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Item Evaluating the Prognostic Value of Fetal Magnetic Resonance Imaging Measurements on Postnatal Pulmonary Outcomes in the Setting of Omphalocele(2024-07-25) Harold, Danielle; Delaney, Lisa; Marine, Megan; McLuckey, Morgan; Newman, Christopher; Forbes-Amrhein, MonicaBACKGROUND: Omphalocele is a disorder of fetal abdominal development with increased risk for respiratory complications after birth secondary to pulmonary hypoplasia. While fetal magnetic resonance imaging (MRI) derived observed-to-expected total fetal lung volume (O/E-TFLV) has been established as an effective measure for prognosticating outcomes in other congenital disorders, it is not well understood whether this measure or others applies to patients with omphalocele. This study aims to assess the ability of fetal MRI measures to predict lung-related morbidity and perinatal outcomes in fetuses with omphalocele. METHODS: A retrospective review of fetal MRIs from 2016 to 2024 was performed, identifying 36 patients at 20-34 weeks gestation with omphalocele which were confirmed at birth. Omphalocele defect volume and MRI-derived fetal lung volumes, including O/E-NFLV and lung volume to head circumference ratio (LVHC), were compared with postnatal outcomes. A Mann-Whitney U test was used to evaluate the predictive value of each measure, along with a stepwise regression model for the outcomes of survival, intubation, and discharge with oxygen support. RESULTS: Both O/E-NFLV and LVHC measures predicted mortality, need for intubation, discharge with oxygen support, and tracheostomy placement with statistical significance (p<0.05). LVHC was the best predictor for mortality and discharge with oxygen support, with a LVHC < 0.067 (AUC 0.905) predicting mortality and LVHC < 0.116 (AUC 0.828) predicting need for oxygen at discharge. A percent extra-abdominal liver greater than 29.32% (AUC 0.803) was the best predictor for intubation. CONCLUSION: This study demonstrated O/E-NFLV and LVHC as effective measures for prognosticating survival and need for postnatal respiratory support in the setting of omphalocele. With this information, fetal MRI can be used to improve the preparation of families and medical teams for necessary postnatal care.Item Food insecurity as a social determinant of 30-day congestive heart failure readmissions(2024-07-26) Blodgett, Alison; Guerrero, Jonathan; Muvuka, BarakaBackground: Approximately 6.7 million Americans have congestive heart failure (CHF), costing the healthcare system over $30 billion annually. Readmissions contribute significantly to these costs, as 20-25% of hospitalized CHF patients are readmitted within 30 days of discharge. The Hospital Readmissions Reduction Program monitors 30-day readmission rates and penalizes hospitals that do not meet targets. Previous research on factors impacting CHF readmissions has largely focused on downstream factors, such as clinical practices, patient health characteristics, income level, insurance type, etc., rather than upstream factors that can potentially inform high-impact interventions. This study explored downstream, midstream, and upstream factors—including demographics, social determinants of health (SDOH), and health behaviors—and their relationship with 30-day CHF readmissions in an urban healthcare system in Northwest Indiana. This was part of an academic-health system participatory research partnership. Methods: This retrospective study analyzed a limited dataset from EPIC™ with SDOH, demographic, health behavior, and health outcomes of adult inpatients between January 2021 and April 2024. Data analysis consisted of descriptive, bivariate (Chi-Square; p<0.05), and multivariate (Binary Logistic Regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040). Results: The sample consisted of 5,489 patients with CHF, predominantly White (63.8%), 65+ years old (76.2%), and publicly insured (91.8%). 30-day readmissions represented 22.4% of CHF admissions. The bivariate analysis revealed significant associations between 30-day CHF readmissions and ethnicity (p=.003), sex (p=.046), language (p=.017), hospital (p=.009), insurance type (p=.003), food insecurity (p=.048), and depression risk (p=.003). Food insecurity remained significantly associated with 30-day CHF readmission (OR=2.128; p=.033) after adjusting for these factors in the multivariate analysis. Conclusion: This study identified food insecurity as an upstream SDOH predicting 30-day CHF readmission. Future research should further explore other upstream factors contributing to 30-day CHF readmissions and evaluate evidence-based food insecurity interventions.Item Kidney Function and Mortality Following Two-Stage Revision Total Joint Arthroplasty for Periprosthetic Joint Infection(2024-07-26) Epley, Rilee L.; Stoops, T. Kyle; Buller, Leonard T.; Deckard, Evan R.; Caccavallo, Peter; Meneghini, R. MichaelBACKGROUND AND HYPOTHESIS: Periprosthetic joint infection (PJI) after total hip and knee arthroplasty (THA, TKA) is reported in up to 2% of cases yet remains a serious complication. The current gold standard of treatment consists of a two-stage surgery involving intravenous antibiotic therapy between stages of implant resection and reimplantation. In addition, studies on the effects of these antibiotics on kidney function after two-stage treatment for PJI are limited. This study evaluated kidney function and mortality before, during, and after two-stage revision for PJI. The hypothesis of the study was that the antibiotics part of the treatment course would not lead to an increased risk of kidney injury. PROJECT METHODS: Clinical data on 160 THAs and TKAs undergoing two-stage treatment for PJI were retrospectively reviewed. Standardized protocols were used for all cases consisting of robust medical optimization by a dedicated perioperative medicine specialist and 6-weeks of intravenous antibiotics prior to reimplantation. Kidney function metrics of serum creatinine (Cr), estimated glomerular filtration rate (eGFR), and blood urea nitrogen (BUN) were collected from routine labs in the electronic medical record along with mortality data. A P-value of 0.05 was considered statistically significant. RESULTS: No significant differences were observed in mean serum Cr (1.10, 1.12, 1.13 mg/dL), eGFR (78.6, 77.7, 74.8 mL/min/1.73m2), or BUN levels (19.8, 18.9, 19.0 mg/dL) between pre-resection, the inter-stage period, or post-reimplant, respectively (P ≥ 0.432; Power ≥ 85.3%). Mortality was 0% within 90-days of resection and 1.4% (2/138) within 1-year of resection (both cardiac events unrelated to kidney function). Kaplan-Meier survivorship estimates were 98% at 2-years and 86% at 5-years post-resection. POTENTIAL IMPACT: Kidney function was not adversely impacted by the antibiotics associated with the two-stage revision procedure for PJI. With proper medical management, the two-stage revision for PJI remains the preeminent treatment for PJI following TJA.Item Analyzing the Effectiveness of a Pre-Arrival Time-Out in Pediatric Trauma Resuscitations(2024-07-26) Spangler, Julian; Raymond, Jodi; Landman, MatthewBACKGROUND: The surgical time-out is standard practice in the operating room. Time-out protocols have been associated with improved care and decreased complications in nonurgent care. However, the use of time-outs in trauma settings is not well studied and no standardized time-out exists. Early trauma time-out studies have found that these time-outs are perceived as effective and help reduce complications. The goal of this study was to draft a pre-arrival time-out protocol at Riley Hospital for Children (RHC), emphasizing introductions, patient details, and the patient’s plan upon arrival. METHODS: In this study, pre-hospital preparation for trauma resuscitations were retrospectively reviewed using trauma video review (TVR). Resuscitations took place in one of four trauma bays at RHC. The TVR analyzed pre-hospital preparations before a formal time-out plan was drafted for items related to the trauma time-out. Twenty-four resuscitations with pre-arrival interactions were available in the TVR for analysis. At the conclusion of this project, a pre-arrival time-out plan was drafted and implemented by invested healthcare professionals. RESULTS: Before intervention, time-outs occurred 29.2% (7/24) of the time. Attendance at time-outs was 76.2±11.7%. The average length of time-outs was 59.6±19.4 seconds and the average time between the end of the time-out and patient arrival was 4 minutes 53.7 seconds ± 3 minutes 37.0 seconds. Introductions were fully completed in 16.7% (4/24) of all scenarios and 57.1% (4/7) of all scenarios with time-outs. A clear leader was identified in 29.2% (7/24) of cases. Discussions about the case occurred 83.3% (20/24) of the time. A stated need for an item occurred in 50.0% (12/24) of pre-hospital preparations. CONCLUSION: The rates of time-outs, introductions, stating patient details, and stating equipment needs before patient arrival is less than desirable. The pre-arrival time-out intervention could be effective in increasing these rates. More data for post-intervention is needed.Item Impact of Social Determinants of Health on Stroke Severity in Northwest Indiana(2024-07-25) Barnard, Jacobus; Lin, David; Cash, Miranda; Armstrong, Grace Zhou; Calumpang, Neon; Han, AmyIntroduction: Stroke significantly contributes to mortality and disability in the United States, yet geographical disparities exist across regions like Northwest Indiana, where stroke incidences and mortality rates are 2-4 times higher than the national average. Social and demographic determinants of health are known factors of stroke risk and outcomes. This study aims to investigate the associations between specific determinants and stroke severity of Stroke Center patients from Lake County, Indiana. Methodology: Data elements were extracted from patients hospitalized at Community Hospital, St. Mary’s Medical Center, and St. Catherine Hospital under Powers Health between January 2022 and May 2024. Data was recorded with the AHA’s GWTG Stroke Case Record Form. Our retrospective study conducted bivariate analysis, using R, on predictor variables of age, sex, race, Hispanic ethnicity, ZIP code, payment sources, and mode of arrival to the ordinal scores of the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Results: Analysis of 1563 patients, excluding non-residents and transfer patients, revealed notable variations in social and demographic characteristics. Patients from certain urban ZIP codes with comparatively lower median household incomes and secondary education attainment had higher, more severe, mean NIHSS and discharge mRS scores (p<0.05). When age-adjusted, Black patients had a 2.5 point higher mean initial and 1.9 point higher mean discharge NIHSS score than White patients (p<0.001, p<0.01). Patients with higher mean scores across all measures were those associated with using Medicare versus private insurance (p<0.0001) and those arriving to the hospital via EMS versus private transport (p<0.01). Conclusions: This research addresses the significance of surveying region-specific social determinants of health for its insight into clinical stroke care and future preventative and quality improvement initiatives. Geographical implementation of interventions and policies can mitigate disparities and impact overall stroke management and prevention strategies.Item Determining the Therapeutic Effect of Human Neuritin 1 on the Restoration of Degenerated Retinal Ganglion Cells from Glaucoma Patients(2024-07-25) Hubbard, Nathan; Hameed, Shahna; Sharma, TasneemBACKGROUND AND HYPOTHESIS: Glaucoma is a group of optic neuropathies that affects approximately 76 million people worldwide. The main risk factor is elevated intraocular pressure (IOP) which predominantly affects retinal ganglion cells (RGC), resulting in cell death and permanent vision loss. Current therapeutics for glaucoma involve reducing IOP and halting progression of disease, but no current treatments can revive degenerated RGCs. Our project aims to evaluate the therapeutic effect of human Neuritin 1 (NRN1) in regenerating and protecting RGCs lost in glaucoma. By administering NRN1 to the RGCs in culture, we hope to elucidate the efficacy in helping glaucomatous RGCs recover from cell death. PROJECT METHODS: Immunofluorescence (IF), gene expression, and karyotyping experiments were performed on iPSCs to confirm they were successfully reprogrammed from donor keratocytes. The iPSCs were differentiated to retinal organoids (RO) to generate RGCs in vitro. After around 30 days of differentiation, the ROs were dissociated to isolate RGCs. The RGCs were seeded at one end of three different in vitro collagen scaffolds. The first received no NRN1 treatment, the second received NRN1 at the cell body, and the third received NRN1 at the opposite end. IF was done on RGC-seeded scaffolds with RBPMS and NEFL antibodies to confirm RGC marker expression and neurite growth. RESULTS: The iPSCs were successfully reprogrammed from donor fibroblasts. We successfully generated RGCs from both non-glaucomatous and glaucomatous donor keratocytes. The RGCs effectively integrated within the collagen scaffolds. After NRN1 treatment, non-glaucomatous and glaucomatous RGCs demonstrated differential expression of RGC specific markers. CONCLUSIONS AND POTENTIAL IMPACT: Our study demonstrates that NRN1 exhibits a therapeutic effect on glaucomatous RGCs. This study lays the foundation that NRN1 could potentially restore vision in glaucoma patients. Additionally, iPSC-derived RGCs can successfully be obtained from human donor eyes and cultured for future research or testing therapeutics.Item Dental Abnormalities in Congenital Ichthyoses: Case Report and Review of the Literature(2024-07-26) Maarouf, Sarah; Clark, Marie; Chen, Anthony; Haggstrom, AnitaWe describe a 1-day old female with features of keratitis-ichthyosis-deafness (KID) syndrome and natal teeth. Genetic analysis confirmed GJB2 263C and A88V de novo pathogenic variants consistent with KID syndrome. Natal teeth were promptly extracted to avoid the risk of aspiration. This review describes subsets of ichthyoses that have been reported in association with dental anomalies, highlighting the need for early dental referral and importance of long-term follow-up.Item 12-Month Postpartum Metabolic Follow-Up of β-cell Function in Women with Pregnancy-related Glucose Intolerance(2024-07-26) Sinha, Arunabh; Lalama, Christina; Abebe, Kaleab; Davis, Esa; Catalano, Patrick; Scifres, ChristinaBackground: Gestational diabetes mellitus (GDM) is associated with long-term risk for maternal Type II Diabetes (T2DM). We evaluated β-cell function during pregnancy and at 12 months postpartum in individuals with varying levels of glucose intolerance in pregnancy. Methods: This is a planned follow-up to the Gestational Diabetes Diagnostic Methods (GDM2) trial, which randomized pregnant individuals to either a 75-gram oral glucose tolerance test (OGTT) with GDM diagnosed with ≥1 abnormal value per IADPSG guidelines, or a 100g OGTT with GDM diagnosed with ≥2 abnormal values per Carpenter-Coustan (CC) criteria. All participants with treated GDM, those with untreated mild glucose intolerance (MGI, one abnormal value on CC criteria), and half of the participants with normal glucose tolerance were invited for a follow-up visit at 12 months postpartum where they underwent a 75g OGTT measuring insulin and glucose at all time points. Measures assessed included Stumvoll, Matsuda, and Disposition Indices and other metabolic factors to evaluate insulin sensitivity, resistance, and β-cell function. Results: In pregnancy and 12-month postpartum visits, the disposition and Matsuda indices demonstrated significantly more insulin resistance among those with MGI and GDM compared to those without GDM (41.0±41.6, 28.7±26.6, 20.0±15.9, p<0.001), whereas the Stumvoll index was similar among groups. The rate of change from pregnancy to postpartum in both the Matsuda and Stumvoll indices were similar across the three groups, indicating individuals were likely returning to their baseline levels of glucose tolerance rather than recovering from a pregnancy-specific metabolic impairment. Although this study was underpowered for this outcome, there was a trend towards higher rates of prediabetes and T2DM in those with MGI and GDM (14.6%, 25.5%, 24%, p=0.09). Conclusions: Patients with MGI have significant impairments in insulin resistance similar to individuals with treated GDM one year postpartum and should receive follow-up for potential progression to T2DM.Item Impacts of Estrogen Receptor Alpha (ERα) Deficiency on Dynamics of the Ovarian Immune Microenvironment(2024-07-31) Salter, Lucy; Sessions, Katherine; Krementsov, Dimitry; Brodeur, TiaItem IMPRS Research Symposium Program(Indiana University School of Medicine, 2024) Nguyen, Anne; Herbert, Brittney-SheaProgram includes the names of symposium presenters, titles of their research projects, and the names and departmental affiliations of their mentors.