bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.