bluuebunny/crossref_metadata_2025 huggingface dataset:
About the “Common” Horse in Serbian Folktales
Authors: Voyvodich Darya
Published: December 2020

O pospolitym koniu w serbskich podaniach ludowych

Artykuł koncentruje się na analizie charakteru pospolitego (niemagicznego) konia w serbskich podaniach ludowych z trzech perspektyw: 1) nazwy i atrybuty, 2) funkcje, 3) właściciele konia, 4) cechy w historiach i baśniach zwierzęcych. Pierwszy aspekt dotyczy częstotliwości nazw i użycia atrybutów związanych z końmi. Drugi definiuje funkcje pospolitego konia: jako pojazdu i pomocy w codziennym życiu, funkcje magiczne, starożytne rytuały i religijne przedstawienie konia, koń, jako część kary śmierci, itp. Trzeci aspekt rozróżnia właścicieli konia ze względu na pochodzenie społeczne (klasa wyższa / niższa). Niemniej jednak typ Cygana nie podlega temu rozróżnieniu. Czwarty aspekt odnosi się do cech w historiach zwierzęcych i baśniach. Wyniki badania pokazują, że każda z tych perspektyw jest ściśle powiązana z rzeczywistością oraz, że niektóre elementy podań ludowych mają ogromne znaczenie z uwagi na ich rolę w zachowaniu starożytnych pojęć religijnych zapomnianych we współczesnym życiu.
Curation of a Multiple Myeloma Cell Surface Database for Immunotherapy Development
Authors: Adaniya Emily , Yu Christina , Perna Fabiana
Published: December 2020

Background/Objective: Every year in the United States, 32,000 individuals are diagnosed with Multiple Myeloma (MM) and 13,000 die from the disease. MM is a cancer of the plasma cells and while treatment exists, MM remains incurable. Our overall goal is to identify biologically and therapeutically relevant cell surface targets to develop MM immunotherapy.  
  
Methods: Given the genomic heterogeneity of MM, we performed surface analysis of seven MM cell lines by Mass-Spectrometry (MS), generating a pool of candidate proteins. Lacking specific tools for studying cell surface proteins, we developed an integrated computational tool with five distinct databases, and scored the likelihood of cell surface location for each molecule. One point was given for each database a protein appeared in. A protein receiving a score of three or more was considered a cell surface protein with high confidence. However, about one third of the candidates were not detected by the computational tool, thus requiring manual curation. We used UniProt and GeneCards to determine the subcellular locations of the unannotated IDs, and further confirmed their location with the computational tool. 
 
Results: Of the 5,454 UniProt IDs produced by MS, 2,026 were not annotated. Causes of an unannotated ID included having an obsolete ID, being an isoform, and/or not being located on the cell surface. Through manual annotation, 8 unique cell surface IDs were added to the existing 448. The 456 targets were further analyzed based on their expression profiles in both MM and normal tissues resulting in 94 of the most promising targets, some of which would have been missed without manual curation.  
 
Conclusion/Potential Impact: Public genomic databases are often incomplete and may contain errors making manual curation a necessary step in error reduction. Left unchecked, promising surface targets could have been overlooked hindering the creation of potentially curative immunotherapies.
Clinical Case Reports as a Tool for Medical Student Education
Authors: Ashraf Adeel , Ashraf Nabeel , Bae Taeok
Published: December 2020

Background: The first two years of medical student education relies on textbooks and lectures for a foundation of knowledge that must be expounded upon in the latter two years. However, this doesn’t mean that students should be constrained to a narrow usage of their intelligence for exam questions, rather they can begin to think about using their knowledge in a clinical setting from the beginning. We researched eight prevalent pathogens that have a higher probability of being encountered by a physician by using real life examples from case reports from around the world. We condensed the materials into a team-based learning (TBL) activity with thought provoking questions related to the case in particular and to fundamental principles of microbiology and immunology as a whole.  
Approach: We searched extensively through online databases to locate clinical case reports that weren’t too uncommon or too simple. Next, we built a TBL activity using the case report as the framework with clinical presentation, lab values, and images in a certain order that would resemble the way that the physician encountered it. A mixture of questions from simple identification to complex mechanisms were asked along with review of other similar pathogens and relevant pharmacology. Along with every activity, a small abridged review of the pathogen was written after researching and consulting appropriate literature. The review included the most clinically significant information to supplement the TBL activity such as history, epidemiology, transmission, disease, diagnosis, and treatment of the pathogen.   
Future implications: These TBL activities can be utilized in future host defense course as a way for students to test their understanding while exploring a more clinically relevant scenario. Hopefully, students will appreciate the real world application of their expansive knowledge, and apply their newly developed understanding in rotations, residency, and even their medical practice.
Assessing the Role of Projections from the Ventral Hippocampus (vHIP) to the Medial Prefrontal Cortex (mPFC) in the Neural Circuitry of Social Familiarity-induced Anxiolysis (SoFiA) using Gi-DREADDs
Authors: Barron M. Regina , Truitt William
Published: December 2020

The social interaction habituation (SI-hab) protocol has been used to demonstrate that rats acquire Social Familiarity-induced Anxiolysis (SoFiA), a form of safety learning where rats display anxiolysis in the presence of a familiar conspecific. SoFiA acquisition and expression can be simplified into four different constructs: social memory, anxiety, safety learning and anxiolysis. The neural circuitry of SoFiA; however, has not been fully identified. As a step towards elucidating the SoFiA neural circuitry we are identifying the role of projections from the ventral hippocampus (vHIP) to the medial prefrontal cortex (mPFC) in SoFiA acquisition.  
Prior work from our lab has shown that the mPFC is needed for acquisition and expression of SoFiA. The mPFC may be the location of convergence of anxiety and social memory processing, making it a loci for safety learning. The goal of the current work is to identify the inputs to the mPFC that are pivotal for SoFiA acquisition. vHIP has been implicated in social memory and projects to the mPFC leading to the hypothesis that SoFiA acquisition requires vHIP projections to mPFC. 
This hypothesis will be tested via intersectional genetics where neural tracts are selectively targeted through viruses. One virus is introduced at the soma of the neuron, and another is introduced at the end of the axon. The first virus, adeno-associated virus 8 (AAV8) will contain Cre-dependent code for an inhibitory DREADD (designer receptors exclusively activated by designer drugs.) The second virus, canine adenovirus 2 (CAV2) is picked up by axon terminals and transported to the soma where it will express Cre. Unfortunately, the uptake and transport of these viruses require specific receptors and the vHIP-mPFC pathway has poor CAV2 uptake. CAV2 levels will be increased by the introduction of Coxsackievirus and Adenovirus receptor (CAR) via AAV8 two weeks prior to CAV2-Cre injection.
A Collective Case Study: Parent-Child Sexual Health Communication of Current and Former Teen Parents in Lawrence County, Indiana
Authors: Betts Aislinn , Greene Allison , Sherwood-Laughlin Catherine
Published: December 2020

Background/Objective: 
In Lawrence County, Indiana, the birth rate for females ages 15-19 is 32.2 births per 1,000, which is significantly higher than the national average of 18.8. Project UNITE, a collaboration between the Lawrence County Pregnancy Coalition and the IU School of Public Health, aims to address this issue through a multifaceted evidence-based intervention. Since parent-child communication shapes values and behaviors, a collective case study was conducted with current and former teen parents to explore their perceptions of sexual health communication with their parents and, if applicable, with their children.  
Methods:  
Of the 58 semi-structured telephone interviews conducted through Project UNITE, eight were selected for this study based on transcript availability and identification as a current teen parent (2) or former teen parent (6). All participants recalled whether they had sexual health conversations with their parents and the extent of the discussions. Five shared experiences talking with their children. Deductive and inductive approaches were used to generate themes, which were then analyzed.  
Results:   
Most participants (7 of 8) reported little to no communication about sexual health with their parents due to a lack of comfortability, limited desire, and poor relationships. In contrast, all respondents with children over the age of five (5 of 5) reported open and frequent conversations with them. Several (3 of 8) recommended providing parents with resources about initiating discussions, and some suggested (2 of 8) a community program to promote sexual health communication. 
Conclusions/Potential Impact:  
The results revealed that while teen parents experienced a lack of sexual health conversations with their parents, they favored open and honest communication with their children. Barriers related to comfortability and knowledge could be alleviated through parental resources and parent-child programs. Medical professionals play a role in this solution by encouraging conversations about sexual health and engaging in educational programs.
Open Abdomen during Extracorporeal Membrane Oxygenation is a Safe and Effective Treatment for Abdominal Compartment Syndrome
Authors: Brown Joshua , Warnock Brielle , Turk Eamaan , Hocutt Gail , Gray Brian
Published: December 2020

Background/Purpose                                                                   
Historically, decompressive laparotomy and open abdomen for abdominal compartment syndrome has contraindicated Extracorporeal Membrane Oxygenation (ECMO) due to seemingly high risk of bleeding and infection. The literature shows few examples of this treatment, and the existing studies are inconclusive. The purpose of this study was to review the series at Riley Hospital for Children and evaluate the effectiveness of ECMO treatment for patients undergoing decompressive laparotomy with open abdomen to recommend future care guidelines.  
Methods                         
We reviewed all pediatric (30 days to 18 years) patients treated with ECMO concurrently with decompressive laparotomy and open abdomen at Riley Hospital for Children from 2000-2019. We compared these patients with non-surgical pediatric patients supported with ECMO for respiratory failure at Riley Hospital for Children during the same period. Demographics, ECMO data, and outcomes were assessed. We performed t-test, ROC, and chi-square analyses. We defined significance as p=0.05.  
Results                     
5 of 82 pediatric respiratory ECMO patients were treated with decompressive laparotomy and open abdomen. Survival among the surgical group was 60%, compared to 57% in the non-surgical group (p=0.9). Surgical patients had a similar incidence of bleeding complications (40%) compared to non-surgical patients (55.8%), p=0.486. Surgical patients had a significantly higher VIS (3126 vs 19.2, p=0.004), PaO2/FiO2 ratio (279.0 vs 72.9, p=0.031), and pump flow rate at 24hrs (112mL/kg/min vs 88.1mL/kg/min, p=0.045) than non-surgical patients, while receiving a similar volume of PRBCs (p=0.581) and requiring ECMO treatment for a similar amount of time (p=0.511).  
Conclusion/Potential Impact                         
ECMO support in patients with decompressive laparotomy and open abdomen was associated with similar survival and bleeding complications compared to non-surgical ECMO patients. ECMO should be offered to or continued in eligible patients with abdominal catastrophe, as it is effective in supporting organ function while not significantly increasing the risk for complications.
Investigating Differences in Nutritional Parameters in Ugandan Children with Plasmodium falciparum Severe Malaria
Authors: Brown Lucy , Co Katrina , Opoka Robert , Datta Dibyadyuti , John Chandy
Published: December 2020

Background: In 2018, malaria produced an estimated 272,000 deaths in children <5 years of age, accounting for 67% of all malaria deaths worldwide, with a majority in the WHO African Region. Malnutrition is an important risk factor for malaria. Wasting, Stunting and Underweight are crucial indicators of malnutrition. Annually, 14 million children <5 are classified as wasted and 59 million children are classified as stunted.  
Objective: The objective of this study is to determine the association between each of the major manifestations of severe malaria (SM) and nutritional parameters – weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) – in children from the Ugandan cities Mulago and Jinja.  
Methods: To assess differences in WAZ, HAZ, and WHZ by the five types of SM and community controls (CC), we evaluated Z-scores from children <5 years old enrolled in a prospective cohort study (NDI, Neurodevelopmental Impairment in Children with Severe Malaria) at enrollment and 12-month follow-up.  
Results: WAZ and WHZ at baseline were significantly lower among SM groups than in CC (p<0.001), but there were no significant differences observed at 12-month follow-up. There were no major differences in HAZ between the SM and CC groups. WAZ and HAZ at baseline were significantly lower among High Mortality (HM) versus Low Mortality (LM) groups (p<0.01). At 12-month follow-up, HAZ remained significantly lower in HM versus LM (p<0.01). There were no major differences in WHZ between the HM and LM groups. Compared to those who survived, the 27 children who died had significantly lower WAZ (p<0.05), but no major differences in HAZ or WHZ. 
Conclusion: Underweight, stunting, and wasting may be risk factors for SM. Overall, a more comprehensive understanding of how SM elicits adverse effects in children is necessary. Nutrition intervention programs must be implemented to prevent child stunting, wasting, underweight, and mortality.
North Central Indiana AHEC: STEPS Program Impact
Authors: Ceglio Katie , Stout Julianne
Published: December 2020

Background/Objective:  
North Central Indiana Area Health Education Center (NCI AHEC) aims to encourage rural students in their service district to pursue healthcare. In light of rural healthcare shortages found in Indiana, they implemented the Successfully Training and Educating Pre-medical Students (STEPS) program, available to college juniors at Indiana University – Kokomo. Through MCAT prep courses, workshops about interviews, and job shadowing, the goal of the program is for more rural students to be accepted into local medical schools, to then return to practice in that rural area. This case study examines the initial impacts of the STEPS program and the path to healthcare for a student at IU – Kokomo. 
 
Methods:  
A mixed methods study was conducted. First, a survey was administered by NCI AHEC to students who participated in the STEPS program using a retrospective pre/post design. The quantitative data, representing students’ opinions and goals, was aggregated and interpreted. An interview was then done with a previous STEPS student. This student’s experience was analyzed.  
 
Results:  
Participation in the STEPS program resulted in increased knowledge about healthcare careers and plans to pursue further education for healthcare careers across all students. The STEPS program has identified strengths, including activities that increase student commitment to pursuing healthcare and mentorship for students. Areas for growth were also identified, including adding application assistance, decreasing competition for resources, and increasing efforts to keep students in Indiana. 
 
Conclusion and Potential Impact:  
Initial evaluation suggests that the STEPS program is beneficial in assisting rural students on their path to a career in healthcare. Analysis of the interviewee’s experience provides recommendations for improvements of the STEPS program in the future.
The Association of Surrogate Decision Makers’ Anxiety and Depression Levels at Baseline with End-of-Life Patient Care Decisions
Authors: Chen Andy , Slaven James , Torke Alexia
Published: December 2020

Rationale: Little is known about how the psychological status of surrogate decision-makers (SDMs) influences their decisions regarding end-of-life patient care. Anecdotal evidence suggests high psychological distress may lead to denial of poor prognosis and continued aggressive treatments. We hypothesized that SDM psychological distress is associated with greater use of life-sustaining treatments and lower hospice use for seriously ill older adults. 
Objectives: To determine the relationships between surrogate anxiety and depression levels and surrogates’ decisions regarding end-of-life treatments. 
Methods: This prospective observational study enrolled patient/surrogate dyads from three Midwestern hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed anxiety (GAD-7) and depression (PHQ-9) levels, and SDM preference for do-not-resuscitate (DNR) status. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of aggressive life-sustaining treatments and hospice for patients who died. 
Results: There were 278 patient/surrogate dyads. After adjusting for other demographic and illness factors, anxiety (adjusted odds ratio [aOR] 1.09; 95% CI 1.02, 1.16; P=.007) and depression (aOR 1.08; 95% CI 1.02, 1.15; P=.011) were associated with greater preference for DNR status. Among patients who died (n=115), anxiety (aOR 0.89; 95% CI 0.79, 0.99; P=.039) was associated with less use of aggressive life-saving interventions within the last 30 days, and anxiety (aOR 1.23; 95% CI 1.09, 1.39; P<.001) and depression (aOR 1.14; 95% CI 1.04, 1.25; P=.004) were associated with greater hospice use. 
Conclusions: Contrary to our hypothesis, heightened SDM psychological comorbidities at baseline are associated with greater DNR preference, as well as less life-sustaining treatment and more hospice use at the end of life. More research is needed to understand the impact of psychological distress on surrogate decision-making.
Comparison of Diffusion and Perfusion Techniques in Differentiating High Versus Low Grade Pediatric Brain Tumors
Authors: Chen Eric , Ho Chang , Gray Benjamin , Parker Jason , Diller Emily , Wen Qiuting , Wu Yu-Chien , Anthony Gregory , Territo Paul
Published: December 2020

Background/Objective: Brain tumors are the most common solid cancer in children and cause significant mortality and morbidity. We compare the effectiveness of different parameters in predicting tumor grade between dynamic contrast enhancement (DCE), intravoxel incoherent motion (IVIM), dynamic susceptibility contrast (DSC) perfusion and diffusion weighted imaging (DWI). 
 
Methods: A retrospective blinded review of pediatric brain tumors with DCE, IVIM, DWI, and DSC was performed. Parametric maps were registered to T2 weighted images. Volumetric regions of interest (ROI) were manually segmented from solid tumor components for each patient by a neuroradiologist (CH), neuroradiology fellow (BG), and medical student (EC). Resulting mean values for parameters from DCE (Ktrans, Kep, Ve, Vp,), IVIM (D, D*, f), DSC (rCBV) and DWI (ADC) were compared using Student’s t-test for high- and low-grade tumor groups based on WHO grading from pathology. For significant parameters, receiver operating characteristic (ROC) analysis with area under curve (AUC) was performed.  
 
Results: 20 subjects were included with 9 low grade and 11 high grade tumors. Significant differences between low versus high grade were demonstrated for D (10−3 mm2/s) (1.4±0.4 vs 0.9±0.2, p=0.01), f (0.04±0.02 vs 0.07±0.02, p=0.02), ADC (10−3 mm2/s) (1.4±0.4 vs 0.9±0.3, p=0.009) and rCBV (2.2±0.9 vs 4.7±2.1, p=0.003). No significant difference was found for D* or any DCE parameter. AUC from ROC was similar for all significant parameters [D (0.81, p=0.003); f (0.80, p=0.003); ADC (0.83, p=0.001); rCBV (0.83, p=0.0005)]. 
 
Conclusion: D and f parameters from IVIM can significantly differentiate high versus low grade pediatric brain tumors similar to ADC and rCBV. Conversely, no DCE parameter was significant. 
 
Scientific Implications: The results will assist the selection of MRI sequences that best predict tumor grade, as well as guide tumor biopsy for the most aggressive tumor portions. Further study of these techniques may correlate with molecular profiling and predict outcome.
Mortality Rates in Mechanically Ventilated Patients with COVID-19
Authors: Class Jonathan , Khan Sikandar , Khan Babar
Published: December 2020

Background/Objective:  
High mortality rates among mechanically ventilated COVID-19 intensive care unit (ICU) patients have raised concerns regarding use of mechanical ventilation in management of patients with COVID-19. Additional data is needed in this discussion to better understand treatment strategies for this vulnerable population. We conducted a study to examine length of stay, duration of mechanical ventilation, mortality, and risk factors for death in critically ill patients with COVID-19. 
 
Methods: 
Observational study in patients admitted to Eskenazi Health and Indiana University Health Methodist ICUs. Participants were 18 years and older patients admitted to the ICU from March 1 2020 to April 27, 2020 who tested positive for COVID-19. Primary outcomes for this study were in-hospital mortality, duration of mechanical ventilation, and the length of stay in the ICU.  
 
Results: 
The study cohort was made up of 242 patients. The mortality rate was 19.8% (48/242) for the overall cohort and 20.5% (38/185) for mechanically ventilated patients. Age was a significant risk factor for in-hospital mortality [increased hazard in in-hospital mortality: age 65-74 years (HR: 3.1, 95%Cl=1.2-7.9, p=0.021), age 75+ (HR: 4.1, 95%CI=1.6-10.5, p=0.003) compared to those younger than 65]. In our Cox’s proportional hazard model, ESRD (HR:5.9, 95%CI=1.3-26.9, p=0.021) along with age were the only risk factors with statistical significance. The median duration of mechanical ventilation in the overall cohort was 9.3 days (IQR=-5.7-13.7). In patients that died, median ICU length of stay was 8.7 days (IQR=4.0-14.9), compared to 9.2 days (IQR=4.0-14.0) in those discharged alive. 
 
Conclusion/Clinical Impact: 
We found lower mortality rates and longer length of stays in our cohort than in previous studies. While more data is needed, this study supports continued use of mechanical ventilation ARDS recommendations for treating patients with ARDS from COVID-19. Further, this data potentially shows a benefit to not having a strained healthcare system.
Wound Microbiome, Biofilm Infection and Interactions with Host Immune Cells in Diabetic Foot Ulcers (DFU)
Authors: Colomb Elaine , Das Amitava , Santra Suman , Roy Sashwati
Published: December 2020

Background: 
The treatment of infected diabetic foot wounds places a great burden on our healthcare system. The problem lies in the complexity of treating these wounds, often made more complex by the formation of a bacterial biofilm leading to chronic infection. This critical review discusses current knowledge of biofilm infection and wound healing related to diabetic foot ulcers. Hypothesis: Wound microbiome and biofilm infection subvert immune cell function, specifically the macrophage defense response, which leads to a non-healing chronic wound. In addition to the critical review of literature, a systematic analysis of wound microbiome was performed on fluids obtained from chronic wound patients presented at the IUHCWC.  
 
Methods: 
A comprehensive literature review was performed on DFU microbiome, biofilm infection and interaction with host immune system, and macrophage interactions with biofilm using life sciences and biomedical search engines such as PubMed. Over 50 original and review articles were critically reviewed to derive the information presented in this work. For the wound microbiome analysis, wound fluids from chronic wound patients (n=20) undergoing wound care at IUHCWC were collected under an IRB approved protocol. DNA extraction was performed from the fluid and was subjected to metagenomic 16S rDNA sequencing using a next-generation sequencing platform for the microbiome analysis.  
 
Results & Conclusions: 
The biofilm induces a persistent state of low-grade inflammation via cytokine release and the continuous production of metabolic waste. Up-regulation of genes such as arginine-1 and interleukin-10, as well as a metabolic shift from aerobic glycolysis to oxidative phosphorylation, promote macrophage polarization to an anti-inflammatory, and more importantly, immune suppressive phenotype incapable of clearing the biofilm infection. A detailed analysis of wound fluid microbiome is currently ongoing and will be presented in the poster presentation forum.  
 
Work supported by IMPRS fellowship to EC and NIH R01DK114718 to SR
Racial and Socioeconomic Differences in Social Work and Department of Child Services Reporting Patterns for THC Positive Pregnant Women
Authors: DiGregory Sydney , Cochrane Anneli , Tucker Edmonds Brownsyne
Published: December 2020

Background and Hypothesis: Tetrahydrocannabinol (THC) is the most commonly used illicit substance during pregnancy. Little research, most with conflicting data, exists on its impact on the developing fetus or birth outcomes. Reporting THC positive urine drug screen (UDS) to social worker (SW) has been left to provider discretion. Similarly, SW has discretion in reporting to Department of Child Services (DCS) if the newborn tests negative for drugs at birth. We hypothesize that there are racial and socioeconomic differences in reporting patterns that result in non-white and publicly insured patients being reported to SW or DCS at higher rates than white or privately insured patients. 
Methods: Data were collected via Cerner and CareWeb chart abstraction of patients who delivered at IU Health hospitals between 1/1/16 to 12/31/17 and tested positive for THC, but no other drugs, during any stage of pregnancy. Data was entered into the secure and encrypted Redcap database. Demographic variables included mother’s age, race, ethnicity, insurance type, and number of previous pregnancies. Descriptive statistics were calculated for demographics by overall, SW, and DCS referral. p-values were calculated using Fisher’s Exact Test for small sample sizes and considered significant at the 0.05 level. The effects of age and number of previous pregnancies were analyzed using two-sample t-test for equal variances. 
Results: 152 patients met inclusion criteria for the analysis. The study population was mostly white (68.4%) and black (30.3%). Their insurance type was 74.3% public, 17.8% private, and 7.9% uninsured. The vast majority of cases were referred to SW (90.8%) and DCS (87.7%). Neither patient race nor insurance were associated with referral to SW (p=.80, p=.79) or DCS (p=.30, p=.25).  
Conclusion: There was no statistically significant association between demographic characteristics and referral patterns, though the study may be underpowered due to low non-referral rate. Addition of 2018-2019 data are planned.
Treatment of Lymphedema with Cell-Based Therapies: A Systematic Review
Authors: Drake Connor , Suh Lily , Neumann Colby , Khan Imran , Sinha Mithun , Sen Chandan , Hassanein Aladdin
Published: December 2020

Introduction 
Lymphedema is a chronic condition that affects over 250 million people worldwide. It results from impaired lymphatic drainage, causing fluid and fat accumulation and eventually fibrosis of the affected limb. Lymphedema can be inherited (primary) or iatrogenic to surgery or parasitic infection (secondary). Breast cancer-related lymphedema is the most common etiology in the U.S. Current treatments have limited success and the disease mechanisms are not well understood. The purpose of this article is to review translational research into lymphedema therapies and its potential clinical impact. 
  
Methods 
A Pubmed search for novel treatment methods was performed with terms “lymphedema,” “cell therapy,” and “gene therapy.” Inclusion criteria were use of in vivo models, English language, and publication dates during the years 2000-2020. 
 
Results 
Secondary lymphedema is currently treated with compression garments and surgery; other approaches are being pursued. These include gene therapy (13 articles), stem cell transplant (16 articles), and immunosuppression (4 articles), which have all demonstrated considerable success in animal models of lymphedema. Growth factors such as VEGF-C are administered through adenoviral vectors and resolve limb swelling by inducing lymphangiogenesis. Stem cells derived from bone marrow or adipose tissue repair lymphatic damage directly by acquiring lymphatic characteristics or indirectly through paracrine signaling to surrounding cells. Immunosuppressive agents reduce inflammation and block antilymphangiogenic factors. Although these mechanisms have been studied in animals, only six human small studies were found, providing limited evidence.  
 
Conclusion 
Despite success in animal models, treatment in human subjects has been sparse. This limited translational feasibility is because of inadequate animal models, safety concerns, and lack of understanding about lymphedema pathophysiology. Although progress in lymphedema research has been made, further inquiry into its mechanism is needed in order to develop more effective and targeted therapies.
Osteology Modules for the Human Structure Course
Authors: Fiallo Maria , Parker Kierra , Mas Jose , Eckel Christine
Published: December 2020

Background and Objective:
The COVID-19 pandemic has created a need to deliver much content for the Human Structure (HS) course virtually. Because osteology is a fundamental component of human gross anatomy, the goal of this project was to create quality interactive osteology modules for HS that can be delivered online.
 
Project Methods:
To ground our module development in best practices for teaching and learning human gross anatomy, we reviewed 100 articles from PubMed databases and selected 9 for discussion during weekly literature review meetings. Key search terms included: education research, computer-assisted instruction (CAI), technology-enhanced learning (TEL), clinically based anatomy, integrated learning, medical education, and more. We created the modules using Microsoft PowerPoint™ and EndNote X9™ for referencing purposes. Bone images were captured and edited with a Nikon USA™ D850 DLSR camera and Adobe Photoshop, respectively. Additional images were obtained from IUSM online textbooks, miscellaneous websites, and the radiology database Radiopaedia™. Each module includes pertinent clinical correlations, radiology, and post-module quizzes for students to assess their higher-order knowledge.
 
Results:
We created 7 osteology modules using best practices for human gross anatomy teaching and learning: (1) Vertebral Column, (2) Thorax, (3) Shoulder Girdle & Brachium, (4) Elbow, Antebrachium, Hand, (5) Pelvic Girdle & Thigh, (6) Knee, Leg, Foot, (7) Cranium & Hyoid.
 
Conclusion and Potential Impact:
Studies have demonstrated that CAI/TEL and radiological imaging work synergistically with traditional didactic methods to facilitate learning of human gross anatomy. Our modules will be used statewide in the HS course for first-year medical students as a CAI learning tool. Looking forward, we plan to use both qualitative and quantitative methods to determine if use of these modules results in better exam performance or aids in other aspects of the learning process.
Correlating Dementia Severity Rating Scale and Schonberg Index Mortality Risk Scores to Aid Caregiver Medical Decision-Making
Authors: Grismore Myranda , Fowler Nicole
Published: December 2020

Background/Hypothesis: 
The 16 million unpaid caregivers serving individuals with Alzheimer’s disease and related dementias (ADRD) are more likely to participate in medical decision-making than caregivers of older adults with other chronic conditions. Their decisions may reflect the patient’s severity of cognitive impairment and life expectancy. Analysis of the relationship between these two factors is needed to improve the prognostic information provided to caregivers. ADRD severity can be measured using the Dementia Severity Rating Scale (DSRS), a validated, informant-based multiple-choice questionnaire that assesses functional and cognitive abilities. Life expectancy can be estimated using the Schonberg Index (SI), a validated, predictive mortality index. We hypothesize that DSRS and SI scores will be correlated. 
 
Methods: 
A retrospective analysis of data from 230 dyads enrolled in the Decisions about Cancer Screening in Alzheimer’s Disease (DECAD) study was performed. The DECAD study is an ongoing randomized controlled trial enrolling dyads of older women with ADRD and their caregivers to test the benefits of a mammography decision aid. In the study, caregivers completed the DSRS and SI questions. DSRS and SI scores were compared using linear regression analysis. Additionally, 20 DECAD interviews were qualitatively evaluated to explore themes of medical decision-making among ADRD caregivers. 
 
Results: 
DSRS scores and SI scores were weakly correlated, yielding an R2 value of 0.1. Interviews revealed that caregivers most frequently considered physician advice, comorbidity status, and patient preferences in decision-making. 67% of moderate ADRD caregivers and 36% of mild ADRD caregivers cited cognitive impairment severity as an influential factor. 
 
Conclusions/Implications: 
Further analysis controlling for time since diagnosis will better establish the relationship between DSRS and SI scores. The resulting increase in accuracy of ADRD prognostic information will aid physicians and caregivers in medical decision-making. Furthermore, understanding what influences caregiver decisions will allow for the provision of improved guidance from physicians.
COVID-19s Impact on the Hispanic Community: How Understanding Culture Can Improve Outcomes
Authors: Guerra Yamilet , Hudson Brenda
Published: December 2020

Background  
A disproportionate burden of SARS-Cov-2 infection, or coronavirus disease 2019 (Covid-19), and death are highest among racial and ethnic minority groups. Based on data available on June 12, 2020, Hispanic people are more likely to acquire COVID-19 and have higher incidence of hospitalization and death compared to their white, non-Hispanic counterparts. While this issue is complex, many have hypothesized that the difference is due to societal factors and communication methods. The aim of this project was to evaluate information related to how the Hispanic population is affected by COVID-19 and how communications about the disease should be designed based on past research, physician input, and cultural sensitivities. 
 
Methods 
We conducted a thorough literature search on COVID-19 articles, both peer reviewed and grey literature, evaluating race and ethnic differences in disease prevalence and severity. Additionally, we conducted interviews with a small number of Indiana doctors who treat Hispanic patients to obtain a doctor’s perspective on the Hispanic community’s needs during the pandemic and ways to help reduce prevalence. 
 
Results 
Physicians in Indiana believe the main approach to help the Hispanic community is by utilizing trusted community resources to communicate information and build relationships with patients over time. It is recommended to develop new methods to deliver essential information about COVID-19 through multiple mediums, in a clear way, and in Spanish with focus on the collective good of the family.  In addition, it is important not to just translate resources from English to Spanish but to design materials addressing barriers specific to the Hispanic community. 
 
Conclusion  
More culturally tailored information should be released to educate the Hispanic community about COVID-19. This information will assist in the design of materials and initiatives for the Hispanic community that we hope will improve methods of communication and care delivery related to COVID-19.
Distinctive Patterns of Tau Accumulation and White-Matter Degeneration on Domain-Specific Neuropsychiatric Test Scores
Authors: Hall Zack , Chien Billy , Risacher Shannon , Saykin Andrew , Wu Yu-Chien , Wen Qiuting
Published: December 2020

Background: 
Diagnosis of AD is often started via cognitive tests such as the Mini Mental Status Exam (MMSE) or Montreal Cognitive Assessment (MOCA) with the diagnosis being finalized with autopsy. Currently, positron emission tomography (PET) tracers are used to visualize tau and beta amyloid accumulation in the brain. These imaging techniques demonstrate significant correlations with cognitive decline and have been used to aid in the diagnosis of AD. Particularly, tau accumulation has been shown to progress in a distinct pattern and has been linked to white matter degeneration. We hypothesized that tau accumulation and white matter degeneration in different brain regions have unique correlation patterns with domain-specific neuropsychiatric test scores.  
Methods: 
This study included 87 older adults (57 cognitively normal subjects and 27 mild cognitive impairment) from the Indiana Alzheimer’s Disease Center. All participants underwent tau-PET ([18F] Flortaucipir PET) and diffusion MRI (dMRI) exams. Tau accumulation was quantified with tau-PET SUVR. White-matter structural connectivity (SC), which probes the integrity of white-matter connections of the brain, was quantified by metrices extracted from dMRI using network analysis. Both tau accumulation and SC measurements were quantified in 84 cortical region of interests (ROIs) and were compared to their domain specific neuropsychiatric test scores with linear regression analysis. 
Results: 
The verbal memory, visual memory, and visuospatial ability all had unique region-specific correlations with white-matter degeneration and tau accumulation. Verbal memory was solely correlated with tau accumulation. Visual memory was related to both tau accumulation and white-matter SC. Finally, visuospatial ability was only correlated with white-matter SC.  
Potential Impact: 
This data reveals that although there is a tight interplay between tau accumulation and white-matter degeneration, they affect brain functions in different ways. Specifically, grey-matter tau accumulation is associated with overall memory loss and decrease in the white-matter connectivity affects the visual-related information processing.
Verbal Fluency, Speech-Language and Neurocognitive Outcomes in Youth with Cochlear Implants
Authors: Hasnain Fahad , Pisoni David , Kronenberger William
Published: December 2020

Background: Cochlear Implants (CIs) restore some hearing to deaf children, although some language domains such as verbal fluency (VF) are at risk for delay. VF, the ability to efficiently retrieve words from the mental lexicon, is critically important for learning, reasoning, and memory. In this study we used a novel assessment paradigm to understand how VF develops in youth with CIs and to investigate associations between VF, speech-language, and neurocognitive functioning. We hypothesized that phonemic VF (retrieving words based on sounds) would show greater delays than semantic VF (retrieving words within category) and that VF would relate to spoken language and memory outcomes.  
 
Methods: 28 prelingually deaf, early-implanted (<4 years), long-term (≥7 years) child and adolescent users of CIs were compared with 33 age and nonverbal IQ-matched normal-hearing (NH) peers. VF measures were compared between CI and NH and were correlated with speech, language, and neurocognitive outcomes.  
 
Results: Compared to NH peers, youth with CIs retrieved fewer words, had longer start latencies, and fewer word clusters in the phonemic VF test. Stronger phonemic VF in the CI sample was associated with better speech perception and language. Stronger VF in both samples was associated with better short-term/working memory and inhibition/concentration.  
 
Conclusion: VF based on phonological (sound) characteristics of words is delayed in youth with CIs, whereas VF based on semantic meaning is relatively spared. Phonemic VF delays have downstream effects on speech perception and language in youth with CIs, whereas both types of VF are associated with verbal short-term/working memory and executive functioning.  
 
Clinical Policy Impact and Implications: Study results indicate a need for assessment and intervention targeting VF (especially phonemic) in youth with CIs as a potential method for improving speech perception, language, verbal memory, and inhibition-concentration outcomes.
Effectiveness of Peer Support Interventions for Adolescents and Young Adults Living with HIV Globally
Authors: Hernandez Helen , Craven Hanna , Toromo Judith , Enane Leslie
Published: December 2020

Background: Adolescents and young adults living with HIV (AYALHIV, ages 10-24) have poorer outcomes in care compared to other age groups. The global Treat All strategy aims to extend antiretroviral therapy (ART) to all individuals living with HIV. Efforts to improve outcomes in the AYALHIV population are essential to successfully achieving viral suppression and improving the long-term health outcomes of young people, and ultimately to ending the HIV pandemic. Peer support interventions are increasingly implemented by care programs, and are broadly favored by AYALHIV. This systematic review will evaluate the current evidence for quantitative effects of peer support interventions on AYALHIV treatment outcomes.  
Methods:  We searched MEDLINE, Embase, Global Health, CINAHL Complete, Cochrane, and Scopus databases for papers published between 1994 and October 2019, in all languages and regions. Studies of the effect of peer support interventions for AYALHIV on measures of adherence or retention in care were included. Solely qualitative studies and those without a comparator or control were excluded. Three researchers screened the papers independently, and those meeting criteria were included. Abstracted variables included study characteristics, participant population, peer intervention characteristics, and outcomes.  
Results: The current evidence base for the effect of peer interventions for AYALHIV is very limited. Included studies were of small sample size, and primarily consisted of observational cohort studies with imperfect comparators. In initial analyses we find that studies of peer interventions have had mixed findings regarding the effect of such interventions on adherence to ART. By contrast, studies have consistently reported a favorable effect of peer interventions on increased retention in care among AYALHIV.  
Conclusion/Implications: Rigorous studies of interventions to improve outcomes among AYALHIV are urgently needed. Further analyses in this review will examine differences according to study population, design, or intervention characteristics, which may underlie variable effects identified.
Reducing Death Anxiety: The Impact of Advanced Care Planning
Authors: Hollenbeck Kendra , Gutwein Tom
Published: December 2020

Background/Objective: Death anxiety affects multiple areas of patient’s physical and mental health. Reducing this phenomenon has the potential to improve quality of end of life (EOL). The effects of spirituality, age, self-esteem, biological sex, presence of symptoms and level of isolation have been previously studied. Advanced care planning (ACP), a simple intervention, which has known positive impacts on quality of EOL by decreasing healthcare costs and undesired hospitalizations, however, only 33% of the population has completed it. This study will examine the correlation between death anxiety and ACP. We hypothesize that there will be a statistically significant lower level of death anxiety in participants with ACP. 
Methods: The study population will include patients presenting to the Parkview Regional Medical Center ED who are ≥65, with a sample size of 1,000. We will use a translated and adapted version of the 17 question Likert-type Scale of Death Anxiety; developed and validated by Cai et al. in 2017. It will be presented via REDCap and will include electronic signature of informed consent. Finally, we will include questions about ACP and advanced directives. Participants will also complete a basic demographic survey to account for confounding factors. Analysis will include a Mann Whitney test, univariate and multivariate regressions.  
Results: This project resulted in a IRB submission drafts of a study protocol, informed consent, SDA survey and REDCap data collection tool. The researchers are seeking Parkview Health-IRB approval in Fall 2020, with an anticipated study start date of Spring 2021.  
Impact: This project has the potential to improve quality of life by decreasing death anxiety and resulting negative stress reactions. Interventions for decreasing death anxiety have not been extensively studied so directions for future research are broad and could include impacts of ACP in varying ages and contexts outside of the ED.
Understanding evidence-based lead mitigation: Is the lead mitigation advice and strategies being communicated to citizens evidence-based?
Authors: James Shania , Beidinger-Burnett Heidi
Published: December 2020

Background and Hypothesis: The CDC has declared that there is no safe blood lead level for a child, but still approximately 37 million homes are lead-contaminated of which 4 million are home to small children. Lead abatement is an expensive strategy to remove all lead hazards rendering a home lead-free. Many of these lead-contaminated homes are in lower socioeconomic areas which makes lead abatement nearly impossible. Given the expense of lead abatement, low-cost interim controls are needed to reduce lead exposure thus creating a lead-safe home. We hypothesize that updated lead mitigation strategies need pursued, and there is a large disparity of lead information disseminated between health departments. 
 
Project Methods: Using JSTOR and Boolean criteria, we conducted a systematic literature review on evidence-based, do-it-yourself (DIY) lead mitigation strategies for sources of lead contamination. Once the literature review was completed, QualtricsR was used to quantitatively and qualitatively evaluate the 50 state health department’s websites for lead policy, user friendliness, and recommended lead interim controls as compared to the literature review.  
 
Results: Results from the literature indicate that there is a lack of current information regarding new strategies for lead mitigation. Research prior to the year 2000 shows that cleaning flat surfaces by wet mopping, washing hands frequently, mulching, removing shoes before entering the home, and painting over deteriorating paint significantly reduces lead accumulation in the home. Preliminary results from the website review found that there is no baseline of uniform information being distributed, and evidence-based practices are not included for each state health department. 
 
Potential Impact: The lack of continuity nationwide for lead mitigation showcases that families are not receiving all of the information that research has to offer to help keep their homes safe. This research indicates that there is a need for national lead policies and recommendations, so each family in the U.S. is equally informed.