Development of a cost-based design model for spread footings in cohesive soils

The use of cost-effective construction design approaches is an emerging concept in the field of sustainable environments. The design of the foundation for the construction of any infrastructure-related building entails three basic requirements, i.e., serviceability limit state (SLS), ultimate limit state (ULS), and economics. Engineering economy coupled with safety are the two main essentials for a successful construction project. The conventional design approaches are based on hit and trial methods to approach cost-effective design. Additionally, safety requirements are prioritized over the economic aspect of foundation design and do not consider safety requirements and cost simultaneously. This study presents a design approach that considers foundation construction costs while satisfying all the technical requirements of a shallow foundation design. This approach is called an optimization process in which the cost-based isolated foundation design charts were developed based on the field SPT N data. The design charts are the first of their kind for the robust design of foundations and can be used to compare the economic impact of different bearing capacity models. Furthermore, the design framework considers the quantitative impact of the different applied factors of safety values in terms of cost. The results show that Vesic’s equation yields higher values of bearing capacities than Terzaghi and Meyerhof. On the other hand, Vesic’s theory offers a 37.5% reduction in cost as compared to the conventional design approach of the foundation for isolated footing

Seizures in 204 comatose children: incidence and outcome

Purpose: Seizures are common in comatose children, but may be clinically subtle or only manifest on continuous electroencephalographic monitoring (cEEG); any association with outcome remains uncertain. Methods: cEEG (one to three channels) was performed for a median 42 h (range 2–630 h) in 204 unventilated and ventilated children aged $\leq$ 15 years (18 neonates, 61 infants) in coma with different aetiologies. Outcome at 1 month was independently determined and dichotomized for survivors into favourable (normal or moderate neurological handicap) and unfavourable (severe handicap or vegetative state). Results: Of the 204 patients, 110 had clinical seizures (CS) before cEEG commenced. During cEEG, 74 patients (36 %, 95 % confidence interval, 95 % CI, 32–41 %) had electroencephalographic seizures (ES), the majority without clinical accompaniment (non-convulsive seizures, NCS). CS occurred before NCS in 69 of the 204 patients; 5 ventilated with NCS had no CS observed. Death (93/204; 46 %) was independently predicted by admission Paediatric Index of Mortality (PIM; adjusted odds ratio, aOR, 1.027, 95 % CI 1.012–1.042; p 3 % fast, aOR 5.43, 95 % CI 1.90–15.6; excess slow with <3 % fast, aOR 8.71, 95 % CI 2.58–29.4; low amplitude, 10th centile <9 $\mu$V, aOR 3.78, 95 % CI 1.23–11.7; and burst suppression, aOR 10.68, 95 % CI 2.31–49.4) compared with normal cEEG, as well as absence of CS at any time (aOR 2.38, 95 % CI 1.18–4.81). Unfavourable outcome (29/111 survivors; 26 %) was independently predicted by the presence of ES (aOR 15.4, 95 % CI 4.7–49.7) and PIM (aOR 1.036, 95 % CI 1.013–1.059). Conclusion: Seizures are common in comatose children, and are associated with an unfavourable outcome in survivors. cEEG allows the detection of subtle CS and NCS and is a prognostic tool

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Shimpai Muyou: Confronting Child Suicides in Japan through a Serious Game & School-Based Intervention

School bullying is responsible for a large number of child suicides in Japan. Serious games have proved to be effective and highly motivational educational tools capable of increasing awareness, changing behavior, reduce risk factors and even improving protective skills. This paper presents a novel approach of using both participatory design and gameplay to sensitize children (aged 7-12 years old) on bullying victimization. Action research strategy is used with intentions to improve the quality of school life in Japan through the use of a serious game called Shimpai Muyou. What makes it stand out from the rest of the crowd is that the entire intervention was design, developed and evaluated through partnering with children in a school setting. The research is largely qualitative and exploratory in nature, stemmed from interdisciplinary core ideas related to technology, education, psychology and interactive theatre. Findings from both formative and summative evaluations indicated that child-users empathically engaged with the synthetic characters, attributing a range of emotions to their actions e.g., empathy, compassion, sadness, anger etc., tackling ethical dilemmas and bullying situations with confidence. From these results, we can conclude that Shimpai Muyou is a useful and engaging school-based anti-bullying intervention

Significance of Social Support to the Self-Esteem of the Elderly in Pakistan

Dignified and satisfying aging is a growing concern for individuals and policymakers across the world. The mechanism of aging reflects different psychological and physical changes over time. This research analyzes the implications of multifaceted life predictors for senior citizen’s self-esteem in Pakistan by examining the impact of socioeconomic status, social integration, general activities, and health in relation to the self-esteem of 312 retired senior citizens. Validated measures such as the Rosenberg Self-esteem Questionnaire and Bowling Quality of Life Questionnaire were used for data gathering. The results indicated that social integration was closely related to the self-esteem of the elderly

Inter-observer reliability in reading amplitude-integrated electroencephalogram in the newborn intensive care unit

Aim: Amplitude-integrated electroencephalogram (aEEG) is widely used in neonates to detect electrical seizure and predict outcome following hypoxic ischaemic encephalopathy and other encephalopathy. Because accurate interpretation is important for clinical decision-making and family counselling, inter-observer reliability is a major concern. We aimed to evaluate inter-observer reliability in the interpretation of aEEG tracings in a neonatal intensive care unit. Methods: Three neonatal intensive care unit clinicians with different levels of experience in reading aEEG independently reviewed and scored aEEG traces using standardised criteria, categories and interpretation rules. Inter-observer reliability was evaluated using weighted Cohen's κ and intra-class correlation coefficients. Results: All 131 tracings from 120 neonates were reviewed by the neontalogist, 128 (97.7%) by the clinical nurse specialist, 73 (55.7%) by the nurse educator and 70 (53.4%) by all three clinicians. The majority (88 of 120, 73.3%) were term infants (mean gestational age 38 weeks, standard deviation 3.2). Average duration of recording was 27h (standard deviation 19.1, range 1-105h). Inter-observer reliability varied across categories and observers - from very good to excellent for the main background activity (intra-class correlation coefficients 0.93-0.98); good to very good for seizures; and moderate to very good for sleep-wake cycle and quality of recording (weighted κs' 0.71-0.85, 0.50-0.75, 0.46-0.81, respectively). Conclusion: While certain aEEG features appear challenging to inter-observer reliability, our findings suggest that with training and consensus guidelines, levels of reliability needed to enhance clinical and prognostic usefulness of aEEG are achievable across clinicians with different levels of experience in reading aEEG

Cost-Based Optimization of Isolated Footing in Cohesive Soils Using Generalized Reduced Gradient Method

This study presents a cost-based optimization model for the design of isolated foundations in cohesive soils. The optimization algorithm not only incorporates safety requirements in the form of ultimate limit state (ULS) and serviceability limit state (SLS) criteria but also deals with the economics simultaneously. In that regard, the generalized reduced gradient (GRG) method is used for the optimization purpose to achieve the least construction cost of an isolated foundation along with the integration of design parameters as optimization variables. The optimization technique is elaborated using a design example in silty clayey soil and the results of the optimized design are compared with those of the conventional design. The optimization model shows that the optimized design can reduce the construction cost by up to 44% as compared to the conventional design cost for the particular example. Moreover, a sensitivity analysis is also performed to evaluate the quantitative impact of cohesive soil properties, design load, and groundwater table on the construction cost. The results indicate that the construction cost majorly depends on the combined effect of four key parameters: Young’s modulus, recompression index, design load, and groundwater table

Cost-Based Optimization of Isolated Footing in Cohesive Soils Using Generalized Reduced Gradient Method

This study presents a cost-based optimization model for the design of isolated foundations in cohesive soils. The optimization algorithm not only incorporates safety requirements in the form of ultimate limit state (ULS) and serviceability limit state (SLS) criteria but also deals with the economics simultaneously. In that regard, the generalized reduced gradient (GRG) method is used for the optimization purpose to achieve the least construction cost of an isolated foundation along with the integration of design parameters as optimization variables. The optimization technique is elaborated using a design example in silty clayey soil and the results of the optimized design are compared with those of the conventional design. The optimization model shows that the optimized design can reduce the construction cost by up to 44% as compared to the conventional design cost for the particular example. Moreover, a sensitivity analysis is also performed to evaluate the quantitative impact of cohesive soil properties, design load, and groundwater table on the construction cost. The results indicate that the construction cost majorly depends on the combined effect of four key parameters: Young&rsquo;s modulus, recompression index, design load, and groundwater table

Emerging antibiotic resistance profiles in urinary tract infections among the elderly: A critical review

Antibiotic resistance is an increasing danger to treating UTIs in aging patients. These assessments found a regarding raise in multidrug-resistant bacteria those making old-style antibiotics less effective. The weakened immune systems, numerous healthcare exposures, and several chronic conditions in elderly patients subsidize to this resistance. These evaluations explore other strategies outside antibiotics. The capable options include cranberry for anticipation, immune-boosting vaccines, and estrogen therapy for postmenopausal women to decrease repetition. Those rapid and precise diagnostic apparatuses like multiplex PCR panels can also recover treatment by identifying the specific bacteria and its antibiotic vulnerability. However antibiotic stewardship programs are crucial to fight resistance. So these programs promote evidence-based prescribing, track antibiotic use, and educate healthcare benefactors on appropriate usage. The continuous monitoring of resistance designs is also important to guide treatment conclusions and public health policies. At last the collaboration among healthcare providers, researchers, and policymakers is highlighted. This cooperation is critical to progress effective approaches to combat resistance, enhance treatment for the elderly, and preserve the upcoming of antibiotics