Failure Trends Research Articles

The burden and trends of heart failure caused by ischemic heart disease at the global, regional, and national levels from 1990 to 2021.

Ischemic heart disease (IHD) is a major cause of heart failure (HF), a condition expected to increasingly affect global health and economics. This study evaluates the global burden, trends, and disparities of HF linked to IHD, aiming to inform health policy development. Data from the Global Burden of Disease Study 2021 (GBD2021) is analyzed using Joinpoint regression, decomposition analysis, and Bayesian age-period-cohort analysis (BAPC). Health disparities are assessed through the Socio-demographic Index (SDI) via the Slope Index of Inequality (SII) and the Concentration Index (CI), with future trends projected from 2022 to 2045. In 2021, global HF cases due to IHD were over 19.16 million, with an age-standardized prevalence rate (ASPR) of 228.31 per 100 000 [95% UI, 188.18 to 279.55] and age-standardized years lived with disability (ASYLDs) rate of 20.43 per 100 000 [95% UI, 13.55 to 28.7].In 2021, there was a 2.87% increase in ASPR and ASYLDs compared to 1990, primarily driven by population growth and aging.Significant reductions in global ASPR and ASYLDs disparities are observed, though the disease burden has intensified in countries with lower SDI levels. Projections indicate that by 2045, while the prevalence and YLDs for HF caused by IHD will increase, while the ASPR and ASYLDs are expected to decrease. The global burden of HF from IHD remains a significant concern. Urgent improvements in the allocation of medical resources and the implementation of effective prevention and management strategies are necessary to address this issue.

Abstract 4121359: Heart Disease and Heart Failure: Trends and Disparities in Mortality Rates in the United States from 2000 to 2020

Background: The remarkable decline in the overall prevalence and mortality rates of cardiovascular diseases (CVD) in the United States (US) over the past few decades has not been consistent across all age groups, sexes, races, and types of cardiovascular diseases. Heart disease (HD) and heart failure (HF) still pose a significant burden to the healthcare system. Objectives: This study sought to describe the age, sex and racial disparities in the trends in mortality rates for these two outcomes in the US over the past two decades. Methods: This was an ecological study with trend analysis of the mortality from heart disease and heart failure in the US between 2000 and 2020. Data on CVD was obtained from the National Centers for Disease Control and Prevention (CDC) surveillance databases and analyzed. Binomial regression models were used to evaluate trends in outcomes. Statistical significance was considered for p-values < 0.05. Results: There was a significant decrease in the age-standardized mortality for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases (p<0.001)). Mortality rates were significantly higher in males (p<0.001, R2 = 0.92), non-Hispanic blacks (p<0.001) and non-Hispanic whites (p<0.001) compared to Hispanics, (R2 = 0.94) and in adults aged 65+ (p<0.001) and 75+ (p<0.001) (R2 = 0.98). There was no significant decrease in the age-standardized mortality for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p=0.706)) due to a reversal in the trend after 2011. Though the rates were significantly lower in males overall (p=0.001, R2 = 0.27), these rates became higher in males and in non-Hispanic Blacks compared to non-Hispanic Whites beyond 2016. Mortality rates due to HF were highest in the 65+ and 75+ age groups. Conclusions: This study on national trends in heart disease and heart failure across age groups, sexes and races over the past two decades confirmed a significant reduction in heart disease mortality rates over this period, but with persistent disparities between males and females, non-Hispanic Blacks and other races and the older age groups. This study also highlights important reversals of heart failure mortality rates trends in more recent years in males and females, and non-Hispanic Blacks and Whites, the reasons for which are amenable to further research.

Trends in Kidney Allograft Failure Among First-Time Transplant Recipients in the United States

Rationale & ObjectiveThe management and outcomes of kidney transplant recipients have evolved over the past three decades. This study of U.S patients whose first kidney allograft failed sought to understand long-term trends in subsequent waitlisting, re-transplantation, and all-cause mortality. Study DesignRetrospective cohort study. Setting & ParticipantsPatients recorded in the United States Renal Data System (USRDS) whose first kidney allograft failed between 1990 and 2019. ExposureThe 5-year period in which the allograft failure occurred: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014, or 2015-2019. Outcomes1) Waitlisting for re-transplantation, 2) re-transplantation, and 3) all-cause mortality following first allograft failure. Analytical ApproachCompeting risk survival analyses using the approach described by Fine and Gray were used for the outcomes of waitlisting and re-transplantation. Cox proportional hazards models were used for the outcome of all-cause mortality. ResultsThe absolute number of patients whose allograft failed and started dialysis increased from 3,197 in 1990 to 5,821 in 2019. Compared to 1990-1994, the rate of waitlisting for a second transplant increased with each subsequent 5-year period, peaking between 2005-2009 before decreasing again subsequently. The rate of re-transplantation following allograft failure decreased by 9%, 14%, 18%, 7%, and 11% in the sequential 5-year eras; and the mortality rate was 25% lower in 2015-2019 (HR=0.75, 95% CI, 0.72-0.77) compared to 1990-1994. Women had a reduced rate of waitlisting (HR 0.93, 95% CI 0.91-0.95) and lower rate of re-transplantation (HR 0.93, 95% CI 0.91, 0.95) compared to men. Compared to White patients, African-American and Hispanic patients had significantly lower rates of waitlisting, re-transplantation, and mortality. LimitationsRetrospective data that lacks granular clinical information. ConclusionsDuring the past three decades, among patients whose first kidney allograft failed and subsequently initiated dialysis, the rates of waitlisting for re-transplantation increased while the rates of re-transplantation and mortality decreased. Race-, ethnicity-, and sex-based disparities in waitlisting and re-transplantation were observed and warrant further investigation.

Railway embankment failure trends and monitoring – lessons learned from the Anglia route

UK railways were constructed with little consideration of engineering practice and with climate change and the associated greater frequency of extreme weather events, comes the impact on earthworks stability and risk to public safety. Many embankments on Network Rail’s Anglia route have shown a gradual degradation through their steep upper slopes and progressive failure within predominantly clay embankment material and underlying soft deposits. A regional wholistic view allows identification of common geotechnical trends and risk categorisation to better enable prioritisation of asset management. Understanding when to intervene is crucial and monitoring the behaviour of earthworks is a vital asset management tool to control risk and extend lifespan. To be a wise investment, slope instrumentation must be properly thought out in line with a detailed interrogation of the site and alongside a well-developed conceptual model. Automated monitoring can bring greater control and allow more accurate evaluation of intervention but must be assessed in line with prioritising large areas with limited budgets. Correct targeting of ground investigation and ensuring sufficient and reliable data can optimise mitigation and provide confidence the solution has provided resilience to railway infrastructure.

Theoretical and numerical investigations of the floor failure characteristics affected by coal mining near complex fault structures

Water inrush from underlying aquifers under the synergistic action of complex faults and mining activities seriously threatens the mining of coal seams in North China. The failure characteristics of the coal seam floor under complex fault conditions are the keys to understanding the water inrush mechanism during mining. To investigate floor failure characteristics and water inrush mechanisms influenced by complex fault structures, theoretical analysis and numerical simulation were carried out. An improved theoretical model is first proposed, including complex fault structures such as horst, graben, and step fault structures. The calculation formula for waterproof coal pillars under complex fault conditions is established based on the improved theoretical model. The failure and displacement characteristics of the coal floor under complex faults are analyzed via numerical simulation. Compared with those under normal mining conditions, the theoretical and numerical simulation results reveal the following: (1) Under the horst structure, the floor failure characteristics show an increase in the compression failure area on both sides, and shear failure occurs on the large-dip fault side. The simulation results reveal that the failure width on the large-dip fault side increases by 25%, indicating a failure trend toward the large-dip fault side. The width of waterproof coal pillars needs to be increased by 20% to ensure mining safety. (2) Under the graben structure, the floor failure characteristics show an increase in the compression failure area on both sides, and shear failure occurs on the small-dip fault side. The simulation results reveal that the failure width on the small-dip fault side increases by 25%, indicating a failure trend toward the small-dip fault side. The width of waterproof coal pillars needs to be increased by 40% to ensure mining safety. (3) Under the step fault structure, the floor failure characteristics show compression failure on both sides, increasing the floor compression failure area on the large-dip fault side. The simulation results show that the failure width on the small-dip fault side increases by 15%, the large-dip fault side increases by 50%, and the floor failure depth increases by 20%. The width of waterproof coal pillars needs to be increased by 50% to ensure mining safety.

Burden and Temporal Trends of Valvular Heart Disease-Related Heart Failure From 1990 to 2019 and Projection Up to 2030 in Group of 20 Countries: An Analysis for the Global Burden of Disease Study 2019.

The aim of this study was to characterize the burden of valvular heart disease (VHD)-related heart failure (HF) in Group of 20 (G20) countries. Using data from the 2019 Global Burden of Disease Study, we estimated VHD-related HF burdens (cases, age-standardized prevalence rates, and years lived with disabilities rates) in G20 countries from 1990 to 2019 by age, sex, and sociodemographic index. The burden of VHD-related HF increased in G20 countries from 1990 to 2019, exhibiting heterogeneity across VHD subtypes. In 2019, Italy, the United States, and the Russian Federation had the highest age-standardized prevalence rates of nonrheumatic VHD-related HF, whereas India, Brazil, and Mexico had the lowest. Rheumatic VHD-related HF was most prevalent in China, India, and Italy, whereas the Republic of Korea, Brazil, and Turkey had the lowest. Nonrheumatic VHD-related HF prevalence peaked among G20 countries in individuals ≥85 years of age, whereas rheumatic VHD-related HF peaked in those 75 to 84 years of age in several countries, including China, India, the Russian Federation, Mexico, Argentina, and Turkey. Age-standardized prevalence rates of nonrheumatic VHD-related HF showed a decreasing trend, more pronounced in women, whereas rheumatic VHD-related HF increased in both sexes, with a lower increase in men. Nonrheumatic VHD-related HF burden correlated with age and sociodemographic index, whereas rheumatic VHD-related HF burden was highest in middle sociodemographic index countries for those <75 years of age. Years lived with disabilities rates for VHD-related HF represented about 9.0% of the overall burden across populations. The increasing burden of VHD-related HF in G20 countries highlights the need for timely interventions to mitigate this growing public health challenge.

Temporal Trends in the Prevalence of Child Undernutrition in China From 2000 to 2019, With Projections of Prevalence in 2030: Cross-Sectional Analysis.

Although the problem of malnutrition among children in China has greatly improved in recent years, there is a gap compared to developed countries, and there are differences between provinces. Research on long-term comprehensive trends in child growth failure (CGF) in China is needed for further improvement. The purpose of this study was to examine trends in stunting, wasting, and underweight among children younger than 5 years in China from 2000 to 2019, and predict CGF till 2030. We conducted a cross-sectional analysis using data from the local burden of disease (LBD) database. Using Joinpoint Regression Software, we examined trends in CGF among children younger than 5 years in China from 2000 to 2019, and predicted the trends of prevalence in 2030, using the Holt-Winters model with trends but without seasonal components. The assessment was performed with Stata 17 (StataCorp). Data were analyzed from October 17, 2023, to November 22, 2023. In 2019, the prevalences of stunting, wasting, and underweight decreased to 12%, 3%, and 4%, respectively (decreases of 36.9%, 25.0%, and 42.9%, respectively, compared with the values in 2000). The prevalence of CGF decreased rapidly from 2000 to 2010, and the downward trend slowed down after 2010. Most provinces had stagnated processes of trends after 2017. The age group with the highest stunting prevalence was children aged 1 to 4 years, and the highest prevalence of wasting and underweight was noted in early neonatal infants. From 2000 to 2019, the prevalence of CGF declined in all age groups of children. The largest relative decrease in stunting and underweight was noted in children aged 1 to 4 years, and the largest decrease in wasting was noted in early neonatal infants. The prevalences of stunting, wasting, and underweight in China are estimated to decrease to 11.4%, 3.2%, and 4.1%, respectively, by 2030. China has nationally met the World Health Organization's Global Nutrition Targets for 2030 for stunting but not for wasting. This study provides data on the prevalence and trends of CGF among children younger than 5 years and reports declines in CGF. There remain areas with slow progress in China. Most units have achieved the goal for stunting prevalence but not wasting prevalence.

Damage mechanism of rock induced by microcrack evolution: A multi-dimensional perspective

This paper investigated the multi-dimensional and multi-scale damage mechanisms of rocks employing Discrete Element Method (DEM) numerical tests, macroscopic damage models, microscopic damage models, and Acoustic Emission (AE) tests. The study analyzed the correlation between the number of microcracks and AE accumulative ring-down count, established a macroscopic damage evolution equation representing rock volume strain, and explored the mechanisms of microscopic damage evolution. The impact of confining pressure and initial microcracks on rock damage characteristics, the relationship between crack volume strain and macroscopic damage evolution, and the effects of different crack types on microscopic damage evolution were discussed. Key findings include: 1) The DEM incorporating gapped contacts can effectively assess the impact of initial microcrack volume on compaction deformation. Concurrently, the consistency observed between the number of microcracks in DEM and the AE accumulative ring-down count aptly characterizes the failure trend. 2) Macroscopic damage is quantitatively derivable through microcrack enumeration, with the noteworthy observation that microcracks undergo substantial development preceding the volumetric expansion of the rock. Consequently, the evolution of macroscopic damage can be aptly described as a piecewise exponential function relative to rock volume strain. 3) Microcracks manifest in two forms: tension and shear, and the evolution of microscopic damage is intricately linked to the type of microcracks, thus prompting a comprehensive consideration of the microscopic damage induced by different microcrack types. This multi-dimensional exploration enhances our understanding of the dynamic processes underlying rock damage at both macroscopic and microscopic levels.

Rapid metastatic recurrence after pancreatic cancer resection: a multi-center, regional analysis of trends in surgical failure over two decades

BackgroundPancreatic ductal adenocarcinoma (PDAc) is a lethal malignancy, attributed in part to high rates of rapid recurrence (rrPDAc) following resection. We sought to characterize recurrence rates over time and investigate factors predictive of rrPDAc. MethodsA regional multi-institutional cancer registry, augmented with data from the National Surgical Quality Improvement Program database, was queried for patients with PDAc from 1996 to 2020. rrPDAc was defined as recurrence within 6 months following curative-intent resection. ResultsWe identified 924 patients who underwent resection for PDAc; rrPDAc occurred in 236 (26%) patients. Median incidence of rrPDAc was 25.3% (IQR 22–30.2%) per year. Median survival in rrPDAc, non-rapid recurrence, and no recurrence was 10.3, 25.2, and 56.1 months respectively (p < 0.001). Variables independently associated with greater odds of rrPDAc included surgical site infection (SSI) (OR 2.06) and nodal positivity (OR 2.05); adjuvant therapy was associated with lower odds (OR 0.38). Neoadjuvant chemotherapy did not alter risk of rrPDAc. Three-year post-recurrence survival was no different in rrPDAc versus those without. ConclusionDespite therapeutic advances, incidence of rrPDAc remains unchanged. SSIs and nodal positivity are independently associated with increased risk of rrPDAc, while adjuvant chemotherapy is associated with lower risk. Strategies focused on preventing rapid recurrence may improve survival.

‘[K]neeling only goes to highlight your ignorance. England is NOT! a #racist country’: aversive racism, colour-blindness, and racist temporalities in discussions of football online

ABSTRACT Drawing on theories of aversive racism and colour-blindness, which stress the invisibility of contemporary racism, this article analyses online discussions on taking the knee (TTK) during EURO2020 men’s football tournament. While highly visible racist abuse directed at Black English players after losing the final to Italy (dominative racism) received most public attention and repudiation, based on 6,850 English language tweets published on Twitter/X, this article shows how subtle racism and colour-blindness were reinforced in discussions around TTK over the duration of the tournament (aversive racism). The article also shows how individuals online developed a variety of strategies (evidence, othering, critique, and activism) to challenge the main arguments against anti-racist activism in football (identified in four themes: BLM, Marxism, virtue signalling, and woke). The article makes an original contribution by examining the changing intensity of online conversations on TTK over the duration of the tournament. Our analysis identifies key moments in the tournament, political elites’ rhetoric, and trends of success and failure as relevant factors that shaped vernacular conversations online. The discussion ultimately argues that investigating the temporal patterns of public discussions on (anti)racism provides valuable insights to understand the contemporary complexity of racism in football and society more broadly.

The impact of the COVID-19 pandemic on tuberculosis treatment outcomes in 49 high burden countries

BackgroundThe COVID-19 pandemic disrupted tuberculosis (TB) health services, including treatment support and access to drugs, as patients were not able to access health facilities. While the effect of this disruption on treatment outcomes has been studied in isolated treatment centres, cities and provinces, the impact of the pandemic on TB treatment outcomes at a country and regional level has not been evaluated.MethodsWe used treatment outcomes for new and relapse TB cases reported to the World Health Organization (WHO) from 49 high TB, TB/HIV and drug-resistant TB burden countries from 2012 to 2019. We developed multinomial logistic regression models for trends in TB treatment success, failure, death and loss to follow up. We predicted TB treatment outcomes for 2020 and 2021, comparing these to observations, by computing ratios between observed and predicted probabilities. We aggregated these risk ratios (RR) for six WHO-defined regions using random-effects meta-analysis.ResultsAcross 49 countries and four TB treatment outcomes, 17 (out of 196) country-outcome pairs in 2020 and 21 in 2021 had evidence of systematic differences between observed and predicted TB treatment outcome probabilities. Regionally, only four (out of 24) region-outcome pairs had evidence of systematic differences in 2020 and four in 2021, where the European region accounted for four of these in total. Globally, there was evidence of systematic differences in treatment failure in both 2020 (RR: 1.14, 95%CI: 1.01–1.28, p = 0.0381) and 2021 (RR: 1.36, 95%CI: 1.03–1.78, p = 0.0277), deaths in 2020 (RR: 1.08, 95%CI: 1.03–1.13, p = 0.0010) and losses to follow up in 2020 (RR: 0.91, 95%CI: 0.86–0.97, p = 0.0059).ConclusionsWhile for some countries and regions there were significant differences between observed and predicted treatment outcomes probabilities, there was insufficient evidence globally to identify systematic differences between observed and expected TB treatment outcome probabilities because of COVID-19-associated disruptions in general. However, larger numbers of treatment failures and deaths on treatment than expected were observed globally, suggesting a need for further investigation.

From Promise to Practice: Recent Growth in 30 Years of Tissue Engineering Commercialization.

This perspective, marking the 30th anniversary of the Tissue Engineering journal, discusses the exciting trends in the global commercialization of tissue engineering technology. Within a historical context, we present an evolution of challenges and a discussion of the last 5 years of global commercial successes and emerging market trends, highlighting the continued expansion of the field in the northeastern United States. This leads to an overview of the last 5 years' progress in clinical trials for tissue engineered therapeutics, including an analysis of trends in success and failure. Finally, we provide a broad overview of preclinical research and a perspective on where the state-of-the-art lies on the horizon.

Global trends in heart failure from 1990 to 2019: An age-period-cohort analysis from the Global Burden of Disease study.

This study aimed to analyse the global prevalence and disability trends of heart failure (HF) from 1990 to 2019, considering both sexes and country-specific economic strata. This study conducted a secondary analysis employing data from the Global Burden of Disease (GBD) study. The analysis is stratified by sex and Socio-demographic Index (SDI) levels. Through age-period-cohort and Joinpoint regression analyses, we investigated the temporal trends in HF prevalence and years lived with disability (YLDs) during this period. Between 1990 and 2019, the global prevalence of HF surged by 106.3% (95% uncertainty interval: 99.3% to 114.3%), reaching 56.2 million cases in 2019. While all-age prevalence and YLDs increased over the 30year span, age-standardized rates decreased by 2019. Countries with higher SDI experienced a more pronounced percentage decrease compared with those with lower SDI. Longitudinal analysis revealed an overall improvement in both prevalence and YLDs for HF, albeit with notable disparities between SDI quintiles and sexes. Ischaemic heart disease and hypertensive heart disease emerged as the most rapidly increasing and primarily contributing causes of HF, albeit with variations observed across different countries. The average annual percentage change for prevalence and YLDs over the period was -0.26% and -0.25%, respectively. This study offers valuable insights into the global burden of HF, considering factors such as population aging, regional disparities, sex differences and aetiological variations. The findings hold significant implications for healthcare planning and resource allocation. Continued assessment of these trends and innovative strategies for HF prevention and management are crucial for addressing this pressing global health concern.

Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study.

Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.

Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study

Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups. Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years). 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]). Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure. None. For the Danish translation of the abstract see Supplementary Materials section.

Analytical trends in airlines registrations and failures in Nigeria air business

Analytical trends in airlines registrations and failures in Nigeria air business

Analysis of compressive failure mechanism of concrete and grouting cubes by Peridynamics

The structural failure forms and mechanisms of plain concrete, grout, and different aggregate concrete under the action of pressure have been puzzling the engineering and academic circles. To provide more favorable analytical means and theoretical support for structural damage and failure, this paper first adopts the experiments to analysis the compressive failure trend of cubic specimens of concrete and grout, and combines the results with the three-dimensional Peridynamics theory (PD) analyzed the damage trend and failure mechanism of the same tests with the same parameters under load. From the comparison, we can conclude that PD could truly analyze the failure mechanism of three-dimensional structures and was superior to the tests. Meanwhile, we also found that different number and position pebbles have a great influence on the failure path and damage mechanism of concrete.

Better kidney allograft survival despite higher-risk donor and recipient characteristics between 1995 and 2014.

Advances in organ procurement, surgical techniques, immunosuppression regimens, and prophylactic antibiotic therapies have dramatically improved kidney transplant graft failure. It is unclear how these interventions have affected longer-term graft failure. It is hypothesized that graft failure has improved over the last 20 years. Data on all first kidney transplants from 1995 to 2014 were extracted from the Australia and New Zealand Dialysis and Transplant Registry with follow-up as of 31 December 2021. Primary exposure was transplant era, classified into 5-year intervals. Primary outcome was all-cause 5-year graft failure. Secondary outcomes included all-cause 10-year graft failure and cause-specific graft failure. Kaplan-Meier curves and multivariable Cox proportional hazards regression models were used to assess trends in all-cause graft failure. Fine-Gray subdistribution hazard models verified that changes in death rates were not biasing the Cox proportional hazards regression models. Cumulative incidence functions were used to assess temporal trends in cause-specific graft failure. Across 10871 kidney transplants, there was a shift towards transplanting more recipients aged >45 years old, with more comorbidities, longer dialysis vintage, body mass index >30kg/m2, and greater human leukocyte antigen mismatches. Donor age has increased but no clear shift in donor source was observed. Compared to 1995-99 (reference), the adjusted hazard ratio for 5-year graft failure was 0.78 (95% CI 0.67-0.91), 0.70 (95% CI 0.59-0.83), and 0.60 (95% CI 0.50-0.73) for 2000-04, 2005-09, and 2010-14, respectively. Ten-year graft failure similarly reduced from 0.83 (95% CI 0.74-0.93) for 2000-04 to 0.78 (95% CI 0.68-0.89) for 2010-14, compared to 1995-99. Medium- and long-term all-cause graft failure has improved steadily since 1995-99. Significant reductions in graft failure due to rejection and vascular causes were observed at 5 years, and due to rejection, vascular causes, death, and glomerular disease at 10 years.

Uniaxial compression test of cement-solidified dredged slurry columns encased with geogrid

This study investigated the performance of unreinforced and geogrid-encased cement-stabilized dredged slurry columns by uniaxial compression tests to simulate the extreme case where the surrounding soil offers no confinement. The objective was to understand the strength characteristics and visualize the deformation damage patterns of the columns with respect to the water content, cement content, length-to-diameter ratio, and geogrid strength. The results show that the unreinforced specimens exhibited strain-softening behavior, whereas geogrid encasement induced strain-hardening, with high-strength geogrids showing superior strain-hardening capacity. Notably, regardless of geogrid strength, encasement enhanced the resistance to deformation and ductility of the columns. Increasing the cement content, reducing the water content, and decreasing the length-to-diameter ratio all contributed to higher peak strength in both unreinforced and geogrid-encased specimens. Geogrid encasement provides confinement that enhances peak strength. The influence of geogrid encasement on peak strength becomes more pronounced at lower cement contents, higher water contents, and higher length-to-diameter ratios. Geogrid encasement also affects failure modes, altering the predominant inclined shear failure observed at the top of unreinforced specimens. Specimens encased with geogrids of higher tensile strength exhibit enhanced integrity and deformation resembling compression strut buckling, with a symmetrically inclined failure trend at the top and bottom.

An Electronic Health Record-integrated Web Application Augments a QI-directed Morbidity & Mortality Conference and Improves Quality of Care

BackgroundIn 2014, we developed a QI-directed Morbidity and Mortality (M&M) Conference, prioritizing discussion of individual and system failures, as well as development of action items to prevent failure recurrence. However, due to a reliance on individual electronic documents to store M&M data, our ability to assess trends in failures and action item implementation was hindered. To address this issue, in 2019, we created a secure electronic health record (EHR)-integrated web application (web app) to store M&M data. Study designIn this study, we assessed the impact of our web app on efficient review and tracking of M&M data, including system failure occurrence and closure of action items. Additionally, in 2021, it was discovered that a backlog of action items existed. To address this issue, we implemented a QI initiative to reduce the backlog, and used the web app to compare action item closure over time. ResultsUse of the web app dramatically improved review of M&M data. During the study period, there was a 67.0% reduction in the occurrence of the most common system failures. Additionally, our QI initiative resulted in a 97.7% reduction in the duration of time to complete a single action item and a 61.1% increase in the on-time closure rate for action items. ConclusionsIntegration of a web app into a QI-directed M&M Conference enhanced our ability to track system level failures and action item closure over time. Using this web app, we demonstrated that our M&M Conference achieved its intended goal of improving the quality of patient care. Level of EvidenceIV.