bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation der Risikoanalyse bei der Behandlung mit offenen radioaktiven Stoffen in der Nuklearmedizin
Authors: Freudenberg Robert , Kästner David , Kotzerke Jörg , Brogsitter Claudia 
Published: January 2024

Zusammenfassung
Ziel Gemäß den Anforderungen des Strahlenschutzrechts hat vor der erstmaligen Behandlung mit radioaktiven Stoffen eine Risikoanalyse (RA) zu erfolgen. Die Durchführung einer solchen RA im Bereich der universitären Nuklearmedizin wurde 2020 publiziert 1. Entsprechend den gesetzlichen Bestimmungen hat eine Aktualisierung bei wesentlichen Änderungen von Teilprozessen zu erfolgen. Spätestens nach 3 Jahren wird eine Überprüfung empfohlen. Die Umsetzung und die Ergebnisse der Aktualisierung werden vorgestellt.
Methodik Es erfolgten schrittweise eine Evaluation der im Rahmen der initialen RA abgeleiteten Maßnahmen, eine Analyse eigener meldepflichtiger Vorkommnisse sowie von Vorkommnissen des BfS-geführten Melde- und Informationssystems für bedeutsame Vorkommnisse bei Strahlenanwendungen am Menschen (BeVoMed). Des Weiteren wurde die RA auf neue Therapien ausgeweitet und Teilbewertungen basierend auf aktuellen Erkenntnissen aktualisiert.
Ergebnisse Die im Rahmen der 2019 durchgeführten RA identifizierten Maßnahmen führten für die Radiojodtherapie, die RSO sowie die SIRT zu einer Reduktion der Risikoprioritätszahlen aufgrund einer Erhöhung der Entdeckungswahrscheinlichkeiten. Ein meldepflichtiges Vorkommnis wurde erkannt und analysiert. Die 3-jährige Erfahrung führte zudem bei vielen Prozessen zu einer Reduktion der Auftretenswahrscheinlichkeit.
Schlussfolgerung Die Aktualisierung der RA hat zu einer Reduktion der Risikoprioritätszahl als Maß für die Risikobewertung geführt, was die hohe Sicherheit bei der Durchführung nuklearmedizinischer Therapien unterstreicht. Dieses Resultat spiegelt sich in der geringen Anzahl gemeldeter nuklearmedizinischer Vorkommnisse des zentralen BeVoMed-Systems wider.
An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies
Authors: Black Kameron Collin , Snyder Nicole Ashley , Zhou Mengyu , Zhu Zhen , Uptegraft Colby , Chintalapani Ani , Orwoll Benjamin 
Published: January 2024

Abstract
Background Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates.
Objective Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine.
Methods This was a quasiexperimental pre–post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation.
Results Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39–4.74, p < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23–2.13, p < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70–3.82, p < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73–1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital.
Conclusion Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.
Buprenorphine Induction Using Microdosing for the Management of Opioid Use Disorder in Pregnancy
Authors: Patel Neil B. , Parilla Barbara V. 
Published: January 2024

Abstract
Background Conventional buprenorphine inductions require patients to abstain from full agonist opioids until they experience mild-to-moderate opioid withdrawal. We described a successful buprenorphine induction case in a pregnant patient using microdosing, which avoided withdrawal symptoms.
Case Presentation The patient is a 29-year-old G2P1001 at 18 2/7 weeks of gestation, who desired a switch from methadone to buprenorphine to minimize neonatal opioid withdrawal syndrome (NOWS), which complicated her last pregnancy. She was given increasing microdoses of buprenorphine over a 7-day period, while continuing her daily dose of methadone. She discontinued the methadone on day 8. She did well during the week of buprenorphine microdosing, with no complaints of withdrawal or cravings. She was engaged in her prenatal care. Her dose of buprenorphine was increased to 8 mg twice daily in the third trimester for some withdrawal symptoms in the evening consisting of new onset nausea and vomiting.The patient underwent an elective 39-week induction of labor and had a spontaneous vaginal delivery of an appropriately grown male fetus. Only nonpharmacologic interventions were used.
Conclusion Buprenorphine microdosing was well tolerated in this patient and avoided withdrawal symptoms in the mothers, and NOWS. A microdosing study in pregnancy is indicated
The professional background of a referring physician predicts the diagnostic yield of small bowel capsule endoscopy in suspected small bowel bleeding
Authors: Compare Debora , Sgamato Costantino , Rocco Alba , Coccoli Pietro , Donnarumma Durante , Marchitto Stefano Andrea , Cinque Sofia , Palmieri Pietro , Nardone Gerardo 
Published: January 2024

Abstract
Background and study aims The diagnostic yield of small-bowel capsule endoscopy (SBCE) in suspected small bowel bleeding (SSBB) is highly variable. Different reimbursement systems and equipment costs also limit SBCE use in clinical practice. Thus, minimizing non-diagnostic procedures is advisable. This study aimed to assess the SBCE diagnostic yield and identify factors predicting diagnostic findings in a cohort of patients with SSBB.

Patients and methods In this retrospective cohort study, we analyzed the medical records of patients who consecutively underwent SBCE for SSBB over 9 years. By logistic regression, we identified covariates predicting diagnostic findings at SBCE. Finally, we performed a post-hoc cost analysis based on previous gastroenterologist or endoscopist consultations versus direct SBCE ordering by other specialists.

Results The final analysis included 584 patients. Most SBCEs were
ordered by a gastroenterologist or endoscopist (74%). The number of SBCEs without any finding
was significantly lower in the gastroenterologist/endoscopist group P<0.001). The SBCE diagnostic yield ordered by a gastroenterologist or
endoscopist was significantly higher than that by other specialists (63% vs 52%, odds ratio
[OR] 1.57; 95% confidence interval [CI] 1.07–2.26, P=0.019). At
multivariate analysis, older age (OR 1.7, 95%CI 1.2–2.4, P=0.005),
anemia (OR 4.9, 95%CI 1.9–12, P=0.001), small bowel transit time
(OR 1, 95%CI 1–1.02, P=0.039), and referring physician (OR 1.8,
95%CI 1.1–2.7, P=0.003) independently predicted diagnostic
findings. Implementing prior gastroenterologist or endoscopist referral vs direct SBCE
ordering would reduce medical expenditures by 16%.
Conclusions The professional background of referring physicians significantly improves the diagnostic yield of SBCE and contributes to controlling public health costs.
Safety Profile of Intra-Arterial Tirofiban as a Rescue Therapy during Mechanical Thrombectomy in Acute Ischemic Stroke
Authors: Athiyappan Karthikeyan Muthugounder , Cherian Mathew , Mehta Pankaj , Poyyamoli Santhosh , Reddy Nikhil Handihal , Jayaraj Anupchakravarthy , Palathingal Shaheer Ali 
Published: January 2024

Abstract
Purpose This article studies the safety profile and role of intra-arterial (IA) tirofiban as a rescue therapy in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy.
Methods This is a retrospective observational study conducted among AIS patients with large vessel occlusion (LVO) eligible for endovascular revascularization and in whom IA tirofiban is given as rescue therapy. If the target vessel shows reocclusion following initial recanalization, flow limiting or significant residual stenosis after thrombectomy, or requires balloon angioplasty or stenting, IA tirofiban at a dose of 0.4 μg/kg/min was administered through the microcatheter in the target vessel followed by intravenous infusion of 0.1 μg/kg/min. The primary safety measure of the study was the incidence of symptomatic hemorrhage.
Results The total number of patients in the study group was 82, 36 were in the tirofiban group and 46 were in the non-tirofiban group. Immediate successful reperfusion was achieved in 31 patients (86.1%) and 41 patients (89%) in the tirofiban and non-tirofiban groups, respectively. Note that 19.4 and 25% of patients in the tirofiban group required adjunct techniques of angioplasty and stenting, respectively. Also, 2.7% patient in the tirofiban group had a symptomatic hemorrhage, while 8.7% in the non-tirofiban group had symptomatic intracranial hemorrhage. On multinomial logistic regression, history of transient ischemic attack, truncal occlusion and watershed infarct pattern predicted the usage of IA tirofiban during mechanical thrombectomy.
Conclusion Usage of IA tirofiban with or without adjunct techniques as a rescue therapy during mechanical thrombectomy in LVO improved recanalization rates without increasing the risk of symptomatic hemorrhage.
Early Prenatal Diagnosis of Cornelia de Lange's Syndrome with Whole-Exome Sequencing: A Case Report
Authors: Iftikhar Amna , Barnes Kathleen , Figueroa Melissa , Francis Antonia P. 
Published: January 2024

AbstractCornelia de Lange's syndrome (CDLS) is a multisystem genetic syndrome characterized by well-defined physical, intellectual, and behavioral characteristics. The diagnosis of CDLS is typically done clinically after birth; however, recent studies have demonstrated the ability to use prenatal ultrasound and whole-exome sequencing to diagnose CDLS prenatally. Here we present a prenatal case in which multiple fetal anomalies were identified on ultrasound at 20 weeks of gestation. Use of whole-exome sequencing allowed for successful diagnosis of CDLS in this fetus prenatally.
The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery
Authors: Fresch Robert , Stephens Kendal , DeFranco Emily 
Published: January 2024

Abstract
Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery.
Objective To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery.
Study Design In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery.
Results There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78–1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34–3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN.
Conclusion A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.
Small Cell Cervical Carcinoma in Pregnancy: Therapeutic Options for an Aggressive Cancer Diagnosis
Authors: Savelli Binsted Alyssa , Kassem Zeinab , Le David , de Veciana Margarita 
Published: January 2024

AbstractNeuroendocrine small cell cervical carcinoma is an aggressive cancer which accounts for approximately 1 to 3% of all cervical neoplasms. Therapy must be altered in pregnancy to optimize maternal–fetal outcomes. A 39-year-old woman presented for a routine prenatal visit and was noted to have a grossly abnormal cervix. Cervical biopsies confirmed small cell carcinoma. At 19 weeks' gestation, chemotherapy was initiated. The patient delivered at 34 weeks' gestation to initiate radiation therapy. Six months later, she was diagnosed with metastatic disease and died from cancer complications. In pregnancy, treatment modalities for small cell cervical carcinoma are based on the patient's gestational age at diagnosis. While aggressive early treatment is preferred, platinum-based chemotherapy can be initiated in the second trimester and radiation therapy delayed until delivery. Small cell cervical carcinoma complicating pregnancy requires aggressive treatment. Chemotherapy in the second trimester with planned delayed radiation therapy, may optimize fetal outcomes.
Intrahepatic Cholestasis of Pregnancy and Transaminitis in Women with COVID-19: A Case Series
Authors: Waldrop Anne R. , Henkel Andrea , Lee Kelley B. , Druzin Maurice L. , Aziz Natali , El-Sayed Yasser , Lyell Deirdre J. 
Published: January 2024

Abstract
Objective The four initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pregnant women presenting at term gestation to our institution presented with transaminitis. Three of the four were diagnosed with intrahepatic cholestasis of pregnancy (IHCP). Growing evidence exists of an associated transaminitis in nonpregnant SARS-CoV-2 patients. However, there are limited data of hepatic involvement of SARS-CoV-2 in pregnancy, and no previous studies have assessed the association with IHCP in patients with coronavirus disease 2019 (COVID-19).
Study Design This was a retrospective, single-center case series of four consecutive pregnant women with a positive result for SARS-CoV-2 presenting with transaminitis in third trimester.
Results The clinical courses of four pregnant women with COVID-19 and transaminitis, three of four of whom were diagnosed with IHCP, are described. Testing for SARS-CoV-2 was done through a reverse transcription polymerase chain reaction test of a nasopharyngeal swab.
Conclusion As we await larger studies ascertaining the incidence of IHCP in SARS-CoV-2, this prevalence highlights the importance of diagnosing IHCP among women with COVID-19 as a potential etiology of transaminitis, as IHCP risks may be ameliorated with earlier delivery. Moreover, delineating a hepatobiliary association in pregnancy may provide further information about the mechanism of liver impairment in SARS-CoV-2 in all patients.
Arthroscopic Treatment of Traumatic Isolated Volar Dislocation of the Distal Radioulnar Joint: Case Report and Management Proposal
Authors: Kaempf Ricardo , Atzei Andrea , Brunelli João Pedro Farina , Delgado Pedro J 
Published: January 2024

Abstract
Background Traumatic isolated dislocation of the distal radioulnar joint (DRUJ) has always been an injury recognized for its rarity, misdiagnosis, and possibility of inability to be reduced at emergency care. As a result, little has been discussed so far about the guidelines and routines for its treatment.It is known that some degree of injury to the triangular fibrocartilage (TFC) is required for a DRUJ to be dislocated. However, there is no evidence to prove that this injury will cause any degree of DRUJ instability following reduction.
Methods We show a case of a patient with traumatic isolated volar dislocation of the DRUJ in which, after failure in the attempt to reduce it in the emergency room, surgical treatment was performed using an arthroscopic method.
Results Computed tomography and magnetic resonance imaging axial sections showed the impaction of the distal ulna, with its groove to the extensor carpi ulnaris tendon blocked in the anterior labrum of the sigmoid notch of the radius. Arthroscopy before reduction showed that the distal portion of the TFC was intact, with damage to the foveal insertion (Palmer Type 1B, Atzei Class 3). After joint reduction, a loop-shaped repair of the TFC foveal lesion was performed through the central disc and attached to the distal ulna footprint. The patient presented good progression, with quick recovery, and no serious complications or the need for a second surery.
Conclusion We indicate the use of arthroscopy in patients with irreducible isolated volar dislocation, with subacute or chronic presentation, who have to be managed in the operating room. It is a useful method for diagnosing and repairing the TFC injury. This will prevent possible complications and provide faster recovery, mainly reducing the time of immobilization.
Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma
Authors: Nguyen Pham Ann B. , De Zoysa Madushka Y. , Ghoshhajra Brian B. , Scott Nandita S. , Hameed Afshan B. 
Published: January 2024

AbstractDue to the potential for severe maternal morbidity and even mortality, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) often presents as a clinical conundrum. While current recommendations encourage coronary interventions when medically indicated even during pregnancy, the hesitation still understandably exists. Meanwhile, given the rarity of the condition, the guidelines for management are still based on expert consensus.We present a case of P-SCAD in a 38-year-old woman with initial presentation at 28 weeks' gestation and recurrence at 9 days postpartum. A unique complication of this case is its transcontinental nature: the initial event occurred while the patient was on vacation across the country from her home. Questions arose not only with regard to her immediate management and care but also when she would be able to travel and how her complex care would be continued cross-country.This case raised important questions regarding the antepartum management of acute coronary syndrome (ACS). It also highlights the importance of multidisciplinary care, especially with a cardio-obstetrics team, in the management of P-SCAD and emphasizes the role for universal screening for cardiac diseases in pregnancy.
Unusual Presentations of Sellar and Suprasellar Space Occupying Lesion: Our Institutional Experience
Authors: Giridharan Ramalingam , Kumar Nirmal , Srisaravanan J. 
Published: January 2024

AbstractA pituitary abscess (PA) is a rare intracranial lesion. It is a critical disorder caused by an infectious process where purulent material accumulates inside the sella turcica. It occurs either as a primary disease or because of an infection and is associated with poor prognosis. In this article, we share our experience with PA. At our institution, we operated on five cases of pituitary abscess since 2016. All the cases presented with bitemporal hemianopia and headache. None of them had fever. Pituitary hormones were normal except in two patients with a previous history of hypothyroidism. Magnetic resonance imaging (MRI) of the brain showed pituitary macroadenoma. They underwent the endoscopic transnasal transsphenoidal approach. Postoperatively their vision has improved. Endocrine functions were normal in all the patients following surgery. Culture sensitivity was sterile in all the patients. Diagnosis of pituitary abscess is highly difficult before surgery. Hence, the diagnosis should be considered when a patient presents with fever, headache, and signs of pituitary dysfunction and meningeal inflammation. Surgical and medical management leads to a lower mortality rate and a higher probability of hormone function recovery.
Low voltage visible light modulation for three colors (red, green, blue) by sputtered lithium niobate thin film
Authors: Hara Hiroki , Yoshinari Jiro , Sasaki Kenji , Kikukawa Takashi , Take Hiroshi , Mino Tetsuya , Shimura Atsushi , Takagi Yasuhiro , Fukuzawa Hideaki 
Published: January 2024

In this study, lithium niobate (LN) optical modulator devices were fabricated using cost-effective sputtered LN thin films. We successfully achieved a significantly small product of half-wave voltage and interaction electrode length (VπL) of 1.2, 1.0, and 0.75 V cm using red (λ = 638 nm), green (λ = 520 nm), and blue (λ = 473 nm) laser light, respectively. This small VπL is owing to the use of a low dielectric material of LaAlSiInOx for buffer insulator between LN waveguides and electrodes, and the change of geometrical configuration of the electrode. Thus, fabricating visible light modulators at low cost can be realized, and sputtered LN thin films can be adopted for visible light communications and consumer-based applications.
Simulation of proton-induced primary displacement damage in GaAs under different ambient temperatures
Authors: Xing Tian , Liu Shuhuan , Song Ci , Wang Xuan , Adekoya Mathew Adefusika , Wang Chao , Li Haodi , Meng Fanjun , Du Xiaozhi , Sun Yunfeng , Zhu Shijie , Wang Lipeng , Chen Wei , Li Kang , Zheng Xiaohai 
Published: January 2024

The performance of on-orbit GaAs-based solar cells is susceptible to the displacement damage effect. The proton-induced primary displacement damage in GaAs on a geosynchronous equatorial orbit (GEO) was simulated and analyzed by combining the Monte Carlo (MC) and molecular dynamics (MD) methods. The MC simulation provided the distribution of primary knock-on atoms (PKAs) in GaAs induced by GEO-related protons to the MD simulation. In MD simulations, the effects of radiation fluence and ambient temperature on the displacement damage were considered. The simulation results showed that GEO-related protons generated a significant number of PKAs within an energy range of below 10 keV in GaAs. The high-fluence radiation emulated by the binary PKA could generate more point defects and cluster defects in GaAs than the low-fluence radiation emulated by single PKAs. As compared to room temperature (300 K), both a low (100 K) and high (500 K) ambient temperature could deteriorate the displacement damage. In addition, a high ambient temperature of 500 K could induce widespread thermal spikes in GaAs as compared to 100 and 300 K. This work can provide useful insight into the proton-induced displacement damage in GaAs and the radiation hardening of GaAs-based photoelectric devices in space.