2025 Poster Abstracts

Author:  Ahmed Abdelwahab

Abstract:  

Objective: Previous studies evaluating bicarbonate therapy in pediatric diabetic ketoacidosis (DKA) populations have been limited by confounding factors such as differences in illness severity, ICU admission bias, and fluid resuscitation. Our study aims to address these limitations by using propensity score (PS) matching to balance baseline characteristics on key clinical outcomes. Our study aims to provide a clearer understanding of bicarbonate’s effects on factors such as cerebral edema, coma risk, acute respiratory failure, and mortality, specifically in pediatric DKA population 

Methods: Our study used TriNetX, a global health research network that aggregates deidentified electronic medical records from over 140 healthcare organizations, to analyze children (<12 years) with DKA. Patients were divided into Cohort A (no bicarbonate) and Cohort B (bicarbonate-treated). Propensity score matching was performed to balance key baseline characteristics and minimize confounding. Risk analysis was conducted to assess outcome differences, with risk differences (RD) and 95% confidence intervals reported. 

Results: Before matching, Cohort A included 226 patients, while Cohort B had 8,950 patients. After matching, both cohorts consisted of 211 patients. Risk analysis showed that cerebral edema risk equalized after matching (RD 0.002, 95% CI: -0.039-0.044, p=0.911). However, coma risk remained significantly higher in bicarbonate-treated patients (RD 0.047, 95% CI: 0.019-0.076, p=0.001), as did acute respiratory failure (RD 0.071, 95% CI: 0.019-0.123, p=0.008). Furthermore, the mortality difference observed before matching disappeared (RD 0.000, 95% CI: -0.040-0.041, p=0.991). 

Discussion: After matching, bicarbonate was not associated with increased cerebral edema risk but remained linked to higher coma and acute respiratory failure rates. Furthermore, the mortality difference disappeared, suggesting bias in earlier studies. These findings indicate that routine bicarbonate use may worsen outcomes, highlighting the need to reconsider its role in pediatric DKA management. 

Author: Aditya Acharya

Abstract: 

Objectives/Goals: The authors of this study took part in a medical mission trip in
Guatemala with Humanity First. We had the opportunity to volunteer at the Humanity First Guatemala medical camp in the rural city of Alotenango, Guatemala. 

Methods/Study Population: The focus of this study is to expand on our personal experience working in Guatemala with Dr. Edwin Can, an internal medicine physician, discussing the broader topic on how healthcare practices around the world are influenced heavily by culture, and social determinants of health.

Results: Dr. Can’s approach to addressing and treating chronic pain states
is to have detailed conversations with his patients on the various stressors in their lives due to the poor social determinants of health that the vulnerable populations of Guatemala suffer from. He also prescribes treatments with as little secondary effects as possible utilizing vitamins and NSAIDs and encouraging the use of traditional medicines. The age of patients we saw at the Medical camp presenting with somatic symptoms of stress were between 20-50 years of age.

Discussion/Significance of Impact: Guatemala has many vulnerable populations, and Humanity First USA had the opportunity to work with Humanity First Guatemala to set up a clinic in Alotenango serving primarily vulnerable people. This study highlights many factors in Guatemala that cause its vulnerable populations to be in a constant high-stress state.

Author: Ornina Atieh

Abstract:  

Background: Long COVID (LC) is characterized by persistent symptoms at least 3 months after a SARS-COV-2 infection. LC has been associated with fungal translocation, gut dysfunction, and enhanced systemic inflammation. Currently, there is no approved treatment for this condition. Vitamins K2/D3 anti-inflammatory effect was shown to help attenuate the course of acute COVID infection. 

Objective: This trial aims to investigate the effects of vitamins K2/D3 on LC symptoms, and gut and inflammatory markers in people with established long COVID.

Methods: This single-site randomized-controlled study enrolled adults experiencing ≥2 moderate LC symptoms at least 3 months after a COVID-19 infection. The RECOVER Long COVID Research Index and number and type of LC symptoms, were considered. Participants were randomized 2:1 to daily 240 µg K2 (pure MK-7 form) and 2000 UI vitamin D3 or standard of care (SOC) for 24 weeks.  Endpoints were changes in symptomatology and in select inflammatory, metabolic and gut biomarkers at 24 weeks. 

Results: We enrolled 151 participants (n=98 received vit K2/D3 and 53 SOC). Median age was 46 years, 71% female and 29% non-white. Baseline demographics were balanced between groups. At 24 weeks, the active treatment group only had a sharp increase in 25(OH) D indicating good treatment adherence. In the vitamins K2/D3 arm, there was a 7.1% decrease in the proportion who had LC Index ⩾12 (vs. 7.2% increase in SOC; p=0.01).  The average number of LC symptoms remained stable in vitamin K2/D3 arm but increased in SOC arm (p=0.03). Additionally, reductions in oxidized LDL, inflammatory markers sTNF-RI and sCD163, and fungal translocation marker (1,3)-β-d-glucan were observed in the vitamins K2/D3 arm compared to the SOC arm (P<0.01) over 24-weeks.

Conclusion: Vitamins K2/D3 improved RECOVER Long COVID Index, number of LC symptoms, and several gut and inflammatory markers. Vitamins K2/D3 provide a promising safe intervention for people suffering from long-COVID.

Author: Ifeoluwa Babatunde

Abstract: 

Objectives:  The objective of this study is to conduct an equity review and critical appraisal of professional and government sponsored pediatric ASD diagnosis and management guideline documents. Hence assessing the correlation between quality and the incorporation of equity considerations in a guidance document.

Methods: A comprehensive search was conducted in PubMed and EMBASE. Professional and governmental websites of organizations which produce pediatric focused health policy documents were also searched for relevant documents. Data from eligible studies were extracted to a spreadsheet. Equity factors considered in the development of the guideline was assessed and extracted using the PROGRESS-Plus framework. The quality of each eligible document was assessed using the Appraisal of Guideline Research and Evaluation Second Edition (AGREE-II) tool.

Results: All 24 documents addressed at least one PROGRESS-Plus equity characteristic. The frequency of characteristics addressed out of the 24 documents were: place of residence - 12 (58%), race/ethnicity - 18 (75%), occupation - 5 (21%), education - 12 (50%), Gender/sex - 14 (58%), Religion - 1 (4%), Socioeconomic status - 14 (58%), Social capital - 8 (33%), and personal characteristics (age and disabilities) - 24 (100%). The Australian, New Zealand, and National Institute for Health and Care Excellence (NICE) guidelines which had the highest AGREE-II scores translated their equity considerations to specific recommendations for each subgroup of ASD persons. In contrast, other guidelines mainly presented background information.

Discussion: This appraisal of guidelines revealed varying degrees of methodological rigor organizations incorporate in the development guidelines. A correlation can be noted here between the integration of equity and the quality of the guideline. Future guidelines should prioritize a more comprehensive approach to equity by providing recommendations or actionable statements to aid the practitioner in addressing systemic barriers that lead to disparities and inequity in ASD Diagnosis and management.

Author: Ifeoluwa Babatunde

Abstract: 

Objectives: The objective of this study is to conduct review of systematic reviews on race related factors that impact pediatric Autism Spectrum Disorder (ASD) diagnosis and management. This would inform an update of American Academy of Pediatrics (AAP) policy on ASD care which aims to eliminate problematic race-based policies that promote health disparities.

Anticipated Methods: A comprehensive search was conducted in PubMed, EMBASE and Cochrane library for previously published systematic reviews. Articles will be eligible if they present evidence that help understand ASD prevalence, diagnostic tools, interventions and outcomes within the context of race and ethnicity. Data from eligible studies will be extracted to a spreadsheet. The quality of each eligible systematic review will be assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool.

Anticipated Results: We anticipate that our review will reveal limitations in the racial equity landscape of ASD research. We expect to find limited reporting in the representation of racial and ethnic groups which form the diversity of the United States. We foresee finding evidence on adaptations to ASD screening tools and interventions to suit the needs of different cultural and linguistic groups. Although a substantial number of systematic reviews have been published on ASD, we anticipate variations in the methodological rigor that indicate an opportunity for more robust methods in evidence synthesis, especially relating to equity.

Discussion: This umbrella review will facilitate an improvement in how racial equity is approached in the design, conduct, synthesis and interpretation of ASD research. If an underrepresentation of ethnic groups is found, it will be a call for future researchers to actively engage the diversity of persons with ASD. We hope that this review will lead to a judicious utility of race and ethnicity data in evidence-based clinical policy development.

Author:  Ifeoluwa Babatunde

Abstract: 

Objectives: The objective of this study is to conduct a network meta-analysis (NMA) and systematic review of available pharmacological interventions used to prevent postoperative pain in adult patients after craniotomy.

Methods: A comprehensive search was conducted in PubMed, EMBASE and Cochrane library for randomized control trials (RCTs) evaluating the effect of various types of analgesic interventions administered to prevent pain in adults undergoing brain surgery. We performed a random effects frequentist network meta-analysis to evaluate outcomes such as postoperative pain score, analgesic consumption, and nausea & vomiting. Lastly, the certainty of evidence (CoE) for each network comparison will be assessed using the GRADE approach. We will classify each intervention from least to most effective.

Anticipated Results: The search identified 84 studies for the analysis. Preliminary findings show varying analgesic efficacy as indicated by the postoperative pain score at 0, 6, 12 and 24 hours for NSAIDs, opioids, and anesthetics. The results showed similar efficacy between the different types of anesthetics regardless of the route of administration. Some studies indicate a benefit in adding epinephrine to the anesthetic block. However, this benefit was inconsistent at the different time points. We anticipate finding a range of certainty of evidence for the different comparisons within the network.

Discussion: This network meta-analysis will provide clinicians with evidence to facilitate pain management decisions for patients who are undergoing brain surgery. These results will also guide the development of standardized pain management protocols for health systems. The network estimates calculated here are limited by the lack of direct comparative studies between combinations of interventions in the literature. However, these limitations should be used to inform future research priorities. Overall, this synthesis of evidence highlights important insights into the effectiveness of options available to patients.

Author: Jhony Baissary

Abstract: 

Introduction: We have previously shown in cross-sectional studies that COVID-19 infection was associated with arterial stiffness and elevated oxidized LDL (oxLDL). Data is limited on assessing the effect of COVID-19 infection on endothelial function, pre- and post-pandemic. The objective of this study was to assess changes in pre-pandemic cardiovascular parameters after COVID-19 infection.

Methods: This prospective cohort study used FDA-approved EndoPAT2000 to measure Augmentation Index (AI; arterial elasticity) and Reactive Hyperemic Index (RHI; endothelial function). Markers of endothelial function, inflammation and gut integrity were collected at pre- and post-pandemic visits. COVID-negative participants were 1:1 propensity score matched to COVID-positive participants on pre-pandemic covariates, and AI5.0 was defined as having worse AI.

Results: Among 156 participants, 50% had documented COVID-19 infection. Groups were balanced (P>0.05) on pre-pandemic characteristics except for smoking status, TNF-RI, TNF-RII, and I-CAM (P<0.05). Increases in oxLDL (P=0.03) were observed in the COVID positive group, and COVID infection had a negative effect on inflammatory markers (VCAM, TNF-RI, TNF-RII, sCD14) and gut integrity (I-FABP, BDG) compared to COVID-negative participants (P<0.05). There was a 16.7% (P=0.02) increase in the proportion of COVID-positive participants with AI≥5.0, without a significant change (P=0.09) among the COVID-negative group. COVID-positive status, female sex, and higher IL-6 and sCD163 were associated (P<0.05) with an increase in having worse AI.

Conclusion: COVID infection is independently associated with arterial stiffness. For COVID survivors, female sex and higher markers of inflammation were associated with arterial stiffness. Long-term cardiovascular effects of arterial stiffness are concerning in this population and should be investigated.

Author: Samantha Bentley

Abstract: 

Nourishing Beginnings (NB) is an integrated referral and service delivery program that provides low-income pregnant individuals with increased nutritional food access throughout pregnancy up to three months postpartum, through community health workers (CHW), who simultaneously address and provide support for social service needs of the client.

Population and Inclusion: Pregnant individuals who are 18 yrs +, Medicaid-eligible, <22 week pregnant, and English speaking. Study Design: 160 participants, randomized to two intervention arms (n=80 each), with additional propensity matched control group (n=160) for primary outcomes only. Data collected at baseline, 8 weeks, near/at delivery and 3 months post-delivery.

Primary Outcomes: Food security, birthweight (gms; <2500), gestational age (weeks,<37 weeks), neonatal or special nursery care stay. The goal of Nourishing Beginnings is to improve long-term health outcomes (i.e., maternal and infant) both directly and mediated through a set of proximal outcomes, including prenatal care, food security, diet and nutrition, reported race discrimination and psychosocial factors including depression, stress, healthy eating self-efficacy, and social support.

Author: Brian Biroscak

Abstract: 

Goals: In addition to the dual challenge facing the D&I field of how to increase the volume as well as optimize the pace of delivered, evidence-based innovations, implementation scientists and practitioners face the triple challenge of how to optimize the effectiveness, efficiency, and equity of their innovations. The NIH-funded Systems Marketing Analysis for Research Translation (SMART) innovation program addresses this gap by combining methods for selecting, tailoring, and optimizing implementation, scale-up and sustainability for effectiveness, efficiency, and equity of clinical and community practices of interest. 

Methods: We used participatory group model building (GMB) with a multidisciplinary team to develop and refine the SMART program theory for selecting and tailoring implementation strategies. Using system dynamics (SD) computer modeling, we then simulated the SMART model across a range of dynamic environments and optimized the pace of implementation outcomes including appropriateness, feasibility, reach, and equity. A sensitivity analysis was then run for optimized pacing to evaluate and identify regions of program path dependence and improve the robustness of implementation outcomes to model uncertainty. 

Results: Computer simulation as an implementation strategy helped identify potential path dependencies in program theory and sensitivity to initial conditions, parameters, and model assumptions. Combining social marketing analysis with scaling up supply to meet demand for practices of interests improved program design with respect to the effectiveness, efficiency, and equity of clinical and community practices of interests. Future work will include empirically testing the program theory with 12 or more translational research projects. 

Discussion: Integrating systems- and marketing sciences for optimizing innovation effectiveness, efficiency, and equity is a promising approach that can help address challenges of equitably implementing clinical and community practices of interest in increasingly dynamic, fast changing environments.

Author: Gabriel Bonassi

Abstract: 

Objectives/Goals: Evaluate potential trends and disparities in the use of physical restraint (PR) during emergency room (ER) visits in the United States from 2018 to 2024.

Methods/Study Population: This observational retrospective cohort analysis used deidentified electronic health records from the TriNetX US Collaborative Network to identify adult patients (≥18 years) who experienced PR (ICD10CM: Z78.1) during an ER visit (HL7V3.0: Visit Type: EMER) on the same day between January 1, 2018 and December 31, 2024. We used a standardized 12‑month lookback period to capture only incident restraint events.

Results: In this study, a total of 59,793 patients were identified (mean age: 61 ± 18 years; range: 18–90). Sex of the cohort was 61.63% male, 37.12% female, and 1.25% undetermined. Regarding patient ethnicity, 12.03% identified as Hispanic or Latino, 76.46% as not Hispanic or Latino, and 11.51% had undetermined ethnicity. With respect to race, 60.62% were classified as White, 25.51% as Black or African American, 5.75% as unknown race, 3.86% as Asian, and 3.64% as other races. In our incidence analysis, we found that the proportion of patients with an incident of PR increased from 23.183% (n = 9,610) in the pre‑pandemic phase (January 1, 2018–March 10, 2020) to 69.971% (n = 33,577) during the Covid-19 intrapandemic phase (March 11, 2020–May 11, 2023), before declining to 64.712% (n = 16,849) in the post‑pandemic phase (May 12, 2023–December 31, 2024).

Discussion/Significance of Impact: This study emphasizes that while Black or African American patients constitute roughly 13% of the US population, they accounted for approximately 26% of all patients who experienced PR in an ER visit from 2018 to 2024. This two-fold overrepresentation suggests disparities in the application of PR and that patient demographics, such as race, can influence the odds of PR application in the ER. In addition, the higher incidence of PR in the ER during the pandemic suggests that operational stress, resource constraints, and altered care protocols can potentially amplify such disparities.

Author: Bracken, Rachel

Abstract: 

Background: People with disabilities (PWD) comprise a significant part of the population, yet experience some of the most profound health disparities. Among the greatest barriers to quality care are inadequate health professions education (HPE) related to caring for PWD and HPE rooted in a medical model of disability centered on deficit and impairment. There is an urgent need to collaborate with the disability community to design medical curricula that will reduce disability stigma and ableism by de-centering the medical model of disability in HPE, yet the processes for developing and assessing community-engaged disability education remain understudied.

Objectives: We will describe the development and evaluation of our community advisory board (CAB) as a model of disability community engagement.

Methods/Study Population: We will describe the results of our mixed methods evaluation, which will include two surveys in June 2024 and December 2024 as well as interviews with CAB members conducted in late summer 2024. The CAB includes representatives from varied disability communities, students, and practicing providers. We will use a modified version of the Partnership Assessment in community-based Research (PAIR) Measure, which examines community-based participatory research partnerships between community and academic stakeholders. Designed in collaboration with community partners, it assesses partnerships across five dimensions: communication, collaboration, partnership, benefits, evaluation, and sustainability. Results. Analyses will include summary descriptive statistics of survey data and thematic analysis of interviews. We examine the process of community engagement in this area of medical education and assess the quality of the collaboration.

Significance: Unless and until PWD are involved in designing health professions curricula and training students, health disparities due to HCP ableism will remain. This project demonstrates the value of community-engaged curriculum design and models best practices for community engagement with pan-disability groups.

Author: Neel Dayal

Abstract:

Objective: Describe the development of treatment-resistant pediatric POTS in previously well-controlled patients, and demonstrate the effectiveness of sotalol as an alternative therapy.

Cases: 3 patients were evaluated that had a previous diagnosis of POTS.

Patient 1 is an 18-year-old female with POTS treated with atenolol and fludrocortisone until she contracted COVID-19. She had increased dysautonomia-related symptoms post-infection requiring escalation of her medications and addition of midodrine to help with associated hypotension. These changes were ineffective in providing symptom control.

Patient 2 is an 18-year-old female with Ehlers-Danlos syndrome and POTS controlled with metoprolol, until she developed recurrent episodes of syncope and severe tachycardia. Even after addition of ivabradine and dose escalation of metoprolol, she had increased frequency and worsening of her POTS symptoms.

Patient 3 is a 17-year-old female treated with metoprolol, midodrine, and ivabradine. After an Epstein-Barr viral infection, her POTS symptoms considerably worsened, and her medications no longer provided benefit.

Results: All 3 patients were started on sotalol twice per day, which provided heart rate control after they became treatment-resistant to other therapies following a viral infection or some unknown etiology. Sotalol caused an average decrease in heart rate of 98.7 bpm, and a standing heart rate of 100 bpm or less for all 3 patients, with remission of their tachycardia symptoms. None of these patients developed any symptoms of dizziness, lightheadedness, or syncope following initiation of sotalol. ECG
evaluation of these patients after starting sotalol treatment showed no proarrhythmias and no QTc prolongation.

Conclusion: 3 previously stable pediatric POTS patients were evaluated after becoming resistant to their previous medications. Sotalol was effective in all 3 patients with remission of their tachycardia symptoms without QTc prolongation or proarrhythmia. These findings show the effectiveness of sotalol in medically resistant pediatric POTS.

Author: Juliann Di Fiore

Abstract: 

Background: The NICU can vary drastically between noisy open bays to extremely quiet single patient rooms.  Both environments are dissimilar to that of the womb. NICU sounds that emulate the womb environment may play a critical role in neuronal maturation of the respiratory control regions of the brain in preterm infants. Apnea, often resulting in bradycardia and intermittent hypoxemia (IH), are common in preterm infants. IH can induce a range of sequelae including anatomical changes in the cardio-respiratory brainstem nuclei further perpetuating respiratory instability. Music exposure in the NICU has been shown to have beneficial effects on sucking behavior, caloric intake, heart rate, pain scores and sleep patterns.  However, the effect of early postnatal womb sound exposure on neuronal maturation of the respiratory control regions of the brain in preterm infants is unclear. 

Objective: To determine the acute effects of womb sound recordings on cardiorespiratory and oxygen stability in moderately preterm infants during hospitalization.

Methods: 19 preterm infants (gestational age 31.6±0.8 wks, birthweight 1822±372gm) were exposed to alternating 6h periods of commercially available womb sound recordings (55-60dB) and ambient noise over a 24 hr period at 34 weeks +/- 2 days corrected age. Respiration, oxygen saturation and heart rate were monitored. Apnea (>5sec), IH (SpO2<85%), and bradycardia (<80bpm) were compared between ambient and womb sound exposures to assess the acute effect of auditory stimulation on cardiorespiratory stability. 

Results: A significant correlation was found between increased oxygen/respiratory instability during ambient conditions and reduced frequency of IH (r2=.24, p=.031), time with hypoxemia (r2=.23, p=.036) and shorter duration of periodic breathing (r2=.38, p=.005) during womb sounds. The reduction in apnea frequency during womb recordings did not reach statistical significance (r2=.17, p=.083). There was no difference in bradycardia frequency or movement duration between exposures suggesting no effect on irritability.
Conclusion

Author: Chloe Edmonds

Abstract: 

Objectives: Dysphagia (difficulty swallowing) is a significant health burden in infants, but these infants are fragile and require a translational model to explore the neurological substrates underlying swallowing pathophysiology. Dysphagia is often associated with airway compromise, which can be predicted by the size of the bolus prior to swallowing. This study used an infant pig model to determine the mechanism underlying the relationship between bolus sizes and entry of ingested material into the airway.

Methods: We recorded infant pigs using videofluoroscopy as they fed on bottles, and measured total pharyngeal transit time (TPT time), which notably occurs after bolus formation. We collected data across three experimental conditions: control infant pigs, pigs with an induced sensory deficit (bilateral anesthetization of the inferior alveolar nerve [IAN], which is known to disrupt feeding), and in pigs with IAN anesthetization along with oropharyngeal stimulation (using capsaicin, which is known to improve swallowing).  

Results: All three experimental groups had a positive relationship between bolus size and TPT time. This relationship did not differ when comparing the three treatments. 

Discussion: These results suggest that a mechanism by which larger boluses produce aspiration is increasing the time it takes the bolus to travel through the pharynx. Further, because this relationship did not differ with IAN lesion nor capsaicin, this study provides further support for the theory that the swallow is reflexive. This reflex is triggered by the growing bolus, but once initiated it is generally unaffected by sensory deficits or stimulation. These results also highlight the role of behavior timing in predicting airway compromise, such that the timing of behaviors may be more critical to performance than the behaviors themselves. This implies that in some cases, treatments for dysphagia may be more successful when they induce changes in coordination of structures involved in swallowing, rather than focusing on strength or the extent of movement of these structures.

Author: Megan Foradori

Abstract: 

Objective: This study includes the pre-implementation and implementation phases of incorporating Age-Friendly Health Systems (AFHS) care for older hospitalized Veterans. Specifically, this work tests the efficacy of the AFHS uptake across four clinical units before, during, and after use of The Implementation Playbook (TIP) as an e-facilitation implementation strategy. The study will provide understanding of the usability, feasibility, fidelity, and acceptability of TIP. 

Study Population: The implementation project seeks to enrich the care of older adult Veterans through enhancing healthcare providers' practices in the Community Living Center (CLC) at the Louis Stokes Cleveland VA Medical Center.

Results: Now completed, the pre-implementation phase included the formation of a multidisciplinary leadership team, including members with experiences at all levels, ensuring many perspectives will inform and enrich the resulting implementation. The naming of a project champion well known to the VA division set the stage for buy-in and ownership. A comprehensive review of the pre-implementation of AFHS activities preceding the effort was completed, including details on the initial staff education and early efforts to integrate AFHS’s mobility assessment and act-ons. Working with informaticists, new electronic health record documentation tools and a dashboard to track progress were developed. After the pre-implementation, the team and the CLC staff will be poised to carry out their efficacy study of e-facilitation using an electronic guide to provide Age-Friendly Healthcare to Veterans in the CLC. 

Discussion: Acknowledging ever-present barriers to implementation, the pre-implementation phase enables the team to complete essential pre-work to increase the likelihood of change adoption. Gathering key perspectives, naming an engaging champion, understanding historical and immediate antecedents orbiting the clinical change, and preparing for data collection and dissemination in the effort ensure that these essential components are established to reduce confounders.
 

Author: Vanessa Franco

Abstract: 

Newborn Screening (NBS) is an important public health program that identifies and treats life-threatening or debilitating conditions in infants before clinical symptoms emerge. Despite widespread U.S. implementation, racial and socioeconomic disparities persist in awareness, diagnosis timing, and treatment access, contributing to higher infant mortality in underserved communities. This study partners with the home-based health care workforce in Cleveland where Black infant mortality rates are disproportionately high. By partnering with First Year Cleveland, an organization dedicated to reducing infant mortality and promoting health equity through local partnerships, we aim to advance health equity. NBS offers a unique platform for representative genomic research and data collection to address community concerns about infant mortality rates and access to care. Our objectives are to identify NBS delivery barriers affecting Cleveland's infant mortality rates and develop community-driven strategies to improve equitable access, education, and care for vulnerable populations.

With our partners, we co-created and refined a survey assessing NBS and prenatal screening awareness and perceptions. The survey will be administered to home-based healthcare providers, including doulas, midwives, and community health workers serving diverse Cleveland populations. We expect survey results to reveal specific awareness and utilization gaps in NBS, along with systemic barriers causing diagnosis and treatment delays. Findings will inform an Action Roadmap to enhance education, training, and data-driven system-level interventions. More broadly, the Action Roadmap will include scalable strategies for incorporating community insights into policies and practices, strengthening NBS impact on reducing health disparities and improving vulnerable infant outcomes.
 

Author: Sarah Frischmann

Abstract: 

Objective: To describe factors associated with chronic school absenteeism (missing >=10% eligible school days) in a cohort of Medicaid-insured children residing in Northeast Ohio.

Methods: Analysis of Medicaid claims, social services and school records July 2018 - June 2022 of Cuyahoga County children aged 6-12 years with 1+ encounters with University Hospitals and enrollment in 1+ participating school districts. Children with asthma had diagnosis code ICD-10 J45 and prescription for a beta-agonist +/- inhaled corticosteroid during the study period. The Andersen and Aday Framework was used to identify variables included in multivariable logistic regression models exploring modifiable factors associated with chronic absenteeism in 2 or more academic years ("persistent chronic absenteeism").

Results: 25,058 children met inclusion criteria, of whom 4970 (19.8%) had asthma.  Chronic absenteeism in the study cohort exceeded State-level estimates in all academic years (from 33 vs 17% in AY2018-19 to 64% vs 30% in AY2021-22).  Among those with asthma, 67.5% were ever chronically absent and 25.3% were persistently chronically absent.  Accounting for demographics (age, sex & race), risks for persistent chronic absenteeism included: poorer indoor air quality (as measured by prenatal tobacco exposure, aOR 1.48, 95%CI 1.07-2.04, p=0.017) & mental health concerns (aOR 1.34, 95%CI 1.01-1.81, p=0.048).  Protective factors included: residence in a census tract with greater opportunity for Health & Environment (aOR 0.66, 95%CI 0.49-0.89, p=0.006) and achieving an Asthma Medication Ratio >50% (aOR 0.77, 95%CI 0.59-1.00, p=0.052).

Discussion: Chronic absenteeism is common among Medicaid-insured children obtaining care in our health system, and influences on attendance are not limited to asthma alone.  Opportunities for clinicians to optimize outcomes for this population include: inquiring about school attendance, absenteeism and reasons for absenteeism, increasing Asthma Medication Ratios, and screening for and treating comorbid mental and behavioral health conditions.
 

Author: Lydia Furman

Abstract: 

Objectives: (1) Demonstrate the feasibility and acceptability of a culturally aligned breastfeeding supportive texting program for African American/Black (AA/B) pregnant and breastfeeding persons (TEAM2BF – texting encourages all moms to breastfeed) and (2) compare exclusive breastfeeding (EBF) at 2 months between this program and a national parenting advice texting program (Bright By Text™ - BBT).

Population: Adult pregnant people (80% own a smartphone and are likely to seek health information on the internet.  As a culturally attuned breastfeeding-supportive texting program, we hypothesize that TEAM2BF will increase EBF among AA/B birthing people and reduce harmful racial inequities in BF. Full results pending.

Author: Robin Gotler

Abstract: 

Objectives:  More participation in clinical research by people of color could strengthen understanding and treatment of illness and disease, improve community health, and increase equity. To help achieve these goals, we sought the perspectives of community health workers (CHWs) and community residents who are black about clinical research. Here we present the results of CHW interviews.

Methods:  We conducted ethnographic interviews with CHWs from A Vision of Change, a Cleveland nonprofit organization, and analyzed preliminary findings on an ongoing basis until saturation was reached, for a total of 12 CHW interviews. Our community/academic team then analyzed the data in more depth using immersion/crystallization and editing approaches to identify relevant themes. External auditors reviewed emerging themes, searched for confirming/ disconfirming evidence, and helped interpret themes in the context of existing literature.

Results: Themes reflect CHWs’ close community connections. 1) CHWs have mixed views of clinical research: an appreciation of its value mixed with skepticism and fear based on past mistreatment of people of color in research and health care. Sub-themes address risks of clinical research and expectations of direct health benefits for participants. 2) CHWs believe that community members are more likely to participate in clinical research if they know people who have had positive research experiences. Sub-themes address specific ways to improve participants’ research experiences. 3) CHWs believe they can serve as a bridge between community members and researchers.

Discussion: Historical injustices and inequity continue to shape CHWs’ perceptions of clinical research. In spite of their concerns, CHWs value clinical research and have insights into how Black research participants’ experiences may be improved. As respected community members with important on-the-ground knowledge, CHWs have great potential as a bridging resource for engaging research participants who are Black in community-relevant clinical research.   
 

Author: Kaiming Guo

Abstract: 

Objectives: Radiation therapy is a key component in cancer treatment, with roughly 50% of cancer patients receiving it during their care. Of these treatments, an estimated 30% to 70% are aimed at palliative care, which focuses on easing symptoms of advanced or metastatic cancer (such as pain from bone, brain, or lung metastases) rather than providing a cure. However, resource limitations often lead to delays of several weeks for CT simulation appointments, which can extend the overall treatment time. To reduce these delays, an alternative approach called simulation-free radiation therapy (SFRT) uses diagnostic imaging in place of traditional CT simulations for planning, which is aimed to simplify the workflow and make palliative radiotherapy more accessible and efficient.

Methods: To evaluate the feasibility of SFRT for palliative care, we will be assessing 90 patients across various treatment sites. Amongst those patients, we compare statistical differences in Hounsfield unit for lung, bone, and soft tissue diagnostic CT (dCT) instead of planning CT (pCT). Account for the max difference on HU units, we will determine the dosimetry difference in typical 3D conformal treatment planning. 
Other challenges include anatomical changes on curved and flat coaches, differences in patient setups will also be investigated. Strategies to address these include developing a curved support foam to replicate diagnostic couch shapes, developing a mock patient setup workflow, and create training programs and quality assurance protocols for clinical staff. 

Anticipated Results: HUs comparison between lung, bone, and soft tissue is anticipated to be different. However, the dCT mean HUs assigned to the slab phantom geometry resulted in a maximum dose difference at the point of interest of below 2% for all introduced heterogeneity, compared with pCT mean HUs. 

Significance: Simulation-free radiotherapy model has been proposed to simplify access to palliative care. It could provide critical support to millions of patients, reducing disparities and enhancing their quality of life.

Author: Jacob Hill

Abstract:

Objectives: Black compared to non-Hispanic White breast cancer survivors have a higher risk of mortality. Depression, which is highly prevalent in older Black breast cancer survivors (BBCS), may increase the risk of cancer recurrence and mortality. Antidepressant drugs have limited response rates and numerous sides effects; therefore, non-pharmacological treatments for depression are needed. Older BBCS are underrepresented in research, and very few studies have been conducted evaluating non-pharmaceutical treatments for depression in older BBCS. Our Co-Principal Investigator led study aims to develop, culturally adapt, and evaluate a Mindfulness-Based Cognitive Therapy-Brief intervention (MBCT-Brief) in older BBCS with the help our community partner (The Gathering Place) and Community Advisory Board (CAB). 

Methods: Our study employs an exploratory sequential mixed methods design. The qualitative phase includes conducting focus groups with older BBCS to describe perspectives, barriers, and facilitators to the proposed MBCT-Brief intervention and clinical trial participation in general. After culturally adapting the intervention based on feedback from the CAB and focus groups, we will conduct the quantitative phase to evaluate the culturally adapted MBCT-Brief intervention in 2 groups (n=8) of older BBCS with depression to establish feasibility and acceptability.

Anticipated Results: We will describe the process of conducting our community-informed health equity research and describe the perspectives, barriers, and facilitators to participating in the MBCT-Brief program and clinical trials in general in older BBCS with depression. We will describe how we culturally adapted the MBCT-Brief program and provide other preliminary results.

Discussion: Our study is the first to develop a non-pharmacological community-based culturally adapted MBCT-Brief intervention to address depression in older BBCS.

Author: Rebecca Jefts

Abstract: 

Objectives/Goals: Emergency medical services (EMS) frequently engage with communities that experience opioid overdoses (ODs) and deliver naloxone to high-risk individuals. In 2021, University Hospitals (UH) became a Project DAWN (Deaths Avoided With Naloxone) partner, which funds community-wide naloxone distribution. As an extension of this program, UH EMS agencies initiated a leave-behind (LB) naloxone program whereby EMS will leave behind kits to individuals while responding to OD EMS calls, regardless of EMS transport to an emergency department (ED). The objective of this study is to evaluate the effectiveness of this program in distributing LB naloxone to individuals after an EMS OD call. 

Methods/Study Population: We initiated an EMS quality improvement (QI) program including key EMS, pharmacy, and emergency medicine stakeholders. The study population and population to be served includes individuals who called EMS and were treated for OD, regardless of ultimate transport to the ED. Program leadership provided extensive education to EMS agencies via email and monthly presentation at virtual and in-person meetings. The UH EMS LB program started 10/1/24 at UH Elyria and St. John Medical Centers. The primary outcome is number of LB naloxone kits distributed. Secondary outcomes include number of EMS calls for OD (denominator of opportunities for LB naloxone). Analysis is descriptive reporting numbers and proportions. 

Results/Anticipated Results: As of January 1, 2025, there were 0 LB naloxone kits distributed by EMS. Based on Ohio-level data, there were, on average, 55 OD-related called to EMS each month. 

Discussion/Significance of Impact: Our UH EMS LB naloxone program has been operational for 3 months, with 0 naloxone kits left behind by EMS. We suspect national trends in overall opioid overdose reduction due to increased naloxone availability, decline in substance use, and increased awareness for testing of substances are contributing to our limited opportunity for leave behind naloxone. 

Author: Gunnur Karakurt

Abstract: 

Objectives/Goals: Intimate partner violence (IPV) is a significant public health issue that adversely affects victims' well-being. IPV is often under-reported, and non-physical forms may not be recognized as IPV. With the rise of social media, people increasingly share relationship problems online, providing valuable data for identifying and understanding IPV. This study aims to develop DetectIPV, a tool using machine learning to predict IPV from free text and to characterize the predictability of different violence types (physical, emotional, sexual) from these texts.

Methods/Study Population: We utilized data from established IPV questionnaires to train machine learning models, including random forest, SVM, logistic regression, and Naïve Bayes, combined with the Universal Sentence Encoder (USE). These models were trained to detect IPV in free text. The study population includes social media posts and other free-text sources where individuals describe their relationship experiences.

Results/Anticipated Results: DetectIPV can identify IPV from free text with an area under the ROC curve (AUROC) of 89%. Type-specific models show that physical abuse is identified with the highest accuracy (AUROC 98%), while sexual abuse is detected with high precision but with lower recall. Emotional abuse prediction is more challenging but still achieves an AUROC above 80%. These results demonstrate the tool's effectiveness in detecting various forms of IPV.

Discussion/Significance of Impact: DetectIPV represents a significant advancement in using technology to address IPV. By analyzing social media and other text corpuses, it can help identify and understand the prevalence, causes, and consequences of IPV. This tool can be used for flagging social media posts, aiding research, and ultimately supporting interventions for victims. DetectIPV is available as a web service, providing a valuable resource for researchers and practitioners in the field.

Author: Elyssa Kim

Abstract:

Objectives: Despite being the fastest-growing population in America, AAPIs are amongst one of the most underrepresented minority groups, constituting less than 2% of clinical trial participants. This disparity affects the generalizability of clinical trial results and equitable healthcare delivery. The aim of this study is to identify barriers to clinical trial participation specific to AAPI communities in Greater Cleveland.

Methods: A survey encompassing cultural and socioeconomic barriers identified in previous literature was delivered in a mixed-methods approach to 50 participants in each of the following communities: Chinese (Cleveland Asiatown), Chinese (Greater Cleveland Area), Pakistani and Afghan. Qualitative data was collected through 5 focus groups, each comprising 5 community members from each community.

Results: 196 surveys were returned: 96 Chinese, 50 Filipino, and 50 from the Afghan community (98% response rate). 176 (90%) had health insurance, and 149 (75.9%) regularly visited a physician. The most reported diseases were hypertension, diabetes, and depression. 114 (58%) of participants had heard of clinical trials, but only 29 (15%) had participated or knew someone who had participated in a clinical trial. 159 (81.1%) respondents would be willing to participate in a clinical trial that involved asking questions; 66 (33.7%) would be willing to give a blood sample. When looking for trusted health information, the top resources were from the government/NIH, health organizations, and physicians, whereas the least trusted were drug companies. The largest barriers reported to clinical trial participation were lack of logistical support (transportation, childcare, paid time off), skepticism about trial benefits and outcomes, and language/cultural barriers.  

Discussion: Providing logistic support, translating materials, and communicating via trusted resources can help improve AAPI clinical trial recruitment and representation in the Greater Cleveland area. By doing so, we can work to close this inequity in representation of AAPI groups in clinical trials.

Author: Bailey Klein

Abstract: 

Hematopoietic stem cells (HSCs) play a crucial role in generating all blood cell types, vital for a functional immune system and oxygen transport. Maintaining this balance throughout life involves a tight regulation of self-renewal, differentiation, and quiescence, influenced by both intrinsic and extrinsic signals. While the influence of many HSC progeny on HSC decisions is known, the role of mast cells (MCs) has remained unexplored. MCs, known for their immunomodulatory functions through secretion of various factors including histamine, present a novel avenue for understanding HSC regulation. In this study, we uncover a novel role for MC-derived histamine in modulating HSC behavior. Our hypothesis posits that MCs act as negative regulators of HSCs. We observed that genetically MC-deficient “SASH” mice exhibit increased hematopoietic output and bone marrow (BM) HSCs, characterized by an enhanced quiescent signature that increases chemoresistance. The SASH microenvironment also shows elevated frequencies of HSC-supportive cell types and increased expression of genes conducive to HSC maintenance, providing a functional advantage when wild-type BM is transplanted into this microenvironment. Moreover, we found that the genetic loss of MCs correlates with lower serum histamine levels in SASH mice, and the augmented hematopoietic phenotype can be reversed by administering exogenous histamine. Subsequent experiments with FDA-approved antihistamines in wild-type mice revealed that cetirizine, an H1R inverse agonist, notably increased HSC frequency in the BM. Overall, our findings highlight MCs as negative regulators of HSCs, laying the groundwork for future studies to unravel the underlying mechanisms and explore the therapeutic potential of cetirizine.

Author: Trisha Lal

Abstract: 

Objective: To identify community-level factors driving geographic discrepancies between colorectal cancer (CRC) screening uptake and early-stage diagnosis. While individual predictors of CRC outcomes are well-documented, the role of broader community characteristics in shaping geographic variability in screening effectiveness remains unclear. We hypothesized broader community characteristics, beyond screening rates, drive these discrepancies.

Methods: CRC patients diagnosed between 2010 and 2019 were identified in the Ohio Cancer Incidence Surveillance System (OCISS). Screening rates were obtained from CDC PLACES (2018). Max-P regionalization aggregated census tracts into statistically reliable communities based on sociodemographic characteristics. Geographic weighted regression (GWR) explored associations between screening rates and early-stage diagnosis proportions. Predictors of discordance, including socioeconomic status, education, healthcare context, and physical infrastructure, were identified using the Variable Selection Using Random Forest (VSURF) algorithm.

Results: 869 communities were delineated from 2,952 census tracts. High screening rates did not consistently predict early detection, with significant regional variability. GWR revealed a positive association in Southern Ohio (avg. coefficient: 0.21, p = 0.002), but no correlation in Northeast Ohio (avg. coefficient: -0.03, p = 0.720). VSURF ranked transportation and vehicle accessibility as the most critical variable influencing early-stage diagnosis. Screening alone was not significant. 

Discussion: Screening rates alone cannot predict early-stage CRC diagnosis, suggesting structural or environmental barriers to timely follow-up colonoscopy after non-invasive screening. By highlighting outlier communities, this approach provides a framework for targeted interventions and future studies. These findings emphasize the need to investigate nuanced, population-level predictors to improve CRC outcomes equitably.

Author: Kyungmi Lee

Abstract: 

Objectives: Multiple sclerosis (MS) is a chronic neurological disease with symptoms that fluctuate and often worsen with age, impacting quality of life. Understanding how age influences daily variability in these symptoms, including fatigue, stress, and happiness, is essential for developing effective management strategies tailored to individuals with MS. The goal of this study was to examine the impact of age on the daily variability and individual differences

Methods: Data were collected from 107 participants with MS over 10 days using the LifeData app, which captured ecological momentary assessment (EMA) responses five times daily. A mixed-effects model was employed to analyze the effects of time, age, and their interactions on fatigue, stress, and happiness, based on a dataset of 5,250 observations.

Results: The within-individual analysis showed a significant increase in fatigue over time (β = 0.221, p  0.05), but older participants reported significantly lower stress levels (β = -0.022, p  0.05) and with age (β = 0.010, p > 0.05). The between-individual analysis revealed significant baseline differences in fatigue (β = -1.435, p  0.05). Age-related differences in fatigue and stress persisted over time.

Discussion: These findings underscore the importance of understanding how age-related factors influence daily fluctuations in fatigue and stress among individuals with MS. By using EMA to capture detailed, real-world data in everyday settings, this study highlights the potential for developing targeted, age-specific interventions. Such personalized care strategies can optimize symptom management and improve quality of life for individuals with MS. Furthermore, real-time symptom tracking through EMA provides insights to guide effective treatments and interventions seamlessly integrated into clinical practice. 

Author: Gloria Liu

Abstract: 

Objectives/Goals: To determine the acute effects of womb sound recordings on cardiorespiratory and oxygen stability in moderately preterm infants during hospitalization.

Methods/Study Population: 19 preterm infants (gestational age 31.6±0.8 wks, birthweight 1822±372gm) were exposed to alternating 6h periods of commercially available womb sound recordings (55-60dB) and ambient noise over a 24 hr period at 34 weeks +/- 2 days corrected age. Respiration, oxygen saturation and heart rate were monitored. Apnea (>5sec), IH (SpO2<85%), and bradycardia (<80bpm) were compared between ambient and womb sound exposures to assess the acute effect of auditory stimulation on cardiorespiratory stability. 

Results: A significant correlation was found between increased oxygen/respiratory instability during ambient conditions and reduced frequency of IH (r2=.24, p=.031, Fig 1), time with hypoxemia (r2=.23, p=.036, Fig 2) and shorter duration of periodic breathing (r2=.38, p=.005, Fig 3) during womb sounds. The reduction in apnea frequency during womb recordings did not reach statistical significance (r2=.17, p=.083). There was no difference in bradycardia frequency or duration of movement between exposures suggesting no effect on irritability.

Discussion/Significance of Impact: Womb sound recordings reduce IH, time in hypoxemia and duration of periodic breathing in infants with increased respiratory instability. These results suggest that womb sounds may play an acute role in peripheral chemoreceptor excitation during early postnatal life in moderately preterm infants with delayed maturation of respiratory control.

Author: Liping Liu

Abstract: 

Introduction: Fear, anxiety, and depression significantly and conversely affect the recovery post-surgery and satisfaction with care of patients with spine surgery. Pre-operative education classes (POEC) may reduce anxiety and improve patient satisfaction. But there is no formal online POEC framework commonly used in spine surgery. We studied the impact of a POEC on patient satisfaction with spine surgery. We aimed to (1) identify POEC attendance rates and (2) evaluate the patient’s satisfaction with POEC.

Materials and Methods: Patients scheduled for elective spine surgeries from July 2021 to Dec 2023 were voluntarily planned for the POEC; the online course was performed by an experienced neurosurgery registered nurse for an hour, followed by 20 minutes of questions and answers (Q &A). After Oct 2022, we switched the online platform from Webex to Zoom with a designed online survey attached to the meeting. The survey was collected and analyzed electronically.

Results: About 53% of patients who underwent spine surgeries were scheduled for the class in 2023, which increased compared to 48% in 2021. The attendance of those patients scheduled for the course increased from 77 (87%) to 236 (89%) in 2022 and 226 (84%) in 2023. The patients showed high satisfaction with our classes; about 96% of patients agreed or strongly agreed that the class was beneficial, were easy to understand answered their questions, and will recommend them to their friends or family. Patients stated in the comments that the preoperative education decreases their anxiety and fear and helps them to prepare for the surgery. The survey return rate dramatically increased from 40% in 2021 to 84% in 2023 after switching to online Zoom classes.

Conclusions: POEC is associated with a high rate of patient-reported satisfaction. Well-designed online education platforms with online surveys can be very effective, efficient, and easy to implement. Future work will analyze the post-surgical assessment of the spine education classes.

Author: Liping Liu

Abstract: 

Introduction: Preoperative Education Class (EC) has been used by many institutions to deal with patient anxiety, pain control, and overall satisfaction. Although the literature suggests EC's effectiveness in joint reconstruction, a few data suggest a positive impact on patient satisfaction, and pain management in spinal surgery. There is no systemic study regarding the effects of EC on elective spine surgery patients' outcomes.

Materials and Methods: Patients with elective spine surgeries from July 2021 to July 2024 were voluntarily scheduled for EC; the EC was performed by an experienced neurosurgery registered nurse for an hour, followed by 20 minutes of questions and answers. We extracted the outcomes data from EMR and further analyzed these patients' outcomes.

Results: Of 1524 patients who had elective spine surgery, 597 (39%) attended the class, whereas 927 (61%) did not. Patient characteristics analysis showed that there were no differences in age; race, ethnic, HA1C, but have significantly slightly differences in BMI, smoking and alcohol use between these two groups. The evaluation of outcomes showed that there was significantly decreased hospital length of stay (LOS) (3 vs 4; P<0.01), surgical site infection (SSI) (1.0% vs 3.3%); P<0.01) and a dramatically increased discharge home (82 % vs 74%; P<0.01) for patients with EC compared to the patients without EC. Patients with EC encounter more with doctors through telephone (44% vs. 31%), messages (38% vs 18%), and refills (49% vs 32%) (P<0.01) four wks. after the surgery compared to the patients without EC. We observed a trend toward decreased 30-day readmission to IP (3.2% vs 3.9%) and ED (7.5% vs 8.5%).

Conclusions: Implementing EC is associated with reduced hospital LOS, lower SSI, and increased the number of patients discharged home. We observed a trend toward decreased 30-day readmission to IP and ED. Further study is needed to evaluate other outcomes such as post-surgery complications, mortality morbidity, and underlying mechanisms for the 30-day readmission. 

Author: Kelsey Lopez

Abstract: 

Introduction: Gun violence is a preventable public health epidemic. Impacted communities face increased risks of physical, mental, and substance use disorders. Current healthcare delivery models are insufficiently structured to address the complex and extended needs of gun violence victims and their chosen families. Healthcare delivery gaps, post-injury priorities and the specific needs of gun-violence survivors and their families have not been quantified. The “SAFE-Communities” initiative sought to quantify these gaps and priorities.

Objectives: To develop and pilot a survey to quantify healthcare delivery gaps and challenges to individuals and chosen family members of individuals who suffered a violent injury

Methods: Using a community based participatory research approach, we partnered with the Cleveland Peacemakers Alliance, Northeast Ohio Coalition for the Homeless, and Frontline Services. A partner meeting was conducted to understand the needs of the community. After, commonly discussed needs were aggregated into themes and a literature search was conducted to examine known surveys applicable to our population. The finalized survey was distributed to our study population. 

Results: Through the partner meeting, themes including urgent necessities, financial and legal concerns, and healthcare necessities were identified. Our proposed survey examined what resources were most needed by those impacted, and the helpfulness of the resources that they did get. Additionally, questions through the Kaiser Family Foundation Surveys on interpersonal violence were identified to ask our population about healthcare experiences and gun safety. 

Significance: This initiative aims to address the current public health issue of gun violence. The “SAFE-Communities”  is a foundational and pilot step towards our long-term goal to build an equitable and inclusive healthcare delivery model to serve the needs of violence survivors and their families in Cleveland.
 

Author: Maeve MacMurdo

Abstract: 

Objectives: The United States employs more than 3 million temporary and seasonal farmworkers. Most of these workers are from Latin America, and often employed in isolated settings, with limited ability to access healthcare or services. There remain significant gaps in our understanding of Latino farmworker health.  In this study, we aim to leverage mobile spirometry combined with community engaged recruitment to both quantify the prevalence of obstructive lung disease in Northeast Ohio Latino farmworkers and identify potential modifiable drivers of respiratory disease in this vulnerable worker group. 

Study population: Latino farmworkers actively employed in agriculture in North East Ohio.

Methods: With guidance from our community partner, recruitment events are scheduled across community settings, including farm break rooms and local Mexican grocery stores. Using a modified version of the National Agriculture Worker survey questionnaires, participants are queried about respiratory symptoms and exposure to potential drivers of poor respiratory health. Baseline spirometry is performed using a mobile spirometry device.  Measurement of exhaled nitric oxide (NO2) is performed. The prevalence of obstructive lung disease (defined by an FEV1/FVC ratio of less than 0.7) will be quantified, and the association between self-reported exposure and lung function evaluated. 

Results:  80 farmworkers have been recruited to date. 92.5% are male, with a median age of 33 (IQR 26-43), and a median 6 years of agricultural work (IQR 4-13). 40% of participants reported at least one persistent respiratory symptom over the past year. 42% met criteria for obstructive lung disease (FEV1/FVC < 0.7), with a median exhaled NO2 of 14ppb (IQR 10-20). This result persisted even when restricted only to participants whose testing met full ATS criteria. 

Discussion: In a convenience sample of Latino farmworkers, respiratory symptoms and obstructive lung disease by pulmonary function criteria was common. The burden of lung disease in this worker group may be significant and under-recognized. 

Author: Shelia Malone

Abstract: 

Objective: This study aimed to identify neighborhood-level disparities contributing to both the increasing rates and high prevalence of hypertension in Cuyahoga County, to inform targeted, actionable public health strategies.

Methods: 15 census tracts identified as having 53% HTN were selected for comparisons (N= 64,903). BRFSS and Environmental Systems Research Institute (Esri) GIS mapping software was used to compare community-level environments between the census tract groups. The data were linked to 2010 census tracts and 2019 American Community Survey (ACS) data to measure educational attainment, income, transportation, nutritional conditions, and demographics that may contribute to HTN prevalence.

Results: We identified fifteen census tracts in Cuyahoga County Ohio with higher HTN prevalence of >53% (54% males; 75-100% African Americans; 30% >65 years old). These census tracts contain many paved surfaces with low greenspace surfaces and 22% of households receive food assistance. The Census tracts with an HTN prevalence of less than 50% (50% males; 31% African Americans; 15 % > 65 years old). The tracts with lower hypertension prevalence have more green space, and a more diverse population, and 5% of households receive food assistance. The fifteen census tracts with higher HTN prevalence have an income level that is 53% lower than the census tracts with HTN prevalence of <50%. Educational attainment is higher in the low HTN prevalence tracts (86.9%) than in the high HTN prevalence tracts (26.6%).

Significance of Impact: Environmental context gaps match census tract HTN prevalence in Cuyahoga County. Minority hypertension control initiatives may be less effective with context-blind health interventions. To reduce HTN disparities, community resources, and health services should support comprehensive bidirectional referral and follow-up systems. This can reduce barriers to social services, lifestyle changes, and HTN management which is important to reduce hypertension disparities. 

Author: Nicolas Mas D Alessandro

Abstract: 

Objectives/Goals: Intraoperative teaching in anesthesiology residency programs often lacks structure, negatively impacting educational consistency. This study aimed to develop and evaluate the Intraoperative Learning Modules program to enhance the quality and structure of intraoperative education.

Methods/Study Population: Our institution's residency program implemented the Intraoperative Learning Modules program, focusing on critical clinical issues, including anaphylaxis, bronchospasm, delayed emergence, difficult airway management, hemorrhage, hypotension, local anesthetic toxicity, malignant hyperthermia, myocardial ischemia, and pneumothorax. Faculty and residents participated in structured discussions about these topics using badge-sized cards to track compliance.

Results/Anticipated Results: The program achieved 100% compliance among faculty and residents. Post-implementation surveys indicated a 29% increase in residents feeling faculty were interested in education and a 16% increase in those who believed faculty fostered inquiry. However, there was a 2% decrease in perceived teaching quality.

Discussion/Significance of Impact: The Intraoperative Learning Modules program established a structured teaching framework, enhancing faculty engagement and perceived educational quality. Despite a slight decline in teaching quality ratings, the initiative highlights the importance of structured approaches in residency education. Future research should focus on balancing structured teaching with quality to ensure sustained improvements in educational outcomes.

Author: Mary Nantongo

Abstract: 

Objectives: Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a serious global public health burden. Peptidoglycan synthesis is an underexplored drug target in Mtb. Carbapenems are effective against TB as they are poor substrates for the Mtb β-lactamase BlaC and inhibit L, D-transpeptidases (LDTs), key β-lactam resistance mechanisms in Mtb. We hypothesize that substituting the C5 position and modifying the R2-side chain enhances carbapenem activity against Mtb. We explored the activity of two novel carbapenems; JDB/NA-1-157 (A) and JDB/NA-1-208 (B) with these modifications both alone and in combinations with β-lactamase inhibitors (Durlobactam and clavulanate) and β-lactam antibiotics (amoxicillin and Ceftriaxone) and evaluated their structure-activity relationships with Mtb peptidoglycan synthesis enzymes.

Methods: Antibiotic susceptibility testing was conducted using broth microdilution for 9 Mtb isolates from TB patients. Timed electrospray ionization mass spectrometry captured acyl-enzyme complexes. Kinetic parameters were measured using a spectrophotometer, Circular dichroism (CD) spectroscopy evaluated BlaC's thermal stability and structural conformational changes.

Results: MICs for A and B, against Mtb isolates, were 1–2 and 2–4 μg/ml, respectively, comparable to meropenem (1–8 μg/ml). Combinations with durlobactam, clavulanate, ceftriaxone, and amoxicillin lowered MICs. Acyl-enzyme complexes were captured with BlaC, LDTs (LdtMt1-3),  PonA1, and DacB1 (only A) but not with LdtMt5 or PBPLipo. Compound A showed superior inhibitory kinetics with BlaC, with a Kiapp of 14 ± 1.4 μM and a Kon of 800 M-1S-1 similar to meropenem (11.4 ± 1.1 μM and 800 M-1S-1 respectively, as well as koff of 1x10-4  ± 0.1 x 10-4 S-1, while B had a Kiapp of 97 ± 19.7 μM. CD revealed secondary structural changes in BlaC without altering its melting temperature. 

Discussion: The novel compounds, particularly A, exhibit significant activity against Mtb peptidoglycan synthesis. Drug A offers slightly increased potential than B. Both could improve TB treatment.

Author: Ose, Oscar

Abstract: 

Dysplastic nevi exemplify the challenge of communicating abstract concepts about ambiguous disease prognoses–an ambiguity that often leads to great concern among patients who think they have or are about to have cancer. The prognostic value of dysplastic nevi and their relationship to melanoma is evolving and debated, creating difficulty in accurately presenting risks despite low objective risk associations. To assess if increased understanding of dysplastic nevi could lead to decreased associated concern, a concise ~1 minute educational video, developed with expert feedback, was analyzed using questions testing knowledge of objective risk as well as cognitive and affective ratings of subjective risk.

100 patients diagnosed with dysplastic nevi were recruited from 11 dermatologists’ clinics at two UH Dermatology locations. Before and after watching the video, patients completed a survey with visual analog and Likert scales describing their perceptions of dysplastic nevi. Paired t-tests were used to analyze how perceptions changed.

After the video, patients reported significantly decreased concern (mean difference -7.01; VAS 0-100; p-value: 0.001) and significantly increased understanding (mean difference 30.76; VAS 0-100; p-value: 2.2 x 10-16) regarding dysplastic nevi. Patients reported ~3 fold decreased perceived associated melanoma risk and significantly increased planned sunscreen (mean difference 0.5; Likert 1-5, p-value: 6.0 x 10-9) and sun protective strategy (mean difference 0.34; Likert 1-5, p-value: 4.3 x 10-5) use.

Our results show that a brief intervention can effectively increase understanding and decrease concern regarding dysplastic nevi in a way that is easy to disseminate in a variety of clinical settings. Next steps include greater distribution of this intervention and expanding the work to focus on how this information modulates intention to get dysplastic nevi surgically removed.

Author: Latia Phillips-Bey

Abstract: 

The Black infant mortality crisis in Northeast Ohio remains a critical public health challenge, with Black infants experiencing mortality rates more than double those of white infants. As of 2024, Black infant mortality in Ohio stands at 14.4 per 1,000 live births, significantly higher than the 5.7 per 1,000 for white infants (Ohio Department of Health, 2024). This disparity is particularly pronounced among Black women aged 13-21, whose vulnerability is compounded by intersecting racial, economic, and social factors. This research explores the potential of trauma-informed mindfulness practices, including yoga therapy, Ayurvedic practices, meditation, somatic exercises, and breathing techniques, as interventions to enhance infant vitality and reduce mortality in underserved Black communities in Northeast Ohio. Specifically, it examines how these holistic practices can address physiological, psychological, and sociocultural factors contributing to poor maternal and infant health outcomes, particularly in the first year of an infant’s life.

Objectives/Goals: The primary objectives of this research are to assess the efficacy of trauma-informed mindfulness practices in improving maternal well-being, enhancing infant vitality, and reducing Black infant mortality rates in underserved communities. Specifically, the study aims to: (1) evaluate the impact of yoga therapy, Ayurveda, meditation, somatic exercises, and breathing techniques on reducing maternal stress and its physiological impacts on infant health, (2) explore the role of these practices in addressing psychological challenges, including anxiety, depression, and trauma, and (3) examine how these interventions foster sociocultural resilience and community solidarity.
Methods/Study Population: This study uses a mixed-methods approach, incorporating both qualitative and quantitative data. The study population consists of Black women aged 13-21 residing in underserved neighborhoods of Northeast Ohio, focusing on those who are pregnant or within the first year postpartum.

Author: Anny Reyes

Abstract: 

Goals: Individual-level social determinants of health (SDOH), including education, income, occupation, health behaviors, social support, and healthcare access, play a critical role in shaping health outcomes. This study examines the impact of SDOH on cognitive outcomes in PWE.

Methods: Data from 607 patients with pharmacoresistant epilepsy (average age=38.72, education= 13.4, 54.7% male, 7.7% non-White) evaluated at the Cleveland Clinic, including neuropsychological assessments and SDOH measures, were analyzed. SDOH variables included financial strength, economic hardship, median household income, educational attainment, and household characteristics (e.g., complex occupation, unemployment, lack of vehicle ownership, single-parent status). Stepwise regression analyses examined the contributions of these SDOH factors to cognitive performance, controlling for demographic (age, sex, race) and clinical variables (epilepsy duration, antiseizure medications, and mesial temporal sclerosis).

Results: Reduced financial strength was linked to poorer Verbal Comprehension (p = .030), Processing Speed (p < .001), Naming (p < .001), and Phonemic Fluency (p = .007), and higher depressive symptoms (p < .001). Lower household income was associated with poorer Auditory Delayed Recall (p = .004) and higher anxiety symptoms (p = .014). Single-parent status, unemployment, and low educational attainment were linked to lower cognitive performance in Naming (p < .001), Visual Attention/Motor Speed (p = .017), and increased Perseverative Errors on a problem-solving task (p = .009), respectively. Conversely, complex occupational roles predicted higher scores across multiple cognitive domains, including Full-Scale IQ (p < .001), Verbal Comprehension (p = .012), and Working Memory (p < .001).

Conclusion: SDOH was associated with cognitive and emotional outcomes in PWE, highlighting the need to address socioeconomic disparities in epilepsy care. Integrating SDOH considerations into clinical strategies could improve outcomes for this vulnerable population.

Author: Samuel Rodgers-Melnick

Abstract: 

Objective: To investigate which characteristics are associated with clinically significant reductions in pain intensity (i.e., numeric rating scale [NRS] reduction ≥2 units) within a single music therapy (MT) session among hospitalized patients.

Methods: We conducted a retrospective electronic health record review of 2039 MT sessions conducted across a large health system among 1203 adult patients reporting a pre-session pain NRS score ≥4 and a complete post-session pain score. We employed a logistic mixed effects model to predict the binary pain reduction response (≥2 units vs. < 2 units) where patients were considered nested within therapists. The model included the following fixed covariates: (1) MT intervention type (i.e., receptive only, recreative [i.e., active instrument play], compositional/creative [e.g., songwriting], or receptive + relaxation/imagery), (2) Other MT characteristics including session length and goal; (3) sociodemographic variables (e.g., age, sex, race/ethnicity, census tract-level social vulnerability index); and (4) clinical characteristics (e.g., total Elixhauser comorbidities, sickle cell disease, receipt of opioids in 12 hours prior to session).

Results: Covariates associated with higher adjusted odds ratios (aOR [95% CI]) included (1) recreative (1.367 [1.004, 1.861]) and relaxation/imagery MT interventions (1.482 [1.014, 2.167]) as compared to receptive; (2) 15-minute increases in session length (1.402 [1.223, 1.607]); (3) 1-unit increases in pre-session pain (1.190 [1.106, 1.281]), (4) 5-unit increase in Elixhauser comorbidities (1.295 [1.047, 1.602); and (5) a documented MT session goal of pain management (3.581, [2.640, 4.856]). Male sex, Medicaid insurance status, and sickle cell disease diagnoses were associated with lower odds of pain reduction ≥2 units.

Discussion: MT interventions involving singing or active instrument play and relaxation/imagery interventions involving guided relaxation, imagery, or breathing exercises may be more effective for reducing pain than interventions only involving live or recorded music.

Author: Asha Sethuraman

Abstract: 

Area deprivation index (ADI) is associate with disparities in outcomes across various medical conditions. The impact of ADI on outcomes in neuro-oncology is largely understudied. This study analyzed the association of ADI with outcomes for patients with glioma. 

The oncology registry was queried for patients diagnosed with cancer at MetroHealth for between 2016-2022 and patients with gliomas and astrocytoma were identified. The medical record was accessed for each patient to obtain additional demographic, medical, procedural, and outcome data. The patient population was stratified by ADI quartile and tests for statistical significance were done to assess for similarities and differences between quartile 1 (low deprivation) and quartile 4 (high deprivation). 
The high deprivation and low deprivation ADI quartiles had no statistically significant difference in baseline demographics. The high deprivation quartile had more African American patients (25% vs 0%; p-value: .02) and more patients on public insurance plans (81% vs 50%; p-value: .05). The laterality, tumor location, IDH status, MGMT status, and surgical procedure types were similar. 

Patients in the higher deprivation group were discharged to a non-home setting at significantly higher rate (50% vs 29%; p-value: .03). We observed a trend towards increased length of stay in the higher deprivation group although this did not achieve statistical significance (9.88 vs. 6.18 days; p-value: .13). More patients in the low deprivation quartile survived to or past the one-year mark (73% vs 88%; p-value: .28). At one year we observed no difference in readmissions, ED visits, tumor progression, or the need for revision surgery. 

Our study showed several differences in baseline demographics and clinical outcomes between the top and bottom ADI quartiles. Most significantly, patients with high deprivation experienced non-home discharge and trends towards longer hospital lengths of stay. Further studies will elaborate on the association of ADI on outcomes in neuro-oncology patients.  

Author: Asha Sethuraman

Abstract: 

In 2018, andexanet alfa (Andexxa) became FDA approved as an anti-factor Xa inhibitor reversal agent intended for patients who require the reversal of anticoagulation due to rivaroxaban (Xarelto) or apixaban (Eliquis). A key consideration when utilizing Andexxa is its notably high cost. This study’s objective is to assess the clinical benefit of Andexxa on patients with spontaneous intracerebral hemorrhages (ICH). 

For this retrospective study, the American Heart Association stroke registry was queried for patients admitted to MetroHealth for ICH between 2020-2023. The medical record was accessed for each patient to obtain demographic, medical, procedural, outcome, and financial data.  A univariate analysis was done to assess for predictors of poor outcomes in patients with ICH.

48 patients on a DOAC with spontaneous ICH between 2020 and 2023 were identified. There were no significant differences in basic demographic information such as age, sex, race, and insurance status. Additionally, there were no significant differences in the baseline ICH score or the NIHSS. While not statistically significant, the Andexxa group trended towards a higher initial ICH volume (19 cc vs 7 cc; p= 0.21). Furthermore, there were no statistically significant differences in dosage of each respective DOAC prescribed between the two groups. The length of stay was higher in the Andexxa group (11 days vs 8 days, p = 0.04). We observed no significant differences in ICH expansion volume between the initial scan and first repeat scan between the two groups (2.4 cc vs 0.21 cc; p =.29). We observed no significant difference between the two groups when looking at hospital and 6-month mortality rates. Total pharmacy charges for Andexxa during the study period was $551,760.00. 

In our study, patients who received Andexxa therapy after spontaneous ICH showed no difference in ICH expansion within 24 hours but had increased cost of care. Further studies should examine whether Andexxa is of clinical value for patients with spontaneous ICH.

Author: Shen, Yanqiu

Abstract: 

Objectives: Heart failure remains a significant health burden, affecting over 6 million people in the United States. While current FDA-approved drugs provide only short-term benefits by enhancing cardiac contractility, they ultimately worsen heart failure symptoms over time. This underscores the urgent need for safer and more effective small-molecule therapies to enhance myocardial performance. Given that cardiac-type myosin binding protein C (cMyBP-C) is a critical modulator of heart muscle function, it represents a promising novel target for treating myocardial diseases.
Methods: Previous studies utilizing a cMyBP-C null mouse model revealed cardiac hypertrophy, reduced systolic function, impaired contractility, and accelerated cross-bridge kinetics, accompanied by increased myosin ATPase activity. These findings indicate that cMyBP-C serves as a key regulatory protein controlling cardiac muscle function by acting as a brake on myosin ATPase activity. To develop new therapeutics, we aim to refine and miniaturize an ex vivo biochemical assay into a high-throughput format for identifying small molecules that target cMyBP-C and regulate myocardial ATPase activity in isolated cardiac myofibrils.
Results: The study will outline the general workflow of the novel high-throughput screening assay, present representative ATPase activity data, and provide dose-response curves for well-characterized sarcomeric contractile modulators. The anticipated results include establishing a robust, sensitive, and reproducible screening assay capable of detecting changes in ATPase activity in response to small molecules targeting cMyBP-C.
Discussion: The ATPase rate measurements will validate the assay’s performance, demonstrating a reliable platform with well-defined control signals for identifying sarcomere-targeted proteins, including cMyBP-C. By enabling the discovery of novel small-molecule modulators, this approach has the potential to advance heart failure treatment by improving myocardial contractility in a safer and more effective manner.