The seismic assessment of unreinforced masonry (URM) buildings with cavity walls is of high relevance in regions such as in Central and Northern Europe, Australia, New Zealand and China because of the characteristics of the masonry building stock. A cavity wall consists of two separate parallel walls usually connected by metal ties. Cavity walls are particularly vulnerable to earthquakes, as the out-of-plane capacity of each individual leaf is significantly smaller than the one of an equivalent solid wall. This paper presents the results of an experimental campaign conducted by the authors on metal wall tie connections and proposes a mechanical model to predict the cyclic behaviour of these connections. The model has been calibrated by us- ing the experimental results in terms of observed failure modes and force-displacement responses. Results are also presented in statistical format.
DOCUMENT
Currently the advances in the field of 3D printing are causing a revolution in the (bio-)medical field. With applications ranging from patient-specific anatomical models for surgical preparation to prosthetic limbs and even scaffolds for tissue engineering, the possibilities seem endless. Today, the most widely used method is FDM printing. However, there is still a limited range of biodegradable and biocompatible materials available. Moreover, printed implants like for instance cardiovascular stents require higher resolution than is possible to reach with FDM. High resolution is crucial to avoid e.g. bacterial growth and aid to mechanical strength of the implant. For this reason, it would be interesting to consider stereolithography as alternative to FDM for applications in the (bio-) medical field. Stereolithography uses photopolymerizable resins to make high resolution prints. Because the amount of commercially available resins is limited and hardly biocompatible, here we investigate the possibility of using acrylates and vinylesters in an effort to expand the existing arsenal of biocompatible resins. Mechanical properties are tailorable by varying the crosslink density and by varying the spacer length. To facilitate rapid production of high-resolution prints we use masked SLA (mSLA) as an alternative to conventional SLA. mSLA cures an entire layer at a time and therefore uses less time to complete a print than conventional SLA. Additionally, with mSLA it takes the same time to make 10 prints as it would to make only one. Several formulations were prepared and tested for printability and mechanical strength.
MULTIFILE
OBJECTIVES:The purpose of the current study was to compare the results of a progressive strength training protocol for soccer players after anterior cruciate ligament reconstruction (ACLR) with healthy controls, and to investigate the effects of the strength training protocol on peak quadriceps and hamstring muscle strength. DESIGN:Between subjects design. SETTING:Outpatient physical therapy facility. PARTICIPANTS:Thirty-eight amateur male soccer players after ACLR were included. Thirty age-matched amateur male soccer players served as control group. MAIN OUTCOME MEASURES:Quadriceps and hamstring muscle strength was measured at three time points during the rehabilitation. Limb symmetry index (LSI) > 90% was used as cut-off criteria. RESULTS:Soccer players after ACLR had no significant differences in peak quadriceps and hamstring muscle strength in the injured leg at 7 months after ACLR compared to the dominant leg of the control group. Furthermore, 65.8% of soccer players after ACLR passed LSI >90% at 10 months for quadriceps muscle strength. CONCLUSION:Amateur male soccer players after ACLR can achieve similar quadriceps and hamstring muscle strength at 7 months compared to healthy controls. These findings highlight the potential of progressive strength training in rehabilitation after ACLR that may mitigate commonly reported strength deficits.
LINK
The seismic assessment of unreinforced masonry (URM) buildings with cavity walls is a relevant issue in many countries, such as in Central and Northern Europe, Australia, New Zealand, China and several other countries. A cavity wall consists of two separate parallel masonry walls (called leaves) connected by metal ties: an inner loadbearing wall and an outer veneer having mostly aesthetic and insulating functions. Cavity walls are particularly vulnerable structural elements. If the two leaves of the cavity wall are not properly connected, their out-of-plane strength may be significantly smaller than that of an equivalent solid wall with the same thickness.The research presented in this paper focuses on a mechanical model developed to predict the failure mode and the strength capacity of metal tie connections in masonry cavity walls. The model considers six possible failures, namely tie failure, cone break-out failure, pull-out failure, buckling failure, piercing failure and punching failure. Tie failure is a predictable quantity when the possible failure modes can be captured. The mechanical model for the ties has been validated against the outcomes of an experimental campaign conducted earlier by the authors. The mechanical model is able to capture the mean peak force and the failure mode obtained from the tests. The mechanical model can be easily adopted by practising engineers who aim to model the wall ties accurately in order to assess the strength and behaviour of the structures against earthquakes. Furthermore, the proposed mechanical model is used to extrapolate the experimental results to untested configurations, by performing parametric analyses on key parameters including a higher strength mortar of the calcium silicate brick masonry, a different cavity depth, a different tie embedment depth, and solid versus perforated clay bricks.
DOCUMENT
Post-earthquake structural damage shows that out-of-plane wall collapse is one of the most prevalent failure mechanisms in unreinforced masonry (URM) buildings. This issue is particularly critical in Groningen, a province located in the northern part of the Netherlands, where low-intensity ground shaking has occurred since 1991 due to gas extraction. The majority of buildings in this area are constructed using URM and were not designed to withstand earthquakes, as the area had never been affected by tectonic seismic activity before. Hence, the assessment of URM buildings in the Groningen province has become of high relevance.Out-of-plane failure mechanisms in brick masonry structures often stem from poor wall-to-wall, wall-to-floor or wall-to-roof connections that provide insufficient restraint and boundary conditions. Therefore, studying the mechanical behaviour of such connections is of prime importance for understanding and preventing damages and collapses in URM structures. Specifically, buildings with double-leaf cavity walls constitute a large portion of the building stock in the Groningen area. The connections of the leaves in cavity walls, which consist of metallic ties, are expected to play an important role. Regarding the wall-to-floor connections, the traditional way for URM structures in Dutch construction practice is either a simple masonry pocket connection or a hook anchor as-built connection, which are expected to be vulnerable to out-of-plane excitation. However, until now, little research has been carried out to characterise the seismic behaviour of connections between structural elements in traditional Dutch construction practice.This thesis investigates the seismic behaviour of two types of connections: wall-to-wall connections between cavity wall leaves and wall-to-floor connections between the masonry cavity wall and timber diaphragm, commonly found in traditional houses in the Groningen area. The research is divided into three phases: (1) inventory of existing buildings and connections in the Groningen area, (2) performance of experimental tests, and (3) proposal and validation of numerical and mechanical models. The thesis explores the three phases as follows:(i) An inventory of connections within URM buildings in the Groningen area is established. The inventory includes URM buildings of Groningen based on construction material, lateral load-resisting system, floor system, number of storeys, and connection details. Specific focus is given to the wall-to-wall and wall-to-floor connections in each URM building. The thickness of cavity wall leaves, the air gap between the leaves and the size and spacing of timber joists are key aspects of the inventory.(ii) Experimental tests are performed on the most common connection typologies identified in the inventory. This phase consists of two distinct experimental campaigns:o The first experimental campaign took place at the laboratory of the Delft University of Technology to provide a comprehensive characterisation of the axial behaviour of traditional metal tie connections in cavity walls. The campaign included a wide range of variations, such as two embedment lengths, four pre-compression levels, two different tie geometries, and five different testing protocols, including both monotonic and cyclic loading. The experimental results showed that the capacity of the wall tie connection is strongly influenced by the embedment length and the tie geometry, whereas the applied pre-compression and the loading rate do not have a significant influence.o The second experimental campaign has been carried out at the laboratory of the Hanze University of Applied Sciences to characterise the seismic behaviour of timber joist-masonry cavity wall connections, reproducing both as-built and strengthened conditions. Twenty-two unreinforced masonry wallets were tested, with different configurations, including two tie distributions, two pre-compression levels, two different as-built connections, and two different strengthening solutions. The experimental results highlighted the importance of cohesion and friction between joist and masonry since the type of failure mechanism (sliding of the joist or rocking failure of the masonry wallet) depends on the value of these two parameters. Additionally, the interaction between the joist and the wallet and the uplift of the latter activated due to rocking led to an arching effect that increased friction at the interface between the joist and the masonry. Consequently, the arching effect enhanced the force capacity of the connection.(iii) Mechanical and numerical models are proposed and validated against the performed experiments or other benchmarks. Mechanical and numerical models for the cavity wall tie and mechanical models for the timber joist-masonry connections were developed and verified by the experimental results to predict the failure mode and the strength capacity of the examined connections in URM buildings.o The mechanical model for the cavity wall tie connections considers six possible failures, namely tie failure, cone break-out failure, pull-out failure, buckling failure, piercing failure and punching failure. The mechanical model is able to capture the mean peak force and the failure mode obtained from the tests. After being calibrated against the available experiments, the proposed mechanical model is used to predict the performance of untested configurations by means of parametric analyses, including higher strength of mortar for calcium silicate brick masonry, different cavity depth, different tie embedment depth, and the use of solid bricks in place of perforated clay bricks.o The results of the experimental campaign on cavity wall ties were also utilised to calibrate a hysteretic numerical model representing the cyclic axial response of cavity wall tie connections. The proposed model uses zero-length elements implemented in OpenSees with the Pinching4 constitutive model to account for the compression-tension cyclic behaviour of the ties. The numerical model is able to capture important aspects of the tie response, such as strength degradation, unloading stiffness degradation, and pinching behaviour. The mechanical and numerical modelling approach can be easily adopted by practitioner engineers seeking to model the wall ties more accurately when assessing URM structures against earthquakes.o The mechanical model of timber-masonry connections examines two different failure modes: joist-sliding failure mode, including joist-to-wall interaction and rocking failure mode due to joist movement. Both mechanical models have been validated against the outcomes of the experimental campaigns conducted on the corresponding connections. The mechanical model is able to estimate each contribution of the studied mechanism. Structural engineers can use the mechanical model to predict the capacity of the connection for the studied failure modes.This research study can contribute to a better understanding of typical Groningen houses in terms of identifying the most common connections used at wall-to-wall and wall-to-floor connections in cavity walls, characterising the identified connections and proposing mechanical models for the studied connections.
DOCUMENT
Background: Lipoedema is a chronic disorder of adipose tissue typically involving an abnormal build-up of fat cells in the legs, thighs and buttocks. Occurring almost exclusively in women, it often co-exists with obesity. Due to an absence of clear objective diagnostic criteria, lipoedema is frequently misdiagnosed as obesity, lymphoedema or a combination of both. The purpose of this observational study was to compare muscle strength and exercise capacity in patients with lipoedema and obesity, and to use the findings to help distinguish between lipoedema and obesity. Design: This cross-sectional, comparative pilot study performed in the Dutch Expertise Centre of Lymphovascular Medicine, Drachten, a secondary-care facility, included 44 women aged 18 years or older with lipoedema and obesity. Twenty-two women with lipoedema (diagnosed according the criteria of Wold et al, 1951) and 22 women with body mass index ≥30kg/m2 (obesity) were include in the study. No interventions were undertaken as part of the study. Results: Muscle strength of the quadriceps was measured with the MicroFET™, and functional exercise capacity was measured with the 6-minute walk test. The group with lipoedema had, for both legs, significantly lower muscle strength (left: 259.9 Newtons [N]; right: 269.7 N; p < 0.001) than the group with obesity. The group with lipoedema had a non-significant, but clinically relevant lower exercise-endurance capacity (494.1±116.0 metres) than the group with obesity (523.9±62.9 metres; p=0.296). Conclusions: Patients with lipoedema exhibit muscle weakness in the quadriceps. This finding provides a potential new criterion for differentiating lipoedema from obesity. We recommend adding measuring of muscle strength and physical endurance to create an extra diagnostic parameter when assessing for lipoedema.
LINK
The seismic assessment of the out-of-plane (OOP) behaviour of unreinforced masonry (URM) buildings is essential since the OOP is one of the primary collapse mechanisms in URM buildings. It is influenced by several parameters, including the poor connections between structural elements, a weakness highlighted by post-earthquake observations. The paper presents a mechanical model designed to predict the contributions of various resisting mechanisms to the strength capacity of timber-joist connections in masonry cavity walls. The research presented in this paper considers two different failure modes: joist-wall interface failure, and OOP rocking behaviour of the URM walls. Consequently, two mechanical models are introduced to examine these failure modes in timber-joist connections within masonry cavity walls. One model focuses on the joist-wall interface failure, adopting a Coulomb friction model for joist-sliding further extended to incorporate the arching effect. The other model investigates the OOP rocking failure mode of walls. The combined mechanical model has been validated against the outcomes of an earlier experimental campaign conducted by the authors. The considered model can accurately predict the peak capacity of the joist connection and successfully defines the contribution of each mechanism in terms of resistance at failure.
DOCUMENT
BackgroundMechanical ventilation affects the respiratory muscles, but little is known about long-term recovery of respiratory muscle weakness (RMW) and potential associations with physical functioning in survivors of critical illness. The aim of this study was to investigate the course of recovery of RMW and its association with functional outcomes in patients who received mechanical ventilation.MethodsWe conducted a prospective cohort study with 6-month follow-up among survivors of critical illness who received ≥ 48 hours of invasive mechanical ventilation. Primary outcomes, measured at 3 timepoints, were maximal inspiratory and expiratory pressures (MIP/MEP). Secondary outcomes were functional exercise capacity (FEC) and handgrip strength (HGS). Longitudinal changes in outcomes and potential associations between MIP/MEP, predictor variables, and secondary outcomes were investigated through linear mixed model analysis.ResultsA total of 59 participants (male: 64%, median age [IQR]: 62 [53–66]) were included in this study with a median (IQR) ICU and hospital length of stay of 11 (8–21) and 35 (21–52) days respectively. While all measures were well below predicted values at hospital discharge (MIP: 68.4%, MEP 76.0%, HGS 73.3% of predicted and FEC 54.8 steps/2m), significant 6-month recovery was seen for all outcomes. Multivariate analyses showed longitudinal associations between older age and decreased MIP and FEC, and longer hospital length of stay and decreased MIP and HGS outcomes. In crude models, significant, longitudinal associations were found between MIP/MEP and FEC and HGS outcomes. While these associations remained in most adjusted models, an interaction effect was observed for sex.ConclusionRMW was observed directly after hospital discharge while 6-month recovery to predicted values was noted for all outcomes. Longitudinal associations were found between MIP and MEP and more commonly used measures for physical functioning, highlighting the need for continued assessment of respiratory muscle strength in deconditioned patients who are discharged from ICU. The potential of targeted training extending beyond ICU and hospital discharge should be further explored.
MULTIFILE
Background The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults. Methods A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence. Results Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics. Conclusions This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.
MULTIFILE
Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices for invasively ventilated patients in intensive care units (ICU) in the Netherlands. A self-administered web-based survey was sent to a single pre-appointed representative of all ICUs in the Netherlands. Response rate was 85% (72 ICUs). We found substantial heterogeneity in the intensity and combinations of airway care interventions used. Most (81%) ICUs reported using heated humidification as a routine prophylactic intervention. All (100%) responding ICUs used nebulized mucolytics and/or bronchodilators; however, only 43% ICUs reported nebulization as a routine prophylactic intervention. Most (81%) ICUs used manual hyperinflation, although only initiated with a clinical indication like difficult oxygenation. Few (22%) ICUs used MI-E for invasively ventilated patients. Use was always based on the indication of insufficient cough strength or as a continuation of home use. In the Netherlands, use of routine prophylactic airway care interventions is common despite evidence of no benefit. There is an urgent need for evidence of the benefit of these interventions to inform evidence-based guidelines.
DOCUMENT
