bluuebunny/crossref_metadata_2025_split huggingface dataset:
Displaying radiation exposure and cost information at order entry for outpatient diagnostic imaging: a strategy to inform clinician ordering
Authors: Kruger Jenna F , Chen Alice Hm , Rybkin Alex , Leeds Kiren , Guzman David , Vittinghoff Eric , Goldman L Elizabeth 
Published: January 2016

BackgroundDisplaying radiation exposure and cost information at electronic order entry may encourage clinicians to consider the value of diagnostic imaging.MethodsAn urban safety-net health system displayed radiation exposure information for CT and cost information for CT, MRI and ultrasound on an electronic referral system for outpatient ordering. We assessed whether there were differences in numbers of outpatient CT scans and MRIs per month relative to ultrasounds before and after the intervention, and evaluated primary care clinicians’ responses to the intervention.ResultsThere were 23 171 outpatient CTs, 15 052 MRIs and 43 266 ultrasounds from 2011 to 2014. The ratio of CTs to ultrasounds decreased by 15% (95% CI 9% to 21%), from 58.2 to 49.6 CTs per 100 ultrasounds; the ratio of MRIs to ultrasounds declined by 13% (95% CI 7% to 19%), from 37.5 to 32.5 per 100. Of 300 invited, 190 (63%) completed the web-based survey in 17 clinics. 154 (81%) noticed the radiation exposure information and 158 (83.2%) noticed the cost information. Clinicians believed radiation exposure information was more influential than cost information: when unsure clinically about ordering a test (radiation=69.7%; cost=46.4%), when a patient wanted a test not clinically indicated (radiation=77.5%; cost=54.8%), when they had a choice between imaging modalities (radiation=77.9%; cost=66.6%), in patient care discussions (radiation=71.9%; cost=43.2%) and in trainee discussions (radiation=56.5%; cost=53.7%). Resident physicians and nurse practitioners were more likely to report that the cost information influenced them (p<0.05).ConclusionsDisplaying radiation exposure and cost information at order entry may improve clinician awareness about diagnostic imaging safety risks and costs. More clinicians reported the radiation information influenced their clinical practice.
The Healthcare Complaints Analysis Tool: development and reliability testing of a method for service monitoring and organisational learning
Authors: Gillespie Alex , Reader Tom W 
Published: January 2016

BackgroundLetters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare Complaints Analysis Tool (HCAT).MethodsHCAT was developed from a taxonomy of healthcare complaints reported in a previously published systematic review. It introduces the novel idea that complaints should be analysed in terms of severity. Recruiting three groups of educated lay participants (n=58, n=58, n=55), we refined the taxonomy through three iterations of discriminant content validity testing. We then supplemented this refined taxonomy with explicit coding procedures for seven problem categories (each with four levels of severity), stage of care and harm. These combined elements were further refined through iterative coding of a UK national sample of healthcare complaints (n= 25, n=80, n=137, n=839). To assess reliability and accuracy for the resultant tool, 14 educated lay participants coded a referent sample of 125 healthcare complaints.ResultsThe seven HCAT problem categories (quality, safety, environment, institutional processes, listening, communication, and respect and patient rights) were found to be conceptually distinct. On average, raters identified 1.94 problems (SD=0.26) per complaint letter. Coders exhibited substantial reliability in identifying problems at four levels of severity; moderate and substantial reliability in identifying stages of care (except for ‘discharge/transfer’ that was only fairly reliable) and substantial reliability in identifying overall harm.ConclusionsHCAT is not only the first reliable tool for coding complaints, it is the first tool to measure the severity of complaints. It facilitates service monitoring and organisational learning and it enables future research examining whether healthcare complaints are a leading indicator of poor service outcomes.HCATis freely available to download and use.
The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of a pharmacist-led telephone based intervention designed to improve medication adherence
Authors: Lyons Imogen , Barber Nicholas , Raynor David K , Wei Li 
Published: January 2016

AimTo test the effectiveness of a tailored, pharmacist-led centralised advice service to improve adherence to patients on established medications.MethodsA parallel group randomised controlled trial was conducted. Patients prescribed at least one oral medication for type 2 diabetes and/or lipid regulation were eligible to participate. 677 patients of a mail-order pharmacy were recruited and randomised (340 intervention, 337 control). The intervention comprised two tailored telephone consultations with a pharmacist, 4–6 weeks apart, plus a written summary of the discussion and a medicines reminder chart. The primary outcome was self-reported adherence to medication at 6-month follow-up, collected via a postal questionnaire, analysed using generalised estimating equations. Secondary outcomes included prescription refill adherence, lipid and glycaemic control and patient satisfaction.ResultsIn intention-to-treat analysis 36/340 (10.6%) of the intervention group were non-adherent (<90% of medication taken in the past 7 days) at 6 months compared with 66/337 (19.6%) in the control group, yielding an unadjusted OR of 1.54 (95% CI 1.11 to 2.15, p=0.01). Analyses of dispensing data also showed that the odds of being classified as adherent (≥90%) were 60% greater for the intervention group compared with the control group (OR 1.60, 95% CI 1.14 to 2.24, p<0.01). In a subsample of patients who provided blood samples, glycaemic and lipid control did not differ significantly between groups (p=0.06 and p=0.24, respectively) but positive trends were observed. Ninety-two per cent of intervention group patients reported that they were satisfied with the service overall.ConclusionsA telephone intervention, led by a pharmacist and tailored to the individuals’ needs, can significantly improve medication adherence in patients with long-term conditions, using a mail-order pharmacy. Further work is needed to confirm a trend towards improved clinical outcome.Trial registration numberNCT01864239.
Rationale for and design of the Idiopathic Pulmonary Fibrosis–PRospective Outcomes (IPF-PRO) registry
Authors: O'Brien Emily C , Durheim Michael T , Gamerman Victoria , Garfinkel Sandy , Anstrom Kevin J , Palmer Scott M , Conoscenti Craig S 
Published: January 2016

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterised by progressive loss of lung function. Its clinical course is variable but ultimately fatal. There is a need for a multicentre patient registry incorporating longitudinal clinical data and biological samples to improve understanding of the natural history of IPF and contemporary practice patterns.Methods/designThe Idiopathic Pulmonary Fibrosis–PRospective Outcomes (IPF-PRO) registry is a national IPF registry in the USA. This registry will enrol approximately 300 patients with newly diagnosed IPF over 2 years at approximately 14 tertiary pulmonary care sites. Participants will be followed for 3–5 years and will receive usual care, as defined by their physician. Clinical data from the year prior to diagnosis will be collected from medical record review on enrolment. Subsequently, data on diagnostic evaluations, pulmonary function tests, physical examinations, laboratory data and clinical events will be collected at routine clinical visits and via a call centre. Participants will complete patient-reported outcome questionnaires at enrolment and then at approximately 6-month intervals. Blood samples for cellular, genetic and transcriptomic analyses will be collected at the same intervals.ResultsThe first results from the IPF-PRO registry will be presented in 2015.ConclusionsThe IPF-PRO registry will improve understanding of the natural history of IPF, its impact on patients and current practice in the diagnosis and care of patients with IPF. The registry will establish a repository of biological samples from a well-characterised patient population for future research.Clinical trial numberNCT01915511.
Complex shoulder girdle injuries following mountain bike accidents and a review of the literature
Authors: Lea Matthew Alexander , Makaram Navnit , Srinivasan Makaram S 
Published: January 2016

BackgroundMountain and road bike accidents are particularly common with the increased popularity of the sport. We reviewed the attendances in our emergency department over a 4-year period looking at cycling injuries to detect the level and grade of these injuries and their outcomes.MethodRoyal Blackburn Hospital caters for a population of 550 000. A search through the Hospital information system revealed 104 patients with fractures following mountain bike injuries. These were looked at in more detail. We present a series of 5 severe shoulder girdle injuries following mountain bike accidents in this cohort, to highlight the serious level of injury sustained in this sport. We searched MEDLINE and EMBASE databases over the past 10 years using the keywords, mountain, biking and fracture. This yielded 7 papers. We compared our series with the literature.Results104 fractures following mountain bike accidents between 2008 and 2011. Fractures of the upper limb were the most common (88.5%) with the clavicle being the most commonly fractured bone (28.8%).ConclusionsMajor scapular injuries with destruction or disruption of the four bar linkage of the shoulder girdle are very common following mountain accidents. Clavicular fractures are the commonest upper limb injury. It is easy to miss a disruption to the four-bar linkage associated with a clavicular injury. This paper highlights the severity of the injuries sustained in mountain bike accidents of the upper limb and requirement of adequate protection in this exhilarating sport.
Assessment of intracranial aneurysm rupture based on morphology parameters and anatomical locations
Authors: Zheng Yongtao , Xu Feng , Ren Jinma , Xu Qiang , Liu Yingjun , Tian Yanlong , Leng Bing 
Published: January 2016

ObjectivesThe aim of the present study was to identify image-based morphological parameters and anatomical locations associated with intracranial aneurysm (IA) rupture.MethodsNine morphological parameters and aneurysm location were evaluated in 150 patients with saccular IAs (82 unruptured, 68 ruptured) using three-dimensional geometry. Aneurysm location and morphological parameters including size, aspect ratio, size ratio, height–width ratio, flow angle, aneurysm inclination angle, parent artery angle, vessel angle, and aneurysm shape were explored to identify a correlation with aneurysm rupture. These factors were analyzed using a two-tailed independent Student t test or the χ test for significance. Significant factors were further examined using logistic regression analysis. Additionally, receiver operating characteristic (ROC) analysis was performed to evaluate each parameter.ResultsStatistically significant differences were observed in ruptured and unruptured groups for aspect ratio, size ratio, height–width ratio, flow angle, aneurysm inclination angle, vessel angle, aneurysm shape, and aneurysm location. Logistic regression analysis further revealed that size ratio (OR 1.66; 95% CI 1.05 to 2.64), height–width ratio (OR 14.22; 95% CI 2.67 to 75.88), aneurysm inclination angle (OR 1.04; 95% CI 1.01 to 1.07), aneurysm shape (OR 4.68; 95% CI 2.44 to 8.98), and aneurysm location (OR 1.60; 95% CI 1.15 to 2.23) had the strongest independent correlation with ruptured IA. The ROC analysis showed that the size ratio and flow angle had the highest area under the curve, with values of 0.735 and 0.730, respectively.ConclusionsSize ratio, height–width ratio, aneurysm inclination angle, aneurysm shape, and aneurysm location might be important for discriminating between ruptured and unruptured aneurysms. Further investigation will determine whether these morphological parameters and anatomical locations will be reliable predictors of aneurysm rupture.
From particle counting to Gaussian tomography
Authors: Parthasarathy K. R. , Sengupta Ritabrata 
Published: January 2016

The momentum and position observables in an [Formula: see text]-mode boson Fock space [Formula: see text] have the whole real line [Formula: see text] as their spectrum. But the total number operator [Formula: see text] has a discrete spectrum [Formula: see text]. An [Formula: see text]-mode Gaussian state in [Formula: see text] is completely determined by the mean values of momentum and position observables and their covariance matrix which together constitute a family of [Formula: see text] real parameters. Starting with [Formula: see text] and its unitary conjugates by the Weyl displacement operators and operators from a representation of the symplectic group [Formula: see text] in [Formula: see text], we construct [Formula: see text] observables with spectrum [Formula: see text] but whose expectation values in a Gaussian state determine all its mean and covariance parameters. Thus measurements of discrete-valued observables enable the tomography of the underlying Gaussian state and it can be done by using five one-mode and four two-mode Gaussian symplectic gates in single and pair mode wires of [Formula: see text]. Thus the tomography protocol admits a simple description in a language similar to circuits in quantum computation theory. Such a Gaussian tomography applied to outputs of a Gaussian channel with coherent input states permit a tomography of the channel parameters. However, in our procedure the number of counting measurements exceeds the number of channel parameters slightly. Presently, it is not clear whether a more efficient method exists for reducing this tomographic complexity. As a byproduct of our approach an elementary derivation of the probability generating function of [Formula: see text] in a Gaussian state is given. In many cases the distribution turns out to be infinitely divisible and its underlying Lévy measure can be obtained. However, we are unable to derive the exact distribution in all cases. Whether this property of infinite divisibility holds in general is left as an open problem.
Compact and On-the-Fly Secure Dynamic Reconfiguration for Volatile FPGAs
Authors: Kashyap Hirak , Chaves Ricardo 
Published: January 2016

The dynamic partial reconfiguration functionality of FPGAs can be attacked, particularly when the FPGA is remotely located or the configuration bitstreams are sent through insecure networks. The existing FPGA technologies provide some built-in security mechanisms; however, these are often inadequate. The existing solutions still impose a significant impact on the reconfiguration process and on the available resources.
This article proposes a solution to improve the security of dynamic partial reconfiguration of FPGAs, without significantly affecting the reconfiguration performance. The proposed solution changes the encryption key of the remotely received bitstream by a randomly generated key, unique for each configuration, when storing them in the external unsecured memory. The native frame-wise error detection mechanism combined with an additional CBC-MAC authentication mechanism, allows for an improved countermeasure against replay attack and wrongful bitstream usage. The proposed solution introduces an overhead of 1% of the available resources on the target FPGA and provides the lowest impact on the reconfiguration process when compared to the state of the art, achieving a reconfiguration throughput of 2.5Gbps. Regarding the built-in security mechanism provided by the Xilinx FPGAs, the solution herein proposed provides better security and improves the reconfiguration performance by more than 3 times.
An Immune-Inflammation Gene Expression Signature in Prostate Tumors of Smokers
Authors: Prueitt Robyn L. , Wallace Tiffany A. , Glynn Sharon A. , Yi Ming , Tang Wei , Luo Jun , Dorsey Tiffany H. , Stagliano Katherine E. , Gillespie John W. , Hudson Robert S. , Terunuma Atsushi , Shoe Jennifer L. , Haines Diana C. , Yfantis Harris G. , Han Misop , Martin Damali N. , Jordan Symone V. , Borin James F. , Naslund Michael J. , Alexander Richard B. , Stephens Robert M. , Loffredo Christopher A. , Lee Dong H. , Putluri Nagireddy , Sreekumar Arun , Hurwitz Arthur A. , Ambs Stefan 
Published: January 2016

Abstract
Smokers develop metastatic prostate cancer more frequently than nonsmokers, suggesting that a tobacco-derived factor is driving metastatic progression. To identify smoking-induced alterations in human prostate cancer, we analyzed gene and protein expression patterns in tumors collected from current, past, and never smokers. By this route, we elucidated a distinct pattern of molecular alterations characterized by an immune and inflammation signature in tumors from current smokers that were either attenuated or absent in past and never smokers. Specifically, this signature included elevated immunoglobulin expression by tumor-infiltrating B cells, NF-κB activation, and increased chemokine expression. In an alternate approach to characterize smoking-induced oncogenic alterations, we also explored the effects of nicotine in human prostate cancer cells and prostate cancer–prone TRAMP mice. These investigations showed that nicotine increased glutamine consumption and invasiveness of cancer cells in vitro and accelerated metastatic progression in tumor-bearing TRAMP mice. Overall, our findings suggest that nicotine is sufficient to induce a phenotype resembling the epidemiology of smoking-associated prostate cancer progression, illuminating a novel candidate driver underlying metastatic prostate cancer in current smokers. Cancer Res; 76(5); 1055–65. ©2015 AACR.
Macrophage Infiltration and Alternative Activation during Wound Healing Promote MEK1-Induced Skin Carcinogenesis
Authors: Weber Christine , Telerman Stephanie B. , Reimer Andreas S. , Sequeira Ines , Liakath-Ali Kifayathullah , Arwert Esther N. , Watt Fiona M. 
Published: January 2016

Abstract
Macrophages are essential for the progression and maintenance of many cancers, but their role during the earliest stages of tumor formation is unclear. To test this, we used a previously described transgenic mouse model of wound-induced skin tumorigenesis, in which expression of constitutively active MEK1 in differentiating epidermal cells results in chronic inflammation (InvEE mice). Upon wounding, the number of epidermal and dermal monocytes and macrophages increased in wild-type and InvEE skin, but the increase was greater, more rapid, and more sustained in InvEE skin. Macrophage ablation reduced tumor incidence. Furthermore, bioluminescent imaging in live mice to monitor macrophage flux at wound sites revealed that macrophage accumulation was predictive of tumor formation; wounds with the greatest number of macrophages at day 5 went on to develop tumors. Gene expression profiling of flow-sorted monocytes, macrophages, and T cells from InvEE and wild-type skin showed that as wound healing progressed, InvEE macrophages altered their phenotype. Throughout wound healing and after wound closure, InvEE macrophages demonstrated sustained upregulation of several markers implicated in alternative macrophage activation including arginase-1 (ARG1) and mannose receptor (CD206). Notably, inhibition of ARG1 activity significantly reduced tumor formation and epidermal proliferation in vivo, whereas addition of L-arginase to cultured keratinocytes stimulated proliferation. We conclude that macrophages play a key role in early, inflammation-mediated skin tumorigenesis, with mechanistic evidence suggesting that ARG1 secretion drives tumor development by stimulating epidermal cell proliferation. These findings highlight the importance of cancer immunotherapies aiming to polarize tumor-associated macrophages toward an antitumor phenotype. Cancer Res; 76(4); 805–17. ©2016 AACR.
Skin Cancer Risk Is Modified by KIR/HLA Interactions That Influence the Activation of Natural Killer Immune Cells
Authors: Vineretsky Karin A. , Karagas Margaret R. , Christensen Brock C. , Kuriger-Laber Jacquelyn K. , Perry Ann E. , Storm Craig A. , Nelson Heather H. 
Published: January 2016

Abstract
Natural killer (NK)–cell phenotype is partially mediated through binding of killer-cell immunoglobulin-like receptors (KIR) with HLA class I ligands. The KIR gene family is highly polymorphic and not well captured by standard genome-wide association study approaches. Here, we tested the hypothesis that variations in KIR gene content combined with HLA class I ligand status is associated with keratinocyte skin cancers using a population-based study of basal cell carcinoma (BCC) and squamous cell carcinomas (SCC). We conducted an interaction analysis of KIR gene content variation and HLA-B (Bw4 vs. Bw6) and HLA-C (C1 vs. C2). KIR centromeric B haplotype was associated with significant risk of multiple BCC tumors (OR, 2.39; 95% confidence interval, 1.10–5.21), and there was a significant interaction between HLA-C and the activating gene KIR2DS3 for BCC (Pinteraction = 0.005). Furthermore, there was significant interaction between HLA-B and telomeric KIR B haplotype (containing the activating genes KIR3DS1 and KIR2DS1) as well as HLA-B and the activating KIR gene KIR2DS5 (Pinteraction 0.001 and 0.012, respectively). Similar but greatly attenuated associations were observed for SCC. Moreover, previous in vitro models demonstrated that p53 is required for upregulation of NK ligands, and accordingly, we observed there was a strong association between the KIR B haplotype and p53 alteration in BCC tumors, with a higher likelihood that KIR B carriers harbor abnormal p53 (P &lt; 0.004). Taken together, our data suggest that functional interactions between KIR and HLA modify risks of BCC and SCC and that KIR encoded by the B genes provides selective pressure for altered p53 in BCC tumors. Cancer Res; 76(2); 370–6. ©2016 AACR.