bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumonia in Indiana nursing homes: a retrospective case series
Authors: Shearn Andrew , Unroe, MD, MHA Kathleen , Carnahan, MD, MPH, MA Jennifer 
Published: January 2019

Background
The Optimizing Patient Transfers, Impacting Medical Quality, & Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a Centers for Medicare and Medicaid (CMS) demonstration project, tasked with reducing potentially avoidable hospitalizations of nursing home residents. OPTIMISTIC-enrolled nursing homes are reimbursed by CMS for treating residents with pneumonia in place. The purpose of this study is to examine the diagnosis, treatment, and outcomes of episodes of pneumonia in OPTIMISTIC nursing homes.
Project Methods
This case series uses data from nursing home medical records of the seven facilities with the highest pneumonia caseload identified from the OPTIMISTIC database. Cases are from billing episodes spanning November 2017 through April 2018. Within each facility, cases of pneumonia were randomly selected for inclusion. Data were entered into an extraction tool designed by the study team.
Results
Data were extracted from 41 records of unique patients. Despite CMS reimbursing for a maximum of 7 days for treatment of pneumonia, 78.0% of patients were monitored beyond that time and with greater attention than usual care. Of all 41 patients treated with antibiotics, 53.7% were given a fluoroquinolone and 24.4% were given amoxicillin/clavulanate. CURB-65 scores showed 58.3% scored in a range recommending hospitalization. Most patients (87.8%) were stabilized in the nursing home; three (7.3%) were hospitalized, one (2.4%) transferred to hospice, and one (2.4%) died.
Conclusion and Potential Impact
OPTIMISTIC-affiliated nursing facilities successfully provide enhanced care for most patients diagnosed with pneumonia in the facilities. Given the high incidence of fluoroquinolone use, one area for improvement is reduction of this medication contraindicated in the elderly.
Copy Number Analysis of Lung Tumor Progression in Mice
Authors: Schultheis Paige A. , Mickler Elizabeth A. , Stearman Robert S. , Geraci Mark W. 
Published: January 2019

Background & Hypothesis
The xeroderma pigmentosum group C (XPC) gene encodes a protein that repairs DNA damage, like that caused by UV light. Its mutation in patients is associated with increased risk of melanoma. In our mouse model, the Xpc gene has a targeted deletion, leading to increased frequency of lung tumors in a mouse strain typically resistant to lung chemical carcinogenesis. We hypothesize that there will be enrichment of specific copy number variations (CNVs) in the genome throughout tumor progression that can distinguish the different stages of carcinogenesis in lung cancer.
Project Methods
Urethane treatments induced lung tumors in Xpc -/- (ko) mice. Laser capture microscopy was used to isolate tumor, hyperplasia, and normal tissue from lung sections. After DNA extraction, genomic DNA (gDNA) was quantified using Quantifluor assay. Whole genome amplification was completed using Repli-G kit. PCR, copy number analysis, and restriction enzyme digestion were quality control measures for amplified gDNA. Single nucleotide polymorphism (SNP) microarrays will assess CNVs in samples that are successfully amplified.
Results
DNA was successfully amplified, as confirmed by the Quantifluor assay. PCR, copy number analysis, and restriction enzyme digestion confirmed 3 out of the 4 amplified samples were comparable to matched non-amplified samples, suggesting mouse gDNA was maintained.
Potential Impact
The mouse model findings can be applied to publically available human genome databases of lung cancer CNVs. Overlapping findings in mice and human CNVs may give insight into novel pathways for effective treatment in lung cancer.
A Descriptive Time Inventory of Emergency Department Nursing Workflows
Authors: Skold Dana , Mitchell, MD Alice 
Published: January 2019

Background: Previous emergency department (ED) process improvement efforts used probabilistic analytical or simulated models without considering the impact of specific tasks on ED patient flow and resource needs. We focus on the tasks and workflows that comprise nursing activity in an urban academic ED and level I trauma center receiving over 80,000 annual visits.
Experimental Design: Using a time/motion observational methodology, we create a minute-by-minute time inventory account of nursing tasks and workflows as observed through the activities of 35 nurses over 124.5 hours, representative of 24/7 patient care in 7 ED care areas. “Tasks” were defined as discrete, measurable, and consequential step(s) to accomplish a clinically meaningful goal (“workflow”). The task with highest cognitive demand for each minute of observation was recorded. We also tracked 12 discrete highest-acuity (“shock”) events and catalogued second-by-second observational accounts of each nurse diverted.
Results: Our data demonstrate significant variation in tasks based on time of day. We observed substantial operational load moving patients between care areas, with intake and discharge comprising 25% of nurse workflows. Downtime averaged 32%, with variation depending on care area. Downtime was highest (47%) with passive video monitoring of psychiatric care and lowest (22%) in high-turnover intake areas. Highest-acuity patient-care events result in significant and variable nurse diversion from other tasks averaging 1:03:29 in combined nursing effort.
Conclusion and Potential Impact: Movement of patients between care areas represents significant operational load. Interruptions and task preparation accounted for a surprising portion of activity. Highest-acuity patient care events result in substantial and variable diversion of nurse care.
Chamas for Change: A Community Based Strategy for Pregnancy, Infancy, and Women Empowerment
Authors: Smith Ryan , Ruhl Laura 
Published: January 2019

Background: Maternal mortality is the leading cause of death among women of childbearing age in Kenya, and 1 in every 19 infants dies before their first birthday. To address this, Chama cha MamaToto was developed as a community-based program for pregnant and breast-feeding women. It integrates health and social education to decrease poor health outcomes and parental stress. It also uses a table banking system called GISHE to develop financial independence. Central to Chamas is peer support and accountability, leading to empowerment of the women. This poster is an analysis of the program’s history, and a summary of data collected by the MNCH team from MTRH.
Results: Women in Chamas had 5 times the odds of delivering in a health facility (OR = 5.07, 95% CI: 2.74-9.39). Children in Chamas had 33% relative reduction in stunting. Women and children in Chamas experienced 30% absolute reduction in harsh punishment (p< 0.001) compared to the control group. The Chamas program showed the potential for combined relative reduction of stillbirths and infant deaths by 56 percent (p<0.083). Additionally, women in Chamas had an 35% absolute increase in EBF for 6 months.
Personal role: My role working with the Chamas program this summer involved a cost analysis of the program as well as developing an implementation manual.
Conclusion: The next steps for the program include a continued scale up in two new sub counties, validation of findings from a cluster RCT, and a scale up of the program to all of Kenya in 2019.
Early surgical intervention is indicated for recurrent spontaneous pneumothorax in children and adolescents
Authors: Tragesser Cody , Gray, MD Brian W. , Landman, MD, MPH Matthew P. 
Published: January 2019

Background: Primary spontaneous pneumothorax (PSP) occurs most often in adolescent patients. There is consensus that surgical intervention plays an important role in preventing recurrence, however, the optimum timing of surgery is debated. We hypothesize that clinical and radiographic factors are associated with eventual need for surgery.
Experimental Design: We searched the medical record for PSP patients between ages 9 and 21 treated from 1/1/08 to 12/31/17 and collected data on chest tube management, radiographic measurements, operative management, and recurrence. We performed univariate analysis on relationships between admission events and eventual surgery or other management strategies.
Results: We identified 68 PSP admissions from 31 patients. Considering only first-time admissions, there was no association between eventual surgery and clinical factors and radiographic findings. The single factor associated with eventual surgery was history of pneumothorax in any lung (p=0.015). For patients with prior pneumothorax who underwent surgery, operation the day after admission would have reduced hospital stay by an average of 1.5 days (min=0, max=9) and an average of 2.2 days (min=0, max=10) if performed on the day of admission, with a mean 1.85 fewer chest x-rays (min=0, max=7). Considering only first admissions, ipsilateral recurrence rate was 16.7% after surgery, 46.7% after chest tube alone, and 100% after observation alone.
Conclusion: This analysis suggests that though eventual surgery is difficult to predict, ipsilateral recurrence rate is reduced following surgery. Furthermore, earlier operation in recurrent patients could reduce resource utilization. Thus, expedited surgical treatment may merit consideration in patients with a history of pneumothorax.
Effects of Temperature and Separation on the Retained Coagulability of Human Blood Utilizing Thromboelastography
Authors: Wiley, MS Michael A. , Alves, PhD Nathan J. 
Published: January 2019

Background and Hypothesis:
Thromboelastography is torsional method of assessing coagulation efficiency (e.g. rate of clot formation and maximum clot strength) by measuring the viscosity changes of blood under low-shear stress. Limited research has been performed to date on how centrifugation and storage of whole blood affects the coagulability when recombined. We hypothesized that centrifuged blood that was stored at its component-specific ideal temperatures would produce a clot with the same clotting characteristics as whole blood.
Experimental Design or Project Methods:
Whole blood samples were collected from healthy volunteers into citrated tubes and were assigned to the following conditions: whole at 25[Symbol]C, whole at 4[Symbol]C, and centrifuged and stored as RBCs, platelets, and plasma (at 4[Symbol]C, 25[Symbol]C, and -20[Symbol]C, respectively) and then recombined. TEG tracings for each condition were obtained over the course of three weeks. We also explored how freezing and thawing whole blood samples and its components affected clotting.
Results:
When compared to room temperature and refrigerated whole blood, separated blood maintains its normal physiologic clotting dynamics and kinetics for a longer period of time. Whole blood at 25[Symbol]C maintains maximum clot strength for approximately one week post draw, whereas freezing whole blood drastically reduces coagulability. Additionally, we discovered that there is no practical difference in the clotting parameters between the first blood draw and subsequent draws.
Conclusion and Potential Impact:
Our study demonstrates the viability of storing blood in its components and recombining them at a later date while minimally affecting its clotting ability, thereby potentially reducing wasted blood products and the need for multiple blood draws for coagulation studies.
Quantifying the effects of mechanical signals on musculoskeletal quality in a model of complete estrogen deprivation
Authors: Wilson Reid , Pagnotti, PhD Gabriel M. , Mohammad, MD, PhD Khalid S. , Guise, MD Theresa A. 
Published: January 2019

Background and Hypothesis:
Post-menopausal, estrogen-receptor positive breast cancer patients are treated with aromatase inhibitors (AIs) to limit tumor progression; however, this causes adverse musculoskeletal effects. Zoledronic acid (ZA) is prescribed to inhibit bone resorption. Mechanical signals, delivered via low intensity vibration (LIV), stimulate bone formation. We hypothesize that combining LIV with ZA will mitigate bone loss in a murine model of complete estrogen-deprivation more effectively than either treatment alone.
Project Methods:
21-week-old C57BL/6 mice (n=20/group) were ovariectomized, receiving daily letrozole injections (OVX/AI) with LIV (OVX/AI+LIV), ZA (OVX/AI+ZA), LIV and ZA (OVX/AI+LIV/ZA) or underwent sham surgery with daily PBS (vehicle) injections (SH-OVX) for 22 weeks. Longitudinal dual energy X-ray absorptiometry (DEXA) and micro-computed tomography scans were analyzed for changes in body composition and bone microarchitecture, respectively.
Results:
OVX/AI reduced whole body (p< 0.0001) and lumbar spine (p<0.0001) bone mineral density (BMD) as compared to SH-OVX by 11% and 28%, respectively, as measured via DEXA. At 22w, OVX/AI+LIV/ZA had greater BMD across both regions-of-interest relative to OVX/AI (p<0.0001). Cortical bone area fraction (p<0.0001) and cortical thickness (p[Symbol]0.001) in distal femora decreased by 8% and 9%, respectively, in OVX/AI relative to SH-OVX. In OVX/AI+LIV/ZA, these parameters were greater relative to OVX/AI (p[Symbol]0.0001). OVX/AI+ZA and OVX/AI+LIV groups were not significantly different from OVX/AI in either cortical bone area fraction or cortical thickness.
Conclusion and Potential Impact:
Complete estrogen-deprivation reduced bone mineral density and altered microarchitecture. Mechanical signals provided via LIV combined with ZA prevent bone loss in aged estrogen-deprived mice. Combining these treatment strategies may reduce skeletal morbidity in breast cancer patients.
This Story Needs to Be Told: Formative Research on Using Animated Storytelling to Address Prospective Minority Clinical Trials Participants’ Need for Comprehensive Knowledge
Authors: Younker Stephanie M. , Ridley-Merriweather Katherine E. 
Published: January 2019

Background: The Komen Tissue Bank (KTB), a clinical trial that collects women’s healthy breast tissue for use as research study controls, currently stores samples demonstrating a noted paucity of minority specimens. Studies have shown minority groups’ participation in clinical trials is dependent upon the groups’ knowledge about the associated research. This study’s purpose is to conduct formative research on animated storytelling’s effectiveness as a communication tool to address minority groups’ expressed need for knowledge and encourage participation in cancer clinical trials.
Methods: I re-coded data previously gathered from a KTB study to evaluate the perceptions of Latinas (n=14) and Asian Americans (n=17) toward breast tissue donation. Extensive review of the current literature yielded data concerning African Americans’ outlooks toward clinical trial participation, and also illustrated the efficacy of using narratives and animation as communication and education tools.
Results: The literature review clearly illuminated the importance of storytelling in minority cultures and suggested the success of using narratives as communication tools. We anticipate our findings could be influenced by a) minorities’ lack of, and need for, comprehensive knowledge, b) previously obscured participation barriers, and c) animated storytelling as an effective delivery method.
Projected Conclusion and Potential Impact: Using an animated storytelling communication tool may successfully increase knowledge about, and comfort with, participation in a cancer clinical trial. The next phase, an animated video production, will tell the comprehensive story of healthy breast tissue donation. The use of this tool could help increase minority participation in cancer prevention and cancer clinical trials.
Are there sex-based differences in myocardial injury in Acute Heart Failure?
Authors: Kramer Kaleb , Hunter, MD Benton , Levy, MD Phillip , Collins, MD Sean , Lane, MS Katie , Li, PhD Xiaochun , Pang, MD Peter S. 
Published: January 2019

Background and Hypothesis:
Myocardial injury in acute heart failure (AHF) contributes to worse outcomes. Whether there are sex-based differences in organ injury in AHF is not well known. This study was designed to assess potential sex-based differences in myocardial injury, as defined by high-sensitivity troponin T (hsTnT) levels, in patients presenting in ED with AHF. We hypothesized that men with AHF have higher hsTnT levels.
Project Methods:
This is a preliminary analysis from the TACIT study, a large, prospective, multi-center, observational, biomarker cohort study. Adult patients diagnosed and treated for AHF, with a systolic blood pressure >100mmHg, and enrolled within 3 hours of first AHF therapy were eligible. Febrile patients, short life-expectancy, ACS, AF with RVR >130bpm, transplant, VAD, or ESRD were excluded. hsTnT were drawn at baseline and 3 hours later. Hemolyzed samples were disregarded as hemolysis falsely lowers hsTnT. A multivariable linear regression model was used to adjust for potential differences in baseline hsTnT using clinically meaningful covariates.
Results:
Of 527 enrolled, 499 comprised the final analysis set. Of these patients, 413 had a non-hemolyzed baseline hsTnT. Notably, more men than women were enrolled; men had higher mean baseline hsTnT values (48.3ng/mL, SD(74.5)) than women (28.3ng/mL SD(39.9)). After multivariable adjustment, baseline hsTnT differences by sex remained significant (p <0.0001).
Conclusion and Potential Impact:
Men with AHF have higher baseline levels of myocardial injury than women. These differences may need to be taken into account for risk-stratification as well as management.
The Degradation and Subcellular Localization of an Oncogenic protein complex in T-cell Leukemia
Authors: Nwosu Chiagozie , Christy Michael , Layer Justin , Davé Utpal 
Published: January 2019

Background and Hypothesis:
LIM domain Only-2 (LMO2) is a key oncogenic driver of human T-cell acute lymphoblastic leukemia. LMO2 functions as part of a large multisubunit complex that regulates gene expression. LMO2 itself does not bind DNA but it does bind class II basic helix loop helix transcription factors, TAL1 or LYL1, which are also part of the LMO2-associated complex. We recently identified LIM domain binding protein 1 (LDB1) as an obligate LMO2 partner that is required for LMO2 protein stability in T-ALL. We believe the interaction between LDB1 and LMO2 is crucial to understanding the pathogenesis of T-ALL and is a potential therapeutic target for this aggressive leukemia. We hypothesize that in the absence of LDB1, LMO2 is rapidly degraded. Nonetheless, the mechanisms for the localization and degradation of LMO2 and its partners have not been fully explored.
Experimental Design or Project Methods:
In this study, we analyzed the first order decay of the LMO2-associated complex including LMO2, SSBP2, SSBP3, TAL1, LYL1, and LDB1. We analyzed the subcellular localization of these same proteins distinguishing between the nucleus and the cytoplasm. Our studies were enabled by cloning the HALO tag to the NH2-terminus of these proteins. Fluorescent small molecules such as HALO ligand, R110, were used for intracellular labeling followed by pulse chase analysis via flow cytometry for half-life and imaging by confocal microscopy.
Results:
We observed a hierarchy of protein stability: LDB1 had the longest half-life, followed by SSBP3, SSBP2, Tal1, LMO2 and Lyl1had the shortest half-lives. Co-expression of LDB1 conferred enhanced staility upon all protein components. All of the protein components studied showed a predominantly nuclear distribution with some in the cytoplasm.
Conclusion and Potential Impact:
The prolonged protein stability of LDB1 allows it to confer enhanced stability to LMO2 and bHLH proteins TAL1 and LYL1. Thus, targeting the assembly of the multisubunit LMO2 complex.
Combined inhibition of Bruton’s Tyrosine Kinase (BTK) and Phosphoinositide 3-kinase (PI3K) p110δ improves monocytosis and splenomegaly in a JMML Mouse Model
Authors: Patel Roshni , Ramdas Baskar , Deng Lisa , Jideonwo-Auman Victoria , Kapur Reuben 
Published: January 2019

Background and Hypothesis: Juvenile myelomonocytic leukemia (JMML) is an aggressive, childhood leukemic disorder for which there are no efficacious chemotherapeutics. Gain-of-function (GOF) mutations in the SHP2 phosphatase oncogene, Ptpn11, are the most common associated mutations. In hematopoietic cells, these mutations lead to increased AKT and ERK activation, which results in hyperproliferation of myeloid cells. Clinically, this manifests as monocytic leukocytosis and marked splenomegaly with the consequence of severe thrombocytopenia. Previously, this lab has shown that pharmacological inhibition of p110d, the hematopoietic-specific catalytic subunit of PI3K, moderates monocytosis and splenomegaly in a JMML mouse model with a SHP2 GOF mutation (E76K mice). Additionally, BTK has been identified as a potential therapeutic target as it cooperates with PI3K to increase activation of AKT and ERK in myeloid cells. Using a dual-hit approach of targeting both PI3K p110d and BTK may serve as a valuable treatment design for JMML.
Experimental Design or Project Methods: We have treated E76K mice with a combination of 20mg/kg ACP319, a PI3K p110d-specific inhibitor, and 20mg/kg acalabrutinib, a BTK-specific inhibitor, via oral gavage twice daily for 21 days and performed hematopoietic analysis including the degree of splenomegaly, monocytosis, and thrombocytopenia.
Results: The combination treatment scheme significantly decreased monocytosis and ameliorated thrombocytopenia compared to vehicle treated mice. Furthermore, splenomegaly was significantly reduced in the combination-treated mice compared to vehicle.
Conclusion and Potential Impact: Combination chemotherapy with PI3K p110d- and BTK-specific inhibitors profoundly corrects disease state hallmarks of JMML, and may warrant further clinical investigation of efficacy.
A comparative study of tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media
Authors: Nambiar Rachna Vijayan , Priyadarshini G. , Tiwari Aishwarya 
Published: January 2019

<p class="abstract"><strong>Background:</strong> CSOM is one of the most common ear diseases in developing countries. Lack of an aerating mastoidectomy at the time of the initial tympanoplasty may be a significant source of failure in patients with chronic non-cholesteatomatous otitis media so cortical mastoidectomy along with tympanoplasty has for long been considered the surgical procedure of choice. The purpose of our study is to ascertain the effectiveness of tympanoplasty with or without cortical mastoidectomy.</p><p class="abstract"><strong>Methods:</strong> Our study was carried out in the Department of Otorhinolaryngology, Aarupadai Veedu Medical College, Pondicherry. It included 50 patients of CSOM tubotympanic type of age between 15 years to 45 years and of either sex who were diagnosed and treated in E.N.T Department during the study period October 2016 to August 2018. Out of 50 patients who underwent surgery in 25 cases tympanoplasty with mastoidectomy was done and tympanoplasty without mastoidectomy was performed in 25 cases. </p><p class="abstract"><strong>Results:</strong> Commonest age group was 15-19 years. Male to female ratio was 1.6:1. In x-ray bilateral mastoids Schuller’s view, 24 patients (48%) had sclerotic mastoids and 26 patients (52%) showed pneumatic mastoids. Clinical improvement, graft uptake and postoperative hearing improvement was similar in both the groups.</p><p class="abstract"><strong>Conclusions:</strong> Most common age group of presentation with CSOM tubotympanic type is 15-25 years. CSOM tubotympanic type appears to be more common in males. Hearing improvement following tympanoplasty alone and tympanoplasty with mastoidectomy were comparable in both the groups. Mastoidectomy with tympanoplasty does not give additional benefit in terms of hearing improvement.</p>