scholarly journals Punching Shear Stress in Post-Tensioned Transfer Plate of Multi-Story Buildings

2020 ◽  
Vol 10 (17) ◽  
pp. 6015
Author(s):  
Byeonguk Ahn ◽  
Thomas H.-K. Kang ◽  
Su-Min Kang ◽  
Jang Keun Yoon
Keyword(s):  
Shear Stress ◽  
Residential Building ◽  
Shear Walls ◽  
Cost Effective ◽  
Punching Shear ◽  
Complete Model ◽  
Potential Cost ◽  
Story Building ◽  
Building Plans ◽  
Post Tensioned

The design of a post-tensioned transfer plate is typically controlled by shear force—in particular, punching shear at the slab-column connection. To verify the accuracy of the separated model only for one floor currently used in the design of a post-tensioned transfer plate, results were compared to a complete model with multi-story building system for which two representative residential building plans were used to emulate physical structural systems. Punching shear stress for the separated model was calculated using the eccentric shear stress model presented in ACI 318. Punching shear stress was found to be overestimated in the separated model, given that interaction between transfer plates and upper shear walls cannot be reflected therein. Differences at column locations were also noted as the number of stories below the transfer floor increased. Consequently, the separated model is not recommended for design of post-tensioned transfer plates. A complete model is more suitable for more realistic and potential cost-effective design, through the inclusion of the interaction between transfer plates and upper shear walls.

scholarly journals Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
J. L. Palmer ◽  
H. J. Siddle ◽  
A. C. Redmond ◽  
B. Alcacer-Pitarch
Keyword(s):  
Musculoskeletal Diseases ◽  
Cost Effective ◽  
Time Frame ◽  
Teaching Hospitals ◽  
Potential Cost ◽  
Foot Health ◽  
Telephone Consultation ◽  
Face To Face ◽  
Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

A virtual multi-disciplinary meeting is a cost-effective method of triaging referrals to a regional musculoskeletal oncology service

2021 ◽  
pp. 003693302110085
Author(s):  
Omer MHF Alanie ◽  
Ashish Mahendra ◽  
Mairi Mackinnon ◽  
Mark McCleery ◽  
Christopher Nicholas ◽  
...  
Keyword(s):  
Screening Tool ◽  
Discharge Rate ◽  
Cost Effective ◽  
Risk Environment ◽  
Potential Cost ◽  
Patient Journey ◽  
Cost Effective Method ◽  
Diagnosis Of Cancer ◽  
Musculoskeletal Oncology ◽  
Prospective Database

Background and aims In 2010, a virtual sarcoma referral model was implemented, which aims to provide a centralised multidisciplinary team (MDT) to provide rapid advice, avoiding unnecessary appointments and providing a streamlined service. The aim of this study is to examine the feasibility of this screening tool in reducing the service burden and expediting patient journey. Methods and results All referrals made to a single tertiary referral sarcoma unit from January 2010 to December 2018 were extracted from a prospective database. Only 26.0% events discussed required review directly. 30.3% were discharged back to referrer. 16.5% required further investigations. 22.5% required a biopsy prior to review. There was a reduction in the rate of patients reviewed at the sarcoma clinic, and a higher discharge rate from the MDT in 2018 versus 2010 (p < 0.001). This gives a potential cost saving of 670,700 GBP over the 9 year period. Conclusion An MDT meeting which triages referrals is cost-effective at reducing unnecessary referrals. This can limit unnecessary exposure of patients who may have an underlying diagnosis of cancer to a high-risk environment, and reduces burden on services as it copes with increasing demands during the COVID-19 pandemic.

Steel Sheet Shear Walls with Burring Holes for Low- to Mid-Rise Housings

2019 ◽  
Author(s):  
Yoshimichi Kawai ◽  
Shigeaki Tohnai ◽  
Shinichiro Hashimoto ◽  
Atsushi Sato ◽  
Tetsuro Ono
Keyword(s):  
Finite Element ◽  
Shear Stress ◽  
Large Deformation ◽  
Deformation Behavior ◽  
Steel Sheet ◽  
Shear Walls ◽  
Shear Load ◽  
Finite Element Analyses ◽  
Plane Shear ◽  
Out Of Plane

<p>Steel sheet shear walls with cold formed edge stiffened burring holes are applied to low- to mid-rise housings in seismically active and typhoon- or hurricane-prone regions. A configuration with burrs on the inside and smooth on the outside enables the construction of omitting the machining of holes for equipments and thinner walls with simplified attachments of finishings. In-plane shear experiments and finite element analyses revealed that the walls allowed shear stress to concentrate in intervals between the burring holes. The walls maintained stable shear load and large deformation behavior, and the deformation areas were limited in the intervals and a large out-of-plane waveform in a sheet was effectively prevented owing to edge stiffened burring ribs. The design methods are developed for evaluating the shear load of the walls at story angle from zero to 1/100, using the idea of decreasing the band width of the inclined tension fields on the intervals with the effects of the thickness.</p>

scholarly journals An Analytical and Numerical Investigation on Punching Shear Behaviour of SCC Slab

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
V. Kavinkumar ◽  
R. Elangovan
Keyword(s):  
Shear Stress ◽  
Shear Failure ◽  
Shear Capacity ◽  
Punching Shear ◽  
Shear Behaviour ◽  
Slab Thickness ◽  
Failure Zone ◽  
Self Compacting Concrete ◽  
Concentrated Load ◽  
Different Thickness

<div><p><em>This research is to study the mechanical properties of Self Compacting Concrete (SCC) as well as punching shear failure of SCC slabs. Self compacting concrete was first invited in 1988 to achieve durable concrete structures .Design of Reinforced concrete slab is often compromised by their ability to resist shear stress at punching shear surface area. The connection between slabs and supporting columns could be susceptible to high shear stress and might cause sudden and brittle failure. Punching shear failure takes the form of truncated pyramid shape. This program includes investigating the effect of SCC, slab thickness on the punching shear behaviour in terms of load-deflection response and ultimate failure load, failure characteristic of punching shear failure (shape of failure zone and size of failure zone) of simply supported slabs of 1000 x 1000 x 50 and 75mm under concentrated load at centre of slab. The slabs are made with both SCC and Conventional concrete (CC). Investigation included two way specimens with different thickness to evaluate the performance of specimen with different thickness and the effect of thickness on punching shear capacity and performance</em>.</p></div>

scholarly journals Evaluating the potential costs and impact of digital health technologies for tuberculosis treatment support

2018 ◽  
Vol 52 (5) ◽  
pp. 1801363 ◽  
Author(s):  
Ntwali Placide Nsengiyumva ◽  
Benjamin Mappin-Kasirer ◽  
Olivia Oxlade ◽  
Mayara Bastos ◽  
Anete Trajman ◽  
...  
Keyword(s):  
Digital Health ◽  
Cost Savings ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Potential Cost ◽  
Health Technologies ◽  
Life Years ◽  
Message Service ◽  
Latent Tb ◽  
Latent Tb Infection

Ensuring adherence and support during treatment of tuberculosis (TB) is a major public health challenge. Digital health technologies could help improve treatment outcomes. We considered their potential cost and impact on treatment for active or latent TB in Brazil.Decision analysis models simulated two adult cohorts with 1) drug-susceptible active TB, and 2) multidrug-resistant TB, and two cohorts treated with isoniazid for latent TB infection (LTBI): 1) close contacts of persons with active TB, and 2) others newly diagnosed with LTBI. We evaluated four digital support strategies: two different medication monitors, synchronous video-observed therapy (VOT), and two-way short message service (SMS). Comparators were standard directly observed treatment for active TB and self-administered treatment for LTBI. Projected outcomes included costs (2016 US dollars), plus active TB cases and disability-adjusted life years averted among persons with LTBI.For individuals with active TB, medication monitors and VOT are projected to lead to substantial (up to 58%) cost savings, in addition to alleviating inconvenience and cost to patients of supervised treatment visits. For LTBI treatment, SMS and medication monitors are projected to be the most cost-effective interventions. However, all projections are limited by the scarcity of published estimates of clinical effect for the digital technologies.

Cost-effectiveness of obeticholic acid for the treatment of non-alcoholic steatohepatitis: an early economic evaluation

2021 ◽  
pp. e20210011
Author(s):  
Chanh-Phong Tran ◽  
John J Kim ◽  
Jordan J Feld ◽  
William WL Wong
Keyword(s):  
Cost Effectiveness ◽  
Drug Cost ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Decompensated Cirrhosis ◽  
Obeticholic Acid ◽  
Potential Cost ◽  
Alcoholic Steatohepatitis ◽  
Early Results

Background: Currently, there are no pharmacological options available for the treatment of non-alcoholic steatohepatitis (NASH). In the 18-month interim analysis of an ongoing randomized, placebo-controlled phase 3 trial (REGENERATE), early results demonstrated that obeticholic acid (OCA) 25 mg significantly improved fibrosis with no worsening of NASH among patients with NASH and fibrosis compared to placebo (PBO). This study aimed to assess the potential cost-effectiveness of OCA compared to PBO in NASH patients. Methods: A state-transition model was developed to perform a cost-utility analysis comparing two treatment strategies, PBO and OCA 25 mg, from a Canadian public payer perspective. The model time horizon was lifetime with annual cycle lengths. Cost and utility parameters were discounted at 1.5% annually. The efficacy data were obtained from the REGENERATE trial, and costs and utilities were derived from other published literature. Probabilistic and deterministic sensitivity analyses were performed to test the robustness of the model. Results: Treatment with OCA led to reductions of 3.58% in decompensated cirrhosis cases, 3.95% in hepatocellular carcinoma, 7.88% in liver transplant, and 6.01% in liver-related death. However, at an annual price of CDN$36,000, OCA failed to be cost-effective compared to PBO at an incremental cost-effectiveness ratio of $815,514 per quality-adjusted life year (QALY). An 88% reduction in drug price to an annual cost of $4,300 would make OCA cost-effective at a willingness-to-pay threshold of $50,000/QALY. Conclusions: OCA failed to be cost-effective compared to PBO, despite demonstrating clinical benefits due to a high drug cost. A significant price reduction would be needed to make the drug cost-effective.

scholarly journals Long-lasting microbial larvicides for controlling insecticide resistant and outdoor transmitting vectors: a cost-effective supplement for malaria interventions

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Guofa Zhou ◽  
Eugenia Lo ◽  
Andrew K. Githeko ◽  
Yaw A. Afrane ◽  
Guiyun Yan
Keyword(s):  
Cost Effectiveness ◽  
Vector Control ◽  
Malaria Vector ◽  
Indoor Residual Spraying ◽  
Cost Effective ◽  
Control Measures ◽  
Malaria Vector Control ◽  
Potential Cost ◽  
Outdoor Transmission ◽  
Indoor And Outdoor

AbstractThe issues of pyrethroid resistance and outdoor malaria parasite transmission have prompted the WHO to call for the development and adoption of viable alternative vector control methods. Larval source management is one of the core malaria vector interventions recommended by the Ministry of Health in many African countries, but it is rarely implemented due to concerns on its cost-effectiveness. New long-lasting microbial larvicide can be a promising cost-effective supplement to current vector control and elimination methods because microbial larvicide uses killing mechanisms different from pyrethroids and other chemical insecticides. It has been shown to be effective in reducing the overall vector abundance and thus both indoor and outdoor transmission. In our opinion, the long-lasting formulation can potentially reduce the cost of larvicide field application, and should be evaluated for its cost-effectiveness, resistance development, and impact on non-target organisms when integrating with other malaria vector control measures. In this opinion, we highlight that long-lasting microbial larvicide can be a potential cost-effective product that complements current front-line long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) programs for malaria control and elimination. Microbial larviciding targets immature mosquitoes, reduces both indoor and outdoor transmission and is not affected by vector resistance to synthetic insecticides. This control method is a shift from the conventional LLINs and IRS programs that mainly target indoor-biting and resting adult mosquitoes.

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