This paper presents the hardened properties of a high-performance fibre-reinforced fine-aggregate concrete extruded through a 9mm diameter nozzle to build layer-by-layer structural components in a ...printing process. The printing process is a digitally controlled additive method capable of manufacturing architectural and structural components without formwork, unlike conventional concrete construction methods. The effects of the layering process on density, compressive strength, flexural strength, tensile bond strength and drying shrinkage are presented together with the implication for mix proportions. A control concrete (mould-cast specimens) had a density of approximately 2250kg/m3, high strength (107MPa in compression, 11MPa in flexure) and 3MPa in direct tension, together with a relatively low drying shrinkage of 175μm (cured in water) and 855μm (cured in a chamber at 20°C and 60% relative humidity) at 184days. In contrast well printed concrete had a density of 2350kg/m3, compressive strength of 75–102MPa, flexural strength of 6–17MPa depending on testing direction, and tensile bond strength between layers varying from 2.3 to 0.7MPa, reducing as the printing time gap between layers increased. The well printed concrete had significantly fewer voids greater than 0.2mm diameter (1.0%) when compared with the mould-cast control (3.8%), whilst samples of poorly printed material had more voids (4.8%) mainly formed in the interstices between filaments. The additive extrusion process was thus shown to retain the intrinsic high performance of the material.
Summary Background A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. Objective ...This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. Methods The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. Results Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. Conclusion An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
Endothelial nitric oxide (NO) is generated by constitutively active endothelial nitric oxide synthase (eNOS), an essential enzyme responsible for cardiovascular homeostasis. Historically, endothelial ...NO was first recognized as a major vasodilator involved in control of vasomotor function and local blood flow. In this review, our attention is focused on the emerging role of endothelial NO in linking cerebrovascular function with cognition. We will discuss the recognized ability of endothelial NO to modulate processing of amyloid precursor protein (APP), influence functional status of microglia, and affect cognitive function. Existing evidence suggests that the loss of NO in cultured human cerebrovascular endothelium causes increased expression of APP and β-site APP-cleaving enzyme 1 (BACE1) thereby resulting in increased secretion of amyloid β peptides (Aβ1-40 and Aβ1-42). Furthermore, increased expression of APP and BACE1 as well as increased production of Aβ peptides was detected in the cerebral microvasculature and brain tissue of eNOS-deficient mice. Since Aβ peptides are considered major cytotoxic molecules responsible for the pathogenesis of Alzheimer's disease, these observations support the concept that a loss of endothelial NO might significantly contribute to the initiation and progression of cognitive decline. In addition, genetic inactivation of eNOS causes activation of microglia and promotes a pro-inflammatory phenotype in the brain. Behavioural analysis revealed that eNOS-deficient mice exhibit impaired cognitive performance thereby indicating that selective loss of endothelial NO has a detrimental effect on the function of neuronal cells. Together with findings from prior studies demonstrating the ability of endothelial NO to affect synaptic plasticity, mitochondrial biogenesis, and function of neuronal progenitor cells, it is becoming apparent that the role of endothelial NO in the control of central nervous system function is very complex. We propose that endothelial NO represents the key molecule linking cerebrovascular and neuronal function.
This paper presents the experimental results concerning the mix design and fresh properties of a high-performance fibre-reinforced fine-aggregate concrete for printing concrete. This concrete has ...been designed to be extruded through a nozzle to build layer-by-layer structural components. The printing process is a novel digitally controlled additive manufacturing method which can build architectural and structural components without formwork, unlike conventional concrete construction methods. The most critical fresh properties are shown to be extrudability and buildability, which have mutual relationships with workability and open time. These properties are significantly influenced by the mix proportions and the presence of superplasticiser, retarder, accelerator and polypropylene fibres. An optimum mix is identified and validated by the full-scale manufacture of a bench component.
Additive manufacturing in construction is beginning to move from an architect's modelling tool to delivering full-scale architectural components and elements of buildings such as walls and facades. ...This paper discusses large-scale additive manufacturing processes that have been applied in the construction and architecture arena and focuses on ‘Concrete Printing’, an automated extrusion based process. The wet properties of the material are critical to the success of manufacture and a number of new criteria have been developed to classify these process specific parameters. These criteria are introduced and key challenges that face construction scale additive manufacturing are presented.
► Built a full-scale of extrusion-based additive manufacturing (AM) machine for Freeform Construction. ► Developed a high performance concrete for Concrete Printing process. ► Created a variety of prototype parts, including the world's first reinforced concrete AM component — WonderBench.
The Randomized Aldactone Evaluation Study (RALES) showed that spironolactone reduces mortality in patients with severe heart failure; however, the drug can cause hyperkalemia, especially when given ...with angiotensin-converting–enzyme (ACE) inhibitors. The current study found that, after the publication of RALES, there was an abrupt increase in the rate of prescriptions for spironolactone and in hyperkalemia-associated morbidity and mortality in patients with heart failure who were receiving an ACE inhibitor.
The Randomized Aldactone Evaluation Study (RALES) showed reduced mortality in patients with severe heart failure. After its publication, there was an increase in hyperkalemia-associated morbidity and mortality.
Heart failure affects approximately 5 million persons annually in Canada and the United States.
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Medications are the mainstay of therapy, and in the past two decades there has been a shift away from the use of diuretics and cardiac glycosides and toward neurohumoral manipulation with angiotensin-converting–enzyme (ACE) inhibitors, beta-adrenergic antagonists, and aldosterone antagonists.
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Published in September 1999, the Randomized Aldactone Evaluation Study (RALES) demonstrated that treatment with spironolactone substantially reduced morbidity and mortality in patients with severe heart failure.
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Spironolactone is inexpensive and generally well tolerated, but in these patients it can provoke life-threatening hyperkalemia when combined with ACE inhibitors. . . .
Laser-plasma accelerators of only a centimetre's length have produced nearly monoenergetic electron bunches with energy as high as 1 GeV. Scaling these compact accelerators to multi-gigaelectronvolt ...energy would open the prospect of building X-ray free-electron lasers and linear colliders hundreds of times smaller than conventional facilities, but the 1 GeV barrier has so far proven insurmountable. Here, by applying new petawatt laser technology, we produce electron bunches with a spectrum prominently peaked at 2 GeV with only a few per cent energy spread and unprecedented sub-milliradian divergence. Petawatt pulses inject ambient plasma electrons into the laser-driven accelerator at much lower density than was previously possible, thereby overcoming the principal physical barriers to multi-gigaelectronvolt acceleration: dephasing between laser-driven wake and accelerating electrons and laser pulse erosion. Simulations indicate that with improvements in the laser-pulse focus quality, acceleration to nearly 10 GeV should be possible with the available pulse energy.
Purpose To evaluate the indications, preoperative workup outcomes, and postoperative rehabilitation of patients with femoroacetabular impingement (FAI) receiving microfracture as an adjunct to hip ...arthroscopy for chondral defects. Methods The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for studies involving patients with FAI treated arthroscopically with microfracture of the hip for chondral defects either solely or as an adjunct to hip arthroscopy. Data regarding indications, investigations, outcomes, and postoperative rehabilitation were abstracted from eligible studies. The references of included studies were additionally searched, and descriptive statistics are provided. Results There were 12 studies included in this review, involving 267 patients. With the exception of a single, one-patient case report, 11 of the 12 studies reported positive outcomes after hip arthroscopy with microfracture. Only 0.7% of the total patients experienced a complication, and 1.1% required further surgery on the basis of outcomes evaluated at a mean follow-up of 29.5 (range, 4 to 60) months across the studies. Eight of 12 studies discussed the preoperative workup of these patients, with X-rays and magnetic resonance imaging being the most common preoperative imaging used. There was little reported on weight-bearing status during postoperative rehabilitation. Conclusions The outcomes reported in the literature after hip arthroscopy with microfracture for chondral defects are, in general, positive, with a very low percentage of patients requiring further surgery or experiencing complications. The most common indication used in the literature for microfracture is a full-thickness, focal chondral defect (Outerbridge grade IV). The vast majority of literature recommends limited weight bearing after microfracture; however, there was significant variation among the specific rehabilitation protocols used. More research is needed to explore what indications and postoperative rehabilitation result in the best outcomes for patients. Level of Evidence Level IV, systematic review of Level II, III, and IV studies.
Summary Objective To characterize pain-related behavior during the course of knee osteoarthritis (OA) induced by destabilization of the medial meniscus (DMM) in wild type (WT) and in ADAMTS-5 null ...mice. Methods DMM surgery was performed in the right knee of CD-1 mice. At regular intervals up to 8 weeks after surgery, mice were assessed for the following parameters: mechanical allodynia ( via withdrawal thresholds to von Frey filaments applied to the plantar surface of both hind paws or to the tail), thermal hyperalgesia, locomotor activity and gait analysis. In addition, mechanical allodynia was tested in C57BL/6 WT or ADAMTS-5 null mice following DMM surgery. Results In CD-1 mice, a robust and progressive decrease in withdrawal threshold was observed in both hind paws after DMM but not sham surgery. Allodynia was apparent as early as 14 days postoperatively. Both sexes developed OA changes after surgery with concurrent mechanical allodynia. No other pain-related behavioral changes were detected up to 8 weeks post-surgery. In C57BL/6 mice, a genetic background in which only males develop OA changes after DMM, males but not females developed allodynia in the ipsilateral hind paw. In contrast, C57BL/6 ADAMTS-5 null mice did not develop OA changes or mechanical allodynia up to 8 weeks post-surgery. Conclusion Joint pathology following DMM surgery in mice is associated with progressive mechanical allodynia. ADAMTS-5 null mice are resistant to DMM-induced OA-like lesions and to the associated mechanical allodynia.
A randomized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors.
A total ...of 1316 grade 7 and 8 girls and boys (mean age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; the Helping, Encouraging, Listening and Protecting Peers (HELPP) initiative; or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at the 6- and 12-month follow-ups.
Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys. A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time than controls.
Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems.
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