Assessment amount of the horizontal and vertical displacements of sea wall using FLAC3D software

Sea Walls are constructed to protect coastal against of waves and prevent water to coastal. In order to properly understand the behavior of these structures must have proper information of loads to the structure. One of the main significance loads over the sea wall is wave’s loads. Weight forces the walls, Weight backfill, Seawater weight on the heel wall and Forces exerted on the beach other forces that enters the coastal wall. Considering the importance of seawalls study on the stability of these structures has been the subject of study. In order to achieve the objectives of the study, three scenarios include changes in the geometry of the wall and Soil properties. In present study four geometry vertical, inclined, convex, concave, are considered and modeling with Flac 3D software. The results of this study showed that the minimum of horizontal and vertical displacement are about convex seawalls and the maximum of them is about vertical concave seawalls. Also the results showed that in the higher shear strength of soils the minimum of horizontal and vertical displacements occurred

Behavior of granite-epoxy composite beams subjected to mechanical vibrations

The capacity to damp mechanical vibrations is one of the most important properties of granite-epoxy composites, even superior to the cast iron one. For this reason, these materials have been adopted for manufacturing of tool machine foundations and precision instruments. This work presents a study concerning the behavior of particulate composite beams, based on granite powder and epoxy, subjected to mechanical vibrations. Composite samples were prepared with different combinations of processing variables, like the weight fraction of epoxy in the mixture and size distributions of granite particles. The damping behavior of the material was investigated adopting the logarithmic decrement method. Samples, in the form of prismatic beams, were excited in the middle point and the output signal was measured in a point located at the extremity. The obtained results showed that composite samples, with weight fractions of about 80% of granite and 20% of epoxy, presented damping properties approximately three times greater than gray cast iron

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Use of Osseocartilaginous Paste Graft for Refinement of the Nasal Dorsum in Rhinoplasty

In both primary and secondary rhinoplasty, establishment or refinement of nasal dorsal aesthetic lines is of paramount importance. Many different techniques used to create a cosmetically acceptable nasal dorsum have been published. The material to be used in nasal dorsal contouring should create a harmonic contour and should be easily shaped, long-lasting, and resistant to infection. Resection of the hump yields an osseocartilaginous complex as a single unit when an osteotome is used. Use of a rasp gives a good amount of fragmented material comprising bone, cartilage, soft tissues, and blood. The authors used this material as a paste graft to refine the nasal dorsum in rhinoplasty and retrospectively evaluated the outcomes. A retrospective chart review of 77 patients who underwent this procedure between 2003 and 2009 was performed. The follow-up period ranged from 22 to 40 months (median, 28 months). The postoperative evaluations included clinical examination and digital photographic documentation. The satisfaction of each patient was assessed with a questionnaire completed at the 12th postoperative month. The described graft, which combines the advantages of cartilage and bone, was shown to be clinically durable. This combination also results in an ideal texture and consistency for molding due to its diced form. The texture of this graft enables the surgeon to give a final shape to the nasal dorsum bimanually. In this study, a paste graft was shown to be a versatile and reliable composite material for nasal dorsal contouring and refinement

Effects of LI4 acupressure on labor pain in the first stage of labor

Introduction: Many pregnant women like to avoid pharmacological or invasive methods of pain management in labor. Acupressure is a non-invasive method that has been suggested for labor pain relief. The purpose of this study was to evaluate the effects of LI4 acupressure on labor pain in the first stage of labor. Materials and Method: This single-blind randomized clinical trial was performed on 100 eligible women who were at the beginning of active phase of labor (3-5 cm dilatation of cervix). The case group (n=50) received LI4 acupressure at the onset active phases for duration of each uterine contraction over a period of 20 minutes, while the control group (n = 50) received a touch at this point without massage. Labor pain was measured several times using a subjective labor pain scale (Visual analogue scale) before intervention, immediately, 20, and 60 minutes after intervention and then each hour until delivery. Finally, severities of pain were compared between the two groups. Results: There were significant differences between the groups in subjective labor pain scores at immediately, 20, 60 and 120 minutes after intervention (P<0.001). Conclusion: These finding showed that LI4 acupressure was effective for decreasing pain in women during labor. LI4 acupressure can be an effective nursing management for women in labor

Effects of LI4 acupressure on labor pain in the first stage of labor

Introduction: Many pregnant women like to avoid pharmacological or invasive methods of pain management in labor. Acupressure is a non-invasive method that has been suggested for labor pain relief. The purpose of this study was to evaluate the effects of LI4 acupressure on labor pain in the first stage of labor. Materials and Method: This single-blind randomized clinical trial was performed on 100 eligible women who were at the beginning of active phase of labor (3-5 cm dilatation of cervix). The case group (n=50) received LI4 acupressure at the onset active phases for duration of each uterine contraction over a period of 20 minutes, while the control group (n = 50) received a touch at this point without massage. Labor pain was measured several times using a subjective labor pain scale (Visual analogue scale) before intervention, immediately, 20, and 60 minutes after intervention and then each hour until delivery. Finally, severities of pain were compared between the two groups. Results: There were significant differences between the groups in subjective labor pain scores at immediately, 20, 60 and 120 minutes after intervention (P<0.001). Conclusion: These finding showed that LI4 acupressure was effective for decreasing pain in women during labor. LI4 acupressure can be an effective nursing management for women in labor

A new extrasupported tip graft in the treatment of bulbous nasal tip

Treatment of bulbous nasal tip is difficult. In the presence of thick, inelastic skin, cartilaginous framework should be supported in special areas. Many tip grafting techniques have been described but the results usually are not satisfactory. We developed a new tip grafting technique to provide extra support and extra length to the nasal tip. The graft is prepared from the septal cartilage and has an extended "A" appearance. The tip graft is supported with a columellar strut graft. Both grafts are inserted into small separate pockets through separate incisions. If necessary, the alar base is reduced with a modified Weir technique. Fifty-two patients were treated with this technique over the last 3 years. Results were satisfactory in all patients without any complications such as graft displacement, infection, or resorption. Extrasupported tip graft is an effective method in the treatment of bulbous nasal tip with thick skin

A left transverse facial cleft with a median cleft of the lower jaw

Objective: A 13-day-old girl with a left transverse facial cleft and a median defect of the lower jaw is reported in detail. Left macrostomia was repaired using a W-plasty technique, and preauricular appendages were excised. The median defect of the mandible demonstrated by computed tomography scan on the first examination had disappeared at 1 year of age