bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can cognitive behavioral therapy (CBT) intervention in patients diagnosed with stage 3/4 gastric cancer increase patients’ acceptance of palliative care earlier in the cancer continuum?
Authors: Sharma Rhea , McCollom Joseph 
Published: December 2020

Background and Hypothesis: Palliative care, though designed improve quality of life in patients diagnosed with a grave illness, is widely stigmatized as an “end of life” service. Cancer diagnosis has been known to cause mental stress on patients; the added stigmatization of palliative care with death is a barrier to care, especially in gastric cancer patients whose delay in treatment can result in poor cancer prognosis and outcomes. Cognitive Behavior Therapy (CBT) intervention is promising is an ideal intervention in this case, yet, understudied in palliative oncology. Successful CBT intervention can combat guilt, denial and stigma, leading to more positive outlook on life and palliative care. We hypothesize that CBT intervention will increase stage 3/4 gastric cancer patients’ acceptance to start palliative care early in their cancer treatment by decreasing associated stigma.

Experimental Design and Results: Study will be an interventional, unblinded, randomized clinical trial with an experimental and control group. A CBT video intervention will be used, preceded and followed by a pre-/post session questionnaire generated from IU’s RedCap. Full intervention will have 4 sessions, with experimental groups divided into those receiving <2, 3 or full 4 sessions. All individuals age 18+ with a recent stage 3/4 gastric cancer diagnosis, who have the ability to provide consent/comprehend the CBT video will be illegible to participate in the study. A spearman’s correlation will be used to test significance of CBT. A negative trend is predicted between CBT intervention and palliative care stigma; as the number of CBT sessions increase, palliative care stigma should decrease accordingly.

Potential Impact: CBT’s effectiveness in alleviating stigma faced by patients with advanced gastric cancer can suggest more psychosocial training for physicians to move away from disease centered approach to one that implements ways that eradicate social barriers to care.
Yield and Efficiency of FIT Tests Alone vs. In Combination with Risk Factors for Colorectal Cancer Screening
Authors: Sheel Vasu , Azzis Leslie , Hinrichs Racehl , Imperiale Thomas 
Published: December 2020

Background: Although colonoscopy (CY) may be considered the best screening test for colorectal cancer (CRC), annual fecal immunochemical test (FIT), which quantifies fecal hemoglobin is a viable alternative. Countries and healthcare systems using FIT-based screening may need to prioritize which FIT positive persons requires CY sooner (e.g. within the same fiscal year). We conducted a systematic review of published literature to understand how the yield/positive predictive value (PPV) of FIT could be improved.
Study Design: We performed a search of electronic databases for articles published between 2015 and June 2020. Titles, abstracts, and full texts were independently screened. Included studies fulfilled predetermined criteria and had descriptive and quantitative data extracted. We identified studies comparing the yield of FIT for advanced colorectal neoplasia ([AN], CRC plus advanced adenomas) among FIT positive persons to the yield of AN when FIT is combined with risk factors (age, sex, BMI, etc.). Data were extracted to find yield and efficiency of FIT alone vs FIT plus risk factors among FIT positive persons.
Results: From 623 titles reviewed, 4 studies met inclusion criteria. The objective of the studies was to increase the yield of AN or CRC in FIT positive patients. The number needed to scope (NNS) among FIT positives to detect AN significantly decreased for each study when looking at high risk groups as yield/PPV increased. The yield with FIT alone ranged from 24% to 46% and the NNS from 2.2 to 4.1. With risk factors, yield and NNS among those at high risk were 33.2 % to 75.6% and from 1.3 to 3.0, respectively.
Conclusion and Potential Impact: This systematic review quantifies how risk factors improve the yield for AN in FIT positive persons, which is information required for countries and health care settings with limited resources that need to direct CY resources to FIT positive patients at high risk for AN.
Qualitative Findings Following Acceptance and Commitment Therapy for Breast Cancer Survivors with Fear of Cancer Recurrence
Authors: Shepler Christine , Cottingham Elizabeth , Stutz Patrick , Johns Shelley 
Published: December 2020

Background: Fear of cancer recurrence (FCR) takes an emotional toll on cancer survivors and significantly undermines quality of life following treatment. During a randomized controlled trial of Acceptance and Commitment Therapy (ACT) for post-treatment breast cancer survivors with clinically significant FCR, we conducted qualitative interviews to glean a deeper understanding of the impact of ACT on survivors’ coping with FCR.
Methods: Breast cancer survivors (stage I-III) who had completed a 6-week ACT intervention were invited to share their experiences in semi-structured qualitative interviews. Interviews were transcribed verbatim and analyzed thematically using a deductive approach. Participants received a $25 gift card for their time. Participants (n=16) were primarily White (81.3%) and college educated (68.8%), with a mean age of 57.3 (SD=11.1) and 75% had an income over $50,000.
Results: Prior to the study, survivors generally coped with FCR by denying their FCR or by attempting to control their fears through faith, lifestyle management, avoidance, and positivity. Survivors uniformly noted the sense of community they felt in their ACT group when listening to other survivors describe their own struggle with FCR. This common bond created a foundation that allowed survivors to embrace the ACT intervention and develop adaptive coping skills related to acceptance, present-moment awareness, and living consistently with one’s values. Survivors noted that these skills reduced the negative impact of FCR and other life challenges and improved quality of life compared to pre-study coping techniques.
Conclusion and Potential Impact: By building trust with other cancer survivors, participants were able to shift from attempts to ‘control’ FCR to a more ‘accepting’ approach to manage FCR and other life stressors. While research with a larger group of participants is needed, initial findings indicate that ACT may be a promising addition to care for cancer survivors.
THE ROLE OF THE MICROBIOME IN RESPIRATORY DISEASE: ALLERGIC RHINITIS
Authors: Singh Arundeep , Kloepfer Kirsten 
Published: December 2020

Background:
Allergic rhinitis is one of the most common disorders affecting patients in the United States and developed and developing countries. Currently, no effective methods of prevention or effective cures exist for allergic rhinitis. This is due to unanswered questions regarding the etiology of allergic sensitization and the development of symptoms after sensitization. Recently dysbiosis of the microbiota has been investigated as a potential contributor to the development of allergic sensitization and symptoms. We decided to review the current evidence and describe potential mechanisms between allergic rhinitis and microbial dysbiosis of the upper airway and GI tract.

Methods:
To perform our review, we utilized PubMed, compiling the most relevant and well-performed studies focusing on the gut and upper respiratory microbiota in allergic rhinitis. Association and experimental studies were predominantly sought and used, though systemic reviews and review articles were included to ensure we included all pertinent studies within the past ten years.

Findings:
Significant evidence exists supporting the hypothesis that dysbiosis in upper respiratory and gut microbiota is associated with the development of allergic rhinitis. Additionally, existing longitudinal studies demonstrate that dysbiosis appears to precede the development of allergic symptoms, while experimental studies in murine models have provided evidence for defining a causative role for microbial dysbiosis. To date, modulation of the microbiome shows efficacy for treatment, but little to no efficacy for prevention.

Conclusion and Potential Impacts:
This review highlights the potential role of the gut and upper respiratory microbiota in the development of allergic rhinitis, providing an additional avenue for treatment and prevention in clinical settings. Given the results of prevention studies utilizing microbiome modulation, more research is required to establish the exact role of the microbiota in allergic disease and to examine the effects of personalized formulations of probiotics to further our understanding and possibly prevent the development of allergic rhinitis.
Glaucoma and Diabetes: A Sweet Connection
Authors: Singh Chevy , Jusufbegovic Denis , Lind John , Pattabiraman Padmanabhan 
Published: December 2020

Background/Objective:
Glaucoma is the leading cause of irreversible blindness in the world. In the United States alone, a little more than three million people live with this disorder which is caused by damage to the optic nerve found in the back of the eye. This is most commonly caused by an increase in the intraocular pressure, or the fluid that maintains the shape and provides nutrients to the eye. Diabetes mellitus (DM), an age-related disorder, is a risk factor for glaucoma. Post-meal, the sugar one eats is managed in the body by the hormone insulin. However, the excess sugar found in diabetics, can exhaust the production of insulin and lead to many adverse complications in the body as well as increase risk of disease. Although some studies suggest a correlation between diabetes and glaucoma, the mechanisms of this association has not been thoroughly investigated. Our objective is to further explore this connection and provide the mechanisms that link diabetes to glaucoma.

Results:
From retrospective literature review, we find that diabetes is known to have an additive effect on neural apoptosis and in the generation of reactive oxygen in patients with high intraocular pressure. DM also impairs retrograde axonal transport, causes an accumulation of fibronectin in trabecular meshwork, changes eye vasculature, causes dysregulation in lipid metabolism, and malabsorption of vitamins.

Conclusion & Scientific/Clinical Policy Impact and Implications:
This study sheds light on one of the most troubling eye conditions worldwide. The symptoms of diabetes described here increase ones’ risk of developing glaucoma. These pathways result in obstruction of aqueous humor drainage or direct damage to the optic nerve cells leading to glaucoma. Diabetes is a common disease that involves many body systems. With knowledge of the relationship between diabetes and glaucoma, measures can be taken to prevent irreversible eye damage in the diabetic population.
Impact of an at home exercise program in the pediatric, adolescent, and young adult cancer population newly diagnosed with acute lymphoblastic leukemia
Authors: Vyas Punit , Halsey Danielle , Kelly Nicholas , Sherman Melissa , Herbert Brooklyn , Bijangi-Vishehsaraei Khadijeh , Klika Riggs , Keith Nicole , Renbarger Jamie , Sajdyk Tammy 
Published: December 2020

Background: Over 30,000 cases of leukemia are diagnosed each year in the United States. For individuals ages 0-39, the one-year relative survival rate is 84.5%, and the 5-year survival is 94%. Improved survival rates come with long-term health challenges due to treatment, including cardiovascular disease, obesity, diabetes, fatigue, low quality of life (QOL), and reduced physical activity (PA). Current literature shows structured exercise in adult survivors can be beneficial for improving the long-term health effects resulting from treatment. Exercise induces the release of many growth factors into the bloodstream that aid in repair of the body following insult. Three factors specific to nerve damage is brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and Platelet-derived growth factor (PDGF). The benefits of exercise seen in adult survivors may translate to young survivors. We hypothesized that an 8-week at home exercise program in newly diagnosed acute lymphoblastic leukemia (ALL) patients (ages 5-25) would improve outcomes compared to baseline or a control group. The preliminary findings presented are based on the initial ten subjects and include physical, biomarker and self-reported outcomes.
Experimental Methods: Newly diagnosed ALL patients were assigned to an 8-week at home exercise intervention during the consolidation phase of treatment. Fitbit activity tracker data and questionnaires were used for assessing adherence and feasibility. Blood samples were taken at baseline and at week eight.
Results: Subjects were not able to complete over 75% of the exercise intervention; however, they did increase their overall physical activity and their neuropathy scores decreased compared to baseline. BDNF significantly increased in the control group, but not in the exercise group.
Conclusion: The results indicate that an exercise program in this population during the consolidation phase may not be feasible. It also supports the association between neuropathy, physical activity, and BDNF levels after long term exercise.
Peripheral Extracorporeal Membrane Oxygenation is a safe and effective support modality for pediatric patients with sepsis
Authors: Warnock Brielle , Brown Joshua , Turk Eamaan , Hocutt Gail , Gray Brian 
Published: December 2020

Background
Extracorporeal Membrane Oxygenation (ECMO) can be used as a treatment modality for pediatric patients with refractory septic shock. Previous studies indicate central ECMO, with direct cardiac cannulation, is superior for septic patients. At Riley Hospital for Children, we believe that peripheral ECMO support, through cervical or femoral vessels, is an effective and safe method of supporting pediatric septic patients in a less invasive manner.

Methods
We reviewed pediatric (30 days to 18 years) patients supported with ECMO for septic shock from 2005-2019 at Riley Hospital for Children and compared them to non-septic respiratory failure patients supported with ECMO. Pre-ECMO data points, demographics, cannulation sites, flow rates, lab values, Vasoactive Ionotropic Score(VIS), P-Prep score, and outcomes were collected and analyzed using t-test and multivariate analyses. We defined a significance as p=0.05.
Results
35 of 80 ECMO patients were supported for septic shock. Septic patients were larger (25.1kg vs 11.4kg, p=0.005) and older (85.6 vs 18.8 months, p=0.001). Pre-ECMO VIS and P-Prep were both greater in the septic group (p=0.007 and p<0.001). Pre-ECMO serum lactate level was higher in the septic group (3.7 vs 1.4, p=0.012) , but by 96hrs, lactate normalized in both groups. Flow rates at 24 hours were similar between the two groups (91mL/kg/min vs 88mL/kg/min, p=0.079). No significant difference in bleeding complications or blood product administration was found, but there was a higher incidence of renal failure in septic patients. Survival in the septic group was similar to the comparison group (51.4% vs 62.2%, p-0.37). Hours on ECMO and length of stay were also similar.
Conclusion and Potential Impact
Despite septic patients appearing more ill prior to ECMO, they had similar mortality, support parameters, and outcomes, showing that septic shock is not a contraindication to peripheral ECMO support in pediatric patients.
Impact of Ethnicity on Stroke Care and Outcome in Allen County
Authors: Watkins Margaret , Wahab Luna , Chang Fen-Lei 
Published: December 2020

Background/Objective: Stroke is the fifth leading cause of death in the US and the leading cause of long-term disability for adults. Research has shown that some ethnic groups have worse health outcomes after suffering from an acute stroke. It has been shown that certain ethnic groups used EMS services less and took longer to arrive at the hospital for acute stroke care. Since time is of the essence for stroke treatment, our study may provide insight on factors that may lead to the delay in the acute stroke management.

Project Methods: In this retrospective chart review, we will look at patients who suffered from an ischemic or hemorrhagic stroke. From each patient’s electronic medical record, demographic information, time from acute stroke onset to hospital stroke activation, stroke severity, usage of EMS services, duration of hospital stay, co-morbid conditions, and stroke outcome will be recorded. Two-way ANOVA is used for statistical analysis.

Results: Data was not able to be collected at this point. We hypothesize that patients of some ethnic groups have longer delay of ED care initiation from the stroke onset, lesser usage of EMS services, and higher rates of co-morbid conditions. We also hypothesize that these factors are correlated with stroke outcome at the time of hospital discharge. In contrast, the distance between home and nearest hospital with stroke care expertise is not different for different ethnic groups.

Conclusion and Potential Impact: The data collected in this study can further explain why some ethnic groups have worse stroke outcomes than others. If the underlying factors responsible for these differences include factors such as failure to use EMS services, steps can then be taken to provide remedy and to promote better acute stroke outcomes for people of all ethnic groups within our community.
Factors Affecting Outcomes in Airway Stenosis Dilations
Authors: Westlake Max , Shew Matthew , Partoo Leila , Kowkutla Ashwini , Parker Noah , Anthony Ben , Halum Stacey 
Published: December 2020

Objectives: Tracheal and subglottic stenosis are often managed with dilation procedures, with additional interventions often added in an attempt to delay recurrence of the stenosis. The goal of this retrospective case series is to evaluate the efficacy of such various factors in prolonging airway stenosis recurrence.

Methods: A total of 345 dilation procedures belonging to 148 patients who presented for endoscopic dilation of clinically significant subglottic and/or tracheal stenosis were reviewed. Data was collected on patient demographics, comorbidities, surgical history, dilation type, adjuvant therapies, type of endoscopic intervention, and if needed, time until next dilation procedure. The patient data was divided into adult and pediatric groups based on age at the time of operation. Bivariate models were performed for both the adult and pediatric patient groups.

Results: The charts for 95 adults receiving 220 dilation procedures were reviewed. None of the adjuvant therapies (cryotherapy, steroid injection, topical mitomycin) were statistically associated with an increase in the number of weeks until next dilation. However, procedures involving 14mm balloon dilators (p<0.0108) and interventions with sharp, radial incisions (p<0.0286) were found to be associated with a significant increase in the number of weeks until next dilation when compared to other dilator types and interventions with laser incisions, respectively. Jackson dilator (p<0.0446) was found to negatively affect outcomes by decreasing the weeks until next dilation. The charts for 53 pediatric patients receiving 125 dilations were reviewed separately, and in these cases, cryotherapy (p<0.0428) was the only factor significantly associated with an increase in weeks until next dilation.

Conclusions: In comparing various factors involved in airway stenosis dilations, balloon dilators and sharp radial incisions were found to significantly increase time needed before the next procedure in adults, while cryotherapy was found to significantly increase time needed before the next procedure in pediatric patients.
Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia
Authors: Wilson Emily , Roberts Aaron 
Published: December 2020

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time.

Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time.

Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time.

Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.
Heterotopic Ossification in Polytrauma
Authors: Young Allison , Chitwood Joe , Perrien Dan , White Fletcher , Kacena Melissa 
Published: December 2020

Background: Heterotopic ossification (HO) is the pathologic development of ectopic bone in muscle and soft tissue. HO is a known complication that can arise in cases of fracture, surgery, burn injury, and nervous system injury. The co-occurrence of traumatic brain injury (TBI) and fracture increases the risk of HO development by 37-50%. This review aims to examine and synthesize the mechanisms involved in HO development after polytrauma, available animal models to study these mechanisms, and possible treatment options for patients.

Project Methods: A literature search was conducted using PubMed and EMBASE with search terms: heterotopic ossification, fracture, and traumatic brain injury. This search produced 33 unique articles.

Results: TBI and fracture contribute to HO development by triggering the release of inflammatory cytokines, neuropeptides, and hormones in response to nervous system and bone damage. Bone morphogenetic protein (BMP), vascular endothelial growth factor (VEGF), and Substance P (SP) are among the known contributors to HO formation. Damage to the blood brain barrier and release of nervous system factors may also contribute to the osteogenic environment that promotes ectopic bone development. Rodent modeling of the biologic mechanisms underlying HO can be exploited to better understand the molecular causes of the condition. There are also options for both prophylaxis and treatment of HO. Prophylaxis options include radiation treatment, non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates. Treatment options include physical therapy and surgical resection.

Potential Impact: HO has a high occurrence rate in military personnel exposed to combat trauma and can lead to restriction of joint movement, pain, and infections in soft tissue. There are limited options for treatment, pointing to a need for further study.