The structural response and progressive failure of batten to rafter connections under wind loads

Batten to rafter connections in light framed timber housing are vulnerable to wind loading and failures of these connections are one of the more common failure modes seen in post windstorm damage surveys. Such failures often occur in a progressive or cascading manner resulting in the loss of a large section of the building envelope. These progressive failures of batten to rafter connections are a complex process influenced by the pressure fluctuations on the roof surface, the response of individual connections and the behaviour of the structural system as a whole. This study presents a method of examining load redistribution and progressive failure behaviour of batten to rafter connections in light framed structures. Nonlinear time history analysis was performed using a finite element model using fluctuating pressures determined from a wind tunnel study and connection properties determined from laboratory testing of connections under dynamic loads. Flow separation and building-induced turbulence cause intermittent 'peak-events' where negative pressures on the roof surface are especially high. These 'peak-events' can move across the roof causing high loads occurring at different connections with slight lead or lag times. Damage to connections occur during the 'peak events' as nails are incrementally withdrawn. Loads are redistributed and load paths change during nail slips, causing damage to spread from an initial location. Load redistribution continues until a few connections fail completely, upon which a cascading failure occurs where almost all connections on the roof fail in rapid succession. As an application of this research, the analyses performed were used to assess the fragility of batten-rafter failures, and the most vulnerable parts of the roof identified. Cost effective retrofitting measures can be justified and designed with this information

Cushing’s disease: does low-dose pasireotide offer a comparable efficacy and safety to high-dose?

Whilst literature is expanding on pasireotide use in the management of Cushing’s disease (CD), there is still currently much unknown about long-term and low-dose pasireotide use in CD. We present a 60-year-old female with residual CD after transphenoidal surgery (TSS), being successfully managed with S.C. pasireotide for over 10 years. For 6 years, her S.C. pasireotide was inadvertently administered at 360 µg twice daily (BID), almost half the recommended dose of 600 µg BID. Despite the low-dose, her urinary free cortisol (UFC) normalised within 6 months and Cushingoid features resolved. She remained in biochemical and clinical remission on the same low-dose for 6 years, before a medication audit discovered her mistaken dose and directed her to take 600 µg BID. With the higher dose 600 µg BID for the next 5 years, her glycaemia worsened without any changes in her UFC and residual tumour volume. Our case showed the continuing effectiveness and safety of treatment with S.C. pasireotide for more than 10 years, and that a low-dose regimen may be considered an option for responders by its safety profile

Pan-regional (cervico-thoraco-lumbo-sacral) spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with non-operative management

Background and importance: Pan-regional (i.e. cervico-thoraco-lumbo-sacral [CTLS]) spinal epidural abscess (SEA) is rare: only 7 cases have been reported to date. Clinical presentation: A 68 year old male, without immunosuppression, presented with severe thoracic back pain and fulminant septicaemia. CT and MRI revealed a Pan-regional CTLS SEA associated with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis. Blood cultures grew Staphylococcus aureus sensitive to flucloxacillin and rifampicin. Given the extent of suppuration, the lack of a clinical spinal ‘level’, as well as haemodynamic instability, neurosurgical management was conservative: with intravenous flucloxacillin and rifampicin. Over several weeks, his condition slowly improved: but at no point was any spinal ‘level’ apparent neurologically. He eventually made a complete clinical and radiological recovery without any operation which was maintained at one year review. Conclusion: Even pan-regional CTLS SEA with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis can be managed non-operatively. A complete clinical and radiological resolution can be achieved with antibiotics alone

Ultrasound Doppler Evaluation of the Pattern of Involvement of Varicose Veins in Indian Patients

Doppler evaluation of lower limb veins was performed to evaluate the pattern of involvement of various sites of incompetence in Indian patients with varicose veins. A prospective Doppler study of 100 consecutive limbs in patients who presented with varicose veins to the vascular surgery department of a tertiary care hospital in India. The Clinico-Etiological Anatomical and Pathological (CEAP) classification was applied for assessment. Doppler evaluation of both superficial and deep venous system of the lower limbs was performed. The data of various sites of reflux was analysed to find the patterns of venous involvement in the affected patients. Superficial venous reflux was seen in all the patients. Deep venous reflux was seen in 50% of the lower limbs examined. Doppler is a simple non-invasive test, and is well tolerated by the patients. Deep venous reflux is common in Indian population, though it rarely occurs in isolation, and is usually associated with superficial reflux