bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Operative Diagnosis for Revision Total Hip Arthroplasty Related to Patient Reported Outcomes?
Authors: Holder, BA, BS Erik , Ciesielski, BS Alex , Ziemba-Davis, BA Mary , Meneghini, MD R. Michael 
Published: January 2019

Background and Hypothesis: Component loosening and instability are the leading causes of revision total hip arthroplasty (THA). The purpose of this study was to compare patient-reported outcomes after revision THA based on failure etiology. We hypothesized that outcomes would differ based on reason for revision.
Project Methods: 187 consecutive revision THAs performed between 2010 and 2017 were retrospectively reviewed. Prospectively collected preoperative and minimum one-year Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., UCLA Activity Level, WOMAC Index, and patient satisfaction were assessed based on failure etiology. Demographic variables and covariates were accounted for including sex, age, BMI, ASA classification, heart disease, lumbar spine pathology, narcotic use, fibromyalgia, depression, and autoimmune arthritis.
Results: Latest UCLA activity level did not differ based on failure etiology (p=0.381). However, the degree of improvement in activity level was higher (p= 0.04) in patients revised for loosening, instability, and infection compared to ALTR and polyethylene wear. HOOS Jr (p=0.949) and WOMAC total (p=0.147) scores did not differ based on failure etiology at latest follow-up, although patients revised for loosening had greater WOMAC improvement compared to all other groups except polyethylene wear (p=0.016). Satisfaction did not vary based on failure etiology (p=0.365), and demographic and covariates were unrelated to outcomes (p[Symbol]0.165).
Conclusion and Potential Impact: We observed that patient-reported outcomes following revision THA vary based on revision reason and activity level improvement is mitigated patients revised for ALTR and poly wear. These findings may help surgeons and patients alike set expectations for recovery following revision THA.
A Bioinformatics Pipeline for Identifying Functional Explanations of SNP-Phenotype Associations on a Transcriptional Level
Authors: Hu Stephan , Rao Dr. Xi , Liu Dr. Yunlong 
Published: January 2019

Background and Hypothesis: Genome-wide association studies (GWAS) have identified thousands of associations between single nucleotide polymorphisms (SNP) and traits of interest. These associations do not offer biological or functional explanations for differences in phenotype. This study works on filling the gap between these associations and their functional effect on phenotype by identifying variants that are associated due, at least in part, to their effect on a transcriptional level.
Experimental Design or Project Methods: GWAS analysis and RNA-sequencing was run on the post-mortem brain tissue of heavy drinkers and non-drinkers. Genes that were associated with differential transcript production were overlaid with chromatin interaction data to identify potential enhancers. A number of properties of enhancers were used to narrow down the list.
Results: Identified enhancers offer a potential functional explanation for the association between a SNP and trait.
Conclusion and Potential Impact: This new technique offers a powerful tool to identify genetic variants in key regulatory regions. Although here it is used for an alcohol use disorder study, this protocol has the potential to be used in a wide range of statistical genomic settings to find functional explanations for associations between SNP and trait.
Marginal Utility of Additional Clinical Shifts on Milestone-Based Competency in an Emergency Medicine Clerkship
Authors: Gerena Rolando G , Whitaker Nash , Corson-Knowles Dan 
Published: January 2019

Background:
Emergency medicine clerkships are a required element of medical school programs. The optimal rotation structure is unknown, and in particular the number of clinical shifts required to achieve basic competency is unknown. In this analysis of one year of evaluations at an academic center, we assess the marginal utility of clinical shifts on competency, as assessed by historical preceptor milestone-based competency evaluations.
The goal of the experiment is to observe the trend of passing rates throughout the course of an EM rotation using competencies including medical knowledge, data interpretation, and clinical judgement. The null hypothesis is that the percentage of students meeting the developmental milestones does not increase throughout the length of the clerkship.
Methods:
Clerkship evaluations of 200 students were retrospectively examined. A short form grading rubric was used to score students across eight developmental milestones. The average percentage of students meeting the developmental milestones were calculated and analyzed over the course of 14 shifts. A one-way ANOVA was used to compare the mean passing rates at different times of the clerkship.
Results:
The average percent of students achieving basic competency increased throughout the length of the clerkship, e.g. medical knowledge competency passing rates increased from 44.2% to 56.0%, first to last shifts respectively. Similar trends were observed in other competencies. The one-way ANOVA gave a p-value of less than 0.05; the null hypothesis was rejected.
Conclusion/Potential Impact:
The results can aid clerkship directors improve current grading rubrics to better assess student competency in their EM clerkships.
SILDENAFIL IS NOT PROTECTIVE TO THE BOWEL FOLLOWING INTESTINAL ISCHEMIA AND REPERFUSION INJURY
Authors: Moore, BS Hannah M. , Drucker, M.D. Natalie A. , Markel, M.D Troy A. 
Published: January 2019

Background and Hypothesis:
Acute Mesenteric Ischemia (AMI) occurs when blood supply to the intestine is decreased. This can lead to intestinal ischemia, cellular damage, necrosis, and if corrected, subsequent reperfusion injury. There are currently no medical treatments to help reverse ischemia and reperfusion injury (I/R) and, therefore novel treatments are necessary. Sildenafil, a compound that increases endogenous nitric oxide (NO) by blocking the phosphodiesterase-5 induced breakdown of cGMP, may function as a potent mesenteric vasodilator. We therefore hypothesized that sildenafil would improve mesenteric perfusion during a mouse model of intestinal I/R.
Experimental Design or Project Methods:
Adult male C57Bl6J mice were anesthetized with isoflurane and a midline laparotomy performed. The base of the superior mesenteric artery was occluded with a non-crushing vascular clamp for 60 minutes. At the end of ischemia, sildenafil (1mg/kg, 10mg/kg, or 100mg/kg) or a PBS vehicle control were administered via intraperitoneal injection. Animals were then allowed to recover. Twenty-four hours after ischemia, animals underwent assessment of mesenteric perfusion by Laser-Doppler imaging. Animals were then euthanized. Perfusion was expressed as a percentage of baseline, depicted as mean +/- SEM, and analyzed by ANOVA. P<0.05 was significant.
Results:
There were no significant differences in mesenteric perfusion between the vehicle group or any of the therapeutic groups. (PBS: 53.03±11.35%; Sildenafil-low: 59.59±7.55%; Sildenafil-medium: 70.51±8.49; Sildenafil-high: 66.4±10.2, p=0.61).
Conclusion:
Sildenafil does not appear to be an effective treatment for improving mesenteric perfusion following intestinal ischemia. Further studies are required to determine the reasons for the ineffectiveness of sildenafil. One possible explanation for these observations could be a lack of PGE5 in the intestinal vascular endothelium.
Using RNA Editing and ADARs to Increase Cell Sensitivity to Interferon Chemotherapies
Authors: Oakes Eimile , Nwosu Obi , Vadlamni Pranathi , Hundley Heather 
Published: January 2019

Background and Hypothesis: During viral infection, viral double stranded RNAs (dsRNAs) are bound by and activate pattern recognition receptors (PRRs). Activated PRRs signal several downstream cellular events, including activating transcription of interferon (IFN). IFN-β can bind to cellular receptors and increase transcription of PRRs, interferon stimulated genes (ISGs), activate Protein Kinase R (PKR) and trigger apoptosis. The ability of IFN to trigger apoptosis makes it a potential chemotherapeutic. However, IFN therapy has had mixed efficacy in inducing tumor cell apoptosis. One mechanism for this failure may be intrinsic mechanisms that prevent dsRNA from binding to and activating PRRs. ADAR1 binds to dsRNA and catalyzes deamination of adenosine to inosine, a process known as RNA editing. Normally, ADAR1 inhibits cellular dsRNAs from initiating the IFN response. Recent studies have shown ADAR1 is overexpressed in several cancers and contributes to oncogenic phenotypes, suggesting inhibition of ADAR1 may increase sensitivity to IFN-β. The Hundley lab recently identified an inhibitor of ADAR1 called ADAR3. ADAR3 has no deaminase activity and is highly expressed in glioblastoma (GBM) tumors. We hypothesize that ADAR3 expressing GBM cells should exhibit a greater antiproliferative effect in response to IFN-b treatment compared to control.
Experimental Design or Project Methods: An MTT assay was conducted in which U87 ADAR3 +/- cell lines were exposed to IFN-β after 24 hours. Cell viability was measured for 3 days post-treatment.
Results: U87 ADAR3 + cells are more sensitive to IFN-β treatment (n=2 biological replicates, p-value= 0.04).
Conclusion and Potential Impact: The results suggest a mechanism to enhance IFN therapy for patients with ADAR3 expressing GBM.
Anxiety Screening in the Emergency Department
Authors: Pinto Michelle , Musey, Jr., MD Paul 
Published: January 2019

Background and Hypothesis:
Preliminary research completed in the Indiana University Health Methodist Emergency Department (ED) determined that the prevalence of undetected or unaddressed abnormal anxiety levels in patients with low-risk chest pain was greater than 45%. This subset was noted to have abnormal anxiety symptoms that persisted following visits and increased ED recidivism. We hypothesize that the prevalence of abnormal anxiety in the general ED population will be similar to the subset of patients with low-risk chest pain shown previously.
Methods:
We enrolled a convenience sample of adult patients with non-psychiatric chief complaints who presented to IUH Methodist and Eskenazi Emergency Departments. Participants were assessed for abnormal anxiety levels using the Generalized Anxiety Disorder 7-item Scale (GAD-7) and the Hospital Anxiety Depression Scale (HADS). Subjects will also complete these assessment tools at 30-days post-enrollment via phone or REDCap survey. Data regarding ED disposition, discharge diagnosis, and ED utilization over the previous 12 months and the 30 days post-enrollment will be collected from the electronic medical record (EMR).
Results:
Over four weeks, 108 patients were screened and 37 gave informed consent and were enrolled. Preliminary analysis shows that 21 subjects (56%) had a GAD-7 score ≥10, indicating abnormal anxiety levels. Full data analysis including comparison of HADS and GAD-7 scores will take place after 50 subjects have been enrolled, completed their 30-day follow-up surveys, and EMR review has taken place.
Conclusion:
Given data regarding ED visits in patients with low-risk chest pain, identification of anxiety and referral may reduce ED utilization.
The risk of bleeding following therapeutic endoscopy is low in patients with cirrhosis
Authors: Reinhart Kathryn , Phatharacharukul Parkpoom , Orman Eric 
Published: January 2019

Background: Patients with cirrhosis may be at increased risk of bleeding after invasive procedures due to defects in coagulation; however the bleeding risk following therapeutic endoscopy remains poorly understood. We aimed to determine the incidence and risk factors for post-procedural bleeding for patients with cirrhosis undergoing therapeutic endoscopy.
Methods: We performed a retrospective cohort study of patients undergoing three common endoscopic procedures (colonoscopic polypectomy, endoscopic variceal ligation, and biliary sphincterotomy) at Indiana University Hospital between 2007 and 2014. Clinical and procedural data were collected, including complications in the 30 days following the proceduress.
Results: We identified 447 procedures: 128 polypectomies, 63 sphincterotomies, and 256 variceal ligations. The incidence of bleeding was 2% (4 polypectomies, 1 sphincterotomy, and 4 variceal ligations) after a median of 4.5 days. . Prophlactic platelet transfusions were provided to 11 patients and plasma was transfused in 17 patients. Of those who received prophylactic transfusions, only one bled (post-polypectomy despite prophylactic hemoclip placement). The patients that bled had a median INR of 1.48 which was slightly elevated compared to the overall median INR 1.26. Post-polypectomy bleeding occurred following removal of fairly large polyps (8, 9, 10, 25 mm) compared to the median overall polyp size of 5 mm.
Conclusion: The incidence of bleeding for patients with cirrhosis undergoing therapeutic endoscopy is low. More data on post-procedural bleeding are needed to determine risk factors and to inform appropriate prophylactic measures. These data may be used to guide clinicians in counseling patients prior to these procedures.
Utilizing Citizen Science to Reverse the Current Lead Testing Paradigm: Development of a Scalable, Low-cost Home Lead Test Kit
Authors: Sawyer Katlyn , Knaub Chris , Tighe Meghanne , Forbes Danielle , Marks Claire , Nicolay Lane , Gutierrez Citlali , Dowd Mike , Bielski Maggie , Sisk Matthew , Ngai Michelle , Lieberman Marya , Peaslee Graham , Beidinger Heidi 
Published: January 2019

Background: The Center for Disease Control recommends case management begin at a blood lead level of 5 μg/dL, yet Indiana does not take action until a blood lead level of 10 μg/dL. Low levels of lead can cause irreversible neurological damage in children. The goal of this study was to design a scalable, low-cost Home Lead Test Kit to proactively find lead in homes.
Methods: Individuals were recruited through community partnerships, community lead testing events, and flyers. Qualitative data was recorded during home visits as participants used the kit. An x-ray fluorescence analyzer was used in the field and laboratory to analyze lead levels of samples. Results were blinded during the analysis.
Results: To date, 40 homes have been recruited, and 20 have been completed. The average completion time of the kit was 23.45 minutes. Of the 8 pre-1950 homes 100% had elevated lead results, of the 7 1950-1978 homes 43% had elevated lead results, and of the 5 post 1978 homes 0% had elevated lead results.
Conclusion and Potential Impact: The study is ongoing. Preliminary results support the hypothesis that pre-1950 homes have a high risk of lead exposure, and post 1978 homes have minimal to no levels of lead. Feedback from study participants regarding kit usability has been positive. Future plans are to produce a kit to be scaled up in St. Joseph County with the goal of a statewide model. This kit may allow citizens to identify lead hazards to prevent children from lead exposure.
IL-6 Stimulates Autophagy in Wild Type and NRF2 Knock Out Mice β-cells
Authors: Stucker K M , Marasco M R , Conteh C M , Muralidharan C , Linnemann A K 
Published: January 2019

Background and Hypothesis:
Pancreatic β-cells exhibit high levels of metabolic activity which generates reactive oxygen species (ROS).  ROS can  lead to β-cell damage and death, which could contribute to diabetes development. Therefore, pathways reducing ROS are of interest as potential therapeutic targets.  We have demonstrated that IL-6 stimulates autophagy and protects β-cells from ROS and apoptosis.  IL-6 also stimulates the translocation of NRF2 to the mitochondria, which is accompanied by several markers of mitophagy, the autophagic degradation of mitochondria.  In this study, we ask where NRF2 fits in the pathway downstream of IL-6 by asking if NRF2 is required for IL-6 stimulation of autophagy and/or mitophagy.
Experimental Design or Project Methods:
Wild type and NRF2 knockout mice were intraperitoneally injected with saline or IL-6 for thirty minutes, and the pancreata were cryopreserved, and cryosectioned.  Immunofluorescence staining was carried out for LAMP-1 (a component of lysosomes) and LC3 (a component of autophagosomes).  Slides were imaged with a LSM 700 confocal microscope.
Results:
IL-6 stimulated autophagy in wild type and NRF2 knockout mice, whereas saline injection did not.
Conclusion:
We have confirmed that IL-6 stimulates autophagy in pancreatic islets and shown that NRF2 is not required for this process.  Ongoing experiments are investigating if NRF2 is required for IL-6 stimulation of mitophagy. These results help us understand how NRF2 functions downstream of IL-6 in the protection of β-cells
Clinical and radiographic factors associated with appendectomy in pediatric patients with abdominal pain and equivocal imaging findings for appendicitis.
Authors: Tursunova Roziya , Landman, MD, MPH Matthew P. 
Published: January 2019

Background and Hypothesis
Acute appendicitis is a common surgical emergency in children. The diagnosis requires physicians to rely on clinical, radiographic and laboratory factors. The nonoperative management of appendicitis is becoming more frequent. This requires an accurate diagnosis prior to initiating therapy to prevent unnecessary antibiotic administration for abdominal pain unrelated to appendicitis. We hypothesize clinical and radiographic factors are associated with appendicitis in patients with abdominal pain and inconclusive imaging studies.
Methods
The DORIS (Dig Our RIS) interactive data-mining tool was utilized to identify patients<18 years of age presenting to the emergency department in 2016 with abdominal pain who obtained abdominal imaging suggestive of early acute appendicitis. Relevant clinical and radiographic information was obtained from the medical record for univariate analysis looking for associations with appendectomy.
Results
One hundred patients were identified with 21 excluded due to imaging for other reasons or with clear non-appendicitis etiologies for pain (e.g. trauma cases, ovarian cyst). Seventy-nine patients were included with 49 (62%) undergoing surgery and 30 who were observed and/or discharged from the ED. Important differences between surgical and nonsurgical patients included: white blood cell count (13.81±0.68 vs. 10.29±0.90, p=0.002), neutrophil percentage (78.31±1.90 vs. 67.78±2.65, p=0.002), appendiceal diameter on CT scan (9.37±0.53 vs. 7.58±0.30, p=0.013).
Conclusion and Potential Impact
In a group of patients with concern for appendicitis and imaging suggestive of early acute appendicitis, distinct clinical and radiographic characteristics are associated with appendicitis. Within a paradigm of nonoperative management of appendicitis, accurate diagnosis will prevent the overutilization of antibiotics.
Current Concepts in the Treatment of Patellofemoral Instability
Authors: Ulrich, BS Gary , Pandit, FRCS (Orth), DPhil (Oxon) Hemant 
Published: January 2019

Background and Hypothesis:
Patellofemoral instability represents a disabling condition, which presents primarily in active, young patients with an increased incidence in the female sex. A patellar dislocation can occur from a high-energy trauma or from an atypical anatomy, such as trochlear dysplasia, patellar dysplasia, patella alta, increased tibial tuberosity-trochlear groove (TT-TG) distance, increased Q-angle, and ligamentous laxity. When a patient presents with patellofemoral instability, the orthopedic surgeon faces many decisions regarding the treatment. Since the risk of a second dislocation after an acute dislocation resides at approximately 17%, many orthopedic surgeons treat the first patellar dislocation non-operatively barring the patient lacks any atypical anatomy. However, after a second dislocation, the likelihood of recurrent dislocations increases to approximately 50%, which directs most orthopedic surgeons to surgical treatment. The current work reviews the anatomical predispositions, clinical presentation, and treatment of patellofemoral instability.
Experimental Design or Project Methods:
The review was constructed via an extensive literature search utilizing the databases of MEDLINE/PubMed, SportDiscus, CINAHL, and Cochrane Central Register of Controlled Trials.
Results:
Multiple treatments exist for patellofemoral instability, which include non-operative treatment, MPFL reconstruction, tibial tubercle osteotomy, and trochleoplasty, along with many other procedures. Each case requires a tailored approach to successfully treat the patellofemoral instability.
Conclusion and Potential Impact:
Patellofemoral instability represents a potentially debilitating condition of anterior knee pain and limited activity. Understanding the anatomical predispositions, clinical presentation, and treatment of patellofemoral instability marks the first step to caring for patients with this condition.
Starting from the Roots: Observing Healthcare and Population Health Endeavors in a Lower Middle Income Country
Authors: Vonderohe Madalyn 
Published: January 2019

The Slemenda Scholarship:
The Slemenda Scholarship is a program that was developed in 1998 for rising second year medical students in order for them to gain experience in the field of global health through the context of the AMPATH Consortium in Eldoret, Kenya. As a medical professional aspiring to work internationally, it is an invaluable experience to observe practices in a well-established partnership such as the one between Moi Teaching and Referral Hospital, Moi University, and Indiana University.
Community Experiences:
The first half of the summer was spent visiting and participating in various AMPATH initiatives. This included rounding on the medical, surgical, gynecological, and pediatric wards, volunteering with the child life team, visiting community health and microfinance projects, observing rural HIV clinics, and working at a school developed for street children in Eldoret.
Primary Project:
The second half of the summer was spent working with the Maternal Newborn and Child Health team, specifically in the Reproductive Health department. I worked as a research assistant for a new project seeking to develop an antenatal care clinic for young girls aged 10-19 in Uasin Gishu County at the Rafiki Centre for Adolescents at Moi Teaching and Referral Hospital. I developed recruitment materials and a database for qualitative and quantitative data collection for the project.
Moving Forward:
On returning to Indiana, it is my goal to champion the work of the AMPATH Consortium and attempt to ensure its longevity through the next generation of globally-minded physician-scientists. I will take the lessons I learned and observations I made in this setting and work to apply them to improving healthcare in underserved areas in our own community as well.