К численному решению задач о деформации анизотропных пластин с отверстием

Представлен подход к расчету напряженно-деформированного состояния пластин с отверстием, основанный на численной параметризации двусвязной области, сведении исходной нелинейной краевой задачи к последовательности линейных двухмерных и интегрировании последних устойчивым численным методом. Исследуется влияние формы и месторасположения отверстия на напряженно-деформированное состояние квадратной пластины.Представлено підхід до розрахунку напружено-деформованого стану пластин, що послаблені отвором. Підхід базується на числовій параметризації двозв’язної області, зведенні вихідної нелінійної задачі до послідовності лінійних двомірних та останніх до одномірних, інтегрування яких проводиться стійким числовим методом. Досліджується вплив форми та місцезнаходження отвору на напружено-деформований стан квадратної пластини.The study presents an approach to stressed-state analysis of plates with apertures which is based on the numerical parameterization of a doubly-connected area, reduction of the initial nonlinear boundary-value problem to a sequence of linear two-dimensional problems and integrating the latter by the stable numerical method. The effect of form and place of an aperture on stressed state of a square plate has been analyzed

Sustainable employability of teachers with hearing loss

Objective In many countries the retirement age is rising. Consequently, age-related hearing loss is an increasing occupational health problem. This study examined the association between hearing loss and sustainable employability of teachers. Design For this cross-sectional study a survey and an online hearing screening test were used. Sustainable employability was measured with the Capability Set for Work Questionnaire (CSWQ), examining seven work values. CSWQ-scores of teachers with poor, insufficient, and good hearing were investigated with ordinal regression analyses. Work values and discrepancies between the importance and achievement of the values were examined by chi-square tests. Study sample Dutch teachers (N = 737) of whom 146 (20%) had insufficient and 86 (12%) poor hearing. Results Teachers with insufficient (OR = 0.64; 95% CI 0.46–0.89) and poor (OR = 0.55; 95% CI 0.36–0.83) hearing had lower CSWQ-scores compared with good hearing teachers. Adjustment for covariates, in particular for self-rated health, attenuated the associations. Compared with good hearing teachers, teachers with poor hearing reported more discrepancies in using their knowledge and skills and setting their own goals at work. Conclusions Hearing loss was negatively associated with sustainable employability of teachers. This emphasises the importance of assessing the hearing status of teachers

Focus Group Study Exploring Factors Related to Frequent Sickness Absence

INTRODUCTION:Research investigating frequent sickness absence (3 or more episodes per year) is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves. METHODS:We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R) model as theoretical framework. RESULTS:Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills) were regarded as solutions to reduce frequent sickness absence. CONCLUSIONS:The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance

Dual Loop Line-Focusing Solar Power Plants with Supercritical Brayton Power cycles

Most of the deployed commercial line-focusing solar power plants with Parabolic Troughs (PTC) or Linear Fresnel (LF) solar collectors and Rankine power cycles use a Single Loop Solar Field (SF), Configuration 1 illustrated in Fig. 2, with synthetic oil as Heat Transfer Fluid (HTF) [1, 2]. However, thermal oils maximum operating temperature should be below ~400ºC for assuring no oil degradation, hence limiting the power cycle gross efficiency up to ~38%. For overcoming this limitation Molten Salts (MS) as HTF in linear solar collectors (PTC and LF) were recently experimented in pilot facilities [3, 4]. Direct MS main drawbacks are the equipments and components material corrosion and the salts freezing temperature, requiring heat tracing to avoid any sald solidification, hence increasing the Solar Field (SF) capital investment cost and parasitic energy looses. Concentrated Solar Power plants (CSP) with Dual Loop SF are being studied since 2012 [5] for gaining the synergies between thermal oils and MS properties. In the Dual Loop SF the HTF in the primary loop is thermal oil (Dowtherm A) [6] for heating the Balance Of Plant (BOP) working fluid from ~300ºC up to ~400ºC, and a secondary loop with Solar Salt (60% NaNO3, 40% KNO3) as HTF, for boosting the working fluid temperature from ~400ºC up to 550ºC [7, 8, 9]. The CSP Dual Loop state of the art technology includes Rankine power cycles, the main innovation of this paper is the integration between Dual Loop SF and the supercritical Carbon Dioxide (s-CO2) Brayton power cycles [10], see Configurations 2 and 3 illustrated in Fig. 3a, Fig 3b. A secondary innovation studied in this paper is the integration between thermal oil HTF (Dowtherm A) in linear solar collectors, a widely validated and mature technology, with the s-CO2 Brayton power cycles. This technical solution is very cost competitive with carbon steel receiver pipes, low SF operating pressure, and no requiring any heat tracing. Two main conclusions are deducted from this researching study. Firstly we demonstrated the higher gross plant efficiency ~44.4%, with 550ºC Turbine Inlet Temperature (TIT), provided by the Dual Loop with the Simple recuperated s-CO2 Brayton cycle with reheating, in comparison with 41.8% obtained from the Dual Loop SF and subcritical water Rankine power cycle. And finally the second conclusion obtained is the selection of the most cost competitive plant configuration with a Single loop SF with Dowtherma A and a s-CO2 Brayton power cycle due to the receiver material low cost and no heat tracing for the thermal oil

Anti-thymocyte globulin exposure in patients with diffuse cutaneous systemic sclerosis undergoing autologous haematopoietic stem cell transplantation

Introduction: Autologous haematopoietic stem cell transplantation improves event-free survival and lung function and reduces skin thickening in patients with progressive diffuse cutaneous systemic sclerosis. Anti-thymocyte globulin is a key lymphoablative constituent of conditioning protocols and is administered in a weight-based dosage. However, whether anti-thymocyte globulin exposure contributes to response to autologous haematopoietic stem cell transplantation and lymphocyte reconstitution in diffuse cutaneous systemic sclerosis patients is unknown. We aimed to explore the relationship between anti-thymocyte globulin exposure, lymphocyte reconstitution and treatment response in diffuse cutaneous systemic sclerosis patients undergoing autologous haematopoietic stem cell transplantation. Methods: A retrospective cohort of 15 diffuse cutaneous systemic sclerosis patients undergoing autologous haematopoietic stem cell transplantation was performed. Clinical characteristics and routine laboratory results were retrieved from electronic medical records. Anti-thymocyte globulin concentrations were measured in cryopreserved plasma samples at four time points (day 1 and week 1, 2 and 4) after stem cell reinfusion. Anti-thymocyte globulin exposure was estimated using a validated population pharmacokinetic model. Results: During a median follow-up of 45 months (interquartile range 19–66), 11 (73%) patients had a treatment response, and 4 (27%) were non-responders. Although all patients received the same weight-based anti-thymocyte globulin dosage, 7.5 mg/kg divided over 3 days, anti-thymocyte globulin exposure varied. Anti-thymocyte globulin exposure was higher in responders than in non-responders (163 AU*day/mL (interquartile range 153–183) and 137 AU*day/mL (interquartile range 101–149), respectively, p =.026). Anti-thymocyte globulin exposure was not correlated with lymphocyte reconstitution or infection rate. Conclusion: Weight-based dosing of anti-thymocyte globulin results in variable anti-thymocyte globulin exposure and treatment response across individuals

Cardio-oncology: an overview on outpatient management and future developments

Recent advances in the early detection and treatment of cancer have led to increasing numbers of cancer survivors worldwide. Nonetheless, despite major improvements in the outcome of these patients, long-term side effects of radio- and chemotherapy affect both patient survival and quality of life, independent of the oncological prognosis. Chemotherapy-related cardiac dysfunction is one of the most notorious short-term side effects of anticancer treatment, occurring in ~10% of patients. Progression to overt heart failure carries a strikingly poor prognosis with a 2-year mortality rate of 60%. Early detection of left ventricular damage by periodic monitoring and prompt initiation of heart failure treatment is key in improving cardiovascular prognosis. To meet the growing demand for a specialised interdisciplinary approach for the prevention and management of cardiovascular complications induced by cancer treatment, a new discipline termed cardio-oncology has evolved. However, an uniform, multidisciplinary approach is currently lacking in the Netherlands. This overview provides an introduction and comprehensive summary of this emerging discipline and offers a practical strategy for the outpatient management of this specific patient population

Reduction of Severe Acute Maternal Morbidity and Maternal Mortality in Thyolo District, Malawi: The Impact of Obstetric Audit

BACKGROUND: Critical incident audit and feedback are recommended interventions to improve the quality of obstetric care. To evaluate the effect of audit at district level in Thyolo, Malawi, we assessed the incidence of facility-based severe maternal complications (severe acute maternal morbidity (SAMM) and maternal mortality) during two years of audit and feedback. METHODOLOGY/PRINCIPAL FINDINGS: Between September 2007 and September 2009, we included all cases of maternal mortality and SAMM that occurred in Thyolo District Hospital, the main referral facility in the area, using validated disease-specific criteria. During two- to three-weekly audit sessions, health workers and managers identified substandard care factors. Resulting recommendations were implemented and followed up. Feedback was given during subsequent sessions. A linear regression analysis was performed on facility-based severe maternal complications. During the two-year study period, 386 women were included: 46 died and 340 sustained SAMM, giving a case fatality rate of 11.9%. Forty-five cases out of the 386 inclusions were audited in plenary with hospital staff. There was a reduction of 3.1 women with severe maternal complications per 1000 deliveries in the district health facilities, from 13.5 per 1000 deliveries in the beginning to 10.4 per 1000 deliveries at the end of the study period. The incidence of uterine rupture and major obstetric hemorrhage reduced considerably (from 3.5 to 0.2 and from 5.9 to 2.6 per 1000 facility deliveries respectively). CONCLUSIONS: Our findings indicate that audit and feedback have the potential to reduce serious maternal complications including maternal mortality. Complications like major hemorrhage and uterine rupture that require relatively straightforward intrapartum emergency management are easier to reduce than those which require uptake of improved antenatal care (eclampsia) or timely intravenous medication or HIV-treatment (peripartum infections)

RISCOS DEL ASERRADOR DE AYACATA [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201