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Background We developed an open-source software for the computerized analysis of antenatal fetal cardiotocography (CTG) without limitation of duration of the registration, enabling batch processing and adaptation to any digital storage system. Methods STVcalc was developed based on literature about the FetalCare system (Huntleigh Healthcare Ltd, Cardiff, UK). For comparison with FetalCare, we selected the CTGs of all women who delivered in 2011 a small-for-gestational-age (SGA) fetus between 24 and 31 weeks by cesarean section (CS) for fetal distress, or had fetal death, before labor onset. Results In 471 CTGs from 39 women, the agreement was 99% for a short-term variation (STV) cut-off of 2.6 ms below 29 weeks and 3.0 ms thereafter, and 95% for 3.5 and 4.0 ms, respectively. In 18 (4%) cases, the proportional difference in STV between FetalCare and STVcalc was more than 10%. Conclusion As only slight differences were observed between the proposed feature-rich application and the FetalCare system, it can be considered valuable for clinical practice and research purposes.

Objective Cardiotocography (CTG) is an important tool for fetal surveillance in severe early-onset fetal growth restriction (FGR). Assessment of the CTG is usually performed visually (vCTG). However, it is suggested that computerized analysis of the CTG (cCTG) including short term variability (STV) could more accurately detect fetal compromise. The objective of this study was to systematically review the literature on the association between cCTG and perinatal outcome and the comparison of cCTG with vCTG. Study design A systematic search was performed in MEDLINE, EMBASE and Google Scholar. Studies were included that assessed prognostic accuracy of STV or compared STV to vCTG in patients with FGR. Risk of bias and concerns about applicability were assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) instrument. Results Of the 885 records identified in the search, five cohort studies (387 patients) were included. We found no randomized studies comparing STV with visual CTG in patients with FGR. The risk of bias of all studies was generally judged as ‘low’. One small study found an association of low STV with neonatal acidosis. One study observed no association of STV with long-term outcome. Composite analysis of all five studies showed a non-significant relative risk for acidosis after a low STV of 1.4 (95% CI 0.6–3.2, N = 387). Further meta-analysis was hampered due to heterogeneity in outcome reporting and use of different thresholds. Conclusion The evidence from the included studies did not support an association of STV and short or long term outcome. However, available data are limited and heterogeneous, and influenced by management based on STV. Solid evidence from a randomized controlled trial comparing STV with vCTG including long term infant outcome is needed before STV can be used clinically for timing of delivery in patients with FGR.

Objectives Early preterm fetal growth restriction is a significant contributor to perinatal morbidity and mortality. The ductus venosus pulsatility index for veins (DV PIV) is proposed as a monitoring tool because it appears to improve perinatal outcomes. The test characteristics and robustness of DV PIV have been inadequately described. The aim of this study was to investigate inter- and intra-observer variability of DV PIV. Study design Nineteen women with a gestational age between 26 and 32 completed weeks were included in this study. Doppler sonographic fetal assessment was performed by two independent maternal-fetal medicine specialists. Each sonographer alternately performed three flow tracings for each participant, in the absence of the other sonographer (six tracings in total per patient). DV PIV was calculated automatically from stored tracings by a third researcher. Inter- and intra-observer variability of DV PIV and limits of agreement were assessed using the Bland–Altman method. Comparison of the distribution was performed with Kendall’s related samples test, and the intraclass correlation coefficient (ICC) was calculated. Results In total, 114 DV measurements were taken from 19 participants with a median age of 31 years [interquartile range (IQR) 26–34 years] at a median gestational age of 28 weeks (IQR 27–29 weeks). The proportional limits of agreement for intra-observer variation were −0.48 to 0.48 and −0.39 to 0.62 for the two observers. ICCs were 0.66 [95% confidence interval (CI) 0.42–0.84] and 0.68 (95% CI 0.45–0.85). The proportional limits of agreement for inter-observer variation were −0.29 to 0.19 with an ICC of 0.89 (95% CI 0.73–0.96). Conclusion Inter-observer variation was far less than intra-observer variation, probably due to mitigation of biological variation by averaging three measurements. DV PIV has acceptable test characteristics for use in a clinical setting when the average of at least three consecutive measurements is used.

The search for quality in education has come to the forefront of the international debate on education. Education ministers worldwide, in developing and developed countries alike are emphasizing the need for better quality, and international organizations are focusing their programmes on qualitative aspects of education. This chapter focuses on the international and global dimensions of the search for better quality in education. It presents a few considerations on international research and international cooperation in this field. As regards the extension of international studies launched by industrialized countries to developing countries, two strategies might be considered: to modify the chosen methodology and adapt it to the situation of the given developing country, or to envisage regional or sub-regional participation. The initiatives of international non-governmental organizations promoting research on the quality of education in developing countries merit encouragement and full support.

DNA vectors have been widely used as a priming of poxvirus vaccine in prime/boost regimens. Whether the number of DNA impacts qualitatively or quantitatively the immune response is not fully explored. With the aim to reinforce T-cell responses by optimizing the prime-boost regimen, the multicentric EV03/ANRS VAC20 phase I/II trial, randomized 147 HIV-negative volunteers to either 3xDNA plus 1xNYVAC (weeks 0, 4, 8 plus 24; n = 74) or to 2xDNA plus 2xNYVAC (weeks 0, 4 plus 20, 24; n = 73) groups. T-cell responses (IFN-γ ELISPOT) to at least one peptide pool were higher in the 3xDNA than the 2xDNA groups (91% and 80% of vaccinees) (P = 0.049). In the 3xDNA arm, 26 (37%) recipients developed a broader T-cell response (Env plus at least to one of the Gag, Pol, Nef pools) than in the 2xDNA (15; 22%) arms (primary endpoint; P = 0.047) with a higher magnitude against Env (at week 26) (P, Author summary Development of a safe and effective HIV-1 vaccine would undoubtedly be the best solution for the ultimate control of the worldwide AIDS pandemic. To date, only one large phase III trial (RV144 Thai study) showed a partial and modest protection against HIV infection. This result raised hope in the field and encouraged the development of vaccines or strategies in order to improve vaccine efficacy. Several vaccine strategies designed to elicit broad HIV-specific T cells and/or neutralizing antibodies to prevent HIV-1 transmission are under evaluation. Among diverse candidate vaccines, the safety and immunogenicity of multi-gene DNA-based and Pox-virus derived vaccines have been evaluated in several clinical studies. The present study was designed to optimize the combination of these two vaccines with the aim of determining the optimal number of DNA primes for a poxvirus-based HIV vaccine regimen. We show here that the prime boost combination is highly immunogenic and that the number of DNA primes induces differentially T cell and antibody responses. A better priming of poxvirus-based vaccine regimens for T cells is obtained with 3 DNA injections. Our results contribute and extend data of several preclinical studies pointing out the potential interest of DNA as a prime capable not only of improving immune responses but also of imprinting the long-term responses to boost vaccines.

The corrosion of steel bars in reinforced concrete structures induces concrete cover cracking and leads to reduction in steel–concrete bond strength. In the present study, a series of pull-out tests were carried out to investigate the potential correlations between corrosion level, surface crack width, and bond strength. The main variables are corrosion level, concrete cover depth, and spacing of stirrups. The test results indicate that the surface crack width is closely linked to the corrosion level of the tensile steel bar, and the crack propagation can be divided into three stages. It is further revealed that the bond strength decreases exponentially with the surface crack width. Based on the test results, an empirical model for estimating the bond strength using the surface crack width is formulated, which considers the pronounced limiting effect of stirrups on the bond degradation. The model is further improved by incorporating the adverse effect of the corrosion of stirrups according to the previous investigations. Comparison with existing experimental database in the literature proves that the proposed models are able to realistically predict the bond strength of corroded steel bars.

The distinct spalling performances of reactive powder concrete (RPC) specimens with various silica fume (SF) contents exposed to high temperatures were observed via high-resolution photography. The RPC microstructures and pore structures after high-temperature exposure were characterized using scanning electron microscopy and mercury intrusion porosimetry. The results provide experimental evidence of the high-temperature spalling mechanism of RPC. Increasing the SF content in RPC increases its compressive strength and compactness, offering greater mitigation of devastating spalling behaviour, but also producing more pulverized spalling remnants. This is attributed to the post-heating cracked microstructure and refined pores, which promote localized rather than entirely explosive spalling.

Die instrumentierte Bauwerksuberwachung erweitert die Moglichkeiten eines Ingenieurs hinsichtlich der Beurteilung von Tragwerken. Dabei ist dieses Werkzeug als Erganzung zu anderen Prufungen zu sehen, nicht als Alternative, da der Fokus der Messungen auf kurz- und langfristigen Veranderungen am Bauwerk liegt und nicht auf der Erfassung des Ist-Zustands. Besonders bei historischen Bauten bieten sich entsprechende Uberwachungen an, da zweifelsohne eine langfristige Erhaltung angestrebt ist. Die Autoren beschreiben in dem Artikel zuerst allgemein die Einbettung der Bauwerksuberwachung in die Bauwerksprufung, gefolgt von einigen Uberlegungen zu Monitoring an historischen Bauten. Zur Illustration wird dieses am Beispiel der instrumentierten Daueruberwachung des Sommerrefektoriums im Kloster Bebenhausen gezeigt.

Objective In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short-term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV-p95); and (3) late changes in fetal DV waveform (DV-no-A). However, many infants per monitoring protocol were delivered because of safety-net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present posthoc subanalysis was to investigate the indications for delivery in relation to 2-year outcome in infants delivered before 32 weeks to further refine management proposals. Methods We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery. Results Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety-net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG-STV group, 51% of infants were delivered because of reduced STV. In the DV-p95 group, 34% of infants were delivered because of abnormal DV and, in the DV-no-A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety-net criterion of spontaneous decelerations in FHR. Two-year intact survival was highest in the DV groups combined compared with the CTG-STV group (P = 0.05 for live births only, P = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG-STV group was restricted to infants delivered because of FHR decelerations in the safety-net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significantly higher intact survival. Conclusions In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group, CTG-STV criteria were used as a safety net but in the CTG-STV group, no DV safety-net criteria were applied, we speculate that the slightly poorer outcome in the CTG-STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Objectives To explore if in early fetal growth restriction (FGR) the longitudinal pattern of short-term fetal heart rate (FHR) variation (STV) can be used for identifying imminent fetal distress and if abnormalities of FHR registration associate with two-year infant outcome. Methods The original TRUFFLE study assessed if in early FGR the use of ductus venosus Doppler pulsatility index (DVPI), in combination with a safety-net of very low STV and / or recurrent decelerations, could improve two-year infant survival without neurological impairment in comparison to computerised cardiotocography (cCTG) with STV calculation only. For this secondary analysis we selected women, who delivered before 32 weeks, and who had consecutive STV data for more than 3 days before delivery, and known infant two-year outcome data. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values except the last one were calculated. Life table analysis and Cox regression analysis were used to calculate the day by day risk for a low STV or very low STV and / or FHR decelerations (DVPI group safety-net) and to assess which parameters were associated to this risk. Furthermore, it was assessed if STV pattern, lowest STV value or recurrent FHR decelerations were associated with two-year infant outcome. Results One hundred and fourty-nine women matched the inclusion criteria. Using the individual STV regression lines prediction of a last STV below the cCTG-group cut-off had a sensitivity of 0.42 and specificity of 0.91. For each day after inclusion the median risk for a low STV(cCTG criteria) was 4% (Interquartile range (IQR) 2% to 7%) and for a very low STV and / or recurrent decelerations (DVPI safety-net criteria) 5% (IQR 4 to 7%). Measures of STV pattern, fetal Doppler (arterial or venous), birthweight MoM or gestational age did not improve daily risk prediction usefully. There was no association of STV regression coefficients, a last low STV or /and recurrent decelerations with short or long term infant outcomes. Conclusion The TRUFFLE study showed that a strategy of DVPI monitoring with a safety-net delivery indication of very low STV and / or recurrent decelerations could increase infant survival without neurological impairment at two years. This post-hoc analysis demonstrates that in early FGR the day by day risk of an abnormal cCTG as defined by the DVPI protocol safety-net criteria is 5%, and that prediction of this is not possible. This supports the rationale for cCTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DVPI is in the normal range.

Repeated loading can affect the serviceability of RC structures by causing the bond deterioration. In the present study a series of pull-out tests have been carried out to investigate the bond deterioration due to the repeated loading of corroded reinforcement. The specimens were corroded to different corrosion level and subjected to repeated loading for various stress levels and loading cycles. The test results showed that the bond behavior under repeated loading was characterized by progressive increase of residual slip. The slip increase became more pronounced when the stress level was increased. The comparison with monotonic test results indicated that the repeated loading exhibited no significant influence on the bond strength and on the slip at peak bond stress for both corroded and non-corroded specimens. It was also found that the corrosion could lead to an increase of applied stress levels, which resulted in the substantial decrease of the fatigue life of bond. Through systematic evaluation of the test data a model for bond stress-slip relationship under repeated loading was proposed. Moreover, empirical equation for the fatigue life of bond of corroded reinforcement was also derived.