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1

Khan, Tasneem A. Data base on dose reduction research projects for nuclear power plants. Division of Regulatory Applications, Office of Nuclear Regulatory Research, U.S. Nuclear Regulatory Commission, 1989.

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2

Frank W. Cawood and Associates. 1,001 prescription drugs: Side effects, dangerous combinations, and natural healing alternatives. Frank W. Cawood Pub., 2000.

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3

Khan, T. A. Dose-reduction techniques for high-dose worker groups in nuclear power plants. Division of Regulatory Applications, Office of Nuclear Regulatory Research, U.S. Nuclear Regulatory Commission, 1991.

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4

Khan, T. A. Dose-reduction techniques for high-dose worker groups in nuclear power plants. Division of Regulatory Applications, Office of Nuclear Regulatory Research, U.S. Nuclear Regulatory Commission, 1991.

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5

H, Pollack Mark, ed. Stopping anxiety medication: Workbook. 2nd ed. Oxford University Press, 2009.

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6

Otto, Michael W. Stopping anxiety medication: Workbook. 2nd ed. Oxford University Press, 2009.

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7

Otto, Michael W. Stopping anxiety medication: Therapist guide. 2nd ed. Oxford University Press, 2009.

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8

Khan, Tasneem A. Data base on nuclear power plant dose reduction research projects. Office of Nuclear Regulatory Research, U.S. Nuclear Regulatory Commission, 1985.

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9

A review of the dose reconstruction program of the Defense Threat Reduction Agency. National Academies Press, 2003.

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10

Dionne, B. J. Occupational dose reduction at Department of Energy contractor facilities: Bibliography of selected readings in radiation protection and ALARA. The Office, 1991.

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11

Dionne, B. J. Occupational dose reduction at Department of Energy contractor facilities: Bibliography of selected readings in radiation protection and ALARA : vol. 4. The Office, 1993.

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12

Cormack, Margaret A. Reducing benzodiazepine consumption: Psychological contributions to general practice. Springer-Verlag, 1989.

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13

A, Khan Tasneem, U.S. Nuclear Regulatory Commission. Office of Nuclear Regulatory Research. Division of Regulatory Applications., and Brookhaven National Laboratory, eds. Data base on dose reduction research projects for nuclear power plants. Division of Regulatory Applications, Office of Nuclear Regulatory Research, U.S. Nuclear Regulatory Commission, 1992.

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14

A, Khan Tasneem, U.S. Nuclear Regulatory Commission. Office of Nuclear Regulatory Research. Division of Regulatory Applications., and Brookhaven National Laboratory, eds. Data base on dose reduction research projects for nuclear power plants. Division of Regulatory Applications, Office of Nuclear Regulatory Research, U.S. Nuclear Regulatory Commission, 1992.

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15

Stopping anxiety medication: Panic control therapy for benzodiazepine discontinuation : therapist guide. Psychological Corp., 1996.

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16

Frank W. Cawood and Associates., ed. 801 prescription drugs: Good effects, side effects & natural healing alternatives. FC&A Pub., 1998.

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17

Lapaz, Camilla. 801 Prescription Drugs: Good Effects, Side Effects & Natural Healing Alternatives. F C & a Pub, 1996.

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18

Frank W. Cawood and Associates., ed. 801 prescription drugs: Good effects, side effects & natural healing alternatives. FC&A Pub., 1996.

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19

Stopping Anxiety Medication : Panic Control Therapy for Benzodiazepine Discontinuation Patient Workbook. Psychological Corp, 2000.

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20

A review of the dose reconstruction program of the Defense Threat Reduction Agency. National Academies Press, 2002.

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21

(US), National Research Council. A Review of the Dose Reconstruction Program of the Defense Threat Reduction Agency. National Academy Press, 2003.

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22

M, Short, and European Society of Contraception. World Congress, eds. The rationale of estrogen dose reduction: The justification for 20 [micrograms] ethinylestradiol. Pathenon Pub. Group, 1997.

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23

Christopher, Weilandics, U.S. Nuclear Regulatory Commission. Office of Nuclear Regulatory Research. Division of Facility Operations., U.S. Nuclear Regulatory Commission. Office of Nuclear Reactor Regulation. Division of Systems Integration., U.S. Nuclear Regulatory Commission. Office of Nuclear Regulatory Research. Division of Regulatory Applications., Brookhaven National Laboratory. Safety and Environmental Protection Division., and Brookhaven National Laboratory, eds. Occupational dose reduction at nuclear power plants: Annotated bibliography of selected readings in radiation protection and ALARA. Division of Facility Operations, Office of Nuclear Regulatory Research, 1985.

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24

J, Dionne B., United States. Dept. of Energy. Assistant Secretary for Environment, Safety, and Health. Office of Health., and Brookhaven National Laboratory. Radiological Sciences Division., eds. Occupational dose reduction at Department of Energy contractor facilities: Study of ALARA programs, status 1990. The Office, 1992.

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25

J, Dionne B., United States. Dept. of Energy. Assistant Secretary for Environment, Safety, and Health. Office of Health., and Brookhaven National Laboratory. Radiological Sciences Division., eds. Occupational dose reduction at Department of Energy contractor facilities: Study of ALARA programs, good practice documents. The Office, 1992.

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26

Occupational dose reduction at Department of Energy contractor facilities: Bibliography of selected readings in radiation protection and ALARA. The Office, 1994.

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27

Moonesinghe, Ramini, and Sue Mallett. Acute pain in patients with renal or hepatic impairment. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199234721.003.0015.

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The metabolism and excretion of many analgesic drugs will be altered in the presence of renal or hepatic impairment. Some analgesic drugs can cause renal or hepatic damage. Protein binding of drugs may be altered by hepatic reduction in production or uraemic displacement from binding sites. In renal disease, paracetamol is the simple analgesic of choice. Morphine can be used with care in mild to moderate renal disease, but fentanyl or oxycodone may be better alternatives. Non-steroidal anti-inflammatory drugs should be avoided in renal disease. In hepatic disease with significant impairment, d
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28

Tenorio, Anna Cecilia, and Akhila Reddy. Opioid Rotation for Toxicity Reduction (DRAFT). Edited by Nathan A. Gray and Thomas W. LeBlanc. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190658618.003.0014.

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This chapter discusses the de Stoutz et al. retrospective review of patients with cancer pain who developed dose-limiting toxicities and underwent opioid rotation that resulted in improvement of symptoms related to opioid induced neurotoxicity, uncontrolled pain, and reduction in morphine equivalent daily dose. This study is the first to establish that opioid rotation, which is substituting one opioid with another using established equianalgesic conversion ratios, is a valuable tool in cancer pain management. This chapter describes the basics of the study, including funding, year study began,
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29

Gidwani, Hitesh, and Chenell Donadee. Hypertensive Emergencies (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0009.

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Hypertensive emergencies may be encountered by rapid response teams (RRTs). Various forms of acute organ dysfunction separate hypertensive urgency from hypertensive emergency. These include acute heart failure, acute coronary syndrome, acute aortic dissection, ischemic stroke, hemorrhagic stroke, hypertensive encephalopathy, sympathetic crisis, postoperative hypertension, and hypertensive emergencies in pregnancy. RRTs must be able to rapidly assess the patient’s condition, initiate treatment, and triage the patient to the appropriate level of care. This chapter summarizes the initial evaluati
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30

Hughes, Jim. Paediatrics. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198813170.003.0017.

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As children’s bones are still growing, different techniques are employed for the reduction and fixation of fractures in children than those used in adults. For all paediatric procedures, radiation protection is of paramount significance. This is best achieved by using dose reduction settings on the image intensifier, good collimation to avoid excessive irradiation, and judicious use of Pb shielding on or around the patient. This chapter covers a selection of orthopaedic procedures for paediatric patients, covering manipulation under anaesthesia, K-wiring, and elastic nailing or flexi-nailing f
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31

Walsh, Richard A. Smoothing out the Ups and Downs. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190607555.003.0001.

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The progressive loss of nigrostriatal dopaminergic neurons with advancing disease exposes the trough between every dose of levodopa in Parkinson’s disease. This is due to the combination of a loss of native dopamine production to fill in this interdose interval and a reduction in dopaminergic terminals to take up and release dopamine long beyond its short plasma half-life. The clinical result is wearing off—an awareness in patients of returning symptomatology while waiting for their next dose. Where consistent and impacting negatively on function on any level, there are a number of initial ora
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32

McLean, Donald, and Claire-Louise Chapple. CT dosimetry. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199655212.003.0015.

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The computed tomography (CT) medical examination is the highest single source of radiation to the general public in the developed world. Its use is rapidly growing, as is its technical complexity. The primary dosimetry formalism is based on the computed tomography dose index (CTDI), which can be measured in air or in standard phantoms using a calibrated pencil ionization chamber with adaptations for wide beam scanners. Displayed dose parameters can be used with caution to estimate patient organ doses, effective dose, and risk, using a variety of models and software. An understanding of automat
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33

Welch, Mary R., and Craig Nolan. Chemotherapy and Radiation Therapy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0143.

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Neurotoxicity is a common problem in oncology practice and neurologists who care for cancer patients encounter a wide range of symptoms attributable to the side effects of radiation and/or chemotherapy. Complications involving the nervous system may be debilitating. Though generally improved by dose reduction or cessation of an offending agent, such symptoms can be irreversible and frequently have a profound impact on quality of life. The appropriate balance between therapeutic efficacy and drug or radiation toxicity requires close attention to the patient’s complaints as well as a thorough un
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34

Gluckman, Sir Peter, Mark Hanson, Chong Yap Seng, and Anne Bardsley. Vitamins C and E and other antioxidants in pregnancy and breastfeeding. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198722700.003.0017.

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Pregnancy is characterized by oxidative stress, wherein high metabolic demands are accompanied by heightened oxygen requirements in tissues. Additionally, a number of disorders of pregnancy are characterized by a reduction in antioxidant activity. Consequently, it has been hypothesized that maternal supplementation with antioxidants, particularly vitamins C and E, may be beneficial in preventing the occurrence of these disorders. Other important dietary antioxidants include carotenoids, and polyphenols (flavonoids). In general, studies of the effect of providing supplementary vitamin C and E t
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35

Keh, Didier. Steroids in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0054.

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The benefit of prolonged application of moderate-dose corticosteroids in systemic inflammatory diseases remains controversial. In critical illness, the endogenous cortisol effect may become insufficient due to adrenal dysfunction and corticosteroid resistance to counterbalance an exaggerated and protracted inflammatory response, which has been termed ‘critical illness-related corticosteroid insufficiency’ (CIRCI). There is evidence that moderate-dose hydrocortisone (200–300 mg/day) significantly fastens shock reversal in patients with septic shock, but may improve survival probably only in pat
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36

Kramer, Carolyn, and Emily Blumberg. Immunosuppressants and Antiretroviral Therapy in HIV-Positive Transplant Patients. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0028.

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Protease inhibitors (PIs), especially ritonavir, are inhibitors of CYP3A4 and P-gp1 and can significantly increase levels of calcineurin inhibitors and mammalian target of rapamycin (mTOR) inhibitors. Cobicistat is an inhibitor of CYP3A4, and its effect on levels of calcineurin inhibitors and mTOR inhibitors is likely to be similar to that of ritonavir. Efavirenz may result in lower concentrations of calcineurin inhibitors and mTOR inhibitors. Dose reduction and careful attention to monitoring drug levels are critical to avoid toxicity and maintain therapeutic immunosuppressive concentrations
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37

Gupta, Rajesh. Randomized controlled trial evidence for gabapentin in post-herpetic neuralgia. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0069.

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The landmark paper discussed in this chapter is ‘Gabapentin for the treatment of postherpetic neuralgia: A randomized controlled trial’, published by Rowbotham et al. in 1998. In the study, a 4-week initial period of titration of gabapentin (up to a maximum of 3,600 mg) or matching placebo was given, followed by a further 4-week period at the maximum tolerated dose. The primary efficacy measure was change in average daily pain score from start to finish of the treatment, and secondary measures observed were the average daily sleep score, a short-form McGill Pain Questionnaire, the subject’s gl
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38

Cerqueira, Manuel D. Gated SPECT MPI. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0006.

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Protocols for SPECT MPI have evolved over the last 40-years based on the following factors: available radiotracers and gamma camera imaging systems, alternative methods of stress, the needs and demands of patients and referring physicians, the need for radiation dose reduction and optimization of laboratory efficiency. Initially studies were performed using dynamic exercise planar multi-day Thallium-201 (Tl-201) studies. Pharmacologic stress agents were not available and novel methods of stress included swallowed esophageal pacing leads, cold presser limb emersion, direct atrial pacing, crushe
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39

Buechel, Ronny R., and Aju P. Pazhenkottil. Basic principles and technological state of the art: hybrid imaging. Edited by Philipp Kaufmann. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0121.

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The core principle of hybrid imaging is based on the fact that it provides information beyond that achievable with either data set alone. This is attained through the combination and fusion of two datasets by which both modalities synergistically contribute to image information. Hybrid imaging is, thus, more powerful than the sum of its parts, yielding improved sensitivity and specificity. While datasets for integration may be obtained by a variety of imaging modalities, its merits are intuitively best exploited when combining anatomical and functional imaging, particularly in the setting of e
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40

Zaret, Barry L. Nuclear Cardiology. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0001.

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Nuclear cardiology is generally considered a clinical phenomenon of the past four decades. However, the field has its roots in earlier times. This chapter focuses on these historical roots as they have evolved into the present era. The initial application of radioisotopes to cardiac studies occurred in the mid-1920s. Ventricular function was evaluated in the 1960s and 1970s by first pass and equilibrium techniques. Myocardial stress perfusion imaging was first performed using potassium-43 and exercise in 1973. Stress imaging rapidly evolved thereafter with new tracers (thallium-201 and technet
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41

Hide, Geoff, and Jennifer Humphries. Computed tomography. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0069.

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Computed tomography (CT), along with its cross-sectional partner MRI, continues to evolve apace. Although MRI retains the larger role in the musculoskeletal system due to its unparalleled soft tissue contrast and, not least, its lack of ionizing radiation, CT offers significant advantages in many areas. Imaging acute trauma is more rapid with CT, allowing 'whole body' assessment of patients following polytrauma, and CT is more useful than MRI in demonstrating the configuration of fractures, aiding surgical planning. CT can clearly identify cortical bone and areas of calcification, making the d
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42

Elder, Grahame J. Metabolic bone disease after renal transplantation. Edited by Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0288.

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Patients who undergo kidney transplantation have laboratory, bone, and soft tissue abnormalities that characterize chronic kidney disease mineral and bone disorder (CKD-MBD). After successful transplantation, abnormal values of parathyroid hormone, fibroblast growth factor 23, calcium, phosphate, vitamin D sterols, and sex hormones generally improve, but abnormalities often persist. Cardiovascular risk remains high and is influenced by prevalent vascular calcification, and fracture risk increases due to a combination of abnormal bone ‘quality’, compounded by immunosuppressive drugs and reducti
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43

Nuevas generaciones sin la infección por el VIH, la sífilis, la hepatitis B y la enfermedad de Chagas en las Américas 2018. ETMI Plus. Organización Panamericana de la Salud, 2019. http://dx.doi.org/10.37774/9789275120675.

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En el presente documento se comunica el progreso logrado en la Región hacia la eliminación de la transmisión maternoinfantil del VIH y la sífilis entre los años 2010 y 2017. Se trata también del primer informe regional sobre la eliminación de la transmisión maternoinfantil y durante la primera infancia de la hepatitis B y la enfermedad de Chagas congénita. Los resultados principales son los siguientes: El acceso de las embarazadas a la atención prenatal y del parto es alto en la Región de las Américas. El tamizaje de la infección por el VIH y la sífilis en las embarazadas sigue siendo alto, pe
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