Intraoperative Hyperglycemia in Adult Patients Undergoing an Emergency Craniotomy Following a Traumatic Brain Injury as a Predictor of Postoperative Outcomes and Mortality

Abstract: The purpose of this study was to determine if there was an association between intraoperative blood glucose ≥150 mg/dl in patients undergoing an emergency craniotomy and Intensive Care Unit (ICU) Length of Stay (LOS), hospital LOS and mortality. Introduction: Traumatic Brain Injuries (TBI)’s are associated with increased morbidity and mortality. The stress response by the body may cause an increase in blood glucose levels which can cause secondary brain injury. When a patient undergoes an emergency craniotomy following a TBI the increased stress on the body can cause an even higher blood glucose. There is no consensus in the literature as to what level is considered to be hyperglycemic, and there are also no definitive guidelines as to when treatment should be started for rising blood glucose levels. Many studies have found an association between preoperative hyperglycemia and poor postoperative outcomes and mortality, but few studies have looked at intraoperative blood glucose levels with postoperative outcomes and mortality. Methodology: This study used a retrospective, quantitative, case control design at Charleston Area Medical Center in West Virginia. The chart review was conducted on adult patients who presented to the operating room for an emergency craniotomy following a TBI from January 1, 2005 through June 1, 2013. The sample was grouped by the first intraoperative blood glucose, the control group was \u3c150 mg/dl (n=72), and the case group was ≥150 mg/dl (n=47). Patient characteristics of age, gender, Body Mass Index (BMI), mechanism of injury (penetrating or blunt), Injury Severity Score (ISS), intraoperative blood glucose, hospital LOS, ICU LOS, and mortality were collected. Means were compared using the Independent t-test for age, BMI, and ISS. Chi-square test was used to compare gender, ASA physical status, and mechanism of injury. With case control groups a logistic regression was used to determine a relationship between mortality with age, gender, BMI, ISS, mechanism of injury, and intraoperative hyperglycemia. Separate linear regressions analyzed ICU LOS and hospital LOS with age, gender, BMI, ISS, mechanism of injury, and intraoperative hyperglycemia. Results: It was found statistically significant in the mean difference between the two groups (intraoperative blood glucose \u3c150 mg/dl and ≥150 mg/dl) in percentage of mortality (5.6% and 21.3%). The mean age of the group was 36.8, mean days in the ICU was 8, mean ISS 28.4, mean days in the hospital 13.9, and mean BMI 26.4. Of the 119 patients, 96 (80.7%) were male, 23 (19.3%) were female, 110 (92.4%) had blunt injury type, 9 (7.6%) had penetrating injury type, and mortality rate was 14 (11.8%). The Odds Ratio showed that the case group was 4.6 times more likely to die compared to the control group which was statistical significant Statistical significance also was found with age and intraoperative glucose with mortality. ISS association with hospital LOS was shown to be statistically significant. No statistical significance was found between ICU LOS and intraoperative blood glucose. Discussion: This study found that intraoperative blood glucose ≥150 mg/dl increased the rate of mortality by 4.6 times. Increased age was also shown to have an association with mortality. Increased hospital LOS was associated with ISS. ICU LOS was not shown to be associated with any of the variables tested. The literature has shown that higher glucose levels, age, and ISS have been associated with increase hospital LOS, ICU LOS, and mortality. Several study limitations were identified and discussed. Conclusion: Intraoperative blood glucose ≥150 mg/dl was associated with a higher rate of mortality. Implications/Recommendations: This study can be used as a guideline to practitioners to use ≥150 mg/dl as a definition for hyperglycemia in the intraoperative period in emergency craniotomy patients following a TBI to increase the rate of survival

Highlighting Faculty Research: The Researcher Profile Audit Service from the Himmelfarb Library at The George Washington University

Researcher profile systems are web-based tools which attempt to capture the scholarly output of a researcher. Some tools such as Google Scholar profiles and ORCiDs are opt-in systems that researchers must actively create and cultivate. Others such as the Scopus author profile are algorithmically generated and must be claimed by an author and checked for accuracy. These profiles continue to grow in importance as a way for fellow researchers, potential employers, and possible collaborators to learn about a researcher’s scholarship. Therefore, it’s important for researchers to maintain these profiles and to ensure that they are accurate and complete. In order to support researchers in the departments served by the Himmelfarb Health Sciences Library, we developed an audit service to assess profiles in a variety of systems and to provide recommendations for improvement

The Medical Institutional Repositories in Libraries (MIRL) Symposium: a blueprint designed in response to a community of practice need.

BACKGROUND: Health sciences libraries in medical schools, academic health centers, health care networks, and hospitals have established institutional repositories (IRs) to showcase their research achievements, increase visibility, expand the reach of institutional scholarship, and disseminate unique content. Newer roles for IRs include publishing open access journals, tracking researcher productivity, and serving as repositories for data sharing. Many repository managers oversee their IR with limited assistance from others at their institution. Therefore, IR practitioners find it valuable to network and learn from colleagues at other institutions. CASE PRESENTATION: This case report describes the genesis and implementation of a new initiative specifically designed for a health sciences audience: the Medical Institutional Repositories in Libraries (MIRL) Symposium. Six medical librarians from hospitals and academic institutions in the U.S. organized the inaugural symposium held virtually in November 2021. The goal was to fill a perceived gap in conference programming for IR practitioners in health settings. Themes of the 2021 and subsequent 2022 symposium included IR management, increasing readership and engagement, and platform migration. Post-symposium surveys were completed by 73/238 attendees (31%) in 2021 and by 62/180 (34%) in 2022. Feedback was overwhelmingly positive. DISCUSSION: Participant responses in post-symposium surveys rated MIRL highly. The MIRL planning group intends to continue the symposium and hopes MIRL will steadily evolve, build community among IR practitioners in the health sciences, and expand the conversation around best practices for digital archiving of institutional content. The implementation design of MIRL serves as a blueprint for collaboratively bringing together a professional community of practice

STS Research Agenda Task Force: Survey Results

As part of our charge to provide STS members with recommended areas for exploration in science and technology library research, we sent out a survey in the Fall of 2014. The 258 responses helped create a snapshot of what areas are currently being researched and what could be important areas of future research.Poster presented at the ACRL 2015 Conference in Portland, OR.UT Librarie

Mechanisms of Taxane Resistance

The taxane family of chemotherapy drugs has been used to treat a variety of mostly epithelial-derived tumors and remain the first-line treatment for some cancers. Despite the improved survival time and reduction of tumor size observed in some patients, many have no response to the drugs or develop resistance over time. Taxane resistance is multi-faceted and involves multiple pathways in proliferation, apoptosis, metabolism, and the transport of foreign substances. In this review, we dive deeper into hypothesized resistance mechanisms from research during the last decade, with a focus on the cancer types that use taxanes as first-line treatment but frequently develop resistance to them. Furthermore, we will discuss current clinical inhibitors and those yet to be approved that target key pathways or proteins and aim to reverse resistance in combination with taxanes or individually. Lastly, we will highlight taxane response biomarkers, specific genes with monitored expression and correlated with response to taxanes, mentioning those currently being used and those that should be adopted. The future directions of taxanes involve more personalized approaches to treatment by tailoring drug–inhibitor combinations or alternatives depending on levels of resistance biomarkers. We hope that this review will identify gaps in knowledge surrounding taxane resistance that future research or clinical trials can overcome

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources

Rolly Protein (ROLP)-Epb4.1/3: A Potential Protein-Protein Interaction Relevant for the Maintenance of Cell Adhesion

We recently described Rolly Protein (ROLP), a small protein synthesized by substrate-adherent cells in a broad range of tissues. In a first set of experiments performed taking advantage of bone forming tibial cartilage as an experimental model we showed that ROLP transcription is associated to cells in an active proliferation state, whereas its downregulation is observed when cell proliferation decreases. Taking advantage of siRNA technology we also documented the expression modulation of some apoptosis-related genes in ROLP-silenced cells. In this work we search for the possible molecular interactors of ROLP by using both the antibody array approach as well as the co-immunoprecipitation approach. Results suggest the occurrence of an interaction of ROLP with Erythrocyte membrane Protein Band 4.1/3 (Epb4.1/3), an oncosuppressor downregulated in tumor development and in metastatic tissues; in addition we report experimental results that keep in line also with a potential interaction of ROLP with other PDZ-containing proteins. We also present experimental evidences supporting a role played by ROLP in cell adhesion thus supporting the existence of a biologically relevant link between ROLP and Epb4.1/3. We here suggest that ROLP might exert its biological role cooperating with Epb4.1/3, a protein that is involved in biological pathways that are often inhibited in tumor metastasis. Given the role of Epb4.1/3 in contrasting cancerogenesis we think that its cooperation with ROLP might be relevant in cancer studies and deserves further investigation