Reviewer Acknowledgments

As we reach our fifth year, we are particularly thankful for the contributions of our peer reviewers. The knowledge, expertise, and guidance offered by the people listed below have ensured that we can continue to share timely research to effect health and well-being across Appalachia

We Welcome Findings from Further Afield

For the past five years, the Journal of Appalachian Health has published timely, high-quality research from within Appalachia. We also welcome submissions from those working outside of Appalachia who produce quality research of direct relevance to our region

Virtual Coaching and Deliberate Practice to Enhance Medical Students\u27 Clinical Reasoning during Oral Case Presentations

ABSTRACT: Introduction Oral case presentations (OP) provide an opportunity for medical students to practice clinical reasoning and communication skills, and for faculty to provide assessment. Specific teaching strategies are needed to improve students’ OP skills. Objective To compare the effectiveness of Virtual Coaching (VC) to Small Group (SG) discussion or Traditional Feedback (TF/control) in improving clinical reasoning during OP, using a validated PBEAR (Problem Representation, Background Evidence, Analysis, Recommendation) tool. Design/Methods Students from two medical schools were randomly assigned to three groups during their inpatient pediatric clerkship. All completed an eLearning module about using illness scripts to promote clinical reasoning and presenting in the PBEAR format. TF/control students completed online “Aquifer” cases; VC students recorded abstracted data from the same cases with on-line faculty feedback and self-reflection; SG students attended faculty facilitated discussions of the same cases. Students were video recorded presenting pre- and post-curriculum cases. Reviewers blinded to assignment groups rated pre and post videos with the PBEAR OP tool. Results The overall score and sub-scale scores improved for all groups. VC students significantly improved in the Analysis subscale compared to SG or controls. Students rated the SG teaching sessions as more enjoyable and effective in improving their clinical reasoning and presentation skills. Conclusions A blended learning curriculum using VC significantly improved students’ clinical reasoning as assessed by the Analysis subscale

Deep Recurrent Modelling of Stationary Bitcoin Price Formation Using the Order Flow

In this paper we propose a deep recurrent model based on the order flow for the stationary modelling of the high-frequency directional prices movements. The order flow is the microsecond stream of orders arriving at the exchange, driving the formation of prices seen on the price chart of a stock or currency. To test the stationarity of our proposed model we train our model on data before the 2017 Bitcoin bubble period and test our model during and after the bubble. We show that without any retraining, the proposed model is temporally stable even as Bitcoin trading shifts into an extremely volatile "bubble trouble" period. The significance of the result is shown by benchmarking against existing state-of-the-art models in the literature for modelling price formation using deep learning.Comment: 10 pages, The 19th International Conference on Artificial Intelligence and Soft Computin

Imaging high-dimensional spatial entanglement with a camera

The light produced by parametric down-conversion shows strong spatial entanglement that leads to violations of EPR criteria for separability. Historically, such studies have been performed by scanning a single-element, single-photon detector across a detection plane. Here we show that modern electron-multiplying charge-coupled device cameras can measure correlations in both position and momentum across a multi-pixel field of view. This capability allows us to observe entanglement of around 2,500 spatial states and demonstrate Einstein-Podolsky-Rosen type correlations by more than two orders of magnitude. More generally, our work shows that cameras can lead to important new capabilities in quantum optics and quantum information science.Comment: 5 pages, 4 figure

Extremely high He isotope ratios in MORB-source mantle from the proto-Iceland plume

The high <sup>3</sup>He/<sup>4</sup>He ratio of volcanic rocks thought to be derived from mantle plumes is taken as evidence for the existence of a mantle reservoir that has remained largely undegassed since the Earth's accretion. The helium isotope composition of this reservoir places constraints on the origin of volatiles within the Earth and on the evolution and structure of the Earth's mantle. Here we show that olivine phenocrysts in picritic basalts presumably derived from the proto-Iceland plume at Baffin Island, Canada, have the highest magmatic <sup>3</sup>He/<sup>4</sup>He ratios yet recorded. A strong correlation between <sup>3</sup>He/<sup>4</sup>He and <sup>87</sup>Sr/<sup>86</sup>Sr, <sup>143</sup>Nd/<sup>144</sup>Nd and trace element ratios demonstrate that the <sup>3</sup>He-rich end-member is present in basalts that are derived from large-volume melts of depleted upper-mantle rocks. This reservoir is consistent with the recharging of depleted upper-mantle rocks by small volumes of primordial volatile-rich lower-mantle material at a thermal boundary layer between convectively isolated reservoirs. The highest <sup>3</sup>He/<sup>4</sup>He basalts from Hawaii and Iceland plot on the observed mixing trend. This indicates that a <sup>3</sup>He-recharged depleted mantle (HRDM) reservoir may be the principal source of high <sup>3</sup>He/<sup>4</sup>He in mantle plumes, and may explain why the helium concentration of the 'plume' component in ocean island basalts is lower than that predicted for a two-layer, steady-state model of mantle structure

Population Health as a Corporate Strategy: The Value of Investing in Wellness

Mr. Thayer and Dr. Fabius provide an enlightening session on the notion of enduring cultures of health. They describe benchmark organizations that have successfully bent their health cost curve without cost shifting or reducing services. They also discuss the importance of aligning efforts across caring providers, engaged health consumers, and enlightened employers to achieve top performance. Presentation: 48 minutes PowerPoint slides at bottom of page

Incidence and Impact of Takotsubo Syndrome in Hospitalized Patients With COVID-19

Background Takotsubo syndrome has been reported in patients with COVID-19, although minimal data are available. This investigation assessed the incidence and impact of takotsubo syndrome on patients hospitalized with COVID-19. Methods A retrospective cohort study was conducted using International Statistical Classification of Diseases, Tenth Revision, codes to identify patients with a primary diagnosis of COVID-19 with or without takotsubo syndrome in the National Inpatient Sample 2020 database. Outcomes between groups were compared after propensity score matching for patient and hospital demographics and comorbidities. Results A total of 211,448 patients with a primary diagnosis of COVID-19 were identified. Of these, 171 (0.08%) had a secondary diagnosis of takotsubo syndrome. Before matching, patients with COVID-19 and takotsubo syndrome, compared with patients without takotsubo syndrome, were older (68.95 vs 64.26 years; P < .001); more likely to be female (64.3% vs 47.2%; P < .001); and more likely to have anxiety (24.6% vs 12.8%; P < .001), depression (17.5% vs 11.4%; P = .02), and chronic obstructive pulmonary disease (24.6% vs 14.7%; P < .001). The takotsubo syndrome group had worse outcomes than the non–takotsubo syndrome group for death (30.4% vs 11.1%), cardiac arrest (7.6% vs 2.1%), cardiogenic shock (12.9% vs 0.4%), length of hospital stay (10.7 vs 7.5 days), and total charges ($152,685 vs$78,468) (all P < .001). After matching and compared with the non–takotsubo syndrome group (n = 508), the takotsubo syndrome group (n = 170) had a higher incidence of inpatient mortality (30% vs 14%; P < .001), cardiac arrest (7.6% vs 2.8%; P = .009), and cardiogenic shock (12.4% vs 0.4%; P < .001); a longer hospital stay (10.7 vs 7.6 days; P < .001); and higher total charges ($152,943 vs$79,523; P < .001). Conclusion Takotsubo syndrome is a rare but severe in-hospital complication in patients with COVID-19

Transcription profiling reveals potential mechanisms of dysbiosis in the oral microbiome of rhesus macaques with chronic untreated SIV infection.

A majority of individuals infected with human immunodeficiency virus (HIV) have inadequate access to antiretroviral therapy and ultimately develop debilitating oral infections that often correlate with disease progression. Due to the impracticalities of conducting host-microbe systems-based studies in HIV infected patients, we have evaluated the potential of simian immunodeficiency virus (SIV) infected rhesus macaques to serve as a non-human primate model for oral manifestations of HIV disease. We present the first description of the rhesus macaque oral microbiota and show that a mixture of human commensal bacteria and "macaque versions" of human commensals colonize the tongue dorsum and dental plaque. Our findings indicate that SIV infection results in chronic activation of antiviral and inflammatory responses in the tongue mucosa that may collectively lead to repression of epithelial development and impact the microbiome. In addition, we show that dysbiosis of the lingual microbiome in SIV infection is characterized by outgrowth of Gemella morbillorum that may result from impaired macrophage function. Finally, we provide evidence that the increased capacity of opportunistic pathogens (e.g. E. coli) to colonize the microbiome is associated with reduced production of antimicrobial peptides