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Measurement of patients' acceptable symptom levels and priorities for symptom improvement in advanced prostate cancer
No full textPurpose: Limited research has evaluated the success criteria and priorities for symptom improvement of patients with cancer to inform patient-centered care. In this study, we adapted and tested a measure of these constructs, the Patient-Centered Outcomes Questionnaire (PCOQ), for patients with advanced prostate cancer. We compared acceptable symptom severity levels following symptom treatment across 10 symptoms and identified patient subgroups based on symptom importance.
Methods: Patients with advanced prostate cancer (N = 99) participated in a one-time survey, which included a modified version of the PCOQ, standard symptom measures, and additional clinical characteristics.
Results: The modified PCOQ demonstrated construct validity through its correlations with related theoretical constructs. There was a moderate correlation between symptom severity and importance. Acceptable symptom severity levels were generally low, with sexual dysfunction having a higher acceptable severity than most other symptoms. Three patient subgroups were identified: (1) those who rated all symptoms as low in importance (n = 43); (2) those who rated all symptoms as moderately important (n = 33); and (3) those who rated all symptoms as highly important (n = 18). Subgroups were associated with functional status, fatigue, sleep problems, pain, and emotional distress.
Conclusion: The modified PCOQ demonstrated preliminary evidence of construct validity. Patients generally considered low symptom severity to be acceptable, with variations across symptoms. Results suggest that symptom severity and importance are related but distinct aspects of the symptom experience in advanced prostate cancer. Patients' diverse priorities for symptom improvement point to the need for individualized treatment plans
A Novel Cell-Cell Communication Structure: Tanycyte and Cilia Hypothalamic Unifying Glia-cilia Structure (HUGS)
No full textPrimary cilia, microtubule-based sensory organelles that mediate cell-cell communication, may facilitate signaling in the brain through direct physical contacts (e.g., synapse-like structures). Similarly, specialized glial cells lining the third ventricle (3V) called tanycytes signal through physical interactions and can dynamically alter their morphology in response to external stimuli and physiological changes. Here, we identify robust cilia-tanycyte contacts; we term HUGS ( H ypothalamic, U nifying G lia-cilia S tructures) and discover that these connections are disrupted in a mouse ciliopathy model ( Bbs4 ) exhibiting hypothalamic dysfunction. These data provide insight into potentially new cell-cell signaling mechanisms deployed by neuronal cilia
Indiana's 2024 Behavioral Health and Human Services Workforce Snapshot: Bachelor Social Workers
No full textThis document is a 2024 data snapshot of actively practicing Bachelor Social Workers (BSWs) in Indiana within the Behavioral Health and Human Services workforce. It reports a small active workforce (71 BSWs) and identifies primary practice settings, most commonly in in‑home services, nonfederal hospital inpatient/acute care, and child welfare or family services. The document highlights core functions, particularly case management, and identifies key populations served, including adults, older adults, individuals with disabilities, and individuals in recovery
Characterizing amyloid and tau positron emission tomography-based stages across the clinical continuum
No full textIntroduction: We standardized positron emission tomography (PET) data across multiple cohorts and tracers to characterize the frequency of amyloid and tau PET severity along the clinical continuum.
Methods: Clinical stage was defined using cohort-specific criteria and included cognitively unimpaired (CU), mild cognitive impairment (MCI), and dementia. Amyloid severity was staged using Centiloids (CL). Tau severity was staged using a hierarchical Braak-based schema. The cumulative probabilities of PET-based stages were estimated using ordinal logistic regressions.
Results: Among 10,396 individuals (mean [standard deviation] age: 71.9 [7.1] years), amyloid levels ≥ 25 CL increased with age among CU and MCI, while amyloid levels ≥ 100 CL were most common in dementia. In 3295 with tau PET, tau severity increased with amyloid and clinical stage and showed complex associations with age. Within each clinical stage, the full spectrum of amyloid and tau PET severity was observed.
Discussion: PET-based staging revealed heterogeneous amyloid and tau burden along the clinical continuum.
Highlights: PET-based staging is feasible across multiple cohorts and PET tracers. There is heterogeneity in amyloid and tau severity across the clinical spectrum. The frequency of amyloid and tau PET severity increased with clinical severity. The likelihood of tau PET severity differed by age, amyloid, and clinical severity
Indiana Emergency Medical Services Workforce July 15, 2024 Student Technical Report
No full textThis report summarizes findings from the Indiana EMS Student Pulse Check survey, administered through the state’s ACADIS training and certification system between October 2023 and June 2024. Eight EMS trainees responded, providing self‑reported information on demographics, training experiences, employment intentions, and factors influencing career decisions. Respondents showed limited racial diversity, equal gender distribution, and minimal prior EMS experience. Most were enrolled in EMT certification programs and learned about EMS careers through personal connections. Students estimated an average training cost of 27.13 upon completion. They reported high comfort with common emergency scenarios but lower comfort with cases involving sexual assault or pediatric death. Employment preferences centered on fire department or hospital‑based ambulance services, with flexible scheduling, commute time, and reimbursement for recertification costs rated as influential factors. Despite the small sample size, the survey provides preliminary insight into the training pipeline, career motivations, and anticipated workforce needs among early‑stage EMS trainees in Indiana
Indiana's 2024 Behavioral Health and Human Services Workforce Snapshot: Licensed Clinical Social Workers
No full textThis document is a 2024 data snapshot of actively practicing Licensed Clinical Social Workers (LCSWs) in Indiana within the Behavioral Health and Human Services workforce. It reports the total number of active LCSWs (4,549) and identifies primary practice settings, with the largest share working in private practice, followed by community mental health centers and telehealth. The document highlights core services provided, particularly general counseling, mental health diagnosis, and telehealth, and identifies key populations served, with a predominant focus on adults and individuals in recovery
Interprofessional Teaching Model for Enhancing Musculoskeletal Examination: Does the Learning Event Length Matter?
No full textBaseline Insulin Secretion Determines Response to Abatacept in Stage 1 Type 1 Diabetes
No full textAbatacept, a cytotoxic T lymphocyte–associated protein 4 immunoglobulin that inhibits T-cell costimulation, was evaluated for 12 months in stage 1 type 1 diabetes (T1D) to delay disease progression. Despite modest preservation of area under the curve C-peptide at 12 months, the primary end point was not met. We adopted the oral minimal model (OMM) to assess β-cell function over 48 months and explored how baseline insulin secretion (ϕtotal) modified treatment response. Using the OMM, ϕtotal was computed from oral glucose tolerance tests conducted at baseline and every 6 months. Participants were stratified into high- and low-secretor groups depending on baseline ϕtotal ≥33rd or <33rd centile, respectively. A sensitivity analysis was performed to validate threshold choice. Among 203 participants (abatacept n = 96; 107 placebo n = 107), 39% receiving abatacept and 47% receiving placebo experienced progression to stage 2 or 3 within 96 months. High secretors receiving abatacept gained 15.8 progression-free months (95% CI 4.85, 26.68; P = 0.005) and had a 54% lower hazard of progression versus those receiving placebo (hazard ratio [HR] 0.46; 95% CI 0.25, 0.84; P = 0.012). Treatment effect differed significantly by secretor status (interaction HR 2.92; 95% CI 1.23, 6.96; P = 0.015). A subgroup of responders to 12 months of abatacept was identified by ϕtotal, providing the first evidence that an immune intervention in stage 1 T1D may delay disease progression.
Article highlights: We sought to investigate whether baseline insulin secretion (ϕtotal), quantified using the oral minimal model assessing β-cell function, could identify a subgroup of responders to abatacept (a cytotoxic T lymphocyte-associated protein 4 immunoglobulin that inhibits T-cell costimulation) among those with stage 1 type 1 diabetes (T1D). Abatacept preserved ϕtotal during and up to 1 year after treatment cessation; high baseline secretors treated with abatacept gained ∼16 months of progression-free survival and had a 54% lower hazard of progression versus those receiving placebo, whereas no benefit was observed in low secretors. This is the first evidence of an immune intervention delaying disease progression in those with stage 1 T1D. Continued treatment may result in a greater delay in progression
Possibility of Influencing 241Am Fluctuations
No full textThis paper reports on results from an experiment designed to search for exotic particles interacting with nuclear matter. These particles could be created through the Primakoff coupling between photons and an external magnetic field. Theory suggests this coupling leads to the production of weakly interacting particles (e.g. axions) that are important to understanding the lack of a measured neutron electric dipole moment (nEDM). The current experiment has been run to look for evidence of weakly interacting particles, created by photons propagating through a magnetic field, by studying their influence on the measured decay spectrum of Americium (241Am). The results shown here reflect a statistically significant difference (sigma > 6.0) between observed decays when the experiment was run in a mode that allowed photons to traverse a magnetic field (light mode or sP for system-Photons) when compared to a second mode where the light was blocked from entering the cavity (dark mode or sD for system-Dark). This difference was observed to impact the count rate for the release of a 59.54keV gamma from 237Np. Repeated experimentation suggests the effect is robust and not due to spurious changes in background events. This could be confirmation that the Primakoff mechanism has been observed for visible photons. As importantly, this experiment looks at the possibility to develop a novel nuclear instrument that can modify nuclear decay rates
434. Impact of a Blood Culture Stewardship Initiative Among Pediatric Febrile Neutropenia Patients on Reducing Carbon Emissions
No full textBackground:
In the United States, the healthcare sector is responsible for about 8.5% of national greenhouse gas emissions. Diagnostic stewardship initiatives can help mitigate these emissions. At Riley Children’s Hospital, a blood culture stewardship initiative was implemented to reduce the number of repeat blood cultures ordered for pediatric febrile neutropenia patients. The purpose of this study was to calculate the reduction in carbon emissions from the blood culture microbiology waste associated with the blood culture stewardship initiative.
Methods:
Starting January 1, 2023, a new febrile neutropenia blood culture protocol was implemented, limiting repeat blood cultures after 48 hours to patients with hemodynamic instability or recurrent fever (defined as a new fever occurring ≥72 hours after being afebrile). The number of blood culture bottles use before (January 2017 to December 2022) and after (January 2023 to December 2023) the initiative were calculated. Then microbiology supplies used for negative and positive blood cultures were documented and weighed. The Mazzetti M+Wastecare calculator was used to calculate the carbon emissions from the transportation, autoclaving, and landfill disposal of the supplies.
Results:
Before and after implementation of the blood culture stewardship initiative, 1,403 bottles per year and 1,075 bottles per year were utilized respectively, resulting in a 31% reduction in use annually. Weights of supplies used for negative and positive blood cultures were recorded (Table 1). Calculated carbon emissions associated with the weights of the supplies used for positive and negative cultures are displayed in Table 2. Overall, the blood culture stewardship intervention reduced carbon emissions by 34.9 kg CO2e annually, equivalent to driving approximately 87 miles in an average passenger vehicle (Table 3).
Conclusion:
The blood culture stewardship initiative among pediatric febrile neutropenia patients resulted in a positive environmental impact as it decreased carbon emissions equivalent to driving approximately 87 miles. Given that carbon emissions associated with manufacturing, packaging, and delivery of supplies were not factored in, this is an underestimate of the full annual reduction in carbon emissions