Virginia Commonwealth University Research Articles

Late Breaking Abstracts

Late Breaking Abstracts

Export Linking Public Institutions of Higher Education (Business Schools), State Trade Agencies and Private Enterprise: A Model and Method for Scaling Global Trade

  In 2015, the Governor of the Commonwealth of Virginia, Mr. Terry McAuliffe, accepted the advice of  companies that were located in Virginia who said  they could use state support to export their goods and services. From this discussion, a the Virginia International Trade Alliance (VITAL) was created to help those companies expand and succeed in the international marketplace (see - https://augustafreepress.com/governor-mcauliffe-announces-creation-of-virginia-international-trade-alliance/ ) This initiative is now  managed by Virginia’s Department of Commerce  (through its economic development agency, known as the Virginia Economic Development Partnership - VCDP).   Over the last 5 years, in partnership with Virginia private businesses, the state’s Chamber of Commerce, and Virginia’s public institutions of higher education, the program has created public-private partnerships that benefit – 1)  large, medium and small companies (with strategic access to global markets), 2) public universities (particularly participating business schools that are educating the next generation of savvy international business managers), and 3) Virginia itself (with more tax revenues realized from enhance international trade, more jobs related to such trade, and more awareness of the Virginia “brand” around the world, as traded goods and services from Virginia become better known and appreciated).  In short, meaningful and well thought out public-private partnerships have led  to  “win-win” realities for all involved .  Virginia Commonwealth University School of Business (VCU-SB) has participated in this program (along with 9 other public Virginia universities) since the inception of VITAL, and to-date the VCU-SB has undertaken over 25 graduate business student VITAL projects (see - https://business.vcu.edu/centers-institutes-and-labs/center-for-international-business-advancement/ ).  Each project has focused on analyzing and selecting international markets for private Virginia companies, and advising them with respect to marketing strategies in promising global markets.  This has all taken place,  while also educating VCU-SB’s participating graduate students on the nuances of global market analysis, and strategies and management practices related to global business success. This conceptual paper represents an overview of how VITAL projects are selected, researched and completed.  The paper provides series of figures to highlight  the theory, practice and necessary steps related to VITAL’s success.  The paper concludes with a call for other states and other countries to create their own form of VITAL (in general, labeled Vibrant International Trade Alliances)  and to extend the underlying partnerships that this model represents to like-minded entities around the world.  The overall objective is  to develop a global network of public/private linkages to scale global trade even further.&nbsp

Clinical Use of a Real-World Low Carbohydrate Diet Resulting in Reduction of Insulin Dose, Hemoglobin A1c, and Weight.

Introduction: Type 2 Diabetes Mellitus (T2DM) is increasing in epidemic proportions. In addition to the morbidity and mortality, for those treated with insulin, the physical, psychological, and financial tolls are often greater. Our real-world study evaluated a Low Carbohydrate Diet (LCD) in patients with T2DM on insulin with respect to glycemic control, insulin reduction, and weight loss.Materials and Methods: A prospective cohort study was conducted via an Electronic Medical Record search for patients attending the Virginia Commonwealth University Medical Weight Loss Program from 2014 to 2020 with Type 2 Diabetes Mellitus who initially presented on insulin. Data was extracted for 1 year after enrollment. The weight loss program focuses on a LCD.Results: Of 185 participants, the mean (± SD) age was 56.1 (9.9) years. Seventy percent were female and 63% were black. Eighty-five completed 12 months (45.9%), reduced their median (25–75% interquartile range, IQR) insulin dose from 69 to 0 units (0–18, p < 0.0001), HbA1c from 8 to 6.9% (6.2–7.8, p < 0.0001), and weight from 116 to 99 kg (85–120, p < 001). Eighty six percent who completed 12 months were able to reduce or discontinue insulin, with 70.6% completely discontinuing. Among all participants who completed 3, 6, or 12 months, 97.6% were able to reduce or eliminate insulin use.Conclusion: In patients with T2DM on a LCD, it is possible to reduce and even discontinue insulin use while facilitating weight loss and achieving glycemic control. A Low Carbohydrate Diet should be offered to all patients with diabetes, especially those using insulin.

1. Early mobilization vs prolonged (>24hrs) bedrest for incidental durotomy

<h3>BACKGROUND CONTEXT</h3> Incidence of unintended durotomy in thoracic and lumbar decompression procedures ranges from 3%-13%. An arbitrary length of flat bed rest is often prescribed as a tool to reduce cerebrospinal fluid (CSF) pressure on a compromised dural closure. Two popular thoughts are that flat bed rest >24 hours increases medical complications, but flat bed rest > 24 hours protects against CSF leaks/wound complications by reducing the hydrostatic pressure on dural repair. <h3>PURPOSE</h3> To assess whether flat bed rest >24 hours after an incidental durotomy is a risk factor for medical complications and results in longer hospital stay. We hypothesize that <24 hours of bed rest results in fewer medical complications and does not increase the rate of CSF leak/wound complications. <h3>STUDY DESIGN/SETTING</h3> Retrospective case cohort study. <h3>PATIENT SAMPLE</h3> Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures were reviewed from 2010-2020. <h3>OUTCOME MEASURES</h3> The duration of bed rest, length of hospital stay and complications (pulmonary, gastrointestinal, urinary and wound) were recorded. <h3>METHODS</h3> Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures at Virginia Commonwealth University in Richmond, Virginia were reviewed from 2010-2020. This is an IRB approved study. The duration of bed rest, length of hospital stay and complications (pulmonary, gastrointestinal, urinary and wound) were recorded. The rates of complications were compared with regard to the duration of flat bed rest (no bed rest or less than 24hrs vs greater than 24hrs). <h3>RESULTS</h3> A total of 420 primarily repaired incidental durotomies were identified. Of these, 254 patients had bed rest ≤ 24 hours and 107 patients were at bed rest > 24 hours. The average length of stay for patients in bed rest ≤ 24 hours was 4.47 ± 3.64 days vs 7.24 ± 4.23 days for bed rest > 24 hours group (p = < 0.0001). Total medical complications and wound complications (8.66% vs 15.89%, P = 0.043) were increased in the prolonged bed rest group. There was a statistically significant increase in rate of ileus, urinary retention, urinary tract infections, pulmonary issues, and altered mental status in the group with prolonged bedrest after an incidental durotomy. There was no statistically significant difference in the need for revision surgery (7.87% vs 8.41%, P = 0.86). The relative risk of a complication in the group with immediate mobilization was 50% less than the group with prolonged bed rest (RR = 0.5, 95% CI: 0.39-0.62, p = < 0.0001). <h3>CONCLUSIONS</h3> In this retrospective study, flat bed rest greater than 24hrs following incidental durotomy was associated with increased length of stay, increased rate of medical and wound complications. The rate of revision surgery was not higher in the durotomy patients who underwent immediate mobilization. Flat bed rest after an incidental durotomy may not be necessary and may result in higher costs and complications. This data can be helpful in planning enhanced recovery after surgery (ERAS) protocols. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Nursing Students Behind Bars

With a large incarcerated patient population in the United States, there is a unique potential for clinical learning for undergraduate nursing students with this population. The Virginia Commonwealth University (VCU) School of Nursing and VCU Health System have created a unique partnership in which baccalaureate nursing students complete their first clinical rotation on VCU Health System's Secure Care Unit (SCU). At the conclusion of their semester, baccalaureate students assigned to the SCU for the fundamentals clinical were asked to provide feedback on their experiences. Both challenges and positive outcomes were identified by students who completed their first clinical rotation providing care to this unique population. The formation of this relationship between the VCU School of Nursing and the VCU Health System's SCU is helping to meet patient, student, and clinical unit needs and also making a positive impact on the stakeholders involved. [J Nurs Educ. 2021;60(8):470-471.].

ASHP Foundation's forecast report feels more relevant than ever this year

ASHP Foundation's forecast report feels more relevant than ever this year

How pharmacy can start to solve the inequity puzzle

How pharmacy can start to solve the inequity puzzle

Pandemic Pedagogy: Practical and Empathetic Teaching Practices

This first-person dissection of pandemic pedagogy, supported by surveillance theory, queer and feminist pedagogical theory, and radically empathetic and nonviolent teaching practices, suggests a better way forward in college and university teaching during the COVID-19 pandemic and beyond. Outlining anti-surveillance and anti-policing practices, as well as instructors’ roles as enforcers of the neoliberal university’s interests and instructors’ needs usurping best teaching and administrative practices, the article attempts to make sense of interconnected limitations and inequities in higher education which the COVID-19 pandemic and subsequent distance and hybrid course delivery models have exposed. The article posits methods to reframe instructor/student interactions in virtual and socially distanced classrooms. In a radical departure from the violent surveillance university model, including an acknowledgement of processes instructors can realistically resist, the article suggests a non-hierarchical and informal ongoing review of teaching practices, a practiced and intentional refusal to engage with neoliberal systems of student control, and an active acknowledgement and decentering of instructors’ feelings when making pedagogical decisions. An accompanying handout, originally presented at the 2020 unConference hosted by the Race, Space, Place Initiative at Virginia Commonwealth University, presents the information in an easy-to-read and dynamic format.

Molly McCarthy, MBA, BSN, RN, RN-BC

Molly McCarthy, MBA, BSN, RN, RN-BC

Muslim Women and Disparities in Cancer Diagnosis: A Retrospective Study

Muslim women often find their religious customs at odds with their healthcare needs, such as regular gynecological check-ups and cervical cancer screenings, especially before marriage. Religious beliefs may also affect beliefs about gender roles, illness and death, affecting seeking healthcare services. This retrospective study explored the differences in care-seeking related to cancer between Muslim women and the general female population at the Virginia Commonwealth University in the United States between 2010 and 2019. There were major differences in insurance status between the two cohorts. Muslim women were less likely to have government-sponsored health insurance and were much more likely to be uninsured than non-Muslim women. We also found that preventable female cancers were more prevalent among Muslim women than among non-Muslim women and was also diagnosed at more advanced stages.

Implementing a Hybrid Summer Transition Program

The mission of the Virginia Commonwealth University Louis Stokes Alliance for Minority Participation (VCU LSAMP) program is to increase the retention and graduation rates of students from underrepresented racial and ethnic groups in science, technology, engineering, and mathematics (STEM) majors and those who matriculate into graduate programs. VCU LSAMP offers a hybrid summer transition program (HSTP) focused on facilitating the high school to college and two-year to four-year college transition process for students majoring in STEM disciplines. The goals of the program are to 1) build community among a cohort of students, 2) orient students to VCU, 3) prepare students for the academic rigors of their first year in a STEM discipline at VCU, 4) expose students to opportunities and careers in STEM, 5) engage them in the VCU LSAMP program, and 6) provide financial support. Five distinct components of the VCU HSTP are 1) a six-week online summer component, 2) a 1 week on-campus orientation, 3) a Design Project Challenge, 4) a transfer student track, and 5) an academic year component. Evaluation data reveals that the HSTP assisted participants with adjustment to the college schedule and setting, facilitated the formation of study groups, and increased overall motivation to graduate. The online courses helped familiarize students with both the academic topics in their chemistry and mathematics classes and the behaviors and norms of STEM majors. On average, participants in the HSTP had higher retention (85%) and graduation (73%) rates when compared with their peers (81% and 64%, respectively). Furthermore, those students who complete the online classes’ requirements had a higher probability of receiving a grade of B or better in their first mathematics or chemistry class.

Reducing Hospital Use of Urban Sickle Cell Adults Using Multidisciplinary Adult Care and Instrumental Support

Background: Sickle cell disease (SCD) is documented to be a key driver of adult hospitalizations, high length of stay, and frequent ED utilization at urban hospitals. In FY16 the average length of stay (ALOS) for adult SCD inpatient encounters at Virginia Commonwealth University Medical Center, an urban tertiary care center containing an adult SCD center, was 6.7 days, compared with an expected ALOS of 4.2 days. The 30-day readmission rate for SCD was 33.7%. Therefore, in an effort to reduce acute care utilization and re-hospitalization for VCU SCD adults, substituting it with ambulatory care and a medical home, we conducted a pilot study.Methods: we implemented Multidisciplinary Adult Care and Instrumental Support (MAIS), a form of the patient-centered medical home, for 5 of the highest SCD adult utilizers, among approximately 500 adults with SCD. There was not a control group. We hired and trained special SCD community health workers, labelled Patient Navigators (PNs), as case managers. PNs coordinated care with adult sickle cell providers, who customized medical interventions according to patient characteristics and needs discovered by PNs. PNs also coordinated care with hospitalists, ED physicians, social workers, mental health providers, and community resources. Issues addressed by PNs included housing, severe mental health and cognitive impairment, educational barriers, transportation barriers, poor ADL skills, domestic violence & stalking, and lack of family support. Analysis used a before-after design.Results: Included very high utilizing patients were ages (21 to 29), 2 were male and 3 were female. Insurance coverages included Medicaid, Medicare, Anthem health keepers and Optima Health. All 5 patients had multiple issues contributing to their high utilization. The 5-patient pilot evaluation showed a 1-year savings of $333,839, a 35.01% improvement for these 5 patients, calculated using the CMS percent change methods (($558,482.71 - $859,368.10)/$859,356.10X100). Additionally, 30-day readmissions were reduced by 18.4%, ALOS was reduced by 1.2 days, and the number of SCD clinic appointments doubled. The table shows savings in discharges, readmissions, and LOS, as well as increases in ambulatory care, for these patients.Conclusions/Future work: We conclude, in an uncontrolled pilot, there were dramatic reductions in hospital costs, discharges, readmissions, and length of stay, as well as increases in ambulatory care, resulting from using MAIS. Our pilot adds support to a growing body of data suggesting that a substantial case management support structure as part of a patient-centered medical home can reduce the risk of repeated ED visits, hospitalization, and lengthy stay in adults with chronic disease. Future work should include more rigorous evaluations, including costs of the program, control group comparisons, and return on investment, and should test whether this approach may complement or may be used instead of other approaches to improve LOS, readmission rates, and cost of care in SCD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Enhancing Adherence to Prescribed Opioids Using a Mobile-Based App: A Feasibility Study in Non-Cancer Pain

Background: Nonadherence (overutilization and underutilization) to prescribed opioids underlies the current US opioid epidemic/crisis. Methods to measure opioid adherence, including patient recall, pill counts, refill rates, biological monitoring such as urine toxicology, and electronic monitoring such as MEMS Caps, each have limitations or are only proxy measures. While not perfect, apps which both collect instantaneous patient reports of utilization using reminders, and have the potential to encourage appropriate behavior, are gaining popularity as a way to monitor adherence. We were interested to develop such an app to monitor opioid adherence, and report here feasibility of a mobile monitoring and reporting system that would provide an accurate unbiased screening tool to systematically analyze opioid adherence simultaneous to pain measures,Methods: We developed a mobile-based application, OpPill, for IOS and android platforms. Development and testing consisted of deep mixed methods research on pain behavior and opioid use among SCD patients (n=21) to determine the application content and/or structure. The Application was used by Sickle Cell Disease patients (n=30) at the Virginia commonwealth university health system. The Mobile Applications Rating scale: A New and validated Tool for Assessing the Quality of Health Mobile Apps for engagement, functionality, aesthetics, information quality, subjective quality, relevance and overall impact was administered post usage to evaluate the Application.Results: A total of 30 patients were tested. Patients were equally divided among males and females, had a high school to graduate level education, with a majority having some college education. The majority of the population found the application to be relevant for their care. When asked to mark all the items they thought the application was designed to do, 37% indicated that it was aimed at improving their physical health, and 37% thought it was designed to help them set goals, while 29.6% and 22.2% said respectively that it helped them feel happy/healthy and reduce negative emotions. In regards to the targeted population, patients where asked if the content was appropriate for sickle cell and the majority said it was well-targeted, with negligible issues (88.8%). Study participants were asked if they would recommend this application to people with sickle cell disease and 100% said they would recommend the application. Patients were also asked to report on the completeness of information within the app, the majority 96% reported on the application's completeness while 4% estimated the information to be minimal or overwhelming. The quality of information as it pertains to sickle cell patients was reported to be relevant (91.7%) while 8.3% found the application to be poorly relevant to sickle cell disease. The application's performance was positively rated at 100% with ease of use positively rated at 91.7%. Most participants (85.7%) found the application to be interesting to use while 74% found it entertaining. All users found the application's navigation to be logical and accurate with consistent and intuitive gestural design.When asked how many times patients thought they would use the application in the next 12 months, results showed 24% would use it over 50 times, 36% would use it somewhere between 10-50 times and 40% would only use it 3-10 times. Some patients reported that they would pay for the application (24%) while 44% said they might pay and 32% reported that they would not pay for this application. On a scale of 1 to 5 with 1 being the lowest and 5 being the highest, mean engagement, functionality, Aesthetics and information scores were calculated and yielded the following results: mean engagement score: 3.96, mean functionality score: 4.54, mean aesthetics score: 3.96 and mean information score: 3.91.Conclusions/Future work: We found feasibility of use of a smartphone application specifically targeted to monitor opioid use and behavior in patients with sickle cell disease (SCD)-associated pain. Results are limited in that results are self-reported. Future work should include validation of reported opioid use from the app. DisclosuresNo relevant conflicts of interest to declare.

Alumni survey of a combined doctor of pharmacy/graduate certificate in aging studies program

IntroductionThe Certificate in Aging Studies at Virginia Commonwealth University allows students to study gerontology while completing their doctor of pharmacy (PharmD) or graduate pharmaceutical sciences degree concurrently. The objective of the study was to evaluate alumni satisfaction with the Certificate in Aging Studies program, its application, and its perceived usefulness. MethodsAlumni of the program (n = 49) were emailed an anonymous electronic survey about their perceptions of the program. The survey was emailed three times. Responses to eight multiple choice questions were summarized using descriptive statistics. Two free response questions were qualitatively analyzed for themes by two investigators. ResultsThe response rate to the survey was 59.2% (n = 29). Most respondents practice in hospital settings (24.1%) and did not undertake additional postgraduate clinical training (44.8%) or earn additional geriatric certifications (69%). The majority (65.5%) reported using the dual program in their career and would recommend the Certificate in Aging Studies to others (96.6%). Most (59%) alumni indicated that the best part of the program was the interprofessional interaction, and 69% suggested no further areas of improvement for the program. ConclusionsA PharmD-Gerontology dual program is one way to enhance the workforce to care for the growing older population. This partnership approach should be considered by schools of pharmacy that also offer degree programs in gerontology.

Poe Studies Association Updates

This past year has presented our organization with a series of challenges. However, our members have responded with ingenuity and flexibility so that we could continue the work of our mission: to support the scholarly and informal exchange of information on the life, works, times, and influence of Edgar Allan Poe.First, I’m pleased to announce that our 2020 American Literature Association presenters were able to postpone their presentations and joined us for this year’s conference. Both of our sessions were prerecorded, and instructions on how to access them will be provided as soon as we have the information. Please note that the American Literature Association has changed the weekend: the conference will take place July 7–11, 2021. As usual, we will hold our annual business meeting, and members will be able to attend virtually. I want to thank Cristina Pérez and Sławomir Studniarz, our members-at-large; Travis Montgomery, our secretary; and our presenters for their work throughout this year to make these sessions possible.Second, “Poe Takes Boston: The Fifth International Edgar Allan Poe Conference” has been rescheduled for April 7–10, 2022, in Boston at the Omni Parker House, a beautiful hotel with an impressive literary legacy. Paul Lewis, Richard Kopley, and Philip Phillips have succeeded in renegotiating our venue contract and rewriting our CFP timeline so that we will be in the best position to hold an in-person conference. We are grateful to them for their time, patience, and planning over the past year, and we hope to gather once again with our friends and colleagues to celebrate Poe.Finally, we plan to continue our monthly PSA online forums via Zoom. When Richard Kopley first proposed this idea to the executive committee, I admit that I was uncertain about how well the idea would be received. With hindsight I can see that my initial response was unwarranted. These sessions provide opportunities for our colleagues around the world to engage in discussions about various topics related to Poe, and I feel like I have been able to get to know so many more of our members through this series. For more information and access to recordings of our previous sessions, you can visit the link under Conferences on the PSA website, https://www.poestudiesassociation.org/conferences.Please watch our listserv for updates on these events and many more. I look forward to seeing you soon—whether online or in person.On January 7, 2021, more than thirty PSA members and other colleagues from sites across the globe joined together via Zoom for the organization’s annual MLA session—this year, a roundtable on “Revisiting Poe’s Poems.” Our four presenters—Maria Ishikawa, Stephen Rachman, Les Harrison, and Edward Whitley—discussed everything from Eureka to beating hearts, from creating an edition of Tamerlane to considering Whitman’s Poe. The dialogue that followed, we hope, will be a prequel to future conversations that take Poe’s poetry seriously and attempt to read it in new and compelling ways. The PSA session at the upcoming 2022 MLA Convention will be titled “Reading Poe Now.”Two panels will be presented at the 2021 American Literature Conference in Boston: “Poe in the Wireless Classroom” and “Poe’s Environmental Humanities.” I will chair the former, which will be prerecorded by the following PSA members: Susan Amper, Bronx Community College, presenting “Wi-finding Poe for the Thumb Generation”; Helciclever Barros da Silva Vitoriano, National Institute for Educational Studies and Research (Anisio, Brazil), presenting “‘The Raven’ Online: Mapping Reprints as well as Literary and Artistic Translations over the Internet”; Les Harrison, Virginia Commonwealth University, presenting “Editing Poe in the DH Classroom”; and Lesley Ginsberg, University of Colorado Springs, presenting “Teaching Poe with Digital Resources in 2020.” I plan to attend ALA in person, so maybe I will see you there for a conversation … six feet apart!As of February 22, 2021, we have 183 members. The checking account has $27,589.81. Restricted funds include: the Leslie Dameron Award, $1,501.88; the Gargano Award, $3,260.10; and the Quinn Award, $2,425.93. Restricted funds total $7,187.91. We hold three CDs, in the amounts of $6,322.74, $2,384.27, and $10,005.89. Adding the CDs to the checking account, we have a total of $46,302.21, but deducting the restricted funds, we have $39,114.30 in available funds.Please remember to renew your membership when due and notify me of change of mailing or email address. Tax-deductible donations to PSA are welcome.

A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace.

Assessments of the Core Entrustable Professional Activities (Core EPAs) are based on observations of supervisors throughout a medical student's progression toward entrustment. The purpose of this study was to compare generalizability of scores from 2 entrustment scales: the Ottawa Surgical Competency Operating Room Evaluation (Ottawa) scale and an undergraduate medical education supervisory scale proposed by Chen and colleagues (Chen). A secondary aim was to determine the impact of frequent assessors on generalizability of the data. For academic year 2019-2020, the Virginia Commonwealth University School of Medicine modified a previously described workplace-based assessment (WBA) system developed to provide feedback for the Core EPAs across clerkships. The WBA scored students' performance using both Ottawa and Chen scales. Generalizability (G) and decision (D) studies were performed using an unbalanced random-effects model to determine the reliability of each scale. Secondary G- and D-studies explored whether faculty who rated more than 5 students demonstrated better reliability. The Phi-coefficient was used to estimate reliability; a cutoff of at least 0.70 was used to conduct D-studies. Using the Ottawa scale, variability attributable to the student ranged from 0.8% to 6.5%. For the Chen scale, student variability ranged from 1.8% to 7.1%. This indicates the majority of variation was due to the rater (42.8%-61.3%) and other unexplained factors. Between 28 and 127 assessments were required to obtain a Phi-coefficient of 0.70. For 2 EPAs, using faculty who frequently assessed the EPA improved generalizability, requiring only 5 and 13 assessments for the Chen scale. Both scales performed poorly in terms of learner-attributed variance, with some improvement in 2 EPAs when considering only frequent assessors using the Chen scale. Based on these findings in conjunction with prior evidence, the authors provide a root cause analysis highlighting challenges with WBAs for Core EPAs.

Analysis of Pediatric Dog Bite Injuries at a Level 1 Trauma Center Over 10 Years.

Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center. This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed. Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair. Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction.

Time of Eating and Cardiorespiratory Fitness in Patients with Heart Failure With Preserved Ejection Fraction and Obesity

Abstract Objectives To examine the impact of eating prior to or after the mean time of evening meal on cardiorespiratory fitness (CRF) in patients with heart failure with preserved ejection fraction (HFpEF) and concomitant obesity. Methods Twelve patients with HFpEF (left ventricular ejection fraction ≥50%) and obesity (body mass index (BMI) ≥30 kg/m2 or fat mass % (FM%) ≥25% men or ≥35% women) underwent a maximal cardiopulmonary exercise test to obtain peak oxygen consumption (VO2) relative to body weight (ml•kg−1•min−1) and exercise time. Bioelectrical impedance analysis was used to measure FM%. Mean evening meal time was established as 7:25 (SD = 2.1 hours) post meridiem (PM) by averaging three consecutive five-pass 24-hour dietary recalls. Participants were classified by having intake prior to (Group I) or after (Group II) 7:25 PM. Total caloric intake and physical activity were obtained at baseline. Differences between groups were assessed with Mann-Whitney U and Spearman's rank correlation was used to examine associations. Results Participants were 64 (52–65) years of age, 75% female, 58% black, and had a BMI of 36.6 (34.2–41.6) kg/m2 with a FM of 42.5 (36.1–45.5)%. Median peak VO2 was 14.6 (11–19.6) ml•kg−1•min−1 and exercise time was 566 (453–786) seconds. Group II had a significantly greater peak VO2 (Group 1: 10.4 (9.5–15.2) ml•kg−1•min−1; Group II: 14.8 (14.4–23.4) ml•kg−1•min−1, P = 0.028) and exercise time (Group 1: 452 (360–505) seconds; Group II: 662 (578–846) seconds, P = 0.007). Physical activity, body composition, age and total daily calories did not differ between groups (all P &amp;gt; 0.1). On univariate analysis, both peak VO2 (r = 0.736, P = 0.006) and exercise time (r = 0.767, P = 0.004) demonstrated a favorable association with time of eating. Conclusions Caloric intake after the mean time of evening meal was associated with better CRF in patients with HFpEF and obesity. Providing nutrients later may help avoid fasting-related stress associated with cardiac metabolic abnormalities found in HF. Prospective randomized controlled trials examining the effects of later evening meal time in patients with HFpEF and obesity are warranted. Funding Sources Study funding was obtained through the American Heart Association, National Institutes of Health and Virginia Commonwealth University Health System.

Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence

Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence

GC&amp;E to be held virtually in June

The 25th Annual Green Chemistry and Engineering Conference (GC&E) will be held online June 14–18, with GC&E Friday events—workshops and technical sessions presented in advance of the conference—starting May 21. The theme for this year’s conference is “Sustainable Production to Advance the Circular Economy.” Each day will start with a live keynote session, plus a poster session, eight concurrent technical sessions, and a networking happy hour. Keynote speakers are Eunice Heath of Dow, Gregg Beckham of the National Renewable Energy Laboratory, Frank Gupton of Virginia Commonwealth University, and Amy Prieto of Colorado State University. The final keynote will be shared among the winners of the American Chemical Society Sustainable Chemistry and Engineering Lectureship Award: Jun Huang of the University of Sydney; Jeremy Luterbacher of the Swiss Federal Institute of Technology, Lausanne (EPFL); and Meagan Mauter of Stanford University. The US Environmental Protection Agency will announce the 2021 winners of the