Marked increase in the incidence rate of esophageal adenocarcinoma in a high-risk area for esophageal cancer

BACKGROUND: Esophageal cancer (EC) is the eighth common cancer worldwide. Esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (EAD) are the most common histologic types of EC. Many recent reports showed an increasing trend in EAD and a decreasing trend in ESCC in many Western countries. Golestan Province in northeastern Iran has been known as a high-risk area for EC. The aim of this study was to describe the time trend of EAD in this area between 2000-2009. METHODS: Data on cancer cases were obtained from Golestan Population-based Cancer Registry. Analysis was done using Joinpoint software. To examine the incidence trends, the annual percent change was calculated. The possibilities of anatomic and histologic misclassification were considered by assessing the trend of ESCC and gastric adenocarcinoma. RESULTS: A total number of 1186 histologically-confirmed EC cases were recruited. The incidence rate of EAD showed a significant increasing trend. There was no significant trend in the incidence of ESCC during the study period. A significant increase in the incidence rate of gastric adenocarcinoma was observed during the period of 2000-2005, followed by a plateau during the period of 2005-2009. CONCLUSIONS: We found a significant increasing trend in the incidence rate of EAD. We find no evidence to support an alternative explanation including anatomic and histologic misclassification. So, the observed rise in the incidence of EAD seems to be real. Therefore, designing and implementation of control programs, including control of preventable risk factors of EAD, should be considered in this high- risk area

Validation of Finite Element Crash Test Dummy Models for Predicting Orion Crew Member Injuries During a Simulated Vehicle Landing

A series of crash tests were conducted with dummies during simulated Orion crew module landings at the Wright-Patterson Air Force Base. These tests consisted of several crew configurations with and without astronaut suits. Some test results were collected and are presented. In addition, finite element models of the tests were developed and are presented. The finite element models were validated using the experimental data, and the test responses were compared with the computed results. Occupant crash data, such as forces, moments, and accelerations, were collected from the simulations and compared with injury criteria to assess occupant survivability and injury. Some of the injury criteria published in the literature is summarized for completeness. These criteria were used to determine potential injury during crew impact events

Orion Crew Member Injury Predictions during Land and Water Landings

A review of astronaut whole body impact tolerance is discussed for land or water landings of the next generation manned space capsule named Orion. LS-DYNA simulations of Orion capsule landings are performed to produce a low, moderate, and high probability of injury. The paper evaluates finite element (FE) seat and occupant simulations for assessing injury risk for the Orion crew and compares these simulations to whole body injury models commonly referred to as the Brinkley criteria. The FE seat and crash dummy models allow for varying the occupant restraint systems, cushion materials, side constraints, flailing of limbs, and detailed seat/occupant interactions to minimize landing injuries to the crew. The FE crash test dummies used in conjunction with the Brinkley criteria provides a useful set of tools for predicting potential crew injuries during vehicle landings

The Use of a Vehicle Acceleration Exposure Limit Model and a Finite Element Crash Test Dummy Model to Evaluate the Risk of Injuries During Orion Crew Module Landings

A review of astronaut whole body impact tolerance is discussed for land or water landings of the next generation manned space capsule named Orion. LS-DYNA simulations of Orion capsule landings are performed to produce a low, moderate, and high probability of injury. The paper evaluates finite element (FE) seat and occupant simulations for assessing injury risk for the Orion crew and compares these simulations to whole body injury models commonly referred to as the Brinkley criteria. The FE seat and crash dummy models allow for varying the occupant restraint systems, cushion materials, side constraints, flailing of limbs, and detailed seat/occupant interactions to minimize landing injuries to the crew. The FE crash test dummies used in conjunction with the Brinkley criteria provides a useful set of tools for predicting potential crew injuries during vehicle landings

Development of Head Injury Assessment Reference Values Based on NASA Injury Modeling

NASA is developing a new capsule-based, crewed vehicle that will land in the ocean, and the space agency desires to reduce the risk of injury from impact during these landings. Because landing impact occurs for each flight and the crew might need to perform egress tasks, current injury assessment reference values (IARV) were deemed insufficient. Because NASCAR occupant restraint systems are more effective than the systems used to determine the current IARVs and are similar to NASA s proposed restraint system, an analysis of NASCAR impacts was performed to develop new IARVs that may be more relevant to NASA s context of vehicle landing operations. Head IARVs associated with race car impacts were investigated by completing a detailed analysis of all of the 2002-2008 NASCAR impact data. Specific inclusion and exclusion criteria were used to select 4071 impacts from the 4015 recorder files provided (each file could contain multiple impact events). Of the 4071 accepted impacts, 274 were selected for numerical simulation using a custom NASCAR restraint system and Humanetics Hybrid-III 50th percentile numerical dummy model in LS-DYNA. Injury had occurred in 32 of the 274 selected impacts, and 27 of those injuries involved the head. A majority of the head injuries were mild concussions with or without brief loss of consciousness. The 242 non-injury impacts were randomly selected and representative of the range of crash dynamics present in the total set of 4071 impacts. Head dynamics data (head translational acceleration, translational change in velocity, rotational acceleration, rotational velocity, HIC-15, HIC-36, and the Head 3ms clip) were filtered according to SAE J211 specifications and then transformed to a log scale. The probability of head injury was estimated using a separate logistic regression analysis for each log-transformed predictor candidate. Using the log transformation constrains the estimated probability of injury to become negligible as IARVs approach zero. For the parameters head translational acceleration, head translational velocity change, head rotational acceleration, HIC-15, and HIC-36, conservative values (in the lower 95% confidence interval) that gave rise to a 5% risk of any injury occurring were estimated as 40.0 G, 7.9 m/s, 2200 rad/s2, 98.4, and 77.4 respectively. Because NASA is interested in the consequence of any particular injury on the ability of the crew to perform egress tasks, the head injuries that occurred in the NASCAR dataset were classified according to a NASA-developed scale (Classes I - III) for operationally relevant injuries, which classifies injuries on the basis of their operational significance. Additional analysis of the data was performed to determine the probability of each injury class occurring, and this was estimated using an ordered probit model. For head translational acceleration, head translational velocity change, head rotational acceleration, head rotational velocity, HIC-36, and head 3ms clip, conservative values of IARVs that produced a 5% risk of Class II injury were estimated as 50.7 G, 9.5 m/s, 2863 rad/s2, 11.0 rad/s, 30.3, and 46.4 G respectively. The results indicate that head IARVs developed from the NASCAR dataset may be useful to protect crews during landing impact

Marked increase in breast cancer incidence in young women : A 10-year study from Northern Iran, 2004-2013

Introduction: Breast cancer is the most frequent cancer among women worldwide. Breast cancer incidence in young women is a health issue of concern, especially in middle-income countries such as Iran. The aim of this study is to report the breast cancer incidence variations in Golestan province, Iran, over a 10-year period (2004-2013). Methods: We analyzed data from the Golestan Population-based Cancer Registry (GPCR), which is a high-quality cancer registry collecting data on primary cancers based on standard protocols throughout the Golestan province. Age-standardized incidence rates (ASRs) and age-specific incidence rates per 100,000 person-years were calculated. Time trends in ASRs and age-specific rates were evaluated using Joinpoint regressions. The average annual percentage change (AAPC) with correspondence 95% confidence intervals (95%CIs) were calculated. Results: A total of 2106 new breast cancer cases were diagnosed during the study period. Most cases occurred in women living in urban areas: 1449 cases (68%) versus 657 cases (31%) in rural areas. Statistically significant increasing trends were observed over the 10-year study period amongst women of all ages (AAPC = 4.4; 95%CI: 1.2-7.8) as well as amongst women in the age groups 20-29 years (AAPC = 10.0; 95%CI: 1.7-19.0) and 30-39 years (AAPC = 5.1; 95%CI: 1.4-9.0). Conclusion: The incidence of breast cancer increased between 2004 and 2013 in Golestan province amongst all age groups, and in particular amongst women aged 20-39 years. Breast cancer should be considered a high priority for health policy making in our community.Peer reviewe

A practice-oriented model for pushover analysis of a class of timber-framed masonry buildings

Timber-Framed (TF) masonry is a structural system characterized by high complexity and diversity. Limited experimental and analytical research has been carried out so far to explore their earthquake response, partly due to the complexity of the problem and partly due to the scarcity of TF buildings across the world. Here, a new practice-oriented non-linear (NL) macro-model is presented for TF masonry structures, based on the familiar diagonal strut approach with NL axial hinges in the struts. The constitutive law for the hinges (axial force vs. axial deformation) is derived on the basis of an extensive parametric analysis of the main factors affecting the response of TF masonry panels subjected to horizontal loading. The parameters studied are related to the geometric features of the panel and the strength of wood as well as the connections of the timber elements. The parametric analysis is performed using a micro-model based on Hill-type plasticity and it is shown that in the studied X-braced walls the masonry infills do not make a significant contribution to the lateral load resistance. Empirical expressions are proposed for the yield and maximum displacement and shear of a horizontally loaded TF panel. The model is verified against available experimental data, and is found to capture well the envelopes of the experimental loops. The model is readily applicable to NL static analysis (pushover) analysis for the assessment of the lateral load capacity of TF masonry buildings, as the number of input parameters for deriving the constitutive law has been limited to only five

Sars coronavirus 2, severe acute respiratory syndrome, and middle east respiratory syndrome in children: A review on epidemiology, clinical presentation, and diagnosis

Context: Coronavirus Disease 2019 (COVID-19) pandemic has caused irreparable damage to society. The pediatric population may be asymptomatic but has positive viral nucleic acid test results and plays an important role in spreading the infection in populations. However, there is a substantial information gap on the epidemiology, pathology, and clinical presentations of COVID-19 in pediatric patients. Evidence Acquisition: English research articles published before April 18, 2020, were reviewed to understand the clinical characteristics of SARS coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in children. The WHO (https://www.who. int/) and CDC (Centers for Disease Control and Prevention, https://www.cdc.gov/) websites were also reviewed to find eligible studies, besides articles extracted from PubMed, Scopus, and Google Scholar. Results: In comparison with SARS and MERS, COVID-19 seems to have wider clinical symptoms and routes of transmission. Multisystem inflammatory syndrome is a unique clinical feature of this novel virus. The low prevalence of COVID-19 in children may be due to lower contacts or incomplete identification rather than resistance to the virus. Conclusions: As this virus is novel, we believe that lessons learned from SARS and MERS outbreaks are very valuable in handling the current pandemic. The aim of this paper was to provide the updated summary of clinical manifestation, diagnostic, molecular, and genetic aspects of the novel coronavirus in comparison with SARS and MERS coronaviruses in children. © 2020, Author(s)

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran):a pragmatic, cluster-randomised trial

Background: A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease. Methods: The PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40�75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle�eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome�occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)�was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985. Findings: Between Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study�3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5) of 3421 participants in the polypill group were women, as were 1679 (49·1) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5 (IQR 48·5�92·2). During follow-up, 301 (8·8) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9) of 3421 participants in the polypill group (adjusted hazard ratio HR 0·66, 95% CI 0·55�0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49�0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51�1·12; pinteraction=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33�0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up�ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group. Interpretation: Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs. Funding: Tehran University of Medical Sciences, Barakat Foundation, and Alborz Darou. © 2019 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved

Modelling low velocity impact induced damage in composite laminates

The paper presents recent progress on modelling low velocity impact induced damage in fibre reinforced composite laminates. It is important to understand the mechanisms of barely visible impact damage (BVID) and how it affects structural performance. To reduce labour intensive testing, the development of finite element (FE) techniques for simulating impact damage becomes essential and recent effort by the composites research community is reviewed in this work. The FE predicted damage initiation and propagation can be validated by Non Destructive Techniques (NDT) that gives confidence to the developed numerical damage models. A reliable damage simulation can assist the design process to optimise laminate configurations, reduce weight and improve performance of components and structures used in aircraft construction