Evaluating Superheavy Load Movement on Flexible Pavements: Identifying Load Nucleus and Elements of Bearing Capacity Investigation

Nowadays, industrial facilities are undergoing massive upgrades and innovations, which require moving Superheavy Loads (SHLs), these are loads with a gross vehicle weight (GVW) and axle weight exceeding the overweight legal limits and require special permits. The axle and tire configurations in SHL permits are variable and often assembled to suite the superheavy components being transported. Therefore, a realistic procedure is required to model SHL move on flexible pavement, considering that SHL axle and tire configurations are non-standard.The work presented in this research aimed to establish a new analysis procedure to model SHL using a representative Nucleus of axle and tire configurations. A clear procedure was proposed to identify SHL representative Nucleus, which when repeated across the SHL area, produces maximum stresses under SHL. Then, the Nucleus procedure was evaluated using a full factorial study, to assess its accuracy and sensitivity for the influence of pavement structure, different SHL cases and pavement analysis temperature.Applying the SHL Nucleus concept elements of bearing capacity were investigated. A second investigation was also conducted, comparing the SHL-induced state of stresses to that under standard truck loading

Evaluation of Mixtures from LTPP SPS-10 Warm Mix Asphalt (WMA) Sections.

The Nevada Department of Transportation (NDOT) commenced a full-scale project in 2016 to extensively evaluate Warm Mix Asphalt (WMA) mixtures that would likely be used in the State in the future. This was accomplished by participating in the Specific Pavement Study (SPS) experiment, which was developed under the Long-Term Pavement Performance (LTPP) program and Federal Highway Administration (FHWA) to evaluate the short- and long-term field performance of WMA relative to hot mix asphalt (HMA) mixtures. This report is a summary of the laboratory evaluation completed by University of Nevada, Reno (UNR) to characterize the mixtures placed on the LTPP SPS-10 Warm Mix Asphalt Study conducted in Washoe Valley, NV under NDOT contract 3598. Aiming to investigate both the laboratory measured properties and field performance of multiple WMA technologies compared to respective HMA counterparts with specific focus on short and long-term performance

The first consensus statement on revisional bariatric surgery using a modified Delphi approach

Background: Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. Methods: We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. Results: Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). Conclusion: Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice

Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus

Purpose: One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods: A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results: Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). Conclusion: Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.info:eu-repo/semantics/publishedVersio

Global Variations in Practices After Bariatric and Metabolic Surgery; the PARTNER study.

Background: With over 1 billion individuals affected globally, obesity and obesity related diseases is now a leading cause of death. Metabolic and bariatric surgery (MBS) has emerged as a cornerstone intervention for severe obesity and its associated comorbidities. Despite its efficacy, postoperative care and follow-up after MBS remains highly variable worldwide.Objective: The PARTNER study aimed to evaluate global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals.Methods: This study was an international online survey conducted between October 2024 and January 2025. A multidisciplinary team developed the questionnaire based on existing literature and international guidelines. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes. Responses were analysed descriptively.Results: A total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures.Conclusion: The PARTNER study reveals significant international variation in postoperative management practices following MBS. These findings underscore the need for more standardized, evidence-based guidelines to improve long-term outcomes and equity of care worldwide.<br/

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Statistical Validation Implementation in Pavement Construction Projects

In the development of a Quality Assurance (QA) program, a state highway agency (SHA) must make several important decisions regarding policies and procedures for assessing how well the materials and construction used by a Contractor on a project satisfy the SHA specifications. One of the key decisions is whether the SHA will conduct the acceptance sampling and testing or utilize Contractor data for acceptance sampling and testing. Title 23 Code of Federal Regulations Part 637 Subpart B (23 CFR 637B) permits SHAs to use Contractor data for construction materials acceptance, as long as SHAs validate the Contractor data with independent test results. Therefore, identifying procedures and guidelines for validating Contractor test data for construction materials is essential to QA programs. These procedures need to be statistically sound and practical for validating Contractor construction materials data. This dissertation documents and presents the results of studying procedures and guidelines for validating Contractor test data. The procedures developed address different applications (materials and procurement types) and related issues, like sampling method, sample size, retesting, associated risks, and practical constraints that have led SHAs to deviate from the AASHTO manuals and specifications. A guide was also prepared in AASHTO format to describe appropriate processes for validating Contractor results and recommend subsequent actions when the results are validated or not validated