Virginia Commonwealth University Research Articles

Editorial introductions

Current Opinion in Endocrinology and Diabetes was launched in 1994, with Obesity added to the title in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of endocrinology and diabetes are divided into 9 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor in chief and Section Editors for this issue. EDITOR IN CHIEF David M. HarlanDavid M. HarlanDr David M. Harlan is a graduate of the University of Michigan (Bachelor of Science) and the Duke University School of Medicine, USA. He completed his internal medicine internship and residency at the Duke University Medical Center. This was before serving for 4 years as a staff internist at the Navy Hospital, San Diego, CA, USA. He then returned to Duke for his fellowship training in diabetes, endocrinology, and metabolism. In 1991 he established his laboratory at the Navy Medical Research Institute, USA, where he rose to become the Director of Combat Casualty Care. He was then appointed to the faculty of the Uniformed Services University of the Health Sciences. In 1999, he moved his laboratory to the National Institutes of Health, where he became the Diabetes Branch Chief within the National Institute of Diabetes, Digestive, and Kidney Diseases. In 2010, he moved to the University of Massachusetts School of Medicine, USA, where he is the William and Doris Krupp Professor of Medicine and co-directs the UMass Diabetes Center of Excellence. His research interests all relate to diabetes and include the immunopathogenesis underlying type 1 diabetes and improved care delivery models for the disease. SECTION EDITORS Matthew J. FreebyMatthew J. FreebyMatthew J. Freeby, MD, is Health Sciences Associate Clinical Professor of Medicine in the Division of Endocrinology, Diabetes, and Hypertension, David Geffen School of Medicine at the University of California Los Angeles, USA. Dr Freeby received his MD from Virginia Commonwealth University, USA and completed his internal medicine internship and residency training at the University of California San Diego. He subsequently completed training in an endocrinology fellowship at Columbia University Medical Center in New York, USA. Dr Freeby is involved in community leadership for the American Diabetes Association and serves on planning committees for the Endocrine Society's annual meetings. His research has focused on a number of diabetes related topics including non-invasive in vivo measurement of beta cell mass as well as the evaluation of general care and complications. He has also collaborated with researchers evaluating iPS as a method for beta cell replacement in type 1 and other rare forms of diabetes. Lynne L. LevitskyLynne L. LevitskyDr Lynne L. Levitsky is a graduate of Bryn Mawr College and Yale Medical School, USA. She received her pediatric training at the Albert Einstein College of Medicine in New York, USA, and at the Children's Hospital of Philadelphia, USA. She was trained in pediatric endocrinology at the University of Maryland in Baltimore, USA. She was a Pediatric Endocrinologist and Professor of Pediatrics at the Pritzker School of Medicine, University of Chicago, USA, until 1990. She then came to Massachusetts General Hospital, USA, as Chief of the Pediatric Endocrine Unit and Associate Professor of Pediatrics at Harvard Medical School. She is now Emeritus Chief and co-director of the Turner Syndrome Wellness Center, USA. Her research interests in carbohydrate metabolism span laboratory studies of transcriptional control of beta cell function, and a role as an investigator in the NIH-sponsored TODAY treatment study of type 2 diabetes in the young. She is a past President of the Pediatric Endocrine Society and was the first head of the Education Council for that organization.

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

Tackling Health Care Disparities: How to Build a Sarcoidosis Center.

Sarcoidosis is a multi-organ system inflammatory disease of unknown etiology that disproportionately affects women and black patients in the United States. In addition, woman and minority patients have worse outcomes. In 2015, sarcoidosis physicians in cardiology, pulmonary medicine and rheumatology joined forces to create a multidisciplinary sarcoidosis at Virginia Commonwealth University. In 2019, the clinic was recognized as a World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) Center of Excellence. We identify four pillars of a patient-centered sarcoidosis clinic: clinical care, research, teaching, and community outreach. We detail how each of these facets plays a critical role in improving the health of individual patients, creating a strong infrastructure to improve the future of sarcoidosis treatment, and developing community-based resources that can empower patients. Most importantly, we highlight how a multidisciplinary clinic can help identify and combat healthcare disparities.

Rage

Rage Hollee McGinnis (bio) Survival (avoidance and fear), moved to rage (acknowledgement and seeing the truth of what is), returned me to centeredness. I write: Fires out.But the embersStill glow. I don’t knowWhich wayThis will go. The fireHas consumedAll that I had to give. I am now left tired.No energy.A vague senseof dread. Rage is an alright emotion,But it tires outToo quickly. I am left empty.What else instead? [End Page 141] Eyes wide openThat things willContinue to go this way. Until we areTruly able to sayto each other: “You are myBrothers and Sisters.I would NEVERTreat you this way.” You can haveYour likes and dislikes,Your good days and bad. But pleaseSTOP KILLINGBecause you are mad. Instead, turn that rageTowards the hurt that you carry,To a culture that also says“You are not good enough for any . . .” There within youis where to beginTo learn to grow love,accepting yourself,And then each other,as family and kin. —Hollee A. McGinnis, a.k.a. Lee Hwa Yeong March 17, 2021, Atlanta Massacre [End Page 142] Hollee McGinnis hollee mcginnis, MSW, PhD, is an assistant professor at Virginia Commonwealth University in the School of Social Work. She has over twenty-five years of community, policy, and research experience on the life course of orphaned and separated children in alternative care. Prior to her doctorate at Washington University in St. Louis, Dr. McGinnis was policy director at the Donaldson Adoption Institute. She received her master of science from Columbia University School of Social Work, and a post-master’s clinical fellowship at the Yale Child Study Center. Adopted from South Korea, in 1996 she founded Also-Known-As, Inc., a non-profit adult intercountry adoptee organization. Copyright © 2022 Frontiers Editorial Collective, Inc

Changes in obesity and diabetes severity during the COVID-19 pandemic at Virginia Commonwealth University Health System

Abstract Introduction: The COVID-19 pandemic significantly changed the lives of millions of people in the USA, preventing them from continuing their regular lifestyles. This study examined the manifestation of “Covibesity” in the patient population of the Virginia Commonwealth University (VCU) Health System and explored the effects of the distraction caused by the pandemic in the management of diabetes disease. Methods: This project analyzed body mass index (BMI) rates of the general adult patient population at the VCU Health System during the COVID-19 pandemic compared to prior years. The project also investigated the changes in the severity of diabetes cases treated at the VCU Health System by comparing HbA1c laboratory results and the number of diabetes-related emergency department (ED) visits before and during the pandemic. The results were stratified by age, gender, and race to examine subpopulations. Results: The mean BMI for the general patient population increased from 2018 to 2019 but decreased in 2020. The mean HbA1c measurements for the diabetic patient population increased from 2018 to 2020, while the number of ED visits declined in 2020 for the same population. When stratified by race, the trends in the outcomes largely reflected those of the overall mean. The African American population had a higher mean BMI, HbA1c, and number of ED visits than other races, but showed the same temporal behavior to the overall mean.

Abstract PR-14: A synergy between the vaginal microbiome and HPV may have explanatory value for racial disparities in risk of pre-cervical cancer

Abstract The vaginal microbiome (VMB) is suggested to be a key player in high-risk Human Papilloma Virus (HPV) infection persistence, leading to the development of cervical intraepithelial neoplasia (CIN). While it is generally accepted that the VMB of women with CIN differs from that of healthy women, the VMB composition before a woman develops CIN has not been well studied. Moreover, no studies have evaluated the role of self-reported race on the VMB-CIN relationship, despite reports that the VMB of non-Latina Black (Black) women generally exhibits increased microbial diversity (often associated with HPV tumorigenesis) and lower prevalence of taxa such as Lactobacillus (reported to have an inverse association with severity of cervical abnormalities) compared to their non-Latina White (White) counterparts. Black women have higher HPV prevalence than Whites (39% vs. 24%), and more persistent HPV infections (601 days vs. 316 days, respectively), despite having a similar number of HPV infections to Whites. This suggests that factors beyond multiple HPV exposures sustain the infection. We hypothesize that HPV and the VMB may interact differently by race, to promote development of CIN. Methods: We used 16S-RNA profiles from the VMB of 3,050 consented women visiting the Virginia Commonwealth University clinics for their annual routine exam between August 2009 and November 2013. Of these, 259 had evidence of subsequent CIN after the VMB sample collection, through October 2020. The VMB profiles were characterized into three groups as “Lactobacillus (L) crispatus” group (including L. crispatus, L. gasseri and L. jensenii), “L. iners” group and “Other” based on a priori knowledge of profiled taxa. The “Other” subgroup included taxa, such as G. vaginalis, A vaginae, and others usually associated with bacterial vaginosis-like states. We used self-reported health histories, confirmed by electronic health records to determine HPV status and obtain other socio-demographic information. Multivariable logistic regression models were adjusted for age, smoking, VMB, HPV, marital and pregnancy status. Results: The cohort was mainly Black (70%), and the VMB prevalence by group was 19%, 30% and 51% for L. crispatus, L. iners, and Other, respectively. Twelve percent reported having an HPV diagnosis in the past, and 302 (10%) women developed CIN during an average of 3.6 years of follow-up (259 with CIN 1/2 and 43 with CIN3+). In crude analyses, risk of CIN was 80% higher for Black women (RR=1.8, p<0.0001) compared to Whites. However, a significant interaction between HPV status and the VMB revealed that the risk of a CIN diagnosis for HPV+ Black women with the “Other” VMB subtype, is five-fold (RR=5.3, p<0.40) the risk for Whites. Conclusions: These preliminary results suggest that interactions between the VMB and HPV may account for the differential risk of CIN by race. If replicated in further analyses, VMB profiling could help elucidate the basis of CIN racial disparities. Citation Format: Katherine Y. Tossas, Jinlei Zhao, Myrna Serrano, Jerome Strauss, Victoria Seewaldt, Gregory Buck, Robert A. Winn. A synergy between the vaginal microbiome and HPV may have explanatory value for racial disparities in risk of pre-cervical cancer [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-14.

OCR: University did not retaliate against student

Case name: Letter to: Virginia Commonwealth University, No. 11‐17‐2064 (OCR 07/15/21).

Virginia’s Response to the Nursing Home COVID Action Network

The Virginia Geriatric Education Center’s GWEP recruited 195 of Virginia's 273 eligible nursing homes, using two Project ECHO Nursing Home Training Centers located at George Mason University and Virginia Commonwealth University. These sessions promoted collaboration, allowed for sharing of successes and challenges, and nurtured quality improvement projects. Our next steps are to survey Virginia’s nursing homes to see if they are interested in future ECHO sessions with other topics. We plan to share these results with the Institute for Healthcare Improvement so that we may be able to continue to enhance this national network of Training Centers with faculty and staffing dedicated to quality assurance and performance improvement. The program has initiated new collaborations with nursing homes across many healthcare disciplines, strengthened connections between nursing homes and research institutions, and will help foster innovative ways to collaborate in this post-pandemic virtually connected world.

Memory Problems During COVID in Low-income Older Adults

Prevention, with widespread lifestyle risk reduction at the community-level, is currently considered an effective method to decrease Alzheimer’s disease (AD). As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Core, diverse older adults (60+) living in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, motivations, self-efficacy, and referral services for AD lifestyle risk. The study sample (n=40, mean age 68 years (range: 60-77 years) was 88% African American/Black (n=35), 100% Non-Hispanic, and 45% males (n=18)). Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average 91.9% (11) sessions/subject were completed. Participants provided positive anecdotal feedback and the need for continued health coaching during COVID. N=30 (75%) of the original sample consented for continued health coaching during the Covid pandemic, 63% female, 88% African American/Black, 60-77 age range (mean age 69 years), and 47% reporting memory problems. Baseline Covid interviews indicated poorer health status associated with reporting memory problems for poor physical health days (F=7.03;p=.01); poor mental health days (F=6.88;p=.01); total mental/physical health poor days (F=2.76;p=.11); sad days (F=15.52;p=.001); worried days (F=6.27;p=.02); tired days (F=9.77;p=.004); feelings of emptiness (F=10.09;p=.004); feelings of rejection (F=3.382;p=.08); feelings of failure (F=7.58;p=.01); little interest/pleasure (F=7.84;p=.009); and feeling down (F=6.75;p=.02). In conclusion, this preliminary work creates the impetus for future large-scale AD prevention investigations to improve the lives of AD-risk, low-income, diverse older adults reporting memory problems. This research indicates the subjective reporting of memory problems requires health intervention.

Alzheimer’s Prevention Lifestyle Risk Coaching in Low-income Older Adults

Prevention, with widespread lifestyle risk reduction at the community-level, is currently considered an effective method to decrease Alzheimer’s disease (AD). As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Core, diverse older adults (60+) living in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, motivations, self-efficacy, and referral services for AD lifestyle risk. The study sample (n=40, mean age 68 years (range: 60-77 years) was 88% African American/Black (n=35), 100% Non-Hispanic, and 45% males (n=18)). Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average 91.9% (11) sessions/subject were completed. On a scale of 0-100 (higher scores more positivity), rated their experience 93.3. On a scale of 0-10 (higher scores more improvement), rated their health improved 8.36. Pre/post-test analyses indicated lifestyle improvement trends over 4-months for total lifestyle risk (F=4.69;p=.037;effect=.12), social activity (F=4.63;p=.063;effect =.09), and improvement in certain psychological domains: AD knowledge (F=4.49;p=.041;effect=.11); cognitive functioning (short-term memory (F=4.99;p=.038;effect= .21); delayed memory (F=2.26;p=.154;effect=.11); Trails A (F=5.60;p=.0294;effect=.24); and Trails B (F=2.22;p=.154;effect=.11). Participants provided positive anecdotal feedback and the need for continued health coaching. In conclusion, this preliminary work creates the impetus for future large-scale lifestyle AD prevention investigations to improve the lives of AD-risk, low-income, diverse older adults. These findings demonstrate that telephone-based health coaching is feasible, based on participant engagement, and effective, based on positive trends in reducing AD risk factors.

Adherence to the American Society for Colposcopy and Cervical Pathology guidelines: an observational study.

ObjectiveThe 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines were developed to provide guidance regarding cervical pathology and to minimize overtreatment of lesions that may resolve spontaneously. We aimed to evaluate the adherence to these guidelines with referrals for colposcopy at a large academic center and to understand the factors associated with incorrect referrals.MethodsThis retrospective observational study involved women referred to the Virginia Commonwealth University for colposcopy or loop electrosurgical excision procedure from January 2015 to December 2016.ResultsReferral requests from 430 women were reviewed. Among these, 17.4% were discordant with the ASCCP guidelines. The most common discordant colposcopy referrals were low-grade squamous intraepithelial lesions (48%) and atypical squamous cells of undetermined significance (29%). The possibility of incorrect referrals was decreased among high-grade lesions (odds ratio [OR], 0.03), while it was increased in women aged <25 years (OR, 31.6) and in those referred by family medicine (OR, 3.6) or internal medicine (OR, 4.4). Ten patients were referred for cervical cytology results of samples collected from the vaginal cuffs despite hysterectomies performed for benign lesions.ConclusionPatients referred outside of the guidelines were most often women aged <25 years with low-grade lesions. Referrals outside evidence-based guidelines may lead to unnecessary procedures and additional healthcare expenses. Our results help identify the areas for provider education and potential areas of concern regarding the implementation of the 2019 ASCCP guideline updates.

669. Metagenomic Plasma Microbial Cell Free DNA-Sequencing Assists in Diagnosis of Infections and Critical Antimicrobial Changes in Immunocompromised Hosts

BackgroundMetagenomic next-generation sequencing of plasma cell-free DNA (Karius®) (plasma mcf-DNA-seq) is a noninvasive approach that may have a unique role for the diagnosis of infectious complications in immunocompromised patients. The rapid turn-around time and noninvasive nature makes this a promising supplement to standard of care. MethodsThe aim of this study is to investigate the utility of plasma-mcf-DNA-seq in clinical practice; how it changes management, correlations between organism abundance over time from symptom onset and the value of negative tests. Retrospective review of plasma-mcf-DNA-seq performed, January 2020 -March 2021. Organism abundance was displayed as a heat map and graphed over time from initiation of antimicrobials. Management changes and concordance with standard of care results were compared for positive and negative tests. This study was approved by the Virginia Commonwealth University Institutional Review Board.ResultsThirty-six adult patients included: 92% immunosuppressed (11 with T cell deficits (solid organ transplant, malignancy, human immunodeficiency virus), 8 with B-cell deficits (hematologic malignancy, diabetes mellitus), and 14 with both (hematopoietic stem cell transplant, aplastic anemia)). Most tests evaluated fever (67%) and/or pneumonia (72%). Patients received a median 7 days of antimicrobials prior to testing. Twenty-one (58%) tests detected 1-5 organisms (14/21 bacteria, 8/21 fungi, and 6/21 viruses). A positive test prompted therapy changes in 14/21 patients. Of the bacterial species identified, 8/20 were considered clinically pathogenic, 3 prompted targeted treatment; 7/8 fungi identified were clinically pathogenic and resulted in antifungal therapy changes to target the species identified. Antimicrobials were de-escalated in 3 patients with negative tests. There was an exponential relationship between the abundance of pathogenic fungi over time from symptom onset, but no such relationship was seen with bacteria. Abundance of fungi and bacteria detected on plasma mcf-DNA-seq test Abundance of bacteria and fungi detected on plasma mcf-DNA-seq test. Data classified by organism and level of immunosuppression. Abundance is expressed in microbial cell free DNA per microliter. Warmer colors towards red represent higher abundance.Figure 1. Bacteria abundance from date of symptom onset. There was no clear trend in bacterial abundance over time from symptom onset. Most bacteria detected were not considered clinically pathogenic.Figure 2. Fungi abundance from date of symptom onset There was an increasing trend in the abundance of fungi detected from time of symptom onset. Seven of the 8 fungi detected were considered clinically pathogenic.ConclusionPlasma-mcf-DNA assisted in making critical management changes including initiation of treatment for identified organisms and de-escalation of antimicrobials. Plasma-mcf-DNA is a promising approach for a non-invasive rapid diagnosis. Disclosures All Authors: No reported disclosures

Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers With No Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial.

The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. This four-arm parallel-group, randomized, placebo-controlled trial took place at two academic medical centers in the United States (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N = 520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8, or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI = 1.9-104.9] and 3.5 [95% CI = 1.2-10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute. The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Jocelyn A. SilvesterJocelyn A. SilvesterDr Jocelyn A. Silvester, MD PhD, is Assistant Professor of Pediatrics at Harvard Medical School, USA, and Director of Research for the Celiac Disease Program at Children's Hospital (BCH) in Boston, Massachusetts, USA. She also maintains a general pediatrics practice in Northern Manitoba and Nunavut through the Ongomiizwin Health Services JA Hildes Northern Medical Unit. Dr Silvester completed her PhD in Biology at the University of Cambridge in England, UK, where she studied mitochondrial ATP synthase under the supervision of Professor Sir John E. Walker. She earned her medical degree from Dalhousie University in Canada and completed her residency in general pediatrics at the University of Manitoba, Canada. She came to the United States for pediatric gastroenterology fellowship training at Boston Children's Hospital. Dr Silvester is co-Chair of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Celiac Disease Special Interest Group and serves on the American Gastroenterological Association Council for section for basic and clinical intestinal disorders. Her research interests include the diagnosis and management of celiac disease with a particular interest in what happens after the diagnosis of celiac disease is made. She is co-Investigator on the Manitoba Celiac Disease Cohort Study, involved in clinical trials for alternative therapies to a gluten-free diet and is leading a consortium of pediatric celiac centers across the United States to develop tools to improve follow-up care. Tilak U. ShahTilak U. ShahDr Shah is an Associate Professor of Medicine at Virginia Commonwealth University (VCU) Health Science Center, USA, as well as Director of Endoscopy and Interventional Endoscopy at the Central Virginia VA Healthcare system in Richmond, VA, USA. He serves as Associate GI Fellowship Program Director at VCU, and is a member of the Development and Therapeutics section of VCU Massey Cancer Center. Dr Shah graduated from the University of North Carolina (UNC) at Chapel Hill, USA, in 1997, and UNC School of Medicine in 2006. He completed internal medicine residency and fellowship training in gastroenterology at Duke University Medical Center, USA. Dr Shah also obtained a master's degree in clinical research from the Duke-NIH Clinical Research Training Program, and underwent formal training in Advanced Endoscopy at Emory University Medical Center, USA. He joined the medical faculty at Virginia Commonwealth University in 2014. Dr Shah has served on American College of Gastroenterology (ACG), American Society of Gastrointestinal Endoscopy (ASGE), and Veterans Administration (VA) Committees. He has served as a reviewer for several journals including American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Digestive Diseases and Sciences, World Journal of Gastroenterology, and Cochrane Database of Systematic reviews, and is section editor for Current Opinion in Gastroenterology. Dr Shah's research interests involve endoscopic approaches to diagnose and treat esophageal and colorectal neoplasia, including advanced imaging, artificial intelligence, endoscopic resection, and cryotherapy. Dr Shah is the recipient of research awards from the ASGE and McGuire Research Institute, and is site investigator for VA Co-Operative and Merit studies. He is an author on over 30 original papers, and has authored two board preparation textbooks, “NMS Medicine Casebook,” and “Acing the Pancreaticobiliary Questions on the GI Boards.”

For Tom Inge (1936–2021)

I met M. Thomas Inge in 1989 at the conference of the Popular Culture Association of the South after I chaired a panel on the antebellum comic writer George Washington Harris. I had tried to put the panel into MLA's national conference but was turned down. Another fan of Harris and his creation, Sut Lovingood, Tom arranged to have the panel added to the regional conference: typical of Tom's generosity. After the panel, he suggested a collection of essays on Harris, which I agreed to work on if he helped; that was one of the best deals I ever made, for it was the start of a collaboration that was part mentorship, part friendship. I doubt my career path would have been the same if I hadn't tried to shoehorn Harris and his rowdy character Sut into MLA. Tom and I also shared a passion for the work of William Faulkner, yet another fan of Harris and Sut.Tom was an indefatigable scholar and author of over fifty books. Twenty-five years ago, I once had a copy of his bibliography, which was then more than forty pages long. It is no exaggeration to say that he was a force majeure in American literature, especially in Southern literature, humor studies, and comic books. He was a founding member of the American Humor Studies Association, started American Humor: An Interdisciplinary Newsletter in 1974 with Larry Mintz, and later was the editor of Studies in American Humor.But it was in the arena of comic books and popular culture that Tom truly stood out. His book Comics as Culture (1990) was foundational for the now burgeoning academic field of comic books and graphic novels. I have this memory of him saying that he had to rent a place to hold his collection of original comic artifacts. I understand Virginia Commonwealth University will be the repository for the collection, making it an instant Mecca for research on comics in American culture. As mentioned in the VCU Libraries tribute to Dr. Inge, “The collection features correspondence from noted artists and writers such as Art Spiegelman, Mort Walker, Bruce Duncan, and Harold Foster in addition to manuscripts of Inge's scholarly works. … In 2018, he received the Lynn Bartholome Eminent Scholar Award, the highest honor offered by the national Popular Culture Association that recognizes distinguished scholars who have made significant and lasting contributions to the study of popular and American culture” (“Thomas Inge, Pioneering Comics Scholar and Former Professor, Dies at 85,” VCU Libraries, May 24, 2021, https://www.library.vcu.edu/).Tom's sense of the comic in American literature was large: he once coaxed me into participating in a special issue he was editing on humor by Nathaniel Hawthorne, not the only time I benefited from his projects. Edgar Allan Poe is perhaps more obvious than Hawthorne as a subject for unexpected humor as a theme and a topic, and here Tom's extensive collection demonstrates its impact. Tom gave the Poe Museum thirty-six comic books, including issues of Classics Illustrated, Edgar Allan Poe's Haunt of Horror, Roman Dirge's Lenore, and Weird Tales of Horror. He also donated a page of original artwork for a Zippy the Pinhead comic strip and a Lenore doll based on the character in the Lenore comics. Some of his other comics formed the core of the Poe Museum's exhibit “Poe in Comics.” Similarly, items from his collection created “Mark Twain in the Comics: An Exhibition” for the 2009 State of Mark Twain Studies.In many ways, Tom was a legend in the part of academia that worked on comics and pop culture, or Southern literature, or humor studies in general, but what I will remember most is how approachable Tom was, always friendly and always gentlemanly in his demeanor. I was lucky our paths crossed, for he provided a model of how scholars in the humanities should work and play.

Review: Death and Rebirth in a Southern City: Richmond’s Historic Cemeteries, by Ryan K. Smith

Review: <i>Death and Rebirth in a Southern City: Richmond’s Historic Cemeteries</i>, by Ryan K. Smith

Being a Young Black Woman in Today’s Society …

Research Article| October 01 2021 Being a Young Black Woman in Today’s Society … Nylan J. Ntabazi Nylan J. Ntabazi Nylan J. Ntabazi is a teaching assistant for the Focused Inquiry Department and an undergraduate student at Virginia Commonwealth University. She is majoring in Forensic Science with a concentration in Forensic Biology and double minoring in Chemistry and Biology. She is active in various community service organizations at her university and was on the Dean’s Honor List for two semesters in 2020. She is the winner of several scholarship awards, including the Chesterfield County Public Schools Superintendent Excellence in Academic and Service Award in 2018. Search for other works by this author on: This Site Google Journal of American Folklore (2021) 134 (534): 383–384. https://doi.org/10.5406/jamerfolk.134.534.0383 Cite Icon Cite Share Icon Share Facebook Twitter LinkedIn MailTo Permissions Search Site Citation Nylan J. Ntabazi; Being a Young Black Woman in Today’s Society …. Journal of American Folklore 1 January 2021; 134 (534): 383–384. doi: https://doi.org/10.5406/jamerfolk.134.534.0383 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All Scholarly Publishing CollectiveUniversity of Illinois PressJournal of American Folklore Search Advanced Search Blackness (racial identity), ethnic stereotyping, personal narratives, racism, women The text of this article is only available as a PDF. Copyright 2021 by the Board of Trustees of the University of Illinois2021 You do not currently have access to this content.

Perspectives of Dental Students in Oral Surgery Education and Training

Graduating dental students are expected to be competent in performing minor oral surgical procedures, but this depends on their education and training while in dental school. Students’ self-perceptions in performing surgical procedures offer valuable insights and highlight shortcomings in the current oral and maxillofacial surgery (OMS) education and training. The surgical skills of dental students have been found deficient in certain aspects in previous surveys conducted in Europe (Macluskey, et al, 2012; Cabbar, et al, 2019), but none have been conducted/published in the United States. The aim of this study is to evaluate dental students’ self-perception of their competency in surgical skills to perform oral surgical procedures and practice "independently" at a dental school in the United States.A cross-sectional survey of dental students in class of 2021 (D4) and 2022 (D3) was conducted at Virginia Commonwealth University (VCU) School of Dentistry February-March 2021. The Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) questionnaire was utilized and adapted, with permission, in accordance with the OMS curriculum in U.S. dental schools. The questionnaire (Figure 1) involves 17 items covering 5 domains (information, experience, skills, knowledge, and interest, in addition to feedback section for comments). The responses were scaled on a 5-point Likert-type scale. The anonymous data were collected and entered into the REDCap database, and the responses were summarized using descriptive statistics and compared using Fisher's Exact test. A P-value of < .05 was considered statistically significant. All narrative feedbacks were tabulated and analyzed qualitatively. Ethical approval was obtained from the Institutional Review Board (IRB # HM20020893).Sixty-four students (46 D3, 18 D4) participated (32 M, 32 F). Most D3 students performed fewer than 25 extractions (91%), while most D4 performed more than 25 extractions (89%). Analysis of the responses per question is detailed in Figure 2. Comparative analysis between the classes showed that the D4 were significantly more confident than D3 in performing surgical extractions while the D3 were significantly more confident in understanding head and neck anatomy. Comparative analysis between the genders showed that the females were significantly more confident than males in various aspects of OMS practice. Overall, the majority of D3 and D4 students felt more confident performing simple dental extractions than surgical extractions. Most students felt the OMS specialty is an enjoyable and rewarding discipline and consider practicing OMS procedures after graduation despite feeling unconfident in certain aspects. Qualitative analysis revealed that the main recurrent themes were the limited time allowed and devoted to practice dental extractions and the need for more hands-on supervised training.The students’ responses highlight the importance of teaching and supervised training by oral surgery faculty and the need to allocate more time to practice surgical procedures to enhance students’ self-confidence. The questionnaire is a useful survey tool to evaluate, and subsequently improve, the OMS curriculum, teaching, and training among the U.S. dental schools. The plan is to conduct a national survey via future collaboration with the ADA and AAOMS.

Are Incisional Biopsies Reliable to Select Definitive Treatment in Patients with Ameloblastoma of the Jaws? A 15-year Interdisciplinary Retrospective Study

Ameloblastomas are tumors of odontogenic epithelium that, although benign, can have a locally aggressive course causing significant morbidity. WHO classifies ameloblastomas as 1 of 3 variants: solid/multicystic, unicystic, and peripheral. Resection, the standard treatment, is deemed curative, but can be debilitating to the patient. Unicystic subtype is considered less aggressive and could be treated with enucleation and curettage. The mercurial presentation of ameloblastomas makes the chosen treatment modality essential in decreasing the recurrence rates and associated morbidity. Definitive treatment is chosen based on an incisional biopsy, but a true diagnosis of unicystic ameloblastoma requires the entire specimen. The aim of this study is to assess the potential sampling error with an incisional biopsy and potential consequences on treatment outcomes at long-term follow-up.This is a retrospective cohort study for patients with ameloblastoma of the jaws treated at the Virginia Commonwealth University Department of Oral and Maxillofacial Surgery between 2005 to 2020. Patients with biopsy-proven ameloblastoma with a minimum of 1-year follow-up after definitive treatment and complete documentation were included. Predictor variables include radiographic findings, incisional biopsy, and histologic samples. Outcome variable is concordance between initial incisional biopsy and final treatment pathology, as well as recurrence rate.A total of 23 patients, 14 males and 9 females, met the inclusion criteria. Table 1 presents demographics and study variables for the sample. On initial incisional biopsy, 4 (17.4%) cases showed a “cystic” mention in the pathology report, 18 cases (78.3%) exhibited solid ameloblastoma, and 1 (4.3%) showed peripheral ameloblastoma. Final pathology after definitive treatment showed solid/multi-cystic ameloblastoma in 20 (87%) cases, 2 (8.7%) were unicystic, and 1 (4.3%) was peripheral ameloblastoma. Overall, initial incisional biopsy and final pathology were concordant in 21 (91%) cases. After histologic investigation, the initial biopsy for 3 (13%) cases exhibited sampling error, which is defined as the sampled tissue not being representative of the entire lesion (Table 2).Segmental resection was the definitive treatment in 14 (60.9%) cases while enucleation and curettage (E&C) were used on 6 (26.1%), and decompression followed by enucleation and curettage on 3 (13%) patients (Table 3). Postoperative follow-up from the day of definitive treatment ranged from 1 year to 15.6 years (mean 3.50 ± 3.22). Four patients (17.4%) had recurrent lesions, with 100% of them seen following conservative management (i.e., E&C or decompression with E&C). The time of recurrence after treatment ranged from 6 months to 10.75 years (mean 4.62 ± 4.25), with 1 case having more than 1 recurrence.Incisional biopsies are acceptably reliable when combined with clinical exam of the lesion and radiographic presentation to select definitive surgical treatment for ameloblastoma. The chance of sampling error should be included in the informed consent with a low threshold for second incisional biopsy when clinical/radiographic findings are not consistent with histopathological report. Consult with an oral and maxillofacial pathologist is essential, both at initial and final histopathology evaluation. Future development of less-invasive treatments that combine medical and/or surgical management, given the benign nature of ameloblastoma, will help patients achieve cure in the long term.