2021 Karen Zier, PhD Medical Student Research Program and Abstracts

Fourth Annual KAREN ZIER PHD MEDICAL STUDENT RESEARCH DAY

Program and Abstracts THURSDAY, MARCH 18, 2021, 12:15 – 4:00PM

TABLE OF CONTENTS — Introduction (pg 4) — Program and Student Speakers (pg 5-6) — List of Abstracts (pg 7-31) — Abstracts (pg 33-151) — Student Index (pg 153-165) — Mentor Index (pg 167-174) — Abstract Topics Area (pg 176-178) — Acknowledgments (pg 180-183)

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Fourth Annual Karen Zier Medical Student Research Day March 18, 2021

Welcome to the 26th Annual Medical Student Research Day, named in honor of Karen Zier, PhD, founding Associate Dean for the Medical Student Research Office. This year has been challenging for everyone on all levels. Our students, faculty and research community have excelled despite this. To keep everyone safe, for 2021, the entire event will be held online via Zoom.

The Icahn School of Medicine at Mount Sinai places great importance on rigorous, mentored scholarship in the education of future physicians. The Medical Student Research Office supports this mission through the Scholarship and Research (SCHOLaR) program, which provides students research curricular training, helps to identify a research mentor and supports the development of a rigorous research project in their area of interest.

Student scholarship is supported by several programs, including the Summer Research Investigators Program, the Scholarly Year Program, and PORTAL (Patient-Oriented Research, Training, and Leadership) which offers a combined MD-Masters of Science in Clinical Research. Additional support is available to students participating in research through the Global Health Summer Program, and Center for Multicultural and Community Affairs (CMCA).

The projects presented reflect the intellectual curiosity and critical thinking of our students and are a result of their hard work and the dedication of their faculty mentors.

The medical student research program flourishes because of the enthusiasm of our students, the support of school leadership, and the commitment of dedicated faculty mentors. We are grateful for the support of Dr. Dennis Charney, Dean of the Icahn School of Medicine at Mount Sinai, and Dr. David Muller, Dean for Medical Education. We would like to send a special thank you to the SCHOLaR Track Advisors for their strong support of medical student scholarship:

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—Jacob Appel, MD, MS, MPH —Supinda Bunyavanich, MD —Kevin Costa, PhD —Darinka Gadikota-Klumpers, PhD —James Iatridis, PhD —Reena Karani, MD, MHPE —Tatyana Kushner, MD, MSCE —Ann-Gel Palermo, DrPH —Paz Polak, PhD

—Perry Sheffield, MD

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Thank you Grace Oluoch and Yakhira Encarnacion-Patterson, Program Administrators for the Medical Student Research Office, for producing the abstract book and handling the Research Day planning and logistics. And a special thank you to Michelle Sainte, Senior Associate Dean for Academic Administration, for her help and creativity.

Jenny J. Lin, MD, MPH

Keith Sigel, MD, PhD

Mary Rojas, PhD

Co-Director of SCHOLaR

Director of PORTAL

Director of the Medical Student Research Office

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PROGRAM 12:15 – 1:15 pm Poster Presentations (Session A) 1:25 – 2:25 pm Poster Presentations (Session B) 2:50 – 3: 05 pm Welcome

Mary Rojas, PhD Director, Medical Student Research Icahn School of Medicine at Mount Sinai

Dennis Charney, MD Anne and Joel Ehrenkranz Dean Icahn School of Medicine at Mount Sinai President for Academic Affairs Mount Sinai Health System

David Muller, MD Dean for Medical Education Icahn School of Medicine at Mount Sinai

3:10 – 4:15 pm Student Oral Presentations

Emma Klein, MS II “Non-Invasive Approach to the Prediction of Severity Degree and Survival in Covid-19 Using a Combination of Semiquantitative-Quantitative CT Findings and Plasma Cytokine Assessment” MENTOR: BACHIR TAOULI, MD

Jeffrey Okewunmi, MS II “Racial Disparities in Care and Outcomes after Total Hip and Knee Arthroplasties: Did the Comprehensive Care for Joint Replacement Program Make a Difference?”

MENTOR: JASHVANT POERAN, MD, PHD

Kevin Weiss, MS II “Dynamics of Anal and Cervical HPV in Women with HIV: Relationship to Anal Precancers” MENTOR: MENTOR: KEITH SIGEL, MD, PHD

Minami Tokuyama, MS III “SARS-COV-2 Infects Enterocytes In Vivo and can Persist up to 7 Months following Symptom Resolution” MENTOR: SAURABH MEHANDRU, MD

Closing Remarks

Jenny Lin, MD, MPH Associate Director SCHOLaR, Medical Student Research Icahn School of Medicine at Mount Sinai

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EMMA KLEIN, MS II “Non-Invasive Approach to the Prediction of Severity Degree and Survival in Covid-19 Using a Combination of SemiquantitativeQuantitative CT Findings and Plasma Cytokine Assessment” Abstract # 57

KEVIN WEISS, MS II “Dynamics of Anal and Cervical HPV in Women with HIV: Relationship to Anal Precancers” Abstract # 114 MENTOR: KEITH SIGEL, MD, PHD

MENTOR: BACHIR TAOULI, MD

JEFFREY OKEWUNMI, MS II “Racial Disparities in Care and Outcomes after Total Hip and Knee Arthroplasties: Did the Comprehensive Care for Joint Replacement Program Make a Difference?”

Abstract # 84 MENTOR: JASHVANT POERAN, MD, PHD.

MINAMI TOKUYAMA, MS III “SARS-COV-2 Infects Enterocytes In Vivo and can Persist up to 7 Months following Symptom Resolution” Abstract # 107 MENTOR: SAURABH MEHANDRU, MD

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SECTION 1:

List of Abstracts Note: Medical student’s name is in bold and the last author is the mentor.

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LIST OF ABSTRACTS

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OUTCOMES OF BALLOON ANGIOPLASTY ALONE AND OTHER ADJUNCTIVE THERAPIES IN THE TREATMENT OF BELOW-KNEE PERIPHERAL ARTERY DISEASE. Sofia Ahsanuddin1, Christopher Hatzis2, Ajit Rao2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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OUTCOMES AFTER DRAF IIB WITH SUPERIOR SEPTECTOMY: A RETROSPECTIVE CHART REVIEW. Eric Alerte1, Todd Spock2, Alfred-Marc Iloreta2. 1Medical Education, 2 Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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INCIDENCE OF CONCUSSION AND RECOVERY OF NEUROCOGNITIVE DYSFUNCTION AMONG YOUTH ATHLETES WITH PREMORBID DEPRESSION OR ANXIETY TAKING ANTIDEPRESSANTS. Muhammad Ali1, Tanvir Choudhri2. 1Medical Education, 2Neurosurgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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EARLY ADVANCES IN COMPUTATIONAL DRUG REPURPOSING AGAINST COVID-19.

Illya Aronskyy1, Yosef Masoudi-Sobhanzadeh3, Antonio Cappuccio2, Elena Zaslavsky2.

1 Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York. 3Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.

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MOLECULAR PROFILING OF ATOPIC DERMATITIS SKIN REVEALS BIOMARKERS OF DISEASE SEVERITY. Kelsey Auyeung1, Helen He2, Jianni Wu3, Ana Pavel2, Emma Guttman-Yassky2.

1,3 Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3SUNY Downstate Medical Center.

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LIST OF ABSTRACTS

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DISPARITIES IN GENETIC COUNSELING FOR GYNECOLOGICAL CANCERS: IDENTIFYING AREAS OF IMPROVEMENT. Elena Baldwin1, Sharonne Holtzman2, Stephanie Blank2. 1Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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PRENATAL PM2.5 EXPOSURE PREDICTS NEUROCOGNITIVE PERFORMANCE AT AGE 9-10 YEARS: A COHORT STUDY OF MEXICO CITY CHILDREN. Esha Bansal1, Hsiao-Hsien Leon Hsu2, Erik de Water2, Martha Tellez Rojo3, Robert Wright2. 1Medical Education, 2,3Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Mexican National Institute of Perinatology.

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THE IMPACT OF SMOKING ON THE ASSOCIATION OF PHTHALATE EXPOSURE AND THYROID HORMONES IN US ADULTS. Joshua Barlow1, Mathilda Alsen2, Christine Little1, Maaike van Gerwen2.

1 Medical Education, 2Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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A COMPARISON OF THE ELIXHAUSER AND CHARLSON COMORBIDITY INDICES: PREDICTING IN-HOSPITAL COMPLICATIONS FOLLOWING ANTERIOR LUMBAR INTERBODY FUSIONS. Rebecca Baron1 , Sean Neifert2, William Ranson3, Alexander Schupper2, Jonathan Gal4, Samuel Cho5, John Caridi2. 1Medical Education, 2Neurosurgery, 3,5Orthopaedics, 4 Anesthesiology. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

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PROCESS MAPPING OF PATIENT FLOW THROUGH PACU. Anastasia Beldovskaya1, Mo Shirur2, Anthony Tanella2. 1Medical Education, 2 Anesthesiology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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LIST OF ABSTRACTS

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PLASTIC SURGERY RESIDENCY PROGRAMS: A REVIEW OF THE NATIONAL RESIDENT MATCHING PROGRAM SINCE THE PLASTIC SURGERY WORKFORCE TASK FORCE, 2008-2020.

Christopher Bellaire1, Farah Sayegh2, John Rutland2, Peter Taub2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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SECONDARY INVASIVE BREAST EVENTS (SIBE) AMONG PATIENTS WITH HIGH RISK ONCOTYPE DX RECURRENCE SCORES (RS) 26-30 AND > 31: RESULTS FROM A LARGE ONCOTYPE DATABASE. Natalie Berger1, Brittney Zimmerman2, Serena Tharakan1, Kelly Suchman1, Krystal Cascetta2, Julia Blanter3, Erin Moshier4, Meng Ru4, Shabnam Jaffer5, Amy Tiersten2.

1 Medical Education, 2Oncological Sciences, 3Medicine, 4Institute for Health Care Delivery Science, 5Pathology. 1,2,3,4,5Icahn School of Medicine at Mount Sinai, New York, New York.

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ASSESSING FORMER U.S. IMMIGRATION JUDGES’ PERSPECTIVES: BEST PRACTICES IN TELEPHONIC MENTAL HEALTH EVALUATIONS. Beselot Birhanu1, Stephanie Wu1, Aliza Green1, Samuel “Gus” Ruchman1, Elizabeth Singer2, Kim Baranowski3, Craig Katz3. 1Medical Education, 2 Emergency Medicine, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

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PANDEMIC PREPAREDNESS FOR DOCTORS IN TRAINING: BEYOND THE BIOMEDICAL APPROACH AND INTEGRATING HUMANITIES EDUCATION FOR FUTURE PHYSICIANS. Benjamin Chi1, Jacob Appel2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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SMALL CHANGES IN ADHERENCE TO HIV ANTIRETROVIRAL THERAPY IMPACTS VIRAL SUPPRESSION AMONG A COHORT OF PERINATALLY INFECTED CHILDREN IN WESTERN KENYA. Samuel Chiacchia1, Ashley Chory2, Michael Scanlon3, Allison DeLong4, J Aluoch5, A Ngeresa5, J Hogan5, A Manne5, F Sang5, C Ashimosi5, E Jepkemboi5, M Orido5, V Novinsky5, S Ayaya5, R Kantor4, Rachel Vreeman2. 1Medical Education, 5Pediatrics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3University of Indiana, 4Brown University, 5AMPATH.

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LIST OF ABSTRACTS

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CLINICAL AND TREATMENT CHARACTERISTICS OF SECONDARY BLADDER MALIGNANCIES FOLLOWING LOW DOSE RATE BRACHY THERAPY FOR PROSTATE CANCER. Chih Peng Chin1, William Smith2, Richard Stock2, Michael Buckstein3.

1 Medical Education, 2Radiation Oncology, 3Radiology.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

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CLIMATE CHANGE CURRICULUM INFUSION PROJECT 2020.

Lindsay Clark1, Sophia Karwoska Kligler1, Perry Sheffield2. 1Medical Education, 2 Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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EVALUATION OF CURRENT NEONATAL PAIN SCALES AS A MEASURE OF NICU STRESS. Elizabeth Clifton1, Emily Spear2, Annemarie Stroustrup3. 1Medical Education, 2,3 Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 Northwell Health New York, New York.

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EXAMINING THE IMPACT OF COVID-19 ON MEDICATION ADHERENCE AND ACCESS TO HIV CARE FOR ADOLESCENTS LIVING WITH HIV IN NEW YORK CITY. Ariella Cohen1, Ashley Chory2, Roxanne Martin2, Jocelyn Childs3, Rachel Waldman1, Samuel Chiacchia1, Grant Callen4, Rachel Vreeman2, Roberto Posada2.

1 Medical Education. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 Mount Sinai Hospital New York, NY, 4Indiana University Indianapolis, IN.

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REDEFINING MEDICAL STUDENT RESEARCH OPPORTUNITIES IN THE COVID-19 ERA. Ella Cohen1, Laura Stein2. 1Medical Education, 2Neurology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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LIST OF ABSTRACTS

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STIMULATING DEGENERATIVE INTERVERTEBRAL DISC (IVD) ENVIRONMENT IN VITRO TO INVESTIGATE THE THERAPEUTIC POTENTIAL OF MSC-DERIVED EXTRACELLULAR VESICLES. George Danias1, Tyler DiStefano2, James Iatridis2. 1Medical Education, 2 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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THE APPLICATION OF DATA ANALYTICS TO INFER THE NEED FOR HEALTHCARE FACILITIES IN LOW-INCOME COUNTRIES. Jared Dashevsky1, Ebrahim Elahi2. 1Medical Education, 2Ophthalmology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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DISPARITIES IN END-OF-LIFE INPATIENT CARE RECEIVED

BY METASTATIC CANCER PATIENTS BETWEEN 2010 - 2017.

Stephanie Deeb1, Pinaki Dutta2, C. Jillian Tsai3. 1Medical Education, 2,3Radiation Oncology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 Memorial Sloan Kettering Cancer Center, NY, NY.

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SCREENING FOR UNMET SOCIAL NEEDS DURING THE COVID-19 PANDEMIC. John Denton1, Leora Mogilner2, Jennifer Acevedo3, Lauren Zajac2.

1 Medical Education, 2Pediatrics, 3Pediatric Environmental Health.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

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SOCIAL VULNERABILITY AND THE CORONAVIRUS IMPACT ON BIRTH EQUITY (VIBE) STUDY. Jennifer Dias1, Katharine McCarthy2, Stephanie Wu1, Sarah Nowlin2, Teresa Janevic3, Elizabeth Howell4, Joanne Stone3, Veerle Bergink3, Sheela Maru3. 1Medical Education, 2 Population Health Science and Policy, 3,4Obstetrics, Gynecology, and Reproductive Science. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York, 4Perelman School of Medicine, University of Pennsylvania.

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LIST OF ABSTRACTS

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POTENTIAL OF RENAL REPLACEMENT TECHNOLOGY TO REDUCE INCIDENCE OF KIDNEY CANCER IN TRANSPLANT PATIENTS: A REVIEW OF THE CURRENT LITERATURE. Calista Dominy1, Kennedy Okhawere2, Talia Korn2, Kirolos Meilika2, Ketan Badani2.

1 Medical Education, 2Urology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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PSYCHOLOGICAL IMPACT OF THE COVID-19 PANDEMIC ON FRONTLINE HEALTH CARE WORKERS DURING THE PANDEMIC SURGE IN NEW YORK CITY. Jordyn Feingold1, Lauren Peccoralo2, Chi Chan3, Carly Kaplan1, Halley Kaye-Kauderer1, Dennis Charney3, Jaclyn Verity2, Alicia Hurtado3, Larissa Burka4, Shumayl Syed1, James Murrough3, Adriana Feder3, Robert Pietrzak3, Jonathan Ripp2. 1Medical Education, 2 Medicine, 3Psychiatry, 4Nursing. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

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SNAPSHOT OF EMERGENCY DEPARTMENT VOLUMES IN THE “EPICENTER OF THE EPICENTER” OF THE COVID-19 PANDEMIC. Nicola Feldman1, Rikki Lane2, Laura Iavicoli2, Veronica Delgado2, Phillip Fairweather2, Stuart Kessler2, Suzanne Bentley2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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NON-INVASIVE VENTILATION VERSUS MECHANICAL VENTILATION IN HYPOXEMIC PATIENTS WITH COVID-19.

Iain Forrest1, Suraj Jaladanki1, Ishan Paranjpe1, Benjamin Glicksberg2, Girish Nadkarni3, Ron Do2. 1Medical Education, 2Genetics and Genomic Sciences, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

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THE IMPACT OF STAY-AT-HOME MEASURES FOR COVID-19 ON COMMON AND NOVEL ASTHMA TRIGGERS. Xanthe Gallate1, Lauren Zajac2, Gregory Gu3, Cordelia Elaiho2, Bian Liu4, Karen Wilson5.

1 Medical Education, 2,5Pediatrics, 3Other, 4Population Health Science and Policy.

1,5 Icahn School of Medicine at Mount Sinai, New York, New York, 2,4Mount Sinai Hospital, 3 Columbia Post-baccalaureate Program, New York, New York.

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LIST OF ABSTRACTS

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THE INCIDENCE AND RISK FACTORS FOR PSEUDOSUBLUXATION FOLLOWING PROXIMAL HUMERAL FRACTURE. Michael Gao, Carl Cirino2. 1Medical Education. 2Orthopaedics.

1 Icahn School of Medicine at Mount Sinai, New York, New York.

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CLINICAL FEATURES OF PAROSMIA ASSOCIATED WITH SARS-COV-2 INFECTION. Katherine Garvey1, David Lerner2, Annie Arrighi-Allisan1, Andrey Filimonov2, Peter Filip2, Janki Shah2, Benjamin Tweel2, Patrick Colley2, Madeleine Schaberg2, Anthony Del Signore2, Satish Govindaraj2, Alfred-Marc Iloreta2. 1Medical Education, 2 Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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NATURAL HISTORY OF OLFACTORY DYSFUNCTION ASSOCIATED WITH SARS-COV-2 INFECTION. Katherine Garvey1, Annie Arrighi-Allisan1, David Lerner2, Peter Filip2, Satish Govindaraj2, Alfred-Marc Iloreta2. 1Medical Education, 2Otolaryngology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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CONVERSION OF LUMBAR SPINE CT SCANS TO MRI USING MACHINE LEARNING. Eric Geng1, Brian Cho2, Varun Arvind2, Lathan Liou3, Jun Kim2, Samuel Cho2.

1 Medical Education, 2,3Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York. 3Did research at Sinai, deferred MS1.

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NUTRITIONAL COMPARISON OF MILK ALLERGIC AND NON-FOOD ALLERGIC CHILDREN. Kyle Gibson1, Stephanie Stanley2, Shrada Agarwal2, Marion Groetch2, Supinda Bunyavanich3. 1Medical Education, 3Pediatrics.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

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LIST OF ABSTRACTS

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ANALYSIS OF NATIONAL DATA ON LAPAROSCOPIC VS OPEN SURGERY FOR CN0 M0 SMALL INTESTINE NEUROENDOCRINE TUMORS. Shivee Gilja1, Celia Divino2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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DIAGNOSING LATERAL PLICA SYNDROME OF THE ELBOW VIA MAGNETIC RESONANCE IMAGING. Matthew Gluck1, Amanda Walsh2, Christopher Bellaire1, Zachary Bernstein2, Michael Hausman2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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THORACIC ENDOGRAFT PLACEMENT IN WOMEN: A RETROSPECTIVE COHORT ANALYSIS. Cody Goldberger1, Nicole Ilonzo2, Rami Tadros2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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E-CONSULTATION AMONG CLINICIANS DURING THE COVID-19 PANDEMIC: A RETROSPECTIVE OBSERVATIONAL STUDY. Gary Gravesandy1, Anna Potapov2. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2RubiconMD, New York, NY.

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PATTERNS OF SOCIAL SERVICES USAGE DURING THE SPRING 2020 COVID PANDEMIC BY SURVIVORS OF TORTURE AND OTHER SERIOUS HUMAN RIGHTS ABUSES AT THE LIBERTAS CENTER FOR HUMAN RIGHTS. Jacques Guyot1, Ayushi Chandramani2, Dinali Fernando2, Ben McVane2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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LIST OF ABSTRACTS

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WE’VE ENTERED AN UNPRECEDENTED MARKET FOR AGING IN PLACE. Kaitlin Hanss1, Megan Zweig2, Chipper Stotz2. 1Medical Education, 2 Rock Health.

1 Icahn School of Medicine at Mount Sinai, New York, New York, 2San Francisco, CA.

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IMPROVING POSTPARTUM CARE: IDENTIFYING OPPORTUNITIES TO REDUCE POSTPARTUM EMERGENCY ROOM VISITS AMONG PUBLICLY-INSURED WOMEN OF COLOR. Taylor Harrell1, Ksenia Gorbenko2, Amy Balbierz2, Luz Guel3, Juan Pena4, Teresa Janevic4, Elizabeth Howell4. 1Medical Education, 2Population Health Science and Policy, 3Environmental Medicine & Public Health, 4Obstetrics, Gynecology, and Reproductive Science. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

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ASSESSING ANXIETY IN CANCER PATIENTS DURING COVID-19 IN NEW YORK. Gabrielle Hernaiz-De Jesus1, Beselot Birhanu1, Molly Lieber2, Annmarie Beddoe3.

1 Medical Education, 3Oncological Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

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ANTI-COLONIALISM IN GLOBAL HEALTH GRANT APPLICATIONS: A SINGLE-SITE, PARTICIPANT-OBSERVATION-BASED ASSESSMENT. Terence Hughes1, Bibhav Acharya2, Nandini Choudhury3, Biraj Karmacharya4, Kim Lipman-White3, Pranil Pradhan4, Anant Raut3, Pragya Rimal5, Sabitri Sapkota3, Aradhana Thapa5, Karen Wilson6, Duncan Maru3. 1Medical Education, 3Global Health, 2 Psychiatry, 6Pediatrics. 1,3,6Icahn School of Medicine at Mount Sinai, New York, New York, 2University of California San Francisco, San Francisco, CA, 4Kathmandu University, Dhulikhel 45200, Nepal, 5Possible Health, New York, NY.

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COMMUNITY PERSPECTIVES ON THE MANIFESTATIONS OF CARDIOVASCULAR DISEASE IN RURAL GHANA: A QUALITATIVE STUDY. Isla Hutchinson Maddox1, Bhavana Patil1, Raymond Aborigo2, Khadija Jones3, Denis Awuni2, Allison Squires4, Abraham Oduro2, Carol Horowitz5, David Heller3.

1 Medical Education, 3Global Health, 5Population Health Science and Policy.

1,3,5 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Navrongo Health Research Center, 4New York University, New York, New York.

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LIST OF ABSTRACTS

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MARJOLIN’S ULCERS VS SQUAMOUS CELL CARCINOMA: A CUMULATIVE RETROSPECTIVE. Sidra Ibad1, Clay Cockerell2. 1Medical Education, 2Dermatology.

1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Cockerell Dermatopathology 2110 Research Row #100 Dallas, TX 75235.

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FACTORS ASSOCIATED WITH MALNUTRITION IN CHILDREN WITH EOSINOPHILIC GASTROINTESTINAL DISEASES. Tyler Italiano1, Talaya McCright-Gill2, Lauren Solinsky2, George Konstantinou3, Mirna Chehade2. 1Medical Education. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3424 General Military Training Hospital Thessaloníki, Greece.

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EFFECT OF CARCINOID TUMOR SURGICAL RESECTION ON PATIENT QUALITY OF LIFE: A PROSPECTIVE ANALYSIS. James Johnson1, Laura Olson2, Venu Bangla2, Celia Divino2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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BARRIERS TO TELEHEALTH ACCESS IN A POPULATION OF VULNERABLE HOMEBOUND ADULTS. Alexander Kalicki1, Peter Gliatto2, Katherine Ornstein2. 1Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

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PSYCHOLOGICAL CONSEQUENCES AMONG RESIDENTS AND FELLOWS DURING THE COVID-19 PANDEMIC IN NEW YORK CITY: IMPLICATIONS FOR TARGETED INTERVENTIONS. Carly Kaplan1, Chi Chan2, Jordyn Feingold1, Halley Kaye-Kauderer1, Robert Pietrzak3, Lauren Peccoralo1, Adriana Feder2, Steven Southwick3, Dennis Charney2, Larissa Burka4, Madeleine Basist5, Jonathan Ripp6, Saadia Akhtar7.

1 Medical Education, 2,3Psychiatry, 5Medicine, 6Geriatrics and Palliative Medicine, 7 Emergency Medicine. 1,2,4,5,6,7Icahn School of Medicine at Mount Sinai, New York, New York, 3Yale School of Medicine, New Haven, Connecticut.

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LIST OF ABSTRACTS

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RACE AND INSURANCE STATUS OUTCOME DISPARITIES FOLLOWING SPLENECTOMY IN TRAUMA PATIENTS ARE SMALLER IN HIGH-VOLUME HOSPITALS. Harrison Kaplan1, Michael Leitman2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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PATIENT CHARACTERISTICS ASSOCIATED WITH RETENTION IN AN ASTHMA SELF-MANAGEMENT TRIAL FOR OLDER ADULTS. Dustin Kee1, Alex Federman2. 1Medical Education, 2Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

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A STUDY OF THE EVOLUTION OF THE TECHNIQUE FOR PITUITARY TUMOR RESECTION: A SINGLE INSTITUTION STUDY. Rebecca Kellner1, Aisosa Omorogbe2, David Lerner3, Alfred-Marc Iloreta3.

1 Medical Education, 2,3Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Mount Sinai.

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LONG TERM OUTCOMES AFTER INITIAL CARDIAC SURGERY IN PATIENTS WITH MARFAN SYNDROME PRESENTING WITH THORACIC AORTIC DISSECTION. Spencer Kiehm1, Timothy Lee2, Natalia Egorova3, Shinobu Itagaki2.

1 Medical Education, 2Cardiovascular Surgery, 3Population Health Science and Policy.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

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KAHOOK DUAL BLADE VERSUS TRABECTOME (KVT): COMPARING OUTCOMES IN COMBINATION WITH CATARACT SURGERY. Eliott Kim1, Gregory Fliney2, Miriam Sarwana3, Sze Wong4, Tak Yee Tania Tai4, Ji Liu2, Soshian Sarrafpour2, Chris Teng2, Nisha Chadha4. 1Medical Education, 2,4Ophthalmology.

1,4 Icahn School of Medicine at Mount Sinai, New York, New York, 2,3Yale School of Medicine, New Haven, CT.

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LIST OF ABSTRACTS

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RNASEQ REVEALS INCREASES IN ATHEROSCLEROSIS-RELATED MARKERS AND IMMUNE AND BARRIER DIFFERENCES IN COMMON ICHTHYOSIS VARIANTS. Madeline Kim1, Daniela Mikhaylov1, Mary Sun1, Kunal Malik2, Helen He2, Yael RenertYuval3, Ana Pavel4, Amy Paller5, Emma Guttman-Yassky2. 1Medical Education, 2,3,5 Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 Rockefeller University, New York, NY, 4University of Mississippi, University, MS, 5 Northwestern University Feinberg School of Medicine, Chicago, IL.

57

NON-INVASIVE APPROACH TO THE PREDICTION OF SEVERITY DEGREE AND SURVIVAL IN COVID-19 USING A COMBINATION OF SEMIQUANTITATIVEQUANTITATIVE CT FINDINGS AND PLASMA CYTOKINE ASSESSMENT. Emma Klein1, Guillermo Carbonell2, Brett Marinelli2, Diane Del Valle3, Maria El-Homsi2, Daniel Stocker4, Michael Chung2, Adam Bernheim2, Miriam Merad5, Sara Lewis2, Sacha Gnjatic5, Bachir Taouli2. 1Medical Education, 2Diagnostic, Molecular and Interventional Radiology, 3Precision Immunology Institute, 4Biomedical Engineering and Imaging Institute, 5Tisch Cancer Institute, 1,2,3,4,5Icahn School of Medicine at Mount Sinai New York, New York.

58

MAKING THE CASE FOR PARKS AS A CRITICAL PART OF PUBLIC HEALTH PREPAREDNESS IN THE AGE OF COVID-19.

Niathi Kona1, Kathleen McGovern2, Andrea Deierlein3, Susan Teitelbaum2, Mary Wolff2, Maida Galvez2. 1Medical Education, 2,3Environmental Medicine & Public Health. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 New York University School of Global Public Health, New York, NY.

59

THE CULTIVATION OF INTERGENERATIONAL RELATIONSHIPS THROUGH A VIRTUAL PLATFORM AS A TOOL TO DECONSTRUCT AGEIST ATTITUDES AMONG PRE-CLINICAL MEDICAL STUDENTS IN THE ERA OF THE COVID-19 PANDEMIC. Krsna Kothari1, Cecily McIntyre1, Dayle LaPolla1, Noelle-Marie Javier2.

1 Medical Education, 2Geriatrics and Palliative Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

60

PHENOTYPIC HETEROGENEITY OF TRAUMA-RELATED PSYCHOPATHOLOGY AND SOCIAL COGNITION IN WORLD TRADE CENTER RESPONDERS. Dayle LaPolla1, Elisa Monti2, Agnes Norbury2, Robert Pietrzak3, Mercedes Perez-Rodriguez2, Adriana Feder2. 1Medical Education, 2,3 Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 Yale School of Medicine.

19

LIST OF ABSTRACTS

61

EVALUATION OF ADHERENCE TO THE CASCADE OF CARE FOR ABNORMAL LIVER TEST MANAGEMENT DURING PREGNANCY. Jessica Lee1, Emma Rosenbluth1, Shaelyn O’hara2, Ruhee Shah1, Rhoda Sperling3, Tatyana Kushner2. 1Medical Education, 2Medicine, 3Obstetrics, Gynecology, and Reproductive Science. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

62

ELICITING AGE INDICATIONS FOR PEDIATRIC DEVICES FROM FDA APPROVAL STATEMENTS. Samuel Lee1, Benjamin Glicksberg2. 1Medical Education, 2Genetics and Genomic Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

63

TELEMEDICINE IN ORTHOPEDICS: A SCOPING REVIEW. Riva Letchinger1, Meredith Mihalopoulos2, Beselot Birhanu2, lily martin3, Jashvant Poeran2. 1Medical Education, 2Orthopaedics, 3Academic Informatics and Technology.1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

64

MD++ A COMMUNITY OF ASPIRING PHYSICIAN-INNOVATORS. Sherman Leung, 2Brenton Fargnoli. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2AlleyCorp, New York, New York.

65

THE IMPACT OF SOCIOECONOMIC STATUS ON THE CLINICAL OUTCOMES OF COVID-19; A RETROSPECTIVE COHORT STUDY. Christine Little1, Maaike van Gerwen2. 1Medical Education, 2Otolaryngology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

20

LIST OF ABSTRACTS

66

PRE-OPERATIVE BIOMARKERS AND MORTALITY RISK AFTER CARDIAC SURGERY. Caroline Liu1, Steven Menez2, Dennis G. Moledina3, Amit Garg4, Heather ThiessenPhilbrook2, Eric McArthur5, Yaqi Jia2, Wassim Obeid2, Sherry G. Mansour3, Chirag R. Parikh2, Steven Coca6. 1Medical Education, 6Medicine. 1,6Icahn School of Medicine at Mount Sinai, New York, New York, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3Yale School of Medicine, New Haven, CT, 4Institute for Clinical Evaluative Sciences, Ontario, Canada, 5Institute for Clinical Evaluative Sciences, Ontario, Canada.

67

THE PENETRANCE OF LONG QT SYNDROME (LQTS) IN PATIENTS WITH DELETERIOUS LQTS VARIANTS. Madeline Lui1, Nihir Patel2, Arden Moscati2, Mariya Shadrina2, Michael Gollob3, Bruce Gelb4, Amy Kontorovich5. 1Medical Education, 2Genetics and Genomic Sciences, 4,5 Medicine. 1,2,4,5Icahn School of Medicine at Mount Sinai, New York, New York, 3University of Toronto, Toronto, ON, Canada.

68

IMPACTFUL LIFE EVENTS, RESILIENCE PROMOTING BEHAVIORS, AND RESILIENCE IN AMERICAN MEDICAL STUDENTS. Cynthia Luo1, Gabriel Santos Malave1, Robert Yanagisawa2, Craig Katz3. 1Medical Education, 2Endocrinology, 3Psychiatry.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

69

BODY MASS INDEX CORRELATES WITH SKIN TO SPINAL CANAL DISTANCE: A LARGE RETROSPECTIVE SINGLE-CENTER STUDY. Kevin Mahmoudi1, Young Joon (Fred) Kwon1, Yoni Goldstein1, Shingo Kihira2, Katherine Garvey1, Samantha Platt1, Puneet Belani2, Thomas Naidich2, Anthony Costa3, Amish Doshi2. 1Medical Education, 2Radiology, 3Neurosurgery. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

70

GEOSPATIAL DISPARITIES IN ACCESS TO PROTON THERAPY IN THE CONTINENTAL UNITED STATES. Luke Maillie1, Matthew Sisk2, Charles Simone II3, Stanislav Lazarev4.

1 Medical Education, 3,4Radiation Oncology. 1,4Icahn School of Medicine at Mount Sinai, New York, New York, 2University of Notre Dame Notre Dame, IN, 3 Memorial Sloan Kettering NY, NY.

21

LIST OF ABSTRACTS

71

RESPONSIVE NEUROSTIMULATION IN PEDIATRIC DRUG-RESISTANT EPILEPSY. Naoum Fares Marayati1, Maite La Vega-Massello2, Fedor Panov3, Saadi Ghatan3, Peter Morgenstern3. 1Medical Education, 2Neurology, 3Neurosurgery.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

72

USE OF A RADIOPAQUE EMBOLIC FOR TRANSARTERIAL CHEMOEMBOLIZATION FOLLOWED BY MICROWAVE ABLATION FOR HEPATOCELLULAR CARCINOMA. Christina Marshall1, Alex Sher2, Vivian Bishay2, Mona Ranade2, Scott Nowakowski2, Rahul Patel2, Edward Kim2, Robert Lookstein2, Aaron Fischman2. 1Medical Education, 2 Radiology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

73

TIME TO TREATMENT OF LARGE VESSEL OCCLUSION PATIENTS WITH NON-MOTOR SYMPTOMS AT AN URBAN, COMPREHENSIVE STROKE CENTER. Naomi Mayman1, John Erdman1, Parul Agarwal2, Laura Stein3. 1Medical Education, 2 Population Health Science and Policy, 3Neurology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

74

KEY ATTRIBUTES OF UNDOMICILED PATIENT ENCOUNTERS AT FOUR MOUNT SINAI HOSPITALS. Jesse McChane1, Andrew Coyle2. 1Medical Education, 2Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

75

IMPACT OF COVID-19 ON THE RATE OF FALLS IN ONE COMMUNITY OF HIGH-RISK, COMMUNITY-DWELLING OLDER ADULTS. Cecily McIntyre1, Laura Prichett2, Matthew McNabney3. 1Medical Education, 3Geriatrics and Palliative Medicine. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2 Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3Johns Hopkins University, Baltimore, MD.

22

LIST OF ABSTRACTS

76

CONTROL OF MESENCHYMAL CELL FATE VIA APPLICATION OF FGF-8B IN VITRO. Paulos Mengsteab1, Takayoshi Otsuka2, Cato Laurencin2.

1 Medical Education, 2Orthopaedics. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2University of Connecticut.

77

GENIPIN-CROSSLINKED FIBRIN SEEDED WITH OXIDIZED ALGINATE MICROBEADS FOR INTERVERTEBRAL DISC CELL DELIVERY. James Meyers1, Christopher Panebianco2, James Iatridis2. 1Medical Education, 2 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

78

REPORTING OF READMISSIONS AFTER TOTAL JOINT ARTHROPLASTY: EXPERIENCE AND LESSONS LEARNED FROM A LARGE HEALTH SYSTEM. Meredith Mihalopoulos1, Jashvant Poeran2, Josiah Mueller2, Ken McCardle2, Leesa Galatz2, Michael Bronson2, Darwin Chen2, Calin Moucha2. 1Medical Education, 2 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

79

RISK REDUCTION STRATEGIES IN PATIENTS AT INCREASED RISK OF BREAST AND OVARIAN CANCER. Ariana Mills1, Hank Schmidt2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

80

IMPACT OF DEVICE ACCESSIBILITY & EXPANDED INTERNET ACCESS ON TELEHEALTH UTILIZATION AMONG AN URBAN HOMEBOUND POPULATION. Kate Moody1, Alexander Kalicki1, Peter Gliatto2, Katherine Ornstein2.

1 Medical Education, 2Geriatrics and Palliative Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

23

LIST OF ABSTRACTS

81

IMAGINING A “GOTHIC DISABILITY”: LITERARY GENRE, POLITICAL THEORY, AND LIVING DISABLED IN RIVA LEHRER’S PORTRAITURE. Olivia Moscicki1, Jacob Appel2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

82

HOW IMMUNE-RELATED GENES AFFECT SEVERITY OF BLADDER CANCER IN DIFFERENT DEMOGRAPHIC GROUPS. Sarah Nathaniel1, John Sfakianos2. 1Medical Education, 2Urology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

83

DOES RACE IMPACT THE INCIDENCE OF POSTPARTUM HEMORRHAGE IN PATIENTS UNDERGOING VBAC. Tonia Ogundipe1, Ayisha Buckley2, Luciana Vieria2. 1Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

84

RACIAL DISPARITIES IN CARE AND OUTCOMES AFTER TOTAL HIP AND KNEE ARTHROPLASTIES: DID THE COMPREHENSIVE CARE FOR JOINT REPLACEMENT PROGRAM MAKE A DIFFERENCE? Jeffrey Okewunmi1, Meredith Mihalopoulos2, Vivien Huang3, Calin Moucha2, Jashvant Poeran2. 1Medical Education, 2Orthopaedics, 3Population Health Science and Policy.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

85

POSTPARTUM DEPRESSION AND ATOPY-RELATED OUTCOMES IN THE CHILD. Paloma Orozco Scott1, Hsiao-Hsien Leon Hsu2, Maria José Rosa2.

1 Medical Education, 2Population Health Science and Policy.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

24

LIST OF ABSTRACTS

86

THE IMPACT OF SUPPLEMENTARY NUTRITION EDUCATION ON ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI (ISMMS) MEDICAL STUDENTS. Ye Park1, Beverly Forsyth1. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

87

RURAL GHANAIAN COMMUNITY IMPRESSIONS OF NURSE-LED CARDIOVASCULAR DISEASE CARE. Bhavana Patil1, Isla Hutchinson Maddox1, Raymond Aborigo2, Khadija Jones3, Denis Awuni2, Allison Squires4, Abraham Oduro2, Carol Horowitz3, David Heller3.

1 Medical Education, 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2 Navrongo Health Research Centre, Navrongo, Ghana, 4New York University, New York, NY.

88

ASSESSMENT OF THE RELATIONSHIP BETWEEN CHILDHOOD OBESITY AND SURGICAL OUTCOMES. Megan Paul1, Brian Coakley2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

89

COMPARING SIRS ALERTS FREQUENCY BETWEEN POSTOPERATIVE SURGERY VS. MEDICAL PATIENTS PLACED ON SEPSIS PATHWAY. Jonah Poster1, Matthew Peacock2, Venu Bangla2, Celia Divino2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

90

ELECTIVE FETAL REDUCTION IN MONOCHORIONIC DIAMNIOTIC (MCDA) TWINS DECREASES ADVERSE OUTCOMES COMPARED TO ONGOING MCDA TWINS. Geeta Rao1, Luciana Vieria2, Elianna Kaplowitz3, Jessica Overbey3, Shaelyn O’hara2, Keisha Paul2, Robert Lookstein2, Andrei Rebarber2, Nathan Fox2, Joanne Stone2.

1 Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3 Population Health Science and Policy. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

25

LIST OF ABSTRACTS

91

ASSESSING THE IMPACT OF THE COVID-19 PANDEMIC ON POSTPARTUM CONTRACEPTION UPTAKE. Paige Rattner1, Chelsea Debolt2, Lorraine Toner2, Sharon Gerber2, Luciana Vieria2.

1 Medical Education, 2Obstetrics, Gynecology, and Reproductive Science.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

92

ANALYSIS OF PERIOPERATIVE OUTCOMES IN OPEN VERSUS MINIMALLY INVASIVE DONOR NEPHRECTOMY. Krishna Ravivarapu1, Nir Tomer1, Alexander Small2, Michael Palese2. 1Medical Education, 2Urology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

93

CUSTOMIZED ENRICHMENT ANALYSIS INVESTIGATING THE ROLES OF HHV6A AND HHV7 TRANSCRIPTOMICS IN ALZHEIMER’S DISEASE. Shoshana Rosenzweig1, Mesude Bicak2, Benjamin Glicksberg3. 1Medical Education, 3 Genetics and Genomic Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

94

A MULTIOMIC APPROACH TO THE DISCOVERY OF BIOMARKERS FOR INTRACRANIAL ANEURYSMS. Christina Rossitto1, Carina Seah1, Dominic Nistal2, Kurt Yaeger2, J Mocco2, Christopher Kellner2. 1Medical Education, 2Neurosurgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

95

VIRTUAL RESTORATIVE HEALTH CIRCLES (RHCS) AS A MEANS OF FACILITATING HEALING AND GROUP REFLECTION WITHIN A COMMUNITY. Nikita Roy1, Ann-Gel Palermo1 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

26

LIST OF ABSTRACTS

96

ULTRA-HIGH-RESOLUTION STRUCTURAL MRI OF AMYGDALA SUBNUCLEI IN EPILEPSY. Mia Saade1, Gaurav Verma2, Lara Marcuse3, Madeline Fields3, Stephanie Brown4, Priti Balchandani2. 1Medical Education, 2Radiology, 3Neurology, 4Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York, 4University of Cambridge.

97

POST-TRAUMATIC GROWTH AND RESILIENCE IN ADOLESCENTS IN PUERTO RICO POST-HURRICANE MARIA. Gabriel Santos Malave1, Cynthia Luo1, Robert Yanagisawa2, Craig Katz3.

1 Medical Education, 2Medicine, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

98

PRENATAL BLOOD LEVELS AND REDUCED PREADOLESCENT GLOMERULAR FILTRATION RATE: MODIFICATION BY BODY MASS INDEX. Charles Saylor1, Marcela Tamayo Ortiz2, Ivan Pantic3, Chitra amarasiriwardena4, Nia Mcrae4, Guadalupe Estrada-Gutierrez5, Sandra Parra Hernandez6, Mari Cruz Tolentino6, Andrea Baccarelli7, Jeffrey Fadrowski8, Chris Gennings4, Lisa Satlin9, Robert Wright4, Martha Tellez Rojo2, Alison Sanders4. 1Medical Education, 8,9 Pediatrics. 1,4,9Icahn School of Medicine at Mount Sinai, New York, New York, 2 Mexican Social Security Institute, 3Mexican Social security institute, 5national institute of perinatology, 6Institute of Perinatology, 7Columbia Mailman School of Public Health, 8 Johns Hopkins, Maryland (MD).

99

ASSESSING FACTORS ASSOCIATED WITH ACCIDENTAL DURAL PUNCTURE IN LABOR AND DELIVERY ANESTHESIA. Ira Schlosberg1, Daniel Katz2. 1Medical Education, 2Anesthesiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

100

EFFECTS OF HORMONAL CONTRACEPTION ON SYMPTOMS OF PERIMENOPAUSE. Ruhee Shah1, Britt Lunde2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

27

LIST OF ABSTRACTS

101

SEASONAL VARIATION IN PRESENTATION AND TIME TO REVASCULARIZATION THERAPY FOR ACUTE ISCHEMIC STROKE. Akarsh Sharma1, Mary Rojas1, Ruben Vega Perez1, I. Singh2, Laura Stein3. 1Medical Education, 2Neurosurgery, 3Neurology.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

102

ROTATIONAL THROMBOELASTOMETRY FOR PREDICTING HEPARIN PLASMA CONCENTRATION IN PARTURIENTS: AN EXPLORATORY IN-VITRO INVESTIGATION. Da Wi Shin1, Chloe Getrajdman2, Daniel Katz2. 1Medical Education, 2 Anesthesiology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

103

NSAID USE AND CONCUSSIONS IN ADOLESCENT ATHLETES: INCIDENCE, SEVERITY, AND RECOVERY. Zachary Spiera1, Theodore Hannah2, Nickolas Dreher2, Naoum Fares Marayati2, Adam Li2, Muhammad Ali2, Dhruv Shankar2, John Durbin2, Alexander Schupper2, Alex Gometz2, Mark Lovell3, Tanvir Choudhri2. 1Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 The Lovell Health Care Institute.

104

LONG-TERM OUTCOMES OF MITRAL VALVE AND TRICUSPID VALVE REPAIR FOR DEGENERATIVE MITRAL VALVE PROLAPSE. Jason Storch1, David H. Adams2, Dimosthenis Pandis2, Shinobu Itagaki2.

1 Medical Education, 2Cardiovascular Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

105

DEVELOPMENT AND VALIDATION OF TECHNIQUES FOR PHENOTYPING STELEVATION MYOCARDIAL INFARCTION FROM ELECTRONIC HEALTH RECORDS. Shelly Teng1, Sulaiman Somani1, Stephen Yoffie1, Benjamin Glicksberg2.

1 Medical Education, 2Genetics and Genomic Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

28

LIST OF ABSTRACTS

106

MUCOSAL B CELL AND PLASMA CELL DEPLETION IS ASSOCIATED WITH INTESTINAL INFLAMMATION. Minami Tokuyama1, Divya Jha2, Alexandra Livanos3, Stephanie Rutledge3, Jean Frederic Colombel3, Saurabh Mehandru3. 1Medical Education, 2 Graduate School of Biomedical Sciences, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

107

SARS-COV-2 INFECTS ENTEROCYTES IN VIVO AND CAN PERSIST UP TO 7 MONTHS FOLLOWING SYMPTOM RESOLUTION. Minami Tokuyama1, Mark Ladinsky2, Divya Jha3, Francesca Cossarini4, Alexandra Livanos4, Jason Reidy5, Michael Tankelevich4, Gustavo Martinez-Delgado4, Pamela Bjorkman2, Saurabh Mehandru4. 1Medical Education, 3Graduate School of Biomedical Sciences, 4Medicine, 5Pathology. 1,3,4,5Icahn School of Medicine at Mount Sinai, New York, New York, 2California Institute of Technology, Pasadena, CA, USA.

108

FACTORS AFFECTING THE UTILIZATION OF ASTHMA ACTION PLANS BY PHYSICIANS DURING THE COVID-19 PANDEMIC. Kirk Tomlinson1, Czer Lim2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

109

MICROBIOLOGIC ETIOLOGY AND INFANT FACTORS ASSOCIATED WITH EARLY ONSET NEONATAL BACTEREMIA AT MOUNT SINAI HOSPITAL. Claudia Torres1, Eudys Briceno-Brito2, Andres Ramirez-Zamudio3, Lorraine Toner3, Roberto Posada2, Rhoda Sperling3. 1Medical Education, 2Pediatrics, 3Obstetrics, Gynecology, and Reproductive Science. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

110

IMPACT AND ROLE OF FLEXNER’S REPORT IN MEDICAL EDUCATION’S STRUCTURE. Ashesh Trivedi1, Darinka Gadikota-Klumpers1. 1Medical Education.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

29

LIST OF ABSTRACTS

111

THE EMPIRE STATE OF HATE: A QUANTITATIVE ANALYSIS OF RACIALLY MOTIVATED ATTACKS DIRECTED AT ASIAN AMERICAN AND PACIFIC ISLANDER (AAPI) NEW YORKERS DURING THE COVID-19 PANDEMIC. Connor Tukel1, Jacob Appel1. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

112

GENDER DIFFERENCES IN TIBIAL ARTERY INTERVENTION FOR CRITICAL LIMB ISCHEMIA (CLI): A RETROSPECTIVE STUDY USING THE VASCULAR QUALITY INITIATIVE (VQI).

Amey Vrudhula1, Windsor Ting2, Ageliki Vouyouka2, Rami Tadros2, Sung Yup Kim2, Michael Marin2, Peter Faries2, Ajit Rao2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

113

EXAMINING THE EFFECTS OF THE COVID-19 PANDEMIC ON THE MENTAL HEALTH OF ADOLESCENTS LIVING WITH HIV IN NEW YORK CITY. Rachel Waldman1, Ashley Chory2, Roxanne Martin2, Jocelyn Childs2, Samuel Chiacchia1, Ariella Cohen1, Rachel Vreeman3, Roberto Posada3. 1Medical Education, 2Arnhold Institute for Global Health, 3Pediatrics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

114

DYNAMICS OF ANAL AND CERVICAL HPV IN WOMEN WITH HIV: RELATIONSHIP TO ANAL PRECANCERS. Kevin Weiss1, Tinaye Mutetwa2, Courtney Chan2, Yuxin Liu3, Michael Gaisa2, Keith Sigel2.

1 Medical Education, 2Medicine, 3Pathology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2,3Mount Sinai Hospital, New York, New York.

115

PERSON-CENTERED CARE: EXPLORING INEQUITIES IN MATERNAL CHILD HEALTHCARE. Stephanie Wu1, Khadija Jones2, Jennifer Dias3, Andrea Archer4, Nandini Choudhury5, George Hagopian3, Sheela Maru6. 1Medical Education, 3,6Obstetrics, Gynecology, and Reproductive Science, 2,4,5,6Arnhold Institute of Global Health.

1,3 Icahn School of Medicine at Mount Sinai, New York, New York.

30

LIST OF ABSTRACTS

116

DEVELOPMENT AND VALIDATION OF TECHNIQUES FOR PHENOTYPING STELEVATION MYOCARDIAL INFARCTION FROM ELECTRONIC HEALTH RECORDS. Stephen Yoffie1, Sulaiman Somani2, Shelly Teng2, Benjamin Glicksberg3.

1 Medical Education, 3Genetics and Genomic Sciences.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

117

PATIENT AND HOSPITAL CHARACTERISTICS ASSOCIATED WITH POSTPARTUM EMERGENCY DEPARTMENT VISITS: A STATEWIDE ANALYSIS. Haley Zarrin1, Carmen Vargas-Torres2, Michelle Lin2. 1Medical Education, 2Emergency Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

118

EVALUATION OF ELAFIN AS A PROGNOSTIC BIOMARKER IN GRAFT-VERSUS-HOST DISEASE. Makda Getachew Zewde1, George Morales2, Steven Kowalyk2, Rachel Young2, Isha Gandhi2, John Levine2, James Ferrara2. 1Medical Education, 2Oncological Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

31

32

SECTION 2:

Abstracts 33

ABSTRACT 1 OUTCOMES OF BALLOON ANGIOPLASTY ALONE AND OTHER ADJUNCTIVE THERAPIES IN THE TREATMENT OF BELOW-KNEE PERIPHERAL ARTERY DISEASE. Sofia Ahsanuddin1, Christopher Hatzis2, Ajit Rao2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The use of atherectomy as an adjunctive treatment modality to treat peripheral artery disease has grown disproportionately in comparison to other procedures in the outpatient setting. Thus, despite its ubiquitous use, there is limited data on the risks and benefits of atherectomy use, including amputation rates, distal embolization rates, and the need for thrombolysis and thrombectomy.

RESEARCH QUESTION: We hypothesized that atherectomy use would improve revascularization of below-knee PAD with potentially higher risk of complications.

METHODS: We queried the Vascular Quality Initiative database for endovascular interventions, comorbidity data, and smoking status. We performed univariate and multivariate analyses using SPSS (n=31,603).

The exposure is treatment type: 1) Balloon Angioplasty, 2) Stenting, 3) Atherectomy with Angioplasty, 4) Atherectomy with Stenting. The outcomes included were 1) current ipsilateral amputation, 2) occlusion length, 3) treatment length, 4) embolization, and 5) thrombolysis and thrombectomy.

RESULTS: In diabetic patients, atherectomy with angioplasty was the preferred treatment modality (75.5%, p=0.013) compared to balloon angioplasty (73.9%), stenting (68.4%, p<0.001), and atherectomy with stenting (68.3%, p<0.001). In patients with a prior ipsilateral amputation, balloon angioplasty was the preferred modality (21.8%) compared to stenting (16.9%, p<0.001), atherectomy with angioplasty (19.3%, p<0.001), and atherectomy with stenting (16.1%, p<0.001). All three groups had lower rates of current ipsilateral amputation rates than balloon angioplasty. Additionally, when accounting for multivariate analysis, there was no significant increased risk of unplanned amputation with atherectomy use. Placement of an embolic protection device was significantly more common with procedures utilizing atherectomy (7.7% and 6.5%, p<0.001) compared to balloon angioplasty alone (0.53%).

CONCLUSIONS: Atherectomy use is associated with lower risk of concurrent ipsilateral amputation compared to balloon angioplasty. There is no significantly increased risk of unplanned amputation with atherectomy use compared to balloon angioplasty. The rates of EPD placement is significantly higher in atherectomy groups, but still overall low usage (<10%).

34

ABSTRACT 2 OUTCOMES AFTER DRAF IIB WITH SUPERIOR SEPTECTOMY: A RETROSPECTIVE CHART REVIEW. Eric Alerte1, Todd Spock2, Alfred-Marc Iloreta2. 1Medical Education, 2Otolaryngology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Endoscopic sinus surgery (ESS) is an important treatment in patients who suffer from chronic rhinosinusitis. Surgical approaches to the frontal sinus (Draf I, IIa, IIb, and III) are of particular interest given their difficulty of dissection and propensity for disease recurrence. Historically, Draf III was the mainstay of treatment for patients with extensive disease. However, recent studies suggest that a Draf IIb with an additional superior septectomy (SS) may be a compelling alternative. It can reduce risk of undertreating frontal sinus disease compared to the Draf IIb and may decrease recovery time and scarring risk compared to the Draf III. Data comparing patient outcomes of Draf IIb with SS to its alternatives is limited.

RESEARCH QUESTION: Is the Draf IIb with SS a reasonable alternative when comparing patient outcomes to those of the Draf IIa, IIb, and III? METHODS: A retrospective review was performed on patients who underwent ESS within the Mount Sinai Health System between 2010 and 2020 (n=129). Of these, 15, 49, 15 and 50 underwent Draf IIa, Draf IIb, Draf IIb with SS, and Draf III, respectively. Demographics, sinonasal comorbidities, and pre- and post-op SNOT22 symptom questionnaire scores were collected. Multivariable linear models with post-op scores as the outcome were built in order to assess the role of surgery type controlling for relevant covariates.

RESULTS: Univariate analysis of post-op SNOT-22 scores indicated surgery type, age, sex, nasal polyposis, asthma and aspirin sensitivity had no significant association, whereas pre-op SNOT-22 score and World Trade Center (WTC) exposure did (p<0.001 and p=0.002). When controlling for pre-op SNOT 22 score and WTC exposure, surgery type remained an insignificant predictor of post-op SNOT22 score (p=0.6). Similar results were found in post-op olfaction scores, controlling for pre-op olfaction scores and sex (p=0.2).

CONCLUSIONS: Surgery type is not a significant predictor of post-op SNOT-22 or olfaction scores when the extent of surgery is tailored to severity of patient disease. We found that patients who undergo the Draf IIb with SS have similar post-operative outcomes to patients undergoing Draf IIb or Draf III. Thus, the procedure may be a useful alternative in patients with extensive disease.

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ABSTRACT 3 INCIDENCE OF CONCUSSION AND RECOVERY OF NEUROCOGNITIVE DYSFUNCTION AMONG YOUTH ATHLETES WITH PREMORBID DEPRESSION OR ANXIETY TAKING ANTIDEPRESSANTS. Muhammad Ali1, Tanvir Choudhri2. 1Medical Education, 2Neurosurgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Concussions in youth sports comprise an estimated 1.6-3.8 million annual injuries in the US. Sex, age, and ADHD have been identified as salient risk factors.

RESEARCH QUESTION: To evaluate the role of premorbid depression or anxiety (AD), with or without antidepressant use, on the incidence of concussion and the recovery of symptoms and neurocognitive dysfunction post-injury.

METHODS: Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) was administered to youth athletes at baseline. Throughout the season concussions were examined by physicians and athletic trainers, followed by re-administration of ImPACT post-injury (PI) and at follow-up (FU), a median of 7 days after PI. Athletes were divided into: unmedicated with AD (AD-only; n=315), on antidepressants (AD-meds; n=81), and without AD or antidepressant use (non-AD; n=7,039). Concussion incidence was the total number of concussions per total number of patient-years. The recovery of neurocognitive post-injury was calculated as standardized deviations from baseline to PI and then FU in the five ImPACT scores: symptom, verbal and visual memory, visual motor skills, and reaction time.

RESULTS: There was no difference in concussion incidence between the AD-only and the non-AD group.

However, the AD-meds group had a greater incidence of concussion than both the AD-only group (OR 2.67[1.88-7.18]) and the non-AD group (OR 2.19[1.16-4.12]. Deviation from baseline in PI symptom scores was greater among the AD-meds group compared to the non-AD group (OR 1.14[1.01-1.28]). At FU the deviation from baseline in symptom scores remained elevated among the AD-meds group as compared to the non-AD group (OR 1.62[1.20-2.20]) and the AD-only group (OR 1.87[1.12-3.10]. Deviation from baseline in FU verbal memory was also greater among the AD-meds group as compared to both the non-AD group (OR 1.57[1.082.27]) and the AD-only group (OR 1.66[1.03-2.69]).

CONCLUSIONS: Premorbid AD alone does not affect the incidence of concussion or the recovery of symptoms and neurocognitive dysfunction post-injury. However, antidepressant-use is associated with increased concussion incidence and elevated symptom and verbal memory scores up to 7 days after concussion, suggesting impaired symptomatic and neurocognitive recovery on ImPACT.

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ABSTRACT 4 EARLY ADVANCES IN COMPUTATIONAL DRUG REPURPOSING AGAINST COVID-19.

Illya Aronskyy1, Yosef Masoudi-Sobhanzadeh3, Antonio Cappuccio2, Elena Zaslavsky2.

1 Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

3 Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.

BACKGROUND: The current COVID-19 pandemic, caused by SARS-CoV-2, has resulted in over a million deaths. De-novo drug development is a lengthy process, impractical in effectively addressing the pandemic.

One promising alternative is computational drug repurposing, which enables the prioritization of drugs through fast in-silico analyses. Recent efforts in computational drug repurposing, based on molecular docking, machine learning, and network analysis for COVID-19, have already produced promising predictions.

RESEARCH QUESTION: The first objective is to aid in the progress of in-silico drug repurposing by compiling information on disease pathogenesis, drug targets, drug databases, and other pertinent information into one study. The second objective is to propagate clinical testing of repurposed drugs by providing information on drugs with success in silico and experimental results.

METHODS: We review the known mechanism of pathogenesis of COVID19. We utilize database information to cross-reference drugs with both in-silico and experimental efficacy against the virus. We classify their MOA’s into drugs inhibiting viral proteins, and drugs inhibiting host pathways contributing to viral pathogenesis.

We discuss strengths and limitations of published methodologies and outline possible future directions.

Finally, we curate a list of SARS-CoV-2 specific data portals and other relevant repositories that can be leveraged in future research.

RESULTS: We have curated a list of over 100 drugs with promising in-silico and experimental results, organized by their MOA’s. Some promising compounds include N3, chloroxine, valacyclovir, Sirolimus + Dactinomycin, and silmitasertib. We created a repository of databases, search engines, and other tools, useful for identification of promising drugs, in silico studies, and other pertinent information on drug development for COVID-19. Among these are CORD-19, COVID-19 Primer, HIT-COVID, PDB, KEGG, IUPHAR, and many others.

CONCLUSIONS: In conclusion, our paper aims to aid in future drug repurposing and development. However, there is still a large gap in knowledge for the treatment of this disease. New drugs and studies are coming out at a rapid rate and promising approaches such as combinational drug therapy are still being developed.

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ABSTRACT 5 MOLECULAR PROFILING OF ATOPIC DERMATITIS SKIN REVEALS BIOMARKERS OF DISEASE SEVERITY. Kelsey Auyeung1, Helen He2, Jianni Wu3, Ana Pavel2, Emma Guttman-Yassky2.

1,3 Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3SUNY Downstate Medical Center.

BACKGROUND: At present, knowledge of the hallmarks of atopic dermatitis (AD) pathogenesis is largely derived from studying patients with moderate-to-severe AD. However, individuals with mild disease constitute the majority of cases, and a genomic characterization of skin across the entire severity continuum is lacking.

RESEARCH QUESTION: The objective of this study was to characterize the molecular profile of mild AD patients compared to moderate-to-severe AD and healthy controls and to elucidate how known molecular markers integral to AD pathogenesis vary with disease severity.

METHODS: RNA-seq was performed on the punch biopsies of lesional and non-lesional skin of AD patients of varying disease severity (22 mild, 20 moderate, 21 severe cases), with healthy controls (20) included for comparison. Statistical analysis was performed in R software. Hypothesis testing was performed using the limma package, and p-values were adjusted using the Benjamini-Hochberg procedure to control for false discovery rates.

RESULTS: Patient cases exhibited significantly increasing numbers of differentially expressed genes with rising disease severity level compared to control (2322 for mild, 2726 for moderate, 4576 for severe with FCH≥2.0 and FDR<0.05). Immune-related genes including markers of Th2 (IL-4R, CCL17), Th22 (IL-22, S100As), Th1 (CXCL10, MX1), and Th17 (IL-17F, IL-19, CXCL1, CAMP/LL37) exhibited incremental severitydependent increases (FCH≥1.5 in severe vs mild phenotypes, FDR<0.05). Among epidermal barrier genes, negative correlations were observed with increasing disease severity for markers of terminal differentiation (FLG, LOR, PSORS1C2; R<-0.28,P≤0.05), late cornified envelope genes (LCE2D, LCE1B, LCE2B, LCE2C, LCE1C, LCE1F; R<-0.28,P≤0.05), claudins (CLDN1, CLDN8, CLDN10; R<-0.33,P≤0.01), cadherins (CDH10, CDH12, CDH19; R<-0.34,P≤0.01), keratins (KRT77; R=-0.43,P≤0.001), and lipid metabolism/biosynthesis (SCEL, FABP4, GPAM, HMGCS2, ACOX2; R<-0.33,P≤0.01).

CONCLUSIONS: Our data suggest that the extent of immune and barrier-related abnormalities in AD is associated with severity of disease. These results contribute to the pinpointing of biomarkers for the development of targeted therapeutics and greater treatment possibilities for patients with varying AD severity.

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ABSTRACT 6 DISPARITIES IN GENETIC COUNSELING FOR GYNECOLOGICAL CANCERS: IDENTIFYING AREAS OF IMPROVEMENT. Elena Baldwin1, Sharonne Holtzman2, Stephanie Blank2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: During recent years, timely genetic testing has improved outcomes in ovarian malignancies.

Despite significant benefits, the literature reports many barriers to genetic testing, such as limited number of trained professionals to deliver proper counseling and self-reported patient anxiety. The literature has also reported significant disparities in genetic counseling based on race, first language, marriage status, level of education, and location of care.

RESEARCH QUESTION: Our goal is to gain a better understanding of the delivery of genetic counseling to gynecologic oncology patients at Mount Sinai. We hope to identify any factors that significantly predict uptake of genetic counseling and factors that present a barrier to care.

METHODS: Our aim is to create a database of all patients at the Mount Sinai Health System who have an “ovarian malignancy” diagnosis through chart review of 350 patients. We collected demographic information including race, ethnicity, primary language, and zip code. We gathered clinical information about their specific diagnosis, year of diagnosis, age at diagnosis, stage, histology, surgery date, post-operative date, family history, and insurance status. We also looked into the flow of the genetic counseling pathway including date of referral and completion, wait time, results, cascade testing, and any changes to the treatment plan based on the results.

RESULTS: Overall, preliminary results show a vast increase in genetic counseling rates in recent years. Our patient population has a high rate of genetic counseling referral with 193 out of 350 patients receiving referrals.

Of the 193 that received a genetic counseling referral, 83 completed genetic counseling, suggesting that there may be a weakness in scheduling and follow up after referral. Women who spoke English and those who had private insurance were more likely to complete genetic counseling. A younger age, an ovarian malignancy, and family history of breast or ovarian cancer were also associated with high uptake of genetic counseling.

CONCLUSIONS: We hope that by identifying these disparities in Mount Sinai’s delivery of genetic counseling, we can create specific patient outreach programs to improve gynecologic oncology outcomes.

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ABSTRACT 7 PRENATAL PM2.5 EXPOSURE PREDICTS NEUROCOGNITIVE PERFORMANCE AT AGE 9-10 YEARS: A COHORT STUDY OF MEXICO CITY CHILDREN. Esha Bansal1, Hsiao-Hsien Leon Hsu2, Erik de Water2, Martha Tellez Rojo3, Robert Wright2.

1 Medical Education, 2,3Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 Mexican National Institute of Perinatology.

BACKGROUND: Prenatal exposure to fine particulates (PM2.5) is an important, under-studied risk factor for lifelong neurocognitive delay and disorder. This study aimed to describe relationships between prenatal PM2.5 exposure and cognitive function at age 9-10 years based on Go/No-Go task performance of Mexico City children.

RESEARCH QUESTION: How does the timing and quantity of prenatal PM2.5 exposure affect neurocognitive performance, as measured by the Go/No-Go task, at age 9-10 years?

METHODS: This study consists of 208 mother-child pairs enrolled in Programming Research in Obesity, Growth, Environment and Social Stressors, a birth cohort study. Daily prenatal PM2.5 exposure was measured for all pairs using residential address and a spatio-temporal model. At age 9-10 years, children performed Go/No-Go tasks. Latent class analysis (LCA) was used to identify neurocognitive phenotypes while multivariate regression and distributed lag modeling (DLM) tested associations between prenatal PM2.5 exposure and Go/No-Go outcomes.

RESULTS: Based on the Go/No-Go task, LCA detected two neurocognitive phenotypes: high performers (Class 1) and low performers (Class 2). Predicting odds of Class 1 vs Class 2 membership based on prenatal PM2.5 exposure timing, DLM analysis identified a CW of gestational days 124 to 219. Additionally, logistic regression modeling showed that average prenatal PM2.5 exposure in the second and early third trimesters correlated with increased odds of membership in low-performance Class 2 (OR = 1.107 [1.068, 1.147], p < 0.01).

CONCLUSIONS: In this cohort of Mexico City children, Go/No-Go task data strongly suggest that increased prenatal PM2.5 exposure predicts decreased neurocognitive function at age 9-10 years. Findings highlight the second and third trimesters of gestation as critical windows during which PM2.5 exposures adversely affect the development of vigilance and inhibitory control. By combining latent class analysis and distributed lag modeling to identify distinct neurocognitive phenotypes, this study contributes to a paradigm shift towards holistic methodologies.

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ABSTRACT 8 THE IMPACT OF SMOKING ON THE ASSOCIATION OF PHTHALATE EXPOSURE AND THYROID HORMONES IN US ADULTS. Joshua Barlow1, Mathilda Alsen2, Christine Little1, Maaike van Gerwen2. 1Medical Education, 2 Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Thyroid function is essential to overall health, but the gland’s need for dietary iodine makes it especially prone to disruption from exogenous factors. Exposure to phthalates and smoking have both been associated with alterations in thyroid function. Some studies have even reported an inverse relationship between smoking and thyroid cancer. Our objective was to assess the impact of smoking on the association between phthalate exposure and thyroid hormone levels.

RESEARCH QUESTION: We hypothesized that phthalate exposure would significantly impact thyroid hormone levels and that smoking cigarettes would possibly modulate these effects.

METHODS: We used the 2011-2012 laboratory subsample of the National Health and Nutrition Examination Survey (NHANES) and included 1,348 adults. Phthalate metabolites and thyroid hormone levels (TSH, total T4, and free T4) were natural log transformed. Smoking status was defined using questionnaire data. Multivariable linear models were adjusted for sex, age, BMI, iodine status and smoking. All statistical analyses were performed using SAS software 9.4 (SAS Institute Inc., Cary, NC).

RESULTS: There was a significant inverse association between levels of mono-(2-ethyl-5-carboxypentyl) phthalate (ECP) (Beta-adjusted = -0.12, p < 0.05), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MHH) (Betaadjusted = -0.14, p < 0.01), and mono-(2-ethylhexyl) phthalate (MHP) (Beta-adjusted = -0.15, p < 0.01) and those of total T4. MHP levels were also negatively associated with TSH (Beta-adjusted = -0.10, p < 0.001).

Upon stratifying for smoking status, there were no significant relationships between phthalate exposure and hormone levels in the smoking group. In the non-smoking group, all significant relationships prevailed except for that between ECP and total T4.

CONCLUSIONS: These results confirm that phthalates have endocrine disrupting properties. Smoking seems to modify this association but future research is needed to elucidate the mechanism behind the impact of smoking on thyroid function and its possible protective effects in the setting of phthalate exposure.

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ABSTRACT 9 A COMPARISON OF THE ELIXHAUSER AND CHARLSON COMORBIDITY INDICES: PREDICTING IN-HOSPITAL COMPLICATIONS FOLLOWING ANTERIOR LUMBAR INTERBODY FUSIONS. Rebecca Baron1, Sean Neifert2, William Ranson3, Alexander Schupper2, Jonathan Gal4, Samuel Cho5, John Caridi2. 1Medical Education, 2Neurosurgery, 3,5Orthopaedics, 4Anesthesiology.

1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI) are commonly used measures that use administrative data to characterize a patient’s comorbidity burden.

RESEARCH QUESTION: The purpose of this study was to compare the ability of these measures to predict outcomes following anterior lumbar interbody fusion.

METHODS: The National Inpatient Sample was queried for all ALIF procedures between 2013 and 2014. The area under the receiver operating curve (AUC) was used to compare the ECI and CCI in their ability to predict post- operative complications when incorporated into a base model containing age, sex, race, and primary payer. Percent superiority was computed using AUC values for ECI, CCI, and base models.

RESULTS: A total of 43,930 hospitalizations were included in this study. The ECI was superior to the CCI and baseline models in predicting minor (AUC 71 vs. 0.66, P < 0.0001) and major (AUC 0.74 vs. 0.67, P < 0.0001) complications. When evaluating individual complications, the ECI was superior to the CCI in predicting airway complications (65% superior, AUC 0.85 vs. 0.72, P [ 0.0001); hemorrhagic anemia (83% superior, AUC 0.71 vs. 0.66, P < 0.0001); myocardial infarction (76% superior, AUC 0.86 vs. 0.67, P < 0.0001); cardiac arrest (75% superior, AUC 0.85 vs. 0.67, P < 0.0001); pulmonary embolism (105% superior, AUC 0.91 vs. 0.71, P < 0.0001); and urinary tract infection (43% superior, AUC 0.76 vs. 0.73, P = 0.046).

CONCLUSIONS: The ECI was superior to the CCI in predicting 6 of the 15 complications analyzed in this study. Combined with previous results, the ECI may be a better predictive model in spine surgery.

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ABSTRACT 10 PROCESS MAPPING OF PATIENT FLOW THROUGH PACU. Anastasia Beldovskaya1, Mo Shirur2, Anthony Tanella2. 1Medical Education, 2Anesthesiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The post anesthesia care unit (PACU) is a critical component in the perioperative care throughput. Delays in patient flow through PACU and resulting lack of PACU bed availability sometimes leads to “PACU holds,” when a patient has to recover in the OR, which in turn delays OR turnover and results in an inefficient use of limited hospital resources. Understanding causes of prolonged PACU stay may inform potential quality improvement (QI) interventions aimed at maximizing efficiency.

RESEARCH QUESTION: Our goal is to gain a better understanding of the PACU throughput and to identify clinical and nonclinical causes of delayed discharge from PACU. METHODS: A medical student interviewed PACU staff and observed processes from patient’s arrival in the PACU until their transfer to an inpatient unit. A process map reflecting the findings was created.

RESULTS: The process map including all the steps of patient flow through PACU can be divided into two consecutive stages. The first stage represents a sequence of events from the patient’s arrival in PACU and until they are marked as ready for discharge to an inpatient unit. During this stage delays are caused by clinical factors most significant of which, according to the staff, are hyperkalemia, hypotension, and uncontrolled pain. The second stage occurs from the time the patient is marked ready for discharge from PACU and until their actual transfer to an inpatient unit. During this stage, which includes a greater number of steps than the preceding (clinical) one, delays are caused by administrative factors, most significant of which are delays in bed assignment by the bed board and slow cleaning of that bed by EVS services. Additional administrative factors include temporary shortages of transporters during certain hours and inability to perform a patient hand-off during the evening change of shift on inpatient units.

CONCLUSIONS: The process map reveals several steps where delays are likely to occur. The most significant delays appear to be administrative and could be further quantified using value-stream mapping.

A more thorough investigation of the processes involving communication with bedboard and EVS services may help us identify targets for a QI intervention.

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ABSTRACT 11 PLASTIC SURGERY RESIDENCY PROGRAMS: A REVIEW OF THE NATIONAL RESIDENT MATCHING PROGRAM SINCE THE PLASTIC SURGERY WORKFORCE TASK FORCE, 2008-2020.

Christopher Bellaire1, Farah Sayegh2, John Rutland2, Peter Taub2.

1 Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: In March 2008, the American Society of Plastic Surgeons and Plastic Surgery Educational Foundation Board of Directors approved recommendations from the Plastic Surgery Workforce Task Force to increase the number of plastic surgery training programs and the number of plastic surgery residents in response to the projected growth in the US population and the number of plastic surgeons approaching retirement.

RESEARCH QUESTION: The present study quantitatively analyzed the supply and demand for plastic surgery residency programs—and resulting changes in competitiveness—since the 2008 Plastic Surgery Workforce Task Force.

METHODS: The present study used data from the National Residency Match Program (NRMP) from 2008 to 2020. The ratio of residency applicants to positions was used to measure the competitiveness of matching, defined as the competitiveness ratio. Pearson’s correlation was used to analyze trends in the competitiveness ratio over time.

RESULTS: There was a large (60%) increase in the number of applicants to integrated plastic surgery residency positions from 2008 to 2020; however, there was an even greater (96%) increase in the number of positions offered. The increase in positions more than off-set the increase in applicants, resulting in a significant decrease in the ratio of applicants-to-positions offered (i.e. competitiveness ratio) over time, with a large effect size (Pearson’s Correlation: R = -0.70, p = 0.007). As a result, this metric for competitiveness decreased significantly following the Plastic Surgery Workforce Task Force’s 2008 recommendations.

CONCLUSIONS: Despite record numbers of applicants seeking to match, the robust development of new programs and positions have, in fact, more than compensated for this rise in demand. While plastic surgery remains a highly competitive specialty, this information may help guide residency programs, as well as medical students who plan to pursue this field.

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ABSTRACT 12 SECONDARY INVASIVE BREAST EVENTS (SIBE) AMONG PATIENTS WITH HIGH RISK ONCOTYPE DX RECURRENCE SCORES (RS) 26-30 AND > 31: RESULTS FROM A LARGE ONCOTYPE DATABASE. Natalie Berger1, Brittney Zimmerman2, Serena Tharakan1, Kelly Suchman1, Krystal Cascetta2, Julia Blanter3, Erin Moshier4, Meng Ru4, Shabnam Jaffer5, Amy Tiersten2. 1Medical Education, 2Oncological Sciences, 3 Medicine, 4Institute for Health Care Delivery Science, 5Pathology. 1,2,3,4,5Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Oncotype RS is a 21-gene assay used to predict the likelihood of distant recurrence and benefit of chemotherapy in patients with lymph node negative (LN-), hormone positive (HR+) breast cancer (BC). The Oncotype RS is used to identify patients who may be spared chemotherapy without adverse impact on survival or SIBE. The TAILORx trial provided evidence that chemotherapy can likely be spared for most patients with Oncotype RS≤25.

RESEARCH QUESTION: More aggressive endocrine therapy with concurrent ovarian suppression in pre-menopausal women may mitigate the need for chemotherapy among patients with higher RS. METHODS: We developed a large oncotype database to determine rates of SIBE among patients with higher genomic risk (RS≥26) to determine the benefit of chemotherapy among these groups. 887 patients with LN-, HR+ BC were identified who were treated between 2006-2018. Among these patients, 515 had follow-up data available for SIBE analysis. Patients were stratified by RS using conservative cutoffs: low risk (<10), intermediate risk (11-25), and high risk (>26). The Kaplan Meier method was used to estimate the time to SIBE distributions overall and among different RS groups with the log rank test used to compare distributions between groups.

RESULTS: The rates of chemotherapy administration were 7% among low RS, 18% among intermediate RS, and 83% among high RS patients. Among the 27 LN- patients with RS 26-30, N=20(74%) received chemotherapy and the remaining 7(26%) did not. The 5-year rate of SIBE was 25% among patients who received chemotherapy and 33% among those who did not receive chemotherapy; p=0.5489.

Among the 23 LN- patients with RS>31, N=21(91%) patients received chemotherapy and the remaining 2(9%) did not. The 5-year rate of SIBE was 0% for both groups of patients; p-value not estimable in this subgroup due to no SIBE in either group.

CONCLUSIONS: There was no statistically significant difference in SIBE with the administration of chemotherapy to patients with higher RS compared with patients who did not receive chemotherapy.

More aggressive endocrine therapy with ovarian suppression has become an alternative option to spare chemotherapy in intermediate risk patients; this approach may be useful among patients with even higher risk Oncotype scores.

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ABSTRACT 13 ASSESSING FORMER U.S. IMMIGRATION JUDGES’ PERSPECTIVES: BEST PRACTICES IN TELEPHONIC MENTAL HEALTH EVALUATIONS. Beselot Birhanu1, Stephanie Wu1, Aliza Green1, Samuel “Gus” Ruchman1, Elizabeth Singer2, Kim Baranowski3, Craig Katz3. 1Medical Education, 2Emergency Medicine, 3Psychiatry.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The United States has seen a recent rise in detention rates amongst asylum seekers.

This trend has been complicated by the Coronavirus pandemic and resulting social distancing mandates.

Many clinics have consequently transitioned to telehealth models, but this poses significant logistical challenges for evaluators who traditionally assess clients in-person. Furthermore, limited data exists on how to most effectively conduct forensic medical evaluations using telephonic or video-based modalities.

RESEARCH QUESTION: This study aimed to identify best practices for telehealth forensic medical affidavits by evaluating the perspectives of former U.S. immigration judges.

METHODS: We conducted nine semi-structured interviews from April-May 2020 and systematically analyzed the findings using consensual qualitative research (CQR) methodology. Transcripts were individually coded before being re-coded using a universal codebook iteratively generated by our team. They were then analyzed for patterns and emerging themes, and a similar consensual process was used for the following phase of analysis in creating domains and categories.

RESULTS: We grouped our findings into five categories: (1) judges’ preferences for the content, format, and style of affidavits, (2) judges’ perceptions of the affidavit’s role in the current legal climate, (3) appraisal and comparison of sample telephonic versus in-person affidavits; (4) attitudes towards telephonic evaluations; (5) recommendations for telephonic evaluations. Our results showed that judges were generally skeptical of the efficacy of telephonic affidavits but believed that they were appropriate in prohibitive contexts like detention. They suggested that evaluators hedge this skepticism by disclosing the use of the modality in their affidavits and include a rationale for why the evaluation was conducted that way. They also advised evaluators to describe the specific strategies used to overcome limitations of the modality, like asking follow-up questions about pauses to account for the lack of visual cues.

CONCLUSIONS: Forensic medical evaluators may utilize the recommendations of immigration judges to inform their telephonic evaluations and bolster the usefulness of their medical-legal affidavits in the adjudication process.

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ABSTRACT 14 PANDEMIC PREPAREDNESS FOR DOCTORS IN TRAINING: BEYOND THE BIOMEDICAL APPROACH AND INTEGRATING HUMANITIES EDUCATION FOR FUTURE PHYSICIANS. Benjamin Chi1, Jacob Appel2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The emergence of SARS-CoV-2 has introduced novel challenges for physicians.

While traditional medical education is sufficient for preparing physicians-in-training on understanding the pathogenesis and mode of transmission for new agents, it does not cover pandemics through a liberal arts perspective. This perspective is critical for physicians as it allows them to understand key issues like how race and gender intersect with the pandemic patient experience and how scarce resources raise difficult bioethical questions that providers often face. Lastly, it provides physicians-in-training historical reference points for the likely day when they practice medicine in a pandemic setting, decreasing uncertainty and enhancing readiness.

RESEARCH QUESTION: We anticipate students that complete an elective course will gain a better understanding of pandemics through a historical, literary, and sociological perspective and feel better prepared to practice medicine in a future pandemic.

METHODS: The Nexus course system at the Icahn School of Medicine at Mount Sinai allows students to register for elective classes. A course titled “Pandemics and Humanities” was designed, created, and registered under this system as a 6-week elective class during the Fall of 2020, with each session focusing on a different theme. Due to COVID-19, classes were conducted weekly over Zoom. Upon completion, course participants were asked to fill out a post-course survey. Only MD or MD/PhD students were allowed to register for the course. To receive credit for completing the class, students had to attend at least 4 of the 6 sessions.

RESULTS: 7 students registered for the course. 6 students attended the minimum requirement for receiving credit. In the post-class survey, 100% of respondents felt that the class would help them as a physician in a future pandemic in some way and felt better informed and prepared about practicing medicine in a pandemic.

CONCLUSIONS: Pandemic preparedness through a liberal arts perspective can be an invaluable addition to future medical education. The Nexus course has shown that some aspects of the class have been beneficial in improving student understanding. This work will inform future work of integrating aspects of it into the mandatory curriculum.

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ABSTRACT 15 SMALL CHANGES IN ADHERENCE TO HIV ANTIRETROVIRAL THERAPY IMPACTS VIRAL SUPPRESSION AMONG A COHORT OF PERINATALLY INFECTED CHILDREN IN WESTERN KENYA. Samuel Chiacchia1, Ashley Chory2, Michael Scanlon3, Allison DeLong4, J Aluoch5, A Ngeresa5, J Hogan5, A Manne5, F Sang5, C Ashimosi5, E Jepkemboi5, M Orido5, V Novinsky5, S Ayaya5, R Kantor4, Rachel Vreeman2.

1 Medical Education, 5Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 University of Indiana, 4Brown University, 5AMPATH. BACKGROUND: As of 2018, approximately 110,000 children (ages 0-14) are living with HIV in Kenya, 75% of whom live in resource-limited or rural settings, and 61% of whom are estimated to be on anti-retroviral therapy (ART). Without nearly perfect adherence to ART, children and adolescents do not achieve viral suppression and are at high risk of HIV-related morbidities and mortality. Better characterizing adherence behavior is essential to improving viral suppression and improving outcomes in this patient population.

RESEARCH QUESTION: We hypothesize that adherence to ART, as measured by electronic dose monitoring, significantly predicts viral failure.

METHODS: Children living with HIV <14 years of age, on first-line pediatric ART regimens and engaged in care at the Academic Model Providing Access to Healthcare (AMPATH) in Eldoret, Kenya were enrolled in a multi-phase, observational study. Participants were followed prospectively with monthly clinical visits, in which adherence was assessed via remote electronic dose monitoring systems (i.e. MEMS).

RESULTS: MEMS data from 706 participants (mean age 8.6 years; 51% female; 2.8 mean years on ART; mean CD4 count = 941.7) were collected and analyzed, revealing significant association between viral failure (VL > 1000 copies/mL; p < 0.001) and treatment adherence <80%. Assuming 14 doses per week, this cutoff suggests that 2-3 missed or late doses per week may contribute meaningfully to the development of viral failure.

CONCLUSIONS: The results of this analysis provide a benchmark for assessing risk of developing viral failure as a function of ART adherence in a cohort of children living with HIV in resource limited or rural settings. Given the prevalence of non-adherence in this patient population, these observations call attention to the risk for drug resistance and highlight the potential value of adherence interventions such as patient counseling and mental health support.

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ABSTRACT 16 CLINICAL AND TREATMENT CHARACTERISTICS OF SECONDARY BLADDER MALIGNANCIES FOLLOWING LOW DOSE RATE BRACHYTHERAPY FOR PROSTATE CANCER. Chih Peng Chin1, William Smith2, Richard Stock2, Michael Buckstein3. 1Medical Education, 2 Radiation Oncology, 3Radiology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Brachytherapy is an effective therapeutic option for patients with localized prostate adenocarcinoma. Brachytherapy delivers a high dose of radiation to a confined region encompassing the prostate gland with a high degree of conformality. However, due to anatomic proximity, the bladder remains at risk of exposure to ionizing radiation and development of secondary malignancies.

RESEARCH QUESTION: In this study, we characterized the clinical course and prognosis of secondary bladder malignancies associated with prostate brachytherapy.

METHODS: We conducted a retrospective study by querying our institutional database for patients with bladder cancer diagnosed between January 2005—April 2019 who had previously undergone low dose rate (LDR) prostate brachytherapy. Patients with bladder tumors confirmed by pathology and followed for greater than 1 year after initial diagnosis were included.

RESULTS: We identified 51 patients who met inclusion criteria. Median age at diagnosis was 78, median time from prostate brachytherapy to diagnosis of bladder cancer was 111 months, and median duration of follow-up was 35.5 months. Majority of the patients initially presented for evaluation due to hematuria.

Most of the tumors spared the anterior bladder wall. The tumors primarily involved the bladder trigone/neck, posterior wall, and lateral walls.

At the time of diagnosis, 32 (63%) patients had non-muscle invasive (NMIBC) and 19 (37%) patients had muscle invasive disease (MIBC). 41 (82%) patients had high-grade disease and 9 (18%) patients had low-grade disease. The 5-year survival for all patients was 78.7% (95% CI: 55.9-90.6). The 5-year survival for NMIBC and MIBC were 75.6% (95% CI: 49.7-89.4) and 93.3% (95% CI: 61.3-100), respectively.

19 in the study developed progression of disease during follow-up with a median time from diagnosis to progression of 10.8 months. The 5-year progression-free survival for all patients was 40.7% (95% CI: 22.2-58.5). The 5-year progression-free survival for NMIBC and MIBC were 44.7% (95% CI: 23.1-64.3) and 48.1% (25.7-69.9), respectively.

CONCLUSIONS: Compared to de novo bladder cancer, bladder cancer secondary to prostate brachytherapy present with high-grade and later stage with comparable survival and progression-free survival.

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ABSTRACT 17 CLIMATE CHANGE CURRICULUM INFUSION PROJECT 2020.

Lindsay Clark1, Sophia Karwoska Kligler1, Perry Sheffield2. 1Medical Education, 2 Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Medical school curricula lack content teaching basic competencies regarding the health impacts of a changing climate. The Climate Change Curriculum Infusion Project (CCCIP) at ISMMS is an on-going project that aims to increase climate change-related health competency in undergraduate medical training.

RESEARCH QUESTION: This study aimed to test visibility and retention of CCCIP content in 10 lectures across 6 courses in the 1st and 2nd year pre-clinical curriculum.

METHODS: An online survey was sent via listserv to current 2nd- and 3rd-year ISMMS students. Participation was voluntary and anonymous. Survey questions were designed to evaluate CCCIP content implemented from 2018 –2020. While assessing visibility and retention of content was the primary focus, additional questions gauged attitudes and motivation of participating students.

RESULTS: 89 students completed the survey (32% overall response rate (RR)) of which 57 were 2nd-years (40% RR) and 32 were 3rd-years (23% RR). 57% of students stated they were “very” or “moderately” familiar” with climate-related health concepts before medical school. A majority of students remembered climaterelated content throughout their first year (74%) and their second year (80%) only “slightly well” or “not well at all”. Students were most consistently able to recall CCCIP material from Medical Microbiology and the core clinical skills course (ASM1). 61% students reported they were not familiar with the CCCIP branding banner used on all slides. A majority of students selected “strongly agree” or “agree” about the importance of climaterelated material to their medical education (82%) and to their future clinical careers (77%). 64% of students responded “no” concerning whether climate-related curriculum content at ISSMS matched their expectation.

CONCLUSIONS: CCCIP content is currently not meeting project goals in terms of visibility and retention.

We plan to share this data and feedback with course directors and instructors in order to encourage review of integrated content (ensure content is still included and as organically as possible) and incorporation of the content into course assessments. Future iterations of CCCIP will prioritize visibility and retention in developing and integrating new course content.

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ABSTRACT 18 EVALUATION OF CURRENT NEONATAL PAIN SCALES AS A MEASURE OF NICU STRESS. Elizabeth Clifton1, Emily Spear2, Annemarie Stroustrup3. 1Medical Education, 2,3Pediatrics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3Northwell Health New York, New York.

BACKGROUND: The N-PASS is a neonatal pain scale used to estimate pain and sedation in the NICU. It has been validated for chronic pain in ventilated or post-operative infants, but not in infants without such interventions. Significantly, the N-PASS uses a correction for post-menstrual age (PMA) that has never been validated. Despite this, it is still one of the most common tools for routine pain assessment in NICU infants regardless of operative or ventilatory status, and the PMA correction remains in use.

RESEARCH QUESTION: The aim of this study is to validate the N-PASS for routine pain assessment in neonates by examining the association between N-PASS scores and salivary cortisol in the NICU-HEALTH preterm birth cohort.

METHODS: Study staff collected salivary cortisol from neonates by inserting a cotton swab in the mouth prior to feeding time. N-PASS scores were assessed by on-duty RN and entered into EPIC every three hours, per NICU protocol. Scores from the 6 hours prior to specimen collection were extracted from the medical record by study staff and averaged for analysis. Mixed-effect regression models were used to assess the association between average N-PASS scores and salivary cortisol level while accounting for repeated measures per child.

RESULTS: 118 salivary cortisol specimens and 154 N-PASS scores were collected from 14 NICU-HEALTH participants during hospitalization. Two linear mixed-effects models were analyzed. In the first model, average N-PASS score was significantly associated with the log of salivary cortisol (β = 0.405, P = 0.012). A second model was run using a recalculated N-PASS score without the PMA correction. Recalculated N-PASS score was not significantly related to log of salivary cortisol (β = -0.509, P = 0.081), however there was a significant association between PMA and log of salivary cortisol (β = -0.173, P = 0.0003).

CONCLUSIONS: In this study, the N-PASS is not sensitive to changes in salivary cortisol beyond the calculation of PMA, and is thus non-intervenable in this population. Previous research from the lab has shown a different tool, the NISS, to be associated with salivary cortisol in the NICU-HEALTH cohort, and is thus intervenable. Further research into the NISS as a routine stress assessment in the NICU is being performed.

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ABSTRACT 19 EXAMINING THE IMPACT OF COVID-19 ON MEDICATION ADHERENCE AND ACCESS TO HIV CARE FOR ADOLESCENTS LIVING WITH HIV IN NEW YORK CITY. Ariella Cohen1, Ashley Chory2, Roxanne Martin2, Jocelyn Childs3, Rachel Waldman1, Samuel Chiacchia1, Grant Callen4, Rachel Vreeman2, Roberto Posada2. 1Medical Education. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Mount Sinai Hospital New York, NY, 4Indiana University Indianapolis, IN. BACKGROUND: High levels of adherence to antiretroviral therapy (ART) are critical to maintain viral suppression and promote optimal health outcomes for adolescents living with HIV (ALWH). Therefore, this population is particularly vulnerable to the disruptions in care and the effects on financial security, travel, and daily routines caused by the COVID-19 pandemic.

RESEARCH QUESTION: This project aims to describe the self-reported impact of the COVID-19 pandemic on the medication adherence and access to medical care of ALWH living in New York City.

METHODS: This is a prospective, phone-based survey and medical record review of ALWH, ages 13-24 years, enrolled in care at the Mount Sinai Jack Martin Fund Clinic. This abstract reports findings from baseline interviews (July/August 2020) and 3-month follow-up interviews (October/November 2020).

RESULTS: Study participants were 10 ALWH (mean age 21 years, 50% male, 90% non-white, 80% perinatally infected, no reported COVID-19 diagnoses). At baseline, all participants reported having access to ART at the time of assessment, 20% reported difficulty refilling prescriptions, and 20% reported skipping doses of ART due to concern that their medication would run out. Furthermore, 40% reported greater difficulty accessing medical care during the pandemic. At follow-up (n=8), no participants reported challenges refilling prescriptions, skipping ART doses due to concern about medication running out, or difficulty accessing care.

However, 50% reported forgetting to take ART in the last 3 days, compared with 30% at baseline. Of the 6 participants who had clinical data both prior to and after NYC’s stay-at-home order (3/14/20), 83% had lower CD4 counts, and 67% had increased viral loads.

CONCLUSIONS: Within this small sample, our results suggest that during the COVID-19 pandemic, participants experienced challenges in ART adherence and medical care access, secondary pandemic impacts which are both critical to maintaining health and improving outcomes for ALWH. It will be important to continue to follow participants’ viral loads over time to identify ongoing impacts. Examining the challenges faced by ALWH during the COVID-19 pandemic can guide the development of systems that better address their concerns and vulnerabilities.

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ABSTRACT 20 REDEFINING MEDICAL STUDENT RESEARCH OPPORTUNITIES IN THE COVID-19 ERA. Ella Cohen1, Laura Stein2. 1Medical Education, 2Neurology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Medical students faced unique challenges during the COVID-19 pandemic as they were forced to navigate a rapidly changing learning environment while managing loss, personal crisis, and uncertainty.

RESEARCH QUESTION: What lessons can be learned from the experience of a medical student doing research during the COVID-19 pandemic?

METHODS: An exploration was performed of the experience of a medical student in the midst of the unprecedented challenges posed by the COVID-19 pandemic to identify key lessons for finding successful research opportunities. Experiences were examined from December 2019, when the student began planning a summer research project, March 2020, as the COVID-19 pandemic forced her to identify a new project and mentor, and June-August 2020, as the student balanced research and a family emergency.

RESULTS: 1. Students should consider whether the effort to get IRB approval is worthwhile, and whether they have enough support to complete the project.

My original project, formulated in December 2019, fell through when I was unable to complete the IRB without guidance before March 2020, when my mentors were forced to turn their attention to the COVID-19 pandemic.

2. Rather than choosing projects by topic, students may benefit more by identifying a strong mentor.

In mid-April, I asked a known mentor if she could help me identify a project, and she invited me to join an existing project. Just as I began completing a second round of chart reviews, I was forced to return home to attend to a family emergency. My mentor regularly checked in on me, and she understood that I had less time and energy for research than planned. She also set aside time to teach me about her field, presenting cases and sharing relevant literature. Ultimately, my work contributed to a manuscript, which marked my first publication, and I learned about a field with which I had little familiarity.

CONCLUSIONS: The COVID-19 pandemic forced many medical students to adapt their summer research plans. The significant flexibility and guidance required for students to successfully adapt their projects to create meaningful research experiences while navigating the personal, financial, and societal repercussions of the COVID-19 pandemic highlight the importance of strong mentorship.

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ABSTRACT 21 STIMULATING DEGENERATIVE INTERVERTEBRAL DISC (IVD) ENVIRONMENT IN VITRO TO INVESTIGATE THE THERAPEUTIC POTENTIAL OF MSC-DERIVED EXTRACELLULAR VESICLES. George Danias1, Tyler DiStefano2, James Iatridis2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: We propose an exosome-based treatment to prevent degeneration of the IVD after disc herniation repair surgery. Exosomes contain genetic materials like miRNAs, which can modulate gene expression. MSC-derived exosomes applied to neurological, liver, kidney, and heart tissues have shown therapeutic efficacy, but this has not been evaluated in IVDs. In order to evaluate this, an in vitro platform that stimulates the degenerative microenvironment of the IVD is necessary. The comparative effects of TNFa and H2O2, two factors associated with IVD degeneration, on annulus fibrosus (AF) cell degeneration in vivo have not been described in the literature.

RESEARCH QUESTION: Q: Which treatment, TNF-a or H2O2, elicits a stronger degenerative phenotype in AF cells for potential rescue with exosomes?

H1: TNF-a and H2O2 will both cause degenerative phenotypes in AF cells H2: TNF-a will cause a stronger degenerative phenotype in AF cells than H2O2 METHODS: One control group of AF cells was cultured according to a standard protocol, one group of AF cells was cultured with 10 ng/mL TNF-a, and one group of AF cells was cultured with 500 mM H2O2. The dependent variables were AF cell gene expression using qPCR of degenerative markers: pro-inflammatory: IL1b, IL6, TNFα, PTGS2, NOS2, NLRP3, TXNIP; anti-inflammatory: GPX1; apoptosis: CASP1, CASP3; AF phenotype and anabolic markers: COL1a1, COL2a1, MKX, SCX, ACAN; pro-catabolism: MMP1; and anticatabolism: TIMP1; RESULTS: TNF-a increased NLRP3 and IL6 expression. GPX1 and PTGS2 expression were increased in TNF-a, while only PTGS2 expression was elevated in the H2O2 group. CASP3 expression was elevated under TNF-a, while H2O2 prompted downregulation of CASP3. COL2A1 expression was significantly decreased with treatment of H2O2, whereas expression of COL1A1, COL2A1, MKX, SCX, and ACAN were decreased with TNF-a treatment. COL2A1 shows a higher response to H2O2 than to TNF-a. MMP1 and TIMP1 are upregulated under H2O2, but only MMP1 was upregulated in the TNF-a group.

CONCLUSIONS: Both H2O2 and TNF-a showed gene expression changes associated with degeneration, with TNF-a prompting greater degenerative phenotype. Because of this, we recommend using TNF-a as a challenge to AF cells when stimulating a degenerative environment in vitro.

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ABSTRACT 22 THE APPLICATION OF DATA ANALYTICS TO INFER THE NEED FOR HEALTHCARE FACILITIES IN LOW-INCOME COUNTRIES. Jared Dashevsky1, Ebrahim Elahi2. 1Medical Education, 2Ophthalmology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Data analytics and machine learning are transforming the awareness of global health issues and the ability of public and non-governmental institutions to deliver goods and services in resourcepoor regions. For example, researchers have made models using data analytics to help create focused interventions in the geospatial mapping of childhood growth failure, educational attainment, and access to timely essential surgery. An area that researchers have yet to sufficiently explore is how data analytics can optimize the placement of healthcare facilities in resource-limited countries.

RESEARCH QUESTION: How can data analytics be used to infer the need for healthcare facilities in resource-constrained countries?

METHODS: A database was built using geospatial and hospital information for 24 low-income countries.

Geospatial data for healthcare facilities were gathered through OpenStreetMap.org, which provides opendata on roads, trails, and buildings. Hospital bed capacity data was obtained by iteratively searching keywords in Google’s search engine and then scraping webpages for bed capacity data. Over 1,600 data points were collected for 21 countries. The data were added to the database and a linear regression model was built to predict hospital bed capacity based on hospital area data.

RESULTS: A simple linear regression was calculated to predict hospital bed capacity on hospital area.

A significant regression equation was found (F(1,488) = 319.2, p-value < .0001) with an R2 of 0.3954. The predicted hospital capacity is equal to 85.18 + 0.001895*(hospital area (m2)). Hospital bed capacity increased .001895 for every 85.19m2 increase in area.

CONCLUSIONS: Hospital area data may be a good predictor of hospital bed capacity in low-income countries and can therefore be used to infer where healthcare facilities are needed. More investigation is required to expand the model to middle-income countries and to include more variables.

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ABSTRACT 23 DISPARITIES IN END-OF-LIFE INPATIENT CARE RECEIVED BY METASTATIC CANCER PATIENTS BETWEEN 2010 - 2017.

Stephanie Deeb1, Pinaki Dutta2, C. Jillian Tsai3. 1Medical Education, 2,3Radiation Oncology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Memorial Sloan Kettering Cancer Center, NY, NY. BACKGROUND: Many patients with metastatic cancer receive multiple invasive medical interventions during their final days. These procedures often represent high-cost, low-value care, and identifying those at high risk of futile care is an important step to advance appropriate end-of-life care.

RESEARCH QUESTION: To analyze patterns of care and interventions during a terminal hospitalization for those with a primary diagnosis of metastatic cancer.

METHODS: This was a population-based retrospective cohort analysis of longitudinal national healthcare data from the National Inpatient Sample, 2010-2017. Utilization and hospital charge records for patients ages ≥ 18 years with metastatic cancer and terminal hospitalization were analyzed using descriptive statistics, Chi square tests, Kruskal-Wallis tests, and multivariable binomial logistic regression models.

RESULTS: Out of 321,898 hospitalizations from metastatic cancer, 21,335 (6.6%) were terminal; 65.9% patients were white,14.1% Black, 7.5% Hispanic; 58.2% were insured by Medicare or Medicaid, 33.2% were privately insured. 63.2% of records indicated admission from ED, 4.6% indicated systemic therapy, and 19.2% indicated invasive ventilation during hospitalization. Black and Asian race as well as Hispanic ethnicity were associated with higher likelihood of ED admission, ventilation, higher total charges, and longer time from admission to death. Private insurance was associated with lower likelihood of ED admission (OR=0.5, 95% CI=0.4-0.5), ventilation (0.8, 0.7-0.8), and lower total charges (0.6, 0.6-0.9). Records indicating care received at an urban teaching hospital were associated with higher likelihood of systemic therapy (2.8, 1.84.2), ventilation (2.9, 2.4-3.5), and higher total charges (3.8, 3.3-4.4). Overall trends from 2010-2017 included declines for systemic therapy and ventilation, and an increase in total charges.

CONCLUSIONS: Patients with metastatic cancer of racial and ethnic minority groups and those with Medicare or Medicaid were more likely to receive low-value, aggressive medical interventions at the end of life. Further studies are needed to determine the underlying cause of low-value care at the end of life, which preferentially impact minority groups, in order to design prospective interventional studies.≈

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ABSTRACT 24 SCREENING FOR UNMET SOCIAL NEEDS DURING THE COVID-19 PANDEMIC. John Denton1, Leora Mogilner2, Jennifer Acevedo3, Lauren Zajac2. 1Medical Education, 2Pediatrics, 3 Pediatric Environmental Health. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The COVID-19 pandemic exacerbated the impact of social determinants of health (SDH), including food insecurity (FI), on low-income and minority families. Since 2017, the Mount Sinai SDH program has screened families at a New York City clinic and referred them to resources. Due to COVID, we adapted our program to a virtual format to better meet families’ needs.

RESEARCH QUESTION: What is the pandemic’s impact on unmet social needs and caregiver stress?

METHODS: Caregivers who screened positive for ≥1 unmet social needs at in-person screening between 2018 - 2020 and consented to follow-up were called by screeners from May-November 2020 to follow-up on referrals, re-screen for unmet social needs, and assess pandemic’s impact. The Perceived Stress Scale (PSS-4) was used to measure caregiver stress since the start of the pandemic; the total stress score was dichotomized into high and low stress based on score. Variables included sociodemographic factors, housing status, FI (Hager screen), home environment and financial concerns. Descriptive statistics and univariate analyses (Chi-square for categorical and Wilcoxon signed-rank for continuous) were done.

RESULTS: Of 107 eligible caregivers, 61 (57.0%) were reached by telephone and 48 (44.8%) completed the survey. 57.4% of children were Hispanic, 25.5% African-American, and 17.0% other; 95.8% had public insurance. Prior to COVID, common concerns were home environment (75%), FI (57.5%), and tobacco smoke incursion (TSI; 38.1%); average number of unmet needs was 2.56. On follow-up during COVID, common concerns were FI (54.3%), home environment (50%), and TSI (32.6%); average number of needs was 2.31.

49% (25/51) of referrals to community-based organizations were completed since the initial screen. For stress, 21 parents (52.5%) scored high (PSS-4 >7) and 19 (47.5%) scored low (PSS-4 <6). High-stress families were more likely to report FI (58%). The number of unmet social needs in high-stress families vs. low-stress families did not significantly differ (p=0.24).

CONCLUSIONS: Adapting screening and referrals during the pandemic allowed the social needs of families with adverse SDH to be addressed. Future work will analyze barriers to referral completion and further explore family stress during the pandemic.

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ABSTRACT 25 SOCIAL VULNERABILITY AND THE CORONAVIRUS IMPACT ON BIRTH EQUITY (VIBE) STUDY. Jennifer Dias1, Katharine McCarthy2, Stephanie Wu1, Sarah Nowlin2, Teresa Janevic3, Elizabeth Howell4, Joanne Stone3, Veerle Bergink3, Sheela Maru3. 1Medical Education, 2Population Health Science and Policy, 3,4 Obstetrics, Gynecology, and Reproductive Science. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York, 4Perelman School of Medicine, University of Pennsylvania.

BACKGROUND: COVID-19 and structural racism have profoundly impacted underserved communities and exposed existing gaps within our healthcare infrastructures. Social distancing protocols significantly impacted care for delivering mothers, and potentiated other harmful effects, including stress, economic hardship, and limited access to resources that may disproportionately affect socially vulnerable groups.

RESEARCH QUESTION: The purpose of this study is to better understand the implications of COVID-19 on pregnancy and post-partum health, care experience and health behaviors among under-represented, socially vulnerable women who received care at three New York City hospitals between January 1 – May 11, 2020.

METHODS: We conducted a cross-sectional survey study in Spanish and English. 918 post-partum patients who received pregnancy care during the study period were sent the survey, of which 248 (27%) completed the online survey. The survey included validated scales: Discrimination in Medical Settings Scale, General Anxiety Disorder-7 scale (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and Perceived Stress Scale (PSS). We classified deliveries after social distancing protocols were implemented on March 15 as pandemic deliveries. Two-sample T-tests and one-way ANOVAs were used for analyses.

RESULTS: In our cohort, women who reported moderate or high financial distress (n=44), housing insecurity (n=88), and/or food insecurity (n=38) scored higher on the PHQ-2, PSS, and GAD-7 mental health scales (p<0.01) compared to women with financial, housing, and food security. Women in financial distress were less likely to attend any of their post-partum health visits (14.63% v. 7.33% attended none, p<0.036) or exclusively breastfeed at hospital discharge (30.77% v. 51.05%, p<0.021) and follow-up (35.9% v. 58.95%, p<0.008).

Latinx and Black women were significantly more likely to report PTSD and any form of discrimination in medical settings, and less likely to have a birth companion compared to women of White, Asian or Other racial identity.

CONCLUSIONS: This study characterizes psychosocial impacts of COVID-19 in underrepresented postpartum women, and reinforces the need for development and expansion of integrated care models to address social vulnerabilities within healthcare.

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ABSTRACT 26 POTENTIAL OF RENAL REPLACEMENT TECHNOLOGY TO REDUCE INCIDENCE OF KIDNEY CANCER IN TRANSPLANT PATIENTS: A REVIEW OF THE CURRENT LITERATURE. Calista Dominy1, Kennedy Okhawere2, Talia Korn2, Kirolos Meilika2, Ketan Badani2.

1 Medical Education, 2Urology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The current standard of care in end-stage renal disease (ESRD) patients is kidney transplantation. The severe lack of donor kidneys leads to extended dialysis treatments being used as the norm to treat patients with (ESRD). Long-term dialysis has been shown to be associated with several comorbidities, including an increased risk for kidney cancer. Additionally, patients who receive a kidney transplant have been found to be at higher risk for cancer in general due to the immunosuppressant drugs required after transplant surgery.

RESEARCH QUESTION: The goal of this review is to assess the potential of two of the most recent innovations in kidney transplant technology, the implantable bioartificial kidney (BAK) and kidney regeneration, in addressing the limited availability of donor organs and the greater likelihood of developing kidney cancer in transplant recipients.

METHODS: The PubMed/Medline database was queried in June and July of 2020 for articles using key terms related to the BAK, kidney regeneration, and renal cancer risk in kidney transplant recipients.

14 publications were selected.

RESULTS: The implantable BAK and kidney regeneration are both able to replace total kidney function and reduce the risk of renal cancer in transplant patients by removing the need for immunosuppressants.

Since both technologies increase the amount of donor organs available, the time patients would spend on dialysis would likely decrease. This could reduce the occurrence of several comorbidities associated with long-term dialysis. These factors can all decrease kidney transplant patients’ susceptibility to kidney cancer.

CONCLUSIONS: Kidney replacement technology shows potential to improve availability of donor kidneys and reduce the risk of a kidney transplant recipient developing renal cell carcinoma. A major limitation of this review is that both of these technologies are in preclinical trials, and thus their potential effects cannot be comprehensively generalized to human patients. Further analysis will need to be conducted once these technologies move into clinical stages to assess their impact on human patients.

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ABSTRACT 27 PSYCHOLOGICAL IMPACT OF THE COVID-19 PANDEMIC ON FRONTLINE HEALTH CARE WORKERS DURING THE PANDEMIC SURGE IN NEW YORK CITY. Jordyn Feingold1, Lauren Peccoralo2, Chi Chan3, Carly Kaplan1, Halley Kaye-Kauderer1, Dennis Charney3, Jaclyn Verity2, Alicia Hurtado3, Larissa Burka4, Shumayl Syed1, James Murrough3, Adriana Feder3, Robert Pietrzak3, Jonathan Ripp2. 1Medical Education, 2Medicine, 3Psychiatry, 4Nursing.

1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: This study sought to assess the magnitude of and factors associated with mental health outcomes among frontline health care workers (FHCWs) providing care during the Spring 2020 COVID-19 pandemic surge in New York City.

RESEARCH QUESTION: We aimed to assess the prevalence of symptoms of COVID-19-related posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in a diverse sample of FHCWs in a single NYC hospital at the height of the pandemic, and to identify demographic, and COVID-19-related personal and work-related factors associated with these outcomes.

METHODS: A cross-sectional, survey-based study over 4 weeks during the Spring 2020 pandemic surge was used to assess symptoms of COVID-19-related-PTSD, MDD, and GAD in 2,579 FHCWs at the Mount Sinai Hospital. Participants were asked about their occupational and personal exposures to COVID-19.

Multivariable logistic regression and relative importance analyses were conducted to identify factors associated with the outcomes.

RESULTS: 3,360 of 6,026 individuals completed the survey (55.8%), with 2,579 (76.8%) analyzed based on endorsing frontline responsibilities and providing information related to the three outcomes. 1,005 (39.0%) met criteria for symptoms of COVID-19-related PTSD, MDD, or GAD. 599 (23.3%) screened positive for PTSD symptoms, 683 (26.6%) for MDD symptoms, and 642 (25.0%) for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19related PTSD (odds ratio [OR]=2.10), MDD (OR=2.83), and GAD (OR=2.68). Higher perceived support from hospital leadership was associated with the lowest risk of all outcomes [PTSD (OR=0.75), MDD (OR=0.72), and GAD (OR=0.76).

CONCLUSIONS: In this large sample of FHCWs during the 2020 NYC pandemic surge, 39% experienced symptoms of COVID-19-related PTSD, MDD, and/or GAD, and pre-pandemic burnout, as well as leadership support, were the most highly associated factors. These findings suggest that interventions aimed at reducing burnout and augmenting support from hospital leadership may be appropriate targets to mitigate the risk for developing further psychopathology in this population and others working in the midst of crisis.

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ABSTRACT 28 SNAPSHOT OF EMERGENCY DEPARTMENT VOLUMES IN THE “EPICENTER OF THE EPICENTER” OF THE COVID-19 PANDEMIC. Nicola Feldman1, Rikki Lane2, Laura Iavicoli2, Veronica Delgado2, Phillip Fairweather2, Stuart Kessler2, Suzanne Bentley2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: NYC Health + Hospitals/Elmhurst (Elmhurst) was one of the first hard-hit hospitals in the COVID-19 pandemic. Understanding trends in the emergency department (ED) of this “epicenter of the epicenter” may allow other locations to prepare as the pandemic spreads.

RESEARCH QUESTION: We hypothesize that the daily volumes of patients who registered to be seen for any reason at the Elmhurst ED surged in March 2020 as the COVID-19 pandemic arrived, then dropped in April and May to levels lower than those seen during the same time period in 2019. In addition, we hypothesize that during this period of the pandemic, a higher proportion of patients presenting to the ED required admission to the hospital for any reason as compared to 2019.

METHODS: Number of daily ED visits and admissions were obtained from the electronic medical record EPIC for the 12 weeks beginning the first Sunday of March 2020 and the corresponding 12 weeks of 2019.

RESULTS: A sharply increasing trend in ED volumes began around March 9, 2020 and peaked on March 18.

During the time period of the peak, between March 9 and March 24, the mean daily visit volume was 285.6, compared to 228.1 during the corresponding timeframe in 2019 (p < 0.0001, unpaired two-tailed t-test). ED volumes then fell rapidly to well below pre-pandemic levels. Between April 12 and May 23, the mean daily volume was 78.6, whereas in 2019 the corresponding mean was 225.3 (p < 0.0001, unpaired two-tailed t-test). Additionally, the daily percentage of ED visits admitted to the hospital began to rise in late March 2020.

Between March 23 and May 23, the mean daily admission rate was 30.1%, compared to 14.1% during the corresponding period in 2019 (p < 0.0001, unpaired two-tailed t-test).

CONCLUSIONS: Although in some areas ED volumes were decreased throughout the entire early COVID-19 pandemic, the epicenter of the crisis demonstrated a two-stage response beginning with a rapid surge in volumes. Similar patterns might be observed as COVID-19 spreads to new areas or reappears as a second wave. Moreover, the decreased volumes and elevated admission rates during April and May 2020, suggesting that fewer patients sought care and those who did had more severe symptoms, raise concern about reduced and delayed care seeking by the public.

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ABSTRACT 29 NON-INVASIVE VENTILATION VERSUS MECHANICAL VENTILATION IN HYPOXEMIC PATIENTS WITH COVID-19.

Iain Forrest1, Suraj Jaladanki1, Ishan Paranjpe1, Benjamin Glicksberg2, Girish Nadkarni3, Ron Do2.

1 Medical Education, 2Genetics and Genomic Sciences, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: A limited supply of mechanical ventilators during the COVID-19 pandemic has led to the use of non-invasive ventilation (NIV) as an alternative method for delivering oxygen to hypoxemic patients with COVID-19; yet this remains controversial with little empirical evidence for efficacy thus far. An analysis of clinical outcomes in hypoxemic patients with COVID-19 receiving different pulmonary interventions is needed. Moreover, identifying subpopulations who benefit from NIV would help inform clinicians deciding respiratory interventions for hypoxemic patients with COVID-19 and personalize their care.

RESEARCH QUESTION: To assess the association of NIV versus MV with in-hospital mortality and morbidity among hypoxemic patients admitted with COVID-19.

METHODS: We performed a retrospective cohort study across 5 hospitals in the Mount Sinai Health System during March-April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at conclusion of respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups stratified by ICU status and hypoxemia severity, and a propensity-matched analysis.

RESULTS: Of 2,381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR=30, 95% CI 16-60) with mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms (55/154 [36%] versus 66/534 [12%], OR=4.3, 95% CI 2.7-6.8), longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92% versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with greater OR of death than NIV. CONCLUSIONS: NIV was associated with lower in-hospital mortality and morbidity than MV. However, the findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed.

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ABSTRACT 30 THE IMPACT OF STAY-AT-HOME MEASURES FOR COVID-19 ON COMMON AND NOVEL ASTHMA TRIGGERS. Xanthe Gallate1, Lauren Zajac2, Gregory Gu3, Cordelia Elaiho2, Bian Liu4, Karen Wilson5. 1Medical Education, 2,5 Pediatrics, 3Other, 4Population Health Science and Policy. 1,5Icahn School of Medicine at Mount Sinai, New York, New York, 2,4Mount Sinai Hospital, 3Columbia Post-baccalaureate Program.

BACKGROUND: Environmental exposures are known to affect asthma; it’s unclear how they may have changed due to stay-at-home measures for Covid-19. This descriptive study compared shifts in asthma-related environmental exposures with changes in asthma symptoms in a sample of children from March to June of 2020.

RESEARCH QUESTION: More time spent at home may have worsened asthma symptoms due to increased exposure to asthma triggers.

METHODS: 36 parents of children ages 3-14 years with asthma who attend a Mount Sinai pediatric clinic were recruited for an anonymous questionnaire about how quarantining for Covid-19 changed the profile of asthma triggers in their homes. Exposure to pests, pesticides, mold, tobacco smoke incursions (TSI) and marijuana smoke incursions (MSI) were assessed against changes in children’s asthma symptoms. Descriptive statistics about whether changes to environmental exposures were associated with symptom improvements were calculated using Fisher’s Exact test on SAS. RESULTS: Overall, 22% of children’s asthma symptoms improved during quarantine while 75% did not. Race was significant in predicting symptom improvement (p = 0.0068) though the factors underlying this correlation (e.g. potential air quality disparities) weren’t assessed. Housing tobacco policies were a significant predictor (18% improved for those living in units with tobacco smoking restrictions vs. 0% for those with no restrictions; p = 0.029). The frequency of MSI into the home was also significant (56% not improved for high frequency MSI vs. 6% not improved for low frequency MSI; p = 0.045), though the frequency of TSI was not (p > 0.05).

Whether the child could play outside was significant (3% improvement for those who could play outside vs.

20% for those who couldn’t; p = 0.049). The presence of traditional asthma triggers such as pests, pesticides and mold were not associated with symptom improvement (p > 0.05). Whether the home was owned or rented was also not significant (p > 0.05), nor was receiving housing support (public or Section 8 housing, p > 0.05).

CONCLUSIONS: Overall staying at home didn’t have a large impact on asthma in our small cohort; potential ways policy may be able to improve asthma during the Covid-19 pandemic include preventing marijuana smoke incursions.

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ABSTRACT 31 THE INCIDENCE AND RISK FACTORS FOR PSEUDOSUBLUXATION FOLLOWING PROXIMAL HUMERAL FRACTURE. Michael Gao, Carl Cirino2. 1Medical Education. 2Orthopaedics. 1Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Pseudosubluxation (PS) of the humeral head in relation to the glenohumeral joint is a common finding following fractures of the proximal humerus. The temporary inferior subluxation of the humeral head is secondary to deltoid atony following blunt trauma to the axillary nerve. Despite the relative frequency of this finding, it is not well described in the literature. This study sought to describe the incidence, risk factors, and rate of resolution of PS. RESEARCH QUESTION: This study sought to describe the incidence, risk factors, and rate of resolution of PS. METHODS: The practice of two fellowship trained shoulder and elbow surgeons were queried for proximal humerus fractures based on the appropriate ICD-9 and ICD-10 codes. The radiographs of patients with proximal humerus fractures were reviewed at the time of injury and all subsequent follow-up through oneyear post-injury. Data collection included the presence of PS, type of fracture based on Neer’s classification, whether or not surgery was performed, and if resolution occurred.

RESULTS: The incidence of PS was 27.6% (110 out of 399 patients) overall. Patients requiring surgical intervention were more likely to develop pseudosubluxation than those who were treated conservatively (p<0.001). There was an increasing incidence of pseudosubluxation based on the Neer classification with 0-part fractures demonstrating a 2.63% (2/76) rate whereas 4-part fractures were found to have PS in 37.5% (21/56) of cases (p<0.001). All but one patient was found to have resolution of the PS at final follow-up or oneyear post-injury. There were no statistical differences in the demographics of patients who developed PS versus those who did not.

CONCLUSIONS: We found that PS occurs in greater than one-quarter of proximal humerus fractures and almost always resolves regardless of intervention. More complex fractures, including those requiring operative intervention developed PS at higher rates than simpler fracture patterns. This study will help both general orthopedists as well as shoulder surgeons understand the epidemiology of PS and appropriate treatment options for PS.

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ABSTRACT 32 CLINICAL FEATURES OF PAROSMIA ASSOCIATED WITH SARS-COV-2 INFECTION. Katherine Garvey1, David Lerner2, Annie Arrighi-Allisan1, Andrey Filimonov2, Peter Filip2, Janki Shah2, Benjamin Tweel2, Patrick Colley2, Madeleine Schaberg2, Anthony Del Signore2, Satish Govindaraj2, Alfred-Marc Iloreta2. 1Medical Education, 2Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: SARS-CoV-2 infection has been linked to new-onset olfactory dysfunction (OD).

Parosmia, a form of qualitative OD, associated with SARS-CoV-2 is not well understood.

RESEARCH QUESTION: This objective of this study was to characterize the clinical features of parosmia associated with SARS-CoV-2 infection.

METHODS: Individuals with OD due to SARS-CoV-2 infection were recruited from otolaryngology practices and a web-based application. Participants completed an OD survey, Modified Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and Sinonasal Outcome Test (SNOT-22). Descriptive statistics were used to analyze responses.

RESULTS: 86 participants completed the surveys at a mean of 231.4 days (SD 22.6 days) after symptom onset. 77.9% were female with a mean age of 41.0 years (SD 12.2 years). 76.7% experienced anosmia as their first OD symptom, with only 5 (5.8%) reporting parosmia and 10 (11.6%) reporting both parosmia and hyposmia at OD onset. Parosmia developed within 1 week of OD onset in 17.4%, 1-2 weeks in 8.1%, 2-4 weeks in 9.3%, 1-4 months in 16.3%, 4-6 months in 11.6% and >6 months in 1.2%. 70.9% experienced at least 2 smell distortions, most commonly phantom smells of chemicals (50%), burning (30.2%), rotten meat (29.1%) and cigarette smoke (26.7%). 55.8% reported concurrent ageusia. 64.0% received treatment, including omega-3 fatty acids (38.3%), smell retraining (29.1%), saline irrigations (15.1%), budesonide irrigations (8.1%), fluticasone sprays (7.0%) and oral steroids (7.0%). Mean QOD-NS and SNOT-22 scores were 13.2 (SD 5.2) and 25.2 (SD 13.2), respectively.

CONCLUSIONS: SARS-CoV-2-induced parosmia develops gradually as olfaction recovers, most often within 1 month of OD onset. Smell distortion varies and impacts quality of life, prompting those affected to pursue a variety of treatments of currently unknown efficacy. Further studies are needed to elucidate clear, effective interventions.

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ABSTRACT 33 NATURAL HISTORY OF OLFACTORY DYSFUNCTION ASSOCIATED WITH SARS-COV-2 INFECTION. Katherine Garvey1, Annie Arrighi-Allisan1, David Lerner2, Peter Filip2, Satish Govindaraj2, Alfred-Marc Iloreta2.

1 Medical Education, 2Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: SARS-CoV-2 infection has been associated with olfactory dysfunction (OD).

However, the clinical characteristics of SARS-CoV-2-induced OD remain unclear.

RESEARCH QUESTION: The objective of this study was to characterize the natural history of OD associated with SARS-CoV-2 infection.

METHODS: In this cross-sectional study, individuals who experienced OD, including anosmia, hyposmia and parosmia, due to SARS-CoV-2 infection from March 1 to October 15, 2020 were recruited from otolaryngology practices and a web-based application. Participants completed a 56-question OD survey.

Descriptive statistics were used to analyze responses.

RESULTS: 145 participants completed the survey at an average of 176.2 days (SD 31.0 days) following symptom onset. 27.0% (39/145) and 80.0% (116/145) tested positive for SARS-CoV-2 via PCR and antibodies, respectively. At symptom onset, 78.6% (114/145) experienced anosmia, 7.6% (11/145) experienced hyposmia, 2.8% (4/145) experienced parosmia and 10.3% (15/145) experienced both hyposmia and parosmia. The majority, 84.8% (123/145), reported sudden onset OD. 52.4% (76/145) reported concurrent ageusia. OD onset preceded other symptoms in 3.5% (4/114) by a mean of 7.8 days (SD 9.4 days), was concurrent with other symptoms in 13.2% (15/114) while the majority, 83.3% (95/114), reported OD onset after other symptoms by a mean of 9.6 days (SD 14.5 days). Mean severity of OD was 9.34/10 (SD 1.4) at its worst and 4.23/10 (SD 3.3) at survey completion. 83.4% (121/145) reported symptom improvement, with 47.9% (58/121) reporting no improvement until at least 4 weeks. The majority (84.1%, 122/145) reported persistent symptoms, with 54.9% (67/122) reporting both hyposmia and parosmia. Only 15.9% (23/145) reported complete recovery.

CONCLUSIONS: SARS-CoV-2 infection is frequently a≈ssociated with severe, sudden anosmia after general symptom onset. While OD improved over time, the majority experience delayed recovery and persistent symptoms.

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ABSTRACT 34 CONVERSION OF LUMBAR SPINE CT SCANS TO MRI USING MACHINE LEARNING. Eric Geng1, Brian Cho2, Varun Arvind2, Lathan Liou3, Jun Kim2, Samuel Cho2. 1Medical Education, 2,3 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Automated conversion of CT to MRI can provide more cost effective care and allow for patients with certain implantable devices or claustrophobia to access MRI imaging. Cyclic generative adversarial neural networks (CycleGAN) are a type of deep learning algorithm that allows for the translation of images from one domain to another. This method can be leveraged in the medical field to improve radiographic analysis. One such application is the conversion of a CT to an MRI scan.

RESEARCH QUESTION: Therefore, we hypothesized that a CycleGAN may be leveraged to translate CT axial images of the lumbar spine into corresponding MRI images. CT and MRI images were obtained from a single academic institution.

METHODS: A total of 4222 from each domain were used to train the model. Evaluation was performed on 100 CT scans that the model had not seen previously. The algorithm used in this study was adopted from Zhu et al. (Github: https://github.com/junyanz/pytorch-CycleGAN-and-pix2pix).

RESULTS: Based on qualitative observation the CycleGAN was able to create realistic MRI scans from corresponding CTs. Our model demonstrates that a deep learning algorithm may be used for image translation of CT to MRIs. However, more rigorous validation is needed before any potential clinical deployment.

CONCLUSIONS: Future plans include further validation. This includes validating on real CT-MRI pairs of the lumbar spine.

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ABSTRACT 35 NUTRITIONAL COMPARISON OF MILK ALLERGIC AND NON-FOOD ALLERGIC CHILDREN. Kyle Gibson1, Stephanie Stanley2, Shrada Agarwal2, Marion Groetch2, Supinda Bunyavanich3.

1 Medical Education, 3Pediatrics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Cow’s milk allergy commonly presents in childhood when adequate nutrition is essential.

Allergen avoidance can lead to decreased intake of nutrients crucial to growth and development. Milk allergy, specifically, is a concern for both its potential to impair calcium and vitamin D intake and its association with growth delays. Few studies have examined the nutritional intake of milk allergic children using data from the past five years during which there has been a dramatic increase in the availability of dairy substitutes.

RESEARCH QUESTION: Investigation of the nutritional effects of milk allergy in the context of new plant based dairy alternatives.

METHODS: We compared the dietary intake of milk allergic and non-food allergic children using dietary intake data collected from a 168-item food frequency questionnaire. Our sampling included 96 children, ages 2 to 19, of which 14 are milk allergic and 82 are non-food allergic.

Saturated fat, total fat, and protein intakes were assessed as percentages of total caloric intake, while vitamin D and calcium were assessed as percentages of recommended daily allowance (RDA) satisfied. We used linear and ordinal logistic regression models and adjusted for age, gender, race/ethnicity, income, and parental education. Statistical analyses were conducted with R 3.6.3 software.

RESULTS: Children with milk allergy had significantly lower fat intake, a healthier fatty acid ratio, and no significant difference in caloric, vitamin D, calcium, and protein intake when compared to non-food allergic children. In our multivariate linear regression models, milk allergy was significantly associated with a reduction in both saturated (β = -3.21; CI = -4.33 to -2.08; p = <0.001) and total fat intake (β = -3.55; CI = -5.96 to -1.15; p = 0.004). Children with milk allergy also had lower odds of having a poor fatty acid intake ratio (OR =0.08; 95%CI = 0.01 to 0.55). Both groups average calcium and vitamin D intakes below current recommendations, and did not significantly differ.

CONCLUSIONS: These findings support the need for increased nutritional supervision as well as calcium and vitamin D supplementation for children with and without milk allergy, and increased supervision of fat and saturated fat intake in non-food allergic subjects.

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ABSTRACT 36 ANALYSIS OF NATIONAL DATA ON LAPAROSCOPIC VS OPEN SURGERY FOR CN0 M0 SMALL INTESTINE NEUROENDOCRINE TUMORS. Shivee Gilja1, Celia Divino2. 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Appropriate surgical management of small intestine neuroendocrine tumors (SI-NET) remains unclear. Few single-institution studies suggest that laparoscopic resection may result in improved short- and long-term outcomes compared to open resection, but no studies have assessed national trends.

RESEARCH QUESTION: To evaluate post-operative outcomes and long-term survival for laparoscopic resections of SI-NET in a national sample.

METHODS: Overall survival of patients who underwent laparoscopic versus open, non-radical resection for clinical N0, M0 SI-NET in the National Cancer Data Base from 2010 to 2017 were evaluated with Kaplan-Meier analysis as well as multivariable Cox proportional hazards modeling and propensity score (PS) matching (adjusting for demographics, comorbidities, facility information, tumor characteristics, diagnostic lab values and biopsy status, and resection type). Short-term outcomes including length of stay (LOS), surgical margins, nodes examined, and 30-day readmission and mortality rates were also compared in the overall and matched cohorts.

RESULTS: Of the 4,120 patients who underwent non-radical resection for cN0, M0 SI-NET, 2,006 (48.7%) received laparoscopy. The laparoscopic to open conversion rate was 15.0% (n=301). Laparoscopic surgery was associated with better surgical margins, shorter LOS, lower mortality rates, similar nodal upstaging and readmission rates, and trended towards better long-term survival (5-year survival: 87.7% vs. 80.7%, p<0.001; multivariable-adjusted HR: 0.84, 95% CI: 0.69-1.03, p=0.09). In a PS-matched analysis of 2,098 patients, well-balanced on all baseline covariates, patients who received laparoscopic surgery had shorter LOS and less nodal upstaging, and similar surgical margins, readmissions and mortality compared to open surgery.

No significant differences were found in 5-year survival (83.4% vs. 82.9%, p=0.22) between the two groups.

CONCLUSIONS: In this national analysis of open versus laparoscopic resection for clinical N0, M0 SI-NET, laparoscopic surgery was associated with shorter LOS, less nodal upstaging, similar 30-day mortality, and trended towards improved long-term survival compared to open surgery. These findings encourage the wider use of laparoscopic resections for clinical N0, M0 SI-NET.

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ABSTRACT 37 DIAGNOSING LATERAL PLICA SYNDROME OF THE ELBOW VIA MAGNETIC RESONANCE IMAGING. Matthew Gluck1, Amanda Walsh2, Christopher Bellaire1, Zachary Bernstein2, Michael Hausman2.

1 Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Lateral plica syndrome is a rare disorder of the elbow that may be misdiagnosed as lateral epicondylitis due to the similarity in symptoms and presentation. Lateral plica syndrome is caused by extra or a thickening of the lateral synovial folds of the elbow plica. The current standard of care for determining lateral plica syndrome is by identifying a thickened synovial fold during an exploratory surgery, typically during the treatment of lateral epicondylitis. Other synovial fold defects can be diagnosed via Magnetic Resonance Imaging (MRI), furthering the notion that a similar method would exist for lateral plica syndrome.

RESEARCH QUESTION: Can lateral plica syndrome be diagnosed pre-operatively using MRI? METHODS: Twenty-five elbow MRIs were obtained from patients devoid of lateral elbow trauma (n=25).

Three different reviewers took measurements of all twenty-five MRIs and a normal standard value was generated. Then three plica affected MRIs were obtained and randomized with seven normal, unaffected MRIs (infected n=3). These MRIs were measured by the same reviewers in a blinded manner and each value was compared to the standardized cut off value of less than 2.0mm thick as determined from the control MRIs. RESULTS: The average lateral plica measurement for a normal healthy individual was found to be 1.56mm with no healthy plica found to be greater than 2.0mm. Following identification of this standardized value, seven more healthy MRIs were randomized with three infected plica syndrome MRIs. The average thickness of the affected lateral plica was found to be 2.34mm with the thickest being 2.65mm. All three independent reviewers identified the lateral plica syndrome affected elbows by utilizing the cut off value of 2.0mm.

CONCLUSIONS: Due to a lack of diagnostic capabilities, the current standard of care to distinguish between the two is a diagnostic exploratory surgery. In patients with persistent chronic “lateral epicondylitis” surgeons should have a high index of suspicion as the patients may have been misdiagnosed originally. We have determined an accurate method to assess lateral synovial fold thickness using MRI and thus, suggest this method as a potential tool to identify lateral plica syndrome.

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ABSTRACT 38 THORACIC ENDOGRAFT PLACEMENT IN WOMEN: A RETROSPECTIVE COHORT ANALYSIS. Cody Goldberger1, Nicole Ilonzo2, Rami Tadros2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Gender is an important factor that affects both the prevalence and severity of vascular disease, especially in major vascular surgery such as thoracic endovascular aortic repair (TEVAR).

However, women are currently underreported and underrepresented in vascular surgery trials.

RESEARCH QUESTION: The aim of this study is to characterize rates of early and late complication, reintervention, and 30-day mortality in women after TEVAR. METHODS: A retrospective chart review utilizing a single center prospectively managed retrospective database was performed. Data for 110 women undergoing TEVAR procedures at Mount Sinai between 2001 and 2019 was compiled. Patient demographics, procedure indication, comorbidities, anesthesia type, intraoperative device measurements and deployment characteristics including stent diameter and proximal landing zone were collected. Post-operative outcomes including cerebrovascular accident, myocardial infarction, bleeding requiring transfusion, and prolonged intubation were analyzed. Primary outcomes were 30-day mortality, early and late complication rate, length of stay, and reintervention rate. Kaplan-Meier analysis for long-term survival was performed.

RESULTS: 52.7% of the 110 patients had cardiac comorbidities, 73.6% had hypertension, 39.1% had cholesterol comorbidities, and 49.1% were either current or former smokers. 50.0% of patients underwent TEVAR for thoracic aortic aneurysm, 13.6% for type B aortic dissection, and 12.7% for penetrating ulcer.

Proximal landing zones were predominantly zone 2 (33.0%). Complications were overall low, with 0% cardiac arrest, 0% wound complications, and 0.9% 30-day mortality. 16.4% of patients had an endovascular aortic stent graft placement or extension reintervention for endoleak. Long-term survival outcomes were 82.4%, 70.8%, 40.0% at 12, 24, and 64 months, respectively, in patients undergoing elective TEVAR. CONCLUSIONS: It is important to highlight characteristics of TEVAR in women in order to direct areas of focus for comparative studies. Future plans will incorporate a comparative study evaluating outcomes after TEVAR in a cohort of men and women.

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ABSTRACT 39 E-CONSULTATION AMONG CLINICIANS DURING THE COVID-19 PANDEMIC: A RETROSPECTIVE OBSERVATIONAL STUDY. Gary Gravesandy1, Anna Potapov2. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2RubiconMD, New York, NY. BACKGROUND: During the early stages of a pandemic and epidemics primary care clinicians (PCCs) are large components of the front line of care. While currently many health communications efforts target the public, it is imperative that clinicians are informed in a timely manner on matters most relevant to their care.

RESEARCH QUESTION: Considering the larger degree of unknowns, as well as the complex roles primary care physicians fulfill during a pandemic, it is likely that primary care consultation topics change with and reflect what information is most crucial to be clarified in a given situation.

METHODS: To determine the most relevant information at different time points during the pandemic 560 consults submitted to RubiconMD’s COVID specialty queue were reviewed and topics of inquiry were recorded. 1179 inquiries were stratified into 34 topics that were then grouped into either Diagnosis, Prevention, Treatment, Risk Factors, Monitoring, Healthcare Worker Precautions, and Complications.

RESULTS: A simple linear regression revealed a significant negative linear relationship between total number of consults submitted and time (p < 0.001) stratified into weeks (R2 = 63.69%). Based on Pearson’s correlation there is a large positive association between inquiries related to Diagnosis (r = 0.79), Prevention (r = 0.73), Risk Factors (r = 0.72), and Treatment (r = 0.50) compared to the total number of consults submitted.

CONCLUSIONS: Further analysis of trends currently suggest a strong correlation between Diagnosis and Prevention inquiries and CDC new COVID case data. There also seems to be an interaction between Complication inquiries concerning respiratory vs. non-respiratory symptoms. Comparison of treatment data to dates of news headlines regarding COVID treatment suggest an increase in inquiry volume post headlines. Further analysis of these 3 trends is planned to determine significance. Analysis and inclusion of resulting data from RubiconMD’s Infectious Disease queue is planned.

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ABSTRACT 40 PATTERNS OF SOCIAL SERVICES USAGE DURING THE SPRING 2020 COVID PANDEMIC

BY SURVIVORS OF TORTURE AND OTHER SERIOUS HUMAN RIGHTS ABUSES AT THE LIBERTAS CENTER FOR HUMAN RIGHTS. Jacques Guyot1, Ayushi Chandramani2, Dinali Fernando2, Ben McVane2. 1Medical Education, 2 Emergency Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The Libertas Center for Human Rights at Elmhurst Hospital provides medical, mental health, social and legal services to survivors of torture, 90% of whom are asylum seekers.

RESEARCH QUESTION: This study aims to measure how the usage of its services changed during the Covid pandemic of spring 2020, in which the residents of Queens, NY were particularly hard-hit.

METHODS: We performed a retrospective, mixed-methods chart review of 799 encounter notes drawn from four two-week sample periods spaced at 15-week intervals over the course of one year. The last coincides with a high case prevalence period of the Covid-19 pandemic in Queens, NY. Changes in utilization rates and proportions of crisis encounters and of subcategories of offered services were studied using chi-square analyses. Phi coefficients were used to examine correlations between these subcategories.

The two-week Covid period was also subject to a qualitative thematic analysis using a grounded theory method. Using an inductive coding process, two coders independently assigned relevant descriptors to each of 152 encounter notes. Themes were then developed through a consensus-driven process with an independent third-party.

RESULTS: The proportion of crisis encounters to total encounters increased from 12% of cases in the nonCovid weeks to 95% of cases during the Covid period. A chi-square analysis confirmed statistical significance.

There were large increases in the proportions of encounters in which employment, finances, food, and housing concerns were addressed and a decline in the proportion of encounters in which mental health needs were addressed.

Our thematic analysis of 152 notes from encounters taking place between April 20 and May 1 2020 produced 11 distinct themes that provided insight into client concerns and common therapeutic strategies used by Libertas providers.

CONCLUSIONS: These findings suggest that there was a large and significant increase in the severity and urgency of Libertas encounters during the Covid pandemic. The shifting patterns of utilization of Libertas services illustrates the significant socioeconomic externalities, brought on by the pandemic, which created non-medical emergencies, often financial in nature, among some of the most vulnerable populations in New York City.

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ABSTRACT 41 WE’VE ENTERED AN UNPRECEDENTED MARKET FOR AGING IN PLACE. Kaitlin Hanss1, Megan Zweig2, Chipper Stotz2. 1Medical Education, 2 Rock Health.

1 Icahn School of Medicine at Mount Sinai, New York, New York, 2San Francisco, CA. BACKGROUND: Technology will become central to the practice of medicine and public health. To explore the digital health landscape in geriatrics, Rock Health, an early-stage digital health venture capital firm, partnered with Mount Sinai’s Diversity Innovation Hub to explore opportunities for investment.

RESEARCH QUESTION: The project focused on two central questions to guide investment strategy: 1) What is the investment rationale to invest in aging in place technology? and 2) What segments of the aging in place market should be targeted?

METHODS: The project methods involved policy research and market analysis to answer the two aforementioned investment strategy questions.

RESULTS: Older adults overwhelmingly want to age in their current homes (“age in place”) and are increasingly comfortable with technology. What is more, changes in CMMS policy over the past 2 years have opened the door to more extensive at-home care insurance coverage. While many older adults today believe they will not be able to afford to age in place, this paradigm will likely shift dramatically over the next decade, accelerated by newfound fears of long-term care facilities in the wake of COVID-19.

A unique opportunity for technology to support older adults and families is evident in the following aging in place segments: 1. Bringing transparency to Medicare Advantage open enrollment and supplemental benefits 2. Fighting loneliness and its detrimental effects on mental health 3. Supporting older adults who experience food insecurity 4. Bridging the communication gap between seniors and healthcare professionals 5. Enabling at-home rehabilitation—particularly in rural areas 6. Extending the acuity of care that can be safely delivered at home 7. Connecting more home care providers to families—especially for assisting ADL and IADLs 8. Proactively supporting unpaid caregivers as they navigate complex decisions CONCLUSIONS: Physicians are in a unique position to shape the emerging digital health landscape to best serve patients. Physicians can drive market excitement and direct investing dollars towards technology that supports patients, guide the creation and design of these products, and to connect patients informedly to these new technologies.

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ABSTRACT 42 IMPROVING POSTPARTUM CARE: IDENTIFYING OPPORTUNITIES TO REDUCE POSTPARTUM EMERGENCY ROOM VISITS AMONG PUBLICLY-INSURED WOMEN OF COLOR. Taylor Harrell1, Ksenia Gorbenko2, Amy Balbierz2, Luz Guel3, Juan Pena4, Teresa Janevic4, Elizabeth Howell4.

1 Medical Education, 2Population Health Science and Policy, 3Environmental Medicine & Public Health, 4 Obstetrics, Gynecology, and Reproductive Science. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Racial and ethnic disparities in maternal health are a public health crisis in the United States.

Black women are more likely to have an emergency department (ED) visit after delivery, and Black and Latina women have a two-fold increased risk of postpartum hospital readmission relative to White women.

Clinical risk factors for postpartum complications and ED usage have been extensively described. Yet, the current body of literature lacks the patient perspective on what brings women to the ER, and whether there were opportunities for intervention along their journey. Identifying key factors that lead to increased rates of postpartum ED visits can inform quality improvement efforts. However, a more thorough investigation into the patient lived experiences driving ED visits, especially for disadvantaged women of color, is needed.

RESEARCH QUESTION: We aimed to explore the postpartum experiences of publicly-insured women of color, and identify how postpartum care can be improved to reduce hospital ED usage after delivery.

METHODS: We conducted four virtual focus groups using a HIPAA compliant platform with 18 publiclyinsured women who primarily identified as Black and/or Latina. Three English focus groups (N=12) were conducted in July and August 2020 and one Spanish focus group (N=6) was conducted in October 2020.

We oversampled women who utilized the emergency department within 30 days of delivery. A moderator guide containing open-ended questions was used to ensure consistency among focus groups. We used Dedoose software to facilitate data management and analysis.

RESULTS: We identified four domains: lack of access to and communication with a medical team; lack of preparation; the value of social support; and participant-identified opportunities for improvement.

CONCLUSIONS: Our findings suggest that focused efforts on enhancing continuity of care to increase healthcare access, strengthening patient-provider communication by training providers to recognize unconscious bias, increasing postpartum preparation by adapting teaching materials to an online format, and engaging women’s caregivers throughout the pregnancy course to bolster social support, may be beneficial to improving postpartum care and reducing excess emergency department usage after delivery.

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ABSTRACT 43 ASSESSING ANXIETY IN CANCER PATIENTS DURING COVID-19 IN NEW YORK. Gabrielle Hernaiz-De Jesus1, Beselot Birhanu1, Molly Lieber2, Annmarie Beddoe3. 1Medical Education, 3 Oncological Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Psychosocial care is a crucial part of effective cancer care; it is recommended that cancer patients be screened periodically for depression and anxiety because of high prevalence in that population.

This in turn can make it more difficult for patients to adhere to treatment and can negatively impact the course of their cancer. To our knowledge, it is not currently understood how and if the stresses of the COVID-19 pandemic have affected cancer patients.

RESEARCH QUESTION: We postulated that severe anxiety among cancer patients would be associated with having thoughts of stopping or changing adherence to treatment, and that differences in anxiety would be stratified among demographic lines.

METHODS: We measured anxiety levels among cancer patients during the COVID-19 pandemic in New York.

All English and Spanish-speaking patients who were scheduled to undergo chemotherapy at the Blavatnik Family – Chelsea Medical Center at Mount Sinai during March & April 2020 were asked to complete an anonymous survey via an emailed link, regardless of COVID-19 status or cancer type. Of the 335 with an email on file, there were 46 respondents (13.7% response rate). The 7-item Generalized Anxiety Disorder Scale (GAD-7) was used to score anxiety levels among respondents and stratify them into two groups: not severe (GAD < 15) and severe (GAD ≥ 15). Participants were also asked whether they had had thoughts of changing or stopping their treatment as a result of COVID-19 (yes or no).

RESULTS: Among respondents, severe anxiety was significantly associated with answering “yes” to this question (Fisher exact test, p < 0.001). Additionally, there was a there was a statistically significant difference between self-identified non-white participants compared to white participants on severity of anxiety (Fishers Exact test=0.014, p <.05).

CONCLUSIONS: These results indicate that the COVID-19 pandemic has the potential to negatively impact treatment in cancer patients by affecting adherence, and that having thoughts of changing or stopping treatment is associated with severe anxiety. In the setting of this outbreak, it is even more crucial for providers to ensure that they are proactively meeting the psychosocial needs of their oncologic patients to continue to deliver effective care.

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ABSTRACT 44 ANTI-COLONIALISM IN GLOBAL HEALTH GRANT APPLICATIONS: A SINGLE-SITE, PARTICIPANT-OBSERVATION-BASED ASSESSMENT. Terence Hughes1, Bibhav Acharya2, Nandini Choudhury3, Biraj Karmacharya4, Kim Lipman-White3, Pranil Pradhan4, Anant Raut3, Pragya Rimal5, Sabitri Sapkota3, Aradhana Thapa5, Karen Wilson6, Duncan Maru3. 1Medical Education, 3Global Health, 2Psychiatry, 6Pediatrics. 1,3,6Icahn School of Medicine at Mount Sinai, New York, New York, 2University of California San Francisco, San Francisco, CA, 4 Kathmandu University, Dhulikhel 45200, Nepal, 5Possible Health, New York, NY. BACKGROUND: Anti-colonialism in global health aims to eliminate colonial power imbalances inherent in Western scholar-driven work. Central to anti-colonial global health are more equitable grant application processes, particularly within NIH’s Fogarty International Center (FIC), a global arm of the largest public biomedical research funder.

RESEARCH QUESTION: How do NIH grant application processes drive/impede efforts to conduct anti-colonial global health research?

METHODS: While interning at a nonprofit focused on one South Asian country, I employed participantobservation while working on two NIH grant applications. Participant-observation included participating in literature reviews, application writing, team meetings, and reflections, and observing team structure and meeting flow. Nonprofit identity, application contents, and country of study are anonymized to protect confidentiality.

RESULTS: All meetings were conducted in English. The team defined application success as being awarded NIH funding. Team leaders demonstrated familiarity with NIH, either through receipt of prior funding, or past selection committee membership. I observed team leaders leverage these experiences to highlight factors believed to increase our likelihood for success. Team leaders focused on curating the full application team before finalizing grant content, and sought team members satisfying two forms of expertise - subject-matter and geospatial-context. Observing individual roles and contributions, I determined that subject-matter expertise was typically filled by widely-cited scholars affiliated with US-based institutions with previous NIH funding. Geospatial-context expertise was typically filled by scholars from the country of study, familiar with on-the-ground realities.

CONCLUSIONS: Based on this single-site participant-observation study, NIH FIC grant processes simultaneously drive and impede anti-colonial efforts in funding applications. Prioritizing geospatial-context expertise serves as an anti-colonial force by strengthening cultural competence and increasing LMIC-basedscholar representation. Observed barriers to even broader LMIC-based-scholar representation include language and use of prior NIH funding receipt and publication count as proxies for subject-matter expertise.

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ABSTRACT 45 COMMUNITY PERSPECTIVES ON THE MANIFESTATIONS OF CARDIOVASCULAR DISEASE IN RURAL GHANA: A QUALITATIVE STUDY. Isla Hutchinson Maddox1, Bhavana Patil1, Raymond Aborigo2, Khadija Jones3, Denis Awuni2, Allison Squires4, Abraham Oduro2, Carol Horowitz5, David Heller3. 1Medical Education, 3Global Health, 5Population Health Science and Policy. 1,3,5Icahn School of Medicine at Mount Sinai, New York, New York, 2Navrongo Health Research Center, 4New York University, New York, New York.

BACKGROUND: As the burden of cardiovascular disease (CVD) continues to rise in Ghana, there are many barriers to widespread prevention and treatment including scant community education about the disease particularly in rural regions. While preventative primary care is provided by a nurse-led initiative, the Community-based Health Planning and Services (CHPS), community members (CM) are not screened regularly for hypertension and are often unaware of a CVD diagnosis.

RESEARCH QUESTION: We aimed to gauge CMs’ understanding of CVD: its symptoms, prevention and prognosis in order to strengthen a primary care intervention in Navrongo.

METHODS: In the Kassena-Nankana Districts outside Navrongo, staff conducted one-on-one interviews with 30 CMs in their preferred languages using interview guides based on the study’s research objectives.

We used convenience sampling to identify respondents who matched our inclusion criteria based on age, gender, and level of engagement with the CHPS program. Research assistants conducted interviews and transcribed audio recordings into English. We coded the transcripts using NVivo qualitative software.

Analysis was guided by the grounded theory approach.

RESULTS: CMs described a rapid disease course for individuals diagnosed with CVD rather than a chronic asymptomatic progression of disease, believing that patients typically suffer a sudden death that cannot be predicted. CMs focused on cardiac symptoms such as palpitations and chest tightness when asked to describe what CVD might feel like, although many also stated that heartburn is a sign. While CMs identified high-burden risk factors including smoking and diet, they also highlighted that emotional burdens and stressors can contribute to and exacerbate symptoms of CVDs. Many CMs expressed interest in counseling on these risk factors.

CONCLUSIONS: The care model in Navrongo directs more resources towards treatment once a patient becomes symptomatic rather than underlining the importance of prevention and early diagnosis of CVD. An analysis of CMs’ understanding demonstrated that education about CVD and its prognosis is fundamental to ensure that - once logistical barriers to expand regular screenings are overcome - the community will participate even if asymptomatic.

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ABSTRACT 46 MARJOLIN’S ULCERS VS SQUAMOUS CELL CARCINOMA: A CUMULATIVE RETROSPECTIVE. Sidra Ibad1, Clay Cockerell2. 1Medical Education, 2Dermatology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2Cockerell Dermatopathology 2110 Research Row #100 Dallas, TX 75235.

BACKGROUND: Marjolin’s ulcers are a type of rare, atypical malignancy arising from locations of trauma or ulceration. The latency period for SCCs from Marjolin’s ulcers is prolonged, requiring around 30-35 years for malignant transformation.

RESEARCH QUESTION: How do Marjolin’s ulcers compare to traditional squamous cell carcinomas?

METHODS: This was a cumulative retrospective study of confirmed cases of Marjolin’s ulcers in the settings of a tertiary care cancer center in South India from 2002-2012, a burn center in southwest China from 2013-2017, and a teaching hospital in Northwestern Tanzania from 2001-2010, chosen for their extensive records of Marjolin’s ulcers in their respective countries. Marjolin’s ulcers were confirmed by a combination of histopathological findings and a history of prior trauma.

RESULTS: 136 of the 210 participants were males and 74 were females. The studies reported 4.3% cases in the age range from 10-19, 9.1% cases from 30-39, 27% cases from 40-49, 26.2% cases from 50-59, 22% cases from 60-69, and 11% cases from 70-100. In the study conducted in the cancer center of India, 28.6% of cases resulted in lymph metastasis, 7.1% resulted in distant metastasis, and 64.3% resulted in no metastasis.

The study reported 21.4% cases of recurrence. In the study conducted in the burn center in China, 33.6% of cases resulted in lymph metastasis, 3.6% resulted in distant metastasis, and 62.9% resulted in no metastasis.

The study reported 4.3% recurrence. Overall, there was a total lymph node metastasis rate of 32.8%, a total distant metastasis rate of 10%, and a 57.1% rate of no metastasis. The total recurrence rate was 14.8%.

CONCLUSIONS: The recurrence rate of 14.8% and metastasis of 42.9% were considerably high, especially considering the low likelihood of metastasis for SCC. Given the high latency period of Marjolin’s ulcers, they will be more likely to reach Stage 3 and Stage 4 than classic SCC. However, it remains unclear why the percentage of lymph metastasis and distant metastasis have a much smaller margin of a difference given that SCCs metastasize primarily to lymph nodes. This suggests that there is less distinction between the lymph node and distant metastasis than are for typical SCCs.

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ABSTRACT 47 FACTORS ASSOCIATED WITH MALNUTRITION IN CHILDREN WITH EOSINOPHILIC GASTROINTESTINAL DISEASES. Tyler Italiano1, Talaya McCright-Gill2, Lauren Solinsky2, George Konstantinou3, Mirna Chehade2.

1 Medical Education. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3 424 General Military Training Hospital Thessaloníki, Greece.

BACKGROUND: Eosinophilic gastrointestinal (GI) diseases, including Eosinophilic Esophagitis (EoE) and Eosinophilic GI Disorder with esophageal involvement (EGID/E), are chronic inflammatory diseases of the GI tract. No studies to date have investigated the association between EoE and EGID/E and signs of malnutrition.

RESEARCH QUESTION: What are the factors associated with malnutrition in children with EoE and EGID/E? METHODS: A retrospective chart review of children 2-20 y.o. seen at the Mount Sinai Center for Eosinophilic Disorders was conducted. Diagnostic pathology reports were reviewed for the peak eosinophil number per high power field (HPF) in all areas of the esophagus. Patients with a count of ≥15/HPF in ≥1 area were included and classified as EoE. Histological severity was categorized by the maximum/mean peak value for each patient. Patients with concurrent GI eosinophilia were included and classified as EGID/E. Malnutrition was assessed using anthropometric data collected ± 3 weeks from biopsy. Weight-for-age and height-for-age z-scores were calculated using the Stata® appropriate function for standard growth curves using the 2000 CDC Growth Reference. Spearman’s Correlation Coefficients were calculated to determine association between z-scores and histological severity for all subjects and for EoE and EGID/E diagnoses separately.

RESULTS: 107 subjects were identified (29.0% Female, 77.6% EoE). Median weight-for-age and heightfor-age z-scores were -0.134 [IQR -1.115, 0.543] and -0.389 [IQR -1.031, 0.309] respectively. Median maximum and mean peak esophageal eosinophil counts were 70.0 [IQR 41.5, 99.5] and 52.3 [IQR 31.0, 75.2] respectively. Overall and for each diagnosis, no statistically significant association was found between z-scores and histological severity.

CONCLUSIONS: Signs of malnutrition were found in our subjects. They were not associated with esophageal histological severity or more extensive GI eosinophilic involvement. Investigation is ongoing to examine other measures of malnutrition (micronutrient deficiencies) and additional factors potentially influencing malnutrition (age at diagnosis/symptom onset, symptom duration/severity). Additional timepoints will also be studied to determine if malnutrition can be reversed with disease remission.

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ABSTRACT 48 EFFECT OF CARCINOID TUMOR SURGICAL RESECTION ON PATIENT QUALITY OF LIFE: A PROSPECTIVE ANALYSIS. James Johnson1, Laura Olson2, Venu Bangla2, Celia Divino2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: For patients with carcinoid tumors, surgery can be potentially curative and reduce carcinoid syndrome symptoms. However, recurrence is common even years after surgery, leading to poor quality of life. Few studies have examined quality of life in patients with these tumors following surgical intervention. In addition, these studies were cross-sectional surveys that examined quality of life at a single time point. To our knowledge, no study has analyzed quality of life changes in carcinoid patients in a prospective manner.

This study aims to assess changes in self-reported quality of life in patients with carcinoid tumors following resection procedures.

RESEARCH QUESTION: We believe that quality of life in those who undergo surgical resection for carcinoid neuroendocrine tumors will improve over time.

METHODS: We administered prospective, longitudinal quality of life assessments using the validated instrument the 12-item Short Form Survey (SF-12). The SF-12 is a validated short form survey that captures information on overall quality of life. For these subjects, we conducted a baseline survey preoperatively followed by 3-month and 6-month post-operative surveys if not lost to follow up. The Physical Health Composite Scores (PCS) and Mental Health Composite Scores (MCS) were computed from the SF-12 survey results, and statistical analysis of these scores was performed with a Wilcoxon signed-rank test with scores paired by study participants.

RESULTS: We have administered the SF-12 to 20 patients who underwent carcinoid tumor resection.

5 patients have completed both follow up surveys at this time. There was no improvement in PCS score when comparing baseline surveys to follow up survey scores. However, there is a mild improvement in MCS 3 months after surgery (p = 0.38), and this trend continues at 6 months as the MCS scores improve by 10 points on average (p=0.06).

CONCLUSIONS: Overall, patients show a trend towards improvement in their MCS as reported on the SF-12 following surgical resection of carcinoid tumors. This is most likely due to the cessation of carcinoid syndrome upon removal of tumors and the neuroendocrine effects. We will continue to administer the survey to the remaining study participants and are currently recruiting additional study subjects.

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ABSTRACT 49 BARRIERS TO TELEHEALTH ACCESS IN A POPULATION OF VULNERABLE HOMEBOUND ADULTS. Alexander Kalicki1, Peter Gliatto2, Katherine Ornstein2. 1Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: In April 2020, the Mount Sinai Visiting Doctors (MSVD) program reduced in-person visits by nearly 100% compared to pre-COVID-19 rates. With the assistance of a grant from the FCC, MSVD purchased 141 video-enabled devices and hopes to increase telehealth usage within the program.

RESEARCH QUESTION: What are the major barriers to telehealth access among the MSVD population?

METHODS: 16 MSVD physician providers were emailed a REDCap survey and asked to complete it for each of their active patients. Physicians were asked about patients’ existing access to telehealth and ability to interact over video without a caregiver present to assist. They were also asked to elaborate barriers to access among their patient population.

RESULTS: The patients were on average 82.7 years old, predominantly female, white, and English speaking.

Of the 873 not in congregate housing, 310 (35%) had previously engaged in video visits. Among these patients, 89% required the assistance of a caregiver (family member or aide).

Of the 563 “tele-naive” patients, 153 were deemed “unable to interact effectively over video” by their provider.

Major reasons cited include cognitive impairment, dementia, and blindness/deafness. Almost 50% (n=274) of the tele-naïve patients would need help to interact over video. Among these, 28% (n=78) do not have a caregiver present who would be able to assist.

Physicians did not know whether their patients had sufficient internet connectivity at home (“Don’t Know”: 72.4%, “Yes”: 14.2%, “No”: 13.4%), had challenges paying cellular plan costs (“Don’t Know”: 65.4%, “Yes”: 22.3%, “No”: 12.3%), or had access to a device with video capability (“Don’t Know”: 48.3%, “Yes”: 9.2%, “No”: 42.5%).

CONCLUSIONS: The COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use at MSVD. However, a majority of MSVD patients have yet to participate in a video-based telehealth encounter, even though they may be able to engage with the help of a caregiver. Still, some patients will always require in-person care. Physicians struggled to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.

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ABSTRACT 50 PSYCHOLOGICAL CONSEQUENCES AMONG RESIDENTS AND FELLOWS DURING THE COVID-19 PANDEMIC IN NEW YORK CITY: IMPLICATIONS FOR TARGETED INTERVENTIONS. Carly Kaplan1, Chi Chan2, Jordyn Feingold1, Halley Kaye-Kauderer1, Robert Pietrzak3, Lauren Peccoralo1, Adriana Feder2, Steven Southwick3, Dennis Charney2, Larissa Burka4, Madeleine Basist5, Jonathan Ripp6, Saadia Akhtar7. 1Medical Education, 2,3Psychiatry, 5Medicine, 6Geriatrics and Palliative Medicine, 7Emergency Medicine. 1,2,4,5,6,7Icahn School of Medicine at Mount Sinai, New York, New York, 3Yale School of Medicine, New Haven, Connecticut.

BACKGROUND: COVID-19 radically changed the learning and working environments for medical trainees, a group already at risk for burnout and distress.

RESEARCH QUESTION: We sought to examine the psychological impact of the COVID-19 pandemic on residents and fellows working at the Mount Sinai Hospital (MSH) in New York City (NYC), the initial epicenter of the United States pandemic.

METHODS: We administered a survey to 991 trainees in frontline specialties working at MSH in NYC between April and May, 2020. The instrument assessed symptoms of major depressive disorder, generalized anxiety disorder, COVID-19-related posttraumatic stress disorder, and burnout. Psychiatric screens were aggregated, such that meeting criteria on any of the three scales was considered a positive screen for psychiatric symptoms. The survey also assessed COVID-19 related exposures, worries, coping strategies, and desired interventions. Multivariable logistic regressions were conducted to identify factors associated with psychiatric symptoms and burnout.

RESULTS: Of the 561 respondents (56.6% response rate), 29.7% screened positive for psychiatric symptoms and 35.8% screened positive for burnout. History of a mental illness, COVID-19-related duties and personal/ career worries, and coping by substance use were all associated with increased likelihood of screening positive for psychiatric symptoms. Positive emotion-focused coping and feeling valued by one’s supervisors were associated with a decreased likelihood of screening positive. Internal Medicine and Surgical specialties, a history of mental illness, increased work hours, duty-related worries, personal/career worries, coping via self-blame and venting, and coping via substance use were associated with higher odds of burnout. Feeling valued by supervisors was associated with decreased burnout odds. The most common crisis-related needs included access to PPE, food provisions, and financial support.

CONCLUSIONS: Psychological distress and burnout affected approximately a third of trainee respondents.

As the pandemic continues to surge, our findings suggest that interventions should include addressing basic needs (e.g. PPE), promoting leadership affirmation, moderating work hours, supporting trainees financially, and enhancing mental health support.

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ABSTRACT 51 RACE AND INSURANCE STATUS OUTCOME DISPARITIES FOLLOWING SPLENECTOMY IN TRAUMA PATIENTS ARE SMALLER IN HIGH-VOLUME HOSPITALS. Harrison Kaplan1, Michael Leitman2. 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Splenectomy is commonly performed as a treatment for splenic injury in trauma patients and has a high rate of complications. The purpose of this study was to identify predictors, including race and insurance status, associated with mortality and complications post-splenectomy in trauma patients.

RESEARCH QUESTION: Are race and insurance status associated with disparities in mortality and complication rates in trauma patients who undergo a splenectomy? Are there other factors, such as hospital size, that can explain these disparities and guide interventions to reduce these disparities in the future?

METHODS: The ACS-TQIP participant user database was queried from 2010-2015. Patients who underwent total splenectomy were identified. All mechanisms of injury, including both blunt and penetrating trauma were included. Patients with advanced directives or age < 18 were excluded. Propensity score matching was used to control for age, pre-existing medical conditions, and the severity of the traumatic injury. Race was categorized into white, Black, and other, based on the primary race field, consistent with previous studies using the TQIP database. Hispanic ethnicity was also analyzed. A chi-squared test was used to find significant associations.

RESULTS: The post-splenectomy mortality rate was 9.2% (n = 1,047), 8.0% (n = 918) had three or more complications, and 20.3% (n = 2,315) had major complications. A primary race of white (OR 0.7, 95%CI 0.60.9) and private insurance (OR 0.5, 95%CI 0.4-0.6) were associated with lower risks of mortality. A primary race of neither black nor white (OR 1.3, 95%CI 1.03-1.7) and a lack of health insurance (OR 1.6, 95%CI 1.3-1.9) were both associated with mortality. Hispanic ethnicity was not associated with mortality. When limited to 600+ bed hospitals, there were no associations between race and mortality.

CONCLUSIONS: In US trauma centers, race and payment status are associated with adverse outcomes after splenectomy following a traumatic injury. These disparities are reduced when limiting the analysis to larger hospitals. Efforts to reduce disparities in outcomes among trauma patients requiring a splenectomy should focus on improving resource availability and quality in lower-volume hospitals.

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ABSTRACT 52 PATIENT CHARACTERISTICS ASSOCIATED WITH RETENTION IN AN ASTHMA SELF-MANAGEMENT TRIAL FOR OLDER ADULTS. Dustin Kee1, Alex Federman2. 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: New self-management interventions are being developed for older adults who suffer from worse asthma morbidity than their younger counterparts, but high rates of study drop out have hampered these efforts and there is limited literature on what factors may influence retention in behavioral intervention studies with older adults. Illness beliefs have been shown to affect asthma self-management but have not been well-studied. A better understanding of these predictors can help researchers account for them to improve trial retention and clinical engagement among underrepresented populations.

RESEARCH QUESTION: Do illness-related beliefs or other patient characteristics have an association with retention in an asthma self-management trial for older adults?

METHODS: Data was from the Supporting Asthma Self-Management Behaviors in Older Adults (SAMBA) trial and subjects were 60 years and older with persistent, uncontrolled asthma. The conceptual framework was based on the Aday-Anderson Behavioral model. Multivariable logistic regression was used to evaluate characteristics associated with study retention at 12 months and 6 months, among all participants and subgroups of control and intervention arms.

RESULTS: A total of 388 individuals participated and 261 (67.3%) completed the 12-month study. Higher perceived relative threat of other chronic diseases relative to asthma was associated with higher study retention (OR=1.10, 95% CI=1.00-1.22, p=0.05) at 12 months. Other variables including specific asthma beliefs, age, cognitive function, health literacy, and asthma symptoms were not found to be significantly associated with retention.

CONCLUSIONS: There was a low overall retention rate, and the finding of greater retention with lower perceived threat of asthma relative to other chronic diseases contrasted expectations based on previous literature. Overall, no consistent associations were found between illness beliefs or other predictor variables and study retention despite a thorough, theory-based analysis. Further research including qualitative studies is needed to better understand why patients complete or drop out of asthma behavioral intervention studies and can be used to guide development of novel strategies for engagement.

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ABSTRACT 53 A STUDY OF THE EVOLUTION OF THE TECHNIQUE FOR PITUITARY TUMOR RESECTION: A SINGLE INSTITUTION STUDY. Rebecca Kellner1, Aisosa Omorogbe2, David Lerner3, Alfred-Marc Iloreta3. 1Medical Education, 2,3 Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Mount Sinai.

BACKGROUND: The technique for endoscopic transsphenoidal pituitary tumor resection has evolved at Mount Sinai Hospital. The endoscopic transsphenoidal approach accesses the tumor through the sphenoid sinus, causing a defect in the skull base. The technique for reconstruction of the skull base defect is variable and involves multiple layers and materials. Complications from pituitary tumor resection include bleeding, CSF leak, and the development of postoperative sinusitis. Published rates in the International Collaborative Study on Craniofacial Surgery suggests a CSF leak rate of 6.5–25.0%.

RESEARCH QUESTION: The transition in technique towards the usage of nasoseptal flaps, the resection of the middle turbinate, and the switch to dissolvable packing results in fewer postoperative leaks and complications.

METHODS: Collected variables and outcomes of interest from patients that received endoscopic transsphenoidal pituitary tumor removal at Mt. Sinai Hospital from 2013 to 2020. Statistical analysis including odds ratio and relative risk calculations will be used to determine the accuracy of our hypothesis.

RESULTS: We have collected the data from 162 endoscopic resections for pituitary tumors from 20132020. Overall, results indicate an increase in the number of cases (1 in 2013 to 40 in 2019, average growth of 117% each year).Of these patients 69% were pituitary adenomas, 5.4% were Rathke’s cleft cysts, 4.3% were craniopharyngiomas and 17% were classified as “other.” There was an increase in the utilization of middle turbinate flaps (0% in 2013 to 35.3% in 2020), a decrease in use of naso-septal flaps (75% in 2013 to 62.7% in 2020), and increase use of tensor fascia lata grafts. Our outcomes across the entire time period show an overall post-op CSF leak rate of 3.1% (with a decrease from 5% in 2015 and 2% in 2020), an average length of stay of 3.52 days (range from 3.3-4.06), and 19.8% 30-day readmission rate. Other notable outcomes include minimal postoperative complications including 2% visual compromise, 5.9% electrolyte imbalance, and no incidence of stroke or mortality.

CONCLUSIONS: Data suggests that the transition in protocol has led to a decrease in the incidence of postoperative CSF leaks than what is reported in the literature and overall low complication rates.

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ABSTRACT 54 LONG TERM OUTCOMES AFTER INITIAL CARDIAC SURGERY IN PATIENTS WITH MARFAN SYNDROME PRESENTING WITH THORACIC AORTIC DISSECTION. Spencer Kiehm1, Timothy Lee2, Natalia Egorova3, Shinobu Itagaki2. 1Medical Education, 2 Cardiovascular Surgery, 3Population Health Science and Policy. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Marfan syndrome (MFS) is a systemic connective tissue disorder that affects 2-3 in 10,000 individuals and can manifest as life-threatening complications of the cardiovascular system. Currently, while indications for and rates of initial cardiac surgery in patients with MFS are well-characterized, long-term outcomes of initial surgery are poorly understood.

RESEARCH QUESTION: What are the long-term outcomes of initial cardiac surgery in patients with MFS presenting with thoracic aortic dissection?

METHODS: Patients with MFS undergoing initial cardiac surgery were identified using ICD-9-CM codes in the SPARCS database in New York (2001-2013) and the OSHPD database in California (1996-2013).

Out-of-state residents and children less than 12-years were excluded. Comorbidities and procedures were identified using ICD-9-CM codes. Deaths were identified using social security death data and inpatient and outpatient records. Baseline characteristics were compared using Student’s t test and Pearson’s Χ2 test.

Long-term survival and freedom from reoperation were estimated using Kaplan-Meier methods. All-cause mortality and reoperation were evaluated using multivariable Cox regression. All statistical analyses were performed using SAS version 9.4.

RESULTS: A total of 1,125 patients with MFS underwent initial cardiac operations, 285 (25%) of whom presented with thoracic aortic dissection. Those who presented with dissection were older (mean, 40.5 [SD 12.8] vs 38.4 [SD 15.0] years; P = .0195) and more likely to have a history of hypertension (56% vs 37%, P < .0001), peripheral vascular disease (11% vs 4%, P < .0001), and stroke (9% vs 3%, P = .0001). Dissection was associated with decreased 15-year survival (58% [95% CI, 49-65%] vs 77% [95% CI, 72-81%], P < .0001) and decreased 15-year freedom from reoperation (56% [95% CI, 49-66%] vs 77% [95% CI, 71-82%], P < .0001). Hazard ratios for all-cause mortality and cardiac reoperation after dissection were 2.8 (95% CI, 2.1-3.7) and 2.5 (95% CI, 1.9-3.5), respectively.

CONCLUSIONS: Patients with MFS who present with thoracic aortic dissection are at significantly increased risk for poor long-term outcomes. Closer monitoring to prevent aortic dissection as well as more careful follow-up may improve longevity in these patients.

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ABSTRACT 55 KAHOOK DUAL BLADE VERSUS TRABECTOME (KVT): COMPARING OUTCOMES IN COMBINATION WITH CATARACT SURGERY. Eliott Kim1, Gregory Fliney2, Miriam Sarwana3, Sze Wong4, Tak Yee Tania Tai4, Ji Liu2, Soshian Sarrafpour2, Chris Teng2, Nisha Chadha4. 1Medical Education, 2,4Ophthalmology. 1,4Icahn School of Medicine at Mount Sinai, New York, New York, 2,3Yale School of Medicine, New Haven, CT. BACKGROUND: While there is growing data on outcomes of minimally invasive glaucoma surgery (MIGS) procedures, few comparative studies exist. This is particularly relevant for Kahook Dual Blade (KDB) and Trabectome ab-interno trabeculotomy (Trabectome), each achieving goniotomy via a distinct surgical technique. This study compared their safety and efficacy.

RESEARCH QUESTION: Does KDB achieve a better safety and efficacy profile compared to Trabectome?

METHODS: This is a retrospective chart review comparing outcomes of KDB performed between January 2016 and March 2020 at NYEE/MSH and Trabectome between January 2013 and December 2019 at Yale Eye Center in combination with cataract surgery. Exclusion criteria included prior intraocular surgery and being lost to follow up after surgery. The primary outcomes were change in intraocular pressure (IOP), change in number of glaucoma medications, and success was defined as IOP reduction of >20% with IOP <21 mmHg. These outcomes were analyzed at postoperative month 6 and year 1. Secondary outcomes included hyphema and need for additional glaucoma procedures. Multilevel modeling controlled for inter-eye effects, baseline IOP, and baseline number of glaucoma medications.

RESULTS: 90 eyes in the KDB group and 125 eyes in the Trabectome group were included. 6 (6.3%) eyes in the KDB group and 5 (3.4%) in the Trabectome group required additional glaucoma surgery and were excluded. Mean preoperative IOP was 16.9 ± 4.5 mmHg in the KDB group and 18.3 ± 5.9 mmHg in the Trabectome group (p=0.06). Mean IOP changes at month 6 and year 1 were -2.3 and -1.4 mmHg in the KDB group and -3.3 (p=0.91) and -3.5 mmHg (p=0.04) in the Trabectome group. Mean changes in glaucoma medications at month 6 and year 1 were -0.9 and -0.6 in the KDB group and -0.4 (p=0.05) and -0.3 (p=0.11) in the Trabectome group. The percentage of eyes achieving success at month 6 and year 1 were 36% and 26% respectively for the KDB group and 49% (p=0.08) and 50% (p=0.04) respectively for the Trabectome group.

CONCLUSIONS: Comparative studies among MIGS help guide individualized glaucoma treatment strategies.

Our study suggests that Trabectome may offer greater success; however, KDB and Trabectome are both well tolerated and effective, each offering unique advantages.

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ABSTRACT 56 RNASEQ REVEALS INCREASES IN ATHEROSCLEROSIS-RELATED MARKERS AND IMMUNE AND BARRIER DIFFERENCES IN COMMON ICHTHYOSIS VARIANTS. Madeline Kim1, Daniela Mikhaylov1, Mary Sun1, Kunal Malik2, Helen He2, Yael Renert-Yuval3, Ana Pavel4, Amy Paller5, Emma Guttman-Yassky2. 1Medical Education, 2,3,5Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Rockefeller University, New York, NY, 4University of Mississippi, University, MS, 5Northwestern University Feinberg School of Medicine, Chicago, IL. BACKGROUND: Complete characterization of many ichthyosis subtypes remains unavailable, hindering development of better treatments. We therefore sought to characterize the transcriptome of four of the most prevalent forms of ichthyosis (Netherton syndrome/NS, epidermolytic ichthyosis/EI, lamellar ichthyosis/LI, and congenital ichthyosiform erythroderma/CIE) across a selection of previously published inflammatory, skin barrier, and atherosclerosis-linked gene sets in the largest ichthyosis cohort to date.

RESEARCH QUESTION: To profile immune, barrier, and atherosclerosis-related gene expression in the common ichthyosis variants METHODS: 4.5mm skin biopsies were obtained from the non-dominant upper outer arms of 40 control subjects and 54 subjects with ichthyosis (7 NS, 13 EI, 16 LI, 18 CIE) recruited at Mount Sinai and Northwestern University and were sequenced via RNASeq. Fold-change (FCH) estimates and hypothesis testing were conducted with contrasts under the general framework for linear models in the limma package in R. P-values were adjusted using the Benjamini-Hochberg procedure.

RESULTS: Differentially expressed genes (DEGs) were defined as absolute FCH > 2 and false discovery rate < 0.05. Most Th22/IL22 and Th17 DEGs were upregulated in all subtypes, while only modest changes were noted in Th2 markers, particularly in NS. Several Th1-related DEGs were upregulated primarily in CIE. Across all subtypes, though less evident in EI, downregulation was observed in many lipid metabolism (e.g.

FADS1/2, FAR2, FA2H) and barrier junction (e.g. CLDN8, CLDN23, CDH10) DEGs, whereas many epidermal differentiation genes were significantly upregulated (e.g. SPRR1A/1B/2C/2G, IVL, PGLYRP3/4). Additionally, we identified several atherosclerosis-associated DEGs that were positively expressed in most subtypes (e.g.

HBEGF, PCSK9, IL36A/B/G, SELE) and significant global downregulation in atheroprotective factor apoE. CONCLUSIONS: Our results suggest that the common ichthyosis variants share abnormalities in Th22/Th17, lipid metabolism, and atherosclerosis-linked markers while exhibiting variations in Th2 and Th1 pathways.

These findings may aid in elucidating the pathogenesis of these subtypes and the development of effective, subtype-specific therapies.

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ABSTRACT 57 NON-INVASIVE APPROACH TO THE PREDICTION OF SEVERITY DEGREE AND SURVIVAL IN COVID-19 USING A COMBINATION OF SEMIQUANTITATIVE-QUANTITATIVE CT FINDINGS AND PLASMA CYTOKINE ASSESSMENT. Emma Klein1, Guillermo Carbonell2, Brett Marinelli2, Diane Del Valle3, Maria El-Homsi2, Daniel Stocker4, Michael Chung2, Adam Bernheim2, Miriam Merad5, Sara Lewis2, Sacha Gnjatic5, Bachir Taouli2.

1 Medical Education, 2Diagnostic, Molecular and Interventional Radiology, 3Precision Immunology Institute, 4Biomedical Engineering and Imaging Institute, 5Tisch Cancer Institute, 1,2,3,4,5 Icahn School of Medicine at Mount Sinai , New York, New York.

BACKGROUND: As of November 2020, COVID-19 has resulted in more than 50 million cases and 1.25 million deaths worldwide. Patients with severe cases tend to have a poor prognosis, and treatment depends on the severity of the disease. However, an accurate predictor of disease progression is lacking.

Cytokine measurements and chest CT imaging may be valuable tools in predicting patient outcome.

RESEARCH QUESTION: The purpose of this study is to assess the performance of semiquantitative and quantitative chest CT assessment and a cytokine signature for prediction of severity degree and death in COVID-19.

METHODS: From March to May 2020, we retrospectively included 56 patients (M/F 37/19, mean age 58y) with positive PCR for SARS- CoV-2 who underwent a chest-CT and a rapid multiplex cytokine assay (IL-6, IL8, IL-1β, and TNFα) within 72 hours. Demographic, clinical and laboratory variables were collected. A CT semiquantitative severity score to evaluate the degree of involvement of each lung lobe was performed by two radiologists. CT quantitative assessment to calculate the aerated lung, ground glass opacity and consolidation volume was carried out using the software 3D slicer in combination with a Python script for semi-automated segmentation of the lung and pneumonia lesions using Hounsfield Units thresholding. Univariate and multivariate analysis of cytokines, CT semiquantitative and quantitative assessments was performed to predict severity degree and survival.

RESULTS: For prediction of severity degree, the cytokine model performed with an AUC (95% CI) of 72.5 (58.2-86.9), the CT semiquantitative model with 77.5 (65.0-90.6), the CT quantitative model with 83.2 (71.4-94.9), and the combined model with 95.3 (90.2-100.0). Sensitivity and specificity were highest in the combined model, at 86.4 and 91.2, respectively. For prediction of survival, the cytokine model performed with an AUC (95% CI) of 73.3 (58.9-87.8), the CT semiquantitative model alone 74.7 (55.4-94.1), the CT quantitative model with 78.4 (61.4-95.4), and the combined model with 80.4 (62.5-98.3). Sensitivity and specificity in the combined model were at 82.8 and 76.5, respectively.

CONCLUSIONS: The combination of CT assessment and cytokines may be helpful in predicting COVID-19 patient outcome.

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ABSTRACT 58 MAKING THE CASE FOR PARKS AS A CRITICAL PART OF PUBLIC HEALTH PREPAREDNESS IN THE AGE OF COVID-19.

Niathi Kona1, Kathleen McGovern2, Andrea Deierlein3, Susan Teitelbaum2, Mary Wolff2, Maida Galvez2.

1 Medical Education, 2,3Environmental Medicine & Public Health. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3New York University School of Global Public Health, New York, NY. BACKGROUND: COVID-19 school closures and restrictions on indoor exercise facilities have decreased children’s opportunities for physical activity (PA), potentially increasing their risk for obesity. The pandemic has subsequently shone a light on the public health importance of parks for outdoor play for children and the need for public investment in parks. Yet, little is known about the physical characteristics of neighborhood parks and playgrounds that attract children to use outdoor spaces. The community-based longitudinal research project Growing Up Healthy in East Harlem examined associations between neighborhood park availability and children’s PA. RESEARCH QUESTION: What physical characteristics of East Harlem parks are associated with use

by African American and Latino children ages 6-8 years old?

METHODS: Characteristics of East Harlem open space resources were assessed via a comprehensive field study conducted by New Yorkers for Parks. Caregivers were asked about children’s neighborhood resource availability, use and weekly PA. Descriptive statistics were used to determine which open space characteristics were associated with use. Negative binomial models predicting count of children reporting use were built to determine which open space characteristics were most predictive of use.

RESULTS: Size of open space resource and number and diversity of active features (play areas, athletic fields, courts, recreation centers) were positively associated with child use (p < 0.05). Addition of one active acre increased the number of children using the resource by a factor of 4.4 (95% CI: 2.1-9.0); increasing the types of features from zero to two increased the number of children using the resource by a factor of 3.4 (95% CI: 1.1-10.7). More frequent use of open space resources (≥4x per week) was associated with a median of 0.97 metabolic equivalent (MET) hours of scheduled PA per week, compared to 0 MET hours with less frequent use (p < 0.05).

CONCLUSIONS: In the age of COVID-19, parks have emerged as a critical yet limited resource for physical activity, socially distant interaction, and mental wellness. Investment in large parks with abundant active features may play a crucial health promotion role for children.

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ABSTRACT 59 THE CULTIVATION OF INTERGENERATIONAL RELATIONSHIPS THROUGH A VIRTUAL PLATFORM AS A TOOL TO DECONSTRUCT AGEIST ATTITUDES AMONG PRE-CLINICAL MEDICAL STUDENTS IN THE ERA OF THE COVID-19 PANDEMIC. Krsna Kothari1, Cecily McIntyre1, Dayle LaPolla1, Noelle-Marie Javier2. 1Medical Education, 2 Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Care for older adults requires a holistic awareness of the patient: familiarizing oneself to their values, support system, and life history. A healthcare provider’s ability to understand these characteristics can be impaired by ageist attitudes acquired through our society’s anti-aging norms and medicine’s tendency to generalize older adults by certain health and disease profiles, thus impairing the formation of a trusting patient-provider relationship and implementation of appropriate medical care. As future physicians, medical students will benefit from educational programs that challenge these stereotypes. For our study, we fostered the development of intergenerational relationships through weekly, 1 hour sessions with an older adult and a medical student. All sessions took place over Zoom in the hopes that even when social gatherings are unsafe, programs teaching the importance of active listening and empathy are possible.

RESEARCH QUESTION: Can pre-clinical medical students’ ageist attitudes be deconstructed over a remote platform?

METHODS: This study utilizes an interventional pre-post design. Medical student participants attended 3 didactic sessions led by the student researchers and leaders in ageism and intergenerational programs.

6 pairs of randomly assigned older adult and medical school dyads met over Zoom for 6 weeks. Student researchers were responsible for recording the date, time, and students’ impressions after each meeting.

Prior to being introduced to their study pair, all participants completed a self-administered online survey addressing ageist beliefs. All participants will fill the same survey upon completion of the 6 meetings.

Investigators will also administer mid-intervention and post-intervention semi-structured interviews with all participants for additional reflection on the experience.

RESULTS: Results are pending the participants’ completion of 6 meetings. We will receive 12 transcribed and coded debrief interviews, 6 pre and post intervention surveys, and pictures of any legacy projects created.

Results will be available by late-February 2021.

CONCLUSIONS: Through pairing older adults and medical students remotely, we hope to have created a framework for an online program that can demystify ageist beliefs amongst future doctors.

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ABSTRACT 60 PHENOTYPIC HETEROGENEITY OF TRAUMA-RELATED PSYCHOPATHOLOGY AND SOCIAL COGNITION IN WORLD TRADE CENTER RESPONDERS. Dayle LaPolla1, Elisa Monti2, Agnes Norbury2, Robert Pietrzak3, Mercedes Perez-Rodriguez2, Adriana Feder2. 1Medical Education, 2,3Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Yale School of Medicine.

BACKGROUND: Social cognition is thought to play a key role in mitigating the deleterious effects of trauma – potentially lowering risk for posttraumatic stress disorder (PTSD), promoting recovery, and reducing the chronicity of PTSD. Further, chronic PTSD is known to be associated with impaired social functioning. However, scarce research has examined how the phenotypic heterogeneity of trauma-related psychopathology relates to alterations in social-cognitive function in trauma-exposed individuals.

RESEARCH QUESTION: We hypothesized that there would be significant differences in social cognition between the group of participants who met criteria for WTC-related PTSD and those who did not go on to develop WTC-related PTSD. Additionally, we hypothesized that heterogeneity in trauma-related psychopathology would predict social-cognitive function.

METHODS: Thirty-eight individuals involved in rescue/recovery work following the 9/11 terrorist attacks on the World Trade Center (WTC) participated in this study. Of the 38 participants, 39.5% met DSM-5 criteria for lifetime WTC-related PTSD. Past-month PTSD, depressive, and trait anxiety symptoms were assessed with the Clinician-Administered PTSD Scale for DSM-5, Beck Depression Inventory-Version II, and State-Trait Anxiety Inventory, respectively. Social cognition was assessed with the Reading the Mind in the Eyes (RMET) and Movie for the Assessment of Social Cognition (MASC) tasks.

RESULTS: There were no significant between-group differences in performance on social cognition tasks.

Greater severity of PTSD avoidance symptoms was associated with lower social cognitive accuracy on the RMET (β=-0.73, p=0.004). Higher trait anxiety (β=1.08, p=0.001) and PTSD anxious arousal (β=0.62, p=0.03) symptoms, and lower somatic-affective symptoms of depression (β=-1.15, p=0.003) were associated with higher hypermentalizing errors – characterized by excessive or distorted social cognition – on the MASC. CONCLUSIONS: Specific PTSD symptom dimensions, as well as comorbid anxiety and somatic-affective depressive symptoms, are independently associated with alterations in social-cognitive function in traumaexposed individuals. Results may help inform assessment and treatment approaches targeted toward social cognition in this population.

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ABSTRACT 61 EVALUATION OF ADHERENCE TO THE CASCADE OF CARE FOR ABNORMAL LIVER TEST MANAGEMENT DURING PREGNANCY. Jessica Lee1, Emma Rosenbluth1, Shaelyn O’hara2, Ruhee Shah1, Rhoda Sperling3, Tatyana Kushner2. 1Medical Education, 2Medicine, 3Obstetrics, Gynecology, and Reproductive Science. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: An estimated 3-5% of pregnant women have elevated liver tests (LTs). There are currently no guidelines for routine LTs during pregnancy, and true prevalence of liver disease in pregnancy is unknown. Therefore, we developed a cascade of care for LT management during pregnancy.

RESEARCH QUESTION: We sought to evaluate whether LTs were assessed and abnormal, and if medical providers acknowledged as abnormal, performed standard hepatic and pregnancy-related workup, a diagnosis was made, and specialty referral was performed.

METHODS: We performed a retrospective secondary analysis of a prospective cohort study that consecutively enrolled pregnant women at the time of routine prenatal anatomy scan to screen for nonalcoholic fatty liver disease. EMR was reviewed to determine if LTs were drawn and abnormal in pregnancy.

RESULTS: Out of 379 pregnant women included, 232 (61%) had LTs assessed at least once during pregnancy. Among those, 64 (28%) had at least one abnormal LT. Among pregnant women with LT abnormalities, median age was 28 (IQR 24.75, 34) with a majority identifying as Black (42%) or Latino (38%).

We evaluated 122 instances of abnormal LTs, which were drawn on labor and delivery (25%), at routine prenatal (22%), the emergency department (20%), or antepartum admission (19%). LTs were least likely to be abnormal during first trimester (32; 26%) and more likely during second (33; 27%) and third (57; 47%) trimesters with 98 (80%) hepatocellular and 24 (20%) cholestatic-pattern abnormalities. Only 58 (48%) were acknowledged as abnormal by the provider. 40 (33%) and 77 (63%) underwent standard and pregnancyrelated workup, respectively. In 62 (51%) a diagnosis was made and 13 (11%) resulted in specialty referral.

Only 7 (6%) completed all cascade of care steps.

CONCLUSIONS: In our cohort, more than half of pregnant women had LTs assessed and close to onethird were abnormal, yet less than half were acknowledged as abnormal. Given the higher prevalence of LT abnormalities than previously reported, there may be a role for routine LTs during pregnancy. Interventions aimed at improving provider knowledge regarding LTs may be helpful in improving rates of adherence to the cascade of care.

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ABSTRACT 62 ELICITING AGE INDICATIONS FOR PEDIATRIC DEVICES FROM FDA APPROVAL STATEMENTS. Samuel Lee1, Benjamin Glicksberg2. 1Medical Education, 2Genetics and Genomic Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Despite the therapeutic benefits of medical devices, significant gaps exist in their application to the pediatric population. The Food and Drug Administration (FDA) requires the highest risk class of devices to submit pre-market approval (PMA) applications subject to stringent testing requirements.

To characterize the pediatric device landscape, we compiled a database of FDA PMA statements with annotations and elucidated the medical device space in terms of approvals for different age groups by device type and specialty.

RESEARCH QUESTION: What is the current pediatric device landscape in terms of device availability, type, and clinical specialty?

METHODS: We retrieved all PMA approval statements containing the words “indicated” or “intended” for medical devices listed in the FDA PMA database as of February 2020. This yielded 2,258 documents in which we filtered for age-related keywords, leaving 284 viable documents for analysis. Two reviewers annotated each document with PubAnnotation for age-related keywords. Based on these manual annotations, we grouped devices into age categories based on FDA delineations (infant=29 days to 2 years, children=2 to 12 years, adolescent=12 to 21 years, and adults=21 years and over). We then tabulated the number of devices available at each age from 0-21 years and analyzed the device types and clinical specialties of devices for the pediatric population.

RESULTS: The 284 documents yielded 140 unique devices (age indications: pediatrics=77, infant=18, child=33, adolescent=68). From age 17-18, the number of devices available more than doubled from 33 to 72, largely driven largely by devices with adolescent age indications. From age 0-17, the average number of clinical specialties was 7.27, while 11 clinical specialties were represented from 18-21.

CONCLUSIONS: In this study on PMA device approval statements, we explored the FDA device landscape and described the large gap in both quantity and diversity of devices for the pediatric population. This may prove to be a difficult obstacle to overcome for pediatricians when making clinical decisions, but reveals clinical specialties that are most affected and can guide future work. To our knowledge, this is the most comprehensive characterization of pediatric devices to date.

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ABSTRACT 63 TELEMEDICINE IN ORTHOPEDICS: A SCOPING REVIEW. Riva Letchinger1, Meredith Mihalopoulos2, Beselot Birhanu2, lily martin3, Jashvant Poeran2. 1Medical Education, 2Orthopaedics, 3Academic Informatics and Technology.1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in orthopedics, and a continued expansion in its use is expected. However, a comprehensive review of the evidence supporting the use of telemedicine in orthopedics is lacking. In orthopedics, not all patient encounters are equally amenable to telemedicine, and may differ between subspecialties. Orthopedic healthcare delivery relies on imaging and in-person exams/rehab.

RESEARCH QUESTION: As telemedicine’s utility in orthopedics is not well understood, our goal is to appraise the current evidence base regarding telemedicine in orthopedics.

METHODS: After protocol development (https://osf.io/s87rv), we systematically searched for published research related to telemedicine/orthopedic surgery across 3 databases: Ovid MEDLINE, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). We excluded reviews, systematic reviews, case reports, discussion papers, editorials, and meta-analyses. After an initial search, two reviewers screened literature results, and a third reviewer resolved discrepancies, before data extraction. Data was extracted on subspecialty, patient case mix, telemedicine characteristics, and outcomes studied.

RESULTS: Screening of the orthopedic telemedicine literature (n=248 studies) indicated the following: studies including TJA patients made up the majority of the published orthopedic telemedicine literature (23%, n=57 studies). Of these, 21% (n=12 studies) focused on THA, 47% (n=27 studies) on TKA, and 32% (n=18 studies) on both. Trauma/fracture (including hip, upper extremity, lower extremity, and general trauma surgery) represented the second most common, comprising 12% (n=30 studies) of all studies. Telemedicine was the least studied in pediatric orthopedics (4%, n=10 studies) and orthopedic oncology (0.8%, n=2 studies).

The number of orthopedic telemedicine studies increased over time, particularly in the past five years, likely representing the increased availability of smartphone and webcam technology. At the time of time of conception of this review, 23 orthopedic telemedicine studies had been published in 2020.

CONCLUSIONS: We are conducting a full-text screen of studies, and once this is completed will have more data available for a final review.

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ABSTRACT 64 MD++ A COMMUNITY OF ASPIRING PHYSICIAN-INNOVATORS. Sherman Leung, 2Brenton Fargnoli. 1Medical Education.

1 Icahn School of Medicine at Mount Sinai, New York, New York, 2AlleyCorp, New York, New York.

BACKGROUND: Physician-led innovation in non-clinical roles through technology, business, and the life sciences has been an emerging career path. However, few medical schools are equipped to support exploration of non-clinical interests alongside medical education. I started MD++ (mdplusplus.org) to provide a platform for aspiring physician-innovators to explore our hybrid career interests. As of January 2021, MD++ has grown to 680 medical students across the country entirely through word of mouth since its launch in November 2019.

RESEARCH QUESTION: Does prior work experience or intent on pursuing a hybrid career in physicianinnovation significantly change student interest in residency or type of residency?

METHODS: From June to November 2020, I received 209 survey responses from students representing 81 medical schools who signed up for MD++ (36% response rate). I excluded 12 responses from schools outside of the US or from graduated students. The survey asked about students’ intention to continue with residency, long-term career interest in a hybrid career, top residency specialty of interest, and backgrounds prior to medical school.

RESULTS: Demographics revealed 18.3% pursuing MD/MBAs, 4.6% MD/PhDs, 3.0% DO, with the remaining majority pursuing MDs. 38.6% were M1s followed by 27.6% M2s, 12.2% M3s, 16.9% M4s and 3.7% in gap years or pursuing joint degrees.

84.9% responded positively to pursuing residency as part of a Likert scale survey “Will you pursue residency after medical school?” This intent to pursue residency did not show a significant relationship with amount of work experience prior to medical school (χ2 = .23) or with intent on pursuing a physician-innovator career (χ2 = .59).

When surveying the community about type of specialty interest, 47.6% answered medical followed by 27.8% mixed and 24.6% surgical. This showed no statistical association (χ2 = .42) when cross-referenced with intent on pursuing a physician-innovator career.

CONCLUSIONS: Data from this survey revealed that the overwhelming majority of students in this community intend on continuing on with residency (83.4%). This data also shows that work experience or intent to pursue a hybrid career is not associated with a decreased interest in residency or type of specialty.

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ABSTRACT 65 THE IMPACT OF SOCIOECONOMIC STATUS ON THE CLINICAL OUTCOMES OF COVID-19; A RETROSPECTIVE COHORT STUDY. Christine Little1, Maaike van Gerwen2. 1Medical Education, 2Otolaryngology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: There have been limited data assessing the influence of disadvantaged socioeconomic status (SES) on the incidence and clinical outcomes of COVID-19 patients within the diverse communities of the United States.

RESEARCH QUESTION: Here, we aim to investigate the association between poverty level, as indicator of SES, and COVID-19 related clinical outcomes, including hospitalization and all-cause mortality.

METHODS: This retrospective cohort study included 3528 patients with laboratory confirmed COVID-19 seen at a large New York City health system between March 1, 2020 and April 1, 2020. Data for neighborhood level poverty was acquired from the American Community Survey 2014-2018 and defined as the percent of residents in each ZIP code whose household income was below the federal poverty threshold (FPT): 0% to <20% below FPT (low poverty) and >20% below FPT (high poverty).

RESULTS: Among those hospitalized for COVID-19, patients who resided in high poverty areas were significantly younger (mean age 62 vs. 67 years, p <0.001), were more likely to of non-Hispanic black race (33.4% vs 23.5%, p <0.001), and a higher prevalence of comorbidities including obesity (p=0.043), asthma (p=0.10) and CKD (p=0.001). Residence in a high poverty area was not associated with an increased risk of COVID-19 related hospitalization (ORadj, 0.98 95% CI, 0.83-1.17), however it was associated with a decreased risk of in-hospital mortality, in particular for male patients (HRadj, 0.61; 95% CI 0.51-0.73).

CONCLUSIONS: This study suggests the existence of an unequal socioeconomic gradient in the demographic and clinical presentation of COVID-19 patients including differences in age, gender and race between low and high poverty groups. Further studies are needed to fully assess the intersectionality of SES with the COVID-19 pandemic.

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ABSTRACT 66 PRE-OPERATIVE BIOMARKERS AND MORTALITY RISK AFTER CARDIAC SURGERY. Caroline Liu1, Steven Menez2, Dennis G. Moledina3, Amit Garg4, Heather Thiessen-Philbrook2, Eric McArthur5, Yaqi Jia2, Wassim Obeid2, Sherry G. Mansour3, Chirag R. Parikh2, Steven Coca6.

1 Medical Education, 6Medicine. 1,6Icahn School of Medicine at Mount Sinai, New York, New York, 2 Johns Hopkins University School of Medicine, Baltimore, MD, 3Yale School of Medicine, New Haven, CT, 4 Institute for Clinical Evaluative Sciences, Ontario, Canada, 5Institute for Clinical Evaluative Sciences, Ontario, Canada.

BACKGROUND: Patients undergoing cardiac surgery are at an increased risk for developing adverse outcomes. Preoperative blood and urine biomarkers may help stratify cardiac surgery patients at high risk for mortality.

RESEARCH QUESTION: Can pre-operative biomarkers improve the prediction of mortality following cardiac surgery beyond current clinical models?

METHODS: The TRIBE-AKI study enrolled 923 patients undergoing cardiac surgery in the USA and Canada from 2007-2010 and was randomly split into a training and test dataset (70:30). A total of 32 plasma and 14 urine biomarkers were measured preoperatively. The primary outcome was 3-year mortality. Models comparing the addition of biomarkers to the STS score (clinical model) were developed through 3 different methods: traditional logistic regression, LASSO logistic regression, and random forest (RF) regression.

Models from the highest performing development approach were replicated in the test dataset. Models were compared through AUC, PPV/NPV, NRI, and IDI. RESULTS: Death by 3 years occurred in 114 of the 1069 (10.7%). Using traditional logistic models, the addition of the 8 plasma (Troponin, IL-6, NTproBNP, TNFR1, YKL-40, FABP, TNFR2) and 2 urine (Il-8 and albumin) biomarkers increased the AUC from 0.63 (0.57, 0.68) to 0.73 (0.69, 0.78). Using LASSO logistic regression models, the addition of a parsimonious set of biomarkers (plasma IL-6, KIM-1, pro-BNP, TNFR1, and YKL-40 and zero urine biomarkers) to the clinical model increased the AUC from 0.64 (0.62 0.66) to 0.66 (0.63, 0.69).

Using RF regression, the addition of all 40 biomarkers to the clinical model increased the AUC from 0.61 (0.55, 0.67) to 0.65 (0.60, 0.70). Replication of the traditional logistic models in the test dataset confirmed biomarker improvement in 3-year mortality prediction (AUC increased from 0.68 (0.61, 0.76) to 0.72 (0.65, 0.79)).

CONCLUSIONS: A traditional logistic model outperformed LASSO and RF models. The addition of biomarkers into all three model development approaches (Logistic, LASSO logistic, and RF) improved discrimination for 3-year mortality prediction modestly beyond clinical characteristics alone. Pre-operative biomarkers may improve mortality risk prediction in the setting of cardiac surgery.

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ABSTRACT 67 THE PENETRANCE OF LONG QT SYNDROME (LQTS) IN PATIENTS WITH DELETERIOUS LQTS VARIANTS. Madeline Lui1, Nihir Patel2, Arden Moscati2, Mariya Shadrina2, Michael Gollob3, Bruce Gelb4, Amy Kontorovich5. 1Medical Education, 2Genetics and Genomic Sciences, 4,5Medicine.

1,2,4,5 Icahn School of Medicine at Mount Sinai, New York, New York, 3University of Toronto, Toronto, ON, Canada.

BACKGROUND: Long QT syndrome (LQTS) develops when cardiac ventricles repolarize improperly, causing a prolonged QTc interval and predisposition for ventricular arrhythmias and sudden cardiac death. The most commonly implicated genes in LQTS are KCNQ1, KCNH2 and SCN5A. The penetrance of LQTS-related phenotypes linked to deleterious variants (DV) in these genes has never been ascertained in an ethnically diverse population using a genotype-first approach.

RESEARCH QUESTION: Do DVs in KCNQ1, KCNH2 and SCN5A identified through non-clinically indicated genomic screening predict QTc prolongation and LQTS-related phenotypes?

METHODS: We identified DV in KCNQ1, KCNH2 and SCN5A using whole-exome sequences (WES) from BioMe (N=32,344) and UK Biobank (UKBB) (N=49,960). DV were those without a benign/likely benign designation in ClinVar meeting one of the following: nonsynonymous, classified as likely pathogenic/ pathogenic in ClinVar by a majority of BADGE labs; stop-loss/-gain; frameshift insertion/deletion; affecting the canonical splice site within 2 base pairs of the exon. Electronic health records (EHR) of subjects with DV were queried for ECGs and LQTS-related diagnoses. QTc intervals and rates of these diagnoses were compared between individuals with and without DV. RESULTS: 98 BioMe (0.30%) and 193 UKBB (0.39%) participants had DV. Of 52 DV+ BioMe subjects with ECGs, 5 males (22%) and 9 females (31%) had a prolonged QTc regardless of which gene was implicated (p<0.05). There was no QTc prolongation in the 48 DV+ UKBB subjects with ECGs. Of DV+ subjects, none in BioMe had an EHR diagnosis of LQTS; the rate in UKBB could not be determined as it is not a searchable diagnosis code. For LQTS-related conditions, BioMe cases (10%) were more likely than controls (5%) to have a diagnosis of epilepsy/convulsions (p<0.05). There were no significant differences in rates of LQTS-related diagnoses between UKBB cases and controls.

CONCLUSIONS: We found a significant association between DV status and epilepsy/convulsions in BioMe only. DV status was not associated with higher rates of arrhythmia or syncope in either biobank. When using a genotype-first approach to remove ascertainment bias, the penetrance of LQTS-associated variants in KCNQ1, KCNH2 and SCN5A may be lower than currently cited.

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ABSTRACT 68 IMPACTFUL LIFE EVENTS, RESILIENCE PROMOTING BEHAVIORS, AND RESILIENCE IN AMERICAN MEDICAL STUDENTS. Cynthia Luo1, Gabriel Santos Malave1, Robert Yanagisawa2, Craig Katz3. 1Medical Education, 2 Endocrinology, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The ongoing COVID-19 pandemic has affected the mental health of young adults, including medical students. We surveyed and interviewed medical students at the Icahn School of Medicine at Mount Sinai about stressful life events experienced, including but not limited to COVID-19, and about their resiliencepromoting behaviors and post-traumatic growth. We hoped to identify specific strategies that are commonly used by medical students to cope with traumatic experiences.

RESEARCH QUESTION: We sought to determine factors contributing to posttraumatic growth and resilience among a cohort of medical students. We hypothesized that medical students who demonstrated greater resilience behaviors experienced less posttraumatic stress and that students who indicated that their most impactful life event was a non-COVID event experienced less COVID-related stress.

METHODS: We anonymously surveyed medical students using scales measuring resilience and posttraumatic growth in the context of their most stressful life event and COVID-19, and we examined correlations between demographics, post-traumatic stress, posttraumatic growth, and resilience. We also conducted optional interviews to provide qualitative insights and find commonalities in students’ experiences.

RESULTS: Out of 78 medical students surveyed, 45% indicated that the COVID-19 pandemic was their most impactful life event (ILE), while 55% chose a non-COVID-19 event. Compared with students who indicated COVID-19 as their ILE, students who indicated a non-COVID ILE experienced significantly less COVID-related stress, greater posttraumatic growth, and more resilient behaviors including establishing and nurturing a supportive social network, developing brain fitness, and finding meaning and purpose in things.

CONCLUSIONS: Given the ongoing COVID-19 pandemic and its effects on mental health, understanding how young adults respond to this and other stressful life events is essential. We identified specific resilience behaviors that medical students commonly used to cope with traumatic experiences. Additionally, our results suggest that stressful experiences prior to or in parallel to COVID encourage posttraumatic growth and development of resilience behaviors that may be protective against COVID-19-related stress.

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ABSTRACT 69 BODY MASS INDEX CORRELATES WITH SKIN TO SPINAL CANAL DISTANCE: A LARGE RETROSPECTIVE SINGLE-CENTER STUDY. Kevin Mahmoudi1, Young Joon (Fred) Kwon1, Yoni Goldstein1, Shingo Kihira2, Katherine Garvey1, Samantha Platt1, Puneet Belani2, Thomas Naidich2, Anthony Costa3, Amish Doshi2. 1Medical Education, 2 Radiology, 3Neurosurgery. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Diagnostic lumbar puncture (LP) is one of the most commonly performed clinical procedures in the United States. When difficulty is encountered with bedside LP, a fluoroscopy-guided LP (FG-LP), performed by a radiologist, is often considered. Despite increasing demand for FG-LP, there is limited quantitative and epidemiological data on patients undergoing this procedure. Additionally, data are scarce on the correlation of iliac crest landmarks to the actual anatomical lumbar level (intercristal line).

RESEARCH QUESTION: The aim of this study is to determine if (1) body mass index (BMI) correlates with skin to spinal canal distance (SCD) and (2) the iliac crest landmark correlates with the presumed anatomical landmark on cross-sectional imaging.

METHODS: In this retrospective, single-center IRB-approved study, we assessed 495 patients who underwent FG-LP and had lumbar CT or MRI within 6 months of presentation. Skin to spinal canal distance was measured on the sagittal view at the L3-L4, L4-L5, and L5-S1 intervertebral levels. The intercristal line was identified by correlating findings on coronal and sagittal planes of CT or MRI. RESULTS: In our cohort of 495 adults (mean age ± standard deviation [SD], 53.2 ± 16.4 years), there was a statistically significant linear correlation between BMI and SCD at each intervertebral level. Mean ± SD (R2) SCD at L3-4, L4-5, and L5-S1 was 6.7 ± 1.6 cm (0.5486), 7.4 ± 1.9 cm (0.5894), and 7.8 ± 1.9 cm (0.5968), respectively. The intercristal line aligned with L3-L4, L4-L5, and L5-S1 in 2.1%, 72.4%, and 6.2% of patients, respectively.

CONCLUSIONS: There was direct, positive linear correlation between BMI and SCD at clinically relevant lumbar disc levels. Furthermore, there is considerable anatomical variance in the intervertebral space that aligns with the superior aspect of the iliac crest. Knowing a patient’s BMI before the procedure may guide clinicians to select appropriate needle length and increase the success rate of LP procedures. The process of obtaining a patient’s BMI is also less resource intensive than an imaging study. Furthermore, understanding the considerable anatomical variance of the iliac crest landmark may help identify strategies for more successful bedside attempts in the future.

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ABSTRACT 70 GEOSPATIAL DISPARITIES IN ACCESS TO PROTON THERAPY IN THE CONTINENTAL UNITED STATES. Luke Maillie1, Matthew Sisk2, Charles Simone II3, Stanislav Lazarev4. 1Medical Education, 3,4 Radiation Oncology. 1,4Icahn School of Medicine at Mount Sinai, New York, New York, 2 University of Notre Dame Notre Dame, IN, 3Memorial Sloan Kettering NY, NY. BACKGROUND: Proton therapy (PT) is an important component of therapy for select cancers due to its improved normal tissue sparing and lower risk of adverse effects compared to conventional photon-based radiotherapy techniques. It is often purported that due to the existence of few centers in the continental United States (U.S.), inequities in access to PT may be present, but no formal study of geospatial access to PT has been conducted to date.

RESEARCH QUESTION: In this investigation, we examined PT access by quantifying travel time to PT centers.

METHODS: Population data from 2014-2018 were available for 320.7 million people in 32,644 zip code tabulation areas (ZCTAs). ArcGIS Pro Mapping software was used to determine travel time from each ZCTA to the nearest PT center. The calculated travel time was then assigned to the population of each ZCTA. Interquartile ranges presented were calculated based on total population. Demographic data were also analyzed.

RESULTS: 36 proton centers were identified. Median travel time was 1.61 (interquartile range (IQR) 0.67-3.36) hours for children and 1.64 (IQR 0.69-3.33) hours for adults. Significant variation in travel time to the nearest PT center was observed between states, with 11 states having a median travel time of <1 hour and 20 states having a median travel time of >3 hours. The West has a longer median travel time of 3.51 (IQR 1.15-7.13) hours when compared to the Midwest (1.70, IQR 0.79-2.69), South (1.60, IQR 0.61-3.12) and Northeast (1.04, IQR 0.57-2.01). Households in the highest income quartile were found to live closer to PT when compared with lower income quartiles. Native Americans were seen to live farther when compared to other races. Time to the nearest PT center did not differ significantly based on insurance status or education level.

CONCLUSIONS: Travel times vary significantly based on state of residence. Disparities in geographic access for certain population groups warrant further examination in order to improve access to this important cancer treatment modality.

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ABSTRACT 71 RESPONSIVE NEUROSTIMULATION IN PEDIATRIC DRUG-RESISTANT EPILEPSY. Naoum Fares Marayati1, Maite La Vega-Massello2, Fedor Panov3, Saadi Ghatan3, Peter Morgenstern3. 1Medical Education, 2Neurology, 3Neurosurgery.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Epilepsy affects an estimated 10.5 million children worldwide. Pediatric epilepsy is managed using a combination of medical management and resective or disconnective surgery. Although safe, surgery is destructive, physically disrupting existing brain anatomy, thereby potentially causing unintended adverse effects. Responsive neurostimulation (RNS), an implantable electrical stimulation device, is a newer strategy to reduce or eliminate seizures. RNS can monitor the seizure network, disrupt it with stimulation, and learn over time to improve control. While initial reports of the use of RNS in adults describe substantial reductions in seizure frequency and improvement in measures of quality of life, little has been published on the role of RNS in children.

RESEARCH QUESTION: How does the implantation of RNS impact seizure outcomes in children? For what seizure etiologies is it effective? What complications are associated with RNS placement and long-term use?

We hypothesize that RNS is effective at significantly decreasing the incidence of seizures in children with epilepsy with an acceptable safety profile.

METHODS: We performed a retrospective, single-center study of all the 29 consecutive patients under age 18 with Drug-Resistant Epilepsy (DRE) who underwent RNS implantation. Patients were followed postoperatively to evaluate response to treatment and complications.

RESULTS: There were 14 boys and 15 girls. Mean age at implant was 13.9 years (7.8-17.8) and follow-up duration was 23.1 months (range 3-53). In patients with >6 months follow-up (n=28), 18 had >50% seizure reduction (64.2%) and 3 were seizure free (10.7%). Twenty-four patients (85.7%) demonstrated measurable improvement in seizure frequency by 6 months post-implant. Of the patients studied, 3 patients developed infections and were treated with antibiotics. Of these three patients, one required a partial removal and had salvaging of a functioning system,and one required a complete removal of the RNS device.

CONCLUSIONS: These data support the safety and early follow-up efficacy of RNS in pediatric DRE, with infection as the primary complicating concern. Further prospective longer-term data collection is ongoing in order to elaborate on the current report and establish statistical comparisons.

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ABSTRACT 72 USE OF A RADIOPAQUE EMBOLIC FOR TRANSARTERIAL CHEMOEMBOLIZATION FOLLOWED BY MICROWAVE ABLATION FOR HEPATOCELLULAR CARCINOMA. Christina Marshall1, Alex Sher2, Vivian Bishay2, Mona Ranade2, Scott Nowakowski2, Rahul Patel2, Edward Kim2, Robert Lookstein2, Aaron Fischman2. 1Medical Education, 2Radiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Current treatment algorithms for HCC depend on tumor resectability and level of metastasis. Patients ineligible for liver transplant receive local ablation procedures. Studies have shown that drug-eluting radiopaque beads have comparatively low systemic exposure, higher tumor concentrations, and lower short term tumor viability. This study focuses on outcomes of using the LC LUMI radiopaque bead.

RESEARCH QUESTION: What are the outcomes of using a radiopaque embolic for TACE/MWA procedures in HCC? METHODS: 160 patients with HCC treated with RO-DEB (LUMI, Boston Scientific) (loaded with 50 mg of Doxorubicin) from 02/2016 to 09/2019 were screened. Patients were excluded if they did not have HCC, were not treated with TACE/MWA, or were not treatment naive before TACE and ablation (n=145). Patient demographics (including ECOG, BCLC stage, Child-Pugh scores) and procedural details were recorded.

Outcomes analyzed included tumor response using mRECIST criteria on post-procedure MRI, target progression, 90-day postoperative mortality, and overall survival. Procedure related adverse events (AEs) and laboratory toxicities were assessed between TACE and MWA and up to 6 months after MWA. End of study was defined as the last communication, retreatment of the same lesion, transplant, or death.

RESULTS: 15 target lesions were included based on the specified criteria. There were 12 male patients (80%), median age 64 (range 49-80), BCLC 0/A/B–1/10/4, CP score A/B–11/4. Average target lesion diameter was 1.8 cm (SD 0.8).RO-DEB were visualized to be within the target lesion and used for targeting on non-contrast CT during MWA for 9 (60%) lesions. mRECIST target response rates at a median of 41 days (range 27-151) were 93.3% CR and 6.7% PR. Target lesion progression occurred in one (6.7%) lesion with recurrence at 283 days and was treated with external radiation. AEs included: grade 1 arm hematoma (n=1), grade 3 hepatic decompensation in the form of ascites and edema and Grade 2 elevation in total bilirubin (n=1). Median overall survival was 254 days and 90-day mortality was 0%.

CONCLUSIONS: TACE with RO-DEB followed by MWA was highly efficacious and safe in this small cohort.

RO-DEB appears to remain visible on CT for months suggesting a benefit for lesion targeting during MWA.

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ABSTRACT 73 TIME TO TREATMENT OF LARGE VESSEL OCCLUSION PATIENTS WITH NON-MOTOR SYMPTOMS AT AN URBAN, COMPREHENSIVE STROKE CENTER. Naomi Mayman1, John Erdman1, Parul Agarwal2, Laura Stein3. 1Medical Education, 2Population Health Science and Policy, 3Neurology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Public health efforts target rapid public recognition and action on signs of stroke because of the time-sensitive nature of damage to the brain and treatment opportunities. However, not all strokes are characterized by the motor weakness and facial droop emphasized in public health campaigns. More research is needed to understand the impact of stroke symptoms on times to presentation and treatment.

RESEARCH QUESTION: Is there a significant difference in times to presentation and treatment in large vessel occlusion (LVO) stroke patients with motor weakness versus those who present without motor weakness but with more subtle localizing signs? We hypothesize that times to treatment do not differ between aphasic patients who present with vs. without motor weakness; however, patients with visual field deficits and neglect take longer to present and receive treatment.

METHODS: Using the American Heart Association’s Get With The Guidelines database, we conducted a retrospective review of consecutive AIS patients presenting to Mount Sinai Hospital from 2015 to 2018.

Characteristics and times to treatment between groups were compared using a T-test. Primary outcome was door to groin puncture time, with secondary outcomes including time to presentation and door to CT time.

RESULTS: We analyzed 209 stroke patients with LVO (n=111 left hemisphere stroke [LHS], n=98 right hemisphere stroke [RHS]). LHS patients who had aphasia without weakness had significantly longer times to presentation (p<0.0001), door to CT (p=0.004), and door to ET times (p=0.002) compared to all other LHS patients. Likewise, RHS patients who had neglect without weakness had significantly longer times to presentation (p<0.0001) and time to ET (p=0.0004) compared to all other RHS patients.

CONCLUSIONS: LVO patients with cortical signs such as aphasia and neglect have delays in presentation and treatment compared to their counterparts who present with more classical stroke signs, such as motor weakness. The data suggest that greater public awareness is needed of the more subtle signs of stroke, and that increased provider ability to recognize these signs may decrease delays to receiving life-saving treatment.

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ABSTRACT 74 KEY ATTRIBUTES OF UNDOMICILED PATIENT ENCOUNTERS AT FOUR MOUNT SINAI HOSPITALS. Jesse McChane1, Andrew Coyle2. 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Substantial research has documented the suboptimal healthcare outcomes experienced by undomiciled individuals, including an associated increase in all-cause mortality. This study adds to our understanding of how undomiciled individuals interact with health systems by examining metrics of healthcare utilization in a large NYC hospital system.

RESEARCH QUESTION: How do undomiciled patient admissions to a large NYC hospital system compare to their stably-housed peers with regards to length of stay (LOS), discharge against medical advice (AMA), and 30-day readmissions?

METHODS: Medical records were included based on the following criteria: [1] search term matching “homeless,” “undomiciled,” or “shelter” and [2] an ED encounter or inpatient admission between 12/01/2018– 6/31/2019 at one of four Mount Sinai hospitals. Housing status during the study period was verified using social work or physician notes. Admissions to psychiatric and detox services and all L&D encounters were excluded. Data were recorded pertaining to LOS, AMA discharge and elopement, and 30-day readmissions.

A control group was generated consisting of all 73,764 admissions to the four hospitals during the study timeframe, excluding the 552 encompassed by the sample population. LOS, AMA discharge rates, and 30day readmissions were compared, using chi-squared (AMA and 30-day readmissions) and single sample t-test (LOS) to determine significance.

RESULTS: 438 patients met study criteria, accounting for 552 discreet admissions. Compared to the control group, the undomiciled population experienced longer lengths of stay (6.6 days vs. 5.48 days, p < 0.01). They were also more likely to leave AMA (16.1% vs. 1.3%, p < 0.01) and were more likely to experience at least one 30-day readmission (32.1% vs. 15.3, p < 0.01). Despite these patterns of utilization in a vulnerable population, only 61 admissions (11.1%) resulted in an enrollment in a social work or care coordination program.

CONCLUSIONS: Compared to the general patient population of a large NYC hospital system, undomiciled patients experienced longer hospital stays and were more likely to leave AMA and be readmitted within 30 days. Targeted enrollment in care coordination and social work-driven programs needs to be considered.

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ABSTRACT 75 IMPACT OF COVID-19 ON THE RATE OF FALLS IN ONE COMMUNITY OF HIGH-RISK, COMMUNITY-DWELLING OLDER ADULTS. Cecily McIntyre1, Laura Prichett2, Matthew McNabney3. 1Medical Education, 3Geriatrics and Palliative Medicine. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Johns Hopkins University, Baltimore, MD. BACKGROUND: Stay-at-home orders prompted by COVID-19 have decreased levels of physical activity.

In older adults who are at increased risk for deconditioning, such a prolonged reduction in activity levels may affect adverse outcomes such as falls.

RESEARCH QUESTION: To examine the relationship between falls among high-risk, community-dwelling older adults at one Program of All-Inclusive Care for the Elderly (PACE) and the COVID-19 closure of its Day Health Center (DHC), a setting which provides participants with social and rehabilitative services and contributes to their weekly physical activity.

METHODS: This was a descriptive study of retrospective, self-reported fall data collected at one PACE site, Hopkins ElderPlus (HEP), in Baltimore, MD. Falls during the three months before the HEP DHC’s closure (“pre-COVID-19”) and the three months following its closure (“COVID-19”) were reviewed. Falls during the same months as COVID-19 of the previous year (“2019”) were also reviewed to better evaluate the impact of time of year on falls, independent of COVID-19. The impact of time period on number of falls per participant, location of fall, activity during fall and harm level and injury associated with fall was analyzed.

RESULTS: 135 HEP participants (mean age: 76 years ±11, 74% female, 69% Black) were enrolled during pre-COVID-19 and COVID-19. 37% of participants (n=50) fell at least once during this time. Participants who fell experienced fewer falls during COVID-19 (mean=.64 falls) than they did pre-COVID-19 (mean=1.24 falls, p<.05). Falls that occurred during COVID-19 were less likely to have occurred while walking than falls prior to COVID-19. Participants who were enrolled during both COVID-19 and the same three months of 2019 and who fell during one of these time periods (n=45, 33%) fell less frequently during COVID-19 (mean=.44 falls) than they did during 2019 (mean=1.20 falls, p<.05).

CONCLUSIONS: Physical activity has been shown to both increase and protect against falls in older adults.

In one population of high-risk, community-dwelling older adults, an abrupt reduction in activity levels may have reduced falls. The long-term consequences of a comparably prolonged period of inactivity merit further study.

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ABSTRACT 76 CONTROL OF MESENCHYMAL CELL FATE VIA APPLICATION OF FGF-8B IN VITRO. Paulos Mengsteab1, Takayoshi Otsuka2, Cato Laurencin2. 1Medical Education, 2Orthopaedics.

1 Icahn School of Medicine at Mount Sinai, New York, New York, 2University of Connecticut.

BACKGROUND: In order to develop strategies to regenerate complex tissues in mammals, understanding the role of signaling in regeneration competent species and mammalian development is of critical importance.

Fibroblast growth factor 8 (FGF-8) signaling has an essential role in limb morphogenesis and blastema outgrowth. Yet, FGF-8’s role in the proliferation and differentiation of mesenchymal stem cells is not well understood.

RESEARCH QUESTION: The aim of this study is to investigate the effect of FGF-8b on the proliferation and differentiation of mesenchymal stem cells (MSCs), which have tremendous potential for therapeutic use of cell-based therapy.

METHODS: Rat adipose-derived stem cells (ADSCs) and muscle progenitor cells (MPCs) were isolated and cultured in growth medium and various types of differentiation medium (osteogenic, chondrogenic, adipogenic, tenogenic, and myogenic medium) with or without FGF-8b supplementation. Proliferation was assessed with a metabolic assay. To test the effect of FGF-8b on the differentiation of ADSCs and MPCs, FGF-8b was supplemented into the growth and differentiation medium of the various lineages.

The differentiation of cells was determined by quantitative real-time PCR (qRT-PCR) and immunostaining.

Statistical analysis was conducted to determine significant differences between groups.

RESULTS: We found that FGF-8b induced robust proliferation regardless of culture medium (~2-fold increase). Genes related to limb development were upregulated in ADSCs by FGF-8b supplementation.

Moreover, FGF-8b enhanced chondrogenic differentiation and suppressed adipogenic and tenogenic differentiation in ADSCs. Osteogenic differentiation was not affected by FGF-8b supplementation.

FGF-8b was found to enhance myofiber formation in rat MPCs. CONCLUSIONS: Overall, this study provides foundational knowledge on the effect of FGF-8b in the proliferation and fate determination of MSCs and provides insight into its potential efficacy for musculoskeletal therapies.

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ABSTRACT 77 GENIPIN-CROSSLINKED FIBRIN SEEDED WITH OXIDIZED ALGINATE MICROBEADS FOR INTERVERTEBRAL DISC CELL DELIVERY. James Meyers1, Christopher Panebianco2, James Iatridis2. 1Medical Education, 2 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Low back and neck pain are a public health concern, costing the US $134.5 Billion in 2016.

The intervertebral disc (IVD) is involved in an estimated ~40% of adult back pain cases, making it a candidate for therapy. Cell therapy has shown regenerative promise, however without addressing the biomechanic needs of the IVD. Injectable cell delivery biomaterials may offer a solution, however biomaterials capable of supporting large spinal loads requires a high-degree of cross-linking, which is cytotoxic. Achieving both biocompatability and requisite biomechanic strength poses a challenge. Previously, this lab reported oxidized alginate (OxAlg) microbeads (MBs) protected annulus fibrosus (AF) cells from genipin cross-linking, before degrading and releasing viable cells. Here we investigate genipin-cross-linked fibrin (FibGen), a high-modulus cell carrier, seeded with OxAlg MBs. RESEARCH QUESTION: 1. Greater genipin concentration will correlate with greater young’s or complex shear moduli, with and without MBs 2. Addition of MBs will lower complex shear and young’s moduli 3. Cleave caspase-3 positivity will be lower in samples with cell-seeded OxAlg MBs

METHODS: Cellular (20 M cells/mL) and acellular 2% (w/v) OxAlg MBs were seeded into FibGen hydrogels with varying genipin concentrations. Young’s (Ey) and complex shear (G*) moduli were tested in these hydrogels. Cellular MBs were harvested after 7 days and stained for cleaved caspase-3 to measure apoptosis. Significant differences (p<0.05) in MB size were determined using a Student’s t-test; one-way ANOVA with Tukey’s post-hoc test was used to determine significant differences in moduli and cleaved caspase-3 immunopositivity.

RESULTS: Increasing genipin led to significant increases in G*. The incorporation of MBs into either FibGen formulation significantly reduced both Ey and G*. OxAlg microencapsulation prior to FibGen seeding significantly reduced apoptosis levels for each formulation, compared to directly seeded FibGen samples.

CONCLUSIONS: This study demonstrated that OxAlg MBs can be seeded into FibGen to improve cell viability. Future experiments will try to reduce levels of apoptosis and test the FibGen+MB constructs over a longer time period.

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ABSTRACT 78 REPORTING OF READMISSIONS AFTER TOTAL JOINT ARTHROPLASTY: EXPERIENCE AND LESSONS LEARNED FROM A LARGE HEALTH SYSTEM. Meredith Mihalopoulos1, Jashvant Poeran2, Josiah Mueller2, Ken McCardle2, Leesa Galatz2, Michael Bronson2, Darwin Chen2, Calin Moucha2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Hospital readmissions following total hip/knee joint arthroplasty (TJA) is an important metric for various stakeholders as it informs hospital quality improvement, public reporting for hospital comparisons, mitigation of financial penalties under the Hospital Readmissions Reduction Program, and monitoring of preventable episode costs in bundled payments.

RESEARCH QUESTION: We sought to answer the question of how to improve (1) external reporting and (2) quality and cost to further decrease readmissions after TJA. METHODS: In the Mount Sinai Health System, we retrospectively assessed 90-day all-cause readmissions after elective TJA (October 2018-September 2019). Chart review identified targets for (1) improved external reporting through harmonization of inclusion/exclusion criteria and (2) continued readmissions reduction focusing on avoidable readmissions. Analyses include descriptive statistics.

RESULTS: Among 3,525 elective TJAs, 138 (3.9%) 90-day readmissions were included: 118 patients had one readmission while 17 had multiple readmissions. Of these readmissions, 41 (29.7%) were planned bilateral TJAs and 5 (3.6%) were planned non-orthopedic surgeries. Main reasons for unplanned readmissions involved surgery-related wound and mechanical complications (44.9%), including surgical site infection (10.1%), wound dehiscence (9.4%), isolated pain (9.4%), and wound drainage (4.3%). Nine patients (6.5%) presented with complaints potentially related to venous thromboembolism. The majority of unplanned readmissions involved patients presenting at the emergency department (ED), either directly (n=69) or following an office visit (n=10). Among the former, 26 patients had no record of communication with the surgeon’s office preceding the ED visit.

CONCLUSIONS: From a reporting perspective, these results demonstrate the need to distinguish planned from unplanned and single from multiple readmissions. From a quality improvement perspective, we identified potential targets, including infection and pain management, anticoagulation prophylaxis protocols, and patient-surgeon communication before ED visits. These findings are likely not unique, and our approach may benefit critical appraisal of readmissions reporting across other health systems.

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ABSTRACT 79 RISK REDUCTION STRATEGIES IN PATIENTS AT INCREASED RISK OF BREAST AND OVARIAN CANCER. Ariana Mills1, Hank Schmidt2. 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Breast cancer (BC) is the most common cause of cancer in women, and it is the second most common cause of cancer death in women. Individuals are high risk for developing BC and ovarian cancer (OC) if they have a pathogenic mutation; strong family history of BC and/or OC; and/or previous pathology of lobular carcinoma in situ (LCIS) or atypia. High risk patients can mitigate their risk of developing BC through high-intensity surveillance, prophylactic/risk reduction surgery (RRS), or chemoprevention.

RESEARCH QUESTION: To investigate the incidence of cancer and mortality in high risk patients based on their elected risk reduction strategy.

METHODS: We conducted a retrospective, single center review of patients seen within the High Risk Program from 2008-2020. We identified 626 patients who met our criteria of high risk and had no personal history of cancer. Our primary endpoints were incidence of cancer determined on pathology and mortality. Follow up data was collected between intake and most recent visit in person.

RESULTS: 517 patients (82.6%) elected surveillance, 106 patients (16.9%) elected RRS, and three patients (0.5%) elected chemoprevention. There was no recorded incidence of BC in the RRS or chemoprevention groups. 17 patients (3.3%) in the surveillance group were diagnosed with BC. One patient (0.9%) in the RRS group was diagnosed with OC. Three patients (0.6%) in the surveillance group and three patients (2.8%) in the RRS group were diagnosed with a non-BC/OC cancer. There was no mortality recorded.

CONCLUSIONS: While the uptake of surveillance was high, all the patients who developed BC were from the surveillance group. These patients were older on average and a larger percentage of them had a history of LCIS or atypia than the patients who did not develop BC. A greater percentage of the RRS group developed a non-BC/OC cancer than the surveillance group. All of the patients in the RRS group that developed a nonBC/OC cancer had a pathogenic mutation versus none of the patients who developed a non-BC/OC cancer in the surveillance group.

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ABSTRACT 80 IMPACT OF DEVICE ACCESSIBILITY & EXPANDED INTERNET ACCESS ON TELEHEALTH UTILIZATION AMONG AN URBAN HOMEBOUND POPULATION. Kate Moody1, Alexander Kalicki1, Peter Gliatto2, Katherine Ornstein2. 1Medical Education, 2 Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Telehealth utilization has increased over the past 10 years; however, this has not been uniform across patients. Medicare beneficiaries >65 are a third as likely as patients of the same age with private insurance to have completed a telehealth video visit. In 2020, 42% of NYC adults >65 lacked broadband internet access, compared to 23% of adults aged 18-64. Disparities in internet access and telehealth use track closely with other barriers to healthcare access such as poverty, unemployment, and primary language, indicating that telehealth compounds identified drivers of health care inequality.

RESEARCH QUESTION: To determine whether improving device accessibility and internet connectivity through the provision of a 4G telehealth tablet increases telehealth utilization among urban homebound patients.

METHODS: A RedCap survey of providers from the Mount Sinai Visiting Doctors (MSVD) Program was used to evaluate their patients’ telehealth ability and access. Results were used to determine which patients would receive a telehealth device provided by a company that specializes in remote patient monitoring.

We will look at telehealth usage in the 3-6 months following device receipt.

RESULTS: No MSVD patient prior to April 2020 had used telehealth. By July 8, 2020, 35% had engaged in at least 1 video visit and so were not considered to receive a device. Among patients with no prior telehealth visit, 89% were thought to need assistance but only 56% of those had someone available to help. All told, 97 were chosen as recipients: they were able to interact over video, had help if needed, had no existing means to connect over video, and were deemed to “definitely benefit” by their provider if they were selected.

CONCLUSIONS: As of Dec. 21st, 22 devices had been disseminated and registered to patients. An EPIC flow sheet collecting information on telehealth use, experience, and capabilities has been added and is active in the EMR for all patients. Currently, a rotating team of research coordinators are disseminating the remaining devices in early 2021. Once all 141 devices are disseminated (device number determined by grant & device cost), we will use the EPIC flow sheet to investigate how many patients who received a device completed a video encounter within 3-6 months.

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ABSTRACT 81 IMAGINING A “GOTHIC DISABILITY”: LITERARY GENRE, POLITICAL THEORY, AND LIVING DISABLED IN RIVA LEHRER’S PORTRAITURE. Olivia Moscicki1, Jacob Appel2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Normative representations of disability manifest “romantic norms” that present people with disabilities only as “supercrips,” victims, or symbols, options which preclude a spacious or even respectful imagining of disability for those who consume these representations—people with disabilities included.

Thus, alternative ways of representing and imagining disability are needed.

RESEARCH QUESTION: I propose that such normative representations of disability resemble what political theorist Bonnie Honig presents as prescriptive romantic norms of democratic participation and that the model of “gothic subjectivity” which she presents as an alternative may also facilitate liberatory imaginings of disability.

METHODS: To examine normative representations of disability and explore gothic subjectivity as an alternative framework, I turn to visual depictions of disability and the narratives they represent. First, I read Rosemarie Garland-Thomson’s visual rhetorics of disability as manifestations of Honig’s romantic norms.

Second, I explore the gothic genre’s relationship to disability and Honig’s translation of it into a framework for democratic participation. Finally, I analyze the work of disabled artist Riva Lehrer as a gothic expression of disability.

RESULTS: In contrast to normative representation, gothic imaginings of disability show their power to hold both the sometimes painful material reality of disability and the value, humanity, and obvious fullness of disabled life. In addition, gothic disability—particularly as manifested in the artwork of Riva Lehrer— recenters the disabled person in their own representation and facilitates the autonomous formation of a disabled subjectivity.

CONCLUSIONS: By offering more complex and autonomous representation, a gothic imagining of disability has the potential to reject ableist norms and instead form empowered disabled subjectivities.

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ABSTRACT 82 HOW IMMUNE-RELATED GENES AFFECT SEVERITY OF BLADDER CANCER IN DIFFERENT DEMOGRAPHIC GROUPS. Sarah Nathaniel1, John Sfakianos2. 1Medical Education, 2Urology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Recently, research has shown that the presence of mutations in certain immune-related genes can be used in classifying bladder cancer patients as high or low risk. However, there has not been any investigation into whether such genetic mutations are more prevalent in certain demographic groups of bladder cancer patients. By examining whether prevalence of these mutations varies according to demographic groups in bladder cancer patients, we might be able to further increase the accuracy with which we identify high risk patients by using genetic data.

RESEARCH QUESTION: Does the prevalence of certain genetic mutations in bladder cancer patients vary according to patient demographic group? Furthermore, is the presence of such genetic mutations indicative of different levels of risk within different demographic cohorts?

METHODS: We obtained genetic, clinical and demographic data of 412 bladder cancer patients from the Cancer Genome Atlas (TCGA). We then analyzed this data by using cBioportal to determine whether the occurrence of certain immune-related genes (RBP7, PDGFRA, AHNAK, OAS1, RAC3, EDNRA, and SH3BP2), as well as those genes investigated in the genetic mutation analysis done in the Sema4 lab at Mount Sinai, was higher in certain racial groups, or higher in men versus women.

RESULTS: For each gene investigated, we ran chi-squared or fisher’s exact tests to determine differences in prevalence of mutations between male and female patients, and between white, African American, and Asian patients. In all genes examined, no statistically significant differences in frequency were found between men and women (p > 0.05). Furthermore, in all genes investigated, no statistically significant differences in frequency were found when comparing between white, African American, and Asian patients (p > 0.05).

CONCLUSIONS: Going forward, we will look at the specific mutations found in each of the samples of the genes we are investigating, and discount non-deleterious mutations from our analysis (such that our analysis only looks at those mutations that could alter the function of the gene). Thus, we will further examine whether specific mutations in each of these genes are more common in different demographic groups.

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ABSTRACT 83 DOES RACE IMPACT THE INCIDENCE OF POSTPARTUM HEMORRHAGE IN PATIENTS UNDERGOING VBAC. Tonia Ogundipe1, Ayisha Buckley2, Luciana Vieria2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: In the United States, there exists disparities along racial lines that pertain to maternal morbidity and mortality. Postpartum hemorrhage happens to be the leading cause of maternal mortality and morbidity and has been found to have racial disparities corresponding to its incidence and outcomes with increased incidence among non-hispanic black, Hispanic, and Asian women. There also exists racial and ethnic disparities in vaginal birth after cesarean (VBAC) success with non-hispanic black women tending to have lower rates of success.

RESEARCH QUESTION: To evaluate whether race has an effect on predicted vaginal birth after cesarean delivery (VBAC) outcomes, particularly does race impact adverse events such as postpartum hemorrhage (PPH).

METHODS: Patients attempting VBAC between 2016 and 2019 were identified from the electronic labor and delivery logbooks. A chart review using data provided in EPIC identified patients who were eligible for inclusion and variables of interest including age, parity, indication for prior cesarean delivery, neonatal data, and delivery complications. Exclusion criteria included multiple gestation, greater than 1 previous cesarean section, previous classical uterine scar, delivery <36 weeks, and incomplete information. Ethnicity was defined as Hispanic/Latinx, not Hispanic/Latinx. Race was defined as Asian, Black, Hispanic/Latinx, White or other as self-reported on admission. Additional variables of interest included previous VBAC, previous successful vaginal delivery, and number of pregnancies. Frequency of successful VBAC were found for the different racial and ethnic groups and chi-square was used to compare the frequencies. The same was done for PPH. RESULTS: We identified 980 patients thus far who met inclusion criteria. There were 4.8% of patients who classified themselves as Asian, 13.8% Black, 58.7% Hispanic/Latinx, 58.7% White, or 9.5% Other. White patients were more likely to have successful VBAC (85.0%) when compared to black (62.2%), Hispanic/Latinx (70.9%), or Asian (64.6%) patients, p <0.0001. There were no differences between races in PPH rates.

CONCLUSIONS: Black race may be associated with a decreased rate of successful VBAC. There were no differences in rates of PPH by race.

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ABSTRACT 84 RACIAL DISPARITIES IN CARE AND OUTCOMES AFTER TOTAL HIP AND KNEE ARTHROPLASTIES: DID THE COMPREHENSIVE CARE FOR JOINT REPLACEMENT PROGRAM MAKE A DIFFERENCE? Jeffrey Okewunmi1, Meredith Mihalopoulos2, Vivien Huang3, Calin Moucha2, Jashvant Poeran2.

1 Medical Education, 2Orthopaedics, 3Population Health Science and Policy.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Racial disparities have been noted in care and outcomes after total hip/knee joint arthroplasties (TJA). However, they have not been systematically evaluated across a full episode of care and it is unclear if the Comprehensive Care for Joint Replacement (CJR) bundled payment program has impacted pre-existing disparities. This study aims to: systematically assess racial disparities in care before, during, and after TJA surgery, and assess the impact of the CJR program on these disparities.

RESEARCH QUESTION: 1) racial disparities in preoperative and postoperative care will be present before the CJR program 2) disparities will be reduced after the CJR program, especially in postoperative care METHODS: This retrospective cohort study includes data on 1,546,982 TJA procedures (2013-2018 Medicare data). Racial disparities, differences between Black versus white patients, were assessed for: preoperative characteristics (Charlson comorbidity index, age), characteristics during hospitalization (length of stay, blood transfusions, combined complications), and postoperative characteristics (90-day readmission, institutional post-acute care). Medicare payments for each period were also assessed. Racial differences were expressed by year in odds ratios (OR) with 95% confidence intervals (CI). A ‘differencein-differences’ analysis (comparing before and after CJR enactment, using non-CJR hospitals as controls) estimated the impact of the CJR program on racial disparities.

RESULTS: Black (compared to white) patients (n=74,390) were more likely to: have a higher comorbidity index (score >0: OR≤1.32, CI: 1.28, 1.37), require more transfusions (OR≤1.84, CI: 1.68, 2.01), be discharged to institutional post-acute care (OR≤1.57, CI: 1.52, 1.62), and be readmitted within 90 days (OR≤1.38, CI: 1.32, 1.44); all p<0.05. Adjusted pre-post analyses demonstrated the CJR program to reduce disparities in institutional post-acute care discharge (-2.63%, CI: -4.24,-1.01, p=0.0015) and 90-day readmission (-1.4%, CI: -2.52,-0.25, p=0.0172), showing a stronger beneficial impact of CJR in Black patients.

CONCLUSIONS: Although racial disparities persist among TJA patients, the CJR program has positively impacted some measures of disparity, highlighting the potential of bundled payments.

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ABSTRACT 85 POSTPARTUM DEPRESSION AND ATOPY-RELATED OUTCOMES IN THE CHILD. Paloma Orozco Scott1, Hsiao-Hsien Leon Hsu2, Maria José Rosa2. 1Medical Education, 2 Population Health Science and Policy. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Caregiver stress during the prenatal and postnatal period have been correlated with childhood atopic outcomes. In mothers with asthma, the presence of depressive symptoms increased their children’s risk for atopy.

RESEARCH QUESTION: Examine the associations between maternal postpartum depression, six months after delivery, and the child’s risk of having wheezed in the last year or ever having wheezed by age 4.

METHODS: This prospective study is based on data from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study. The Edinburgh Postnatal Depression Scale (EDPS) estimated maternal postpartum depression, scores were dichotomized around “fairly high possibility of depression”, ≥ 13, and “unlikely depression” <13. Child atopy was estimated using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. In the sample of 500 children, 33.3% of the children had ever wheezed by age 4 and 12.6% reported wheezing within the last year. We used a modified Poisson regression for statistical analysis.

RESULTS: There was a borderline association for the overall [1] sample (N=500) between maternal postpartum depression and the child’s risk of having wheezed in the last year (RR= 1.69, P=0.062) or ever having wheezed at age 4 (RR=1.197, P=0.338). After sex stratification, the association was stronger in males.

In males, postpartum depression increased risk of having a wheeze within the last year (RR=2.8239, P=0.0069) and ever having wheezed (RR=1.529; P=0.05). For females, the risk of having a wheeze within the last year (RR= 1.787, P= 0.16) and ever having wheezed (RR=0.7413; P=0.462) were not statistically significant.

CONCLUSIONS: Maternal postpartum depression is associated with increased risk of having a wheeze or ever having wheezed by age four. More investigation into the sex differences and understanding the temporal and specific associations should be conducted. Mitigating postpartum depression may positively influence male children’s atopic health.

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ABSTRACT 86 THE IMPACT OF SUPPLEMENTARY NUTRITION EDUCATION ON ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI (ISMMS) MEDICAL STUDENTS. Ye Park1, Beverly Forsyth1. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Medical students receive inadequate nutrition education at ISMMS. There is a need for current ISMMS medical students to receive supplementary nutrition education and to identify how this impacts them as future physicians.

RESEARCH QUESTION: How do the attitudes of medical students currently receiving inadequate nutrition education change after receiving supplementary nutrition education?

METHODS: An optional 5-week (9hrs) Food as Medicine Nexus Course covered modules of Clinical Nutrition and Food and Health Equity. Surveys were distributed at the beginning of the course and after each module (wks 0, 3, and 5) to evaluate change in students’ confidence, motivation, and empowerment in (1) incorporating nutrition into their future care as physicians, (2) advocating for nutrition, and (3) addressing health disparities related to the food system.

RESULTS: 20 1st- and 2nd-year medical students enrolled in the Food as Medicine Nexus Course. The average attendance rate was 60%. On average, students reported 4.5 out of 5 that they feel their current/ future mandated medical training lacks nutrition education. Average participation in surveys was 52%.

Students surveyed at the end of wk 3 showed statistically significant increases in feeling that it was more important to have adequate nutrition education integrated within their training, as well as more confident and empowered in the three metrics. Students surveyed at the end of the course (wk5) showed statistically significant increases from wk 3 to 5 in feeling more motivated and empowered in (1), more empowered in (2), and more confident in (3).

CONCLUSIONS: ISMMS medical students who feel that nutrition education is lacking in their current mandated training felt that it was more important to have adequate nutrition education in their training after completing the Food as Medicine Nexus course. Over 5 weeks, students also displayed statistically significant increases or upward trends in confidence, motivation, and empowerment in all metrics. However, conclusions are limited from data of students who are self-selecting to be in an optional course. Nonetheless, the survey results highlight that students are engaging in supplemental nutrition education and gaining valuable nutrition exposure.

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ABSTRACT 87 RURAL GHANAIAN COMMUNITY IMPRESSIONS OF NURSE-LED CARDIOVASCULAR DISEASE CARE. Bhavana Patil1, Isla Hutchinson Maddox1, Raymond Aborigo2, Khadija Jones3, Denis Awuni2, Allison Squires4, Abraham Oduro2, Carol Horowitz3, David Heller3. 1Medical Education, 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2Navrongo Health Research Centre, Navrongo, Ghana, 4New York University, New York, NY. BACKGROUND: The Community-based Health Planning and Services (CHPS) program is Ghana’s nurse-led coalition providing primary care to rural communities. While it focuses on infectious diseases and maternal health, the rising cardiovascular disease (CVD) burden and sparse treatment in rural Ghana suggests a need for CHPS expansion to include hypertension and other CVD care.

RESEARCH QUESTION: In northern Ghana, we aimed to understand rural community beliefs regarding CHPS’s capacity to provide CVD education and treatment, in order to inform the development of a CHPS CVD care model.

METHODS: In the Kassena-Nankana districts, staff interviewed 30 adult community members (CM) regarding their experience with CVD care through CHPS. We used convenience sampling to identify respondents who matched our inclusion criteria based on age, gender, and level of engagement with CHPS. Interview guides were written in English but conducted in the interviewee’s preferred language, by trained research assistants fluent in English, Kasem, and Nankam. Trained research assistants from the Navrongo Health Research Centre conducted the interviews and transcribed the audio recordings directly into English. The transcripts were coded using the NVivo qualitative software and analyzed using a grounded theory approach.

RESULTS: Key themes emerged from the analysis of interviews. Respondents concurred that CHPS nurses provide chiefly symptomatic CVD relief with medication, followed by a referral to a hospital for definitive care. Most CM felt, however, that CHPS nurses could also provide screening and further CVD treatment if medication access and clinical training are improved. Few CM mentioned diet and behavioral counseling as part of the current CHPS care plan, while most were interested in receiving more CVD education.

CONCLUSIONS: Navrongo CM see CHPS as offering CVD care only for symptomatic patients – and believe the program should also focus on preventative screening and education in any CHPS care model for CVD. Most CM felt CHPS nurses were capable of providing that service with more training, and were open to participating in such a CVD program. The findings intend to inform the design of a community-based model using CHPS to screen and treat hypertension and other CVDs.

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ABSTRACT 88 ASSESSMENT OF THE RELATIONSHIP BETWEEN CHILDHOOD OBESITY AND SURGICAL OUTCOMES. Megan Paul1, Brian Coakley2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: 18.5% of children in the US meet the definition of obese. While multiple studies show that obesity increases the risk of post-operative complications among adults, there exists almost no data on how obesity impacts surgical outcomes among children.

RESEARCH QUESTION: The research question involved evaluating the short-term effects of surgery on pediatric patients to see if there is a link between childhood obesity and response to surgical intervention.

Our hypothesis was that obesity, like in adults, can lead to more adverse complications in children.

METHODS: This is a retrospective chart review of 500 pediatric surgical patients between ages 2 and 18 at MSH over 1 year. Patients were stratified into 3 groups including “obese” (BMI > 30), “overweight” (BMI 25-30) and “non-overweight” (BMI < 25). Pre-op data were collected such as prior surgeries as was perioperative information such as blood loss. Post-op complications were also analyzed. All categorical analyses were conducted using chi square tests while quantitative information was evaluated using Kruskal-Wallis Testing, all at a significance level of p<0.05.

RESULTS: Overall, 28 patients (6.1%) were obese, 42 (9.4%) were overweight, and 386 (84.5%) were considered normal or underweight (“non-overweight”). 43 patient charts were excluded due to lack of BMI data. Obese patients had more tonsillectomies and/or adenoidectomies as well as appendectomies as a percentage of total surgeries compared to their counterparts (p<0.05).

7.1% of obese patients reported wound evisceration compared to 4.8% and 0.5% of overweight and nonoverweight patients, respectively (p<0.05). Obese patients also reported an average of 63.5 mL of blood loss compared to 15.1 and 21.9 mL in overweight and non-overweight patients, respectively (p<0.05). Finally, obese patients had shorter post-op follow-up times at 16.1 days compared to overweight patients at 17.2 days and non-overweight patients at 28.3 days (p<0.05).

CONCLUSIONS: Ultimately, obesity was associated with more adverse outcomes in this study population than in non-obese individuals. Next steps should include evaluating more charts in order to capture more obese patients and expanding the study interval beyond one year.

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ABSTRACT 89 COMPARING SIRS ALERTS FREQUENCY BETWEEN POSTOPERATIVE SURGERY VS. MEDICAL PATIENTS PLACED ON SEPSIS PATHWAY. Jonah Poster1, Matthew Peacock2, Venu Bangla2, Celia Divino2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Early identification of sepsis is necessary to improve patient outcomes as survival decreases with each passing hour of delayed antibiotic treatment. The Systemic Inflammatory Response Syndrome (SIRS) criteria is a widely used electronic alert system as an early indicator of sepsis.

RESEARCH QUESTION: We suspect that the SIRS alerts generate more false positive hits in patients recovering from surgery as compared to patients on medical units.

METHODS: We conducted a retrospective review of sepsis screening reports generated between January 2020 and August 2020. All patients who triggered a post-admission SIRS alert were included in our analyses.

Patients who had a SIRS alert within postoperative day 5 or less were included in the surgery cohort. All other patients were included in the medical cohort. The study endpoint was a physician order to place the patient on the sepsis pathway. The sepsis pathway is an order set for early sepsis treatment. Lastly, we explore the differences in the vital signs metrics between the two cohorts.

RESULTS: A total of 106 unique patients were included in the study who triggered 132 alerts. Thirty-two alerts, from 30 patients, were included in the surgery cohort. One hundred alerts, from 78 patients, were included in the medical cohort. The medical cohort had 50 (50%) true positive alerts and 50 (50%) false positive alerts.

The surgery cohort had 9 (28%) true positive hits and 23 (72%) false positive hits. There were significantly more false positive hits in the surgery cohort as compared to the medical cohort X2 (1, N=132) =4.69, p=0.03.

White blood cell count and number of vital sign deviations were significantly different between the medical and surgery cohorts. Heart rate was significantly higher amongst surgery patients off the sepsis pathway as compared to surgery patients placed on the sepsis pathway.

CONCLUSIONS: SIRS alerts produce significantly more false positive hits for patients recently recovering from surgery as compared to medical patients. Sepsis alert criteria could be better improved to increase specificity for patients recovering from surgery. We did not find clinically useful vital sign differences amongst surgery patients placed on versus off the sepsis protocol.

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ABSTRACT 90 ELECTIVE FETAL REDUCTION IN MONOCHORIONIC DIAMNIOTIC (MCDA) TWINS DECREASES ADVERSE OUTCOMES COMPARED TO ONGOING MCDA TWINS. Geeta Rao1, Luciana Vieria2, Elianna Kaplowitz3, Jessica Overbey3, Shaelyn O’hara2, Keisha Paul2, Robert Lookstein2, Andrei Rebarber2, Nathan Fox2, Joanne Stone2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3Population Health Science and Policy. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Multifetal Pregnancy Reduction (MPR) is a technique used to reduce the fetal number with the goal of mitigating the risk of adverse outcomes, specifically preterm birth (PTB). MCDA twins are subject to unique complications which contribute to adverse pregnancy outcomes. Our objective was to compare outcomes of elective reduction of MCDA twins by radiofrequency ablation (RFA) to planned ongoing MCDA twins.

RESEARCH QUESTION: Does elective MPR reduce the risk of preterm birth?

METHODS: We performed a retrospective review of 315 MCDA twin gestations that underwent first-trimester ultrasound at two practices within one institution. Planned elective reduced twins were compared with planned ongoing MCDA twins. The primary outcome was PTB at less than 34 weeks. Secondary outcomes included PTB < 37 weeks, unintended loss, adverse maternal and neonatal outcomes.

RESULTS: Among 375 identified MCDA twins, complete follow-up data was available for 315 patients (84%).

Of these pregnancies, 14 (4.4%) underwent elective MPR and 301 (95.6%) were planned ongoing twins.

Patients who underwent elective MPR had significantly higher maternal age (p<0.01) and were more likely to be of Asian race/ethnicity (p<0.01) compared to patients with ongoing twins. They were also more likely to have undergone IVF (p=0.03) and chorionic villus sampling (p<0.01). Patients with ongoing pregnancies had an 8-fold risk of PTB <37 weeks compared to elective RFA patients (OR 8.0, 95% CI 2.4-26.4; p<0.01) although no difference in PTB < 34 weeks. All patients who underwent elective RFA had successful pregnancies with no pregnancy losses or terminations. Twenty-two patients (7.3%) with planned ongoing twins had total pregnancy loss < 24 weeks, 24 (8%) had unintended pregnancy loss < 24 weeks, 16 (5.3%) underwent a medically indicated RFA and 5 (1.7%) had intrauterine fetal demise (IUFD) > 24 weeks. There was no significant difference in loss rates between the two groups.

CONCLUSIONS: In this study of MCDA twins, patients who elected to undergo MPR had lower rates of PTB < 37 but not < 34 weeks without an increased risk of pregnancy loss. Further research is needed to clarify if this improves long term outcomes.

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ABSTRACT 91 ASSESSING THE IMPACT OF THE COVID-19 PANDEMIC ON POSTPARTUM CONTRACEPTION UPTAKE. Paige Rattner1, Chelsea Debolt2, Lorraine Toner2, Sharon Gerber2, Luciana Vieria2. 1Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Due to COVID-19, telemedicine was incorporated into postpartum care to reduce transmission risk.

RESEARCH QUESTION: Our objective was to compare postpartum contraception uptake between March 1, 2019-May 31, 2019 and March 1, 2020-May 31, 2020.

METHODS: This is a retrospective cohort study of postpartum patients who delivered at the Mount Sinai Hospital System between March 1, 2019-May 31, 2019 and March 1, 2020-May 31, 2020. We recorded postpartum contraception uptake at hospital discharge and at outpatient postpartum visits. We compared four categories: short-acting reversible contraception (SARC), long-acting reversible contraception (LARC), “barrier methods/other” (condoms, diaphragms, spermicides), and sterilization. The 2019 and 2020 patient cohorts did not differ significantly in terms of maternal age, gravidity, ethnicity, or insurance type. This study was approved by the Mount Sinai IRB. RESULTS: 1,106 patients were included in our analysis, 443 and 663 who delivered in 2019 and 2020 respectively. There were no significant differences in the number of patients offered and accepting contraception at hospital discharge and postpartum visit between the 2019 and 2020 groups. Type of contraception given at postpartum visit differed significantly between 2019 and 2020 (p=0.006), with the 2020 group more likely to use SARC (55 vs. 42%) and less likely to use LARC (15 vs. 24%). Notably, 26% of the 2020 group had telehealth postpartum visits (vs. 0% in 2019). Within the 2020 group, type of contraception differed significantly between in-person and telehealth visits (p=0.001). Patients who had telehealth visits were less likely to use “barrier/other” methods (14 vs. 32%) and more likely to use SARC (67 vs. 51%).

CONCLUSIONS: Despite COVID-19, overall uptake of postpartum contraception did not change significantly; however, the type of contraception differed significantly, particularly at telehealth visits. Additional research is needed to understand why telehealth postpartum visits may increase the uptake of short acting contraception over barrier methods.

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ABSTRACT 92 ANALYSIS OF PERIOPERATIVE OUTCOMES IN OPEN VERSUS MINIMALLY INVASIVE DONOR NEPHRECTOMY. Krishna Ravivarapu1, Nir Tomer1, Alexander Small2, Michael Palese2. 1Medical Education, 2 Urology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Donor nephrectomy (DN) can be done as an open surgery or as minimally invasive surgery (MIS), which includes laparoscopic and robotic approaches. Understanding the rates of each approach over time, as well as the difference in outcomes and risk factors for each approach is critical information for physicians.

RESEARCH QUESTION: We hypothesize that MIS DN will exhibit more favorable outcomes compared to open DN. METHODS: We reviewed all live DN reported in the Statewide Planning and Research Cooperative System (SPARCS) database of New York State. Patients who underwent DN between 2000-2013 were identified and grouped by open surgical approach or MIS approach. Perioperative outcomes assessed were length of stay (LOS) and 30-day and 90-day readmission rates. Multivariate logistic regression was used to determine predictors of readmission following DN, controlling for age, sex, race, income, and insurance.

RESULTS: We analyzed 6,661 patients who underwent DN. MIS accounted for 23.6% of DN cases and open approach accounted for 76.4%. There was an upward trend in the annual rate of MIS approach over the course of the study time period. The mean LOS for open DN (2.86 days) was greater than the mean LOS for MIS DN (2.76 days) (p=0.022). Furthermore, open DN had a 1.59-fold increased risk of a prolonged LOS more than 4 days (p<0.001). The overall 30-day DN readmission rate was 3.69% and 90-day readmission rate was 4.62%. 30-day readmission rates following MIS DN and open DN were 3.02% and 3.9% respectively. 90day readmission rates following MIS DN and open DN were 3.7% and 4.9% respectively. In the multivariate regression, black patients had a 1.553-fold increased risk of 30-day readmission and a 1.47-fold increased risk of 90-day readmission following DN (p=0.019). Open surgery DN exhibited a 1.4-fold increased risk of 90-day readmission (p=0.026).

CONCLUSIONS: There is a significantly greater risk of 90-day readmission when an open surgery approach is used for DN over MIS DN. Overall, the rates of readmission and LOS for open surgery are also shown to be higher. There has also been an upward trend in the rate of MIS DN; this shift towards MIS DN is promising and will likely continue in the future in order to improve perioperative outcomes.

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ABSTRACT 93 CUSTOMIZED ENRICHMENT ANALYSIS INVESTIGATING THE ROLES OF HHV6A AND HHV7 TRANSCRIPTOMICS IN ALZHEIMER’S DISEASE. Shoshana Rosenzweig1, Mesude Bicak2, Benjamin Glicksberg3. 1Medical Education, 3 Genetics and Genomic Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Human herpesvirus (HHV) 6A and HHV7 have been implicated in the development of late-onset Alzheimer’s Disease (AD). These viruses have been implicated in the regulation of AD gene expression through dysfunction of microglia cells. Transcriptomics analysis can elucidate a relationship between immune mechanisms and AD. RESEARCH QUESTION: Acute infection of microglia cells with HHV6A and HHV7, a novel experimental design, will validate this experiment type for investigation of the effects of long-term infection on postmortem samples, as shown in Redhead et al. (2018).

METHODS: HHV6A and HHV7 infected and non-infected microglia RNA-Seq samples at 1 and 6 days after infection were analyzed to obtain differentially expressed genes (DEGs). FASTQC, Principal Component Analysis and multidimensional scaling were used to assess sample quality. Sequences were aligned to hg19 reference genome using STAR. Following TMM normalization, Limma’s voom with Benjamini-Hochberg false discovery rate was used to process samples. AD implicated DEGs were collated from five recent publications for a customized enrichment analysis using GAGE. DEGs were compared to the AlzGene repository.

RESULTS: We identified 167 and 12 DEGs, and 157 and 64 DEGs when comparing non-infected samples against HHV6A and HHV7 after 1 and 6 days of infection, respectively. When comparing HHV6A and HHV7 infected samples, 60 and 66 DEGs were identified at day 1 and 6, respectively. TXNDC5, ANK2, FOXP2, and NAP1L3, all previously implicated in AD, were significantly upregulated after 1 day in both infected samples. We found 46 unique DEGs that overlapped with AlzGene. Customized enrichment was performed against 24,910 DEGs collated from the literature, resulting in 177 enriched KEGG pathways, involving 8,480 genes, and 935 GO enriched ontology groups, involving 28,001 genes. Compared to collated DEGs, 82.3% of AlzGene DEGs overlapped.

CONCLUSIONS: This exploratory analysis reveals DEGs and pathways previously implicated in AD suggesting acute infection by HHV6A and HHV7. Follow-up data with additional time points and increased viral activity is necessary to interpret genetic signatures and pathways, however, these results validate captured infection and provide a strong base for future findings.

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ABSTRACT 94 A MULTIOMIC APPROACH TO THE DISCOVERY OF BIOMARKERS FOR INTRACRANIAL ANEURYSMS. Christina Rossitto1, Carina Seah1, Dominic Nistal2, Kurt Yaeger2, J Mocco2, Christopher Kellner2.

1 Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Intracranial aneurysm (IA) is a cerebrovascular disorder that when ruptured can cause devastating subarachnoid hemorrhage. Analytes that correlate with IA size have the potential to be used as a blood-based test to monitor IA presence and growth in patients. Our approach illustrates the power of multi-omics analysis in IA biomarker discovery.

RESEARCH QUESTION: The purpose of this study was to utilize multi-omics data to identify differential expression of monocyte RNA and protein in patients with IA. METHODS: IA characteristics were obtained through cerebral angiography. Monocyte RNA was extracted from blood samples of 8 IA patients, subjected to RNA sequencing, and pseudo-aligned using Kallisto.

Plasma protein levels were assessed through the Olink Inflammatory Panel. To analyze monocyte RNA expression, patient samples were divided into large (diameter > 7mm) and small aneurysm (< 7mm) cohorts and differentially expressed genes were identified using DESeq. The top 20 differentially expressed transcripts and clinical characteristics underwent linear regression to evaluate ability to predict aneurysm size. To analyze protein expression, the top 70 expressed proteins underwent linear regression to predict aneurysm size.

RESULTS: Of the 8 patients with IA, 87.5% (n=7) were female, with a mean aneurysm size of 7.8 mm. Linear regression of monocyte RNA revealed 4 transcripts predictive of aneurysm size at P < 0.05: HIST2H4A (P = 0.0122), CAMK2D (P=0.0267), WARS1 (P=0.0378), ANXA1 (P=0.0418). Multiple linear regression modeling with the 4 genes was not significant for prediction of aneurysm size (multiple R-squared: 0.7681, adjusted R-squared: 0.459, P = 0.2403). Linear regressions of clinical characteristics were not significant. Linear regression of protein expression revealed 7 proteins predictive of aneurysm size at P < 0.05: Beta-NGF (P=0.0318), CASP-8 (P=0.0382), CXCL6 (P=0.039), CCL28 (P=0.0447), TNFRSF9 (P=0.0443), CXCL11 (P=0.0461), MCP-2 (P=0.0465).

CONCLUSIONS: In this small pilot study, we were able to identify potential biomarkers for IA growth.

The adoption of this protocol at a larger scale may have a direct impact on precision medicine and the discovery of biomarkers for IA.

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ABSTRACT 95 VIRTUAL RESTORATIVE HEALTH CIRCLES (RHCS) AS A MEANS OF FACILITATING HEALING AND GROUP REFLECTION WITHIN A COMMUNITY. Nikita Roy1, Ann-Gel Palermo1 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The COVID-19 Pandemic has further exacerbated an already-existing disparity in access to supportive healing within communities that live on the margins of our healthcare system. With the transition to a virtual space that has taken place in the year 2020, Radical Health (RH) has adapted their programming to bring Restorative Health Circles (RHCs) to a virtual platform, called MyCircles. There is a huge need for these services in the East Harlem (EH) community and beyond as it represents a key strategy to support the collective healing and processing of life events. This project was conducted in partnership with the Mount Sinai Diversity Innovation Hub. RESEARCH QUESTION: How can we most efficiently and productively market, recruit, and execute RHCs to reach the widest network and provide the greatest benefit to the community?

METHODS: The target audience was the EH community, and within it, groups that have shared lived experiences, (e.g. being a new mother or father, Black men, Black women). Project activities include planning, recruiting, and executing several RHCs among several different groups, and collected survey data on the efficacy of these RHCs within those groups. We also course-corrected program efficiency strategies throughout the project period and developed a guide to aid future RH interns in planning, recruiting, and executing RHCs from start to finish.

RESULTS: The RHCs conducted during this project period were well-attended and well-received. Future work with Radical Health will consolidate metrics on the events to present as research findings. Ultimately, the success of these events depends on their accessibility, user-interface ease and the efforts of the chosen facilitator. Understanding these metrics can clue us into ways to improve and expand RHCs in the future.

CONCLUSIONS: Ideally, companies like Radical Health would work in tandem with doctors to facilitate increased access to alternative forms of health care. With our structured healthcare system that leaves gaps open for patient access to services like RHCs, there lies a need to explore just how these kinds of programs can be seamlessly integrated into the network, such that doctors can better understand, interact with, and therefore increase access to these programs in the future.

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ABSTRACT 96 ULTRA-HIGH-RESOLUTION STRUCTURAL MRI OF AMYGDALA SUBNUCLEI IN EPILEPSY. Mia Saade1, Gaurav Verma2, Lara Marcuse3, Madeline Fields3, Stephanie Brown4, Priti Balchandani2.

1 Medical Education, 2Radiology, 3Neurology, 4Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York, 4University of Cambridge.

BACKGROUND: Localization of seizure onset has implications for further treatment of epilepsy, especially in patients who are drug-refractory and may turn to neurological surgery to alleviate their symptoms. However, lesions cannot be localized in many patients with epilepsy at clinical field strengths of 1.5 and 3 Tesla. 7 Tesla (7T) magnetic resonance imaging (MRI) has the power to elucidate structures previously uncoverable at clinical field strengths. The use of 7T MRI to isolate the amygdala subnuclei in patients with epilepsy has the potential to provide further pathophysiological explanation and reveal imaging biomarkers of the amygdala in epilepsy.

RESEARCH QUESTION: Volumetric analysis of the amygdala subnuclei using 7T MRI will reveal differences between patients with epilepsy and healthy controls.

METHODS: T1- and T2-weighted images at 7T were obtained from healthy participants and patients with epilepsy. Using automated segmentation, the volume of each amygdala subnuclei was measured.

Amygdala subnuclei volumes were normalized to intracranial volume. False discovery rate (FDR) correction for multiple comparisons was performed, and a p-value < 0.05 was considered significant.

RESULTS: 44 controls and 51 patients with epilepsy underwent MRI study. Amygdala subnuclei volumes were compared, but no between-group differences survived FDR correction. However, of the 22 patients with epilepsy with known left-sided seizure onset, volumes of the amygdala left basal nucleus (p = 0.02, r2 = 0.25), left accessory basal nucleus (p = 0.02, r2 = 0.23), left lateral nucleus (p = 0.03, r2 = 0.21), and left cortical nucleus (p = 0.03, r2 = 0.21) each displayed significant negative associations with epilepsy duration.

CONCLUSIONS: Analysis of 7T MRI structural features in patients with epilepsy revealed potential biomarkers of epilepsy. Further participant recruitment is needed to continue to validate the differences seen.

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ABSTRACT 97 POST-TRAUMATIC GROWTH AND RESILIENCE IN ADOLESCENTS IN PUERTO RICO POST-HURRICANE MARIA. Gabriel Santos Malave1, Cynthia Luo1, Robert Yanagisawa2, Craig Katz3. 1Medical Education, 2 Medicine, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Hurricane Maria and the COVID-19 pandemic have greatly impacted the lives of adolescents in Puerto Rico. Understanding how individuals respond to stress can elucidate strategies used to cope and grow from impactful life events (ILE) while minimizing adverse mental health consequences. This expands on work with medical students in Fukushima post-3/11.

RESEARCH QUESTION: Adolescents who utilize more resilience behaviors will experience more post-traumatic growth. Adolescents who demonstrate post-traumatic growth from a previous event will experience less COVID-related stress.

METHODS: Students were anonymously surveyed and responded to the Davidson-Trauma Scale (DTS), Post-Traumatic Growth Inventory (PTGI), Connor-Davidson Resilience Scale-10 (CDRS-10), Resilient Behavior Scale (RBS), and questions specific to COVID-19 and Hurricane Maria. Data was analyzed by examining correlations between scales and between scales and questions specific to COVID-19 and natural disasters.

RESULTS: The RBS and CDRS-10 were positively correlated with each other (r = .679, p = .002). The PTGI was positively correlated with the RBS (r = .878, p < .001) but not the CDRS-10. Students who chose a prior non-COVID-19 ILE experienced less COVID-19 stress (p = 0.047) than those who chose COVID-19.

Post-traumatic growth (PTG) was greater in those who indicated an ILE affected them and others instead of only them (p = 0.04). PTG was also positively correlated with finding something positive in Hurricane Maria (r = .458, p = 0.024) but not COVID-19. In the free response section, most indicated meeting new people and coming together as positive aspects of Hurricane Maria.

CONCLUSIONS: Our results indicate adolescents’ resilient behaviors, not resiliency per se, were associated with post-traumatic growth since only RBS was correlated with PTG. Additionally, undergoing prior stressful events appears to mitigate distress from future stressors. Finally, experiencing an ILE alongside others appears to lead to greater PTG suggesting an important role for social connection.

The social isolation of COVID-19 may have diffused the potential to find something positive in the event even in those experiencing PTG.

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ABSTRACT 98 PRENATAL BLOOD LEVELS AND REDUCED PREADOLESCENT GLOMERULAR FILTRATION RATE: MODIFICATION BY BODY MASS INDEX. Charles Saylor1, Marcela Tamayo Ortiz2, Ivan Pantic3, Chitra amarasiriwardena4, Nia Mcrae4, Guadalupe Estrada-Gutierrez5, Sandra Parra Hernandez6, Mari Cruz Tolentino6, Andrea Baccarelli7, Jeffrey Fadrowski8, Chris Gennings4, Lisa Satlin9, Robert Wright4, Martha Tellez Rojo2, Alison Sanders4.

1 Medical Education, 8,9Pediatrics. 1,4,9Icahn School of Medicine at Mount Sinai, New York, New York, 2 Mexican Social Security Institute, 3Mexican Social security institute, 5national institute of perinatology, 6 Institute of Perinatology, 7Columbia Mailman School of Public Health, 8Johns Hopkins, Maryland (MD).

BACKGROUND: Lead is a potent tubular and glomerular nephrotoxicant. The kidney may be uniquely vulnerable during the perinatal period, given that nephron formation is largely complete by the 3rd trimester.

Injury during this period may result in impaired glomerular filtration later in life.

RESEARCH QUESTION: Our study examines whether perinatal lead exposure impairs adolescent glomerular filtration, and whether perinatal lead exposure acts synergistically with adolescent adiposity to decrease estimated glomerular filtration rate (eGFR).

METHODS: Our study included 453 mother-child pairs participating in the PROGRESS birth cohort in Mexico City. We applied linear regression models to assess the relationship between prenatal bone and blood lead level (BLL) with preadolescent eGFR, and adjusted for covariates including age, sex, BMI z-score, indoor tobacco smoke exposure, and socioeconomic status.

RESULTS: We observed overall null associations between perinatal lead exposure and adolescent eGFR. However, among overweight participants only, we observed significant, inverse associations between BLL and preadolescent eGFR after adjusting for the associated covariates. This finding was replicated across three different time points, including 2nd trimester, 3rd trimester, and cord blood lead levels. For example, among overweight participants, a one ln-unit increase in 2nd trimester BLL was associated with a 10.5 unit decrease in cystatin C-based eGFR (95% CI: -18.1, -2.8; p = 0.008). We also observed null relationships between BMI z-score and eGFR overall, as well as among overweight participants. However, categorical obesity was associated with a statistically significant 5.9-unit decrease in eGFR (95% CI: -11.0, -0.8, p = 0.02).

CONCLUSIONS: Our study warrants further research into the complex interplay between adolescent adiposity and perinatal lead exposure as it pertains to renal function. Our findings also underscore the importance of public health interventions to reduce lead exposure. Future studies will further elucidate the timeline of glomerular filtration rate through adolescence to better understand the environmental exposures that may impair kidney function.

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ABSTRACT 99 ASSESSING FACTORS ASSOCIATED WITH ACCIDENTAL DURAL PUNCTURE IN LABOR AND DELIVERY ANESTHESIA. Ira Schlosberg1, Daniel Katz2. 1Medical Education, 2Anesthesiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Epidural anesthesia is a common practice during labor and delivery. Accidental dural puncture (ADP) may occur, causing mothers to experience nausea, headache, and risk of CSF leak and infection. Mother’s discomfort can also negatively impact bonding with her newborn.

RESEARCH QUESTION: What factors (e.g. training/experience level, fatigue, time of day) are associated with ADP during epidural anesthetic administration for mothers in labor?

METHODS: This was a non-randomized, self-report, survey-based, observational study. Anesthesiologists at 3 Mount Sinai hospitals in NYC participated, completing the questionnaire following incidents of ADP. Questions included clinician experience level, length of shift, time of day, and other factors that may have contributed to ADPs. RESULTS: 39 questionnaires were collected from 7/17/2019 to 6/19/2020. Of total ADPs, 71.8% were by 1st and 2nd year anesthesia residents (non-interns). Majority of clinicians (55.3%) who endorsed ADPs completed <100 epidurals in their careers, 26.3% completed 100-500 such procedures. Most performed recent epidurals, prior to ADP, in the same day (69.2%) or in the last week (20.5). ADPs occurred equally across different times of day and were not highly prevalent during 24 hour shifts (10.3%). The average reported fatigue during ADP was 3.63 (scale 1-10). A common reason for ADP described by clinicians was a “strange loss of resistance” reported in 42.1% of ADPs. Among non-attendings, 50% of ADPs occurred while the attending was supervising from afar.

CONCLUSIONS: Practitioner inexperience is the major factor contributing to ADPs. Whether the clinician felt out of practice did not play a role as most ADPs occurred in the same day/week of one’s last performed epidural. Fatigue and long length of shift were not highly reported. As this study only included those with reported incidences of ADP, further research might include questions to all epidural administrators and compare characteristics of those with and without history of ADP. Additionally, interventions aimed at training anesthesiologists to anticipate and prevent any “strange loss of resistance” may improve outcomes and reduce incidence of ADP.

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ABSTRACT 100 EFFECTS OF HORMONAL CONTRACEPTION ON SYMPTOMS OF PERIMENOPAUSE. Ruhee Shah1, Britt Lunde2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Women typically continue using contraception until menopause, but few studies of contraceptive efficacy involve women over 35. Additionally, few studies have investigated the effect of hormonal contraception on symptoms of perimenopause.

RESEARCH QUESTION: What effect does hormonal contraception have on symptoms of perimenopause?

METHODS: The study is a prospective cohort study. We recruited women between the ages of 42 and 52 from two ob-gyn practices affiliated with Mt. Sinai. Women were assigned to estrogen-only, progestin, or non-hormonal contraception groups based on their method of contraption. A standardized survey was administered orally, and included demographic characteristics as well as a validated menopause rating scale (MRS).

RESULTS: We ran an unpaired T-Test, which showed no statistically significant difference between the progestin-only and non-hormonal contraception group (p=.19). The progestin group had a mean MRS score of 15 (N=6; median =16), and the non-hormonal group had a mean MRS score of 11.1 (N=10, median = 9.5).

CONCLUSIONS: Though the non-hormonal contraception group had a lower mean MRS score, these results were not statistically significant. Further survey data involving more participants is needed for more robust results.

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ABSTRACT 101 SEASONAL VARIATION IN PRESENTATION AND TIME TO REVASCULARIZATION THERAPY FOR ACUTE ISCHEMIC STROKE. Akarsh Sharma1, Mary Rojas1, Ruben Vega Perez1, I. Singh2, Laura Stein3. 1Medical Education, 2 Neurosurgery, 3Neurology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Rapid revascularization improves outcomes, including early neurological improvement as well as functional outcomes at 90 days, for acute ischemic stroke (AIS) patients. However, restrictive time windows for alteplase (tPA) and endovascular thrombectomy (ET) limit treatment. Seasonal variation in etiology, severity, eligibility for therapy, and functional outcomes following treatment have been reported in studies abroad. However, seasonal variation in stroke presentation and outcomes in an urban northeastern US population is not well known. Moreover, it is unclear whether seasonal variations impact functional outcomes.

RESEARCH QUESTION: Assess seasonal variation in patient presentation and time to initiation of revascularization therapy for AIS. METHODS: We retrospectively analyzed AIS patients presenting to the Mount Sinai Hospital (MSH) ED from 2016-8 contained in the American Heart Association’s Get with the Guidelines Database. Patients were classified by season of presentation, revascularization modality and door-to-treatment time. KruskalWallis H tests were run between groups to compare door-to-treatment initiation times by season and type of revascularization therapy.

RESULTS: 808 patients were treated. 28.1% presented during spring (n=227), 25.7% summer (n=208), 24.1% winter (n=195), and 22.0% (n=178) fall. 14.7% (n=119) were treated with revascularization therapy, including 57.1% (n=68) tPA, 26.9% (n=32) ET, and 16% (n=19) tPA+ET. Median door-to-treatment time was 60 mins for tPA, 102.5 mins ET, and in patients treated with tPA+ET, 55 and 160 mins for tPA and ET, respectively.

Among patients treated with ET, time-to-treatment differed by season with a mean rank time score in minutes of 9.07 for winter, 13.70 spring, 22.38 summer, and 21.00 fall (χ2(3) = 10.21, p <0.02). No significant differences in time-to-treatment were observed by season for patients treated with tPA with or without ET. CONCLUSIONS: ET time-to-treatment was fastest during spring and winter seasons but there was no difference in time to treatment with tPA with or without thrombectomy. This may reflect additional experience with stroke systems of care and improved procedural skill over the course of the academic year, but further study is needed.

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ABSTRACT 102 ROTATIONAL THROMBOELASTOMETRY FOR PREDICTING HEPARIN PLASMA CONCENTRATION IN PARTURIENTS: AN EXPLORATORY IN-VITRO INVESTIGATION. Da Wi Shin1, Chloe Getrajdman2, Daniel Katz2. 1Medical Education, 2Anesthesiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Many parturients require anticoagulation. When these patients present to the labor floor while still on anticoagulation, current guidelines and conventional tests do not inform clinicians about the relative safety about utilizing neuraxial anesthesia. Thromboelastometry is a point-of-care device that evaluates viscoelastic changes during coagulation. The ratio of the INTEM clotting time (CT) to the HEPTEM CT (I:H) has been investigated to assess the relative impact of heparin on the clotting time of the blood in cardiac surgery, but not specifically for parturients.

RESEARCH QUESTION: To examine the relationship between IH-ratio against known heparin concentrations in the blood of term parturients.

METHODS: Venous whole blood was drawn from 77 consented participants. Each participant was randomly assigned a plasma heparin concentration (0, 0.05, 0.1, 0.2, 0.25 and 0.3 U/mL), and a solution of unfractionated heparin and 0.9% NaCl was created based on the participant’s hematocrit.

Thromboelastometry was performed and the primary outcome was the I:H. A nonlinear regression model was created and it was determined y=a/[1 + exp(b(x-c))] was fit to predict the heparin concentration based on the I:H. The goodness of fit for the model is reported as mean absolute error with its range.

RESULTS: A nonlinear logistic model showed a positive correlation between the I:H and the heparin concentration. At 0.05 U/mL, the I:H was normal (< 1.1). A ratio of 1.2 or below was seen in patients with heparin concentrations > 0.1 U/mL in 4/29 samples, indicating wide variability in heparin responsiveness between patients. At 0.3 U/mL, the I:H was significantly prolonged and ranged from 1.37 to 2.2. The mean absolute error of the model was 0.053 (0.001-0.157).

CONCLUSIONS: To our knowledge, this is the first study to examine the relationship between I:H and plasma heparin concentration using thromboelastometry in parturients. Given the in vitro nature of the project, the clinical applicability is limited, however, this may represent the step towards examining the utility of the I:H in parturients receiving anticoagulants and the safety for neuraxial anesthesia. Large-scale studies are needed to determine if IH ratios can predict heparin activity and neuraxial safety in parturients.

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ABSTRACT 103 NSAID USE AND CONCUSSIONS IN ADOLESCENT ATHLETES: INCIDENCE, SEVERITY, AND RECOVERY. Zachary Spiera1, Theodore Hannah2, Nickolas Dreher2, Naoum Fares Marayati2, Adam Li2, Muhammad Ali2, Dhruv Shankar2, John Durbin2, Alexander Schupper2, Alex Gometz2, Mark Lovell3, Tanvir Choudhri2. 1Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3The Lovell Health Care Institute.

BACKGROUND: Due to concerns about potential long-term effects of concussion in young athletes, concussion prevention has become a major focus for amateur sports leagues. Athletes have been known to frequently use anti-inflammatory medications to manage injuries, expedite return to play, and treat concussion symptoms. However, the effects of baseline nonsteroidal anti-inflammatory drug (NSAID) use on susceptibility to severe head injury and concussion remains unclear.

RESEARCH QUESTION: Does baseline NSAID use modulate concussion incidence, severity, and recovery in young athletes?

METHODS: Data from 25,815 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tests was obtained through a research agreement with ImPACT Applications. Subjects were age 12-22 years old. Those who reported NSAID use at baseline were assigned to one cohort (AI, N=197) while all others were assigned to the control cohort (CT, N=11380). Athletes reported for baseline ImPACT testing at the start of a season. Upon suffering a head injury, athletes were sent for ImPACT testing if concussion was suspected. ImPACT test results were used to assess concussion symptom severity. For the purposes of this study ImPACT concussion is defined as a post-injury ImPACT test indicating significant adverse change from baseline in at least two of the five ImPACT composite scores. Recovery from ImPACT concussion is defined as days to follow up ImPACT test results that do not meet criteria for ImPACT concussion. Differences in incidence, severity, and recovery were assessed using chi-squared tests, unpaired t-tests, and Kaplan-Meier plots.

RESULTS: The CT cohort was comprised of a higher percentage (p < 0.0001) of males (66.30%) than the AI cohort (44.16%). However, no statistically significant differences were found in suspected concussion incidence (CT=0.489, AI=0.500, p=0.9219), ImPACT concussion incidence (CT=0.175, AI=0.169, p=0.7201), injury severity (CT mean=8.449, AI mean=7.668, p=0.4921), or median recovery time (CT=8, AI=8, p=0.6416).

CONCLUSIONS: In our analysis, we found no evidence that preinjury use of NSAIDs affects concussion risk in adolescent athletes. We also found no indication that preinjury NSAID use affects the severity of initial injury presentation or concussion recovery.

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ABSTRACT 104 LONG-TERM OUTCOMES OF MITRAL VALVE AND TRICUSPID VALVE REPAIR FOR DEGENERATIVE MITRAL VALVE PROLAPSE. Jason Storch1, David H. Adams2, Dimosthenis Pandis2, Shinobu Itagaki2. 1Medical Education, 2 Cardiovascular Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: There is a body of evidence to show the efficacy of Mitral Valve Repair Surgery over replacement, however not enough research has been done for Tricuspid Valve Repair. Repairing a regurgitant Tricuspid Valve concomitantly with an index Mitral Valve procedure has the potential to eliminate long-term complications in one procedure. The safety and efficacy of Tricuspid Valve Repair concomitant to a Mitral Valve Repair should be adequately assessed.

RESEARCH QUESTION: Does the addition of Tricuspid Valve Repair concomitant to Mitral Valve Repair in a reference center prove safe and effective by not adding significant risk as well as reducing right-heart complications arising from tricuspid regurgitation (TR).

METHODS: Out of 646 patients who presented to Mount Sinai with degenerative mitral valve prolapse with surgical indications from 2003-10, 645 patients who underwent successful mitral valve repair were retrospectively reviewed. Concomitant tricuspid repair was performed in 419 (65%) patients. The primary endpoints were long-term survival, recurrent MR, and recurrent TR, defined as moderate to severe and analyzed with multivariable cox regression adjusting for preoperative class I and II indications (ventricular dimension, pulmonary artery pressure, and the presence of atrial fibrillation). Mean follow-up time was 9.0 years.

RESULTS: Survival at 10 years and 15 years for combined MVR-TVR patients was 92.0% (95% CI 89-94%) and 81.7% (74-87%). These numbers are favorably comparable to isolated mitral repair survival rates of 1% failure/year. The cumulative incidence of MR at 10 years and 15 years were 2.8% (1.6-4.7%) and 7.4% (2.017.5%) with preoperative end-systolic LV diameter more than 40mm as a risk factor (HR2.8, 1.1-7.6). The cumulative incidence of TR at 10 years and 15 years were 2.0% (0.8-4.3%) and 5.0% (1.1-13.5%) with concomitant tricuspid repair as a protective factor (HR0.11, 0.02-0.56).

CONCLUSIONS: Mitral and tricuspid valve repair as a default strategy for degenerative mitral valve prolapse is both feasible and durable. The benefits seen in patients with combined MVR-TVR outweigh the potential risks for a concomitant TVR, despite this not being standard of care at most centers.

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ABSTRACT 105 DEVELOPMENT AND VALIDATION OF TECHNIQUES FOR PHENOTYPING ST-ELEVATION MYOCARDIAL INFARCTION FROM ELECTRONIC HEALTH RECORDS. Shelly Teng1, Sulaiman Somani1, Stephen Yoffie1, Benjamin Glicksberg2. 1Medical Education, 2 Genetics and Genomic Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Classifying hospital admissions into various acute myocardial infarction phenotypes in electronic health records (EHR) is a challenging task with strong research implications that remains unsolved.

RESEARCH QUESTION: In this study, we take advantage of a cardiac catheterization procedure record in a patient’s hospital admission to investigate the benefits it affords for identifying hospital admissions for STEMIs from a large, multi-center EHR. Additionally, we focus on isolating by unique patient encounters (i.e. hospital admissions) associated with a STEMI, not only patients who have ever had a STEMI on any or their first patient encounter.

METHODS: We designed several query algorithms to phenotype ST-elevated myocardial infarction (STEMI) on a multi-center EHR containing 5.1 million patients and 115 million patient encounters by using various combinations of discharge summaries, diagnosis codes, ECG readings, and the presence of cardiac catheterizations on the encounter. For example, a sample criterion queries for patient encounters containing diagnosis codes and discharge summaries related to ‘STEMI’, as filtered by regular expression pattern matching methods. A subset of approximately 50 unique encounters for 50 unique patients were retrieved for each criterion and manually investigated in the patient chart. Positive predictive value (PPV) was calculated for each query algorithm.

RESULTS: We demonstrate that robustly phenotyping STEMIs by selecting discharge summaries containing ‘STEMI’ has the potential to capture the highest absolute number of STEMIs (PPV = 0.36, N = 2,110, STEMIs captured = 760), but the addition of a STEMI-related ICD code and cardiac catheterizations to these summaries yields the highest precision (PPV = 0.94, N = 952).

CONCLUSIONS: To our knowledge, this study is the first study to design and validate phenotyping algorithms using cardiac catheterizations to identify not only patients with a STEMI, but the specific encounter when it occurred.

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ABSTRACT 106 MUCOSAL B CELL AND PLASMA CELL DEPLETION IS ASSOCIATED WITH INTESTINAL INFLAMMATION. Minami Tokuyama1, Divya Jha2, Alexandra Livanos3, Stephanie Rutledge3, Jean Frederic Colombel3, Saurabh Mehandru3. 1Medical Education, 2Graduate School of Biomedical Sciences, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Given emerging evidence of B cell dysregulation in inflammatory bowel disease (IBD), there is increasing interest in B cell-targeted therapies. Yet, there is also evidence of de novo IBD in individuals treated with rituximab (RTX), an anti-CD20 monoclonal antibody that depletes B cells. Thus, there is a clear need to understand the impact of B cell depletion on the mucosal immune system.

RESEARCH QUESTION: What alterations in the mucosal immune system are associated with colitis in the setting of sustained B cell depletion?

METHODS: Here, we provide a detailed examination of the gastrointestinal immune system in a RTX-treated patient with colitis by flow cytometry (FC) and immunofluorescence (IF) microscopy compared to 10 healthy controls.

RESULTS: A 68-year-old woman with rheumatoid arthritis, stage IV marginal zone lymphoma and granulomatosis with polyangiitis was treated with multiple courses of RTX between 2010 and 2017. Three months after her last dose, she developed non-bloody diarrhea and fecal incontinence, which have persisted to date. Colonoscopy revealed a mid-transverse colon stricture and pan-colonic inflammation confirmed on histopathological examination (HPE). The terminal ileum (TI) while endoscopically uninflamed also showed mild inflammation on HPE. FC revealed a profound depletion of CD19+ B cells and plasma cells (CD45+CD3-D27+ CD38hi) in the TI and colon that was confirmed by IF microscopy. Among mucosal T cell subsets, an expanded population of terminally differentiated effector memory T cells (CD3+ CD45RA+ CCR7-), expressing markers of cellular proliferation (Ki67) and activation (CD38) was detected. While the overall frequency of natural killer (NK) cells was similar, there was an increased proportion of the cytotoxic subset (CD3-CD14-CD19 -CD16+CD56lo) in the colon. Additionally, increased frequencies of conventional dendritic cell (CDC) subsets, CDC1 (CD141+) and CDC2 (CD1c+) were observed in the TI and colon.

CONCLUSIONS: A sustained depletion of mucosal B cells is associated with inflammation characterized by T cell, NK cell and myeloid cell dysfunction. Caution is urged in the planning of B cell directed therapies with emphasis on more selective targeting of pathogenic B cells and avoidance of protracted, pan-B cell depletion.

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ABSTRACT 107 SARS-COV-2 INFECTS ENTEROCYTES IN VIVO AND CAN PERSIST UP TO 7 MONTHS FOLLOWING SYMPTOM RESOLUTION. Minami Tokuyama1, Mark Ladinsky2, Divya Jha3, Francesca Cossarini4, Alexandra Livanos4, Jason Reidy5, Michael Tankelevich4, Gustavo Martinez-Delgado4, Pamela Bjorkman2, Saurabh Mehandru4.

1 Medical Education, 3Graduate School of Biomedical Sciences, 4Medicine, 5Pathology. 1,3,4,5Icahn School of Medicine at Mount Sinai, New York, New York, 2California Institute of Technology, Pasadena, CA, USA. BACKGROUND: Host ACE-2 and TMPRSS2 facilitate SARS-CoV-2 infection and are highly expressed in the gastrointestinal (GI) tract, particularly in the small bowel, as well as the lungs. GI symptoms represent the most common extra pulmonary manifestation of COVID-19 and viral RNA has been isolated from fecal samples of COVID-19 patients, where it can persist longer than in nasopharyngeal swabs. While SARS-CoV-2 infection of enterocytes has been demonstrated in vitro, in vivo studies are lacking. Here we examined human intestinal tissue at various stages of COVID-19.

RESEARCH QUESTION: Does SARS-CoV-2 infect human enterocytes in vivo and how long can the virus persist?

METHODS: Small intestinal biopsies from patients who underwent clinically indicated endoscopic procedures after a positive SARS-CoV-2 nasopharyngeal swab (n=27) or were found to have positive serology (n=2) were analyzed by immunofluorescence (IF) (n=25) and electron microscopy (EM) (n=14) for the presence of virus. Clinical details were also collected.

RESULTS: Patients ranged from 15 days to 7 months post symptom onset. Sixteen of 29 patients had detectable SARS-CoV-2 antigen by either IF or EM. Virus was restricted to the epithelium and patchy in distribution. It was detected as soon as 15 days after symptom onset and persisted up to 7 months after symptom resolution. Despite the presence of the virus, only half of these patients had any signs of inflammation on histology. Seven patients were nasopharyngeal swab positive within 3 days of the procedure and, of these, 6 had detectable antigen in intestinal tissue. In two patients where the virus was present at 3 months and 4 months after mild COVID-19, additional biopsies were obtained at 7 months and 6 months, respectively, both of which showed persistent viral antigen. Interestingly, only 37.5% (6 of 16) of patients with virus detected in the small bowel had GI symptoms during their acute illness as compared to 46.1% (6/13) of patients where no virus could be detected in the intestines.

CONCLUSIONS: SARS-CoV-2 infects enterocytes in humans in vivo and can persist in the intestines up to 7 months following symptom resolution. This persistence is not associated with an overt inflammatory infiltrate and does not appear to correlate with COVID-19 associated GI symptoms.

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ABSTRACT 108 FACTORS AFFECTING THE UTILIZATION OF ASTHMA ACTION PLANS

BY PHYSICIANS DURING THE COVID-19 PANDEMIC. Kirk Tomlinson1, Czer Lim2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Having an asthma action plan (AAP) may be of greater importance during the COVID-19 pandemic in order to balance the need to prevent exposure to COVID-19 through unnecessary ED visits with the possible need for earlier intervention in asthmatics. Previous studies have found that AAPs are not widely implemented by physicians, with a prevalence of approximately 50%. This study seeks to further identify factors related to the utilization of AAPs by physicians. Identification of such factors may lead to greater usage.

RESEARCH QUESTION: Which demographic, economic, and physician factors are related to the utilization of asthma action plans by physicians in their management of pediatric asthma?

METHODS: From 3/1 to 4/30/2020, 213 of 3267 pediatric telehealth visits in the Mount Sinai Health System were coded with a primary diagnosis containing the keyword “asthma.” A chart review was conducted of these 213 visits (213 patients) to determine if each patient had an AAP (the dependent variable) on file with the MSHS or mention of the existence of a plan elsewhere. Information on patient demographics, insurance type, asthma severity, and physician type was also extracted as independent variables. A multivariate logistic regression model was created using SAS 9.4 to assess which independent variables were significantly related to the dependent variable.

RESULTS: Of 213 patients, 165 (77.6%) had an AAP. Of patients managed by specialists, 90% had an AAP vs 35% managed by generalists. 77.5 % of those with Medicaid had an AAP vs 77.9% of those with private insurance or who self-paid. Our regression model included independent variables of age, sex, Medicaid insurance, asthma severity, specialist physician, and non-English language and found only specialist physician (β=24.98, p<0.0001) and moderate persistent asthma severity (β=4.96, p=0.025) to have statistical significance.

CONCLUSIONS: Our model found being a specialist physician and moderate persistent asthma severity are related to AAP use. This echoes the findings of other studies, which suggest specialists are more likely to utilize AAPs than generalists. Given that generalists are also more likely to manage milder cases of asthma, our study suggests generalists should be targeted for increased AAP utilization.

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ABSTRACT 109 MICROBIOLOGIC ETIOLOGY AND INFANT FACTORS ASSOCIATED WITH EARLY ONSET NEONATAL BACTEREMIA AT MOUNT SINAI HOSPITAL. Claudia Torres1, Eudys Briceno-Brito2, Andres Ramirez-Zamudio3, Lorraine Toner3, Roberto Posada2, Rhoda Sperling3. 1Medical Education, 2Pediatrics, 3Obstetrics, Gynecology, and Reproductive Science.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Early-onset neonatal sepsis (EOS) is often acquired through vertical transmission and is an important cause of morbidity and mortality in infants. The etiology of neonatal sepsis has changed over time, and the intrapartum management of women at risk for infection has been shown to improve neonatal outcomes.

RESEARCH QUESTION: To identify the microbiologic etiology of EOS and evaluate the impact of maternal illness, labor and delivery practices, and postnatal factors on EOS rates at Mount Sinai Hospital.

METHODS: An IRB approved descriptive retrospective chart review of cases of EOS in infants less than 7 days of age at MSH from 2015-2018 was conducted. A total of 41 infants were identified. Clinical charts were reviewed and classified into two groups based on age at time of presentation: very early onset sepsis (VEOS) (age days 0-2) and delayed early onset sepsis (DEOS) (age days 3-7). Corresponding maternal charts were reviewed to identify obstetric risk factors and whether at-risk mothers received appropriate intrapartum prophylaxis.

RESULTS: In the VEOS, 41% of cases were caused by Group B Streptococcus (GBS), 30% by E.coli, and 18% by other streptococcus. In the DEOS, 33% of cases were coagulase-negative Staphylococci, 27% E.coli, and 20% S. aureus. There were no cases of GBS among the DEOS group. On average, VEOS occurred in term infants (37.40 ± 4.41 weeks) with a normal weight (2840 ± 88g), while DEOS occurred in preterm infants (30.74 ± 6.08 weeks) with low birth weight (1550 ± 104g). 36.4% of GBS isolates demonstrated resistance to clindamycin. E.coli isolates demonstrated resistance to ampicillin/sulbactam (66.7%), co-trimoxazole (41.7%), and gentamicin (25%). No extended spectrum beta-lactamase-producing E.coli isolates were identified.

63.6% of infants who developed GBS EOS were born to women with a documented GBS negative screening test.

CONCLUSIONS: The microbiologic etiology of VEOS and DEOS varied, with GBS only identified in the VEOS group and E.coli common in both. The failure to identify GBS colonization in women whose infants developed GBS EOS requires exploration. Our study demonstrates the need for strategies to reduce the risk of E.coli EOS among preterm, low birth weight neonates, and investigation into E.coli EOS resistance patterns.

142

ABSTRACT 110 IMPACT AND ROLE OF FLEXNER’S REPORT IN MEDICAL EDUCATION’S STRUCTURE. Ashesh Trivedi1, Darinka Gadikota-Klumpers1. 1Medical Education.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: In 1910, the Carnegie Foundation for the Advancement of Teaching published Medical Education in the United States and Canada, a comprehensive survey of all American medical education (MedEd). Their report condemned most schools’ teaching methods in favor of the educational model of Johns Hopkins SOM – biomedical research led and basic science centered. The Flexner Report, as it is now referred, became the ideological blueprint from which the architecture of modern MedEd is derived.

RESEARCH QUESTION: How did the Flexner Report come to play such a pivotal role in shaping the apparent incompatibility in MedEd between “push to publish” productive research and medical humanism centering patient welfare?

METHODS: This study will conduct a primary analysis of the Flexner Report, its medical contemporaries’ responses, and secondary scholarly literature on the subject. I will evaluate its 110 year aftermath through an analysis of seminal texts in the AMA and LCME’s own histories of the foundation of MedEd. RESULTS: By 1910, the AMA was preparing for a radical overhaul of allopathic MedEd’s priorities and assessments. The Flexner Report provided legitimacy to revamping momentum as an “unbiased source” outside of the medical field. Flexner’s subsequent role as secretary of the Carnegie Foundation’s General Education Board becomes relevant because it enabled him to fundraise only for the “acceptable” medical schools. Through the report, the AMA leveraged the Carnegie Foundation’s philanthropic drive to legitimize and institutionalize a model of MedEd prioritizing biomedical sciences and research over patient welfare.

Despite the descriptive nature of the text, Flexner’s report was sensationalized and turned into a mythos that hegemonized MedEd at the turn of the century.

CONCLUSIONS: A close reading of Flexner’s text, its historical conditions, and critiques from prominent medical contemporaries yields a truer image of a historical Flexner at odds with the dominant historical interpretation of his report. Contemporary medical practitioners must re-examine Flexner’s report and engineer a foundation of MedEd which harmonizes biomedical research and patient-centered practice and refuses to validate and reproduce this problematic and parochial divide.

143

ABSTRACT 111 THE EMPIRE STATE OF HATE: A QUANTITATIVE ANALYSIS OF RACIALLY MOTIVATED ATTACKS DIRECTED AT ASIAN AMERICAN AND PACIFIC ISLANDER (AAPI) NEW YORKERS DURING THE COVID-19 PANDEMIC. Connor Tukel1, Jacob Appel1. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Global health pandemics have historically been associated with increased rates of discriminatory attacks directed against racial and ethnic minority groups, and the COVID-19 pandemic offers a modern example of this phenomenon. The purpose of this study is to longitudinally analyze NYPD complaint report and hate crime data in order to identify trends and/or disparities in crimes specifically directed against Asian American and Pacific Islander (AAPI) New Yorkers for 2020 versus previous years.

RESEARCH QUESTION: Are there significant differences in cases of assault and harassment, and/or incidents formally classified as “hate crimes” directed against AAPI New Yorkers during the COVID-19 pandemic (I.e. Jan-Sep 2020) as compared with similar time periods in previous years?

METHODS: We took publicly available historic and current NYPD crime reports and hate crime data and extracted information for incidents in which the victims were identified as AAPI. We analyzed changes in rates of assault and harassment complaints against AAPI New Yorkers, as well as in officially documented hate crimes against members of this community.

RESULTS: While we did see a general trend of increasing crimes, and specifically assault-type crimes, being committed against AAPI New Yorkers over the last 5-6 years, there did not appear to be a statistically significant increase in frequency of these complaints during the COVID-19 pandemic relative to previous years’ crime trends. However, NYPD Hate Crime reports did show a significantly increased number of “official hate crimes” motivated by anti-Asian biases for Q1, Q2, and Q3 2020 versus previous years.

CONCLUSIONS: Increased numbers of official hate crimes against AAPI New Yorkers without broader increases in general crimes –including misdemeanor assault, harassment, and other similar offenses– for 2020, as compared with previous years, may suggest that racially-motivated attacks are predominantly being carried out by smaller, perhaps more extreme segments of the local population. Ultimately, further research will be needed to refine the sociological forces underlying these trends.

144

ABSTRACT 112 GENDER DIFFERENCES IN TIBIAL ARTERY INTERVENTION FOR CRITICAL LIMB ISCHEMIA (CLI): A RETROSPECTIVE STUDY USING THE VASCULAR QUALITY INITIATIVE (VQI).

Amey Vrudhula1, Windsor Ting2, Ageliki Vouyouka2, Rami Tadros2, Sung Yup Kim2, Michael Marin2, Peter Faries2, Ajit Rao2. 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: While millions of Americans suffer from peripheral arterial disease (PAD), limited data exists on gender differences in outcomes in the treatment of critical limb ischemia (CLI).

RESEARCH QUESTION: What gender differences exist in outcomes among patients with critical limb ischemia (CLI) receiving intervention in tibial vessels?

METHODS: The VQI is a national database of over 700,000 vascular surgical procedures from 737 participating sites. The VQI Peripheral Vascular Intervention (PVI) dataset was filtered for procedures treating tibial occlusive lesions in patients with CLI. When a patient underwent multiple procedures, all procedures were included, and data from all years available was used. All procedures, excluding one procedure, were from 2010-2020. All analyses were conducted using SPSS 20 (IBM, Armonk NY). Chi-square analysis was used to compare categorical variables. Nominal variables were assessed for normality using a KolmogorovSmirnov Test, and a Mann-Whitney U-Test was used when normality was not met.

RESULTS: The average age of males and females was 68 and 70 (p=0.000, U = 1.70 x 107), respectively.

Overall rates of comorbidities were similar between the two groups, although male patients were more likely to have diabetes, chronic kidney disease, and coronary artery disease. Female patients were more likely to have had prior stroke and COPD. Females and males undergoing tibial CLI intervention experienced similar rates of major amputations. Female patients had overall lower amputation rates (30.6% vs. 35.3 %, p = .002, χ2 = 9.314) but experienced a higher rate of other postoperative complications (10.4% vs. 7.3%, p=0.000, χ2 = 21.279) and access site complications (2.7% vs. 1.9%, p = .017, χ2 =5.670). These complications included hematoma, renal complication, thrombosis, and perforation rates. Men were more likely to have more than one artery treated, but total occlusion length did not significantly differ between groups.

CONCLUSIONS: Males and females have similar rates of limb salvage for infrageniculate interventions but females experience higher rates of postoperative complications. Further studies are required to further elucidate gender differences in tibial CLI intervention and identify high-risk groups undergoing tibial intervention.

145

ABSTRACT 113 EXAMINING THE EFFECTS OF THE COVID-19 PANDEMIC ON THE MENTAL HEALTH OF ADOLESCENTS LIVING WITH HIV IN NEW YORK CITY. Rachel Waldman1, Ashley Chory2, Roxanne Martin2, Jocelyn Childs2, Samuel Chiacchia1, Ariella Cohen1, Rachel Vreeman3, Roberto Posada3. 1Medical Education, 2Arnhold Institute for Global Health, 3Pediatrics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Adolescents living with HIV (ALWH) experience high rates of mental health problems, including depression, anxiety, and substance use. The economic and social consequences of the COVID-19 pandemic have the potential to exacerbate pre-existing mental health problems or result in new mental health diagnoses among ALWH. RESEARCH QUESTION: To describe the impact of the COVID-19 pandemic and resulting social and economic changes on the mental health of ALWH in NYC. METHODS: Telephone surveys were conducted at baseline and 3 months with ALWH enrolled in care at the Jack Martin Fund Clinic in NYC. These surveys included mental health related screening questions that asked about symptoms of depression and anxiety. Here, we report on initial interviews conducted in July and August 2020 as well as follow-up interviews conducted in October and November 2020.

RESULTS: Of the 10 ALWH (mean age 21 years, 50% male, 80% perinatally infected) interviewed, only 1 had a prior diagnosis of depression at baseline. However, when interviews were conducted in July and August 2020, just over 4 months after the World Health Organization declared COVID-19 a pandemic, 30% of participants reported experiencing at least one depressive symptom nearly every day for the preceding 2 weeks. In follow-up interviews conducted 3 months later, participants reported a decrease in depressive symptoms, with only 2 participants reporting at least one depressive symptom nearly every day for the preceding two weeks. However, there was an increase in reported symptoms of anxiety with 25% of the participants who completed follow-up interviews reporting symptoms of anxiety nearly every day for the preceding 2 weeks.

CONCLUSIONS: The COVID-19 pandemic has affected the mental health of ALWH, with an observed increase in symptoms of depression at enrollment in the study, and increased symptoms of anxiety three months later. This highlights the importance of providing ongoing access to mental health care for ALWH during the COVID-19 pandemic and other times of crisis. Subjects will continue to be followed longitudinally as part of this study, and the impact on control of HIV disease will be examined.

146

ABSTRACT 114 DYNAMICS OF ANAL AND CERVICAL HPV IN WOMEN WITH HIV: RELATIONSHIP TO ANAL PRECANCERS. Kevin Weiss1, Tinaye Mutetwa2, Courtney Chan2, Yuxin Liu3, Michael Gaisa2, Keith Sigel2.

1 Medical Education, 2Medicine, 3Pathology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2,3Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York.

BACKGROUND: Women living with HIV (WLH) are highly susceptible to high-risk human papillomavirus (HPV)-associated precancer and cancer in the lower anogenital tract. The dynamics of anal and cervical HPV infection and their relationship to anal cancer precursors are not well studied. We aimed to determine the prevalence of anal and/or cervical HPV infection among WLH as well as their association with anal cancer precursors, i.e. high-grade squamous intraepithelial lesions (HSILs).

RESEARCH QUESTION: In women living with HIV, what contributions do HPV persistence and concordance make to development of cancers?

METHODS: The current study included 144 WLH who underwent anal cancer screening at our program between 2012-19 and met the following criteria: (1) anal HPV DNA testing (HPV16, 18 and 12 other high-risk types) upon initial and follow-up visits; (2) cervical HPV DNA testing within six months of the initial visit; and (3) high-resolution anoscopy (HRA) examination and biopsy within 3 months of anal HPV testing. We analyzed anal and cervical HPV coinfection and concordance, anal HPV persistence/clearance, and the incidence of anal HSIL by anal/cervical HPV status.

RESULTS: At baseline, 45% of the cohort had anal high-risk HPV (hrHPV) infection alone, 3% had cervical hrHPV infection alone, while 28% had anal/cervical coinfection. Biopsy-proven HSIL was detected in 31%.

Among subjects with coinfection, 56% had concordance of HPV types. Among WLH with anal HPV at baseline, HPV was persistent in 54% of subjects and cleared in 46% upon follow-up (median interval: 534 days). The rate of anal HPV persistence was similar between subjects with anal infection alone and those with anal/cervical coinfection. Anal HSIL was associated with persistent anal HPV infection, anal HPV type 16/18, but not with cervical HPV type 16/18 infection (incidence rate ratios 6.8 (p<0.01), 6.2 (p<0.001), and 1.4 (p = 0.44), respectively).

CONCLUSIONS: In WLH, anal HPV infection may be more common than cervical infection. Persistent anal HPV infection appears to be independent of cervical HPV status. Our findings challenge the theory that the cervix forms the main reservoir of HPV and further indicates that anal cancer screening is likely warranted for WLH regardless of cervical HPV status.

147

ABSTRACT 115 PERSON-CENTERED CARE: EXPLORING INEQUITIES IN MATERNAL CHILD HEALTHCARE. Stephanie Wu1, Khadija Jones2, Jennifer Dias3, Andrea Archer4, Nandini Choudhury5, George Hagopian3, Sheela Maru6. 1Medical Education, 3,6Obstetrics, Gynecology, and Reproductive Science, 2,4,5,6 Arnhold Institute of Global Health. 1,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: High maternal mortality and morbidity continues to be an issue in the US, especially among racial/ethnic minorities. The Person-Centered Framework for Reproductive Health Equity emphasizes social determinants and facility quality factors that affect health-seeking behaviors, which can help explain the worse outcomes experienced by these communities.

RESEARCH QUESTION: What are social determinants that affect utilization of maternity care in a diverse, largely immigrant, and publicly insured/uninsured population?

METHODS: 10 semi-structured interviews were conducted with staff at Elmhurst/Queens Hospitals and CBOs. 5 focus group discussions in English, Spanish, Mandarin, Bengali, and Nepali were conducted with women residing in Queens who recently gave birth. Broad sections in the interview/discussion guide included: social determinants of health, patient birth experience, facility quality, and impact of COVID-19 on care. Both were audio-recorded, transcribed, and qualitatively analyzed using an inductive coding technique in Dedoose, a data analysis software.

RESULTS: Clinical and CBO staff cited health literacy, income, and language as the social determinants that had the greatest impact on patient healthcare. Staff viewed health literacy and language as closely linked in immigrant communities, given that new immigrants may not be familiar with how the hospital system works.

In contrast, patients from all ethnic groups reported that transportation and hospital location impacted their decision to seek care at a certain hospital. Notably, patients did not believe that access to insurance was a factor that affected their utilization of care, as all but one patient were able to sign up for Medicaid during pregnancy.

CONCLUSIONS: Future health systems interventions should focus on improving patient health literacy and increasing access of care to patients from different cultural and linguistic backgrounds. The differing responses of patients and providers also indicates a potential gap in understanding patient needs.

148

ABSTRACT 116 DEVELOPMENT AND VALIDATION OF TECHNIQUES FOR PHENOTYPING ST-ELEVATION MYOCARDIAL INFARCTION FROM ELECTRONIC HEALTH RECORDS. Stephen Yoffie1, Sulaiman Somani2, Shelly Teng2, Benjamin Glicksberg3. 1Medical Education, 3 Genetics and Genomic Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Classifying hospital admissions into various acute myocardial infarction phenotypes in electronic health records (EHR) is a challenging task with strong research implications that remains unsolved.

RESEARCH QUESTION: In this study, we take advantage of a cardiac catheterization procedure record in a patient’s hospital admission to investigate the benefits it affords for identifying hospital admissions for STEMIs from a large, multi-center EHR. Additionally, we focus on isolating by unique patient encounters (i.e. hospital admissions) associated with a STEMI, not only patients who have ever had a STEMI on any or their first patient encounter.

METHODS: In this study, we design and validate algorithms to phenotype ST-elevated myocardial infarction (STEMI) on a multi-center EHR containing 5.1 million patients and 115 million patient encounters by using discharge summaries, diagnosis codes, ECG readings, and the presence of cardiac catheterizations on the encounter.

RESULTS: We demonstrate that robustly phenotyping STEMIs by selecting discharge summaries containing ‘STEMI’ has the potential to capture the most number of STEMIs (PPV = 0.36, N = 2,110), but that addition of a STEMI-related ICD code and cardiac catheterizations to these summaries yields the highest precision (PPV = 0.94, N = 952).

CONCLUSIONS: To our knowledge, this study is the first study to design and validate phenotyping algorithms using cardiac catheterizations to identify not only patients with a STEMI, but the specific encounter when it occurred.

149

ABSTRACT 117 PATIENT AND HOSPITAL CHARACTERISTICS ASSOCIATED WITH POSTPARTUM EMERGENCY DEPARTMENT VISITS: A STATEWIDE ANALYSIS. Haley Zarrin1, Carmen Vargas-Torres2, Michelle Lin2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: An Emergency Department (ED) visit can be a sentinel event for women at highest risk of mortality.

RESEARCH QUESTION: We aim to describe patient and hospital characteristics associated with postpartum ED visits.

METHODS: We identified all obstetric discharges and ED visits by the same patient in New York in 2014 by linking the State Inpatient Database to the State Emergency Department Database. We performed descriptive statistics of patient and hospital factors and a multi-level logistic regression with a two-level nested mixed effects to account for clustering at a hospital level to determine predictors of ED visits.

RESULTS: Of 226,522 eligible deliveries identified, 12,832 (6%) were associated with an ED visit within 42 days. ED visits were more frequent among women who were identified as Black (14.6% of deliveries vs. 23.6% of ED visits), Hispanic (15.9% of deliveries vs. 20.8% of ED visits), from the lowest income quartile (26.3% of deliveries vs. 37.6% of ED visits). After adjusting for patient and hospital characteristics, patients were more likely to have an ED visit if they were age 10-19 (OR=1.19, p=0.001) compared to those age 20-29, Black (OR=1.29, p<0.001) or Hispanic (OR=1.23, p< 0.001) relative to White race, insured by Medicare (OR=2.04, p<0.001) or Medicaid (OR=1.56, p<0.001) relative to commercial insurance, from the lowest income quartile (OR-1.09, p=0.05) relative to the highest quartile, had a Charlson comorbidity score of 2 (OR=2.05, p<0.001) or 3 (OR=3.69, p<0.001) relative to those without comorbidities, and who delivered at a safety-net hospital (OR=1.69, p<0.001). Obstetric complications most commonly associated with ED revisits were pulmonary edema or acute heart failure (OR=4.07, p<0.001), sepsis (OR=5.32, p<0.001), and air or thrombotic embolism (OR=8.57, p=<0.001). The most common diagnoses associated with readmission from the ED were postpartum complications (28%) and surgical wounds complications (26%).

CONCLUSIONS: ED visits prior to the standard 42-day obstetric follow up are not rare. Women of younger age, who are Black or Hispanic, with public insurance, comorbidities, obstetric complications, and those treated at safety-net hospitals had higher ED visit rates and benefit from improved postpartum care coordination.

150

ABSTRACT 118 EVALUATION OF ELAFIN AS A PROGNOSTIC BIOMARKER IN GRAFT-VERSUS-HOST DISEASE. Makda Getachew Zewde1, George Morales2, Steven Kowalyk2, Rachel Young2, Isha Gandhi2, John Levine2, James Ferrara2. 1Medical Education, 2Oncological Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Acute graft-versus-host disease (GVHD) is a major cause of mortality in patients receiving hematopoietic cell transplantation (HCT) for hematologic malignancies. Almost half of patients treated with systemic corticosteroids for GVHD do not respond to treatment, and these patients experience a very high rate of nonrelapse mortality (NRM). The skin is the most commonly involved organ in GVHD. Elafin, a protease inhibitor, was previously identified as a diagnostic biomarker of skin GVHD. Whether elafin can serve as a prognostic biomarker in patients presenting with skin GVHD is unclear.

RESEARCH QUESTION: Patients with high serum elafin concentrations at the start of GVHD treatment will experience more 6-month NRM compared to those with low elafin concentrations.

METHODS: 526 patients who received treatment for skin GVHD were analyzed from the Mount Sinai Acute GVHD International Consortium (MAGIC). Serum elafin concentrations were measured using ELISA. Patients were then divided randomly into equal training and test cohorts. A competing risk regression model was developed to model 6-month NRM using elafin concentration in the training cohort. For comparison, additional models were developed using concentrations of validated GVHD biomarkers ST2 and REG3a, or the combination of elafin, ST2 and REG3a. ROC curves were constructed using the test cohort to evaluate the predictive ability of each model and stratify patients into high- and low-risk biomarker groups. The cumulative incidence of NRM, overall survival, and four-week treatment response were compared between risk groups.

RESULTS: 57% of patients were stratified into the low-risk elafin group, and paradoxically they had a higher incidence of 6-month NRM (17%) compared to the high-risk group (11%), although this difference was not statistically significant (P=0.19). Overall survival at 6 months (67%) and four-week response (78%) were identical in the low- and high-risk elafin groups. ST2 and REG3a predicted NRM as expected; adding elafin to the model did not improve its performance.

CONCLUSIONS: In patients treated with systemic steroids for skin GVHD, elafin concentrations at the start of treatment do not predict 6-month NRM, overall survival, or treatment response at four weeks.

151

152

SECTION 3:

Student Index 153 153

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Ahsanuddin, Sofia

Ajit Rao, MD

Surgery

1

Alerte, Eric

Alfred-Marc Iloreta, MD

Otolaryngology

2

Ali, Muhammad

Tanvir Choudhri, MD

Neurosurgery

3

Aronskyy, Illya

Elena Zaslavsky, PhD

Neurology

4

Auyeung, Kelsey

Emma Guttman-Yassky, MD, PhD

Dermatology

5

Baldwin, Elena

Stephanie Blank, MD

Obstetrics, Gynecology, and Reproductive Science

6

Bansal, Esha

Robert Wright, MD, MPH

Environmental Medicine & Public Health and Pediatrics

7

Barlow, Joshua

Maaike van Gerwen, MD, PhD

Otolaryngology

8

Baron, Rebecca

John Caridi, MD

Neurosurgery

9

Beldovskaya, Anastasia

Anthony Tanella, MD

Anesthesiology

10

154

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Bellaire, Christopher

Peter Taub, MD

Surgery

11

Berger, Natalie

Amy Tiersten, MD

Oncological Sciences

12

Birhanu, Beselot

Craig Katz, MD

Psychiatry

13

Chi, Benjamin

Jacob Appel, MD, MS, MPH

Psychiatry

14

Chiacchia, Samuel

Rachel Vreeman, MD

Global Health

15

Chin, Chih Peng

William Smith, MD Michael Buckstein, MD, PhD

Radiation Oncology

Clark, Lindsay

Perry Sheffield, MD, MPH

Pediatrics

17

Clifton, Elizabeth

Annemarie Stroustrup, MD, MPH

Pediatrics, Northwell Health

18

Cohen, Ariella

Rachel Vreeman, MD, MS Roberto Posada, MD

Cohen, Ella

Laura Stein, MD, MPH

Radiology

16

Global Health Pediatrics/ Infectious Diseases

19

Neurology

20

155

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Danias, George

James Iatridis, PhD

Orthopaedics

21

Dashevsky, Jared

Ebrahim Elahi, MD

Ophthalmology

22

Deeb, Stephanie

C. Jillian Tsai, MD, PhD

Radiation Oncology, Memorial Sloan Kettering Cancer Center

23

Denton, John

Lauren Zajac, MD, MPH

Pediatrics

24

Dias, Jennifer

Sheela Maru, MD, MPH

Obstetrics, Gynecology, and Reproductive Science

25

Dominy, Calista

Ketan Badani, MD

Urology

26

Feingold, Jordyn

Jonathan Ripp, MD, MPH

Medicine

27

Feldman, Nicola

Suzanne Bentley, MD, MPH

Emergency Medicine

28

Forrest, Iain

Ron Do, PhD

Genetics and Genomic Sciences

29

Gallate, Xanthe

Karen Wilson, MD, MPH

Pediatrics

30

156

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Gao, Michael

Carl Cirino, MD

Orthopaedics

31

Garvey, Katherine

Alfred-Marc Iloreta, MD

Otolaryngology

32 & 33

Geng, Eric

Samuel Cho, MD

Orthopaedics

34

Gibson, Kyle

Supinda Bunyavanich, MD, MPH

Genetics and Genomic Sciences, Pediatrics

35

Gilja, Shivee

Celia Divino, MD

Surgery

36

Gluck, Matthew

Michael Hausman, MD

Orthopaedics

37

Goldberger, Cody

Rami Tadros, MD

Surgery, Vascular Surgery, Radiology

38

Gravesandy, Gary

Anna Potapov, MD, MPH

RubiconMD

39

Guyot, Jacques

Dinali Fernando, MD Ben McVane, MD

Emergency Medicine Emergency Medicine

40

157

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Hanss, Kaitlin

Chipper Stotz

Rock Health

41

Harrell, Taylor

Elizabeth Howell, MD

Obstetrics, Gynecology, and Reproductive Science

42

Hernaiz-De Jesus, Gabrielle

Annmarie Beddoe, MD, MPH

Oncological Sciences

43

Hughes, Terence

Duncan Maru, MD, PhD

Global Health, Internal Medicine, Pediatrics

44

Hutchinson Maddox, Isla

David Heller, MD, MPH

Global Health, General Internal Medicine

45

Ibad, Sidra

Clay Cockerell, MD

Dermatology

46

Italiano, Tyler

Mirna Chehade, MD, MPH

Pediatrics/Allergy and Immunology & Medicine/ Gastroenterology

47

Johnson, James

Celia Divino, MD

Surgery

48

Kalicki, Alexander

Katherine Ornstein, PhD

Geriatrics and Palliative Medicine

49

Kaplan, Carly

Saadia Akhtar, MD

Emergency Medicine

50

158

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Kaplan, Harrison

Michael Leitman, MD

Surgery

51

Kee, Dustin

Alex Federman, MD, MPH

Medicine

52

Kellner, Rebecca

Alfred-Marc Iloreta, MD

Otolaryngology

53

Kiehm, Spencer

Shinobu Itagaki, MD

Cardiovascular Surgery

54

Kim, Eliott

Nisha Chadha, MD

Ophthalmology

55

Kim, Madeline

Emma Guttman-Yassky, MD, PhD

Dermatology

56

Klein, Emma

Bachir Taouli, MD

Radiology

57

Kona, Niathi

Maida Galvez, MD, MPH

Environmental Medicine & Public Health, Pediatrics

58

Kothari, Krsna

Noelle-Marie Javier, MD

Geriatrics and Palliative Medicine

59

LaPolla, Dayle

Adriana Feder, MD

Psychiatry

60

159

STUDENT INDEX MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Lee, Jessica

Tatyana Kushner, MD

Liver Disease, Obstetrics, Gynecology and Reproductive Science

61

Lee, Samuel

Benjamin Glicksberg, PhD

Genetics and Genomic Sciences

62

Letchinger, Riva

Jashvant Poeran, MD, PhD

Orthopaedics

63

Leung, Sherman

Brenton Fargnoli

Alley Corp.

64

Little, Christine

Maaike van Gerwen, MD, PhD

Otolaryngology

65

Liu, Caroline

Steven Coca, DO

Nephrology

66

Lui, Madeline

Bruce Gelb, MD Amy Kontorovich, MD, PhD

Pediatrics/ Cardiology, Genetics and Genomic Sciences Medicine

67

Luo, Cynthia

Robert Yanagisawa, MD Craig Katz, MD

Medicine/Endocrinology, Diabetes and Bone Disease Psychiatry

68

Mahmoudi, Kevin

Amish Doshi, MD

Radiology

69

Maillie, Luke

Stanislav Lazarev, MD

Radiation Oncology

70

STUDENT NAME

160

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Marayati, Naoum Fares

Peter Morgenstern, MD

Neurosurgery

71

Marshall, Christina

Aaron Fischman, MD

Radiology

72

Mayman, Naomi

Laura Stein, MD, MPH

Neurology

73

McChane, Jesse

Andrew Coyle, MD

Medicine

74

McIntyre, Cecily

Matthew McNabney, MD

Geriatrics and Palliative Medicine, Johns Hopkins University

75

Mengsteab, Paulos

Cato Laurencin, MD, PhD

Orthopaedics, University of Connecticut

76

Meyers, James

James Iatridis, PhD

Orthopaedics

77

Jashvant Poeran, MD, PhD

Orthopaedics

Mihalopoulos, Meredith

Mills, Ariana

78 Calin Moucha, MD

Orthopaedics

Hank Schmidt, MD, PhD

Surgery

Peter Gliatto, MD

Geriatrics and Palliative

Katherine Ornstein, PhD

Geriatrics and Palliative

Moody, Kate

79

80

161

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Moscicki, Olivia

Jacob Appel, MD, MPH

Psychiatry

81

Nathaniel, Sarah

John Sfakianos, MD

Urology

82

Ogundipe, Tonia

Luciana Vieria, MD

Obstetrics, Gynecology, and Reproductive Science

83

Okewunmi, Jeffrey

Jashvant Poeran, MD, PhD

Orthopaedics

84

Orozco Scott, Paloma

Maria José Rosa, DrPH

Population Health Science and Policy

85

Park, Ye

Beverly Forsyth, MD

Medical Education

86

Patil, Bhavana

David Heller, MD, MPH

Global Health & General Internal Medicine

87

Paul, Megan

Brian Coakley, MD

Surgery

88

Poster, Jonah

Celia Divino, MD

Surgery

89

Rao, Geeta

Joanne Stone, MD

Obstetrics, Gynecology, and Reproductive Science

90

162

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Rattner, Paige

Luciana Vieria, MD

Obstetrics, Gynecology, and Reproductive Science

91

Ravivarapu, Krishna

Michael Palese, MD

Urology

92

Rosenzweig, Shoshana

Benjamin Glicksberg, PhD

Genetics and Genomic Sciences

93

Rossitto, Christina

Christopher Kellner, MD

Neurosurgery

94

Roy, Nikita

Ann-Gel Palermo, DrPH

Medical Education & Pediatrics

95

Saade, Mia

Priti Balchandani, PhD

Radiology

96

Robert Yanagisawa, MD

Medicine

Santos Malave, Gabriel

97 Craig Katz, MD

Psychiatry

Saylor, Charles

Alison Sanders, PhD

Pediatrics & Environmental Medicine & Public Health

98

Schlosberg, Ira

Daniel Katz, MD

Anesthesiology

99

Shah, Ruhee

Britt Lunde, MD, MPH

Obstetrics, Gynecology, and Reproductive Science

100

163

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Sharma, Akarsh

Laura Stein, MD, MPH

Neurology

101

Shin, Da Wi

Daniel Katz, MD

Anesthesiology

102

Spiera, Zachary

Tanvir Choudhri, MD

Neurosurgery

103

David H. Adams, MD

Cardiovascular Surgery

Shinobu Itagaki, MD

Cardiovascular Surgery

Teng, Shelly

Benjamin Glicksberg, PhD

Genetics and Genomic Sciences

105

Tokuyama, Minami

Saurabh Mehandru, MD

Gastroenterology

106, 107

Tomlinson, Kirk

Czer Lim, MD

Emergency Medicine, Medical Education, Pediatrics

108

Torres, Claudia

Roberto Posada, MD

Pediatrics

109

Trivedi, Ashesh

Darinka Gadikota-Klumpers, PhD

Global Health, Medical Education

110

Storch, Jason

104

164

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Tukel, Connor

Jacob Appel, MD

Medical Education

111

Vrudhula, Amey

Ajit Rao, MD

Surgery

112

Rachel Vreeman, MD, MS

Pediatrics

Waldman, Rachel

113 Roberto Posada, MD

Pediatrics

Keith Sigel, MD, PhD

General Internal Medicine, Infectious Diseases

114

Wu, Stephanie

Sheela Maru, MD, MPH

Obstetrics, Gynecology, and Reproductive Science, Arnhold Institute of Global Health

115

Yoffie, Stephen

Benjamin Glicksberg, PhD

Genetics and Genomic Sciences

116

Emergency Medicine, Population Health Science and Policy

117

Pediatrics, Oncological Sciences

118

Weiss, Kevin

Zarrin, Haley

Zewde, Makda Getachew

Michelle Lin, MD, MPH, MS

James Ferrara, MD

165

166

SECTION 4:

Mentor Index 167

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Adams

David H.

MD

Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai

104

Akhtar

Saadia

MD

Emergency Medicine, Icahn School of Medicine at Mount Sinai

50

Appel

Jacob

MD, MPH

Psychiatry, Icahn School of Medicine at Mount Sinai

14, 81, 111

Badani

Ketan

MD

Urology, Icahn School of Medicine at Mount Sinai

26

Priti

PhD

Radiology, Icahn School of Medicine at Mount Sinai

96

Beddoe

Annmarie

MD, MPH

Oncological Sciences, Icahn School of Medicine at Mount Sinai

43

Bentley

Suzanne

MD, MPH

Emergency Medicine, Icahn School of Medicine at Mount Sinai

28

Stephanie

MD

Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai

6

Michael

MD, PhD

Radiology, Icahn School of Medicine at Mount Sinai

16

Supinda

MD, MPH

Genetics and Genomic Sciences, Pediatrics, Icahn School of Medicine at Mount Sinai

35

Caridi

John

MD

Neurosurgery, Icahn School of Medicine at Mount Sinai

9

Chadha

Nisha

MD

Ophthalmology, Icahn School of Medicine at Mount Sinai

55

Balchandani

Blank

Buckstein

Bunyavanich

168

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Mirna

MD, MPH

Pediatrics/Allergy and Immunology & Medicine/ Gastroenterology, Icahn School of Medicine at Mount Sinai

Samuel

MD

Orthopaedics, Icahn School of Medicine at Mount Sinai

34

Choudhri

Tanvir

MD

Neurosurgery, Icahn School of Medicine at Mount Sinai

3, 103

Coakley

Brian

MD

Surgery, Icahn School of Medicine at Mount Sinai

88

Steven

DO

Nephrology, Icahn School of Medicine at Mount Sinai

66

Clay

MD

Dermatology, Cockerell Dermatopathology 46 2110 Research Row #100 Dallas, TX 75235

Coyle

Andrew

MD

Medicine, Icahn School of Medicine at Mount Sinai

74

Divino

Celia

MD

Surgery, Icahn School of Medicine at Mount Sinai

36, 48, 89

Do

Ron

PhD

Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai

29

Doshi

Amish

MD

Radiology, Icahn School of Medicine at Mount Sinai

69

Elahi

Ebrahim

MD

Ophthalmology, Icahn School of Medicine at Mount Sinai

22

Feder

Adriana

MD

Psychiatry, Icahn School of Medicine at Mount Sinai

60

Alex

MD, MPH

Medicine, Icahn School of Medicine at Mount Sinai

52

Chehade

Cho

Coca

Cockerell

Federman

47

169

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Fernando

Dinali

MD

Emergency Medicine, Icahn School of Medicine at Mount Sinai

40

Ferrara

James

MD

Oncological Sciences, Icahn School of Medicine at Mount Sinai

118

Fischman

Aaron

MD

Radiology, Icahn School of Medicine at Mount Sinai

72

Forsyth

Beverly

MD

Medical Education, Icahn School of Medicine at Mount Sinai

86

Gadikota-Klumpers

Darinka

PhD

Global Health & Medical Education, Icahn School of Medicine at Mount Sinai

110

Environmental Medicine & Public Health, Pediatrics, Icahn School of Medicine at Mount Sinai Pediatrics/Cardiology, Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai

Galvez

Maida

MD, MPH

Gelb

Bruce

MD

Gliatto

Peter

MD

Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

80

Glicksberg

Benjamin

PhD

Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai

62, 93, 105, 116

Guttman-Yassky

Emma

MD, PhD

Dermatology, Icahn School of Medicine at Mount Sinai

5, 56

Hausman

Michael

MD

Orthopaedics, Icahn School of Medicine at Mount Sinai

37

David

MD, MPH

Global Health & General Internal Medicine, Icahn School of Medicine at Mount Sinai

45, 87

MD

Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai

42

Heller

Howell

Elizabeth

58

67

170

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Iatridis

James

PhD

Orthopaedics, Icahn School of Medicine at Mount Sinai

21, 77

Iloreta

Alfred-Marc

MD

Otolaryngology, Icahn School of Medicine at Mount Sinai

2, 32, 33, 53

Itagaki

Shinobu

MD

Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai

54, 104

Javier

Noelle-Marie

MD

Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

59

Katz

Craig

MD

Psychiatry, Icahn School of Medicine at Mount Sinai

13, 68, 97

Katz

Daniel

MD

Anesthesiology, Icahn School of Medicine at Mount Sinai

99, 102

Christopher

MD

Neurosurgery, Icahn School of Medicine at Mount Sinai

94

Amy

MD, PhD

Medicine, Icahn School of Medicine at Mount Sinai

67

Tatyana

MD

Liver Disease, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai

61

Cato

MD, PhD

Orthopaedics, University of Connecticut

76

Lazarev

Stanislav

MD

Radiation Oncology, Icahn School of Medicine at Mount Sinai

70

Leitman

Michael

MD

Surgery, Icahn School of Medicine at Mount Sinai

51

Kellner

Kontorovich

Kushner

Laurencin

Lim

Czer

MD

Lin

Michelle

MD, MPH, MS

Emergency Medicine, Medical Education, Pediatrics, Icahn 108 School of Medicine at Mount Sinai Emergency Medicine, Population Health Science and Policy, Icahn 117 School of Medicine at Mount Sinai 171

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Obstetrics, Gynecology, and Reproductive Science, 100 Icahn School of Medicine at Mount Sinai Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount 25, 115 Sinai

Lunde

Britt

MD, MPH

Maru

Sheela

MD, MPH

Maru

Duncan

MD, PhD

Medicine, Pediatrics, Icahn School of Medicine at Mount Sinai

44

McNabney

Matthew

MD

Geriatrics and Palliative Medicine, Johns Hopkins University, Baltimore, MD

75

Ben

MD

Emergency Medicine, Icahn School of Medicine at Mount Sinai

40

Saurabh

MD

Medicine, Icahn School of Medicine at Mount Sinai

106, 107

Morgenstern

Peter

MD

Neurosurgery, Icahn School of Medicine at Mount Sinai

71

Moucha

Calin

MD

Orthopaedics, Icahn School of Medicine at Mount Sinai

78

Ornstein

Katherine

PhD

Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

49, 80

Palermo

Ann-Gel

DrPH

Medical Education & Pediatrics, Icahn School of Medicine at Mount Sinai

95

Palese

Michael

MD

Urology, Icahn School of Medicine at Mount Sinai

92

Poeran

Jashvant

MD, PhD

Orthopaedics, Icahn School of Medicine at Mount Sinai

63, 78, 84

Posada

Roberto

MD

Pediatrics, Icahn School of Medicine at Mount Sinai

19, 109, 113

Potapov

Anna

MD, MPH

RubiconMD, New York, NY

39

McVane

Mehandru

172

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Rao

Ajit

MD

Surgery, Icahn School of Medicine at Mount Sinai

1, 112

Ripp

Jonathan

MD, MPH

Medicine, Icahn School of Medicine at Mount Sinai

27

Rosa

Maria José

DrPH

Population Health Science and Policy, Icahn School of Medicine at Mount Sinai

85

98

Sanders

Alison

PhD

Pediatrics & Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai

Schmidt

Hank

MD, PhD

Surgery, Icahn School of Medicine at Mount Sinai

79

Sfakianos

John

MD

Urology, Icahn School of Medicine at Mount Sinai

82

Sheffield

Perry

MD, MPH

Pediatrics, Icahn School of Medicine at Mount Sinai

17

114

Sigel

Keith

MD, PhD

General Internal Medicine, Infectious Diseases, Icahn School of Medicine

Smith

William

MD

Radiation Oncology, Icahn School of Medicine at Mount Sinai

16

Stein

Laura

MD, MPH

Neurology, Icahn School of Medicine at Mount Sinai

73

Stein

Laura

MD, MPH

Neurology, Icahn School of Medicine at Mount Sinai

20, 101

90

Stone

Joanne

MD

Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai

Stotz

Chipper

BA

Rock Health, San Francisco, CA

41

Annemarie

MD, MPH

Pediatrics, Northwell Health New York, New York

18

Stroustrup

173

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Tadros

Rami

MD

Surgery, Vascular Surgery, Radiology, Icahn School of Medicine at Mount Sinai

38

Tanella

Anthony

MD

Anesthesiology, Icahn School of Medicine at Mount Sinai

10

Taouli

Bachir

MD

Radiology, Icahn School of Medicine at Mount Sinai

57

Taub

Peter

MD

Surgery, Icahn School of Medicine at Mount Sinai

11

Tiersten

Amy

MD

Oncological Sciences, Icahn School of Medicine at Mount Sinai

12

Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY, NY Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai

Tsai

C. Jillian

MD, PhD

Vieria

Luciana

MD

Vreeman

Rachel

MD, MS

Global Health, Icahn School of Medicine at Mount Sinai

15, 19, 113

Wilson

Karen

MD, MPH

Pediatrics, Icahn School of Medicine at Mount Sinai

30

Environmental Medicine & Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai Medicine/Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai

23

83, 91

Wright

Robert

MD, MPH

Yanagisawa

Robert

MD

Zajac

Lauren

MD, MPH

Pediatrics, Icahn School of Medicine at Mount Sinai

24

Zaslavsky

Elena

PhD

Neurology, Icahn School of Medicine at Mount Sinai

4

Maaike

MD, PhD

Otolaryngology, Icahn School of Medicine at Mount Sinai

8, 65

van Gerwen

7

68, 97

174

175

SECTION 5:

Abstracts Topics Area 176

ABSTRACT TOPICS AREA CATEGORY Adolescent Health Allergy and Immunology

POSTER POSITION 88 35, 47

Anesthesiology, Perioperative, and Pain Medicine

10, 99, 102

Cardiology

67, 105, 116

Cardiothoracic Surgery

54, 66, 104

Dermatology

5, 46, 56

Diagnostic, Molecular and Interventional Radiology

57, 69, 72

Disability

81

Emergency Medicine

28

Environmental Medicine & Public Health

7, 24, 58, 65, 85

Family Medicine & Community Health

74

Gastroenterology

106

General Internal Medicine

52, 114

General Surgery

48, 89

Genetics and Genomic Sciences

93

Geriatrics and Palliative Medicine

41, 49, 59, 75, 80

Global Health Health policy/ Population Health Health System Operations & Strategic Planning

13, 15, 17, 19, 22, 40, 43, 44, 45, 87, 98 95, 111 39

177

CATEGORY Hematology & Medical Oncology Infectious Diseases

POSTER POSITION 12, 118 4, 107, 113

Innovation

64

Liver Diseases

61

Medical Education Neurology Neurosurgery Newborn Medicine Obstetrics, Gynecology, and Reproductive Science Ophthalmology Orthopaedics Otolaryngology-Head and Neck Surgery Pediatrics Psychiatry, Psychology, Mental Health

14, 20, 86,110 73, 96, 101 3, 9, 71, 94, 103 18, 109 6, 25, 42, 83, 90, 91, 100, 115, 117 55 21, 31, 34, 37, 63, 76, 77, 78, 84 2, 8, 32, 33, 53 30, 62, 108 27, 60, 68, 97

Pulmonary, Critical Care and Sleep Medicine

29

Radiation Oncology

16

Radiation Oncology

23, 70

Surgery

11, 36, 51, 79

Urology

26, 82, 92

Vascular Surgery Well-being & Resilience

1, 38, 112 50 178

179

SECTION 5:

Acknowledgements 180

POSTER SESSION FACILITATORS Claire Ankuda, MD, MPH Geriatrics and Palliative Medicine

Thomas Marron, MD, PhD Medicine, Hematology and Medical Oncology

Francesca Cossarini, MD Medicine, Infectious Diseases

Peter Morgenstern, MD Neurosurgery & Pediatrics

Stephanie H. Factor, MD, MPH Medicine, Infectious Diseases, Obstetrics, Gynecology and Reproductive Science

Jashvant Poeran, MD, PhD Population Health Science and Policy, Orthopedics, & Medicine

Alex D. Federman, MD Medicine, General Internal Medicine

Alison Sanders, PhD Pediatrics, Environmental Medicine & Public Health

Scott L. Friedman, MD Medicine, Liver Diseases, Pharmacological Sciences

Perry E. Sheffield, MD Environmental Medicine & Public Health, Pediatrics

Nathan Fox, MD Obstetrics, Gynecology and Reproductive Science

Keith Sigel, MD, PhD Medicine, General Internal Medicine

Darinka Gadikota-Klumpers, PhD Medical Education

Richard Silvera, MD, MPH Medicine, Infectious Diseases

Joanne Hojsak, MD Pediatrics, Pediatric Critical Care Medicine, Medical Education

Elizabeth Spencer, MD Pediatrics, Pediatric Gastroenterology

Minal S Kale, MD Medicine, General Internal Medicine Kalypso Karastergiou, MD, PhD Medicine, Endocrinology, Diabetes and Bone Disease Daniel Katz, MD Anesthesiology, Perioperative & Pain Medicine Jenny Lin, MD, MPH Medicine, General Internal Medicine

Francesca Stillitano, PhD Medicine, Cardiology Maria Giovanna Trivieri, MD, PhD Medicine, Cardiology Rajwanth Veluswamy, MD Medicine, Hematology and Medical Oncology Luciana Vieira, MD Obstetrics, Gynecology, and Reproductive Science

181

EVENT COMMITTEE Mary Rojas, PhD Director, Medical Student Research Associate Profession in Medical Education Jenny J. Lin, MD, MPH Associate Director of SCHOLaR Professor of Medicine/General Internal Medicine Keith Sigel, MD, PhD Co-Director, PORTAL Program (MD/MSCR) Associate Director Research Associate Professor of Medicine/General Internal Medicine Grace A. Oluoch, MBA Senior Program Coordinator Medical Student Research Office Yakhira Encarnacion-Patterson, MPH Senior Program Coordinator Medical Student Research Office

182

183