Quantification of the service life extension and environmental benefit of chloride exposed self-healing concrete

Formation of cracks impairs the durability of concrete elements. Corrosion inducing substances, such as chlorides, can enter the matrix through these cracks and cause steel reinforcement corrosion and concrete degradation. Self-repair of concrete cracks is an innovative technique which has been studied extensively during the past decade and which may help to increase the sustainability of concrete. However, the experiments conducted until now did not allow for an assessment of the service life extension possible with self-healing concrete in comparison with traditional (cracked) concrete. In this research, a service life prediction of self-healing concrete was done based on input from chloride diffusion tests. Self-healing of cracks with encapsulated polyurethane precursor formed a partial barrier against immediate ingress of chlorides through the cracks. Application of self-healing concrete was able to reduce the chloride concentration in a cracked zone by 75% or more. As a result, service life of steel reinforced self-healing concrete slabs in marine environments could amount to 60-94 years as opposed to only seven years for ordinary (cracked) concrete. Subsequent life cycle assessment calculations indicated important environmental benefits (56%-75%) for the ten CML-IA (Center of Environmental Science of Leiden University-Impact Assessment) baseline impact indicators which are mainly induced by the achievable service life extension

Combined cervicosternotomy and cervicotomy for true retrosternal goiters : a surgical cohort study

Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010-2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a 'standard' thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

Contains fulltext : 97171.pdf (postprint version ) (Open Access)BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe

Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study

Background: To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma. Methods: Demographics, perioperative outcomes and complications were evaluated for consecutive patients who underwent adrenalectomy for phaeochromocytoma from 2012 to 2020 in nine high-volume UK centres. Odds ratios were calculated using multivariable models. The primary outcome was postoperative complications according to the Clavien–­­Dindo classification and secondary outcome was duration of hospital stay. Results: Data were available for 406 patients (female n = 221, 54.4 per cent). Two patients (0.5 per cent) had perioperative death, whilst 148 complications were recorded in 109 (26.8 per cent) patients. On adjusted analysis, the age-adjusted Charlson Co-morbidity Index ≥3 (OR 8.09, 95 per cent c.i. 2.31 to 29.63, P = 0.001), laparoscopic converted to open (OR 10.34, 95 per cent c.i. 3.24 to 36.23,

Comparative LCA of concrete with recycled aggregates: a circular economy mindset in Europe

[EN] Purpose Construction and demolition waste (C&DW) is the largest waste stream in the European Union (EU) and all over the world. Proper management of C&DW and recycled materials¿including the correct handling of hazardous waste¿can have major benefits in terms of sustainability and the quality of life. The Waste Framework Directive 2008/98/EC aims to have 70% of C&DW recycled by 2020. However, except for a few EU countries, only about 50% of C&DW is currently being recycled. In the present research, the environmental impact of concrete with recycled aggregates and with geopolymer mixtures is analysed. The aim of the present research is to propose a comparative LCA of concrete with recycled aggregates in the context of European politics. Methods Life cycle assessment (LCA) methodology is applied using Simapro© software. A cradle to grave analysis is carried out. The results are analysed based on the database Ecoinvent 3.3 and Impact 2002+. Results Results show that the concrete with 25% recycled aggregates is the best solution from an environmental point of view. Furthermore, geopolymer mixtures could be a valid alternative to reduce the phenomenon of ¿global warming¿; however, the production of sodium silicate and sodium hydroxide has a great environmental impact. Conclusions A possible future implementation of the present study is certainly to carry out an overall assessment and to determine the most cost-effective option among the different competing alternatives through the life cycle cost analysis.Colangelo, F.; Gómez-Navarro, T.; Farina, I.; Petrillo, A. (2020). Comparative LCA of concrete with recycled aggregates: a circular economy mindset in Europe. International Journal of Life Cycle Assessment. 25(9):1790-1804. https://doi.org/10.1007/s11367-020-01798-6S17901804259Akhtar A, Sarmah (2018) Construction and demolition waste generation and properties of recycled aggregate concrete: a global perspective. 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J Clean Prod 184:815–825Braga AM, Silvestre JD, de Brito J (2017) Compared environmental and economic impact from cradle to gate of concrete with natural and recycled coarse aggregates. J Clean Prod 162:529–543Chen C, Habert G, Bouzidi Y, Jullien A, Ventura A (2010) LCA allocation procedure used as an incitative method for waste recycling: an application to mineral additions in concrete. Res Con Rec 54(12):1231–1240Chen Z, Gu H, Bergman RD, Liang S (2020) Comparative life-cycle assessment of a high-rise mass timber building with an equivalent reinforced concrete alternative using the Athena impact estimator for buildings. Sustainability (Switzerland) 12(11):4708Colangelo F, Cioffi R (2017) Mechanical properties and durability of mortar containing fine fraction of demolition wastes produced by selective demolition in South Italy. 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Attribution: how is it relevant for loss and damage policy and practice?

Attribution has become a recurring issue in discussions about Loss and Damage (L&D). In this highly-politicised context, attribution is often associated with responsibility and blame; and linked to debates about liability and compensation. The aim of attribution science, however, is not to establish responsibility, but to further scientific understanding of causal links between elements of the Earth System and society. This research into causality could inform the management of climate-related risks through improved understanding of drivers of relevant hazards, or, more widely, vulnerability and exposure; with potential benefits regardless of political positions on L&D. Experience shows that it is nevertheless difficult to have open discussions about the science in the policy sphere. This is not only a missed opportunity, but also problematic in that it could inhibit understanding of scientific results and uncertainties, potentially leading to policy planning which does not have sufficient scientific evidence to support it. In this chapter, we first explore this dilemma for science-policy dialogue, summarising several years of research into stakeholder perspectives of attribution in the context of L&D. We then aim to provide clarity about the scientific research available, through an overview of research which might contribute evidence about the causal connections between anthropogenic climate change and losses and damages, including climate science, but also other fields which examine other drivers of hazard, exposure, and vulnerability. Finally, we explore potential applications of attribution research, suggesting that an integrated and nuanced approach has potential to inform planning to avert, minimise and address losses and damages. The key messages are In the political context of climate negotiations, questions about whether losses and damages can be attributed to anthropogenic climate change are often linked to issues of responsibility, blame, and liability. Attribution science does not aim to establish responsibility or blame, but rather to investigate drivers of change. Attribution science is advancing rapidly, and has potential to increase understanding of how climate variability and change is influencing slow onset and extreme weather events, and how this interacts with other drivers of risk, including socio-economic drivers, to influence losses and damages. Over time, some uncertainties in the science will be reduced, as the anthropogenic climate change signal becomes stronger, and understanding of climate variability and change develops. However, some uncertainties will not be eliminated. Uncertainty is common in science, and does not prevent useful applications in policy, but might determine which applications are appropriate. It is important to highlight that in attribution studies, the strength of evidence varies substantially between different kinds of slow onset and extreme weather events, and between regions. Policy-makers should not expect the later emergence of conclusive evidence about the influence of climate variability and change on specific incidences of losses and damages; and, in particular, should not expect the strength of evidence to be equal between events, and between countries. Rather than waiting for further confidence in attribution studies, there is potential to start working now to integrate science into policy and practice, to help understand and tackle drivers of losses and damages, informing prevention, recovery, rehabilitation, and transformation

La présence de Job et Qohélet dans « Tête d'Or » de Paul Claudel

In general the aspects usually thought of in connection with Claudel's writings are that of a certain understanding of hope, joy and religious victory. However, one aspect of this author which is often forgotten is that of a reflection on the mystery and the problem of evil. This is why the author of this article has decided to compare Claudel's first work, Tete d'or (written a little before his final conversion and marked by a bitter spiritual struggle) with the book of Job. He follows the structure of the biblical book in order to bring out more clearly the Jobian themes in Claudel's play. Further still, this article tries to show how much the author, in the writing of Tete d'or, was inspired by a certain biblical style, in particular that of Ecclesiastes