BackgroundTo assess the impact of knowing central corneal thickness (CCT) on glaucoma management in a United Kingdom district general hospital.MethodsA masked observational non-interventional study included 304 eyes of 152 consecutive glaucoma cases attending general clinic. CCT was measured using a hand-held pachymeter. IOP, as measured by the Goldmann applanation tonometer (GAT), was adjusted for CCT using a normogram. Two identical study sheets were retrospectively constructed from each subject's case notes: one included the CCT and adjusted IOP information, the other excluded. Study sheets were randomly presented to a single masked observer to decide glaucoma management. The difference in management decision was noted.ResultsThe mean ± standard deviation CCT was 561.5 ± 35.7 μm, 538.9 ± 41.4 μm, 538.3 ± 40.3 μm for ocular hypertension (OHT), primary open angle glaucoma (POAG) and normal pressure glaucoma (NPG) subjects respectively. IOP adjustment was greater than ±2 mmHg in 33.9%(103/304) of eyes. CCT and adjusted IOP information led to different treatment option in 37%(55/152). Of the most important changes 20.4%(31/152) cases would have been commenced on additional IOP-lowering medication, 2.0%(3/152) would have been counselled for trabeculectomy surgery and 3.3%(5/152) of the cohort would have been observed rather than treated.ConclusionCCT and adjusted IOP measurement can influence glaucoma management in a clinical context. It helps attribute risk and hence aids patient management decisions.
In plated beam, an adhesive is used primarily to adhere the external plate to the concrete beam to achieve a composite action. Even though some work has been found to indicate that the choice of softer adhesive increased the capacity of beam (MacDonald & Calder, 1982), relatively stiffer adhesives have been largely assumed to provide better strengthening. Largely, due to the fact that adhesive has been widely consid-ered as an insignificant structural component towards the capacity of a composite beam; material capabilities (if not structural) of adhesive have also been ignored for further research towards studying its effects on premature failures (particularly debonding). Under mixedmode loading, the adoption through discretisation of Cohesive Zone Model as a bulk material (indicative of adhesive component) and to simulate interfacial cracks is shown here to achieve the objectives. The outcomes of the research indicate the critical material properties of adhesive in all directions, such as stiffness, strength and crack energy, play crucial role in controlling the behaviour of modes of failure. Further, based on this study, recommenda-tions have been proposed on the choice of adhesive type at different locations of plated beam so as to capture a failure warning and avoid catastrophic failure.
Retrofitting of RC beam by gluing a steel plate at the soffit has been a widely adopted technique due to its ease of use, calculations and having minimal variations on structural aesthetics; hence, a large number of such retrofitted structures exist today. However, such structures have also failed frequently due to the formation of premature failures such as peeling and debonding. The further investigations conducted in literature indicated that such undesirable failures can be effected by a large number of geometrical and material parameters. Although, the characterisation and relative influence of such parameters on modes of failures remain unknown; as the past studies have been largely case sensitive or focussing on a small set of parameters. Therefore, to address these issues, a simple but focussed numerical model has been validated through literature for multiple modes of failures over wide range of possible parameters. Further, targeting the response of beam and its critical locations, the authors of this study suggest that the understanding of relative impact of effective parameters, in terms of beam capacity and brittleness of modes of failure, can be broadly utilised to re-evaluate the cause(s) of failure(s) through case studies, or to predict the future of retrofitted structures/beams.
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