University Of Minnesota Research Articles

Safety and efficacy of iron supplementation with 3 months of daily ferrous sulphate in children living with HIV and mild-to-moderate anaemia in Uganda: a double-blind, randomised, placebo-controlled trial

Iron deficiency is the most common nutritional deficiency in the world, but iron supplementation can increase risk of opportunistic infections, especially in children living with HIV. We aimed to assess the effect of supplemental iron on haemoglobin concentration in children living with HIV and mild-to-moderate anaemia in Uganda. We did a double-blind, randomised, placebo-controlled trial of iron supplementation in children aged 6 months to 12 years living with HIV at two sites (ie, Kampala and Fort Portal, Uganda). Inclusion criteria were confirmed diagnosis of HIV and stable treatment with antiretroviral therapy for at least 6 months. Exclusion criteria were already taking iron supplementation, acute illness, current opportunistic infection, fever, known sickle cell disease, severe undernutrition, or any chronic illness requiring medical attention. Children were randomly assigned (1:1) via simple randomisation to an 84-day course of either ferrous sulphate or identical placebo tablets once per day. Randomisation codes were computer-generated and stratified by age (ie, 6-23 months or 24 months and older) by the Toronto Institute of Pharmaceutical Technology, the tablet manufacturer. Participants and all individuals giving the interventions, assessing outcomes, and analysing data were masked to group assignment. Children aged 6-23 months received tablets of 12·5 mg ferrous sulphate or identical placebo; children aged 24 months or older received tablets of 30·0 mg ferrous sulphate or identical placebo. Caregivers were instructed to give the supplement after a meal, preferably after an evening meal. The primary outcome was mean haemoglobin concentration at day 84. All analyses were intention to treat. This trial is registered at ClinicalTrials.gov (NCT03596996). Between May 5, 2018, and Nov 6, 2019, 973 children living with HIV were screened, of whom 200 (20%) met all inclusion criteria and were enrolled. 102 (51%) were randomly assigned to receive iron and 98 (49%) to receive placebo. In the iron group, 57 (56%) of 102 children were male and 45 (44%) were female. In the placebo group, 44 (45%) of 98 children were male and 54 (55%) were female. Iron supplementation was associated with improvement in haemoglobin in unadjusted analysis (p=0·029), but not adjusted analysis (p=0·10), and with improvement in ferritin and hepcidin in both adjusted (p=0·0046; p=0·0079) and unadjusted (p<0·0001; p<0·0001) analyses at day 84. There were four hospital admissions, all for children in the iron group; none were fatal: two children were admitted to hospital with pneumonia, one with severe malaria, and one with hepatitis. Frequency of admissions was not significantly different between groups (p=0·12). Iron could have haematological benefit and improve iron status in children living with HIV in Uganda. Future studies powered for morbidity outcomes with longer follow-up are needed, as are those that evaluate the effects of iron supplementation on neurocognitive outcomes. Minnesota Masonic Charities, the Department of Pediatrics at the University of Minnesota, the Hennepin Healthcare Research Institute, and the US National Institutes of Health.

Ambulance Transports from NCAA Division 1 Football Games.

There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings. Patient care reports (PCRs) from ambulance transports originating from varsity collegiate football games at the University of Minnesota across six years were examined. Pertinent information was abstracted from each PCR. Across the six years of data, there were a total of 73 patient transports originating from NCAA collegiate football games: 45.2% (n = 33) were male, and the median age was 22 years. Alcohol-related chief complaints were involved in 50.7% (n = 37) of transports. In total, 31.5% of patients had an initial Glasgow Coma Scale (GCS) of less than 15. The majority (65.8%; n = 48; 0.11 per 10,000 attendees) were transported by Basic Life Support (BLS) ambulances. The remaining patients (34.2%; n = 25; 0.06 per 10,000 attendees) were transported by Advanced Life Support (ALS) ambulances and were more likely to be older, have abnormal vital signs, and have a lower GCS. This analysis of ambulance transports from NCAA Division 1 collegiate football games emphasizes the prevalence of alcohol-related chief complaints, but also underscores the likelihood of more life-threatening conditions at mass gatherings. These results and additional research will help inform emergency preparedness at mass-gathering events.

Postpartum Management of Hypertensive Disorders of Pregnancy in Six Large U.S. Hospital Systems: Descriptive Review and Identification of Clinical and Research Gaps.

Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin-Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management. KEY POINTS: · Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.. · There is a variation in the BP threshold for antihypertensive treatment initiation.. · Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring..

8524 Pituitary Hormone Dysregulation In Symptomatic Long COVID: A Multi-Center Observational Study

Abstract Disclosure: S.L. Sims: None. A. Labadzhyan: None. Z. Chen: None. S. Kim: None. J. Brathwaite: None. L. Cullen: None. M. Koga: None. U. Cheliadinova: None. V. Hwe: None. D. Gomez: None. C. Andriakos: None. T. Melnik: None. E. Puig-Wong: None. S. Whelan: None. S. Cheng: None. S. Joung: None. Z. Abelev: None. C. Le: None. R. Zabner: None. Y. Kawakami: None. T. Araki: Consulting Fee; Self; Chiesi. Objective: Pituitary hormone dysregulation has been reported in symptomatic long COVID, but it has not been rigorously studied. We conducted a multicenter observational cross-sectional study to assess pituitary hormone levels in long COVID patients and a longitudinal study to follow patients with abnormal results. Methods: Male and female adults with confirmed symptomatic long COVID were recruited from post COVID clinics at Mount Sinai in New York, Cedars-Sinai in Los Angeles, and the University of Minnesota, as well as nationwide physician referrals. Pituitary hormone levels were measured, and because fatigue is common in long COVID, patients completed the QoL-AGHDA survey. Those who exceeded pre-determined survey cutoffs or demonstrated any hormone abnormality were invited to the longitudinal study to repeat surveys and blood work every 3 months. A separate cohort with banked serum samples from before and 3, 6, and 9 months after subacute COVID was used as a comparator. Correlation analysis examined associations between QoL-AGHDA scores and pituitary hormone levels. Results: 246 patients were enrolled in the cross-sectional study after a median of 17.0 months (range, 1-39) since the most recent SARS-CoV2 infection prior to the onset of long COVID symptoms. 56% were enrolled in the longitudinal study due to a high questionnaire score and/or pituitary hormone abnormalities. Current mean follow-up period is 7.95 ± 3.2 months. Mildly elevated prolactin levels were most frequent, observed in 12.7% of patients (males 14.0%, females 12.2%). These patients presented post-COVID with galactorrhea, irregular menses, erectile dysfunction, and nonspecific symptoms of hyperprolactinemia. On follow-up, mild hyperprolactinemia tended to persist. Mildly low IGF1 levels (Z-score &amp;lt;-1.0) were observed in 9.0% of patients (males 6.3%, females 10.0%); on follow-up, IGF1 levels recovered in only 15% of these patients. 2.0% of the entire cohort showed transiently elevated IGF1 levels (Z-score &amp;gt;2.0). Low morning cortisol (&amp;lt;5.0 µg/dL) was observed in 3.3% of patients, but response to cosyntropin stimulation was normal. Mild secondary hypothyroidism was observed in 3.7% of all patients, and mild hypogonadism was observed in 7.8% of males. There was no correlation between QoL-AGHDA score and level of each pituitary hormone. After excluding pre-COVID hormone abnormalities in the post subacute COVID cohort, the rate of hyperprolactinemia was lower than that seen in the long COVID cohort (1% vs 12.7%). The rate of low IGF1 levels was higher in the subacute COVID cohort (22% vs 9.0), but unlike with long COVID, low IGF1 levels after subacute COVID recovered in 3-6 months. Conclusion: Abnormalities in pituitary hormone levels in symptomatic long COVID are frequent, with persistent hyperprolactinemia in &amp;gt;10%. Pituitary hormone screening may be important in patients with prolonged symptomatic long COVID. Presentation: 6/3/2024

8757 Contingency Planning in the Event of Insulin Pump Failure or Malfunction - a Quality Improvement Initiative

Abstract Disclosure: S. Avula: None. H. Hashmi: None. A.R. Ankireddypalli: None. S. Inkollu: None. M. Salim: None. A. Ahmed: None. J. Kohlenberg: None. T. Harindhanavudhi: None. Background: People using insulin pump therapy are at risk of adverse outcomes, including hyperglycemia and diabetic ketoacidosis, in the event of pump failure or malfunction. A standing prescription for subcutaneous basal insulin, which can be filled as needed, has the potential to prevent these adverse outcomes. Aim: We aimed to increase the percentage of standing prescriptions for subcutaneous basal insulin by 20 % over 6-month duration for people using insulin pump therapy. Methods: Pre-intervention: We retrospectively obtained baseline electronic health record data for people with diabetes on insulin pump therapy in our health system (M Health Fairview, University of Minnesota) from January 1, 2022, to December 31, 2022. Intervention: Over a six-month duration, a multifaceted intervention was implemented. (1) During the rooming process for endocrinology appointments, the medical assistants inquired if the person using insulin pump therapy had a standing prescription for basal insulin in the event of insulin pump failure or malfunction. If not, the medical assistant encouraged the person with diabetes to review this with their Endocrinologist. (2) Informational brochures, placed in the exam rooms, encouraged people using insulin pump therapy to discuss a standing order for basal insulin. (3) Emails were sent to all endocrinology providers to encourage discussion of the provision of a standing prescription for basal insulin for people on insulin pump therapy. Post - intervention: We recorded the number of people with a standing prescription for subcutaneous basal insulin from 5/1/2023 to 5/14/2023. Results: The total number of patients with diabetes on insulin pumps prior to the intervention was 256. Of 256 patients with insulin pump therapy, 109 patients (42.6%) had standing basal insulin prescribed. A post-intervention chart review of patients with diabetes on an insulin pump was conducted for a total of 69 patients, of which 56 patients (81.2%) had backup basal insulin prescribed. The estimation of difference was - 0.3858 (p= &amp;lt;0.05; 95% CI for difference -0.4961, -0.2754). Conclusion: This multipronged approach increased the prescription availability and awareness among providers and patients for a standing order of basal insulin in the event of insulin pump failure or malfunction from 42% to 81%. Limitations of this study include the limited duration of intervention and the need to send repeated reminders to all providers, including clinic staff. The next plan is to create a best practice alert in EMR to alert providers to have a backup basal insulin plan for anyone on an insulin pump. Create a custom dot phrase of insulin backup plan in EMR. Presentation: 6/3/2024

The extraordinary "ordinary magic" of resilience.

In this essay, I will briefly sample different instances of the utilization of the concept of resilience, attempting to complement a comprehensive representation of the field in the special issue of Development and Psychopathology inspired by the 42nd Minnesota Symposium on Child Psychology, hosted by the Institute of Child Development at the University of Minnesota and held in October of 2022. Having established the general context of the field, I will zoom in on some of its features, which I consider "low-hanging fruit" and which can be harvested in a systematic way to advance the study of resilience in the context of the future of developmental psychopathology.

B-140 Use of the metabolic health index for correlation with comorbidity reduction for patients undergoing bariatric surgery

Abstract Background Bariatric surgery is a commonly performed procedure aimed at addressing obesity and its associated health issues. However, while weight loss is often a primary focus, the broader improvements in metabolic health, including reductions in conditions such as type 2 diabetes mellitus (T2DM) and dyslipidemia, are not consistently quantified. The recent development of the Metabolic Health Index (MHI) by van Loon et al. provides a potential laboratory index that encompasses various metabolic parameters to predict improvements in comorbidities post-surgery. Our study aimed to assess the utility of MHI in correlating with changes in metabolic health status among patients undergoing bariatric surgery at a U.S. medical center. Methods In our current study, we conducted a retrospective analysis of 300 patients who had undergone bariatric surgery between 2012 and 2019 at the University of Minnesota. We selected patients who had both baseline and one-year post-surgery laboratory values available, including age, hemoglobin A1C (HbA1c), triglycerides, potassium, and creatinine for estimated glomerular filtration rate (eGFR), which were necessary for calculating MHI using the equation of van Loon et al. Thirty patients met the inclusion criteria and their eGFRs were calculated using the 2021 CKD-EPI equation. Using the published formulae, we calculated the MHI for each patient before and after surgery. Patients were stratified based on improvements in diabetic (T2DM) and dyslipidemic status, with lower stratification numbers indicating better outcomes. We then conducted correlation analyses to examine the relationship between changes in MHI, individual components of MHI, BMI, and the reduction in the two comorbidities. We also examined if any of the initial values of MHI, its components and BMI correlated with the magnitude of reduction in the two comorbidities. Results In the patient cohort examined, initially 46.7% of the population were non-diabetic and this changed to 53.3% one year after surgery. The number of patients with diabetes decreased from 33.3% to 13.3%, indicating a benefit of bariatric surgery in alleviating type 2 diabetes mellitus (T2DM). Dyslipidemia decreased from 36.7% to 13.3% post-surgery. Most of the patients had reductions in both the BMI and MHI scales and a linear relationship between the two values was observed. A Spearman correlation analysis revealed that the values of HbA1c (rho= 0.56, p = 0.0014)) and MHI (rho = 0.5, p = 0.005) had a correlation with the reduction in T2DM and the reduction in triglycerides (rho= 0.73, p= 0.0) correlated with reduction in dyslipidemia. On the other hand, the reduction in BMI did not correlate with the improvement in the comorbidities examined. It was determined that the initial values of MHI, its components, and BMI had no correlation to the degree of reduction in comorbidities. Conclusions Our findings suggest that MHI and HbA1C may serve as valuable indicators of metabolic health improvements following bariatric surgery, while BMI changes alone may not fully capture these improvements. Laboratory-based measurements such as MHI offer a promising approach for assessing and monitoring metabolic health outcomes in bariatric surgery patients, providing insights beyond traditional weight-based metrics.

Evolution of Pancreas Transplantation At A Single Institution-50+ Years and 2500 Transplants.

To describe the evolution of pancreas transplantation, including improved outcomes and factors associated with improved outcomes over the past 5 decades. The world's first successful pancreas transplant was performed in December 1966 at the University of Minnesota. As new modalities for diabetes treatment mature, we must carefully assess the current state of pancreas transplantation to determine its ongoing role in patient care. A single-center retrospective review of 2500 pancreas transplants was performed over >50 years in bivariate and multivariable models. Transplants were divided into 6 eras; outcomes are presented for the entire cohort and by era. All measures of patient and graft survival improved progressively through the 6 transplant eras. The overall death-censored pancreas graft half-lives were >35 years for simultaneous pancreas and kidney (SPK), 7.1 years for pancreas after kidney (PAK), and 3.3 years for pancreas transplants alone (PTA). The 10-year death-censored pancreas graft survival rate in the most recent era was 86.9% for SPK recipients, 58.2% for PAK recipients, and 47.6% for PTA. Overall, graft loss was most influenced by patient survival in SPK transplants, whereas graft loss in PAK and PTA recipients was more often due to graft failures. Predictors of improved pancreas graft survival were primary transplants, bladder drainage of exocrine secretions, younger donor age, and shorter preservation time. Pancreas outcomes have significantly improved over time through sequential, but overlapping, advances in surgical technique, immunosuppressive protocols, reduced preservation time, and the more recent reduction of immune-mediated graft loss.

Frustrations with time spent on cancer care among patients with metastatic breast or advanced ovarian cancer.

235 Background: Individuals with cancer face substantial demands on their energy and time due to the complexity of cancer care. We sought to describe frustrations with time-consuming aspects of cancer care among individuals with advanced ovarian or breast cancer. We hypothesized that frustrations would be highest for time spent on administrative tasks, particularly for those who are younger, employed, and have dependents. Methods: We analyzed baseline survey data from an ongoing prospective study of the time burdens of cancer care among individuals receiving treatment for ovarian or metastatic breast cancer at the University of Minnesota and University of Alabama-Birmingham. The survey included questions about frustrations with the time needed for cancer-related activities such as travel time, finding transportation, care coordination, receiving treatment, and paperwork (0=Not at all, 10=Extremely frustrated). We summarized the data using descriptive statistics and made comparisons across demographic and clinical characteristics using Wilcoxon rank-sum and Kruskal-Wallis tests. Results: A total of 67 participants completed the baseline survey, 37 (55.2%) with metastatic breast cancer and 30 (44.8%) with ovarian cancer. About 1/4 of participants (26.9%) were under 50 years old, 34.3% had dependents, 39.1% were employed, and 57.6% lived 30+ miles from the cancer clinic; 73.1% were non-Hispanic (NH) White and 22.4% NH Black; 4.5% reported another race/ethnicity. Over half (58.2%) agreed minimizing time spent on cancer-related activities was important to them; those employed were significantly more likely to agree (76.0% vs. 48.7%, p=0.03). Activities with the highest reported frustrations were the number of trips, time for care-related travel or paperwork, and wait time. Younger participants reported higher frustration with wait time (p=0.04) and time at the infusion center than older participants (p=0.03). Employed participants reported significant frustration with having to take time off work (p&lt;0.0001), and those with dependents reported frustration needing to organize dependent care (p=0.01). Participants living 30+ miles from the cancer clinic reported greater frustrations with travel time (p=0.01), time needed for care coordination (p=0.01) and waiting for the provider (p=0.02). Some (10.6%) participants reported lacking reliable transportation and, among those, reported high frustration with the time needed for numerous activities, including finding transportation, paperwork, care coordination, and making appointments (all p&lt;0.05). Conclusions: Cancer-related time demands are frustrating for many patients. Those employed, younger, with dependents, living further from the cancer clinic, and without reliable transportation experience greatest frustrations about time lost, underscoring the need to address these often unrecognized aspects of care.

Disambiguating Clinical Abbreviations by One-to-All Classification: Algorithm Development and Validation Study.

Electronic medical records store extensive patient data and serve as a comprehensive repository, including textual medical records like surgical and imaging reports. Their utility in clinical decision support systems is substantial, but the widespread use of ambiguous and unstandardized abbreviations in clinical documents poses challenges for natural language processing in clinical decision support systems. Efficient abbreviation disambiguation methods are needed for effective information extraction. This study aims to enhance the one-to-all (OTA) framework for clinical abbreviation expansion, which uses a single model to predict multiple abbreviation meanings. The objective is to improve OTA by developing context-candidate pairs and optimizing word embeddings in Bidirectional Encoder Representations From Transformers (BERT), evaluating the model's efficacy in expanding clinical abbreviations using real data. Three datasets were used: Medical Subject Headings Word Sense Disambiguation, University of Minnesota, and Chia-Yi Christian Hospital from Ditmanson Medical Foundation Chia-Yi Christian Hospital. Texts containing polysemous abbreviations were preprocessed and formatted for BERT. The study involved fine-tuning pretrained models, ClinicalBERT and BlueBERT, generating dataset pairs for training and testing based on Huang et al's method. BlueBERT achieved macro- and microaccuracies of 95.41% and 95.16%, respectively, on the Medical Subject Headings Word Sense Disambiguation dataset. It improved macroaccuracy by 0.54%-1.53% compared to two baselines, long short-term memory and deepBioWSD with random embedding. On the University of Minnesota dataset, BlueBERT recorded macro- and microaccuracies of 98.40% and 98.22%, respectively. Against the baselines of Word2Vec + support vector machine and BioWordVec + support vector machine, BlueBERT demonstrated a macroaccuracy improvement of 2.61%-4.13%. This research preliminarily validated the effectiveness of the OTA method for abbreviation disambiguation in medical texts, demonstrating the potential to enhance both clinical staff efficiency and research effectiveness.

Exploring the East Asian Collection at the Wangensteen Historical Library of Medicine and Biology at the University of Minnesota

Abstract The Wangensteen Historical Library of Medicine and Biology (WHL) at the University of Minnesota (UMN) is a special collections library founded in the mid-1960s. It has been continuously collecting rare East Asian items over the last fifteen years, and now constitutes more than half of the UMN rare East Asian collection. The materials in WHL were primarily acquired for their relevance to medicine and biology but may also be beneficial to other disciplines. Most of the WHL items are understudied and less well known to the public. This article will feature four items to showcase the collection’s strength and diversity.

Abstract B168: A qualitative examination of how state policy and sociopolitical environmental influence experiences of cancer care for minoritized sexual and gender populations who have experienced breast cancer

Abstract Introduction: A growing body of literature is investigating how structural barriers, including policies, impact cancer outcomes among marginalized populations, including the 2SLGBTQ+ (two spirit, lesbian, gay, bisexual, transgender, queer, asexual, intersex, and gender non- conforming or gender non-binary)(sexual and gender minoritized (SGM)) communities. An underresearched area is how the state-level policy and sociopolitical environment shape the experiences and outcomes of SGM people who have experienced breast cancer. Using data from the Elsie Study, this research examines how SGM people who have experienced breast cancer are impacted by their state’s policies and sociopolitical context. To the authors' knowledge, this study is the first of its kind to examine these experiences of breast cancer care for SGM people. Methods: The Elsie Study is the largest qualitative survey of SGM people who have experienced cancer conducted within the U.S. To date the Elsie Study at the University of Minnesota has conducted 60-90 minute semi-structured interviews with thirteen sexally and gender minoritized people who have experienced breast cancer. Our participants were recruited from advertising campaigns on social dating applications, including HER, and community organizations. Interviews were conducted nationwide over Zoom and phone beginning in June 2023 and continuing through June 2024. Summary of data: Our participants who have experienced breast cancer have diverse sexual orientations, gender identities, and racial and ethnic backgrounds. Among the thirteen sexually and gender minoritized participants who experienced breast cancer, their sexual orientations encompass those who identify as lesbian, gay, bisexual, queer, or some of these interchangeably. Participants’ gender identities include identifying as cisgender woman, genderqueer, non-binary, transgender man, and transgender woman. Participants’ racial and ethnic backgrounds are white, Black or African American, Latino/a/x, and Asian. Participants at the intersections of marginalized identities noted substantial difficulties in receiving culturally competent care during breast cancer treatment. A majority of SM and GM women and non-binary participants mentioned the importance of living in a “queer and trans friendly state,” liberal cities, or states with marriage equality for aspects such as accessing culturally competent cancer care and participating in cancer research. Conclusions: Narratives such as those expressed by our SGM participants who experienced cancer are important for understanding how state policy and sociopolitical contexts shape access to healthcare and even cancer research. Our study has wide implications for how affirming state policy and sociopolitical climates may afford more equity in cancer care for SGM people. Citation Format: Courtney Sarkin, Alexandra M. Ecklund, Ben Weideman, Rhea Alley, B.R. Simon Rosser, G. Nic Rider. A qualitative examination of how state policy and sociopolitical environmental influence experiences of cancer care for minoritized sexual and gender populations who have experienced breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B168.

Rethinking IPE duration: a five-year comparative analysis of competency development across two introductory IPE course models

ABSTRACT Best practices have not yet been established in the interprofessional education (IPE) literature to guide the ideal dose and duration of IPE experiences across the curriculum. As such, the content, structure, and delivery format of IPE offerings vary significantly across institutions. The University of Minnesota had the rare opportunity to evaluate learner-perceived collaborative competency outcomes due to the transition of its centrally offered introductory IPE course. Data were collected consistently, longitudinally, and for a high volume of learners and professions across two IPE course models applied within the same academic institution. Retrospective analysis of pre-post interprofessional collaborative competency scores collected for over 5,000 learners from 17 health profession degree programs demonstrated nearly identical self-reported competency attainment for both a 12- and 4-hour introductory IPE offering, assessed using the ICCAS tool over the course of 5-year format transition. If student-reported competency attainment is the same following an introductory IPE experience regardless of the dosage, then academic IPE programs may be better positioned by decreasing their introductory emphasis and instead focus their resources on exploring innovative workplace-based and competency-based IPE strategies in line with contemporary recommendations. Further studies are needed to explore the implications of and next steps in this line of research.

Center for Advanced Studies in Child Welfare, University of Minnesota

Objective and ApproachPrior research has found that experiences of homelessness are associated with an increased likelihood of child protection involvement, and vice-versa. However, it is not clear how involvement with the child welfare system may impact family housing stability during and after their involvement. The objective of this study was to more deeply understand the housing stability of families involved with child welfare over time. To examine this issue, we linked administrative data from Minnesota’s Homelessness Management Information System with social services data from the Department of Human Services (e.g., receipt of food support, childcare or housing assistance, child welfare), for families involved with child welfare in Minnesota between 2019 and 2021. ResultsApproximately a quarter of child welfare-involved families experienced homelessness during their involvement with the child welfare system. Rates of homelessness were similarly high in the two years prior to and following child welfare involvement. Although a large proportion of families experienced homelessness before and during their child welfare involvement, we saw no increase in the proportion of families receiving housing support after their involvement in the system. Conclusions and ImplicationsOur findings indicate that involvement with the child welfare system and the resources provided through this involvement do not have a significant impact on family’s experiences of homelessness. This suggests the need for closer collaboration between the child welfare system and housing services to identify more effective solutions for housing instability among families within the child welfare system.

Diffusion Tensor Imaging in Boys With Adrenoleukodystrophy: Identification of Cerebral Disease and Association With Neurocognitive Outcomes.

Childhood cerebral adrenoleukodystrophy (C-ALD) is a severe inflammatory demyelinating disease that must be treated at an early stage to prevent permanent brain injury and neurocognitive decline. In standard clinical practice, C-ALD lesions are detected and characterized by a neuroradiologist reviewing anatomical MRI scans. We aimed to assess whether diffusion tensor imaging (DTI) is sensitive to the presence and severity of C-ALD lesions and to investigate associations with neurocognitive outcomes after hematopoietic cell therapy (HCT). In this retrospective cohort study, we analyzed high-resolution anatomical MRI, DTI, and neurocognitive assessments from boys with C-ALD undergoing HCT at the University of Minnesota between 2011 and 2021. Longitudinal DTI data were compared with an age-matched group of boys with ALD and no lesion (NL-ALD). DTI metrics were obtained for atlas-based regions of interest (ROIs) within 3 subdivisions of the corpus callosum (CC), corticospinal tract (CST), and total white matter (WM). Between-group baseline and slope differences in fractional anisotropy (FA) and axial (AD), radial (RD), and mean (MD) diffusivities were compared using analysis of covariance accounting for age, MRI severity (Loes score), and lesion location. Among patients with NL-ALD (n = 14), stable or increasing FA, stable AD, and stable or decreasing RD and MD were generally observed during the 1-year study period across all ROIs. In comparison, patients with mild posterior lesions (Loes 1-2; n = 13) demonstrated lower baseline FA in the CC splenium (C-ALD 0.50 ± 0.08 vs NL-ALD 0.58 ± 0.04; pBH = 0.022 adjusted Benjamini-Hochberg p-value), lower baseline AD across ROIs (e.g., C-ALD 1.34 ± 0.03 ×10-9 m2/s in total WM vs NL-ALD 1.38 ± 0.04 ×10-9 m2/s; pBH = 0.005), lower baseline RD in CC body and CST, and lower baseline MD across ROIs except CC splenium. Longitudinal slopes in CC splenium showed high sensitivity and specificity in differentiating early C-ALD from NL-ALD. Among all patients with C-ALD (n = 38), baseline Loes scores and DTI metrics were associated with post-HCT neurocognitive functions, including processing speed (e.g., FA WM Spearman correlation coefficient R = 0.64) and visual-motor integration (e.g., FA WM R = 0.71). DTI was sensitive to lesion presence and severity as well as clinical neurocognitive effects of C-ALD. DTI metrics quantify C-ALD even at an early stage.

A New Variant of Avian Encephalomyelitis Virus Associated with Neurologic Signs in Turkey Poults.

Avian encephalomyelitis (AE) is a disease caused by the avian encephalomyelitis virus (AEV) of the genus Tremovirus in the family Picornaviridae. Recently, cases of turkey poults showing neurological signs were submitted to the veterinary diagnostic laboratories at South Dakota State University and the University of Minnesota. The affected birds were showing nervous neurological signs such as tremors, inability to stand, torticollis, and wing drop. Clinical signs were observed by 3 weeks of age. Necropsy of birds revealed no significant gross lesions in the internal organs, including the brain. There was no significant bacterial growth in the brains. Microscopic examination of various sections of the brain revealed multifocal lymphocplasmacytic perivascular cuffs in the cerebellum and cerebral cortex. The brain samples were processed for detection and whole genome sequencing by next-generation sequencing. Three full-length polyprotein sequences (6405 nt) of AEV were assembled. All three sequences shared 99.9-100% nucleotide and 100% amino acid identities with each other. Only 77.7-78.5% of nucleotide and 90.3-92.5% of amino acid identities with AEV field strains and vaccine sequences were available in GenBank. This indicates that a new divergent variant of AEV is circulating in the field and causing AE outbreaks in the Midwest region.

Hypersonic Stability and Breakdown Measurements on the AFRL/AFOSR BOLT II Flight Geometry

The Air Force Research Laboratory/Air Force Office of Scientific Research (AFRL/AFOSR) introduced the Boundary Layer Turbulence (BOLT II) flight experiment to further the understanding and modeling of a hypersonic turbulent boundary layer on a geometry that features concave surfaces with swept leading edges. In support of the flight experiment, this paper identifies and documents the transition instabilities and quantifies the breakdown to turbulence on a 25%-scale BOLT II model in hypersonic flow. Experiments were conducted in the conventional Actively Controlled Expansion wind tunnel facility and the Mach 6 Quiet Tunnel located at the Texas A&M University National Aerothermochemistry and Hypersonics Laboratory. Global surface heating was viewed using infrared thermography with on-surface measurements made using high-frequency Kulite and PCB Piezotronics surface pressure transducers. Modal growth was observed among the sensors both upstream and downstream of the model. Off-surface measurements were made in the mixed-mode region utilizing constant-temperature hot-film anemometry in the Mach 6 Quiet Tunnel. Comparisons were made to the Direct Numerical Simulation (DNS) results from the University of Minnesota. Amplified content was observed between f=53 and 75 kHz in the root-mean-square voltage fluctuations of the hot-film measurements.

Interrater Reliability and Precision of a Novel Hand Strength Assessment and Treatment Device: The GripAble.

Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings. To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials). Measurement study. Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis. Thirty volunteers, age ≥18 yr, without any hand problems. Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision. GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults. GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.

The Influence of a COVID-19 Vaccine Mandate on Vaccination Rates in a University Setting.

We surveyed (September 9-17, 2021) students, staff, and faculty at the University of Minnesota, a large, highly vaccinated university, to evaluate whether the COVID-19 vaccine mandate increased self-reported vaccine uptake. Vaccine mandates have the potential to improve public health but should consider the context of implementation and costs associated with infringements on personal choice. Policymakers need to be equipped with data to inform decisions about vaccine mandates in light of contextual factors and potential backlash affecting public health interventions. (Am J Public Health. Published online ahead of print August 29, 2024:e1-e6. https://doi.org/10.2105/AJPH.2024.307804).

Improving complex agronomic and domestication traits in the perennial grain crop intermediate wheatgrass with genetic mapping and genomic prediction.

The perennial grass Thinopyrum intermedium (intermediate wheatgrass [IWG]) is being domesticated as a food crop. With a deep root system and high biomass, IWG can help reduce soil and water erosion and limit nutrient runoff. As a novel grain crop undergoing domestication, IWG lags in yield, seed size, and other agronomic traits compared to annual grains. Better characterization of trait variation and identification of genetic markers associated with loci controlling the traits could help in further improving this crop. The University of Minnesota's Cycle 5 IWG breeding population of 595 spaced plants was evaluated at two locations in 2021 and 2022 for agronomic traits plant height, grain yield, and spike weight, and domestication traits shatter resistance, free grain threshing, and seed size. Pairwise trait correlations were weak to moderate with the highest correlation observed between seed size and height (0.41). Broad-sense trait heritabilities were high (0.68-0.77) except for spike weight (0.49) and yield (0.44). Association mapping using 24,284 genome-wide single nucleotide polymorphism markers identified 30 main quantitative trait loci (QTLs) across all environments and 32 QTL-by-environment interactions (QTE) at each environment. The genomic prediction model significantly improved predictions when parents were used in the training set and significant QTLs and QTEs used as covariates. Seed size was the best predicted trait with model predictive ability (r) of 0.72; yield was predicted moderately well (r=0.45). We expect this discovery of significant genomic loci and mostly high trait predictions from genomic prediction models to help improve future IWG breeding populations.