bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation on the Robustness of Rotor/Stator Contact Interactions With Respect to Small Mistuning
Authors: Nyssen Florence , Batailly Alain 
Published: July 2021

Abstract
In this work, the impact of small mistuning on rotor/stator contact interactions is investigated. First, a detailed study of a rotor/stator interaction between the first bending modes and the second engine order is presented in the tuned case. Then, a numerical investigation on the effect of mistuning on the studied rotor/stator contact interaction is carried out. In particular, a stochastic analysis is performed to evaluate the robustness of the interaction with respect to the mistuning level. Simulations are conducted using a reducedo rder model (ROM) of an industrial-bladed disk that combines both physical degrees-of-freedom (along blades tip for contact treatment) and modal coordinates. Mistuning is introduced in the tuned ROM by means of a modified version of the component mode mistuning method that allows to keep physical degrees-of-freedom within the reduced basis. Nonlinear amplification factors, i.e., the amplification factors in the context of contact nonlinearities, are compared with their linear counterparts, and the latter are computed using a linear forcing on each blade using a two nodal diameters traveling wave excitation on the mistuned and the tuned bladed disk. The comparison between the linear and nonlinear amplification factor for each sample highlights that no correlation exists between a mistuning pattern leading to high amplifications in a linear context or when contact nonlinearities are taken into account. Therefore, dedicated analyses on the effect of mistuning should be undertaken with contact nonlinearities considerations at the design stage especially if intentional mistuning is considered.
On the Use of an Inflatable Rubber Lip to Improve the Reverse Thrust Flow Field in a Variable Pitch Fan
Authors: Rajendran David John , Pachidis Vassilios 
Published: July 2021

Abstract
The installed variable pitch fan (VPF) reverse thrust flow field is obtained from the flow solution of an integrated airframe-engine research model for the complete reverser engagement regime during the aircraft landing run from 140 knots to 40 knots. The model includes a twin-engine airframe, complete flow path representation of a future 40 000 lbf high bypass ratio geared turbofan engine, and a bespoke reverse flow-capable VPF design. The reverse thrust flow field, at all speeds, indicates that the reverse flow out of the nacelle inlet is washed downstream by the freestream toward the engine exit regions. Consequently, reverse flow enters the engine through the bypass nozzle from a 180 deg turn of the washed-down stream. This results in a region of circumferentially varying separated flow at the nozzle lip that acts as a blockage to the reverse flow entry into the engine. To mitigate the blockage issue, smooth guidance of the reverse flow into the engine to avoid separation can be achieved by using an inflatable rubber lip that would define a bell-mouth-like geometric feature with a round radius at the nacelle exit region. In nominal engine operation, the rubber lip would be stowed flush within the contours of the optimized nacelle surface. The design space of the rubber lip is studied by considering different rounding radii and locations of the turn radius with respect to the nacelle trailing edge. The choices of the design parameters are chosen by considering the nacelle edge thickness, inflation air volume requirement, weight, and thickness of support structures. The effect of these designs on the reverse thrust flow field is studied by incorporating the designs into the integrated model, with realistic installation-related restrictions. It is observed that a rounding radius of 0.1× nacelle length is sufficient to reduce the blockage and increase the ingested reverse flow by 47% to 18% in the 140–40 knots landing speed range. The inflatable rubber lip represents a design modification that can aid in the improvement of VPF reverse thrust operation, in cases where an augmentation of reverse thrust capability over the baseline is desired.
Response to Comment on “Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women”
Authors: Klein Samuel , Yoshino Mihoko 
Published: July 2021

Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women
In evaluating any randomized clinical trial, it is important to determine whether baseline differences between groups could have affected the primary outcome. In our study, muscle insulin sensitivity, which was identical in both groups at baseline, improved after nicotinamide mononucleotide (NMN), not placebo, therapy. Differences in baseline intrahepatic triglyceride content between groups do not negate the effects of NMN observed in muscle.
Interplay between worsening kidney function and cardiovascular events in patients with type 2 diabetes: an analysis from the ACCORD trial
Authors: Ferreira João Pedro , Ferrao Diana , Rossignol Patrick , Zannad Faiez , Sharma Abhinav , Vasques-Novoa Francisco , Leite-Moreira Adelino 
Published: July 2021

IntroductionPatients with type 2 diabetes (T2D) have an increased risk of worsening kidney function (WKF) over time compared with patients without diabetes. Data evaluating the inter-relation between WKF, cardiovascular risk, and clinical events are scarce. We aim to study the association of WKF with subsequent cardiovascular events and the probabilities of transition from WKF to hospitalization or death according to patients’ risk. We have used a large population of patients with T2D and a high cardiovascular risk enrolled in the Action to Control Cardiovascular Risk in Diabetes Study.Research design and methodsTime-updated, joint, and multistate modeling were used. WKF was defined as an estimated glomerular filtration rate (eGFR) decline greater than 40% from baseline. A total of 10 251 patients were included, of whom 1213 (11.8%) presented WKF over a median (percentile25–75) follow-up time of 5.0 (4.1–5.7) years.ResultsPatients who experienced WKF were slightly older, more frequently women, and had longer diabetes duration. Patients experiencing WKF, regardless of baseline kidney function, had a higher risk of subsequent cardiovascular events, including the composite of cardiovascular death or hospitalization for heart failure (HHF), with ≈2-fold higher risk. Joint modeling showed that renal function deterioration frequently occurs even among patients who did not experience a cardiovascular event. In multistate models, patients with a medium-high cardiovascular risk (compared with those with a low cardiovascular risk) are at higher risk of HHF or cardiovascular death first (HR=4.76, 95% CI 3.63 to 6.23) than of WKF first (HR=1.37, 95% CI 1.21 to 1.56); remarkably, the risk of cardiovascular death or HHF is highest after a WKF event (HR=6.20, 95% CI 2.71 to 14.8).ConclusionsIn patients with T2D and a high cardiovascular risk, WKF occurs in more than 10% of patients and is independently associated with risk of subsequent cardiovascular events, irrespective of baseline eGFR. Preventing serious WKF and the transition from WKF to HHF or cardiovascular death is an important objective of future trials.Trial registration numberNCT00000620.
Performance management in complex adaptive systems: a conceptual framework for health systems
Authors: Newton-Lewis Tom , Munar Wolfgang , Chanturidze Tata 
Published: July 2021

Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.The current evidence base is too limited to guide reforms to strengthen performance management in a particular context. Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment. It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance. The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context.
Artificial intelligence projects in healthcare: 10 practical tips for success in a clinical environment
Authors: Wilson Anthony , Saeed Haroon , Pringle Catherine , Eleftheriou Iliada , Bromiley Paul A , Brass Andy 
Published: July 2021

There is much discussion concerning ‘digital transformation’ in healthcare and the potential of artificial intelligence (AI) in healthcare systems. Yet it remains rare to find AI solutions deployed in routine healthcare settings. This is in part due to the numerous challenges inherent in delivering an AI project in a clinical environment. In this article, several UK healthcare professionals and academics reflect on the challenges they have faced in building AI solutions using routinely collected healthcare data.These personal reflections are summarised as 10 practical tips. In our experience, these are essential considerations for an AI healthcare project to succeed. They are organised into four phases: conceptualisation, data management, AI application and clinical deployment. There is a focus on conceptualisation, reflecting our view that initial set-up is vital to success. We hope that our personal experiences will provide useful insights to others looking to improve patient care through optimal data use.
Study protocol for a randomised controlled trial evaluating the clinical effect of antibiotic prophylaxis in children with recurrent respiratory tract infections: the Approach study
Authors: Peeters Daphne , van Geloven Nan , Visser Loes E , Bogaert Debby , van Rossum Annemarie M C , Driessen Gertjan J A , Verhagen Lilly M 
Published: July 2021

IntroductionRespiratory tract infections (RTIs) affect children all over the world and are associated with significant morbidity and mortality. In particular, recurrent RTIs cause a high burden of disease and lead to frequent doctor visits. Children with recurrent RTIs generally have no significant alterations or deficits in systemic immunity. In an attempt to treat the assumed bacterial component involved, they are often treated with prolonged courses of prophylactic antibiotics taken on a daily basis. Despite its common use, there is no evidence that this is beneficial. Studies assessing the clinical effectiveness of antibiotic prophylaxis as well as potential adverse effects and antibiotic resistance development, are therefore urgently needed.Methods and analysisWe present a protocol for a randomised double-blind placebo-controlled trial comparing co-trimoxazole with placebo treatment in children with recurrent RTIs. A total of 158 children (aged 6 months–10 years) with recurrent RTIs without significant comorbidity will be enrolled from a minimum of 10 Dutch hospitals. One group receives co-trimoxazole 18 mg/kg two times per day (36 mg/kg/day) and the other group receives a placebo two times per day for a period of 3 months. The main objective is to determine whether antibiotic prophylaxis is more effective than placebo to prevent/reduce respiratory symptoms in children with recurrent RTIs. Respiratory symptoms will be scored by parents on a daily basis in both study arms by the use of a mobile phone application. Our primary outcome will be the number of days with at least two respiratory symptoms during the treatment.Ethics and disseminationEthics approval was obtained from the Medical Ethics Research Committee Zuidwest Holland/LDD. A manuscript with the study results will be submitted to a peer-reviewed journal. All participants will be informed about the study results. The results of the study will inform clinical guidelines regarding the prophylactic treatment of children with recurrent RTIs.Trial registration numberNL7044.
Fidelity assessment of nurse-led non-pharmacological package of care for knee pain in the package development phase of a feasibility randomised controlled trial based in secondary care: a mixed methods study
Authors: Nomikos Polykarpos Angelos , Hall Michelle , Fuller Amy , Millar Bonnie , Ogollah Reuben , Valdes Ana , Doherty Michael , Walsh David A , das Nair Roshan , Abhishek A 
Published: July 2021

ObjectivesTo evaluate fidelity of delivery of a nurse-led non-pharmacological complex intervention for knee pain.SettingSecondary care. Single-centre study.Study designMixed methods study.ParticipantsEighteen adults with chronic knee pain.Inclusion criteriaAge >40 years, knee pain present for longer than 3 months, knee pain for most days of the previous month, at least moderate pain in two of the five domains of Western Ontario and McMaster Universities Osteoarthritis Index pain scale.InterventionsNurse-led non-pharmacological intervention comprising assessment, education, exercise, use of hot/cold treatments, footwear modification, walking aids and weight-loss advice (if required).Outcome(s)Primary: fidelity of delivery of intervention, secondary: nurses’ experience of delivering intervention.MethodsEach intervention session with every participant was video recorded and formed part of fidelity assessment. Fidelity checklists were completed by the research nurse after each session and by an independent researcher, after viewing the video-recordings blinded to nurse ratings. Fidelity scores (%), percentage agreement and 95% Confidence Intervals (CI) were calculated. Two semi-structured interviews were conducted with the research nurse.ResultsFourteen participants completed all visits. 62 treatment sessions took place. Nurse self-report and assessor video rating scores for all 62 treatment sessions were included in fidelity assessment. Overall fidelity was higher on nurse self-report (97.7%) than on objective video-rating (84.2%). Percentage agreement between nurse self-report and video-rating was 73.3% (95% CI 71.3 to 75.3). Fidelity was lowest for advice on footwear and walking aids. The nurse reported difficulty advising on thermal treatments, footwear and walking aids, and did not feel confident negotiating achievable and realistic goals with participants.ConclusionsA trained research nurse can deliver most components of a non-pharmacological intervention for knee pain to a high degree of fidelity. Future research should assess intervention fidelity in a routine clinical setting, and examine its clinical and cost-effectiveness.Trial registration numberNCT03670706.
Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review
Authors: Pandor Abdullah , Tonkins Michael , Goodacre Steve , Sworn Katie , Clowes Mark , Griffin Xavier L , Holland Mark , Hunt Beverley J , de Wit Kerstin , Horner Daniel 
Published: July 2021

IntroductionHospital-acquired thrombosis accounts for a large proportion of all venous thromboembolism (VTE), with significant morbidity and mortality. This subset of VTE can be reduced through accurate risk assessment and tailored pharmacological thromboprophylaxis. This systematic review aimed to determine the comparative accuracy of risk assessment models (RAMs) for predicting VTE in patients admitted to hospital.MethodsA systematic search was performed across five electronic databases (including MEDLINE, EMBASE and the Cochrane Library) from inception to February 2021. All primary validation studies were eligible if they examined the accuracy of a multivariable RAM (or scoring system) for predicting the risk of developing VTE in hospitalised inpatients. Two or more reviewers independently undertook study selection, data extraction and risk of bias assessments using the PROBAST (Prediction model Risk Of Bias ASsessment Tool) tool. We used narrative synthesis to summarise the findings.ResultsAmong 6355 records, we included 51 studies, comprising 24 unique validated RAMs. The majority of studies included hospital inpatients who required medical care (21 studies), were undergoing surgery (15 studies) or receiving care for trauma (4 studies). The most widely evaluated RAMs were the Caprini RAM (22 studies), Padua prediction score (16 studies), IMPROVE models (8 studies), the Geneva risk score (4 studies) and the Kucher score (4 studies). C-statistics varied markedly between studies and between models, with no one RAM performing obviously better than other models. Across all models, C-statistics were often weak (<0.7), sometimes good (0.7–0.8) and a few were excellent (>0.8). Similarly, estimates for sensitivity and specificity were highly variable. Sensitivity estimates ranged from 12.0% to 100% and specificity estimates ranged from 7.2% to 100%.ConclusionAvailable data suggest that RAMs have generally weak predictive accuracy for VTE. There is insufficient evidence and too much heterogeneity to recommend the use of any particular RAM.PROSPERO registration numberSteve Goodacre, Abdullah Pandor, Katie Sworn, Daniel Horner, Mark Clowes. A systematic review of venous thromboembolism RAMs for hospital inpatients. PROSPERO 2020 CRD42020165778. Available fromhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778
Impact of living with a bilateral central vision loss due to geographic atrophy—qualitative study
Authors: Madheswaran Gopinath , Ramesh S Ve , Pardhan Shahina , Sapkota Raju , Raman Rajiv 
Published: July 2021

ObjectiveGeographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India.Design, participants, setting and methodsA qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL.ResultsTen participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support).ConclusionGA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.
‘Gut health’ and the microbiome in the popular press: a content analysis
Authors: Marcon Alessandro R , Turvey Stuart , Caulfield Timothy 
Published: July 2021

ObjectiveExtensive research and important discoveries on the microbiome have led to a growth in media coverage. This study explores how the microbiome has been portrayed in press sources popular among American and Canadian audiences.DesignContent analysis.MethodsUsing the FACTIVA Database, we compiled a finalised data set of (N=830) articles from press sources popular among American and Canadian audiences which were published between 1 January 2018 and 11 October 2019 and which contained at least one of the following search terms: ‘microbiome’, ‘microbiota’, ‘gut health’, ‘healthy gut’, ‘unhealthy gut’, ‘gut bacteria’, ‘probiotic’ or ‘probiotics.’ We performed content analysis on the articles to determine how often ideas of the microbiome were presented as beneficial, in which health contexts, and whether actions could be taken to reap stated benefits. We compared this portrayal of benefits with critical portrayals of the microbiome.ResultsAlmost all of the articles (94%) described health benefits associated with the microbiome with many (79%) describing actions which could be taken to reap stated benefits. Articles most often described health benefits in more broad, general context (34%) and most commonly outlined actions related to food/drug (45%) as well as probiotic (27%) intake. Only some articles (19%) provided microbiome-related critiques or limitations. Some of the articles (22%) were focused on highlighting specific research developments, and in these articles, critiques or limitations were more common.ConclusionsArticles discussing the microbiome published for American and Canadian audiences typically hype the microbiome’s impact and popularise gut health trends while only offering a little in the way of communicating microbiome science. Lifestyle choices including nutrition, taking probiotics, stress management and exercise are often promoted as means of reaping the microbiome-related health benefits. The trend of actionable ‘gut health’ is foregrounded over more evidence-based descriptions of microbiome science.