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... Hindawi International Journal of Vascular Medicine Volume 2021, Article ID 6693895, 16 pages https://doi.org/10.1155/2021/6693895 Review Article Getting to the Heart of the Matter: Myocardial Injury, Coagulopathy, and Other Potential Cardiovascular Implications of COVID-19 Aaron Schmid , Marija Petrovic , Kavya Akella , Anisha Pareddy , and Sumathilatha Sakthi Velavan Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, USA Correspondence should be addressed to Aaron Schmid; aschmid310@marian.edu and Sumathilatha Sakthi Velavan; ssakthivelavan@marian.edu Received 15 December 2020; Revised 30 March 2021; Accepted 8 April 2021; Published 6 May 2021 Academic Editor: Antonio Bozzani Copyright 2021 Aaron Schmid et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. COVID-19 was primarily identied as a respiratory illness, but reports of patients presenting initially with cardiovascular complaints are rapidly emerging. Many patients also develop cardiovascular complications during and after COVID-19 infection. Underlying cardiovascular disease increases the severity of COVID-19 infection; however, it is unclear if COVID-19 increases the risk of or causes cardiovascular complications in patients without preexisting cardiovascular disease. The review is aimed at informing the primary care physicians of the potential cardiovascular complications, especially in patients without underlying cardiovascular disease. A comprehensive literature review was performed on cardiac and vascular complications of COVID-19. The primary cardiac and vascular complications include myocarditis, acute coronary syndrome, myocardial injury, arrhythmia, heart failure, shock, multisystem inammatory syndrome, venous and arterial thrombotic events, stroke, and coagulopathy. A detailed analysis of the pathogenesis revealed six possible mechanisms: direct cardiac damage, hypoxia-induced injury, inammation, a dysfunctional endothelial response, coagulopathy, and the catecholamine stress response. Autopsy reports from studies show cardiomegaly, hypertrophy, ventricular dilation, infarction, and brosis. A wide range of cardiac and vascular complications should be considered when treating patients with conrmed or suspected COVID-19 infection. Elevated troponin and natriuretic peptides indicate an early cardiac involvement in COVID-19. Continuous monitoring of coagulation by measuring serum D-dimer can potentially prevent vascular complications. A long-term screening protocol to follow-up the patients in the primary care settings is needed to follow-up with the patients who recovered from COVID cardiovascular complications. 1. Introduction The World Health Organization (WHO) describes coronaviruses as a group of viruses, several of which infect humans, which usually cause respiratory disease or illness, ranging from the common cold to severe acute respiratory distress syndrome (ARDS) [1]. The most recently discovered coronavirus, SARS-CoV-2, causes the infectious disease COVID-19, a pandemic aecting many countries around the world [1]. COVID-19 typically presents clinically as fever, dry cough, dyspnea, and fatigue, but signs and symptoms vary widely [1]. Reports are emerging of patients presenting with cardio- vascular symptoms, including chest tightness and heart palpitations [2, 3]. Some patients present exclusively with cardiac complaints and do not have any other respiratory complaints [3]. Underlying cardiovascular disease increases the risk of severe COVID-19 disease and death [4, 5], but does COVID-19 infection increase the risk of, or cause, cardiovascular complications or cardiovascular disease in patients without underlying cardiovascular disease? Dweck et al. (2020) demonstrated that the cardiovascular system seems to be one of the most common organ systems aected by COVID-19. After excluding patients with preexisting ischemic heart disease, heart failure, and valvular heart 2 International Journal of Vascular Medicine disease, 46% of patients with COVID-19 with an indication for echocardiography (suspected left ventricular failure, suspected right heart failure, and elevated cardiac biomarkers) had echocardiographic abnormalities including myocardial infarction, myocarditis, and Takotsubo cardiomyopathy [6]. Another study showed 50% of COVID-19 patients had electrocardiographic abnormalities, and 42% experienced chest pain, palpitations, or dyspnea [7]. In the same study, 75% of cases in the same study had cardiac magnetic resonance (CMR) abnormalities [7]. These complications are consistent with previous case reports [810]. COVID-19 triggers several cardiac sequelae, including myocardial injury, acute coronary syndromes, myocarditis, arrhythmias, and acute onset heart failure [1114]. The overall incidence of cardiac injury caused by COVID-19 varies from 7-64%, depending on the parameter used, among hospitalized patients in various reports [6, 7, 1113]. COVID-19 can also manifest as vasculopathy. Recent studies have shown the impact that COVID-19 has had on increasing the risk of coagulopathies, including thrombotic events such as deep venous thrombosis (DVT), coagulopathy, and stroke [1518]. General risks for coagulopathy and pathogenesis of thrombosis include age, acute illness, being bedridden, stasis, genetics, fever, diarrhea, sepsis, liver injury, CKD, COPD, HF, and malignancy [19]. This review intends to provide the primary care physicians with concise knowledge of potential cardiovascular complications in COVID-19 patients to understand the disease course better and decide how to manage and treat patients. Major common cardiac and vascular complications in COVID-19 patients were investigated, with an emphasis on those without known underlying cardiovascular disease. The authors expect this review will contribute to the intake and management of patients with suspected and conrmed COVID-19 infection making evaluation and treatment safer and more ecient. The aim is to ensure physicians are up to date on the cardiovascular complications that can arise from COVID-19. 2. Main Text 2.1. Pathogenesis of COVID-19 Cardiovascular Disease. The exact mechanism by which COVID-19 causes myocardial injury and damage is being investigated. Kim et al. proposed six dierent mechanisms by which COVID-19 infection may cause cardiovascular injury and manifestations [20]. These mechanisms do not individually explain the cardiac injury caused by COVID-19, but rather multiple factors aect the cardiovascular system in dierent ways. (1) Direct Cardiac Damage Mediated via an AngiotensinConverting Enzyme (ACE-2) Receptor-Dependent Myocardial Infection [20]. ACE-2 receptors are expressed in the heart, more highly expressed than in the lungs [21], and the SARS-CoV-2 virus binds and utilizes these receptors. Also, this virus can decrease angiotensin 1-7 levels, which play a protective role against cardiovascular complications [22] (2) Hypoxia-Induced Injury from Oxidative Stress, Acidosis, and Mitochondrial Damage [20]. Researchers built on the idea of hypoxia-induced cardiac injury stating that the common manifestation of respiratory distress caused by COVID-19 infection can result in hypoxemia leading to an oxygen supply and demand mismatch [23, 24]. Hypoxemia arising from COVID19-induced lung injury may lead to injury of cardiomyocytes as hypoxemia can cause accumulation of metabolites, including oxygen free radicals [25] (3) Inammation Leading to Vessel Hyperpermeability and Angiospasm, Causing Microvascular Damage to the Heart [20]. A dysfunctional endothelial response during COVID-19 infection, due to direct COVID19 infection of endothelial cells, aging, or chronic disease, turns into increased apoptosis and disruption of intercellular junctions. This, in turn, leads to increased permeability, leakage of uid, leukocytes, and proteins. This hyperpermeability and leakage then interfere with oxygen exchange in the lungs and induce microcirculatory disorders in the heart [26] (4) Damage Mediated by a Systemic Inammatory Reaction and Cytokine Storm [20]. Research suggests that in COVID-19-infected patients, the systemic inammatory reaction, immunologic derangement, and cytokine storm can lead to arrhythmia, thrombosis, coagulopathy, and other cardiovascular sequelae [23]. Guo et al. showed that rising troponin levels, indicating myocardial injury, in patients with COVID-19 correlated to rising C-reactive protein levels suggesting that the myocardial injury may be inammation-mediated or related to an inammatory mechanism. Inammatory cytokines released due to COVID-19 infection may lead to tissue damage and dysfunction, reduce coronary blood ow and oxygen supply, and may lead to plaque destabilization and the formation of microthrombi [27]. Studies have shown that severe COVID-19 patients are exposed to high concentrations of cytokines [28]. Release of cytokines and damage-associated molecular patterns trigger endothelial activation leading to vasodilation and prothrombotic events [19, 29, 30]. These aspects of COVID-19 infection are driving factors of ARDS, coagulopathy, and COVID-19-related cardiovascular complications [31] (5) Vessel Occlusion as a Result of Coagulopathy, Thrombosis, Embolus, Plaque Instability, or Plaque Rupture from the Systemic Inammatory Response [20]. Occlusion leads to myocardial ischemia and infarction. COVID-19 patients are prone to venous thrombosis due to fever and diarrhea, hypotension due to dehydration, secondary infections, and prolonged bed rest [17]. Direct infection of endothelial cells increases cytokine production, enhances tissue factor expression, and increases NF-B [32]. This, in turn, can trigger an inammatory response and activation of the coagulation pathway, creating an ideal International Journal of Vascular Medicine environment for thrombotic events to occur [32, 33]. Platelets from critically ill COVID-19 patients showed upregulation of eIF4E, p38, and phosphorylation of ERK1/2, which indicates increased activation of the MAPK pathway. Increased MAPK signaling promotes thromboxane generation, a mechanism triggering platelet hyperactivity that may be present in COVID-19 patients [34]. Thrombotic events in patients with COVID-19 may be due to antiphospholipid antibodies. Still, it is dicult to dierentiate the cause of a thrombotic event as it may coincide with other causes such as DIC, heparin-induced thrombocytopenia, and thrombotic microangiopathy [35] (6) Another Possible Cause Is Stress-Induced Cardiomyopathy and Cardiac Injury [20]. Increased cardiac workload, up to eight-fold, during viral infection, to compensate for the increased metabolic demands, compounded by the many eects of the infection on the lungs and breathing, considerably impairs cardiac function [36] To summarize, direct injury, hypoxia, microvascular damage, and systemic inammatory syndrome may all lead to inammation of the heart, myocarditis, and acute cardiac injury. 2.2. Cardiac Complications. Myocarditis and acute cardiac injury further complicate the infection with the potential to lead to arrhythmia, heart failure, and cardiogenic shock [20]. Pertinent cardiac ndings from several COVID-19 studies are presented in Table 1. 2.2.1. Myocarditis. Myocarditis has many dierent causes, including infection (viral, bacterial, etc.), autoimmune disease (SLE, etc.), and medications. Myocarditis can also be idiopathic. Inammation seen in myocarditis can be focal or global, can lead to chamber dysfunction or necrosis, and has the potential to cause chronic cardiovascular complications [37]. The clinical presentation of COVID-19 is like the myocarditis of any etiology and includes fever, hypotension, dyspnea, chest pain, and arrhythmia. Viral myocarditis may also mimic myocardial infarction, acute coronary syndrome, or heart failure with nonspecic electrocardiographic changes (ST elevation, T-wave inversion, ST depression, and pathologic Q-waves), elevated enzymes, hemodynamic instability, tachycardia, displaced point of maximal impulse, or S3/S4 gallop. Myocarditis may also progress to heart block, arrhythmia, and impairment of left ventricular function [3741]. Myocarditis, of any cause, is often preceded by u-like and gastrointestinal symptoms. These are also some of the most common presenting symptoms of patients with COVID-19, making the diagnosis and management of the disease process tricky [42]. COVID-19-related myocarditis manifestation can range from mild symptoms to acuteonset heart failure. Patients who present with fulminant 3 myocarditis often have a fever, sinus tachycardia, cold extremities, and low pulse pressure [43]. Recognition that viral myocarditis with the frequent rise in troponin is integral to the diagnostic and treatment approach considered in COVID-19-infected patients. Fulminant myocarditis and heart failure have also occurred in COVID-19-infected patients [44]. Multiple case reports of fulminant myocarditis in COVID19 patients without underlying cardiovascular disease have been described [9, 19, 45]. While this type of injury could be due to direct damage to the heart by circulating virus, it is suspected to be mediated by immune system reaction and inammation as most cases of fulminant myocarditis were sporadic and resolved after treatment [46]. An occurrence of acute myocarditis in an adolescent patient was reported. The patient had almost none of the typical signs and symptoms except fever, thus, indicating testing for COVID-19 in the pediatric age group with features suggestive of acute myocarditis [47]. A study of 1,216 patients with COVID-19 infection showed that 55% of patients that received an echocardiogram (due to suspected left or right heart failure, chest pain with ST-elevation, cardiac biomarker elevation, ventricular arrhythmia, suspected tamponade, or cardiogenic shock) had an abnormal echocardiogram. Left ventricular abnormalities were seen in 39%, and right ventricular abnormalities were seen in 33%. Evidence for myocardial infarction was seen in 3%, and evidence of myocarditis was seen in 3%. Of the 1216 patients, 901 (74%) patients did not have an underlying cardiac disease; still, 46% of them had abnormal echocardiograms, and 13% had severe disease. 25% of those without the preexisting cardiac disease had abnormal left ventricles, 33% had abnormal right ventricles [6]. 2.2.2. Acute Coronary Syndrome (ACS). Increased risk for thrombotic events can lead to increased ACS risk in COVID-19 positive patients. Furthermore, upon onset of inammation, ACS can be caused by plaque rupture due to macrophage activation, endothelial cell activation, smooth muscle cell activation, tissue factor expression, and further inammation onset due to platelet activation [20]. Cases of both occluded and patent myocardial infarctions have been observed previously in the setting of viral illnesses [4850]. Although the frequency remains unclear, myocardial injury with ST-segment elevation has been observed in COVID-19 patients. In a case series of 18 patients with COVID-19, 14 had focal ST-segment elevation, and four had diuse ST-segment elevation. Ten patients had STsegment elevation upon presentation. The other eight patients developed ST-segment elevation during hospitalization. Still, their treatment is unknown, and if it included azithromycin or hydroxychloroquine, it might have contributed to the development of rhythm abnormalities. Eight patients had a reduced left ventricular ejection fraction [8]. Several other case reports have demonstrated ST-segment elevation or Brugada pattern on electrocardiography [5154]. The link between fever and Brugada pattern and cardiac arrest has been described extensively in the literature. Patients with Brugada pattern and COVID-19 should be monitored regardless of their respiratory conditions [55].  Cardiac injury biomarkers Shock Coagulopathy Medications 23% 77% 11% 7% Coronary artery disease CHF Cardiomyopathy Previous MI 19% Dyslipidemia 100% 0% 57% 12% 6% Hypertension CV disease Comorbidities ICU Non-ICU 12% 75% 41% 12% Antibiotic use Antiviral use Mechanical ventilation 15% 23% Elevated troponin Arrhythmia Heart failure 50% 37% Myocarditis 416 274 Shi et al. Chen [57] et al. [89] 4% 11% 31% 20% 20% 8% 34% 43% 86% 91% 24% 41% 44% 64 64 62 (median) (median) (median) 24 Bhatraju et al. [114] Myocardial infarction ECG abnormalities Cardiomyopathy CMR abnormalities 75% 32% Clinical ndings 29% Palpitations 63 (median) 52 (median) Age Cardiac symptoms Chest pain 5700 139 Richardson et al. [113] N Eiros et al. [7] 17% 8-12% n/a 1527 Li et al. [25] 137 Liu et al. [11] 41% 14% 2% 10% 17% 21% 10% 7% 71 57 (mean) (median) 339 Wang et al. [115] 27% 73% 17% 59% 95% 40% (n = 68) 150 Ruan et al. [56] 3% 15% 5% 95% 2% 1% 47 (median) 1099 Guan et al. [116] Table 1: Cardiac complications. 100% 0% 71% 33% n/a 21 Arentz et al. [75] 138 Wang et al. [13] 52 Yang et al. [110] 15% 15% 32% 68% 10% 7% 12% 12% 31% 15% 26% 74% 12% 90% 18% 9% 17% 7% 10% 100% 0% 42% 23% 49 56 60 (median) (median) (mean) 41 Huang et al. [117] 8% 30% 26% 74% 17% 19% 23% 17% 17% 56 191 Zhou et al. [74] 4% 11% 33% 24% 89% 98% 34% 6% 28% 28% 59 (mean) 187 Guo et al. [27] 100% 0% 40% 100% 100% 10 (mean) 20 Grimaud et al. [118] 11% 71% 4% 96% 100% n/a 28 Stefanini et al. [119] 4 International Journal of Vascular Medicine Survived Death Richardson et al. [113] 5147 553 Eiros et al. [7] 12 12 Bhatraju et al. [114] 359 57 161 113 Shi et al. Chen [57] et al. [89] Li et al. [25] 274 65 Wang et al. [115] 121 16 Liu et al. [11] 82 68 Ruan et al. [56] Table 1: Continued. 1084 15 Guan et al. [116] 10 11 Arentz et al. [75] 35 6 Huang et al. [117] 132 6 Wang et al. [13] 20 32 Yang et al. [110] 137 54 Zhou et al. [74] 144 43 Guo et al. [27] 20 0 Grimaud et al. [118] 17 11 Stefanini et al. [119] International Journal of Vascular Medicine 5 6 International Journal of Vascular Medicine Table 2: Denition and incidence of cardiac injury from COVID-19 studies. Study Patients (N) Cardiac injury denition Incidence of cardiac injury in COVID-19 infection (N (%)) Guo et al. [27] 187 52 (27.8%) Huang et al. [117] 41 Wang et al. [13] 138 Yang et al. [120] 52 Zhou et al. [74] 191 Elevated troponin-T Elevated hs-troponin-I ECG Echo Elevated troponin-I ECG Echo Elevated hs-troponin-I Elevated troponin-I ECG Echo It is essential to note the overlapping disease course and symptomatology between ACS and COVID-19 [12]. The signs and symptoms of infection and cardiac damage can present similar to acute coronary syndrome; therefore, a high index of suspicion for dierential diagnoses must be required by physicians, and alternative noninvasive diagnostic methods utilized [20]. 2.2.3. Biomarkers of Myocardial Injury. The denition of myocardial or cardiac injury varies between studies, and no integrated denition is currently present. Varying denitions of myocardial injury are presented in Table 2. Elevated cardiac biomarker levels, myocardial inammation, electrocardiographic abnormalities, and echocardiographic abnormalities are highly prevalent in patients with COVID-19. These signs are associated with a more severe disease course and a worse prognosis. Signs of myocardial injury have been seen in up to 30% of hospitalized COVID19 patients [4, 27, 56, 57]. Evidence of myocardial injury is most often correlated to elevated troponin levels. Potential causes for elevated troponin in COVID-19 patients include myocarditis, cardiomyopathy, hypoxic injury, ischemic injury (increased oxygen demand due to fever or tachycardia, or decreased oxygen supply due to hypotension or hypoxemia), vascular or microvascular damage (due to increased reactive oxygen species, endothelin imbalance, or endothelial dysfunction), and systemic inammation (cytokine storm). The clinical value of troponin levels outside of acute coronary syndrome, myocardial infarction, and heart failure is dicult to quantify [27]. While abnormal troponin levels may lead to unnecessary use of resources and testing, all action must be taken to appropriately monitor and treat COVID-19infected patients due to the similar presentation of ACS and COVID-19 infection and the potential for fatal outcomes. Further research is needed to establish the clinical value of troponin levels in COVID-19-infected patients. Elevated troponin levels were associated with elevated levels of CRP and NT-proBNP, linking myocardial injury to the severity of inammation and ventricular dysfunction [27]. 2.2.4. Arrhythmia. Arrhythmias represent one of the complications of COVID-19 infection, demonstrated in 16.7% of 5 (12%) 10 (7.2%) 12 (23%) 33 (17%) patients with an increased prevalence of 44.4% in patients admitted to the ICU [4, 58]. Arrhythmia was demonstrated in another study in 16.7% of hospitalized COVID-19 patients [13]. There appear to be more possible mechanisms causing arrhythmia in COVID-19 patients than other cardiac complications, possibly explaining its high prevalence. Arrhythmia could result from myocarditis, myocardial ischemia, infection-induced hypoxia, fever, metabolic disarray, hormonal dysregulation, medication, or inammation. Myocarditis-induced arrhythmias have been seen in COVID-19 positive patients in an acute setting or chronic myocarditis [43]. Electrolyte abnormalities, in particular, hypokalemia, which can occur in any systemic illness, may also be of particular concern in causing arrhythmia in COVID-19-infected patients due to the virus interaction with the renin-angiotensin-aldosterone system [59]. Myocarditis or myocardial inammation could result in sinus node dysfunction and, ultimately, arrhythmia in COVID-19 patients [60, 61]. Palpitations were one of the most common presenting symptoms in 7.3% of patients in a cohort of 137 COVID-19 patients [11]. More serious arrhythmia complications shown to arise in COVID-19 infection include ventricular tachycardia, atrial brillation, ventricular brillation, atrioventricular block, and cardiogenic shock [4, 58, 62]. Patients diagnosed with COVID-19 infection that have elevated cardiac biomarkers may develop new-onset arrhythmia. New-onset arrhythmia in the setting of elevated cardiac biomarkers can indicate myocarditis and should raise suspicion for underlying myocarditis. Primary care physicians must include this in their treatment plan and provide adequate monitoring and follow-up [4]. The risk of arrhythmia could also be associated with the usage of early COVID-19 treatments such as azithromycin and hydroxychloroquine. The use of hydroxychloroquine and azithromycin has independently been shown to cause arrhythmia [63, 64]. While they were used in COVID-19 patients, no studies were found separating COVID-19 patients experiencing arrhythmia into groups receiving the drug(s) and not receiving the drug(s). This makes it even more challenging to discern a cause of arrhythmia and the true prevalence of arrhythmia in patients with COVID-19 International Journal of Vascular Medicine infection not taking hydroxychloroquine or azithromycin [1113, 65]. Another evidence showed that many patients might have higher QT values even before starting the drugs potentially causing further QT prolongation [66]. In patients grouped under Out of hospital arrests during the COVID19 pandemic, a study on post-ROSC (return of spontaneous circulation) showed prolonged QTc values in 12 out of 27 patients [67]. The incidence of arrhythmia needs to be further evaluated in future studies in COVID-19 patients not given azithromycin or hydroxychloroquine, as the exact contribution of COVID-19 infection to arrhythmia development is unknown. Hence, physicians must keep the risk of arrhythmia and myocarditis in mind when treating and evaluating COVID-19 patients. 2.2.5. Out of Hospital Cardiac Arrest (OHCA). A higher incidence of out-of-hospital cardiac arrest has been noted in patients suspected of or with a conrmed diagnosis of COVID-19 [68] [67]. Even in patients on whom emergency personnel attempted resuscitation, OHSA occurred at 14.9% points more in 2020 as compared to 2019 [69]. Another study observed a lower attitude of laypeople in initiating cardiopulmonary resuscitation during the COVID-19 outbreak compared to 2019. The study also noted that a conrmed or suspected COVID-19 infection did not inuence the resuscitative attempts by BLS and ALS sta [70]. A doubling of the incidence of OHCA and a simultaneous reduction in survival rate that was noticed during the COVID-19 pandemic was also noted in Paris. The rise was partly attributed to COVID-19 infection and indirectly related to lockdown and health care services-related adjustments [71]. When the number of COVID-19 cases peaked in New York City, a three-fold higher number of OHCA underwent resuscitation compared to the same period in 2019 and most were older, more likely to have specic comorbidities [72]. A study across a longer time period conrmed that the OHCA trend paralleled the ascending and descending phases of the COVID-19 pandemic [73]. 2.2.6. Heart Failure. Heart failure has been shown to occur in up to 23% of infected patients. They seem to occur secondary to exacerbation of left ventricular dysfunction, myocarditis, acute coronary syndrome, arrhythmia, pulmonary hypertension, ARDS, or cardiomyopathy [12, 74]. The incidence of cardiomyopathy in critically ill ICU patients has yet to be evaluated on a large scale but has been shown to develop in up to 33% of patients [75]. A small case series of COVID19 patients with acute cor pulmonale showed profound hemodynamic instability and cardiac arrest with acute right ventricular failure [76]. 2.2.7. Children and Multisystem Inammatory Syndrome. The pediatric population appear to have a milder clinical course but may still show some cardiac complications such as arrhythmia and must be monitored [77]. A systemic inammation syndrome, like Kawasaki disease, has been shown in children as well. A case report of a pediatric patient diagnosed with COVID19, presenting with Kawasaki-like disease, showed arrhythmia, electrocardiographic abnormal- 7 ities, elevated biomarkers, left ventricular systolic dysfunction, pericardial eusion, delayed capillary rell, and gallop on auscultation [78]. Kawasaki disease is associated with left ventricular systolic dysfunction in 20% of patients, coronary artery dilation in 29%, and mitral regurgitation in 27%, suggesting shared mechanisms between Kawasaki disease, cardiac complications and abnormalities, and myocarditis [79]. Despite having a milder clinical course, children should be monitored for cardiac complications and, upon presenting with any Kawasaki-like disease, should be tested for COVID-19. 2.3. Vascular Complications. A wide range of vascular complications has been recognized in patients aected with COVID-19 that include venous and arterial thrombosis, neurological ischemic events, and coagulopathy as summarized in Table 3. 2.3.1. Venous Thrombotic Events (VTE). In a recent study, 184 COVID-19 positive patients in the ICU were evaluated for thrombotic events. All the patients received standard doses of thromboprophylaxis following hospital protocol upon arrival [80]. The patients were in the hospital for a median duration of 7 days: 27% of the patients had conrmed VTE by CTAP or ultrasonography and 3.7% had arterial thrombotic events [80]. Approximately 31% of patients with COVID-19 in the ICU had thrombotic complications despite thromboprophylaxis [80]. These patients also exhibited prolonged PT (prothrombin time) and aPTT (activated partial thromboplastin time) time [80]. 2.3.2. Concomitant Venous and Arterial Thrombotic Events. In a case study, a COVID-19 positive patient was observed to have a severe case of venous thrombosis and arteriosclerosis obliterans of the lower extremities. The patient had a past medical history of uncontrolled type 2 diabetes. Upon arrival to the hospital, lab report showed marked C-reactive protein increase and elevated D-dimer level of over eight ug/mL with a normal PT and aPTT. Vascular ultrasound found DVT in the left lower extremity (LLE) and dorsalis pedis artery occlusion in the LLE on arrival. Anticoagulation and other supportive therapy were given, and after three days, vascular ultrasound conrmed bilateral lower extremity thrombosis with arterial tibialis anterior occlusion and dorsalis pedis artery occlusion on both lower extremities. This patient specically had many risks and predispositions for DVT, however, it should be anticipated that an infection like COVID19 could encourage an even greater hypercoagulable environment as seen with this patient who after three days developed many more clots [18]. Three of four COVID-19 patients in another case series had dermal arterial thrombosis suggestive of antiphospholipid syndrome, one also developed venous thrombosis, and all four patients had elevated D-dimer [81]. Another case series reported arterial thrombosis in three patients. A patient, one-week post-COVID-19-recovery, presented with thrombotic occlusion of all tibial arteries on the right leg, an aortic thrombus in the visceral aorta, and thrombotic occlusion of the left popliteal artery. A patient with no 9 10 (African American) 4 7 12 41 80 Fox et al. [95] Tian et al. [121] Rapkiewicz et al. [100] Bradley et al. [96] Giacca et al. [102] Edler et al. [97] 80 30 12 4 2 25 67 Total Hearts population studied Bryce et al. [93] Study Right ventricular dilation 8.2 days (range 0-25) from admission; 11.6 days from symptom onset 15-52 days from disease onset 12.9 days (range 3-25) from symptom onset; mean 4.4 days from admission 7 days (range 1-14) from symptom onset Hypertension (25%) Mean 79.2 Male -77; female -84 70.4 Range 44-65 Range 59-81 Hypertension (85%), coronary artery disease (14%) Cardiomyopathy (11.25%), arrhythmia (1.25%), cardiac insuciency (38.75%), atrial brillation (18.75%), hypertension (31.25%) Left ventricular hypertrophy (100%) 9.5 days (range 0-61) from admission Hypertension (62.7%), coronary artery disease (31.3%), heart failure (14.9%), atrial brillation (13.4%) Cardiac enlargement Mean time to death Cardiac comorbidities Hypertension (70%), atrial brillation Range 44-78 (10%), heart failure (10%) 69 (range 34-94) Mean/range age (years) Myocyte hypertrophy (12/12) Megakaryocytes with brin microthrombi in cardiac microvasculature (7/7) Scattered myocyte necrosis; no signicant lymphocytic inltration Myocyte hypertrophy and interstitial brosis Other ndings 83% 100% 100% Cardiac interstitial brosis 25% 60% Epicardial mononuclear inltrate Table 3: Vascular complications and pathology. 24% Cardiomyocyte damage suggestive of hypoxic injury (54%) 100% 90% 80.6% Elevated D-dimer 25% Myocardial infarction Cerebral infarct (30%) Neurological vascular lesions 40% 6% Venous thromboembolism Pulmonary embolism (21%) Pulmonary thrombosis (77%) Subsegmental pulmonary emboli (17%) Pulmonary arterial thrombi (57%), venous thrombosis (29%), CD61 platelet aggregates or thrombi (100%) Small, rm thrombi in peripheral parenchyma (100%) Intravascular brin thrombi (25%), CD61 platelet aggregates or thrombi (31%), large pulmonary emboli (6%) Other 8 International Journal of Vascular Medicine 11 12 Wichmann et al. [98] 12 11 Total Hearts population studied Lax et al. [94] Study Coronary/ischemic heart disease (50%) Mean 73 (range 52-87) Biventricular hypertrophy (25%) Biventricular hypertrophy (100%), biventricular dilation (91%) 8.55 days (range 4-18) from symptom onset Hypertension (81.8%), coronary artery disease (27.27%) Mean 80.5 (range 66-91) Other ndings Cardiac enlargement Mean time to death Cardiac comorbidities Mean/range age (years) 90.90% Cardiac interstitial brosis Table 3: Continued. Epicardial mononuclear inltrate 50% Myocardial infarction 71% 86% Elevated D-dimer Neurological vascular lesions 58% Venous thromboembolism Pulmonary embolism Pulmonary arterial thrombosis Other International Journal of Vascular Medicine 9 10 atherosclerotic or thromboembolism risk had an occlusive thrombus at the aortic bifurcation with occlusion of the right common iliac artery and stenosis of the left common iliac artery. Another patient developed a stroke in the territory of the left middle cerebral artery [82]. Additionally, certain types of rashes in COVID-19 patients may be an early clinical sign of an underlying thrombotic or hypercoagulable state [81, 83]. Primary care physicians caring for COVID-19 patients must be aware of hallmark manifestations of cutaneous thrombosis including livedoid and purpuric rashes and necrotic eruptions, all associated with elevated D-dimer levels [81]. 2.3.3. Stroke. Mao et al. (2020) studied 214 patients that tested positive for COVID-19, and of these patients, 36.4% were found to have neurologic symptoms. 41.1% of the patients in this study were severely infected. They had a higher prevalence of nervous system events such as ischemic stroke and cerebral hemorrhage, as well as symptoms of impaired consciousness. They also had high white cell count, high neutrophil count, lower lymphocyte counts, and elevated C-reactive protein (CRP) levels when compared to patients with nonsevere infection [84]. Through this study, the importance of screening severe patients that are older, presenting with comorbidities and fewer typical symptoms of COVID-19, for the potential of stroke or other neurologic symptoms is evident. In a case study in Wuhan, China, three critically ill patients that tested positive for COVID-19 were observed to have coagulopathies. Imaging showed that all three COVID-19 positive patients developed multiple cerebral infarcts. Patient 3 developed a thrombotic event 18 days from disease onset, while patients 1 and 2 developed thrombotic events 18 and 33 days after disease onset, respectively. All the patients showed leukocytosis, thrombocytopenia, elevated brinogen, elevated d dimer, and presence of anticardiolipin IgA antibody and anti-B2 glycoprotein IgA and IgG antibodies [85]. A retrospective study looked at four COVID-19 positive patients that presented with acute stroke. All patients had hypertension. This may suggest the importance of considering comorbidities, especially hypertension, when analyzing patients for risk of mortality due to COVID-19 presenting with stroke. Two of the patients presented with left shift h, while the other two had an elevated cardiac troponin T and D-dimer. IL-6 was only taken in patient 4, and it was elevated, C-reactive protein was tested in patient 1, 3, and 4 and was signicantly elevated in all [29]. These results are consistent with other case studies discussed in which patients presented with coagulopathies. 2.4. Coagulopathy. During the outbreak of COVID-19 in Wuhan, China, abnormal coagulation patterns were recorded by some investigators. One case study investigated 183 patients who were conrmed COVID-19 positive [16]. Of these patients, 71.4% of nonsurvivors and 0.6% of survivors met the criteria of coagulopathy during their hospital stay [16]. An 11.5% mortality was reported in this study. These patients were revealed to have signicantly higher D- International Journal of Vascular Medicine dimer and brin degradation product levels, prolonged PT, and aPTT time compared to those patients that survived [16]. Although the laboratory ndings were consistent with the classic presentation of disseminated intravascular coagulation (DIC), COVID-19 patients generally tend to have thrombotic events rather than the bleeding that is often seen in DIC. However, studies have shown the dierence between the presentation of COVID-19-associated coagulopathy (CAC) and classic DIC [86]. COVID-19 patients presenting with vasculopathies often had abnormal PT/aPTT, D-dimer, and platelet counts [15, 16, 18, 19, 29, 80, 84, 85, 87, 88]. Ninety-nine patients with COVID-19 were used in a retrospective study to look at clinical outcomes with symptoms and lab values documented [89]. The aPTT was found to be decreased in 16% of patients, while the PT was found to be decreased in 30% of patients [89]. A much smaller percentage of patients have an increase in PT or aPTT [89]. In CAC, PT and aPTT can be prolonged or normal, while in DIC, they are both elevated. Prolonged aPTT/PT levels may also be due to administration of LMWH in the hospital, and aPTT prolongation may be due to the presence of antiphospholipid antibodies [90]. In DIC, brinogen levels may be normal to low due to brinolysis suppression from the overproduction of plasminogen activator inhibitor 1 (PAI-1), while in CAC, brinogen levels are elevated [86]. Platelet counts may be high or low in CAC, while in DIC, they are consistently low [86]. Low platelet counts can be indicative of platelets forming aggregates that may result in a thrombotic event [87]. Antiphospholipid antibodies are present in lab testing of COVID-19 patients that present with thrombotic events [85]. Complement is activated, and antiphospholipid antibodies are present in CAC, while both are negative in DIC [86]. In both DIC and CAC, the primary cause and target of coagulopathy are the macrophage and endothelial cells resulting in microthrombosis, with additional venous thrombosis seen in CAC [86]. Endothelial dysfunction and direct endothelial infection can cause a dysfunctional endothelial response during COVID-19 infection. This further contributes to the pathogenesis of thrombosis, coagulation disorders, and myocardial injury in COVID-19 patients [26]. Elevated D-dimer and increased inammatory cytokines IL-1 and IL-6 are also seen in both [86]. D-dimer elevation may be due to the vascular disease state created in some COVID-19 patients along with potential multisystem organ involvement, low-grade inammation, and hypercoagulability [30]. Elevated C-reactive protein was also found in some patients presenting with COVID-19 [18, 29, 84, 89]. Creactive protein typically increases signicantly with inammation [91]. Inammation plays a signicant role in the pathogenesis of clot formation. C-reactive protein has also been found to promote platelet adhesion to the endothelial ceiling, promoting thrombosis [92]. Studies noted this elevated nding, however, did not discuss it in too much detail. Further studies on the correlation of C-reactive protein and thrombotic events in COVID-19 patients would provide a better sense of the importance of using this lab test in the care of COVID-19 patients. International Journal of Vascular Medicine 2.5. Pathology. Many studies have reported cardiac autopsy ndings in COVID-19 patients (Table 3). The gross ndings were reported to be cardiomegaly variably involving the chambers such as global hypertrophy, biventricular hypertrophy or left ventricular hypertrophy, and right ventricular dilatation [9395]. The histopathological examination revealed myocyte hypertrophy, areas of infarction, lymphocytic inltration within the myocardium with or without necrosis, epicardial mononuclear inltrates, and lymphocytic endotheliitis [9599]. A rare nding of an increased number of megakaryocytes in cardiac tissue with brin microthrombi was also noted [100]. The presence of SARS CoV-2 RNA was found in the autopsied hearts [96, 98, 101]. Another report showed isolated cells of heart tissue testing positive for viral RNA, not accompanied by viral replication, infection, or inammation [102]. Endomyocardial biopsy (EMB) in a COVID-19infected patient showed low-grade myocardial inammation and viral particles in the myocardium, suggesting either a viremic phase or, alternatively, infected macrophage migration from the lung [103]. Another study showed myocardial inammation with elevated lymphocytes and macrophages in the absence of tissue necrosis [104]. EMB serves in an accurate diagnosis and provides tissues for the development of specic biomarkers for SARS-CoV-2 myocarditis. However, its use is limited due to contagious spread risk [43]. 2.6. Further Implications of COVID-19 on Cardiovascular System 2.6.1. Cardiovascular Symptoms as the Primary Clinical Presentation. The National Health Commission of China (NHC) has shown some patients with later conrmed COVID-19 rst presented to the doctor because of cardiovascular symptoms such as heart palpitations and chest tightness [3, 11]. A case report of a healthy patient testing positive for COVID-19 reported ndings of myopericarditis accompanied by systolic dysfunction. Additionally, NTproBNP and troponin T levels were elevated, ST elevation was seen on electrocardiography, and thickened walls and diuse edema were detected on cardiac magnetic resonance imaging. The patient did not show any respiratory involvement during the clinical course. These ndings could indicate eventual heart failure onset [105]. A patient with exertional angina presented without fever or respiratory symptoms showed elevated cardiac biomarkers and tested positive for COVID-19 [106]. Another case report was about a patient with persistent chest pressure for two days. The patient denied cough, fever, and dyspnea. Initial ECG showed ST-elevation. The predominant symptoms the patient presented with were cardiac in nature, and there were no signs of infection; however, the patient tested positive for COVID-19 [107]. 2.6.2. Cardiovascular Complications in Patients without Underlying Cardiac Disease. The NHC showed that 11.8% of patients without the underlying cardiovascular disease had substantial heart damage with elevated troponin levels and cardiac arrest [3, 11]. Of the 1216 patients in an echocar- 11 diography study of COVID-19 patients, 901 (74%) patients did not have underlying cardiac disease, yet still, 46% of them had abnormal echocardiograms, and 13% had severe disease. 25% of those without preexisting cardiac disease had abnormal left ventricles, and 33% had abnormal right ventricles [6]. Multiple case reports of fulminant myocarditis, cardiac hypertrophy, electrocardiographic abnormalities, echocardiographic abnormalities, elevated biomarkers, and shock have also all been described [9, 45]. A patient without any past medical history was detailed, showcasing the development of atrial brillation days after the onset of COVID19 infection [62]. Another patient with COVID-19 presented with T-wave inversion, elevated troponin and natriuretic peptides, and echocardiographic signs of left ventricular dysfunction and was conrmed to have myocarditis. He had no history of cardiovascular disease, coronary artery disease, heart failure, lung disease, cancer, hypertension, or smoking [104]. Evaluation of cardiac manifestations in all COVID-19 conrmed or suspected cases is recommended to include but not limited to cardiac symptoms, chest X-ray or CT, unstable vital signs, cardiac biomarkers (ULN of CK-MB, Tn-I, Tn-T), electrocardiography, and echocardiography. It has been shown that cardiovascular complications in COVID-19 infection indicate a worse prognosis [4]. Early investigation, monitoring, and treatment are warranted. Physician recognition that viral myocarditis and notably COVID-19 simulating a myocardial infarction presentation with the frequent rise in troponin is integral to the diagnostic and treatment approach considered in COVID-19infected patients [12]. Further research is needed to determine the time of onset of cardiac complications to make a recommendation on when this monitoring should be started. 2.6.3. Does the Risk of Cardiovascular Disease Persist after COVID-19 Infection? A cohort of 100 COVID-19-recovered patients showed independent of preexisting conditions, CMR evidence of cardiac involvement in 78%, and ongoing myocardial inammation in 60% of patients 2 to 3 months after diagnosis [108]. Another study showed that in patients with no comorbidities, the death rate was 61.5% with elevated hs-Tnl and cardiac involvement [69]. Abnormalities included raised myocardial native T1 and native T2, myocardial late gadolinium enhancement (LGE) indicative of regional scarring, pericardial enhancement, elevated troponin, and decreased left ventricular ejection fraction [108]. This study suggests long-lasting cardiac involvement and exposes the need for ongoing investigation and monitoring of long-term cardiovascular complications from COVID-19. While often bacterial, an increased risk of cardiovascular disease and complications has been linked to pneumonia in a 10-year follow-up study [109]. It is likely that COVID-19 as a primarily respiratory illness, whether pneumonia-like or respiratory distress, will cause similar adverse outcomes. A research suggested that COVID-19-recovered patients will continue to have subclinical or apparent clinical cardiovascular abnormalities, and that those with recovered cardiac function may continue to be at higher risk of developing 12 cardiomyopathy and arrhythmia. The authors suggested developing cardiac screening tools for COVID-19recovered patients now so that future complications can be caught and managed early. Myocardial injury, microinfarction, and brosis can lead to long-term cardiovascular sequelae postinfection such as cardiomyopathy, systolic and diastolic dysfunction, PVCs and VT, and atrial brillation [110]. The concern of myocardial inammation led to investigating the use of cardiac magnetic resonance (CMR) imaging in competitive athletes recovered from COVID-19 [111]. CMR may allow risk stratication before the post-COVID patients can resume their athletic physical activity [111]. It is too early to know if long-term heart damage will be seen in these patients. Follow-up studies such as CISCO-19 [112] and other long-term screening measures are needed. Long-term follow-up studies of these diseases and their association with cardiovascular disease development are scarce. Follow-up studies of COVID-19 survivors are needed. 3. Conclusion Acute cardiac injury is a common cardiovascular complication of COVID-19, and it occurs from direct myocardial injury, inammation, myocardial oxygen supply, and demand mismatch, acute coronary events, and can be iatrogenic or from other unknown causes. Acute coronary events do not appear to be well documented but could result from plaque rupture or aggravation of the preexisting coronary disease. Heart failure can also result from myocardial injury or dysfunction or increased metabolic demand due to systemic disease, causing an acute decompensation of preexisting heart failure. Arrhythmia seems to occur in both mild and severe cases. However, little is known about the clinical value of these complications and manifestations of heart disease in COVID-19. Biomarker elevation, cardiac injury, and other cardiac sequelae may reect the systemic disease and clinical course of COVID-19 infection. Prolonged PT and aPTT, elevated d-dimer levels, and increased brin degradation levels are linked to a higher risk of mortality in COVID-19 patients. The mentioned lab values, excluding the PT/aPTT, signify a hypercoagulable state in a patient, which indicates potential thromboembolism. VTE has frequently been reported, and, upon presentation, patients with suspected and conrmed COVID-19 infection should be assessed for VTE risk. In treating patients with COVID-19, antiplatelet and anticoagulation therapies should be considered. Continued monitoring for signs of cardiac damage and coagulation (D-dimer) can help predict and potentially prevent COVID-19 complications. The cardiovascular system is involved early in the disease course reected in the release of prognostic and highly sensitive troponin and natriuretic peptides. Still, the actual time of onset of cardiovascular complications and symptoms has not been formally evaluated, leaving room for improvement in future research. Developing a cardiovascular screening protocol for COVID-19-recovered patients is crucial for monitoring the patients on a long-term basis by the primary care physician. International Journal of Vascular Medicine Conflicts of Interest The authors declare no conicts of interest. Authors Contributions Aaron Schmid, Marija Petrovic, Kavya Akella, and Anisha Pareddy conceived the idea of the review; Aaron Schmid initiated the design of creating the manuscript; all the authors were involved in literature search and review, writing, revision, and nal approval of the manuscript. Acknowledgments The authors would like to acknowledge Daniel Gelfman, MD, for his time in reviewing and providing thoughtful guidance. References [1] WHO, Q &A on coronaviruses (COVID-19), World Health Organization, 2020. [2] M. Madjid, P. Safavi-Naeini, S. D. Solomon, and O. Vardeny, Potential eects of coronaviruses on the cardiovascular system: a review, JAMA Cardiology, vol. 5, no. 7, pp. 831840, 2020. [3] Y. Y. Zheng, Y. T. Ma, J. Y. Zhang, and X. Xie, COVID-19 and the cardiovascular system, Nature Reviews. Cardiology, vol. 17, no. 5, pp. 259-260, 2020. [4] E. Driggin, M. V. Madhavan, B. Bikdeli et al., Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic, Journal of the American College of Cardiology, vol. 75, no. 18, pp. 2352 2371, 2020. [5] G. D. Batty and M. Hamer, Vascular risk factors, Framingham risk score, and COVID-19: community-based cohort study, Cardiovascular Research, vol. 116, no. 10, pp. 16641665, 2020. [6] M. R. Dweck, A. Bularga, R. T. Hahn et al., Global evaluation of echocardiography in patients with COVID-19, European Heart Journal Cardiovascular Imaging, vol. 21, no. 9, pp. 949958, 2020. [7] R. Eiros, M. Barreiro-Perez, A. Martin-Garcia et al., Pericarditis and myocarditis long after SARS-CoV-2 infection: a cross-sectional descriptive study in health-care workers, medRxiv, 2020. [8] S. Bangalore, A. Sharma, A. Slotwiner et al., ST-segment elevation in patients with covid-19 - a case series, The New England Journal of Medicine, vol. 382, no. 25, pp. 2478 2480, 2020. [9] H. Hu, F. Ma, X. Wei, and Y. Fang, Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin, European Heart Journal, vol. 42, no. 2, p. 206, 2021. [10] P. Meyer, S. Degrauwe, C. Van Delden, J. R. Ghadri, and C. Templin, Typical takotsubo syndrome triggered by SARS-CoV-2 infection, European Heart Journal, vol. 41, no. 19, p. 1860, 2020. [11] K. Liu, Y. Y. Fang, Y. Deng et al., Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province, Chinese Medical Journal, vol. 133, no. 9, pp. 1025 1031, 2020. International Journal of Vascular Medicine [12] K. Mahajan and S. Chandra, Cardiovascular comorbidities and complications associated with coronavirus disease 2019, Medical Journal, Armed Forces India, vol. 76, no. 3, pp. 253260, 2020. [13] D. Wang, B. Hu, C. Hu et al., Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, JAMA, vol. 323, no. 11, pp. 10611069, 2020. [14] P. K. Vlachakis, A. Tentolouris, D. Tousoulis, and N. Tentolouris, Current data on the cardiovascular eects of COVID-19, Hellenic Journal of Cardiology, vol. 61, no. 1, pp. 4648, 2020. [15] J. Sung and S. Anjum, Coronavirus disease 2019 (COVID19) infection associated with antiphospholipid antibodies and four-extremity deep vein thrombosis in a previously healthy female, Cureus, vol. 12, article e8408, 2020. [16] N. Tang, D. Li, X. Wang, and Z. Sun, Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia, Journal of Thrombosis and Haemostasis, vol. 18, no. 4, pp. 844847, 2020. [17] Z. Zhai, C. Li, Y. Chen et al., Prevention and treatment of venous thromboembolism associated with coronavirus disease 2019 infection: a consensus statement before guidelines, Thrombosis and Haemostasis, vol. 120, no. 6, pp. 937948, 2020. [18] B. Zhou, J. She, Y. Wang, and X. Ma, Venous thrombosis and arteriosclerosis obliterans of lower extremities in a very severe patient with 2019 novel coronavirus disease: a case report, Journal of Thrombosis and Thrombolysis, vol. 50, no. 1, pp. 229232, 2020. [19] B. Bikdeli, M. V. Madhavan, D. Jimenez et al., COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review, Journal of the American College of Cardiology, vol. 75, no. 23, pp. 29502973, 2020. [20] I. C. Kim, H. A. Kim, J. S. Park, and C. W. Nam, Updates of cardiovascular manifestations in COVID-19: Korean experience to broaden worldwide perspectives, Korean Circulation Journal, vol. 50, no. 7, pp. 543554, 2020. [21] H. Liu, S. Gai, X. Wang et al., Single-cell analysis of SARSCoV-2 receptor ACE2 and spike protein priming expression of proteases in the human heart, Cardiovascular Research, vol. 116, no. 10, pp. 17331741, 2020. [22] G. Tersalvi, M. Vicenzi, D. Calabretta, L. Biasco, G. Pedrazzini, and D. Winterton, Elevated troponin in patients with coronavirus disease 2019: possible mechanisms, Journal of Cardiac Failure, vol. 26, no. 6, pp. 470475, 2020. [23] A. S. Larson, L. Savastano, R. Kadirvel, D. F. Kallmes, A. E. Hassan, and W. Brinjikji, Coronavirus disease 2019 and the cerebrovascular-cardiovascular systems: what do we know so far?, Journal of the American Heart Association, vol. 9, no. 13, article e016793, 2020. [24] W. Tan and J. Aboulhosn, The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease, International Journal of Cardiology, vol. 309, pp. 7077, 2020. [25] G. Li, R. Hu, and X. Gu, A close-up on COVID-19 and cardiovascular diseases, Nutrition, Metabolism, and Cardiovascular Diseases, vol. 30, no. 7, pp. 10571060, 2020. [26] J. F. Bermejo-Martin, R. Almansa, A. Torres, M. GonzalezRivera, and D. J. Kelvin, COVID-19 as a cardiovascular dis- 13 [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] ease: the potential role of chronic endothelial dysfunction, Cardiovascular Research, vol. 116, no. 10, pp. e132e133, 2020. T. Guo, Y. Fan, M. Chen et al., Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19), JAMA Cardiology, vol. 5, no. 7, pp. 811818, 2020. S. Mohammadi, M. Abouzaripour, N. Hesam Shariati, and M. B. Hesam Shariati, Ovarian vein thrombosis after coronavirus disease (COVID-19) infection in a pregnant woman: case report, Journal of Thrombosis and Thrombolysis, vol. 50, no. 3, pp. 604607, 2020. A. Avula, K. Nalleballe, N. Narula et al., COVID-19 presenting as stroke, Brain, Behavior, and Immunity, vol. 87, pp. 115119, 2020. D. E. Leisman, C. S. Deutschman, and M. Legrand, Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inammation, Intensive Care Medicine, vol. 46, no. 6, pp. 11051108, 2020. P. C. Evans, G. E. Rainger, J. C. Mason et al., Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science, Cardiovascular Research, vol. 116, no. 14, pp. 21772184, 2020. S. Subramaniam and I. Scharrer, Procoagulant activity during viral infections, Frontiers in Bioscience, vol. 23, no. 3, pp. 10601081, 2018. J. C. Kwong, K. L. Schwartz, and M. A. Campitelli, Acute myocardial infarction after laboratory-conrmed inuenza infection, The New England Journal of Medicine, vol. 378, no. 26, pp. 2540-2541, 2018. B. K. Manne, F. Denorme, E. A. Middleton et al., Platelet gene expression and function in patients with COVID-19, Blood, vol. 136, no. 11, pp. 13171329, 2020. Y. Zuo, S. K. Estes, R. A. Ali et al., Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19, Science Translational Medicine, vol. 12, no. 570, article eabd3876, 2020. R. Adao and T. J. Guzik, Inside the heart of COVID-19, Cardiovascular Research, vol. 116, no. 6, pp. e59e61, 2020. M. Esfandiarei and B. M. McManus, Molecular biology and pathogenesis of viral myocarditis, Annual Review of Pathology, vol. 3, no. 1, pp. 127155, 2008. G. W. Dec Jr., H. Waldman, J. Southern, J. T. Fallon, A. M. Hutter Jr., and I. Palacios, Viral myocarditis mimicking acute myocardial infarction, Journal of the American College of Cardiology, vol. 20, no. 1, pp. 8589, 1992. Group JCSJW, Guidelines for diagnosis and treatment of myocarditis (JCS 2009), Circulation Journal, vol. 75, no. 3, pp. 734743, 2011. G. Hufnagel, S. Pankuweit, A. Richter, U. Schonian, and B. Maisch, The European study of epidemiology and treatment of cardiac inammatory diseases (ESETCID). First epidemiological results, Herz, vol. 25, no. 3, pp. 279285, 2000. J. C. Schultz, A. A. Hilliard, L. T. Cooper Jr., and C. S. Rihal, Diagnosis and treatment of viral myocarditis, Mayo Clinic Proceedings, vol. 84, no. 11, pp. 10011009, 2009. A. L. Caforio, R. Marcolongo, C. Basso, and S. Iliceto, Clinical presentation and diagnosis of myocarditis, Heart, vol. 101, no. 16, pp. 13321344, 2015. 14 [43] B. Siripanthong, S. Nazarian, D. Muser et al., Recognizing COVID-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management, Heart Rhythm, vol. 17, no. 9, pp. 14631471, 2020. [44] R. O. Bonow, G. C. Fonarow, P. T. O'Gara, and C. W. Yancy, Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality, JAMA Cardiology, vol. 5, no. 7, pp. 751753, 2020. [45] J. H. Zeng, Y. X. Liu, J. Yuan et al., First case of COVID-19 complicated with fulminant myocarditis: a case report and insights, Infection, vol. 48, no. 5, pp. 773777, 2020. [46] X. Wei, Y. Fang, and H. Hu, Immune-mediated mechanism in coronavirus fulminant myocarditis, European Heart Journal, vol. 41, no. 19, article 1855, 2020. [47] M. Gnecchi, F. Moretti, E. M. Bassi et al., Myocarditis in a 16-year-old boy positive for SARS-CoV-2, The Lancet, vol. 395, no. 10242, article e116, 2020. [48] G. Cuervo, D. Viasus, and J. Carratala, Acute myocardial infarction after laboratory-conrmed inuenza infection, The New England Journal of Medicine, vol. 378, p. 2540, 2018. [49] G. Lippi, C. J. Lavie, and F. Sanchis-Gomar, Cardiac troponin I in patients with coronavirus disease 2019 (COVID19): evidence from a meta-analysis, Progress in Cardiovascular Diseases, vol. 63, no. 3, pp. 390-391, 2020. [50] M. Barnes, A. E. Heywood, A. Mahimbo, B. Rahman, A. T. Newall, and C. R. Macintyre, Acute myocardial infarction and inuenza: a meta-analysis of case-control studies, Heart, vol. 101, no. 21, pp. 17381747, 2015. [51] D. Chang, M. Saleh, Y. Garcia-Bengo, E. Choi, L. Epstein, and J. Willner, COVID-19 infection unmasking Brugada syndrome, HeartRhythm Case Reports, vol. 6, no. 5, pp. 237 240, 2020. [52] M. I. Vidovich, Transient Brugada-Like Electrocardiographic Pattern in a Patient With COVID-19, JACC: Case Reports, vol. 2, no. 9, pp. 12451249, 2020. [53] G. Mahadevaiah, A. Aleem, A. Secaira, S. Saba, and N. Shari, ST elevation in a patient with COVID-19 infectionassociated fever: a case of Brugada pattern, Cureus, vol. 12, article e8722, 2020. [54] T. Asif and Z. Ali, Transient ST segment elevation in two patients with COVID-19 and a normal transthoracic echocardiogram, European Journal of Case Reports in Internal Medicine, vol. 7, no. 5, article 001672, 2020. [55] A. Sorgente, L. Capulzini, and P. Brugada, The known into the unknown: Brugada syndrome and COVID-19, JACC: Case Reports, vol. 2, no. 9, pp. 1250-1251, 2020. [56] Q. Ruan, K. Yang, W. Wang, L. Jiang, and J. Song, Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China, Intensive Care Medicine, vol. 46, no. 5, pp. 846848, 2020. [57] S. Shi, M. Qin, B. Shen et al., Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China, JAMA Cardiology, vol. 5, no. 7, pp. 802 810, 2020. [58] P. E. Lazzerini, M. Boutjdir, and P. L. Capecchi, COVID-19, arrhythmic risk and inammation: mind the gap!, Circulation, vol. 142, no. 1, pp. 79, 2020. [59] M. Bansal, Cardiovascular disease and COVID-19, Diabetes and Metabolic Syndrome: Clinical Research and Reviews, vol. 14, no. 3, pp. 247250, 2020. International Journal of Vascular Medicine [60] G. Cimino, G. Pascariello, N. Bernardi et al., Sinus node dysfunction in a young patient with COVID-19, JACC: Case Reports, vol. 2, no. 9, pp. 12401244, 2020. [61] G. Peigh, M. Leya, J. Baman, E. Cantey, B. Knight, and J. Flaherty, Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series, European Heart Journal - Case Reports, vol. 4, no. FI1, pp. 16, 2020. [62] S. M. Kochav, E. Coromilas, A. Nalbandian et al., Cardiac arrhythmias in COVID-19 infection, Circulation. Arrhythmia and Electrophysiology, vol. 13, no. 6, article e008719, 2020. [63] T. J. Guzik, S. A. Mohiddin, A. Dimarco et al., COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options, Cardiovascular Research, vol. 116, no. 10, pp. 16661687, 2020. [64] D. M. Roden, A current understanding of drug-induced QT prolongation and its implications for anticancer therapy, Cardiovascular Research, vol. 115, no. 5, pp. 895 903, 2019. [65] C. I. Wu, P. G. Postema, E. Arbelo et al., SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes, Heart Rhythm, vol. 17, no. 9, pp. 14561462, 2020. [66] M. Saleh, J. Gabriels, D. Chang et al., Eect of chloroquine, hydroxychloroquine, and azithromycin on the corrected QT interval in patients with SARS-CoV-2 infection, Circulation. Arrhythmia and Electrophysiology, vol. 13, no. 6, article e008662, 2020. [67] E. Baldi, G. M. Sechi, C. Mare et al., COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests, European Heart Journal, vol. 41, no. 32, pp. 30453054, 2020. [68] P. S. Chan, S. Girotra, Y. Tang, R. Al-Araji, B. K. Nallamothu, and B. McNally, Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic, JAMA Cardiology, vol. 6, no. 3, pp. 296303, 2021. [69] S. Ghio, E. Baldi, A. Vicentini et al., Cardiac involvement at presentation in patients hospitalized with COVID-19 and their outcome in a tertiary referral hospital in northern Italy, Internal and Emergency Medicine, vol. 15, no. 8, pp. 1457 1465, 2020. [70] E. Baldi, G. M. Sechi, C. Mare et al., Treatment of out-ofhospital cardiac arrest in the COVID-19 era: a 100 days experience from the Lombardy region, PLoS One, vol. 15, no. 10, article e0241028, 2020. [71] E. Marijon, N. Karam, D. Jost et al., Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study, The Lancet Public Health, vol. 5, no. 8, pp. e437e443, 2020. [72] P. H. Lai, E. A. Lancet, M. D. Weiden et al., Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City, JAMA Cardiology, vol. 5, no. 10, pp. 11541163, 2020. [73] E. Baldi, All the Lombardia CARe researchers, R. Primi et al., Out-of-hospital cardiac arrest incidence in the dierent phases of COVID-19 outbreak, Resuscitation, vol. 159, pp. 115-116, 2021. [74] F. Zhou, T. Yu, R. du et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet, vol. 395, no. 10229, pp. 10541062, 2020. International Journal of Vascular Medicine [75] M. Arentz, E. Yim, L. Kla et al., Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state, Journal of the American Medical Association, vol. 323, no. 16, pp. 16121614, 2020. [76] C. Creel-Bulos, M. Hockstein, N. Amin, S. Melhem, A. Truong, and M. Sharifpour, Acute cor pulmonale in critically ill patients with covid-19, The New England Journal of Medicine, vol. 382, no. 21, article e70, 2020. [77] X. Lu, L. Zhang, H. du et al., SARS-CoV-2 infection in children, The New England Journal of Medicine, vol. 382, no. 17, pp. 16631665, 2020. [78] J. S. Chiu, M. Lahoud-Rahme, D. Schaer, A. Cohen, and M. Samuels-Kalow, Kawasaki disease features and myocarditis in a patient with COVID-19, Pediatric Cardiology, vol. 41, no. 7, pp. 15261528, 2020. [79] B. F. Printz, L. A. Sleeper, J. W. Newburger et al., Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inammatory markers in acute Kawasaki disease, Journal of the American College of Cardiology, vol. 57, no. 1, pp. 8692, 2011. [80] F. A. Klok, M. Kruip, N. J. M. van der Meer et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19, Thrombosis Research, vol. 191, pp. 145147, 2020. [81] E. Droesch, M. Hoang, M. DeSancho, E. Lee, C. Magro, and J. Harp, Livedoid and purpuric skin eruptions associated with coagulopathy in severe COVID-19, JAMA Dermatology, vol. 156, no. 9, pp. 13, 2020. [82] G. Singh, H. Attique, N. Gadela, K. Mapara, and S. Manickaratnam, COVID-19 related arterial coagulopathy, Cureus, vol. 12, article e9490, 2020. [83] C. Galvn Casas, A. Catal, G. Carretero Hernndez et al., Classication of the cutaneous manifestations of COVID19: a rapid prospective nationwide consensus study in Spain with 375 cases, The British Journal of Dermatology, vol. 183, no. 1, pp. 7177, 2020. [84] L. Mao, H. Jin, M. Wang et al., Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China, vol. 77, Tech. Rep. 6, JAMA Neurol, 2020. [85] Y. Zhang, M. Xiao, S. Zhang et al., Coagulopathy and antiphospholipid antibodies in patients with covid-19, The New England Journal of Medicine, vol. 382, no. 17, article e38, 2020. [86] T. Iba, J. H. Levy, J. M. Connors, T. E. Warkentin, J. Thachil, and M. Levi, The unique characteristics of COVID-19 coagulopathy, Critical Care, vol. 24, no. 1, p. 360, 2020. [87] G. Lippi, M. Plebani, and B. M. Henry, Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis, Clinica Chimica Acta, vol. 506, pp. 145148, 2020. [88] G. Zhang, J. Zhang, B. Wang, X. Zhu, Q. Wang, and S. Qiu, Analysis of clinical characteristics and laboratory ndings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis, Respiratory Research, vol. 21, no. 1, p. 74, 2020. [89] N. Chen, M. Zhou, X. Dong et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet, vol. 395, no. 10223, pp. 507513, 2020. [90] I. W. Uthman and A. E. Gharavi, Viral infections and antiphospholipid antibodies, Seminars in Arthritis and Rheumatism, vol. 31, no. 4, pp. 256263, 2002. 15 [91] M. B. Pepys and G. M. Hirscheld, C-reactive protein: a critical update, The Journal of Clinical Investigation, vol. 111, no. 12, pp. 18051812, 2003. [92] G. Yaron, A. Brill, O. Dashevsky et al., C-reactive protein promotes platelet adhesion to endothelial cells: a potential pathway in atherothrombosis, British Journal of Haematology, vol. 134, no. 4, pp. 426431, 2006. [93] C. Bryce, Z. Grimes, E. Pujadas et al., Pathophysiology of SARS-CoV-2: targeting of endothelial cells renders a complex disease with thrombotic microangiopathy and aberrant immune response. The Mount Sinai COVID-19 autopsy experience, medRxiv, 2020. [94] S. F. Lax, K. Skok, P. Zechner et al., Pulmonary arterial thrombosis in COVID-19 with fatal outcome: results from a prospective, single-center, clinicopathologic case series, Annals of Internal Medicine, vol. 173, no. 5, pp. 350361, 2020. [95] S. E. Fox, A. Akmatbekov, J. L. Harbert, G. Li, J. Quincy Brown, and R. S. Vander Heide, Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans, The Lancet Respiratory Medicine, vol. 8, no. 7, pp. 681686, 2020. [96] B. T. Bradley, H. Maioli, R. Johnston et al., Histopathology and ultrastructural ndings of fatal COVID-19 infections in Washington State: a case series, Lancet, vol. 396, no. 10247, pp. 320332, 2020. [97] C. Edler, A. S. Schrder, M. Aepfelbacher et al., Dying with SARS-CoV-2 infection-an autopsy study of the rst consecutive 80 cases in Hamburg, Germany, International Journal of Legal Medicine, vol. 134, no. 4, pp. 12751284, 2020. [98] D. Wichmann, J. P. Sperhake, M. Ltgehetmann et al., Autopsy ndings and venous thromboembolism in patients with COVID-19, Annals of Internal Medicine, vol. 173, no. 4, pp. 268277, 2020. [99] Z. Varga, A. J. Flammer, P. Steiger et al., Endothelial cell infection and endotheliitis in COVID-19, Lancet, vol. 395, no. 10234, pp. 1417-1418, 2020. [100] A. V. Rapkiewicz, X. Mai, S. E. Carsons et al., Megakaryocytes and platelet-brin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: a case series, EClinicalMedicine, vol. 24, p. 100434, 2020. [101] V. G. Puelles, M. Ltgehetmann, M. T. Lindenmeyer et al., Multiorgan and renal tropism of SARS-CoV-2, The New England Journal of Medicine, vol. 383, no. 6, pp. 590592, 2020. [102] R. Bussani, E. Schneider, L. Zentilin et al., Persistence of viral RNA, pneumocyte syncytia and thrombosis are hallmarks of advanced COVID-19 pathology, EBioMedicine, vol. 61, article 103104, 2020. [103] G. Tavazzi, C. Pellegrini, M. Maurelli et al., Myocardial localization of coronavirus in COVID-19 cardiogenic shock, European Journal of Heart Failure, vol. 22, no. 5, pp. 911915, 2020. [104] P. Wenzel, S. Kopp, S. Gbel et al., Evidence of SARS-CoV-2 mRNA in endomyocardial biopsies of patients with clinically suspected myocarditis tested negative for COVID-19 in nasopharyngeal swab, Cardiovascular Research, vol. 116, no. 10, pp. 16611663, 2020. [105] R. M. Inciardi, L. Lupi, G. Zaccone et al., Cardiac involvement in a patient with coronavirus disease 2019 (COVID19), JAMA Cardiology, vol. 5, no. 7, pp. 819824, 2020. 16 [106] M. Rehman, A. Gondal, and N. U. Rehman, Atypical manifestation of COVID-19-induced myocarditis, Cureus, vol. 12, article e8685, 2020. [107] J. A. Fried, K. Ramasubbu, R. Bhatt et al., The variety of cardiovascular presentations of COVID-19, Circulation, vol. 141, no. 23, pp. 19301936, 2020. [108] V. O. Puntmann, M. L. Carerj, I. Wieters et al., Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID19), JAMA Cardiology, vol. 5, no. 11, pp. 12651273, 2020. [109] V. F. Corrales-Medina, K. N. Alvarez, L. A. Weissfeld et al., Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease, Journal of the American Medical Association, vol. 313, no. 3, pp. 264274, 2015. [110] R. D. Mitrani, N. Dabas, and J. J. Goldberger, COVID-19 cardiac injury: implications for long-term surveillance and outcomes in survivors, Heart Rhythm, vol. 17, no. 11, pp. 19841990, 2020. [111] S. Rajpal, M. S. Tong, J. Borchers et al., Cardiovascular magnetic resonance ndings in competitive athletes recovering from COVID-19 infection, JAMA Cardiology, vol. 6, no. 1, pp. 116118, 2021. [112] K. Mangion, A. Morrow, C. Bagot et al., The chief scientist oce cardiovascular and pulmonary imaging in SARS coronavirus disease-19 (CISCO-19) study, Cardiovascular Research, vol. 116, no. 14, pp. 21852196, 2020. [113] S. Richardson, J. S. Hirsch, M. Narasimhan et al., Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area, Journal of the American Medical Association, vol. 323, no. 20, pp. 20522059, 2020. [114] P. K. Bhatraju, B. J. Ghassemieh, M. Nichols et al., Covid-19 in critically ill patients in the Seattle region - case series, The New England Journal of Medicine, vol. 382, no. 21, pp. 2012 2022, 2020. [115] L. Wang, W. He, X. Yu et al., Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up, The Journal of Infection, vol. 80, no. 6, pp. 639645, 2020. [116] W. J. Guan, Z. Y. Ni, Y. Hu et al., Clinical characteristics of coronavirus disease 2019 in China, The New England Journal of Medicine, vol. 382, no. 18, pp. 17081720, 2020. [117] C. Huang, Y. Wang, X. Li et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet, vol. 395, no. 10223, pp. 497506, 2020. [118] M. Grimaud, J. Starck, M. Levy et al., Acute myocarditis and multisystem inammatory emerging disease following SARSCoV-2 infection in critically ill children, Annals of Intensive Care, vol. 10, no. 1, p. 69, 2020. [119] G. G. Stefanini, M. Montorfano, D. Trabattoni et al., ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes, Circulation, vol. 141, no. 25, pp. 21132116, 2020. [120] H. Yang, L. C. Yang, R. T. Zhang, Y. P. Ling, and Q. G. Ge, Risks factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes, Beijing Da Xue Xue Bao. Yi Xue Ban, vol. 52, no. 3, pp. 420424, 2020. [121] S. Tian, Y. Xiong, H. Liu et al., Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies, Modern Pathology, vol. 33, no. 6, pp. 1007 1014, 2020. International Journal of Vascular Medicine  ...

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... Fall 2021 Issue# 3 By Isabella Simons The Indiana Latino lnstitute's Impact on Marian University ida McCammon founded The Indiana Latino Institute (ILi) in 2007 due to the lack of a w orking health and education sy stem throughout the state for the Latino community. According to Maria Quiroz-Southwood, the Education Program Director at ILi, McCammon w anted to bring the Spanish language into the healthcare sy stem for Spanish-speaking patients. ILi offers programming in health and education , including the Indiana Tobacco Program , and the Education Program that started in 2005 . A ILi started basic - connecting Latino students with colleges. The very first Education Summit had 500 students and has grown. In 2079, ILi had over 2,800 students betw een Indianapolis and South Bend. This year they are working to host it in person in Indianapolis, South Bend, and Evansville, aiming to reach over 3,000 students. There are different areas for education , including the College Access program, where the staff pre pares students for college, off ering w orkshops, college coaching, and their Education Summit. #2 Th e Marian Ph oenix Daniela Lopez is a senior at Marian. She said that when in high school, she told her teachers that she wanted to go to college, but she didn't know how. This teacher connected her with ILi in 2076, and she attended the Education Summit. Lopez said "I needed to hear a professional that had a similar story, a similar journey... I didn't know what the process was to go to college. They really filled me in , asked me the hard questions, and just really advocated for me." The second piece of ILi is College Success a program run by Kennya Santiago, a College and Workforce Development Specialist who works specifically with college students. She does one -on -one coaching and coordinates the summer internship program . Lopez said that the coaching helped her to be a better advocate. They inspired her to find a solution to any problem she faces . That as a student w ho doesn 't qualify for financial aid, ILi helped her find scholarships and opportunities. One program is Systems Change, where ILi is working with higher education institutions and focusing on issues and areas of reten tion, recruitment, and graduation rates of Latino students at their schools. ILi has been meeting with chancellors and presidents of higher institutions since 2077. Last year at the Higher Education Consortium in 2020, the results were memorandums of understanding (MOU) that ILi offered higher education institutions. This occurred due to issues impacting Latino students going to their higher education institutions, such as financial aid : eligible for financial aid , first-generation and they need money, DACA or undocumented and there are financial constraints, along with understanding the process of applying to college. ILi is w orking w ith higher institutions to make it easier and more understandable. Last February, the Indiana University of Bloomington signed an MOU w ith ILi stating that for the next fi ve y ears they w ill take t w o students who have w orked w ith ILi, offering a full scholarship. Tw enty-tw o other institutions have signed that MOU , includ- ing Marian, who is giving two scholarships to Latino students. Quiroz-Southwood said that Marian is wonderful to work with. They do one-on-one college coaching. Quiroz-Southwood said that students usually want to get connected with an internship or a scholarship, or they are interested in graduating college. Quiroz-Southwood said that students need guidance on what to do next and are looking for mentors. Quiroz-Southwood directs students to sign up on line at http://indianalatinoinstitute. org/, Under the education tab. Within 48 business hours, they will contact that student to set up an appointment. Quiroz-Southwood talked about Marian, saying that Ill is excited to continue working with them and see that collaboration grow. Along with college coaching, there are other programs built for student success. Ashley Anderson, the College Program Manager, talked about Pathway to Careers, a five-year program to reduce poverty among the Latino community through education. They are trying to increase the number of Latino high school students going to college. There currently is a gap of 15% between Latino students and Caucasian people attending college. Ill is trying to close that gap, and one of the first steps is to recruit more Latino students in Indianapolis. Ill is partnered with three institutions in Indianapolis- Ivy Tech, Marian, and IUPUI. They are concerned with making sure students are getting connected with academic advising, succeeding in classes, and are on track to graduate. Ill works with their student success offices, helping Latinos get involved with student clubs and organizations all for the betterment of their future Anderson said that the goal is to help students go to college and get a job and help support families. Ill's goal is to provide access to good jobs for students, as well as to drive down poverty in Marion County within the Latino population. By doing this, it will not only help students, but generations to come. Lopez said that after going through programs with Ill, "I can speak for myself, I didn't know what the process was to go to college. They really filled me in, asked me the hard questions, and just really advocated for me, and they don't just do that for me, but with everyone in the community they serve." The Marian Phoenix #3 By Nico as Jones A New Look at Higher Learning: A Look Inside Saint Joe Indy ~ For an accompany ing video please go to www.themarianpheonix.com elson Duerson had no clue what his future held beyond high school until a representative from a newer college, St. Joe Indy came to his school. He is now in his second year toward earning an associate's degree in social work at St. Joe Indy. "It was a blessing most definitely... if not for N #4 The Marian Phoenix St. Joe, I honestly don't know where I would 've gone," Duerson said. Saint Joseph College of Marian University is a two-year college where students can earn their associate's degree. Known by locals as St. Joe Indy, created as a collaboration between Saint Joseph College and Marian University. The original Saint Joseph College was a four-year school in Rensselaer, Indiana, and was known for its strong liberal arts foundation. The school faced a series of hardships, with enrollment declining and their finances dwindling, leading to the schoo l's board of trustees suspending operations after the 2076-2077 school year According to Journal & Courier. Plans were announced the next year, to open a new junior col lege in Indianapolis with the help of Marian University. This new school wou ld offer a focused curriculum for students looking to earn their associate's degree According to South Bend Tribune. Students ranging from all backgrounds and year leve ls were able to discuss why they chose St. Joe Indy and openly spoke about their experience. Many of the responses praised the college for what they were doing. They enjoyed the close-knit community feeling it offered, even if there wasn't much of a "campus." Jada Fox, a sophomore studying business who is also a student orientation leader, said "my first day there felt like home." Fox enjoys the comfortable atmosphere that her peers and professors have and believes that the support systems in place help her succeed. Fox is taking time to explore her future options but knows the faculty of St. Joe Indy wi ll be there to support her in any endeavors. The school was built where the Temple of Christ Church used to be. The facility received interior renovations to accommodate classrooms and bring in technology that helps students prepare for modern careers. Parts of the chapel remain intact for both religious purposes and to preserve the history of the building. Hosting three levels, the basement offers classrooms and a small dining area where students have access to cooking appliances, vend ing machines, and a food pantry for those in need. It also has dedicated rooms where K-12 teachers hold online classes. Th e ground floor is primarily where students commune for classes and socializing. Students have access to professors' offices w here they can receive further help or plan for their future. They use the top floor for Marian's Adult Program {MAP), where people w ith full-time jobs or families can still earn a degree on their time. St. Joseph College of Marian University formally opened in the fall of 2079. Small class sizes ensured the college could fulfill its mission : providing a community with support systems and professional opportunities that help students be successful. With St. Joe's liberal art core classes and Marian's Franciscan va lues, students wou ld be prepared to begin their ve nture into the professional wor ld. St. Joe Indy's most unique feature is their Earn and Learn program, where second-year students can be placed in a paid internship whi le still completing classes. Some companies the college has partnered with include One America bank, CNO Financial Group, and Citizens En ergy Group. Professors and advisors work with students to create a flexible schedule that can accommodate education and jobs, even if the students are not a part of the program. Students like Oscar Gonzalez, a sophomore studying Business Management, plan to use what he learns to help grow his entrepreneurship. He currently runs a lawn and landscaping business and hopes to grow it with a merger alongside his family's constructio n company. Before graduation, he is excited to learn about topics like administrating money, professionalism, and marketing. He is confident that putting in the effort and paying attention are the keys to his success at St. Joe Indy. The college has been open for three years now and has seen much success . An increase in enrollment and the addition of new courses offer promising growth for the college. Students have graduated with their associate's degree, with some choosing to transfer to Marian University's main campus and others heading into their career. On paper, the young college is making leaps and bounds with talks of sister colleges being opened around the state. The true test, however, of a college's success is from the perspective of the students. ''The teachers, they care ... That's what means a lot," said Duerson, regarding the professors. St. Joe Indy recognizes that students are not just students. They have other responsibilities , such as work, family, and outside organizations. This , among many other benefits, can make St. Joe Indy the perfect place for those who want an education w ithout the t ypica l constraints. If you are interested in knowing more about St. Joe Indy, go to https://findout.marian.edu/twoyearcollege/ The Marian Phoenix #5 N :l I.. u r::l C'tl ...J >. .0 I/) 0 0 .c: a. Top Row: Anthony Roberts, Jada Briscoe-Fox, Lynea Wa res Bottom Row: Niya Crafton, Nelson Duerson, Victure A. Coffey, Oscar Gonzalez # 6 The M arian Ph oen ix a p 0 a a z ynameis Laura Cruz and I'll be introducing a few Marian Knights in this piece. I wanted to write about students in their hometowns because I feel like sometimes we forget that ou r fe llow peers aren't just from Indianapoli s. These students, Leonardo lbar- M ra Ortiz, Nicolas Jones, and Vanessa Gomez are all from different tow ns and c ities around Indiana. I had the pleasure of accompanying them to the place they ca ll home and do ing a photoshoot in the most "popular" or "known" areas of their town/c ity. First, we have Leonardo Ibarra Ortiz. Leo is a junior at Marian University, majoring in Business Management with a minor in Pastoral Leadership. His hometown is Columbus, IN which is south of Indianapolis. Leo would describe his hometown as "unique with lots of modern architecture." In th is picture, Leo is in front of his hometown 's public library, the Cleo Roge rs Memorial County Library. For him, taking a picture here brings back many memories from when he was younger. He remembers walking to the library from his middle school at the end of th e day. Th e Marian Phoenix #7 Behind Leo is one of Columbus's top employers, Cummins. Around Columbus, you can find multiple engine plants and corporate offices located in the city. ... I..; -- I- --, One thing that was distinctive about Clayton is that on every utility pole they had a picture of a veteran. I found this special because it shows how the community/town comes together to celebrate Veterans Day. Vanessa took me to the Fort Ben Cultural Campus. She mentioned that this is all new and that it's a popular destination among the people in Lawrence. --- Fort Harrison State Park is also a popular destination. She mentioned that this is where everyone in Lawrence goes for prom pictures. We were not able to enter the park, but the scenery was beautiful. The Marian Phoenix # ll I ~ Being a Knight The following few stories are the first part in a proposed year-long series of articles that attempts to answer the question: Are we losing what it means to be a Knight? Part 1: Parking arian 's mission statement states that the university will provide students with the resources they need to create a meaningful impact and live a productive life on campus. It stresses the importance of the Franciscan v alues: dignity of the individual, peace and justice, responsible stew ardship, and reconciliation. M Parking is important not only for our students but also for our faculty and staff. The rapid grow th at the university has led to parking shortages. What kind of atmosphere has this created w ithin the campus? Is Marian treating the students w ith dignity when they feel their basic needs aren't being # 72 The Marian Ph oen ix met? Marian University is growing in most aspects but one: parking . Students, faculty, and staff are finding it difficult to navigate parking on campus. The lack of parking has been increasing in animosity over the years. This issue accelerated w hen Marian constructed Caito-Wagner Hall, a dorm for freshman students . Construction started last spring and opened in fall 2027. Marian broke ground for the E. S. Witchger School of Engin eering the same year. Both buildings have one thing in common: they demolished a parking lot to build them . Because of this, students, faculty, and staff are finding it hard to park. Besides limited parking, certain lots are reserved for commuters and teachers, and residents. Detective Gregory Hunter, a member of the Marian University Police Department (MUPD}, confirmed that when Marian hosts a game, more parking lots are cleared out for spectators, and penalization for not moving a vehicle from those locations is a $50 fine and the police station w ill tow the car. A senior communication student, Elizabeth Hosty, recei ved t w o tickets w ithin the last y ear, one for not moving her car during a game, and the oth-  Part 1 By Amari Fields, Julia Akre, Isabella Simons, Connor Matthews Photos by Jalynn Edwards er for not having the proper parking pass, which proved to be untrue. Hosty said that the first ticket was her fault, but for the second, MUPD did not realize she had the correct pass. This is a common problem for students with a car on campus. With the taking away of two parking lots on the main campus, students feel that the school is not able to serve them. Hosty added she believes that the school is expanding too rapidly and that the students here are being forgotten. She fears the expansion of Marian is only aimed to fit as many students on campus as possible without being able to handle the growth. She discussed the problem of parking for commuters, saying that the residents park close to the dorms, and the professors park in the commuter lots, but there is not a designated space for commuters. She said that it is aggravating for commuters because they need to be active earlier in the morning if they want to find a good parking spot. Students are not the only ones navigating this new struggle, but it forced faculty and staff to change habits to accommodate the little on-campus parking. According to Greg Ginder, Sr. Vice President for Personnel, Finance, Facilities, and Technology, many employees of Marian have contacted him about their struggle to get to their classes because of the seeming lack of parking. Ginder contested the claim that Marian is ill-equipped to house the number of cars on campus by addressing the fact that parking is available in the parking lot on 30th street, The Iron Skillet across the street The Marian Phoenix #13 times, they don't look at stuff until a crisis or tragedy happens." that Marian is leasing and the parking lot next to St. Joe's that is free for Marian to use. In the future, Marian is looking into the possibility of a shuttle syst em from the Velod rome and sc hool to open more spaces for park ing . However, people find th e accommodating spaces too far. According to Ginder, in 2079, Maria n hired park ing specialists to come t o ca mpus and ana lyze th e parking situat ion. Th ey looke d at the spaces available and the project ed demand for pa rk in g spots and stated that by this semester, Marian should have an excess of available 152 spaces. However, these spaces are in areas w here people have reportedly felt un comfortab le parking in . Professor James Norton , a Professor of English , expressed his concerns for safety at the parking lot across 30th street . "It's extreme ly dangerous [crossing t he street] ... so mebody's going to get hurt." He has seen the dangers of the crosswalk, w here cars have sped up, tryi ng to get past the light before the student s do. Norton fears Marian w ill act only after a tragedy has struck. He said , "A lot of #74 The Marian Phoenix Professor Norton discussed parking passes, saying th at teach ers' parking passes are free. When he lea rned th at students pay for them , h e sa id , "I think we should be charged, personally. If you are [ch arg ed], I should be c harg ed $200 or $300 if th e stud ents are." Norton does not believe, how - ever, that this change and growth are bad . Norton has been a professor at Marian since 1999. Over the years, he has seen t wo growth cycles occurring simultaneously. There is a considerable grow th of buildings, but he praises the intellectual growth of th e student population. Professor Norton said that after they build the engineering school, Marian's focus w ill be on recruiting more students. He said , "in t erms of physicality, w here are th ey going to build another building? " There are different tags yo u can receive for each parking violation . Detective Gregory Hunter, a member of the MUPD, discussed the different tags that people ca n hold. Ye llow is commuters, blue is residents, and faculty and st aff, according to him , can park almost anywhere. He discussed the pink clinical tag for third or fourth-y ear medical students. Hunter said that they only co me to campus once eve ry f ew weeks, but th ey still pay $200 for th e parking pass, eve n though th ey spe nd nearly all their time in hospitals. Th e dark red pass is for parking at Allison Mansion, and it is rese rved for th e ad ministrat ive staff that wo rks there. Hunter said that there is a hi era rchy in permitting to park at Allison Mansion because yo u must wo rk there to receive one. Hunter also discussed w here the money fro m fines, w hich are t y pically 50 dollars, for both students, employees, and staff goes to keeping speed bumps intact, funding extra pavement for the parking lots, and filling potholes. He said that people think th ey are ticketing constantly, however; the MUPD is averag ing a ticket a day. He described the kinds of ticket-warranting v iolations that occur on campus: some examples include w hen people park in no parking zones, at reserved spots, or in the grass. He discussed the idea of a cap o n selling parking passes and noted that it has not been considered by the parking committee. He said that th ere are still parking tags that have not been issued, and that parking spaces have increased. When speaking at the SGA meeting on Tuesday, October 26, Marian University's presi- dent, Daniel Elsner, said Marian is looking at expanding parking by acquiring some of the land at the golf course across the street. According to Marian Unive rsity's president, Daniel Elsner, "All things are moving and changing . You're going to see this university getting more and more involved, we' ll probably have new graduate programs ... we'l l probably do a lot more things." But, w ith all this expansion and change, w ill students get left behind? Will it make all "fo ur-hundred sixty students, full-time freshman" reconsider their college decision? The Marian Ph oenix # 75 Part 2: What does it mean to be a Knight? Understanding Knighthood through the Franciscan values By Julia Akre and Jalynn Edwards Photos by Jalynn Edwards arian has a deep-rooted connection with the Franciscan Values. The values, peace, and justice, dignity of the individual , reconciliatio n , and responsible stewardsh ip; are carved into the water fountain, along the wa lls of the dining commons, and displayed elsewhere on campus. M As the average student goes about their day at Marian University, they come across the Franciscan va lues being integrated into the classroom in some form or another. This is by des ign. Accord ing to The Marian website, "The Marian University educational experience integrates our four Franciscan Sponsorsh ip Values." Students and facu lty seem to have different ideas about what these va lues mean. The school emphasizes these values and encourages professors to incorporate them into their classes, but according to various faculty members, Marian does not provide professors w ith an adequate explanation of w hat they are, or how they wa nt them to be portrayed to students. Thus, students are left to interpret these va lues on their own and based upon an #76 The Marian Phoenix array of different exp lanations given to them by professors in different departments, w ho may not be on the same page about w hat the va lues are or w hat they mean. Johnny Goldfinger, Associate Professor of Political Science, dedicates the first week of his classes to teaching w hat these values are from a Catholic, Franciscan standpoint, despite himself not being Christian. Goldfinger believes that every va lue ultimately stems from peace and justice. To have peace, yo u must have justice, he said . His emphasis on the importance of the va lues to the Marian experience is echoed by Ryan Penry, the undergraduate student body president. Penry described the val ues as an opportunity to make sure that policies are being upheld and rules are being followed. He emphasizes the importance of living in a gray zone of understanding and peace rather than a polarizing zone of black and white. And while he thinks all values are important, Penry said that responsible stewardship is Marian's most important value. He highlights the importance of service w ithin responsible stewardship. We do acts of service every day without even realizing it, he said. Through this va lu e, we are enco uraged to hold each other accountable. Responsible stewardship is rooted in the Christian belief that the world is created by God, according to Goldf inger. People should not abuse God 's creation, but rather do their best to replenish w hat has been used and take only what is needed, leav ing the wor ld better for the next generation . Just as we are called to treat the earth's resources with dignity, we must do the same for others, he said. Which connects with the value: dignity of the individual. According to Goldfinger, dignity of the individual is about giving everyone w hat they are due, treating them justly according to their actions, and recognizing the spark of divinity w ithin them . Penry said something similar, noting that people come from different wa lks of life, and it is important to treat them w ith the dignity and respect they deserve. Though we may strive to uphold the dignity of the individual, we also may make mistakes wh ich is w here the grace of reconciliation comes in . The value of reconciliation I l comes into play when a wrong has been committed by one party to another, Goldfinger said. He said that forgiveness is asked but a transformative process resulting in changed actions must follow. It is out of injustice that a better connection can be made. Similarly, Penry said that it is important to take time to reconcile with others. Being aware of potential negative impacts you can have on others and being proactive in correcting those wrongs is especially important. These values play an intrinsic role for the Marian community. Father (Fr.) Barry, the campus chaplain, said there should be a deeper dive into each value and how they are incorpo- rated into everyone's lives. He said that a true Marian Knight is someone who implements these values daily. However, not all students do this. "All true Knights are Marian students, but not all Marian students are true Knights!" he said. t I The Marian Phoenix #77 Ambassador Knights By Isabella Simons and Connor Matthews arian University is home to many students, all with diverse interests and passions. Among them are students who become Ambassadors and represent the school . Their main goal is to inspire their community and help prospective Knights. They show commitment, passion, and an overall love for Marian. Take, for example, Mary Flemming , Tony Flemming, Annie Klare, and Baylee Hunt, who all represent Marian University. M Anthony Flemming first visited Marian during his eighth-grade year, when his older sister was attend ing school here. He was drawn to Marian for the Catholic identity and the Franciscan Va lues. After enrolling, Flemming became involved through different campus opportunities, and became a Marian Ambassador and Mentor for other Ambassadors in 2020. His journey has been filled w ith passion for discovering a community. "The people here are an accurate representation of who this community is," he said . " Everyone can make an impact here at Marian." This is just what Annie Klare wa nted to do when she joined the Ambassador program last year. Through being an ambassador, she has learned about other majors, as we ll as random facts about Marian. "This year I really started to get involved on campus, and I always tell people I could never picture myself at another school," she said. "I think it is the perfect fit # 78 The Marian Phoenix for me." Because of her experience as an Ambassador, she is interested in working at Marian following her graduation. Baylee Hunt first college choice after high school was not Marian, but she knew that her good grades wou ld aid her in the admissions process. She recognized that the school 's nursing program was top-notch, and w hen she came to campus, she fell in love. Hunt said that knew Marian was where she needed to be to succeed. She currently serves two positions here, as a Marian Ambassador and as a Presidential Ambassador. She enjoys both jobs, especially working with prospective students as an Ambassador. "I really do enjoy sharing that love that I have for the campus w ith prospective students and their families ," she said. She appreciates the support that the school provides. Hunt said that she loves Marian and can't imagine herself anywhere else. She said that it is a good feeling to be all hyped for the same cause. Bay lee and Mary Flemming are both Presidential Ambassadors, and this allows Flemming to uphold her school in a very special way. Very similar to those in her community, she loves the intentionality that is Marian. It has not only become a home for her but a place to grow in her faith life. Every student is empowered to make an impact. To leave their mark. Ambassadors, along w ith every Knight, can share their pride and live their passion . This is what we all have in common here at Marian. We can share our identity with those who have come before us and hopefully give that excitement to those in the future. This is what it means to be a Knight. Incoming Knights BY Nicolas Jones Photos by Laura Cruz hen incoming students arrive at Marian University, part of their orientation involves President Elsner formally Knighting them. With the tap of a sword on each shoulder, a person is transformed from just being a student into a Knight. A diverse group of individuals are brought together through being Knighted. What this means to each person is different and unique to them. W Jacob Marin is a senior baseball player studying Management. He came to Marian University as a pitcher with goals of personal success on and off the field. To Marin, Knighthood is represented through the relationships he makes with his professors. He said "you are guaranteed a great connection if you put in the effort to get to know your teacher." Marian currently has a 73:7 student to teacher ratio. When on the pitch, Marin sees the Franciscan value of Dignity of the Individual. Through the highs and the lows of baseball, he said it is always about collecting yourself in the end and preparing for the next match, which is most important. Looking toward the future, Marin hopes that Marian will invest more in its outdoor facilities, saying people want to take pride in their field. He believes that all teams deserve to prac- The M a rian Phoenix #19 tice and use quality facilities. Lisa Cantu, an athlete on the cycling team, is a junior studying Finance. She came from Mexico to cy cle for Marian 's nationally recognized team . Cantu believes th at Knighthood is the sum of a student's experience at Marian: No matter what sports, organizations, or groups a student is a part of, there is alw ay s a sense of community. She said , "The community is very supportive and there is al w ay s someone that can help y ou out if y ou need anything." For Cantu, the Major Taylor Velodrome is where she finds connections between her home in Mexico and her one at #20 The M arian Phoenix Marian. Cycling is a global sport that connects people through the competition of racing . One big change she wants to see at Marian is the representation of more nationalities. She believes it is important that local students have access to a wide array of different cultures and for international students to have events that remind them of home. Cantu is optimistic that more international students will come to Marian as it continues to grow. Claudia Arteaga, an international student from Zacatecas, Mexico, is a junior studying Social Work and Spanish . She believes that Knighthood is about being brave and daring . No matter w hat challenges she has faced in college, she uses the embodiment of a Knight to face them head-on. When Arteaga finds herself in difficult situations, she goes to the Marian Hall Chapel to remind herself of w hat it means to be a knight. She said, "The chapel is a place w here I can pray and have the energy to keep myself going." The chapel emphasizes all of the blessings God has given her and gives her the strength to continue in all of her endeavors. She encourages future students to find comfort in the churches across campus and to broaden their social circles through them. The Marian Phoenix #21 U) I... a, +-' +-' a, __J ...U) a, C a, 0) :J w he sound of my alarm clock took me from my dreams. It also caught me from falling off the side of my bed . I checked my watch; the time read 7:55 a.m . My first class w as at 8:00 a.m. This had to be a mistake. My alarm wouldn't turn off and the snow continued to come dow n. A quick reach underneath the bed expecting m y textbooks , only to find my jar of peanut butter. I had everything I needed. T With no time to wa ste, I left my room, leaving my books behind, and raced down the hallway. As I pass by the trash room, I toss the now empty jar of peanut butter and make my way towards the stairw ell. I make the jump down the stairw ell effortlessly. The outdoors brought a crisp scent of w inter as I walked out of Doyle. My honey brown hair was now covered in small patches of snow. "It never surprises me how all my Mondays begin the same way. Where did all this snow come from?" I said to myself. Tw o-minute w arning. I am now what they call in football the Red Zone. Time was running out. I raised my fist in anger. "There is no way I am losing my perfect streak of making it on time to class. Not today!" The snow continued to fall. I knew w hat I had to do. I have done it before, and I will do it again . The campus w as dead silent. From my back pocket, I retrieve a small whistle. I gave it a call. As if the snowstorm wasn't enough, the next instant brought a terrible w ind, almost knocking me off my feet . After the "storm" settled and I climbed out of a pile of snow, a w elcoming figure stood before me. It was an Ow l, the size of Knightro, but twice as mighty; his feathers were the color of a great oak. "Oscar! You won't believe how happy I am to see you!" I embraced him. There wasn't a moment to lose. A quick fly through campus brought us to Marian Hall. Oscar didn't hesitate to throw me off his back and onto the roof. The owl settled close to me, protecting me from the wind. "Any advice, old friend?" I ask while shivering in the cold. The owl turned to face me. His rusted copper eyes comforted me; his presence gave me courage. Five seconds of intense staring was all he needed. After that, he disappeared into the storm. "You never cease to amaze me," I replied. Making my way down the side of the building and through the window was the real challenge of my morning. At long last, I found myself at Marian Hall in room 420. Cold and wet, I stood before the threshold of the classroom, holding a small slip of paper in my hands. It was folded with the words on one side reading. Dear Family and the rest of the t I I By Connor Matthews paper blank. "Another adventure begins." Then I walk through the door along with the professor. Flynn had never experienced something so sweet. Or at least that is what he explained to me. His bright blue eyes expanded like tiny ripples. Even though the snow continued to fall, something about the sensation kept him warm inside. Almost as if by magic. I sat next to him outside the dining commons, listening to him go on about signs or of a winged giant. "It all started last week. In the corner of my eye, I caught a glimpse of a g iant silhouette, perched on top of Doyle Hall ," he said. serious. I need to know. .. where did you find this?" asked Flynn, holding up the mysterious pastry. It looked like half fruit, half sponge cake, but bite-size. "You meant to say, 'Where can I find more?' right?" I say while taking a sip from my Starbucks. Snow continued to fall. The sun was already down by this t ime of day, and everyone was heading to Alumni Hall to watch "How the Grinch Stole Christmas." We two friends sat alone. The bell tower struck six o'clock. "Come on, I want to show you something," I say, rising from my seat and offering him a hand . A sudden burst of excitement brought Flynn to his feet . Flynn ignored my "ignorance." He knew what he saw. Something was going on . "Are we going to find more?! " asked Flynn , his hands rubb ing against each other, trying to keep himself warm . The pastry's effect or magic had faded. Snow continued to fall. I gather all of my things and put on an extra j acket. "The funny thing is that I seem to be the only one able to see these things and I know I'm not going crazy... and ... Listen, this is Leading Flynn through the unshoveled walkway, we made our way to the Ecolab. It was down there that we made In between bites, I would only respond with a gentle nod. memories and kept all of our secrets. Tonight, I w as ready to reveal one of my own that I had been keeping from Flynn . "Eugene, will you slow dow n , please?! Some of us are carrying unnecessary weight around!" I laugh to myself. Flynn w as growing plumper with the holiday season ever approaching . "Will this snow ever stop? " said Flynn, "Seriously, fall ended less than a week ago." I was ready to stop then . Flynn , not paying attention, tripped over the last step down the w inding stairs. "I've brought you here to tell you something . Actually, more like show you something ." I say quietly. I set down my backpack and reached into my back pocket. "Why are you whispering? It's not like anyone is listening," replied Flynn . "Someone is always listening." And with that, I gave my whistle a call. Oscar appeared almost immediately in between the two of us. To my surprise, Flynn didn't The Marian Phoenix #23 react instinctively to a giant owl appearing from nowhere. Silence. Oscar's prime way of communicating . Flynn finally broke it. "This ... is ... without a doubt, the best day of my life!" he exclaimed aesthetically, through tears that froze like ice. "I am sorry I didn't tell you sooner." I said, "I had to make sure that he was okay with it first." I reached out and stroked Oscar's neck. "It's so good to see you, Oscar! Now, what do you have for me today, Old Friend?" I asked. Oscar turned to reveal a small pouch that he kept tied to his neck. "Any more of those pastries from last week?" "Wait, those came from HIM?!" asked Flynn, still shaking with excitement. I didn't respond immediately. I kept busy going through the continents within the pouch. Finally, I pulled out a small book that was decorated with blue and gold, with people smiling and hugging. It was the familiar brand of a Marian University student planner. "Where did you find this?" I ask. Oscar gave no response. Or did he? Out of the three of us, you would think that the Giant Owl would have all the answers. I still think to this day that whatever I find in Oscar's pouch was put there for a reason . It was then always my job (no thanks to Oscar) to find out that reason. #24 The Marian Phoenix On the cover was written someone's name in perfect calligraphy. "Flynn! Give me your flashlight." Flynn didn't hesitate. He quickly pulled it out and flipped it on, pointing at my face. The snow became very light. "I appreciate you blinding me ... " I say as I swipe it from Flynn's hands. Shining it over the cover, I was able to make out only a name. No number, no address, nothing else. It only read Harper. "Harper. Why does that name sound familiar?" I said. Flynn pushed me aside. Stuffing his hand into the pouch, he retrieved yet another pastry. Oscar gave a quiet bow, then launched himself into the night. Flynn was ready to begin snacking on his prize. "Wait, you might want to save that one," I said. I then took the planner and placed it gently into my backpack. The snow ceased falling. Final thoughts ... Dear Family, Flynn is overw helming me with questions. It is possible that the pastry I found with Oscar's pouch severa l w eeks ago is the key to turning from looking to seeing the w orld the w ay I see it. Speaking of Oscar, I think he is becoming a lot quieter than usual. I think he is hiding something . What is there for a Giant Owl to hide? How much do I understand about his world, which is slowly becoming my world? Of course, these are the regular thoughts of any college freshman. My thoughts return to the planner. Why did Oscar find it for me? I will write again soon! Sincerely, Eugene he fire was so delightful in Doyle Hall. That is, if we had a fireplace, that would be delightful. Snow fell outside. I have always loved this time of year. Everyone was in high Christmas spirits. I do not think Flynn could have planned to have any more sweets than he already had. T There was magic in the air. The snow fell in a picturesque way. Hot chocolate came alive in my mouth as I took a sip from my mug. In between sips, I bu sy myself with decorating the community space. Flynn took charge of the Christmas tree. Everything was coming together nicely. And yet I felt that something was missing. "Flynn , do you know where those crimson red lights are?" I ask. Fly nn responded with a questionable gesture (due to the marshmallow s in his mouth). There w ere just the two of us decorating the residential hall. Until our RA Lawrence Calloway entered the scene. The first thing I noticed w as 1J QJ -, r+ I\J the confidence in his walk. He wore a Santa Claus hat and had an ugly sweater on. Obviously, this was a power move. He walked up to me and Flynn . "Alrighty, my dudes! What's popping? Did you find enough garland for the windows?" His breath smelt of peppermint. I showed him our progress, like a toddler showing his parents how well he had "cleaned" his room. Snow fell outside. All three of us were silent. The awkwardness was as palpable as the peppermint breath . Flynn tried to quickly arrange a set of ornaments. Clearly, there was something we were missing. Lawrence took off his Santa Claus hat and let out a soft sigh. leave. And that was that. Flynn was out the door with no questions asked, without stopping to zip up his winter coat. Then there were two. I did not have a problem with Lawrence, but ever since I told Flynn my secret about Oscar, only three days ago, I could not help but feel like word had gotten out. Of course, there was also the possibility that someone may have seen Oscar flying around campus ... how much did I know about the Giant Owl? I still have the suspicion that he is keeping secrets. I began thinking once again about the Student Planner I found in Oscar's pouch ... "So, Eugene, do you want to tell me why I saw you with a giant owl yesterday?" Lawrence said , interrupting my thoughts. "I left both of you almost two hours ago, this place looks the same as when I left." I began opening a storage tub by the fireplace. Taking out a shriveled-up piece of garland, I let out a sigh. "I think we're just lacking resources. I just need to make a trip to Stokley Mansion, they have extra garland there." I said, hoping it sounded convincing. At that moment, Flynn jumped in between both of us. "Don't worry, fellas! I'll make the trip over there and be back in no time." Flynn said , too eagerly. I had a feeling he just wanted an excuse to This only confirmed my suspicions. I did not expect to be caught off guard, and yet there I was, my jaw stretched as if I was trying to bite an apple. The moment I realized, I faked it into a yawn . "I ... do not know what you are talking about. We've had harsh weather all week. It was probably just snow mirage ... illusion-thing", I picked up a box of ornaments, "Anyway, do you think there are too many ornaments on this side of the tree?" Lawrence gave me a flat stare. In sympathy, his expression told me "You're a terrible liar." He took a nutcracker from one of the storage tubs and placed it on a table. He then sat down on one of the lounge chairs. Power move. "Listen bro, I know that something is going on around here and it's my job as a RA of Marian University to keep a sense of order. I will eventually find out what I need to know. Something is going on and I know it." he said . Snow continued to fall outside. A bitter chill came in, as students began flooding into the community area. Even among the crowd of people, Lawrence's stare never left me. Flynn: ALLISON MANSION I do not remember the storage area taking this long to find. I know I am in the right place, there is only one mansion on campus, right? I wonder where everyone is ... could it be finals week and I just forgot? Wait, didn't we already have finals? Eugene would know, he always seems to be on top of things. I take a small granola bar from my pocket. Dinner would be soon . I had to find where they kept all the Christmas decorations. I decided to try the lower level of the building, there I will have better luck. I do not know if it was my hunger that was playing tricks on me, but I began hearing a voice. It was calling me. The voice was familiar. Was this all a dream? With every step I took, it became ever clearer. I stub my toe walking across a board on the floor, positioned differently from the others. The Marian Phoenix #25 Very pecu liar. Which room am I even in? Where is this leading me? Why do I have so many questions? I bend down to examine it closely. The board is rough, and the edges were worn as if someone had taken it out several times before. With my shivering hands and my weakened body (I need to find some food), I take it out of the ground myself, only for it to revea l a set of staircases. The next minute of staring into the darkness that the stairs led to, was far too intense for me to handle. I need to get back. This was a mistake. I begin placing the longboard back into place when suddenly I encounter a silhouette emerging from the darkness. It starts walking up the stairs. EUGENE: CLARE HALL The night's events were over. I could finally escape from all the questions so that I could write down what very few answers I did have. There is so much I want to tell you if I ever get the chance to be alone. A lone. What happened to Flynn? It had been over an hour now since I had escaped from my RA. Who else knew? Who can I trust? Immediately my m ind drifts back to the Student Planner I have in my pack. Who is Harper? "I told you ... the game started thirty minutes ago ... w here? ... Harper ... ," voices cried out in the distant part of the dining commons. There w as my answer. I think? With no time to think, I ran into #26 The Marian Phoen ix the crowd of people wa lking in unison. They were headed towards the Marian Gym. "Wait! You mentioned something about a girl named Harper? Who is she? How do you know her? Where can I find her?" I asked , what sounded like a mi llion questions. The group did not respond, for a second, I thought they were going to just walk away when one of the girls spoke up. "Harper Lee, the author that wrote, To Kill a Mockingbird. We were just mentioning one of our readings for class," she answered . Then the group continued their merry way. I was ready to become a hermit. How does one shake off that level of awkwardness? The answer did not have to be shouted at me from across the room, it came on its own. It was only awkward if I made it that way. I made my way out of Clare Hall, back into the cold of night. Slowly but surely, I made my way back to Doyle. At that moment it dawned on me: I did not know Harper's last name. That could help me find her. I reached for my pack and pulled out the Student Planner. I became a captain lost at sea during a storm; his only hope w as the map he held in his hands ... the answer became clear on the last page of the book. Harper had her name written on both ends, the last page show ed her first and last name: Harper Gibbons. Suddenly Oscar appeared in front of me. I let out a small smile, then turned to make sure no one else was in the area . "You can't be here right now; someone will see. Hurry before someone comes this w ay," I pleaded . Oscar only gave a small tilt of his long neck. Then the behemoth of an owl did something quite unexpected. He spoke. "Why would I be worried about others seeing me? There is something important to discuss; you have discovered the name of miss Harper Gibbons. Now I must te ll you, she needs your he lp ... she is in danger." he said , with a voice that sounds like a British Siri . Dearest Family, I need to make this letter short. I am not sure, but I fee l I might be running out of time. So many things are getting out of my control. I thought I had all the answers until I found out that Oscar cou ld speak. What else is he keeping from me? Why did he choose me? He told me that tomorrow will bring more adventures and that I w il l need my strength . This is more than w hat I signed up for having a giant owl as a friend . Speaking of friends, Flynn has yet to make an appearance. I have so much I need to tell him. Well , I hope you are all happy and in good health! I wi ll be sure to write when I have more of an understanding of what is going on. Sincerely, "Harper ... Gibbons," I said , w hispering with the winter w ind. Eugene I I Aut mn By Isabella Simons Photos by Nicolas Jones Leaves crunch beneath my boots on this beautiful autumn day. I look up and see the trees , their leaves different colors: marigold , crimson, copper, and a blazing orange as though they were lit on fire by the sun . I watch as leaves fall, tumbling to the ground, as if by magic. They spin lazily, then continue their descent. I feel a cool breeze blow by, making me shiver. I breathe in the aroma of this beautiful day, the clear, crisp scent of fall. I look down at the dying flowers, waiting to be reborn in the spring. Their petals drift to the ground, as if under a spell. I watch as squirrels scutter by, gathering nuts, preparing for winter. They scamper away as I walk past. I pass tree after tree and look up in wonder at their beauty: the rough bark of their trunks, like hand-carved art. The leaves, so delicate, yet strong, enduring even the worst of storms . Th e branches, reaching out to say hello. This feeling inside me is peaceful: the feeling that autumn is here. C: 0 ...., - -c w ~ I.. ~ 3: a, z - By Amari Fields I've never really seen myself anywhere but in Indiana. The only time I've ever really traveled was for cheerleading and it was local or on a plane ride to Orlando, Florida. Other than that, I always stayed at home. For some months now, my closest friends and I have wanted to go to New York. We recently went to my best friend's birthday and to see professional wrestling. To be honest, I don't know the first thing about a vacation. I'm so consumed with the idea of only traveling for #28 The Marian Phoenix cheer, and those trips were mainly business trips. We came, we showed up; we handled our business and left the next morning. Sometimes we stayed a little extra to enjoy ourselves, but looking back, I felt little joy or excitement in any of those moments. It was almost like I was going through the motions of what excitement is supposed to be about. Now I'm thrilled to finally be lucky enough to travel with some of my best friends, doing the things we always talked about doing: New York, Manhattan, Brooklyn, and Queens. I packed my bags a month early, excited about the trip. I knew that a week in the city will more or less feel like a day. I will be celebrating not only my birthday but my best friend's birthday who was born six days after me. We've always talked about having our birthdays together for three and a half years, which feels like a century now. We will leave our mark in the city somehow. The city definitely never slept, and we didn't either. From running around trying to book Ubers to spending endless hours in Times Square, sleep was never not on our side during this week. We saw some very strange things in New York: From the random Disney characters to amateur photographers snapping pictures to illegal jaywalking- it was an adventure for sure! My favorite thing about Times Square was walking. Being there, I realized that being able to walk to places without needing a car and worrying about how many miles I've driven, or how much gas prices were was nice. The only thing I truly had to worry about was not only my safety while riding with strangers but also worrying about how  BROOl(LYN BRIDGE much money I blew in New York in forty-eight hours. Those two days were a lot. There was so much, and all you could really do is just spend money. Nobody was truly lying when they said New York was expensive. I'm not sure how they do it, but a big round of applause for them. Thankfully, the Uber rides came to an end. After those forty-eight hours, I learned how to take the metro for the rest of those four days. Another thing in life to appreciate was the fact that taking the subway isn't a horrible thing in life. I used to be scared taking them because of movies or the news and oddly enough; it made me appreciate the subway even more. New York as a whole made me see the world differently. It was a unique experience for me, both good and bad. As long as the trip felt, the Brooklyn Bridge felt even longer. That was a never-ending experience: Walking from the sunrise to the latest nights was hard. There had been points where I was ready to go home because it's a big city and as much as I claim that I want something bigger and better, I might've over-exaggerated the idea of wanting to live somewhere with such a dense population. It stressed me how many people were crossing the street, or how many dogs there were. So many dogs, so many people! I felt like a true resident of New York after getting honked at for crossing the street out of impatience. It was freeing, in a way. I knew I still had responsibilities to take care of back at home, but that week, I let them all go. I am a very anxious and stressedout individual. Yes, I've shared about how stressful the trip was, but I wasn't stressed out about an overdue assignment, a final, or anything related to school. I did feel stress, the stress of being in a big city, but that was a rather beautiful stress. It was a breath I never knew I needed until that night. I wanted to enjoy myself, and I did just that. New York will forever have a spot in my heart. It helped me figure out what I might want in life while struggling to find myself. I will forever be grateful for my week in New York. The Marian Phoenix #29 By Maddie Smith The House on 33rd Take me back to that house on 33rd . Warm and inv iting like an old friend w ith its cream-colored w alls, and rusty brick fireplace and the soft keys of ivory inviting all to come in. But now that old friend has turned into a stranger its cold and depressing and throws my heart into a fit of anger. The once w elcoming door reeks of alcohol. The living room is full of flashing strobe lights and college kids getting into drunken fights. As a child the backy ard w as a place of inspiration for playing croquet, or hopscotch or being a jungle explorer w hen dad forgot to cut the grass and finding stray kitties to give a home but most the time mom said to leave them alone. Now the backyard is full of trash Heaps of burned furniture and broken glass The w hite painted garage is cracked and chipping rusted metal gate creaking and squeaking once luscious green jungle grounds shri veling kitties don 't come around anymore. #30 The Marian Phoenix I My Mind is like the Sea My mind Is like the sea with each crashing wave of the tide against the jagged rocks of the shore an anger brews and bubbles inside each scathing word burns with sea spray in an open wound. Other times when the sea is calm on the inside I am filled with peace for my mind is like the sea like the fish swirling tranquilly through clear waters I am filled with creativity. My mind is like the sea When rain droplets pelt the tremulous waters likewise tears trickle down my face smoke billows over the water just as my eyes become clouded with haze The sea is like me as my mind is like the sea . Constantly moving and changing a complexity of swirling emotions. We are one. The Marian Phoenix #37 Be a part of our staff. Get more information by emailing marianstudentmedia@gmail.com  ...

... Franciscan Values Exhibition collaboration 1 introduction Create an exhibition featuring Marians Franciscan Values. ART 341 Design for Social Impact is a studio graphic design course with a mission to activate students awareness of social issues on their journey to becoming citizen designers. Through studio projects, students learn to apply Human Centered Design (HCD) principles to their personal design methodology. For the highlighted project of this poster, the design brief challenged students to create an exhibition featuring Marians Franciscan Values. Students employed HCD principles to inform the conceptual content of their posters, poster design, and presentation format. Student research indicated the exhibition should raise awareness of the Franciscan Values in our everyday lives. Collaboration between students designers and members of the Marian community was necessary to define individual topics for the poster exhibition now featured in the Marian Hall second floor gallery. + and ART DESIGN 2 Define/empathize 4 co-design Ive learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. ~Maya Angelou Design research aims to understand the interests and needs of the audience, define context, and establish creative focus. Design is most often used to describe an object or end result. Design in its most effctive form is a process, an action, a verb not a noun. In order to better understand the Franciscan Values and Marians audience, students studied and researched the following: The history of Marians Franciscan Values Understanding Marians diverse community and awareness of the Franciscan Values Understanding how HCD and Design Thinking apply to socially active design Defining empathy in design Articulated their personal core values as designers and their relationship to Marians Franciscan Values Students surveyed one-hundred plus members of the community using a Qualtrics survey and an additional forty individual interviews, to gain a clearer understanding of our communitys perception and understanding of Marians Franciscan Values. Feedback obtained through the survey and interviews assisted students with identifying priority social issues which supported the topical focus of their design proposals. Information collected through the research phase of the project provided students with a basis to begin developing creative concepts focused on specific social issues. The final topics students selected for their projects synthesized social issues identified through the surveys and interviews with their own personal commitments. Research indicated the following: Rrespondents were most passionate about responsible use of the earths resources; Marians greatest strength lies in reverence for persons; Responsible use of the earths resources was identified as an area for most improvement; Most respondents were interested in learning more about delight with all creation and responsible use of earths resources. Interviews indicated significant concern for sharing the gifts entrusted to us with those in need and/or less fortunate. Dignity of individual and care for creation were the two most identified values student designers focused on during the ideation phase of the project. Care for Creation was chosen as the exhibition title. Although any form of media was available for exploration, students determined as a group to focus on designing posters as the best form of presentation in the exhibition format. Concepts students chose to focus on for their posters included: Mental healthcare for the homeless Human rights as guaranteed by the United States Constitution Protecting rain forests Gun violence among teenagers Recycling Domestic abuse Natural way to heal the body Collaboration among student designers, faculty, and external focus groups provided input as concepts and visual prototypes were produced. The exhibition has received positive feedback from the community throughout its presentation in the Marian Hall Gallery. Department of Art and Design MARIAN UNIVERSITY Halley Martin care for self 3 synthesize/IDEATe Production presentation 5 Ronan Weber teenage gun violence At Marian University, we are united by our Franciscan Values. This was the foundational premise for our exhibition problem. The student designers challenge was to determine a project concept (social, environmental, political, etc.) that simultaneously embraces our Franciscan values, and serves a purpose which benefits our Marian community. Charles Connor Millerhuman rights APRIL 15-DEC. 30 Laura Kuebler-preservation of rain forests Credits: Exhibition Designers: Laura Kuebler, Haley Martin, Connor Miller, Justin Pond, Darius Shelton, Olivia Swalley, Ronan Weber Faculty: Kevin Rudynski, Associate Professor of Art and Design  ...

... Adaptable Online Discussion Format to Increase Student Interest, Peer Interactions, and Information Literacy Kristy J. Wilson, College of Arts and Sciences, Marian University Indianapolis, 3200 Cold Spring Rd, Indianapolis, IN 46222 BACKGROUND STUDENTS EXPLORE DIVERSE INTERESTS ON TOPICS Online instruction poses several challenges including creating opportunities for students to interact and get to know each other. I will discuss an adaptable online discussion format that has students explore the real-world implications of course context and diversity issues and allow students to build the classroom community. The discussion format utilizes current events and elements of students' daily lives to increase student interest in course content. ADAPTABLE DISCUSSION FORMAT VERY POSITIVE RESPONSE TO DISCUSSIONS Discussion Topics Support Student Interest by Providing Relevance to Content Discussion Prompt on Malnutrition See information on Relevance Continuum (Priniski et al, 2018) Students Explore a Wide Range of Topics around Health Disparities CONCLUSIONS & FUTURE DIRECTIONS See information on Self-Determination Theory ( Deci & Ryan, 2000 Students Explore a Wide Range of Topics around Malnutrition DISCUSSION RUBRIC Example Student Post from Health Disparities Discussion format is appropriate for students at different educational levels (freshman, juniors/seniors) Discussion topics can be related to content and/or social issues then considered along a relevance continuum Student response to discussion format has been overwhelmingly positive Create new discussions in content areas, societal issues, and diversity topics Place discussions on a website to increase access REFERENCES Rubric from ( Jones, 2020 1. Wilson KJ. (2021) Online discussions in biochemistry to increase peer interactions and student interest. Biochem Mol Bio Educ. 49(2): 298300. 2. Priniski, S.J., Hecht, C.A, Harackiewicz, J.M. (2018) Making Learning Personally Meaningful: A New Framework for Relevance Research. J Exp Educ. 86(1): 11-29. 3. Harackiewicz, J.M., Canning, E.A., Tibbetts, Y., Priniski, S.J., Hyde, J.S. (2016) Closing achievement gaps with a utility-value intervention: disentangling race and social class. J Pers Soc Psychol. 111:74565.  ...

... INTRODUCTION RESULTS Response rate: 100% for both pre- and post-camp surveys Demographics: 15% of participants identifying as male and 85% as female. The participants included three sophomores (11.5%), nine juniors (34.6%), twelve seniors (46.2%), and two incoming college freshmen (7.7%). Additionally, 24% of participants indicated their ethnicity as Hispanic while the remainder selected Non-Hispanic. Of the campers 46.1% identified as Caucasian, 42.3% as Black, and 15.3% preferred not to answer. Context: Efforts to increase the diversity among healthcare providers may help close the gap of health disparities, combat inequities, and address medical access in underserved populations1. In response to the need for more healthcare providers from populations under-represented in medicine, Marian University College of Osteopathic Medicine (MU-COM) hosted a weeklong day camp for high school students with the goal of introducing them to different healthcare careers and osteopathy. Objective: To determine the effect of a healthcare camp on recognition of careers in medicine and awareness of the osteopathic profession. Marians Healthcare Camp Increases Campers Perceptions of Careers in Healthcare: Hypothesis was tested through administration of an anonymous and voluntary pre- and post-camp survey. Survey included asking participants to list careers in healthcare during the precamp survey. Campers rotated through activity stations daily, highlighting a unique patient case using Simulation, Anatomage table, ShareCare virtual reality, and osteopathic manipulative medicine (OMM) lab. Onboarding and debriefing sessions were utilized to facilitate discussion and contextualize relative healthcare provider roles related to the patient case of the day. Current osteopathic medical students, along with other students in the health professions, served as counselors and activity leaders allowing campers to create connections with in-training members of the medical community. At the conclusion of the healthcare camp, a second survey was administered to all participants that asked campers to list careers in healthcare. A Wilcoxan Signed-Rank test was employed to compare participants pre- and post-camp responses of their perceptions of healthcare careers. The effect of demographic data on responses to careers in healthcare were analyzed using either the Mann-Whitney U test or the Kruskal-Wallis ANOVA, as appropriate. ** 11.5 14 12 10 Number of Careers Demographic data included gender, race, ethnicity, the presence of a healthcare worker in their immediate family, and previous participation in a healthcare camp. Perceptions of Careers in Healthcare by High School Campers 8 6 5.4 4 2 **p<0.001 0 Pre-camp Post-camp Awareness of the Osteopathic Profession: Increased from 0 to 42% as indicated by listing DO, osteopathy, osteopathic, or OMM in the pre- and post-camp surveys. Demographic data did not significantly affect program outcomes as assessed by survey data related to perception of careers in healthcare or awareness of the osteopathic profession. The survey results support the implementation of a healthcare camps as an effective measure to increase the perception of careers in healthcare while also enhancing the awareness of the osteopathic profession in high school students. Gender Female Male Other 22 4 0 Ethnicity Hispanic Non-Hispanic Prefer Not to Answer 6 19 1 Race Black Caucasion Asian Black & Caucasion Prefer Not to Answer 10 11 0 1 4 Awareness of Osteopathic Profession Pre-camp 0% Post-camp 42% Brian Skinner, PharmD, BCPS, Clint Whitson, MS, & Julia Hum, PhD College of Osteopathic Medicine Perceptions of Careers in Healthcare: Prior to the intervention of the healthcare camp, participants were able to list on average 5.4 healthcare professions, which significantly increased to 11.5 careers on the post-camp survey (p<0.05). CONCLUSIONS A Model for Addressing Disparities METHODS Future healthcare camps will include an overnight component to expand the student population beyond that of central Indiana. Further, as a means of encouraging and supporting campers to continue to pursue a career in healthcare, camp attendees are eligible for additional scholarships should they attend Marian University. ACKNOWLEDGMENTS Thank you to the Tom Wood Family Foundation for their generous support of and vision for Marian University's Healthcare Camp.  ...

... Mark Latta, Department of English Inclusive & Humanizing Pedagogy Course Description Students explore the relationship between print and culture through experiential and community engaged learning to prepare and publish zines, placards, and retailready books and publications. Additionally, this class explores theories of circulation, the history of the book and written technologies, and explores the ways texts and print culture shape relationships between knowledge and society. Work produced within this course will often center underrepresented and under-explored perspectives and voices. Texts produced within this class will have long-lasting impact and make permanent contributions to society. Learning Objectives A. Understand theories of circulation and print culture B. Analyze the relationship between print, culture, power, and the generation of knowledge. C. Apply technical and theoretical understandings of print culture to strategies of publication. D.Evaluate and prepare originally authored material for publication E. Negotiate the creation of retail-ready texts featuring work from a local or regional author(s) High Impact Practices ENG 480 Publishing and Print Culture combines five high-impact practices (HIP): Writing intensive curriculum Community engaged learning Collaborative assignments and projects Undergraduate research Diverse learning Combining and layering these HIPs centers learning on students strengths and talents, connects learning objectives to real-world outcomes, and demonstrates relevancy of course content and applied scholarship. ENG 480 Publishing & Print Culture centers the English Departments commitment to social justice, critical inquiry, and the use of community-based writing to address social concerns and honor diverse perspectives. Assignments foster active-learning, build upon student strengths, and encourage students to link outcomes to personally and socially relevant inquiry. Reflection & Inquiry Zines Printed series of reflective & expressive inquiry zines combining multiple genres. Zines used as formative & summative assessment. One of the audience members asked Bretts group what it was like working with someone who was incarcerated. The discussion on how our age group holds stigmas that affect how we approach and who we choose to work with stood out to me. We talk so much about the Franciscan Values, yet theres still so many vulnerable populations that our misconceptions limit us from approaching. Zine Fest Showcase and celebration of student work & print culture. Held at Hackelmeier Memorial Library. Students organize, plan, & promote event. Hearing and working with these stories changed me. I feel like Im a part of something. Community Chapbook Publication & Celebration Create retail-ready chapbooks for print and digital distribution. Partner with Indiana Prison Writers Workshop, Flanner Community Writing Center, Ujamaa Bookstore Three new works published through Fraternitas Press (Marian English Dept.). Available for sale locally and online (digital & print). Generation of culture and direct participation in the circulation of ideas. Deep exploration of narrative as tool for personal & social change Development of communication, creative, & practical professional and advocacy skills Student Perspectives: The process was empowering. I genuinely felt that my opinions mattered and realized the importance of discourse. Tanishas amazing recipes and ideas are now part of the world, and I helped make that happen. Major Assignments: Impact & Outcomes Zine Fest, Nov. 2021 Chapbook: Interdisciplinary Project-Based Inquiry Working in small teams, students partnered with three community members & organizations to produce retail-ready chapbooks, preserving unique stories & experience through print culture. Students had no prior book printing experience. Brett Buskirk, The Shadowed Mirror Near Northwest Area Community Food Memoir, Vol. 1 Tanisha Neely, How You Make That Ideas and stories were circulated through class discussions, chapbooks, media appearances, social media, and our community publishing celebration. Students circulated stories and witnessed the generative power of stories when circulated.  ...

... EXPLORING IDENTITY & CULTURALLY RESPONSIVE TEACHING THROUGH COMMUNITY ENGAGED LEARNING IN EDU 190 Lizzy, Digital Storytelling Final Project ---- What Diversity Means to Us EDU 190 Fall 2021 Word Cloud ALLISON SEGARRA HANSEN & DR. CATHI CORNELIUS Course Essential Questions Who am I? Where did I come from? What do I carry with me? What (historical) practices, experiences, and influences have significantly impacted my dispositions, assumptions, expectations, and behaviors? How might all these things impact the way I approach teaching my future students? How will I help students to successfully navigate and negotiate cultural differences/conflict (assimilation v. acculturation)? How will I teach for social action (equity for all)? Community Engaged Teacher Preparation Community-engaged teacher preparation is an innovative paradigm through which to prepare socially just, equity-focused teachers with the capacity to enact pedagogies that are culturally relevant, responsive, and sustaining. Operationalized through candidates situated learning in historically marginalized communities, this approach emphasizes the concerted cultivation of collaborative relationships among universities, communities, and schools; the elevation of funds of knowledge and community cultural wealth; and an indepth analysis of social inequality and positionality, and the intersections between the two, as essential knowledge for future teachers. As a means through which to address the persistent achievement gap between racially, socioeconomically, and linguistically non dominant and dominant students, community-engaged teacher preparation is a prototype through which to advance educational equity. Identity & Positionality of Professor Segarra I have been an educator for 15 years. I attended a 4-year college for teaching and obtained my teaching license. I was a founding teacher of a charter school in an urban, economically disenfranchised area. The demographics of the school community was 60% Hispanic/Latino and 40% Black. I grew up in a middle class, majority white school community and was trained to teach in a rural, low-income, majority white environment. The mismatch of my personal experiences in schooling spaces in comparison to where I began teaching remains a significant part of my positionality as the professor of this course. I transitioned into teacher prep and co-designed the 90s series courses for KEC in response to how unprepared my colleagues and I were to teach during my first 4 years. Also of note is my Latinidad, which inspires me to create more equitable classrooms for Black and brown students. As the professor of this course, I must acknowledge the power structure between myself and my students (pre-service teachers) as they discover and uncover important pieces of their complex identities and how to navigate them as culturally responsive educators. Zygmunt, E., Cipollone, K., Clark, P., & Tancock, S. (2018). Communityengaged teacher preparation. In Oxford Research Encyclopedia of Education. 25% Our Community Placements Fall 2021 Segarra lecture slide 56% 19% Megan, Brianna, Kathryn Digital Storytelling Final Project Anna, Adam, Sarah, and Averie Final Project Presentation School on Wheels Teachers' Treausures Holy Angels Catholic School Mein, Erika L., "Asset-Based Teaching and Learning with Diverse Learners in Postsecondary Settings" (2018). Departmental Technical Reports (CS). 1271. Impact on Pre-Service Teachers This was an extremely beneficial course, and one I will be taking with me into my future classrooms. -Anonymous Course Evaluation Comment Fall 2021 My experience volunteering at Teachers' Treasures has exposed me to various ways to be creative in the classroom and a deeper insight into the reality of being a teacher. I have been able to see all the different needs and materials teachers can use to help their students. I have also heard a lot of the teachers talk among themselves about how their schools run things, hold events, and provide opportunities for students to thrive. For example, one man carried out a white board to create a bracket for a spelling bee tournament. Ive been able to recognize a lot of how my idea of a teacher was very narrow. It has helped me a lot not only as a future educator, but as a person, being exposed to a diverse community of professionals. This shows a lot of my implicit bias - socioeconomic, racial, linguistic, and cultural bias. I have not personally had many conversations with the teachers, but I have observed how some of the older volunteers interact with some of the teachers, and I have also recognized some subconscious biases and stereotypes that I do not feel necessarily effect how I encountered the teachers, but defintely gave me something to think about. These examples are things I plan on including in my final project. -Megan, Reflection #8 Impact on Partner(s) Very responsive to student emotional needs. Always checking in with each student, this strategy helps manage expectations and gives student a voice. Lauren should keep this up. With her Spanish language skills Lauren worked especially well with our ELL students. This skill will serve her well in the future. Kept productively challenging students, including sometimes hard to engage 5th graders. Tonisue was able to strike a balance between creating confidence with review tasks and pushing students to challenge themselves in new areas, especially in phonics work, which is essential with our population. Calmed higher energy students and effectively got them to reengage with material at hand. Elizabeth worked very well with both younger (K) students and our middle level students (5). I've seen improvement in one student's social emotional regulation thanks to Elizabeth's guidance. -Jen, School on Wheels Mentor newamerica.org/education-policy/reports/culturally-responsive-teaching/ Impact on Pre-Service Teachers I really enjoy my clinical and it has even taught me a lot about my stereotypes and biases. It was not easy for me to overcome these biases as I just recently found out about them. Research in class really helped me open my eyes to the fact I have these hidden biases, stereotypes, myths, lies, etc. Once I got this background knowledge on this I was able to reflect on myself and dispel or become self aware of these issues so I would not bring them into the classroom. Without the class lessons we had I most likely would have a much different experience in my clinical. -Carter, Reflection #8 In conclusion, I am extremely grateful for EDU 190 and my clinical through School on Wheels. I have learned a lot about how to be more culturally aware and I have learned a lot about myself as well. Ultimately, the best way to end implicit bias, racism, and microaggressions is through education. As an educator, I intend to do my part by embracing every childs differences and creating equity within my classroom. -Lizzy Digital Storytelling Final Project  ...

... Marians HHMI inclusive excellence project Jason Chan (PD), HHMI team Howard Hughes Medical Institute HHMI GOALS Private foundation that traditionally funded STEM programs, including Faculty and trainee research Gillman Fellowships to advance diversity in STEM workforce Science programs (HHMI BioInteractive, SEA-PHAGES) Inclusive excellence in institutions of higher education All students, regardless of where they come from and where they are going, deserve a meaningful and positive experience in scienceand engage in scientific thinking and discovery. We aims for a community of university faculty, staff, students, and administrators to be engaged in discussions and practices to increase their institutions capacity for inclusion Fall 19 Naama Lewis Math Liz Osika Associate Provost Matt DeLong Math Brooke Kile Institutional Research Tony Ribera CTL Jennifer Plumlee Academic Engagement Marian submits a Pre-proposal to HHMIs specific funding challenge: Meaningful evaluation of effective and inclusive teaching, which will inform faculty practices, including promotion and tenure decisions Our group focuses on how to use data to drive informed decision making January 20 Advanced to next stage, but Marians HHMI leadership team Carina Collins Biology 2021-22 Marian Learning Communities discuss important topics, including HHMI discussions on ie3 challenge Spring 20 Jason Chan (PD) Biology Whats going on now and whats next? Marians inclusive excellence project Demystifying tenure and promotion, specifically for female faculty Grading practices, and alternative grading Writing and brainstorming as a group Metacognitive activities for students; understanding pre-requisite knowledge for current assessments survey on faculty perception of teaching practices what are we hearing and seeing in classes; a possible student auditing process of departments 2021-22 Marian continues to participate in ie3LC, where 16 institutions are actively discuss what inclusive, equitable, and antiracist approaches to teaching means developing ideas to evaluate and reward inclusive teaching HHMI changed funding mechanism Collaboration Competition 100 institutions work together through common goals 100 institutions fight for awards HHMI funds 106 schools and forms ie3 learning communities (ie3LCs) Winter 21 Five MLC groups (25 people) on: Equitable Assessment Equitable Access Student Voices Sp/Su 2022 Our ie3LC (16 institutions) will develop projects that meaningfully evaluate effective and inclusive teaching Join our work How do include student voice? Summer 21 Marian awarded a $30,000 ie3LC Learning grant October 2021 HHMI commits approx. $8 million dollars to support the work of each ie3LC Marians HHMI team develops Marian Learning Communities (MLCs) Lets continue discussions, reflections, and engagement As early as Fall 2022, there will be opportunities for grants and stipends to participate. Inclusive excellence is a Marian Community effort. We hope you join the discussion.  ...