bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lean on us – industrial efficiency in hospice care
Authors: Kelby Simon 
Published: September 2011

With a tightening economy and increasingly complex patient needs our hospice sought novel ways to increase efficiency. Turning to industry for inspiration we appointed a volunteer expert in process management to help develop and run hospice efficiency projects.Aims▶Expert develops a clear methodology for hospices and leads the process▶The expert trains staff in these principles▶Improve patient safety and care▶Increase staff and volunteer satisfaction▶To be Staff led – Staff to identify problems, seek solutions, implement and take responsibility for them▶Develop processes to continuously improve.MethodsA volunteer industry expert in process management first developed Lean for use in hospices and then ran the Lean projects. Lean is a widely used tool in industry and the care sector but not previously used in hospices. Staff identified problems; solutions were trialled, adjusted and implemented using Lean tools. The expert ensured projects were focused, delivering a tangible benefit in reasonable time.Results▶£2500 reduction in purchasing of goods▶Reduced handovers by over 5 h per week▶Increased gift aid by £10 000 per year▶Higher staff and volunteer satisfaction as fully involved.▶Reduced wasted time increasing time spent with patients.ConclusionsUsing an industry expert allowed the development of Lean for hospices and greatly speeded the implementations of solutions, helping us see processes in a fresh light. Staff trained in Lean now use their own initiative to solve problems using Lean principles.Recommendations▶Lean is successfully adaptable for hospices▶Project solutions must be management encouraged but staff led▶Use an expert to set up the process but staff must be trained to run the process long term▶Significant efficiencies can be made while improving staff enthusiasm.
Rainbow of ribbons (ROR)
Authors: Ramsden Ramsden 
Published: September 2011

IntroductionROR is a campaign which gives individuals a chance to dedicate a ribbon to someone who has added colour to their lives. The ribbon is then tied in the grounds of the Hospice with an open day for the public to view the ribbons.Aims▶To find a new income stream from an in-memory campaign.▶Replace our Ray of Sunshine (ROS) balloon release event with something environmentally friendly▶Encourage visitors to the Hospice▶Organise an event with low staff time costs.MethodsAll individuals that have made an in-memory donation in the last 3 years on our system are mailed, these people are invited to dedicate a ribbon to someone special. Once returned a ribbon is tied in the Hospice grounds, and name entered into the Ribbons book.To gain extra publicity we ask a celebrity to tie the first ribbon to encourage supporters not known to the Hospice a chance to donate. ROR is aimed at in-memory donations but we stress that people can donate a ribbon to anyone who has added colour the their lives.Results▶A significant income increase from the ROS event▶Increased gift-aid on donations▶More visitors to the Hospice▶Less staff time on the day therefore less cost compared to ROS▶Environmentally friendly▶The dip in 2009 was from the introduction of our Midnight Walk which takes place in September by 2010 income increased again.ConclusionsROR is a fantastic alternative to our original event and is on a par with Light Up A Life for an in-memory event. The event captures and inspires people's imaginations, there is a wealth of opportunities for community groups to get involved and therefore makes this event a fantastic income stream for any Hospice.
Enhanced summary care record “significant conversations” template
Authors: Plenderleith Stephen , Clack Sam , Nightingale Tracy , Speakman John 
Published: September 2011

This project, supported by a grant from West Midlands Workforce Deanery, is working with PCT commissioners and IT department, Primary Care, Hospice services and the regional Cancer centre to pilot an End of Life “significant conversations” template. This is available via the Summary Care Record to any acute service providing care to an EoL patient across South Birmingham; West Midlands ambulance, Primecare OOH services, PCT drop in centres and the Accident and Emergency department.Patients do not want to have to give the same information over and over again and yet the Gold Standards Framework, Holistic Needs Assessment, Preferred Priorities of Care and Liverpool Care Pathway documents all cover similar ground again and again. No pilot of any nationally recommended “pathway” document, has so far seriously addressed the need for information to travel with the patient. Patient held records though trialled in some areas have the ever present problem of being forgotten or lost and so often lead to clinical staff having to duplicate their clinical entries.Bury and Bolton both piloted the use of an End of Life template with one GP system using the functionality of the Summary Care Record. This pilot project takes the template a leap further by working across four GP systems (potentially covering over 95% of patients nationally). “Significant conversations” data can be collected in primary care, hospital and hospice settings. Daily automatic transfer of data back to the patients' primary care record ensures the GP is kept up to date and that the SCR record remains current for use by any service providing ongoing or acute care to patients.Due to complete in November 2011. The proposed poster will outline details of the project scope, data being collected and technical solutions utilised.
Working alone, in the safety zone!
Authors: Birch Helen , Edmondson Kate , Stafford Jane 
Published: September 2011

BackgroundA hospice at home service was set up 2 years ago to work alongside existing primary care services to fill identified gaps in care for patients nearing the end of life whose preferred place of care is home. Part of the service is a 24 h 7 day a week sitting service predominately delivered by trained healthcare assistants (HCA's) plus Bank RN and HCA's.AimsStaff follow the care plans of the district nurse who undertake all patient assessments. However the personal safety of the staff (lone workers) is the responsibility of the Hospice. A simple daily risk assessment to ensure continuous attention to safety was required.MethodA comprehensive risk assessment checklist which covers all aspects of safety and security is quickly completed by staff at each shift in the patient's home. Completed checklists are checked by the Co-ordinator after every shift with identified risks immediately addressed prior to the next staff member visiting that patient. This complements other staff safety measures: Lone Worker Policy, provision of personal tracker badges and mobile phones.ResultsFor each of the 4000 patient sits provided since the service began, a checklist has been completed. Recurring themes identified excessive smoking, threatening dogs and ‘difficult to find’ home addresses as key areas of risk. Expected risk, that is, insecure environment and difficult family dynamics, are hardly featured. A recent survey demonstrated that hospice at home staff felt robust systems were in place to minimise risks to their safety as lone workers in the community.This poster describes the setting up of the risk assessment system, the checklist, results of the staff survey, and themes emerging from completed checklists.
How common are palliative care needs among older people who die in the emergency department?
Authors: Beynon Teresa , Gomes Barbara , Murtagh Fliss E M , Glucksman Ed , Parfitt Andy , Burman Rachel , Edmonds Polly , Carey Irene , Keep Jeff , Higginson Irene J 
Published: September 2011

ObjectiveTo determine the prevalence and nature of palliative care needs in people aged 65 years or more (65+) who die in emergency departments (EDs).MethodsThis was a retrospective analysis of routine hospital data from two EDs in South London. Patients aged 65+ living in the hospitals' catchment area who died in the ED during a 1 year period (2006–2007) were included. Palliative care needs identified by diagnosis and symptoms, and problems likely to benefit from palliative care documented in clinical records 3 months prior to the final ED attendance were extracted.ResultsOver 1 year, 102 people aged 65+ died in the ED, frequently following an acute event (n=90). 63.7% presented out of hours. 98/102 were admitted by ambulance, over half (n=59) from home. Half (n=50) had attended the same ED or been admitted to the same hospital in the previous 12 months. Over half (58/102) presented with diagnoses that signalled palliative care need. Of these, 29 had recorded symptoms a week before death and 28 had complex social issues 3 months prior to death. Only eight were known to palliative care services.ConclusionsThere is considerable palliative care need among older people who ultimately died in the ED, of whom only a minority were known to palliative care services in this study. Previous ED and hospital admission suggest opportunities for referral and forward planning. More older people in need of palliative care must be identified and managed earlier to avoid future undesired admissions and deaths in hospital.
Thermal and hydrocarbon-charge history and the relationship between diagenesis and reservoir connectivity: Venture field, offshore Nova Scotia, eastern Canada1Geological Survey of Canada Contribution 20100418.
Authors: Karim Atika , Pe-Piper Georgia , Piper David J.W. , Hanley Jacob J. 
Published: September 2011

Fluid inclusions in diagenetic cements in Upper Jurassic – Lower Cretaceous sandstones offshore Nova Scotia provide constraints on the fluid migration history in gas reservoirs of the Scotian basin. Diagenetic minerals from six wells in the Venture field were analysed by optical petrography, scanning electron microscopy (SEM), and electron microprobe. A total of 122 primary and secondary fluid inclusions were analysed from different cements. Primary aqueous inclusions in quartz overgrowths have homogenization temperatures (Th) of 111.8 ± 7.1 °C (1σ) and in later carbonate cements 126.5 ± 2.1 °C; inclusions in both cements are highly saline (16–26.1 wt.% NaCl equivalent). Secondary aqueous and hydrocarbon-bearing inclusion trails crosscutting silica cement and detrital quartz have Th of 121.6 ± 13.6 °C and low salinities (8.7 ± 6.0 wt.%). Secondary carbonic inclusions have CO2 melting temperatures (–56.6 ± 0.1 °C) and Th (–9.3 ± 0.8 °C) indicating a high-density carbonic phase. Late carbonate cements in the same sandstone units vary in chemical composition in different wells, and connected reservoirs show similar late carbonate assemblages, suggesting that the late carbonate cementation may be partly controlled by the reservoir fill and spill sequence. Silica and late carbonate cementation involved highly saline fluid flow, likely at about ∼135 Ma. Hydrocarbon migration postdated silica cementation and was associated with secondary fracturing, suggesting that it corresponded to the onset of overpressure.
PGC1α Promotes Tumor Growth by Inducing Gene Expression Programs Supporting Lipogenesis
Authors: Bhalla Kavita , Hwang Bor Jang , Dewi Ruby E. , Ou Lihui , Twaddel William , Fang Hong-bin , Vafai Scott B. , Vazquez Francesca , Puigserver Pere , Boros Laszlo , Girnun Geoffrey D. 
Published: September 2011

Abstract
Despite the role of aerobic glycolysis in cancer, recent studies highlight the importance of the mitochondria and biosynthetic pathways as well. PPARγ coactivator 1α (PGC1α) is a key transcriptional regulator of several metabolic pathways including oxidative metabolism and lipogenesis. Initial studies suggested that PGC1α expression is reduced in tumors compared with adjacent normal tissue. Paradoxically, other studies show that PGC1α is associated with cancer cell proliferation. Therefore, the role of PGC1α in cancer and especially carcinogenesis is unclear. Using Pgc1α−/− and Pgc1α+/+ mice, we show that loss of PGC1α protects mice from azoxymethane-induced colon carcinogenesis. Similarly, diethylnitrosamine-induced liver carcinogenesis is reduced in Pgc1α−/− mice as compared with Pgc1α+/+ mice. Xenograft studies using gain and loss of PGC1α expression showed that PGC1α also promotes tumor growth. Interestingly, while PGC1α induced oxidative phosphorylation and tricarboxylic acid cycle gene expression, we also observed an increase in the expression of two genes required for de novo fatty acid synthesis, ACC and FASN. In addition, SLC25A1 and ACLY, which are required for the conversion of glucose into acetyl-CoA for fatty acid synthesis, were also increased by PGC1α, thus linking the oxidative and lipogenic functions of PGC1α. Indeed, using stable 13C isotope tracer analysis, we show that PGC1α increased de novo lipogenesis. Importantly, inhibition of fatty acid synthesis blunted these progrowth effects of PGC1α. In conclusion, these studies show for the first time that loss of PGC1α protects against carcinogenesis and that PGC1α coordinately regulates mitochondrial and fatty acid metabolism to promote tumor growth. Cancer Res; 71(21); 6888–98. ©2011 AACR.
Targeting the Immunoregulator SRA/CD204 Potentiates Specific Dendritic Cell Vaccine-Induced T-cell Response and Antitumor Immunity
Authors: Yi Huanfa , Guo Chunqing , Yu Xiaofei , Gao Ping , Qian Jie , Zuo Daming , Manjili Masoud H. , Fisher Paul B. , Subjeck John R. , Wang Xiang-Yang 
Published: September 2011

AbstractAlthough dendritic cell (DC) vaccines offer promise as cancer immunotherapy, further improvements are needed to amplify their clinical therapeutic efficacy. The pattern recognition scavenger receptor SRA/CD204 attenuates the ability of DCs to activate CD8+ T-cell responses. Therefore, we examined the impact of SRA/CD204 on antitumor responses generated by DC vaccines and we also evaluated the feasibility of enhancing DC vaccine potency by SRA/CD204 blockade. DCs from SRA/CD204-deficient mice were more immunogenic in generating antitumor responses to B16 melanoma, compared with DCs from wild-type mice. Similarly, siRNA-mediated knockdown of SRA/CD204 by lentiviral vectors improved the ability of wild-type DCs to stimulate the expansion and activation of CD8+ T cells specific for idealized or established melanoma antigens in mice. Using SRA/CD204-silenced DCs to generate antigen-targeted vaccines, we documented a marked increase in the level of antitumor immunity achieved against established B16 tumors and metastases. This increase was associated with enhanced activation of antigen specific CTLs, greater tumor infiltration by CD8+ T cells and NK cells, and increased intratumoral ratios of both CD4+ and CD8+ T-effector cells to CD4+CD25+ T-regulatory cells. Our studies establish that downregulating SRA/CD204 strongly enhances DC-mediated antitumor immunity. In addition, they provide a rationale to enhance DC vaccine potency through SRA/CD204-targeting approaches that can improve clinical outcomes in cancer treatment. Cancer Res; 71(21); 6611–20. ©2011 AACR.
A Hypermethylated Phenotype Is a Better Predictor of Survival than MGMT Methylation in Anaplastic Oligodendroglial Brain Tumors: A Report from EORTC Study 26951
Authors: van den Bent Martin J. , Gravendeel Lonneke A. , Gorlia Thierry , Kros Johan M. , Lapre Lariesa , Wesseling Pieter , Teepen Johannes L. , Idbaih Ahmed , Sanson Marc , Smitt Peter A.E. Sillevis , French Pim J. 
Published: September 2011

Abstract
Purpose: The MGMT promoter methylation status has been suggested to be predictive for outcome to temozolomide chemotherapy in patients with glioblastoma (GBM). Subsequent studies indicated that MGMT promoter methylation is a prognostic marker even in patients treated with radiotherapy alone, both in GBMs and in grade III gliomas.
Experimental Design: To help determine the molecular mechanism behind this prognostic effect, we have conducted genome-wide methylation profiling and determined the MGMT promoter methylation status, 1p19q LOH, IDH1 mutation status, and expression profile on a series of oligodendroglial tumors [anaplastic oligodendrogliomas (AOD) and anaplastic oligoastrocytomas (AOA)] within EORTC study 26951. The series was expanded with tumors of the same histology and treatment from our own archive.
Results: Methylation profiling identified two main subgroups of oligodendroglial brain tumors of which survival in the CpG island hypermethylation phenotype (CIMP+) subgroup was markedly better than the survival of the unmethylated (CIMP−) subgroup (5.62 vs. 1.24 years; P &lt; 0.0001). CIMP status correlated with survival, MGMT promoter methylation, 1p19q LOH, and IDH1 mutation status. CIMP status strongly increases the predictive accuracy of survival in a model including known clinical prognostic factors such as age and performance score. We validated our results on an independent data set from the Cancer Genome Atlas (TCGA).
Conclusion: The strong association between CIMP status and MGMT promoter methylation suggests that the MGMT promoter methylation status is part of a more general, prognostically favorable genome-wide methylation profile. Methylation profiling therefore may help identify AODs and AOAs with improved prognosis. Clin Cancer Res; 17(22); 7148–55. ©2011 AACR.
The NEDD8-Activating Enzyme Inhibitor, MLN4924, Cooperates with TRAIL to Augment Apoptosis through Facilitating c-FLIP Degradation in Head and Neck Cancer Cells
Authors: Zhao Liqun , Yue Ping , Lonial Sagar , Khuri Fadlo R. , Sun Shi-Yong 
Published: September 2011

Abstract
TNF-related apoptosis-inducing ligand (TRAIL) is a tumor-selective cytokine with potential anticancer activity and is currently under clinical testing. Head and neck squamous cell carcinoma (HNSCC), like other cancer types, exhibits varied sensitivity to TRAIL. MLN4924 is a newly developed investigational small molecule inhibitor of NEDD8-activating enzyme with potent anticancer activity. This study reveals a novel function of MLN4924 in synergizing with TRAIL to induce apoptosis in HNSCC cells. MLN4924 alone effectively inhibited the growth of HNSCC cells and induced apoptosis. When combined with TRAIL, synergistic effects on decreasing the survival and inducing apoptosis of HNSCC cells occurred. MLN4924 decreased c-FLIP levels without modulating death receptor 4 and death receptor 5 expression. Enforced expression of c-FLIP substantially attenuated MLN4924/TRAIL–induced apoptosis. Thus c-FLIP reduction plays an important role in mediating MLN4924/TRAIL–induced apoptosis. Moreover, MLN4924 decreased c-FLIP stability, increased c-FLIP ubiquitination, and facilitated c-FLIP degradation, suggesting that MLN4924 decreases c-FLIP levels through promoting its degradation. MLN4924 activated c-jun-NH2-kinase (JNK) signaling, evidenced by increased levels of phospho-c-Jun in MLN4924-treated cells. Chemical inhibition of JNK activation not only prevented MLN4924-induced c-FLIP reduction, but also inhibited MLN4924/TRAIL–induced apoptosis, suggesting that JNK activation mediates c-FLIP downregulation and subsequent enhancement of TRAIL-induced apoptosis by MLN4924. Because knockdown of NEDD8 failed to activate JNK signaling and downregulate c-FLIP, it is likely that MLN4924 reduces c-FLIP levels and enhances TRAIL-induced apoptosis independent of NEDD8 inhibition. Mol Cancer Ther; 10(12); 2415–25. ©2011 AACR.
The Bcl-2/Bcl-XL/Bcl-w Inhibitor, Navitoclax, Enhances the Activity of Chemotherapeutic Agents In Vitro and In Vivo
Authors: Chen Jun , Jin Sha , Abraham Vivek , Huang Xiaoli , Liu Bernard , Mitten Michael J. , Nimmer Paul , Lin Xiaoyu , Smith Morey , Shen Yu , Shoemaker Alexander R. , Tahir Stephen K. , Zhang Haichao , Ackler Scott L. , Rosenberg Saul H. , Maecker Heather , Sampath Deepak , Leverson Joel D. , Tse Chris , Elmore Steven W. 
Published: September 2011

Abstract
The ability of a cancer cell to avoid apoptosis is crucial to tumorigenesis and can also contribute to chemoresistance. The Bcl-2 family of prosurvival proteins (Bcl-2, Bcl-XL, Bcl-w, Mcl-1, and A1) plays a key role in these processes. We previously reported the discovery of ABT-263 (navitoclax), a potent small-molecule inhibitor of Bcl-2, Bcl-XL, and Bcl-w. While navitoclax exhibits single-agent activity in tumors dependent on Bcl-2 or Bcl-XL for survival, the expression of Mcl-1 has been shown to confer resistance to navitoclax, most notably in solid tumors. Thus, therapeutic agents that can downregulate or neutralize Mcl-1 are predicted to synergize potently with navitoclax. Here, we report the activity of navitoclax in combination with 19 clinically relevant agents across a panel of 46 human solid tumor cell lines. Navitoclax broadly enhanced the activity of multiple therapeutic agents in vitro and enhanced efficacy of both docetaxel and erlotinib in xenograft models. The ability of navitoclax to synergize with docetaxel or erlotinib corresponded to an altered sensitivity of the mitochondria toward navitoclax, which was associated with the downmodulation of Mcl-1 and/or upregulation of Bim. These data provide a rationale to interrogate these combinations clinically. Mol Cancer Ther; 10(12); 2340–9. ©2011 AACR.
Chemoprevention of Colon Cancer in a Rat Carcinogenesis Model Using a Novel Nanotechnology-Based Combined Treatment System
Authors: Chaudhary Abhishek , Sutaria Dhruvitkumar , Huang Ying , Wang Jeffrey , Prabhu Sunil 
Published: September 2011

AbstractColorectal cancer (CRC) is the third most common cause of cancer death in the United States, accounting for approximately 51,000 deaths each year. We have previously shown in vitro chemopreventive effects of mixtures of aspirin, folic acid, and calcium (AFAC) on colon cancer cell lines. The objective of the present study was to evaluate the in vivo effects of orally administered, colon targeted chemopreventive combination regimens on the inhibition of aberrant crypt foci (ACF) in a rat model of colon carcinogenesis using (i) unmodified (free drug) combinations of AFAC and (ii) nanoparticle-encapsulated combinations of the same agents. A 14-week animal study was conducted in three phases to determine an optimal effective dose from AFAC combinations and evaluate the efficacy of nanotechnology-based chemopreventive regimens administered in combined (mixtures) and individual (single entity) forms. ACF inhibition when compared with azoxymethane-treated rat control group was significant in both the unmodified and the modified nanoparticle-mediated chemopreventive regimens, showing a range of 31% to 38% (P &lt; 0.05) and 50% to 75% (P &lt; 0.001) reduction, respectively, in the number of ACFs. In addition, the nanoparticulate combination regimens of AFAC showed a 2-fold increase in suppression of ACF compared with free drug mixtures. Individual administration of nanoparticle-encapsulated drugs showed no significant effect on the reduction of ACF. Histochemical analysis provided further confirmation of chemopreventive effects, showing a significant reduction in cell nuclear proliferation. Overall, our results provide a strong proof of concept using nanoparticle-mediated combination treatment in the chemoprevention of colon cancer. Cancer Prev Res; 4(10); 1655–64. ©2011 AACR.