bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Lean principles to optimise inpatient phlebotomy services
Authors: Le Rachel D , Melanson Stacy E F , Santos Katherine S , Paredes Jose D , Baum Jonathan M , Goonan Ellen M , Torrence-Hill Joi N , Gustafson Michael L , Tanasijevic Milenko J 
Published: May 2014

BackgroundIn the USA, inpatient phlebotomy services are under constant operational pressure to optimise workflow, improve timeliness of blood draws, and decrease error in the context of increasing patient volume and complexity of work. To date, the principles of Lean continuous process improvement have been rarely applied to inpatient phlebotomy.AimsTo optimise supply replenishment and cart standardisation, communication and workload management, blood draw process standardisation, and rounding schedules and assignments using Lean principles in inpatient phlebotomy services.MethodsWe conducted four Lean process improvement events and implemented a number of interventions in inpatient phlebotomy over a 9-month period. We then assessed their impact using three primary metrics: (1) percentage of phlebotomists drawing their first patient by 05:30 for 05:00 rounds, (2) percentage of phlebotomists completing 08:00 rounds by 09:30, and (3) number of errors per 1000 draws.ResultsWe saw marked increases in the percentage of phlebotomists drawing their first patient by 05:30, and the percentage of phlebotomists completing rounds by 09:30 postprocess improvement. A decrease in the number of errors per 1000 draws was also observed.ConclusionsThis study illustrates how continuous process improvement through Lean can optimise workflow, improve timeliness, and decrease error in inpatient phlebotomy. We believe this manuscript adds to the field of clinical pathology as it can be used as a guide for other laboratories with similar goals of optimising workflow, improving timeliness, and decreasing error, providing examples of interventions and metrics that can be tailored to specific laboratories with particular services and resources.
Augmentation of N-butyl cyanoacrylate embolization of cranial, head, and neck tumors by simultaneous infusion of 5% dextrose solution
Authors: Alaraj Ali , Dashti Reza , Mehta Nikhil K , Goodin Sean , Charbel Fady T , Aletich Victor A 
Published: May 2014

BackgroundN-Butyl cyanoacrylate (NBCA) is an adhesive liquid embolic agent widely used for embolization of cranial, head and neck tumors. Adequate distal penetration of NBCA into vessels with the smallest possible diameter, while preventing its reflux, is still a challenge, even in experienced hands. Simultaneous infusion of 5% dextrose in water solution (D5W) through the guiding catheter has been described before as a technique for improving embolization of dural arteriovenous malformations.ObjectiveTo describe our experience with a modified D5W guide catheter push technique during embolization of hemorrhagic cranial, head and neck tumors. The embolization technique and pitfalls which might lead to complications are discussed in detail.MaterialsA retrospective series of 20 patients treated with the D5W push technique during embolization of cranial, head and neck lesions between 2007 and 2013 is presented. The goal of embolization was preoperative or palliative embolization of hemorrhagic tumors. Localization and histopathologic diagnosis of lesions, concentration of NBCA used, subsequent surgical treatment, intraoperative blood loss, and complications were evaluated.ResultsA total of 44 arterial pedicles were embolized during 22 treatment sessions. Adequate embolization of the lesions was achieved in all cases. Transient ischemic attack due to atheroma embolization (from the aorta) was seen in one patient (4%). Persistent vascularity of tumor associated with minimal intraoperative bleeding was reported in one patient (4%). Recurrence of epistaxis was reported in two patients diagnosed with Osler–Weber–Rendu syndrome.ConclusionsThe D5W push technique during NBCA embolization of cranial, head and neck tumors is a safe and effective method to enhance penetration of the embolizing agent.
Prepubertal gonadectomy in cats: different surgical techniques and comparison with gonadectomy at traditional age
Authors: Porters N. , Polis I. , Moons C. , Duchateau L. , Goethals K. , Huyghe S. , de Rooster H. 
Published: May 2014

Feasibility, surgical time and complications of different surgical techniques for prepubertal gonadectomy (PPG; 8–12 weeks of age) in cats were studied and compared to gonadectomy at traditional age (TAG; 6–8 months of age). Kittens were randomly assigned to PPG or TAG. Ovarian pedicle haemostasis for PPG was achieved by ligatures (n=47), vascular clips (n=50), bipolar electrocoagulation (n=50), or pedicle tie (n=50); for TAG (n=34) ligatures were used. In male cats, PPG consisted of closed castration by spermatic cord knot (n=92) or ligature (n=91) while TAG (n=34) was an open castration by spermatic cord knot. A linear (surgical time) and a logistic regression (complications) model were designed. Significance was set at 0.05. For female PPG, clips and coagulation were the fastest procedures; placement of ligatures was most time‐consuming. In male PPG, knot placement was significantly faster than ligation. In both sexes, very few intraoperative or wound complications were observed, irrespective of the surgical technique used. Surgical times in females (ligatures) as well as in males (knot) were significantly shorter for PPG than for TAG. PPG was as safe as TAG, yet took less time to perform and did not result in a greater rate of postoperative complications.
Long-term impact of temperature on the hydraulic permeability of bentonite
Authors: Harrington J. F. , Volckaert G. , Noy D. J. 
Published: May 2014

Abstract
In a Swedish repository for the disposal of heat-emitting waste, the long-term thermal stability of the bentonite engineered barrier forms a key component of the safety case. Central to such consideration is the evolution of hydraulic permeability and a potential degradation of hydraulic properties, in response to prolonged thermal exposure of the clay. To address this issue, a detailed programme of laboratory-based experiments has been undertaken at both the British Geological Survey and Studiecentrum voor Kernenergie/Centre d'Etude de L'Energie Nucleaire, in order to examine the hydraulic behaviour of bentonite that had previously been exposed to elevated temperatures. Hydraulic properties were calculated from both steady-state pressure gradients and from analysis of the pressure transients. Inspection of the data found no significant difference in hydraulic behaviour between the virgin material and clay samples taken from the Canister Retrieval Test. Based on these observations, the authors find no evidence for an adverse increase in hydraulic conductivity of bentonite as a result of prolonged thermal exposure to temperatures of 80 °C.
Effects of MAPK and PI3K Pathways on PD-L1 Expression in Melanoma
Authors: Atefi Mohammad , Avramis Earl , Lassen Amanda , Wong Deborah J.L. , Robert Lidia , Foulad David , Cerniglia Michael , Titz Bjoern , Chodon Thinle , Graeber Thomas G. , Comin-Anduix Begonya , Ribas Antoni 
Published: May 2014

Abstract
Purpose: PD-L1 is the main ligand for the immune inhibitory receptor PD-1. This ligand is frequently expressed by melanoma cells. In this study, we investigated whether PD-L1 expression is controlled by melanoma driver mutations and modified by oncogenic signaling inhibition.
Experimental Design: Expression of PD-L1 was investigated in a panel of 51 melanoma cell lines containing different oncogenic mutations, including cell lines with innate and acquired resistance to BRAF inhibitors (BRAFi). The effects of targeted therapy drugs on expression of PD-L1 by melanoma cells were investigated.
Results: No association was found between the level of PD-L1 expression and mutations in BRAF, NRAS, PTEN, or amplification of AKT. Resistance to vemurafenib due to the activation of alternative signaling pathways was accompanied with the induction of PD-L1 expression, whereas the resistance due to the reactivation of the MAPK pathway had no effect on PD-L1 expression. In melanoma cell lines, the effects of BRAF, MEK, and PI3K inhibitors on expression of PD-L1 were variable from reduction to induction, particularly in the presence of INFγ. In PD-L1–exposed lymphocytes, vemurafenib paradoxically restored activity of the MAPK pathway and increased the secretion of cytokines.
Conclusions: In melanoma cell lines, including BRAFi-resistant cells, PD-L1 expression is variably regulated by oncogenic signaling pathways. PD-L1–exposed lymphocytes decrease MAPK signaling, which is corrected by exposure to vemurafenib, providing potential benefits of combining this drug with immunotherapies. Clin Cancer Res; 20(13); 3446–57. ©2014 AACR.
Effects of Proximate Foreclosed Properties on Individuals’ Systolic Blood Pressure in Massachusetts, 1987 to 2008
Authors: Arcaya Mariana , Glymour M. Maria , Chakrabarti Prabal , Christakis Nicholas A. , Kawachi Ichiro , Subramanian S.V. 
Published: May 2014

Background—
No studies have examined the effects of local foreclosure activity on neighbors’ blood pressure, despite the fact that spillover effects of nearby foreclosures include many known risk factors for increased blood pressure. We assessed the extent to which living near foreclosed properties is associated with subsequent systolic blood pressure (SBP) measurements.

Methods and Results—

We used 6590 geocoded observations collected from 1740 participants in the Framingham Offspring Cohort across 5 waves (1987–2008) of the Framingham Heart Study to create a longitudinal record of exposure to nearby foreclosure activity. We distinguished between real estate–owned foreclosures, which typically sit vacant, and foreclosures purchased by third-party buyers, which are generally put into productive use. Counts of lender-owned foreclosed properties within 100 m of participants’ homes were used to predict measured SBP and odds of being hypertensive. We assessed whether self-reported alcoholic drinks per week and measured body mass index helped to explain the relationship between foreclosure activity and SBP. Each additional real estate–owned foreclosure located within 100 m of a participant’s home was associated with an increase in SBP of 1.71 mm Hg (
P
=0.03; 95% confidence interval, 0.18–3.24) after adjustment for individual- and area-level confounders but not with odds of hypertension. The presence of foreclosures purchased by third-party buyers was not associated with SBP or with hypertension. Body mass index and alcohol consumption attenuated the effect of living near real estate–owned foreclosures on SBP in fully adjusted models.

Conclusions—
Real estate–owned foreclosed properties may put nearby neighbors at risk for increased SBP, with higher alcohol consumption and body mass index partially mediating this relationship.
Clinical Features and Prognosis of Patients With Coronary Spasm–Induced Non–ST‐Segment Elevation Acute Coronary Syndrome
Authors: Nakayama Naoki , Kaikita Koichi , Fukunaga Takashi , Matsuzawa Yasushi , Sato Koji , Horio Eiji , Yoshimura Hiromi , Mizobe Michio , Takashio Seiji , Tsujita Kenichi , Kojima Sunao , Tayama Shinji , Hokimoto Seiji , Sakamoto Tomohiro , Nakao Koichi , Sugiyama Seigo , Kimura Kazuo , Ogawa Hisao 
Published: May 2014

Background

The prevalence, clinical features, and long‐term outcome of patients with non–
ST
‐segment elevation acute coronary syndrome (
NSTE ACS
) associated with coronary spasm are not fully investigated.

Methods and Results

This observational multicenter study enrolled 1601 consecutive patients with suspected
NSTE
‐
ACS
who underwent cardiac catheterization between January 2001 and December 2010. A culprit lesion was found in 1152 (72%) patients. In patients without a culprit lesion, the acetylcholine provocation test was performed in 221 patients and was positive in 175 patients. In the other patients, coronary spasm was verified in 145 patients during spontaneous attack. Spasm‐induced
NSTE
‐
ACS
was diagnosed in 320 (20%) patients. Multivariable analysis identified age <70 years (odds ratio [
OR
] 2.19, 95%
CI
1.58 to 3.04), estimated glomerular filtration rate >60 mL/min per 1.73 m
2
(
OR
1.72, 95%
CI
1.16 to 2.56), and lack of hypertension (
OR
2.55, 95%
CI
1.90 to 3.41), dyslipidemia (
OR
2.76, 95%
CI
2.05 to 3.73), diabetes mellitus (
OR
2.49, 95%
CI
1.78 to 3.48), previous myocardial infarction (
OR
5.37, 95%
CI
2.89 to 10.0), and elevated cardiac biomarkers (
OR
2.84, 95%
CI
2.11 to 3.83) as significant correlates of spasm‐induced
NSTE
‐
ACS
(
P
<0.01 for all variables). Transient
ST
‐segment elevation during spontaneous attack (variant angina) was observed in 119 patients with spasm‐induced
NSTE
‐
ACS
. Variant angina was more common in nondyslipidemic men among patients with spasm‐induced
NSTE
‐
ACS
.

Conclusions

The study showed frequent involvement of coronary spasm in the pathogenesis of
NSTE
‐
ACS
. Variant angina was observed in one third of patients with spasm‐induced
NSTE
‐
ACS
. Coronary spasm should be considered even in patients with less coronary risk factors and nonobstructive coronary arteries.
The Small Powers in World Politics
Authors: Wong Pak Nung , Kieh George Klay 
Published: May 2014

Abstract
This paper aims to conceptualize a framework for better understanding the challenges, actions and rationales of the African and Asian small powers in the post-1989 global order. The paper will be divided into three parts. First, it will review the literature on small power/state studies. Second, following a critique of the major approaches in small power studies, we will argue for the need for a critical realist perspective to better capture the relationships between domestic politics and foreign relations of the small power in Africa and Asia. Third, against the comparative trajectories in which the u.s. has attained global hegemony after 1991 and China has gradually become a great power after 2000, in light of the recent u.s. containment policy shift towards China which has stirred up versatile dynamics of East Asian small power politics, in favor of a global multi-polarity, we will highlight the foundation of our approach for building the strong small powers in terms of two main aspects of economic nationalism: resource-focused and sovereignty-asserting.
China and Small States in Food Security Governance
Authors: Chan Gerald 
Published: May 2014

Abstract
China’s need to ensure food sufficiency for its people is nothing new. What is new is the country’s recent active search for food from around the world, including small states in Africa and Latin America. The country has begun to acquire food of a high quality, in competition with other countries. China can make use of its politico-economic power to influence the behaviour of others to achieve food security, thereby highlighting a puzzling question: How does China balance its national interests against its global responsibility? China competes with other countries for a steady supply of food at an affordable price, while at the same time it wants to be seen as a peaceful country and a responsible member of the international community. As the largest developing country in the world, how does China see its role in the global management of food security, and how do others see China in this role? In addressing these questions, this paper argues that China begins to shoulder greater responsibility globally in this area, based on its bilateral and multilateral engagements, especially with small states, in a win-win way. The paper concludes that China has to do more to allay the fears of the outside world and to clear the suspicions harboured by others about its intentions and behaviour, a lesson which carries wide implications for China’s global governance in other issue areas.
Pakistan and Singapore as Small Powers
Authors: Siddiqi Farhan Hanif 
Published: May 2014

Abstract
The subject of international relations and its theories are based primarily on what the great powers do. Major ir theories including realism and neorealism have put small states and powers at the very margins of their respective theories arguing that since they do not display any form of power at the national and systemic levels they could as easily be discarded from theoretical and empirical debate and analysis. The present article challenges this theoretical construct and seeks to investigate whether the small powers are innate non-players in the international system and hence ‘vulnerable’ entities or display forms of power vis-à-vis the great powers in which their ‘maneuverability’, influence and independence may be manifest. This is attempted with respect to a comparative analysis of Pakistan and Singapore in which both an endogenously driven explanation taking into account both states’ domestic constitutive features are brought into focus alongside a behaviorally-oriented exogenous explanation bordering on power and security.
The Impact of Food and Global Economic Crises (2008) on Food Security in Egypt
Authors: Ahmed Samah Sayed 
Published: May 2014

Abstract
This paper aims to study how food security in Egypt influenced by the global rising of food prices occurs during the period 2006-2008 and the global economic crisis beginning in 2008. In order to achieve the aim of the study, the paper was divided into three main sections in addition to introduction, the second one analyze the features of food crisis and its reasons and its effects on the poor and households. The third section represents the global economic crisis and its impacts on the most vulnerable households. The fourth section, analyze the status of food security in Egypt before and after the two crises, government response to food and global economic crises, role of international organizations in Egypt as a result of the two crises, the Arab awakening and its impact on food security, finally, the paper introduces some policy options to address food insecurity in Egypt.
The main conclusion of the study is that the Egyptian economy is highly vulnerable to food and economic global shocks, and the status of food security after the two crises is classified as a serious case.
The Effects of Video Game Experience and Active Stereoscopy on Performance in Combat Identification Tasks
Authors: Keebler Joseph R. , Jentsch Florian , Schuster David 
Published: May 2014

Objective We investigated the effects of active stereoscopic simulation-based training and individual differences in video game experience on multiple indices of combat identification (CID) performance. Background Fratricide is a major problem in combat operations involving military vehicles. In this research, we aimed to evaluate the effects of training on CID performance in order to reduce fratricide errors. Method Individuals were trained on 12 combat vehicles in a simulation, which were presented via either a non-stereoscopic or active stereoscopic display using NVIDIA’s GeForce shutter glass technology. Self-report was used to assess video game experience, leading to four between-subjects groups: high video game experience with stereoscopy, low video game experience with stereoscopy, high video game experience without stereoscopy, and low video game experience without stereoscopy. We then tested participants on their memory of each vehicle’s alliance and name across multiple measures, including photographs and videos. Results There was a main effect for both video game experience and stereoscopy across many of the dependent measures. Further, we found interactions between video game experience and stereoscopic training, such that those individuals with high video game experience in the non-stereoscopic group had the highest performance outcomes in the sample on multiple dependent measures. Conclusion This study suggests that individual differences in video game experience may be predictive of enhanced performance in CID tasks. Application Selection based on video game experience in CID tasks may be a useful strategy for future military training. Future research should investigate the generalizability of these effects, such as identification through unmanned vehicle sensors.
Occult Primary Head and Neck Squamous Cell Carcinoma: Utility of Discovering Primary Lesions
Authors: Davis Kara S. , Byrd J. Kenneth , Mehta Vikas , Chiosea Simon I. , Kim Seungwon , Ferris Robert L. , Johnson Jonas T. , Duvvuri Umamaheswar 
Published: May 2014

ObjectiveCancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status.Study DesignRetrospective, matched‐pairs analysis contrasting 2 cohorts based upon discovery of primary lesion.SettingTertiary teaching hospital.Subjects and MethodsRecords of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980‐2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan‐Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age.ResultsDiscovered lesions were more likely to exhibit HPV positivity (P <. 001). Matched‐pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019‐0.822; P =. 030). Discovery of the primary was associated with improved cause‐specific survival (HR = 0.142; 95% CI, 0.021‐0.93; P =. 0418) and disease‐free survival (HR = 0.25; 95% CI, 0.069‐0.91; P =. 03).ConclusionHPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause‐specific survival, and disease‐free survival in patients initially presenting as CUP in matched‐pair and cohort comparison analyses.