bluuebunny/crossref_metadata_2025_split huggingface dataset:
Numerical and Experimental Study on the Correlation Between Wear and Transmission Error of Carbon Fiber-Reinforced Polymer Gears Cured in Autoclave
Authors: Černe Borut , Vukašinović Nikola , Bergant Zoran , Zorko Damijan 
Published: November 2023

Abstract
This study presents a comprehensive investigation of the wear properties of carbon fiber reinforced polymer (CFRP) gears manufactured by an autoclave curing process. The composite gears were mated with a 42CrMo4 steel pinion and subjected to nominal tooth bending stresses between 60–150 MPa. Infrared cameras were used to monitor temperature in real time while wear rates were measured at regular intervals. Finite element analysis was performed to investigate the in-mesh contact and root stress behavior of the gears at various loads and running times. The results showed a significant deviation from the ideal meshing and stress conditions with increasing wear. In addition, the influence of the measured wear level on the path of contact and transmission error of the gear pair was studied in detail. Since the transmission error is a critical factor affecting the NVH performance of the gear pair, it is crucial to understand the potential influence of the deviations from the ideal gear meshing conditions caused by the gear wear on this phenomenon. The study has shown that while even small levels of wear have a significant impact on transmission error, the correlation between these two characteristics is generally not linearly proportional. Similarly, wear was found to influence the actual path of meshing contact very substantially.
Impact of the COVID-19 pandemic on patients with hepatocellular carcinoma in the West of Scotland: a cohort study
Authors: McLaren Alistair Stewart , Spoor Johannes A , Cartwright Douglas , Naylor Gregory , Barclay Stephen , Priest Matthew , Puttagunta Srikanth , Armstrong Kirsty , Ballantyne Stuart , Stanley Adrian , Jeffry Evans Thomas R 
Published: November 2023

ObjectiveThe COVID-19 pandemic had an undoubted impact on the provision of elective and emergency cancer care, including the diagnosis and management of patients with hepatocellular carcinoma (HCC). Our aim was to determine the effects of the COVID-19 pandemic on patients with HCC in the West of Scotland.DesignThis was a retrospective audit of a prospectively collated database of patients presented to the West of Scotland Multidisciplinary Team (MDT) between April and October 2020 (during the pandemic), comparing baseline demographics, characteristics of disease at presentation, diagnostic workup, treatment and outcomes with patients from April to October 2019 (pre pandemic).ResultsThere was a 36.5% reduction in new cases referred to the MDT during the pandemic. Patients presented at a significantly later Barcelona Cancer Liver Clinic stage (24% stage D during the pandemic, 9.5% pre pandemic, p<0.001) and with a significantly higher Child-Pugh Score (46% Child-Pugh B/C during the pandemic vs 27% pre pandemic, p<0.001). We observed a reduction in overall survival (OS) among all patients with a median OS during the pandemic of 6 months versus 17 months pre pandemic (p=0.048).ConclusionThe impact of the COVID-19 pandemic is likely to have contributed to a reduction in the presentation of new cases and survival among patients with HCC in the West of Scotland. The reason for this is likely multifactorial, but disruption of standard care is likely to have played a significant role. Resources should be provided to address the backlog and ensure there are robust investigation and management pathways going forward.
Association between dyslipidaemia and dry eye disease: a systematic review and meta-analysis
Authors: Li Yingsi , Xie Luoying , Song Wenjing , Chen Shudi , Cheng Yu , Gao Yuan , Huang Meiting , Yan Xiaoming , Yang Songlin 
Published: November 2023

PurposeTo report a systematic review and meta-analysis of the association between dry eye disease (DED) and dyslipidaemia.MethodsPubMed, Embase, Web of Science and Cochrane Library were systematically searched from January 2000 to December 2021. We included observational studies to assess the correlation of DED with meibomian gland dysfunction and dyslipidaemia without any language restrictions. The pooled OR with 95% CI was calculated in Stata V.15.ResultsOf 6727 identified studies, 18 studies (21 databases) with a total of 2 663 126 patients were analysed in our meta-analysis. The results showed that DED risk was associated with dyslipidaemia (OR=1.53, 95% CI: 1.41 to 1.66, p=0.001), especially elevated total cholesterol levels (OR=1.57, 95% CI: 1.25 to 1.99, p<0.001), elevated low-density lipoprotein cholesterol levels (OR=1.13, 95% CI: 1.06 to 1.20, p<0.001) and high-density lipoprotein cholesterol levels (OR=1.06, 95% CI: 1.01 to 1.11, p<0.001), but not with serum triglyceride levels. Moreover, having a history of lipid-lowering drug use (OR=1.41, 95% CI: 1.19 to 1.67, p<0.001) was also found to be positively associated with DED risk.ConclusionsThe findings suggested that dyslipidaemia and lipid-lowering drug use might be associated with an increased risk of DED. More evidence is needed to confirm the findings by prospective studies.PROSPERO registration numberCRD42022296664.
Skills and competencies in health data analytics for health professionals: a scoping review protocol
Authors: Nkwanyana Akhona , Mathews Verona , Zachary Iris , Bhayani Vishwa 
Published: November 2023

IntroductionHealthcare data analytics is a methodological approach to the systematic analysis of health data, and it provides opportunities for healthcare professionals to improve health system management, patient engagement, budgeting, planning and performing evidence-based decision-making. Literature suggests that certain skills and/or competencies for health professionals working with big data in health care would be required. A review of the skills and competencies in health data analytics required by health professionals is needed to support the development or re-engineering of curriculum for health professionals to ensure they develop the abilities to make evidence-based decisions that ultimately can lead to the effective and efficient functioning of a healthcare system.MethodsUsing Arksey and O’Malley’s framework, this study will review literature published in English from January 2012 to December 2022. The database search includes Academic Search Complete, CINAHL, and MEDLINE via EBSCOhost, PubMed, Science Direct, Scopus, and Taylor and Francis. The reference lists of key studies will be searched to identify additional appropriate studies to include. The review will be conducted using an inclusion and exclusion criteria. Iterative processes will be involved at the various stages of search strategy piloting, screening and data extraction. Articles will be reviewed through a two-step process (title and abstract, and full-text review) by at least two reviewers. Data will be described quantitatively and/or qualitatively and presented in diagrams and tables.Ethics and disseminationEthical clearance has been received, and strict protocol measures will be followed to ensure the data reported is of quality and relevant to the review purpose. The results will be disseminated through a peer-reviewed scientific journal, presentation at national and/or international conferences, and other platforms such as social media (eg, LinkedIn, Twitter), and relevant stakeholders.
Clinical Observation, Management and Function Of low back pain Relief Therapies (COMFORT): A cluster randomised controlled trial protocol
Authors: Abdel Shaheed Christina , Ivers Rowena , Vizza Lisa , McLachlan Andrew , Kelly Patrick J , Blyth Fiona , Stanaway Fiona , Clare Philip James , Thompson Rachel , Lung Thomas , Degenhardt Louisa , Reid Sharon , Martin Bradley , Wright Michael , Osman Rawa , French Simon , McCaffery Kirsten , Campbell Gabrielle , Jenkins Hazel , Mathieson Stephanie , Boogs Monika , McMaugh Jarrod , Bennett Carol , Maher Christopher 
Published: November 2023

IntroductionLow back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help them implement the guidelines. This trial will evaluate a multifaceted intervention to support general practitioners (GPs) and their patients with LBP implement the recommendations in the latest opioid prescribing guidelines.Methods and analysisThis is a cluster randomised controlled trial that will evaluate the effect of educational outreach visits to GPs promoting opioid stewardship alongside non-pharmacological interventions including heat wrap and patient education about the possible harms and benefits of opioids, on GP prescribing of opioids medicines dispensed. At least 40 general practices will be randomised in a 1:1 ratio to either the intervention or control (no outreach visits; GP provides usual care). A total of 410 patient–participants (205 in each arm) who have been prescribed an opioid for LBP will be enrolled via participating general practices. Follow-up of patient–participants will occur over a 1-year period. The primary outcome will be the cumulative dose of opioid dispensed that was prescribed by study GPs over 1 year from the enrolment visit (in morphine milligram equivalent dose). Secondary outcomes include prescription of opioid medicines, benzodiazepines, gabapentinoids, non-steroidal anti-inflammatory drugs by study GPs or any GP, health services utilisation and patient-reported outcomes such as pain, quality of life and adverse events. Analysis will be by intention to treat, with a health economics analysis also planned.Ethics and disseminationThe trial received ethics approval from The University of Sydney Human Research Ethics Committee (2022/511). The results will be disseminated via publications in journals, media and conference presentations.Trial registration numberACTRN12622001505796.
Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper
Authors: Er Ying Ting , Chan Yoke Mun , Mohd Shariff Zalilah , Abdul Hamid Habibah , Mat Daud Zulfitri 'Azuan , Yong Heng Yaw 
Published: November 2023

IntroductionNutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers.Methods and analysisA total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents’ personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups.Ethics and disseminationEthical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research.Trial registration numberClinicaltrial.gov ID:NCT05377151.
Perceived value and benefits of the Community Paramedicine at Clinic (CP@clinic) programme: a descriptive qualitative study
Authors: Marzanek Francine , Nair Kalpana , Ziesmann Andrea , Paramalingam Aarani , Pirrie Melissa , Angeles Ricardo , Agarwal Gina 
Published: November 2023

ObjectivesCommunity Paramedicine (CP) is increasingly being used to provide chronic disease management for vulnerable populations in the community. CP@clinic took place in social housing buildings to support cardiovascular health and diabetes management for older adults. The purpose of this study was to examine participant perceptions of their experience with CP@clinic as well as potential ongoing programme benefits.DesignThis descriptive qualitative study used focus groups to understand resident experiences of the CP@clinic programme. Groups were facilitated by experienced moderators using a semistructured guide. An inductive coding approach was used with at least two researchers taking part in each step of the analysis process.SettingCommunity-based social housing buildings in Ontario, Canada.ParticipantsForty-one participants from four CP@clinic sites took part in a focus group. Convenience sampling was used with anyone having taken part in a CP@clinic session being eligible to attend the focus group.ResultsAnalysis yielded six themes across two broad areas: timely access to health information and services, support to achieve personal health goals, better understanding of healthcare system (Personal Benefits); and sense of community, comfortable and familiar place to talk about health, facilitated communication between healthcare professionals (Programme Structure). Participants experienced discernible health changes that motivated their participation. CP@clinic was viewed as a programme that created connections within the building and outside of it. Participants were enthusiastic for the continuation of the programme and appreciated the consistent support to meet their health goals.ConclusionsCP@clinic was successful in creating a supportive and friendly environment to facilitate health behavioural changes. Ongoing implementation of CP@clinic would allow residents to continue to build their chronic disease management knowledge and skills.Trial registration numberTrial registration number:NCT02152891, Clinicaltrials.gov.
Nurses’ experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities
Authors: Moore Angelena , Knutsen Glette Malin 
Published: November 2023

ObjectivesThis study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses’ experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients.DesignAn explorative qualitative study.SettingThe study was conducted at three out-of-hours primary care facilities in southwest Norway.ParticipantsA total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study.ResultsThe analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses’ health; nurses’ awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism.ConclusionPresenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.
Early 6 months usage of single anTiplAtelet OR anTicoAgulant followed by single antiplatelet after transcatheter aortic valve replacement: protocol for a multicentre, open-label, randomised controlled clinical trial
Authors: Hu Xiangming , Xu Haiyan , Wang Can , Wang Yang , Wang Yan , Zhou Daxin , Zhu Qifeng , Xu Kai , Yang Jian , Zhang Haibo , Jiang Nan , Zhang Junjie , Fang Zhenfei , Fu Guosheng , Guo Yingqiang , Li Yi , Wang Moyang , Feng Dejing , Niu Guannan , Zhang Erli , Chen Yang , Ye Yunqing , Wu Yongjian 
Published: November 2023

IntroductionThe strategy for initiating antithrombotic therapy to prevent bioprosthetic valve thrombosis (BPVT) after transcatheter aortic valve replacement (TAVR) remains uncertain. There is still lacking evidence on the efficacy and safety of early 6 months usage of single-antiplatelet therapy (SAPT) or oral anticoagulant (OAC) after TAVR in patients without anticoagulant indications.Methods and analysisThis is a multicentre, randomised controlled, open-label trial, and 650 patients undergoing TAVR from 13 top TAVR centres in China will be recruited. Each eligible participant will be randomly assigned to two groups (1:1 ratio) as (1) SAPT (aspirin 75–100 mg for 6 months) group or (2) OAC group (warfarin, therapeutic international normalised ratio at 1.8–2.5 for 6 months), both followed by sequential aspirin 75–100 mg for 6 months. Participants in both groups will be invited for three follow-up visits of 1, 6 and 12 months after discharge. We will use both the net clinical benefit endpoint (composite of all-cause mortality, myocardial infarction, stroke/transient ischaemic attacks, peripheral artery thrombosis, intracardiac thrombosis and major bleeding and disabling or life-threatening bleeding) and the BPVT endpoint evaluated by four-dimensional CT as our primary endpoints. P value of <0.05 of two-sided test will be considered statistically significant.Ethics and disseminationThe present study was approved by the Institutional Review Boards at Fuwai Hospital, National Center for Cardiovascular Diseases of China (Approval No. 2023-1947). All patients will be informed of the details of the study and will sign an informed consent prior to inclusion in the study. Results of this study will be published in a peer-reviewed journal.Trial registration numberNCT05375474.
Impact of consensus molecular subtypes on survival with and without adjuvant chemotherapy in muscle-invasive urothelial bladder cancer
Authors: Koll Florestan J , Döring Claudia , Herwig Leon , Hoeh Benedikt , Wenzel Mike , Cano Garcia Cristina , Banek Severine , Kluth Luis , Köllermann Jens , Weigert Andreas , Chun Felix K-H , Wild Peter , Reis Henning 
Published: November 2023

AimsAdjuvant chemotherapy after radical cystectomy can reduce the risk of recurrence and death in advanced muscle-invasive urothelial bladder cancer (MIBC). Molecular subtypes have been shown to be associated with survival. However, their predictive value to guide treatment decisions is controversial and data to use subtypes as guidance for adjuvant chemotherapy is sparse. We aimed to assess survival rates based on MIBC consensus molecular subtypes with and without adjuvant chemotherapy.MethodsGene expression profiles of 143 patients with MIBC undergoing radical cystectomy were determined from formalin-fixed, paraffin-embedded specimen to assign consensus molecular subtypes. Expression of programmed cell death ligand-1 (PD-L1) and immune cell infiltration were determined using multiplex immunofluorescence. Matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy on overall survival (OS) for molecular subtypes applying Kaplan-Meier and Cox regression survival analyses.ResultsSamples were luminal papillary: 9.1% (n=13), luminal non-specified: 6.3% (n=9), luminal unstable: 4.9% (n=7), stroma-rich: 27.9% (n=40), basal/squamous (Ba/Sq): 48.9% (n=70) and neuroendocrine-like (NE-like): 2.8% (n=4). Ba/Sq tumours had the highest concentration of PD-L1+ tumour and immune cells. Patients with luminal subtypes had better OS than those with NE-like (HR 0.2, 95% CI 0.1 to 0.7, p<0.05) and Ba/Sq (HR 0.5, 95% CI 0.2 to 0.9, p<0.05). No survival benefit with adjuvant chemotherapy was observed for luminal tumours, whereas Ba/Sq had significantly improved survival rates with adjuvant chemotherapy. Retrospective design and sample size are the main limitations.ConclusionConsensus molecular subtypes can be used to stratify patients with MIBC. Luminal tumours have the best prognosis and less benefit when receiving adjuvant chemotherapy compared with Ba/Sq tumours.
Polycomb repressor complex 2 suppresses interferon-responsive MHC-II expression in melanoma cells and is associated with anti-PD-1 resistance
Authors: James Jamaal L , Taylor Brandie C , Axelrod Margaret L , Sun Xiaopeng , Guerin Lindsey N , Gonzalez-Ericsson Paula I , Wang Yu , Sanchez Violeta , Fahey Catherine C , Sanders Melinda E , Xu Yaomin , Hodges Emily , Johnson Douglas B , Balko Justin M 
Published: November 2023

BackgroundDespite the remarkable success of immunotherapy in treating melanoma, understanding of the underlying mechanisms of resistance remains limited. Emerging evidence suggests that upregulation of tumor-specific major histocompatibility complex-II (tsMHC-II) serves as a predictive marker for the response to anti-programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) therapy in various cancer types. The genetic and epigenetic pathways modulating tsMHC-II expression remain incompletely characterized. Here, we provide evidence that polycomb repressive complex 2 (PRC2)/EZH2 signaling and resulting H3K27 hypermethylation suppresses tsMHC-II.MethodsRNA sequencing data from tumor biopsies from patients with cutaneous melanoma treated with or without anti-PD-1, targeted inhibition assays, and assays for transposase-accessible chromatin with sequencing were used to observe the relationship between EZH2 inhibition and interferon (IFN)-γ inducibility within the MHC-II pathway.ResultsWe find that increased EZH2 pathway messenger RNA (mRNA) expression correlates with reduced mRNA expression of both presentation and T-cell genes. Notably, targeted inhibition assays revealed that inhibition of EZH2 influences the expression dynamics and inducibility of the MHC-II pathway following IFN-γ stimulation. Additionally, our analysis of patients with metastatic melanoma revealed a significant inverse association between PRC2-related gene expression and response to anti-PD-1 therapy.ConclusionsCollectively, our findings demonstrate that EZH2 inhibition leads to enhanced MHC-II expression potentially resulting from improved chromatin accessibility atCIITA, the master regulator of MHC-II. These insights shed light on the molecular mechanisms involved in tsMHC-II suppression and highlight the potential of targeting EZH2 as a therapeutic strategy to improve immunotherapy efficacy.