West Virginia University Research Articles

The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients

BackgroundMajor depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems.MethodsEnrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size.Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.DiscussionThe study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT.Trial registrationClinicalTrials.gov NCT04120285. Registered on October 19, 2019.

Genetics education in primary care residency training: satisfaction and current barriers

BackgroundGenetics education can be integrated into general care medicine through primary care residency programs. A study of primary care residents was done to evaluate quality, satisfaction, and barriers in genetics education in residency training programs. Thus, providing more evidence for the necessity for its development and progress.MethodsA cross-sectional descriptive self-administered questionnaire survey was delivered to four primary care West Virginia University (WVU) residency training programs in 2020–2021. The anonymous 14-item survey included the following questionnaire domains: general data, genetics training satisfaction, and genetics education barriers.ResultsThe survey response rate was 52% (70/123) and 59 participants completed the survey. Overall, respondents viewed genetic education as critical to their chosen specialty (90%). Trainees at all educational levels obtained their education mostly from class based educational curricula (77% from lectures, 65% from didactic and 49% from grand rounds). The majority of survey respondents indicated insufficient experience with genetic patient care (34% ward genetic consultation, 5% clinic experience, 0% genetic department rotation). The percentage of residents who were satisfied with genetic topics were as follows: basic genetics (57%), capturing family history (82%), initiating basic genetic workup (15%), a basic understanding of the genetic report (23%), basic management surveillance in the genetic patient (18%), understanding the genetic referral and explaining it to a patient (47%).Residents reported barriers to genetic interest included complexity of the field (87%), followed by limited utility of genetics testing (41%). The most common suggestions for improving the genetic education component were to provide more lectures (61%), followed by enhanced advertisement of genetic education resources specifically rotations in the genetics department (22%). Other suggestions include the integration of genetic education in inpatient learning (20%) and providing research experience (7%).ConclusionPrimary care residents were satisfied with their genetic knowledge in the classroom and stated a clear need for enhanced hands-on clinical skills and research experience in their current residency training. The survey suggestions for improvement can enhance primary care residents’ genetic training that can lead to advances in rare disease recognition, precision medicine, and improve access to genetics testing.

Introducing conflict resolution and negotiation training into a biomedical sciences graduate curriculum

BackgroundAnalysis of the biomedical workforce and graduate education have produced recommendations for modifications of pre-doctoral training to broadly prepare trainees for wider ranging scientific careers. Development of training in professional skills is widely recommended, but details of implementation are not widely available. In alignment with these recommendations, we have incorporated professional skills training into the biomedical science graduate curriculum at West Virginia University. An important component of the training is developing conflict resolution and negotiation skills. This training will provide useful skills for academic careers, non-academic careers and life situations outside of the workplace. Conflict resolution/negotiation skills are also relevant in managing issues in diversity, equity and inclusivity. We report our experience in developing this component of the training program, provide an overview of the approach to delivery and practice of skills, and provide an analysis of the reception and effectiveness of the training.MethodsEvaluation of effectiveness of training used the principals of the Kirkpatrick Four Level Model of Evaluation. At the end of the course, students completed a questionnaire about their perceptions of training and were asked how they would respond to different scenarios requiring conflict resolution/negotiation skills. Several months later, students were surveyed to determine if they used some of these skills and/or witnessed situations where these skills would be useful.ResultsWe report our experience in developing conflict resolution/negotiation training in our graduate curriculum, provide an overview of the approach to delivery and practice of skills, and provide an analysis of the reception and effectiveness of the training. The results suggest this training meets a need and is effective. Importantly, these materials provide a template for others wishing to implement similar training in their curricula.ConclusionsConflict resolution and negotiation training meets a need in graduate education. A mixed approach using didactic and interactive components spaced out over time appears to be an effective method of training.

P-43 Correlation of mesothelin expression with recurrence in colorectal cancer (CRC) patients

Mesothelin (MSLN) is a membrane bound protein that can promote survival, proliferation and invasion of cancer cells. Our previous work had shown a significant association between MSLN expression on resected localized CRC (Stage I-III) and future development of peritoneal carcinomatosis (PC) (p < 0.001). MSLN expression in early stage CRC was also associated with an inferior overall survival. We expanded this work by examining an additional cohort of patients at West Virginia University (WVU), WV, USA. This is a retrospective study of patients with localized CRC who underwent surgical resection from 2005-2019 at WVU. The patients were categorized into two groups based on whether they had a recurrence. Metastatic group comprised of patients who recurred and control group constituted patients who did not have a recurrence after a minimum of 5 years of surveillance. Metastatic group is further subdivided into 2 subgroups; SOM: patients who developed metastases in solid organs only; PC group: patients who developed PC at any time. MSLN staining with immunohistochemistry was performed using Rockland (MN1) mouse monoclonal antibody and scored based on intensity (0, 1+, 2+, and 3+) and percent positivity (0: 50%). MSLN total score was defined as the sum of intensity and percent positivity, with a total score of 3 or greater considered “positive” for MSLN expression. Fisher’s exact test was performed to determine the association of MSLN score and future recurrence of CRC. Out of a total of 484 patients diagnosed with localized CRC, 88 patients had a recurrence. Out of 88 patients, SOM and PC groups comprised 48 (54%) and 19 (22%) patients respectively while 21 patients (24%) had local recurrence. Control group comprised 126 patients. MSLN staining was completed on 70 patients in the entire cohort and the results are presented here. Among 70 patients, 14 patients had a recurrence in either solid organs (n-9) or peritoneum (n-5) and 56 patients did not recur. Positive MSLN score was demonstrated on resected CRC tissues in 8 out of 14 patients who had a recurrence; Five of them from the SOM group (5 out of 9 patients (55.6%)) and 3 from the PC group (3 out of 5 patients (60%)). Contrastingly, only 16 out of 56 patients (28.5%) in the control group had a positive MSLN score. Based on Fisher’s exact test, a near significant association was observed between positive MSLN score and future development of cancer recurrence (p: 0.06). No statistical significance was observed between positive MSLN score and location of metastases (SOM vs PM) likely due to limited sample size. A higher proportion of patients who had a recurrence (SOM+PC groups) had a positive MSLN score on their resected CRC specimens compared to the patients who did not recur (control group) (p: 0.06). MSLN staining results on the remaining patients is ongoing. Precision medicine informatics to identify patients at highest risk of development of future recurrence is key to personalize treatment for patients with colorectal cancer.

Introduction from the Editorial Team

Introduction from the Editorial Team Selima Sultana, Paul Knapp, Ridwaana Allen, and Tyler Mitchell Our Editorial Team is grateful for the opportunity to contribute to Southeastern Geographer, the flagship journal of the Southeastern Division of the American Association Geographers (SEDAAG). We are pleased to report that the 2021 Annual SEDAAG Meeting in Florence, Alabama during November 20–22 was well attended following the virtual-format platform arrangement for the 2020 conference. The success of the SEDAAG Conference is made possible by the extensive work of numerous division members. We recognize the outstanding contributions of Lynn Resler and Jennifer Rahn for their roles as SEDAAG President and SEDAAG Vice-President, respectively, and Local Arrangement Chair, Michael Pretes during this unprecedented and challenging time. We were pleased that AAG President Emily Ye attended the meeting and presented the Keynote Address at the Awards Banquet. SEDAAG meetings offer a suite of professional development benefits and have excelled in distinguishing exceptional contributions in scholarship, instruction, and service. The recognition of awards is judged by the members of the Honors Committee, who must decide on recipients of nominated awards prior to the meeting and then spend much of the meeting evaluating student presentations. We applaud the efforts of the Committee, especially committee chair Douglas Allen, for their dedication. We note that while we list some of the 2021 awardees below, there were no nominations for the prestigious Research Honors Award. 2021 Awardees • Southeastern Geographer Award for Best Paper: Thomas Saladyga and Stockton Maxwell (A Multi-Century Fire History from the Potomac Highlands of West Virginia) and Gabe Schwartzman (POWER and the Future of Appalachia: Discursive Framings of an Economic Transition) • Southeastern Geographer Cover Art: Yin-Hsuen Chen, Old Dominion University • Lifetime Achievement Award: Bobby Wilson (posthumous) • Outstanding Service Award: Heidi J.L. Lannon, Santa Fe College • Excellence in Teaching: Ingrid Luffman, East Tennessee State University • John Fraser Hart Award, Best Ph.D. Student Paper: Savannah Collins-Key, University of Tennessee • Best Master's Paper: Avery Catherwood, University of North Carolina Greensboro [End Page 89] The conclusion of the annual meeting marks the transition of SEDAAG Officers. We thank Lynn Resler for her excellent work as President during 2019–2021 while navigating the numerous issues associated with the onset and continuation of the COVID-19 pandemic, and Treasurer, Amy Potter of Georgia Southern University. We congratulate newly elected President William (Bill) Graves of the University of North Carolina Charlotte, and Treasurer Paul McDaniel of Kennesaw State University for their two-year appointments as SEDAAG Officers. SEDAAG also welcomed newly elected State Representatives Jordan Cissell (Samford University), Johanna Engström (University of Florida), Michele Abee (Bellarmine University), Dean Hardy (University of South Carolina), and Thomas Saladyga (Concord University). We extend our warm thanks to the outgoing state representatives Caroline McClure (University of Alabama), Cynthia Simmons (University of Florida), Peggy Gripshover (Western Kentucky University), Conor Harrison (University of South Carolina), and Jamison Conley (West Virginia University) for their commitment and contributions to SEDAAG during the past two years. Please consider Southeastern Geographer as a publication outlet for work that relates to the American South. As an Editorial Team, we try to process manuscripts in a timely fashion with an average initial decision time of approximately six weeks. Manuscript submissions during the past four years have been from authors located from many locations outside of the SEDAAG region and SEDAAG membership is not a requirement to submit work to the journal. We are thankful for the contributions of authors and external reviewers that make Southeastern Geographer an outstanding journal. We are also grateful for the contributions of Joseph Weber of the University of Alabama for his role as Book Editor. Issue 62.2 (Summer) contains four papers, which we summarize below, and two book reviews. Biggs builds on cultural geography and the geographies of memory to explore how the managers at three historic sites in Durham, North Carolina attempt to manage the interests of historic preservation with present-day use and enjoyment of these sites. Rather than viewing the landscapes surrounding these sites as racially neutral backdrops, Biggs maintains that they are racialized spaces with their own histories. Specifically, the trees and grass at these sites are not...

Detection of high-grade glioma clusters: Spatial case-control study using EMR data from 2010-2021.

e14016 Background: High-grade gliomas (HGGs), like Glioblastomas (GBMs), are the most common malignant intracranial tumors with dismal prognosis. Rural areas have higher HGG related mortality and lesser research advancements. The objective of this study was to identify zip codes with disproportionate risk of HGGs compared to other brain malignancies. Methods: Patients’ electronic health data for this case-control study was extracted from West Virginia University Hospital Systems, 2010-2021. HGG cases were defined using diagnoses codes ICD10-C71 and ICD9-191 (excluding low grade gliomas). The control group was defined by using diagnoses codes ICD10-D32, C79.3, C71 (excluding HGG cases) and ICD9-225.2, 225.4, 198.3, 191 (excluding HGG cases). Controls were exact matched four controls to every case based upon patient five-year age categories and gender. Clustering was assessed globally through difference in Ripley’s-K between cases and controls; and locally using scan statistics. Results: The locations of HGGs and other brain tumors were clustered in the northern and northeastern regions of WV. Global cluster analyses detected statistically significant dispersion of HGG cases compared to our control group. Local cluster analysis identified multi-zip code cluster of HGG patients in northeastern WV between 2010-2021. The average relative risk of HGG compared to other brain malignancies was 1.25, indicating a 25% increase in risk of HGGs compared to other brain cancers within this region. While the local cluster was not statistically significant, the zip code level estimates of relative risk within the cluster ranged from 0.00 to 5.01. This indicated that certain zip codes within the cluster had five times the risk of HGGs compared to non-HGG brain malignancies relative to zip codes outside of the cluster. Conclusions: Findings indicate community level disparities in risk of HGGs relative to other brain malignancies. Additionally, results suggest that HGG cases are seen across the state at a more dispersed pattern than for non-HGG related brain tumors. These overall spatial trends could potentially be attributable to differences in clinical practice, access to care, or social determinants of health throughout WV. Spatial multivariable modeling techniques are needed to identify the specific neighborhood level factors associated with disproportionate patterns of risk identified for WV HGG patients.

Neema Avashia

Neema Avashia Skylar Bensheimer (bio) In truth, I've always felt uneasy in my relationship to the word 'Appalachian'... do you not count if you are Brown, Indian, the child of immigrants who moved to a place out of necessity again thirty years later, when work disappeared?= Neema Avashia writes in Another Appalchia: Coming Up Queer and Indian in a Mountain Place, her debut essay collection. [End Page 58] Published in March by West Virginia University Press, the book explores the economic decline in her West Virginia hometown, the struggles to represent her intersecting identities, and the significant relationships that shaped her as a child in Appalachia. Avashia's work has been published The Bitter Southerner, The Kenyon Review Online, Still: The Journal, and other magazines. Avashia spoke with writer and Appalachian Review student assistant Skylar Bensheimer to discuss her new essay collection. ________ SKYLAR BENSHEIMER: I wanted to start with the opening essay, "Directions to a Vanishing Place." It feels like a natural way to start the collection, especially with the second person and the directives. Did you know you wanted to begin the collection with that essay? NEEMA AVASHIA: Yes, largely because it was the first essay I wrote in the collection. It was the first essay to be published, the first essay that set the direction for what I was going to do. For readers who are unfamiliar, I felt like I needed to ground them in the place, and I felt like there wasn't another way to do that besides taking them there. If I start with this idea of directions and I locate you in the place, then with everything that comes after, there's less burden to establish place. It still has to happen to some extent, but it's less of a need in other essays if I do a good job in that first essay. SB: In the opening pages, you listed when and where each essay had been published before, and they were all published in the last couple of years. It's also a relatively short book, but you still cover a lot of subjects and touch [End Page 59] Click for larger view View full resolution Neema Avashia [End Page 60] on a lot of topics. What was the process like when you were compiling these essays? Were there cuts that you had to make? NA: It was actually the opposite. It wasn't so much cutting as it was figuring out if there was enough there for a collection. I have a mentor, Geeta Kothari, who's a professor at the University of Pittsburgh, and she said, "You need 50,000 words. You can't do anything with this until you have at least 50,000 words." So, there were some ways where I thought, Okay. I'm going to see if I have enough things to say that can get me to 50,000 words and that can feel like a complete collection. It wasn't so much cutting as it was writing to a goal or writing to a place where I felt like I had a complete collection. SB: One of the through-lines that really interested me in the book was this theme of isolation, whether that is being a minority in a conservative, mostly white area, the move from rural West Virginia to Boston, where you describe neighbors not really knowing each other, or when you write about the pandemic. Would you characterize those experiences as isolating, or do you think of them in a different way? NA: I think "isolating" is the right word for them. It's taken me a long time to understand, but when you're somebody whose identity is so intersectional, it can be really hard to find places where you don't feel isolated because even if one or two parts of you are represented, the thing that starts to surface for you is the thing that's not represented. That becomes the thing I'm most aware of. There are not a lot of places where queerness, Appalachian-ness, and Indian-ness are held together, and because of that you can end up in disconnects...

From Bingo to Certified Medical Director: How the Futures Program Helped Solidify My Journey

I first stepped into a nursing home when I was six years old. My mother was a certified nursing assistant who always worked 12-hour shifts. Since my father was also working, sometimes she had no choice but to have the bus drop me off at the long-term care facility where she worked. On those days I would sit in the dining hall with the residents who were under my mother’s care. I vividly remember playing bingo and poker with them. Those memories, glimpses of a moment in time, became the foundation for my career. Pursuing a geriatric medicine fellowship was an easy decision for me. During my interview with University of Pittsburgh Medical Center (UPMC) Presbyterian–Shadyside, I expressed an interest in post-acute and long-term care settings. That was when I first heard of the Futures Program, an opportunity that immediately appealed to me. I wanted to spend more time improving the ways that we care for our most vulnerable populations, and I also wanted to seek guidance and support for becoming a certified medical director. And after two years under a pandemic, I looked forward to an in-person conference! When we gathered in Baltimore, MD, at the 2022 Annual Conference of AMDA – The Society for Post-Acute and Long-Term Care Medicine, I felt invigorated by the small group sessions, the Q&As, and the larger events that Futures Program participants could take part in. It was rewarding just to be in the same room with so many people who shared my passion for this field, and the learning opportunities were seemingly endless. Throughout the conference I looked for pieces of advice that could follow me back to UPMC. Wayne Saltzman, MD, PhD, CMD, delivered an excellent presentation in which he asked us to remember five simple rules that would help us prevent adverse events. At one point in his presentation Dr. Saltzman said, “A good day starts with a good morning,” and that has stuck with me. He spoke of entering his facility at the start of busy days, and despite challenging situations, he said he always will take time to wish his staff a good morning. Since then, I have introduced myself to more of the staff at our nursing home, which has fostered better communication and better overall care. The leadership session, hosted by Suzanne Gillespie, MD, RD, CMD, and Elizabeth Galik, PhD, CRNP, opened my eyes to how many mentors had already helped me get to this point. It was then that I truly understood how the Futures Program gives rising clinical leaders in geriatrics a chance to find new mentors. Drs. Gillespie and Galik also asked us to reflect on our goals and values and consider how we bring them into the work that we do. In doing so, I was reminded of the little girl who enjoyed sitting with the residents, the one who went on to become a medical student and physician who spent all her electives in PALTC. Joining the Futures Program felt like a natural fit. I left that session with a solidified goal: become a certified medical director but never lose sight of that bingo-playing little girl. I could not be more thankful for the foundation that the Futures Program provides for us, and for the friendships and connections it has helped me make. I look forward to getting more involved with the Society very soon! Dr. Assadzandi is a graduate of Mercyhurst University and West Virginia University School of Medicine, where she also completed her family medicine residency. This June, she is finishing a fellowship with UPMC’s Division of Geriatric Medicine and will then join the department as a clinical assistant professor focusing on post-acute and long-term care.

Evaluation of terminal sire breeds for hair sheep production systems: Feedlot environment

Improving carcass merit while maintaining parasite resistance in Katahdin crossbred lambs has potential to improve profitability for U.S. sheep producers. To assess crossbred lamb parasite resistance, carcass merit and gain, purebred Katahdin ewes from the Southwest Virginia Agricultural Research and Extension Center (Glade Spring, VA) were mated to Katahdin (KT), Suffolk (SU) or Texel (TX) rams for three years. Lambs were born and raised in Virginia. Two weeks post-weaning, lambs were transported to the West Virginia University Animal Science Farm (Morgantown, WV). Lambs were dewormed and transitioned to a complete pellet (16% CP) and fed ad lib for the duration of the study. After transition, all lambs were infected with 10,000 Haemonchus contortus L3 larvae (HcL3) in suspension given orally. Weights, blood and fecal samples were collected weekly. After a 5 week primary infection, all lambs were treated with levamisole (8 mg/kg) and rested for 2–3 weeks, after which, lambs were challenge infected with 10,000 HcL3 and sampled weekly until slaughter endpoint in Years 1&2. Ultrasonic determination of REA and fat depth occurred 1 week prior to slaughter in Years 1&2. In Year 3 carcass evaluation did not occur and ultrasonic measurements were taken at termination of the trial. In Years 1&2, 5 lambs from each sire group (n = 15) were randomly selected for carcass analysis at the Virginia Tech Meats Laboratory. No significant sire effect differences were observed in FEC during primary infections across all 3 years. Fecal egg count of KT lambs peaked at week 6 during challenge infection but reduced FEC rapidly one week later. SU-sired lambs grew faster to a larger body weight than TX sired lambs (55.72 kg vs. 49.51 kg; 0.37 kg/d vs. 0.32 kg/d, P < 0.0001), with KT progeny having the least amount of weight gain (44.8 kg; 0.30 kg/d). Analysis of REA using ultrasound and live carcass measurements exhibited no difference between SU- (16.92 cm2) or TX-sired lambs (17.10 cm2) but both breeds were significantly higher than Katahdin lambs (13.67 cm2;P < 0.01). Leg score favored SU- (11.8) and TX-sired (12.0) lambs compared to KT-sired lambs (10.7;P < 0.01). Feed efficiency measured in RFI showed no significant difference between KT-, SU- or TX sired lambs (−0.08, 0.04, −0.04 kg/d respectively; P = 0.65). Taken together these data demonstrate that carcass merit of TX-sired lambs is equivalent to SU-sired lambs supporting the option of using an alternative terminal sire on Katahdin ewes without detrimental loss of parasite resistance in crossbred progeny.

Single-center experience on progressive multifocal leukoencephalopathy (PML) cases, neuroimaging relevance, and management at West Virginia University (WVU).

Progressive multifocal leukoencephalopathy (PML) is an increasingly common and rapidly fatal demyelinating infection of central nervous system caused by the highly prevalent John Cunningham (JC)virus in immunocompromised individuals belonging to all age groups and genders. Human immunodeficiency virus (HIV) is the most common predisposing factor among other immunodeficient conditions leading to reactivation and multiple neurological symptoms. It has varied findings on magnetic resonance imaging (MRI) and diagnosis is confirmed by positive JC virus in cerebrospinal fluid (CSF). We report 12 confirmed cases of PML from a single academic center. We comprehensively described clinical presentations, risk factors, CSF and neuroimaging findings, treatment and outcome for these cases of PML, a rare disease. The cases were almost equivalently distributed among young and old age groups and both genders. Positive JC virus on CSF was present in the majority of cases along with mild to severe reduction in lymphocyte counts. Significant MRI changes were present in all cases ranging from T2 hypertense signals to white matter lesions in various regions. Treatment with the reversion of immune-modulators, optimization of antiviral therapy (ART), plasmapheresis (PLEX), IVIG, Mirtazapine, oral steroids, and others was started as soon as the diagnosis was made in the majority of the cases. However, PML is a rapidly fatal illness and hence, survival was only seen in 4 cases in our study. The objective of this article is to highlight the importance of early diagnosis of PML with CSF findings and neuroimaging, early reversion of immunosuppressive medications, and careful monitoring and treatment of HIV cases with goals to reduce mortality, long-term morbidity, and deficits.

Extending Macroeconomic Impacts Forecasting for NEMS

To comprehensively model the macroeconomic impacts that result from changes in long-term energy-economy forecasts, the United States (U.S.) Department of Energy’s National Energy Technology Laboratory (NETL) partnered with West Virginia University (WVU)’s Regional Research Institute to develop the NETL/WVU econometric input-output (ECIO) model. The NETL/WVU ECIO model is an impacts forecasting model that functions as an extension of the U.S. energy-economic models available from the U.S. Energy Information Administration’s National Energy Modeling System (NEMS) and the U.S. Environmental Protection Agency’s Market Allocation (MARKAL) model. The ECIO model integrates a macroeconomic econometric forecasting model and an input-output accounting framework along derived forecast scenarios detailing a baseline of the U.S. ener-gy-economy and an alternative forecast on how power generation resources can meet future levels of energy demand to generate estimates of the impacts to gross domestic product, employment, and labor income. This manuscript provides an overview of the model design, assumptions, and standard outputs.

Reviving Microscopy in Paramedical Anatomy Courses Using Web‐based Virtual Microscopy and Interactive Exercises

As the paramedical programs evolved at West Virginia University, large combined anatomy courses with gross and microanatomy laboratories were replaced with predominantly didactic courses geared towards each individual field. The first year pharmacy anatomy course and the dental hygiene oral histology both place emphasis on histology but the courses did not give students the opportunity to experience student‐directed active learning using a microscope. We created a series of laboratory exercises using a virtual microscopy website developed within our department that features a large collection of annotated normal and pathological histological specimens. The website mimics the actual use of a microscope and facilitates student independent study. Students were provided with laboratory guidelines and faculty video tutorials to facilitate their use of the programs and understanding of histology. In addition, we created identification exercises using a separate website where students could view and label specimens, enter text and share comments with peers and faculty via a chat room. Students readily adapted to using the virtual microscope and the on‐line platform proved to be extremely advantageous when COVID restricted personal contact with students. There was renewed engagement with students taking the lead in interpretation of specimens and group discussion. Students were allowed unlimited attempts in the identification exercises which promoted “educated guessing” and continual faculty feedback. Incorporation of a laboratory component into the courses allowed students to practice their interpretational skills and improved overall academic performance by testing students on other facets of learning. Improvement in academic performance of the dental hygiene students was most pronounced since the laboratory component was integrated throughout the semester. Student feedback was very positive encouraging our further development of clinically‐related exercises.

First person - Michael Robichaux.

ABSTRACTFirst Person is a series of interviews with the first authors of a selection of papers published in Disease Models & Mechanisms, helping early-career researchers promote themselves alongside their papers. Michael Robichaux is first author on ‘ Subcellular localization of mutant P23H rhodopsin in an RFP fusion knock-in mouse model of retinitis pigmentosa’, published in DMM. Michael conducted the research described in this article while a postdoctoral fellow in Ted Wensel's lab at Baylor College of Medicine, Houston, TX, USA. He is now an assistant professor at West Virginia University, Morgantown, WV, USA, investigating the intricate subcellular processes in photoreceptor neurons that enable vision.

Metabolic bone disease and fracture risk after gastric bypass and sleeve gastrectomy: comparative analysis of a multi-institutional research network.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed bariatric procedures. Multiple studies have investigated the metabolic bone complications after bariatric surgery, but there is a paucity of data comparing bone health after RYGB and SG. To compare the rates of major fractures and osteoporosis after Roux-en-Y gastric bypass and sleeve gastrectomy. Data from TriNetX multi-institutional research network that includes data from multiple health care organizations in the USA was analyzed at West Virginia University. We conducted a retrospective cohort study using TriNetX, a federated multi-institutional research network. We identified patients who underwent RYGB or SG. Primary outcome was the rate of major fractures at 3 years after the procedure. Other outcomes includedthe rate of spine fracture, femur fracture, osteoporosis, and vitamin D deficiency at follow-up. In unmatched analysis, patients with SG were less likely to have major fractures or an osteoporosis diagnosis than RYGB patients at 3 years after the procedure (P < .05). After propensity-score matching, similar results were noted; patients with SG were less likely to have major fractures than RYGB patients at 3 years after procedure (2.85% versus 3.66%, risk ratio [RR]: .78, 95% confidence interval [CI]: .71-.85), and a lower rate of osteoporosis diagnosis was noted in the SG group. High rates of vitamin D deficiency were noted in both cohorts. The incidence of spine fractures was significantly lower in the SG group than in the RYGB group (.76% versus 1.18%, RR: .65, 95% CI: .54-.77). Similarly, the incidence of femur fracture was significantly lower after SG (RR: .62, 95% CI: .44-.88). Female sex, higher age, smoking history, and diabetes were independently associated with osteoporosis diagnosis during follow-up (all P values <.05). Our analyses showed that RYGB is associated with a higher risk of osteoporosis, vitamin D deficiency, and osteoporotic fractures. Thus, in patients with a higher baseline osteoporotic risk, SG may be preferred option; however, further studies are needed.

This Way Back by Joanna Eleftheriou

Reviewed by: This Way Back by Joanna Eleftheriou Bryon Macwilliams (bio) Joanna Eleftheriou, This Way Back. In Place series. Morgantown: West Virginia University Press, 2020. Pp. 270. Paper $23.99. At first blush Joanna Eleftheriou's collection of essays, This Way Back, seems an unlikely fit for a book series rooted "in place": much is written from a neither here nor there place. Then again, for Eleftheriou—the child of a Greek-Cypriot father and a Greek-American mother, raised in both the United States and Cyprus—liminal space is her place. "I was born with nostalgia in my blood," she writes (59), reminding readers that the word nostalgia comes from the Greek words nostos, homecoming, and algos, pain. Eleftheriou's nostalgia is a burden. After all, how much of a homecoming can there ever be when one has little sense of home? And how much pain must one carry beyond the wounds necessary for personal growth? The pain of duty to a father—his expectations, and his unfulfilled dreams. The pain of disapproval of a mother—and of mother and daughter's shared religion, Orthodox Christianity, with which the writer, a lesbian, is "incompatible" (11). The ache from "centuries-old collective memory" among Greek Cypriots and Greeks, generally—what Eleftheriou calls the "lament" of "our Greek nation's fall from its old glory" (107). Then there is the weight of obligation to dead ancestors—those who worked the land Eleftheriou inherited, and whose newly independent country was partitioned before she was born—and the longing for love that, for many years, Eleftheriou found merely in "the stars . . . the ocean, and words, my work" (139). Throughout the 17 essays in the book, Eleftheriou's first, it is clear that, for a long time, these and other forces conspired to tell the writer that her life—her self—could wait. [End Page 248] The book turns in large part on the family's decision, in the writer's early adolescence, to move from the borough of Queens, New York, to the father's village of Asgata near the Cypriot coastal city of Limassol. As a young adult Eleftheriou returned to the United States, where she is now an assistant professor of English at Christopher Newport University in Virginia. "It's taken decades to begin winding my Americanness back into my identity," she writes. "I had trouble making peace with the birthplace I'd left" (75). In one essay Eleftheriou—"desperate to make sense of a certain kind of beauty that I had just begun to see"—explores desire and permission through the life of the actor Melina Mercouri, for whom "pleasure was her life's guiding principle" (34). In another she wonders when duty to family ends, telling her father in an unsent letter: "I'm not sure I can find a man and marry quick enough to give you peace" (136). She watches from afar footage of Cyprus's first gay pride parade, concluding that "when teachers and priests and politicians said that the Greeks had suffered and deserved to have their human rights better protected" they meant "only certain Greeks—the Greeks who dated the opposite sex" (185). By the end of the book Eleftheriou hopes that telling her story can "offer liberation from this ghost that lives inside me: a sense of exile, a sense of not belonging, a sense of being trapped and unable to flee" (228). There is a sense, too, of Eleftheriou—a runner—trying literally to outrun her ghosts in the early mornings and moonlit evenings among the hills around Asgata. The publisher promotes the book as an essay collection that "reads like a memoir." But, while the essays tell different parts of the same stories, the book reads more like Eleftheriou's description, in a scholarly essay on nonfiction hybrids, of Richard Rodriguez's Hunger of Memory (1983): The book is "divided into discreet parts" that revolve around ideas and "[only] loosely follow the chronology" of her life (Eleftheriou 2014, 42). Indeed, there isn't a clear sense of time in the book. The essays are arranged such that Eleftheriou's sexuality—"I am, indeed, the first gay Orthodox woman I know" (198...

Telemedicine versus in-Person Primary Care: Impact on Visit Completion Rate in a Rural Appalachian Population.

The use of telemedicine increased during the global Coronavirus disease 2019 (COVID-19) pandemic. Rural populations often struggle with adequate access to care while simultaneously experiencing multiple health disparities. Yet, telemedicine use during the COVID-19 pandemic has been understudied on its effect on visit completion in rural populations. The primary purpose of this study is to understand how telemedicine delivery of family medicine care affects patient access and visit completion rates in a rural primary care setting. We performed a retrospective cohort study on primary care patient visits at an academic family medicine clinic that serves a largely rural population. We gathered patient demographic and visit type and completion data on all patients seen in the West Virginia University Department of Family Medicine between January 2019 and November 2020. The final sample included 110,999 patient visits, including 13,013 telemedicine visit types. Our results show that telemedicine can increase completion rates by about 20% among a sample of all ages and a sample of adults only. Working-aged persons are more likely to complete telemedicine visits. Older persons with higher risk scores are more likely to complete their visits if they use telemedicine. Telemedicine can be a tool to improve patient access to primary care in rural populations. Our findings suggest that telemedicine may facilitate access to care for difficult-to-reach patients, such as those in rural areas, as well as those who have rigid work schedules, live longer distances from the clinic, have complex health problems, and are from areas of higher poverty and/or lower education.

Habitat Use and Niche Partitioning of Regina septemvittata and Nerodia sipedon in a Small Appalachian Stream in West Virginia

The common water snake, Nerodia sipedon, and the queen snake, Regina septemvittata are two species of stream-dwelling water snakes in the Family Natricidae native to the northern panhandle of West Virginia. Nerodia sipedon is a large-bodied generalist, ranging up to 140 cm in length and 400 g in mass, which feeds on many fish and amphibian species. Regina septemvittata is a smaller specialist, reaching only 92 cm in length and 100 g in mass, which primarily consumes freshly molted crayfish. In an ongoing study conducted by students at West Virginia University, I studied the habitat preferences of both of these species in the North fork of Short Creek as there has been little research done on habitat preferences in small streams. Morphological, environmental, and behavioral data on each snake that was captured. Qualitative habitat evaluation indexes (QHEI) were also collected to assess stream health in conjunction with presence and abundance of both species. No significant differences were found in the presence or abundance as it relates to QHEI, but trends show higher rates of presence and abundance in sites with lower QHEI scores. These results suggest that there is minimal interspecific competition of habitat present between N. sipedon and R. septemvittata, as well as support the hypothesis that both species thrive in more disturbed habitats.

Thirteen Synchronous Multifocal Calcifying Epithelial Odontogenic Tumors (CEOT): Case Report and Review of the Literature

<h3>Introduction</h3> Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor) is a rare benign, locally aggressive neoplasm of the jaws that accounts for approximately 1% of all odontogenic tumors. The CEOT was first defined by Pindborg in 1955 and has been reported approximately 350 times in the literature; 7 of these reported multiple, synchronous lesions (up to 4). We report the eighth case in an individual with the largest number (by far) of CEOTs reported to date and provide a literature review of multifocal CEOT cases. <h3>Materials and methods</h3> A 30-year-old male presented to the Oral and Maxillofacial Surgery Department of the West Virginia University School of Dentistry (WVU SoD) to extract multiple impacted teeth previous to constructing a complete denture. <h3>Results</h3> A pantograph showed 15 impacted teeth, almost all associated with well-demarcated cyst-like radiolucencies, some with small, ill-defined radiopaque flecks. Microscopically the lesions showed sheets of strands of polygonal epithelial cells with eosinophilic cytoplasm. Spread throughout the epithelium and connective tissue were small spherical amorphous pale purplish calcifications. Each lesion was similar and consistent with a diagnosis of CEOT. <h3>Conclusion</h3> We report a patient with 13 independent CEOTs scattered throughout all quadrants, suggesting genetic mutation of a tumor suppressor gene, such as the PTCH1 gene, which has been previously identified in patients with solitary CEOTs. This is the largest number of Pindborg tumors or any other type of odontogenic tumors, yet reported in a single individual.

Tax Consequences When a New Employer Bears the Cost of the Employee's Terminating a Prior Employment Relationship

The next few months will be busy ones for moving companies that have NCAA basketball coaches as customers. In the past few months, several men’s college basketball coaches have accepted jobs at different schools. Several of those coaches, who were still under contract at their former institution, had buy out provisions that allowed them to terminate their relationship for a set price. John Beilein is a prominent example of this since his buy out price was so high. Last season, Beilein was the head basketball coach at West Virginia University where he was under contract with the school until 2012. On April 3 of this year, the University of Michigan hired Beilein to become the head coach of its men’s basketball team. Under his contract with West Virginia University, if Beilein left that position before the contract term expired, he was required to pay a specified amount to the university. Initially, it was reported that the amount to be paid was in the vicinity of $2,000,000 to $2,500,000. Subsequently, it was reported that West Virginia and Beilein agreed that Beilein would pay the university $1,500,000 over a five-year period in full settlement of his obligation.

The Black Athlete in West Virginia: High School and College Sports from 1900 through the End of Segregation

As of 2021, West Virginia's two Historically Black Colleges and Universities (HBCUs), Bluefield State and West Virginia State, are the only two in the country that have a majority white student body. Both compete today in NCAA Division II intercollegiate sports and receive much less funding than the state's largest public colleges, Marshall University and West Virginia University. Despite such demographic and financial changes in the past fifty years of West Virginia higher education, there is a rich history of African American colleges and high schools in the state, and this is especially true for African American athletic achievement. For example, the Pittsburgh Courier voted Bluefield State in 1927 and 1928 and West Virginia State in 1936 as Black-college national co-champions in football, yet neither college enjoyed much athletic-program success following desegregation. The story of how these two colleges changed from national African American football powerhouses to majority-white universities is but one analyzed within The Black Athlete in West Virginia, but it is perhaps the central, most critical theme.In what is the work's strongest chapter, the authors trace how Bluefield State and West Virginia State became the first HBCUs in the United States to join a white-colleges-only athletic conference, in their case, the West Virginia Intercollegiate Athletic Conference (WVIAC). Both university presidents were strong believers in desegregation, and both initiated the process of joining WVIAC themselves within months of the Brown v. Board ruling. Within about six months, WVIAC college presidents met and approved both schools’ applications to join. Just like that, a West Virginia collegiate sport league was integrated, a relatively direct process that contrasts with the turmoil-filled integration stories present in chapters on Marshall and West Virginia University. But like so many civil rights stories, this simple narrative was not so cut and dry.Joining the WVIAC was celebrated among most in the two colleges, but some felt African American academic leadership betrayed Black athletes and that WVIAC membership was a step backward. First, the best African American teams from West Virginia colleges had a chance of being recognized as the national Black-college champion. This honor, typically determined by the votes of Black newspapers, was forfeited with WVIAC membership. Next, while desegregation was recognized by an overwhelming majority as a social good, the growing number of white students at each HBCU—especially Bluefield State—led to social conflict within a decade of joining the WVIAC. “While other campuses erupted in protests over the Vietnam War,” the authors write, “Bluefield's black students protested what they believed was a move by the state of West Virginia to make Bluefield State a white college and to erase its cultural heritage as a historically black college” (150). A bomb planted by an unknown perpetrator exploded in the campus physical education building in 1968. In response, the university closed its dormitories, effectively making the college a white commuter college (the surrounding county population was just 7 percent African American). Throughout all this, Bluefield State maintained a strong basketball culture largely comprised of out-of-state African American players, and social division grew.The only shortcoming in this well-researched book is that its title is a misnomer. It would have been better named “The Black Basketball and Football College Athlete in West Virginia.” Of the book's ten chapters, four are exclusively about basketball, and another four are more generally about school integration, with basketball and football serving as major cultural landmarks. Women's sports, high school sports, and other men's collegiate sports do receive an occasional mention, such as future US Olympic wrestler Bobby Douglas, but more of these examples would have provided greater depth. For instance, famed African American sportswriter Wendell Smith played baseball at West Virginia State College. Smith claimed that a white Major League scout told him that he would never be signed to a lucrative contract due to professional baseball's color barrier, at which point Smith promised himself to fight for baseball integration. He would go on to be a pivotal character in Jackie Robinson's story, which began for Smith on a baseball diamond just outside Charleston, West Virginia. Regardless, this is a strong contribution to sport history, to the history of school desegregation, and to West Virginia history. Anyone with interest in any of these topics should consider this work a top priority.