bluuebunny/crossref_metadata_2025_split huggingface dataset:
PedsQL for Prediction of Postoperative Patient-Reported Outcomes following Chiari Decompression Surgery
Authors: Baygani, BS Shawyon , Zieles,BS Kristin , Jea, MD, MHA Andrew 
Published: October 2019

Background and Hypothesis: Chiari malformation type I (CM-I) is a common pediatric disorder in which the cerebellar tonsils herniate the foramen magnum with associated spinal symptoms. The purpose of this study is to determine if the preoperative Pediatric Quality of Life Inventory (PedsQL) score is predictive of intermediate-term PedsQL outcomes following Chiari decompression surgery. The utility of preoperative patient-reported outcomes (PROs) to postoperative PROs has been previously demonstrated in adult spine surgery. However, to our knowledge, there is currently no widely accepted tool to predict short-, intermediate-, or long-term outcomes after pediatric Chiari decompression surgery.
Project Methods: A prospectively maintained database was retrospectively reviewed. Patients who underwent first-time decompression for symptomatic Chiari malformation were identified and grouped by their preoperative PedsQL scores: mild disability (score 80–100), moderate disability (score 60–80); and severe disability (score < 60). PedsQL outcomes were collected at 6-week, 3-month, and 6-month follow-up. Preoperative PedsQL subgroups were tested for an association with demographic, perioperative characteristics, and improvements between groups by one-way ANOVA, chi-square, or Wilcoxon signed rank test, where appropriate.
Results: The postoperative patient- and parent-reported PedsQL values were significantly different between all three groups at 6-weeks, 3-months, and 6-months after surgery (p < 0.05), except at the 6-month timepoint for parent-reported outcomes (p = 0.111). Patients with higher preoperative disability demonstrated statistically significant greater improvements (compared to preoperative score) in parent-reported PedsQL at all timepoints after surgery, except at the 6-month parent-reported outcomes (p = 0.133).
Conclusion: Patients with worse preoperative disability, as assessed by PedsQL, experienced lower absolute PedsQL scores at all timepoints after surgery but had greater improvement in short- and intermediate-term PROs. We conclude that PedsQL is an efficient and accurate tool that can quickly assess patient disability in the preoperative period and predict both short-term and long-term surgical outcomes.
Neonatal Follow Up Study: A Retrospective Chart Review of Developmental Outcomes
Authors: Wolfe, MD Heather , Gilham, NP Denise , Stace, RN, CPN Susan , Emili, BS Uchechukwu 
Published: October 2019

Background and Hypothesis: According to the CDC, Preterm birth is defined as a baby born before 37 weeks of gestation. 1 In 2016 preterm birth affected 1 in every 10 infant born in the United States.1 Preterm birth has been known to cause many birth defects along with developmental delays and has attributed to 17% of all infant death. Neonatal Follow Up clinics or programs have been instrumental in helping infants catch up developmentally.3 We believe that with the NFC, we will be able to develop a standard for preterm babies and the normalization of their development.
Experimental Design or Project Methods: A retrospective chart review was conducted to determine the developmental outcome of infants that were born prior to 37 weeks’ gestation. Infants were divided into extreme, very, and moderate preterm cohorts. Test of Infant Motor Performance (TIMP), Ages and Stages Questionnaire (ASQ), Bayley Scales of Infant Development (BSID) and Modified Checklist for Autism in Toddlers (M-CHAT) scores were used to determine a standard for when preterm babies in each cohort normalize developmentally.
Results: Analysis of the data showed that the developmental turning point for each cohort varies. Within the extreme preterm cohort, one can see that there was no clear turning point for development. For the very preterm group, by TIMP 2, one could see a turning point and a decrease in delays. Lastly, moderately preterm cohort, the number of delays was seen tot decrease from the administration of TIMP 2 and continue in this trend.
Conclusion and Potential Impact: Through the administration of these developmental tests, physicians are able to track the development of preterm babies. We concluded that with the proper follow up, one can see an improvement in development as early as the administration of TIMP 2.
1) Preterm Birth https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm 2) Suave, R., & Lee, S. K. (2006). Neonatal follow-up programs and follow-up studies: Historical and current perspectives. Paediatrics and Child Health. http://doi.org/10.1093/pch/11.5.267 3) Voller, S. M. B. (2018). Follow-Up Care for High-Risk Preterm Infants. Pediatric Annals, 47(4). http://doi.org/10.3928/19382359-20180325-03
Gastric Per-Oral Endoscopic Myotomy (G-POEM) for the Treatment of Gastroparesis: A Single Center Experience
Authors: Gregor Lennon , Wo John , DeWitt John , Gupta Anita , Yim Brandon , Mendez Martha , Al-Haddad Mohammad 
Published: October 2019

Background and Hypothesis: Gastroparesis is a difficult-to-treat disease that has variable presentation. Treatments for gastroparesis include pharmacotherapy, botulinum toxin injection into the pylorus, or surgical pyloroplasty. Based on patient response to pyloric directed therapies, it is theorized that endoscopic pyloromyotomy will prove to be an effective minimally invasive treatment. Early feasibility studies of endoscopic pyloromyotomy (G-POEM) demonstrated safety and early clinical success. Our aim is to assess the safety and sustained clinical efficacy of the G-POEM procedure.
Experimental Design or Project Methods: Patients with confirmed diagnosis of gastroparesis on gastric scintigraphy were assessed using PAGI-SYM to determine symptom severity. EndoFLIP of pylorus and four-hour solid phase gastric emptying scan (GES) were utilized to access gastric function pre and post G-POEM. Post G-POEM follow up at 1, 3, 6, and 12 months was completed. PAGI-SYM was collected at all follow ups. For 6- and 12month visits, GES and EndoFLIP were conducted.
Results: Twenty-eight patients (age: 28-80, 82% female) underwent G-POEM between February 2018 to July 2019. All cases were done under general anesthesia with technical success rates of 100%. There were adverse events in 3/28 of the cases that were successfully managed endoscopically. There was significant improvement in gastric emptying post G-POEM (4-hour average retention rates of 6.3% compared to 35.0% pre-GPOEM, p < 0.001). There was a significant improvement in patient reported PAGI-SYM score from baseline (3.0) and 3months post G-POEM (0.80), p < 0.001. There was a trend towards sustained improvement in PAGI-SYM score on 6 month follow up, but this did not reach statistical significance (2.10, p = 0.22). There were improvements noted in pylorus cross sectional area and distensibility index on EndoFLIP post G-POEM, but this did not reach statistical significance and will require further assessment and a larger sample size.
Conclusion and Potential Impact: G-POEM appears to be a safe and feasible treatment alternative for gastroparesis with significant short-term improvements in gastric emptying rates and overall symptom scores. A larger cohort of patients is needed to validate these findings and examine the long-term effect of G-POEM on patients’ wellbeing and healthcare utilization.
Evaluating the Effect of Acarbose Treatment on Insulin Secretion and Sensitivity in Early Diabetes Using a Novel Interpretation of the Disposition Index Equation
Authors: Hanna Clarissa , Hannon Tamara , Considine Robert V. , Mather Kieren J. 
Published: October 2019

Background and Hypothesis: In pathologic states such as obesity and insulin resistance, there is a progressive decline in insulin sensitivity requiring greater insulin secretion to maintain normoglycemia. The inverse relationship between insulin sensitivity and secretion is mathematically defined by the Disposition Index (DI), a measure of βcell function adjusted for insulin sensitivity. We are working to generalize the DI equation to allow direct physiologic interpretation of the DI term, and of the slope relating insulin secretion with insulin sensitivity. We tested study treatment effects hypotheses using these new analytic methods.
Background and Hypothesis: In pathologic states such as obesity and insulin resistance, there is a progressive decline in insulin sensitivity requiring greater insulin secretion to maintain normoglycemia. The inverse relationship between insulin sensitivity and secretion is mathematically defined by the Disposition Index (DI), a measure of βcell function adjusted for insulin sensitivity. We are working to generalize the DI equation to allow direct physiologic interpretation of the DI term, and of the slope relating insulin secretion with insulin sensitivity. We tested study treatment effects hypotheses using these new analytic methods.
Results: These analyses revealed statistically significant 1-year changes in DI, in secretion-sensitivity coupling slopes, and in the joint changes in secretion and sensitivity. However, these treatment effects did not differ by randomized treatment group, suggesting an on-study effect beyond the randomized treatments.
Conclusion and Potential Impact:
We have applied a novel analytic approach to evaluate the secretion-sensitivity relationship modeled by the disposition index equation to investigate the effect of randomized therapy on β-cell function in a placebo-controlled randomized clinical trial. These analyses revealed study effects on the secretion-sensitivity relationship that have not been previously described, suggesting that this novel approach will have value in clinical studies of β-cell dysfunction and treatment effects.
Vision Dysfunction in Circadian Clock Gene Bmal Mice
Authors: Khan Humza , Mathew Deepa , Luo Qianyi , Bhatwadekar Ashay 
Published: October 2019

Background and Hypothesis: The circadian rhythm disruption due to shift work results in a range of disorders such as metabolic disturbances, obesity, cardiovascular diseases, and insulin resistance. Interestingly, the core clock gene Brain and Muscle ARNT-Like 1 (Bmal1), is dysfunctional in shift workers. We reasoned dysfunctional Bmal will affect normal vision function. To do so, a genetically modified mouse with disrupted Bmal was assessed for visual function. We hypothesized that Bmal knockout mice will exhibit reduced retinal functions such as impaired acuity, accommodation, and tracking.
Experimental Design or Project Methods: The Bmal+/- mice were inbred and genotyped to obtain wild-types (WT), Bmal+/-, and Bmal-/-. To assess the retinal function, we performed electroretinogram (ERG) recordings at the zeitgeber times (ZT) of 0, 6, 12, and 18 which correspond to 7 AM, 1 PM, 7 PM, and 1 AM, respectively, under both scotopic and photopic conditions. The optokinetic response (OKR) assessments were measured in between ZT-3-ZT7.
Results: Consistent with previous studies, the ‘a’ wave and ‘b’ wave amplitudes of WT mice demonstrated a circadian rhythm under scotopic condition. There was a decrease in ERG amplitude of Bmal+/-, and Bmal-/- when compared to the WT group. Under photopic conditions, the circadian peak of ERG amplitude was reversed for Bmal-/- when compared to both WT and Bmal+/- mice. The OKR assessment was decreased substantially for Bmal+/- (0.3748c/d), and Bmal-/- (0.3130c/d) as compared to the WT mice (0.4827c/d).
Conclusion and Potential Impact: Our studies demonstrate that the loss of Bmal leads to vision dysfunction possibly due to impaired rod and cone function. Furthermore, by using a mouse model of circadian rhythm dysfunction, we identified that individuals working on irregular shifts might be vulnerable to vision dysfunction, and our studies warrant timely testing of visual function and strategies for prevention of vision problems in shift workers.
Role of perilipins in the development of fatty liver disease.
Authors: Kubascik Erica , DeGoey Madison , Gupta Dr. , Kostrominova Dr. 
Published: October 2019

Background and Hypothesis: Lipid droplets (LDs) are fatty acid (FA) containing structures within cells. In obesity, hepatic LDs accumulate more FA which may cause steatosis and nonalcoholic fatty liver disease (NAFLD). Perilipins (PLINs) are a family of LDassociated proteins involved in intracellular trafficking and signaling. In hepatocytes, NAFLD alters expression of PLINs. Using metabolomics, Dr. Gupta’s laboratory previously showed enlarged LDs and altered PLIN1, 3, and 4 content in NOD2-/- compared to wild type (WT) mice on high fat diet (HFD). Nucleotide-binding and oligomerization domain (NOD) is an intracellular receptor that regulates sensitivity to obesity.
To expand on Dr. Gupta’s study, we quantified diet-induced alterations and visualized intracellular distribution of PLINs in mouse livers. We hypothesized that PLIN2, 3, and 4 concentrations would increase whereas PLIN1 would decrease in NOD2-/-HFD compared to WTHFD mice.
Methods: Immunostaining was used to visualize intracellular distribution of PLINs. Western blotting was used to quantify differences in PLINs protein expression.
Results: LD distribution showed WT regular chow (RC) = NOD2-/-RC < WTHFD<<NOD2-/-HFD. Bright LD-associated staining for PLIN2 was observed in both small and large LDs in all four groups. PLIN3 brightly stained the bile ducts, and it stained small LDs but not large LDs. PLIN4 stained small intracellular LDs in all four groups. PLIN1 showed a trend for decrease in both NOD2-/-HFD and WTHFD compared with RC mice. PLIN2 appears to be decreased in WTHFD and both NOD2-/- groups compared to WTRC. PLIN3 seemed to show increased expression in WTHFD but not in NOD2-/-. PLIN4 showed a trend for decreased expression in both NOD2-/-RC and NOD2-/-HFD mice compared to WTRC.
Conclusion: Despite enlarged LD size, there was no detectable increase in PLINs expression in NOD2-/-HFD compared to WTHFD. This may be due to the impact of other LDassociated proteins in the livers of NOD2-/- mice.
Prevalence of impairing behavioral health problems in ED patients and association with ED utilization.
Authors: Nader Setarah Mohammad , Musey Jr., MD, MS, FACEP Paul 
Published: October 2019

Background and Hypothesis: It has been observed that patients with poor mental health are relatively frequent users of the Emergency Departments (ED). The objective of this study is to evaluate the prevalence of numerous behavioral health domains (depression, anxiety, PTSD, substance abuse, and suicidality) in patients presenting to the Emergency Department and the association of each of these domains with ED utilization.
Experimental Design or Project Methods: This prospective study seeks to enroll a convenience sample of 1000 Englishspeaking adults presenting to IU Health Methodist and Eskenazi Emergency Departments without psychiatric chief-complaints. Patients were assessed for behavioral health problems using the CAT-MHTM, PHQ-8 and GAD-7 screening tools, which were administered via tablet device. Additionally, data on disposition medical history, discharge diagnoses, and ED utilization in the 12 months before and after enrollment from electronic medical records and data from the Indiana Network for Patient Care (INPC) will be reviewed.
Results: Over the course of five weeks, 375 patients have been enrolled. Of those 59.4% were female with an overall mean age of 46.1 (SD ± 16.4); 52.9% were white and 39.8% black/African American. Among enrollees 42.2% screened positive for depression, 29.7% for anxiety, and 1.3% for suicidal ideation. Patients who screened positive for depression were predominately females (76.1% vs 23.9%), those who screened positive for anxiety were also predominately females (71.6% vs. 28.4%). However, 3 out of the 5 (60%) patients that screened positive for suicidal ideation were males. The preliminary analysis of GAD-7 showed of those enrolled 215 (57.5%) had no anxiety, 157 (42%) had mild-severe anxiety. PHQ-8 scores showed 194 (51.9%) had no depression, 178 (47.5%) had mild-severe depression. Similarly, CAT-MH results showed 216 (57.8%) had no depression, 158 (42.2%) had mild-severe depression, while 263 (70.3%) had no anxiety and 111 (29.7%) had mild-severe anxiety. Full data analysis including comparative analysis of the CAT-MH with PHQ-8 and GAD-7 scores will take place after 1000 patients have been enrolled and data has been received from the INPC.
Conclusion and Potential Impact: In our sample, almost half of patients that visit the ED have screened positive for mental health problems. We believe that early identification and appropriate referral may reduce inappropriate ED utilization.
Tranexamic Acid Increases Early Postoperative Pain and Decreases Time to First Opioid Following Total Knee Arthroplasty
Authors: Seetharam Sachin , Keller Sydney , Ziemba-Davis Mary , Meneghini MD R. Michael 
Published: October 2019

Background and Hypothesis: Tranexamic acid (TXA) decreases blood loss in total knee arthroplasty (TKA). However, TXA evoked pain in rats by inhibiting GABA and glycine receptors in the spinal dorsal horn, and caused cellular death in ex vivo and in vitro human periarticular tissues exposed to clinical concentrations of TXA. We evaluated inpatient postoperative pain and blood loss in TKA performed with and without TXA.
Project Methods: 105 consecutive cemented TKAs without TXA were compared to 72 consecutive cemented TKAs with TXA. Procedures were performed by a single surgeon using identical perioperative medical and pain-control protocols. Outcomes included: average of q2-4 hour pain scores during the first 24 hours after PACU discharge, average pain during remainder of stay, final pain score prior to discharge, time in minutes to first opioid after PACU discharge, total opioids in morphine equivalents (MEQs) during the first 24 hours after PACU discharge, average MEQs per remaining days of stay, and mean g/dL pre- to postoperative decrease in hemoglobin. Multivariate analyses accounted for 15 demographics and covariates.
Results: The sex (p=0.393), age (p=0.784), and BMI (p=0.930) of the two cohorts were similar. Mean pain during the first 24 hours was greater (4.1 vs. 3.2, p=0.001), MEQs consumed during the first 24 hours were greater (45 vs. 37, p=0.069), and time to first opioid medication was shorter (326 vs. 414, p=0.023) in patients who received TXA. The decrease in hemoglobin was less in patients who received TXA (-2.2 vs. -2.7, p<0.001).
Conclusion and Potential Impact: Our hypothesis based on animal and laboratory studies that TXA may increase early postoperative pain was confirmed by three metrics. Consistent with the effective life of TXA, pain and opioid consumption after 24 hours did not differ based on TXA use. Further work is warranted to investigate the nature consequences associated with TXA, relative to its demonstrated benefits for blood conservation.
The efficacy of P.O.P. on Teen violence and the anti-violence programing in Northwest Indiana and greater Chicagoland area
Authors: Sloss Isaiah , Anokwute Chiamara , Rutland, MD Reuban , McGee, MD Michael 
Published: October 2019

Background: Fights, bullying, and gun violence in the Northwest Indiana and Chicagoland middle schools and high schools can have long lasting effects on a student’s physical, emotional, or mental wellbeing. Project Outreach and Prevention on Youth Violence (henceforth POP) is a foundation started by two NWI doctors, Dr. Michael McGee and Dr. Reuban Rutland, looking to do their part in preventing victims of youth violence from reaching their emergency departments. POP also reaches students underrepresented in medicine to breach that gap. Programs such as POP’s Health Professions Enrichment Program (HPEP). POP also utilizes school rallies and violence prevention seminars throughout the year to reach at risk youth. Activities at these rallies include Stop the Bleed training, where students are trained and certified by professionals on how to stop a bleed to various parts of the body. POP also utilizes local celebrities, artists, public figures, and community leaders to incentivize the participation of their target population. Does implementation of anti-violence events with school age students by professionals and community leaders decrease incidences of violence or increase interest in college/STEM professions?
Hypothesis:

There is an increase in the interest in college/STEM professions.
There is a decrease in incidences of violence at schools with active SAVE chapters or participating in an anti-violence event

Experimental Design or Project Methods: Surveys, Observations, Student Interviews, Intervention, Cohort Study, Program evaluations, Longitudinal Study (Go to each school nearby and request the info) The study’s population includes students from 7th grade through high school seniors located throughout 13 schools in the northwest Indiana region. POP
Results: Analyze Survey Data and interviews for positive correlation with the data.
Conclusion/Potential Impact: Pending Review; The potential impact this project yielding positive results would help demonstrate efficacy of POP and enable us to seek more funding opportunities and implement these programs on a wider scale and hopefully being able to see lower instances of violence in areas where programing takes place.
L’internationalisation des marchés en productions animales
Authors: CHATELLIER Vincent 
Published: October 2019

Les productions animales représentent 16 % du commerce agroalimentaire international. Le déséquilibre croissant entre l’offre et la demande de produits animaux dans les pays asiatiques où la consommation progresse, surtout en Chine, stimule les échanges au bénéfice des grands pays exportateurs que sont l’Union européenne (UE), les États-Unis, la Nouvelle-Zélande, le Brésil et l’Australie. Si cette évolution offre des opportunités commerciales pour les pays structurellement excédentaires, les achats ne sont pas toujours réguliers d’une année à l’autre et la concurrence par les prix est très forte, même si certains pays ont des exigences qualitatives. L’UE, qui est excédentaire en produits laitiers et en viande porcine, mais déficitaire (en valeur) en viande bovine et en viande de volailles, est le premier exportateur mondial de productions animales (avec 22 % du total, hors commerce intra-UE en 2016). En utilisant les données statistiques des douanes (BACI et COMEXT) de 2000 à 2016, cet article traite de l’évolution du commerce en productions animales. Il présente l’évolution du commerce international pour différents types de biens (produits laitiers, viande bovine, viande porcine, viande de volailles) et met en évidence les trajectoires commerciales des principaux pays déficitaires (Chine, Japon et Russie) et excédentaires (Inde, Australie, Nouvelle-Zélande, Brésil, États-Unis et UE).