Academic literature on the topic 'Bristol Twp'

Background:In the ACTION (NCT02109666) study, multivariable Cox proportional hazards regression models showed that the predictors of 1-year retention to abatacept treatment were: patient global pain assessment, country, reason for stopping last biologic, number of prior biologic treatments, abatacept monotherapy, RF/anti-cyclic citrullinated peptide (CCP) status, previous neoplasms, psychiatric disorders and cardiac disorders.1 Machine learning techniques, using the gradient-boosting model, subsequently identified additional predictors of abatacept retention in patients with moderate-to-severe RA enrolled in ACTION; however, the analysis did not show the directionality of the predictors.2Objectives:To improve the clinical interpretability of the machine learning model in terms of directionality and the importance of each variable in predicting retention.Methods:Previous analyses using the gradient-boosting model to identify predictors of abatacept retention at 1 year in the ACTION study have been described.2 This analysis used SHapley Additive exPlanations (SHAP), a mathematical framework, to show how a particular predictor value influences prediction in the context of all other predictors. Higher SHAP values indicate a higher likelihood of retention. The contribution of every variable in the model’s prediction (with the exception of country variables) was computed for each data point to capture individual variable impact. This enabled interpretation for level of importance and directionality at a patient level.Results:Using data from 2350 patients enrolled in ACTION (May 2008 to December 2013), the mean retention rate at 1 year was 59.3% (n=1393). Overall variable importance is shown in Figure 1. After removal of country variables, the top five baseline predictors of retention were: no previous corticosteroid use, ACR functional class II, ≥2 prior biologic treatments prior to abatacept initiation, abatacept monotherapy and HAQ-DI. In terms of directionality, no previous corticosteroid use, ≥2 prior biologic treatments prior to abatacept initiation, abatacept monotherapy and a higher HAQ-DI score at baseline were associated with a lower likelihood of retention; ACR functional class II was associated with a higher likelihood of retention.Conclusion:The gradient-boosting model previously identified predictors of abatacept retention from ACTION;2 the addition of SHAP in this analysis has provided information on the importance and directionality of those predictors. The most important predictor of abatacept retention was no previous corticosteroid use, which was associated with lower retention. The models and predictors identified could be further refined by using additional datasets from clinical trials. Machine learning offers an innovative and complementary approach to biostatistics and could be used to identify treatment response predictors at an individual patient level, leading to a more personalised treatment approach.References:[1]Alten R, et al. RMD Open 2017;3:e000538.[2]Alten R, et al. Presented at the virtual ACR Convergence 2020; 5–9 November 2020. Poster number 1745.Acknowledgements:This study was supported by Bristol Myers Squibb. Professional medical writing and editorial assistance was provided by Claire Line, PhD, at Caudex and was funded by Bristol Myers Squibb.Disclosure of Interests:Rieke Alten Speakers bureau: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Grant/research support from: AbbVie, Bristol Myers Squibb, Gilead, Janssen, Lilly, Pfizer, Claire Behar Shareholder of: I have not invested directly in pharmaceutical companies producing drugs/devices for use in rheumatology however I may have shares via the funds linked to my life insurance., Consultant of: Bristol Myers Squibb, Christine Boileau Consultant of: AstraZeneca, Bristol Myers Squibb, Nanobiotix, Pierre Merckaert Consultant of: Bristol Myers Squibb, Ebenezer Afari Consultant of: Bristol Myers Squibb, Virginie Vannier-Moreau Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sean Connolly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Aurelie Najm Speakers bureau: Bristol Myers Squibb, Consultant of: Bristol Myers Squibb, Pierre-Antoine Juge Consultant of: Bristol Myers Squibb, Angshu Rai Shareholder of: Amgen Inc, Consultant of: Amgen Inc, Employee of: Amgen Inc, Bristol Myers Squibb, Yedid Elbez Consultant of: Bristol Myers Squibb, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

ABSTRACT While previous studies have shown that microtubules (MTs) are essential for maintaining the highly biased axial growth of the Drosophila bristle, the mechanism for this process has remained vague. We report that the MT minus-end marker, Nod-KHC, accumulates at the bristle tip, suggesting that the MT network in the bristle is organized minus end out. Potential markers for studying the importance of properly polarized MTs to bristle axial growth are Ik2 and Spindle-F (Spn-F), since mutations in spn-F and ik2 affect bristle development. We demonstrate that Spn-F and Ik2 are localized to the bristle tip and that mutations in ik2 and spn-F affect bristle MT and actin organization. Specifically, mutation in ik2 affects polarized bristle MT function. It was previously found that the hook mutant exhibited defects in bristle polarity and that hook is involved in endocytic trafficking. We found that Hook is localized at the bristle tip and that this localization is affected in ik2 mutants, suggesting that the contribution of MTs within the bristle shaft is important for correct endocytic trafficking. Thus, our results show that MTs are organized in a polarized manner within the highly elongated bristle and that this organization is essential for biased bristle axial growth.

Background:Although EULAR/ACR guidelines suggest tapering biologic treatment for RA following sustained remission in patients (pts), specific de-escalation (DE) regimens are not defined. The Phase IIIb Assessing Very Early Rheumatoid arthritis Treatment (AVERT)-2 trial (NCT02504268) is evaluating SC abatacept (ABA) + MTX versus ABA placebo (PBO) + MTX in Anti-Citrullinated Protein Antibody (ACPA)-positive pts with early (ACR/EULAR 2010 criteria; disease duration ≤6 mths), active RA (SDAI >11). AVERT-2 was designed to investigate achievement of SDAI remission and a clinically meaningful dose DE strategy among pts in sustained remission who completed induction with ABA + MTX. In moderately to severely active RA and JIA patients, a relationship between ABA Cmin and efficacy was observed. Therefore, this analysis in very early RA patients, reports on the pharmacokinetics (PK) and immunogenicity of ABA and the maintenance of remission during the DE period of AVERT-2.Objectives:To assess the relationship between changes in ABA exposure and the maintenance of remission and the effect of immunogenicity on exposure during the DE period of AVERT-2.Methods:Pts received blinded SC ABA (125 mg once wkly [QW]) + MTX or ABA PBO + MTX induction treatment for 56 wks. Pts who completed induction with ABA + MTX and had sustained SDAI remission (≤3.3 at Wks 40 and 52) were re-randomized 1:1:1 to ABA QW + MTX for 48 wks (Arm C), ABA every other wk (EOW) + MTX for 24 wks followed by ABA PBO + MTX for 24 wks (Arm D), or ABA QW + MTX PBO for 48 wks (Arm E) in the DE period. ABA trough (Cmin) and anti-drug antibody (ADA) samples were collected in all subjects during the DE period. Serum ABA concentrations and ADA were measured using a validated enzyme immunoassay method and an electrochemiluminescence assay, respectively. Efficacy endpoints included change from DE Day 1 in SDAI score, HAQ-DI score, Physician’s Global Assessment (PhGA), and tender (TJC) and swollen (SJC) joint counts. The relationship between ABA Cmin and efficacy endpoints were assessed. Additionally, the impact of immunogenicity on ABA Cmin was explored.Results:Mean ABA Cmin values remained stable throughout the DE period for subjects in Arms C and E. ABA Cmin values decreased by ~50% in subjects in Arm D for the first 24 weeks from the start of DE and were ~0 for weeks 24-48 consistent with the change in the frequency of ABA dosing from EOW to ABA withdrawal (Figure 1 top).Figure 1:Mean (SD) ABA Cmin values (top) and Mean Change From Baseline in SDAI (bottom) in Subjects in DE Arm C (ABA QW + MTX), D (ABA EOW + MTX followed by ABA placebo + MTX), and E (ABA QW + MTX placebo)The incidence of immunogenicity appeared to increase upon withdrawal of ABA in Arm D. ADA formation did not appear to affect ABA Cmin, as ABA Cmin remained consistent between pts with and without ADA.Upon withdrawal of ABA in Arm D, there appeared to be an increase in the mean change from baseline (Day 1 of DE) in SDAI over time, which followed a similar time course as the washout of ABA (Figure 1 bottom). Similar results were observed for other efficacy endpoints such as HAQ-DI, PhGA, TJC, and SJC.Conclusion:The PK data in these early onset, MTX-naive, ACPA+ RA pts correlated well with the maintenance of remission in Arms A and E. Tapering of ABA from EOW to MTX only in Arm D results in a corresponding decrease in ABA Cmin, an increase in positive antibody response, and loss of remission.References:[1]Emery et. al. ACR [Abstract L11]. Nov. 2019. Atlanta GA USA[2]Li et. al. J Clin Pharmacol. Vol 59(2). Feb 2019.Disclosure of Interests:Yash Gandhi Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sean Connolly Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kuan-Hsiang Gary Huang Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Robert Wong Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Shannon Chilewski Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Bindu Murthy Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb

The blade tip shroud brush seal is applied to replace the labyrinth seal for the aerodynamic performance improvement of turbine stage. The leakage flow characteristics of the brush seal are numerically predicted by using the Reynolds-Averaged Navier–Stokes equations and non-linear Darcian porous medium model. The numerical leakage flow rate of the brush seal is in well agreement with the experimental data. The last and first long teeth of the labyrinth seal were designed to bristle pack named as the postposed and preposed brush seals based on the 1.5 turbine stage. The leakage flow rate and aerodynamic performance of the turbine stage with blade tip shroud labyrinth seal and brush seal are numerically investigated. The effect of the sealing clearance between bristle pack and tip shroud on the aerodynamic performance of turbine stage is conducted which ranged from 0 mm to 0.4 mm. The axial deflection of the bristle pack is analyzed with consideration of the aerodynamic forces and contact frictional force. The obtained results show that the leakage flow rate of the tip shroud brush seals with bristle tip 0.4 mm clearance which decreases by up to 18% in comparison with the labyrinth seal, and the aerodynamic efficiency increases by 0.6%. Compared to the tip labyrinth seal, tip shroud brush seals can decrease the relative deflection angle of exit flow. This flow behavior results in reducing the mixing loss between the tip leakage flow and mainstream. The similar axial deflection of the bristle pack for two kinds of brush seals is observed at the same sealing clearance. The deflection of the bristle pack under the function of the aerodynamic forces is protected by the backing plate. This work provides the theoretical basis and technical support for the brush seal application in the turbine industries.

Abstract Introduction: The phase 2 CheckMate 205 study (NCT02181738) of nivolumab (nivo) has demonstrated high objective response rates, durable efficacy, and acceptable safety profiles in patients (pts) with relapsed/refractory classical Hodgkin lymphoma (R/R cHL) after failure of autologous hematopoietic cell transplantation (auto-HCT) regardless of prior brentuximab vedotin (BV) treatment (Younes A et al. Lancet Oncol 2016; Fanale M et al. ICML 2017 [Oral 125]). Recently proposed new response criteria aim to account for atypical patterns of response with checkpoint inhibitors which may not be fully captured by conventional response criteria (Cheson BD et al. Blood 2016; Younes A et al, Ann Oncol 2017). Studies in solid tumors have shown that pts may continue to derive clinical benefits from nivo beyond disease progression as defined by conventional criteria (George S et al, JAMA Oncol 2016; Long GV et al, JAMA Oncol 2017). Here we report outcomes among pts with R/R cHL treated beyond progression (TBP) in CheckMate 205. Methods: This single-arm, multicenter study enrolled pts (age ≥18 y) with R/R cHL after failure of auto-HCT into 3 independent cohorts (A: BV naïve, B: BV after auto-HCT, C: BV before and/or after auto-HCT). Nivo 3 mg/kg IV every 2 wk was given until disease progression or unacceptable toxicity. Response was assessed by 2007 International Working Group criteria. Best overall response (BOR) was assessed per investigator. A protocol amendment in July 2014 allowed pts to be TBP (investigator-assessed) if they met prespecified criteria, including deriving clinical benefit, stable performance status, and non-rapid progression. Pts TBP were required to discontinue in the event of further progression (≥10% increase in tumor burden). Tumor burden after initial progression was assessed in a prespecified analysis. Exploratory analyses assessed overall survival (OS) and time to next therapy (TTNT) in pts TBP. Results: In total, 70/243 (29%) pts were TBP: 19 in Cohort A, 23 in B, and 28 in C. Demographics were similar to the overall study population: 57% had stage IV disease at study entry, median (range) age was 37 (18-72) y, and median number of prior therapies was 3 (2-5). BOR prior to progression was complete remission (CR) in 5 (7%) pts, partial remission (PR) in 31 (44%), stable disease (SD) in 20 (29%), and progressive disease in 13 (19%) (BOR was non-evaluable in 1 pt). Among pts TBP, the initial cause of progression was a ≥50% increase in total tumor burden in 13 (19%) pts, non-target lesion progression in 17 (24%), and new lesions in 47 (67%) (pts could have multiple findings as reasons for progression). The median time to initial progression in pts TBP was 6 mo; 11 mo in pts with initial BOR of CR and 7 mo in pts with initial PR or SD. At December 2016 database lock, median (range) doses of nivo beyond progression were 8 (1-43), and median duration of treatment beyond progression was 5 (0-19) mo. Overall, 21 (30%) pts TBP remained on treatment; the most common reason for discontinuation was further disease progression (80%). The majority of pts TBP demonstrated stable reductions in tumor burden with continued treatment. Median (95% CI) TTNT from first study dose of nivo was 17 (14, not estimable) mo (Figure). Median OS from date of initial progression was not reached in pts TBP and OS was 84% (95% CI 70, 92) at 1 y. Treatment-related adverse events (TRAEs) occurred in 46% of pts (13% grade [G] 3-4) after progression, vs 64% (9% G3-4) prior to progression. Serious TRAEs after progression were aspartate aminotransferase increase (n=1) and hypercalcemia (n=1), both G3-4. Ten deaths occurred in pts TBP; 7 were due to disease progression and none were considered related to study drug. Conclusions: In total, 29% of pts from CheckMate 205 Cohort A/B/C were TBP. New lesions were the most common reason for initial progression in pts TBP. Stable reductions in tumor burden were seen with continued treatment in pts TBP, and median TTNT and OS remained high. Proposed updates to response criteria may help to better assess the long-term efficacy of checkpoint inhibitors. These data suggest that pts considered to show stable performance status, non-rapid progression, and clinical benefits despite progression according to conventional response criteria may derive long-term benefits from continued nivo treatment. Study funding: BMS. Writing support: Simon Wigfield, Caudex, funded by BMS. Disclosures Cohen: Bioinvent: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takada: Research Funding; Bristol Myers Squibb: Research Funding; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Infinity: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; LAM Therapeutics, Inc: Research Funding. Engert: Amgen: Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Affimed: Consultancy, Honoraria, Research Funding. Ansell: Merck: Research Funding; Celldex: Research Funding; Seattle Genetics: Research Funding; Bristol-Myers Squibb: Research Funding; Affimed: Research Funding. Younes: Roche: Consultancy, Honoraria, Other: Third-party medical writing assistance, under the direction of Anas Younes, was provided by Scott Malkin of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd.; Bayer: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Research Funding; Janssen: Honoraria; Merck: Honoraria; Curis: Research Funding; Sanofi: Honoraria; Takeda Millenium: Honoraria; Johnson & Johnson: Research Funding; Seattle Genetics: Honoraria; Incyte: Honoraria; Celgene: Honoraria. Trneny: Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Savage: Roche: Research Funding; Seattle Genetics: Consultancy, Honoraria; Bristol-Myers Squibb: Honoraria; Merck: Honoraria; Celgene: Consultancy. Ramchandren: Seattle Genetics: Consultancy; Janssen: Research Funding; Merck: Research Funding; Pharmacyclics: Research Funding. Collins: ADC Therapeutics: Research Funding; Roche: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria; Celgene: Research Funding; Celleron: Consultancy; MSD: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Bristol-Myers Squibb: Research Funding; Amgen: Research Funding. Fanale: AMGEN: Membership on an entity's Board of Directors or advisory committees; CELGENE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; TAKEDA: Honoraria, Research Funding; ONYX: Research Funding; SEATTLE GENETICS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; MOLECULAR TEMPLATES: Research Funding; MERCK: Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GENENTECH: Research Funding; ADC THERAPEUTICS: Research Funding. Armand: Bristol-Myers Squibb: Consultancy, Other: research funding (institutional); Merck: Consultancy, Other: research funding (institutional); Infinity: Consultancy; Pfizer: Consultancy, Other: research funding (institutional); Affimed: Other: research funding (institutional); Otsuka: Other: research funding (institutional); Sequenta: Other: research funding (institutional); Sigma Tau: Other: research funding (institutional); Roche: Other: research funding (institutional); Tensha: Other: research funding (institutional). Zinzani: Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Verastem: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees. De Boer: Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; MSD: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees, Other: Non-restricted grant for research in head and neck cancer; Eisai: Membership on an entity's Board of Directors or advisory committees; Astellas: Other: member of Independent Data Monitoring Committee. Shipp: Cell Signaling: Honoraria; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Research Funding; Takeda: Other: Scientific Advisory Board; Merck: Other: Scientific Advisory Board; Gilead: Other: Scientific Advisory Board; AstraZeneca: Honoraria. Santoro: Merck: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees. Timmerman: Seattle Genetics: Consultancy; Celgene: Consultancy; Bristol-Myers Squibb: Consultancy, Honoraria, Other: Travel expenses, Research Funding; Genmab: Consultancy, Equity Ownership; Kite Pharma: Research Funding; ImmuneGene: Research Funding. Sacchi: Bristol-Myers Squibb: Employment. Sy: Bristol-Myers Squibb: Employment. Kuruvilla: BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria; Janssen: Consultancy; Hoffman LaRoche: Consultancy; Seattle Genetics: Consultancy, Honoraria; Amgen: Honoraria; Roche: Honoraria; Janssen: Honoraria; Lundbeck: Honoraria; Merck: Honoraria; Karyopharm: Research Funding; Roche: Research Funding; Celgene: Honoraria, Research Funding.

The work to be described forms part of an experimental study into the overall influence that the end region of a flap has on the flow of a high lift wing system. Here, our attention will be restricted mainly, but not entirely, to the tip flow of the flap itself. The study has been a collaborative venture over the past three years between British Aerospace-Civil Aircraft Division and the Aerospace Engineering Department of Bristol University, the latter funded by an SER.C research grant. BAe's major contribution was the undertaking of the main test programme, with University participation, using a large swept wing, high lift half model in the Filton low speed wind tunnel. The model was loaned by RAE for the study.

AbstractThe paper examines the role of universities in city development under the Triple Helix model through case studies of Russian and British cities. The cases of Bristol and Sheffield illustrate that the implementation of the Triple Helix model can be achieved through different approaches. In Bristol, universities reached beyond their campuses to create a ground for cooperation with partners. In Sheffield, there was a platform for interaction with partners using the brand of a top university. Meanwhile, the examples of Tomsk and Novosibirsk provide some evidence for the growing importance of universities in the innovative urban economy. The comparative analysis provides recommendations for Russian universities, whose application of the Triple Helix model is prevented by the lack of experience in developing an effective marketing strategy and weak interactions between research and enterprises.

George Gabriel Stokes won the coveted title of Senior Wrangler in 1841, a year in which the examination papers for the Cambridge Mathematical Tripos were notoriously difficult. Coming top in the Mathematical Tripos was a notable achievement, but for Stokes it was a prize hard won after several years of preparation, and not only years spent at Cambridge. When Stokes arrived at Pembroke College, he had spent the previous two years at Bristol College, a school which prided itself on its success in preparing students for Oxford and Cambridge. This article follows Stokes' path to the senior wranglership, tracing his mathematical journey from his arrival in Bristol to the end of his final year of undergraduate study at Cambridge. This article is part of the theme issue ‘Stokes at 200 (Part 1)’.

Diabetes är en utav Sveriges vanligaste folksjukdomar och idag lever 300 000 personer med denna kroniska sjukdom, och antalet ökar. I denna litteraturöversikt behandlas typ 2 diabetes vilken är den vanligast förekommande typen av diabetes. Något botemedel finns idag inte utan dagens behandling består av insulin, antidiabetika, god kosthållning samt fysisk aktivitet och är mer av ett preventivt syfte för att förebygga åtföljande komplikationer. Diabetes är vanligt förekommande inom vården och sjuksköterskan har ett stort ansvar i behandlingen, då den till stor del består av patientundervisning. I tidigare forskning har det framkommit att sjuksköterskor upplevt att de har brister i sin kunskap och undervisning. Syftet med denna litteraturöversikt består i att beskriva resurser och brister i sjuksköterskans undervisningsarbete av patienter med typ 2 diabetes. Totalt analyserades 15 vetenskapliga artiklar och sex teman framkom. Dessa är; Undervisning och information, Kunskap, Kommunikation, Motivation och engagemang, Psykisk påverkan och Förutsättningar. Resultatet visar att det finns både resurser och brister i sjusköterskans undervisningsarbete av patienter med typ 2 diabetes. Dessa påverkar sjuksköterskan i hennes undervisningsarbete och därmed även patienternas vårdkvalitet.

Diabetes is one of the most common diseases in Sweden today and 300 000 persons live with this chronic disease and the number is increasing. In this literature survey type 2 diabetes is processed which has the highest prevalence rate. No cure exists, instead treatment focuses on preventive measures consisting of insulin, antidiabetic, diet therapy and physical activity, which is found effective in preventing complications. The diabetes prevalence is high in all health care instances and the nurse has a great responsibility which to a large extent consists of patient education. Former surveys have shown that nurses experienced shortage in their knowledge and education skills. The aim of this literature survey is to describe resources and failures in nurse education of patients with type 2 diabetes. A total of 15 scientific articles where analysed and six themes emerged. The themes are; Education and information, Knowledge, Communication, Motivation and engagement, Psychical influence and Presumptions. The results show that there are both resources and failures in nurse education of patients with type 2 diabetes. These resources and short-comings affect the nurse in her education and consequently the patients quality of care.

Syftet med uppsatsen var att undersöka vilken typ av brister som anmäls till IVO iärenden som rör familjehemsvård inom socialtjänsten och hur dessa brister kanförstås utifrån ett förändringsperspektiv. I denna kvalitativa dokumentstudie har 30klagomål analyserats utifrån en innehållsanalys av sekundärdata. Resultatet påvisaratt både familjehem och vårdnadshavare upplevt brister i kommunikationen från ochmed socialtjänsten, det visar även att det skett en särbehandling mellanvårdnadshavare. Studien visar att klagomålen berör olika områden, dock ger flertaletklagande uttryck för att de inte känner sig lyssnade på. I diskussionen diskuterasresultatet utifrån studiens centrala begrepp, tolkningsram samt tidigare forskning.Studiens resultat och diskussion visar att det finns ett behov av att stärkakommunikationen mellan socialtjänsten och dess brukare, en viktig faktor i det äratt försöka säkerställa att information mottagits och förståtts på ett korrekt sätt.
The purpose with this essay was to research what type of flaws reported in casesabout family home care in the social services and how they can be understood froma change perspective. In this qualitative document study, 30 complaints have beenanalyzed with content analysis of secondary data. The result shows that both familyhomes and caregivers have experienced communication flaws from and with thesocial services, it also shows that there has been special treatment betweencaregivers. The flaws concern different areas, many express that they do not feellistened to. In the discussion, the results are discussed based on the study's keyconcepts, interpretive framework and previous research. The results and discussionshow that there is a need to strengthen the communication between the socialservices and its users, an important factor is to ensure that information is receivedand understood in a correct way.

BAKGRUND Modifierad Atkins Diet (MAD) och ketogenkost är kostbehandlingar som ordineras till barn med svårbehandlad epilepsi. Andra patientgrupper som behandlas med dessa dieter är patienter med glukostransportprotein typ 1-brist. Kostbehandlingarna är kolhydratfattiga och fettrika. I Sverige finns fyra sjukhus som arbetar med MAD och ketogenkost. I dagsläget saknas studier som beskriver hur behandlingarna upplevs av berörda familjer. SYFTE Syftet med studien var att utforska hur föräldrar till barn som behandlas med MAD eller ketogenkost upplever kostbehandlingen. METOD Kvalitativa intervjuer baserade på en halvstrukturerad frågeguide har genomförts. Fem familjer från olika delar av landet deltog i studien. Intervjuerna spelades in med mp3-spelare för att sedan transkriberas ordagrant. Samtalen analyserades genom kvalitativ innehållsanalys. RESULTAT Föräldrarna berättade om en rädsla och oro inför behandlingsstarten och att introduktionsperioden som familjerna erbjöds inför kostbehandlingen visade sig vara mycket viktig för kommande behandlingsprocess. Föräldrarna upplevde det svårt att tillaga en varierad kost och att det var viktigt med adekvata hjälpmedel och regelbunden vårdkontakt för att kunna tillämpa kostbehandlingen i vardagslivet. Deras behov av stöd förändrades under behandlingsprocessen. Genomgående var att informanterna upplevde att de sociala aktiviteterna anpassades efter kostbehandlingen. Föräldrarna upplevde det som viktigt att ha kontakt med andra familjer i liknade situation. Trots att föräldrarna upplevde flera olika praktiska och sociala problem ansåg de ändå att det positiva, som var kopplat till behandlingens resultat övervägde. En förälder uttryckte sig med orden ”Vi fick tillbaka vårt barn”- vilket återspeglar många föräldrars åsikt om behandlingen. SLUTSATS MAD och ketogenkost kräver mycket tid och kunskap för berörda familjer och påverkar deras vardag både praktiska och socialt. Med stöd från vård, barnomsorg, familj och vänner upplevde föräldrarna att det var lättare att upprätthålla behandlingen. Det finns också ett behov av att få prata med andra föräldrar och familjer som är liknande situationer.
BACKGROUND Modified Atkins Diet (MAD) and Ketogenic Diet are treatments prescribed to children suffering from refractory epilepsy. Patients with glucose transporter protein type 1 deficiency are also commonly treated with these diets, which are low in carbohydrates and high in fat. In Sweden, there are four hospitals implementing these treatments, but there is currently not sufficient information on how they are affecting the families. OBJECTIVE The purpose of this study was to explore how parents of children treated with MAD or Ketogenic Diet experience the treatment. METHOD Qualitative interviews based on a semi-structured topic guide was conducted. Five families from different parts of Sweden participated in this study. The interviews were recorded with an mp3 device and transcribed verbatim. Qualitative content analysis was used for data analysis. RESULT The parents disclosed anxiety before the start of the treatment and they acknowledged that the first week of introduction, which they, were offered before the start, proved to be essential for the rest of the treatment process. The families found it difficult to cook a balanced meal according to the dietary requriements, and also that it was important to have adequate resources and routine contact with health services to be able to apply the treatment to daily life. Their need for support changed during the treatment process. The informants believed their social activities were accommodated due to treatment. The parents felt the need to be in contact with other families in a similar situation. One parent expressed him-/herself with the words “We got our child back”, which reflects many parents view, regarding the treatment. CONCLUSION MAD and Ketogenic Diet require a lot of time and knowledge and affect practical and social aspects in daily living. With the support of health care, child care, family and friends, the parents felt it was easier to maintain treatment. The informants also shed light on the necessity of being in contact with other parents and families in similar situations.

AbstractIn 1997, Britons were shocked by a report from the General Medical Council (GMC) of a series of deaths from bungled surgery at the Bristol Royal Infirmary. In response to parents’ complaints, the GMC had launched an investigation into the high mortality of cardiac surgery of children at the Infirmary. It found that of 53 children who were operated on, 29 had died and 4 suffered severe brain damage. Three surgeons were found guilty of serious professional misconduct, and two were stricken from the medical register [1].

The early 1860s were tumultuous for the country and Bristow. Exempt from military service, he organized patriotic concerts and composed overtly nationalistic works, including Keep Step with the Music of Union and Columbus Overture (both 1861). He divorced Crane (1863) and married Louise Holder (1864), a widow with a young daughter, Nina. They moved to Morrisania (now in the Bronx) and added daughter Estelle Viola (1868). Bristow’s gigging activities diminished, but he commuted daily to Manhattan to teach and to perform with the two philharmonic societies, the Harmonic Society and the Mendelssohn Union (1867-1871), and in various churches. He wrote two oratorios: Praise to God (1861) and Daniel (1867).

George Bristow’s passionate support for American musicians in an 1854 journalistic battle with two critics (Richard Storrs Willis and John Sullivan Dwight) has unduly colored his historical reputation as an old-fashioned hothead who was hostile to German music and musicians; some have even called him a Know-Nothing. Commentary and descriptions from letters and print media, however, suggest that his contemporaries considered him to be not only a highly esteemed composer, performer, and educator, but also one of the most important classical-music composers active in America during most of the second half of the nineteenth century.

Bristow’s stature in New York as a composer, conductor, and organist was unrivaled during the 1870s. He continued to perform with the two orchestras and to conduct several society choirs. The number of new compositions slowed during the 1870s, but his significant works included Great Republic: Ode to the American Union (1870-1876), Pioneer: A Grand Cantata (1872), and his programmatic Arcadian Symphony (1872). An increasingly number of his compositions were performed during the decade, including a revival (unsuccessful) of Rip Van Winkle. He enjoyed a third Grand Testimonial Concert and the performance of his Arcadian Symphony in a Baltimore concert of American music (both 1875).

Bristow organized two piano and melodeon businesses--the first a disaster, the second more successful. He provided testimonials to many instrument manufacturers (Steinway, Chickering, Bradbury, and Weber pianos) and other music-related endeavors. He was also associated with the United States Mutual Pianoforte Association (1867), a nonprofit that made pianos available to the general public at low prices. Bristow also served as a musical-instrument judge at the 1876 Centennial Exposition and became swept up in a controversy about the judging process. He was defended by some New York critics but was deemed guilty by association by many and must have rued the day he agreed to take on the task.

This study discussed whether the media is a tool that produces orientalist representations and whether the media is effective in the internalization of orientalism. The aim of the study is to identify the orientalist discourse in the language and culture of the media through discourse analysis method, and to discuss the effects of the media on the formation of self-orientalism as well as the instrumentality of the media on this issue. In the study, a sample of the documentary named Istanbul and Bristol in 1971 From Two Children's Point of View, which is a co-production of BBC-TRT, was taken, and the documentary was analysed with the orientalist discourse analysis method of Edward Said. As a result of the research, it was seen that the media has a discourse that alienates Eastern culture and is also a tool in the production and internalization of orientalism.

Stephan Körner was one of the leading late twentieth-century British philosophers whose work ranged widely from the philosophy of science and mathematics to that of ethics, law and politics. Born in Czechoslovakia, he fled to England after the Nazi invasion of 1939 and later served in the Czech army. Körner resumed his academic career after demobilization and held Chairs of Philosophy at the Universities of Bristol, Yale and Graz. Two of his books reached a wide non-specialist readership – Kant (1955) and What is Philosophy? (1969) – and he was elected Fellow of the British Academy in 1967. Obituary by John Shepherdson FBA.

Over the last two and a half years, Covanta Energy, working with their technology partner, Martin GmbH of Germany, has developed and commercialized a new technology for reducing NOx emissions from Energy from Waste (EfW) facilities. NOx levels below 60 ppm (7% O2) have been reliably achieved, which is a reduction of 70% below the current EPA standard and typical levels of today’s EfW facilities in the United States. This technology represents a significant step forward in NOx control for the EfW industry. The technology, known as VLN™, employs a unique combustion system design, which in addition to the conventional primary and secondary air streams, also features a new internal stream of “VLN™-gas,” which is drawn from the combustor and re-injected into the furnace. The gas flow distribution between the primary and secondary air, as well as the VLN™-gas, is controlled to yield the optimal flue gas composition and furnace temperature profile to minimize NOx formation and optimize combustion. The VLN™ process is combined with conventional, aqueous ammonia SNCR technology to achieve the superior NOx performance. The SNCR control system is also integrated with the VLN™ combustion controls to maximize NOx reduction and minimize ammonia slip. A simplified version of the process, known as LN™, was also developed and demonstrated for retrofit applications. In the LN™ process, air is used instead of the internal VLN™ gas. The total air flow requirement is higher than in the VLN™ process, but unchanged compared to conventional systems, minimizing the impact on the existing boiler performance and making it ideal for retrofit applications. Covanta first demonstrated the new VLN™ and LN™ processes at their Bristol, Connecticut facility. One of Bristol’s 325 TPD units was retrofitted in April of 2006 to enable commercial scale testing of both the VLN™ and LN™ processes. Since installing and starting up the new system, Bristol has operated in both VLN™ and LN™ modes for extended periods, totaling more than one year of operation at NOx levels at or below 60 ppm (7% O2). The system is still in place today and being evaluated for permanent operation. Based on the success of the Bristol program, Covanta installed LN™ NOx control systems in a number of other existing units in 2007 and 2008 (total MSW capacity of over 5000 TPD), and is planning more installations in 2009. All of these retrofits utilize the Covanta LN™ system to minimize any impacts on existing boiler performance by maintaining existing excess air levels. Going forward, Covanta is making the LN™ technology available to its existing client base and is working with interested facilities to complete the necessary engineering and design modifications for retrofit of this innovative technology. For new grassroots facilities, Covanta is offering the VLN™ system with SNCR as its standard design for NOx control. An additional feature, particular to VLN™, is the reduced total combustion air requirement, which results in improved boiler efficiency. This translates into increased energy recovery per ton of waste processed. In addition to introducing the VLN™ and LN™ processes, this paper will provide an overview of the Bristol development and demonstration project. NOx and NH3 slip data from Bristol will be presented, illustrating the extended operating experience that has been established on the system. Other operating advantages of the new technology will also be discussed, along with lessons learned during the start-up and initial operating periods. The VLN™ technology has been demonsrated to decrease NOx emissions to levels well below any yet seen to date with SNCR alone and is comparable to SCR-catalytic systems. The result is a significant improvement in NOx control for much less upfront capital cost and lower overall operating and maintenance costs. VLN™ also also goes hand in hand with higher energy efficiency, whereas SCR systems lower energy efficiency due to an increased pressure drop and the need for flue gas reheat. The commercialization of the VLN™ and LN™ processes represents a significant step forward in the reduction of NOx emissions from EfW facilities.

<p>The inauguration of the Great Western Railway, the line connecting London and Bristol (United Kingdom, approximately 450 000 inhabitants), in 1840 changed part of the outskirts of Bristol to a major railway hub and home of many rail‐related activities. Due to these activities, an area behind the station in between the railway, the River Avon and the Bath road, known at the time as Temple Island, was restricted to rail uses (workshops, depots or goods, engines and carriage sheds) for more than 150 years, making it inaccessible and unattractive as the railway use decreased.</p><p>The transformation of this area into a new neighborhood in the city center is one of the most important urban development projects currently being carried out in Bristol. The new St Philips footbridge spans the River Avon, contributing to accessibility to the site. The footbridge is an innovative solution to a complex crossing problem: the connection of two banks with a significant elevation difference, and development planned for only one of them in the immediate future. The design should be appropriate for the current site and the future scenario.</p><p>The bridge is a 50m‐span and 4‐m wide steel beam with a forked geometry, seamlessly hosting a ramp for disabled and cyclists and a staircase to maximise functionality. The design approach to generate its shape was at the same time structural, aesthetical, and functional. Thanks to this holistic design approach, the bridge is compact, simple, elegant, and clearly legible for both footbridge and river path users.</p>

Turbomachinery sealing applications require accommodating large rotor excursions at high surface speeds. Achieving seal compliance under such demanding conditions combined with typical high operating temperatures poses a major engineering challenge. Formed by a dense pack of bristles, brush seals have emerged as viable alternatives to conventional labyrinth seals. Being contact seals, brush seals undergo unavoidable bristle wear in operation. Rate and extent of bristle wear determines seal life and performance. Detailed understanding of brush seal contact loads is necessary to estimate seal wear performance. The complicated nature of bristle behavior under various combinations of pressure load and rotor interference requires computer analysis to study details that may not be available through analytical formulations. This work presents a summary of a 3-D computational brush seal tip force and wear analysis. The analysis models a representative brush segment with bristles formed by 3-D beam elements. Bristle interlocking and frictional interactions (interbristle, bristle-backing plate and bristle-rotor) are included to better calculate resulting seal stiffness and tip forces. Results are compared to stiffness measurements and full scale seal wear tests.

Brush seals are designed to survive transient rotor rubs. Inherent brush seal flexibility reduces frictional heat generation. However, high surface speeds combined with thin rotor sections may result in local hot spots. Considering large surface area and accelerated oxidation rates, frictional heat at bristles tips is another major concern especially in challenging high temperature applications. This study investigates temperature distribution in a brush seal as a function of frictional heat generation at bristle tips. The two-dimensional axisymmetric CFD analysis includes the permeable bristle pack as a porous medium allowing fluid flow throughout the bristle matrix. In addition to effective flow resistance coefficients, isotropic effective thermal conductivity as a function of temperature is defined for the bristle pack. Employing a fin approach for a single bristle, a theoretical analysis has been developed after outlining the brush seal heat transfer mechanism. Theoretical and CFD analysis results are compared. To ensure coverage for various seal designs and operating conditions, several frictional heat input cases corresponding to different seal stiffness have been studied. Frictional heat generation is outlined to introduce a practical heat flux input into the analysis model. Effect of seal stiffness on nominal bristle tip temperature has been evaluated. Analyses show a steep temperature rise close to bristle tips that diminishes further away. Heat flux conducted through the bristles dissipates into the flow by a strong convection at fence height region.

Numerical investigations of leakage flow fields of two kinds of brush seals with four sealing clearances were conducted in this paper. The Reynolds-Averaged Navier-Stokes (RANS) and non-Darcian porous medium model solutions were applied as the numerical approach to analyze the flow characteristics of brush seal. The reliability and accuracy of the RANS and non-Darcian porous medium model for leakage flow in brush seals were established by comparison with the experimental data. The referenced labyrinth seal was changed into a multi-stage brush seal which has two configurations. One configuration had a traditional geometrical structure. The other had a shim structure installed between the front plate and brush bristle pack. The leakage flow rates of the brush seal with two different configurations were calculated for four bristle pack tip clearances (0mm, 0.1mm, 0.3mm, 0.5mm) which were compared with the results for the referenced labyrinth seal. The numerical results show that the leakage flow rate increases rapidly with the increasing of clearance between the bristle pack tip and the rotor surface for two kinds of brush seals. The sealing performance of the brush seal with shim structure is similar to that of the traditional design with the same sealing clearance and flow conditions. In addition, as compared with the traditional brush seal, the brush seal with shim structure can reduce the pressure difference between the bristle free and fence height at 0.3mm and 0.5mm sealing clearance. The leakage flow patterns in brush seals with two different configurations were also illustrated.

Thanks to their compliant nature and superior leakage performance over conventional labyrinth seals, brush seals found increasing use in turbomachinery. Utilizing high temperature super-alloy fibers and their compliance capability these seals maintain contact with the rotor for a wide range of operating conditions leaving minimal passage for parasitic leakage flow. Consequently, the contact force/pressure generated at seal rotor interface is of importance for sustained seal performance and longevity of its service life. Although some analytical and numerical models have been developed to estimate bristle tip pressures, they simply rely on linear beam equation calculations and other such assumptions for loading cases. In this paper, previously available analytical and/or numerical models for bristle tip force/pressure have been modified and enhanced. The nonlinear cantilever beam equation has been solved and results are compared to a linear cantilever beam equation solution to establish application boundaries for both methods. The results are also compared to experimental data. With the support of testing, an empirical model has been developed for tip forces under operating conditions.

This paper describes an experimental effort designed to validate a general 2D bristle contact friction model. The model extends the 1D integrated bristle friction model to a 2D space by allowing the “bristle spring” to not only stretch along the direction of the bristle displacement but also rotate due to the instantaneous direction change of the velocity or motion trend in the common tangential plane of the contacting surfaces involved at the point of interest. The model is capable of simulating frictional behaviour in both sliding and sticking regimes occurring in general 3D rigid-body contact. With such an extension, the resulting friction model can be readily used to compute 3D contact friction forces in both sticking and sliding regimes. Two experiments were designed and implemented to validate the new 2D bristle model. The experiments were able to passively produce common frictional phenomena such as sliding, sticking, and stick-slip.

In this paper an experimental programme and a CFD based mathematical model using a brush seal at two bristle to rotor clearances (0,27 mm. and 0,75 mm.), are presented. The experimental programme examined the radial pressure distributions along the backing ring, the axial pressure distribution along the rotor, and the mass flow through the seal, through a range of pressure ratios while exhausting to atmosphere. The results from this experimental programme have been used to further calibrate a CFD based model. This model treats the bristle pack as an axisymmetric, anisotropic porous region, and is calibrated by the definition of non-linear resistance coefficients in three orthogonal directions. The CFD analysis calculates the aerodynamic forces on the bristles, which are subsequently used in a separate program to estimate the bristle movements, stresses and bristle and rotor loads. The analysis shows that a brush seal with a build clearance produces a very different flow field within the bristle pack to one with an interference, and the need to understand the bulk movements of the bristles. These are shown to be affected by the level of friction between the bristles and the backing ring, which has an important effect on the bristles wear and seal leakage characteristics.

Brush seals effectively control leakage in air breathing engines, albeit only applied for relatively low-pressure differentials. Hybrid brush seals (HBS) are an alternative to resolve poor reliability resulting from bristle tip wear while also allowing for reverse shaft rotation operation. A HBS incorporates pads contacting the shaft on assembly; and which under rotor spinning, lift off due to the generation of a hydrodynamic pressure. The ensuing gas film prevents intermittent contact, reducing wear and thermal distortions. The paper presents rotordynamic measurements conducted on a test rig for evaluation of HBS technology. Single frequency shaker loads are exerted on a test rotor holding a hybrid brush seal and measurements of rotor displacements follow for operating conditions with increasing gas supply pressures and two rotor speeds. A frequency domain identification method delivers the test system stiffness and damping coefficients. The HBS stiffness coefficients are not affected by rotor speed though the seal viscous damping shows a strong frequency dependency. The identified HBS direct stiffness decreases ∼15% as the supply/discharge pressure increases Pr = 1.7 to 2.4. The HBS cross-coupled stiffnesses are insignificant, at least one order of magnitude smaller than the direct stiffnesses. A structural loss factor (γ) and dry friction coefficient (μ) represent the energy dissipated in a HBS by the bristle-to-bristle and bristle-to-pads interactions. Predictions of HBS stiffness and damping coefficients correlate well with the test derived parameters. Both model predictions and test results show the dramatic reduction of the seal equivalent viscous damping coefficients as the excitation whirl frequency increases.

Bristle tip contact forces and resulting stress levels under engine conditions are critical to optimizing brush seal performance as well as to achieving operational safety. Literature survey reveals the lack of test data and analysis methods for evaluating seal stiffness and stress levels under operating conditions. In an attempt to meet this need, a custom test rig design and methodology has been developed to perform stiffness tests under pressure and rotor speed of 3000 rpm. Finite element simulations have been performed for brush seals and results have been correlated with the test data of this study. Considering the critical importance of contact loads on brush seal overall performance and system health, and due to the complicated structure of brush seals, where bristles are contacting with each other as well as with the backing plate and the rotor, CAE analyses with high fidelity is required to simulate the test and turbine operating conditions. For this purpose, FE methodology has been developed for structural analyses of brush seals. 3D finite element models of brush seals have been constructed and simulations have been performed for pressurized rotor-rub conditions. CAE model of brush seals includes rotor-bristle, bristle pack-backing plate and inter-bristle contacts with friction. Simulations with non-rotating rotor and transient analyses with rotating rotor have been conducted, and the extracted bristle tip force levels are correlated with the test results. Inertial effects during dynamic tests have also been simulated through transient analyses and results show good agreement with the dynamic test data. Displacement and stress profiles obtained from correlated FE models give better understanding of brush seal behavior under turbine operating conditions.