CT04702412; https//clinicaltrials.gov/.

ClinicalTrials.gov identifier NCT04702412; https//clinicaltrials.gov/.In order to investigate the effect of pre-loading damage on the structural performance of Carbon Fiber Reinforced Polymer (CFRP) strengthened Reinforced Concrete (R.C.) beams, experimental and Finite Element Modelling (FEM) investigation was carried out on six R.C. beams. Five of the R.C. beams were damaged up to different levels of strain in the main steel bars before Flexure CFRP strengthening. One of the R.C. beams loaded up to failure and was kept as a control beam for comparison. The experimental results showed that the failure mode of the CFRP strengthened specimen was controlled by CFRP debonding followed by concrete crushing; however, the control beam failed in concrete crushing after yielding the steel bars, which is a ductile failure. The CFRP sheet increases the strength and initial stiffness of the R.C. beams and reduces ductility and toughness. Also, CFRP application increases the first crack and yielding steel bars load by 87.4% and 34.4%, respectively. Furthermore, the pre-damage level does not influence the strength and ductility of the strengthened R.C. beams except for the highest damage levels, which experienced a slight decrease in load capacity and ductility. However, the initial stiffness decreases with increasing pre-damage levels by 40%. Design guideline ACI 440.2R (2004) predicts the ultimate load capacity marvelously for externally bonded Fiber-Reinforced Polymer (FRP) beams compared to the experimental maximum load capacity. The excellent agreement between experimental and FEM results indicates that the constitutive models used for concrete and reinforcement and the cohesive interface model can well capture fracture behavior. However, The FEM analysis predicts the beam to be slightly stiffer and more robust, probably because of the assumed perfect bond between concrete and reinforcement. The developed FEM can be used for further parametric study.

The COVID-19 pandemic has affected the health systems in many ways. selleck chemicals It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient’s experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening’s implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal.

In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization’s six building blocks of health system as a theoretical framework which included sthen the health system.

This study approached a unique way to strengthen the health system by exploring patients’ feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government’s role to continue its efforts to strengthen the health system.Geometrical fencing is a scientific approach to fencing pioneered by Camillo Agrippa in the XVIth century which consists of characterizing the geometrical structure of fencing movements. Many geometrical spaces are involved in a duel, which evolve over time according to the skills of the fencers and the game rules. In this article, the concept of motion scheme is introduced as a flexible geometrical structure to represent fencing spaces evolving over time. The method is applied to the video of a duel of the Olympic games 2016. Five main results are presented. First, decisive actions of the duel are deduced from the distance between fencers. Second, footwork is reconstructed from horizontal movements of the feet. Third, a kinematic model is developed and compared with data in the literature. Fourth, the lunge attack is characterized and compared with data in the literature. Fifth, the role of the free hand is studied in the case of protective and balancing gestures. These findings provide rich information on the geometrical structure of fencing movements as well as on the tactical-strategic choices made by the fencers in real competition conditions. Finally, four applications illustrate the scientific value of motion schemes in fencing and other sports.Burnout syndrome is a syndrome of emotional exhaustion, professional efficacy and cynicism. A significant proportion of medical students reported having burnout syndrome during their training in medical education. Several tools including the Copenhagen Burnout Inventory-Student Survey (CBI-SS) are considered to be a valid measurement of burnout syndrome in medical students. This study aimed to translate, culturally adapt, and validate the CBI-SS for assessing burnout syndrome among preclinical medical students in Thailand. This study was conducted during February to March 2019 at the Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand), which is Thailand’s largest and oldest medical school, and Thailand’s largest national tertiary referral center. After receiving formal permission to do so from the copyright owner, the original English language version of the CBI-SS was translated to Thai language using an internationally recommended and accepted forward-backward translation protocol. nents, and confirmatory factor analysis revealed good fit indices of the Thai CBI-SS. Confirmatory factor analysis showed good fit indices of CBI-SS domains (χ2/df = 2.39; CFI = 0.957; GFI = 0.909; RMSEA = 0.058; TLI = 0.949; and NFI = 0.928). The convergent validity analysis using the Average Variance Extracted (AVE) and the Composite Reliability (CR) was adequate for all dimensions (personal AVE = 0.626, CR = 0.893; study-related AVE = 0.601, CR = 0.899; colleague-related AVE = 0.677, CR = 0.913; teacher-related AVE = 0.606, CR = 0.900). The HTMT values for all variables are in the range from 0.315 to 0.833, confirming the discriminant validity. The Thai CBI-SS was found to be a valid and reliable tool for evaluating burnout syndrome in preclinical medical students in Thailand.Introduction Human cytomegalovirus (HCMV) is the most common congenital infection, expecially severe after a maternal primary infection; sequelae in neonates born to mothers experiencing a non-primary infection have been already reported. Hereby, two cases of severe fetal HCMV disease in seroimmune gravidas referred to our Unit are described. Cases presentation Case 1 A fetus at 21 weeks’ gestation with signs of anemia and brain abnormalities at ultrasound (US), described at magnetic resonance (MR) imaging as ependymal irregularity and bilateral asymmetric parenchimal thinning; amniotic fluid sample was positive for HCMV although the woman had a previous immunity; after termination of pregnancy, autopsy demonstrated a thicken layer of disorganized neurons on the right cortical plate, while on the left there was a morphological pattern coherent with polymicrogyria. Case 2 A fetus at 20 weeks’ gestation with anemia, moderate atrio-ventricular insufficiency, hepatosplenomegaly but no major cerebral lesions. Fetal blood was positive for HCMV, although unexpected for pre-pregnancy maternal immunity, and intrauterine transfusion was needed. A cesarean section at 34 weeks gestation was performed due to worsening condition of the fetus, who had a birthweight of 2210 grams, needed platelet transfusions but MR examination and clinical evaluation were normal. Conclusion The impact of non-primary maternal infection on pregnancy outcome is unknown and fetal brain damage in HCMV seroimmune transmitter-mothers can occur as a consequence of maternal re-infection or reactivation for a hypotetic different role of HCMV-primed CD4+ or CD8+ T-cells in fetal brain, with progressive brain lesions coexistent in the first case and with severe unexpected anemia in the second case. A previous maternal HCMV immunity should not exempt to test anemic fetuses for such infection, nor to consider a potential transplacental transmission.

A growing trend in medicine is older adults and increased need for geriatric services. Falls contribute heavily to hospitalizations and worsening of overall health in this frail demographic. There are numerous biological and physical culprits which, if targeted, can prevent falls. The objective was to review benefits of different types of exercises for fall prevention for older persons who are community-dwelling or living in long-term care facilities.

A systematic review was conducted to determine the different types of exercises for fall prevention. Data extraction via a standardized protocol was performed to assess study design, outcomes, limitations, and author’s conclusions. Corroborative themes were identified and the authors responsible for the contributing research were cited as they came up. Nineteen randomized controlled trials were identified, between 1990 and 2018, using MEDLINE, PubMed, Cochrane, CINAHL, and Web of Science databases. Studies involving adults greater than age 60 in high-risk community or nursing home populations in the English language with a duration longer than or equal to 6 weeks with focuses on either low-risk balance, strength, or combination of both and whole-body vibration.

Balance exercise training increased balance at 6 and 12-month intervals involving balance, strength, and cognitive training.

Insignificant results were seen in whole-body vibration and differing results existed for Tai Chi. It is important to recognize that although exercises help reduce the risk of falling and play a significant role in improving mobility safely, there will always be a risk of falls.

Insignificant results were seen in whole-body vibration and differing results existed for Tai Chi. It is important to recognize that although exercises help reduce the risk of falling and play a significant role in improving mobility safely, there will always be a risk of falls.Digital technology has been used in the field of diagnostic breast pathology and immunohistochemistry (IHC) for decades. Examples include automated tissue processing and staining, digital data processing, storing and management, voice recognition systems, and digital technology-based production of antibodies and other IHC reagents. However, the recent application of whole slide imaging technology and artificial intelligence (AI)-based tools has attracted a lot of attention. The use of AI tools in breast pathology is discussed briefly as it is covered in other reviews. Here, we present the main application of digital technology in IHC. This includes automation of IHC staining, using image analysis systems and computer vision technology to interpret IHC staining, and the use of AI-based tools to predict marker expression from haematoxylin and eosin-stained digitalized images.