Background
Several patient-reported outcome measures are available to monitor headache impact, but are those reliable in real-life clinical practice?
Methods
Two identical patient-reported outcome ...measures (HALT-90 and MIDAS) were applied simultaneously in each clinical visit to a series of patients treated with monoclonal antibodies for migraine and intra-individual agreement was evaluated using the intraclass correlation coefficients.
Results
Our sample included 92 patients, 92.4% females, 45 years old on average. Moderate (0.50 to 0.75) and even poor (<0.50) ICC were observed in all but the first item of these patient-reported outcome measures in at least one evaluation. Over time, missing data were more frequent and no learning effect was detected.
Discussion
We observed intra-personal variation in reliability when answering patient-reported outcome measures, persisting in repeated applications, and a decrease in the motivation to respond, which should alert clinicians for these additional challenges in real-life clinical practice.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and ...systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP. This review provides an overview of the available multifactorial scoring systems and biochemical markers for predicting severe AP with a special focus on their advantages and limitations.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of ...extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil-lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index for severity in AP (BISAP) score, showed the best predictive values. The present study enabled the identification, for the first time, of SIRI as a new prognostic tool for AP severity, and validated hepcidin and the NLR as better prognostic markers than C-reactive protein (CRP) at 48 h of symptom onset.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Acute pancreatitis (AP) is a severe disease associated with high morbidity and mortality. Clinical studies can provide some data concerning the etiology, pathophysiology, and outcomes of this ...disease. However, the study of early events and new targeted therapies cannot be performed on humans due to ethical reasons. Experimental murine models can be used in the understanding of the pancreatic inflammation, because they are able to closely mimic the main features of human AP, namely their histologic glandular changes and distant organ failure. These models continue to be important research tools for the reproduction of the etiological, environmental, and genetic factors associated with the pathogenesis of this inflammatory pathology and the exploration of novel therapeutic options. This review provides an overview of several murine models of AP. Furthermore, special focus is made on the most frequently carried out models, the protocols used, and their advantages and limitations. Finally, examples are provided of the use of these models to improve knowledge of the mechanisms involved in the pathogenesis, identify new biomarkers of severity, and develop new targeted therapies.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The aim of this study was to assess the usefulness of a new miniaturized echocardiographic system (MS) to perform bedside echocardiography in initial outpatient cardiology consultations, in addition ...to physical examination.
One hundred eighty-nine patients referred for initial cardiology outpatient consultations at two tertiary hospitals in two countries were studied. Each patient was submitted to physical examination followed by MS assessment. Scanning time, the number of examinations with abnormal results after physical examination and the MS, and the information obtained by physical examination alone and followed by the MS (in terms of its importance in reaching a diagnosis, in the necessity of performing routine echocardiography, and in the decision to release the patient from the outpatient clinic) were assessed.
The scanning time with the MS was 180 ± 86 seconds. Its use after physical examination led to diagnoses in 141 patients (74.6%) and to an additional 37 patients (19.6%) being released from the outpatient clinic. After physical examination followed by MS assessment, only 64 patients (33.9%) were sent to the echocardiography lab. The MS modified the decision of whether to send a patient to the echocardiography lab, with referral determined by the MS in 27 patients (14.3%) and no referral determined by the MS in 58 patients (30.7%).
The new MS caused a negligible increase in the duration of consultations. It showed additive clinical value over physical examination, increasing the number of diagnoses, reducing the use of unnecessary routine echocardiography, increasing the number of adequate echocardiographic studies, and determining a large number of releases from the outpatient clinic.
The production of municipal waste is increasing all over the world. Although a significant part of the waste is collected as commingled waste, much of it is recyclable if disposed of properly. Thus, ...separate deposition and collection plays an extremely important role today, more than ever, not only in terms of preventing pollution but also from the point of view of recycling as a driver of circular economy and of efficient use of resources. This work is focused on the development of compaction equipment to be applied to containers, which allows a more efficient approach to the process of collecting waste for recycling. As a management option, recycling depends on collective behavior which is based on individual acts. Therefore, individual use of plastic/metal compaction systems can help meet recycling targets, even as a complement to conventional bins. Thus, herein a proposal is presented for a plastic/metal collection station with a built-in compaction element that allows for the compacting of the separated waste, individually, in an easily accessible drawer. Sorting and compacting waste before collection will result in a reduction of the number of collection/transport stops, which will also translate into higher energy efficiency, cost savings, optimization of the transported tons/km ratio, and profitability.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The radiant floor system market is growing rapidly because Europe is moving toward a low-carbon economy and increased awareness about environmental sustainability and energy efficiency, stimulated by ...the ambitious EU Energy Efficient Directive and nZEB challenge. The high growth rate of the market share is due to the involvement of homeowners in the specifications of their living commodities, so they are thus willing to invest more at the initial stage to obtain long-term benefits and lower energy exploration costs. We performed an experimental campaign over three slabs with a hydronic radiant floor system of equal dimensions, shape, and pipe pitch with different screed mortar formulations to assess their performance throughout a heating/cooling cycle. The temperature at different heights within the interior of the screed mortars and at the surface were monitored. The results revealed that an improved screed mortar has a relevant impact on the efficiency of the system. Moreover, a three-dimensional transient heat transfer model was validated using the experimental data. The model was used to evaluate the impact of different finishing materials, namely wood, cork, ceramic, and linoleum, on the floor surface temperatures. The results showed differences of 15% in the surface temperature when using different floor finishing solutions.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
This paper describes the implementation and assessment of the predictive performance of a two dimensional mixed-mode fracture smeared crack model (MMFSCM) in a finite element method (FEM) based ...software. The referred constitutive model is based on the integration of the aggregate interlock and fibre pullout resisting mechanisms to simulate the behaviour of Fibre Reinforced Concrete (FRC) in both fracture mode I and II. The models used to simulate the contribution of each resisting mechanism predict the normal and shear stresses at the crack level based on the crack opening and sliding displacements. For this purpose, two aggregate interlock models and three fibre pullout models are used. The appraisal of this approach is conducted by simulating two numerical case studies consisting of a three-point notched beam bending test (3PNBBT) for assessing the structural behaviour in mode I, and shear panel tests to appraise the predictive performance of the model in mode II. In addition, modifications to the original formulation of the fibre pullout models are proposed, and a multi-linear branch model is also developed and implemented in order to facilitate the use of inverse analysis tools for defining the mode I behaviour. The numerical simulations have predicted with good accuracy the experimental responses, both in mode I and mode II, capturing not only the peak loads but also the evolution trend of the post-peak responses of the analysed scenarios. The modifications proposed to the fibre pullout models enhanced the overall predictive performance of the MMFSCM. The multi-linear branch model exhibited excellent performance, capturing the experimental response with very good accuracy in all 3PNBBT simulations.
•Two-dimensional integrated mixed-mode smeared crack model for simulating FRC.•Aggregate interlock and fibre pullout models used to simulate the fracture process of FRC.•Implementation of the proposed constitutive model in a FEM based software.•Improvements were implemented in the fibre pullout models for increasing their predictive performance.•The good predictive performance of the MMFSCM is demonstrated by using experimental data.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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•Combining SSFRC and SHFRC are explored for the strengthening of tunnels.•A layered curved shell model is adopted in the FEM.•The proposed approach was implemented for a typical ...Portuguese underground tunnel.•A significant reduction of consumed materials was achieved.
Strengthening and rehabilitation of underground tunnels are frequently an inseparable part of upgrading the railway network. Short fibres have been replacing pre-installed steel mesh with technical and economic advantages on the stabilization and securing of rock and soil systems in underground tunnels through the fibre reinforced shotcrete (FRS) technology. The strengthening efficiency of this technology can be even increased by shotcreting suitable arrangements of strain-softening and strain-hardening fibre reinforced concrete (SSFRC and SHFRC), despite requiring technological developments in terms of mix compositions and shotcrete equipment. The potential of combining SSFRC and SHFRC for the strengthening of underground tunnels is explored in this paper through numerical simulations based on the finite element method. The predictive performance of the adopted material nonlinear constitutive models is initially validated by simulating experimental tests where SSFRC and SHFRC were used for the strengthening of masonry elements or for the prefabrication of tunnel segments. By using a layered curved shell model, the potential of various strengthening configurations is assessed for a typical Portuguese underground tunnel by demonstrating the gains in terms of stiffness and load carrying capacity when proper use of SSFRC and SHFRC is adopted. It is revealed that, by using a shotcrete technology capable of placing SSFRC and SHFRC in layers according to the outputs of advanced numerical analysis, an efficient strengthening system with a significant reduction of consumed materials can be achieved.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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