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Item Altered standards of care for health care providers in the pandemic influenza(Indiana University, 2009) Kinney, Eleanor D.; McCabe, Heather A.; Gilbert, Amy Lewis; Shisler, Janna JoPandemic influenza will pose tremendous challenges to health care providers, state public health authorities, and the public. All will have to conduct business under the most adverse of circumstances. It will be difficult for providers to meet the customary legal standards of care imposed by state and federal regulatory authorities, as well as the common law tort system. This white paper will explore the legal issues associated with altered standards of care in pandemic influenza.Item Correction to: Inaugural BMC Ecology and Evolution image competition: the winning images(Springer Nature, 2021-09-09) Harman, Jennifer L.; Cuff, Alison L.; Settele, Josef; Jacobus, Luke M.; Liberles, David A.; Traulsen, Arne; IUPUC Division of ScienceFollowing the publication of the original article [1], we were notified that: The description of Fig. 2 was incorrect: This image shows "an amphipod crustacean of the species E. verrucosus densely covered with an overgrown colony of parasitic ciliates. Ciliates living on weakened crustaceans are capable of forming vast colonies resembling a "fur coat" Should read: This image shows "an amphipod crustacean of the species E. verrucosus densely covered with an overgrown colony of parasitic ciliates and unknown oomycetes or fungi. These organisms on weakened crustaceans are capable of forming vast colonies resembling a "fur coat". The caption of Fig. 2 was changed from “Eulimnogammarus verrucosus, a species of crustacean endemic to the UNESCO World Heritage Site Lake Baikal, suffering from a parasitic ciliate infection. Attribution: Kseniya Vereshchagina” to “Eulimnogammarus verrucosus, a species of crustacean endemic to the UNESCO World Heritage Site Lake Baikal, suffering from a parasitic ciliate and unknown oomycete (water mold) or fungi infection. Attribution: Kseniya Vereshchagina”. The affiliations of the 3rd and 4th authors had been swapped by mistake. The original article has been corrected.Item COVID-19 vaccine confidence and hesitancy among health care workers: A cross-sectional survey from a MERS-CoV experienced nation(PLOS, 2021-11-29) Barry, Mazin; Temsah, Mohamad-Hani; Alhuzaimi, Abdullah; Alamro, Nurah; Al-Eyadhy, Ayman; Aljamaan, Fadi; Saddik, Basema; Alhaboob, Ali; Alsohime, Fahad; Alhasan, Khalid; Alrabiaah, Abdulkarim; Alaraj, Ali; Halwani, Rabih; Jamal, Amr; Alsubaie, Sarah; Al-Shahrani, Fatimah S.; Memish, Ziad A.; Al-Tawfiq, Jaffar A.; Medicine, School of MedicineObjectives: This study aimed to identify coronavirus disease 2019 (COVID-19) vaccine perception, acceptance, confidence, hesitancy, and barriers among health care workers (HCWs). Methods: An online national cross-sectional pilot-validated questionnaire was self-administered by HCWs in Saudi Arabia, which is a nation with MERS-CoV experience. The main outcome variable was HCWs' acceptance of COVID-19 vaccine candidates. The factors associated with vaccination acceptance were identified through a logistic regression analysis, and the level of anxiety was measured using a validated instrument to measure general anxiety levels. Results: Out of the 1512 HCWs who completed the study questionnaire-of which 62.4% were women-70% were willing to receive COVID-19 vaccines. A logistic regression analysis revealed that male HCWs (ORa = 1.551, 95% CI: 1.122-2.144), HCWs who believe in vaccine safety (ORa = 2.151; 95% CI: 1.708-2.708), HCWs who believe that COVID vaccines are the most likely way to stop the pandemic (ORa = 1.539; 95% CI: 1.259-1.881), and HCWs who rely on the Centers for Disease Control and Prevention website for COVID 19 updates (ORa = 1.505, 95% CI: 1.125-2.013) were significantly associated with reporting a willingness to be vaccinated. However, HCWs who believed that the vaccines were rushed without evidence-informed testing were found to be 60% less inclined to accept COVID-19 vaccines (ORa = 0.394, 95% CI: 0.298-0.522). Conclusion: Most HCWs are willing to receive COVID-19 vaccines once they are available; the satisfactoriness of COVID-19 vaccination among HCWs is crucial because health professionals' knowledge and confidence toward vaccines are important determining factors for not only their own vaccine acceptance but also recommendation for such vaccines to their patients.Item Evaluation of an educational program for essential newborn care in resource-limited settings: Essential Care for Every Baby(Springer Nature, 2015-06-24) Thukral, Anu; Lockyer, Jocelyn; Bucher, Sherri L.; Berkelhamer, Sara; Bose, Carl; Deorari, Ashok; Esamai, Fabian; Faremo, Sonia; Keenan, William J.; McMillan, Douglas; Niermeyer, Susan; Singhal, Nalini; Pediatrics, School of MedicineBackground: Essential Care for Every Baby (ECEB) is an evidence-based educational program designed to increase cognitive knowledge and develop skills of health care professionals in essential newborn care in low-resource areas. The course focuses on the immediate care of the newborn after birth and during the first day or until discharge from the health facility. This study assessed the overall design of the course; the ability of facilitators to teach the course; and the knowledge and skills acquired by the learners. Methods: Testing occurred at 2 global sites. Data from a facilitator evaluation survey, a learner satisfaction survey, a multiple choice question (MCQ) examination, performance on two objective structured clinical evaluations (OSCE), and pre- and post-course confidence assessments were analyzed using descriptive statistics. Pre-post course differences were examined. Comments on the evaluation form and post-course group discussions were analyzed to identify potential program improvements. Results: Using ECEB course material, master trainers taught 12 facilitators in India and 11 in Kenya who subsequently taught 62 providers of newborn care in India and 64 in Kenya. Facilitators and learners were satisfied with their ability to teach and learn from the program. Confidence (3.5 to 5) and MCQ scores (India: pre 19.4, post 24.8; Kenya: pre 20.8, post 25.0) improved (p < 0.001). Most participants demonstrated satisfactory skills on the OSCEs. Qualitative data suggested the course was effective, but also identified areas for course improvement. These included additional time for hands-on practice, including practice in a clinical setting, the addition of video learning aids and the adaptation of content to conform to locally recommended practices. Conclusion: ECEB program was highly acceptable, demonstrated improved confidence, improved knowledge and developed skills. ECEB may improve newborn care in low resource settings if it is part of an overall implementation plan that addresses local needs and serves to further strengthen health systems.Item How I treat unique and difficult-to-manage cases of CAR T-cell therapy–associated neurotoxicity(American Society of Hematology, 2023) Santomasso, Bianca D.; Gust, Juliane; Perna, Fabiana; Medicine, School of MedicineWith growing indications for chimeric antigen receptor (CAR) T-cell therapy, toxicity profiles are evolving. There is an urgent and unmet need of approaches to optimally manage emerging adverse events that extend beyond the standard paradigm of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS). Although management guidelines exist for ICANS, there is little guidance on how to approach patients with neurologic comorbidities, and how to manage rare neurotoxicity presentations, such as CAR T-cell therapy-related cerebral edema, severe motor complications or late-onset neurotoxicity. In this study, we present 3 scenarios of patients treated with CAR T cells who develop unique types of neurotoxicity, and we describe an approach for the evaluation and management based on experience because objective data are limited. The goal of this study is to develop an awareness of emerging and unusual complications, discuss treatment approaches, and help institutions and health care providers establish frameworks to navigate how to best address unusual neurotoxicities to ultimately improve patient outcomes.Item Inaugural BMC Ecology and Evolution image competition: the winning images(Springer Nature, 2021-08-13) Harman, Jennifer L.; Cuff, Alison L.; Settele, Josef; Jacobus, Luke M.; Liberles, David A.; Traulse, Arne; IUPUC Division of ScienceThe inaugural BMC Ecology and Evolution image competition attracted entries from talented ecologists and evolutionary biologists worldwide. Together, these photos beautifully capture biodiversity, how it arose and why we should conserve it. This editorial celebrates the winning images as selected by the Editor of BMC Ecology and Evolution and senior members of the journal's editorial board.Item Measurement of Nontechnical Skills During Robotic-Assisted Surgery Using Sensor-Based Communication and Proximity Metrics(American Medical Association, 2021-11-01) Cha, Jackie S.; Athanasiadis, Dimitrios; Anton, Nicholas E.; Stefanidis, Dimitrios; Yu, Denny; Surgery, School of MedicineThis cohort study uses sensor-based communication and proximity metrics to assess surgeon nontechnical skills during robotic-assisted surgery.Item A Mixed-method Analysis of Community-Engaged Theatre Illuminates Black Women’s Experiences of Racism and Addresses Healthcare Inequities by Targeting Provider Bias(Sage, 2020) Wasmuth, Sally; Pritchard, Kevin; Milton, Cierra; Smith, Emily; Occupational Therapy, School of Health and Human SciencesTheatre has been a powerful means of eliciting social change. This paper describes methods and outcomes of a theatre project to reduce healthcare inequities experienced by Black women. We conducted narrative interviews with a convenience sample of Black women and conducted thematic analysis of interview transcripts to learn about their experiences of healthcare and to inform development of a professional theatrical production. To assess the impact of the performance on the audience, we used a single post-test concurrent mixed-methods design using a self-created Likert-type survey that included space for open-ended responses. Ten Black women completed narrative interviews. Thematic analysis revealed 5 main themes: being ignored, being accused, being talked-down to, fearing harm, and being hurt. Narratives were used to create a script that centered on these themes, and that was professionally produced and performed. Audience members (n = 113, 25% healthcare providers) produced a mean total post-test score of 19.28 (agree/strongly agree) on a 25-point survey with 2 items scoring in the 2 to 3 range (disagree/not sure). Thematic analysis data revealed the extent to which Black women experienced discrimination in multiple settings. Quantitative survey data suggested audience members conceptually understood and were aware of inequity, but open-ended responses revealed this information was new for some, and prior knowledge for others. The audience reported planning to change personal behaviors that may contribute to inequity. Participants were unsure if they had contributed to inequity in the past. The performance stimulated conversation about implicit bias and discrimination and encouraged audience members to examine their contributions to the problem. Future pre-post studies are needed to better assess the impact of the performance. Theatre has the potential to illuminate the extent and nature of discrimination in healthcare and society, and to foster conversations that allow audience members to consider their own potential contributions to discrimination.Item Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US(American Medical Association, 2021-08-02) Lall, Michelle D.; Bilimoria, Karl Y.; Lu, Dave W.; Zhan, Tiannan; Barton, Melissa A.; Hu, Yue-Yung; Beeson, Michael S.; Adams, James G.; Nelson, Lewis S.; Baren, Jill M.; Surgery, School of MedicineImportance: The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career. Objective: To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation. Design, setting, and participants: In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts. Main outcomes and measures: The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts. Results: Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]). Conclusions and relevance: In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.Item Provider Attitudes, Preferences, and Practices Regarding Sexual and Reproductive Health for Adolescents and Young Adults with Sickle Cell Disease(Elsevier, 2021) Leroy-Melamed, Maayan; Jacob, Seethal; Shew, Marcia L.; Kazmerski, Traci M.; Pediatrics, School of MedicinePurpose: With improvements in life expectancy, adolescents and young adults (AYAs) with sickle cell disease (SCD) increasingly face sexual and reproductive health (SRH) concerns. As subspecialists often serve as primary care providers for those with chronic disease, this study examines pediatric SCD providers' practices and attitudes related to SRH of AYA women with SCD. Methods: We developed an adapted survey to identify SCD provider attitudes and practices in addressing menses, sexual activity, contraception, and pregnancy for their female patients. We electronically distributed this survey to the American Society of Pediatric Hematology/Oncology SCD interest group. We used descriptive statistics to analyze results. Results: A total of 78 pediatric SCD providers completed the survey. A majority (95%) rated SRH discussions as moderately important or higher, with 89% agreeing this care should be standardized. Most respondents reported discussing SRH, such as menses (78%), teratogenic medications (61%), and contraception (90%), with their female patients with SCD at least annually. Although most refer AYAs with SCD for birth control (83%), 39% endorsed a preferred method, with 33% of these favoring levonorgestrel intrauterine devices in this population and 40% injectable contraception. Approximately half of respondents (57%) reported that the use of combined hormonal contraceptives was unacceptable despite published guidelines that support potential benefits outweighing theoretical risk in AYAs with SCD. Conclusions: The range of SRH conversations and contraceptive recommendations for AYAs from pediatric SCD providers is broad. SCD providers and AYAs with SCD would benefit from improved evidence and educational resources related to contraception as well as coordinated SRH counseling.