Miller Family Research Articles

Microbial taxonomic and functional shifts in adolescents with type 1 diabetes are associated with clinical and dietary factors.

Evidence indicates a link between the pathogenesis of type 1 diabetes (T1D) and the gut microbiome. However, the regulation of microbial metabolic pathways and the associations of bacterial species with dietary factors in T1D are largely unknown. We investigated whether microbial metagenomic signatures in adolescents with T1D are associated with clinical/dietary factors. Adolescents with T1D (case) and healthy adolescents (control) were recruited, and microbiome profiling in participants' stool samples was performed using shotgun metagenomic sequencing. The bioBakery3 pipeline (Kneaddata, Metaphlan 4 and HUMAnN) was used to assign taxonomy and functional annotations. Clinical (HbA1c) and dietary information (3-day food record) were collected for conducting association analysis using Spearman's correlation. Adolescents with T1D exhibited modest changes in taxonomic composition of gut microbiome. Nineteen microbial metabolic pathways were altered in T1D, including downregulation of biosynthesis of vitamins (B2/flavin, B7/biotin and B9/folate), enzyme cofactors (NAD+ and s-adenosyl methionine) and amino acids (aspartate, asparagine and lysine) with an upregulation in the fermentation pathways. Furthermore, bacterial species associated with dietary and clinical factors differed between healthy adolescents and adolescents with T1D. Supervised models modeling identified taxa predictive of T1D status, and the top features included Coprococcus and Streptococcus. Our study provides new insight into the alteration of microbial and metabolic signatures in adolescents with T1D, suggesting that microbial biosynthesis of vitamins, enzyme cofactors and amino acids may be potentially altered in T1D. Research grants from NIH/NCCIH: R01AT010247 and USDA/NIFA: 2019-67017-29253; and Larry & Gail Miller Family Foundation Assistantship.

“Long as There’s Capitalism, Baby”: The Relevancy of The American Clock

abstract With millions of Americans leaving the workplace during the Great Resignation, Arthur Miller’s 1980 play The American Clock continues to be a relevant and prescient barometer for our current socioeconomic climate. Whether Americans were speculating in penny stocks leading up to the Great Depression or using online platforms to bet on “meme stocks” and cryptocurrency today, or whether naively trusting in Rockefeller or Elon Musk as economic saviors spouting esoteric pecuniary wisdom, Miller’s play is a timeless mirror reflecting the foibles of human nature. Miller’s adaptation of historical figures such as Jesse Livermore not only scrutinizes the greed and gullibility of 1920s America but also informs current economic and social dynamics. Like much of Miller’s work, the play includes autobiographical elements, with the Baum family corresponding to the Miller family’s experience during the Depression. This article demonstrates how The American Clock remains relevant in the twenty-first century.

Ah, Wilderness!

Ah, Wilderness!

In Memoriam: Robert (Bob) Miller 1947–2022

In Memoriam: Robert (Bob) Miller 1947–2022

P123 Novel Type 2 Diabetes Prevention Curriculum Increased Skin Carotenoids and Lowered BMI Percentile in Adolescents

<h3>Background</h3> Adolescent type 2 diabetes (T2D) incidence increased 4.8% annually between 2002-2015 and accounts for 20% of adolescent diabetes diagnoses. Obesity is strongly correlated with T2D among adolescents. Few previous interventions show efficacy at improving adolescent eating and exercise behaviors, which could decrease the proportion of overweight and obese adolescents and reduce risk for T2D. <h3>Objective</h3> To evaluate efficacy of a novel T2D prevention curriculum on nutrition behaviors and anthropometrics in adolescents. <h3>Study Design, Setting, Participants</h3> Quasi-experimental intervention versus control study with convenience sampling. Trained researchers taught curriculum to adolescents at three schools during mandatory health education classes, while students in three population-matched control schools received standard nutrition education in their health education classes. Six lessons incorporated elements of Social Cognitive Theory including technology, goal-setting, competition, incentives, and peer support to promote behaviors that reduce risk for type 2 diabetes. Outcome variables were assessed at baseline (T1); 1-day post curriculum delivery (T2); and 1-month follow-up (T3). <h3>Measurable Outcome/Analysis</h3> Outcome variables included BMI percentile for age and sex, skin carotenoids, and sugar-sweetened beverage (SSB) intake. Multi-level general linear mixed effects regression models, independent t-tests, and Pearson chi-square tests assessed differences in intervention effectiveness (Stata version 15). <h3>Results</h3> Adolescents in intervention group (n = 436) lowered BMI percentile (<i>P</i> = 0.011) and increased skin carotenoids (<i>P</i> < 0.001) compared to control group (n = 316), at T3 follow-up visit. No changes in SSB consumption occurred. <h3>Conclusions</h3> Novel intervention components may increase adolescent motivation and engagement, resulting in behavioral changes that reduce risk for type 2 diabetes. Future intervention designs focused on strategies shown to motivate adolescent behavior change are recommended. <h3>Funding</h3> Larry and Gail Miller Family Foundation

231-OR: Antecedent Hypoglycemia Increases Damage Due to a Subsequent Myocardial Infarction in Rats

Several clinical trials have noted an association between hypoglycemia and major cardiovascular events; however, a direct link between antecedent hypoglycemia and worse cardiac outcomes has not been established. We hypothesized that antecedent recurrent hypoglycemia predisposes the heart to increased damage following a subsequent myocardial infarction. To test this hypothesis, adult Sprague Dawley rats were subjected to 3 days of recurrent insulin-induced hypoglycemia (25-30 mg/dl, 90 minutes each day; n = 6) or saline (control, n = 6) . On the following day, all rats underwent a myocardial infarction (MI) induced by occlusion of the left anterior descending artery for 30 minutes followed by reperfusion for 60 minutes. Electrocardiograms indicated ST elevation during the MI, which returned to normal sinus rhythm upon reperfusion. Hearts were removed immediately and analyzed for damage. MI induced ventricular damage from rats that underwent antecedent recurrent hypoglycemia (39 ± 5%) was significantly higher than control rats (16 ± 4%; p&amp;lt;0.001, Figure) . Additionally, plasma norepinephrine levels were elevated 14-fold in rats that underwent recurrent hypoglycemia. These studies indicate that antecedent hypoglycemia directly contributes to worse outcomes following an MI and that increased norepinephrine is associated with this damage. Disclosure C.G.Christensen: None. S.Fisher: None. C.M.Reno: None. Funding University of Utah’s Driving Out Diabetes, a Larry H. Miller Family Wellness InitiativeNational Institutes of Health (P30 DK020579) Juvenile Diabetes Research Foundation (1-FAC-2020-984-A-N)

994-P: Prevalence and Persistence of Post-diagnosis Hyperglycemia in Cancer Patients

Introduction: Cancer patients are more likely to develop hyperglycemia (HG) compared to cancer-free adults, and this increased risk is highest in the year following cancer diagnosis. The persistence of post-diagnosis HG and degree of glycemic control in this population is unclear. Methods: This study utilized data from n=9,588 cancer patients from the Huntsman Cancer Institute, UT. Clinicodemographic characteristics, biomarkers, and cancer diagnoses were extracted from electronic medical records (EMR) and tumor registry. Patients with a new HG diagnosis (ICD) of any kind between 30 days and 1 year after cancer diagnosis were included. Persistence of HG was determined through elevated Hemoglobin A1c (HbA1c) and/or new anti-HG medication prescription. Patients who did not survive &amp;gt;1 year after cancer diagnosis or were diagnosed with cancer &amp;lt;1 year prior to EMR abstraction were excluded. Results: Of the 2,964 (30.9%) cancer patients with a HG diagnosis after cancer, 26.2% (n=777) were diagnosed with HG between 30 days and 1 year after cancer diagnosis, of these n=357 met criteria for HG evaluation. Data on HbA1c and/or anti-HG medication &amp;gt;1 but &amp;lt;2 years post-cancer diagnosis was available for 109 patients. Of these, 60 (55.0%) received a new anti-HG medication prescription and an additional 30 (27.5%) had an HbA1c greater than 5.7%, indicative of HG. Interestingly, body mass index (BMI) was similar among those that did and did not receive anti-HG medication (32.0 ± 6.4 vs. 32.6 ± 7.8 kg/m2, respectively), suggesting an alternate mechanism for lack of glycemic control. Discussion: Taken together, 82.5% of patients diagnosed with HG in the year following a cancer diagnosis still presented with HG between one and two years post-cancer diagnosis, and there was no difference by BMI among those that did and did not receive anti-HG medications. This suggests that HG post-cancer diagnosis is not a transient effect of cancer therapy (e.g., corticosteroids), and may have long-term health implications in cancer survivors. Disclosure R. Viskochil: None. S. Hardikar: None. S. Pauleck: None. M. Winn: None. K. Funai: None. M. L. Litchman: Research Support; Self; Abbott Diabetes. W. Akerley: None. H. Colman: Advisory Panel; Self; Adastra Pharmaceuticals, Orbus Therapeutics, Consultant; Self; Best Doctors/Teladoc. C. M. Ulrich: None. M. C. Playdon: None. Funding University of Utah Health/Larry H. Miller Family Wellness Initiative

1010-P: Prevalence of Acute Diabetes Complications following Cancer Diagnosis and Treatment

Introduction: Multiple case studies have reported diabetic ketoacidosis (DKA) in recently-diagnosed cancer patients, especially those taking immune checkpoint inhibitors. The prevalence of DKA and other acute diabetes complications (ADC), including hypoglycemia and hyperosmolarity, and their relationship with the onset of systemic cancer therapy is unclear. Methods: This study utilized data from n=9,588 cancer patients from the Huntsman Cancer Institute, UT. Data on clinicodemographic characteristics, biomarkers, and cancer diagnoses were extracted from electronic medical records (EMR) and tumor registry. Patients included in this analysis received an ICD diagnosis of hypoglycemia, hyperosmolarity with or without coma, and/or DKA with or without coma. Systemic therapy was defined as any chemotherapy, immunotherapy or hormone therapy resulting from a specific first primary cancer diagnosis. Results: There were 243 instances of ADC within this cohort, occurring in 211 (2.2%) unique patients. Of these 211 unique patients with an ADC, 106 (50.0%) experienced their first ADC within one year after cancer diagnosis, with a median time to ADC diagnosis of 88 days. Forty-seven (44%) of these patients experienced the ADC following the onset of systemic therapy, with a median time from systemic therapy onset to ADC diagnosis of 120 days. In these 47 patients who received an ADC diagnosis following the onset of systemic therapy, 40 (85.1%) received chemotherapy (n=20 as monotherapy), 20 (42.6%) received immunotherapy (n=4 as monotherapy) and 12 (25.5%) received hormone therapy (n=2 as monotherapy). Only 54% of patients experiencing an ADC after cancer diagnosis had a history of diabetes prior to cancer, and on average their first diabetes diagnosis was 5.4 ± 4.4 years prior to their cancer diagnosis. Discussion: ADCs may be common following a cancer diagnosis, however a substantial number occurred prior to the onset of systemic cancer therapy and in patients with no prior history of diabetes. Disclosure R. Viskochil: None. S. Hardikar: None. S. Pauleck: None. M. Winn: None. K. Funai: None. M. L. Litchman: Research Support; Self; Abbott Diabetes. W. Akerley: None. H. Colman: Advisory Panel; Self; Adastra Pharmaceuticals, Orbus Therapeutics, Consultant; Self; Best Doctors/Teladoc. C. M. Ulrich: None. M. C. Playdon: None. Funding University of Utah Health/Larry H. Miller Family Wellness Initiative

474-P: Durable Reductions in A1C and Diabetes Distress with a One-Day Hybrid DSMES Intervention

The effectiveness of time efficient diabetes self-management education and support (DSMES) interventions that include both group and individual sessions is lacking. This study tested the impact of the Diabetes One-Day Education and Care (D1D) Program on A1C and diabetes distress.D1D is an 8-hour DSMES hybrid (group and individual sessions) program delivered by an interdisciplinary team. Group sessions focused on the AADE7 self-care behaviors and included an interactive lunch with chef demonstration. Three 30-minute individual session were with a nurse practitioner/endocrinologist, pharmacist, dietitian, nurse, and/or exercise specialist. A1C and diabetes distress were collected at baseline, 3- and 6-months.Participants (N=213) were 59% female, 85% White, with an average age of 56.4±16 years and average diabetes duration of 11.7±11.3 years. Most participants had type 2 diabetes (80%). Compared to baseline (8.2% ±2.1), A1C levels were significantly lower at 3-months (7.6±1.6%, p<.001) and 6-months (7.6±1.5%, p=.001). Compared to baseline (60.8 ±20.3), diabetes distress levels were significantly lower at 3-months (-11.3, p<001) and 6-months (-10.30, p<001).D1D is a one-day hybrid DSMES program that demonstrated durable reductions in A1C and diabetes distress.View largeDownload slideView largeDownload slide DisclosureM. L. Litchman: Research Support; Self; Abbott Diabetes. S. Fisher: None. X. Wang: None. R. K. Delaney: None. J. Neuberger: None. A. Reeder: None. S. R. Jones: None. J. S. Simonetti: Consultant; Self; Rhythm Pharmaceuticals, Research Support; Self; Rhythm Pharmaceuticals . M. Wahl: None. A. Fagerlin: None.FundingLarry H. & Gail Miller Family Foundation

VIRTUAL RECONSTRUCTION OF THE BIRTHPLACE OF REMBRANDT VAN RIJN: FROM HISTORICAL RESEARCH OVER 3D MODELING TOWARDS VIRTUAL PRESENTATION

Abstract. 2019 marks the 350th anniversary of the death of the famous seventeenth-century painter Rembrandt van Rijn. Rembrandt was born in 1606 in the city of Leiden, located in the Netherlands. Here he grew up, was educated and set up his early practice before moving to Amsterdam at age 31. He is the son of a miller's family, which lived and worked in the city at the dawn of the Dutch Golden Age – a period in which Leiden transformed from a medieval city to an early modern metropolis. Although the historical city fabric of Leiden is well preserved, the birthplace of the famous painter, unfortunately, has been demolished. Also, the surroundings are unrecognizable today. For this reason, the tourism and marketing department of the city asked Erfgoed Leiden, the regional heritage department, to make a 3D virtual reconstruction of Rembrandt's birthplace and its surrounding. It resulted in a multi-disciplinary collaboration between archivists, building archaeologist, and a 3D artist. This paper reflects this cooperation from historical research over aspects of the 3D modeling pipeline to the final products of the reconstruction. Following a reliability matrix, the data were categorized for their reliability after careful evaluation of their accuracy depending on the source.

Proliferating miller indices of C20 fullerene device under DFT-NEGF regime

We present ab-initio scrutiny of electron transport through C20 fullerene cleaved with gold electrodes having unique set of miller orientations. The three families of miller indices {100}, {110} and {111} are considered with four exclusive device models for elucidating electronic transport under applied potential of − 2 to +2V. Thereafter, the quantum calculations employing DFT-NEGF are performed for envisaging density of states, transmission function, energy levels, molecular orbitals, charge transfer. These electronic transfer parameters lead to the study of its two electrical parameters: current and conductance. We conclude that in molecular-devices of constituted miller family {110}, HOMO-LUMO gap are inversely proportional to extent of charge carriers. While for miller devices {100} and {111}, the situation is fully contrasting with HOMO-LUMO gap being directly proportional to its charge carriers. Another important conclusion is that the gold electrodes having miller family {100} and {111} are providing equal opportunity to fullerene molecule to imply its behavior while electrodes of miller family {110} are over shadowing the performance of fullerene molecule.

O'Neill on the Musical Theater Stage

O'Neill on the Musical Theater Stage

Ah, Wilderness!

Ah, Wilderness!

O'Neill on the Musical Theater Stage

O'Neill on the Musical Theater Stage

Ah, Wilderness!

Ah, Wilderness!, that rare bird, an O'Neill comedy, ends with the young Richard Miller looking forward to a bright future after learning a life lesson that O'Neill never experienced in his youth. Based loosely on the prosperous Rippin and McGinley families, who lived in Eugene O'Neill's neighborhood during his New London boyhood, Ah Wilderness! portrays the upbringing that O'Neill never had but perhaps longed for, especially after his youth lapsed and he began to reflect upon the dysfunctionality of his early life. Natalie Abrahami's production at London's Young Vic radically altered O'Neill's nostalgic and whimsical portrait of his adolescence by summoning the ghost of O'Neill to haunt his original memory play.Abrahami's revision began with cutting the script to a mere one-and-a-half hours. She also disregarded the realistic set design described in O'Neill's copious stage directions, staging instead the abstraction of a ruined home into which the audience intruded. As we step into the theater, we enter an almost dreamlike reality in which a dilapidated house has nearly succumbed to sand dunes after years of neglect. It was as if the sands of time have literally piled upon the stage, and the image is surely meant to evoke the first and perhaps happiest home O'Neill had owned as an adult, the former Life-Saving Service station at Peaked Hill Bar, which collapsed and washed into the sea a decade later, a year before the writing of Ah, Wilderness!Calling on the quintessential memory play of the twentieth century—Tennessee Williams's The Glass Menagerie—Abrahami created a narrator character (played by David Annen), who walked the line between observer and actor throughout the performance. He was a storyteller who appeared to be reliving his past as both a silent spectator and an active participant. During the opening scene, costumed as O'Neill, Annen recited the stage directions so meticulously worked out by the playwright whom he was ghosting, to borrow Marvin Carlson's term. With occasional interjections into the story as Mr. McComber and George, the bartender, Annen captured the uncanny feeling of watching O'Neill inhabit the world of his creation. The O'Neill character at times even seemed to be writing the play as the action was unfolding.This framing of the play through the eyes of a character who represents the author opened up a wider inquiry into the autobiographical nature of Ah, Wilderness! The production reiterated the process of self-archeology. The dining room of the Miller family literally had to be dug from the sand that had hidden it for many years. The uncovering of the table triggered the memory of the Fourth of July meal that was so significant in the lives of these characters and a defining scene in the play. Books that had been cherished by the youthful Richard Miller (played by George MacKay) were excavated like the bones of an extinct species.As most O'Neillians know, the plot of Ah, Wilderness! is only indirectly autobiographical, for it dramatizes a fantasized family, with drug and alcohol abuse in little evidence. The mother, father, and older brother (Janie Dee, Martin Marquez, and Ashley Zhangazha) create the impression of an average, yet blissful, home. Richard, the character who most resembles the youthful O'Neill, despite his precocious knowledge of books still has some growing up to do. At one point, the young, angst-ridden Richard emerges with a hangover from hell in dark sunglasses and black jeans and t-shirt. As the play progresses, the ghost of O'Neill continues to invade the Miller home, casting doubt on the play's portrayal of youth as a paradise. Richard and the other young boys of the town might perceive it that way, but the haunting presence of O'Neill suggests otherwise.George MacKay's performance as the young, defiant, and literary Richard Miller was delightful. He was able to inhabit the youthful spirit of rebellion required of the character, while also finding the vulnerability that lives within this young man, as we see when he is left heartbroken by Muriel (Georgia Bourke), when he tastes alcohol for the first time, or has a conversation with his first prostitute, Belle (Yasmin Page). The rest of the cast superbly portrayed the other members of the Miller family. Dominic Rowan's drunken, disorderly Uncle Sid was well crafted and the comedic highlight of the show. Yet his humorous moments were often turned on their head, as, for example, when Sid attempts to reconcile with Lily, portrayed by Susannah Wise, and fails; in this moment he broke our hearts along with hers.I enjoyed this night at the Young Vic. However, in some respects Abrahami's production was guided by O'Neill's ghost, which at times took me on conceptual detours rather than deepening my investigation of Richard's journey. This left me to wonder whose story we were watching: that of the young Richard or the ghosted playwright, Eugene O'Neill?

Little Dixie’s Circus Cemetery

[ILLUSTRATION OMITTED] Often referred to as Little Dixie, the southeastern corner of Oklahoma is home to more than just customs stemming from Native American influences in the 1800s and southerners who later migrated to the area in the 1900s. Outside of similarities in agriculture, architecture, demographics, and politics resembling the American South, in one town you can add another unique feature to the list: the circus. Hugo, Oklahoma, the county seat of Choctaw County, has served as the winter home for traditional tent shows since the 1940s. The Miller family's Al G. Kelly and Miller Brothers was the first to call Hugo, Oklahoma, home, thanks to the support of local businessman and circus fan Vernon Pratt. While Pratt offered the Millers free water for their animals, it proved to be a good move for circus owner Obert Miller and his two sons, Kelly and D. R., as the family was looking for a warmer climate over the winter months. Soon after the Millers established Hugo as their winter quarters, other shows followed. In addition to the town's temperate climate, Hugo also has easy access to state highways, which run north and south as well as east and west, creating more options when planning circus routes. The Hugo-based tent shows often followed the agricultural harvest and brought entertainment to rural communities throughout the South. Through the years, approximately twenty circuses established winter quarters in Hugo, with notable owners such as Herb Walters, the Miller family, and Jack Moore all setting up shop in the Little Dixie town known as Circus City, U.S.A. As of 2014, only three traditional tent circuses continue to call Hugo home: Carson and Barnes, Kelly Miller, and Culpepper & Merriweather. Despite the boom and later decline of circuses in the area, Hugo continues to hold strong to its circus heritage. One distinct reminder of this heritage can be found while exploring the tombstones at the Mount Olivet Cemetery. In the 1960s, a section of the cemetery was established as Showmen's Rest, serving as the final resting place for circus entertainers, employees, and show owners from not only Oklahoma but all parts of the country. Wandering through row after row of unique markers and engravings sparked an interest in the people laid to rest there. Unanswered questions led to the development of an oral history project focused on preserving the culture of those with circus ties in the Little Dixie town of Hugo, Oklahoma. NOTE Photos and interview excerpts were recorded as part of The Big Top Show Goes On: An Oral History of Occupations Inside and Outside the Canvas Tent. Made possible by a 2011 Archie Green Fellowship from the American Folklife Center at the Library of Congress, oral history transcripts, recordings, and images from this project are available at the Oklahoma State University Library and the Library of Congress American Folklife Center in Washington, D.C. [ILLUSTRATION OMITTED] We had a gentleman that worked for us, and he was just a drifter that came on as a teenager and ended up spending his whole life with us. His name was John Carroll, and he worked with the animals. And especially back in the old days, some of the guys that would come along, they were drifters and didn't really have family connections, and so the circus kind of ended up being their family and their home, and they spent their lives here. So John Carroll was one of those characters. He had lost his eye in an accident, and he received like an insurance settlement. I think it was seventeen thousand dollars or something, and he didn't have a family. About five or six years later, he passed away. And unbeknownst to my father, he had left this insurance settlement to my father. My dad didn't know what to do with it, and about that same time my uncle passed away, and that was in 1960. So he got the idea of making this place where circus people would be buried, because a lot of times circus people, like I say, don't have roots, and they would be buried in Timbuktu. …

Regional brain volume abnormalities in Lesch-Nyhan disease and its variants: a cross-sectional study

Lesch-Nyhan disease is a rare, X-linked, neurodevelopmental metabolic disorder that is caused by abnormalities in the levels of hypoxanthine-guanine phosphoribosyltransferase enzyme activity. The neural substrates associated with Lesch-Nyhan disease remain poorly understood. We aimed to use voxel-based morphometry to identify affected brain regions in classic Lesch-Nyhan disease and Lesch-Nyhan variant disease, and to identify regions that differ between the two disease types. In this cross-sectional study, we recruited patients with classic Lesch-Nyhan disease or Lesch-Nyhan variant disease from clinics, referrals, the Lesch-Nyhan Syndrome Registry, and the Matheny School and Hospital (Peapack, NJ, USA), and healthy controls from the Baltimore metropolitan area (MD, USA). We used voxel-based morphometry to analyse grey matter volume between groups using a three-group ANCOVA, followed by six pairwise post-hoc group comparisons. Between Oct 3, 1993, and April 29, 2013, we recruited 21 patients with classic Lesch-Nyhan disease, 17 patients with variant disease, and 33 healthy controls. Patients with classic Lesch-Nyhan disease had a 20% reduction in intracranial volume (17% reduction in grey matter volume; 26% reduction in white matter volume) compared with healthy adults. The largest differences were in basal ganglia, and frontotemporal and limbic regions, with sparing of parieto-occipital regions. Grey matter volumes of patients with Lesch-Nyhan variant disease were invariably between those of patients with classic Lesch-Nyhan disease and healthy controls. Compared with healthy controls, patients with classic disease showed additional grey matter volume reductions in the temporal lobe and left lateralised structures, and patients with variant disease showed additional reductions in lingual and precuneus regions with sparing of right frontal and temporal regions. Patients with classic disease had reductions of volume in the ventral striatum and prefrontal areas compared with those with the variant form. We noted regional abnormalities associated with known neurological and behavioural deficits in patients with classic Lesch-Nyhan disease. Patients with Lesch-Nyhan variant disease show milder grey matter abnormalities in many of the same brain regions and preservation of grey matter volume in other regions, which could provide important clues to the neural substrates of differences between the phenotypes. National Institute of Child Health and Human Development, Therapeutic Cognitive Neuroscience Fund, and Benjamin and Adith Miller Family Endowment on Aging, Alzheimer's and Autism Research.

Learning from the Past, Building for the Future

AbstractThe Illinois Holocaust Museum and Education Center (IHMEC) strives to engage youth as citizens through Make a Difference! The Harvey L. Miller Family Youth Exhibition. Teaching about the Holocaust is complex and challenging work. Holocaust education is mandated in Illinois elementary and high schools, yet the Museum finds that many teachers are unsure of how to teach such sensitive and complex topics; such as civics, character education, the Holocaust, human behavior, and genocide. In fact, direct teaching of the Holocaust is not recommended by the United States Holocaust Memorial Museum until 7th grade or later due to the level of emotional preparation needed to study this material. Thus, IHMEC takes a spiraled approach to learning, in which younger children's emotional preparation is supported through more basic studies of civic engagement, creating character and understanding human behavior resulting in activities that the children can carry out on a day-to-day basis. This spiraled preparation ...

Learning from the Past, Building for the Future

The Illinois Holocaust Museum and Education Center (IHMEC) strives to engage youth as citizens through Make a Difference! The Harvey L. Miller Family Youth Exhibition. Teaching about the Holocaust is complex and challenging work. Holocaust education is mandated in Illinois elementary and high schools, yet the Museum finds that many teachers are unsure of how to teach such sensitive and complex topics; such as civics, character education, the Holocaust, human behavior, and genocide. In fact, direct teaching of the Holocaust is not recommended by the United States Holocaust Memorial Museum until 7th grade or later due to the level of emotional preparation needed to study this material. Thus, IHMEC takes a spiraled approach to learning, in which younger children's emotional preparation is supported through more basic studies of civic engagement, creating character and understanding human behavior resulting in activities that the children can carry out on a day-to-day basis. This spiraled preparation enables them to tackle the deeper issues of the Holocaust as the children mature.

Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction by Jim Downs (review)

Reviewed by: Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction by Jim Downs Jane E. Schultz Jim Downs. Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction. New York: Oxford UP, 2012. 264 pp. $29.95. It is an eerie coincidence that the letters of “emaciation” can be found within the word “emancipation.” Both of these concepts are at the heart of Jim Downs’s Sick from Freedom, which is as much about the relocation and institutionalization of African Americans in the post-Emancipation era as it is about the intersections of race and health. Margaret Humphrey’s 2008 Intensely Human zeroed in on the health of black soldiers. With the publication of Sick from Freedom, readers have a second study that, in considering a broader swath of humanity, offers a differential diagnosis on African Americans caught in the transition between slavery and freedom. Downs’s book explores how the development of government programs to manage the ex-slave population—particularly the Medical Division of the Freedmen’s Bureau created in 1866, almost as an afterthought to the Bureau’s mission of economic aid—exploited that population under the rhetorical guise of putting new citizens to work. So concerned was the federal government to claim success with its Reconstruction of the South that it scarcely kept data on the inmates of the forty freed people’s hospitals the Medical Division established in the postwar period, choosing instead to utilize nosological reporting which eschewed clinical details. Even a sidelong glance into containment facilities for the newly freed would have revealed the horrendous fallout of thousands who were dying of starvation and exposure. In its conviction to put black men to work, the Bureau sponsored initiatives that helped freedmen find jobs as manual laborers, but which had unintended consequences for women and children. This putative gendering of the African American work force meant that freedwomen, whose expertise in agricultural and domestic work had been well documented during slavery, were now left without sponsored employment and thus a means of sustenance, which imperiled their families’ survival. The shattering of kinship networks during slavery indeed only hastened the deterioration of black health after it. The insupportable conditions in the winter of 1864 faced by the Joseph Miller family, for example, when all but Miller himself were ordered away from Camp Nelson, Kentucky, resulted first in the death of Miller’s seven-year-old son from exposure, and then in the death of every other family member, including ultimately, Miller himself. Downs notes poignantly that their emancipation was no “jubilee, but rather . . . a continuous process of displacement, deprivation, and . . . death” (21). Caught between the political agenda of Bureau officials, who sought to demonstrate improvement in black health outcomes by closing down hospitals prematurely, and former Confederates, who read the declining health prospects of the black population as the inevitable result of removing black bodies from white planter protection, the African American ex-slave community was ripe for exploitation. [End Page 524] Public fears about black dependency understood as the likely result of institutional help put the Bureau in a defensive position. Bureau leader and Civil War general Oliver Otis Howard saw the ameliorative potential of limiting the number of freed people with access to the Bureau’s largesse as an opportunity to appease legislators anxious to prove to constituents that ex-slaves were becoming self-sufficient citizens rather than a drag on scarce federal resources. Not only did political posturing fail to address black needs, but also did misconceptions about the resilience and medical mysteries of black bodies, such as physicians’ belief that blacks were immune to malaria—a misguided assumption that led in fact to higher mortality. Downs’s commentary about the smallpox epidemic of 1866 and 1867 is scathing. In the fall of 1865, 800 blacks were dying of the disease every week, and by 1867, nearly 50,000 had perished—an estimate that is probably too low, given federal officials’ circulation of the “medical fiction” that only blacks were likely to contract smallpox and that the race would go extinct in a short time. Such propaganda, according to Downs, fueled the...