bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent Engineering of Toothed Bodies for Generalized Function Transmission
Authors: Dooner David B. , Seireg Ali A. 
Published: February 2021

Abstract
This paper presents a novel interactive computerized approach for the integrated design and manufacture of different types of toothed bodies based on mathematical derivations from theories of kinematic geometry. An important feature of the developed methodology is that the design and manufacturing data for the toothed bodies which satisfy specified functional requirements and the corresponding cutters used to produce them are synthesized concurrently. The procedure is applicable to any case of conventional or non-conventional gearing as well as transmission function and is particularly useful for the design and manufacture of skew axis gearing. An example of a hypoidal gear pair and the cutters used to produce them are presented to illustrate features of the developed methodology and interactive software.
Profile Modifications for Minimum Static Transmission Error in Cylindrical Gears
Authors: Regalado Isaias , Houser Donald R. 
Published: February 2021

Abstract
The theoretical advantage of conjugate action in involute gears is lost due to the deflection of the teeth under load and due to manufacturing and assembling errors. These factors produce instantaneous variations in the gear ratio commonly referred to as transmission error. The transmission error has been proven to have a strong relationship with the noise emitted by the transmission. In order to reduce the transmission error, the contacting surfaces of the gears are modified to compensate for the deflections and errors. These modifications may be performed in the direction of the profile, the lead or in a more general sense it may be topographical (defined point by point). This paper describes a non-iterative procedure for the calculation of the modifications for minimum transmission error based on a predefined load distribution. The results presented agree with the common practice for spur gears of tip relief in the direction of the profile and crowning in the direction of the lead, but for helical gears the need for a more complicated modification is observed.
Making the Grade: An Exploration of Incline Running on a Bodyweight-Supportive Treadmill
Authors: Wagner Megan , Dames Kevin D. 
Published: February 2021

Context: Bodyweight-supporting treadmills are popular rehabilitation tools for athletes recovering from impact-related injuries because they reduce ground reaction forces during running. However, the overall metabolic demand of a given running speed is also reduced, meaning athletes who return to competition after using such a device in rehabilitation may not be as fit as they had been prior to their injury. Objective: To explore the metabolic effects of adding incline during bodyweight-supported treadmill running. Design: Cross-sectional. Setting: Research laboratory. Participants: Fourteen apparently healthy, recreational runners (6 females and 8 males; 21 [3] y, 1.71 [0.08] m, 63.11 [6.86] kg). Interventions: The participants performed steady-state running trials on a bodyweight-supporting treadmill at 8.5 mph. The control condition was no incline and no bodyweight support. All experimental conditions were at 30% bodyweight support. The participants began the sequence of experimental conditions at 0% incline; this increased to 1%, and from there on, 2% incline increases were introduced until a 15% grade was reached. Repeated-measures analysis of variance was used to compare all bodyweight-support conditions against the control condition. Main Outcome Measures: Oxygen consumption, heart rate, and rating of perceived exertion. Results: Level running with 30% bodyweight support reduced oxygen consumption by 21.6% (P < .001) and heart rate by 12.0% (P < .001) compared with the control. Each 2% increase in incline with bodyweight support increased oxygen consumption by 6.4% and heart rate by 3.2% on average. A 7% incline elicited similar physiological measures as the unsupported, level condition. However, the perceived intensity of this incline with bodyweight support was greater than the unsupported condition (P < .001). Conclusions: Athletes can maintain training intensity while running on a bodyweight-supporting treadmill by introducing incline. Rehabilitation programs should rely on quantitative rather than qualitative data to drive exercise prescription in this modality.
Searching for the true attrition rate of UK paediatric trainees
Authors: Redman Melody Grace , Carzedda Davide , Jay Nicola , Clark Simon J , Rogers Marie 
Published: February 2021

ObjectiveTo quantitatively analyse the number of doctors leaving the paediatric specialty training (ST) programme in the UK, to assist with evidence-based workforce planning.DesignData were sought on those leaving the UK paediatrics training programme between 2014 and 2019 from Heads of Schools of Paediatrics and Freedom of Information Act requests.SettingRetrospective data analysis.Outcome measuresOverall attrition rate, attrition rate across level of training, attrition rate across geographical area, recorded reason for leaving.ResultsAll results must be interpreted with caution due to limitations in record keeping and analysis. The annual attrition rate across all ST levels between 2014 and 2019 is estimated at 3.7%–4.2% (ie, 749–845 trainees may have left the paediatric training programme over 2014–2019). No reason for leaving was recorded for three-quarters of individuals, around 630 doctors. Of those leaving paediatrics, significantly more (χ², p=0.015) did so at ST3 (20.3%) versus the next highest training year, ST2 (13.6%).ConclusionsThis project seems to demonstrate worryingly poor record-keeping of the true attrition rate of paediatric trainees by organisations responsible for workforce planning, including Health Education England, the Royal College of Paediatrics and Child Health and individual paediatric schools across the UK. To allow evidence-based workforce planning for the benefit of UK children, it is vital that accurate records on trainees who leave the training programme are kept and shared across the UK.
Investigating the feasibility and acceptability of the HOLOBalance system compared with standard care in older adults at risk for falls: study protocol for an assessor blinded pilot randomised controlled study
Authors: Liston Matthew , Genna Gregory , Maurer Christoph , Kikidis Dimitris , Gatsios Dimitris , Fotiadis Dimitris , Bamiou Doris-Eva , Pavlou Marousa 
Published: February 2021

IntroductionApproximately one in three of all older adults fall each year, with wide ranging physical, psychosocial and healthcare-related consequences. Exercise-based interventions are the cornerstone for falls prevention programmes, yet these are not consistently provided, do not routinely address all components of the balance system and are often not well attended. The HOLOBalance system provides an evidence-based balance training programme delivered to patients in their home environment using a novel technological approach including an augmented reality virtual physiotherapist, exergames and a remote monitoring system. The aims of this proof-of-concept study are to (1) determine the safety, acceptability and feasibility of providing HOLOBalance to community dwelling older adults at risk for falls and (2) provide data to support sample size estimates for a future trial.MethodsA single (assessor) blinded pilot randomised controlled proof of concept study. 120 participants will be randomised to receive an 8-week home exercise programme consisting of either: (1) HOLOBalance or (2) The OTAGO Home Exercise Programme. Participants will be required to complete their exercise programme independently under the supervision of a physiotherapist. Participants will have weekly telephone contact with their physiotherapist, and will receive home visits at weeks 0, 3 and 6. Outcome measures of safety, acceptability and feasibility, clinical measures of balance function, disability, balance confidence and cognitive function will be assessed before and immediately after the 8 week intervention. Acceptability and feasibility will be explored using descriptive statistics, and trends for effectiveness will be explored using general linear model analysis of variance.Ethics and disseminationThis study has received institutional ethical approvals in Germany (reference: 265/19), Greece (reference: 9769/24-6-2019) and the UK (reference: 19/LO/1908). Findings from this study will be submitted for peer-reviewed publications.Trial registration numberNCT04053829.Protocol versionV.2, 20 January 2020
Assessing the efficacy, safety and utility of closed-loop insulin delivery compared with sensor-augmented pump therapy in very young children with type 1 diabetes (KidsAP02 study): an open-label, multicentre, multinational, randomised cross-over study protocol
Authors: Fuchs Julia , Allen Janet M , Boughton Charlotte K , Wilinska Malgorzata E , Thankamony Ajay , de Beaufort Carine , Campbell Fiona , Yong James , Froehlich-Reiterer Elke , Mader Julia K , Hofer Sabine E , Kapellen Thomas M , Rami-Merhar Birgit , Tauschmann Martin , Hood Korey , Kimbell Barbara , Lawton Julia , Roze Stephane , Sibayan Judy , Cohen Nathan , Hovorka Roman 
Published: February 2021

IntroductionDiabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group.Methods and analysisThe study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1–7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1–4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants’ and caregivers’ experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed.Ethics and disseminationEthics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d’Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations.Trial registration numberNCT03784027.
Development and evaluation of a decision aid for family surrogate decision-makers for patients with acute kidney injury requiring renal replacement therapy (RRT) in ICUs: a study protocol
Authors: Zheng Miao , Yin Changlin , Cao Ying , Zhang Yonghui , Zhang Kuoliang , Zhang Xiaoqin , Bian Wei , Wang Lihua 
Published: February 2021

IntroductionShared decision making is endorsed by guidelines for both acute kidney injury and critical care medicine. However, there is still a huge need for effective interventions, especially those focusing on decisions about renal replacement therapy for intensive care unit (ICU) patients with acute kidney injury. The decision aids provide evidence-based support for shared decision making, to achieve better decisions through enhanced knowledge of treatment options and treatment aligns with patients’ preferences and values. Therefore, our objectives are to develop and evaluate a decision aid systematically and rigorously for family surrogate decision makers of ICU patients with acute kidney injury who need renal replacement therapy.Methods and analysisWe will use a systematic development process that focuses on user-centred design to develop and evaluate the decision aid in three phases: (1) development of a draft prototype for the decision aid based on extensive literature reviews, interviews with key stakeholders and evidence synthesis; (2) alpha testing (‘near live’ usability) the decision aid during simulated clinical encounters to test its comprehensibility, acceptability and usability and (3) beta testing (‘live’ usability) to examine the aid’s clinical feasibility. User testing will be conducted using mixed-methods approach to support iterative revision of the decision aid. The IPDASi (V.4.0) will be used for following qualitative assessment. All interviews will be analysed by Colaizzi’s seven-step approach to qualitative analysis. The coding scheme will use to analyse user interactions. Questionnaire surveys will be analysed using paired sample t-tests when related to the before-and-after survey, otherwise using one-sample t-test.Ethics and disseminationEthical approval for this research was obtained from the Ethics Committee of the First Affiliated Hospital of Army Medical University, PLA (Ref: KY2020104). All participants will sign a formal informed consent form. The findings will be published in peer-reviewed journals and reported in appropriate meetings.Trial registration numberChiCTR2000031613.
Retrospective cohort study evaluating clinical, biochemical and pharmacological prognostic factors for prostate cancer progression using primary care data
Authors: Merriel Samuel William David , Ingle Suzanne Marie , May Margaret T , Martin Richard M 
Published: February 2021

ObjectivesTo confirm the association of previously reported prognostic factors with future progression of localised prostate cancer using primary care data and identify new potential prognostic factors for further assessment in prognostic model development and validation.DesignRetrospective cohort study, employing Cox proportional hazards regression controlling for age, prostate specific antigen (PSA), and Gleason score, was stratified by diagnostic stage.SettingPrimary care in England.ParticipantsMales with localised prostate cancer diagnosedbetween 01/01/1987 and 31/12/2016 within the Clinical Practice ResearchDatalink database, with linked data from the National Cancer Registration andAnalysis Service and Office for National Statistics.Primary and secondary outcomesPrimary outcome measure was prostate cancer mortality. Secondary outcome measures were all-cause mortality and commencing systemic therapy. Up-staging after diagnosis was not used as a secondary outcome owing to significant missing data.Results10 901 men (mean age 74.38±9.03 years) with localised prostate cancer were followed up for a mean of 14.12 (±6.36) years. 2331 (21.38%) men underwent systemic therapy and 3450 (31.65%) died, including 1250 (11.47%) from prostate cancer. Factors associated with an increased risk of prostate cancer mortality included age; high PSA; current or ex-smoker; ischaemic heart disease; high C reactive protein; high ferritin; low haemoglobin; high blood glucose and low albumin.ConclusionsThis study identified several new potential prognostic factors for prostate cancer progression, as well as confirming some known prognostic factors, in an independent primary care data set. Further research is needed to develop and validate a prognostic model for prostate cancer progression.
Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL
Authors: Robert René , Frasca Denis , Badin Julie , Girault C , Guitton Christophe , Djibre Michel , Beuret Pascal , Reignier Jean , Benzekri-Llefevre Dalila , Demiri Suela , Rahmani Hassène , Argaud Laurent Argaud , I"her Erwan , Ehrmann Stephan , Lesieur Olivier , Kuteifan Khaldoune , Thouy Francois , Federici Laura , Thevenin Didier , Contou Damien , Terzi Nicolas , Nseir Saad , Thyrault Martial , Vinsonneau Christophe , Audibert Juliette , Masse Juliette , Boyer Alexandre , Guidet Bertrand , Chelha Riad , Quenot Jean-Pierre , Piton G , Aissaoui Nadia , Thille Arnaud W , Frat Jean-Pierre 
Published: February 2021

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631
Exacerbation of visual hallucinations in Charles Bonnet syndrome due to the social implications of COVID-19
Authors: Jones Lee , Ditzel-Finn Lara , Potts Judith , Moosajee Mariya 
Published: February 2021

ObjectiveCharles Bonnet syndrome (CBS) occurs secondary to sight loss, characterised by spontaneous visual hallucinations. Symptom manifestation can be influenced by social isolation. This research aims to evaluate the effect of the COVID-19 pandemic lockdown on patients with CBS.Methods and analysisA prospective cross-sectional survey of 45 individuals with active CBS. Open and closed ended questions were used to measure patient-reported features of hallucinatory experiences during the COVID-19 lockdown and perceived episode triggers. Analysis comprised of descriptive statistics, analysis of variance and associations, supplemented with qualitative descriptions.ResultsThe survey was operational for 31 days during the COVID-19 pandemic (June–July 2020). The mean (±SD) age of respondents was 69.3 (±18) years and the majority (42.2%) had macular disease. Loneliness during the lockdown was associated with changes in the nature of visual hallucinations (p=0.04). Individuals experiencing greater loneliness were, on average, older than those with no changes to their feelings of loneliness (mean age 73.3±17 vs 60.2±19 years; p=0.03). Despite experiencing greater feelings of loneliness (67%), most individuals (60%) had not accessed support services for this reason.ConclusionsAround half of respondents in this survey experienced exacerbation of visual hallucinations during the COVID-19 pandemic, which may partly be explained by loneliness and/or environmental triggers. We provide suggestions to promote effective patient self-management of symptoms.
Intratumoral virotherapy with 4-1BBL armed modified vaccinia Ankara eradicates solid tumors and promotes protective immune memory
Authors: Hinterberger Maria , Giessel Raphael , Fiore Giovanna , Graebnitz Fabienne , Bathke Barbara , Wennier Sonia , Chaplin Paul , Melero Ignacio , Suter Mark , Lauterbach Henning , Berraondo Pedro , Hochrein Hubertus , Medina-Echeverz José 
Published: February 2021

BackgroundHuman cancers are extraordinarily heterogeneous in terms of tumor antigen expression, immune infiltration and composition. A common feature, however, is the host′s inability to mount potent immune responses that prevent tumor growth effectively. Often, naturally primed CD8+T cells against solid tumors lack adequate stimulation and efficient tumor tissue penetration due to an immune hostile tumor microenvironment.MethodsTo address these shortcomings, we cloned tumor-associated antigens (TAA) and the immune-stimulatory ligand 4-1BBL into the genome of modified vaccinia Ankara (MVA) for intratumoral virotherapy.ResultsLocal treatment with MVA-TAA-4-1BBL resulted in control of established tumors. Intratumoral injection of MVA localized mainly to the tumor with minimal leakage to the tumor-draining lymph node. In situ infection by MVA-TAA-4-1BBL triggered profound changes in the tumor microenvironment, including the induction of multiple proinflammatory molecules and immunogenic cell death. These changes led to the reactivation and expansion of antigen-experienced, tumor-specific cytotoxic CD8+T cells that were essential for the therapeutic antitumor effect. Strikingly, we report the induction of a systemic antitumor immune response including tumor antigen spread by local MVA-TAA-4-1BBL treatment which controlled tumor growth at distant, untreated lesions and protected against local and systemic tumor rechallenge. In all cases, 4-1BBL adjuvanted MVA was superior to MVA.ConclusionIntratumoral 4-1BBL-armed MVA immunotherapy induced a profound reactivation and expansion of potent tumor-specific CD8+T cells as well as favorable proinflammatory changes in the tumor microenvironment, leading to elimination of tumors and protective immunological memory.