bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low stimulus environments: reducing noise levels in continuing care
Authors: Brown Juliette , Fawzi Waleed , Shah Amar , Joyce Margaret , Holt Genevieve , McCarthy Cathy , Stevenson Carmel , Marange Rosca , Shakes Joy , Solomon-Ayeh Kwesi 
Published: February 2016

AbstractIn the low stimulus environment project, we aimed to reduce the levels of intrusive background noise on an older adult mental health ward, combining a very straightforward measure on decibel levels with a downstream measure of reduced distress and agitation as expressed in incidents of violence. This project on reducing background noise levels on older adult wards stemmed from work the team had done on reducing levels of violence and aggression.We approached the problem using quality improvement methods. Reducing harm to patients and staff is a strategic aim of our Trust and in our efforts we were supported by the Trust’s extensive programme of quality improvement, including training and support provided by the Institute for Healthcare Improvement and the trust’s own Quality Improvement team.Prior to the project we were running a weekly multi-disciplinary quality improvement group on the ward. We established from this a sub-group to address the specific problem of noise levels and invited carers of people with dementia on our ward to the group. The project was led by nursing staff. We used a noise meter app readily downloadable from the internet to monitor background noise levels on the ward and establish a baseline measure. As a group we used a driver diagram to identify an overall aim and a clear understanding of the major factors that would drive improvements. We also used a staff and carer survey to identify further areas to work on. Change ideas that came from staff and carers included the use of the noise meter to track and report back on noise levels, the use of posters to remind staff about noise levels, the introduction of a visual indication of current noise levels (the Yacker Tracker), the addition of relaxing background music, and adaptations to furniture and environment. We tested many of these over the course of nine months in 2015, using the iterative learning gained from multiple PDSA cycles.The specific aim was a decrease from above 60dB to below 50dB in background noise on the wards. Following our interventions, we have managed to decrease noise levels on the ward to 53dB on average.The success of this project to date has relied on the involvement of ward staff and carers - those most affected by the problem - in generating workable local solutions. As many of the change ideas amounted to harm free interventions it was easier for us to make a case to test them out in the real-life setting. Nevertheless we were surprised at how effective such seemingly simple ideas have been in improving the environment on the ward. We have incorporated the change ideas into routine practice and are advising other wards on similar projects.
Improving residents' handovers through just-in-time training for structured communication
Authors: Rourke Liam , Amin Aditi , Boyington Curtiss , Ao Peter , Frolova Natalia 
Published: February 2016

AbstractIn a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover.During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.
Reducing the overuse of βhCG measurements in the emergency gynaecology clinic
Authors: Frost Lucy 
Published: February 2016

AbstractSerial βhCG testing can be a helpful tool in deciding how to manage pregnancy of unknown location. Its use in emergency gynaecology clinics can prevent unnecessary admission and intervention. However, despite NICE Guidelines on when it is safe to opt for conservative management, it was identified that there was a problem with over-testing of βhCG when patients could be discharged with instructions to repeat a urinary pregnancy test in two weeks. Two PDSA cycles were undertaken to improve the awareness of NICE guidelines: the first involved formal and informal educational sessions and the second involved the inclusion of a guideline summary on the front of patients’ notes when they were having serial βhCG tests for doctors to refer to.Case notes were reviewed for 157 women who had βhCG tests at baseline and 48 hours. Of these, 139 were suitable for serial βhCG testing, and 83 of these were suitable for discharge after 48 hours. Of the 83 patients that were eligible for discharge, there were 31 unnecessary βhCG tests done, 23 of which were prior to intervention. A significant improvement was noted, with between 4-10 unnecessary βhCG tests per fortnight prior to intervention, 0-3 following the first intervention, and 0-2 following the second. Reduction in unnecessary βhCG testing has positive implications for patients, who do not have to take unnecessary time off work, prolong an already very distressing period, and have unnecessary blood tests. There are also cost and time saving implications for the hospital.
Genomic Landscape of Somatic Alterations in Esophageal Squamous Cell Carcinoma and Gastric Cancer
Authors: Hu Nan , Kadota Mitsutaka , Liu Huaitian , Abnet Christian C. , Su Hua , Wu Hailong , Freedman Neal D. , Yang Howard H. , Wang Chaoyu , Yan Chunhua , Wang Lemin , Gere Sheryl , Hutchinson Amy , Song Guohong , Wang Yuan , Ding Ti , Qiao You-Lin , Koshiol Jill , Dawsey Sanford M. , Giffen Carol , Goldstein Alisa M. , Taylor Philip R. , Lee Maxwell P. 
Published: February 2016

Abstract
Gastric cancer and esophageal cancer are the second and sixth leading causes of cancer-related death worldwide. Multiple genomic alterations underlying gastric cancer and esophageal squamous cell carcinoma (ESCC) have been identified, but the full spectrum of genomic structural variations and mutations have yet to be uncovered. Here, we report the results of whole-genome sequencing of 30 samples comprising tumor and blood from 15 patients, four of whom presented with ESCC, seven with gastric cardia adenocarcinoma (GCA), and four with gastric noncardia adenocarcinoma. Analyses revealed that an A&gt;C mutation was common in GCA, and in addition to the preferential nucleotide sequence of A located 5 prime to the mutation as noted in previous studies, we found enrichment of T in the 5 prime base. The A&gt;C mutations in GCA suggested that oxidation of guanine may be a potential mechanism underlying cancer mutagenesis. Furthermore, we identified genes with mutations in gastric cancer and ESCC, including well-known cancer genes, TP53, JAK3, BRCA2, FGF2, FBXW7, MSH3, PTCH, NF1, ERBB2, and CHEK2, and potentially novel cancer-associated genes, KISS1R, AMH, MNX1, WNK2, and PRKRIR. Finally, we identified recurrent chromosome alterations in at least 30% of tumors in genes, including MACROD2, FHIT, and PARK2 that were often intragenic deletions. These structural alterations were validated using the The Cancer Genome Atlas dataset. Our studies provide new insights into understanding the genomic landscape, genome instability, and mutation profile underlying gastric cancer and ESCC development. Cancer Res; 76(7); 1714–23. ©2016 AACR.
Immunologic and Metabolic Features of Pancreatic Ductal Adenocarcinoma Define Prognostic Subtypes of Disease
Authors: Hutcheson Jack , Balaji Uthra , Porembka Matthew R. , Wachsmann Megan B. , McCue Peter A. , Knudsen Erik S. , Witkiewicz Agnieszka K. 
Published: February 2016

Abstract
Purpose: Pancreatic ductal adenocarcinoma (PDA) is associated with an immunosuppressive microenvironment that supports the growth of the malignancy as well as immune system evasion. Here we examine markers of immunosuppression in PDA within the context of the glycolytic tumor microenvironment, their interrelationship with tumor biology and association with overall survival.
Experimental Design: We utilized tissue microarrays consisting of 223 PDA patients annotated for clinical stage, tumor size, lymph node involvement, and survival. Expression of CD163, FoxP3, PD-L1, and MCT4 was assessed by IHC and statistical associations were evaluated by univariate and multivariate analysis. Multimarker subtypes were defined by random forest analysis. Mechanistic interactions were evaluated using PDA cell lines and models for myeloid differentiation.
Results: PDA exhibits discrete expression of CD163, FoxP3, and PD-L1 with modest individual significance. However, combined low expression of these markers was associated with improved prognosis (P = 0.02). PDA tumor cells altered macrophage phenotype and function, which supported enhanced invasiveness in cell-based models. Lactate efflux mediated by MCT4 was associated with, and required for, the selective conversion of myeloid cells. Correspondingly, MCT4 expression correlated with immune markers in PDA cases, and increased the significance of prognostic subtypes (P = 0.002).
Conclusions: There exists a complex interplay between PDA tumor cells and the host immune system wherein immunosuppression is associated with negative outcome. MCT4 expression, representative of the glycolytic state of PDA, contributes to the phenotypic conversion of myeloid cells. Thus, metabolic status of PDA tumors is an important determinant of the immunosuppressive environment. Clin Cancer Res; 22(14); 3606–17. ©2016 AACR.
Catheter Ablation of Nonparoxysmal Atrial Fibrillation Using Electrophysiologically Guided Substrate Modification During Sinus Rhythm After Pulmonary Vein Isolation
Authors: Yang Gang , Yang Bing , Wei Youquan , Zhang Fengxiang , Ju Weizhu , Chen Hongwu , Li Mingfang , Gu Kai , Lin Yazhou , Wang Benqi , Cao Kejiang , Kojodjojo Pipin , Chen Minglong 
Published: February 2016

Background—
The high incidence of postprocedural atrial tachycardia reduces the absolute arrhythmia-free success rate of extensive ablation strategies to treat nonparoxysmal atrial fibrillation (NPAF). We hypothesized that a strategy of targeting low-voltage zones and sites with abnormal electrograms during sinus rhythm (SR-AEs) in the left atrium after circumferential pulmonary vein isolation and cavotricuspid isthmus ablation in patients with NPAF is superior.

Methods and Results—

A total of 86 consecutive patients with NPAF were enrolled in study group. After circumferential pulmonary vein isolation, cavotricuspid isthmus ablation and cardioversion to SR, high-density mapping of left atrium was performed. Areas with low-voltage zone and SR-AE were targeted for further homogenization and elimination, respectively; 78 consecutive sex- and age-matched patients with NPAF who were treated with the stepwise approach served as the historical control group. In the study group, 92% (79/86) were successfully cardioverted after circumferential pulmonary vein isolation and cavotricuspid isthmus ablation. Among the patients converted to SR, 70% (55/79) had low-voltage zone and SR-AE and received additional ablation, whereas in 30% (24/79) without SR-AE or low-voltage zone, no further ablation was performed. During a follow-up period of >30 months, the Kaplan–Meier estimated probability to maintain SR at 24 months was 69.8% versus 51.3%. And after a single procedure, 3.5% (3/86) developed postprocedural atrial tachycardia in study group, compared with 30% (24/78) in control group (
P
=0.0003).

Conclusions—
A strategy of selective electrophysiologically guided atrial substrate modification in SR after circumferential pulmonary vein isolation and cavotricuspid isthmus ablation is clinically more effective than the stepwise approach for NPAF ablation.

Clinical Trial Registration—

URL:
http://clinicaltrials.gov
. Unique identifier: NCT01716143.
Randomized Study of Persistent Atrial Fibrillation Ablation
Authors: Bassiouny Mohamed , Saliba Walid , Hussein Ayman , Rickard John , Diab Mariam , Aman Wahaj , Dresing Thomas , Callahan, Thomas , Bhargava Mandeep , Martin David O. , Shao Mingyuan , Baranowski Bryan , Tarakji Khaldoun , Tchou Patrick J. , Hakim Ali , Kanj Mohamed , Lindsay Bruce , Wazni Oussama 
Published: February 2016

Background—
Achieving long-term successful outcomes with ablation of persistent atrial fibrillation (AF) remains a clinical and procedural challenge. We aimed to assess 2 ablation strategies for persistent AF: pulmonary vein antral isolation (PVAI) in sinus rhythm after direct current cardioversion versus PVAI and ablation targeting complex-fractionated atrial electrograms while in AF.

Methods and Results—

Between June 2009 and July 2013, patients with continuous persistent AF for ≥3 months were prospectively randomized to either direct current cardioversion before PVAI and posterior wall/septum ablation while in sinus rhythm (group 1), versus same ablation in group 1 in addition to complex-fractionated atrial electrogram ablation while in AF (group 2). The procedural profiles and clinical outcomes of the 2 strategies were compared. Ninety patients were randomized to group 1 (n=46) or group 2 (n=44). There were no differences in baseline characteristics between groups. Over 365 days of follow-up after the index procedure, 16 patients (35%) in group 1 and 13 patients (30%) in group 2 remained arrhythmia-free off antiarrhythmic medications. Over long-term follow-up (median, 867 days), arrhythmia-free survival off antiarrhythmic medications was more likely in group 1 than in group 2 in Kaplan–Meier analysis (Log Rank
P
=0.04). Group 1 ablation was associated with significantly shorter procedural duration and fluoroscopy time (231±72 versus 273±76 min;
P
=0.008 and 54 [Q1–Q3: 46–67] versus 66 (Q1–Q3: 53–83] min;
P
=0.018, respectively).

Conclusions—
In patients with persistent AF, PVAI in sinus rhythm after direct current cardioversion is associated with higher success and shorter procedural and fluoroscopy times compared with PVAI in AF with additional complex-fractionated atrial electrogram ablation.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02429648.
γ‐Glutamyltransferase and Risk of Sudden Cardiac Death in Middle‐Aged Finnish Men: A New Prospective Cohort Study
Authors: Kunutsor Setor K. , Khan Hassan , Laukkanen Jari A. 
Published: February 2016

Background

γ‐Glutamyltransferase (
GGT
) has been linked to an increased risk of several cardiovascular outcomes; however, the relationship of
GGT
with sudden cardiac death (
SCD
) has not been investigated previously. We aimed to assess the association of
GGT
with risk of
SCD
.

Methods and Results

Serum
GGT
activity was assessed at baseline in the Kuopio Ischemic Heart Disease prospective cohort of 1780 men, and 136
SCD
s were recorded during 22 years of follow‐up. Correction for within‐person variability was made using data from repeated measurements taken several years apart. The regression dilution ratio of log
e
GGT
adjusted for age was 0.68 (95%
CI
0.61–0.74). Serum
GGT
was log‐linearly associated with risk of
SCD
. The hazard ratio for
SCD
per 1 SD higher baseline log
e
GGT
values (2‐fold higher) was 1.30 (95%
CI
1.10–1.54;
P
=0.002) after adjustment for several established risk factors and remained consistent with further adjustment for alcohol consumption, resting heart rate, lipids, and C‐reactive protein (hazard ratio 1.26, 95%
CI
1.05–1.50;
P
=0.014). The corresponding hazard ratios were 1.48 (95%
CI
1.15–1.89;
P
=0.002) and 1.40 (95%
CI
1.07–1.82;
P
=0.014) after correction for within‐person variability. Hazard ratios remained unchanged after accounting for incident coronary events and did not vary importantly by levels or categories of prespecified conventional risk factors.

Conclusions

GGT
is positively, log‐linearly, and independently associated with future risk of
SCD
in the general male population. Further research is needed to replicate these findings.
There and back again: contributions on Pseudevoplitus Ruckes (Heteroptera: Pentatomidae)
Authors: GRAZIA JOCELIA , BOLZE GISELE JARDIM , BARÃO KIM RIBEIRO 
Published: February 2016

Pseudevoplitus Ruckes was recently revised and new species were described. The genus has a Neotropical distribution, with species mainly found in the Amazon. Here, we describe the previously unknown female of P. roraimensis and add localities to its known distribution. Also, a new species, P. angelomachadoi sp. nov. (Holotype male deposited in MNHN: French Guiana, Acarouany, 15.IX.1998, A. Matocq leg.), from the Amazonia of French Guiana is described; it can be distinguished from other species of the genus mainly by the bell-shaped pygophore in males, and the gonocoxites 8 widely obscuring the laterotergites 8 basally, in females, a unique character of this species. The key to species of Pseudevoplitus is updated to include the new species and females.
The Microwave Radiative Properties of Falling Snow Derived from Nonspherical Ice Particle Models. Part I: An Extensive Database of Simulated Pristine Crystals and Aggregate Particles, and Their Scattering Properties
Authors: Kuo Kwo-Sen , Olson William S. , Johnson Benjamin T. , Grecu Mircea , Tian Lin , Clune Thomas L. , van Aartsen Bruce H. , Heymsfield Andrew J. , Liao Liang , Meneghini Robert 
Published: February 2016

AbstractA 3D growth model is used to simulate pristine ice crystals, which are aggregated using a collection algorithm to create larger, multicrystal particles. The simulated crystals and aggregates have mass-versus-size and fractal properties that are consistent with field observations. The growth/collection model is used to generate a large database of snow particles, and the single-scattering properties of each particle are computed using the discrete dipole approximation to account for the nonspherical geometries of the particles. At 13.6 and 35.5 GHz, the bulk radar reflectivities of nonspherical snow particle polydispersions differ from those of more approximate spherical, homogeneous, ice–air particle polydispersions that have the same particle size distributions, although the reflectivities of the nonspherical particles are roughly approximated by polydispersions of spheres of 0.1–0.2 g cm−3 density. At higher microwave frequencies, such as 165.5 GHz, the bulk extinction (and scattering) coefficients of the nonspherical snow polydispersions are comparable to those of low-density spheres, but the asymmetry parameters of the nonspherical particles are substantially less than those of spheres for a broad range of assumed spherical particle densities. Because of differences in the asymmetry of scatter, simulated microwave-scattering depressions using nonspherical particles may well exceed those of spheres for snow layers with the same vertical water path. It may be concluded that, in precipitation remote sensing applications that draw upon input from radar and/or radiometer observations spanning a range of microwave frequencies, nonspherical snow particle models should be used to properly interpret the observations.
Interannual Modulations of Oceanic Imprints on the Wintertime Atmospheric Boundary Layer under the Changing Dynamical Regimes of the Kuroshio Extension
Authors: Masunaga Ryusuke , Nakamura Hisashi , Miyasaka Takafumi , Nishii Kazuaki , Qiu Bo 
Published: February 2016

Abstract
The Kuroshio Extension (KE) fluctuates between its different dynamic regimes on (quasi) decadal time scales. In its stable (unstable) regime, the KE jet is strengthened (weakened) and less (more) meandering. The present study investigates wintertime mesoscale atmospheric structures modulated under the changing KE regimes, as revealed in high-resolution satellite data and data from a particular atmospheric reanalysis (ERA-Interim). In the unstable KE regime, a positive anomaly in sea surface temperature (SST) to the north of the climatological KE jet accompanies positive anomalies in upward heat fluxes from the ocean, surface wind convergence, and cloudiness. As revealed in the atmospheric reanalysis, these positive anomalies coincide with local lowering of sea level pressure, weaker vertical wind shear, warming and thickening of the marine atmospheric boundary layer (MABL), anomalous ascent, and convective precipitation. In the stable KE regime, by contrast, the corresponding imprints of sharp SST gradients across the KE and Oyashio fronts on the wintertime MABL are separated more distinctly, and so are the surface baroclinic zones along those two SST fronts. In the ERA-Interim data, such mesoscale imprints of the KE variability as above are not well represented in a period during which the resolution of SST data prescribed is relatively low. The present study thus elucidates the importance of high-resolution SST data prescribed for atmospheric reanalysis in representing modulations of the MABL structure and air–sea fluxes by the variability of oceanic fronts and/or jets, including the modulations occurring with the changing KE regimes through the hydrostatic pressure adjustment and vertical mixing mechanisms.
Doppler Radar Observations of Anticyclonic Tornadoes in Cyclonically Rotating, Right-Moving Supercells
Authors: Bluestein Howard B. , French Michael M. , Snyder Jeffrey C. , Houser Jana B. 
Published: February 2016

AbstractSupercells dominated by mesocyclones, which tend to propagate to the right of the tropospheric pressure-weighted mean wind, on rare occasions produce anticyclonic tornadoes at the trailing end of the rear-flank gust front. More frequently, mesoanticyclones are found at this location, most of which do not spawn any tornadoes. In this paper, four cases are discussed in which the formation of anticyclonic tornadoes was documented in the plains by mobile or fixed-site Doppler radars. These brief case studies include the analysis of Doppler radar data for tornadoes at the following dates and locations: 1) 24 April 2006, near El Reno, Oklahoma; 2) 23 May 2008, near Ellis, Kansas; 3) 18 March 2012, near Willow, Oklahoma; and 4) 31 May 2013, near El Reno, Oklahoma. Three of these tornadoes were also documented photographically. In all of these cases, a strong mesocyclone (i.e., vortex signature characterized by azimuthal shear in excess of ~5 × 10−3 s−1 or a 20 m s−1 change in Doppler velocity over 5 km) or tornado was observed ~10 km away from the anticyclonic tornado. In three of these cases, the evolution of the tornadic vortex signature in time and height is described. Other features common to all cases are noted and possible mechanisms for anticyclonic tornadogenesis are identified. In addition, a set of estimated environmental parameters for these and other similar cases are discussed.