Indianapolis Zoo

We know that freshwater biodiversity loss is occurring at an unprecedented rate: around one-quarter of freshwater fish, Odonata, and freshwater crabs, shrimp and crayfish are threatened with extinction. However, even in many well-studied parts of the world, we know very little or nothing about the status and trends of freshwater fungi. Aquatic fungi are vitally important to the health of our freshwaters but they are also vastly understudied, so much so that many species are not yet described or even discovered. They do not feature (yet) in conservation plans and conservation decision-making, and in general, we are simply unaware of aquatic fungi. Over the past couple of years, several important projects and groups have become established to address this deficit in aquatic fungi knowledge, including the IUCN SSC Aquatic Fungi Specialist Group. To support their efforts here in Indiana, we embarked on a project to collect, isolate and identify freshwater ascomycete fungi from submerged wood in aquatic habitats of Indianapolis, the White River and further afield. This baseline information provides a crucial first step for bio-monitoring activities and habitat restoration, so that freshwater ascomycetes, and hence clean water, can be conserved. Samples were taken from 37 sites in Indiana and have so far given insight into 20 taxa of aquatic fungi present in our freshwaters, including one new genus to science. Additionally, we continue to work on highlighting freshwater fungi and their role in the ecosystem through networking with conservation and freshwater organizations here in Indiana, networking with other ongoing freshwater projects to boost our ability to sample the state, and engaging students and the public about the project and that fungi exist in our waterways. In this talk, we will summarize our project activities so far and draw some lessons learned on how to boost the conservation of organisms that pretty much nobody knows about.

In the United States, adult human papillomavirus (HPV) vaccination coverage remains low at 20-50%, depending on age, and cervical cancer (CC) screening rates range from 68 to 76%. Few studies have evaluated characteristics of women who are both HPV vaccinated and up to date (UTD) with screening as an integrated outcome. The purpose of the present study was to classify women into four prevention categories and examine factors associated with being double protected compared to unprotected. Data were gathered via an online survey from a sample of low-income women (household income < USD 50,000) provided by a research survey company (n = 719). Women were classified into four categories: vaccinated only, screened only, both vaccinated and screened (double protected), or neither (unprotected). Sociodemographic characteristics, healthcare access, and Health Belief Model constructs were assessed. Multivariable logistic regression compared women who were double protected with those unprotected (n = 274). Most women were UTD with screening only (57.8%), while 15.5% were double protected and 22.6% were unprotected. Younger age (Odds Ratio [OR = 0.93; 95% Confidence Interval [CI]: 0.89, 0.98), having ≥1 medical visit in the past year (OR = 4.16; 95% CI: 1.74, 9.95), higher perceived CC risk (OR = 3.65; 95% CI: 1.41, 9.43), greater perceived benefits of CC screening (OR = 1.96; 95% CI: 1.45, 2.66), and higher HPV knowledge (OR = 1.09; 95% CI: 1.01, 1.17) were associated with higher odds of being double protected. A substantial proportion of low-income women lack comprehensive CC prevention. Integrated, bundled prevention strategies that simultaneously promote HPV vaccination and screening may be important to reduce CC disparities.

CASE REPORT A 51-year-old man with a history of peptic ulcer disease, complicated by perforation status postpartial gastrectomy with gastrojejunostomy (Billroth II) 6 years prior, presented with chronic diarrhea, intermittent feculent vomiting, severe weight loss, and fatigue. His symptoms had been ongoing for 4 months but progressively worsened over the past month. Laboratory evaluation revealed hypokalemia, hypoalbuminemia, and hypoproteinemia. Initial computed tomography scan with intravenous contrast alone showed no evidence of intestinal obstruction. Metabolic, hormonal, and infectious workup, including Clostridium difficile, was unrevealing. Upper endoscopy showed evidence of feculent liquid in gastric cavity (Figure 1). Anatomy was consistent with previous partial distal antrectomy and gastrojejunostomy, and a clean base marginal ulcer was observed (Figure 1). Efferent jejunal limb was characterized by healthy-appearing mucosa (Figure 1). Interestingly, another tract was identified at the anastomotic site leading into transverse colon, raising suspicion of a gastrojejunocolic fistula, approximately 25 mm in largest cross-sectional diameter (Figure 1). The fistula likely developed secondary to chronic transmural erosion of a marginal ulcer with gradual extension into the adjacent transverse colon, resulting in a mature gastrojejunocolic tract. A subsequent small bowel follow-through demonstrated contrast preferentially passing into the jejunum with retrograde flow into the transverse colon, confirming gastrojejunocolic fistula (Figure 1). The patient was started on total parenteral nutrition due to severe malabsorption and sarcopenia, with plans for surgical fistula takedown once nutritional status was optimized. Gastrojejunocolic fistula is a late complication of gastrojejunostomy and classically presents with diarrhea, feculent vomiting, and weight loss.1 Diagnosis is established by demonstrating communication between the gastric or jejunal limb and the transverse colon.1,2 Upper gastrointestinal endoscopy, computed tomography, or oral contrast studies can confirm the diagnosis.2,3 Management of chronic gastrojejunocolic fistula is primarily surgical, after optimization of nutritional status.3 Alternatively, in nonsurgical candidates with acute or subacute, smaller fistulas, endoscopic closure may be considered4Figure 1.: (A) Gastric mucosa with feculent material. (B) Gastroenterostomy with marginal ulcer (yellow arrow); gastrojejunocolic fistula (red arrow). (C) Transverse colon visualized after traversing gastrojejunocolic fistula. (D) Small bowel follow-through with contrast passing preferentially in the jejunum (blue arrow) with retrograde flow into the transverse colon (red arrow).DISCLOSURES Author contributions: R. Karna: design, drafting, revision. T. Nasereddin: design, draft. MA Butt: draft, revision. E. Aoun: concept, design, obtaining images, supervision, administrative and clinical support. R. Karna is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.

BackgroundAlthough cerebrospinal fluid (CSF) biomarkers detect Alzheimer's disease (AD) changes early, their invasiveness and cost limit widespread use. Blood‐based metabolite measures, reflecting real‐time physiological states, may offer a non‐invasive alternative for early AD detection and monitoring.MethodUsing data from the Alzheimer's Disease Neuroimaging Initiative, we measured 249 plasma metabolites via NMR spectroscopy and identified those significantly altered in AD compared to controls. We then applied Discriminative Event‐Based Modeling (DEBM) to estimate the temporal sequence of AD‐related blood metabolites alongside CSF biomarkers (Aβ42, total tau, phosphorylated tau). To validate these findings, we conducted longitudinal analyses assessing cross‐correlation with cognitive performance, mixed‐effects models relating baseline metabolites to changes in cognition over 72 months, and longitudinal mediation analyses to examine causal pathways.ResultEight plasma metabolites were significantly altered in AD (Tab. 1). DEBM indicated that two metabolite ratios—phospholipids to total lipids in medium HDL and in large LDL—potentially preceded or coincided with CSF Aβ42 (Figure 1). Cross‐correlation analyses showed both baseline CSF Aβ42 and these metabolite ratios were most strongly associated with executive function and memory at 24 months (Figure 2). Linear mixed models revealed that higher phospholipids to total lipids ratio in medium HDL was linked to better cognition and slower cognitive decline. Longitudinal mediation analysis further supported a pathway where the medium HDL ratio preceded CSF Aβ42, which in turn influenced cognitive decline.ConclusionOur results suggest that specific HDL lipid composition changes may occur very early in the AD cascade, slightly before or concurrent with CSF Aβ42 alterations. These findings support the potential utility of blood metabolite measures, particularly the phospholipids to total lipids ratio in medium HDL, as early AD biomarkers. Further research and replication in independent cohorts are needed to confirm these observations and advance non‐invasive AD screening.

Introduction: The non-steroidal mineralocorticoid receptor antagonist finerenone reduces the risk of heart failure (HF) hospitalization in people with type 2 diabetes and chronic kidney disease (CKD), but whether these benefits vary according to baseline HF risk is uncertain. Purpose: To evaluate the relative and absolute effects of finerenone on HF outcomes across different levels of HF risk, based on the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HF DM ). Methods: We conducted a post-hoc individual participant data analysis of the FIDELITY program, consisting of the FIDELIO-DKD and FIGARO-DKD trials, which assessed the efficacy and safety of finerenone versus placebo on clinical outcomes in people with type 2 diabetes and albuminuric CKD. TRS-HF DM is a validated integer-based score (0-7 points) to predict HF events based on 5 clinical variables (history of HF [2 points], history of atrial fibrillation, history of coronary artery disease, eGFR &lt;60 mL/min/1.73m 2 , UACR 30-300 mg/g, UACR &gt;300 mg/g [2 points]). Participants were categorized into 4 groups according to TRS-HF DM score at baseline (0-1, 2, 3, 4+). Relative and absolute treatment effects on HF hospitalization or cardiovascular death were examined across TRS-HF DM score categories. Results: Of 12,990 participants, 12,984 (99.95%) had available data to calculate TRS-HF DM . The proportion of participants who had a score of 0-1, 2, 3, and 4+, were 7.3%, 34.9%, 37.9%, and 19.9%, respectively. Compared with placebo, finerenone reduced the risk of time-to-first HF hospitalization or cardiovascular death (HR, 0.83; 95% CI, 0.74-0.93) with consistent relative effect across TRS-HF DM risk categories (P interaction =0.89; Figure 1 ). Relative effects on HF hospitalization (HR, 0.78; 95% CI, 0.66-0.92) and cardiovascular death (HR, 0.88; 95% CI, 0.76-1.02) were similarly consistent across TRS-HF DM risk categories (P interaction =0.42 and 0.90, respectively; Figure 1 ). Absolute risk reductions for HF hospitalization or cardiovascular death appeared greater across higher TRS-HF DM risk categories with fewer corresponding numbers needed to treat to prevent one outcome ( Figure 2 ). Conclusions: In people with type 2 diabetes and CKD, finerenone reduces the risk of HF hospitalization or cardiovascular death, with greater absolute benefits in people at higher risk for HF events.

We aimed to describe the experiences of nurses working on the COVID-19 frontlines and make recommendations for change at administrative, institutional, and health policy levels. We used a qualitative descriptive study design to gather a rich and data-near account of nurses' experiences in their own words. We conducted 10 semistructured interviews with nurses practicing in emergency departments or intensive care in the United States during the pandemic. Using Sandelowski's method, we independently coded data and identified emerging themes through an iterative process. Most nurses worked in Indiana, were in their 20s, and had less than 5 years of experience (range, 1.5-23 years; mean, 6.2 years). Five themes about pandemic nursing challenges emerged: (1) Shortages, (2) The Public's View of Nursing, (3) Death and Moral Conflict, (4) Emotional Toll, and (5) Unrealistic Expectations. Nurses reported wide-scaling challenges, which interfered with their ability to deliver high-quality patient care and impacted their mental and emotional well-being. Nurses faced significant challenges, and in many cases, the pandemic exacerbated existing issues in the healthcare system. In the aftermath of the pandemic, there remains a critical need for change at administrative, institutional, and health policy levels to support nurses and invest in the sustainability of the profession.