bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resiliency in Medical Students and Residents Participating in the Global Health AMPATH Kenya Elective
Authors: Keilman Courtney L. , Baenziger, MD Jenny 
Published: January 2019

Burnout has become a prominent issue among healthcare providers. The demands of working long shifts, prolonged periods of stress and increased time spent charting all contribute to this phenomenon. Current research suggests that an intrinsic sense of resilience may be key in combating this epidemic. Just as our sense of empathy and compassion can be cultivated through experience, so too can our level of resilience. We propose that engaging in an international health project during medical professional education may promote a greater sense of resiliency. To analyze this, we will use the Connor-Davidson Resilience Scale© to survey 4thyear medical students and residents at the Indiana University School of Medicine (IUSM) that have participated in the AMPATH rotation at Moi University in Kenya between June 2018 and May 2019. To determine the potential change in resilience we will ask our subjects to complete the survey prior to their trip, as well as 1-months and 1-year after their trip. This study may lead to the advocacy for such projects to be integrated into medical education curricula to combat the growing problem that is physician burnout.
Mapping Out Receptors: High Throughput Screening of Endothelial Monocyte Activating Polypeptide II (EMAPII) Using PRESTO-TANGO
Authors: Lam Nathan , Maier Bernhard , Chelvanambi Sarvesh , Hato Takashi , Clauss Matthias 
Published: January 2019

Background: Secreted endothelial monocyte activating polypeptide II (EMAPII/AIMP1) is a pro-apoptotic, pro-inflammatory ligand implicated in diseases such as colorectal cancer, cardiovascular disease, and emphysema. Thus, EMAPII has been shown to induce apoptosis through CXCR3 receptor binding. However, not all EMAPII functions have been attributed to CXCR3. Discovery of new receptors interacting with EMAPII could lead to development of new therapies blocking cognate ligand-receptor binding. We hypothesize the existence of at least one unknown secondary receptor for EMAPII.
Methods: The PRESTO-TANGO assay, a construct which converts G-protein coupled receptor (GPCR) ligand binding into luciferase activity measurable by luminometer, was validated using transfection with TANGO-modified CXCR3 and S1P1R as test receptors in HTLA cells. Protocols for cell transfection, adherence, and cultivation were optimized with IP10, EMAPII, and S1P as test ligands.
Results: The assay was successfully validated using several GPCR activation readouts. Binding curves were generated for S1P/S1P1 (EC50= 569nM), IP10/CXCR3 (EC50= 47.1 nM), and EMAPII/CXCR3 (EC50= 628 nM). Conditions for the PRESTO-TANGO assay were further refined for maximal signal-to-noise ratio and robust inter-assay reproducibility in preparation for high-throughput screening. We are currently testing 314 TANGO-modified GPCRs for EMAPII affinity.
Conclusion: We have validated the Tango assay for the known EMAPII-CXCR3 ligand-receptor system, a valuable tool for evaluation of anti-EMAPII therapeutics. Discovery of a novel EMAPII receptor would allow for the development of therapies including neutralizing antibodies (analogous to the PD1 receptor antibody Pembrolizumab for solid tumors) in diseases such as colorectal cancer, cardiovascular disease, and emphysema.
Understanding the Algebraic and Logical Structure of Speech Perception
Authors: Misiolek Kalina A. , Worth Robert M. , Rubchinsky Leonid L. 
Published: January 2019

Background: Although subject to much variation, the anatomy of language comprehension has become increasingly clear with the advent of fMRI; however, the steps of speech comprehension remain elusive. There are two main theories of language processing – hierarchical and sequential (or probabilistic). According to the hierarchical theory, sentences are broken down (e.g. sentence to words to syllables to phonemes) and then reconstructed while syntactic and semantic meanings are attached. Sequential theory suggests the use of “word-level statistics” and n-gram-type models to predict sequences of word meanings.1 Although evidence suggests both models play some role, as a starting point, many comprehension models focus on hierarchical theory, and many of those in turn rely on neural networks. However, in various ways, these models fall short of explaining how the brain can biologically carry out all the steps.
Methods: We attempt to create a hierarchical model of speech comprehension using linear logic (or a related logic) or Category Theory, with the hope that such an approach may be able to explain the process more naturally. We focus on the second half of comprehension (i.e. the reconstruction) to make use of existing neuronal logic gate models.2 The goal is to construct a linear logic model or to create categories and associated functors that could explain hierarchical linguistic processing and many neurolinguistic study results.
Potential Impact: Although this model would only account for hierarchical linguistic processing, it would be a huge step forward in understanding how our brain processes speech – and possibly other inputs – at the level of neuron bundles.
References:

Frank, S. L., Christiansen, M. H. (2018). Hierarchical and sequential processing of language. Language, Cognition and Neuroscience, 1-6. doi:10.1080/23273798.2018.1424347

Goldental, A., Guberman, S., Vardi, R., & Kanter, I. (2014). A computational paradigm for dynamic logic-gates in neuronal activity. Frontiers in Computational Neuroscience, 8. doi:10.3389/fncom.2014.00052
REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL
Authors: Mohiuddin, BS Amer , Rice, BA Justin , Ziemba-Davis, BA Mary , Meneghini, MD R. Michael 
Published: January 2019

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature.
Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented.
Results: Average age and BMI were 63 years and 30 kg/m2. 67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days.
Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI. Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.
Disease Severity in Non-alcoholic Fatty Liver Disease (NAFLD) Patients with No Prior Diagnosis of Cirrhosis – A Unique Insight Using Vibration-Controlled Transient Elastography (VCTE)
Authors: Muschi David , Vuppalanchi Dr. Raj 
Published: January 2019

Background and Hypothesis:
The severity of fibrosis is a strong prognostic indicator in patients with non-alcoholic fatty liver disease (NAFLD). However, routine evaluation with a liver biopsy in patients with NAFLD is not feasible and as such, the assessment of disease severity is often limited in small sample sizes. Vibration-controlled transient elastography (VCTE) is a non-invasive tool that can simultaneously assess for both liver fibrosis and steatosis by estimating liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) respectively. The aim of the current study is to estimate the prevalence of (1) abnormal LSM indicative of any fibrosis based on LSM ≥ 6.5 kPa, (2) compensated Advanced Chronic Liver Disease (cACLD) – suggestive(10-15kPa) and highly suggestive (>15 kPa), and (3) severe steatosis
Experimental Design or Project Methods:
Patients seen at digestive and liver disorders clinic at Indiana University Hospital that underwent VCTE between 8/2013-4/2018 were identified from the Fibrocan502 Touch data table. The ICD10 codes used as the indication for performing the VCTE were extracted and confirmed with the review of electronic health records.
Results:
1240 patients met the criteria. The prevalence of abnormal LSM in the study cohort was 66% with 38.5 % having LSM suggestive of cACLD and 22% having LSM highly suggestive of cACLD. The prevalence of severe steatosis was 77%. The proportion of NAFLD patients with cACLD (suggestive and highly suggestive) during the study period was not significantly different (Figure1).
Conclusion and Potential Impact:
There are many NAFLD patients with liver stiffness indicative of abnormal LSM and 22% have LSM that is highly suggestive of cACLD. The proportion of patients with cACLD is steady over the study duration.
Role of CCL21 on the Transcriptional Regulation of MHC II in Malignant Glioma Infiltrating Plasmacytoid Dendritic Cells
Authors: Newman Sharlé , Chintala Sreenivasulu , Henriquez Mario , Dey Mahua 
Published: January 2019

Background and Hypothesis: Glioblastoma (GBM) is a malignant brain tumor characterized by high tumor heterogeneity and an immunosuppressive tumor microenvironment (TME). Immunomodulation approaches have been investigated, but outcomes remain poor. Several studies describe the functional deregulation of immune cells including, T cells, dendritic cells (DC), and macrophages. Plasmacytoid dendritic cells (pDC), which accumulate in the GBM TME, are shown to have an immunosuppressive phenotype characterized by a lack of IFN-[Symbol] secretion and upregulation of MHC II. MHC II presentation is transcriptionally regulated by several factors produced by tumor cells including, TGFβ, TNFα, and IL10 through the modulation of CIITA, the catalytic component of the enhanceosome. GBM tumor cells secrete several chemokines/cytokines, which may regulate MHC II expression in pDCs. We hypothesize that chemokine CCL21 transcriptionally upregulates MHC II through the activation of CIITA in pDC.
Experimental Design/Project methods: We performed experiments using two GBM tumor cells models GL261 and CT2A and used western blot, PCR, immunohistochemistry, immunofluorescence, and flow cytometry to determine the levels of CCL21 and its ligands ACKR3/4 in tumor cells and pDC.
Results: We observed overexpression of CCL21 in GBM and upregulation of MHCII in tumor associated pDC. We predict that inhibition of CCL21 will lead to downregulation of MHC II in tumor associated pDC which could potentially lead to reversal of the immunosuppressive TME by presenting the antigens to T cells.
Conclusions/Potential Impact: The results of this study can elucidate novel mechanisms of MHCII regulation and identify CCL21 as a potential therapeutic target for immunotherapy development in GBM.
Patient Perception of Empathy from Emergency Medicine Residents
Authors: Ofoma, MS Max , Pettit, MD Katie 
Published: January 2019

Background and Hypothesis: This project analyzes the effect of years of training and gender of ED providers on patients’ perception of empathy from them. The project will also explore how patient characteristics may impact the patients’ perception of empathy from the ED providers.
It is expected that women providers in their third year of training will exhibit higher scores of empathy. It has been previously demonstrated that white women with a college education have the worst perceptions of empathy from their ED providers.
Experimental Design or Project Methods: Eligible patients from Eskenazi/Methodist Hospital, who have had a CT scan ordered, will be enrolled via convenience sample. Patient perceptions of physician empathy will be assessed via the “Empathy Behavior Survey for Patients” (EBS) and “Jefferson Scale of Patient Perceptions of Physician Empathy” (JSPPPE). Patient demographic data and information about the provider ordering the CT scan will be recorded as well.
Results: On the EBS/JSPPE, 1st, 2nd, and 3rd year residents were given scores of 51/31.5, 51/31, and 51.5/33 respectively. Male residents were given a median score of 51 on the EBS and 32 on the JSPPPE. Female residents were given a median score of 50.5 and 31 on the JSPPPE. White female patients with a college education gave a score of 50.5 on the EBS and a 32.5 on the JSPPPE.
Conclusion and Potential Impact: Years of training or gender do not seem to have an impact on patient perception of empathy nor do White female patients with a college education.
Decreased Dynamic Flexibility of Brain Functional Connectivity in Prodromal Alzheimer’s Disease
Authors: Osborn Zachary G. , Risacher Shannon L. , West John D. , Tallman Eileen , Apostolova Liana , Sporns Olaf , Saykin Andrew J. 
Published: January 2019

Background and Hypothesis:
In neuroimaging, functional connectivity (FC), defined as the correlation between the functional MRI signals of two brain grey matter regions of interest (ROIs), is thought to reflect communication between ROIs. Changes in whole brain FC networks have been detected in Alzheimer’s disease (AD); however, traditional FC networks generated using the entire length of an fMRI scan could miss cognitively relevant fluctuations in FC. Analyzing dynamic patterns of FC within subsets of fMRI scans is hypothesized to enable greater sensitivity to deficits of information transfer and processing in AD compared to static FC.
Project Methods:
Functional MRI data of 58 participants with either subjective cognitive decline (SCD), mild cognitive impairment (MCI), AD, or controls were divided into time windows; the FC within each window provides sequential dynamic FC networks (dFC). Each dFC network was partitioned into subnetworks, e.g. visual or motor, whose member ROIs are strongly interconnected, and the functional flexibility of an ROI was estimated by the number of times it switches subnetworks in a scan.
Results:
The flexibility of the left inferior parietal lobule, right rostral lateral orbitofrontal cortex, and right amyglada/parahippocampal gyrus showed the highest correlations with Montreal Cognitive Assessment scores: r = 0.2516, 0.2480, and 2421, respectively. Although no correlations reached conventional significance (p = 0.0568, 0.0605, and 0.0671, uncorrected), this may reflect low power that should be increased with a planned larger sample.
Potential Impact:
Dynamic FC analyses may help clarify the neurophysiological mechanisms underlying cognitive decline, but methodological refinements and higher resolution data are likely needed to realize this potential.
Immune regulation of neuronal injury and repair by observing T cell activation
Authors: Regele Eric J. , Runge Elizabeth M. , Kennedy Felicia M. , Sanders Virginia M. , Jones Kathryn J. 
Published: January 2019

Background and Hypothesis:
It is unknown how the immune system maintains the majority of facial motoneuron (FMN) survival after axotomy. IL-10 cytokine is necessary for FMN survival and CD4+ T cells are activated and play a critical role in survival, but do not produce IL-10. It was proposed that the source of IL-10 resides in the CNS; however, it is possible that antigen presenting cells (APC) produce IL-10 which activate CD4+ T cells to a neuroprotective phenotype. The regulation of IL-10 receptors (IL-10R) in immunodeficient compared to wild-type (WT) mice in the facial nucleus was studied in this experiment, as well as the possibility of the PNS producing IL-10.
Experimental Design or Project Methods:
To study APC’s role in motoneuron survival, we transferred WT whole splenocytes into global IL-10 knock out (KO) mice prior to axotomy. To study IL-10R gene expression, immunodeficient RAG-2 KO mice received WT or IL-10R-/- CD4+ T cells prior to axotomy.
Results:
qPCR revealed that WT mice upregulate IL-10R after axotomy, whereas RAG-2 KO mice had decreased expression comparatively. RAG-2 mice who received WT CD4+ T cells transfer restored IL-10R comparable to WT values.IL-10R was rescued in RAG-2 mice after the adoptive transfer of WT CD4+T cells. When IL-10R-/- CD4+ cells were transferred into RAG-2 mice, IL-10R values were restored; however, these T cells were unable to rescue FMN survival.
Conclusion and Potential Impact:
If WT whole splenocytes transferred into global IL-10 KO mice rescue FMN survival, it implies that APC play a role in producing IL-10. If they cannot mediate rescue, then peripheral IL-10 is unlikely sufficient for FMN survival. CD4+ T cells regulate central IL-10R response and must respond to IL-10 to mediate FMN survival. The transfer of whole splenocytes provides APCs capable of producing IL-10 and CD4+ T cells capable of responding to IL-10.
Attitudes toward Contraception Initiation in the Emergency Department among Providers and Patients
Authors: VanderVinne, DO Nathan , Ryckman, BS Sydney , Coy, DO Lynn , Swartz, MD, JD Kimberly , Bernard, MD Caitlin , Kline, MD Jeffrey 
Published: January 2019

Background and Hypothesis:
In 2011, 45% of 6.1 million pregnancies were unintended. Women between the ages of 20-24, those with lower education, lower income, and of African American descent had higher rates of unintended pregnancies.i In 2014, there were 25.9 million visits to the ED by women under the age of 24.ii Intervention within the Emergency Department to assess fertility status and provide contraception when appropriate has the potential to help reduce the number of mistimed and unwanted pregnancies.
Experimental Design or Project Methods:
This study aims to assess the attitudes toward providing contraception within the Emergency Department via surveys. The provider survey will be sent through a large national list serve; the patient survey was given to women 18-45 years old within the Emergency Departments of a large county hospital and inner-city urban hospital.
Results:
So far, 200 surveys were collected. 32 women were planning to get pregnant within the next year, 135 were not attempting to get pregnant, 13 were unsure, and 20 could not get pregnant. The number of women who were unsure or did not want to get pregnant totaled to 148; out of these women, 62% showed interest in receiving access to birth control within the ED. We still plan to do more data analysis, including how many of these women are currently using birth control and demographic analysis looking at race, education level, and relationship status.
Conclusion and Potential Impact:
If there is substantial interest, we will then conduct a study to initiate contraception within the ED. This will hopefully contribute to reducing the unintended pregnancy rate.
Determining Health Utilities for Immunosuppression in Pediatric Inflammatory Bowel Disease
Authors: Schmidt, BA Lauren , Bennett, Jr., MD, MS William E. 
Published: January 2019

Background and Hypothesis: Inflammatory Bowel Disease is a significant cause of gastrointestinal pathology in children and adolescents, with increasing incidence. The medications used to control this disease have an overall low risk of detrimental side effects, but when they occur can be serious or life-threatening. The most important side effects of immunosuppression in IBD are infection and malignancy, but little is known about how these risks affect patients’ and their families’ decisions about medication use. Clinical utilities are a standard methodology used to assign risk to various hypothetical health states. We hypothesized that lower health utility scores would be assigned to scenarios related to cancer than to infection, even if the risks or severity were similar.
Experimental Design or Project Methods: This study determines the clinical utility of immunosuppression and cancer / infection risk in children with inflammatory bowel disease using the standard gamble technique. The standard gamble technique measures individual preferences for many different therapeutic modalities, under uncertain results. The study will look at the health utilities of at least 50 families at Riley hospital for Children and IU North, with at least 25 patients with ulcerative colitis and 25 patients with Crohn’s disease. In addition to the perfect health and death, we propose to utilize six different hypothetical health states during this study: (1) untreated IBD, (2) on a medication with no side effects, (3) on a medication with risk of a treatable infection, (4) on a medication with risk of an untreatable infection, (5) on a medication with risk of a treatable cancer, (6) and on a medication with risk of an untreatable cancer. We will also gather subject demographics, family education, family income, and perform an assessment of numeracy. These variables will then be used in a regression model to assess the effect of these confounders.
Results: We have not yet enrolled subjects, but now that the tool and Standard Gamble design are complete, we expect to rapidly accrue enrollment over the next two weeks and will update results at that time.
Conclusion and Potential Impact: Health utility data in pediatric IBD are quite scarce, with room for further research. It is crucial to understand the health utilities in individuals with inflammatory bowel disease (IBD), specifically in pediatric patients. This allows for cost-utility analysis to play a role in determining effectiveness for a wide variety of treatment modalities. It is also important when discussing treatment options with families when the risk of infection or cancer are present. Knowledge gained from this study may help us design interventions that focus on educating families about the nature and magnitude of these important risks in immunosuppressive therapy.
Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation to Improve Surgical Candidacy Prior to Abdominal Operation: A Retrospective Analysis
Authors: Schmitz Adam , Haste, MD Paul , Johnson, MD Matthew S. 
Published: January 2019

Background and Hypothesis: TIPS creation is typically reserved for patients with refractory ascites or variceal hemorrhage. While TIPS have also been created prior to planned abdominal operation to decrease morbidity related to portal hypertension, there is little in the literature supporting its efficacy in that indication. The goal of this study was to determine if preoperative TIPS creation allows successful abdominal operation and improves outcomes.
Experimental Design or Project Methods: A retrospective review of records of 22 patients who underwent preoperative TIPS creation between 2011 and 2016 was performed. Clinical and serologic data were obtained for 21 patients since one patient was completely lost to follow up after TIPS creation. The primary endpoint was whether patients underwent planned abdominal operation following TIPS. Operative outcomes and reasons that patients failed to undergo planned operation were examined as secondary endpoints.
Results: The mean age was 56.4 ± 8.8 years, and the mean Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were 7.2 ± 1.5 and 11.9 ± 4.3, respectively. Thirty-day mortality after TIPS creation was 9.5%. Eleven patients (52.4%) underwent planned abdominal operation and the thirty-day mortality rate was 0%. One of these 11 patients (9.1%) had surgical wound dehiscence and infection 53 days after operation. Reasons for failure to proceed to abdominal operation after TIPS were multifactorial.
Conclusion and Potential Impact: In our population, TIPS allowed successful abdominal operation in the majority of patients, with thirty-day TIPS mortality of 9.5%, no perioperative mortality, and 9.1% major postoperative morbidity.