bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing generalizability of a new-onset type 1 diabetes Biobank
Authors: Ciresi Colette , Wendholt Kathleen , Mullen Maureen , Evans-Molina Carmella , DiMeglio Linda 
Published: January 2019

Background and Hypothesis:
Type 1 diabetes (T1D) is characterized by insulin deficiency due to autoimmune pancreatic beta cell destruction. The Wells Center Pediatric Diabetes Research Program is collecting blood and urine samples from children with new onset T1D admitted to Riley Hospital. These samples are being used to discover biomarkers predictive of disease heterogeneity and course. Since not every newly-diagnosed child enrolls in the Biobank, we examined if persons enrolled are similar or different from the at-large population of newly-diagnosed children to know how generalizable samples collected are from our newly-diagnosed population.
Project Methods:
Between September 2016 and May 2018, 71 newly-diagnosed children (mean age 9.6±4.3 years) and their caregivers were approached by researchers and asked to provide blood/urine samples. Thirty-four consented/assented (as required); 21 had blood and urine collected; 13 urine only. We looked for differences in age, sex, race, BMI, socioeconomic status (based on zip code), and admission bloodwork parameters between participants and non-participants.
Results:
Overall, participants were more likely to be white and have higher admission bicarbonate. Children who provided blood and urine had no other significant differences from non-participants. Children who provided urine only were more likely to be male and to have higher admission bicarbonate than non-participants. Currently, we are obtaining data to make comparisons with the general population of all patients diagnosed at Riley.
Conclusion/Potential Impact:
Our Biobank will provide samples to explore novel biomarkers to facilitate highly-targeted therapies and to screen future preventative treatments. As we continue to collect data, it will remain important to monitor and carefully consider its generalizability.
Canines in the emergency department: a novel approach to stress reduction in emergency medicine providers
Authors: Davis Jacob C. , Van Ryzin, MD Kimberly J. , Linville Courtney T. , Pettit, MS Kate L. , Kline, MD Jeffrey A. 
Published: January 2019

Background and Hypothesis:
Cognitive stress during shiftwork contributes to burnout in emergency care. We hypothesize that if emergency care providers (physicians and nurses) were to interact with a therapy dog, their stress levels will decrease.
Experimental Design or Project Methods:
Consenting emergency medicine physicians and nurses provided three self-reported assessments of stress as well as saliva samples near the beginning of their shift. During peak hours in the emergency department at Eskenazi Hospital participants are randomized to interact with either a therapy dog or perform a mindfulness exercise via art therapy for five minutes. Self-perceived stress and saliva samples are obtained 30 minutes later and again near the end of shift. To assess potential change in participant behavior, patients of providers in either group receive a validated questionnaire assessing perceived empathy of the provider. Salivary cortisol will be measured at the end of the study by a vendor (Salimetrics). The sample size of 40 per group is predicated on a 25% decrease in self-reported stress in the dog group on the emergency care worker stress scale (ECWSS).
Results:
From June 1 to July 10, 24 participants have been randomized (12 in each group). Seven participants (58%) exposed to dogs had a mean decrease in the ECWSS of -5 (+/-1.8) compared with four participants (33%) who had a mean decrease of -2 (+/-0.8) after art therapy. The mean overall change in ECWSS after dog was -2 (+/-1.5) vs. +3 (+/-1.5) after art therapy. Current data suggest a greater decrease of self-reported stress after interaction with a therapy dog, compared to art therapy.
Conclusion and Potential Impact:
Interim analysis suggests that exposure to a therapy dog decreases stress in a subset of emergency care workers. This work will help determine if human-animal interaction can modulate stress biology imposed by providing emergency medical care.
Determining the cellular localization of C.elegans Editing Enzyme
Authors: Dudley Anna , Hundley Heather , Rajendren Suba 
Published: January 2019

Background and Hypothesis:
Over two thirds of human mRNAs contain adenosine(A)-to-inosine (I) editing sites indicating that RNA editing significantly alters the flow of genetic information. RNA editing is required for normal development and proper neuronal function in all animals. Aberrant RNA editing is identified in several neurological disorders and cancers.
A-to-I RNA editing is catalyzed by adenosine deaminases that act on RNA (ADARs) proteins. These enzymes commonly bind to double stranded RNA (dsRNA) and catalyze the conversion of adenosine to inosine. However, it is unknown whether these different regions of mRNA are edited by ADARs in the cytoplasm or nucleus. Early research has shown that inosines are present in the nucleus, while new additional evidence shows activity in cytoplasm as well. What dictates the location of the editing is yet unknown.
Experimental Design:
The subcellular localization of the ADAR editing enzyme will be determined by performing western blots of fractionated Caenorhabditis elegans embryos. Unlike mammals, ADAR editing is not essential in C. elegans, thus making it an easy system to address mechanistic questions about RNA editing. Embryos will be attained from wild-type, ADR-1 and ADR-2 knockout worms, and biochemical techniques will be used to obtain nuclei and cytoplasmic fractions. These fractions will be subjected to SDS-PAGE and western blotting for the ADAR editing enzyme, ADR-2. I will also use positive controls of a nuclear protein (histone) and a cytoplasmic protein (Tubulin) to test the fractionation.
Anticipated Results:
That there will be more ADR-2 enzyme in the nucleus than the cytoplasm.
Potential Impact:
Knowing the location of the edited RNA will allow researchers to have a better idea of what mechanisms influence the editing of ADAR, and what dictates the localization of dsRNA. Current theories involve the number of inosine groups, cellular conditions which effect localization, and nuclear retention molecules other than inosine.
Quantitative Effect of Emergency Department Case Management on Visits, Diagnostics, and Cost
Authors: Nickel, MD Jeffrey , Connelly Nancy , Duffner Cameron , Pablo Xyryl , Hughes Aeleia 
Published: January 2019

Background and Hypothesis:
In 2012, Parkview Health initiated a case management (CM) program with the hypothesis that it would reduce emergency department (ED) visits, radiation exposure, and costs for patients who had visited a Parkview ED 5 or more times within 6 months.
Experimental Design or Project Methods:
This retrospective case series involved examining medical records of 460 CM patients from 2011 to 2018, recording the amount of Parkview ED visits, diagnostic tests, and affected cost accumulated in the year prior to CM enrollment compared to each of the next 2 years. Demographics, chief complaints, diagnoses, psychiatric and drug use history, and whether the patients had insurance and a primary care provider were also recorded. Patient data was excluded if the patient was younger than 18 at the time of CM enrollment, had not yet completed 2 years in the CM program, or if medical records were not available. ANOVA and 1-sided, paired t-testing were performed to evaluate significance of the results.
Results:
Comparing the year before enrollment to the 2nd year after, ED visits were reduced from 5,264 to 2,012 for 378 patients (63%, p<0.01), the affected cost was reduced from $551,734.45 to $246,248.34 for 299 patients (55%, p<0.01), and the number of diagnostic tests was reduced from 6,040 to 1,883 for 104 patients (69%, p<0.01).
Conclusion and Potential Impact:
Patients enrolled in Parkview’s CM program showed statistically significant reductions in ED visits, radiologic exposures, and affected costs over 2 years, with implicit improved health outcomes. Projected 10-year affected cost savings range from $3.7 million to $9.1 million.
Lung Ultrasound Proficiency Study
Authors: Fabre Katarina L. , Russell Frances M. 
Published: January 2019

Background and Hypothesis: Acute heart failure (AHF) is a major public health burden, and accounts for billions of dollars in healthcare costs annually. Pulmonary congestion is a primary reason patients with AHF seek emergency care. B-lines on lung ultrasound (LUS) is an objective measurement of congestion. It has great implications on diagnosis and prognosis for patients with AHF, but is operator dependent. The goal of this study was to determine if novice sonographers, with limited training, could quantify LUS B-lines with good correlation when compared to experts.
Methods: This was a prospective observational study of novice sonographers from three academic institutions. Sonographers received a structured 2-hour ultrasound training on LUS B-line assessment, which included lecture, B-line video review to practice counting, and hands-on patient scanning. Sonographers quantified B-lines in 4 lung zones in each hemithorax in patients with pulmonary edema. The primary objective was measured by comparing novice sonographer B-line counts to a blinded expert reviewer. We used a cumulative sum method for statistical analysis.
Results: There were xx sonographers, who scanned xx patients with pulmonary edema. We found … (will await Eckert’s stats).
Conclusion and Potential Impact: Will await Eckert’s stats- if successful, the quantification of B-lines by novice sonographers in patients with AHF may greatly impact diagnosis, prognosis and risk stratification.
Aspergeillus Fumigatus: The Effects of Adiponectin on Inflammatory Cytokine Production
Authors: Foust Rick , Templeton Robert 
Published: January 2019

Background and Hypothesis: Although inflammatory cytokines are important for antifungal defenses, excessive production significantly increases host immune pathology. It is therefore important to identify host pathways that limit detrimental inflammation in invasive fungal infection. Our prior results showed that mice with invasive aspergillosis (IA) that were deficient in the metabolic cytokine production produced more of the cytokine Tumor Necrosis Factor (TNF) than alveolar in wild-type control mice. Therefore, we hypothesize that adiponectin inhibits antifungal cytokine secretion in alveolar macrophages.
Experimental Design or Project Methods: To test this hypothesis, the commonly used A. fumigatus strain Af293 was purchased from the Fungal Genetics Stock Center and grown on and harvested from agar. The alveolar macrophage cell line MH-S and cytokine ELISA kits was obtained from MilliporeSigma and ThermoFisher, respectively. MH-S cells were stimulated with swollen, fixed Af293 conidia for 24 hours in the presence or absence of recombinant mouse adiponectin. After 24 hours, supernatants and cells was were collected and assayed for ILs 1a, 6, and TNF protein and mRNA , by ELISA and quantitative RT-PCR, respectively.
Results: Although our preliminary results suggest possible inhibition of cytokine secretion by adiponectin in response to A. fumigatus, significant differences have thus far not been observed.
Conclusion and Potential Impact: We are therefore currently optimizing our experimental conditions to improve antifungal cytokine secretion. These studies may ultimately assist in the discovery of novel therapeutic targets and improve the prognosis of A. fumigatus infections
Assessing Student Engagement and Higher Order Skill Proficiency During the First and Second Year of Medical School – A Comparison Between the Legacy and Recently Reformed Active Learning Curricula
Authors: Francis Brandon , Hopper, PhD Mari 
Published: January 2019

Background and Hypothesis: This study set-out to determine if:

students enrolled in Indiana University’s reformed curricula (RC) demonstrate higher levels of engagement (E) and higher order skill (HOS) proficiency than students prior to reform in the legacy curriculum (LC).

students increase E and HOS from first year of medical school (MS1) to second year (MS2).
students performing in lowest HOS quartile during MS1 will demonstrate greater gains in HOS by MS2 than students in higher quartiles.

Experimental Design or Project Methods: Determined E using a validated self-report survey (Ahlfeldt, 2007). Assessed HOS using the standardized Collegiate Learning Assessment (CLA+), professionally developed and validated by the Council for Aid to Education (https://cae.org/flagship-assessments-cla-cwra/cla/). Statistical analysis was preliminary; further analysis to be completed by statistician. Between group comparison of LC and RC via t test assuming unequal variance; paired t test for within group comparison MS1 to MS2 (significance p<0.05).
Results: Students in RC increased E significantly from MS1 (39.0±7.0) to MS2 (40.8±5.3) and demonstrate significantly higher E than LC MS2 students (36.3±5.3). There were no differences in HOS proficiency when comparing RC to LC, or MS1 to MS2. Students in RC in the lowest quartile for HOS during MS1 (1688.8±53.1) significantly increased when re-tested during MS2 (1809.5±86.8).
Conclusion and Potential Impact: Curricular reform resulted in higher E when compared to LC. Despite increased E, there were no related changes in HOS. Results from quartile analysis agreed with previous reports that active learning preferentially benefits lower performing students (Koles, 2010).
Medical Students’ Studying Approach to a Changing Medical School Anatomy Curriculum
Authors: Gibson, BA Daniel , Husmann, PhD Polly 
Published: January 2019

Background and Hypothesis:
With medical school curriculum changes, students have to reassess how they approach their studies. This study evaluates how medical students planned to study gross anatomy before and after the 2016 Indiana University School of Medicine (IUSM) curriculum change. Student study plans are hypothesized to be different before and after the curriculum change.
Methods:
First-year medical students from 2015-2017 were given a survey prior to their gross anatomy course. The survey integrated 37 Likert scale questions about resources the students might use, study strategies, demographics, prior anatomy and/or physiology courses, etc. T-tests were run between the curriculum and student grades as well as seven categories that grouped related questions from the survey. Comparisons were also made between the upper and lower thirds of the class.
Results:
The final course and NMBE percentages were found to be significantly different between curricula (p<0.0001/p<0.0001). Differences in planned usage of text-based, lab-based, and web-based resources were also significant (p<0.0001/p=0.002/p=0.007). Analyses additionally found that students in the upper third of all classes were more likely to have a prior anatomy and physiology course (p=0.031).
Conclusion and Potential Impact:
Student study plans for anatomy have changed with the revision of the curriculum. Current students are planning to use outside resources (e.g., textbooks, websites) more than previous cohorts in the traditional curriculum. In addition, students with prior knowledge of anatomy and physiology may have an advantage in understanding medical anatomy. These findings have implications for the long-term retention of this material and subsequent student outcomes.
Assessing lead exposure sources at the property scale in Indianapolis
Authors: Hentz, BS Emily , Filippelli, PhD Gabriel , Springer Noah , Hopkins, MA, BS, BA Emily , Orr Isheka , Smith, BA Rachel 
Published: January 2019

Background and Hypothesis:
Lead (Pb) was phased out of paint and gasoline over 40 years ago due to neurotoxicity in humans, but has persisted in soils and poses a legacy threat to many. The Indianapolis 46218 zip code has had >10% children exhibiting Pb poisoning. This zip code has had historically high soil Pb levels, and is undergoing redevelopment. We hypothesize that redevelopment will act to re-expose new populations of people to the legacy Pb present in the area.
Experimental Design or Project Methods:
We sampled 5 parks and 7 playgrounds. Stratified random sampling based on permit type was used to select properties from 25 issued and 25 closed permits from 527 identified demolition permits. Nearby residential properties were selected, with permission of residents. Samples were taken near the dripline of the house, front yard, and street, or from each quadrant at sites without houses. Samples were dried, crushed, sieved to 150 microns, and assessed using X-Ray Fluorescence.
Results:
Mean Pb levels from driplines (1026 ppm) were significantly higher than streets (p=0.001), parks (p=0.002), yards (p=0.001), and demolition sites (p=0.000). Pb concentrations for playgrounds had the lowest median lead levels (42 ppm), while dripline samples had the highest (289 ppm). The EPA standard for children’s play areas is 400 ppm.
Conclusion and Potential Impact:
While all samples from playgrounds were below 400 ppm, children are also likely playing at their homes, where no legislation effectively protects them from potential Pb poisoning and values were found above 400 ppm. An immediate outcome from this project is the education. Residents who agreed to testing (n=42) received results of the test and guidelines to prevent Pb poisoning. More work remains to ensure preventive rather than reactive strategies are employed to protect children’s health.
Fat Soluble Vitamin, B12 and Iron Deficiency in Patients with Coliform Small Intestinal Bacterial Overgrowth (SIBO)
Authors: Howard Gage , Wo John 
Published: January 2019

Background and Hypothesis: Vitamin deficiency has been described as a clinical complication of SIBO. However, it is unclear if the type of bacterial colonization is an important determinant in vitamin and nutritional complications. Our aim was to characterize the prevalence of specific vitamin and mineral deficiencies (vitamins A, D, E, K, B12, and iron) in patients with and without coliform SIBO. We hypothesized that results would show a significant increase in the incidence of vitamin and/or mineral deficiency in patients with coliform SIBO.
Methods: A prospective registry was formulated, consisting of patients presenting to our outpatient motility clinic with suspected SIBO. Serum levels of vitamins A, D, E, INR for K, B12 and iron studies were obtained. Upper enteroscopy-aspiration and quantitative aerobic-anaerobic cultures were performed. Primary study endpoints were prevalences of clinical vitamin/mineral deficiencies (A, D, E, K, B12, and iron) based on the final diagnosis: A) SIBO by coliform bacteria (>104 CFU/mL), B) SIBO by upper respiratory tract (URT) bacteria (>105 CFU/mL) and no SIBO. 2x3 chi square, univariate and multivariate analyses were utilized.
Expected Results: 128 subjects were enrolled, and 96 subjects underwent aspiration. Final diagnoses were the following: coliform SIBO in 32 (33%) and no SIBO or URT SIBO in 64 (67%). The presence of any vitamin deficiency appears to be more prevalent in patients with coliform SIBO (46.7%) than those without (28.1%), but it is currently unclear if these differences reach statistical significance.
Conclusions: 1) Fat-soluble vitamin deficiency may be more common in coliform SIBO, but its absence does not exclude the possibility of coliform SIBO being present. 2) Although a high folate and low B12 can be suggestive of SIBO, these derangements were not common in our heterogeneous group of patients.
*Will send update following data analysis*
Developmental Toxicity of TCE Exposure in Zebrafish: Analyzing Vitamin D Metabolism
Authors: Grisby Briana M. , Thompson Kathryn M. , Freeman Jennifer L. 
Published: January 2019

Background and Hypothesis: Trichloroethylene (TCE) is an industrial solvent used since the 1940s. A known carcinogen, it is found in over half of Superfund sites where levels have reached 12,000 parts per billion (ppb; µg/L), though the US Environmental Protection Agency maximum contaminant level in drinking water is 5 ppb. In this study, the zebrafish model was used to investigate the developmental toxicity of TCE by assessing its effects on metabolism. Preliminary studies have shown a reduction in gene expression of the cytochrome P450 (CYP) enzymes responsible for breakdown of vitamin D. As a result, we expected to see lower levels of downstream metabolites, namely calcitriol, as detected by an Enzyme-Linked Immunosorbent Assay (ELISA).
Experimental Design: At 0-2 hours post fertilization (hpf), embryos were dosed with TCE at either 0 or 10 ppb. At 72 hpf, the larvae were removed from the TCE and prepared for the ELISA procedure.
Results: ELISA revealed similar levels of calcitriol between the control and 10 ppb groups. The difference between the two groups did not show statistical significance (p>0.05).
Conclusion: These results suggest that there may not be a direct relationship between CYP gene expression and certain downstream metabolic effects or that the organism was able to compensate for the biological changes. If the latter, additional time points for TCE exposure could be evaluated. As studies continue, we plan to evaluate CYP gene expression at higher concentrations to correlate with other biological effects and determine if there is consistency with results from lower concentrations.
Tendon transfer of pronator teres to flexor pollicis longus to restore thumb flexion in incomplete tetraplegia
Authors: Jarrett Nathan P. , Merrell Gregory A. 
Published: January 2019

Background and Hypothesis: Incomplete tetraplegia creates immense barriers to autonomy for individuals with spinal cord injuries. These patients may retain control of some forearm extensors, but use of flexors is largely eliminated, affecting many movements necessary for daily activities. Although tendon transfers using brachioradialis and other muscles to restore hand function are standard practice, pronator teres has not been extensively studied as a donor for flexors. The purpose of this study is to quantify forearm pronation capability pre- and post-tendon transfer of pronator teres to flexor pollicis longus in a cadaver model. We hypothesize that tendon transfer will make thumb flexion possible, while preserving forearm pronation against gravity at a minimum.
Experimental Design: Five cadaver arms were evaluated for pronation capability against gravity before and after tendon transfer. In both stages, the arms were also assessed for the pronation forces produced at the wrist when pulling pronator teres with 25, 50, and 75 N of force. With each force, the arms were tested in full supination and neutral position.
Results: All five arms were capable of pronating against gravity before and after the tendon transfer. Following the transfer, pronation force decreased, but the difference was not statistically significant.
Conclusion and Potential Impact: Pronator teres to flexor pollicis longus tendon transfer produces thumb flexion while retaining the forearm’s ability to pronate. Used in conjunction with well-established donors, such as brachioradialis, pronator teres’ expendability could offer an additional motor unit for restoring hand function in tetraplegic patients.