Open Access Journals at IU Indianapolis
Not a member yet
23580 research outputs found
Sort by
Examining the Experienced Barriers to Seeking Mental Health Treatment Among Metropolitan Millennial Black Men
Get PDFThe increase in the prevalence of mental illness among Black millennials has led to more awareness and advocacy within the generation. However, Black millennial men are still utilizing counseling services at significantly lower rates than millennial Black women and men of other races. Consequently, this can lead to the increase of suicide completions and undiagnosed mental health issues among Black men who experience more severe and disabling symptoms of mental illness. Negative stigma associated with counseling is prevalent in the Black community, especially among Black men, and little attention has been given to research the barriers to treatment they experience. Based on past reported themes, Black Masculinity and Critical Race Theory are utilized as a multi-dimensional framework for this phenomenological study to provide in-depth information on the barriers to counseling experienced by metropolitan millennial Black men. Using Interpretive Phenomenological Analysis of the semi-structured interviews of this study, results indicated the following three themes as experienced barriers: Black Pride, Classical Masculinity, and Negative perceptions of mental health and counseling. Implications for improving advocacy efforts by mental health professional and advocates as well as future research are provided.  
Toward (Racial) Justice-in-the-Doing of Place-Based Community Engagement
Get PDFCommunity and campus partners benefit from place-based community engagement to enact a commitment to racial equity and community-driven decision making. Racial equity is paramount in place-based community engagement. However, very little attention has been given to the ways whiteness in the ideological foundations of higher education shapes the work lives of professionals, faculty, and the collaborations they form to address community issues. Thus, the commitment to racial equity will be no more than words without the necessary work toward the #relationshipgoal of disrupting hegemonic whiteness as a shaping force in community-university interactions. The purpose of this case study is to foreground the paradoxes of whiteness-at-work in an informal place-based community engagement collaboration between the Center for Public Life at Oklahoma State University-Tulsa and members of the historic Greenwood community in Tulsa, Oklahoma. The case study design reflected participatory action research; data sources included semi- and unstructured interviews, field notes from participant observation, artifacts and documents, researcher journals and participant reflections. Reading this case with an eye to whiteness-at-work underscores the necessity of acknowledging the power of the university to determine the culture of the partnership and taking necessary steps to disrupt the practices which serve to devalue local communities and their ways of being, knowing, and doing to address the issues they prioritize. Doing the internal, interpersonal, and institutional work to disrupt hegemonic whiteness is the justice-in-the-doing in place-based community engagement that may garner the racial equity to which we aspire
Experiential Extractivism in Service-Learning and Community Engagement: What We Take and What We Leave Behind
Get PDFExtractivism is so often characterized as resource extractivism – the exploitation of a community’s natural resources for economic gain. However, when we think about the relationships between community and university, there are many ways in which the university can take out of the community or benefit to an extent that extracts human, capital, and natural resources. I contend that some of the university-community engagement work that has been done in the last 20 years replicates colonial structures in ways that have harmed communities under the well-intentioned guise of service-learning, community-based learning, or “development.” Drawing on Du Bois (1947) and on Riofrancos’ (2020) work on colonialism and extractivism, this paper will explore the role of the university as both a transformer and oppressor through global learning. I will explore the promise and pitfalls for these engaged pedagogies, and propose pathways to avoiding unjust, extractive practices in the pursuit of learning and student development. I will end with recommendations for just, equitable, and critical community-based global learning and some promising examples
Leveraging University Capital and In-Kind Resources into Community Partnerships
Get PDFPublic universities with campuses positioned in urban, low-income neighborhoods have an opportunity and civic obligation to engage with the K-12 schools, non-profits, and community-based organizations who directly serve their community. However, the lack of centralization of our community-facing work and the need to institutionalize community engagement leave community-engaged administrators and scholars with limited budgets and without formal strategic plans that prioritize the commitment of university resources. This paper presents five types of capital that can be leveraged from universities as in-kind resources to create educational programing for youth from low-income communities. Findings highlight the planning and implementation of three out-of-school time (OST) educational partnership programs alternatively based within a community center, on campus, and in two public schools. A document review and deductive thematic analysis of archival data capturing the in-kind resources from the university during a six-year period found the following types of capital were leveraged: physical, financial, intellectual, human, and social. Findings reveal granular examples of what, where, and how to leverage in-kind campus resources to launch and sustain educational youth programming and the early renderings of a strategic model for establishing inter-organizational alliances with cross-campus units for mutually beneficial outcomes that come from institutionalizing community engagement
Factors Predictive of Surgical Success in Medial Rectus Resection/Advancement for Consecutive Exotropia
Get PDFBackground and Objective: Consecutive exotropia after unilateral or bilateral medial rectus recession is a common clinical problem. One surgical intervention to address the misalignment involves isolating and reattaching healthy muscle to the globe. The purpose of this study was determining factors indicative of surgical success in medial rectus resection and advancement with non-adjustable sutures for consecutive exotropia.
Methods: Through retrospective chart review, 118 patients were identified to have consecutive exotropia using billing codes from June 2016 to October 2020 at Indiana University Health. 60 of these patients who maintained adequate follow-up either underwent the above intervention (n = 49) or underwent resection only (n = 11). Exclusion criteria included lack of medial rectus procedure or poor postoperative documentation. Patient demographics and data were gathered, including preoperative and intraoperative measurements, final postoperative deviation, and whether additional surgeries were necessary. Chi-squared and two-sample t-tests were performed to analyze the effect of each parameter on surgical success, defined as distance deviation ≤ 10 prism diopters of esotropia or exotropia at final postoperative visit.
Results: Smaller total intraoperative adjustment–resection plus advancement–was significantly associated with surgical success (p = 0.044). Additionally, smaller preoperative deviations were significantly associated with patients who underwent unilateral surgery (p = 0.0093 near and 0.0021 distance).
Conclusion: Patients with smaller preoperative deviations tended to have better outcomes, and those patients tended to have unilateral surgery. It is unclear whether a smaller deviation might have led surgeons to select unilateral medial rectus surgery or if the smaller deviation itself is a predictor of success. Relatively limited time of follow-up is a limitation in this study, as there is well-documented postoperative drift of increasing exotropia over time. A larger cohort or randomized controlled trial may provide additional insight that could increase the percentage of successful outcomes with a single surgery
One Hundred Percent Tumor Necrosis is Associated with Survival in Ewing Sarcoma
Get PDFBackground and Objectives:Ewing sarcoma is a primary malignancy affecting both bone and soft tissue. Following preoperative chemotherapy and surgical resection, histologic response (tumor necrosis) is correlated with patient survival. The most prognostic cutoff for tumor necrosis continues to be debated. The objective of this study was to explore several cutoffs and determine their prognostic value in a contemporary cohort of Ewing sarcoma patients.
Methods:The National Cancer Database was used to identify 564 patients with osseous and soft tissue tumors in the Ewing sarcoma family from 2010 to 2015. All patients had documented preoperative chemotherapy, surgical resection, and vital status. Survival was stratified by tumor necrosis using Kaplan Meier analysis. 356 patients with osseous tumors were included in multivariate logistic and cox regression analyses to identify predictors of histologic response and survival, respectively.
Results:In a combined soft tissue and osseous tumor cohort, there was a significant difference (p = 0.01, log-rank test) in overall survival between patients with 100% necrosis and patients with less than 100% necrosis. This was observed over the 5-year study period. Other cutoffs were not statistically different. In patients with osseous tumors, less than 100% necrosis was negatively associated with survival (HR 3.48 [95% CI 1.19-10.13]; p< 0.05), with only skip metastasis having a stronger negative association (HR 4.31 [95% CI 1.22-15.29]; p< 0.05). Male sex (OR 0.50 [95% CI 0.28-0.90]; p<0.05), tumors located in the axial skeleton (OR 0.30 [95% CI 0.12- 0.77]; p<0.05), and positive surgical margins (OR 0.28 [95% CI 0.08-0.95]; p<0.05) were negatively associated with 100% necrosis.
Conclusion and Implications:A cutoff of 100% tumor necrosis was associated with improved survival in Ewing sarcoma. This association was strong relative to other commonly used prognostic factors in osseous cases and is a valuable tool to counsel patients and guide future clinical trials
Preliminary Assessment of Cognitive Changes in Pediatric Cancer Survivors After a Neurocognitive Intervention
Get PDFBackground: Pediatric patients with acute lymphoblastic leukemia (ALL) receive large doses of neurotoxic chemotherapy as part of their treatment. Though lifesaving, it can induce life-long issues. Cognitive deficits are one of the most common reported concerns in survivorship clinic among pediatric cancer survivors. One unique approach to improving deficits in cognitive functioning is The Mediated Learning Experience (MLE) developed by Reuven Feuerstein. MLE is based on neuronal plasticity. Findings from MLE studies have shown improvements in cognitive task performance, increases in daily functioning, and increased learning in patients with neurological impairment. However, MLE has never been administered to children or adolescent cancer survivors with cognitive deficits.
Methods: Survivors were recruited from the Survivor Clinic in IU North Hospital. Survivors were 10-16 years of age, English speaking, and reporting executive functioning issues in school. The intervention utilized was the MLE enrichment tool: Organization of Dots. Participants met with MLE certified mediators 30 – 40 minutes biweekly for 8 weeks. At 5 weeks, separate interviews were conducted with parents and participants to assess perceived changes in cognitive functions. These interviews asked participants to rate perceived changes on a Likert-type scale, which allowed for comparison of perceived changes reported by participants and parents.
Results: Four participants and their parents completed the 5-week interview. Preliminary results show participants and their parents perceive positive changes in the participants’ cognitive skills, new learning, motivation, transfer, metacognition, and active learning.
Conclusion/Potential Impact: Many pediatric cancer survivors experience cognitive deficits following their cancer treatment. There are limited options for these individuals for assistance in improving function, most of which are costly or difficult to access. The current study demonstrated that utilization of the MLE approach by Feuerstein can be a feasible option for filling the resource gap in neurocognitive rehabilitation
Biopsy or no biopsy? Risk of Malignancy in Thyroid Nodules Based on TI-RADS Criteria
Get PDFPurpose: To assess the risk of malignancy in thyroid nodules recommended for biopsy using the American College of Radiology (ACR) Thyroid Imaging Reporting & Data System (TIRADS).
Methods: We conducted a retrospective review of ultrasound (US) guided thyroid biopsies performed from 2018- 2023 at IU Health hospitals for nodules which were recommended for biopsy based on ACR TI-RADS criteria and compared with histopathology results. The research was conducted at University and Methodist Hospital radiology reading rooms.
Results: Of the total 210 thyroid nodules recommended for biopsy, only 8.57% of nodules biopsied were malignant. Positive malignancy rate for TR-3 was 10.2%, TR-4 was 7.1%, and TR-5 was 12.5%. TR-3 nodules less than 2.9 cm were all benign on histopathology. TR-4 nodules less than 1.5 cm were all benign on histopathology. TR-5 nodules were all benign on histopathology. The most common malignancy was papillary thyroid carcinoma.
Conclusion: ACR TI-RADS is currently the standard of care for guidelines and lexicon for radiologists for characterizing thyroid nodules. Our results demonstrate that all TR-3 nodules less than 2.9 cm were all benign and most of the TR-4 and TR-5 nodules biopsied were benign on histopathology. The lower biopsy rate for positive malignancy even for TR-4 and TR-5 nodules respectively raises the need for revision for existing TI-RADS criteria, as more nodules could be followed up with ultrasound rather than percutaneous biopsy, which will alleviate patient anxiety as well as decrease overall healthcare costs
Retrospective Analysis of Suicide Deaths in Allen County Indiana, 2013 – 2022
Get PDFSuicide rates at a national and state level have been on the rise over the past two decades. Patterns observed at the local level is less understood and underrepresented in research. Since local government can have a large impact on resource allocation in a community, revealing local suicide patterns could help facilitate targeted preventative efforts for at-risk populations. This study aims to analyze demographic patterns observed in Allen County suicides from 2013 –2022, focusing on age groups and education attainment. Data collection was completed on the 604 individuals who died by suicide in Allen County over the past decade. The collection process included documenting various demographics accessed through death certificates and coroner’s files. Within the county, suicide numbers increased over the decade. Results showed that males represented more than a 3:1 ratio of total suicides, a gunshot wound was the method of injury for 53% of all suicides, and decedents with a high school degree or less represented 62% of suicides within the population. These results echo what research has shown at the national level. Additionally, the 20-34 and the 35-54 age groups produced the greatest number of suicides consistently over the 10 years, and these suicides occurred most often in late spring and early summer. Within the 20-34 age group, individuals were more likely to commit suicide by gunshot wound (p = 0.000133). Decedents of minority ethnic and racial groups had lower education attainment compared to non-Hispanic (p = 0.000027) or white (p = 0.003314) individuals. This information could be provided to local schools with the hopes of implementing more targeted preventative measures for at-risk groups. Knowledge of suicide patterns in healthcare could lead to improved care for patients. Finally, public health entities can use these findings to adapt current health initiates to fit the needs of Allen County
Assessing the Self-Rating Scale Item as a Measure for Lactulose Adherence
Get PDFBackground/Objective:Hepatic encephalopathy (HE) is a defining complication of end-stage liver disease. The standard treatment is lactulose, but adherence is difficult due to complex dosing regimens and side effects. We adapted a single item self-reported adherence measure - the Self Rating Scale Item (SRSI) - for lactulose use and examined its relationship with clinical events, cognition, and quality of life.
Methods:We performed a cross-sectional study of patients with cirrhosis and HE seen at Indiana University Hospital 5/31/2023-7/14/2023. Clinical history and demographic information were collected through electronic health records and patient interviews. Patients provided the SRSI, which reflects their self-perceived ability to take lactulose, bowel movement frequency, perception of missing doses, and quality of life (PROMIS-29+2). Cognition was measured using the Animal Naming Test (ANT). The relationship between the SRSI and other measures was assessed.
Results:42 patients met eligibility criteria and enrolled. The median age was 59, and 55% were female. Patients were divided across SRSI categories: ≤good, very good, and excellent. Patients with better adherence were more likely to have ascites, but other demographics were similar between groups. Ascites was present in 43%, 64%, and 93% of ≤good, very good, and excellent categories, respectively. A higher SRSI score was associated with fewer missed doses and more days achieving bowel movement targets. 79% in the ≤good category skipped lactulose doses compared to 29% and 21% in very good and excellent groups. SRSI was not associated with HE-related hospitalizations or ANT. Higher SRSI was associated with improved sleep and cognitive function, with a trend towards decreased fatigue and pain.
Conclusion/Potential Impact:The SRSI is associated with other measures of lactulose adherence and quality of life and may be a promising tool to measure lactulose adherence. Adopting the SRSI may be a useful way to improve lactulose dosing, adherence, and health outcomes