bluuebunny/crossref_metadata_2025_split huggingface dataset:
Four-year evaluation of drug-impaired driving drug concentrations
Authors: Cieri Grace , Mohr Amanda L.A , Fogarty Melissa , Chan-Hosokawa Aya , Logan Barry K 
Published: September 2024

Abstract
Drug-impaired driving is a significant public health and safety concern in the USA. To help assess current patterns of drug use in drivers, we evaluated 4 years of drug positivity in a large cohort of suspected impaired drivers. Samples collected between January 2017 and December 2020 were tested via a method compliant with the National Safety Council’s Alcohol, Drugs, and Impairment Division’s Tier I scope of recommended drugs. In 2017, NMS Labs received 17 346 driving under the influence of drugs cases, 17 471 in 2018, 19 050 in 2019, and 16 539 in 2020. The most common drug class detected was cannabinoids in ∼50% of the cases each year. The most common drugs detected over the 4 years were delta-9 tetrahydrocannabinol (delta-9 THC), ethanol, amphetamine/methamphetamine, fentanyl, and alprazolam. Delta-9 THC increased in positivity over the study, having been identified in 45% of cases in 2017, 46% in 2018, 46% in 2019, and 49% in 2020. Ethanol was found in 59% of cases in 2017, 59% in 2018, 61% in 2019, and 53% in 2020. Delta-9 THC and ethanol were the most common drug combination, found together in ∼19% of the cases every year of the study. Statistically significant increases in the average concentration of the following drugs were observed: fentanyl (5.7 ng/mL in 2017 to 9.6 ng/mL in 2020), methamphetamine (301 ng/mL in 2017 to 381 ng/mL in 2020), and delta-9-THC (6.4 ng/mL in 2017 to 7.3 ng/mL in 2020). Other findings included increases in the maximum reported concentrations between 2017 and 2020 for amphetamine (1400 to 2700 ng/mL), methamphetamine (5550 to 13 000 ng/mL), and fentanyl (56 to 310 ng/mL). Statistically significant concentration decreases were noted for several central nervous system depressants, notably prescription benzodiazepines, and several prescription narcotic analgesics.
The rise of bromazolam in postmortem cases from Travis County, TX, and surrounding areas: 2021 to 2023
Authors: Ellefsen Kayla N , Smith Christina R , Simmons Paul D , Edelman Lauren A , Hall Brad J 
Published: September 2024

Abstract
As novel psychoactive substances (NPSs) have continued to emerge over the past decade, NPS benzodiazepines have likewise increased in prevalence. They pose an evolving threat to public health and safety with regard to postmortem cases, particularly when used in combination with opioids. Bromazolam was first detected in Travis County, Texas, in April 2021. Given the recent onset of the fentanyl epidemic in this region, the international rise of bromazolam, and increased reports of “benzo-dope,” a retrospective study was conducted to characterize bromazolam-positive deaths in Travis County and surrounding counties from 2021 to 2023. Bromazolam was identified in 112 deaths from 2021 to 2023, accounting for 1.57% of cases submitted for toxicology testing (n = 7129). During that interval, a 7.5-fold increase in postmortem bromazolam-related drug toxicities from 2021 (n = 7) to 2023 (n = 53) was observed. Fatalities primarily occurred in men in their early 30s. Postmortem concentrations ranged from 21 to 220 ng/mL, with mean (median) concentrations of 69.4 ± 48.4 (53.5) ng/mL. Polydrug use was present in 99% of bromazolam-positive deaths with co-occurrence with other drugs and drug classes widely varying over time. Bromazolam was attributed as the sole cause of death in one case with a postmortem blood concentration of 23 ng/mL. Polydrug use in bromazolam-related drug toxicities commonly involved fentanyl (82%), methamphetamine (41%), and cocaine (28%). Similarly, cases where bromazolam was an incidental finding and noncontributory to the cause of death often involved methamphetamine (38%), alprazolam (33%), and cocaine (33%). In light of the significant increase in fentanyl-related deaths in Travis County, the increasing prevalence of bromazolam accompanying fentanyl was particularly alarming due to the heightened risk of toxicity when used in combination. Identifying and evaluating bromazolam-related deaths clarify the impact of bromazolam on this population, promote awareness, and aid in identifying meaningful harm reduction strategies to decrease bromazolam-related morbidity and mortality.
The Fractured Insurance Landscape of Laser Therapy for Scar Revision
Authors: Heron Matthew J , Reinoso Tyler R , Dane Julia M , Rezwan Siam K , Mack Sylvia , Broderick Kristen P , Cooney Carisa M , Caffrey Julie A 
Published: September 2024

Abstract
Fractional laser therapy improves skin texture, range of motion, and quality of life for patients with traumatic scars. Nevertheless, anecdotal evidence suggests declining insurance coverage for laser therapy. We aimed to characterize the landscape of insurance coverage for fractional laser therapy present our 6 year reimbursement trends. We cross-sectionally analyzed the 60 largest American health insurers by enrollee size and market share. For each, we identified their laser therapy policy for scar revision and extracted their documentation, prior and continuing authorization requirements and treatment guidelines. We also collected retrospective institutional claims data from 2017 to 2022 to investigate trends in reimbursement. Of the 60 largest health insurers, we identified 11 (18.3%) policies on scar revision and 40 policies (66.7%) on reconstructive surgery, including scar revision. Nineteen policies considered laser therapy medically necessary with evidence of functional impairment refractory to prior treatment. Three insurers denied laser coverage under any circumstance. Of the 1,531 claims submitted by our institution for burn scar laser therapy, 13.8% were denied. Patients with Medicare (ORadj, 3.78) or Medicaid (ORadj, 2.80) had significantly greater odds of coverage than privately insured patients (P &lt; .01). There was a 14.5% annual reduction in the odds of reimbursement during the study period (ORadj, 0.86, P &lt; .01). Laser therapy is a powerful treatment that is not widely available to patients with traumatic scars. Our institutional data suggest this access may be further eclipsed by decreasing trends in coverage since 2017. Strategies are needed to protect patient access to this life-changing treatment.
Advanced Practice Providers in Burn Care, 2013-2022
Authors: Das Rishub K , Jagasia Puja M , Bailey Amanda E , Mubang Ronnie , Drolet Brian C 
Published: September 2024

Abstract
This study evaluated the prevalence and characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6918 (43.3%) surgeons, 4264 (26.7%) other physicians, and 4783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of advanced practice providers providing services related to burns will increase by 56.7% from 2502 in 2022 to 3921 (95% CI, 3541–4303; R2 = 0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.
Retooling the regulation of net-zero subsidies: lessons from the US Inflation Reduction Act
Authors: Leonelli Giulia Claudia , Clora Francesco 
Published: September 2024

Abstract
The US Inflation Reduction Act (IRA) has heralded the advent of a new era of industrial policy within and beyond the USA. As the net-zero economy transition unfolds and national economic security paradigms entrench, industrial policy is here to stay. Net-zero subsidies are employed as multipurpose policy tools to promote domestic manufacturing, de-risk from China, and boost the net-zero transition. This new scenario prompts a fresh look at old questions surrounding environmental subsidies and their justification, actionability, and countervailability. This article makes three contributions. First, it articulates a conceptual framework to assess questions surrounding the justification of net-zero subsidies. It advocates a direct focus on their environmental effectiveness, drawing a distinction between justifiable trade-distorting effects and unjustifiable protective or discriminatory application associated with the pursuit of reshoring or geopolitical goals. Second, it employs a careful analysis of different IRA tax credits to operationalize the article’s framework and test its robustness. Third, it draws on legal and economic insights to shed some light on the environmental effects of different groups of net-zero subsidies. On these grounds, it advances a streamlined three-fold categorization and demarcates the boundaries within which different subsidies should be justifiable, non-actionable and non-countervailable.
Beyond lung cancer screening, an opportunity for early detection of chronic obstructive pulmonary disease and cardiovascular diseases
Authors: Gendarme Sébastien , Maitre Bernard , Hanash Sam , Pairon Jean-Claude , Canoui-Poitrine Florence , Chouaïd Christos 
Published: September 2024

Abstract

Background
Lung cancer screening programs concern smokers at risk for cardiovascular diseases (CVDs) and chronic obstructive pulmonary disease (COPD). The LUMASCAN (LUng Cancer Screening, MArkers and low-dose computed tomography SCANner) study aimed to evaluate the acceptability and feasibility of screening for these 3 diseases in a community population with centralized organization and to determine low-dose computed tomography (CT) markers associated with each disease.

Methods
This cohort enrolled participants meeting National Comprehensive Cancer Network criteria (v1.2014) in an organized lung cancer–screening program including low-dose CT scans; spirometry; evaluations of coronary artery calcifications (CACs); and a smoking cessation plan at inclusion, 1, and 2 years; then telephone follow-up. Outcomes were the participation rate and the proportion of participants affected by lung cancer, obstructive lung disease, or CVD events. Logistic-regression models were used to identify radiological factors associated with each disease.

Results
Between 2016 and 2019, a total of 302 participants were enrolled: 61% men; median age 58.8 years; 77% active smoker; 11% diabetes; 38% hypertension; and 27% taking lipid-lowering agents. Inclusion, 1-year, and 2-year participation rates were 99%, 81%, 79%, respectively. After a median follow-up of 5.81 years, screenings detected 12 (4%) lung cancer, 9 of 12 via low-dose CT (78% localized) and 3 of 12 during follow-up (all stage IV), 83 (27%) unknown obstructive lung disease, and 131 (43.4%) moderate to severe CACs warranting a cardiology consultation. Preexisting COPD and moderate to severe CACs were associated with major CVD events with odds ratios of 1.98 (95% confident interval [CI] = 1.00 to 3.88) and 3.27 (95% CI = 1.72 to 6.43), respectively.

Conclusion
The LUMASCAN study demonstrated the feasibility of combined screening for lung cancer, COPD, and CVD in a community population. Its centralized organization enabled high participation and coordination of healthcare practitioners.
Primary care physicians and laypersons’ perceptions of multicancer detection clinical trial designs
Authors: Samimi Goli , Temkin Sarah M , Weil Carol J , Han Paul K , LeeVan Elyse , Rubinstein Wendy S , Swigart Tessa , Caban Sarah , Dent Katherine , Minasian Lori M 
Published: September 2024

Abstract

Background
The National Cancer Institute Cancer Screening Research Network is launching a pilot study (Vanguard) to determine feasibility of successful completion of a clinical trial of multicancer detection tests. This focus group study reports perceptions of primary care physicians and laypersons of different clinical trial designs and willingness to participate in a multicancer detection clinical trial.

Methods
We undertook 14 focus groups with 88 laypersons and 6 focus groups with 45 primary care physicians. Participants were shown graphics of clinical trial designs and asked for their reactions. Focus group recordings were transcribed verbatim, and thematic analysis of the transcripts were conducted to identify emergent themes.

Results
Primary care physician and layperson participants recognized the importance of conducting clinical trials to determine the clinical utility of multicancer detection tests. Primary care physicians expressed reluctance to participate in trials because of workload burden, and laypersons expressed hesitancy about enrolling in the control group. Primary care physicians and laypersons expressed concern about a study design in which multicancer detection test results would not be returned to the control group (intended effect), but they respectively indicated a willingness to refer patients to, or participate in, a multicancer detection test clinical trial given transparent and clear communication on collection and use of biospecimens and data, particularly if a multicancer detection test would eventually be run and results eventually returned.

Conclusion
This study yielded important insights to guide trial design in planning prospective evaluation of multicancer detection testing. Maintaining transparency and trust while possibly withholding multicancer detection test results to maximize trial feasibility and efficiency is of particular concern.
Design and Pilot Implementation of an ECHO Module on Hepatitis C Virus Infection During Pregnancy
Authors: Yee Lynn M , Aronsohn Andrew , Shah Seema K , Lee Karen K , Rodriguez Isa , Otero Sebastian , Gower Patrick , Fishbein Joseph , Johnson Daniel , Jhaveri Ravi 
Published: September 2024

Abstract
We developed a Project ECHO® module to offer prenatal providers training on engaging in shared decision-making about hepatitis C virus (HCV) treatment during pregnancy. In this pilot program, the ECHO module addressing HCV during pregnancy and the potential benefits of treatment was associated with increases in self-efficacy scores among participants.
Development of Influenza-Specific CD4 T Cell-Mediated Immunity in Children Following Inactivated Influenza Vaccination
Authors: Shannon Ian , Huertas Nelson , White Chantelle L , Yang Hongmei , Nayak Jennifer L 
Published: September 2024

Abstract

Background
While both cellular and humoral immunity are important in immunologic protection against influenza, how the influenza-specific CD4 T cell response is established in response to early vaccination remains inadequately understood. In this study, we sought to understand how the CD4 T cell response to inactivated influenza vaccine (IIV) is established and develops throughout early childhood.

Methods
Influenza-specific CD4 T cell responses were quantified following IIV over 2 influenza seasons in 47 vaccinated children between 6 months and 8 years of age who had no documented history of natural influenza infection during the study. Peripheral blood mononuclear cells were stimulated with peptide pools encompassing the translated regions of the pH1, H3, HAB, and NP proteins, and CD4 T cell responses were assessed via multiparameter flow cytometry.

Results
There was boosting of H3- and HAB-specific CD4 T cells but not cells specific for the pH1 HA protein post-vaccination. A positive correlation between age and the magnitude of the influenza-specific CD4 T cell response was seen, with an overall greater magnitude of IFNγ-producing cells in subjects ≥3 years of age. Changes in CD4 T cell functionality were also noted in older compared to younger children, with increases in CD4 T cells producing IFNγ and TNF or IL-2 as well as IFNγ alone.

Conclusions
Inactivated influenza vaccine elicits a CD4 T cell response to H3 and HAB, with increases in the magnitude of the CD4 T cell response and changes in cellular functionality throughout childhood. This suggests that repeated influenza vaccination contributes to the development of anti-influenza CD4 T cell memory in children.
Prevalence and risk factors of sexual dysfunction in female participants with rheumatoid arthritis: a systematic review and meta-analysis
Authors: Huang Jiaguo , Guo Chuan , Sun Ji , Hua Runmiao , Fan Yi 
Published: September 2024

Abstract

Background
The prevalence and risk factors of female sexual dysfunction (FSD) in female participants with rheumatoid arthritis (RA) were reported with inconsistent results. However, no systematic review and meta-analysis of pooled data provide reliable estimates of FSD prevalence in female participants with RA.

Aim
To investigate the global prevalence and risk factors of FSD in female participants with RA and to analyze the association between FSD risk and RA.

Methods
The study search of this systematic review and meta-analysis was conducted through PubMed, Cochrane Library, Web of Science, and Embase from the inception date to December 10, 2023. Random effects meta-analysis was performed to derive the pooled prevalence. Q and I2 tests were used to analyze heterogeneity among the studies. Subgroup analyses and meta-regression were used to detect the sources of heterogeneity.

Outcomes
The pooled prevalence of FSD in female participants with RA was calculated, and odds ratios (ORs) and 95% CIs were used to assess the strength of the association between FSD-related risk factors and RA.

Results
A total of 13 studies were included in our analysis, involving 2327 participants. The pooled prevalence of FSD in female participants with RA was 49.1% (95% CI, 38.2%-60%). The participants with RA had a higher risk of FSD than healthy controls (OR, 3.10; 95% CI, 1.74-5.53). The significant risk factors of FSD in female participants with RA were depression status (OR, 1.42; 95% CI, 0.88-2.29) and menopause (OR, 5.46; 95% CI, 2.04-14.63).

Clinical Implications
Female participants with RA had a significantly increased prevalence of FSD, indicating that sexual function in female participants with RA should be concerned by clinicians.

Strengths and Limitations
The strength of this study is that it is the first meta-analysis to assess the global prevalence and risk factors of FSD in female participants with RA. A limitation is that the results, after the articles were pooled, showed significant heterogeneity and publication bias.

Conclusions
The present systematic review and meta-analysis revealed that the overall prevalence of FSD in female participants with RA was 49.1%, indicating a significant association between FSD risk and RA among females. Moreover, menopause and depression status were significantly associated with FSD in female participants with RA.
The Transnational Law of Renewable Energy
Authors: Sourgens Frédéric G , Baldwin Edward , Banet Catherine 
Published: September 2024

Abstract
Undertaken in Dubai in 2023, the ‘first global stocktake’ under the Paris Agreement called for a tripling of installed global renewable energy capacity. Achieving this goal will require significant financial, technical, and legal effort, and a key task in meeting it will be to ‘derisk’ global renewable energy projects by making the rules governing these projects more transparent, predictable, and uniform. This book aids this task by providing a unified and comprehensive analysis of the transnational law that currently governs renewable energy projects, thus providing a transnational legal approach. Drawing on regulatory frameworks and practice in public international law, comparative law, and transnational case law, the book establishes the first transnational lex regenerativa, or transnational law of renewable energy. The volume covers a range of regulatory topics relating to transnational renewable energy projects, including the regulation of their entry into the market and financial support mechanisms. It also covers commercial topics from construction to joint operation to financing, as well as further addressing the role of renewable energy in advancing global sustainable development. The book will appeal to practitioners and government officials, as well as students and academics doing research regarding global renewable energy projects.
Renewable Energy Project Financing
Authors: Sourgens Frédéric G , Baldwin Edward , Banet Catherine 
Published: September 2024

Abstract
This chapter explores the commercial aspects of constructing renewable energy projects, emphasizing the need for financing due to their capital-intensive nature. It discusses how financing allows parties with expertise but limited financial capacity to take advantage of new opportunities. It also highlights the importance of financing terms, which can impact the feasibility of supporting multiple projects with a given investment capital. The chapter outlines the project finance model for transnational renewable projects, introducing the concept of ‘bankability’ and discussing players, structures, and terms. It covers incentive structures offered by states to increase financing availability and concludes that a more mature transnational law of renewable energy could facilitate quicker and more efficient deployment of renewable projects worldwide.
Dispute Resolution
Authors: Sourgens Frédéric G , Baldwin Edward , Banet Catherine 
Published: September 2024

Abstract
This chapter focuses on dispute resolution in international renewable energy projects and discusses structuring concerns for drafting dispute resolution mechanisms in project documents and corporate structuring considerations for investment protection treaties. It stresses the avoidance of disputes and considers formal dispute resolution as a last resort, emphasizing the importance of supporting all parties’ reasonable returns and policy outcomes. It also introduces the traditional arbitration paradigm for large-scale projects and argues its use in renewables. The chapter highlights the interconnected nature of project disputes and outlines how to address complex disputes within the arbitration paradigm. It describes dispute resolution under international investment protection treaties and suggests replicating treaty protections through contractual undertakings with host governments.
Alternative Dispute Resolution
Authors: Sourgens Frédéric G , Baldwin Edward , Banet Catherine 
Published: September 2024

Abstract
This chapter examines alternative dispute resolution methods to arbitration, which is often a last resort for resolving disputes that have already damaged relationships between parties. It highlights the limitations of arbitration in long-term projects like renewable energy ventures. It also introduces negotiation as a primary tool, emphasizing its formal and informal aspects and the importance of decisional authority in early dispute avoidance. The chapter discusses mediation as another effective method that utilizes a third party to facilitate settlements and expert determination that resolves technical disputes quickly. It suggests combining these methods in multi-step dispute resolution clauses to incentivize early resolution and avoid arbitration.