims to study the effects of the size and location of openings on deep beams. The analysis of deep beams with openings presents a rather complex problem for engineers, as there are currently no guidelines within the design codes for this problem. Using the strut and tie model is a feasible solution, but also gives some uncertainties due to the various models that can be used. This paper proposes using a strut and tie model for the deep beams with openings where reinforcement is laid out in the form of embedded struts and ties. The study is divided into an experimental and a numerical part. The experimental study was conducted on eight reinforced concrete deep beams under vertical loads. Seven of the beams had web openings of different sizes and locations, while the eighth specimen was a reference beam without any openings. The beams had the same concrete dimensions with the size of the openings in the web taken as 150 150 mm and 300 300 mm, and the location of the opening in the horizontal direction was varied between 0.11 to 0.4 the span. The experimental results were analyzed in terms of cracking pattern, mode of failure, and load-deflection behavior and then compared to numerical analysis conducted using a finite element program. A parametric study followed to investigate the influence of reinforcement arrangement and reinforcement around the openings on the behavior of deep beams. The results showed that large web openings that directly interrupted the compression strut had the most reduction in beam capacity and that the location of the opening did not significantly affect the strength of the beam in the case of small openings. Doi: 10.28991/CEJ-SP2021-07-011 Full Text: PD

Analysis of the punching behavior of RC flat slabs with horizontal and vertical shear reinforcement

Punching failure is one of the major drawbacks of using flat slabs in the design of reinforced concrete structures. Punching shear analysis is very complicated which appears clearly in the large variation of the equations used by the different codes in calculating the punching shear capacity. There are many factors that affect the punching shear capacity of an element. This current research aims to investigate the contribution of two of these factors which are the horizontal flexural reinforcement, and the vertical shear reinforcement in the form of stirrups. Following the experimental program conducted at the reinforced concrete laboratory of the Faculty of Engineering at Cairo University, Egypt and verification using the finite non-linear analysis software (ANSYS 15), good correlation was observed between the analytical models and their corresponding experimental data. This proves that ANSYS 15 allows for studying the punching behavior of the flat slab in more details which could not be monitored in the laboratory. As a result, a detailed parametric study as well as comparison with some design codes was conducted using thirteen full scale flat slab specimens in order to simulate real life problems. The specimens had a loaded span of 2000 mm and a total thickness of 250 mm. The variables under study were the flexural reinforcement ratio and stirrups spacing and diameter in order to further enhance the understanding of the behavior of flat slabs in punching

Flexural Behavior of One-Way Slabs Reinforced with Welded Wire Mesh under Vertical Loads

This paper aims to study the behavior of one-way concrete solid slabs reinforced with welded wire mesh to investigate the efficiency of using welded wire mesh in the construction of structural slabs as a replacement for ordinary steel bars. This research included experimental and analytical programs. Nine 700×1050 mm one-way simple specimens and six 525×1050 mm continuous one-way slabs with two equal spans were tested under point, line, and uniform static loads. The experimental program studied the use of welded mesh and the number of layers utilized. Numerical analysis was conducted using finite element modeling developed using the ABAQUS 6.13 software package. Experimental and analytical results showed good correlation: the number of layers of welded metal mesh and load type significantly affected the peak vertical load capacity of simple and continuous slabs, with slabs showing higher values with welded mesh than those of ordinary reinforcing bars. In addition, using welded metal mesh to reinforce solid slabs enhanced their cracking behavior as well as their ductility. Doi: 10.28991/CEJ-2022-08-04-03 Full Text: PD

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this