• Acute and Critical Care
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• v.33 no.4
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• pp.238-245
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• 2018

Background: Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes. Methods: Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured. Results: A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days). Conclusions: Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.

• Acute and Critical Care
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• v.33 no.4
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• pp.252-259
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• 2018

Background: The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward. Methods: In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU. Results: The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time ($26.7{\pm}25.1$ vs. $12.1{\pm}16.0days$, P=0.003), length of stay in the general ward ($70.6{\pm}89.1$ vs. $40.5{\pm}42.2days$, P=0.008), length of total hospital stay ($107.5{\pm}95.6$ vs. $74.7{\pm}51.2days$, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions: Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct T-cannula.

• Acute and Critical Care
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• v.33 no.4
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• pp.260-268
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• 2018

Background: The purpose of this study was to evaluate the clinical application of modified Burns Wean Assessment Program (m-BWAP) scoring at first spontaneous breathing trial (SBT) as a predictor of successful liberation from mechanical ventilation (MV) in patients with endotracheal intubation. Methods: Patients requiring MV for more than 72 hours and undergoing more than one SBT in a medical intensive care unit (ICU) were prospectively enrolled over a 3-year period. The m-BWAP score at first SBT was obtained by a critical care nursing practitioner. Results: A total of 103 subjects were included in this study. Their median age was 69 years (range, 22 to 87 years) and 72 subjects (69.9%) were male. The median duration from admission to first SBT was 5 days (range, 3 to 26 days), and the rate of final successful liberation from MV was 84.5% (n=87). In the total group of patients, the successful liberation from MV group at first SBT (n=65) had significantly higher m-BWAP scores than did the unsuccessful group (median, 60; range, 43 to 80 vs. median, 53; range, 33 to 70; P<0.001). Also, the area under the m-BWAP curve for predicting successful liberation of MV was 0.748 (95% confidence interval, 0.650 to 0.847), while the cutoff value based on Youden's index was 53 (sensitivity, 76%; specificity, 64%). Conclusions: The present data show that the m-BWAP score represents a good predictor of weaning success in patients with an endotracheal tube in place at first SBT.

• Acute and Critical Care
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• v.33 no.4
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• pp.276-279
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• 2018

In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an $i-gel^{(R)}$ (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an $i-gel^{(R)}$. However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.

• Advances in concrete construction
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• v.7 no.2
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• pp.117-126
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• 2019

When designing reinforced concrete (RC) members, the rebar is assumed to resist all tensile forces, but the resistance of the concrete in the tension area is neglected. However, concrete can also resist tensile forces and increase the tensile stiffness of RC members, which is called the tension stiffening effect (TSE). Therefore, this study assessed the TSE, particularly after yielding of the steel bars and the effects of the steel ratio on the TSE. For this purpose, RC member specimens with steel ratios of 2.87%, 0.99%, and 0.59% were fabricated for uniaxial tensile tests. A vision-based non-contact measurement system was used to measure the behavior of the specimens. The cracks on the specimen at the stabilized cracking stage and the fracture stage were measured with the image analysis method. The results show that the number of cracks increases as the steel ratio increases. The reductions of the limit state and fracture strains were dependent on the ratio of the rebar. As the steel ratio decreased, the strain after yielding of the RC members significantly decreased. Therefore, the overall ductility of the RC member is reduced with decreasing steel ratio. The yielding plateau and ultimate load of the RC members obtained from the proposed equations showed very good agreement with those of the experiments. Finally, the image analysis method was possible to allow flexibility in expand the measurement points and targets to determine the strains and crack widths of the specimens.

• Advances in concrete construction
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• v.6 no.6
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• pp.561-583
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• 2018

A variety of polycarboxylate ether (PCE)-based superplasticizers are commercially available. Their influence on the rheological retention and slump loss in respect of concrete differ considerably. Fluidity and slump loss are the cardinal features responsible for the quality of concrete. These are related to the dispersion of cement particles and the hydration process which are greatly influenced by type of polycarboxylate ether (PCE)-based superplasticizers. On the backdrop of relatively less studies in the context of rheological retention of high strength self-consolidating concrete (HS-SCC), the experimental investigations were carried out aiming at quantifying the effect of the six different PCE polymers (PCE 1-6) on the rheological retention of HS-SCC mixes containing two types of Ordinary Portland Cements (OPC) and unwashed crushed sand as the fine aggregate. The tests that were carried out included $T_{500}$, V-Funnel, yield stress and viscosity retention tests. The supplementary cementitious materials such as fly ash (FA) and micro-silica (MS) were also used in ternary blend keeping the mix paste volume and flow of concrete constant. Low water to binder ratio was used. The results reveal that not only the PCEs of different polymer groups behave differently, but even the PCEs of same polymer groups also behave differently. The study also indicates that the HS-SCC mixes containing PCE 6 and PCE 5 performed better as compared to the mixes containing PCE 1, PCE 2, PCE 3 and PCE 4 in respect of all the rheological tests. The PCE 6 is a new class of chemical admixtures known as Polyaryl Ether (PAE) developed by BASF to provide better rheological properties in even in HS-SCC mixes at low water to binder mix. In the present study, the PCE 6, is found to help not only in reduction in the plastic viscosity and yield stress, but also provide good rheological retention over the period of 180 minutes. Further, the early compressive strength properties (one day compressive strength) highly depend on the type of PCE polymer. The side chain length of PCE polymer and the fineness of the cement considerably affect the early strength gain.

• Advances in concrete construction
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• v.6 no.6
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• pp.645-658
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• 2018

Despite being one of the most abundantly used construction materials because of its exceptional properties, concrete is susceptible to deterioration and damage due to various factors particularly corrosion, improper loading, poor workmanship and design discrepancies, and as a result concrete structures require retrofitting and strengthening. In recent times, Fiber Reinforced Polymer (FRP) composites have substituted the conventional techniques of retrofitting and strengthening of damaged concrete. Most of the research studies related to concrete strengthening using FRP have been performed on undamaged test specimens. This contribution presents the results of an experimental study in which concrete specimens were damaged by mechanical loading and elevated temperature in laboratory prior to application of Carbon Fiber Reinforced Polymer (CFRP) sheets for strengthening. The test specimens prepared using concrete of target compressive strength of 28 MPa at 28 days were subjected to compressive and splitting tensile testing up to failure and the intact pieces of the failed specimens were collected for the purpose of repair. In order to induce damage as a result of elevated temperature, the concrete cylinders were subjected to $400^{\circ}C$ and $800^{\circ}C$ temperature for two hours duration. Concrete cylinders damaged under compressive and split tensile loads were re-cast using concrete and rich cement-sand mortar, respectively and then strengthened using CFRP wrap. Concrete cylinders damaged due to elevated temperature were also strengthened using CFRP wrap. Re-cast and strengthened concrete cylinders were tested in compression and splitting tension. The obtained results revealed that re-casting of specimens damaged by mechanical loadings using concrete & mortar, and then strengthened by single layer CFRP wrap exhibited strength even higher than their original values. In case of specimens damaged by elevated temperature, the results indicated that concrete strength is significantly dropped and strengthening using CFRP wrap made it possible to not only recover the lost strength but also resulted in concrete strength greater than the original value.

• Advances in concrete construction
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• v.8 no.1
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• pp.65-76
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• 2019

This paper investigates the effect of recycled glass powder (RGP) on flowing properties of self-compacting mortars (SCMs) containing different ratios of fillers and superplasticizer dosages. Fly ash (FA), nano-silica (NS), micro-silica (MS), metakaolin (MK) and rice husk ash (RHA) are used as fillers and their synergistic effect with RFP is studied. The effects of fillers and high-range water reducer (HRWR) on flowing ability of mortars are primarily determined by slump flow and V-funnel flow time tests. The results showed that for composites with a higher RGP content, the mortar flowing ability increased but tended to decrease when the composites containing 10% MK or 5% RHA. However, the flowing ability of samples incorporating 5% RGP and 10% SF or 25% FA showed an opposite result that their slump flow spread decreased and then increased with increasing RGP content. For specimens with 3% NS, the influence of RGP content on flowing properties was not significant. Except RHA and MS, the fillers studied in this paper could reduce the dosage of HRWR required for achieving the same followability. Also, the mixture parameters were determined and indicated that the flowability of mixtures was also affected by the content of sand and specific surface area of cement materials. It is believed that excess fine particles provided ball-bearing effect, which could facilitate the movement of coarse particles and alleviate the interlocking action among particles. Also, it can be concluded that using fillers in conjunction with RGP as cementitious materials can reduce the material costs of SCM significantly.

• Advances in concrete construction
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• v.8 no.1
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• pp.21-31
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• 2019

The rich recipe of ultra high performance concrete (UHPC) offers the higher mechanical, durability and dense microstructure property. The variable like cement/sand ratio, amount of supplementary cementitious material, water/binder ratio, amount of fiber etc. alters the UHPC hardened properties to any extent. Therefore, to understand the effects of these variables on the performance of UHPC, inevitably a stage-wise development is required. In the present experimental study, the effect of sand/cement ratio, the addition of finer material (fly ash and quartz powder) and, hybrid fiber on the fresh, compressive and microstructural property of UHPC is evaluated. The experiment is conducted in three phases; the first phase evaluates the flow value and strength attainment of ingredients, the second phase evaluates the efficiency of finer materials (fly ash and quartz powder) to develop the UHPC and the third phase evaluate the effect of hybrid fiber on the flow value and strength of ultra high performance hybrid fiber reinforced concrete (UHP-HFRC). It has been seen that the addition of fly ash improves the flow value and compressive strength of UHPC as compared to quartz powder. Further, the usage of hybrid fiber in fly ash contained matrix decreases the flow value and improves the strength of the UHP-HFRC matrix. The dense interface between matrix and fiber and, a higher amount of calcium silicate hydrate (CSH) in fly ash contained UHP-HFRC is revealed by SEM and XRD respectively. The dense interface (bond between the fiber and the UHPC matrix) and the higher CSH formation are the reason for the improvement in the compressive strength of fly ash based UHP-HFRC. The differential thermal analysis (DTA/TGA) shows the similar type of mass loss pattern, however, the amount of mass loss differs in fly ash and quartz powder contained UHP-HFRC.

• Advances in concrete construction
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• v.7 no.3
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• pp.151-166
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• 2019

This paper introduces a new efficient analytical method, based on shear deformations obtained with 2D elasticity theory approach, to perform an explicit closed-form solution for calculation the interfacial shear and normal stresses in plated RC beam. The materials of plate, necessary for the reinforcement of the beam, are in general made with fiber reinforced polymers (Carbon or Glass) or steel. The experimental tests showed that at the ends of the plate, high shear and normal stresses are developed, consequently a debonding phenomenon at this position produce a sudden failure of the soffit plate. The interfacial stresses play a significant role in understanding this premature debonding failure of such repaired structures. In order to efficiently model the calculation of the interfacial stresses we have integrated the effect of shear deformations using the equilibrium equations of the elasticity. The approach of this method includes stress-strain and strain-displacement relationships for the adhesive and adherends. The use of the stresses continuity conditions at interfaces between the adhesive and adherents, results pair of second-order and fourth-order coupled ordinary differential equations. The analytical solution for this coupled differential equations give new explicit closed-form solution including shear deformations effects. This new solution is indented for applications of all plated beam. Finally, numerical results obtained with this method are in agreement of the existing solutions and the experimental results.