10th Annual Master's Symposium Program Booklet

10th Annual Master’s Symposium

The

Friday, April 5, 2024

10:00 am - 5:00 pm

Inn at Longwood Medical Longwood Hall

Agenda

Moderator: Jason Silverstein, Co-Director, Master of Science in Media, Medicine and Health program

Welcome – 10:00am - 10:10am

• Rosalind A. Segal, Dean for Graduate Education

• Kimberly Lincoln, Director of Administration and Student Affairs

Oral presentations (In-person) – 10:10am - 11:00am

• Terry Cho (SM-BMI) DNA Characterization Reveals Potential Operon-Unit Packaging of Extracellular Vesicle Cargo from a Gut Bacterial Symbiont

• Qiyuan Zhou (MMSc–IMM) Modeling T Cell- B Cell Interaction in Rheumatoid Arthritis in a 3D Organoid System

• Aya Awwad (MMSc-CI) Comparative Risk Prediction Using Homocitrulline and Carbamylated Albumin: Two Circulating Markers of Protein Carbamylation

• Naginder Singh (MMSc-CI) Optimizing Anesthesia Precision: Improving pEEG Monitoring for Total Intravenous Anesthesia (TIVA)

• Adriana Liimakka (SM-BMI) Identifying Genetic Variants Associated with the Arthrofibrosis Phenotype and Predicting Joint Stiffness Risk After Total Joint Arthroplasty

Break – 11:00am - 11:20am

Oral presentations (remote via Zoom) – 11:20am - 12:30pm

• Mikio Hayashi (MMSc-MedEd) Factors Influencing the Sense of Belonging Among Medical Students with Disabilities in a Medical University Environment

• Laurence Gariépy-Assal (MMSc-MedEd) Cultural Humility as a Framework to Teach Cross-Cultural Communication in Pediatric Residency Training

• Meher Chaundry (SM-HQS) Improving Care for Boarded Emergency Behavioral Health Patients through Medication Reconciliation Redesign

• Ian Stevens (SM-BETH) An Exploratory Review of the ‘Treatment Resistant’ Phenomenon as a Justification for Neurosurgical Intervention

• Joshua Eyitemi (SM-HQS) Serving the Hard-to-Reach: Enhancing Emergency Care in a Remote Community

• Dessislava Fessenko (SM-BETH) Ethical Requirements for Achieving Fairness in Radiodiagnostic Machine Learning

Alumni Lunch Panel – 12:30pm - 2:00pm

Moderator: Evan Walsh, Career Advisor for Graduate Education

• Haim Moore (MMSc-IMM) Class of 2022

• Mark Murakami (MMSc-BMI) Class of 2016

• Shawna Novak (MMSc-GHD) Class of 2023

• Constantine Psimopoulos (MBE) Class of 2023

• Susana Orrego Villegas (MMSc-GHD) Class of 2023

Poster session (remote via Zoom) – 2:00pm - 3:00pm

• Saman Ahmad (SM-HQS) Improving Serious Adverse Drug Reaction Reporting to Health Canada Under Vanessa's Law

• Saleh Al Jundi (MMSc-CI) Whole Blood and PRP Similarly Stimulate Fibroblast Proliferation in 3-D Matrices

• Prizka Avilia Puspa (MMSc-CI) The Association of Polygenic Risk Score for Primary Open Angle Glaucoma with Selective Laser Trabeculoplasty Outcomes

• Utieyin Dediare (SM-CSO) Optimization of After Care Post Liver Transplant Intervention

• Yanming Gan (SM-BMI) Decode Retrotransposon-fusion RNAs in Stomach Cancer

• Ibrahim Gassama (MMSc-GHD) Investigating the Causes and Downstream Effects of Factors Leading to Prescribing of Antibiotics in Outpatients for Children Under Five Years at Koidu and Portloko Hospitals in Sierra Leone

• Farah Hasin (SM-HQS) Enhancing Sepsis Care: A Call to Action and Quality Improvement Initiatives at a Community Academic Hospital

• Patricia Lora (SM-BETH) The Right to Be Childfree: Ethical Inquiry on Female Sterilization

• Miguel Pinto-Salinas (MMSc-MedEd) Impact of Regulations and Accreditation Standards on National Knowledge Examination Scores of Peruvian Medical Trainees: A Mixed-Methods Study

• Janine Robredo (MMSc-GHD) Understanding the Factors Associated with Nutritional Outcomes Among Children Under Five Years Old in Negros Occidental, Philippines: A Cross-Sectional Mixed-Methods Study

• Brandon Tang (MMSc-MedEd) General Medicine Inpatient Initiative Medical Education Database (GEMINI MedED): A Multicenter, Retrospective Study of Resident Clinical Care in Internal Medicine

• Renqi Wang (MMSc-IMM) Synthetic Gene Circuits for Ovarian Cancer Immunotherapy

• Kay Wu (SM-BMI) Multitask Deep Learning for Comprehensive Lumbar Spine MRI Interpretation

• Xiaowen Xu (MMSc-IMM) GSDMD Protects Mice from Escherichia coli K1 Pathogenesis in the Brain

• Tessa Youngner (SM-BETH) Advancing Restorative Justice through Clinical Genomics: A Multi-Stakeholder Framework to Ethically Integrate Gene Therapy for Sickle Cell Disease

Oral presentations (In-person) – 3:00pm - 3:50pm

• Egbe Enobakhare (MMSc-GHD) Mixed Methods Assessment of Factors That Prevent Physical and Sexual Violence: Understanding the Perspective of Women Accessing Care at a Hospital in Nigeria

• Dagny Reese (MMSc-IMM) Targeting Chemokine Gradients in Triple Negative Breast Cancer with Responsive NK Cells

• Bróna Moloney (MMSc-CI) Association of Diabetes with Changes in Blood Pressure during Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial

• Nadir Al- Saidi (SM-MMH) The Internet vs. Kidney Stones: Assessing the Quality of Kidney Stone Prevention Content Online

• Claudia Bejarano Zambrano (MMSc-GHD) The Multiple Dimensions of Violence Suffered by Women as Barriers to Exercising Their Sexual and Reproductive Rights

Closing remarks

Johanna L. Gutlerner, Senior Associate Dean for Graduate Education

Reception – 4:00pm - 5:00pm

Program Descriptions

Master of Science in Bioethics (SM-BETH)

Equips students with the foundational theoretical knowledge, practical skills and hands-on experience needed to lead in the integration of bioethical issues related to clinical practice and research, as well as health law and policy.

Master of Science in Biomedical Informatics (SM-BMI)

Develops highly-trained researchers who can integrate, interpret and act upon the large-scale, high-throughput and complex data that are generated in the course of biomedical research and the practice of medicine.

Master of Medical Sciences in Clinical Investigation (MMSc-CI)

Delivers world-class training in the methods and conduct of clinical investigation for future leaders in patient-oriented research. A Translational Investigation track and pathways on comparative research and clinical trials have recently been added.

Master of Science in Clinical Service Operations (SM-CSO)

Provides physicians, clinicians, nurses, industry leaders, allied health professionals and administrators with the operations management training they need to lead teams, optimize efficiency and improve the patient experience.

Master of Medical Sciences in Global Health Delivery (MMSc-GHD)

Offers a rigorous cross-university curriculum focused on developing the tools needed to perform social and delivery science and policy research in resource-limited settings.

Master of Science in Healthcare Quality and Safety (SM-HQS)

Equips clinicians and clinical administrators with the operational skills to lead and work effectively in quality improvement and safety initiatives within their health care organizations.

Master of Medical Sciences in Immunology (MMSc-IMM)

Designed for students with a strong undergraduate biology background and an interest in medicine or fundamental research, as well as academic physicians who seek an in-depth knowledge of immunology to further their professional goals and research expertise.

Master of Science in Media, Medicine, and Health (SM-MMH)

Offers an evidence-based, multidisciplinary storytelling and arts-driven curriculum focused on health education and intervention. Designed for anyone with a desire to make a difference by combining art and science with the power and reach of the mass media.

Master of Medical Sciences in Medical Education (MMSc-MedEd)

Gives those who already excel in one of the health sciences disciplines an opportunity to turn their specialized knowledge and skill towards the advancement of health professions education.

Abstracts

Oral Presentations

(in alphabetical order)

Nadir Al-Saidi (SM-MMH) The Internet vs. Kidney Stones: How Accurate is Kidney Stone Prevention Information on the Internet?

Authors: Nadir Al-Saidi, Bassel Salka, Dawan Naqshabandi, Belgin Kazkaz, Antonio R. H. Gorgen, Roshan M. Patel

As patients increasingly seek health information online, our study evaluates the top 50 results for "kidney stone prevention" on Google, YouTube, TikTok, and Instagram using DISCERN to assessed video quality and AUA guideline adherence. Results revealed that Google leads (DISCERN 60.1), followed by YouTube (40.4), TikTok (26.6), and finally Instagram (28.8). Google content is health system-dominated (72%), YouTube by physicians (56%). Notably, TikTok exhibits quality differences between physician and non-physician creators. In conclusion, Google excels, suggesting an opportunity for urologists to enhance content quality on TikTok, YouTube, and Instagram.

Aya Awwad (MMSc-CI) Comparative Risk Prediction Using Homocitrulline and Carbamylated Albumin: Two Circulating Markers of Protein Carbamylation

Authors: Aya Awwad, MD; Eugene P. Rhee, MD; Morgan Grams, MD, PhD; Hernan Rincon Choles, MD; James Sondheimer, MD; Jiang He, MD; Jing Chen, MD; Chi-yuan Hsu, MD, MSc; Vasan Ramachandran, MD; Paul Kimmel, MD; Kendra Wulczyn, MD; Anders Berg, MD, PhD; Jim Lash, MD; Mengyao Tang, MD, MPH; Sahir Kalim, MD, MMSc, and the CRIC Study Investigators

Background and hypothesis: Protein carbamylation, a post-translational protein modification primarily driven by urea, independently associates with adverse clinical outcomes in patients with CKD. Biomarkers used to quantify carbamylation burden have mainly included carbamylated albumin (C-Alb) and homocitrulline (HCit, carbamylated lysine). In this study, we aimed to compare the prognostic utility of these two markers to facilitate comparisons of existing studies employing either marker alone, and to inform future carbamylation studies.

Methods: Both serum C-Alb and free HCit levels were assayed from the same timepoint in 1632 individuals with CKD stages 2 -4 enrolled in the prospective Chronic Renal Insufficiency Cohort (CRIC) study. Adjusted Cox proportional hazard models were used to assess risks for the outcomes of death (primary) and end stage kidney disease (ESKD) using each marker. C-statistics, net reclassification improvement, and integrated discrimination improvement were used to compare the prognostic value of each marker.

Results: Participant demographics included mean (SD) age 59 (11) years; 702 (43%) females; 700 (43%) white. C-Alb and HCit levels were positively correlated with one another (Pearson correlation coefficient 0.64). Higher C-Alb and H-Cit levels showed similar increased risk of death (e.g., the adjusted hazard ratio [HR] for death in the 4th carbamylation quartile compared to the 1st was 1.90 (95% confidence interval [CI] 1.35 -2.66) for C-Alb, and 1.89 [1.27-2.81] for HCit). Both biomarkers also had similar HRs for ESKD. The c-statistics were similar when adding each carbamylation biomarker to base models (e.g., for mortality models, the c-statistic was 0.725 [0.707-0.743] with C-Alb and 0.725 [0.707-0.743] with HCit, both compared to a based model 0.723). Sim ilarities were also observed for the net reclassification improvement and integrated discrimination improvement metrics.

Conclusions: C-Alb and HCit had similar performance across multiple prognostic assessments. The markers appear readily comparable in CKD epidemiological studies.

Claudia Bejarano Zambrano (MMSc-GHD) The Multiple Dimensions of Violence Suffered by Women as Barriers to Exercising Their Sexual and Reproductive Rights

Authors: Claudia Lizeth Bejarano Zambrano Esq., MD, MMSc-GHD student, Michael Knipper, MD, Joia Mukherjee MD, MPH, Nadeem Kasmani MD, MMSc-GHD, Hannah Gilbert, PhD, Carlos Antonio González Palacios, PhD, María Fernanda Bejarano Zambrano, BS

While SRH is crucial to women´s health and well-being, the needs of those in remote, underserved communities are often overlooked. We conducted a mixed-methods field study with women from a community of day laborers in Mexicali, whose only form of income is brick making. Assessing personal and social barriers to SRH, preliminary results reveal multiple forms of violence as main obstacles to exercising SRH rights. Gender -based

violence begins in homes and transcends to health services through forced interventions, mistreatment, and poor-quality healthcare. Direct and structural violence disproportionately affects women in remote areas, contributing to inequity in access to quali ty SRH.

Meher Chaudhry (SM-HQS) Improving Care for Boarded Emergency Behavioral Health Patients through Medication Reconciliation Redesign

Limited availability of inpatient psychiatric beds in the East Tennessee area has resulted in increased patient volumes and lengths of stay (LOS) in Emergency Departments (ED). The current median LOS for boarded psychiatric patients at our ED is 1.5 days (upper limit 5d). This increased LOS creates a critical need to give home medications in the ED, but review has shown that 49% of patients have not been receiving them. After applying QI tools to direct input from interprofessional frontline staff, we propose a new process for home medication reconciliation and aim to improve medication ordering from 51% to 90% by May of 2024. Interventions are underway and results anticipated over the next few months. The project, if successful, will increase patient safety by closing a critical gap and fostering collaboration between hospital pharmacy and ED staff.

Byeongyeon

(Terry) Cho (SM-BMI) DNA Characterization Reveals

Potential Operon-Unit Packaging of Extracellular Vesicle Cargo From a Gut Bacterial Symbiont

Authors: Byeongyeon Cho, Grace Moore, Loc-Duyen Pham, Chirag Patel, Aleksandar Kostic

Extracellular vesicles (EVs) are known to contain components including protein complexes, RNA, and DNA. We employed long-read DNA sequencing on purified extracellular vesicles from a gut symbiont, Parabacteroides goldsteinii, to characterize the genomic component within EV cargos. Our findings challenge the notion of DNA packaging into EVs as a stochastic event. Instead, we demonstrate that EV-DNA packaging is non-random. Here, we suggest a novel hypothesis of selective EV -DNA packaging, potentially arranged in operon-units, providing new insights into EV’s genetic makeup and its potential role, underlining the importance of our findings in microbial community dynamics.

Egbe Enobakhare (MMSc-GHD) Mixed Methods Assessment of Factors That Prevent Physical and Sexual Violence: Understanding the Perspective of Women Accessing Care at a Hospital in Nigeria

Purpose: To generate a holistic understanding of physical and sexual violence against women in the healthcare setting of Central Hospital Benin, quantify the prevalence, identify high-risk populations, and provide nuanced insights into the underlying factors contributing to these forms of violence.

Methods: Mixed methods involving a quantitative cross-sectional, case control study (n=84) and qualitative interviews (n=20) at Central Hospital, Benin City, Nigeria.

Results: The data analysis is currently underway, and results will be presented upon completion

Future plans: Publish research to inform strategies and interventions that can help prevent and address physical and sexual violence against women.

Joshua Eyitemi (SM-CSO) Serving the Hard-to-Reach: Enhancing Emergency Care in a Remote Community

Purpose: To address barriers to delivering quality care at a remote community emergency care unit

Methods: This project involves expanding and optimizing the physical layout, implementing design changes, and integrating technology into care. Evaluation will include data analysis, performance metrics, patient feedback, and benchmarking against best practices.

Results: Expected results are higher degree of patient privacy during the triage process, and enhancement of operational efficiency accommodate the growing healthcare needs of the remote community.

Future Plans: Sustaining positive outcomes, addressing emerging challenges, and sharing insights with the healthcare community for ongoing improvement in emergency care, especially in remote areas.

Dessislava Fessenko (SM-BETH) Ethical Requirements for Achieving Fairness in Radiodiagnostic Machine Learning

Radiodiagnostics by machine-learning systems (MLS) is often perceived as objective and fair. It may, however, exhibit bias towards certain patient subgroups. A typical reason for this is that MLS measure only standard endogenous causes for patients’ conditions and fail to monitor external aggravating factors. For example, standard osteoarthritis MLS measure causes within the knee, e.g., radiographic severity, but do not track causes external to the knee, e.g., life stress inflicting higher pain. Such MLS therefore fail to consider all pertinent personal, health and socioeconomic circumstances, and how they intersect (i.e., intersectionality) and depend on broader social conditions (i.e., embeddedness). This capstone explored the ethical obligations to ensure fairness of MLS precisely in light of intersectionality and social embeddedness. Literature review highlighted the impact of various contingencies, such as patients’ comorbidities, social roles and health determinants, on patients’ health and health need s. Addressing these needs is essential to patients’ functioning and flourishing, which are the ultimate goals of fairness under the dominant justice theories.

To achieve these goals, MLS must therefore incorporate patients’ relevant personal, health and socioeconomic circumstances and address their impact on patients’ health conditions and needs. The capstone proposed a set of interventions to tackle these issues. It recommended a paradigm shift in the development of MLS that enables MLS to screen both endogenous disease causes and the effects of relevant socioeconomic circumstances. The capstone developed a checklist of ethical requirements for instituting this shift and ensuring fairness. The requirements center patients’ intersectionality and social embeddedness through (i) integrating in MLS adequate measurable medical indicators of the impact of relevant socioeconomic circumstances, (ii) ethically sourced, diverse, representative and correct patient data concerning these indicators, and (iii) iterative socially sensitive co-exploration and co-design of datasets and MLS involving all relevant stakeholders.

Laurence Gariépy-Assal (MMSc-MedEd) Cultural Humility as a Framework to Teach Cross-Cultural Communication in Pediatric Residency Training

Authors:

Laurence Gariépy-Assal, MD CM, FRCPC, Ahmed Moussa, MD, MMEd, FRCPC, FAAP, Angela M. Feraco, MD MMSc, Dr Donna Luff, PhD, Dr Jennifer Kesselheim, MD, M.Ed, MBE

With North-America’s ethnocultural diversity, there is an ever-growing need for patient-centered cross-cultural care delivery. Communication has long been recognized as a quintessential medical competency as effective communication has been shown to improv e patient outcomes. Poor communication across cultures significantly increases health inequities, directly impacts quality of care, treatment adherence, and leads to increased misdiagnosis and hospital admissions. Although medical education agencies recognize the need for formal training in providing cross-cultural care, little time is allotted to the development and assessment of these aptitudes in residency curricula. Resident physicians graduate with low self-reported skills in that domain.

Cultural humility (CH) has recently given way to better inform effective cross-cultural communication (CCC). CH is the ability to recognize one’s cultural biases and limitations. It puts forward a life -long learning approach to diversity while focusing on self-reflection and power differential awareness. CH offers a conceptual framework to ground the development of patient-centered CCC training interventions.

Purpose: The purpose of this study is to assess the feasibility of developing a simulation-based session (SBS) to teach CCC and its potential impact on delivering culturally effective care.

Methods: Using expert consensus and collaboration with community patient partners, we developed a SBS on CCC using CH as a conceptual framework. Following IRB approval, pediatric residents from the University of Montreal were recruited (n=25) to participate to the curriculum (Fall 2024).

Data collection: Survey data is collected using MicrosoftForms and statistical analysis carried out using Stata. Demographic data will be presented using descriptive statistics. Categorical variables will be analyzed using chi-square and continuous variables using independent ttest. We will consider p< 0.05 as statistically significant. Qualitative analysis of curriculum satisfaction and postcard exercise will be conducted through coding of emerging themes.

Mikio Hayashi (MMSc-MedEd) Factors Influencing the Sense of Belonging Among Medical Students with Disabilities in a Medical University Environment

Authors: Mikio Hayashi, Hiroko Mori, Timothy Rogers, Jennifer Arnold

Medical universities have become more aware of disability inclusion, and the importance of the climate at medical universities for medical students with disabilities has been discussed. However, it is unclear what factors influence their sense of belonging in a medical university environment. A qualitative phenomenological study utilizing organizational paradox theory was carried out with the 25 Japanese faculty members who interacted with them to address this problem. The findings of this study are expected to contribute to resolving problems by acting as an important source of information for each medical university when considering how to cultivate a more inclusive environment.

Adriana P. Liimakka (SM-BMI) Identifying Genetic Variants Associated with the Arthrofibrosis Phenotype and Predicting Joint Stiffness Risk After Total Joint Arthroplasty

Authors: Adriana P. Liimakka, BS; David J. Oliver, PhD; Soumya Raychaudhuri, MD, PhD; Antonia F. Chen, MD, MBA

Arthrofibrosis (AF), also referred to as stiffness, is one of the most prevalent complications of primary total knee arthroplasty (TKA) procedures and results from excessive scar tissue deposition in the periarticular joint space. While AF is a well-documented complication of TKA, its pathogenesis is incompletely understood and has limited the development of disease-modifying treatment. In this study, we perform a genome wide association study to identify single nucleotide polymorphisms associated with AF and investigate their relationship with the phenotype.

Bróna Moloney (SM-MMH) Association of Diabetes with Changes in Blood Pressure during Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial.

Authors: Bróna M. Moloney, Glenn M. Chertow, Finnian R. Mc Causland

Purpose: Data regarding patterns of peri-dialysis blood pressure (BP) control according to diabetes is sparse.

Methods: In this post hoc analysis of the Frequent Hemodialysis Network Daily Trial we used random effects regression to estimate the association of diabetes (versus none) with intra-dialytic hypotension (IDH) and peridialytic BP.

Results: In adjusted models, diabetes (vs. none) was associated with a 93% higher risk of IDH (IRR 1.93; 95% CI 1.26, 2.95), a lower nadir intraHD BP (-4.2; 95%CI -8.3, -0.2 mmHg), but not with the pre- or post-HD systolic BP.

Future Plans: Will examine differences in body composition according to diabetes.

Dagny Reese (MMSc-IMM) Targeting Chemokine Gradients in Triple Negative Breast Cancer with Responsive NK Cells

Authors: Dagny Reese, BSc, Madison Leone, BSc, Raymond Quinones Alvarado, BSc, Wilfredo Garcia-Beltran, MD, PhD

Despite advancements in chimeric antigen receptor NK cell (CAR-NK) therapies, challenges persist in homing CAR-NK cells to the tumor microenvironment (TME). Targeting TME-specific cytokines and chemokines crucial for tumor progression is a potential strategy to enhance CAR-NK efficacy. We have identified the CXCL16-CXCR6 axis as a potential target for CAR-NK therapies in triple negative breast cancers, in which it is differentially expressed. Utilizing transwell assays, co-cultures, and 3D systems, we have explored a contextual role of CXCL16’s isoforms in recruiting CXCR6+ NK cells, providing insights into a potential avenue for enhancing CAR-NK cell therapies in solid tumors.

Naginder Singh (SM-HQS) Optimizing Anesthesia Precision: Improving pEEG Monitoring for Total Intravenous Anesthesia (TIVA)

Purpose: Enhancing the provision of processed electroencephalography (pEEG) monitoring in total intravenous anesthesia (TIVA) is the focus of this initiative. Recent advancements in pEEG technology boost the safety and precision of administering general anesthesia, crucial for TIVA with its variable dosing requirements.

Methods: Methodology involves a targeted analysis at a tertiary academic hospital, driving improvements in provider training, workflow, and the acquisition of monitors.

Results: Early outcomes indicate a substantial uptick in the adoption of this transformative technology, showcasing the effectiveness of implemented interventions.

Future plans: The team anticipates that this successful quality improvement approach will translate into measurable clinical benefits for patients in future.

Ian Stevens (SM-BETH) An Exploratory Review of the ‘Treatment Resistant’ Phenomenon as a Justification for Neurosurgical Intervention

While used colloquially to describe neuropsychiatric illnesses that do not respond to therapy, the meaning behind ‘treatment resistance’ has not received much scholarly attention. Such an opaqueness becomes all the more concerning given how frequently it’s used as a criterion to justify surgical intervention(s) with neuropsychiatric conditions. To clarify this, a mixed methods review of this criterion was proposed so that its qualitative, quantitative, and conceptual characteristics could be captured. PubMed, ClinicalTrials.gov, U.S. Food and Drug Administration, and the related ethical literature were to serve as the sources for this exploratory study.

Qiyuan Zhou (MMSc-IMM) Modeling T Cell- B Cell Interaction in Rheumatoid Arthritis in a 3D Organoid System

Authors: Qiyuan Zhou, Kathryne E. Marks, Deepak A. Rao

We have constructed a 3D organoid model to recapitulate the inflammatory T-B interactions in rheumatoid arthritis synovium by combining T-cells, Bcells, and synovial fibroblasts in Matrigel. Inclusion of memory CD4 T cells and B cells in the organoids results in differentiation of B cells into plasmablasts. Organoids constructed with CXCL13 producing CD4 T cells and memory B cells contain lymphoid aggregates similar to those observed in RA synovial tissue. Future plans include using the model to explore the intervention strategies by targeting the synovial fibroblasts and the interactions themselves such as through CXCL13 blockade.

Alumni Panel

(in alphabetical order)

Haim Moore (MMSc-IMM, Class of 2022)

Haim is currently a second-year medical student at UMass Chan. Haim graduated from UMass Dartmouth in 2018 before joining the Boehm Lab at the Broad Institute of MIT and Harvard. After leaving the Broad he joined the MMSc-Immunology program at Harvard Medical School. For his master’s thesis, he researched Gamma Delta T cells in colorectal cancer in Lydia Lynch’s lab at Brigham & Women’s Hospital. Haim continues to focus on his passion for oncology and research as a Research Scholar at the Children’s Hospital of Los Angeles. In addition, Moore is a Resident Tutor at the Lowell House at Harvard University and is part of the pre-med committee that helps students apply to medical school.

Mark is an Assistant Professor of Medicine at Harvard Medical School and an Independent Investigator in the Division of Hematologic Neoplasia at the Dana-Farber Cancer Institute. He received his medical education at Washington University in St. Louis, where he also earned a master’s degree in biology and biomedical sciences for his work defining pathogenic mechanisms of the bone marrow failure syndrome severe congenital neutropenia under Dr. Daniel Link. He clinically trained in Internal Medicine at the Massachusetts General Hospital and in Hematology and Medical Oncology at the Dana-Farber/Partners CancerCare program, where he developed an interest in treating patients with hematologic malignancies. He performed postdoctoral research into mechanisms of minimal residual disease and functional biomarkers of drug sensitivity in acute lymphoblastic leukemia under the mentorship of Dr. David Weinstock. Concurrently, he earned a Master of Medical Sciences degree in Biomedical Informatics at Harvard Medical School to complement his skills in genomics and experimental therapeutics. Since opening his independent laboratory in 2018, he has focused on developing therapeutic strategies to overcome minimal residual disease in leukemia and lymphoma and leads clinical genomics and enterprise-level data management efforts for the Adult Lymphoma group at the Dana-Farber Cancer Institute.

Mark Murakami (MMSc-BMI, Class of 2016)

Shawna is a global health practitioner and medical doctor working at the intersection of health and peacebuilding. As Executive Director of the Canada International Scientific Exchange Program (CISEPO) and a current Global Health and Social Medicine fellow at Harvard Medical School, she works on health system strengthening, and fostering collective efforts towards peacebuilding within a rights-based framework. Her research uses implementation science frameworks and mixed methods to unpack the complex interrelationship between health equity, gender equity, and peacebuilding within socio-political ecosystems. She has worked extensively in epidemic prevention and control, particularly during the COVID-19 pandemic, in her role as a clinical public health advisor with the Global Health Unit of the Canadian Red Cross. She earned an MMSc in Global Health Delivery from Harvard Medical School and is currently completing a Doctorate in Education. Shawna is an Associate Faculty with Ariadne Labs at Harvard School of Public Health and teaches at the University of Toronto. Her work has garnered support from organizations such as Ashoka Changemakers, United Way, the Fund for Innovation and Transformation (FIT), and Global Affairs Canada. Shawna serves on the Women for Dignity and Development Foundation Board, the Save a Child's Heart Canada Medical Advisory Committee, the WHO Civil Society Advisory Commission, the WHO Migrant and Refugee Health Advisory Committee, and the Consortium for Universities in Global Health (CUGH) Health Workforce Committee. She also serves as a consultant to the WHO in the MENA region.

Shawna Novak (MMSc-GHD, Class of 2023)

Constantine aka 'Kosti' Psimopoulos is a Kinesiologist and a Harvard Medical School alumnus and trained bioethicist (MBE ’23). After graduation, and as a guest Lecturer, he joined a course development and teaching team led by Prof. Evelynn Hammonds and the joint HMS/HSPH Initiative’s Director Dr. Deepali Ravel, introducing a Racism in Health and Scientific Research module, taught to all Doctoral students (many in the MD/PhD programs), as part of the Responsible Conduct in Science MED

SCI 300 course overseen by our very own Dean Roz Segal at HMS. He has been teaching Ethics of Human Subjects Research at Johns Hopkins and Bioethics and AI at MIT. Just last week, he joined the faculty of Harvard's Initiative on Health, Spirituality and Religion, of which he is also an Administrator, and the Human Flourishing program. He also holds an academic teaching position (Teaching Fellow) in the Department of Systems Biology at HMS, Scientific Citizenship Initiative, funded by the NIH (National Institutes of Health), tasked with developing ethics training modules and a new curriculum employing simulation-based, anti-racism pedagogy for genetics researchers and future scientists at the Medical School. Finally, by virtue of being a Doctor of Bioethics candidate, he has another visiting research appointment in Global Health and Social Medicine and the Center for Bioethics at HMS, conducting research on public health ethics, social justice, AI and theological bioethics. For more information, please visit his scholar webpage at: https://scholar.harvard.edu/constantine

Constantine Psimopoulos (MBE, Class of 2023)

Susana is a specialist in Health Economics and Management. As a Senior Healthcare Project Manager and data analyst, Susana and her team work in Latin America to enhance the quality of the healthcare system, focusing particularly on Colombia. They have spearheaded national interest programs in Breast Cancer, Palliative Care, and COVID-19.

She is also a researcher in the Epidemiology and Biostatistics Research group at CES University. Susana is keen on exploring how new technologies and artificial intelligence can bridge the digital divide and fortify the healthcare system with enhanced quality and accountability. In her HMS thesis, she looked at the impact of medical attention using Telemedicine during COVID-19 on the Colombian healthcare system through mixed-methods research and the creation of a GIS map. Following her graduation, Susana remained in Boston to serve as a Teaching Fellow during the fall of 2023 at Harvard College and in the spring of 2024 at HMS.

Susana Orrego Villegas (MMSc-GHD, Class of 2023)

(in alphabetical order)

Saman Ahmad (SM-HQS) Improving Serious Adverse Drug Reaction Reporting to Health Canada under Vanessa's Law

Authors: Saman Ahmad, MD, FRCPC, Emily McDonald, MD, FRCPC, MSc (Epi), Anjala Tess, MD

Vanessa’s Law mandates that hospitals report all severe adverse drug reactions (SADR) to Health Canada within 30 days of their documentation. McGill University Health Centre (MUHC) is not currently reporting any. The aim is to design an easy-to-access/fill reporting tool and a streamlined process to review/send them to Health Canada, along with raising awareness about Vanessa’s Law. The primary outcome is the number of reports sent to Health Canada and the process measure is how many forms are completed every two weeks. We will use run charts and conduct an interrupted time series to assess for improvement after the intervention.

Saleh Al Jundi (MMSc-CI) Whole Blood and PRP Similarly Stimulate Fibroblast Proliferation in 3-D Matrices

Authors: Saleh Al Jundi, Martha Murray, Benedikt Proffen

Summary (75-100 words)

The current gold standard for addressing ACL injuries involves surgical ACL reconstruction (ACLR) which utilizes an autograft tendon from the hamstring or patellar tendon. Our team has produced an extracellular matrix powder (ECM-P) which is mixed with the patient's blood before use to form an injectable gel that can be delivered arthroscopically between the torn ends of the ligament, eliminating the need for an autograft. The hydrogel mix forms a microenvironment around the ACL to facilitate clot formation and wound healing. Our study involves a multistep cell culture plan which focuses on optimizing the concentration of the ECM-P hydrogel for ACL healing. This initial study aims to determine the preference between using whole blood or platelet-rich plasma (PRP) in conjunction with ECM-P.

Purpose

The purpose of this study is to characterize cellular outgrowth of ACL fibroblasts into terminally sterilized ECM-P mixtures and to identify a preferred mixture (ECM-P/PRP or ECM-P/whole blood) to allow for fibroblast migration and proliferation and to accurately measure cellular outgrowth in following cell culture studies.

Methods

Ovine ACL tissue samples were harvested and then cut with a surgical blade into 1 mm x 1mm samples. These explants then were cultured with 4 ml of DMEM/F-12 culture media in each well. Molds were filled with 0.25 ml of ECM-P/PRP gel or ECP-P/whole blood gel, and one 1 mm x 1 mm ACL tissue sample was placed on top of the gel. Afterwards, another 0.25ml of the gel was added to cover the top of the ACL tissue, creating an ECM-P construct with the ACL tissue sample in the center. Once all 74 constructs were made, they were placed in a 12 well plate and placed into the incubator at 37C for 1 hour to allow further gelation. Next, the 74 constructs were placed in a 24 well plate, with one construct per well and cultured in DMEM/F-12. Samples were cultured for 28 days with media being changed twice weekly. After 28 days, the ACL tissue was removed from the gels and cell outgrowth into the gel was measured using the MTT assay, Picogreen dsDNA assay, RTqPCR and histology.

Results

Differences in measuring DNA content between PRP and whole blood constructs was not statistically significant at p=0.8236 (p<0.05). Using the RT-qPCR delta-delta Ct method, differences in gene expression of COL1A1 and COL3A1 by ACL fibroblasts between PRP and whole blood constructs were not statistically significant according to an unpaired t -test at p=0.3179 and p=0.5601, respectively. However, differences in measuring fibroblast metabolic activity, using the MTT assay, between PRP and whole blood constructs were statistically significant at p=0.0002 (p<0.05).

Conclusion

The use of whole blood instead of PRP in 3-D matrices does not impair the measurement of cellular outgrowth by the Picogreen dsDNA assay and RTqPCR. Future experiments will aim to investigate cellular outgrowth of ACL fibroblasts into various concentrations of ECM-P mixtures and to identify a preferred ECM-P powder density for fibroblast migration and proliferation in the ACL.

Prizka Avilia Puspa (MMSc-CI) The Association of Polygenic Risk Score for Primary Open Angle Glaucoma with Selective Laser Trabeculoplasty Outcomes

Authors: Avilia Puspa, Prizka; Sekimitsu, Sayuri; Hegazy, Doaa; Aziz, Kanza; Zhao, Yan; Wiggs, Janey; Segre, Ayelle; Zebardast, Nazlee

This study investigates the association between Polygenic Risk Score (PRS) for Primary Open Angle Glaucoma (POAG) and Selective Laser Trabeculoplasty (SLT) outcomes in glaucoma patients. 72 eyes from 48 patients were categorized into high and low PRS groups based on a crossancestry genome-wide association study. Kaplan-Meier survival and Cox proportional hazard models analyze treatment failure, defined as less than 20% intraocular pressure reduction, need for additional medications, or further surgery. We found significant differences in failure rates between the high (78% at 6 months, 89% at 12 months) and low PRS groups (37% at 6 months, 63% at 12 months) (Figure 1). High PRS is notably linked with increased SLT failure risk, indicating its potential role in predicting SLT outcomes. However, given the dominance of POAG cases, broader research involving more diverse glaucoma types is necessary.

The 12th major cause of death in the U.S. is End Stage Liver Disease (ESLD). The estimated cost of a liver transplant is in the region of $100 K USD per patient. However, this cohort of patients after care experience has

Figure 1. Kaplan-Meier curve of SLT failure Utieyin Dediare (SM-CSO) Optimization of After Care Post Liver Transplant Intervention

inherent challenges unveiled via literature review and descriptive analytics of surveillance data across the three US major transplant sites. Continuous quality improvement tools are suggested to address some the challenges including commercial burden of disease per capita/center. In the long run this work can focus on opening the game at the intersection between research, public health, and service design itself. These can be powerful tools to align with the organization’s goals for better provision of value based, equitable, sustainable healthcare and well-being for all stakeholders. Optimizing critical processes and generating proactive metrics on par with other financial, lean manufacturing and operational metrics.

Yanming Gan (SM-BMI) Decode Retrotransposon-fusion RNAs in Stomach Cancer

Authors: Yanming Gan and Eunjung A. Lee

Approximately 45% of the human genome consists of transposable elements (TEs). Prior research indicates that unregulated TEs may spliced into adjacent introns or exons of genes that code for proteins, resulting in TE-chimeric transcripts and peptides (TE fusions). In this project, we hired two bioinformatic tools, rTea and TEProF2 to assay TE fusions in 39 pairs of RNA-sequencing samples, derived from stomach cancer and matched normal tissues. We comprehensively assessed the prevalence and recurrence of TE fusions in these samples to provide a landscape of TE fusions in stomach cancer. In addition, we identified 555 recurrent tumorspecific TE fusions, and performed case studies on those fusions which also involved cancer genes to investigate the potential effects of TE fusions in cancer.

Ibrahim Gassama (MMSc-GHD) Investigating the Causes and Downstream Effects of Factors Leading to Prescribing of Antibiotics in Outpatients for Children Under Five Years at Koidu and Portloko Hospitals in Sierra Leone

Authors:

Ibrahim Gassama, Joan Kaufman Ph.D., Jonathan D Quick MD, MPH, Naphtal Nyirimanzi MD, MGHD

This study delves into the multifaceted exploration of factors influencing the prescription of antibiotics for children under five in outpatients at Koidu and

Portloko hospitals in Sierra Leone. By investigating the root causes and subsequent repercussions of antibiotic prescription, the research aims to contribute valuable insights into the prescription patterns and healthcare 5 of 9 practices, ultimately facilitating the development of targeted interventions to enhance pediatric healthcare in the region.

Farah Hasin (SM-HQS) Enhancing Sepsis Care: A Call to Action and Quality Improvement Initiatives at a Community Academic Hospital

Authors: Hasin, F; Blanchard, M; Abid, M; Jaafar, N; Ali, M; Sharma, R; Durney, J

This Quality improvement study addresses the critical global challenge of sepsis with a 20% mortality rate. Focusing on the Surviving Sepsis Campaign's 3-hour and 6-hour bundles, we explore compliance rates and associated care gaps at our academic community hospital. With a current compliance rate of 40%, below the national average, our analysis reveals delayed sepsis diagnosis and antibiotic administration as a major contributor. Delays in sepsis identification and suboptimal compliance correlate with extended patient stays and adverse outcomes. Our purpose is to establish a collaborative, multi-stakeholder Sepsis committee, raise organizational awareness, and implement Quality Improvement (QI) initiatives using the IHI and Harvard QI models. This research aims to transform sepsis care, enhance patient outcomes, and provide a model for community hospitals nationwide. Future plan s involve continuous monitoring, refinement, and dissemination of successful strategies for sustainable improvement.

Patricia Lora (SM-BETH) The Right to Be Childfree: Ethical Inquiry on Female Sterilization

Authors: Patricia Lora, MD Annekathryn Goodman, MD, MS, MPH Michael Ieong, MD

It is relatively common for many childfree women to be repeatedly denied a request for sterilization despite being competent, legally eligible individuals, and the procedure a method of birth control and basic health care. There is current data that examines legislation, accessibility, case analys es for surgical training, and statistical comparisons with male sterilization, but

there is barely any evaluation of the ethical implications and why is it so dangerous to restrict access to the procedure.

Purpose: To explore the obstacles women without children, face when they seek permanent sterilization, either for medical or personal reasons, and experience denials and a lack of respect for their autonomy.

Methods: It is a literature review that examines the current data in books, articles, and anecdotes. The covariates being tested are age, native language, geographic location, and insurance or lack thereof. The idea is to discover how much influence do these specific factors have on the ethical decision-making (if at all).

Results to date: There are certain barriers to accessibility to sterilization for childfree women, the biggest one being the doctors’ fear for patient’s regret when, if present, is not theirs to bear. Age plays a role as well, and women report that it is fairly common to r eceive “too young” as a reason for denial (especially when they are under 30 years old), while it is less common for men to find a doctor who refuses to perform their vasectomies.

Future plans:

- To interview patients and specialists for a fresh perspective on the matter with an ethical lens.

- To devise a strategy on how to have a more ethical conversation regarding voluntary sterilization.

- To publish results on a bioethical journal.

- To apply first-hand the key points learned on future practice.

Miguel Pinto-Salinas (MMSc-MedEd) Impact of Regulations and Accreditation Standards on National Knowledge Examination Scores of Peruvian Medical Trainees: A Mixed-Methods Study

Authors: Miguel Angel Pinto-Salinas, Yoon Soo Park, Herman Vildózola

Our study investigates the influence of National Regulations and Accreditation Standards (NRAS) on the performance of Peruvian medical trainees. Using a mixed-methods approach, we analyze longitudinal National Knowledge Examination Scores (ENAM) and gather insights from medical school leaders. Our preliminary analysis reveals a complex pattern of ENAM score trends, influenced by factors such as university type, region, and ASPEFAM membership. Additionally, we explore variations in

performance among different medical schools. Our ongoing research aims to delve deeper into the impact of NRAS and understand the drivers of these trends. This study contributes to improving medical education in Peru and beyond.

Janine Robredo (MMSc-GHD) Understanding the Factors Associated with Nutritional Outcomes Among Children Under Five Years Old in Negros

Occidental, Philippines: A Cross-Sectional Mixed-Methods Study

Authors: Peter Rohloff, MD, PhD; Janine Patricia G. Robredo, MD, MBA; Hannah Gilbert, PhD; Nadeem Kasmani, MD, MS

This research aims to identify factors influencing nutritional outcomes of children under five in Negros Occidental, Philippines. Despite national progress, stark regional disparities persist, necessitating localized insights. Utilizing a convergent mixed-methods design, quantitative assessments estimate malnutrition burden and identify associated factors, while qualitative insights delve into lived experiences and systemic influences. The study revealed significant initial findings, emphasizing a higher stunting prevalence in rural Don Salvador Benedicto, linked to maternal employment impact on childcare practices. The research plans to deepen data analysis, offering crucial insights to partner organizations and nonprofits, enhancing the efficacy of nutrition initiatives in these communities.

Brandon Tang (MMSc-MedEd) General Medicine Inpatient Initiative Medical Education Database (GEMINI MedED): A Multicenter, Retrospective Study of Resident Clinical Care in Internal Medicine

Authors: Brandon Tang, Andrew CL Lam, Chang Liu, Surain Roberts, Marwa Ismail, Amol Verma, Fahad Razak, Martin Pusic, Shiphra Ginsburg, Brian M Wong

Purpose: To measure and interpret variation in clinical care amongst senior internal medicine (IM) residents at the University of Toronto between 20102019.

Methods: This retrospective cohort study links data from 793 IM residents to clinical data from 88,633 unique patients using the novel GEMINI MedED database. Descriptive statistics will be used to characterize

variation in pneumonia-specific (e.g., orders first line antibiotics) and general care (e.g., orders advanced imaging).

Conclusion: By characterizing variation in resident clinical care, this work serves as a first step toward aligning assessment and feedback in residency education with high quality patient care.

Renqui Wang (MMSc-IMM) Synthetic Gene Circuits for Ovarian Cancer Immunotherapy

Authors: Chu-Yen Chen, Renqi Wang, Yen-Nien Liu, Bo Zhu, Ming-Ru Wu

This study introduces a synthetic gene circuit platform for ovarian cancer treatment, a leading cause of cancer-related death in women. Delivered via lentiviruses, these circuits target ovarian cancer cells by detecting abnormal transcription factor activities and initiate localized immunotherapy. This approach has shown remarkable specificity, with nearly a 1,000-fold higher activity in cancer cells compared to normal cells in vitro. Ongoing research focuses on optimizing immunotherapeutic outputs in mouse models. Additionally, this platform holds the potential for treating other diseases characterized by aberrant transcription factor activities, including metabolic, autoimmune, and neurodegenerative disorders

Kay Wu (SM-BMI) Multitask Deep Learning for Comprehensive Lumbar Spine MRI Interpretation

Authors: Kay Wu, Christopher Bridge, Stuart Pomerantz, Albert Kim

This research aims to enhance lumbar spine MRI interpretation through the development of a multitask deep learning model such that lumbar spinal diseases can be more comprehensively characterized for improved diagnostic reporting and treatment planning. The model is trained on a large and robust dataset of over 54,000 cases from the Greater Boston area, the first of its kind. The model classifies and grades various lumbar spinal conditions, including stenosis, disc bulging, and facet arthropathy. Current results show successful training for stenosis classification, and future plans involve expanding the model's capabilities to characterize additional aspects of spinal disease.

Xiaowen Xu (MMSc-IMM) GSDMD Protects Mice from Escherichia coli K1 Pathogenesis in the Brain

Authors: Xiaowen Xu, Georgia Gunner, and Isaac Chiu

We are investigating the role of GSDMD in the brain and E. coli K1-induced meningitis. We showed that GSDMD-deficient microglia have reduced pyroptosis and IL-1beta release compared to wild type microglia. Through injecting bacteria into mouse’s cisterna magna, we found that GSDMDdeficient female mice have worse disease progression and shorter lifespan compared to wild types. Future work will include using flow cytometry and histology for investigating immune response and how bacteria spreads in the brain, and in vitro experiments such as bacterial killing assays. This research aims to elucidate E. coli K1's pathogenesis in the brain and GSDMD's role in meningitis.

Tessa Youngner (SM-BETH) Advancing Restorative Justice through Clinical Genomics: A Multi-Stakeholder Framework to Ethically Integrate Gene Therapy for Sickle Cell Disease

On December 8, 2023, the U.S. Food & Drug Administration (FDA) approved two novel gene therapies (GT) that promise to effectively cure sickle cell disease (SCD), a notoriously debilitating and historically marginalized condition that affects more than 100,000 Americans. While society has largely heralded this milestone in clin ical genomics and SCD care as a revolutionary step towards restorative justice, many underlying issues complicate the clinical integration of GT for SCD. As such, this capstone project aimed to: 1) explore diverse stakeholders' perspectives around the clinical implementation of GT for SCD; 2) identify urgent ethical and practical issues threatening this pivotal moment in SCD care and genomic medicine; and 3) recommend interventions to advance restorative justice through SCD care & GT. Data was collected through a targeted literature review structured around eight key stakeholders, as well as participation in relevant listening sessions and discussions with thought leaders. Through this research, four overarching priorities arose as key themes that need to be addressed for the ethical and successful integration of GT: a) safety & efficacy; b) accessibility & equity; c) shared decisionmaking; and d) feasibility. Furthermore, the literature identified more than 15 ethical issues and 20 recommended interventions specific to the SCD community’s integration of GT. A comprehensive framework was created to

synthesize and disseminate these findings to key stakeholders. Future activities include soliciting feedback from key stakeholders and adapting the framework to meet the evolving needs of the SCD community, as well as other disease populations seeking restorative justice in the genomic era.

Message from the Dean

Thank you for participating in the 10th anniversary Harvard Medical School Master’s Symposium. This annual event is an opportunity to learn from scholars from across our programs. And it is an opportunity to connect with your peers and recognize our shared goal of improving human health and alleviating suffering. We thank the oral and poster presenters for sharing their insights and discoveries. We want to extend a special thank you to the members of our alumni panel for joining us and sharing their postgraduation experiences. And finally, we thank the audience for your engagement and curiosity.

Johanna L. Gutlerner Senior Associate Dean for Graduate Education