Open Access Journals at IU Indianapolis
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Relationship between Perivascular Space Burden, White Matter Hyperintensities, and Cognitive Function
Full text linkIntroduction: Perivascular space (PVS) is believed to be involved in clearing metabolic waste from the brain. PVS has been found to increase in size in patients with Alzheimer’s disease, but the relationship between PVS enlargement and cognitive function still requires further investigation. This study seeks to clarify the relationship between Montreal Cognitive Assessment (MoCA) scores and the percentage of brain volume occupied by perivascular space. We take into account confounding factors such as white matter hyperintensities (WMH), a biomarker associated with cognitive decline. We hypothesize that PVS enlargement leads to decreased brain waste clearing efficiency, which subsequently leads to cognitive impairment.
Methods: The included participants (n = 15, ages 62 to 89, female: n = 9) were recruited for the 3YWU study from the Indiana Alzheimer\u27s Disease Research Center. The sample included the control group (n = 9) and patients with mild cognitive impairment (n = 1) and subjective cognitive decline (n = 5). For imaging processing, the enhanced PVS contrast (EPC) was calculated by dividing T1-weighted images by T2-weighted images, followed by applying the Frangi filter to capture the vessel-like PVS structure. Three trained and blinded reviewers then further manually improved the PVS masks. For the analysis, we calculated the correlation coefficients between the Montreal Cognitive Assessment (MoCA) scores and normalized PVS volume, as well as a partial correlation coefficient while controlling for the normalized WMH volume.
Results. We found a negative association between the PVS volume and MoCA scores of -0.28 (p=0.31), and after controlling for WMH, we still observed a negative correlation of -0.34 (pvalue of 0.23).
Conclusion. Our results suggest that PVS enlargement is a possible factor in cognitive impairment. However, further investigation is necessary to characterize these correlations
Addition of Misoprostol to Double-Balloon Catheter for Cervical Ripening Associated with Improved Obstetric Outcomes
Full text linkIntroduction: If induction of labor (IOL) is indicated but the cervix is deemed unfavorable, cervical ripening agents like mechanical dilators and synthetic prostaglandin E1 medications can be used. The objective of this study was to compare labor outcomes of women who underwent cervical ripening with a double-balloon catheter alone or with the addition of concurrent misoprostol. We hypothesized that concomitant use of misoprostol and cervical ripening balloon (CRB) was associated with increased vaginal delivery rates compared to CRB use alone.
Methods: We conducted a retrospective cohort analysis consisting of patients who underwent IOL with CRB at Eskenazi Hospital. Comparison between the two cohorts was done using a chisquare/ fishers’ exact test for the categorical variables and t-test for the continuous variables.
Results: A total of 134 patients were analyzed in the cohort, with 82 receiving concurrent misoprostol and 52 not receiving any additional pharmaceutical agents. Patients who received misoprostol and CRB had higher vaginal delivery rates (84.2% vs. 51.9%, p<0.01), decreased EBL (388.0 vs. 592.1 mL, p=0.01), and were not more likely to be given terbutaline (90.2% vs. 75%, p=0.02) compared to patients treated with CRB alone. There were no differences in neonatal outcomes (NICU admission, birth weight, or 5-min APGAR scores) or occurrence of uterine tachysystole between the cohorts. The multivariate analyses showed similar trends, although additional medication, medication use before balloon placement, advanced maternal age, and terbutaline use were not strong independent predictors of the vaginal delivery rate.
Conclusion and Potential Impact: We found that concurrent use of misoprostol and CRB during IOL was associated with increased vaginal delivery rate and decreased EBL when compared with patients who had CRB alone. Potential impacts of this study include providing evidence-based recommendations on cervical ripening practices as well as guiding future studies investigating the possible benefits with standardization of IOL practices
Food Insecurity: An Upstream Social Determinant of 30-Day Congestive Heart Failure Readmissions
Full text linkBackground:
Approximately 6.7 million Americans have congestive heart failure (CHF), costing the healthcare system over $30 billion annually. Readmissions contribute significantly to these costs, as 20-25% of hospitalized CHF patients are readmitted within 30 days of discharge. The Hospital Readmissions Reduction Program monitors 30-day readmission rates and penalizes hospitals that do not meet targets. Previous research on factors impacting CHF readmissions has largely focused on downstream factors such as race, ethnicity, sex, and clinical practices rather than upstream factors that can potentially inform high-impact interventions. This study explored downstream, midstream, and upstream factors—including demographics, social determinants of health (SDOH), and health behaviors—and their relationship with 30-day CHF readmissions in an urban healthcare system in Northwest Indiana. This was part of an academic-health system participatory research partnership.
Methods:
This retrospective study analyzed a limited dataset from EPIC™ with SDOH, demographic, health behavior, and health outcomes of adult inpatients between January 2021 and April 2024. Data analysis consisted of descriptive, bivariate (Chi-Square; p<0.05), and multivariate (Binary Logistic Regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040).
Results:
The sample consisted of 5,489 patients with CHF, predominantly White (63.8%), 65+ years old (76.2%), and publicly insured (91.8%). 30-day readmissions represented 22.4% of CHF admissions. The bivariate analysis revealed significant associations between 30-day CHF readmissions and ethnicity (p=.003), sex (p=.046), language (p=.017), hospital (p=.009), insurance type (p=.003), food insecurity (p=.048), and depression risk (p=.003). Food insecurity remained significantly associated with 30-day CHF readmission (OR=2.128; p=.033) after adjusting for these factors in the multivariate analysis.
Conclusion:
This study identified food insecurity as an upstream SDOH predicting 30-day CHF readmission. Future research should further explore other upstream factors contributing to 30-day CHF readmissions and evaluate evidence-based food insecurity interventions.  
Re-Imagining Social Work’s Role in Suicidology: Embracing an Ecological Practice Approach
Full text linkSuicide continues to impact individuals and communities at alarming rates, with many vulnerable populations being at a disproportionately higher risk. As a profession, social work is well matched to address the comprehensive and intertwined risk factors that perpetuate acute and chronic risk for suicide. This conceptual article introduces a developing practice model that social workers may adopt to address suicidality for some vulnerable populations. Within this model, external processes beyond intrapsychic functioning are notable, and social workers can prioritize integrating additional systems into intervention planning. A case scenario illustrates an example of embracing an ecological systems approach that emphasizes various roles within social work practice. Introducing an applied approach to conceptualizing suicidality offers social work education and research an opportunity to advance its positionality in suicidology
Executive Coaching for Social Work Faculty: A Framework for Enhancing Leadership and Impact in the Academy
Full text linkExecutive coaching considers the challenges and opportunities of leaders and organizations. Social work faculty face unique challenges that require academic expertise, leadership acumen, and management skills. While executive coaching has been a long-standing practice in the corporate world, its relevance to social work faculty is relatively unrecognized. This paper examines the science of executive coaching and its alignment with the research, teaching, and service responsibilities of social work faculty. It also presents a framework for how executive coaching can align with professional development for social work faculty. While not all social work faculty aspire to someday hold administrative roles, there may be opportunities for leadership throughout their careers for which executive coaching can position them for success. The implications of executive coaching for social work faculty include the opportunity to examine their potential leadership capabilities, enhance job satisfaction, and serve as social impact leaders for students, colleagues, and the profession
Nutrition deficiencies are associated with decreased wound healing in patients with peripheral arterial disease (PAD)
Full text linkBackground: Chronic limb threatening ischemia (CLTI) represents end-stage peripheral arterial disease (PAD) and is associated with a 30% annual risk of amputation, often due to non-healing wounds. Wound healing in PAD is multifactorial, but the role of nutritional deficiencies in healing arterial wounds is not well-studied. We sought to delineate the role of macro- and micronutrient malnutrition in healing ischemic wounds in PAD patients.
Methods: This was a retrospective chart review of all adult patients with non-invasive vascular laboratory evidence of PAD and distal lower extremity arterial wounds seen at the Comprehensive Wound Center at Indiana University Health from January 2020-May 2024. Primary endpoints were percent of wound healed by area and volume. Statistical analysis was performed with Stata18 (StataCorp LP, College Station, Tex). Chi-square analysis was conducted for categorical variables, with Fisher’s exact test where appropriate. Continuous variables were compared using t-tests. A significance level of 0.05 was used for all analyses.
Results: Eighty-three patients met our inclusion criteria. Initial Vitamins B12 and C deficiency were associated with less wound healed by volume (p=.0005) and area (p=0.038), respectively. Fewer patients with hyperlipidemia had wound area decrease by at least 50% (p=0.049). There were no other significant differences in wound area or volume based on other macro- or micronutrients or demographic factors. Positive screening for food insecurity was not associated with macro- or micro-nutrient deficiencies (p=0.673).
Conclusions: Vitamin C and Vitamin B12 deficiencies were associated with significantly less wound area and volume healed by the end of the treatment, respectively. Patients with dyslipidemia were less likely to heal 50% of their wounds by area. Nutrient deficiencies were less common than expected from screening. Improved screening methods may help identify at risk patients. Patients with vitamin B12 or C deficiency and dyslipidemia should these deficiencies corrected as part of their comprehensive wound care plan
Towards Global Harmonization: A Comparative Analysis of Taiwan\u27s Pharmaceutical Track and Trace System
No full textThis article is a comparative study of the U.S. Drug Supply Chain SecurityAct, the EU Falsified Medicines Directive, and Taiwan’s pharmaceutical trackand trace system. This comparative approach will highlight the commonalitiesand differences in these various frameworks as they relate to pharmaceuticaltrack and trace and assess how these systems can learn from each other. Thearticle will provide a springboard for discussing an international framework forpharmaceutical track and trace, focusing on legal and operationalinteroperability. The core of the article will revolve around the need for nationalpharmaceutical track and trace systems to be interoperable with other nationalor regional systems. It will further emphasize how a collaborative internationalapproach is necessary to ensure the full effectiveness of the pharmaceuticalsupply chain. This article will give special attention to Taiwan’s pharmaceuticaltrack and trace system, providing a description of Taiwan’s pharmaceuticaltrack and trace regime and the elements necessary for its success, itsweaknesses, and opportunities for growth in a global track and trace system. Byintegrating the provisions of Taiwan’s Pharmaceutical Affairs Act, associatedregulations, and data from various sources, the Taiwanese government hassuccessfully created a comprehensive track and trace system for pharmaceuticalproducts. Integration among government systems in Taiwan further enhancesthe track and trace ecosystem’s comprehensiveness, enabling data to undergovarious verification and auditing processes. Finally, this article will argue thatnational track and trace systems should be interoperable with other national andregional systems to guarantee complete protection of the pharmaceutical supplychain. Therefore, this article will conclude with a proposal for a worldwideunified, interoperable, and digital platform for pharmaceutical track and trace
