bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Adoption of Quality Improvement Interventions to Implement Evidence‐Based Practices for Pressure Ulcer Prevention in U.S. Academic Medical Centers
Authors: Padula William V. , Mishra Manish K. , Makic Mary Beth F. , Wald Heidi L. , Campbell Jonathan D. , Nair Kavita V. , Valuck Robert J. 
Published: October 2015

ABSTRACTObjectiveIn 2008, the U.S. Centers for Medicare and Medicaid Services enacted a nonpayment policy for stage III and IV hospital‐acquired pressure ulcers (HAPUs), which incentivized hospitals to improve prevention efforts. In response, hospitals looked for ways to support implementation of evidence‐based practices for HAPU prevention, such as adoption of quality improvement (QI) interventions. The objective of this study was to quantify adoption patterns of QI interventions for supporting evidence‐based practices for HAPU prevention.MethodsThis study surveyed wound care specialists working at hospitals within the University HealthSystem Consortium. A questionnaire was used to retrospectively describe QI adoption patterns according to 25 HAPU‐specific QI interventions into four domains: leadership, staff, information technology (IT), and performance and improvement. Respondents indicated QI interventions implemented between 2007 and 2012 to the nearest quarter and year. Descriptive statistics defined patterns of QI adoption. A t‐test and statistical process control chart established statistically significant increase in adoption following nonpayment policy enactment in October 2008. Increase are described in terms of scope (number of QI domains employed) and scale (number of QI interventions within domains).ResultsFifty‐three of the 55 hospitals surveyed reported implementing QI interventions for HAPU prevention. Leadership interventions were most frequent, increasing in scope from 40% to 63% between 2008 and 2012; “annual programs to promote pressure ulcer prevention” showed the greatest increase in scale. Staff interventions increased in scope from 32% to 53%; “frequent consult driven huddles” showed the greatest increase in scale. IT interventions increased in scope from 31% to 55%. Performance and improvement interventions increased in scope from 18% to 40%, with “new skin care products . . .” increasing the most.Linking Evidence to ActionAcademic medical centers increased adoption of QI interventions following changes in nonpayment policy. These QI interventions supported adherence to implementation of pressure ulcer prevention protocols. Changes in payment policies for prevention are effective in QI efforts.
Interdisciplinary tutorial on sonic booms: A “super” sonic saga
Authors: Sparrow Victor W. 
Published: October 2015

This tutorial will provide an introduction to sonic booms, including background, current status of research, and future prospects. Supersonic aircraft generate sonic booms, so the physics of shock propagation through the atmosphere is involved. But those shocks are ultimately heard on the ground indoors and outdoors, both by people and wildlife. Hence, physical acoustics, psychological and physiological acoustics, animal bioacoustics, structural acoustics, vibration, and noise are all involved. Aircraft manufacturers have plans to build new civilian supersonic passenger aircraft, and these new aircraft intend to have sonic booms that are much quieter than those produced by either military aircraft or the now-retired Concorde supersonic airliner. Thus, an additional objective of this tutorial is to provide a quick-start technical basis for ASA members to understand the basics of sonic booms, enabling them to communicate effectively about sonic booms. If the aircraft manufacturers meet their stated goals, millions of people around the world will potentially begin hearing quiet sonic booms in the future. The material is highly interdisciplinary and should be useful both to the curious and to specialists across almost all of the Acoustical Society of America's technical areas. [The opinions, findings, conclusions, and recommendations stated here are those of the author and do not necessarily reflect the views of sponsors of the ASCENT Center of Excellence including the Federal Aviation Administration.]
In conjunction with the Tutorial Lecture on sonic booms on Monday evening, Gulfstream Aerospace Corporation will be bringing their sonic boom simulator to the Jacksonville, FL meeting. The Supersonic Acoustic Signature Simulator II is a specially equipped mobile audio booth designed to accurately reproduce the noise an observer on the ground would hear if a supersonic aircraft flew by. More specifically, the visitor at the ASA meeting will experience a back-to-back comparison of two radically different synthesized sonic booms. The first sonic boom signature will represent the “traditional” N-wave signature produced by the Concorde. The second sonic boom will represent a shaped signature that is representative of a low-boom aircraft. The intent of this demonstration is to provide the visitor with an opportunity to experience a fully immersive simulation that contains a sophisticated auralization of stimuli that contribute to subjective response caused by a sonic boom.
The simulator will only be available on Monday, November 2 (12:00 noon to 7:00 p.m.), and Tuesday, November 3 (9:00 a.m. to 6:00 p.m.), and will be located at Jacksonville Landing, just steps away from the Hyatt Regency. Walking directions will be provided on site via convenient signs. Please come and take advantage of this special opportunity to hear the Supersonic Acoustic Signature Simulator II.
Polyploid Titan Cells Produce Haploid and Aneuploid Progeny To Promote Stress Adaptation
Authors: Gerstein Aleeza C. , Fu Man Shun , Mukaremera Liliane , Li Zhongming , Ormerod Kate L. , Fraser James A. , Berman Judith , Nielsen Kirsten 
Published: October 2015

ABSTRACT

Cryptococcus neoformans
is a major life-threatening fungal pathogen. In response to the stress of the host environment,
C. neoformans
produces large polyploid titan cells. Titan cell production enhances the virulence of
C. neoformans
, yet whether the polyploid aspect of titan cells is specifically influential remains unknown. We show that titan cells were more likely to survive and produce offspring under multiple stress conditions than typical cells and that even their normally sized daughters maintained an advantage over typical cells in continued exposure to stress. Although polyploid titan cells generated haploid daughter cell progeny upon
in vitro
replication under nutrient-replete conditions, titan cells treated with the antifungal drug fluconazole produced fluconazole-resistant diploid and aneuploid daughter cells. Interestingly, a single titan mother cell was capable of generating multiple types of aneuploid daughter cells. The increased survival and genomic diversity of titan cell progeny promote rapid adaptation to new or high-stress conditions.

IMPORTANCE
The ability to adapt to stress is a key element for survival of pathogenic microbes in the host and thus plays an important role in pathogenesis. Here we investigated the predominantly haploid human fungal pathogen
Cryptococcus neoformans
, which is capable of ploidy and cell size increases during infection through production of titan cells. The enlarged polyploid titan cells are then able to rapidly undergo ploidy reduction to generate progeny with reduced ploidy and/or aneuploidy. Under stressful conditions, titan cell progeny have a growth and survival advantage over typical cell progeny. Understanding how titan cells enhance the rate of cryptococcal adaptation under stress conditions may assist in the development of novel drugs aimed at blocking ploidy transitions.
Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis
Authors: Lankhorst N E , van Middelkoop M , Crossley K M , Bierma-Zeinstra S M A , Oei E H G , Vicenzino B , Collins N J 
Published: October 2015

BackgroundPatellofemoral pain (PFP) has traditionally been viewed as self-limiting, but recent studies show that a large proportion of patients report chronic knee pain at long-term follow-up. We identified those patients with an unfavourable recovery (‘moderate improvement’ to ‘worse than ever’ measured on a Likert scale) and examined whether there is an association between PFP and osteoarthritis (OA) at 5–8-year follow-up.MethodsLong-term follow-up data were derived from 2 randomised controlled trials (n=179, n=131). Patient-reported measures were obtained at baseline. Pain severity (100 mm visual analogue scale (VAS)), function (Anterior Knee Pain Scale (AKPS)) and self-reported recovery were measured 5–8 years later, along with knee radiographs. Multivariate backward stepwise linear regression analyses were used to evaluate the prognostic ability of baseline pain duration, pain VAS and AKPS on outcomes of pain VAS and AKPS at 5–8 years.Results60 (19.3%) participants completed the questionnaires at 5–8-year follow-up (45 women, mean age at baseline 26 years) and 50 underwent knee radiographs. No differences were observed between responders and non-responders regarding baseline demographics, and 3-month and 12-month pain severity and recovery. 34 (57%) reported unfavourable recovery at 5–8 years. 48 out of 50 participants (98%) had no signs of radiographic knee OA. Multivariate models revealed that baseline PFP duration (>12 months; R2=0.22) and lower AKPS (R2=0.196) were significant predictors of poor prognosis at 5–8 years on measures of worst pain VAS and AKPS, respectively.Summary and conclusionMore than half of participants with PFP reported an unfavourable recovery 5–8 years after recruitment, but did not have radiographic knee OA. Longer PFP duration and worse AKPS score at baseline predict poor PFP prognosis. Education of health practitioners and the general public will provide patients with more realistic expectations regarding prognosis.
A LOCAL SURVEY AMONGST 92 PATIENTS WITH MULTIPLE SCLEROSIS: WHAT CAN WE LEARN ABOUT THIS POPULATION'S DISEASE MANAGEMENT? HOW SATISFIED ARE PATIENTS WITH OUR SERVICE?
Authors: Bashford James , Silber Eli 
Published: October 2015

In order to better inform local clinical practice, we collected primary data from our local MS population. We addressed important aspects concerning relapse management, bone health, mental health, sphincter dysfunction, symptom burden, recognition of comorbidities and pharmacological treatment. An emphasis was placed on discovering the extent of patient satisfaction with the local service.An 11-page patient questionnaire was distributed to consecutive consenting patients attending the MS clinic. A supplemental questionnaire was provided to those patients on regular natalizumab therapy. In total, 92 full and 22 natalizumab questionnaires were completed.Two particular areas highlighted for improvement with regards to patient management and patient education were bone and mental health:1. Only 26% of respondents confirmed having had a dual-energy X-ray absorptiometry (DEXA) scan. When asked if reduced ability in MS is an important risk factor for osteoporosis, only 44/92 patients confirmed they thought this was true.2. In the last year, 41% and 58% of respondents have suffered from depression and anxiety, respectively. Despite this, only a third of these patients received any treatment (pharmacological or non-pharmacological) for anxiety, depression or both.Encouragingly, 95% of those surveyed would recommend our MS service to a friend or family member.
SEASON OF GLANDULAR FEVER AS A RISK FACTOR FOR MULTIPLE SCLEROSIS
Authors: Downham Christina , Visser Elizabeth , Vickers Mark , Counsell Carl 
Published: October 2015

BackgroundGlandular fever (GF) is a known risk factor for multiple sclerosis (MS) but it is unclear if the risk varies by season due to vitamin D-related variations in immune responses.MethodsPatients with MS diagnosed between 16–60 yrs were identified from the Clinical Practice Research Datalink (CPRD) along with up to six controls per case, matched by age, gender, general practice and duration of observation in CPRD prior to the date of diagnosis (index date). The numbers of patients and controls with a coded diagnosis of GF prior to the index date were identified and the date of GF diagnosis noted. Multivariable logistic regression analysed whether cases were more likely than controls to have GF in winter rather than summer, adjusted for age, gender and region.Results9247 cases (118 with GF) and 55033 controls (483 with GF) were included. GF was more common in MS cases than controls (odds ratio [OR] 1.77, 95% CI 1.53–2.05) but winter exposure was not associated with a higher risk of MS than summer (OR 1.09, 95% CI 0.72–1.66).ConclusionsGlandular fever in winter as opposed to summer does not appear to be associated with a greater risk of developing MS.
REGIONAL EFFICACY OF NATALIZUMAB TREATMENT IN RELAPSING-REMITTING MULTIPLE SCLEROSIS (RRMS)
Authors: Doshi Anisha , Voysey Zanna , Bunting Eva , Malik Muzaffar , Rashid Waqar 
Published: October 2015

Natalizumab is an established treatment for highly active Relapsing-Remitting Multiple Sclerosis (RRMS). Two-year efficacy in the AFFIRM trial showed No Evidence of Disease Activity(NEDA) – no relapses, no disability progression, no new MRI lesions – in 37% of patients compared with 7% in the placebo group. NEDA is increasingly used as a treatment goal in RRMS.MethodologyWe performed a retrospective analysis of Natalizumab treatment in RRMS patients in our centre. We assessed the proportion of patients achieving NEDA in a typical clinical setting with at least 1 year treatment duration and analysed for predictors of response.ResultsMean age was 41.44 (13–62), 77% (51) of patients were female. 56 out of 66 patients had been on Natalizumab for >1year and were analysed. 55.36% patients achieved NEDA at 1 year. No statistically significant predictors (age, gender, starting disability and relapse rate) of response were identified.DiscussionThe data confirms in a typical UK clinical setting good treatment response was achieved in highly active RRMS patients using Natalizumab. No additional factors were found which could predict treatment response suggesting within the limitations of power and length of this study that Natalizumab is effective in a broad range of highly active RRMS patients.
THE PHYSICAL, SOCIAL & ECONOMIC EXTENT OF MULTIPLE SCLEROSIS IN SUSSEX
Authors: Howells Jacob , Rashid Waqar 
Published: October 2015

BackgroundMultiple sclerosis (MS) is the most common disabling illness of young adults in the UK causing significant social and economical cost. The aim of this study was to ascertain further detail of the characteristics of the MS population in an area of Sussex representing about 25% of the whole region.MethodsThe following was obtained from community databases: (a) demographics; (b) employment status; (c) DMT use; (d) walking aid use and (e) utilisation of social care.ResultsN=665. The mean (SD) age was 54 (13.2) years; Relapsing-Remitting MS 51%, Secondary Progressive MS 29% and Primary Progressive MS 15%. Of participants <65 years: 56% were unemployed, 44% worked part or full-time; 57.8% of participants required walking aids to mobilise, 23.3% were on a DMT, 35.1% required informal care and 20.2% required external social care. We found associations (at α level=0.05) between unemployment and: SPMS, walking aid use, informal care and external social care.DiscussionThis study highlights the needs of people with MS in Sussex. Of note is the impact on employment and the need for walking aids and additional care associated with MS. This knowledge will allow us to better develop services for people with MS with commissioners.
PARTIAL INDEPENDENCE OF FINGOLIMOD EFFECT ON DIFFUSE VS. FOCAL DAMAGE
Authors: Constantinescu C , Stefano N De , Kappos L , Radue EW , Sprenger T , Meier D Piani , Häring D , Tomic D 
Published: October 2015

ObjectiveTo investigate if the effects of fingolimod 0.5mg on brain volume loss are mediated through effects on focal disease activity (FD) or independent-reduction of diffuse damage (DD).MethodsFREEDOMS and FREEDOMS-II data was pooled and analyzed post-hoc. Assessment of the percent brain volume change (PBVC) at M12 and 24, in patients with no evidence of FD, (absence of new Gd+ T1-lesions and/or new/enlarging T2-lesions) and clinical relapses. Regression analysis of the intent-to-treat (ITT) population to quantified whether the extent of the treatment effect was maintained for patients with new/active lesions and relapsesResultsOf the 1383 patients included, 808 patients (placebo=142; fingolimod=666) showed no FD at M12 and 573 patients (placebo=79; fingolimod=494) at M24 showed no FD. Fingolimod significantly reduced PBVC by 52% and 42% vs. placebo, over 12M and 24M respectively. In the pooled ITT population, fingolimod reduced 49% of PBVC (p<0.001)vs placebo over 24M. This effect was still evident when adjusting for new-active lesions and relapse activity (28% reduction vs placebo, p<0.001). The regression model suggests 57% of fingolimod effect on PBVC is FD-independent. Fingolimod effect on DD is partly independent of its treatment effect on FD, suggesting fingolimod impacts both inflammatory and neurodegenerative components.
EARLY PREDICTION OF LONG-TERM RESPONSE TO NATALIZUMAB IN MULTIPLE SCLEROSIS
Authors: Raffel Joel , Gafson Arie , Dahdaleh Samer , Nicholas Richard 
Published: October 2015

IntroductionIn people with multiple sclerosis treated with interferon-beta or glatiramer acetate, new MRI lesions and relapses during the first year of treatment predict poor prognosis. However, this association has not been studied in those receiving natalizumab.MethodologyData were collected on early relapses and new MRI activity from an observational cohort of 161 patients on natalizumab, with long-term follow-up. Two outcome measures were used. The first – ‘Clinical Activity Years 1–3’ – defined non-responders as those with relapses or EDSS progression at years 1–3 post-treatment, versus baseline. The second – ‘Disability Progression Years 3+’ – defined non-responders as those with EDSS progression at 3–7 years post-treatment, versus baseline.Results‘Clinical Activity Years 1–3’ was strongly predicted by early relapses (Odds Ratio (OR) 8.4, p<0.0001), and by a combined score of early relapses and MRI activity (Modified Rio Score 1: OR 4.9, p<0.001. Modified Rio Score 2: OR 19.0, P<0.01). In contrast, ‘Disability Progression Years 3+’ was not predicted by early relapses or MRI activity.ConclusionsRelapses and new MRI activity within the first year of starting natalizumab predict short-term outcomes, but not long-term disability outcomes. This requires further validation in other cohorts.
EFFECT OF TERIFLUNOMIDE ON LYMPHOCYTE AND NEUTROPHIL COUNTS
Authors: Weller Belinda , Comi Giancarlo , Freedman Mark , Kappos Ludwig , Miller Aaron , Olsson Tomas , Wolinsky Jerry , Benamor Myriam , Truffinet Philippe , O'Connor Paul 
Published: October 2015

IntroductionTeriflunomide is an immunomodulator known to decrease the proliferation of stimulated lymphocytes via inhibition of dihydro-orotate dehydrogenase. Lymphocyte/neutrophil counts were assessed in pooled data from one phase 2 and three phase 3 (TEMSO, TOWER, and TOPIC) placebo-controlled studies.MethodsPatients were randomized to receive once-daily teriflunomide 14mg (n=1002), 7mg (n=1045), or placebo (n=997). Blood samples were collected throughout the studies.ResultsMean baseline lymphocyte and neutrophil counts were similar across groups. Small decreases in mean lymphocyte and neutrophil counts occurred within the first 12 weeks (lymphocytes) or 6 weeks (neutrophils) of treatment, and stabilized within the normal range for most patients thereafter. Patients with neutrophil counts <1×10^9^/L were to discontinue treatment; 11 (1.1%; 14 mg), 8 (0.8%; 7 mg), and 1 (0.1%; placebo) patients discontinued due to neutropenia or neutrophil count decrease as per protocol requirements. Neutropenia was reported as a serious adverse event (SAE) in 7 (0.7%; 14 mg), 2 (0.2%; 7 mg), and 3 (0.3%; placebo) patients; there were no lymphopenia SAEs. No link between neutrophil or lymphocyte count decreases and infection was observed.ConclusionsThese data demonstrate that teriflunomide has small, reversible effects on lymphocyte/neutrophil counts, with no increase in infection risk observed. (Study supported by Genzyme, a Sanofi company).
EARLY RELAPSES IN PATIENTS WITH HIGHLY ACTIVE MULTIPLE SCLEROSIS COMMENCED ON FINGOLIMOD; THE LEEDS TEACHING HOSPITAL EXPERIENCE
Authors: Weerasinghe Kalani Chisha , Shanmugarajah Priya , Russell Melanie , Ford Helen 
Published: October 2015

Fingolimod is the much anticipated oral disease modifying treatment for patients with highly active Multiple sclerosis. A total of 42 patients were commenced on Fingolimod from December 2012 to June 2014 in Leeds Hospitals NHS Trust.Four patients discontinued treatment due to patient choice, consecutive severe relapses and hepatotoxicity. No other severe side effects were noted in these 42 patients. A total of ten relapses were seen in nine patients. Of which eight out of ten relapses occurred within the first two months. Of the nine patients who experienced relapses, five (55%) were previously treated with Natalizumab, as opposed to four on injectable Disease Modifying Treatments (45%).The five patients previously treated with Natalizumab all underwent a three month wash out period prior to commencing Fingolimod. The relapses all took place within the first two months following initiation of Fingolimod.Early relapses in a patient group with highly active disease would suggest that a period of three months without disease modifying treatment could be too long. Currently this period has been shortened to four weeks and it remains to be seen if this will result in fewer early relapses in patients commencing Fingolimod.
CLINICAL AND ELECTROPHYSIOLOGICAL CHARACTERISTICS OF 103 PATIENTS WITH SENSORY NEURONOPATHY
Authors: Lavin Timothy , Al-Bachari Sarah , Gosal David Yunus 
Published: October 2015

Sensory Neuronopathy (SN) represents a distinct peripheral nervous system disorder associated with degeneration of the Dorsal Root Ganglia. We present our retrospective review of 103 patients with an electro-clinical diagnosis of SN.Average age of onset was 54 yr. Aetiologies included Sjogrens (21%), Probable Inflammatory (16%), Idiopathic (29%), Inherited (20%), Toxic (5%) and paraneoplastic (9%).Of those with inherited SN (n=21); CANVAS syndrome 2/21, mitochrondrial cytopathy 9/21 with 4 confirmed POLG1 mutations, 3/21 presumed HSANIIb, Frederich's Ataxia 1/21 and 6/21 unidentified phenotypes.Clinically, acquired causes commonly presented with pain (62%), asymmetrical/non-length dependent sensory disturbance (91%) as compared to the inherited group who are more likely to present with gait disturbance without prominent sensory symptoms (52%).Of the cohort with presumed inflammatory disease, 29 patients were immunosuppressed with 12 patients responding to a combination of steroids and Mycophenolate. IVIG was not found to be beneficial with no sustained benefit in 7 patients.Paraneoplastic causes (n=9) included Breast (n=2), Neuroendocrine tumours (n=2), Carcinoid (n=2), Bowel (n=1), SCLC (n=1) and unknown primary (n=1) with only 4 Hu positiveConclusionsSensory neuronopathy is clinically and aetiologically pleomorphic. In cases with a suspected inflammatory cause it is worthwhile considering a trial of immunomodulatory treatment.