bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis
Authors: Gunn J K L , Rosales C B , Center K E , Nuñez A , Gibson S J , Christ C , Ehiri J E 
Published: April 2016

ObjectiveTo assess the effects of use of cannabis during pregnancy on maternal and fetal outcomes.Data sources7 electronic databases were searched from inception to 1 April 2014. Studies that investigated the effects of use of cannabis during pregnancy on maternal and fetal outcomes were included.Study selectionCase–control studies, cross-sectional and cohort studies were included.Data extraction and synthesisData synthesis was undertaken via systematic review and meta-analysis of available evidence. All review stages were conducted independently by 2 reviewers.Main outcomes and measuresMaternal, fetal and neonatal outcomes up to 6 weeks postpartum after exposure to cannabis. Meta-analyses were conducted on variables that had 3 or more studies that measured an outcome in a consistent manner. Outcomes for which meta-analyses were conducted included: anaemia, birth weight, low birth weight, neonatal length, placement in the neonatal intensive care unit, gestational age, head circumference and preterm birth.Results24 studies were included in the review. Results of the meta-analysis demonstrated that women who used cannabis during pregnancy had an increase in the odds of anaemia (pooled OR (pOR)=1.36: 95% CI 1.10 to 1.69) compared with women who did not use cannabis during pregnancy. Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR=1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight=109.42 g: 38.72 to 180.12) compared with infants whose mothers did not use cannabis during pregnancy. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21).Conclusions and relevanceUse of cannabis during pregnancy may increase adverse outcomes for women and their neonates. As use of cannabis gains social acceptance, pregnant women and their medical providers could benefit from health education on potential adverse effects of use of cannabis during pregnancy.
Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry
Authors: Beck Ben , Bray Janet , Smith Karen , Walker Tony , Grantham Hugh , Hein Cindy , Thorrowgood Melanie , Smith Anthony , Smith Tony , Dicker Bridget , Swain Andy , Bailey Mark , Bosley Emma , Pemberton Katherine , Cameron Peter , Nichol Graham , Finn Judith 
Published: April 2016

IntroductionOut-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consortium (Aus-ROC) OHCA epidemiological registry (Epistry).Methods and analysisThe Aus-ROC Epistry is designed as a population-based cohort study. Data collection started in 2014. Six ambulance services in Australia (Ambulance Victoria, SA Ambulance Service, St John Ambulance Western Australia and Queensland Ambulance Service) and New Zealand (St John New Zealand and Wellington Free Ambulance) currently contribute data. All OHCA attended by ambulance, regardless of aetiology or patient age, are included in the Epistry. The catchment population is approximately 19.3 million persons, representing 63% of the Australian population and 100% of the New Zealand population. Data are collected using Utstein-style definitions. Information incorporated into the Epistry includes demographics, arrest features, ambulance response times, treatment and patient outcomes. The primary outcome is ‘survival to hospital discharge’, with ‘return of spontaneous circulation’ as a key secondary outcome.Ethics and disseminationEthics approval was independently sought by each of the contributing registries. Overarching ethics for the Epistry was provided by Monash University HREC (Approval No. CF12/3938—2012001888). A population-based OHCA registry capturing the majority of Australia and New Zealand will allow risk-adjusted outcomes to be determined, to enable benchmarking across ambulance providers, facilitate the identification of system-wide strategies associated with survival from OHCA, and allow monitoring of temporal trends in process and outcomes to improve patient care. Findings will be shared with participating ambulance services and the academic community.
Improving acute medical management: Junior Doctor Emergency Prescription Cards
Authors: Hutton Joe , Gingell Megan , Hutchinson Lisa 
Published: April 2016

Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways.We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines.Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC “usability”. To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12).The EPCs were well received (80% quite/very useful) and found “easy to use” (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97.7%).The EPCs support the management of unwell patients, are relevant to the workload of modern doctors practice and may improve patient care. This improvement measure could be applied to other NHS trusts and medical specialties.
Improving the uptake and comprehensiveness of bedside cognitive testing amongst liaison psychiatrists over an eight-month period.
Authors: McCormack Ruaidhri 
Published: April 2016

The aim of this quality improvement (QI) project was to improve the uptake and comprehensiveness of bedside cognitive testing amongst liaison psychiatrists over an eight month period.The baseline measurement involved an audit of the practice of the neuropsychiatry liaison team over six months at the 840 bed St Thomas's Hospital in London, UK. Of 35 referrals, 21 patients were able, and suitable, for cognitive testing based on the referral data and clinical interview. Fourteen (66.6%) of these patients had an Addenbrooke's Cognitive Examination (ACE), while 5 (23.8%) had frontal testing. The frontal tests performed were variable and inconsistent.Two Plan-Do-Study-Act (PDSA) cycles were then conducted. Clear guidance was issued to the team on the use of the ACE or Montreal Cognitive Assessment (MoCA) in suitable patients, and how these can be supplemented by frontal testing. Given the inconsistency in the types and combination of frontal tests being conducted at baseline, a frontal lobe test sheet containing established tests was developed and implemented. In PDSA cycle 1, 100% (n=10) of able and suitable referrals had an ACE or MoCA while 100% had frontal testing (80% of these using the dedicated test sheet). In PDSA cycle 2, improvements were broadly maintained with 85.7% (n=6) of referrals having an ACE/MoCA and 85.7% having frontal testing (83.3% of these using the dedicated frontal test sheet). In conclusion, our team improved the uptake and comprehensiveness of bedside cognitive testing by changing existing practice with clear protocols regarding the use of the ACE/MoCA and the implementation of a frontal test sheet.
Improving Weekend Out Of hours Surgical Handover (WOOSH)
Authors: Boyer Melissa , Tappenden Janine , Peter Mark 
Published: April 2016

An effective surgical handover is imperative to optimise patient care and safety, whilst ensuring progression of clinical management and the delivery of an efficient service. The introduction of full-shift working, as a response to progressive implementation of the European Working Time Directive (EWTD), has placed the spotlight on patient and doctor safety. Effective handover between shifts is vital to protect patient safety and assist doctors with clinical governance. The weekend is a critical point where the transfer of patient care to the ongoing weekend team is efficient, thorough and informative, as this is a point in the patient journey where the patient is the most vulnerable. The weekend team is often not responsible for the management of the patient throughout the week and poor or incomplete information can have disastrous consequences on patient safety. (1,2,3)There is a general consensus and anecdotal evidence that this process is variable, occasionally unsafe or of poor quality, and can be improved. (4,5,6,7,8,9,10,11) However, no standardised format is deemed optimal or available. The aim therefore, was to design and implement a weekend handover proforma, in order to deliver a more efficient and safer system for patient care over the weekend without increasing junior doctor workload. The Weekend Out Of Hours Surgical Handover (WOOSH) form was designed following consultation with medical, nursing and allied health professionals. All staff were instructed how to complete the form, with pre- and post-intervention questionnaires undertaken.The results of the study enforce and advocate the permanent practice of the WOOSH form with 93.33% endorsing the permanent introduction of the form and 100% finding the form useful.
Improving cranial ultrasound scanning strategy in neonates
Authors: Bray Lisa 
Published: April 2016

Cranial ultrasound scans are undertaken in this tertiary neonatal intensive care unit by the doctors within the department. A quality improvement project was undertaken by means of two PDSA cycles to determine adherence to neonatal cranial ultrasound scanning schedule, assess the quality of scan reporting, and formulate a comprehensive guideline outlining best practice. The baseline measurements assessed 93 scans of preterm infants and 9 of term infants. The results of this prompted intradepartmental education (PDSA cycle 1) then creation and implementation of a documentation template, a local guideline, and education via presentations, posters, and email (PDSA cycle 2). These encompassed 77 preterm and 5 term scans. In our baseline measurements, 52% of preterm infant scans and 44% of term infant scans were performed to schedule. Of premature baby scan reports, 75% had the time documented and 92% the name of the scanning doctor. After implementing changes PDSA cycle 2 data showed that 74% of preterm infant scans and all term infant scans were performed according to schedule, with 100% having the doctor's name and time of scan documented.We successfully introduced a guideline and documentation template, improving performance to schedule and documentation in most areas. It remains an ongoing challenge to adhere to basic standards of documentation; a template can assist in achieving this. Rotating trainees may offer insight into areas that could benefit from quality improvement. This enthusiasm can be successfully harnessed to implement changes to improve quality of patient care.
Long-term risk of atrial fibrillation after the death of a partner
Authors: Graff Simon , Fenger-Grøn Morten , Christensen Bo , Pedersen Henrik Søndergaard , Christensen Jakob , Li Jiong , Vestergaard Mogens 
Published: April 2016

ObjectivesSevere psychological stress is generally associated with an increased risk of acute cardiovascular diseases, such as myocardial infarction, but it remains unknown whether it also applies to atrial fibrillation. We conducted a population-based case–control study using nationwide Danish health registers to examine the risk of atrial fibrillation after the death of a partner.MethodsFrom 1995 through 2014, we identified 88 612 cases with a hospital diagnosis of atrial fibrillation and 886 120 age-matched and sex-matched controls based on risk-set sampling. The conditional logistic regression model was used to calculate adjusted ORs of atrial fibrillation with 95% CIs.ResultsPartner bereavement was experienced by 17 478 cases and 168 940 controls and was associated with a transiently higher risk of atrial fibrillation; the risk was highest 8–14 days after the loss (1.90; 95% CI 1.34 to 2.69), after which it gradually declined. One year after the loss, the risk was almost the same as in the non-bereaved population. Overall, the OR of atrial fibrillation within 30 days after bereavement was 1.41 (95% CI 1.17 to 1.70), but it tended to be higher in persons below the age of 60 years (2.34; 95% CI 1.02 to 5.40) and in persons whose partner had a low predicted mortality 1 month before the death, that is, ≤5 points on the age-adjusted Charlson Comorbidity Index (1.57; 95% CI 1.13 to 2.17).ConclusionsThe severely stressful life event of losing a partner was followed by a transiently increased risk of atrial fibrillation lasting for 1 year, especially for the least predicted losses.
Phantom smoking among young adult bar patrons
Authors: Guillory Jamie , Lisha Nadra , Lee Youn Ok , Ling Pamela M 
Published: April 2016

ObjectiveTo explore the prevalence and sociodemographic makeup of smokers who do not self-identify as smokers (ie, phantom smokers) compared with self-identifying smokers in a sample of bar-going young adults aged 18–30 years to more accurately assess young adult prevalence of smoking and inform cessation message targeting.MethodsCross-sectional surveys of smokers (n=3089) were conducted in randomly selected bars/nightclubs in seven US cities. Logistic regression models assessed associations between phantom smoking (past 30-day smoking and denial of being a smoker), tobacco and alcohol use behaviours (eg, social smoking, nicotine dependence, smoking while drinking, past 30-day alcohol use) and demographics.ResultsCompared with smokers, phantom smokers were more likely to be college graduates (OR=1.43, 95% CI 1.03 to 1.98) and to identify themselves as social smokers (OR=1.60, 95% CI 1.27 to 2.12). Phantom smokers had lower odds of smoking while drinking (OR=0.28, 95% CI 0.25 to 0.32), being nicotine dependent (OR=0.36, 95% CI 0.22 to 0.76) and having quit for at least 1 day in the last year (OR=0.46, 95% CI 0.36 to 0.69) compared with smokers.ConclusionsThis research extends phantom smoking literature on college students to provide a broader picture of phantom smoking among young adults in high-risk contexts and of varying levels of educational attainment. Phantom smokers may be particularly sensitive to social pressures against smoking, suggesting the importance of identifying smoking as a behaviour (rather than identity) in cessation messaging to ensure that phantom smokers are reached.
Channeling radiation of multi-GeV positrons in single crystals
Authors: Chirkov P. N. , Chesnokov Y. A. , Maisheev V. A. , Bolognini D. , Hasan S. , Prest M. , Vallazza E. 
Published: April 2016

The process of radiation of 120 GeV positrons moving in a channeling regime in (011) plane of a single crystal was considered. At the beginning on the basis of the theory of nonlinear oscillations, the trajectory of moving positrons at different initial conditions was derived. Then taking into account the nonlinearity of motion, the distribution function over oscillation amplitudes of channeling particles was found. After this, the intensity of radiation at different initial conditions was calculated with the help of two various methods. These results may be useful for comparison with experimental data at positron energies from 100 and more GeV.
Toward Improving Ice Water Content and Snow-Rate Retrievals from Radars. Part I: X and W Bands, Emphasizing CloudSat
Authors: Heymsfield Andrew J. , Matrosov Sergey Y. , Wood Norman B. 
Published: April 2016

AbstractMicrophysical data and radar reflectivities (Ze, −15 < Ze < 10 dB) measured from flights during the NASA Tropical Clouds, Convection, Chemistry and Climate field program are used to relate Ze at X and W band to measured ice water content (IWC). Because nearly collocated Ze and IWC were each directly measured, Ze–IWC relationships could be developed directly. Using the particle size distributions and ice particle masses evaluated based on the direct IWC measurements, reflectivity–snowfall rate (Ze–S) relationships were also derived. For −15 < Ze < 10 dB, the relationships herein yield larger IWC and S than given by the retrievals and earlier relationships. The sensitivity of radar reflectivity to particle size distribution and size-dependent mass, shape, and orientation introduces significant uncertainties in retrieved quantities since these factors vary substantially globally. To partially circumvent these uncertainties, a W-band Ze–S relationship is developed by relating four years of global CloudSat reflectivity observations measured immediately above the melting layer to retrieved rain rates at the base of the melting layer. The supporting assumptions are that the water mass flux is constant through the melting layer, that the air temperature is nearly 0°C, and that the retrieved rain rates are well constrained. Where Ze > 10 dB, this Ze–S relationship conforms well to earlier relationships, but for Ze < 10 dB it yields higher IWC and S. Because not all retrieval algorithms estimate either or both IWC and S, the authors use a large aircraft-derived dataset to relate IWC and S. The IWC can then be estimated from S and vice versa.
Robust Wind and Precipitation Responses to the Mount Pinatubo Eruption, as Simulated in the CMIP5 Models
Authors: Barnes Elizabeth A. , Solomon Susan , Polvani Lorenzo M. 
Published: April 2016

Abstract
The volcanic eruption of Mount Pinatubo in June 1991 is the largest terrestrial eruption since the beginning of the satellite era. Here, the monthly evolution of atmospheric temperature, zonal winds, and precipitation following the eruption in 14 CMIP5 models is analyzed and strong and robust stratospheric and tropospheric circulation responses are demonstrated in both hemispheres, with tropospheric anomalies maximizing in November 1991. The simulated Southern Hemisphere circulation response projects strongly onto the positive phase of the southern annular mode (SAM), while the Northern Hemisphere exhibits robust North Atlantic and North Pacific responses that differ significantly from that of the typical northern annular mode (NAM) pattern. In contrast, observations show a negative SAM following the eruption, and internal variability must be considered along with forced responses. Indeed, evidence is presented that the observed El Niño climate state during and after this eruption may oppose the eruption-forced positive SAM response, based on the El Niño–Southern Oscillation (ENSO) state and SAM response across the models. The results demonstrate that Pinatubo-like eruptions should be expected to force circulation anomalies across the globe and highlight that great care must be taken in diagnosing the forced response as it may not fall into typical seasonal averages or be guaranteed to project onto typical climate modes.
On the Abruptness of Bølling–Allerød Warming
Authors: Su Zhan , Ingersoll Andrew P. , He Feng 
Published: April 2016

Abstract
Previous observations and simulations suggest that an approximate 3°–5°C warming occurred at intermediate depths in the North Atlantic over several millennia during Heinrich stadial 1 (HS1), which induces warm salty water (WSW) lying beneath surface cold freshwater. This arrangement eventually generates ocean convective available potential energy (OCAPE), the maximum potential energy releasable by adiabatic vertical parcel rearrangements in an ocean column. The authors find that basin-scale OCAPE starts to appear in the North Atlantic (~67.5°–73.5°N) and builds up over decades at the end of HS1 with a magnitude of about 0.05 J kg−1. OCAPE provides a key kinetic energy source for thermobaric cabbeling convection (TCC). Using a high-resolution TCC-resolved regional model, it is found that this decadal-scale accumulation of OCAPE ultimately overshoots its intrinsic threshold and is released abruptly (~1 month) into kinetic energy of TCC, with further intensification from cabbeling. TCC has convective plumes with approximately 0.2–1-km horizontal scales and large vertical displacements (~1 km), which make TCC difficult to be resolved or parameterized by current general circulation models. The simulation herein indicates that these local TCC events are spread quickly throughout the OCAPE-contained basin by internal wave perturbations. Their convective plumes have large vertical velocities (~8–15 cm s−1) and bring the WSW to the surface, causing an approximate 2°C sea surface warming for the whole basin (~700 km) within a month. This exposes a huge heat reservoir to the atmosphere, which helps to explain the abrupt Bølling–Allerød warming.