bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Evidence in Clinical Guidelines and Everyday Practice for Mechanical Ventilation in Swedish Intensive Care Units
Authors: Eldh Ann Catrine , Vogel Gisela , Söderberg Anna , Blomqvist Hans , Wengström Yvonne 
Published: June 2013

ABSTRACTBackground and AimOne way to support evidence‐based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice.MethodsInviting all general ICUs in Sweden (N = 65), a national survey was performed on occurrence of MV guidelines, and a review of submitted ICU guidelines by four evidence items from the AGREE instrument. In addition, ICU head nurses and senior physicians were interviewed using semistructured and open‐ended questions to explore development and dissemination of MV guidelines, staff adherence or nonadherence to guidelines, and everyday practice of MV management bedside.FindingsFifty‐five ICUs (85%) participated in the study; 51 ICUs submitted a total of 245 guidelines, including recommendations for medical or nursing MV actions. None of the documents included how evidence had been sought or assessed, while 22% included a list of references (n = 54). No guidelines included patients’ experiences of MV. According to the managers, the guidelines were most often compiled by a multiprofessional team sharing the information through the ICU's website. The guidelines were mainly used as a basis for MV management bedside, but variation occurred as a result of personal preferences, lack of awareness, and adjustment to patients’ needs.ConclusionsLocal MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.
Turning Knowledge Into Action at the Point‐of‐Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence‐Based Practice
Authors: Dogherty Elizabeth J. , Harrison Margaret B. , Graham Ian D. , Vandyk Amanda Digel , Keeping‐Burke Lisa 
Published: June 2013

ABSTRACTBackgroundFacilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well‐established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America.AimTo describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice.MethodsTwenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in‐depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses’ facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison.ResultsA number of factors emerged at various levels associated with the successes and failures of participants’ efforts to facilitate evidence‐based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability.ConclusionsFactors at the individual, environmental, organizational, and cultural level influence facilitation of evidence‐based practice in real situations at the point‐of‐care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.
Automatic reconstruction of the arterial and venous trees on volumetric chest CT
Authors: Park Seyoun , Min Lee Sang , Kim Namkug , Beom Seo Joon , Shin Hayong 
Published: June 2013

Purpose:This paper introduces a novel approach to classify pulmonary arteries and veins from volumetric chest computed tomography (CT) images. Although there is known to be a relationship between the alteration of vessel distributions and the progress of various pulmonary diseases, there has been relatively little research on the quantification of pulmonary vesselsin vivo due to morphological difficulties. In particular, there have been few efforts to quantify the morphology and distribution of only arteries or veins through automated algorithms despite the clinical importance of such work. In this study, the authors classify different types of vessels by constructing a tree structure from vascular points while minimizing the construction cost using the vascular geometries and features of CT images.Methods:First, a vascular point set is extracted from an input volume and the weights of the points are calculated using the intensity, distance from the boundaries, and the Laplacian of the distance field. The tree construction cost is then defined as the summation of edge connection costs depending on the vertex weights. As a solution, the authors can obtain a minimum spanning tree whose branches correspond to different vessels. By cutting the edges in the mediastinal region, branches can be separated. From the root points of each branch, the cut region is regrouped toward the entries of pulmonary vessels in the same framework of the initial tree construction. After merging branches with the same orientation as much as possible, it can be determined manually whether a given vessel is an artery or vein. Our approach can handle with noncontrast CT images as well as vascular contrast enhanced images.Results:For the validation, mathematical virtual phantoms and ten chronic obstructive pulmonary disease (COPD) noncontrast volumetric chest CT scans with submillimeter thickness were used. Based on experimental findings, the suggested approach shows 9.18 ± 0.33 (mean ± SD) visual scores for ten datasets, 91% and 98% quantitative accuracies for two cases, a result which is clinically acceptable in terms of classification capability.Conclusions:This automatic classification approach with minimal user interactions may be useful in assessing many pulmonary disease, such as pulmonary hypertension, interstitial lung disease and COPD.
Giant crinoid stems from the Lower Carboniferous (Mississippian) of Clitheroe, Lancashire, UK
Authors: Donovan S. K. 
Published: June 2013

Summary:

Hitherto, large crinoid pluricolumnals and attachment structures, commonly
c
. 30–60+ mm in diameter, from the Mississippian of Salthill Quarry in Lancashire, England, have been left in open nomenclature. The columnal morphospecies
Bystrowicrinus
(col.)
westheadi
sp. nov. is erected for these pluricolumnals, representing the dististele and attachment structure of a xenomorphic crinoid stem of a cladid or camerate. The column is homeomorphic or irregularly heteromorphic, with a circular, elliptical or pentagonal section, a relatively small pentastellate lumen, radially symplectial articulation and distal radicular attachment. The mesistele-dististele transition involves an abrupt increase in diameter. No large thecae known from this site could obviously be associated with such a dististele. The large column grew to such a diameter over a period of years, indicated by numerous, densely packed growth lines. Attachment was by both robust, unbranched radices and the weight of the large, inflexible column. Nutrient absorption and gaseous exchange would have occurred through the ectoderm.
A new record of the trace fossil
Selenichnites
from the Middle Jurassic Scalby Formation of the Cleveland Basin, Yorkshire
Authors: Romano Mike , Whyte Martin A. 
Published: June 2013

Summary:

Trace fossils of the ichnogenus
Selenichnites
are described from the Long Nab Member of the Scalby Formation, which is the highest unit of the Middle Jurassic Ravenscar Group of the Cleveland Basin, Yorkshire. The presence of
Selenichnites hundalensis
at this level extends the known range of this ichnospecies in the Cleveland Basin from the Bajocian up into the Bathonian. Together with other associated specimens, assigned to
Selenichnites
isp. and
Selenichnites
isp. indet., these ichnotaxa are regarded as having been made by limulids which inhabited a coastal environment that experienced both marine and freshwater conditions. One of the specimens provides evidence as to the depth of burial the maker achieved.
Regional Interdependency of Precipitation Indices across Denmark in Two Ensembles of High-Resolution RCMs
Authors: Sunyer Maria Antonia , Madsen Henrik , Rosbjerg Dan , Arnbjerg-Nielsen Karsten 
Published: June 2013

Abstract
Outputs from climate models are the primary data source in climate change impact studies. However, their interpretation is not straightforward. In recent years, several methods have been developed in order to quantify the uncertainty in climate projections. One of the common assumptions in almost all these methods is that the climate models are independent. This study addresses the validity of this assumption for two ensembles of regional climate models (RCMs) from the Ensemble-Based Predictions of Climate Changes and their Impacts (ENSEMBLES) project based on the land cells covering Denmark. Daily precipitation indices from an ensemble of RCMs driven by the 40-yr ECMWF Re-Analysis (ERA-40) and an ensemble of the same RCMs driven by different general circulation models (GCMs) are analyzed. Two different methods are used to estimate the amount of independent information in the ensembles. These are based on different statistical properties of a measure of climate model error. Additionally, a hierarchical cluster analysis is carried out. Regardless of the method used, the effective number of RCMs is smaller than the total number of RCMs. The estimated effective number of RCMs varies depending on the method and precipitation index considered. The results also show that the main cause of interdependency in the ensemble is the use of the same RCM driven by different GCMs. This study shows that the precipitation outputs from the RCMs in the ENSEMBLES project cannot be considered independent. If the interdependency between RCMs is not taken into account, the uncertainty in the RCM simulations of current regional climate may be underestimated. This will in turn lead to an underestimation of the uncertainty in future precipitation projections.
Hepatocellular carcinoma associated with budd-chiari syndrome: imaging features and transcatheter arterial chemoembolization
Authors: Liu Feng-Yong , Wang Mao-Qiang , Duan Feng , Fan Qing-Sheng , Song Peng , Wang Yan 
Published: June 2013

Abstract

Background
Budd–Chiari syndrome (BCS) often leads to hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) has been increasingly used to treat BCS patients with HCC. The purposes of this study were to illustrate imaging features in BCS patients with HCC, and to analyze the effects of TACE on BCS patients with HCC.

Methods
246 consecutive patients with primary BCS were retrospectively studied. 14 BCS patients with HCC were included in this study. BCS were treated with angioplasty and/or stenting, and HCC were managed with TACE. Imaging features on ultrasonography, CT, MRI, and angiography and the serum AFP level were analyzed.

Results
Inferior vena cava block and stricture of hepatic venous outflow tract more frequently occurred. Portal vein invasion was found in only 2 patients (14.2%). Imaging studies showed that most nodules of HCC were near the edge of liver, irregular, more than 3 cm in diameter, heterogeneous mass and solitary (≤3 nodules). HCC in patients associated with BCS was isointense or hypointense in nonenhanced CT images, and exhibited heterogeneous enhancement during the arterial phase and washout during the portal venous phase on enhanced CT and MRI. The serum AFP level significantly declined after TACE treatment.

Conclusions
BCS patients with inferior vena cava block and stricture of hepatic venous outflow tract seems to be associated with HCC. A single, large, irregular nodule with a peripheral location appears to be HCC. TACE can effectively treat HCC in BCS patients.
A link between premenopausal iron deficiency and breast cancer malignancy
Authors: Jian Jinlong , Yang Qing , Shao Yongzhao , Axelrod Deborah , Smith Julia , Singh Baljit , Krauter Stephanie , Chiriboga Luis , Yang Zhaoxu , Li Jinqing , Huang Xi 
Published: June 2013

Abstract

Background
Young breast cancer (BC) patients less than 45 years old are at higher risk of dying from the disease when compared to their older counterparts. However, specific risk factors leading to this poorer outcome have not been identified.

Methods
One candidate is iron deficiency, as this is common in young women and a clinical feature of young age. In the present study, we used immuno-competent and immuno-deficient mouse xenograft models as well as hemoglobin as a marker of iron status in young BC patients to demonstrate whether host iron deficiency plays a pro-metastatic role.

Results
We showed that mice fed an iron-deficient diet had significantly higher tumor volumes and lung metastasis compared to those fed normal iron diets. Iron deficiency mainly altered Notch but not TGF-β and Wnt signaling in the primary tumor, leading to the activation of epithelial mesenchymal transition (EMT). This was revealed by increased expression of Snai1 and decreased expression of E-cadherin. Importantly, correcting iron deficiency by iron therapy reduced primary tumor volume, lung metastasis, and reversed EMT markers in mice. Furthermore, we found that mild iron deficiency was significantly associated with lymph node invasion in young BC patients (p<0.002).

Conclusions
Together, our finding indicates that host iron deficiency could be a contributor of poor prognosis in young BC patients.
UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results
Authors: Humphris Gerry , Crawford John R , Hill Kirsty , Gilbert Angela , Freeman Ruth 
Published: June 2013

AbstractBackgroundA recent UK population survey of oral health included questions to assess dental anxiety to provide mean and prevalence estimates of this important psychological construct.MethodsA two-stage cluster sample was used for the survey across England, Wales, and Northern Ireland. The survey took place between October-December 2009, and January-April 2010. All interviewers were trained on survey procedures. Within the 7,233 households sampled there were 13,509 adults who were asked to participate in the survey and 11,382 participated (84%).ResultsThe scale was reliable and showed some evidence of unidimensionality. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Percentiles and confidence intervals were presented and can be estimated for individual patients across various age ranges and gender using an on-line tool.ConclusionsThe largest reported data set on the MDAS from a representative UK sample was presented. The scale’s psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Practitioners within the UK have a resource to estimate the rarity of a particular patient’s level of dental anxiety, with confidence intervals, when using the on-line percentile calculator.
Spica prunellae promotes cancer cell apoptosis, inhibits cell proliferation and tumor angiogenesis in a mouse model of colorectal cancer via suppression of stat3 pathway
Authors: Lin Wei , Zheng Liangpu , Zhuang Qunchuan , Zhao Jinyan , Cao Zhiyun , Zeng Jianwei , Lin Shan , Xu Wei , Peng Jun 
Published: June 2013

AbstractBackgroundConstitutive activation of STAT3 is one of the major oncogenic pathways involved in the development of various types of malignancies including colorectal cancer (CRC); and thus becomes a promising therapeutic target. Spica Prunellaehas long been used as an important component in many traditional Chinese medicine formulas to clinically treat CRC. Previously, we found thatSpica Prunellaeinhibits CRC cell growth through mitochondrion-mediated apoptosis. Furthermore, we demonstrated its anti-angiogenic activitiesin vivoandin vitro. To further elucidate the precise mechanism of the potential tumoricidal activity ofSpica Prunellae, using a CRC mouse xenograft model, in this study we evaluated its therapeutic efficacy against CRC and investigated the underlying molecular mechanisms.MethodsCRC mouse xenograft model was generated by subcutaneous injection of human colon carcinoma HT-29 cells into nude mice. Animals were given intra-gastric administration with 6 g/kg of the ethanol extract ofSpica Prunellae(EESP) daily, 5 days a week for 16 days. Body weight and tumor growth were measured every two days. Tumor growthin vivowas determined by measuring the tumor volume and weight. HT-29 cell viability was examined by MTT assay. Cell apoptosis and proliferation in tumors from CRC xenograft mice was evaluated via immunohistochemical staining (IHS) for TUNEL and PCNA, and the intratumoral microvessel density (MVD) was examined by using IHS for the endothelial cell-specific marker CD31. The activation of STAT3 was evaluated by determining its phosphorylation level using IHS. The mRNA and protein expression of Bcl-2, Bax, Cyclin D1, VEGF-A and VEGFR2 was measured by RT-PCR and IHS, respectively.ResultsEESP treatment reduced tumor volume and tumor weight but had no effect on body weight change in CRC mice; decreased HT-29 cell viability in a dose-dependent manner, suggesting that EESP displays therapeutic efficacy against colon cancer growthin vivoandin vitro, without apparent toxicity. In addition, EESP significantly inhibited the phosphorylation of STAT3 in tumor tissues, indicating its suppressive action on the activation of STAT3 signaling. Consequently, the inhibitory effect of EESP on STAT3 activation resulted in an increase in the pro-apoptotic Bax/Bcl-2 ratio, decrease in the expression of the pro-proliferative Cyclin D1 and CDK4, as well as down-regulation of pro-angiogenic VEGF-A and VEGFR-2 expression. Finally, these molecular effects led to the induction of apoptosis, the inhibition of cell proliferation and tumor angiogenesis.ConclusionsSpica Prunellaepossesses a broad range of anti-cancer activities due to its ability to affect STAT3 pathway, suggesting thatSpica Prunellaecould be a novel potent therapeutic agent for the treatment of CRC.
Knock-in/Knock-out (KIKO) vectors for rapid integration of large DNA sequences, including whole metabolic pathways, onto the Escherichia coli chromosome at well-characterised loci
Authors: Sabri Suriana , Steen Jennifer A , Bongers Mareike , Nielsen Lars K , Vickers Claudia E 
Published: June 2013

Abstract

Background
Metabolic engineering projects often require integration of multiple genes in order to control the desired phenotype. However, this often requires iterative rounds of engineering because many current insertion approaches are limited by the size of the DNA that can be transferred onto the chromosome. Consequently, construction of highly engineered strains is very time-consuming. A lack of well-characterised insertion loci is also problematic.

Results
A series of knock-in/knock-out (KIKO) vectors was constructed for integration of large DNA sequences onto the E. coli chromosome at well-defined loci. The KIKO plasmids target three nonessential genes/operons as insertion sites: arsB (an arsenite transporter); lacZ (β-galactosidase); and rbsA-rbsR (a ribose metabolism operon). Two homologous ‘arms’ target each insertion locus; insertion is mediated by λ Red recombinase through these arms. Between the arms is a multiple cloning site for the introduction of exogenous sequences and an antibiotic resistance marker (either chloramphenicol or kanamycin) for selection of positive recombinants. The resistance marker can subsequently be removed by flippase-mediated recombination. The insertion cassette is flanked by hairpin loops to isolate it from the effects of external transcription at the integration locus. To characterize each target locus, a xylanase reporter gene (xynA) was integrated onto the chromosomes of E. coli strains W and K-12 using the KIKO vectors. Expression levels varied between loci, with the arsB locus consistently showing the highest level of expression. To demonstrate the simultaneous use of all three loci in one strain, xynA, green fluorescent protein (gfp) and a sucrose catabolic operon (cscAKB) were introduced into lacZ, arsB and rbsAR respectively, and shown to be functional.

Conclusions
The KIKO plasmids are a useful tool for efficient integration of large DNA fragments (including multiple genes and pathways) into E. coli. Chromosomal insertion provides stable expression without the need for continuous antibiotic selection. Three non-essential loci have been characterised as insertion loci; combinatorial insertion at all three loci can be performed in one strain. The largest insertion at a single site described here was 5.4 kb; we have used this method in other studies to insert a total of 7.3 kb at one locus and 11.3 kb across two loci. These vectors are particularly useful for integration of multigene cassettes for metabolic engineering applications.
Pathologic fracture does not influence prognosis in stage IIB osteosarcoma: a case–control study
Authors: Zuo Dongqing , Zheng Longpo , Sun Wei , Hua Yingqi , Cai Zhengdong 
Published: June 2013

AbstractObjectiveThis study tested the implication of pathologic fractures on the prognosis in stage IIb osteosarcoma.MethodsA single center retrospective evaluation of clinical management and oncologic outcome was conducted with 15 pathological fracture patients (M:F = 10:5; age: mean 23.2, range 12–42) and 50 non-fracture patients between April 2002 and December 2010. These stage IIB osteosarcoma patients were matched for age, tumor site (femur, tibia, and humerus), and osteosarcoma subtype (i.e., control patients with osteosarcoma in the same sites as the fracture patients). All osteosarcoma patients with pathological fractures underwent brace or cast immobilization, adjuvant chemotherapy, and limb salvage surgery or amputation. Musculoskeletal Tumor Society (MSTS) functional scores were assessed. The mean follow-up time was 34.7 months (range, 8–47 months).ResultsFollowing limb salvage surgery, no statistical differences were observed in major complications (fracture = 20.0%, control = 12.0%,P= 0.43) or local recurrence complications (fracture = 26.7%, control = 14.0%,P= 0.25). Overall 3-year survival rates of the fracture and control groups (66.7% and 75.3%, respectively) were not statistically different (P= 0.5190). Three-year disease-free survival rates of the fracture and control groups were 53.3% and 66.5%, respectively (P= 0.25).ConclusionsPathologic fracture was not a prognostic indicator of recurrence or overall survival in localized osteosarcoma patients. Limb salvage can be achieved by and maintaining adequate surgical margins and applying adjuvant chemotherapy.