A peridynamic theory for linear elastic shells

A state-based peridynamic formulation for linear elastic shells is presented. The emphasis is on introducing, possibly for the first time, a general surface based peridynamic model to represent the deformation characteristics of structures that have one physical dimension much smaller than the other two. A new notion of curved bonds is exploited to cater for force transfer between the peridynamic particles describing the shell. Starting with the three dimensional force and deformation states, appropriate surface based force, moment and several deformation states are arrived at. Upon application on the curved bonds, such states beget the necessary force and deformation vectors governing the motion of the shell. Correctness of our proposal on the peridynamic shell theory is numerically assessed against static deformation of spherical and cylindrical shells and flat plates

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

National prospective cohort study of the burden of acute small bowel obstruction

Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

Solid phase extraction of cerium(IV) with crosslinked poly(acrylic acid) coated on silica gel

1528-1532A selective method has been developed for extraction and separation of Ce(IV) with the high molecular mass crosslinked poly(acrylic acid), coated on silanized silica gel. The coated materials act as stationary phase for the extraction. The structure and thermal stability of crosslinked poy(acrylic acid) has been elucidated with the help of FTIR and TGA. Ion exchange and breakthrough capacity of the exchanger have been measured. Surface morphology of the exchanger has been studied by SEM. Ce(IV) has been separated quantitatively from various synthetic mixtures containing metal ions commonly present in thorium and uranium ores, minerals and fission products. The developed method has been tested for some real samples. A plausible mechanism for Ce(IV) extraction and elution has been suggested

Leading Health Indicators: A Comparison of Hispanic With Non-Hispanic Whites and Non-Hispanic Blacks, United States 2003

Objective: One of the goals of Healthy People 2010 is to eliminate health disparities among racial/ethnic groups. This study compared Hispanics with non-Hispanic Whites and non-Hispanic Blacks on six leading health indicators (LHIs) by demographics characteristics, access to medical care, and general health status. Setting: Data were gathered from 2003 Behavioral Risk Factor Surveillance System (BRFSS), a state based random-digit-dialed telephone survey. Participants: Respondents were non-institutionalized adults age >/= 18 years. Methods: Respondents were compared by physical activity, smoking, binge drinking, obesity, health insurance coverage, specific source of ongoing care, influenza vaccination within last 12 months, and any pneumococcal vaccination. Logistic regression models were constructed to evaluate racial/ethnic differences in LHIs after adjusting for confounding variables. Results: Responses from 235,784 participants were analyzed (Hispanic518,929, non-Hispanic White5202,035, non-Hispanic Black5 14,820). Hispanics did not meet the target of any LHIs. Regardless of educational attainment, and after adjusting for confounders, Hispanics were less likely than non-Hispanic Whites to be moderately physically active, to have healthcare coverage or a specific source of ongoing care, and to have received a pneumococcal vaccination. They were less likely to smoke but equally as likely to have received a flu shot. Hispanics with more than a high school education were equally likely to binge drink but more likely to be obese than non- Hispanic Whites after adjusting for confounding factors. Conclusions: To eliminate the health disparities of Hispanics by 2010, culturally appropriate health education and accessible preventive services are needed

A modified peridynamics correspondence principle: Removal of zero-energy deformation and other implications

We look for an enhancement of the correspondence model of peridynamics, emphasizing the elimination of zero-energy deformation modes. We propose an approach based on the notion of sub-horizons. The most useful feature of this proposal is the setup which, whilst providing solutions with the necessary stability, deviates only marginally from the original correspondence formulation. A thorough analysis of the sub-horizon based method is furnished based on the well-posedness of integral equations and energy spectrum, which clearly demonstrate a removal of zero energy modes. We also show how other forms of unphysical deformation modes, e.g. material collapse within horizon, jump discontinuities and vanishing energy modes, can be prevented with the present proposal. Finally, a set of numerical simulations are undertaken that attest to the remarkable efficacy of the sub-horizon based approach. (C) 2018 Elsevier B.V. All rights reserved