The hybrid of floating stone column by numerical and physical evaluation

Rapid population growth amplifying demand for accommodation and infrastructure has resulted in soft ground being increasingly used in construction. Problems related to soft ground can be remedied by adopting a ground improvement technique. The stone column is one of the most effective and feasible techniques for soft clay soil improvement. Stone columns increase bearing capacity and reduce the settlement of soil. However, soft ground of more than 40 meters depth makes stone column treatment costlier. The design of floating stone columns within soft ground is sometimes needs to adopt. However, this method is not popular compared to the end bearing stone columns due to low mobilised shear resistance and resulted in higher occurrence of punching failure. This research is aimed for addressing the shortcoming floating stone columns with proposing the hybrid dimension floating stone columns. The hybrid stone column size able to increase the mobilised shear resistance, decrease punching failure, and reduce the volume of aggregates. In the present work, finite element analysis was performed using the program PLAXIS 2D. An elastic-perfectly plastic constitutive soil model relation based on the Mohr-Coulomb criterion was utilized to predict the behaviour of soft clay strengthen by stone column. Response Surface Methodology (RSM) was used to optimize the hybrid stone column size with the Design-Expert 6.0.4 software. The laboratory physical model tests were performed based on the sizes of optimum hybrid stone column size proposed by RSM. The results revealed that the optimal parameter of the uniform diameter of 44 mm with a length of 100 mm increases its load bearing capacity of 3260.7 N and the lowest settlement was recorded at a diameter of 24.2 mm with a length of 400 mm to achieve 25.8 mm of settlement. Moreover, the hybrid column size i.e. the first stone column diameter of 43 mm and second diameter of 21.2 mm with the same lengths of 200 mm each diameter able to achieve load-bearing capacity of 3350.9 N and settlement of 24.5 mm. Thus, by comparing with the uniform diameter stone column of 44 mm and length of 400 mm, the hybrid column able to increase the load bearing capacity by 3% and decrease the settlement by 5%. In addition, a good agreement was obtained between the numerical and physical models with variation 25%. In addition, the hybrid stone column size is able to reduce the volume of aggregates up to 40%

Hvað þurfa hjúkrunarfræðingar að vita um fíkn?

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Hjúkrunarfræðingar takast í starfi sínu á við fíkn í sínum margvíslegustu myndum. Í þessari grein er fíkn skilgreind og sagt frá eðli og orsökum vímuefnasjúkdóm

Ljósmæðraþjónusta á landsbyggðinni Mikilvægi þjónustunnar og upplifun ljósmæðra af því að starfa þar

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnBreytingar hafa orðið á barneignarþjónustu víðsvegar um heiminn og er Ísland ekki þar undanskilið. Lokanir fæðingardeilda á landsbyggðinni hafa leitt til miðstýringar og nú í dag eru flestar fæðingar hérlendis á tveimur stærstu sjúkrahúsum landsins eða um 76% á Landspítalanum í Reykjavík og 9,5% á Sjúkrahúsinu á Akureyri. Þessi þróun hefur leitt til skerðingar á þjónustu við þær konur sem kjósa að búa á landsbyggðinni og því mikilvægt að skoða hvernig ljósmæðraþjónustu á landsbyggðinni er háttað, ræða mikilvægi hennar og hvernig hægt er að varðveita hana og efla. Í þessari grein, sem byggir á lokaverkefni í ljósmóðurfræði vorið 2016, er fjallað um þjónustu ljósmæðra á landsbyggðinni með áherslu á hvert mikilvægi ljósmæðraþjónustu er og upplifun ljósmæðra af því að starfa þar, leiðbeinandi minn var Ólöf Ásta Ólafsdóttir. Tekið var viðtal við Önnu Maríu Oddsdóttur, ljósmóður á Sauðárkróki, til að kynnast starfi hennar þar og aðstæðum á Norð- urlandi

Unequal tracks? Studies on work, retirement and health

Background. In Sweden, the proportion of people aged 65 and older has doubled since 1950, and is projected to continue to increase. The increased longevity and proportion of older people in the population pose a challenge for financing and maintaining of the welfare, social security and pension systems. One way to address this challenge is through policy reforms aimed at raising the retirement age, increasing financial incentives for working beyond the official retirement age, abandoning or restricting early retirement routes, and prolonging the total employment period over the life span in order to receive full pension. The success of such reforms will partly depend on the health and working capacity of people in the upper end of their labour market career. In general, women have poorer health than men at all ages, and people with more socioeconomic resources have better health than those with fewer resources. Thus, women and men, as well as different socioeconomic groups, have varying prospects for extending working life. Moreover, an extended working life might have different health effects across gender and socioeconomic position. Aim. The overarching aim of this dissertation is to empirically study how retirement is influenced by health status, socioeconomic position, and gender in Sweden; and in turn how the timing of exit from the labour market is associated with health and functioning in late life. Data. The four studies in this thesis were based on nationally representative longitudinal data from the Swedish Level-of-Living Survey (LNU), the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), the Swedish Longitudinal Occupational Survey of Health (SLOSH), Swedish Cause of Death Register, and income register data from Statistics Sweden: the Income and Taxation Register (IoT) and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA). Study I. There is no consensus on how retirement age is defined and operationalized, neither in research nor in the social policy debate. By comparing a series of four commonly used measures of retirement age assessed on the basis of the LNU survey and LISA register data (n=540), the findings show that different operationalisations give different retirement ages and different empirical results e.g. the size and even direction of the association between self-rated health and retirement age varies depending on the operationalisation. This highlights the importance that readers are aware of the definition of retirement age used when evaluating results from studies on retirement, and that researchers clearly state the definition of retirement age in their studies. Study II. The period from 1980 to 2010 was characterised by technological advancements and reconstruction of the labour market, financial crisis, and several policy reforms with implications for retirement and labour market exit. This study includes four population-based cohorts aged 50-70 at inclusion year (LNU 1981, 1991, 2000 and 2010) that were followed prospectively for two years each, using waves of LNU survey data together with IoT and LISA income register data (n=3690). The aim was to study the predictive value of physical functioning for retirement over a three-decade period. The results show that mobility limitations and musculoskeletal pain were not as predictive of retirement in 2010 compared to the early 1980s, especially for women. Along with changes to the labour market, and to the social security and pension systems, the importance of good physical functioning for continued work is decreasing. Study III. The increased need for people to prolong working life raises concerns about possible consequences on health in later life for people in various socioeconomic position. This study used data from LNU, SWEOLD, LISA, and the Swedish Cause of Death Register, and the quasi-experimental method of propensity score matching (n=1852 for mortality analysis and n=1461 for late life health analysis). The findings show no significant average effects of prolonging working life to age 66 or above, on mortality, the ability to climb stairs without difficulty, self-rated health, limitations in activities of daily living (ADL), or musculoskeletal pain in late life. Overall, there were no systematic socioeconomic differences in the health effects of prolonging working life. This indicates that there are no long-term physical health consequences of prolonging working life past the normative retirement age. Study IV. When and how retirement takes place, can be affected by and have an impact on health. The aim was to identify trajectories of self-rated health (n=2181) and physical working capacity (n=2151) over the retirement transition using latent trajectory analysis utilising seven waves of SLOSH data covering up to 11 years before and 11 years after retirement. The findings show that most people maintained their pre-retirement levels of self-rated health and physical working capacity during the transition to retirement. The majority had good health throughout the study period (70-75%). People in the trajectory characterised by poor health before and after retirement were more likely to have had a poor working environment and low socioeconomic position. A small group (8-15%), characterised by poor psychosocial working environment and lower socioeconomic position, saw a decline in self-rated health and physical working capacity after retirement. Conclusions. The findings of this thesis indicate that the large majority of people in the upper end of their working career have good enough physical health to meet the terms of pension reforms aimed at raising the retirement age. Moreover, physical health in late life is not negatively impacted by prolonged working life. However, the results also show a group of people with low socioeconomic position and poor working environment that have poor health years before retirement. Therefore, it is still important for policymakers to recognise that those who have a poor working environment and lower socioeconomic position might not have the health capacity to continue working, despite reforms raising the retirement age. Preventing early exit from the labour force for people with physical limitations might increase health inequalities in late life and result in more demands on the social security system and the health care system. This is important for policymakers to consider, as current and future policy reforms might have to be adapted for people who have spent many years on the labour market in harmful working conditions

Hepatotoxicity associated with the use of Herbalife

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Objective: Many herbal products are known to be hepatotoxic. In a recent survey in Iceland concerning adverse reactions related to herbal medicines, Herbalife products were implicated in the majority of the reported cases of hepatotoxicity. Methods: The clinical presentations of five cases of Herbalife related liver injury during the period of 1999-2008 are analysed. Causality was assessed by using the WHO-UMC system for causality assessment and the RUCAM method. Results: Of the five cases there were four females and one male; median age was 46 years (range 29-78). Herbalife had been used for 1 to 7 months prior to presentation. Four patients presented with a hepatocellular and one with a cholestatic reaction. Median values were for bilirubin 190 mmol/L (range: 26-311; ref. < 20 mmol/L), ALP 407 U/L (range: 149-712; ref. 35-105 U/L) and ALT 24 87 U/L (range: 456-2637; ref. 70 and 45 U/L for males and females, respectively). Liver biopsy was performed in 2 patients and was consistent with toxic hepatitis in both cases. Other causes of hepatitis were excluded by appropriate serological testing and ultrasound. Causality assessment according to RUCAM was probable in three cases and possible in two. Using the WHO-UMC criteria causality was certain in one case, probable in two and possible in two cases. Conclusions: Hepatotoxicity is probably associated with the use of Herbalife products. Hepatotoxicity due to herbal remedies is an important differential diagnosis in the diagnostic work-up of liver injury.Tilgangur: Mörg náttúruefni eru þekkt að því að geta valdið lifrarskaða. Nýleg íslensk könnun á aukaverkunum náttúruefna sýndi að lifrarskaði var oftast tengdur notkun Herbalife. Aðferðir: Lýst er fimm tilfellum af eitrunarlifrarbólgu í tengslum við notkun á ýmsum Herbalifevörum á Íslandi á árunum 1999 til 2008. Orsakatengsl voru metin með skilmerkjum WHO-UMC en einnig með RUCAM aðferðinni. Niðurstöður: Af fimm sjúklingum voru fjórar konur og einn karl. Miðgildi aldurs var 46 ár (spönn 29-78 ár). Lengd Herbalifenotkunar var á bilinu 1-7 mánuðir. Fjórir sjúklinganna voru með klíníska mynd lifrarfrumuskaða en einn með gallstíflulifrarskaða. Miðgildi fyrir eftirfarandi voru: bílirúbín 190 µmol/L (spönn: 26-311; eðlilegt <20 µmol/L), ALP 407 U/L (spönn: 149-712; eðl. 35-105 U/L) og ALT 2487 U/L (spönn: 456-2637; eðl. 70 og 45 U/L fyrir karla og konur). Lifrarástunga var gerð í tveimur sjúklinganna og samrýmdust vefjabreytingar eitrunarlifrarbólgu. Aðrar orsakir lifrarbólgu voru útilokaðar með viðeigandi mótefnaprófum og ómskoðun. Orsakatengsl voru samkvæmt RUCAM-aðferðinni líkleg í þremur og möguleg í tveimur en samkvæmt skilmerkjum WHO örugg í einu tilfelli, líkleg í tveimur og möguleg í tveimur. Ályktanir: Telja verður líklegt að notkun á Herbalifevörum tengist eitrunarlifrarbólgu. Eitrunarlifrarbólga af völdum náttúruefna er mikilvæg mismunagreining hjá sjúklingum með lifrarskaða

‘Human First’: Teaching close reading and creative writing to medical students: Presentation of a new narrative medicine course in Denmark – and a review of the literature assessing the empirical evidence for the utility of such courses

The University of Southern Denmark has introduced a mandatory course in Narrative Medicine into the curriculum of undergraduate medical students. It is part of a trajectory called ‘Human First’, which aims to improve the students’ empathic abilities by teaching them narrative competencies to draw on in their future clinical encounters as medical doctors. Although, theoretical accounts seem to make a strong case for the utility and value of educational interventions, such as courses in narrative medicine or medical humanities, there has been a lack of empirical studies providing evidence to support such accounts – especially those focusing on the long-term effects and impact on patient care. Our systematic literature search and review of empirical studies regarding the effects of teaching close reading of fictional texts and creative writing to medical and health care students, tentatively confirmed previous indications of positive effects. Larger, multi-site and more rigorous studies that assess the long-term impacts of these educational interventions and adjust for local variations are, however, still in short supply. Finally, we present critical reflections on whether empathy and similar phenomena are at all measurable and discuss the possibility of meaningfully evaluating the utility of curricular interventions such as narrative medicine courses