bluuebunny/crossref_metadata_2025_split huggingface dataset:
LEVEL OF SEPSIS KNOWLEDGE IN UK AMBULANCE SERVICES
Authors: Murphy-Jones Barry , Shaw Joanna 
Published: August 2016

BackgroundSepsis is responsible for over 37,000 deaths a year in the UK, with long term morbidity consequences for survivors. More than 40% of cases develop within the community, making the ambulance service vitally important. This project sought to ascertain the current level of sepsis knowledge in UK ambulance services to better understand potential knowledge gaps.MethodsThis observational study used an online questionnaire to describe the level of knowledge of sepsis and how it is recognised and managed in the pre-hospital setting. A convenience sample of clinicians at one ambulance service was invited to complete a questionnaire which consisted of ten questions and was hosted on the web-based tool SurveyMonkey®. One hundred and seventy-one complete responses were received from ambulance staff (response rate 5.4%) and data were entered into Microsoft Excel and analysed using descriptive statistics.ResultsThe questionnaire identified 59% of respondents (n=100) had heard of the terms sepsis and systemic inflammatory response syndrome, with 23% (n=40) identifying all three stages of sepsis. Sixty-nine per cent of respondents (n=118) identified the correct definition of sepsis, and 23% (n=39) believed this definition was used in the pre-hospital setting.Four per cent of respondents (n=7) identified all of the common signs and symptoms and 22% (n=37) knew all of the pre-hospital interventions for severe sepsis and septic shock. Finally, 71% (n=121) agreed paramedics could identify patients at high risk of sepsis, with 94% (n=161) agreeing pre-hospital recognition and interventions may improve outcomes for sepsis.ConclusionsFindings showed poor knowledge of sepsis, its recognition and pre-hospital management which is supported by other literature. As a result, a mandatory training programme has been delivered and a sepsis screening tool, including prompts for appropriate management, has been produced. A continuous clinical audit will also be introduced to understand how this knowledge is applied in practice.
PARAMEDIC RESUSCITATION DECISION-MAKING IN OUT OF HOSPITAL CARDIAC ARREST: AN EXPLORATORY STUDY
Authors: Brandling Janet , Kirby Kim , Black Sarah , Voss Sarah , Benger Jonathan 
Published: August 2016

BackgroundThere are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. This study explored the influences on paramedic decision-making when commencing and ceasing resuscitation attempts in OHCA.MethodsFour focus groups were convened with 16 clinically active paramedics from emergency response vehicles and specialist teams as well as teaching and management staff. Four case vignettes were discussed in these focus groups to explore paramedic decision-making. The initial three focus groups were formulated to test and refine the research methodology and consisted of non-standard paramedics (i.e. those in management, teaching or specialist paramedic roles). The final focus group consisted of ‘standard’ paramedics. The focus group discussions were audio recorded and transcribed in full. Thematic analysis was used after the focus groups had taken place and for final reporting.ResultsThere are three stages in the paramedic decision-making process when deciding whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These are: factual information available to the paramedic; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. Variations in context and circumstance are vast, and therefore simple guidance cannot suit every case.ConclusionsAn improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in practice could inform the development of more effective guidelines, leading to greater consistency and paramedic confidence, with the potential for improved patient outcome.
TIMELY SOCIAL CARE AND EMERGENCY HOSPITAL ADMISSIONS
Authors: Porter Alison , Bardsley Martin , Ford David , Grenfell John , Heaven Martin , Morrison-Rees Sian , Oades Judith , Sewell Bernadette , Tingay Karen , Watkins Alan 
Published: August 2016

BackgroundAppropriate and timely social care can potentially delay or avoid the need for interventions such as emergency hospitalisation. Routine data provides scope to examine the relationship between emergency hospital admissions in Wales and local authority-supported social care for people aged 65 and over.MethodsThis observational study employed mixed methods for data collection and analysis covering the period January 2006 to December 2012. We used interrupted time series analyses to study overall trends in the use of social care and unplanned use of secondary care across Wales. Within one case study area, we used the SAIL database to link health and social care data anonymously, to examine service use at an individual level.ResultsAt an all-Wales level, we observed no relationship between trends in health care and social care for older people.In our case study area, we examined data on ‘qualifying emergency admissions’ (QEAs), that is, the first emergency admission to hospital in the study period for a person aged 65 or over. Over the study period, about four-fifths of all the people receiving social care (n=10,864) also had a QEA.We compared those receiving social care before the QEA (n=3362) with those who received social care only after their QEA (n=7478). Those receiving social care before the QEA were likely to:▸ have fewer subsequent admissions (1.4 v 2.9, p<0.01).▸ have a shorter length of stay for all subsequent admissions (41.5 v 66.4 days, p<0.01)ConclusionsAnonymously linking health and social care data for research is feasible and has potential for being taken further. Linked data reveals more about the relationship between health and social care use than unlinked data sets.Social care appears targeted appropriately at the frailest older people, and seems to have a protective effect in reducing emergency admissions and length of stay following an admission.
RAPID INTERVENTION WITH GLYCERYL TRINITRATE IN HYPERTENSIVE STROKE TRIAL-2 (RIGHT-2): SAFETY AND EFFICACY OF TRANSDERMAL GLYCERYL TRINITRATE, A NITRIC OXIDE DONOR
Authors: Bath Philip M W , Dixon Mark , Appleton Jason , Scutt Polly , England Timothy , Foster Hayley , Howard Harriet , Jarvis Malcolm , Montgomery Alan , Pocock Stuart , Potter John , Price Christopher , Robinson Tom , Roffe Christine , Siriwardena A Niro , Sprigg Nikola , Wardlaw Joanna 
Published: August 2016

RationaleHigh blood pressure (BP) is common in acute stroke and is associated with poor outcome. Previous hospital-based trials testing the effects of BP lowering on functional outcome have been inconclusive. The PIL-FAST and RIGHT pilot trials confirmed the feasibility of performing single-centre ambulance-based stroke trials in the UK. In both RIGHT and a subgroup of patients recruited within 6 hours into the large ENOS trial, transdermal glyceryl trinitrate (GTN), a nitric oxide donor, lowered BP and reduced death or disability. Based on these results, RIGHT-2 aims to test the safety and efficacy of transdermal GTN in the pre-hospital setting.MethodsParamedics from 7 UK ambulance services serving 40 comprehensive or primary stroke care centres will screen, consent, randomise and treat 850 patients presenting within 4 hours of FAST-positive stroke and with systolic BP >120 mm Hg. Treatment will comprise GTN or similar sham patch, and will be continued in hospital for 3 days. The primary outcome will be the modified Rankin Scale at day 90. Secondary outcomes include vascular events, disability, quality of life, mood and cognition. Neuroimaging and biomarkers will examine potential mechanisms of action.StatusRecruitment commenced in October 2015. Challenges with the trial and baseline characteristics of the first recruited patients will be presented.FundingBritish Heart Foundation.
PARAMEDIC SUPPLIED “TAKE HOME” NALOXONE: A RANDOMISED FEASIBILITY STUDY
Authors: Moore Chris , Lloyd Greg , Oretti Rosanna , Russell Ian T , Snooks Helen 
Published: August 2016

Introduction“Take Home” Naloxone (THN) kits for use in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for opioid overdose presents an opportunity to distribute THN kits. This feasibility study will assess the acceptability of THN, and gather data to inform definitive trial planning.Methods and analysisCluster randomised trial with staggered allocation of paramedics (clusters) to groups. Paramedics in an urban area of south Wales, UK were invited to take part and randomly allocated to training. Patients attended by trained paramedics and issued THN kits fell into the intervention group. Patients attended by paramedics following usual practice (until they received their training) fell into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended Emergency Department, suffered further overdose, died within 12 months; and about follow up rates: numbers of patients consented, completed questionnaire (postal or telephone). We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups.Preliminary findings (unvalidated data)85 of 102 eligible paramedics took part. The number of opioid related EMS contacts (n=215), exceeded the number predicted (100–120) for the 12-months period. Of the 182 cases attended by study paramedics, 148 were attended by trained paramedics. 35 of the 55 patients eligible for the intervention were offered it. 25 accepted the intervention, received training and a THN kit. As anticipated, follow-up of participants proved challenging. Of the 215 events for which we have data, 58 were repeat episodes involving 25 individual users. The number of repeat encounters experienced by these individuals ranged from 2 to 5. Six deaths were recorded during the study period.
HOME OR HOSPITAL FOR PEOPLE WITH DEMENTIA AND ONE OR MORE OTHER MULTIMORBIDITIES: WHAT IS THE POTENTIAL TO REDUCE AVOIDABLE EMERGENCY ADMISSIONS?
Authors: Voss Sarah , Benger Jonathan , Black Sarah , Brandling Janet , Buswell Marina , Cheston Richard , Kirby Kim , Purdy Sarah 
Published: August 2016

Older people with multiple health problems often call a 999 ambulance. Where one of these health problems is dementia, the risk of ambulance use, A&E attendance and hospital admission are all increased. It is important to try and reduce this, as patients with dementia tend to have poor outcomes when they are taken to A&E or admitted to hospital unnecessarily.This study aims to find out why older people with multiple health issues including dementia are taken to hospital by ambulance, instead of being treated in the community. This will build on earlier work to find the true burden of dementia on pre-hospital care. It will look at the length of time paramedics spend at the scene, factors guiding the decision to transport and alternatives to A&E visits and hospital admissions.There will be 3 phases of work:Phase 1: Analysis of existing ambulance service data from previous 999 calls.Phase 2: Observations of ambulance call-outs to patients with multiple health problems including dementia.Phase 3: An assessment of what could be provided in the community to avoid hospital admission.This proposal is part of an overall research plan, and will inform further investigations and future service delivery. We plan to study issues specific to the ambulance service that reduce or increase the risk of someone with dementia and other long-term health conditions requiring hospital care, rather than being looked after in or close to their own home. It contributes to a larger piece of work developing and evaluating safe and effective alternatives to hospital admission for people with dementia. This will lead to a reduction in the number of avoidable emergency admissions, and better patient outcomes, for example through the introduction of rapid response health and social care teams as described in the NHS Five Year Forward View (2014).
PREHOSPITAL RISK STRATIFICATION USING A MODIFIED THROMBOLYSIS IN MYOCARDIAL INFARCTION (PRISM TIMI) SCORE: A RETROSPECTIVE MEDICAL RECORD REVIEW
Authors: Reed Ashley 
Published: August 2016

BackgroundParamedics convey patients with non-ST elevation acute coronary syndrome (NSTEACS) to emergency departments (EDs). The patient should be risk stratified using a risk stratification model (RSM) in the ED to determine the risk of death or adverse cardiovascular events. This determines if the patient should be transferred to a specialist heart attack centre (HAC) for an invasive procedure. If paramedics were to risk stratify the patients in the prehospital environment using a Modified Thrombolysis in Myocardial Infarction (MTIMI) RSM this could result in primary triage to an appropriate hospital. This could reduce secondary transfers, decrease demand on EDs, provide better patient care, reduce length of hospital stay and could provide cost savings to the National Health Service.AimTo determine if paramedics' use of a MTIMI RSM is more accurate than current practice at identifying and risk stratifying patients suffering from suspected high risk NSTEACS.MethodsA retrospective medical record review.Results108 patient notes were used in this study, 84 from the ED and 24 from the HAC. Current practice produced a c-statistic (c) of 0.73 (95% Confidence Interval (CI) 0.62 to 0.85) and the MTIMI RSM (c=0.72, 0.61 to 0.83). The best RSM overall was the abbreviated MTIMI RSM with only three variables identified through logistic regression [diabetes mellitus, over 65 years and the electrocardiogram (ECG)] (c=0.79, 0.68 to 0.89).ConclusionsThe main reason that current practice was similar to the MTIMI RSM was that they both used the ECG variable, which alone was approximately twelve times more prognostic than any other variable. The need to identify a RSM with a good prognostic power that can be used in the prehospital environment still exists. Therefore, other RSMs should be explored in a prospective study.
Orthopaedic interventions in patients with psoriatic arthritis: a descriptive report from the SPAR cohort
Authors: Haque Naba , Lories Rik J , de Vlam Kurt 
Published: August 2016

ObjectivesTo evaluate the current needs for joint surgery in patients with psoriatic arthritis (PsA).MethodsThe patient database at the Rheumatology Department of the University Hospitals Leuven, was cross-sectionally analysed using demographic, medical, laboratory, radiological and surgical data of 269 patients with PsA. Patients were grouped by the presence or absence of orthopaedic surgery and compared for gender, age, mean health assessment questionnaire (HAQ) score, current medication and disease duration. The data were assessed using descriptive statistics and Student's t-tests.ResultsOverall 48.33% of the patients underwent 1 or more orthopaedic surgeries at some point of time. A total of 280 surgical interventions were flagged in the database, including both joint sacrificing and non-joint sacrificing procedures. Mean disease duration±SD at the time of surgery was 1.58 years±12.05. Age of the patients with surgeries was 54.13 years±11.03 SD and not different from those without surgeries (53.73 years±12.81 SD; p=0.78). 41.54% of the patients underwent a single surgery while 58.46% had multiple surgeries. A significant difference in the mean HAQ score was observed among the patients with and without surgeries (p<0.001). Of all the surgeries 63.92% were performed after diagnosis whereas 36.07% were performed before a diagnosis of PsA was made. Among the surgeries performed before diagnosis 40.59% were arthroscopies including 9.90% of diagnostic arthroscopies.ConclusionsThe number of surgical interventions has significantly increased in patients with PsA compared with historical cohorts even with a relatively shorter disease duration. There was a significant difference in HAQ score between the patients with or without surgeries.
History of hydrothermal fluid flow in the midcontinent, USA: the relationship between inverted thermal structure, unconformities and porosity distribution
Authors: King Bradley D. , Goldstein Robert H. 
Published: August 2016

Abstract

A comprehensive study of the Cambrian–Ordovician Arbuckle Group suggests that multiple fluid migration events have affected reservoir porosity via fractures and preferred stratigraphic horizons. Fluid inclusion homogenization temperatures from late-stage precipitates yield temperatures higher than can be explained by burial conditions or an elevated geothermal gradient. Fluid inclusion melting temperatures yield salinity values that indicate multiple fluids evolving through time. Hydrocarbon fluid inclusions in late-stage baroque dolomite suggest oil migration concurrent with hydrothermal fluid flow. Depleted δ
13
C and δ
18
O values provide evidence for a high-temperature basinal fluid source as well as for the preferential flow of hydrothermal fluids through permeable zones in the Mississippian and Arbuckle Group, where pore systems related to paleokarst are overlain by less permeable units. Radiogenic strontium isotopic data support fluid–rock interaction with siliciclastic material or basement rock at some point during the fluid migration history. Variable
87
Sr/
86
Sr values suggest multiple sources for the fluids responsible for the cements and a transition from an advective fluid flow system to a vertical fluid flow system. The ancient aquifer system was vertically connected during migration of hydrothermal fluids, and a temperature-controlled vertical density gradient appears to have played an important role in late-stage porosity evolution, focusing the hottest fluids in the upper sections of permeable layers.
Improving the Performance of Somatic Mutation Identification by Recovering Circulating Tumor DNA Mutations
Authors: Fu Yu , Jovelet Cécile , Filleron Thomas , Pedrero Marion , Motté Nelly , Boursin Yannick , Luo Yufei , Massard Christophe , Campone Mario , Levy Christelle , Diéras Véronique , Bachelot Thomas , Garrabey Julie , Soria Jean-Charles , Lacroix Ludovic , André Fabrice , Lefebvre Celine 
Published: August 2016

Abstract
DNA extracted from cancer patients' whole blood may contain somatic mutations from circulating tumor DNA (ctDNA) fragments. In this study, we introduce cmDetect, a computational method for the systematic identification of ctDNA mutations using whole-exome sequencing of a cohort of tumor and corresponding peripheral whole-blood samples. Through the analysis of simulated data, we demonstrated an increase in sensitivity in calling somatic mutations by combining cmDetect to two widely used mutation callers. In a cohort of 93 breast cancer metastatic patients, cmDetect identified ctDNA mutations in 54% of the patients and recovered somatic mutations in cancer genes EGFR, PIK3CA, and TP53. We further showed that cmDetect detected ctDNA in 89% of patients with confirmed mutated cell–free tumor DNA by plasma analyses (n = 9) within 46 pan-cancer patients. Our results prompt immediate consideration of the use of this method as an additional step in somatic mutation calling using whole-exome sequencing data with blood samples as controls. Cancer Res; 76(20); 5954–61. ©2016 AACR.
Targeting Alpha-Fetoprotein (AFP)–MHC Complex with CAR T-Cell Therapy for Liver Cancer
Authors: Liu Hong , Xu Yiyang , Xiang Jingyi , Long Li , Green Shon , Yang Zhiyuan , Zimdahl Bryan , Lu Jingwei , Cheng Neal , Horan Lucas H. , Liu Bin , Yan Su , Wang Pei , Diaz Juan , Jin Lu , Nakano Yoko , Morales Javier F. , Zhang Pengbo , Liu Lian-xing , Staley Binnaz K. , Priceman Saul J. , Brown Christine E. , Forman Stephen J. , Chan Vivien W. , Liu Cheng 
Published: August 2016

Abstract
Purpose: The majority of tumor-specific antigens are intracellular and/or secreted and therefore inaccessible by conventional chimeric antigen receptor (CAR) T-cell therapy. Given that all intracellular/secreted proteins are processed into peptides and presented by class I MHC on the surface of tumor cells, we used alpha-fetoprotein (AFP), a specific liver cancer marker, as an example to determine whether peptide–MHC complexes can be targets for CAR T-cell therapy against solid tumors.
Experimental Design: We generated a fully human chimeric antigen receptor, ET1402L1-CAR (AFP-CAR), with exquisite selectivity and specificity for the AFP158–166 peptide complexed with human leukocyte antigen (HLA)-A*02:01.
Results: We report that T cells expressing AFP-CAR selectively degranulated, released cytokines, and lysed liver cancer cells that were HLA-A*02:01+/AFP+ while sparing cells from multiple tissue types that were negative for either expressed proteins. In vivo, intratumoral injection of AFP-CAR T cells significantly regressed both Hep G2 and AFP158-expressing SK-HEP-1 tumors in SCID-Beige mice (n = 8 for each). Moreover, intravenous administration of AFP-CAR T cells in Hep G2 tumor-bearing NSG mice lead to rapid and profound tumor growth inhibition (n = 6). Finally, in an established intraperitoneal liver cancer xenograft model, AFP-CAR T cells showed robust antitumor activity (n = 6).
Conclusions: This study demonstrates that CAR T-cell immunotherapy targeting intracellular/secreted solid tumor antigens can elicit a potent antitumor response. Our approach expands the spectrum of antigens available for redirected T-cell therapy against solid malignancies and offers a promising new avenue for liver cancer immunotherapy. Clin Cancer Res; 23(2); 478–88. ©2016 AACR.