Determination of Behavior of Coupled Shear Walls Subjected to Horizontal Forces through Nonlinear Static Methods

Coupled shear walls are one of the systems commonly used in medium and highrise structures to resist lateral forces. Yet these systems should not collapse or be induced severe damage during earthquake actions. For this reason, coupled shear walls must have high strength, high ductility, high energy absorption capacity and high shear stiffness to limit lateral deformations. The recent advances in structural engineering have increased the interest in performance based design. In the study herein, hence, the performance based design of a coupled shear wall system has been carried out. The design has later been checked against nonlinear time history analysis and the design performed has been confirmed to be quite safe. In the second stage of the study, the horizontal capacity of couple shear walls is predicted by the pushover analyses. Though these procedures have been used for different types of structures, they have not been employed for coupled shear walls. The procedures employed are conventional pushover (deformation and forced based), force based adaptive pushover, and deformation based adaptive pushover. The capacity curves obtained through these procedures have been compared with the one determined through Incremental Dynamic Analysis. The evaluation shows that it is almost unlikely to determine the capacity curve of coupled shear walls by the nonlinear static analyses. Nonetheless, the displacement based adaptive pushover analyses has been able to predict the base shear capacity and capture the displacement profile of the system up to a certain level in the nonlinear region

Apofizealne avulzijske ozljede prednje donje šiljaste izbočine: rehabilitacija sine qua non – prikaz slučaja

Apophyseal injuries of the anterior superior iliac spine and pubic bone are common, whereas injuries to the anterior inferior iliac spine are only rarely encountered. When it occurs in children, it may be difficult to diagnose and is easily mistaken for slipped capital femoral epiphysis. To make timely and correct diagnosis, the physician must have thorough understanding of the basic anatomical relationships and awareness of the existence of this injury. In this case report treatment and follow-up period in a 12-year-old patient with apophyseal avulsion of anterior inferior iliac spine is described and the differential diagnosis is discussed.Apofizealne ozljede prednje gornje šiljaste izbočine bočne kosti i stidne kosti su česte, dok su ozljede prednje donje šiljaste izbočine bočne kosti rijetke. Kada se dogodi u djece ponekad je teško postaviti dijagnozu i lako se zamijeni s poskliznućem epifize glave femura. Da bi se postavila točna i pravovremena dijagnoza liječnik mora temeljito razumijeti osnovne anatomske odnose i biti svjestan mogućnosti pojave ove ozljede. U ovom prikazu slučaja iznosi se liječenje i praćenje tijekom dvije godine 12-godišnjeg bolesnika s apofizealnom avulzijom prednje donje šiljaste izbočine bočne kosti, a raspravljeno je o diferencijalnoj dijagnozi

Damage diagnosis in beam-like structures by artificial neural networks

Applicability of artificial neural networks is examined in determining the natural frequencies of intact beams and crack parameters of damaged beams. Multi-layer perceptron (MLP) and radial basis neural networks (RBNN) are utilized for training and validation of input data. In the first part of the study, the first four frequencies of free vibration are predicted based on beam properties by the networks. Showing the effectiveness of the neural networks in predicting the vibrational frequencies, the second part of the study is carried out. At this stage of the inverse problem, the frequencies and mode shape rotation deviations in addition to beam properties are used as input to the networks to determine the crack parameters. Different hidden nodes, epochs and spread values are tried to find the optimal neural networks that give the lowest error estimates. In both parts of the study, the RBNN model performs better. The robustness of the network models in the presence of noise is also shown. It is shown that the optimal MLP network predicts the crack parameters slightly better in the presence of noise. As a conclusion, the trained RBNN model can be used in health monitoring of beam-like structures as a crack identification algorithm

Numerical Study of Influence of Infill Walls on the Vertical Irregularity Limit of Turkish Seismic Code

Abstract -Weak/soft story irregularities are resulted from sudden changes of stiffness, strength and/or mass between adjacent stories. These irregularities introduce a soft zone into a structure where the damage initiates and concentrates, often leading to complete collapse. It is argued that masonry infill walls not constructed at ground floors of some commercial building create such a zone. To examine this phenomenon along stiffness irregularity conditions described in Turkish Seismic Cod

Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization

Pleomorphic Carcinoma of the Lung with High Serum Beta-human Chorionic Gonadotropin Level and Gynecomastia

Although gynecomastia is a well-defined paraneoplastic syndrome in patients with non-small cell lung cancer, the association with pleomorphic carcinoma has not been reported. A 50-yr-old man presented with bilateral gynecomastia and elevated serum beta-human chorionic gonadotropin (βhCG) level. Chest tomography showed a mass in the right middle lobe. Right middle lobectomy and mediastinal lymph node dissection were performed. βhCG levels decreased rapidly after surgery. Histological examination revealed pleomorphic carcinoma with positive immunostaining for βhCG. Serum βhCG levels began to increase gradually on postoperatively 4th month. Computed tomography detected recurrence and chemotherapy was started. After second cycle of chemotherapy, βhCG levels decreased dramatically again and tomography showed regression in mass. Patient died 6 months later due to brain metastasis. βhCG expression may be associated with aggressive clinical course and increased risk of recurrence, also βhCG levels may be used to evaluate therapy response in patients with pleomorphic carcinoma

Multiple Myeloma Treatment in Real-world Clinical Practice : Results of a Prospective, Multinational, Noninterventional Study

Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: M.M. has received personal fees from Janssen, Celgene, Amgen, Bristol-Myers Squibb, Sanofi, Novartis, and Takeda and grants from Janssen and Sanofi during the conduct of the study. E.T. has received grants from Janssen and personal fees from Janssen and Takeda during the conduct of the study, and grants from Amgen, Celgene/Genesis, personal fees from Amgen, Celgene/Genesis, Bristol-Myers Squibb, Novartis, and Glaxo-Smith Kline outside the submitted work. M.V.M. has received personal fees from Janssen, Celgene, Amgen, and Takeda outside the submitted work. M.C. reports honoraria from Janssen, outside the submitted work. M. B. reports grants from Janssen Cilag during the conduct of the study. M.D. has received honoraria for participation on advisory boards for Janssen, Celgene, Takeda, Amgen, and Novartis. H.S. has received honoraria from Janssen-Cilag, Celgene, Amgen, Bristol-Myers Squibb, Novartis, and Takeda outside the submitted work. V.P. reports personal fees from Janssen during the conduct of the study and grants, personal fees, and nonfinancial support from Amgen, grants and personal fees from Sanofi, and personal fees from Takeda outside the submitted work. W.W. has received personal fees and grants from Amgen, Celgene, Novartis, Roche, Takeda, Gilead, and Janssen and nonfinancial support from Roche outside the submitted work. J.S. reports grants and nonfinancial support from Janssen Pharmaceutical during the conduct of the study. V.L. reports funding from Janssen Global Services LLC during the conduct of the study and study support from Janssen-Cilag and Pharmion outside the submitted work. A.P. reports employment and shareholding of Janssen (Johnson & Johnson) during the conduct of the study. C.C. reports employment at Janssen-Cilag during the conduct of the study. C.F. reports employment at Janssen Research and Development during the conduct of the study. F.T.B. reports employment at Janssen-Cilag during the conduct of the study. The remaining authors have stated that they have no conflicts of interest. Publisher Copyright: © 2018 The AuthorsMultiple myeloma (MM) remains an incurable disease, with little information available on its management in real-world clinical practice. The results of the present prospective, noninterventional observational study revealed great diversity in the treatment regimens used to treat MM. Our results also provide data to inform health economic, pharmacoepidemiologic, and outcomes research, providing a framework for the design of protocols to improve the outcomes of patients with MM. Background: The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. Patients and Methods: Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. Results: A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. Conclusion: The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits.publishersversionPeer reviewe

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Western images of Turkey in the twentieth century

While the general idea is to demonstrate how non-Western culture has been represented by a Western one, the particular aim of the thesis is to offer an analysis of twentieth century images of Turkey in the West mainly through the texts of thrillers and travel accounts. Since Turkey has generally been treated as a Middle Eastern country in terms of geography, culture and religion in those texts I have randomly selected, the negative images of Turkey and the Turks have been examined from a non-European point of view taking into account Michel Foucault's analysis interpreted by Edward Said. In order to provide a better understanding of the texts studied in the thesis, there is a brief presentation of the history and development of travel writing and popular fiction as distinct literary genres in the Introduction. Moreover, as the thesis demonstrates that there are a great number of direct or indirect references to historical representations of the Turks identified with the Ottomans, a chronological account of early images is made in the first chapter. These images can be summed up under such general headings as 'Lustful' and 'Terrible' Turks or a combination of both. The analysis of contemporary images of Turkey has been undertaken separately in ensuing chapters. While the images of violence are discussed in the second chapter, the images of the exotic which appear in the third, and the fourth chapter deals with first impressions of Turkey and the Turks. The thesis, which concludes with a discussion of the evolving process of Turkish stereotypes from verbal to visual towards the end of the twentieth century, suggesting that there are also other discourses in the media, particularly in the cinema worth examining as they also construct and perpetuate the negative image discerned in the selection of the texts