Digital Commons Network^™

Use Of Structural Equation Models To Predict Dengue Illness Phenotype, Sangshin Park, Anon Srikiatkhachorn, Siripen Kalayanarooj, Louis Macareo, Sharone Green, Jennifer F. Friedman, Alan L. Rothman

Cell and Molecular Biology Faculty Publications

Background: Early recognition of dengue, particularly patients at risk for plasma leakage, is important to clinical management. The objective of this study was to build predictive models for dengue, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) using structural equation modelling (SEM), a statistical method that evaluates mechanistic pathways.

Methods/Findings: We performed SEM using data from 257 Thai children enrolled within 72 h of febrile illness onset, 156 with dengue and 101 with non-dengue febrile illnesses. Models for dengue, DHF, and DSS were developed based on data obtained three and one day(s) prior to fever resolution (fever days -3 …

T Cell Epitope Engineering: An Avian H7n9 Influenza Vaccine Strategy For Pandemic Preparedness And Response, Leonard Moise, Bethany M. Biron, Christine M. Boyle, Nese Kurt Yilmaz, Hyesun Jang, Celia Schiffer, Ted M. Ross, William D. Martin, Anne S. De Groot

Cell and Molecular Biology Faculty Publications

The delayed availability of vaccine during the 2009 H1N1 influenza pandemic created a sense of urgency to better prepare for the next influenza pandemic. Advancements in manufacturing technology, speed and capacity have been achieved but vaccine effectiveness remains a significant challenge. Here, we describe a novel vaccine design strategy called immune engineering in the context of H7N9 influenza vaccine development. The approach combines immunoinformatic and structure modeling methods to promote protective antibody responses against H7N9 hemagglutinin (HA) by engineering whole antigens to carry seasonal influenza HA memory CD4⁺ T cell epitopes – without perturbing native antigen structure – by …

Optimal Duration For Continuation Of Statin Therapy In Bacteremic Patients, Ajinkya M. Pawar, L. Laplante, Tristan T. Timbrook, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Background: Evidence suggests statins may improve survival in patients with bloodstream infections. However, there is no consensus on optimal timing and duration of exposure.

Objectives: To quantify statin therapy duration associated with decreased mortality in bacteremic statin users.

Methods: We conducted a case-control study using OptumClinformatics™ with matched Premier hospital data (1 October 2009–31 March 2013). Cases who died during the hospitalization were matched 1:1 to survivors on disease risk scores (DRSs). Post-admission statin therapy duration was evaluated in patients with at least 90 days of pre-admission continuous statin use. Classification and regression tree (CART) analysis was …

Stevens-Johnson Syndrome And Toxic Epidermal Necrolysis With Antiepileptic Drugs: An Analysis Of The Food And Drug Administration Adverse Event Reporting System (Faers), Eric P. Borrelli, Y. Lee, Andrew M. Descoteaux, Stephen Jon Kogut, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Objective

Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially fatal adverse skin reactions that are most commonly triggered by certain medications. One class of medications that has been highly associated with SJS/TEN reactions is antiepileptic drugs (AEDs). We sought to quantify the risk of SJS/TEN associated with AEDs as a class, as well as individual AEDs, in the United States.

Methods

An analysis was performed of the US Food and Drug Administration Adverse Event Reporting System (FAERS) from July 2014 through December 2017. Rates of SJS/TEN were calculated for each AED compared with all other non‐AEDs. …

Effectiveness Of A Multivitamin Supplementation Program Among Hiv-Infected Adults In Tanzania, Christopher R. Sudfeld, L. Buchanan, Nzovu Ulenga, Donna Spiegelman, Expeditho Mtisi, Ellen Hertzmark, Aisa N. Muya, David Sando, Ester Mungure, Mucho Mizinduko, Wafaie W. Fawzi

Pharmacy Practice and Clinical Research Faculty Publications

Objective: The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania.

Design: We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012.

Methods: The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation …

Outcomes In Human Immunodeficiency Virus Infected Recipients Of Heart And Lung Transplants, Chao Chen, Wen, Nicholas Belviso, Stephen Jon Kogut, Jerry Mccauley

Pharmacy Practice and Clinical Research Faculty Publications

Background: With the advent of combined antiretroviral therapy (cART), growing evidence has shown human immunodeficiency virus (HIV) may no longer be an absolute contraindication for solid organ transplantation. This study compares outcomes of heart transplantations between HIV‐positive and HIV‐negative recipients using SRTR transplant registry data.

Methods: Patient survival, overall graft survival and death‐censored graft survival were compared between HIV‐positive and HIV‐negative recipients. Multivariate Cox regression and Cox regression with a disease risk score (DRS) methodology were used to estimate the adjusted hazard ratios among heart transplant recipients (HTRs).

Results: In total, 35 HTRs with HIV+ status were …

Predictors Of Mortality Among A National Cohort Of Veterans With Recurrent Clostridium Difficile Infection, Haley J. Appaneal, R. Caffrey, Maya Beganovic, Sanja Avramovic, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Though recurrent Clostridium difficile infection (CDI) is common and poses a major clinical concern, data are lacking regarding mortality among patients who survive their initial CDI and have subsequent recurrences. Risk factors for mortality in patients with recurrent CDI are largely unknown.

Methods: Veterans Affairs patients with a first CDI (stool sample with positive C. difficile toxin(s) and ≥2 days CDI treatment) were included (2010–2014). Subsequent recurrences were defined as additional CDI episodes ≥14 days after the stool test date and within 30 days of the end of treatment. A matched (1:4) case–control analysis was conducted using …

1238. A National Comparison Of Antibiograms Between Veterans Affairs Long-Term Care Facilities And Affiliated Hospitals, Maria-Stephanie Tolg, R. Caffrey, Haley Appaneal, Robin Jump, Vrishali Lopes, David Dosa, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here, we evaluate if LTCFs can use antibiograms from affiliated hospitals as their own antibiogram.

Methods: Facility-specific antibiograms were created for all Veterans Affairs (VA) LTCFs and VA Medical Centers (VAMCs) for 2017. LTCFs and affiliated VAMCs were paired and classified as being on the same campus or geographically distinct campuses based on self-report. For each pair, Escherichia colisusceptibility rates (%S) to cefazolin, ceftriaxone, cefepime, ciprofloxacin, nitrofurantoin, sulfamethoxazole/trimethoprim, ampicillin/sulbactam, piperacillin/tazobactam, and imipenem were compared. As guidelines discourage empiric use of antibiotics if susceptibility rates are

Results …

470. Concomitant Antibiotic Use And Death Among A National Cohort Of Veterans With Clostridium Difficile Infection (Cdi), Haley Appaneal, R. Caffrey, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Antibiotic use is a well-known risk factor for development of CDI, and there is preliminary evidence suggesting concomitant antibiotic use may result in poor outcomes, including death. This work investigated the effect of concomitant antibiotic exposure during CDI treatment on mortality among patients with CDI.

Methods: We conducted a national retrospective study of Veterans with a first CDI between 2010 and 2014, defined as a positive C. difficile toxin(s) and no episode in the year prior. Those treated with guideline recommended CDI treatment were included (10–14 days of PO or IV metronidazole, PO or PR vancomycin, or …

Real World Evidence - What It Is And What It Can Tell Us According To The International Society For Pharmacoepidemiology (Ispe) Comparative Effectiveness Research (Cer) Special Interest Group (Sig), Hongbo Yuan, Sanni Ali, Emily S. Brouwer, Cynthis J. Girman, Jeff J. Guo, Jennifer L. Lund, Elisabetta Patorno, Jonathan L. Slaughter, Xuerong Wen, Dimitri Bennett

Pharmacy Practice and Clinical Research Faculty Publications

On December 8, 2016, the New England Journal of Medicine published a sounding board on Real World Evidence (RWE)¹ by the US Food and Drug Administration (FDA) leadership. While the value of RWE based on nonrandomized observational studies was appreciated, such as for hypothesis generating, safety, and measuring quality in healthcare delivery, the authors expressed concerns on the quality of data sources and the ability of methodologies to control for confounding. In response, we offer a few considerations regarding these concerns.

Generalizing Evidence From Randomized Trials Using Inverse Probability Of Sampling Weights, Ashley L. Buchanan, G. Hudgens, Stephen R. Cole, Katie R. Mollan, Paul E. Sax, Eric S. Daar, Adaora A. Adimora, Joseph J. Eron, Michael J. Mugavero

Pharmacy Practice and Clinical Research Faculty Publications

Results obtained in randomized trials may not easily generalize to target populations. Whereas in randomized trials the treatment assignment mechanism is known, the sampling mechanism by which individuals are selected to participate in the trial is typically not known and assuming random sampling from the target population is often dubious. We consider an inverse probability of sampling weighted (IPSW) estimator for generalizing trial results to a target population. The IPSW estimator is shown to be consistent and asymptotically normal. A consistent sandwich-type variance estimator is derived and simulation results are presented comparing the IPSW estimator to a previously proposed stratified …

1067. Comparative Effectiveness Of Nafcillin Or Oxacillin, Cefazolin, And Piperacillin/Tazobactam In Methicillin-Sensitive Staphylococcus Aureus Bacteremia, Maya Beganovic, Cusumano, Vrishali Lopes, Kerry L. Laplante, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Background: β-Lactam antibiotics are recommended as first line for treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. The objective of this study was to compare effectiveness among β-lactam therapies in MSSA bacteremia patients that were exclusively treated with one antibiotic.

Methods: This was a retrospective cohort study of patients hospitalized at Veterans Affairs (VA) medical centers with MSSA bacteremia from January 1, 2002 to October 1, 2015. Patients were included if they were treated exclusively with nafcillin, oxacillin, cefazolin, or piperacillin/tazobactam (i.e., monotherapy with no changes in therapy). The primary outcome was 30-day mortality, and secondary outcomes were time to discharge, …

699. Relationship Between Klebsiella Pneumoniae Antimicrobial Resistance And Biofilm Formation, Jaclyn Cusumano, Daffinee, Megan Luther, Vrishali Lopes, Aisling R. Caffrey, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Klebsiella pneumoniae is a frequently multidrug-resistant organism with a high propensity to form biofilm. K. pneumoniae is the most common carbapenem-resistant Enterobacteriaceae (CRE), and labeled an urgent threat by the CDC. The relationship between K. pneumoniae biofilm formation and specific antimicrobial resistance patterns has not been well defined.

Methods: K. pneumoniae isolates (n = 139) were evaluated for antimicrobial resistance and biofilm formation (CDC, Providence VA Med. Ctr., Rhode Island Hosp., BEI, and ATCC). Susceptibility was based predominantly on 2017 CLSI (Clinical and Laboratory Standards Institute) breakpoints. Isolates were categorized as multidrug-resistant (MDR: resistant to ≥ …

Clinical And Genetic Risk Factors For Biofilm-Forming Staphylococcus Aureus, Megan Luther, M. Parente, Aisling R. Caffrey, Katie Daffinee, Vrishali V. Lopes, Emily T. Martin, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

The molecular and clinical factors associated with biofilm-forming methicillin-resistant Staphylococcus aureus (MRSA) are incompletely understood. Biofilm production for 182 MRSA isolates obtained from clinical culture sites (2004 to 2013) was quantified. Microbiological toxins, pigmentation, and genotypes were evaluated, and patient demographics were collected. Logistic regression was used to quantify the effect of strong biofilm production (versus weak biofilm production) on clinical outcomes and independent predictors of a strong biofilm. Of the isolates evaluated, 25.8% (47/182) produced strong biofilms and 40.7% (74/182) produced weak biofilms. Strong biofilm-producing isolates were more likely to be from multilocus sequence typing (MLST) clonal complex 8 …

Assessing Individual And Disseminated Effects In Network-Randomized Studies, Ashley L. Buchanan, H. Vermund, Samuel R. Friedman, Donna Spiegelman

Pharmacy Practice and Clinical Research Faculty Publications

Implementation trials often involve clustering via risk networks, where only some participants directly received the intervention. The individual effect is that among directly treated persons beyond being in an intervention network; the disseminated effect is that among persons engaged with those directly treated. We employ a causal inference framework and discuss assumptions and estimators for individual and disseminated effects and apply them to HIV Prevention Trials Network 037. HIV Prevention Trials Network 037 was a Phase III, network-level, randomized controlled HIV prevention trial conducted in the US and Thailand from 2002 to 2006 that recruited persons who injected drugs, who …

What Is The Role For Metronidazole In The Treatment Of Clostridium Difficile Infection? Results From A National Cohort Study Of Veterans With Initial Mild Disease, Haley J. Appaneal, R. Caffrey, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Metronidazole may still be an appropriate therapeutic option for mild Clostridium difficile infection (CDI) in select patients, but data is limited to guide clinicians in identifying these patients.

Methods: Our two-stage study included a national cohort of Veterans with a first episode of mild CDI (2010–2014). First, among those treated with metronidazole, we identified predictors of success, defined as absence of all-cause mortality or recurrence 30-days post-treatment, using multivariable unconditional logistic regression. Second, among a subgroup of patients with characteristic/s predictive of success identified in the first-stage, we compared clinical outcomes among those treated with metronidazole compared …

Improved Survival With Continuation Of Statins In Bacteremic Patients, Ajinkta M. Pawar, L. Laplante, Tristan T. Timbrook, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Objectives: Varying statin exposures in bacteremic patients have different impacts on mortality. Among patients with adherent statin use, we sought to evaluate the impact of statin continuation on inpatient mortality in bacteremic patients.

Methods: A retrospective cohort study was conducted using Optum Clinformatics^TM with matched Premier Hospital data (October 2009–March 2013). Patients with a primary diagnosis of bacteremia and 6 months of continuous enrollment prior to the admission, receiving antibiotics at least 2 days of antibiotics during the first 3 days of admission, were selected for inclusion. Furthermore, patients demonstrating adherent statin use based on 90 days of continuous …

Antimicrobial Textiles For Long Duration Space Flight, Keerthi Jagadeesan

Major Papers by TMD Master of Science Students

The review that follows was performed with the objective of contributing to the development, methodology and evaluation analysis of developing antimicrobial textiles for long duration space flight (LDSF) of which there has been little study. This is of much importance as the study of microbiomes in space travel is still limited and there are no mechanisms available for efficiently washing clothes during space travel. The current launch costs for space travel are high (approx. $10,000 per pound) so the weight of clothes needs to be carefully allocated for at least three years of travel to mars. This study is a …

Algorithms Used To Identify Ventricular Arrhythmias And Sudden Cardiac Death In Retrospective Studies: A Systematic Literature Review, Yizhou Ye, Paul Larrat, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Drug-induced QT interval prolongation may increase the risk of sudden cardiac death or ventricular arrhythmias (SCD/VA), and therefore affects the safety profile of medications. Administrative databases can be used to inform pharmacoepidemiologic drug safety studies for such rare events. In order to compare event rates between studies, validated operational definitions of these events are needed. We conducted a systematic literature review in PubMed to identify algorithms for SCD/VA. Twenty-two studies were included in the review. Fifteen (68%) studies evaluated International Classification of Diseases, 9th revision (ICD-9) based medical data, of which six utilized a common, validated operational definition. This algorithm …

1829. A Systems Approach To Nursing Home Antimicrobial Stewardship, Stefan Gravenstein, Manning, Rosa R. Baier, Christopher Crnich, H. Edward Davidson, Kerry L. Laplante, David Dosa, Robin Jump

Pharmacy Practice and Clinical Research Faculty Publications

Background: Up to 70% of nursing home (NH) residents receive one or more courses of antibiotics (ATB) annually, of which over half may be inappropriate and risk harm. The current availability of in-house NH data is often insufficient to measure and track appropriateness, due to incomplete data or unusable formatting. Our 3-year project to improve antimicrobial stewardship (AMS) used the Centers for Disease Control and Prevention’s (CDC) Core Elements of AMS for NHs, with guided input from NH providers to develop and implement an electronic ATB de-escalation decision support tool that also captures otherwise inaccessible data.

Methods: Our baseline …

Isolation And Identification Of Probiotic Bacteria For The Management Of Epizootic Shell Disease, Grace Underwood

Open Access Master's Theses

Epizootic shell disease (ESD) is an emerging disease in the American lobster (Homarus americanus) characterized by lesions, mainly on the carapace. The diseased appearance of the shell due to the lesions has had significant negative impact upon the lobster fisheries in New York, Connecticut, Rhode Island, and Massachusetts, since fishers are not able to sell affected lobsters to the more lucrative live market. ESD lesions are different from other shell diseases found in the American lobster populations because they are due to a poly-microbial infection that degrades the epicuticle layer, while the pillars of the chitin matrix remain …

Utilization Of Probiotics To Manage Epizootic Shell Disease In American Lobsters, Homarus Americanus, Melissa Hoffman

Open Access Master's Theses

Epizootic shell disease (ESD) in the American lobster, Homarus americanus, has a major impact on the southern New England lobster industry, yet there are no practical tools for managing the disease. The goal of this study was to identify bacterial probiotics that could be used to manage ESD in wild lobster populations. Candidate bacterial isolates (n = 24) were previously isolated from lobsters in Narragansett Bay and identified as having probiotic characteristics against ESD-associated bacteria Thalassobius sp. and Aquimarina macrocephali, or the fish pathogen Vibrio anguillarum. Healthy lobster post-larvae were exposed to five of the candidate strains …

On The Problem And Promise Of Metaphor Use In Science And Science Communication, Cynthia Taylor, Bryan M. Dewsbury

Biological Sciences Faculty Publications

The language of science is largely metaphorical. Scientists rely on metaphor and analogy to make sense of scientific phenomena and communicate their findings to each other and to the public. Yet, despite their utility, metaphors can also constrain scientific reasoning, contribute to public misunderstandings, and, at times, inadvertently reinforce stereotypes and messages that undermine the goals of inclusive science. This paper 1) examines the generative potential of metaphors to the advancement of scientific knowledge and science communication, 2) highlights the ways in which outdated metaphors may limit scientific inquiry and contribute to public misunderstandings, and 3) critically analyzes the implications …

Protective Versus Pathologic Pre-Exposure Cytokine Profiles In Dengue Virus Infection, Heather Friberg, Coreen M. Beaumier, Sangshin Park, Pamela Pazoles, Timothy P. Endy, Anuja Mathew, Jeffrey R. Currier, Richard G. Jarman, Kathryn B. Anderson, Steve Hatch, Stephen J. Thomas, Alan L. Rothman

Cell and Molecular Biology Faculty Publications

Background: Hyperendemic circulation of all four types of dengue virus (DENV-1-4) has expanded globally, fueling concern for increased incidence of severe dengue. While the majority of DENV infections are subclinical, epidemiologic studies suggest that type-cross-reactive immunity can influence disease outcome in subsequent infections. The mechanisms controlling these differential clinical outcomes remain poorly defined.

Methodology/Principal findings: Blood samples were collected from a cohort of school-aged Thai children who subsequently experienced a subclinical DENV infection or developed dengue illness. PBMC collected prior to infection were stimulated in vitro with DENV and the secretion of 30 cytokines was measured using a …

Upregulation Of Hla‐E By Dengue And Not Zika Viruses, Elena Drews, Awadalkareem Adam, Phone Htoo, Elizabeth Townsley, Anuja Mathew

Cell and Molecular Biology Faculty Publications

Introduction. The most severe form of dengue virus (DENV) illness, dengue haemorrhagic fever, is characterised by plasma leakage and increased vascular permeability. Objectives. Given the critical role that endothelial cells play in the pathogenesis of DENV, we wanted to determine whether infection with DENV altered the expression of MHC class I related genes including HLA‐E. Results. In this study, we provide evidence that HLA‐E but not MICA/B or HLA‐G is upregulated by all four serotypes of DENV in an endothelial cell line human microvascular endothelial cells (HMEC)‐1. In contrast, Zika virus (ZIKV), a related flavivirus, where plasma leakage is …

Eastern Oyster Larval Transcriptomes In Response To Probiotic And Pathogenic Bacteria, Tejashree Modak

Open Access Dissertations

Oysters are described as keystone species serving an important ecological role. As filter-feeders they help in maintaining water quality. Oyster reefs provide refuge and support to different organisms. The eastern oyster, Crassostrea virginica, native to the East Coast of United States and Gulf of Mexico is a part of the rapidly growing aquaculture industry. Aquaculture production depends on a healthy and constant supply of oyster larvae that are provided by hatcheries. Several hatcheries on the east coast that provide C. virginica seed to oyster farms face significant losses owing to Vibrio infections causing massive larval mortalities. Use of antibiotics …

1437. Family Duty And Safety Linked To Overcoming Attitudinal Barriers To Adult Pneumococcal Vaccination In Disparate Populations, Maria-Stephanie Tolg, Marc L. Hutchison, Brian Krueger, Katherine Kelly Orr, Jennifer M. Deangelis, Aisling R. Caffrey, Kerry L. Laplante

Political Science Faculty Publications

Background: Minority adult populations are at a higher risk for invasive pneumococcal disease and also have significantly lower vaccination rates when compared with the general population. Ingrained attitudes are a significant barrier to receipt of pneumococcal vaccine in these disparate populations, and therefore we tested targeted informational messaging to overcome these.

Methods: A survey instrument of attitudinal questions related to pneumococcal vaccination was administered via YouGov, an online public national survey house in 2017. Socioeconomic information was captured and linked to baseline Likert scale attitudinal question responses. Respondents were randomly assigned into subsamples that received different science-based messages …

Evaluating The Effects Of Attitudes On Health-Seeking Behavior Among A Network Of People Who Inject Drugs, Ayako Miura

Open Access Master's Theses

The transmission of HIV/AIDS remains a great concern among people who inject drugs (PWIDs) in the United States. PWIDs are often embedded in a unique HIV/AIDS risk network via the shared use of drug equipment and risky sexual behavior. However, the characteristics of PWIDs in risk networks present challenges in a collection of network data resulting in limited studies of these networks of PWIDs. Our study employed causal inference methods applied to an observational study with dissemination to assess attitudes toward HIV/AIDS risk among PWIDs and their effect on health-seeking behaviors.

We used data from the Social Factors and HIV …

Solid Waste Management In Coastal Ghana, Ivy Akuoko

Open Access Master's Theses

Solid waste management is a major problem in most areas of coastal Ghana, where waste is dumped into drains that discharge into the sea or is dumped directly onto beaches. This is as a result of inadequate waste management infrastructure, low patronage of the few infrastructure available, and poor management. The consequence is an increase in vulnerability to sanitation related diseases such as malaria, typhoid and cholera as well as threatened coastal ecosystems’ health. Improper solid waste disposal practices are usually counter-productive to the many benefits and uses of the coast and directly impact the livelihoods and businesses that are …

Peruvian Antiquities And The Collecting Of Cultural Goods, Terrence H. Witkowski

Markets, Globalization & Development Review

Ancient art, artifacts, and architecture have long excited the intellectual curiosity and acquisitive passions of private and institutional collectors who, in turn, have funded archaeological research, preservation initiatives, and public education. Yet, the procurement of these goods also has encouraged looting and trafficking activities. Supplying collectors has destroyed much cultural evidence in source countries and has raised questions about who should control heritage and history. This article investigates the market for Peruvian antiquities, the surviving material culture created by the country’s inhabitants before the Spanish Conquest. It briefly reviews Peru’s early history and the history of collecting its artifacts, and …