System reliability-based design of 2D steel frames by advanced analysis

The design of steel frames by geometric and material nonlinear analysis also referred to as -inelastic‖ or -advanced‖ analysis, is permitted by most specifications such as AISC360-10 and AS4100. In these specifications, the strength of a structural frame can be determined by system analysis in lieu of checking member resistances to the specific provisions of the Specification, provided a comparable or higher level of structural reliability. In designing by advanced analysis, the system resistance factor is applied to the frame strength determined by analysis. Provided that the design strength exceeds the required strength, the design is deemed adequate, requiring no further check of individual member resistance. The system-based design of steel structures by advanced analysis leads to a more efficient structural design process and achieves a more uniform level of structural reliability. The main impediment to adopting the procedure in practical applications is the apparent difficulty in assigning an appropriate resistance factor to the structural system. This thesis illustrates the novel framework of the system design-by-analysis approach and how to determine suitable system resistance factors accounting for inherent uncertainties in the ultimate strength of a frame. All key parameters influencing the frame strength are modelled as random and Monte-Carlo type simulations are conducted. New approaches for modelling initial geometric imperfections and residual stresses are introduced. The simulation results for a series of 2D low-to-mid-rise steel frames, which represent typical steel building inventory as well as frames from the literature, are presented obtained according to the proposed methodology. Braced and moment resisting frames are analysed under various load combinations and the system resistance factors are derived for different reliability levels

Psychological impact of preconception counseling: Assessment of anxiety before and during pregnancy

Objective: Assessment of anxiety levels in women and men before and after preconception counseling and during the first trimester of pregnancy. Methods: Couples were recruited from the fertility clinic of the University Medical Center Nijmegen, the Netherlands. Anxiety was assessed using the 40-item Spielberger State-Trait Anxiety Inventory (STAI). Results: 53 women and 51 men (74%) completed the STAI both before and after counseling. Anxiety levels did not change significantly after counseling or during the first trimester of pregnancy. 83.4% would recommend preconception counseling to others. Conclusion: Preconception counseling is valued by the majority of women and men and does not lead to adverse psychological effects. Copyrigh

Uniform Registration Agreements on Cholesteatoma Care: A Nationwide Consensus Procedure

Background: To coordinate and align the content for registration of cholesteatoma care. Methods: Systematic Delphi consensus procedure, consisting three rounds: two written sessions followed by a face-to-face meeting. Before this procedure, input on important patient outcomes was obtained. Consensus was defined as at least 80% agreement by participants. Hundred-thirty-six adult patients who had undergone cholesteatoma surgery and all ENT surgeons of the Dutch ENT Society were invited. The consensus rounds were att

Feedback preferences of patients, professionals and health insurers in integrated head and neck cancer care

Background: Audit and feedback on professional practice and health care outcomes are the most often used interventions to change behaviour of professionals and improve quality of health care. However, limited information is available regarding preferred feedback for patients, professionals and health insurers. Objective: Investigate the (differences in) preferences of receiving feedback between stakeholders, using the Dutch Head and Neck Audit as an example. Methods: A total of 37 patients, medical specialists, allied health professionals and health insurers were interviewed using semi-structured interviews. Questions focussed on: “Why,” “On what aspects” and “How” do you prefer to receive feedback on professional practice and health care outcomes?. Results: All stakeholders mentioned that feedback can improve health care by creating awareness, enabling self-reflection and reflection on peers or colleagues, and by benchmarking to others. Patients prefer feedback on the actual professional practice that matches the health care received, whereas medical specialists and health insurers are interested mainly in health care outcomes. All stakeholders largely prefer a bar graph. Patients prefer a pie chart for patient-reported outcomes and experiences, while Kaplan-Meier survival curves are preferred by medical specialists. Feedback should be simple with firstly an overview, and 1-4 times a year sent by e-mail. Finally, patients and health professionals are cautious with regard to transparency of audit data. Conclusions: This exploratory study shows how feedback preferences differ between stakeholders. Therefore, tailored reports are recommended. Using this information, effects of audit and feedback can be improved by adapting the feedback format and contents to the preferences of stakeholders

LINH-cijfers: Praktijkondersteuning in de huisartspraktijk.

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Decision strategies for mental health problems : a comparative judgement analysis study of general practitioners and mental health workers

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LINH-cijfers: Huisartsenpost: gewone klachten met acuut karakter.

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