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... DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Marian University Leighton School of Nursing Doctor of Nursing Practice Final Project Report for Students Graduating in May 2022 Disproportionate Impact of COVID-19 on BIPOC Communities Frederich L. Walker II Marian University Leighton School of Nursing Chair: Marie Goez, DNAP, CRNA (Signature) Committee Member(s): Christina Pepin, PhD, RN, CNE (Signature) Date of Submission: October 20, 2021 1 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 2 Table of Contents Abstract....4 Introduction..5 Background..5 Problem Statement ..7 Organizational Gap Analysis of Project ..7 Review of Literature ...7 Search Methodology8 History and Healthcare8 Socioeconomic Factors......10 Comorbidities and Culture.11 Sociocultural Factors.....11 Biological Factors......13 Theoretical Framework..13 Goals, Interventions and Outcomes...14 Project Design/Methods.14 Ethical Considerations..15 Data Analysis and Results.15 Discussion. 16 Conclusion.17 References..19 Appendix....21 Appendix A....22 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 3 Appendix B22 Appendix C....29 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 4 Abstract COVID-19 is an infectious respiratory illness that has taken hundreds of thousands of lives and infected millions more in the United States. Unfortunately, Black Indigenous and People of Color (BIPOC) communities are over-represented in deaths and infections. Healthcare disparities are multifactorial, and dependent on a complex interplay of demographic, socioeconomic, cultural, genetic, and historical variables. This education was given to CRNAs to educate them on the different issues contributing to the disproportionate impact of COVID-19 on BIPOC communities. Healthcare workers who on the front lines of this pandemic are not routinely educated by employers of this social issue, which leads to a lack of education for their patients. A lack of knowledge of one's risk factors has negative effects on more a vulnerable part of the population attempting to mitigate exposure risk to COVID-19. In addition, these communities of color are shown to have decreased access to healthcare, overrepresentation in essential jobs, reduced ability to work from home which leads to the reduced ability to social distance. DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 5 Disproportionate Impact of COVID-19 on BIPOC Communities This project is submitted to the faculty of Marian University Leighton School of Nursing as partial fulfillment of degree requirements for the Doctor of Nursing Practice, Nurse Anesthesia track. As of June 2021, according to the Center for Disease Control (CDC): American Indians are 3.3x more likely to get infected and 2.4x more likely to die; Black Americans are 2.9x more likely to get infected and 2.0x more likely to die, and Hispanic Americans and Asian Americans are 2.8 and 1.1x more likely to get infected with COVID-19 than Caucasian Americans. Black Americans were half of all COVID-19 deaths in Alabama (52%), Georgia (51%), Louisiana (59%), Mississippi (66%), and the District of Columbia (75%) (Yehia et al., 2020). This pattern is also seen in the United Kingdom, where 14% of individuals infected with COVID-19 are Asian and 12% are Black, where the Asian population make up less than 7% of the population, and the Black population is 3% (CDC, 2020). Background According to the Centers for Disease Control and Prevention (2021), American Indians, Asian Americans, African Americans, and Hispanic Americans have respectively 3.3x, 1.0x, 2.9x, and 2.8x, higher infection rates than Caucasian Americans (Centers for Disease Control and Prevention, 2021). It is clear that these communities currently face an increased burden of disease and COVID death. In addition to the massive number of people who have lost their lives, the increased rates of hospitalization place an economic strain on our patients, healthcare system, and taxpayers. The average cost of an uninsured or out-of-network provider for COVID-19 hospitalization is $73,300 (Fair health, 2021). These staggering statistics cannot possibly convey the devastating loss of human life that is represented and immensely disproportionate among BIPOC communities. DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 6 Healthcare disparities go back hundreds of years in the United States and exist because of a complex interplay of socioeconomic, historical, environmental, and political factors. As a result, BIPOC community members are proven to have decreased trust in the medical system, leading to fewer people of color (POC) regularly visiting a primary care physician and engaging in primary prevention techniques. POC are overrepresented in essential jobs, such as service and transportation, making social distancing and working from home impossible and therefore increasing their risk for exposure to COVID-19. Additionally, BIPOC community members have higher rates of comorbidities, language barriers, crowded living situations, and more environmental pollution, which further increasing exposure risk (Hooper et al., 2020). Amid this pandemic, accurate information is challenging to decipher from anecdotal information. In the hospital, social distancing guidelines have limited learning opportunities for healthcare staff by reducing the occurrence of staff meeting and conferences. There needs to be increased awareness among nurses to provide culturally intelligent care and provide patients with the proper education to mitigate risk factors and close the healthcare disparities gap. Patientcentered care is a cornerstone of practicing anesthesia, and this same framework of individualized care must be applied to our patients at the highest risk of COVID-19 hospitalization and death. Research shows that when compared to anesthesiologists, CRNAs care for a higher percentage of Medicaid eligible and low-income populations. This means that because CRNAs are more likely to provide anesthesia for populations at higher risk for COVID19 they are an ideal healthcare population to disseminate education to regarding their vulnerable patient population (Lao et al., 2015). DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 7 Problem Statement What do CRNAs who care for COVID-19 patients know about the disproportionate impact of COVID-19 on BIPOC community members in the hospital as of 2021? Assessing the CRNAs knowledge of COVID-19 and the populations it unequally affects is essential because they provide insights into knowledge gaps. It is unknown what practicing CRNAs know about COVID-19 hospitalizations and mortality rates among BIPOC communities and the associated risk factors among those communities that contribute to those disparities. There needs to be increased education and training for CRNAs to facilitate culturally intelligent, equitable care and provide patients with the right education to mitigate risk factors and close the healthcare disparities gap. Organizational Gap Analysis of Project Continuing education is an ongoing aspect of healthcare certification. Throughout this pandemic, hospital employers have provided clinical and ancillary staff education regarding the many protocols and developments related to COVID-19. However, there is little education regarding how COVID-19 affects different communities differently. This education is particularly beneficial for CRNAs because they are the primary anesthesia providers for BIPOC communities and Medicaid-eligible recipients. Review of Literature COVID-19 is a viral infectious agent that has taken over four and a half million lives worldwide and infected hundreds of millions. History shows that socially disadvantaged groups are the most vulnerable in times of crisis, leading to more infections, deaths, and worse outcomes (Penner et al., 2013). COVID-19 is no different in the sense that BIPOC and individuals of lower socioeconomic status are overrepresented in infection rates, hospitalizations, and deaths. DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 8 Search Methodology PubMed and Google Scholar were the databases used for obtaining the necessary literature. The literature review's exclusion criteria were articles older than five years, apart from any landmark studies. Peer reviewed articles in English were used in this study. The Boolean phrases used to find literature in PubMed and Google Scholar are as follows; coronavirus AND race, COVID-19 impact on minorities, Healthcare AND race, Disproportionate impact of COVID-19 Health care disparities AND ethnicity, COVID-19 death AND ethnicity. 40 articles were screened for this study and 13 were used. History and Healthcare The United States has a deleterious history regarding BIPOC community members and health care. In 1808 the United States banned the importation of slaves from Africa; however, slaves were still allowed to be sold and transported around the United States. Death rates and infant mortality were so high for enslaved people, slave owners needed a way to maintain their enslaved workforce without importing slaves from overseas. The solution was to force enslaved women to reproduce and find a way to decrease the infant mortality rate. This ushered in a new area of violence, trauma, and surgical innovation. Part of the solution was to force enslaved women, often as young as 13 years old, to become pregnant. At this time physicians began experimenting on pregnant enslaved women without anesthesia to develop surgical techniques. Dr. Marion Sims, now identified as the father of modern gynecology, had no formal training and was one of the people who performed these horrific acts of violence against enslaved women. He perpetuated the notion that Black people did not feel pain. This notion that Black people did not feel pain was established in the medical community and was formally taught by physicians well into the 20th century. It was claimed that Black people bore a "Negro disease," DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 9 which made them have physically different characteristics such as thicker skulls and less sensitive nerve endings that are more resistant to pain and injury. This racist myth led to inaccurate and harmful assumptions regarding how much anesthesia Black people needed and still results in Black people's pain being systemically undertreated in the hospital today (Hoffman et al., 2016). Additional trauma that the Black community suffered at the hands of trusted medical professionals occurred from1932 to 1972, when the Public Health Service pretended to treat infected members of the Black community with syphilis and intentionally withheld the lifesaving treatment to better understand the disease process. At the time, this study had such a detrimental impact that it decreased the national life expectancy of Black men by 1.5 years (Alsan & Wanamaker, 2018). From the 1920s to the1980s, hundreds of thousands of Black women, Indigenous Americans, and disabled White people were victims of a government-funded eugenics program where medical students would perform hysterectomies on "undesirable" individuals. This atrocity was later named "The Mississippi appendectomies" because the victims believed they were having minor procedures such as an appendectomy. During a six-year timespan in the 1970s, 25% of Indigenous American women of childbearing age were forcibly sterilized (Matthew, 2015). These are just a few examples of the horrific crimes that the BIPOC community have suffered from at the hands of medical professionals, and it comes as no surprise that these communities now. have less trust in physicians and the healthcare system. As a result, BIPOC community members are less likely to engage in health promotion activities and are more likely to seek treatment later in an illness's progression (Penner et al., 2013). DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 10 Socioeconomic Factors COVID-19 presents unique challenges for BIPOC community members who are socioeconomically disadvantaged. For example, people of color live in more urban and densely populated areas, making social distancing more difficult. Haywood (2020), Laurenchin (2020), Hooper (2020), and Kirby (2020) all agree that POC make up a more significant percentage of service industry jobs were working from home is impossible. Additionally, multigenerational families living in the same household are more common in Black, Hispanic, and Asian households. Multigenerational households combine individuals with different levels of exposure risk. An adolescent member of the family may go to school or various events, the parents go to work, and everyone comes home and potentially infects the household's most vulnerable members, the very young and the elderly. Additionally, Lower socioeconomic households taking time off work, paying copays, and health insurance premiums contribute less time for health promotion behaviors (Hooper et al., 2020). Systemic social challenges have also impacted where BIPOC individuals can obtain housing. Redlining is the federal housing administration's systematic denial of home loans to individuals deemed as high risk. The term comes from mortgage lenders drawing red lines on a map around neighborhoods where BIPOC communities predominantly resided, making it so these communities were deemed high risk and denied access to home loans. Redlining took place legally from 1945-1959 but its impact is still felt today. It has been found that individuals in these neighborhoods suffer from higher rates of chronic diseases which are risk factors for poor outcomes from COVID-19. It has also been found that individuals living in historically redlined neighborhoods, primarily BIPOC, continue to suffer from decreased life expectancy DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 11 rates that average 3.6 years below and up to 14.7 years below their non-redlined counterparts (Richardson et al., 2020). Socially disadvantaged communities have fewer health services options, less social mobility, and greater reliance on government programs such as Medicaid. BIPOC individuals compromise half of the population in metropolitan cities around the United States. These densely populated areas have unique risk factors associated with COVID-19, such as poorer air quality and public transportation dependence. However, Toby (2020) and Hooper (2020) agree that the disease burden on communities of color is not due to socioeconomic factors alone. Comorbidities and Culture BIPOC individuals have more health comorbidities, such as obesity, hypertension, cardiovascular disease, and renal disease, contributing to increased hospitalization and mortality relative to their overall population (Toby, 2020; Hooper, 2020; Haywood, 2020; Abuelgasim, 2020). In a retrospective chart review by Price-Haywood (2020) comprising of 3626 patients in Louisiana, 76.9% of hospitalized patients were Black, and 70.6% of COVID-19 deaths were Black. This study also showed that over 80% of patients requiring mechanical ventilation were Black, even though the length of hospital stay was similar across all racial groups. Although racial differences in rates and mortality are multifactorial, and encompass various economic, demographic, and social factors, Haywood (2020) and Penner (2020) agree that POC seeks treatment later, ultimately contributing to their morbidity and mortality. Sociocultural Factors It is likely that there are also cultural and socioeconomic barriers influencing BIPOC individuals to seek treatment later in COVID-19s disease progression. As stated previously, BIPOC communities have a history of distrust and betrayal from the scientific and medical DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 12 community, leading to generations of distrust of physicians and the healthcare system. According to Penner (2013), minorities are more likely to have non-minority physicians leading to "racially discordant" medical interactions where patients are more reluctant to use preventive health services. Cultural identity is an individual's self-perception that ties them to their ethnicity, religion, or nationality (Penner et al., 2013). Penner (2013) describes behaviors that are synonymous with an individual's culture as "in-group" behaviors and the thoughts, beliefs, and actions of other cultures referred to as "out-group" behaviors. To maintain cultural identity, people mirror their in-group behaviors. According to a study by Penner (2013), Black participants viewed health promotion activities like exercising, getting enough sleep, and a balanced diet are viewed as out-group behaviors compared to middle-class while White participants who viewed these same activities as in-group behaviors. Individuals can often see the differences among their cultures but often see the other cultures as the same (Penner et al., 2013). This mindset leads to stereotyping members who are not of the same ethnic, social class, or religion. Stereotyping influences physicians' perceptions of patients and patient adherence expectations, which impacts a physicians treatment decisions and recommendations. It is shown that BIPOC individuals receive less aggressive medical treatment for the same diagnosis and fewer opioid analgesics in the emergency room than White patients (Penner et al., 2013). Stereotyping had played a role in the early stages of COVID-19 when a young Cameroonian student was infected with COVID-19 in China, becoming the first African infected with the virus. After his recovery, numerous myths from social media were spread throughout the Chinese medical community and internationally, claiming Black immunity to COVID-19. Stereotyping based on a single individual is a dangerous example of in-group members seeing DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 13 out-group members as homogenous. A similar situation occurred during the AIDS epidemic, where the disease was characterized as only plaguing White gay men. This misinformation led to fewer prevention strategies by Black and Hispanic Americans, which ultimately led to increased AIDS infection rates among Black and Hispanic Americans (Laurencin & McClinton, 2020). Biological Factors Biological factors within different ethnicities can alter an individual's response to an inflammatory reaction independent of comorbidities (Abuelgasm, 2020). For example, Abuelgasm (2020) shows that African people have an increased inflammatory reaction when exposed to infectious pathogens. Increased inflammatory states may serve as an adaptive characteristic for a myriad of infectious agents; however, in the pathophysiological process of COVID-19, the cytokine storm causes morbidity in severe cases. Additionally, the angiotensinconverting enzyme-2 (ACE2) is an entry point for the SARS-CoV-2. east Asian populations have higher expressions of ACE2 levels compared to Caucasians. There is limited research on gene expression related to COVID-19 specifically. Theoretical Framework The Transcultural Nursing Theory created by Madeline Lelinger will be the theoretical framework to guide my DNP project. The United States is becoming more diverse, but healthcare workers have seen slower growth in diversity than the national demographic. According to Lancellotti (2008), the lack of diversity is linked to healthcare disparities. Transcultural Nursing Theory attempts to provide culturally congruent care tailored for individuals, their unique risk factors and cultural needs through the nurse-patient level. This theory guides my project by educating the healthcare workforce about the disproportionate impact of COVID-19 on BIPOC individuals. The Sunrise Model (Appendix A) is a visual DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 14 depiction of the sociocultural aspects that impacts every patient's care. This model is deductive, where the outside is the general worldview, and as you move toward the center, the influences become more specific to the patient. COVID-19 disproportionately impacts people of color for various reasons, such as socioeconomic, ethnohistorical, language, and environmental. All of which are included in the Sunrise model. Goals, Interventions and Outcomes The primary objective of my DNP project is to bring awareness to the disparities that exist in COVID-19 infections and deaths among BIPOC community members to CRNAs, who are more likely to provide anesthesia for these venerable populations in comparison to Anesthesiologists (Lao et al., 2015). My project aims to induce a practice change by educating CRNAs on historical and societal processes affecting care. Culturally intelligent care in the United States health care system is a recent aspect acknowledged as being important in medical education. Decades of pseudoscience regarding race and legalized federally mandated discrimination led to national health inequalities. The disproportionate infection and the death toll of COVID-19 on BIPOC communities and the factors that make these communities more at risk needs to be is not being taught to the individuals who care for these patients. Project Design My educational intervention is a teaching project for CRNAs, the primary anesthesia providers for BIPOC, and Medicaid eligible community members (Lao et al., 2015). There is little education for CRNAs regarding culturally intelligent care. Additionally, acknowledging the historical inaccuracies previously regarded as fact will lead to healthcare professionals dismantling unconscious preconceived notions that contribute to health care disparities. DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 15 The research sampling participants were found using a non-probability convenience sample. After obtaining IRB approval from Marian University. I requested permission to post my anonymous survey on a private Facebook group for CRNAs and SRNAs. The CRNA & SRNA page is a private group that requires the members to have an active American Association of Nurse Anesthetist (AANA) membership to gain access to the page. Upon opening the survey link, CRNAs would complete a pre-intervention knowledge assessment before the teaching intervention, a YouTube video containing a Prezi presentation with a voice recording that I created to provide education on the disproportionate impact of COVID-19 on BIPOC communities and their unique risk factors, and a 9-question knowledge assessment after (see Appendix B). The pre-test and post-test questions are the same. My pre and post-test data will be quantitative, and I will use the data analyzer Qualtrics to collect the data and SPSS to analyze the data. The quantitative analysis will be an objective measurement by which the present teaching interventions effectiveness can be judged. Ethical Considerations The Marian Internal Review Board (IRB) approval was obtained prior to initiating the DNP Project (Appendix C). Participants anonymity was maintained during this project by using an anonymous link for the survey and data collection. Data Analysis and Results Of 32 total study participants, 6 completed the entire study, 8 completed only the pre-test, and 18 did not complete the pre-test or the post-test. Of the 6 individuals that completed the survey in its entirety, all of their post-test average scores increased from pre-test values. A paired-sampled t-test was calculated to compare the mean pre-test scores to the mean post-test scores after the teaching intervention. The mean pre-test score was 26.5 (sd= 7.09), and the mean DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 16 on the final was 50.7 (sd=31.0). A significant difference from pre-test to final was found (t(5)=2.228, p=0.038). The null hypothesis is rejected. The 8 participants who only completed the pretest had a mean score of 30.98. The data was not averaged for the 18 individuals who did not complete the pre-test or post-test. Discussion As a result of the teaching intervention, participants mean scores significantly increased from their pre-test to post-test values. All participants who completed the study either selected "neutral" or "strongly disagree" when asked if their employer-provided them with information regarding COVID-19's disproportionate impact on BIPOC communities. Five out of six believe the presentation helped them to understand COVID-19 and the impact on BIPOC communities. Four out of six participants agreed or strongly agreed that they would be willing to utilize various strategies (such as education, technology, unique services, etc.) to provide equitable and preventative care for patients at increased risk for COVID-19. Five out of six believed that cultural intelligence is essential to providing equitable care. Unfortunately, the response rate is too low to generalize to a larger population. On the Facebook post where the survey link was distributed, elements of the survey were described; pretest, 9-minute video, and post-test. Also, participants were made aware of how long the study will take, which was approximately 15 minutes. Of the 32 participants, only 6 completed the study in its entirety. The lack of completed responses could signify the clinician's disinterest in studying the social justice issues or a lack of incentive to learn how and why COVID-19 affects BIPOC communities disproportionately. This is a concerning finding and should be further investigated. One of the strengths of this study is that all 6 participants that completed the study has taken care of at least one patient who was diagnosed with COVID, and only 7 of the 32 total DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 17 participants said they had not taken care of a COVID patient. This means that, as predicted, this kind of study is relevant to the CRNA population. This also further supports the need for CRNA education on COVID-19s impact on BIPOC communities. The education about COVID's effect on BIPOC communities is reaching the providers to take care of them. Although the response rate was low, this study can serve as a preliminary effort to educate CRNAs and SRNAs on how to see their patients on a more human level, where they are aware of the societal, cultural, economic, and environmental factors regarding COVID-19 and how they affect their patient population. Conclusion BIPOC communities have suffered disproportionately from war, disease, climate change, and disaster throughout history because of the socioeconomic and environmental barriers that limit their ability to preserve their well-being. These same devastating patterns are being seen with COVID-19; however, there is an opportunity to protect and serve the BIPOC community in a way that is far overdue by researching and implementing interventions on the specific impact and unique risk factors on BIPOC communities. Currently, collecting accurate data on race and infection is not routine, contributing to the gap in knowledge about culturally specific interventions (Laurencin, 2020; Kirby, 2020; Hooper, 2020; Abuelgasim, 2020). Clinicians must stay up to date regarding best medical practices and expand their awareness of the whole patient through cultural and public health awareness. Research shows that BIPOC patients have a history of abuse by the medical practitioners, which leads to generations of distrust, seeking treatment later, and untreated pain, which ultimately leads to worse outcomes. Unfortunately, modern medical education often either amplifies destructive racial myths about people and rarely mentions these practices' historical, economic, and sociocultural effects. As stated before, none DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 18 of the participants who completed the survey had received information from their employer regarding the disproportionate impact of COVID-19 on BIPOC communities, and all of them have taken care of COVID-positive patients. Ignorance and unwillingness to educate current and future healthcare providers about the past and current sociocultural implications perpetuate the public health crisis of COVID-19. This can inevitably lead all vulnerable populations, including BIPOC communities, to face a more significant death and disease burden to COVID-19. Fortunately, participants in this study have shown that teaching interventions are effective in bringing awareness to social issues that affect the BIPOC community. DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 19 References Alsan, M., & Wanamaker, M. (2018). TUSKEGEE AND THE HEALTH OF BLACK MEN. The quarterly journal of economics, 133(1), 407455. https://doi.org/10.1093/qje/qjx029 Abuelgasim, Eyad., Saw, L. J., Shirke, M., & Zeinah, M., Harky, A. (2020). COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities. Current Problems in Cardiology, 45(8). https://doi.org/10.1016/j.cpcardiol.2020.100621 Centers for Disease Control and Prevention. (n.d.) COVID-19 Hospitalization and death by race/ethnicity. CDC. Retrieved September 26th, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigationsdiscovery/hospitalization-death-by-race-ethnicity.html Hooper, M. W., Napoles, A. M., & Perez-Stable, E. J. (2020). COVID-19 and racial/ethnic Disparities. The Journal of the American Medical Association, 323(24), 24662467. https://doi.org/10.1001/jama.2020.8598 Kirby, T. (2020). Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. The Lancet Respiratory Medicine, 8(6), 547-548. https://doi.org/10.1016/S2213-2600(20)30228-9 Ko, L. (2020, November 19). Unwanted Sterilization and Eugenics Programs in the United States | No Ms Bebs | Independent Lens | PBS. Independent Lens. https://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenicsprograms-in-the-united-states/ Lancellotti, K. (2008). Culture Care Theory: A Framework for Expanding Awareness of Diversity and Racism in Nursing Education. Journal of Professional Nursing, 24(3)179183. https://doi.org/10.1016/j.profnurs.2007.10.007 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 20 Laurencin, C. T & McClinton, Aneesah. (2020). The COVID-19 Pandemic: A call to action to identify and address racial and ethnic disparities. racial ethnic disparities. Doi:10.1007/s40615-020-00756-0 Lelinger, M. (2002). Lelinger's Sunrise Enabler for the Theory of Culture Care Diversity and Universality [Online image]. Nursing Theories. http://nursingtheories.blogspot.com/2011/07/leiningers-theory-of-culture-care.html Matthew, D. B. (2015). Just medicine a cure for racial inequality in American healthcare. New York University Press. Penner, L. A., Hagiwara, N., Eggly, S., Gaertner, S. L., Albrecht, T. L., & Dovidio, J. F. (2013). Racial healthcare disparities: A social psychological analysis. National Institute of Health, 24(1), 70-122. https://doi.org/10.1080/10463283.2013.840973 Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L. (2020). Hospitalization and mortality among black patients and white patients with Covid-19. The New England Journal of Medicine. https://doi.org/10.1056/NEJMsa2011686 Richardson, J. R., Mitchell, B. M., Meier, H. C. S. M., Lynch, E. L., & Edlebi, J. E. (2020). Redlining and Neighborhood Health. National Community Reinvestment Coalition. Published. https://ncrc.org/holc-health/ Shah, M., Sachdeva, M., & Dodiuk-Gad, R. P. (2020). COVID-19 and racial disparities. Journal of the American Academy of Dermatology, 83(1), e35. https://doi.org/10.1016/j.jaad.2020.04.046 Yehia, B. R., Winegar, A., & Fogel, Richard. (2020). Association of race with mortality among patients hospitalized with coronavirus disease 2019 (COVID-19) at 92 US hospitals. JAMA Network Open, 3(8), Article e2018039. 10.1001/jamanetworkopen.2020.18039 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Appendix A 21 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Appendix B What is your age? 20-30 30-40 40-50 50-60 60+ Which of these best describes your current gender identity (please check all that apply)? Cisgender male/man Cisgender female/woman Transgender female/woman Transgender male/man Gender queer/gender non-binary/gender fluid A gender not listed (please describe): _____ What is your ethnicity? Asian or Pacific Islander Black or African American Hispanic or Latinx Native American or Alaskan Native White Multiracial or Biracial A race/ethnicity not listed here Years of Anesthesia experience 22 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 0-5 5-10 10-15 15-20 20+ Region of current anesthesia practice Northeast Southwest West Southeast Midwest Have you provided care for a COVID-19 positive patient? Yes, 1-10 Yes, 10-20 Yes, 20+ No As of June 2021, the health disparities between racial/ethnic groups of people regarding hospitalization and death rates due to COVID-19 have: Decreased Remained the same Increased There is not enough data to quantify 23 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES (As of June 2021) What is the race/ethnicity of people with the highest hospitalization and mortality rate in the US for COVID-19? American Indian or Alaska Native, Non-Hispanic persons Asian, Non-Hispanic persons Black or African American, Non-Hispanic persons Hispanic or Latino persons White, Non-Hispanic persons (As of June 2021) What are the rate ratios of hospitalization and death of American Indian or Alaska Native, Non-Hispanic persons compared to White, Non-Hispanic persons? 1.0x hospitalization 1.0x death 2.8x hospitalization 2.3x death 2.9x hospitalization 2.0x death 3.3x hospitalization 2.4x death (As of June 2021) What are the rate ratios of hospitalization and death of Asian, Non-Hispanic persons compared to White, Non-Hispanic persons? 1.0x hospitalization 1.0x death 2.8x hospitalization 2.3x death 2.9x hospitalization 2.0x death 3.3x hospitalization 2.4x death (As of June 2021) What are the rate ratios of hospitalization and death of Black or African American, Non Hispanic persons compared to White, Non-Hispanic persons? 1.0x hospitalization 1.0x death 2.8x hospitalization 2.3x death 24 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES 2.9x hospitalization 2.0x death 3.3x hospitalization 2.4x death 25 (As of June 2021) What are the rate ratios of hospitalization and death of Hispanic or Latino persons compared to White, Non-Hispanic persons? 1.0x hospitalization 1.0x death 2.8x hospitalization 2.3x death 2.9x hospitalization 2.0x death 3.3x hospitalization 2.4x death Select which factor(s) contribute(s) to a higher risk of COVID-19 mortality. Select all that apply. Ability to work from home Health comorbidities Living in a multi-generational family household Living in metropolitan areas Living in rural areas Not having health insurance Poor housing conditions Reliance on public transport Salaried wage employment Trust in healthcare systems Select which factor(s) are more likely to apply to BIPOC (Black, Indigenous and people of color) when compared to White people. Select all that apply. Ability to work from home Health comorbidities DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Living in a multi-generational family household Living in metropolitan areas Living in rural areas Not having health insurance Poor housing conditions Reliance on public transport Salaried wage employment Trust in healthcare systems 26 True or False: After adjusting for healthcare access factors and socioeconomic differences, BIPOC (Black, Indigenous and people of color) receive equal quality of treatment for the same diagnosis when compared to White people. True False Please rate the degree to which you agree/disagree with the following statements: This presentation was beneficial in my understanding of COVID-19's impact on BIPOC (Black, Indigenous and people of color). Strongly Disagree Disagree Neutral Agree Strongly Agree My employer has provided me with information regarding COVID-19's disproportionate impact on BIPOC (Black, Indigenous and people of color). DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Strongly Disagree Disagree Neutral Agree Strongly Agree 27 My employer has provided me with interventions aimed to reduce COVID-19's disproportionate impact on BIPOC (Black, Indigenous and people of color). Strongly Disagree Disagree Neutral Agree Strongly Agree In order to provide quality care, it is important to be culturally intelligent. Strongly Disagree Disagre Neutral Agree Strongly Agree I would be willing to utilize various strategies (such as: education, technology, unique services, etc) in order to provide equitable and preventative care for patients at increased risk for COVID19. Strongly Disagree Disagree DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Neutral Agree Strongly Agree 28 DISPROPORTIONATE IMPACT OF COVID-19 ON BIPOC COMMUNITIES Appendix C 29  ...

... J Osteopath Med 2022; 122(1): 1520 Medical Education Brief Report Jennifer Taylor*, DHEd, MPH, Amanda Wright, DO and Michael Summers, MD The pandemic silver lining: preparing osteopathic learners to address healthcare needs using telehealth https://doi.org/10.1515/jom-2021-0162 Received June 10, 2021; accepted August 24, 2021; published online October 22, 2021 Abstract Context: During the COVID-19 pandemic, many clinicians quickly adapted their way of practicing patient care by offering telehealth and virtual office visits while simultaneously having to minimize direct patient care. The shift in direct clinical learning opportunities provided to third- and fourth-year medical students required a shift in the educational curriculum to develop learner skills around the appropriate use of telehealth in patient care. Objectives: The aim of this project was to provide exposure to students so they could learn the telemedicine equipment and best practices, and how to identify infectious diseases to improve access to care and meet the needs of the patient. Methods: In July and August of 2020, the Indiana Area Health Education Centers Program partnered with Marian University College of Osteopathic Medicine (MUCOM) to support a 1 day telehealth simulation (online curriculum, group lecture, and two standardized patient encounters) into their clerkship curriculum. We utilized a retrospective pretest-posttest to assess changes in learner knowledge around telehealth after the program. At the conclusion of the telehealth training program, students were asked to complete a retrospective pretest-posttest assessing their level of preparedness to utilize telehealth equipment, their preparedness to demonstrate telehealth best practices in a manner consistent with protecting patient (and data) *Corresponding author: Jennifer Taylor, DHEd, MPH, Department of Family Medicine, Indiana University School of Medicine, 1110 W. Michigan Street, LO 200, Indianapolis, IN 46202-5102, USA, E-mail: jtaylor8@iupui.edu. https://orcid.org/0000-0003-2574-1895 Amanda Wright, DO and Michael Summers, MD, Department of Family Medicine, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA. https://orcid.org/0000-0001-6290-3094 (A. Wright) Open Access. 2021 Jennifer Taylor et al., published by De Gruyter. International License. privacy, their condence to utilize telehealth for identication of infectious diseases, and their condence to utilize telehealth to identify proper treatment plans. Results: A total of 96 learners completed the program in 2020. Posttest results demonstrate a statistically significant (p<0.05) improvement for learners self-reported level of preparedness to utilize telehealth equipment, their preparedness to demonstrate telehealth best practices in a manner consistent with protecting patient (and data) privacy, their confidence to utilize telehealth for identification of infectious diseases, and their confidence to utilize telehealth to identify proper treatment plans. Conclusions: Our telehealth curriculum involving a video, interactive learning session, and two standardized patient experiences provided osteopathic medical learners with realistic simulated case scenarios to work through in effort to improve their knowledge and self-efficacy around the utilization of telehealth in practice. Keywords: area health education centers; medical education; self-efficacy; students; telehealth. Telehealth connects patients to vital healthcare services through videoconferencing, remote monitoring, electronic consults, and wireless communications to improve access to health care [1]. The goal of telehealth is to increase access to physicians and specialists in order to help ensure that patients receive the right care, at the right place, at the right time [1]. Although telehealth technology has the potential to revolutionize healthcare delivery, providers were slow to participate in telemedicine prior to the pandemic [2]. With the emergence of the COVID-19 pandemic, the healthcare system demonstrated the agility to apply telehealth approaches yet exposed the gap in widespread telehealth implementation [3, 4]. Simultaneously, over the past several years, medical specialty organizations have developed specialty-specic guidelines and tips for optimal telehealth use, yet formal curricular education for medical students appears to lag against other advancements in telehealth [5]. In order to develop a health workforce willing and able to practice telehealth, early exposure This work is licensed under the Creative Commons Attribution 4.0 16 Taylor et al.: Preparing osteopathic learners to address healthcare needs throughout undergraduate medical education is necessary to prepare learners to practice telehealth [3]. As the COVID-19 pandemic unfolded, many clinicians quickly adapted their way of practicing patient care by offering telehealth and virtual office visitsespecially for vulnerable populations in rural and medically underserved communities [6]. In addition, the federal government, state Medicaid programs, and private insurers expanded coverage for virtual telehealth care services [7]. During the rst quarter of 2020, the number of telehealth visits increased by approximately 50% compared with the same period in 2019, with a 154% increase in visits during surveillance week 13 in 2020 compared with the same time period in 2019 [8]. This appeared to be closely related to the rise in COVID-19 related evaluations [8]. Although telehealth is becoming a standard component in the practice of medicine, telehealth has not universally been a component of medical school training. One 2019 review noted that over one-fourth of allopathic schools reported in 20152016 that they had preclinical telehealth training [9]. Both the American Medical Association (AMA) [10] and the American Association of Colleges of Osteopathic Medicine (AACOM) [11] recommend training medical students in telehealth services. On March 17, 2020, the Association of American Medical Colleges (AAMC) and AACOM recommended that medical students be paused from clinical rotations due to the increase in COVID-19 cases and concerns over student safety and an inadequate amount of personal protective equipment. As a result, medical learners were left with a gap in the curriculum that could be utilized in other manners in which to augment clinical knowledge and skills. Simulation is a widely utilized model of medical training. Simulations allow hands-on training in the presence of faculty oversight and feedback to the learner. The program described in this article closely aligned with the Indiana Area Health Education Center Network (IN-AHEC) goal to enhance workforce training around the use of telehealth technologies as a response to the COVID-19 pandemic. This article describes the medical student telehealth training 1 day program developed at Marian University College of Osteopathic Medicine (MUCOM) in partnership with the IN-AHEC Network during the 2020 COVID-19 pandemic year and the initial positive student-reported outcomes after its rst-year of implementation. Methods In July and August of 2020, IN-AHEC partnered with MUCOM to support a telehealth simulation demonstration project into their medical education curriculum. Experience in telehealth is beneficial to future physicians because telehealth plays a role in patient care when geography, physician shortages, or safety concerns limit the availability of face-to-face visits. The purpose of the project was to improve osteopathic students knowledge, confidence, and preparedness for utilizing telehealth equipment to follow best practices, identify infectious disease, and develop appropriate treatment plans. This study was reviewed and approved with exempt status (10638) by the Indiana University Institutional Review Board. The program was conducted for educational purposes, not research purposes, thus written consent was not obtained. Rather, we utilized the existing education data to assess the impact of the program. The program and related study were funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Area Health Education Centers COVID program (grant T1KHP39172). Students did not receive any compensation for participating in the educational program. The MUCOM telehealth program provided a hybrid of didactic modules, in-person lecture, and simulated telehealth with realistic case studies to expose learners to appropriate and inappropriate uses of telehealth for patient care. The 1 day learning session utilized an online didactic curriculum, in-person lecture, and two standardized patient encounters. Participation in the telehealth curriculum was mandatory for all third- and fourth-year osteopathic medical students. For part of the curriculum, all students were required to watch the American College of Physicians (ACP) comprehensive review of telemedicine [12]. On the day of the program, groups of 1520 students engaged in an interactive 45 min small group lecture (facilitated by faculty) on telemedicine followed by a virtual encounter with a standardized patient utilizing telemedicine. All students had two separate 30 min encounters with a standardized patient offsite via the computer. The encounter was typical of what would be seen in a family medicine telemedicine encounter. The two cases included an uncomplicated urinary tract infection and chest pain. The chest pain case emphasized that not all encounters can be conducted via telemedicine. In this case, students were trained to recognize that the patient should be referred to the Emergency Department immediately. After each case, students received feedback from the standardized patient and participated in a post-encounter debrief with program faculty. Following the program, the learners were given the external program survey to share their experience in a manner separate from their academic course grade. Although all students engaged in the same specic cases, they were not permitted to share any knowledge of the cases with their peers. Figure 1 outlines the curricular topics of the telehealth curriculum. We utilized a retrospective pretest-posttest to assess changes in learner knowledge around telehealth after the program. The retrospective pretest-posttest method is a simple method of assessing changes in self-efficacy because the act of asking both contemporary and retrospective answers at the same time ensures that the participants frame of reference for interpreting a given question will remain the same [13]. At the conclusion of the telehealth training program, students were asked to complete a retrospective pretest-posttest assessing their level of preparedness to utilize telehealth equipment, their preparedness to demonstrate telehealth best practices in a manner consistent with protecting patient (and data) privacy, their condence to utilize telehealth to identify infectious diseases, and their condence to utilize telehealth to identify proper treatment plans. Students responded utilizing a ve-point Likert scale ranging from strongly disagree to strongly agree. The survey completed by students was voluntary and not connected to their academic scores in the curriculum. All demographic Taylor et al.: Preparing osteopathic learners to address healthcare needs 17 Figure 1: Curricular learning objectives for the telehealth program. and program evaluations were completed on a self-reported form by the students, which allowed for them to self-identify their race and ethnicity (with open formatting if they did not think that the provided HRSA-identified federal categories did not fit their identity). Demographic information around race and ethnicity was collected according to federal requirements associated with the funding because the AHEC program strives to enhance opportunities for health profession students from underrepresented-in-medicine backgrounds. The inclusion criteria for the study required the student both to be engaged in the telehealth curriculum and to complete the post-event AHEC program evaluation tool. To test the potential statistical significance in the hypothesis, we conducted a paired-sample t-test to assess a difference in the means in the students pre- and posttest. All data were collected with FormAssembly software and storage in a cloud-based Salesforce platform. All statistical analysis was conducted utilizing IBM SPSS 26. We considered two-sided p values of < 0.05 as statistically signicant. Table : Demographics self-reported by study participants. Male Female Asian Black or African American More than one race Other White Hispanic or Latinx Self-identied as coming from a rural background Self-identied as coming from a disadvantaged background Academic year Academic year Academic year Academic year n= % . . . . . . . . . . . . . . Results In July and August of 2020, 95 osteopathic medical students participated in a training program to develop their preparedness and confidence to utilize telehealth and completed the AHEC program evaluation tool. As highlighted in Table 1, the majority of our study population selfidentied as white (74; 77.9%) and female (55; 57.9%). Three-fourths (72; 75.8%) of our participants reported coming from a rural (38; 40.0%) and/or disadvantaged background (34; 35.8%). The results of the telehealth preparedness assessments are highlighted in Table 2 below, which depicts the pretest-posttest means, paired t-test, sample mean, and standard deviation. We asked the learners to self-report their self-efcacy on feeling prepared for utilizing telehealth equipment. The mean pretest score for utilizing telehealth equipment was 1.91 (where zero indicates strongly disagree and four is strongly agree), while the posttest score was 3.03. The t-test results showed a statistically signicant gain (t=9.677; n=76; p<0.05), and the overall results indicate an increase in self-efcacy around utilizing telehealth equipment. We asked the learners to self-report their self-efficacy on feeling prepared to demonstrate telehealth best practices in a manner consistent with protecting patient (and data) privacy. The mean pretest score for demonstrating telehealth best practices was 1.95, and the posttest score was 2.99. The t-test results showed a statistically significant gain (t=7.934; n=77; p<0.05), and the overall results indicate an increase in self-efcacy of how to utilize telehealth in a manner consistent with telehealth best practices. We asked the learners to self-report their self-efficacy on utilizing telehealth to identify infectious diseases. The mean pretest score for utilizing telehealth to identify infectious diseases was 1.62, and the mean posttest score was 2.79. The t-test results showed a statistically significant gain (t=11.283; n=76; p<0.05), and the overall results indicate an increase in self-efcacy in the ability to utilize telehealth visits to identify infectious diseases. Lastly, we asked the learners to self-report their selfefficacy to utilize telehealth to identify the proper treatment plans. The mean pretest score for utilizing telehealth 18 Taylor et al.: Preparing osteopathic learners to address healthcare needs Table : Retrospective pretest-posttest responses regarding the levels of preparedness and condence using telehealth. Paired-sample mean (where zero is strongly disagree and four is strongly agree) and standard deviation between the pretest and posttest. Pretest mean Posttest Overall change mean in mean Standard deviation t (df) . ()a . ()a . ()a . ()a I feel prepared to utilize telehealth equipment. . . . . I feel prepared to demonstrate telehealth best practices in a manner consistent with protecting patient (and data) privacy. I feel condent in my ability to utilize telehealth for identication of infectious diseases. I feel condent in my ability to utilize telehealth to identify proper treatment plans. . . . . . . . . . . . . a p<.. to identify the proper treatment plans was 2.05, and the mean posttest score was 3.05. The t-test results showed a statistically significant gain (t=9.398; n=77; p<0.05), and the overall results indicate an increase in self-efcacy on identifying the proper treatment plans when utilizing telehealth equipment and services. Our findings demonstrate a statistically significant improvement for learners self-reported level of preparedness to utilize telehealth equipment, preparedness to demonstrate telehealth best practices in a manner consistent with protecting patient (and data) privacy, confidence to utilize telehealth to identify infectious diseases, and confidence to utilize telehealth to identify proper treatment plans. In further analysis, we found no significant differences based on the gender, rural background, disadvantaged backgrounds, or academic year of the learners. Discussion Given the dynamic shift to better incorporate telehealth into professional practice as result of the COVID-19 pandemic, medical education has a duty to enhance the academic curriculum to ensure that learners have the skills to utilize telehealth into practice. Medical learners need to be equipped with the tools needed to utilize telehealth to address the AHEC mission to increase access to care by enhancing the health workforce. During the project, we discussed with the students that telemedicine was being much more utilized in private practice due to the pandemic. The continued utilization of telehealth will ensure that providers can meet the needs of their patients in rural and urban underserved communities, especially for those with challenges associated with transportation, distance, mobility, or time (associated with employment and travel) [14]. This project showed significant improvement in the learners self-reported knowledge and confidence around utilizing telehealth in practice. Coupling simulation as an immersive teaching and learning tool with active learning methodology allows students to move from rote memory to acquiring the cognitive schema to apply memorized information into practice [15]. Existing research around simulation-based learning reported that students felt that the model improved their clinical skills, their ability to retain learning materials, their clinical decision-making, and their communication skills with patients [16]. The inclusion of the telehealth training program provided osteopathic medical learners with realistic simulated case scenarios to work through to improve their skills utilizing telehealth in practice. While we recognize that correlation does not necessarily equate to causation, we believe in this case that the core components of the program provided learners with an increased opportunity to apply the didactic materials in a valuable manner to increase skills and self-efficacy around how to utilize telehealth equipment, learn best practices, and utilize the technology to identify infectious diseases to develop appropriate patient care plans. The aim of this project was to provide exposure to students so that they could learn the telemedicine equipment and the best practices, and to learn how to identify infectious diseases to improve access to care and meet the needs of the patient. This meets the mission of osteopathic physicians to provide care that includes osteopathic principles and practice, which is the integration of osteopathic philosophy into healthcare practices. Moving forward, osteopathic principles and practice could be further integrated into the telemedicine curriculum by expanding the learning objectives to include the identification of chief complaints, diagnostic maneuvers, and techniques that may be addressed and taught via telemedicine (such as the Galbreath technique, a manipulative treatment for otitis media). Taylor et al.: Preparing osteopathic learners to address healthcare needs The study faced several limitations that may impact the application of our study. Our findings are based on that of one osteopathic medical school curriculum, therefore participation in similar programs across the nation may result in varying experiences for the learners. While the program was mandatory for all third- and fourth-year medical students, we had several learners who did not complete the external program evaluation provided by the AHEC program, therefore those students were not included in the study results looking at the 95 students. A further limitation is the self-reported nature of the evaluations. The program results rely on the students self-reported knowledge and self-efficacy rather than observable assessment by a faculty. Additionally, although we believe that the program has a strong potential to positively influence learner self-efficacy pertaining to utilizing telehealth, we cannot discount the bias related to the selfreported nature of the evaluation. Conclusions The landscape of providers utilizing telehealth to improve access to care and subsequent patient outcomes will continue to evolve, and the undergraduate medical education curriculum needs to evolve simultaneously. Our telehealth curriculum involving a video, interactive learning session, and two standardized patient experiences in telehealth improved students selfreported knowledge in telehealth. Future studies should observe learning sessions and assess applied skills to develop a health workforce that is willing and competent to utilize evolving and emerging technology to improve patient health outcomes. Research funding: The project described was supported by Bureau of Health Professions, Health Resources and Services Administration Grant Number T1KHP39172. The contents of this article are solely the responsibility of the authors and do not necessarily represent the ofcial views of the U.S. Department of Health and Human Services, Health Resources and Services Administration, Area Health Education Centers COVID program. Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave nal approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that 19 questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Competing interests: None reported. Ethical approval: This study was reviewed and approved with exempt status (10638) by the Indiana University Institutional Review Board. References 1. American Hospital Association. Telehealth fact sheet: AHA. Available from: https://www.aha.org/center/emerging-issues/marketinsights/telehealth/telehealth-factsheet [Accessed 18 Mar 2021. 2. Talal AH, Sokitou EM, Jaanimgi U, Zeremski M, Tobin JN, Markatou M. A framework for patient-centered telemedicine: application and lessons learned from vulnerable populations. J Biomed Inf 2020;112:103622. 3. Camhi SS, Herweck A, Perone H. Telehealth training is essential to care for underserved populations: a medical student perspective. Med Sci Educ 2020;30:14. 4. Wegermann K, Wilder JM, Parish A, Niedzwiecki D, Gellad ZF, Muir AJ, et al. Racial and socioeconomic disparities in utilization of telehealth in patients with liver disease during COVID-19. Dig Dis Sci 2021:17. https://doi.org/10.1007/s10620021-06842-5. 5. Walker C, Echternacht H, Brophy PD. Model for medical student introductory telehealth education. Telemed J E Health 2019;25: 71723. 6. Tapper EB, Asrani SK. The COVID-19 pandemic will have a longlasting impact on the quality of cirrhosis care. J Hepatol 2020;73: 4415. 7. U.S. Health Resources and Services Administration. Billing for telehealth during COVID-19. Available from: https://telehealth. hhs.gov/providers/billing-and-reimbursement/?gclid= Cj0KCQjw8vqGBhC_ARIsADMSd1Bj054hxS5iVjKirdEImEWCf8gjWXIaY7_tKsT7X28_Oo2SzUzh9waAu5XEALw_wcB [Accessed 2 Jul 2021]. 8. Koonin LM, Hoots B, Tsang CA, Leroy Z, Farris K, Jolly T, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic - United States, January-March 2020. MMWR Morb Mortal Wkly Rep 2020;69:15959. 9. Waseh S, Dicker AP. Telehealth training in undergraduate medical education: mixed-methods review. JMIR Med Educ 2019;5:e12515. 10. Kelly J, American Medical Association. AMA encourages telehealth training for medical students, residents. Available from: https://www.ama-assn.org/press-center/press-releases/ ama-encourages-telemedicine-training-medical-studentsresidents [Accessed 25 Jun 2021]. 11. American Association of Colleges of Osteopathic Medicine. Updated message from AACOM regarding students returning to clinical activities. Available from: https://www.aacom.org/newsand-events/news-detail/2020/05/05/updated-message-fromaacom-regarding-students-returning-to-clinical-activities [Accessed 25 Jun 2021]. 12. American College of Physicians. Telemedicine: a practical guide for incorporation into your practice. Available from: https://assets. 20 Taylor et al.: Preparing osteopathic learners to address healthcare needs acponline.org/telemedicine/scormcontent/#/ [Accessed 2 Jul 2021]. 13. Chang R, Little TD. Innovations for evaluation research: multiform protocols, visual analog scaling, and the retrospective pretestposttest design. Eval Health Prof 2018;41:24669. 14. Woodall T, Ramage M, LaBruyere JT, McLean W, Tak CR. Telemedicine services during COVID-19: considerations for medically underserved populations. J Rural Health 2021;37: 2314. 15. Erlam GD, Smythe L, Wright-St Clair V. Simulation is not a pedagogy. Open J Nurs 2017;7:77987. 16. El Naggar MA, Almaeen AH. Students perception towards medical-simulation training as a method for clinical teaching. J Pak Med Assoc 2020;70:61823.  ...

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... he VOL. Ill hoenix No. 2 Marian College, Indianapolis, Indiana, Winter, 1940 ICE LURES SKATERS Freshmen Speak at Peace Conferenee NOTED HISTORIAN TO SPEAK One of the foremost and sounde t I Following are the contributions in 1 authoririe on ::V1exico and a frequent part, of brgaret Ann McCarthy and cc nrriburor to Am erica rhe Rev. Mary Roe Turner, re pectively to James A. :Magner, .T.D., will peak the panel di cus ions at the Ohio Valat ::V1arian Hall on rhe afternoon of ley rudent Peace Federation which Thursday, February I. Dr. ::Vlagner met December 2, 1939, at Mt. t. Joseph, Ohio. is a profes or at the Quigley PreparaPEACE A [D THE LITURGY tory Seminary in Chicago, Illinoi . In Liturgy", as defined by one writer, addition to research, lecturing, and " is chat set of rites and services m teaching, Father Magner has publi hed .ind by which the Church lives its many articles on Mexico, pain and supernatural life, chat is, is born to China. He i dire tor of the Charle divine life, nurtures its life, develops that life toward greater union with Carroll Forum. Hi late t distinction God, greater love of Him, more ar- 1 is his election in 19 39 a counsellor of dent praise of the beloved." :hi! American Catholic Hi torical The Chur h is constantly pleading As :iciarion. for peace in her liturgical practices. o word occurs more frequently in the Mis al than securus, "free from Religious Council Functions anx.iery". In the Ordinary of the .Mas alone there are seven specific mentions of peace. The word "peace" The Religious Council organized is first mentioned at the Gloria in exov. 10, last, crosses the threshold celsis, the Christmas hymn, in which of the new year with enthusiastic che angels proclaimed peace to men I h S on earth. The theme of the entire p Ians f or action. ntegratmg t e o. . hymn is glory to the Father, peace A now-bound campus and frozen dality, C .. M.C., and C.A.I.P. Uruts, from the Son. lakes invite winter sports. The skaters it i pledged to direct all student The Church asks for peace specific- are Miss Jean Seagar, teacher of physiactivities of a religious character. ally for herself in the Te igit,", the cal education, and Rose Marie Davey, ith the memory of pre-Christmas first prayer of the Canon of the Mass. tudent. " leep the sleep of peace", and "Grant ________________ projects still vivid, the Council is them a place of refreshment, light, Pax et bo1111111! Our cw Year con idering new objectives. Meanand peace," are quotations from the greeting to each student, to each while those already established are beCommemoration of the Dead. Before reader, and patron of the Phoenix. ing fostered. the Agnus Dei the priest salutes the May every day of 1940 be blessed Present incumbents are Charlotte people saying, "The peace of the Lord with peace and all that is good. Cambro,n, '42, president; Mary Jane be ever with you". The third part of Sister Mary John O.S.F. Lang, 41, prefect of , the o~aliry the Agnus Dei is a plea to the Lamb Chapter, Mary Duffy, 42, president of God to "grant us peace". A pertiof the C .. M.C. Unit, Margaret Ann nent ceremony at High Masses is the M C h ' , h . f h c art. Y, 4), c a'.rman t e C.A. kiss of peace, a glorious symbol of our ouls at peace just before our last LP. Umt, vice-president ; Mary Ann the union of Christians among them- momentous journey. secretary; Ro emary selves and with Christ. The Church, Twice in recent times the popes Mahan, ' '43 not contented with these beautiful have recommended special prayers for pragg, 41, treasurer. prayers daily repeated in every Mass peace--Benedict XV in 1914 and Pius throughout the world, has instituted XI in 1935. The Church, the mother a special Mass for Peace. of nations, is the natural enemy of Quotations from the ew Testa- violence and blood- hed. The mission ment uphold the statement that the of the Church is one of peace, because FRE HME TAKE OVER Catholic Church from her very begin- she has for her object reconciliation of otice the difference? \'(/ ell, ning has taken an active part in main- man with God. The Church is al- the up-to-the-minute freshman taining peace. The words of Christ ways pleading through her liturgy not class has taken over the winter regarding peace are carefully pre- only for peace in the domain of con- issue of the PHOE IX. We hope served by the evangelists. The im- science, but also in the public and you like it. portance the Church attaches to peace ocial order. CALLI G ALL PE IE is especially emphasized in the proper 1Y TICAL BODY OF CHRI T Herc's your chance to show of the Mass for the eighteenth Sunday The My tical Body is the purpose some of that school spirit! The after Pentecost. The palm branches for which God became Man. To put . A. C. i g1vmg away 5 a a bles ed on Palm unday are a symbol it more clearly, the Mystical Body is benefit project for the college. of peace. It is interesting to note that the Church and Christ is its Head. Let your motto be "Don't sell Jerusalem in its original interpreta- The charter of the Church includes tion means "peace". all people, for Christ said: "Going your thoughts, sell your tickets for a penny." In her acraments Holy Mother therefore teach ye all nations." All Church displays her intense interest human beings of every race and creed, FORMAL A OU CEME T in peace. In Baptism we are made white and black, Catholic and non"It's a Hundred to One" we'll friends of God. The Holy Eucharist Catholic, Jew azi, and Commu- have fun at the Columbia Club, unites us more closely with God, in- nist, belong to the Church; they are February 3. Hurry, girls, get your uring our peace with Hirn. In the constituents of the Mystical Body- dates! sacrament of Penance Christ brings a real living Body of which Christ is Thanks to Mr. and Mrs. J. H. peace t.o the penitent sinner. Extreme the Head. Lang. ;...________________, Unction is the sacrament that puts (Continued on Page 3) I I '----------------.....! i-- FLASH Dr. Theodore Maynard Lectures On December 5, 1939, :Marian students had the rare treat of hearing Dr. Theodore Maynard, eminent English author, give his personal impresions of Chesterton and Belloc. Mr. Maynard is well qualified to appraise the two first-ranking litterateur for he has been associated with each as friend and colleague . "Chesterton," said Mr. Maynard, " was by far the greater man; for innocence is always superior to experience. Chesterton guesses brilliantly, reaches conclusions by intuition; Belloc knows and reasons, regards everything with the cold scrutiny of the philosopher. Yet men are not persuaded wholly by force of syllogisms; and Chesterton's child-like, romantic nature revealed in his writings, convinccs more easily than Belloc's logic." Much stress was laid upon the ancestral background of both men. Bell , F h l l oc s renc awyer-pamter, Insh so dier heritage was shown to be the basis for his extraordinary versatility. Belloc i a front-rank dialectician, amateur draftsman and painter, journalist, politician, lecturer, traveler, and historian. "Belloc sees everything with the eye of a poet, artist, historian, and soldier." Chesterton, the product of a less romantic background, son of a culcured London business man, studied art in London two years before he di covered that his lifework was that of a writer. He like Belloc _ ' ' was ar tist, lecturer, traveler, and journalist; but hi quick humorous sketches though possessing unique individu~ aliry, did not take the world by storm he was not a good lecturer; and, "although an excellent free-lance journalist, he was one of the world's worst editors." Yet so distinctly pleasing and his own were the style and matter of his writings that Chesterton lives on. "His intellectual consi tency is comparable to that of St. Thomas Aquinas. His use of epigrams and paradoxes attracted many people to him." Chestertonian paradoxes, such as, "If a thing is worth doing at all, it is worth doing badly," were di~ rected toward discovering some neglected or little regarded aspect of the truth. ( Continued on Page 4 ) 11 TER-SE IE TER A RETREAT 1 UAL CHEDULED This year's retreat from January 24-26 will be conducted bv the Reverend Stephen Thuis, 0.S.B., rector of St. Meinrad eminary, t. Meinrad, Indiana. THE P HOE N I X Page Two Winter, 1940 Wanted, Popular Songs THE Smiles PHOENIX Publi hed by the tudents of Marian College When Tom Moore asked permission She never built a libraryShe didn't have the cash. he didn't seek to turn the world From follies vain and rash; And yet she loved her fellowmen And sought to bring them ease, She scattered ashes on the walk, When it began to freeze. Indianapoli , Indiana to write the nation's songs rather than its law, he was'a smart young "1 hrn W'r speak of a <>ood prrss, \\7 e mean one that not only contains man. Did anybody ever hear of a law making the Hit Parade? We i nothing in1urious to tbe principles of faith, but is a proclaimer of its prin- march l to music, we go to s eep to , ciplcs."-Pius XI. music, we eat co music music is the STAFF Editor-in-chief _____________________________33etty Spencer, Rosemiq A i tant Editors Business Manager pragg, '41, Mary Duffy, Charlotte Cambron, _______ :\fary Rapia, '41, Margaret Roe Foltz, Circulation Manager _ _ _____ ___ __ _ Typist _________ _ _ _______ Angelus Lynch, - -- _Mary Jane Moran, cement of friendship-and the nation's songs are the nation's most sincere expression of life md love and '41 interests. What the world needs is fewer perThat is why we sometimes worry. sons who use two-dollar words in a '42 You see, the song of the nation, so two-bit conservation. '42 much more important than its laws, I '41 are almost entirely written by God's ' -I enemies . . . or at least by those who You would not pan '41 never heard of Christ and His law and The jokes we use, ' 42 love. ame half a dozen Catholic Could you but see THE THREE WISEMEN Christmas is not long past. What gifts were given us? "God hath not given us the spirit of fear, but of power, of love, and of sobriety." That is what t. Paul ha aid. As we grow up, we learn from our teachers and others, what evils there are; now, we see the world at war. Fear may come. But we have three gifts, like three wi emen, to lead us to where the star directs. The first is power. What can we know of this? Convent school girls are notably gentle creatures. Is it real power to be able to create peace? This 5 ,ft. i, ,u,dy i;i,t:u tln:: <-ull"~" Hu<.lenc who may learn chat the positive elements of peace are ju tice and charity for all; that part of justice and charity i the submission of ourselves to proper authority; that fear has no place in the creation of true peace. composers. Can't, eh? That's not Those we refuse!! surprising. ame some of the popular song writers. Any Catholics you . . Miss Lukanitsch: "This 1s the plot know among chem? Toe a great - ch at we I, of my detective story. Two burglars many, are chere.? The f act 1s l1ave not one outstandin g C at h oIi c creep stealthily toward the house. aII our 20 , 000 , 000 . W e They climb a wall and force open a composer in be window and enter the room. The are 1etting t h e song of ch e nation h ma d e by men not of our f a1t , not clock strikes one." of our culture. Mary Ann Mahan, breathlessly: Yet we have potential composers " \Vhich one?" I and possible lyncists on every college campus. Cole Porter walked off a George Morgaa: Happy, here is a campus on to Broadway. Rome was little green snake. oniy twenty-four when he turned out "Happy" Glaser: Well, stay away "Pins and eedles." from it. le may be as dangerous as And our last gift i obriety. That looks rather dull. But this gift is "But," retort the young composers a npe one. earnestness seriousness of purpose, which is more precious than the gold of and lyricists, "who wane our songs?" the wisemen. This is the gift in which power and love burn like frankinThe Queen's '\ ork does. And Rosebud: Give me sotp.e of chat cense. It makes gaiety po sible, it laughs at fear. they'll pay for the good ones and monoaceticacidester of salicylicacid. Power. Love. Sobriety. These are our gifts about which our elders publish them too. The Queen's Work Druggist: Do you mean aspirin? have taught us. 1s holding a contest for campus comRosebud: Yes! I never can think of posers, college men and women only. that name. -Vivian Lukanitsch. Fifty dollars goes for the best song. Twenty-five dollars for every publishable song accepted. They can be P.S. If you don't like any of the religious; but they can be merely above, don't read them.-R. M. D. COLLEGE SPIRIT clean, wholesome, amusing; propaganand M. E. Z. For the collegian who proposes to derive from college what is of greatest da in type, or just modern, fresh, and value, college spirit is a prim requisite. To overlook this vital element is to suited to the tastes of young men and young women. lose much of the best college offers. While college is a place where knowledge They are asking for your songs. A PORTRAIT OF CHRIST is gained, its true purpose is to fie the student for a richer life; chat is, to How about getting out chat one you cultivate his caste for the finer things; to prepare him to contribute to che wrote? How about teaming up with The eyes of the boy Christ social moral, and incelleccual ends of the world. In the light of these diverse some?ne and writing ~ne? H~w. about were grave as they saw . . . . . . . proving that there 1s music m the goals, 1t 1s easily understood that more than the gaming of knowledge 1s ID~ h f h C h 1. C , Deep into the heart . . . . earc o c e at o 1c ampusr of the doctors of law; volved. The knowledge we have acquired will do little good if we have no way Closing date is February 15th. High purpose was stamped to apply it or if we are not able to benefit ourselves or others. In addition to -Guest editorial, Quem's Work on each line of His face-the information gleaned from books and from college courses, the student Office. He had come but to love, must include chat training which will allow his education and knowledge to yea e'en to erase be useful. The college spirit is one excellent means of accomplishing chis. The guilt of all sin 1 JAPANESE BLOCK e'er so loathsome and base. It lxings into play chat awareness of the good, one is enjoying, that sense of 1 PRINTS EXHIBITED appreciation which is an asset in every personality. le calls for cooperation This now beauteous form of a student with fellow students and teachers in planning activities and carAn oriental atmosphere pervaded would not ever be so; rying them out. Here is a genuine nursery, where the social virtues and Marian Hall, as Japanese wood-block Cruel pain and great anguish graces may thrive where the participant may learn che essentials of success pr!nts, carv~d on cherry wood and its ch n11 . Al I are not able to evince would once bend it low. an d experience the same degree of emo- printed f on 11 nee h paper ' held . d the d. atten. . . t1on o a t e artistic-mm e . SeasonH is sacred head wounded t1onal ~n_c~us1asm _or ~heir Al~a Mater but each can resolutely accept the al landscapes representing all four seaby many a thorn; respon 1btl1ty that 1s his as an mtegral part of the college, to enter whole- sons were viewed through the invisiHis face, oh, so haggard; ouledly into her intere ts, which are fundamentally his own. hie but spicy haze of incense. Still his body all torn. May 1940 find "college spirit" registered not as a proverbial ew Year's lli!eda ndh oc her nature stu dies empha. . . . size t e enchantment of the East All this for us sinners resolution but one which will be smcerely and wholeheartedly pursued by all E 11 bl H k , Th specia y nota e was o usa1 s e Our great God has borne. students. -R. M .T. Waie.-P. D. _ I I I I -R. S. Winter, 1940 THE FRESHMEN SPEAK AT SOCIAL WORKER DISPEACE CONFERENCE CUSSES HISTORY OF CHILD WELFARE Continued from Page 1 The members are attached to this Body in different ways. There are those who are united by faith, the Christians; and there are those who are united potentially. The blessed in Heaven and the souls in Purgatory are part of this Mystical Body. All these bonds are validated by the supreme bond, the Blood of Christ. By analogy the individual members are cells of the Mystical Body, thriving on the living Eucharistic Food. This is what Christ meant when He said, " I am the Life". This is what is implied in the statement, "I am the vine and you the branches". The branches draw their sustenance from the vine. From these facts we may see why "peace" is incorporated into the Mystical Body. By it all mankind are one body and one with Christ. The identification of the God-man with men was something that only the love of God could accomplish. The Most Precious Blood is the only thing that could make the Jew the brother of the azi; the Catholic, the brother of the Communist. Our purpose has been to show that peace will come from a realization of the doctrine of the Mystical Body. This Body which is held together by the love of God for man the love of man f or G od , an d t h e 1ove of man for fellow man is the soul of peace. CO TRIBUTORS: FRESHMA llose Marie Davey-Frankfort High School, Frankfort, Ind. Peggy Dillhoff-lmmaculate Conception Academy, Oldenburg, Ind. High Jane Ferguson - Shorewood School, Milwaukee, Wis. "Happy" Glaser-Our Lady of Angels High School, Cincinnati, 0. Rosemary Mackinaw - St. John's Academy, Indianapolis, Ind. Margaret John's Ind. Ann McCarthy - St. Academy, Indianapolis, Regina Shaughnessy - St. Mary's Academy, Indianapolis, Ind. Mary Rose Turner-Lawrence High School, Lawrence, Ind. Mary Elizabeth Zerr - St. Joseph High School, Shelbyville, Ind. Page Three PHOENIX THE WORLD I SAW B:> Theodore Maynard CHINA AND INDIA HOLD MISSION INTEREST Theodore Maynard, depicting life China and India-lands of possibilMiss Helen Faragher of the Indian- on three continents, gives a frank ities chat's how Marian Mission apous Crulct W'eliare Bureau of the and captivating self-revelation in Crusaders look at chem. Of China, the .ueparcment of l'ubltc Welfare, in her The World I Saw. Born in India, the newly entered scene of labor of the cau;:. to the Social Psychology class son _of ~ligent and steadfast English nrst :foreign missionaries among the J.Jecember 1, emphasized that the fun- nuss10nanes, Mr. Maynard _spends his Sisters of St. Francis, Oldenburg, we damencal principle of child welfare pre-school years there. He_ 1s educate~ nope soon to have first-hand informais the preservation of the home. Msgr. lil England._Early _he realizes chat his tion. J..eegan pointed the way when he said: ever-mcreasmg d~s1re to wnce cannot Here's just one example of the rel O forget the home is to forget the be fulfilled unul its possessor ~as cent spectacular expansion of the chlld." This was the keynote of the reached. some 1I10er peace of _= d Church in India. In 1885, there were nrst White House Conference on conce_rrun~ the purpose and destmy of only 2,000 Catholics in Chota NagChlld Welfare in 1919. man 10 this world. pur, India; in 1935, the grace of God l ne rust plan embodying this prinFo~ several !ears the author trav:- and the indefatigable work of Misciple was the establishment, in metro- 1 els_ :'idely se~king the answer to this sionaries had raised that number to poUtan areas, of a Mothers' Aid Fund, , dnvmg quest10n. In Amenca he at- 256,000 . If at other places the exto enable destitute mothers to care for ! tempts, unsuccessfully, to preach the pansion has been less rapid and breaththeir children in the home. The Social I Gospel in a ew England village taking, it is still considerable. Security Act of 1935 and the Desti- church . . Subsequently he is forced to For every ninety lndiabs in Greater tute Children's Act of 1936 extended e~age lil manual labor. Shortly he India, there is just one Catholic Iafederal assistance to all destitute chil- returns to _Eng(and. . dian compared with one Catholic for dren without removing the guardian- . The penod rmmediately fo!lcwing every six Americans in the United slup of parents or relatives. his conversion to the Catholic Church States. At that India is better off Child Welfare Aid in the United prov~ one ~f di.flicult readjustment . than China where there is only one States has been supplemented by the Ca nd1 dacy _10 two mona st enes par- Catholic for every 140 Chinese. Here outstanding work of Catholic Wei- tially conv10ces _him th_at he is not 1s a genuine challenge. fare organizations. A Pittsburg priest mtended for rehgwus _life. Of t~s pioneered in the establishment of t.li.e he is_ completely convmced after his Cottage Plan. mHar~1aillge to Sara liCasey. ST ART THE DAY IN A PERFECT The local Child Welfare Bureau is ustrious "terary career, begun WAy WITH A CUP OF . . cares for dependent, destitute, and u nd er_ th e t~telage of Cecil Chesterillegitimate children according to the ton, u; cont 10ued by the Meynells. Indiana Welfare A~t of 1936; it li- The author now moves in the world censes and approves boarding and fos- of E~wm Arl'.ngton ~obinson'. ~cln-1 , C. D. KENNY CO. ter homes, nurseries, hospitals, and St . V10 ce~t Millay, Michael Williams, . . . P nor . to and Padraic Colum. Sugar, Coffee, Tea ot h er child ren ,s mst1tut10ns. October 1 1939 35 069 children had Mr. Maynard infuses his own aniIndianapolis been aided; of thes/4,003 were from _matc_d p~rsonalit~ ~to a book, c~arrnMarion County. '.ng 10 its descnpt1on and gerual in - Doris Ann Becker, '42. its humor. - Evelyn Owens, '41. I 7:30 Coffee Sodality Reception Held With ~imple _but impressive ceremorues, six candidates for membership in Our Lady, Seat of Wisdom, Chapter of the Sociality of the Blessed Virgin Mary were inducted into the Sociality with all the rights and privileges of regular members on Tuesday, December 12, 1939. The day selected was the feast of Our Lady of Guadalupe following close in the wake of that of the Immaculate Conception. -R. M. St. Mary Academy 429 East Vermont Street THE HIGH SCHOOL If It's INSURANCE FOR YOUR GIRL WE WRITE IT! Courses Call Main 4268 Regular FOUR-YEAR Literary Course combined 635-636 Dixie Terminal Bldg. with full TWO-YEAR Cincinnati, Ohio Commercial Course Jos. T. Dillhoff The Sportsman's Store, Inc. Headquarters for Ice Skates and Rink Skates 126 N. Pennsylvania St. Ma 4413 Indianapolis Compliments of The Abbey Press GIFTS FOR CATHOLICS at ST. MEINRAD, INDIANA Krieg Brothers CATHOLIC SUPPLY HOUSE 19 East Ohio Street Compliments of OUR LADY OF ANGELS HIGH SCHOOL St. Bernard, Ohio Winter, 1940 THE PHOENIX Page Four PINAFORE CAST Freshmen Stand Revealed in Song and Story Dr. Theodore Maynard Lectures ( Continued from Page 1) Chesterton fulfills the rypical conception of a poet, being absent-minded I and not often punctual. Belloc is an I Pc, , D illhoff- .in .1rttst, " ymphonentirely different type; yet the two izi~ o" with , mphonic ; another men were fast friends. Chesterton, ''Pe ~ o' :.h H~.ut". who became a Catholic at the age of "' . fifty, combated the pessismism of the Georgi.:m.1 Feldman - an exemplar of nineties with his doctrines and childche ru le co b en, but not heard; like optimism, based on personal huhappie t Jt '':,ly Prayer". mility. His philosophy was expressed in a few words, "Directly you take a Jan Ferguson- a brown-eyed u an; supercilious at ti tu de enjoyment .1dmitt ing " LoYe pencd My Eye".' withers." Ro em:irv Fi her-.1 chlmpion cypBelloc and Chesterton, so like and i t; n ;t mu h a ki n to the 'Tee ltty yet unlike, met when they united in Fi hie/'. ardent patriotic condemnation of the Imperialism promoting the Boer war. " Happ y '' Gia er-the calle t . irl in As Mr. Maynard pointed out, in their the fre hman cla ; tandmg r.'individual methods of approach lies que c .. . " Take :,le Out to th BJ!; their chief difference: "Belloc argued Ga me". against it; Chesterton laughed at it." Ro emary :.bckin aw - the living With what seemed to be characterfrc hmm " radio" ; cautioned "Lady, Their happy smiies tell the succe of the recent Opera H.M.S. Pinafore- istic abruptness, Dr. Maynard conGo Li gbcly! " The ca t left to right: Front row, Mary Duffy, Boatswain; Betty pencer, cluded this informal discmssion by Mary .Anne Mahan the auburn- ir Jo eph Porter; Rosemary Mackinaw Hebe; Mary Rapia, Ralph Rack- reading four of his own poetic creahaired chauffeur who breezes up the straw; Irene Lippert, Josephine; Mary Jane Lang, Captain Corcoran; Jane tions.- R. M. drive at rwo minute to nine . . . Ferguson, Buttercup; and Mary Margaret Cox, Dick Dead-eye. c ond row: Peggy Dillhoff, Mary Elizabeth Zerr, Rosemary Gueutal, Little bits of powder, "In 11y :.1erry O ld mobile". Rose Marie Davey, and Marie Seal. Little dabs of paint Margare t A.,n I C arthy-a studious Will certainly make any girl Top row: Rose-Mary Spragg, Doris Ann Becker, Mary Rose Turner Alice coll en wi th oratorical leanings; Walpole, Peggy Foltz, Mary Ann~ 1ahan, Charlotte Cambron, Mary Jane Look like what she ain't. keepin g the girls ... " pell-Bound". Moran Margaret Ann McCarthy, George Ann Morgan, Georgiana Feldman, Regina haughnessy, Rosemary Glaser. ~ George Ann .Morgan-the "one-man how"- playin 0 the violin, mandoCompliments of SKATER'S WALTZ lin, " uke" and " radio" and singing LIBRARY ACQUIRES over WFB:.1; ju st "A Litcle Bit NEW TREASURES A FRIEND Independent". A brave and daring sportsman, II y pnze d among recent I ventured on the ice. E spec1a . h fl . . ~ Regu:i-a ~.au hne y- t c ut1 t; ty~1- gifts to the Library are the following: "Perseverance" was my mottofy rng \\nen In h Eyes Are mil1. Christ's Image, the first volume "Grace at any price." ing" . of the French Library of Fine Arts, "Do you chink the water's deep or Mary Rose Tu rne r-an "out-of-door" ed_iced by Pierre Tisne, Pari . It ~onnot'. . . . ,, hobbyist who sp ecializes in chemis- ta ms 12 plate and H reproductions Do you think the ice 1s chin? The Hoosier Station says: cry good at " Concen tratin' ". in colour of masterpieces. With my custo~ary fearlessness, , 2. tudenl Guidance by William- I boldly started !Il. LISTEN TO THESE NEW Alice '\v' al pole-a r egular racer for the on. I slipped, recovered slided, with cusLOCAL SHOWS morning bu ; m ore practical than 3. Heroines of Christ edited by tomary vim, " Alice in Wonderland". Rev. Jo eph Husslein, S.J. tottered, reeled, hit the ground, "Three Quarter Time" ,.E z fi h h f 4. Complete PlaJs of Gilbert and Then peacefully gave in. Monday thru Friday, 3 :00 P. M. ,nary . err - r t Ill t e rus or // . I d. "You can have t he ice w ho want 1t, " "Wm. Wirges Presents" the ma il ; ot h crw1 e "L"1t t le Ze rr 1S11 l!'an, me u mg numerous photohi d E h ,, graph from recent performances by ac ng, I declaime , Monday thru Friday, 3:30 P. J\L c ~H. G., R. M. D., L E. z. the D'Oyly Carte Company. Gave one last look of anguish, " HOOSIER TALENT TIME" 5. Cow plete W ork.s of Lewis Car- Then started off again. Tuesdays- t; L5-9:45 P. M. roll. -R. M. 6. Unhersil)' of Literature in twenty volumes, edited by W. H . Depuy. Ro e la ne DJ, ey-a loYer of hor_c ; her gloric sung in "Ro e Iarie'\ .1. WFBM ============================= Haag's Drug Store 30th and Clifton COMPLIMENTS Courteou s Service OF We d eliver Ta 0480 Mr. and Mrs. Joseph H. Lang John S. Gingrich Compliments of GENERAL CONTRACTOR OMAR CO. Indianapolis Broadw ay 4385 Makers of The Blue Ribbon Bread Academy of the Immaculate Conception Oldenburg, Indiana State Commissioned High School for Girls  ...

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