Sodium restriction is the primary dietary therapy for individuals with heart failure (HF); however, there is little information available to support or refute the use of sodium restriction to manage HF. The overall goal of this work was to generate data related to dietary sodium in patients with chronic HF that would contribute to the development of evidence-based guidelines. The specific objectives were to investigate the optimal methods for measuring sodium intake in HF, to describe the habitual consumption of sodium and other nutrients in HF, and to evaluate the relationship between sodium intake and clinical outcomes in HF. We studied stable ambulatory HF patients who were optimally medicated and participating in multidisciplinary HF programs. We determined that: (1) a strong relationship exists between 24-hour urine collections and food records for sodium intake assessment in non-HF cardiac patients and HF patients not taking loop diuretics. However, the relationship between urinary sodium excretion and sodium intake in HF patients taking loop diuretics was disturbed, suggesting that food records may be a better method for estimating sodium intake in this group. (2) Mean sodium intake in HF and non-HF cardiac patients was similar, and approximately half of patients in each group had sodium intake levels that exceeded the Dietary Reference Intakes tolerable upper level of 2300 mg/d. We also found that both groups had inadequate intakes of several nutrients, including potassium, calcium, magnesium, folate, and vitamin D and E. (3) Finally, we showed that a high sodium diet (>2800 mg/day) in HF was associated with risk of acute decompensated HF, all-cause hospitalization, and all-cause mortality over a median 3 year follow-up period. This is the first published study that prospectively related sodium intake to clinical outcomes in HF. In summary, these data provide novel contributions related to the measurement of sodium intake that can be used in clinical or academic settings. We also describe inadequacies in intake of several vitamins and minerals, which could be addressed through dietary counselling. Finally, we importantly offer insight into a threshold of sodium intake (>2800 mg/day) that could contribute to adverse clinical outcomes in HF.

The tumour suppressor p27kip1 (p27) is a potent inhibitor of cell growth and proliferation. We identified NF-κB activator, IKKα, as a novel interacting partner of p27 in a protein microarray screen. Both the IKKα and IKKβ components of the IKK complex were mapped to the C-terminal domain of p27. To investigate the physiological function of the p27-IKK interaction, we employed a well-established model of LPS-induced sepsis which is known to activate the IKK/NF-κB pathway. Lentivirally-mediated overexpression of p27 blocked LPS activation of NF-κB. Furthermore, in LPS-injected animals transduced with TAT-p27, a significant improvement in the left ventricular function of the heart was observed. TAT-p27 treatment was also shown to attenuate the endotoxin effect and significantly improve survival compared to both saline and TAT-LacZ controls. Our results indicate that p27 attenuates inflammation, possibly through inhibiting the IKK-dependent activation of NF-κB, thus supporting a novel link between both cell cycle regulation and inflammation.

Background and Purpose: Governments and policy makers continue to look to entrepreneurship as a vehicle to economic development. This is informed by the perception shared by governments and policy makers that entrepreneurship is a good thing and we ought to have more of it. Thus a wave of policies has emerged in the UK and elsewhere which advocates for an increase in the level of enterprise activity. Our understanding of how and when governments intervene to assist entrepreneurs, and indeed which, if any, specific entrepreneurs should receive assistance in some shape or form, still has substantial knowledge gaps. The review aims to contribute to the building of this knowledge. Methodology: The systematic review methodology was followed to examine the entrepreneurship literature. Quantitatively, the data was examined using basic descriptive statistics and content analysis. Qualitatively, the data was analyzed based on an inductive approach in order to identify emerging, frequent, dominant or significant themes that dominate in understanding entrepreneurship. Findings: This review has identified factors which affect entrepreneurial performance, the market failure that result as well as the policy instruments defined in literature that aim to rectify the perceived market failure. Different typologies were identified which illustrate how the different policy instruments are categorised. Further, this review highlights the complex nature of public policy and entrepreneurship and raises the importance of adopting a more coherent “holistic” approach when advocating for intervention in entrepreneurship and public policy.

The thesis covers data fusion for aircraft navigation systems in distributed sensor systems. Data fusion methodologies are developed for the design, development, analysis and simulation of multisensor aircraft navigation systems. The problems of sensor failure detection and isolation (FDI), distributed data fusion algorithms and inertial state integrity monitoring in inertial network systems are studied. Various existing integrated navigation systems and Kalman filter architectures are reviewed and a new generalised multisensor data fusion model is presented for the design and development of multisensor navigation systems. Normalised navigation algorithms are described for data fusion filter design of inertial network systems. A normalised measurement model of skewed redundant inertial measurement units (SRIMU) is presented and performance criteria are developed to evaluate optimal configurations of SRIMUs in terms of the measurement accuracy and FDI capability. Novel sensor error compensation filters are designed for the correction of SRIMU measurement errors. Generalised likelihood ratio test (GLRT) methods are improved to detect various failure modes, including short time and sequential moving-window GLRT algorithms. State-identical and state-associated fusion algorithms are developed for two forms of distributed sensor network systems. In particular, innovative inertial network sensing models and inertial network fusion algorithms are developed to provide estimates of inertial vector states and similar node states. Fusion filter-based integrity monitoring algorithms are also presented to detect network sensor failures and to examine the consistency of node state estimates in the inertial network system. The FDI and data fusion algorithms developed in this thesis are tested and their performance is evaluated using a multisensor software simulation system developed during this study programme. The moving-window GLRT algorithms for optimal SRIMU configurations are shown to perform well and are also able to detect jump and drift failures in an inertial network system. It is concluded that the inertial network fusion algorithms could be used in a low-cost inertial network system and are capable of correctly estimating the inertial vector states and the node states.

Sodium restriction is the primary dietary therapy for individuals with heart failure (HF); however, there is little information available to support or refute the use of sodium restriction to manage HF. The overall goal of this work was to generate data related to dietary sodium in patients with chronic HF that would contribute to the development of evidence-based guidelines. The specific objectives were to investigate the optimal methods for measuring sodium intake in HF, to describe the habitual consumption of sodium and other nutrients in HF, and to evaluate the relationship between sodium intake and clinical outcomes in HF. We studied stable ambulatory HF patients who were optimally medicated and participating in multidisciplinary HF programs. We determined that: (1) a strong relationship exists between 24-hour urine collections and food records for sodium intake assessment in non-HF cardiac patients and HF patients not taking loop diuretics. However, the relationship between urinary sodium excretion and sodium intake in HF patients taking loop diuretics was disturbed, suggesting that food records may be a better method for estimating sodium intake in this group. (2) Mean sodium intake in HF and non-HF cardiac patients was similar, and approximately half of patients in each group had sodium intake levels that exceeded the Dietary Reference Intakes tolerable upper level of 2300 mg/d. We also found that both groups had inadequate intakes of several nutrients, including potassium, calcium, magnesium, folate, and vitamin D and E. (3) Finally, we showed that a high sodium diet (>2800 mg/day) in HF was associated with risk of acute decompensated HF, all-cause hospitalization, and all-cause mortality over a median 3 year follow-up period. This is the first published study that prospectively related sodium intake to clinical outcomes in HF. In summary, these data provide novel contributions related to the measurement of sodium intake that can be used in clinical or academic settings. We also describe inadequacies in intake of several vitamins and minerals, which could be addressed through dietary counselling. Finally, we importantly offer insight into a threshold of sodium intake (>2800 mg/day) that could contribute to adverse clinical outcomes in HF.

In the last decade, reliability problems have become a critical subject in power modules. Understanding design weakness and failure mechanisms of thick wire bond are two critical steps in managing the risk of wire bond heel crack which is the topic of this thesis. Although this thesis does not target a specific type of power modules, we note that thick wire bond heel crack failures occur in Insulated Gate Bipolar Transistors (IGBTs). In fact, our aim is to understand failure mechanism in 300μm thick wire bonds with different geometries and materials. Since these wires experience harsh environmental conditions and high load transients, the wires undergo repetitive flexural movement which causes heel crack due to fatigue. For the purpose of understanding this failure mechanism, two experimental setups are built and utilized. The first experimental setup loads the wires using constant currents and observes the response using a scanning laser vibrometer to measure the displacement. The second experimental setup applies repetitive prescribed displacement to the first foot of the wire and detects fatigue failure using a Wheatstone bridge. It is realized that wires have different displacement property depending on their geometry and material. Maximum displacements are observed for Al-H11 instead of CuCorAl and PowerCu.

Bakgrund: Hjärtsvikt är en kronisk sjukdom som påverkar livet både för den drabbade och dess närstående. Prognosen är allvarlig och slutskedet kan liknas vid cancersjukdom. Allt fler vårdas i hemmet, vilket ställer krav på egenvård och närståendes delaktighet. Närstående är ofta inte förberedda för den nya ansvarsfyllda rollen som sjukdomen kan medföra. Syfte: Syftet var att beskriva närståendes upplevelser av att leva nära en person med hjärtsvikt. Metod: En allmän litteraturstudie genomfördes och baserades på tolv kvalitativa och tre kvantitativa vetenskapliga artiklar. Resultat: Det framkom fyra kategorier av upplevelser i resultatet; ovisshet, förändrade roller, social påverkan samt fysisk och psykisk påverkan, som var för sig och tillsammans kunde leda fram till att livet förändrades för närstående till personer med hjärtsvikt. Slutsats: Hjärtsvikt förändrar livet för närstående och innebär nya krav och anpassning i vardagen. Hälsan påverkas både fysisk och psykiskt. Risken att drabbas av egen ohälsa ökar. Konsekvenserna av att vara närstående är flera särskilt då närstående själva ofta är äldre och har egna hälsoproblem. För att kunna stödja närstående måste sjuksköterskan förstå deras upplevelser. Att synliggöra dem kan främja både den sjuke och dess närstående. / Background: Heart failure is a chronic disease and effects life both for the ill person and their family. The prognosis is serious and can be compared with cancer. More people receive care in their home which increases the demands in self-care and their families’ participation. With the disease come new responsibilities, which families aren’t always prepared for, including new roles. Aim: To describe experiences of living close to a person with heart failure. Method: A literature review was conducted which was based on twelve qualitative and three quantitative scientific articles. Results: Four main categories were identified: experience of uncertainty, changing roles, physical and psychological effects and social effects. Conclusion: Heart failure changes the lives of the families. It involves new demands and adjustment in every-day-life and affects both their physical and mental health. The risk of developing health problem increases. The consequences of living close to a person with heart failure are many, especially if they are older and have health problems of their own. Nurses need to be aware of families’ experiences to be able to support them. We believe that both the ill person and their family can benefit from nurses making their experiences visible.

Heart failure is a chronic condition that increases the risk for death and disability. Beta blockers and ACE inhibitors have become standard treatments in heart failure because clinical trials have demonstrated their beneficial effect on mortality and morbidity in these patients. As not much is known about adherence to these medications, the main objectives of this project were to determine long term adherence to ACE inhibitors and beta blockers and determine how various degrees of adherence to a beta blocker can affect major health outcomes in patients with heart failure.<p> Data was obtained from Saskatchewan health from January 1, 1994 to December 31, 2003 for all heart failure patients from their first hospitalization for heart failure. Adherence was calculated using the fill frequency measure of adherence, and all survival analyses were completed using the Cox proportional hazards model.<p>Although 14, 000 patients were admitted to hospital for a first admission for heart failure, only 1143 subjects started a beta blocker and 5084 subjects started an ACE inhibitor within 3 months of the index hospitalization. Within the first year, adherence was excellent for both beta blockers (80.8 percent) and ACE inhibitors (82.5 percent). The proportion of patients remaining adherent slowly decreased to reach approximately 60 percent, for both medication classes, after 4 years. There was no significant difference in all-cause mortality between patients with high adherence and low adherence, but there appeared to be a trend towards decreased survival time in those remaining adherent throughout the study period [HR = 1.18 (95% CI: 0.98 to 1.43; p=0.07)].<p>Since the overall rate of adherence to beta blockers was excellent in most patients during the first year, it is possible that non-adherence is not responsible for a significant burden of mortality in Saskatchewan heart failure patients, and perhaps and the focus of quality improvement should be optimal prescribing of evidence-based therapies, and continued adherence over time.

I examensarbetet har avvikelse- och underhållsrapporter rörande FörstaAmfibieregementets stridsbåtssystem analyserats för att finna eventuella brister. Iexamensarbetet finns statistik från hela 2008 representerat. Utifrån de rapporter ochden statisktik som dessa brister givit upphov till har de delsystem och komponentermed störst felfrekvens blivit granskade. I rapporten presenteras troliga orsaker tilluppkomna fel och brister, men även förslag på åtgärder för att öka tillgänglighetenpå systemet.Under arbetet med rapporten har det dock visat sig att marinens Drift, Informationoch Underhållsstödsystem (DIUS) kan vara den största orsaken till en minskadtillgänglighet. Systemet är inte anpassat för det stora antalet marina enheter ochpersonal som arbetar med systemet och de sistnämnda har inte alltid rätt utbildning. / This thesis has analysed incident and maintenance reports concerning the FirstMarine Regiment’s combat boat maintenance system. The aim was to find thosepossible deficiencies and shortcomings causing reduced accessibility. In addition, thethesis includes an analysis of maintenance-related statistics reported in 2008. Byusing these reports and statistical data as our factual base, we have examined thoseparts of the maintenance system and its components most frequently affected bydeficiencies and shortcomings. The thesis presents the most likely reasons for thesenegative occurrences, but also recommendations regarding measures that willincrease the overall accessibility.During our research, however, it also became evident that the main and most likelyreason for the reduced accessibility was the inherent capacity of the maintenancesystem (DIUS) used by the Royal Swedish Navy. In conclusion, this system is notsufficiently adapted to the great number of naval units and personnel who are usingit. Further, the naval personnel operating the system sometimes lack adequatetraining.

Extant literature has a controversy over the effects of customer relationship on customer responses to service failure. Buffering perspective suggests that strong relationship can mitigate customers¡¦ unfavorable reactions to service failure; whereas amplifying perspective finds that these negative customer responses are enhanced by strong relationship. Until now, it still lacks a unified framework to explain the mechanisms under each perspective and to reconcile both perspectives. The motivation of this research is to fill up this research gap and to solve the controversy over the effects of customer relationship under service failures. By integrating interdependence theory and reciprocity theory, this research proposes a framework to analyze when and why each of buffering and amplifying effects would occur and how amplifying effects can shift to buffering effects. The major conjectures of the framework proposed by this research are that customer relationship has amplifying effects on customers¡¦ immediate responses while it has buffering effects on their prolonged responses; moreover, customers¡¦ immediate and prolonged responses are guided by different reciprocity motivations and the shift from amplifying effects to buffering effects is triggered by motivation transformation that can be enhanced by increasing a number of customers¡¦ social concerns. This framework is verified through one survey study and two experimental studies. Collectively, the results broadly support that: (a) a customer relationship has amplifying effects on customers¡¦ immediate responses while has buffering effects on their prolonged responses; (b) immediate responses are majorly governed by self-oriented motivations in reciprocation of the firms¡¦ past behavior, whereas to some extent prolonged responses are guided by relationship-oriented motivations in reciprocation of the firms¡¦ anticipated behavior; (c) transformation of reciprocity motivations triggers the shift from amplifying effects into buffering effects; (d) concern about future of relationship with the firm increases the possibility of transformation and thus the occurrence of buffering effects.