bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Long-Acting Injectable Ketamine Loaded PLGA Microparticles as a Non-opioid Analgesic
Authors: Daniels Juma N. , Otte Andrew 
Published: December 2021

Background/Objective: Ketamine, a psychedelic, is a noncompetitive N-methyl-D-aspartate receptor antagonist that may also bind to mu opioid receptors. Historically, it has been used as an anesthetic (KetalarÒ), although now has found uses as a novel, quick acting, antidepressant for treatment-resistant depression (SpravatorÒ) and could be used as an adjuvant to opioid analgesia providing opioid-sparing effects. One major advantage over opioids is Ketamine does not suffer from respiratory depression and maintains patent airways during anesthesia. Ketamine is only available as a short-acting injectable solution or a nasal spray. Our goal is to develop a long-acting injectable form in a biodegradable matrix poly(lactic-co-glycolic) acid (PLGA) that does not have a burst release and provides 5-7 days of steady-state plasma levels.
Methods: A mechanistic approach towards development of a long-acting injectable began with a solubility screen of Ketamine. Based on these results, experiments began with an oil in water emulsification with two theoretical drug loadings (25% and 40%) and two processing conditions – (1) aqueous extraction and (2) aqueous extraction, intermediate drying, and a 25% Ethanol wash. The formulations were characterized for drug loading, drug release, and crystallinity and imaged using scanning electron microscopy (SEM).
Results: Minimal differences were noted in the release profiles between formulations. Although, a significant difference was noted between the two processing conditions, where the extra intermediate drying step and 25% ethanol wash resulted in a significant slowing of the drug release rate.
Conclusion and Implications: The difference in release kinetics is hypothesized to be due to densification of the PLGA matrix, based on the increase in surface roughness/wrinkling in the SEM images, crystallinity increase, and on their respective powder x-ray diffraction patterns. Our preliminary results demonstrate the feasibility of a longer acting Ketamine using PLGA. Further refinement of these formulations and rodent pharmacokinetic studies will be done in future.
Correlation of Liver Stiffness Measurements with AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) Scores in Pediatric Patients with Hepatitis B or Liver Transplantation
Authors: Patel Bhumi , Molleston Jean 
Published: December 2021

Background and Objective:
Current standard for assessing liver fibrosis is biopsy. However, its invasive nature, cost, and limited sampling are problematic for many patients. Fibroscan is a technology that utilizes transient elastography (TE) to measure liver stiffness (LSM) quickly and non-invasively. TE is a novel method in children and has shown to be a measure of fibrosis. Biomarkers for hepatic fibrosis include the APRI and FIB-4 scores, which are not well-studied in children. Our goal is to correlate APRI and FIB-4 with LSM in children who have hepatitis B (hep B) or have received liver transplants (LT).

Methods:
LSM scores of 26 children with hep B and 41 children with LT were retrieved from a research database at Riley Hospital for Children. We then obtained laboratory results closest to the date (+/- 1 year) of their TE. Those results were used to determine APRI and FIB-4 scores. Spearman correlation (rs) was determined between LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in each disease.

Results:
Table 1. Spearman Correlations for LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in Hep B and LT

Disease

Comparison

Spearman Correlation (rs)

Hep B

LSM

APRI

0.321

LSM

FIB-4

0.376

APRI

FIB-4

0.731*

LT

LSM

APRI

0.303

LSM

FIB-4

0.526*

APRI

FIB-4

0.632*

*p < 0.05

Conclusion and Potential Impact:
The moderate correlation of LSM with FIB-4 in LT shows potential for future clinical use, but the correlations of LSM with APRI in both conditions and the correlation of LSM with FIB-4 in Hep B are weaker. APRI and FIB-4 are strongly correlated in these children. However, additional studies with larger sample sizes should be completed. Because patients with LT and chronic hep B regularly need longitudinal evaluation, finding non-invasive tools are important to ensure compliance and ease.
Stomach Volume Evaluation on Fetal MRI and its use in Prenatal Identification of Esophageal Atresia
Authors: Phadnis Aditya , Forbes-Amrhein Monica 
Published: December 2021

Swallowing of amniotic fluid alters the volume of the fetal stomach; therefore an abnormal fetal stomach size can be indicative of pathology. Previous studies have used linear measurements on ultrasound to approximate stomach sizes. Fetal magnetic resonance imaging (MRI) allows for volumetric measurement of the stomach. The objective of this study was to develop a library of normal fetal stomach volumes on MRI at each gestational age. We also sought to measure stomach volumes of fetuses with esophageal atresia and compare to normal volumes at similar gestation ages (GA).
A retrospective review of fetal MRIs from patients 20-38 weeks GA was conducted. Exclusion criteria for the controls included any impairment that would impede swallowing or alter stomach sizes. Patients with esophageal atresia were identified and postnatal records were reviewed to confirm the diagnosis. The stomach volume was measured on T2-weighted imaging using Phillips Intellispace software. The stomach volumes of the controls at each GA were compared using one-way ANOVA with Games-Howell Post-Hoc (p<0.05). The stomach volume in esophageal atresia was compared to controls using a T-test (p<0.001).
185 control studies, 10 at each week of gestation, and 8 patients with esophageal atresia were included. For normal fetuses, there was a trend of increased stomach size and broadened standard deviation with increasing GA. No significant difference was found between any two sequential weeks, however the difference in second and third trimester volumes was significant (p<0.001). The patients with esophageal atresia had significantly smaller stomach volumes compared to control patients of the same GA range (p<0.001).
This pilot study established reference values for fetal stomach volume, which was found to increase with GA. The stomach volume is significantly smaller in patients with esophageal atresia. Thus, esophageal atresia can be identified prenatally, allowing for delivery at an appropriate acuity NICU and early intervention.
Why Should I Take My Medicine? A Review Of ED Visits For Seizures.
Authors: Reed John L. , Gutwein Thomas E. 
Published: December 2021

Study hypothesis
The costs of anti-epileptic medication (AED) and poor care coordination result in increased Emergency Department (ED) visits for seizure events and produce both direct and indirect economic burdens on patients with frequent seizures.

Methods
A retrospective chart review study of ED visits with chief concern of seizure from two hospitals over a two-year period was performed; resulting in 152 visits recorded in this study. Data collected included demographic information, relevant seizure or past medical history (PMH), diagnostics performed in the ED, and the admission status of the patient along with the total charges per encounter. Data was analyzed descriptively and with logistic regression analysis.

Results
The results yielded by this study were generally in-line with the results of similar studies, indicating a higher relative rate of ED seizure visits for males, people of Black race, and infant and toddler populations. A high proportion of Medicaid/Medicare coverage and indiscernible employment status for most patients were also noted. Observed differences in average cost among patients with and without epilepsy and male versus female patients were not shown to be statistically significant. However, the increased likelihood of admission with increasing age was shown to be significant with an average age difference between admitted and discharged populations of approximately 10 years (p= 0.003).

Conclusions
The data provided here is not sufficient to examine the complex relationship between seizures, epilepsy, and costs among various other patient factors. Further study is necessary to minimize direct and indirect costs of seizures.

Acknowledgments
This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Community Workforce Differences in Mental Health Across Gender and Job Description in Southwest Indiana
Authors: Rone Victoria , Koleilat Majed , Garcia Kara 
Published: December 2021

Background and Hypothesis: In May 2020, a community partnership was built in Southwest Indiana to determine the local prevalence of COVID-19 to guide reopening in the region. One year later, a follow-up survey study was launched to address new, pressing questions related to mental health in the community workforce. We hypothesized that adverse mental health symptoms would be disproportionately experienced by specific worker groups based on degree of in-person contact over the past year and demographic characteristics such as age and gender.
Methods: For the 2021 survey, participants were invited through their place of employment or via phone to participate in a short online survey consisting of questions related to demographics, general work roles, company policies over the past year, and wellness. When examining mental health, the Patient Health Questionnaire-2 (PHQ-2) and General Anxiety Disorder-2 (GAD-2) were used to determine feelings of depression and anxiety, respectively.
Results: 480 participants filled out the 2021 online survey (73% of which were returning). 442 of these responses were complete and eligible for analysis of mental health and degree of in-person contact. 345 responses were complete and eligible for information regarding age. No correlation was found between age and mental health. However, differences were observed based on gender and job description. Women (n=244) and customer-facing employees (n=99) reported more frequent symptoms of anxiety and depression, with customer-facing women reporting the most. Comparing only employees that did not work remotely during the pandemic, customer-facing employees still reported more frequent symptoms of anxiety and depression.
Conclusion and Potential Impact: The impacts of COVID-19 on the workforce are still being studied, but the pandemic continues to take its toll. These mental health trends will help guide future policies to support and improve employee wellbeing, both within participating companies and the workforce at large.
The Effect of Acute Inpatient Rehabilitation on Functional Outcomes and Discharge Disposition Following Liver Transplant
Authors: Willoughby Meghan , Ramsey-Morrow Jacob , Littell Kyle A. 
Published: December 2021

Background: Patients undergoing liver transplantation often face many challenges with functional independence, which acute rehabilitation can assist them in overcoming. Due to increased yearly liver transplantations, further investigation is required to evaluate the efficiency of acute rehabilitation. The objective of this study is to analyze the efficacy of acute rehabilitation in patients who underwent liver transplantation, primarily using Functional Independence Measure (FIMTM) scores and discharge disposition.
Methods: A retrospective chart review was conducted on 143 encounters, consisting of 107 patients who underwent liver transplantation. Inclusion factors consisted of undergoing liver transplantation between January 2014–December 2018, admission into acute rehabilitation within 6 months post-transplant, and the availability of admission date, admission FIMTM, duration of stay, discharge FIMTM, and discharge disposition. These factors were evaluated in this study.
Results: Patients who underwent acute rehabilitation following liver transplantation were found to have statistically significant positive FIMTM change (P < 0.00001) and FIMTM efficiency (P < 0.00001). The mean FIMTM change and efficiency were 25.4±18.5 and 2.0±1.6, respectively, for patients meeting inclusion criteria, and 35.7±11.8 and 2.4±1.0, respectively, when return to acute care (RTAC) encounters were excluded. A positive correlation was found between longer duration of stay in acute rehabilitation and positive FIMTM change for all patients meeting inclusion criteria (P < 0.00001, r = 0.465), and excluding RTAC encounters (P < 0.00001, r = 0.393). 34.3% (n = 49) of encounters had an RTAC, 3.5% (n = 5) were discharged to a skilled nursing facility (SNF), and 62.2% (n = 89) were discharged to the community. Overall, 83.2% (n = 89) of patients ultimately had a community discharge. Infection, respiratory/CV complications, and gastrointestinal complications were the most common causes for RTAC.
Conclusion: Acute rehabilitation provides patients who have received a liver transplant with the opportunity to significantly improve their function and independence.
To feed, or not to feed? Evaluating enteral nutrition practices in surgical neonates
Authors: Anderson Cassandra , Bhatia Manisha , Hunter-Squires JoAnna , Saula Peter , Gray Brian 
Published: December 2021

Background: Early enteral feeding initiation following surgical procedures in neonates has demonstrated several benefits. In high income countries, where parenteral nutrition is readily available, enteral feeding initiation is often delayed. This study seeks to examine clinical factors and decision-making processes that guide nutrition practices in surgical neonates in the United States (US) and Kenya.
Methods: A REDCap survey was developed and distributed to pediatric surgery attendings and fellows at Riley and Peyton Manning Children’s Hospitals in Indiana (US) and Shoe4Africa Children’s and AIC Kijabe Hospitals in Kenya. Nine responses were collected during the initial two-week long pilot, then analyzed using REDCap and SPSS 25.
Results: Responses were collected from eight pediatric surgery attendings and a fellow practicing in Indianapolis, IN. The three most highly ranked clinical factors important for initiation of enteral feeds were stability of the patient, nasogastric or orogastric output color, and gastric output volume. Factors most highly ranked for advancement of feeds included frequency and volume of emesis and abdominal distension. These factors were similarly ranked for foregut and hindgut procedures. Protocols for pyloric stenosis (n=6) include initiation of enteral nutrition within 24-48 hours. Four of nine respondents felt that surgeons at their institution are not aggressive enough in feeding surgical neonates. The primary perceived barrier to achieving full enteral nutrition was patient gut dysmotility (n=8). All respondents felt that they were similarly (n=4) or more (n=5) proactive in feeding surgical neonates compared to their peers.
Conclusions and Impact: Feeding practices in surgical neonates are dependent on individual clinician decision-making processes and patient factors. Once the data from the Kenyan surgeons is collected, comparisons between practice patterns will be analyzed. Real-world enteral feeding practices will be evaluated in an adjunct observational study, which we hope will inform protocols with earlier enteral feeding initiation in the future.
Surgical and Transcatheter Pulmonary Valve Replacement: A Single Institution Comparison
Authors: Barron Emily , Brown John W. , Turrentine Mark W. , Hoyer Mark , Rodefeld Mark H. , Ephrem Georges , Herrmann Jeremy L. 
Published: December 2021

Background and Hypothesis: Pulmonary valve replacement (PVR) is one of the most commonly performed procedures for patients with congenital heart disease. Transcatheter-based PVR (TPVR) approaches have emerged as alternatives to surgical pulmonary valve replacement (SPVR), but few studies have directly compared clinical outcomes between the two interventions. Further characterization of performance between the two valve procedures may inform clinical decision-making.
Project Methods: Using institutional databases, we identified patients aged ≥ 9 years who underwent either a TPVR or SPVR at Riley Hospital for Children between January 2009 and June 2020. Exclusions were made for previous endocarditis diagnosis, <1 year follow-up, and concomitant left heart procedures. Valve dysfunction was defined as ≥ moderate regurgitation or gradient ≥ 40 mmHg.
Results: 94 (TPVR, n=52; SPVR, n=42) patients met inclusion criteria. Average follow-up for SPVR and TPVR patients was 5.1(2.0,6.7) and 2.9(1.6,4.8) years, respectively (p=0.007). The SPVR cohort was younger, had lower BMI, and underwent more prior sternotomies. Hospital length of stay was shorter after TPVR (1.0 day vs. 5.0 days, p<0.001). Despite being younger, BSA-indexed valve size was larger in the SPVR cohort (14.7 mm/m2 vs 12.9 mm/m2, p<0.001). Short-term mortality (0% vs 2%, p=0.36), endocarditis (0% vs 6%, p=0.11), and reintervention (12% vs 8%, p=0.49) did not differ between groups. Intermediate-term valve dysfunction/failure was greater in SPVR patients (29% vs 12%, p=0.04) with time to dysfunction 809(421,1565) and 1184(181,1627) days for SPVR and TPVR, respectively. Valve implantation failure due to pre-stent migration occurred in 4% of TPVR cases; one required surgical intervention.
Conclusion and Potential Impact: In patients undergoing PVR at our institution, rates of mortality and infective endocarditis are similar between interventions. Intermediate-term valve dysfunction/failure was greater in SPVR cohort, but length of follow-up was significantly longer in these patients. Reintervention rates were similar between procedures.
A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals
Authors: Becker Timothy , Pei Kevin Y 
Published: December 2021

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies.
Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive). Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis.
Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1)

Laparoscopic

Robotic

Complications

N = 49,800

N = 50

P Value

Odds ratio

Any Complication

5302 (10.6%)

5 (10%)

1

1.06

Superficial surgical site infection

423 (0.8%)

0

>0.9

Organ Space SSI

1,355 (2.7%)

0

>0.9

Postoperative Intra-abdominal Abscess

1353 (2.7%)

0

>0.9

Sepsis

1,696 (3.4%)

1 (2%)

>0.9

1.7

Table 1. Complications for Laparoscopic versus Robotic appendectomy.
Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training.
Comparing Recurrence and Retreatment of Three Doses of Bevacizumab in Treating Severe Retinopathy of Prematurity
Authors: Chopra Jay , Boente Charline 
Published: December 2021

Purpose: To determine recurrence and retreatment patterns after treatment of severe retinopathy of Prematurity (ROP) with either 0.5 mg, 0.25 mg, or 0.125 mg of intravitreal bevacizumab for retinopathy of prematurity.
Methods: In this retrospective chart review, data was examined for babies who had severe ROP and were treated with intravitreal bevacizumab doses of either 0.500 mg, 0.250 mg, or 0.125 mg at Riley Hospital for Children in Indianapolis from 2014 to 2021. Data collected included demographic information, past medical history, and characteristics of ROP. The data was statistically analyzed using SPSS software.
Results: One eye was analyzed for each baby. Out of 85 babies, 79 babies were included in the study. 26 babies were treated with 0.125 mg bevacizumab, 37 with 0.25 mg, and 16 with 0.5 mg. All babies showed initial response to the bevacizumab, with 61 babies (77.2%) receiving retreatment with laser for either recurrence or persistent avascular retina. While the babies treated with lower doses had higher percentages of retreatment (23 babies (88.5%) in the 0.125 mg, 29 babies (78.4%) in the 0.25 mg, and 9 babies (56.3%) in the 0.5 mg group), the difference was not statistically significant (p=0.069). Most of the retreatments were due to recurrence of ROP (0.125 mg: 20 (87.0%), 0.25 mg: 19 (65.5%), 0.50 mg: 8 (88.9%)) (p=0.339). On average, the babies in the 0.125 mg group were retreated with laser at 3.4 weeks earlier gestational age and 4.7 weeks sooner after initial treatment than the higher dosing groups, however, this difference was not statistically significant (p=0.181, p=0.287).
Conclusion: The outcomes comparing three doses of intravitreal bevacizumab for severe ROP showed a slight variation in recurrence and retreatment patterns but no statistically significant difference in our study.