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Creating Program Culture Through Competition: How Multi-Disciplinary Design Teams Will Help to Birth a New Program
No full textThis paper will describe a new program in the Herron School of Art + Design on the Indiana University Indianapolis Campus as it ventures into developing an Interior Design Program with an emphasis on Energy Efficient and Evidence Based Design. With an internationally recognized rich history of People Centered Design practices, the department has proven to be a trailblazer, and now we will be building upon that with the integration of globally recognized design competitions as the basis for our program development & growth. Leaning on the experience of a faculty member new to the department, but not new to design competitions, this multi-disciplinary team & competition approach will serve as the introduction of AEI curriculum (architecture, engineering, & interior design) to the student body. In addition to the implementation of AEI, we will include expertise of People Centered Design, the cornerstone of the department, and introduce students to interior environments designed be to be both aesthetically pleasing and maximizes its energy efficiency and universal designed user-friendliness. Our new plan of study will give students a real-world experience of give and take amongst peers, project management, and design development. Incorporating the Building Information Modeling (BIM) approach, students will have developed the dynamic presentation imagery and needed construction documents to sell the concept. The assessment will allow us to utilize the data to help with the future course development, program growth, and long-term planning of the degree program. This will be a multi-year project, and this paper will focus on step one which is curriculum building, team development and the multi-disciplinary approach.
The Multidisciplinary Design approach has proven to be both challenging and rewarding in both industry and academia. Bringing together bright minds to attack a design problem functionally and systematically can evaluate the boundaries of all team members. “For some professionally, vocationally, or technically oriented careers, curricula delivered in higher education establishments may focus on teaching material related to a single discipline. By contrast, multidisciplinary, interdisciplinary, and transdisciplinary teaching (MITT) results in improved affective and cognitive learning and critical thinking, offering learners/students the opportunity to obtain a broad general knowledge base” Pooley, Alison and Wanigarathna, Nadeeshani
A Psychometric Evaluation of the Staff-Reported EOLD-CAD Measure among Nursing Home Residents with Cognitive Impairment
No full textObjectives: The End-of-Life Dementia-Comfort Assessment in Dying (EOLD-CAD) scale is one of the few outcome instruments designed to capture symptom burden and well-being among nursing home residents with dementia; however, psychometric evaluations of the EOLD-CAD are limited. Although the instrument is often used to assess outcomes prospectively, it was originally developed and tested as a postmortem assessment. The purpose of this study is to evaluate the instrument properties of the EOLD-CAD using staff reports from a large sample of nursing home residents with cognitive impairment prior to death.
Methods: Using data from the multi-state UPLIFT clinical trial, this study evaluated the psychometric properties of the EOLD-CAD from 168 nursing home staff members reporting outcomes for 611 living residents with moderate to severe cognitive impairment. Staff also reported on resident quality-of-life using two different single item measures. We conducted confirmatory factor analysis (CFA) and assessed construct validity, inter-item reliability, and observer report bias.
Results: CFA produced a four-factor solution. All factor loadings were > 0.40, ranging from 0.61-0.95 for Physical Distress, 0.71-0.91 for Dying Symptoms, 0.61-0.78 for Emotional Distress, and 0.89-0.94 for Well-Being. Model indices suggest a good fit to the data with root mean square error of approximation (RMSEA) = 0.053 (95% CI = (0.044, 0.062)), comparative fit index (CFI) = 0.971, and standardized root mean square residual (SRMR) = 0.093, with the SRMR slightly above the conventional threshold of > 0.08. Based on intraclass correlation coefficients (ICC), patterns of observer reports were identified among staff who provided data for multiple residents. ICCs were notably high (> 0.60) for Well-Being items. The EOLD-CAD elicited a Cronbach's alpha of 0.73, and the instrument was negatively correlated with items measuring resident quality of life.
Conclusions: We found that when the EOLD-CAD was completed by nursing home staff familiar with the respective residents, observer-based patterns were detectable. Such patterns were adjusted for in our CFA, from we found that the EOLD-CAD exhibited multidimensionality with a four-factor structure capturing: Physical Distress, Emotional Distress, Dying Symptoms, and Well-Being. In addition to the CFA, the EOLD-CAD demonstrated generally valid and reliable psychometric properties in our population of long-stay nursing home residents with moderate to severe cognitive impairment
Racial disparities in hydrocephalus mortality and shunt revision: a study from the Hydrocephalus Clinical Research Network
No full textObjective: Several studies of administrative data have noted higher mortality rates for Black/African American children with shunted hydrocephalus. A longitudinal study of children with hydrocephalus secondary to myelomeningocele showed lower lifetime rates of shunt revision in minority children compared to White children, indicating a possible disparity in hydrocephalus treatment. The goal of this study is to identify racial and ethnic disparities in mortality or in shunt revision rates by using the Hydrocephalus Clinical Research Network (HCRN) hydrocephalus registry sample.
Methods: The HCRN registry was queried for patients with shunted hydrocephalus for whom data on all lifetime hydrocephalus procedures were available. Patients with a primary shunt placement prior to 2023 were included, with follow-up extending through March 19, 2024. A Cox proportional hazards model was created to determine the effect of race and ethnicity on mortality while controlling for age at initial shunt placement, sex, hydrocephalus etiology, gestational age at birth, and presence of complex chronic conditions. Similarly, a proportional means model was used to evaluate association with lifetime number of shunt revision surgeries. The authors' hypothesis was that when controlling for other variables, minority children would have higher mortality and fewer shunt revision surgeries than White children.
Results: A total of 5656 children were included in the analysis of mortality. There were 579 deaths. Race and ethnicity were independently associated with mortality, with Black (HR 1.32, 95% CI 1.05-1.65), other non-White (HR 1.39, 95% CI 1.03-1.86), and Hispanic (HR 1.50, 95% CI 1.22-1.84) children having a higher mortality rate than White children. In the analysis of 4081 children with shunts, Hispanic ethnicity was also independently associated with fewer total shunt revisions (HR 0.84, 95% CI 0.72-0.98).
Conclusions: In children with hydrocephalus, when controlling for other factors, there is a higher mortality rate among Hispanic, Black, and other non-White children, and fewer shunt revisions among Hispanic children. These findings highlight important potential disparities in hydrocephalus treatment
The role for artificial intelligence in identifying combination therapies for Alzheimer’s disease
No full textDespite substantial investment in biomedical and pharmaceutical research over the past two decades, the global prevalence of Alzheimer's disease (AD) and AD-related dementias (AD/ADRD) is still rising. This underscores the significant unmet need for identifying effective disease-modifying therapies. Here, we provide a critical perspective on the application of data science and artificial intelligence (AI) to the rational design of drug combinations in AD and ADRD, addressing their potential to transform therapeutic development. We examine AI's current and prospective capabilities in therapeutic discovery, identify areas where AI-driven strategies can enhance drug combination development, and outline how multidisciplinary professionals in the field, including clinical trialists, neuropsychiatrists, pharmacologists, medicinal chemists, and computational scientists, can leverage these tools to address therapeutic gaps. We also highlight AI's role in synthesizing the rapidly growing amount of biomedical data in the field of AD/ADRD, especially clinical trials, biomarkers, multi-omics data (genomics, transcriptomics, proteomics, metabolomics, interactomics, and radiomics), and real-world patient data. We further explore AI's utility in prioritizing potential drug combination regimens and estimating clinical effect size in combination therapy trials for AD/ADRD. Lastly, we emphasize AI-powered network medicine methodologies for prioritizing drug combinations targeting AD/ADRD co-pathologies and summarize the challenges of their translation to clinical practice
The effects of socioeconomic status on perceived self‐efficacy among caregivers of persons with Alzheimer's disease and related dementias
No full textBackground:
Among ADRD caregivers, self‐efficacy, defined as a “person's belief about their ability to organize and execute courses of action to manage given situations,” is associated with reduced caregiver burden. Socioeconomic status (SES) has been associated with health outcomes, but little is known about how it impacts self‐efficacy in this population. The current aim is to study this association across three self‐efficacy domains: 1) obtaining respite, 2) responding to disruptive patient behaviors (RDPB), and 3) controlling upsetting thoughts (CUT).
Methods:
Baseline data among a sample of caregivers (n = 144) were examined. An ANCOVA was conducted with SES (race, education level, household income, employment, and insurance status) as independent variables and scores from the three domains measured by the Revised Scale for Caregiving Self‐Efficacy, as dependent variables.
Results:
There were no significant differences in self‐efficacy related to obtaining respite and RDPB between SES groups. There were significant differences in the CUT domain scores between household income (F=4.615, p < .05) and insurance status groups (F=3.432, p < .01). Pairwise comparisons revealed that individuals with private health insurance or Medicaid reported higher self‐efficacy in RDPB when compared to individuals covered by Medicare and another insurance type (e.g. Medicare Advantage) (p < .01; p < .05). Individuals with graduate degrees had significantly higher RDPB scores when compared to those with trade school/some college/associates degrees (p < .05). In the CUT domain, full time employees reported higher self‐efficacy than those who were unemployed (p < .05), and Medicaid recipients scored significantly higher than individuals with private insurance (p < .05), Medicare+ (p < .05) or other insurance (p < .01).
Conclusion:
It is important to consider SES when designing interventions for ADRD caregivers. Our results indicate that insurance status, educational level, and employment status may be related to self‐efficacy among ADRD caregivers, specifically regarding responses to disruptive behaviors and controlling upsetting thoughts. For example, those with private insurance and Medicaid may have access to more resources that teach them to cope and manage disruptive behaviors. Education level may also be related to factors that can increase self‐efficacy such as understanding ADRD symptoms and how to manage them. Future studies should examine mediating factors and examine differences among a larger sample
Vitamin C supplementation to pregnant smokers alters asthma- and allergy-associated CpGs in child buccal DNA at 5 years of age
No full textBackground: We previously reported improved respiratory outcomes in babies born to pregnant smokers supplemented with vitamin C (500 mg/day) versus placebo in a randomized clinical trial. Improved respiratory outcomes persisted to 5 years of age and were associated with buccal DNA methylation (DNAm) measured using the InfiniumMethylationEPIC array. The objective of this study was to examine associations of vitamin C treatment and lung function with buccal DNAm using a custom-content Asthma&Allergy array enriched for asthma and allergy loci likely to have a functional impact on gene expression.
Results: We profiled DNAm at 36,999 CpGs in loci previously associated with asthma or allergic diseases using custom-content Asthma&Allergy arrays in 137 subjects (65 placebo; 72 vitamin C) with pulmonary function testing (PFT) at the 5-year visit in the "Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function" (VCSIP) double-blind, placebo-controlled randomized clinical trial. We examined the association of buccal DNAm with (1) vitamin C treatment vs placebo, (2) forced expiratory flow between 25 and 75% of expired volume (FEF25-75) and (3) wheeze at 4-6 years of age. We identified 9 genome-wide differentially methylated CpGs (DMCs; FDR < 0.05) and 2 differentially methylated regions (DMRs) between vitamin C and placebo subjects and one CpG associated with FEF25-75 at FDR significance. DNAm at 5 CpGs mediated a significant proportion of the vitamin C treatment effect on lung function, including 2 CpGs annotated to the SLC25A37 gene involved in mitochondrial iron transport.
Conclusions: Our study revealed association of in utero vitamin C supplementation and childhood lung function with DNAm at novel loci, providing additional insight toward potential mechanisms for the persistent effects of vitamin C supplementation to pregnant smokers
Postpandemic Trends and Missed Opportunities in Prevention and Diagnosis of Pediatric HIV
No full textBackground: Progress against HIV in the US slowed during the COVID-19 pandemic. Associated impacts for pediatric HIV may be substantial amid pandemic-related exacerbations of health inequities. We assessed pre-/post-pandemic trends in pediatric HIV diagnoses and characterized gaps in prevention or diagnosis.
Methods: We performed a retrospective cohort study of children and adolescents with HIV (CAHIV) <18 years of age, treated at Indiana University Health facilities from January 2009 to December 2023. Demographic data, acquisition route, risk factor(s) and diagnosis year were abstracted, and compared pre-/post-2020. To assess trends, an interrupted time series analysis was conducted using an autoregressive integrated moving average model. Postpandemic missed opportunities for prevention or diagnosis were categorized.
Results: Among 126 CAHIV, with perinatal (73%) or nonperinatal (27%) HIV, 104 were diagnosed pre-2020 and 22 were diagnosed 2020 onwards. HIV diagnosis post-2020 was associated with nonperinatal acquisition ( P < 0.001), older age ( P = 0.004), US birth ( P = 0.002) and US diagnosis ( P < 0.001). Nonperinatal diagnoses in 2022 (n = 6) and 2023 (n = 5) were significantly higher than 1.6/year prepandemic (95% prediction interval 0-3.6). Among 8 CAHIV with perinatal HIV diagnosed post-2020-4 US-born-missed opportunities occurred across the mother-infant/pediatric care cascades. Among 14 CAHIV with nonperinatal HIV diagnosed post-2020, there were missed opportunities for preexposure prophylaxis (79%) and for HIV testing (65%) despite documented risk factors and indications.
Conclusions and relevance: Nonperinatal HIV diagnoses increased post-2020, with gaps in adolescent prevention and diagnosis. Perinatal diagnoses in US-born infants signal critical gaps in perinatal prevention. Dedicated efforts are needed to prevent new pediatric HIV in the US
Thyroid Storm in the Shadows of Multiple Endocrine Neoplasia (Men) 2A: A Case of Overlapping Endocrine Emergencies
No full textThyroid storm is observed in patients with untreated Graves' disease, typically triggered by stressors such as acute illness or recent surgery. This case presents a female with acute metabolic encephalopathy initially attributed to drug overdose and septic shock, later diagnosed with thyroid storm. Despite clinical stabilisation, the patient developed resistant hypertension and elevated metanephrine levels, raising suspicion for phaeochromocytoma and potential multiple endocrine neoplasia (MEN) 2A. This case highlights the importance of considering syndromic and autoimmune associations in complex endocrine presentations.
Learning points: Thyroid storm should be considered when there is a rising temperature and increasing agitation despite appropriate treatment.If hypertension persists after the fever of thyroid storm was managed with propylthiouracil and iodine an additional diagnosis, such as phaeochromocytoma, should be considered.We found no published reports on MEDLINE linking Graves' disease or thyroid storm with MEN 2A to help guide our management