Indiana Counties Research Articles

Population Structure and Mating Type Distribution of Cercospora sojina from Soybeans in Indiana, United States.

Frogeye leaf spot on soybeans is traditionally considered as a southern disease in the United States but its impact in North Central USA has been rising in recent years. In this study, we investigated the population structure and mating type distribution in the C. sojina population from Indiana, USA. Based on 27 single nucleotide polymorphism markers, 49 multi-locus genotypes (MLGs) were identified in 234 isolates collected from 29 counties in Indiana in 2020. Bayesian analysis grouped the 49 MLGs into three clusters. This grouping was supported by principal coordinate analysis and, in large part, by the unweighted pair group method with arithmetic mean and minimal spanning tree. Only one mating-type idiomorph was found in each isolate and in each MLG. The MAT1-1 idiomorph was found in 22 MLGs and the MAT1-2 idiomorph was found in 27 MLGs. Based on clone-corrected data, the distribution of mating-type idiomorphs did not deviate significantly from 1:1 ratio in Indiana as a whole and in 22 out of 24 counties where two or more MLGs were found. Thirty MLGs contained QoI-resistant isolates and 22 MLGs contained QoI-sensitive isolates, with three MLGs containing both types of isolates. MLG1, the most common MLG with 90 isolates, contained mostly QoI-resistant isolates. Interestingly, MLG1 was also the dominant genotype in the Tennessee population collected in 2015, suggesting that MLG1 has been a dominant genotype in a wider region for many years. Based on the standard index of association (r¯d), the Indiana population as a whole was in significant linkage disequilibrium. However, in five out of 16 counties where three or more MLGs were found, the null hypothesis of linkage equilibrium was not rejected. Tests of linkage disequilibrium between locus pairs showed that 33.3% of locus pairs on the same contigs were in significant disequilibrium and 17.7% of locus pairs on different contigs were in significant disequilibrium. The possibility of a cryptic sexual stage was discussed.

Descriptive analysis of recommendations made by county-level overdose fatality review teams in indiana to combat the opioid epidemic

Overdose fatality review teams (OFRTs) are becoming more common across U.S. communities as a means of addressing the overdose epidemic and improving local overdose prevention strategies; however, empirical examinations of the work of OFRTs are lacking. The current study seeks to characterize recommendations for local overdose prevention strategies made by county-level OFRTs across Indiana in order to understand their practices. MethodsA qualitative descriptive content analysis was conducted on recommendations made by 19 county-level OFRTs across Indiana in 2022. ResultsOFRTs generated 1512 recommendations during 2022 based on case reviews of 291 overdose deaths occurring across 19 Indiana counties; of those, 26.8 % (n=405) were specific to the case reviewed, rather than relevant to the broader community, and were not further coded. The remaining 1109 recommendations were coded according to their overall scope, recommendation strategy, and target agency. The most common recommendations addressed substance use more broadly (e.g., improving substance use screening/assessment in healthcare settings), followed by recommendations directly addressing overdose risk (e.g., naloxone distribution, increasing harm reduction programs). Other common recommendations related to mental health, OFRT practices, and addressing social determinants of health. Common recommendation strategies were to implement new services or service improvements. ConclusionResults highlight the extent of further efforts needed to improve overdose prevention and the need for further research and support of OFRTs across the United States.

Effects of Online Naloxone Training for Laypersons: An Extended-Baseline Assessment

Background: While laypersons can play a crucial role in administering naloxone in opioid overdoses, they must be recruited and trained to effectively manage overdose events as good Samaritans. This study aimed to examine the effectiveness of a technology-based intervention that recruited and trained laypersons to administer naloxone. Methods: Opioid Rapid Response System (ORRS) was an online recruitment and training intervention which capitalized on social cognitive theory and a digital media engagement model to mobilize laypersons to administer intranasal naloxone. ORRS was developed based on a randomized waitlisted controlled trial (N = 220). This secondary analysis is a within-group, extended-baseline assessment of the waitlisted group (n = 106), considering that they served as their own control prior to receiving the training. ORRS was conducted in five counties of Indiana with adults who did not self-identify as a certified first responder. Five indices were generated from 23 variables: knowledge of overdose signs, knowledge of overdose management, self-efficacy in responding, concerns about responding, and intent to respond. Paired t-test compared changes between 3 timepoints. Results: Three indices had significantly greater increases associated with training compared to extended baseline: recognizing opioid overdose signs (difference = 0.08; 95%CI = 0.02, 0.15; t = 2.48; p = 0.01); knowledge of overdose management (difference = 0.27; 95%CI = 0.18, 0.35; t = 5.99; p < 0.01); and self-efficacy in overdose management (difference = 0.68; 95%CI = 0.45, 0.91; t = 5.78; p < 0.01). Concerns related to overdose management significantly decreased as expected (difference = −1.53; 95%CI = −1.86, −1.21; t = −9.27; p < 0.01). Conclusions: ORRS provided strong support for self-efficacy, concerns, and knowledge related to overdose management, and the digital modality accelerates largescale dissemination.

Detection of the benzodiazepine bromazolam by liquid chromatography with quadrupole time of flight mass spectrometry in postmortem toxicology casework and prevalence in Indiana (2023).

For the past 60 years, benzodiazepines such as chlordiazepoxide, diazepam, and alprazolam have been used as pharmaceutical medications for the treatment of myriad conditions including anxiety, seizures, and insomnia. In more recent years, novel benzodiazepine derivatives have emerged as illicit substances in powders and counterfeit tablets on the illicit drug market. In 2016, bromazolam, a brominated derivative of alprazolam, emerged on the illicit drug market in Europe, but the substance was not reported in the USA until 2019-2020. In this study, we report the emergence and subsequent prevalence of bromazolam in postmortem blood in the state of Indiana during 2023. Analysis was completed by a solvent protein precipitation extraction with acetonitrile and detection by liquid chromatography with quadrupole time of flight mass spectrometry. During 2023, bromazolam was detected in 94 cases across 25 counties in Indiana. It was never the sole substance detected and was commonly detected alongside fentanyl (83 cases), norfentanyl (77 cases), 4-anilino-N-phenethylpiperidine (76 cases), acetylfentanyl (49 cases), methamphetamine (32 cases), naloxone (25 cases), 11-nor-9-carboxy-tetrahydrocannabinol (24 cases), and benzoylecgonine (20 cases). After official query with the Indiana Department of Health, it was found that bromazolam was specifically included in the cause of death certification in 31 fatalities (32.9%). Due to the scarcity of information regarding this novel benzodiazepine derivative in postmortem toxicology and its involvement in fatalities, it is important that forensic toxicology laboratories consider adding bromazolam to their comprehensive scope of analysis.

Cytauxzoonosis in Indiana, USA: a case series of cats infected with Cytauxzoon felis (2018-2022).

This case series describes six cases involving seven cats naturally infected with Cytauxzoon felis in Indiana, USA. Medical records were retrospectively reviewed and all available information on signalment, history, clinical and diagnostic findings, treatment, outcome and pathology was reported. Cats infected with C felis were domestic shorthairs, were aged between 2 and 9 years and all but one of the cats were male. The seven infected cats originated from five counties in southwestern Indiana. Six of seven cats were found to have acute cytauxzoonosis based on clinical signs, gross pathologic lesions, observation of C felis in tissues and/or detection of C felis DNA. One cat was identified as a subclinical survivor cat with no known clinical history of cytauxzoonosis. The reported cases are the first confirmed reports of acute and chronic cytauxzoonosis in cats from Indiana and document an expansion in the range of C felis. Veterinary practitioners in Indiana should consider infection with C felis as a differential diagnosis for cats that present with fever, inappetence, lethargy, depression, dehydration, dyspnea, hemolytic crisis, anorexia or icterus. Administration of approved acaricides to cats currently offers the best protection and control against C felis infection.

The influence of rurality on melanoma diagnosis in Indiana: A retrospective cohort study.

Research from across the United States has shown that rurality is associated with worse melanoma outcomes. In Indiana, nearly a quarter of all residents live in rural counties and an estimated 2180 cases of melanoma will be diagnosed in 2023. This study examines how geographical location affects the stage of melanoma diagnosis in Indiana, aiming to identify and address rural health disparities to ultimately ensure equitable care. Demographics and disease characteristics of patients diagnosed with melanoma at Indiana University Health from January 2017 to September 2022 were compared using Students t-tests, Wilcoxon tests, chi-squared or Fisher's exact tests. Patients from rural areas presented with more pathological stage T3 melanomas (15.0% vs. 3.5%, p < 0.001) in contrast to their urban counterparts. Additionally, rural patients presented with fewer clinical stage I melanomas (80.8% vs. 89.3%) and more clinical stage II melanomas (19.2% vs. 8.1%), compared to urban patients, with no stage III (p = 0.028). Concerningly, a significantly higher percentage of the rural group (40.7%) had a personal history of BCC compared to the urban group (22.6%) (p = 0.005) and fewer rural patients (78.0%) compared to urban patients (89.4%) received surgical treatment (p = 0.016). Patients from rural counties in Indiana have higher pathological and clinical stage melanoma at diagnosis compared to patients from urban counties. Additionally fewer rural patients receive surgical treatment and may be at higher risk of developing subsequent melanomas.

First report of Calonectria ilicicola causing red crown rot of soybean in Indiana.

Soybean (Glycine max [L.] Merr.) samples from commercial fields in Decatur and Spencer counties, Indiana were submitted to the Purdue Plant and Pest Diagnostic Lab in August to October 2022. Plants exhibited whole-leaf to interveinal chlorosis of the foliage, red to dark brown external lesions on the crown spreading from the soil-line upward, and severe root rot. In the fields, patches of diseased plants were observed, with greater than 50% of the plants affected and yield loss up to 50%. Orange to red perithecia were present on the exterior of symptomatic stem tissue and ranged in size from 329 to 433 × 232 to 306 µm (n = 10). Stems were surface sterilized in 10% Clorox (0.825% NaOCl) for 1 min, then rinsed with sterile distilled water and dried. In a laminar flow hood, sections of symptomatic stem tissue were plated on using quarter-strength potato dextrose agar (QPDA) and incubated under fluorescent lights on a 12-hr light/dark cycle at 20°C. After 6 days, fungal colonies with fluffy aerial hyphae, which were white near the colony margins and orange to burnt-red near their center, grew uniformly from the stem tissue plated. Elongate, cylindrical hyaline conidia with zero to three septations measuring 45.5 to 73.8 × 4.4 to 6.7 µm (n = 22) grew in clusters from symptomatic stem tissue within the plate. Perithecia developed after 14 days. Falcate, hyaline ascospores with one to two septa measuring 29.4 to 54.7 × 4.6 to 6.8 (n = 23) µm developed within the perithecia. Calonectria ilicicola Boedijn & Reitsma was confirmed based on morphological characteristics (Padgett et al. 2015). Isolate PPDL 22-01457B was used for DNA extraction using the ZR Fungal/Bacterial DNA Miniprep kit (Zymo Research, Irvine, CA). The internal transcriber region (ITS), actin (ACT) and β-tubulin (TUB2) genes were amplified (Carbone and Kohn 1999; Glass and Donaldson 1995; O'Donnell and Cigelnik 1997; White et al. 1990). Amplicons were sent for Sanger sequencing (Genewiz, Inc., South Plainfield, NJ), submitted to Genbank, and assigned accession numbers ITS: OQ932995, Actin: OR484986, and β-tubulin: OR546281. Sequences were analyzed using the NCBI BLASTn tool with results showing 99.5 to 100% identical to C. ilicicola (GenBank accessions LC500063, OQ303403, CP085825, respectively). To perform Koch's Postulates, 90 soybean seeds (CP3620E) were planted in potting media (Berger, Saint-Modeste, Quebec, Canada) in a seed flat with 45 of the plants used as controls and grown under grow lights for 16hr light/8hr dark at 20℃. Individual seedling crowns were inoculated 3 days post-emergence with a 5 to 10 ml spore and hyphal suspension that was scraped from the surface of a 14-day old QPDA culture after adding 300 mL deionized (DI) to each plate grown at 20 to 22°C. The control plants received sterile-DI water. Plants were covered in a plastic bag for 72 h. Plant stems were sprayed with sterile-DI water once a day for seven days. Symptoms were observed after four days, but significant crown rot and lesions developed after two weeks before wilting and dying. Calonectria iliciola was isolated uniformly from symptomatic plants and identified morphologically. Control plants showed no symptoms. Inoculations were repeated 3 times with similar results. As of fall 2023, red crown rot has been confirmed in Adams and Rush counties in Indiana. Red crown rot has been confirmed in several Midwest states (Kleczewski et al. 2019, Neves et al. 2023), but the extent of its distribution and disease management strategies are still limited.

Bedrock Geologic Database of the Indiana Portions of the Princeton, Evansville, Mount Vernon, and West Frankfort 30- x 60-minute Quadrangles

Located in the eastern Illinois Basin, the Princeton 1:100,000-scale quadrangle comprises portions of Knox, Gibson, Pike, Dubois, Posey, Vanderburgh, Warrick, and Spencer Counties in Indiana as well as small portions of Edwards, Gallatin, Wabash, and White Counties in Illinois. The mapped area is situated in the rolling topography of the Wabash Lowland and dominated by Pennsylvanian-age coal-bearing strata. Pennsylvanian siliciclastics in the Princeton quadrangle host economically important coal seams. The most widespread coal beds occur in the Carbondale Group, but the Raccoon Creek Group hosts coal of superior quality (low sulfur, low ash) in Indiana. Surface and underground mining of these coals have been extensive, with expansive impacts on the landscape and subsequent reclamation. Bedrock outcrops are obscured mainly by glacial sediments and extensive fluvial deposits from the Wabash River that formed deep channels (paleo and active) filled with outwash and alluvium. The geologic map of Gray and others (1970), the Compendium of Paleozoic Rock-Unit Stratigraphy in Indiana (1986), and Indiana Geologic Names Information System (IGNIS, https://legacy.igws.indiana.edu/ignis/) are the fundamental compilation of previous geological knowledge from this area. Additional data come from previous 1:24,000-scale mapping through the National Cooperative Mapping Program STATEMAP component. However, most information for the Bedrock Geologic Database of the Indiana Portions of the Princeton, Evansville, Mount Vernon, and West Frankfort 30- x 60-minute Quadrangles and, more broadly, the western corridor, is derived from Indiana-scale coal seam mapping conducted between 2011 and 2017 based on the National Coal Resources Data System (NCRDS), Indiana Coal Quality Database (ICQD), and geophysical logs from oil and gas wells archived in the Petroleum Database Management System (PDMS). The majority of these data were previously presented in Esri-based Indiana Coal Atlas StoryMaps for the entire western corridor. This geologic mapping project was funded in part through the STATEMAP Program supported by the U.S. Geological Survey under Cooperative Agreement No. G22AC00424. The Bedrock Geologic Database of the Indiana Portions of the Princeton, Evansville, Mount Vernon, and West Frankfort 30- x 60-minute Quadrangles is a composite geodata set that conforms to "GeMS (Geologic Map Schema)--a standard format for the digital publication of geologic maps," available at http://ngmdb.usgs.gov/Info/standards/GeMS/. Metadata records associated with each element within the geodata set contain more detailed descriptions of their purposes, constituent entities, and attributes. An OPEN shapefile version of the data set is also available. It consists of shapefiles, DBF files, and delimited text files and retains all information in the native geodatabase, but some programming will likely be necessary to assemble these components into usable formats.

Stigma as a local process: Stigma associated with opioid dependency in a rural-mixed Indiana county

BackgroundBecause the nature and magnitude of stigmatizing views associated with opioid dependency vary by social, cultural, and structural factors, strategies to reduce public stigma towards opioid dependency should vary by context. We leverage a unique dataset with evidence of multiple stigmatizing views to understand how to target interventions to reduce stigma in a state disproportionately impacted by the opioid epidemic, with a specific focus on a rural-mixed county. MethodsData come from the representative Person-to-Person Health Study (2018–2020) of 2,050 Indiana residents, 224 from the rural-mixed Fayette County. Bivariate statistics and multivariate regression analyses were used to evaluate the association between Fayette County and measures of stigma (e.g., desire for social distance, prejudice, causal attributions) relative to the rest of Indiana. ResultsFayette County statistically differed from the rest of Indiana on most demographic characteristics and measures of stigmatizing views. Multivariate regressions revealed that compared to the rest of Indiana, residence in Fayette County was associated with a higher desire for social distance, perceptions of unpredictability, and attributing opioid dependency to genetics and the way the person was raised. ConclusionOur results contribute to growing evidence supporting the need for local approaches to address stigma. Stigma in Fayette County primarily reflects concerns about how people manage their opioid dependency. Strategies focusing on treatment and recovery potential, accompanied by extending the influence of supportive stakeholders and policies, will become important to address this stigma.

Indiana Contraceptive Use Metrics through PATH4YOU Program: Initial Review

Objective—PATH4YOU is Indiana’s first state-wide contraceptive access project and provides contraceptive access via in-person and telehealth visits using a reproductive justice framework. Our objective was to evaluate outcomes of the PATH4YOU program to determine the distribution of contraceptive access among people in Indiana.&#x0D; Study Design—We analyzed programmatic data of reproductive-age people who received care in the PATH4YOU program from September 2021 to June 2023. All participants received pregnancy intention screening, comprehensive contraceptive counseling and decision support, and no-cost contraceptive method access, including long-acting reversible contraception (LARC). We evaluated age, location (county), primary method of contraception received, partner site visited, and in-person vs telehealth visit type using descriptive statistics. Geographical mapping analysis was used to determine areas of Indiana most impacted by the PATH4YOU program.&#x0D; Results—Between September 2021 and June 2023, 1,024 people received care at 1,231 visits through the PATH4YOU program. The average age of participants was 27.6 years old. A significant (49.3%) proportion of the participants live in Marion County. The most common primary methods of contraception were the implant (25.8%), contraceptive pills (20.5%), and intrauterine devices (16.0%). The most visited partner sites included People’s Health Center in Indianapolis (24.8%) and via telehealth (22.5%). Most people received contraceptive access in one in-person (66.0%) or telehealth (17.9%) visit.&#x0D; Conclusion—The PATH4YOU state-wide contraceptive access project provided a range of contraceptive methods via both in-person and telehealth visits to a wide reach of people across multiple counties in Indiana.&#x0D; Implications—The unique PATH4YOU model of care using both in-person and telehealth visits is a novel way to increase contraceptive access throughout a state with highly variable access to traditional in-person contraceptive care. Further research is necessary to evaluate direct impacts of the program on minoritized and traditionally excluded populations to evaluate long-term outcomes like maternal mortality.

DON’T SAY GAY: LGBTQIA+ INCLUSION ON LONG-TERM CARE AND ASSISTED LIVING FACILITIES’ WEBPAGES

Abstract Many LGBTQIA+ older adults experience a variety of health disparities resulting from a lifetime of minority stress. Due to experiences of discrimination, isolation, and stigmatization, LGBTQIA+ populations have higher rates of depressive symptomology and anxiety, as well as substance abuse when compared to heterosexual, cis-gender peers. They are also more likely to experience social isolation and have a lower average socioeconomic status. For older LGBTQIA+ adults who depend on long-term care, relative levels of facility inclusiveness have the potential to mitigate or exacerbate poor health outcomes. This study examines public signals of LGBTQIA+ inclusion by assisted living and long-term care facilities in the state of Indiana. Data was collected from a stratified-random sample of 100 long term care facilities, located in rural (n = 14), mixed (n = 24), and urban (n = 62) counties in Indiana. Each facility’s website was reviewed for the presence of LGBTQIA+ inclusion, operationalized as inclusive images, symbols, messages, anti-discrimination policies, and equal opportunity employment statements or logos. The most observed signals were statements or logos indicating non-discrimination, including fair housing policies (59%) and equal opportunity employment messages (32%). These policies were most common among facilities that were part of a larger ownership group. Non-policy LGBTQIA+ inclusion symbols were rare (1%) and included a blog post with tips on finding an LGBTQIA+ inclusive care community. Findings suggest an overall dearth of LGBTQIA+ inclusive signals among older adult care facilities in Indiana.

Bedrock Geologic Database of the Vincennes 30- x 60-Minute Quadrangle, Indiana

Located in the eastern Illinois Basin, the Vincennes 1:100,000-scale quadrangle comprises portions of Daviess, Knox, Sullivan, and Greene Counties in Indiana. It is situated in the rolling topography of the Wabash Lowland and dominated by Pennsylvanian-age coal-bearing strata. Pennsylvanian siliciclastics in the Vincennes quadrangle host economically significant coal seams. The most widespread coal beds occur in the Carbondale Group, but the Raccoon Creek Group hosts superior coal quality (low sulfur, low ash) in Indiana. Both surface and underground mining of these coals have been extensive, with expansive impacts on the landscape and subsequent reclamation. Bedrock outcrop is largely obscured by multiple cycles of glacial sediments, and extensive fluvial activity of the Wabash River has formed deep channels (paleo and active) filled with outwash and alluvium. The geological map of Gray and others (1970) is the fundamental compilation of previous geological knowledge from this area. Additional geological information for the Vincennes quadrangle comes from previous 1:24k-scale mapping through the STATEMAP program. Specifically, Fraser and others (1998) conducted bedrock mapping in the 7.5-minute Wheatland and Washington quadrangles, and Fraser and Zlotin (1997) did some mapping in the 7.5-minute Montgomery quadrangle. Conolly and others (1996) performed a coal availability study in the 7.5-minute Wheatland quadrangle. However, the most information for the 1:100k Vincennes quadrangle and, more broadly, the western corridor, comes from the Indiana-scale coal seam mapping conducted between 2011 and 2017 based on the Indiana Coal Stratigraphic Database (NCRDS) and Indiana Coal Quality Database (ICQD), and geophysical logs from petroleum wells archived in the Petroleum Database Management System (PDMS). These data were previously presented in Esri-based Indiana Coal Atlas StoryMaps for the entire western corridor (Drobniak and others, 2017a, 2017b, 2017c, 2017d). This geologic map was funded in part through the STATEMAP Program supported by the U.S. Geological Survey under Cooperative Agreement No. G21AC10646. The Bedrock Geologic Database of the Vincennes 30- x 60- Minute Quadrangle is a composite geodata set that conforms to "GeMS (Geologic Map Schema)--a standard format for the digital publication of geologic maps," available at http://ngmdb.usgs.gov/Info/standards/GeMS/. Metadata records associated with each element within the geodata set contain more detailed descriptions of their purposes, constituent entities, and attributes. An OPEN shapefile version of the data set is also available. It consists of shapefiles, DBF files, and delimited text files and retains all information in the native geodatabase, but some programming will likely be necessary to assemble these components into usable formats.

Developing the Opioid Rapid Response System™ for Lay Citizen Response to the Opioid Overdose Crisis: a Randomized Controlled Trial.

Emergency responders face challenges in arriving timely to administer naloxone in opioid overdoses. Therefore, interest in having lay citizens administer naloxone nasal spray has emerged. These citizens, however, must be recruited and trained, and be in proximity to the overdose. This study aimed to develop the Opioid Rapid Response System (ORRS)tm to meet this need by developing a system to recruit and train citizen responders and evaluate outcomes in a randomized clinical trial. ORRS recruitment messages and training platform were developed iteratively and then outcomes for each were evaluated in a randomized, unblinded two-arm waitlist-controlled trial. ORRS was field tested in 5 Indiana counties, recruiting adult citizen responders (age 18 or older) who did not self-identity as a certified first responder. Participants were recruited using either personal or communal messages and then randomly assigned to online naloxone training and waitlisted-control conditions. Pre- and post-surveys were administered online to measure the exposure to recruitment messages and training effects on knowledge of opioid overdose, confidence responding, concerns about responding, and intent to respond. Of the 220 randomized participants (114 training, 106 waitlisted-control), 140 were analyzed (59 training, 81 waitlisted-control). Recruited participants more frequently identified with communal appeal than with the personal appeal (chi-square = 53.5; p < 0.0001). Between-group differences for intervention effects were significant for knowledge of overdose signs (Cohen's d = 1.17), knowledge of overdose management (d = 1.72), self-efficacy (d = 1.39), and concerns (d = 1.31), but not for intent (d = 0.17), which suffered from a ceiling effect. ORRS provides stronger support for efficacy than that reported for other training interventions and the digital modality eases rapid dissemination.Trial Registration: NCT04589676.

County-level correlates of completed HPV vaccination in Indiana

The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9–14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9–14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.

COVID-19 and Policing: A Qualitative Study of Sheriff Departments in Rural Indiana

The main objective of this research was to explore and analyze the impact of the COVID-19 pandemic on practices in law enforcement and jails, with a specific focus on sheriff departments serving in small, rural counties in the state of Indiana. This study identified and analyzed various issues and trends pertaining to COVID-19's effect upon jail and offender management, patrol and criminal investigation, personnel and offender safety, public service and expectations, courthouse trial and case management, and community trust in sheriff departments. Semi-structured interviews were employed with current sheriffs working in four different counties in Indiana in this qualitative research. The results showed that COVID-19 has brought to the forefront two major themes: (a) precautions taken by sheriff departments against COVID-19 and (b) changes in the way the criminal justice system works. Findings were further grouped into three categories according to each sheriff’s sentiments: negative (e.g., increase in expenses, loss of workforce, and mental health), positive (e.g., decrease in the workload and decrease in jail population), and mixed (e.g., precautions against COVID-19, changing crime patterns, and trust). The study concluded that COVID-19 caused a wave of change that sent ripples through these communities, the criminal justice system, and sheriff departments in particular.

Pretrial Decision-Making Matrices: The Role of Risk and Charge Weighting in Risk Assessment–Guided Decisions

Pretrial risk assessments are used in local pretrial settings to inform release and supervision decisions. Yet, there is little research on the implementation of pretrial risk assessments in practice. We examined the characteristics of pretrial decision-making matrices in a statewide sample of counties using the same risk assessment tool. We procured pretrial decision-making matrices from 29 Indiana counties that had received or were in the process of receiving pretrial certification (88.6% response rate). Using a structured coding protocol, we found matrices shared common features but differed in their structure and available release and supervision options. Matrices weighted index charge information more heavily than risk assessment information, suggesting risk assessments likely explain between 20% and 36% of variability in decisions given typical rates of judicial adherence. Local decision-makers should be aware that structuring matrices to weight charge information more heavily than risk assessment information may limit the risk management potential of these tools.

“That Doesn’t Sound Like a Good Treatment”: Objections to Medications for Opioid Use Disorder (MOUD) and Moral Capital in Rural Indiana

Stigma associated with the use of the medications for opioid use disorder (MOUD), methadone and buprenorphine, is widespread and pervasive. I examine local perspectives toward MOUD in a rural Indiana county through 29 qualitative interviews with people with and without opioid use experience. Objections to Methadone Maintenance Treatment (MMT) voiced by interviewees centered on the perceived length of treatment, the continuation of an addict habitus or disposition, and the profit motives of the local MMT clinic. Local understandings of the temporal rationalities associated with methadone and buprenorphine treatment were used by interviewees in determinations of treatment legitimacy, as well as its moral acceptability. In rural contexts, the loss of moral capital known to accompany any association with illicit substance use can threaten economic survival for the poor. MOUD providers may want to carefully consider the meaning and experience of time with regard to treatment duration, as well as the moral landscapes of rural contexts, while creating treatment plans and communicating them to patients.

Understanding comorbidities and health disparities related to COVID-19: a comprehensive study of 776936 cases and 1362545 controls in the state of Indiana, USA.

To characterize COVID-19 patients in Indiana, United States, and to evaluate their demographics and comorbidities as risk factors to COVID-19 severity. EHR data of 776936 COVID-19 cases and 1362545 controls were collected from the COVID-19 Research Data Commons (CoRDaCo) in Indiana. Data regarding county population and per capita income were obtained from the US Census Bureau. Statistical analysis was conducted to determine the association of demographic and clinical variables with COVID-19 severity. Predictive analysis was conducted to evaluate the predictive power of CoRDaCo EHR data in determining COVID-19 severity. Chronic obstructive pulmonary disease, cardiovascular disease, and type 2 diabetes were found in 3.49%, 2.59%, and 4.76% of the COVID-19 patients, respectively. Such COVID-19 patients have significantly higher ICU admission rates of 10.23%, 14.33%, and 11.11%, respectively, compared to the entire COVID-19 patient population (1.94%). Furthermore, patients with these comorbidities have significantly higher mortality rates compared to the entire COVID-19 patient population. Health disparity analysis suggests potential health disparities among counties in Indiana. Predictive analysis achieved F1-scores of 0.8011 and 0.7072 for classifying COVID-19 cases versus controls and ICU versus non-ICU cases, respectively. Black population in Indiana was more adversely affected by COVID-19 than the White population. This is consistent to findings from existing studies. Our findings also indicate other health disparities in terms of demographic and economic factors. This study characterizes the relationship between comorbidities and COVID-19 outcomes with respect to ICU admission across a large COVID-19 patient population in Indiana.

Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents.

Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.

The continuing evolution of a cancer prevention, screening, and survivorship ECHO: A second year of implementation.

An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non-specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback-driven curriculum design. Cancer care is multi-disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States.