京都大学 / 新制・課程博士 / 博士(工学) / 甲第24578号 / 工博第5084号 / 新制||工||1974(附属図書館) / 京都大学大学院工学研究科建築学専攻 / (主査)教授 西山 峰広, 教授 聲高 裕治, 准教授 倉田 真宏 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

American Foreign Policy at the outset of the Twentieth century evolved from a realist to an idealist position as the United States transitioned to an imperial power. This ideal framework was formed in the crucible of China during the Spheres of Influence and the Open Door. The US had to play delicate game of helping China to maintain their territorial, and administrative integrity while at the same time protecting their newly acquired overseas interests against more established imperial actors. While there were many missteps, and failures during this transition perhaps the most the important result was the change toward the approach of US foreign policy. Not only did the United States have to balance realist geo-political goals, but it had to define what an imperial United States looked like. In a sense the United States was starting from scratch, processing to a completely different game and in order to be successful it had evolve.

The scope of pharmacy practice in global health has expanded over the past decade creating additional education and training opportunities for students, residents and pharmacists. There has also been a shift from short-term educational and clinical experiences to more sustainable bidirectional partnerships between high-income countries (HICs) and low- to middle-income countries (LMICs). As more institutional and individual partnerships between HICs and LMICs begin to form, it is clear that there is a lack of guidance for pharmacists on how to build meaningful, sustainable, and mutually beneficial programs. The aim of this paper is to provide guidance for pharmacists in HICs to make informed decisions on global health partnerships and identify opportunities for engagement in LMICs that yield mutually beneficial collaborations. This paper uses the foundations of global health principles to identify five pillars of global health engagement when developing partnerships: (a) sustainability, (b) shared leadership, (c) mutually beneficial partnerships, (d) local needs-based care and (e) host-driven experiential and didactic education. Finally, this paper highlights ways pharmacists can use the pillars as a framework to engage and support health care systems, collaborate with academic institutions, conduct research, and interface with governments to improve health policy.

The application of carbon reinforced-fiber polymers (CFRP) to structures is a new development that is still under intense research. However, the rehabilitation or retrofit of damage reinforced concrete members by the external bonding of CFRP is becoming increasingly popular in the construction industry. The objective of the tests presented in this thesis is to study different CFRP designs on the reinforced concrete beams and compare their failure modes. The main goal is to determine the CFRP design on the reinforced concrete beams that result in a progressive and gradual failure mode with enough warning before final failure. Different CFRP designs are investigated and compared with theoretical predictions. A retrofitting concept is also employed in this research. The retrofitting concept is the idea of strengthening cracked structures. The strengthening of the beams performed in the lab is carried out under sustained loads and on previously cracking the beams to simulate the realistic case that is usually faced in practice on the field. The RC beams are strengthened in flexure to double their flexural capacity by applying the adequate amounts of CFRP to the tension face of the beams. Due to the CFRP strengthening and increasing the strength capacity of the beams, different CFRP anchorage methods are employed to the beams for additional shear reinforcement to ensure flexural failure. The different CFRP anchorage methods will also be observed for their effectiveness during the debonding and propagation mechanism as well as evaluated for their progressive failure mode.

In this thesis, a fully nonlinear finite element study of the flexural behavior of doubly reinforced concrete beams strengthened using different Carbon Fiber Reinforced Polymer (CFRP) composite strengthening configurations has been carried out. Prior to the study, a total of six beams were constructed, pre-cracked, strengthened and tested to failure under a four-point loading condition (Zhao and O'Riordan-Adjah, 2004). Then, for the purpose of this thesis work, detailed three dimensional finite element models were created not only to correlate the results obtained from the experiments, but also to predict the load capacity, failure modes and crack pattern of reinforced concrete (RC) beams strengthened using Fiber Reinforced Polymer (FRP) composites. Knowing the behavior for each of the materials that compose the beam (concrete, steel, bonding material or interface, and FRP laminates) and how to get their properties, an accurate and representative finite element model can be created. Tests and analytical (FE) results showed that the strengthened configuration plays an important role in the overall strength, failure mechanisms, and, more significantly, the ductile behavior of the beams. Considerable increases in the load-carrying capacity of the RC beams were observed. Increases that range from 12% (using FRP only on the bottom of the beam) to 35% (FRP on the bottom + 45 degrees sides' configuration as explained later) compared to the control beam before ultimate failure were obtained. Failure modes were also affected since the beam with only FRP on the bottom failed completely by debonding of the laminate while the beams with side FRP anchorage strips failed by a combination of composite debonding on the sides and concrete crushing. Finally, ductile behavior of the beams was greatly improved due to the application of the strengthening material on the side of the concrete beams, serving as an anchorage to the bottom fabric. The accuracy of the model has been validated comparing the results obtained from the six beam tests to the ones determined using the FE approach. Good agreement between the two has been found.

American maternal health is a concern and has even been described as a “crisis” (Gingrey, 2020). The US is an outlier in maternal health in comparison to other industrialized countries with more than a 50% increase in maternal death rates comparatively speaking (Taylor et al., 2022). A significant change in postpartum care must occur. Hope Health Today LLC, the proposed continuing education Limited Liability Company (LLC), will be the catalyst to this health care change. Hope Health Today LLC’s initial continuing education program will positively educate healthcare providers to better serve this at-risk population. Hope Health Today LLC will provide professional education for licensed occupational therapists, physical therapists, physicians, nurses, and midwives. The initial continuing education (CEU) course will be a holistic guide for Diastasis Recti Abdominis (DRA) recovery and postpartum care. The course will cover pelvic floor and deep core anatomy, a 20-week diastasis recti abdominis recovery program, postpartum body mechanics, breast feeding positions, roles and interpersonal relationships, signs of postpartum depression, and return to intimacy. HopeHealth Today LLC aims to make a positive impact for postpartum families. Making a change at the policy level through American College of Obstetrics and Gynecology (ACOG) to provide a 4-week pelvic floor therapy referral to all postpartum patients. Hope Health Today LLC will advance the profession of occupational therapy through advocating for a women’s health board certification through American Occupational Therapy Association (AOTA) and improving quality postpartum patient outcomes through providing research based continuing education for health care providers. HopeHealth TodayLLC will educate the public through social media. HopeHealth TodayLLC will advance the current state of postpartum care. The ambition of this company is to educate the public to know what to expect from their women’s health providers and what to ask for if care is not reaching appropriate standards.

Strong health systems are needed to implement clinical and public health interventions. Global evidence-informed health systems guidance, such as that created by the World Health Organization (WHO), has been used to help strengthen health systems. However, global guidance needs to be contextualized or adapted to fit the realities of a particular setting. A workbook for contextualizing health systems guidance was developed to accompany WHO guidance on optimizing health worker roles to increase access to and use of key interventions for improving maternal and newborn health. This dissertation investigates the development and use of the workbook, using qualitative research methods, to help in the planning of future knowledge translation tools, to provide insights for practice and research, and to improve the workbook. First, a single case study explores the development of the workbook, which helped uncover the key features of the process, barriers that arose, and facilitators that helped overcome some of these barriers (chapter 2). Second, a single embedded case study examined the use of the workbook in two real-life settings, Peru and Uganda (chapter 3). Third, a critical interpretive synthesis of the literature was used to better define contextualization and to find what and how contextual factors could be used by policymakers to adapt guidance to their setting (chapter 4). Together, the three studies presented in this dissertation offer substantive, methodological and disciplinary contributions to the field of health systems and policy through a comprehensive examination of the workbook. It presents recommendations for improving the workbook from the perspectives of global guidance developers, users at the national level, and the broader literature on guidance and guideline development, contextualization and implementation. It also supports the continued use of workbooks, or other tools, to contextualize guidance in an effort to strengthen health systems, especially in low- and middle-income countries. / Dissertation / Doctor of Philosophy (PhD) / Strong health systems are needed in order for the right mix of clinical care and public health interventions to get to those who need them. The World Health Organization writes guidance at the global level to help countries strengthen their health systems. This guidance can be used to develop health guidance or policy for the national or subnational (e.g., provincial, state) level, but it first needs to be contextualized or adapted to that particular jurisdiction. It is important to consider what the problem is and what causes it, policy options to help deal with the problem, implementation considerations, as well as factors related to both the health system and the political system that can affect whether or not the intervention will be implemented. A workbook was developed to help contextualize guidance. This dissertation explores the process of developing and evaluating its use to help in the planning of future tools, to provide insights for practice and research, and to improve the workbook.

There are a great number of old structures around the world, some of which were designed for completely different purposes than in their current application. Swedish railway bridges were for example only designed for maximum axle loads of 200 kN in the beginning of the 20th century, while the highest axle loads of today are twice as high. The traffic intensities have also increased dramatically and the velocities are now higher than ever before. Reinforced concrete trough bridges were typically designed and built in the mid-20th century and it is still one of the most frequent railway bridge types in Sweden. The trough bridges were normally designed for traffic loads which were smaller than the loads today and in order to maintain an old structure as the loads increases, structural upgrading of the load bearing capacity might be necessary. Upgrading the load carrying capacity can be performed in two ways, namely administrative upgrading or strengthening. Administrative upgrading refers to refined design calculations, using real material data, geometry and loads, which provides a higher capacity than the original design and the bridge can thereby be upgrading with minor physical impact. Upgrading by strengthening on the other hand, refers to, often, larger physical alteration of the structure in order to enhance the original load carrying capacity.Upgrading methods for increased flexural resistance of concrete trough bridges has been developed and tested previously, but strengthening methods for increased shear resistance in the bridge deck are still absent. The objective of this thesis is therefore to find an existing- or develop a new strengthening method which can be applied in order to enhance the shear resistance of concrete trough bridge decks. The difficulties associated to strengthening of existing railway bridges include traffic during the strengthening work and concrete surfaces concealed by the ballast.The State-of-the-Art indicated that none of the existing strengthening techniques were sufficient for this application and internal unbonded post-tensioning in the transverse direction was nominated as the most promising method. The research was thereafter focused on testing the possibilities and strengthening effects of post-tensioning. Two laboratory investigations were performed during the research project and the method was finally tested in a field test on a 50 years old trough bridge in Haparanda, Sweden. The strengthening procedure of internal unbonded post-tensioning consists of four consecutive steps:1.Transverse drilling of the horizontal holes through the bottom slab.2.Installation of the prestressing system.3.Post-tensioning of the system.4.Sealing of the prestressing system.The laboratory and field tests were successful and the results proved that the internal steel reinforcement within the concrete was compressed when the trough bridge was post-tensioned. Due to the compression, a higher load could be carried by the bridge deck before the tensile reinforcement yields and the bridge fails. In other words, the flexural capacity of the bridge deck was increased. The field test actually showed that eight steel bars, post-tensioned with 430 kN per bar on the Haparanda Bridge, completely counteracted the tensile stresses caused by a train with 215 kN axle loads. The effect on the shear resistance was however not as easy to measure, but the laboratory test recorded a significant strain reduction in the tensile reinforcement which was bent up at the transition zone between the bridge deck and the main girders. The reduced strain might be interpreted as lower shear stresses and post-tensioning can thereby be considered to have a positive effect on the shear resistance of the bridge deck. Shear design according to the protocol of Eurocode 2 or BBK was however found to be restrictive in predicting the post-tensionings effect on the shear capacity and further research is proposed in chapter 8. / Det finns ett stort antal gamla konstruktioner runtom i världen och många byggdes för helt andra användningsområden än vad de numera används till. Som ett exempel kan nämnas att svenska järnvägsbroar i början av 1900-talet byggdes för att klara av att bära axellaster på maximalt 200 kN, medan några av våra nybyggda broar är konstruerade för dubbelt så stora axellaster. Även traffikmängden har mångdubblats och tåghastigheterna är nu högre än någonsin. Trågbroar i armerad betong är en typisk bro som byggdes i Sverige framförallt på 50-talet och den är fortfarande en av de vanligaste brotyperna i Sverige. Trågbroarna konstruerades normalt för att bära lägre laster än vad vi har idag och för att kunna ha kvar dessa broar när lasterna ökar kan det krävas någon form av uppgradering av bärförmågan. Det finns två sätt att förbättra bärförmågan på en gammal bro, nämligen administrativ uppgradering eller förstärkning. Administrativ uppgradering innebär att nya förbättrade beräkningsmetoder används tillsammans med verkliga materialhållfastheter, geometrier och laster för att mer noggrant räkna ut brons bärförmåga. Normalt visar det sig att bärförmågan är högre än vad de ursprungliga beräkningarna antydde. På så vis höjs kapaciteten med minimal fysisk åverkan på bron. Uppgradering genom förstärkning innebär däremot att konstruktionens bärförmåga höjs genom att förändra bron ur ett rent fysiskt perspektiv. Metoder för att öka böjkapaciteten på trågbroar i betong har utvecklats och testats tidigare, men förstärkningsmetoder för att höja tvärkraftskapaciteten saknas däremot fortfarande. Målet för denna avhandling ligger därför i att utveckla en förstärkningsmetod som kan användas för att förbättra tvärkraftskapaciteten för bottenplattan på trågbroar i betong. Det finns dock några svårigheter sammankopplade med förstärkning av befintliga järnvägsbroar, t.ex. tågtraffik under förstärkningsförfarandet och att viktiga betongytor är skyddade av ballast.Inga befintliga förstärkningsmetoder bedömdes däremot som lämpliga för det avsedda användningsområdet vid ”State-of-the-Art’’ studien. Invändig efterspänning av broplattan i tvärledd bedömdes som den bäst lämpade förstärkningsmetoden och efterföljande forskning fokuserades på att reda ut möjligheter för och förstärkningseffekter av efterspänning. Två olika laboratorieförsök genomfördes under forskningsprojektet och förstärkningsmetoden testades slutligen vid ett fältförsök på en 50 år gammal järnvägsbro i Haparanda.Själva tillvägagångssättet för förstärkningsmetoden består av fyra viktigaoch sammanhängande arbetssteg:1. Borrning av horisontella hål tvärs igenom trågbrons bottenplatta.2. Installation av själva försstärkningssystemet.3. Efterspänning av förstärkningssystemet.4. Förslutning av förstärkningssystemet.Både laboratorie och fältförsöken blev lyckade och resultaten visade att stålarmeringen inuti betongen trycktes ihop när trågbron efterspänndes. Tack vare denna kompression så kan broplattan bära högre laster innan dragarmeringen börjar flyta och bron slutligen går sönder. Med andra ord så höjdes brons böjkapacitet. Fältförsöket visade att de åtta spännstagen, efterspännda med 430 kN per stag, helt och hållet motverkade dragarmeringens påkänningar av ett tåg med axellasten 215 kN. Förstärkningsmetodens effekt på tvärkraftskapaciteten är däremot inte lika lätt att påvisa men laboratorieförsöken visade att töjningen reducerades betydligt i den uppbockade dragarmeringen, i zonen där plattan fäster i huvudbalkarna. De lägre töjningsnivåerna kan tolkas som lägre skjuvpåkänningar och efterspänningen kan därmed ha en positiv effekt på broplattans tvärkraftskapacitet. Laboratorieförsöken visade däremot att både Eurokod 2 och BBK är restriktiva när det gäller att uppskatta efterspänningens effekt på tvärkraftskapaciteten. En ny förstärkningsmetod för trågbroar i betong har därmed föreslagits i och med denna avhandling, men en del frågetecken kvarstår och i kapitel 8 ges därför förslag på fortsatta forskningsområden.

<p>Recent experiments have highlighted the efficacy of post-installed reinforcement in enhancing the capacity of groups of  bonded anchors undergoing concrete breakout failure mode. This technique is particularly useful to enhance the performance of anchorages installed in members of limited dimensions such as beams and columns. This thesis presents the results of corresponding numerical investigations on bonded anchor groups in concrete strengthened with post-installed supplementary reinforcement subjected to tension loads. The study is conducted using the 3D Finite Element (FE) approach. The constitutive law of concrete is the microplane model with relaxed kinematic constraint. The interface between anchor or reinforcement and concrete is modeled with two-node bar elements, which are assigned with corresponding bond-stress slip characteristics. The proposed FE approach is validated against experimental results available in the literature by comparing load-displacement behavior and failure mode. </p> <p>The validation incorporates anchor groups with different configurations of post-installed supplementary reinforcing steel bars. The numerical investigations provide a deeper insight into the detailed behavior of anchor groups with post-installed reinforcement through the visualization of crack patterns, stress flows, and strain development. The results show that the post-installed rebars can lead to a significant increase in the performance of post-installed anchorages, and the load increase depends on the number and arrangement of rebars and the failure mode of the system. </p> <p>Lastly, the thesis presents a parametric study on strengthened anchor groups with post-installed rebars in narrow reinforced concrete (RC) members under various configurations. These simulations mimic anchorages used for seismic retrofitting beam-column joints in RC structures using a fully fastened haunch retrofit solution. Due to the limited width and depth of beams and columns, the capacity of the anchorages is often the weakest link in such retrofitting methods. The results from the FE study indicate that the post-installed supplementary reinforcement can be an efficient solution for upgrading the performance of post-installed anchorages in such retrofitting techniques.</p>

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