Background: Chronic constipation is common in people with intellectual disabilities, and seems to be highly prevalent in people with severe or profound intellectual and multiple disabilities (SPIMD). However, there is no current widely accepted definition for the constipation experienced by these individuals. Aim: This Delphi study aims to compile a list of operationalized criteria and symptoms of constipation in people with SPIMD based on practical experiences of and consensus between experts supporting them. Methods: A two-round Delphi study with an intermediate evaluation and analyses was conducted. Parents and relatives of persons with SPIMD and support professionals were included. The panel answered statements and open questions about symptoms and criteria of constipation. They were also requested to provide their opinion about classifying criteria and symptoms into domains. Answers to statements were analysed separately after both rounds with regard to consensus rate and displayed qualitatively; answers to open questions were analysed deductively. Results: In the first Delphi round (n = 47), consensus was achieved on criteria within the domains 'Defecation’ and 'Physical features', that were assigned to broader categories. Symptoms retrieved within the domain ‘Behavioural/Emotional’ were brought back to the panel as statements. After the second Delphi round (n = 38), consensus was reached on questions about domains, and for eight criteria (domain ‘Defecation’ n = 5; domain ‘Physical features n = 3). Within the domain ‘Behavioural/Emotional’, consensus was achieved for five symptoms. Criteria and symptoms with consensus >70% were considered ‘generic’ and
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Seismic risk assessment of two real RC multi-story buildings, located on similar soil profile in Kocaeli, is conducted in respect to code-based linear and nonlinear approaches, as well as to P25-v2 Method, a recently suggested method for risk evaluation and preliminary assessment of existing buildings against life-loss. Twenty-five different parameters and seven different collapse criteria are taken into consideration in the suggested P25-v2 Method, including soil and topographic conditions, earthquake demand, various structural irregularities, material and geometrical properties, and location of the buildings. After summarizing the different methodologies and describing the case study buildings, 3D linear-elastic and static nonlinear analyses are performed in parallel to the application of the P25 Method-v2. One of the two case study buildings totally collapsed during 1999 Kocaeli Earthquake, while the other survived with negligible damage, noting that both had legal construction and occupation permissions. SAP2000 and SeismoStruct software packages have been utilised for the analysis procedure to find out the damage states of the structural members at critical stories and to determine the performance levels of the case study buildings. The code-based performance levels and the final performance scores obtained by the preliminary assessment technique are compared in order to underline the existence of the correlation between the detailed procedure and the suggested preliminary assessment technique with the real damage state. Consequently, structural inadequacies, weak points of the buildings and failure reasons are also discussed in this paper.
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Does real estate still have the value that it once had, or will the valuation of real estate change due to surprising products and services, innovative business models, different market strategies, innovative ways of organizing and managing in the (real estate) markets? Innovation revolves around good facilities in an attractive and stimulating environment. Take disruptive real estate. The driving force behind these developments are new technology, viability, organizing differently and managing, and these have a big impact on the valuation of real estate. Established names like Nokia, Kodak, Blockbuster, Oad, Free Record Shop, Hyves and V&D collapse, and others, like Hema, Shell, hotel chains and healthcare institutions are the least bothered by it. However, disruptive organizations like Amazon, Zalando, Uber, Tesla and its competitor Faraday Future, who wants to exceed Tesla in everything, clearly respond to viability in the environment, and this is determinative for competitive strength and thus impacts the current and future valuation of real estate. Blockchain – a distributed database that contains a growing list of data items and that is hardened against manipulation and counterfeiting - plays an important role in that. The notaries and brokers have already experienced this in the recent period, and it will continue to have an effect on real estate owners, financiers, users, builders, brokers, notaries and the cadastre. The real estate world finds itself at a tipping point of a transition: a dramatic and irreversible shift in (real estate) systems in society.
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