Florida College

About: Florida College is a education organization based out in Temple Terrace, Florida, United States. It is known for research contribution in the topics: Medicine & Internal medicine. The organization has 395 authors who have published 206 publications receiving 18364 citations.

Proton Beam Dosimetry Using Cerenkov Radiation- a Characterization of the Relationship Between Light Emission and Dose

Abstract: Abstract Purpose To study the relationship between Cerenkov photon emission and absorbed dose in water, soft tissue, and cortical bone for a primary proton beam. A proportionality constant between the number of Cerenkov photons and the absorbed dose is produced, which will aid in future in vivo dosimetry work. Materials and Methods An ab initio description of the relation between Cerenkov emission and absorbed dose is derived from the Frank-Tamm formula, the Bethe-Bloch equation, and the relation between energy fluence, mass collision stopping power, and dose. A proportionality constant is introduced to quantify the amount of Cerenkov radiation emission per Gray of absorbed dose. MCNP 6.2 is then used to obtain said proportionality constant for a spread-out Bragg peak used in proton therapy at the University of Florida Proton Therapy Institute. A correlation between proton energy and Cerenkov emission is also obtained for a water, soft tissue, and cortical bone phantom for proton energies of 10 – 150 MeV in 10 MeV increments. The central axis depth dose curve for a solid water phantom was also produced and compared to the central axis Cerenkov emission profile to ascertain the feasibility of using Cerenkov output as an estimator of the Bragg peak location. Results The cortical bone was found to emit the most Cerenkov photons, followed by water and then soft tissue. The cortical bone produced the most Cerenkov photons due to its having the largest Sellmeier coefficients, and therefore largest refractive index. The differences between the water and soft tissue Cerenkov output is likely due to the larger electron density for water. The proportionality constant between Cerenkov photon emission and absorbed dose was found to be 6.99 x 10 8 photons/Gray, which comports well with other studies performed for photons. The Cerenkov output was also found to be a poor predictor of the Bragg peak location for a proton beam. Conclusions: The proportionality constant, which relates the quantity of Cerenkov photon emission to absorbed dose, was found and determined to be of the same order of magnitude as that for a primary photon beam. The Cerenkov light output was found to be an inadequate predictor of the Bragg peak location, and therefore cannot be used for Bragg peak dosimetry, which is of preeminent importance in proton therapy.

Hardware Salvage in the Lower Extremity after Flap Coverage: 10-Year Single Center Outcomes Analysis

Abstract: Background: An unanswered question with open tibial fractures is whether the type of flap used affects hardware retention. Flap survival may not equate hardware retention or limb salvage. In this study, we performed a 10-year single institution review and analysis of all patients who had placement of hardware for open tibial fractures followed by flap coverage. Methods: Inclusion criteria consisted of patients who underwent pedicled or free flap coverage of Gustilo IIIB or IIIC tibial fractures requiring open reduction and internal fixation. Outcomes and complications were statistically analyzed based on flap type. Flap type was stratified into free versus pedicled flaps and muscle versus fasciocutaneous flaps. Primary outcome measures included hardware failure and infection requiring hardware removal. Secondary outcome measures included limb salvage, flap success, and fracture union. Results: Overall primary outcome measures were better for pedicled flaps (n = 31), with lower rates of hardware failure and infection (25.8%; 9.7%) compared with free flaps (n = 27) (51.9%; 37.0%). Limb salvage and flap success was not different comparing pedicled and free flaps. There was no significant difference in outcomes between muscle and fasciocutaneous flaps. Multivariable analysis showed that patients who had free versus pedicled flaps or muscle versus fasciocutaneous flaps had a higher chance of hardware failure. A formal orthoplastic team was established in the period from 2017 to 2022, after which flap numbers were higher and hardware failure less for pedicled and fasciocutaneous flaps. Conclusions: Pedicled flaps were associated with lower rates of hardware failure and infection requiring hardware removal. A formal orthoplastic team improves hardware-related outcomes.

A Comparison of Clinical and Cost Outcomes After Pancreatectomies at a Safety-net Hospital using a National Registry

Abstract: Background: Our institution (UFHJ) meets the criteria of both a large, specialized medical center (LSCMC) and a safety-net hospital (AEH). Our aim is to compare pancreatectomy outcomes at UFHJ against other LSCMCs, AEHs, and against institutions that meet criteria for both LSCMC and AEH. In addition, we sought to evaluate differences between LSCMCs and AEHs. Materials and Methods: Pancreatectomies for pancreatic cancer were queried from the Vizient Clinical Data Base (2018 to 2020). Clinical and cost outcomes were compared between UFHJ and LSCMCs, AEHs, and a combined group, respectively. Indices >1 indicated the observed value was greater than the expected national benchmark value. Results: The mean number of pancreatectomy cases performed per institution in the LSCMC group was 12.15, 11.73, and 14.31 in 2018, 2019, and 2020, respectively. At AEHs, 25.33, 24.56, and 26.37 mean cases per institution per year, respectively. In the combined group of both LSCMCs and AEHs, 8.10, 7.60, and 7.22 mean cases, respectively. At UFHJ, 17, 34, and 39 cases were performed each year, respectively. Length of stay index decreased below national benchmarks at UFHJ (1.08 to 0.82), LSCMCs (0.91 to 0.85), and AEHs (0.94 to 0.93), with an increasing case mix index at UFHJ (3.33 to 4.20) from 2018 to 2020. In contrast, length of stay index increased in the combined group (1.14 to 1.18) and overall was the lowest at LSCMCs (0.89). Mortality index declined at UFHJ (5.07 to 0.00) below national benchmarks compared with LSCMCs (1.23 to 1.29), AEHs (1.19 to 1.45), and the combined group (1.92 to 1.99), and was significantly different between all groups (P<0.001). Thirty-day re-admissions were lower at UFHJ (6.25% to 10.26%) compared with LSCMCs (17.62% to 16.83%) and AEHs (18.93% to 15.51%), and significantly lower at AEHs compared with LSCMCs (P<0.001). Notably, 30-day re-admissions were lower at AEHs compared with LSCMCs (P<0.001) and declined over time and were the lowest in the combined group in 2020 (17.72% to 9.52%). Direct cost index at UFHJ declined (1.00 to 0.67) below the benchmark compared with LSCMCs (0.90 to 0.93), AEHs (1.02 to 1.04), and the combined group (1.02 to 1.10). When comparing LSCMCs and AEHs, there were no significant differences between direct cost percentages (P=0.56); however, the direct cost index was significantly lower at LSCMCs. Conclusion: Pancreatectomy outcomes at our institution have improved over time exceeding national benchmarks and often were significant to LSCMCs, AEHs, and a combined comparator group. In addition, AEHs were able to maintain good quality care when compared with LSCMCs. This study highlights the role that safety-net hospitals can provide high-quality care to a medically vulnerable patient population in the presence of high-case volume.

Arts Engagement as a Health Behavior: An Opportunity to Address Mental Health Inequities

Abstract: The significance of mental health inequities globally is illustrated by higher rates of anxiety and depression amongst racial and ethnic minority populations as well as individuals of lower socioeconomic status. The COVID-19 pandemic has further exacerbated these pre-existing mental health inequities. With rising mental health concerns, arts engagement offers an accessible, equitable opportunity to combat mental health inequities and impact upstream determinants of health. As the field of public health continues to shift its focus toward social ecological strategies, the social ecological model of health offers an approach that prioritizes social and structural determinants of health. To capture the impacts of arts engagement, this paper creates an applied social ecological model of health while aiming to advocate that engaging in the arts is a protective and rehabilitative behavior for mental health.