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NephroCheck Implementation and its Impact on the Incidence of Acute Kidney Injury After Coronary Artery Bypass Graft Surgery
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NephroCheck Implementation and its Impact on the Incidence of Acute Kidney Injury After Coronary Artery Bypass Graft Surgery
Michael C. MacCourtney
Problem Statement: Acute kidney injury occurs in up to 50% of patients after cardiac surgery (Meersche et al., 2017). This contributes to significant morbidity, mortality, and costs (Helgadottir et al., 2016). At the time of the project implementation, the standard of care involved measuring renal function utilizing serum creatinine (SCr) and urine output (UOP) without NephroCheck. These renal function labs do not represent a timely and accurate assessment of the patient’s current renal status because they do not show a change until days after the patient’s initial renal injury (Nalesso et al., 2020).This delays interventions (Nalesso et al., 2020).
Background: Acute kidney injury (AKI) development after coronary artery bypass graft surgery (CABG) is a common occurrence that contributes to significant morbidity, mortality, and costs (Helgadottir et al., 2016). Prevention of long-term complications involves identification of patients at risk for AKI and optimizing their fluid status (Helgadottir et al., 2016). Based on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, optimizing fluid status generally involves administering intravenous fluids (IVF) in response to serum creatinine (SCr) and urine output (UOP) levels (KDIGO, 2012). However, these renal function parameters are insufficient in the monitoring of AKI as they may not change or respond to the noxious stimuli during CABG until days after surgery which impacts timely intervention strategies (Nalesso et al., 2020). The urinary biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin growth factor-binding protein 7 (IGFBP7) have been used to identify renal pathology sooner than SCr and UOP (Wen & Parikh, 2021). NephroCheck is an immunoassay test that measures the urinary concentrations of TIMP-2 and IGFBP7 and was approved by the Food and Drug Administration (FDA) in 2014 (Nalesso et al., 2020).
Project Goal: The purpose of this project is to incorporate NephroCheck in the Open Heart ICU setting at a community hospital in West Virginia and examine the incidence of moderate to severe AKI in CABG patients after implementation.
Project Aims: 1. Evaluate the current practice for assessing renal function in CABG patients. 2. Implement project that adopts NephroCheck as the standard of care. 3. Evaluate the results of the project after six months of NephroCheck implementation.
Methods: Deidentified quarterly reports based on Society of Thoracic Surgeon (STS) renal failure data were utilized to examine the incidence of moderate to severe AKI and dialysis before and after incorporation of NephroCheck. Statistical analysis including independent t-testing and Mann-Whitney U testing was utilized to compare the results. Likert-style surveys were administered to staff during an initial debriefing to ensure staff understood how to collect the NephroCheck lab.
Implementation: Meetings with CVT intensivist to adopt NephroCheck as the standard of care and review deidentified quarterly reports based on STS Renal Failure data.
Results: Statistical analysis was utilized to compare the means before and after implementation of NephroCheck. Independent t-test and Mann-Whitney U test were used to compare the means. During the pre-intervention period, the mean percentage of renal failure was 1.69%. The mean percentage of renal failure during the post-intervention period was 1.19%. Statistical comparison of pre-intervention (M = 1.68, SD = 1.55) to post-intervention (M = 1.43, SD = 1.06, t = .307, p = .104) (U = 12, p = .916) showed a decrease in the percentage of renal failure but the results were not statistically significant. The mean percentage of dialysis during the pre-intervention period was .806%. The mean percentage of dialysis during the post-intervention period was .580%. Statistical comparison of pre-intervention (M = .806, SD = 1.17) to post-intervention (M = .580, SD = .795, t = .358, p = .235) (U = 12, p = .916) showed a decrease in the percentage of dialysis but the results were not statistically significant.
Conclusions: Evidence suggests utilization of NephroCheck can decrease the incidence of moderate to severe AKI. The results of this project produced a decrease in moderate to severe AKI and dialysis. However, the results were not statistically significant
Computational Approaches for Diagnosing Neurological Impairments and Restoring Functional Movement
No full textMovement is the primary means by which the nervous system converts intention into interaction with the environment. Voluntary limb motion enables standing, walking, reaching, and grasping—actions that underpin self‑care, communication, and economic participation. When diseases or injuries disrupt the pathways that couple neural commands to muscle forces—whether through cortical stroke, spinal cord injury, or peripheral nerve damage—mechanical outcomes such as weakness, loss of coordination, and ultimately reduced mobility emerge. These impairments cascade into secondary complications, increased dependence on caregivers, and diminished quality of life. Quantifying how the lesion alters the mechanics of movement is therefore essential for designing targeted interventions that restore function and prevent long‑term disability.
In this dissertation, I have developed biomechanical models and computational methods to improve the diagnosis of—and rehabilitation from—motor impairments that arise after injuries to the central nervous system (CNS) and the peripheral nervous system (PNS), detailed in respective chapters. Chapter 2 presents real‑time forward and inverse dynamic models of bipedal locomotion and details analysis of selected numerical solvers and stabilizing viscoelastic contributions that enable fast, stable, high‑fidelity biomechanical simulations. Chapter 3 details the use of these models for quantitative description of the biomechanical origins of knee flexion deficits observed after stroke; to that end, I leverage a torque‑decomposition approach—rarely used in biomechanics but common in mechanical engineering—to identify variables contributory to the deficit. Chapter 4 shifts the focus from central to peripheral lesions, proposing and testing a novel real‑time method capable of inferring missing muscle activity from sparse EMG recordings, which could be used to generate control signals for assistive and rehabilitative technologies. Chapter 5 presents a perspective on anatomically constrained neural networks describing new approaches to approximate musculoskeletal transformations, needed to accurize and personalize them. Chapter 6 recapitulates main results and outlines directions for clinical translation and algorithmic refinements / extensions of presented solutions
Daily Consumption Smoothing? New Evidence from a Payment Diary
Get PDFThis paper shows that consumption and income data in the Diary of Consumer Payment Choice (DCPC) cover high percentages of U.S. data, forecast well in real time, and replicate the literature’s estimation and general rejection of PIH models with time aggregated data. Novel estimates reveal evidence of daily consumption smoothing after accounting for three features of daily data: 1) discrepancy between consumption and expenditures (e.g., bill payments); 2) discrete daily expenditures and income; and 3) asynchronous consumption and income. Convenience samples used in the literature appear to reflect selection effects related to payment choices (cash or mobile) that affect model inference. Relative to bank transactions data, the DCPC is more representative, publicly available, and offers other advantages
Drafting a Solution: Overcoming the Existential Crisis of the Selective Service System
No full textWith the growing fears of a large-scale combat operation against a near-peer adversary, the United States may confront a need to fully mobilize its military for the first time since World War II. A full-scale mobilization would likely necessitate the return of conscription (a.k.a. the draft). The Selective Service System (“SSS”) is currently the federal agency that oversees and conducts the draft in accordance with the provisions of the Military Selective Service Act (“Act”). Yet, this Act has remained untouched for more than two decades, meaning the current conscription system is functionally identical to that used during the Vietnam War, the last conflict during which the United States utilized conscription. Because of the lack of continued amendment and evolution of the conscription system, the functionality of the SSS may not succeed in sufficiently mobilizing the number of conscripts required of a large-scale combat operation in a rapid and fair manner. Demographic shifts in the American population since the Vietnam War are substantial, with a shockingly small pool of the individuals eligible for the draft being deemed eligible for military service. The aforementioned eligibility issue is a result of declining mental and physical health, criminal history, drug history, and more among eligible individuals. Under the current conscription system, the large pool of ineligible registrants must slowly be filtered out through medical examinations, a process which would slow the speed at which the SSS could produce the desired number of mobilized conscripts required by a national emergency. Additionally, the bias and discrimination that stemmed from the draft boards instituted during the Vietnam War has remained uncorrected, leaving the opportunity for unfair and unjust draft classifications to run rampant during any future use of conscription. Without an amendment to the current Act, the SSS is unlikely to achieve its objective of rapidly producing conscripts in a fair and equitable manner
Asylum Eligibility: A Circuit Split Between the Second and Fourth Circuits Based Upon Death Threats Rising to the Level of Persecution Per Se
No full textAsylum eligibility requires applicants to satisfy a three-pronged set of requirements in order to be granted admission into the United States. In a July 2024 decision, the Second Circuit court issued a decision that challenged a line of precedent established by the Fourth Circuit—specifically examining whether death threats rise to the persecution threshold set by the Immigration and Nationality Act (“INA”). The Second Circuit now holds that the receipt of death threats alone is insufficient to establish persecution, thereby making alien petitioners who have received such threats ineligible for asylum or related forms of relief from removal. In contrast, the Fourth Circuit ruled that death threats, when serious and credible, can amount to persecution per se, potentially qualifying petitioners for asylum. This divergence has led to inconsistent outcomes for similarly situated asylum seekers depending on the jurisdiction their case is adjudicated in. This Note discusses the conflicting views between the Second and Fourth Circuit, the differences in statutory interpretation, the potential impacts inconsistent rulings can have on the United States as well as asylum seekers, and realistic policy recommendations moving forward. The United States receives a high volume of asylum applications each year. To remain effective, the system must provide fair judgments for those seeking protection while preventing abuse of the process. This Note further recommends that Congress amend the INA to explicitly list death threats as a qualifying form of persecution. Uniformity across jurisdictions will offer the needed guidance to asylum seekers faced with death threats and those deciding upon their eligibility, in turn allowing more straightforward interactions with the asylum application process
Foreshadowing the Stop Campus Hazing Act : Education, Prevention, and University Liability
No full textOn December 23, 2024, President Joseph R. Biden signed into law the Stop Campus Hazing Act (the “SCHA”). The SCHA amends the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, 20 U.S.C. § 1092(f), a subsection of the Higher Education Act of 1965 (the “Clery Act”). The SCHA defines “hazing” and “student organization,” expands the current Annual Security Reporting requirements, calls for a new form of reporting, and requires policies relating to hazing. It also requires each covered institution of higher education to publish a policy statement regarding hazing awareness and prevention programs that includes a description of research-informed campus-wide prevention programs designed to reach students, staff, and faculty. This Article highlights the various ways in which higher education institutions have, and can be, held liable for student hazing on their campuses. This Article also, and more critically, highlights what effective teaching and learning should look like in the contexts of hazing awareness and prevention. It provides particular insight as to such skills, as recommended under the SCHA, as bystander intervention, ethical leadership, and building group cohesion without hazing
Confronting the Challenges of Regulating Artificial Intelligence
No full textPublic opinion polls conclude that the American public is in favor of regulating artificial intelligence (“AI”), and many technology companies publicly claim that they would welcome regulation. And yet the United States has struggled to enact federal comprehensive AI regulations beyond a short-lived Executive Order. Why? Part I of this Article explains why regulating AI is so difficult, focusing on six key reasons: AI is a global issue; AI is not one discrete issue; AI is developing at a speed that is unprecedented; lawmakers largely lack the technical expertise effective AI regulation requires; the stakes of getting the regulation wrong are so large that paralysis results; and there is currently high-profile hostility toward federal regulation. Exploring each of those complications helps contextualize the relative lack of U.S. federal action on AI regulation. But a choice to not enact comprehensive federal AI regulation does not mean that AI will not be regulated in the U.S. Rather, as Part II discusses, if the U.S. does not enact federal AI regulation, AI will still be “regulated,” either through corporate self-regulation by AI developers, existing federal and state regulatory structures (namely antitrust, copyright, and privacy), and/or private tort actions. Each of these alternatives to AI regulation has important limitations. Part III concludes by offering some optimism, building the case for why now is an ideal time for AI regulation, notwithstanding the many challenges. There is public support for AI regulation, we can implement lessons learned from existing regulations, and technology companies themselves at least claim to welcome it. It is time to confront the challenges of regulating AI to help ensure innovation, prosperity, and safety
The Law of Unintended Consequences: Examining West Virginia\u27s Data Privacy Legislation and What Could Have Been
Get PDFNew Jack Hustler – Ice Cube
No full texthttps://researchrepository.wvu.edu/fixation-db-music-videos/7324/thumbnail.jp