bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the transport of urgent specimens to an off-site laboratory using a novel sticker-tracker
Authors: Sepahzad Afsoon , Ejiofor Florence , Giles Susan , Klaber Robert 
Published: October 2013

AbstractObtaining results for urgent microbiology specimens in an efficient manner is imperative to ensure that patients receive appropriate antibiotic therapy. A previous audit carried out in the Paediatric department of a central teaching hospital and a number of clinical incidents, highlighted a delay in transport of specimens (exceeding eight hours) and 'missing' specimens. This results in empirical antibiotic treatment of infection, with delay in confirming microbiology result and unnecessary, distressing repeat investigation. As an initial step we sought staff opinion to further explore the problem. A sticker was designed for the microbiology specimen bag to assign accountability, track each step in the transport process and to raise awareness of the problem. The sticker required the member of staff responsible at each stage of the process to time, date and sign it, to allow tracking of potential delays. The new sticker tracking system was promoted and launched in the Paediatric department. Initial challenges included lack of awareness of the protocol and lack of pods for sending urgent specimens. The team met regularly and completed stickers were analysed weekly to identify on-going issues and to devise solutions. Consequently total transport time was reduced to an average of 69 minutes by September (within four hr target). Our intervention improved the efficiency and reliability of urgent specimen transport. This is likely to result in safer antibiotic use and avoid the need for repeat investigation. The system is now also used in the Neonatal department and has lead to the development of a new 'Central Specimens Reception'.
Improving medical SHO weekend handover at a tertiary referral centre
Authors: Curtis Olivia , Fisher Rachel 
Published: October 2013

AbstractThe GMC states that, 'You must be satisfied that, when you are off duty, suitable arrangements have been made for your patients' medical care...including effective hand-over procedures' [1].The medical weekend handover system at this tertiary referral centre involved multiple pieces of paper with no clear list of tasks, and no way to identify critically unwell patients. Patients could be missed from the ward round or could be difficult to identify under pressure. The authors felt this process could pose a threat to patient safety so decided to improve it.A questionnaire was distributed to all 11 medical SHOs with 100% response rate. Results showed that 72% thought the process was unstructured, 81% did not think the process was always safe, and 100% thought it could be improved. After discussions with senior medical management and with the approval of the trust audit committee, a new weekend handover proforma was designed, taking into consideration the results and comments from the questionnaire.The new proforma is accessible through a shared drive, which can be accessed by all medical SHOs in the hospital. Each team is able to copy their patients onto the combined ward-based list. There are columns for specific weekend jobs and registrar/SHO reviews. Any potentially unwell patients are highlighted in bold and discussed with the on-call SHO on Friday.All medical SHOs were given a post-implementation questionnaire after the new handover process had been in place for two months. Results of this showed that 100% of SHOs felt an improvement had been made, with 100% stating that the new system was more structured (64% always, 36% most of the time). The SHO's perception of patient safety increased from 81% generally unsafe, to 100% generally safe. The new handover has been well received and supported by the current SHO cohort. Improvements in the structure of handover have been made with perceived improvements in patient safety. Due to the success of the system, the handover proforma is being implemented in the trust's sister hospital.
Using a screening tool to improve timely referral of patients from acute oncology-haematology to palliative care services
Authors: Begum Akhtari 
Published: October 2013

AbstractThis project was done at specialist cancer hospital in Qatar. At a haematology-oncology inpatient department most patients were not getting access to palliative care unless they were at the very end stages of life. Data collected from 2008-2011 showed significant numbers of patients were dying within one month of their transfer to palliative care. There was no standard measure to identify the prospective palliative care patients. A multidisciplinary team developed a Palliative care referral screening tool based on the National Cancer Care Network guideline. Retrospective medical record review done from January to April 2012 showed a mean of 68% of patients who scored more than five were not consulted, 32% of patients who scored more than seven were not transferred to palliative care and seven percent died without any referral. The team used various kinds of quality planning, analysis and improvement tools in the form of process mapping, value analysis, Fish Bone diagrams, stakeholders’ analysis and communication, physician survey, "Pareto’s principal" (80 / 20 rule, the law of vital few) and other data collection tools.The palliative care referral process was standardised by preparing and implementing an objective scoring tool based on international best practice. It changed the referral culture and helped manage the psychological barriers of patients, families and caregivers. Extensive orientation and education of all key stakeholders was implemented. Monthly auditing of patient records was carried out. The aim has been achieved, exceeded and sustained, and we reduced the percentage of patients who scored more than five without palliative consultation from a mean of 68% to 16% and those who scored more than seven without palliative care transfer from a mean of thirty two percent to three percent, after four months of the project's implementation.Standardising the referral process and creating an objective referral tool is needed to facilitate safe, collaborative, continuous and patient centered care. Timely referral of cancer patients to palliative care minimises patient and caregiver distress, ensures better quality of life, and provides an appropriate measure for end of life care.
Improving documentation and use of ultrasound for suprapubic catheter insertions.
Authors: Day Nigel 
Published: October 2013

AbstractThe British Association of Urological Surgeons (BAUS) published recommendations for the safe insertion of suprapubic catheters (SPCs) in January 2011. They identified a number of parameters surrounding the insertion and maintenance of catheters that should be identified, implemented and documented on each insertion. One such recommendation was the use of ultrasound, if available and appropriate, to aid insertion and improve patient safety. A previous review of our documentation showed that in 2009, ultrasound imaging was not utilised in any of the 19 SPC insertions.We retrospectively collected data for 36 SPC insertions between April 2010 and December 2011. The information collated was the same as that collected for the BAUS national SPC insertion audit. This quality improvement project identified a significant increase in the use of ultrasound during SPC insertion since 2009 with 17 out of the 36 (47%) cases using this imaging modality. Despite this increase, there was still substantial room for improvement. We also identified some areas of documentation that needed improving, particularly with regard to insertion technique and indication for insertion. As a result, a proforma was designed to be used on each SPC insertion ensuring that all required data is easily identifiable and clearly documented. This proforma is now being used as standard mandatory clinical practice within our Trust.
Improving transmission rates of electronic discharge summaries to GPs
Authors: Barr Rory , Chin Kuen Yeow , Yeong Keefai 
Published: October 2013

AbstractDischarge summaries are a vital tool to communicate information from Hospital to Primary Care teams; updating GPs about what happened during an admission, and handing over care detailing any follow up care required. Historically, Discharge Summaries have been posted to hospitals, increasing costs for hospitals, creating administrative work for GP practices receiving the letters, and resulting in some letters being lost or delayed in reaching the GP, with implications for patient safety if follow up requests are not received and acted upon.In an effort to improve patient care, the Clinical Commissioning Group in Surrey drew up a contract with Ashford and St Peter's Foundation Trust, aiming to increase the percentage of discharge summaries sent electronically from the rate of 9% sent within 24 hours, to over 75%. This contract set targets of 50% in May, 65% in June, and 80% in July. Financial penalties would be imposed if targets were not achieved, starting in June 2013.The Trust set up a working group comprising of doctors, IT personnel and ward PAs to devise a multi-pronged solution to achieve this target. The electronic discharge summary system was reviewed and improvements were designed and developed to make the process of signing off letters easier, and transmission of signed off letters became automated rather than requiring manual transmission by ward PAs. Presentations and leaflets to explain the importance of prompt completion and transmission of discharge summaries were given to Doctors to improve compliance using the revised IT system. Figures on transmission rates were automatically emailed to key stakeholders every day (Ward PAs, Divisional Leads) showing performance on each ward. This helped identify areas requiring more intervention. Areas (e.g. Day Surgery) that had not used electronic discharge summaries were engaged with, and persuaded to take part.As a result, transmission rates of Discharge Summaries within 24 hours of patient discharge increased from 9% on May 11th 2013, to 76% by June 29th 2013. This has improved communication with GPs, led to more reliable handover of care, and reduced costs for the Trust (both in processing and postage costs, and by avoiding fines).
Improving patient discharge process using electronic medication input tool and on-line guide to arranging follow-ups
Authors: Barr Rory , Chin Kuen Yeow , Yeong Keefai 
Published: October 2013

AbstractComplete, accurate and timely discharge summaries (TTOs) enable effective communication between hospital teams and GPs. It can prevent adverse events and reduce hospital readmission rates (1). If the discharge summary does not contain important information (e.g. follow-up arrangements, accurate discharge medication list), or if follow-up arrangements are not made, then patient care and outcome can be adversely affected (2,3).An electronic Medication Input Wizard was developed to improve the quality and reduce the error rates of TTOs. The Wizard makes entering drug information faster; prompts for reasons medication changes; provides examples for Controlled Drug (CD) prescribing; and prompts to refer patients taking warfarin to anticoagulation clinic. An on-line guide was developed which explains how to arrange investigations and appointments. Retrospective studies of TTOs were carried out before and after these interventions, analysing documentation of medication and completion of intended follow-up arrangements.A baseline audit found 65% of medication changes on TTOs were not clearly documented, and only 8% with changes documented reasons. 40% of prescriptions for CDs were incorrect delaying discharge by 4.9 hours per patient. 80% of intended follow-ups actually happened.After intervention, TTOs written using the Wizard had 100% of medication changes documented, and 75% were documented with reasons. CD errors decreased to 28% (76% of errors were done without using the Wizard). Follow-up arrangements that occurred increased to 86%. A survey showed 78% of Doctors reported the Wizard was faster than typing the details in separate textboxes, and 94% believed it was beneficial.Systems should be optimised to encourage better documentation of medication details and reduce prescribing errors. Guides that explain how to make follow-up arrangements should be accessible to Doctors, to make sure follow-ups are organised correctly.
New replacement name for the genus Longitergus Pham, Bai, Heiss &amp; Cai, 2013 (Hemiptera: Heteroptera: Aradidae)
Authors: YANG WEI-CHENG 
Published: October 2013

The flat bug genus Longitergus was established by Pham, Bai, Heiss & Cai (2013) with two species: L. productus and L. similis from Vietnam and with L. productus as its type species. Unfortunately, the name Longitergus Pham, Bai, Heiss & Cai (2013) was preoccupied by Longitergus Wang (1993), a subgenus Yezoceryx (Longitergus) Wang, 1993 in Ichneumonidae (Hymenoptera: Ichneumonoidea) based on type species Yezoceryx breviclypeus Wang, 1982 from China. Thus, the genus Longitergus Pham, Bai, Heiss & Cai, 2013 is a junior homonym of the subgenus Yezoceryx (Longitergus) Wang, 1993. According to Article 60 of the International Code of Zoological Nomenclature, I propose for Longitergus Pham, Bai, Heiss & Cai, 2013 the new replacement name Neolongitergus nom. nov.. Accordingly, two new combinations are herein proposed for the flat bug species currently included in this genus: Neolongitergus productus (Pham, Bai, Heiss & Cai, 2013) and Neolongitergus similis (Pham, Bai, Heiss & Cai, 2013).
An Assessment of the Influences of Surface and Subsurface Water Level Dynamics in the Development of Gullies in Anambra State, Southeastern Nigeria
Authors: Okoyeh Elizabeth I. , Akpan Anthony E. , Egboka B. C. E. , Okeke H. I. 
Published: October 2013

Abstract
Gully erosion–induced problems have been challenging the people and government of Anambra State in southeastern Nigeria for a long time. In spite of the numerous geoscientific and engineering studies so far conducted in the area, the underlying causes of these problems still remain poorly understood. In an attempt to contribute to the understanding of the underlying processes responsible for the persistent gully erosion problems in Anambra State, an integrated study utilizing hydrological, geomorphological, and geophysical data was undertaken. Results of the analyses show that bulk density, pH, and organic matter content of the soil range from 1610 to 1740 kg m−3, 5.10 to 5.30, and 0.32% to 0.46%, respectively. Particle size analyses results show that the soils are dominated by coarse sand materials (50%–68%). Variations in the Atterberg limit parameters (liquid limit, plastic limit, and plasticity index) also point to the dominance of coarse materials in the shallow subsurface. Vertical electrical sounding results capture the shallow surface as being dominated by resistive sandy materials that are underlain by lowly resistive clayey materials. Thus, the area is dominated by porous, friable, and poorly cemented coarse materials that are located on a long and steeply sloping terrain of the tectonically elevated Awka–Orlu cuesta. Both overland and subsurface flow processes are responsible for the gully erosion problems confronting the area. Human activities (e.g., deforestation, uncontrolled urbanization, and absence of requisite legislation to protect the environment) and the high elevation of the Awka–Orlu cuesta have aggravated the severity of the problems. An aggressive reforestation program particularly with native trees, promulgation of necessary legislation to protect the environment, and setting up and empowering an enforcement agency should be vigorously pursued. Also, necessary enlightenment campaigns on best agricultural practices that can reduce surface runoff in soil and water conservation may also be helpful in changing the mindset of people.
The Relationship of Weddell Polynya and Open-Ocean Deep Convection to the Southern Hemisphere Westerlies
Authors: Cheon Woo Geun , Park Young-Gyu , Toggweiler J. R. , Lee Sang-Ki 
Published: October 2013

Abstract
The Weddell Polynya of the mid-1970s is simulated in an energy balance model (EBM) sea ice–ocean coupled general circulation model (GCM) with an abrupt 20% increase in the intensity of Southern Hemisphere (SH) westerlies. This small upshift of applied wind stress is viewed as a stand in for the stronger zonal winds that developed in the mid-1970s following a long interval of relatively weak zonal winds between 1954 and 1972. Following the strengthening of the westerlies in this model, the cyclonic Weddell gyre intensifies, raising relatively warm Weddell Sea Deep Water to the surface. The raised warm water then melts sea ice or prevents it from forming to produce the Weddell Polynya. Within the polynya, large heat loss to the air causes surface water to become cold and sink to the bottom via open-ocean deep convection. Thus, the underlying layers cool down, the warm water supply to the surface eventually stops, and the polynya cannot be maintained anymore. During the 100-yr-long model simulation, two Weddell Polynya events are observed. The second one occurs a few years after the first one disappears; it is much weaker and persists for less time than the first one because the underlying layer is cooler. Based on these model simulations, the authors hypothesize that the Weddell Polynya and open-ocean deep convection were responses to the stronger SH westerlies that followed a prolonged weak phase of the southern annular mode.
Autonomous Ocean Turbulence Measurements Using Shear Probes on a Moored Instrument
Authors: Fer Ilker , Paskyabi Mostafa Bakhoday 
Published: October 2013

Abstract
An internally recording, autonomous instrument has been tested for measurements of ocean turbulence from a mooring line. Measurements were made at a single level in the water column, but for an extended period of time, at a predetermined duty cycle. The instrument is designed to measure, independently, in two different parts of the turbulence wavenumber spectrum: eddy correlation measurements in the inertial subrange and small-scale shear and temperature gradient measurements in the dissipation subrange using shear probes and fast-response thermistors. For the deployment reported here, the instrument is located in the wave-affected layer, and only the dissipation subrange from the shear probes can be confidently utilized for turbulence measurements. The velocity spectra in the inertial subrange are severely contaminated by platform motion and noise, and the dissipation range of the temperature gradient spectrum is not satisfactorily resolved. The shear spectra are found to be relatively free of contamination in the 1–20-Hz frequency range and are used for dissipation rate calculations. The quality of the measurements is constrained by the angle of attack and the magnitude of mean flow relative to the wave oscillatory velocities. Dissipation rates are consistent with a scaling expected from breaking long waves, when background shear is weak, and are elevated when the gradient Richardson number is small, consistent with additional turbulence production by shear. While limited to a single depth, the instrument makes it possible to collect time series for 3 weeks continuously or for 3 months at a 25% duty cycle.
From what we know to what we do: lessons learned from the translational CLAHRC initiative in England
Authors: Currie Graeme , Lockett Andy , Enany Nellie El 
Published: October 2013

Objectives: There exists a translation gap between academic research and clinical practice in health care systems. One policy-driven initiative to address the translation gap in England are the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), funded by the National Institute of Health Research (NIHR). These aim to bring together NHS organizations and universities to accelerate the translation of evidence-based innovation into clinical practice. Our aim was to draw out lessons for policy-makers regarding the mobilization of such initiatives. Methods: Qualitative semi-structured interviews with 174 participants across nine CLAHRCs plus in-depth case studies across four CLAHRCs. Those interviewed were staff who were central to the CLAHRCs including senior managers and directors, junior and senior academics, and health care practitioners. Results: Social positions of the CLAHRC leaders, conceived as institutional entrepreneurs, together with the antecedent conditions for CLAHRC bids, had an impact on the vision for a CLAHRC. The process of envisioning encompassed diagnostic and prognostic framing. Within the envisioning process, the utilization of existing activities and established relationships in the CLAHRC bid influenced early mobilization. However, in some cases, it led to a translational ‘lock in’ towards established models regarding applied research. Conclusions: The CLAHRC experiment in England holds important lessons for policy-makers regarding how to address the translation gap. First, policy makers need to consider whether they set out a defined template for translational initiatives or whether variation is encouraged. We might expect a degree of learning from pilot activities within a CLAHRC that allows for greater clarity in the design of subsequent translational initiatives. Second, policy makers and practitioners need to understand the importance of both antecedent conditions and the social position of senior members of a CLAHRC (institutional entrepreneurs) leading the development of a bid. Whilst established and well-known clinical academics are likely to be trusted to lead CLAHRCs, and the presence of pre-existing organizational relationships are important for mobilization, privileging these aspects may constrain more radical change.
NumbL is essential for Xenopusprimary neurogenesis
Authors: Nieber Frank , Hedderich Marie , Jahn Olaf , Pieler Tomas , Henningfeld Kristine A 
Published: October 2013

Abstract

Background
Members of the vertebrate Numb family of cell fate determinants serve multiple functions throughout early embryogenesis, including an essential role in the development of the nervous system. The Numb proteins interact with various partner proteins and correspondingly participate in multiple cellular activities, including inhibition of the Notch pathway.

Results
Here, we describe the expression characteristics of Numb and Numblike (NumbL) during Xenopus development and characterize the function of NumbL during primary neurogenesis. NumbL, in contrast to Numb, is expressed in the territories of primary neurogenesis and is positively regulated by the Neurogenin family of proneural transcription factors. Knockdown of NumbL afforded a complete loss of primary neurons and did not lead to an increase in Notch signaling in the open neural plate. Furthermore, we provide evidence that interaction of NumbL with the AP-2 complex is required for NumbL function during primary neurogenesis.

Conclusion
We demonstrate an essential role of NumbL during Xenopus primary neurogenesis and provide evidence for a Notch-independent function of NumbL in this context.