bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decisions to Enter and Leave Skilled Nursing Facilities for Post-Acute Rehabilitation: A Qualitative Study
Authors: Chimitt Daniel , Carnahan Jennifer 
Published: December 2020

Background and Hypothesis:
Approximately 40% of patients aged 80+ enter a Skilled Nursing Facility (SNF) following a hospitalization. SNFs can be used as “safety nets” to expedite the discharge process of older adults and it can be difficult to pinpoint how and who made the decision for a hospitalized older adult to discharge to a SNF.
This project examines the factors that drive older adults to enter and leave a SNF for their rehabilitation care.

Project Methods:
Interview transcripts from a qualitative study with patients and their caregivers were used to examine factors influencing admission to and discharge from SNFs. Baseline interviews were conducted within two to seven days after returning home from a SNF stay followed by a follow up phone call one to two weeks after the initial interview. Transcripts and audio files were coded (using NVivo version 12+) for major themes. Interviews were analyzed using a constant comparative method to elicit themes of interest to interviewees.

Results:
There were 24 baseline interviews and X follow up interviews performed with a total of 24 patients and 15 caregivers. The primary theme identified was that patients perceived a loss of autonomy when considering the decision-making process. 75% (18/24) patients or their caregivers felt the healthcare team told them they must go to a SNF for their rehabilitation. 38% (9/24) patients or caregivers felt they had no choice but to leave due to insurance coverage and 50% (12/24) stated that they needed more time.

Potential Impact:
To achieve better patient outcomes, one must understand both the purpose of skilled nursing facilities and also how patients and their families are feeling as they transition through this uncertain period of their lives. Restoring a patient’s sense of autonomy will foster better patient-healthcare relationships and improve trust in the system.
Intra-muscular administration of autologous bone marrow mononuclear cells reduces opioid dependency in patients with critical limb threatening ischemia.
Authors: Couetil Justin , Murphy Michael 
Published: December 2020

Background and Hypothesis
Critical limb-threatening ischemia (CLTI) is a severe limitation in perfusion of the lower extremities. It is the most advanced stage of peripheral arterial disease. Characterized by unremitting rest pain and/or gangrene, the CLTI patient population has an excessively high rate of opioid use and addiction. The MOBILE Trial was a Phase II multi-center, double-blinded placebo controlled trial designed to assess the safety and efficacy of autologous bone marrow cells (ABMC) in treating patients with CLTI. Our central hypothesis is that cell therapy may provide trophic effects in the treated limb that may decrease opioid requirements.

Project Methods
The primary endpoint of the MOBILE Trial was amputation-free survival at 52 weeks. Secondary endpoints included limb perfusion measures, ambulatory function, quality of life (VascuQol), pain assessment with a visual analog score, and opioid requirements, as tabulated by prescriptions reported to us. A post-hoc statistical analysis using ANOVA was conducted to describe changes in pain and quality of life measures along the study, and Fisher’s test to compare the incidence of new opioid prescriptions between treatment groups.

Results
There were no differences in quality of life and visual analog pain measures between the ABMC and placebo groups (P= 0.42). There was however a 36% decrease in new opioid prescriptions in the ABMC groups as compared to placebo (P = 0.058, HR: -0.44-1.012). This reduction did not correlate with changes in limb perfusion measures, gender, age, diagnosis of diabetes, or Rutherford score.

Discussion
The results of this analysis demonstrate an effect of ABMC in reducing opioid use in a high-risk addiction patient population. These findings are consistent with other studies assessing mesenchymal stem cells in chronic pain syndromes. The effect of ABMC did not correlate with changes in limb perfusion suggesting other beneficial trophic effects of cells in ischemic induced neuropathies. This discovery suggests a potential therapeutic strategy for reducing opioid dependency.
Gene Network Analysis Reveals Association between Somatic Loss of Y and Genes Involved in Hemostasis
Authors: Dharla Vijai Kumar , Lui Yunlong , Nudelman Kelly 
Published: December 2020

Background and Hypothesis:
Somatic loss of the Y chromosome (LOY) is associated with diagnoses of various cancers, Alzheimer’s disease, and cardiovascular events. In the case of cardiovascular disorders, no mechanistic link to LOY has been elucidated. To explore this relationship, we utilized Weighted Gene Co-Expression Analysis (WGCNA), a powerful technique that can reveal associations between modules of co-expressed genes and clinical traits. We hypothesized WGCNA would reveal a module that illuminates the relationship between LOY and cardiovascular disease.

Methods:
Information about 403 male participants was obtained from Alzheimer’s Disease Neuroimaging Initiative (ADNI), including Genome Wide Association Study (GWAS), microarray, and patient demographic data. GWAS data was obtained from each participant within one year of collecting gene expression data. Using GWAS data for each participant, a median log R ratio was calculated for probes in the male specific region of the Y (MSY), which showed detectable LOY in 16 participants. Microarray data was used for WGCNA. Genes with correlated expression levels were organized into modules which were tested for associations with age, Alzheimer’s disease status, APOE-e4 allele status, and LOY. Ensembl IDs were used to investigate Gene Ontology (GO) enrichment in the GO database.

Results:
One module was associated with LOY (p=0.001). GO enrichment revealed significant representation of 47 GO terms within this module. Highly enriched GO terms included “platelet aggregation” (FDR = 8.05 x 10-6), “blood coagulation, fibrin clot formation” (FDR= 0.0328), “regulation of megakaryocyte differentiation” (FDR=3.01 x 10-5), and other terms related to the vascular response to injury.

Potential Impact:
WGNCA revealed a module associated with LOY that is related to vascular injury response. While LOY is associated with cardiovascular events, more work is needed to explore its association with biomarkers for cardiovascular disease. Our findings warrant more investigation into the relationship between LOY and cardiovascular dysfunction in males.
Tourniquets and Adductor Canal Blocks in Total Knee Arthroplasty: Is There a Synergistic Effect on Postoperative Pain and Quadriceps Weakness?
Authors: Dimmett Macy , Ziemba-Davis Mary , Buller Leonard , Meneghini R. Michael 
Published: December 2020

Background and Hypothesis: Adequate pain control and avoidance of falls are crucial for successful early recovery following total knee arthroplasty (TKA). Studies have shown an increase in postoperative quadriceps weakness (QW) and pain associated with tourniquet use during TKA. Additionally, increasing doses of adductor canal block (ACB) anesthetic per unit of BMI are associated with QW after TKA. This retrospective cohort study examined whether tourniquets and ACBs have a synergistic effect on postoperative QW and pain.

Experimental Design or Project Methods: 348 TKAs in 319 patients performed by a single surgeon between October 2015 and May 2018 were retrospectively reviewed. Outcomes included QW as documented in the physical therapy evaluation, average pain score during the first 24 hours after PACU discharge, average pain score during the remainder of the hospital stay, and final pain score prior to discharge.

Results: Sex, age, and BMI did not differ in patients with ACBs with (n=177) and without (n=168) tourniquet use (p≥0.330). The overall prevalence of QW in the sample was 8.7%. Proportionally more patients with ACBs and tourniquets (11.6%) had QW compared to patients with ACBs without tourniquets (6.1%), but the difference was not statistically significant with the numbers available. Patient-reported pain scores at the three time points did not differ significantly between patients who received ACBs with or without tourniquets.

Conclusion and Potential Impact: There appears to be no synergistic effect of ACBs and tourniquet use on postoperative pain. However, due to the effect size and number of cases in each group, the synergistic effect of ACBs and tourniquet use on QW deserves additional study with a larger sample size as these results may impact functional recovery and postoperative complications among patients undergoing primary TKA.
NICU Admission Rates for suspected Growth Restricted Fetuses Born at Full Term
Authors: Dolan Madison , Gordon Geoffrey 
Published: December 2020

Background and Hypothesis:

Fetal growth restriction (FGR) is the second leading cause for infant morbidity and mortality behind preterm birth. It is a sonographic estimated fetal weight (EFW) below the 10th percentile for gestational age. Neonates born <2500g at full-term are classified as “low birth weight.” In the United States, more than 8% of all births fit this classification. These fetuses are at increased risk for both short and long term complications. Traditionally delivery at a NICU capable facility is recommended with an expected birth weight <2500g. There is little data to support this arbitrary cut-off. This study was designed to compare rates of NICU admission and short term complications for liveborn neonates at full-term. We hypothesize these rates will be increased in neonates with a birth weight <2500g.

Methods:

This is a proposed retrospective chart review of liveborn neonates at full-term at a regional medical system between January 2013 – December 2020. We excluded women under the age of 18, twins, fetuses with genetic syndromes, anomalies, or abnormal Umbilical Artery Dopplers. Neonates were categorized into two categories: birth weight between 2000 – 2499g and birth weight between 2500-3000g. Outcomes included rates of NICU admission, tachypnea, acidosis, hypoglycemia, hyperbilirubinemia, feeding difficulties, APGAR scores, and temperature instability. Chi-square and logistic regression were used.

Results:

This study design will be submitted in the form of an IRB protocol. Results will include statistical comparisons between weight groups for NICU admission and other short term complications. Additionally data analysis on social and demographic characteristics will be done.

Conclusions:

Results of this study will help determine an adequate cut off for delivery planning and identify characteristics of the mother and fetus to be taken into consideration. These findings could increase need for a prospective trial, be used in evaluation of ultrasound accuracy, and impact the standard of care.
Retrospective Chart Review Comparing CKD COVID-19 Positive Patient Outcomes to non-CKD Patient Outcomes
Authors: Eckert Nicole , Sankari Safiya , Allen Katie , Lui Hui Siu , Mendonca Eneida 
Published: December 2020

Background/Objective:
Since January 2020, there have been over 3 million individuals infected with the coronavirus in the United States, quickly spreading across at least 171 countries. The severity and morbidity of patients with COVID-19 are significantly increased when comorbidities, such as Chronic Kidney Disease (CKD), are present. Because the main target of SARS-CoV-2 is ACE2, patients with CKD may be a more vulnerable population. The goal of this study was to determine if COVID-19 positive patients with CKD had increased mortality, inpatient admission, and ED visitation rates compared to those without CKD.

Methods:
This retrospective chart review includes patients from over 100 separate healthcare entities who were diagnosed with COVID-19 between January 1, 2020 and July 13, 2020 and are over the age of 18. The subjects were first separated into those diagnosed with CKD and those without, basic descriptive calculations were computed, and a Chi Square test was used to analyze outcomes.

Results:
The CKD COVID-19 positive population was compromised of 47.5% men and 52.5% women while the non-CKD control group was made up of 45.4 % men, 54.1% women, and 0.5% other. The median Charlson index for the CKD and non-CKD population was 4 and 1, respectively. The interest and control groups were further divided into subpopulations by age and race and analyzed accordingly. Chi square tests demonstrated that there is a statistically significant difference (p<0.05) in all clinical outcomes tested of CKD patients diagnosed with COVID-19 compared to non-CKD patients. The CKD population had increased mortality, inpatient admission, and ED visitation rates when compared.

Discussion:
This study demonstrates that comorbidities, more specifically CKD, may be associated with a higher severity of COVID-19 than those without. Future studies are needed to explore the relationship more extensively, analyze other outcomes, and manage confounding variables.
Biomarker sST2 in Adults with Transposition of the Great Arteries Palliated by Mustard Procedure
Authors: Ferguson Haley , Martinez Hugo , Pride Melanie , Hurwitz Roger , Payne Mark 
Published: December 2020

Background: Transposition of the great arteries (TGA) is a congenital heart defect (CHD) in which the aorta and pulmonary artery are transposed; it requires urgent surgical intervention. The Mustard procedure was an early surgery allowing survival into adulthood. However, this procedure is associated with long-term adverse effects including arrhythmias and heart failure (HF). A key factor impairing HF management in adults with CHD is lack of biomarkers to predict outcome. Soluble ST2 (sST2) is a protein secreted by myocytes in response to mechanical strain and fibrosis. No studies have focused specifically on sST2 in TGA individuals that underwent a Mustard procedure. In this study, we hypothesized adults with TGA palliated with a Mustard procedure would have higher levels of sST2 than healthy individuals, and this would correlate with functional class status.

Methods: We screened the Pediatric Cardiology database for D-TGA subjects and Mustard operation. Healthy controls were recruited from clinic and the community. Patients were matched by age to a control group of 21 healthy individuals. Severity of symptoms was assessed by NYHA functional classification. sST2 levels were obtained using Critical Diagnostics Presage ST2 Assay kit. Additionally, cTnI, BNP, lipid panel, insulin, glucose, and EKG and echocardiography (TGA) were obtained at IUSM clinical laboratories.

Results: We identified 45 patients with D-TGA and Mustard operation. 19 patients were included in analysis: 12 male and 7 female subjects aged 18 to 46, mean of 34.9 years. In the Mustard group, 9 subjects were assigned to NYHA class II, and 9 to class III. The control group was asymptomatic. sST2 levels in the Mustard group were elevated in 53%, while only 29% in the controls. Of the Mustard subjects with elevated sST2, 67% had elevated cTnI, 80% arrhythmias, 70% EKG T-wave abnormalities, and 80% took cardiac medications. 90% of these patients had low HDL, 40% high LDL, and 40% low insulin.

Conclusion: This study demonstrates patients with Mustard operation averaged higher sST2 levels than healthy subjects. Importantly, of the patients with elevated levels, there was a significant association of sST2 with biomarker abnormalities and clinical heart failure signs. This suggests in patients with D-TGA palliated with Mustard procedure, sST2 may add predictive value to cardiac related morbidity and mortality.
Developing a Minimally Invasive Cell-Based Model to Predict Response to Major Trauma
Authors: Gates Kayla , Nunge Rebecca , Adom Jamila , Kaplan Mark , McKinley Todd 
Published: December 2020

Background. Physical trauma results in a systemic inflammatory response. Preliminary research in orthopedic trauma patients suggests that patients with similar demographics and severity of injury vary in their response to traumatic injury. Analysis of the immunological response post-injury showed a sustained pro-inflammatory response with delayed reparative cytokine expression in trauma sensitive patients, while the trauma tolerant patients had an early inflammatory expression with resolution by 72 hours post-injury. Thus, we hypothesize that differential response to non-traumatic injury might serve as a predictive tool for the identification of trauma tolerant and sensitive patients prior to injury. The goal of this research is to test whether immunological changes to inflammatory stimuli can predict tolerance or sensitivity to trauma using an-vitro cell-based assay.
Methods. Splenocytes were isolated from naive C57BL/6 mice and subjected to biological trauma in vitro using LPS (100 ng/mL) or hypoxic trauma using hydrogen peroxide (50 µM, 100 µM, and 200 µM) with or without proinflammatory cytokines, IL-1β (1 ng/mL) , IL-6 (200 ng/mL), and IL-33 (150 ng/mL). Inflammation and hypoxia were assessed using IL-6 and HIF-1ɑ expression respectively via qPCR 24 hours post-treatment. Cell death and pro-inflammatory cytokine production using multiplex analysis were used to measure outcomes.
Results. Both types of treatments showed increased cell death compared to the control group. qPCR data is pending.
Conclusion. With these studies as a core of the experimental approach, this in vitro cell-based assay will be used to assess immunologic response to inflammatory stimuli across the genetic variation of mouse strains. Findings from this project could enable the development of a clinical test that accurately predicts immunologic response to trauma and related-complications based on patients’ sensitivity to pre-traumatic injury.
Parent Preferences for Ulnar Polydactyly Management
Authors: Goebel Gunnar , Loewenstein Scott , Adkinson Joshua 
Published: December 2020

Introduction: Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with either suture ligation or surgical excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly.

Methods: We developed an ad-hoc survey instrument for parents of children with type B ulnar polydactyly that assessed motivation for choosing treatment, parent-reported outcomes, and overall satisfaction. Face validity was confirmed with a think-out-loud protocol using 5 test subjects. We administered surveys via telephone after treatment was complete. We assessed for differences between the cohort who chose in-office suture ligation versus the cohort who opted for operating-room excision using Chi square and Fischer exact tests for categorical variables and Student t-test for continuous variables.

Results: Seventy of the 156 parents of consecutive patients contacted agreed to participate (45% response rate), with a mean follow-up of 2.25 years. Twenty-eight chose in-office suture ligation and 42 chose surgical excision. Rapid treatment was prioritized more often in those who selected suture ligation than in those who opted for surgical excision (p=0.044). The complication rate for suture ligation was significantly higher than for surgical excision (p<0.0001), with the most common complication being a residual bump (i.e. nubbin or neuroma stump) (64%). Respondents with residual bumps reported significantly less satisfaction with the aesthetic appearance of their child’s hand (p<0.001) and with their child’s treatment outcome (p=0.028) compared to those without residual bumps.

Conclusion: Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Time to treatment plays a determinative role in parents opting for suture ligation rather than surgical excision. Regardless of treatment, the majority of parents remain extremely satisfied with the outcomes.
Search Functionality Within the Electronic Health Record and Health Information Exchange Databases
Authors: Gregory Brandon , Hill Jordan , Schleyer Titus 
Published: December 2020

Background and Hypothesis:
In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.

Project Methods:
Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms.

Results:
From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms.

Potential Impact:
The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow.