bluuebunny/crossref_metadata_2025 huggingface dataset:
Pancreatic Islet Composition Affects Hormone Secretion in Isolated Alpha and Beta cells
Authors: Phillips William , Brissova Marcella , Kilburn Julie , Niland Joyce , Evans-Molina Carmella
Published: December 2020

Background/Objective:  
The Integrated Islet Distribution Program (IIDP) distributes islets from five isolation Centers and serves as the main source of human islets for research in the U.S.  In 2016, the IIDP initiated the Human Islet Phenotyping Program (HIPP), which provides standardized post-shipment assessment of islet hormone secretion and endocrine cell composition for each IIDP-supported islet isolation.  To date, islets from 276 non-diabetic donors have been analyzed.  We hypothesized that analysis of this unique resource will provide novel insights into how demographic and clinical features impact islet health.  
 
Methods: 
Relationships between insulin and glucagon secretion assessed by perifusion and islet composition (% of β- and α-cells) were analyzed using SAS Version 9.4.  For each analysis, the isolation center was used as a covariate.   
 
Results:   
Of the 276 donors, 60% were male; 59% of donors were Caucasian, 28% were Hispanic, 9% were African-American; 4% were Asian; and 0.36% were American Indian.  The % of β-cells was moderately correlated with insulin responses to 16.7 mM glucose (r=0.2785; p<0.0001) and 20 mM KCL (r=0.3109, p<0.0001).  Similarly, the α-cell% was moderately correlated with total glucagon content (r=0.3362, p<0.0001) and glucagon responses to 1.7 mM glucose + 1mM epinephrine (r=0.2015, p=0.0001). The % of β -cells was negatively correlated with glucagon total content (r=-.243,p=.0001), while the α-cell% was negatively correlated with insulin stimulation index to KCL (r=-0.2573, p<0.0001). Notably, Asian donors exhibited a significantly higher β-cell% compared to other groups (p<0.05).  Consistent with this, glucose-stimulated insulin secretion was higher in Asian donors compared to responses observed in islets from African American donors (p<0.01). 
 
Conclusion:  
These data indicate that islet cell composition influences insulin and glucagon secretory responses and suggests that race may impact islet composition and hormone secretion. Continued analysis of the HIPP dataset may aid in our understanding of risk factors for the development islet dysfunction in diabetes.
Retrospective Review of Interventional Radiology Treatment and Outcomes in Pediatric Liver Disease
Authors: Purk Anna , Pfaff Sean , Marshalleck Francis , Molleston Jean
Published: December 2020

Background: Interventional radiology (IR) procedures offer less invasive and low risk options for the treatment of pediatric liver abnormalities, as well as life sustaining measures to bridge patients to transplant. Literature regarding IR interventions for pediatric liver disease is limited. Common conditions that can be treated with IR procedures include vascular anomalies: congenital portosystemic shunts, arteriovenous malformations (AVM), and Budd-Chiari malformation. Transjugular intrahepatic portosystemic shunt (TIPS) can be used to prevent recalcitrant variceal bleeding in portal HTN.  Liver biopsy (percutaneous and transjugular) is used to sample the liver and can be targeted to tumors and other lesions. Percutaneous approaches to image biliary abnormalities and treat strictures are useful in children after liver transplant and also without.,  
 
Objective: describe liver IR procedures and their outcomes in a single-center cohort study   
 
Methods: Patients will be identified through retrospective chart review at Riley Hospital for Children to identify and record the diagnoses, interventions, and relevant outcomes for eligible patients. Descriptive statistics can then be performed. This data set can be used to help inform clinicians on indications and expected outcomes for relevant hepatic IR procedures.  
 
Conclusion: It is anticipated that data collected for this project will show increased utilization of these procedures at the end of the study period compared to the beginning, and the complication rate for the IR procedure will be lower when compared to equivalent traditional procedures to treat the same condition.
Hepatic microRNAs in Type II Diabetes Pathogenesis
Authors: Qian Gene , Morral Nuria
Published: December 2020

Background/Objective: 
Diabetes mellitus is a disease with increasing incidence worldwide affecting more than 435 million patients, most of whom have Type II diabetes (T2D). Of the many organs affected by T2D, the liver is responsible for much of the dysregulated metabolic pathways in response to insulin signaling. These include, but are not limited to gluconeogenesis, glycogen storage, fatty acid and cholesterol biosynthesis and transport, and fatty acid oxidation. Recent studies show significant differences in miRNA expression profiles between healthy and disease states of T2D. This implicates an important role of miRNAs in T2D pathogenesis and makes miRNAs an attractive therapeutic target and diagnostic marker for T2D patients. The aim of this review is to provide an overview of the hepatic miRNAs relevant to T2D pathogenesis. 
 
Methods: 
We compiled and reviewed articles from the PubMed database that were relevant to miRNAs and T2D pathogenesis in the liver. 
 
Results: 
We found that hepatic miRNAs affect most if not all dysregulated metabolic pathways in T2D pathogenesis, which we categorized into carbohydrate metabolism, lipid metabolism, and insulin signaling. The miRNAs that are most represented in our literature include miR-122, miR-33a/b, miR-29, and miR-21. These miRNAs target a variety of molecules, including transcription factors that are master regulators of metabolic pathways (FOXO1, HNF4α), lipid transporters (ABCA1, ABCG1), or key insulin signaling molecules (IRS1/2, caveolin-1). In addition, circulating miR-122 is associated with the risk of developing metabolic syndrome and T2D in the general population. 
 
Conclusion and Potential Impact: 
Multiple miRNAs are dysregulated in the liver of animal models of T2D. Administration of miRNA mimics or antagomirs to correct aberrant miRNA expression improved the pathophysiology in vivo. miRNAs are also promising tools as markers for disease development. Ultimately, the identification of miRNAs can guide future research to facilitate the diagnosis and improve the treatment of T2D.
Effects of Irregular Shifts on Incidence of Type II Diabetes Among Healthcare Workers
Authors: Rameswara Varun , Blevins Amy , Eckert George , Jusufbegovic Denis , Bhatwadekar Ashay
Published: December 2020

Background/Objective: 
The prevalence of shift work ranges around 20% among American and European workers and is significantly higher in the healthcare field. Variable work schedules among shift workers are associated with adverse health effects, including the increased risk of metabolic disorders and obesity. This systematic review aims to evaluate the association between shift work and type 2 diabetes/insulin resistance. 
 
Methods: 
This research is part of a more extensive systematic review that has been registered on Prospero. Due to time constraints, we began with a scoping search with the goal of completing a rapid review. Searches were completed using the Ovid and PubMed databases with the following keywords and subject headings: Health Personnel; Shift Work Schedule; Circadian Rhythm; Work Schedule Tolerance; Metabolic Diseases; Overweight; Glucose Metabolism Disorders; Lipid Metabolism Disorders; Malabsorption Syndromes; Metabolic Syndrome; and Diabetes Mellitus. The resulting articles were uploaded onto Covidence for screening and data extraction. After screening the abstracts for diabetes and insulin resistance, eight articles were selected for the full-text screening of which data extraction was performed on three. 
 
Results: 
Overall, 163,555 participants performing evening, night, rotating shifts, or regular shifts were identified in the three studies. The average age of study participants was found to be 44.0 yrs,  163,422 were females (>99.9%), and of the total participants, 98,303 subjects were shift workers (60.10%). For healthcare shift workers, there was a significant association between shift work and diabetes across all three studies; however, the effect was modest (relative risk in the range of 1.19-1.26).    
 
Conclusion: 
There is a positive relationship between shift work and diabetes among healthcare workers. Therefore, strategies focusing on reducing shift work or treating these workers as a high-risk group for diabetes by taking measures to minimize other exposures will be beneficial in reducing the incidence of diabetes among this population.
Evaluation of Consultation Notes Within and Across Institutions: A Preliminary Study
Authors: Sangani Amee , Savoy April
Published: December 2020

Background/Objective: Patients with multiple chronic conditions require specialty consultations both within and across institutions for effective co-management of comorbidities. Poor communication during the referral process increases physician workload, patient burden and risks. Successful co-management relies on bi-directional information flow that supports interpersonal communication and establishment of clear tasks and responsibilities among physicians. However, flow of health information is often limited to specific health network access, phone calls, or faxes. Interpersonal communication is dependent on limited encounter notes. In this preliminary study, our objective was to understand how consultants’ notes support physician collaboration within and across health care institutions.  
 
Project Methods: To assess consultants’ notes, outpatient charts were randomly selected from the Indiana Network for Patient Care database representing consultations with five different specialties within the IU Health network, including referrals from within and outside of IU Health. The Quality of Consult Assessment tool was adapted to assess content of notes, emphasizing clinical recommendations, distribution of tasks and responsibilities, and communication plans. 
 
Results: Our sample included ten charts for patients who had comorbidities. All notes contained clinical recommendations that included an assessment and plan. 70% of notes contained explicit responsibilities of the consultants. Conversely, only one contained explicit responsibilities for referrers. Charts denoted reliance on support staff to send messages between referrers, consultants, and patients via phone and fax. Phone calls and faxes were more prominent in referrals across institutions.  
 
Conclusion and Impact: Our preliminary findings indicate that current clinical documentation supports specialty referrals for transitions of care rather than co-management of care. Difficulties in accessing patient charts across institutions leads to a lack of clinical context and workflow inefficiencies when attempting to co-manage care. These findings demonstrate negative implications in health outcomes for patients with multiple comorbidities that require more care coordination within and across institutions.
Subsequent opioid overdose resulting in death in individuals in Allen County, Indiana who receive naloxone administration for past opioid overdose
Authors: Schwartz Cassandra , Dykstra Thomas , Sanders Jana
Published: December 2020

Background and Hypothesis: 
Over-prescription of opioids has contributed to increases in opioid overdose (OOD) and OOD deaths. Studies suggest recurring OODs in an individual could be contributing. After a non-fatal overdose, one study found 7% of patients continued to abuse opioids and had another OOD within 1 year. Additionally, the literature suggests a positive correlation between non-fatal overdose and increased risk of subsequent overdose death. Allen County has also experienced increases in overdoses and overdose deaths. We aim to isolate opioid-specific overdoses and deaths in Allen County from current overdose data. We hypothesize individuals in Allen County who received naloxone for OOD have an increased risk of death from a subsequent OOD. An additional objective is to utilize data from the county ambulance service and the two major Allen County health systems to gain more accurate and current accountings of the OOD data.  
 
Methods: 
This study is a retrospective case-control using electronic medical records and/or electronic patient care reports from the Three Rivers Ambulance Authority, Parkview Health, and Lutheran Health Network. Patients who received naloxone between 2018-2020 will be divided into a case group of individuals who died of OOD and a control group of living individuals. Demographics and naloxone administrations data per subject will be collected. Box-and-whisker plots, a Mann-Whitney U Test, and a Wilcoxon matched-pairs signed rank test will be done for comparisons.  
 
Results and Conclusion: 
This project has resulted in a study protocol ready for IRB submission with IRB approval and study start date anticipated for Summer 2021. 
 
Potential Impact: 
This study will add to existing knowledge on OOD and subsequent OOD death. Specifically, this study will provide more accurate and current accountings of the OOD data that may aid in the development of policy and interventions to reduce the local opioid crisis.
Application of Viscoelastic testing to the field of Otolaryngology Head and Neck Surgery: A Scoping Review
Authors: Shariff Faisal , Marsee Mathew , Walsh Mark
Published: December 2020

Background: 
In Otolaryngology Head and Neck Surgery (OHNS), hematologic management requires attention to the intricate nature of hemostatic competence. Elderly patients can experience drug induced coagulopathies. Strategies are needed in order to minimize hemorrhagic and thromboembolic risk and maximize positive outcomes. Viscoelastic tests (VETs) such as Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM) have been used to guide blood component therapy. The purpose of this scoping review is to understand the utilization of VETs in OHNS. 
 
Methods:  
 
This scoping review included studies that discussed the utilization of VETs in the field of OHNS. The inclusion criteria was studies that discussed the application of VETs in Flap/Plastic Reconstruction, Facial Trauma/Resuscitation, Tonsillectomy, Obstructive Sleep Apnea (OSA), Epistaxis, Sinus Surgery, and HNC Resection. Studies that focused on general medical VET use were not included. 
 
Results: 
 
Fourteen articles met the study inclusion criteria from an initial pool of 45 articles. Seven articles discussed the use of VETs in free flap/reconstructive surgery, five articles explored use in HNC, two articles discussed use in facial trauma and resuscitation, one article mentioned use in OSA, and one article examined use in epistaxis.  
 
Conclusion and potential impact: 
 
Of the fourteen articles included, two articles found no clinically significant association between TEG parameters and flap loss or complications. Five studies found that TEG or ROTEM helpful in predicting coagulation clotting, a prothrombotic state, or a hyperfibrinolytic state in free flap and HNC patients. For facial trauma and HNC cancer patients two different studies found ROTEM helpful in guiding blood component resuscitation. Using the TEG, one study demonstrated a hypercoagulable state in OSA patients. This review encourages wider use of VETs in OHNS in order to monitor hemostasis and improve surgical outcomes. Further research is necessary to better understand how VETs can tailor hematologic management of OHNS patients.
Can cognitive behavioral therapy (CBT) intervention in patients diagnosed with stage 3/4 gastric cancer increase patients’ acceptance of palliative care earlier in the cancer continuum?
Authors: Sharma Rhea , McCollom Joseph
Published: December 2020

Background and Hypothesis: Palliative care, though designed improve quality of life in patients diagnosed with a grave illness, is widely stigmatized as an “end of life” service. Cancer diagnosis has been known to cause mental stress on patients; the added stigmatization of palliative care with death is a barrier to care, especially in gastric cancer patients whose delay in treatment can result in poor cancer prognosis and outcomes. Cognitive Behavior Therapy (CBT) intervention is promising is an ideal intervention in this case, yet, understudied in palliative oncology. Successful CBT intervention can combat guilt, denial and stigma, leading to more positive outlook on life and palliative care. We hypothesize that CBT intervention will increase stage 3/4 gastric cancer patients’ acceptance to start palliative care early in their cancer treatment by decreasing associated stigma.  
 
Experimental Design and Results: Study will be an interventional, unblinded, randomized clinical trial with an experimental and control group. A CBT video intervention will be used, preceded and followed by a pre-/post session questionnaire generated from IU’s RedCap. Full intervention will have 4 sessions, with experimental groups divided into those receiving <2, 3 or full 4 sessions. All individuals age 18+ with a recent stage 3/4 gastric cancer diagnosis, who have the ability to provide consent/comprehend the CBT video will be illegible to participate in the study. A spearman’s correlation will be used to test significance of CBT. A negative trend is predicted between CBT intervention and palliative care stigma; as the number of CBT sessions increase, palliative care stigma should decrease accordingly. 
 
Potential Impact: CBT’s effectiveness in alleviating stigma faced by patients with advanced gastric cancer can suggest more psychosocial training for physicians to move away from disease centered approach to one that implements ways that eradicate social barriers to care.
Yield and Efficiency of FIT Tests Alone vs. In Combination with Risk Factors for Colorectal Cancer Screening
Authors: Sheel Vasu , Azzis Leslie , Hinrichs Racehl , Imperiale Thomas
Published: December 2020

Background: Although colonoscopy (CY) may be considered the best screening test for colorectal cancer (CRC), annual fecal immunochemical test (FIT), which quantifies fecal hemoglobin is a viable alternative. Countries and healthcare systems using FIT-based screening may need to prioritize which FIT positive persons requires CY sooner (e.g. within the same fiscal year). We conducted a systematic review of published literature to understand how the yield/positive predictive value (PPV) of FIT could be improved.  
Study Design: We performed a search of electronic databases for articles published between 2015 and June 2020. Titles, abstracts, and full texts were independently screened. Included studies fulfilled predetermined criteria and had descriptive and quantitative data extracted. We identified studies comparing the yield of FIT for advanced colorectal neoplasia ([AN], CRC plus advanced adenomas) among FIT positive persons to the yield of AN when FIT is combined with risk factors (age, sex, BMI, etc.). Data were extracted to find yield and efficiency of FIT alone vs FIT plus risk factors among FIT positive persons.  
Results: From 623 titles reviewed, 4 studies met inclusion criteria. The objective of the studies was to increase the yield of AN or CRC in FIT positive patients. The number needed to scope (NNS) among FIT positives to detect AN significantly decreased for each study when looking at high risk groups as yield/PPV increased. The yield with FIT alone ranged from 24% to 46% and the NNS from 2.2 to 4.1. With risk factors, yield and NNS among those at high risk were 33.2 % to 75.6% and from 1.3 to 3.0, respectively. 
Conclusion and Potential Impact: This systematic review quantifies how risk factors improve the yield for AN in FIT positive persons, which is information required for countries and health care settings with limited resources that need to direct CY resources to FIT positive patients at high risk for AN.
Qualitative Findings Following Acceptance and Commitment Therapy for Breast Cancer Survivors with Fear of Cancer Recurrence
Authors: Shepler Christine , Cottingham Elizabeth , Stutz Patrick , Johns Shelley
Published: December 2020

Background: Fear of cancer recurrence (FCR) takes an emotional toll on cancer survivors and significantly undermines quality of life following treatment. During a randomized controlled trial of Acceptance and Commitment Therapy (ACT) for post-treatment breast cancer survivors with clinically significant FCR, we conducted qualitative interviews to glean a deeper understanding of the impact of ACT on survivors’ coping with FCR. 
Methods: Breast cancer survivors (stage I-III) who had completed a 6-week ACT intervention were invited to share their experiences in semi-structured qualitative interviews. Interviews were transcribed verbatim and analyzed thematically using a deductive approach. Participants received a $25 gift card for their time. Participants (n=16) were primarily White (81.3%) and college educated (68.8%), with a mean age of 57.3 (SD=11.1) and 75% had an income over $50,000.   
Results: Prior to the study, survivors generally coped with FCR by denying their FCR or by attempting to control their fears through faith, lifestyle management, avoidance, and positivity. Survivors uniformly noted the sense of community they felt in their ACT group when listening to other survivors describe their own struggle with FCR. This common bond created a foundation that allowed survivors to embrace the ACT intervention and develop adaptive coping skills related to acceptance, present-moment awareness, and living consistently with one’s values. Survivors noted that these skills reduced the negative impact of FCR and other life challenges and improved quality of life compared to pre-study coping techniques. 
Conclusion and Potential Impact: By building trust with other cancer survivors, participants were able to shift from attempts to ‘control’ FCR to a more ‘accepting’ approach to manage FCR and other life stressors. While research with a larger group of participants is needed, initial findings indicate that ACT may be a promising addition to care for cancer survivors.
THE ROLE OF THE MICROBIOME IN RESPIRATORY DISEASE: ALLERGIC RHINITIS
Authors: Singh Arundeep , Kloepfer Kirsten
Published: December 2020

Background: 
Allergic rhinitis is one of the most common disorders affecting patients in the United States and developed and developing countries. Currently, no effective methods of prevention or effective cures exist for allergic rhinitis. This is due to unanswered questions regarding the etiology of allergic sensitization and the development of symptoms after sensitization. Recently dysbiosis of the microbiota has been investigated as a potential contributor to the development of allergic sensitization and symptoms.  We decided to review the current evidence and describe potential mechanisms between allergic rhinitis and microbial dysbiosis of the upper airway and GI tract.  
 
Methods: 
To perform our review, we utilized PubMed, compiling the most relevant and well-performed studies focusing on the gut and upper respiratory microbiota in allergic rhinitis. Association and experimental studies were predominantly sought and used, though systemic reviews and review articles were included to ensure we included all pertinent studies within the past ten years.  
 
Findings: 
Significant evidence exists supporting the hypothesis that dysbiosis in upper respiratory and gut microbiota is associated with the development of allergic rhinitis. Additionally, existing longitudinal studies demonstrate that dysbiosis appears to precede the development of allergic symptoms, while experimental studies in murine models have provided evidence for defining a causative role for microbial dysbiosis. To date, modulation of the microbiome shows efficacy for treatment, but little to no efficacy for prevention. 
 
Conclusion and Potential Impacts: 
This review highlights the potential role of the gut and upper respiratory microbiota in the development of allergic rhinitis, providing an additional avenue for treatment and prevention in clinical settings. Given the results of prevention studies utilizing microbiome modulation, more research is required to establish the exact role of the microbiota in allergic disease and to examine the effects of personalized formulations of probiotics to further our understanding and possibly prevent the development of allergic rhinitis.
Glaucoma and Diabetes: A Sweet Connection
Authors: Singh Chevy , Jusufbegovic Denis , Lind John , Pattabiraman Padmanabhan
Published: December 2020

Background/Objective:  
Glaucoma is the leading cause of irreversible blindness in the world. In the United States alone, a little more than three million people live with this disorder which is caused by damage to the optic nerve found in the back of the eye. This is most commonly caused by an increase in the intraocular pressure, or the fluid that maintains the shape and provides nutrients to the eye. Diabetes mellitus (DM), an age-related disorder, is a risk factor for glaucoma. Post-meal, the sugar one eats is managed in the body by the hormone insulin. However, the excess sugar found in diabetics, can exhaust the production of insulin and lead to many adverse complications in the body as well as increase risk of disease. Although some studies suggest a correlation between diabetes and glaucoma, the mechanisms of this association has not been thoroughly investigated. Our objective is to further explore this connection and provide the mechanisms that link diabetes to glaucoma.  
 
Results: 
From retrospective literature review, we find that diabetes is known to have an additive effect on neural apoptosis and in the generation of reactive oxygen in patients with high intraocular pressure. DM also impairs retrograde axonal transport, causes an accumulation of fibronectin in trabecular meshwork, changes eye vasculature, causes dysregulation in lipid metabolism, and malabsorption of vitamins.  
 
 
Conclusion & Scientific/Clinical Policy Impact and Implications:   
This study sheds light on one of the most troubling eye conditions worldwide. The symptoms of diabetes described here increase ones’ risk of developing glaucoma. These pathways result in obstruction of aqueous humor drainage or direct damage to the optic nerve cells leading to glaucoma. Diabetes is a common disease that involves many body systems. With knowledge of the relationship between diabetes and glaucoma, measures can be taken to prevent irreversible eye damage in the diabetic population.
Impact of an at home exercise program in the pediatric, adolescent, and young adult cancer population newly diagnosed with acute lymphoblastic leukemia
Authors: Vyas Punit , Halsey Danielle , Kelly Nicholas , Sherman Melissa , Herbert Brooklyn , Bijangi-Vishehsaraei Khadijeh , Klika Riggs , Keith Nicole , Renbarger Jamie , Sajdyk Tammy
Published: December 2020

Background: Over 30,000 cases of leukemia are diagnosed each year in the United States. For individuals ages 0-39, the one-year relative survival rate is 84.5%, and the 5-year survival is 94%. Improved survival rates come with long-term health challenges due to treatment, including cardiovascular disease, obesity, diabetes, fatigue,  low quality of life (QOL), and reduced physical activity (PA). Current literature shows structured exercise in adult survivors can be beneficial for improving the long-term health effects resulting from treatment. Exercise induces the release of many growth factors into the bloodstream that aid in repair of the body following insult. Three factors specific to nerve damage is brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and Platelet-derived growth factor (PDGF). The benefits of exercise seen in adult survivors may translate to young survivors. We hypothesized that an 8-week at home exercise program in newly diagnosed acute lymphoblastic leukemia (ALL) patients (ages 5-25) would improve outcomes compared to baseline or a control group. The preliminary findings presented are based on the initial ten subjects and include physical, biomarker and self-reported outcomes. 
Experimental Methods: Newly diagnosed ALL patients were assigned to an 8-week at home exercise intervention during the consolidation phase of treatment. Fitbit activity tracker data and questionnaires were used for assessing adherence and feasibility. Blood samples were taken at baseline and at week eight. 
Results:  Subjects were not able to complete over 75% of the exercise intervention; however, they did increase their overall physical activity and their neuropathy scores decreased compared to baseline. BDNF significantly increased in the control group, but not in the exercise group. 
Conclusion: The results indicate that an exercise program in this population during the consolidation phase may not be feasible. It also supports the association between neuropathy, physical activity, and BDNF levels after long term exercise.
Peripheral Extracorporeal Membrane Oxygenation is a safe and effective support modality for pediatric patients with sepsis
Authors: Warnock Brielle , Brown Joshua , Turk Eamaan , Hocutt Gail , Gray Brian
Published: December 2020

Background 
Extracorporeal Membrane Oxygenation (ECMO) can be used as a treatment modality for pediatric patients with refractory septic shock. Previous studies indicate central ECMO, with direct cardiac cannulation, is superior for septic patients. At Riley Hospital for Children, we believe that peripheral ECMO support, through cervical or femoral vessels, is an effective and safe method of supporting pediatric septic patients in a less invasive manner. 
 
Methods 
We reviewed pediatric (30 days to 18 years) patients supported with ECMO for septic shock from 2005-2019 at Riley Hospital for Children and compared them to non-septic respiratory failure patients supported with ECMO. Pre-ECMO data points, demographics, cannulation sites, flow rates, lab values, Vasoactive Ionotropic Score(VIS), P-Prep score, and outcomes were collected and analyzed using t-test and multivariate analyses. We defined a significance as p=0.05.  
Results 
35 of 80 ECMO patients were supported for septic shock. Septic patients were larger (25.1kg vs 11.4kg, p=0.005) and older (85.6 vs 18.8 months, p=0.001). Pre-ECMO VIS and P-Prep were both greater in the septic group (p=0.007 and p<0.001). Pre-ECMO serum lactate level was higher in the septic group (3.7 vs 1.4, p=0.012) , but by 96hrs, lactate normalized in both groups. Flow rates at 24 hours were similar between the two groups (91mL/kg/min vs 88mL/kg/min, p=0.079). No significant difference in bleeding complications or blood product administration was found, but there was a higher incidence of renal failure in septic patients. Survival in the septic group was similar to the comparison group (51.4% vs 62.2%, p-0.37). Hours on ECMO and length of stay were also similar.  
Conclusion and Potential Impact 
Despite septic patients appearing more ill prior to ECMO, they had similar mortality, support parameters, and outcomes, showing that septic shock is not a contraindication to peripheral ECMO support in pediatric patients.
Impact of Ethnicity on Stroke Care and Outcome in Allen County
Authors: Watkins Margaret , Wahab Luna , Chang Fen-Lei
Published: December 2020

Background/Objective: Stroke is the fifth leading cause of death in the US and the leading cause of long-term disability for adults. Research has shown that some ethnic groups have worse health outcomes after suffering from an acute stroke. It has been shown that certain ethnic groups used EMS services less and took longer to arrive at the hospital for acute stroke care. Since time is of the essence for stroke treatment, our study may provide insight on factors that may lead to the delay in the acute stroke management.  
 
Project Methods: In this retrospective chart review, we will look at patients who suffered from an ischemic or hemorrhagic stroke. From each patient’s electronic medical record, demographic information, time from acute stroke onset to hospital stroke activation, stroke severity, usage of EMS services, duration of hospital stay, co-morbid conditions, and stroke outcome will be recorded. Two-way ANOVA is used for statistical analysis.  
 
Results: Data was not able to be collected at this point. We hypothesize that patients of some ethnic groups have longer delay of ED care initiation from the stroke onset, lesser usage of EMS services, and higher rates of co-morbid conditions. We also hypothesize that these factors are correlated with stroke outcome at the time of hospital discharge. In contrast, the distance between home and nearest hospital with stroke care expertise is not different for different ethnic groups.  
  
Conclusion and Potential Impact: The data collected in this study can further explain why some ethnic groups have worse stroke outcomes than others. If the underlying factors responsible for these differences include factors such as failure to use EMS services, steps can then be taken to provide remedy and to promote better acute stroke outcomes for people of all ethnic groups within our community.
Factors Affecting Outcomes in Airway Stenosis Dilations
Authors: Westlake Max , Shew Matthew , Partoo Leila , Kowkutla Ashwini , Parker Noah , Anthony Ben , Halum Stacey
Published: December 2020

Objectives: Tracheal and subglottic stenosis are often managed with dilation procedures, with additional interventions often added in an attempt to delay recurrence of the stenosis. The goal of this retrospective case series is to evaluate the efficacy of such various factors in prolonging airway stenosis recurrence.  
 
Methods: A total of 345 dilation procedures belonging to 148 patients who presented for endoscopic dilation of clinically significant subglottic and/or tracheal stenosis were reviewed. Data was collected on patient demographics, comorbidities, surgical history, dilation type, adjuvant therapies, type of endoscopic intervention, and if needed, time until next dilation procedure. The patient data was divided into adult and pediatric groups based on age at the time of operation. Bivariate models were performed for both the adult and pediatric patient groups.  
 
Results: The charts for 95 adults receiving 220 dilation procedures were reviewed. None of the adjuvant therapies (cryotherapy, steroid injection, topical mitomycin) were statistically associated with an increase in the number of weeks until next dilation. However, procedures involving 14mm balloon dilators (p<0.0108) and interventions with sharp, radial incisions (p<0.0286) were found to be associated with a significant increase in the number of weeks until next dilation when compared to other dilator types and interventions with laser incisions, respectively.  Jackson dilator (p<0.0446) was found to negatively affect outcomes by decreasing the weeks until next dilation. The charts for 53 pediatric patients receiving 125 dilations were reviewed separately, and in these cases, cryotherapy (p<0.0428) was the only factor significantly associated with an increase in weeks until next dilation.  
 
Conclusions: In comparing various factors involved in airway stenosis dilations, balloon dilators and sharp radial incisions were found to significantly increase time needed before the next procedure in adults, while cryotherapy was found to significantly increase time needed before the next procedure in pediatric patients.
Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia
Authors: Wilson Emily , Roberts Aaron
Published: December 2020

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time. 
 
Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time.  
 
Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time. 
 
Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.
Heterotopic Ossification in Polytrauma
Authors: Young Allison , Chitwood Joe , Perrien Dan , White Fletcher , Kacena Melissa
Published: December 2020

Background: Heterotopic ossification (HO) is the pathologic development of ectopic bone in muscle and soft tissue.  HO is a known complication that can arise in cases of fracture, surgery, burn injury, and nervous system injury.  The co-occurrence of traumatic brain injury (TBI) and fracture increases the risk of HO development by 37-50%.  This review aims to examine and synthesize the mechanisms involved in HO development after polytrauma, available animal models to study these mechanisms, and possible treatment options for patients.   
 
Project Methods: A literature search was conducted using PubMed and EMBASE with search terms: heterotopic ossification, fracture, and traumatic brain injury.  This search produced 33 unique articles.   
 
Results:  TBI and fracture contribute to HO development by triggering the release of inflammatory cytokines, neuropeptides, and hormones in response to nervous system and bone damage.  Bone morphogenetic protein (BMP), vascular endothelial growth factor (VEGF),  and Substance P (SP) are among the known contributors to HO formation.  Damage to the blood brain barrier and release of nervous system factors may also contribute to the osteogenic environment that promotes ectopic bone development.  Rodent modeling of the biologic mechanisms underlying HO can be exploited to better understand the molecular causes of the condition.  There are also options for both prophylaxis and treatment of HO.  Prophylaxis options include radiation treatment, non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates.  Treatment options include physical therapy and surgical resection.  
 
Potential Impact: HO has a high occurrence rate in military personnel exposed to combat trauma and can lead to restriction of joint movement, pain, and infections in soft tissue.  There are limited options for treatment, pointing to a need for further study.
Pinpointing Problems: A Literature Review of Diabetic Peripheral Neuropathy
Authors: Young Nicholas , Khanna Savita
Published: December 2020

A subset of diabetic polyneuropathy, DPN is the most common neurological complication of diabetes. DPN affects around 12–50% of individuals with diabetes mellitus. DPN compromises the function of nerves in the hands, feet, legs, and arms. It is common for DPN to start in the feet, and often both feet are affected at once. This review of the literature seeks to summarize the current state of DPN research and key findings. 
Dissemination of community awareness about the diabetic foot may play a major role in managing DPN. Clinical tests for DPN are simple but lack a standardized approach for the quantification of pain and sensory loss. Thus, estimates of prevalence or intervention efficacy vary widely. Research into burden of disease focuses on ulceration, an ominous sign resulting in amputation and high morbidity/mortality. DPN increases the risk of fall, deteriorates mental health conditions, causes disability lowering quality of life. Specific research regarding the role of social determinants of health in DPN is lacking. It is clear, however, that race, low income, and lack of health insurance are associated with higher burden. Controlling blood glucose is highly effective in managing DPN. It can prevent DPN in Type 1 diabetes and can be effective for preventing DPN in Type 2 diabetes. Treatment of DPN is symptomatic and of limited efficacy in only a fraction of patients, relying primarily on antidepressants and anticonvulsants for the relief of pain. In management of DPN, exercise and psychological therapies can improve outcomes and improve nerve conduction velocity. Combined lifestyle interventions have shown success in prevention of microvascular complications of diabetes and ulceration and may be effective in DPN as well. Harmonization of quantitative diagnostic criteria and definitions of diabetic neuropathies would provide more useful endpoints for trials, epidemiological and mechanistic insight, and potential for earlier detection.
Misled by the Xpert-Kikuchi’s disease masquerading as tuberculosis
Authors: Krishnakumar Aparna , Sivaprakasam Elayaraja , Ravichandran Latha , Pasupathy Umapathy , Premkumar Sarala , Mohan Ram
Published: December 2020

Kikuchi-Fujimoto disease (KFD), also called histiocytic-necrotizing lymphadenitis is a rare, idiopathic and self-limiting cause of lymphadenitis. Clinical presentation of KFD closely resembles nodal tuberculosis (TB). Here we present a case of an adolescent female whose diagnosis of KFD was made despite being misled in the course. A 15-year-old female, previously treated for tuberculous lymphadenitis was brought with complaints of fever for 1 month. Various possibilities considered were TB reactivation, autoimmune disorders, lymphoma. Lymph node biopsy for gene Xpert showed TB bacilli detected but low with no RIF resistance. Despite anti tuberculous treatment initiation, there was no improvement in the clinical condition. Histopathology of cervical node showed features of Kikuchi lymphadenitis. Literature search revealed that gene Xpert can detect the intact DNA of Mycobacterium tuberculosis even years after the previous treatment. On stopping anti tuberculosis therapy (ATT) and starting IV steroid, she started improving dramatically. KFD should always be kept as a differential diagnosis in any individual with fever and lymphadenopathy. Diagnosis can be misled in any patient based on gene Xpert reports alone which often turns out to be positive if there is past history of TB as gene Xpert detects DNA from non-intact cells suggesting that dead bacilli contribute to the false positivity.
Sosyal Medyada Satın Alma Niyetinin Demografik Özellikler Açısından İncelenmesi
Authors: CEVHER Muhammed Fatih
Published: December 2020

Amaç: Sosyal medya platformlarında etkileyici kişilerin gücünden yararlanarak kurgulanan pazarlama stratejilerinin etkileri son yıllarda dikkat çekmektedir. Sosyal medya etkileyicilerinin / fenomenlerinin kullanılmasıyla, tüketicilere ürün ve markalarıyla ilgili mesajları iletmek isteyen firmaların “Influencer marketing” adı altında fenomen kullanım stratejileri ve hedefleri de önem arz etmektedir. Bu nedenle çalışmanın amacı sosyal medyada etkileyici olarak kabul edilen sosyal medya fenomenlerinin tüketicilerin satın alma niyetine etkilerini tüketicilerin demografik özellikleri açısından incelemeye yöneliktir. Yöntem: Çalışmada nicel araştırma yöntemlerinden anket tekniği kullanılmıştır. Sosyal medya uygulamalarını kullanan 818 kişiye yapılan anket ile tüketicilerin demografik özelliklerine göre satın alma niyetleri arasındaki farklılıklar tespit edilmeye çalışılmıştır. Veriler SPSS istatiksel analiz programı aracılığıyla t-testi ve ANOVA testleri yapılarak analiz edilmiştir. Bulgular: Tüketicilerin demografik özellikleri, sosyal medya üzerinden satın alma niyetleri kapsamında farklılık göstermektedir. Ayrıca çalışmanın hipotezleri test edilmiş 3 hipotezin desteklenmediği 2 hipotezin ise desteklendiği tespit edilmiştir. Desteklenen hipotezlere bakıldığında ise tüketicilerin eğitim düzeyleri ve gelir düzeyleri ile satın alma niyetleri arasında anlamlı farklılıkların oluştuğu tespit edilmiştir. Tartışma: Tüketicilerin satın alma niyetlerinin; sahip oldukları demografik özellikler açısından incelenmesi konusunda çalışmaların az olması dikkat çekmektedir. Sosyal medya konusunda yapılan çalışmalar tüketici davranışları üzerinden satın alma niyetini ölçmeye çalışmış ve az sayıda çalışmanın olduğu görülmüştür. Çalışmanın bu alana katkı sağladığı gibi sosyal medyadaki tüketicilerin farklı yönleriyle araştırılması için de bir öngörü sağlayacağı düşünülmektedir. Çalışmanın literatüre yeni bakış açılarıyla eklenecek çalışmalar hem reel sektörde işletmelere hem de bu alanda çalışma yapmak isteyen akademisyenlere rehberlik edeceği beklenmektedir.
SONORIDADES FRONTEIRIÇAS NO SUL DA AMÉRICA: O CASO DA MILONGA
Authors: Trombetta Gerson Luís , Carraro Gadhyego
Published: December 2020

O artigo analisa a constituição das sonoridades musicais típicas da fronteira entre Uruguai, Argentina e Rio Grande do Sul (Brasil). O estudo trabalha com a hipótese de que a referida região de fronteira é um espaço histórico e peculiar, marcado por características climáticas (frio e vento), geográficas (pampa) e econômicas, modos de vida, condições psicológicas (isolamento e melancolia) e encontros culturais que impulsionaram processos híbridos capazes de gerar sonoridades específicas, destacando-se, de modo especial, a milonga.
PATRIMÔNIO INDUSTRIAL NA AMAZÔNIA: ACENOS HISTÓRICOS DA ESTRADA DE FERRO DE BRAGANÇA
Authors: Rosa Larisse Fátima Farias , Palácios Flávia Olegário
Published: December 2020

A Estrada de Ferro de Bragança (EFB) foi a primeira ferrovia construída na Amazônia. O projeto da via férrea pretendia otimizar a conexão entre Belém (capital do Pará) e Bragança (maior cidade da Zona Bragantina). A composição da EFB demandou o uso de novos materiais e técnicas construtivas no início do século XX. Sendo escolhidos elementos provenientes da arquitetura do ferro para integrar o acervo da ferrovia de forma estrutural e ornamental. O artigo objetivou investigar dados da arquitetura do ferro utilizada na composição da EFB. A abordagem metodológica foi realizada por meio de fontes histórico-documentais com o recorte temporal de aproximadamente trinta anos (1883-1910). Resultando na sistematização de informações visando compreender o uso significativo de elementos da arquitetura do ferro e a importância da preservação dessas peças.
Questões de Identidade e Distinção Social através do consumo de caranguejo, peixe e caju no litoral piauiense na primeira metade do século XX
Authors: Baptista Marcus Pierre De Carvalho , Costa Filho Alcebíades , Nascimento Francisco De Assis de Sousa
Published: December 2020

Este artigo teve como objetivo refletir sobre hábitos alimentares dos sujeitos que viveram em Parnaíba na primeira metade do século XX e de que forma a comida e o seu modo de preparo suscitou questões de Identidade e Diferença. A metodologia empregada foi a pesquisa bibliográfica a partir de Hall (2006), Woodward (2014), Silva (2014), Certeau, Giard e Mayol (1996), Carneiro (2003) e a documental através de jornais, livros de memória, documentos do poder executivo e crônicas de viajantes. A pesquisa permitiu entender que o hábito e as diferentes formas de consumir o caranguejo, o peixe e o caju no litoral do Piauí possibilitou a distinção de grupos sociais, fabricação de identidades culinárias e identificação com o espaço litorâneo.