bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving combined contraceptive pill/oral contraceptives prescribing in general practice
Authors: Russell Sophie , Wiles Helen 
Published: October 2017

IntroductionEighty per cent of contraceptive care occurs in the general practice setting. UK Medical Eligibility Criteria provides clear guidelines for the safe provision of appropriate contraception. The Faculty of Sexual and Reproductive Health and the National Institute for Health and Care Excellence offer further recommendations for initiation and continuation of the combined contraceptive pill/oral contraceptives.Method and analysisUsing the Egton Medical Information Systems database of an inner city, average size general practice we performed a retrospective analysis of combined contraceptive pill/oral contraceptives consultations to identify areas of substandard prescribing. Through three subsequent improvement cycles we demonstrated that the safety of combined contraceptive pill/oral contraceptives prescribing could be enhanced by consistent application of UK Medical Eligibility Criteria. By encouraging general practitioners to promote safe sex and use local long-acting reversible contraception options we were able to enhance the quality of consultations as dictated by national guidelines. Regular education and use of an amended EMIS template (to include UK Medical Eligibility Criteria) enabled us to improve both the safety and quality of community-combined contraceptive pill/oral contraceptives prescribing in a sustainable fashion.
Improvement in patient and physician notification of cardiac rhythm device report transmissions
Authors: Czosek Richard J , Brown James , Proctor Diane , Koch Paula , Martin Michelle , Rust Mary , Anderson Jeffrey B 
Published: October 2017

BackgroundCardiac rhythm devices (CRD) require complex management to identify potential device or patient issues. While easy to obtain, report processing is complex and time consuming. In our population, a majority of reports were performed outside of institutional protocols and no method for electrophysiology (EP) notification for unscheduled reports existed. These process breakdowns led to potential issues with safety and associated loss of work efficiency.ObjectiveOur aim was to decrease the percentage of reports without EP notification from 30% to 10% over a 9-month time period.MethodsWe created a detailed process map of in-office and home device reporting. Failure mode and effects analysis (FMEA)/Pareto charts were used to determine the mechanistic underpinnings of notification failures and identify areas for process improvement. Multiple interventions were implemented using the Plan-Do-Study-Act (PDSA) technique. Process run charts and control charts were used to evaluate ongoing changes.ResultsOur FMEA identified failures related to (1) lack of physician understanding of the device reporting system, (2) lack of an easy to use method of EP notification and (3) lack of patient understanding of report notification. Pareto charts identified the most frequent failures to be associated with specific cardiology subspecialties as well as reports sent from home. We performed multiple interventions including(1) creation of an easy to use method of EP notification used by patients and medical staff, (2) physician education and (3) patient education. Compared with baseline reporting, there was a decrease from 30% to <10% of device reports obtained without EP notification. This process improvement additionally resulted in a 34% reduction in time required for device processing.ConclusionsDevelopment of a unified EP reporting system and quality improvement methodology resulted in improved CRD report notification and improved efficiency for staff. These process changes resulted in improvement across differing cardiac subspecialty providers and patients.
Clinical utility of amyloid PET imaging with (18)F-florbetapir: a retrospective study of 100 patients
Authors: Carswell Christopher James , Win Zarni , Muckle Kirsty , Kennedy Angus , Waldman Adam , Dawe Gemma , Barwick Tara D , Khan Sameer , Malhotra Paresh A , Perry Richard J 
Published: October 2017

Background and objectiveAmyloid-positron emission tomography (PET) imaging (API) detects amyloid-beta pathology early in the course of Alzheimer’s disease (AD) with high sensitivity and specificity. (18)F-florbetapir (Amyvid) is an amyloid-binding PET ligand with a half-life suitable for clinical use outside of the research setting. How API affects patient investigation and management in the ‘real-world’ arena is unknown. To address this, we retrospectively documented the effect of API in patients in the memory clinic.MethodsWe reviewed the presenting clinical features, the pre-API and post-API investigations, diagnosis and outcomes for the first 100 patients who had API as part of their routine work-up at the Imperial Memory Centre, a tertiary referral clinic in the UK National Health Service.ResultsAPI was primarily used to investigate patients with atypical clinical features (56 cases) or those that were young at onset (42 cases). MRI features of AD did not always predict positive API (67%), and 6 of 23 patients with MRIs reported as normal were amyloid-PET positive. There were significantly more cases categorised as non-AD dementia post-API (from 11 to 23). Patients investigated when API was initially available had fewer overall investigations and all patients had significantly fewer investigations in total post-API.ConclusionsAPI has a clear impact on the investigation of young-onset or complex dementia while reducing the overall burden of investigations. It was most useful in younger patients, atypical presentations or individuals with multiple possible causes of cognitive impairment.
A pilot study of surgical telementoring for leg fasciotomy
Authors: Talbot Max , Harvey E J , Berry G K , Reindl R , Tien H , Stinner D J , Slobogean G 
Published: October 2017

IntroductionAcute extremity compartment syndrome requires rapid decompression. In remote locations, distance, weather and logistics may delay the evacuation of patients with extremity trauma beyond the desired timeline for compartment release. The aim of this study was to establish the feasibility of performing telementored surgery for leg compartment release and to identify methodological issues relevant for future research.MethodsThree anaethetists and one critical care physician were recruited as operators. They were directed to perform a two-incision leg fasciotomy on a Thiel-embalmed cadaver under the guidance of a remotely located orthopaedic surgeon. The operating physician and the surgeon (mentor) were connected through software that allows for real-time supervision and the use of a virtual pointer overlaid onto the surgical field. Two experienced orthopaedic traumatologists independently assessed the adequacy of compartment decompression and the presence of iatrogenic complications.Results14 of 16 compartments (in four leg specimens) were felt to have been completely released. The first evaluator considered that the deep posterior compartment was incompletely released in two specimens. The second evaluator considered that the superficial posterior compartment was incompletely released in two specimens. The only complication was a large laceration of the soleus muscle that occurred during a period of blurred video signal attributed to a drop in bandwidth.ConclusionsThis study suggests that surgical telementoring may enable physicians to safely perform two-incision leg fasciotomy in remote environments. This could improve the chances of limb salvage when compartment syndrome occurs far from surgical care. We found interobserver variation in the assessment of compartment release, which should be considered in the design of future research protocols.
Intratumoral HPV16-Specific T Cells Constitute a Type I–Oriented Tumor Microenvironment to Improve Survival in HPV16-Driven Oropharyngeal Cancer
Authors: Welters Marij J.P. , Ma Wenbo , Santegoets Saskia J.A.M. , Goedemans Renske , Ehsan Ilina , Jordanova Ekaterina S. , van Ham Vanessa J. , van Unen Vincent , Koning Frits , van Egmond Sylvia I. , Charoentong Pornpimol , Trajanoski Zlatko , van der Velden Lilly-Ann , van der Burg Sjoerd H. 
Published: October 2017

AbstractPurpose: Human papillomavirus (HPV)–associated oropharyngeal squamous cell cancer (OPSCC) has a much better prognosis than HPV-negative OPSCC, and this is linked to dense tumor immune infiltration. As the viral antigens may trigger potent immunity, we studied the relationship between the presence of intratumoral HPV-specific T-cell responses, the immune contexture in the tumor microenvironment, and clinical outcome.Experimental Design: To this purpose, an in-depth analysis of tumor-infiltrating immune cells in a prospective cohort of 97 patients with HPV16-positive and HPV16-negative OPSCC was performed using functional T-cell assays, mass cytometry (CyTOF), flow cytometry, and fluorescent immunostaining of tumor tissues. Key findings were validated in a cohort of 75 patients with HPV16-positive OPSCC present in the publicly available The Cancer Genome Atlas database.Results: In 64% of the HPV16-positive tumors, type I HPV16-specific T cells were present. Their presence was not only strongly related to a better overall survival, a smaller tumor size, and less lymph node metastases but also to a type I–oriented tumor microenvironment, including high numbers of activated CD161+ T cells, CD103+ tissue-resident T cells, dendritic cells (DC), and DC-like macrophages.Conclusions: The viral antigens trigger a tumor-specific T-cell response that shapes a favorable immune contexture for the response to standard therapy. Hence, reinforcement of HPV16-specific T-cell reactivity is expected to boost this process. Clin Cancer Res; 24(3); 634–47. ©2017 AACR.See related commentary by Laban and Hoffmann, p. 505
Island Sign
Authors: Li Qi , Liu Qing-Jun , Yang Wen-Song , Wang Xing-Chen , Zhao Li-Bo , Xiong Xin , Li Rui , Cao Du , Zhu Dan , Wei Xiao , Xie Peng 
Published: October 2017

Background and Purpose—
The aim of the study was to investigate the usefulness of the computed tomography (CT) island sign for predicting early hematoma growth and poor functional outcome.

Methods—
We included patients with spontaneous intracerebral hemorrhage (ICH) who had undergone baseline CT within 6 hours after ICH symptom onset in our hospital between July 2011 and September 2016. Two readers independently assessed the presence of the island sign on the admission noncontrast CT scan. Multivariable logistic regression analysis was used to analyze the association between the presence of the island sign on noncontrast admission CT and early hematoma growth and functional outcome.

Results—

A total of 252 patients who met the inclusion criteria were analyzed. Among them, 41 (16.3%) patients had the island sign on baseline noncontrast CT scans. In addition, the island sign was observed in 38 of 85 patients (44.7%) with hematoma growth. Multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and the presence of the island sign on baseline CT scan independently predicted early hematoma growth. The sensitivity of the island sign for predicting hematoma expansion was 44.7%, specificity 98.2%, positive predictive value 92.7%, and negative predictive value 77.7%. After adjusting for the patients’ age, baseline Glasgow Coma Scale score, presence of intraventricular hemorrhage, presence of subarachnoid hemorrhage, admission systolic blood pressure, baseline ICH volume, and infratentorial location, the presence of the island sign (odds ratio, 3.51; 95% confidence interval, 1.26–9.81;
P
=0.017) remained an independent predictor of poor outcome in patients with ICH.

Conclusions—
The island sign is a reliable CT imaging marker that independently predicts hematoma expansion and poor outcome in patients with ICH. The noncontrast CT island sign may serve as a potential marker for therapeutic intervention.
Mechanical Thrombectomy in Perioperative Strokes
Authors: Premat Kévin , Clovet Olivier , Frasca Polara Giulia , Shotar Eimad , Bartolini Bruno , Yger Marion , Di Maria Federico , Baronnet Flore , Pistocchi Silvia , Le Bouc Raphaël , Pires Christine , Sourour Nader , Alamowitch Sonia , Samson Yves , Degos Vincent , Clarençon Frédéric 
Published: October 2017

Background and Purpose—
Perioperative strokes (POS) are rare but serious complications for which mechanical thrombectomy could be beneficial. We aimed to compare the technical results and patients outcomes in a population of POS versus non-POS (nPOS) treated by mechanical thrombectomy.

Methods—
From 2010 to 2017, 25 patients with POS (ie, acute ischemic stroke occurring during or within 30 days after a procedure) who underwent mechanical thrombectomy (POS group) were enrolled and paired with 50 consecutive patients with nPOS (control group), based on the occlusion’s site, National Institute of Health Stroke Scale, and age.

Results—

Respectively, mean age was 68.3±16.6 versus 67.2±16.6 years (
P
=0.70), and median National Institute of Health Stroke Scale score at admission was 20 (interquartile range, 15–25) versus 19 (interquartile range, 17–25;
P
=0.79). Good clinical outcome (modified Rankin Scale score of 0–2 at 3 months) was achieved by 33.3% (POS) versus 56.5% (nPOS) of patients (
P
=0.055). Successful reperfusion (modified Thrombolysis In Cerebral Infarction score of ≥2b) was obtained in 76% (POS) versus 86% (nPOS) of cases (
P
=0.22). Mortality at 3 months was 33.3% in the POS group versus 4.2% (nPOS) (
P
=0.002). The rate of major procedural complications was 4% (POS) versus 6% (nPOS); none were lethal. Average time from symptoms’ onset to reperfusion was 4.9 hours (±2.0) in POS versus 5.2 hours (±2.6).

Conclusions—
Successful reperfusion seems accessible in POS within a reasonable amount of time and with a good level of safety. However, favorable outcome was achieved with a lower rate than in nPOS, owing to a higher mortality rate.
Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting
Authors: Haussen Diogo C. , Grossberg Jonathan A. , Bouslama Mehdi , Pradilla Gustavo , Belagaje Samir , Bianchi Nicolas , Allen Jason W. , Frankel Michael , Nogueira Raul G. 
Published: October 2017

Background and Purpose—
Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs.

Methods—
Prospective and consecutive data of patients <65 years old with cryptogenic stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography.

Results—

Twenty-four patients were identified (91.6% strokes/8.4% transient ischemic attacks [TIAs]). Median age was 46 (41–59) years, 61% were female, and 75% were black. Median National Institutes of Health Stroke Scale score was 10.5 (3.0–16.0) and ASPECTS (Alberta Stroke Program Early CT Score) was 8 (7–8). There were no parenchymal hemorrhages, and 96% of patients were independent at 3 months. All webs caused <50% stenosis. In patients with bilateral webs (58%), median ipsilateral web length was larger than contralateral (3.1 [3.0–4.5] mm versus 2.6 [1.85–2.9] mm;
P
=0.01), respectively. Twenty-nine percent of patients had thrombus superimposed on the symptomatic carotid web. A recurrent stroke/TIA involving the territory of the previously symptomatic web occurred in 7 (32%; 6 strokes/1 TIA) patients: 3 <1 week, 2 <first year, and 3 >1 year of follow-up. Two recurrences occurred on dual antiplatelet therapy, 3 on antiplatelet monotherapy, 1 within 24 hours of thrombolysis, and 1 off antithrombotics. Median follow-up was 12.2 (8.0–18.0) months. Sixteen (66%) patients were stented at a median 12.2 (7.0–18.7) days after stroke with no periprocedural complications. No recurrent strokes/TIAs occurred in stented individuals (median follow-up of 4 [2.4–12.0] months).

Conclusions—
Carotid web is associated with high recurrent stroke/TIA risk, despite antithrombotic use, and is amenable to carotid stenting.
The Ilkhanid Revetment Aesthetic in the Buqʿa Pir-i Bakran: Chaotic Exuberance or a Cunningly Planned Architectural Revetment Repertoire?
Authors: Grbanovic Ana Marija 
Published: October 2017

The Pir-i Bakran mausoleum (completed by 1312–13; Linjan, Isfahan) is considered to be a typical example of exuberant Ilkhanid architectural decoration. In the 1970s, the International Association of Mediterranean and Oriental Studies (IsMEO) undertook significant research and restoration work on the mausoleum. After their efforts were interrupted by the onset of the Iranian Revolution, restoration activities were continued by the Iranian Cultural Heritage Organization. Almost four decades later, questions concerning the mausoleum’s history, function, decorative program, patronage, and craftsmen—as well as the identity of the deceased—nonetheless remain unresolved. The mausoleum’s tile and original polychrome stucco decoration also require further scholarly attention. This article proposes a new view of the mausoleum’s decorative aesthetic and contributes to our understanding of the Ilkhanid architectural legacy. The article argues that, rather than being a haphazard application, the aesthetic characteristics of Pir-i Bakran’s revetments were determined by multiple undertakings executed according to specific decorative principles. Moreover, the mausoleum’s decorative program illustrates a rapid change in Ilkhanid decorative principles and aesthetics. I also propose a hypothetical timeline of mausoleum’s constructive and decorative undertakings, and reconsider its function and political significance.
Between Istanbul and Gujarat: Descriptions of Mecca in the Sixteenth-Century Indian Ocean
Authors: Burak Guy 
Published: October 2017

In 1543, a quarter century after the Ottoman conquest of the Holy Cities, the Meccan jurist, hadith scholar, and chronicler Jar Allah Muhammad Ibn Fahd (d. 1547) completed a short work devoted to the construction projects undertaken in the city by the Ottoman sultans Selim I (r. 1512–20) and his son Süleyman (r. 1520–66). The work is highly unusual from the perspective of the Arabic historiographical tradition and constitutes the first comprehensive response by an Arab chronicler to the emergence of an Ottoman imperial architectural idiom around the turn of the sixteenth century. The article situates Ibn Fahd and his work in three interrelated contexts: (a) the incorporation of Mecca and Medina into the Ottoman domains; (b) the emergence of an Ottoman architectural idiom and visual interest in the description of the Holy Sanctuaries across the Indian Ocean, from Istanbul to Gujarat; and (c) the competition between the new Custodians of the Two Holy Sanctuaries and other Islamic rulers, past and present. In particular, the article focuses on the challenges posed by the sultans of Gujarat, who were also quite interested in the Holy Sanctuaries. This interest is captured in Muhyi al-Din Lari’s (d. 1526–27) description of the pilgrimage and the Haramayn, which was written for the Gujarati sultan Muzaffar Shah II (r. 1511–26).
Impact of Arctic Wetlands on the Climate System: Model Sensitivity Simulations with the MIROC5 AGCM and a Snow-Fed Wetland Scheme
Authors: Nitta Tomoko , Yoshimura Kei , Abe-Ouchi Ayako 
Published: October 2017

Abstract
Wetlands cover large areas of the middle and high latitudes and influence the surface water and energy budget, surface hydrology, and the climate system. In this study, a scheme implicitly representing a snow-fed wetland, in which snowmelt can be stored with consideration of subgrid terrain complexity, was implemented in the Minimal Advanced Treatments of Surface Interaction and Runoff (MATSIRO) land surface model. An atmospheric general circulation model (AGCM) experiment was conducted using the Model for Interdisciplinary Research on Climate, version 5 (MIROC5), with and without the wetland scheme, with the main aim of reducing the model bias of warm and dry boreal summer at mid- to high latitudes. The experiment showed not only a better surface hydrology but also a weaker land–atmosphere coupling strength and larger (smaller) latent (sensible) heat flux due to the delayed snowmelt runoff. The summer warm and dry bias was partially improved over snowy and flat areas, particularly over much of western Eurasia and North America, without an apparent deterioration of simulated surface hydrology and climate over the rest of the land in the other seasons; the mean absolute error of 2-m air temperature and precipitation over land at 45°–90°N in summer decreased by 19% and 4%, respectively. The next step of model development will involve implementing an explicit representation of subgrid-scale surface water and related processes.
Submesoscale Instabilities in Mesoscale Eddies
Authors: Brannigan Liam , Marshall David P. , Naveira Garabato Alberto C. , Nurser A. J. George , Kaiser Jan 
Published: October 2017

AbstractSubmesoscale processes have been extensively studied in observations and simulations of fronts. Recent idealized simulations show that submesoscale instabilities also occur in baroclinic mesoscale cyclones and anticyclones. The instabilities in the anticyclone grow faster and at coarser grid resolution than in the cyclone. The instabilities lead to larger restratification in the anticyclone than in the cyclone. The instabilities also lead to changes in the mean azimuthal jet around the anticyclone from 2-km resolution, but a similar effect only occurs in the cyclone at 0.25-km resolution. A numerical passive tracer experiment shows that submesoscale instabilities lead to deeper subduction in the interior of anticyclonic than cyclonic eddies because of outcropping isopycnals extending deeper into the thermocline in anticyclones. An energetic analysis suggests that both vertical shear production and vertical buoyancy fluxes are important in anticyclones but primarily vertical buoyancy fluxes occur in cyclones at these resolutions. The energy sources and sinks vary azimuthally around the eddies caused by the asymmetric effects of the Ekman buoyancy flux. Glider transects of a mesoscale anticyclone in the Tasman Sea show that water with low stratification and high oxygen concentrations is found in an anticyclone, in a manner that may be consistent with the model predictions for submesoscale subduction in mesoscale eddies.