bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNIVERSAL RADIATION PROTECTION SYSTEM (URPS); A NATURAL GLOBAL STANDARDISED TREND FOR HUMAN EXPOSURE CONTROL IN 21st CENTURY
Authors: Sohrabi M 
Published: April 2019

Abstract
In order to address the many deficiencies with current radiological protection system worldwide, this paper proposes a new Universal Radiation Protection System (URPS) Hypothesis with novel philosophy, concepts and methodologies of applying principles of equal human health-effect risks of an individual per unit radiation dose either from environmental natural background (NBG) or man-made sources; a ‘standardised integrated dose system’ for integrating all individual doses with emphasis on national NBG doses; considering worker as a member of public; and a ‘cause–effect conservation principle’ for epidemiology risk estimation. The URPS also a radiation hypothesises fractionation weighting factors (WF); a ‘URPS Model’ for bridging ‘linear no-threshold and hormesis models’; example dose limit for workers; as well as new terms and definitions. State-of-the-art developments on URPS hypothesis are presented and discussed with simple global natural trends for standardised human exposure control in order to protect workers, patients, public and environment by standardised methods independent of source and country of origin in the 21st century.
Relationship between Future Orientation and Pain Severity in Fibromyalgia Patients: Self-Compassion as a Coping Mechanism
Authors: Chang Edward C , Lucas Abigael G , Chang Olivia D , Angoff Harrison D , Li Mingqi , Duong Ashley H , Huang Judy , Perera Marisa J , Sirois Fuschia M , Hirsch Jameson K 
Published: April 2019

Abstract
The present study examined the relationship between future orientation and fibromyalgia-related pain severity in a sample of 287 adults with fibromyalgia. Specifically, authors examined dimensions of self-compassion (for example, self-kindness, isolation, mindfulness) as possible mechanisms through which future orientation might be associated with pain severity. Results of conducting a multiple mediator test with 10,000 bootstraps indicated that the significant negative association between future orientation and pain severity was mediated through one specific self-compassion dimension, namely, isolation. The article concludes with a discussion of the implications of the present findings for working with fibromyalgia patients, specifically the potential value of social workers working with fibromyalgia patients to build future orientation as a resilience factor to combat pain severity. Also discussed is the value of working with patients to develop a sustainable social support system that can disrupt experiences of social isolation and disconnectedness from others, and which appear to contribute to greater pain severity.
Nutrient availability alters the correlation between spring leaf-out and autumn leaf senescence dates
Authors: Fu Yongshuo H , Piao Shilong , Delpierre Nicolas , Hao Fanghua , Hänninen Heikki , Geng Xiaojun , Peñuelas Josep , Zhang Xuan , Janssens Ivan A , Campioli Matteo 
Published: April 2019

AbstractLeaf senescence (LS) affects tree fitness, species distribution and ecosystem structure and functioning. The drivers of LS and the processes underlying it have been studied, but the studies have mainly focused on environmental cues and have mainly been based on statistical analyses using in situ data sets. Experimental investigation and field verification of the processes and drivers are thus urgently needed. We conducted a nutrient-addition experiment after a spring-warming experiment in which an ~40-day range of leaf-out (LO) dates was induced in horse chestnut (Aesculus hippocastanum) and beech (Fagus sylvatica) saplings. We found that both increased nutrient supply and advanced LO date significantly affected the timing of LS, but their effects were opposite, as the former delayed and the latter advanced the senescence. The effects of nutrient supply and LO interacted species specifically. In chestnut, the delay of senescence caused by fertilization increased with the delay of LO and was thus stronger for individuals that flushed late in the spring. On the contrary, in beech the delay of senescence caused by fertilization decreased with the delay of LO and was insignificant for individuals with the latest LO. The experimental findings for beech were confirmed with mature trees at a regional scale. The interactive effect between nutrients and LO on senescence may be associated with variable sensitivity to photoperiod, growth sink limitation and/or direct effect of foliar nutrition on the timing of senescence. Our novel results show that the interactive effects of LO and nutrient supply on the timing of LS should be further addressed experimentally in forthcoming studies. It would also be interesting to consider our results in the further development of phenological models used in assessing the effects of climatic change. The differences found in the present study between horse chestnut and beech suggest that the results found for one species cannot necessarily be generalized to other species, so studies with different temperate tree species are called for.
Artificial Intelligence and Machine Learning in Anesthesiology
Authors: Connor Christopher W. 
Published: April 2019

Abstract
Commercial applications of artificial intelligence and machine learning have made remarkable progress recently, particularly in areas such as image recognition, natural speech processing, language translation, textual analysis, and self-learning. Progress had historically languished in these areas, such that these skills had come to seem ineffably bound to intelligence. However, these commercial advances have performed best at single-task applications in which imperfect outputs and occasional frank errors can be tolerated.
The practice of anesthesiology is different. It embodies a requirement for high reliability, and a pressured cycle of interpretation, physical action, and response rather than any single cognitive act. This review covers the basics of what is meant by artificial intelligence and machine learning for the practicing anesthesiologist, describing how decision-making behaviors can emerge from simple equations. Relevant clinical questions are introduced to illustrate how machine learning might help solve them—perhaps bringing anesthesiology into an era of machine-assisted discovery.
Compressive Pressure Versus Time in Cauda Equina Syndrome
Authors: Pronin Savva , Koh Chan Hee , Bulovaite Edita , Macleod Malcolm R. , Statham Patrick F. 
Published: April 2019

Study Design.
Systematic review and meta-analysis.

Objective.
To examine the relationship between compressive pressure and its duration in cauda equina compression, and the effects of subsequent decompression, on neurophysiological function, and pathophysiology in animal studies. We further aim to investigate these relationships with systemic blood pressure to assess whether a vascular component in the underlying mechanism may contribute to the clinical heterogeneity of this disease.

Summary of Background Data.
The complex relationship between preoperative factors and outcomes in cauda equina syndrome (CES) suggests heterogeneity within CES which may inform better understanding of pathophysiological process, their effect on neurological function, and prognosis.

Methods.
Systematic review identified 17 relevant studies including 422 animals and reporting electrophysiological measures (EP), histopathology, and blood flow. Modeling using meta-regression analyzed the relationship between compressive pressure, duration of compression, and electrophysiological function in both compression and decompression studies.

Results.
Modeling suggested that electrophysiological dysfunction in acute cauda equina compression has a sigmoidal response, with particularly deterioration when mean arterial blood pressure is exceeded and, additionally, sustained for approximately 1 hour. Accounting for pressure and duration may help risk-stratify patients pre-decompression. Outcomes after decompression appeared to be related more to the degree of compression, where exceeding systolic blood pressure tended to result in an irreversible lesion, rather than duration of compression. Prognosis was most strongly associated with residual pre-decompression function.

Conclusion.
Compressive pressure influences effects and outcomes of cauda equina compression. We suggest the presence of two broad phenotypic groups within CES defined by the degree of ischaemia as a potential explanatory pathophysiological mechanism.

Level of Evidence: 1
Predictive Factors of Male Sexual Dysfunction After Traumatic Spinal Cord Injury
Authors: Ferro Josepha Karinne de Oliveira , Lemos Andrea , Silva Caroline Palácio da , Lima Claudia Regina Oliveira de Paiva , Raposo Maria Cristina Falcão , Cavalcanti Geraldo de Aguiar , Oliveira Daniella Araújo de 
Published: April 2019

Study Design.
Observational study (Ethics Committee Number 973.648).

Objective.
Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction.

Summary of Background Data.
Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation.

Methods.
Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level.

Results.
Forty-five subjects with mean injury time of 7.5 years (CI 5.2–9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07–0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02–0.66), masturbation (OR: 0.13; 95% CI: 0.02–0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01–0.92). Ejaculation (OR: 0.01; 95% CI: 0.00–0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38–178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01–0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0–62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1–44.8) are associated with satisfaction.

Conclusion.
Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction.

Level of Evidence: 3
Mentoring millennials in surgical education
Authors: Louie Michelle , Moulder Janelle K. , Wright Kelly , Siedhoff Matthew 
Published: April 2019

Purpose of review
We seek to define the Millennial generation and identify strengths that can be employed to improve medical and surgical education and career development. We outline how generational traits can be incorporated into adult learning theory, offer suggestions for modernizing traditional teaching and mentorship models, and discuss why Millennials are ideally positioned to succeed in 21st century medicine.

Recent findings
Millennials (born ∼1981 to 1996) have several consistently identified traits that should be considered when teaching trainees and mentoring junior faculty. Millennials are technologically savvy, accustomed to accessing and assimilating large amounts of information quickly, using the electronic medical record with ease, and learning from a variety of media sources. They learn better with alternatives to traditional lectures, and respond well when given discrete goals, encouragement, and direct feedback early and often. Millennials prefer team-based learning and a flat hierarchy. Millennials are socially responsible, culturally diverse, and strive to promote diversity and work-life integration.

Summary
Although the individuals that make up the Millennial generation may not encompass each attribute associated with this cohort, collectively, this generation of physicians is positioned to usher medicine into a new era.
RETINAL FLECKS IN STARGARDT DISEASE REVEAL CHARACTERISTIC FLUORESCENCE LIFETIME TRANSITION OVER TIME
Authors: Solberg Yasmin , Dysli Chantal , Escher Pascal , Berger Lisa , Wolf Sebastian , Zinkernagel Martin S. 
Published: April 2019

Purpose:
Stargardt disease is the most common inherited juvenile macular dystrophy and is characterized by yellowish flecks across the posterior pole. The purpose of this study was to investigate fluorescence lifetime changes of retinal flecks over time using fluorescence lifetime imaging ophthalmoscopy.

Methods:
Longitudinal fluorescence lifetime data of 12 patients with Stargardt disease (mean age ± SEM, 42.25 ± 2.1 years; range, 28–58 years) were acquired using a fluorescence lifetime imaging ophthalmoscope based on a Heidelberg Engineering Spectralis system. Retinal autofluorescence was excited with a 470-nm laser. The emitted fluorescence was detected in two wavelength channels: a short spectral channel (498–560 nm) and a long spectral channel (560–720 nm). The mean retinal autofluorescence lifetimes were calculated and further analyzed with corresponding color fundus images, autofluorescence intensity images, and spectral domain optical coherence tomography. Patients were classified into three subtypes.

Results:
All patients with Stargardt disease displayed characteristic autofluorescence lifetime patterns. Mean fluorescence lifetime values within areas of yellow flecks were significantly prolonged (long spectral channel 484 ps) compared with the surrounding tissue (long spectral channel 297 ps). In 91.6% of the eyes, flecks with short fluorescence lifetimes (long spectral channel 255 ps) were identified. Short lifetime flecks progressed to flecks with characteristic long lifetimes in 75.1% of eyes within a mean interval of 29.2 months (range 3–45 months). Between baseline and follow-up, the rate of newly developed short lifetime flecks (number/per year) based on subtypes was 2.62 in Group 1, 1.43 in Group 2, and 0.81 in Group 3.

Conclusion:
Recent onset flecks in Stargardt disease display short fluorescence lifetimes and convert into longer fluorescence lifetime flecks over time. This transition may represent a change in the composition of retinal deposits with accumulation of lipofuscin and retinoid by-products from the visual cycle. With emerging treatment options, these findings may prove useful to monitor disease progression and therapeutic effects.
Exploring Hygienic Behaviors and Vulvodynia
Authors: Klann Alexandra M. , Rosenberg Jessica , Wang Tanran , Parker Samantha E. , Harlow Bernard L. 
Published: April 2019

Objectives
Vulvodynia is common and characterized by vulvar discomfort and pain. However, few studies have assessed hygienic practices in relation to onset. We investigated whether hygienic behaviors were associated with the onset of vulvodynia.

Materials and Methods
We assessed a self-reported history of personal hygienic behaviors, including wearing tight-fitting clothing, vulva care and genital washing, pubic hair removal, douching, and powdering, a year before first reported onset of vulvar pain among 213 clinically confirmed cases and a similar time period among 221 general population controls.

Results
Compared with women who reported never wearing tight-fitting jeans or pants, women wearing tight-fitting jeans or pants 4 or more times per week had twice the odds of vulvodynia (95% CI = 1.14–3.95). Relative to controls, women with vulvodynia were substantially less likely to report use of soaps and gels to cleanse the vulva (95% CI = 0.17–0.63). Among women who chose to remove pubic hair, those who removed pubic hair from the mons pubis compared with bikini-area only hair removal, were 74% more likely to have vulvodynia (95% CI = 1.05–2.89). Finally, compared with women who reported bikini-area only hair removal less than monthly, those who removed hair from the mons pubis weekly or more were nearly 2 times more likely to be vulvodynia cases (95% CI = 0.83–3.49).

Conclusions
Wearing tight-fitting jeans or pants and removing hair from the mons pubis area were associated with increased odds of vulvodynia. Research on how hygienic practices could influence vulvar pain in larger and more temporally addressed populations is warranted.
Utility of mean platelet volume to predict the prevalence of coronary artery disease on coronary angiography in patients with stable angina
Authors: Lin Yangyi , Chen Xia , Xu Xiangdong 
Published: April 2019

Background
Approximately 50% of patients with stable angina have coronary artery disease (CAD) on coronary angiography. The mean platelet volume (MPV) has been proposed as a marker that reflects platelet size and reactivity. This study investigated the predictive value of high MPV in patients with stable angina for diagnosing stable CAD.

Patients and methods
A total of 491 patients with chest pain who underwent selective coronary angiography for suspected CAD were enrolled. The patients were divided into the CAD group and non-CAD group according to angiography. All demographic, laboratory, and angiographic data were collected.

Results
Patients with MPV in the highest tertile were more likely to have CAD (66.9 vs. 51.0 vs. 35.7% for the highest, middle, and lowest tertiles; P = 0.001), had lower platelet counts (186 ± 48 vs. 199 ± 52 vs. 223 ± 63; P < 0.001), and had higher hemoglobin A1c levels (6.8 ± 1.5 vs. 6.5 ± 1.5 vs. 6.2 ± 1.1; P < 0.001). MPV had a positive correlation with hemoglobin A1c (r = 0.16; P < 0.001). Patients with CAD (n = 248) had higher MPV than those without CAD (n = 243) (11.0 ± 1.0 vs. 10.5 ± 0.9; P < 0.001). MPV was an independent predictor of CAD in patients with stable angina, with an adjusted odds ratio of 1.820 (95% confidence interval: 1.453–2.279; P < 0.001).

Conclusion
The presence of high MPV predicts the prevalence of CAD on coronary angiography in patients with stable angina, and this result may ultimately reduce unnecessary invasive coronary angiography.
Desensitization for sensitized patients awaiting heart transplant
Authors: Byku Mirnela , Chang Patricia P. 
Published: April 2019

Purpose of review
This review summarizes contemporary desensitization strategies for patients awaiting cardiac transplantation in an era when specific management is still somewhat controversial.

Recent findings
The number of sensitized patients awaiting heart transplantation is rising. Clinical assessment of antibody levels is mostly focused on human leukocyte antigen (HLA) antibodies. Sensitization to HLA antigens increases the risk of antibody medicated rejection and cardiac allograft vasculopathy after transplant, thus translates to reduced access to compatible donors and increased wait time to transplant. Desensitization therapy is commonly considered in listed patients with cPRA more than 50%, to either decrease the amount of circulating anti-HLA antibodies, reduce the antibody production, or a combination of both. Despite promising results on specific therapies (e.g., plasmapheresis, intravenous immunoglobulin, rituximab, bortezomib), there is a significant gap in knowledge on desensitization therapies in heart transplantation. Most data are from small observational studies and extrapolated from nonheart solid organ transplants.

Summary
Management of the sensitized patient awaiting heart transplant is individualized. Desensitization can facilitate negative cross-match and successful transplantation, but is associated with significant cost and potential adverse effects. The long-term outcomes of desensitization therapy remain to be determined, further emphasizing the importance of personalizing the treatment approach to each patient.
Recent Insights Into the Pathogenic Mechanism of Pancreatitis
Authors: Gukovskaya Anna S. , Gorelick Fred S. , Groblewski Guy E. , Mareninova Olga A. , Lugea Aurelia , Antonucci Laura , Waldron Richard T. , Habtezion Aida , Karin Michael , Pandol Stephen J. , Gukovsky Ilya 
Published: April 2019

Abstract
Acute pancreatitis (AP) is a potentially lethal inflammatory disease that lacks specific therapy. Damaged pancreatic acinar cells are believed to be the site of AP initiation. The primary function of these cells is the synthesis, storage, and export of digestive enzymes. Beginning in the endoplasmic reticulum and ending with secretion of proteins stored in zymogen granules, distinct pancreatic organelles use ATP produced by mitochondria to move and modify nascent proteins through sequential vesicular compartments. Compartment-specific accessory proteins concentrate cargo and promote vesicular budding, targeting, and fusion. The autophagy-lysosomal-endosomal pathways maintain acinar cell homeostasis by removing damaged/dysfunctional organelles and recycling cell constituents for substrate and energy. Here, we discuss studies in experimental and genetic AP models, primarily from our groups, which show that acinar cell injury is mediated by distinct mechanisms of organelle dysfunction involved in protein synthesis and trafficking, secretion, energy generation, and autophagy. These early AP events (often first manifest by abnormal cytosolic Ca2+ signaling) in the acinar cell trigger the inflammatory and cell death responses of pancreatitis. Manifestations of acinar cell organelle disorders are also prominent in human pancreatitis. Our findings suggest that targeting specific mediators of organelle dysfunction could reduce disease severity.
Patient satisfaction with information on chemotherapy
Authors: Oosterhof Piter , Sombroek Melissa , Crul Mirjam 
Published: April 2019

Abstract

Introduction:
Patients, who are starting systemic treatment for an oncological disease, receive a large amount of information on their treatment at multiple time points from several different healthcare professionals. In the OLVG hospital in Amsterdam, the information provision was harmonized in a multiprofessional treatment team. Afterward, the satisfaction with drug information was measured in ambulatory patients.

Methods:
The clinical care pathway of the oncology patient who receives antineoplastic drug treatment was mapped out, identifying the different moments where information can be given and by whom. In 3 multidisciplinary meetings, the different time points for patient contact were assigned to one of the healthcare professionals and the content of the information to be given was agreed upon by the team. For measurement of patient satisfaction, the validated Satisfaction with Information about Medicines Scale (SIMS) questionnaire was used during a 1-week period at the oncology day-care department.

Results:
Information at each contact with the patient was standardized in a map of the patients’ clinical care pathway. Forty-eight patients returned a SIMS questionnaire showing a high overall satisfaction rate of 81%.

Conclusion:
This study has shown that harmonizing information provision to patients on anticancer drug treatment is feasible and results in high levels of information satisfaction in oncology patients.