This research aims to study experimentally behavior of hybrid deep beams when subjected to two point's monotonic and repeated loading in presence or absence of web openings. All tested deep beams have the same reinforcement in flexural (ρ= 0.0184) and web (ρ w =0.003) and same dimensions of (1500mm length, 150mm width and 350 mm height). In this research, the idea of hybridity was achieved by reinforcing the two shear spans with steel fiber keeping the middle span free from this fiber. The aim was to strengthen shear wings against shear failure (diagonal strut failure). To achieve the aim, twelve deep beams were cast and tested. Six of them were tested under monotonic loading as control beams to the other six beams tested under repeated loading at levels of 55% of the ultimate load of their control beams. The variables attempts were: loading type (either monotonic or repeated), beam type (either hybrid or non-hybrid), steel fiber (SF) ratio, and finally web opening sizes. The results illustrate that the ultimate load of deep beam with web openings under monotonic loading increases as the SF ratio increases. When SF was added to shear spans with a ratios of 1% and 2% under monotonic loading system, the ultimate load percentages increase are 37.5% and 68.75%, respectively compared with ultimate loads of beams which are without SF. Also, using fiberous concrete in casting the entire length of beams leads to an increase in the ultimate load of 4.55% as compared with deeps beams with the same SF ratio of 1%, and 43.75% as compared with beams cast with conventional concrete. The results using different opening size of square shapes, it was found that the ultimate load decrease as size of web openings increases from 0.61% of beam size to 1.37% of beam size by 10.17% and 25.42%, respectively as compared with hybrid deep beam without openings.
This research aims to study experimentally behavior of hybrid deep beams with web openings when subjected to two points' monotonic and repeated loading in effect of web openings shape. All tested deep beams have the same flexural (0.0184) and web reinforcement (ρ w =0.003) and same dimensions of (1500mm length, 150mm width and 350mm height). In this research, the idea of hybridity was achieved by reinforcing the two shear spans with steel fiber keeping the middle span free from this fiber. The aim was to strengthen shear region against shear failure (diagonal strut failure). To achieve the aim, six deep beams were cast and tested. Three of them were tested under monotonic loading as control beams to the other three beams tested under repeated loading at levels of 55% of the ultimate load of their control beams. The variables studied were: loading type (either monotonic or repeated) and web opening shapes. The results indicated that using different opening shapes (rectangular, circular or square) with an equivalent shape of 1.37% of beam size show that the ultimate load of beams with rectangular opening decreases by 10% as compared with beams with square web openings of the same area. Also, the ultimate load of beams with circular openings increases by 6.8% as compared with beams with square web openings of the same area. Also, it can be concluded that deep beams haves circular openings are increasing in ultimate loads by 17.5% as compared to rectangular web openings shapes with equivalent area.
In this study, the behavior of reinforced concrete deep beams with large opening, used for efficient creation of doors, windows, and passage openings, which were strengthened by carbon fiber-reinforced polymer (CFRP) sheets, is examined. This analysis was carried out using finite element method and ANSYS computer program. The fiber reinforced concrete deep beams were subjected to a point monotonic loading. The results of the suggested analysis procedure were verified with experimentally tested deep beams given in reference [1]. The parametric study examined the CFRP sheets configuration and their thickness used as external reinforcement, and the results of strengthened beams are compared with reference unstrengthen deep beams to insure the effectiveness of external reinforcing method. The strengthened beams indicate an increase in load carrying capacity up to 25, 53 and 59% for vertical orientation CFRP sheets with 0.7, 1.4 and 2.8 mm thickness respectively. On the other hand, horizontal strengthening raises beams strength by 54, 78 and 90% for 0.7, 1.4 and 2.8 mm thickness respectively. Meanwhile deep beams with ring type configuration sheets augmented the strength by 85, 92 and 97% for the three types of the used sheet thicknesses. Load-deflection relationships indicate that the combined reinforced concrete and CFRP laminate system possess some nonlinear deformability. The use of CFRP laminates on the deep beams was found to have an influence on the stress concentration and the mode of failure. Anchoring the CFRP laminates around the opening regions helped in using a larger portion of the strength of the laminates. The deep beams strengthened by CFRP sheets exhibited diagonal shear cracks that were developed at a much slower rate and were ultimately accompanied by the peeling off of the CFRP laminates.
<b>Objective: </b>To analyze national and state-specific trends in diabetes-related hospital admissions and determine whether disparities in rates of admission exist between demographic groups and geographically dispersed states. <p><b>Research Design and Methods: </b>We conducted<b> </b>serial cross-sectional analyses of the National Inpatient Sample (2008, 2011, 2014, 2016) and State Inpatient Databases for Arizona, Florida, Kentucky, Iowa, Maryland, Nebraska, New Jersey, New York, North Carolina, Utah, and Vermont for 2008, 2011, 2014, 2016/2017 among adult patients with Type 1 and Type 2 diabetes-related ICD codes (ICD-9 [250.XX], ICD-10 [E10.XXX, E11.XXX, E13.XXX]. We measured hospitalization rates for people with diabetes (all-cause hospitalizations) and for admissions with a primary diagnosis of diabetes or diabetes-related complications (diabetes-specific hospitalizations) per 10,000 persons per year. </p> <p><b>Results: </b>Nationally, all-cause and diabetes-specific hospitalizations declined by 3.1% (95% CI -5.5, -0.7) and 19.1% (95% CI -21.6, -16.6), respectively, over 2008-2016. The analysis of individual states showed that diabetes-specific admissions in individuals ≥65 years old declined during this time (16.3-48.8% decrease) but increased among patients 18-29 years old (10.5-81.5% increase) and that rural diabetes-specific admissions decreased in just over half of the included states (15.2-69.2% decrease). There were no differences in changes in admission rates among different racial/ethnic groups. </p> <p><b>Conclusions: </b>Overall rates of diabetes-related hospitalizations decreased over 2008-2016/7, but there were large state-level differences across subgroups of patients. The rise in diabetes hospitalizations among young adults is a cause for concern. These state- and subpopulation-level differences highlight the need for state-level policies and interventions to address disparities in diabetes healthcare use. </p>
Objective: To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. <p>Research Design and Methods: We conducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between January 2008 and July 2017. We also incorporated studies from a previous CE review from 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: cost-saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars.</p> <p>Results: Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: (I) Cost-saving: 1) Angiotensin-converting enzyme inhibitor (ACEI)/Angiotensin Receptor Blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management; 2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy; 3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers; 4) telemedicine for diabetic retinopathy screening compared with office screening; and 5) bariatric surgery compared with no surgery for individuals with T2D and obesity (BMI≥30 kg/m<sup>2</sup>). (II) Very cost-effective: 1) intensive glycemic management (targeting A1c <7%) compared with conventional glycemic management (targeting A1c level of 8-10%) for individuals with newly diagnosed type 2 diabetes (T2D); 2). multi-component interventions (involving behavior change/education and pharmacological therapy targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, nephropathy/retinopathy, secondary prevention of CVD with aspirin) compared with usual care; 3) statin therapy compared with no statin therapy for individuals with T2D and history of cardiovascular disease; 4) diabetes self-management education and support compared with usual care; 5) T2D screening every 3 years starting at age 45 years compared with no screening; 6) integrated, patient-centered care compared with usual care; 7) smoking cessation compared with no smoking cessation; 8) daily aspirin use as primary prevention for cardiovascular complications compared with usual care; 9) self-monitoring of blood glucose three times per day compared with once per day among those using insulin; 10) intensive glycemic management compared with conventional insulin therapy for T2D among adults aged 50+ years; and 11) collaborative care for depression compared with usual care. </p> Conclusions: Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources.
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