The performance of three advanced constitutive models has been evaluated based on element tests and on a comparative study on the simulation of vibratory pile driving tests in saturated sand. The ...inspected constitutive models are the Sanisand model and Hypoplasticity with Intergranular Strain (Hypo+IGS) as well as with Intergranular Strain Anisotropy (Hypo+ISA) extension. The performance of the constitutive models is first evaluated by the simulation of element tests used for the parameter calibration of the sand used in the model tests. The constitutive models are then applied for the simulation of a vibratory pile driving test. The pile penetration, the driving force, the pore water pressure development and the incremental displacement in the vicinity of the pile tip are compared to the measurements in the model tests. The strengths and weaknesses of the different constitutive models are assessed. Generally, the model predictions showed good agreement with the experimental results. Despite different constitutive formulations (hypoplastic vs. elasto-plastic), all three models were able to reproduce the main mechanisms of the driving process properly. It may be concluded that all three models allow a proper prediction of vibratory pile driving as long as a proper calibration of the material parameters is secured.
The urticaria activity score (UAS) is the gold standard for assessing disease activity in patients with chronic spontaneous urticaria (CSU). Two different versions, the UAS7 and UAS7TD, are currently ...used in clinical trials and routine care. To compare both versions and to obtain data on their interpretability, 130 CSU patients applied both versions and globally rated their disease activity as none, mild, moderate, or severe. UAS7 and UAS7TD values correlated strongly (r = .90, P < .001). Interquartile ranges for UAS7 and UAS7TD values for mild, moderate, and severe CSU were 11‐20 and 10‐24, 16‐30 and 16‐32, and 27‐37 and 28‐40. UAS7 values were slightly, but significantly lower as compared to UAS7TD values (mean difference: 1.6 ± 4.6, P < .001). This difference was driven by lower wheal subscores (2.1 ± 3.5, P < .001) and was most pronounced in patients with severe CSU (2.5 ± 5.6, P < .01). The UAS7/UAS7TD ratio was 0.96 ± 0.21 and did not differ significantly between mild, moderate, and severe CSU. Since the results of both UAS versions are comparable, we recommend the use of the UAS7, which is less burdensome in administration and scoring.
This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference ...held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Summary
Background
Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient ...characteristics and the burden of CSU in routine clinical practice. AWARE (A World‐wide Antihistamine‐Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real‐life setting.
Objective
To describe the baseline characteristics of the first 1539 German AWARE patients with H1‐antihistamine‐refractory CSU.
Methods
This prospective non‐interventional study included patients (18–75 years) with a diagnosis of H1‐antihistamine‐refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU‐Q2oL), and angioedema QoL questionnaire (AE‐QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively.
Results
Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m2, respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second‐generation H1‐antihistamines (46.3%), first‐generation H1‐antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU‐Q2oL, and total AE‐QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%).
Conclusions and Clinical Relevance
This study reveals that German H1‐antihistamine‐refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.
The high‐cycle accumulation (HCA) model by Niemunis et al. allows the prediction of the mechanical response of sand under millions of load cycles . It has originally been developed with focus on sand ...under drained high‐cyclic loading assuming a constant strain amplitude, which can be periodically updated. In order to apply it for partially drained or fully undrained conditions, an adaptive definition of the strain amplitude is proposed in this work. The proposed extension allows taking into account the influence of rapid changes in soil stiffness on the strain amplitude as encountered, for example, in case of large changes in effective stress during the high‐cyclic loading. Two approaches are presented for the update of the strain amplitude: a ‘private’ update in each integration point combined with a nonlocal smoothing algorithm and an update in a separate analysis performed parallel to the simulation using the HCA model. Both approaches are compared to the methodology used in previous work employing so‐called update cycles. The importance and advantages of the proposed modifications are demonstrated by the simulation of undrained cyclic triaxial tests and monopile foundations for offshore wind turbines (OWTs) under high‐cyclic lateral loading and partially drained conditions.
This guideline, together with its sister guideline on the management of urticaria Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA²LEN/EDF/WAO ...Guideline: Management of urticaria. Allergy, 2009; 64:1427-1443 is the result of a consensus reached during a panel discussion at the 3rd International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). Urticaria is a frequent disease. The life-time prevalence for any subtype of urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors, and pathomechanisms. In addition, it outlines evidence-based diagnostic approaches for different subtypes of urticaria. The correct management of urticaria, which is of paramount importance for patients, is very complex and is consequently covered in a separate guideline developed during the same consensus meeting. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
The back-analysis of model tests on piles subjected to high-cyclic lateral loading using the high-cycle accumulation (HCA) model is presented. The installation of the pile prior to the lateral ...loading is taken into account using a Coupled-Eulerian–Lagrangian method. A comparison between the measured pile rotation and the results of simulations with incorporation of the installation-induced soil changes as well as simulations assuming wished-in-place initial conditions is made. A distinct influence of the installation process on the lateral response of the pile is observed. The installed piles exhibit larger resistance and less accumulation of deformation during the cyclic loading. The simulations taking into account the installation process are in better accordance with the measurements in the model tests compared to the wished-in-place simulations. It is concluded that the consideration of the installation process in a back-analysis of driven piles subjected to monotonic or cyclic loading is of great importance.
Background
Chronic spontaneous urticaria (CsU) is a frequent dermatological disease that might last for months or years with high impact on quality of life. Known causes are autoreactive phenomena, ...infections or intolerances, rarely IgE‐mediated allergies. One‐third of CsU patients benefit from a low‐pseudoallergen diet. Additionally, it is often discussed, that reducing histamine ingestion alone might improve clinical symptoms and quality of life in CsU patients despite the uncertain role of the histamine‐degrading enzyme diamine oxidase (DAO).
Objective
Aim of this study was to investigate the impact of low‐histamine diet on symptoms and quality of life in patients with CsU.
Methods
Patients suffering from CsU accompanied by gastrointestinal symptoms were included in the study. They underwent low‐histamine diet for at least 3 weeks. During the whole study, urticaria activity score (UAS) was recorded daily in a patient′s diary. Quality of life was assessed during screening, baseline and post diet visits by completing questionnaires (DLQI and Cu‐Q(2)oL). DAO activity was measured before and after elimination diet.
Results
A total of 75% of the patients had a benefit from the low‐histamine diet. Thirty‐four of 56 patients (61%) reached the primary endpoint of the study, an improvement of UAS 4 of ≥3. Overall, a significant reduction from 9.05 to 4.23 points (P = 0.004) was achieved; the average reduction in a strongly affected subgroup was 8.59 points (P < 0.001). DAO activity remained stable.
Conclusion
Low‐histamine diet is a therapeutically useful, simple and cost‐free tool to decrease symptoms and increase quality of life in CsU patients with gastrointestinal involvement. Further research is needed to understand the role of diamine oxidase.
Summary
Background
Cholinergic urticaria (CholU), a common form of chronic inducible urticaria, is characterized by itchy weals that occur in response to physical exercise or passive warming. CholU ...patients frequently exhibit a high burden of disease. As of yet, no specific instrument is available to assess their disease‐related quality‐of‐life (QoL) impairment.
Objective
The aim of this study was to develop and validate the first disease‐specific QoL instrument for CholU patients, the Cholinergic Urticaria Quality‐of‐Life Questionnaire (CholU‐QoL).
Methods
Using a combined approach of the literature search, semistructured patient interviews and expert opinion, we developed 96 potential CholU‐QoL items. Subsequent item selection was performed by means of impact analysis complemented by an expert review for face validity. The resulting final CholU‐QoL was then tested for levels of validity, reliability and influence factors in 88 CholU patients. In parallel, an US American‐Canadian English version of the CholU‐QoL was developed.
Results
The final 28‐item CholU‐QoL was found to have a 5‐domain structure (“symptoms,” “functional life,” “social interaction,” “therapy,” “emotions”) with excellent internal consistency. The CholU‐QoL also showed a valid total score, and good levels of convergent validity, known‐groups validity, as well as test‐retest reliability. Multiple regression analysis found no significant drivers of the CholU‐QoL total score.
Conclusions and Clinical Relevance
The CholU‐QoL is the first disease‐specific QoL instrument for CholU and also the first specific QoL measure in the field of chronic inducible urticarias. It may serve as a valuable tool for clinical trials and improve routine patient management.
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