Structural Reliability of the Tampico Bridge under Wind Loading

A highway bridge located in Tampico, on the east coast of Mexico, is analyzed to determine its structural reliability against wind loading. The inherent variabilities of the random wind force and of the mechanical properties of steel constitute the aleatory uncertainty; this contributes to the probability of failure of the steel girder. The idealization of the loading and of the bridge structure, and the analysis of the structural response to wind loading, contribute to additional uncertainty of the epistemic type, which leads to a range of possible (or distribution of) failure probabilities. The design with the minimum expected life-cycle cost is the optimal design. However, for this optimal design, the 90% value (or the mean plus one standard deviation value) of the corresponding failure probability or safety index may be selected for a risk-aversive design. The proposed criteria constitute a new approach to make conservative decisions and involve the epistemic uncertainty on the bridge design and assessment proces

The Men's Safer Sex (MenSS) trial: protocol for a pilot randomised controlled trial of an interactive digital intervention to increase condom use in men

Introduction: Sexually transmitted infections (STI) are a major public health problem. Condoms provide effective protection but there are many barriers to use. Face-to-face health promotion interventions are resource-intensive and show mixed results. Interactive digital interventions may provide a suitable alternative, allowing private access to personally tailored behaviour change support. We have developed an interactive digital intervention (the Men's Safer Sex (MenSS) website) which aims to increase condom use in men. We describe the protocol for a pilot trial to assess the feasibility of a full-scale randomised controlled trial of the MenSS website in addition to usual sexual health clinical care.Methods and analysis: Participants: Men aged 16 or over who report female sexual partners and recent unprotected sex or suspected acute STI. Participants (N=166) will be enrolled using a tablet computer in clinic waiting rooms. All trial procedures will be online, that is, eligibility checks; study consent; trial registration; automated random allocation; and data submission. At baseline and at 3, 6 and 12 months, an online questionnaire will assess condom use, self-reported STI diagnoses, and mediators of condom use (eg, knowledge, intention). Reminders will be by email and mobile phone. The primary outcome is condom use, measured at 3 months. STI rates will be recorded from sexual health clinic medical records at 12 months. The feasibility of a cost-effectiveness analysis will be assessed, to calculate incremental cost per STI prevented (Chlamydia or Gonorrhoea), from the NHS perspective.Ethics and dissemination: Ethical approval: City and East NHS Research Ethics Committee (reference number 13 LO 1801). Findings will be made available through publication in peer-reviewed journals, and to participants and members of the public via Twitter and from the University College London eHealth Unit website. Raw data will be made available on request

Evidence-based decision support for pediatric rheumatology reduces diagnostic errors.

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists. METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases (averaging 22 findings per disease). Rheumatology content in the database was developed using both primary references and textbooks. The frequency, timing, age of onset and age of disappearance of findings, as well as their incidence, treatability, and heritability were taken into account in order to guide diagnostic decision making. These capabilities allowed key information such as pertinent negatives and evolution over time to be used in the computations. Efficacy was measured by comparing whether the correct condition was included in the differential diagnosis generated by clinicians before using the software ( unaided ), versus after use of the DDSS ( aided ). RESULTS: The 26 clinicians demonstrated a significant reduction in diagnostic errors following introduction of the software, from 28% errors while unaided to 15% using decision support (p \u3c 0.0001). Improvement was greatest for emergency medicine physicians (p = 0.013) and clinicians in practice for less than 10 years (p = 0.012). This error reduction occurred despite the fact that testers employed an open book approach to generate their initial lists of potential diagnoses, spending an average of 8.6 min using printed and electronic sources of medical information before using the diagnostic software. CONCLUSIONS: These findings suggest that decision support can reduce diagnostic errors and improve use of relevant information by generalists. Such assistance could potentially help relieve the shortage of experts in pediatric rheumatology and similarly underserved specialties by improving generalists\u27 ability to evaluate and diagnose patients presenting with musculoskeletal complaints. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02205086

A Review of the Research on Childminding: Understanding Children's Experiences in Home-Based Childcare Settings

This paper offers a discussion of the literature of an under-developed area of early years research—the exploration of childminding or home-based childcare and the contribution which this form of provision makes for children and families. Despite growing interest in childminding at the policy level and some international research on understanding home-based childcare settings and practices, there remains a relative dearth of studies conceptualising and reviewing the extant literature. This paper addresses this gap by presenting the findings of a comprehensive database search for literature and a review of published international work from 1990 to 2013. It offers a conceptual analysis of the notion of “home-based childcare”, with a focus on understanding caregivers’ practices, and the key issues and debates that characterise the field. The paper argues that home-based childcare not only offers a specialist type of service as family support, especially for vulnerable families, but that it provides a form of pedagogical approach to children’s developmental and educational outcomes that is distinct from any other types of early years care

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition

Engineering the Ratios of Nanoparticles Dispersed in Triphasic Nanocomposites for Biomedical Applications.

Polymer/ceramic nanocomposites integrated the advantages of both polymers and ceramics for a wide range of biomedical applications, such as bone tissue repair. Here, we reported triphasic poly(lactic-co-glycolic acid) (PLGA, LA/GA = 90:10) nanocomposites with improved dispersion of hydroxyapatite (HA) and magnesium oxide (MgO) nanoparticles using a process that integrated the benefits of ultrasonic energy and dual asymmetric centrifugal mixing. We characterized the microstructure and composition of the nanocomposites and evaluated the effects of the HA/MgO ratios on degradation behavior and cell-material interactions. The PLGA/HA/MgO nanocomposites were composed of 70 wt % PLGA and 30 wt % nanoparticles made of 20:10, 25:5, and 29:1% by weight of HA and MgO, respectively. The results showed that the nanocomposites had a homogeneous nanoparticle distribution and as-designed elemental composition. The cell study indicated that reducing the MgO content in the triphasic nanocomposite increased the BMSC adhesion density under both direct and indirect contact conditions. Specifically, after the 24 and 48 h of culture, the PLGA/HA/MgO group with a weight ratio of 70:29:1 (P70/H29/M1) exhibited the greatest average cell adhesion density under direct and indirect contact conditions among triphasic nanocomposites. During a 28-day degradation study, the mass loss of triphasic nanocomposites was 18 ± 2% for P70/H20/M10, 9 ± 2% for P70/H25/M5, and 7 ± 1% for P70/H29/M1, demonstrating that MgO nanoparticles accelerated the degradation of the nanocomposites. Postculture analysis showed that the pH values and Mg2+ ion concentrations in the media increased with increasing MgO content in the nanocomposites. Triphasic nanocomposites provided different degradation profiles that can be tuned for different biomedical applications, especially when a shorter or longer period of degradation would be desirable for optimal bone tissue regeneration. The concentration and ratio of nanoparticles should be adjusted and optimized when other polymers with different degradation modes and rates are used in the nanocomposites

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1-T3 oropharyngeal cancer

Altered fractionation radiotherapy with concomitant boost (AFRT-CB) may be considered an alternative treatment for patients not appropriate for chemoradiation (CRT). As functional outcomes following AFRT-CB have been minimally reported, this exploratory paper describes the outcomes of patients managed with AFRT-CB or CRT at 6 months post-treatment

Sanitation and hygiene in Kibera Slums, Nairobi : women´s concerns and nurses promotional tools

The purpose of the study was to review the relevant literature of sanitation and hygiene regarding women in poor urban centres and explore ways on empowering women on sanitation and hygiene. The aim of the study was to describe the typical concerns for women regarding sanitation and hygiene in Kibera as well as providing women with practical suggestions to improve Hygiene and Sanitation in slums. The data collection method involved reviewing relevant literature which consisted research materials from poor urban centres and developing countries. In addition, United Nations publications and educational books for research were referred to. The findings suggest that there are seven sanitation and hygiene concerns that women experience: Toileting, water, poverty, problems caused by poor sanitation, communicable diseases, insecurity and gender inequality. Nurses need to promote hygiene and sanitation practices by advocating, educating, campaigning and participating in designing community projects that affect sanitation and hygiene. Furthermore, nurses need to work within communities, churches, and schools. As a conclusion, the findings of this study give idea on designing a poster for the community health care nurses who are working with women living in under privileged environments.Tämän kirjallisuuskatsauksen tarkoituksena oli käydä läpi asiaankuuluvaa kirjallisuuta koskien puhtaanapitoa ja hygieniaa naisten näkökulmasta köyhissä kaupunkilaiskeskustoissa. Lisäksi tarkoituksena oli tutkia naisten voimallistamisen keinoja puhtaanapidossa ja hygieniassa. Kirjallisuuskatsauksen pyrkimyksenä oli selvittää naisten tyypillisiä huolenaiheita puhtaanapitoon ja hygieniaan liittyen Kiberassa. Samalla kirjallisuuskatsauksen päämääränä oli tarjota käytännöllisiä neuvoja hygienian ja puhtaanapidon kehittämiseen slummialueilla. Aineisto kerättiin käymällä läpi asiaankuuluvaa kirjallisuutta, joka koostui sekä köyhissä kaupunkilaiskeskustoissa tehdyistä tutkimuksista että kehitysmaatutkimuksista. Lisäksi kirjallisuuskatsauksessa viitattiin Yhdistyneiden Kansakuntien julkaisuihin ja kasvatukselliseen kirjallisuuteen. Tutkimustulokset osoittavat, että naisten huolenaiheet näissä ympäristöissä puhtaanapitoa ja hygieniaa koskien voidaan jakaa seitsämään osaan: käymäläkulttuuriin, vesiongelmiin, köyhyyteen, vaillinaisen puhtaanapidon aiheuttamiin ongelmiin, tartuntatauteihin, turvattomuuteen ja sukupuolten väliseen epätasa-arvoon. Sairaanhoitajien tulisi edistää hygienia- ja puhtaanapitokäytäntöjä puoltamalla paikallisia yhteisöjä, opettamalla, järjestämällä kampanjoita ja osallistumalla yhteisöjen projektinsuunnitteluun näiden asioiden taholta. Olisi suotuisaa, että sairaanhoitajat toimisivat paikallisten yhteisöjen, kirkkojen ja koulujen sisällä. Tämä kirjallisuuskatsaus tarjoaa idean julistemallille, jonka tarkoituksena olisi yhteisön omien sairaanhoitajien kautta toimia tämän ongelman lieventämiseksi naisille epäsuosiollisissa ympäristöissä

A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer

Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1–T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4–6 weeks post-treatment, and at 6 months post-treatment. Deterioration from pretreatment to 4–6 weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB

Kegiatan Pengabdian Masyarakat Pemberdayaan Masyarakat dalam Upaya Peningkatan Kesadaran untuk mengurangi risiko Penyakit Kronis di Wilayah Tengger

Suku Tengger merupakan salah satu suku yang berada di wilayah kerja Puskesmas Sukapura yang masih mempertahankan tradisi leluhur seperti perayaan adat. Pada saat perayaan tersebut, masyarakat Tengger menyajikan makanan bersantan dan tinggi lemak. Hal itu diindikasi sebagai salah satu penyebab penyakit kronis yang menyerang usia pralansia dan lansia seperti hipertensi, diabetes melitus, dan obesitas. Berdasarkan data dari puskesmas setempat, diketahui angka tersebut cukup tinggi sehingga tujuan dari kegiatan pengabdian masyarakat ini adalah untuk melakukan deteksi dini, pemeriksaan serta melakukan penyuluhan kepada warga setempat tentang masalah penyakit kronis. Kegiatan yang dilakukan antara lain analisis masalah dengan pihak puskesmas serta melakukan kerja sama, kemudian melaksanakan kegiatan berupa pemeriksaan kesehatan serta penyuluhan. Pemeriksaan dilakukan selama tiga hari untuk melakukan screening untuk memeriksa hipertensi, kadar gula darah, dan obesitas. Pasien yang ditemukan pada kondisi kronis dirujuk ke puskesmas setempat untuk dilakukan pemeriksaan lebih lanjut dan diberikan edukasi untuk melakukan pemeriksaan rutin. Kegiatan KIE (komunikasi, informasi, dan edukasi) tetap dilakukan pada masyarakat. Hasil dari kegiatan pengabdian masyarakat disusun dan dilaporkan pada pemerintah setempat