Publications by authors named "Caroline Kraft"

6 Publications

  • Page 1 of 1

Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department.

Am J Emerg Med 2020 Nov 12. Epub 2020 Nov 12.

UNC School of Medicine, UNC Chapel Hill, Chapel Hill, NC, United States of America. Electronic address:

Background And Objectives: Lack of mental health resources, such as inpatient psychiatric beds, has increased frequency and duration of boarding for mental health patients presenting to U.S. emergency departments (EDs). The purpose of this study is to describe characteristics of mental health patients with an ED length of stay of one week or longer and to identify barriers to their disposition.

Methods: This study was conducted in an academic ED in which emergency psychiatric evaluations and care are provided by a Psychiatric Emergency Services (PES) team contained within the Department of Emergency Medicine. Prolonged boarding was defined as an ED length of stay of 7 days or more. Pediatric, adult, and geriatric mental health patients with prolonged ED boarding from January 1 to August 31, 2019 were included. This study includes prospective data collection of the boarding group and retrospective identification and data collection of a comparison group of non-barding patients over the same 8-month period to compare patient characteristics and outcomes for each group.

Results: Between January 1 and August 31, 2019, the PES team completed 2,745 new assessments of mental health patients, of whom 39 met criteria for prolonged ED boarding. The following characteristics were associated with boarding: child (8%), male (64%), having Medicaid (49%) or both Medicaid and Medicare (18%), and having either a neurodevelopmental (15%) or neurocognitive disorder (15%) with a median stay of 18 days. Barriers to discharge included being declined from all state inpatient psychiatric hospitals (69%), declined from community living environments (21%), or declined from both (10%). The most common ED non-boarding patients were: Caucasian (64%), have a diagnosis of unspecified mental disorder (including suicidal ideation) or other specified mental disorder (59%) and have private insurance (42%) with a median stay of 1 day.

Conclusion: In this study of mental health patients with prolonged ED stays, the primary barrier to disposition was the lack of patient acceptance to inpatient psychiatric hospitals, community settings, or other housing. Early identification of potential prolonged boarding, quality treatment and care for those patients, and effective case management, may resolve the ongoing challenges of boarding within the ED.
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http://dx.doi.org/10.1016/j.ajem.2020.11.021DOI Listing
November 2020

Vascular dimorphism ensured by regulated proteoglycan dynamics favors rapid umbilical artery closure at birth.

Elife 2020 09 10;9. Epub 2020 Sep 10.

Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, United States.

The umbilical artery lumen closes rapidly at birth, preventing neonatal blood loss, whereas the umbilical vein remains patent longer. Here, analysis of umbilical cords from humans and other mammals identified differential arterial-venous proteoglycan dynamics as a determinant of these contrasting vascular responses. The umbilical artery, but not the vein, has an inner layer enriched in the hydrated proteoglycan aggrecan, external to which lie contraction-primed smooth muscle cells (SMC). At birth, SMC contraction drives inner layer buckling and centripetal displacement to occlude the arterial lumen, a mechanism revealed by biomechanical observations and confirmed by computational analyses. This vascular dimorphism arises from spatially regulated proteoglycan expression and breakdown. Mice lacking aggrecan or the metalloprotease ADAMTS1, which degrades proteoglycans, demonstrate their opposing roles in umbilical vascular dimorphism, including effects on SMC differentiation. Umbilical vessel dimorphism is conserved in mammals, suggesting that differential proteoglycan dynamics and inner layer buckling were positively selected during evolution.
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http://dx.doi.org/10.7554/eLife.60683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529456PMC
September 2020

Contrast adaptation appears independent of the longitudinal chromatic aberration of the human eye.

J Opt Soc Am A Opt Image Sci Vis 2019 Apr;36(4):B77-B84

As ocular chromatic aberration was suspected to cue contrast adaptation in human vision, the purpose of this study was to investigate contrast adaptation under monochromatic light conditions. Single and complex frequency adaptation stimuli were used, and monochromatic conditions were achieved using band pass filters with short (470±2  ), medium (530±2  ), and long (630±2  ) transmission wavelengths. Post-adaptational contrast sensitivity was shown to be significantly decreased for all wavelength conditions for the single frequency stimulus. A significant difference of contrast adaptation between short and long wavelengths was found. Consistently, adaptation led to a significant decrease in contrast sensitivity for the complex frequency stimulus. To conclude, contrast adaptation under mesopic illumination occurs independently of the longitudinal chromatic aberration of the eye; it can be inferred that this mechanism can be used to distinguish between the sign of optical defocus in poly- and monochromatic light conditions.
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http://dx.doi.org/10.1364/JOSAA.36.000B77DOI Listing
April 2019

Secreted metalloproteases ADAMTS9 and ADAMTS20 have a non-canonical role in ciliary vesicle growth during ciliogenesis.

Nat Commun 2019 02 27;10(1):953. Epub 2019 Feb 27.

Department of Biomedical Engineering- ND20, Cleveland Clinic Lerner Research Institute, Cleveland, OH, 44195, USA.

Although hundreds of cytosolic or transmembrane molecules form the primary cilium, few secreted molecules are known to contribute to ciliogenesis. Here, homologous secreted metalloproteases ADAMTS9 and ADAMTS20 are identified as ciliogenesis regulators that act intracellularly. Secreted and furin-processed ADAMTS9 bound heparan sulfate and was internalized by LRP1, LRP2 and clathrin-mediated endocytosis to be gathered in Rab11 vesicles with a unique periciliary localization defined by super-resolution microscopy. CRISPR-Cas9 inactivation of ADAMTS9 impaired ciliogenesis in RPE-1 cells, which was restored by catalytically active ADAMTS9 or ADAMTS20 acting in trans, but not by their proteolytically inactive mutants. Their mutagenesis in mice impaired neural and yolk sac ciliogenesis, leading to morphogenetic anomalies resulting from impaired hedgehog signaling, which is transduced by primary cilia. In addition to their cognate extracellular proteolytic activity, ADAMTS9 and ADAMTS20 thus have an additional proteolytic role intracellularly, revealing an unexpected regulatory dimension in ciliogenesis.
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http://dx.doi.org/10.1038/s41467-019-08520-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393521PMC
February 2019

Self-assessment of refractive errors using a simple optical approach.

Clin Exp Optom 2018 05 21;101(3):386-391. Epub 2018 Jan 21.

Institute for Ophthalmic Research, Eberhard Karls University of Tuebingen, Tuebingen, Germany.

Background: This explorative study investigated procedures for the self-assessment of spherocylindrical refractive errors.

Methods: Eighteen participants with a mean age of 34.0 ± 8.8 years were enrolled. Adjustable Alvarez lenses were mounted in a rotatable ring holder and two procedures were tested for the self-adjustment: (1) rotation of the lens in three meridians: 0°, 60° and 120° and (2) rotation of the optotypes in the same meridians. Starting from maximum positive power, the participants were required to decrease the power of the Alvarez lens until the optotypes (0.0 logMAR) appeared to be clear the first time. Best-corrected visual acuity (BVA) was measured using a psychophysical staircase procedure. Bland-Altmann analysis was carried out in order to calculate the limits of agreement between the self-refraction method and the standard subjective refraction.

Results: Using procedure 1, 77 per cent of the subjects achieved a VA ≥ 0.1 logMAR (6/7.5) and the same was true for 88 per cent of the subjects using procedure 2. Using procedure 1, a significantly worse BVA was found, when compared to subjective refraction (ΔVA = -0.15 logMAR, F  = 7.11, p = 0.046, median test). Analysis of variance (ANOVA) analysis showed a significant influence of the refraction method on the oblique astigmatism component J but not for the spherical equivalent M and the straight astigmatism component J (M: F  = 0.532, p = 0.661; J : F  = 0.056, p = 0.983; J : F  = 13.97, p < 0.001; ANOVA). The limits of agreement for the spherical equivalent error M were ± 1.10 D and ± 1.20 D and for the astigmatic components J ± 0.78 D and ± 0.59 D and for J ± 0.62 D and ± 0.54 D, for procedure 1 and procedure 2, respectively.

Conclusions: Fixed adjustable Alvarez lenses and rotatable stimuli can provide a fast and precise self-assessment method to measure the spherocylindrical error of the eye.
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http://dx.doi.org/10.1111/cxo.12650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947140PMC
May 2018

Logistical Challenges and Opportunities for Conducting Peer Nomination Research in Schools.

New Dir Child Adolesc Dev 2017 Sep;2017(157):45-59

University of Oklahoma.

Although conducting psychological research within schools has always required effort, persistence, and the careful navigation of various interests, there is a consensus among child and adolescent researchers that, over the past 2 decades, it has become increasingly difficult to collect data within schools. In this chapter, we lay out common and consistent difficulties, frustrations, and obstacles that researchers face when attempting to conduct peer nomination research in schools. Many of these difficulties are faced not only by researchers conducting peer nominations but by any investigator attempting to do school-based research, and we discuss these issues more broadly. We also focus on the specific challenges associated with sociometric methods. We present suggestions and solutions for overcoming these issues and consider ways that researchers can give back to schools and establish long-term partnerships that benefit the students, teachers, and administrators of participating schools, as well as the researchers themselves. Such partnerships have the potential to make data collection easier and to open doors to new research opportunities.
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http://dx.doi.org/10.1002/cad.20208DOI Listing
September 2017