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Investigating the Associations Between the Perivascular Space, Age, and Cognitive Function in Cognitively Normal and Impaired Individuals
Get PDFBackground and Hypothesis: Perivascular spaces (PVS) are a component of the glymphatic system, which is believed to help remove waste products from the brain. Dilated PVS have been correlated with normal aging and neurological conditions. In this study, we sought to evaluate the associations between age, PVS volume, and Montreal Cognitive Assessment (MoCA) score in cognitively normal participants (CN), as well as those with subjective cognitive decline (SCD), and mild cognitive impairment (MCI). We hypothesize that greater PVS volumes will be associated with lower MoCA scores.
Methods: PVS delineation was conducted on MRI images of participants from the Indiana Alzheimer’s Disease Research Center (ages 62-89; with 9 CN, 5 SCD, 1 MCI). For image processing, the enhanced PVS contrast (EPC) was calculated by dividing T1-weighted images by T2-weighted images, followed by Frangi filter to capture the vessel-like PVS structure. Three blinded reviewers used the imaging software FSLeyes to analyze EPC and FLAIR images to correct the mask. Partial correlation was applied to PVS volume normalized to total brain volume and MoCA scores while controlling for age.
Results: A partial correlation between MoCA score and PVS volume was -0.24 (p=0.40) after controlling for age. The sample sizes were not sufficient to investigate if these correlations varied among the different research groups.
Scientific Implications: Our analysis suggests that enlarged PVS volume might contribute to decline in cognitive function, however, further work is needed to provide more insights to the pathologic alterations of PVS in individuals with cognitive complaints or impairment
A Prospective Study of the Impact of Levonorgestrel Intrauterine Devices on Sexual and Bladder Health
Get PDFBackground/Objective: Intrauterine devices (IUDs) are highly effective and safe methods of contraception, but concerns grow over their impact on women’s bladder and sexual health. Oral contraceptives (OCPs) have been found to decrease androgen levels in women and can cause bladder dysfunction. Due to the local effects of progesterone from the IUD near the bladder, it is reasonable to propose that similar bladder dysfunction seen in women taking OCPs may be experienced by women with levonorgestrel-IUD (Lng-IUDs). When it comes to women’s sexual health, the literature is mixed on the true side effect profile of IUDs.
Methods: Using a prospective study design, women aged 18-45 from gynecologic centers at Indiana University opting for a Lng-IUD were recruited. Women within 6 months postpartum, still breastfeeding, or undergoing IUD replacement were excluded. Participants completed standardized REDCap questionnaires pre-placement and at 3- and 6- months post placement to assess sexual function and lower urinary tract symptoms using Female Sexual Function Index and Urinary Distress Inventory, Short Form.
Results: 11 participants have been recruited and filled out baseline surveys thus far: 81.8% with Mirena placed and 18.2% with Kyleena. Indications for Lng-IUD placement included contraception, irregular or painful meses, menorrhagia, or abnormal bleeding. 50% reported no frequent urination, and 20% no pain or discomfort with urination. 9.1% reported being very satisfied with their overall sexual life over the past 4 weeks and 36.4% reported being moderately satisfied. Participants will continue to be recruited and will receive 3- and 6- month post-IUD questionnaires.
Conclusion: Few prospective studies in the United States explore the side effect profile of IUDs on sexual health, and international data are inconsistent. In addition, no studies investigate the impact of IUDs on bladder dysfunction. Going forward, we will utilize patient surveys to help make informed reproductive decisions
Sociodemographic and Behavioral Determinants of Hospitalizations for Labor and Delivery Complications in an Urban Health System
Get PDFBackground: The United States (US) has the highest maternal mortality ratio (MMR) among high-income countries, with Indiana having the 3rd highest MMR in the US. For every maternal death, 20 to 30 more experience life-threatening complications. Labor and delivery complications are key contributors to severe maternal morbidity and mortality, costing over $30 billion. Identifying and addressing underlying social determinants of health (SDOH) are high-impact strategies for improving maternal health outcomes. This study examined a comprehensive group of socio-demographic and behavioral determinants of hospitalization for labor and delivery complications in an urban health system in Northwest Indiana (NWI).
Methods: This retrospective study analyzed data generated from inpatient SDOH screenings in EPIC™ at an urban health system in NWI between January 2021 and April 2024, using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE). Complications of labor and delivery were determined using ICD-10 Codes. Data analysis utilized IBM SPSS V. 29.0 to produce descriptive statistics, bivariate analysis (Chi-Square, Mann-Whitney, Kruskal Wallis; p<0.05), and multivariate analysis (binary logistic regression; p<0.05).
Results: The sample consisted of 1444 patients who received labor and delivery services, 36.6% of whom experienced complications. Patients were predominantly non-White (54.6%) with a median age of 27. The bivariate analysis revealed statistically significant associations between labor and delivery complications and race (p<0.001), age (p<0.001), insurance type (p<0.001), family income (p=0.002), smoking (p<0.001), postpartum depression risk (p=0.006), co-morbidities (p<0.001), BMI (p<0.001), and hospital (p<0.001). The multivariate analysis found that age (OR=0.957; p<0.001) and former smoking (OR=0.652; p=0.007) remained significant.
Conclusion: Routine hospital-based SDOH screenings and referrals can help identify nonmedical risk and protective factors for complicated labor and delivery, which in turn informs multi-level strategies to improve maternal health outcomes. Future research will validate these findings and further explore SDOH in larger, more diverse samples. 
Assessing the Rainbow Gap: A Critical Analysis of LGBTQ+ Inclusivity in Social Work Research
Get PDFRecent developments in American political and social life pertaining to the lived experiences of LGBTQ+ people call for critical research examining the unjust systems perpetuating heteronormativity, heterosexism, homophobia, and transphobia. This study examines the extent to which mainstream social work research investigates the lived experiences of LGBTQ+ people as well as the systems that perpetuate oppression and discrimination pertaining to gender and sexuality. The researchers conducted a content analysis of three peer-reviewed top social work journals (N=854) to determine the prevalence of LGBTQ+ inclusive research. Findings revealed that only 2.3% (n=20) of articles consider the LGBTQ+ community or systems that perpetuate heterosexism, homophobia, and transphobia. Findings show that even fewer articles (n=6) apply a critical theoretical frame of queer theory to understand the lived experiences of LGBTQ+ people and even fewer examine gender and sexuality at the intersection of race (n=6, 0.7%). This article demonstrates a dearth of research pertaining to the lived experiences of LGBTQ+ people and calls for more intentional social work research as it relates to this population
Breaking the Wheel: The Role of Academia
Get PDFMinnesota Attorney General Keith Ellison provided remarks during a plenary session at the 2024 CUMU Annual Conference. The following essay is an abbreviated version of his plenary speech
The Regulatory Role of Folate Receptor Beta on Inflammasome Activation
Get PDFBackground and Hypothesis: Group B Streptococcus (GBS) causes intrauterine infection during pregnancy. The inflammatory response of macrophages at the maternal-fetal interface to GBS may contribute to host defense. The NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome regulates macrophage responses, activated by microbial patterns and danger signals, leading to caspase-1-driven release of proinflammatory cytokines like IL-1β and cleavage of gasdermin D (GasD), which induces pyroptotic cell death. Folate receptor beta (FRβ), encoded by the FOLR2 gene, is a GPI-anchored glycoprotein that is highly expressed by macrophages, but its function is unknown. We hypothesize that FRβ regulates NLRP3 activation.
Method of Study: The human monocytic cell line THP-1 was CRISPR/Cas9-modified to delete the FOLR2 gene (knock-out, KO) or mock-transfected for wild-type (WT) control cells. WT and FOLR2 KO macrophages were cultured in a physiologic amount of folate (25 nM) for 7d before being treated with phorbol 12-myristate 13-acetate (PMA) to induce macrophage differentiation. WT and FOLR2 KO macrophages were stimulated for 4h with either GBS or FSL-1 (toll-like receptor 2/6 agonist); or for 3h with lipopolysaccharide (LPS) + 30m ATP (LPS+ATP), or LPS + 30m Nigericin (LPS+Nig). Supernatants were analyzed for IL-1β, caspase-1, and cleaved GasD release by ELISA, while lysates were analyzed for IL-1β, caspase-1, and cleaved GasD by Western Blot.
Results: FRβ KO macrophages showed a reduced ability to secrete IL-1β after FSL-1 or LPS+Nig stimulation vs WT macrophages, which was not observed in the cellular lysate. Also observed was a significantly reduced ratio of cleaved GasD in FRβ KO macrophages stimulated with LPS+Nig compared to WT macrophages, not seen in the cell supernatant. There was not an observed significant difference between FRβ KO and WT macrophages in the amount of caspase-1 both inside and outside the cell. Both WT and FRβ KO macrophages were weakly, and equally, stimulated with GBS or LPS+ATP.
Conclusions: FRβ KO THP-1 cells exhibit a reduced NLRP3-dependent inflammatory response to stimulation, suggesting a proinflammatory regulatory role for FRβ in immune surveillance
Sexual Dimorphism in the Skeleton of Adult and Aged Mice with Alzheimer’s Disease-Related Mutations
Get PDFBackground and Hypothesis: Alzheimer’s disease (AD) is a progressive neurological disease characterized by gradual impairment in cognition and memory. Osteoporosis is another common degenerative disease in aging populations. Recent research has uncovered links between AD and bone biology, as well as potential sex-linked differences in disease progression, but the mechanisms behind this are yet to be fully understood. We hypothesize that at both 4 and 13 months of age, female mice with AD-related mutations will have more age-related adverse effects on bone microstructure and geometry than their male counterparts.
Project Methods: Male and female mice expressing humanized forms of AD-linked mutations (Swedish/Artic/Austrian) in the Amyloid Precursor Protein (APP-SAA) were raised until either 4 or 13 months of age to accelerate plaque formation. Dxa/Piximus data was collected for body weight, total bone mineral density (BMD), femur BMD, and spine BMD for both age groups and sexes. Trabecular bone from distal femora and cortical bone from femoral mid-diaphyses were then analyzed by μCT. Sexes were analyzed separately by 2-way ANOVA (Tukey’s post-hoc multiple comparisons) or unpaired t-test.
Results: Our results show that among mice with AD-related mutations, female sex is associated with more pronounced age-related effects on bone. Both sexes displayed increases in tissue and marrow area, point of maximal inertia, and tissue mineral density, but females showed a more detrimental effect with age. The deleterious effects of age were more apparent in trabecular bone than cortical, with female APP-SAA mice also displaying significantly lower BV/TV, Tb.N., Tb.Th., and higher Tb.Sp. than male APP-SAA mice at both ages.
Conclusion and Potential Impact: AD and osteoporosis are prevalent and debilitating diseases affecting millions of patients throughout the United States. The results from this study will help to understand the relationship between them and identify potential interactions between sex and disease progression
From Birth to Practice: An Analysis of Migration Patterns Among U.S. Orthopaedic Surgeons
Get PDFPurpose: The purpose of this study is to understand the geographic migration of orthopaedic surgeons from birth, through training, to final practice location, and determine what predicts where orthopaedic surgeons practice.
Methods:This retrospective observational study analyzed data gathered by the American Medical Association (AMA) on 8,676 orthopaedic surgeons who completed residency training between 2004 and 2017 and had over 5 years in practice. Data extracted included location of birth, medical school, residency, and final attending practice location as of January 1st, 2023. Relationships were determined using chi-squared analysis and logistic regression.
Results: Residency location was the most predictive of attending location, with 96.52% of residents from 2008 – 2017 represented. Attending surgeons located where they completed residency training was census division (CD) dependent and ranged from 16.37% (Mountain West) to 71.59% (Middle Atlantic Northeast) with an average of 49.34%. Significant associations (p<0.00001) were observed between attending location and birth, medical school, and residency locations for all CDs. Heatmapping of ACGME data showcased that residency allocation across the US is not predicated by the population of the given state.
Conclusion: This study suggests that birth and training location are highly predictive of where orthopaedic surgeons will practice in the United States. These relationships are stronger in some areas of the country than others. Residency location was most predictive of practice location, and therefore, the geographic allocation of residency positions is likely to influence the distribution of practicing orthopaedic surgeons. Residency allocation and retention is highly variable across the United States, further impacting the distribution. This information should guide decision makers in graduate medical education to ensure that future expansion and/or reallocation of orthopaedic residency positions serves population needs and provides equitable access to orthopaedic care in the United States
Making Time for Research (and You): Using an “Intentionality Toolkit” to Achieve Your Goals and Mitigate Feelings of Overwhelm
Get PDFIntroduction
Academic, professional, and personal life are a lot to balance, and there is always more work to do than there are hours in the day. The Bullet Journal Method, the Weekly Meeting, and the Semester Plan, which come together as an “intentionality toolkit,” are three practices to help prioritize competing interests, mitigate feelings of overwhelm, and practice saying “no.”
Experience
Each method hosts its own distinct benefits: the Bullet Journal Method offers a strategy for managing your day-to-day tasks, the Weekly Meeting provides short-term planning and the opportunity to practice saying “no” to requests, and the Semester Plan helps break down long-term goals into smaller, achievable tasks.
Discussion
An intentionality toolkit can help in numerous ways. This includes reducing cognitive load; improving prioritization practices; improving openness and flexibility; mitigating perfectionism; owning your time; and incorporating reflective practices into your workweek. This isn’t a perfect toolkit. It is a set of options that might be beneficial to librarians.
Takeaways
These three techniques create a toolkit to provide structure and personal accountability, specifically to achieve goals that traditionally have less oversight and accountability, like writing and research
Ethical Reflections on Career Outcome Data
Get PDFIn higher education’s competitive landscape, driven by rankings, enrollment targets, and demands for return on investment (ROI) of degrees, career outcomes data is seen as a panacea. However, ethical considerations are conspicuously absent from the myriad discussions on career outcomes data collection. Critical issues such as student privacy, data security, accuracy, reliability, and transparency persist. This paper explores the ethical dimensions of career outcomes data collection and reporting, examining current practices, identifying gaps, and proposing solutions that higher education institutions can adopt to enhance transparency, accountability, and public trust