bluuebunny/crossref_metadata_2025_split huggingface dataset:
USE OF CLINICAL EXPOSURE INDEX AND DEVIATION INDEX BASED ON NATIONAL DIAGNOSTIC REFERENCE LEVEL AS DOSE-OPTIMIZATION TOOLS FOR GENERAL RADIOGRAPHY IN KOREA
Authors: Park Hyemin , Yoon Yongsu , Kim Jungmin , Kim Jungsu , Jeong Hoiwoun , Tanaka Nobukazu , Morishita Junji 
Published: October 2020

Abstract
The International Electrotechnical Commission introduced the concepts of exposure index (EI), target exposure index (EIT) and deviation index (DI) to manage and optimize patient dose in real time. In this study, we have proposed an appropriate method for setting the EIT based on the Korean national diagnostic reference levels (DRLs). Furthermore, we evaluated the use of clinical EI, EIT and DI as tools for patient dose optimization in clinical environments by observing the changes in DI with those in EIT. According to the Korean national exposure conditions, we conducted experiments on three representative radiographic examinations (chest posterior–anterior, lateral and abdomen anterior–posterior) of clinical environments. As the exposure conditions and DRLs varied, the clinical EI, EIT and DI also varied. These results reveal that the clinical EI, EIT and DI can be used as tools for optimizing the patient dose if EIT is periodically and properly updated.
Early Gestational Exposure to Inhaled Ozone Impairs Maternal Uterine Artery and Cardiac Function
Authors: Garcia Marcus , Salazar Raul , Wilson Thomas , Lucas Selita , Herbert Guy , Young Tamara , Begay Jessica , Denson Jesse L , Zychowski Katherine , Ashley Ryan , Byrum Stephanie , Mackintosh Samuel , Bleske Barry E , Ottens Andrew K , Campen Matthew J 
Published: October 2020

Abstract
Exposure to air pollutants such as ozone (O3) is associated with adverse pregnancy outcomes, including higher incidence of gestational hypertension, preeclampsia, and peripartum cardiomyopathy; however, the underlying mechanisms of this association remain unclear. We hypothesized that O3 exposures during early placental formation would lead to more adverse cardiovascular effects at term for exposed dams, as compared with late-term exposures. Pregnant Sprague Dawley rats were exposed (4 h) to either filtered air (FA) or O3 (0.3 or 1.0 ppm) at either gestational day (GD)10 or GD20, with longitudinal functional assessments and molecular endpoints conducted at term. Exposure at GD10 led to placental transcriptional changes at term that were consistent with markers in human preeclampsia, including reduced mmp10 and increased cd36, fzd1, and col1a1. O3 exposure, at both early and late gestation, induced a significant increase in maternal circulating soluble FMS-like tyrosine kinase-1 (sFlt-1), a known driver of preeclampsia. Otherwise, exposure to 0.3 ppm O3 at GD10 led to several late-stage cardiovascular outcomes in dams that were not evident in GD20-exposed dams, including elevated uterine artery resistance index and reduced cardiac output and stroke volume. GD10 O3 exposure proteomic profile in maternal hearts characterized by a reduction in proteins with essential roles in metabolism and mitochondrial function, whereas phosphoproteomic changes were consistent with pathways involved in cardiomyopathic responses. Thus, the developing placenta is an indirect target of inhaled O3 and systemic maternal cardiovascular abnormalities may be induced by O3 exposure at a specific window of gestation.
Using Insights From Sports Psychology to Improve Recently Qualified Doctors’ Self-Efficacy While Managing Acutely Unwell Patients
Authors: Church Helen R. , Murdoch-Eaton Deborah , Sandars John 
Published: October 2020

Problem
Doctors experience a range of negative reactions when managing acutely unwell patients. These may manifest as emotions or behaviors. Without appropriate coping strategies, these emotions and behaviors can impede optimal clinical performance, which directly affects patient care. Athletes use performance enhancing routines (PERs) to minimize the effect of their negative emotions and behaviors on competitive performance. The authors investigated whether PERs could similarly improve recently qualified doctors’ emotional and behavioral control while managing acutely unwell patients and whether the doctors perceived any effect on clinical performance.

Approach
Twelve doctors within 2 years of graduation from medical school recruited from 2 sites in Sheffield and Chesterfield, United Kingdom, implemented PERs using the PERFORM (Performance Enhancing Routines For Optimization of Readiness using Metacognition) model over a 4-month period between April and December 2017. The doctors’ perceptions of PERFORM’s effect on their ability to manage patients was evaluated using self-reported mixed-methods data, including think-aloud commentaries, semistructured interviews, and self-efficacy scores.

Outcomes
Doctors reported that PERFORM improved their ability to control negative emotions or behaviors during an acutely unwell patient in situ simulation, showing a statistically significant improvement in self-efficacy scores (P = .003, effect size = 0.89). Qualitative data revealed perceived improvement in aspects of clinical performance such as enhanced knowledge recall and decision making. These performance attributes appeared to positively impact interprofessional relationships and patient care. Doctors individualized their PERs and supported the wider implementation of PERFORM in health care education.

Next Steps
This is the first study to employ individualized PERs based on sports psychology in a medical context. The PERFORM model could be introduced into existing acute patient management courses to provide emotional regulation coaching alongside clinical skills training. Further research might investigate PERFORM’s effect in other environments where emotional and behavioral control is paramount, such as surgery.
Magnetic Resonance Spectroscopy Assessment of Brain Metabolite Concentrations in Individuals With Chronic Whiplash-associated Disorder
Authors: Farrell Scott F. , Cowin Gary J. , Pedler Ashley , Durbridge Gail , de Zoete Rutger M.J. , Sterling Michele 
Published: October 2020

Objectives:
Pathophysiologic mechanisms underpinning ongoing pain in whiplash-associated disorder (WAD) are not well understood, however, alterations in brain morphology and function have been observed in this population and in other chronic pain conditions. This study investigated metabolite profiles of brain regions in people with chronic WAD compared with controls.

Materials and Methods:
Thirty-eight individuals with chronic WAD (mean [SD] age, 39.5 [11.3] years, 23 female individuals) and 16 pain-free controls (38.9 [12.7] years, 11 female individuals) underwent multivoxel brain magnetic resonance spectroscopy. At the anterior cingulate cortex (ACC), primary motor cortex (1MC), and somatosensory cortex (SSC), ratios of metabolite concentrations were calculated for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myo-inositol (Ins), and glutamate/glutamine (Glx). Chronic WAD group participants completed clinical questionnaires and cold and pressure pain threshold assessment. Data were analyzed with hypothesis testing and Spearman correlations (P≥0.05), with Benjamini-Hochberg corrections (5% false discovery rate).

Results:
No group differences were observed for NAA:Cr, NAA:Cho, Cr:Cho, Glx:NAA, Glx:Cr, Glx:Cho, Ins:NAA, Ins:Cr, Ins:Cho or Ins:Glx for left or right ACC, 1MC, or SSC following correction for multiple comparisons. No significant correlations were observed between metabolite ratios and any clinical variable.

Discussion:
These results suggest that ongoing pain and disability in this population may not be underpinned by metabolite aberrations in the brain regions examined. Further research is required to progress our understanding of cortical contributions to neurophysiologic mechanisms in chronic WAD.
Toward Understanding Movement-evoked Pain (MEP) and its Measurement
Authors: Fullwood Dottington , Means Sydney , Merriwether Ericka N. , Chimenti Ruth L. , Ahluwalia Simar , Booker Staja Q. 
Published: October 2020

Objective:
Individuals with chronic pain conditions often report movement as exacerbating pain. An increasing number of researchers and clinicians have recognized the importance of measuring and distinguishing between movement-evoked pain (MEP) and pain at rest as an outcome. This scoping review maps the literature and describes MEP measurement techniques.

Materials and Methods:
The scoping review utilized 6 databases to identify original studies that targeted pain or movement-related outcomes. Our search returned 7322 articles that were screened by title and abstract by 2 reviewers. The inclusion criteria focused on the measurement of MEP before, during, and after movement tasks in adults with chronic pain. Studies of children below 18 years of age or with nonhuman animals, case studies, qualitative studies, book chapters, cancer-related pain, non-English language, and abstracts with no full publish text were excluded from the study.

Results:
Results from 38 studies revealed great variation in the measurement of MEP, while almost all of the studies did not provide an explicit conceptual or operational definition for MEP. In addition, studies collectively illuminated differences in MEP compared with rest pain, movement provocation methods, and pain intensity as the primary outcome.

Discussion:
These results have clinically significant and research implications. To advance the study of MEP, we offer that consistent terminology, standardized measurement (appropriate for pain type/population), and clear methodological processes be provided in research publications. On the basis of the findings, we have put forth a preliminary definition of MEP that may benefit from the continued scholarly dialog.
The Iliopectineal Fascia: A Cadaveric Anatomical Study
Authors: Barker Jordan P. , Yang Yang , Matz Jacob , Marmor Meir T. , Morshed Saam 
Published: October 2020

Objectives:
The iliopectineal fascia (IPF) serves as an important anatomical compass during the ilioinguinal and anterior intrapelvic approaches. The purpose of this investigation is to qualitatively and quantitatively describe the IPF by cadaveric dissection.

Methods:
Dissections were performed on 7 paired fresh-frozen cadaveric pelvic specimens. Measurements were made with surgical rulers to determine attachments of the IPF relative to surrounding anatomy.

Results:
The IPF is the thickened anterior portion of the iliopsoas fascia, attached superolaterally at the iliac crest for a mean insertion distance of 2.5 cm (range, 2.0–3.0 cm), immediately posterior to the origin of the inguinal ligament. Inferomedially, the IPF attaches to a bony ridge along the apex of the iliopectineal eminence, between the pelvic brim posteriorly and the anterior wall of the acetabulum anteriorly (mean distance, 4.3 cm; range, 3.1–5.6 cm). The attachment at the iliopectineal eminence is 7.8 cm (range, 6.0–10.0 cm) from the pubic symphysis, measured curvilinearly along the brim. The mean length of the IPF between its superolateral and inferomedial attachments is 9.2 cm (range, 8.0–11.8 cm). Anterolaterally, the IPF is the site of attachment of the internal oblique and transversus abdominis. Posteriorly, the IPF continues as the iliopsoas fascia.

Conclusions:
The authors have sought clarity and reconciliation of the myriad terms and descriptions of the IPF and its surrounding anatomy. We recommend a thorough understanding of this anatomy to enable safe and effective surgery via the ilioinguinal and anterior intrapelvic approaches to the acetabulum.
Which Lymph Node Staging System Better Predicts Prognosis in Patients With Gastric Carcinoma? A Comparative Study Between 3 Different Lymph Node Classifications for Resected Gastric Cancer in a Western Tertiary Center
Authors: Díaz del Arco Cristina , Estrada Muñoz Lourdes , Sánchez Pernaute Andrés , Ortega Medina Luis , García Gómez de las Heras Soledad , García Martínez Ricardo , Fernández Aceñero María Jesús 
Published: October 2020

Introduction:
Gastric cancer (GC) is an aggressive disease with high mortality rates. Lymph node (LN) staging of GC is a major source of controversy. The aim of this study is to compare the prognostic value of 3 different LN classifications for patients with resected GC: the eighth TNM staging system, lymph node ratio (LNR, ratio between positive and total LN) and a new anatomic-based classification (Choi classification).

Materials and Methods:
A retrospective study of all cases of GC resected in a tertiary hospital in Spain (n=377). Clinical data were collected; histologic slides were reviewed; and univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed.

Results:
In all, 315 patients fulfilled inclusion criteria. Univariate analysis showed that all classifications were significantly associated with tumor death and progression (P<0.001). All staging systems were independent prognostic factors for DFS. Area under the curve ratios for Choi, N stage, and LNR classifications were 0.738, 0.730, and 0.735, respectively. TNM and LNR classifications were independent prognosticators for OS, while Choi classification was an independent factor only in patients with ≥16 LN resected. Area under the curve ratios for Choi, N stage, and LNR classifications were 0.707, 0.728, and 0.732, respectively. Kaplan-Meier curves depending on LNR classification showed the best patient stratification for both OS and DFS.

Conclusions:
The 3-staging systems had similar prognostic performance, but LNR-based classification stratified patients better. Further studies are needed to evaluate the impact of the number of LN examined, cutoff values, and anatomic extent of LN disease in GC.
Trends in Professional Radiation Exposures of Medical Staff Covered by Personal Dose Monitoring at a Rijeka Clinical Hospital Centre (2000 to 2015)
Authors: Žauhar Gordana , Dresto-Alač Branka 
Published: October 2020

Abstract
The increase in the number of radiological procedures observed in recent years also means greater exposure to ionizing radiation for the medical staff performing these procedures. This is most pronounced in the teams that perform interventional and invasive radiological procedures. The aim of this study was to examine the impact of increasing numbers of radiological procedures on the effective dose received by medical staff and to determine which professions received the highest exposure to ionizing radiation. Data for effective doses of 326 employees of Rijeka Clinical Hospital Centre covered by personal dosimetry in the period from 2000 to 2015 have been analyzed. Employees were divided by sex, by departments in which they were employed, and according to their professions. The analysis has shown that the exposure level of workers working in the ionizing radiation zone is typically well below the dose limits. During 2015, most employees (over 96.3%) received an annual effective dose of less than 0.1 mSv. Only three persons received an annual dose higher than 0.5 mSv, and one person received an annual dose of 6.9 mSv. Comparison of the radiation exposure doses of medical workers of different professions has shown that the highest dose of radiation is received by cardiologists involved in interventional cardiology procedures. Therefore, the additional need is to take care of their protection, check the manner of their work, and ensure more even workload of cardiologists participating in procedures that involve higher exposure to ionizing radiation.
Tritium Air Concentration Calculation Using Passive Monitors
Authors: Culp Todd , Robinson Alexandra 
Published: October 2020

Abstract
Passive tritium air monitoring was conducted at Sandia National Laboratories’ Z-Machine located in New Mexico. When conducting low-level measurements, indication of the measurement’s uncertainty and of the detection limit of the counting technique are important to understand. Therefore, a calculational methodology is presented to enable the determination of the airborne tritium concentration by analysis of the minimum detectible activities for the Passive Tritium Monitoring System and the laboratory counting system used. General discussions of the advantages and disadvantages of the Passive Tritium Monitoring System are provided.
Healthcare Providers' Views on Hepatitis C Testing and Counseling Among Sexual Partners of Hepatitis C–Infected Persons
Authors: Dunham Katherine , McDonald Jessica , Yousaf Anna , Barocas Joshua A. , Neill Marguerite A. , Noska Amanda , Flanigan Timothy P. 
Published: October 2020

Background
Current hepatitis C virus (HCV) counseling guidelines do not recommend that HCV-infected patients notify their partners or encourage them to get tested. We aimed to assess healthcare professionals' knowledge of and attitudes toward counseling and testing recommendations for HCV-infected patients.

Methods
A 15-question, anonymous survey was designed and distributed via e-mail to a convenience sample of healthcare professionals who work with Brown University– or Boston University–affiliated hospitals to assess their knowledge of and attitudes toward counseling recommendations for HCV-infected patients. The data were collected electronically and analyzed using descriptive statistical methods.

Results
Of the 55 respondents (a 20% response rate), 73% incorrectly believed that at the time when the survey was completed, the US Centers for Disease Control and Prevention HCV testing guidelines already recommended partners of HCV-infected patients be tested for HCV infection. Furthermore, 80% of respondents believed that recommendations should be revisited to explicitly include that HCV-infected patients encourage their partners to get tested. When counseling patients with HCV, 44% of respondents reported that they always ask whether the patient's partners have been tested for HCV and 42% reported that they sometimes do. Similarly, 42% reported that they always suggest that the HCV-infected patient's partners be tested for HCV.

Conclusions
Our survey shows that healthcare providers believe that HCV counseling and testing recommendations could be revisited, with specific attention given to the promotion of HCV testing for partners of HCV-infected patients.
Emerging roles of bile acids in control of intestinal functions
Authors: Yang Jiufang , Palmiotti Anna , Kuipers Folkert 
Published: October 2020

Purpose of review
Bile acids and their signalling pathways are increasingly recognized as potential therapeutic targets for several diseases. This review summarizes new insights in bile acid physiology, focussing on regulatory roles of bile acids in intestinal functions.

Recent findings
Recent studies have highlighted the interactions between bile acids and gut microbiome: interfering with microbiome composition may be beneficial in treatment of liver and metabolic diseases by modulating bile acid composition, as different bile acid species have different signalling functions. In the intestine, bile acid receptors FXR, VDR and TGR5 are involved in control of barrier function, paracellular ion transport and hormone release. Specific microbial bile acid metabolites modulate immune responses of the host. In addition, new functions of bile acids in regulation of gastric emptying and satiation via brain–gut–liver axis have been discovered. Identification of Cyp2c70 as the enzyme responsible for generation of hydrophilic mouse/rat-specific muricholic acids has allowed the generation of murine models with a human-like bile acid composition.

Summary
Specific bile acids act as important signalling molecules affecting whole body metabolism, specific transport processes and immunity in different segments of the intestinal tract. Their relevance for human (patho)physiology is emerging. Novel mouse models with human-like bile acid composition will aid to accelerate translational research.
Care During Pregnancy, Childbirth, Postpartum, and Human Milk Feeding for Individuals Who Identify as LGBTQ+
Authors: Griggs Kellie M. , Waddill Colette B. , Bice April , Ward Natalie 
Published: October 2020

Abstract
The growing number of families that include members of sexual and/or gender minority (SGM) groups requires perinatal nurses to know how to provide respectful and affirming care to all people, including this population. Approximately 19% of adults who are members of SGM groups are raising 3 million children, with many hoping to become pregnant, foster, use surrogacy, or adopt in the future. Based on current literature, many nurses are not prepared to meet the clinical needs of patients who are members of SGM groups in the maternity setting. Likewise, patients and families of SGM groups often perceive that nurses are uncomfortable with providing care and are not always satisfied with their care. To meet these needs, it is important that nurses use strategies focused on promoting respectful, affirming care, reducing negative experiences, and eliminating marginalizing language and practices. Nurses must incorporate a holistic care focus for patients who are members of SGM minority groups that includes standardized strategic education; development of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, or Plus (LGBTQ+) affirming and inclusive policies, practices, and language; flexibility, personal reflection of self-bias; and creating an environment of individualized compassionate care.
Predicting Posttraumatic Stress and Depression Symptoms Among Frontline Firefighters in China
Authors: Shi Junyi , Chen Yaru , Li Xiaohui , An Yuanyuan 
Published: October 2020

Abstract
To investigate the prevalence and comorbidity rate of potential posttraumatic stress disorder (PTSD) and depression in frontline firefighters in China, as well as to analyze the related predictive factors for PTSD and depression, our study included 261 firefighters who completed assessments including the Demographic Data Forum, PTSD Checklist for DSM-5, Center for Epidemiological Studies Depression Scale, Chinese version of Perceived Stress Scale, and Perceived Social Support Scale. Among the participants, 1.9% and 11.9% were identified as having potential PTSD and depression, respectively. There was a 9.1% chance of comorbid PTSD among the depressed firefighters and a 60% chance of comorbid depression among the firefighters with PTSD. Perceived stress positively predicted both PTSD and depression; perceived social support negatively predicted both PTSD and depression. Whereas family exogenous support predicted both PTSD and depression, family endogenous support only predicted depression. In addition, PTSD was predicted by rank. Soldiers and sergeants demonstrated higher level of PTSD than officers. Future studies on mental health of firefighters should take factors like perceived stress, social support, and rank into consideration.