Indianapolis Metropolitan Area Research Articles

Examining associations between social vulnerability indices and COVID-19 incidence and mortality with spatial-temporal Bayesian modeling

This study compares two social vulnerability indices, the U.S. CDC SVI and SoVI (the Social Vulnerability Index developed at the Hazards Vulnerability & Resilience Institute at the University of South Carolina), on their ability to predict the risk of COVID-19 cases and deaths. We utilize COVID-19 cases and deaths data for the state of Indiana from the Regenstrief Institute in Indianapolis, Indiana, from March 1, 2020, to March 31, 2021. We then aggregate the COVID-19 data to the census tract level, obtain the input variables, domains (components), and composite measures of both CDC SVI and SoVI data to create a Bayesian spatial-temporal ecological regression model. We compare the resulting spatial-temporal patterns and relative risk (RR) of SARS-CoV-2 infection (COVID-19 cases) and associated death. Results show there are discernable spatial-temporal patterns for SARS-CoV-2 infections and deaths with the largest contiguous hotspot for SARS-CoV-2 infections found in the southwest of the Indianapolis metropolitan area. We also observed one large contiguous hotspot for deaths that stretches across Indiana from the Cincinnati area in the southeast to just east and north of Terre Haute (southeast to west central). The spatial-temporal Bayesian model shows that a 1-percentile increase in CDC SVI was significantly (p ≤ 0.05) associated with an increased risk of SARS-CoV-2 infection by 6 % (RR = 1.06, 95 %CI = 1.04 -1.08). Whereas a 1-percentile increase in SoVI was significantly predicted to increase the risk of COVID-19 death by 45 % (RR = 1.45, 95 %CI =1.38 – 1.53). Domain-specific variables related to socioeconomic status, age, and race/ethnicity were shown to increase the risk of SARS-CoV-2 infections and deaths. There were notable differences in the relative risk estimates for SARS-CoV-2 infections and deaths when each of the two indices were incorporated in the model. Observed differences between the two social vulnerability indices and infection and death are likely due to alternative methodologies of formation and differences in input variables. The findings add to the growing literature on the relationship between social vulnerability and COVID-19 and further the development of COVID-19-specific vulnerability indices by illustrating the utility of local spatial-temporal analysis.

Examining factors that influence African‐Americans and Blacks’ participation in Alzheimer’s biomarker research

AbstractBackgroundAfrican Americans and Blacks in the US are less likely to engage in Alzheimer’s disease (AD) research studies, despite having two to three times higher risks of developing AD compared to Whites. Understanding the various factors influencing African Americans and Blacks’ participation in AD research, especially studies that involve biomarkers, is important for increasing equity in AD research, and advancing AD diagnosis and treatment for diverse populations.MethodStudy participants included 164 community‐dwelling African Americans and Blacks in the Indianapolis metropolitan area, aged 55 and older, and who had no prior participation in AD research. Participants were administered a 24‐item survey to examine their knowledge of AD, willingness to participate in biomarker research procedures (genetic testing, brain MRI, and PET Scan), and views of incentives for participation.ResultMost participants were female (68%) and had less than 16 years of education (71%). About half were 65 years old or older. Most participants (84%) reported that they did not know what caused AD or how to manage it, and only 43% were aware that “Black people are at higher risk of developing dementia, including Alzheimer’s disease, compared to Whites.” Most participants were willing to do or consider participating in biomarker procedures common in AD research studies (90% genetic testing, 86% MRI, and 82% PET scan).The majority (85%) were agreeable to future contact for research participation. Most participants viewed return of test results, particularly from cognitive testing (81%) and brain scans (82%), and information about brain health (72%) as incentives to participate in research.ConclusionOur findings revealed that older African‐American and Black participants are willing to engage in Alzheimer’s disease biomarker research study procedures. They also viewed knowledge (in the form of return of results and information about brain health) as a major incentive for participation. Our findings suggest that future outreach and recruitment strategies tailored towards African Americans and Blacks may benefit from focusing on the value of knowledge these studies can provide to participants. We also identified opportunities to educate African Americans and Blacks about their increased risk for AD and the causes and prevention of AD.

Buprenorphine and opioid analgesics: Dispensation and discontinuity among accidental overdose fatalities in the Indianapolis metropolitan area, 2016–2021

BackgroundThis study describes overall trends and sociodemographic disparities in buprenorphine and opioid analgesic uptake and prescribing patterns prior to fatal overdose events. MethodsWe examined toxicology data from all accidental overdose deaths from 2016 to 2021 (N = 2682) in a large metropolitan area. These data were linked at the individual-level with a prescription drug monitoring program (PDMP). ResultsFewer than half of all deaths had any kind of PDMP record (39.9 %, n = 1070). Among those with a buprenorphine prescription, 10.6 % (n = 35) of decedents had a buprenorphine dispensation within 7 days of their death, while the majority (64.7 %, n = 214) were dispensed buprenorphine more than 30 days prior to death. Evidence existed of racial disparities among those with any buprenorphine uptake, whereby Black individuals (7.3 %, n = 24) had significantly fewer any dispensations compared to White individuals (92.7 %, n = 307). Among those with an opioid analgesic prescription, about 12.2 % (n = 90) were dispensed within 7 days of death, with the majority (68.5 %, n = 506) occurring more than 30 days prior to death. Like buprenorphine dispensations, Black individuals were prescribed a significantly smaller proportion of opioid analgesics (21.9 %, n = 162) versus White individuals (77.7 %, n = 574). Buprenorphine was detected in 78.5 % of deaths where fentanyl was present in the toxicology record, significantly greater when compared to opioid analgesics (57.5 %). ConclusionConsistent with prior research, our findings suggest prescription opioid analgesics may protect against fatal overdoses. Access to buprenorphine treatment did not keep pace with the rising lethality of the overdose crisis, and in recent years, a smaller percentage of the people at risk of fatal overdose availed themselves of MOUD preceding their death.

Evaluation of Contraception Access within the Indianapolis Metropolitan Area

Background: Access to family planning care and the full-spectrum of contraception, including same-day access to long acting reversible contraception (LARC) is critical to reduce unintended pregnancy and maternal/infant mortality. However, access remains variable for many women in Indiana. We sought to examine access to various contraceptive practices within the Indianapolis metropolitan area. 
 
 Methods: A telephone survey of clinic managers was conducted between June-July 2020 of all identified IU Health, Eskenazi, and HealthNet primary care and OB/GYN providers in the Indianapolis metropolitan area. The 27-question survey gathered information regarding contraceptive practices (e.g. contraceptive method availability, same-day LARC insertion/removal, pregnancy intention screening, educational materials, and parental consent policies). The data was compared based on type of medical provider (OB/GYN, Family Medicine, and Pediatrics). 
 
 Results: In total, 82 sites were identified, 58 surveys (70.7%) were completed. Oral contraception is the most commonly offered contraception (91.4%), followed by depot medroxyprogesterone acetate (DMPA) injection (84.5%), and the contraceptive patch (81.0%). LARC placement is available in 51.7% of all clinics, but only 34.5% offer same-day placements. Routine pregnancy intention screening is offered in 43.1% and educational materials in 74.1% of practices. OB/GYN clinics provide the most comprehensive access, 69.2% provide same-day LARC insertion (84.6% LARC removals). Family medicine practices are variable regarding contraceptive choices: over 91% offer oral contraception and DMPA injections, but only 20.8% place LARCs and 41.7% remove LARCs. Half (50%) of pediatric clinics provide oral contraception, while 50% do not provide any contraceptives. Parental consent for minors to obtain contraception provision is highly variable. 
 
 Conclusion: Contraceptive practices vary among primary care and OB/GYN providers in the Indianapolis area. This variability in access leads to barriers for use, particularly for young women. Efforts to ensure comprehensive, same-day access to all forms of contraception (including LARCs), pregnancy intention screening, and contraceptive educational materials are needed.

EXPLORATION OF MUNICIPAL MOBILITY USING SMARTPHONE GPS DATA

Abstract. Due to the advances in location-acquisition techniques, smartphone GPS location data has emerged with opportunity for research, development, innovation, and business. A variety of research has been developed to study human behaviour through exploring patterns from these data. In this paper, we use smartphone GPS location data to investigate municipal mobility. Kernel density estimation and emerging hot spot analysis are used to the GPS dataset to demonstrate GPS user (point) distribution across space and time. Flow maps are capable of tracking clustering behaviours and direction maps drawn upon the orientation of vectors can precisely identify location of the events. Case study with Indianapolis metropolitan area traffic rush hour verifies the effectiveness of these methods. Furthermore, we identify smartphone GPS data of vehicles and develop a concise and effective method for traffic volume estimation for county highway network. It is shown that the developed smartphone GPS data analytics is powerful for predicting reliable annual average daily traffic estimation. The study showcases the capability of GPS location data in identifying municipal mobility patterns for both citizens and vehicles.

A cross-sectional community-based observational study of asymptomatic SARS-CoV-2 prevalence in the greater Indianapolis area.

The Asymptomatic novel CORonavirus iNfection (ACORN) study was designed to investigate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in the asymptomatic adult population of the Indianapolis metropolitan area, to follow individuals testing positive for the development of symptoms, and to understand duration of positive test results. ACORN is a cross‐sectional community‐based observational study of adult residents presenting asymptomatic for COVID‐like illness, defined as the self‐reported absence of the following three symptoms in the last 7 days: fever (≥100°F), new‐onset or worsening cough, and new‐onset or worsening shortness of breath. SARS‐CoV‐2 infection was determined by real‐time reverse transcription‐polymerase chain reaction in nasopharyngeal swab samples. SARS‐CoV‐2 infection prevalence was expressed as a point estimate with 95% confidence interval (CI). Test results are reported for 2953 participants who enrolled and underwent nasopharyngeal swab testing between 7 April 2020 and 16 May 2020. Among tested participants, 91 (3.1%; 95% CI: 2.5%‐3.7%) were positive for SARS‐CoV‐2. Overall, baseline characteristics, medical history, and infection risk factors were comparable between SARS‐CoV‐2 positive and negative participants. Within the ongoing 14‐day follow‐up period for positive participants, 58 (71.6%) of 81 assessed participants remained asymptomatic while others (n = 23, 28.4%) reported one or more symptoms. Indiana had “Stay‐at‐Home” orders in place during nearly the entire test period reported here, yet 3.1% of asymptomatic participants tested positive for SARS‐CoV‐2. These results indicate screening questions had limited predictive utility for testing in an asymptomatic population and suggest broader testing strategies are needed. Importantly, these findings underscore that more research is needed to understand the viral transmission and the role asymptomatic and presymptomatic individuals play in this global pandemic.

Frequency of Pediatric Emergencies in Ambulatory Practices.

We examined pediatric emergency medical services (EMS) runs originating from ambulatory practices in the greater Indianapolis metropolitan area between January 1, 2012, and December 31, 2014. Probabilistic matching of pickup location addresses and practice location data from the Indiana Professional Licensing Agency were used to identify EMS runs from ambulatory settings. A manual review of EMS records was conducted to validate the matching, categorize illnesses types, and categorize interventions performed by EMS. Demographic data related to both patients who required treatment and practices where these events occurred were also described. Of the 38 841 pediatric EMS transports that occurred during the 3-year period, 332 (0.85%) originated from ambulatory practices at a rate of 42 per 100 000 children per year. The most common illness types were respiratory distress, psychiatric and/or behavioral emergencies, and seizures. Supplemental oxygen and albuterol were the most common intervention, with few critical care level interventions. Community measures of low socioeconomic status were associated with increased number of pediatric emergencies in ambulatory settings. Pediatric emergencies in ambulatory settings are most likely due to respiratory distress, psychiatric and/or behavioral emergencies, or seizures. They usually require only basic interventions. EMS data are a valuable tool for identifying emergencies in ambulatory settings when validated with external data.

Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.

To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting. Observational, retrospective study. Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE). During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO. METHODS/INTERVENTION: A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014). The 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn). It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.

The Use of Personal Value Estimations to Select Images for Preservation in Public Library Digital Community Collections

A considerable amount of information, particularly in image form, is shared on the web through social networking sites. If any of this content is worthy of preservation, who decides what is to be preserved and based on what criteria. This paper explores the potential for public libraries to assume this role of community digital repositories through the creation of digital collections. Thirty public library users and thirty librarians were solicited from the Indianapolis metropolitan area to evaluate five images selected from Flickr in terms of their value to public library digital collections and their worthiness of long-term preservation. Using a seven-point Likert scale, participants assigned a value to each image in terms of its importance to self, family and society. Participants were then asked to explain the reasoning behind their valuations. Public library users and librarians had similar value estimations of the images in the study. This is perhaps the most significant finding of the study, given the importance of collaboration and forming partnerships for building and sustaining community collections and archives.

Remote Estimation of Nutrients for a Drinking Water Source Through Adaptive Modeling

Morse Reservoir, a major water supply for the Indianapolis metropolitan area, IN, USA, experiences nuisance cyanobacterial blooms due to agricultural and point source nutrient loadings. Hyperspectral remote sensing data from both in situ and airborne AISA measurements were applied to an adaptive model based on Genetic Algorithms-Partial Least Squares (GA-PLS) by relating the spectral signal with total nitrogen (TN) and phosphorus (TP) concentrations. Results indicate that GA-PLS relating in situ spectral reflectance to the nutrients yielded high coefficients of determination (TN: R 2 = 0.88; TP: R 2 = 0.91) between measured and estimated TN (RMSE = 0.07 mg/L; Range: 0.6–1.88 mg/L), and TP (RMSE = 0.017; Range: 0.023–0.314 mg/L). The GA-PLS model also yielded high performance with AISA imaging data, showing close correlation between measured and estimated values (TN: RMSE = 0.11 mg/L; TP: RMSE = 0.02 mg/L). An analysis of in situ data indicated that TN and TP were highly correlated with chlorophyll-a and suspended matter in the water column, setting a basis for remotely sensed estimates of TN and TP. Spatial correlation of TN, TP with chlorophyll-a and suspended matters further confirmed that remote quantification of nutrients for inland waters is based on the strong association of optically active constituents with nutrients. Based on these results, in situ and airborne hyperspectral remote sensors can provide both quantitative and qualitative information on the distribution and concentration of nutrients in Morse Reservoir. Our modeling approach combined with hyperspectral remote sensing is applicable to other productive waters, where algal blooms are triggered by nutrients.

Remote detection of cyanobacteria through phycocyanin for water supply source using three-band model

Accurate remote estimation of phycocyanin (PC) in turbid productive waters is challenging because of their optical complexity. This study aims to test the performance of three-band models (TBM) and two-band models (TWM), as well as optimal band models (OBM) for spectral estimation of PC concentration. The Eagle Creek Reservoir is one of the major drinking and recreational water systems for the Indianapolis metropolitan area and has been strongly affected by algal, particularly cyanobacterial blooms. A total of 222 effective samples collected under a diverse range of algal bloom and optical conditions in 15 field campaigns during 2006, 2007, 2008, and 2010 were used for testing different models. The TBM, using wavebands at approximately 630, 710, and 720nm, can explain 84%–93% of the PC concentration variability when applied to various datasets that were grouped in terms of different years or aggregated together. These TBMs can be used to estimate PC concentrations with RMSE ranging from 7.31 to 29.26μg/L. The results for the aggregated original, narrow band spectra, simulated MEdium Resolution Imaging Spectrometer (MERIS) and Hyperion spectra further indicate that TBM, TWM, and OBM can be used to estimate PC concentration with acceptable accuracy (0.60<R2<0.73). The TBM can be used to estimate PC concentrations with RMSE of 22.7, 31.5, and 28.3μg/L, respectively, for the original narrow band, simulated MERIS, and simulated Hyperion spectra. The TBM and OBM exhibited similar accuracy, but outperformed TWM for PC estimation. When calibrated with large representative dataset, the TBM presents robust performance, which can be used as an effective tool for water resources managers to assess cyanobacterial blooms in water supply source.

The effects of electric vehicles on residential households in the city of Indianapolis

There is an increasing impetus to transform the U.S transportation sector and transition away from the uncertainties of oil supply. One of the most viable current solutions is the adoption of electric vehicles (EVs). These vehicles allow for a transportation system that would be flexible in its fuel demands. However, utilities may need to address questions such as distribution constraints, electricity tariffs and incentives and public charging locations before large scale electric vehicle adoption can be realized. In this study, the effect of electric vehicles on households in Indianapolis is examined. A four-step traffic flow model is used to characterize the usage characteristics of vehicles in the Indianapolis metropolitan area. This data is then used to simulate EV usage patterns which can be used to determine household electricity usage characteristics. These results are differentiated by the zones with which the households are associated. Economic costs are then calculated for the individual households. Finally, possible public charging locations are examined.

Blastomycosis in Indiana: Digging Up More Cases

The endemic region of blastomycosis historically has included the state of Indiana. However, few published reports of blastomycosis exist to substantiate this distinction. A surge of patients with blastomycosis in central Indiana (Indianapolis and surrounding counties) beginning in 2005 prompted us to review our local experience. We propose that this surge was related to major highway construction around Indianapolis.We reviewed all microbiologically confirmed cases from four hospitals serving central Indiana. Chart review was completed for adult patients, and data were collected on clinical presentations, methods of diagnosis, comorbidities, radiologic findings, treatment, and outcomes. We plotted patient residence addresses with sites of highway construction.Fifty-nine patients were identified from laboratory results and physician referral. Interestingly, a surge of blastomycosis incidence occurred in 34 patients between 2005 and 2008 during which time major highway projects were under way around the Indianapolis metropolitan area. The majority of these patients presented acutely and with pulmonary involvement. Fungal culture and antigen testing were the most sensitive means to diagnosis. Antifungal therapy was highly effective.This urban outbreak of blastomycosis in Indianapolis should prompt clinicians to consider blastomycosis in this highly endemic area of histoplasmosis.

Distribution Patterns of Sciurus niger (Eastern Fox Squirrel) Leaf Nests Within Woodlots Across a Suburban/Urban Landscape

To determine habitat characteristics that influence Sciurus niger (Eastern Fox Squirrel) abundance and distribution within a suburban/urban landscape in the midwestern United States, I documented the density and placement of fox squirrel leaf nests in 20 woodlots in the Indianapolis metropolitan area, Marion County, IN. The woodlots varied in size (0.94 to 19.5 ha), approximate age, shape, and degree of isolation from other woodlots and suitable squirrel habitat in the surrounding area. Only 8.0% of nests were located in a tree with another nest, and nests were randomly distributed in all but one woodlot, where they were uniformly dispersed. Nest density was not significantly related to woodlot size, approximate age, shape, or degree of isolation. Fox squirrel leaf nests were not found in greater densities along the edge of each woodlot, contrary to previous reports. My results suggest that the distribution patterns of fox squirrels within suburban/urban landscapes are similar to patterns within landscapes fragmented by agriculture.

Health Effects of Ozone and Other Environmental Measures on Children's Respiratory Health in the Indianapolis Metropolitan Area, 1997-1999

Health Effects of Ozone and Other Environmental Measures on Children's Respiratory Health in the Indianapolis Metropolitan Area, 1997-1999

An analysis of an urban heat sink

The urban heat island effect is recognized as a common and pervasive urban climatological phenomenon. Here the less common phenomenon of an urban heat sink is examined with respect to the mechanism which might explain its formation. Thematic Mapper (TM) data for a study area of central Indiana, including the Indianapolis metropolitan area, are employed in an effort to assess the heat sink in both qualitative and quantitative terms. The phenomenon is found to be regionally pervasive under specific conditions, and quite strong (6.4°C in our central Indiana case study). Explanations of the phenomenon are sought in the temporal and surface characteristics within the study area. A number of factors have contributed to the phenomenon: time and date of data acquisition, climatological conditions relating to soil moisture and air temperature, and agricultural land preparation relating to soil density. More specific understanding of the anomalous urban heat sink is sought through an examination of urban versus rural emissivity variations. Although it is an important variable, emissivity variation does not account for the magnitude of the heat sink gradient that we have observed. The anomaly within our study area and its magnitude can only be understood with reference to low thermal inertia (and consequent low conductivity) of the soil, which in turn are the result of specific observable conditions: dry, bare, and low density soil.