Background/Objective:Interfacility transfers are an integral part of integrated systems of care in modern healthcare. Many transferred patients are older adults, a particularly vulnerable patient population. Unfortunately, interfacility transfers can result in discomfort during the transport, increased distance from family and home, a significant bill for the ambulance ride, and risk of an accident occurring during transport. Methods:To better understand the experiences of older adults before, during, and after interfacility transfer, cognitive interviews were performed with patients and their caregivers at the bedside of the receiving hospital. A standard set of questions was used to assess multiple aspects of the interfacility transfer process including the consent process at the sending hospital, experience with the transfer, and perceived benefits/harms resulting from the transfer. Results:21 patients and 14 caregivers were interviewed in this study and five themes were present throughout these conversations. These themes included, a perceived lack of participation in the decision to be transferred, failed expectations at the receiving hospital, and greater trust in trauma centers like Methodist Hospital. Conclusion:Our interviews demonstrate a greater need for thorough consent for transfer at sending hospitals discussing the realistic outcomes and risks that can be expected from interfacility transfer. With these conversations patients and their caregivers can be empowered to make informed decisions about their care and will likely be more satisfied with the care that they receive and know what to expect during their treatment.
{"title":"Older Adults and their Experience with Interfacility Transfer","authors":"Dillon Bille, Nancy Glober","doi":"10.18060/27884","DOIUrl":"https://doi.org/10.18060/27884","url":null,"abstract":"Background/Objective:Interfacility transfers are an integral part of integrated systems of care in modern healthcare. Many transferred patients are older adults, a particularly vulnerable patient population. Unfortunately, interfacility transfers can result in discomfort during the transport, increased distance from family and home, a significant bill for the ambulance ride, and risk of an accident occurring during transport. \u0000Methods:To better understand the experiences of older adults before, during, and after interfacility transfer, cognitive interviews were performed with patients and their caregivers at the bedside of the receiving hospital. A standard set of questions was used to assess multiple aspects of the interfacility transfer process including the consent process at the sending hospital, experience with the transfer, and perceived benefits/harms resulting from the transfer. \u0000Results:21 patients and 14 caregivers were interviewed in this study and five themes were present throughout these conversations. These themes included, a perceived lack of participation in the decision to be transferred, failed expectations at the receiving hospital, and greater trust in trauma centers like Methodist Hospital. \u0000Conclusion:Our interviews demonstrate a greater need for thorough consent for transfer at sending hospitals discussing the realistic outcomes and risks that can be expected from interfacility transfer. With these conversations patients and their caregivers can be empowered to make informed decisions about their care and will likely be more satisfied with the care that they receive and know what to expect during their treatment.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"5 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139438428","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}
Jeffrey Liu, Doaa Hassan Salem, Hunter Jill, S. Janga, Amir Hajrasouliha
Background:Vision is a valuable part of life: influencing our perception of the world and of memories. Diabetes, and more specifically, Diabetic Retinopathy (DR) can affect our vision, taking away sight potentially permanently if left untreated. Currently, Diabetic Retinopathy is the leading cause for adult blindness and will continue to rise with increasing prevalence of adult diabetes. Diabetic Macular Edema (DME), a complication of DR, is diagnosed by ophthalmologists using optical coherence tomography (OCT); however, the sheer amount of DME-related imaging creates a time strain on ophthalmologists, creating a demand to further optimize the image reading process. In this study, we hypothesize that increasing the rate and ease of diagnosing DME by introducing artificial intelligence-based methods in primary medical clinics will increase the long-term preservation of ocular health in diabetic patients. Methods:Due to the nature of our retrospective cohort study, consent was not acquired and images were also de-identified. We categorized 676 patient files by HbA1c, non-proliferative diabetic retinopathy (NPDR) severity, and proliferative diabetic retinopathy (PDR). Retinal OCT images were annotated to identify central macular edema, a common feature of DME. Retinal fundus images were also annotated to identify microaneurysms and hemorrhages, two additional features commonly used for detecting either DR or DME. Results:A lesion features dataset was prepared to train our AI model. OCT and fundus imaging features were extracted and combined to train the AI model for DME detection. From annotations of the in-house Macular thickness dataset, it was seen that 167 patients had DME from the total 389 diabetic retinopathy patients. Conclusion:We will continue to prepare more datasets like the macular thickness dataset for our AI. We predict that after our AI receives substantial training with the datasets, the AI will potentially demonstrate some capability of diagnosing DME, supporting its use in medical diagnostics.
背景：视力是生命中宝贵的一部分：影响我们对世界和记忆的感知。糖尿病，尤其是糖尿病视网膜病变（DR）会影响我们的视力，如果不及时治疗，可能会永久性地夺走我们的视力。目前，糖尿病视网膜病变是导致成人失明的主要原因，而且随着成人糖尿病发病率的增加，其发病率还将继续上升。糖尿病性黄斑水肿（DME）是糖尿病性视网膜病变的并发症之一，眼科医生使用光学相干断层扫描（OCT）对其进行诊断；然而，与糖尿病性黄斑水肿相关的大量成像给眼科医生造成了时间压力，从而产生了进一步优化图像阅读过程的需求。在本研究中，我们假设通过在基层医疗诊所引入基于人工智能的方法来提高 DME 的诊断率和简易性，将提高糖尿病患者眼部健康的长期保护率。方法：由于我们的研究属于回顾性队列研究，因此未征得患者同意，同时也对图像进行了去标识化处理。我们按照 HbA1c、非增殖性糖尿病视网膜病变（NPDR）严重程度和增殖性糖尿病视网膜病变（PDR）对 676 份患者档案进行了分类。对视网膜 OCT 图像进行了注释，以识别黄斑中心水肿，这是 DME 的常见特征。此外，还对视网膜眼底图像进行了注释，以识别微动脉瘤和出血，这是检测 DR 或 DME 的另外两个常用特征。结果：我们准备了一个病变特征数据集来训练人工智能模型。我们提取了 OCT 和眼底成像特征，并将其结合起来训练用于 DME 检测的人工智能模型。从内部黄斑厚度数据集的注释中可以看出，在总共 389 名糖尿病视网膜病变患者中，有 167 名患者患有 DME。结论：我们将继续为人工智能准备更多像黄斑厚度数据集这样的数据集。我们预测，在我们的人工智能接受了大量的数据集训练后，人工智能将有可能显示出诊断 DME 的某些能力，从而支持其在医疗诊断中的应用。
{"title":"Clinical Features for Detecting Diabetic Macular Edema using Artificial Intelligence","authors":"Jeffrey Liu, Doaa Hassan Salem, Hunter Jill, S. Janga, Amir Hajrasouliha","doi":"10.18060/27721","DOIUrl":"https://doi.org/10.18060/27721","url":null,"abstract":"Background:Vision is a valuable part of life: influencing our perception of the world and of memories. Diabetes, and more specifically, Diabetic Retinopathy (DR) can affect our vision, taking away sight potentially permanently if left untreated. Currently, Diabetic Retinopathy is the leading cause for adult blindness and will continue to rise with increasing prevalence of adult diabetes. Diabetic Macular Edema (DME), a complication of DR, is diagnosed by ophthalmologists using optical coherence tomography (OCT); however, the sheer amount of DME-related imaging creates a time strain on ophthalmologists, creating a demand to further optimize the image reading process. In this study, we hypothesize that increasing the rate and ease of diagnosing DME by introducing artificial intelligence-based methods in primary medical clinics will increase the long-term preservation of ocular health in diabetic patients. \u0000Methods:Due to the nature of our retrospective cohort study, consent was not acquired and images were also de-identified. We categorized 676 patient files by HbA1c, non-proliferative diabetic retinopathy (NPDR) severity, and proliferative diabetic retinopathy (PDR). Retinal OCT images were annotated to identify central macular edema, a common feature of DME. Retinal fundus images were also annotated to identify microaneurysms and hemorrhages, two additional features commonly used for detecting either DR or DME. \u0000Results:A lesion features dataset was prepared to train our AI model. OCT and fundus imaging features were extracted and combined to train the AI model for DME detection. From annotations of the in-house Macular thickness dataset, it was seen that 167 patients had DME from the total 389 diabetic retinopathy patients. \u0000Conclusion:We will continue to prepare more datasets like the macular thickness dataset for our AI. We predict that after our AI receives substantial training with the datasets, the AI will potentially demonstrate some capability of diagnosing DME, supporting its use in medical diagnostics.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"5 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139438480","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}
Stasia Mallin, Amogh Kambalyal, Tara Holloran, Christopher Newman, Megan Marine
Background/Hypothesis: Brief resolved unexplained events (BRUEs) are events in infants characterized by cyanosis, abnormal breathing, abnormal tone, and altered responsiveness. Practice guidelines define high-risk and low-risk BRUEs and do not recommend imaging in low-risk patients. We evaluated imaging in these patients and hypothesized that high-risk patients would have more imaging studies and abnormalities. Methods: Using the radiology information system, a retrospective review was performed between 2016-2022 for patients <1 year presenting with BRUE. Defined search terms were used to identify imaging within one week of presentation. Patients were evaluated for clinical presentation, medical history, physical examination, imaging studies ordered, and final diagnoses. Results: 126 patients were identified. 113 patients (46 female; 93 high-risk), between 3 and 355 days old (average age 97 days), met inclusion criteria. Imaging included chest radiographs (99), head CTs (24), brain MRIs (19), skeletal surveys (16), and others (22). There was no difference in the number of imaging studies obtained between these groups (p=0.423, Mann-Whitney U test). However, a greater proportion of high-risk patients had imaging abnormalities (p=0.023, Fisher’s exact test). Only 1/20 (5%) low-risk patients had abnormal imaging (PCR proven viral bronchiolitis). 26/93 (28%) high-risk patients had abnormal findings, most commonly on chestradiographs (15), brain MRIs (9), head CTs (4), and skeletal surveys (3). 18/26 high-risk patients had imaging abnormalities leading to a diagnosis other than BRUE (viral bronchiolitis, bronchopulmonary dysplasia, nonaccidental trauma, perinatal HSV infection, ventricular septal defect, double aortic arch, intestinal malrotation, and neurofibromatosis). Overall, 7/93 (7.5%) high-risk BRUE patients had significant pathology. Conclusion: High-risk patients were more likely to have an imaging abnormality compared to low-risk patients, which is consistent with current imaging recommendations given only one low-risk imaging abnormality. Interestingly, 7.5% of the high-risk patients had significant pathology diagnosed by imaging.
{"title":"Radiological Findings in Patients Presenting with Brief Resolved Unexplained Events (BRUEs)","authors":"Stasia Mallin, Amogh Kambalyal, Tara Holloran, Christopher Newman, Megan Marine","doi":"10.18060/27727","DOIUrl":"https://doi.org/10.18060/27727","url":null,"abstract":"Background/Hypothesis: Brief resolved unexplained events (BRUEs) are events in infants characterized by cyanosis, abnormal breathing, abnormal tone, and altered responsiveness. Practice guidelines define high-risk and low-risk BRUEs and do not recommend imaging in low-risk patients. We evaluated imaging in these patients and hypothesized that high-risk patients would have more imaging studies and abnormalities. \u0000Methods: Using the radiology information system, a retrospective review was performed between 2016-2022 for patients <1 year presenting with BRUE. Defined search terms were used to identify imaging within one week of presentation. Patients were evaluated for clinical presentation, medical history, physical examination, imaging studies ordered, and final diagnoses. \u0000Results: 126 patients were identified. 113 patients (46 female; 93 high-risk), between 3 and 355 days old (average age 97 days), met inclusion criteria. Imaging included chest radiographs (99), head CTs (24), brain MRIs (19), skeletal surveys (16), and others (22). There was no difference in the number of imaging studies obtained between these groups (p=0.423, Mann-Whitney U test). However, a greater proportion of high-risk patients had imaging abnormalities (p=0.023, Fisher’s exact test). Only 1/20 (5%) low-risk patients had abnormal imaging (PCR proven viral bronchiolitis). 26/93 (28%) high-risk patients had abnormal findings, most commonly on chestradiographs (15), brain MRIs (9), head CTs (4), and skeletal surveys (3). 18/26 high-risk patients had imaging abnormalities leading to a diagnosis other than BRUE (viral bronchiolitis, bronchopulmonary dysplasia, nonaccidental trauma, perinatal HSV infection, ventricular septal defect, double aortic arch, intestinal malrotation, and neurofibromatosis). Overall, 7/93 (7.5%) high-risk BRUE patients had significant pathology. \u0000Conclusion: High-risk patients were more likely to have an imaging abnormality compared to low-risk patients, which is consistent with current imaging recommendations given only one low-risk imaging abnormality. Interestingly, 7.5% of the high-risk patients had significant pathology diagnosed by imaging.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"7 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139438972","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}
August Rodefeld, Ping-Chang Kuo, B. Scofield, Jimmy Yen
Background and Hypothesis:Every year, more than 690,000 people in the United States suffer an ischemic stroke. Many survivors are left with long-term disability. While the initial insult to the brain is caused by hypoxia resulting from cerebral artery occlusion, a secondary insult is caused by peripheral immune cell infiltration across the blood brain barrier (BBB) and subsequent cytotoxic insult. Previous studies have demonstrated that interferon beta (IFNβ) limits peripheral immune cell infiltration across the BBB and reduces brain infarction volume. We hypothesize that during ischemic stroke IFNβ suppresses brain endothelial cells (bECs) activation to reduce their expression of adhesion molecules as one of the mechanisms by which it decreases peripheral immune cell infiltration across the BBB. Experimental Design:In this project, bEnd.3 cells, a cell line of bECs, were activated by TNF-α, a pro-inflammatory cytokine. Tissue plasminogen activator (tPA), an FDA-approved thrombolytic for ischemic stroke, was included in the study. bEnd.3 cells were treated with IFNβ at 1.5 hours prior TNF-α or TNF-α + tPA stimulation to evaluate its modulation of adhesion cell expression. The adhesion molecule expression was determined by flow cytometry. Results were further confirmed by in vivo studies in which stroke animals were subjected to tPA treatment in the presence or absence of IFNβ. Results:Our results showed that TNF-α induced ICAM-1, VCAM-1, E-selectin, and P-selectin expression. Importantly, we found IFNβ suppressed the expression of aforementioned adhesion molecules in bEnd.3 cells treated with TNF-α or TNF-α+tPA. Our in vivo results demonstrated that IFNβ treatment reduced ICAM-1 and E-selectin, but not VCAM-1 or P-selectin expression in the ischemic brain. Conclusion and Potential Impact:Our study demonstrates that IFNβ modulates bEC expression of adhesion molecules in vitro and in vivo of ischemic stroke, suggesting IFNβ, an FDA-approved drug for Multiple Sclerosis, shows potential to improve ischemic stroke outcomes.
{"title":"Interferon Beta Modulation of Brain Endothelial Cell Activation in Ischemic Stroke","authors":"August Rodefeld, Ping-Chang Kuo, B. Scofield, Jimmy Yen","doi":"10.18060/27762","DOIUrl":"https://doi.org/10.18060/27762","url":null,"abstract":"Background and Hypothesis:Every year, more than 690,000 people in the United States suffer an ischemic stroke. Many survivors are left with long-term disability. While the initial insult to the brain is caused by hypoxia resulting from cerebral artery occlusion, a secondary insult is caused by peripheral immune cell infiltration across the blood brain barrier (BBB) and subsequent cytotoxic insult. Previous studies have demonstrated that interferon beta (IFNβ) limits peripheral immune cell infiltration across the BBB and reduces brain infarction volume. We hypothesize that during ischemic stroke IFNβ suppresses brain endothelial cells (bECs) activation to reduce their expression of adhesion molecules as one of the mechanisms by which it decreases peripheral immune cell infiltration across the BBB. \u0000Experimental Design:In this project, bEnd.3 cells, a cell line of bECs, were activated by TNF-α, a pro-inflammatory cytokine. Tissue plasminogen activator (tPA), an FDA-approved thrombolytic for ischemic stroke, was included in the study. bEnd.3 cells were treated with IFNβ at 1.5 hours prior TNF-α or TNF-α + tPA stimulation to evaluate its modulation of adhesion cell expression. The adhesion molecule expression was determined by flow cytometry. Results were further confirmed by in vivo studies in which stroke animals were subjected to tPA treatment in the presence or absence of IFNβ. \u0000Results:Our results showed that TNF-α induced ICAM-1, VCAM-1, E-selectin, and P-selectin expression. Importantly, we found IFNβ suppressed the expression of aforementioned adhesion molecules in bEnd.3 cells treated with TNF-α or TNF-α+tPA. Our in vivo results demonstrated that IFNβ treatment reduced ICAM-1 and E-selectin, but not VCAM-1 or P-selectin expression in the ischemic brain. \u0000Conclusion and Potential Impact:Our study demonstrates that IFNβ modulates bEC expression of adhesion molecules in vitro and in vivo of ischemic stroke, suggesting IFNβ, an FDA-approved drug for Multiple Sclerosis, shows potential to improve ischemic stroke outcomes.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"48 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140510360","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}
Byoungchan An, Jodi L. Raymond, Matthew Paul Landman
Background: The Emergency Medical Services (EMS) system has faced significant stress due to the COVID-19 pandemic and now workforce issues. This study was performed to evaluate potential changes in pediatric trauma patient transport over that time period. We hypothesized that more trauma patients would use private transportation/personal vehicles to arrive at the ED in the post-pandemic time frame when compared pre-pandemic. Methods: This was a retrospective cohort study of patients that were admitted to the Emergency Department of Riley Hospital for Children between 01/01/2017 to 12/31/2022. Patients were excluded if they were transferred from another hospital or had mechanisms of injury including burns, suffocations, drownings, hangings, medical, and ingestions. Pre- and post-COVID patients were defined as admission to the ED before or after March 25, 2020, the day after a stay at home orders were implemented in Indiana. Univariate and multivariate analyses were performed. Results: A total of 4,116 patients matching the criteria were identified with 52% arriving after the start of the COVID-19 shut down orders. 30.6% of patients arrived by private operated vehicles (POV) during pre-covid times and 30.3% in the post-covid years (p=0;39). A logistic regression analysis was performed for mortality which demonstrated that transport mode (ground ambulance vs helicopter vs POV) was not statistically associated with mortality rate (OR 0.36, 95% CI 0.12 – 1.10, p=0.07), when controlling for important clinical variables associated with injury severity. Conclusion: There was no statistical difference in arrival by POV before and after the COVID-19 pandemic in our cohort. Additionally, there was no significant data to suggest that transport mode was associated with mortality. Further research should be done to assess potential barriers to transport to pediatric trauma centers, particularly considering ongoing EMS workforce strains.
{"title":"Changes in Transport Mode for Pediatric Trauma Patients Before and After the COVID-19 Pandemic","authors":"Byoungchan An, Jodi L. Raymond, Matthew Paul Landman","doi":"10.18060/27956","DOIUrl":"https://doi.org/10.18060/27956","url":null,"abstract":"Background: The Emergency Medical Services (EMS) system has faced significant stress due to the COVID-19 pandemic and now workforce issues. This study was performed to evaluate potential changes in pediatric trauma patient transport over that time period. We hypothesized that more trauma patients would use private transportation/personal vehicles to arrive at the ED in the post-pandemic time frame when compared pre-pandemic. \u0000Methods: This was a retrospective cohort study of patients that were admitted to the Emergency Department of Riley Hospital for Children between 01/01/2017 to 12/31/2022. Patients were excluded if they were transferred from another hospital or had mechanisms of injury including burns, suffocations, drownings, hangings, medical, and ingestions. Pre- and post-COVID patients were defined as admission to the ED before or after March 25, 2020, the day after a stay at home orders were implemented in Indiana. Univariate and multivariate analyses were performed. \u0000Results: A total of 4,116 patients matching the criteria were identified with 52% arriving after the start of the COVID-19 shut down orders. 30.6% of patients arrived by private operated vehicles (POV) during pre-covid times and 30.3% in the post-covid years (p=0;39). A logistic regression analysis was performed for mortality which demonstrated that transport mode (ground ambulance vs helicopter vs POV) was not statistically associated with mortality rate (OR 0.36, 95% CI 0.12 – 1.10, p=0.07), when controlling for important clinical variables associated with injury severity. \u0000Conclusion: There was no statistical difference in arrival by POV before and after the COVID-19 pandemic in our cohort. Additionally, there was no significant data to suggest that transport mode was associated with mortality. Further research should be done to assess potential barriers to transport to pediatric trauma centers, particularly considering ongoing EMS workforce strains. ","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533441","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}
Objective—PATH4YOU is Indiana’s first state-wide contraceptive access project and provides contraceptive access via in-person and telehealth visits using a reproductive justice framework. Our objective was to evaluate outcomes of the PATH4YOU program to determine the distribution of contraceptive access among people in Indiana. Study Design—We analyzed programmatic data of reproductive-age people who received care in the PATH4YOU program from September 2021 to June 2023. All participants received pregnancy intention screening, comprehensive contraceptive counseling and decision support, and no-cost contraceptive method access, including long-acting reversible contraception (LARC). We evaluated age, location (county), primary method of contraception received, partner site visited, and in-person vs telehealth visit type using descriptive statistics. Geographical mapping analysis was used to determine areas of Indiana most impacted by the PATH4YOU program. Results—Between September 2021 and June 2023, 1,024 people received care at 1,231 visits through the PATH4YOU program. The average age of participants was 27.6 years old. A significant (49.3%) proportion of the participants live in Marion County. The most common primary methods of contraception were the implant (25.8%), contraceptive pills (20.5%), and intrauterine devices (16.0%). The most visited partner sites included People’s Health Center in Indianapolis (24.8%) and via telehealth (22.5%). Most people received contraceptive access in one in-person (66.0%) or telehealth (17.9%) visit. Conclusion—The PATH4YOU state-wide contraceptive access project provided a range of contraceptive methods via both in-person and telehealth visits to a wide reach of people across multiple counties in Indiana. Implications—The unique PATH4YOU model of care using both in-person and telehealth visits is a novel way to increase contraceptive access throughout a state with highly variable access to traditional in-person contraceptive care. Further research is necessary to evaluate direct impacts of the program on minoritized and traditionally excluded populations to evaluate long-term outcomes like maternal mortality.
{"title":"Indiana Contraceptive Use Metrics through PATH4YOU Program: Initial Review","authors":"Molly Ruggles, Kathleen Wendholt, Caitlin Bernard","doi":"10.18060/27764","DOIUrl":"https://doi.org/10.18060/27764","url":null,"abstract":"Objective—PATH4YOU is Indiana’s first state-wide contraceptive access project and provides contraceptive access via in-person and telehealth visits using a reproductive justice framework. Our objective was to evaluate outcomes of the PATH4YOU program to determine the distribution of contraceptive access among people in Indiana. \u0000Study Design—We analyzed programmatic data of reproductive-age people who received care in the PATH4YOU program from September 2021 to June 2023. All participants received pregnancy intention screening, comprehensive contraceptive counseling and decision support, and no-cost contraceptive method access, including long-acting reversible contraception (LARC). We evaluated age, location (county), primary method of contraception received, partner site visited, and in-person vs telehealth visit type using descriptive statistics. Geographical mapping analysis was used to determine areas of Indiana most impacted by the PATH4YOU program. \u0000Results—Between September 2021 and June 2023, 1,024 people received care at 1,231 visits through the PATH4YOU program. The average age of participants was 27.6 years old. A significant (49.3%) proportion of the participants live in Marion County. The most common primary methods of contraception were the implant (25.8%), contraceptive pills (20.5%), and intrauterine devices (16.0%). The most visited partner sites included People’s Health Center in Indianapolis (24.8%) and via telehealth (22.5%). Most people received contraceptive access in one in-person (66.0%) or telehealth (17.9%) visit. \u0000Conclusion—The PATH4YOU state-wide contraceptive access project provided a range of contraceptive methods via both in-person and telehealth visits to a wide reach of people across multiple counties in Indiana. \u0000Implications—The unique PATH4YOU model of care using both in-person and telehealth visits is a novel way to increase contraceptive access throughout a state with highly variable access to traditional in-person contraceptive care. Further research is necessary to evaluate direct impacts of the program on minoritized and traditionally excluded populations to evaluate long-term outcomes like maternal mortality.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"27 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533598","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}
Jinan Ayub, Mary De Laosa, Sarah Bilinski, James F. Chmiel, Don B. Sanders
Background and Objective: Advances in the treatment of cystic fibrosis (CF) with cystic fibrosis transmembrane regulator modulators have improved morbidity and mortality, however, clinical outcomes vary among genetically similar patients due to contributions of social determinants of health (SDOH). Pancreatic insufficiency, CF-related diabetes (CFRD), Pseudomonas infections, and lower BMI increase risk of severe lung disease, measured by forced expiratory volume in 1 second (FEV1). This project aims to identify socially vulnerable patients and evaluate the impact of SDOH on clinical outcomes. Methods: From January to July 2023, SDOH screeners were distributed to families of children with CF at Riley Hospital for Children, documenting transportation, housing, food insecurity, insurance, and medication costs. Clinical outcomes for each patient including FEV1% predicted, BMI/WFL percentile, CFRD, hospitalizations, respiratory infections with Pseudomonas aeruginosa, and pancreatic insufficiency within the past 12 months were recorded. Patients were categorized by SDOH vulnerability, and associations with poor clinical outcomes were analyzed using the Chi-squared test of independence. Results: A total of 193 screeners were analyzed: males represented 52.6% of the cohort, 2.60% identified as non-white race, and 3.65% reported Hispanic ethnicity. Overall, 51.8% screened positive for at least one SDOH (SDOH+) and 48.1% screened negative (SDOH-). The average FEV1% predicted decline among SDOH+ patients was 5.79% and 3.51% among SDOH- patients. SDOH+ patients were more likely to have at least a 5% decline in FEV1% predicted (p=0.037) and to be hospitalized due to exacerbations of CF lung disease at least once in the past 12 months (p=0.030). Although low BMI percentile, Pseudomonas infection, and CFRD were not significantly associated with SDOH, socially vulnerable patients demonstrated higher rates of these clinical outcomes. Conclusion and Clinical Implications: SDOH impact CF clinical outcomes. Screeners are effective in identifying socially vulnerable patients and serve as the first step in addressing unmet social needs.
{"title":"Effects of Social Determinants of Health on Clinical Outcomes in Pediatric Cystic Fibrosis Patients","authors":"Jinan Ayub, Mary De Laosa, Sarah Bilinski, James F. Chmiel, Don B. Sanders","doi":"10.18060/27961","DOIUrl":"https://doi.org/10.18060/27961","url":null,"abstract":"Background and Objective: \u0000Advances in the treatment of cystic fibrosis (CF) with cystic fibrosis transmembrane regulator modulators have improved morbidity and mortality, however, clinical outcomes vary among genetically similar patients due to contributions of social determinants of health (SDOH). Pancreatic insufficiency, CF-related diabetes (CFRD), Pseudomonas infections, and lower BMI increase risk of severe lung disease, measured by forced expiratory volume in 1 second (FEV1). This project aims to identify socially vulnerable patients and evaluate the impact of SDOH on clinical outcomes. \u0000Methods: \u0000From January to July 2023, SDOH screeners were distributed to families of children with CF at Riley Hospital for Children, documenting transportation, housing, food insecurity, insurance, and medication costs. Clinical outcomes for each patient including FEV1% predicted, BMI/WFL percentile, CFRD, hospitalizations, respiratory infections with Pseudomonas aeruginosa, and pancreatic insufficiency within the past 12 months were recorded. Patients were categorized by SDOH vulnerability, and associations with poor clinical outcomes were analyzed using the Chi-squared test of independence. \u0000Results: \u0000A total of 193 screeners were analyzed: males represented 52.6% of the cohort, 2.60% identified as non-white race, and 3.65% reported Hispanic ethnicity. Overall, 51.8% screened positive for at least one SDOH (SDOH+) and 48.1% screened negative (SDOH-). The average FEV1% predicted decline among SDOH+ patients was 5.79% and 3.51% among SDOH- patients. SDOH+ patients were more likely to have at least a 5% decline in FEV1% predicted (p=0.037) and to be hospitalized due to exacerbations of CF lung disease at least once in the past 12 months (p=0.030). Although low BMI percentile, Pseudomonas infection, and CFRD were not significantly associated with SDOH, socially vulnerable patients demonstrated higher rates of these clinical outcomes. \u0000Conclusion and Clinical Implications: \u0000SDOH impact CF clinical outcomes. Screeners are effective in identifying socially vulnerable patients and serve as the first step in addressing unmet social needs. ","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"44 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533746","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}
Maansi Asthana, R. M. Ferreira, D. L. Gisch, Ying-Hua Cheng, M. Eadon
Background: Lupus nephritis (LN) affects 1 in 3 individuals with systemic lupus erythematosus. Suboptimal treatment precipitates irreversible kidney damage, leading to end stage renal disease. Kidney damage in lupus is characterized by immune cells injuring epithelial, endothelial, and stromal cells. We characterized molecular neighborhoods composed of immune cells interacting with resident cells of the kidney through spatial transcriptomics (ST). Methods: Visium ST experiments were conducted in 8 healthy controls (233 glomeruli) and 3 LN samples (48 glomeruli). Cell type labels from the Kidney Precision Medicine Project single cell RNA-seq atlas were transferred to deconvolute ST spots into specific cell types. Using histology and NPHS2 expression, glomeruli were selected as functional tissue units. Data were normalized, dimensionally reduced, and clustered with Seurat v4. Spatially anchored gene signatures of LN were identified. Glomeruli were re-clustered according to cell composition, to identify associated neighborhoods by fisher’s exact test. We characterized the cell composition, differentially expressed genes (DEGs), and pathways of relevant neighborhoods. Results: Between LN and control glomeruli, we identified HSPA8, PLEK, COL1A2 DEGs, associated with hypoxia, fibrosis, and immune response. We identified glomerular neighborhoods consistent with immune complex deposition, endothelial dysfunction (e.g. wire loop lesions), and mesangial cell expansion enriched in LN (p<0.05). Immune complex-mediated injury neighborhoods were characterized by interferon signaling, endothelial cell migration, and vascular genesis, consistent with DEGs BST2, CXCL12, and ENG. Endothelial dysfunction neighborhoods present cellular adhesion, immune cell signaling, and hypoxic pathways. DEGs included ITGB2, HLA-DPB1, and EGR1. Pathways enriched in mesangial expansion neighborhoods included matrix adhesion, podocyte development, and ERK1 and ERK2 cascade, aligned with ITGB3, NPHS1, and APOE DEGs. Conclusion/ Clinical Impact and Implications: Neighborhood characterization provides insight into cell-cell interactions that drive kidney disease progression. Future directions will change how kidney biopsy specimens drive treatment by delineating specific cell-cell interactions, linking molecular and histopathological signatures, and defining genes associated with therapeutic resistance.
{"title":"Spatially Anchored Molecular Neighborhoods in Lupus Nephritis","authors":"Maansi Asthana, R. M. Ferreira, D. L. Gisch, Ying-Hua Cheng, M. Eadon","doi":"10.18060/27960","DOIUrl":"https://doi.org/10.18060/27960","url":null,"abstract":"\u0000 \u0000 \u0000Background: \u0000Lupus nephritis (LN) affects 1 in 3 individuals with systemic lupus erythematosus. Suboptimal treatment precipitates irreversible kidney damage, leading to end stage renal disease. Kidney damage in lupus is characterized by immune cells injuring epithelial, endothelial, and stromal cells. We characterized molecular neighborhoods composed of immune cells interacting with resident cells of the kidney through spatial transcriptomics (ST). \u0000Methods: \u0000Visium ST experiments were conducted in 8 healthy controls (233 glomeruli) and 3 LN samples (48 glomeruli). Cell type labels from the Kidney Precision Medicine Project single cell RNA-seq atlas were transferred to deconvolute ST spots into specific cell types. Using histology and NPHS2 expression, glomeruli were selected as functional tissue units. Data were normalized, dimensionally reduced, and clustered with Seurat v4. Spatially anchored gene signatures of LN were identified. Glomeruli were re-clustered according to cell composition, to identify associated neighborhoods by fisher’s exact test. We characterized the cell composition, differentially expressed genes (DEGs), and pathways of relevant neighborhoods. \u0000Results: \u0000Between LN and control glomeruli, we identified HSPA8, PLEK, COL1A2 DEGs, associated with hypoxia, fibrosis, and immune response. We identified glomerular neighborhoods consistent with immune complex deposition, endothelial dysfunction (e.g. wire loop lesions), and mesangial cell expansion enriched in LN (p<0.05). Immune complex-mediated injury neighborhoods were characterized by interferon signaling, endothelial cell migration, and vascular genesis, consistent with DEGs BST2, CXCL12, and ENG. Endothelial dysfunction neighborhoods present cellular adhesion, immune cell signaling, and hypoxic pathways. DEGs included ITGB2, HLA-DPB1, and EGR1. Pathways enriched in mesangial expansion neighborhoods included matrix adhesion, podocyte development, and ERK1 and ERK2 cascade, aligned with ITGB3, NPHS1, and APOE DEGs. \u0000Conclusion/ Clinical Impact and Implications: \u0000Neighborhood characterization provides insight into cell-cell interactions that drive kidney disease progression. Future directions will change how kidney biopsy specimens drive treatment by delineating specific cell-cell interactions, linking molecular and histopathological signatures, and defining genes associated with therapeutic resistance. \u0000 \u0000 \u0000","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":"17 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534188","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}
Purpose: To assess the risk of malignancy in thyroid nodules recommended for biopsy using the American College of Radiology (ACR) Thyroid Imaging Reporting & Data System (TIRADS). Methods: We conducted a retrospective review of ultrasound (US) guided thyroid biopsies performed from 2018- 2023 at IU Health hospitals for nodules which were recommended for biopsy based on ACR TI-RADS criteria and compared with histopathology results. The research was conducted at University and Methodist Hospital radiology reading rooms. Results: Of the total 210 thyroid nodules recommended for biopsy, only 8.57% of nodules biopsied were malignant. Positive malignancy rate for TR-3 was 10.2%, TR-4 was 7.1%, and TR-5 was 12.5%. TR-3 nodules less than 2.9 cm were all benign on histopathology. TR-4 nodules less than 1.5 cm were all benign on histopathology. TR-5 nodules were all benign on histopathology. The most common malignancy was papillary thyroid carcinoma. Conclusion: ACR TI-RADS is currently the standard of care for guidelines and lexicon for radiologists for characterizing thyroid nodules. Our results demonstrate that all TR-3 nodules less than 2.9 cm were all benign and most of the TR-4 and TR-5 nodules biopsied were benign on histopathology. The lower biopsy rate for positive malignancy even for TR-4 and TR-5 nodules respectively raises the need for revision for existing TI-RADS criteria, as more nodules could be followed up with ultrasound rather than percutaneous biopsy, which will alleviate patient anxiety as well as decrease overall healthcare costs.
{"title":"Biopsy or no biopsy? Risk of Malignancy in Thyroid Nodules Based on TI-RADS Criteria","authors":"Faadil Shariff, Vivek Halappa","doi":"10.18060/27782","DOIUrl":"https://doi.org/10.18060/27782","url":null,"abstract":"Purpose: To assess the risk of malignancy in thyroid nodules recommended for biopsy using the American College of Radiology (ACR) Thyroid Imaging Reporting & Data System (TIRADS). \u0000Methods: We conducted a retrospective review of ultrasound (US) guided thyroid biopsies performed from 2018- 2023 at IU Health hospitals for nodules which were recommended for biopsy based on ACR TI-RADS criteria and compared with histopathology results. The research was conducted at University and Methodist Hospital radiology reading rooms. \u0000Results: Of the total 210 thyroid nodules recommended for biopsy, only 8.57% of nodules biopsied were malignant. Positive malignancy rate for TR-3 was 10.2%, TR-4 was 7.1%, and TR-5 was 12.5%. TR-3 nodules less than 2.9 cm were all benign on histopathology. TR-4 nodules less than 1.5 cm were all benign on histopathology. TR-5 nodules were all benign on histopathology. The most common malignancy was papillary thyroid carcinoma. \u0000Conclusion: ACR TI-RADS is currently the standard of care for guidelines and lexicon for radiologists for characterizing thyroid nodules. Our results demonstrate that all TR-3 nodules less than 2.9 cm were all benign and most of the TR-4 and TR-5 nodules biopsied were benign on histopathology. The lower biopsy rate for positive malignancy even for TR-4 and TR-5 nodules respectively raises the need for revision for existing TI-RADS criteria, as more nodules could be followed up with ultrasound rather than percutaneous biopsy, which will alleviate patient anxiety as well as decrease overall healthcare costs.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625741","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}
Diabetic retinopathy (DR) is a known chronic complication of diabetes mellitus and is one of the leading causes of visual impairment. The chronic inflammation associated with DR poses large risks not only for the vasculature but also for the surrounding neuronal tissue. Potential biomarkers, especially those surrounding microRNAs (miRNAs), have been proposed to indicate the progression of DR. Levels of certain miRNAs have been shown to be either down or upregulated in type 1 diabetes patients and have shown correlations with specific types of DR. MicroRNA-150 (miR-150) has also been shown to have protective effects on cells in hypoxic environments, but when downregulated, miR-150 actually induces apoptosis. And, it has been shown to be downregulated in patients with type 1 and type 2 diabetes as well as patients with obesity. We hypothesize then that the levels of miR-150 from a peripheral blood sample should be indicative of the progression of DR and may be used for potential early intervention. In this project, we assessed miR-150 levels in the peripheral blood mononuclear cells (MNCs) of individuals with different severities of DR by isolating mononuclear cells and extracting RNA. We then reverse-transcribed the RNA into cDNA and used RT-qPCR to measure the levels of miR-150 in individuals with varying DR severity. MiR-150 levels in the MNCS were decreased in individuals with diabetes with no retinopathy, moderate NPDR and severe NPDR groups when compared to control individuals; however, there was a marginal increase in the miR-150 mild NPDR group. The data could show evidence that a peripheral blood draw could be used as a less invasive approach to assessing the severity of diabetic retinopathy in patients. This would change the disease management and future treatments individually.
众所周知，糖尿病视网膜病变（DR）是糖尿病的一种慢性并发症，也是导致视力损伤的主要原因之一。与糖尿病视网膜病变相关的慢性炎症不仅对血管，而且对周围的神经元组织都构成巨大风险。有人提出了一些潜在的生物标志物，尤其是与微小核糖核酸（miRNA）有关的生物标志物，以指示 DR 的进展。某些 miRNA 的水平在 1 型糖尿病患者中出现了下调或上调，并显示出与特定类型 DR 的相关性。微RNA-150（miR-150）也被证明对缺氧环境中的细胞有保护作用，但当其被下调时，miR-150实际上会诱导细胞凋亡。而且，在 1 型和 2 型糖尿病患者以及肥胖症患者中，miR-150 已被证明是下调的。因此我们推测，外周血样本中的 miR-150 水平应能指示 DR 的进展，并可用于潜在的早期干预。在该项目中，我们通过分离单核细胞并提取 RNA，评估了不同严重程度的 DR 患者外周血单核细胞（MNCs）中的 miR-150 水平。然后，我们将 RNA 反转录为 cDNA，并使用 RT-qPCR 测定不同严重程度 DR 患者的 miR-150 水平。与对照组相比，无视网膜病变的糖尿病患者、中度NPDR组和重度NPDR组的MNCS中的miR-150水平有所下降；然而，miR-150轻度NPDR组的水平略有上升。这些数据可以证明，外周血抽取可以作为一种创伤较小的方法来评估患者糖尿病视网膜病变的严重程度。这将单独改变疾病管理和未来的治疗方法。
{"title":"MicroRNA-150 (miR-150) as a Potential Biomarker for Diabetic Retinopathy","authors":"Conner Smith, Qianyi Luo, Neha Mahajan, Ashay Bhtwadekar","doi":"10.18060/27785","DOIUrl":"https://doi.org/10.18060/27785","url":null,"abstract":"Diabetic retinopathy (DR) is a known chronic complication of diabetes mellitus and is one of the leading causes of visual impairment. The chronic inflammation associated with DR poses large risks not only for the vasculature but also for the surrounding neuronal tissue. Potential biomarkers, especially those surrounding microRNAs (miRNAs), have been proposed to indicate the progression of DR. Levels of certain miRNAs have been shown to be either down or upregulated in type 1 diabetes patients and have shown correlations with specific types of DR. MicroRNA-150 (miR-150) has also been shown to have protective effects on cells in hypoxic environments, but when downregulated, miR-150 actually induces apoptosis. And, it has been shown to be downregulated in patients with type 1 and type 2 diabetes as well as patients with obesity. We hypothesize then that the levels of miR-150 from a peripheral blood sample should be indicative of the progression of DR and may be used for potential early intervention. In this project, we assessed miR-150 levels in the peripheral blood mononuclear cells (MNCs) of individuals with different severities of DR by isolating mononuclear cells and extracting RNA. We then reverse-transcribed the RNA into cDNA and used RT-qPCR to measure the levels of miR-150 in individuals with varying DR severity. MiR-150 levels in the MNCS were decreased in individuals with diabetes with no retinopathy, moderate NPDR and severe NPDR groups when compared to control individuals; however, there was a marginal increase in the miR-150 mild NPDR group. The data could show evidence that a peripheral blood draw could be used as a less invasive approach to assessing the severity of diabetic retinopathy in patients. This would change the disease management and future treatments individually.","PeriodicalId":20522,"journal":{"name":"Proceedings of IMPRS","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625866","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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