bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence Of Liquidity And Profitability On Tax Avoidance (Case Study On Consumption Goods Industry Registered On The Idx 2015-2019)
Authors: Novianto Robertus Ary
Published: January 2024

Several factors indicate that the company is committing tax avoidance, including the liquidity and profitability policies. The research was conducted in order to investigate the influence of liquidity and profitability on tax avoidance the research method used is explanatory. The research sample is manufacturing companies in the consumer goods industry sector which are listed on the Indonesia Stock Exchange (BEI) for the 2015-2019 periods, totaling 57 companies. The data analysis technique used to test the hypothesis in this study is multiple linear regression analysis. The presumption of research results from previous studies shows that the liquidity and profitability variables affect tax avoidance.
The Effect Of Legal Nigilism And Legal Idealism On The Level Of Legal Consciousness And Culture
Authors: Makhmut Utemuratov
Published: January 2024

This article describes the system of tasks to improve the legal culture and the elimination of legalnihilism and legal idealism, still found in the minds and activities of members of society.And also about how legalnihilism and legal idealism, which feed each other, as a common beneficial phenomenon of legal illiteracy.
Morphometric characteristics of the abdominal surface of the diaphragm for various benefits
Authors: Prosvetov Vadim A. , Gaivoronsy Ivan V. , Surov Dmitry A. , Goryacheva Inga A. , Panenko Pavel S. , Fandeeva Oksana M.
Published: January 2024

The dependence of the regional morphometric characteristics of the abdominal surface of the diaphragm on body shape was evaluated because the information available in the specialized literature on this issue differs significantly. The study was conducted on 30 corpses aged 50–70 years, who were embalmed using a special technology (preserving tissue elasticity, giving the diaphragm a physiological shape with deep exhalation by pumping air into the abdominal cavity). The objects were then frozen, abdominal organs were sequentially removed, and linear dimensions and areas of subdiaphragmatic, subhepatic, and splenic depressions, physiological openings (inferior vena cava, aorta, esophagus, and ligamentous apparatus of the upper floor of the peritoneal cavity), area nuda, diaphragm legs, and lumbar–rib triangles were examined. The results of the analysis of the morphometric parameters revealed significant statistically significant differences in the linear dimensions and areas of the right and left subdiaphragmatic, subhepatic, splenic depressions, and individual parts of the diaphragm in individuals with different body shapes. For these anatomical formations of the peritoneum, the highest values of morphometric parameters are characteristic of the brachymorphic form of the physique, except for the sizes of the lumbar–costal triangles, medial legs, and height of the diaphragm domes, which have the maximum dimensions with a dolichomorphic form. Attention was drawn to the significant differences in the area nuda between extreme forms of physique, which reached 59%. Statistically significant differences were found in the morphometric parameters of the abdominal surface of the diaphragm in mesomorphic and extreme forms of physique; however, they are characterized by smaller values, ranging from 8% to 42% for various parameters. Of particular importance is knowledge of the size of the studied parts of the diaphragm covered by the peritoneum during cytoreductive interventions. Anatomical studies performed on specially embalmed objects with preservation of tissue elasticity and the physiological shape of the diaphragm allow us to obtain its reliable morphometric characteristics.
A new look at the immunopathogenesis of infection caused by the human immunodeficiency virus
Authors: Moskalev Alexander V. , Gumilevsky Boris Yu. , Apchel Vasiliy Ya. , Cygan Vasiliy N.
Published: January 2024

Thanks to the achievements of biotechnology and genetics, numerous features of reproduction of the human immunodeficiency virus and its immunopathogenesis have been established. Genetic studies have called into question the African origin of the virus. Thus, the number of individuals with mutational changes in the CCR5∆32 allele among the population providing genetic protection against human immunodeficiency virus is decreasing from north to south. The probability of adaptation of the great ape virus in the human population is characterized. New biological effects and their influence on the immunopathogenesis of infection of the well-known human immunodeficiency virus genes Gag (structural proteins), Pol (enzymes) and Env (envelope glycoproteins), the proteins encoded by them, as well as a number of additional proteins have been discovered. Thus, the main task of the Tat gene is to stimulate the transcription of proviral deoxyribonucleic acid and the transport of ribonucleic acid from the nucleus to the cytoplasm of the cell. Rev promotes the synthesis of viral structural proteins and enzymes, ensures the availability of full-sized genomic ribonucleic acid for inclusion in the reproduced viral progeny. Viruses with the absence of the vif gene are about 1000 times less virulent compared to wild strains. The APOBEC3G factor inhibits the reproduction of lentiviruses in primates, but in humans it is characterized by polymorphism of biological effects. Viral protein R affects the rate of reproduction of the virus in T-lymphocytes, contributes to their destruction. It also promotes proteasomal degradation and protein modification. Vpr targets may be a structurally specific endonuclease subunit SLX4, uracil-deoxynucleoacid glycosylase 2, and a helicase-like transcription factor. Vpu is a powerful inhibitor of teterin by type 1 immunodeficiency viruses of group M, and in group N viruses it shows low activity. Vpu, Nef, and Env proteins of most lentiviruses are characterized by higher tropicity to the CD4 receptor compared to teterin, serine incorporation proteins. These proteins are incorporated into viral particles and reduce their infectivity by inhibiting fusion with target cells. The protein containing the tripartite motif 5a, the protein of mixovirus activity 2/B constitute an ancient system of protection against retroviruses and are extremely variable in their effectiveness to disrupt the reproduction of viruses.
Frequency and causes of blood chimera in combat trauma victims
Authors: Tsygankov Кirill A. , Gorban Denis Yu. , Lakhin Roman E. , Shchegolev Aleksey V. , Savelyeva Lidiya P. , Konoshenko Pavel P.
Published: January 2024

The frequency and causes of blood chimeras in victims of combat trauma who arrived from special military operations were analyzed. Data from immunohematological studies of patients admitted to the clinics of the Military Medical Academy named after S. M. Kirov in the period from February to December 2022 were analyzed. All patients were assessed for blood group membership by AV0 systems and Rh factor with phenotyping of erythrocytes and the presence of antierythrocyte antibodies. Chimerism was found in 21% of the patients. According to the AB0 system, general chimerism was detected in 3. 1% of cases, whereas blood chimerisms for antigens A and B were found in 81. 8% and 36. 4% of the cases, respectively. Moreover, blood chimerism for antigens C, c, E, and e was detected in 100% of the cases, and for antigen D, the rate of chimerism was 7. 6%. The identified chimerism in the patients was caused by the use of “universal” doses of erythrocyte blood components by advanced medical service units. In general, the frequency of blood chimerism in victims of combat trauma in the clinics of the Military Medical Academy named after S. M. Kirov was 21%. Blood chimerism in combat trauma victims did not lead to significant immunization. Despite the absence of detected immunization, blood chimerism was a favorable background for possible hemolytic posttransfusion complications during treatment. Possible options for the prevention of blood chimerism include the introduction into practice of advanced use of artificial oxygen carriers, active use of hardware support for reinfusion of blood spilled into the cavity, and preparation of autokrovi for certain patients. These measures are aimed at reducing the number of transfusions of donor blood components, thereby preventing the formation of antierythrocyte antibodies and blood chimeras.
Evaluation of strength of intermediate supports of string rail track structure at uSky center in Sharjah (UAE)
Authors: Tsyrlin Michael I. , Unitsky Anatoli E. , Sharshov Roman А.
Published: January 2024

The paper presents strength analysis of the general arrangement and units of intermediate supports of the string rail track structure at the uSky Center in Sharjah (UAE).
Aim: Strength analysis of intermediate supports under the impact of a complex of loads from the track structure, vehicle and wind load.
Methods: The calculation was performed using the finite element method using Midas Gen and ANSYS programs.
Results: Analysis of the calculation results showed sufficient reliability of all elements of the intermediate supports.
A Heideggerian Phenomenological Qualitative Study
Authors:   , Ayala Jasiel , Smith Budhai Stephanie
Published: January 2024

Demographics in the United States are rapidly changing. It is projected that by the year 2050, the minority population of the country will instead be the majority (Craig & Richeson, 2017), and according to the Pew Research Center (2019), in some areas of the country, this is already the case. With changing demographics in the United States resulting in minority-majority schools, high school teachers are not prepared and lack the knowledge, skills, and dispositions required to teach through a culturally responsive lens (Mosconi, 2022). Teacher preparation programs do not effectively support teachers in building their capacity to integrate culturally sustaining pedagogies into their instructional practices (Harper, 2017). The purpose of this qualitative Heideggerian phenomenological study is to explore the experiences of teachers during their teacher preparation programs to understand the training and preparation they received to integrate culturally sustaining practices (CSP) into their instruction. Understanding how K-12 Teacher Preparation Program Standards affect the effectiveness of new teachers in the classroom is crucial to ensure that proper training is provided and that all students succeed. One focus group and three semi-structured interviews were conducted to capture teacher's perceptions and experiences of teacher preparation programs and their current ability to be equity-minded educators with the ability to serve ethnically, culturally, and linguistically diverse learners. Three overarching research questions guided this study: (1) How do high school teachers describe their teacher preparation programs' impact on their preparedness to utilize culturally sustaining pedagogies? (2) How do high school teachers describe the ways that in-service professional development has been used to build their knowledge gaps surrounding culturally sustaining pedagogies? (3) What do high school teachers share as ways that teacher preparation programs and in-service professional development can be improved to support teachers' capacity to serve ethnically, culturally, and linguistically diverse learners? The researcher conducted one-on-one and a focus group interview. The major themes included the lack of CSP training in Teacher Preparation Programs and in Local Educational Agencies, the unintentional CSP field training experiences, and CSP challenges at LEAs. Keywords: teacher preparation programs, culturally sustaining pedagogy, culturally responsive pedagogy, equity-mindedness, Eurocentric curriculum, and pre-service teacher
PELUANG DAN TANTANGAN METAVERSE SEBAGAI MEDIA PEMBELAJARAN SEJARAH: SEBUAH KAJIAN LITERATUR SISTEMATIS
Authors: Alim Muhammad Rofiul
Published: January 2024

Abstract: The metaverse technology was massively developed in the last decade. The utilization and development of the metaverse in the field of education is considered in line with the concept of society 5.0 and 21st century competencies. Innovation makes the learning process interactive by cultivating critical thinking, communication, creative thinking, and collaboration. The development of the metaverse in the field of education is an effort to present the concept of student center learning. This research method uses a literature review by collecting scientific studies, analyzing, and comparing the use and utilization of the metaverse in education. Data search procedures, data analysis, topic determination, literature review and conclusions related to the opportunities and challenges of the metaverse as a medium for learning history. Data analysis used a literature review with descriptive qualitative. The keywords in the literature search are "Metaverse" and "Learning Media" with a publication period of 2015-2023. The Opportunities for metaverse technology in the world of education have great opportunities to be developed to improve the quality of education. The presence of metaverse technology has challenges such as crime and digital data security and a lack of humanity. This needs to be balanced with an understanding of digital literacy so that it is the center of progress in human-centered society, science and technology. Abstrak:Teknologi metaverse masif dikembangkan dalam dekade belakangan. Pemanfaatan dan pengembangan metaverse dalam bidang pendidikan dinilai selaras dengan konsep masyarakat 5.0 dan kompetensi abad 21. Inovasi menjadikan proses belajar pembelajaran interaktif dengan menumbuhkan critical thinking, communication, creative thinking, and collaboration. Pengembangan metaverse pada bidang pendidikan menjadi upaya menghadirkan konsep pembelajaran student center. Metode penelitian ini menggunakan literature review dengan mengumpulkan kajian ilmiah, menelaah, dan membandingkan penggunaan dan pemanfaatan metaverse pada pendidikan. Prosedur pencarian data, analisis data, penentuan topik, literature review dan kesimpulan terkait peluang dan tantangan metaverse sebagai media pembelajaran sejarah. Analisis data menggunakan literatur review dengan kualitatif deskriptif. Kata kunci dalam pencarian literatur yakni “Metaverse” dan “Media Pembelajaran” dengan rentang waktu publikasi tahun 2015-2023. Peluang teknologi metaverse di dunia pendidikan memiliki peluang besar untuk dapat dikembangkan untuk meningkatkan kualitas pendidikan. Hadirnya teknologi metaverse memiliki tantangan seperti adanya kejahatan dan keamanan data digital dan kurangnya sisi kemanusiaan. Hal ini perlu diimbangi pemahaman literasi digital sehingga pusat kemajuan pada human-centered society, sains, dan teknologi.
Antifungal Activity of a Wireless Electroceutical Dressing
Authors: McKinley Josey , Basaran-Akgul Nese , Steiner Shomita S. , Sen Chandan K. , Templeton Steven P.
Published: January 2024

Background:Fusarium and Mucor are two filamentous fungus strains that can cause infections in humans. Fusarium is known for causing corneal infections. Patients who have diabetes mellitus or are immunocompromised are at a higher risk of mucormycosis. Wireless electroceutical dressing (WED) contains embedded silver and zinc nanoparticles in a geometric pattern. Both zinc and silver have been known to be antimicrobial; yet the combination results in a weak electric field when exposed to an electrolyte-containing solution. WED has been found to have antifungal effects against Candida albicans and Aspergillus fumigatus.
Methods:We investigated the antifungal effect of WED against Fusarium and Mucor growth and survival through daily radial growth and optic density readings.
Results:Our results show that the WED weakly inhibits radial growth of Fusarium strains and strongly inhibits radial growth of Mucor strains, with greater inhibition near physiologic temperatures. Although zinc and silver-only fabric inhibited the radial growth of Mucor, no growth occurred on WED (Ag-Zn) plates for Mucor strains. Optic density readings had mixed results; Ag-Zn liquid cultures had reduced absorbance than control cultures for both strains. Zone of inhibition studies of Fusarium showed no growth on Ag-Zn fabrics with full coverage on all other control and metal containing plates. WED had a greater effect on reducing Mucor growth than Fusarium.
Conclusions:WED utilizes a weak electrical field created by silver and zinc nanoparticles to create an antifungal effect. This leads to strong inhibition of Mucor, Candida, and Aspergillus growth and weak inhibition of Fusarium growth. Further studies are needed to determine the specific effect of WED on fungal viability, the mechanism, and in vivo efficacy. This work could increase patient treatment options for fungal wound infections.
Suppression of Inflammation-induced Abdominal Aortic Aneurysm Formation by Induction of Elastin Tolerance
Authors: Chen Stone , Doiron Theresa , Jimenez Olivia , Sualeh Ali , Stashevsky Jennifer , Madison Mackenzie , Gil Chang-Hyundai , Miller Steven , Murphy Michael
Published: January 2024

Abdominal aortic aneurysm (AAA) is a vascular disease process whereby the aorta expands to apoint where rupture may occur. This serious condition is diagnosed in approximately 200,000 people in the United States per year and accounts for over 15,000 deaths annually. The only medical intervention proven to reduce the risk of AAA rupture is surgical repair; however, such repair is associated with high risk of death, reduced quality of life, and high expense. AAA is caused by the weakening of the artery wall due to inflammation-induced destruction of its structural components. Our clinical data shows increased levels of circulating elastin degradation products in patients with AAA, especially smokers, compared to risk factor matched controls. This observation led us to hypothesize that an immune reaction to elastin fragments initiates the inflammatory cascade in the aorta that leads to AAA formation. To test this hypothesis, C57BL/6 mice were injected with poly(lactide-co-glycolide) nanoparticle-encapsulated IL-10 to induce immune tolerance or nanoparticle-encapsulated control ovalbumin. Injection of elastin fragments was performed 7 days later to induce an immune response. AAA of the infrarenal aorta was induced by topical application of elastase during laparotomy procedure 14 days after nanoparticle injection. Aorta diameter was measured 16 days post-operatively with Microfil. Immunologic changes were evaluated by cytokine analysis, Tr1/Th17 cell ratio inperipheral blood, and splenic Th17 and Tr1 response to elastin. Based on prior work, we expect that induction of elastin tolerance using poly(lactide-co-glycolide) nanoparticle-encapsulated IL-10 will suppress abdominal aortic aneurysm expansion and promote an anti-inflammatoryenvironment characterized by increased Tr1/Th17 cell ratio, increased levels of anti-inflammatory cytokines, and decreased pro-inflammatory cytokine expression.
Clinical Applications of Next-Generation Sequencing for Cancer Diagnostics and Targeted Cancer Therapy
Authors: Mosteller Alex , Masood Ashiq
Published: January 2024

Next-generation sequencing (NGS) is a revolutionary technology that has effectively sequence massive quantities of genomic DNA or RNA at a shorter time and a lower cost. The NGS is routinely used in oncology to tailor care for individual patient. In this review, we discuss the role of NGS how it can provide a more personalized approach to targeted cancer therapy. A literature review was conducted via PubMed and articles were screened for publication dates within the past 10 years. Primary literature consisting of clinical trials and review articles were utilized. Search terms included “(next-generation sequencing) AND (cancer)”, “(next-generation sequencing) AND (cancer diagnostics)”, and “(next-generation sequencing) AND “(cancer therapy)”.
From the literature review, we found that NGS is indicated for daily practice as a diagnostic tool for advanced NSCLC, colon cancer, prostate cancer, cholangiocarcinoma, and some advanced rare cancers. We also found evidence suggesting that NGS is helpful in identifying actionable mutations that will, in turn, allow the patient to be matched to a more individualized cancer treatment.
As oncology care continues to move in the direction of more personalized care, the potential applications of NGS in the field of oncology will continue to evolve. Our review will help further the understanding of NGS and provide context for its value in patient care and its ability to provide an avenue for targeted therapy.
Hypoxia Gene Networks in Gliomas
Authors: Muller John , Jackson Luke , O’Herron Elise , Cooper Scott , Richardson Angela
Published: January 2024

Background and Hypothesis:Gliomas are the most common primary brain tumor and range from low grade to high grade, with glioblastomas (GBM) being the most aggressive. Translation of therapies for these tumors from preclinical models to clinical practice has been limited. Preclinical studies are typically performed in ambient air (21% oxygen), while physiological oxygen tension (physioxia) is 3-5%. Extracranial tumor tissue processed in physioxia demonstrates distinct gene expression profiles and chemoresistance as compared to the same samples processed in ambient air. However, the role of varying oxygen tension in gliomas has not been well studied. GBMs often have areasof necrosis with presumed low oxygen tension, while these findings are typically absent in lower grade gliomas. In this study, we examine expression of hypoxia related genes in patient samples obtained from grade II, III and IV gliomas. We hypothesize that increasing tumor grade will be associated with differential expression of hypoxia-related genes.
Methods:Gene expression in patient brain tumor samples (glioblastoma, high grade astrocytoma, low grade astrocytoma) and normal brain samples (from epilepsy surgery) was assayed using real time PCR. Hypoxia-related gene expression was examined in cBioPortal for Cancer Genomics by comparing survival in the top-expressing and bottom-expressing quartile for these transcripts.
Results:Patient samples were screened for differences in gene expression with greater than two-fold upregulation in GBM as compared to normal brain tissue. Expression level of one of these genes, ADM, was significantly associated with survival in patients with GBM (p<0.05). Additional differences between grades of glioma will also be presented.
Potential Impact:This work demonstrates differential expression of hypoxia-related gene transcripts in gliomas. The next step is to assess differences between patient samples processed in differing oxygen tensions to assess efficacy of chemotherapeutics and gene expression in samples that have never been exposed to ambient air.
The Potential Tripartite Connection: Alzheimer's Disease, Fracture Healing, and the Gut Microbiome
Authors: Parker Reggie , Varner Will , Nazzal Murad , Creecy Amy , Karnik Sonali J. , Blosser Rachel J. , Scott Elizabeth , Harris Alexander , Morris Ashlyn , Wang Hannah , Margetts Tyler , Dragisic Marko , Ganguly Upasana , Fehrenbacher Jill C. , Fischer Kathryn D. , Movila Alexandru , Oblak Adrian L. , Hathaway-Schrader Jessica , Kacena Melissa A.
Published: January 2024

Alzheimer's disease (AD), fracture healing, and the gut microbiome are interconnected aspects of health that have gained significant research interest. Recent studies suggest gut dysbiosis may play a role in AD pathogenesis, potentially through the gut-brain axis, a bidirectional communication system. Moreover, the gut microbiome's role in bone health could link dysbiosis and fracture risk. Furthermore, research reports have revealed that the brain communicates with bone, termed the bone-brain axis. Despite these insights, the effect of the gut microbiome on fracture healing in AD remains largely unexplored.
To uncover these connections, our study uses the AD mouse models, 3xTg and 5xFAD. We conducted osteotomies on these mice and analyzed fecal samples that were collected at different timepoints. Fecal samples are being examined via qPCR and 16s RNA analysis toidentify and quantify bacterial phyla. These findings will be linked to both AD progression, gauged through behavior and histological analyses, and fracture healing, quantified using X-ray mRUST scoring, microCT, and histology.
We hypothesize that the progression of AD could alter the gut microbiome, potentially affecting fracture healing. This might occur through inflammation pathways triggered by specific gut bacteria. We may identify specific gut bacteria that play critical roles in both fracture healing and AD. We anticipate finding a shift towards pro-inflammatory bacterial phyla in the context of AD progression and during the fracture healing process. If this hypothesis is validated, it could unlock new therapeutic strategies aimed at targeting the gut microbiome to improve bone health, fracture healing, and AD progression in patients.
Evaluation of Insertion Speed and Hand Kinematics During Cochlear Implantation in a Fixed Cadaveric Temporal Bone Model
Authors: Patel Radha , Wesson Troy , Burgin Sarah
Published: January 2024

Background:Cochlear implant is the treatment of choice for replacement of sensory deprivation from severe to profound sensorineural hearing loss. Slower insertion of the electrode into the cochlea leads to less intracochlear trauma. Accurate measures of hand motion and insertion speed during live cochlear implant electrode insertions on human subjects are limited.
Methods:Data from a single surgeon was collected during insertion of a cochlear electrode into a cadaveric temporal bone using inertial measurement units (IMUs), devices that measure linear acceleration in 3 dimensions (x,y,z). The sensors were affixed as follows: dorsal second digit, dorsal hand, and dorsal wrist with three trials at each position. The extremity inserting the electrode into the inner ear was labeled “inserting limb,” while the other extremity was labeled “non-inserting limb.” Root mean square (RMS) calculations were utilized to record the net acceleration, from which average speed per trial was calculated using the midpoint method.
Results:Mean speeds for first digit, hand, and wrist for the inserting limb were 0.23 ± 0.11, 0.15 ± 0.06, 0.16 ± 0.04 mm/s respectively. Mean speeds for first digit, hand, and wrist for the non-inserting limb were 0.26 ± 0.10, 0.13 ± 0.03, 0.16 ± 0.09 mm/s, respectively. The difference in speed between “inserting” and “non-inserting” limbs for all three IMU positions, as well as the relative speeds between all three positions, were statistically significant (p<0.001).
Conclusion and Potential Impact:Available literature suggests the mean insertion speed during live cochlear implant surgery is 96.5 mm/min (1.60 mm/s), which is significantly faster than the mean speeds collected during this fixed cadaveric temporal bone study regarding all three positions (p<0.001). Though preliminary, this data of insertions speeds highlights the need for further investigation during live cochlear implant surgery on human subjects using IMUs.
Factors Associated with Fetal Growth in Pregnancies Complicated by Type 2 Diabetes Mellitus
Authors: Rutty-Serrano Valeria , Scifres Christina
Published: January 2024

Background and Hypothesis:The prevalence of type 2 diabetes (T2DM) is increasing, and it is associated with an increased risk for adverse perinatal outcomes. Fetal overgrowth is associated with an increased risk for obesity and diabetes in offspring of individuals with type 2 diabetes, and we sought to identify factors associated with excess fetal growth in pregnant individuals with T2DM.
Experimental Design or Project Methods:This was a retrospective cohort study of 350 pregnant individuals with T2DM who delivered at IU Health Hospitals or Eskenazi Hospital from January 1, 2019-December 31,2021. We excluded pregnancies complicated by twin gestation or stillbirth. Maternal demographic data and perinatal outcomes were abstracted from the electronic medical record. Birth weights were classified as small for gestational age (SGA; <10th percentile), appropriate for gestational age (AGA; 10-90th percentile), and large for gestational age (LGA; >90th percentile) using a US birth weight standard. Maternal characteristics and pregnancy outcomes were compared across the 3 categories using ANOVA and chi squared statistic. Multinomial logistic regression was used to identify factors associated with birth weight category.
Results:LGA birth weight occurred in 95 (27%) and SGA birth occurred in 32 (9%) of pregnancies. After adjusting for covariates, HbA1c after 20 weeks’ gestation was significantly associated with risk for SGA birth weight (aOR 0.4, 95% CI 0.19-0.94) and LGA birth weight (aOR 1.47, 95% CI 1.10-1.96). Individuals requiring treatment with both insulin and oral agents at the first prenatal visit were at increased risk for LGA birth weight (aOR 4.49, 95% CI 1.43-14.10).
Conclusion and Potential Impact:Our findings highlight the important relationship between glycemic control in the second half of pregnancy and fetal growth. Additional research is needed to optimize glycemic control in pregnant individuals with T2DM.
Understanding Barriers Faced by Rural Adolescent and Young Adult Cancer Survivors
Authors: Sakel Joseph , Gass Brittany , Moore Courtney , Cockrum Brandon , Hawryluk Bridget , Parks Lisa , Garcia Kara , Sajdyk Tammy
Published: January 2024

Background and Hypothesis:The current 5-year survival rate for adolescent and young adult (AYA) cancer diagnoses is 85.8%. However, AYA cancer survivors face many challenges including loss of insurance, infertility, sexual health concerns, physical disability, education barriers, housing instability, food insecurity, and decreased financial well-being. Survivors in rural areas may face additional challenges, such as lack of access to cancer centers, tailored resources, and networks of fellow AYA cancer survivors that may be available in large cities. The study goal was to better understand specific barriers to survivorship care for this rural population, using a comprehensive interactive workbook distributed to cancer survivors in Southwest Indiana.
Methods:A prototype workbook was distributed to 42 AYA survivors in southwest Indiana. Follow-up interviews were conducted with 11 individuals. Interviews with the first wave of eligible participants (n=7) provided perspectives on the workbook, helped identify potential improvements, and offered further insight into their survivorship experiences. These eligible participants were also invited to participate in an online forum to facilitate group discussions on potential improvements to the workbook. Responses were evaluated through affinity mapping to identify common themes.
Results:AYA cancer was found to have a lasting impact on physical health, mental health, and relationships for many of the AYA survivors. Importantly, only 27% of participants who completed the workbook responded “yes” to having received a survivorship care plan, suggesting barriers in communication between survivors and healthcare providers. Regarding overall health, the three largest barriers identified by cancer survivors in rural southwest Indiana were insurance coverage, mental health services, and the availability of services needed.
Conclusion:To strengthen survivorship care to rural survivors, our study suggests a need for better distribution and explanation of survivorship care plans, as well as increased access to stable insurance, medical services, and mental health services.
Development of a Novel Atherosclerotic Heart Disease Biomarker Program
Authors: Salvas John P. , Johnson Cynthia , Raman Subha V.
Published: January 2024

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of heart attack, stroke, and sudden death worldwide. Clinical risk scores help estimate the likelihood of adverse cardiac events to guide preventative strategies. Current risk scores for atherosclerotic events like heart attack and stroke use known cardiovascular risk factors including smoking, diabetes, lipid levels, and blood pressure. However, these scores underestimate risk in certain patient populations and do not predict the atherosclerotic disease in individual patients that leads to subsequent events. Our aim is to design a novel biomarker-enabled model to predict the presence and burden of coronary artery atherosclerosis in patients with diabetes, to ultimately help personalize preventive therapies that target disease burden, not just risk factors, for more effective prevention of ASCVD events.
Methods: Patients with diabetes have been prospectively enrolled in a health plans-based screening program with co-enrollment in the Indiana Biobank, which includes coronary CT angiography, an AI-based quantitation of atherosclerosis, and biobanking of DNA, plasma, and serum. We identified candidate biomarkers based on current literature and determined which could be impactful based on cost, efficacy, and feasibility of implementation guided by interviews with potential collaborating entities.
Results: We have identified polygenic risk scores, non-coding RNAs and candidate blood biomarkers with predictive potential for atherosclerotic heart disease. Subsequent work will entail i) direct assays of banked biospecimens for the selected minimally invasive biomarkers and ii) computational analysis to assess incremental predictive value for disease burden over clinically available risk scores.
Conclusions and Potential Impact: We are progressing towards the development of a novel mode to predict patient-specific burden of coronary atherosclerotic disease burden in patients with diabetes. We expect that a multidimensional approach including contemporary biomarkers will improve predictive value of atherosclerotic heart disease burden, affording more tailored treatment to prevent ASCVD events.
Association of Case Duration with Late vs. Early Physical Therapy Initiation in Treatment of Work-Related Musculoskeletal Injuries: A Retrospective Analysis
Authors: Sawyers Grant , Roebuck Amelia , Coupe Amanda , Knipp Michael , Wu Tungyun
Published: January 2024

Background:Occupational medicine providers treat patients who are injured while working. Conservative management with over-the-counter anti-inflammatory medicines, physical modalities (ice/heat), and activity restrictions are first-line treatment strategies. Physical therapy (PT) is often added to assist with patients’ return to baseline through symptom reduction and restoration of function. PT efficacy on outcomes and healthcare costs has been described in other patient populations but less described in injured worker populations. This study focused on associations between PT timing and case duration for treating musculoskeletal injuries in a regional injured workerpopulation.
Methods:A retrospective chart review of 795 patients receiving care at Parkview Occupational Health (POH) for musculoskeletal injuries from 2017-2023 was conducted to determine if early PT was associated with case duration. Patients employed in Indiana and referred to PT within Parkview were included in the study. Age, BMI, and case duration were compared between early vs. late PT groups using two-sampled t-test. Race, sex, smoking status, and injury type were compared using chi-squared tests.
Results:The mean case duration (73.41 days) when PT was initiated early (≤ 30 days after date of injury, DOI) was significantly shorter compared to the mean case duration (104.21 days) when PT was initiated late (p<0.0001). Case duration was even shorter (67.61 days) when early PT was defined as ≤14 days after injury (p=0.001). There was no significant difference in case duration (mean difference=9.5 days) between patients initiating PT within 14 days and within 15-30 days (p=0.15). Injury type (back vs. other musculoskeletal injuries) was significantly associated with PT timing (p=0.002).
Conclusion/Implications:Future analysis should compare case duration, days of restricted work, advanced imaging utilization, and specialist referral rate between patients with early and late PT initiation. This comparison will aid in development of best practice guidance for treatment of work-related musculoskeletal injuries at POH.
Elevated Psychiatric Comorbidities in Patients with Low-risk Chest Pain Presenting in The Emergency Department
Authors: Dang Linh , Kroenke Kurt , Stump Timothy , Monahan Patrick , Connors Jill , Cherynak Yelena , Musey Paul
Published: January 2024

Background/Objective: Low-risk chest pain (LRCP), i.e. chest pain that does not pose an imminent risk or have a cardiovascular cause, constitutes the majority (80%) of cases of chest pain presenting to the emergency department (ED). Past research shows that in patients withLRCP without a history of cardiovascular disease, many will meet criteria for panic or generalized anxiety disorder. The purpose of this project is to examine the psychiatric comorbidities of patients with LRCP including differences by severity of anxiety.
Methods: Baseline data collected in the Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study were analyzed to determine: the rates of depression, somatization, posttraumatic stress disorder (PTSD), disability, and low self-efficacyin relation to increasing levels of anxiety (low anxiety but positive for panic disorder vs moderate vs severe anxiety). Also, anxiety severity groups are compared for demographic and other patient characteristics to identify potential predictors of anxiety severity.
Results: In 265 patients with LRCP who screened positive for panic disorder and/or generalized anxiety disorder, the proportion with low, moderate and severe anxiety symptoms was 9%, 44% and 47%, respectively. Overall, 57% (n=150) also screened positive for depression, 54%(n=144) for somatization syndrome, and 56% (n=149) for PTSD. Rates of depression, somatization, PTSD, and disability increased as the level of anxiety increased. Compared to patients with low to moderate anxiety, patients with severe anxiety were more likely to have depression (odds ratio = 3.0), somatization (OR = 2.7), PTSD (OR = 2.6), disability (OR = 2.4), and low self-efficacy (OR = 3.5).
Conclusion and Potential Implications: Patients with LRCP and anxiety are likely to have other psychiatric comorbidities. Additionally, as rates of comorbidities increase with the anxiety severity, detection and management of anxiety is essential to provide optimal care for low-riskchest pain.
Amyloidosis in the Head and Neck: A Case Presentation and Literature Review
Authors: Dave Neeti , Anthony Benjamin
Published: January 2024

Background: As reported by the Cleveland Clinic, amyloidosis is a rare disease that affects 5 to 12 out of every 1 million people worldwide. Of those affected, 19% present with amyloidosis of the head and neck. Amyloidosis results from the accumulation of insoluble amyloid protein intissue due to improper synthesis and processing of proteins. Amyloidosis of the head and neck region is rare and can be localized or systemic. Surgical intervention is often necessary to remove the amyloid tissue. Dr. Benjamin Anthony and Dr. Hector Mesa encountered a case of head and neck amyloidosis at an Indiana University hospital. An investigation of this case reveals the disease’s presentation, diagnosis, and treatment.
Project Methods: The patient’s data and surgical pathology reports were collected and formatted for analysis. Histological images of the pathology slides and laryngoscopy footage were obtained for examination. The case data was then compared to a literature review of other similar cases. After the comparison, the effectiveness of surgical treatments was analyzed and areas for future research were identified.
Results: After review of the literature and case, tissue biopsy followed by mass spectrometry was determined to be an effective diagnostic method. The literature and case differed in the clinical presentations they reported and the surgical intervention they concluded was most effective. Most literature reported the CO2 laser to be the most effective at resecting the disease, while the case review indicated the laryngeal coblator.
Conclusion and Potential Impact: Despite the need for further research in diagnosing and treating amyloidosis, the literature and the case demonstrate effective methods exist. Research into treatment poses a greater need due to surgical limitations and potential morbidity. Ongoing research will analyze data from past Indiana University Health cases to evaluate diagnostic methods and treatment approaches. Thus, providing valuable insights for improving patient care.
Biopsy or no biopsy? Risk of Malignancy in Thyroid Nodules Based on TI-RADS Criteria
Authors: Shariff Faadil , Halappa Vivek
Published: January 2024

Purpose: To assess the risk of malignancy in thyroid nodules recommended for biopsy using the American College of Radiology (ACR) Thyroid Imaging Reporting & Data System (TIRADS).
Methods: We conducted a retrospective review of ultrasound (US) guided thyroid biopsies performed from 2018- 2023 at IU Health hospitals for nodules which were recommended for biopsy based on ACR TI-RADS criteria and compared with histopathology results. The research was conducted at University and Methodist Hospital radiology reading rooms.
Results: Of the total 210 thyroid nodules recommended for biopsy, only 8.57% of nodules biopsied were malignant. Positive malignancy rate for TR-3 was 10.2%, TR-4 was 7.1%, and TR-5 was 12.5%. TR-3 nodules less than 2.9 cm were all benign on histopathology. TR-4 nodules less than 1.5 cm were all benign on histopathology. TR-5 nodules were all benign on histopathology. The most common malignancy was papillary thyroid carcinoma.
Conclusion: ACR TI-RADS is currently the standard of care for guidelines and lexicon for radiologists for characterizing thyroid nodules. Our results demonstrate that all TR-3 nodules less than 2.9 cm were all benign and most of the TR-4 and TR-5 nodules biopsied were benign on histopathology. The lower biopsy rate for positive malignancy even for TR-4 and TR-5 nodules respectively raises the need for revision for existing TI-RADS criteria, as more nodules could be followed up with ultrasound rather than percutaneous biopsy, which will alleviate patient anxiety as well as decrease overall healthcare costs.
Retrospective Analysis of Suicide Deaths in Allen County Indiana, 2013 – 2022
Authors: Sherman Kathleen , Williams Aaron , Sanders Jana , Gutwein Thomas
Published: January 2024

Suicide rates at a national and state level have been on the rise over the past two decades. Patterns observed at the local level is less understood and underrepresented in research. Since local government can have a large impact on resource allocation in a community, revealing local suicide patterns could help facilitate targeted preventative efforts for at-risk populations. This study aims to analyze demographic patterns observed in Allen County suicides from 2013 –2022, focusing on age groups and education attainment. Data collection was completed on the 604 individuals who died by suicide in Allen County over the past decade. The collection process included documenting various demographics accessed through death certificates and coroner’s files. Within the county, suicide numbers increased over the decade. Results showed that males represented more than a 3:1 ratio of total suicides, a gunshot wound was the method of injury for 53% of all suicides, and decedents with a high school degree or less represented 62% of suicides within the population. These results echo what research has shown at the national level. Additionally, the 20-34 and the 35-54 age groups produced the greatest number of suicides consistently over the 10 years, and these suicides occurred most often in late spring and early summer. Within the 20-34 age group, individuals were more likely to commit suicide by gunshot wound (p = 0.000133). Decedents of minority ethnic and racial groups had lower education attainment compared to non-Hispanic (p = 0.000027) or white (p = 0.003314) individuals. This information could be provided to local schools with the hopes of implementing more targeted preventative measures for at-risk groups. Knowledge of suicide patterns in healthcare could lead to improved care for patients. Finally, public health entities can use these findings to adapt current health initiates to fit the needs of Allen County.
Evaluating the Utility of Procalcitonin and C-Reactive Protein to Predict Bacteremia in Children with Musculoskeletal Infections
Authors: Smith Alex , Wood James
Published: January 2024

Background:Musculoskeletal infections (MSKI; osteomyelitis, septic arthritis) are among the most common invasive bacterial infections in children, often associated with complications. Bacteremia precedes these complications; thus, early identification may prevent them. Acute inflammatory markers, C-reactive protein (CRP) and Procalcitonin (PCT) are often elevated in children with acute MSKI. PCT is understudied in children with MSKI. The primary goal of this study was to evaluate the utility of PCT and CRP in distinguishing children with MSKI with bacteremia vs. those without.
Methods:Patients 6 months to 18 years with strong clinical suspicion of MSKI were prospectively enrolled at Riley Hospital for Children from July 2019 to May 2022 unless clinical evidence suggested an alternative diagnosis or if informed consent was not obtained. CRP was obtained at admission and PCT was collected within 96 hours of presentation to the hospital. Demographic data was recorded from electronic medical records. Two-sided P values of <0.05 were considered statistically significant for univariate analysis and logistic regression.
Results:Thirty-seven patients were enrolled, the majority being non-Hispanic white males (40.5%), median age of 8 years (IQR, 4-12). Median PCT in children with bacteremia was higher (0.41 ng/mL [IQR 0.14-0.8 ng/mL]) compared to those without (0.10 ng/mL [IQR 0.05-0.31 ng/mL]) (p=0.03). Median CRP in children with bacteremia was higher (13.7 mg/dL [IQR, 9.15-19.9]) compared to those without (4.1 mg/dL, [IQR 0.65-5.8]) (p<0.01). Both PCT and CRP showed good ability to discriminate those with bacteremia from those without, with an area under the ROC of 0.75 (95% CI 0.56, 0.94) and 0.80 (95% CI 0.64, 0.95), respectively.
Conclusions:Initial PCT and CRP demonstrated utility in detecting bacteremia in patients presenting with MSKIs. This study warrants further exploration into the usage of PCT and CRP as early predictors of bacteremia for more appropriate treatment and potentially fewer complications of these infections in pediatric patients.