Limitations on ACI Code Minimum Thickness Requirements for Flat Slab

Reinforced concrete two-way flat slabs are considered one of the most used systems in the construction of commercial buildings due to the ease of construction and suitability for electrical and mechanical paths. Long-term deflection is an essential parameter in controlling the behavior of this slab system, especially with long spans. Therefore, this study is devoted to investigating the validation of the ACI 318-19 Code long-term deflection limitations of a wide range of span lengths of two-way flat slabs with and without drop panels. The first part of the study includes nonlinear finite element analysis of 63 flat slabs without drops and 63 flat slabs with drops using the SAFE commercial software. The investigated parameters consist of the span length (4, 5, 6, 7, 8, 9, and 10m), compressive strength of concrete (21, 35, and 49 MPa), the magnitude of live load (1.5, 3, and 4.5 kN/m2), and the drop thickness (0.25tslab, 0.5tslab, and 0.75tslab). In addition, the maximum crack width at the top and bottom are determined and compared with the limitations of the ACI 224R-08. The second part of this research proposes modifications to the minimum slab thickness that satisfy the permissible deflection. It was found, for flat slabs without drops, the increase in concrete compressive strength from 21MPa to 49MPa decreases the average long-term deflection by (56, 53, 50, 44, 39, 33 and 31%) for spans (4, 5, 6, 7, 8, 9, and 10 m) respectively. In flat slab with drop panel, it was found that varying drop panel thickness t2 from 0.25  to 0.75  decreases the average long-term deflection by (45, 41, 39, 35, 31, 28 and 25%) for span lengths (4, 5, 6, 7, 8, 9 and 10 m) respectively. Limitations of the minimum thickness of flat slab were proposed to vary from Ln/30 to Ln/19.9 for a flat slab without a drop panel and from Ln/33 to Ln/21.2 for a flat slab with drop panel. These limitations demonstrated high consistency with the results of Scanlon and Lee's unified equation for determining the minimum thickness of slab with and without drop panels. Doi: 10.28991/cej-2021-03091769 Full Text: PD

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Experimental investigation of two-way concrete slabs reinforced by perforated steel plates under concentrated load

This research experimentally investigates the effect of using the perforated steel plate instead of steel bars as a reinforcing system in two-way concrete slabs. The study consists of casting four slabs using self-compacting concrete. Three slabs are reinforced by a perforated steel plate and one slab is reinforced by traditional bar reinforcement. The amount of steel in both types of reinforcement is equal. The slabs are tested under a monotonic concentrated load at their middle point. The results show a significant enhancement in behavior. The ultimate load increased about 43% to 76%, depending on the size of the openings. Moreover, the final crack width in all slabs reinforced by a perforated steel plate was smaller than in the slab reinforced by a traditional steel bar. The results of this study may be used in future research to introduce a method that will lead to an improvement in the overall behavior of two-way concrete slabs