bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of experience on the sensitivity and specificity of the whispered voice test: a diagnostic accuracy study
Authors: McShefferty David , Whitmer William M , Swan Iain R C , Akeroyd Michael A 
Published: April 2013

ObjectivesTo determine the sensitivity and specificity of the whispered voice test (WVT) in detecting hearing loss when administered by practitioners with different levels of experience.DesignDiagnostic accuracy study of WVT, through acoustic analysis of whispers of experienced and inexperienced practitioners (experiment 1) and behavioural validation of these recordings (experiment 2).SettingResearch institute with a pool of patients sourced from local clinics in the Greater Glasgow area.Participants22 people had their whispers recorded and analysed in experiment 1; 4 older experienced (OE), 4 older inexperienced (OI) and 14 younger inexperienced (YI). In experiment 2, 73 people (112 individual ears) took part in a digit recognition task using 2 OE and 2 YI whisperers from experiment 1.Main outcome measuresAverage level (dB sound pressure level) across frequency, average level across all utterances (dB A) and within/across-digit deviation (dB A) for experiment 1. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WVT for experiment 2.ResultsIn experiment 1, OE whisperers were 8–10 dB more intense than inexperienced whisperers across all whispered utterances. Variability was low and comparable regardless of age or experience. In experiment 2, at an optimum threshold of 40 dB HL, sensitivity and specificity were 63% (95% CI of 58% to 68%) and 93% (92% to 94%), respectively, for OE whisperers. PPV was 56% (51% to 61%), NPV was 95% (94% to 96%). For YI whisperers at an optimum threshold of 29 dB HL, sensitivity and specificity were 80% (78% to 82%) and 52% (50% to 55%), respectively. PPV was 65% (63% to 67%) and NPV was 70% (67% to 72%).ConclusionsWVT is an effective screening test, providing the level of the whisperer is considered when setting the test's hearing-loss criterion. Possible implications are voice measurement while training for inexperienced whisperers.
Patterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol
Authors: Hands Chris , Reid Eleanor , Meredith Paul , Smith Gary B , Prytherch David R , Schmidt Paul E , Featherstone Peter I 
Published: April 2013

BackgroundThe recognition of patient deterioration depends largely on identifying abnormal vital signs, yet little is known about the daily pattern of vital signs measurement and charting.MethodsWe compared the pattern of vital signs and VitalPAC Early Warning Score (ViEWS) data collected from admissions to all adult inpatient areas (except high care areas, such as critical care units) of a NHS district general hospital from 1 May 2010 to 30 April 2011, to the hospital's clinical escalation protocol. Main outcome measures were hourly and daily patterns of vital signs and ViEWS value documentation; numbers of vital signs in the periods 08:00–11:59 and 20:00–23:59 with subsequent vital signs recorded in the following 6 h; and time to next observation (TTNO) for vital signs recorded in the periods 08:00–11:59 and 20:00–23:59.Results950 043 vital sign datasets were recorded. The daily pattern of observation documentation was not uniform; there were large morning and evening peaks, and lower night-time documentation. The pattern was identical on all days. 23.84% of vital sign datasets with ViEWS ≥ 9 were measured at night compared with 10.12–19.97% for other ViEWS values. 47.42% of patients with ViEWS=7–8 and 31.22% of those with ViEWS ≥ 9 in the period 20:00–23:59 did not have vital signs recorded in the following 6 h. TTNO decreased with increasing ViEWS value, but less than expected by the monitoring protocol.ConclusionsThere was only partial adherence to the vital signs monitoring protocol. Sicker patients appear more likely to have vital signs measured overnight, but even their observations were often not followed by timely repeat assessments. The observed pattern of monitoring may reflect the impact of competing clinical priorities.
Barriers to research in palliative care in France
Authors: Rhondali Wadih , Berthiller Julien , Hui David , Yennu Sriram , Lafumas Veronique , Ledoux Mathilde , Strasser Florian , Filbet Marilène 
Published: April 2013

PurposePalliative care (PC) needs expansion of its research capacity to improve the quality of care. This is particularly true for France that contributed less than 2% of all European PC research publications. We conducted a survey to assess the barriers French healthcare professionals (HCPs) involved in PC research had to face.MethodsWe surveyed all 420 PC departments registered in the French National Association for Palliative Care (SFAP) database using a previously used questionnaire. We documented the ethical limitations, time constraints, financial resources, patient issues and methodological issues related to PC research.ResultsWe obtained 382 responses. Ninety-two (24.1%) HCPs were involved in a research project during the last 5 years. In univariate results, predictors of being involved in PC research were men (p=0.004), physician (p=0.022), working at a university hospital (p<0.001). There was a trend towards working in a PC unit (p=0.052). The main barriers to participating in PC research were lack of time (80.1%) and patient issues (47.4%). Lack of methodological support (33.0%) and financial limitations (30.4%) were also reported as major barriers.ConclusionsThere is a consensus that PC research and publication in the English language for peer-reviewed journals must be expanded in France but at this stage, clinical teams still lack specific funding and appropriate support. More research is needed to confirm our results and to determine the best ways to develop PC research capacity in France.
Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare
Authors: Wilson Richard , Goodacre Steve W , Klingbajl Marcin , Kelly Anne-Maree , Rainer Tim , Coats Tim , Holloway Vikki , Townend Will , Crane Steve 
Published: April 2013

Background and objectiveRisk-adjusted mortality rates can be used as a quality indicator if it is assumed that the discrepancy between predicted and actual mortality can be attributed to the quality of healthcare (ie, the model has attributional validity). The Development And Validation of Risk-adjusted Outcomes for Systems of emergency care (DAVROS) model predicts 7-day mortality in emergency medical admissions. We aimed to test this assumption by evaluating the attributional validity of the DAVROS risk-adjustment model.MethodsWe selected cases that had the greatest discrepancy between observed mortality and predicted probability of mortality from seven hospitals involved in validation of the DAVROS risk-adjustment model. Reviewers at each hospital assessed hospital records to determine whether the discrepancy between predicted and actual mortality could be explained by the healthcare provided.ResultsWe received 232/280 (83%) completed review forms relating to 179 unexpected deaths and 53 unexpected survivors. The healthcare system was judged to have potentially contributed to 10/179 (8%) of the unexpected deaths and 26/53 (49%) of the unexpected survivors. Failure of the model to appropriately predict risk was judged to be responsible for 135/179 (75%) of the unexpected deaths and 2/53 (4%) of the unexpected survivors. Some 10/53 (19%) of the unexpected survivors died within a few months of the 7-day period of model prediction.ConclusionsWe found little evidence that deaths occurring in patients with a low predicted mortality from risk-adjustment could be attributed to the quality of healthcare provided.
Methodological proposal for implementing an intervention to prevent pedestrian injuries, a multidisciplinary approach: the case of Cuernavaca, Morelos, Mexico
Authors: Rodríguez Jorge M , Híjar Medina Martha , Campuzano Julio César , Bangdiwala Shrikant I , Villaveces Andrés 
Published: April 2013

ObjectiveTo describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach.MethodologyThis study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998–2007), an analysis and geocoding of pedestrian injuries (2008–2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the ‘best evidence’ adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention.ResultsBetween 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention.ConclusionsA combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.
Comparison of digital outcrop and conventional data collection approaches for the characterization of naturally fractured reservoir analogues
Authors: Seers Thomas D. , Hodgetts David 
Published: April 2013

Abstract
In this study, fracture systems developed within faulted, high-porosity sandstones in the decommissioned mines of Alderley Edge, Cheshire, UK are characterized using lidar (Light Detection And Ranging)-based analysis. The geometry of the mine workings prove to be conducive to the extraction of fracture attributes, whilst providing a degree of exposure of a notable Triassic-aged reservoir outcrop analogue (Helsby Sandstone Formation) not afforded at the surface.
To test the fidelity of the approach, fracture statistics generated from lidar-derived digital outcrop models are compared to an equivalent dataset collected using conventional manual surveys, with digital outcrop and manually acquired fracture attributes used to populate discrete fracture network models. These are upscaled to provide equivalent porous medium properties, enabling the impact of uncertainties introduced into fracture modelling workflows by lidar-based techniques to be assessed.
Whilst broadly comparable to fracture attributes obtained using manual surveys, the systematic underrepresentation of fracture properties is observed within lidar-derived dataset, resulting in the underestimation of fracture network flow capacity. The study results suggest that, whilst enhancing data acquisition rates and coverage of exposure surfaces, the use of digital discontinuity analysis may introduce additional biases into fracture datasets, increasing the level of uncertainty within resultant modelled networks.
Landscape evolution and ice-sheet behaviour in a semi-arid polar environment: James Ross Island, NE Antarctic Peninsula
Authors: Davies Bethan J. , Glasser Neil F. , Carrivick Jonathan L. , Hambrey Michael J. , Smellie John L. , Nývlt Daniel 
Published: April 2013

Abstract
This study of landscape evolution presents both new modern and palaeo process-landform data, and analyses the behaviour of the Antarctic Peninsula Ice Sheet through the Last Glacial Maximum (LGM), the Holocene and to the present day. Six sediment-landform assemblages are described and interpreted for Ulu Peninsula, James Ross Island, NE Antarctic Peninsula: (1) the Glacier Ice and Snow Assemblage; (2) the Glacigenic Assemblage, which relates to LGM sediments and comprises both erratic-poor and erratic-rich drift, deposited by cold-based and wet-based ice and ice streams respectively; (3) the Boulder Train Assemblage, deposited during a Mid-Holocene glacier readvance; (4) the Ice-cored Moraine Assemblage, found in front of small cirque glaciers; (5) the Paraglacial Assemblage including scree, pebble-boulder lags, and littoral and fluvial processes; and (6) the Periglacial Assemblage including rock glaciers, protalus ramparts, blockfields, solifluction lobes and extensive patterned ground. The interplay between glacial, paraglacial and periglacial processes in this semi-arid polar environment is important in understanding polygenetic landforms. Crucially, cold-based ice was capable of sediment and landform genesis and modification. This landsystem model can aid the interpretation of past environments, but also provides new data to aid the reconstruction of the last ice sheet to overrun James Ross Island.
The Offshore New Harbour Project: deciphering the Middle Miocene through Late Eocene seismic stratigraphy of Offshore New Harbour, western Ross Sea, Antarctica
Authors: Pekar Stephen F. , Speece Marvin A. , Wilson Gary S. , Sunwall David S. , Tinto Kirsty J. 
Published: April 2013

Abstract
In the Austral spring of 2008, over 48 km of multi-channel seismic data were collected offshore of New Harbour, which is located in the western most Ross Sea, Antarctica. This project is part of the ANDRILL (Antarctic Geological Drilling) Programme's Offshore New Harbour Project, with its aim to investigate the stratigraphic and tectonic history of the inner shelf of southern McMurdo Sound. Correlating the seismic data to CIROS-1 and ANDRILL AND-2A drillholes provided age dates ranging from Late Miocene to at least Late Eocene for the reflectors and lithological descriptions for the seismic units. This permitted development of a glacial history of this area, resulting in dividing the seismic data into three units: an Upper Eocene–Lower Oligocene unit; an Upper Oligocene–Lower Miocene unit; and a Middle Miocene and younger unit. The seismic section below 700 mbsf has two possible interpretations: (1) substantial Eocene strata are present downdip of CIROS-1, which would represent a potential future-drilling objective for the ANDRILL Programme; or (2) these reflectors may be equivalent to Devonian strata recovered at the Cape Roberts 3 as the two-way traveltime of Eocene and Devonian strata are nearly identical, making it difficult to discriminate between them in seismic data.
Heat-flow determinations of basement age in small oceanic basins of the southern central Scotia Sea
Authors: Barker P. F. , Lawver L. A. , Larter R. D. 
Published: April 2013

Abstract
Results are reported from seven heat flow stations in small basins of the southern part of the central Scotia Sea (CSS), undertaken in order to determine basement ages. The basins are small, which makes magnetic anomaly-based ages ambiguous and preserves basin subsidence that may have been anomalous as a result of local factors. The fact that these small basins formed in a back-arc setting adds additional uncertainty to depth-based age estimates. The results confirm that basin extension commenced in the Eocene, and indirectly support a relatively young, back-arc origin for the northern CSS, but do not affect previously published suggestions of the age of onset of the Antarctic Circumpolar Current.
Mesozoic to recent evolution of intraplate stress fields under multiple remote stresses: The case of Signy Island (South Orkney Microcontinent, Antarctica)
Authors: Maestro A. , López-Martínez J. , Bohoyo F. 
Published: April 2013

Abstract

Palaeostresses inferred from approximately 3200 brittle mesostructures measured at 43 sites in Signy Island show a stress field characterized by compressional, strike-slip and extensional stress states. There is a dominant NW–SE horizontal compression direction as well as three (NNW–SSE, WNW–ESE and ENE–WSW) secondary σ
1
horizontal stress directions. Orientation of σ
3
shows a main mode trending NW–SE together with secondary north–south and NE–SW extensional stress directions. The NNW–SSE horizontal compression is consistent with the stretching–shearing direction defined from the fold-axis trend. This is owing to a subduction-related tectonic regime during early to middle Jurassic times. In middle Jurassic/early Cretaceous times, the tectonic regime changes to extensional with north–south extensional stress directions. The early processes of subduction of the northern sector of the Weddell Sea oceanic crust below the South Orkney Microcontinent, from the Paleocene until the middle Miocene, is related to the σ
1
direction WNW–ESE to NW–SE. The spreading of Powell Basin took place from the late Eocene to the early Miocene and is the cause of east–west and NE–SW extensional processes in the southern South Orkney Microcontinent. Finally, the NW–SE σ
3
direction is related to the current left-lateral strike-slip movement between the Scotia and Antarctic plates.
History of the grounded ice sheet in the Ross Sea sector of Antarctica during the Last Glacial Maximum and the last termination
Authors: Hall Brenda L. , Denton George H. , Stone John O. , Conway Howard 
Published: April 2013

Abstract
Knowledge of variations in the extent and thickness of the Antarctic Ice Sheet is key for understanding the behaviour of Southern Hemisphere glaciers during the last ice age and for addressing issues involving global sea level, ocean circulation and climate change. Insight into past ice-sheet behaviour also will aid predictions of future ice-sheet stability. Here, we review terrestrial evidence for changes in ice geometry that occurred in the Ross Sea sector of Antarctica at the Last Glacial Maximum (LGM) and during subsequent deglaciation. During the LGM, a thick grounded ice sheet extended close to the continental shelf edge in the Ross Embayment. This ice reached surface elevations of more than 1000 m along the coast of the central and southern Transantarctic Mountains and Marie Byrd Land. The local LGM occurred by 18 ka on the coast, but as late as 7–10 ka inland. The first significant thinning took place at roughly 13 ka, with most ice loss happening in the Holocene. This history makes it unlikely that the Ross Sea sector was a major contributor to meltwater pulse 1A (MWP 1A). Resolution of a possible Antarctic origin for MWP 1A awaits detailed reconstructions from all sectors of the ice sheet.
Palaeobiogeography of Austral echinoid faunas: a first quantitative approach
Authors: Saucede Thomas , Pierrat Benjamin , Brayard Arnaud , David Bruno 
Published: April 2013

Abstract
Few studies have been devoted to the palaeobiogeography of Antarctic echinoids, all of them analysing and discussing distribution patterns in a qualitative way. The present work aims at exploring the evolution of palaeobiogeographic relationships of Austral echinoid faunas through four time intervals, from the Maastrichtian to the present day, using a quantitative approach: the Bootstrapped Spanning Network procedure. Analyses were successfully performed and improve our knowledge of biogeographic relationships between the different Austral regions. Biogeographic maps were produced that can be easily and intuitively discussed. Our results mostly agree with palaeobiogeographic studies performed on other benthic invertebrates and are congruent with the palaeogeographic evolution of Antarctica. However, two main points markedly contrast with other works: there is no evidence of an Austral provincialism at the end of the Cretaceous and early Cenozoic, and echinoid data suggest isolation of southern Argentina from other Austral regions, including Antarctica, in the Early Miocene.
Risk of Precancer Determined by HPV Genotype Combinations in Women with Minor Cytologic Abnormalities
Authors: Gage Julia C. , Schiffman Mark , Solomon Diane , Wheeler Cosette M. , Gravitt Patti E. , Castle Philip E. , Wentzensen Nicolas 
Published: April 2013

Abstract
Background: Studies suggest that testing for individual human papillomavirus (HPV) genotypes can improve risk stratification in women with minor cytologic abnormalities. We evaluated genotyping for HPV16, HPV16/18, and HPV16/18/45 in carcinogenic HPV-positive women with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology.
Methods: For women enrolled in the ASCUS–LSIL Triage Study (ALTS), we calculated the age-stratified (&lt;30 and 30+ years) positivity and cumulative risk over two years of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) when testing positive or negative for three genotype combinations: HPV16, HPV16/18, and HPV16/18/45.
Results: Among women with ASCUS cytology, HPV16 positivity was 17.1% and increased to 22.0% (P &lt; 0.001) for HPV16/18 and 25.6% (P &lt; 0.001) for HPV16/18/45. Among women with LSIL cytology, HPV16 positivity was 21.1% and increased to 30.0% (P &lt; 0.001) for HPV16/18 and 34.0% (P = 0.017) for HPV16/18/45. Regardless of cytology and age group, the greatest risk difference between test positives and test negatives was observed for HPV16 with decreasing risk stratification for HPV16/18 and HPV16/18/45. However, testing negative for any of the three combinations while being positive for another carcinogenic type still implied a two-year risk of CIN3+ of 7.8% or more.
Conclusions: Although genotyping for HPV16, 18, and 45 provided additional risk stratification in carcinogenic HPV-positive women with minor cytologic abnormalities, the risk among genotype-negative women was still high enough to warrant immediate colposcopy referral.
Impact: HPV genotyping in HPV-positive women with minor cytologic abnormalities will likely not alter clinical management. Adding HPV45 to genotyping assays is not warranted. Cancer Epidemiol Biomarkers Prev; 22(6); 1095–101. ©2013 AACR.