Central Indiana Research Articles

Clinical Courses and Characteristics of Residents During a SARS-CoV-2 Outbreak at a Central Indiana Skilled Nursing Facility

Background/Objective: Older adults such as skilled nursing facility residents have increased risk of serious SARS-CoV-2 infection and comprise a large proportion of the COVID-19 pandemic’s deceased—the US Centers for Medicare & Medicaid Services report 232,831 cases and 38,518 resident deaths to date. Recent case reports reveal, as in other diseases, older adults may experience atypical symptomology, complicating identification of ill residents and efforts to slow transmission. While a few facility outbreaks have been characterized epidemiologically, little research exists regarding clinical timelines and trajectories which residents experience during COVID-19 illness. 
 Methods: From May 9, 2020-June 1, 2020, daily notes on each COVID-19 positive resident’s status (n = 69) were taken by the medical director of a central Indiana nursing facility. Combined with a retrospective resident chart review of this same period, these notes were examined for COVID-19 infection symptoms and illness timelines to descriptively categorize a number of common illness trajectories and symptoms seen in residents with SARS-CoV-2 infection. 
 Results: Residents fit four descriptive clinical timelines: concurrent symptom load with quick death (Avg 5.6 days) (n = 5), accumulating symptom load with gradual decline (Avg. 13.9 days) (n = 9), prolonged active symptom load with periods of stabilization and symptom reoccurrence (n = 42), and asymptomatic or atypical symptom load (n = 12). Most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. Of the 14 residents who died (20.3% of infected), 8 died in the facility and 6 died in the hospital. 
 Conclusion and Implications: This retrospective case study adds to literature describing the presentation and symptomology of SARS-CoV-2 infection in residents of skilled nursing facilities and aids efforts to evaluate resident presentation, prognosis, and disease course. Robust descriptions of expected clinical courses may support realistic expectations of disease progression for residents and their family members experiencing future outbreaks.

North Central Indiana AHEC: STEPS Program Impact

Background/Objective: 
 North Central Indiana Area Health Education Center (NCI AHEC) aims to encourage rural students in their service district to pursue healthcare. In light of rural healthcare shortages found in Indiana, they implemented the Successfully Training and Educating Pre-medical Students (STEPS) program, available to college juniors at Indiana University – Kokomo. Through MCAT prep courses, workshops about interviews, and job shadowing, the goal of the program is for more rural students to be accepted into local medical schools, to then return to practice in that rural area. This case study examines the initial impacts of the STEPS program and the path to healthcare for a student at IU – Kokomo. 
 
 Methods: 
 A mixed methods study was conducted. First, a survey was administered by NCI AHEC to students who participated in the STEPS program using a retrospective pre/post design. The quantitative data, representing students’ opinions and goals, was aggregated and interpreted. An interview was then done with a previous STEPS student. This student’s experience was analyzed. 
 
 Results: 
 Participation in the STEPS program resulted in increased knowledge about healthcare careers and plans to pursue further education for healthcare careers across all students. The STEPS program has identified strengths, including activities that increase student commitment to pursuing healthcare and mentorship for students. Areas for growth were also identified, including adding application assistance, decreasing competition for resources, and increasing efforts to keep students in Indiana. 
 
 Conclusion and Potential Impact: 
 Initial evaluation suggests that the STEPS program is beneficial in assisting rural students on their path to a career in healthcare. Analysis of the interviewee’s experience provides recommendations for improvements of the STEPS program in the future.

Quantifying urban expansion using Landsat images and landscape metrics: a case study of the Halton Region, Ontario

The Halton Region, as part of the Greater Toronto Area (GTA), is regarded as one of the fastest growing regions in Canada, generating 20% of national gross domestic product. It is also one of the most desirable places for living and for thriving businesses. This research attempts to assess the urban expansion in the Halton Region, Ontario, Canada from 1989 to 2019 using satellite images, analysis approaches, and landscape metrics. Multitemporal Landsat images and the supervised learning algorithms in GIS software were used to explore the dynamic changes and to classify the urban and nonurban areas. The temporal urban expansion in the Halton Region experienced a dramatic rise, and it mainly occurred from the centre of the area. The analysis of landscape metrics based on different methods including the Land Use in Central Indiana (LUCI) model, the vegetation-impervious surface-soil (V-I-S) model, and the census data of Canada was carried out to understand the transition mode of the urbanization in the Halton Region. Also, the population growth in the centre of the Halton Region was considered as one of the driving forces affecting urban expansion. The results showed that most of the landscape metrics rose between 1989 and 2019, indicating that leapfrog pattern of urbanization occurred over the entire period. The purpose of this research is to evaluate urbanization in the Halton Region and give the city managers data to make appropriate decisions in further urban planning.

Nursing Home Transfers for Behavioral Concerns: Findings from the OPTIMISTIC Demonstration Project.

To characterize pretransfer on-site nursing home (NH) management, transfer disposition, and hospital discharge diagnoses of long-stay residents transferred for behavioral concerns. This was a secondary data analysis of the Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care project, in which clinical staff employed in the NH setting conducted medical, transitional, and palliative care quality improvement initiatives and gathered data related to resident transfers to the emergency department/hospital setting. R software and Microsoft Excel were used to characterize a subset of transfers prompted by behavioral concerns. NHs in central Indiana were utilized (N = 19). This study included long-stay NH residents with behavioral concerns prompting transfer for acute emergency department/hospital evaluation (N = 355 transfers). The measures used in this study were symptoms prompting transfer, resident demographics and baseline characteristics (Minimum Data Set 3.0 variables including scores for the Cognitive Function Scale, ADL Functional Status, behavioral symptoms directed toward others, and preexisting psychiatric diagnoses), on-site management (e.g., medical evaluation in person or by phone, testing, and interventions), avoidability rating, transfer disposition (inpatient vs emergency department only), and hospital discharge diagnoses. Over half of the transfers, 56%, had a medical evaluation before transfer, and diagnostic testing was conducted before 31% of transfers. After transfer, 80% were admitted. The most common hospital discharge diagnoses were dementia-related behaviors (27%) and altered mental status (27%), followed by a number of medical diagnoses. Most transfers for behavioral concerns merited hospital admission, and medical discharge diagnoses were common. There remain significant opportunities to improve pretransfer management of NH transfers for behavioral concerns.

Thelma: A Happy Modern Woman

This interpretive biography of the author’s mother Thelma Boyd Johnson (1913-2001) charts various critical points in her life, from its beginning on a farm in central Indiana to an urban life of motherhood, a career in banking, and her passions for reading and family.

Characteristics of the Largest Network Component of Individuals With or Exposed to Early Syphilis in Central Indiana: 2016 to 2017.

The surge of syphilis infections in the United States continues. This study examined the sexual networks of early syphilis cases to determine whether repeat infection, demographics, or behaviors differed among network components (groups of connected persons). We examined a retrospective cohort of all early syphilis cases in Central Indiana reported from January, 1, 2016, to January 24, 2018, in the state's reporting database. Cases were linked to their sexual partners and analyzed using UCINET and NetDraw. Attributes of network members were derived from disease intervention specialist interviews. Repeat cases were defined as those who also had ≥1 early syphilis infection at any time between 2011 and 2017. The resulting network included 1140 unique individuals, 436 cases and 704 contacts. We compared members of the main component, that is, the largest one, with the rest of the network using multiple logistic regression and network analyses. The network formed 197 separate components. The main component contained 473 individuals (41% of the cohort). Main component members were more likely to have repeat early syphilis, gonorrhea, Black race, male sex, and a history of methamphetamine use, and be HIV positive by multiple logistic regression. Results from multiple centrality measures indicated persons who might be most effective at disseminating information or fragmenting the main component. Network analysis identified a group of linked individuals most likely to be reinfected with syphilis in Central Indiana. Further investigation is needed to determine whether engaging such a high-risk group could better focus resources and decrease infections.

My Whole World Changed: A Qualitative Exploration of the Coping Experiences of Transgender Women After an HIV Diagnosis.

The aim of this study was to generate a theoretical stage model that describes transgender women's coping strategies and responses after a new HIV diagnosis. The sample included 18 transgender women living with HIV in a large metropolitan city in central Indiana. Semi-structured interviews were conducted, digitally recorded, transcribed verbatim, and analyzed using grounded theory methods. Participants commonly described the experience of being newly diagnosed with HIV as, having the world change. Four stages through which attempts at coping occurred were identified: having the world come crashing down; shutting out the world; living in a dark world; and reconstructing the world. This model advances our understanding of the social and behavioral factors that influence how transgender women cope with a new HIV diagnosis and how their coping responses influence entry and engagement in the HIV care continuum.

Replacing dietary antibiotics with 0.20% l-glutamine and synbiotics following weaning and transport in pigs.

Dietary antibiotic use has been limited in swine production due to concerns regarding antibiotic resistance. However, this may negatively impact the health, productivity, and welfare of pigs. Therefore, the study objective was to determine if combining dietary synbiotics and 0.20% l-glutamine would improve pig growth performance and intestinal health following weaning and transport when compared with traditionally used dietary antibiotics. Because previous research indicates that l-glutamine improves swine growth performance and synbiotics reduce enterogenic bacteria, it was hypothesized that supplementing diets with 0.20% l-glutamine (GLN) and synbiotics (SYN; 3 strains of Lactobacillus [1.2 × 10^9 cfu/g of strain/pig/d] + β-glucan [0.01 g/pig/d] + fructooligosaccharide [0.01 g/pig/d]) would have an additive effect and improve pig performance and intestinal health over that of dietary antibiotics. Mixed-sex pigs (N = 226; 5.86 ± 0.11 kg body weight [BW]) were weaned (19.4 ± 0.2 d of age) and transported for 12 h in central Indiana. Pigs were blocked by BW and allotted to one of two dietary treatments (5 to 6 pigs per pen): antibiotics (positive control [PC]; chlortetracycline [441 ppm] + tiamulin [38.5 ppm]), no antibiotics (negative control [NC]), GLN, SYN, or the NC diet with both the GLN and SYN additives (GLN + SYN) fed for 14 d. From day 14 post-weaning to the end of the grow-finish period, all pigs were provided common antibiotic-free diets. Data were analyzed using PROC GLIMMIX and PROC MIXED in SAS 9.4. Overall, haptoglobin was greater (P = 0.03; 216%) in NC pigs compared with PC pigs. On day 13, GLN and PC pigs tended to have reduced (P = 0.07; 75.2% and 67.3%, respectively) haptoglobin compared with NC pigs. On day 34, the jejunal goblet cell count per villi and per millimeter tended to be greater (P < 0.08; 71.4% and 62.9%, respectively) in SYN pigs compared with all other dietary treatments. Overall, jejunal mucosa tumor necrosis factor-alpha (TNFα) gene expression tended to be greater (P = 0.09; 40.0%) in NC pigs compared with PC pigs on day 34. On day 34, jejunal mucosa TNFα gene expression tended to be greater (P = 0.09; 33.3%, 41.2%, and 60.0%, respectively) in GLN pigs compared with SYN, GLN + SYN, and PC pigs. Although it was determined that some metrics of pig health were improved by the addition of GLN and SYN (i.e., haptoglobin and goblet cell count), overall, there were very few differences detected between dietary treatments and this may be related to the stress load incurred by the pigs.

Relationship Between Tick Activity, Tick-Borne Diseases, Cognitive and Affective Risk Assessment in Peri-domestic Areas.

Peri-domestic areas constitute an important source of tick exposure and tick-borne diseases (TBD). Nonetheless, the association between distal TBD risk factors (i.e. cognitive-/affective-risk perceptions, knowledge of the effectiveness of personal protective behaviors) and proximal TBD risk (i.e. tick activity and TBD diagnosis), among adult residents of private residential properties (PRP) is unknown.Data was collected from 299 PRP in south and central Indiana. We used Mann-Whitney U and Kruskal-Wallis non-parametric tests to identify differences in proximal and distal outcome measures.We found evidence of 'tick activity' at thirty-nine percent of PRP (n=116). Thirteen-percent of respondents (n=40) self-reported a TBD diagnosis within their household. We found no significant association between 'self-reported TBD diagnosis within a household' and 'tick activity in the peri-domestic area.' Mean scores on 'affective tick & TBD risk assessment' were significantly higher among respondents when 'tick activity' was present in the peri-domestic area (median=2, M=2.54, p<0.001). Similarly, respondents who 'self-reported TBD diagnosis within their household' had significantly higher mean scores on 'affective tick & TBD risk assessment' (median=3, M=3.30) than those who did not (median=1, M=1.93), (U=2750, p<0.001). The proportion of peri-domestic areas with 'tick activity' was significantly higher if the primary respondent was male or an older adult respectively, compared to females and younger adults.Occupational/recreation-based settings may be more important pathways of tick exposure than peri-domestic settings in Indiana. Beyond education, it is important to consider the feelings and emotions that are elicited when at-risk populations consider their peri-domestic tick exposure and TBD risk, and where necessary design interventions to address those affective assessments.

Effects of increasing dietary L-glutamine to replace antibiotics on pig health and performance following weaning and transport.

Supplementing nursery diets with 0.20% L-glutamine (GLN) may provide similar growth and health benefits as dietary antibiotics, but it was unknown if greater inclusion levels may provide additional benefits. Therefore, the study objective was to evaluate the impact of replacing dietary antibiotics with increasing GLN levels on growth performance, therapeutic antibiotic treatment rates, welfare measures, and production costs in pigs after weaning and transport. We hypothesized that withholding dietary antibiotics may negatively impact performance and increase therapeutic treatment rate, and that diet supplementation with 0.20% to 1.00% GLN may incrementally improve productivity and reduce therapeutic antibiotic treatment rates compared with dietary antibiotics. Mixed sex pigs (N = 308; 5.64 ± 0.06 kg body weight [BW]) were weaned (19.1 ± 0.2 d of age) and transported in central Indiana in 2017. Pigs were blocked by BW and allotted to one of seven dietary treatments (n = 8 pens/dietary treatment): dietary antibiotics (positive control [PC]; chlortetracycline [441 mg/kg] + tiamulin [38.6 mg/kg]), no antibiotics or added GLN (negative control [NC]), 0.20% GLN, 0.40% GLN, 0.60% GLN, 0.80% GLN, or 1.00% GLN fed for 14 d. From d 14 to 35, pigs were provided nonantibiotic common diets in two phases. Overall, average daily gain (ADG) was reduced (P = 0.01; 17.7%) from d 0 to 14 in NC, 0.20% GLN, 0.60% GLN, 0.80% GLN, and 1.00% GLN pigs compared with PC pigs, but no ADG differences were detected between 0.40% GLN pigs and PC pigs. Increasing GLN in the diet tended to increase ADG (linear; P = 0.10). Overall, d 35 BW was greater (P = 0.01) in 0.80% GLN and PC pigs compared with NC, 0.20% GLN, and 0.60% GLN pigs, and was greater for 0.40% GLN and 1.00% GLN pigs vs. 0.20% GLN pigs. However, no d 35 BW differences were detected (P > 0.05) between PC, 0.40% GLN, 0.80% GLN, and 1.00% GLN pigs. Increasing GLN in the diet tended to increase (linear; P = 0.08) d 35 BW. Overall, income over feed and therapeutic injectable antibiotics cost (IOFAC) for enteric and unthrifty challenges were greater (P = 0.02) in 0.80% GLN pigs compared with NC, 0.20% GLN, and 0.60% GLN pigs, but no IOFACs for enteric and unthrifty challenges differences were detected between 0.80% GLN pigs and 0.40% GLN, 1.00% GLN, and PC pigs. In conclusion, GLN supplemented pigs had improved performance after weaning and transport compared with the NC pigs with 0.40% GLN being the most effective level.

An Analysis of the Economic Effects of Cover Crop Use on Farm Net Returns per Acre in Central Indiana

Utilizing cover crop treatments can have significant agronomic benefits for a farm enterprise. However, implementing this technology introduces additional costs. Data were obtained from a Central Indiana case farm to evaluate the relationship between applied nitrogen and corn yield, and how this relationship is impacted by introducing three different species of cover crops: annual ryegrass, cereal rye, and an oats and radish blend. The resulting information was then translated into a partial budget so that the effects on net returns could be analyzed using historical prices and stochastic modelling. The results showed that the impact on net returns per acre varied among cover crop species. The implementation of annual ryegrass resulted in a negative change to net returns. Conversely, implementing cereal rye or an oats and radish blend resulted in a positive change to net returns, with the largest net benefits accruing to the oats and radish blend.

4355 Impact of Demographic & Racial Differences on DNA Repair Capacity in Lung Cancer

OBJECTIVES/GOALS: Lung cancer is the leading cause of cancer-related mortality in the United States for both men and women. African Americans are disproportionately affected with lung cancer, having higher incidence and mortality rates compared to Caucasian men and women. African American smokers are diagnosed with lung cancer at a lower age with lower cumulative smoking history. Differences in socioeconomic and environmental factors likely contribute to lung cancer disparities, but less is known about acquired biologic alterations that can promote initiation and progression of lung cancer, particularly in African Americans. This is of interest because there may be other biological, genetic, or environmental factors contributing to lung cancer outcomes as it relates to differences in gender and race. One potential biologic variable may be in the DNA repair capacity (DRC), which describes a cell’s ability to repair damage to DNA caused by carcinogens, oxidants, and radiation. Altered DNA repair is a hallmark of cancer, leading to mutations and malignant transformation. We hypothesize that DRC is decreased in African Americans with lung cancer compared to Caucasian Americans with lung cancer, contributing to the disparity that exists in this racial group. We will 1) perform a retrospective chart review to determine demographic differences between African Americans and Caucasians at three central Indiana hospitals and 2) determine the impact of race and lung cancer on DRC amongst African Americans and Caucasians with and without lung cancer. METHODS/STUDY POPULATION: Lung cancer patients are identified in 3 central Indiana hospitals with different payer source and patient populations using ICD codes. Collected demographics include age, gender, pack-years, lung cancer histology, treatment, and mortality. DRC is measured by host-cell reactivation (non-homologous end-joining and nucleotide excision repair pathways) by flow-cytometry. Measurement of DRC is performed on PBMCs obtained from 120 patients (male and female, African Americans and Caucasians with and without lung cancer). Correlation of DRC and lung cancer will be determined by comparing lung cancer diagnosis to quartile DRC, and adjusted for confounders (measured demographics). Correlative measures will include measures of DNA damage and genomic instability. RESULTS/ANTICIPATED RESULTS: 3450 lung cancer patients were diagnosed with lung cancer at Indiana University Hospital between 1/1/2000 – 5/31/2015. Of these, 48.2% were female and 92.7% smokers. African Americans, Caucasians and Other ethnicities represented 12%, 86% and 2%, respectively. Of smokers, 11.4% were African American. The primary payer source was Federal/Medicare. Retrospective review of lung cancer patients from two additional health systems (county and VA hospitals) will be performed as above with outcomes measured. DRC and additional correlative measures will be performed as in Methods. DISCUSSION/SIGNIFICANCE OF IMPACT: If present, altered DRC in African Americans compared to Caucasians may contribute to the disproportional impact of lung cancer on African Americans. If DRC is decreased in African Americans with lung cancer, future studies will focus on identifying potential genetic, epigenetic and environmental causes for this decrease.

Spatial Life Cycle Analysis of Soybean-Based Biodiesel Production in Indiana, USA Using Process Modeling

Life Cycle Analysis (LCA) has long been utilized for decision making about the sustainability of products. LCA provides information about the total emissions generated for a given functional unit of a product, which is utilized by industries or consumers for comparing two products with regards to environmental performance. However, many existing LCAs utilize data that is representative of an average system with regards to life cycle stage, thus providing an aggregate picture. It has been shown that regional variation may lead to large variation in the environmental impacts of a product, specifically dealing with energy consumption, related emissions and resource consumptions. Hence, improving the reliability of LCA results for decision making with regards to environmental performance needs regional models to be incorporated for building a life cycle inventory that is representative of the origin of products from a certain region. In this work, we present the integration of regionalized data from process systems models and other sources to build regional LCA models and quantify the spatial variations per unit of biodiesel produced in the state of Indiana for environmental impact. In order to include regional variation, we have incorporated information about plant capacity for producing biodiesel from North and Central Indiana. The LCA model built is a cradle-to-gate. Once the region-specific models are built, the data were utilized in SimaPro to integrate with upstream processes to perform a life cycle impact assessment (LCIA). We report the results per liter of biodiesel from northern and central Indiana facilities in this work. The impact categories studied were global warming potential (kg CO2 eq) and freshwater eutrophication (kg P eq). While there were a lot of variations at individual county level, both regions had a similar global warming potential impact and the northern region had relatively lower eutrophication impacts.

Prescribed fire promotes acorn survival and seedling emergence from simulated caches

Prescribed fire increasingly is used to promote oak (Quercus) establishment in many hardwood forests across North America. However, how prescribed fire affects several key components of the oak regeneration process, including acorn survival and germination, is relatively unknown. Acorn mortality during a prescribed fire is likely affected by acorn dormancy, burn season, and previous burial (caching) by scatterhoarding rodents. We assessed the effect of fall and spring prescribed fires on seedling emergence for artificially cached and un-cached northern red oak (Q. rubra) and white oak (Q. alba) acorns in situ in granivore-proof exclosures through eight prescribed fires over two years at two sites in central Indiana. The odds of cached acorn emergence were 3.4–12.1 times higher following fall and spring prescribed fires than the unburned control. Red oak emergence was 1.7 times higher following fall burns than spring burns, whereas white oak emergence was unaffected by burn season. Lower winter temperatures following fall burns may have driven observed differences between burn seasons for northern red oak acorns. Our study links the oak-rodent conditional mutualism hypothesis with the oak-fire hypothesis, by suggesting that prescribed fire may produce environmental conditions that shift interactions between oaks and scatterhoarding rodents toward a more mutualistic relationship.

Preliminary Map Showing Quaternary Geology of the Mooresville East 7.5-Minute Quadrangle, Indiana

The Mooresville East 7.5-minute quadrangle is situated near the maximum limit of Wisconsin Episode glacial deposits in northeastern Morgan County. Till and outwash of Wisconsin Episode age and Holocene alluvium are the dominant surficial materials in the quadrangle. Wisconsin Episode eolian sand, loess, and colluvium are also present, with eolian sand and colluvium being adjacent to the West Fork White River valley and loess blanketing Wisconsin Episode till and outwash. Holocene (post-glacial) alluvium is found in the West Fork White River and White Lick Creek valleys and tributaries. Mississippian Borden Group bedrock controls many aspects of the surficial geology of the southeastern sector of the quadrangle. For much of this area, bedrock controls the topography and is less than 20 ft below the ground surface. It is mantled on the summits and shoulders of interfluves mainly by Wisconsin till and minor amounts of sand and gravel (outwash) and eolian sand. The depth to bedrock (Borden Group) is greater along the trend of the modern West Fork White River valley, with depths greater than 100 ft. This bedrock paleovalley is filled with mainly Wisconsin Episode outwash (sand and gravel), and the paleovalley was a major path for meltwater in central Indiana during the Wisconsin Episode, from around 27,000 to 19,000 years ago. The Wisconsin Episode maximum limit lies just outside the quadrangle boundary to the south and east. The Laurentide Ice Sheet reached its maximum limit 24,000 years ago, based on radiocarbon dating of organics within till at the terminal moraine in the adjacent Cope quadrangle. Evidence for a readvance of the ice sheet is found in the Mooresville East quadrangle, which occurred 21,700 years ago; the southern limit of the readvance runs through the central part of the quadrangle, just south of State Highway 144.

Evaluation of the predictive reliability of a new watershed health assessment method using the SWAT model.

The purpose of watershed assessments is to give information about conditions of water quality, stream morphology, and biological integrity to identify the sources of stressors and their impacts. In recent decades, different watershed assessment methods have been developed to evaluate the cumulative impacts of human activities on watershed health and the condition of aquatic systems. In the current research, we propose a new approach for assessing watershed vulnerability to contamination based on spatial analysis by using geographic information systems (GIS) and the analytic hierarchy process (AHP) technique. This new procedure, designed to identify vulnerable zones, depends on six basic factors that represent watershed characteristics: land use/land cover, soil type, average annual precipitation, slope, depth to groundwater, and bedrock type. The general assumptions for assessing watershed vulnerability are based on the response of watersheds to different contamination impacts and how the six selected factors interact to affect watershed health. The new watershed vulnerability assessment technique was used to create maps showing the relative vulnerabilities of specific sub-watersheds in the Eagle Creek Watershed in central Indiana. The results showed a remarkable difference in watershed susceptibility between the sub-watersheds in their vulnerability to pollution. To test the reliability of the proposed vulnerability assessment technique, the SWAT (Soil and Water Assessment Tool) model was applied to predict the water quality in each sub-watershed. Using the SWAT model, some parameters (e.g., total suspended solids [TSS] and nitrate) were tested based on the availability of the data needed for comparison. Both the SWAT and the newly proposed method produced good results in predicting water quality loads, which validated the proposed method. Hence, the results of the evaluation of the predictive reliability of the watershed vulnerability assessment method revealed that the proposed approach is suitable as a decision-making tool to predict watershed health.

The BoilerWoRx Project: Mobile Public Health Advocacy

BoilerWoRx is a mobile health initiative that was created in response to Indiana's opioid public health crisis. This College of Pharmacy program is multidisciplinary with students from engineering, nursing, liberal arts, and medicine. BoilerWoRx offers education to both students and community members. There is a comprehensive training for students who volunteer with the BoilerWoRx team, which include various educational Ted Talks, naloxone training, along with assessment tool trainings. For the community members at the events, drug disposal kits, wellness education, syringe service assistance, naloxone distribution, mental health assessments, and community resources are available. Currently, BoilerWoRx is working with engineering students and the research team to create and track quality outcomes from the community events. Data collection includes: location of events, how many community members engaged, how many drug destruction bags and naloxone doses distributed, and how many individuals use the destruction bags. We currently have two grants that support the BoilerWoRx program. One is the Firestarter Grant that focuses on strengthening the partnership with the Tippecanoe County Health Department (TCHD). The second grant is from North Central Indiana Area Heath Education Center (AHEC) and is focused on providing continuing education events for providers and community healthcare workers as well as community events within each of the counties in north central Indiana that AHEC serves. The continuing education will focus on harm reduction, naloxone training and distribution, and medication assisted treatment (MAT). The initial focus of BoilerWoRx has been in the Lafayette and West Lafayette area, but the partnership with AHEC has expanded our endeavors into neighboring counties. Through this initiative, the College of Pharmacy and BoilerWoRx strive to educate community members and healthcare professionals about the resources available in their own communities and surrounding areas. Over time, this should ideally translate to improved public health outcomes across various counties in Indiana.

A GIS-Based Water Balance Approach Using a LiDAR-Derived DEM Captures Fine-Scale Vegetation Patterns

Topography exerts strong control on microclimate, resulting in distinctive vegetation patterns in areas of moderate to high relief. Using the Thornthwaite approach to account for hydrologic cycle components, a GIS-based Water Balance Toolset is presented as a means to address fine-scale species–site relationships. For each pixel within a study area, the toolset assesses inter-annual variations in moisture demand (governed by temperature and radiation) and availability (precipitation, soil storage). These in turn enable computation of climatic water deficit, the amount by which available moisture fails to meet demand. Summer deficit computed by the model correlates highly with the Standardized Precipitation–Evapotranspiration Index (SPEI) for drought at several sites across the eastern U.S. Yet the strength of the approach is its ability to model fine-scale patterns. For a 25-ha study site in central Indiana, individual tree locations were linked to summer deficit under different historical conditions: using average monthly climatic variables for 1998–2017, and for the drought year of 2012. In addition, future baseline and drought-year projections were modeled based on downscaled GCM data for 2071–2100. Although small deficits are observed under average conditions (historical or future), strong patterns linked to topography emerge during drought years. The modeled moisture patterns capture vegetation distributions described for the region, with beech and maple preferentially occurring in low-deficit settings, and oak and hickory dominating more xeric positions. End-of-century projections suggest severe deficit, which should favor oak and hickory over more mesic species. Pockets of smaller deficit persist on the landscape, but only when a fine-resolution Light Detection and Ranging (LiDAR)-derived Digital Elevation Model (DEM) is used; a coarse-resolution DEM masks fine-scale variability and compresses the range of observed values. Identification of mesic habitat microrefugia has important implications for retreating species under altered climate. Using readily available data to evaluate fine-scale patterns of moisture demand and availability, the Water Balance Toolset provides a useful approach to explore species–environment linkages.

“Joy Turned to Sorrow”: Stillborns in Howard County, Indiana, 1890–1940

This examination of north central Indiana between 1890 and 1940 offers a unique insight into the historic response to stillborn and newborn infant deaths. With a remarkable record of those interred, as well as local newspapers from these communities, the records of families who endured these losses allow us to discover their public responses to stillbirths. This examination also considers the broader social and cultural forces that shaped how families and communities responded to stillbirths, including advertisements for the famous patent medicine, Dr. Pierce’s, which promised that women taking their pills would prevent a stillborn baby, and the heavily reported Canadian Great Stork Derby.

Mind the Gaps: Facilitators and Barriers to Behavioral Change Related to Infant Mortality Rate

Background and Hypothesis: Marion County suffers from stark racial disparities in infant mortality rate (IMR) with black babies experiencing an IMR of 11.6 and white babies 4.5, to culminate at a state average of 7.3. Since 2016, WeCare Indiana has worked to reduce the IMR in Central Indiana by connecting pregnant, post-partum, and childbearing age women with Community Health Workers (CHW) and community organizations that help with areas including but not limited to baby supplies, housing, and food insecurity. The goal of this research was to identify factors that promote changes in behaviors in WeCare clients as well as barriers to behavior modification in relation to the five pillars of the WeCare program: food insecurity, mental health, smoking, breastfeeding, and safe sleep.&#x0D; Experimental Design or Project Methods: Qualitative analysis of unstructured CHW follow-up notes from 2016 to 2018 of 1775 WeCare clients from mostly 13 highest risk zip codes for IM in Central Indiana was completed using keyword searches and clustering narrative entries into themes associated with the apriori areas of behavioral change.&#x0D; Results: Several key influencers of behavioral change were identified: (1) CHW dissemination of eligibility information about WIC, (2) CHW referral of clients to behavioral health resources, and (3) Pack n Play resources bundled with Safe Sleep class. Persistent barriers to positive behavioral change included: (1) lack of transportation to food resources, (2) unmanaged stress propagating substance use and smoking, (3) employment interfering with breastfeeding, and (4) lack of Safe Sleep education for all caretakers.&#x0D; Conclusion and Potential Impact: Next steps include sharing qualitative findings with CHW to reinforce positive behavioral change as well as investigating solutions for the barriers that prevent change within the five pillars of WeCare Indiana. Data from this study will be used to help interpret the calculated behavioral change scores relative to baseline measures that were found from quantitative analysis.