Destructive and Nondestructive Tests for Concrete Containing a Various Types of Fibers

Fibers have been considered an effective material that was used to improve the concrete's weak properties, namely its tensile strength, ductility, and crack resistance. Thus, the current study highlights two major objective, the former is the fibers shapes and types on the mechanical properties of the fresh and hardened concrete while the latter explores the impact of the fiber contents on the concrete mechanical properties developments. To achieve these targets six types of fibers (five of them made of steel and the last was polyolefin fibers) with various shapes are utilized. The tests were carried out to investigate the fibers shape and material contribution in the concrete mix properties improvement. The samples were subjected to destructive and non-destructive tests such as workability, compression, bending, and splitting. The non-destructive tests include ultrasonic pulse velocities and the Schmidt Hammer test. Three kinds of fibers (two of steel and one of polyolefin fiber) are used with variable content ratios of 0.5, 0.75, 1.0, and 1.5% to study the fiber content effect. Generally, the workability of fresh concrete has a reverse relationship with fiber presence and fiber content ratios. The compressive capacity, splitting and flexural strength has a direct proportion with fibers contents. The hooked steel fibers appeared the best results in terms of shape comparison. Doi: 10.28991/CEJ-2022-08-11-07 Full Text: PD

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

Abstract Background 4D Multiphase Steady State Imaging with Contrast (MUSIC) acquires high-resolution volumetric images of the beating heart during uninterrupted ventilation. We aim to evaluate the diagnostic performance and clinical impact of 4D MUSIC in a cohort of neonates and infants with congenital heart disease (CHD). Methods Forty consecutive neonates and infants with CHD (age range 2 days to 2 years, weight 1 to 13 kg) underwent 3.0 T CMR with ferumoxytol enhancement (FE) at a single institution. Independently, two readers graded the diagnostic image quality of intra-cardiac structures and related vascular segments on FE-MUSIC and breath held FE-CMRA images using a four-point scale. Correlation of the CMR findings with surgery and other imaging modalities was performed in all patients. Clinical impact was evaluated in consensus with referring surgeons and cardiologists. One point was given for each of five key outcome measures: 1) change in overall management, 2) change in surgical approach, 3) reduction in the need for diagnostic catheterization, 4) improved assessment of risk-to-benefit for planned intervention and discussion with parents, 5) accurate pre-procedural roadmap. Results All FE-CMR studies were completed successfully, safely and without adverse events. On a four-point scale, the average FE-MUSIC image quality scores were >3.5 for intra-cardiac structures and >3.0 for coronary arteries. Intra-cardiac morphology and vascular anatomy were well visualized with good interobserver agreement (r = 0.46). Correspondence between the findings on MUSIC, surgery, correlative imaging and autopsy was excellent. The average clinical impact score was 4.2 ± 0.9. In five patients with discordant findings on echo/MUSIC (n = 5) and catheter angiography/MUSIC (n = 1), findings on FE-MUSIC were shown to be accurate at autopsy (n = 1) and surgery (n = 4). The decision to undertake biventricular vs univentricular repair was amended in 2 patients based on FE-MUSIC findings. Plans for surgical approaches which would have involved circulatory arrest were amended in two of 28 surgical cases. In all 28 cases requiring procedural intervention, FE-MUSIC provided accurate dynamic 3D roadmaps and more confident risk-to-benefit assessments for proposed interventions. Conclusions FE-MUSIC CMR has high clinical impact by providing accurate, high quality, simple and safe dynamic 3D imaging of cardiac and vascular anatomy in neonates and infants with CHD. The findings influenced patient management in a positive manner

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of Fiber Type and Shape on the Shear Behavior of Reinforced Concrete Corbels without Hoop Re-bars

In this research, the structural behavior of reinforced concrete brackets cast with concrete containing different types of fibers was studied. Seven samples of reinforced concrete corbels were cast and tested. One specimen was cast without fiber as a reference, and the other samples were made with six different types of fibers at a constant volume fraction (1% of the total concrete volume). The fibers used in the research were made of two different materials: steel and polyolefin. One specimen was cast with polyolefin fiber, and in the five remaining samples, steel fiber was used. Straight, crimped, and three different dimensions of hooked fiber were used. The results showed that the corbels with straight and hooked end steel fiber (6, 5, and 3 cm length), crimped steel fiber sized 3 cm, straight steel fiber sized 12 mm, and straight polyolefin fiber sized 6 cm showed 69.2%, 57.7%, 38.5%, 61.5%, 92.3%, and 100% higher cracking loads than the control corbel made with normal concrete, respectively, as well as exhibiting (51.7%, 48.3%, 31.0%, 24.1%, 12.1%, and 3.4%) higher ultimate loads than the control corbel. From these results, it can be concluded that the shape of the steel fiber clearly affects the ultimate load. For the same length, and despite the lack of aspect ratio, steel fibers gave an increase in the maximum load of 46.6% when compared with polyolefin fibers. Doi: 10.28991/CEJ-2022-08-03-08 Full Text: PD

Vaccination against Corynebacterium pseudotuberculosis infections controlling caseous lymphadenitis (CLA) and oedematousskin disease

Corynebacterium pseudotuberculosis (C. pseudotuberculosis) is a causative organism of caseous lymphadenitis (CLA) in sheep and acute disease in buffaloes known as oedematous skin disease (OSD). Human affected with the disease show liver abscess and abscess in the internal lymph nodes. The vaccination against CLA up till now occurs by using formalin inactivated whole cells of biovar 1 (sheep strain). Combined vaccine composed of formalin inactivated whole cells of sheep strain and recombinant phospholipase D (rPLD) and another vaccine composed of formalin inactivated whole cells (buffalo origin) and rPLD were prepared in Biotechnology center for services and Researches laboratory at Cairo university and applied for protection against CLA. Both vaccines induced complete protection (100%) against challenge with virulent biovar 1 or biovar 2. Also vaccination against OSD was performed by two types of vaccines. Vaccine-1 was composed of formalin inactivated whole cell biovar 1 combined with rPLD and the second vaccine was composed of formalin inactivated whole cells of biovar 2 combined with rPLD. No lesions developed in vaccinated and non vaccinated buffaloes challenged with C. pseudotuberculosis biovar revealing that biovar 1 C. pseudotuberculosis is not infective for buffaloes. Buffaloes vaccinated with the second vaccine and control non vaccinated animals challenged with biovar 2 (buffalo origin) resulted in development of OSD in all animals. This indicates that OSD results due to production of toxin (s) other than PLD. Discovering this toxin (s) is of value in formulation of a future vaccine against OSD. Keywords: Corynebacterium pseudotuberculosis, Caseous lymphadenitis, Oedematous skin disease, Vaccination, Recombinant phospholipase

Zoonotic risk and public health hazards of companion animals in the transmission of Helicobacter species

Objective: Helicobacteriosis is worldwide infection caused by Helicobacter species that affects both humans and animals. The current work correlated the zoonotic and public health repertoire of Helicobacter species in companion animals (dogs and cats). Methods: Samples were collected from apparently healthy dogs (70), cats (65), and 70 human patients who had been in contact with these animals in the Cairo and Giza governorates. The samples included serum, feces, and stool samples and biopsies of gastric fundus fragments (~5 mm). All samples were examined by culture, biochemical analysis, serology, and molecular identification. Results: Helicobacter species were detected at a rate of 43.4% by PCR. H. heilmannii was more predominant, with a rate of 16%, whereas H. pylori was detected at 6%. H. pylori and H. heilmannii were isolated from both human and companion samples, whereas all samples were negative for H. felis. Conclusion: Dogs and cats were reservoirs and played a major source in human helicobacters infection