Simulation of non-linear bearing forces for post-stability investigation

Different types of bearing designs were developed to improve dynamic properties of rotor-bearing systems. Elliptical bearings, multisleeve bearings, tilting pad and other designs such as herringbone groove were utilized to increase resistance to the onset of self excited vibrations. Experimental trials are costly, two alternative methods are used to gain a qualitative insight. The first one creates mathematical model and applies both a digital or an analog computer simulation. The second one investigates phenomena occurring on the laboratory rig with the bearing replaced by an electronic simulating device, working in a feedback loop, which produces forces,which are functions of journal displacement and velocity. The simulated hydrodynamic forces are produced according to assumed characteristics matched to the bearing type. The principal benefit of the analog simulation is that nonlinear characteristics of a subsystem are precisely identified and mathematical methods applied for a wide class of problems are checked on the experimental installation

Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature

Abstract: Background: A person’s chronic health condition or disability can have a huge impact on the quality of life (QoL) of the whole family, but this important impact is often ignored. This literature review aims to understand the impact of patients' disease on family members across all medical specialities, and appraise existing generic and disease-specific family quality of life (QoL) measures. Methods: The databases Medline, EMBASE, CINHAL, ASSIA, PsycINFO and Scopus were searched for original articles in English measuring the impact of health conditions on patients' family members/partner using a valid instrument. Results: Of 114 articles screened, 86 met the inclusion criteria. They explored the impact of a relative's disease on 14,661 family members, mostly 'parents' or 'mothers', using 50 different instruments across 18 specialities including neurology, oncology and dermatology, in 33 countries including the USA, China and Australia. These studies revealed a huge impact of patients' illness on family members. An appraisal of family QoL instruments identified 48 instruments, 42 disease/speciality specific and six generic measures. Five of the six generics are aimed at carers of children, people with disability or restricted to chronic disease. The only generic instrument that measures the impact of any condition on family members across all specialities is the Family Reported Outcome Measure (FROM-16). Although most instruments demonstrated good reliability and validity, only 11 reported responsiveness and only one reported the minimal clinically important difference. Conclusions: Family members' QoL is greatly impacted by a relative's condition. To support family members, there is a need for a generic tool that offers flexibility and brevity for use in clinical settings across all areas of medicine. FROM-16 could be the tool of choice, provided its robustness is demonstrated with further validation of its psychometric properties.Peer reviewe

Appropriate and inappropriate influences on outpatient discharge decision making in dermatology : a prospective qualitative study

© 2015 British Association of Dermatologists.BACKGROUND: Outpatient discharge decision making in dermatology is poorly understood. OBJECTIVE: To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics. METHODS: Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed. RESULTS: The mean age of the clinicians was 48.8 years (range 33.0-67.0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty-eight influences were reported, with five main themes: (i) disease-based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician-based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient-based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice-based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy-based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate. CONCLUSION: This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness.Peer reviewe

Effects of rehabilitation on the patients with chronic low back pain

This study was done to observe the effects of rehabilitation on chronic low back pain on 139 patient. They were divided into two groups:  a) One group (n=71) received naproxen (non-steroidal anti-inflammatory drug, NSAID) with selective rehabilitation and b) another group (n= 68) treated with NSAID only. The patients were followed up weekly for eight weeks. The improvement was found in both groups after treatment. In patients with rehabilitation, the pre-treatment and post-treatment mean scores (Oswastry Disability Index, Visual Analogue Scale and Modified Zung Index) were 34.3 ± 9.8 and 9.9 ± 8.0 respectively (p<0.001). Treatment with NSAID only reduced the mean scores from 34.9 ± 13.5 to 16.0 ± 14.4 (p<0.001) after treatment. There was no significant difference in clinical improvement between the groups in pre-treatment compare with week one, rehabilitation group (29.7 ± 8.7) vs NSAID group (31.5 ± 13.8). While significant improvement was found in rehabilitation group in comparison to NSAID group after 8th week, rehabilitation group vs NSAID group scores were 10.0 ± 7.9 vs 15.9 ± 14.5 respectively (p= 0.004). In conclusion, rehabilitation can be used as an adjunct to NSAID for better improvement

EEG correlated functional MRI and postoperative outcome in focal epilepsy

Background: The main challenge in assessing patients with epilepsy for resective surgery is localising seizure onset. Frequently, identification of the irritative and seizure onset zones requires invasive EEG. EEG correlated functional MRI (EEG-fMRI) is a novel imaging technique which may provide localising information with regard to these regions. In patients with focal epilepsy, interictal epileptiform discharge (IED) correlated blood oxygen dependent level (BOLD) signal changes were observed in approximately 50% of patients in whom IEDs are recorded. In 70%, these are concordant with expected seizure onset defined by non-invasive electroclinical information. Assessment of clinical validity requires post-surgical outcome studies which have, to date, been limited to case reports of correlation with intracranial EEG. The value of EEG-fMRI was assessed in patients with focal epilepsy who subsequently underwent epilepsy surgery, and IED correlated fMRI signal changes were related to the resection area and clinical outcome. Methods: Simultaneous EEG-fMRI was recorded in 76 patients undergoing presurgical evaluation and the locations of IED correlated preoperative BOLD signal change were compared with the resected area and postoperative outcome. Results: 21 patients had activations with epileptic activity on EEG-fMRI and 10 underwent surgical resection. Seven of 10 patients were seizure free following surgery and the area of maximal BOLD signal change was concordant with resection in six of seven patients. In the remaining three patients, with reduced seizure frequency post-surgically, areas of significant IED correlated BOLD signal change lay outside the resection. 42 of 55 patients who had no IED related activation underwent resection. Conclusion: These results show the potential value of EEG-fMRI in presurgical evaluation

Rapid identification of BCR/ABL1-like acute lymphoblastic leukaemia patients using a predictive statistical model based on quantitative real time-polymerase chain reaction: clinical, prognostic and therapeutic implications.

BCR/ABL1-like acute lymphoblastic leukaemia (ALL) is a subgroup of B-lineage acute lymphoblastic leukaemia that occurs within cases without recurrent molecular rearrangements. Gene expression profiling (GEP) can identify these cases but it is expensive and not widely available. Using GEP, we identified 10 genes specifically overexpressed by BCR/ABL1-like ALL cases and used their expression values - assessed by quantitative real time-polymerase chain reaction (Q-RT-PCR) in 26 BCR/ABL1-like and 26 non-BCR/ABL1-like cases to build a statistical "BCR/ABL1-like predictor", for the identification of BCR/ABL1-like cases. By screening 142 B-lineage ALL patients with the "BCR/ABL1-like predictor", we identified 28/142 BCR/ABL1-like patients (19·7%). Overall, BCR/ABL1-like cases were enriched in JAK/STAT mutations (P < 0·001), IKZF1 deletions (P < 0·001) and rearrangements involving cytokine receptors and tyrosine kinases (P = 0·001), thus corroborating the validity of the prediction. Clinically, the BCR/ABL1-like cases identified by the BCR/ABL1-like predictor achieved a lower rate of complete remission (P = 0·014) and a worse event-free survival (P = 0·0009) compared to non-BCR/ABL1-like ALL. Consistently, primary cells from BCR/ABL1-like cases responded in vitro to ponatinib. We propose a simple tool based on Q-RT-PCR and a statistical model that is capable of easily, quickly and reliably identifying BCR/ABL1-like ALL cases at diagnosis

Detailed spectral and morphological analysis of the shell type supernova remnant RCW 86

Aim. We aim for an understanding of the morphological and spectral properties of the supernova remnant RCW 86 and for insights into the production mechanism leading to the RCW 86 very high-energy γ-ray emission. Methods. We analyzed High Energy Spectroscopic System (H.E.S.S.) data that had increased sensitivity compared to the observations presented in the RCW 86 H.E.S.S. discovery publication. Studies of the morphological correlation between the 0.5–1 keV X-ray band, the 2–5 keV X-ray band, radio, and γ-ray emissions have been performed as well as broadband modeling of the spectral energy distribution with two different emission models. Results. We present the first conclusive evidence that the TeV γ-ray emission region is shell-like based on our morphological studies. The comparison with 2–5 keV X-ray data reveals a correlation with the 0.4–50 TeV γ-ray emission. The spectrum of RCW 86 is best described by a power law with an exponential cutoff at Ecut = (3.5 ± 1.2stat) TeV and a spectral index of Γ ≈ 1.6 ± 0.2. A static leptonic one-zone model adequately describes the measured spectral energy distribution of RCW 86, with the resultant total kinetic energy of the electrons above 1 GeV being equivalent to ~0.1% of the initial kinetic energy of a Type Ia supernova explosion (1051 erg). When using a hadronic model, a magnetic field of B ≈ 100 μG is needed to represent the measured data. Although this is comparable to formerly published estimates, a standard E−2 spectrum for the proton distribution cannot describe the γ-ray data. Instead, a spectral index of Γp ≈ 1.7 would be required, which implies that ∼7 × 1049/ncm−3 has been transferred into high-energy protons with the effective density ncm−3 = n/1 cm−3. This is about 10% of the kinetic energy of a typical Type Ia supernova under the assumption of a density of 1 cm−3