bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact performance of headguards for combat sports
Authors: McIntosh Andrew S , Patton Declan A 
Published: July 2015

Background/aimTo assess the impact energy attenuation performance of a range of headguards for combat sports.MethodsSeven headguards worn during combat sport training or competition, including two Association Internationale de Boxe Amateur (AIBA)-approved boxing models, were tested using drop tests. An International Organization for Standardization (ISO) rigid headform was used with a 5.6 kg drop assembly mass. Tests were conducted against a flat rigid anvil both with and without a boxing glove section. The centre forehead and lateral headguard areas were tested. Peak headform acceleration was measured. Tests from a selection of drop heights and repeated tests on the same headguard were conducted.ResultsHeadguard performance varied by test condition. For the 0.4 m rigid anvil tests, the best model headguard was the thickest producing an average peak headform acceleration over 5 tests of 48 g compared with 456 g for the worst model. The mean peak acceleration for the 0.4, 0.5 and 0.6 frontal and lateral rigid anvil impact tests was between 32% and 40% lower for the Top Ten boxing model compared with the Adidas boxing model. The headguard performance deterioration observed with repeat impact against the flat anvil was reduced for impacts against the glove section. The overall reduction in acceleration for the combination of glove and headguard in comparison to the headguard condition was in the range of 72–93% for 0.6 and 0.8 m drop tests.ConclusionsThe impact tests show the benefits of performance testing in identifying differences between headguard models.
Improving reporting of critical incidents through education and involvement.
Authors: Donnelly Peter 
Published: July 2015

AbstractCritical incident reporting involves highlighting events and near-misses which have a potential impact on patient care and patient safety. Reporting of critical incidents is a recognised tool in improving patient safety. Within the community paediatric setting in the Belfast Health & Social Care Trust (BHSCT) there is a paucity of incident report forms. The purpose of this quality improvement project was to establish the barriers to reporting critical incidents and to implement plan-do-study-act (PDSA) cycles to create a climate for change.The methodology for this project was to firstly perform a baseline audit to review all submitted critical incident reports for the Community Paediatric team in the BHSCT for a six month period. A questionnaire was distributed to staff within the multidisciplinary team to establish examples of barriers to reporting. Interventions performed included introducing an agreed definition of a critical incident, distributing/presenting questionnaire findings to senior members of the various management teams and providing feedback to healthcare workers after presentation of a critical incident presentation. A review of incident reports was performed over the subsequent six month period to assess how the interventions impacted on incident reporting.Over 12 questionnaires 28 barriers to reporting critical incidents were reported which fell into five separate categories. Staff members were twice as likely to report negativity after reporting a critical incident. Overall critical incident reporting within the BHSCT Community Paediatric team improved from 11 incident reports (1.8 per month) to 22 incident reports (3.7 per month) after completion of the quality improvement project. This represents an increase of 100%.
Transition: the experiences of support workers caring for people with learning disabilities towards the end of life
Authors: O'Sullivan Gavan , Harding Richard 
Published: July 2015

AimThis research aims to provide a better understanding of the experience of support workers, as paid carers, caring for adults with learning disabilities (LDs) nearing the end of life in residential settings.BackgroundIn the past 100 years, people with LDs (also referred to as ‘learning difficulty’, ‘mental retardation’ and ‘intellectual disability’ internationally) are living longer with life expectancy approaching the population norm and more likely to die from diseases such as cancer, respiratory and vascular diseases. Community-based supported accommodation has become the foremost provider for people with LDs in their late 30 s or over in the UK. In the midst of the transition from living to dying for people with LDs, and even postdeath, the needs of support workers are often neglected against a background where most are unqualified, often with little experience of death and dying event, and with limited access to clinical supervision and education.Methods3 focus groups involving 13 support workers were conducted at 3 independent service provider settings for people with LDs in London.FindingsIn recounting the experiences of these groups of support workers, 6 themes are described: strong emotional bond and identification; collaboration with other services; training issues around the extended role; support within the organisation; relationship with family/other residents; and grieving the ‘loss’.ConclusionsAlthough support workers play a key role in meeting the end-of-life care needs of people with LDs in residential settings, their own needs are often neglected. There are still significant gaps in understanding these needs and practice development in this area.
Predictors of mortality in patients with flail chest: a systematic review
Authors: Battle Ceri E , Evans Phillip A 
Published: July 2015

ObjectiveTo summarise the risk factors for mortality in patients with flail chest based on available evidence in the literature.MethodsA systematic review was completed using articles from PubMed, EMBASE, the Centre for Review and Dissemination database and the Cochrane Library. Additional studies were identified by hand-searching bibliographies, and grey literature was sought by searching abstracts from all relevant Emergency Medicine Conferences. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for patients with flail chest.ResultsThis review found seven studies that matched the inclusion criteria, with a total of 944 patients. Patient age of ≥65 years was reported as a predictor of mortality when controlling for injury severity score (ISS) (p<0.02, OR 2.1, 95% CI 1.0 to 4.6). An ISS of ≥31 was reported to be a predictor of mortality in two studies; however, neither controlled for patient age. Pulmonary contusion, bilateral flail chest and hospital length of stay were not consistently found to be associated with mortality.ConclusionsThe main independent predictors of mortality in patients with flail chest were reported to be increased age and ISS. More data are needed regarding the association of hospital length of stay, presence of pulmonary contusion and bilateral flail chest.
In the era of the 24 h laboratory, does communicating Gram stain results from blood cultures flagging positive outside of conventional working hours alter patient management?
Authors: Moore Jonathan S , Koerner Roland J 
Published: July 2015

AimsAs laboratories move towards 24 h a day working patterns, we aim to evaluate if expediting the availability of provisional blood culture results outside of normal working hours would derive clinical benefit.Methods116 blood cultures flagging positive outside of conventional working hours (20:00–09:00) were studied. In each case, medical records were reviewed and cases discussed with clinicians to determine if earlier communication of results would have altered management and affected the outcome.ResultsOrganisms were seen in 102/116 blood cultures. In total, 76/82 (92.7%) patients with cultures deemed to be significant were on an antibiotic. The isolate was sensitive to the prescribed antibiotic in 56/74 (76%) cases. Input from a microbiologist is likely to have altered management in 14 (13.7%) cases, but unlikely to have affected any outcomes.ConclusionsWe found no compelling evidence that expediting the availability of Gram stain results from positive blood cultures alone improves patient outcome.
Do macroeconomic contractions induce or ‘harvest’ suicides? A test of competing hypotheses
Authors: Gemmill Alison , Falconi April , Karasek Deborah , Hartig Terry , Anderson Elizabeth , Catalano Ralph 
Published: July 2015

BackgroundResearchers often invoke a mortality displacement or ‘harvesting’ mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment—induction or displacement.MethodsWe apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000–2011. Tests are conducted separately for working age (20–64 years old) men and women as well as older (aged 65 years and older) men and women.ResultsDisplacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4–6 months later.ConclusionsDisplacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments.
Improvement of Protonic Ceramic Fuel Cells with Thin Film BCZY Electrolyte
Authors: Okuyama Yuji , Ebihara Noriaki , Okuyama Kenji , Mizutani Yasunobu 
Published: July 2015

The performance of protonic ceramic fuel cells (PCFCs) using the thin film BaCe0.6Zr0.2Y0.2O3-δ (BCZY622) electrolyte has been studied. The reference cell with the La0.8Sr0.2MnO3-δ cathode and Ni anode showed a poor performance and short-term degradation. The overpotential of the anode and ohmic loss were the major limiting factors for degradation, and a solid solution of Ni in the BCZY electrolyte has been observed. The electrical conductivity and the proton concentration of BCZY and BCZY622 doped with 5wt% NiO were measured by an impedance analysis and thermogravimetric analysis. The electrical conductivity and the proton concentration of BCZY622 decreased by introducing NiO. To avoid a short-term degradation, the cell construction, manufacturing process, and cathode materials were improved. As a result, a carefully designed PCFC with a thin film BCZY622, Ba0.5Sr0.5Co0.8Fe0.2O3-δ
cathode and Ni/BCZY622 cermet anode showed the good power density of 200-300mW/cm2 in the wide temperature range of 873 - 1073K , and had a stable generation.
Defining Effective Combinations of Immune Checkpoint Blockade and Oncolytic Virotherapy
Authors: Rojas Juan J. , Sampath Padma , Hou Weizhou , Thorne Steve H. 
Published: July 2015

Abstract
Purpose: Recent data from randomized clinical trials with oncolytic viral therapies and with cancer immunotherapies have finally recapitulated the promise these platforms demonstrated in preclinical models. Perhaps the greatest advance with oncolytic virotherapy has been the appreciation of the importance of activation of the immune response in therapeutic activity. Meanwhile, the understanding that blockade of immune checkpoints (with antibodies that block the binding of PD1 to PDL1 or CTLA4 to B7-2) is critical for an effective antitumor immune response has revitalized the field of immunotherapy. The combination of immune activation using an oncolytic virus and blockade of immune checkpoints is therefore a logical next step.
Experimental Design: Here, we explore such combinations and demonstrate their potential to produce enhanced responses in mouse tumor models. Different combinations and regimens were explored in immunocompetent mouse models of renal and colorectal cancer. Bioluminescence imaging and immune assays were used to determine the mechanisms mediating synergistic or antagonistic combinations.
Results: Interaction between immune checkpoint inhibitors and oncolytic virotherapy was found to be complex, with correct selection of viral strain, antibody, and timing of the combination being critical for synergistic effects. Indeed, some combinations produced antagonistic effects and loss of therapeutic activity. A period of oncolytic viral replication and directed targeting of the immune response against the tumor were required for the most beneficial effects, with CD8+ and NK, but not CD4+ cells mediating the effects.
Conclusions: These considerations will be critical in the design of the inevitable clinical translation of these combination approaches. Clin Cancer Res; 21(24); 5543–51. ©2015 AACR.
See related commentary by Slaney and Darcy, p. 5417
A Phase I Trial of Combined Ridaforolimus and MK-2206 in Patients with Advanced Malignancies
Authors: Gupta Shilpa , Argilés Guillem , Munster Pamela N. , Hollebecque Antoine , Dajani Olav , Cheng Jonathan D. , Wang Ruixue , Swift Ann , Tosolini Alessandra , Piha-Paul Sarina A. 
Published: July 2015

Abstract
Purpose: The PI3K/Akt/mTOR signaling pathway is aberrantly activated in many cancers. Combining ridaforolimus, an mTOR inhibitor, with MK-2206, an Akt inhibitor, may more completely block the PI3K pathway and inhibit tumor growth.
Experimental Design: This phase I study assessed dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) for the combination of oral ridaforolimus plus oral MK-2206 in patients with advanced solid tumors. Efficacy was evaluated in patients with biomarker-identified estrogen receptor–positive breast cancer (low RAS gene signature and high Ki67 index) or castration-resistant prostate cancer (PTEN deficiency) with PI3K pathway addiction.
Results: Thirty-five patients were enrolled: 11 patients in part A (three breast cancer) and 24 biomarker-eligible patients in part B (16 breast cancer, eight prostate cancer). One patient with breast cancer from part A was also found to be biomarker-eligible when tested after she had clinical response. The MTD was 10 mg/d ridaforolimus 5 d/wk + 90 mg/wk MK-2206; 1 of 17 patients experienced DLT (grade 3 rash) at this dose. The most common adverse events at MTD were rash (44.4%), stomatitis (38.9%), diarrhea (27.8%), and decreased appetite (27.8%). By investigator assessment, 2 of 16 (12.5%) evaluable patients with breast cancer had partial response; by central assessment, 2 of 14 (14.3%) evaluable patients had complete response. Two patients had durable stable disease (SD) for 416 and 285 days, respectively. No patients with prostate cancer responded; one patient had SD for ≥6 months.
Conclusions: Combination ridaforolimus and MK-2206 showed promising activity and good tolerability in heavily pretreated patients with hormone-positive and -negative breast cancer exhibiting PI3K pathway dependence. Clin Cancer Res; 21(23); 5235–44. ©2015 AACR.
Analysis of Molecular Markers by Anatomic Tumor Site in Stage III Colon Carcinomas from Adjuvant Chemotherapy Trial NCCTG N0147 (Alliance)
Authors: Sinicrope Frank A. , Mahoney Michelle R. , Yoon Harry H. , Smyrk Thomas C. , Thibodeau Stephen N. , Goldberg Richard M. , Nelson Garth D. , Sargent Daniel J. , Alberts Steven R. 
Published: July 2015

AbstractPurpose: To determine the frequency and prognostic association of molecular markers by anatomic tumor site in patients with stage III colon carcinomas.Experimental Design: In a randomized trial of adjuvant FOLFOX ± cetuximab, BRAFV600E and KRAS (exon 2) mutations and DNA mismatch repair (MMR) proteins were analyzed in tumors (N = 3,018) in relationship to tumor location, including subsite. Cox models were used to assess clinical outcome, including overall survival (OS).Results: KRAS codon 12 mutations were most frequent at the splenic flexure and cecum; codon 13 mutations were evenly distributed. BRAF mutation frequency sharply increased from transverse colon to cecum in parallel with deficient (d) MMR. Nonmutated BRAF and KRAS tumors progressively decreased from sigmoid to transverse (all P &lt; 0.0001). Significantly, poorer OS was found for mutant KRAS in distal [HR, 1.98; 95% confidence interval (CI), 1.49–2.63; P &lt; 0.0001] versus proximal (1.25; 95% CI, 0.97–1.60; P = 0.079) cancers. BRAF status and outcome were not significantly associated with tumor site. Proximal versus distal dMMR tumors had significantly better outcome. An interaction test was significant for tumor site by KRAS (Padjusted = 0.043) and MMR (Padjusted = 0.010) for OS. Significant prognostic differences for biomarkers by tumor site were maintained in the FOLFOX arm. Tumor site was independently prognostic with a stepwise improvement from cecum to sigmoid (OS: Padjusted = 0.001).Conclusions: Mutation in BRAF or KRAS codon 12 was enriched in proximal cancers whereas nonmutated BRAF/KRAS was increased in distal tumors. Significant differences in outcome for KRAS mutations and dMMR were found by tumor site, indicating that their interpretation should occur in the context of tumor location. Clin Cancer Res; 21(23); 5294–304. ©2015 AACR.
A Cluster-Randomized, Controlled Trial of a Simplified Multifaceted Management Program for Individuals at High Cardiovascular Risk (SimCard Trial) in Rural Tibet, China, and Haryana, India
Authors: Tian Maoyi , Ajay Vamadevan S. , Dunzhu Danzeng , Hameed Safraj S. , Li Xian , Liu Zhong , Li Cong , Chen Hao , Cho KaWing , Li Ruilai , Zhao Xingshan , Jindal Devraj , Rawal Ishita , Ali Mohammed K. , Peterson Eric D. , Ji Jiachao , Amarchand Ritvik , Krishnan Anand , Tandon Nikhil , Xu Li-Qun , Wu Yangfeng , Prabhakaran Dorairaj , Yan Lijing L. 
Published: July 2015

Background—
In rural areas in China and India, the cardiovascular disease burden is high but economic and healthcare resources are limited. This study (the Simplified Cardiovascular Management Study [SimCard]) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers with the aid of a smartphone-based electronic decision support system.

Methods and Results—

The SimCard study was a yearlong cluster-randomized, controlled trial conducted in 47 villages (27 in China and 20 in India). Recruited for the study were 2086 individuals with high cardiovascular risk (aged ≥40 years with self-reported history of coronary heart disease, stroke, diabetes mellitus, and/or measured systolic blood pressure ≥160 mm Hg). Participants in the intervention villages were managed by community health workers through an Android-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications. In comparison with the control group, the intervention group had a 25.5% (
P
<0.001) higher net increase in the primary outcome of the proportion of patient-reported antihypertensive medication use pre- and post-intervention. There were also significant differences in certain secondary outcomes: aspirin use (net difference: 17.1%;
P
<0.001) and systolic blood pressure (–2.7 mm Hg;
P
=0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored, and country-specific results revealed important differences between the regions.

Conclusions—
The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in resource-poor settings in China and India. Larger trials in more places are needed to ascertain the potential impacts on mortality and morbidity outcomes.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01503814.
Stroke and Bleeding Risk Associated With Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation in Clinical Practice
Authors: An JaeJin , Niu Fang , Lang Daniel T. , Jazdzewski Kristin P. , Le Paul T. , Rashid Nazia , Meissner Brian , Mendes Robert , Dills Diana G. , Aranda Gustavus , Bruno Amanda 
Published: July 2015

Background
The quality of antithrombotic therapy for patients with nonvalvular atrial fibrillation during routine medical care is often suboptimal. Evidence linking stroke and bleeding risk with antithrombotic treatment is limited. The purpose of this study was to evaluate the associations between antithrombotic treatment episodes and outcomes.

Methods and Results

A retrospective longitudinal observational cohort study was conducted using patients newly diagnosed with nonvalvular atrial fibrillation with 1 or more stroke risk factors (
CHADS
2
≥1) in Kaiser Permanente Southern California between January 1, 2006 and December 31, 2011. A total of 1782 stroke and systemic embolism (
SE
) and 3528 major bleed events were identified from 23 297 patients during the 60 021 person‐years of follow‐up. The lowest stroke/
SE
rates and major bleed rates were observed in warfarin time in therapeutic range (
TTR
) ≥55% episodes (stroke/
SE
: 0.87 [0.71 to 1.04]; major bleed: 4.91 [4.53 to 5.28] per 100 person‐years), which was similar to the bleed rate in aspirin episodes (4.95 [4.58 to 5.32] per 100 person‐years). The warfarin
TTR
≥55% episodes were associated with a 77% lower risk of stroke/
SE
(relative risk=0.23 [0.18 to 0.28]) compared to never on therapy; and the warfarin
TTR
<55% and on‐aspirin episodes were associated with a 20% lower and with a 26% lower risk of stroke/
SE
compared to never on therapy, respectively. The warfarin
TTR
<55% episodes were associated with nearly double the risk of a major bleed compared to never on therapy (relative risk=1.93 [1.74 to 2.14]).

Conclusions

Continuation of antithrombotic therapy as well as maintaining an adequate level of
TTR
is beneficial to prevent strokes while minimizing bleeding events.