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Indiana Emergency Medical Services Workforce April 15 - June 30, 2025, Student Data Report
No full textThis report summarizes findings from the Indiana EMS Student Pulse Check survey completed between April 15 and June 30, 2025. A total of 127 valid responses were analyzed to describe the demographics, training experiences, and employment intentions of recent EMS program completers. Two‑thirds of respondents reported completing EMT training, and 41.7% became aware of EMS careers through personal connections. Students reported an average training cost of 23.11, with paramedic students reporting the highest costs and expected earnings. Most respondents had no prior ambulance experience and indicated high comfort with EMS runs involving accidents, burns, and suspected COVID‑19 cases, while scenarios involving sexual assault or pediatric deaths were associated with lower comfort levels. Employment preferences aligned strongly with students’ training level, with many indicating interest in roles within fire departments and ambulance services. Health insurance, long‑term disability coverage, and life insurance were the most important benefits identified, while flexible scheduling and peer support were the most valued employment options. Geographic data showed that 63.8% of respondents completed training within their county of residence, suggesting substantial accessibility of EMS education across Indiana
Advanced chronic kidney disease increases the odds of ERCP adverse events but not post-ERCP pancreatitis: a propensity-matched analysis of the US Collaborative Network
No full textBackground: Patients with chronic kidney disease (CKD) are at an increased risk choledocholithiasis, requiring intervention with endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP-related adverse events in this population is limited, hence this study.
Methods: This retrospective cohort study utilized the TriNetX database to assess the odds of ERCP-related adverse events in patients with stages 4 and 5 chronic kidney disease, as well as end-stage renal disease (ESRD) on dialysis. Primary outcomes were ERCP-related pancreatitis (PEP), bleeding, cholangitis, and perforation. Secondary outcomes were failure to extubate/new post-procedure intubation, intensive care unit (ICU) admissions, and all-cause mortality.
Results: After propensity score matching, our study included 4450 patients in the aCKD cohort and 4450 patients in the matched control cohort who underwent ERCP. Patients with aCKD had an increased odds of bleeding (OR 2.1, p < 0.001), cholangitis (OR 1.6, p < 0.001), ICU admissions (OR 2.2, p < 0.001), intubation (OR 3.0, p < 0.001) and mortality (OR 1.8, p < 0.001) compared to those with normal renal function. The odds of PEP (OR 1.1, p = 0.542) and perforation (OR 1.3, p = 0.528) were statistically similar between the two cohorts. No subgroup differences in ERCP-related AE were found except for increased ICU admissions odds in ESRD patients.
Conclusion: aCKD patients are a demonstrably high-risk group for certain ERCP-related AEs but not for PEP or perforation, a finding that may change the previous widespread perception of increased PEP risk in this population. Additional studies are needed to validate our findings and investigate potential interventions to improve clinical outcomes in this high-risk population
Aberrant intrinsic functional network connectivity in Early‐Onset Alzheimer's Disease
No full textBackground:
Neurodegeneration in sporadic early‐onset Alzheimer's disease (EOAD) at the stage of MCI and mild dementia is characterized by atrophy most prominently in posterior temporoparietal cortical areas. These “EOAD signature” regions (Touroutoglou et al., 2023) spatially correspond to key nodes of several canonical large‐scale functional networks, including the default mode, frontoparietal, language, and dorsal attention networks. While current evidence points to abnormal functional connectivity in EOAD compared with healthy controls, prior studies employed small samples and have yielded mixed results. Here, we analyzed a large sample of sporadic EOAD patients from the Longitudinal Early‐Onset Alzheimer's Disease Study (LEADS) to test the central hypothesis that EOAD disrupts the functional integrity of several brain networks. We also hypothesized that AD‐related connectivity alteration would be associated with the magnitude of cognitive impairment and of cortical atrophy in the EOAD signature.
Method:
We analyzed whole‐brain multi‐band functional MRI data (duration = 10 min) collected at wakeful rest from sporadic EOAD (n = 239) and cognitively unimpaired (CU) (n = 68) participants from the LEADS cohort (Table 1). We used a custom pipeline to conduct preprocessing, confound removal, and quality control of MRI data. The residual functional timeseries data were used to calculate seed‐based functional connectivity of each anatomically distinct cortical region within the EOAD signature (Figure 1A). We then compared these seed‐based connectivity maps between EOAD and CU participants, while controlling for age, sex, and estimates of in‐scanner head motion.
Result:
EOAD patients showed abnormally stronger connectivity in all EOAD signature regions than CU participants, involving multiple large‐scale functional networks (Figure 1B). In EOAD patients, stronger functional connectivity within multiple networks was associated with worse cognitive impairment and greater atrophy in the EOAD signature (Figure 2). An exploratory analysis of whole‐cortex functional connectome further showed that AD‐related hyperconnectivity was prominently observed in relation to the default mode and frontoparietal networks.
Conclusion:
In patients with sporadic EOAD, phenotypically vulnerable cortical regions exhibit prominent disruption of intrinsic functional connectivity. Our findings support the selective vulnerability of cortical functional networks in EOAD, which may underlie the distinct pattern of AD pathology spreading and cognitive impairment in this AD clinical phenotype
Indiana's 2024 Active Behavioral Health and Human Services Workforce Geographic Distribution
No full textThis document presents a 2024 geographic distribution snapshot of Indiana’s active Behavioral Health and Human Services (BHHS) workforce, based on licensure renewal data. It maps the population per BHHS professional full‑time equivalent (FTE) across the state, categorizing areas by workforce density to highlight regional variation in access to behavioral health services
470. IDSA Chalk Talks as a Catalyst for Enhancing Clinical Teaching and Professional Identity through Medical Education Innovation
No full textBackground:
In 2022, the Infectious Diseases Society of America (IDSA)’s Medical Education Community of Practice (MedEdCOP) launched a novel peer-reviewed platform for ID educators to publish chalk talks —concise, high-yield teaching scripts designed for the clinical learning environment. This open-access library enables educators to disseminate their work and offers ready-to-use teaching materials for others to adopt or adapt. We sought to evaluate the impact of chalk talk authorship on contributors' self-assessed teaching skills, professional identity, and connection to the ID education community.
Methods:
In alignment with best practices in medical education survey design, we developed and distributed an anonymous online survey via Qualtrics LLC. This survey assessed authors' perspectives across the following domains before versus after chalk talk authorship: self-perceived clinical teaching skills, educator identity, value as educators, and sense of connection to IDSA and the MedEdCOP. Paired, two-sided t-tests were used to analyze pre- and post-authorship values. This study was reviewed by the Washington University IRB and classified as exempt.
Results:
Between 2022 and 2024, 60 chalk talks were published by 41 unique authors through two rounds of peer review. Of these, 29 authors (71%) completed the survey (Table 1). Respondents reported statistically significant improvements in self-assessed clinical teaching skills post-authorship (Figure 1). They also experienced strengthened educator identity and greater perceived value as educators (Figure 2). Additionally, 75% reported an increased post-authorship connection to IDSA and the MedEdCOP. Notably, 73% found the experience helpful in demonstrating scholarly contributions.
Conclusion:
Authorship of IDSA chalk talks meaningfully enhanced participants’ self-assessed teaching skills and professional identity, while fostering a sense of value and community. This initiative supports educational innovation and dissemination, contributes to the recruitment and retention of high-quality educators in infectious diseases, and serves as a model for comparable efforts across IDSA and other professional societies
The implementation of tuberculosis preventive therapy in HIV care clinics in Africa, Asia and Latin America: a multiregional site survey
No full textIntroduction: Towards the 'End TB Strategy' targets, the WHO recommends the provision of tuberculosis (TB) preventive therapy (TPT) for high-risk groups including people living with HIV (PLWH). 3 years after the release of the updated 2020 WHO guidelines, we investigated the implementation of TPT services at HIV clinics in low-income and middle-income countries (LMICs), focusing on TB screening, populations eligible for TPT and available TPT regimens.
Methods: In 2023, we surveyed HIV care clinics in the International Epidemiology Databases to Evaluate AIDS consortium in Africa, the Asia-Pacific and Latin America and the Caribbean. We used descriptive statistics to summarise TPT implementation according to WHO guidelines and multivariable logistic regression models to estimate associations with clinic characteristics.
Results: Of 172 HIV clinics included, 142 (83%) were in Africa, 22 (13%) in the Asia-Pacific and 8 (5%) in Latin America; 108 (63%) were located in urban areas. After ruling out active TB, TPT was reportedly offered to PLWH (122 clinics, 71%), household contacts of individuals with active TB (120 clinics, 70%) and other high-risk populations. TPT for PLWH was more frequently available in clinics in lower-income and low-middle-income countries, in high TB burden countries, and in district hospitals compared with other facility types. Clinics reported use of isoniazid-based (160 clinics, 93%) and shorter rifamycin-based (129 clinics, 75%) TPT regimens. Reported barriers to TPT initiation included patient refusal at 71 (41%) and drug shortages at 67 (39%) clinics.
Conclusions: TPT was available at most HIV care clinics in LMICs but further efforts are needed to reinforce WHO recommendations and ensure that TPT is consistently accessible to people at higher risk of developing active TB, especially PLWH
Indiana's 2024 Physician Assistant Workforce Snapshot
No full textThis document is a 2024 workforce snapshot of actively practicing Physician Assistants (PAs) in Indiana. It reports the total number of active PAs (2,414) and identifies primary practice settings, with most practicing in hospital inpatient settings, outpatient office/clinic environments, and emergency departments. The document highlights key clinical areas, including surgical subspecialties, emergency medicine, and family medicine/general practice, and identifies core patient populations served, primarily adults and older adults. It also includes a geographic distribution map showing population per PA full‑time equivalent (FTE) across the state, illustrating regional variation in workforce availability
Lrat-Cre Exhibits Widespread Expression Beyond Hepatic Stellate Cells Across Multiple Tissues
No full textHepatic stellate cells (HSCs) play a central role in liver fibrosis, shifting from quiescent vitamin A-storing cells to activated, myofibroblast-like cells that secrete collagen and other profibrotic factors1. HSCs have thus become a major focus in liver fibrosis research, and several Cre driver lines have been created to target HSCs in mice. However, early Cre lines had significant limitations. Glial fibrillary acidic protein (Gfap)-Cre labels only a subset of HSCs and also induces recombination in cholangiocytes2. Collagen type I alpha 1 (Col1a1)-Cre and alpha-smooth muscle actin (αSMA)-Cre/CreERT2 primarily label activated myofibroblasts and broadly mark portal fibroblasts and vascular smooth muscle cells3,4. Platelet-derived growth factor receptor beta (Pdgfrβ)-Cre reliably labels HSCs but also recombines pericytes and smooth muscle cells, limiting its specificity5. The introduction of lecithin-retinol acyltransferase (Lrat)-Cre marked a major advance, offering highly specific labeling of quiescent and activated HSCs and rapidly becoming the most widely used driver for HSC tracing and genetic perturbation2. However, the extrahepatic expression of Lrat-Cre remains incompletely understood. This is a critical limitation, given that liver biology is closely coordinated with other organs to maintain systemic metabolism. Addressing these gaps is essential for the accurate interpretation of HSC-specific genetic models in liver biology
Impact of prior endoscopic or surgical interventions on clinical outcomes after peroral endoscopic myotomy for achalasia
No full textBackground: The aim of this study is to compare outcomes of POEM for achalasia between those with (PI) or without (NPI) previous disease intervention.
Methods: Single-center retrospective study of consecutive achalasia patients with or without ≥ 1 prior intervention with pneumatic dilation (PD), Heller myotomy (LHM), and/or Botox injection (BTI) who underwent POEM and had ≥ 6-month follow-up. Baseline testing: Eckardt Score (ES), high-resolution manometry (HRM), and functional lumen imaging probe (FLIP) of the esophagogastric junction (EGJ) at 50-mL distention. Between 6 and 12 months after POEM, patients were questioned about daily PPI use and HRM, ES, FLIP, EGD, and pH testing off anti-secretory medications were repeated when possible. Clinical response was defined as follows: ES ≥ 3, EGJ-DI > 2.8 mm2/mmHg, and integrated relaxation pressure (IRP) 6%. Outcomes were compared between the PI and NPI groups.
Results: 471 patients (mean: 55 ± 19 yrs; 60% M) with type 1 (17%), 2 (72%) or 3 (11%) achalasia with no prior (n = 325) or a prior (n = 126) intervention were identified. The PI group was older (p 6% (49%) were similar between the two groups.
Conclusion: Achalasia patients with previous LES-directed interventions undergoing POEM are older, have lower ES, lower LES pressure/tone, and require longer POEM times compared to those without previous interventions. Prior intervention does not impact the frequency of clinical response, daily PPI use, esophagitis or post-POEM GERD