129 research outputs found
A non-linear procedure for the numerical analysis of crack development in beams failing in shear
In this work, a consistent formulation for the representation of concrete behavior before and after cracking has been implemented into a non-linear model for the analysis of reinforced concrete structures, named 2D-PARC. Several researches have indeed pointed out that the adoption of an effective modeling for concrete, combined with an accurate failure criterion, is crucial for the correct prediction of the structural behavior, not only in terms of failure load, but also with reference to a realistic representation of crack initiation and development. This last aspect is particularly relevant at serviceability conditions in order to verify the fulfillment of structural requirements provided by Design Codes, which limit the maximum crack width due to appearance and durability issues. In more details, a constitutive model originally proposed by Ottosen and based on non-linear elasticity has been here incorporated into 2D-PARC in order to improve the numerical efficiency of the adopted algorithm, providing at the same time an accurate prediction of the structural response. The effectiveness of this procedure has been verified against significant experimental results available in the technical literature and relative to reinforced concrete beams without stirrups failing in shear, which represent a problem of great theoretical and practical importance in the field of structural engineering. Numerical results have been compared to experimental evidences not only in terms of global structural response (i.e. applied load vs. midspan deflection), but also in terms of crack pattern evolution and maximum crack widths
Numerical simulation of early-age shrinkage effects on RC member deflections and cracking development
Shrinkage effects on short-term behavior of reinforced concrete elements are often neglected both in design code provisions and in numerical simulations. However, it is known that their influence on serviceability performance can be significant, especially in case of lightly-reinforced beams. As a matter of fact, the restraint provided by the reinforcement on concrete determines a reduction of the cracking load of the structural element, as well as an increase of its deflection. This paper deals with the modeling of early-age shrinkage effects in the field of smeared crack approaches. To this aim, an existing non-linear constitutive relation for cracked reinforced concrete elements is extended herein to include early-age concrete shrinkage. Careful verifications of the model are carried out by comparing numerical results with significant experimental data reported in technical literature, providing a good agreement both in terms of global and local behavior
The T.O.S.C.A. Project: Research, Education and Care
Despite recent and exponential improvements in diagnostic-
therapeutic pathways, an existing “GAP” has been revealed
between the “real world care” and the “optimal care”
of patients with chronic heart failure (CHF). We present the
T.O.S.CA. Project (Trattamento Ormonale dello Scompenso
CArdiaco), an Italian multicenter initiative involving different
health care professionals and services aiming to explore the
CHF “metabolic pathophysiological model” and to improve
the quality of care of HF patients through research and continuing
medical education
Risk Factors Associated with Adverse Fetal Outcomes in Pregnancies Affected by Coronavirus Disease 2019 (COVID-19): A Secondary Analysis of the WAPM study on COVID-19
To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6\ub19.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible
Sex-Differences in the Pattern of Comorbidities, Functional Independence, and Mortality in Elderly Inpatients: Evidence from the RePoSI Register
Background: The RePoSi study has provided data on comorbidities, polypharmacy, and sex dimorphism in hospitalised elderly patients. Methods: We retrospectively analysed data collected from the 2010, 2012, 2014, and 2016 data sets of the RePoSi register. The aim of this study was to explore the sex-differences and to validate the multivariate model in the entire dataset with an expanded follow-up at 1 year. Results: Among 4714 patients, 51% were women and 49% were men. The disease distribution showed that diabetes, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, and malignancy were more frequent in men but that hypertension, anaemia, osteoarthritis, depression, and diverticulitis disease were more common in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment, mood disorders, and disability in daily life measured by the Barthel Index (BI) were worse in women. In the multivariate analysis, BI, CIRS, and malignancy significantly increased the risk of death in men at the 1-year follow-up, while age was independently associated with mortality in women. Conclusions: Our study highlighted the relevance and the validity of our previous predictive model in the identification of sex dimorphism in hospitalised elderly patients underscoring the need of sex-personalised health-care
Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation
Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention
Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD
Background We explore longitudinal trajectories of clinical indicators, patient-reported outcomes, and hospitalizations, in the years preceding death in a population of older patients with advanced chronic kidney disease (CKD). Methods The EQUAL study is a European observational prospective cohort study with an incident eGFR Results We included 661 decedents with a median time to death of 2.0 years (IQR 0.9-3.2). During the years preceding death, eGFR, Subjective Global Assessment score, and blood pressure declined, with accelerations seen at 6 months preceding death. Serum hemoglobin, hematocrit, cholesterol, calcium, albumin, and sodium values declined slowly during follow-up, with accelerations observed between 6 and 12 months preceding death. Physical and mental quality of life declined linearly throughout follow-up. The number of reported symptoms was stable up to 2 years prior to death, with an acceleration observed at 1 year prior to death. The rate of hospitalization was stable at around one hospitalization per person year, increasing exponentially at 6 months preceding death. Conclusions We identified clinically relevant physiological accelerations in patient trajectories that began similar to 6 to 12 months prior to death, which are likely multifactorial in nature, but correlate with a surge in hospitalizations. Further research should focus on how to effectively use this knowledge to inform patient and family expectations, to benefit the planning of (end-of-life) care, and to establish clinical alert systems.Clinical epidemiolog
Effect of high temperatures on the behavior of concrete tunnel linings: a numerical study
In this work, the performance of concrete tunnel linings subjected to high temperatures is assessed by performing 3D FE simula-tions. The analyses account for all the different stages of lining construction and use, from its installation, to its service life, to the possible spreading of fire. In order to realistically represent the soil excavation phase and the subsequent lining installation, a step-by-step procedure is followed, whereas a sequentially coupled thermo-mechanical procedure is applied for the fire stage. The behavior of concrete subjected to high temperatures is described by using the non-linear constitutive model “2D-PARC FIRE”. This model considers all the main features governing concrete behavior (i.e. cracking, crushing, shrinkage, creep and time-dependency of concrete mechanical properties) by also including the effects of thermal strains and the degradation of material properties due to fire
Numerical modeling of the cracking behavior of RC and SFRC shear-critical beams
In this work, a consistent formulation for the representation of concrete behavior before
and after cracking is implemented into a constitutive model for the analysis of reinforced
concrete structures. This formulation, based on non-linear elasticity, is particularly attractive
since concrete stiffness matrix is expressed as a function of only two parameters,
namely the secant values of elastic modulus and Poisson coefficient, which are properly
updated during the analysis. As confirmed by comparisons with experimental data, the
followed procedure is able to represent the dilatation and crushing of concrete under
compressive loads and, due to its versatile nature, it can be easily extended to fiber
reinforced elements
Evaluation of the response of concrete tunnel linings subjected to fire: a three-dimensional approach
This work is focused on the development of a refined nonlinear constitutive model for the analysis up to failure of concrete elements subjected to fire, able to account the main features governing concrete be-havior, i.e. cracking and crushing. In particular, the model is applied to the structural assessment of unreinforced concrete tunnel linings in order to deal with all the different stages of tunnel life, from its construction to its service conditions, also taking into account the possible development of a fire and its effects on the lining system. The reliability and accuracy of the proposed model are checked against analytical closed-form solutions
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