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High Transepidermal Water Loss at the Site of Wound Closure Is Associated With Increased Recurrence of Diabetic Foot Ulcers: The NIDDK Diabetic Foot Consortium TEWL Study
No full textObjective: The National Institute of Diabetes and Digestive and Kidney Diseases Diabetic Foot Consortium tested the hypothesis that compromised restoration of the skin barrier function of closed diabetic foot ulcers (DFUs), as measured by high transepidermal water loss (TEWL), is associated with an increased risk of DFU recurrence.
Research design and methods: This was a multicenter noninterventional study measuring TEWL in 418 adult participants with diabetes and a recently healed DFU. TEWL was measured at the center of the closed wound and at an anatomically similar reference area on the contralateral foot within 2 weeks of wound closure (visit 1); measurements were repeated at a wound closure confirmation visit 2 weeks later (visit 2). Participants were observed for up to 16 weeks to assess for wound recurrence. Participant self-reported and clinician assessments of DFU wound recurrence were recorded.
Results: DFU recurrence by week 16 occurred in 21.5% of participants. Mean TEWL at the center of the healed DFU at visit 1 was higher for those with recurrence compared with those without (P = 0.006). Among participants with high TEWL (>30.05 g · m-2 · h-1), 35% reported wound recurrence by 16 weeks versus 17% of those with low TEWL. The odds ratio for recurrence for participants with high TEWL was 2.66 (P < 0.001). Self-reported wound recurrence was highly concordant with clinician assessment of wound recurrence.
Conclusions: Compromised wound healing mechanisms culminating in wound closure associated with defective skin barrier function is associated with increased risk of DFU recurrence. Measurement of TEWL has value as a predictor of functional wound healing and could affect clinical practice, leading to better outcomes
The dynamics of cognitive decline toward Alzheimer's disease progression: Results from ADSP‐PHC's harmonized cognitive composites
No full textIntroduction: Accurately assessing the temporal order of cognitive decline across multiple domains is critical in Alzheimer's disease (AD). Existing literature presents controversial conclusions likely due to the use of a single cohort and different analytical strategies.
Methods: Harmonized composite cognitive measures in memory, language, and executive functions from 13 cohorts in the Alzheimer's Disease Sequencing Project Phenotype Harmonization Consortium (ADSP-PHC) were used. A double anchoring events-based sigmoidal mixed model was developed using time to incident AD diagnosis as the time scale.
Results: In general, decline in memory occurred before decline in language, followed by decline in executive function. This temporal order generally persisted within each subgroup of apolipoprotein E ε4 carrier status, sex, and race/ethnicity.
Discussion: This study demonstrated the use of harmonized data across multiple cohorts to characterize the temporal order of cognitive decline along AD progression. Using time to incident AD diagnosis as the time scale can enhance research reproducibility and clinical practice.
Highlights: Alzheimer's Disease Sequencing Project Phenotype Harmonization Consortium's harmonized composite cognitive measures from 13 cohort studies fitted with a novel double anchoring event-based sigmoidal mixed model reveal the following temporal order of cognitive decline toward AD progression: memory, language, and executive function. If only investigated using individual cohort studies, the temporal order of cognitive decline would vary due to the underlying heterogeneities across studies. This temporal order generally persisted within each subgroup of apolipoprotein E ε4 carrier status, sex, and race/ethnicity
Preserved Subcutaneous Implantable Cardioverter-defibrillator Function Following Septal Myectomy and Coronary Artery Unroofing in a Pediatric Patient with Severe Hypertrophic Cardiomyopathy
No full textHypertrophic cardiomyopathy (HCM) is an inherited disease present in 1 in 500 individuals and is the most common cause of sudden cardiac death in children. We present the case of a 17-year-old boy with HCM and a primary prevention subcutaneous implantable cardioverter-defibrillator (S-ICD) who developed left ventricular outflow tract obstruction and a myocardial bridge of the left anterior descending coronary artery. The patient underwent a septal myectomy/myotomy and muscular bridge unroofing. The S-ICD system was undisturbed during the surgery, with no loss of function. Septal myectomy may be accomplished in pediatric HCM patients following optimal S-ICD placement with maintained S-ICD function
Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes With the United States General Population
No full textDay-to-Day Activity Avoidance in the Context of Urinary and Fecal Incontinence: Preliminary Results from Young Adults with Spina Bifida in an Ecological Momentary Assessment Study
No full textBackground: Studies suggest that young adults with spina bifida (YASB) often avoid important daily activities (ADL) due to urinary (UI) and fecal (FI) incontinence, but no research has prospectively examined how often ADL avoidance occurs, or the context in which it occurs. We used ecological momentary assessment (EMA) over 30 days to describe the frequency of avoidance, the activities YASB most commonly avoid, and the preliminary association of daily avoidance with affect, incontinence anxiety and health-related quality of life (HRQoL).
Method: We analyzed a subsample of YASB participants (18 - 27 years; N=23 of total 88 participants) who completed a larger 30-day prospective EMA study examining the daily prevalence and context of UI and FI in adults with SB. Participants completed an end-of-day EMA tracking daily ADL avoidance on days when they were worried about possible UI or FI and on days when the had actual UI or FI. Additional day-level measures were affect and incontinence anxiety. HRQoL was reported in beginning- and end-of-study surveys.
Results: YASB contributed 643 total EMAs; 57.5% had any incontinence. ADL avoidance was most frequent with actual FI (20.5%) and least frequent with worry about FI (3.5%, p=0.02) (UI worry: 8.3; actual UI: 8.9%, p=0.546). The most common basic ADL avoided were eating, drinking and spending time with family/friends. Negative mood and incontinence anxiety were significantly higher on days with all types of avoidance. Higher baseline HRQoL was associated with fewer in-study ADLs avoided, which were in turn associated with higher end-of-study HRQoL.
Discussion: YASB avoid key activities of daily living (e.g., eating, drinking, seeing family/friends) both when they worry about possible incontinence that may but does not occur, and when they experience actual incontinence. In other words, a dry day is not a day free of the negative effects of incontinence. ADL avoidance patterns vary between UI and FI. Tailored interventions addressing actual incontinence and worry about possible incontinence incorporating daily mood or incontinence anxiety can potentially minimize ADL avoidance and its impact on long-term HRQoL
Exploring the Lived Experiences of Social Workers in Juvenile Justice Settings: A Hermeneutic Phenomenological Inquiry Grounded in Ricoeur's Interpretive Framework
No full textIUISocial work and juvenile justice play critical roles in supporting a shared vulnerable youth population between the ages of 13 and 18. Despite their shared focus, these fields continue to exhibit marked differences. The primary objective of the juvenile justice system is to administer justice and prevent youth from engaging in criminal behavior that may persist into adulthood. In contrast, social work is grounded in a holistic approach that emphasizes individuals' overall well-being and empowerment. Despite the critical role social workers play as practitioners in juvenile justice settings, their lived experiences have remained underexplored. This hermeneutic phenomenological study aimed to comprehensively explore the lived experiences of social workers who practice in carceral and custodial host settings using Paul Ricoeur's Theory of Interpretation and the Vancouver School of Doing Phenomenology for data collection and analysis. Through in-depth interviews with eleven practitioners and a multi-layered analysis process, the study examined how social workers made meaning of their roles and navigated ethical tensions in environments that often prioritize punitive approaches to care. Findings illuminated six core themes: ethics and advocacy in host settings, emotional labor, gaps in training, mentorship and peer support, role strain, and boundary-setting. These insights highlight the complexity of social work within juvenile justice settings and underscore the importance of educational, institutional, and policy-level supports that sustain professional values and promote youth-centered, trauma-informed care. The study contributes to the limited literature on social work in juvenile justice settings, offering implications for practice, policy, and social work education, and calls for greater integration of frontline voices in systemic reform efforts.
Keywords: hermeneutic phenomenology, host settings, justice-involved youth, juvenile justice settings, Ricoeur, social workers, theory of interpretation, the Vancouver School of Doing Phenomenolog
Modulating mitochondria with natural extract compounds: from bench to clinical therapeutic opportunities for COPD
No full textChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that leads to death and disability worldwide, and it is caused by hereditary and environmental factors. It is characterized by chronic inflammation, emphysema, and irreversible limitation of airflow. Dual or triple therapy with a traditional approach can provide relief from COPD symptoms by reducing the frequency and severity of the outbreaks, but there are no current therapies to reverse the long-term decline in lung function. Although ICS rescue inhalers demonstrate efficacy in acute attacks, these cannot be utilized for chronic management of COPD due to adverse effects. Therefore, novel agents and therapeutic strategies are urgently needed to address this disease. It is believed that malfunctioning mitochondria are associated with COPD pathogenesis, contributing to inflammation, apoptosis, and cellular senescence. A better understanding of these mechanisms could provide novel therapeutic approaches for maintaining lung and skeletal muscle function. Many natural extract compounds show therapeutic potential for COPD and are associated with few adverse reactions. Notably, these natural compounds can improve mitochondrial function and exhibit a variety of anti-inflammatory, antioxidant, and immunomodulatory properties. In this review, we systemically summarize the pathogenic role of impaired mitochondria in COPD and the potential mechanisms by which natural extract compounds may ameliorate these impairments
No Kidney Left Behind: Rescuing Unused Donor Kidneys for Transplant at the First Centralized Assessment and Repair Center
No full textRescue of non-used kidneys may be facilitated using sub-normothermic acellular machine perfusion (SNAP), which can prolong safe preservation times and provide additional viability assessment. While blood-based normothermic machine perfusion (NMP) has been utilized internationally, barriers to adoption of NMP in the US include limited availability, staffing and facility resource limitations, geographic distances between donor and recipient hospitals, blood shortages, and reliance on hypothermic machine perfusion (HMP). To overcome obstacles to adoption, the first centralized kidney Assessment and Repair Center (ARC) was established in West Lafayette, Indiana. Organized as an independent public benefit company, this center was designed to provide sub-normothermic acellular perfusion (SNAP) and assessment services to rescue unused/hard-to-place (HTP) kidneys. An acellular, human serum albumin-based perfusate was chosen, and a second cold ischemic time (CIT) was validated during pre-clinical testing. Between April 2024- May 2025, 158 unused deceased donor kidneys were transported to the ARC, resulting in 142 transplants (90%) after SNAP assessment. SNAP is feasible when performed by a centralized ARC and reduces kidney discard rates by providing objective viability assessment data. Moreover, SNAP allows for extended preservation times of nearly 70 h, enabling improved logistical planning and broader sharing of deceased donor kidneys
Left ventricular deformation and tissue characteristics in hypertrophic cardiomyopathy patients with HFpEF: a CMR study
No full textPurpose: This study aimed to evaluate left ventricular (LV) deformation and tissue characteristics using cardiac magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF), to examine their associations with heart failure status, and to explore the correlations between CMR parameters and the H2FPEF score.
Methods: This retrospective study included 105 patients with HCM who underwent 3.0-T CMR. Participants were classified into HFpEF (n = 46) and non-HF (n = 59) groups according to the 2019 ESC HFA-PEFF algorithm. Global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and corresponding systolic and early-diastolic strain rates were derived using CMR feature tracking. Myocardial tissue characterization included native T1 and T2 mapping, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). Group differences were assessed with t-tests or chi-square tests. Associations between strain, tissue parameters, and the H2FPEF score were evaluated using Spearman correlations. Multivariable logistic regression was performed to identify independent CMR predictors of HFpEF.
Results: Compared with non-HF patients, those with HCM-HFpEF showed significantly reduced LV systolic and early-diastolic strain rates, including sGRSr (P = 0.010), sGCSr (P = 0.044), sGLSr (P = 0.018), and eGLSr (P = 0.006). They also demonstrated a higher prevalence and greater extent of LGE, as well as elevated native T1 and ECV values (all P < 0.05). Strain parameters correlated significantly with tissue characteristics (native T1 and mean ECV), except for GCS and ECV. In multivariable analysis, drinking, atrial fibrillation, lower LV-eGLSr, and higher ECV in segments with maximal wall thickness were independently associated with HCM-HFpEF. The H₂FPEF score showed weak but significantly correlations with native T1, ECV, and T2 values in both global and hypertrophied myocardial segments (r = 0.199-0.252, all P < 0.05).
Conclusions: HCM patients with HFpEF exhibit both systolic and diastolic dysfunction, accompanied by increased diffuse and focal fibrosis. Independent predictors of HFpEF include lower LV-eGLSr, higher segmental ECV, atrial fibrillation, and drinking. The H2FPEF score shows significant associations with tissue-level abnormalities, highlighting the complementary role of CMR-derived strain and tissue characterization in the early detection and risk stratification of HFpEF in HCM
Campus-wide examination of evidence synthesis publication output
No full textIntroduction: A team of three librarians and an MLIS student collaborated to examine evidence synthesis (ES) articles published by authors affiliated with a single university campus. The team established the null hypothesis that at Indiana University Indianapolis and Indiana University School of Medicine, ES projects are only published by authors affiliated with health sciences disciplines. Additionally, the team established a second null hypothesis that librarian co-authorship only occurs in ES publications by campus-affiliated authors in health sciences disciplines.
Methods: The librarians built a Scopus search strategy to capture ES articles with at least one author affiliated with IU Indianapolis. The search used the date range 2021 – 2025 to account for the publication of PRISMA-S in 2020. “Author affiliation and methods” screening was conducted independently by two reviewers in Covidence. Data extraction recorded whether publications included a librarian coauthor and identified the school within IU Indianapolis of each affiliated author. For authors within the School of Medicine, the affiliated department was also recorded.
Discussion: Next steps for the project include a second round of data extraction looking for search quality indicators in each article based on elements outlined in PRISMA-S and the general PRISMA guidelines. By examining ES projects conducted by authors affiliated with IU Indianapolis, the null hypotheses could be rejected if ES publications occurring outside of the health science disciplines are identified with librarian co-authors. Libraries on the IU Indianapolis can potentially use quantitative data on ES publications by campus-affiliated authors as evidence for hiring and training more librarians on systematic searching.
This presentation won the "Excellence in Research" award for papers at the Midwest Chapter of Medical Librarians Association 2025 Annual Conference