bluuebunny/crossref_metadata_2025 huggingface dataset:
The Catalan Syndrome? Revisiting the Relationship Between Income and Support for Independence in Catalonia
Authors: Muñoz Jordi
Published: December 2021

The surge in support for independence in Catalonia (Spain) has received much political, journalistic, as well as academic attention. A popular account of the Catalan case stresses the allegation that motives relating to fiscal selfishness are behind the independence movement. The evidence presented in support of this argument is the positive correlation between income and support for independence. Some scholars, such as Thomas Piketty, even talk about a “Catalan syndrome,” according to which support for independence can ultimately be explained by fiscal selfishness and the prospect of creating a sort of tax haven in Catalonia. As prominent as this argument is, in this article I show that it rests on weak theoretical and empirical grounds. In order to do so, I reassess the existing evidence, using a more nuanced empirical strategy that allows for non-linear relations to emerge and controls for potential confounders. Then, I also present new evidence based on recently published census-tract level fiscal data, merged with election results. Finally, I spell out the mechanisms and observable implications of the “Catalan syndrome” argument and show that fiscal selfishness is not an important driver of the Catalan independence movement.
A case study on the updates of Turkish rapid visual screening methods for reinforced-concrete buildings
Authors: IŞIK Ercan , ULU Ali Emre , AYDIN Mehmet Cihan
Published: December 2021

The changes in rapid seismic assessment methods that can be used to determine the regional earthquake risk distribution of buildings have become inevitable, with the Turkish Building Earthquake Code and Turkish Earthquake Hazard Map which updated in 2018, Within the scope of this study, risk prioritization was made according to the last two regulations for ten different settlements that located in the same earthquake zone in the previous earthquake map. With the current regulation, it has once again emerged that site-specific based analysis and evaluations are necessary. While the building performance scores in the previous regulation were the same for all provinces since they were located in the same earthquake zone, different values were obtained for the provinces with the current regulation. As the PGA value increased, the design spectral acceleration coefficient increased and the building's performance score was lower. This increases the risk in these regions.
Does Shareholding Heterogeneity on First Major Shareholder Incentively Affect Audit Characteristics?-Evidence From Tobacco and Non-tobacco Enterprises
Authors: Lipai Zhang
Published: December 2021

Objectives: This study is to examine the effect of first major shareholders on audit characteristics, and emphasize their incentives towards corporate reform. In addition, we also emphasize on the tobacco industry that is totally state-owned by Chinese central government, as their
internal audits are mainly conducted by the State Council. Methods: Taking A-share listed enterprises in Chinese Shanghai and Shenzhen Stock Exchange as samples, this paper analyzes the changes in corporate audit characteristics, which are caused by the holding heterogeneity on the first major
shareholders. Then a series of endogenous and robustness tests are to confirm the baseline results. Based on the results of population, we specifically analyze and forecast the tobacco industries. Results: This positive relationship remains significant. Also, the channels for the first major
shareholder to reduce non-standard audit opinions originate from their constraints and incentives, which reflect on enhanced supervision, sustainable business operation and market competition. These contribute to their revised managerial behavior. Finally, additional tests illustrate that
the effect of strengthened equity is heterogeneous in terms of size, equity nature and growth stage of enterprises. Conclusion: The study domestrates the importance of equity structure and first major shareholders, which calls attention to managerial motives and behavior. The marginal effect
is supposed to be shrunk in tobacco business as it is initially in absolute control by public authority. The already economic profits have made it reached favorable audit report. The enhanced shareholdings of first major shareholders could alleviate managerial myopia and moral hazard, and
give the inspiration to enterprises in the reform of the ownership structure. Research limitations/implications-Effect of increasing first major shareholders’ holdings on audits is required to be applied in certain situations. However, the unavailable data and minimal samples of listed
tobacco enterprises make it hard to clearly estimate the shareholding effect in this certain industry. Therefore, we have to qualitatively analyse tobacco business based on average population. Originality/value-This paper enlarges the role of major shareholders in audit characteristics, and
emphasizes their managerial behavior towards audit process. The study indicates that stronger first major shareholdings tend to obtain qualified and standard audit opinions, pay higher audit fees and select high-quality auditors. The results and anlyses could enlight the tobacco and non-tobacco
industries.
Development and Sales of Tobacco Cultural Tourism Products Under the Background of Global Tourism
Authors: Li Peng , Deng Aimin , Ren Fei
Published: December 2021

Objectives: Through the investigation of tobacco development and tobacco sales, this paper studies the development and sales of tobacco cultural tourism products under the background of global tourism. Methods: Taking a scenic spot as an example, this paper takes the number of tourists
received in 2019 and 2020 and the number of cigarette sales of retailers in the scenic spot as the original data. Correlation analysis is used to demonstrate the point of view. Results: The development efficiency of tobacco cultural tourism products is affected by sales volume. The increase
in the number of tourists is in direct proportion to cigarette sales. When the number of tourists is large, the corresponding cigarette sales will be large. When the number of tourists is small, cigarette sales are also relatively small. Secondly, affected by some special activities and holidays,
cigarette sales will also increase in a short time, but it has little to do with the change in the number of tourists. Conclusion: The development of tobacco cultural tourism products should be based on the sales volume and the cultural orientation of scenic spots. The large increase of tourists
can bring considerable economic benefits to the scenic spot. Expanding publicity to attract tourists is an indispensable means for the development of the scenic spot. This is also the core concern of the development of tobacco cultural tourism products. When formulating relevant measures for
the development and sales of tobacco cultural tourism products, managers should take into account the interests of all parties and achieve balanced development.
Logistics Management of Tobacco Enterprises Under Supply Chain System
Authors: Tan Lin , Zhang Ailing , Li Sha
Published: December 2021

Objectives: This paper studies the logistics management of tobacco enterprises under the supply chain system. Using the knowledge and theory of supply chain management and logistics, this paper studies the method of constructing supply chain and promotes the reform of tobacco industry
and the development of logistics construction. Methods: This paper makes a systematic and comprehensive research by using JIT method. Based on reality and overall situation, make a comprehensive and systematic strategic plan for the development of tobacco industry. This paper analyzes the
current situation of tobacco supply chain management, and puts forward the countermeasures to solve the current situation of tobacco supply chain. Results: Tobacco logistics and supply chain management in China has just started, is still in the exploratory stage, and there are still many imperfections
and areas that need to be improved. Although many tobacco enterprises have initially built cigarette logistics centers with Municipal Bureau companies as the main body, the information construction has also reached a certain level. Overall, the integration of resources between industrial and
commercial enterprises is far from enough. At present, only some provinces and cities have realized the logistics resource sharing of industrial and commercial enterprises in the same city, and the informatization has also reached a high level. The phenomenon of repeated logistics construction
in the whole tobacco industry is still serious. Conclusion: In order to realize the integration of logistics resources in the whole industry and reduce the overall cost, tobacco companies should first strengthen the joint reorganization of the industry and establish large tobacco industry
groups. Secondly, efforts should be made to realize the organizational structure adjustment and business process re-engineering of industrial enterprises. Thirdly, on the basis of the existing logistics level, establish a third-party logistics company across administrative regions to realize
the informatization of the whole cycle of cigarette distribution..
Application of Ultrasound Evaluation of Diaphragm Function in Guiding Ventilator Evacuation
Authors: Cui Xinmeng , Zhang Ri , Lv Huan , Li Li
Published: December 2021

Objective. To investigate the clinical effect of the application of ultrasound evaluation of diaphragm function in guiding ventilator evacuation. Methods. 100 patients with ventilator evacuation who were admitted to our hospital from March 2019 to June 2020 were selected as the study
objects, and divided into the observation group and the control group, according to whether they succeeded in weaning. Among them, 50 patients succeeding in weaning were from the observation group; while 50 patients failing in weaning were from the control group. The Diaphragm Movement Degree
(DMD) and Diaphragmatic Thickness at the End of Expiration (DTee), Diaphragmatic Thickness at the End of Inspiration (DTei) and Diaphragm Thickening Fraction (DTF), the right diaphragm displacement, diaphragm contraction velocity at 0 min, 5 min and 30 min of two groups as well as the ROC
curve were all analyzed to predict weaning results of the ultrasound diaphragm index. Results. (1) There were no significant differences in Sequential Organ Failure Assessment (SOFA) score. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ventilator ventilation time and
oxygenation index before weaning between the two groups (T=0.14,0.03, 0.04, 0.59, P=0.89, 0.97, 0.56). (2) Left DMD (18.59±2.96) mm. Right DMD (19.86±2.94) mm. Left DTei (2.69±0.16) mm. Right DTei (2.81 ±0.31) mm. Left DTee (1.93±0.11) mm. Right DTee (1.92±0.16)
mm. Left DTF (0.40±0.11) mm and Right DTF (0.47±0.09) mm in the observation group were significantly higher than Left DMD (13.05±3.16) mm. Right DMD (13.13±3.63) mm. Left DTei (2.16±0.34) mm. Right DTei (2.18±0.39) mm. Left DTee (1.92±0.16)
mm. Right DTee (1.68±0.24) mm. Left DTF (0.25±0.06) mm and right DTF (0.27±0.07) mm in the control group, T = 9.05, 10.19, 9.97, 8.94, 6.93, 5.88, 8.46, 12.40, P=0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00, with statistical significance. (3) The ROC curve showed that
left and right DMD, left and right DTei, left and right DTee as well as left and right DTF can be used to predict the success of weaning. Conclusion. In the guidance of ventilator evacuation, the application of ultrasound evaluation of diaphragm function can effectively evaluate the timing
of weaning, and played a positive role in improving the success rate of weaning.
Research on the Influence of Major Shareholders’ Reduction of Tobacco Related Listed Companies on Enterprise Value: Based on the Intermediate Effect of Financing Constraints
Authors: Chen Hong , Xu Can
Published: December 2021

Objectives: Compared with ordinary consumer goods, tobacco and tobacco products have their particularity, which not only plays an important role in the economic development of all countries in the world, but also plays a different role in people’s daily life. In China, the
production and sales of tobacco leaves, cigarettes and other tobacco products as well as related tobacco machinery and raw and auxiliary materials have an important impact on fiscal revenue. As the Chinese stock market has basically completed the share-trading reform, stocks that were originally
restricted from circulation have begun to circulate. With the continuous increase in the number of lifted bans, the phenomenon of major shareholders reducing their shareholding is also happening constantly. Methods: the paper provides empirical evidence to avoid the adverse effects of major
shareholders’ reductions on the promotion of corporate value of listed tobacco Enterprises. From the perspective of the flow of shares after the major shareholders reduce their holdings, with the help of the theory of financing constraints, the article uses an empirical analysis method
to explore the effect of the major shareholders of listed tobacco Enterprises on the value of the reduced listed private companies after they reduce their holdings. Results: the results show that when the equity of listed tobacco Enterprises is acquired by state-owned enterprises after the
reduction of major shareholders, that is, when state-owned enterprises participate in the shares, the reduction of major shareholders contributes to the increase of the value of tobacco Enterprises. And the larger the reduction proportion of major shareholders, the greater the value of the
enterprise. However, when major shareholders reduce their holdings and the equity is acquired by investment institutions and small and medium shareholders, it is not conducive to the improvement of corporate value. Especially when major shareholders maliciously reduce their holdings, it would
have an adverse impact on the company’s development and stock price. Conclusion: therefore, from the perspective of enterprise value appreciation, no matter what the purpose is for major shareholders to reduce their holdings, the flow of equity to state-owned enterprises after the reduction
is the best choice. The financing constraints of the enterprise could be reduced and it helps enhance the value of the enterprise.
Ultra-Widefield Fluorescein Angiography as a Predictor for Visual Outcomes in Retinal Vein Occlusion
Authors: Tsang Clayton , Hajrasouliha Amir , Mathew Sunu
Published: December 2021

Background and purpose: Retinal vein occlusion (RVO) is the second most common cause of vascular disease leading to visual impairment. Fluorescein angiography (FA), which can visualize areas of vascular non-perfusion, has been used historically to evaluate RVO. Recent advent of ultra-widefield imaging (UWFA) has extended the ability to visualize larger retinal areas, yet the prognostic use is unclear. A retrospective case series study was conducted to better characterize the link between ischemia and visual acuity (VA) outcomes using UWFA. Experimental method: The study used retrospective analysis of patients with RVO from September 2017 until June 2020. UWFA images of patients with RVO were analyzed by correlating VA to the surface area of retinal nonperfusion (NP) or the presence of macular ischemia (MI). VA was recorded at time of UWFA and at follow-up (average 4.7 months) and classified as ischemic if Snellen acuity was 20/200 or worse. NP surface area was measured using ImageJ (NIH, Bethesda, MD). Eyes with abnormal and ischemic foveal avascular zones were categorized as having MI. Results: 13 eyes met inclusion criteria for the study. At initial presentation, ischemic eyes had greater NP compared to nonischemic eyes (p=0.02). At follow-up, eyes with ischemia had greater NP on their original UWFA compared to nonischemic eyes (p=0.03). When comparing eyes with and without MI, there were no significant differences in VA at initial presentation (p=0.30) or at follow-up (p=0.44). Conclusion and Implications: UWFA is important in the prognosis of RVO patients as visual outcomes correlate to the NP of the entire retina. The presence of MI alone was not successful in predicting visual outcomes. This suggests that UWFA is a more powerful diagnostic method compared to traditional FA techniques, which cannot identify peripheral nonperfusion. Future work will center around analyzing other retinal imaging methods and comparing prognostic efficacy.
Longitudinal Evaluation of Pulmonary Function in Premature Infants
Authors: Settle Abigail , Tiller Christina , Bjerregaard Jeffrey , Robinson Marylyn , Slaven James , Tepper Robert
Published: December 2021

Background:
Infants born premature have decreased pulmonary function compared to full-term infants. Longitudinal infant studies are needed to determine whether impaired pulmonary function following premature birth demonstrates catch-up growth. This study measured airway and parenchymal function in infants born premature at approximately 6 months and 1 year of age to assess growth and the effects of gestational age (GA) and sex.
 
Methods:
37 infants born premature participated in two study visits (V1 and V2) at Riley Hospital in Indianapolis, IN. While sleeping, forced expiratory maneuvers were preformed to measure airway function. DLCO, diffusion capacity of the lung, and VA, alveolar volume, were measured under conditions of room air. Z scores were calculated to compare infants born premature and full-term, adjusting for size, race, and sex.
 
Demographics:
The subjects consisted of 21 females and 16 males. There were 7 subjects born at 24 – 28 weeks, 6 at 29 – 31 weeks, and 24 at 32 – 36 weeks.
 
Pulmonary Testing Results:

Variable

Z Score

V1

V2

V2-V1

Male

Female

GA

DLCO

-0.17
(-0.59, 0.26)

*-0.75
(-1.18, -0.31)

*-0.58
(-1.03, -0.12)

*-0.86
(-1.42, -0.30)

-0.05
(-0.53, 0.43)

*0.13
(0.001,0.28)

VA

0.06
(-0.24, 0.45)

-0.24
(-0.70, 0.23)

-0.30
(-0.72 ,0.14)

-0.14
(-0.71, 0.43)

-0.04
(-0.53, 0.45)

0.09
(-0.05, 0.23)

FVC

*-0.38
(-0.60, -0.17)

**-1.05
(-1.36, -0.74)

**-0.67
(-0.98, -0.36)

**-0.71
(-1.04, -0.38)

**-0.72
(-1.01, -0.44)

0.07
(-0.01, 0.15)

FEF50

**-0.88
(-1.15, -0.62)

**-1.36
(-1.63, -1.08)

*-0.47
(-0.80, -0.14)

**-1.12
(-1.44, -0.79)

**-1.12
(-1.40, -0.84)

**0.15
(0.07,0.23)

FEF75

**-0.57
(-0.88, -0.26)

**-1.16
(-1.48, -0.83)

*-0.59
(-0.93, -0.24)

**-0.76
(-1.16, -0.35)

**-0.97
(-1.32, -0.62)

**0.21
(0.11,0.31)

* = p < 0.05    ** = p < 0.001

 
DLCO was decreased in male subjects compared to female subjects and male full-term infants. VA was not significantly different between subjects and full-term infants. Compared to full-term infants, subjects had decreased forced vital capacity (FVC) and forced expiratory flow at 50% and 75% vital capacity (FEF50 and FEF75). DLCO, FVC, FEF50, and FEF75 exhibited a significant decrease in pulmonary function from V1 to V2 among subjects. Gestational age showed a positive relationship for DLCO, FEF50, and FEF75.
 
Conclusion and Potential Impact:
The subjects did not exhibit catch-up growth, or an increase in z score from V1 to V2, in parenchymal and airway function for DLCO, FVC, FEF50, and FEF75. Gestational age and sex were factors affecting pulmonary function. As premature infants are born with lower pulmonary function than full-term infants, it is important to understand how lungs continue to develop after release from the NICU.
Localization of IL-1α Responsive Dermal Populations in an Ex Vivo Human Model of Wound Healing
Authors: Sikoski Andrej , Jayapranu Krish , Zhou Hong-Ming , Liu Yunglong , Xuei Xiaoling , Gao Hongyu , Turner Matthew J.
Published: December 2021

While playing a critical role in skin wound healing, the inflammatory phase of this process is poorly understood. To gain a better understanding of the inflammatory phase of wound healing, we developed an ex vivo skin culture model of skin injury-induced inflammation. Previous work in our laboratory showed ex vivo culture of human skin induces an interleukin 1 alpha (IL-1α)-dependent response characterized by increased transcript and protein levels for the inflammatory cytokines/chemokines, IL-6, CXCL1, and CSF3. However, the cellular sources of these factors in ex vivo cultured human skin have not been determined. Prior work with ex vivo cultured mouse skin and single cell RNA sequencing suggested fibroblasts and endothelial cells were potential cellular sources for these inflammatory mediators. The current studies used spatial transcriptomics analysis of ex vivo cultured human skin to localize the IL-1α target cell populations/skin tissue regions that produce IL-6, CXCL1 and CSF3. The Visium Gene Expression Solution platform (10x Genomics Inc.) was used to generate spatial transcriptomics data from skin specimens preserved immediately after biopsy or after skin culture for 24 hours. Loupe Browser version 5.1.0 (10x Genomics Inc) was used for data analysis to identify and characterize cell populations/regions expressing IL6, CXCL1, and CSF3 and associated differentially expressed genes (including cell type-specific transcripts). Notably, these IL-1α-induced transcripts were localized to the parent dermis region cluster. Analysis of subclusters in the dermal region showed differential expression of these inflammatory transcripts in regions enriched with either or both fibroblast and endothelial cell specific-type markers. Potential novel markers of this inflammatory response, like SOD2, were identified and warrant future investigation. Subsequent studies in identifying the targets of IL-1α in skin inflammation is called for, as they may lead to better understanding of this processes in wound healing and better clinical outcomes.
Measuring the Impact of Human-Centered Design Research
Authors: Smith Victoria , Claxton Gina
Published: December 2021

Background/Objective: Human-centered design (HCD) is an approach to research that aims to facilitate participant engagement in research studies. Research Jam is the Patient Engagement Core of the Indiana Clinical and Translational Sciences Institute (Indiana CTSI) that applies HCD to health research. The objective of this project is to assess the impact and efficacy of the HCD approach in health research. This project follows-up with previous investigators who have completed a project with Research Jam to measure impact on investigators’ attitudes towards HCD and participant engagement as well as the efficacy and implementation of the project-specific tools and deliverables that resulted from the work with Research Jam. 
Project Methods: A survey was developed in Qualtrics and sent to investigators (N=34) from Research Jam’s portfolio of completed projects (2015-2020). Five follow-up interviews were conducted and analyzed in NVivo.
Results: Survey response rate was 50%. Of the projects listed by the investigators, 89% had deliverables that were reported as feasible and relevant to the target audience. Long-term sustainability of the deliverables showed room for improvement. For all projects, 81% were reported to have helped the investigator learn how to better engage with participants to inform their subsequent research.
Potential Impact: These findings demonstrate that HCD produces deliverables that are feasible and relevant to target audiences, and health researchers view HCD as a useful method to engage more directly with research participants. These results can serve as a guide for Research Jam to continue to refine processes, such as improving long-term sustainability of the deliverables, and to direct future projects.
Ventilator Associated Pneumonia in Pediatric Trauma Patients
Authors: Sullivan Dalton , Landman Matthew P. , Gahagen Rachel E. Gahagen
Published: December 2021

Background:
Ventilator associated pneumonia (VAP) is a common hospital-acquired infection found in intubated trauma patients. In previous adult studies, VAP has been associated with an increase in length of stay, cost, morbidity, mortality, and longer mechanical ventilation. There remains little examination of the risk factors, prognosis, and microbiology of VAP within the pediatric trauma population. This study aims to analyze factors associated with VAP in pediatric trauma patients.
Methods:
The Riley Hospital for Children Trauma Registry was utilized to identify intubated pediatric trauma patients from 2016-2020. Patients were excluded if intubated for less than 48 hours.   VAP was defined as positive if patients met either Centers for Disease Control definition and or were clinically diagnosed with and treated for VAP. Univariate and multivariate modeling was performed.
Results:
A total of 171 patients met inclusion criteria and 43 (25%) were diagnosed with VAP. The median age was 8 years (2-13) and ISS was 26.5 (22-35). The median duration of intubation was 203.8 hours (117.3-331.3). The overall mortality was 55 (32.2%). While variables such as lower age and use of MTP resulted in a higher likelihood of mortality, VAP diagnosis was not associated with increased mortality. BAL analysis displayed that the most common cultured bacteria were H. influenzae, Staph. aureus, and Strep. Pneumoniae with most VAPs being diagnosed on day 2 of admission. When analyzing the impact of age, ISS, intubation hours, ICU days, and GI prophylaxis on VAP, only age was significantly associated with VAP: for each year the odds of VAP rose by 10%.
Conclusions:
A quarter of the pediatric trauma patients were diagnosed with VAP during the study period.  No modifiable risk factors were found for VAP with only patient age demonstrating significance for the diagnosis.  Further investigation into VAP definition and prevention in pediatric trauma patients should occur given it’s prevalence.
Comparison of Trimethoprim-Sulfamethoxazole vs. Clindamycin for the Treatment of Children with Musculoskeletal Infections
Authors: Tyte Julian , Russell Kelsey , Wood James B.
Published: December 2021

Background:
Musculoskeletal infections ([MSKI]; osteomyelitis, septic arthritis, pyomyositis) are common invasive infections in children. With increasing antibiotic resistance and allergies, treatment options are limited. Trimethoprim-sulfamethoxazole (TMP-SMX) has activity against common MSKI pathogens, yet pediatric MSKI outcomes data are limited. Our aim was to evaluate outcomes of children with MSKI treated with TMP-SMX compared to clindamycin. We hypothesized that outcomes would be similar between groups.
Methods:
We conducted a retrospective review of children <18 years old, admitted to Riley Hospital for Children from January 2010-June 2021 treated with TMP-SMX or clindamycin for MSKI. Patients were identified by ICD-9/10 codes. Patients were excluded if TMP-SMX or clindamycin was not the main treatment, they had symptoms >30 days, hardware associated infection, or an alternative diagnosis. Treatment success was defined as no evidence of infection at the end therapy. Treatment failure was defined as antibiotic intolerance, or development of recurrent/chronic osteomyelitis. Adverse drug reactions were recorded.
Results:
One-hundred-sixty-three patients (30 TMP-SMX, 133 clindamycin) met eligibility criteria. The majority were non-Hispanic white males, median age of 1.75 years (IQR, 1-3.75) for the TMP-SMX group, and 7 years (IQR 3-10) for the clindamycin group. Osteomyelitis was the most common infection type in both groups (TMP-SMX 43.3%, clindamycin 54.1%).  S. aureus was the most common pathogen in both groups (TMP-SMX 36.7%, clindamycin 48.1%). Of the patients that completed follow-up, 84% successfully completed treatment with TMP-SMX, compared to 86.4% with clindamycin (odds ratio [OR] 0.82; 95% CI 0.25-2.46, p=0.75). Adverse drug reactions occurred in 6.7% of the TMP-SMX group, compared to 10.5% in the clindamycin group (OR 0.61; 95% CI 0.13-2.57, p=0.52).
Conclusions:
Preliminary results show that TMP-SMX is well tolerated and not associated with higher risk of treatment failure compared to clindamycin in the treatment of pediatric MSKI. Randomized controlled trials to evaluate optimal treatment are needed.
Social Risk Factors for Asthma Exacerbations Among Pediatric Patients: A Scoping Review
Authors: Vinjimoor Shriya , Meltzer Alex , Mendonca Eneida
Published: December 2021

Background: Asthma is the most common chronic illness among the pediatric patient population. While several studies have investigated the biological and environmental factors associated with asthma exacerbations, research on the relationship between asthma and social determinants of health is limited. This scoping review addresses this gap in knowledge by exploring social factors that are associated with the risk of asthma exacerbations among pediatric patients and mapping identified variables onto the SAVI database.
Methods: The OVID Medline, Embase, and PsycInfo databases were systematically searched for studies published as of July 2, 2021. No restrictions on study design or publication type were made but search was limited to English manuscripts. Resulting studies were screened based on phased eligibility criteria on Covidence. In Phase 1, duplicates were removed. In Phase 2, studies unrelated to asthma and those with participants outside of 2-18 years of age were excluded based on title and abstract screening. In Phase 3, studies that investigated asthma exacerbations as well as its association with social factors were retained while studies solely looking at non-social factors or abstract-only studies were excluded based on the full text screening. In Phase 4, data on frequency of both inpatient and outpatient physician visits for asthma were extracted along with information on study characteristics and social factors.
Results: Following the initial database search, 3312 studies were retrieved for the scoping review. 772 duplicates were removed during Phase 1. 1628 studies were excluded during the abstract and title screening in Phase 2. Upon resolving 384 conflicts, the remaining 912 studies proceeded to full text screening in Phase 3.
Conclusion: The initial literature screening suggests an association between social risk factors and pediatric asthma exacerbations. Incorporating large scale change of these social factors with individual pharmacological treatment could help improve pediatric asthma outcomes.
Effects of Gkn1 On Biofilm Formation
Authors: Wasserman-Bruck Tova , Boger-May Boger-May , Rubadeux Derek , Ruley-Haase Katelyn , Boone David L.
Published: December 2021

Background and Objectives:
Gastrokine-1 (Gkn1) is a protein produced solely in the stomach and secreted into the lumen of the gut. Gkn1 has a BRICHOS domain which is anti-amyloidogenic. While the exact function of Gkn1 is not yet completely understood, Gkn1 has a protective role against IBD in induced models of colitis. Since microbes secrete amyloid to facilitate biofilm formation, we hypothesized that Gkn1 may play a protective role against IBD by inhibiting amyloid formation by biofilm forming microbes in the gut. We examined the effects of varying concentrations of Gkn1 on known biofilm forming microbes to determine if there was a dose responsive inhibitory effect of Gkn1 on biofilm formation. 
Methods:
Bacterial colonies from Adherent Invasive E. coli and E. faecalis were cultured and incubated at 37 degrees Celsius overnight. The samples were then diluted 1:100 and inoculated into 96-well costar microassay plates with concentrations of Gkn1 ranging from 0.00075 to 0.025 mg/ml. At 8, 24, or 48 hour time points the plates were then washed to remove planktonic bacteria, and adherent biofilms were stained with crystal violet. Biofilm formation was analyzed by comparing the OD590/OD600 against a control.  
Results: 
Using a one-way ANOVA, we determined that there is dose response inhibition of biofilm formation with Gkn1, with the greatest inhibition of biofilm formation at concentrations of Gkn1 between 0.00312 and 0.0125 mg/ml. 
Conclusions: 
A dose response inhibition of Gkn1 on biofilm formation was identified. Since Gkn1 has demonstrated a protective role against IBD in induced colitis, targeting intestinal luminal amyloids may be a potential therapeutic approach for IBD.
Alliances to Disseminate Addiction Prevention and Treatment (ADAPT): Assessing the Exchange of Ideas in Alliances Between Juvenile Justice and Community Mental Health Centers
Authors: Patrick Elise , Schwartz Katherine , Ouyang Fangquian , Taylor Stanley , Aalsma Matthew
Published: December 2021

Background/Hypothesis: 
In the US, over half of youth involved in the juvenile justice system meet criteria for substance use disorder (SUD). Further, SUD is a consistent predictor of recidivism. Thus, significant improvements are needed to assure that justice-involved youth who meet criteria for SUD are screened and referred to care, especially in rural settings. ADAPT, an ongoing, statewide project, employs a learning health system (LHS) model to implement evidence-based practices (EBPs) to develop and improve alliances between juvenile justice (JJ) and community mental health centers (CMHCs).  We assessed collaboration, “alliance,” between these systems. 
 
Methods:  
The LHS alliance was assessed with self-report surveys distributed to personnel at 8 county sites. These included the cultural exchange inventory (CEI) measure to assess the process of exchanges in knowledge (beliefs about the process of implementing EBPs), and outcomes of those exchanges (beliefs about the outcome of interagency collaboration), to assess the alliance between JJ and CMHCs.  
 
Results:  
Pre-implementation surveys indicated a significant difference between CMHC respondents (CEI Output M=3.55, SD=1.53) compared to JJ respondents (M=2.89, SD=1.57) about the outcomes of the exchange of ideas [t(190)=2.13, p=0.03]. Both CMHC (CEI Process M=3.93, SD=1.45) and JJ participants (CEI Process M=3.84, SD=1.96) reported similar beliefs about the process of idea exchange t(119)=0.27, p=0.78). Further, participants from low rurality counties (i.e., more urban) reported less favorably to beliefs about the outcomes of collaboration (CEI Output M=3.16, SD=1.62) compared to medium rurality county participants [M=3.76, SD=1.39; t(120)=2.03, p=0.04]. Thus, we find a difference in perception of collaboration both between systems and between counties of varying rurality. 
 
Conclusion/Potential Impact:  
These findings help capture the current barriers to collaboration that exist between JJ and CMHCs before implementation of the LHS framework. Understanding these barriers between systems is essential to better cultivate interagency alliances to improve care for justice-involved youth with SUDs.
Changes in Receptive Field Size in Syngap1 +/- Mouse Model of Autism Spectrum Disorder
Authors: Anderson Evan , Martin Charles A , Dadarlat Maria
Published: December 2021

Background and Hypothesis:  Autism spectrum disorder (ASD) is a form of intellectual disability with impairments in social functioning and cognition. Mutations within the SynGAP1 gene are associated with ASD due to over activation of RAS-GTP causing insertion of AMPA receptors onto the post synaptic membrane, and thus early maturation of dendrites. These mutations lead to an excitatory/inhibitory imbalance within the brain, and patients often present with intellectual disability, seizures, and issues of cognition. Research has shown that Syngap1 +/- mice have decreased cortical gray matter brain volume throughout areas involved in the visual system pathway. However, hierarchal visual processing has not been well characterized in a Syngap1 +/- mouse model of autism.  
Project Methods:  Using 64 and 128 channel microelectrodes, we recorded the neural activity within V1 of four mice. Neural activity was recorded in response to visual stimuli - testing receptive field size between two wild-type and two Syngap1 +/- mice. Data was run through spike sorting algorithms to identify neurons. Receptive field area for each neuron was then calculated and compared between the two genotypes.  
Results:  The receptive field areas of Syngap1 +/- mice were statistically larger (p < 0.01) compared to wild type mice. Syngap1 +/- mice had a mean receptive field area of 450.5 visual degrees (±443.7) and WT mice had a mean receptive field area of 261.1 visual degrees (±187.21). Most of the neurons within Syngap +/- had no distinct receptive field, 67.9%, while only 25.7% of wild type neurons lacked a distinct receptive field.  
Conclusion and Potential Impact:  Overall, Syngap1 +/- mice had larger, and less distinct receptive fields compared to wild type mice. Deficiencies in the Syngap1 protein may impair refinement of visual stimuli. Understanding the mechanism of response of missing SynGAP1 can inform directed therapies and interventions to treat patients with the missing gene and manage their intellectual disability.
A survey study of the impact of COVID-19 on women at high risk for infant mortality in Central Indiana
Authors: Asthana Tanvi , Tang Qing , Hodges Matt , Litzelman Debra
Published: December 2021

Background/Objective: The WeCare program aims to reduce infant mortality through the community health worker model by assisting high risk women of child-bearing age. The COVID-19 pandemic introduced additional challenges for women already at high risk factor for infant mortality (IM). The aim of this survey study is to assess the impact of the COVID-19 pandemic in this population.
Methods: Enrolled WeCare participants were given an optional COVID-19 phone survey (modified from the IeDEA survey*) between August 2020 and May 2021 to assess the impact of COVID-19 on their daily lives, income, food security, and mental health. Trained research assistants and community health workers administered surveys. Verbal consent was obtained over the phone.  Data was entered into REDCap.  From REDCap, data was exported to SAS version 9.4 to calculate descriptive statistics and chi square tests.
Results:  Fifty-six primarily women of color (68%) completed the survey. Sixty-two percent of women lived in high-risk zip codes for infant mortality in Central Indiana. Fifty-seven percent of women worked prior to the outbreak. Forty-eight percent of the working women lost income, and seventy percent of women worked jobs requiring interaction with the public.  These women experienced greater food insecurity (38%), depression (24%), and anxiety (31%) compared to before the pandemic (p<0.001).
Conclusion/Discussion: The demographics and residence of those interviewed were representative of the WeCare cohort (NS differences in race/ethnicity/age). In comparing the prevalence of food insecurity, depression and anxiety between the survey sampled during covid and prior to covid, all factors were significantly increased. These vulnerable women (many pregnant or postpartum), often major breadwinners in their household, held jobs putting them at high risk for covid infections, and lost these high-risk jobs at an alarming rate.  These data confirm the detrimental impact of COVID-19, especially on a population already at high risk for IM.  
Acknowledgement of original authors of the *IeDEA survey: Suzanne Goodrich, Michael Scanlon, Leslie Enane, Kara Wools-Kaloustian
The Effects of TMP Treatment and High Fat Diet on Bone Fracture Healing
Authors: Zike Samuel , Nielsen Jeffery , De Andrade Staut Caio , Alentado Vincent , Dadwal Ushashi , Dalloul Christopher , Elsayed Abduallah , Hux Nicholas , Tewari Nikhil , Shaikh Mustafah , Myers Sarah , Nazzal Murad , Battina Hanisha , Blosser Rachel , Li Jiliang , Low Stewart , Niedrauer Mary , Low Philip , Kacena Melissa A.
Published: December 2021

Delayed and impaired bone fracture healing are associated with diabetic populations. This is a challenging problem for orthopaedic surgeons especially in the US where the percentage of type 2 diabetic patients continues to climb at an alarming rate. Limited treatment options exist for orthopaedic surgeons to improve fracture healing, and the most commonly used therapies involve placement of proteins (bone morphogenetic protein), graft tissue, or demineralized bone matrix at the fracture site. We have previously demonstrated that local administration of the main megakaryocyte growth factor, thrombopoietin, enhances bone healing. Here we demonstrate the utility of systemically administering thrombopoietin mimetic peptides (TMPs) to improve impaired fracture healing in a mouse model of type 2 diabetes. Briefly, 120 male mice on a C57BL/6 background were placed on a low fat diet (LFD) or high fat diet (HFD) for 12 weeks prior to undergoing a surgically created femoral fracture. Mice were treated with 33 nmol/kg of TMP or saline immediately after surgery and daily for the following week. Mice were euthanized at 1, 2, and 4 weeks post-surgery (n=10/group). Here, we confirmed that HFD resulted in impaired fracture healing. We also showed accelerated bone union and increased callus formation in TMP treated mice compared to saline groups, irrespective of diet (p<0.05). Among TMP groups that were fed either a HFD or LFD, the HFD TMP group showed greater improvements in bone healing compared to the HFD saline control mice. Further study on TMP should include alternative routes of administration and providing treatment when a surgical repair appears to be deteriorating. Although there is more to be understood about the clinical importance and mechanism by which systemic TMP treatment enhances fracture healing, these data appear promising.
AMPATH Surgical App: Open Appendectomy
Authors: Matthews Joshua , Bhatia Manisha , Saruni Seno , Hunter-Squires JoAnna L.
Published: December 2021

Background/Objective: Due to a geographic shortage of surgical providers within Kenya, doctors without surgical training are expected to complete emergency surgical procedures. The Academic Model Providing Access to Healthcare (AMPATH) surgical team is developing an education module, delivered via mobile phone app and self-made simulators, dedicated to the skills necessary to complete open appendectomy. We hypothesize that our model and curriculum will provide a low-cost method of effectively simulating the open appendectomy.  
Methods: After developing a step-based curriculum, an initial prototype of a model for the appendectomy was constructed. Expert academic surgeons from Indiana University were identified to test the prototype by performing an open appendectomy on the model. Feedback on both the model and the procedure was obtained via recorded video and REDCap.
Results: A total of 8 expert surgeons were consulted on the model, each presented with an updated version of the appendectomy model and procedure based on feedback. Experts provided feedback on the model and each substep of the curriculum. Overall, the curriculum was clear with each substep receiving a median score of at least 82 out of 100 for clarity. While the model received lower scores in utility and “realism, expert feedback was incorporated in an iterative process such that latter models demonstrated net improvement in the realism and utility of several substeps, including “the appendectomy”.
Conclusion: A low-cost appendectomy model with corresponding curriculum was developed, and refined with expert feedback, to facilitate this project’s transition to its next stage – testing on medical trainees. Additionally, the model and curriculum will enable the development of an AI algorithm to give the learner real-time feedback as they perform the simulation.
Implications: Ultimately, this study may create a platform that increases access to best possible practice and improves outcomes in settings where surgical education is limited.
Radiographic Outliers, Revisions, and Functional Outcomes in Fixed-Bearing Medial Unicompartmental Arthroplasty
Authors: Harris Colin , Deckard Evan R. , Ziemba-Davis Mary , Sonn Kevin A. , Meneghini R. Michael
Published: December 2021

Background and Hypothesis:
Unicompartmental Knee Arthroplasty (UKA) is a technically demanding procedure vulnerable to errors in component positioning. Recent studies suggest robotic-assistance improves precision of implant placement, minimizes outliers, and improves survivorship. However, we have previously demonstrated an experienced surgeon can match robotic accuracy. This study evaluated revision rates and functional outcomes of radiographic outliers in manual UKA.
Experimental Design or Project Methods:
A retrospective review of 222 consecutive fixed-bearing medial UKAs was conducted. Implant positioning and alignment were assessed radiographically measuring tibial coronal (TCA), femoral coronal (FCA), tibial sagittal (TSA) and femoral sagittal (FSA) angles as well as implant overhang. UCLA Activity Level and all-cause survivorship were evaluated. Student’s t-test, Chi square, and Kaplan Meier curves were used in analyses with alpha ≤ .05 designating statistical significance.
Results:
Using previously published alignment goals, our manual UKAs achieved the following targets: 92% for TCA, 100% for FCA, 88% for TSA, and 100% for FSA. For implant overhang, 100% met medial, anterior, and posterior targets. Our manual UKAs achieved desired alignment and overhang goals more frequently than previously published manual success. Survivorship free from aseptic revision in this study was 96% at 8.5 years. Additionally, there was no difference in UCLA Activity Level improvement comparing outliers and non-outliers (p³0.159).
Conclusion and Potential Impact:
Manual UKAs performed by an experienced surgeon showed improved success in achieving alignment and implant overhang goals compared to published manual UKA data and similar success compared to published robotic-assisted UKA data. We found no differences in revision rates or functional outcomes between outliers and non-outliers using previously published targets. For robotic assistance to be cost effective, it must demonstrate improved outcomes or survivorship when compared to manual UKAs. Our results contradict recently published claims that manual alignment outliers and failure rates fail to meet expectations for UKA.
Are Opioids Overprescribed to Pediatric Neurosurgery Patients? A Prospective Study on Prescribing Practices and Patient Use
Authors: Burroughs Leah , Ash Denise , Ackerman Laurie
Published: December 2021

Background and Hypothesis: The opioid crisis continues to worsen in the United States with opioid overdose deaths reaching record highs in 2020. While a large body of literature exists surrounding the risks of opioids in adults, opioids also pose unique risks to pediatric patients, including accidental ingestion, nonmedical use, and acute cerebellitis causing death. Opioid medications prescribed in the medical setting are often an unwitting source of excess opioids, with half of pediatric overdoses in those under 2 years of age. Although legislative efforts have significantly limited opioid prescribing, recent studies suggest these medications may still be overprescribed. We hypothesized opioid medications are overprescribed to pediatric neurosurgery patients upon hospital discharge.
Methods: Pediatric patients undergoing neurosurgical procedures at Riley Hospital for Children were identified prospectively. Surgery type, length of stay, and inpatient use of opioid medications were collected. Patients prescribed an opioid medication upon hospital discharge were contacted 7 days after discharge and asked to report the number of doses of opioid medication used.
Results: Thirty patients were successfully contacted 7 days after hospital discharge. Patients underwent a variety of cranial and spinal procedures and the mean length of hospital stay was 3.9 days. An average of 24.9 doses of opioid medication were prescribed at hospital discharge, while an average of 3.8 doses were used by patients in the 7 days following hospital discharge. Twelve patients (40%) had used zero doses of the prescribed opioid medication at 7-day follow-up.
Conclusions: Pediatric neurosurgery patients used only 15.3% of prescribed opioids in 7 days after hospital discharge. This creates an excess of leftover opioid medication that may increase the risk of accidental ingestion and misuse. The present study highlights the need for educational initiatives for providers to minimize excess opioids prescribed and for parents to safely dispose of leftover opioid medication.