bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of biological weighting functions to estimate the microdosimetric RBE in BNCT
Authors: Selva Anna , Bianchi Anna , Bellan Luca , Fagotti Enrico , Pisent Andrea , Conte Valeria
Published: October 2023

In the framework of the MUNES project, a prototype accelerator-based thermal neutron source was developed and installed at the Legnaro National Laboratories of INFN. The microdosimetric characterization of this radiation field was performed with a Tissue-Equivalent Proportional Counter with interchangeable cathode walls, either doped with 100 ppm of 10B or without boron doping. A suitable subtraction procedure allowed to discriminate the gamma, neutron and BNC dose components (Selva et al., 2022, Appl. Radiat. Isot. 182, 110144). The measured microdosimetric spectra can be weighted with a biological weighting function to estimate the Relative Biological Effectiveness of the radiation field, for the purpose of intercomparison between different thermal neutron sources. This work compares, therefore, the biological doses resulting from four different weighting functions applied to the same initial microdosimetric spectrum, discussing strengths and limitations of each of them.
EURADOS whole-body dosemeters intercomparisons: lessons learnt from individual results
Authors: Romero Ana Maria , Figel Markus , Grimbergen Tom , McWhan Andrew , Stadtmann Hannes
Published: October 2023

Every 2 years since 2008, Eurados WG2 has organised a whole-body dosemeters intercomparison (IC) in photon and beta fields. This paper presents the information that individual participants can extract from their results. The irradiation plan of each IC was designed to allow participants check the performance of some important characteristics of their dosimetry systems, in particular: linearity, angular response, energy response and response to mixed fields. The analysis of anomalous responses indicates that many systems can reduce the number of outliers by improving their calibration procedures.
A comprehensive Monte Carlo simulation of the neutron response of multi-element microdosimetric detectors based on THick Gas Electron Multiplier
Authors: Singh R , Byun S H
Published: October 2023

We present comprehensive Monte Carlo simulations for the neutron response of the multi-element microdosimetric detector based on THick Gas Electron Multiplier (THGEM). Simulations were carried out using the MCNP6.2 code to calculate the deposited energy spectrum in the gaseous sensitive volumes for three different configurations, 7 × 3, 19 × 5, 37 × 7 that occupy a cylindrical volume of 5-cm diameter by 5-cm length. The energy response was computed from 10 keV to 2 MeV. The response variation was investigated between sensitive volumes as well as between layers. The simulated energy response showed a good agreement against the evaluated fluence-to-kerma conversion coefficients in the energy region 10–100 keV, whereas discrepancies were observed in the region above 250 keV. The angular response simulations showed a variation of less than 10%.
Fast method of determining the ambient dose equivalent at a depth of 10 mm of gamma-neutron fields based on recombination methods
Authors: Kuć Michał
Published: October 2023

The subject of the work is the presentation of a new measurement algorithm to be used in dosimetry, based on recombination chambers and methods. The algorithm enables fast measurements of the ambient dose equivalent rate H*(10) with a time resolution of several seconds. In addition to significantly reducing the measurement time, the method allows for the automation of the measurement with continuous evaluation of the results quality. Operating principles are based on frequent charge measurements with precise determination of the measurement moment. With well-known charge and measurement time, the ionisation current and therefore H*(10) can be easily calculated. The time constant of such a system is close to zero and allows to shorten the measurement time dozens of times while improving the quality of measurement by analysing the collected charge course.
Photon spectra in NPL standard monoenergetic neutron fields
Authors: Roberts N J , Bennett A , Cheema S S
Published: October 2023

A High Purity Germanium (HPGe) detector has been used to measure the photon spectra in the majority of monoenergetic neutron fields produced at NPL (0.144, 0.250, 0.565, 2.0, 5.0 and 16.5 MeV). The HPGe was characterised and then modelled to produce a response matrix. The measured pulse height spectra were then unfolded to produce photon fluence spectra. The new spectra were used to improve the photon to neutron dose equivalent ratios from some earlier work at NPL with Geiger–Muller tubes and electronic personal dosemeters.
Occupational radiation dose on the hand of assisting medical staff in diagnostic CT scans
Authors: Nagamoto Keisuke , Moritake Takashi , Kowatari Munehiko , Morota Koichi , Nakagami Koichi , Matsuzaki Satoru , Nihei Shun-ichi , Kamochi Masayuki , Kunugita Naoki
Published: October 2023

Chronic radiation exposure increases the risk of skin damage of medical personnel engaged in radiology. However, hand dose measurements in computed tomography (CT) for diagnostic purposes have not been evaluated. The occupational radiation dose to the hands of CT assistants was herein investigated to evaluate its compliance with the equivalent dose limit for the hand (500 mSv/year). The occupational doses of nine CT assistants were measured in 89 cases (April 2017–May 2018) by installing radio-photoluminescence glass dosemeters (GD-302 M) (70-μm dose-equivalent conversion coefficient = 0.37) on the dorsal aspect of both hands. The occupational dose to the hand was the highest with head holding (right: 1.14 mSv/CT scan, left: 1.07 mSv/CT scan). Considering the results for annual work, even for head holding, the hand dose of the CT-assisting personnel was insignificant. However, CT assistants should be mindful of the possibility of locally higher doses to hands.
Further development of the LNMRI/IRD’s TNF2 thermal system for flexible dose rate irradiation
Authors: Astuto Achilles , Patrão Karla C S , Fonseca Evaldo S , Pereira Walsan W , Lopes Ricardo T
Published: October 2023

The ‘Inverse Square Law’ (ISL)(  1) requires the existence of a point radiation source to be validated, but in some cases where there is more than one source, its use is possible as long as a point is determined where a virtual source can be positioned and from this point the points correspond to the ISL. Ambient dose equivalent rate values were obtained by simulation and measurements at various points along the LNMRI Thermal Neutron Flux 2 (TNF2) central axis front face, determining a function corresponding to the inverse square of the distance and the font position at the virtual point ‘y0’, so that the ISL is respected. This function will help in the neutron monitors calibration, previously estimating the ambient dose equivalent at a certain distance from the face.
Evaluation of the neutron spectrum at flight altitude with Geant4 using different parameterizations
Authors: Pazianotto Maurício T , Federico Claudio A , Gonçalez Odair L , Carlson Brett V
Published: October 2023

Cosmic-ray-induced particles at flight altitude present an increasing concern because of the development of aircraft with high maximum cruising altitude (higher than 40 000 ft) and because of the miniaturisation of and increase in the amount of embedded electronic systems. There are different codes used to estimate the radiation field through the atmosphere, using different approaches and Monte Carlo methods. This work aims to evaluate the influence on the neutron spectra at ground and flight altitude of the parameterizations employed to describe spallation reactions and the density profile of the atmosphere. The results show that different versions of Geant4 and the data driven models used significantly change the neutron fluence rate and the ambient dose equivalent rate. The results show that the different atmospheric density profiles considered do not significantly change the neutron spectra. In this work, we also present comparisons with onboard and ground level measurements.
Single-cell DNA sequencing—a potential dosimetric tool
Authors: Mathew Felix , Manalad James , Yeo Jonathan , Galarneau Luc , Ybarra Norma , Wang Yu Chang , Tonin Patricia N , Ragoussis Ioannis , Kildea John
Published: October 2023

We hypothesised that single-cell whole-genome sequencing has the potential to detect mutational differences in the genomes of the cells that are irradiated with different doses of radiation and we set out to test our hypothesis using in silico and in vitro experiments. In this manuscript, we present our findings from a Monte Carlo single-cell irradiation simulation performed in TOPAS-nBio using a custom-built geometric nuclear deoxyribonucleic acid (DNA) model, which predicts a significant dose dependence of the number of cluster damages per cell as a function of radiation dose. We also present preliminary experimental results, obtained from single-cell whole-genome DNA sequencing analysis performed on cells irradiated with different doses of radiation, showing promising agreement with the simulation results.
Experimental validation of energy dependences of YALO3:Mn TL detectors: irradiation to ISO radiation qualities
Authors: Chumak Vadim , Zhydachevskyy Yaroslav , Voloskyi Vitaliy , Bakhanova Elena , Stasiv Vasyl , Gieszczyk Wojciech , Ubizskii Sergii , Berkowski Marek , Suchocki Andrzej
Published: October 2023

The effect of application of filters, made of different materials and various thickness, is studied by Monte Carlo calculations using MCNP6.2 code. The calculated data were validated by experimental studies (benchmark tests). Experimental results obtained for YAlO3:Mn high-Z TL detectors irradiated to different standard ISO radiation qualities (X-ray series N-40, N-60, N-80, N-100, N-120, N-150 and N-200 as well as isotopic series S-Cs) modified by various metal (copper and aluminum) filters of thickness of 0.5, 0.8 and 1 mm. The experimental results are compared with results of Monte Carlo simulations done for the same ‘radiation-attenuator-detector’ combinations and geometry. Obtained results show good consistence between the experimental and calculated data that testifies adequacy of the used calculations and their applicability to modeling of modification of an output from the high-Z detectors exposed to photons of various energies.
Numerical model of human head phantom to ensure dosimetry of dose components for boron neutron capture therapy
Authors: Michaś Edyta , Tyminska Katarzyna , Gryzinski Michal A , Kocik Janusz , Barczynski Ryszard J
Published: October 2023

Extremely important aspects of the boron neutron capture therapy are, first of all, administering to the patient a boron compound that selectively reaches the neoplastic cells, and in the second step, the verification of the irradiation process. This paper focuses on the latter aspect, which is the detailed dosimetry of the processes occurring after the reaction of thermal neutrons with the boron-10 isotope. The results of computer simulations with the use of a new type of human head phantom filled with a polymer dosimetric gel will be presented in this article.
EURADOS intercomparison IC2020ph on whole body dosemeters for photons
Authors: Boziari Argiro , Stadtmann Hannes , Askounis Panagiotis , Grimbergen Tom , Romero Ana , McWhan Andrew , Figel Markus
Published: October 2023

The European Dosimetry Group has been organising international intercomparisons (ICs) for personal dosemeters on a regular basis. The IC announced in 2020 was postponed to the end of 2020 and the beginning of 2021 due to coronavirus (COVID-19) restrictions. The irradiation plan consisted of nine irradiation setups with five different photon radiation qualities (S-Cs, S-Co, N-150, W-60, W-80) and two different angles of irradiation incidence (0o and 60o). A total of 112 monitoring services from 50 countries with 132 dosimetry systems participated. The present work describes and analyses the individual results for the personal dose equivalent quantities Hp(10) and, if submitted, Hp(0.07) for all participating systems. It also presents the organisational details and the difficulties arising from the COVID-19 crisis during the IC. The statistical results showed a satisfactory performance with the medians of all Hp(10) and Hp(0.07) response values very close to unity. However, there are few individual monitoring services with significant large variations.
Evaluation of calibration factors of digital survey meters in a secondary standard dosimetry laboratory
Authors: Azah Collins K , Deatanyah Philip , Appiah Prince M , Osei Samuel , Amoako Joseph K , Sam Frederick
Published: October 2023

The calibration of radiological survey meters is an important consideration in achieving standardisation of doses. This provides traceability for field instruments to an International System of Units. Seventy-one digital survey meters were calibrated by the substitution method in a 137Cs beam in a secondary standard dosimetry laboratory using a PTW spherical ionisation chamber coupled to a Physikalisch-Technische-Werkstaetten (PTW) UNIDOS Electrometer. The calibration factors determined ranged from 0.59 to 1.98. Thirty-six pieces of equipment have their calibration factors within 0.9–1.1. A total of 36% of the survey meters recorded calibration factors corresponding to a percentage deviation above 20% whilst 64% fell within 20% deviations from the true value. The best value of a calibration factor obtained in this work was 1.00 from two survey meters. The errors due to survey meters being out of calibration can usually be corrected by frequent recalibration.
Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis
Authors: Cowan Henry R , McAdams Dan P , Ouellet Leah , Jones Courtney M , Mittal Vijay A
Published: October 2023

Background and Hypothesis

Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course.

Study Design

Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning.

Study Results

CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning.

Conclusions

This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
Imputing missing sleep data from wearables with neural networks in real-world settings
Authors: Lee Minki P , Hoang Kien , Park Sungkyu , Song Yun Min , Joo Eun Yeon , Chang Won , Kim Jee Hyun , Kim Jae Kyoung
Published: October 2023

Sleep is a critical component of health and well-being but collecting and analyzing accurate longitudinal sleep data can be challenging, especially outside of laboratory settings. We propose a simple neural network model titled SOMNI (Sleep data restOration using Machine learning and Non-negative matrix factorIzation [NMF]) for imputing missing rest-activity data from actigraphy, which can enable clinicians to better handle missing data and monitor sleep–wake cycles of individuals with highly irregular sleep–wake patterns. The model consists of two hidden layers and uses NMF to capture hidden longitudinal sleep–wake patterns of individuals with disturbed sleep–wake cycles. Based on this, we develop two approaches: the individual approach imputes missing data based on the data from only one participant, while the global approach imputes missing data based on the data across multiple participants. Our models are tested with shift and non-shift workers' data from three independent hospitals. Both approaches can accurately impute missing data up to 24 hours of long dataset (>50 days) even for shift workers with extremely irregular sleep–wake patterns (AUC > 0.86). On the other hand, for short dataset (~15 days), only the global model is accurate (AUC > 0.77). Our approach can be used to help clinicians monitor sleep–wake cycles of patients with sleep disorders outside of laboratory settings without relying on sleep diaries, ultimately improving sleep health outcomes.
How COVID-19 and Racial Justice Protests Influenced Social Workers’ Perceptions of Policy and Political Participation
Authors: Krings Amy , Wathen Maria V , Kilbane Teresa
Published: October 2023

Drawing on political opportunity theory, this study examined how the political context created by the COVID-19 pandemic and Black Lives Matter protests influenced social workers’ perceptions about social welfare policy and political participation in the summer of 2020. Authors conducted a thematic analysis of the open-ended survey responses of 120 social work practitioners. Regarding perceptions of policy, respondents reported that they experienced new awareness about the breadth and depth of structural racism in the United States; that they held pessimistic views of the government’s ability to mitigate harm associated with the pandemic or racial injustice; and that structural change, including the expansion of the social safety net, was needed. Regarding participation, respondents described how they used new forms of political engagement in part because of social distancing, but even more so because they were motivated by highly visible acts of racial injustice. At the same time, they experienced barriers to participation including a fear that they were not adequately prepared and asked for additional support from social work professional organizations. Respondents believed that more education is needed about racial justice and political action. These findings have important implications for social work education and practice, especially work to promote social justice.
Factors Associated with Interest in Engaging in Psychological Interventions for Pain Management
Authors: Miller-Matero Lisa R. , Yaldo Marissa , Chohan Sikander , Zabel Celeste , Patel Shivali , Chrusciel Timothy , Salas Joanne , Wilson Lauren , Sullivan Mark D. , Ahmedani Brian K. , Lustman Patrick J. , Scherrer Jeffrey F.
Published: October 2023

Objective:

Engagement in evidence-based psychological interventions for pain management is low. Identifying characteristics associated with interest in interventions can inform approaches to increase uptake and engagement. The purpose of this study was to examine factors associated with interest in psychological interventions among persons with non-cancer pain receiving prescription opioids.

Methods:Participants

with non-cancer pain and a new 30-90 day opioid prescription were recruited from two health systems. Participants (N=845) completed measures regarding pain, opioid use, psychiatric symptoms, emotional support, and interest in psychological interventions for pain management.

Results:

There were 245 (29.0%) participants who reported high interest in psychological interventions for pain management. In bivariate analyses, variables associated with interest included younger age, female gender, greater pain severity, greater pain interference, greater number of pain sites, lower emotional support, depression, anxiety, and post-traumatic stress disorder (P<0.05). In a multivariate model, greater pain severity (OR=1.17; CI: 1.04-1.32), depression (OR=2.10; CI: 1.39-3.16), PTSD (OR=1.85; CI: 1.19-2.95), and lower emotional support (OR=0.69; CI: 0.5-0.97) remained statistically significant.

Discussion:

The rate of interest in psychological interventions for pain management was low, which may indicate that patients initiating opioid treatment of chronic pain have low interest in psychological interventions. Greater pain severity and psychiatric distress were related to interest, and patients with these characteristics may especially benefit from psychological interventions. Providers may want to refer to psychological interventions prior to or when opioids are initiated. Additional work is needed to determine if this would reduce long-term opioid use.
New strategies for the treatment of breast cancer with leptomeningeal metastasis
Authors: Chew Sonya M. , Seidman Andrew D.
Published: October 2023

Purpose of review

Leptomeningeal metastasis is a complication of metastatic breast cancer that has a rising incidence likely due to the increased availability of novel systemic therapies, which have improved survival with better extracranial disease control but with limited intracranial efficacy. A poor prognosis of less than 6 months has historically been associated with leptomeningeal metastasis and it is often an exclusion factor for enrollment in clinical trials. There are limited evidence-based data supporting use of therapeutics in leptomeningeal metastasis patients and recommendations are largely derived from retrospective reports and small prospective studies. However, in recent years, there has been a surge in effective modern therapeutics with promising intracranial activity.

Recent findings

The study aims to review the most recent updates in the management of leptomeningeal metastasis in breast cancer. We discuss the effectiveness and limitations of intrathecal administration, predictive biomarkers in the cerebrospinal fluid, proton radiation therapy and promising new systemic therapies such as antibody drug conjugates.

Ongoing development of clinical trials that allow inclusion of leptomeningeal metastasis are essential for establishing efficacy potential and discovering new treatment options in this population of great unmet need.
Recent advances in allogeneic transplantation for acute myeloid leukemia
Authors: Montoro Juan , Balaguer-Roselló Aitana , Sanz Jaime
Published: October 2023

Purpose of review

This review highlights recent advancements in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with acute myeloid leukemia (AML).

Recent findings

Important improvements have been observed throughout the allo-HSCT procedure and patient management. Universal donor availability and reduced risk of graft-versus-host disease (GVHD) have been achieved with the introduction of posttransplant cyclophosphamide for GVHD prophylaxis. It has contributed, together with advances in conditioning regimens, GVHD treatment and supportive care, to a reduced overall toxicity of the procedure. Relapse is now the most frequent cause of transplant failure. With increased knowledge of the biological characterization of AML, better prediction of transplant risks and more profound and standardized minimal residual disease (MRD) monitoring, pharmacological, and immunological strategies to prevent relapse are been developed.

Allo-HSCT remains the standard of care for high-risk AML. Increased access to transplant, reduced toxicity and relapse are improving patient outcomes. Further research is needed to optimize MRD monitoring, refine conditioning regimens, and explore new GVHD management and relapse prevention therapies.
Machine learning applications and challenges in graft-versus-host disease: a scoping review
Authors: Mushtaq Ali Hassan , Shafqat Areez , Salah Haneen T. , Hashmi Shahrukh K. , Muhsen Ibrahim N.
Published: October 2023

Purpose of review

This review delves into the potential of artificial intelligence (AI), particularly machine learning (ML), in enhancing graft-versus-host disease (GVHD) risk assessment, diagnosis, and personalized treatment.

Recent findings

Recent studies have demonstrated the superiority of ML algorithms over traditional multivariate statistical models in donor selection for allogeneic hematopoietic stem cell transplantation. ML has recently enabled dynamic risk assessment by modeling time-series data, an upgrade from the static, “snapshot” assessment of patients that conventional statistical models and older ML algorithms offer. Regarding diagnosis, a deep learning model, a subset of ML, can accurately identify skin segments affected with chronic GVHD with satisfactory results. ML methods such as Q-learning and deep reinforcement learning have been utilized to develop adaptive treatment strategies (ATS) for the personalized prevention and treatment of acute and chronic GVHD.

To capitalize on these promising advancements, there is a need for large-scale, multicenter collaborations to develop generalizable ML models. Furthermore, addressing pertinent issues such as the implementation of stringent ethical guidelines is crucial before the widespread introduction of AI into GVHD care.
Preclinical glioma models in neuro-oncology: enhancing translational research
Authors: Barachini Serena , Morelli Mariangela , Santonocito Orazio Santo , Mazzanti Chiara Maria
Published: October 2023

Purpose of review

Gliomas represent approximately 25% of all primary brain and other central nervous system (CNS) tumors and 81% of malignant tumors. Unfortunately, standard treatment approaches for most CNS cancers have shown limited improvement in patient survival rates.

Recent findings

The current drug development process has been plagued by high failure rates, leading to a shift towards human disease models in biomedical research. Unfortunately, suitable preclinical models for brain tumors have been lacking, hampering our understanding of tumor initiation processes and the discovery of effective treatments. In this review, we will explore the diverse preclinical models employed in neuro-oncology research and their contributions to translational science.

By utilizing a combination of these preclinical models and fostering interdisciplinary collaborations, researchers can deepen their understanding of glioma brain tumors and develop novel therapeutic strategies to combat these devastating diseases. These models offer promising prospects for personalized and efficacious treatments for these challenging malignancies. Although it is unrealistic to fully replicate the complexity of the human body in vitro, the ultimate goal should be to achieve the closest possible resemblance to the clinical context.
Management of neurofibromatosis type 1 associated tumors of central and peripheral nervous system
Authors: Eoli Marica
Published: October 2023

Purpose of review

In recent years emerging evidence suggests that some tumor types, extremely rare in general population and understudied, can be observed in NF1 and neoplasms related with this condition harbor peculiar genetic and epigenetic features. The aim of this review is to summarize recent advances that, delving into the tumor complexity, have identified new diagnostic tools and potential tumor subtype that may have been associated with clinical implications.

Recent findings

The available data confirmed the presence of peculiar molecular signatures in those tumors, different from those observed in sporadic neoplasms and suggest that a specific reference to NF1 associated neoplasms would deserve to be mentioned in tumor WHO classification. Comprehensive multiomic analysis shows that the histologic assessment does not always match the methylation group assignment and facilitates tumor subclassification into categories predictive of clinical behavior. The non-invasive assessment of tumor genetic profiles by the analysis of plasma ctDNA is representative of tumor features, may help differential diagnosis and may identify malignant transformation, sparing the patient from repeated biopsies.

A better knowledge of NF1 associated tumors at the molecular level may suggest changes in the clinical management of the disease and open new frontiers of personalized treatment.
Neurorehabilitation in brain tumours: evidences and suggestions for spreading of knowledge and research implementation
Authors: Bartolo Michelangelo , Intiso Domenico , Zucchella Chiara
Published: October 2023

Purpose of review

The last few decades have seen an increase in life expectancy in brain tumour patients; however, many patients report sensory-motor and cognitive disabilities due to the tumour itself, but also to the effect of anticancer treatments (surgery, radiotherapy, chemotherapy), supportive treatments, as well as individual patient factors. This review outlines the principles on which to base neurorehabilitation treatments, with the aim of stimulating an early rehabilitative management, in order to reduce disability and functional limitation and improve the quality of life of the persons affected by brain tumour.

Recent findings

Although not definitive, evidences suggest that an early neurorehabilitative evaluation, performed with a multidisciplinary approach, may identify the different functional impairments that can affect people with brain tumour. Furthermore, identifying and classifying the person's level of functioning is useful for designing achievable recovery goals, through the implementation of tailored multidisciplinary rehabilitation programs. The involvement of different professional figures allows to treat all the components (physical, cognitive, psychological and participation) of the person, and to redesign one's life project, lastly improving the quality of life.

Overall, the evidences suggest a critical need for the development of this clinical area by spreading the concept of rehabilitation among neuro-oncologists and producing high quality research.
Frequent outbreaks of dengue in Nepal – causes and solutions: a narrative review
Authors: Pokharel Pashupati , Khanal Surakshya , Ghimire Sagun , Pokhrel Kailash M. , Shrestha Abhigan B.
Published: October 2023

Dengue is a viral illness caused by dengue virus, a flavivirus transmitted by the bite of female Aedes aegypti and Aedes albopictus. In the year 2022, Nepal witnessed the largest ever dengue outbreak in the country. Dengue cases were reported from all seven provinces, affecting all 77 districts of the country. As of 31st December 2022, altogether 54 784 dengue cases have been identified, with Bagmati province reporting the highest. The country’s capital, Kathmandu, reported the highest burden of dengue cases (26%). The high degree of pre-monsoon rainfall because of climate change and mismanaged waste disposal system were the main cause of the 2022 dengue outbreak in Nepal. Furthermore, unplanned urbanization, Aedes vector expansion, open border policy with India, inefficient dengue surveillance system, and insufficient preventive efforts by the government are the causes of frequent dengue outbreaks. Awareness among the general public regarding vector control measures, improved surveillance of acute febrile illness, utilization of vector risk mapping techniques, and establishment of temperature-based early warning systems are utmost to halt future dengue outbreaks in Nepal.
A pilot study on the prevalence of peripheral arterial disease in Kigali, Rwanda
Authors: Dockery Dominique M. , Nussenzweig Samuel , Harelimana James G. , Ahishakiye Egide , Allu Sai , Licht Aron H. , Cunningham Ryan , Ingabire Emeline , Josiane Izere , Nisingizwe Philemon , Hirwa Christian , Munyesyaka Aimable , Moreira Carla C. , Patterson Robert B. , Martin Kyle D.
Published: October 2023

Background:

The global burden of peripheral arterial disease (PAD) is high, but few studies have measured the prevalence of PAD in low- and middle-income countries. The objective of this pilot study was to estimate the prevalence of PAD and associated risk factors in a naïve population in Kigali, Rwanda.

Methods:

This is a mixed-methods, cross-sectional study conducted at three health centers in Kigali. Patients meeting the criteria were administered an ankle-brachial index (ABI) and a survey. An ABI </=0.9 was the value diagnostic for PAD and >1.3 was used for an inconclusive ABI. A post hoc analysis stratified by HIV status was conducted.

Results:

A total of 861 participants were included with an overall PAD positivity rate of 3.14%, and 166 patients (19.3%) had inconclusive ABIs. Patients with diagnostic ABIs were more likely to be older (63 vs. 56, P=0.009), of lower wealth indexes (P=0.016), and smokers [13 (48.1%) vs. 217 (32.5%), P=0.041]. Patients with inconclusive ABIs were more likely to be male [70 (42%) vs. 140 (21%), P≤0.001], to have chronic kidney disease [4 (2.4%) vs. 2 (0.3%), P=0.016], and to be positive for HIV [44 (27%) vs. 127 (19%), P=0.041]. People with HIV were more likely to be younger (54 vs. 57, P<0.01) and less likely to have other comorbidities such as diabetes [27 (16%) vs. 171 (25%), P<0.01] and hypertension [57 (33%) vs. 307 (45%), P<0.01].

Conclusions:

The prevalence of PAD in our study’s population was 3.14%. This pilot study identified a comorbid burden for HIV and PAD in Rwanda.
Drug overdose in Pakistan, a growing concern; A Review
Authors: Ochani Sidhant , Athar Fatima Binte , Nazar Muhammad Wajeeh , Rani Suraksha , Ochani Khushi , Hasibuzzaman Md. Al , Ullah Kaleem
Published: October 2023

The primary cause of overdose in Pakistan is a lack of implementation of pharmaceutical drug sales regulations. The use of a drug or medicine over the recommended safe dose, whether accidentally or purposely, constitutes a drug overdose. The type of drug, amount consumed, and medical history of the person who overdosed determine its severity. It can be accidental or intentional and can result in serious medical issues or even death. In Pakistan, there is growing concern about two major categories of overdoses: opioid overdose and recreational drug overdose. About 700 people die of drug-related complications and overdose in Pakistan every day, which translates to 250 000 deaths every year. In Pakistan, an estimated 7 million individuals take drugs regularly. Among them, 4 million use cannabis, and 2.7 million use opiates. Since 2005, ANF Model Addiction Treatment & Rehabilitation Centers (MATRC) have treated more than 14 000 patients. At least 604 individuals connected to Pakistani drug trafficking have been found guilty by the ANF since 2014. Another promising cause of drug overdose is qualified doctors negligence. Many doctors do not spend enough time with their patients and do not adequately educate them about the disease, drug dosage, timing, drug-drug interactions, drug-food interactions, and adverse effects. There is a need for immediate action, which includes employee training, psychoeducational campaigns on mental health and suicide, medical resources for quick treatment of self-poisoning, and revised government regulations on drug sales. To lower the prevalence and negative effects of overdoses in Pakistan, it may be necessary to educate the ‘chemist’ and restrict the number of tablets that can be prescribed at once.
Recent Status of Procedures in a Single Nationwide Cosmetic Surgery Group
Authors: Funakoshi Yusuke , Saito Masao , Kawaguchi Ko , Hiramatsu Eri , Yamamoto Nobuo , Hondo Yoshiko , Nakagawa Yumiko , Okumura Koki , Sato Asami , Teranishi Hiroo
Published: October 2023

Background:

Recently, cosmetic surgery demand has increased due to the spread of promotional social media in Japan. However, understanding the overall landscape remains difficult due to many clinics with varied procedure options. To understand the current trends and status of cosmetic surgery in Japan, we analyzed large-scale data from a group of clinics throughout the country.

Methods:

We analyzed data from 152,457 patients in our database. The periods from September 2018 to August 2021 and September 2021 to February 2023 were defined as the first and second periods, respectively, and the statuses of procedures were compared between the two.

Results:

Eye procedures were the most common (23.6%), followed by face-lifts (19.5%) and dark circles under the eyes (10.4%). Between the first and second periods, the number of procedures in the second period (128,898 cases) was overwhelmingly higher than that in the first period (23,559 cases). Orbital fat removal for dark circles under the eyes significantly increased (OR 2.97, 95%CI 2.78–3.17); procedures in provincial cities significantly increased (Kinki/Chugoku/Shikoku: OR 2.21, 95%CI 2.08–2.36); and procedures for patients with occupations where appearance is considered important, such as nightlife businesses or being a celebrity, decreased (celebrity: OR 0.44, 95%CI 0.38–0.51, nightlife business: OR 0.58, 95%CI 0.53–0.62).

Conclusions:

In Japan, cosmetic surgery has become increasingly common in recent years, and the trend has been changing over time. In the future, it will be important to organize and enhance our large-scale database to disseminate more accurate and useful information.
The Montreal Plastic Surgery Residency Bootcamp: Structure and Utility
Authors: Gervais Valerie , Grabs Detlev , Bougie Emilie , Salib George E. , Bortoluzzi Patricia , Tremblay Dominique M.
Published: October 2023

Transitioning from medical school to surgical residency is a difficult endeavor. To facilitate this period, the University of Montreal’s plastic surgery program developed and implemented an intensive 1-month bootcamp rotation. It is the only one of its kind and length amongst plastic surgery residency programs in North America. It includes didactic teachings in anatomy, cadaveric dissections, and surgical approaches for an array of procedures. Clinical and technical skills are reviewed with senior residents and attending surgeons. Research opportunities and case scenarios are also covered. An anonymous online 30-question survey was sent to all residents who participated in the bootcamp rotation between 2013 and 2020. Questions evaluated residents’ knowledge of anatomy, basic surgical skills, common approaches, flap knowledge, and on-call case management, before and after the bootcamp. Seventeen plastic surgery residents responded to this questionnaire (81%). The majority confirmed that the bootcamp helped them prepare for residency, research, and on-calls, and also helped them expand their knowledge of anatomy and surgical skills. The residents responded positively to the bootcamp’s structure and implementation. This study proposes that surgical programs could benefit from a bootcamp rotation at the beginning of their curriculum. The purpose is to facilitate the transition between medical school and postgraduate training, and to ensure a basic level of competence for all junior residents. Further prospective studies could demonstrate the bootcamp’s impact in board certification rates and acceptance into fellowship training programs.
Doxycycline for the Treatment of Lyme Disease in Young Children
Authors: Brown Katie , Corin Sarah , Handel Andrew S.
Published: October 2023

Background: 

Doxycycline is considered the first-line treatment of Lyme disease in adolescents and adults, but largely disproven concerns of permanent tooth staining prevented its use and evaluation in children <8 years old. We sought to describe short-term adverse effects and treatment failures among young children receiving oral doxycycline for Lyme disease.

Methods: 

We completed a 2-pronged evaluation of children with Lyme disease treated with doxycycline. We performed a retrospective case series of patients <8 years old who were diagnosed with Lyme disease and treated with doxycycline. We then performed a telephone follow-up survey study of the patients’ parents to gather additional details regarding clinical outcomes and adverse reactions to doxycycline. Descriptive statistics were calculated.

Results: 

A total of 32 patients were identified through the retrospective case series and 18 participated in the follow-up survey. The most common clinical diagnosis (22/32; 69%) was single erythema migrans. Seven (22%) had neurological Lyme disease. Three patients (9%) stopped doxycycline treatment prematurely due to adverse effects. During telephone follow-up, 2 children were reported to have dental staining. No patients were identified with treatment failure during the retrospective case series. On telephone follow-up, 3 patients had residual symptoms after treatment, though none were convincing of treatment failure.

Conclusions: 

Our study suggests that doxycycline is generally well-tolerated and an effective treatment of Lyme disease in young children. Prospective, observational studies with long-term assessment of dental staining and clinical outcomes are needed. Alternative antibiotics, principally amoxicillin, remain the preferred treatment of non-neurological Lyme disease manifestations in young children, but doxycycline is likely a safe and effective alternative when needed.
Ten-year Single Center Experience With Colistin Therapy in NICU
Authors: Kaya Tuğba Barsan , Sürmeli Onay Özge , Aydemir Özge , Tekin Ayşe Neslihan
Published: October 2023

Background:

Colistin, a cationic polypeptide antibiotic of the polymyxin class has come back into use due to its potent antimicrobial activity against multidrug-resistant Gram-negative bacteria and the lack of new antibiotics. The purpose of this study was to assess the critically ill infants treated with colistin in our neonatal intensive care unit and to identify predisposing factors for the emergence of acute kidney injury (AKI) following colistin treatment.

Methods:

This was a retrospective case-control study that included infants with proven or suspected nosocomial infections in the neonatal intensive care unit of a University Hospital between January 2012 and March 2022. Over the same time period, the clinical and laboratory characteristics and outcomes of patients who received antibiotic combination with colistin were compared to patients who received antibiotic combination without colistin.

Results:

A total of 77 patients were in the colistin group (ColG) and 77 patients were in the control group. The demographic and clinical characteristics of the study groups were similar. In the ColG compared to the control group, hyponatremia, hypokalemia, hypophosphatemia, hypomagnesia and AKI were all more prevalent (P < 0.05). The most important finding in our study was the higher incidence of AKI and mortality in ColG, as well as the increasing nephrotoxic effect of other medications when used in conjunction with colistin.

Conclusion:

During colistin therapy, newborn infants must be closely monitored for AKI. Clinicians should be aware of an increased incidence of hyponatremia, hypokalemia, hypophosphatemia, hypomagnesia, AKI and its consequences in infants given colistin. As awareness increases, harmful effects will decrease.
Prescribing Pattern and Efficacy of Oral Antibiotics for Pediatric Urinary Tract Infections in Japan: A Descriptive Study Using a Nationwide Claims Database
Authors: Muramatsu Daichi , Yanai Takanori , Yoshida Satomi , Kawakami Koji
Published: October 2023

Background:

Pediatric urinary tract infections are often treated with third-generation cephalosporins; however, the increasing prevalence of Escherichia coli resistant to cephalosporins has reduced their effectiveness. Although resistance is prevalent in Asia, the prescribing patterns and clinical effectiveness of antibiotics have mostly been reported in the United States. This study aimed to describe the prescription patterns and effectiveness of oral antibiotics for treating pediatric urinary tract infections in Japan.

Methods:

This descriptive study used data from a nationwide Japanese claims database. We identified patients <6 years old with urinary tract infections who received oral antibiotics between January 2016 and December 2020. Descriptive analyses were performed to assess prescription patterns. Moreover, logistic regression analyses were conducted to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for treatment failure among the commonly prescribed antibiotics and patient characteristics. Treatment failure was defined as the prescription of different antibiotics within 7 days of the primary prescription.

Results:

Of the 4,127 patients, 2,766 (67.0%) were prescribed third-generation cephalosporins, and 347 (8.4%) were prescribed amoxicillin. Trimethoprim-sulfamethoxazole and amoxicillin-clavulanate were prescribed to 63 (1.5%) and 50 (1.2%) patients, respectively. Treatment failure was observed in 118 (2.9%) patients and more often in amoxicillin-treated patients than in cefcapene pivoxil-treated patients [OR, 2.18 (95% CI: 1.04–4.58)].

Conclusions:

Third-generation cephalosporins are the most commonly prescribed antibiotics for the initial therapy of pediatric urinary tract infections in Japan. Third-generation cephalosporins are still effective in Japan, despite the high prevalence of resistance against cephalosporins.
Identifying Obstructive Sleep Apnea Risk Using the STOP-BANG Questionnaire in a Cardiology Clinic
Authors: Rogel Megan , Iverson Lindsay , Hall Alex
Published: October 2023

Untreated obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality, warranting enhanced awareness, screening, and action among healthcare providers to optimize patient outcomes. Attempting to address the potential under detection of OSA, this quality improvement project implemented the STOP-Bang Sleep Apnea Questionnaire at a cardiology clinic, with the goals to stratify risk for OSA in 100% of patients and increase provider referral of high risk patients for sleep studies. The setting was an outpatient cardiology clinic in Pensacola, Florida. The sample included new and existing patients 18 years or older who had one or more of the following diagnoses: hypertension, heart failure, coronary artery disease, atrial fibrillation, or arrhythmia. Methods involved collecting and comparing preintervention sleep study referral rate data with 6-week STOP-Bang questionnaire implementation data. Results demonstrated a 65% (279 of 428 patients seen) screening implementation rate and a modest but statistically significant increase in the overall referral rate from 2.6% preintervention to 5.1% postintervention (p = .040). Overall, standard use of the STOP-Bang questionnaire may enable higher detection and referral of OSA.