bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimisation of gamma spectrometry measurements in atmosphere during nuclear emergencies
Authors: Magnoni Mauro , Bertino Stefano , Bellina Luca 
Published: May 2023

Abstract
During emergencies following a major nuclear accident a prompt and accurate characterisation of the radioactive cloud is one of the main task of any radioactivity monitoring system. This task is usually performed by means of γ-spectrometry High Purity Germanium (HPGe) measurements on atmospheric particulate samples gathered by means of high-volume pumps. The key parameters describing the performances of a monitoring system are the Minimum Detectable Activities (MDAs) of the most relevant radionuclides. These parameters depend on a number of factors related to the efficiency of the available germanium detector, the volume of air filtered by the sampling devices and the γ-decay scheme of each radionuclides as well. Besides the MDAs, another very important characteristic of a monitoring system, especially during an evolving emergency, is its capability of giving reliable results at a given and constant pace. It is therefore important to define the time resolution of the monitoring system, i.e. the minimum time needed to produce the data, namely the activity concentrations of the radionuclides in the atmosphere. The optimization of the measurements procedures are discussed in this work: in particular it is demonstrated that, being t the time resolution of the monitoring system, the lowest MDAs can be achieved with a sampling time given by (2/3)·t and a counting time of (1/3)·t. Finally, the MDAs achievable for a standard monitoring system based on a 30% HPGe detector are calculated for all the most important fission products.
Radiofrequency personal exposimetry during outdoor entertainment of young adults: a case study
Authors: Vecsei Zsuzsanna , Szilágyi Zsófia , Thuróczy György 
Published: May 2023

Abstract
Radiofrequency (RF) exposure has grown substantially over time in the public area. Personal dosimetry measurements are intended to estimate how human RF exposure relates to exposure limits that do not pose a health risk. For our case study, an outdoor festival was chosen to assess realistic RF exposure of young adults during their entertainment. Band-selective RF exposure—sorted along 2G–4G uplinks and downlinks, 5G and Wi-Fi bands—was evaluated. Electric field strength data subsets were classified on the basis of activities as well as crowd density. 2G contributed the most to the overall RF exposure. Highest RF exposure was associated with attendance in a concert. In moderately crowded situations, RF exposure was higher than in the most crowded ones. However, the total measured electric field values were higher than in other outdoor environment, but still far below the national and international directives of regulatory RF-EMF exposure limits.
Respiratory protection strategies for the public in emergency response
Authors: Shin Seung Hun , Lee Hyeonmin , Kim Hee Reyoung 
Published: May 2023

Abstract
A strategy was established to minimize the stochastic effects of internal and external exposure to radioactive substances by wearing respiratory protection equipment (RPE) during an emergency evacuation. During the evacuation of residents in the event of a nuclear power plant accident, the stochastic effects of internal exposure caused by the inhalation of radioactive aerosol and external exposure due to accumulated radioactive particles in the filter medium of a mask must be minimized. The radioactivity concentration along an evacuation route considers atmospheric dispersion and the resuspension of particles deposited on surfaces. The effective dose due to internal exposure is evaluated using inhalation dose coefficients for each particle diameter. When the face seal leakage and filter medium penetration ratio for each particle diameter of the RPE (N95) is taken into consideration, the internal dose is reduced by 97.2%. Furthermore, the accumulated radioactivity in the filter medium decreases by 91.4% when the respirator is replaced every 48 h.
Preliminary study on individual radiation dose received by medical staff for dose constraint determination
Authors: Milecz-Mitykó Richárd , Bérczi Viktor , Czibor Sándor , Bánsághi Zoltán , Taba Gabriella , Kári Béla , Györke Tamás 
Published: May 2023

Abstract
The staff of the Radiation Protection Service of a European clinical center measured the radiation dose by type-tested thermoluminescent dosemeter systems to which the medical staff was exposed, to assess the effectiveness of current procedures and equipment for optimalisation prompted by the requirements EU Basic Safety Standard 2013. There were three participating sites, the Site 1 was an external hospital, whereas Sites 2 and 3 are part of the same clinical center, who provided data regarding their personnel, from technologists, nurses and medical doctors. In this preliminary study, only a low number of cases were available and used to establish a new, more realistic yearly dose constraint, namely 6 (from two) mSv for whole-body effective dose, 15 (from two) mSv for eye lens dose and 300 (from 50) mSv for extremity dose. Furthermore, the state of safety culture and protection equipment was assessed. Collection of the sufficient amount of data for statistical evaluation is ongoing.
On the Social Existence of Mental Health Categories: The Case of Sex Addiction
Authors: Brossard Baptiste , Roy Melissa , Brown Julia , Hemmings Benjamin , Larocque Emmanuelle 
Published: May 2023

Abstract
Mental health categories can circulate in societies regardless of whether they are recognized by medical professionals. This article asks why some labels are adopted en masse to commonly characterize some forms of distress, while other labels remain confined to specialist spheres. Contrasting with many examples of medicalization, “sex addiction” offers a heuristic case study because it was only after its exclusion from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994 that it became widely used to pathologize sexual excess in Western cultures. To understand how this and other categories acquire such popularity, it is necessary to account more explicitly for the multiple social appropriations of these categories within various non-medical fields and examine how they circulate between these fields. Drawing on two years of qualitative data collection from North American and Australian social institutions of non-medical therapy, law, the media, and religion, this article proposes a theoretical and methodological framework for studying the “social existence” of mental health categories such as sex addiction.
An Immunologic and Biomechanical Comparison of Polyether Ether Ketone-Zeolite and Polyether Ether Ketone Interbody Fusion Devices
Authors: Cheng Boyle C. , Swink Isaac , McClain Edward J. , Vyas Praveer S. , Muzzonigro Thomas , Carbone Jake , Zaidi Ali , Long Jason D. , Altman Daniel T. , Yu Alexander K. 
Published: May 2023

Study Design.
A laboratory study comparing polyether ether ketone (PEEK)-zeolite and PEEK spinal implants in an ovine model.

Objective.
This study challenges a conventional spinal implant material, PEEK, to PEEK-zeolite using a nonplated cervical ovine model.

Summary of Background Data.
Although widely used for spinal implants due to its material properties, PEEK is hydrophobic, resulting in poor osseointegration, and elicits a mild nonspecific foreign body response. Zeolites are negatively charged aluminosilicate materials that are hypothesized to reduce this pro-inflammatory response when used as a compounding material with PEEK.

Materials and Methods.
Fourteen skeletally mature sheep were, each, implanted with one PEEK-zeolite interbody device and one PEEK interbody device. Both devices were packed with autograft and allograft material and randomly assigned to one of 2 cervical disc levels. The study involved 2 survival time points (12 and 26 weeks) and biomechanical, radiographic, and immunologic endpoints. One sheep expired from complications not related to the device or procedure. A biomechanical evaluation was based on measures of segmental flexibility, using 6 degrees of freedom pneumatic spine tester. Radiographic evaluation was performed using microcomputed tomography scans in a blinded manner by 3 physicians. Levels of the pro-inflammatory cytokines, interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha at the implant, were quantified using immunohistochemistry.

Results.
PEEK-zeolite and PEEK exhibited an equivalent range of motion in flexion extension, lateral bending, and axial torsion. A motion was significantly reduced for implanted devices at both time points as compared with native segments. Radiographic assessments of fusion and bone formation were similar for both devices. PEEK-zeolite exhibited lower levels of IL-1β (P = 0.0003) and IL-6 (P = 0.03).

Conclusion.
PEEK-zeolite interbody fusion devices provide initial fixation substantially equivalent to PEEK implants but exhibit a reduced pro-inflammatory response. PEEK-zeolite devices may reduce the chronic inflammation and fibrosis previously observed with PEEK devices.
Implementation of a Private Payer Bundled Payment Model While Maintaining High-Value Lumbar Spinal Fusion
Authors: Issa Tariq Z. , Lee Yunsoo , Lambrechts Mark J. , D’Antonio Nicholas D. , Toci Gregory R. , Mazmudar Aditya , Kalra Andrew , Sherman Matthew , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K. 
Published: May 2023

Study Design:
Retrospective single-institution cohort

Objective:
To evaluate the implementation of a commercial bundled payment model in patients undergoing lumbar spinal fusion.

Summary of Background Data:
BPCI-A caused significant losses for many physician practices, prompting private payers to establish their own bundled payment models. The feasibility of these private bundles has yet to be evaluated in spine fusion.

Methods:
Patients undergoing lumbar fusion from October to December 2018 in BPCI-A before our institution’s departure were included for BPCI-A analysis. Private bundle data was collected from 2018 to 2020. Analysis of the transition was conducted among Medicare-aged beneficiaries. Private bundles were grouped by calendar year (Y1, Y2, Y3). Stepwise multivariate linear regression was performed to measure independent predictors of net deficit.

Results:
The net surplus was the lowest in Y1 ($2,395, P=0.03) but did not differ between our final year in BPCI-A and subsequent years in private bundles (all, P>0.05). AIR and SNF patient discharges decreased significantly in all private bundle years compared with BPCI. Readmissions fell from 10.7% (N=37) in BPCI-A to 4.4% (N=6) in Y2 and 4.5% (N=3) Y3 of private bundles (P<0.001). Being in Y2 or Y3 was independently associated with a net surplus in comparison to the Y1 (β: $11,728, P=0.001; β: $11,643, P=0.002). Postoperatively, length of stay in days (β: $-2,982, P<0.001), any readmission (β: -$18,825, P=0.001), and discharge to AIR (β: $-61,256, P<0.001) or SNF (β: $-10,497, P=0.058) were all associated with a net deficit.

Conclusions:
Nongovernmental bundled payment models can be successfully implemented in lumbar spinal fusion patients. Constant price adjustment is necessary so bundled payments remain financially beneficial to both parties and systems overcome early losses. Private insurers who have more competition than the government may be more willing to provide mutually beneficial situations where cost is reduced for payers and health systems.

Level of Evidence.
3
Noninvasive Monitoring of Arterial Pressure: Finger or Lower Leg As Alternatives to the Upper Arm: A Prospective Study in Three ICUs
Authors: Lakhal Karim , Dauvergne Jérôme E. , Kamel Toufik , Messet-Charriere Hélène , Jacquier Sophie , Robert-Edan Vincent , Nay Mai-Anh , Rozec Bertrand , Ehrmann Stephan , Muller Grégoire , Boulain Thierry 
Published: May 2023

OBJECTIVES:
When the upper arm is inaccessible for measurements of arterial pressure (AP), the best alternative site is unknown. We performed a between-site comparison of the agreement between invasive and noninvasive readings of AP taken at the lower leg, the finger, and the upper arm. The risk associated with measurement errors and the trending ability were also assessed.

DESIGN:
Prospective observational study.

SETTING:
Three ICUs.

PATIENTS:
Patients having an arterial catheter and an arm circumference less than 42 cm.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Three triplicates of AP measurements were collected via an arterial catheter (reference AP), a finger cuff system (ClearSight; Edward Lifesciences, Irvine, CA), and an oscillometric cuff (at the lower leg then the upper arm). Trending ability was assessed through an additional set of measurements after a cardiovascular intervention. The default bed backrest angle was respected. Failure to measure and display AP occurred in 19 patients (13%) at the finger, never at other sites. In 130 patients analyzed, the agreement between noninvasive and invasive readings was worse at the lower leg than that observed at the upper arm or the finger (for mean AP, bias ± sd of 6.0 ± 15.8 vs 3.6 ± 7.1 and 0.1 ± 7.4 mm Hg, respectively; p < 0.05), yielding a higher frequency of error-associated clinical risk (no risk for 64% vs 84% and 86% of measurements, respectively, p < 0.0001). According to the International Organization for Standardization (ISO) 81060-2:2018 standard, mean AP measurements were reliable at the upper arm and the finger, not the lower leg. In 33 patients reassessed after a cardiovascular intervention, both the concordance rate for change in mean AP and the ability to detect a therapy-induced significant change were good and similar at the three sites.

CONCLUSIONS:
As compared with lower leg measurements of AP, finger measurements were, when possible, a preferable alternative to upper arm ones.
Treatment of Urinary Tract Infections in Hospitalized Adults
Authors: Maldonado Cody R. , Grubbs Riley , Spilman Sarah K. , Jansen Jeffrey W. 
Published: May 2023

Background
The purpose of the study was to evaluate whether ceftriaxone therapy would result in less clinical failure than levofloxacin therapy in hospitalized adults treated for urinary tract infections (UTIs).

Methods
This was a single-center, retrospective cohort study of hospitalized adult patients with UTI as admitting diagnosis from 2012 to 2017. Patients were included in the study if they received ≥48 continuous hours of levofloxacin or ceftriaxone. The primary end point was clinical failure, defined as a composite of attributable mortality, in vitro resistance, or change of antimicrobial class. All variables from bivariate analysis with significance P < 0.20 were included in a multivariate regression model completed in the backward stepwise method to determine predictors of clinical failure.

Results
Of the 325 patients who met study inclusion criteria, 187 (57%) received ceftriaxone and 138 (43%) received levofloxacin. Clinical failure occurred in 11% of patients treated with ceftriaxone and 22% of patients treated with levofloxacin (P < 0.01). Ceftriaxone therapy was associated with reduced odds of clinical failure when controlling for chronic kidney disease, history of UTIs, cirrhosis, and fever at therapy initiation.

Conclusions
Patients treated with ceftriaxone experienced significantly less clinical failure than patients treated with levofloxacin despite low baseline resistance rates.
Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial
Authors: Donoso Rodrigo , Torres Andrés , Klagges Jorge , Mercado Yuri , Gonzalez Tomás , Astudillo Macarena , Norambuena Héctor , Medina Emilio 
Published: May 2023

Purpose:
To compare clinical outcomes between an enhanced and a conventional monofocal intraocular lens (IOL) after cataract surgery.

Setting:
Ophthalmology Unit, Hospital del Salvador, University of Chile (tertiary care hospital).

Design:
Double-masked, prospective randomized controlled trial.

Methods:
66 healthy adults with corneal astigmatism less than 1.50 diopters and axial length between 21 and 27 mm were randomly allocated (1:1) for bilateral phacoemulsification with either an enhanced monofocal IOL (ICB00) or a conventional aspheric monofocal IOL (ZCB00) implant. The refractive target was emmetropia in both eyes. Visual acuities, defocus curves, Catquest-9SF, and quality of vision (QoV) were measured 3 months postoperatively.

Results:
Binocular uncorrected intermediate visual acuity was improved in patients implanted with the enhanced monofocal lens (0.37 ± 0.12) compared with the conventional monofocal (0.45 ± 0.10) (P < .01). There were no significant differences in corrected distance visual acuity (CDVA), Catquest-9SF, or QoV scores.

Conclusions:
The enhanced monofocal IOL provided 1 additional line of intermediate visual acuity after cataract surgery. There was no significant change in either CDVA or QoV.
Comparing Short-Term Knee-Related Quality of Life and Associated Clinical Outcomes Between Youth With and Without a Sport-Related Knee Injury
Authors: Le Christina Y. , Pajkic Andrea , Losciale Justin M. , Filbay Stephanie R. , Emery Carolyn A. , Manns Patricia J. , Whittaker Jackie L. 
Published: May 2023

Objective:
To compare short-term changes in knee-related quality of life (QOL) and associated clinical outcomes between youth with and without a sport-related knee injury.

Design:
Prospective cohort study.

Setting:
Sport medicine and physiotherapy clinics.

Participants:
Youth (11-19 years old) who sustained an intra-articular, sport-related knee injury in the past 4 months and uninjured youth of similar age, sex, and sport.

Independent Variable:
Injury history.

Main Outcome Measures:
Knee-related QOL (Knee injury and Osteoarthritis Outcome Score, KOOS), knee extensor and flexor strength (dynamometry), physical activity (accelerometer), fat mass index (FMI; bioelectrical impedance), and kinesiophobia (Tampa Scale for Kinesiophobia, TSK) were measured at baseline (within 4 months of injury) and at 6-month follow-up. Wilcoxon rank sum tests assessed between-group differences for all outcomes. Regression models assessed the association between injury history and outcome change (baseline to 6-month follow-up), considering sex. The influence of injury type, baseline values, and physiotherapy attendance was explored.

Results:
Participants' (93 injured youth, 73 uninjured control subjects) median age was 16 (range 11-20) years and 66% were female. Despite greater improvements in KOOS QOL scores (20; 95% confidence interval, 15-25), injured participants demonstrated deficits at 6-month follow-up (z = 9.3, P < 0.01) compared with control subjects, regardless of sex. Similar findings were observed for knee extensor and flexor strength and TSK scores but not for physical activity or FMI. Lower baseline values were associated with greater outcome changes in injured youth.

Conclusions:
Youth have worse knee-related QOL, muscle strength, and kinesiophobia early after a sport-related knee injury than control subjects. Despite improvements, deficits persist 6 months later.
Brief Report: Use and Side Effects of Sodium–Glucose Transporter 2 Inhibitors Among US People With HIV With Clinical Indications
Authors: Sise Meghan E. , Katz-Agranov Nurit , Strohbehn Ian A. , Harden Destiny , Moreno Daiana , Durbin Claudia , Toribio Mabel , Neilan Tomas G. , Zanni Markella V. 
Published: May 2023

Background:
Sodium–glucose transporter 2 (SGLT2) inhibitors have been approved for treatment of diabetes mellitus (DM), chronic kidney disease, and heart failure, but little is known about prescription levels and safety profiles among people with HIV (PWH).

Methods:
We leveraged data from the US Mass General Brigham electronic healthcare database to determine the use/uptake of SGLT2 inhibitors among PWH with type II diabetes (DM2) (with or without chronic kidney disease, proteinuria, or heart failure) and to assess rates of adverse events among PWH with DM2 taking SGLT2 inhibitors.

Results:
Among eligible PWH with DM2 receiving care at US Mass General Brigham (N = 907), SGLT2 inhibitors were prescribed to 8.8%. SGLT2 inhibitors were prescribed to a fraction of eligible PWH with DM2 and a concomitant diagnosis of chronic kidney disease (3.8%), proteinuria (13.2%), or heart failure (8.2%). PWH with DM2 on SGLT2 inhibitors experienced side effects (urinary tract infection, diabetic ketoacidosis, and acute kidney injury) at rates comparable with PWH with DM2 prescribed glucagon-like peptide-1 agonists. Rates of mycotic genitourinary infections were higher among those prescribed SGLT2 inhibitors (5% vs. 1%, P = 0.17), but no cases of necrotizing fasciitis ensued.

Conclusions:
Additional studies are needed to characterize population-specific salutary and adverse effects of SGLT2 inhibitors among PWH and potentially augment prescription rates when guideline indicated.
A Systematic Review and Meta-Analysis Comparing the Clinical Outcomes of Profunda Artery Perforator Versus Gracilis Thigh Flap as a Second Choice for Autologous Breast Reconstruction
Authors: Borrelli Mimi R. , Spake Carole S.L. , Rao Vinay , Sinha Vikram , Crozier Joseph W. , Basta Marten N. , Lee Gordon K. , Kwan Daniel K. , Nazerali Rahim 
Published: May 2023

Purpose
Autologous breast reconstruction remains a versatile option to produce a natural appearing breast after mastectomy. The deep inferior epigastric perforator remains the most commonly used flap choice, but when this donor site is unsuitable or unavailable, the transverse upper gracilis (TUG) or profunda artery perforator (PAP) flaps are popular secondary alternatives. We conduct a meta-analysis to better understand patient outcomes and adverse events in secondary flap selection in breast reconstruction.

Methods
A systematic search was conducted on MEDLINE and Embase for all articles published on TUG and/or PAP flaps for oncological breast reconstruction in postmastectomy patients. A proportional meta-analysis was conducted to statistically compare outcomes between PAP and TUG flaps.

Results
The TUG and PAP flaps were noted to have similar reported rates of success and incidences of hematoma, flap loss, and flap healing (P > 0.05). The TUG flap was noted to have significantly more vascular complications (venous thrombosis, venous congestion, and arterial thrombosis) than the PAP flap (5.0% vs 0.6%, P < 0.01) and significantly greater rates of unplanned reoperations in the acute postoperative period (4.4% vs 1.8%, P = 0.04). Infection, seroma, fat necrosis, donor healing complications, and rates of additional procedures all exhibited high degree of heterogeneity precluding mathematical synthesis of outcomes across studies.

Conclusions
Compared with TUG flaps, PAP flaps have fewer vascular complications and fewer unplanned reoperations in the acute postoperative period. There is need for greater homogeneity in reported outcomes between studies to enable for synthesis of other variables important in determining flap success.