Loyola University Research Articles

COMMUNICATION PREFERENCES OF PATIENTS WITH LIMITED ENGLISH PROFICIENCY IN THE OTOLARYNGOLOGY CLINIC SETTING

In the United States, people with limited English proficiency (LEP) and lower health literacy have reduced access to care and poorer health outcomes. There is a lack of data on how to best provide language assistance services in the ambulatory setting. This study will evaluate what type of professional language interpretation services are preferred by LEP patients in the otolaryngology clinic population. Our study aims are 1) to assess the communication preferences of patients with LEP in the healthcare setting regarding interpreter services, 2) to determine if there are specific LEP patient demographics that correlate with communication preferences in the healthcare setting regarding interpreter services, and 3) to determine if there is a correlation between health literacy and degree of language barrier, and if there is, to what degree, and how may this affect the patient’s preferences and experience. LEP adult patients and adult caregivers of pediatric patients treated at 5 of Loyola University Medical Center Otolaryngology clinic sites will be consented and given a one-time study questionnaire to complete in their native language. The questionnaire will ask about the patient’s background, place of birth, primary place of birth, primary language, years living in the United States, self-reported English language proficiency and fluency, self-reported health status, and preferences for the type of language support services. Health literacy will be assessed with the Brief Health Literacy Screen. Targeted interventions can potentially be designed and incorporated in the healthcare setting based on the data and identified communication preferences and the demographic correlations. This in turn has the potential to reduce healthcare disparities and improve outcomes for LEP patients.

Assessing the Impact of Race, Sexual Orientation, and Gender Identity on USMLE Style Questions: Preliminary Results of a Randomized Controlled Trial

Abstract Introduction/Objective Medical students are expected to graduate with cultural competence, which improves the quality of care of different minority groups and may help reduce health disparities. Incorporation of diversity, equity, and inclusion into medical teaching is critical to the development of culturally competent physicians; however, centuries of medical pedagogy have tied certain pathologies to racial and sexual/gender minority patients. This not only encourages stereotyping to arrive at the correct answer but also narrows the differential diagnosis developed by the future physician. We are surveying US and non-US third- and fourth-year medical students and first-year residents to demonstrate to what extent inclusion of race, sexual orientation, and gender identity data in question stems influences diagnosis and clinical decision-making. Methods/Case Report The survey consists of three sections. The first section collects demographic information, including age, race, gender identity, region, type of medical degree, current level of training, completion of examinations, and MCAT score. The second section presents one of two sets of twelve USMLE style questions with (experimental) or without (control) key demographic data, including race, sexual orientation, and gender identity. The third section presents four questions in order to assess participants’ understanding of the higher burden of hypertension among Black patients and attitudes regarding the role of their medical education in the development of biases. Participants were randomized to the set of twelve questions in the second section. Results (if a Case Study enter NA) Preliminary results from 25 medical trainees associated with Loyola University Chicago demonstrate that the presence of demographic data including race, sexual orientation, and gender identity impact answer choice on standardized questions. Conclusion The preliminary results of this study are significant because they suggest that race, sexual orientation, and gender identity are still being used in pathology education to highlight certain disease processes, potentially in a manner that is out of proportion to actual disease prevalence.

686. Management and Outcomes of Patients Referred to a Specialty Clinic for C. difficile Infection

Abstract Background Clostridioides difficile infection (CDI) poses an urgent threat in the United States with an estimated 223,900 cases of hospitalization and 12,800 estimated deaths in 2017. CDI manifestations range from diarrhea, pseudomembranous colitis, to fulminant colitis. Due to spores that are unaffected by current antimicrobial therapies, recurrence remains a common challenge. Patients with 2 or more episodes have an estimated 40-65% rate of recurrence. We reviewed the management and outcomes of patients referred to our specialty CDI clinic. Methods A retrospective chart review was conducted on all new patients presenting to the Loyola University Medical Center CDI clinic between 01/01/2021 and 12/31/2021. Each chart was reviewed for demographic information, comorbidities that may confound diagnosis, and characteristics that place the patient at high risk of recurrent CDI. Visits were characterized by the number of prior CDI episodes, timeline of recurrences, and prior therapies used. 30- and 60-day symptom recurrence were assessed. Results A total of 48 new patients presented to the CDI clinic. The median age was 63 years, 64.5% were white, and 64.5% were female. Patients presenting with recurrent CDI accounted for 79% of cases (38/48), with 48% (13/48) of patients having two or more recurrences. The most common decision for initial management was to not give further antimicrobials and monitor for symptoms (35%). 12% of patients only required monitoring while 23% of patients had a questionable CDI diagnosis and were referred elsewhere for further evaluation. For the 30 patients who received treatment, vancomycin or fidaxomicin tapers were selected 73% (22/30) and bezlotoxumab 20% (6/30) of the time. 8.6% (2/23) of patients with a history of two or more CD episodes had recurrence. Overall, patients experienced a subsequent recurrence rate of 12.5% (6/48) and 15% (7/48) at 30 and 60 days, respectively. The number of times each management approach was selected for initial patient appointments. The number of times each treatment regimen was selected when a patient was deemed to need antibiotic therapy. The percentage of patients who had either recurrence or resolution at 60 days after the end of therapy. Conclusion CDI is a difficult-to-treat infection with many patients suffering from multiple recurrences. Dedicated outpatient follow-up is important for monitoring therapy and excluding alternate etiologies. Expert management of CDI through a dedicated clinic results in lower recurrence for high-risk patients and spared 35% of patients further antimicrobial exposure. Disclosures Larry H. Danziger, PharmD, Ferring Pharmacetuicals: Advisor/Consultant Andrew M. Skinner, MD, Academy for Continued Healthcare Learning: Honoraria|American Society of Healthcare Pharmacists: Honoraria|Ferring Pharmaceuticals: Honoraria|MJH Life Sciences: Honoraria

Abstract 16961: Characterization of Extracellular Vesicles and RNA Content and Its Relevance to Thrombo-Inflammatory Biomarkers in Patients With Acute Pulmonary Embolism

Introduction: Pulmonary embolism (PE) is a complex disease with significant morbidity and mortality rates globally. Previous studies have shown that extracellular vesicles (EV) carrying disease specific ribonucleic acids (RNA’s) may contribute to pro-inflammatory and pro-coagulant state in VTE. This study aimed on profiling EV related parameters, RNA content, and thrombo-inflammatory markers in patients with acute PE compared to healthy individuals. Materials & Methods: Prospective cohort of patients with PE (n=72) were compared with normal healthy individuals (n=19) and further stratified by PE severity. Blood samples were collected under an IRB-approved project from Loyola University Chicago. Plasma samples were analyzed for the EV parameters, RNA parameters, and thrombo-inflammatory markers (D-Dimer, PAI-1, and CRP) respectively. Results: PE cohort includes 72 patients (41 male, and 31 female) with a median age of 67-years (interquartile range; IQR= 53-76), and a median body mass index (BMI) of 27.5-kg/m 2 (IQR= 24.7-35.7). Compared to controls, EV concentration, and EV/ng RNA were significantly (p= <0.05) lower, while D-Dimer, CRP and PAI-1 were significantly (p= <0.05) higher in patients with PE. In correlation analysis, varying levels of positive and negative correlations between the EV, and RNA parameters, and thrombo-inflammatory markers were noted (Figure 1). Upon stratification on PE severity, D-dimer was higher in massive PE compared to low-risk (p= 0.012), and sub-massive PE (p=0.036) respectively. Conclusion: These studies demonstrate significant changes in extracellular vesicles, RNA content and thrombo-inflammatory markers in acute PE patients compared to healthy controls. These changes may be due to the drivers of VTE pathogenesis or the result of a consumption process in acute PE. Further large scales studies on disease specific exosomes and RNA signatures are warranted to understand their relevance.

5 Normative Data Collection for the Multicultural Neuropsychological Scale (MUNS)

Objective:Despite the array of neuropsychological tests available, these assessments are largely made and developed for use in WEIRD (western, educated, industrialized, rich, democratic) societies (Fernandez, 2019; Ponsford, 2017). The Multicultural Neuropsychological Scale (MUNS) was developed with underrepresented groups in mind as a universally valid neuropsychological assessment which can be used across cultures and adapted to different languages. To assist with the validation of the MUNS as a cross-cultural instrument, investigators administered the MUNS to a cognitively 'healthy’ college-aged population in the United States as a means of collecting normative data. Results were compared to samples taken from an Argentine university, Universidad Catelica de Cerdoba, and combined with another American university, Marymount Loyola University. The goal of this comparison was to provide evidence supporting the validity of the MUNS as a universal, cross-cultural neuropsychological assessment battery.Participants and Methods:Students from James Madison University (JMU) in Harrisonburg, Virginia (N = 24, Age = 20.083 1.93, Female = 87.5%) were recruited via a campus-wide email. Students who met inclusionary criteria were selected for MUNS administration. Students completed a background questionnaire and effort measure (REY-15; Rey, 1964) before completing the MUNS battery, consisting of eight subtests with four delayed trials. Descriptive statistics of the group were assessed, and one-way ANOVAs were conducted on the various subtests to determine whether differences exist between the American and Argentine samples.Results:No significant difference between groups was found for seven subtests. A difference existed on the Attention subtest between the American (f (1, 106) = 45.409, p < .001).Conclusions:The results show support for the cross-cultural validity of the MUNS. The only significant difference was found in the Arrows (Old) subtest. This is in alignment with previous administrations of the MUNS (Fernandez et al., 2018). Further studies are needed to assess potential bias within this subtest, as well as to pursue comparison studies for the New Arrows subtest administered within this USA sample. The present findings provide further evidence that the MUNS can be applied as a neuropsychological assessment across a variety of populations.

Variability in prostate cancer detection among radiologists and urologists using MRI fusion biopsy.

The aim of this study is to evaluate the impact of radiologist and urologist variability on detection of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) with magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion prostate biopsies. The Prospective Loyola University MRI (PLUM) Prostate Biopsy Cohort (January 2015 to December 2020) was used to identify men receiving their first MRI and MRI/TRUS fusion biopsy for suspected PCa. Clinical, MRI and biopsy data were stratified by radiologist and urologist to evaluate variation in Prostate Imaging-Reporting and Data System (PI-RADS) grading, lesion number and cancer detection. Multivariable logistic regression (MVR) models and area under the curve (AUC) comparisons assessed the relative impact of individual radiologists and urologists. A total of 865 patients (469 biopsy-naïve) were included across 5 urologists and 10 radiologists. Radiologists varied with grading 15.4% to 44.8% of patients with MRI lesions as PI-RADS 3. PCa detection varied significantly by radiologist, from 34.5% to 66.7% (p= 0.003) for PCa and 17.2% to 50% (p= 0.001) for csPCa. Urologists' PCa diagnosis rates varied between 29.2% and 55.8% (p= 0.013) and between 24.6% and 39.8% (p= 0.36) for csPCa. After adjustment for case-mix on MVR, a fourfold to fivefold difference in PCa detection was observed between the highest-performing and lowest-performing radiologist (OR 0.22, 95%CI 0.10-0.47, p< 0.001). MVR demonstrated improved AUC for any PCa and csPCa detection when controlling for radiologist variation (p= 0.017 and p= 0.038), but controlling for urologist was not significant (p= 0.22 and p= 0.086). Any PCa detection (OR 1.64, 95%CI 1.06-2.55, p= 0.03) and csPCa detection (OR 1.57, 95%CI 1.00-2.48, p= 0.05) improved over time (2018-2020 vs. 2015-2017). Variability among radiologists in PI-RADS grading is a key area for quality improvement significantly impacting the detection of PCa and csPCa. Variability for performance of MRI-TRUS fusion prostate biopsies exists by urologist but with less impact on overall detection of csPCa.

Development and external validation of multimodal postoperative acute kidney injury risk machine learning models.

To develop and externally validate machine learning models using structured and unstructured electronic health record data to predict postoperative acute kidney injury (AKI) across inpatient settings. Data for adult postoperative admissions to the Loyola University Medical Center (2009-2017) were used for model development and admissions to the University of Wisconsin-Madison (2009-2020) were used for validation. Structured features included demographics, vital signs, laboratory results, and nurse-documented scores. Unstructured text from clinical notes were converted into concept unique identifiers (CUIs) using the clinical Text Analysis and Knowledge Extraction System. The primary outcome was the development of Kidney Disease Improvement Global Outcomes stage 2 AKI within 7 days after leaving the operating room. We derived unimodal extreme gradient boosting machines (XGBoost) and elastic net logistic regression (GLMNET) models using structured-only data and multimodal models combining structured data with CUI features. Model comparison was performed using the receiver operating characteristic curve (AUROC), with Delong's test for statistical differences. The study cohort included 138 389 adult patient admissions (mean [SD] age 58 [16] years; 11 506 [8%] African-American; and 70 826 [51%] female) across the 2 sites. Of those, 2959 (2.1%) developed stage 2 AKI or higher. Across all data types, XGBoost outperformed GLMNET (mean AUROC 0.81 [95% confidence interval (CI), 0.80-0.82] vs 0.78 [95% CI, 0.77-0.79]). The multimodal XGBoost model incorporating CUIs parameterized as term frequency-inverse document frequency (TF-IDF) showed the highest discrimination performance (AUROC 0.82 [95% CI, 0.81-0.83]) over unimodal models (AUROC 0.79 [95% CI, 0.78-0.80]). A multimodality approach with structured data and TF-IDF weighting of CUIs increased model performance over structured data-only models. These findings highlight the predictive power of CUIs when merged with structured data for clinical prediction models, which may improve the detection of postoperative AKI.

Diagnosis of Irritable Bowel Syndrome: Primary Care Physicians Compared with Gastroenterologists.

Objective: To examine disparities between primary care provider (PCP) and gastroenterologist diagnosis and management of irritable bowel syndrome (IBS).Design: Retrospective cross-sectional study.Setting: A 547-bed quaternary-care hospital within the Loyola University Healthcare System.Participants: 1000 patients aged 18-65 with an ICD-10 diagnosis of IBSMethods: We randomly selected 1000 patients aged 18 to 65 years within the Loyola University Healthcare System's electronic medical record with an ICD-10 diagnosis of IBS. Physician notes and diagnostic results were reviewed for documentation of symptoms fulfilling Rome IV criteria and resolution of symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of primary diagnoses assigned by PCPs and gastroenterologists were assessed along with number of diagnostic tests ordered.Results: The mean age (SD) was 45 (12) years, and 76.9% were female. Sensitivity of an IBS diagnosis by a PCP was 77.6% (95% CI 73.3-81.9), compared with 60.1% (95% CI 54.7-65.6) for a gastroenterologist. Specificity of an IBS diagnosis by a PCP was 27.5% (95% CI 23.5-31.5), compared with 71.1% (95% CI 64.6-77.5) for a gastroenterologist diagnosis of IBS. A gastroenterologist diagnosis of IBS carried a high PPV (77.3%, 95% CI 72.0-82.6) compared with 44.6% (95% CI 40.7-48.5) for a PCP. Of 180 patients with outcome data, 69.4% had resolution of symptoms at follow-up.Conclusion: The sensitivity of gastroenterologist diagnosis of IBS closely matches the sensitivity of Rome IV criteria in validation studies. The high specificity and PPV of gastroenterologists suggest more cautious diagnosis by gastroenterologists, with PCPs more likely to assign a diagnosis of IBS incorrectly or without sufficient documentation of symptoms fulfilling Rome IV criteria. Reported resolution rates suggest primary care management of IBS is appropriate, but PCPs may benefit from gastroenterologist consultation and diagnostic guidelines for greater specificity in diagnosing IBS.

Medieval Manuscripts at Loyola University Chicago

Abstract: This article provides a summary overview of the collection of pre-1600 western European manuscripts in Loyola University Chicago Archives &amp; Special Collections. The collection presently comprises four manuscript codices, at least thirty-eight fragments, and four documents. The codices are a thirteenth-century book of hours from German-speaking lands; a fifteenth-century Dutch prayer book; a preacher's compilation written probably in southern Germany in the 1440s; and two fifteenth-century Italian humanist booklets, bound together since the nineteenth century, transmitting Donatus's commentary on the Eunuchus (incomplete) and an anthology of theological excerpts, respectively. The fragments consist of thirteen leaves from books dismembered by modern booksellers (most are from fifteenth-century books of hours) and a larger number of binding fragments, all but two of which remain in situ. These represent the remains of ten manuscript books: four Latin liturgical books, two texts of Roman civil law, one large-format thirteenth-century Italian Bible, one thirteenth-century copy of Ptolemy's Almagest in the translation of Gerard of Cremona, one late fourteenth-century copy of the Ockhamist Tractatus de principiis theologiae , and one fifteenth-century Dutch book of hours in the translation of Geert Grote. Many of these materials have remained unidentified until now.

Navigating Faith and Science

Navigating Faith and Science

New archival digital exhibit.

Innovations in Language, Emotion, and Empathy Research is a digital exhibit which celebrates the forgotten contributions to psychology by Prof. Vincent V. Herr, S. J. (1901-1970) and his colleagues in the mid-20th century. It draws on the substantial unpublished material in the Herr Papers at the Loyola University Chicago Archives and Special Collections. The online exhibition showcases over 40 archival documents, images, and photographs. These are elaborated with detailed text presenting Herr's research achievements and impactful collaborations. During his time at Loyola University Chicago, Herr pursued a range of interrelated projects using innovative assessment approaches to measure linguistic, emotional, and social aspects of healthy and disordered mental states. He was adept in experimental techniques which he applied to questions in psychiatry and social psychology. Herr investigated individual differences in emotionality and empathy through original tasks and instrumental measures. He collaborated with colleagues at Harvard and Yeshiva Universities on the religion and mental health project in the 1950s and 1960s supported by the National Institute of Mental Health and became an advisor to Vatican II in 1965. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Externally validated deep learning model to identify prodromal Parkinson’s disease from electrocardiogram

Little is known about electrocardiogram (ECG) markers of Parkinson’s disease (PD) during the prodromal stage. The aim of the study was to build a generalizable ECG-based fully automatic artificial intelligence (AI) model to predict PD risk during the prodromal stage, up to 5 years before disease diagnosis. This case–control study included samples from Loyola University Chicago (LUC) and University of Tennessee-Methodist Le Bonheur Healthcare (MLH). Cases and controls were matched according to specific characteristics (date, age, sex and race). Clinical data were available from May, 2014 onward at LUC and from January, 2015 onward at MLH, while the ECG data were available as early as 1990 in both institutes. PD was denoted by at least two primary diagnostic codes (ICD9 332.0; ICD10 G20) at least 30 days apart. PD incidence date was defined as the earliest of first PD diagnostic code or PD-related medication prescription. ECGs obtained at least 6 months before PD incidence date were modeled to predict a subsequent diagnosis of PD within three time windows: 6 months–1 year, 6 months–3 years, and 6 months–5 years. We applied a novel deep neural network using standard 10-s 12-lead ECGs to predict PD risk at the prodromal phase. This model was compared to multiple feature engineering-based models. Subgroup analyses for sex, race and age were also performed. Our primary prediction model was a one-dimensional convolutional neural network (1D-CNN) that was built using 131 cases and 1058 controls from MLH, and externally validated on 29 cases and 165 controls from LUC. The model was trained on 90% of the MLH data, internally validated on the remaining 10% and externally validated on LUC data. The best performing model resulted in an external validation AUC of 0.67 when predicting future PD at any time between 6 months and 5 years after the ECG. Accuracy increased when restricted to ECGs obtained within 6 months to 3 years before PD diagnosis (AUC 0.69) and was highest when predicting future PD within 6 months to 1 year (AUC 0.74). The 1D-CNN model based on raw ECG data outperformed multiple models built using more standard ECG feature engineering approaches. These results demonstrate that a predictive model developed in one cohort using only raw 10-s ECGs can effectively classify individuals with prodromal PD in an independent cohort, particularly closer to disease diagnosis. Standard ECGs may help identify individuals with prodromal PD for cost-effective population-level early detection and inclusion in disease-modifying therapeutic trials.

Filling the gaps: A community case study in using an interprofessional approach and community-academic partnerships to address COVID-19-related inequities.

Public health challenges rapidly escalated during the COVID-19 pandemic. In response to a severe lack of resources and support in the near western suburbs of Chicago, the COVID Equity Response Collaborative: Loyola (CERCL) was established by an interprofessional team of Loyola University Chicago students, staff, and faculty. CERCL sought to minimize the negative impact of COVID-19 on vulnerable communities, those that are largely Black, Hispanic, or low-income. From April 2020 to the present, the collaborative utilized community-academic partnerships and interdisciplinary collaborations to conduct programming. CERCL's programming included free community-based testing, screening for and assistance with social determinants of health, dissemination of relevant and reliable COVID-related information, provision of personal protective equipment, and facilitation of access to vaccines. With partners, the collaborative conducted 1,500 COVID-19 tests, trained 80 individuals in contact tracing, provided over 100 individuals with specifically tailored resources to address social and legal needs, distributed 5,000 resource bags, held 20 community conversations, canvassed 3,735 homes, and hosted 19 vaccine clinics. Community-academic partnerships with the health system, community and governmental agencies, and the local public health department have been critical to CERCL efforts. The interdisciplinary and interprofessional successes demonstrated in this case study lends the example of a relevant, sustainable, and practical intervention to address nuanced public health issues.

Editorial introductions.

Editorial introductions.

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#2724 THROMBO-INFLAMMATORY BIOMARKERS OF CARDIORENAL SYNDROME IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS IN END STAGE RENAL DISEASE

Abstract Background and Aims Cardiovascular disease is a highly common complication in patients with end stage renal disease (ESRD) on maintenance hemodialysis. In the ESRD patient population, cardiovascular mortality is 20 times higher compared to the general population. The strong relationship of both illnesses can be explained through cardiorenal syndrome (CRS). CRS encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in one organ may induce similar effect in the other organ. The diagnosis, prognosis and risk stratification of CRS is poorly understood. Current literature reveals that inflammation and thrombosis are integral to CRS development and key cardiac and renal biomarkers are elevated in CRS patients. Hence, this study aims to demonstrate that thrombo-inflammatory biomarkers and laboratory parameters give a telling narrative of ESRD progression to CRS. Method Plasma samples were collected from 95 ESRD patients which were recruited with an approved IRB protocol at Loyola University Medical Center hemodialysis unit. Normal human plasma (NHP) was obtained from a commercial source (George King Biomedical, Overland Park, KS). Thrombo-inflammatory biomarkers, including Annexin V, MPO, Troponin, L-FABP, VEGF, D-dimer, TNF-alpha, IL-6, CRP, eNOS, Nitrotyrosine, MDA, NEFA, NO, vWF and MCP-1 were measured using commercially available ELISA methods. Cardiovascular comorbidities and laboratory parameters were obtained from EPIC chart analysis. Results were then statistically analyzed using GraphPad Prism v.9; the results were compiled into mean ± SEM, percent change comparison to NHP, analyzed for significance. Results Several cardiovascular comorbidities were seen in the 95 ESRD patient samples including AF (22%), PAD (29%), HF (24%), CAD (22%), DVT (15%), COPD (6.5%), and PE (5.3%). Overall, 25% of the ESRD patients have CRS. Laboratory parameters, ferratin (521.99 ±289.33) and PTH (442.91 ± 1.50) were elevated in ESRD patients. Most of the thrombo-inflammatory CRS biomarkers were elevated in ESRD patients. Biomarkers including Annexin V (ESRD 7.57 ± 5.24, 23.64% vs. 6.125 ± 8.29, p&amp;lt; 0.001), L-FABP (106599.43 ± 176728.97, 1983% vs. 5116.33 ± 1767.88, p&amp;lt;0.0001), D-dimer (ESRD 1447.01 ± 2103, 650.53% vs. 192.8 ± 212.9, p&amp;lt;0.0001), TNF-alpha (ESRD 2.52 ± 1.06, 35.87% vs. 1.85 ± 1.20, p&amp;lt;0.0001), IL-6 (ESRD 5.211 ± 10.36, 317.21% vs. 1.25 ± 1.24, p &amp;lt;0.0001), CRP (ESRD 14.53 ± 14.11, 2214.43% vs. 0.63 ± 0.99, p&amp;lt; 0.0001), NO (ESRD 34.74 ± 19.74, 151.74% vs. 13.8 ± 5.60, p&amp;lt;0.0001), vWF (ESRD 200.7 ± 25.89, 183.03% vs. 70.91 ± 23.13 p&amp;lt; 0.0001) and MCP-1 (148.4 ± 56.09, 67.49% vs. 88.6 ± 27.25, p&amp;lt;0.0001) showed significant increase when compared to NHP. Conclusion This study suggests that thrombo-inflammatory biomarkers and laboratory parameters may be helpful in indicating CRS in ESRD patients. Ultimately, these biomarkers can now be readily used to correlate against other biomarker findings and studied further to determine their accuracy in prognosis and diagnosis of CRS.

Nature as Guide: Wittgenstein and the Renewal of Moral Theology. By David Goodill. Washington, D.C.: Catholic University of America Press, 2022. Pp. xiii, 319. $75.00.

The Heythrop JournalEarly View Book Review Nature as Guide: Wittgenstein and the Renewal of Moral Theology. By David Goodill. Washington, D.C.: Catholic University of America Press, 2022. Pp. xiii, 319. $75.00. Matthew Dunch SJ, Corresponding Author Matthew Dunch SJ [email protected] Loyola University ChicagoSearch for more papers by this author Matthew Dunch SJ, Corresponding Author Matthew Dunch SJ [email protected] Loyola University ChicagoSearch for more papers by this author First published: 04 June 2023 https://doi.org/10.1111/heyj.14233Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Defining risk of central nervous system relapse in acute myeloid leukemia following allogeneic stem cell transplantation.

e19009 Background: Relapse following allogeneic stem cell transplant (AlloSCT) for acute myeloid leukemia (AML) remains the commonest cause of death post-transplant. Central nervous system (CNS) relapse is a devastating complication. With an estimated incidence of 2-8%, defining those patients at high risk and the management following CNS relapse remains controversial. We sought to identify demographic, clinical, molecular, and laboratory risk factors that would predispose AML patients to CNS relapse. Methods: This was a single institution retrospective study at Loyola University Medical Center. Inclusion criteria were adult patients with AML undergoing first AlloSCT from January 2012 to June 2021. Diagnosis of CNS relapse following AlloSCT was defined as leukemic blasts detected in spinal fluid analysis in accordance with established criteria. Chi-square tests were used to test the association between the experiencing of relapse and the categorical variables recorded. Wilcoxon Rank Sum test were used to assess the relationship between relapse experience and each of the demographic variables. Due to the low count of patients with CNS relapse and in order to avoid a poor estimation of confidence limits of any effect size, we limited our analyses to descriptive statistics and univariable analyses. Results: 198 patients met inclusion criteria with 8 cases (4.0% total) identified with CNS relapse following AlloSCT. Our analysis initially characterized 44 variables including age, race, HCT-CI risk, and day 100 chimerism. Univariate analysis is shown in the table below. Of note, it revealed that 62.50% of patients with CNS relapse had a chimerism value ≤98% at day 100 post-transplant as compared to 22.58% of patients without CNS relapse (p-value 0.02). Additionally, 87.50% of the CNS relapse group versus 51.38% of the group without relapse had favorable to intermediate AML risk scores (p-value 0.07). Conclusions: We observed a 4.0% rate of CNS relapse, which is consistent with what has been repored in the literature. Our results suggest that day 100 chimerism and disease risk index may be predictive of CNS relapse. Since there is a 10.6% incidence (5/47) of eventual CNS relapse amongst those with ≤98% chimerism at day 100, these patients could be considered for a lumbar puncture and bone marrow biopsy to prevent full relapse. Further research in this topic would be valuable to provide additional AML guidance in managing this uncommon complication, such as which patients may benefit from prophylactic strategies. [Table: see text]

Impact of body mass index (BMI) and weight changes on hematopoietic stem cell transplant (HSCT) outcomes in the elderly population.

e19058 Background: HSCT remains the only curative treatment for high-risk hematologic malignancies. Reduced intensity conditioning (RIC) has increasingly allowed transplant of elderly patients. However, maximizing outcomes in this population remains a challenge. We examine the influence of BMI and weight changes on HSCT outcomes in the elderly. Methods: This was a retrospective review of 216 patients ≥60 years of age who underwent first HSCT at the Loyola University Medical Center between 8/30/2000-6/15/2017. Pearson Chi-square tests for independence evaluated the associations between categorical variables and timing of recurrence. Fisher’s exact test were used where expected frequencies were &lt;5. Independent two-sample t-tests and ANOVA assessed differences in numerical variables. Results: BMI at time of transplant, defined as underweight (BMI&lt;18), normal weight (BMI 18-25), overweight (BMI 25-30), and morbidly obese (BMI&gt;30), did not impact incidence of cardiac dysfunction, pulmonary complications (Cx’s), renal Cx’s, graft versus host disease (GVHD), paraenteral nutrition (TPN) use, changes in albumin, or mortality. However, there was a trend towards increased disease relapse in those who were not normal weight (p=.08). Normal weight (BMI 18-25) at Day 100 was associated with decreased cardiac dysfunction (p=.02), days of hospitalization (p = .03), and mortality (p = .02) compared to non-normal BMI (BMI &lt; 18 or BMI &gt; 25). But there appeared no difference in rates of renal Cx's, GVHD, TPN use, or relapse. Having &gt;10% weight change at discharge from transplant admission was associated with increased renal Cx’s (p = .007), infectious Cx’s (p = .03), use of TPN (p = .006), length of hospital stay (p = .0002), and mortality (p = .009). However, it was not associated with cardiac dysfunction, pulmonary Cx’s, readmissions by 6 months, GVHD, or relapse. Having &gt;10% weight change at Day 100 was associated with increased risk of acute (p = .01) and chronic GVHD (p = .002) and readmissions by 6 months (p = .01), but not with other Cx’s, relapse, or mortality. Conclusions: Patients who were underweight or overweight at key timepoints may impact complications and HSCT outcomes. Furthermore, maintaining a stable weight during transplant admission and the first 100 days was associated with decreased rates of complications and adverse HSCT outcomes. These findings warrant further evaluation into age-related weight and nutritional targets to improve understanding and optimize HSCT outcomes in this vulnerable population. [Table: see text]

0108 Sleep Health of Adolescents in the Department of Juvenile Justice: A Qualitative Analysis of Night Staff Interviews

Abstract Introduction Limited research exists regarding the sleep environment and sleep health of youth in juvenile justice facilities. We examined the perspectives of facility night staff on the sleep-living environment and conditions of detained youth using semi-structured interviews. Methods In collaboration with Maryland’s Department of Juvenile Services (DJS) we conducted virtual semi-structured interviews (45 minutes) with superintendents, medical staff, and night staff at all state facilities. We present the data reported by night staff (n=10) here, each representing a different facility. Interview questions focused on facility structure, protocols, and youth healthcare. Inductive qualitative analyses examined high frequency themes with the aim of understanding the sleep environment, sleep patterns, and overall youth wellbeing. After transcription of each interview, coder 1 examined each transcript to identify high frequency themes; coder 2 reviewed these first codes. Few disagreements occurred; in those cases, a third coder helped reach consensus. Theme frequency is expressed as a percentage of the total number of transcriptions (e.g., 4 interviews out of 10=40%). Results Major themes reported by night staff include environmental disruptions, ability to personalize sleep areas, youth well-being, and sleep challenges. Environmental disruptions included moderate noise levels (40%); youth temperature complaints (50%); and youth lighting complaints (60%). More specifically, 50% reported youth reported night lighting complaints (including blue light) within the dorms. While 40% described room personalization is allowed, 40% stated it is also limited. For instance, while youth are allowed to display family pictures, they are not allowed to display any gang-related material as it could cause altercations between youth. Complaints of trouble sleeping is addressed in 50% of facilities by utilizing a weeklong sleeping log (e.g., staff report number of times youth are awake during the night during their safety checks). Seventy percent of staff reported that work affects their sleep and psychological wellbeing and 60% shared that they sleep 3 - 6 hours/night. Conclusion Assessment and modifications of the sleep-living environment in juvenile justice facilities are needed. Ongoing countermeasures in the Maryland system include noise buffering panels, light modifications, and sleep-health staff trainings. Support (if any) Kolvenbach grant, Loyola University Maryland and Maryland Department of Juvenile Services’ supportive collaboration.