Characteristics of the four types of pharmacoeconomic evaluations [11].
\r\n\tThis book aims to introduce general concepts about clock synchronization describing clock generation techniques and the properties of oscillators, phase-locked loops and in general of frequency synthesizers. Also welcome are topics that describe clock synchronization for digital ICs and the pertaining low-latency clock domain crossing techniques based on clock phase adjustment and standards for clock synchronization, such as the IEEE1588 and the Precision Time Protocol. Moreover, the book aims to describe the issues of sub-nanosecond synchronization in distributed systems on scales from a few tens of meters to a few tens of kilometers.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"543befd169b67a8eef0040e3a88b7e25",bookSignature:"Prof. Raffaele Giordano",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/8461.jpg",keywords:"General Properties, Clock Signals, Clock Distribution Systems, Clock Generation, Frequency Stability, Phase Locked Loops, Frequency Synthesizers, Low Latency, Predictable Latency, Clock Synchronization, Global Position System, IEEE 1588",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 5th 2019",dateEndSecondStepPublish:"December 25th 2019",dateEndThirdStepPublish:"February 23rd 2020",dateEndFourthStepPublish:"May 13th 2020",dateEndFifthStepPublish:"July 12th 2020",remainingDaysToSecondStep:"a year",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"193125",title:"Prof.",name:"Raffaele",middleName:null,surname:"Giordano",slug:"raffaele-giordano",fullName:"Raffaele Giordano",profilePictureURL:"https://mts.intechopen.com/storage/users/193125/images/system/193125.jfif",biography:'Raffaele Giordano is a Senior Assistant Professor at the Univerisity of Naples "Federico II", Italy. He has spent most of his scientific career in the field of research and development of electronics for data acquisition and processing in Nuclear and Subnuclear Physics experiments, including ATLAS, RD51, Belle2 and SuperB. He is the author of 371 papers on well-recognized scientific international peer-reviewed journals, including IEEE TNS, NIM-A, and JINST. His H-index is higher than 63 and the total number of citations is around 20k. He gave numerous contributions to international conferences (including 15 oral, 2 invited oral). 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From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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More than 40% of the people suffer in their adult life from a chronic disease, and approximately 20% are hospitalized because of it. Another perspective is that they are costly, but in many cases preventable. The main cause is usually lifestyle choices that are hard to change; eating foods that are low in fats, becoming more physically active, and avoiding tobacco can help from developing high-risk conditions and diseases.
\nPatients with multiple chronic diseases struggle with great challenges on their daily lives; also, they experience poor health outcomes and will tend to use health national services more than patients with single chronic disease. Not respecting treatment prescriptions have both personal health impact and health economics consequences. These people are regarded as the highest cost patient populations in the healthcare system [1], with a poor adherence to treatment and medical advices. Worldwide, experts are examining the situation in which health care can be better organized to meet the needs of every patient. It was demonstrated that every dollar spent for improving adherence saves seven dollars in total healthcare costs [2, 3].
\nThe absence of appropriate clinical practice guidelines for patients with multiple chronic diseases is a huge problem, which healthcare providers contend. Furthermore, patient-centered care needs to be supported through the transition of a more oriented approach to help patients prioritize their condition.
\nMoreover, not taking the required medication prescribed can have both personal health impact and health economics consequences. Recently, patients have shown increased interest in their own healthcare possibilities, raising the overall rate of adherence to treatment. However, the cost-effectiveness is still a parameter that is often ignored when a medical expert chooses to treat different kinds of conditions. Adherence is defined as “persistence in a practice,” so this definition emphasizes the routine that people with chronic disease ideally engage in when taking prescription medication [4].
\nThe term first used was “compliance.” Charavel et al. [5] described this concept like physician alone makes the treatment decision, while the passive and dependent patient is obliged to comply with it. But the patient is not so silent and the term “adherence” is more used, the patient is more engaged in taking prescription medication.
\nAdherence cannot be defined as an “all or nothing” response in which the patient either follows the prescriber’s instruction to the letter (adherence) or deviates from it in some way (nonadherence) [6]. A patient is considered adherent if he/she takes 80% of his/her prescribed medicine(s). In the current era of free and easy access to information, with a higher educational level across the population, the concept of “concordance” seems to win for some diseases, when the patient want to defer decisions entirely to their health professionals or family members. Some patients prefer a collaborative role, whereas others prefer a passive role.
\nThe most common chronic diseases that have a low adherence rate to treatment are asthma, diabetes, heart disease, obesity, rheumatic diseases, eating disorders, chronic obstructive pulmonary disease (COPD), and psychotic disorders.
\nThe estimated rate of adherence is only half of the percentage of the patients with chronic diseases. Ten days after a new prescription has been filled [7], another quarter of the patients have missed one dose of the medication (intentionally or unintentionally). This kind of behavior causes concern among the medical experts, so they have to make strong decisions in order to make the treatment more functional for every patient.
\nThe top three therapy classes used for chronic diseases are inflammatory conditions, multiple sclerosis, and cancer. These three account more than a half of the total spend for all specialty medications. The new trend is that patients often shift from using brand medications to lower cost generics; as they do this, the copayments decline and also the adherence drops significantly.
\nThe medications used to treat diabetes, high blood cholesterol and high blood pressure, ulcer, and asthma were the most expensive traditional therapy class. Also these classes had the minimum nonadherence rate (between 20 and 35%). In the case of ulcer disease, it is more likely for aged people to be more adherent to the treatment. Asthma is another case of strong nonadherence cases for the pediatric patients.
\nCorrect understanding of barriers for adherence and strategies used can help physicians educate their patients more appropriately, reducing the risk of nonadherence and achieving an improvement of the healthcare system [8].
\nA lot of studies were done to estimate the costs related to nonadherence to drug therapy in developed countries, making distinctions between primary nonadherence (prescriptions not being filled by the patient) and secondary nonadherence (medication not being taken as prescribed). World Health Organization (WHO) published in 2003 a report of poor adherence to treatment of chronic diseases in which developing countries were found to have a higher rate of nonadherence than the 50% average of nonadherence to long-term therapy for chronic diseases in developed countries [9].
\nMills et al. [10] examined both developed and developing nations in a systematic review of adherence and reported the same important barriers (fear of disclosure, substance abuse, forgetfulness, suspicions of treatment, too complicated regimens, too many pills, and decreased quality of life), with some facilitators reported by patients in developed nation (having a sense of self-worth, accepting their disease, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen).
\nAn economic evaluation of adherence consists in assessing the outcomes and costs of intervention designed to improve health. It is like we evaluate a new intervention when the new one is not compared with usual health care, for example the standard intervention, but with no intervention at all. The incremental cost-effectiveness ratio (ICR) is the difference in costs (C) between the drug and no drug divided by the difference in effects (E) between the drug and no drug.
\nThere are four form of economic evaluation of interventions:
Cost-effectiveness analysis
Cost-utility analysis
Cost-benefit analysis
Cost-minimization analysis
A summary of the characteristics of these types of economic evaluation is described in \nTable 1\n.
\nMethods | \nCosts | \nEffects | \nEvaluation question | \n
---|---|---|---|
Cost-effectiveness analysis (CEA) | \nMonetary units | \nNatural units (life-years gained, burns prevented, etc.) | \nComparisons of interventions with same objective | \n
Cost-utility analysis (CUA) | \nMonetary units | \nUtility and QALY (quality-adjusted life-year) or DALY (disability-adjusted life-year) | \nComparison of interventions with different objectives | \n
Cost-benefits analysis (CBA) | \nMonetary units | \nMonetary units | \nAre the benefits worth the costs? | \n
Cost-minimization analysis (CMA) | \nMonetary units | \nThe effects are not measured, since they are considered to be equal | \nLeast-cost comparisons of programs with the same outcome | \n
Characteristics of the four types of pharmacoeconomic evaluations [11].
The most used techniques are cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). A budget impact analysis (BIA) might be added to the economic evaluation.
\nA cost-effectiveness analysis of adherence shows effects in naturally occurring units, such as death, illnesses or burns prevented, and the costs in monetary units (Euros, Dollars, etc.). We can use this type of analysis because it provides information about the relative efficiency of alternative interventions that serve the same goal, what happened if the adherence is smaller comparative with a higher value. A cost-effective analysis must contain effect outcomes and the costs for the different values of adherence and should compare them. Cost-effectiveness analysis is the simplest type of economic evaluation to explain the differences in outcomes.
\nMeasuring benefits in natural units is the main advantage and focusing on a single outcome—adherence—could be considered a disadvantage.
\nCost-utility analysis evaluates the difference in costs relative to the difference in quality adjusted life years (QALYs). Both types of effects—on the life expectancy and on quality of life—are used to justify the costs. QALYs are represented by the number of gained life years corrected for quality of life. The QALY is the standard outcome measure existed in health economic evaluations, but there are some countries (Germany, Spain, and USA) that decided to ban the use of QALY in Health Technologies Assessment (HTA), after considering that QALY is methodologically and ethically not robust for health decision making. It is based on the use of subjective parameters, which are less robust than the chemical and biochemical parameters.
\nQALYs are determined with the aid of generic measurement instruments like EQ-5D [12], SF-6D (Short Form 6D), DCE (discrete-choice experiment), or MCDA (multi-criteria decision analysis). Another examples of generic instruments are Nottingham Health Profile (NHP), quality of well-being scale (QWB), sickness impact profile (SIP), and Health Utilities Index (HUI) Mark III.
\nEQ-5D is one of the most commonly used questionnaires to measure health-related quality of life (HRQOL). It consists of a questionnaire about five directions of current health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analogue scale (EQ-VAS). It was developed for adults, but a new version has been recently developed for children aged 8–18 years old (EQ-5D-Y) and the five dimensions are: walking about, look-after myself, doing usual activities, having pain or discomfort, feeling worried, sad or unhappy.
\nNottingham Health Profile (NHP) [13] includes two parts: Part I about distress within the following domains: emotions, sleep, social isolation, energy, pain, and mobility and Part II about health-related problems within the domains: occupation, housework, social life, home life, sex life, hobbies, and holidays.
\nQuality of Well-Being Scale (QWB) [14] includes questions about symptoms/problems, mobility, physical activity, and social activity.
\nSickness impact profile (SIP) [15] includes questions about sleep/rest, eating, work, ambulation, mobility, communication, home management, recreation and pastimes, body care and movement, alertness behavior, emotional behavior, and social interaction.
\nHealth Utilities Index (HUI) Mark III [16] includes questions about vision, hearing, speech, ambulation, dexterity, cognition, pain and discomfort, and emotion\n(Figure 1\n).
\nEQ-5D health questionnaire.
The complexity of assessing outcomes in cost-utility analysis is a disadvantage, even if this analysis can decide the best way of spending a given treatment budget or the healthcare budget as a whole.
\nCost-benefit analysis evaluates the difference in costs relative to the difference in benefits, with the benefits expressed in monetary units. This is the only pharmacoeconomic analysis that could determine how much more or less of society’s resources could be allocated to pursuing increasing patient adherence.
\nMeasuring benefits in monetary units is a disadvantage because it is a problem to valuate benefits, including death and disease, in money units.
\nThis analysis is performed when two health alternatives are equal, but few interventions are actually equally effective. Some evidence must support the assertion that outcomes are the same.
\nCost-minimization analysis is not an appropriate method of analysis adherence costs.
\nIn order to estimate costs, studies must include costs for hospitalization, outpatient services, hospital stays, emergency care, clinical visits, laboratory tests, professional services, pharmaceuticals, and medical devices. Patients’ copayments and deductibles must not be included in costs assessment. Indirect costs (cost to society due to illness) and direct nonmedical costs (costs to the patient such as travel) could have a significant impact on total costs.
\nThe concept of adherence or compliance can be measured in many different ways, including multi-item questionnaire scales, individual questionnaire, independent observations from patients and physicians, electronic monitoring devices, etc.
\nMany methods have been utilized to collect data for measuring medication adherence. Some data collection techniques include directly observing patients consuming medications, monitoring through electronic pill dispensers, and measuring clinical outcomes, such as, serum drug concentration levels. Other methods include clinical data from clinical trials, administrative claims data, electronic pharmacy databases, registries, patient and provider surveys, and paper medical records. There are several methods for measuring medication adherence using data obtained from these techniques that measure the time a patient has access to medication, including the medication possession ratio (MPR = number of days of medication supplied within the refill interval/number of days in refill interval), proportion of days covered (PDC=total days all drugs available/days in follow-up period), missing days, time to discontinuation, persistence rate, medication gaps, or self-reported questionnaires like Composite Adherence Score (CAS), Morisky Medication Adherence Scale (MMAS) with 4/8/9 questions, and Compliance Questionnaire for Rheumatology (CQR) with 5/19 questions.
\nIn rheumatology clinics, Berry et al. [17] found nonadherence patients who were answering ‘no’ to the question “Have you taken medicine regularly as prescribed or directed?”, more common among new (28%) than follow-up patients (1%). Overall, the patients were more on nonsteroidal anti-inflammatory drug (NSAIDs) than on disease-modifying antirheumatic drug (DMARDs), also the adherence was better for them, according to the symptoms and directed dose. Another difference measured in adherence is the cultural one, especially because of the economic impact of the treatment, that can lead to big cost problems. The follow-up adherence among patients with lupus depends on the medications prescribed. McElhone et al. [18] discussed that the perfect adherence rate is between 100% for treatment with azathioprine, 94% for oral steroids, and 68% for NSAIDs.
\nIn the case of rheumatoid arthritis (RA), adherence is estimated at similar values. Researchers such as Neame and Hammond [19] found that 90% of the patients with RA are in fact taking their medication according to doctors’ recommendations. Adherence rate is also correlated with the type of medication that is prescribed. The overall adherence is approximately 70% for NSAIDs, 50% for sulfasalazine and 80% for methotrexate, according to Klerk et al. [20]. Viewing the results, the weekly treatment with methotrexate may facilitate the enhanced adherence rate. In addition, patients’ result are not as dependent on NSAIDs as it is thought, and this can be a good thing for the recent concerns about the cardiovascular risk associated with continuous usage of the high-dose drug.
\nThe healthcare costs and the nonadherence to treatment for diabetes are both problems that need to be resolved. The information that is available at this moment regarding patient’s adherence in diabetes is very poor. Studies have shown that adherence in diabetes is related more often to insulin (from 19 to 46%) [21], than to oral agents. The complications and the cost-effectiveness of antidiabetic drugs are a serious problem, according to the American Diabetes Association [22]. Inadequate use or poor adherence to insulin results in ketoacidosis that often requires hospitalization and more costs.
\nFor people with diabetes, all-cause medical costs decrease as hypoglycemic drugs’ adherence increases.
\nSokol et al. [2] demonstrated that costs and hospitalization risk for people with diabetes monotonically decreased as adherence to drug treatment increased (\nTable 2\n).
\nAdherence level | \nMedical cost ($) | \nDrug cost ($) | \nTotal cost ($) | \nHospitalization risk (%) | \n
---|---|---|---|---|
1–19 | \n8812 | \n55 | \n8867 | \n30 | \n
20–39 | \n6959 | \n165 | \n7124 | \n26 | \n
40–59 | \n6237 | \n285 | \n6522 | \n25 | \n
60–79 | \n5887 | \n404 | \n6291 | \n20 | \n
80–100 | \n3808 | \n763 | \n4570 | \n13 | \n
Costs for people with diabetes.
Even if drug cost is bigger and medical cost is smaller in the case of adherent patients (adherence level>80), the total cost is the smallest. These savings probably reflect the effects of improved glycemic level on related diseases like microvascular disease or neuropathy, reducing the need for medical services.
\nBalkrishnan et al. [23] found that a 10% increase in medication possession ratios (MPRs) for an antidiabetic medication was associated with an 8.6% reduction in total annual healthcare costs.
\nCobden et al. [36] used MPR to assess diabetic patients and found that MPR of 80% or greater was associated with significant reduction in all-cause healthcare costs. MPR of 68% was associated with total mean costs of $8056, whereas an MPR of 59% had total mean costs of $8699.
\nGilmer et al. [24] estimated that medical care costs increased significantly for each 1% increase in HbA1c (glycosylated hemoglobin) above 7%. For a person with an HbA1c value of 6%, successive 1% increases in HbA1c resulted in cumulative increases in charges of almost 4, 10, 20, and 30%. For adults with diabetes and other diseases the costs are also increased. The most substantial cost increments occurred in individuals who had diabetes in combination with heart disease and hypertension: a 1% improvement in HbA1c level from 10 to 9% was associated with increasing in costs of $4116. The differences in costs are lower if the HbA1c value is smaller. If the patient isn’t adherent to the antidiabetic medicines, the increased HbA1c will rise the costs for healthcare system (\nTable 3\n).
\n\n | Changes in HbA1c levels | \n|||
---|---|---|---|---|
10–9% | \n9–8% | \n8–7% | \n7–6% | \n|
Patients with diabetes, heart disease, and hypertension | \n$4116 | \n$3090 | \n$2237 | \n$1504 | \n
Patients with diabetes and heart disease | \n$2796 | \n$2088 | \n$1503 | \n$1002 | \n
Patients with diabetes and hypertension | \n$1703 | \n$1260 | \n$897 | \n$588 | \n
Patients with diabetes | \n$1205 | \n$869 | \n$601 | \n$378 | \n
Costs for patients with diabetes and other diseases.
Nonadherence to oral hypoglycemic medications may partly explain why only 43% of patients with diabetes mellitus have HbA1c below 7% level [21].
\nChronic obstructive pulmonary disease (COPD) is a chronic limitation hat is usually progressive and not reversible. The main treatment for this condition aims to reduce symptoms, prevent exacerbations and delay the progression of the disease. Although medication has not been shown to modify the long-term of lung disease, various medications are available to prevent and control patients’ symptoms, and improve health. Patient adherence to medication for COPD is very poor compared with rates for medicines and other long-terms conditions. Nonadherence to medication is a risk factor for morbidity, hospital admission and increased mortality.
\nZaniolo et al. [27] made a budget impact study to demonstrate the implications of the adherence to patients with chronic obstructive pulmonary diseases. The target population that they examined corresponds to the entire sick population. They simulated that the same target population is managed under the same strategies of medical purpose. The current strategy is defined in order to reproduce the actual pattern of healthcare resource consumption and related costs for COPD management.
\nToy et al. [28] had examined in their study the adherence level among patients with inhaled COPD medications. They used the data from real-world clinical practice, as well as the national healthcare database. As a conclusion, it was emphasized that a correct management of COPD can be aided by the frequency which the patient is using the drug. Drugs with fewer daily doses are associated with improved adherence, and as well with lower healthcare resource use and cost. For 1000 COPD patients, a 5% increase in proportion of days covered (PDC) reduced the annual number of inpatient visits with 2.5% and emergency room visits with 1.8%, with a slightly increased outpatient visits (+0.2%) and a net reduction in annual cost of approximately $300,000. This study suggests that dosing frequency should be an important method in increasing adherence of COPD patients because patients with once-daily dosing frequency had highest adherence levels relative to patients with twice-daily, three times daily and four times daily dosing frequency.
\nSimoni-Wastila et al. [25] used administrative data with COPD patients, medication continuity and proportion of days covered (PDC) for assessing adherence. COPD patients with higher adherence to prescribed treatments experienced fewer hospitalizations and lower medicare costs than those who presented lower adherence behaviors. Both lack of interruption in drug dispensing and higher adherence were associated with better clinical outcomes.
\nThe costs for heart diseases are creating a burden on the patients’ finances. Most commonly they experience acute myocardial infarction, known as heart attack. The costs include ambulance rides, diagnostic test, hospital stays, and also surgery if needed. Employees suffering from heart disease require additional days off, so they are less productive at work, so it is not cost-effective for the economy. Additionally, the premature deaths caused by heart diseases are growing in the United States. In 2010, according to George and Hong [26], $41.7 billion was lost in potential productivity due to cardiovascular diseases.
\nTo lower the high costs of this condition, patients must make small changes in their lifestyle. These preventive changes include weight lost, exercising, avoiding smoking, eating healthy, also they can monitor their blood pressure and cholesterol levels every month, for lowering the rate of mortality.
\nSokol et al. [2] demonstrated that hospitalization risk for people with hypertension monotonically decreased as adherence to drug treatment increased. Differences were significantly higher than the outcome for adherence >80% in the case of low adherence (<60%). We observe higher costs only for adherence in the interval [20].
\nIn the case of congenitive heart failure, the differences in costs were not so obvious like in the case of hypertension. The total costs are the highest in the case of adherent patients (adherence level >80%). Hospitalization risk is significant higher than the outcome for adherent patients with congenitive heart failure in the case of patients with adherence in the interval (\nTables 4\n and \n5\n) [20].
\nAdherence level | \nMedical cost ($) | \nDrug cost ($) | \nTotal cost ($) | \nHospitalization risk (%) | \n
---|---|---|---|---|
1–19 | \n4847 | \n31 | \n4878 | \n28 | \n
20–39 | \n5973 | \n89 | \n6062 | \n24 | \n
40–59 | \n5113 | \n184 | \n5297 | \n24 | \n
60–79 | \n4977 | \n285 | \n5262 | \n20 | \n
80–100 | \n4383 | \n489 | \n4871 | \n19 | \n
Healthcare costs and hospitalization risk at different levels of adherence for patients with hypertension.
Adherence level | \nMedical cost ($) | \nDrug cost ($) | \nTotal cost ($) | \nHospitalization risk (%) | \n
---|---|---|---|---|
1–19 | \n9826 | \n15 | \n9841 | \n58 | \n
20–39 | \n7643 | \n90 | \n7733 | \n63 | \n
40–59 | \n11244 | \n134 | \n11378 | \n65 | \n
60–79 | \n13766 | \n158 | \n13924 | \n64 | \n
80–100 | \n12261 | \n437 | \n12698 | \n57 | \n
Healthcare costs and hospitalization risk at different levels of adherence for patients with congenitive heart failure.
Similarly, for hypertensive patients, the total costs are the smallest even if the drug cost is higher. These values reflect the impact of related conditions like, for example, renal disease.
\nLevine et al. [29] estimated for cardiology patients in USA that 125,000 deaths per year lead to a societal cost of 20 million lost work days and $1.5 billion lost earnings.
\nMcCombs et al. [30] used individual patient inpatient and outpatient claims data to identify increased health service costs associated with interruptions in therapy. The medicines costs were lower with $281, but the healthcare costs were higher with $873 ($637 due to increased hospitalization).
\nMorbidity from nonadherence to medications is a major public health problem in many therapeutic areas [31]. About one in four people do not adhere well to prescribe drug therapy. Poor adherence is considered a critical barrier to treatment success and remains one of the challenges to healthcare professionals [32]. Combining adherence to drug therapy with adherence to other interventions limits the ability to examine the relation between adherence to drug therapy and health outcomes. The effect of adherence should be measured on an objective health outcome, such as mortality. Individual studies have reported that good adherence was associated with a lower risk of mortality. The association between adherence to harmful therapy and mortality is a very important subject in the light of recent issues of the safety of patients and postmarket drug surveillance.
\nThe correlations between the mortality/morbidity rates for most chronic diseases are shown in \nTable 6\n.
\nChronic noncommunicable diseases | \nPercentage mortality | \nPercentage morbidity | \n
---|---|---|
\n | \n||
Rheumatic heart disease, hypertensive heart disease, ischemic heart disease, cerebrovascular disease, inflammatory heart disease | \n49.90 | \n21.23 | \n
\n | \n||
Mouth and oropharynx cancers; esophagus cancer; stomach cancer; colon and rectum cancers; liver cancer; pancreas cancer; trachea, bronchus, lung cancers; melanoma and other skin cancers; breast cancer, cervix uteri cancer; corpus uteri cancer; ovary cancer; prostate cancer; bladder cancer; lymphomas; multiple myeloma; leukemia | \n21.23 | \n10.83 | \n
\n | \n||
Chronic obstructive pulmonary disease, asthma | \n11.04 | \n7.90 | \n
\n | \n||
Peptic ulcer disease, cirrhosis of the liver, appendicitis | \n5.87 | \n6.66 | \n
\n | \n||
Unipolar depressive disorders, bipolar disorder, schizophrenia, epilepsy, alcohol use disorders, Alzheimer’s and other dementias, Parkinson disease, multiple sclerosis, drug use disorders, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder, insomnia, migraine, lead-caused mental retardation | \n3.32 | \n27.70 | \n
\n | \n2.95 | \n2.32 | \n
\n | \n||
Nephritis and nephrosis, benign prostatic hypertrophy | \n2.53 | \n2.18 | \n
\n | \n0.72 | \n1.14 | \n
\n | \n0.44 | \n0.25 | \n
\n | \n||
Rheumatoid arthritis, osteoarthritis, gout, low back pain | \n0.32 | \n4.32 | \n
\n | \n0.21 | \n0.54 | \n
\n | \n||
Abdominal wall defect, anencephaly, anorectal atresia, cleft lip, cleft palate, esophageal atresia, renal agenesis, Down syndrome, congenital heart anomalies, spina bifida | \n0.15 | \n3.92 | \n
\n | \n||
Glaucoma, cataracts, age-related vision disorders, adult-onset hearing loss | \n0.01 | \n9.94 | \n
\n | \n||
Dental caries, periodontal disease, edentulism | \n0.01 | \n1.06 | \n
Morbidity and mortality rates for chronic diseases [33].
Most nonadherence is intentional. Patients make the decision to not take their medicines based on some reasons:
Fear: Patients may be scared of potential side effects or side effects they had previously with the same or similar medication.
Cost: The prices of medicine can be a barrier to adherence.
Misunderstanding: Patients do not understand the need for medicine, the side effects or the expected time it will take to see some results.
Too many medications: The greater the number of different medicines prescribed and the higher the dosing frequency, the more likely a patient is nonadherent.
Lack of symptoms: Patients who do not feel any differences when they start or stop to take their medicines may see no reason to take it.
Worry: Concerns about becoming dependent on a medicine leads to nonadherence.
Depression: Patients who are depressed are less likely to take their medications as prescribed.
Mistrust: Patients may be suspicious of their doctor’s motives for prescribing certain medications, for example because of the marketing efforts of pharmaceutical companies to influence some prescribing patterns.
The costs of new drugs often exceed the costs of existing drugs. Such increased costs can be compensated by savings in other areas of health system (costs-offsets). For example, a new drug has fewer side effects and fewer costs to cure them. But, the first step is the patient to be adherent and to respect the prescription.
\nWe cannot say that nonadherence always leads to financial losses. Nonadherence is not always bad for the patient. Nonadherence is protective if the prescription is inappropriate or has adverse reactions. It is not useful to pay for an inefficient drug. New undesired costs will appear if side effects occur. Savings associated with undercompliance with overprescribed medications are positive economic effects. We must highlight the fact that the doctor, the pharmacist and the patient carry mutual responsibility for the outcome of the treatment. Further work is needed to develop optimal adherence patterns for individual patients and treatments. Important policy decisions need to be made about increasing nonadherence.
\nPhysicians play a key role in medication adherence. Trust and communication are two elements critical in optimizing adherence. Various studies have shown that physicians trust is more important than treatment satisfaction in predicting adherence to prescribed therapy. In consequence, physicians trust correlates positively with the acceptance of new medication, and improves the self-reported health status. A recent meta-analysis of physician communication and patient adherence to treatment found that there is a 19% higher risk of nonadherence among patients whose physician communicates poorly than among patients whose physician communicates well [34].
\nHealthcare providers play an unique role in assisting patients to carry out healthy behaviors and also to change patient’s beliefs about the risks and benefits of new medication. Another factor is concordance, in which patients and their providers (and physicians) agree whether and how a medication should be taken. Adherence requires the patient to believe there is a benefit to the medicine being prescribed and agree with the instructions on how to take it. Building trust and developing skills for successful communication between the patients and their provider, demands time, effort, knowledge, and practice.
\nEven those patients who fill and refill their prescriptions appropriately may have lapses in the continuity of their doses. One in five patients who receives a prescription medication cannot read the label.
\nElliot et al. [35] concluded there is not possible to make definitive conclusions about the cost-effectiveness of Adherence-Enhancing Interventions (AEIs) due to the heterogeneity of the reported studies: unclear reported adherence and outcomes, poorer quality of costs data, and omitted some cost elements.
\nThe assessment of pharmaceutical drugs and healthcare programs has been in recent years expanded beyond efficacy and safety to cover economic implications and other consequences. The incorporation of an economic perspective into the decision making process as to which therapies will be reimbursed by the national healthcare system and not only that, has made the subject of debate and discussion. National programs combining patient education with behavioral intervention strategies could decrease the financial losses due to poor adherence. The intention of this chapter was to highlight a very important problem of adherence in direct symbiosis with the economic situation. To ascertain the true extent of financial losses due to low adherence in emerging countries, more studies are urgently required. The absence of national policies grows the financial losses due to poor adherence. The answer, in our opinion, is not to spend more money on drugs and expensive treatment costs, but to work towards the patient in general. As individuals we are constantly making choices as to how we use our time and money, but we do not always think about our well-being regarding the health.
\nWith the rapid development of the economy and the large-scale development of water energy, the construction of reservoir dams has become an important engineering initiative to meet the needs of social and economic development. Over time, the sediment in the reservoir continues to accumulate, and the storage capacity for prosperity and flood control continues to decrease or even loses capacity completely. In addition, due to a lack of water level data and drainage area data in the original design or a lack of labor, equipment, funds, or other resources during construction, the construction of small storage capacity reservoirs cannot meet the current demand for water resources. Therefore, the construction of new water conservancy facilities or the heightening of the old dams has become an urgent problem to consider. Compared with the construction of a new dam, raising an original dam body does not require the consideration of the location of a new dam, and it can obtain a larger storage capacity at a lower economic cost. Therefore, the dam heightening scheme has attached increasing attentions from engineers [1].
Addressing the technical problems that rise during the process of heightening is becoming a top priority due to the large amount of work and the complexity of construction technology. There are different key problems in dam heightening engineering due to the dam type and heightening method. Earth-rock dams are a widely used type of dam. Due to the permeability of earth-rock materials, it is urgent to study the impact of seepage on the earth-rock dam during the heightening process [2]. For slope-type heightened and thickened concrete dams, the key issues related to dam heightening are the stress concentrations and deformation of the dam body during construction and operation, stress analysis and structural form of the interface between new and old concrete, and design of drainage and water stop [3]. Periodic changes in the temperature and changes in the temperature of the old dam after new concrete is placed will cause problems such as deterioration of the dam heel stress, cracks in the joint surface, and cracks in the downstream dam surface [4].
There are many engineering precedents for dam elevation, such as the Goscheneralp Dam and Grande Dixence Dam in Switzerland, Steenbras Dam in South Africa, Roseires Dam in Sudan, and Danjiangkou Dam and Songyue Dam in China [3, 5, 6, 7, 8, 9]. Due to the rapid increases in the urban population of Cape Town, raising the Steenbras Dam offered an effective solution to the problem of a serious water shortage. During the course of anchoring the dam, engineers considered that post-stressing would have advantages in terms of cost and expedition. Essentially the process is one of placing vertical cables through the wall of a mass concrete dam from the crest into the foundation and stressing the cables to produce stabilizing compressive forces on the upstream face. Similar to the Steenbras Dam, the Songyue Dam also raised the dam to meet the water supply needs of Helong City. The Songyue Dam is located in a severely cold area, with an average annual temperature of 4.8°C, and the temperature changes greatly during the year. Therefore, the heightened structure needed to adapt to the characteristics of the severely cold area. The calculation research on the Songyue Dam heightening scheme shows that setting a sliding joint in the middle of the joint surface can absorb the shrinkage and deformation of a part of the newly poured concrete, which has a significant effect on improving the tensile stress of the upstream and downstream dam surfaces.
The Zhushou Reservoir is located in Sichuan Province, China, which is located in a seismically active area. The dam of Zhushou Reservoir is a clay core rock-debris dam. To meet the production and domestic water demand of nearby cities, it is necessary to expand the capacity of the Zhushou Reservoir. Under the action of gravity loads, water loads, and earthquake loads, effectively coordinating the deformation of the rockfill of the new and old dams to allow the stress and deformation of the seepage control system to be within the allowable range of the materials is a major technical difficulty to be solved. Therefore, based on the experience of previous engineering technologies, the necessary theoretical research is carried out to accurately predict the stress and deformation of the dam, especially the coordination between the deformation of the old and new dams, to improve the rationality of engineering design and to improve future engineering operations.
The Zhushou Reservoir pivotal project is located in Liangshan Prefecture, Sichuan Province, and is a medium-sized reservoir. The dam is made of a clay core rock-debris dam. Its top elevation is 2416.10 m, the dam length is 190.00 m, the top elevation of the wave-proof wall is 2417.10 m, the dam height is 63.4 m, and the width of the dam top is 6.0 m. Both the upper and lower dams are provided with rockfilled prisms. The upstream slope is protected by dry block stone, while the downstream slope is protected by a dry block stone arch ring and turf in the circle. The thickness of the dry block stone is 40 cm. The top width of the gravel soil core wall is 6.0 m, the top elevation is 2415.3 m, and the upper and lower slopes are 1:0.4.
According to the water supply project planning of the Baihetan hydropower station resettlement area, to meet the production and domestic water demand of the resettlement area, the Zhushou Reservoir should be expanded and matched to the corresponding water diversion project. The dam should be increased from 63.4 m to 98.1 m. At the same time, when the dam is heightened, the impervious body of the original dam should be strengthened [10].
The objective of dam heightening is to make use of the water-retaining capacity of the original core wall dam to produce rockfill heightening on the top and downstream slope of the old dam so that the original dam body becomes a part of the heightened dam. At the same time, a core wall and foundation anti-seepage system of the original dam is strengthened, a concrete cutoff wall is added, and the foundation anti-seepage curtain grouting is strengthened. The anti-seepage type of the heightening dam body adopts the upstream reinforced concrete-faced slab, the slope ratio of the upstream dam is 1:1.4, and the comprehensive slope of the downstream rockfill body is 1:1.6 [11]. Figures 1 and 2 show general view of the Zhushou Reservoir dam.
Plane figure of heightening of the Zhushou Reservoir dam.
Standard profile of heightening of the Zhushou Reservoir dam.
To avoid excessive deformation and cracking of the lower core wall caused by the compression of the upper high rockfill, the cutoff wall is constructed after the upper rockfill body is filled and settled for 3 months. The concrete connecting plate between the cutoff wall and the toe slab shall be constructed after the toe slab and the face plate are completed.
The overall construction procedure is as follows: old dam filling → new dam filling to 2447.90 m → core wall reinforcement and cutoff wall construction → toe slab construction → panel construction → connecting plate construction → new dam filling to 2451 m. The water level remains at 2395.0 m during the construction period. The construction period of dam heightening is 31 months, which are as follows:
From September of the first year to February of the second year, the construction period of the old dam filling is 6 months.
From March of the second year to November of the second year, the construction period of the new dam filling to an elevation of 2447.9 m is 9 months.
From December of the second year to May of the third year, the construction period of core wall reinforcement and cutoff wall construction is 6 months.
During June of the third year, the construction period of toe slab is 1 month.
From July of the third year to August of the third year, the construction period of concrete panel and wave wall construction is 2 months.
From September of the third year to November of the third year, the construction period of connecting plate construction is 3 months.
From December of the third year to July of the fourth year, the construction period of new dam filling to 2451 m is 4 months.
Figure 3 shows a finite element mesh diagram of a typical riverbed section, Figure 4 shows a three-dimensional finite element mesh diagram, and Figure 5 shows an anti-seepage system (core wall, connecting plate, toe slab and panel) meshing diagram, where the X forward direction is defined as from the left bank to the right bank, the Y forward direction is defined as upstream to downstream, and the Z forward direction is defined as the opposite direction of gravity. The three-dimensional solid element adopts an 8-node hexahedral isoparametric element and a 4-node tetrahedral isoparametric element, and the latter is treated as a degenerated hexahedral element. There are 29,905 generating units and 33,482 nodes in total.
Finite element mesh diagram of a typical riverbed section.
Three-dimensional finite element mesh diagram.
Anti-seepage system meshing diagram.
According to the above construction and water storage process, the order of the filling and storage simulation in the finite element calculation is as follows: old dam filling → new dam filling to 2447.90 m (the water level remained at 2395.0 m) → cutoff wall construction → toe slab construction → panel construction → connecting plate construction → new dam filling to 2451 m → upstream water storage to a normal water level elevation of 2444 m. There are 70 stages for simulation, including 42 stages for dam filling and 38 stages for water storage. Figure 6 shows the simulation diagram of the Zhushou Reservoir construction and water storage process. Figure 7 shows the water level-time curve of the Zhushou Reservoir during the construction and water storage process.
The Zhushou reservoir construction and water storage process simulation diagram.
The Zhushou reservoir water level-time curve during the construction and water storage process.
As the main body of the concrete-faced rockfill dam, reasonable simulation of its stress–strain relationship is very important to improve the rationality of the calculation results of the stress and deformation of the concrete-faced rockfill dam. In this project, the constitutive model of rockfill material is based on the Shen Zhujiang double-yield surface elastic-plastic model proposed by Shen Zhujiang. Compared with the nonlinear elastic model, the model can consider the dilatancy and shear-shrinkage characteristics of rockfill bodies and can more accurately reflect the stress-strain characteristics of dam bodies than other models.
In the Shen Zhujiang double-yield surface elastic-plastic model, the two-yield surfaces are only regarded as the boundary of elastic region and are no longer related to hardening parameters. The double-yield surface is used to establish the unloading criterion, make the elastic-plastic matrix symmetrical, and specify the direction of plastic strain. As shown in Figure 8, due to the double-yield surface, not only the loading direction B will produce plastic strain, but also the loading directions A and C will produce plastic strain.
Double hardening model.
The two-yield surfaces of the Shen Zhujiang double-yield surface elastic-plastic model are
where
where
The model adopts the normal flow rule, so the plastic potential surface is orthogonal to the direction of the plastic strain increase and
Tangent Young’s modulus is defined as
where
In the formula, the elastic Poisson’s ratio
where
However, the expression of
where
The Shen Zhujiang elastic-plastic model has eight model parameters, which are
The Shen Zhujiang elastic-plastic model can also be calculated by the parameters of the model Duncan
The tangent Poisson’s ratio
For unloading, the modulus of resilience is calculated as follows:
where
The loading and unloading criteria of the Shen Zhujiang elastic-plastic model are as follows:
If
If
If
For coarse-grained materials,
where
The linear elastic model is used for concrete materials, and the stress–strain relationship conforms to the following generalized Hooke’s law:
where
At present, the Goodman thickness-free elements and Desai thin-layer elements are commonly used. Because the interface is a kind of interface without a thickness, it is more suitable to use the Goodman element without a thickness to theoretically simulate the interface. However, in fact, a Goodman element without a thickness must obtain a large normal stiffness to avoid overlap. In addition, shear dislocation does not necessarily occur on the interface and may penetrate into the soil at a certain distance. Desai thin-layer elements reflect normal deformation to a certain extent, but the choice of the thickness of thin-layer elements has a great influence on the calculation results. A large element thickness will introduce errors in the physics, and a small element thickness will introduce errors in the mathematics. Desai suggests that the ratio of the thickness
For the constitutive model of the contact surface, the hyperbolic model and ideal elastic-plastic model of the relationship between the shear stress and relative displacement proposed by Clough and Duncan are most commonly used. The results show that the shear stress on the interface between the soil and structure is not uniform, the shear deformation is actually a rigid-plastic deformation, and the contact friction model can be well simulated.
Before the shear stress
The deformation on the contact surface can be divided into two parts: basic deformation and failure deformation. The basic deformation is similar to the deformation calculation model of other soils, expressed as
There are two forms of failure and deformation of the elements: tension cracking and slip. The rigid-plastic model is used to calculate the relative shear deformation of the element. There is no relative slip on the contact surface before failure, and after failure, the relative slip will continue to develop.
For the three-dimensional thin-layer contact surface element, the Y direction is the normal direction of the contact surface:
If the contact surface is under tension,
The value of
The flexibility matrix
The dam uses C25 concrete and C30 concrete. The unit weight, elastic modulus and Poisson’s ratio of C25 and C30 concrete are 2.5 t/m3, 2.8 × 104 N/mm2, and 0.167 and 2.5 t/m3, 3.0 × 104 N/mm2, and 0.167, respectively.
The lithology of the newly filled rockfill material in the Zhushou Reservoir is the Ordovician Hongshiya Formation (O1h) quartz sandstone, fine sandstone with silty mudstone, and Qiaojia Formation (O2q) gray thin-to-medium thick sandstone, dolomite, and limestone. According to design filling standards and field testing data, the triaxial CD test had been carried out on rockfill materials of the heightening dam and the filling materials of the old dam body. The calculated parameters determined by the test are shown in Table 1.
Material name | Δ | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Old dam | Gravel clay core wall | 1.84 | 56.9 | 29.3 | 0 | 164.4 | 0.46 | 0.69 | 3.68 | 0.1 | 0.3 |
Stone slag in the upper part of the dam hell (elevation above 2390 m) | 2.04 | 0 | 41.8 | 9.1 | 318.8 | 0.46 | 0.79 | 2.78 | 0.04 | 0.35 | |
Stone slag in the lower part of the dam shell (elevation above 2390 m) | 2.12 | 0 | 44.9 | 9.1 | 431.3 | 0.38 | 0.72 | 3.3 | 0.09 | 0.37 | |
Rockfill | 2.14 | 0 | 47.7 | 10.1 | 811 | 0.31 | 0.54 | 10.4 | 0.12 | 0.4 | |
New dam | Cushion zone | 2.2 | 0 | 58.8 | 10.9 | 1245.6 | 0.35 | 0.60 | 10.4 | 0.12 | 0.4 |
Transition region | 2.17 | 0 | 59.5 | 13.3 | 1405.4 | 0.29 | 0.65 | 10.1 | 0.15 | 0.39 | |
Main rockfill area | 2.16 | 0 | 59.4 | 13.6 | 1301.5 | 0.27 | 0.60 | 9.3 | 0.15 | 0.39 | |
Secondary rockfill area | 2.14 | 0 | 56.1 | 11.9 | 954.1 | 0.37 | 0.63 | 9.5 | 0.13 | 0.36 |
Calculated parameters of the dam material.
Considering the stress and deformation of the new dam after filling and storage period and influence of the stress and deformation of the new dam on the old dam, Table 2 lists the characteristic values of the stress and deformation of the dam body.
Statistical items | Dam body | ||
---|---|---|---|
Completion period | Storage period | ||
Displacement along the river (cm) | Downstream | −18.2 | −10.2 |
Upstream | 6.9 | 9.25 | |
Settlement (cm) | 47.5 | 48.8 | |
Major principal stress (MPa) | 2.13 | 2.14 | |
Minor principal stress (MPa) | 1.21 | 1.23 |
Characteristic values of stress and deformation of the dam body.
Figures 9 and 10 show the contour of the displacements of the dam body during the completion period and the storage period. The simulation results show that the maximum horizontal displacement occurs in the dam body of the old dam and the maximum settlement occurs at the interface between the old and new dams. During the completion period, the maximum settlement of the dam is 47.5 cm, and the horizontal displacement to the upstream and downstream is 18.2 cm and 6.90 cm, respectively. After the water storage, the maximum deformation of the dam body under upstream water load was reduced to 10.2 cm, while the horizontal displacement towards the downstream was increased to 9.25 cm, and the maximum settlement was increased to 48.8 cm.
Contour of the displacements of the dam body during the completion period (cm). (a) Displacement along the river and (b) settlement.
Contour of the displacements of the dam body during the storage period (cm). (a) Displacement along the river and (b) settlement.
The results of principal stress calculation show that due to the large modulus of cutoff wall and pile foundation, significant stress concentration has occurred in the dam.
Table 3 lists the characteristic values of the stress and deformation of the cutoff wall.
Statistical items | Cutoff wall | ||
---|---|---|---|
Completion period | Storage period | ||
Dam axial displacement (cm) | Left side bank | / | −0.11 |
Right side bank | / | 0.12 | |
Displacement along the river (cm) | Downstream | / | 10.6 |
Settlement (cm) | / | 0.48 | |
Dam axial stress (MPa) | Tensile stress | −0.21 | −2.53 |
Compressive stress | 1.18 | 3.21 | |
Major principal compressive stress (MPa) | 2.25 | 12.0 | |
Minor principal tensile stress (MPa) | −0.23 | −1.74 |
Characteristic values of stress and deformation of the cutoff wall.
Since the cutoff wall is constructed after the new dam is filled to 2447.9 m, the deformation of the cutoff wall will not occur during the completion period, so only the deformation distribution during the storage period is given. Figure 11 shows contour of the displacement of the cutoff wall during the storage period. The axial displacement of the dam is represented by the compression from both sides towards the riverbed, and the deformation in the direction of the right bank and the left bank is 0.12 cm and 0.11 cm, respectively. The axial displacement of the dam is generally small. For the displacement along the river, the water load shows a deformation towards the downstream, and the maximum value is 10.6 cm. Because the upper part of the impervious wall is filled with rockfill and supported by the connecting plate, the deformation along the river of the impervious wall increases first and then decreases slightly from the bottom to the top. For the vertical displacement, the maximum value is 0.48 cm, which increases gradually from the bottom to top under the action of the upper water load.
Contour of the displacements of the cutoff wall during the storage period (cm). (a) Dam axial direction, (b) displacement along the river and (c) settlement.
Figure 12 shows the contour of the dam axial stresses on the downstream and upstream sides of the cutoff wall during the completion period. Figure 13 shows the contour of the dam axial stresses on the downstream and upstream sides of the cutoff wall during the storage period. Because the cutoff wall will be built after the new dam is basically completed, the stress difference between the upstream and downstream faces of the completion period is small, the stress of the cutoff wall is mainly caused by the self-weight, and the tensile and compressive stresses are small. During the storage period, the axial stress of the dam corresponds to the deformation direction. After storage, the upstream face is in tension at both ends of the middle compression zone, while the downstream face is basically in compression, but the pressure stress at both sides is significantly greater than that at the riverbed. The maximum value of the tensile and compressive stress is −2.53 MPa and 3.21 MPa, respectively. For the major principal stress, the downstream stress is greater than the upstream stress because the deformation is oriented downstream during the storage period. At the same time, due to the relatively small height of the wall near the bank slope and the influence of the boundary constraints, the local stress near the bank slope is concentrated, so the stress at the bank slope on both banks is large, and the maximum pressure stress is 12.0 MPa. For the minor principal stress, the upstream and downstream faces are all in compression at the middle part and tension at both sides. The maximum tensile stress is −1.74 MPa.
Contour of the dam axial stresses on the downstream and upstream sides of the cutoff wall during the completion period (MPa). (a) Downstream side and (b) upstream side.
Considering the ultimate compressive strain of 700 με and ultimate tensile strain of 100 με, the allowable compressive strength and tensile strength of C25 concrete are 19.6 MPa and −2.8 MPa, respectively. From the above calculation results, the tensile and compressive stresses of the cutoff wall are all within the allowable range for C25 plain concrete (Figure 13).
Contour of the dam axial stresses on the downstream and upstream surface of the cutoff wall during the storage period (MPa). (a) Downstream side and (b) upstream side.
Table 4 lists the characteristic values of the stress and deformation of the connecting plate and toe slab during the storage period.
Statistical items | Storage period | ||
---|---|---|---|
Connecting plate and toe slab | Dam axial displacement (cm) | Left side bank | −0.71 |
Right side bank | 0.89 | ||
Displacement along the river (cm) | Upstream | / | |
Downstream | 5.36 | ||
Settlement (cm) | 5.63 | ||
Connecting plate | Dam axial stress (MPa) | Tensile stress | −1.81 |
Compressive stress | 0.56 | ||
Major principal stress (MPa) | Compressive stress | 0.86 | |
Minor principal stress (MPa) | Tensile stress | −1.82 | |
Compressive stress | 0.32 | ||
Toe slab | Dam axial stress (MPa) | Tensile stress | −4.78 |
Compressive stress | 1.53 | ||
Major principal stress (MPa) | Compressive stress | 6.33 | |
Minor principal stress (MPa) | Tensile stress | −4.80 | |
Compressive stress | 0.90 |
The characteristic values of the stress and deformation of the connecting plate and toe slab during the storage period.
Figure 14 shows the contour of the deformation of the connecting plate and toe slab during the storage period. For the axial displacement of the dam, the water displacement is represented by the compression from both sides of the riverbed. The axial displacement of the dam is generally small. The maximum displacements of the left and right banks after water storage are 0.71 cm and 0.89 cm, respectively, which occur in the 0 + 209 and 0 + 65 sections. The displacement of the river is characterized by a downward-directed deformation under the water load during the storage period, with a maximum value of 5.36 cm, which occurs in the 0 + 125 section of the riverbed. For the vertical displacement, the maximum value is 5.63 cm during the storage period, which also occurs at the 0 + 125 section of the riverbed. It can also be seen from Figure 14 that due to the deformation joint between the connecting plate and the toe slab, the connection between the toe slab and the connecting plate is staggered, but the magnitude is small, and the setting of the toe slab length is appropriate.
Contour of the deformation of the connecting plate and toe slab during the storage period (cm). (a) Dam axial displacement, (b) displacement along the river and (c) settlement.
Figure 15 shows the contour of the dam axial stresses of the connecting plate and toe slab during the storage period. Under the action of water loading, the deformation of the connecting plate is constrained by the toe slab, and the deformation of the toe slab is constrained by the face slab, so the stress of the toe slab is greater than that of the connecting plate. The dam axial stress, corresponding to the deformation direction, is mainly manifested as tension at both ends and compression in the middle, and the downstream compressive stress is greater than the upstream compressive stress. After the storage period, the maximum tensile compressive stress is −4.78 MPa and 1.53 MPa, respectively, which occurs at the right end of the toe slab and in the 0 + 95 section of the riverbed.
Contour of the dam axial stresses of the connecting plate and toe slab during the storage period (MPa).
Considering the ultimate compressive strain of 700 με and ultimate tensile strain of 100 με for C30 concrete, the allowable compressive strength and tensile strength are 27.3 MPa and −3.9 MPa, respectively. It can be seen from the above calculation results that the compressive stress and tensile stress of the connecting plate and toe slab are within the allowable range for C30 plain concrete, but the maximum tensile stress of the toe plate exceeds the allowable value of C30 plain concrete, and the exceeding area is mainly located in the local area at the junction of the toe slab and the bank slope, which could be resolved by adding reinforcement.
The Zhushou Reservoir was transformed from a clay core rock-debris dam to a concrete-faced rockfill dam, with the maximum dam height increasing from 63.4 m to 98.1 m. The three-dimensional finite element method was used to simulate the operation process of construction filling and the storage period, and the conclusions are discussed as follows:
The simulation results show that the maximum horizontal displacement occurs in the dam body of the old dam, and the maximum settlement occurs at the interface between the old and new dams. Due to the large modulus of cutoff wall and pile foundation, significant stress concentration has occurred in the dam.
During the storage period, the maximum axial tensile and compressive stresses of the cutoff wall are −2.53 MPa and 3.21 MPa, respectively, and the maximum major and minor principal stresses are 12.0 MPa and −1.74 MPa, respectively. The tensile and compressive stresses are all within the allowable range for C25 plain concrete, and the cutoff wall will not be damaged under static conditions.
During the storage period, the maximum axial tensile and compressive stresses of the toe slab (connecting plate) dam are −4.78 MPa and 1.53 MPa, respectively, and the maximum major and minor principal stresses are 6.33 MPa and −4.80 MPa, respectively. The compressive stress of toe slab and connecting plate and the tensile stress of connecting plate are all within the allowable range for C30 plain concrete, but the tensile stress of the local area at the junction of toe slab and bank slope has exceeded the allowable value for C30 plain concrete, so the reinforcement should be strengthened at this location.
As an Open Access publisher, IntechOpen is dedicated to maintaining the highest ethical standards and principles in publishing. In addition, IntechOpen promotes the highest standards of integrity and ethical behavior in scientific research and peer-review. To maintain these principles IntechOpen has developed basic guidelines to facilitate the avoidance of Conflicts of Interest.
",metaTitle:"Conflicts of Interest Policy",metaDescription:"As an Open Access publisher, IntechOpen is dedicated to maintaining the highest ethical standards and principles in publishing. In addition, IntechOpen promotes the highest standards of integrity and ethical behavior in scientific research and peer-review.",metaKeywords:null,canonicalURL:"/page/conflicts-of-interest-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\\n\\nA Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\\n\\nA Conflict of Interest can be identified at different phases of the publishing process.
\\n\\nIntechOpen requires:
\\n\\nCONFLICT OF INTEREST - AUTHOR
\\n\\nAll Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\\n\\nCONFLICT OF INTEREST – ACADEMIC EDITOR
\\n\\nEditors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\\n\\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\\n\\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\\n\\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\\n\\nCONFLICT OF INTEREST - REVIEWER
\\n\\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\\n\\nEXAMPLES OF CONFLICTS OF INTEREST:
\\n\\nFINANCIAL AND MATERIAL
\\n\\nNON-FINANCIAL
\\n\\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\\n\\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\\n\\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\\n\\nEXAMPLES:
\\n\\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\\n\\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\\n\\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\\n\\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\\n\\nPolicy last updated: 2016-06-09
\\n"}]'},components:[{type:"htmlEditorComponent",content:"In each instance of a possible Conflict of Interest, IntechOpen aims to disclose the situation in as transparent a way as possible in order to allow readers to judge whether a particular potential Conflict of Interest has influenced the Work of any individual Author, Editor, or Reviewer. IntechOpen takes all possible Conflicts of Interest into account during the review process and ensures maximum transparency in implementing its policies.
\n\nA Conflict of Interest is a situation in which a person's professional judgment may be influenced by a range of factors, including financial gain, material interest, or some other personal or professional interest. For IntechOpen as a publisher, it is essential that all possible Conflicts of Interest are avoided. Each contributor, whether an Author, Editor, or Reviewer, who suspects they may have a Conflict of Interest, is obliged to declare that concern in order to make the publisher and the readership aware of any potential influence on the work being undertaken.
\n\nA Conflict of Interest can be identified at different phases of the publishing process.
\n\nIntechOpen requires:
\n\nCONFLICT OF INTEREST - AUTHOR
\n\nAll Authors are obliged to declare every existing or potential Conflict of Interest, including financial or personal factors, as well as any relationship which could influence their scientific work. Authors must declare Conflicts of Interest at the time of manuscript submission, although they may exceptionally do so at any point during manuscript review. For jointly prepared manuscripts, the corresponding Author is obliged to declare potential Conflicts of Interest of any other Authors who have contributed to the manuscript.
\n\nCONFLICT OF INTEREST – ACADEMIC EDITOR
\n\nEditors can also have Conflicts of Interest. Editors are expected to maintain the highest standards of conduct, which are outlined in our Best Practice Guidelines (templates for Best Practice Guidelines). Among other obligations, it is essential that Editors make transparent declarations of any possible Conflicts of Interest that they might have.
\n\nAvoidance Measures for Academic Editors of Conflicts of Interest:
\n\nFor manuscripts submitted by the Academic Editor (or a scientific advisor), an appropriate person will be appointed to handle and evaluate the manuscript. The appointed handling Editor's identity will not be disclosed to the Author in order to maintain impartiality and anonymity of the review.
\n\nIf a manuscript is submitted by an Author who is a member of an Academic Editor's family or is personally or professionally related to the Academic Editor in any way, either as a friend, colleague, student or mentor, the work will be handled by a different Academic Editor who is not in any way connected to the Author.
\n\nCONFLICT OF INTEREST - REVIEWER
\n\nAll Reviewers are required to declare possible Conflicts of Interest at the beginning of the evaluation process. If a Reviewer feels he or she might have any material, financial or any other conflict of interest with regards to the manuscript being reviewed, he or she is required to declare such concern and, if necessary, request exclusion from any further involvement in the evaluation process. A Reviewer's potential Conflicts of Interest are declared in the review report and presented to the Academic Editor, who then assesses whether or not the declared potential or actual Conflicts of Interest had, or could be perceived to have had, any significant impact on the review itself.
\n\nEXAMPLES OF CONFLICTS OF INTEREST:
\n\nFINANCIAL AND MATERIAL
\n\nNON-FINANCIAL
\n\nAuthors are required to declare all potentially relevant non-financial, financial and material Conflicts of Interest that may have had an influence on their scientific work.
\n\nAcademic Editors and Reviewers are required to declare any non-financial, financial and material Conflicts of Interest that could influence their fair and balanced evaluation of manuscripts. If such conflict exists with regards to a submitted manuscript, Academic Editors and Reviewers should exclude themselves from handling it.
\n\nAll Authors, Academic Editors, and Reviewers are required to declare all possible financial and material Conflicts of Interest in the last five years, although it is advisable to declare less recent Conflicts of Interest as well.
\n\nEXAMPLES:
\n\nAuthors should declare if they were or they still are Academic Editors of the publications in which they wish to publish their work.
\n\nAuthors should declare if they are board members of an organization that could benefit financially or materially from the publication of their work.
\n\nAcademic Editors should declare if they were coauthors or they have worked on the research project with the Author who has submitted a manuscript.
\n\nAcademic Editors should declare if the Author of a submitted manuscript is affiliated with the same department, faculty, institute, or company as they are.
\n\nPolicy last updated: 2016-06-09
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