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Reinforcement corrosion is the main deterioration mechanism in chloride-exposed reinforced concrete (RC) structures. Depending on the moisture level, corrosion might initiate when aggressive agents like chloride ions reach the reinforcement surface. The propagation of active corrosion depends on both the moisture level and oxygen availability. Corrosion reduces the crosssectional area and ductility of reinforcement. Depending on the severity of the attack and the corrosion products at the interface, it can lead to cracking and spalling of the concrete, thereby modifying bond-slip behaviour. Knowledge of the distribution of corrosion attack is required for the structural assessment of existing marine-exposed RC structures to extend their service life. This paper summarises observations of corrosion distribution on rebars excavated from RC elements after long-term exposure.

Selenium nanoparticles (SeNPs) are emerging as a novel nanotechnological approach to improve growth, primary and secondary metabolite production, and crop quality. The seedling stage is critical for successful crop establishment and achieving better yields, and SeNPs could improve seedling fitness and metabolism. The impact of SeNPs, previously synthesized with Amphipterygium glaucum extracts and characterized, was evaluated on the seedling stage of serrano pepper (Capsicum annuum). Four weekly foliar applications were made with 0, 2.5, and 10 µM SeNPs. Non-targeted metabolomic analysis was performed by gas chromatography-mass spectrometry (GC-MS) for shoot and root metabolomes. Leaves SPAD values and growth traits (root length, shoot height, stem diameter, and fresh and dry weight) increased with SeNPs application. The highest shoot growth was obtained with 2.5 µM, whereas 10 µM increased root development. Non-targeted metabolomic analysis revealed differences in the abundance of detected metabolites from several families (alpha-hydroxy acids, carboxylic acids, sugar derivatives, fatty acids, terpenes, polyols, phytosterols, and phenolic compounds). Metabolic pathway analysis (MetPA) showed that SeNPs impacted routes related to the L-galactose, ascorbate-aldarate metabolism, fatty acids, citrate cycle, and sugars. SeNPs significantly increased galactopyranose and D-mannitol in shoots and glycerate in roots. These metabolites are involved in cell wall remodeling, stress responses, and energy metabolism. The results contribute to understanding the biological effects of SeNPs and their potential to improve plant growth at 10 µM. Nevertheless, a multi-omics approach combining targeted transcriptomic and metabolomic analyses is needed to fully elucidate the mechanisms underlying the SeNPs effect on plant response to environmental stressors.

Nils Henrik Holmedahl,1 Britt Øverland,2 Ove Fondenes,3 Ivar Ellingsen,1 Jon Andrew Hardie4 1Glittreklinikken LHL Helse as, Hakadal, Norway; 2Lovisenberg Diakonale Hospital, ENT Department, Oslo, Norway; 3Norwegian National Centre of Excellence in Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway; 4Department of Clinical Science, University of Bergen, Norway Purpose: To explore the associations between sleep hypoventilation (SH) and daytime arterial pressures of carbon dioxide (PaCO2), sleep stages, and sleep apneas/hypopneas (AHI) in subjects with chronic obstructive pulmonary disease (COPD). SH has previously been found in COPD-subjects with chronic hypercapnic respiratory failure (CHRF) using supplementary oxygen (LTOT), and has been proposed as a possible predictor for CHRF. Patients and methods: A prospectively designed observational study in a pulmonary rehabilitation hospital of 100 (39 male) stable COPD inpatients with a mean forced expiratory volume in 1 second (FEV1) of 1.1 L (42% of predicted) and a mean age of 64 years, using polysomnography with transcutaneous measurement of carbon dioxide pressure increase (ΔPtcCO2). Results: SH as defined by the American Academy of Sleep Medicine (AASM) was found in 15 of the subjects, seven of whom used LTOT. However, six had SH despite being normocapnic during the daytime (only one on LTOT). Subjects with SH had a greater ΔPtcCO2 increase from nonrapid eye movement (NREM) to rapid eye movement (REM) sleep stages compared to non-SH subjects (mean [standard deviation] between-groups difference =0.23(0.20) kPa, P

Abstract Background Studies on adolescent smoking indicate that the smoking behaviours of their parents, siblings and friends are significant micro-level predictors. Parents' socioeconomic status (SES) is an important macro-level predictor. We examined the longitudinal relationships between these predictors and the initiation and development of adolescents' smoking behaviour in Norway. Methods We employed data from The Norwegian Longitudinal Health Behaviour Study (NLHB), in which participants were followed from the age of 13 to 30. We analysed data from the first 5 waves, covering the age span from 13 to 18, with latent curve modeling (LCM). Results Smoking rates increased from 3% to 31% from age 13 to age 18. Participants' smoking was strongly associated with their best friends' smoking. Parental SES, parents' smoking and older siblings' smoking predicted adolescents' initial level of smoking. Furthermore, the same variables predicted the development of smoking behaviour from age 13 to 18. Parents' and siblings' smoking behaviours acted as mediators of parents' SES on the smoking habits of adolescents. Conclusions Parents' SES was significantly associated, directly and indirectly, with both smoking initiation and development. Parental and older siblings' smoking behaviours were positively associated with both initiation and development of smoking behaviour in adolescents. There were no significant gender differences in these associations.

Abstract Background Gastrointestinal complaints are very common in the general population and very often co-occur with common mental disorders. We aimed to study the prospective impact of gastrointestinal complaints on long term sickness absence, and address the contribution from co-occurring common mental disorders and other somatic symptoms. Method Health data on 13 880 40-45 year olds from the Hordaland Health Study (1997-99) were linked to national registries on sickness absence. As part of a wider health screening, gastrointestinal complaints were ascertained. Participant's anxiety and depression, and the presence of other somatic symptoms were evaluated. In Cox regression models, we predicted sickness absences over an average 5.4 years follow-up, with adjustment for confounders, anxiety and depression and other somatic symptoms. Results After adjusting for gender, level of education and smoking, those reporting GI complaints had higher risk for later sickness absence (HR = 1.42, 95% CI 1.34-1.51). GI complaints were associated with both anxiety (OR = 3.66, 95% CI 3.31-4.04) and depression (OR = 3.28, 95% CI 2.89-3.72), and a high level of other somatic symptoms (OR = 8.50, 95% CI 7.69-9.40). The association of GI complaints was still independently associated with future sickness absence (HR = 1.17, 95% CI 1.10-1.16) adjusting for mental illness and other somatic symptoms. Discussion Sickness absence is a complex behavioural outcome, but our results suggest GI complaints contribute by increasing the risk of long term sickness absence independently of comorbid mental illness and presence of other somatic symptoms. Occupational consequences of illness are important, and should also be addressed clinically with patients presenting with GI complaints.

Abstract Background Improvements in treatment of mental disorders are repeatedly called for. General practitioners (GPs) are responsible for the majority of treatment of mental disorders. Consequently, we interviewed GPs about their opinions on how treatment of mental disorders in primary health care contexts could be improved. Methods Among GPs affiliated within the Norwegian reimbursement system, we approached 353, and made contact with 246 GP's. One-hundred of these agreed to participate in our study, and 95 of them expressed opinions on how to improve treatment of mental disorders. The telephone interviews were based on open-ended questions, responses were transcribed continuously, and content analysis was applied. Results are presented both as frequency tables of common responses, and as qualitative descriptions and quotations of opinions. Results Nearly all (95%) of the GPs had suggestions on how to improve treatment of mental disorders in primary health care. Increased capacity in secondary health care was suggested by 59% of GPs. Suggestions of improved collaboration with secondary health care were also common (57%), as were improvements of GPs' skills and knowledge relevant for diagnosing and treating mental disorders (40%) and more time for patients with mental disorders in GP contexts (40%). Conclusions The GPs' suggestions are in line with international research and debate. It is thought-provoking that the majority of GPs call for increased capacity in secondary care, and also better collaboration with secondary care. Some GPs made comparisons to the health care system for physical disorders, which is described as better-functioning. Our study identified no simple short-term cost-effective interventions likely to improve treatment for mental disorders within primary health care. Under-treatment of mental disorders is, however, also associated with significant financial burdens.

Abstract Background Most western countries have disability benefit schemes ostensibly based upon requiring (1) a work inhibiting functional limitation that (2) can be attributed to a diagnosable condition, injury or disease. The present paper examines to what extent current practice matches the core premises of this model by examining how much poorer the perceived health of disability benefit recipients is, compared to the employed and the unemployed, and further to examine to what extent any poorer perceived health among benefit recipients can be attributed to mental or somatic illness and symptoms. Methods Information on disability benefit recipiency was obtained from Norwegian registry data, and merged with health information from the Hordaland Health Study (HUSK) in Western Norway, 1997–99. Participants (N = 14 946) aged 40–47 were assessed for perceived physical and mental health (Short Form-12), somatic symptoms, mental health, and self reported somatic conditions and diseases treated with medication. Differences associated with employment status were tested in chi-square and t-tests, as well as multivariate and univariate regression models to adjust for potential confounders. Results Recipients of disability benefits (n = 1 351) had poorer perceived physical and mental health than employees (n = 13 156); group differences were 1.86 and 0.74 pooled standard deviations respectively. Self reported somatic diagnoses, mental health and symptoms accounted for very little of this difference in perceived health. The unemployed (n = 439) were comparable to the employed rather than the recipients of disability benefits. Conclusion Recipients of disability benefits have poor perceived health compared to both the employed and the unemployed. Surprisingly little of this difference can be ascribed to respondents' descriptions of their illnesses and symptoms. Even allowing for potential underascertainment of condition severity, this finding supports the increasing focus on non-disease oriented contributing factors. Rehabilitation efforts aiming at return to work should have a strong focus on the patients' perceptions of their health in addition to symptom relief and social factors.

Nicholas Smith*, Joseph Overland*, John E Greenwood Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia *These authors contributed equally to this work Abstract: Cavity wounds, defined as a loss of continuity of the skin or mucous membrane with associated tissue loss, represent a complex management issue for health care providers. The successful management of a deep cavity wound centers on assessment of the patient, assessment of the wound, and treating the underlying etiology. Adequate debridement and an appropriate dressings plan aim to create the optimum conditions that promote healing. Regular follow-up and serial examinations are essential to ensure progress and address any complication in a timely manner. Finally, continued patient education and the management of patient concerns are important to encourage compliance with management goals. In this review, we discuss the main management issues surrounding deep cavity wounds, review the current and emerging therapies available in the treatment of deep cavity wounds, discuss options for the management of pain, and discuss the impacts on quality of life for these patients. Keywords: pressure sore, pain management, debridement

Deepti Radia,1 Ibrahim Momoh,2 Richard Dillon,1 Yvonne Francis,1 Laura Cameron,1 Toni-Lee Fagg,1 Hannah Overland,1 Susan Robinson,1 Claire N Harrison11Haematology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; 2Bupa Home Healthcare, Harlow, UKAbstract: This article describes the initiation and evolution of the Rapid-Access Anemia Clinic (RAAC) at Guy's and St Thomas' Hospitals, London, UK. This clinic was set up to provide diagnosis and treatment, and to coordinate investigative procedures, where necessary, into the underlying causes of anemia. Initially piloted with anemic preoperative orthopedic patients, the clinic now treats a wide range of conditions, deriving from both internal and external referrals. Treatment includes dietary advice, supplementation with iron, vitamin B12 and folate, and blood transfusion. Most patients at the RAAC need iron replacement, the majority of which require intravenous (IV) iron. Therefore the first-line IV iron-administration protocol is carefully considered to ensure viability of the service and patient satisfaction. Four IV irons available in the UK are discussed, with explanation of the benefits and drawbacks of each product and the reasoning behind the IV iron choice at different stages of the RAAC's development. Costs to the service, affected by IV iron price and administration regimen, are considered, as well as the product's contraindications. Finally, the authors reflect on the success of the RAAC and how it has improved patients' quality-of-treatment experience, in addition to benefiting the hospital and National Health Service in achieving specific health-care mandates and directives. Drawing from the authors' experiences, recommendations are given to assist others in setting up and providing a successful rapid-access anemia service or similar facility.Keywords: hemoglobin, iron deficiency, ferric carboxymaltose, iron sucrose, iron dextran, iron isomaltoside

Fatigue is a critical issue for concrete structures subjected to repetitive and varying loads, particularly in infrastructure and transportation systems. This review paper presents a comprehensive overview of the current state of knowledge on concrete fatigue and identifies areas for further research. Material and size factors that influence fatigue performance and life estimation of concrete such as concrete composition, internal moisture content and reinforcement are explored, along with environmental conditions such as presence of external moisture and seawater exposure. The paper also acknowledges the challenges associated with predicting concrete fatigue life accurately due to the heterogeneous nature of concrete and its complex behavior under cyclic loading.

The objective of this experiment is to investigate the behaviour of lightweight aggregate concrete (LWAC) under compression and with stress gradients. Experimental program contained three sets of LWAC which were used for production of 21 prisms. Lightweight aggregate argillite slate, called Stalite, from North Carolina had been used. The sets differed in using dry (0.10% moisture content) or saturated (7.9% moisture content) aggregate. The third set included a small amount of polyvinyl alcohol fibres (PVA). The geometry of the prisms were 100 × 140 × 480 mm (width × length × height). Prismatic samples were loaded centrically and eccentrically in compression.

Abstract Background Disability benefits exist to redeem social and financial consequences of reduced work ability from medical conditions. Physicians are responsible for identifying the medical grounds for benefit claims. The aim of this study was to explore physicians' views on verifiability of medical conditions and related work ability in this context. Methods Information on verifiability of diagnostic categories and work ability was obtained from a survey among a representative sample of general practitioners (GPs) in Norway (n = 500, 25.2% response rate). Verifiability was defined as to what extent the assessment is based on objective criteria versus on information from the patient. We enquired about the diagnostic categories used in official statistics on main disability benefit causes in Norway and elsewhere. Results On a scale from 0 (low verifiability) to 5 (high verifiability), the mean level of verifiability across all diagnostic categories was 3.7 (SD = 0.42). Degree of verifiability varied much between diagnostic categories, and was low in e.g. unspecified rheumatism/myalgia and dorsopathies, and high in neoplasms and congenital malformations, deformation and chromosomal abnormalities. Verifiability of work ability was reported to be more problematic than that of diagnostic categories. The diagnostic categories rated as the least verifiable, are also the most common in disability pension awards. Conclusion Verifiability of both diagnostic categories and work ability in disability assessments are reported to be moderate by GPs. We suggest that the low verifiability of diagnostic categories and related work ability assessments in the majority of disability pension awards is important in explaining why GPs find the gatekeeping-function problematic.