bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a Telemedicine Bridge Clinic to Engage Patients in Opioid Use Disorder Treatment
Authors: Lynch Michael J. , Houck Patty , Meyers Jessica , Schuster James , Yealy Donald M. 
Published: March 2022

Objectives
We aimed to assess the feasibility of using a telemedicine bridge clinic model as a low-barrier mechanism to initiate patients on medication treatment for opioid use disorder (MOUD) while facilitating engagement in long-term treatment.

Methods
We established a telemedicine bridge clinic after the U.S. Drug Enforcement Administration temporarily suspended regulations limiting initial treatment of patients with buprenorphine via both audiovisual and audio-only technology during the COVID-19 public health emergency. The rate of engagement in medication treatment for opioid use disorder MOUD based upon review of the Prescription Drug Monitoring Program is described. Referral sources, technology utilization, and payer mix are also presented.

Results
The Bridge Clinic scheduled 208 new patient visits and physicians evaluated 200, a show rate of 96% from April 2020 to July 2021. Of the 200 patients who were treated, 192 (96%) were diagnosed with opioid use disorder. Most patients (159/200, 79%) scheduled audio-only visits. At least 1 prescription for buprenorphine was filled by 185/192 (96%) of opioid use disorder patients within 30 days of the telemedicine visit and 147/192 (77%) of patients filled 2 or more prescriptions. Most patients were covered by Medicaid (62%) or were uninsured (19%). There was no significant difference in outcomes for patients evaluated by audio-only vs. audiovisual techniques.

Conclusion
A Bridge Clinic using audiovisual and audio-only telemedicine served a high-risk, vulnerable population and facilitated engagement in evidence-based MOUD.
Simple, Rapid Spectrophotometric Assay of Dispensed Methadone for Diversion Control
Authors: Brooklyn John R. , Matthews Dwight E. 
Published: March 2022

Objectives
Treatment of opioid use disorder with methadone is highly effective. Methadone is dispensed from opioid treatment programs under regulated circumstances. However, diversion of take-home doses can occur and is difficult to detect. We wanted to test the application of a handheld ultraviolet light absorption spectrometer to detect the concentration of methadone in take-home bottles that were suspected of being altered by the patient.

Methods
Standardized dilutions of methadone hydrochloride oral concentrate were used to calibrate absorption wavelengths and then compared to take homes from suspected and unsuspected bottles to see if measured concentrations differed from expected doses.

Results
Ten standardized “control” doses were analyzed to determine 99% confidence intervals. These were compared to 104 samples “not-of-concern” obtained randomly over a 10-month period. An additional 103 methadone bottles of concern from 27 patients showed 15 bottles with <25% and 8 with <75% of expected concentrations.

Conclusions
A handheld, low-cost ultraviolet light spectrometer detected altered take-home doses of methadone. This assay presents a simple and effective method for methadone clinics to perform inhouse analysis on “call back” methadone doses. It allows individual clinics to define diversion rates of their patient body, while allowing state and federal agencies to better understand how much prescribed methadone is diverted for illicit uses.
Changes in the Patient-Reported Outcomes Measurement Information System (PROMIS) scores following sacral neuromodulation for lower urinary tract symptoms
Authors: Jaworski Elaine Minerva , Sanderson Derrick J. , Gevelinger Matthew , Doyle Paula J. 
Published: March 2022

Abstract

Background
Sacral neuromodulation (SNM) treatment of refractory urinary symptoms is associated with quality of life improvements using disease-specific instruments. There is a paucity of information relating universal health outcomes to effective treatment of urinary symptoms. The objective was to analyze changes in Patient-Reported Outcomes Measurement Information System (PROMIS) item-bank scores following SNM for treating refractory lower urinary tract symptoms (LUTS).

Materials and methods
This is a sub-analysis collected from an institutional review board approved, retrospective chart review evaluating changes between pre- and post-procedure PROMIS scores in subjects undergoing successful SNM implantation for refractory LUTS at a multidisciplinary adult continence clinic. The difference between pre- and post-procedure PROMIS scores was compared via two-sided Wilcoxon signed-rank test, with p <0.05 considered statistically significant.

Results
Of the 29 subjects, most were female (89.66%), Caucasian (68.97%), nonsmokers (89.66%) with public insurance (62.07%). The median age was 63years and body mass index was 33.2kg/m2. Procedure indications included urinary urge incontinence (83%), mixed urinary incontinence (10%), retention (17.24%), and overactive bladder (3%). Pain Interference and Depression scores had a nonsignificant improvement from 64.2 (ranging 58.9–67.5) to 60.75 (ranging 55.2–67.2), p = 0.21, and 55.2 (ranging 51.5–59.9) to 53.4 (ranging 49.5–61.1), p = 0.33, respectively. Median Physical Function scores demonstrated nonsignificant worsening following implantation from 38.0 (ranging 34.7–40.9) to 36.1 (ranging 33.1–40.8) (p = 0.25). Twenty-one subjects (72%) reported an improvement in at least 1 PROMIS item-bank with 6 subjects (21%) reporting no improvement in any of the item-banks.

Conclusions
Treatment of refractory LUTS with SNM resulted in no statistically significant changes in the PROMIS item-banks of Physical Function, Pain Interference, or Depression. Further prospective investigation is necessary to delineate the relationship of the self-reported universal-health outcomes in the treatment of LUTS.
The effect of micronized progesterone and medroxyprogesterone acetate in combination with transdermal estradiol on hemostatic biomarkers in postmenopausal women diagnosed with POI and early menopause: a randomized trial
Authors: Mittal Monica , Chitongo Paradzai , Supramaniam Prasanna Raj , Cardozo Linda , Savvas Mike , Panay Nick , Arya Roopen , Hamoda Haitham 
Published: March 2022

Abstract

Objective:
To compare the impact of micronized progesterone (MP) or medroxyprogesterone acetate (MPA) in combination with transdermal estradiol (t-E2) on traditional coagulation factors and thrombin generation parameters in postmenopausal women diagnosed with premature ovarian insufficiency or early menopause.

Method:
Randomized prospective trial conducted in women diagnosed with premature ovarian insufficiency or early menopause and an intact uterus, recruited over 28 months. All participants were prescribed t-E2 and randomized to either cyclical MP or MPA using a web-based computer randomization software, Graph Pad. Thrombin generation parameters were measured at baseline and repeated after 3-months. Traditional hemostatic biomarkers were measured at baseline and repeated after 3, 6, and 12-months. Seventy-one participants were screened for the study, of whom 66 met the inclusion criteria. In total, 57 participants were randomized: 44 completed the thrombin generation assessment arm of the study, whilst 32 completed 12-months of the traditional coagulation factor screening component of the trial.

Results:
Thrombin generation parameters did not significantly change from baseline after 3-months duration for either progestogen component when combined with t-E2, unlike the traditional coagulation factors. Protein C activity, free Protein S, and Antithrombin III levels decreased with time in both treatment arms.

Conclusion:
Fluctuations in traditional hemostatic biomarkers were not reproduced by parallel changes in thrombin generation parameters that remained neutral in both groups compared with baseline. The absence of statistically significant changes in thrombin generation for the first 3-months of hormone therapy use is reassuring and would suggest a neutral effect of both progestogens on the global coagulation assay.
Quantification of a Facility Radiological Security Risk Index With a Graphical User Interface Tool
Authors: Rane Shraddha , Harris Jason T. 
Published: March 2022

Abstract
Healthcare facilities around the world routinely use radioactive sources to diagnose and treat illness. To effectively manage the security of radioactive sources, these facilities need to understand the risk, which is comprised of threat, vulnerability, and consequences. The threat component of risk requires knowledge of potential adversaries and understanding their capabilities and intentions. To help articulate the multiple layers of threat and support better informed decisions, the research developed a risk-based methodology to evaluate radiological security at the facility level. The methodology is applied to a radiological dispersal device (RDD) incident from three radionuclides of concern: 137Cs, 60Co, and 192Ir. The results of the research have led to the creation of a potential facility risk index (PFRI). The PFRI is mathematically represented as the exponential product of the maximum expected utility among the threat groups, the sum of geographic vulnerability and cultural vulnerability, and net consequences. The PFRI is a novel risk index that quantifies the facility risk on a scale of 1 to 10, 1 being “very low risk” and 10 being “very high risk.” A MATLAB-based graphical user interface (GUI) tool was also developed to enable the radiological facility (i.e., healthcare facility) staff to conduct self-assessments and manage their most valuable assets. The PFRI methodology is a useful starting point for any healthcare facility risk assessment and is a valuable input for decision makers considering potential investments in security upgrades.
Discharges of Nuclear Medicine Radioisotopes: The Impact of an Abatement System
Authors: Barbosa Nathaly , Castillo Lorena Sandoval , Quimbayo Juan Sebastián 
Published: March 2022

Abstract
Clinical uses of radiopharmaceuticals imply the administration of radioactive substances that are mainly excreted through urine. The Nuclear Medicine Department at the Instituto Nacional de Cancerología (INC-COL) in Bogota, Colombia, administers radiopharmaceuticals for diagnostics and treatment to many patients, resulting in tens of cubic meters of radioactive waste water (WW) every day. As Colombian regulatory limits for liquid radioactive discharges to the sewer system are lower than in other countries, longer WW decay times are required, even when an in-house waste water treatment plant (WWTP) is used. To fulfill the requirements for controlled disposal of radioactive discharges, a complementary abatement system was implemented to retain WW for periods as long as 360 d, and was connected to the hospital´s WWTP. These holding times can cause major changes in the WW physicochemical parameters, reaching levels higher than acceptable. In this study, we evaluate the decontamination and decay efficiency of the retention system using water quality parameters and the amount of radioactivity in the effluents stored in the tanks and the WWTP. According to the results, to maintain the physicochemical parameters below acceptable levels, biological and chemical treatment of decayed WW is necessary before discharging it into urban waste water. Using the principles of dilution, retention, and decay, an integral radioactive WW management system was implemented favoring the quality of discharges and activity levels to the sewer system, with efficiencies close to 100% for WW from discharges in diagnostic procedures ranging from 98% (131I) to 100% (177Lu) for WW from discharges in therapeutic procedures. Activity concentration assessment in medically-derived radionuclides using an in-house waste water treatment plant (WWTP) and a complementary abatement system; an in-house WWTP could be used as an abatement system for short-lived radionuclides; and a tank-based abatement system attached to the in-house WWTP showed higher efficiencies for long-lived radionuclides and adequate physicochemical parameters for the discharge to the city sewage system.
Global Disability Trajectories Over the First Decade Following Combat Concussion
Authors: Mac Donald Christine L. , Barber Jason , Johnson Ann , Patterson Jana , Temkin Nancy 
Published: March 2022

Objective:
To examine global disability trajectories in US military with and without traumatic brain injury (TBI) over the first decade following deployment to identify risk profiles for better intervention stratification, hopefully reducing long-term cost.

Setting:
Patients and participants were enrolled in combat or directly following medical evacuation at the time of injury and followed up every 6 months for 10 years.

Participants:
There are 4 main groups (n = 475), 2 primary and 2 exploratory: (1) combat-deployed controls without a history of blast exposure “non-blast- control” (n = 143), (2) concussive blast TBI “‘blast-TBI” (n = 236) (primary), (3) combat-deployed controls with a history of blast exposure “blast-control” (n = 54), and (4) patients sustaining a combat concussion not from blast “non-blast-TBI” (n = 42) (exploratory).

Design:
Prospective, observational, longitudinal study.

Main Measures:
Combat concussion, blast exposure, and subsequent head injury exposure over the first decade post-deployment. Global disability measured by the Glasgow Outcome Scale Extended (GOSE).

Results:
Latent class growth analysis identified 4 main trajectories of global outcome, with service members sustaining combat concussion 37 to 49 times more likely to be in the worse disability trajectories than non-blast-controls (blast-TBI: odds ratio [OR] = 49.33; CI, 19.77-123.11; P < .001; non-blast-TBI: OR = 37.50; CI, 10.01-140.50; P < .001). Even blast-exposed-controls were 5 times more likely to be in these worse disability categories compared with non-blast-controls (OR = 5.00; CI, 1.59-15.99; P = .007). Adjustment for demographic factors and subsequent head injury exposure did not substantially alter these odds ratios.

Conclusions:
Very high odds of poor long-term outcome trajectory were identified for those who sustained a concussion in combat, were younger at the time of injury, had lower education, and enlisted in the Army above the risk of deployment alone. These findings help identify a risk profile that could be used to target early intervention and screen for poor long-term outcome to aid in reducing the high public health cost and enhance the long-term quality of life for these service members following deployment.
Parathyroidectomy for dialysis patients in the era of calcimimetics: The surgeons’ point of view
Authors: Lee Chen-Hsen , Chen Jui-Yu , Kuo Po-Chung , Chen Wei-Ting 
Published: March 2022

Calcimimetics is a new drug for lowering serum parathyroid hormone (PTH), calcium and phosphate in patients with hyperparathyroidism (HPT) on long-term dialysis. It became available on market in 2006. The impact of calcimimetics on the treatment by parathyroidectomy (PTx) was reviewed from the surgeons’ point of view. Cure of renal HPT by calcimimetics is not feasible, but calcimimetics can improve preoperative cardiac ventricle ejection fractions by lowering serum PTH. Heart failure is not necessarily a contraindication for PTx. PTx should be done before irreversible organ damage occurs. Limb gangrenes is an ominous sign and should be prevented by frequent checkup for peripheral arterial circulation. The impact of renal osteodystrophy on the quality of life and as indirect cause of mortality deserves more attention in patients with renal HPT. Delayed referral to PTx leads to more complicated patients. A consensus between nephrologists and surgeons about propitious timing for PTx is necessary. Future prospect on the surgical treatment of renal HPT is proposed.
Supplemental figure; http://links.lww.com/ASAIO/A782
Novel approaches beyond standard immunofluorescence for kidney biopsies
Authors: Santoriello Dominick , Nasr Samih H. 
Published: March 2022

Purpose of review
Immunofluorescence on frozen tissue (IF-F) utilizing antibodies against immunoglobulin (Ig) heavy and light chains (IgA, IgG and IgM, kappa and lambda) and components of classical and alternative complement pathways (C1q, C3c and C4) is the standard of renal pathology. However, conventional IF-F has limitations, particularly in nephropathies associated with organized and/or monoclonal Ig deposits. This review will discuss new applications of established methods beyond conventional IF-F and recent novel immunohistochemical methods.

Recent findings
The combined application of paraffin immunofluorescence (IF-P) and IgG subtype staining excluded monotypic deposits in 62–66% of DNA J homolog subfamily B member 9-associated fibrillary glomerulonephritis (FGN) with apparent monotypic deposits by IF-F, whereas IF-P unmasks IgG deposits in a subset of cases of immunotactoid glomerulopathy. A novel IF technique targeting epitopes at the junction of the Ig heavy and light chains was introduced and unmasked polytypic deposits in a subset of glomerulonephritis with apparent monotypic deposits on IF-F. A recent study described the successful application of co-detection by indexing (CODEX) multiplexed IF to visualize more than a dozen target antigens within a single kidney tissue section. Finally, immunohistochemical protocols for detection of the novel antigens in membranous nephropathy have already entered the clinical practice of renal pathology.

Summary
Novel ancillary techniques in renal pathology have the potential to significantly enhance our ability to evaluate renal biopsies.
The ‘ramp filter’ artifact in filtered back projection is due to attenuation not ramp filtering
Authors: Hansen Christopher L. 
Published: March 2022

Background
Artifactually decreased counts in regions of the left ventricle adjacent to intense splanchnic activity have been described in single photon emission computed tomography imaging and attributed to the side lobes of ramp filtering, a crucial step in filtered back projection. However, filtered back projection is based on a mathematical proof that makes no assumptions about the distribution of activity implying there is another cause for this artifact.

Methods
Computer simulations of a left ventricle with varying intensity, proximity and size of adjacent splanchnic activity was created with and without attenuation. Both filtered back projection and an iterative expectation maximization algorithm were performed. Volume weighted bullseyes were generated then the ratio of average activity in regions in the anterior and inferior walls of the bullseye were calculated.

Results
In the absence of attenuation, there was no effect on uptake despite intense adjacent splanchnic activity. The effect of attenuation alone was mild but was greatly amplified by adjacent splanchnic uptake. This effect varied with the intensity, proximity and size of adjacent activity. Moving the attenuation to the apex of the left ventricle produced a paradoxical increase in counts to the inferior wall. The effect on iterative reconstruction was less pronounced than with filtered back projection and the paradoxical increase with attenuation at the apex did not occur.

Conclusion
The ramp filter artifact in single photon emission computed tomography reconstruction is due to attenuation, not ramp filtering per se. Adjacent splanchnic activity can result in either an increase or decrease in counts. These effects are less pronounced and more consistent with iterative reconstruction.
Role of p53 in regulation of hematopoiesis in health and disease
Authors: Barajas Sergio , Cai Wenjie , Liu Yan 
Published: March 2022

Purpose of review
Human aging is associated with an exponential increase in the occurrence of clonal hematopoiesis of indeterminate potential (CHIP). CHIP is associated with increased risks of de novo and therapy-related hematologic neoplasms and serves as a reservoir for leukemic relapse. Somatic mutations in the TP53 gene, which encodes the tumor suppressor protein p53, rank in the top five among genes that were mutated in CHIP. TP53 mutations in CHIP are associated with an increased incidence of myeloid neoplasms such as myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). This review focuses on mechanisms by which mutant p53 promotes CHIP progression and drives the pathogenesis of MDS and AML. We will also discuss potential therapeutic approaches that can target mutant p53 and improve treatment outcomes of MDS and AML.

Recent findings

TP53 was frequently mutated in individuals with CHIP as well as in patients with MDS and AML. While clinical studies suggest that p53 mutant hematopoietic stem and progenitor cell expansion may predispose the elderly to hematologic neoplasms, the underlying mechanisms are not fully understood. Recent findings suggest that mutant p53 may utilize both cell autonomous and noncell autonomous mechanisms to promote CHIP development. Furthermore, we and others have demonstrated that several gain-of-function mutant p53 proteins have enhanced oncogenic potential beyond dominant-negative and loss-of-function effects. Notably, TP53 allelic state has important implications for genome stability, clinical presentation, and outcomes in MDS. Some small molecules reactivating wild-type p53 tumor suppressor activity show promising effects on some human MDS and AML cells with TP53 mutations in preclinical and early phases of clinical studies.

Summary

TP53 mutations in MDS and AML are correlated with advanced disease, poor prognosis, reduced overall survival, and dismal outcomes. Deep understanding of the functions of mutant p53 proteins is essential to devise effective therapies for patients with myeloid neoplasms and other human cancers with TP53 mutations. Targeting mutant p53 directly or pathways regulated by mutant p53 holds great potential in preventing CHIP progression and treating MDS and AML patients with TP53 mutations.
Macrophage SR-B1 in atherosclerotic cardiovascular disease
Authors: Huby Thierry , Le Goff Wilfried 
Published: March 2022

Purpose of review
Scavenger receptor class B type 1 (SR-B1) promotes atheroprotection through its role in HDL metabolism and reverse cholesterol transport in the liver. However, evidence indicates that SR-B1 may impact atherosclerosis through nonhepatic mechanisms.

Recent findings
Recent studies have brought to light various mechanisms by which SR-B1 affects lesional macrophage function and protects against atherosclerosis. Efferocytosis is efficient in early atherosclerotic lesions. At this stage, and beyond its role in cholesterol efflux, SR-B1 promotes free cholesterol-induced apoptosis of macrophages through its control of apoptosis inhibitor of macrophage (AIM). At more advanced stages, macrophage SR-B1 binds and mediates the removal of apoptotic cells. SR-B1 also participates in the induction of autophagy which limits necrotic core formation and increases plaque stability.

Summary
These studies shed new light on the atheroprotective role of SR-B1 by emphasizing its essential contribution in macrophages during atherogenesis as a function of lesion stages. These new findings suggest that macrophage SR-B1 is a therapeutic target in cardiovascular disease.