Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process

Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA.

Development and Validation of a Forklift Truck Powertrain Simulation

Fuel economy has become an important consideration in forklift truck design, particularly in Europe. A simulation of the fuel consumption and performance of a forklift truck has been developed, validated and subsequently used to determine the energy consumed by individual powertrain components during drive cycles.
The truck used in this study has a rated lifting capacity of 2500kg, and is powered by a 2.6 litre naturally aspirated diesel engine with a fuel pump containing a mechanical variable-speed governor. The drivetrain consisted of a torque convertor, hydraulic clutch and single speed transmission.
AVL Cruise was used to simulate the vehicle powertrain, with coupled Mathworks Simulink models used to simulate the hydraulic and control systems and governor. The vehicle has been simulated on several performance and fuel consumption drive cycles with the main focus being the VDI 2198 fuel consumption drive cycle.
To validate the model, a truck was instrumented and measurements taken to compare the performance and instantaneous fuel consumption to simulated values. The fuel injector pump was modified and calibrated to enable instantaneous fuel flow to be measured.
The model has been validated to within acceptable limits and has been used to investigate the effect four different torque converters have on the fuel consumption and performance of the forklift truck. The study demonstrates how the model can be used to compare the fuel consumption and performance trade-offs when selecting drivetrain components.

Responding to desire to die statements from patients with advanced disease:recommendations for health professionals

It is not uncommon for patients with advanced incurable disease to express a desire to hasten their death. Health professionals often have difficulty responding to such statements, and find it challenging to ascertain why these statements are made. Health professionals may struggle to determine whether a 'desire to die' statement (DTDS) is about a request for hastened death, a sign of psychosocial distress, or merely a passing comment that is not intended to be heard literally as a death wish. Given the lack of guidelines to assist health professionals with this issue, we have prepared multidisciplinary recommendations for responding to a DTDS, underpinned by key principles of therapeutic communication and a systematic review of empirical literature. Where the relevant literature was lacking, the recommendations were drafted by the authors (clinicians and/ or academics from the following disciplines: nursing, medicine, psychiatry, psychology, sociology, aged care and theology), based on their expert opinion. Multiple drafts of the recommendations were circulated to the authors for refinement until consensus was reached. Strategies for advancing the evidence base for the maturation of guidelines in this area are offered.

The use of a dynamic truck-trailer drive-by system to monitor bridge damping

Bridge structures are continuously subject to degradation due to the environment, ageing and excess loading. Periodic monitoring of bridges is therefore a key part of any maintenance strategy as it can give early warning if a bridge becomes unsafe. This article investigates an alternative method for the monitoring of bridge dynamic behaviour: a truck-trailer vehicle system, with accelerometers fitted to the axles of the trailer. The method aims to detect changes in the damping of a bridge, which may indicate the existence of damage. A simplified vehicle-bridge interaction model is used in theoretical simulations to assess the effectiveness of the method in detecting those changes. The influence of road profile roughness on the vehicle vibration is overcome by recording accelerations from both axles of a trailer and then analysing the spectra of the difference in the accelerations between the two axles. The effectiveness of the approach in detecting damage simulated as a loss in stiffness is also investigated. In addition, the sensitivity of the approach to the vehicle speed, road roughness class, bridge span length, changes in the equal axle properties and noise is investigated.

Clinical end points for drug treatment trials in BCR-ABL1-negative classic myeloproliferative neoplasms: consensus statements from European LeukemiaNET (ELN) and Internation Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT)

The discovery of somatic mutations, primarily JAK2V617F and CALR, in classic BCR-ABL1-negative myeloproliferative neoplasms (MPNs) has generated interest in the development of molecularly targeted therapies, whose accurate assessment requires a standardized framework. A working group, comprised of members from European LeukemiaNet (ELN) and International Working Group for MPN Research and Treatment (IWG-MRT), prepared consensus-based recommendations regarding trial design, patient selection and definition of relevant end points. Accordingly, a response able to capture the long-term effect of the drug should be selected as the end point of phase II trials aimed at developing new drugs for MPNs. A time-to-event, such as overall survival, or progression-free survival or both, as co-primary end points, should measure efficacy in phase III studies. New drugs should be tested for preventing disease progression in myelofibrosis patients with early disease in randomized studies, and a time to event, such as progression-free or event-free survival should be the primary end point. Phase III trials aimed at preventing vascular events in polycythemia vera and essential thrombocythemia should be based on a selection of the target population based on new prognostic factors, including JAK2 mutation. In conclusion, we recommended a format for clinical trials in MPNs that facilitates communication between academic investigators, regulatory agencies and drug companies.

Fighting Talk: The Statements of 'The IRA/New IRA'

With the advent of the new violent dissident merger, ‘The IRA/New IRA’, the group and its affiliates have had to legitimise their new existence. They have utilised the maintenance of paramilitary activity to achieve this. However, they have also produced a number of organisational statements, justifying their position, tactics and strategies. This article analyses the evolution of these statements, both pre and post-merger from 2007 to 2015. 126 individual statements and 4 magazines are analysed using grounded theory. This analysis found that the statements have a dual strategy, aiming to foster trust in the movement and distrust in their perceived enemies. One of the dominant ways in which the group aims to foster trust, is by proposing their possession of an historical mandate from the republican forefathers of 1916, as well as the internally lauded paramilitaries from the Troubles era PIRA. The focus of the distrust narrative has been on the ‘constitutional nationalism’ of Sinn Féin. However, it also pours scorn on the PSNI, and capitalism, across the island of Ireland. The analysis of these statements can provide us with an understanding of the future direction of the group, as well as giving us insight, which can inform the development of any counter-narrative.

Establishing the main Guidelines for Cast Steel to Produce Truck Parts

Este trabalho foi realizado na Scania CV AB e teve como principal objectivo estabelecer uma diretriz sobre a possível utilização de aços vazados. Existe uma grande necessidade na realização deste trabalho, de forma a apoiar os engenheiros de projecto no seu processo de selecção dos materiais mais adequados, para produzir componentes mais leves e de elevado desempenho. Esta diretriz apresenta informação relacionada com propriedades mecânicas, processos de fundição, vazabilidade, tipologia de defeitos, tratamentos térmicos, soldabilidade e tratamentos superficiais dos aços vazados. Este trabalho foi limitado, na seleção de materiais para componentes do camião, a aços vazados que poderiam ser aplicados em dois componentes específicos: um componente estrutural da carroçaria sujeito a esforços de fadiga e a um colector de gases de combustão, sujeito a fluência, oxidação, fadiga por corrosão, fadiga-térmica e fadiga-mecânica. Foi realizado um benchmark focado nestes dois componentes de forma a saber que materiais são utilizados de momento por outras empresas concorrentes. Foi realizada ainda uma análise sobre possíveis materiais que possam ser aplicados em cada componente referido. Foi conduzida uma caracterização no estado bruto de fundição de um aço inoxidável vazado usado para produzir um protótipo do colector de gases. Esta caracterização consistiu numa análise microestrutural e medição de macro e microdurezas. Além da caracterização inicial, foram aplicados um conjunto de tratamentos térmicos, de forma a estudar a possibilidade de eliminar os carbonetos presentes inicialmente nas fronteiras de grão. As principais conclusões deste trabalho são que o aço vazado apresenta potencial para ser uma escolha válida em diversas aplicações, devido a um leque alargado de propriedades apresentadas tipicamente por este material. Relativamente a aplicações estruturais, o aço vazado é vantajoso comparativamente ao ferro fundido, quando são requeridos, por exemplo, soldabilidade e elevada resistência, combinada com elevada tenacidade à fractura. Para componentes sujeitos a elevadas temperaturas de serviço, o aço inoxidável vazado é vantajoso quando usado a temperaturas superiores a 750°C, apesar do seu elevado custo. O tratamento térmico composto por um recozimento de solubilização seguido de envelhecimento, elimina quase na totalidade os carbonetos presentes nas fronteiras de grão e verifica-se um aumento de dureza através de uma precipitação de carbonetos finamente dispersos na matriz, que poderão também aumentar a resistência à fluência.

Why aren't brand names regognized as intangible assets in the financial Statements? A study of the subjectivity of brand valuation

The goal of this paper is to determine and to quantify how subjective brand valuation is. To do so, we review the different valuation methods and apply the Hirose model to a sample of 20 US companies from the technology sector. Even if the results vary in function of the rankings we choose as a comparison, we may identify the trend that brands are usually overvalued in those rankings. It explains why internally generated goodwill (which includes brand names) is not recognized as an intangible asset in the financial statements.

Occupational exposure of truck drivers to dust and polynuclear aromatic hydrocarbons: a pilot study in Geneva, Switzerland.

The exposure to dust and polynuclear aromatic hydrocarbons (PAH) of 15 truck drivers from Geneva, Switzerland, was measured. The drivers were divided between "long-distance" drivers and "local" drivers and between smokers and nonsmokers and were compared with a control group of 6 office workers who were also divided into smokers and nonsmokers. Dust was measured on 1 workday both by a direct-reading instrument and by sampling. The local drivers showed higher exposure to dust (0.3 mg/m3) and PAH than the long-distance drivers (0.1 mg/m3), who showed no difference with the control group. This observation may be due to the fact that the local drivers spend more time in more polluted areas, such as streets with heavy traffic and construction sites, than do the long-distance drivers. Smoking does not influence exposure to dust and PAH of professional truck drivers, as measured in this study, probably because the ventilation rate of the truck cabins is relatively high even during cold days (11-15 r/h). The distribution of dust concentrations was shown in some cases to be quite different from the expected log-normal distribution. The contribution of diesel exhaust to these exposures could not be estimated since no specific tracer was used. However, the relatively low level of dust exposure dose not support the hypothesis that present day levels of diesel exhaust particulates play a significant role in the excess occurrence of lung cancer observed in professional truck drivers.