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Indiana Emergency Medical Services Workforce July 1 - September 30, 2025, Student Date Report
No full textThis report summarizes findings from the Indiana EMS Student Pulse Check survey completed between July 1 and September 30, 2025. A total of 87 valid responses were analyzed to describe recent EMS program completers’ demographics, training experiences, and employment intentions. Most respondents were male and White, with over half enrolled in EMT programs and half reporting they learned about EMS careers through someone in the field. A majority had no prior ambulance experience. Students reported an average training cost of 24.36, though costs and wage expectations varied substantially by program, from low averages for EMR students to significantly higher averages for paramedic students. Respondents expressed strong comfort with common EMS scenarios such as COVID‑19 care and accident response. Employment preferences centered on EMT roles—primarily in ambulance settings—and many students favored working in fire departments. Key community factors influencing job decisions included cost of living, commute time, and proximity to spouse work or school. Health insurance, paid time off, and retirement plans were identified as the most important employment benefits. Geographic data indicated that fewer than half of students completed training within their home county
Impact of cardiometabolic risk factors on hepatocellular carcinoma incidence in patients with chronic hepatitis B: A retrospective cohort study
No full textBackground and aims: Chronic hepatitis B virus (HBV) infection remains a major global health burden and a leading cause of hepatocellular carcinoma (HCC). While cirrhosis is a well-established risk factor, the contributions of metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiometabolic risk factors (CMRFs) are less clearly defined. This study aimed to evaluate the impact of MASLD and CMRFs on HCC risk in patients with chronic hepatitis B (CHB).
Methods: We conducted a retrospective cohort study of CHB patients at Songklanagarind Hospital between 2011 and 2021, excluding those diagnosed with HCC within six months of follow-up. Clinical and imaging data were analyzed. Cumulative HCC incidence was estimated using Nelson-Aalen plots. Multivariable Cox regression was used to identify independent predictors. The aMAP score was evaluated in subgroups with obesity, CMRFs, and MASLD.
Results: Among 4,944 patients, 151 (3.1%) developed HCC. Cirrhosis (adjusted hazard ratio [aHR] 7.22), obesity (aHR 1.85), and male sex (aHR 1.78) were independent risk factors. Statin use (aHR 0.43), higher platelet count (aHR 0.62), and higher albumin (aHR 0.64) were protective. Diabetes and hypertension showed nonsignificant trends, and steatosis and dyslipidemia without statins were not significantly associated with HCC. Risk increased with the number of CMRFs. The aMAP score showed good discrimination in patients with obesity (C-index 0.82), CMRFs (0.79), MASLD (0.74), and in the non-cirrhotic MASLD and non-MASLD (0.69 and 0.71, respectively).
Conclusions: Cirrhosis, male sex, and obesity were key HCC risk factors. The aMAP score effectively stratified HCC risk among metabolically at-risk CHB patients
A High Fat/High Sucrose Diet Alters the Skeletal Response to Adenine-Induced Chronic Kidney Disease in Male Rats
No full textBackground: Chronic kidney disease (CKD) impacts a large and growing proportion of the population. Fracture rates are high in individuals with CKD compared to the non-CKD population. Dietary patterns consisting of higher fat and sugar intake are associated with higher risk of developing CKD, but the impact of different dietary patterns on the skeleton in the setting of CKD is largely unknown.
Objective: To assess the impact of a high fat/high sucrose diet (HFHS) in male Sprague Dawley rats with adenine-induced CKD (Ad).
Methods: Rats were given the HFHS or standard diet (SD) for 4 weeks followed by 8 weeks with adenine incorporated into those diets for the Ad groups.
Results: All Ad rats, regardless of diet, had high circulating blood urea nitrogen and parathyroid hormone (PTH). Ad + SD rats had greater femoral volumetric cortical porosity and pore number and lower mechanical properties than Ad + HFHS rats. Ad + HFHS had a lower percentage of cortical bone osteocytes positive for PTHR1 and RANKL matching trends in porosity; however, the HFHS diet led to greater TNF-α-positive osteocytes and trabecular osteoclast numbers.
Conclusions: There were differences in the skeletal response to adenine-induced CKD based on diet with the standard diet leading to a skeletal phenotype more associated with high PTH. These data demonstrate both the complexity of systemic alterations impacting bone in CKD and highlight the importance of understanding the influence of dietary factors on skeletal outcomes
Missed and Misdiagnosed: Precision Medicine Approaches to Screening for Familial Hypercholesterolemia and Lipoprotein(a)
No full textP-410. Enhancing the Clinical Impact of mcfDNA-NGS through an ID-Physician Led Diagnostic Stewardship Approval Protocol in a Quaternary Pediatric Hospital
No full textBackground:
Microbial cell-free DNA next-generation sequencing (mcfDNA-NGS) is a noninvasive diagnostic tool capable of rapidly detecting a broad range of pathogens and resistance genes. While promising, its clinical utility has shown mixed results. To optimize its use, we implemented an ID physician-led diagnostic stewardship approval protocol with mandatory ID consultation to guide test ordering, interpretation, and antimicrobial management.
Methods:
From February 2022 to March 2025, we conducted a prospective, single-center study at Riley Hospital for Children to assess the clinical utility of mcfDNA-NGS testing under an ID physician-led diagnostic stewardship approval protocol [Figure 1]. A panel of three infectious diseases physicians reviewed all test requests before approval, and the clinical relevance and impact of the results were subsequently evaluated.
Results:
A total of 54 mcfDNA-NGS tests were approved from 50 patients (median age: 9.5 years), with 64.8% yielding clinically significant results. In 24.1% of cases, mcfDNA-NGS provided the sole microbiologic diagnosis. Overall, 53.7% of tests led to clinical management changes, including earlier diagnosis (14.8%), initiation of targeted antimicrobial therapy (27.8%), and antimicrobial de-escalation (27.8%). Among patients with immunocompromising conditions (n=25), 76.0% of test results were clinically significant, and 48.0% led to clinical management changes: earlier diagnosis (20.0%), targeted therapy initiation (24.0%), and de-escalation (28.0%). Notably, the diagnosis of culture-negative endocarditis (n=9) had the highest yield, with all results leading to clinical management changes. There were no instances in which mcfDNA-NGS testing prompted unnecessary antibiotic therapy or invasive procedures. Additionally, 20.7% of test requests were deemed unnecessary and were canceled following stewardship review.
Conclusion:
An ID physician-led diagnostic stewardship approval protocol enhanced the clinical utility of mcfDNA-NGS testing in a pediatric cohort. These findings support broader implementation and call for multicenter studies to further refine diagnostic stewardship strategies that maximize the clinical value of mcfDNA-NGS
Stearoyl-CoA desaturase-1 controls the differentiation and antitumoral function of Th9 lymphocytes
No full textBackground: Stearoyl-CoA desaturase 1 (SCD1) is a key enzyme in fatty acid (FA) metabolism that catalyzes the addition of a cis double bond to palmitic and stearic saturated FAs, producing palmitoleic and oleic monounsaturated FAs, respectively. Interleukin (IL)9-secreting CD4+ T-helper lymphocytes (Th9) exert antitumoral activity in preclinical cancer models. In the present study, we evaluated the role of SCD1 in Th9 differentiation and their antitumoral properties.
Results: A specific monounsaturated FA profile is found in Th9 lymphocytes compared with Th1, Th2, Th17 and regulatory T cell (Treg) lymphocyte subsets and is correlated to the induction of SCD1 expression in mouse and human Th9 differentiated in vitro with TGFβ1 and IL4. The expression of SCD1 is also detected in tumor-draining lymph nodes and tumor-infiltrating Th9 lymphocytes of mice. The canonical Smad3 and non-canonical Pi3K members of the TGFβ signaling drive SCD1 expression in combination with IL4 during Th9 polarization. The invalidation of SCD1 gene expression or inhibition of its activity blocks Th9 differentiation by disrupting Smad2/3 activation. Furthermore, the lipidomic analysis between Th9 and Th9 invalidated for SCD1 gene or activity reveals a change in the FA profile, specifically a decrease in palmitoleic and oleic acids. Nevertheless, only oleic acid restores Th9 differentiation in CD4+ T lymphocytes invalidated for SCD1 gene or activity under TGFβ1 and IL4 polarizing conditions. Finally, invalidation of the SCD1 gene or its activity leads to the loss of Th9 antitumoral functions and promotes tumor growth through the production of TGFβ1.
Conclusion: We demonstrate that SCD1 contributes to Th9 differentiation and their antitumoral activity via the regulation of Smad2/3 signaling
Effect of Prophylactic Mesh and Placement Plane on Abdominal Wall Outcomes Following DIEP Flap Reconstruction
No full textBackground/Objective:
The deep inferior epigastric perforator (DIEP) flap is the most widely used autologous option for breast reconstruction. Donor-site morbidity, particularly abdominal wall weakness or bulge, remains a recognized complication. Prophylactic mesh has been proposed to reduce these risks, but the optimal plane of mesh placement has not been established. This study examines abdominal wall outcomes in patients undergoing DIEP flap reconstruction with and without prophylactic mesh, as well as across different planes of mesh placement.
Methods:
A retrospective review of patients who underwent DIEP flap reconstruction (2021–2025) at a single institution was performed. Patients were grouped by mesh type and location. Demographic data and postoperative outcomes were collected. Significance was set at p<0.05.
Results:
A total of 250 patients underwent DIEP flap reconstruction, including 150 with prophylactic mesh (retrorectus, n=81; overlay, n=69) and 100 without mesh. When analyzed by mesh use overall, patients with mesh had a significantly lower rate of abdominal bulge compared with those without mesh (2.7% vs. 9%, p=0.027). Subgroup analysis by plane of mesh trended towards significance demonstrating lowest rate of bulge in the retrorectus group (1.2%) compared with overlay mesh (4.3%) (p=0.06). Rates of infection and hernia were similar among groups. (p=0.6)
Conclusion:
Prophylactic mesh placement during DIEP flap reconstruction is associated with a significantly lower risk of abdominal bulge compared with no mesh. Retrorectus placement demonstrated the lowest rates of donor-site complications
2025 Indiana Emergency Medical Services Workforce Data Report
No full textThis report summarizes supplemental survey and licensure data collected from Indiana emergency medical services (EMS) professionals for renewal years 2023–2025. Across the period, 12,501 individuals renewed EMS credentials in 2023, 13,341 in 2024, and 11,665 in 2025, with 8.9%, 49.6%, and 42.9% respectively identified as actively providing EMS care in Indiana. The actively practicing workforce was consistently more than 90% White and roughly one‑third under age 35. More than 90% completed qualifying EMS education in Indiana, and about one‑third reported some college as their highest level of education. Firefighters represented the largest proportion of EMS professionals each year, and most respondents identified 911 EMS response as their primary service focus. Over 40% reported working more than 48 hours per week, and most responded to 1–10 calls during a typical shift period. Geographic patterns show higher concentrations of EMS coverage in metropolitan counties, particularly Marion and Lake. The report provides a statewide snapshot of workforce demographics, education, employment characteristics, service provision, and geographic distribution
Bowen Policy Snapshot: Indiana's Dental Hygiene Workforce 2024 Supply and Demand
No full textThis snapshot report summarizes current supply estimates and future demand projections for Indiana’s dental hygiene workforce. Drawing on data from the 2024 Oral Health Workforce Data Report and Lightcast analytics, the document outlines the number of actively practicing dental hygienists in the state and identifies anticipated workforce trends from 2025 to 2035
