bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium Incidence, Duration and Severity in Critically Ill Patients with COVID-19
Authors: Hammes Jessica , Khan Sikandar , Lindroth Heidi , Khan Babar 
Published: December 2020

Background:
COVID-19 is associated with severe respiratory failure and high mortality in critically ill patients.2,4,5 Neurologic manifestations of the disease, including delirium and coma, may also be associated with poor clinical outcomes. Delirium is associated with prolonged mechanical ventilation and mortality.3 this study sought to describe the rates, duration, and severity of delirium in patients admitted to the ICU with COVID-19.
Methods:
A retrospective, observational study was conducted from March 1stto April 27th, 2020, at Indiana University Health Methodist and Eskenazi Health Hospitals. The delirium measurements were extracted in the first 14 days of the ICU stay, using the Richmond Agitation and Sedation Scale (RASS) and the CAM-ICU and CAM-ICU7, for those with a positive COVID-19 diagnosis. The primary outcomes were delirium rates and duration; the secondary outcome was delirium severity. Descriptive statistics and median group comparisons were done using SAS v9.4.
Results:
Of 144 patients in the study, 73.6% experienced delirium and 76.4% experienced delirium or coma. The median delirium or coma duration was 7 days (IQR: 3-10), and the median delirium duration was 5 days (IQR: 2-7). The median CAM-ICU-7 score was 6 (IQR: 2-7) signifying severe delirium. Mechanical ventilation was associated increased risk of developing delirium (OR: 22.65, 95% CL: 5.24-97.82). Mortality was also more likely in patients experiencing delirium: 26.4% compared to 15.8% in patients without delirium.
Conclusion:
Of the 144 patients included, 73.6% experienced delirium lasting on average 5 days: the median delirium score being severe. Mechanical ventilation was also associated with greater odds of developing delirium. Because Covid-19 is associated with high rates of delirium, leading to increased rates of functionality disability, more resources and attention are needed to prevent and manage delirium in patients.1

References

Brummel NE, Jackson JC, Pandharipande PP, et al. Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Critical Care Medicine. 2014;42(2):369-377.

Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020.

Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. Anesthesiology. 2016;125(6):1229-1241.

Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020.

Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain, behavior, and immunity. 2020:S0889-1591(0820)30357-30353.
Related Risk Factors among Women Enrolled in a Community-Based Perinatal Care Program
Authors: Hodges Matt , Tang Qing , Litzelman Debra 
Published: December 2020

Background: Adverse maternal and infant health outcomes are influenced by a broad array of psychosocial determinants and behavioral risk factors. We evaluated the correlations between risk factors including mental illness and substance misuse among women from high-risk ZIP Codes in Indianapolis enrolled in a community-based perinatal care program.
Methods: We performed a prospective cohort study of 918 women enrolled in the WeCare community perinatal care program. Data was collected during visits by community health workers (CHWs). CHWs met with the patients at home or over the phone and provided individually tailored care related to mental health, substance use, and nutrition amongst other topics.
Results: Women with anxiety or depression were nearly twice as likely to experience complications during birth (depression: 22.4% vs. 11.5%, p = 0.022; anxiety: 21.9% vs. 11.2%, p = 0.007). Women with depression were also nearly twice as likely to report substance misuse (18.4% vs. 9.6%, p = 0.046) and women with anxiety were more than twice as likely to report substance misuse (21.9% vs. 9.0%, p = 0.0004) as well as smoking during pregnancy (21.9% vs. 9.7%, p = 0.0012). Women who reported stable or improved anxiety symptoms were less likely to report substance misuse (8.6% vs. 19.0%, p = 0.004) and women who reported stable or improved depression symptoms were less likely to report substance misuse (8.4% vs. 24.1%, p = 0.0002). There was a strong correlation between anxiety and depression. Over 70% (71.4%) of women with depression also presented with anxiety, and over 90% (92.2%) of women who reported stable or improved depression symptoms also reported stable or improved anxiety symptoms.
Conclusions: Many of the risk factors associated with adverse maternal and infant health outcomes exist in interwoven relationships. The inclusion of CHWs into a healthcare team could assist in addressing these factors together in a holistic manner.
Venous Thromboembolism and D-dimer In Patients with COVID-19
Authors: Hoffer Joshua , Stewart Lauren , Pettit Kate , Kline Jeffrey 
Published: December 2020

Background and Hypothesis: The potential association between venous thromboembolism (VTE) and COVID-19 is an area of growing research, and methods of effective prophylaxis, detection, and treatment continue to be sought. D-dimer assays have been previously established as a highly sensitive — albeit nonspecific — test to assess patient risk of VTE, but the full clinical utility of this test in COVID-19 patients is currently not well understood. We hypothesized that, in patients presenting to the emergency department (ED) and determined to be positive for COVID-19, an elevated D-dimer value is associated with an increased 30-day incidence of VTE.

Project Methods: Deidentified patient encounter data was collected and analyzed from a multicenter registry of ED patients tested for SARS-CoV-2. We measured the frequency of a positive SARS-CoV-2 test and compared the incidence of VTE between SARS-CoV-2 positive and negative patients. We also compared average D-dimer values in SARS-CoV-2 positive patients with and without VTE.

Results: Of 6,445 patient encounters queried, 2,051 tested positive for SARS-CoV-2 (32%).
SARS-CoV-2 positive patients had a significantly higher incidence of VTE in the 30-day follow-up period compared to SARS-CoV-2 negative patients (3.2 vs. 1.6%, p= 0.0002). D-dimer values were available for 537 of these SARS-CoV-2 patients, with an average D-dimer of 1813.83 ng/mL. The average D-dimer in SARS-CoV-2 positive patients who did develop VTE tended to be higher than those who did not develop VTE (2969 ng/mL vs. 1822 ng/mL), although this difference was not statistically significant (p=0.34). The fitted areas for binomial receiver operating characteristic curves of D-dimer for detection of VTE in patients with and without SARS-CoV-2 were 0.628 and 0.829, respectively.

Conclusion and Potential Impact: We found a positive SARS-CoV-2 test to be associated with a higher incidence of VTE. However, an elevated D-dimer continues to be nonspecific for VTE in SARS-CoV-2 positive patients, and performs more poorly in SARS-CoV-2 positive patients than in negative patients. Additional clinical criteria should be identified to further guide the use of diagnostic imaging modalities and prophylactic anticoagulation in COVID-19 positive patients with suspicion of VTE.
Balancing Student Sex Education Needs with Community Preferences: A Qualitative Study in Rural Indiana
Authors: Hoseus Sarah , Meagher Carolyn , James Rebecca , Cope-Barnes Doug , Ott Mary 
Published: December 2020

Background and Purpose: Rural youth experience high rates of teen pregnancy. Despite this increased health risk, little data exist on evidence-based sex education programs (EBPs) in rural communities. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we describe the challenges and community-derived solutions in implementing an EBP in rural Indiana schools, providing insight on rural EBP implementation.

Methods: As part of a larger federally funded implementation project, an abstinence focused EBP (Making a Difference! and Guiding Good Choices) was taught at middle schools located in twelve counties in rural southern and eastern Indiana. Three community agencies implemented the curriculum over three years. Afterwards, SH and CM conducted interviews of the agency partners (n=13) and of key school stakeholders (n=6). Interviews were conducted via Zoom, audio-recorded, transcribed, field notes written, and all data analyzed using thematic analysis. Codes were developed from the EPIS framework and included outer contexts of communities, inner contexts of schools, preparation activities, implementation, and potential sustainability. We asked participants to identify challenges and solutions.

Results: Challenges and solutions were mapped onto the EPIS framework. Outer context challenges included religion, conservative communities, outside agencies, and parenting beliefs. Inner context challenges included lack of teacher and administrator support. Preparational challenges included lack of communication with parents, lack of community outreach, and lack of parent education. Implementational challenges included teaching a 60-minute lesson in 45 minutes and classroom engagement of schoolteachers. Sustainment challenges included teacher discomfort with the topic. Community-derived solutions included building community trust before implementation, providing information to parents, inviting administrators to observe, offering a student question box, and training school staff to implement the program.

Conclusion and Potential Impact: Many challenges emerged during implementation because of perceived lack of preparation. Future implementation of EBPs in rural communities should focus more on aspects of exploration and preparation.
The Negative Effect of Time and Air Exposure on HSC/HSPC Populations
Authors: Junge Chase , Dausinas Paige , Basile Chris , O'Leary Heather 
Published: December 2020

Background: Hematopoietic stem and progenitor cells (HSC/HSPCs) inhabit niches within bone marrow that have significantly lower oxygen tension (1-4% O2, LowO2) than ambient air (21% O2) and provide signals regulating HSC signaling/function/self-renewal. Despite this knowledge, the majority of HSC/HSPC experiments are performed in ambient air, not replicating the endogenous environment. Our previous studies of HSC/HSPCs in LowO2 demonstrated enhanced phenotypic (CD150) marker expression, and frequency, of HSC/HSPC in live cells (~3fold LSK/LSKCD150 p=0.04) relative to historic data (fixed cells) as well as alterations in novel signaling/functional pathways.

Methods: Our novel technology facilitates the isolation/sorting, and analysis of rare HSC populations, in live cells, continuously at their native LowO2 environments (3% O2). All assays have been adapted and validated in LowO2.

Results: Time course (0 min, 15 min, 40 min, 60 min, 180 min) analysis comparing phenotypic markers of HSC/HSPC populations at LowO2 and ambient air, showed HSC/HSPC enhancement at baseline in LowO2 that were significantly blunted by exposure to air (p-value =.00007) and time beginning at 40 min (p-value =.00003). Phenotypic expression, as shown by the marker CD150, was also diminished by exposure to air (p-value =.0008) and via time (p-value =.05). Analysis via mRNA sequencing showed enhancement in 324 and 73 (LSK, LSKCD150) pathways including calcium channel complex and calcium ion binding when HSC/HSPC remained in LowO2 compared to air. Analysis of calcium regulation via FURA staining correlated with these data confirming increased calcium influx in LowO2 HSC/HSPC populations.

Potential Impact: Our findings demonstrate significant negative impacts of ambient air, fixation, and time from harvest on HSC/HSPC phenotype and function. These findings suggest the critical importance of studying HSC/HSPC, live, quickly, and in their native environment, highlight potential caveats of current approaches, and rationale for lack of comparable results for studies of HSC/HSPC in the literature.
Pathology Communication Following Endoscopy
Authors: Kabir Jason , Maratt Jennifer 
Published: December 2020

Background: Colonoscopies and esophagogastroduodenoscopies (EGDs) are commonly performed to screen for polyps and Barrett’s esophagus (BE), respectively. Findings from screening exams determine if, and when, surveillance is needed. Within the Veterans Health Administration (VHA), communication of test results is mandated; however, there is no clear guidance on how to communicate these results. The aim of this study was to determine the content and readability of endoscopy pathology letters that are used to relay results to patients within the VHA.

Methods: We used Corporate Data Warehouse to identify patients who had a colonoscopy for colorectal cancer screening or post-polypectomy surveillance, or an EGD for BE screening or surveillance, between 2010-2018. We then identified patients who had either: low-risk colon adenomas (LRA), high-risk colon adenomas (HRA), non-dysplastic BE (NDBE), BE with low-grade dysplasia (BE-LGD), or BE with high-grade dysplasia (BE-HGD). Pathology letters for each of these findings were obtained and reviewed by two reviewers independently to categorize as containing ‘alarming,’ ‘not alarming,’ or ‘balanced’ terminology. The readability of each letter was determined by using Microsoft Word to obtain the Flesch-Kincaid reading ease and grade level equivalency scores.

Results: Pathology letters from Richard L. Roudebush VA Medical Center were found to be non-alarming for LRAs, HRAs, and NDBE; balanced for BE-LGD; and alarming for BE-HGD. The average Flesch-Kincaid reading ease and grade level equivalency scores for the letters were 41.44 and 10.28, respectively.

Conclusion and Potential Impact: While pathology letters may contain risk-appropriate terms to describe lesions, readability measures indicate that the content is above the recommended reading ease and grade level for an average adult in the U.S. Improving the readability of pathology letters could improve patients’ understanding of their risk status, thus leading to increased adherence to surveillance endoscopy recommendations.
Rates and Risk-Factors of Post Implantation Infection in Cardiac Implantable Electronic Devices
Authors: Karnani David , White Eric 
Published: December 2020

Background/Hypothesis:
Cardiac implantable electronic devices (CIED) include permanent pacemakers (PPM), implantable cardioverter defibrillators (ICD), and cardiac resynchronization therapy (CRT). Both ICDs and dual chamber PPMs are two-lead systems; whereas, CRT is a three-lead system. Indications for CIEDs include arrythmia, risk of sudden cardiac death and AV block. From 1993 to 2003, over 4 million CIEDs were implanted. With the upward trend in the rate of CIED implantations, the post-operative infection burden has increased concurrently. Device related infections are a serious complication of CIED implants. They are associated with a significant increase in the rate of mortality as well as a significant increase in financial burden. We hypothesize two-lead systems will have significantly lower rate of infection than three-lead devices
Methods:
This study will be a retrospective review of patient charts who are hospitalized in the Parkview Health medical system in Fort Wayne, Indiana over a three-year period. All patients who have received a CIED during that time frame will be included in the study. Patients will be categorized by specific implant type and recorded as developing post-operation infection or not. Demographic and health status data will also be collected and analyzed for correlation with the development of device related infection.
Results:
Our results will compare the device related infection rate for two-lead versus three lead systems, as well as the infection rate for each type of CIED. We also expect to find results which support a correlation between specific patient demographics and patient health factors.

Conclusion and Impact:
The results of this study will serve as a guide for identifying high risk procedures and patients. The objective is to provide providers with guidelines for the use of post-operative prophylaxis in order to reduce the incidence of CIED-related infection.
Repetitive Transcranial Magnetic Stimulation as a Probe of Episodic Memory Neurocircuitry in Schizophrenia
Authors: Kleyn Taylor , Francis Michael , Visco Andrew , Hummer Tom 
Published: December 2020

Background and Hypothesis:
People with schizophrenia often experience impairments with episodic memory (EM). Due in part to a lack of understanding regarding the neural mechanisms of EM, there are no effective treatments. Recent research indicates that the precuneus may be associated with EM impairment. Repetitive transcranial magnetic stimulation (rTMS) is a commonly employed intervention for treatment resistant depression, but its potential for investigating other psychiatric disorders such as schizophrenia is unclear. We hypothesize that, compared to sham stimulation, 1 Hz rTMS will decrease precuneus activity and 20 Hz rTMS will increase precuneus activity during an EM task.

Experimental Design:
Seven patients with early phase psychosis underwent a baseline fMRI scan during an EM recognition task that required participants to accurately identify which images were previously shown (targets) or not shown (foils). Next, participants had three separate rTMS sessions targeting the precuneus, each one week apart, in a randomized order: inhibitory (1 Hz) rTMS, excitatory (20Hz) rTMS, and sham stimulation. Each rTMS session was immediately followed by fMRI during the EM task.

Results:
We currently remain blind to the conditions because the study is ongoing. Participants had relatively lower accuracy during foil trials in one treatment session. During this same session, precuneus activity was relatively stronger to foils than targets, compared to other treatment sessions. These preliminary results suggest that rTMS applied to the precuneus may impact episodic memory and related brain activity in early psychosis

Conclusion and Potential Impact:
Data from this study will help determine whether targeting the precuneus with rTMS impacts functional activation in patients with schizophrenia during EM tasks. Additionally, relationships between EM performance and changes in precuneus activity will be identified. If effective, rTMS may represent a novel treatment for EM deficits in schizophrenia.
Characterization of Fall and Refall Risk Factors in the Elderly Presenting to the Emergency Department: Retrospective Chart Review Protocol
Authors: Lawson Bret , Gutwein Tom 
Published: December 2020

Background/Objective: Falls are a major contributor to morbidity and mortality of the elderly population. Aside from the direct burden of falls on the patients, the CDC estimates falls cost around $50 billion annually, most of which is covered by Medicare/Medicaid. There are, however, fall prevention clinics that are focused on prevention and fall avoidance training in order to decrease the risk of falls. The goal of this work is to identify the population that is at a heightened risk of falls and analyze how this risk is mitigated with completion of a fall prevention program.
Methods: Men and women over the age of 65 who presented to the ED from January 2015- January 2019 were considered for the chart review. Approximately 480 charts are to be analyzed assuming 10% loss due to lack of data in chart or expiration of the patient. Medical history, fall history, and demographics will be input into a data collection tool designed by the researchers. Statistical significance will be identified by Fishers test, unpaired t-test, Χ2 test appropriately. Fall risk factors that are identified as significant will be used in univariate and multivariate logistic regression to test for predictive value.
Results: This work produced an IRB submission draft, RedCap data collection tool and is pending approval by Parkview Health IRB for Fall 2020. The researchers anticipate beginning work on the study in Spring 2021.
Impact and Implications: Identification of risk factors associated with falls and refall events may be used to better distinguish the patient population that would benefit from a fall clinic referral. Increased knowledge of risk factors and protocolization of referrals may lead to decreased morbidity and mortality among the elderly as well as relieve some.
Aged Ossabaw swine exhibit intimal medial thickening of coronary arteries similar to that of humans
Authors: Lehr Trevor , Arnold Chris , Byrd James , Alloosh Mouhamad , Sturek Michael 
Published: December 2020

Background: Coronary artery disease (CAD) continues to be one of the leading causes of death in the United States. A major contributing factor to CAD is intima media thickening (IMT), which is an early stage in CAD progression to a complex, flow-limiting stenosis. Ossabaw swine have been shown to be exemplary models of human cardiovascular disease, yet there is a paucity of data in animal models of aging. We hypothesized that aged swine would have increased IMT compared to healthy young swine.
Methods: Young (3.1 +0.5 years, N=3) and old (10.7 + 1.2 years, N=3) Ossabaw miniature swine were fed a normal lean diet. Epicardial coronary arteries were interrogated in vivo with IVUS. Images were analyzed every millimeter over the most proximal 45 millimeters of the artery. Intimal thickening (wall coverage; echogenic) was measured as a percentage of total circumference of the vessel lumen. IMT included the echolucent medial layer and was measured as a percentage of total arterial area. Data were represented as mean + SEM and p < 0.5 was deemed significant by independent t-test.
Results: Aged swine showed greater IMT compared to the younger swine (18.7+1.2% versus 7.0+1.3%; p < .002). Differences in wall coverage proved not to be significant, as old swine measured 20.3+4.4% and young swine measured 14.5+4.8% (p < .22).
Conclusion: Our data support the hypothesis that old Ossabaw swine exhibited increased intima media thickening compared to lean young swine. This finding further exhibits how coronary artery disease, quantified with clinically used IVUS in the Ossabaw swine model, translates exceptionally well to humans.