bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
The Role of Alcohol in Hippocampal Calcium Channel (Cav1.2) expression
Authors: Kokoska Ryan , Rodriguez Eric , Yamamoto Bryan 
Published: December 2020

Background and Hypothesis:
Voltage-gated L-type calcium channels (Cav1.2 and Cav1.3) in the hippocampus play important roles in glutamatergic neurotransmission underlying memory and learning. Their overexpression has been implicated in neuroexcitatory cell death and disease states including chronic alcoholism. While increases in Cav1.2 gene expression have been reported in the hippocampus after chronic ethanol exposure in rats, the regional distribution of Cav1.2 protein after voluntary ethanol (EtOH) drinking has not been reported. We hypothesize that the expression of Cav1.2 channels within the hippocampus is increased by EtOH drinking in a region-specific manner.

Methods:
Male Sprague Dawley rats were allowed 28 days of intermittent access to a 10% EtOH solution. At 24 hours after the last exposure to EtOH, brains were collected and processed for immunohistochemistry. Cav1.2 associated immunofluorescent signal from subregions of the hippocampus was quantified using ImageJ analysis software.

Results:
Immunohistochemical results indicate that Cav1.2 immunoreactivity in the hippocampal stratum granulosum layer within the Dentate Gyrus and the stratum pyramidale layer within CA1 and CA3 regions was increased in response to EtOH treatment. There was no significant change in Cav1.2 immunoreactivity for the CA2 region.

Conclusion:
This study suggests that calcium signaling in subregions of the hippocampus is differentially affected by EtOH consumption that may contribute to eventual calcium-mediated apoptosis.

Impact and Implications:
Understanding the process of EtOH-induced hippocampal calcium signaling presents opportunities for understanding the consequences of chronic alcohol exposure related to hippocampal function including memory and learning, and possible interventional therapies for alcohol damage.
The Impact of Covid-19 on Inmate Trust in Health Care and Willingness to Seek Treatment - A Qualitative Investigation
Authors: Kumalo Valarie , Nelson Alexander , Messmore Niki 
Published: December 2020

Background and Objective:
The coronavirus has disproportionately impacted vulnerable members of society. With the U.S. as the global leader in incarceration and the difficulties prison systems face implementing many of the mitigation strategies employed by the general population, the incarcerated population is in a uniquely vulnerable position particularly within an already strained prison healthcare system. Given the nature of prisons as total institutions, negative experiences with the virus coupled with a lack of autonomy could lead to a loss of trust in the healthcare system which has the potential to impact health-seeking behaviors. In this study, we aim to examine the effect of Covid-19 on Indiana inmates’ trust in healthcare.

Project Methods:
Data from 380 surveys distributed across Indiana’s prison system will be collected and analyzed. These results will be used to develop an interview protocol to conduct at least 25 in-depth interviews which will then be coded using NVivo to identify any emerging themes regarding their experiences with Covid-19. Prior to this, in-depth literature reviews were done on health care in prison populations and trust in healthcare.

Results:
The surveys and interview protocol will be developed in the ensuing months and thus no data has yet been collected. The literature review revealed that the quality and accessibility of care in prisons is lacking, an issue exacerbated by the pandemic. Because of the disproportionate number of preexisting issues, inmates worried about the ability of prison administrators to properly protect inmates from contracting the virus. Additionally, it was found that trust likely does have an effect on health, and that many commonalities of inmates are poor predictors for trust.

Potential Impact:
This study aims to identify potential loss of trust in healthcare systems to inform community reentry programs in developing strategies that prioritize inmate health needs and perceptions.
Effect of Prior History of Dementia and a Diagnosis of COVID-19 on Delirium in the ICU
Authors: Kupty Amira , Chang Fen-Lei 
Published: December 2020

Background: Delirium occurred in nearly two out of every three patients in the ICU from prior studies. It is associated with poor health outcomes, including long-term cognitive and motor decline, increased risk of dementia, and increased mortality. In the context of COVID-19, patients are more likely to develop delirium due to the severity of the illness involving multiple organ systems. Our study evaluates factors contributing to the occurrence of delirium in the ICU for patients with or without a history of dementia and with or without a recent diagnosis of COVID-19.
Methods: We performed a retrospective chart review of ICU patients in Fort Wayne, IN from January through the end of June of 2020. Patients were grouped by whether they developed delirium or not and whether they had pre-existing dementia. We recorded age, sex, race, BMI, level of education, high risk medications, comorbidities, enteric/NPO feeding, mechanical ventilation, mobility, and lab results including CBC and BMP at the onset of delirium. Additionally, we included severity of delirium, length of stay, functional status at time of discharge, and COVID-19 status.
Results: We were unable to collect data at the time. However, we hypothesized that the incidence and severity of ICU delirium is associated with the severity of dementia and COVID status, among other factors.
Potential Impact: This study can shed light on the contribution of dementia history to ICU delirium and potential factors contributing to delirium incidence and severity. The COVID pandemic offers opportunities to differentiate effects of neurological (dementia) versus non-neurological factors (respiratory, renal, cardiovascular, and metabolic) on ICU delirium.
Correlating mRUST scoring with fracture healing in the mouse model
Authors: McGuire Anthony , Knox Adam , Staut Caio de Andrade , Kacena Melissa , Natoli Roman , Collier Christopher 
Published: December 2020

Background/Objective: Long bone fractures are an expensive and frequent cause of disability in humans. Research seeking to accelerate and improve the healing process is more essential than ever. Animal models, mice especially, provide an inexpensive and reproducible model of in vivo fracture healing. However, many measures of murine fracture healing outcomes are either expensive or destructive, limiting their ability to be translated to clinical studies. We seek to determine how these measures such as biomechanics, µCT, and histology correlate to the relatively new, inexpensive, and non-destructive method of mRUST scoring in a mouse model.
Methods: One hundred and thirty-five, 12-week old male C57BL6/J mice were divided into nine groups of 15 mice. Mice underwent a surgically created, femoral fracture. At biweekly timepoints, anteroposterior and lateral radiographs were taken, and 15 mice were sacrificed at each time point (7, 10, 14, 17, 21, 24, 28, 35, and 42 days post-surgery) for biomechanical, µCT, and histological analyses. The modified Radiographic Union Scale for Tibial fractures (mRUST scoring) provides a score based on the visualization of a callus and fracture line in four cortices on the radiographs. Data analysis will be performed to determine the degree of correlation between mRUST scoring and other fracture healing outcomes.
Results/Conclusion: Data collection in this experiment is still forthcoming. Upon successful completion of this project, we will have established numerical correlations between mRUST scoring and other fracture healing outcomes, such as biomechanics, µCT microarchitecture, and histology. These correlations will provide a powerful tool in future mouse fracture healing studies, as data on the state and strength of fracture repair could be determined by simple radiograph.
Scientific/Clinical Policy Impact and Implications: This study will both provide future murine fracture studies with an inexpensive and non-destructive method of assessment that is more directly translatable to human fracture studies.
Serum Endothelin-1 Levels in Pediatric Patients after Cardiac Transplantation
Authors: O'Connor Stephen , Johansen Michael , Parent John 
Published: December 2020

Background and Hypothesis:
Worldwide, approximately 650 pediatric heart transplants occur annually. Coronary artery vasculopathy (CAV) is the foremost cause of allograft failure following heart transplantation, accounting for more than 25% of deaths within one-year post transplant. Within 10 years, 30-45% of children will be diagnosed with CAV, yet the mechanism of disease is still misunderstood. Endothelin-1 (ET-1) has been shown to play an important role in development and promotion of CAV, however no studies have evaluated ET-1 levels in the pediatric population following heart transplant.

Methods:
All patients enrolled in the study have underwent cardiac transplant and present for annual cardiac catheterization and blood draw, with data being stored in a REDCAP database. Centrifuged plasma will be analyzed for ET-1 levels and compared to accepted standard pediatric values. Relationships between ET-1 levels and other lab values will be evaluated for correlation.

Results:
Currently awaiting plasma results.

Conclusion and Potential Impact:
This study will establish ET-1 levels in pediatric patients post cardiac transplantation. If ET-1 levels are correlated with CAV severity and are increased, ET-1 levels have the potential to be an inexpensive and easily available biomarker for continuing to monitor CAV progression. Using currently available ET-1 therapies such as ERAs has the potential to lower morbidity and mortality rates by delaying or reducing re-transplantation in patients with CAV.
Food Prescriptions for Management of Prediabetes and Type 2 Diabetes among Food Insecure Youth: A Pilot Protocol
Authors: Oswald Jonathan , Yazel Lisa , Hannon Tamara 
Published: December 2020

Introduction: Food access and food insecurity represent significant barriers to healthy eating in low-income communities. Food prescription programs have attempted to address these barriers by providing subsidized access to fresh produce through a physician-community collaboration. However, little is known about the health outcomes associated with food prescriptions, especially among youth with diabetes. To address this, we report data from the past two years of the Veggie Box program, a free produce distribution program of Indy Urban Acres. Additionally, we propose a feasibility study to 1) establish a food prescription program for food insecure youth with prediabetes and type 2 diabetes through the Veggie Box program and 2) assess health outcomes of youth who receive a prescription for Veggie Box.
Methods: Through 2018 and 2019, the Veggie Box has been distributed weekly to a low-income community on the eastside of Indianapolis. Participant outcomes have been measured through survey assessment of food and beverage consumption, food insecurity, quality of life indicators, and program satisfaction. The proposed study aims to recruit 70 food insecure families with children aged 10-16 who have prediabetes or type 2 diabetes. Participants will receive a Veggie Box once every two weeks for a total of 12 weeks and will be provided access to a dietitian, health coach, and monthly group diabetes prevention sessions. Participant outcomes will be assessed at baseline and 12 weeks using the same surveys from the past two years with the addition of BMI and HbA1c measurements.
Results: The past two years of Veggie Box distribution led to a statistically significant increase in fruit (p=0.009) and vegetable (p=0.001) consumption among Veggie Box recipients. There was not a significant change in reported food security.
Discussion/Conclusion: Early results from the Veggie Box program showed that it increased fruit and vegetable consumption, indicating its potential use as a food prescription for food insecure youth with prediabetes and type 2 diabetes. This study will begin to fill the gap in knowledge related to health outcomes of food insecure youth with diabetes who are provided a food prescription.
Return to Driving After Hip and Knee Arthroscopic Procedures: A systematic review and meta-analysis
Authors: Palma Samantha , Patel Purva , Palan Jeya , Pandit HG , Van Duren BH 
Published: December 2020

Background: Hip and knee arthroscopies are common orthopaedic procedures. As patients are looking to return to their regular schedules and regain their independence post-surgery, physicians often encounter the question of, “when can I drive again?” While safety of the patient is of the utmost importance when making these recommendations, it is equally important to consider the possibility of harm to others and potential legal ramifications. The purpose of this study is to consolidate evidence from available literature and undertake a systematic review and meta-analysis to determine when it is safe for patients to return to driving after hip and knee arthroscopic procedures.
Methods: A systematic review was conducted using PRISMA guidelines. OVID, EMBASE, and COCHRANE databases were searched through June 2020 for articles containing keywords and/or MeSH terms “Hip arthroscopy” and “knee arthroscopy” in conjunction with “total brake response time” or “reaction time” in the context of automobile driving. Title review and full article review were done to assess quality and select relevant articles. Review Manager Version 5.4 was utilized for statistical analysis.
Results: 8 papers were included in the meta-analysis of Brake Reaction Time (BRT). Meta-analysis of all Knee BRTs showed times slower-than or equal-to-baseline BRTs through 5 weeks, with a trend of improving BRT from 6 to 10 weeks (only weeks 8 and 10 were significant P < 0.05). Of all Hip BRTs, week 2 showed slower-than-baseline BRTs, but after week 4 demonstrated a trend toward faster BRTs through week 8 (only week 8 was significant P < 0.05).
Conclusion: BRTs met baseline/control values and continued to improve after 6 weeks following knee arthroscopy and after 4 weeks following hip arthroscopy. Based on these results it would be safe to recommend return to driving at 6 weeks after knee arthroscopy and 4 weeks after hip arthroscopic procedures.
Propofol-induced damage to the blood-brain barrier endothelium evinces a vascular endothelial growth factor (VEGF) -dependent mechanism.
Authors: Parsons Dustin , Hughes Jason , Canfield Scott 
Published: December 2020

Background and Hypothesis:
Propofol is an anesthetic commonly used to induce general anesthesia for a myriad of medical procedures. However, a growing corpus of evidence suggests that propofol-induced increases in VEGF may contribute to blood-brain barrier (BBB) leakiness in varying animal models. The BBB is a neurovascular structure which protects the central nervous system from pathogens, toxins, and other deleterious metabolites; therefore, considerations regarding BBB integrity in humans are indispensable to the practice of anesthesia. We hypothesize that propofol-induced BBB dysfunction in human models is partially mediated by an increase in VEGF expression.

Methods:
We utilized human induced pluripotent stem cells (hiPSC) to derive brain microvascular endothelial cells (BMECs)—the barrier forming cell type of the BBB. BMECs were then subjected to clinically relevant doses of propofol for 3 hours, and barrier integrity was monitored via transendothelial electrical resistance (TEER) and para-cellular permeability for up to 72 hours. Propofol-induced VEGF levels were determined with an ELISA assay. Axitinib, a VEGF receptor blocker, was further utilized to assess the role of VEGF in propofol-induced BBB breakdown.

Results:
Prior works, including this study, have shown that propofol induces BBB damage, as demonstrated by decreases in TEER; here, preliminary work with ELISA assays further suggest that BMECs treated with propofol demonstrate an upregulation of VEGF. Pretreatment of BMECs with Axitinib before the addition of propofol partially rescues TEER and thus attenuates the propofol-mediated diminution of TEER. These observations thereby implicate VEGF as a damage mediator after propofol treatment.

Conclusion and Potential Impact:
This study utilized an in vitro model to demonstrate that propofol may mediate, in part, damage to blood- brain barrier endothelium via a VEGF dependent mechanism; thus, this work may guide future investigations to facilitate the development of safer anesthetic alternatives, or towards additional pharmacologic interventions that counteract propofol-mediated damage during anesthetic induction.
Drivers and Barriers to the Use of Health Information Exchange Amongst Clinicians in the Emergency Department
Authors: Richter Ben , Dixon Brian 
Published: December 2020

Background:
Health Information Exchange (HIE) describes the exchange of medical data between various health care organizations. Though research is limited, widespread use of HIE may improve patient outcomes while improving efficiency and thus lowering health care costs for patients. The paucity of existing research necessitates further study into the effects of HIE use in the clinical setting. The Indiana Network for Patient Care (INPC) is one of the most comprehensive HIE networks in the country, and provides an ideal environment for conducting research regarding factors that influence HIE use.
Methods:
A group of 20 clinicians from the Emergency Department were chosen to answer a set of questions regarding their HIE use. This group included physicians, nurse practitioners, physician assistants, and registered nurses from various health care organizations across the state of Indiana. Interview questions were centered around four main themes: Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Conditions. Interviews were recorded and transcribed, then subject to qualitative analysis using NVivo software.
Results:
The Single Sign-On and EHR Button were the most commonly discussed features in terms of facilitating HIE use. Providers used HIE most often when the patient reported previous admission at a different hospital, or when the patient was incapacitated and could not provide information. Although clinicians had unanimous social support for using HIE, inadequate training regarding HIE was apparent, and served as the most common barrier to its use.
Conclusion/Impact:
The implementation of Single Sign-On and access to the INPC via a button integrated into the user’s EHR are critical for widespread use of HIE, while lack of physician training serves as a major barrier to its use. Implementing SSO and EHR button features while improving HIE training may spurn additional use of HIE and thus lower costs for both hospitals and patients.
Determining the prevalence and density of asymptomatic Plasmodium falciparum infections in low and high transmission settings in Western Kenya
Authors: Salgado Christina , Gaskin Erik , Macklin Michael , Onyango Eliud , Surridge Rachel , Nallandhighal Srinivas , Bhardwaj Jyoti , Datta Dibyadyuti , Turnbull Lindsey , O'Meara Wendy , Ayodo George , John Chandy , Tran Tuan 
Published: December 2020

Background/Objective: Malaria remains a global health burden as 2018 saw 228 million cases worldwide. Pre-elimination efforts aim to decrease disease transmission, which depends on development of asexual parasites to sexual gametocytes within the human host. To better determine the relationship between asexual parasites and gametocytes, we aim to quantify both stages within the same blood sample by developing a multiplex RT-qPCR assay. We hypothesize that gametocytemia decreases linearly with asexual parasitemia at higher parasitemias but increases at lower parasitemia to improve transmission probability.

Methods: We conducted a cross-sectional survey of healthy participants aged 0 to 92 years at four sites in Western Kenya (Ajigo, Webuye, Kipsamoite, Kapsisywa) with varying levels of transmission to determine prevalence of asymptomatic P. falciparum blood-stage infections. Parasite density was quantified by light microscopy and by quantitative PCR of genomic DNA isolated from dried blood spots using varATS primers. For varATS-positive samples, we isolated RNA from whole-blood and performed stage-specific quantification by multiplex Taqman RT-qPCR targeting PfPIESP2 (asexual), Pfs25 (female), and Pfs230p (male).

Results: Among all participants, 127 of 1355 (9.37%) were positive for asymptomatic P. falciparum infection by varATS-qPCR. Using varATS positivity as the standard, multiplex RT-qPCR targeting PfPIESP2 yielded a sensitivity of 78%. Across sites, overall parasite prevalence and gametocyte prevalence were highest in Ajigo (42.1%; 36%) followed by Webuye (10.5%; 9%) and Kipsamoite/Kapsisywa (0.873%; 0.1%). Pfs25-quantified gametocytemia decreased with decreasing varATS-quantified asexual parasitemia; however, the data poorly fit a linear model (R2 = 0.088).

Conclusions: PfPIESP2 detected 78% of varATS-positive samples, suggesting it may be poorly sensitive at detecting low-density blood-stage infections. Assay design may improve with a more sensitive gene target and further optimization. Based on quantification results, the relationship between gametocytemia and asexual parasitemia appears direct but non-linear. Further work is necessary to better model the relationship between stage-specific parasitemia levels.