bluuebunny/crossref_metadata_2025_split huggingface dataset:
Setting the main circadian clock of a diurnal mammal by hypocaloric feeding
Authors: Mendoza Jorge , Gourmelen Sylviane , Dumont Stephanie , Sage‐Ciocca Dominique , Pévet Paul , Challet Etienne 
Published: May 2012

Key points
Timed hypocaloric feeding alters the main circadian clock, the suprachiasmatic nucleus (SCN), in nocturnal rodents.
The endogenous oscillatory mechanism in the SCN is similar between nocturnal and diurnal mammals.
In this study we report that in the diurnal rodent Arvicanthis ansorgei, a timed hypocaloric feeding (HF) entrains and shifts behavioural and molecular circadian rhythms in the SCN. Nevertheless, instead of phase advancing the clock as in nocturnal rodents, HF phase delays the Arvicanthis SCN pacemaker.
Thus, HF modifies the circadian system of the diurnal rodent Arvicanthis ansorgei differentially from nocturnal rodents.
The present results will help us to better understand the circadian system in diurnal species and how feeding cues can synchronize daily rhythms.
Abstract  Caloric restriction attenuates the onset of a number of pathologies related to ageing. In mammals, circadian rhythms, controlled by the hypothalamic suprachiasmatic (SCN) clock, are altered with ageing. Although light is the main synchronizer for the clock, a daily hypocaloric feeding (HF) may also modulate the SCN activity in nocturnal rodents. Here we report that a HF also affects behavioural, physiological and molecular circadian rhythms of the diurnal rodent Arvicanthis ansorgei. Under constant darkness HF, but not normocaloric feeding (NF), entrains circadian behaviour. Under a light–dark cycle, HF at midnight led to phase delays of the rhythms of locomotor activity and plasma corticosterone. Furthermore, Per2 and vasopressin gene oscillations in the SCN were phase delayed in HF Arvicanthis compared with animals fed ad libitum. Moreover, light‐induced expression of Per genes in the SCN was modified in HF Arvicanthis, despite a non‐significant effect on light‐induced behavioural phase delays. Together, our data show that HF affects the circadian system of the diurnal rodent Arvicanthis ansorgei differentially from nocturnal rodents. The Arvicanthis model has relevance for the potential use of HF to manipulate circadian rhythms in diurnal species including humans.
The Primary Target Organ of Cryptococcus gattii Is Different from That of Cryptococcus neoformans in a Murine Model
Authors: Ngamskulrungroj Popchai , Chang Yun , Sionov Edward , Kwon-Chung Kyung J. 
Published: May 2012

ABSTRACT

Cryptococcosis is caused by the opportunistic pathogen
Cryptococcus neoformans
or by the primary pathogen
Cryptococcus gattii
. Epidemiological studies suggest that patients infected with
C. gattii
mainly present with pulmonary disease, while those infected with
C. neoformans
commonly manifest meningoencephalitis. We compared the pathogenesis of the two species using the
C. neoformans
H99 and
C. gattii
R265 strains in a murine inhalation model.
C. neoformans
grew faster in the brain and caused death by meningoencephalitis, while
C. gattii
grew faster in the lungs and caused death without producing fulminating meningoencephalitis. Despite the consistent failure to recover R265 cells from blood, a fraction of the R265 population was detected in the extrapulmonary organs, including the brain. Upon intravenous (i.v. ) inoculation of 10
4
cells via the tail vein, however,
C. gattii
produced severe meningoencephalitis, demonstrating that
C. gattii
cells can efficiently cross the blood-brain barrier. Interestingly, i.v. inoculation with five cells caused brain infection in only 10% of
C. gattii
-infected mice, compared to 60% of mice infected with
C. neoformans
. In mice that had been initially inoculated via the pulmonary route and subsequently challenged intravenously, a protective effect was observed only in mice infected with
C. gattii
.
C. neoformans
cells grew 10 to 100 times faster than
C. gattii
cells in blood or serum collected from naive mice. The paucity of meningoencephalitis upon inhalation of
C. gattii
, therefore, may be partly due to an unknown factor(s) in the host’s blood coupled with immune protection that reduces dissemination to the brain and fosters lung infection.

IMPORTANCE
While
Cryptococcus neoformans
is the most common cause of fatal meningoencephalitis, especially in HIV patients,
Cryptococcus gattii
causes disease mainly in non-HIV patients. Clinical studies revealed that most patients infected with
C. gattii
VGII strains have lung infections with minimal brain involvement. Despite extensive clinicopathological studies on cryptococcosis in animal models, only a few have included
C. gattii
. We compared the pathogenesis of the two species in mice using an inhalation model. Similar to infection in humans, even though
C. gattii
can cross the blood-brain barrier, it failed to cause fatal meningoencephalitis but caused fatal lung infection. We show that growth of
C. gattii
in mouse blood is significantly slower than that of
C. neoformans
and that a secondary protective phenomenon, though weak, manifests itself only in
C. gattii
infection. Our study provides a model for understanding the clinicopathological differences between these two closely genetically related pathogens.
Impact of Surgical Intervention and Postoperative Pain on Electrical Skin Resistance at Acupuncture Points: An Exploratory Study
Authors: Kramer Sybille , Zaps Daniela , Kutz Dieter F , Wiegele Bernhard , Kolb Florian P , Zimmer Katrin , Lehmeyer Lukas , Fleckenstein Johannes , Becker Ursula , Lang Philip M , Irnich Dominik 
Published: May 2012

Objectives One theory about acupuncture suggests that pathological processes can cause measurable changes in electrical skin resistance (ESR) at acupuncture points (APs). Although the theory has yet to be proven, ESR measurements (ESRMs) form a frequently used part of contemporary acupuncture. The aim of this study was to test the so-called ‘electrical responsiveness’ of APs in the setting of a defined operative trauma. Methods ESRMs (n=424) were performed at the APs and surrounding skin of GB34 and ST38 in 163 participants using an impedance meter array developed for the purpose of ESRMs. For each group the percentage of measurements with a significantly different ESR between the APs and the surrounding skin was calculated and compared with each other. Measurements of four groups were compared: healthy control subjects (n=30) and patients after ophthalmic (n=29), hip (n=42) and shoulder (n=30) surgery. The influence of postoperative pain intensity was also assessed. Results Group comparison showed no significant differences for ST38. The ESRMs at GB34 had a significantly higher percentage of measurements with an increased ESR after ophthalmic (23.2%) and hip (22.2%) surgery, but not after shoulder surgery (7.5%). Subgroup analysis showed that an increase in pain intensity tended to lead to a decrease in the number of APs with ESR changes. Conclusion These results suggest that reactive changes in ESR at APs might exist. Pain and alertness seem to have an impact on ESR at APs. However, the current data do not allow for conclusions to be drawn concerning the clinical use of ESRMs.
Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study
Authors: Benn Jonathan , Burnett Susan , Parand Anam , Pinto Anna , Vincent Charles 
Published: May 2012

ObjectiveThe study had two specific objectives: (1) To analyse change in a survey measure of organisational patient safety climate and capability (SCC) resulting from participation in the UK Safer Patients Initiative and (2) To investigate the role of a range of programme and contextual factors in predicting change in SCC scores.DesignSingle group longitudinal design with repeated measurement at 12-month follow-up.SettingMultiple service areas within NHS hospital sites across England, Wales, Scotland and Northern Ireland.ParticipantsStratified sample of 284 respondents representing programme teams at 19 hospital sites.InterventionA complex intervention comprising a multi-component quality improvement collaborative focused upon patient safety and designed to impact upon hospital leadership, communication, organisation and safety climate.MeasuresA survey including a 31-item SCC scale was administered at two time-points.ResultsModest but significant positive movement in SCC score was observed between the study time-points. Individual programme responsibility, availability of early adopters, multi-professional collaboration and extent of process measurement were significant predictors of change in SCC. Hospital type and size, along with a range of programme preconditions, were not found to be significant.ConclusionA range of social, cultural and organisational factors may be sensitive to this type of intervention but the measurable effect is small. Supporting critical local programme implementation factors may be an effective strategy in achieving development in organisational patient SCC, regardless of contextual factors and organisational preconditions.
The effects of a ‘discharge time-out’ on the quality of hospital discharge summaries
Authors: Mohta Namita , Vaishnava Prashant , Liang Cathy , Ye Kye , Vitale Matt , Dalal Anuj , Schnipper Jeff 
Published: May 2012

BackgroundHigh-quality discharge summaries are a key component of a safe transition in care. The purpose of this study was to determine the effects of standardised feedback and a ‘discharge time-out’ (DTO) on the quality of discharge summaries.MethodsDuring 2006–2007, the authors trained hospitalists to provide two interventions at their discretion: (1) feedback on one discharge summary to each intern using a standardised form and (2) a DTO, modelled after the surgical time-out, in which key questions about the patient's hospital course and discharge plan are answered verbally by the intern during rounds on the day of discharge. To evaluate these interventions, trained clinicians, blinded to group assignment, performed an explicit review of two discharge summaries before and after intervention implementation. The authors used a mixed linear model to evaluate relative improvement over time.ResultsThe authors compared 14 interns who only received a 1-h lecture and a small-group resident-led training session with 13 interns who also received feedback and 12 interns who received feedback and a DTO. Save greater improvement in the documentation of tasks to be completed after discharge (39% vs 8% absolute improvement, p=0.05) by interns receiving an intervention, most domains were unaffected by having received a DTO and/or feedback.ConclusionThese results suggest that standardised feedback and a DTO integrated into attending rounds have limited potential to improve discharge summaries as currently designed. This study stresses the need for developing and refining interventions that can improve the narrative flow of discharge summaries.
The H-PEPSS: an instrument to measure health professionals' perceptions of patient safety competence at entry into practice
Authors: Ginsburg Liane , Castel Evan , Tregunno Deborah , Norton Peter G 
Published: May 2012

BackgroundEnhancing competency in patient safety at entry to practice requires introduction and integration of patient safety into health professional education. As efforts to include patient safety in health professional education increase, it is important to capture new health professionals' perspectives of their own patient safety competence at entry to practice. Existing instruments to measure patient safety knowledge, skills and attitudes have been developed largely to examine the impact of specific patient safety curricular initiatives and the psychometric analyses of the instruments used thus far have been exploratory in nature.MethodsConfirmatory factor analytic approaches are used to extensively test theHealth Professional Education in Patient Safety Survey (H-PEPSS), a newly designed survey rooted in a patient safety competency framework and designed to measure health professionals' self-reported patient safety competence around the time of entry to practice. The H-PEPSS focuses primarily on the socio-cultural aspects of patient safety including culture, teamwork, communication, managing risk and understanding human factors.ResultsResults support a parsimonious six-factor measurement model of health professionals' perceptions of patient safety competency. These results support the validity of a reduced version of the H-PEPSS and suggest it can be appropriately used at or near training completion with a variety of health professional groups.ConclusionsGiven increased demands for patient safety competency among health professionals at entry to practice and slow, but emerging changes in health professional education, ongoing research to understand the extent of patient safety competency among health professionals around the time of entry to practice will be important.
Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study
Authors: Gurses Ayse P , Kim George , Martinez Elizabeth A , Marsteller Jill , Bauer Laura , Lubomski Lisa H , Pronovost Peter J , Thompson David 
Published: May 2012

BackgroundCardiac surgery is a complex, high-risk procedure with potential vulnerabilities for patient safety. The evidence base describing safety hazards in the cardiovascular operating room is underdeveloped but is essential to guide future safety improvement efforts.ObjectiveTo identify and categorise hazards (anything that has the potential to cause a preventable adverse patient safety event) in the cardiovascular operating room.MethodsAn interdisciplinary team of researchers used prospective methods, including direct observations, contextual inquiry and photographs to collect hazard data pertaining to the cardiac surgery perioperative period, which started immediately before the patient was transferred to the operating room and ended immediately after patient handoff to the post-anaesthesia/intensive care unit. Data were collected between February and September 2008 in five hospitals. An interdisciplinary approach that included a human factors and systems engineering framework was used to guide the study.ResultsTwenty cardiac surgeries including the corresponding handoff processes from operating room to post-anaesthesia/intensive care unit were observed. A total of 58 categories of hazards related to care providers (eg, practice variations), tasks (eg, high workload), tools and technologies (eg, poor usability), physical environment (eg, cluttered workspace), organisation (eg, hierarchical culture) and processes (eg, non-compliance with guidelines) were identified.DiscussionHazards in cardiac surgery services are ubiquitous, indicating numerous opportunities to improve safety. Future efforts should focus on creating a stronger culture of safety in the cardiovascular operating room, increasing compliance with evidence-based infection control practices, improving communication and teamwork, and developing a partnership among all stakeholders to improve the design of tools and technologies.
Emergency care provision at the 2009 Special Olympics Great Britain
Authors: Williamson Timothy , Wheeler Patrick , Stephens Catherine , Ferguson Mike 
Published: May 2012

BackgroundThe Special Olympics Great Britain (SOLGB) summer games 2009 were held in Leicester between 25 and 31 July. They involved 2413 athletes that were engaged in 21 different sports across 19 different locations. The onsite healthcare was provided by a specialist medical team. The hospital services available were at the local emergency department (ED) and the co-located urgent care centre (UCC).AimTo assess the on-site provision required to support a large multisport event for people with learning disabilities and to ascertain the impact on the local hospital services.MethodsOn-site consultations were documented on SOLGB medical record forms. Referrals to the local ED and UCC were identified from the SOLGB medical notes or from the ED/UCC attendance codes, as a specific code was applied to all patients related to the games.Results581 on-site consultations were documented at SOLGB 2009, of which 95% of these were for athletes. 477 treatments were completed in total, of which 444 were undertaken on-site (93%). 20 people attended the ED; there were no documented attendances at the UCC. 17 of the 20 attendances at the ED were athletes competing.ConclusionAllocation of the healthcare team was appropriate, with the exception of one sport, where a doctor was moved from a nearby event to consult on 13 occasions. Attendances to the local ED and UCC were minimal. Therefore, the model of on-site medical care that was used, which led to minimal impact on NHS resources, will support the arrangements of medical requirements at future SOLGB games.
Association between admission delay and adverse outcome of emergency medical patients
Authors: Junhasavasdikul Detajin , Theerawit Pongdhep , Kiatboonsri Sumalee 
Published: May 2012

AimTo determine whether admission delay (lead-time) and other factors are associated with hospital mortality rates of emergency medical patients.MethodsPatients presenting with emergency conditions during August to November 2009, and admitted to medical wards, including intensive care units, were enrolled. The time each patient spent in the ED, and other parameters were recorded. The primary outcome was the association between lead-time and hospital mortality. The secondary outcome was the association between lead-time and delta Modified Early Warning Score (MEWS) (MEWS at ward − MEWS at ED).Results381 cases were analysed. The overall mortality rate was 8.9%. By univariate analysis, the significant factors associated with mortality outcome were lead-time, ECOG (Eastern Cooperative Oncology Group) score, MEWS at ED, delta MEWS and sepsis. By multivariate analysis, the remaining significant factors were MEWS at ED, delta MEWS and sepsis. There was no significant relationship between delta MEWS and lead-time. In a sub-group of patients admitted to intensive care units, however, there was a positive correlation between lead-time and delta MEWS.ConclusionMEWS, delta MEWS and sepsis were predictors of hospital mortality in emergency medical patients. Lead-time was not associated with mortality, which could be due to benefits of various treatments initiated in the ED. In patients requiring intensive care, however, the longer lead-time probably led to higher MEWS and mortality.
Can training improve laypersons helping behaviour in first aid? A randomised controlled deception trial
Authors: Van de Velde Stijn , Roex Ann , Vangronsveld Karoline , Niezink Lidewij , Van Praet Koen , Heselmans Annemie , Donceel Peter , Vandekerckhove Philippe , Ramaekers Dirk , Aertgeerts Bert 
Published: May 2012

BackgroundThere is limited evidence indicating that laypersons trained in first aid provide better help, but do not help more often than untrained laypersons. This study investigated the effect of conventional first aid training versus conventional training plus supplementary training aimed at decreasing barriers to helping.MethodsThe authors conducted a randomised controlled trial. After 24 h of conventional first aid training, the participants either attended an experimental lesson to reduce barriers to helping or followed a control lesson. The authors used a deception test to measure the time between the start of the unannounced simulated emergency and seeking help behaviour and the number of particular helping actions.ResultsThe authors randomised 72 participants to both groups. 22 participants were included in the analysis for the experimental group and 36 in the control group. The authors found no statistically or clinically significant differences for any of the outcome measures. The time until seeking help (geometrical mean and 95% CI) was 55.5 s (42.9 to 72.0) in the experimental group and 56.5 s (43.0 to 74.3) in the control group. 57% of the participants asked a bystander to seek help, 40% left the victim to seek help themselves and 3% did not seek any help.ConclusionSupplementary training on dealing with barriers to helping did not alter the helping behaviour. The timing and appropriateness of the aid provided can be improved.Trial registrationThe authors registered this trial at ClinicalTrials.gov asNCT00954161.
Observational cadaveric study of emergency bystander cricothyroidotomy with a ballpoint pen by untrained junior doctors and medical students
Authors: Neill Andrew , Anderson Philip 
Published: May 2012

ObjectiveApart from case reports and anecdotes, there are no published studies on the feasibility of using non-medical devices for emergency bystander cricothyroidotomy. This study evaluated the ability of non-trained junior doctors and medical students to place an emergency cricothyroidotomy on an embalmed cadaver using only a blade and a ballpoint pen.MethodsParticipants were junior doctors with no prior experience of surgical airways and second year medical students at the end of their head and neck anatomy course. Nine participants were asked to place an emergency cricothyroidotomy in an undissected embalmed cadaver using only a No 26 scalpel and a dismantled ballpoint pen (Papermate Flexigrip Ultra, external diameter 8.9 mm; internal diameter 7.0 mm). Times were recorded and direct visualisation by dissection was used to assess placement and complications.ResultsNine participants performed a total of 14 separate cricothyroidtomies on separate cadavers. Landmarks were palpable by researchers in 10 of the 14 cadavers. Eight of 14 (57%) procedures were deemed successful. No major vascular injury occurred. Injuries to the thyroid and cricoid cartilages were common; four of 14 (29%) of these injuries were fractures.ConclusionsIn embalmed cadavers, inexperienced junior doctors and medical students with no prior training were able to place a successful cricothyroidotomy slightly more than half the time. It suggests that surgical cricothyroidotomy with a ballpoint pen and blade is a feasible option in extremis. It is unknown whether junior doctors from other specialties, such as emergency medicine, would perform better.
Usefulness of imprint and brushing cytology in diagnosis of lung diseases with flexible bronchoscopy
Authors: Michels Guido , Topalidis Theodoros , Büttner Reinhard , Engels Marianne , Pfister Roman 
Published: May 2012

BackgroundTo increase the diagnostic yield in pulmonary diseases, histopathology, imprint cytology and brushing cytology are assessed in combination during flexible bronchoscopy. However, the individual diagnostic discrimination of the three methods is unclear.MethodsThe authors performed the three sampling techniques in 102 consecutive patients with suspected pulmonary pathologies and compared the definitive diagnosis with those of histopathology, imprint and brushing cytology for their diagnostic values regarding evidence of malignancy.Results33.3% of all histopathological specimens, 31.4% of all imprints and 26.5% of brush biopsy specimens were positive for malignancy. The values for sensitivities were 94% for histopathology, 89% for imprint cytology and 75% for brushing cytology, respectively. Although brushing cytology had limited sensitivity, in two cases a malignant lung tumour was only diagnosed from cytological examination of brushing.ConclusionIn conclusion, routine imprint cytology does not increase the diagnostic sensitivity, whereas routine brushing cytology should be used in combination with histopathology to obtain the highest diagnostic rate of yield.