Open Access Policy Articles

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The IUPUI Faculty Council adopted an open access policy on October 7th, 2014 (available from: https://openaccess.indianapolis.iu.edu/). This policy shows IUPUI's commitment to disseminating the fruits of research and scholarship as widely as possible. Open access policies increase authors’ rights, readership and citation rates for scholarly articles. The opt out provision ensures that all faculty authors have the freedom to publish in the journal of their choice.

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Now showing 1 - 10 of 25886

HPV Vaccine Awareness, Past Behaviors, and Future Intentions Among a Diverse Sample of Fathers Aged 27 to 45 Years: A National Survey
(Sage, 2024) Quist, Kevin M.; Fontenot, Holly B.; Zimet, Gregory; Lim, Eunjung; Matsunaga, Masako; Liebermann, Erica; Allen, Jennifer D.; Pediatrics, School of Medicine
Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to receive it. We conducted a cross-sectional, online survey among fathers aged 27 to 45 between March and April 2022, to assess associations between HPV vaccination awareness, behaviors, intentions, and psychosocial constructs from the Health Belief Model. We examined the characteristics of those who had (a) heard of the HPV vaccine, (b) already received ≥ 1 dose, and (c) intentions for future vaccination among those who had never been vaccinated. Among 400 men who completed the survey, 32% were not aware of the HPV vaccine. Among those who were aware, 41% had received ≥ 1 dose. Sixty-three percent of unvaccinated men reported that they intended to get vaccinated in the future. Multivariable logistic regression analyses revealed that age and race/ethnicity were associated with having been vaccinated previously. Among the unvaccinated, multivariable logistic regression analyses revealed that those with a higher perceived risk of HPV-associated cancer had 3.73 greater odds of reporting they would seek vaccination compared to those with lower perceived risk (95% confidence interval [CI] = [1.28, 12.3]). We did not find perceived benefits, barriers, or decision self-efficacy to be related to future vaccine intentions. Since recommendations for this group include shared clinical decision-making, public health efforts should focus on raising awareness of vaccine eligibility, emphasizing risk factors for HPV-associated cancers so that individuals have an accurate perception of risk, and encouraging conversation between men and their providers.
OTHR-27. Narrative Medicine Applied: A Study Elucidating How One Neuro-Oncology Team Grapples With Distress
(Oxford University Press, 2024-06-18) Riley, Kathy; Toback, Alison L.; Knight, Kelsey; Wimer, Tammy; Coven, Scott L.; Tailor, Jignesh K.; Lion, Alex H.; Medicine, School of Medicine
BACKGROUND: Absorbing the cumulative weight of neuro-oncology patient stories in isolation leads providers to experience burnout and distress that some in our study called “debilitating.” Sands, Stanley, & Charon (2008) describe the field of pediatric oncology as one that “taunts professionals with the random unfairness” of grave childhood illness. They reason that clinicians in this demanding field may benefit from narrative training to build empathy, teamwork, and resilience. Narrative medicine is a rigorous and evidence-based field of study that utilizes the method of close reading of literature and art to engage providers in discussion and personal reflection. In narrative medicine workshops, participants immerse themselves in a text or image, contemplate their experiences and their relation to the text, write in response to a prompt, and share their writings with one another (Charon, et al., 2017). METHODS: This study sought to understand how narrative medicine workshops conducted in a pediatric neuro-oncology clinical setting impacted individual team members, as well as inter- and intra-team relationships. Data collection for the study included pre- and post-surveys, qualitative interviews, and observation notes recorded by workshop facilitators. Researchers applied Clark’s (2014) framework of three distinct levels – relationship to oneself, relationship to the patient, and relationship to others on the team – to development of pre- and post-survey and qualitative interview questions. RESULTS: Although quantitative data failed to demonstrate that the workshops reduced participant distress, qualitative research generated evidence that the very act of participating in narrative medicine workshops provided a safe space for providers to discuss job-related distress, breaking down hierarchical barriers and moving them toward what one participant called “professional intimacy.” CONCLUSIONS: This research suggests that engaging in narrative medicine practice as a healthcare team may in and of itself alleviate distress and foster healing dialogue in a stressful clinical environment suffused with pain and loss.
Health Factors Associated With Development and Severity of Poststroke Dysphagia: An Epidemiological Investigation
(American Heart Association, 2024) Krekeler, Brittany N.; Schieve, Heidi J. P.; Khoury, Jane; Ding, Lili; Haverbusch, Mary; Alwell, Kathleen; Adeoye, Opeolu; Ferioloi, Simona; Mackey, Jason; Woo, Daniel; Flaherty, Matthew; De Los Rios La Rosa, Felipe; Demel, Stacie; Star, Michael; Coleman, Elisheva; Walsh, Kyle; Slavin, Sabreena; Jasne, Adam; Mistry, Eva; Kleindorfer, Dawn; Kissela, Brett; Neurology, School of Medicine
Background: Dysphagia after stroke is common and can impact morbidity and death. The purpose of this population-based study was to determine specific epidemiological and health risk factors that impact development of dysphagia after acute stroke. Methods and results: Ischemic and hemorrhagic stroke cases from 2010 and 2015 were identified via chart review from the GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study), a representative sample of ≈1.3 million adults from southwestern Ohio and northern Kentucky. Dysphagia status was determined on the basis of clinical assessments and necessity for alternative access to nutrition via nasogastric or percutaneous endoscopic gastrostomy tube placement. Comparisons between patients with and without dysphagia were made to determine differences in baseline characteristics and premorbid conditions. Multivariable logistic regression determined factors associated with increased risk of dysphagia. Dysphagia status was ascertained from 4139 cases (1709 with dysphagia). Logistic regression showed that increased age, Black race, higher National Institutes of Health Stroke Scale score at admission, having a hemorrhagic stroke (versus infarct), and right hemispheric stroke increased the risk of developing dysphagia after stroke. Factors associated with reduced risk included history of high cholesterol, lower prestroke modified Rankin Scale score, and white matter disease. Conclusions: This study replicated previous findings of variables associated with dysphagia (older age, worse stroke, right-sided hemorrhagic lesions), whereas other variables identified were without clear biological rationale (eg, Black race, history of high cholesterol, and presence of white matter disease) and should be investigated in future studies to determine biological relevance and potential influence in stroke recovery.
Investigating Unconscious Race Bias and Bias Awareness Among Vascular Surgeons
(medRxiv, 2024-06-05) Howard, Kerry A.; Witrick, Brian; Clark, Ashley; Morse, Avery; Atkinson, Karen; Kapoor, Pranav; McGinigle, Katharine L.; Minc, Samantha; Alabi, Olamide; Hicks, Caitlin W.; Gonzalez, Andrew; Cené, Crystal W.; Cykert, Samuel; Kalbaugh, Corey A.; Surgery, School of Medicine
Background: Implicit bias can influence behavior and decision-making. In clinical settings, implicit bias may influence treatment decisions and contribute to health disparities. Given documented Black-White disparities in vascular care, the purpose of this study was to examine the prevalence and degree of unconscious bias and awareness of bias among vascular surgeons treating peripheral artery disease (PAD). Methods: The sampling frame included all vascular surgeons who participate in the Vascular Quality Initiative (VQI). Participants completed a survey which included demographic questions, the race implicit association test (IAT) to measure magnitude of unconscious bias, and six bias awareness questions to measure conscious bias. The magnitude of unconscious bias was no preference; or slight, moderate, or strong in the direction of pro-White or pro-Black. Data from participants were weighted to account for nonresponse bias and known differences in the characteristics of surgeons who chose to participate compared to the full registry. We stratified unconscious and conscious findings by physician race/ethnicity, physician sex, and years of experience. Finally, we examined the relationship between unconscious and conscious bias. Results: There were 2,512 surgeons in the VQI registry, 304 of whom completed the survey, including getting IAT results. Most participants (71.6%) showed a pro-White bias with 73.0% of this group in the moderate and strong categories. While 77.5% of respondents showed conscious awareness of bias, of those whose conscious results showed lack of awareness, 67.8% had moderate or strong bias, compared to 55.7% for those with awareness. Bias magnitude varied based on physician race/ethnicity and years of experience. Women were more likely than men to report awareness of biases and potential impact of bias on decision-making. Conclusions: Most people have some level of unconscious bias, developed from early life reinforcements, social stereotypes, and learned experiences. Regarding health disparities, however, these are important findings in a profession that takes care of patients with PAD due to heavy burden of comorbid conditions and high proportion of individuals from structurally vulnerable groups. Given the lack of association between unconscious and conscious awareness of biases, awareness may be an important first step in mitigation to minimize racial disparities in healthcare.
Cleaved TMEM106B forms amyloid aggregates in central and peripheral nervous systems
(Springer Nature, 2024-06-17) Bacioglu, Mehtap; Schweighauser, Manuel; Gray, Derrick; Lövestam, Sofia; Katsinelos, Taxiarchis; Quaegebeur, Annelies; van Swieten, John; Jaunmuktane, Zane; Davies, Stephen W.; Scheres, Sjors H. W.; Goedert, Michel; Ghetti, Bernardino; Grazia Spillantini, Maria; Center for Electron Microscopy, School of Medicine
Filaments made of residues 120-254 of transmembrane protein 106B (TMEM106B) form in an age-dependent manner and can be extracted from the brains of neurologically normal individuals and those of subjects with a variety of neurodegenerative diseases. TMEM106B filament formation requires cleavage at residue 120 of the 274 amino acid protein; at present, it is not known if residues 255-274 form the fuzzy coat of TMEM106B filaments. Here we show that a second cleavage appears likely, based on staining with an antibody raised against residues 263-274 of TMEM106B. We also show that besides the brain TMEM106B inclusions form in dorsal root ganglia and spinal cord, where they were mostly found in non-neuronal cells. We confirm that in the brain, inclusions were most abundant in astrocytes. No inclusions were detected in heart, liver, spleen or hilar lymph nodes. Based on their staining with luminescent conjugated oligothiophenes, we confirm that TMEM106B inclusions are amyloids. By in situ immunoelectron microscopy, TMEM106B assemblies were often found in structures resembling endosomes and lysosomes.
The role of patient-reported outcomes in a patient-centered care model for managing chronic liver diseases
(Wolters Kluwer, 2024-06-14) Verma, Manisha; Desai, Archita P.; Medicine, School of Medicine
The impact of abstinence from chronic alcohol consumption on the mouse striatal proteome: sex and subregion-specific differences
(Frontiers Media, 2024-06-03) Duffus, Brittnie-Lee M.; Haggerty, David L.; Doud, Emma H.; Mosley, Amber L.; Yamamoto, Bryan K.; Atwood, Brady K.; Pharmacology and Toxicology, School of Medicine
Alcohol misuse is the third leading preventable cause of death in the world. The World Health Organization currently estimates that 1 in 20 deaths are directly alcohol related. One of the ways in which consuming excessive levels of alcohol can both directly and indirectly affect human mortality and morbidity, is through chronic inflammation. Recently, studies have suggested a link between increased alcohol use and the incidence of neuroinflammatory-related diseases. However, the mechanism in which alcohol potentially influences neuroinflammatory processes is still being uncovered. We implemented an unbiased proteomics exploration of alcohol-induced changes in the striatum, with a specific emphasis on proteins related to inflammation. The striatum is a brain region that is critically involved with the progression of alcohol use disorder. Using mass spectrometry following voluntary alcohol self-administration in mice, we show that distinct protein abundances and signaling pathways in different subregions of the striatum are disrupted by chronic exposure to alcohol compared to water drinking control mice. Further, in mice that were allowed to experience abstinence from alcohol compared to mice that were non-abstinent, the overall proteome and signaling pathways showed additional differences, suggesting that the responses evoked by chronic alcohol exposure are dependent on alcohol use history. To our surprise we did not find that chronic alcohol drinking or abstinence altered protein abundance or pathways associated with inflammation, but rather affected proteins and pathways associated with neurodegeneration and metabolic, cellular organization, protein translation, and molecular transport processes. These outcomes suggest that in this drinking model, alcohol-induced neuroinflammation in the striatum is not a primary outcome controlling altered neurobehavioral function, but these changes are rather mediated by altered striatal neuronal structure and cellular health.
Prevalence, predictors, and in-hospital outcomes of ST-elevation myocardial infarction among young adults without traditional cardiovascular risk factors in the United States
(Elsevier, 2024-05-28) Shamaki, Garba Rimamskep; Safiriyu, Israel; Antia, Akanimo; Abd El-Radi, Waddah K.; Tinago, Chiwoneso Beverley; Ilonze, Onyedika; Medicine, School of Medicine
Background: Standard Modifiable Cardiovascular Risk Factors (SMuRF) such as hypertension, diabetes mellitus, hypercholesterolemia, and smoking have long been established in the etiology of atherosclerotic disease. Studies suggest that patients without any of these risk factors (SMuRF-less) who present with ST-elevation myocardial infarction have worse outcomes. Methods: The National Inpatient Sample databases (2016 to 2020) was queried to identify STEMI admissions as a principal diagnosis using ICD 10 codes. The study population aged 18 to 45 years were divided into cohorts of SMuRF and SMuRF-less based on the presence of ≥1 risk factor (hypertension, diabetes mellitus, hyperlipidemia, and smoking), and in-hospital outcomes were compared. Results: 41,990 patients were identified as the final study population. 38,495 patients were identified as SMuRF, and 3495 patients were SMuRF-less. Compared to SMuRF patients, SMuRF-less patients are more likely to be females (23.2 % vs. 21.2 %), have congestive heart failure (16.6 % vs. 13.7 %, p < 0.01) but less likely to have obesity (13.7 % vs 28.0 %, p < 0.01) In evaluating outcomes, SMuRF-less patients had higher adjusted in-hospital mortality (aOR 2.6, CI 1.5-4.2, p < 0.01), Cardiogenic shock (aOR 1.8, CI 1.3-2.5, p < 0.01), acute kidney injury (aOR 1.4, CI 1.0-1.9, p = 0.02), and Extramembrane Corporeal Oxygenation (aOR 4.1, CI 1.1-15.1, p = 0.03). Fluid and electrolyte abnormalities was an independent predictor of mortality among SMuRF-less patients (aOR 3.82, CI 1.3-11.2, p < 0.01). Conclusion: Young patients who present with STEMI and have no traditional cardiovascular risk factors have worse in-hospital outcomes. Further research is needed to evaluate the impact of non-traditional risk factors on acute myocardial infarction.
Doubling Down on Wnt Signaling to Overcome Myeloma Bone Disease
(Oxford University Press, 2023) Delgado-Calle, Jesus; Roodman, G. David; Medicine, School of Medicine
A Unique Use of Regional Information Exchange by a Statewide Health System Serving Refugees: "Operation Allies Welcome"
(Thieme, 2023) Webber, Emily C.; Peterson, Rachel J.; Lory, Katie; Kanis, Jessica; Saysana, Michele; Schneider, Kimberly S.; Pediatrics, School of Medicine
Background: In September 2021, a military camp in the United States was identified for an initial relocation of over 6,600 Afghanistan refugees. This case report describes a novel use of existing health information exchange to expedite and provide health care for a large refugee population throughout the state during the duration of their entry into the United States. Methods: Medical teams of the health systems and military camp partnered to provide a scalable, reliable mechanism for clinical data exchange leveraging an existing regional health information exchange. Exchanges were evaluated for clinical type, originating source, and closed loop communication with the refugee camp and personnel military camp. Results: Approximately 50% of the camp residents were under the age of 18 years. Over 20 weeks, approximately 4.51% of the refugee camp residents were cared for in participating health systems. A total of 2,699 clinical data messages were exchanged, 62% of which were clinical documents. Conclusion: All health systems participating in care were offered support to utilize the tool and process set up using the regional health information exchange. The process and guiding principles may be applied to other refugee health care efforts to provide efficient, scalable, and reliable means of clinical data exchange to health care providers in similar situations.

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