Digital Commons Network^™

Admission Pao2 And Mortality Among Pediatric Icu Patients And Critically Ill Subgroups, Cara Holton

Research Days

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Background and Objectives: Studies analyzing the association between hyperoxia and mortality in critically ill pediatric patients and those admitted after cardiac arrest are conflicting and limited by small sample sizes. The aim of this study is to evaluate the association between PaO2 on admission to the pediatric ICU and mortality in a heterogeneous, multicenter cohort and among subgroups of critically ill patients.

Methods/Design: A retrospective cohort study was conducted using data from Virtual Pediatric Systems (VPS) database. VPS is a clinical pediatric critical care database with over 135 participating hospitals in North America. All VPS …

Safety, Timing And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda

Research Days

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Background: Early postoperative ( < 6weeks) cardiac catheterization (EPOCC) has been considered high risk and often delayed. Recently, the safety of EPOCC has been demonstrated. The optimal timing of catheterization and its outcomes in struggling postoperative patients remains uncertain.

Objective: To describe EPOCC in our center and its impact on length of stay (LOS), number of mechanical ventilation days, number of ECMO days, and catheter-based interventions.

Methods: This is a retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and EPOCC within 30 days after surgery. Cohorts were early EPOCC (≤72 hr) vs late EPOCC ( >72 hr). Data on timing, indication, and complications of EPOCC; days of mechanical ventilation and ECMO; and CICU/total hospital LOS were collected. Data was analyzed using chi-square and Student’s t-test, …

Ekg Technology: It Is Time For A Change!, Megan Carroll

Research Days

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Background: Technology for obtaining pediatric EKGs has not changed in over 70 years. Current guidelines recommend a 12-lead EKG, which takes approximately 7 minutes to complete. Newer adult technology utilizes between 1-6 leads for EKG analysis. There has not been a study in pediatrics to assess the minimum number of leads required to attain diagnostic accuracy.

Objectives/Goal: To determine the appropriate number of leads needed to read pediatric EKGs safely and accurately.

Methods/Design: This is a single center systematic review that included randomly selected EKGs from our hospital database (2017-2020) read by two independent pediatric …

Increased Prevalence Of Parenteral Nutrition-Associated Liver Disease In Neonates With Congenital Heart Disease, Yasasvhinie Santharam

Research Days

Background: A life-sustaining therapy, use of total parenteral nutrition (TPN) allows for meeting nutritional needs of low birth weight, premature, or otherwise complex infants with conditions that prevent feeding through the GI tract. However, 40-60% of infants on long-term TPN have been shown to develop parenteral nutrition-associated liver disease (PNALD)1 , a serious condition characterized by cholestatic jaundice, steatosis, and hepatic fibrosis. Given these risks, providers must account for risk of hepatic injury when prescribing TPN, including attributes of gestational age, infection, surgical and diagnosis history2-6 . Yet with a multifactorial pathogenesis, significant heterogeneity in PNALD incidence still occurs. Looking …

Pharmacometabolomics Profiling Of Preterm Infants Validates Patterns Of Metabolism Associated With Response To Dexamethasone Treatment For Bronchopulmonary Dysplasia, Bradley C. Stockard

Research Days

Background: Bronchopulmonary dysplasia (BPD) is one of the most common health complications of premature birth. Corticosteroids are commonly used for treatment of BPD, but their use is challenging due to variability in treatment response.

Objectives/Goal: Previous pharmacometabolomics study has established patterns of metabolite levels with response to dexamethasone. We obtained additional patient samples for metabolomics analysis to find associations between the metabolome and dexamethasone response in a validation cohort.

Methods/Design: 14 infants provided 15 plasma and 12 urine samples. The measure of treatment response was the calculated change in respiratory severity score (deltaRSS) from pre-to-post treatment. Each metabolite was assessed …

Patient-Facing Antihemophilic Factor Clinical Decision Support Tool, Chandni Dargan

Research Days

Background: Hemophilia represents a medical condition suited to individualization. Adherence with prophylactic antihemophilic factor regimens ranges from 6%-167%. Clinical decision support tools (CDS) have been shown to improve guideline compliance and enhance patient adherence.

Objectives/Goal: The objective of this study is to evaluate the usability, usefulness, and satisfaction of a pharmacology-driven, patient-facing antihemophilic factor CDS.

Methods/Design: A patient-facing CDS was created to allow patients and families to explore factor levels at any time during their regimen and with the administration of different dosing regimens. Development followed a user-centered design process to ensure development of a product targeted to the needs …

Association Of Patient Demographics, Code Characteristics, And Survival To Discharge After In-Hospital Cardiac Arrests In The Pediatric Intensive Care Unit, Nathan Lavoy

Research Days

Background: Lower socioeconomic status and minority background have been linked to worse outcomes after out-ofhospital and in-hospital cardiac arrests (IHCA). Despite this, there has not been a focus on IHCA within a pediatric intensive care unit (PICU) evaluating patient demographics and code characteristics.

Objectives/Goal: The primary objective is to describe patient demographics, code characteristics, and survival to discharge of patients that suffer IHCA in a quaternary PICU. The goal of this descriptive, retrospective study is to identify possible differences in outcomes related to patient demographics, laying the foundation for further QI initiatives.

Methods/Design: Participants included patients between 24 hours and …

Maternal Antepartum Administration Of Lactoferrin Ameliorates Neonatal Infection By Bacteremia-Producing Escherichia Coli In Mice, Charity Dunlop

Research Days

Background: E. coli is a major cause of neonatal sepsis. Vaginal pathogenic E. coli strains ascend into the pregnant uterus infecting the offspring of colonized mothers. Lactoferrin (LF) is an antibacterial and immunomodulatory glycoprotein that has been given to preterm newborns to prevent lateonset sepsis. However, the effects of maternal LF administration to prevent neonatal E. coli invasive infection have not been studied.

Objectives/Goal: Our goal was to test the hypothesis that LF pre-treatment of pregnant mice administered prenatally will significantly reduce the bacterial load in their embryos following infection with E. coli.

Methods/Design: Human LF 100 mcg/mL or placebo …

Evaluation Of The Outcomes Of Oral Challenges To Azithromycin, Cephalexin And Trimethoprim-Sulfamethoxazole In Pediatrics, Hannah N. Neuhaus

Research Days

Rationale: Antibiotic hypersensitivity complicates treatment for various infections and leads to long-term healthcare costs and antibiotic resistance.Data regarding the outcomes of oral challenges to trimethoprim-sulfamethoxazole, azithromycin and cephalexin are limited in Pediatrics. The goal of this study was to characterize the outcomes and safety of oral challenges to these antibiotics in Pediatrics.

Methods: A retrospective chart review was performed of pediatric patients who underwent oral challenges to cephalexin, azithromycin and trimethoprim-sulfamethoxazole in Allergy Clinic over the last 12 years.

Results: Ten patients underwent oral challenge to trimethoprim-sulfamethoxazole and all were successful. Thirteen patients underwent oral challenge to azithromycin and twelve …

Assessment Of Dental Care In Children With Congenital Heart Disease, Mollie Walton

Research Days

Background: The incidence of infective endocarditis (IE) is significantly higher in patients with congenital heart disease (CHD) compared to the general population. Studies have investigated the incidence of IE in adults with CHD to identify the factors that contribute to the development of IE. One such factor is suboptimal oral health. Several studies have shown that children with CHD have higher levels of untreated oral disease as compared to children without CHD.

Objectives/Goal: Identify factors that may affect compliance with routine dental care, including: age, sex, severity of CHD, repair/palliation, and qualification for prophylactic antibiotics.

Methods/Design: A retrospective chart review …

Prenatal Diagnosis Of Absent Aortic Valve With Continuous Mitral Regurgitation In Turner’S Syndrome: Too Many Things Gone Awry, Amulya Buddhavarapu

Research Days

Background: Congenitally absent aortic valve (AAoV) is a rare anomaly associated with high incidence of perinatal mortality.

Case: A female fetus of twin gestation underwent a fetal echocardiogram at 24 weeks gestation. Findings: rudimentary AoV leaflets with severe aortic insufficiency and aortic arch flow reversal, left ventricular (LV) non-compaction with severe dysfunction. Continuous moderate regurgitation across a dysplastic, functionally atretic mitral valve and borderline restrictive left to right flow through the foramen ovale (FO) was noted, setting for an inverse circular shunt: Aorta - LV- left to right atrium (FO) - right ventricle - pulmonary artery - ductus arteriosus - …

Neonatal Hypoxia Due To Pulmonary Artery Thrombus, Bianca Cherestal

Research Days

Background: Pulmonary artery thrombus is rare and should be considered in neonates with refractory hypoxia.

Case: Preterm female neonate had persistent hypoxia after birth despite intubation, high-frequency oscillatory ventilation (FiO2 100%), and inhaled nitric oxide. Delivery was via c-section at 33 weeks 4 days for new onset hydrops and poor biophysical profile. Echocardiogram revealed echo brightness in the lumen of the left pulmonary artery (LPA) with no color flow (figure 1a), concerning for occlusive thrombus. Chest CT angiogram confirmed the diagnosis (figure 1b, c). Hematology was consulted and recommended systemic thrombolysis (tissue plasminogen activator, tPA) with concomitant anticoagulation (Bivalirudin). Imaging …

Sigirr Variants Identified In Nec Infants Exaggerate Toll-Like Receptor Mediated Inflammation, Jennie Godwin

Research Days

Background: A key event underlying uncontrolled inflammation in necrotizing enterocolitis (NEC) is pathologic activation of Toll-like receptors (TLR). TLR4 recognizes lipopolysaccharide (LPS), from Gramnegative bacteria, and TLR2 peptidoglycans (PAM3Csyk4, PAM), from Gram-positive bacteria. TLR4 and TLR2 signaling events induce an inflammatory cascade through NF-kB, a cytokine inducing transcription factor. Single-immunoglobulin interleukin-1-related receptor (SIGIRR) is a major negative regulator of TLR-mediated NF-kB activation. Previous work from our lab suggests that loss of function in SIGIRR may predispose to NEC. Our lab has identified four variants in NEC patients predicted to alter function of SIGIRR. We hypothesized that identified SIGIRR variants will …

The Effects Of Necrotizing Enterocolitis And Short Chain Fatty Acids On The Developing Brain In Mice, Maribel Martinez, Venkatesh Sampath, Paula Nichols, Wei Yu, Suban Burale, Tianhua Lei

Research Days

Background: Necrotizing enterocolitis (NEC) is a devastating disease in premature infants characterized by acute intestinal inflammation and necrosis with a mortality of 15%-30%. Approximately 50% of infants that survive NEC will develop neurodevelopmental defects[1]. Studies on the effects of NEC on the neonatal brain are limited, however it’s postulated that neurodevelopmental damage is induced via cytokine activation of toll-like-receptor 4 (TLR4) by high mobility group box protein 1 (HMGB1) on the microglia Accumulation of reactive oxygen and demyelination contribute to neuronal damage. Therapies that limit the development of NEC can potentially also limit the neuroinflammatory changes seen in NEC[2]. We …

Identifying Predictive Factors For Patients Transferred From Floor To Picu Within 24 Hours Of Admission By A Pediatric Critical Care Transport Team, Gina Patel

Research Days

Background: Appropriate triage and disposition during transport can reduce the need for unplanned transfers to the pediatric intensive care unit (PICU) within 24 hours of admission. We sought to determine predictive factors of patients admitted to the inpatient ward that required PICU transfer within 24 hours following transport by Children’s Mercy Critical Care Transport (CMCCT) team. The pediatric early warning score (PEWS) is used to monitor changes in the level of acuity for inpatients at our hospital and has been utilized to measure acuity during transport. We hypothesized patients with respiratory illness and PEWS > 4 during interfacility transport are at …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Understanding Clinical Application, Edward Lyon

Research Days

Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.

Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.

Methods: A retrospective chart review occurred on 15 patients in the PICU …

The Experience Of White Captives Among The Natives Of The Old Northwest Territory Between 1770 And 1850, Analucia Lugo

The Purdue Historian

In the late 18^th to mid-19^th centuries, hundreds of white settlers were taken captive by Native American groups across the Old Northwest Territory. Reasons for their capture varied from revenge to adoption, however, the treatment they received greatly depended on the captive’s gender. While females were more likely to be kept alive and better-taken care of, males faced a greater probability of facing violence or even death, though torture was common among both groups. Many captives undertook participatory roles within their respective captive communities, with some deciding to assimilate completely into a new way of life. Captivity narratives …

An Examination Of Sexist Roots Of The Psychiatric Diagnosis Of Nymphomania In 19th Century America, Madeline W. Reese

The Purdue Historian

During the mid to late nineteenth century, psychiatrists increasingly focused on women’s sexual deviance. Nymphomania was a diagnosis that emerged from existing scientific and popular understandings of sex and gender differences, sexual appropriateness, and morality of domestic relationships. Medical journals and popular conceptions of female sexuality are indicators of how this diagnosis was prejudiced and used exclusively for women. The nymphomaniac diagnosis was rooted in the patriarchal desire to keep women oppressed.

The Meaning And Malleableness Of Liberty From 1897-1945, Quentin E. Smith

The Purdue Historian

This paper covers how the substance and meaning of liberty changed during the ending years of the Gilded Age (1870-1900) through the beginning ages of the Civil Rights Movement (1954-1968). Economic liberty took shape in the cases Allegeyer v. Louisiana (1897) and Lochner v. New York (1905). Civil liberties would take several more years to come into the Supreme Court’s jurisdiction. The case Gitlow v. New York (1925) began the establishment of incorporation of the Bill of Rights to the states, otherwise known as our fundamental liberties (note: The Supreme Court used selective incorporation, however). In the case U.S. v. …

From The Stars To The Headlines: The Propaganda Of Yuri Gagarin, Peyton Edelbrock

The Purdue Historian

There were no haphazard decisions made by the Soviet Union when it came to choosing the first man to be sent to space. Months of training, careful planning, and well-hidden secrets eventually led to the decision of Yuri Gagarin. This led to the mass production of propaganda to spread, from Yuri Gagarin touring around the world to music being written about him, all centered around his trip to space and Soviet excellency. This propaganda still stands today in Russia, and its God-like idolization of cosmonauts is forever present.

Wealth, Desire, And Consequences Of The Antebellum Slaveholder, Macaira L. Mullen

The Purdue Historian

In the United States’ Declaration of Independence it articulates, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty and the pursuit of Happiness.” Walter Johnson’s book Soul by Soul delves deep into the “Life Inside the Antebellum Slave Market.” The enslaved female’s life was lived as the purchased property of a white slaveholding male. This book raised some good thoughts to go along with it. Such as, looking into the slaveholder after purchase. If there were conflicted …

Organized Savagery: Legitimization Of British Occupation In The Post-Ottoman State, Jamie M. Emerson

The Purdue Historian

The Great War of 1914-1918 saw the internment of hundreds of thousands of prisoners of war, captured and maintained by the hand of their enemy. Allegations and accounts of ill-treatment under the enemy’s care abounded during and after the war. Leading up to the Peace Conference of 1919, negotiators chose to account for the suffering of these prisoners in their demands for indemnities and reparations. This paper assesses how the British Parliament and press used stories about the suffering of British and Indian prisoners of war in Ottoman internment camps as a means to delegitimize Ottoman rule and legitimize British …

Cover Page, Madeline W. Reese

The Purdue Historian

No abstract provided.

Creating A Healthy Rural Ecosystem For Community Vitality: Developing Rural Community Business Research, Karalyn Kutzer, Dr. Emily Newell

Thinking Matters Student Research Symposium

The objective of this project is to create a model of and mechanism for statewide, systematic data collection to support workforce development pathways for P-20 students in rural Maine to ensure the long-term vitality and success of these communities. Businesses, as sites of financial and social capital development, can be more thoughtfully calibrated to local workforce needs in these communities. However, data is not currently made available to businesses and community leaders that would allow them to make thoughtful decisions about how to use community resources and time in order to create these partnerships. Businesses and economic growth in rural …

Uninspired, Andrew Zhang '22

Heliotrope: IMSA's Arts & Literary Magazine

No abstract provided.

Three Steps To Create A Designated Eld Curriculum Aligned To Academic Content, Melanie Wolf-Greenberg, Tracey Horvath, Eugenia F. Krimmel

Journal of English Learner Education

One of the top five factors influencing student achievement is the development of a curriculum that ensures all students have an equal opportunity to learn (Marzano, 2003). Many schools today do not have a comprehensive plan for the education of English Learners (ELs) blended or aligned to the mainstream content classroom. The authors have developed a process to create a designated English Language Development (ELD) curriculum which uses content area academic standards as its foundation. The benefits of a designated ELD curriculum reach beyond the individual ELD specialist’s lesson planning. School administrators and key stakeholders in the community will be …

Six Strategies For Classroom Success: Enhancing Teaching And Learning For English Learners In Diverse Content Areas, Scott Freiberger

Journal of English Learner Education

As a result of the pandemic, teaching and learning has changed drastically over the past few years (Dascalu et al., 2021). Planning for classroom success for English Learners (ELs) includes pivoting to using educational technology to keep students motivated with well-planned topics, thought-provoking discussions, and respectful yet probing questioning techniques (Freiberger, 2020). In addition to enhancing academic language, educators may also consider infusing various contemporary technologies to revamp vocabulary knowledge, uplift language and literacy, and polish academic performance. Here are six strategies for enhancing teaching and learning for ELs in diverse content areas.

When Teachers Are The Gatekeepers Of Gifted And Talented Programs: Potential Factors For English Learners' Underrepresentation And Possible Solutions, Isabel Haller-Gryc

Journal of English Learner Education

The inclusion of English learners (ELs) in gifted and talented (GT) programs is an issue needing attention as data reveal that this group is still disproportionately under-represented. This article discusses the concerns when the GT identification process is dependent upon general education teacher referrals. Teachers’ implicit biases, lack of familiarity with the knowledge and skills required to work with English learners, and a lack of understanding of what "gifted" looks like in diverse students are identified as potential contributors to an inequitable gifted identification process that many ELs experience. The author discusses perceived solutions to combat the under-representation that results …

The First Days Of School Are The Most Challenging: English Learners’ Stories Of Resilience And Their Recommendations, Jill Hendrickson Lohmeier, Shanna Rose Thompson, Bangsil Oh

Journal of English Learner Education

The Multilingual learner (ML) population is steadily increasing in U.S. schools. Navigating new educational environments can be challenging for MLs, especially on the first day. This study draws upon data collected during two improvement-focused evaluations and is guided theoretically by the extant ML literature as well as Bronfenbrenner’s (2005) bioecological model of human development and Bandura’s (2018) concept of human agency in social cognitive theory. Mixed methods were used to identify the strengths and opportunities for improvement for two school districts’ ML programs. This article draws mainly from the data collected through student focus groups. Through the high school MLs’ …

Collaborative Writing With Young Multilingual Learners, Loren D. Jones, Luciana C. De Oliveira

Journal of English Learner Education

Effectively teaching writing to multilingual learners (MLs) has been identified as one of the most prominent challenges currently facing educators. Collaborative writing has been identified as one promising pedagogical practice that responds to this challenge; however, little of the existing research focuses on the elementary level. This study seeks to address this gap in the literature, describing a design-based research study focused on collaborative writing with MLs in a diverse first-grade classroom. This paper showcases two iterations of collaborative writing, closely examining the how-to and opinion texts that two focal MLs produced with their peers. The evaluation of students’ writing …