METHODS: 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.
CONCLUSIONS: 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.

OBJECTIVE: Open-source data systems, largely drawn from media sources, are commonly used by scholars due to the lack of a comprehensive national data system. It is unclear if these data provide an accurate and complete representation of firearm injuries and their context. The study objectives were to compare firearm injuries in official police records with media reports to better identify the characteristics associated with media reporting.
METHODS: Firearm injuries were identified in open-source media reports and compared to nonfatal firearm injury (n = 1642) data from official police records between January 1, 2021 to December 31, 2022 in Indianapolis, Indiana. Events were matched on date, location, and event circumstances. Four multivariate, multi-level mixed effects logistic regression models were conducted to assess which survivor, event, and community characteristics were associated with media reporting. Data were analyzed 2023 - January 2024.
RESULTS: Media reported 41% of nonfatal shootings in 2021 and 45% in 2022(p < 0.05), which is approximately two out of every five shootings. Shootings involving multiple survivors, children, and self-defense were more likely to be reported, whereas unintentional shootings and shootings that occurred in structurally disadvantaged communities were less likely to be reported.
CONCLUSIONS: Findings suggest that relying on media reports of firearm injuries alone may misrepresent the numbers and contexts of shootings. Public health interventions that educate journalists about these important issues may be an impactful firearm violence prevention strategy. Also, it is critical to link data systems at the local level to ensure interventions are designed and evaluated using accurate data.

In this case study, we examine a broad range of impacts on tourism and recreation based on projected changes to Indiana\'s climate. The direct impacts of climate change on Indiana include increases in the number of hot and extremely hot days each summer, fewer mild days, more rain, and less snow. Each direct impact will affect tourism and recreation. Additionally, a range of indirect impacts are anticipated, including climate-related changes in health issues, new infrastructure needs, changes in forests and other recreational areas, and shifting consumer attitudes toward travel and recreation. Although direct impacts are predictable, indirect impacts on the complex tourism system are harder to anticipate, and the tourism and recreation industry must build resilience to respond to future change. The paper concludes with recommendations for future study.

OBJECTIVE: Propose standardized communication formats and procedures at the point of distribution (POD) sites to facilitate the effective management and alleviate friction points that may occur while responding to a widespread medical incident within the National Incident Management System (NIMS).
METHODS: Through observation of POD operations and interviews with key personnel in Indiana and county emergency management agencies (EMA), identify current communication practices and propose a structured command and control (C2) framework that would streamline management requirements during a widespread activation.
METHODS: The State of Indiana, various counties throughout Indiana.
CONCLUSIONS: Current C2 practices are adequate for small-scale events. However, a standardized approach to the C2 and reporting framework may provide more responsive situational awareness and incident management of larger-scale medical incidents within Indiana.

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Outbreak detection and disease control may be improved by simplified, semi-automated reporting of notifiable diseases to public health authorities. The objective of this study was to determine the effect of an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities.
We conducted a 2-year (2012-2014) controlled before-and-after trial of a health information exchange (HIE) intervention in Indiana designed to prepopulate notifiable disease reporting forms to providers. We analyzed data collected from electronic prepopulated reports and \"usual care\" (paper, fax) reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Primary outcomes were changes in reporting rates, completeness, and timeliness between intervention and control clinics.
Provider reporting rates for chlamydia and gonorrhea in intervention clinics increased significantly from 56.9% and 55.6%, respectively, during the baseline period (2012) to 66.4% and 58.3%, respectively, during the intervention period (2013-2014); they decreased from 28.8% and 27.5%, respectively, to 21.7% and 20.6%, respectively, in control clinics (P < .001). Completeness improved from baseline to intervention for 4 of 15 fields in reports from intervention clinics (P < .001), although mean completeness improved for 11 fields in both intervention and control clinics. Timeliness improved for both intervention and control clinics; however, reports from control clinics were timelier (mean, 7.9 days) than reports from intervention clinics (mean, 9.7 days).
Electronic, prepopulated case reporting forms integrated into providers\' workflow, enabled by an HIE network, can be effective in increasing notifiable disease reporting rates and completeness of information. However, it was difficult to assess the effect of using the forms for diseases with low prevalence (eg, salmonellosis, histoplasmosis).

We examined two near-road monitoring sites where the daily PM2.5 readings were among the highest of any near-road monitoring location in the U.S. during 2014-2016: Denver, Colorado, in February 2014 and Indianapolis, Indiana, in November 2016. At the Denver site, which had the highest measured U.S. near-road 24-hr PM2.5 concentrations in 2014, concentrations exceeded the daily National Ambient Air Quality Standards (NAAQS) on three days during one week in 2014; the Indianapolis site had the second-highest number of daily exceedances of any near-road site in 2016 and the highest 3-year average PM2.5 of any near-road site during 2014-2016. Both sites had hourly pollutant, meteorological, and traffic data available, making them ideal for case studies. For both locations, we compared air pollution observations at the near-road site to observations at other sites in the urban area to calculate the near-road PM2.5 \"increment\" and evaluated the effects of changes in meteorology and traffic. The Denver near-road site consistently had the highest PM2.5 values in the Denver area, and was typically highest when winds were near-downwind, rather than directly downwind, to the freeway. Complex Denver site conditions (near-road buildings and roadway alignment) likely contributed to higher PM2.5 concentrations. The increment at Indianapolis was also highest under near-downwind, rather than directly downwind, conditions. At both sites, while the near-road site often had higher PM2.5 concentrations than nearby sites, there was no clear correlation between traffic conditions (vehicle speed, fleet mix) and the high PM2.5 concentrations.

Agricultural and urban contaminants are an environmental concern because runoff may contaminate aquatic ecosystems, resulting in stress for exposed fish. The objective of the present controlled, field-based study was to assess the impacts of high-intensity agriculture and urban land use on multiple life stages of the fathead minnow (Pimephales promelas), using the Maumee River (Toledo, OH, USA) as a case study. Laboratory cultured adult and larval fathead minnows were exposed for 21 d, and embryos were exposed until hatching to site-specific water along the lower reach of the Maumee River. Adult minnows were analyzed for reproduction and alterations to hematologic characteristics (vitellogenin, glucose, estradiol, 11-ketotestosterone). Water and fish tissue samples were analyzed for a suite of multiresidue pesticides, hormones, and pharmaceuticals. Contaminants were detected in every water and tissue sample, with 6 pesticides and 8 pharmaceuticals detected in at least 82% of water samples and at least half of tissue samples. Effects differed by exposed life stage and year of exposure. Fecundity was the most sensitive endpoint measured and was altered by water from multiple sites in both years. Physiological parameters associated with fecundity, such as plasma vitellogenin and steroid hormone concentrations, were seldom impacted. Larval fathead minnows appeared to be unaffected. Embryonic morphological development was delayed in embryos exposed to site waters collected in 2016 but not in 2017. A distinction between agricultural and urban influences in the Maumee River was not realized due to the great overlap in contaminant presence and biological effects. Differences in precipitation patterns between study years likely contributed to the observed biological differences and highlight the need for environmental exposure studies to assess the environmental risk of contaminants. Environ Toxicol Chem 2019;00:1-17. © 2019 SETAC.

Pediatric pain is associated to patient weight and demographics in specialized settings, but pain prevalence and its associated patient attributes in general pediatric outpatient care are unknown. Our objective was to determine the rate of positive pain screenings in pediatric primary care and evaluate the relationship between reported pain and obesity, demographics, and exam findings during routine pediatric encounters.
Cross-sectional observational study of 26,180 patients ages 2 to 19 seen in five urban pediatric primary care clinics between 2009 and 2016. Data were collected from systematic screening using a computerized clinical decision support system. Multivariable logistic regressions were used to analyze the association between pain reporting and obesity (body mass index), age, sex, race, season, insurance status, clinic site, prior pain reporting, pain reporting method, and exam findings.
Pain was reported by the patient or caregiver in 14.9% of visits. In adjusted models, pain reporting was associated with obesity (Odds Ratio (OR) 1.23, 95% Confidence Intervals (CI) 1.11-1.35) and severe obesity (OR 1.32, CI 1.17-1.49); adolescents (OR 1.47, CI 1.33-1.61); and females (OR 1.21, CI 1.12-1.29). Pain reported at the preceding visit increased odds of pain reporting 2.67 times (CI 2.42-2.95). Abnormal abdominal, extremity, ear, nose, throat, and lymph node exams were associated with pain reporting. Pain reporting increased in minority races within clinics that predominantly saw a concordant race.
Pain is common in general pediatric encounters, and occurs more frequently in obese children and those who previously reported pain. Pain reporting may be influenced by seasonal variation and clinic factors. Future pediatric pain screening may be guided by associated risk factors to improve identification and targeted healthcare interventions.

To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths.
We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings.
Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%.
Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths. Public Health Implications. Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths.