bluuebunny/crossref_metadata_2025 huggingface dataset:
The Negative Effect of Time and Air Exposure on HSC/HSPC Populations
Authors: Junge Chase , Dausinas Paige , Basile Chris , O'Leary Heather
Published: December 2020

Background: Hematopoietic stem and progenitor cells (HSC/HSPCs) inhabit niches within bone marrow that have significantly lower oxygen tension (1-4% O2, LowO2) than ambient air (21% O2) and provide signals regulating HSC signaling/function/self-renewal. Despite this knowledge, the majority of HSC/HSPC experiments are performed in ambient air, not replicating the endogenous environment. Our previous studies of HSC/HSPCs in LowO2 demonstrated enhanced phenotypic (CD150) marker expression, and frequency, of HSC/HSPC in live cells (~3fold LSK/LSKCD150 p=0.04) relative to historic data (fixed cells) as well as alterations in novel signaling/functional pathways.  
 
Methods: Our novel technology facilitates the isolation/sorting, and analysis of rare HSC populations, in live cells, continuously at their native LowO2 environments (3% O2). All assays have been adapted and validated in LowO2.  
 
Results: Time course (0 min, 15 min, 40 min, 60 min, 180 min) analysis comparing phenotypic markers of HSC/HSPC populations at LowO2 and ambient air, showed HSC/HSPC  enhancement at baseline in LowO2 that were significantly blunted by exposure to air (p-value =.00007) and time beginning at 40 min (p-value =.00003).  Phenotypic expression, as shown by the marker CD150, was also diminished by exposure to air (p-value =.0008) and via time (p-value =.05). Analysis via mRNA sequencing showed enhancement in 324 and 73 (LSK, LSKCD150) pathways including calcium channel complex and calcium ion binding when HSC/HSPC remained in LowO2 compared to air. Analysis of calcium regulation via FURA staining correlated with these data confirming increased calcium influx in LowO2 HSC/HSPC populations.  
 
Potential Impact: Our findings demonstrate significant negative impacts of ambient air, fixation, and time from harvest on HSC/HSPC phenotype and function. These findings suggest the critical importance of studying HSC/HSPC, live, quickly, and in their native environment, highlight potential caveats of current approaches, and rationale for lack of comparable results for studies of HSC/HSPC in the literature.
Pathology Communication Following Endoscopy
Authors: Kabir Jason , Maratt Jennifer
Published: December 2020

Background: Colonoscopies and esophagogastroduodenoscopies (EGDs) are commonly performed to screen for polyps and Barrett’s esophagus (BE), respectively. Findings from screening exams determine if, and when, surveillance is needed. Within the Veterans Health Administration (VHA), communication of test results is mandated; however, there is no clear guidance on how to communicate these results. The aim of this study was to determine the content and readability of endoscopy pathology letters that are used to relay results to patients within the VHA.     
 
Methods: We used Corporate Data Warehouse to identify patients who had a colonoscopy for colorectal cancer screening or post-polypectomy surveillance, or an EGD for BE screening or surveillance, between 2010-2018. We then identified patients who had either: low-risk colon adenomas (LRA), high-risk colon adenomas (HRA), non-dysplastic BE (NDBE), BE with low-grade dysplasia (BE-LGD), or BE with high-grade dysplasia (BE-HGD). Pathology letters for each of these findings were obtained and reviewed by two reviewers independently to categorize as containing ‘alarming,’ ‘not alarming,’ or ‘balanced’ terminology. The readability of each letter was determined by using Microsoft Word to obtain the Flesch-Kincaid reading ease and grade level equivalency scores.  
 
Results: Pathology letters from Richard L. Roudebush VA Medical Center were found to be non-alarming for LRAs, HRAs, and NDBE; balanced for BE-LGD; and alarming for BE-HGD. The average Flesch-Kincaid reading ease and grade level equivalency scores for the letters were 41.44 and 10.28, respectively. 
 
Conclusion and Potential Impact: While pathology letters may contain risk-appropriate terms to describe lesions, readability measures indicate that the content is above the recommended reading ease and grade level for an average adult in the U.S. Improving the readability of pathology letters could improve patients’ understanding of their risk status, thus leading to increased adherence to surveillance endoscopy recommendations.
Rates and Risk-Factors of Post Implantation Infection in Cardiac Implantable Electronic Devices
Authors: Karnani David , White Eric
Published: December 2020

Background/Hypothesis: 
Cardiac implantable electronic devices (CIED) include permanent pacemakers (PPM), implantable cardioverter defibrillators (ICD), and cardiac resynchronization therapy (CRT). Both ICDs and dual chamber PPMs are two-lead systems; whereas, CRT is a three-lead system. Indications for CIEDs include arrythmia, risk of sudden cardiac death and AV block. From 1993 to 2003, over 4 million CIEDs were implanted. With the upward trend in the rate of CIED implantations, the post-operative infection burden has increased concurrently. Device related infections are a serious complication of CIED implants. They are associated with a significant increase in the rate of mortality as well as a significant increase in financial burden. We hypothesize two-lead systems will have significantly lower rate of infection than three-lead devices 
 Methods: 
This study will be a retrospective review of patient charts who are hospitalized in the Parkview Health medical system in Fort Wayne, Indiana over a three-year period. All patients who have received a CIED during that time frame will be included in the study. Patients will be categorized by specific implant type and recorded as developing post-operation infection or not. Demographic and health status data will also be collected and analyzed for correlation with the development of device related infection. 
 Results: 
Our results will compare the device related infection rate for two-lead versus three lead systems, as well as the infection rate for each type of CIED. We also expect to find results which support a correlation between specific patient demographics and patient health factors. 
 
Conclusion and Impact: 
The results of this study will serve as a guide for identifying high risk procedures and patients. The objective is to provide providers with guidelines for the use of post-operative prophylaxis in order to reduce the incidence of CIED-related infection.
Repetitive Transcranial Magnetic Stimulation as a Probe of Episodic Memory Neurocircuitry in Schizophrenia
Authors: Kleyn Taylor , Francis Michael , Visco Andrew , Hummer Tom
Published: December 2020

Background and Hypothesis:  
People with schizophrenia often experience impairments with episodic memory (EM). Due in part to a lack of understanding regarding the neural mechanisms of EM, there are no effective treatments. Recent research indicates that the precuneus may be associated with EM impairment. Repetitive transcranial magnetic stimulation (rTMS) is a commonly employed intervention for treatment resistant depression, but its potential for investigating other psychiatric disorders such as schizophrenia is unclear. We hypothesize that, compared to sham stimulation, 1 Hz rTMS will decrease precuneus activity and 20 Hz rTMS will increase precuneus activity during an EM task. 
 
Experimental Design:  
Seven patients with early phase psychosis underwent a baseline fMRI scan during an EM recognition task that required participants to accurately identify which images were previously shown (targets) or not shown (foils). Next, participants had three separate rTMS sessions targeting the precuneus, each one week apart, in a randomized order: inhibitory (1 Hz) rTMS, excitatory (20Hz) rTMS, and sham stimulation. Each rTMS session was immediately followed by fMRI during the EM task. 
 
Results:  
We currently remain blind to the conditions because the study is ongoing. Participants had relatively lower accuracy during foil trials in one treatment session. During this same session, precuneus activity was relatively stronger to foils than targets, compared to other treatment sessions. These preliminary results suggest that rTMS applied to the precuneus may impact episodic memory and related brain activity in early psychosis 
 
Conclusion and Potential Impact:  
Data from this study will help determine whether targeting the precuneus with rTMS impacts functional activation in patients with schizophrenia during EM tasks. Additionally, relationships between EM performance and changes in precuneus activity will be identified. If effective, rTMS may represent a novel treatment for EM deficits in schizophrenia.
Characterization of Fall and Refall Risk Factors in the Elderly Presenting to the Emergency Department: Retrospective Chart Review Protocol
Authors: Lawson Bret , Gutwein Tom
Published: December 2020

Background/Objective: Falls are a major contributor to morbidity and mortality of the elderly population. Aside from the direct burden of falls on the patients, the CDC estimates falls cost around $50 billion annually, most of which is covered by Medicare/Medicaid. There are, however, fall prevention clinics that are focused on prevention and fall avoidance training in order to decrease the risk of falls. The goal of this work is to identify the population that is at a heightened risk of falls and analyze how this risk is mitigated with completion of a fall prevention program.  
Methods: Men and women over the age of 65 who presented to the ED from January 2015- January 2019 were considered for the chart review. Approximately 480 charts are to be analyzed assuming 10% loss due to lack of data in chart or expiration of the patient. Medical history, fall history, and demographics will be input into a data collection tool designed by the researchers. Statistical significance will be identified by Fishers test, unpaired t-test, Χ2 test appropriately. Fall risk factors that are identified as significant will be used in univariate and multivariate logistic regression to test for predictive value.  
Results: This work produced an IRB submission draft, RedCap data collection tool and is pending approval by Parkview Health IRB for Fall 2020. The researchers anticipate beginning work on the study in Spring 2021.  
Impact and Implications: Identification of risk factors associated with falls and refall events may be used to better distinguish the patient population that would benefit from a fall clinic referral. Increased knowledge of risk factors and protocolization of referrals may lead to decreased morbidity and mortality among the elderly as well as relieve some.
Aged Ossabaw swine exhibit intimal medial thickening of coronary arteries similar to that of humans
Authors: Lehr Trevor , Arnold Chris , Byrd James , Alloosh Mouhamad , Sturek Michael
Published: December 2020

Background:  Coronary artery disease (CAD) continues to be one of the leading causes of death in the United States.  A major contributing factor to CAD is intima media thickening (IMT), which is an early stage in CAD progression to a complex, flow-limiting stenosis.  Ossabaw swine have been shown to be exemplary models of human cardiovascular disease, yet there is a paucity of data in animal models of aging.  We hypothesized that aged swine would have increased IMT compared to healthy young swine.   
Methods: Young (3.1 +0.5 years, N=3) and old (10.7 + 1.2 years, N=3) Ossabaw miniature swine were fed a normal lean diet.  Epicardial coronary arteries were interrogated in vivo with IVUS. Images were analyzed every millimeter over the most proximal 45 millimeters of the artery.  Intimal thickening (wall coverage; echogenic) was measured as a percentage of total circumference of the vessel lumen.  IMT included the echolucent medial layer and was measured as a percentage of total arterial area. Data were represented as mean + SEM and p < 0.5 was deemed significant by independent t-test. 
Results: Aged swine showed greater IMT compared to the younger swine (18.7+1.2% versus 7.0+1.3%; p < .002).  Differences in wall coverage proved not to be significant, as old swine measured 20.3+4.4% and young swine measured 14.5+4.8% (p < .22). 
Conclusion: Our data support the hypothesis that old Ossabaw swine exhibited increased intima media thickening compared to lean young swine.  This finding further exhibits how coronary artery disease, quantified with clinically used IVUS in the Ossabaw swine model, translates exceptionally well to humans.
Incidence and Causes of Tibial Component Loosening Based on Level of Obesity in a Large Consecutive Cohort of Cemented Primary TKAs without Stem Extensions
Authors: Longawa Lilly , Buller Leonard , Ziemba-Davis Mary , Meneghini R. Michael
Published: December 2020

Background and Hypothesis: Aseptic loosening is one of the most common failure mechanisms of total knee arthroplasty (TKA) requiring revision.  The influence of obesity on tibial component aseptic loosening remains unknown. Some surgeons advocate the addition of a tibial stem extension to reduce the risk of loosening. The purpose of this study was to quantify the incidence and causes of revision for tibial component loosening in a large consecutive cohort of cemented primary TKAs without stem extensions based upon level of obesity.  
 
Experimental Design or Project Methods: 534 consecutive cemented primary TKAs performed between 2016 and 2018 by one surgeon were retrospectively reviewed. Procedures were performed using consistent surgical, perioperative medical, and pain-control protocols. All tibial implants were tapered thin keeled designs without stem extensions and implanted with low viscosity cement. Medical records were examined and all-cause revisions of the index surgery were documented.  
 
Results: After exclusions for confounds, 525 TKAs were analyzed. Mean age and BMI were 67.8 years and 33.9kg/m2 respectively and 72% were female. Mean follow-up was 19.1 (SD 10.5) months and 48% had minimum two-year follow-up. 41.3% of patients had a BMI greater than 35kg/m2 and 21.9% above 40kg/m2. There were 11 revisions in 10 patients, 1.9% out of all TKAs performed.  Five TKAs required both-component revision and three involved the femoral component only. No tibial component revisions were performed for aseptic loosening. 
 
Conclusion and Potential Impact: None of the standard tibial implants with a keeled design without stem extensions failed in a patient population with greater than 40% obesity.  Despite some suggesting tibial stem extensions should be used in obese TKA patients, these findings suggest that tibial component failure in obese patients may be design specific and routinely utilizing stem extensions may not be warranted and could result in deleterious bone loss at revision if required for reasons other than aseptic loosening.
Impact of Gabapentin and Pregabalin on Neurological Outcome After Central Nervous System Injury
Authors: Morton Caleb , Cheng Fen-Lei
Published: December 2020

Background and Purpose:  
Injury to the central nervous system (CNS) is often detrimental to the health, functionality, and quality of life in both the short- and long-term. Injuries that fall under this umbrella include traumatic brain injury (TBI), traumatic spinal cord injury (TSCI), and stroke. These types of injuries vary in what initiates them, but their proposed mechanisms leading to cell dysfunction and death are strikingly similar. There has been pre-clinical and limited retrospective data supporting the idea that gabapentin and pregabalin both have neuroprotective qualities and may alleviate some of the sub-acute damage initiated by these different injuries. The purpose of this study is to determine whether patients taking either gabapentin or pregabalin at the time of their injury tend to have better outcomes than patients with similar injuries who were not taking either one of the two medications. 
Methods: 
This is a retrospective chart review analysis of 600 patients admitted to Parkview Hospitals from 2016-2019 for TBI, TSCI, or stroke. The outcomes of patients taking either gabapentin or pregabalin with one of the prior diagnoses will be compared to patients with the same diagnosis who were not taking either of the medications mentioned. Statistical analysis will be performed to evaluate if any significant difference exists between the outcomes at discharge of patients taking either medication versus patients who were not. 
Results: 
Results will be listed as comparisons between patients grouped by injury, and sub-grouped by medication usage. P-values will be included to show significance of comparisons. 
Conclusion and Potential Impact:  
The main impact of this study is to provide evidence and support leading to a potential method to improve outcomes in patients with CNS injuries. Secondary impacts are providing basis for development of a CNS injury registry and support for developing a unified CNS injury assessment scale to allow comparison of the treatments of different CNS injuries.
Validation of the COVAS (Comorbidities, Obesity, Vitals, Age, Sex) Score as a Practical Tool for Assessing Need for Intensive Care Services in Suspected SARS-CoV2 Patients
Authors: Kline Jeffrey , Sharp Adam , Munson Caleb
Published: December 2020

Background and Hypothesis 
Various scoring instruments have been proposed to risk-stratify patients with suspected COVID-19. Here we test prognostic system derived and tested in the Kaiser Permanente health system (the COVAS score).  
Experimental Design and Methods 
This was a primary analysis of the multicenter RECOVER registry, which includes patients tested for SARs-CoV-2 from 40 emergency departments around the US.  We extracted components of COVAS score with two modifications, and computed a modified COVAS score, and used that as the “test” to compute the area under the receiver operating characteristic curve (AUROC) to predict any initial intensive care unit (ICU) admission or transfer to ICU.  
Results 
For SARS-CoV-2 positive patients, for the prediction of ICU admission, the COVAS AUROC=0.74 (95% CI = 0.72 to 0.77), with overall mean = 7.4 (SD=4.7), and the mean for ICU admission was higher (10.1, SD=4.6) versus no ICU admission (6.8, SD=4.5), p<0.001 paired t-test. For SARS-CoV-2 negative patients, the COVAS score showed an AUROC= 0.70 (0.68-0.72) and the mean was 7.3, SD=4.2.  
Potential Impact 
The modified COVAS scoring system had modest overall discriminative value at predicting ICU admission, but was more accurate in SARS-CoV-2 positive patients, compared with SARs-CoV-2 negative suggesting the instrument is calibrated to predict ICU requirements in patients with suspected COVID-19, as opposed to functioning as a generic risk-stratification tool.
Using COVID-19 Narratives to Think Deeply About Physicians’ Conflicting Roles and Responsibilities
Authors: Olivera Jesus , Gunderman Richard
Published: December 2020

Background: In recent decades, many physicians have abandoned the private practice model of medicine, electing instead to work as hospital employees. For the most part, hospitals and physician employees enjoy a synergistic relationship. In other cases, conflicts can arise between the two parties. This paper explores a subset of such conflicts, those which transpired within the context of the COVID-19 pandemic.  
 
Methods: We utilized the study of Narrative, a Medical Humanities discipline, as an analytical tool. First, we compiled narratives detailing disagreements between various clinicians and their respective employers’ COVID-19 response. Second, we employed literary analysis question prompts to explore the ethical implications of, and potential solutions to, such conflicts.   
 
Results: Physicians, like all individuals, have multiple roles within society. In today’s healthcare landscape, many physicians concurrently assume the roles of caregiver and employee. The moral priorities, values, and obligations inherent to these two roles can sometimes be misaligned, creating ethical dilemmas for physicians and their employers. 
 
Conclusion: Physicians must recognize that their primary professional responsibility is to patients. When the welfare or safety of patients appears to be at risk, physicians have a duty to advocate on their behalf. However, physicians and hospital administration alike must seek out synergies and minimize potential conflict. Good hospitals should have forums, communication lines, and organizational cultures that allow clinicians to openly voice concerns and feedback. Good physicians should voice dissenting opinions in a diplomatic, stepwise, and cooperative manner. If patient welfare remains at risk, other recourses are available, but teamwork and collaboration should be the initial focus. 
 
Impact and Implications:  
This discussion can help physicians think deeply about their different roles and responsibilities in society and how to ethically balance those roles. It can also inform various topics within healthcare ethics, including care transformation, resource allocation, organizational ethics, and patient advocacy.
Impact of the COVID-19 Pandemic on Cystic Fibrosis Pulmonary Exacerbations
Authors: Patel Shreya , Thompson Misty , Slaven James , Ren Clement
Published: December 2020

​Background and Hypothesis 
     CF pulmonary ￼exacerbations (PEx) are episodes of decline in respiratory function that can be triggered by a variety of mechanisms, including respiratory viral infections.  The COVID-19 pandemic resulted in school closures and home isolation policies and a potential reduction in exposure to other respiratory viruses.  The goal of this project is to study the impact of the COVID-19 pandemic on CF PEx at the Riley Hospital for Children. We hypothesize that the incidence of PEx will be lower during the period of the COVID-19 lockdown from March 1 to May 15 in 2020 compared to the same time interval in 2019.  ￼ 
￼ 
Methods￼ 
We performed a retrospective chart review of children with CF ages 2-12 (N=80) seen at Riley in 2019 and 2020 and collected data within the following timeframes: January 1 to March 15 2019 and 2020, and March 16 to May 15 2019 and 2020.  We collected data on baseline clinical features and details of each PEx event.  Data were analyzed with parametric and non-parametric descriptive statistic tests as appropriate; significance was set at P≤0.05. ￼ 
￼ 
Results 
     The percent of PEx events in the study cohort was significantly lower in 2020 compared to 2019 for January 1 to March 15 (56% vs 42%, P=0.0116) and March 16 to May 15 (35% vs 14%, P<0.0001).  The percent of in-person PEx events was significantly lower during March 16 to May 15 in 2020 compared to 2019 (15% vs 1%, P=0.0066) 
￼ 
Conclusions and Potential Impact ￼ 
     COVID-19 restrictions were associated with a decrease PEx events.  We speculate that this reflects a reduced exposure to respiratory viral infections in general. The decrease in in-person PEx events may reflect a shift towards telehealth during the COVID-19 restrictions.  These results provide a foundation for further research into triggers and prevention of CF PEx.
A Comparison of Metabolic Disruptions in Alzheimer Disease and Parkinson Disease
Authors: Plyer Cade , Chang Fen-Lei
Published: December 2020

Background and Hypothesis: 
There has been a shift in focus toward metabolic factors in the study of neurodegenerative disorders as their importance has been highlighted by recent discoveries involving disruption of shared mechanisms. Alzheimer disease (AD) and Parkinson disease (PD) share similar metabolic risk factors. We hypothesize that type 2 diabetes mellitus (T2DM) will be most associated with AD, while gastrointestinal (GI) problems will be most associated with PD; however, both AD and PD will have greater associations with GI problems and T2DM relative to control. 
Project Methods: 
This retrospective chart review included three groups: AD, PD, and control. All data were obtained from neurology clinics in Parkview Health's electronic medical record (EMR). ICD-10 codes identified 65+ year old patients who had visited a clinic within the last year and had a diagnosis of either AD, PD, or non-neurodegenerative symptoms (control): neuropathy, headaches, or seizures. ANOVA and chi-square tests were performed for group analyses, and multiple regression analyses were performed between AD and PD disease severity and various metabolic predictors (e.g., HbA1c, total cholesterol). 
Results: 
This study currently consists of a protocol. Data collection and analysis will take place between May 2021 and August 2022. 
Potential Impact: 
This study aims to fully characterize certain metabolic disruptions with AD and PD by analyzing a ten-year span of clinical data in the same patient population; this may reveal risk factors that are amenable to clinical interventions. This may also facilitate the understanding of Lewy body dementia, a disorder that contains elements of both AD and PD. The main metabolic elements explored in this study are those concerning GI problems (e.g., constipation) and T2DM (e.g., elevated HbA1c). These associations will form the basis of a follow-up study that investigates the potential mechanisms linking these disruptions with pathogenesis of either AD or PD.
Multilevel Factors Underlying Adolescent Retention and Disengagement in HIV Care
Authors: Risk Nathan , Toromo Judith , Misquith Chelsea , Enane Leslie
Published: December 2020

Background/Objective: Adolescents (ages 10-19) living with HIV are at risk for disengagement from HIV care, resulting in poor health and potential for viral transmission. It is important to uncover the central barriers that result in adolescents becoming disengaged from care in order to develop interventions or models to support adolescent retention. We sought to investigate the multilevel barriers and facilitators to adolescent retention in HIV care. 
 
Methods: A systematic search was performed to identify relevant studies from 1994 onwards, both qualitative and quantitative, in any language, and in all geographic regions. Title and abstract screening identified relevant articles. A full text review determined final inclusion. Key variables were extracted, focused on the range of multilevel barriers and facilitators to retention, and any differences according to population or setting. Preliminary findings are summarized. 
 
Results: Quantitative factors associated with disengagement include: older adolescence, racial or ethnic minority status, family-level poverty, and receiving care at a rural clinic. Qualitative barriers to retention include: distance to the clinic and associated travel costs, psychosocial challenges and lack of support for them, anticipated stigma with inadvertent disclosure of HIV status, nondisclosure of HIV status to both the adolescent and family members, negative experiences with care providers, challenges requesting absence from school, and negative school environments. Facilitators to retention include: having strong social support, having a family member with HIV, having positive relationships with providers and clinic staff, attending an adolescent-dedicated clinic or a clinic with adolescent-dedicated hours, having access to intensive counseling, and having access to peer groups/peer mentors.  
 
Conclusion and Policy Implications: Improving adolescent retention requires addressing the multilevel factors that lead to disengagement. Interventions with potential to mitigate against the range of challenges adolescents face are needed to support adolescents to overcome these challenges and continue in life-long HIV care.
How Pediatric Hematologic and Oncologic Patients Experienced Virtual Learning During COVID-19: Importance of Amplifying the Family Voice for Informing Future Recommendations
Authors: Rose Margaret , LaMotte Julia , Todd Hannah , Fraser Greer , Fraser Louise , Renbarger Jamie , Romack Donna , Sajdyk Tammy
Published: December 2020

Background: With medical advancements in the detection and treatment of pediatric oncologic and hematologic disorders, survival and life expectancy rates continue to improve. However, the treatments themselves have been linked to long-term cognitive issues (e.g., attention, working memory, and executive functioning). These difficulties have particular salience to academic achievement and often necessitate educational accommodations to support learning. However, these plans are designed for the traditional school environment and may be insufficient for virtual learning. The purpose of this study is to investigate the perceived impact of COVID-19 in the context of virtual learning for children with hematologic or oncologic disorders to inform the development of appropriate recommendations for patients and schools this fall.  
Methods: Qualitative interviews assessing academic accommodations and COVID-19 adjustments to virtual learning were conducted separately with participants and their guardians by phone.  Medical histories were obtained via electronic health record.  
Results: Thirty children (Mage=12.8 years, SD=1.4 years) with status post cancer treatment (n=17), sickle cell disease (n=11), or neurofibromatosis type 1 (n=2), with an IEP (n=15) or 504-plan (n=15) in place prior to COVID-19. During virtual learning, children reported a lack of interaction with teachers or other resource help. Guardians felt pressured to assist with schoolwork without sufficient support or qualifications. Anecdotally, families still expressed gratitude to their schools and teachers, revealing overall low expectations for virtual learning.  
Potential Impact: This pediatric population faces unique education challenges, specific to neurocognitive impairment secondary to their chronic health conditions. Unsurprisingly, families perceived that their educational needs were not met during virtual learning related to COVID-19. To prevent the cascading effect of insufficiently addressed academic needs, the inclusion of family’s perceived experiences is critical for informing individual recommendations and the Indiana Department of Education broadly during the transition back to school this fall, both in the physical and virtual classrooms.
The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features
Authors: Rukes Marelle , Jones Alexander , Novinger Leah , Davis Kyle , Campiti Vincent , Yedlicka Grace , Bonetto Andrea
Published: December 2020

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients.  
 
Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05.   
 
Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension.  
 
Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes.
Identification of Atypical Diabetes Using Algorithms to Search the Electronic Medical Record
Authors: Salichs-Perez Veronica , Robert Hood Daniel , Saeed Zeb , Evans-Molina Carmella
Published: December 2020

Background and Hypothesis: 
Atypical diabetes (DM) comprises phenotypically and potentially genotypically distinct forms of DM not fitting current sub-categories of classification. Understanding these rare and uncharacterized types of DM can potentially inform the application of personalized therapeutic approaches and is the emphasis of a recent NIH-funded Consortium focused on Rare and Atypical Diabetes (RADIANT). We aimed to employ informatic-based algorithms to identify potentially atypical DM cases from electronic medical records (EMR) to identify candidates for inclusion in RADIANT. 
 
Project Methods: 
Diabetic patients were identified based on two DM diagnostic codes, treatment with anti-diabetic medication, and two diagnostic labs elevated.  We filtered for patients with BMI <25 at diagnosis and normal lipid profile. Charts were reviewed manually.  Demographic and clinical data were extracted from EMR and entered into a REDCap database. SPSS was used for statistical analysis.  
 
Results:  
A total of 21,820 individuals met criteria for DM; 208 were identified as potentially atypical. Chart review was completed for 126 cases. Fifteen were deceased and removed from the final cohort. Of those remaining, 12 (11%) exhibited features consistent with atypical diabetes. The remainder were classified as typical T2D. No significant differences regarding ethnicity or diabetes complication status were identified between typical and atypical cases. Demographics of atypical cases were, 66% female, and 33% male. The average age of diagnosis was 46.8 ± 19.3 yrs. Average BMI was 23.7 ± 4.1. Atypical diabetes individuals were more likely to present with ketoacidosis (p=0.01) exhibiting a trend towards increased insulin use (50% vs. 14%; p=0.09).  
 
Conclusion:  
Our study suggests that using EMR may be effective in flagging phenotypically distinct forms of DM in real world settings, associated with a high false positive rate. Data suggests this form of atypical diabetes represents a small percentage of overall DM cases (0.05%). Future studies will focus on application of algorithms to identify other atypical diabetes subsets.
Exploratory Analysis of COVID-19 Case Demographics in Gary, Indiana
Authors: Snapp Cameron , Trimoski Bill , Brown Martin , Han Amy , Kostrominova Tatiana
Published: December 2020

Background and Hypothesis: 
Health disparities are prevalent in Black populations, and COVID-19 is not an exception. COVID-19 is a pandemic that has been confirmed in 3.8 million Americans and has caused 133,283 deaths in the US (4/20/2020). Recent literature suggests that minoritized and impoverished populations are more severely impacted by COVID-19. Gary, Indiana has a large Black population (80%), high number of residents living below the poverty line (34%), and high unemployment rate (20%). We hypothesized that Black individuals in Gary have a higher rate of positive cases, hospitalizations, and deaths than non-Black individuals. Also, we hypothesized that income (median household income measured by zip code) is negatively correlated with COVID-19 deaths. 
Experimental Design and Project Methods:In collaboration with the Gary Health Department, we analyzed demographic data on all positive cases in the city from 4/16/2020 through 6/19/2020. Case data was de-identified with 16 dimensions including age, race, sex, ethnicity, hospitalization, death, and zip code.  Data was analyzed using Pearson's chi-square test and regression analysis. 
Results: 
Positive cases and hospitalizations are 2-fold and 3-fold more frequent in the Black population compared to the non-Black population in Gary (p<0.0001, P<0.01, age and population-adjusted), respectively. Median household income of a zip code is exponentially and negatively correlated with COVID-19 related deaths in that zip code (R2=0.7450, p=0.0123). 
Conclusion and Potential Impact:  
In Gary, there is a clear health disparity of both income and race, specifically in the context of COVID-19. Health officials can utilize this data to reallocate resources to highly populated, low income, and predominantly Black neighborhoods. In addition, future predictive analysis could be beneficial in developing a model to predict COVID-19 prevalence and severity. Such a model would help local health departments prepare for a second Covid-19 wave, providing for better outcomes for at risk populations through resource allocation.
Diagnostic Accuracy and Uptake of the PHQ-9 Depression Scale in Pregnancy and the Postpartum Period
Authors: Wang Larry , Kroenke Kurt
Published: December 2020

Purpose: Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period globally. While the legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS), the PHQ-9 is the most widely used depression measure in clinical practice and is considered a viable alternative in many PND guidelines. This systematic review examines the criterion and convergent validity of the PHQ-9 as a screener for PND.  
Methods: The following databases were searched in June 2020: MEDLINE, Embase, and PsychInfo. Search terms were the PHQ-9 AND perinatal AND depression. Variants of each were also included as an OR statement such as “patient health questionnaire” as a variant of the PHQ-9. Only studies published in English and after 2001 were accepted as the PHQ-9 was not available as a screening test before then.   
Results: A total of 35 articles were eligible for criterion (n=10) or convergent validity (n=25). Studies with criterion validity had sensitivity and specificity ranging from 65 to 95 and 62 to 89, respectively. For the 7 articles using the standard PHQ-9 cut point ≥ 10, median sensitivity and specificity were 0.82 and 0.84, respectively. The median AUC was 0.88. Of the 9 correlation values shared between the PHQ-9 and EPDS, values range from 0.36 to 0.77 with a median of 0.60. The median Cohen’s kappa value of 0.535 in four studies showed good agreement.  
Conclusion: Of the criterion validity articles, the sensitivity, specificity, and AUC indicate the PHQ-9 may be used to screen for PND. The convergent validity comparison articles between the PHQ-9 and EPDS also support use of the PHQ-9 in perinatal populations.
Characterizing Muscle Phenotype and Prognosis in Patients with Multiple Myeloma
Authors: Zhou Shannon , Silverman Libbie , Young Andrew , Roodman David , Suvannasankha Attaya , Zimmers Teresa
Published: December 2020

Background/Objective: 
Low muscle mass (myopenia), poor muscle quality, myosteatosis, and muscle loss are associated with mortality in solid tumors. However, their impact in hematological malignancies remains unclear. We sought to determine how muscle phenotype relates to survival in patients with multiple myeloma. 
Methods: 
We performed a retrospective review of patients with multiple myeloma treated at Indiana University Hospital from 2012-2016. Total skeletal muscle area (SMA) (cm2) and radiodensity were measured on baseline (closest to diagnosis) and last CT scans at the third lumbar vertebrae area. SMA was normalized to height (SMA cm2/m2) to define skeletal muscle index (SKMI). Myopenia was defined as (SKMI) <52.4 cm2/m2 (men) and <38.5 cm2/m2 (women). Myosteatosis and obesity were defined per published BMI-specific cutoffs. Difference in survival between groups was estimated using log rank test.  
Results: 
Of 455 patients with multiple myeloma, 137 had more than one CT scan; 42 of these have been assessed to date. Half (21/42) were myopenic. Myopenia was equally prevalent across BMI categories and showed no association with survival. More than half of patients displayed myostetatosis; however, this was not associated with survival.  Obesity and myopenic obesity were likewise not correlated with survival. Below-median baseline SKMI correlated with mortality, HR 2.721 (95% CI, 1.160-5.564: P=0.0129). As well, below-median final SMA correlated with mortality, HR 2.381 (95% CI, 1.094-5.181, P=0.0213). On average patients lost .7129% of SMA (95% CI; -6.072%-4.646%). Females had higher mortality, HR 2.355 (95% CI 0.9895-5.604, P=0.0215).  
Conclusion and Potential Impact: 
Although this study represents a fraction of treated patients to date, myopenia was prevalent among patients at diagnosis of multiple myeloma. Low muscle mass and sex appear to be important prognostic factors for survival. Additional measurements as well as univariate and multivariate analyses are necessary to verify these findings and identify additional factors that contribute to survival in multiple myeloma.
DA ÁFRICA PARA OS ANGOLANOS: MARIO PINTO DE ANDRADE, FRANTZ FANON E JOSEPH KI-ZERBO NOS MOVIMENTOS DE LIBERTAÇÃO (1954-1964)
Authors: Mendonça Anderson Guimarães
Published: December 2020

Este artigo tem por objetivo discutir as ideologias, aqui chamadas de contra-ideologia, dos principais pensadores que influenciaram o movimento revolucionário em Angola sob a perspectiva do nacionalismo como bandeira de luta pela autodeterminação. Este texto se norteia pelas discussões sócio-políticas acerca do papel social dos sujeitos históricos em modificar o seu espaço e serem atores políticos em seus respectivos lugares. Toda discussão sobre a África é hoje de máxima relevância, inclusive multidisciplinar, para compreendermos não só as relações culturais do Brasil, mas também as diferentes civilizações do mundo que sob a perspectiva de uma história internacional, nos propomos apresentar essa discussão sobre intelectuais nacionalistas em Angola.
Os dilemas internos da ideologia da guerra fria, ou quem pode sonhar o Sonho Americano?
Authors: Marques dos Santos Sandro
Published: December 2020

Quando a ideia de criar um Trem da Liberdade para atravessar os Estados Unidos com os maiores símbolos e emblemas nacionais foi apresentada, muitos afro-americanos a receberam com desconfiança. Para muitos deles, falar em liberdade nos Estados Unidos parecia uma piada de mal gosto. Como o país poderia se apresentar como uma terra livre enquanto a segregação era a realidade de milhões de seus cidadãos? Com o início da Guerra Fria, essa discrepância entre a retórica e a realidade se tornou grande demais, colocando um dilema para a política externa do país. Esse artigo intenta analisar esse dilema e as formas pelas quais ele foi endereçado pelas forças políticas norte-americanas, buscando traçar considerações críticas sobre seus resultados políticos.
HISTÓRIA DA ALIMENTAÇÃO EM IMAGENS: PRÁTICAS ALIMENTARES, HOSPEDAGEM E PEREGRINAÇÃO EM DUAS CANTIGAS DE ALFONSO X, O SÁBIO
Authors: Antunes Junior Guilherme
Published: December 2020

O presente artigo analisará duas cantigas atribuídas a Alfonso X, o Sábio, a 157 e a 159. Ambas apresentam características semelhantes, pois tratam da alimentação de peregrinos em uma rota comum, o caminho ao santuário de Notre-Dame de Rocamadour, atualmente sudoeste da França. Ao comparar textos poéticos e imagens, observa-se a rica quantidade de informações sobre a cultura alimentar, os utensílios de cozinha e as práticas religiosas no século XIII. No entanto, as iconografias não são “cópias da realidade”, uma vez que são representações e construções discursivas.
A INVENÇÃO DA GASTRONOMIA "TÍPICA ALEMÃ" NA MÍDIA IMPRESSA CONTEMPORÂNEA DO VALE DOS SINOS, RS, BRASIL
Authors: Canha Blum Fátima Vitoria , Rieth Ricardo Willy
Published: December 2020

O artigo aborda representações da  assim chamada gastronomia “típica alemã” na mídia impressa de cidades do Vale do Rio dos Sinos, Rio Grande do Sul, Brasil, região há quase dois séculos estreitamente vinculada à história da imigração e colonização por germânicos. Mediante a análise de discursos textuais e imagéticos publicados em jornais, amparada teoricamente nos Estudos Culturais, investiga-se a produção de sentidos em torno às práticas culinárias e alimentares e, com destaque para as estratégias de invenção da gastronomia "típica alemã" na contemporaneidade e os processos negociação de identidades a elas vinculados.Palavras-chave: Estudos Culturais; Etnicidade; Gastronomia Alemã; Pedagogias Culturais; Mídia Impressa
COZINHA MINEIRA E ABASTECIMENTO ALIMENTAR NOS CAMPOS DE VILA RICA DE OURO PRETO NO SÉCULO XVIII E INÍCIO DO SÉCULO XIX
Authors: Pires Maria do Carmo
Published: December 2020

A cozinha mineira é reconhecida como elemento identitário das populações que habitavam e habitam as Minas Gerais. Há elementos norteadores comuns que fizeram parte do processo de povoamento e de formação social da região, entretanto também houve espaço para novas incorporações. Este artigo pretende analisar a formação das freguesias do campo de Vila Rica de Ouro Preto no século XVIII e o papel destas localidades na produção e no comércio de alimentos. Visa também identificar os produtos que circulavam na região por meio da análise de documentação produzida pela Câmara de Vila Rica. A produção de muitos víveres em quintais e pomares, como hortaliças, frutos diversos e criação de porcos e galinhas, proporcionou o que atualmente tem se destacado como comida mineira: uma combinação de vegetais, carnes, cereais e laticínios. É essa a combinação do trivial e costumeiro, mas também das épocas festivas.Palavras-chave: Comida mineira, freguesias do campo, Vila Rica de Ouro Preto.
Działalność religijna i dobroczynna przeworskiego ośrodka Kanoników Regularnych Stróżów Najświętszego Grobu Bożego w Jerozolimie
Authors: Rolski Zbigniew , Thomas Ireneusz
Published: December 2020

Tradycja dobroczynności zakonu bożogrobców w Polsce jest jednym z ciekawszych wątków tego opracowania. Zakon ten po raz pierwszy w tej części Europy wprowadził profesjonalny system leczenia szpitalnego dla ubogich. Rodzina magnacka Tarnowskich, kierując się polityką dworu królewskiego Jagiellonów, umacniała chrystianizację ziem Rusi Czerwonej od 1394 (1396) i otrzymała zgodę na sprowadzenie Kanoników Regularnych Stróżów Najświętszego Grobu w Jerozolimie do ośrodka duszpasterskiego w Przeworsku. Związek między zabudowaniami Grobu Bożego a liturgią i rozbudowanymi formami kultu Grobu Bożego miał swój specyficzny i oryginalny charakter. O ile kaplice Grobu Świętego związane z kalwariami i poszczególne przedstawienia Grobu nienależące do Miechowitów były miejscem kultu Męki Pańskiej, o tyle w przypadku przedstawień Grobu Świętego u bożogrobców ich związek z kultem i liturgią miał głębszy sens. Grób Pański w Przeworsku był i jest nie tylko zabytkiem architektonicznym, ale także miejscem żywego kultu religijnego. Przez blisko trzy stulecia istnienia przeworskiego Sepulchrum Domini spotykano różne formy kultu Grobu Pańskiego, zarówno w formie kultu liturgicznego, jak i paraliturgicznego, dlatego w pracy omówiono je bardziej szczegółowo. W dzisiejszych czasach szczególnie ważne dla kontynuacji tradycji średniowiecznych bractw religijnych kultywujących istotę Bożego Grobu są zorganizowane grupy młodych mężczyzn, a ostatnio także kobiet, które tworzą oddziały „Turków”, pełniących straż przy Bożym Grobie. W Przeworsku i okolicznych wsiach są one nadal widoczne, zwłaszcza w okresie wielkanocnym, zapewniając porządek w czasie uroczystości religijnych i pobożnego nawiedzania kościołów przez wiernych.