Open Access Journals at IU Indianapolis
Not a member yet
23580 research outputs found
Sort by
Transformation in Blake; or the Huts of America:: The Structure for Land and Enslaved Labor in the South
Get PDFADHD and Sleep Disordered Breathing in the Pediatric Population – Comparing Real World Prevalence to Literature Estimates
Get PDFBackground/Objective: Literature has demonstrated a bidirectional relationship between attention-deficit hyperactivity disorder (ADHD) and sleep disordered breathing (SDB) in the pediatric population. SDB is a term used to describe a range of disorders that impact and interrupt ventilation patterns during sleep. ADHD and SDB have overlapping symptoms such as inattention, impulsivity, hyperactivity, cognitive impairments, and behavior problems. It is important to recognize SDB in children, as it has been associated with hypertension, cardiovascular disease, atrial fibrillation, growth failure, and negatively impacted school performance. Previous studies estimate a 25 to 57% incidence of SDB in children and adolescents diagnosed with ADHD. The primary goal of this study was to evaluate if the prevalence of SDB in children diagnosed with ADHD, as recorded in a national electronic medical record database, is consistent with previous studies.
Methods: Data was obtained from the IU School of Medicine-Evansville RWEdataLab (CRC/Sidus Insights) Psychiatry dataset, which contains de-identified records across the United States from 4.89 million patients with psychiatric diagnoses. Selection criteria included patients currently less than 20 years of age with both an ADHD diagnosis and a SDB diagnosis. Primary retrospective analysis compared patients with an ADHD diagnosis to patients with ADHD+SDB diagnoses.
Results: 68,259 patients < 20 years of age were diagnosed with ADHD. 1,959 patients also had a SDB diagnosis, indicating a prevalence of 2.87%. 72.79% of individuals with both diagnoses had ADHD as their first recorded diagnosis or had both ADHD and SDB diagnoses first recorded on the same date.
Conclusion and Potential Impact: Prevalence of SDB in children with ADHD was found to be substantially lower than estimated literature prevalence of 25 to 57%. Future research is necessary to identify if current practitioners are regularly screening for SDB in children with ADHD
Antifungal Therapy after Candida-Positive Bile Cultures: Impact on Patient Prognosis
Get PDFIntroduction: The detection of Candida species in bile cultures has been increasingly observed, raising concerns if this represents colonization or an active infection, referred as ‘Candida cholangitis’ or biliary candidiasis. The presence of Candida in bile was linked to poorer prognosis and potential progression to candidemia, however, the necessity of antifungal treatment remains unaddressed. This study aimed to evaluate the epidemiology of patients with Candida-positive bile cultures and the impact of initial antifungal therapy on patient outcomes.
Methods: A retrospective observational study was conducted involving 661 bile cultures from ERCPs performed between 2010 and 2016, of which 170 cultures (25.7%) from 151 patients showed Candida species growth. Patient charts were reviewed via Cerner EMR and the Indiana Health Information Exchange’s CareWeb, with death dates confirmed through the Database Registration of Indiana’s Vital Events (DRIVE). Data on patient demographics, medical history, ERCP details, and outcomes were catalogued and analyzed using REDCap, Excel, and GraphPad Prism.
Results: Over six years, 25.7% of bile cultures performed post-ERCP showed Candida species. Only 19.2% of these patients received antifungal therapy within seven days of the procedure. A chisquare test for homogeneity showed no significant differences in sex (p=0.09), race/ethnicity (0.26), comorbidities (p=0.47), or other factors between treatment groups. All patients started on antifungals within seven days were inpatient prior to ERCP (p<0.01), potentially indicating more severe prior comorbidities or more diligent monitoring of bile culture results prompting antifungal intervention. Despite antifungal intervention, differences in mortality within one year (p=0.89), recurrence of Candida cholangitis (p=0.96), development of invasive candidiasis (p=0.94), and rehospitalization rates (p=0.42) were not statistically significant between treated and untreated groups.
Discussion: Initial results suggest antifungal treatment does not significantly impact patient outcomes within one year. To enhance statistical power, the data sample will be expanded to include ERCP bile cultures from 2017-2023 prior to further manuscript submission or publication
Evaluating the Prognostic Value of Fetal Magnetic Resonance Imaging Measures on Postnatal Pulmonary Outcomes in the Setting of Omphalocele
Get PDFBackground/Objective: Omphalocele is a disorder of fetal abdominal development with increased risk for respiratory complications after birth secondary to pulmonary hypoplasia. While fetal magnetic resonance imaging (MRI) derived observed-to-expected total fetal lung volume (O/E-TFLV) has been established as an effective measure for prognosticating outcomes in other congenital disorders, it is not well understood whether this measure or others applies to patients with omphalocele. This study aims to assess the ability of fetal MRI measures to predict lung-related morbidity and perinatal outcomes in fetuses with omphalocele.
Methods: A retrospective review of fetal MRIs from 2016 to 2024 was performed, identifying 36 patients at 20-34 weeks gestation with omphalocele which were confirmed at birth. Omphalocele defect volume and MRI-derived fetal lung volumes, including O/E-NFLV and lung volume to head circumference ratio (LVHC), were compared with postnatal outcomes. A Mann-Whitney U test was used to evaluate the predictive value of each measure, along with a stepwise regression model for the outcomes of survival, intubation, and discharge with oxygen support.
Results: Both O/E-NFLV and LVHC measures predicted mortality, need for intubation, discharge with oxygen support, and tracheostomy placement with statistical significance (p<0.05). LVHC was the best predictor for mortality and discharge with oxygen support, with a LVHC < 0.067 (AUC 0.905) predicting mortality and LVHC < 0.116 (AUC 0.828) predicting need for oxygen at discharge. A percent extra-abdominal liver greater than 29.32% (AUC 0.803) was the best predictor for intubation.
Conclusion: This study demonstrated O/E-NFLV and LVHC as effective measures for prognosticating survival and need for postnatal respiratory support in the setting of omphalocele. With this information, fetal MRI can be used to improve the preparation of families and medical teams for necessary postnatal care
The Impact of Social Demographics, Disease Activity, and Organ Damage on Time to Diagnosis in Pediatric Systemic Lupus Erythematosus
Get PDFBackground/Objective: Pediatric Systemic Lupus Erythematosus (pSLE) is a systemic autoimmune disease with variable clinical presentation. Untreated SLE can cause significant impairment, making early recognition and diagnosis critical in preventing irreversible organ damage. This study aims to understand the relationship between sociodemographic factors, disease activity at diagnosis, and time to diagnosis.
Methods: A retrospective chart review of 156 pSLE patients evaluated by the Department of Pediatric Rheumatology at Riley Hospital for Children between 2017 and 2023 examined various sociodemographic and disease-related variables: race, ethnicity, preferred language, sex, insurance type, Area of Deprivation Index, disease activity (SLEDAI-2K score), and cumulative organ damage (SLICC/ACR Damage Index). SLEDAI-2K scores were calculated for 132 (84.6%) of the patient cohort. Time to diagnosis was calculated in weeks from symptom onset to diagnosis. Multiple regressions analysis was conducted using time to diagnosis as the dependent variable and social demographic variables as predictors. Data was collected with REDCap and analyzed with IBM SPSS Statistics (Version 28).
Results: No significant correlation was found between time to diagnosis and: age at diagnosis, type of insurance, ethnicity, preferred language, state ADI decile, sex, or SLICC/ACR Damage Index. There was a significant correlation between time to diagnosis and SLEDAI-2K disease activity score calculated at time of diagnosis (Pearson Correlation= -0.245, p<0.005).
Conclusion: The study showed no significant correlation between time to diagnosis and several sociodemographic variables. These findings suggest that pSLE patients from racial and ethnic minority groups and those with public insurance may have equitable access to care compared to non-minoritized groups and those with private insurance in Indiana. Additionally, the study did show a significant negative correlation between time to diagnosis and disease activity. Future work can include strategies to find and diagnose low-disease activity patients earlier
Trauma-Informed Approaches to Support Victim-Survivors of Elder Financial Exploitation
Get PDFElder financial exploitation, which includes scams, fraud, and financial abuse, is a growing elder justice issue that affects the health, financial security, and emotional well-being of older adults. Social workers play a critical role in elder financial exploitation prevention, detection, and response, including helping victim-survivors heal from the traumatic loss of trust, feelings of shame, and financial loss. In this article, we summarize research on the social and emotional costs of elder financial victimization and advocate for person-centered and trauma-informed interventions. We highlight research on trauma-informed interventions used to treat older adult victim-survivors in other contexts and communities such as domestic violence, older combat veterans, and older adults with other forms of past trauma. We describe how social workers can improve the lives of elder financial exploitation victim-survivors using trauma-informed psychotherapy, peer support groups, community engagement, care coordination, and advocacy within financial institutions and justice systems. This paper also showcases recent innovations in person-centered and trauma-informed care for elder mistreatment and offers recommendations for further research on and greater access to trauma-informed services
Substance Use Disorder is a Disease, But Not Everyone Who Has a Substance Use Disorder Has the Disease
Get PDFSocial workers commonly work with individuals, families, groups, and communities to support substance use disorder recovery. Substance use disorder is prevalent in many social work settings, including child welfare, criminal justice, healthcare, policy advocacy, and, of course, clinical social work. Therefore, schools of social work and students must be prepared to treat substance use disorder through multiple avenues using contemporary science to guide practice. This conceptual article supports the work of social work educators and student learning by highlighting the key symptoms of substance use disorder as a brain disease and emphasizing that not everyone who has a substance use disorder also has the brain disease. Additionally, guidance is provided on when social workers should recommend abstinence or harm reduction as the recovery goal in clinical treatment planning. Examples of abstinence and harm reduction clinical treatment plans are provided, and schools of social work can incorporate these examples into their curricula, which is especially important for schools that offer concentrations in substance use and mental health disorder treatment. The article ends with implications for social work and suggestions for future research to advance the evolving science of substance use disorder recovery
Implementing Trauma-Informed Care in Higher Education: Bridging Research to the Classroom
No full textThis paper builds upon insights from the workshop, “From Campus to Community: Implementing Trauma-Informed Care in Higher Education,” presented at the 2024 Coalition of Urban and Metropolitan Universities (CUMU) conference. The workshop introduced participants to trauma-informed care principles and their application in higher education, forming the foundation of the framework explored in this manuscript. Grounded in SAMHSA’s Six Guiding Principles, this paper synthesizes relevant research, highlights actionable strategies, and offers practical applications to bridge theory and practice. The discussion emphasizes the importance of creating supportive classroom environments through techniques such as consistent routines, peer support, and culturally responsive teaching. Faculty development programs, including the Trauma-Informed Higher Education Certification, are presented as tools to equip educators with the skills to implement these practices effectively while advocating for systemic institutional changes. The role of institutional leadership, particularly the emergence of Chief Wellbeing Officers, is examined as a key factor in embedding trauma-informed care into policies and organizational culture. Additionally, the paper highlights the connection between trauma-informed approaches and community engagement, demonstrating how initiatives align with regional well-being and equity goals. By integrating these practices, the manuscript underscores the transformative potential of trauma-informed care to foster resilience, inclusivity, and academic success. It concludes by calling for continued research and strategic implementation to create supportive environments where all members of the academic community can thrive
Beyond Boundaries: Advancing the Urban Mission Through Innovation, Equity, and Community Partnership
Get PDFIn October 2024, scholars, practitioners, institutional leaders, and community partners converged in Minneapolis for the 29th annual conference of the Coalition of Urban and Metropolitan Universities (CUMU). A diverse and vibrant metropolitan area with a long history of civic innovation, collaboration across sectors, and community engagement, the Minneapolis-St. Paul area delivered a fitting context for the meeting. The Twin Cities region, like most urban settings, is grappling with important issues about racial equity, economic disparity, public safety, and other issues relevant to CUMU’s mission and the work of urban and metropolitan universities across the nation