Seismic Resistance of RC Corner Eccentric Beam-Column Sub-assemblages

An experimental investigation studied performance of reinforced concrete (RC) corner beam-column connection (BCC) subjected to cyclic loading. Each BCC consisted of upper, lower column and two beams; one of them was free end (A) while the other was fixed end (B). The cyclic loading was applied on the end of beam (A) while the beam (B) was unloaded and subjected to torsion stresses due to fixation. Two variables were investigated. The first is the eccentricity of the beam about column edge while the second is the effect of stirrup joint configuration on reinforced concrete beam column connection under cyclic loading. All BCCs were tested under reversible 14 cycles. The vertical displacement at the free end of beam (A), horizontal sway at mid height of the column, crack and ultimate loads were observed in details at each cycle. The results showed that the increase of stirrup length in the joint decreased the deflection at the same level of the load. The ultimate load of specimen, which was shifted by 25 mm, was less than the ultimate load of specimen, without shift, by 24%. When the joint stirrup was extended outside the column core by 50 mm in specimen Sp2, the capacity of the connection increased

Seismic Resistance of RC Corner Eccentric Beam-Column Sub-assemblages

An experimental investigation studied performance of reinforced concrete (RC) corner beam-column connection (BCC) subjected to cyclic loading. Each BCC consisted of upper, lower column and two beams; one of them was free end (A) while the other was fixed end (B). The cyclic loading was applied on the end of beam (A) while the beam (B) was unloaded and subjected to torsion stresses due to fixation. Two variables were investigated. The first is the eccentricity of the beam about column edge while the second is the effect of stirrup joint configuration on reinforced concrete beam column connection under cyclic loading. All BCCs were tested under reversible 14 cycles. The vertical displacement at the free end of beam (A), horizontal sway at mid height of the column, crack and ultimate loads were observed in details at each cycle. The results showed that the increase of stirrup length in the joint decreased the deflection at the same level of the load. The ultimate load of specimen, which was shifted by 25 mm, was less than the ultimate load of specimen, without shift, by 24%. When the joint stirrup was extended outside the column core by 50 mm in specimen Sp2, the capacity of the connection increased

Experimental Investigation of RC Exterior Beam Column Connection with Eccentric Beam Subjected to Reversible Quasi Static Loads

Insufficiency of the Beam Column Joint (BCJ) caused structures failures particularly in case of the earthquakes. In most of the buildings, the beam center line was not aligned with the column center line. So, the effect of the eccentricity of the beam was studied in this article. Behaviour of reinforced concrete (RC) eccentric beam-column joint under reversible cyclic loading was investigated experimentally. The experimental program is one specimen. The specimen consisted of column and beam. The column divided into symmetry two parts (upper and lower parts). The beam fixed in middle of the column and it was free end. The main parameter was the effect of the eccentricity of the beam center line about the column center on behaviour of RC BCJ. The specimen was tested under reversible ten cycles. The horizontal displacement for the column and the vertical deflection at free end of the beam were recorded at each cycle. The crack pattern of the tested specimen was studied at every cycle in details. It was noticed that the eccentricity of the beam has concentrated more stresses on the joint side close to the eccentricity. The failure took place at the joint due to its weakness

Economic Policies, Structural Change and the Roots of the ‘Arab Spring’ in Egypt

This paper analyses the economic challenges facing Egypt in the post-Mubarak period, demonstrating the ways in which economic policy choices over the 2000s have contributed to the economic and social outcomes witnessed in the run up to the 2011 uprisings. The article investigates three specific policy areas and demonstrates their role in reducing employment opportunities, eroding wages and facilitating the creation of an increasingly unequal economic and social structure in Egypt. The three policy areas addressed by the article are (i) the general misplaced fiscal focus on expenditure-reduction rather than revenue-enhancement and the lack of progressive revenue growth; (ii) the manipulation and use of subsidies in Egypt to appease the populous instead of fostering employment generation; (iii) the failure to adequately promote employment-intensive investment

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks