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PubMed1997

Tractor-trailer crashes in Indiana: a case-control study of the role of truck configuration.

Studies of the crash experience of tractors pulling multiple trailers have reached different conclusions concerning the relationship of truck configuration to crash risk. A previous case-control study found a significant increase in crash risk for double-trailer trucks in the state of Washington. The present case-control study was done of tractor-trailers crashing on Indiana interstates during November 1989-March 1991. Controls were obtained for 25% of the crash sites and were all tractor-trailers passing the crash sites during a traffic observation session one to four weeks following a crash on the same day of the week for 30 minutes at the same time of day. Logistic regression identified day of week, time of day, urban/rural area, and specific highway as significant predictors of controls' truck configuration. This model was applied to the cases to estimate the expected number of double-trailer cases. For all crashes combined, no increased crash risk was observed for doubles (Standardized Crash Ratio (SCR) = 83). Doubles were significantly underinvolved in multiple-vehicle crashes (SCR = 74), crashes on dry roads (SCR = 61), and crashes on wet (other than snow, ice, or slush) roads (SCR = 54). Doubles were significantly overinvolved in crashes on roads with snow, ice, or slush (SCR = 153). Because truck configuration was highly associated with driver age and work operation attributes among trucks in crashes, the absence of control data on these potential confounders precluded definitive assessment of the intrinsic risk of multiple versus single-trailer vehicles.

Accidents, Traffic↗
PubMed2003

Antiplatelet prescribing patterns for TIA and ischemic stroke: the Indiana University experience.

OBJECTIVE: To evaluate antiplatelet prescribing patterns by Indiana University Hospital (IU) neurologists, determine what drives antiplatelet agent decisions, and determine changes made with recurrent cerebrovascular events despite proven antiplatelet therapy. There are now four approved therapies for secondary prevention of cerebrovascular events. As these agents exhibit their effects through different pathways, physicians must choose antiplatelet agents based on other factors. DESIGN: We retrospectively reviewed charts of neurology patients diagnosed with non-fatal ischemic stroke or TIA at IU from January 1, 1997 to August 31, 2001. Patients were excluded if: discharge diagnosis was not non-fatal ischemic stroke or TIA, they were enrolled in clinical trials, or were placed on anticoagulation therapy with warfarin. Patients' antiplatelet agents at discharge were reviewed to determine if specific factors led to the choice of antiplatelet agent. RESULTS: A total of 177 patients experienced non-fatal ischemic strokes or TIAs. Of these, 74 were not on prior antiplatelet therapy and 103 were on antiplatelet agents prior to admission. For patients not on therapy, aspirin was the most commonly prescribed agent, with a trend for low-dose aspirin. For patients already on an antiplatelet agent, typically the dose of aspirin was increased or combination therapy initiated. CONCLUSION: Our experience supports the use of aspirin as a first-line agent for secondary prevention in cerebrovascular disease. For antiplatelet-nai;ve patients, low-dose aspirin is the most frequently used agent. For patients previously on antiplatelet agents, aspirin dosage is increased or clopidogrel is added. High-dose aspirin and ticlopidine use is no longer favored.

Adult↗
PubMed2003

Nephrectomy for metastatic renal cell carcinoma: Indiana University experience.

OBJECTIVES: To report on the short-term morbidity of radical nephrectomy in 32 patients with poorer performance status and more advanced primary renal cell carcinoma (RCC). Nephrectomy followed by immunotherapy has been shown to improve survival in selected, good performance status patients with metastatic RCC. METHODS: We report on 32 patients who underwent radical nephrectomy (20 open procedures and 12 laparoscopic) in the setting of metastatic RCC at Indiana University between 1999 and 2002. The study group included patients with advanced primary tumors (inferior vena cava involvement, large size, and involvement of adjacent structures). The patients' performance status score ranged from 0 to 2. RESULTS: The average hospital stay was 5.1 days. No significant intraoperative complications were encountered, and postoperative complications occurred in 6 patients, including one perioperative death. At 4 weeks postoperatively, 21 (72.4%) of 29 assessable patients had a performance status equal to, or better than, their preoperative status, including 4 patients who converted from a preoperative performance status of 2 to 0 or 1 postoperatively. Eleven patients (34.4%) went on to receive postoperative immunotherapy. CONCLUSIONS: The results of our study demonstrated that radical nephrectomy in the setting of metastatic RCC has a low morbidity and acceptable recovery in these patients with advanced primary tumors and poorer performance status.

Adult↗
PubMed2001

Fluoroquinolone susceptibility, resistance, and pharmacodynamics versus clinical isolates of Streptococcus pneumoniae from Indiana.

The in vitro activity and pharmacodynamics (AUC(0-24)/MIC) of levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin were evaluated against 307 clinical isolates of Streptococcus pneumoniae from Indianapolis, Indiana. Organisms were collected between January 1999 and April 2000, and MICs were determined by broth microdilution. Serum concentration-time profiles were simulated for the following oral regimens administered once daily: levofloxacin 500 mg and 750 mg; gatifloxacin 400 mg; moxifloxacin 400 mg; gemifloxacin 320 mg. Free 24 h area under the serum concentration-time curves (AUC(0-24)) were calculated, and the average AUC(0-24)/MIC was calculated for each regimen. Differences in AUC(0-24)/MIC among agents were determined by analysis of variance (Scheffe post-hoc test, p < 0.05). Overall, gemifloxacin was the most potent agent tested. Five (1.7%), 4 (1.3%), and 2 (0.7%) isolates were resistant to levofloxacin, gatifloxacin, and moxifloxacin, respectively. None of the isolates was resistant to gemifloxacin. Gemifloxacin AUC(0-24)/MIC was significantly greater than all other regimens (p < 0.0001), with the exception of moxifloxacin. However, the percent of isolates for which an AUC(0-24)/MIC >or= 30-50 can be achieved is similar for gemifloxacin, moxifloxacin, gatifloxacin, and levofloxacin 750 mg. Large comparative studies are needed to determine if the differences in AUC(0-24)/MIC among fluoroquinolones are clinically significant.

Anti-Infective Agents↗
PubMed2000

A community outbreak of hepatitis A in a religious community in Indiana: failure of immune serum globulin to prevent the spread of infection.

An outbreak of hepatitis A occurred in a religious community in Indiana, USA. Sixty-nine cases were ascertained among the 4466 residents over a year, and the highest attack rate was in children. The management of the outbreak included the widespread use of prophylactic immune serum globulin (ISG). Despite this, further cases occurred. To guide further ISG administration, a survey was undertaken to ascertain what proportion remained susceptible to HAV infection. From a random sample of 600 people in the affected community 440 saliva specimens (73%) were obtained. Of these, 12.5% were found to be immune (95% confidence intervals from 9-16%). No changes were made to the ISG administration policy. There was no evidence to suggest that administration of ISG had any effect on the duration of the outbreak. There was a low rate of symptomatic infection among young children (less than 10 years); as ISG does not prevent the spread of the virus its use is not recommended in future outbreak situations.

Adolescent↗
PubMedDate not supplied

Videoconferencing and other distance education techniques in chemoinformatics teaching and research at Indiana University.

At a time when the demand for people with expertise in chemoinformatics is increasing, there is still only a very small number of academic institutions that offer chemoinformatics-related classes and degrees. The distance education (DE) approach allows both learning and research to be carried out at multiple geographic locations and institutions, thus leveraging the few educational offerings that are available. In this paper, distance education techniques and technologies (with emphasis on videoconferencing) are reviewed, and examples of how they are used to increase the accessibility of chemoinformatics education and research at the Indiana University School of Informatics are presented.

Chemistry↗
PubMed2002

Phenotypic and genotypic characterization of the Indiana University rat lines selectively bred for high and low alcohol preference.

The Indiana lines of selected rats, the HAD and LAD replicates and the P and NP lines, were bred for high and low alcohol preference. The P and HAD lines have met criteria for an animal model of alcoholism in that they voluntarily consume sufficient ethanol to achieve significant blood alcohol concentrations, and their alcohol-seeking behavior is reinforced by the pharmacological effects of ethanol rather than its taste, caloric content, or other properties. These lines have been characterized extensively for associated behavioral and physiological phenotypes. The P and HAD rats show an enhanced responsiveness to the stimulatory effects of ethanol and reduced sensitivity to the aversive sedative effects of ethanol. Consistent findings with the selected lines include differences in the mesolimbic dopamine reward system, as well as differences in serotonin, GABA, endogenous opioid, and neuropeptide Y systems. Genetic mapping studies have identified quantitative trait loci influencing alcohol preference on chromosomes 3, 4, and 8 in the inbred P/NP rats and on chromosomes 5, 10, 12, and 16 in the noninbred HAD1/LAD1 rats. The elucidation of the genotypes and phenotypes that result in excessive alcohol intake may lead to a better understanding of alcohol abuse and alcoholism and could guide strategies for potential treatment and prevention.

Alcohol Drinking↗
PubMed1992

Linkage of the Indiana kindred of Gerstmann-Sträussler-Scheinker disease to the prion protein gene.

The Indiana kindred variant of Gerstmann-Sträussler-Scheinker disease has amyloid plaques that contain prion protein (PrP), but is atypical because neurofibrillary tangles like those of Alzheimer disease are present. To map the position of the disease causing gene, we used three markers for linkage analyses. A missense mutation at codon 198 of the PrP gene (PRNP) is found in all definitely affected individuals and yields a maximum lod score of 6.37 (theta = 0). The disease also is concordant with the two other PRNP-region markers. These results demonstrate tight linkage of the disease-causing gene to PRNP and support the hypothesis that the codon 198 mutation is the cause of IK-GSS. Our studies also suggest that methionine/valine heterozygotes at PRNP codon 129 have a later age of onset of the disease than codon 129 valine/valine homozygotes.

Adult↗
PubMed2006

Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States.

BACKGROUND: Measles was declared eliminated from the United States in 2000 but remains endemic worldwide. In 2005, a 17-year-old unvaccinated girl who was incubating measles returned from Romania, creating the largest documented outbreak of measles in the United States since 1996. METHODS: We conducted a case-series investigation, molecular typing of viral isolates, surveys of rates of vaccination coverage, interviews regarding attitudes toward vaccination, and cost surveys. RESULTS: Approximately 500 persons attended a gathering with the index patient one day after her return home. Approximately 50 lacked evidence of measles immunity, of whom 16 (32 percent) acquired measles at the gathering. During the six weeks after the gathering, a total of 34 cases of measles were confirmed. Of the patients with confirmed measles, 94 percent were unvaccinated, 88 percent were less than 20 years of age, and 9 percent were hospitalized. Of the 28 patients who were 5 to 19 years of age, 71 percent were home-schooled. Vaccine failure occurred in two persons. The virus strain was genotype D4, which is endemic in Romania. Although containment measures began after 20 persons were already infectious, measles remained confined mostly to children whose parents had refused to have them vaccinated, primarily out of concern for adverse events from the vaccine. Seventy-one percent of patients were from four households. Levels of measles-vaccination coverage in Indiana were 92 percent for preschoolers and 98 percent for sixth graders. Estimated costs of containing the disease were at least 167,685 dollars, including 113,647 dollars at a hospital with an infected employee. CONCLUSIONS: This outbreak was caused by the importation of measles into a population of children whose parents had refused to have them vaccinated because of safety concerns about the vaccine. High vaccination levels in the surrounding community and low rates of vaccine failure averted an epidemic. Maintenance of high rates of vaccination coverage, including improved strategies of communication with persons who refuse vaccination, is necessary to prevent future outbreaks and sustain the elimination of measles in the United States.

Adolescent↗
PubMedDate not supplied

Public policy analysis of Indiana's minority health initiatives.

Similar to national health trends in the US, racial/ethnic minorities in the state of Indiana continue to experience disparities in poor health status from preventable health conditions. To address this problem, people from minority communities across the state mobilized a broad base of individuals and organizations to facilitate the successful legislative enactment of a statewide minority health initiative. A case study of the initiative is presented for public policy analysis. The theoretical framework for the study is Etzioni's Societal Guidance Theory. The findings show that minority health advocates were able to impact favorably on public policy formulation and funding of the initiative by increasing knowledge about minority health status among grass-roots people, generating public consensus for public policy intervention, setting mutual goals via a 5-year strategic minority health plan, creating organizational structures to implement the plan and utilizing power to push the initiative through the legislative process. The weaknesses of the initiative efforts include a limited infrastructure development of minority health coalitions, restricted effective use of the legislative process and varying degrees of linkages among other advocacy groups. Improvements in these areas are discussed and recommendations are made for the implementation phase of the initiative.

Health Knowledge, Attitudes, Practice↗
PubMed2004

Using an electronic medical record system to describe injury epidemiology and health care utilization at an inner-city hospital in Indiana.

Injuries are a major public health problem worldwide. In the USA, injuries cause 146, 400 deaths annually, with 31 million non-fatal injury visits to emergency departments (EDs). EDs thus represent an important source of injury data. The primary objective of the current study was to describe the epidemiology of injury-related ED visits and assess injury-related utilization of health care resources in an inner-city hospital in Indiana, using data stored in a computerized medical record system. It involved a retrospective review of the records for injury visits to EDs and injury admissions over a 3-year period. The variables extracted and analysed included patients' demographics, external cause of injury, diagnosis, length of stay, ED and hospital charges. A total of 60,470 injury-related ED visits were made, the majority of patients were male (61.6%), uninsured (63.1%), treated in ED and discharged (98.4%). The leading causes of injury were falls (18.8%), motor vehicle crashes (18.4%), assaults (17.6%), being struck (11.2%) and overexertion (10.6). Firearms caused most injury deaths (32.4%; n = 314); motor vehicle crashes were the leading cause of hospitalization (26.6%; n = 642) and also the most expensive to treat as inpatients (mean charge $19,190). The mean charge per patient treated and discharged was $150 compared to $11,116 for patients admitted. These findings demonstrate the value of computerized medical records in capturing and storing E-coded injury data. The system generates data that can be used for epidemiological surveillance and injury prevention at the local level, and for assessment of impact of specific injuries on health care resources.

Accidental Falls↗
PubMed1993

Interferon induction by viruses. XXII. Vesicular stomatitis virus-Indiana: M-protein and leader RNA do not regulate interferon induction in chicken embryo cells.

Several field isolates, strains, mutants, and revertants of vesicular stomatitis virus (VSV), Indiana (IN) serotype, were studied that differed greatly in their capacity to induce interferon (IFN) in aged chick embryo cells. The predicted M-protein amino acid sequence of a wild-type field isolate that induced > or = 10,000 units/ml IFN in chicken embryo cells was identical to that of a wild-type field isolate that induced < 2 units/ml and of a noninducing wild-type laboratory strain. The 47-base plus-strand leader RNA sequences were the same for five IFN-inducing, and eight noninducing independent isolates of wild-type VSV IN. Our data show that the M-protein and plus-strand leader RNA do not of themselves regulate the induction of IFN in this system. Because the capacity of VSV IN to induce IFN resides in virion-associated elements (Marcus and Sekellick, 1987, J. Interferon Res. 7, 269-284), the differences in IFN yield observed with various isolates must result from changes in other virion components that remain to be determined.

Amino Acid Sequence↗
PubMed2006

Sowing the seeds for sustainable change: a community-based participatory research partnership for health promotion in Indiana, USA and its aftermath.

Community-based participatory research (CBPR) increasingly is being used in both developed and developing countries to study and address community-identified issues through a collaborative and empowering action-oriented process. In 2003-2005, a study was undertaken to document the impacts of CBPR on healthy public policy in the US. From an initial review of 80 partnership efforts, 10 were selected as best capturing the range and diversity of projects meeting the study criteria, and were the subject of in-depth case study analysis. This article presents and analyzes one of these cases, a collaboration between researchers at the Indiana University School of Nursing and the Healthy Cities Committee of New Castle, IN, USA. With its action component still underway a decade after the formal study's completion, the partnership was selected to enable an examination of sustainable change through CBPR. Beginning with a participatory door-to-door health survey of 1000 households using a non-probability quota sampling strategy, the project involved community members in many stages of the research process. A smoking rate of twice the national average was among the study findings that helped to galvanize the community into action. A variety of health promoting environmental and 'small p policy' changes were undertaken ranging from a bill restricting indoor smoking in public places to an initiative to develop a system of trails throughout the county to promote physical fitness and decreased reliance on automobiles. This article examines the evolution of the original CBPR partnership, its research methods and findings, and the environmental changes it sought to promote healthier lifestyles. Success factors, barriers and sustainability benchmarks are discussed. The case study offers an example of the potential of CBPR for helping to lay the groundwork for long-term sustainable change in support of healthier communities.

Air Pollution, Indoor↗
PubMed1991

gyrA mutations in ciprofloxacin-resistant, methicillin-resistant Staphylococcus aureus from Indiana, Minnesota, and Tennessee.

Mutational changes occurring at amino acid codons 84 and 85 located in the gyrA gene of methicillin-resistant Staphylococcus aureus (MRSA) were studied using radiolabeled oligonucleotide probes to examine the incidence of these ciprofloxacin resistance determinants in 30 MRSA isolates from Indiana, Minnesota, and Tennessee. Four separate oligonucleotide probes, one each corresponding to the wild-type sequence, a mutation at codon 84 (nucleotide 251), a mutation at codon 85 (nucleotide 253), and mutations at both, were used to examine the total genomic DNA from each of the 30 isolates, which had been restricted, electrophoresed, and Southern blotted. The probes indicated that 15 of the 28 ciprofloxacin-resistant isolates gave results consistent with a single mutation at codon 84. Four of the 28 ciprofloxacin-resistant strains had results consistent with a mutation at codon 84 and possibly at codon 85. The two ciprofloxacin-sensitive isolates from Tennessee showed homology with the wild-type probe sequence. Five isolates (4, Minnesota; 1, Tennessee) had no homology with any probe. By oligonucleotide probes, ciprofloxacin-resistant MRSA from diverse geographic regions contained similar gyrA mutations at codons 84 or 85 in 19 of 28 ciprofloxacin-resistant isolates.

Base Sequence↗
PubMed1989

Ixodes dammini (Acari: Ixodidae) in Indiana.

Ixodes dammini Spielman, Clifford, Piesman and Corwin is reported from Indiana for the first time. Four specimens were taken from deer and one from a dog. All specimens are adult females and all were collected in 1987. The significance of this finding is discussed.

Animals↗
PubMed1995

Aedes albopictus (Diptera: Culicidae) eggs: field survivorship during northern Indiana winters.

Aedes albopictus (Skuse) is an Asian mosquito that recently has colonized North America via used tire transport. Temperate Ae. albopictus populations overwinter as diapausing eggs, but tropical populations cannot diapause. Eggs of tropical (SABAH) and temperate (INDY) Ae. albopictus were obtained in diapause-inducing conditions and placed inside a scrap tire to monitor overwintering survival in northern Indiana during the winters of 1989-1990 and 1990-1991. Diapause eggs of Ae. triseriatus (Say), a native North American mosquito, were included for comparison. Tropical Ae. albopictus from Malaysia did not survive either winter. Temperate Ae. albopictus from Indianapolis, IN, did not survive the winter of 1989-1990, but 78% survived the winter of 1990-1991. In contrast, 92 and 96% of Ae. triseriatus survived the winters of 1989-1990 and 1990-1991, respectively. Neither mean temperature nor absolute minimum temperature (a winter's lowest temperature) accurately predicted Ae. albopictus overwintering survivorship in the field. The possible effect of snow and other insulating materials on the overwintering survivorship of Ae. albopictus eggs is discussed.

Adaptation, Physiological↗
PubMed1984

Serologic evidence for widespread infection with La Crosse and St. Louis encephalitis viruses in the Indiana human population.

The vast under-reporting of La Crosse virus and St. Louis encephalitis virus infections in Indiana residents was evident when numerous inapparent infections were detected retrospectively using serum dilution neutralization analyses of serum obtained in November 1978-April 1979 from 10,208 persons (0.2% of the state's population). An antibody prevalence rate of 3.6% to St. Louis encephalitis virus was detected in the sample population as a whole, with rates as high as 13.2% for residents of individual counties. The estimated average annual rate of infection for the whole population was 0.32%. The antibody prevalence to La Crosse virus in the sample population as a whole was 2.3%, with rates ranging up to 12.5% for residents of individual counties. The estimated average annual rate of infection for the whole population was 0.29%. The epidemiologic behavior of the two viruses was quite different. Age-specific antibody prevalence for St. Louis encephalitis virus indicated a pattern of endemic infection existed in the population as a whole; antibody prevalence rose as the population aged. However, many other infections apparently occurred during the 1975 and earlier epidemics. Age-specific antibody prevalence for La Crosse virus indicated a typical pattern of endemic infection was present. The antibody prevalence to La Crosse virus was best described by the Poisson distribution and that of St. Louis encephalitis virus by the negative binomial distribution. These data support the hypothesis that St. Louis encephalitis virus primarily produces intermittent epidemics in the Midwest while La Crosse virus produces continuous seasonal endemic infections. However, evidence suggestive of a low level of interepidemic St. Louis encephalitis virus infection in the population was also obtained. Computer-drawn synagraphic mapping view "maps" of regional antibody prevalence rates demonstrated the existence of distinct foci of infection for each virus in the human population.

Adolescent↗
PubMed2004

A large histoplasmosis outbreak among high school students in Indiana, 2001.

BACKGROUND: A histoplasmosis outbreak occurred in an Indiana high school in November-December 2001. METHODS: To describe the risk factors for this outbreak, we conducted a cohort study of all available students and staff (N = 682) and an environmental investigation. RESULTS: Of the 523 (77%) persons who displayed serologic evidence of recent Histoplasma capsulatum infection, 355 (68%) developed symptoms consistent with acute pulmonary histoplasmosis. Rototilling of soil in a school courtyard known to be a bird roosting site had been performed during school hours on November 12, 2001, 14 days before both the peak of the onset of illness and a rise in student absenteeism. Being a student (odds ratio, 3.3; 95% confidence interval, 2.2-5.0) and being a student in a classroom near the courtyard during the rototilling (odds ratio, 3.1; 95% confidence interval, 1.8-5.2) were independently associated with infection and symptomatic illness. H. capsulatum was isolated from environmental samples, including soil from the courtyard and dust collected from a filter of a heating, ventilating and air-conditioning system. CONCLUSIONS: Soil-disrupting activities within a school courtyard caused the largest outbreak to date of histoplasmosis among adolescents. Improved efforts are needed to educate the community in endemic areas about histoplasmosis to prevent the occurrence of such outbreaks in the future. In addition, increased awareness among health care providers of this disease would facilitate appropriate diagnosis and treatment.

Adolescent↗