bluuebunny/crossref_metadata_2025 huggingface dataset:
Revisiting California’s Past Great Earthquakes and Long-Term Earthquake Rate
Authors: Hough Susan E. , Page Morgan , Salditch Leah , Gallahue Molly M. , Lucas Madeleine C. , Neely James S. , Stein Seth
Published: December 2020

In this study, we revisit the three largest historical earthquakes in California—the 1857 Fort Tejon, 1872 Owens Valley, and 1906 San Francisco earthquakes—to review their published moment magnitudes, and compare their estimated shaking distributions with predictions using modern ground-motion models (GMMs) and ground-motion intensity conversion equations. Currently accepted moment magnitude estimates for the three earthquakes are 7.9, 7.6, and 7.8, respectively. We first consider the extent to which the intensity distributions of all three earthquakes are consistent with a moment magnitude toward the upper end of the estimated range. We then apply a GMM-based method to estimate the magnitudes of large historical earthquakes. The intensity distribution of the 1857 earthquake is too sparse to provide a strong constraint on magnitude. For the 1872 earthquake, consideration of all available constraints suggests that it was a high stress-drop event, with a magnitude on the higher end of the range implied by scaling relationships, that is, higher than moment magnitude 7.6. For the 1906 earthquake, based on our analysis of regional intensities and the detailed intensity distribution in San Francisco, along with other available constraints, we estimate a preferred moment magnitude of 7.9, consistent with the published estimate based on geodetic and instrumental seismic data. These results suggest that, although there can be a tendency for historical earthquake magnitudes to be overestimated, the accepted catalog magnitudes of California’s largest historical earthquakes could be too low. Given the uncertainties of the magnitude estimates, the seismic moment release rate between 1850 and 2019 could have been either higher or lower than the average over millennial time scales. It is further not possible to reject the hypothesis that California seismicity is described by an untruncated Gutenberg–Richter distribution with a b-value of 1.0 for moment magnitudes up to 8.0.
Tłumacz: uważny czytelnik i pośrednik. Literatura bułgarska w najnowszych przekładach Wojciecha Gałązki
Authors: Siedlecka Sylwia
Published: December 2020

Celem artykułu jest omówienie najnowszych inicjatyw przekładowych Wojciecha Gałązki, krakowskiego bułgarysty, literaturoznawcy i wybitnego tłumacza bułgarskiej prozy i poezji. W ciągu kilkunastu miesięcy, między 2019 a 2020 rokiem w przekładzie Gałązki ukazało się siedem utworów bułgarskich pisarzy i poetów: powieść Pod jarzmem Iwana Wazowa (2020); tomy poetyckie: Skądkolwiek wyjawiony Petyra Pyrwanowa (2019), Sezony uczuć Petyra Karaangowa (2020), Odblaski księżyca Nikołaja Liliewa (2020), Sen o szczęściu Pencza Sławejkowa (2020) oraz proza poetycka i wiersze zawarte w tomie Przeciwko nieobecności Nikołaja Kynczewa (2020). Zawarty w artykule przegląd inicjatyw translatorskich Gałązki uzupełniony został omówieniem konkretnych problemów związanych zarówno z praktyką przekładową (struktury brzmieniowe, gramatyczne, przekładalność związków frazeologicznych, uwzględnienie konwencji literackiej w procesie przekładu), jak i szerszych kwestii, związanych z rozumieniem przekładu jako transferu między kulturami (wymóg zgłębienia kontekstów oraz tradycji obu kultur, których przekład dotyczy) oraz rozumieniem roli samego tłumacza, którego Gałązka określa jako uważnego czytelnika i pośrednika między kulturami.
Balance y prospectiva de la iniciativa ciudadana europea en la intersección entre la vieja y la nueva Europa
Authors: Martín Martínez Magdalena M.
Published: December 2020

La entrada en vigor el 1 de enero de 2020 del nuevo Reglamento (UE) 2019/78 sobre la Iniciativa Ciudadana Europea (ICE) invita a realizar un balance del instrumento por excelencia llamado a impulsar la participación de la ciudadanía en la vida democrática de la UE. En el presente trabajo analizaremos su configuración jurídica, indagando en la eficacia y en los problemas políticos y jurídicos detectados durante las sucesivas fases de su aplicación. También examinaremos detalladamente la implementación práctica de las modificaciones legales introducidas para mejorar su funcionamiento, entendiendo que los resultados no solo ofrecen una prospectiva del devenir de esta institución, sino que tienen un valor extra como indicadores de la encrucijada actual en la que se halla la UE, ya que esta nueva etapa en la aplicación de la ICE ha coincidido con los albores de la Conferencia sobre el Futuro de Europa. En este capítulo inédito del proceso de integración europea el empoderamiento de los ciudadanos constituye un problema crucial de la democracia compleja de la UE, en la que la ICE debe contribuir decisivamente a la adopción de políticas y normas eficaces para que la Unión afronte los retos inesperados de la post pandemia.
El TJUE se declara incompetente para pronunciarse sobre un recurso por incumplimiento cuando la infracción del derecho de la UE resulta de un ilícito internacional. (Sentencia de 31 enero 2020, Eslovenia/Croacia, C-457/18)
Authors: Martinez Capdevila Carmen
Published: December 2020

El 31 de enero de 2020 el TJUE dictó sentencia en el asunto Eslovenia/Croacia (C-457/18), declarándose incompetente para pronunciarse sobre el recurso. En el trasfondo de éste se encontraba el laudo dictado en 2017 por un tribunal arbitral delimitando la frontera entre los dos países balcánicos. El TJUE niega su competencia para conocer de las violaciones del derecho UE alegadas por Eslovenia por entender que son accesorias con respecto al eventual incumplimiento del laudo arbitral por Croacia. Además, rechaza que la frontera entre los Estados miembros determinada en este instrumento pueda asumirse como presupuesto fáctico a la luz del cual apreciar la realidad de la infracción del derecho UE por parte croata. Tras su análisis, la sentencia del TJUE se considera acertada en ambos aspectos. Se defiende, además, que no supone que el Tribunal ignore el Derecho internacional, incluidos los principios pacta sunt servanda y res iudicata.
Impact of SSKI vs. Corticosteroids on Total Thyroidectomy for Graves Disease: A Retrospective Review
Authors: Baumgartner Timothy , Allison Hannah , McDow Alexandria
Published: December 2020

Background: Graves disease is an autoimmune disorder resulting in overproduction of thyroid hormone. While medical management can be used to reestablish euthyroid state, definitive management includes radioactive iodine or total thyroidectomy. For patients undergoing thyroidectomy, SSKI is frequently prescribed preoperatively to decrease thyroid vascularity and intraoperative blood loss. However, corticosteroids is often given when rapid preparation is necessary prior to surgery. This study explores the impact of SSKI compared to corticosteroids and hypothesizes that replacement of SSKI with corticosteroid will improve surgical outcomes.  
Methods: We performed a retrospective review of 26 Graves patients undergoing total thyroidectomy from 2015-2020. 18 patients received SSKI prior to surgery, 2 received a corticosteroid in addition to SSKI, 1 received a corticosteroid alone, and 5 received neither. Symptomatology, length of stay, intraoperative blood loss, transient hypoparathyroidism, and thyroid weight were compared. 
Results: Patients receiving corticosteroids experienced shorter stays (1.0 day vs 1.3 days), greater postoperative parathyroid hormone levels (43.0 pg/mL vs 28.9 pg/mL), less intraoperative blood loss (14.4 mL vs 41.4 mL), and presented with smaller thyroid glands (30 g vs 47 g) compared to those who received SSKI. There was a statistically significant difference in estimated blood loss between the groups (p = 0.0348). For some patients, the addition of a steroid to SSKI decreased surgery time (1.98 hours vs 2.32 hours). 
Conclusion: Despite limitations in sample size and the retrospective nature of this study, results suggest a positive impact of corticosteroid use on surgical and patient outcomes compared to SSKI alone. Future examination may benefit from greater sample size and equal distribution of patients among groups. We propose further exploration with a prospective study to evaluate the impact of SSKI vs. corticosteroids on surgical difficulty and postoperative complications for Graves disease patients.
CaMKK2-Mediated Effects on Mechanically Induced Bone Formation in Male and Female Mice
Authors: Bello Margaret , Warrick Adam , Mattingly Brett , Williams Justin , Sankar Uma
Published: December 2020

Background and Hypothesis: Ca2+/calmo-dulin-dependent protein kinase kinase 2 (CaMKK2) is a serine-threonine protein kinase that plays a significant role in both anabolic and catabolic pathways of bone remodeling. Mechanical loading of bone translates an external force into both biochemical and structural changes. It has been shown that deletion or inhibition of CaMKK2 results in increased bone density in male and female mice. We hypothesize that the lack of CaMKK2 in bone cells will result in loading-induced bone mass accrual with no difference between male and female mice. 
Experimental Design or Project Methods: The right tibia of anesthetized 16-week-old wild-type (WT) and CaMKK2 knockout (KO) mice were loaded at 2 Hz for 220 cycles and with peak forces specific to both sex and genotype. Loading was accomplished using an electro actuator (Bose ElectroForce 3200; EnduraTEC, Minnetonka, MN, USA). This was repeated 3, 5, 8 and 10 days after initial loading. The non-loaded left tibia served as an internal control. Calcein and alizarin red were administered intraperitoneally on days 9 and 16, respectively to metabolically label newly formed bone. Nineteen days after initial loading, mice were sacrificed. Blood and long bones of the lower limbs were collected for analysis. 
Results: Using microcomputer tomography; dynamic histomorphometry; histology, immunohistochemistry, enzyme-linked immunosorbent assay and real-time reverse transcription-polymerase chain reaction, we will assess bone volume, bone formation rate, and underlying mechanisms at the cellular and molecular level. These data are forthcoming. 
Conclusion and Potential Impact: With expanded knowledge on how bone growth is augmented, clinical outcomes related to osteoporosis and fracture healing, for example, may be improved. This may be accomplished through novel therapy related to these pathways that increases bone density or decreases fracture healing time.
Do Distracted Driving Laws Impact Cell Phone Usage on (Preventable) Outcomes While Driving: A Systematic Review of the Last 20 Years?
Authors: Bhuiya Nudar , Hollister Lisa , Zhu Thein
Published: December 2020

Background/Objective: 
Distracted driving due to cellphone use can lead to serious and fatal consequences. In 2017, an estimated 14% of all distraction-affected fatal crashes in the U.S. were related to the driver’s cellphone use. Many states have passed distracted driving laws to help reduce the number of unfortunate outcomes related to a driver’s cellphone use. It is important to evaluate whether these laws are truly effective at building safer roads. The main objective of this proposed study is to execute a systematic review of literature published in the last 20 years in order to further the understanding of how distracted driving laws affect drivers’ cellphone usage and its associated outcomes. 
Proposed Methods:  
A systematic review will be conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement established by Moher et al. The various steps that will be taken to properly select and analyze articles include eligibility criteria, information sources and search strategy, study selection, evaluation of selected articles, data collection, and summary measures.  
Expected Results:  
After implementing the various steps from the PRISMA statement, certain articles will be selected to fulfill the research objective. It is expected that most of the publications selected for this systematic review will be in support of distracted driving laws. It is also expected that these laws are in fact effective at reducing drivers’ cellphone use and various negative outcomes, such as crashes.  
Conclusions/Potential Impact:  
A systematic review will be completed utilizing the proposed protocol written in the summer of 2020. If needed, additional details and changes will be applied to the protocol before the study officially begins. This systematic review may help us gain an understanding of the effects of distracted driving laws, which may impact the approach to creating future policies and interventions intended to promote safer driving roads.
The use of branching scenarios to improve pharmacology content application
Authors: Bouwer Miranda , Guerrero Jonathan
Published: December 2020

Background/Objective:  
The Indiana University School of Medicine currently has many resources to offer its medical students to aid in their studies.  But, there are no interactive pharmacology modules available.  Pharmacology lectures only make up a small portion of lectures, but contain significant material students are expected to know.  Previously published studies demonstrate a positive impact of interactive modules on medical student education.  The goal of this project is to create interactive pharmacology modules to identify if this improves knowledge of pharmacology and standards of care. 
 
Methods:  
To start, one topic in pharmacology was chosen from each of the three spring semester first year classes.  UpToDate and primary literature articles were used to develop the content in each module to follow the most current guidelines.  A Pressbook was created for each topic and H5P was used to create the interactive branching scenarios which will be embedded in the learning management platform Canvas.  Students are given information in the module and are expected to answer relevant questions.  Based on the answer chosen, they either progress or have to answer the question again after receiving feedback.  Each module contains approximately three to four questions that the students advance through.  The modules will be implemented as part of the pre-work for the relevant lecture or small group and are intended to take up no more than 5-10 minutes of time. 
 
Results/Conclusion:  
Two survey questions will be added to the end of the course surveys for the three spring semester first year classes for the school year 2020-2021.  These questions will assess student satisfaction and the module’s usefulness. 
 
Potential Impact: 
Providing interactive, branching scenario activities may increase student satisfaction of pharmacology content, improve content application, and become a useful tool for future content in other courses as well.
Medication use among participants in a clinical trial of massage for chronic neck pain.
Authors: Brent James , Bair Matthew
Published: December 2020

Background and Hypothesis: 
Chronic neck pain is a common problem in veterans and is treated with NSAIDS and other analgesics. Massage is gaining traction due to patient demand, and concerns of long-term use of opioids and NSAIDS. We evaluated the use of analgesics and psychotropics among veterans in a clinical trial of massage for chronic neck pain. We hypothesized that analgesic use would be common and change over time. 
Project Methods: 
This is a retrospective chart review study of patients enrolled in the TOMCATT trial. The TOMCATT trial addressed biological, psychological, and social aspects to the treatment of chronic neck pain. Eligible patients were Veterans with chronic neck pain at the Richard L. Roudebush VA Medical Center in Indianapolis. The medications assessed by reviewing the pharmacy records embedded in the VA’s EMR were acetaminophen, NSAIDS, muscle relaxants, opioids, topical analgesics, antidepressants, benzodiazepines, and anxiolytics. Patient medication use was assessed for 9 months during the trial. 
Results: 
Of the 235 veterans reviewed 33 were female and 202 were male. 11% of the patients were not prescribed medication during their trial. At kickoff date, 24% were prescribed acetaminophen, 29% NSAIDS, 40% muscle relaxants, 20% opioids, and 34% topical analgesics.  At 9 months, those prescribed analgesics changed only slightly. Also, at kickoff date 35% were on antidepressants, 6% on benzodiazepines, and 5% on anxiolytics. These medications did not change much by 9-months.  
Conclusion and Potential Impact 
Analgesics and antidepressants/anxiolytics were frequently prescribed among participants in this clinical trial. The most prescribed analgesics were muscle relaxants and topical analgesics.  Overall, analgesic use did not change much over the course of the trial.  In future work, we will monitor the continued use of meds to see if muscle relaxants and topicals remain the most used analgesics.
Examining spondyloarthritis in patients with inflammatory bowel disease
Authors: Burns Catherine , Jan Reem
Published: December 2020

Background/Objective: Axial spondyloarthritis refers to a syndrome of inflammatory back pain associated with radiographic or magnetic resonance imaging abnormalities. Peripheral spondyloarthritis can include dactylitis, enthesitis or oligo-arthritis. Together these encompass common extra-gastrointestinal manifestations of inflammatory bowel disease (IBD), with the prevalence of ankylosing spondylitis estimated to be about 3% in patients with IBD and unspecified sacroiliitis occurring in 10%. The goals of this study are to validate the accuracy of the Toronto Axial Spondyloarthritis Questionnaire in identifying patients with rheumatologic symptoms in the context of IBD, to re-evaluate the prevalence of spondyloarthritis in this population, and to identify any differences in referral rate between racial and ethnic groups. 
 
Methods: Patients were selected based on the following criteria: diagnosis of IBD, upcoming appointment with their gastroenterologist, prior consent in the Genesys database and access to an operational MyChart account. Patients were sent a link and asked to complete a RedCap survey modified from the Toronto Axial Spondyloarthritis Questionnaire. Positive patient responses will be analyzed in a follow-up visit with a rheumatologist to investigate the patients’ symptoms. 
 
Results: At present, the survey was sent to 86 patients with 26 respondents completing the survey. Of the respondents, 6 patients had experienced back pain for a duration of 3 months or longer. Eleven patients had pain and swelling of a joint unrelated to injury. Seven patients experienced pain and swelling of an entire finger or toe unrelated to injury. Seven patients experienced heel pain unrelated to injury. One patient is followed by rheumatology. 
 
Conclusion/Potential Impact: Major extra gastrointestinal manifestations of IBD include axial or peripheral spondyloarthritis which can lead to disabling back pain and/ or joint disease. With the modified Toronto Axial Spondyloarthritis Questionnaire, gastroenterologists could have a better way to identify concerning symptoms, leading to increased referral to rheumatologists and potential changes in treatment plans.
Barriers and Facilitators Along the HIV Care Cascade Among Hospitalized Adolescents in Western Kenya
Authors: Cabe Marielle , Toromo Judith , Enane Leslie
Published: December 2020

Background/Objective: There are 1.7 million adolescents living with HIV (ALHIV) globally, the majority of whom live in Eastern and Southern Africa. Despite increasing access to antiretroviral therapy (ART), ALHIV experience poorer HIV-related outcomes at each stage of the care cascade relative to other age groups. We sought to investigate barriers and facilitators experienced at each stage of the HIV “care cascade” – testing, linkage to care, retention in care, and adherence to and viral suppression on ART – among a cohort of hospitalized adolescents.  
 
Methods: This qualitative study used semi-structured interviews of hospitalized ALHIV and their caregivers to investigate if crucial delays occurred at each stage of the HIV care cascade. Interviews explored barriers and facilitators at each stage, and were guided by a framework that considered adolescent- or family-level factors, developmental and mental health needs, society-level, programmatic, and health system factors. Interviews were audio-recorded, transcribed and translated. Members of the study team independently coded each transcript after inter-coder reliability was established.  
 
Results: Hospitalized ALHIV experienced critical delays in care, most frequently at the stages of HIV diagnosis and ART adherence. Common barriers to testing related to lack of awareness around perinatal HIV and unknown maternal HIV status. Barriers to adherence were complex and heterogeneous. Common barriers included lack of HIV disclosure or problematic disclosure to the adolescent; intense stigma and challenges coming to terms with one’s HIV status; and issues related to ART side effects and tolerance. Facilitators to adherence included family supervision and support in ART taking, and HIV education and adherence counseling provided at the clinic. 
 
Conclusion and Policy Impact: Hospitalized adolescents experienced significant delays in care, most frequently at the stages of pediatric HIV diagnosis and ART adherence. Barriers to adherence are particularly complex. Interventions to address adolescent ART adherence are urgently needed.
Decisions to Enter and Leave Skilled Nursing Facilities for Post-Acute Rehabilitation: A Qualitative Study
Authors: Chimitt Daniel , Carnahan Jennifer
Published: December 2020

Background and Hypothesis:  
Approximately 40% of patients aged 80+ enter a Skilled Nursing Facility (SNF) following a hospitalization. SNFs can be used as “safety nets” to expedite the discharge process of older adults and it can be difficult to pinpoint how and who made the decision for a hospitalized older adult to discharge to a SNF.  
This project examines the factors that drive older adults to enter and leave a SNF for their rehabilitation care. 
 
Project Methods:  
Interview transcripts from a qualitative study with patients and their caregivers were used to examine factors influencing admission to and discharge from SNFs. Baseline interviews were conducted within two to seven days after returning home from a SNF stay followed by a follow up phone call one to two weeks after the initial interview. Transcripts and audio files were coded (using NVivo version 12+) for major themes. Interviews were analyzed using a constant comparative method to elicit themes of interest to interviewees. 
 
Results:  
There were 24 baseline interviews and X follow up interviews performed with a total of 24 patients and 15 caregivers. The primary theme identified was that patients perceived a loss of autonomy when considering the decision-making process. 75% (18/24) patients or their caregivers felt the healthcare team told them they must go to a SNF for their rehabilitation. 38% (9/24) patients or caregivers felt they had no choice but to leave due to insurance coverage and 50% (12/24) stated that they needed more time. 
 
Potential Impact:  
To achieve better patient outcomes, one must understand both the purpose of skilled nursing facilities and also how patients and their families are feeling as they transition through this uncertain period of their lives. Restoring a patient’s sense of autonomy will foster better patient-healthcare relationships and improve trust in the system.
Intra-muscular administration of autologous bone marrow mononuclear cells reduces opioid dependency in patients with critical limb threatening ischemia.
Authors: Couetil Justin , Murphy Michael
Published: December 2020

Background and Hypothesis  
Critical limb-threatening ischemia (CLTI) is a severe limitation in perfusion of the lower extremities. It is the most advanced stage of peripheral arterial disease. Characterized by unremitting rest pain and/or gangrene, the CLTI patient population has an excessively high rate of opioid use and addiction. The MOBILE Trial was a Phase II multi-center, double-blinded placebo controlled trial designed to assess the safety and efficacy of autologous bone marrow cells (ABMC) in treating patients with CLTI. Our central hypothesis is that cell therapy may provide trophic effects in the treated limb that may decrease opioid requirements. 
 
Project Methods  
The primary endpoint of the MOBILE Trial was amputation-free survival at 52 weeks. Secondary endpoints included limb perfusion measures, ambulatory function, quality of life (VascuQol), pain assessment with a visual analog score, and opioid requirements, as tabulated by prescriptions reported to us. A post-hoc statistical analysis using ANOVA was conducted to describe changes in pain and quality of life measures along the study, and Fisher’s test to compare the incidence of new opioid prescriptions between treatment groups. 
 
Results 
There were no differences in quality of life and visual analog pain measures between the ABMC and placebo groups (P= 0.42). There was however a 36% decrease in new opioid prescriptions in the ABMC groups as compared to placebo (P = 0.058, HR: -0.44-1.012). This reduction did not correlate with changes in limb perfusion measures, gender, age, diagnosis of diabetes, or Rutherford score. 
 
Discussion 
The results of this analysis demonstrate an effect of ABMC in reducing opioid use in a high-risk addiction patient population. These findings are consistent with other studies assessing mesenchymal stem cells in chronic pain syndromes. The effect of ABMC did not correlate with changes in limb perfusion suggesting other beneficial trophic effects of cells in ischemic induced neuropathies. This discovery suggests a potential therapeutic strategy for reducing opioid dependency.
Gene Network Analysis Reveals Association between Somatic Loss of Y and Genes Involved in Hemostasis
Authors: Dharla Vijai Kumar , Lui Yunlong , Nudelman Kelly
Published: December 2020

Background and Hypothesis: 
Somatic loss of the Y chromosome (LOY) is associated with diagnoses of various cancers, Alzheimer’s disease, and cardiovascular events. In the case of cardiovascular disorders, no mechanistic link to LOY has been elucidated. To explore this relationship, we utilized Weighted Gene Co-Expression Analysis (WGCNA), a powerful technique that can reveal associations between modules of co-expressed genes and clinical traits. We hypothesized WGCNA would reveal a module that illuminates the relationship between LOY and cardiovascular disease. 
 
Methods: 
Information about 403 male participants was obtained from Alzheimer’s Disease Neuroimaging Initiative (ADNI), including Genome Wide Association Study (GWAS), microarray, and patient demographic data. GWAS data was obtained from each participant within one year of collecting gene expression data. Using GWAS data for each participant, a median log R ratio was calculated for probes in the male specific region of the Y (MSY), which showed detectable LOY in 16 participants. Microarray data was used for WGCNA. Genes with correlated expression levels were organized into modules which were tested for associations with age, Alzheimer’s disease status, APOE-e4 allele status, and LOY. Ensembl IDs were used to investigate Gene Ontology (GO) enrichment in the GO database. 
 
Results: 
One module was associated with LOY (p=0.001). GO enrichment revealed significant representation of 47 GO terms within this module. Highly enriched GO terms included “platelet aggregation” (FDR = 8.05 x 10-6), “blood coagulation, fibrin clot formation” (FDR= 0.0328), “regulation of megakaryocyte differentiation” (FDR=3.01 x 10-5), and other terms related to the vascular response to injury. 
 
Potential Impact: 
WGNCA revealed a module associated with LOY that is related to vascular injury response. While LOY is associated with cardiovascular events, more work is needed to explore its association with biomarkers for cardiovascular disease. Our findings warrant more investigation into the relationship between LOY and cardiovascular dysfunction in males.
Tourniquets and Adductor Canal Blocks in Total Knee Arthroplasty: Is There a Synergistic Effect on Postoperative Pain and Quadriceps Weakness?
Authors: Dimmett Macy , Ziemba-Davis Mary , Buller Leonard , Meneghini R. Michael
Published: December 2020

Background and Hypothesis:  Adequate pain control and avoidance of falls are crucial for successful early recovery following total knee arthroplasty (TKA). Studies have shown an increase in postoperative quadriceps weakness (QW) and pain associated with tourniquet use during TKA. Additionally, increasing doses of adductor canal block (ACB) anesthetic per unit of BMI are associated with QW after TKA. This retrospective cohort study examined whether tourniquets and ACBs have a synergistic effect on postoperative QW and pain.  
 
Experimental Design or Project Methods:  348 TKAs in 319 patients performed by a single surgeon between October 2015 and May 2018 were retrospectively reviewed. Outcomes included QW as documented in the physical therapy evaluation, average pain score during the first 24 hours after PACU discharge, average pain score during the remainder of the hospital stay, and final pain score prior to discharge. 
 
Results:  Sex, age, and BMI did not differ in patients with ACBs with (n=177) and without (n=168) tourniquet use (p≥0.330). The overall prevalence of QW in the sample was 8.7%. Proportionally more patients with ACBs and tourniquets (11.6%) had QW compared to patients with ACBs without tourniquets (6.1%), but the difference was not statistically significant with the numbers available. Patient-reported pain scores at the three time points did not differ significantly between patients who received ACBs with or without tourniquets.  
 
Conclusion and Potential Impact:  There appears to be no synergistic effect of ACBs and tourniquet use on postoperative pain. However, due to the effect size and number of cases in each group, the synergistic effect of ACBs and tourniquet use on QW deserves additional study with a larger sample size as these results may impact functional recovery and postoperative complications among patients undergoing primary TKA.
NICU Admission Rates for suspected Growth Restricted Fetuses Born at Full Term
Authors: Dolan Madison , Gordon Geoffrey
Published: December 2020

Background and Hypothesis: 
 
Fetal growth restriction (FGR) is the second leading cause for infant morbidity and mortality behind preterm birth. It is a sonographic estimated fetal weight (EFW) below the 10th percentile for gestational age. Neonates born <2500g at full-term are classified as “low birth weight.” In the United States, more than 8% of all births fit this classification. These fetuses are at increased risk for both short and long term complications. Traditionally delivery at a NICU capable facility is recommended with an expected birth weight <2500g. There is little data to support this arbitrary cut-off. This study was designed to compare rates of  NICU admission and short term complications for liveborn neonates at full-term. We hypothesize these rates will be increased in neonates with a birth weight <2500g.  
 
Methods: 
 
This is a proposed retrospective chart review of liveborn neonates at full-term at a regional medical system between January 2013 – December 2020. We excluded women under the age of 18, twins, fetuses with genetic syndromes, anomalies, or abnormal Umbilical Artery Dopplers.  Neonates were categorized into two categories: birth weight between 2000 – 2499g and birth weight between 2500-3000g. Outcomes included rates of NICU admission, tachypnea, acidosis, hypoglycemia, hyperbilirubinemia, feeding difficulties, APGAR scores, and temperature instability. Chi-square and logistic regression were used.  
 
 
Results: 
 
This study design will be submitted in the form of an IRB protocol. Results will include statistical comparisons between weight groups for NICU admission and other short term complications. Additionally data analysis on social and demographic characteristics will be done. 
 
 
Conclusions: 
 
Results of this study will help determine an adequate cut off for delivery planning and identify characteristics of the mother and fetus to be taken into consideration. These findings could increase need for a prospective trial, be used in evaluation of ultrasound accuracy, and impact the standard of care.
Retrospective Chart Review Comparing CKD COVID-19 Positive Patient Outcomes to non-CKD Patient Outcomes
Authors: Eckert Nicole , Sankari Safiya , Allen Katie , Lui Hui Siu , Mendonca Eneida
Published: December 2020

Background/Objective: 
Since January 2020, there have been over 3 million individuals infected with the coronavirus in the United States, quickly spreading across at least 171 countries. The severity and morbidity of patients with COVID-19 are significantly increased when comorbidities, such as Chronic Kidney Disease (CKD), are present. Because the main target of SARS-CoV-2 is ACE2, patients with CKD may be a more vulnerable population. The goal of this study was to determine if COVID-19 positive patients with CKD had increased mortality, inpatient admission, and ED visitation rates compared to those without CKD.  
 
Methods:  
This retrospective chart review includes patients from over 100 separate healthcare entities who were diagnosed with COVID-19 between January 1, 2020 and July 13, 2020 and are over the age of 18. The subjects were first separated into those diagnosed with CKD and those without, basic descriptive calculations were computed, and a Chi Square test was used to analyze outcomes.    
 
Results: 
The CKD COVID-19 positive population was compromised of 47.5% men and 52.5% women while the non-CKD control group was made up of 45.4 % men, 54.1% women, and 0.5% other. The median Charlson index for the CKD and non-CKD population was 4 and 1, respectively. The interest and control groups were further divided into subpopulations by age and race and analyzed accordingly. Chi square tests demonstrated that there is a statistically significant difference (p<0.05) in all clinical outcomes tested of CKD patients diagnosed with COVID-19 compared to non-CKD patients. The CKD population had increased mortality, inpatient admission, and ED visitation rates when compared.  
 
Discussion: 
This study demonstrates that comorbidities, more specifically CKD, may be associated with a higher severity of COVID-19 than those without. Future studies are needed to explore the relationship more extensively, analyze other outcomes, and manage confounding variables.
Biomarker sST2 in Adults with Transposition of the Great Arteries Palliated by Mustard Procedure
Authors: Ferguson Haley , Martinez Hugo , Pride Melanie , Hurwitz Roger , Payne Mark
Published: December 2020

Background: Transposition of the great arteries (TGA) is a congenital heart defect (CHD) in which the aorta and pulmonary artery are transposed; it requires urgent surgical intervention. The Mustard procedure was an early surgery allowing survival into adulthood. However, this procedure is associated with long-term adverse effects including arrhythmias and heart failure (HF). A key factor impairing HF management in adults with CHD is lack of biomarkers to predict outcome. Soluble ST2 (sST2) is a protein secreted by myocytes in response to mechanical strain and fibrosis. No studies have focused specifically on sST2 in TGA individuals that underwent a Mustard procedure.  In this study, we hypothesized adults with TGA palliated with a Mustard procedure would have higher levels of sST2 than healthy individuals, and this would correlate with functional class status. 
 
 
Methods: We screened the Pediatric Cardiology database for D-TGA subjects and Mustard operation. Healthy controls were recruited from clinic and the community. Patients were matched by age to a control group of 21 healthy individuals.  Severity of symptoms was assessed by NYHA functional classification. sST2 levels were obtained using Critical Diagnostics Presage ST2 Assay kit. Additionally, cTnI, BNP, lipid panel, insulin, glucose, and EKG and echocardiography (TGA) were obtained at IUSM clinical laboratories.   
 
Results: We identified 45 patients with D-TGA and Mustard operation. 19 patients were included in analysis: 12 male and 7 female subjects aged 18 to 46, mean of 34.9 years. In the Mustard group, 9 subjects were assigned to NYHA class II, and 9 to class III. The control group was asymptomatic. sST2 levels in the Mustard group were elevated in 53%, while only 29% in the controls. Of the Mustard subjects with elevated sST2, 67% had elevated cTnI, 80% arrhythmias, 70% EKG T-wave abnormalities, and 80% took cardiac medications.  90% of these patients had low HDL, 40% high LDL, and 40% low insulin.   
 
Conclusion: This study demonstrates patients with Mustard operation averaged higher sST2 levels than healthy subjects. Importantly, of the patients with elevated levels, there was a significant association of sST2 with biomarker abnormalities and clinical heart failure signs.  This suggests in patients with D-TGA palliated with Mustard procedure, sST2 may add predictive value to cardiac related morbidity and mortality.
Developing a Minimally Invasive Cell-Based Model to Predict Response to Major Trauma
Authors: Gates Kayla , Nunge Rebecca , Adom Jamila , Kaplan Mark , McKinley Todd
Published: December 2020

Background. Physical trauma results in a systemic inflammatory response.  Preliminary research in orthopedic trauma patients suggests that patients with similar demographics and severity of injury vary in their response to traumatic injury.  Analysis of the immunological response post-injury showed a sustained pro-inflammatory response with delayed reparative cytokine expression in trauma sensitive patients, while the trauma tolerant patients had an early inflammatory expression with resolution by 72 hours post-injury.  Thus, we hypothesize that differential response to non-traumatic injury might serve as a predictive tool for the identification of trauma tolerant and sensitive patients prior to injury.  The goal of this research is to test whether immunological changes to inflammatory stimuli can predict tolerance or sensitivity to trauma using an-vitro cell-based assay. 
Methods. Splenocytes were isolated from naive C57BL/6 mice and subjected to biological trauma in vitro using LPS (100 ng/mL) or hypoxic trauma using hydrogen peroxide (50 µM, 100 µM, and 200 µM) with or without proinflammatory cytokines, IL-1β (1 ng/mL) , IL-6 (200 ng/mL), and IL-33 (150 ng/mL). Inflammation and hypoxia were assessed using IL-6 and HIF-1ɑ expression respectively via qPCR 24 hours post-treatment. Cell death and pro-inflammatory cytokine production using multiplex analysis were used to measure outcomes.  
Results. Both types of treatments showed increased cell death compared to the control group. qPCR data is pending. 
Conclusion. With these studies as a core of the experimental approach, this in vitro cell-based assay will be used to assess immunologic response to inflammatory stimuli across the genetic variation of mouse strains. Findings from this project could enable the development of a clinical test that accurately predicts immunologic response to trauma and related-complications based on patients’ sensitivity to pre-traumatic injury.
Parent Preferences for Ulnar Polydactyly Management
Authors: Goebel Gunnar , Loewenstein Scott , Adkinson Joshua
Published: December 2020

Introduction: Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with either suture ligation or surgical excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly. 
 
Methods: We developed an ad-hoc survey instrument for parents of children with type B ulnar polydactyly that assessed motivation for choosing treatment, parent-reported outcomes, and overall satisfaction. Face validity was confirmed with a think-out-loud protocol using 5 test subjects. We administered surveys via telephone after treatment was complete. We assessed for differences between the cohort who chose in-office suture ligation versus the cohort who opted for operating-room excision using Chi square and Fischer exact tests for categorical variables and Student t-test for continuous variables.  
 
Results: Seventy of the 156 parents of consecutive patients contacted agreed to participate (45% response rate), with a mean follow-up of 2.25 years. Twenty-eight chose in-office suture ligation and 42 chose surgical excision. Rapid treatment was prioritized more often in those who selected suture ligation than in those who opted for surgical excision (p=0.044). The complication rate for suture ligation was significantly higher than for surgical excision (p<0.0001), with the most common complication being a residual bump (i.e. nubbin or neuroma stump) (64%). Respondents with residual bumps reported significantly less satisfaction with the aesthetic appearance of their child’s hand (p<0.001) and with their child’s treatment outcome (p=0.028) compared to those without residual bumps. 
 
Conclusion: Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Time to treatment plays a determinative role in parents opting for suture ligation rather than surgical excision. Regardless of treatment, the majority of parents remain extremely satisfied with the outcomes.
Search Functionality Within the Electronic Health Record and Health Information Exchange Databases
Authors: Gregory Brandon , Hill Jordan , Schleyer Titus
Published: December 2020

Background and Hypothesis: 
In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.  
 
Project Methods:  
Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms. 
 
Results:  
From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms. 
 
Potential Impact:  
The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow.
scRNA-Seq Identifies IL-1 Responsive Cell Subsets in the Skin Injury-induced Inflammatory Response
Authors: Harpold Kayla , Zhou Hong-Ming , Slominski Radomir , Seymour Leroy , Bell Maria , Dave Priya , Atumonye Joseph , Wright III William , Dawes Avery , Griesenauer Brad , Paczesny Sophie , Kaplan Mark , Spandau Dan , Liu Yunglong , Xuei Xiaoling , Gao Hongyu , Hoki Aki , Turner Matthew
Published: December 2020

Inflammation is an integral aspect of skin wound healing; however, the mechanisms that regulate inflammatory cascades in this context are not well defined. To better understand how skin inflammation impacts wound healing, we developed an ex vivo skin culture system to model key aspects of the inflammatory phase of wound healing. In this model, a defined set of proinflammatory cytokines and chemokines, mirroring those produced in wounds in vivo, are produced when mouse or human skin biopsies are cultured ex vivo.  We refer to this pattern of cytokine and chemokine induction as the skin injury-induced inflammatory response. Previous studies in our laboratory demonstrated this response is initiated by the cytokine, interleukin 1 alpha (IL-1α). To understand the cellular sources and targets of IL-1α during the skin injury-induced inflammatory response, skin biopsies from mouse tail skin were cultured ex vivo for 8 hours followed by processing for single cell RNA sequencing (scRNAseq). Using bioinformatic software, R, and the package, Seurat, analysis of scRNAseq data from this experiment identified 22 distinct cell population clusters. While no populations exhibited significant expression of Il1a transcripts, multiple cell populations expressed Il1r1 transcripts, which encodes the ligand-specific subunit of the IL-1 receptor.  Notably, fibroblast, endothelial cell and stromal cell clusters were characterized by expression of Il1r1 and the skin injury-induced inflammatory response transcripts Il6, Cxcl1 and/or Csf3. Furthermore, Reactome Pathway Analysis suggested the Il-1 signaling axis was activated in these cell populations. This information provides a basis for future studies to understand how IL-1 signaling in fibroblasts, endothelial cells and stromal cells impacts wound healing in vivo, which could in turn lead to novel therapeutic approaches to clinically relevant outcomes.