bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous iontophoresis of adrenergic agonists can mimic in vivo neural effects on vasodilation
Authors: Stout John A. , C. Ilinca Ungureanu C. Ilinca Ungureanu , Miller Olivia G. , Metzler-Wilson Kristen
Published: January 2023

Iontophoresis utilizes electrical current to non-invasively deliver agents through the skin. This pilot study sought to determine if iontophoresis could be paired with laser Doppler flowmetry (LDF) to administer adrenergic and cholinergic agonists and measure the subsequent changes in cutaneous blood flow. We hypothesized that iontophoresis administration would produce vascular tone changes consistent with those seen during other delivery methods. We iontophoresed phenylephrine, clonidine, isoproterenol, and acetylcholine to the forearm of one generally healthy 44-year-old female using existing or adapted protocols. We also created half-strength protocols with the goal of establishing dose-response relations. We quantified erythrocyte flux via LDF and beat-by-beat arterial blood pressure via finger photoplethysmography. After baseline, each drug was administered using its half and full-strength protocols, separated by a washout period. Finally, we stimulated maximal blood flow at each iontophoresis site via non-noxious local heating to 43°C. Cutaneous vascular conductance (CVC; laser Doppler flux/ mean arterial pressure) was calculated during baseline and following iontophoresis. We administered vehicle (deionized water) alone as a control, using the same protocols and analysis. The drug responses generally matched our predictions with the exception of phenylephrine, which caused vasodilation. Vehicle administration also caused vasodilation. Full-strength application generally led to a more pronounced change in CVC, suggesting that a dose-response relation might be established with additional data. Applications of certain agents led to a higher CVC than “maximal”, possibly raising the need to alter the method for establishing maximal cutaneous blood flow. Overall, our findings indicate that iontophoresis and LDF can be used to effectively administer adrenergic and cholinergic agonists to non-glabrous skin and affect vascular tone. This non-invasive technique could be used to investigate responses to these agents in those whose cutaneous neural receptor characteristics have been altered as a consequence of disease.
Gene Expression Data Points to a Role for Hypoxia in Medulloblastoma Pathogenesis
Authors: Blocher III William A. , Cooper Scott H. , Richardson Angela M.
Published: January 2023

Background:
Medulloblastoma (MB) is the most common intracranial tumor in children. While molecular classification of MB is well-established, detailing cell origin, biological properties, and biomarkers, little research has been performed concerning the MB tumor microenvironment. Hypoxia is significantly associated with tumor spread, poor prognosis, malignant phenotype, and resistance to radiotherapy and chemotherapy in numerous cancer types. The aim of the present study was to assess a possible role for hypoxia in MB and the potential effect on clinical outcomes.
Methods:
We, therefore, performed a systematic review examining the role of hypoxia in MB as well as pediatric brain tumors in general. In vitro studies have identified a role for HIF-1α in chemotherapy resistance, while patient samples suggest hypoxia-induced changes in gene expression as well as proteomic, metabolomic, and lipidomic profiles. Based on this literature review, 55 candidate hypoxia-related genes were identified. The PedcBioPortal for Integrated Childhood Cancer Genomics was used to assess expression differences in pediatric patient samples for these genes of interest.
Results:
RNA expression was analyzed for correlation with survival, molecular group, and Chang stage. Expression of DDAH1, HYOU1, MYC, and RBX1 were significantly associated with survival. ANOVA and Ttest with a Bonferroni correction were used to assess for expression differences between groups and Chang stage. Multiple hypoxia candidate genes (ARNT2, BHLHE40, CYP3A5, DDAH1, DDIT4L, EGLN3, MT3, MYC, MYCN, TGFBR2, TP53, VEGFA) were significantly correlated with molecular group. Expression levels of TGFBR3 and GPR37 were associated with Chang stage.
Conclusion and Potential Impact:
The results of our systematic review and gene expression analyses support a role for hypoxia in the pathogenesis and potentially the clinical outcomes of children with MB. Future studies comparing gene expression levels at normal oxygen tension (21%) and physiologic oxygen tension (1-3%) will allow us to assess the role of hypoxia in medulloblastoma pathogenesis.
The Reach, Implementation, and Effectiveness of Virtual Sex Education for Foster Care Youth
Authors: Cornwell Ailish , Farrelly Monica , Cope-Barnes Doug , Meagher Carolyn G. , Ott Mary A.
Published: January 2023

Background and Objective:   Foster care youth have high rates of adverse sexual health outcomes (i.e. STIs, teen pregnancy, sexual trauma), and are important targets for evidence-based sex education.With the COVID-19 pandemic, sex education programming was moved to a virtual format. However, few data existed to guide this transition. We conducted a mixed-methods analysis of the reach, implementation, and effectiveness of    virtual vs in-person sex education for foster care youth before, after, and during the COVID-19 pandemic.  
Methods:  Indiana Proud and Connected Teens (IN-PACT) provided three evidenced-based programs to system-involved youth. The data used in this study includes facilitator forms (n=64) from 2020-2021 virtual programming and youth surveys from 2018-2020 representing in-person (n=965) and virtual (n=50) delivery. Reach was measured using youth survey demographics and sexual behaviors; implementation by free responses from facilitators on challenges and adaptation for virtual teaching; and effectiveness by youth behavior intention and attendance records.
Results:Reach: demographic diversity was maintained for virtual programs, but youth in virtual programs had lower rates of risk behaviors.Implementation: technical, curricular, and relational challenges were experienced and these inspired creative solutions. The sensitivity of the topics likely contributed to relational challenges such as decreased group trust.
Effectiveness: more virtual youth planned to be abstinent in the future, however they had less sexual experience to start with. Fewer youth completed more than 75% of virtual programming as compared to in-person. Conclusions and Impact:  In-person sex education programming has a wider reach, experiences less implementation challenges, and holds better attendance records than virtual programming. However, if virtual programming becomes necessary again from a public health perspective, sex educators and researchers can build on these findings to design virtual sex education that maintains the reach, implementation, and effectiveness of in-person formats.
Impacts of Interprofessional Spiritual Care Education Within a Healthcare Team: a Qualitative Analysis
Authors: Davis Justin , Oyedele, RN, BSN Oladele , Lion, DO, MPH Alex H. , Szilagyi, MDiv, MLA, MS, ACPE Csaba , Puchalski, MD, MS, OCDS, FACP, FAAHPM Christina
Published: January 2023

Background: Spirituality is frequently utilized by patients experiencing cancer and blood disorders to maintain their well-being and cope with their diagnosis. The provision of spiritual care is a critical aspect of whole person care and is associated with increased quality of life and positive coping with pain. Generalist aspects of spiritual care may be provided by any team member trained to do so. The Interprofessional Spiritual Care Education Curriculum (ISPEC©) is an online program which provides this training.
Methods: We utilized ISPEC© for the training of Pediatric Hematology-Oncology team members. From 21 team members who were trained, a convenience sample of 8 participants were interviewed regarding their experience. Using a phenomenological approach for interview and analysis, we explored the experience of interprofessional spiritual care training. Through iterative review of interview transcripts, themes representing the essence of the lived experience were identified. Theme saturation was reached through the interviews of the 8 participants.
Results: Three major themes emerged. These themes were (1) Knowledge gained, (2) Barriers to Providing Spiritual Care, and (3) Impact on the Healthcare Team. While the experience of interprofessional spiritual care training mitigated one barrier (lack of training), it also revealed barriers within the standard workflow, which participants became interested in changing. Through education on generalist spiritual care, there were both benefits to patients whose spiritual needs could be better addressed, and an increased understanding of the team member's own spiritual needs.
Conclusion: Interprofessional spiritual care education, utilizing ISPEC©, has a strong potential to develop pediatric hematology-oncology team members’ capabilities to attend to the spiritual aspect of whole-person care. In addition to contributing to the well-being of patients, the experience of training in spiritual care also holds benefits to the team members as they are learning to recognize their own spiritual needs and resources.
Food Insecurity Is Associated With an Increased Risk of Neonatal Acute Kidney Injury and Abnormal Kidney Function
Authors: Delbridge Abigail C. , Wallace Samantha , Chaudhry Paulomi , Soranno Danielle , Starr Michelle C.
Published: January 2023

Background: Prenatal food insecurity (FI) negatively affects both maternal and infant health. These effects may be even more notable in infants as 1) prematurity and neonatal intensive care unit (NICU) admission increase the risk of kidney disease, 2) maternal malnutrition leads to decreased kidney mass, and 3) FI accelerates the progression of kidney disease.Our aim was to determine the association between FI and kidney health.
Methods: Single-site prospective cohort study.Parents of infants admitted to the NICU at Riley Children’s Health at Indiana University, Indianapolis, IN were interviewed. We collected demographic characteristics and FI status using the Hunger Vital Signs (a validated two-question screening tool). Maternal and infant data were abstracted from medical records and kidney outcomes were compared by FI status.
Results: A total of 45 infants were enrolled in this study. In the cohort, the mean gestational age was 32 weeks and the average birthweight was 1.8kg. 26 (60%) reported a household income >$50,000 per year and 21 (47%) held an Associate’s degree or higher. Of the cohort, 22% (10/45) lived in FI households. Infants from FI households were more likely to have AKI than those from food secure households (60% vs 17%, p=0.007) and were more likely to have an abnormal serum creatinine at two weeks of age (70% vs 31%, p=0.028). While not statistically significant, infants from FI households had a trend towards higher likelihood of IUGR (30% v 14%).
Conclusion: Food insecurity was common among families with infants admitted to the NICU. Infants born into FI households were more likely to have AKI and delayed maturation of kidney function than those born in food secure households. This emphasizes the importance of FI screening as part of prenatal care along with the need for resources such as food pantries for families admitted to the NICU.
Characteristics of Hospitalized Pediatric Patients with a Malnutrition Diagnosis at Riley Hospital for Children
Authors: Denning Ellen , Vanderpool Charles
Published: January 2023

Background: A diagnosis of malnutrition in hospitalized patients has been shown to negatively affect clinical outcomes by impairing immune responses (a subsequently increasing infection and complication rates), increasing the average length of stay in the hospital, and increasing mortality. In the past, there have been efforts to study the characteristics and prevalence of pediatric populations diagnosed with malnutrition in a hospital setting, but until 2014, no universal standards were used for malnutrition diagnosis and documentation. In 2014, The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) introduced a recommendation for standardization of identification and documentation of pediatric malnutrition. These recommendations guided a series of malnutrition awareness initiatives at Riley Hospital for Children (Riley) with a focus on increasing malnutrition documentation efficiency and integrity. Subsequently, the number of malnutrition diagnoses at Riley has increased from 2016 when the initiative started through 2021.
Objective: The purpose of this study is to identify characteristics of patient populations diagnosed with malnutrition that may benefit from early intervention.
Methods: Individuals with a diagnosis of malnutrition at Riley Hospital for Children (excluding Obstetric patients) from the years 2019-2021 were included in this study. Patient level data was used to study average length of stay (LOS), 30-day readmission percentage, admitting service, primary diagnosis, and demographics of this population.
Results: Preliminary data analysis suggests there is a decreasing trend in readmission within 30 days for patients diagnosed with malnutrition. A similar trend is seen in the entire population of patients treated at Riley Hospital for Children in the same period. Of note, the entire patient population of Riley has seen a decreasing average length of stay while the patient population with a malnutrition diagnosis have seen an increasing average LOS.  These observations have not been evaluated for significance at this time.
Changes in Cortical Composition during Gyrification in the Developing Brain
Authors: Doherty Sarah , Garcia Kara E.
Published: January 2023

Background and Hypothesis: Abnormal brain folding has been implicated in neurodivergent conditions such as schizophrenia and autism, yet the mechanical and biological processes responsible for this process are not well understood. One current hypothesis is that cortex growth outpaces growth of the underlying white matter to drive mechanical buckling. However, mechanical stresses, such as those resulting from buckling, can also influence cellular behavior. In this study, we hypothesized that mechanical stresses from cortical folding influence processes of biological growth within the cortex, such as dendrite arborization within the neuropil and neuronal differentiation.
Methods: To quantify change in cell body size and neuropil over the period of cortical folding, sections of the developing ferret brain (postnatal days 20, 26, 32, and 38) were stained with FluoroNissl dye, imaged with confocal microscopy, and analyzed using Fiji software. Change in percent neuropil, cell area, cell density, and overall length were quantified at upper, middle, and lower thirds of the cortex to assess the influence of bending stresses within gyri and sulci during development.
Results: Preliminary analysis revealed a substantial increase in neuropil over time in the upper layers of the cortex. However, gyral regions expected to experience mechanical tension and increased expansion did not exhibit the hypothesized differences in neuropil or cell size. Though there was an overall increase in neuropil volume fraction and cell body size over time, throughout all layers of the cortex, these factors only accounted for roughly 2/3 of the physical growth quantified throughout these cortical layers.
Potential Impact: Findings indicate that neuropil and cell body expansion are insufficient to fully explain the growth observed during cortical folding. These results highlight a potential role for alternative cellular processes, such as the migration of other cell types into the cortex, to induce cortical growth and folding in gyrencephalic species.
Creating a Patient Registry for the Parkview Vein Clinic
Authors: Fliotsos Katrina , GeRue Michael , Sowden David
Published: January 2023

Background/Objective: The Parkview Vein Clinic provides individualized care to patientssuffering from venous disease by providing assessment, education, treatment, ultrasound imaging, and surgical interventions all under one roof. The Vein Clinic has experienced a consistent increase in patient volume since opening in 2019, creating a need for tracking patient outcomes. Patient registries are useful tools for tracking high volumes of patients, assessing outcomes, and improving treatment guidelines. The main objective of    this quality improvementproject is to define the workflow for creating a patient registry for the Vein Clinic and determine which data points are feasible to collect.
Methods: This is a retrospective chart review of patients with the diagnosis of “venous stasis ulcer” seen at the Vein Clinic from September 2019 to July 2022. A total of 84 data fields were collected on each patient, including information on demographics, medical history, ulcer descriptions, imaging, procedure information, and post-procedure follow-up. The Society for Venous Surgery Vascular Quality Initiative was used as a template for registry design, with the goal of merging the registry with the national database in the future.
Results: Venous ulcer information, including number of healed ulcers, duration of ulcer, and largest diameter active ulcer, was not readily accessible within the chart and required expanded review find and quantify. All other categories were readily accessible in the chart.
Conclusions: The data collected by the registry will be useful for future quality improvement purposes of the Vein Clinic. Creation of a structured reporting template in Epic would help facilitate the ease and accuracy of data extraction and help maintain the internal validity of the registry. More detailed follow-up assessments should be implemented to track patient outcomes, which could include use of the Venous Clinical Severity Score or a patient-reported outcomes assessment.
Assessing Psychosocial Risk Factors in Children with Sickle Cell Disease
Authors: Frey Nicole , LaMotte Julia , Bouck Jillian , Parker Genese , Daas Roua , Jacob Seethal A.
Published: January 2023

Background and Objective: Most patients with sickle cell disease (SCD) in U.S. identify as Black/African American. This is an important psychosocial risk factor to consider given well-documented systemic racism in medicine resulting in disparate health outcomes, particularly for individuals managing a chronic health condition like SCD. The purpose of our research is to determine the level of psychosocial risk factors in children with SCD at Riley Hospital and assess the utility of Psychosocial Assessment Tools (PATs) in this setting.  
Methods: The PAT is a validated caregiver-report screener administered as part of the clinical visit. Each PAT is scored by the SCD Social Worker to provide tailored resources to families. Scores are stratified into 3 risk tiers indicating level of psychosocial intervention necessary- Universal, Targeted, or Clinical. Descriptive analyses were performed to determine patient and caregiver demographics, experiences, beliefs, and overall risk categorization.
Results: There were 141 completed PATs for analysis. Ninety-five percent of the patients identified as Black/African-American with an average age of 8.57 years (0-22 years). Most caregivers were Black, single women over 21 with at least a high school degree. Sixty-seven percent of patients fell into the Universal range, 29% in the Targeted range, and 4% in the Clinical range. The Family Structures/Resources Subscore had the highest average, and includes questions about insurance coverage, transportation, and money problems. Forty-six percent of families reported some form of financial difficulty, with housing, utility bills, and car costs as the most common.
Conclusion and Impact: Implementation of a psychosocial risk screener in the SCD clinic identified financial challenges for almost half of families, allowing for timely resource support. Many of these families, however,were categorized as Universal, indicating that distribution of resources must not be based on total PAT score alone. Future steps include evaluating the effect of resource provision at SCD visits on improving barriers to care.
Combinatorial Inhibition of Epigenetic Regulators to Treat Glioblastoma
Authors: Burket Noah , Koenig Jenna , Saratsis Amanda
Published: January 2023

Background:
Glioblastoma multiforme (GBM) is a deadly primary brain cancer that is diagnosed in 12,000 patients in the US annually with a median survival time of 15 months. Temozolomide is the standard-of-care for GBM; however, many tumors are resistant, necessitating the expansion of therapeutic options. EZH2 and JMJD3 are two proteins responsible for epigenetic regulation of the genome via histone methylation, with EZH2 also affecting non-histone targets. Prior studies showed that inhibition of these proteins decreased cell counts and induced radiosensitivity in GBM. Thus, we investigated combined use of EZH2 inhibitor, EPZ-6438, and JMJD3 inhibitor, GSK-J4, in the treatment of temozolomide-resistant GBM10 cells.
Methods:
Non-irradiated cells were treated with both drugs singly or combined, and counted at 24-, 48-, and 72-hour intervals. Irradiated cells were pre-treated with each drug or combination therapy for three days, irradiated, and then counted at 24-, 48-, and 72-hour intervals. Western blot allowed investigation of dsDNA damage biomarker yH2AX, gene-silencing modification H3K27me3, total H3, tumor suppressor p53, EZH2, JMJD3, ySTAT3, and total STAT3 expression in non-irradiated and irradiated cells following drug treatment.
Results:
Single EPZ-6438 and GSK-J4 treatment decreased cell count in a dose and time dependent manner. GSK-J4 was more effective than EPZ-6438, and combinatorial treatment was most effective. Western blot revealed that GSK-J4 but not EPZ-6438 treatment followed by radiation increased H3K27me3 expression. EPZ-6438 treatment increased yH2AX expression, but this was not further increased by radiation. Meanwhile, GSK-J4 treatment increased yH2AX, but only after radiation.
Discussion:
Decreased cell count following GSK-J4 treatment may be due to increased gene silencing resulting from the inhibition of H3K27 demethylation. Additionally, increased dsDNA breaks observed in EPZ-6438 and GSK-J4 treatments supports their roles in radiosensitizing GBM cells.
Potential Impact:
This study highlights the importance of further investigation into GSK-J4 and EPZ-6438 combination therapy in temozolomide-resistant GBM tumors.
Lutheran Children’s Hospital Neonatal Follow-Up Clinic: Risk of Developmental Delay of Preterm Neonates as a Function of Gestational Birth Age
Authors: Russell Abigail , Stace Susie , Soldner Susie Allison
Published: January 2023

Background/Objectives:About 1 in 10 babies are born prematurely, a number that increased from previous years because more resources are available and fertility treatments are effective. Children born prematurely have a higher risk of developmental delays that are associated physically, socially, linguistically, and neurodevelopmentally. With these delays being commonly associated with preterm infants, there is the need to continuously study the longitudinal effects caused by being born prematurely. Our objectives include creating a more comprehensive care plan, comparing gestational age with developmental delay levels, and noting correlations between delays and their respective cohort. We hypothesis the more premature the child was born, the higher the likelihood of developmental delay(s).
Methods:Two main tests were used to look for a correlation between the delay or lack of a delay with the child’s adjusted age. TIMP, Test of Infant Motor Performance, was used at two different age intervals to measure infant motor capacity. The ASQ, Ages and Stages Questionnaire, was used to screen several different developmental areas of concern, including social and behavioral abilities.
Results:The data shows the developmental delay decreasing over time in all preterm cohorts with an exception being the late preterm cohort, likely due to its small sample size. The Chi-square test is not significant for the TIMP1 and TIMP2 comparisons of preterm cohorts. The ASQ data sets did not have a clear consensus of data.
Conclusions:There is an increase of developmental delay in neonatal infants in comparison to the standard developmental milestones. A positive finding is that there is an overall decrease in developmental delay as the child progresses in age.
Potential Impact: This research may promote other hospitals to implement a NFC for patient care and research considerations.
Dynamic and Stimuli-Responsive Hydrogel Systems for Controlled Release of Proteins
Authors: Sammour Yasser , Dimmitt Nathan , Lin Chien-Chi
Published: January 2023

Background and HypothesisHydrogels have been extensively used as biomaterials for controlled release applications due to their biocompatibility and tunable networks. Stimuli-responsive, or smart, hydrogels are of interest due to their potential for localized release based upon local stimuli such as pH. In addition to smart materials, dynamic hydrogels have been utilized to obtain unique release profiles such as biphasic release curves. We hypothesized that by leveraging dynamic and stimuli-responsive click chemistry we can fabricate hydrogels with unique and controlled release profiles.
Project MethodsA new reversible addition fragmentation chain transfer (RAFT) polymer known as PADO, was synthesized bearing a ketone functional group allowing for crosslinking with hydrazide bearing motifs to form a pH labile acylhydrazone bond. In addition, polyethylene glycol (PEG) based hydrogels have been extensively used in controlled release applications due to their biocompatibility and antifouling properties. Previously, we have developed a novel conjugation technique for functionalizing norbornene onto hydroxyl-terminated PEG through a cyclic desymmetrization reaction with carbic anhydride. The new polymer, PEGNBCA, was further conjugated with dopamine via amide conjugation to form PEGNBD. Mass loss and protein release analysis were conducted for PADO and PEGNBD hydrogels, respectively.
ResultsMass loss studies confirmed that PADO hydrogel degraded faster at mildly acidic pH of 6 compared to physiological pH of 7.4. In addition, the rapid hydrolysis of PEGNBD crosslinked via inverse electron demand Diels-Alder reaction demonstrated higher protein release compared to conventional PEGNB hydrogels, which are hydrolytically resistant.
Conclusion/ImpactThe sensitivity to degradation PADO hydrogels in an acidic environment, and the hydrolytically sensitive PEGNBD hydrogels, can be utilized for targeted therapeutic release. For example, the pH-sensitive hydrogel system can be utilized for therapeutic release into an acidic neoplasm while having minimal release in neutral pH tissues.
Geriatric Trauma Patients and Firearm Ownership: Planning for Cognitive Decline
Authors: Scanameo Laura , Redilla Nicholas , Swartwood Brigitte , Smith Harrison , Levin Jeremy , Meagher Ashley
Published: January 2023

Background/Objective: It’s estimated that roughly 13 million older adults will suffer from dementia in the United States by 2050 and over 30% of adults ≥65 years own a firearm. There is a lack of information on the attitudes of older adult firearm owners in the Midwest regarding management of firearms and dementia. The study’s aim was to survey geriatric trauma patients about firearm ownership, storage, and planning for cognitive decline.
Methods: Patients were approached for study participation if they were admitted to the trauma service at an urban academic level I trauma center, aged ≥60 years, and own or live with a firearm. Participants were approached in person and if they agreed to participate, an anonymous survey was conducted during their admission. Our primary outcome was rate at which participants would consider having a planning conversation following survey participation if they had not already done so. Results were analyzed for thematic trends.
Results: Over the study, 50 patients were approached with 19 (38%) meeting inclusion criteria. Of the eligible participants, 10 (~53%) were successfully enrolled. There was an equal male-to-female participation rate with an age range of 61-85 years. Twenty percent (n=2) of participants had previous conversations with family members about firearm management and dementia. After survey participation, 70% (n=7) of participants intended to have planning conversations. A theme of giving firearm responsibility to others emerged in response to prompting participant’s biggest concern of firearm management and dementia.
Conclusion and Potential Impact: Sixty percent (n=6) of participants expressed a desire to have new planning conversations with family after survey participation, which met the primary outcome of the study. Further work to assess barriers to study participation is ongoing. These results have the potential to better inform educational interventions for adult firearm owners to guide conversation and outline available resources.
Towards a Metaphysics of Harm
Authors: Schantz Eli
Published: January 2023

Background/Objective:The concept of harm underpins both the philosophical foundation of medicine and its everyday practice. The depth to which medicine relies on harm, however, starkly contrasts with our limited philosophical understanding of it: despite fifty years of research, no single analysis of harm has become accepted among metaphysicists. In the face of this important and unsettled debate, this investigation sought to lay a foundation for a more complete metaphysics of harm.
Methods:This investigation was built upon two analyses performed in sequence. First, the four basic accounts of harm—Counterfactualism, Historicalism, State non-Comparitivism, and Will non-Comparitivism—were compared to our intuitive judgements on challenging cases. Following this, their failures were assessed for commonalities that could guide further investigation.
Results:Counterfactualism, Historicalism, and State non-Comparitivism fail due to their inability to account for the individualized nature of harm; and while Will non-Comparitivism can properly individualize harm, it cannot account for harm to infants, the incapacitated, or animals. A more conservative form of Will non-Comparitivism, rooted in the notion of volitions rather than the will, may therefore be able to individualize harm while retaining the ability to account for harm to all relevant beings.
Conclusion:An account of harm based on volitions, then, may be capable of achieving two basic desiderata for a theory of harm. Such a theory would have significant effects on both the philosophy and practice of medicine: it would, for example, render paternalism incoherent, and would root essentially all clinical decision-making in the volitions and values of patients.Further work, however, remains to be done. The more complex theories of harm advanced by Klocksiem, Thomson, and Hanser remain to be assessed, as does the comparative nature of a volitional account. Further, the compatibility of a volitional account with other established desiderata in the field must be determined.
The Effects of the COVID-19 Pandemic on IVC Filter Placement
Authors: Schneider Dylan , Keltner Emily , White Eric
Published: January 2023

This project was supported by the Parkview Research Center and the Student Education and Research Fellowship Program.This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Background: IVC filters are self-expanding stents that have been used to prevent pulmonary embolisms when anticoagulants are contraindicated. Retrieval of filters is imperative to their success as prolonged dwell time can cause further complications such as filter erosion, displacement, or thrombus. The IVC filter clinic was created in July 2017 to improve patient outcomes, follow-up, and removal of filters.
Objectives: The purpose of this study is to determine differences in indication, removal rate, follow-up rate, dwell time, mortality, and general trends before and during the COVID-19 pandemic.
Methods: The current study is a retrospective chart review of patients who received an IVC filter between July 2017 and June 2022. In determining differences related to the COVID-19 pandemic, March 2020 was used as the start date, and it is ongoing through June 2022.
Results: There was a decrease in 1 year survival (86% vs 63%, p = .000412) when patients did not receive a follow-up office visit. There was a decrease in follow-up rate (86% vs 77%, p = .049762) after the onset of the COVID-19 pandemic. Patients who had their filter removed were more likely to be alive at 1 year than those who did not get their filter removed (95% vs 72%, p < .00001). There was no significant change in indication, removal rate, dwell time, or 1-year mortality after the start of the pandemic.
Conclusions and Potential Impact: Patient survival can be improved if they attend a follow-up visit, and if they have their filter removed. We also identified patients whose filters did not improve their mortality because of other underlying medical conditions whereas other patients were successfully treated. This indicates the need for a more selective process in placing filters. This also confirms previous research that COVID-19 restrictions and fear caused secondary negative effects on patient outcomes.
Outcomes of Arterial and Caval Resection During Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Metastatic Testicular Cancer
Authors: Smith Raymond , Cary Clint
Published: January 2023

Background/Objective:In the United States, testicular cancer is the most common solid tumor in men aged 15 to 34. Fortunately, testicular cancer has a cure rate greater than 90% and a 97% five-year survival rate. For the men not cured, a relapse to the retroperitoneum (RP) is most common. Of the patients with RP metastases, a minimal number may require post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) with resection of the aorta, external iliac, or inferior vena cava (IVC). We hypothesized this procedure would yield reasonable cure rates with acceptable levels of postoperative complications to warrant the indication for surgery.
Methods:Between 2000 and 2020, 2,054 patients with metastatic testicular cancer underwent a PC-RPLND; of those men, 39 also underwent an aortic, external iliac, and/or IVC resection. For the men with a PC-RPLND and vascular resection, demographic, clinical, pathologic, and operative information were reviewed. Next, a Kaplan-Meier curve was created to determine overall survival
Results:In this retrospective cohort study of 39 patients, PC-RPLND and vascular resection occurred at a median age of 40. The median follow-up of the cohort was 9 months. The median pre-operative mass size was 9 cm and 19 cm in the RP and pelvis, respectively. At PC-RPLND, 54%, 13%, 18%, and 15% of patients demonstrated cancer, teratoma, teratoma and cancer, and necrosis, respectively. Following PC-RPLND and vascular resection, 22 (56%) patients recurred. The median (IQR) time to relapse was 4.2 (2.5 – 8.2) months. Recurrence to the lung was most common, followed by the RP and liver. In total, 17 (44%) patients died of disease with a median overall survival of 14.8 months.
Conclusion:With an overall survival rate of 45% at two years in this heavily pretreated patient population, PC-RPLND with resection of the aorta, external iliac, and/or IVC is reasonable in very select cases.
Targeted Inhibition of the HGF/c-Met Pathway by Merestinib Augments the Effects of Albumin-Bound Paclitaxel in Gastric Cancer
Authors: Kaurich Quinn , Huang Jennifer , Awasthi Niranjan
Published: January 2023

Background and Hypothesis: Combination chemotherapy regimens are commonly used to treat gastric adenocarcinoma (GAC), but the median survival time remains less than one year. Nab-paclitaxel has demonstrated high antitumor activity in previous GAC studies. Many growth factors and their receptors are overexpressed in GAC and have been implicated in its pathophysiology. We hypothesize that merestinib, a small-molecule inhibitor targeting c-Met, Axl, and DDR1/2 pathways, will have significant antitumor effects and will enhance the response to nab-paclitaxel in GAC preclinical models.
Project Methods: In vitro proliferation and protein expression were assessed using WST-1 and immunoblot assays. Subcutaneous xenografts of MKN-45 and SNU-1 cell lines were implanted in mice to study tumor growth inhibition. Immunohistochemistry was performed to examine intratumor proliferation and microvessel density.
Results: In vitro assays showed that nab-paclitaxel and merestinib decreased cell proliferation in all three cell lines, with an additive effect in combination. Reduction in cell proliferation at low doses of nab-paclitaxel (10 nM), merestinib (100 nM), and their combination was 87%, 82%, and 94% (MKN-45 cell line, high phospho-c-Met expression), 59%, 50%, and 82% (SNU-1 cell line, low phospho-c-Met expression), and 53%, 19%, and 66% in gastric fibroblasts. Immunoblot analysis of merestinib treated MKN-45 cells revealed increased expression of apoptotic proteins and decreased expression of phospho-c-Met, phospho-EGFR, phospho-IGF-1R, phospho-ERK, and phospho-AKT. In gastric fibroblasts, merestinib decreased phospho-ERK and increased apoptotic protein expression. Phospho-c-Met and phospho-EGFR were not detected in SNU-1 immunoblots; however, phospho-ERK, phospho-VEGFR, and apoptotic protein expression increased after treatment. In MKN-45 xenografts, net tumor growth in control, nab-paclitaxel, merestinib, and combination groups was 503 mm3, 115 mm3, 91 mm3, and -9.7 mm3. Immunohistochemistry analysis of tumor cell proliferation and microvessel density corroborated tumor growth study results.
Conclusion: The data suggest that merestinib in combination with nab-paclitaxel carry a promising potential for improving clinical GAC therapy.
Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use and ICU Delirium Incidence
Authors: Macha Alexis , Nasser Baker , Mulkey Malissa , Khan Sikandar , Perkins Anthony , Gao Su , Wang Sophia , Campbell Noll , Khan Babar
Published: January 2023

Background: Delirium is a form of acute brain dysfunction which is associated with longer hospital stays, cognitive decline, and increased risk of mortality. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been proposed to have neuroprotective effects. ACE inhibitors and ARBs both block the action of angiotensin II leading to an increase in release of acetylcholine. As acetylcholinergic failure is implicated in delirium pathophysiology, ACE inhibitors or ARBs may improve cognitive function and protect against ICU delirium.
Objective: To study the relationship between the prescription of ACEIs or ARBs on delirium occurrence in ICU patients.Design: Observational studySetting: ICUs in three large academic hospitals in IndianapolisPatients: 4791 patients admitted to the ICU for more than 24 hours
Methods and Main Results: The Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU) were used to evaluate patients for the presence of delirium while in the ICU. ACEI/ARB exposure was determined if the patient had prescription for these medications 6 months prior to ICU admission. The cohort of 4791 participants had a mean age of 60.7 years (SD: 16.1), 46% were female, and 39% were African American. The most common comorbidities were hypertension (68%), hyperlipidemia (49%), and depression (43%). Delirium incidence in this cohort was 13%. Prescription of an ACEI alone (OR: 0.91, 95% CI: 0.73, 1.15, p=0.425) or ARB alone (OR: 0.64, 95% CI: 0.38, 1.07, p=0.114) were not significantly associated with decreased odds of delirium.
Conclusion: Prescription of an ACEI or ARB 6 months prior to ICU admission was not associated with reduced incidence of ICU delirium, although further research is needed. Larger studies with medication adherence data are needed to further study the relationship among ACEI/ARBs and delirium.
The Impact of STEM Based Programs on Girls and Women
Authors: Martinez-Garcia Alicia , Vowels-Duce Jordyn , Messmore Niki
Published: January 2023

Background/Objective: Girls Inc. of Greater Indianapolis focuses on inspiring girls to be strong, smart, and bold through empowering programming that concentrates on underprivileged populations. Eureka!, a STEM based program through Girls Inc., serves to foster confidence and knowledge in STEM through its workshops with local collaborators and mentors. STEM programs for girls, especially underrepresented girls, are crucial due to the enduring gender gap, which refers to the lower rates of interest, pursuit, and employment of girls and women in STEM. This research serves to investigate the impact of STEM based extracurricular experiences for girls on their attitudes and knowledge surrounding STEM.
Methods: Five STEM confidence related questions were chosen from the Outcome Measurement Activity survey conducted at Eureka! and a literature review was performed using PubMed sources.
Results: With respect to the Eureka! survey, it was found that in less than one year there was an increase in confidence ratings for the five selected questions, ranging from a 22.7% to a 54.5% increase in confidence. The literature review identified STEM program reports and studies on STEM activities as beneficial to building girls’ confidence, which often led to a stronger desire to pursue STEM related careers. Studies found that participating in STEM activities was associated with an increase in STEM major declarations in college compared to control groups and national averages.
Implications: This review allows the significance of extracurricular STEM activities on girls to be seen and will hopefully encourage schools and organizations to create and support STEM based programming for girls. It will also benefit Girls Inc by conveying the importance of their new Eureka! program and begins their own research into their impact.
Comparative analysis and optimization of thermodynamic behavior of combined gas-steam power plant using grey-taguchi and artificial neural network
Authors: MADAN Komal , SINGH Omendra Kumar
Published: January 2023

In the published studies, to the best of the authors’ understanding, the grey Taguchi-based statistical technique has not been applied for the optimization of combined gas-steam power plants. In view of this, seven essential input parameters namely compressor inlet air temperature, pressure ratio, fuel temperature, volumetric flow rate of fuel, gas turbine maximum temperature, compressor efficiency, and turbine efficiency are chosen with the aim of determining the optimal combination of design variables that maximize the net power generation, thermal efficiency, exergetic effciency, and minimize the specific fuel consumption. Also, the impact weight of each parameter on output indicators has been evaluated. While the Taguchi approach helps to create an orthogonal array of L27 (3^7), the ANOVA method determines the contribution of each input argument on the objective function. Unlike the Taguchi and ANOVA optimization methodology, the grey relational analysis is performed to transform the multi-objective function into a single objective by way of estimating its grey relational grade. The most favorable combination of input parameters is determined as A1B1C1D1E3F3G3 and under this state, the optimum values of power generation, thermal efficiency, exergetic efficiency, and specific fuel consumption are found to be 259911 kW, 64.9 %, 66.27 %, and 0.1839 kg/kWh respectively. Moreover, the contribution ratio on the output characteristic of the combined cycle is found to be maximum for turbine efficiency (42.41 %) and minimum for fuel temperature (0.59 %). The effectiveness of the grey-Taguchi method is acknowledged and validated using an artificial neural network technique in MATLAB.
Clinical study on ectopic pregnancy
Authors: Patel Tejal L. , Chouhan Garima
Published: January 2023

Background: Ectopic pregnancy is a life-threatening emergency which is one of the important cause of maternal morbidity and mortality in early pregnancy. Ectopic pregnancy must be suspected in any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding. It is of great importance to diagnose the condition early to prevent complications. The aim of the study is to review all cases of ectopic pregnancy and determine the incidence, high risk factors, types of clinical presentation and mode of management in a tertiary care hospital.
Methods: A retrospective study conducted on 108 patients of ectopic pregnancy admitted at obstetrics and gynaecology department, civil hospital Ahmedabad from January 2021 to June 2022.
Results: In this study 108 patients, diagnosed with ectopic pregnancy observed during the study period, with an incidence of 1.09%. Majority of women were aged 20-30 years (45.3%) and multiparous (59.25%). The 66.6% cases were ruptured ectopic. The most common risk factors were pelvic inflammatory disease (16.7%), past history of infertility (14.8%) and IUCD (12.03%). Lower abdominal pain was seen in 98 (90.74%) patients and pallor was seen in 84 (77.78%). Majority of patients had tubal ectopic pregnancies. Most common mode of treatment was unilateral salpingectomy (79.62%).
Conclusions: Ectopic pregnancy is leading cause of maternal mortality in first trimester. Safe sexual practices can reduce pelvic infections and ectopic pregnancy incidences. Early diagnosis before tubal rupture can reduce morbidity and mortality in ectopic pregnancy.
Evaluation of postmenopausal bleeding: a cross sectional study
Authors: Paul Papiya , Devi Rajkumari Praneshwari , Kom Telen Thangkhojam , Nath Priyanka , Devi Thoudam Neesha , Longjam Nirmala
Published: January 2023

Background: Postmenopausal bleeding (PMB) is one of the most common reasons for referral to tertiary care centres with a strong suspicion of malignancy. Endometrial cancer is the most common cause of gynaecological malignancy in the West, but in India the incidence rates are low. Eighty to ninety percent (80-90%) women have benign conditions in India. The aim and objectives of my study are to evaluate causes of PMB and sociodemographic characteristics among postmenopausal women.
Methods: A hospital based analytical cross-sectional study was conducted among women above 45 years with PMB admitted in the department of obstetrics and gynaecology, regional institute of medical sciences (RIMS), Imphal. The study was conducted for a period of two years from October 2019 to September 2021.
Results: In this study, out of 50 postmenopausal women 35 (70%) belong to age group >50 years and only 15 (30%) belong to age group <50 years. The most common cause of PMB in this study was found to be endometrial atrophy (12 out of 50) and two thirds of them having ET between 2-4 mm. This association is found to be statistically significant. The incidence of genital tract malignancy in our study is 14%. Incidence of endometrial carcinoma (8%) is slightly higher than cervical cancer (6%). The incidence of premalignant lesions (endometrial hyperplasia with atypia, endometrial intraepithelial neoplasia, cervical intraepithelial neoplasia) is 20% in this study. The study did not show significant association of clinical variables with benign, premalignant or malignant causes of PMB.
Conclusions: With increase in life expectancy the incidence of PMB is expected to increase in future. Since the incidence of malignancy is quite high, any bleeding in that age group should be evaluated in the line of malignancy unless proved to be otherwise.