Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

[pt] O SISTEMA LOGÍSTICO DA INDÚSTRIA PETROLÍFERA BRASILEIRA

Aluminium tubular structural members may experience web crippling failure due to localize concentrated loads or reactions. This paper reports an experimental program on strengthening of high strength aluminium tubular structural members using externally bonded carbon fibre-reinforced polymer (CFRP). A series of tests on CFRP strengthened aluminium square and rectangular hollow sections subjected to web crippling are presented. The web crippling tests were conducted under two loading conditions of End-Two-Flange (ETF) and End-One-Flange (EOF). A total of 27 web crippling tests were conducted in this study. The investigation was mainly focused on the effects of web slenderness of aluminium tubular sections on CFRP strengthening against web crippling. The tests were performed on eight different sizes of square and rectangular hollow sections which covered a wide range of slenderness (flat portion of web depth-to-thickness) ratio from 6.2 to 61.8. Material properties of each aluminium section were obtained from tensile coupon tests. Most of the strengthened specimens were failed by debonding of CFRP plate from the aluminium tubes. Three main failure modes were observed in the tests, namely the adhesion, combination of adhesion and cohesion, and interlaminar failure of CFRP plate. The failure modes and the load-web deformation behaviour of the aluminium sections are also presented. It was found that the web crippling capacity of aluminium sections are significantly increased due to CFRP strengthening, especially for those sections with higher web slenderness ratio.link_to_OA_fulltextThe 7th International Conference on Steel and Aluminium Structures (ICSAS 2011), Sarawak, Malaysia, 13-15 July 2011. In Proceedings of the 7th ICSAS, 2011, p. 85-9

FRP strengthening of lean duplex stainless steel hollow section subjected to end bearing load

Session MO2D - Cold-formed & Light-gauge Structure

Use of Stainless Steel as Structural Members in Bridge Construction and Fibre Reinforced Polymer Strengthening

Parallel Session-VI: MaterialsStainless steels are increasingly used as a structural member in bridge construction due to its exceptional and attractive features in terms of durability, high strength, superior corrosion resistance etc. Over the last few years, stainless steel has been playing an important role in the construction of bridges, because of their combination of high strength and corrosion resistance. Structural uses of stainless steel in bridges and several recent examples of using stainless steels in bridge construction are presented in this study. The webs of cold-formed stainless steel members in bridge construction may cripple due to concentrated bearing load in the absence of stiffeners. However, the web crippling strength can be enhanced by Fibre Reinforced Polymer (FRP) strengthening in the web of the sections. This paper presents an extensive experimental and numerical investigation of FRP strengthening lean duplex stainless steel hollow sections subjected to web crippling. The investigation was focused on the effects of surface treatment, web slenderness, different adhesives and FRPs for the strengthening. The lean duplex stainless steel type EN 1.4162 was used in the investigation. A series of laboratory tests was performed on five different sizes of square and rectangular hollow sections that covered a wide range of web slenderness ratio from 8.2 to 56.2. The failure loads, failure modes, enhancement of load carrying capacity for FRP strengthening and the load-web deformation behaviour of lean duplex stainless steel sections are presented in this study. This study is also focused on the nonlinear finite element analysis using the program ABAQUS. The numerical results were verified against the test results. It is shown that the strengths of lean duplex stainless steel hollow sections may increase up to 76% due to the strengthening of FRP

Effects of different widths of CFRP plate strengthened aluminium tubular sections subjected to two-flange-loading conditions

This paper presents a test program on strengthening of high strength aluminium tubular structural members using externally adhesive bonded carbon fibre-reinforced polymer (CFRP). A series of tests was performed on carbon fibre-reinforced polymer strengthening of aluminium tubular structural members subjected to End-Two-Flange (ETF) and Interior-Two-Flange (ITF) loading conditions. A total of 20 web crippling tests was conducted. The investigation was mainly focused on the effects of different widths of CFRP plate strengthening against web crippling. Three different widths of CFRP plate strengthening were considered. The test specimens were fabricated by extrusion from 6061-T6 heat-treated aluminium alloys. The tests were performed on three different sizes of square and rectangular hollow sections which covered a wide range of web slenderness (flat portion of web depth-to-thickness) ratio from 6.2 to 62.8. Most of the strengthened specimens were failed by debonding of CFRP plates from the aluminium tubes. There are mainly three different failure modes observed in the tests, namely the adhesion, combination of adhesion and cohesion, and combination of adhesion and interlaminar failure of CFRP plate. The failure loads, failure modes and the load-web deformation behaviour of the aluminium sections are presented in this study. The web crippling capacity of aluminium tubular sections are significantly increased due to CFRP strengthening, especially for those sections with large value of web slenderness ratio. It is found that CFRP strengthening against web crippling to be effective when the CFRP width having the same width as the bearing length.link_to_OA_fulltex

Moralidade e honra : os juízos de adolescentes em medidas socioeducativas de internação

This research investigates children s drawings in Guarani, their relationships with their natural and cultural environment, seeking the same look on your own universe, so we know aspects of their customs and traditions. To this end we conducted a qualitative research, ethnographic, school Guarani indigenous municipality of Aracruz (Espírito Santo), with classes from 1st to 5th year of elementary school. Were discussed theories about children s drawing from the works of Iavelberg, Brent Wilson, Cola, among other authors who consider the design as a cultural product of a given society. The collected data were analyzed based on semiotics greimasiana, with emphasis in the plan of expression and contentEsta pesquisa consiste em um estudo sobre o juízo a respeito da honra em adolescentes que cumprem medidas socioeducativas de internação. Participaram dessa investigação 30 adolescentes, com idade variando entre 16 e 17 anos, do sexo masculino, que no momento da coleta de dados eram internos em uma unidade do Instituto de Atendimento Socioeducativo do Espírito Santo (Iases), na região metropolitana da grande Vitória/ES. Realizamos entrevistas individuais, de acordo com o método clínico proposto por Piaget (1926/s.d.; 1932/1994). Por intermédio dos resultados encontrados, constatamos que, quanto: (1) à caracterização dos participantes, a maioria dos adolescentes estuda na instituição, onde cursam, principalmente, as séries finais do ensino fundamental. No que diz respeito aos delitos cometidos, que culminaram com sua entrada na instituição, verificamos que os internos mencionam, dentre outros: roubo ou furto , tráfico de drogas ou associação ou uso , homicídio ou latrocínio e tentativa de homicídio ou tentativa de latrocínio ; (2) às admirações e não admirações sobre si mesmo, os dados permitiram-nos concluir que os entrevistados admiram, com maior incidência, a perseverança/força de vontade , o respeito pelas pessoas e a bondade/generosidade ; ademais, averiguamos que as não admirações que os jovens citam com maior frequência são o comportamento antissocial no relacionamento interpessoal , a ação relacionada a delito , a ausência de autocontrole e a autossuficiência ; (3) à representação a respeito do juízo da sociedade sobre si mesmo, os participantes ponderam ser considerados como uma pessoa que, dentre outros aspectos, transgride , não mudará de vida , possui qualidade ruim , possui qualidade boa , futuro é a morte , é um perigo para a sociedade e mudará de vida ; (4) à honra propriamente dita, os jovens exemplificam-na por meio da reputação , melhora no relacionamento interpessoal , dedicação ao trabalho , dentre outros. Por sua vez ao conceituarem a honra evidenciam, principalmente, respostas de reputação , ação correta e bondade/generosidade . Por fim, a maioria dos adolescentes afirma ser honrado, justificando pelos seguintes conteúdos, dentre outros: mudança de vida , ação relacionada a delito , bondade/generosidade e melhora no relacionamento interpessoal . É necessário salientar que em nossos resultados há uma predominância de respostas e justificativas associadas à moralidade e, portanto, ao conceito com honra (La Taille, 2002b). Com efeito, destacamos que nosso trabalho contribui para com a compreensão do universo dos adolescentes em medidas socioeducativas de internação, evidenciando dados que poderão conduzir práticas, reflexões e outras pesquisas. Finalmente, ao fornecermos elementos sobre a honra desses jovens, estamos colaborando, acadêmica e socialmente, para a concretização de uma vida boa (La Taille, 2006). Para nós, este é o caminho que devemos construir, socialmente, com o outro e para o outroCoordenação de Aperfeiçoamento de Pessoal de Nível Superio