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Due to renovation and fighting in the world, a huge accumulation of construction and demolition waste is formed. These materials are effectively used as aggregates, but there is very little information about the use of scrap concrete to create cementless binders. The purpose of the work is to be a comprehensive study of the composition and properties of concrete wastes of various fractions with the aim of their rational use as cementless binders. The scientific novelty lies in the fact that the nature of the processes of structure formation of a cementless binder based on sandy fractions of the screening of fragments of destroyed buildings and structures, as a complex polyfunctional system, has been theoretically substantiated and experimentally confirmed. Different percentages of non-hydrated clinker minerals in concrete scrap were determined. In the smallest fraction (less than 0.16 mm), more than 20% of alite and belite are present. Waste of the old cement paste is more susceptible to crushing compared to the large aggregate embedded in it, therefore, particles of the old cement paste and fine aggregate predominate in the finer fractions of the waste. Comprehensive microstructural studies have been carried out on the possibility of using concrete scrap as a completely cementless binder using scanning electron microscopy, X-ray diffraction analysis, and differential thermal analysis. It has been established that for cementless samples prepared from the smallest fractions (less than 0.315 mm), the compressive strength is 1.5–2 times higher than for samples from larger fractions. This is due to the increased content of clinker minerals in their composition. The compressive strength of the cementless binder after 28 days (7.8 MPa), as well as the early compressive strength at the age of 1 day after steaming (5.9 MPa), make it possible to effectively use these materials for enclosing building structures.

Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores ( 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.

Quality is considered as an instrument to achieve excellence in all areas more specifically in education. Academic excellence has been a central value in higher education. Accreditation is raised to develop and enhance the quality of education in academic world. Nowadays there are many accreditation bodies in all around the world. AACSB, EFMD and AMBA are highly integrated accreditation agencies specialized for business schools. General presumptions regarding the standards and quality of those institutions are to facilitate continuous quality improvement in education by assessing any business school or management program. Main purpose of this research paper is to investigate the relationship between quality of education and accreditation by exploring the effect and benefits of accreditations in higher education institutions. This research found out that accreditation agencies are encouraging business schools to make themselves accountable for improving and enhancing the quality of education by impactful and intellectual contribution and scholarly education. In order to achieve that accreditation bodies have to set specific standards and criteria, self-evaluation, peer review and consultation services that determine business schools to meet the standards. The paper also observed positive effects of accreditation on students, faculty members and public in general.

The main aim of this research is to study the effects of adding polyethylene terephthalate or ‘PET’ waste to high-performance concrete (HPC) and the resulting properties and behaviour under freezing–thawing conditions. Natural sand is substituted with the PET aggregates at varying dosages (0–7·5% by volume of the sand) to produce HPC mixes. Mechanical properties of HPC were evaluated. The freezing–thawing resistance was measured to determine the durability factor (DF) of HPC with and without PET aggregates. The results indicated that the frost resistance of concrete mixes containing various amounts of PET aggregate was better than that of the reference mix, and the higher DF was that of the mix containing 5% replacement ratio, during 300 cycles of rapid freezing and thawing tests. The use of PET waste aggregates presented various advantages like increased flexural strength, improved frost resistance and a change in failure mode. This research study ensured that recycled waste plastic as a substitution of sand in HPC can help with decreasing the consumption of natural sand and with solving some of the environmental problems posed by plastic wastes.

The world's population growth and the increasing demand for new infrastructure facilities and buildings , present us with the vision of a higher resources consumption, specially in the form of more durable concrete such as High Performance Concrete (HPC) . Moreover , the growth of the world pollution by plastic waste has been tremendous. The aim of this research is to investigate the change in mechanical properties of HPC with added waste plastics in concrete. For this purpose 2.5%, 5% and 7.5% in volume of natural fine aggregate in the HPC mixes were replaced by an equal volume of Polyethylene Terephthalate (PET) waste , got by shredded PET bottles. The mechanical properties (compressive, splitting tensile, and flexural strength ) evaluated at the ages of (7 ,28, 56 and 91) days while the static modulus of elasticity tested at (28 and 91) days . The results indicated that HPC containing PET-aggregate presented lower compressive strength and static elasticity . The splitting strength displayed an arising trend at the initial stages, however, they have a tendency to decrease after a while. On the other hand, flexural strength results gave better modulus of rapture at all ages of curing , as compared with reference concrete specimens.

Repair of an inguinal hernia is one of the most common operations performed in general surgery with significant costs to health care and society. Rates of repair are increasing annually and have the potential to double over the coming years.1 The most common symptom patients have from their hernia is pain that is usually mild to moderate and generally does not affect work or leisure activities. Up to one third of patients are asymptomatic or have very little in the way of symptoms from their hernia.2 For those that undergo repair, around 10% will have a significant wound infection or hematoma, 3% will have severe chronic pain, and 5% to 10% will develop a recurrent hernia.3 One of the most common reasons for recommending inguinal hernia repair to patients is the risk of strangulation. Strangulation is associated with an increased morbidity and mortality; however, it is uncommon with only around 1 in 400 of all patients presenting with an inguinal hernia requiring bowel resection for this complication.2 Using life-table analyses based on 2 population groups, Fitzgibbons et al estimated that the lifetime risk of strangulation for an 18-year-old with an inguinal hernia is 0.272% (or 1 in 368) while that for a 72-year-old is 0.034% (or 1 in 2941).4 It is not known what the risk of pain or strangulation from an asymptomatic inguinal hernia is or if these patients are likely to develop warning symptoms before the latter event occurs. If this were the case, then there may be a window of opportunity to operate before a serious complication arises. This study examines patient outcome comparing operation with a wait-and-see policy in patients with an asymptomatic inguinal hernia.

Persistent pain after hernia repair is common, although it is usually mild. In 3% of patients it is severe, however, and has significant effects on work and social activities. The purpose of this review was to examine factors that affect pain after hernia repair. Although the type of anaesthetic used, local or general, and the operation type, open or laparoscopic, seems to affect acute pain, chronic persistent pain is influenced by the age of the patient and whether the hernia was painful preoperatively. Preliminary evidence indicating that use of a lightweight mesh may reduce chronic pain requires further research before definitive conclusions can be drawn.