Fracture toughness of matrix cracked FRC and FGC beams using equivalent TPFM

In the present work, the fracture toughness (KIC) of full-depth (FD) fiber-reinforced concrete (FRC) and layered functionally graded concrete (FGC) matrix cracked (MC) beams has been determined by the equivalent relationships of the two-parameter fracture model (ETPFM). Forty-eight MC-FGC and MC-FD FRC beam specimens with span-depth ratios (L/d) equal 4, 5, and 6 were tested under the 3PB configuration. The MC length-depth ratio (ao/d) remained constant equal to one-third. All FRC beams have the same constitutes materials with hooked-end steel fiber volume fraction equals 1%. The FGC beams are composed of three equal layers, i.e., FRC in the bottom layer at the tension side, normal strength concrete (NSC) at the middle layer, and high strength concrete at the upper layer in the compression side. The results showed that the predicted values of KIC obtained from ETPFM are considered logic according to the maximum size of the non-damaged defect concept. The crack mouth opening displacement estimated from ETPFM showed acceptable values close to the present experimental results. The KIC values calculated within the presence of fibers in front of and through the MC for FRC beam specimens having 1% SFs is more than twice the value of NSC

Experimental assessment of different strengthening techniques for opening in reinforced concrete beams

The present experimental study includes testing thirteen reinforced concrete beams with openings at different locations to investigate the efficiency of strengthening such openings. Different strengthening techniques around the opening after and before casting include diagonal bars, upper and lower steel, and carbon fiber reinforced polymers (CFRP), were examined. All beams were made from 30 MPa compressive strength and tested under four-point loading.  The cross section of the beams is 400 mm depth x 160 mm width and beam length 2400 mm. The dimensions of the opening are 200 mm x 200 mm. The stiffness, deflection, failure load, and failure mode of the strengthened beams were discussed. Experimental results showed that the beams strengthened with upper and lower steel around opening at mid-span increase the load-carrying capacity by 16.59%. However, beams strengthened by CFRP sheets around the opening in the shear zone increase the load carrying capacity by 47.7% compared to opened beam

Effect of different parameters controlling the flexural behavior of RC beams strengthened with NSM using nonlinear finite element analysis

Near surface mounted technique become the most attractive technique for strengthening RC structures. Several researches had been conducted to study experimentally the flexural behavior of RC members strengthened with NSM technique unlike the numerical researches. In this paper a numerical investigation utilizes the non-linear finite element (FE) modeling using ANSYS was performed. The developed FE model considers the behavior of the epoxy-concrete interface using a particular continuum damage approach, called cohesive zone model (CZM) which is capable of predicting the failure mode of the strengthened beams. The modified model study the effect of different parameters such as NSM bar number, NSM bar length, end inclination angle and end inclination leg length on the flexural behavior of strengthened beams. The results showed that, The developed FE model able to predict the expected modes of failure in NSM technique, the NSM bar length was effective till 0.5 of beam span, beams strengthened with end inclined angle 45º NSM bar gives the highest improvement in load carrying capacity, this improvement was very close in case of using end inclined angle of 60º and 90º

Interpretable Deep Learning for Discriminating Pneumonia from Lung Ultrasounds

Lung ultrasound images have shown great promise to be an operative point-of-care test for the diagnosis of COVID-19 because of the ease of procedure with negligible individual protection equipment, together with relaxed disinfection. Deep learning (DL) is a robust tool for modeling infection patterns from medical images; however, the existing COVID-19 detection models are complex and thereby are hard to deploy in frequently used mobile platforms in point-of-care testing. Moreover, most of the COVID-19 detection models in the existing literature on DL are implemented as a black box, hence, they are hard to be interpreted or trusted by the healthcare community. This paper presents a novel interpretable DL framework discriminating COVID-19 infection from other cases of pneumonia and normal cases using ultrasound data of patients. In the proposed framework, novel transformer modules are introduced to model the pathological information from ultrasound frames using an improved window-based multi-head self-attention layer. A convolutional patching module is introduced to transform input frames into latent space rather than partitioning input into patches. A weighted pooling module is presented to score the embeddings of the disease representations obtained from the transformer modules to attend to information that is most valuable for the screening decision. Experimental analysis of the public three-class lung ultrasound dataset (PCUS dataset) demonstrates the discriminative power (Accuracy: 93.4%, F1-score: 93.1%, AUC: 97.5%) of the proposed solution overcoming the competing approaches while maintaining low complexity. The proposed model obtained very promising results in comparison with the rival models. More importantly, it gives explainable outputs therefore, it can serve as a candidate tool for empowering the sustainable diagnosis of COVID-19-like diseases in smart healthcare

Finite element analysis of the behavior of bonded composite patches repair in aircraft structures

This paper aims to analyze the multi-effects of the glass fiber reinforced polymer (GFRP) composite patch to repair the inclined cracked 2420-T3 aluminum plate. Three-dimensional finite element method (FEM) was used to study the effect of GFRP composite patch with different stacking composite laminate sequence, [0°]4, [90o]4, [45o]4, [0o/45o]2s and [0°/90°]4s on the crack driving force, J-integral, of inclined cracked 2420-T3 aluminum plate. Furthermore, the effects of patch geometry, number of layers, single or double side patch and crack incline angle are described. The present results show that the patch has a high effect in case of a crack in pure mode I. Furthermore, the effectiveness of the composite patch is increasing with the crack length increases. Moreover, the efficiency of the composite patch has a high effect by changing the fiber orientation, the number of layers, and the single or double side patch

The relation between of insulin like growth factor II and endometrial carcinoma

Background: Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women. The need of a soft marker that can be used with CA-125 tumor marker for early detection of endometrial cancer and to predict late stages and advanced histopathological grades and to specify the cases who will be managed by complete surgical staging including para aortic and pelvic lymphadenectomy is of great importance. The aim of the study was to evaluate the role of insulin like growth factor 2 in endometrial carcinoma and to correlate it with different histopathological grades of the disease.Methods: This study was applied on sixty patients with abnormal uterine bleeding and were divided into two groups, Group A included 30 cases of endometrial carcinoma, while Group B included 30 cases complaining of abnormal vaginal bleeding due to other causes as a control group. Serum samples were taken from all patients and estimation of IGF-2 serum levels using ElISA technique was done. Comparison of IGF-2 serum level between both groups and correlation of its levels with different histopathological grades of endometrial cancer group were done.Results: As regard comparison between both groups and ILGF2 serum level, study results demonstrated that ILGF2 levels ranged between 600.0-1440.0 ng/ml and 40.0-560.0 ng/ml with the mean of 781.33 ng/ml±196.45 and 336.0 ng/ml±212.86 for cases Group A and control Group B respectively. There was a statistically significant difference between the two studied groups regarding ILGF2 serum level (p<0.001). As regards correlation between histopathological grades and ILGF-2 serum level in cases Group A, the study revealed a strong positive correlation.Conclusions: ILGF-2 can be used as a serum marker for endometroid adenocarcinoma of the body of the uterus and to predict its higher histopathological grades

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

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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research