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Abstract Background Private small-sized care homes (

The meshing mechanical characteristics of crown gear pairs have an important impact on the bearing capacity and transmission performance of crown gear coupling. Based on the conventional crown gear pair structure, a late-model of crown gear pairs with transition gear sleeves is proposed, the meshing mechanical characteristics of crown gear pair are analyzed, and the influence of different inclination angles on the meshing mechanical characteristics of crown gear pairs is discussed. The results show that the maximum equivalent stress and strain of the conventional crown gear pair occurs on the internal gear shaft sleeve, and the maximum equivalent stress and strain of the new crown gear pair occurs on the transition gear sleeve; compared with the conventional gear pair system, the maximum equivalent stress in the new gear pair system is reduced by 32.12%, and the maximum equivalent strain is reduced by 21.4%. The stress concentration of the external gear shaft sleeve of the conventional gear pair occurs at the tooth root, and the stress concentration of the external gear shaft sleeve of the new gear pair occurs at the middle bulge position； compared with the conventional gear pair, the maximum equivalent stress of the external gear sleeve in the new gear pair is reduced by 15.75%. With the increase of the inclination angle between shafts, the maximum equivalent stress and strain in the conventional gear pair increase, while the equivalent stress and strain of the external gear sleeve in the new gear pair is partially transferred to the transition gear sleeve. Therefore, the external gear shaft sleeve in the new structure can still maintain a lower equivalent stress under a larger inclination angle, which can effectively protect the expensive external gear shaft sleeve.

BackgroundMedical distrust in patients has been related with poor compliance to medications and suboptimal clinical outcomes. Effective interventions may improve medical distrust in patients which is warranted specific studies.ObjectiveTo evaluate the effect of health literacy and exercise interventions on medical mistrust in patients with type 2 diabetes (T2DM) .MethodsThis study was based on a cluster randomized-controlled trial conducted during February 2015 to March 2016. A total of 800 T2DM patients were recruited from four community health service centers in Minhang and Changning Districts of Shanghai by using a multi-stage sampling method. All patients were randomly divided into the control group and 3 intervention groups in the community. Routine care was provided to all the patients, and on this basis, health literacy intervention, exercise intervention and health literacy + exercise intervention (comprehensive intervention) were performed to the three intervention groups based on partnership to improve diabetes education (PRIDE) toolkit, respectively. Information was collected using the Chinese versions of Health Literacy Management Scale (c-HeLMS) , the 5-item Diabetes Numeracy Test Scale (c-DNT-5) , and Medical Mistrust Index (c-MMI) at baseline, 3-, 6-, 12- (end of intervention) and 24-months follow-up (post-intervention) . The generalized estimating equation was used to evaluate the effect of the interventions at each time point.ResultsA total of 780 patients were recruited in this study. The c-MMI was a reliable and valid scale to measure medical mistrust in our subjects, with Cronbach's α of 0.826. The median score and interquartile range of c-MMI was 31 (7) at baseline while the rate of medical mistrust (scores≥30) was 65.9% (514/780) , both of which decreased at almost each follow-up survey in four groups. Compared with the control group, a lower risk of medical mistrust was observed at the 3-months〔OR (95%CI) =0.42 (0.23, 0.78) 〕 and 6-months of follow-up〔OR (95%CI) =0.46 (0.24, 0.88) 〕 for the health literacy group, at the 6-months〔OR (95%CI) =0.50 (0.25, 0.99) 〕, 12-months〔OR (95%CI) =0.43 (0.22, 0.86) 〕 and 24-months of follow-up〔OR (95%CI) =0.37 (0.19, 0.72) 〕 for the exercise group, and at the 6-months〔OR (95%CI) =0.30 (0.16, 0.56) 〕 for the comprehensive group.ConclusionBoth health literacy and exercise intervention may effectively decrease the scores of c-MMI and reduce the risk of medical mistrust in diabetes patients.

ObjectiveTo investigate the prevalence and risk factors of injury among both primary and middle school students in Changning District， Shanghai， and to provide evidence for injury prevention.MethodsIn 2018， data of basic characteristics and injury-related factors were obtained through field questionnaire survey among the selected primary and middle schools （2 of each）.ResultsThe study finally included 1 821 students， with injury incidence rate of 30.1%. Among them， the injury incidence rate for the primary schools was 32.0%， and 28.8% for the middle schools. The top three injury types were falls， sharps injuries， and blunt injuries. Age， gender， myopia， and injury-related knowledge/behaviors were significantly related to injury incidence.ConclusionFalls should still be the priority of injury prevention for primary/middle school students in Changning District. The effect of reducing injuries can be achieved by improving health education about injury-related knowledge/behaviors.

Objective To analyze the secular trends of pancreatic cancer incidence and mortality in Changning district of Shanghai from 1974 to 2013. Methods We calculated the age-standardized rates of incidence and mortality and the average annual percent changes for pancreatic cancer using Segi's world standard population and the data from Shanghai Cancer Registry. Age-period-cohort model was constructed to further assess the effect of age, diagnosis period and birth cohort on the secular trends of pancreatic cancer incidence and mortality. Results During 1974-2013, the age-standardized incidence and mortality rates were 6.49/105 and 6.01/105 in male, 4.83/105 and 4.57/105 in female, respectively. The age-standardized incidence was increased by 0.8% per year in male during past 40 years, while there was no change in mortality. The age-standardized incidence and mortality rates were increased by 1.6% and 1.3% per year in female. After adjusting the effects of diagnosis period and birth cohort, the incidence and mortality rates of pancreatic cancer increased by about 11% every 5 years older in both male and female. Diagnosis period and birth cohort had no statistical impact on the incidence and mortality of pancreatic cancer. Conclusion The age-standardized incidence of pancreatic cancer shows significantly rising trends during 1974-2013 in both male and female in Changning district of Shanghai, as well as the age-standardized mortality in female. The incidence and mortality rates also increase with age.

Despite a growing number of research on the impact of open CEOs on organisational outcomes, their role in shaping corporate innovation strategies has received little scholarly attention. This paper uses a large sample of panel data from Chinese knowledge-intensive high-tech listed companies to investigate how CEOs affect innovation ambidexterity when they possess open tendencies, and how managerial discretion, influenced by firm and environment-level factors, affects such relationship. The results show that open CEOs exhibit attributes of broad interests, divergent thinking, and creativity that positively affect innovation ambidexterity, and this relationship tends to be stronger when working context give them greater managerial discretion. Specifically, state ownership has a negative moderating effect, while the intensity of market competition enhances the positive relationship between CEO openness and innovation ambidexterity, and simultaneously mitigates the negative effect of state ownership. By examining the impact of this important CEO personality trait on corporate innovation strategies, we extend the literature on the upper echelon theory (UET) and ambidextrous innovation (AI), which is also a response to emphasising that more attention should be paid to the micro-foundation of organisational innovation in the future. [ABSTRACT FROM AUTHOR]

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