From the Chief Residents

As your Chief Residents, we would like to take a moment to express our heartfelt congratulations to each and every one of you on your incredible scholarly achievements over the past year. We have been impressed by the quality and diversity of your scholarly work. From interdisciplinary clinical research projects that have been submitted to journals across numerous subspecialties, to contributions to the Health Equity and Quality Improvement Summit, you have all demonstrated a passion for excellence and a commitment to advancing the field of medicine. We are grateful for the opportunity to have worked alongside you and to have witnessed your growth and development as physician scholars. We are confident that your accomplishments will serve as a source of inspiration for future generations of medical professionals. Once again, congratulations on your achievements, and we wish you all the best in your future endeavors

More Social Needs Endorsed by Caregivers of Young Children Experiencing Everyday Discrimination

Background: Both discrimination and social needs are underlying risk factors for poor health outcomes; however, there are no studies looking at how feelings of discrimination impact reporting of social needs in the pediatric health care setting. Objective: To compare caregiver report of social needs and desire for help addressing social needs in the pediatric primary care setting based on respondents’ experiences with discrimination. Methods: We conducted a cross-sectional study of caregivers of children aged 2-5 in an urban primary care setting. Caregivers completed a tool to screen for 15 social needs and desire for help to address these needs, with in-person assistance available. The tool was adapted based on qualitative data with this same population and included items from the PHQ-2, 2-item food insecurity screener, and WE CARE survey. The short version of the “Everyday Discrimination Scale” was also completed, and caregivers were categorized as experiencing everyday discrimination if they responded “rarely”, “sometimes”, or “often” on any of 5 types of discrimination. If caregivers experienced everyday discrimination, they were also asked about perceived basis for discrimination. T-tests were conducted to compare the number of reported social needs and number of needs for which a caregiver desired help between groups based on experience of everyday discrimination and type of discrimination. Results: One hundred seventy-eight caregivers (94% mothers, mean age 32) of diverse racial and ethnic backgrounds (29% white, 61% black; 10% Hispanic) completed the screening tool. Sixty-seven percent had public insurance, and 35% were from households with an annual income below $20,000. Fifty-three percent of caregivers reported everyday discrimination, especially in regards to being treated with less respect and receiving poorer service in stores and restaurants (Figure 1) and most commonly on the basis of race (48%), gender (38%), and age (31%). Both caregivers who endorsed everyday discrimination in general, and those endorsing discrimination specifically by gender and age, reported a significantly higher number of social needs and number of social needs for which they wanted help (Table 1). Conclusions: In an urban population of mostly young Black mothers, the majority endorsed feeling some degree of everyday discrimination. Despite this, caregivers who endorsed feelings of discrimination, especially because of their gender and age, reported more social needs and a greater desire for help addressing these needs. This suggests that caregivers feel comfortable reporting sensitive social needs in the context of a child’s healthcare setting even though they may experience everyday discrimination. These findings may also suggest an association between experienced discrimination and social needs, with both potentially influenced by similar sociodemographic factors

Improving Advanced Care Planning Discussion and Documentation

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively

The Socioeconomic Impact on Presentation and Clinical Course of Celiac Disease

Introduction Celiac Disease (CD) is a chronic autoimmune condition primarily affecting the small intestine. CD is triggered by ingestion of gluten and the only effective treatment for CD involves strict and lifelong elimination of dietary gluten. Compliance with the gluten free diet (GFD) relies on purchasing gluten-free foods. Studies have shown the cost of a GFD to be from 76% to 518% more expensive than gluten containing counterparts. Because of this, the economic burden that CD patients face may be substantial, placing these patients at high risk for dietary neglect. Financial limitation aside, GFD availability also varies by differing neighborhoods, resulting in economic food deserts across the country.https://jdc.jefferson.edu/gastrohepposters/1006/thumbnail.jp

Dynamic sampling schemes for optimal noise learning under multiple nonsmooth constraints

We consider the bilevel optimisation approach proposed by De Los Reyes, Sch\"onlieb (2013) for learning the optimal parameters in a Total Variation (TV) denoising model featuring for multiple noise distributions. In applications, the use of databases (dictionaries) allows an accurate estimation of the parameters, but reflects in high computational costs due to the size of the databases and to the nonsmooth nature of the PDE constraints. To overcome this computational barrier we propose an optimisation algorithm that by sampling dynamically from the set of constraints and using a quasi-Newton method, solves the problem accurately and in an efficient way

Transfer of LacZ Marker Gene to the Meniscus

Background: Lesions in the avascular two-thirds of the meniscus do not heal well and are of concern clinically. Various growth factors promote the synthesis of matrix by meniscal cells and thus have the potential to augment healing. However, their clinical application is severely hindered by problems with delivery. An attractive approach to overcoming such problems is to transfer genes that encode the growth factors in question to the site of the injury. As a prelude to this, we evaluated methods for delivering genes to the meniscus. Methods: Gene transfer was evaluated in vitro and in vivo with a lacZ marker gene, which expresses the enzyme β-galactosidase. Two types of vectors were tested: an adenovirus and a retrovirus. Monolayers of lapine, canine, and human meniscal cells, as well as intact lapine and human menisci, were used for the in vitro studies. Lesions were created in the menisci of rabbits and dogs for the in vivo studies. Gene transfer to the sites of the experimental meniscal lesions in vivo was accomplished in two ways. In the lapine model, a suspension of adenovirus carrying the lacZ marker gene was mixed with whole blood and the clot was inserted into the lesion. In the canine model, retrovirally transduced allogenic meniscal cells carrying the lacZ marker gene were embedded in collagen gels and transferred to the defects. The animals were killed at various time-points, and gene expression was evaluated by histological examination of sections stained with 5-bromo-4-chloro-indolyl-β-D-galactose (X-gal), from which a blue chromagen is released in the presence of β-galactosidase. Results: Monolayer cultures of lapine, canine, and human meniscal cells were susceptible to genetic transduction by both adenoviral and retroviral vectors. In vitro gene transfer to intact human and lapine menisci proved possible both by direct, adenoviral, delivery and indirect, retroviral, delivery. Gene expression persisted for at least twenty weeks under in vitro conditions. With regard to the in vivo studies, gene expression persisted within the clot and in some of the adjacent meniscal cells for at least three weeks in the lapine defect model. In the canine defect model, gene expression persisted within the transplanted, transduced meniscal cells for at least six weeks. Conclusions: It is possible to transfer genes to sites of meniscal damage and to express them locally within the lesion for several weeks. Clinical Relevance: Healing of the avascular portion of the meniscus may be improved by the transfer of genes encoding the appropriate growth factors. To our knowledge, the present report is the first to describe methods for transferring genes to the meniscus. When used in conjunction with the appropriate growth-factor genes, these techniques should help to provide the basis for potential alternative treatment options for meniscal lesions. Additional studies are needed to determine whether these techniques will lead to improved healing of meniscal defects in vivo

Social sensing of high-impact rainfall events worldwide: a benchmark comparison against manually curated impact observations

This is the final version. Available on open access from the European Geosciences Union via the DOI in this recordCode and data availability: The Python code is available on request in a private GitHub repository (https://github.com/seda-lab/social_sensing, last access: 17 December 2020) (Seda-lab, 2020), which can be made available on request. Data used in this study were collected using the Twitter API. Due to Twitter's policy on redistributing Twitter content (https://developer.twitter.com/en/developer-terms/more-on-restricted-use-cases, last access: 17 December 2020) (Twitter, 2020), the tweet data cannot be made publicly available but can be provided on request in the form of tweet IDs which can be rehydrated with the tweet content by the requester using the Twitter API.mpact-based weather forecasting and warnings create the need for reliable sources of impact data to generate and evaluate models and forecasts. Here we compare outputs from social sensing – analysis of unsolicited social media data, in this case from Twitter – against a manually curated impact database created by the Met Office. The study focuses on high-impact rainfall events across the globe between January–June 2017. Social sensing successfully identifies most high-impact rainfall events present in the manually curated database, with an overall accuracy of 95 %. Performance varies by location, with some areas of the world achieving 100 % accuracy. Performance is best for severe events and events in English-speaking countries, but good performance is also seen for less severe events and in countries speaking other languages. Social sensing detects a number of additional high-impact rainfall events that are not recorded in the Met Office database, suggesting that social sensing can usefully extend current impact data collection methods and offer more complete coverage. This work provides a novel methodology for the curation of impact data that can be used to support the evaluation of impact-based weather forecasts

Predicting treatment outcome for incompetent defendants

This studv examined the ~rediction of outcome in a sample of defendants hospitalized i o r treatment of incompetency. Defendants' demog;aphic characteristics and scores on 18 scales of the Computer-Assisted Determination of Competency to Proceed instrument (CADCOMP) were used to predict competency restoration and length of stay (LOS). During the period of study, almost 90 percent of the defendants were restored to competency after a mean stay of over 280 days. Demographic characteristics were unrelated to outcome. Several CADCOMP scales, including two scales measuring psycholegal ability and one measuring psychopathology, were correlated with both outcome criteria. Discriminant analysis using the CADCOMP scales accurately classified 76.7 percent of the defendants into short and long stay groups. Although promising, the findings are nevertheless consistent with prior research in suggesting that examiners should exercise caution in providing feedback to the courts concerning competency restoration and the period of time needed for treatment

Evolutionary Reduction of the First Thoracic Limb in Butterflies

Members of the diverse butterfly families Nymphalidae (brush-footed butterflies) and Riodinidae (metalmarks) have reduced first thoracic limbs and only use two pairs of legs for walking. In order to address questions about the detailed morphology and evolutionary origins of these reduced limbs, the three thoracic limbs of 13 species of butterflies representing all six butterfly families were examined and measured, and ancestral limb sizes were reconstructed for males and females separately. Differences in limb size across butterflies involve changes in limb segment size rather than number of limb segments. Reduction of the first limb in both nymphalids and riodinids appears particularly extensive in the femur, but the evolution of these reduced limbs is suggested to be a convergent evolutionary event. Possible developmental differences as well as ecological factors driving the evolution of reduced limbs are discussed

Social sensing of high-impact rainfall events worldwide: a benchmark comparison against manually curated impact observations

Impact-based weather forecasting and warnings create the need for reliable sources of impact data to generate and evaluate models and forecasts. Here we compare outputs from social sensing – analysis of unsolicited social media data, in this case from Twitter – against a manually curated impact database created by the Met Office. The study focuses on high-impact rainfall events across the globe between January–June 2017. Social sensing successfully identifies most high-impact rainfall events present in the manually curated database, with an overall accuracy of 95 %. Performance varies by location, with some areas of the world achieving 100 % accuracy. Performance is best for severe events and events in English-speaking countries, but good performance is also seen for less severe events and in countries speaking other languages. Social sensing detects a number of additional high-impact rainfall events that are not recorded in the Met Office database, suggesting that social sensing can usefully extend current impact data collection methods and offer more complete coverage. This work provides a novel methodology for the curation of impact data that can be used to support the evaluation of impact-based weather forecasts