About

Paulina D. Arnold is an assistant professor of law at the University of Michigan Law School. She teaches and writes about coercive state power outside the criminal law, including civil procedure, civil confinement, and immigration law. Arnold is interested in both the justifications for civil confinement and the formal legal doctrines that restrict and permit the government’s power to incarcerate, such as habeas and due process. Her work examines similarities, tensions, and incoherencies across civil and criminal carceral systems to interrogate the state’s power to confine in the absence of explicitly punitive goals. Previously, Arnold was a Forrester Fellow at Tulane Law School and a staff attorney at CASA in Maryland, where she supported working-class immigrant communities through direct representation, legislative advocacy, impact litigation assistance, and other forms of movement lawyering.

Research topics

• Computer Science
• Internal medicine
• Medicine
• Endocrinology
• Emergency medicine
• Intensive care medicine
• Medical physics
• Medical emergency
• Surgery

Selected publications

• 202. Targeting <i>Clostridioides difficile</i> Infection Prevention Efforts with Artificial Intelligence

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background Infections with Clostridioides difficile are associated with prolonged hospital stays, higher costs, and significant morbidity. Artificial intelligence (AI) tools can accurately predict which hospitalized patients are most likely to acquire C. difficile infection (CDI). However, to date, such tools have not been used in clinical practice. We investigated how AI tools for CDI risk stratification could be integrated into clinical workflows to promote targeted infection prevention efforts. Details of the infection prevention bundle (a) Screenshot of the BPA for enhanced handwashing precautions. This BPA instructs the receiving provider to place an order for putting up the “Enhanced Handwashing Precautions” sign, depicted in Figure 2. (b) Screenshot of the BPA for antimicrobial stewardship. This BPA is educational and provides a list of recommendations for reducing risk of CDI, including discontinuing unnecessary acid suppressants, minimizing unnecessary antibiotics, consulting the beta-lactam allergy evaluation service, and encouraging patient to eat yogurt if appropriate. Methods A previously validated AI model for predicting CDI risk from routinely collected data in electronic health records was used to generate daily risk scores for adult inpatients presenting to Michigan Medicine between January 1, 2023 and December 31, 2023. These scores were used to focus infection prevention efforts on high-risk patients in 10 selected hospital units with the greatest concentration of CDI cases. The infection prevention bundle, aimed at reducing both susceptibility and exposure, included provider-facing best practice alerts (BPAs) for enhanced handwashing precautions and antimicrobial stewardship (Figure 1). Using retrospective data, we determined a risk threshold that targets 5 alerts/unit/week on average. Clinical staff on selected units were educated about the AI tool by the study team. Picture of the “Enhanced Handwashing Precautions” sign This sign is placed on the door of the rooms for high-risk patients in selected hospital units and instructs all persons to wash their hands with soap and water upon room entry. Results During the study, 12,983 hospitalizations corresponding to 10,815 patients were assessed daily by the model, totaling 109,068 CDI risk scores. Among this population, 2,151 (16.6%) high-risk hospitalizations exceeded the risk threshold and triggered BPAs (an average of 4.1 alerts/unit/week). Among the high-risk population, 1,647 (76.6%) and 117 (5.4%) hospitalizations received an order for enhanced handwashing precautions and an order for a β-lactam allergy evaluation consultation, respectively. Field observations and interviews with clinical staff revealed challenges associated with behavior changes such as compliance with handwashing using soap and water to remove spores. Conclusion AI tools can be integrated into clinical workflows to promote targeted infection prevention efforts. However, continuous monitoring of how such tools interact with existing workflows and education on novel infection prevention strategies are key to success. Disclosures Krishna Rao, MD, MS, Merck and Company, Inc.: Grant/Research Support|Rebiotix Inc.: Advisor/Consultant|Seres Therapeutics: Advisor/Consultant|Summit pharmaceuticals: Advisor/Consultant

  PublisherOA PDFDOI

• Feasibility and Performance of Continuous Glucose Monitoring to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit

  Journal of Diabetes Science and Technology · 2024 · 7 citations

  • Medicine
  • Emergency medicine
  • Intensive care medicine

  BACKGROUND: We evaluated the feasibility of real-time continuous glucose monitoring (CGM) for titrating continuous intravenous insulin infusion (CII) to manage hyperglycemia in postoperative individuals in the cardiovascular intensive care unit and assessed their accuracy, nursing acceptance, and postoperative individual satisfaction. METHODS: Dexcom G6 CGM devices were applied to 59 postsurgical patients with hyperglycemia receiving CII. A hybrid approach combining CGM with periodic point-of-care blood glucose (POC-BG) tests with two phases (initial-ongoing) of validation was used to determine CGM accuracy. Mean and median absolute relative differences and Clarke Error Grid were plotted to evaluate the CGM accuracy. Surveys of nurses and patients on the use of CGMs experience were conducted and results were analyzed. RESULTS: In this cohort (mean age 64, 32% female, 32% with diabetes) with 864 paired POC-BG and CGM values analyzed, mean and median absolute relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.7% of paired CGM and POC-BG were in Zones A and B of the Clarke Error Grid. Responses from nurses reported CGMs being very or quite convenient (n = 28; 93%) and it was favored over POC-BG testing (n = 28; 93%). Majority of patients (n = 42; 93%) reported their care process using CGM as being good or very good. CONCLUSION: This pilot study demonstrates the feasibility, accuracy, and nursing convenience of adopting CGM via a hybrid approach for insulin titration in postoperative settings. These findings provide robust rationale for larger confirmatory studies to evaluate the benefit of CGM in postoperative care to improve workflow, enhance health outcomes, and cost-effectiveness.

  PublisherOA PDFDOI

• 1040-P: Feasibility and Performance of Continuous Glucose Monitoring (CGM) to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit (CV-ICU)

  Diabetes · 2023-06-20

  article

  We evaluated the utility of real-time CGM for titrating intravenous (IV) insulin via a validated institutional computerized insulin infusion (CII) algorithm in the CV-ICU. We used a hybrid approach of combining CGM with periodic point-of-care blood glucose (POC-BG) tests to validate the continued accuracy of CGM. We also surveyed nurses on this care change. Dexcom G6 CGMs were applied to 61 post-surgical patients with hyperglycemia (34% with diabetes) receiving IV insulin. CGM values were validated with POC-BG every(Q) 1-2 h per the CII protocol. Once validated (i.e., within 20% of POC-BG values if BG ≥100 mg/dL or within 20 mg/dL if BG &amp;lt;100 mg/dl), sensor values were then used to titrate IV insulin doses per CII algorithm. POC-BG checks were then reduced to Q6h validation. Among 857 paired POC-BG and CGM values analyzed, the mean and median average relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.6% of paired CGM and POC-BG were in Zone A and B of the Clarke Error Grid (Figure). Thirty nurse respondents found CGM very or quite convenient (n=28; 93%) and favored it over POC-BG testing (n=28; 93%). This pilot study demonstrates that using CGM via a hybrid approach for CII titration protocol is feasible, has high accuracy, and higher nursing convenience. Disclosure L.Ang: None. Y.Qu: None. R.Freeman: None. N.H.Esfandiari: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter &amp; Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. R.Gianchandani: None. F.Akanbi: None. L.F.Schroeder: None. Y.Lin: None. C.A.Degeorge: None. P.Arnold: None. S.Knotts: None. E.Dubois: None. N.Desbrough: None.

  PublisherDOI

• Insulin Bolus Calculator: Lessons Learned from Institutional Experience

  Journal of Diabetes Science and Technology · 2020 · 3 citations

  • Computer Science
  • Medicine
  • Intensive care medicine

  Insulin bolus calculators have proven effective in improving glycemia and patient safety. Insulin calculators are increasingly being implemented for inpatient hospital care. Multidisciplinary teams are often involved in the design and review of the efficacy and utilization for these calculators. At times, unintended consequences and benefits of utilization are found on review. Integration of our insulin calculator into our electronic health record system was a multidisciplinary effort. During implementation, several obstacles to effective care were identified and are discussed in the following manuscript. We describe the barriers to utilization and potential pitfalls in clinical integration. We further describe benefits in patient education, time of insulin administration versus meal delivery, variations in insulin bolus for ketone correction, variation in care, and maximum bolus administration. Sharing lessons learned from experiences using electronic insulin calculator order sets will further our goals of improved patient care in the hospital setting.

  PublisherOA PDFDOI

• Improving Hospital Glucometrics, Workflow, and Outcomes with a Computerized Intravenous Insulin Dose Calculator Built into the Electronic Health Record

  Journal of Diabetes Science and Technology · 2020 · 17 citations

  • Computer Science
  • Medicine
  • Emergency medicine

  OBJECTIVE: To adjust for dynamic insulin requirements in critically ill patients, intravenous (IV) insulin infusions allow for titration of the dose according to a prespecified algorithm. Despite the adaptability of IV insulin protocols, human involvement in dose calculation allows for error. We integrated a previously validated IV insulin calculator into our electronic health record (Epic) and instituted it in the cardiovascular intensive care unit (CVICU). We aim to describe the design of the calculator, the implementation process, and evaluate the calculator's impact. METHOD: Employing an aggressive training program and user acceptance testing prior to significant elbow support at the time of institution, we successfully integrated the insulin calculator in our CVICU. We evaluated the glucometrics before and after implementation as well as nursing satisfaction following calculator implementation. RESULTS: Overall, our implementation led to increased frequency of blood sugar at various glycemic targets, a trend toward less hypoglycemia or hyperglycemia. For severe hypoglycemia, our preintervention cohort had 0.02% of blood sugars less than 40 mg/dL but no blood sugars less than 40 mg/dL were identified in our patient's postintervention. For the CVICU target blood glucose of 70-180 mg/dL, 87.97% blood sugars at baseline met goal compared to 91.39% at one month, 91.24% at three months, and 90.87% at six months postintervention. CONCLUSION: By utilizing an aggressive education campaign championing superusers and making adjustments to the calculator based on early problems that were encountered, we were able to improve glycemic control and limit glucose variability at our institution.

  PublisherOA PDFDOI

• Effects of exogenous ketone supplementation on blood ketone, glucose, triglyceride, and lipoprotein levels in Sprague–Dawley rats

  Nutrition & Metabolism · 2016-02-04 · 158 citations

  articleOpen access

  BACKGROUND: Nutritional ketosis induced by the ketogenic diet (KD) has therapeutic applications for many disease states. We hypothesized that oral administration of exogenous ketone supplements could produce sustained nutritional ketosis (>0.5 mM) without carbohydrate restriction. METHODS: We tested the effects of 28-day administration of five ketone supplements on blood glucose, ketones, and lipids in male Sprague-Dawley rats. The supplements included: 1,3-butanediol (BD), a sodium/potassium β-hydroxybutyrate (βHB) mineral salt (BMS), medium chain triglyceride oil (MCT), BMS + MCT 1:1 mixture, and 1,3 butanediol acetoacetate diester (KE). Rats received a daily 5-10 g/kg dose of their respective ketone supplement via intragastric gavage during treatment. Weekly whole blood samples were taken for analysis of glucose and βHB at baseline and, 0.5, 1, 4, 8, and 12 h post-gavage, or until βHB returned to baseline. At 28 days, triglycerides, total cholesterol and high-density lipoprotein (HDL) were measured. RESULTS: Exogenous ketone supplementation caused a rapid and sustained elevation of βHB, reduction of glucose, and little change to lipid biomarkers compared to control animals. CONCLUSIONS: This study demonstrates the efficacy and tolerability of oral exogenous ketone supplementation in inducing nutritional ketosis independent of dietary restriction.

  PublisherOA PDFDOI

• Different calorie restriction treatments have similar anti-seizure efficacy

  Seizure · 2016-01-07 · 8 citations

  articleOpen access
  PublisherOA PDFDOI

• Effect of Sustaining Dietary Ketosis on the Hippocampal and Serum Metabolome of Sprague‐Dawley Rats

  The FASEB Journal · 2015-04-01 · 3 citations

  article

  The ketogenic diet (KD) has been successfully used to treat pediatric refractory epilepsy since the 1920s and is currently being investigated as an adjunct treatment for many disease states. The therapeutic efficacy of the KD results from an elevation of blood ketones. We previously reported that oral administration of ketone supplements produced nutritional ketosis (>0.5 mM) without carbohydrate restriction and the effects of a 28-day administration of five ketone supplements on blood glucose, ketones, and lipids in male Sprague-Dawley rats. We hypothesized that the 28-day administration would affect metabolomic markers. Serum (~300 μL) and hippocampal tissues for ketone supplements 1,3 butanediol acetoacetate diester (KE) and (1:1 mixture of sodium/potassium beta-hydroxybutyrate mineral salt solution (BMS) and medium chain triglyceride oil (MCT)) BMS+MCT were collected on day 28 at 4 hours post-intragastric gavage (peak ketone elevation). Metabolon analyzed samples by gas and liquid chromatography in tandem with mass spectrometry. Both ketone supplements significantly increased serum TCA cycle intermediates: citrate, fumarate and malate. KE supplement significantly increased alpha-ketoglutarate and BMS+MCT supplement significantly increased succinate in the rat serum. Additionally, both supplements affected medium chain fatty acids, dicarboxylic acids, adenosine, inflammatory mediators, antioxidants, and bile acids in both serum and hippocampal tissue. Although both forms of ketone supplementation increased brain and blood ketone levels, the global metabolic profiles were different.

  PublisherDOI

• Anticonvulsant properties of an oral ketone ester in a pentylenetetrazole-model of seizure

  Brain Research · 2015-05-28 · 32 citations

  article
  PublisherDOI

• Non-Toxic Metabolic Management of Metastatic Cancer in VM Mice: Novel Combination of Ketogenic Diet, Ketone Supplementation, and Hyperbaric Oxygen Therapy

  PLoS ONE · 2015-06-10 · 97 citations

  articleOpen access

  The Warburg effect and tumor hypoxia underlie a unique cancer metabolic phenotype characterized by glucose dependency and aerobic fermentation. We previously showed that two non-toxic metabolic therapies - the ketogenic diet with concurrent hyperbaric oxygen (KD+HBOT) and dietary ketone supplementation - could increase survival time in the VM-M3 mouse model of metastatic cancer. We hypothesized that combining these therapies could provide an even greater therapeutic benefit in this model. Mice receiving the combination therapy demonstrated a marked reduction in tumor growth rate and metastatic spread, and lived twice as long as control animals. To further understand the effects of these metabolic therapies, we characterized the effects of high glucose (control), low glucose (LG), ketone supplementation (βHB), hyperbaric oxygen (HBOT), or combination therapy (LG+βHB+HBOT) on VM-M3 cells. Individually and combined, these metabolic therapies significantly decreased VM-M3 cell proliferation and viability. HBOT, alone or in combination with LG and βHB, increased ROS production in VM-M3 cells. This study strongly supports further investigation into this metabolic therapy as a potential non-toxic treatment for late-stage metastatic cancers.

  PublisherOA PDFDOI

Frequent coauthors

• Dominic P. D’Agostino

  TreadStone Technologies (United States)

  9 shared

• Csilla Ari

  University of South Florida

  7 shared

• Raffaele Pilla

  Fatebenefratelli Hospital

  6 shared

• Angela M. Poff

  University of South Florida

  5 shared

• Roma Gianchandani

  Cedars-Sinai Medical Center

  4 shared

• Nathan P. Ward

  4 shared

• Marcellino Monda

  University of Campania "Luigi Vanvitelli"

  3 shared

• Jacob Sherwood

  University of South Florida

  3 shared

Labs

• University of Michigan Law SchoolPI

Awards & honors

• Forrester Fellow at Tulane Law School
• Fellow of CASA in Maryland