Black and Gifted: Hiding In Plain View

Abstract This dissertation examines representation of African Americans in gifted programs in an urban school district where the creation of gifted programs was enacted as a tool for desegregation. The research is conducted from the perspectives of gifted African American students in an effort to shed some light on whether an achievement gap exists or is the makeup of the program itself a deterrent to the enrollment of African American students. A qualitative study was conducted using personal narratives from students who were enrolled in a self-contained gifted program in the urban school districts. The participants gave personal interviews where they answered a series of questions which recanted stories and details of their middle or high school years in a gifted program. Three African American females participated in the research. Each female was enrolled in a gifted program for at least three years. The interviews were collected and coded for similar phrases and responses to questions about the experience of an African American in gifted programs. Findings in the research revealed that African Americans were in the minority in each participant’s individual gifted program. In addition, each participant revealed that she had no more than two African American teachers throughout the three years she was enrolled in a gifted program. Participants further revealed that she experienced cultural isolation from other African American students who were not in the gifted program. Each participant reported experiencing bias from teachers, traditional students, and fellow gifted students

Central Line-Associated Bloodstream Infection Risk Factors in a Pediatric Population

Background Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates. Methods This is a single-institution case-control study of pediatric patients (≤18 years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed. Results We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors. Discussion Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates

A Leptin-regulated Circuit Controls Glucose Mobilization During Noxious Stimuli

Adipocytes secrete the hormone leptin to signal the sufficiency of energy stores. Reductions in circulating leptin concentrations reflect a negative energy balance, which augments sympathetic nervous system (SNS) activation in response to metabolically demanding emergencies. This process ensures adequate glucose mobilization despite low energy stores. We report that leptin receptor–expressing neurons (LepRb neurons) in the periaqueductal gray (PAG), the largest population of LepRb neurons in the brain stem, mediate this process. Application of noxious stimuli, which often signal the need to mobilize glucose to support an appropriate response, activated PAG LepRb neurons, which project to and activate parabrachial nucleus (PBN) neurons that control SNS activation and glucose mobilization. Furthermore, activating PAG LepRb neurons increased SNS activity and blood glucose concentrations, while ablating LepRb in PAG neurons augmented glucose mobilization in response to noxious stimuli. Thus, decreased leptin action on PAG LepRb neurons augments the autonomic response to noxious stimuli, ensuring sufficient glucose mobilization during periods of acute demand in the face of diminished energy stores

Disease Burden and Functional Outcomes in Congenital Myotonic Dystrophy: A Cross-Sectional Study

OBJECTIVE: Herein, we describe the disease burden and age-related changes of congenital-onset myotonic dystrophy (CDM) in childhood. METHODS: Children with CDM and age-matched controls aged 0 to 13 years were enrolled. Participants were divided into cohorts based on the following age groups: 0-2, 3-6, and 7-13 years. Each cohort received age-appropriate evaluations including functional testing, oral facial strength testing, neuropsychological testing, quality-of-life measurements, and ECG. Independent-samples t test or Wilcoxon 2-sample test was used to compare the differences between children with CDM and controls. Probability values less than 0.05 are reported as significant. RESULTS: Forty-one participants with CDM and 29 healthy controls were enrolled. The 6-minute walk was significantly different between CDM (258.3 m [SD 176.0]) and control participants (568.2 m [SD 73.2]). The mean lip force strength was significantly different in CDM (2.1 N [SD 2.8)] compared to control participants (17.8 N [SD 7.6]). In participants with CDM, the mean IQ (65.8; SD 18.4) was 3 SDs below the mean compared to standardized norms. Measurements of grip strength, sleep quality, and quality of life were also significantly different. Strength measures (oral facial strength, grip strength, and 6-minute walk) correlated with each other but not with participant IQ. CONCLUSIONS: This work identifies important phenotypes associated with CDM during childhood. Several measures of strength and function were significantly different between participants with CDM and controls and may be useful during future therapeutic trials

The Lantern, 2009-2010

• I\u27m Pregnant. It\u27s Yours • The Nightmare • What Death Became After Cyparissus • Substances • Ain\u27t That a Man? • Portrait • The 100th Chemo • Looking into Her Toy Box with a Lover • They Used to Talk About Burning Cities • MESSAGE: Absence for Allen Ginsberg • Lunch with Candide • Behold! Man of Unbelief! Behold! • Dream #1 Final Strophe • Patience (Things You Will Discover) • Four Years • He Falls Like Leaves • The Quilt • Ariel (Turning Tricks at Fisherman\u27s Wharf, Monterey, California) • Extranjera • The Taste of Morning • Fear of Glory • The Rum Bottle\u27s Fortune • While Thinking of What to Write • Dying in Spring • Tutte le Eta di Firenze • Token • A House Grows Into Itself • Gravity • Father with the Skyy • He Says He Dreams of Me • Myth • Sun-Veins and Wishbones • Attempts at Bravery • One Boy in Four Parts • Blacktop Rollin\u27 • Getting My Feet Wet • The Long Ride After Ending • Wet Tongues and Sweaty Cotton • Norman Bates is My Mother • Sims Trek • Tomorrow Comes Today • The Writer\u27s Process • This Too Was Real • Venus from the Waves • Shark • Monday\u27s Expectations • Recognition • The Black Shoes • Climax • Andrew • Bottles • Calle de Cusco • God in the Machine • The 26th of December • Lollipop Lollipop • When Dinosaurs Roamed the Earth • Meaning • Jeffrey • Looking • Jagged Edges • Fading Storm • Shoes • Cover Image: Death by Chocolatehttps://digitalcommons.ursinus.edu/lantern/1175/thumbnail.jp

CYP24A1 variant modifies the association between use of oestrogen plus progestogen therapy and colorectal cancer risk

BACKGROUND: Menopausal hormone therapy (MHT) use has been consistently associated with a decreased risk of colorectal cancer (CRC) in women. Our aim was to use a genome-wide gene-environment interaction analysis to identify genetic modifiers of CRC risk associated with use of MHT. METHODS: We included 10 835 postmenopausal women (5419 cases and 5416 controls) from 10 studies. We evaluated use of any MHT, oestrogen-only (E-only) and combined oestrogen-progestogen (E+P) hormone preparations. To test for multiplicative interactions, we applied the empirical Bayes (EB) test as well as the Wald test in conventional case-control logistic regression as primary tests. The Cocktail test was used as secondary test. RESULTS: The EB test identified a significant interaction between rs964293 at 20q13.2/CYP24A1 and E+P (interaction OR (95% CIs)=0.61 (0.52-0.72), P=4.8 × 10(-9)). The secondary analysis also identified this interaction (Cocktail test OR=0.64 (0.52-0.78), P=1.2 × 10(-5) (alpha threshold=3.1 × 10(-4)). The ORs for association between E+P and CRC risk by rs964293 genotype were as follows: C/C, 0.96 (0.61-1.50); A/C, 0.61 (0.39-0.95) and A/A, 0.40 (0.22-0.73), respectively. CONCLUSIONS: Our results indicate that rs964293 modifies the association between E+P and CRC risk. The variant is located near CYP24A1, which encodes an enzyme involved in vitamin D metabolism. This novel finding offers additional insight into downstream pathways of CRC etiopathogenesis

Genome-Wide Diet-Gene Interaction Analyses for Risk of Colorectal Cancer

Dietary factors, including meat, fruits, vegetables and fiber, are associated with colorectal cancer; however, there is limited information as to whether these dietary factors interact with genetic variants to modify risk of colorectal cancer. We tested interactions between these dietary factors and approximately 2.7 million genetic variants for colorectal cancer risk among 9,287 cases and 9,117 controls from ten studies. We used logistic regression to investigate multiplicative gene-diet interactions, as well as our recently developed Cocktail method that involves a screening step based on marginal associations and gene-diet correlations and a testing step for multiplicative interactions, while correcting for multiple testing using weighted hypothesis testing. Per quartile increment in the intake of red and processed meat were associated with statistically significant increased risks of colorectal cancer and vegetable, fruit and fiber intake with lower risks. From the case-control analysis, we detected a significant interaction between rs4143094 (10p14/near GATA3) and processed meat consumption (OR = 1.17; p = 8.7E-09), which was consistently observed across studies (p heterogeneity = 0.78). The risk of colorectal cancer associated with processed meat was increased among individuals with the rs4143094-TG and -TT genotypes (OR = 1.20 and OR = 1.39, respectively) and null among those with the GG genotype (OR = 1.03). Our results identify a novel gene-diet interaction with processed meat for colorectal cancer, highlighting that diet may modify the effect of genetic variants on disease risk, which may have important implications for prevention. © 2014

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

I Dream Citrus Dreams

Block and three prints of citrus fruit, each measuring 8x10 cm. Purchased from the Ursinus College Student Art Exhibition for the permanent Library collection.https://digitalcommons.ursinus.edu/student_art/1084/thumbnail.jp

Will the Volcker Rule’s Complexity Be Its Undoing?

Regulators today face evolving challenges in an increasingly complex financial world. Some of these challenges include protecting taxpayers, allowing for organizational autonomy, and promoting economic stability. One recent effort to address such concerns is the Volcker Rule, designed to prevent some of the main causes of the 2008 financial crisis. While many believe it was a good idea, some have highlighted its deep complexity and doubt whether the rule can be implemented successfully. The Dodd-Frank Wall Street Reform and Consumer Protection Act (“Dodd-Frank”) is one of the most significant regulatory reforms in the financial industry since the passing of the Securities Acts of 1933 and 1934, which instituted thorough registration and reporting requirements for publically traded companies in the wake of the Great Depression. Just as the Securities Acts were designed to protect consumers after the Great Depression, Dodd-Frank was born out of the Great Recession of 2008. The Volcker Rule, a centerpiece of Dodd-Frank, is among the most hotly debated portions of the Act. In its simplest terms, the Volcker Rule prohibits banks from engaging in proprietary trading and from having certain relationships with hedge funds and private equity funds. Proprietary trading is a high-risk form of trading where banks use client accounts to trade for direct gain. When the risks pay off, a bank can stand to gain significant returns. However, when banks use their clients’ money to engage in risky investments and then lose, taxpayers bear the brunt of the loss, as the Federal Deposit Insurance Corporation insures this money. The Volcker Rule is intended to prevent this problem by ensuring that high risk trading is left to hedge funds and other smaller institutions that, should they fail, would not destroy the economy. While this strategy may seem simple and straightforward, the rule itself is so complex and often debated that banks may fail to comply or may even seek to exploit loopholes and demand special treatment. The rule’s complexities begin with its many exceptions. For example, while proprietary trading is banned generally, there is an exception for trading in U.S. government, agency, state, and municipal obligations, and an exception for when a bank allocates the risks associated with equities trading to its foreign entities. The Volcker Rule’s unique complexities could mean that its enforcement is particularly difficult. The final version of the Volcker Rule distinguishes between trading that is based on market speculation—generally self-serving and impermissible—and those permissible trading activities that are designed to benefit clients and lessen a bank’s exposure to risk. While a bank is required to demonstrate that its trades are linked to its clients’ needs, determining whether some trades were made merely under the guise of permissible activity can be difficult because often there is very little evidence of impropriety in those cases. Furthermore, the rule is not always clear about what constitutes a violation. Without a clear standard and enough evidence of misbehavior, regulators may be forced to make hard determinations case-by-case. In addition, administration of the rule itself presents challenges. The Volcker Rule was promulgated by five administrative agencies that possess different enforcement mandates. These agencies don’t always agree about what constitutes proper banking activities. Because banks will be subject to oversight by at least three of these agencies, regulators may disagree about whether or not a given action constitutes a violation. This risk for varying interpretations is especially high in this case, as the agencies’ views over how to regulate banks derives from their differing historical mandates: the banking-focused regulators, who monitor the safety and soundness of a given bank, tend to be more concerned with internal matters (for example, a bank’s capital holdings level) while the securities regulators, who focus on protecting investors and the functioning of financial markets, pay more attention to the risks associated with buying and selling assets. These differences heighten the risk of inconsistent application of the rule. Ultimately, if the Volcker Rule “lacks bright-line distinctions,” its enforcement will burden the enforcing agencies. Some analysts expect day-to-day compliance to be extremely expensive, time-consuming, and complex. Although the rule’s authors left some areas grey intentionally to ensure that banks have some wiggle room as they engage in legitimate buying and selling, the agencies will have to make the ultimate judgments regarding compliance. The success of the Volcker Rule rests upon whether federal regulators will succeed in enforcing the “spirit as well as the letter of the law” as they monitor the powerful banking industry. While no one can know yet whether the Volcker rule will be a successful pillar of financial reform (or instead that complexity will kill this proverbial cat) mandatory compliance begins July 2015. This is part two of a three-part series featuring winning essays of a Penn Law administrative law writing competition