Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments

Objectives The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs). Methods A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set, and; 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria. Results At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors, and; 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment. Conclusions This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.

An MRI study of pituitary volume and parasuicidal behavior in teenagers with first-presentation borderline personality disorder

This structural magnetic resonance imaging study examined the relationship between pituitary gland volume (PGV) and lifetime number of parasuicidal behaviors in a first-presentation, teenage borderline personality disorder (BPD) sample with minimal exposure to treatment. Hierarchical regression analysis revealed that age and number of parasuicidal behaviors were significant predictors of PGV. These findings indicate that parasuicidal behavior in BPD might be associated with greater activation of the hypothalamic-pituitary-adrenal (HPA) axis. Further studies are required using direct neuroendocrine measures and exploring other parameters of self-injurious behavior, such as recency of self-injurious behavior, intent to die and medical threat.

Mechanical behavior of circular and square concrete filled steel tube stub columns under local compression

This paper presents a combined experimental and numerical study on the behaviour of both circular and square concrete-filled steel tube (CFT) stub columns under local compression. Twelve circular and eight square CFT stub columns were tested to study their bearing capacity and the key influential parameters. A 3D finite element model was established for simulation and parametric study to investigate the structural behaviour of the stub columns. The numerical results agreed well with the experimental results. In addition, analytical formulas were proposed to calculate the load bearing capacity of CFT stub columns under local compression.

Computer analysis of impact behavior of concrete filled steel tube columns

This paper presents a numerical study of the response of axially loaded concrete filled steel tube (CFST) columns under lateral impact loading using explicit non-linear finite element techniques. The aims of this paper are to evaluate the vulnerability of existing columns to credible impact events as well as to contribute new information towards the safe design of such vulnerable columns. The model incorporates concrete confinement, strain rate effects of steel and concrete, contact between the steel tube and concrete and dynamic relaxation for pre-loading, which is a relatively recent method for applying a pre-loading in the explicit solver. The finite element model was first verified by comparing results with existing experimental results and then employed to conduct a parametric sensitivity analysis. The effects of various structural and load parameters on the impact response of the CFST column were evaluated to identify the key controlling factors. Overall, the major parameters which influence the impact response of the column are the steel tube thickness to diameter ratio, the slenderness ratio and the impact velocity. The findings of this study will enhance the current state of knowledge in this area and can serve as a benchmark reference for future analysis and design of CFST columns under lateral impact.

Nonlinear analysis for the pre- and post-yield behaviour of a hybrid structure by a higher-order element with the refined plastic hinge approach

Efficient and accurate geometric and material nonlinear analysis of the structures under ultimate loads is a backbone to the success of integrated analysis and design, performance-based design approach and progressive collapse analysis. This paper presents the advanced computational technique of a higher-order element formulation with the refined plastic hinge approach which can evaluate the concrete and steel-concrete structure prone to the nonlinear material effects (i.e. gradual yielding, full plasticity, strain-hardening effect when subjected to the interaction between axial and bending actions, and load redistribution) as well as the nonlinear geometric effects (i.e. second-order P-d effect and P-D effect, its associate strength and stiffness degradation). Further, this paper also presents the cross-section analysis useful to formulate the refined plastic hinge approach.

Influence of structural sealant joints on the blast performance of laminated glass panels

This paper investigates the influence of structural sealant joints on the blast performance of laminated glass (LG) panels, using a comprehensive numerical procedure. A parametric study was carried out by varying the width, thickness and the Young’s modulus (E) of the structural silicone sealant joints and the behavior of the LG panel was studied under two different blast loads. Results show that these parameters influence the blast response of LG panels, especially under the higher blast load. Sealant joints that are thicker, have smaller widths and lower E values increase the flexibility at the supports and hence increase the energy absorption of the LG panel while reducing the support reactions. Results also confirmed that sealant joints designed according to current standards perform well under blast loads. Modeling techniques presented in this paper could be used to complement and supplement the guidance in existing design standards. The new information generated in this paper will contribute towards safer and more economical designs of entire facade systems including window glazing, frames and supporting structures.

A thorough investigation of the interdependent behavior of prestressed system

Due to the existing of many prestressed members in the structural system, the interdependent behavior of all prestressed members is the main concern in the analysis of the pretension process. A thorough investigation of this mutual effect is essential for an effective, reliable, and optimal analysis. Focus on this aspect, this paper presents an investigation of the interdependent behavior of all prestressed members in the whole structural system based on influence matrix (IFM). Four different types of IFM are introduced. Two different solving methods are brought forth to analyze the pretension process. The direct solving method solves for the accurate solution, whereas the iterative solving method repeatedly amends to achieve an approximate solution. A numerical example is then conducted. The result shows that various kinds of complicated batched and repeated tensioning schemes can be analyzed reliably, effectively, and completely based on IFM.

Performance of soft-hard-soft (SHS) cement based composite subjected to blast loading with consideration of interface properties

This paper presents a combined experimental and numerical study on the damage and performance of a soft-hard-soft (SHS) multi-layer cement based composite subjected to blast loading which can be used for protective structures and infrastructures to resist extreme loadings, and the composite consists of three layers of construction materials including asphalt concrete (AC) on the top, high strength concrete (HSC) in the middle, and engineered cementitious composites (ECC) at the bottom. To better characterize the material properties under dynamic loading, interface properties of the composite were investigated through direct shear test and also used to validate the interface model. Strain rate effects of the asphalt concrete were also studied and both compressive and tensile dynamic increase factor (DIF) curves were improved based on split Hopkinson pressure bar (SHPB) test. A full-scale field blast test investigated the blast behavior of the composite materials. The numerical model was established by taking into account the strain rate effect of all concrete materials. Furthermore, the interface properties were also considered into the model. The numerical simulation using nonlinear finite element software LS-DYNA agrees closely with the experimental data. Both the numerical and field blast test indicated that the SHS composite exhibited high resistance against blast loading.

Structural and lithium ion transport studies in sol-gel-prepared lithium silicophosphate glasses

Lithium silicophosphate glasses have been prepared by a sol-gel route over a wide range of compositions. Their structural and electrical properties have been investigated. Infrared spectroscopic studies show the presence of hydroxyl groups attached to Si and P. MAS NMR investigations provide evidence for the presence of different phosphatic units in the structure. The variations of de conductivities at 423 K and activation energies have been studied as a function of composition, and both exhibit an increasing trend with the ratio of nonbridging oxygen to bridging oxygen in the structure. Ac conductivity behavior shows that the power law exponent, s, is temperature dependent and exhibits a minimum. Relaxation behavior has been examined in detail using an electrical modulus formalism, and modulus data were fitted to Kohlraush-William-Watts stretched exponential function. A structural model has been proposed and the unusual properties exhibited by this unique system of glasses have been rationalized using this model. Ion transport in these glasses appears to be confined to unidimensional conduits defined by modified phosphate chains and interspersed with unmodified silica units.

Structural and optical investigation of semiconductor CdSe/CdS core-shell quantum dot thin films

Highly luminescent CdSe/CdS core-shell nanocrystals have been assembled on indium tin oxide (ITO) coated glass substrates using a wet synthesis route. The physical properties of the quantum dots (QD) have been investigated using X-ray diffraction, transmission electron microscopy and optical absorption spectroscopy techniques. These quantum dots showed a strong enhancement in the near band edge absorption. The in situ luminescence behavior has been interpreted in the light of the quantum confinement effect and induced strain in the core-shell structure.

In search of inorganic nonlinear optical materials for second harmonic generation

In a search for inorganic oxide materials showing second-order nonlinear optical (NLO) susceptibility, we investigated several berates, silicates, and a phosphate containing trans-connected MO6, octahedral chains or MO5 square pyramids, where, M = d(0): Ti(IV), Nb(V), or Ta(V), Our investigations identified two new NLO structures: batisite, Na2Ba(TiO)(2)Si4O12, containing trans-connected TiO5 octahedral chains, and fresnoite, Ba2TiOSi2O7, containing square-pyramidal TiO5. Investigation of two other materials containing square-pyramidal TiO5 viz,, Cs2TiOP2O7 and Na4Ti2Si8O22. 4H(2)O, revealed that isolated TiO5, square pyramids alone do not cause a second harmonic generation (SHG) response; rather, the orientation of TiO5 units to produce -Ti-O-Ti-O- chains with alternating long and short Ti-O distances in the fresnoite structure is most likely the origin of a strong SHG response in fresnoite,

Hybrid structural control using magnetorheological dampers for base isolated structures

In this paper two nonlinear model based control algorithms have been developed to monitor the magnetorheological (MR) damper voltage. The main advantage of the proposed algorithms is that it is possible to directly monitor the voltage required to control the structural vibration considering the effect of the supplied and commanded voltage dynamics of the damper. The efficiency of the proposed techniques has been shown and compared taking an example of a base isolated three-storey building under a set of seismic excitations. Comparison of the performances with a fuzzy based intelligent control algorithm and a widely used clipped optimal strategy has also been shown.

A multiscale study on the structural and mechanical properties of the luffa sponge from Luffa cylindrica plant

Cellular materials that are often observed in biological systems exhibit excellent mechanical properties at remarkably low densities. Luffa sponge is one of such materials with a complex interconnecting porous structure. In this paper, we studied the relationship between its structural and mechanical properties at different levels of its hierarchical organization from a single fiber to a segment of whole sponge. The tensile mechanical behaviors of three single fibers were examined by an Instron testing machine and the ultrastructure of a fractured single fiber was observed in a scanning electronic microscope. Moreover, the compressive mechanical behaviors of the foam-like blocks from different locations of the sponge were examined. The difference of the compressive stress-strain responses of four sets of segmental samples were also compared. The result shows that the single fiber is a porous composite material mainly consisting of cellulose fibrils and lignin/hemicellulose matrix, and its Young's modulus and strength are comparable to wood. The mechanical behavior of the block samples from the hoop wall is superior to that from the core part. Furthermore, it shows that the influence of the inner surface on the mechanical property of the segmental sample is stronger than that of the core part; in particular, the former's Young's modulus, strength and strain energy absorbed are about 1.6 times higher. The present work can improve our understanding of the structure-function relationship of the natural material, which may inspire fabrication of new biomimetic foams with desirable mechanical efficiency for further applications in anti-crushing devices and super-light sandwich panels.

Study on tracheal collapsibility, compliance, and stress by considering nonlinear mechanical property of cartilage

Tracheal cartilage has been widely regarded as a linear elastic material either in experimental studies or in analytic and numerical models. However, it has been recently demonstrated that, like other fiber-oriented biological tissues, tracheal cartilage is a nonlinear material, which displays higher strength in compression than in extension. Considering the nonlinearity requires a more complex theoretical frame work and costs more to simulate. This study aims to quantify the deviation due to the simplified treatment of the tracheal cartilage as a linear material. It also evaluates the improved accuracy gained by considering the nonlinearity. Pig tracheal rings were used to exam the mechanical properties of cartilage and muscular membrane. By taking into account the asymmetric shape of tracheal cartilage, the collapse behavior of complete rings was simulated, and the compliance of airway and stress in the muscular membrane were discussed. The results obtained were compared with those assuming linear mechanical properties. The following results were found: (1) Models based on both types of material properties give a small difference in representing collapse behavior; (2) regarding compliance, the relative difference is big, ranging from 10 to 40% under negative pressure conditions; and (3) the difference in determining stress in the muscular membrane is small too: <5%. In conclusion, treating tracheal cartilage as a linear material will not cause big deviations in representing the collapse behavior, and mechanical stress in the muscular part, but it will induce a big deviation in predicting the compliance, particularly when the transmural pressure is lower than -0.5 kPa. The results obtained in this study may be useful in both understanding the collapse behavior of trachea and in evaluating the error induced by the simplification of treating the tracheal cartilage as a linear elastic material.

Influence of non-stoichiometric defects on nonlinear absorption and refraction in Nd:Zn co-doped lithium niobate

Nonlinear absorption and refraction phenomena in stoichiometric lithium niobate (SLN) pure and co-doped with Zn and Nd, and congruent lithium niobate (CLN) were investigated using Z-scan technique. Femtosecond laser pulses from Ti:Sapphire laser (800 nm, 110 fs pulse width and 1 kHz repetition rate) were utilized for the experiment. The process responsible for nonlinear behavior of the samples was identified to be three photon absorption (3PA). This is in agreement with the band gap energies of the samples obtained from the linear absorption cut off and the slope of the plot of Ln(1 − TOA) vs. Ln(I0) using Sutherland’s theory (s = 2.1, for 3PA). The nonlinear refractive index (n2) of Zn doped samples was found to be lower than that of pure samples. Our experiments show that there exists a correlation between the nonlinear properties and the stoichiometry of the samples. The values of n2 fall into the same range as those obtained for the materials of similar band gap.