Analysis of laminated composite skew shells using higher order shear deformation theory

Static analysis of skew composite shells is presented by developing a C0 finite element (FE) model based on higher order shear deformation theory (HSDT). In this theory the transverse shear stresses are taken as zero at the shell top and bottom. A realistic parabolic variation of transverse shear strains through the shell thickness is assumed and the use of shear correction factor is avoided. Sander's approximations are considered to include the effect of three curvature terms in the strain components of composite shells. The C0 finite element formulation has been done quite efficiently to overcome the problem of C1 continuity associated with the HSDT. The isoparametric FE used in the present model consists of nine nodes with seven nodal unknowns per node. Since there is no result available in the literature on the problem of skew composite shell based on HSDT, present results are validated with few results available on composite plates/shells. Many new results are presented on the static response of laminated composite skew shells considering different geometry, boundary conditions, ply orientation, loadings and skew angles. Shell forms considered in this study include spherical, conical, cylindrical and hypar shells

Assessment of Risk and Prophylaxis for Venous Thromboembolism and Adherence to the American College of Chest Physicians Recommendations during Early Days of Hospital Stay at a Tertiary Care Teaching Hospital in a Developing Country

Aim: The aim is to assess risk and evaluate the usage of pharmacological thromboprophylaxis adhering to the American College of Chest Physicians (ACCP) recommendations for prevention of venous thromboembolism (VTE) during early days of hospital stay in critically ill and surgery patients at a tertiary care teaching hospital. Patients and Methods: A prospective study was conducted over 1 year where all patients admitted in Intensive Care Unit (ICU), and surgery wards were enrolled in the study after an informed written consent. A structured pro forma was designed, and effective risk stratification for VTE was done. Patients were followed until discharge to record any pharmacological thromboprophylaxis according to the ACCP prevention of thrombosis recommendations. Results: A total of 210 patients included in this study as per the Caprini VTE Risk Assessment tool. Of 210, 150 (60%) patients were critically ill and 60 (40%) were surgical patients with an average age of 65.3 ± 11 and 55.4 ± 12 years, respectively. Of 150 critically ill patients, 21.3% of patients were classified having moderate VTE risk, 33.3% of patients having higher and 45.3% of patients having highest VTE risks. Of 60 postsurgical patients, 13.3% of patients were categorized having moderate VTE risk, 36.6% of patients having higher and 50% of patients having highest VTE risks. Pharmacological thromboprophylaxis was administered to 35.2% of patients, of which, 46.6% and 6.6% were ICU patients and postsurgical patients, respectively. This shows underutilization of pharmacological thromboprophylaxis. Adherence to guideline recommendations (choice of drug, dose, and duration) was observed in all postsurgical patients and 33% of critically ill patients. Conclusions: Pharmacological thromboprophylaxis to higher and highest VTE risk patients was too low, particularly in both the units and very low in surgery ward. Efforts required improving patient safety practice, particularly in higher and highest risk categories