BEHAVIOUR OF HIGH STRENGTH CONCRETE COMPOSITE SLABS WITH DIFFERENT END ANCHORAGES

This study is performed to investigate experimentally the behaviour of steel deck composite slabs with different end anchorages. End anchorage as a type of shear connection for composite slabs plays an important role to prevent relative slip between concrete and steel deck. The presented composite slab specimens are made of high strength concrete and loaded at a specific shear span. Objectives of this study is to evaluate experimentally load carrying capacity, end slip, mode of failure, shear bond capacity, and the end anchorage contribution to the whole composite slab behaviour. Research also presents a comparison between the experimental results and the theoretical results derived according to m-k and partial shear connection methods included in these standards (BS 5950-4:1994, CSSBI S3-2003, and EC4 EN 1994-1-1:2004)

Bond Strength of Concrete Containing Different Recycled Coarse Aggregates

Some of the remnants of construction demolition wastes could be used after recycling as coarse aggregate in concrete industry. Among these wastes are ceramics, shale bricks and hardened concrete. This research was carried out to determine the effect of using such recycled aggregate (RA) as total or partial replacement of the natural dolomite coarse aggregate in concrete mixes on their compressive and bond strength with steel bars. Two types of concrete were investigated in this research which included normal concrete and self-compacted concrete. The main variables taken into consideration wee, the type of concrete, the type and percentage of the recycled aggregate and the age of testing. The consistency of the normal fresh concrete was measured by the slump test. However, the workability and flowability of the self-compacted fresh concrete were measured using slump test, V-funnel test. Out of the experimental test results, equations were predicted which correlated between the concrete compressive strength and bond strength of both the recycled aggregate ordinary concrete and the recycled aggregate self-compacted concrete. These equations were completely different than that of the steel-concrete bond equation of concrete with natural aggregate. Out of this research results, the recycled aggregate concrete could be used in both non structural applications and in some structural applications with special precautions

Feasibility of using self-compacting concrete in civil engineering applications

This research aimed to investigate the feasibility of using self-compacting concrete in civil engineering applications as a producing a precast hollow unit. The behavior of the hollow sections cast with self-compacted concrete beneath line-load was evaluated. An experimental work was carried out and a finite element model with ANSYS (version 15) was adopted. A total of fourteen hollow beams were cast and tested. The most variables taken into thought were; the types of reinforcement (reinforced steel bar and steel wire meshes), the types of steel wire meshes (expanded and welded steel wire mesh), number of layers of steel meshes (one layer and two layers), cross section thickness of concrete (40 mm and 60mm), concrete cover thickness (15mm and 20 mm) and also the shapes of cross section (square or circular). Special attention to initial cracking load, ultimate load, deflection, cracking pattern, energy absorption and ductility index were investigated. Good agreement was found compared with the experimental results. Out of this research; this paper presents applications of self-compacted concrete for casting skinny structural hollow members. These members can be used as precast units within the construction of the tunnel to decrease the problems in highway roads due to the difficulty of using crossing bridges particularly for kids and old people which are very useful for developing countries with great economic advantages

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Mechanical properties of self-compacted fiber concrete mixes

Increased productivity and improved working environment have had high priority in the development of concrete construction over the last decade. The major impact of the introduction of self-compacting concrete (SCC) is connected to the production process. The productivity is drastically improved through the elimination of vibration compaction and process reorganization. The working environment is significantly enhanced through avoidance of vibration induced damages, reduced noise and improved safety. Additionally, SCC technology has improved the performance in terms of hardened concrete properties like surface quality, strength and durability. The main objective of this research was to determine the optimum content of fibers (steel and polypropylene fibers) used in SCC. The effect of different fibers on the fresh and hardened properties was studied. An experimental investigation on the mechanical properties, including compressive strength, flexural strength and impact strength of fiber reinforced self-compacting concrete was performed. The results of the investigation showed that: the optimum dosage of steel and polypropylene fiber was 0.75% and 1.0% of the cement content, respectively. The impact performance was also improved due to the use of fibers. The control mix specimen failed suddenly in flexure and impact, the counterpart specimens contain fibers failed in a ductile manner, and failure was accompanied by several cracks