Josephine Baker & Me: Black Femme Identity in Performance

The paper explores the complicated intersection between Black womanhood and performance by considering Josephine Baker as a site to engage the concept of “performing identity.” It discuss both the development of burlesque and the history of Josephine Baker to provide a foundation for the investigation of her early-career movement and visual practices. Then, the paper explore these hallmarks through Sherril Dodds’ “critical components of neo-burlesque striptease” writ into her book, Dancing on the Canon: Embodiments of Value in Popular Dance. The second half of this document includes a script of CATHARSIS, a self-devised solo show created to process one’s personal journey towards self-recognition amidst the (de)stabilizing effects of adoption. The show broadly explores the dynamic relationship between visibility, movement, and healing as Megh negotiates what it means to take space and be vulnerable in an environment that seeks to minimize black femme expression. The script is followed by a reflection on the initial two performances

Fusobacterium nucleatum: A Rare Presentation of Hepatic Abscesses

Fusobacterium nucleatum is a facultative anaerobic gram-negative bacillus found in the oral cavity, gastrointestinal tract, and genitourinary tract. Fusobacterium nucleatum is a rare cause of hepatic abscesses and empyema. We describe a case of Fusobacterium liver abscess and empyema, resulting in extensive thrombophlebitis in intraabdominal and extremity veins. A 78-year-old female with past medical history significant for bicytopenia and tooth repair 8 months prior presented with mild diarrhea and fatigue. She was febrile, tachycardic, and tachypneic. On physical exam, she had mild epigastric tenderness and bilateral lower extremity pitting edema. Labs were notable for an AKI and elevated LFTs. Imaging revealed multiple \u3e10cm hepatic abscesses, a small right pleural effusion, a segmental pulmonary embolism, along with extensive intraabdominal and extremity DVTs. Vascular surgery did not recommend intervention. She underwent IR drainage of three abscesses as well as chest tube drainage of pleural effusion. Blood, abscesses, and pleural effusion culture grew Fusobacterium nucleatum. Plural effusion also grew Lactobacillus rhamnosus. She received metronidazole and was eventually switched to ampicillin/sulbactam. Source and malignancy work up were negative. The source of Fusobacterium nucleatum hepatic abscesses in descending order of frequency is periodontal flora, cryptogenic, and gastrointestinal tract. Given her diarrhea, the source may have been translocation from her gastrointestinal tract, however, it could also be periodontal due to her recent tooth repair. Treatment includes source control and antibiotics, ranging from 2 weeks to 6 months. This case illustrates the rare disease process of Fusobacterium hepatic abscess formation and the bacteria’s thrombogenic characteristics.https://scholarlycommons.henryford.com/merf2020caserpt/1044/thumbnail.jp

A RETROSPECTIVE CHART REVIEW ANALYZING THE RELATIONSHIP BETWEEN BLOOD PRESSURE RECHECKS AND POLYPHARMACY

ABSTRACT BODY: Background: Hypertension (HTN) affects nearly 80 million people in the United States. A patient’s blood pressure (BP) measurement may influence the number of antihypertensives prescribed. Providers often do not recheck BP when a patient’s measurement is elevated despite research supporting that remeasuring may result in a significant decrease in BP. We hypothesized that patients who have BP remeasured in clinic would have lower BP values and thus less antihypertensive medication. In our academic general internal medicine (GIM) clinic, providers are encouraged to manually repeat BP if elevated on vitals taken by medical assistants using an automated cuff at check-in. Our aim was to determine if repeating BP in patients with uncontrolled HTN is associated with a reduced number of antihypertensive medications. Our secondary aims were to assess the frequency at which BP is rechecked and to determine if there were disparities in provider or patient factors in whom BP was repeated. Methods: We performed a retrospective chart review on patients between the age of 18-85 with a hypertension diagnosis who were seen at our urban academic GIM clinic between 01/01/2019 and 12/31/2019. Individuals with ESRD and HF were excluded. We collected data including age, BP readings, provider type (resident or senior staff), gender, race, time of appointment, BMI, and comorbidities. Results: A total of 2259 patients met the inclusion criteria. The mean age was 59.8 years, BMI was 33.2, first systolic BP was 153.7 mmHg, and first diastolic BP was 89.3 mmHg. A total of 1301 (58%) patients were seen by a trainee, 1307 (57%) were seen in the morning, 1287 (57%) were female, and 1885 (83%) were black. A total of 929 (41%) patients had their BP rechecked. The mean antihypertensives prescribed in the group with BP rechecked was 2.3 medications, compared to 2.4 medications in those whose BP was not rechecked (p-value= 0.3241). There was no significant difference between provider or trainee rechecking BP (p-value=0.3425), race of patient (p-value=0.9863), and age of patient (p-value=0.0896). Morning appointments (p-value=0.0009), Males (p-value=0.0445), less obese patients (p-value=0.0188), and patients with COPD (p-value=0.0170) were more likely to be rechecked. When comparing the first and second BP measurement, 82.56% systolic and 72.23% of diastolic measurements improved with an average of a 10.7 systolic decrease and a 5.1 diastolic decrease. Conclusions: Rechecking BP in patients with uncontrolled HTN was associated with a decrease in BP. However, rechecking BP was not associated with a reduction in antihypertensive medications in patients with uncontrolled BP. Numerous factors were associated with a decreased likelihood of BP remeasurement including high BMI, female patients, and later appointment times. Learning Objective #1: Rechecking BP in patients with uncontrolled HTN leads to decreased BP readings in clinic. Learning Objective #2: Rechecking BP in clinic is not associated with a reduction in antihypertensive medications in patients with uncontrolled HTN

Disparities in Use of Virtual Primary Care During the Early COVID-19 Pandemic

Background: The COVID-19 pandemic increased the use of virtual health care. However, certain factors may disparately affect some patients\u27 utilization of virtual care. Associations between age, racial categories (White or Black), and socioeconomic disadvantage were evaluated during the early COVID-19 pandemic. Methods: This cross-sectional retrospective study included adult patients with virtual or in-person primary care encounters at a large, midwestern hospital system with widespread urban and suburban offices between March 1, 2020, and June 30, 2020. Virtual visits included synchronous video and telephone visits and asynchronous patient portal E-visits. Chi-squared tests and multivariable logistic analysis assessed the associations between ages and racial categories, and area deprivation index with the use of virtual versus in-person primary care. Results: Of 72,153 patient encounters, 43.0% were virtual visits, 54.6% were White patients, and 45.4% were Black. Across equivalent age ranges, black patients were slightly less likely to utilize virtual care than similarly aged White patients, but not consistently across virtual modalities. Women were more likely to use virtual care across all modalities, and individuals \u3e65 years were more likely to use telephone visits and less likely to use video and E-visits, regardless of race. Patients residing in areas with the greatest socioeconomic advantage were more likely to utilize video and E-visits. Conclusions: Differential patterns of utilization emerged across racial categories and age ranges, suggesting that racial disparities are exacerbated depending upon patient age and mode of utilization

Diagnosis of Parkinson's disease on the basis of clinical and genetic classification: a population-based modelling study.

BackgroundAccurate diagnosis and early detection of complex diseases, such as Parkinson's disease, has the potential to be of great benefit for researchers and clinical practice. We aimed to create a non-invasive, accurate classification model for the diagnosis of Parkinson's disease, which could serve as a basis for future disease prediction studies in longitudinal cohorts.MethodsWe developed a model for disease classification using data from the Parkinson's Progression Marker Initiative (PPMI) study for 367 patients with Parkinson's disease and phenotypically typical imaging data and 165 controls without neurological disease. Olfactory function, genetic risk, family history of Parkinson's disease, age, and gender were algorithmically selected by stepwise logistic regression as significant contributors to our classifying model. We then tested the model with data from 825 patients with Parkinson's disease and 261 controls from five independent cohorts with varying recruitment strategies and designs: the Parkinson's Disease Biomarkers Program (PDBP), the Parkinson's Associated Risk Study (PARS), 23andMe, the Longitudinal and Biomarker Study in PD (LABS-PD), and the Morris K Udall Parkinson's Disease Research Center of Excellence cohort (Penn-Udall). Additionally, we used our model to investigate patients who had imaging scans without evidence of dopaminergic deficit (SWEDD).FindingsIn the population from PPMI, our initial model correctly distinguished patients with Parkinson's disease from controls at an area under the curve (AUC) of 0·923 (95% CI 0·900-0·946) with high sensitivity (0·834, 95% CI 0·711-0·883) and specificity (0·903, 95% CI 0·824-0·946) at its optimum AUC threshold (0·655). All Hosmer-Lemeshow simulations suggested that when parsed into random subgroups, the subgroup data matched that of the overall cohort. External validation showed good classification of Parkinson's disease, with AUCs of 0·894 (95% CI 0·867-0·921) in the PDBP cohort, 0·998 (0·992-1·000) in PARS, 0·955 (no 95% CI available) in 23andMe, 0·929 (0·896-0·962) in LABS-PD, and 0·939 (0·891-0·986) in the Penn-Udall cohort. Four of 17 SWEDD participants who our model classified as having Parkinson's disease converted to Parkinson's disease within 1 year, whereas only one of 38 SWEDD participants who were not classified as having Parkinson's disease underwent conversion (test of proportions, p=0·003).InterpretationOur model provides a potential new approach to distinguish participants with Parkinson's disease from controls. If the model can also identify individuals with prodromal or preclinical Parkinson's disease in prospective cohorts, it could facilitate identification of biomarkers and interventions.FundingNational Institute on Aging, National Institute of Neurological Disorders and Stroke, and the Michael J Fox Foundation