Multiple Application Propfan Study (MAPS): Advanced tactical transport

This study was conducted to ascertain potential benefits of a propfan propulsion system application to a blended wing/body military tactical transport. Based on a design cruise Mach no. of 0.75 for the design mission, the results indicate a significant advantage in various figures of merit for the propfan over those of a comparable technology turbofan. Although the propfan has a 1.6 percent greater takeoff gross weight, its life cycle cost is 5.3 percent smaller, partly because of a 27 percent smaller specific fuel consumption. When employed on alternate missions, the propfan configuration offers significantly improved flexibility and capability: an increase in sea level penetration distance of more than 100 percent, or in time-on-station of 24 percent, or in deployment payload of 38 percent

Review of Maxillary Expansion Appliance Activation Methods: Engineering and Clinical Perspectives

Objective. Review the reported activation methods of maxillary expansion devices for midpalatal suture separation from an engineering perspective and suggest areas of improvement. Materials and Methods. A literature search of Scopus and PubMed was used to determine current expansion methods. A U.S. and Canadian patent database search was also conducted using patent classification and keywords. Any paper presenting a new method of expansion was included. Results. Expansion methods in use, or patented, can be classified as either a screw- or spring-type, magnetic, or shape memory alloy expansion appliance. Conclusions. Each activation method presented unique advantages and disadvantages from both clinical and engineering perspectives. Areas for improvement still remain and are identified in the paper

Adrenal suppression in patients taking inhaled glucocorticoids is highly prevalent and management can be guided by morning cortisol

Context Up to 3% of US and UK populations are prescribed glucocorticoids (GC). Suppression of the hypothalamo–pituitary–adrenal axis with the potential risk of adrenal crisis is a recognized complication of therapy. The 250 μg short Synacthen stimulation test (SST) is the most commonly used dynamic assessment to diagnose adrenal insufficiency. There are challenges to the use of the SST in routine clinical practice, including both the staff and time constraints and a significant recent increase in Synacthen cost. Methods We performed a retrospective analysis to determine the prevalence of adrenal suppression due to prescribed GCs and the utility of a morning serum cortisol for rapid assessment of adrenal reserve in the routine clinical setting. Results In total, 2773 patients underwent 3603 SSTs in a large secondary/tertiary centre between 2008 and 2013 and 17.9% (n=496) failed the SST. Of 404 patients taking oral, topical, intranasal or inhaled GC therapy for non-endocrine conditions, 33.2% (n=134) had a subnormal SST response. In patients taking inhaled GCs without additional GC therapy, 20.5% (34/166) failed an SST and suppression of adrenal function increased in a dose-dependent fashion. Using receiver operating characteristic curve analysis in patients currently taking inhaled GCs, a basal cortisol ≥348 nmol/l provided 100% specificity for passing the SST; a cortisol value <34 nmol/l had 100% sensitivity for SST failure. Using these cut-offs, 50% (n=83) of SSTs performed on patients prescribed inhaled GCs were unnecessary. Conclusion Adrenal suppression due to GC treatment, particularly inhaled GCs, is common. A basal serum cortisol concentration has utility in helping determine which patients should undergo dynamic assessment of adrenal function

Design Parameterization for Concurrent Design and Manufacturing of Mechanical Systems

Design changes are frequently encountered in the product development process. The complexity of the design changes is multiplied when the product design involves multiple engineering disciplines. Very often, a simple change in one part may propagate to its neighboring parts, therefore, affects the entire product assembly. Both parts and assembly must be regenerated for a physically valid product model, at the same time, the regenerated product model must meet designer's expectations.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Are quasars accreting at super-Eddington rates?

In a previous paper, Collin & Hur\'e (2001), using a sample of Active Galactic Nuclei (AGN) where the mass has been determined by reverberation studies (Kaspi et al. 2000), have shown that if the optical luminosity is emitted by a steady accretion disc, about half of the objects are accreting close to or higher than the Eddington rate. We conclude here that this result is unavoidable, unless the masses are strongly underestimated by reverberation studies, which does not seem to be the case. There are three issues to the problem: 1. Accretion proceeds at Eddington or super-Eddington rates through thick discs. Several consequences follow: an anti-correlation between the line widths of the lines and the Eddington ratios, and a decrease of the Eddington ratio with an increasing black hole mass. Extrapolated to all quasars, these results imply that the amount of mass locked in massive black holes should be larger than presently thought. 2. The optical luminosity is not produced directly by the gravitational release of energy, and super-Eddington rates are not required. The optical luminosity has to be emitted by a dense and thick medium located at large distances from the center (10$^3$ to $10^4$ gravitational radii). It can be due to reprocessing of the X-ray photons from the central source in a geometrically thin warped disc, or in dense "blobs" forming a geometrically thick system, which can be a part of the accretion flow or the basis of an outflow. 3. Accretion discs are completely "non standard". Presently neither the predictions of models nor the observed spectral distributions are sufficient to help choosing between these solutions.Comment: 16 pages, 11 figures, accepted in A&

Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases

Abstract Background Surgical resection of colorectal liver metastases (CRLMs) is the standard of care when possible, although this strategy has not been compared with non-operative interventions in controlled trials. Although survival outcomes are clear, the cost-effectiveness of surgery is not. This study aimed to estimate the cost-effectiveness of resection for CRLMs compared with non-operative treatment (palliative care including chemotherapy). Methods Operative and non-operative cohorts were identified from a prospectively maintained database. Patients in the operative cohort had a minimum of 10 years of follow-up. A model-based cost–utility analysis was conducted to quantify the mean cost and quality-adjusted life-years (QALYs) over a lifetime time horizon. The analysis was conducted from a healthcare provider perspective (UK National Health Service) in a secondary care (hospital) setting. Results Median survival was 41 and 21 months in the operative and non-operative cohorts respectively (P &amp;lt; 0·001). The operative strategy dominated non-operative treatments, being less costly (€22 200 versus €32 800) and more effective (4·017 versus 1·111 QALYs gained). The results of extensive sensitivity analysis showed that the operative strategy dominated non-operative treatment in every scenario. Conclusion Operative treatment of CRLMs yields greater survival than non-operative treatment, and is both more effective and less costly. </jats:sec