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- Scholarship from the Division of Diversity, Equity and Inclusion as well as IUPUI authored or connected scholarship about diversity.
Recent Submissions
Special Section on Inclusive Digital Health: Notable Papers on Addressing Bias, Equity, and Literacy to Strengthen Health Systems
(Thieme, 2022-12-04) Dixon, Brian E.; Holmes, John H.; Epidemiology, Richard M. Fairbanks School of Public Health
Objective: To summarize significant research contributions on addressing bias, equity, and literacy in health delivery systems published in 2021.
Methods: An extensive search using PubMed and Scopus was conducted to identify peer-reviewed articles published in 2021 that examined ways that informatics methods, approaches, and tools could address bias, equity, and literacy in health systems and care delivery processes. The selection process comprised three steps: (1) 15 candidate best papers were first selected by the two section editors; (2) external reviewers from internationally renowned research teams reviewed each candidate best paper; and (3) the final selection of three best papers was conducted by the editorial committee of the Yearbook.
Results: Selected best papers represent studies that characterized significant challenges facing biomedical informatics with respect to equity and practices that support equity and literacy in the design of health information systems. Selected papers represent the full spectrum of this year’s yearbook theme. In general, papers identified in the search fell into one of the following categories: (1) descriptive accounts of algorithmic bias in medical software or machine learning approaches; (2) enabling health information systems to appropriately encode for gender identity and sex; (3) approaches to support health literacy among individuals who interact with information systems and mobile applications; and (4) approaches to engage diverse populations in the use of health information systems and the biomedical informatics workforce
Conclusions: Although the selected papers are notable, our collective efforts as a biomedical informatics community to address equity, literacy, and bias remain nascent. More work is needed to ensure health information systems are just in their use of advanced computing approaches and all persons have equal access to health care and informatics tools.
Global neuropathologic severity of Alzheimer's disease and locus coeruleus vulnerability influences plasma phosphorylated tau levels
(Springer, 2022-12-27) Murray, Melissa E.; Moloney, Christina M.; Kouri, Naomi; Syrjanen, Jeremy A.; Matchett, Billie J.; Rothberg, Darren M.; Tranovich, Jessica F.; Hicks Sirmans, Tiffany N.; Wiste, Heather J.; Boon, Baayla D. C.; Nguyen, Aivi T.; Reichard, R. Ross; Dickson, Dennis W.; Lowe, Val J.; Dage, Jeffrey L.; Petersen, Ronald C.; Jack, Clifford R., Jr.; Knopman , David S.; Vemuri, Prashanthi; Graff-Radford, Jonathan; Mielke, Michelle M.; Neurology, School of Medicine
Background
Advances in ultrasensitive detection of phosphorylated tau (p-tau) in plasma has enabled the use of blood tests to measure Alzheimer’s disease (AD) biomarker changes. Examination of postmortem brains of participants with antemortem plasma p-tau levels remains critical to understanding comorbid and AD-specific contribution to these biomarker changes.
Methods
We analyzed 35 population-based Mayo Clinic Study of Aging participants with plasma p-tau at threonine 181 and threonine 217 (p-tau181, p-tau217) available within 3 years of death. Autopsied participants included cognitively unimpaired, mild cognitive impairment, AD dementia, and non-AD neurodegenerative disorders. Global neuropathologic scales of tau, amyloid-β, TDP-43, and cerebrovascular disease were examined. Regional digital pathology measures of tau (phosphorylated threonine 181 and 217 [pT181, pT217]) and amyloid-β (6F/3D) were quantified in hippocampus and parietal cortex. Neurotransmitter hubs reported to influence development of tangles (nucleus basalis of Meynert) and amyloid-β plaques (locus coeruleus) were evaluated.
Results
The strongest regional associations were with parietal cortex for tau burden (p-tau181 R = 0.55, p = 0.003; p-tau217 R = 0.66, p < 0.001) and amyloid-β burden (p-tau181 R = 0.59, p < 0.001; p-tau217 R = 0.71, p < 0.001). Linear regression analysis of global neuropathologic scales explained 31% of variability in plasma p-tau181 (Adj. R2 = 0.31) and 59% in plasma p-tau217 (Adj. R2 = 0.59). Neither TDP-43 nor cerebrovascular disease global scales independently contributed to variability. Global scales of tau pathology (β-coefficient = 0.060, p = 0.016) and amyloid-β pathology (β-coefficient = 0.080, p < 0.001) independently predicted plasma p-tau217 when modeled together with co-pathologies, but only amyloid-β (β-coefficient = 0.33, p = 0.021) significantly predicted plasma p-tau181. While nucleus basalis of Meynert neuron count/mm2 was not associated with plasma p-tau levels, a lower locus coeruleus neuron count/mm2 was associated with higher plasma p-tau181 (R = -0.50, p = 0.007) and higher plasma p-tau217 (R = -0.55, p = 0.002). Cognitive scores (Adj. R2 = 0.25–0.32) were predicted by the global tau scale, but not by the global amyloid-β scale or plasma p-tau when modeled simultaneously.
Conclusions
Higher soluble plasma p-tau levels may be the result of an intersection between insoluble deposits of amyloid-β and tau accumulation in brain, and may be associated with locus coeruleus degeneration.
Systematic literature review and meta-analysis of clinical outcomes and prognostic factors for melanoma brain metastases
(Frontiers, 2022-12-07) Tan, Xiang-Lin; Le, Amy; Scherrer, Emilie; Tang, Huilin; Kiehl, Nick; Han, Jiali; Jiang, Ruixuan; Diede, Scott J.; Shui, Irene M.; Epidemiology, Richard M. Fairbanks School of Public Health
Background: More than 60% of all stage IV melanoma patients develop brain metastases, while melanoma brain metastases (MBM) is historically difficult to treat with poor prognosis.
Objectives: To summarize clinical outcomes and prognostic factors in MBM patients.
Methods: A systematic review with meta-analysis was conducted, and a literature search for relevant studies was performed on November 1, 2020. Weighted average of median overall survival (OS) was calculated by treatments. The random-effects model in conducting meta-analyses was applied.
Results: A total of 41 observational studies and 12 clinical trials with our clinical outcomes of interest, and 31 observational studies addressing prognostic factors were selected. The most common treatments for MBM were immunotherapy (IO), MAP kinase inhibitor (MAPKi), stereotactic radiosurgery (SRS), SRS+MAPKi, and SRS+IO, with median OS from treatment start of 7.2, 8.6, 7.3, 7.3, and 14.1 months, respectively. Improved OS was observed for IO and SRS with the addition of IO and/or MAPKi, compared to no IO and SRS alone, respectively. Several prognostic factors were found to be significantly associated with OS in MBM.
Conclusion: This study summarizes pertinent information regarding clinical outcomes and the association between patient characteristics and MBM prognosis.
Molecular classification and biomarkers of clinical outcome in breast ductal carcinoma in situ: Analysis of TBCRC 038 and RAHBT cohorts
(Elsevier, 2022-12-12) Strand, Siri H.; Rivero-Gutiérrez, Belén; Houlahan, Kathleen E.; Seoane, Jose A.; King, Lorraine M.; Risom, Tyler; Simpson, Lunden A.; Vennam, Sujay; Khan, Aziz; Cisneros, Luis; Hardman, Timothy; Harmon, Bryan; Couch, Fergus; Gallagher, Kristalyn; Kilgore, Mark; Wei, Shi; DeMichele, Angela; King, Tari; McAuliffe, Priscilla F.; Nangia, Julie; Lee, Joanna; Tseng, Jennifer; Storniolo, Anna Maria; Thompson, Alastair M.; Gupta, Gaorav P.; Burns, Robyn; Veis, Deborah J.; DeSchryver, Katherine; Zhu, Chunfang; Matusiak, Magdalena; Wang, Jason; Zhu, Shirley X.; Tappenden, Jen; Ding, Daisy Yi; Zhang, Dadong; Luo, Jingqin; Jiang, Shu; Varma, Sushama; Anderson, Lauren; Straub, Cody; Srivastava, Sucheta; Curtis, Christina; Tibshirani , Rob; Angelo, Robert Michael; Hall , Allison; Owzar , Kouros; Polyak , Kornelia; Maley, Carlo; Marks, Jeffrey R.; Colditz, Graham A.; Hwang, E. Shelley; West , Robert B.; Medicine, School of Medicine
Ductal carcinoma in situ (DCIS) is the most common precursor of invasive breast cancer (IBC), with variable propensity for progression. We perform multiscale, integrated molecular profiling of DCIS with clinical outcomes by analyzing 774 DCIS samples from 542 patients with 7.3 years median follow-up from the Translational Breast Cancer Research Consortium 038 study and the Resource of Archival Breast Tissue cohorts. We identify 812 genes associated with ipsilateral recurrence within 5 years from treatment and develop a classifier that predicts DCIS or IBC recurrence in both cohorts. Pathways associated with recurrence include proliferation, immune response, and metabolism. Distinct stromal expression patterns and immune cell compositions are identified. Our multiscale approach employed in situ methods to generate a spatially resolved atlas of breast precancers, where complementary modalities can be directly compared and correlated with conventional pathology findings, disease states, and clinical outcome.
Combination Therapy With Rapamycin and Low Dose Imatinib in Pulmonary Hypertension
(Frontiers Media, 2021-11-11) Shi, Yinan; Gu, Chenxin; Zhao, Tongtong; Jia, Yangfan; Bao, Changlei; Luo, Ang; Guo, Qiang; Han, Ying; Wang, Jian; Black, Stephen M.; Desai, Ankit A.; Tang, Haiyang; Medicine, School of Medicine
Rationale:
Enhanced proliferation and distal migration of human pulmonary arterial smooth muscle cells (hPASMCs) both contribute to the progressive increases in pulmonary vascular remodeling and resistance in pulmonary arterial hypertension (PAH). Our previous studies revealed that Rictor deletion, to disrupt mTOR Complex 2 (mTORC2), over longer periods result in a paradoxical rise in platelet-derived growth factor receptor (PDGFR) expression in PASMCs. Thus, the purpose of this study was to evaluate the role of combination therapy targeting both mTOR signaling with PDGFR inhibition to attenuate the development and progression of PAH.
Methods and Results:
Immunoblotting analyses revealed that short-term exposure to rapamycin (6h) significantly reduced phosphorylation of p70S6K (mTORC1-specific) in hPASMCs but had no effect on the phosphorylation of AKT (p-AKT S473, considered mTORC2-specific). In contrast, longer rapamycin exposure (>24 h), resulted in differential AKT (T308) and AKT (S473) phosphorylation with increases in phosphorylation of AKT at T308 and decreased phosphorylation at S473. Phosphorylation of both PDGFRα and PDGFRβ was increased in hPASMCs after treatment with rapamycin for 48 and 72 h. Based on co-immunoprecipitation studies, longer exposure to rapamycin (24-72 h) significantly inhibited the binding of mTOR to Rictor, mechanistically suggesting mTORC2 inhibition by rapamycin. Combined exposure of rapamycin with the PDGFR inhibitor, imatinib significantly reduced the proliferation and migration of hPASMCs compared to either agent alone. Pre-clinical studies validated increased therapeutic efficacy of rapamycin combined with imatinib in attenuating PAH over either drug alone. Specifically, combination therapy further attenuated the development of monocrotaline (MCT)- or Hypoxia/Sugen-induced pulmonary hypertension (PH) in rats as demonstrated by further reductions in the Fulton index, right ventricular systolic pressure (RVSP), pulmonary vascular wall thickness and vessel muscularization, and decreased proliferating cell nuclear antigen (PCNA) staining in PASMCs.
Conclusion:
Prolonged rapamycin treatment activates PDGFR signaling, in part, via mTORC2 inhibition. Combination therapy with rapamycin and imatinib may be a more effective strategy for the treatment of PAH.