Background: Despite the high efficacy and safety of routine vaccinations, most of the United States is currently falling well short of the Healthy People 2020 goals for childhood vaccination rates. A large racial disparity exists within the IU Health (IUH) system, with about a 26% difference between Black/African American (BAA) and white patient vaccination rates as of 2022. Within IUH, the most commonly missed appointment is the 4-month well child check, a critical appointment for staying up to date on vaccinations. In response to this disparity, a pilot program was launched to assist BAA patients in scheduling, attending visits, and getting vaccinated. This study also investigates the roles of insurance, race, ethnicity, and gender in racial disparities of routine vaccination rates among IU Health pediatric patients at the Riley Pediatric Care Center (PCC). Project Methods: A cohort of patients at the PCC clinic who were not meeting vaccination recommendations were compared to the PCC patient population as a whole to identify drivers of under-vaccination. These patients were also compared to patients within the pilot vaccination program to assess program efficacy in scheduling and attending 4-month well child checks. Results: The largest differences between the cohort not meeting the vaccination measure and the PCC patient population were race and insurance status. Patients not meeting vaccination recommendations were more likely to be BAA and to use Medicaid. The pilot program patient population had much higher rates of attendance at 4-month well child checks and vaccination rates for rotavirus among BAA patients than the IUH BAA patient population as a whole. Conclusions: The data from this study will help identify drivers of racial disparities in vaccination rates and guide data-driven and community-informed interventions to ameliorate the disparity. The pilot program has shown great success and warrants strong consideration for increased investment and expansion.
{"title":"Racial Disparities in Childhood Vaccination Rates","authors":"Neal Hayhurst, Meagan O’Neill","doi":"10.18060/27856","DOIUrl":"https://doi.org/10.18060/27856","url":null,"abstract":"Background: Despite the high efficacy and safety of routine vaccinations, most of the United States is currently falling well short of the Healthy People 2020 goals for childhood vaccination rates. A large racial disparity exists within the IU Health (IUH) system, with about a 26% difference between Black/African American (BAA) and white patient vaccination rates as of 2022. Within IUH, the most commonly missed appointment is the 4-month well child check, a critical appointment for staying up to date on vaccinations. In response to this disparity, a pilot program was launched to assist BAA patients in scheduling, attending visits, and getting vaccinated. This study also investigates the roles of insurance, race, ethnicity, and gender in racial disparities of routine vaccination rates among IU Health pediatric patients at the Riley Pediatric Care Center (PCC). \u0000Project Methods: A cohort of patients at the PCC clinic who were not meeting vaccination recommendations were compared to the PCC patient population as a whole to identify drivers of under-vaccination. These patients were also compared to patients within the pilot vaccination program to assess program efficacy in scheduling and attending 4-month well child checks. \u0000Results: The largest differences between the cohort not meeting the vaccination measure and the PCC patient population were race and insurance status. Patients not meeting vaccination recommendations were more likely to be BAA and to use Medicaid. The pilot program patient population had much higher rates of attendance at 4-month well child checks and vaccination rates for rotavirus among BAA patients than the IUH BAA patient population as a whole. \u0000Conclusions: The data from this study will help identify drivers of racial disparities in vaccination rates and guide data-driven and community-informed interventions to ameliorate the disparity. The pilot program has shown great success and warrants strong consideration for increased investment and expansion.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"55 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alex Nelson, N. Anton, Mohammed Kalantar, Dimitrios Stefanidis
Background/Objective: Cognitive load (CL) is the amount of mental effort and resources required to complete a task and process information in the working memory. In a surgical setting, high CL decreases attention to critical details, and slows down decision-making, increasing errors which can compromise patient safety. Our aim was to determine if CL differences exist between trainees and experienced attending surgeons. Such differences could inform readiness for trainee autonomy and training paradigms. Methods: Eye trackers were used by attending general surgeons and trainees during robotic gastrointestinal procedures to determine their CL. Average fixation rate (AFR), fixation to saccade (F:S) ratio, and change in pupil size, were recorded and compared between attending surgeons and trainees to determine differences in intraoperative cognitive load. Results: Three attendings and three trainees participated. While operating, trainees had a lower AFR (M=0.775, SD= 0.093) and a lower F:S (M=0.497, SD=0.102) compared to attendings (M=0.842, SD=0.152 and M=0.592, SD=0.243, respectively). Both trainees and attendings had a larger pupil size (M=4.29, SD=0.773 and M=3.63, SD=0.077, respectively) while operating compared to their pupil size while not operating (M=4.057, SD=0.821 and M=3.496, SD=0.059, respectively. Conclusion and Potential Impact:In this pilot study, we determined eye tracking metrics can be used to detect differences in intraoperative CL between trainees and attending surgeons and while they were operating or observing. Further research should determine methods that decrease CL of trainees.
{"title":"Intraoperative Cognitive Load Differences between Trainees and Attending Surgeons","authors":"Alex Nelson, N. Anton, Mohammed Kalantar, Dimitrios Stefanidis","doi":"10.18060/27753","DOIUrl":"https://doi.org/10.18060/27753","url":null,"abstract":"Background/Objective: Cognitive load (CL) is the amount of mental effort and resources required to complete a task and process information in the working memory. In a surgical setting, high CL decreases attention to critical details, and slows down decision-making, increasing errors which can compromise patient safety. Our aim was to determine if CL differences exist between trainees and experienced attending surgeons. Such differences could inform readiness for trainee autonomy and training paradigms. \u0000Methods: Eye trackers were used by attending general surgeons and trainees during robotic gastrointestinal procedures to determine their CL. Average fixation rate (AFR), fixation to saccade (F:S) ratio, and change in pupil size, were recorded and compared between attending surgeons and trainees to determine differences in intraoperative cognitive load. \u0000Results: Three attendings and three trainees participated. While operating, trainees had a lower AFR (M=0.775, SD= 0.093) and a lower F:S (M=0.497, SD=0.102) compared to attendings (M=0.842, SD=0.152 and M=0.592, SD=0.243, respectively). Both trainees and attendings had a larger pupil size (M=4.29, SD=0.773 and M=3.63, SD=0.077, respectively) while operating compared to their pupil size while not operating (M=4.057, SD=0.821 and M=3.496, SD=0.059, respectively. \u0000Conclusion and Potential Impact:In this pilot study, we determined eye tracking metrics can be used to detect differences in intraoperative CL between trainees and attending surgeons and while they were operating or observing. Further research should determine methods that decrease CL of trainees.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"17 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Yallourakis, Eric Gonsiorowski, Baraka Muvuka, Jonathan E. Guerrero
Background: Hospital length of stay (LOS) is a crucial metric that impacts patient outcomes, healthcare resource utilization, and financial burden. In 2019 the CDC reported the average LOS in community hospitals was 5.4 days. Prolonged LOS is associated with an increased risk of hospital-acquired infections, decreased hospital bed availability limiting patient access to care, and cognitive impairment, particularly among the elderly. This indicates the importance of addressing LOS as a healthcare priority. This study examined the relationship between LOS and social determinants of health (SDOH), patient demographics, health behaviors, and health outcomes as part of a long-term Community Based Participatory Research partnership between IUSM-NW and St. Mary Medical Center (SMMC). Methods: This retrospective study analyzed EPIC™-generated data for adult inpatient visits at an urban hospital in Northwest Indiana from January 2021 to March 2023. Data analysis was performed using SPSS 28.0, consisting of descriptive statistics, bivariate analysis (One-way ANOVA, Independent T-tests, Kruskal Wallis H; p<0.05), and Simple Linear Regression. This study was granted an exemption by the Indiana University Human Research Protection Program (IRB #14040). Results: The sample comprised of 10,916 predominantly white (77.7%) patients with a median age of 65 (IQR=22) and a median LOS of 4 days (IQR= 5). Bivariate analysis revealed LOS was significantly associated with age (p<0.001), race (p<0.033), sex (p<0.012), insurance type (p<0.001), physical inactivity (p<0.001), and smoking tobacco (p<0.001). After controlling for all factors in the multivariate analysis, age (p<0.020), physical inactivity (p<0.013), and insurance type (p<0.013) retained their significance. Conclusions: These findings highlight the significance of demographic, behavioral, and social factors in relation to hospital LOS. Understanding these factors holds immense potential to guide the development of targeted interventions and healthcare strategies to optimize patient care and reduce LOS.
{"title":"Identifying Socio-Demographic and Behavioral Predictors of Prolonged Hospital Stay in an Urban Hospital in Northwest Indiana","authors":"Michael Yallourakis, Eric Gonsiorowski, Baraka Muvuka, Jonathan E. Guerrero","doi":"10.18060/27817","DOIUrl":"https://doi.org/10.18060/27817","url":null,"abstract":"Background: Hospital length of stay (LOS) is a crucial metric that impacts patient outcomes, healthcare resource utilization, and financial burden. In 2019 the CDC reported the average LOS in community hospitals was 5.4 days. Prolonged LOS is associated with an increased risk of hospital-acquired infections, decreased hospital bed availability limiting patient access to care, and cognitive impairment, particularly among the elderly. This indicates the importance of addressing LOS as a healthcare priority. This study examined the relationship between LOS and social determinants of health (SDOH), patient demographics, health behaviors, and health outcomes as part of a long-term Community Based Participatory Research partnership between IUSM-NW and St. Mary Medical Center (SMMC). \u0000Methods: This retrospective study analyzed EPIC™-generated data for adult inpatient visits at an urban hospital in Northwest Indiana from January 2021 to March 2023. Data analysis was performed using SPSS 28.0, consisting of descriptive statistics, bivariate analysis (One-way ANOVA, Independent T-tests, Kruskal Wallis H; p<0.05), and Simple Linear Regression. This study was granted an exemption by the Indiana University Human Research Protection Program (IRB #14040). \u0000Results: The sample comprised of 10,916 predominantly white (77.7%) patients with a median age of 65 (IQR=22) and a median LOS of 4 days (IQR= 5). Bivariate analysis revealed LOS was significantly associated with age (p<0.001), race (p<0.033), sex (p<0.012), insurance type (p<0.001), physical inactivity (p<0.001), and smoking tobacco (p<0.001). After controlling for all factors in the multivariate analysis, age (p<0.020), physical inactivity (p<0.013), and insurance type (p<0.013) retained their significance. \u0000Conclusions: These findings highlight the significance of demographic, behavioral, and social factors in relation to hospital LOS. Understanding these factors holds immense potential to guide the development of targeted interventions and healthcare strategies to optimize patient care and reduce LOS.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Bisch, Caylin L Billingsley, R. Katzenellenbogen
Background and Hypothesis: Human Papillomavirus (HPV) is the causative agent in nearly all cervical cancer cases. It has been shown that the HPV type 16 E6 protein interacts directly with the host protein NFX1-123. Short-term studies have shown that NFX1-123 remains in the cytoplasm; however, it has not been investigated whether NFX1-123 actually translocates to the nucleus in the long term. We hypothesize that over time, NFX1-123 translocates to the nucleus of the cell in long term cultures with 16E6. This present study seeks to optimize the AmbionTM Paris system to allow for pure, proper separation of the cytoplasmic and nuclear cellular compartments. Project Methods: Three biologically unique backgrounds of human foreskin keratinocytes (HFKs) were cultured in a monolayer tissue culture dish. Using the AmbionTM Paris system, proteins were isolated as whole cell extracts, or nuclear and cytoplasmic fractions. For one lysis method, only protease inhibitors were added to the lysis buffers of the AmbionTM Paris system. For another lysis method, 1% NP-40 and protease inhibitors were added to the lysis buffers of the Paris system. Protein lysate concentrations were quantified, then purity of subcellular lysates was determined by western blotting. Histone H3 and GAPDH were used to identify nuclear and cytoplasmic compartments, respectfully. Results: Western blotting confirmed that adding 1% NP-40 to the lysis reagents of the AmbionTM Paris kit optimized subcellular fractionization. Potential Impact: Being able to efficiently separate the cytoplasmic and nuclear compartments will allow for accurate identification of NFX1-123 localization during long-term HPV16 infection. If NFX1-123 is found to move into the nucleus under the influence of HPV 16E6, then this could indicate potential transcriptional regulatory functions of the NFX1-123 protein during HPV infection, which is unique from its function in non-infected cells.
{"title":"The Quandary of Cellular Fractionation — Optimizing Ambion™ Paris System to Advance HPV16 Cancer Research","authors":"Emma Bisch, Caylin L Billingsley, R. Katzenellenbogen","doi":"10.18060/27889","DOIUrl":"https://doi.org/10.18060/27889","url":null,"abstract":"Background and Hypothesis: Human Papillomavirus (HPV) is the causative agent in nearly all cervical cancer cases. It has been shown that the HPV type 16 E6 protein interacts directly with the host protein NFX1-123. Short-term studies have shown that NFX1-123 remains in the cytoplasm; however, it has not been investigated whether NFX1-123 actually translocates to the nucleus in the long term. We hypothesize that over time, NFX1-123 translocates to the nucleus of the cell in long term cultures with 16E6. This present study seeks to optimize the AmbionTM Paris system to allow for pure, proper separation of the cytoplasmic and nuclear cellular compartments. \u0000Project Methods: Three biologically unique backgrounds of human foreskin keratinocytes (HFKs) were cultured in a monolayer tissue culture dish. Using the AmbionTM Paris system, proteins were isolated as whole cell extracts, or nuclear and cytoplasmic fractions. For one lysis method, only protease inhibitors were added to the lysis buffers of the AmbionTM Paris system. For another lysis method, 1% NP-40 and protease inhibitors were added to the lysis buffers of the Paris system. Protein lysate concentrations were quantified, then purity of subcellular lysates was determined by western blotting. Histone H3 and GAPDH were used to identify nuclear and cytoplasmic compartments, respectfully. \u0000Results: Western blotting confirmed that adding 1% NP-40 to the lysis reagents of the AmbionTM Paris kit optimized subcellular fractionization. \u0000Potential Impact: Being able to efficiently separate the cytoplasmic and nuclear compartments will allow for accurate identification of NFX1-123 localization during long-term HPV16 infection. If NFX1-123 is found to move into the nucleus under the influence of HPV 16E6, then this could indicate potential transcriptional regulatory functions of the NFX1-123 protein during HPV infection, which is unique from its function in non-infected cells.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arris Yoniles, Olufisayo Anjorin, Meghana Bhaskara, Meijing Wang
Background: Previous studies have indicated better myocardial responses with preserved cardiac function in female animals compared to males after LPS challenge; however, the mechanisms remain incompletely understood. Our published studies have revealed that TNFa substantially increased in heart tissue and serum following LPS. Females experienced less cardiac dysfunction than males during equivalent dose of TNFa infusion. Therefore, sex-related disparities in myocardial impairment could be due to an indirect/secondary outcome from LPS-induced inflammatory cytokines, like TNFa. To dissect the potential mechanism underlying myocardial reactions between males and females, we aim to determine any sex differences in LPS-caused direct effects on cardiac function using coronary infusion of LPS. Methods: Isolated hearts from aged-matched adult male and female mice were subjected to LPS infusion via Langendorff after >20-min equilibration (Eq), with left ventricular developed pressure (LVDP) continuously recorded. Dose responsive experiments with LPS at 2.5, 5.0, and 7.5 mg/kg of body weight were performed in male hearts. Significant depression of LVDP (>20% drop) after LPS infusion was considered rapid response to LPS. Female estrous cycle was determined via vaginal smear. Results: Male hearts infused with 5.0 and 7.5 mg/kg of LPS demonstrated significant depression of LV function. Males also experienced worse outcomes of LV function than females following 5.0 mg/kg of LPS infusion. A trend of earlier response to LPS occurred in male hearts compared to females. However, there were no significant differences in cardiac function between female groups in different estrous phases. Conclusion and Potential Impact: Our data demonstrates that male hearts exhibit higher sensitivity to LPS-induced rapid cardiac dysfunction compared to females, but estrogen may have little influence on LPS-induced rapid functional depression. The insight from our data can be used to better understand the differences between male and female outcomes to cardiac pathologies and insult.
{"title":"Sex-Based Differences in LPS-induced Rapid Myocardial Dysfunction","authors":"Arris Yoniles, Olufisayo Anjorin, Meghana Bhaskara, Meijing Wang","doi":"10.18060/27815","DOIUrl":"https://doi.org/10.18060/27815","url":null,"abstract":"Background: Previous studies have indicated better myocardial responses with preserved cardiac function in female animals compared to males after LPS challenge; however, the mechanisms remain incompletely understood. Our published studies have revealed that TNFa substantially increased in heart tissue and serum following LPS. Females experienced less cardiac dysfunction than males during equivalent dose of TNFa infusion. Therefore, sex-related disparities in myocardial impairment could be due to an indirect/secondary outcome from LPS-induced inflammatory cytokines, like TNFa. To dissect the potential mechanism underlying myocardial reactions between males and females, we aim to determine any sex differences in LPS-caused direct effects on cardiac function using coronary infusion of LPS. \u0000 \u0000Methods: Isolated hearts from aged-matched adult male and female mice were subjected to LPS infusion via Langendorff after >20-min equilibration (Eq), with left ventricular developed pressure (LVDP) continuously recorded. Dose responsive experiments with LPS at 2.5, 5.0, and 7.5 mg/kg of body weight were performed in male hearts. Significant depression of LVDP (>20% drop) after LPS infusion was considered rapid response to LPS. Female estrous cycle was determined via vaginal smear. \u0000 \u0000Results: Male hearts infused with 5.0 and 7.5 mg/kg of LPS demonstrated significant depression of LV function. Males also experienced worse outcomes of LV function than females following 5.0 mg/kg of LPS infusion. A trend of earlier response to LPS occurred in male hearts compared to females. However, there were no significant differences in cardiac function between female groups in different estrous phases. \u0000 \u0000Conclusion and Potential Impact: Our data demonstrates that male hearts exhibit higher sensitivity to LPS-induced rapid cardiac dysfunction compared to females, but estrogen may have little influence on LPS-induced rapid functional depression. The insight from our data can be used to better understand the differences between male and female outcomes to cardiac pathologies and insult.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 0","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Hypothesis:The prevalence of type 2 diabetes (T2DM) is increasing, and it is associated with an increased risk for adverse perinatal outcomes. Fetal overgrowth is associated with an increased risk for obesity and diabetes in offspring of individuals with type 2 diabetes, and we sought to identify factors associated with excess fetal growth in pregnant individuals with T2DM. Experimental Design or Project Methods:This was a retrospective cohort study of 350 pregnant individuals with T2DM who delivered at IU Health Hospitals or Eskenazi Hospital from January 1, 2019-December 31,2021. We excluded pregnancies complicated by twin gestation or stillbirth. Maternal demographic data and perinatal outcomes were abstracted from the electronic medical record. Birth weights were classified as small for gestational age (SGA; <10th percentile), appropriate for gestational age (AGA; 10-90th percentile), and large for gestational age (LGA; >90th percentile) using a US birth weight standard. Maternal characteristics and pregnancy outcomes were compared across the 3 categories using ANOVA and chi squared statistic. Multinomial logistic regression was used to identify factors associated with birth weight category. Results:LGA birth weight occurred in 95 (27%) and SGA birth occurred in 32 (9%) of pregnancies. After adjusting for covariates, HbA1c after 20 weeks’ gestation was significantly associated with risk for SGA birth weight (aOR 0.4, 95% CI 0.19-0.94) and LGA birth weight (aOR 1.47, 95% CI 1.10-1.96). Individuals requiring treatment with both insulin and oral agents at the first prenatal visit were at increased risk for LGA birth weight (aOR 4.49, 95% CI 1.43-14.10). Conclusion and Potential Impact:Our findings highlight the important relationship between glycemic control in the second half of pregnancy and fetal growth. Additional research is needed to optimize glycemic control in pregnant individuals with T2DM.
背景与假设：2 型糖尿病（T2DM）的发病率正在上升，而且与围产期不良结局的风险增加有关。胎儿过度生长与2型糖尿病患者后代肥胖和糖尿病风险增加有关，我们试图找出与T2DM孕妇胎儿过度生长有关的因素。实验设计或项目方法：这是一项回顾性队列研究，研究对象是2019年1月1日至2021年12月31日期间在IU健康医院或Eskenazi医院分娩的350名T2DM孕妇。我们排除了双胎妊娠或死胎的孕妇。产妇人口统计学数据和围产期结果均来自电子病历。出生体重按照美国出生体重标准划分为胎龄小（SGA；第90百分位数）。采用方差分析和卡方统计对 3 个类别的孕产妇特征和妊娠结局进行比较。多项式逻辑回归用于确定与出生体重类别相关的因素。结果：95 名孕妇（27%）的出生体重为 LGA，32 名孕妇（9%）的出生体重为 SGA。调整协变量后，妊娠 20 周后的 HbA1c 与 SGA 出生体重（aOR 0.4，95% CI 0.19-0.94）和 LGA 出生体重（aOR 1.47，95% CI 1.10-1.96）的风险显著相关。在首次产前检查时需要同时使用胰岛素和口服药物治疗的患者，其出生体重为 LGA 的风险也会增加（aOR 4.49，95% CI 1.43-14.10）。结论和潜在影响：我们的研究结果强调了妊娠后半期血糖控制与胎儿生长之间的重要关系。需要开展更多研究，以优化患有 T2DM 的孕妇的血糖控制。
{"title":"Factors Associated with Fetal Growth in Pregnancies Complicated by Type 2 Diabetes Mellitus","authors":"Valeria Rutty-Serrano, Christina Scifres","doi":"10.18060/27765","DOIUrl":"https://doi.org/10.18060/27765","url":null,"abstract":"Background and Hypothesis:The prevalence of type 2 diabetes (T2DM) is increasing, and it is associated with an increased risk for adverse perinatal outcomes. Fetal overgrowth is associated with an increased risk for obesity and diabetes in offspring of individuals with type 2 diabetes, and we sought to identify factors associated with excess fetal growth in pregnant individuals with T2DM. \u0000Experimental Design or Project Methods:This was a retrospective cohort study of 350 pregnant individuals with T2DM who delivered at IU Health Hospitals or Eskenazi Hospital from January 1, 2019-December 31,2021. We excluded pregnancies complicated by twin gestation or stillbirth. Maternal demographic data and perinatal outcomes were abstracted from the electronic medical record. Birth weights were classified as small for gestational age (SGA; <10th percentile), appropriate for gestational age (AGA; 10-90th percentile), and large for gestational age (LGA; >90th percentile) using a US birth weight standard. Maternal characteristics and pregnancy outcomes were compared across the 3 categories using ANOVA and chi squared statistic. Multinomial logistic regression was used to identify factors associated with birth weight category. \u0000Results:LGA birth weight occurred in 95 (27%) and SGA birth occurred in 32 (9%) of pregnancies. After adjusting for covariates, HbA1c after 20 weeks’ gestation was significantly associated with risk for SGA birth weight (aOR 0.4, 95% CI 0.19-0.94) and LGA birth weight (aOR 1.47, 95% CI 1.10-1.96). Individuals requiring treatment with both insulin and oral agents at the first prenatal visit were at increased risk for LGA birth weight (aOR 4.49, 95% CI 1.43-14.10). \u0000Conclusion and Potential Impact:Our findings highlight the important relationship between glycemic control in the second half of pregnancy and fetal growth. Additional research is needed to optimize glycemic control in pregnant individuals with T2DM.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Bice, Peyton Estes, Benjamin E. Loflin, Roufael Hanna, Stephen Schlecht
Background and Hypothesis:A human placental-derived extracellular matrix (ECM) allograft has previously been developed and is indicated by the manufacturer for reducing tissue inflammation and accelerated repair. To evaluate the efficacy of this product for reducing post-anterior cruciate ligament (ACL) injury inflammation, we used a novel murine in vivo ACL injury model. This model has previously been shown to induce significant synovitis, infrapatellar fat pad (IFP) fibrosis, and articular cartilage (AC) degradation within 2 weeks following an ACL injury. We hypothesized that intra-articular injections of the allograft would correspond with a decrease in synovitis, fibrosis, and articular cartilage degradation. Experimental Design or Project Methods:Ten-week-old C57BL/6J mice were randomly placed into 4 groups (n=10/group). For all mice, the right ACL was ruptured. One group served as sham controls, with a single intra-articular saline injection 24-hours following injury. The remaining three groups received 1, 2, and 6 allograft injections respectively beginning 24-hours after injury. Mice were euthanized 14 days after injury. Following euthanasia, the degree of IFP fibrosis, knee synovitis, and AC degradation were histopathologically evaluated. Results:Thus far, 5 mice per group have been analyzed. Within this subset of mice, those that received 6 injections demonstrated a significantly higher synovitis score (p < 0.01) than the sham group. The 1-injection (p < 0.01), 2-injection (p = 0.16), and 6-injection (p = 0.03) groups each displayed greater IFP fibrosis, relative to sham. No significant differences were found in AC degeneration across groups. Conclusion and Potential Impact:If the current results hold, following the analyses of the remaining mice, then this particular orthobiologic may not be suitable for reducing the post-ACL injury inflammatory response in mice. However, there are several limitations to this pilot study that will first need to be accounted for to confirm the lack of efficacy found.
{"title":"The Effects of Extracellular Matrix Allograft Administration on Knee Inflammation Following an Anterior Cruciate Ligament Injury in Mice","authors":"Caroline Bice, Peyton Estes, Benjamin E. Loflin, Roufael Hanna, Stephen Schlecht","doi":"10.18060/27887","DOIUrl":"https://doi.org/10.18060/27887","url":null,"abstract":"Background and Hypothesis:A human placental-derived extracellular matrix (ECM) allograft has previously been developed and is indicated by the manufacturer for reducing tissue inflammation and accelerated repair. To evaluate the efficacy of this product for reducing post-anterior cruciate ligament (ACL) injury inflammation, we used a novel murine in vivo ACL injury model. This model has previously been shown to induce significant synovitis, infrapatellar fat pad (IFP) fibrosis, and articular cartilage (AC) degradation within 2 weeks following an ACL injury. We hypothesized that intra-articular injections of the allograft would correspond with a decrease in synovitis, fibrosis, and articular cartilage degradation. \u0000Experimental Design or Project Methods:Ten-week-old C57BL/6J mice were randomly placed into 4 groups (n=10/group). For all mice, the right ACL was ruptured. One group served as sham controls, with a single intra-articular saline injection 24-hours following injury. The remaining three groups received 1, 2, and 6 allograft injections respectively beginning 24-hours after injury. Mice were euthanized 14 days after injury. Following euthanasia, the degree of IFP fibrosis, knee synovitis, and AC degradation were histopathologically evaluated. \u0000Results:Thus far, 5 mice per group have been analyzed. Within this subset of mice, those that received 6 injections demonstrated a significantly higher synovitis score (p < 0.01) than the sham group. The 1-injection (p < 0.01), 2-injection (p = 0.16), and 6-injection (p = 0.03) groups each displayed greater IFP fibrosis, relative to sham. No significant differences were found in AC degeneration across groups. \u0000Conclusion and Potential Impact:If the current results hold, following the analyses of the remaining mice, then this particular orthobiologic may not be suitable for reducing the post-ACL injury inflammatory response in mice. However, there are several limitations to this pilot study that will first need to be accounted for to confirm the lack of efficacy found.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wael Gad, Brianna Chandler, Brendan Jones, Baraka Muvuka, Jonathan E. Guerrero, Joshua Mangum
Background: Engaging in regular physical activity has been proven to have beneficial health effects such as preventing chronic diseases and improving mental health. Recent studies have demonstrated correlations between socio-demographic factors and physical activity levels. This study determined the associations between socio-demographic factors, social determinants of health and the amount of weekly physical activity in patients occupying an urban underserved area. Methods: This study retrospectively analyzed a dataset generated by St. Mary Medical Center from EPIC™ with demographic characteristics and physical activity levels partitioned by time per week for adult inpatient visits from January 2021 to March 2023. Patients were stratified into physical activity levels based upon published guidelines: inactive (no physical activity), insufficiently active (<150 minutes per week) or sufficiently active (≥150 minutes per week). Data analysis was conducted in SPSS 28.0 using tests of association including Kruskal Wallis H and multivariate ordinal regression model. This study was exempted by Indiana University Human Research Protection Program (IRB # 14040). Results: The sample of individuals from the dataset who answered physical activity questions was comprised of 1498 patients. There was a statistically significant difference in physical activity level by age group (p<0.001), sex (p<0.05), insurance category (p<0.001), and social connections risk score (p<0.001); with race (p=0.057) and language (p=0.054) approaching significance. Multivariate analysis showed that age was the only significant factor when accounting for all variables, with higher age groups reporting lower proportions of physically active individuals. Conclusion: Determining how socio-demographic factors influence physical activity levels will direct efforts to form and implement new interventions in the Northwest Indiana urban area and support community health initiatives. This data makes it possible to inform practitioners of the demographics that are at risk of being insufficiently active and having them direct those patients to programs in place to help bridge the lapse.
{"title":"Association of Socio-Demographic Factors, Social Determinants of Health, and Weekly Physical Activity in an Urban Hospital in Northwest Indiana","authors":"Wael Gad, Brianna Chandler, Brendan Jones, Baraka Muvuka, Jonathan E. Guerrero, Joshua Mangum","doi":"10.18060/27938","DOIUrl":"https://doi.org/10.18060/27938","url":null,"abstract":"Background: Engaging in regular physical activity has been proven to have beneficial health effects such as preventing chronic diseases and improving mental health. Recent studies have demonstrated correlations between socio-demographic factors and physical activity levels. This study determined the associations between socio-demographic factors, social determinants of health and the amount of weekly physical activity in patients occupying an urban underserved area. \u0000Methods: This study retrospectively analyzed a dataset generated by St. Mary Medical Center from EPIC™ with demographic characteristics and physical activity levels partitioned by time per week for adult inpatient visits from January 2021 to March 2023. Patients were stratified into physical activity levels based upon published guidelines: inactive (no physical activity), insufficiently active (<150 minutes per week) or sufficiently active (≥150 minutes per week). Data analysis was conducted in SPSS 28.0 using tests of association including Kruskal Wallis H and multivariate ordinal regression model. This study was exempted by Indiana University Human Research Protection Program (IRB # 14040). \u0000Results: The sample of individuals from the dataset who answered physical activity questions was comprised of 1498 patients. There was a statistically significant difference in physical activity level by age group (p<0.001), sex (p<0.05), insurance category (p<0.001), and social connections risk score (p<0.001); with race (p=0.057) and language (p=0.054) approaching significance. Multivariate analysis showed that age was the only significant factor when accounting for all variables, with higher age groups reporting lower proportions of physically active individuals. \u0000Conclusion: Determining how socio-demographic factors influence physical activity levels will direct efforts to form and implement new interventions in the Northwest Indiana urban area and support community health initiatives. This data makes it possible to inform practitioners of the demographics that are at risk of being insufficiently active and having them direct those patients to programs in place to help bridge the lapse.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background:Musculoskeletal infections (MSKI; osteomyelitis, septic arthritis) are among the most common invasive bacterial infections in children, often associated with complications. Bacteremia precedes these complications; thus, early identification may prevent them. Acute inflammatory markers, C-reactive protein (CRP) and Procalcitonin (PCT) are often elevated in children with acute MSKI. PCT is understudied in children with MSKI. The primary goal of this study was to evaluate the utility of PCT and CRP in distinguishing children with MSKI with bacteremia vs. those without. Methods:Patients 6 months to 18 years with strong clinical suspicion of MSKI were prospectively enrolled at Riley Hospital for Children from July 2019 to May 2022 unless clinical evidence suggested an alternative diagnosis or if informed consent was not obtained. CRP was obtained at admission and PCT was collected within 96 hours of presentation to the hospital. Demographic data was recorded from electronic medical records. Two-sided P values of <0.05 were considered statistically significant for univariate analysis and logistic regression. Results:Thirty-seven patients were enrolled, the majority being non-Hispanic white males (40.5%), median age of 8 years (IQR, 4-12). Median PCT in children with bacteremia was higher (0.41 ng/mL [IQR 0.14-0.8 ng/mL]) compared to those without (0.10 ng/mL [IQR 0.05-0.31 ng/mL]) (p=0.03). Median CRP in children with bacteremia was higher (13.7 mg/dL [IQR, 9.15-19.9]) compared to those without (4.1 mg/dL, [IQR 0.65-5.8]) (p<0.01). Both PCT and CRP showed good ability to discriminate those with bacteremia from those without, with an area under the ROC of 0.75 (95% CI 0.56, 0.94) and 0.80 (95% CI 0.64, 0.95), respectively. Conclusions:Initial PCT and CRP demonstrated utility in detecting bacteremia in patients presenting with MSKIs. This study warrants further exploration into the usage of PCT and CRP as early predictors of bacteremia for more appropriate treatment and potentially fewer complications of these infections in pediatric patients.
{"title":"Evaluating the Utility of Procalcitonin and C-Reactive Protein to Predict Bacteremia in Children with Musculoskeletal Infections","authors":"Alex Smith, James Wood","doi":"10.18060/27784","DOIUrl":"https://doi.org/10.18060/27784","url":null,"abstract":"Background:Musculoskeletal infections (MSKI; osteomyelitis, septic arthritis) are among the most common invasive bacterial infections in children, often associated with complications. Bacteremia precedes these complications; thus, early identification may prevent them. Acute inflammatory markers, C-reactive protein (CRP) and Procalcitonin (PCT) are often elevated in children with acute MSKI. PCT is understudied in children with MSKI. The primary goal of this study was to evaluate the utility of PCT and CRP in distinguishing children with MSKI with bacteremia vs. those without. \u0000Methods:Patients 6 months to 18 years with strong clinical suspicion of MSKI were prospectively enrolled at Riley Hospital for Children from July 2019 to May 2022 unless clinical evidence suggested an alternative diagnosis or if informed consent was not obtained. CRP was obtained at admission and PCT was collected within 96 hours of presentation to the hospital. Demographic data was recorded from electronic medical records. Two-sided P values of <0.05 were considered statistically significant for univariate analysis and logistic regression. \u0000Results:Thirty-seven patients were enrolled, the majority being non-Hispanic white males (40.5%), median age of 8 years (IQR, 4-12). Median PCT in children with bacteremia was higher (0.41 ng/mL [IQR 0.14-0.8 ng/mL]) compared to those without (0.10 ng/mL [IQR 0.05-0.31 ng/mL]) (p=0.03). Median CRP in children with bacteremia was higher (13.7 mg/dL [IQR, 9.15-19.9]) compared to those without (4.1 mg/dL, [IQR 0.65-5.8]) (p<0.01). Both PCT and CRP showed good ability to discriminate those with bacteremia from those without, with an area under the ROC of 0.75 (95% CI 0.56, 0.94) and 0.80 (95% CI 0.64, 0.95), respectively. \u0000Conclusions:Initial PCT and CRP demonstrated utility in detecting bacteremia in patients presenting with MSKIs. This study warrants further exploration into the usage of PCT and CRP as early predictors of bacteremia for more appropriate treatment and potentially fewer complications of these infections in pediatric patients.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Atrophy in the hippocampus is responsible for memory and cognitive decline in Alzheimer’s Disease (AD). Progression and presentation of AD in men and women are different, and the hippocampus and its subregions could be affected differently. By identifying what areas of the hippocampus are affected by sex, diagnostic tools can be better used to clinically identify and treat AD. Aims: The goals of the proposed research are: (1) use in vivo MRI techniques to isolate the hippocampus in a mouse model, (2) use data analysis to compare the volume of the hippocampus and its subregions in 5xFAD mice, and (3) see if sex plays a role in differing hippocampal volume, and (4) assess the translational utility of using structural MRI to measure hippocampal integrity for future in vivo human brain studies/clinical practice. Methods: We used the imaging software FSLeyes to examine MRI images and isolate hippocampal subregion masks. MRI images were taken at the 2-month age period when amyloid-B deposition begins in the forebrain. Upon isolation of the hippocampal mask of each MRI, group classification was identified, and quantitative analysis was performed to compare groups. Results: We found significant lower spatial volume in Stratum Granulosum (SG) of the hippocampus in female mice compared to male mice. The SG contains dentate granule cells, responsible for spatial memory. Apart from this, the data that we obtained was nonsignificant but did show that female mice contained mainly smaller hippocampus subregions and total volumes despite TICV being larger in females. Conclusion and Impact: More data is needed to observe the degeneration of SG over a lifetime and assess if it is the reason why males retain spatial memory in AD as opposed to females. Otherwise, analyzing hippocampal volume in the early stages of AD doesn’t appear to be sufficient in explaining outstanding sex differences in AD presentation and progression.
{"title":"Sex differences in region-specific hippocampal areas in Alzheimer’s Disease: an animal-based approach","authors":"Jackson Sawyer, Syed Salman Shahid, Yu-Chien Wu","doi":"10.18060/27772","DOIUrl":"https://doi.org/10.18060/27772","url":null,"abstract":"Background: Atrophy in the hippocampus is responsible for memory and cognitive decline in Alzheimer’s Disease (AD). Progression and presentation of AD in men and women are different, and the hippocampus and its subregions could be affected differently. By identifying what areas of the hippocampus are affected by sex, diagnostic tools can be better used to clinically identify and treat AD. \u0000Aims: The goals of the proposed research are: (1) use in vivo MRI techniques to isolate the hippocampus in a mouse model, (2) use data analysis to compare the volume of the hippocampus and its subregions in 5xFAD mice, and (3) see if sex plays a role in differing hippocampal volume, and (4) assess the translational utility of using structural MRI to measure hippocampal integrity for future in vivo human brain studies/clinical practice. \u0000Methods: We used the imaging software FSLeyes to examine MRI images and isolate hippocampal subregion masks. MRI images were taken at the 2-month age period when amyloid-B deposition begins in the forebrain. Upon isolation of the hippocampal mask of each MRI, group classification was identified, and quantitative analysis was performed to compare groups. \u0000Results: We found significant lower spatial volume in Stratum Granulosum (SG) of the hippocampus in female mice compared to male mice. The SG contains dentate granule cells, responsible for spatial memory. Apart from this, the data that we obtained was nonsignificant but did show that female mice contained mainly smaller hippocampus subregions and total volumes despite TICV being larger in females. \u0000Conclusion and Impact: More data is needed to observe the degeneration of SG over a lifetime and assess if it is the reason why males retain spatial memory in AD as opposed to females. Otherwise, analyzing hippocampal volume in the early stages of AD doesn’t appear to be sufficient in explaining outstanding sex differences in AD presentation and progression.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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