Appropriate antibiotic use has become an important issue. However, collecting data on the use of all antibiotics in a hospital is difficult without an advanced computerized system and dedicated staff. This paper examines if 1–3 antibiotics can satisfactorily represent the total antibiotic consumption at the hospital level.t (time) such as t, t2, and t3 to capture the time trend and whether t belongs to each month or not to capture the monthly variations. The ordinary least squares method was used to explain the total antibiotic amount with these variables, and then the estimated model was employed to predict the use for 2013. To determine which antibiotics were the most representative in tracking general trends in antibiotic use over time, we tried various combinations of antibiotics to find the combination that best minimized the 2013 prediction error.We collected antibiotic data from six large university hospitals in Korea for some years between 2004 and 2012. Since the total antibiotics consist of a few chosen representative antibiotics and the rest, we used those chosen antibiotics along with additional variables constructed only with We found that fluoroquinolones and aminoglycosides were the most representative, followed by beta-lactam/beta-lactamase inhibitors and 4th-generation and 3rd-generation cephalosporins. The mean prediction error over 12 months in 2013 with these few antibiotics was only 1–3% of the monthly antibiotic consumption amount.The total antibiotic consumption amount at the hospital level can be represented sufficiently by a few antibiotics, such as fluoroquinolones and aminoglycosides, which means that hospitals can save resources by tracing only the usage of those few antibiotics instead of the entire inventory. Since the choice of fluoroquinolones and aminoglycosides is based solely on our Korean data, other hospitals may follow the same modelling methodology to find their own representative antibiotics.The online version of this article (10.1186/s12879-018-3132-7) contains supplementary material, which is available to authorized users. Antimicrobial resistance is a worldwide problem, which poses a serious threat to global public health . In 2011As is well documented, the overuse/misuse of antibiotics has been recognized as a key factor for the emergence of antimicrobial-resistant organisms . InapproTo this end, we collected data on antibiotic prescriptions from six large Korean university hospitals with good computerized systems. There were considerable difficulties in collecting data on antibiotics because there were too many different types of antibiotics but no experienced/dedicated staff to collect data on antibiotics. There was no problem obtaining data on the prescription department, administration route and volume of drug, but a big problem in the data collection was that antibiotics were recorded by the brand name, not by the ingredient names nor by the antibiotic class name. This required extra effort to convert the data into a suitable and consistent form.The goal of this paper is to explore whether it is possible to look at only a couple of representative antibiotics to determine the total antibiotic consumption at the hospital level. If yes, this means a considerable savings in terms of time and effort to keep track of all antibiotic use. To this goal, we built a statistical model, in which 1–3 representative antibiotics are chosen to predict the total antibiotic consumption at the hospital level, with an acceptably small magnitude of prediction error.t only. Because the total amount consists of the representative antibiotics and the remaining (non-representative) ones, this modelling strategy amounts to explaining the remaining antibiotics using their correlations with the representative antibiotics as well as the time and month dummy variables. We estimate the model using the observations over 2004–2012 of six large university hospitals in Korea, one of which is the Hanyang University Seoul Hospital (HUS). Then, the model prediction capability is evaluated for the ensuing year (2013), using the data from HUS.We build a simple linear statistical model, where the total antibiotic consumption at the hospital level is explained by 1–3 representative antibiotics along with time and month dummy variables–the time and month dummy variables are “free”, as they depend on time index We collected data on the total antibiotic prescriptions for inpatients and their total patient days in 2004, 2008 and 2012 from six university hospitals (4 tertiary and 2 secondary) in Korea: Hanyang University Seoul Hospital (758 beds), Chungbuk University Hospital (620 beds), Chonnam University Hospital (970 beds), Gyeongsang University Hospital (889 beds), Hanyang University Guri Hospital (578 beds), and Korea University Ansan Hospital (543 beds). In addition, we collected data from HUS for each year between 2004 and 2013 on the total antibiotic prescription records and the total patient days. All data were extracted from the electronic billing system by the data processing department in each hospital.We define antibiotics as medications with class J01 in Anatomical Therapeutic Chemical (ATC), which does not include antifungal agents nor anti-tuberculosis agents. Systemic agents with oral or parenteral administration routes are included, but topical agents are excluded. We convert each class of antibiotic amount to a defined daily dose (DDD) by using the ATC of the WHO and then standardize for 1000 patient days .We classify antibiotic agents into 19 classes: 1st-generation cephalosporins (1st CEP), 2nd-generation cephalosporins (2nd CEP), 3rd-generation cephalosporins (3rd CEP), 4th-generation cephalosporins (4th CEP), aminoglycosides (AG), beta-lactam/beta-lactamase inhibitors (BL-BLI), carbapenems, fluoroquinolones (FQ), glycopeptides, lincosamide, macrolides, metronidazole, monobactam, oxazolidinone, penicillins, polymyxin, tetracyclines, tigecycline and trimethoprim/sulfamethoxazole. Other antibiotics such as amphenicol, fosfomycin, and streptogramin are excluded because they are rarely used.nht denote the patient days for hospital h = 1 … 6 and month t; t ranges over 1 … 12 (year 2004), 49 … 60 (year 2008) and 97 … 108 (year 2012) for the hospitals other than HUS, and t ranges over t = 1 … 108 for HUS. Let DDDaht denote the DDD for antibiotics a, hospital h, and time t. With ‘≡’ standing for “defined as”, let ‘all-hospital patient days at time t’ and ‘all-hospital DDD for antibiotics a at time t’ beLet Then, the all-hospital DDD per 1000 patient days for antibiotics a at month t ism (‘m’ for main) be the number of the main  antibiotics; m = 1, 2 or 3 in this paper. Listing the main antibiotics first, the total antibiotic amount at time t can be written asLet Yt with the main antibiotics, it is necessary to account for the remaining part To achieve our goal of representing the total t to capture the trend, (ii) month dummies to capture the monthly variations, (iii) and some calendar time dummies to capture “structural breaks” , if there are any. Since all three types are determined by t, no data collection is needed for them. We illustrate these three types next. Let 1[A] = 1 if A holds, and 0 otherwise.We used three types of free variables to account for t = 1 … 17 monthly observations over January 2004 to May 2005. First, use a polynomial function such as t …tp). Second, capture the monthly variations with the month dummies; e.g., the February dummy 1[t ∈ February] is to capture the February effect relative to the baseline January, where ‘∈’ means “belonging to”, and the March dummy 1[t ∈ March] is to capture the March effect relative to January. Third, there might be a big policy change, say, a crackdown on antibiotic abuse at t = 6 and onwards, in which case 1[6 ≤ t] can be used to account for the crackdown that is a structural break.Suppose we have t-based variables are in the model, whereas the other antibiotics are not, in essence, the omitted non-representative antibiotics are explained by their correlations with the main antibiotics and the t-based variables. After the model parameters are estimated using the time-series data up to t = 108 (December 2012), we then construct the predicted Yt for t = 109~ 120 (2013) for HUS using the estimated model; let Since the main antibiotics and t = 1~ 108, predicting t = 1~ 108 is “in-sample prediction”, and predicting t = 109~ 120 is “out-sample prediction”. The out-sample prediction is to pick the representative antibiotics, and the in-sample prediction is just to see how the chosen representative antibiotics perform in fitting the in-sample observations. Since we put more emphasis on predicting the future than on explaining the past, the out-sample prediction is our primary criterion to determine the representative antibiotics, whereas the in-sample prediction is secondary.After model estimation using m = 2. For each main antibiotic candidate, we obtain To explain how to select 1–3 main antibiotics, suppose In other words,  is the am, the reason is that there is a trade-off in setting m large v. small. If m is large, say 10, we can trace the overall antibiotic consumption better, but then the representativeness will be worse; if m is small, say 1, then the opposite happens. Between these extremes, 1–3 seem to be reasonable values, and for each chosen value of m, we try different combinations of antibiotics.To explain why we consider different values for t-based variables collectively explain Yt, is shown in Additional file P < 0.05. R2 shows the proportion of the Yt variation explained by all “regressors”  jointly.The model for the ordinary least squares (OLS) estimator, where the main antibiotic amount and the above “free” Pooling all time-series data of the six hospitals into one big data set, Table m = 1, and it is 17.2 using AG and 4th CEP for m = 2, where the predictors were obtained with all six hospitals’ data. In contrast, the mean prediction error is 20.7 DDD/1000 patient days using only FQ for m = 1, and it is 18.3 using FQ and AG for m = 2, where the predictors were obtained with only the HUS data.Table In Table m = 1, 2, and 3 is, respectively,Define the “mean prediction error multiplied by 100 and divided by the monthly antibiotics consumption amount in Table m = 1, 2, and 3 isUsing the HUS data, the relative mean prediction error for m = 2 and 3 cases here and the rows for m = 2 and 3 in Table 2, although the predicted Y is for HUS, using all the hospital data is preferable to using only the HUS data to minimize the prediction error.Judging from the Figure m = 1,2,3) values for the six hospitals, and the fitness looks good; Fig. t = 52 in Fig. t] in the OLS for the HUS data.Figure Taking the most prescribed antibiotics  as the three representative antibiotics, we redrew Figs. Collecting data on all antibiotics is a tedious and painstaking task in Korea, and this may be the case in other countries as well. We showed that it is possible to use only 1–3 representative antibiotics to track the total antibiotic consumption at the hospital level. Our main finding is that FQ and AG are the most representative, followed by BL-BLI, 4th CEP and 3rd CEP. Our mean prediction error is only 1–3% of the monthly antibiotic consumption amount, which is the average across the hospitals and years in our data. Whether or not these levels of prediction error are tolerable depends on how much we save in terms of time and money by not collecting data on the other antibiotics.Although our representative antibiotics were selected, not based on their medical effectiveness, but based on how well they collectively represented the total antibiotics usage, the representative antibiotics also happened to be the most commonly prescribed for inpatients, except for 4th CEP. To better monitor antibiotic consumption in hospitals, one of the broad-spectrum antibiotics or antibiotics against multi-drug resistant pathogens (such as carbapenems) could be co-monitored with our representative antibiotics.The overall antibiotic usage patterns in our data differ little from other studies in Korea. A single-centre study found that 3rd CEP was the most commonly prescribed antibiotic for hospitalized patients in Korea, followed by FQ, BL-BLI and 1st CEP . AdditioThe antibiotic usage pattern is different at various levels. For instance, in Italy and the UK, AG are not used as frequently as in Korea , 11, whit and different structural breaks at different times. Once the methodology is set, the hospital would then address the problem of selecting a few representative antibiotics, which is in fact more difficult than it looks; e.g., if three are to be chosen out of 20 antibiotics in total, there are 1140 possible combinations. In this case, despite many differences across countries and hospitals within the same country, our findings should be helpful in choosing antibiotics to consider first ; of course, the most commonly prescribed antibiotics in the hospital would also make good candidates.The methodology we presented used basic statistics for predicting future time-series variables. It should not be too difficult for hospitals to tailor the methodology to meet their needs, finding a few representative antibiotics by using, e.g., different functions of We attribute the structural break in Fig. As the HUS time-series data plot illustrates in Fig. There are some notable limitations in our study. First, the six university hospitals were selected, not by any sampling principle, but by ease in data collection, in which sense our data may not be representative of the large university hospitals in Korea that would be our study population of interest. For five hospitals, we could gather only three years of data, which resulted in relatively larger standard errors than we would have liked. Second, the prediction performance was gauged using only one hospital’s single-year data, and thus, using other hospital data or a longer time span of data may alter/qualify our findings. Third, we adopted a relatively simple ordinary least squares estimator to find the time trend and monthly variations; more statistically sophisticated models and approaches may refine and improve the prediction capability. Finally, we measured antibiotic consumption by DDD instead of days of therapy (DOT). According to a recent guideline for antibiotic stewardship programmes, DOT is preferred to DDD as a measure of antibiotic consumption . HoweverAs far as we are aware, our study is the first of its kind to look at the possibility of using only a few antibiotics to track the total antibiotic consumption at the hospital level. Hopefully, more studies will be done to save medical personnels’ time and effort surrounding non-essential data collection, so that they can concentrate on more important healthcare activities.This study showed that the total antibiotic consumption at the hospital level can be represented sufficiently well by a few antibiotics. FQ and AG were the most representative in the sense of minimizing the mean prediction error, followed by BL-BLI, 4th CEP and 3rd CEP; the mean prediction error is only 1–3% of the monthly antibiotic consumption amount. Despite this positive finding, because our analysis is based solely on Korean data and because the medical environment/practice of each country and each hospital differs, other hospitals may follow a similar modelling strategy to find their own representative antibiotics instead of readily adopting the aforementioned antibiotics as the most representative.Additional file 1:Supplementary materials. The model for ordinary least squares (OLS) estimator. (DOCX 97 kb)


Each year, an estimated 2 million persons in the United States are infected with antibiotic-resistant bacteria, and approximately 23,000 die as a result . The risThe use of antibiotics is the single most important factor leading to antibiotic resistance around the world. In September, the White House issued an executive order and announced the National Strategy to Combat Antibiotic-Resistant Bacteria.CDC will leverage its expertise and build on core strengths to address the threat of antibiotic resistance to slow the development of resistant bacteria and prevent the spread of resistant infections by 1) strengthening national surveillance efforts to track resistant bacteria, 2) advancing development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria, and 3) improving international collaboration and capacities for antibiotic resistance prevention, surveillance, control, and antibiotic research and development.http://www.cdc.gov/getsmart/week.This year, Get Smart About Antibiotics Week is being observed during November 17–23, 2014. This is an annual observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate prescribing and use. The observance is a key component of CDC’s efforts to improve antibiotic stewardship in communities, in health care facilities, and on farms in collaboration with state-based programs and others. Get Smart About Antibiotics Week coincides with many global antibiotic resistance observances, including those in Europe, Australia, and Canada. Information on scheduled activities and how to get involved in combating antibiotic resistance is available at


Concrete is one of the most common materials used to construct a variety of civil infrastructures. However, since concrete might be susceptible to brittle fracture, it is essential to confirm the strength of concrete at the early-age stage of the curing process to prevent unexpected collapse. To address this issue, this study proposes a novel method to estimate the early-age strength of concrete, by integrating an artificial neural network algorithm with a dynamic response measurement of the concrete material. The dynamic response signals of the concrete, including both electromechanical impedances and guided ultrasonic waves, are obtained from an embedded piezoelectric sensor module. The cross-correlation coefficient of the electromechanical impedance signals and the amplitude of the guided ultrasonic wave signals are selected to quantify the variation in dynamic responses according to the strength of the concrete. Furthermore, an artificial neural network algorithm is used to verify a relationship between the variation in dynamic response signals and concrete strength. The results of an experimental study confirm that the proposed approach can be effectively applied to estimate the strength of concrete material from the early-age stage of the curing process. Concrete is one of the most common materials used to construct civil infrastructures, such as buildings and bridges. However, it is also one of the most difficult materials to manage because concrete is a mixture, consisting of cement, water, sand, gravel, and other aggregates. Due to its heterogeneous property, it is difficult to mathematically predict the compressive strength of concrete during and/or after curing. In particular, predicting the compressive strength during the curing process is important to reduce the construction time and cost by determining the appropriate curing time to achieve sufficient strength. The in situ strength of concrete structures can be determined with high precision by performing a destructive strength test and material analysis on core samples extracted from the structure . HoweverThermal property-based concrete strength NDT methods focus on the hydration heat occurring during the curing process. Concrete hardens due to the hydration process between water and cementitious materials. Because the hydration process involves an exothermic reaction, the concrete generates a certain amount of heat during the curing process. The strength of concrete can be estimated from the degree of hydration, and it can be calculated by measuring the hydration heat. Therefore, the strength of concrete can be estimated by measuring the thermal history of concrete through thermocouples, fiber optic sensors, or other thermal sensors ,3. The pBecause the concrete is heterogeneous material, the strength of concrete is hard to estimate using a formal equation. To overcome this limitation, the neural network was used to estimate the strength of concrete. The strength of HPC (High Performance Concrete) can be modeled using a modified neural network architecture  and fuzzIn this context, this study proposes a novel method to estimate the strength of concrete at the early-age stage by integrating an artificial neural network algorithm with dynamic response signals of the concrete material. The dynamic response signals of the concrete, including both electromechanical impedances and guided ultrasonic waves, are obtained from an embedded piezoelectric sensor module. The cross-correlation coefficients of the electromechanical impedance signals and the amplitudes of the guided ultrasonic wave signals are selected to quantify the variations in dynamic response signals according to the strength of the concrete. Furthermore, an artificial neural network algorithm is used to verify a relationship between the variations in dynamic response signals and concrete strength. The results of an experimental study confirm that the proposed approach can be effectively applied to estimate the strength of concrete materials from the early-age stage of the curing process.Piezoelectric sensors can interconvert mechanical energy and electrical energy. Due to this piezoelectric effect, a piezoelectric sensor can be used simultaneously as both an actuator and a sensor. This study employs a lead zirconate titanate (PZT) patch to generate vibration and waves to the concrete structure, and measure the dynamic responses of the concrete ,17. TablTo obtain dynamic responses from the inside of concrete structures, the sensors should be embedded within the concrete. However, the PZT can be easily broken by stresses, such as the thermal stress and shrinkage stress of concrete. To protect the PZT in the concrete, an embedded piezoelectric sensor has been developed . The novThe electromechanical impedance (EMI) method has been developed for structural health monitoring, damage detection, and NDT ,20. If tThe dynamic stiffness of concrete changes, according to the development of strength during the curing process. Also, the EMI signals measured in the concrete media should vary during the curing stage. Therefore, the strength of concrete can be estimated by tracking the variation of the EMI signals.In this study, an EMI measurement system based on a self-sensing technique with a single embedded piezoelectric sensor was used. A voltage divider-based self-sensing circuit as described in The harmonic wave measurement method is also used to estimate the strength of concrete. The embedded piezoelectric sensor module consists of two embedded piezoelectric sensors, one of which introduces a harmonic wave to the concrete, while the other senses the propagated waves.The harmonic wave propagation in the concrete media can be idealized as one-dimensional longitudinal wave propagation, as A is the harmonic amplitude, and ω is the angular frequency [The wave equation of a one-dimensional longitudinal wave is:requency .E) is the factor that affects the most change, not only of the strength of concrete, but also of the amplitude of harmonic wave propagation. Hence, the strength of concrete can be estimated by measuring the amplitude of harmonic wave propagation through concrete [Concrete is a cementitious material that has the adhesive and cohesive properties to bond inert aggregates into a solid mass of adequate strength and durability. After casting, the concrete gradually stiffens, until the hydration is completed. The physical properties of concrete, especially the strength, are rapidly changed during curing process. Young’s modulus  comprises a number of processing elements that are connected to form layers of neurons, although the networks may be complex. The missing links between sets of inputs and outputs are found by determining the optimal synaptic weights, based on the available training data of the inputs and outputs . A superThe input to the ANN are the variables, , with Φ10 × 20 cm standard cylinders cast with the same concrete as that of the test specimen, at 16, 25, 38, 51, 75, and 99 h after casting. The EMI and harmonic wave signals were measured using the NI-PXI DAQ system (1042Q), and a self-sensing circuit board was used for EMI measurement. The EMI was measured in the frequency range of 5 kHz~200 kHz, with a 2 MHz sampling rate. The harmonic wave was actuated with a 100 kHz frequency signal, and measured with a 5 MHz sampling rate. The dynamic response signals were measured every hour after casting, up to 100 h.The measurement result of EMI is shown below. CC) was calculated to provide quantitative information about signal variation. The 1-CC values were derived using the following equation:0) is the real part of the impedance function at the baseline (the EMI data before embedment), Re(Zi) is the real part of the impedance of the i-th hour at each measured data, N is the total number of datasets.The cross-correlation coefficient index .The equation for estimating the strength was derived using a linear regression method using the 1-To quantify the signal variation, the amplitude of the harmonic wave is extracted as a feature of wave propagation. Although the slope of decreasing amplitude is not clear and both data are not the same, the two sets of amplitude data show that the amplitude decreases according to the increase of strength. This is caused by the inverse relationship between the wave amplitude, and the Young’s modulus (E) of the propagation media. However the amplitudes only change by 1%, and the variation patterns are dissimilar between module 1 and 2. This is due to the fact that the path of wave was different because the placement of aggregates. Thus the amplitude of harmonic wave is not recommended to estimate concrete strength estimation in this specimen.The features of the dynamic response signals have a certain pattern related to the increase in concrete strength. The ANN was utilized to recognize the pattern and estimate the strength of concrete, using the features from the dynamic response signals. The transfer function of ANN was tan-sigmoid function and the learning rule was Levenberg–Marquadt backpropagation. Also, the ANN had 10 hidden layers and one output layer.CC of the impedance signals and the output data was the reference strength. The unmeasured reference strength was calculated by the interpolation using the measured reference strength and the curing time. The ANN was trained by data from module 1 and the trained ANN was verified by inputting the data from module 2.The input data consisted 100 sets of the 1-In this paper, an ANN model trained by dynamic response signals is proposed to estimate early-age strength monitoring of concrete. The dynamic response signals, the electromechanical impedance and ultrasonic harmonic waves are changed by the strength variation of the host concrete. The EMI and harmonic waves were measured during the curing process using two embedded piezoelectric sensor modules, and the reference strength was measured using a destructive test on standard cylinders. From a series of experimental studies, it was confirmed that the dynamic response signals obtained from the concrete during the early-age of the curing process has a pattern according to the strength. According to the strength gain, the resonant frequency of EMI was gradually increased and the amplitude of harmonic wave was decreased. The variation in resonant frequency of the two sensor modules had a similar tendency while the variation in amplitude of the harmonic wave response of the two sensor modules had a dissimilar result caused by the path difference. Thus, the EMI variation was selected to estimate the strength of concrete. The cross-correlation coefficient was used to quantify the variation in EMI according to the strength gain. Furthermore, an artificial neural network algorithm was used to define the relationship between the variation in EMI and the strength of concrete. The ANN model was trained by the variation in 1-CC of EMI measured by sensor module 1 and verified by the data of sensor module 2. The results conclusively confirmed that the proposed approach could be effectively applied to estimate the strength of concrete material from the early-age stage of the curing process.


Date of publication: 9 September 2016Crimean–Congo haemorrhagic fever in Spainhttp://ecdc.europa.eu/en/publications/Publications/crimean-congo-haemorrhagic-fever-spain-risk-assessment.pdfDate of publication: 6 September 2016Salmonella Enteritidis phagetype 8, MLVA type 2-9-7-3-2 infections Multi-country outbreak of http://ecdc.europa.eu/en/publications/Publications/29-08-2016-RRA-Salmonella%20Enteritidis-United%20Kingdom,%20Netherlands.pdfDate of publication: 1 September 2016Measles and rubella monitoring, July 2016http://ecdc.europa.eu/en/publications/Publications/measles-rubella-monitoring-july-2016.pdfDate of publication: every FridayECDC communicable disease threats reporthttp://ecdc.europa.eu/en/publications/surveillance_reports/Communicable-Disease-Threats-Report/Pages/default.aspx


These four unrecovered patients had a history of CKD, a longer period of persistently elevated SCr, a thinner total renal parenchyma thickness, and continuous elevated serum IgG4 levels after steroid therapy, compared with those recovered patients (P < 0.05). We concluded that recovery and long-term prognosis of the disease were primarily associated with timely diagnosis and proper treatment.IgG4-related retroperitoneal fibrosis (IgG4-RPF) is a newly recognized entity which often mimics cancer. We aimed to investigate the clinical features and the causes of renal failure, as well as to explore the factors affecting the prognosis of renal function by analysis of the clinical data of patients with IgG4-RPF. We reviewed clinical features of 10 patients with renal failure caused by IgG4-RPF, which was confirmed by pathology review and clinic-pathologic correlations. All patients were male, and the mean age at onset was 64.2 ± 10.0 years. Five patients were revealed with acute renal failure (ARF), while the other five ones with ARF on chronic kidney disease (CKD) (A on C) at diagnosis. Initial favorable responses obtained in 90% of the patients who underwent steroid therapy. The serum creatinine (SCr) level returned to normal in six patients including five with ARF and one with A on C, while those of the rest four patients with A on C restored to baseline levels (GFR remained below 60 ml/min/1.73 m IgG4-related disease (IgG4-RD) is a newly recognized entity characterized by tumour-like swelling in multiple sites caused by lymphoplasmacytic infiltration and sclerosis, and it has been associated with elevated serum IgG4 level and infiltration of IgG4-positive plasma cells in the involved organs and tissues , 2. IgG4More and more reports on IgG4-RPF as an extrapancreatic lesion of AIP have been published recently, and to be more exact, IgG4-RPF is now regarded as a typical lesion associated with IgG4-RD , 8. Prev1. Although the published literature included several small case series and individual case reports of IgG4-RPF, only very few reports focused on renal failure caused by IgG4-RPF, and the investigation of long-term clinical follow-up and prognostic factors of renal function were absent. We accordingly examined the clinicopathological features of patients with renal failure caused by IgG4-RPF, and investigated their prognostic factors of renal function.Similar to RPF, IgG4-RPF also develops around the abdominal aorta and iliac arteries, often entrapping the ureters and ultimately leading to hydronephrosis and renal failureAll of the ten patients were male. The mean age at onset was 64.2 ± 10.0 years old. The average time from the symptoms onset to the diagnosis being established was 10.6 ± 7.6 months. The mean duration of elevated SCr levels before steroid therapy was 1.5 (0.3–26.0) months. Various initial symptoms were predominantly related to RPF, including back pain (10%), edema of the lower extremities (20%), oliguria (10%), weight loss (20%) and hypertension (10%), while other initial symptoms were due to non-RPF associated diseases, including swelling of salivary glands (30%), mediastinal tumour (10%), swelling of the lacrimal glands (10%), dry mouth (10%), pulsatile abdominal mass (10%) and pain of the lower extremities (10%). Allergic history was found in five patients (50%). Past medical history included hypertension (3 cases), chronic kidney disease , coronary heart disease (1 case), cerebral haemorrhage (2 cases) and urinary bladder tumour (1 case) (Table n = 1), mandibular gland (n = 5), lacrimal gland (n = 2), peripheral lymph nodes (n = 3), pancreas (n = 2), thymus (n = 1), gastrointestinal tract (n = 1), biliary system (n = 1), aorta abdominalis (n = 1), lung (n = 1) and inner ear (n = 1). The mean number of organs involved was 3.5 ± 1.3, which was not correlated with the serum IgG4 concentration before therapy .Evident lesions of IgG4-RD were present in other eleven organs besides retroperitoneum in this series of patients, including the renal interstitium ; the mean eosinophil count was 1.9 ± 1.6 × 109/L, without eosinophilia detected. The median C-reactive protein (CRP) level was 6.8 (0.6–42.3) mg/L, and high CRP level were seen in 6 patients (60%); all cases presented elevated ESR with an average level of 34.5 (17.0–110.0) mm/1 h. Positive ANAs were seen in 20% of patients, and 90% of patients (9 patients) showed elevated serum IgG4 with an average IgG4 level of 8.1 (1.4–13.1) g/L. 70% cases with hypocomplementemia and 90% patients with anemia resulted in a mean complement C3 of 0.8 ± 0.2 g/L and an average Hb of 90.5 ± 22.9 g/L, respectively. Five A on C cases had an average GFR of 39.4 ± 9.3 ml/min/1.73m2 and five ARF cases had a mean SCr of 632.5 ± 269.3 μmol/L. Four patients had mild urine protein and one patient was confirmed with IgG4-related tubulointerstitial nephritis (IgG4-TIN) by kidney biopsy. One of our patients developed septicaemia which suggested a severe inflammatory reaction in the course of disease.The median WBC count was 6.7 (3.9–26.6) × 10n = 6) had a higher median level of 0.9 (0.8–1.1) g/L, and there was borderline significant difference between the two groups (P = 0.057).All the four patients with proteinuria had hypocomplementemia with a median complement C3 level of 0.7 (0.7–0.8) g/L, while the patients without proteinuria . The ureter was involved in the retroperitoneal masses which led to ureterohydronephrosis in all patients. Renal atrophy was observed in 6 cases , including one with bilateral renal atrophy and five with unilateral renal atrophy. The median total renal parenchymal thickness was 3.0 (1.7–3.9) cm. There was moderate correlations between the duration of elevated SCr levels before steroid therapy and total renal parenchymal thickness (1.5 cm (0.3–26) vs 3.0 cm (1.7–3.9), r = 0.75, P < 0.05).The retroperitoneal masses were detected primarily in the left renal hilus in 1 patient (Case 10), in the periaortic region in 5 patients , and in the periiliac area in 4 patients . One case was complicated with abdominal aortic aneurysm (Case 4), and abdominal aortic calcification was found in 6 cases. The retroperitoneal masses involved the ureter and were associated with ureterohydronephrosis in all patients  accepted FDG-PET test. FDG uptake was detected in the retroperitoneal masses in all the three patients and was also detected in many of the other IgG4-related lesions.Abundant infiltration of IgG4-positive plasma cells, storiform fibrosis and obliterative phlebitis were histologically confirmed in the resected salivary glands , peripheral lymph nodes (Case 4 and 7), lacrimal gland (case 8), pancreas (Case 6), bile duct (Case 5), and thymus (Case 2), as well as needle biopsies including the organs of retroperitoneum (Case 8) and kidney (Case 2). We found a significant IgG4 + plasma cells infiltration, with a median number of IgG4 + plasma cells/high power field (hpf) of 50.5 (34–60), and the ratio of IgG4 + to IgG + was 63.5% (50–80%).In the initial phase of clinical course, four patients were treated with surgical intervention, including implanting ureteral stents  and abdominal aortic stents (Case 4). Six patients accepted hemodialysis . Steroid therapy was implemented on all patients, among whom 9 patients responded well. The initial dose of oral prednisolone was 0.6–0.8 mg/kg/d, which was gradually tapered by 2.5-5.0 mg every one to two weeks according to serological and imaging tests. Maintenance therapy with low-dose of prednisolone (5-10 mg/day) was administered in all of these patients. One patient  was not sensitive to corticosteroids and received immunosuppressive treatment  along with low-dose corticosteroids. The whole course lasted for 6-8 months according to the function recovery of organs involved.P = 0.007); the median serum IgG4 concentration was 2.1 (1.2–11.0) g/L, which was also obviously decreased compared with those before treatment (P = 0.009). However, no correlation was observed between the measurements .After steroid therapy, the median number of organs involved decreased to 1.0 (1.0–2.0), which was significantly less than pretherapy (P = 0.005), and six patients recovered to normal SCr level but four patients developed CKD later .At the end of course of steroid therapy, SCr decreased significantly to 139.6 ± 76.7 μmol/L , a longer duration of elevated SCr before therapy , a thinner total renal parenchymal thickness (2.2 cm (1.7–2.3) vs 3.8 cm (2.5–3.9), p = 0.010) and higher post-treatment serum IgG4 concentrations (5.1 g/L (2.3–11.0) vs 1.3 g/L (1.2–2.3), P = 0.010). There were no significant differences in disease duration, age at onset, serum inflammatory markers, the treatment other than prednisolone  with an average eGFR of 31.5 ± 11.2 ml/min/1.73mAll the patients were followed up for a median period of 48 (12–74) months. Over the entire follow-up, no patients died or developed tumours. Two patients (20%) suffered a relapse during follow-up. One patient developed sclerosing cholangitis after steroid withdrawal, and the other experienced sensorineural hearing loss (SNHL) during the course of steroid reduction. Restarting prednisolone at a dose of 40 mg/d led to a complete remission in both of them.IgG4-RPF is a rare disease which often mimics cancer, and has a high risk of developing CKD. There have been several reports on IgG4-RPF , but non1. The manifestations of IgG4-RD in the retroperitoneum consist of retroperitoneal fibrosis and inflammatory abdominal aortic aneurysms. IgG4-RD occurs predominantly in men in their fifth and sixth decades of life1. The mean age at onset was 64.2 ± 10.0 years old in this study, similar to those in previous reports.IgG4-RD is an immune-mediated fibro-inflammatory condition that can affect nearly any organSeveral reports have suggested that concurrent RPF occurs in approximately 10% of cases of IgG4-RD , 16. HowIgG4-RD usually occurs with a history of chronic allergic conditions, such as allergic rhinitis, atopic eczema, asthma and peripheral blood eosinophilia , 11. SomThe laboratory findings observed in the present series were similar to those previously reported in the literature, including increased levels of CRP (60% vs. 58–79% –22) and Hypocomplementemia has also been frequently observed in IgG4-RD, and complement C3 levels commonly returned to normal after treatment –25. HoweIn this study, one patient in our centre accepted renal biopsy, and renal pathology confirmed IgG4-RPF combined with IgG4-TIN. As a matter of fact, the urinary system can be affected by IgG4-RD in a variety of patterns. Ureteral encasement and renal dysfunction are closely related to IgG4-RPF, while underlying tubulointerstitial nephritis and membranous glomerulonephritis can also be present , 18, 27.IgG4-RPF is often sensitive to steroid therapy, and remission occurs after therapy of 6-9 months . The effP < 0.05). Patients with ARF had a better prognosis of renal function than those with CKD history during steroid therapy.The prognosis of iRPF is related to renal involvement. No predictors or risk factors have been identified for relapse of IgG4-RPF . Risk faTherefore, recovery and prognosis of renal function were primarily related to timely diagnosis and treatment. In our centre, post-treatment SCr levels decreased to 139.6 ± 76.7 μmol/L, which was significantly lower than pretherapy, thus delaying the progression of CKD. In addition, the Case 8, who was complicated with CKD, achieved an approving recovery of renal function. Thus, patients with CKD caused by IgG4-RPF should carefully evaluate the disease activity, and actively try to use steroid therapy in order to restore the renal function to the maximum extent. Persistently elevated IgG4 concentrations after therapy may indicate poor prognosis of renal function; however it is still inconclusive whether serum IgG4 concentrations return to normal at the end of steroid treatment.In conclusion, this center, for the first time in China, performed the analysis of clinical features and prognostic factors in 10 patients with renal failure caused by IgG4-related retroperitoneal fibrosis, hoping to provide information for nephrologist in the diagnosis, therapy and prognosis estimation. However, these results must be confirmed by a prospective, multicentre study with a larger number of patients. The diagnosis of and therapy for IgG4-RPF is not yet standardized, and further studies are needed to determine the optimal treatment and long-term follow-up outcomes for the patients with renal failure.Between January 2001 and January 2015, a total of 36 patients treated at the Affiliated Hospital of Qingdao University were diagnosed with IgG4-RD, of which, 13 patients were with IgG4-RPF (33.3%) and 10 (77%) patients revealed renal failure caused by IgG4-RPF. Here, those 10 patients with renal failure were involved in our study. The study protocol was approved by the Ethics Committee of the Affiliated Hospital, Qingdao University. Informed consent was obtained from each subject.The diagnosis of IgG4-RD was predicated upon the careful clinicopathologic correlation. Through observing biopsy materials from at least one organ of every patient, we concluded that the major histopathologic features included dense lymphoplasmacytic infiltration, fibrosis with a storiform pattern in focal (or diffuse) areas, and obliterative phlebitis. Significant IgG4+ plasma cell infiltration was considered if there were more than 10 IgG4+ plasma cells per high power field (hpf) and an IgG4+-to-IgG+ ratio of at least 50%. RPF was diagnosed by contrast-enhanced computed tomography (CT) following commonly accepted radiological criteria, including soft tissue masses surrounding the aorta and/or adjacent tissues on CT and/or magnetic resonance imaging (MRI). Patients were excluded if they had possible secondary causes of idiopathic retroperitoneal fibrosis, such as drugs , malignancies, external beam radiation, tuberculosis, or asbestos exposure .Renal parenchymal thickness was measured using the first and last noncontrast CT image levels from the anterior, posterior and lateral locations of the kidney that clearly included the collecting system. The mean of these measurements was defined as the renal parenchymal thickness. The sum of bilateral renal parenchymal thickness measurements was the total renal parenchymal thickness .t-test; all continuous non-normally distributed data were analysed by non-parametric testing. Categorical variables were assessed by the Chi-square test or Fisher's exact tests, as appropriate. Correlations were determined using Pearson's correlation coefficient  or Spearman's correlation coefficient (nonparametric data). A P-value < 0.05 was considered significant for all statistical testing while 0.05 < P < 0.1 was borderline significant.Statistical analysis was performed using SPSS software, version 19 . Significant differences for continuous, normally distributed data were analysed by Student


S-methyl-11C]-L-methionine ([11C]MET) uptake in the pancreas might be a central indicator of beta cell function. Since gastric emptying was recently shown to influence glycemic control in subjects after pancreaticoduodenectomy , we looked for imaginable relationships between gastric emptying, pre- and postprandial insulin concentrations, and [11C]MET uptake.[11C]MET were administered and the activity  over the pancreas was measured at 15, 30, and 60 minutes after injection. Total integrated SUVmax (area under the curve [AUC]) and incremental SUVmax were calculated.Nineteen tumor-free survivors after PD  and 10 healthy controls  were given a mixed test meal. One gram of paracetamol was ingested with the meal to evaluate the speed of gastric emptying. Insulin, glucose, and paracetamol plasma concentrations were measured before and over 180 minutes after ingestion. Beta cell function was calculated from fasting glucose and insulin plasma concentrations. Simultaneously, 800 MBq of [11C]MET in the pancreas was significantly higher (p < 0.0001) in controls compared to the PD group. Gastric emptying was significantly slower in controls compared to pancreatectomy subjects (p < 0.0001). Paracetamol AUC30 correlated with the SUVmax increment between 15 and 30 minutes , suggesting a relationship between gastric emptying and the uptake of [11C]MET. Total integrated SUVmax correlated with insulin AUC60  in patients after PD. Multivariate regression analysis revealed insulin AUC60 and beta cell function, calculated from the fasting insulin to glucose ratio, as independent predictors of 11C-methionine uptake, i.e. total integrated SUVmax, in patients after PD .The uptake of [11C]MET uptake may represent basal and postprandial beta cell function. The findings suggest a possible usefulness of this imaging procedure for further studying beta cell function.Postprandial [ S-methyl-11C]-L-methionine ([11C]MET), a PET tracer, radiolabeled with short-lived carbon-11 without any alteration to the molecular structure, is an universal donor of transmethyl reactions that participates in the synthesis of DNA and RNA. Methionine is mainly incorporated in the liver, brain, pancreas, and in tumors, where its main metabolic pathway is protein incorporation [11C]MET PET imaging for the examination of the pancreas in 1976 [11C]MET uptake and protein incorporation in duodenal aspirate in patients with chronic pancreatitis, and observed a diminished uptake and incorporation of the tracer. Tracer uptake and amylase output after secretin stimulation were closely correlated MET uptake in type I diabetics, showing a lower tracer uptake as compared to healthy controls. Moreover, in pancreas transplantation, a relationship was found between tracer uptake in the donor pancreas and the duration of insulin independence after transplantation. The authors also suggested this nuclear medical approach to evaluate prospective pancreas donors MET uptake seems to be a central indicator of beta cell function. Therefore, we looked for factors associated with the postprandial uptake in PD. We focused on possible relationships between gastric emptying, pre- and postprandial insulin concentrations, and [11C]MET uptake.MET was prepared on-site for a maximum of three consecutive patients [11C]MET and underwent the first of three PET-CTs after 15 minutes of accumulation. The process required three to five minutes per image. To reduce radiation exposure, only one primary CT scan was obtained to be fused with the subsequent PET scans. To obtain the best possible imaging quality, subjects remained in a supine position, moving as little as possible, until the last scan was recorded. At 15, 30, and 60 minutes after tracer application, PET scans were recorded.MET uptake: AUC60 = (C15 + C30)*15/2 + ((C30 + C60)*30/2). Delta represents the incremental growth over time and is the difference between concentrations of a measured parameter at two different time points.The area under the curve (AUC) was calculated using the trapezoid rule to retrieve integrated values of the measured parameters. Therefore, AUC over 30 minutes (AUC11C]MET pancreas to liver ratio (PLR) was calculated. Regions of interest were the body and tail of the gland. Tracer uptake increments (delta-SUVmax) were calculated between 15–30 and 15–60 minutes. AUC60 of SUVmax was calculated as a measure of total uptake.Maximum tissue standardized uptake values (SUVmax) were obtained manually, based on regions of interest over the pancreas and over the liver. The [The homeostasis model assessment (HOMA) was applied to calculate beta cell function and insulin resistance. The formula by Matthews et al.  is based11C]MET PET-CT scans.After an overnight fast, an indwelling catheter was inserted into the cubital vein and blood was sampled before the ingestion of a liquid test meal (described below), as well as 10, 20, 30, 60, 90, 120, 150, and 180 minutes thereafter for the measurement of insulin, glucose, and paracetamol concentrations. Blood samples were obtained alongside the MET uptake was significantly higher in controls compared to patients, at any of the three time points of measurement  and beta cell function emerged as independent predictors of 11C-methionine uptake, i.e., total integrated SUVmax  compared to controls, suggesting more rapid gastric emptying in the PD patients regardless of pylorus preservation (PPPD). The higher fasting glucose in the PD patients probably reflects the lower steady-state beta cell function. The rapid postprandial rise of plasma glucose can be explained by the more rapid gastric emptying, a relationship that is also observed after operations such as total or partial gastrectomy MET uptake was measured, were twice the value of those in controls. Since our test meal contained no glucose and only 26 g carbohydrates compared with the 75 g glucose used in the oral glucose test by Harmuth et al. MET uptake and early insulin concentrations suggest that the tracer uptake represents insulin production. Moreover, the preprandial baseline beta cell function also correlates with SUVmax. Differences in age might contribute to the difference of tracer uptake and insulin production between controls and PD subjects MET uptake of the pancreas in patients suffering from chronic pancreatitis and alcohol disease, showing a relationship between tracer accumulation and enzyme output of the pancreas as well as tracer incorporation into digestive enzymes. Chronic pancreatitis is a destructive disease that involves the exo- and endocrine pancreas; therefore, diabetes is a common complication [11C]MET PET as an appropriate tool for examining the exocrine gland, diabetes and impaired endocrine function is hardly addressed in these publications. However, beta cell function is probably also represented by methionine accumulation in the pancreas. In patients after PD, the exocrine pancreatic function is significantly impaired MET uptake and insulin production. One major limitation of this study was the younger control group of healthy subjects, which prevented us to assess the impact of age on the measurements.Unfortunately, our results do not allow us to determine the relative impact of exocrine and endocrine function, and further studies with simultaneous measurement of both functions seem to be desirable to clarify the correlation between [11C]MET uptake in combination with plasma insulin concentrations during a test meal, illustrates the relationship between tracer uptake and insulin production. The findings suggest that this imaging procedure is an appropriate tool to further study beta cell function.This study, the first to look at [


AbstractRoa is herein described from the Verde Island Passage in the Philippines, West Pacific Ocean. Roarumsfeldisp. n. was found on mesophotic coral ecosystems at Puerto Galera and Batangas, and sampled through technical mixed-gas rebreather diving at 100–130 m depth. This represents the fifth known species of Roa. The main differences between Roarumsfeldisp. n. and its congeners are the lower number of pored scales in the lateral line, longer snout, longer caudal peduncle, shorter caudal fin, pelvic fin color , and genetics . Roa spp. are usually seen in pairs, but the two specimens we collected were solitary individuals. We have kept one of the specimens alive in the California Academy of Sciences’ Twilight Zone exhibit for more than one year, where it thrives and is feeding on a variety of dried and fresh food.A new species of the butterflyfish genus  Roacf.modesta. After the specimen arrived in San Francisco and entered quarantine, MW noticed that the recent arrival differed from our previously collected specimens by having a black spine in the ventral fin (white in others). We went through our previous years’ collections and found a second specimen of this species collected by spear in 2015 in Puerto Galera, Philippines.While collecting live specimens in Anilao, Philippines to display at the California Academy of Sciences’ Twilight Zone: Deep Reefs Revealed exhibit in 2016, LAR collected a butterflyfish identified at the time as Roa Jordan, 1923, which currently contains four species, all from mesophotic coral ecosystems  in the Indo-Pacific. Although some taxonomists consider this genus as a “modestus species complex” within Chaetodon  was described from Japan and is distributed along the northwestern Pacific, recorded in the Philippines, Hong Kong, Taiwan, Ryukyu and Ogasawara Islands, and Nagasaki, in Japan  occurs in the northwestern Indian Ocean, from India to the Red Sea, while Roaexcelsa  is only known from the Pacific oceanic islands of Hawaii, Johnston Atoll, Pohnpei, and Guam , and comparative material was obtained from the California Academy of Sciences (CAS) fish collection. Mitochondrial Cytochrome c oxidase subunit I (COI) DNA was sequenced and analyzed for the new species. DNA extraction and PCR amplification of the COI were performed following PageBreakprotocols. DNA sequences were then compared to all other Roa species available in GenBank . GenBank accession number for the new species is MF995631.The specimens were collected using hand nets or a Hawaiian sling while diving on mixed-gas, closed-circuit rebreather (Hollis Prism 2). Counts were performed using a microscope, and morphological characters were measured to the nearest 0.1 mm following Taxon classificationAnimaliaPerciformesChaetodontidaehttp://zoobank.org/DA519076-63AA-4866-B4D3-300C1B2F3CC8Puerto Galera, Philippines.PNM 15198 (Field number: HTP 506). 77.53 mm SL, GenBank accession number MF995631, Puerto Galera, Oriental Mindoro, Philippines. 13°31'17.68"N, 120°59'41.78"E, depth 110 m, collected by LA Rocha using a Hawaiian sling, 10 April 2015 . Data from R.australis, R.excelsa and R.modesta also from Roarumsfeldi sp. n. differs from all of its congeners by the smaller number of pored scales in the lateral line pored scales (27 versus 37-46 in other Roa), longer snout (35.9% in HL vs. 28.2–35.5%), shorter first dorsal ray (12% in SL vs. 16.6–26.6%), longer caudal peduncle (8.5% in SL vs. 4.2–8.2%), shorter caudal fin (15.9% in SL vs. 19.8–25.9%), and a dark brown pelvic-fin spine .Dorsal fin rays XI, 20, last soft ray branched to the base and counted as one; dorsal-fin base length: spines 40.0% in SL, and soft rays 31.1% in SL; spines increase in height from the first to the fourth: length of first spine 9.1% in SL, length of second spine 18.3% in SL, length of third spine 24.5% in SL, length of fourth spine 29.1% in SL. Soft dorsal fin follows sharp descent of rear portion of body. First soft ray 12.0% in SL. Anal-fin rays III, 17, last soft ray branched to the base and counted as one; anal-fin base 34.2% in SL; second spine very long, 25.3% in SL. Pectoral fin 13; length 29.1% in SL  than R.jayakari (22–24); longer head (41.0% in SL) than R.excelsa (34.9–37.1); fewer dorsal-fin rays (20) and shorter dorsal-fin rays base (31.1% in SL) than R.modesta (22 rays and 35.3–40.8% in SL); and shorter 3rd anal-fin spine (12.8% in SL) and longest anal-fin ray (13.8% in SL) than R.australis . Moreover, the COI gene sequence of Roarumsfeldi does not match any other Roa species available at Genbank. The uncorrected genetic divergence at the COI gene between R.rumsfeldi and the two other available Roa (R.jayakari and R.modesta) is 10.5% and 8.4%, respectively.In addition to the singular characteristics presented in the diagnosis section, Roamodesta and R.excelsa in shallow waters of Japan and Hawaii, Roa species are normally found at depths exceeding 100 m, with trawling being the most common sampling method for these species (MCEs (60 to 150 m) is enabling new records of reef fishes around the globe (MCE taxa, including Roa species. Here we consider Roa as a valid genus due to its morphological and niche uniqueness, however, a more detailed phylogenetic study is necessary to understand the evolutionary history of this group and its relationship with the Chaetodon lineage.Despite a few records of  species . As trawhe globe , as wellhe globe . The expPageBreak


Recycled aggregate concrete (RAC) is an environmentally friendly building material. This paper investigates the mechanical behavior of recycled aggregate concrete filled steel tube (RACFST) columns exposed to fire. Two groups of 12 columns were designed and tested, under axial compression, before and after fire, to evaluate the degradation of bearing capacity due to fire exposure. Six specimens were subjected to axial compression tests at room temperature and the other six specimens were subjected to axial compression tests after a fire exposure. The main parameters of the specimens include the wall thickness of the steel tube (steel content) and the type of concrete materials. Several parameters as obtained from the experimental results were compared and analyzed, including the load-bearing capacity, deformation capacity, and failure characteristics of the specimens. Meanwhile, rate of loss of bearing capacity of specimens exposed to fire were calculated based on the standards EC4 and CECS28:90. The results show that concrete material has a large influence on the rate of loss of bearing capacity in the case of a relatively lower steel ratio. While steel content has little effect on the rate of loss of bearing capacity of concrete-filled steel tube (CFST) columns after fire, it has a relatively large influence on the loss rate of bearing capacity of the RACFST columns. The loss of bearing capacity of the specimens from the experiment is more serious than that from the calculation. As the calculated values are less conservative, particular attention should be given to the application of recycled aggregate concrete in actual structures. Recycled aggregate concrete (RAC) is a type of concrete material that is made from recycled concrete aggregate (RCA) obtained from waste concrete by cleaning, crushing, and grading ,2. The eThe concept of recycled aggregate concrete was first proposed in 1950s. With extensive research, recycled concrete is no longer a novel technology, and the relevant research is mainly focused on the application of recycled concrete . FlexuraIn the application of recycled concrete column structure, Konno et al. ,24 reporFire is one of the most frequent and widespread disasters in a structure. Once fire occurs in a building, the bearing capacity of the building will be greatly reduced. Fire may cause a continuous collapse type accident, resulting in serious loss of life and property. A study  foresaw To this end, two groups of 12 RACFST specimens are designed in this paper. The main parameters are steel ratio  and the type of concrete materials. One group comprises control specimens that are subjected to axial compression test, and the other group is subjected to axial compression test after being exposed to ISO-834 standard heating. The mechanical properties of the RACFST columns are studied at room temperature and after fire.The length of specimens is 500 mm; the steel tube was seamless tube with wall thickness of either 4 mm or 5 mm; and the diameter of the specimen is 500 mm. The concrete material types were divided into three types: (1) ordinary fine aggregate concrete (FAC); (2) semi-recycled concrete with the replacement rate of recycled coarse aggregate as 100%; and (3) fully recycled concrete, that is, the coarse and fine aggregate are fully replaced by recycled coarse aggregate and fine aggregate. The experimental parameters of concrete for the first group are shown in RCA is the replacement percentage of coarse aggregate in the recycled concrete; and RPRFA represents the replacement percentage of fine aggregate in recycled concrete.In The standard cube compressive strength test was performed on standard concrete cubes (100 mm side with adjustment coefficient of 0.95 ). There Before the fire test, the concrete cubes (each cubes has three samples), which had been cured in advance, were put into a fire stove at 0–1000 °C for an hour. After the fire exposure, the cubes were tested for compressive strength. The average compressive strengths of concrete cubes after fire exposure are shown in fy is the yield strength at room temperature; fu is the ultimate strength at room temperature; and δ is the breaking strain of the steel coupon. Correspondingly, fy-fire is the yield strength after fire; fu-fire is the ultimate strength after fire; and δ-fire is the breaking strain of the steel coupon after fire. The stress–strain curves of steel coupons before and after fire are show in Coupons from the steel tube were tested for tensile strength before and after fire exposure according to the standard GB/T 228-2002 . The dimFor the first group of specimens , the specimens were subjected to axial compression test directly. For the second group of specimens , due to the need for fire resistance test, three K-type thermocouples were arranged in a circular tube based on the principle of symmetry. The arrangement of the sectional drawing is shown in The experiment was conducted in the mechanics laboratory of Beijing University of Technology using a 100-tonne capacity hydraulic testing machine, WE-100. To ensure that the measured deformation values could truly reflect the deformation of the column, an extensometer (with standard distance of 150 mm) was installed around the middle of the columns. The displacement of the specimen was measured by a displacement meter, and the test specimen was arranged as shown in Specimen C-N-T1 is taken as a typical example to describe the failure process of the specimen. The deformation of the specimen is not significant during the initial loading; the main phenomenon that was observed for the steel surface was the peeling of rusted material. When the axial load reached 650 kN, the steel tube began to yield, and the rate of deformation of the steel tube was accelerated. When the load reached 780 kN, the specimen exhibited an elastic-plastic platform. When the load reached 890 kN, the lower part of the specimen showed relatively larger expansion as shown in Fy, peak load Fu, and their corresponding axial deformations are as follows: the axial deformation of yield load Δy, the axial deformation peak load of Δu. Each load has a measured value (MV) and relative value (RV).With the same wall thickness of steel tube, the yield load of C-H-T1 specimen is relatively low. The difference between the yield loads of C-N-T1, C-Ra-T1 and C-Rb-T1 is only 2.6%–2.9%. The results show that concrete material has little effect on the yield loads of specimens. Under the yield load, the deformation of hollow steel tube specimen is the largest. The axial deformation of C-Rb-T1 specimen is 12.3% and 11.0% higher than that of C-N-T1 and C-Ra-T1, respectively. Under the peak load, the axial deformation of C-Rb-T1 is also the largest. The reason is that the elastic modulus of recycled concrete (Rb) is relatively low. It is shown that the concrete material has a great influence on the axial deformation of the specimen.With the same concrete materials, the yield and peak load of C-N-T2 were 8.8% and 14.9% higher than that of C-N-T1. Meanwhile, the axial deformation under peak load of C-N-T2 is obviously smaller than that of C-N-T1. It is shown that with the increase of the wall thickness of the steel tube, the axial stiffness of the specimen under the peak load is obviously improved, and the increase of axial stiffness of specimen under yield load is not significant.ε) curve of the specimens can be divided into two stages, namely, the elastic stage and the plastic hardening stage. When the wall thickness of the steel pipe was 4 mm, the curves of the elasticity curves of C-N-T1, C-Ra-T1 and C-Rb-T1 were almost coincident, and the strain did not change with the load, which is due to the higher axial stiffness. On the other hand, because of its low axial stiffness, the strain of C-H-T1 was slightly larger than that of the above-mentioned three specimens. A similar observation was made for the specimens with the wall thickness of 5 mm. When the curve entered into the plastic hardening stage, strain increased rapidly with an increase in load. Concrete type has little effect on the axial rigidity of the specimen.Because the deformation of one point is random, and the deformation of different points is not uniform. In paper, the development of the mean strain of the central area (150 mm of the 500 mm) was monitored. ε curves of C-N-T1 and C-N-T2 were basically the same in the elastic phase, but the curves started to deviate in the early stage of plasticity. As shown in When the specimens had the same concrete materials , the N-εSix specimens from the second group were subjected to fire before performing the axial loading test. The main parameters were the concrete material type and the wall thickness of the steel pipe (steel ratio). The distribution of temperature field and the failure modes of RACFST columns were investigated after fire.The fire test was carried out in the fire laboratory of China Academy of Building Research (CABR). Six specimens were put into a small vertical fire furnace as shown in In order to analyze the internal temperature field of the specimens, the temperature–time curves were recorded by the thermocouples as shown in In the early stage of loading, both the displacement and the strain increased slowly with the load, the rust on the surface of the specimen began to fall off, the upper part of the steel column showed bulging but the deformation of the lower part of the column was not obvious. When the loading reached to 55%–65% of the ultimate load, the displacement and strain increased rapidly, the lateral expansion of the specimen was visible, the column began to warp to one side, and the top of the steel tube deformed seriously. When the load increased to the ultimate load, the extent of drum-shaped deformation was increasing, and the middle part of the specimen was severely buckled. After the ultimate load was exceeded, the longitudinal displacement and strain continued to increase, but the bearing capacity of the steel column decreased slightly. The specimen failure occurred finally in the form of buckling. The failure modes of the specimens are shown in It can be seen from the curve of axial load–axial displacement (N-Δ) in ε curve) of specimen can be used to analyze the deformation of the specimens, especially the deformation of the middle part of the specimens. As shown in The axial force-average longitudinal strain (N-ε) curve was basically coincident in the elastic stage for FC-N-T1 and FC-Ra-T1 specimens. Because of the low axial stiffness, the elastic phase of FC-Rb-T1 was relatively short, which means that even with a relatively smaller load, the middle of the specimen began to yield. Compared to the specimen C-N-T2 that was not subjected to fire, the bearing capacity of FC-N-T2 decreased by only 5.3%, which indicated that an increase in wall thickness of the steel tube could reduce the damage of the infill concrete. Therefore, a reasonable increase in the wall thickness of a steel tube can not only increase the axial compressive bearing capacity of specimens under normal temperature, but also improve the residual bearing capacity of specimens after fire.ε = 5 × 10−3), the load of FC-N-T2 and FC-N-T1 was not much different, but the bearing capacity of FC-N-T2 could continue to rise for a long time. The results show that the wall thickness has a great influence on the bearing capacity of the specimen both before and after the fire.The trend of load–strain curves of C-N-T1 (FC-N-T1) and C-Ra-T1 (FC-Ra-T1) were basically identical for the same wall thickness before and after the fire. The results showed that the semi-recycled concrete with 100% coarse aggregate had good mechanical properties before and after fire, but the ultimate bearing capacity of C-Ra-T1 was degraded after fire, as shown in In order to analyze the degradation of bearing capacity of specimens, the bearing capacities before and after fire were compared. Regardless of the impact of concrete materials  and (6), uNe, represents the test result of the ultimate bearing capacity of the specimens under normal temperature; fuNe, represents the test result of the ultimate bearing capacity of the specimens after fire; and uNc, represents the calculated ultimate bearing capacity of the specimens under normal temperature.The results are shown in When calculating the bearing capacity of the specimens, the standard values were used for the necessary parameters. It can be seen that the bearing capacity of the specimens which experienced fire was about 82.6%–92.3% of that before fire, indicating that the bearing capacity of the specimens decreased significantly after fire. Especially for specimens produced by recycled concrete, the bearing capacity was markedly decreased. Therefore, RACFST column should be properly protected from fire in actual structures, such as by adding external protective layer covering the concrete surface.The calculated results based on EC4 and CECS28: 90 standards are close to the experimental values, with a discrepancy of 2.99%–3.60%. This indicates that the standard equations can be used to calculate the ultimate bearing capacity of RACFST columns under axial compression when at normal temperature. The calculated values are lower than the experimental values, so the calculated results are conservative.In order to further analyze the degradation of bearing capacity of specimens after fire, relationships between the wall thickness, concrete material and the ratio of bearing capacity In this paper, two groups of 12 recycled aggregate concrete-filled steel tubular (RACFST) columns were experimentally studied. Six specimens were subjected to axial compression tests under normal temperature, and the other six specimens were subjected to axial compression tests after fire. The failure modes and the degradation of bearing capacity of specimens were analyzed. The specific conclusions are as follows:(1)The specimen failure occurred finally in the form of buckling. The failure mode of a recycled concrete column specimen which experienced fire was similar to that without fire. The N-Δ curve changed linearly in the early stage and then the axial stiffness of the specimen decreased rapidly after yielding. It is worth noting that the bearing capacity and deformation ability of specimens were weakened after fire; the RACFST columns were damaged seriously, but the overall ductility of specimen was still good.(2)A temperature platform (the temperature is maintained at 100–150 °C) was observed in the temperature field of the interior of recycled concrete-filled steel tube columns and of ordinary concrete-filled steel tube columns. For concrete-filled steel tube column, the maximum temperature of FC-Rb-T1 was 14.7% lower than that of FC-N-T1, which indicates that the tendency of rise in internal temperature of RACFST column was low.(3)For the specimens which experienced fire, when the wall thickness of the steel pipe was relatively small, concrete material had a large influence on the bearing capacity. However, with an increase in wall thickness of the steel tube, the influence of concrete material was diminished. For identical concrete material, the ultimate bearing capacity of the steel tube with wall thickness of 5 mm was 11% higher than that of 4 mm thick wall (ordinary concrete N) [16%  and 21% ]. The wall thickness of steel pipe was the main factor to determine the bearing capacity of RACFST column.(4)The axial compressive stiffness of specimens with 100% replacement of coarse and fine aggregates was severely damaged. Meanwhile, its elastic phase was relatively short, indicating that in the case of relatively smaller bearing capacity, the middle region of the steel tube showed large deformation, or even exhibited a drum package. Therefore, considering the safety of structures, it is not recommended to use recycled concrete material with 100% replacement of coarse and fine aggregate.


The aim of the study was to assess the antibiotic use in dairy animals and to trace its usage pattern among the small, medium, and large dairy farmers in Eastern Haryana region of India.Karnal and Kurukshetra districts from Eastern region of Haryana state were purposively selected, and four villages from each district were selected randomly. From each village, 21 farmers were selected using stratified random sampling by categorizing into small, medium, and large farmers constituting a total of 168 farmers as respondents. An antibiotic usage index (AUI) was developed to assess usage of antibiotics by dairy farmers.Frequency of veterinary consultancy was high among large dairy farmers, and they mostly preferred veterinarians over para-veterinarians for treatment of dairy animals. Small farmers demanded low-cost antibiotics from veterinarians whereas large farmers rarely went for it. Antibiotics were used maximum for therapeutic purposes by all categories of farmers. Completion of treatment schedules and follow-up were strictly practiced by the majority of large farmers. AUI revealed that large farmers were more consistent on decision-making about prudent use of antibiotics. Routine use of antibiotics after parturition to prevent disease and sale of milk without adhering to withdrawal period was responsible for aggravating the antibiotic resistance. The extent of antibiotic use by small farmers depended on the severity of disease. The large farmers opted for the prophylactic use of antibiotics at the herd level.Antibiotic usage practices were judicious among large dairy farmers, moderately prudent by medium dairy farmers and faulty by small farmers. The frequency of veterinary consultancy promoted better veterinary-client relationship among large farmers. Antibiotics can be regarded as an “endangered species” facing extinction due to the emergence of antibiotic resistance and void in the continuous development of new antibiotics . The extJudicious prescription and antibiotic conservation practices of veterinarians are affected by the demand of farmers to get antibiotics by giving reference to past treatment leads . The strLimited research has been done to assess antibiotic use in milk production in India. So in the present study, an antibiotic usage index (AUI) was developed to measure antibiotic usage pattern of dairy farmers.No animal was used for the study. Hence, ethical approval was not needed.This study was a non-experimental research design.The study was conducted in Eastern region of Haryana state of India. Haryana ranks second in the country in per capita per day availability of milk. The Eastern Haryana region has 1157 veterinary institutions and has 53.3 and 58.3% of total cow and buffalo population of the state, respectively. Karnal and Kurukshetra districts of Haryana were purposively selected, and four villages from these districts were randomly selected. The study was conducted during 2016-2017.From each village, 21 farmers were selected randomly using stratified random samplings by categorizing into small, medium, and large farmers constituting a total of 168 farmers as respondents. The farmers rearing one to four animals were categorized as smallholder dairy farmers, four to 10 animals as medium holder dairy farmers and those with more than 10 animals were considered as large dairy farmers for the purpose of this study following relevant literature .An AUI was developed by incorporating 19 indicators under four dimensions of the use of antibiotics, i.e., symptom level, cow level, herd level, and perceived alternatives, based on the opinion of a panel of 40 experts. Under symptom level indicators were frequency of veterinary consultancy, experience of treatment, seeking therapeutic intervention, alteration in dose of antibiotics, and change in mode of administration of antibiotics. Contingent use of antibiotics, varying the dose of antibiotics according to severity of disease, sale of milk of treated animal, discontinuance of treatment after the disappearance of symptoms and increase in dose in case of poor response to treatment were indicators of animal level usage of antibiotics. Routine use of antibiotics, animal husbandry practices, dry cow therapy and preference to animals according to milk quota in diagnosis were the indicators under the herd-level dimension of antibiotic usage. Four indicators, namely, vaccination, physical barriers such as teat sealant, indigenous traditional knowledge, and use of prebiotics/probiotics to prevent animal disease were selected under the perceived dimensions of alternatives to the antibiotics in the study. For making the indicators scale-free, following methods were applied:Where,i=1, 2, 3,…, n indicatorsj=1, 2, 3 dimensions of judicious use of antibioticsij=Value of ith indicator of jth dimension.XEquation (1) was applicable for indicators having positive implications on the use of antibiotics. Equation (2) was applicable for indicators having negative implications on judicious use of antibiotics.The composite AUI for farmers was calculated by taking the weighted mean of three dimensions, i.e.,Where,W=Weight assigned to respective dimensionsSLI=Symptom level indexALI=Animal level indexHLI=Herd level indexAPI=Alternatives perceived indexAUI=Antibiotic usage index.The relevancy weightage (RW) and mean relevancy score (MRS) were worked out. The indicators with statements having RW >0.70 and MRS >2.25 were considered for including in the usage index.AUI was developed, and score of each dimension ranged from 0 to 1. The responses of farmers were recorded on this AUI which reflected the degree of judicious decision-making regarding antibiotic use.AUI was prepared by expert judgment method. Cumulative square root frequency was used for categorization of farmers according to the antibiotic usage pattern.The veterinary consultancy including the frequency of contact with veterinarians was found low among small farmers (50.00%) in comparison to medium farmers (76.79%) and large farmers (87.50%). It is clear from The utilization of veterinary services and its frequency are enlisted in Small farmers frequently used alternatives such as indigenous technical knowledge (12.51%), homeopathic (5.36%), and ayurvedic medicines (3.57%) in animal husbandry. It was observed that large farmers hardly relied on indigenous technical knowledge as well as ayurvedic and homeopathic medicines. .It was found that majority of small farmers (98.21%) used the antibiotics for therapeutic purpose, while it is subtherapeutic use was found very low (1.79%) . Medium On the basis of cumulative square root frequency, the three categories  were used to locate the farmers according to the appropriateness of decision-making. After considering the overall antibiotic usage practices by small, medium, and large farmers it was found that large farmers were more consistent with the prudent use of antibiotics as reflected from the score of AUI .The respondents were classified into three categories  according to cumulative square root frequency. Levels of decision-making regarding the antibiotic usage were observed under the following subheads.The decisions of smallholder dairy farmers regarding the antibiotic use were mainly focused at symptom level because of small herd size and resultant ease of observation . It was Majority of the medium farmers made the decision regarding the antibiotic use at animal level as revealed through usage index score of 0.22 .Majority of large farmers adhered to the decision regarding antibiotic use at herd level. The usage index score of 0.28 among large farmers was more consistent than small farmers (0.06) and large farmers (0.13) at herd level. Furthermore, the consistency and accuracy of level of decision-making in the respective categories increased from small farmers (0.18) to the medium farmers (0.22) and highest for large farmers (0.28) at symptom, cow, and herd level, respectively .The usage index score of 0.05 for utilizing or seeking to utilize alternatives with respect to large farmers was more judicious than medium farmers (0.03) and small farmers (0.01).et al. [Over-the-counter sales of antibiotics (either without a prescription or by reusing old prescriptions) and informal consent with paravets and veterinarians ensured high antibiotic consumption in the farms . There wet al. .et al. [et al. [This study revealed that frequency of disease and choice of primary antibiotics for disease treatment were influenced by herd size. Increasing herd size has been associated with increased morbidity and mortality if antibiotics were not used . Monitoret al. . Accordi [et al. , benefitet al. [et al. [Scanty information is present about antibiotic use in low-income countries like India. As pointed by Redding et al. , understet al. . The preet al.  that moset al. . Thus, tet al. . The fin [et al.  that non [et al. . It was Majority of small farmers opted for therapeutic use of antibiotics because they consulted veterinarians after manifestations of symptoms in the advanced stage of disease . Medium et al. [Higher levels of education among large farmers led to higher levels of awareness and knowledge about antibiotic resistance . For impet al. . The selet al. . The oveet al. .The usage index score of 0.18 was found for smallholder dairy farmers regarding usage pattern of antibiotics because the frequency of veterinary consultancy was affected by severity of disease, observed symptom, and familiarity with disease . This scThe usage index score of antibiotics 0.22 for medium farmers was more judicious than small farmers (0.18) . The conet al. [The large farmers were found to use antibiotics more judiciously than small and medium dairy farmers. The antibiotics usage index score of 0.28 for large farmers revealed more prudent use of antibiotics than small farmers (0.18) and medium farmers (0.22) . The speet al.  reportedet al. . It was et al. .et al. [Use of teat sealant during critical time of dry period, looking forward toward use of homeopathy and indigenous technical knowledge, use of probiotics/prebiotics could be alternatives perceived by the farmers. The usage index score of 0.05 was found for large farmers which were more judicious than medium farmers (0.03) and small farmers (0.01) for the alternatives of antibiotics . Organizet al.  reportedet al. . The Redet al. .Irrational use of antibiotics in dairy farming in Eastern Haryana are aggravated by poor knowledge and misconceptions about antibiotics, false practices, limited supervision, and easy access to antibiotics. It demands prompt action on antibiotic misuse coupled with continuing education and counseling for veterinarian about prudent use of antibiotics. Farmers with good economic condition utilized better veterinary consultancy services and performed best antibiotic usage practices. For reducing the pace of antibiotic resistance, no single approach can solve the problem because of interwoven complex interests of all stakeholders. Cumulative impact of numerous interventions will have a significant impact if practiced in well-organized manner followed by development of new antibiotics. Formulating new policies on antibiotic resistance are not likely to be transformative unless role of all the stakeholders involved in decision-making regarding the antibiotic use are taken into account. A contingent system approach by integrating the farmers, veterinarians, and other stakeholders offering robust antibiotic stewardship along with a properly designed antibiotic resistance surveillance program is required.JG designed the research work and VK and JG executed the work at field level. VK analyzed the data. Both authors contributed equally in preparation and revision of the manuscript. All authors read and approved the final manuscript.