bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals
Authors: Mumford Virginia , Greenfield David , Hogden Anne , Debono Deborah , Gospodarevskaya Elena , Forde Kevin , Westbrook Johanna , Braithwaite Jeffrey 
Published: September 2014

ObjectivesThe study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates.DesignA retrospective, longitudinal, multisite comparative survey.SettingAcute public hospitals in New South Wales, Australia.Participants96 acute hospitals with accreditation survey results from two surveys during 2009–2012 and submitted data for more than four hand hygiene audits between 2010 and 2013.OutcomesOur primary outcome comprised observational hand hygiene compliance data from eight audits during 2010–2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity.ResultsAverage hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010–2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (p<0.05). The association between hand hygiene rates, accreditation outcomes and infection control scores is less clear.ConclusionsOur results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores.
Impact of introducing an electronic physiological surveillance system on hospital mortality
Authors: Schmidt Paul E , Meredith Paul , Prytherch David R , Watson Duncan , Watson Valerie , Killen Roger M , Greengross Peter , Mohammed Mohammed A , Smith Gary B 
Published: September 2014

BackgroundAvoidable hospital mortality is often attributable to inadequate patient vital signs monitoring, and failure to recognise or respond to clinical deterioration. The processes involved with vital sign collection and charting; their integration, interpretation and analysis; and the delivery of decision support regarding subsequent clinical care are subject to potential error and/or failure.ObjectiveTo determine whether introducing an electronic physiological surveillance system (EPSS), specifically designed to improve the collection and clinical use of vital signs data, reduced hospital mortality.MethodsA pragmatic, retrospective, observational study of seasonally adjusted in-hospital mortality rates in three main hospital specialties was undertaken before, during and after the sequential deployment and ongoing use of a hospital-wide EPSS in two large unconnected acute general hospitals in England. The EPSS, which uses wireless handheld computing devices, replaced a paper-based vital sign charting and clinical escalation system.ResultsDuring EPSS implementation, crude mortality fell from a baseline of 7.75% (2168/27 959) to 6.42% (1904/29 676) in one hospital (estimated 397 fewer deaths), and from 7.57% (1648/21 771) to 6.15% (1614/26 241) at the second (estimated 372 fewer deaths). At both hospitals, multiyear statistical process control analyses revealed abrupt and sustained mortality reductions, coincident with the deployment and increasing use of the system. The cumulative total of excess deaths reduced in all specialties with increasing use of the system across the hospital.ConclusionsThe use of technology specifically designed to improve the accuracy, reliability and availability of patients’ vital signs and early warning scores, and thereby the recognition of and response to patient deterioration, is associated with reduced mortality in this study.
Concordance between digital pathology and light microscopy in general surgical pathology: a pilot study of 100 cases
Authors: Houghton Joseph P , Ervine Aaron J , Kenny Sarah L , Kelly Paul J , Napier Seamus S , McCluggage W Glenn , Walsh Maureen Y , Hamilton Peter W 
Published: September 2014

Aim(1) A pilot study to determine the accuracy of interpretation of whole slide digital images in a broad range of general histopathology cases of graded complexity. (2) To survey the participating histopathologists with regard to acceptability of digital pathology.Materials and methodsGlass slides of 100 biopsies and minor resections were digitally scanned in their entirety, producing digital slides. These cases had been diagnosed by light microscopy at least 1 year previously and were subsequently reassessed by the original reporting pathologist (who was blinded to their original diagnosis) using digital pathology. The digital pathology-based diagnosis was compared with the original glass slide diagnosis and classified as concordant, slightly discordant (without clinical consequence) or discordant. The participants were surveyed at the end of the study.ResultsThere was concordance between the original light microscopy diagnosis and digital pathology-based diagnosis in 95 of the 100 cases while the remaining 5 cases showed only slight discordance (with no clinical consequence). None of the cases were categorised as discordant. Participants had mixed experiences using digital pathology technology.ConclusionsIn the broad range of cases we examined, digital pathology is a safe and viable method of making a primary histopathological diagnosis.
Deglaciation, sea-level change and the Holocene colonization of Norway
Authors: Glørstad Håkon 
Published: September 2014

Abstract

The Norwegian coast facing the Atlantic Ocean was ice free as early as the Allerød oscillation in the late Pleistocene. The landscape was probably habitable for humans. It has, therefore, been assumed by several scholars that this coastline was visited or inhabited from the Late Glacial period onwards. In part, this argumentation is based on the presumed proximity of the Norwegian mainland and Doggerland, which existed between present-day Denmark and Great Britain because of a much lower global sea level. The aim of this paper is to examine the
14
C dates available from the oldest Norwegian settlement sites, and to compare them to the Quaternary processes of deglaciation and sea-level change. The hypothesis is advanced that humans did not settle in present-day Norway before a sheltering passage of islands and peninsulas had developed between the Swedish west coast (Bohuslän) and the Oslo area. This happened in the second half of the Preboreal period, at approximately 9.3 cal ka BC, or in the final centuries of the tenth millenniun BC.

Supplementary material:

14
C dates used in Figures 2, 4 and 9 are available at
http://www.geolsoc.org.uk/SUP18779
.
Benign Breast Tissue Composition in Breast Cancer Patients: Association with Risk Factors, Clinical Variables, and Gene Expression
Authors: Sun Xuezheng , Sandhu Rupninder , Figueroa Jonine D. , Gierach Gretchen L. , Sherman Mark E. , Troester Melissa A. 
Published: September 2014

Abstract
Background: Breast tissue composition (epithelium, non-fatty stroma, and adipose) changes qualitatively and quantitatively throughout the lifespan, and may mediate relationships between risk factors and breast cancer initiation. We sought to identify relationships between tissue composition, risk factors, tumor characteristics, and gene expression.
Methods: Participants were 146 patients from the Polish Breast Cancer Study, with data on risk factor and clinicopathological characteristics. Benign breast tissue composition was evaluated using digital image analysis of histologic sections. Whole-genome microarrays were performed on the same tissue blocks.
Results: Mean epithelial, non-fatty stromal, and adipose proportions were 8.4% (SD = 4.9%), 27.7% (SD = 24.0%), and 64.0% (SD = 24.0%), respectively. Among women &lt;50 years old, stroma proportion decreased and adipose proportion increased with age, with approximately 2% difference per year (P &lt; 0.01). The variation in epithelial proportion with age was modest (0.1% per year). Higher epithelial proportion was associated with obesity (7.6% in nonobese vs. 10.1% in obese; P = 0.02) and with poorly differentiated tumors (7.8% in well/moderate vs. 9.9% in poor; P = 0.05). Gene expression signatures associated with epithelial and stromal proportion were identified and validated. Stroma-associated genes were in metabolism and stem cell maintenance pathways, whereas epithelial genes were enriched for cytokine and immune response pathways.
Conclusions: Breast tissue composition was associated with age, body mass index, and tumor grade, with consequences for breast gene expression.
Impact: Breast tissue morphologic factors may influence breast cancer etiology. Composition and gene expression may act as biomarkers of breast cancer risk and progression. Cancer Epidemiol Biomarkers Prev; 23(12); 2810–8. ©2014 AACR.
Efficacy of a Cathepsin K Inhibitor in a Preclinical Model for Prevention and Treatment of Breast Cancer Bone Metastasis
Authors: Duong Le T. , Wesolowski Gregg A. , Leung Patrick , Oballa Renata , Pickarski Maureen 
Published: September 2014

Abstract
Cathepsin K (CatK) is essential for osteoclast-mediated bone resorption. CatK expression is also detected in breast cancer cells that metastasize to bone. Here, the CatK inhibitor L-235 dosed in prevention (10, 30, and 100 mg/kg, p.o., b.i.d.) or treatment regimen (30 mg/kg) was compared with the bisphosphonate zoledronic acid (ZOL, 7.5 μg/kg/wk, s.c.) in the intratibial injection model of MDA-MB-231 breast carcinoma in nude rats. Progression of osteolysis, skeletal tumor burden, and local metastasis was evaluated by radiography through 42 days and ex vivo μCT and histology. IHC and RT-PCR confirmed the increases in CatK protein and mRNA levels in human breast cancer primary and metastatic tumors. In the experimental model of breast cancer bone metastasis, L-235 dosed in preventive mode resulted in a dose-related reduction of osteolysis of 72%, 75%, and 87% respectively, compared with ZOL by 86% versus intact. Similarly, L-235 significantly reduced intratibial tumor volume by 29%, 40%, and 63%, respectively, compared with 56% by ZOL versus vehicle. Efficacy of L-235 and ZOL on reduction of osteolytic lesions and tumor burden was comparable in treatment versus preventive regimens. All L-235 doses inhibited cortical disruption and extraskeletal tumor growth to a level comparable with ZOL. Assessment of local metastasis demonstrated that treatment with the CatK inhibitor was more effective than ZOL in reducing breast cancer invasion. These data support the role of CatK in breast cancer skeletal growth and metastasis and CatK inhibitors may represent a novel oral therapy for treatment of metastatic breast cancer. Mol Cancer Ther; 13(12); 2898–909. ©2014 AACR.
Factors Associated With Periesophageal Vagal Nerve Injury After Pulmonary Vein Antrum Isolation
Authors: Miyazaki Shinsuke , Taniguchi Hiroshi , Kusa Shigeki , Komatsu Yuki , Ichihara Noboru , Takagi Takamitsu , Iwasawa Jin , Kuroi Akio , Nakamura Hiroaki , Hachiya Hitoshi , Hirao Kenzo , Iesaka Yoshito 
Published: September 2014

Background

Periesophageal vagal nerve injury is recognized as a rare complication in atrial fibrillation ablation procedures. We investigated the factors associated with the occurrence of symptomatic p
eriesophageal vagal nerve injury
after pulmonary vein antrum isolation.

Methods and Results

Overall, 535 consecutive patients who underwent sole
pulmonary vein antrum isolation
were included. Point‐by‐point radiofrequency applications were applied using irrigated‐tip catheters under minimal sedation without esophageal temperature monitoring. In the initial 165 patients, the ablation settings for the posterior left atrium were a maximum energy of 25 to 30 W and a duration of 30 seconds. In the subsequent 370 patients, the power was additionally limited to 20 to 25 W at specific parts of the posterior
left atrium
where the ablation line transversed the esophagus. Symptomatic gastric hypomotility was found in 13 patients, and all were observed during the initial period (7.9%). No other collateral damage was observed. Logistic regression analysis revealed that the body mass index was the only independent predictor for identifying patients with gastric hypomotility (odds ratio 0.770; 95% confidence interval 0.643 to 0.922;
P
=0.0045) during the initial period. The prevalence of gastric hypomotility was significantly higher in the initial study period than subsequently (0 of 370, 0%;
P
<0.0001). All except for 1 patient recovered completely with conservative treatment within 4 months after the procedure.

Conclusions

P
eriesophageal vagal nerve injury
is more common collateral damage than direct esophageal injury in
pulmonary vein antrum isolation
procedures. Titrating the
radiofrequency
energy at specific areas where the ablation line transverses the esophagus and taking account of the body mass index might reduce occurrences not only of direct esophageal damage but also of
periesophageal vagal nerve injury
in
pulmonary vein antrum isolation
procedures.
Validation of the Montreal Cognitive Assessment Versus Mini-Mental State Examination Against Hypertension and Hypertensive Arteriopathy After Transient Ischemic Attack or Minor Stroke
Authors: Webb Alastair J.S. , Pendlebury Sarah T. , Li Linxin , Simoni Michela , Lovett Nicola , Mehta Ziyah , Rothwell Peter M. 
Published: September 2014

Background and Purpose—
Lack of reduced cognitive impairment with blood pressure (BP) lowering in trials may reflect use of the Mini-Mental State Examination (MMSE), which is insensitive to mild cognitive impairment after cerebrovascular events compared with the Montreal Cognitive Assessment. We determined relationships between impairment on MMSE versus Montreal Cognitive Assessment (MoCA) with the major physiological determinant of vascular cognitive impairment: hypertension and hypertensive arteriopathy.

Methods—
Cognitive impairment in consecutive patients 6 months after transient ischemic attack or minor stroke was defined as significant, mild, or none (MMSE<23, 23–26, ≥27; MoCA<20, 20–24, ≥25) and related to 20 premorbid systolic BP readings, home BP measurement (3 measurements, 3×daily for 1 month), and hypertensive arteriopathy (creatinine, stroke versus transient ischemic attack, leukoaraiosis) by ordinal regression.

Results—

Of 463 patients, 45% versus 28% had at least mild cognitive impairment on the MoCA versus MMSE (
P
<0.001). Hypertensive arteriopathy was more strongly associated with cognitive impairment on the MoCA than MMSE (creatinine: odds ratio=3.99; 95% confidence interval, 2.06–7.73 versus 2.16, 1.08–4.33; event: 1.53, 1.06–2.19 versus 1.23, 0.81–1.85; leukoaraiosis: 2.09, 1.42–3.06 versus 1.34, 0.87–2.07). Premorbid and home BP measurement systolic BP were more strongly associated with impairment on vascular subdomains of the MoCA than MMSE (odds ratio/10 mm Hg: visuospatial 1.29 versus 1.05; attention 1.18 versus 1.07; language 1.22 versus 0.91; naming 1.07 versus 0.86).

Conclusions—
The stronger relationship between impairment on the MoCA with hypertensive arteriopathy, independent of age, indicates a greater sensitivity for vascular-origin cognitive impairment. Use of MoCA should improve sensitivity for cognitive impairment and treatment effects in future studies.
Effect of Peer Education on Stroke Prevention
Authors: Kronish Ian M. , Goldfinger Judith Z. , Negron Rennie , Fei Kezhen , Tuhrim Stanley , Arniella Guedy , Horowitz Carol R. 
Published: September 2014

Background and Purpose—
Efforts to reduce disparities in recurrent stroke among Black and Latino stroke survivors have met with limited success. We aimed to determine the effect of peer education on secondary stroke prevention among predominantly minority stroke survivors.

Methods—
Between 2009 and 2012, we enrolled 600 stroke or transient ischemic attack survivors from diverse, low-income communities in New York City into a 2-arm randomized clinical trial that compared a 6 week (1 session/week), peer-led, community-based, stroke prevention self-management group workshop (N=301) to a wait-list control group (N=299). The primary outcome was the proportion with a composite of controlled blood pressure (<140/90 mm Hg), low-density lipoprotein cholesterol <100 mg/dL, and use of antithrombotic medications at 6 months. Secondary outcomes included control of the individual stroke risk factors. All analyses were by intent-to-treat.

Results—

There was no difference in the proportion of intervention and control group participants achieving the composite outcome (34% versus 34%;
P
=0.98). The proportion with controlled blood pressure at 6 months was greater in the intervention group than in the control group (76% versus 67%;
P
=0.02). This corresponded to a greater change in systolic blood pressure in the intervention versus control group (−3.63 SD, 19.81 mm Hg versus +0.34 SD, 23.76 mm Hg;
P
=0.04). There were no group differences in the control of cholesterol or use of antithrombotics.

Conclusions—
A low-cost peer education self-management workshop modestly improved blood pressure, but not low-density lipoprotein cholesterol or antithrombotic use, among stroke and transient ischemic attack survivors from vulnerable, predominantly minority urban communities.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov/show/NCT0102727
. Unique identifier: NCT01027273.
Mesoscale Structure of Cape Farewell Tip Jets
Authors: Moore G. W. K. 
Published: September 2014

Abstract
Cape Farewell, Greenland’s southernmost point, is characterized by a number of low-level jets that are the result of topographic flow distortion associated with passing extratropical cyclones. The heavy seas associated with these wind events are a hazard to maritime traffic in the region. In addition, the air–sea heat flux associated with these weather systems plays an important role in the climate system by contributing to the forcing of the lower limb of the Atlantic meridional overturning circulation. In this paper, the North American Regional Reanalysis will be used to generate a higher-resolution climatology of these mesoscale jets as compared to previous studies. Through the use of a diagnostic that partitions the occurrence frequency of high-speed wind events by wind direction, the author shows that there are four different types of Cape Farewell tips jets that are characterized as having either northwesterly, southwesterly, northeasterly, or southeasterly wind direction. All four types have distinct regions in the vicinity of Cape Farewell where their respective occurrence frequencies and air–sea heat fluxes are at a maximum. The southwesterly and northeasterly jets closely resemble the wind systems previously identified as being westerly and easterly tip jets. There are also instances where one type evolves into another and so it is possible to view westerly tip jets as a continuum with the northwesterly and southwesterly events identified in this paper representing end members with a similar picture for easterly tip jets. The position of a particular event along these continua will determine its impact on local weather and the coupled climate system.
A Method for Retrieving the Ground Flash Fraction and Flash Type from Satellite Lightning Mapper Observations
Authors: Koshak William J. , Solakiewicz Richard J. 
Published: September 2014

AbstractAn analytic perturbation method is introduced for retrieving the lightning ground flash fraction in a set of N lightning flashes observed by a satellite lightning mapper. The value of N must be large, typically in the thousands, and the satellite lightning optical observations consist of the maximum group area (MGA) produced by each flash. Moreover, the method subsequently determines the flash type (ground or cloud) of each of the N flashes. Performance tests of the method were conducted using simulated observations that were based on Optical Transient Detector (OTD) and Lightning Imaging Sensor (LIS) data. It is found that the mean ground flash fraction retrieval errors are below 0.04 across the full range 0–1 under the nominal conditions defined. In general, it is demonstrated that the retrieval errors depend on many factors (i.e., the number N of satellite observations, the magnitude of random and systematic instrument measurement errors, the ground flash fraction itself, and the number of samples used to form certain climate distributions employed in the method). The fraction of flashes accurately flash typed by the method averaged better than 78%. Overall, the accuracy of ground flash fraction and flash-typing retrievals degrade as the simulated population ground and cloud flash MGA distributions become more identical. Finally, because the analytic perturbation method was found to be quite robust (i.e., it performed well for several arbitrary underlying MGA distributions), it is not restricted to the lightning problem studied here but can be applied to any inverse problem having a similar problem statement.
Analysis of the Ross Ice Shelf Airstream Forcing Mechanisms Using Self-Organizing Maps
Authors: Nigro Melissa A. , Cassano John J. 
Published: September 2014

Abstract
The Ross Ice Shelf airstream (RAS), a prominent transport mechanism of cold, continental air to the north, is the most common wind pattern over the Ross Ice Shelf, Antarctica. The forcing mechanisms of the RAS include katabatic drainage, mesoscale forcing, and synoptic forcing. This paper uses the 15-km output from the Antarctic Mesoscale Prediction System (AMPS) and the method of self-organizing maps (SOM) to analyze how the combination of these forcing mechanisms impacts the strength and position of the RAS. It is found that the strength and position of the RAS is mainly driven by the thermal forcing in the region of the Transantarctic Mountains. This forcing includes the pressure gradient associated with cold air pooling at the base of the Transantarctic Mountains, as well as, the pressure gradient associated with the temperature contrast between the cold air located over the East Antarctic Plateau and the warm ambient air over the Ross Ice Shelf. These forcing mechanisms are analyzed in a region near the southern tip of the Ross Ice Shelf. In this region, the pressure gradient associated with the temperature contrast between the East Antarctic Plateau and the ambient air over the ice shelf is usually present during RAS events, while the pressure gradient associated with the cold air pooling varies between RAS events. The analysis shows that, in the region of the southern Ross Ice Shelf, RAS events can occur without the presence of cold air pooling.