bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement of fluid balance monitoring through education and rationalisation
Authors: Vincent Masaki , Mahendiran Thabo 
Published: December 2015

AbstractFluid input/output charts in hospital inpatients are a valuable source of information for doctors reviewing intravenous fluid prescription, but are notorious for being incomplete and inaccurate. Lack of awareness of the importance of fluid balance amongst nursing staff and an excess of unnecessary monitoring are two factors contributing to the problem. We conducted a quality improvement project on the respiratory ward in a large district general hospital aiming to specifically address these two factors. Pre-intervention audit showed that only 53% of input/output monitoring was clinically indicated, with an average chart completion of 50%. Using e-Learning and verbal presentation to raise awareness around fluid balance, we implemented a new system whereby daily medical review of charts lead to rationalisation of monitoring. Post-intervention audit showed a 93% reduction in unnecessary monitoring, with corresponding increases in completion (40%) and accuracy (48%) of remaining charts. In conclusion, education has enabled a culture change on the ward that has drastically increased the quality of fluid balance monitoring.
Using visual prompts to aid analgesia prescribing
Authors: Ryland Kathryn 
Published: December 2015

AbstractAnalgesia prescribing is fundamental to a patient's journey, affecting length of stay and patient experience. Laminated prompts are used throughout the NHS Foundation Trust to aid doctors prescribing.A baseline questionnaire was carried out to gather doctors' prescribing habits and current ability to convert opioids to their morphine equivalent. Ninety three percent of doctors said they were moderately to extremely confident when prescribing analgesia. However, when asked to carry out a simple opioid conversion only 14% answered correctly. Eighty three percent of doctors said they were prescribing laxatives alongside opioids frequently (57%) or almost all the time (25%). When actual rates were sampled only 14% of patients were prescribed a concurrent laxative.Laminated pain management guideline cards were created and distributed to doctors at sign in for weekly teaching.Doctor interviews were carried out to see if they were in possession of a prompt card and a simple opioid conversion question was asked. If they did not have a prompt card at the time of interview they were issued with one after answering the conversion question. Rates of concurrent laxative prescribing were collected from the electronic prescribing record of patients on the acute medical unit. Posters were displayed in doctors' offices and drug rooms. Laxative prescribing rates were re-collected and compared with the survey responses.Distribution of laminated prompts increased accuracy of opioid conversion by 86%. Error rates fell as prompt prevalence increased until there was 100% prevalence and 0% error. Concurrent prescribing of laxatives increased to 50% after posters were displayed around the acute medical unit.Doctors reported they were confident when prescribing analgesia. They reported that they often prescribed concurrent medications, however this did not relate to actual prescribing practices. Visual prompts improved doctors analgesia conversion knowledge and prescribing practices.Laminated prompt cards are now incorporated in new doctors' induction packs.
Cancer incidence and survival in Lynch syndrome patients receiving colonoscopic and gynaecological surveillance: first report from the prospective Lynch syndrome database
Authors: Møller Pål , Seppälä Toni , Bernstein Inge , Holinski-Feder Elke , Sala Paola , Evans D Gareth , Lindblom Annika , Macrae Finlay , Blanco Ignacio , Sijmons Rolf , Jeffries Jacqueline , Vasen Hans , Burn John , Nakken Sigve , Hovig Eivind , Rødland Einar Andreas , Tharmaratnam Kukatharmini , de Vos tot Nederveen Cappel Wouter H , Hill James , Wijnen Juul , Green Kate , Lalloo Fiona , Sunde Lone , Mints Miriam , Bertario Lucio , Pineda Marta , Navarro Matilde , Morak Monika , Renkonen-Sinisalo Laura , Frayling Ian M , Plazzer John-Paul , Pylvanainen Kirsi , Sampson Julian R , Capella Gabriel , Mecklin Jukka-Pekka , Möslein Gabriela ,   in collaboration with The Mallorca Group (http://mallorca-group.eu)
Published: December 2015

ObjectiveEstimates of cancer risk and the effects of surveillance in Lynch syndrome have been subject to bias, partly through reliance on retrospective studies. We sought to establish more robust estimates in patients undergoing prospective cancer surveillance.DesignWe undertook a multicentre study of patients carrying Lynch syndrome-associated mutations affectingMLH1,MSH2,MSH6orPMS2. Standardised information on surveillance, cancers and outcomes were collated in an Oracle relational database and analysed by age, sex and mutated gene.Results1942 mutation carriers without previous cancer had follow-up including colonoscopic surveillance for 13 782 observation years. 314 patients developed cancer, mostly colorectal (n=151), endometrial (n=72) and ovarian (n=19). Cancers were detected from 25 years onwards inMLH1andMSH2mutation carriers, and from about 40 years inMSH6andPMS2carriers. Among first cancer detected in each patient the colorectal cancer cumulative incidences at 70 years by gene were 46%, 35%, 20% and 10% forMLH1, MSH2, MSH6andPMS2mutation carriers, respectively. The equivalent cumulative incidences for endometrial cancer were 34%, 51%, 49% and 24%; and for ovarian cancer 11%, 15%, 0% and 0%. Ten-year crude survival was 87% after any cancer, 91% if the first cancer was colorectal, 98% if endometrial and 89% if ovarian.ConclusionsThe four Lynch syndrome-associated genes had different penetrance and expression. Colorectal cancer occurred frequently despite colonoscopic surveillance but resulted in few deaths. Using our data, a website has been established athttp://LScarisk.orgenabling calculation of cumulative cancer risks as an aid to genetic counselling in Lynch syndrome.
Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement
Authors: Fenerty Lynne , Heatley Jennifer , Young Julian , Thibault-Halman Ginette , Kureshi Nelofar , Bruce Beth S , Walling Simon , Clarke David B 
Published: December 2015

BackgroundNova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia.MethodsA baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence.ResultsBaseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia.ConclusionsResults from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.
Lupus anticoagulant, disease activity and low complement in the first trimester are predictive of pregnancy loss
Authors: Mankee Anil , Petri Michelle , Magder Laurence S 
Published: December 2015

IntroductionMultiple factors, including proteinuria, antiphospholipid syndrome, thrombocytopenia and hypertension, are predictive of pregnancy loss in systemic lupus erythematosus (SLE). In the PROMISSE study of predictors of pregnancy loss, only a battery of lupus anticoagulant tests was predictive of a composite of adverse pregnancy outcomes. We examined the predictive value of one baseline lupus anticoagulant test (dilute Russell viper venom time) with pregnancy loss in women with SLE.MethodsFrom the Hopkins Lupus Cohort, there were 202 pregnancies from 175 different women after excluding twin pregnancies and pregnancies for which we did not have a first trimester assessment of lupus anticoagulant. We determined the percentage of women who had a pregnancy loss in groups defined by potential risk factors. The lupus anticoagulant was determined by dilute Russell viper venom time with appropriate mixing and confirmatory testing. Generalised estimating equations were used to calculate p values, accounting for repeated pregnancies in the same woman.ResultsThe age at pregnancy was <20 years (2%), 20–29 (53%), 30–39 (41%) and >40 (3%). 55% were Caucasian and 34% African-American. Among those with lupus anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or higher disease activity had a higher rate of pregnancy loss than those without (p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss.ConclusionsThe strongest predictor of pregnancy loss in SLE in the first trimester is the lupus anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the lupus anticoagulant could be considered, even in the absence of history of pregnancy loss.
Comparison of four different collateral scores in acute ischemic stroke by CT angiography
Authors: Seker Fatih , Potreck Arne , Möhlenbruch Markus , Bendszus Martin , Pham Mirko 
Published: December 2015

PurposeMultiple scores have been described for the assessment of collateralization in acute ischemic stroke. Currently, there is no gold standard for collateral assessment by CT angiography (CTA). This study compared four frequently used collateral scores with regard to their correlation with early infarct core and mismatch ratio.Methods30 consecutive patients with acute occlusion of the M1 segment or terminal carotid artery were reviewed retrospectively. Collaterals were assessed using dynamic and also single-phase CTA according to grading systems by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR), Alberta Stroke Program Early CT Score (ASPECTS) (on collaterals), Christoforidiset aland Miteffet al. The Christoforidis and ASITN/SIR scores, which were initially designed for conventional angiography, were adapted to be applicable to CTA. The scores were compared with respect to early infarct core and mismatch ratio in perfusion CT estimated by RAPID software using Spearman correlation.ResultsASITN/SIR and ASPECTS collateral scores showed good correlation with early infarct core (rho=−0.696, p<0.001 and rho=−0.677, p<0.001) and mismatch ratio (rho=0.609, p<0.001 and rho=0.581, p<0.001). In contrast, the Christoforidis and Miteff scores correlated less well with infarct core (rho=0.245, p=0.191 and rho=−0.272, p=0.145, respectively) and mismatch ratio (rho=−0.329, p=0.075 and rho=0.279, p=0.135, respectively). ASPECTS and ASITN/SIR showed excellent cross-correlation (rho=0.901, p<0.001).ConclusionsCompared with the Christoforidis and Miteff scores, the modified ASITN/SIR and ASPECTS collateral scores showed consistently higher correlation with the extent of early infarct core and mismatch volume. This is probably because these scores evaluate the extent and delay of vascular enhancement in the affected territory rather than the backflow of contrast medium to the occlusion.
Challenges and Opportunities of Integrating Human Health into the Environmental Assessment Process: The Canadian Experience Contextualised to International Efforts
Authors: Mahboubi Pouyan , Parkes Margot W. , Chan Hing Man 
Published: December 2015

A scoping review of the literature was conducted to identify the most pressing issues pertaining to the application of Health Impact Assessment (HIA) and the integration of health concerns into the Environmental Assessment (EA) process in Canada and internationally. The issues identified include the need for government intervention, gaps in methodology and tools, limitations of capacity and expertise, poor intersectoral, disciplinary and public collaboration/participation, challenges of data quantification and analytic complexity, and the need for process efficiency. The issues presented were also contextualised to the status quo practice of EA in Canada and the Canadian Environmental Assessment Act (CEAA 2012). Recommendations were proposed as a starting point for improved integration. First, a commitment by the actors involved to the protection of human health — aligned with the core mandate of the CEAA. Second, the achievement of intersectoral, disciplinary and public collaboration, led by government, ideally the health sector. The case is made for a new era of Canadian leadership and innovation at the interface of health and EA.
IS THE IPCC’s 5THASSESSMENT A DENIER OF POSSIBLE MACROECONOMIC BENEFITS FROM MITIGATING CLIMATE CHANGE?
Authors: ROSEN RICHARD A. 
Published: December 2015

This review summarizes what we know about the macroeconomics of mitigating climate change over the period 2010 to 2100 as presented in the 2014 IPCC Working Group III report. The review finds that little more, if anything, has been learned about the macroeconomics of mitigating climate change over the long run since the 2007 IPCC report. Furthermore, while the 2014 report is quite self-critical about the serious weaknesses in its methodologies, the self-criticisms are not explicitly taken into account when the net macroeconomic costs of mitigation are reported. Nor do the research teams that run the integrated assessment models relied on in the report utilize any systematic methodology for assessing the inherent uncertainty in the macroeconomic results reported. Thus, the basic quantitative “findings” are misleading — and, perhaps, even deceptive — in part because they appear to preclude the possibility of large macroeconomic benefits from mitigating climate change.
Geochemical characteristics and palaeoenvironmental reconstruction of the sediments from the Gulf of Tonkin, South China Sea
Authors: Cui Zhenang , Hou Yueming , Xia Zhen , Liang Kai , Xue Qiao , Zhang Liang 
Published: December 2015

Abstract

Geochemical investigations of sediments from core GC22 from the Tonkin Gulf, South China Sea, have been carried out in order to reconstruct the palaeoenvironmental evolution of the area during the Holocene. Vertical variations in Al/Ti, K/Al and Mg/Al clearly indicate the degree of chemical weathering in the source area. Zr/Ti and SiO
2
/Al
2
O
3
recorded the history of current velocity changes, and La/Co v. La/Sc, combined with distribution patterns of rare earth elements, suggested that Hainan Island was the main source of the sediments during the Holocene. Based on the results of the analysis, the evolution of palaeoenvironments in the Tonkin Gulf can be divided into four stages: (1) 10.12–6.46 ka BP, the regional climate got warmer, and the sea level of the gulf rose rapidly, which is indicated by rapid declines in Sr/Ba and CaO. (2) 6.46–4.3 ka BP, the gulf had a stable depositional environment, and the local climate became cold and dry. (3) 4.3–3.55 ka BP, the currents and sedimenary provenance in the gulf were significantly influenced by the opening of the Qiongzhou Strait. (4) 3.55 ka BP–present, the regional sea level remained roughly stable.
Identification of Novel Fusion Genes in Testicular Germ Cell Tumors
Authors: Hoff Andreas M. , Alagaratnam Sharmini , Zhao Sen , Bruun Jarle , Andrews Peter W. , Lothe Ragnhild A. , Skotheim Rolf I. 
Published: December 2015

Abstract
Testicular germ cell tumors (TGCT) are the most frequently diagnosed solid tumors in young men ages 15 to 44 years. Embryonal carcinomas (EC) comprise a subset of TGCTs that exhibit pluripotent characteristics similar to embryonic stem (ES) cells, but the genetic drivers underlying malignant transformation of ECs are unknown. To elucidate the abnormal genetic events potentially contributing to TGCT malignancy, such as the existence of fusion genes or aberrant fusion transcript expression, we performed RNA sequencing of EC cell lines and their nonmalignant ES cell line counterparts. We identified eight novel fusion transcripts and one gene with alternative promoter usage, ETV6. Four out of nine transcripts were found recurrently expressed in an extended panel of primary TGCTs and additional EC cell lines, but not in normal parenchyma of the testis, implying tumor-specific expression. Two of the recurrent transcripts involved an intrachromosomal fusion between RCC1 and HENMT1 located 80 Mbp apart and an interchromosomal fusion between RCC1 and ABHD12B. RCC1-ABHD12B and the ETV6 transcript variant were found to be preferentially expressed in the more undifferentiated TGCT subtypes. In vitro differentiation of the NTERA2 EC cell line resulted in significantly reduced expression of both fusion transcripts involving RCC1 and the ETV6 transcript variant, indicating that they are markers of pluripotency in a malignant setting. In conclusion, we identified eight novel fusion transcripts that, to our knowledge, are the first fusion genes described in TGCT and may therefore potentially serve as genomic biomarkers of malignant progression. Cancer Res; 76(1); 108–16. ©2015 AACR.
Whole Genome Sequencing Defines the Genetic Heterogeneity of Familial Pancreatic Cancer
Authors: Roberts Nicholas J. , Norris Alexis L. , Petersen Gloria M. , Bondy Melissa L. , Brand Randall , Gallinger Steven , Kurtz Robert C. , Olson Sara H. , Rustgi Anil K. , Schwartz Ann G. , Stoffel Elena , Syngal Sapna , Zogopoulos George , Ali Syed Z. , Axilbund Jennifer , Chaffee Kari G. , Chen Yun-Ching , Cote Michele L. , Childs Erica J. , Douville Christopher , Goes Fernando S. , Herman Joseph M. , Iacobuzio-Donahue Christine , Kramer Melissa , Makohon-Moore Alvin , McCombie Richard W. , McMahon K. Wyatt , Niknafs Noushin , Parla Jennifer , Pirooznia Mehdi , Potash James B. , Rhim Andrew D. , Smith Alyssa L. , Wang Yuxuan , Wolfgang Christopher L. , Wood Laura D. , Zandi Peter P. , Goggins Michael , Karchin Rachel , Eshleman James R. , Papadopoulos Nickolas , Kinzler Kenneth W. , Vogelstein Bert , Hruban Ralph H. , Klein Alison P. 
Published: December 2015

Abstract
Pancreatic cancer is projected to become the second leading cause of cancer-related death in the United States by 2020. A familial aggregation of pancreatic cancer has been established, but the cause of this aggregation in most families is unknown. To determine the genetic basis of susceptibility in these families, we sequenced the germline genomes of 638 patients with familial pancreatic cancer and the tumor exomes of 39 familial pancreatic adenocarcinomas. Our analyses support the role of previously identified familial pancreatic cancer susceptibility genes such as BRCA2, CDKN2A, and ATM, and identify novel candidate genes harboring rare, deleterious germline variants for further characterization. We also show how somatic point mutations that occur during hematopoiesis can affect the interpretation of genome-wide studies of hereditary traits. Our observations have important implications for the etiology of pancreatic cancer and for the identification of susceptibility genes in other common cancer types.
Significance: The genetic basis of disease susceptibility in the majority of patients with familial pancreatic cancer is unknown. We whole genome sequenced 638 patients with familial pancreatic cancer and demonstrate that the genetic underpinning of inherited pancreatic cancer is highly heterogeneous. This has significant implications for the management of patients with familial pancreatic cancer. Cancer Discov; 6(2); 166–75. ©2015 AACR.
This article is highlighted in the In This Issue feature, p. 109
Effectively Communicating Risk and Uncertainty to the Public: Assessing the National Weather Service’s Flood Forecast and Warning Tools
Authors: Hogan Carr Rachel , Montz Burrell , Maxfield Keri , Hoekstra Stephanie , Semmens Kathryn , Goldman Elizabeth 
Published: December 2015

Abstract
Given the constant bombardment of weather information in different formats and time frames with different levels of certainty, how does an important message make an impact? For weather and river forecast offices, this is a pressing question given a likely future of increasing high-impact storm events. These offices need to quickly and effectively motivate public response to impending events such as flooding. Currently, communication of flood potential is accomplished through a suite of forecast and warning products, including river hydrographs, precipitation forecasts, and flood watches and warnings. Despite advances in forecast accuracy and lead time, people fail to respond to warnings and often suffer substantial damages and loss of property. To understand how the public uses and interprets National Weather Service (NWS) flood products, an extreme storm scenario was presented using NWS forecast products in a series of focus groups in the Delaware River basin (Pennsylvania–New Jersey). Findings from the sessions informed revisions of the products to which participants reported increased understanding and motivation to take action. Participants demonstrated a strong preference for river-level information presented through the NWS hydrograph among all the NWS products shown depicting an approaching hurricane. Simplified graphics, explanations in general terms, intuitive colors, and geographic specificity are key recommendations to improve comprehension of risk and uncertainty. The National Oceanic and Atmospheric Administration (NOAA) and NWS are taking steps to operationalize some of these suggestions. This study’s methods and results are applicable to other areas and hazard types.
Projected Changes in Mid-Twenty-First-Century Extreme Maximum Pavement Temperature in Canada
Authors: Fletcher Christopher G. , Matthews Lindsay , Andrey Jean , Saunders Adam 
Published: December 2015

AbstractFuture climate warming is virtually certain to bring about an increase in the frequency of heat extremes. Highway design and pavement selection are based on a temperature regime that reflects the local climate zone. Increasing heat extremes could, therefore, shift some areas into a different performance grade (PG) for pavement, and more-heat-resistant materials are associated with increased infrastructure costs. This study combines observations, output from global climate models, and a statistical model to investigate changes in 20-yr return values of extreme maximum pavement temperature TPmax. From a multimodel range of simulated TPmax, future changes in PG are computed for 17 major Canadian cities. Relative to a 1981–2000 baseline, summertime Canada-wide warming of 1°–3°C is projected for 2041–70. As a result, climate change is likely to bring about profound changes to the spatial distribution of PG, with the severity of the changes directly linked to the severity of the projected warming. Even under weak simulated warming, an increase in PG is projected for greater Toronto, which is Canada’s largest urban area; under moderate (strong) warming 7 of 17 (9 of 17) major cities exhibit an increase. The influence of model spatial resolution is evaluated by comparing the results from global climate models with output from a set of regional climate models focused on North America. With the exception of mountainous terrain in western Canada, spatial resolution is not a major determining factor for projections of future PG changes.