Титульные страницы и содержание

BACKGROUND: Psychotropic drugs are prescribed to approximately 30-40% of adults with intellectual disability (ID) and challenging behaviour, despite the limited evidence of effectiveness and the potential of adverse events. AIMS: To assess the prevalence of adverse events in association with psychotropic drug use in adults with ID and challenging behaviour and to examine the relation of these adverse events with the person's quality of life. METHOD: The presence of adverse events was measured with a questionnaire that had to be filled in by the physicians of the participants. Movement disorders were measured separately with a standardised protocol. The strength of the association between adverse events and Intellectual Disability Quality of Life-16 (IDQOL-16), and daily functioning was investigated using linear regression analyses, taking into account the severity of disease (CGI-S) as potential confounder. RESULTS: Virtually all of 103 adults with ID and challenging behaviour had at least one adverse event (84.4%) and almost half had ≥3 adverse events (45.6%) across different subclasses. Using psychotropic drugs increased the prevalence of adverse events significantly. Respectively 13% of the patients without psychotropic drugs and 61% of the patients with ≥2 psychotropic drugs had ≥3 adverse events. Having adverse events had a significantly negative influence on the quality of life. CONCLUSIONS: A large majority of all patients had at least one adverse event associated with psychotropic drug use. More attention is needed for these adverse events and their negative influence on the quality of life of these patients, taking into account the lack of evidence of effectiveness of psychotropic drugs for challenging behaviour

PUNCHING SHEAR IN PRESTRESSED CONCRETE DECK SLABS: A COMPREHENSIVE STUDY

A large number of bridges in the Netherlands have transversely post tensioned deck slabs cast in-situ between flanges of precast girders and were found to be critical in shear when evaluated by Eurocode 2. To investigate the bearing (punching shear) capacity of such bridges, a 1:2 scale bridge model was constructed in the laboratory and static tests were performed by varying the transverse prestressing level (TPL). A 3D solid, 1:2 scale model of the real bridge, similar to the experimental model, was developed in the finite element software DIANA and several nonlinear analyses were carried out. It was observed that the experimental and numerical ultimate load carrying capacity was much higher than predicted by the governing codes due to lack of consideration of compressive membrane action (CMA). In order to incorporate CMA in the Model Code 2010 (fib 2012) punching shear provisions for prestressed slabs, numerical and theoretical approaches were combined. As a result, sufficient factor of safety was observed when the real bridge design capacity was compared with the design wheel load of Eurocode 1. It was concluded that the existing bridges still had sufficient residual bearing capacity with no problems of serviceability and structural safety

Influence of fibre orientation on the performance of steel fibre-reinforced concrete

The performance of fibre-reinforced materials in the hardened state depends on the material behaviour, the production method and influences related to the structure. The position and the orientation of fibres in a structure can differ from the homogenous distribution and the random orientation in a mixer. Due to the flow of the concrete, fibres are able to orient which makes the prediction of the structural behaviour of fibre-reinforced concrete more complex, but it also offers the potential for an improved structural performance. Synergetic effects were observed with regard to flowable concrete related to the fibre efficiency. This paper discusses two studies on the effect of fibre orientation on the performance of steel fibre- reinforced concrete. The first study discusses the relation between fibre orientation and the distribution of fibre orientation. The analysis indicates that the variation of fibre orientation follows a Gaussian law and the distribution of fibre orientation can be predicted from the average fibre orientation. The second study on tunnel segments discusses the influence of production on the fibre orientation and how this affects the splitting tensile strength. The fibre orientation affects the fibre efficiency and the structural performance of steel fibre-reinforced concrete.Postprint (published version

Application of FRC constitutive models to modelling of slabs

Fibre reinforcement technology has advanced significantly in recent years and, as a result, expanded into different applications. In particular, steel fibre-reinforced concrete has been successfully employed in flat slabs of several buildings in Europe with fibres as the only reinforcement. However, design methods for fibre-reinforced concrete (FRC) structures do not consider differences that may result from material characterisation tests that are not representative of the structural behaviour and fibre orientation of real-scale elements. In this regard, this paper presents a numerical study in which two constitutive models for FRC based on the bending test are applied to estimate the flexural behaviour of full-scale slabs of different dimensions. Likewise, a parametric study is conducted to analyse how the parameters of these constitutive models affect the flexural response of the slabs, and a numerical fit of the experimental data is performed. Finite element simulations using the constitutive models overestimate the experimental results. The parametric study also reveals that the parameter r2 (stress after cracking) has a particularly importance influence on the response. Furthermore, enhanced sectional behaviour of the slabs was observed as their width was increased.Peer ReviewedPostprint (published version

Movement disorders in adults with intellectual disability and behavioral problems associated with use of antipsychotics

Background Antipsychotic drugs are prescribed to approximately 30% to 40% of adults with intellectual disability (ID) and behavioral problems despite lack of evidence of effectiveness and potential adverse effects, including movement disorders. Aims The aim of this study was to examine the prevalence of movement disorders (dyskinesia, akathisia, dystonia, and parkinsonism) in in-patient adults with mild to borderline ID and behavioral problems associated with use of antipsychotics. Methods Prevalence of movement disorders was measured with a standardized protocol. The strength of the association between antipsychotic drug use and movement disorders was assessed using logistic regression analysis. Results Almost half (44.0%) of 134 in-patient adults with ID and behavioral problems had any movement disorder. Parkinsonism, dyskinesia, akathisia, and dystonia were present in, respectively, 36.6%, 11.2%, 9.0%, and 0.7% of patients with ID. It appeared that current use of any antipsychotic drug (odds ratio, 3.0; 95% confidence interval, 1.0-8.4) and a dose in target range (odds ratio, 5.5; 95% confidence interval, 1.5-20.4) were significantly associated with the risk of having movement disorders. Conclusions The prevalence of movement disorders in people with ID and behavioral problems is high, especially in ID patients using antipsychotics. More attention is needed for these movement disorders and their potential impact