bluuebunny/crossref_metadata_2025 huggingface dataset:
Major Adverse Cardiac Events After Radiation Therapy in Lung Cancer
Authors: Omari Ramsey , Curtis Charles , Burket Nichole , Weisman Michael , Chen Xiaofeng , Lautenschlaeger Tim
Published: December 2021

Motivation: 
Receiving radiation to the heart has been recognized as a risk factor for the development of major adverse cardiovascular events (MACEs) for many years. However, recent data suggests that radiation dosing to substructures of the heart serve as a better surrogate for evaluating the risk of developing a MACE than whole heart radiation dose. Recent papers suggest that dosing to the left anterior descending artery (LAD) can be used as a robust marker for cardiotoxicity risk; however, this association lacks corroborative data and is currently not incorporated into clinically routine care. 
Problem: 
In this paper we seek to investigate the relationship between radiation dose to the LAD and risk of developing a MACE in lung cancer patients treated with curative intent radiation. 
Approach: 
Chart review to confirm the presence of MACE events was performed in patients who were identified based on elevated troponin values to potentially have had a MACE after receiving their last dose of radiation therapy. Patients who had multiple courses of radiation therapy separated in time (>60 days) that received greater than 0.2 Gy whole heart dose during their subsequent courses before having a MACE were excluded. Selected patients were then stratified based on presence cardiovascular co-morbidities. Contours of patient’s LADs were made after patient selection, and will be verified by an expert (e.g., cardiologist or thoracic radiologist). 
Results: 
Dose to the LAD will be calculated and an assessment of the correlation between radiation dose and risk of having a MACE will be made. Analysis will assess the cardiac event rate at various times as well as time to MACE. 
Implications: 
This paper can help set a quantifiable standard with which radiation oncologists can use to minimize their patient’s risk of developing a MACE by minimizing radiation dosing to specific cardiac substructures while maintaining tumor coverage.
Obesity-Induced Inflammation Cooperates with Loss of DNA Methyltransferase 3A to Develop Early-Onset of Leukemia
Authors: Pandhiri Taruni , Kumar Pasupuleti Santhosh , Ramdas Baskar , Kanumuri Rahul , Kapur Reuben
Published: December 2021

Obesity is an increasing epidemic disease world-wide responsible for enhancing the risk for developing Type 2 diabetes mellitus (T2DM) as well as cancer. However, it is unclear if and how obesity contributes to the transformation of pre-leukemic stem and progenitors (pre-LHSC/Ps) into full-blown leukemia such as acute myeloid leukemia (AML) or severe form of myeloproliferative neoplasm (MPN). We hypothesized that obesity induced chronic inflammation might be responsible for clonal selection of pre-LHSC/Ps bearing pre-leukemic mutations such as DNA methyltransferase 3A (DNMT3A) and for promoting the progression of early-onset MPN towards severe forms of AML/leukemia. To test this hypothesis, we genetically crossed pre-leukemic Dnmt3a+/-;Mx-Cre+ mice with leptin deficient obese (LepOb/Ob) mice to obtain Ob/Ob;Dnmt3a+/-;Mx-Cre+ compound mutant mice. Further, the Dnmt3a gene was deleted by giving the PolyIC and the deletion was confirmed through PCR. After 12 days of post-PolyIC the myeloid cells (neutrophils and monocytes) were expanded in Ob/Ob;Dnmt3a+/-;Mx-Cre+ mice compared to Dnmt3a+/-;Mx-Cre+, Dnmt3a+/-;Mx-Cre-, Ob/Ob and WT mice. We have harvested and analyzed all these mice after 26 days of post-PolyIC. Interestingly, Ob/Ob;Dnmt3a+/-;Mx-Cre+ mice showed increased BM cellularity, both the frequency of lineage negative, Sca-1+ and c-KIT+ (LSK) cells, short-term hematopoietic stem cells (ST-HSCs; LSK/CD48+/CD150-), granulocyte macrophage progenitor (GMPs; LSK/CD16+/CD34+), and reduction in LT-HSCs (LT-HSCs; LSK/CD48-/CD150+) compared to other groups. Flow cytometry analysis of PB, BM and spleen from Ob/Ob;Dnmt3a+/-;Mx-Cre+ mice demonstrated a significant increase in the frequency of mature myeloid cells (Gr-1+/Mac-1+) and a profound reduction in B220+ B cells compared to other groups. Remarkably, these mice also showed splenomegaly, elevated heart size and early signs of AML blasts as reflected by the presence of c-KIT+/CD11b+ double positive cells in the BM, consistent with severe MPN/AML development. Taken together, these results demonstrate that obesity induced inflammation cooperates with pre-leukemic Dnmt3a+/- mutation to induce an early-onset of severe MPN/AML like disease.
Development of Long-Acting Injectable Ketamine Loaded PLGA Microparticles as a Non-opioid Analgesic
Authors: Daniels Juma N. , Otte Andrew
Published: December 2021

Background/Objective: Ketamine, a psychedelic, is a noncompetitive N-methyl-D-aspartate receptor antagonist that may also bind to mu opioid receptors.  Historically, it has been used as an anesthetic (KetalarÒ), although now has found uses as a novel, quick acting, antidepressant for treatment-resistant depression (SpravatorÒ) and could be used as an adjuvant to opioid analgesia providing opioid-sparing effects.  One major advantage over opioids is Ketamine does not suffer from respiratory depression and maintains patent airways during anesthesia.  Ketamine is only available as a short-acting injectable solution or a nasal spray. Our goal is to develop a long-acting injectable form in a biodegradable matrix poly(lactic-co-glycolic) acid (PLGA) that does not have a burst release and provides 5-7 days of steady-state plasma levels. 
Methods: A mechanistic approach towards development of a long-acting injectable began with a solubility screen of Ketamine. Based on these results, experiments began with an oil in water emulsification with two theoretical drug loadings (25% and 40%) and two processing conditions – (1) aqueous extraction and (2) aqueous extraction, intermediate drying, and a 25% Ethanol wash.  The formulations were characterized for drug loading, drug release, and crystallinity and imaged using scanning electron microscopy (SEM). 
Results: Minimal differences were noted in the release profiles between formulations. Although, a significant difference was noted between the two processing conditions, where the extra intermediate drying step and 25% ethanol wash resulted in a significant slowing of the drug release rate. 
Conclusion and Implications: The difference in release kinetics is hypothesized to be due to densification of the PLGA matrix, based on the increase in surface roughness/wrinkling in the SEM images, crystallinity increase, and on their respective powder x-ray diffraction patterns.  Our preliminary results demonstrate the feasibility of a longer acting Ketamine using PLGA. Further refinement of these formulations and rodent pharmacokinetic studies will be done in future.
Correlation of Liver Stiffness Measurements with AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) Scores in Pediatric Patients with Hepatitis B or Liver Transplantation
Authors: Patel Bhumi , Molleston Jean
Published: December 2021

Background and Objective: 
Current standard for assessing liver fibrosis is biopsy. However, its invasive nature, cost, and limited sampling are problematic for many patients. Fibroscan is a technology that utilizes transient elastography (TE) to measure liver stiffness (LSM) quickly and non-invasively. TE is a novel method in children and has shown to be a measure of fibrosis. Biomarkers for hepatic fibrosis include the APRI and FIB-4 scores, which are not well-studied in children. Our goal is to correlate APRI and FIB-4 with LSM in children who have hepatitis B (hep B) or have received liver transplants (LT). 
 
Methods: 
LSM scores of 26 children with hep B and 41 children with LT were retrieved from a research database at Riley Hospital for Children. We then obtained laboratory results closest to the date (+/- 1 year) of their TE. Those results were used to determine APRI and FIB-4 scores. Spearman correlation (rs) was determined between LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in each disease. 
 
Results: 
Table 1. Spearman Correlations for LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in Hep B and LT 

Disease 

Comparison 

Spearman Correlation (rs) 

Hep B 

LSM 

APRI 

0.321 

LSM 

FIB-4 

0.376 

APRI 

FIB-4 

0.731* 

LT 

LSM 

APRI 

0.303 

LSM 

FIB-4 

0.526* 

APRI 

FIB-4 

0.632* 

*p < 0.05 
 
Conclusion and Potential Impact: 
The moderate correlation of LSM with FIB-4 in LT shows potential for future clinical use, but the correlations of LSM with APRI in both conditions and the correlation of LSM with FIB-4 in Hep B are weaker. APRI and FIB-4 are strongly correlated in these children. However, additional studies with larger sample sizes should be completed. Because patients with LT and chronic hep B regularly need longitudinal evaluation, finding non-invasive tools are important to ensure compliance and ease.
Stomach Volume Evaluation on Fetal MRI and its use in Prenatal Identification of Esophageal Atresia
Authors: Phadnis Aditya , Forbes-Amrhein Monica
Published: December 2021

Swallowing of amniotic fluid alters the volume of the fetal stomach; therefore an abnormal fetal stomach size can be indicative of pathology. Previous studies have used linear measurements on ultrasound to approximate stomach sizes. Fetal magnetic resonance imaging (MRI) allows for volumetric measurement of the stomach. The objective of this study was to develop a library of normal fetal stomach volumes on MRI at each gestational age. We also sought to measure stomach volumes of fetuses with esophageal atresia and compare to normal volumes at similar gestation ages (GA). 
A retrospective review of fetal MRIs from patients 20-38 weeks GA was conducted.  Exclusion criteria for the controls included any impairment that would impede swallowing or alter stomach sizes.  Patients with esophageal atresia were identified and postnatal records were reviewed to confirm the diagnosis. The stomach volume was measured on T2-weighted imaging using Phillips Intellispace software. The stomach volumes of the controls at each GA were compared using one-way ANOVA with Games-Howell Post-Hoc (p<0.05).  The stomach volume in esophageal atresia was compared to controls using a T-test (p<0.001).   
185 control studies, 10 at each week of gestation, and 8 patients with esophageal atresia were included. For normal fetuses, there was a trend of increased stomach size and broadened standard deviation with increasing GA.  No significant difference was found between any two sequential weeks, however the difference in second and third trimester volumes was significant (p<0.001).   The patients with esophageal atresia had significantly smaller stomach volumes compared to control patients of the same GA range (p<0.001).  
This pilot study established reference values for fetal stomach volume, which was found to increase with GA. The stomach volume is significantly smaller in patients with esophageal atresia.  Thus, esophageal atresia can be identified prenatally, allowing for delivery at an appropriate acuity NICU and early intervention.
Why Should I Take My Medicine? A Review Of ED Visits For Seizures.
Authors: Reed John L. , Gutwein Thomas E.
Published: December 2021

Study hypothesis 
The costs of anti-epileptic medication (AED) and poor care coordination result in increased Emergency Department (ED) visits for seizure events and produce both direct and indirect economic burdens on patients with frequent seizures. 
 
Methods 
A retrospective chart review study of ED visits with chief concern of seizure from two hospitals over a two-year period was performed; resulting in 152 visits recorded in this study.  Data collected included demographic information, relevant seizure or past medical history (PMH), diagnostics performed in the ED, and the admission status of the patient along with the total charges per encounter.  Data was analyzed descriptively and with logistic regression analysis. 
 
Results 
The results yielded by this study were generally in-line with the results of similar studies, indicating a higher relative rate of ED seizure visits for males, people of Black race, and infant and toddler populations. A high proportion of Medicaid/Medicare coverage and indiscernible employment status for most patients were also noted.  Observed differences in average cost among patients with and without epilepsy and male versus female patients were not shown to be statistically significant.  However, the increased likelihood of admission with increasing age was shown to be significant with an average age difference between admitted and discharged populations of approximately 10 years (p= 0.003). 
 
Conclusions 
The data provided here is not sufficient to examine the complex relationship between seizures, epilepsy, and costs among various other patient factors.  Further study is necessary to minimize direct and indirect costs of seizures. 
 
Acknowledgments 
This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Community Workforce Differences in Mental Health Across Gender and Job Description in Southwest Indiana
Authors: Rone Victoria , Koleilat Majed , Garcia Kara
Published: December 2021

Background and Hypothesis: In May 2020, a community partnership was built in Southwest Indiana to determine the local prevalence of COVID-19 to guide reopening in the region. One year later, a follow-up survey study was launched to address new, pressing questions related to mental health in the community workforce. We hypothesized that adverse mental health symptoms would be disproportionately experienced by specific worker groups based on degree of in-person contact over the past year and demographic characteristics such as age and gender.  
Methods: For the 2021 survey, participants were invited through their place of employment or via phone to participate in a short online survey consisting of questions related to demographics, general work roles, company policies over the past year, and wellness. When examining mental health, the Patient Health Questionnaire-2 (PHQ-2) and General Anxiety Disorder-2 (GAD-2) were used to determine feelings of depression and anxiety, respectively.  
Results: 480 participants filled out the 2021 online survey (73% of which were returning). 442 of these responses were complete and eligible for analysis of mental health and degree of in-person contact. 345 responses were complete and eligible for information regarding age. No correlation was found between age and mental health. However, differences were observed based on gender and job description. Women (n=244) and customer-facing employees (n=99) reported more frequent symptoms of anxiety and depression, with customer-facing women reporting the most. Comparing only employees that did not work remotely during the pandemic, customer-facing employees still reported more frequent symptoms of anxiety and depression. 
Conclusion and Potential Impact: The impacts of COVID-19 on the workforce are still being studied, but the pandemic continues to take its toll. These mental health trends will help guide future policies to support and improve employee wellbeing, both within participating companies and the workforce at large.
Effects of the COVID-19 Pandemic on the Spiritual and Mental Well-Being of ICU Surrogates and their Treatment Preferences
Authors: Williams Anthony , Torke Alexia M. , Burke Emily S. , Slaven James E.
Published: December 2021

Aspects of religiosity and spirituality (R/S) are associated with alleviating stress and influencing the treatment decision-making process in surrogates of patients in the intensive care unit (ICU). The COVID-19 pandemic has affected the mental health of the population, but no significance has been established with spiritual well-being. This study hypothesized that the pandemic negatively affected surrogate spiritual well-being in a relationship mediated by a surrogate’s intrinsic religiosity, religious coping, and non-organizational religiosity. It was also hypothesized that surrogates would desire less aggressive treatments and have lower goals of patient function due to the pandemic. Baseline surrogate survey data using the FACIT-sp, Brief RCOPE and Durel scales, as well as answers to questions regarding treatment preferences and goal of patient function from the Chaplain Family Project were used in this study along with the pandemic status of the surrogate at the time of interview. There were 100 surrogates interviewed prior to the pandemic and 82 interviewed during the pandemic with a mean age of 54.5 and 53.8 years, respectively, who were mostly white (82.0% and 75.6%, respectively), female (72.0% and 72.0%, respectively), and on average had obtained at least an associate degree. There was a significantly greater preference for aggressive, life-sustaining interventions (LSIs) over relief of pain (26.1% pre-pandemic to 40.9% during pandemic, p=0.0494) and a significantly fewer proportion of patient-surrogate advance conversations (66.7% to 51.9%, p=0.0435) in the during pandemic group. There was no statistical difference found in spiritual well-being, intrinsic religiosity, religious coping, non-organizational religiosity (NOR), treatment preferences, nor patient function goals between the pandemic status groups, when controlling for surrogate demographics and previous patient advance care planning. A longitudinal study should further investigate the possible effect of the pandemic upon surrogate spiritual well-being and ICU decisions and experiences for greater clarity.
The Effect of Acute Inpatient Rehabilitation on Functional Outcomes and Discharge Disposition Following Liver Transplant
Authors: Willoughby Meghan , Ramsey-Morrow Jacob , Littell Kyle A.
Published: December 2021

Background: Patients undergoing liver transplantation often face many challenges with functional independence, which acute rehabilitation can assist them in overcoming. Due to increased yearly liver transplantations, further investigation is required to evaluate the efficiency of acute rehabilitation. The objective of this study is to analyze the efficacy of acute rehabilitation in patients who underwent liver transplantation, primarily using Functional Independence Measure (FIMTM) scores and discharge disposition.
Methods: A retrospective chart review was conducted on 143 encounters, consisting of 107 patients who underwent liver transplantation. Inclusion factors consisted of undergoing liver transplantation between January 2014–December 2018, admission into acute rehabilitation within 6 months post-transplant, and the availability of admission date, admission FIMTM, duration of stay, discharge FIMTM, and discharge disposition. These factors were evaluated in this study.
Results: Patients who underwent acute rehabilitation following liver transplantation were found to have statistically significant positive FIMTM change (P < 0.00001) and FIMTM efficiency (P < 0.00001). The mean FIMTM change and efficiency were 25.4±18.5 and 2.0±1.6, respectively, for patients meeting inclusion criteria, and 35.7±11.8 and 2.4±1.0, respectively, when return to acute care (RTAC) encounters were excluded. A positive correlation was found between longer duration of stay in acute rehabilitation and positive FIMTM change for all patients meeting inclusion criteria (P < 0.00001, r = 0.465), and excluding RTAC encounters (P < 0.00001, r = 0.393). 34.3% (n = 49) of encounters had an RTAC, 3.5% (n = 5) were discharged to a skilled nursing facility (SNF), and 62.2% (n = 89) were discharged to the community. Overall, 83.2% (n = 89) of patients ultimately had a community discharge. Infection, respiratory/CV complications, and gastrointestinal complications were the most common causes for RTAC.                
Conclusion: Acute rehabilitation provides patients who have received a liver transplant with the opportunity to significantly improve their function and independence.
To feed, or not to feed? Evaluating enteral nutrition practices in surgical neonates
Authors: Anderson Cassandra , Bhatia Manisha , Hunter-Squires JoAnna , Saula Peter , Gray Brian
Published: December 2021

Background: Early enteral feeding initiation following surgical procedures in neonates has demonstrated several benefits. In high income countries, where parenteral nutrition is readily available, enteral feeding initiation is often delayed. This study seeks to examine clinical factors and decision-making processes that guide nutrition practices in surgical neonates in the United States (US) and Kenya.  
Methods: A REDCap survey was developed and distributed to pediatric surgery attendings and fellows at Riley and Peyton Manning Children’s Hospitals in Indiana (US) and Shoe4Africa Children’s and AIC Kijabe Hospitals in Kenya. Nine responses were collected during the initial two-week long pilot, then analyzed using REDCap and SPSS 25.  
Results: Responses were collected from eight pediatric surgery attendings and a fellow practicing in Indianapolis, IN. The three most highly ranked clinical factors important for initiation of enteral feeds were stability of the patient, nasogastric or orogastric output color, and gastric output volume. Factors most highly ranked for advancement of feeds included frequency and volume of emesis and abdominal distension. These factors were similarly ranked for foregut and hindgut procedures. Protocols for pyloric stenosis (n=6) include initiation of enteral nutrition within 24-48 hours.  Four of nine respondents felt that surgeons at their institution are not aggressive enough in feeding surgical neonates. The primary perceived barrier to achieving full enteral nutrition was patient gut dysmotility (n=8). All respondents felt that they were similarly (n=4) or more (n=5) proactive in feeding surgical neonates compared to their peers.  
Conclusions and Impact: Feeding practices in surgical neonates are dependent on individual clinician decision-making processes and patient factors. Once the data from the Kenyan surgeons is collected, comparisons between practice patterns will be analyzed. Real-world enteral feeding practices will be evaluated in an adjunct observational study, which we hope will inform protocols with earlier enteral feeding initiation in the future.
Surgical and Transcatheter Pulmonary Valve Replacement: A Single Institution Comparison
Authors: Barron Emily , Brown John W. , Turrentine Mark W. , Hoyer Mark , Rodefeld Mark H. , Ephrem Georges , Herrmann Jeremy L.
Published: December 2021

Background and Hypothesis: Pulmonary valve replacement (PVR) is one of the most commonly performed procedures for patients with congenital heart disease. Transcatheter-based PVR (TPVR) approaches have emerged as alternatives to surgical pulmonary valve replacement (SPVR), but few studies have directly compared clinical outcomes between the two interventions. Further characterization of performance between the two valve procedures may inform clinical decision-making. 
Project Methods: Using institutional databases, we identified patients aged ≥ 9 years who underwent either a TPVR or SPVR at Riley Hospital for Children between January 2009 and June 2020. Exclusions were made for previous endocarditis diagnosis, <1 year follow-up, and concomitant left heart procedures. Valve dysfunction was defined as ≥ moderate regurgitation or gradient ≥ 40 mmHg. 
Results: 94 (TPVR, n=52; SPVR, n=42) patients met inclusion criteria. Average follow-up for SPVR and TPVR patients was 5.1(2.0,6.7) and 2.9(1.6,4.8) years, respectively (p=0.007). The SPVR cohort was younger, had lower BMI, and underwent more prior sternotomies. Hospital length of stay was shorter after TPVR (1.0 day vs. 5.0 days, p<0.001). Despite being younger, BSA-indexed valve size was larger in the SPVR cohort (14.7 mm/m2 vs 12.9 mm/m2, p<0.001). Short-term mortality (0% vs 2%, p=0.36), endocarditis (0% vs 6%, p=0.11), and reintervention (12% vs 8%, p=0.49) did not differ between groups. Intermediate-term valve dysfunction/failure was greater in SPVR patients (29% vs 12%, p=0.04) with time to dysfunction 809(421,1565) and 1184(181,1627) days for SPVR and TPVR, respectively. Valve implantation failure due to pre-stent migration occurred in 4% of TPVR cases; one required surgical intervention.  
Conclusion and Potential Impact: In patients undergoing PVR at our institution, rates of mortality and infective endocarditis are similar between interventions. Intermediate-term valve dysfunction/failure was greater in SPVR cohort, but length of follow-up was significantly longer in these patients. Reintervention rates were similar between procedures.
A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals
Authors: Becker Timothy , Pei Kevin Y
Published: December 2021

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies.  Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies. 
Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive).  Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis.  
Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1) 

 

Laparoscopic 

Robotic 

 

Complications 

N = 49,800 

N = 50 

P Value 

Odds ratio 

Any Complication 

5302 (10.6%) 

5 (10%) 

1 

1.06 

Superficial surgical site infection 
 

423 (0.8%) 

0  

>0.9 

 

Organ Space SSI 
 

1,355 (2.7%) 

0 

>0.9 

 

Postoperative Intra-abdominal Abscess 

1353 (2.7%) 

0 

>0.9 

 

Sepsis 

1,696 (3.4%) 

1 (2%) 

>0.9 

1.7 

Table 1. Complications for Laparoscopic versus Robotic appendectomy.  
Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training.
Comparing Recurrence and Retreatment of Three Doses of Bevacizumab in Treating Severe Retinopathy of Prematurity
Authors: Chopra Jay , Boente Charline
Published: December 2021

Purpose: To determine recurrence and retreatment patterns after treatment of severe retinopathy of Prematurity (ROP) with either 0.5 mg, 0.25 mg, or 0.125 mg of intravitreal bevacizumab for retinopathy of prematurity.
Methods: In this retrospective chart review, data was examined for babies who had severe ROP and were treated with intravitreal bevacizumab doses of either 0.500 mg, 0.250 mg, or 0.125 mg at Riley Hospital for Children in Indianapolis from 2014 to 2021. Data collected included demographic information, past medical history, and characteristics of ROP. The data was statistically analyzed using SPSS software.
Results: One eye was analyzed for each baby. Out of 85 babies, 79 babies were included in the study. 26 babies were treated with 0.125 mg bevacizumab, 37 with 0.25 mg, and 16 with 0.5 mg. All babies showed initial response to the bevacizumab, with 61 babies (77.2%) receiving retreatment with laser for either recurrence or persistent avascular retina. While the babies treated with lower doses had higher percentages of retreatment (23 babies (88.5%) in the 0.125 mg, 29 babies (78.4%) in the 0.25 mg, and 9 babies (56.3%) in the 0.5 mg group), the difference was not statistically significant (p=0.069). Most of the retreatments were due to recurrence of ROP (0.125 mg: 20 (87.0%), 0.25 mg: 19 (65.5%), 0.50 mg: 8 (88.9%)) (p=0.339). On average, the babies in the 0.125 mg group were retreated with laser at 3.4 weeks earlier gestational age and 4.7 weeks sooner after initial treatment than the higher dosing groups, however, this difference was not statistically significant (p=0.181, p=0.287).
Conclusion: The outcomes comparing three doses of intravitreal bevacizumab for severe ROP showed a slight variation in recurrence and retreatment patterns but no statistically significant difference in our study.
The Attitudes, Perspectives, and Barriers Among Primary Care Physicians Towards Addressing Sexual Health of Perimenopausal-Aged Women
Authors: Farhat Ali , Henriksen Brian
Published: December 2021

Background/Objective: Menopause is the natural cessation of menstruation that typically occurs in women between ages 45 and 50. Menopause can lead to numerous issues regarding sexual health such as vulvovaginal atrophy, low desire, issues with vaginal lubrication, and an inability to achieve climax. Despite these issues, very few physicians initiate conversations about sexual health. Female patients generally feel uncomfortable bringing up the topic without first being asked by their physicians, so it is imperative to assess the reasons why physicians rarely discuss the topic.
Methods: Sixteen semi-structured interviews were conducted with family medicine physician faculty and residents regarding barriers to discussing sexual health with their patients. Interviews were transcribed, reviewed, and coded for common themes. Generalizable categories were identified from these themes.
Results: Patient embarrassment and cultural/religious norms were the most stated barriers to discussing sexual health. Adherence to norms and the lack of sexual education among patients were the most stated potential reasons for these barriers. The use of standardized questions and increasing efforts to directly discuss sexual dysfunction were the most stated potential solutions to these barriers. Better medical education regarding female sexual health and developing routines to ask about sexual health were the most stated strategies to help family medicine physicians to better serve this population.
Conclusion and Potential Impact: This study established, from a family medicine perspective, the barriers and respective potential solutions towards improving the sexual health of women of menopausal age. Patients with suboptimal sexual health can affect other aspects of their health. If barriers to discussing this topic with patients can be reduced, more sexual dysfunction diagnoses can be made, and family medicine physicians can better guide and treat patients to resolve these issues and improve overall quality of life.
Time Required for Planned and Unplanned Episodes of Care in Septic and Aseptic Hip and Knee Revision Surgery
Authors: Hulsman Luci , Ziemba-Davis Mary , Hicks Shelly A. , Meneghini R. Michael , Buller Leonard T.
Published: December 2021

Background: Surgical reimbursement rates are established by the Centers for Medicare and Medicaid Services (CMS). Studies have indicated that revision hip (rTHA) and knee (rTKA) arthroplasties require significantly more work effort, but are reimbursed less than primary procedures. This study quantified planned and unplanned work performed for revision surgeries by the surgeon and/or the surgeon’s team during the episode of care “reimbursement window.” Quantification of time was performed separately for aseptic and septic (two-stage) revisions and compared to allowed reimbursement amounts. 
 
Methods: All unilateral rTHA and rTKA procedures performed over a 10-year period by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90 days postoperatively. Impromptu patient inquiries and treatments after discharge, but within the episode of care, involving the surgeon/surgeon team constituted unplanned work. Planned and unplanned work minutes were summed and divided by the number of patients reviewed to obtain average minutes of work per patient. 
 
Results: Calculations demonstrated average per patient work for aseptic rTKA exceeded the reimbursable amount by 31 minutes. Calculated average minutes of work per patient required for aseptic rTHA fell within the number of minutes approved for reimbursement. Average per patient work for septic rTKA and rTHA exceeded the reimbursable amounts by 331 and 166 minutes, respectively, equating to 2.8 to 5.5 hours of uncompensated time. 
 
Conclusion: Revision hip and knee procedures are substantially more complex than primary procedures, with many surgeons referring patients to out-of-network care. Financially dis-incentivizing surgeons to care for these patients reduces patient access to care when high quality care is needed the most, especially infection cases susceptible to high sepsis and mortality rates. Study findings will be applied to advocacy efforts for appropriate legislative reform.
Fabrication of an Electrically Conductive Adhesive for Skin Mounted Bioelectronic Devices
Authors: Gong Sunland L. , Kim Min Ku , Chang Tae Hoo , Lee Chi Hwan
Published: December 2021

Background: Skin mounted bioelectronics are difficult to integrate with the skin since biocompatible adhesives are not conductive or unsuitable for long-term use. Skin conformability is essential but strong adhesives can damage soft tissue in younger and frail individuals as well as the device during removal. Developing a noninvasive long-lasting biocompatible conductive adhesive for skin that can be used with bioelectronics allows for better treatment options and the improvement of patient outcomes.
Methods: This study creates a soft hydrogel using graphene oxide flakes (GO) and polyvinyl alcohol. Networked GO is reduced in a solution of sodium dithionite and sodium hydroxide to form a conductive network within the hydrogel. Adhesive properties are achieved by incorporating a polyacrylic acid polymer into the hydrogel with the addition of N-hydroxysulfosuccinimide (NHS) groups to the polymer. NHS reacts with amine groups found on tissue to form covalent bonds that can be released with a biocompatible trigger solution of sodium bicarbonate and glutathione.
Results: Hydration of the hydrogel at 65°C demonstrated that the hydrogel swelled anistropically with swelling ratios of 1.05/1.06/5.5 (length/width/thickness). This showed that the hydrogel can integrate into various surfaces without deformation. The hydrogel demonstrated an impedance of 106.1~164.6 Ω⋅m (20~500 Hz), which is comparable to conventional devices. The hydrogel was chemically bound to amine functionalized polydimethylsiloxane (PDMS) and glass. Peel test showed peak adhesion forces of 100.5 N⋅m-1(Force⋅Width-1) when bound to PDMS or glass. Signal quality of the hydrogel showed that the hydrogels demonstrated ECG and EMG signals comparable to commercially available materials.
Conclusions: The importance of this study is to create a soft material that bonds between electrodes and skin. The results demonstrate that the hydrogel has electrical characteristics comparable to conventional electrodes for use in ECG and EMG. In addition, it can create adhesion via chemical bonds that can be released on demand.
Retrospective Analysis of COVID-19 Pandemic Impact on Breast Cancer Screening Rates in Northwest Indiana
Authors: Green Daniel L. , Han Amy
Published: December 2021

Background: Few changes to healthcare delivery during the COVID-19 pandemic altered pre-pandemic diagnostic testing as much as those made to cancer screening. Several studies show that screening volumes decreased by as much as 80% across multiple modalities and cancer types in the spring of 2020. These studies examined large hospital systems in the American East and West, but communities with predominantly Black populations like Gary, Indiana, have been absent from this research.
Methods: Our study captures how the COVID-19 pandemic affected access to diagnostic screening for cancerous and precancerous breast lesions through mammography using patient-level data. “Hospital A” provided data from 17,973 mammography encounters that occurred between March 2019 and June 2021. Screening volumes from the eight-week period from March 23rd and May 17th in 2020, the period elective procedures were suspended, was compared to three other distinct periods: the previous 8-week period, the next 8-week period, and the same 8-week period from 2019.
Results: From the 17,973 encounters, the average patient age was 61.7 (SD 11.4) years, 61.0% of patients paid with Medicare or Medicaid, and 66.0% of patients identified as Black. Despite performing a weekly average of 190 (12.3) mammograms during the 2019 baseline period and 158 (16.1) mammograms in the eight weeks preceding the COVID-19 pandemic, the weekly average fell to 13 (22.4) mammograms during the study period with zero occurring in a four-week stretch. Fortunately, volume returned sharply to near pre-pandemic levels in the eight weeks following the study period with 139 (18.9) average weekly mammograms.
Conclusion: Despite a 93% year-over-year decrease in mammography during the height of the pandemic, volume returned in the summer of 2020. Concerning, however, is that average monthly volume (582 (88.5) mammograms) in the first six months of 2021 remains 22.1% lower than 2019 numbers (747 (66.7) mammograms).
Effects of Alginate Encapsulation on the Vertebral Bone Adherent Mesenchymal Stromal Cell Paracrine Secretome
Authors: Kedo Mahmood , Gil Chang-Hyun , Doiron Theresa , J. Miller Steven , P. Murphy Michael
Published: December 2021

Background/Objectives: Mesenchymal stromal cells (MSCs) are spindle-shaped multipotent stem cells that can be found in any vascularized organ especially bone marrow, adipose tissue, and cord blood. MSCs have pro-angiogenic and myogenic properties which have been proposed as a potential treatment for preventing limb amputations in patients with critical limb threatening ischemia (CLTI) due to peripheral artery disease (PAD) and diabetes mellitus. Allogeneic MSCs from a young healthy donor may decrease the risk of amputation by promoting angiogenesis and muscle regeneration. However, their potency may be limited by host immune reactions to allogeneic cells. Encapsulating MSCs in a hydrogel may help to protect transplanted MSCs from the immune system of the host. Additionally, encapsulation may enhance the secretion of anti-inflammatory and pro-angiogenic factors from MSCs. Some of the molecules involved in fighting inflammation and promoting angiogenesis include interleukin (IL)-10, IL-33, hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and angiopoietin-1. 
 
Methods. For the encapsulation group, MSCs were centrifuged in a 2% alginate solution through a needle and into a calcium chloride bath. Both unencapsulated and encapsulated MSCs were incubated for 48 hours in various conditions including normoxia, normoxia with high glucose (diabetic mimic), hypoxia, and hypoxia with high glucose. The media was then harvested and analyzed using enzyme-linked immunosorbent assays (ELISAs) (R&D Systems, MN) for IL-10, HGF, VEGF, and angiopoietin-1. 
 
Results. No detectable levels of IL-10, HGF, or angiopoietin-1 were found in either cell media group. VEGF levels were significantly elevated in hypoxic high glucose conditions compared to normoxic and normoxic high glucose conditions within the unencapsulated group. 
 
Discussion. These results demonstrate that hypoxic high glucose conditions duplicating ischemic diabetic muscle amplify MSC VEGF secretion. The next step is to run a VEGF ELISA on the encapsulated cell media group and compare those results to the unencapsulated cell media group. 
 
WC: 300
Food Insecurity and Mental Health Outcomes among Low Income, Minority Cohorts during the COVID-19 Pandemic
Authors: Kodukula Sai , Han Amy
Published: December 2021

Objective:  
To examine the impact of the COVID-19 shutdowns on food insecurity and mental health outcomes among low income, minority communities in Northwest Indiana. 
 
Methods:  
Surveys were distributed to 160 households during the Northwest Indiana food bank distribution hours to assess food security mental health status. The survey assessed participant food security through questions adapted from the USDA food security survey module. Participant anxiety, depression, and stress scores were aggregated from questions adapted from the PHQ-4. A multiple logit regression model was utilized to estimate the risk associated with food security status and the surveyed variables. Anecdotal evidence was also collected to understand pandemic specific factors impacting participant food security.  
 
Results:  
Food insecurity was linked to significantly increased risk of anxiety, depression and stress. Those who identify to be food insecure have an 811 % increased risk of anxiety, 411% increased risk of depression, and 535% increased risk of stress compared to those who are food secure. In addition, a significant correlation exists between median household income and poor mental health. Anecdotal evidence identifies poor job security, food distributions, and support networks as exacerbating factors towards participant’s declining mental health.  
 
Conclusions:  
Our findings highlights the exacerbated impact the pandemic has had on the food security and mental health of vulnerable populations. In the light of these results and anecdotal feedback, public health measures must focus on getting increased funding towards local food banks to increase the frequency of mobile distribution markets coupled with direct subsidies to allow for food purchases, especially for those households with children. Given its impact on mental health, food insecurity status should regularly be screened by physicians access to the right resources must be provided for those screening as high risk.
Are we ready for evidence-based prosthodontics? - A literature review
Authors: Srivastava Ayush , Hazra Ranjoy , Kumar Dinesh , Khattak Amit , Legha V S , Kalia Deepak
Published: December 2021

Traditional methods will be rendered obsolete, if not supplemented by current techniques and evidence. This requires a clinician to continuously recognize, scrutinize and consolidate the best available scientific literature in the field. Continuous improvement in the quality of research conducted, as well as reporting the findings should be encouraged to improve upon current and future treatments. This review showcases the most prominent controversies in prosthodontics and how the current evidence answers the questions. A PubMed, Met line and google scholar search with the keywords, Evidence-based dentistry and Evidence-based Prosthodontics was done from the year 1960-2021. Meta-analysis of randomized control trials and systematic reviews related to the evidence in complete dentures, fixed partial dentures, implants and prosthodontics were considered in the inclusion criteria. Literature reviews and case reports were excluded from the search. Evidence-based practice is a new level of sophistication in the practice of dentistry. Rather than considering the cost of material or the individual preference of the operator, choosing the right technique to maximize clinical efficiency should be based on scientific evidence.
Mandible Implant overdenture – A case report
Authors: Kumar Chippalapally Arun , Gugloth Goverdhan , Yadav B.Yaswanth
Published: December 2021

Implant overdentures have ended up being one of the most incredible elective choices in prosthetic recovery of different instances of edentulism. They fulfill the patient's expectations, work on personal satisfaction with their drawn out workableness and unsurprising results. Throughout the long term, critical progressions have occurred in the embed frameworks and the strategies for connections. This paper depicts a case report in which a totally edentulous patient was restored with implant overdenture in mandible and a total denture replacement in the maxilla
La evaluación en tiempos del COVID-19: una mirada desde los docentes
Authors: Suárez Oscar Jardey , Hernández Barbosa Rubinsten , Lizarazo Osorio Julio del Carmen , Orjuela Osorio Claudia Patricia
Published: December 2021

El artículo presenta consideraciones alrededor de la evaluación de profesores universitarios de Colombia, México y Perú que participaron de un curso de formación en modalidad virtual, en el contexto de la pandemia de COVID-19. Es un estudio de enfoque mixto, con información recolectada por medio de una encuesta, validada por pares de expertos, que indagó por aspectos propios de la evaluación, aplicada en un entorno virtual de aprendizaje, en modalidad asincrónica. Para el procesamiento de la información se acudió a un análisis interpretativo. A nivel cuantitativo, se consideraron los indicadores de fiabilidad la técnica de análisis de componentes principales, para determinar las variables de la evaluación. Los resultados indican que la evaluación tradicional prevalece, pero se necesitan cambios en su fundamento y realización. Se identificaron cuatro variables: evaluación habitual; evaluación habitual en crisis; evaluación continua y formativa; y evaluación con recursos tecnológicos. La principal conclusión es que la situación forzada por la pandemia en la educación ha puesto en crisis el control de la evaluación, lo que genera una reflexión al colectivo de profesores sobre este aspecto.
Pensamiento crítico y videojuegos en estudiantes de educación básica secundaria
Authors: Ramírez Espinosa Fredy Nelson
Published: December 2021

El presente documento es una revisión de artículos sobre pensamiento crítico y videojuegos en estudiantes de educación básica secundaria, que corresponde a la primera fase del avance de una tesis doctoral en ciencias de la educación. Se plantea como problema de investigación, dada la situación en Colombia y en Latinoamérica de los diferentes estallidos sociales prepandemia y pos-pandemia y el resultado de la consulta anticorrupción y el plebiscito por la paz, para determinar cómo se puede desde el diseño de un videojuego de roles relacionado con el contexto, desarrollar el pensamiento crítico en estudiantes de grado noveno del Colegio Cundinamarca ubicado en Bogotá y contribuir a la educación para la paz. En el primer apartado se hace una aproximación a los principales conceptos teóricos de la investigación. En el segundo, los estudios se discriminan por las herramientas TIC utilizadas, la metodología, los principales referentes teóricos sobre pensamiento crítico y los métodos y las didácticas para su desarrollo. La revisión documental está enmarcada en la metodología de investigación llamada el estado del arte, que corresponde a una investigación cualitativo-documental de carácter crítico-interpretativa que revisa los estados producidos por las personas en su representación bibliográfica. En los resultados, se hace un análisis general de los estudios con uso de TIC y de su importancia, y se enfatiza en los trabajos que utilizan como herramienta los videojuegos en los cuales se identifican tres tendencias. Por último, se plantea una discusión sobre la pertinencia de la investigación y las conclusiones.