A Cheerio Tastes Like the Body of Christ: A Memoir

Schwab, Steven, M.A., Summer 2008 Integrated Arts and Education A Cheerio Tastes Like the Body of Christ: A Memoir Chair: Dr. James Kriley, Committee member: Dorothy Morrison Committee member: Karen Kaufmann This memoir documents my personal spiritual journey from childhood to present day. I have selected six events from my history that illustrate this theme. The memoir describes my family’s strong connection to the Roman Catholic religion, my participation in following the dogma of the Church, a rejection of the religion and the search for a philosophy that satisfied my needs. The settings for the pieces are in Idaho, Oregon, Italy, Sudan, Guatemala, and Montana

2012 Poll of Emerging Adults [Thriving, Struggling & Hopeful]

Report for the 2012 Clark University Poll titled Emerging Adults: Thriving, Struggling & Hopeful . A great deal of attention—most of it negative—is being paid to emerging adults (ages 18-29) in American society. We frequently hear that they are lazy, selfish, poorly educated, and both reluctant and ill-equipped to take on the responsibilities of adult life. We are told that they are, essentially, doomed: They are sure to have a less prosperous and enjoyable life than their parents did, given the depths of the 2008 recession that occurred just as they were trying to enter the job market and build a career. We are warned that they are clinging to an “extended adolescence” and never, ever want to grow up. But are all these negative stereotypes actually true? With the first Clark University Poll of Emerging Adults (Worcester, Mass.), we intend to contribute data that can cast light on a wide range of questions regarding today’s emerging adults. The Clark University Poll of Emerging Adults is based on 1,029 interviews of 18- to 29-year-olds, conducted by Purple Strategies, a survey research firm, from April 16 to April 26, 2012. Three methods were used to obtain participants: 529 interviews were conducted via the Internet, 400 via cell phone, and 100 via landline telephone. Description from the Preface and Methodology sections of the 2012 Clark University Poll

2014 Poll of Established Adults Ages 25-39 [Becoming Established Adults: Busy, Joyful, Stressed -- and Still Dreaming Big]

Report for the 2014 Poll of Established Adults Ages 25-39 titled Becoming Established Adults: Busy, Joyful, Stressed -- and Still Dreaming Big . So what happens after emerging adulthood? Many emerging adults feel like they are not entirely adult. So when does the feeling of reaching adulthood become firmly established? Emerging adults are highly optimistic and hopeful about the shape their adult lives will take. So how do they feel about their lives once they have chosen a career path and a marriage partner? At ages 18-29 they enjoy the freedom and the sense of wide-open possibilities that come with being an emerging adult, even as they also experience a substantial amount of anxiety. Do they lament the loss of freedom once they reach their thirties and make commitments to others? Does their anxiety wane once they are more securely established in a career path? These were the kinds of questions we sought to answer in the 2014 Clark University Poll of Established Adults, ages 25-39. We chose the 25-39 age range rather than 30-39 because people make the transition to an established adulthood at different points. The Clark University Poll of Established Adults entailed interviews with 1,011 people ages 25-39. The data collection was conducted by Purple Strategies, a professional survey research firm, from April 12 to May 12, 2014. Participants were contacted via three methods: cell phones (107), landlines (140), and the Internet (764). Description from the Preface and Methodology sections of the 2014 Clark University Poll. An infographic summarizing the 2014 Poll of Established Adults has been made available as a supplemental file

FDG-PET Lacks Sufficient Sensitivity to Detect Myxoid Liposarcoma Spinal Metastases Detected by MRI

Purpose. To document a case of myxoid liposarcoma in which PET scan was less sensitive than MRI in detecting spinal metastasis. Materials and Methods. The case of a 65-year-old female with a history of myxoid liposarcoma (MLS) of the thigh resected 5 years previously and now presenting with low back pain is presented. Her medical oncologist ordered an FDG-PET scan to evaluate distant recurrence. Subsequently, an MRI of her spine was obtained by her surgeon. Results. The FDG-PET scan was obtained 1 week prior to the MRI, and it did not show increased glucose uptake in the spine. Her MRI did show increased signal intensity in her lumbar spine. CT needle biopsy confirmed the lesion to be metastatic MLS. Conclusion. FDG-PET scans are utilized to detect distant recurrence of cancerous lesions. Myxoid liposarcoma has a unique propensity to metastasize to the spine. Previous reports have documented the unreliability of bone scintigraphy to diagnose these metastases. Our report demonstrates that FDG-PET may also lack the sensitivity needed to detect these lesions. We advocate total spine MRI when screening for metastases in this population when they present with back pain

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

Background: Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool. Questions/Purposes: We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra- and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model. Methods: We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model. Results: Intra- and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum. Conclusions: Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges. Level of Evidence: Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidenc

The Utility of Non-Specific ECG Findings in the Setting of Low High-Sensitivity Cardiac Troponin Levels

Objective: Our objective was to assess the relationship between non-specific ischemic electrocardiogram (nsi-ECG) findings and the occurrence of major adverse cardiac events (MACE) within a 30-day timeframe among patients in the Emergency Department (ED) with low high-sensitivity cardiac troponin (hs-cTnI) levels. Methods: We conducted a secondary analysis of the RACE-IT trial, a randomized trial performed across 9 EDs from July 2020 through March 2021 that looked at the effectiveness of hs-cTnI in evaluating the risk for acute myocardial infarction (AMI). Our study assessed the association between nsi-ECG findings (left bundle branch block, ST-segment changes, or T-wave inversions) and 30-day MACE (death, AMI, heart failure hospitalization, or coronary revascularization) in patients who had AMI ruled out based on low hs-cTnI levels. Results: 16,606 patients were included in this analysis. Combined, there were 3345 patients with potentially ischemic ECG findings. Thirty-day death or AMI occurred in 66 patients. Death within 30 days occurred in 47 patients, of whom 38 were adjudicated as non-cardiac. There was no difference in MACE events based on potentially ischemic findings (OR 1.38, 95% CI 0.79 - 2.39, p=0.257). The presence of ST-segment changes, however, had a trend towards greater odds of MACE (OR 2.53, 95% CI 0.92 - 6.99). Conclusion: Non-specific ischemic ECG findings in the setting of low hs-cTnI are not associated with greater MACE events within 30 days of discharge for patients with possible AMIs. The use of nsi-ECG findings should be considered in the context of hs-cTnI levels when evaluating risk for coronary disease

Tissue microarray immunohistochemical detection of brachyury is not a prognostic indicator in chordoma.

Brachyury is a marker for notochord-derived tissues and neoplasms, such as chordoma. However, the prognostic relevance of brachyury expression in chordoma is still unknown. The improvement of tissue microarray technology has provided the opportunity to perform analyses of tumor tissues on a large scale in a uniform and consistent manner. This study was designed with the use of tissue microarray to determine the expression of brachyury. Brachyury expression in chordoma tissues from 78 chordoma patients was analyzed by immunohistochemical staining of tissue microarray. The clinicopathologic parameters, including gender, age, location of tumor and metastatic status were evaluated. Fifty-nine of 78 (75.64%) tumors showed nuclear staining for brachyury, and among them, 29 tumors (49.15%) showed 1+ (<30% positive cells) staining, 15 tumors (25.42%) had 2+ (31% to 60% positive cells) staining, and 15 tumors (25.42%) demonstrated 3+ (61% to 100% positive cells) staining. Brachyury nuclear staining was detected more frequently in sacral chordomas than in chordomas of the mobile spine. However, there was no significant relationship between brachyury expression and other clinical variables. By Kaplan-Meier analysis, brachyury expression failed to produce any significant relationship with the overall survival rate. In conclusion, brachyury expression is not a prognostic indicator in chordoma

Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma.

Study Design:Retrospective cohort study. Objectives:(1) To assess patient-reported outcomes-physical function, pain, and quality of life-in patients who underwent resection of a mobile spine chondrosarcoma. (2) To assess complications (90 days), readmissions, reoperations, oncological outcomes, and neurologic status. Methods:Thirty-three patients with spinal conventional chondrosarcoma resection between 1984 and 2014 at one hospital were included. The primary outcome measures were-minimally 6 months after surgery-the EuroQol 5 Dimensions (EQ5D), PROMIS-Physical Function, PROMIS-Pain Intensity, and Oswestry (ODI) Disability Index, or Neck (NDI) Disability established in 14 out of 20 alive (70.0%) patients. Complications, readmission, reoperations, oncological outcomes, and neurological status were reported for the complete cohort of 33 patients. Results:After spine chondrosarcoma resection, patients (n = 14) reported worse physical function (median 43, range 22-61, P = .026), worse quality of life (median EQ5D 0.70, range 0.04-1, P = .022), and comparable pain intensity (median 47, range 31-56, P = .362) when compared with US general population values. The median NDI/ODI was 25 (range 0-72) indicating mild to moderate disability. Patients undergoing reoperation had worse patient-reported outcomes than those who did not. Eighteen (55.5%) out of 33 patients suffered complications (90 days), 14 (42.4%) had unplanned readmission, and 13 (39.4%) underwent reoperation. Intralesional resection was associated with increased readmission, reoperation, and recurrence rate. Conclusions:Chondrosarcoma affects quality of life and physical function and its treatment frequently results in complications and reoperations. Our findings can be used to inform future patients about expected outcomes

Pelvic Morphology Differs in Rotation and Obliquity Between Developmental Dysplasia of the Hip and Retroversion

Background: Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality. Questions/Purposes: We asked: How does DDH and retroversion differ with respect to rotation and coronal obliquity as measured by the pelvic width index, anterior inferior iliac spine (AIIS) sign, ilioischial angle, and obturator index? And what is the predictive value of each variable in detecting acetabular retroversion? Methods: We reviewed AP pelvis radiographs for 51 dysplastic and 51 retroverted hips. Dysplasia was diagnosed based on a lateral center-edge angle of less than 20° and an acetabular index of greater than 14°. Retroversion was diagnosed based on a lateral center-edge angle of greater than 25° and concomitant presence of the crossover/ischial spine/posterior wall signs. We calculated sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for each variable used to diagnose acetabular retroversion. Results: We found a lower pelvic width index, higher prevalence of the AIIS sign, higher ilioischial angle, and lower obturator index in acetabular retroversion. The entire innominate bone is internally rotated in DDH and externally rotated in retroversion. The areas under the ROC curve were 0.969 (pelvic width index), 0.776 (AIIS sign), 0.971 (ilioischial angle), and 0.925 (obturator index). Conclusions: Pelvic morphology is associated with acetabular pathomorphology. Our measurements, except the AIIS sign, are indirect indicators of acetabular retroversion. The data suggest they can be used when the acetabular rim is not clearly visible and retroversion is not obvious. Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidenc