bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gamma rays and neutrons attenuation performance of a developed lead borate glass for radiotherapy room
Authors: Zeed Mona Abo , El Shazly Raed M , Elesh Eman , El-Mallah Hanaa M , Saeed Aly 
Published: December 2023

Abstract
The development of radiation therapy necessitated a continuous R&D for radiotherapy rooms' glass windows to reach the highest levels of protection for the staff of the radiotherapy facility. Therefore, in this article, a novel type of lead borate glass depending on parallel augmenting of lead and boron was produced to be used as gamma-rays and fast and thermal neutrons barriers in radiotherapy rooms. Neutrons and gamma rays’ attenuation parameters, fast neutrons removal cross section ${\varSigma}_R$, thermal neutron total cross section ${\sigma}_T$, mass attenuation coefficient $\sigma$, linear attenuation coefficient μ, half-value layer, mean free path, effective atomic number Zeff, effective electron density Neff, and buildup factor for energy absorption (energy absorption buildup factor) and exposure (exposure buildup factor) were studied extensively. Three tools, Phy-X/PSD, EpiXS and XCOM computer programs and the standard mixture rules were utilized to estimate the attenuation parameters. The improvement caused by the augmentation of lead and boron in both gamma rays and neutrons attenuation was evident from the obtained results. The glass containing the highest lead and boron concentration PbB5, 40Pb-50B, which is the most efficient attenuator for gamma rays and both thermal and fast neutrons was recommended to be a distinguished choice as a shield in a radiotherapy room.
“What if that’s your last sleep?” A qualitative exploration of the trauma of incarceration and sleep
Authors: Elumn Johanna E , Li Patrick , Lytell Malcolm S , Garcia Marisol , Wang Emily A , Klar Yaggi Henry 
Published: December 2023

Abstract

Study Background/Objectives
Sleep is an underexplored factor in the health of people involved in the criminal legal system. This study addresses the paucity of research on how individual, social, and physical environmental factors impact sleep health during and after incarceration by highlighting the voices of people involved in the criminal legal system through a community-engaged qualitative research approach.

Methods
We conducted 20 semi-structured interviews with men recently released from prison for a study on trauma and healthcare during incarceration and after release. Interviews were coded and analyzed using reflexive thematic analysis and a critical realist framework. Our research team included people with a history of incarceration who performed central roles in the research process.

Results
Three themes emerged from participants’ descriptions of sleep during and after incarceration: (1) concerns about health contributing to sleep problems, (2) lack of access to treatment for sleep disorders leading to ongoing sleep problems, and (3) issues of safety contributing to sleep problems during incarceration and after release.

Conclusions
This study identifies factors and domains influencing sleep during and after incarceration. By identifying which interpersonal, environmental, and structural factors impact sleep quality, medical and carceral staff are better equipped to ameliorate sleep health disparities within populations with a history of incarceration and those actively bound by the criminal legal system. Future research should examine other factors impacting sleep in incarcerated and recently released populations and develop multi-level interventions to improve sleep health.
Persistence of Abortion Stigma Inscribed in the Legal Framework: The Case of Abortion Attitudes in Poland
Authors: Kwiatkowska Agnieszka , Pustułka Paula , Buler Marta 
Published: December 2023

Abstract
This article offers novel insights into the mechanism of abortion stigma and its pervasive impact on attitudes toward abortion. Specifically, it tracks the impact of the restrictive Polish 1993 law, known as the “abortion compromise,” on attitudes toward pregnancy terminations over three decades, exploring the role of abortion stigma in the observed shifts. Employing data from representative surveys and in-depth interviews with young women, this study demonstrates how gendered sexuality norms inscribed in the law are responsible for locating abortion in the realm of morality, thus intensifying its stigma. Remarkably, we uncover a unique convergence of “pro-choice” and “pro-life” perspectives in Poland. The growing unanimity of attitudes is attributed to the stigmatization of abortion that surpasses the medical or legal justifications of the 1993 law. Thus, the results crucially inform the strategies needed for the women’s rights movement aiming to liberalize the restrictive legislation.
DNase aggravates intestinal microvascular injury in IBD patients by releasing NET‐related proteins
Authors: Shao Yiming , Li Linbin , Yang Yunxi , Ye Yulan , Guo Zaiwen , Liu Lu , Huang Jiamin , Chen Yi , Gao Xi , Sun Bingwei 
Published: December 2023

AbstractNeutrophils accumulate in the inflammatory mucosa of patients with inflammatory bowel disease (IBD), and excessive release of NETs (neutrophil extracellular traps may be one of the important factors that cause IBD progression. However, the specific mechanism underlying vascular injury caused by NETs remains unclear. Immunofluorescence, ELISA, and flow cytometry were used in this study to detect the expression of NETs and DNase in the tissue and peripheral blood samples of patients with IBD. DSS mouse model was used to detect colon injury and vascular permeability. We found that NETs and DNase levels increased in the colon of patients with IBD. We found an increase in the activity of NET‐related MPO released by DNase. DNase released NET‐related proteins and damaged vascular endothelial cells in vitro. In DSS mouse model, the synchronous increase of DNase and NETs in the colon leads to an increase in vascular injury markers (CD44, sTM). DNase aggravated colon injury and increased vascular permeability in vivo, which was inhibited by gentamicin sulfate (GS). GS does not reduce the expression of DNase, but rather reduces the release of NET‐related proteins to protect vascular endothelium by inhibiting DNase activity. MPO and histones synergistically damaged the vascular endothelium, and vascular injury can be improved by their active inhibitors. We further found that H2O2 is an important substrate for MPO induced vascular damage. In conclusion, in IBD, DNase, and NET levels increased synchronously in the lesion area and released NET‐related proteins to damage the vascular endothelium. Therefore, targeting DNase may be beneficial for the treatment of IBD.
Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting
Authors: Bennett Rebecca J. , Bucks Romola S. , Saulsman Lisa , Pachana Nancy A. , Eikelboom Robert H. , Meyer Carly J. 
Published: December 2023

Objectives:
The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol.

Design:
The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews).

Results:
Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC’s skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants.

Conclusions:
The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.
Partial DMEK Donor Removal as a Successful Treatment of Donor-Related Fungal Keratitis
Authors: Yalamanchili Siri P. , Cleary Sean M. , Sell Shawn S. , Eden Robert A. , Schultze Robert L. 
Published: December 2023

Abstract:
An 84-year-old woman with Fuchs dystrophy underwent uncomplicated Descemet membrane endothelial keratoplasty in her right eye (OD). Donor rim culture returned positive for Candida albicans with no signs of clinical infection until postoperative week (POW) 14 when the patient noted new eye pain and photosensitivity in the OD. Examination revealed 3+ cells without hypopyon and 2 infiltrates localized to a small peripheral area of previously noted clinically insignificant inferior donor graft scrolling. Anterior chamber tap of the OD was performed, which showed no fungal growth. The patient was administered topical fortified voriconazole 1% 6 times a day and oral voriconazole 200 mg twice a day. On day 3, the infiltrate enlarged, and intracameral amphotericin (0.15 mg/mL, 0.1 cc) was injected. On day 6 with progression of the infiltrate, a partial donor descemetorhexis to remove the infiltrate and intracameral injection of voriconazole (0.25 mg/mL, 0.1 cc) were performed. Culture from the partially removed graft was positive for C. albicans. Vision improved to logMAR 0.18 (Snellen 20/30) with no evidence of recurrence to postoperative month 10. To the best of our knowledge, this is the first case of late-onset Candida interface keratitis successfully treated with a partial descemetorhexis.
Decreased platelet activation predicts hepatic decompensation and mortality in patients with cirrhosis
Authors: Hofer Benedikt S. , Brusilovskaya Ksenia , Simbrunner Benedikt , Balcar Lorenz , Eichelberger Beate , Lee Silvia , Hartl Lukas , Schwabl Philipp , Mandorfer Mattias , Panzer Simon , Reiberger Thomas , Gremmel Thomas 
Published: December 2023

Background and Aims:
Patients with cirrhosis show alterations in primary hemostasis, yet prognostic implications of changes in platelet activation remain controversial, and assay validity is often limited by thrombocytopenia. We aimed to study the prognostic role of platelet activation in cirrhosis, focusing on bleeding/thromboembolic events, decompensation, and mortality.

Approach and Results:
We prospectively included 107 patients with cirrhosis undergoing a same-day hepatic venous pressure gradient (HVPG) and platelet activation measurement. Platelet activation was assessed using flow cytometry after protease-activated receptor (PAR)-1, PAR-4, or epinephrine stimulation. Over a follow-up of 25.3 (IQR: 15.7–31.2) months, first/further decompensation occurred in 29 patients and 17 died. More pronounced platelet activation was associated with an improved prognosis, even after adjusting for systemic inflammation, HVPG, and disease severity. Specifically, higher PAR-4–inducible platelet activation was independently linked to a lower decompensation risk [adjusted HR per 100 MFI (median fluorescence intensity): 0.95 (95% CI: 0.90–0.99); p=0.036] and higher PAR-1-inducible platelet activation was independently linked to longer survival [adjusted HR per 100 MFI: 0.93 (95% CI: 0.87–0.99); p=0.040]. Thromboembolic events occurred in eight patients (75% nontumoral portal vein thrombosis [PVT]). Higher epinephrine-inducible platelet activation was associated with an increased risk of thrombosis [HR per 10 MFI: 1.07 (95% CI: 1.02–1.12); p=0.007] and PVT [HR per 10 MFI: 1.08 (95% CI: 1.02–1.14); p=0.004]. In contrast, of the 11 major bleedings that occurred, 9 were portal hypertension related, and HVPG thus emerged as the primary risk factor.

Conclusions:
Preserved PAR-1- and PAR-4–inducible platelet activation was linked to a lower risk of decompensation and death. In contrast, higher epinephrine-inducible platelet activation was a risk factor for thromboembolism and PVT.
HYDROXYCHLOROQUINE CAN BE RESUMED WITH CLOSE MONITORING AFTER RETINOPATHY HAS DEVELOPED, WITHOUT MAJOR VISUAL LOSS: CASE REPORT
Authors: Sunness Janet S. , Sunness Rivka Hadassah , Hellmann David B. 
Published: December 2023

Purpose:
The aim of this study was to present a patient with systemic lupus erythematosus on longstanding hydroxychloroquine (HCQ) use for whom HCQ was stopped because of signs of toxicity and then resumed four years later because of dire systemic need.

Methods:
This is a long-term retrospective study. Humphrey visual fields (10-2 and 24-2), fundus autofluorescence imaging, and spectral domain optical coherence tomography (OCT) were used to follow progression over time.

Results:
The patient was on HCQ for 26 years, with a cumulative dose over 3,000 g. HCQ was stopped in 2011 because of macular toxicity. She remained off HCQ for four years, during which time she developed type 1 diabetes due to an immunologic attack on the pancreas and then JC (John Cunningham) viremia after a period of treatment with mycophenolate, which put her at risk for progressive multifocal leukoencephalopathy. Mycophenolate was discontinued, and HCQ was resumed with careful follow-up over the next 7 years. The toxic maculopathy showed only mild slow progression since HCQ was resumed.

Conclusion:
Careful annual monitoring using Humphrey visual field 10-2 and spectral domain OCT imaging remains the standard of care for the patients on HCQ. However, it may be possible with close monitoring when there is compelling systemic need to resume HCQ after it has been stopped, with only slow progression of the retinopathy. This allowed the patient to have an improved quality of life and reduced the risk of severe morbidity and mortality.
Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians
Authors: Meador Margaret , Sachdev Neha , Anderson Eboni , Roy Debosree , Bay R. Curtis , Becker Lauren H. , Lewis Joy H. 
Published: December 2023

ABSTRACT
The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.
Youth Preseason Performance on the Sport Concussion Assessment Tool 5 Across Multiple Sports
Authors: Leggett Benjamin , Eliason Paul , Sick Stacy , Burma Joel S. , Wong Sophie K. , Laperrière David , Goulet Claude , Fremont Pierre , Russell Kelly , Schneider Kathryn J. , Emery Carolyn A. 
Published: December 2023

Objective:To examine preseason Sport Concussion Assessment Tool 5 (SCAT5) performance of adolescent sport participants by environment (in-person/virtual), sex, age, concussion history, collision/noncollision sport participation, and self-reported medical diagnoses.Design:Cross-sectional.Setting:Canadian community and high-school sport settings.Participants:Three thousand eight hundred five adolescent (2493 male, 1275 female, and 37 did not disclose; 11- to 19-year-old) sport participants.Assessment of Risk Factors:Sport Concussion Assessment Tool 5 administration method (in-person/virtual), sex (male/female/unreported), age (years), concussion history (0/1/2/3+), collision/noncollision sport participant, and self-reported medical diagnoses [attention deficit disorder or attention-deficit/hyperactivity disorder, headache/migraine, learning disability, and psychiatric disorder (ie, anxiety/depression/other)].Outcome Measures:Preseason SCAT5 outcomes including total number of symptoms (TNS; /22), symptom severity score (SSS; /132), Standardized Assessment of Concussion (SAC; /50), and modified Balance Error Scoring System (mBESS; /30).Results:Multiple multilevel linear or Poisson regression complete case analyses adjusting for clustering and robust standard errors, with β-coefficients (95% CI) back-transformed to indicate an increase/decrease in SCAT5 subdomains when relevant for clinical interpretation. Virtual (V) performance was associated with fewer symptoms reported [TNSDifference V-IP= −1.53 (95% CI, −2.22 to −0.85)], lower SSS [−2.49 (95% CI, −4.41 to −0.58)], and fewer mBESS errors (IP) [−0.52 (95% CI, −0.77 to −0.27)] compared with in-person. For every one-year increase in age, more symptoms [TNS = 0.22 (95% CI, 0.01-0.44)], higher SSS [0.52 (95% CI, 0.01-1.06)], higher SAC [0.27 (95% CI, 0.15-0.38), and poorer balance [mBESS = −0.19 (−0.28 to −0.09)] were observed. Differences between males and females were also seen across all SCAT5 outcomes. Individuals reporting any medical diagnosis or 3+ concussion history also reported more symptoms (TNS) and higher SSS than those who did not.Conclusions:Administration environment, sex, age, concussion history, and medical diagnoses were associated with SCAT5 subdomains and are important considerations when interpreting the SCAT5 results.
Comparison of the Utility of PI-RADS 2.1, ADC Values, and Combined Use of Both, for the Diagnosis of Transition Zone Prostate Cancers
Authors: Liu Xinghua , Xiong Qiuxia , Zeng Wenbing , Yang Ran , Wen Yun , Li Xiang 
Published: December 2023

Objective
To assess the performance of apparent diffusion coefficient (ADC; values or category) alone, Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) scoring alone, and the two in combination, to diagnose transition zone prostate cancers (PCas).

Methods
This retrospective study included 222 patients who underwent multiparametric magnetic resonance imaging of the prostate between May 2020 and December 2022 and who had pathologically confirmed PCa or benign prostatic hyperplasia (BPH). Prostate Imaging Reporting and Data System version 2.1 and ADC (values or category) were used in the assessment of suspicious findings identified in the transition zone. The interobserver agreements for region-of-interest measurements were calculated by intraclass correlation coefficients. Logistic regression analyses were used to determine the performance of PI-RADS v2.1 alone and in combination with ADC (values or category) to diagnose PCa. Receiver operating characteristic curve and DeLong test were used to evaluate the diagnostic performance of the quantitative parameters.

Results
A total of 152 patients had BPH, and 70 patients had PCa. For BPH versus PCa, the ADC values of PCa (0.64 × 10−3 ± 0.16 × 10−3 mm2/s) were significantly lower than BPH (1.06 ± 0.18 × 10−3 mm2/s; P < 0.001). The PI-RADS scores for PCa (5 [interquartile range, 5–5]) were significantly higher than BPH (2 [interquartile range, 2–3]; P < 0.001). For all patients who had PI-RADS 1–5, the combined use of ADC (values or category) together with PI-RADS v2.1 did not perform significantly better than the use of PI-RADS v2.1 alone. The receiver operating characteristic of ADC category in combination with PI-RADS v2.1 score, 0.756 (95% confidence interval, 0.646–0.846), was significantly higher than that for PI-RADS 2.1 alone, 0.631 (95% confidence interval, 0.514–0.738), in PI-RADS 3–4 lesions (P = 0.047).

Conclusion
The ADC category can help to improve the diagnostic performance of PI-RADS v2.1 category 3–4 lesions in diagnosing PCa.
Distinct Molecular Processes Mediate Donor-derived Cell-free DNA Release From Kidney Transplants in Different Disease States
Authors: Gauthier Patrick T. , Madill-Thomsen Katelynn S. , Demko Zachary , Prewett Adam , Gauthier Philippe , Halloran Philip F. ,   the Trifecta-Kidney Investigators
Published: December 2023

Background.
Among all biopsies in the Trifecta-Kidney Study (ClinicalTrials.gov NCT04239703), elevated plasma donor-derived cell-free DNA (dd-cfDNA) correlated most strongly with molecular antibody–mediated rejection (AMR) but was also elevated in other states: T cell–mediated rejection (TCMR), acute kidney injury (AKI), and some apparently normal biopsies. The present study aimed to define the molecular correlates of plasma dd-cfDNA within specific states.

Methods.
Dd-cfDNA was measured by the Prospera test. Molecular rejection and injury states were defined using the Molecular Microscope system. We studied the correlation between dd-cfDNA and the expression of genes, transcript sets, and classifier scores within specific disease states, and compared AMR, TCMR, and AKI to biopsies classified as normal and no injury (NRNI).

Results.
In all 604 biopsies, dd-cfDNA was elevated in AMR, TCMR, and AKI. Within AMR biopsies, dd-cfDNA correlated with AMR activity and stage. Within AKI, the correlations reflected acute parenchymal injury, including cell cycling. Within biopsies classified as MMDx Normal and archetypal No injury (NRNI), dd-cfDNA still correlated significantly with rejection- and injury-related genes. TCMR activity (eg, the TCMRProb classifier) correlated with dd-cfDNA, but within TCMR biopsies, top gene correlations were complex and not the top TCMR-selective genes.

Conclusions.
In kidney transplants, elevated plasma dd-cfDNA is associated with 3 distinct molecular states in the donor tissue: AMR, recent parenchymal injury (including cell cycling), and TCMR, potentially complicated by parenchymal disruption. Moreover, subtle rejection- and injury-related changes in the donor tissue can contribute to dd-cfDNA elevations in transplants considered to have no rejection or injury.