Medicine and Health Sciences Commons^™

Ai And Ml-Based Risk Assessment Of Chemicals: Predicting Carcinogenic Risk From Chemical-Induced Genomic Instability, Ajay Vikram Singh, Preeti Bhardwaj, Peter Laux, Prachi Pradeep, Madleen Busse, Andreas Luch, Akihiko Hirose, Christopher J. Osgood, Michael W. Stacey

Biological Sciences Faculty Publications

Chemical risk assessment plays a pivotal role in safeguarding public health and environmental safety by evaluating the potential hazards and risks associated with chemical exposures. In recent years, the convergence of artificial intelligence (AI), machine learning (ML), and omics technologies has revolutionized the field of chemical risk assessment, offering new insights into toxicity mechanisms, predictive modeling, and risk management strategies. This perspective review explores the synergistic potential of AI/ML and omics in deciphering clastogen-induced genomic instability for carcinogenic risk prediction. We provide an overview of key findings, challenges, and opportunities in integrating AI/ML and omics technologies for chemical risk assessment, …

A Pilot Study Of Intraoperative Application Of Cooled Radiofrequency To Reduce Post-Operative Pain Following Total Knee Arthroplasty, Jonathan Liew, Lucy J. Salmon, Rajat Mittal, Leo Pinczewski

Medical Papers and Journal Articles

Background: Total Knee Arthroplasty (TKA) is a successful treatment for end stage knee osteoarthritis (OA), but can be associated with significant pain in the early post-operative period. Cooled radiofrequency ablation (CRFA) has reported to reduce knee OA pain by targeting the periarticular nerves. The objective of this pilot study was to assess the effectiveness of intra-operative CRFA for reducing pain and opiate use after TKA.

Methods: This was a non randomised prospective study with control group. Participants were sequentially recruited preoperatively and underwent TKA, with CRFA to 6 targeted sites prior to cementing of implants, and were compared to controls …

Vulnerability To Environmental And Climatic Health Provocations Among Women And Men Hospitalized With Chronic Heart Disease: Insights From The Resilience Trial Cohort, Simon Stewart, Sheila Patel, Terase Lancefield, Thalys Rodrigues, Nicholas Doumtsis, Ashleigh Jess, Emily-Rose Vaughan-Fowler, Yih Kai Chan, Jay Ramchand, Paul Yates, Jason Kwong, Christine Mcdonald, Louise Burrell

IHR Papers and Journal Articles

Aims: We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health.
Methods and results: The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had …

Cross-Sectional And Longitudinal Associations Between Treatment For Herpes Virus Infection And The Dispensing Of Antidementia Medicines: An Analysis Of The Australian Pharmaceutical Benefits Scheme Database, Stephanie Tan, Erin Kelty, Amy Page, Christopher Etherton-Beer, Frank Sanfilippo, Osvaldo P. Almeida

IHR Papers and Journal Articles

Background: Evidence from previous observational studies suggest that infection by herpes simplex virus (HSV) and varicella zoster virus (VZV) increase the risk of dementia.

Objective :To investigate if older adults exposed to HSV treatment have lower risk of dementia than the rest of the population.

Methods: We used the 10% Australian Pharmaceutical Benefits Scheme (PBS) database from 2013 to 2022 to ascertain the cross-sectional, time-series and longitudinal association between exposure to HSV treatment and the dispensing of antidementia medicines. Participants were men and women aged 60 years or older. We used Anatomical Therapeutic Chemical (ATC) codes to identify medicines dispensed …

Supply Of Nirmatrelvir/Ritonavir And Molnupiravir For Patients With Covid-19 In The First Eight Months Since Listing On The Australian Pharmaceutical Benefits Scheme: A Retrospective Observational Study, Derrick Lopez, Douglas Pritchard, Frank Sanfilippo, Erin Kelty, Amy Page, Christopher Etherton-Beer, Osvaldo P. Almeida, David Preen

IHR Papers and Journal Articles

Objectives: To compare the supply of molnupiravir and nirmatrelvir/ritonavir in relation to patient characteristics and other co-prescribed medicines and to estimate the number of patients without contraindications to nirmatrelvir/ritonavir who were treated with molnupiravir.

Study design, setting: Retrospective observational study of patients identified in the Pharmaceutical Benefits Scheme (PBS) 10 % sample dataset who were supplied with either molnupiravir or nirmatrelvir/ritonavir between May and December 2022. We supplemented the PBS dataset with aggregated counts from published literature to determine prevalence of clinical contraindications to nirmatrelvir/ritonavir. Main outcome measures: We used multivariable Poisson regression to estimate risk ratios (RR) of receiving …

Improved Risk Prediction In Human Papillomavirus-Associated Endocervical Adenocarcinoma Through Assessment Of Binary Silva Pattern-Based Classification: An International Multicenter Retrospective Observational Study Led By The International Society Of Gynecological Pathologists (Isgyp), Aime Powell, Anjelica Hodgson, Paul Cohen, T. Joseph Rabban, Kay Park, W. Glenn Mccluggage, C Blake Gilks, Naveena Singh, Esther Oliva

IHR Papers and Journal Articles

Endocervical adenocarcinomas (EACs) are a group of malignant neoplasms associated with diverse pathogenesis, morphology, and clinical behavior. As a component of the International Society of Gynecological Pathologists International Endocervical Adenocarcinoma Project, a large international retrospective cohort of EACs was generated in an effort to study potential clinicopathological features with prognostic significance that may guide treatment in these patients. In this study, we endeavored to develop a robust human papillomavirus (HPV)-associated EAC prognostic model for surgically treated International Federation of Gynecology and Obstetrics (FIGO) stage IA2 to IB3 adenocarcinomas incorporating patient age, lymphovascular space invasion (LVSI) status, FIGO stage, and pattern …

Editorial: 2022 In Review: Vector Biology, David P. Tchouassi, Janet Midega, Baldwyn Torto

All Peer-Reviewed Publications

This editorial summarizes collections on the Research Topic “2022 in Review: Vector Biology’’ that focus on entomologic surveillance insights related to mosquito-borne diseases such as dengue and malaria, and sandfly-borne leishmaniasis. Specifically, the editorial discusses the entomologic drivers of dengue virus transmission, host-feeding relationships among various mosquito vectors, sample efficiency of malaria vectors using a suite of trapping techniques and improving sandfly surveillance using odor-baited trapping strategies. The research article by Kamau et al. assessed variation in the biological attributes of adult Aedes aegypti mosquitoes by estimating critical parameters of vectorial capacity (vectors abundance, human blood feeding rates, survival) that …

Usp22 Overexpression Fails To Augment Tumor Formatiaon In Mmtv-Erbb2 Mice But Loss Of Function Impacts Mmtv Promoter Activity, Xianghong Kuang, Andrew Salinger, Fernando Benavides, William J Muller, Sharon Y R Dent, Evangelia Koutelou

Faculty, Staff and Student Publications

The Ubiquitin Specific Peptidase 22 (USP22), a component of the Spt-Ada-Gcn5 Acetyltransferase (SAGA) histone modifying complex, is overexpressed in multiple human cancers, but how USP22 impacts tumorigenesis is not clear. We reported previously that Usp22 loss in mice impacts execution of several signaling pathways driven by growth factor receptors such as erythroblastic oncogene B b2 (ERBB2). To determine whether changes in USP22 expression affects ERBB2-driven tumorigenesis, we introduced conditional overexpression or deletion alleles of Usp22 into mice bearing the Mouse mammary tumor virus-Neu-Ires-Cre (MMTV-NIC) transgene, which drives both rat ERBB2/NEU expression and Cre recombinase activity from the MMTV promoter resulting …

The Effect Of Creatine Nitrate And Caffeine Individually Or Combined On Exercise Performance And Cognitive Function: A Randomized, Crossover, Double-Blind, Placebo-Controlled Trial, Gina Mabrey, Majid S. Koozehchian, Andrew T. Newton, Alireza Naderi, Scott C. Forbes, Monoem Haddad

Research, Publications & Creative Work

This study examined the effect of creatine nitrate and caffeine alone and combined on exercise performance and cognitive function in resistance-trained athletes. In a double-blind, randomized crossover trial, twelve resistance-trained male athletes were supplemented with 7 days of creatine nitrate (5 g/day), caffeine (400 mg/day), and a combination of creatine nitrate and caffeine. The study involved twelve resistance-trained male athletes who initially provided a blood sample for comprehensive safety analysis, including tests for key enzymes and a lipid profile, and then performed standardized resistance exercises—bench and leg press at 70% 1RM—and a Wingate anaerobic power test. Cognitive function and cardiovascular …

Belzutifan, Hif-2Α Inhibitor, And Clear Cell Renal Cell Carcinoma With Somatic Von-Hippel-Lindau Loss-Of-Function Mutation, Kok Hoe Chan, Ningjing Li, Ran Lador, Mark Amsbaugh, Anneliese Gonzalez, Putao Cen

Faculty, Staff and Student Publications

The Von-Hippel-Lindau (VHL) gene, acting as a tumor suppressor, plays a crucial role in the tumorigenesis of clear cell renal cell carcinoma (ccRCC). Approximately 90% of individuals with advanced ccRCC exhibit somatic mutations in the VHL gene. Belzutifan, orally administered small-molecule inhibitor of hypoxia-induced factor-2α, has demonstrated promising efficacy in solid tumors associated with germline loss-of-function mutations in VHL, including ccRCC. However, its impact on cases with somatic or sporadic VHL mutations remains unclear. Here, we present 2 cases where belzutifan monotherapy was employed in patients with advanced ccRCC and somatic loss-of-function mutations in VHL. Both patients exhibited a swift …

Editorial: Emerging Anti-Cancer Compounds And Immunomodulators For Pancreatic Cancer Treatment, Kathleen E Delgiorno, Stephen Safe, Jennifer M Bailey-Lundberg

Faculty, Staff and Student Publications

No abstract provided.

Chronic Lymphocytic Leukemia: Novel Perspectives - How To Teach An Old Dog New Tricks, Tamar Tadmor, Jan Burger

Faculty, Staff and Student Publications

No abstract provided.

Outcomes For Patients With Head And Neck Sarcoma Treated Curatively With Radiation Therapy And Surgery, Alison K Yoder, Ahsan Farooqi, Devarati Mitra, J Andrew Livingston, Dejka M Araujo, Erich M Sturgis, Ryan Goepfert, Andrew J Bishop, B Ashleigh Guadagnolo

Faculty, Staff and Student Publications

PURPOSE: Soft tissue sarcomas (STSs) of the head and neck (H&N) are rare malignancies that are challenging to manage. We sought to describe the outcomes of patients treated with curative intent using combined surgery and radiation therapy (RT) for H&N STS.

METHODS AND MATERIALS: We performed a single-institution retrospective review of patients with nonmetastatic STS of the H&N who were treated from 1968 to 2020. The Kaplan-Meier method was used to estimate disease-specific survival (DSS) and local control (LC). Multivariable analyses (MVAs) were conducted using Cox proportional hazards model.

RESULTS: One hundred ninety-two patients had a median follow-up of 82 …

First-In-Human Phase 1 Study Of The Arginase Inhibitor Incb001158 Alone Or Combined With Pembrolizumab In Patients With Advanced Or Metastatic Solid Tumours, Aung Naing, Kyriakos P Papadopoulos, Michael J Pishvaian, Osama Rahma, Glenn J Hanna, Elena Garralda, Omar Saavedra, Sven Gogov, Howard Kallender, Lulu Cheng, Michael Smith, Xuejun Chen, Emil Kuriakose, Todd Bauer

Faculty, Staff and Student Publications

Objective: The arginase inhibitor INCB001158 was evaluated for safety (primary endpoint) in locally advanced or metastatic solid tumours; pharmacokinetics, pharmacodynamics and efficacy were also assessed.

Methods and analysis: In this non-randomised, open-label, three-part phase 1 study, INCB001158 was orally administered two times per day as monotherapy or in combination with intravenous pembrolizumab 200 mg every 3 weeks. Dose expansion was conducted in tumour-type cohorts (with or without prior anti-PD-1/PD-L1 (programmed death protein 1/programmed death ligand 1) therapy).

Results: A total of 107 patients received INCB001158 50-150 mg two times per day as monotherapy, and 153 patients, including 6 with moderate …

Tumor Treating Fields (Ttfields) For Spinal Metastasis–The Case For Bone Removal And Spinal Implants As Waveguides To Enhance Field Strength At The Target, Claudio E Tatsui, Kristen W Carlson, Chirag B Patel

Faculty, Staff and Student Publications

No abstract provided.

An Online Module To Promote Self-Care And Resiliency In Nursing Students, Karen Higgins, Janice Hawkins, Beth Tremblay, Lynn Wiles

Ellmer School of Nursing Faculty Publications

Because the demands of nursing education can impact the physical and mental health of nursing students, the American Association of Colleges of Nursing’s revised Essentials require inclusion of self-care and resilience education in nursing curricula. This article describes the development, implementation, and evaluation of a self-care module in a new online undergraduate course. Using the REST mnemonic (relationships, exercise, soul, and transformative thinking), students developed personalized self-care plans for the semester. End-of-course evaluations revealed an increase in self-care activities. The most used activities were exercise, humor, intentional rest, and healthy eating.

Impact Of A Design Thinking Educational Activity On Graduate Students’ Knowledge, Confidence, And Perceived Benefits, Janice Hawkins, John Baaki, Beth Tembley, Robert J. Hawkins

Ellmer School of Nursing Faculty Publications

Background: Design Thinking is gaining recognition as an innovative and creative approach to problem solving. Though nurse leaders need problem solving tools to address health care challenges, Design Thinking concepts are not commonly taught in nursing education. To introduce graduate level nursing students to Design Thinking, we held an educational activity focused on this content as part of required coursework.

Purpose: The purpose was to describe and compare outcomes of a Design Thinking educational activity on students’ perceived knowledge, confidence, and benefits to nursing practice.

Methods: Graduate level nursing students participated in a 3-hour educational activity. After the session, …

Patient Satisfaction Informs Improvement Strategies In Emergency Department, Esmat Swallmeh

Doctoral

Recently, patient satisfaction has become one of the key performance indicators used to measure the performance of healthcare institutions and has emerged as a primary strategic indicator of quality and efficacy within the healthcare system. Inadequate care of patient experience in acute hospitals may negatively impact patients’ adherence, readmission rates and mortality. This dissertation critically evaluates over 2,000 peer-reviewed papers relevant to patient satisfaction within the emergency department (ED) environment. It describes the theories, tools, determinants, and methods to increase patient satisfaction. Despite growing attention to patient satisfaction, the academic literature still lacks a comprehensive overview. In addition, the literature …

Hypoxia-Adenosine Axis As Therapeutic Targets For Acute Respiratory Distress Syndrome, Katherine Figarella, Jieun Kim, Wei Ruan, Tingting Mills, Holger Klaus Eltzschig, Xiaoyi Yuan

Faculty, Staff and Student Publications

The human respiratory and circulatory systems collaborate intricately to ensure oxygen delivery to all cells, which is vital for ATP production and maintaining physiological functions and structures. During limited oxygen availability, hypoxia-inducible factors (HIFs) are stabilized and play a fundamental role in maintaining cellular processes for hypoxia adaptation. First discovered during investigations of erythropoietin production regulation, HIFs influence physiological and pathological processes, including development, inflammation, wound healing, and cancer. HIFs promote extracellular adenosine signaling by enhancing adenosine generation and receptor signaling, representing an endogenous feedback mechanism that curbs excessive inflammation, supports injury resolution, and enhances hypoxia tolerance. This is especially …

Development And Initial Validation Of A Hospital Stress Questionnaire, Daniel M Ford, Rebecca Lawton, Elizabeth Travis, Elizabeth A Teale, Daryl B O'Connor

Faculty, Staff and Student Publications

BACKGROUND: Hospitalisation can be a traumatic experience, where inpatients are exposed to an abundance of physical and psychological stressors. Evidence suggests that these hospital-related stressors negatively impact health: a phenomenon known as post-hospital syndrome. The current study aimed to identify hospital-related stressors, and to develop and provide initial validation for a new measure of in-hospital stress.

METHODS: Measure development occurred in three stages: (i) semi-structured interviews, (ii) item generation, and (iii) pilot testing. Twenty-one patients were interviewed regarding their recent hospital experiences, and a list of hospital-related stressors was produced. These stressors were compiled into a questionnaire and piloted on …

Outcomes And Toxicities In Patients With Diffuse-Large B Cell Lymphoma Involving The Gastrointestinal Tract And Digestive Organs, Gohar S Manzar, Elaine E Cha, Kelsey L Corrigan, Alison K Yoder, Benjamin R Schrank, Lewis F Nasr, Dai Chihara, Luis Malpica Castillo, Ranjit Nair, Preetesh Jain, Sattva S Neelapu, Maria A Rodriguez, Paolo Strati, Loretta J Nastoupil, Jillian R Gunther, Bouthaina S Dabaja, Chelsea C Pinnix, Susan Y Wu, Penny Q Fang

Faculty, Staff and Student Publications

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) involving the gastrointestinal (GI) organs is rare, and real-world outcomes after combined modality therapy (CMT) with systemic therapy (ST) and radiotherapy (RT) are not well-characterized, particularly in the contemporary era. We characterized outcomes in a large cohort of GI-DLBCL patients treated with ST alone or CMT.

METHODS: Patients with GI-DLBCL treated at a single institution were retrospectively reviewed. Kaplan-Meier and Cox regression models estimated survival. Multivariable analyses were conducted using the Cox proportional hazards model.

RESULTS: Of 204 patients, gastric involvement was most common (63%). Most presented with early-stage disease (61%). All patients received …

Examining Predictors Of Cocaine Withdrawal Syndrome At The End Of Detoxification Treatment In Women With Cocaine Use Disorder, Bernardo Aguzzoli Heberle, Bruno Kluwe-Schiavon, Carla Bicca, Leonardo Melo Rothmann, Rodrigo Grassi-Oliveira, Thiago Wendt Viola

Faculty, Staff and Student Publications

BACKGROUND: Detoxification is frequently recommended as a treatment for moderate to severe Cocaine Use Disorder (CUD). However, the response to detoxification varies among patients, and previous studies have focused mostly on patterns of drug use behavior to test associations with treatment outcomes, overlooking the potential impact of psychosocial factors, other clinical variables, and individual life experiences. In this study we comprehensively examined several variables aiming to find the most relevant predictors to classify patients with severe versus non-severe cocaine withdrawal symptoms at the end of detoxification.

METHODS: Data from 284 women with CUD who enrolled in a 3-week detoxification program …

Carbimazole-Associated Pancreatitis: Report From Western India, Vyankatesh Shivane, Nihar Mehta, Ajay Jhaveri, Saba Samad Memon

Faculty, Staff and Student Publications

Pancreatitis is a very rare complication of methimazole and carbimazole therapy. We describe a case of possible carbimazole-associated pancreatitis. A 41-year-old Asian man (with no comorbidities) reported to the hospital with atrial fibrillation and a fast ventricular rate. He was diagnosed with hyperthyroidism due to Graves disease. His rhythm was reverted with amiodarone, and carbimazole was initiated at 15 mg daily for the medical management of Graves disease. Fifteen days later, he presented with acute severe abdominal pain and vomiting with elevated serum amylase 387 U/L (reference range, 28-100 U/L) and lipase levels 206 U/L (reference range, 13-60 U/L). Magnetic …

The Lawnmower And The Pediatric Lower Extremity: A Catastrophic Combination, Sairandri Sathyanarayanan, Chioma G Obinero, Jackson C Green, Kasra N Fallah, Matthew R Greives, Wendy Chen, Phuong D Nguyen

Faculty, Staff and Student Publications

BACKGROUND: Lower extremity (LE) trauma within the pediatric population may be debilitating and have different implications and etiologies than in adults. Specifically, lawnmower injuries can cause catastrophic sequelae to the lower extremities, often requiring complex reconstruction or resulting in amputation. This study aims to present our experience with pediatric LE lawnmower injuries at one of the busiest level 1 trauma centers in the United States.

METHODS: An IRB-approved retrospective analysis was performed studying pediatric patients (age < 18 >years) who experienced LE trauma due to a lawnmower injury over a 5-year period (2012-2017). Patient demographics, perioperative data, and types of reconstruction were …

Efficacy And Safety Of Trastuzumab Deruxtecan In Patients With Her2-Expressing Solid Tumors: Primary Results From The Destiny-Pantumor02 Phase Ii Trial, Funda Meric-Bernstam, Vicky Makker, Ana Oaknin, Do-Youn Oh, Susana Banerjee, Antonio González-Martín, Kyung Hae Jung, Iwona Ługowska, Luis Manso, Aránzazu Manzano, Bohuslav Melichar, Salvatore Siena, Daniil Stroyakovskiy, Anitra Fielding, Yan Ma, Soham Puvvada, Norah Shire, Jung-Yun Lee

Faculty, Staff and Student Publications

PURPOSE: Trastuzumab deruxtecan (T-DXd) is a human epidermal growth factor 2 (HER2)-directed antibody-drug conjugate approved in HER2-expressing breast and gastric cancers and HER2-mutant non-small-cell lung cancer. Treatments are limited for other HER2-expressing solid tumors.

METHODS: This open-label phase II study evaluated T-DXd (5.4 mg/kg once every 3 weeks) for HER2-expressing (immunohistochemistry [IHC] 3+/2+ by local or central testing) locally advanced or metastatic disease after ≥1 systemic treatment or without alternative treatments. The primary end point was investigator-assessed confirmed objective response rate (ORR). Secondary end points included safety, duration of response, progression-free survival (PFS), and overall survival (OS).

RESULTS: At primary …

Trajectory Clustering Of Immune Cells And Its Association With Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage, So Young Won, Museong Kim, Han-Gil Jeong, Bosco Seong Kyu Yang, Huimahn Alex Choi, Dong-Wan Kang, Yong Soo Kim, Young Deok Kim, Si Un Lee, Seung Pil Ban, Jae Seung Bang, Moon-Ku Han, O-Ki Kwon, Chang Wan Oh

Faculty, Staff and Student Publications

Background and purpose: The immune response following aneurysmal subarachnoid hemorrhage (aSAH) can exacerbate secondary brain injury and impact clinical outcomes. As the immune response after aSAH is a dynamic process, we aim to track and characterize immune cell trajectories over time to identify patterns associated with various clinical outcomes.

Methods: In this retrospective single-center study of patients with aSAH, we analyzed immune cell count trajectories, including neutrophil, monocyte, and lymphocyte counts, collected from day 1 to day 14. These trajectories were classified into four distinct clusters utilizing the k-means longitudinal clustering method. A comprehensive multivariable analysis was performed to explore …

Personalization Of Sudep Risk: A Survey Of Transient Subclinical Comorbid Changes, Kristina A Simeone, Dawn M Martenz, Shruthi H Iyer, Cameron P Booth, Shelby E Herr, Stephanie A Matthews, Samantha B Draves, Laura L Heinemann, Pierce L Greenberg, Samden D Lhatoo, Elizabeth Donner, Timothy A Simeone

Faculty, Staff and Student Publications

Objective: Preclinical data report within subject modifiable ailments emerge weeks prior to SUDEP, including sleep disorders and cardiorespiratory changes; findings which support anecdotal clinical data. Here, we bridge preclinical findings with future clinical/preclinical studies, and survey whether caretakers or family members of victims noticed transient changes prior to SUDEP. The aim of this pilot study is to identify potential modifiable changes that may synergistically increase SUDEP risk for future research.

Methods: A mobile electronic survey was posted on SUDEP community websites. The survey queried whether changes in seizures, sleep, physical well-being, emotional well-being, cognition, breathing, or heart rate were noticed …

First Evidence Of Microplastic Inhalation Among Free-Ranging Small Cetaceans, Miranda K Dziobak, Andreas Fahlman, Randall S Wells, Ryan Takeshita, Cynthia Smith, Austin Gray, John Weinstein, Leslie B Hart

Faculty, Staff and Student Publications

Plastic is a ubiquitous environmental contaminant, resulting in widespread exposure across terrestrial and marine spaces. In the environment, plastics can degrade into microparticles where exposure has been documented in a variety of fauna at all trophic levels. Human epidemiological studies have found relationships between inhaled microplastics and oxidative stress and inflammation. Previous studies of bottlenose dolphins (Tursiops truncatus) have reported prevalent exposure to plasticizing chemicals (e.g., phthalates) as well as particle loads in gastrointestinal tracts, but exposure from inhalation has not yet been studied. The objective of this study was to determine if inhalation is a viable route of microplastic …

20-Year Inflation-Adjusted Medicare Reimbursements (Years: 2000-2020) For Common Lumbar And Cervical Degenerative Disc Disease Procedures, Pedram Honarpisheh, Samantha L Parker, Christopher R Conner, Sami Anjum, Jessica R Stark, John C Quinn, John M Caridi

Faculty, Staff and Student Publications

OBJECTIVE: Reimbursement trends for common procedures have persistently declined over the past 2 decades. Spinal instrumentational and fusion procedures are increasingly utilized and have increased in clinical complexity, yet longitudinal inflation-adjusted data for Medicare reimbursements of these procedures have not been evaluated.

METHODS: The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements for the 5 most common spinal procedures and associated instrumentations from 2000-2020. Current Procedural Terminology (CPT) codes include 22551, 22600, 22633, 63030, and 63047 as well as instrumentation CPT codes 22840 and 22842-6. The nominal values were adjusted …

Does An Early, Balanced Resuscitation Strategy Reduce The Incidence Of Hypofibrinogenemia In Hemorrhagic Shock?, David T Lubkin, Krislynn M Mueck, Gabrielle E Hatton, Jason B Brill, Mariela Sandoval, Jessica C Cardenas, Charles E Wade, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVES: Some centers have recommended including concentrated fibrinogen replacement in massive transfusion protocols (MTPs). Given our center's policy of aggressive early balanced resuscitation (1:1:1), beginning prehospital, we hypothesized that our rates of hypofibrinogenemia may be lower than those previously reported.

METHODS: In this retrospective cohort study, patients presenting to our trauma center November 2017 to April 2021 were reviewed. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen

RESULTS: Of 29 782 patients, 6618 level 1 activations, and 1948 patients receiving emergency release blood,

CONCLUSIONS: Low rates of hypofibrinogenemia were found in our center which treats hemorrhage with early, balanced …