2023 Medical Student Research Day Abstract Book by Icahn School of Medicine at Mount Sinai

and Abstracts

THURSDAY, MARCH 16, 2023, 12:15 – 4:00 PM

KAREN ZIER P H D

Sixth Annual

MEDICAL STUDENT RESEARCH DAY Program

Introduction (pg 4)

— Program and Student Speakers (pg 5-6)

List of Abstracts (Section 1: pg 7-32)

— Abstracts (Section 2: pg 33-155)

Student Index (Section 3: pg 156-166)

Mentor Index (Section 4: pg 167-175)

—

Abstract Topics Area (Section 5: pg 176-179)

Acknowledgements (Section 6: pg 181-183)

Sixth Annual Karen Zier Medical Student Research Day

March 16, 2023

Welcome to the 28th Annual Medical Student Research Day, named in honor of Karen Zier, PhD, founding Associate Dean for the Medical Student Research Office. Last year we held the posters sessions in person and the platform presentations virtually and it was an enormous success. This year, we are planning to have the entire event in person.

The Icahn School of Medicine at Mount Sinai places immense 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 MDMasters 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 Diversity Innovation Hub (DIH), and more. 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, and Michelle Sainté-Willis, Senior Associate Dean for Medical Education Administration. We would like to send a special thank you to the SCHOLaR Track Advisors for their dedicated support making this day possible:

– Ahsan, Fariha, MPA, MSc

– Jacob Appel, MD, MS, MPH

– Supinda Bunyavanich, MD

– Kevin Costa, PhD

– Darinka Gadikota-Klumpers, PhD

– Leona Hess, PhD

– James Iatridis, PhD

– Reena Karani, MD, MHPE

– Tatyana Kushner, MD, MSCE

– Minal Kale, MD

– Ann-Gel Palermo, DrPH

– Perry Sheffield, MD

– Rainer Soriano, MD

Thank you Grace Oluoch and Yakhira Encarnacion-Patterson, program administrators for the Medical Student Research Office, for producing the abstract book and the Research Day planning and organization.

Jenny J. Lin, MD, MPH

Co-Director of SCHOLaR Keith Sigel, MD, PhD Director of PORTAL Mary Rojas, PhD Director of the MSRO

12:15 – 1:15 pm

Session A –

Poster Presentations

Annenberg 12 & 13th Floors

Group B – Lunch

Welcome 2:35 - 2:50 pm

Mary Rojas, PhD

1:25 – 2:25 pm

Session B –

Poster Presentations

Annenberg 12 & 13th Floors

Group A – Lunch

2:35–4:00 pm

Platform Presentations

Stern Auditorium

Zoom

Webinar ID: 835 4913 3329

Passcode: 683278

Student Platform Presentations 3:00 - 4:00 pm

Sofia Ahsanuddin, MS Scholarly Year

Director, Medical Student Research Office

Icahn School of Medicine at Mount Sinai

David Muller, MD

Dean for Medical Education

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

Mitochondrial Dysfunction in Steady State Sickle Cell Disease (SCD) Characterized by Flavoprotein Fluorescence (FPF) in the Retina

MENTOR: RICHARD ROSEN, MD

Ashley Brown, MS II

Prevalence of Adverse Pregnancy Outcomes in Wilson’s Disease during Pregnancy: Systematic Review and Meta-Analysis

MENTOR: TATYANA KUSHNER, MD

Yaelle Shaked, MS II

Association between Metals and Thyroid Cancer in Puerto Rico - A National Health and Nutrition

Examination Survey and Ecological Study

MENTOR: MAAIKE VAN GERWEN, MD, PHD

Andrew Tieu, MS II

Computational Design of Custom Therapeutic Cells to Correct Failing Human Cardiomyocytes

MENTOR: KEVIN COSTA, PHD

Closing Remarks 4:00 pm

Jenny Lin, MD, MPH

Associate Director, SCHOLaR

Medical Student Research Office

Icahn School of Medicine at Mount Sinai

5 PROGRAM

STUDENT SPEAKERS

SOFIA AHSANUDDIN, MS III

“Mitochondrial Dysfunction in Steady State Sickle Cell Disease (SCD)

Characterized by Flavoprotein Fluorescence (FPF) in the Retina”

Abstract #: 3

MENTOR: RICHARD ROSEN, MD

ASHLEY BROWN, MS II

“Prevalence of Adverse Pregnancy Outcomes in Wilson’s Disease during Pregnancy: Systematic Review and Meta-Analysis”

Abstract #: 14

MENTOR: TATYANA KUSHNER, MD

YAELLE SHAKED, MS II

“Association between Metals and Thyroid Cancer in Puerto Rico - A National Health and Nutrition Examination Survey and Ecological Study”

Abstract #: 99

MENTOR: MAAIKE VAN GERWEN, MD, PHD

ANDREW TIEU, MS II

“Computational Design of Custom Therapeutic Cells to Correct Failing Human Cardiomyocytes”

Abstract #: 105

MENTOR: KEVIN COSTA, PHD

SECTION 1: List of Abstracts

Note: Medical students’ name is in bold and the last author is the mentor.

LIST OF ABSTRACTS

SOCIODEMOGRAPHIC AND BEHAVIORAL PREDICTORS OF DEPRESSION PREVALENCE IN NORTHERN GHANA.

Dorothy Adu-Amankwah1 , Masih Babagoli1 , Raymond Aborigo2 , Engelbert Nonterah3 , Irene Kuwolamo4 , Khadija Jones 5 , David Heller6 1 Medical Education, 2 Social Sciences, 3 Clinical Science, 4 Social Sciences, 5 Global Health, 6 Medicine. 1,5,6 Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4 Navrongo Research Health Centre, Navrongo, Ghana.

IMPACTS OF THE COVID-19 PANDEMIC ON SKIN CANCER SURGERIES.

Aneesh Agarwal1 , Shayan Owji2 , Benjamin Ungar2 , Nicholas Gulati2 , Jonathan Ungar2 1 Medical Education, 2 Dermatology. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

MITOCHONDRIAL DYSFUNCTION IN STEADY STATE SICKLE CELL DISEASE (SCD) CHARACTERIZED BY FLAVOPROTEIN FLUORESCENCE (FPF) IN THE RETINA.

Sofia Ahsanuddin1 , Hernan Rios2 , Jordan Bellis 3 , Luis Duran2 , Maxime Centeno4 , Jeffrey Glassberg4 , Richard Rosen2 1 Medical Education, 2 Ophthalmology, 3 Oncological Sciences, 4 Emergency Medicine. 1,3,4 Icahn School of Medicine at Mount Sinai, New York, New York, 2 New York Eye and Ear Infirmary of Mount Sinai, New York, NY.

PASS STUDY: RELATIONSHIP OF FOOD INSECURITY AND PARENTAL STRESS IN FAMILIES SCREENED FOR SDH AT A PEDIATRIC CLINIC IN EAST HARLEM, NYC.

Katherine Aliano Ruiz1 , Zachary Gallin1 , Jennifer Acevedo2 , Adina Singh2 , Sonia Khurana1 , Paige Cloonan1 , Chris Gennings 3 , Shachi Mistry 3 , Haley Ottensoser1 , Eve Spear4 , Lauren Zajac 5 , Leora Mogilner5 . 1 Medical Education, 2 Population Health Science and Policy, 3 Environmental Medicine and Public Health, 4 Biology, 5 Pediatrics. 1,2,3,5 Icahn School of Medicine at Mount Sinai, New York, New York, 4 Barnard College, New York, NY.

DOES PATIENTS’ PRIMARY SPOKEN LANGUAGE MAKE A DIFFERENCE IN REPORTED PAIN SCORES AFTER TOTAL HIP OR KNEE REPLACEMENT SURGERY?

Diego Arevalo1 , Nicole Zubizarreta 2 , Brett Hayden3 , Darwin Chen3 , Samuel DeMaria4 , Calin Moucha3 , Jashvant Poeran2 1 Medical Education, 2 Population Health Science and Policy, 3 Orthopaedics, 4 Anesthesiology. 1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, New York.

LIST OF ABSTRACTS

SOCIO-DEMOGRAPHIC AND BEHAVIORAL FACTORS ASSOCIATED WITH HYPERTENSION PREVALENCE IN FOUR RURAL COMMUNITIES IN NORTHERN GHANA.

Masih Babagoli1 , Dorothy Adu-Amankwah1 , Engelbert Nonterah2 , Raymond Aborigo 3 , Irene Kuwolamo 3 , Khadija Jones4 , David Heller5

1 Medical Education, 2 Clinical Sciences, 3 Social Sciences, 4 Global Health,

5 Medicine. 1,4,5 Icahn School of Medicine at Mount Sinai, New York, New York,

2,3,4 Navrongo Health Research Centre, Navrongo, Ghana.

SEVERE PREOPERATIVE VENOUS CLINICAL SEVERITY SCORES ARE NOT ASSOCIATED WITH HIGHER ODDS OF MAJOR REOPERATIONS.

Halbert Bai1 , Jason Storch2 , Andrew Min2 , Jenny Chen2 , Annie Chang2 , Keva Li2 , Jinseo Kim2 , Bianca Vama 2 , Justin Wang2 , Mikeely Siegel2 , Sachi Lele2 , Windsor Ting2

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

PREDICTORS OF REINTERVENTION AFTER ILIOFEMORAL VEIN STENTING.

Halbert Bai1 , Jason Storch2 , Annie Chang2 , Andrew Min2 , Jenny Chen2 , Keva Li2 , Jinseo Kim2 , Bianca Vama 2 , Justin Wang2 , Mikeely Siegel2 , Sachi Lele2 , Windsor Ting2

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

DAILY VS TWICE DAILY DOSING OF NIFEDIPINE FOR BLOOD PRESSURE CONTROL IN PREGNANCY AND POSTPARTUM.

Isabelle Band1 , Jessica Peterson2 , Kelly Wang2 , Angela Bianco2

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

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

LIST OF ABSTRACTS

ANTIPSYCHOTIC USE AND COVID INFECTION RISK.

Sewit Bereket1 , Rachel Litke2 , Tonia Ogundipe1 , Charles Mobbs2

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

CLIMATE CHANGE AND MEDICAL EDUCATION: UNDERSTANDING NATIONWIDE CURRICULAR EFFORTS.

Olivia Blanchard1 , Lucy Greenwald1 , Perry Sheffield2 .

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

IMPACTFUL LIFE EVENTS, POST-TRAUMATIC STRESS, AND RESILIENCE PROMOTING BEHAVIORS IN JAPANESE MEDICAL STUDENTS AT FUKUSHIMA MEDICAL UNIVERSITY.

Anna Blech1 , Hideki Sato2 , Satoshi Waguri2 , Masaharu Maeda 2 , Craig Katz3 , Robert Yanagisawa4 . 1 Medical Education, 2 Disaster Psychiatry, 3 Psychiatry, 4 Medicine. 1,3,4 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Fukushima Medical University Fukushima, Japan.

PRINCIPLES OF BEHAVIORAL SCIENCE TO ENHANCE COMMUNITY HEALTH MESSAGING CAMPAIGN DESIGN, IMPLEMENTATION, AND EVALUATION.

James Brooks1 , Faven Araya 2 , Maya Korin3 , Idris Muhammed4 , Kristelle Pierre2 , Luz Claudio 3 1 Medical Education, 2 Operations, 3 Environmental Medicine and Public Health, 4 Public Health. 1,3 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Arthur Ashe Institute for Urban Health, 4 Morehouse School of Medicine.

PREVALENCE OF ADVERSE PREGNANCY OUTCOMES IN WILSON’S DISEASE DURING PREGNANCY: SYSTEMATIC REVIEW AND META-ANALYSIS.

Ashley Brown1 , Sasha Kogan2 , Marcia Lange1 , Lily Martin3 , Tatyana Kushner4 . 1 Medical Education, 2 Medicine, 3 Levy Library, 4 Liver Diseases. 1,3,4 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY

FIGURATIVE LANGUAGE IN CANCER CONVERSATIONS: DIFFERENCES BY SOCIODEMOGRAPHIC CHARACTERISTICS.

Nicholas Buehler1 , Jeannys Nnemnbeng2 , Laura Gelfman3 , Cardinale Smith3 , Julia Frydman3 . 1 Medical Education, 2 Clinical Research, 3 Geriatrics and Palliative Medicine. 1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

LIST OF ABSTRACTS

QUALITATIVE ASSESSMENT OF THE EFFICACY OF PSYCHIATRIC TRAINING MODULES IN PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY IN THE DOMINICAN REPUBLIC.

Gabriela Calcano Castro1 , Myles Solan1 , Dhruv Gupta 2 , Xiomara Fernandez3 , Craig Katz2 1 Medical Education, 2,3 Psychiatry. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Instituto Terapeutico y Psicologico para la Familia, Jarabacoa, Dominican Republic.

ESTABLISHING A POVERTY ASSESSMENT TOOL FOR USER FEES AT AN AMBULATORY SURGERY CENTER IN RURAL UGANDA.

Peter Campbell1 , Chelsia Melendez1 , Makda Getachew Zewde1 , Katie Glerum2 , Joseph Okello-Damoi3 , Anna Kalumuna3 , Linda Zhang2 1 Medical Education, 2,3 Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Kyabirwa Surgical Center Kyabirwa, Uganda.

SITE OF LUMINAL NARROWING AFFECTS LIKELIHOOD OF SUCCESSFUL DILATION WHEN ULTRA-THIN ENDOSCOPES ARE REQUIRED.

Michael Chang1 , Michael Smith2 1 Medical Education, 2 Gastroenterology and Hepatology. 1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Mount Sinai Morningside and West Hospitals.

ELUCIDATION OF RISK FACTORS FOR CEAP CLASS AMONG VASCULAR SURGERY PATIENTS.

Annie Chang1 , Halbert Bai2 , Andrew Min2 , Jason Storch2 , Jenny Chen2 , Keva Li2 , Windsor Ting2 1 Medical Education, 2Vascular Surgery.

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

SIGNIFICANT PREDICTORS OF PREOPERATIVE VCSS COMPOSITE SCORE FOR VASCULAR SURGERY PATIENTS AT A SINGLE INSTITUTION.

Annie Chang1 , Halbert Bai2 , Andrew Min2 , Jason Storch2 , Jenny Chen2 , Keva Li2 , Windsor Ting2 1 Medical Education, 2Vascular Surgery.

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

LIST OF ABSTRACTS

REMOTE PATIENT MONITORING OF CENTRAL RETINAL FUNCTION WITH MACUSTAT®: A MULTI-MODAL MACULAR FUNCTION SCAN.

Earnest Chen1 , Michael Mills2 , Tara Gallagher3 , Ranya Habash4 , Ronald Gentile5 , Sean Ianchulev6 . 1 Medical Education, 2,3,4,5,6 Ophthalmology. 1,6 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Prism Eye Institute, Oakville, Ontario, Canada, 3 Gentile Retina Practice, New York City, NY, 4 Bascom Palmer Eye Institute, Miami, FL, 5 New York Eye and Ear of Mount Sinai, New York, NY.

PATIENT’S PERCEIVED UTILITY OF THE MACUSTAT TEST TO ASSESS RETINAL CARE QUALITY.

Earnest Chen1 , Ronald Gentile2 , Sean Ianchulev 3 1 Medical Education, 2,3 Ophthalmology. 1,3 Icahn School of Medicine at Mount Sinai, New York, New York, 2 New York Eye and Ear of Mount Sinai, New York, NY.

DELAYED TYPE HYPERSENSITIVITY REACTIONS TO VARIOUS ALLERGENS MAY DIFFERENTLY MODEL INFLAMMATORY SKIN DISEASES.

EXAMINING HEALTHCARE NGO TRENDS THROUGH GOOGLE ANALYTICS. Jenny Chen1 , Nicolas Douard2 , Evan Afshin2 , Joan LaRovere2 , Ebrahim Elahi3 . 1 Medical Education, 2 Data Science, 3 Ophthalmology. 1,3 Icahn School of Medicine at Mount Sinai, New York, New York, 2Virtue Foundation, New York, NY. 24

Julia Cheng1 , Emma Guttman-Yassky2 1 Medical Education 2 Dermatology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 25

HEAD-TO-HEAD COMPARISON OF VISION TESTS INTEGRATED INTO A VIRTUAL REALITY TECHNOLOGY AGAINST THEIR CLINICAL ANALOGUES.

Christopher Cheng1 , Margarita Labkovich1 , Andrew Warburton2 , Randal Serafini3 , James Chelnis4 1 Medical Education, 2 Anesthesiology, 3 Neuroscience, 4 Ophthalmology.

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

LIST OF ABSTRACTS

EVALUATING THE IMPACT OF CLIMATE-RELATED MATERIAL IN THE PRECLINICAL CURRICULUM: MOUNT SINAI CLIMATE CHANGE CURRICULUM INFUSION PROJECT (CCCIP) 2020.

Lindsay Clark1 , Perry Sheffield2 . 1 Medical Education, 2 Pediatrics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 27

IMPACT OF PERIPHERAL ARTERY DISEASE ON OUTCOMES IN HIGH BLEEDING RISK PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION.

Rebecca Cohen1 , Alessandro Spirito2 , Samantha Sartori2 , Clayton Snyder2 , Birgit Vogel2 , Samin Sharma 2 , George Dangas2 , Annapoorna Kini2 , Roxana Mehran2 1 Medical Education, 2 Cardiovascular Research Institute.

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

INCREASED SEVERITY OF INFLUENZA-ASSOCIATED HOSPITALIZATIONS IN RESOURCE-LIMITED SETTINGS: RESULTS FROM THE GLOBAL INFLUENZA SURVEILLANCE NETWORK (GIHSN).

Lily Cohen1 , Chelsea Hansen2 , Cecile Viboud2 , Sandra Chaves 3 1 Medical Education, 2 International Epidemiology and Population Studies, 3 Epidemiology. 1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 NIH, 3 Foundation for Influenza Epidemiology, Fondation de France, Paris, France. 29

OX40/OX40L IS INTEGRAL TO THE PATHOGENESIS OF AA AT THE SKIN AND BLOOD LEVEL.

Dante Dahabreh1 , Daniel Lozano-ojalvo2 , Ester del Duca 2 , Jonathan Bar2 , James Krueger2 , Emma Guttman-Yassky2 . 1 Medical Education 2 Dermatology.

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

PSYCHOLOGICAL OUTCOMES AMONG MEDICAL STUDENTS THAT HAVE EXPERIENCED CHILDHOOD TRAUMA.

Candida Damian1 , Mary Rojas1 1 Medical Education.

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

LIST OF ABSTRACTS

BENT PEDAGOGIES: CENTERING QUEER THEORIES AND VOICES IN A NOVEL APPROACH TO LGBTQ UNDERGRADUATE EDUCATION.

Christopher DeVita1 , Alli Morgan1 , Beverly Forsyth2 . 1 Medical Education, 2 Medicine. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

GERIATRIC RENAL TRANSPLANT CO-MANAGEMENT PROGRAM: A NEW MODEL TO OPTIMIZE PRE-TRANSPLANT CARE AND EVALUATION FOR FRAIL OLDER ADULTS.

Jared Doan1 , Stephanie Chow2 , Fred Ko2 1 Medical Education, 2 Geriatrics and Palliative Medicine. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

IS OBESITY ASSOCIATED WITH INCREASED ADVERSE OUTCOMES AMONG FORCEPS ASSISTED VAGINAL DELIVERIES?

Tahera Doctor1 , Catherine Stratis1 , Camila Cabrera 2 , Kelly Wang3 , Guillaume Stoffels2 , Keisha Paul3 , Chloe Getrajdman2 , Henri Rosenberg2 , Elizabeth Cochrane2 , Lauren Ferrara 2 , Angela Bianco2 , Chelsea DeBolt2 . 1 Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science, 3 Biostatistics.

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

DOSIMETRIC COMPARISON OF IMRT VS. 3D-CRT TO SPARE ERECTILE AND OTHER SEXUAL STRUCTURES IN FEMALE RECTAL CANCER PATIENTS UNDERGOING PELVIC RADIOTHERAPY.

Margaret Downes1 , Vishruta Dumane2 , Kristin Hsieh2 , Ayesha Ali3 , Orly Morgan4 , Lucy Greenwald1 , Deborah Marshall2 . 1,4 Medical Education, 2,3 Radiation Oncology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, 4 Miller School of Medicine at University of Miami, Miami, Florida. 35

THE IMPACT OF SURGERY ON MORTALITY IN ELDERLY PATIENTS WITH PROXIMAL HUMERUS FRACTURES: A RETROSPECTIVE ANALYSIS OF MEDICARE BENEFICIARIES.

Akiro Duey1 , Nicole Zubizarreta 2 , Brocha Stern2 , Jashvant Poeran2 , Leesa Galatz2 , Bradford Parsons2 , Paul Cagle2 . 1 Medical Education, 2 Orthopaedics.

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

LIST OF ABSTRACTS

PULMONARY HYPERTENSION IN CHILDREN WITH SEVERE OBSTRUCTIVE SLEEP APNEA.

Monica Feeley1 , Jason Bronstein2 , Douglas Bush2 . 1 Medical Education, 2 Pediatrics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 37

EVALUATION OF THE REDUCTION AND ASSOCIATION OF THE SCAPHOID, CAPITATE, AND LUNATE (RASCL) PROCEDURE IN RESOLVING CARPAL INSTABILITY: A BIOMECHANICAL ANALYSIS.

Pierce Ferriter1 , Christian Awah2 , Matthew Gluck1 , Philip Nasser2 , Amanda Walsh2 , Michael Hausman2 1 Medical Education, 2 Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 38

COVID-ERA CHRONIC KIDNEY DISEASE PATIENT ENGAGEMENT VARIES DISTINCTLY BY SOCIO-DEMOGRAPHIC FACTORS.

James Fleming1 , Richa Deshpande2 , Lili Chan3 , Kirk Campbell3 , Ellerie Weber2

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

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York. 39

HISTOLOGIC EOSINOPHILIA IN PEDIATRIC IBD.

Hannah Freid1 , Elizabeth Spencer2 . 1 Medical Education, 2 Gastroenterology.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 40

TACKLING FOOD INSECURITY WITH A CLINIC-BASED FOOD PANTRY AND REFERRALS TO COMMUNITY-BASED FOOD PANTRY IN NEW YORK CITY.

Zachary Gallin1 , Leora Mogilner2 , Lauren Zajac 3 , Sonia Khurana 2 , Paige Cloonan2 , Jennifer Acevedo2 , Eve Spear4 , Haley Ottensoser3 , Alexis Burgess2

1 Medical Education, 2 Pediatrics, 3 Preventive Medicine, 4 Biology. 1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York, 4 Barnard College, New York, NY.

LIST OF ABSTRACTS

INDIVIDUAL SOCIOECONOMIC FACTORS HAVE A GREATER IMPACT ON PROXY-REPORTED END-OF-LIFE OUTCOMES THAN REGIONALITY.

William Gansa1 , Hannah Kleijwegt2 , Subashini Rajagopalan2 , Melissa Aldridge2 , Mohamed Benyamine2 , Claire Ankuda 2 . 1 Medical Education, 2 Geriatrics and Palliative Medicine. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 42

WHITE MATTER MARKERS FOR TREATMENT OUTCOMES IN MAJOR DEPRESSIVE DISORDER.

Jack Gomberg1 , Jungho Cha 2 , Juna Khang2 , Boadie Dunlop 3 , Edward Craighead4 , Ki Sueng Choi2 , Helen Mayberg2 1 Medical Education, 2,3 Neurology, 4 Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3,4 Emory University. 43

THE EFFE CT OF CAGE DIMENSIONS ON SUBSIDENCE FOLLOWING ANTERIOR CERVICAL DISCECTOMY AND FUSION.

Christopher Gonzalez1 , Akiro Duey2 , Eric Geng2 , Justin Tang2 , Pierce Ferriter2 , Ashley Rosenberg2 , Ula Isleem2 , Bashar Zaidat2 , Paul Al-Attar2 , Jonathan Markowitz2 , Jonathan Gal2 , Jun Kim2 , Samuel Cho2 1 Medical Education, 2 Orthopaedics.

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

THE EFFECTS OF NEIGHBORHOOD CHARACTERSTICS ON PUERTO RICAN CHILD MENTAL HEALTH DURING THE COVID-19 PANDEMIC.

Brianna Gordon1 , Cristiane Duarte2 . 1 Medical Education, 2 Psychiatry.

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

2 Columbia University, New York, New York.

FAMILY CAREGIVERS’ CHALLENGES NAVIGATING THE INSURANCE LANDSCAPE FOR FAMILY MEMBERS WITH DEMENTIA IN A HOME-BASED PRIMARY CARE PROGRAM.

Mikayla Gordon Wexler1 , Jennifer Reckrey2 .

1 Medical Education, 2 Geriatrics and Palliative Medicine.

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

LIST OF ABSTRACTS

DISPARITIES IN HEALTH OUTCOMES IN MEDICAID PATIENTS WITH EPILEPSY BY PRACTICE SETTING: PROMOTING HEALTH EQUITY IN ACADEMIC MEDICAL CENTERS.

Evelyn Gotlieb1 , Parul Agarwal2 , Leah Blank 2 , Nathalie Jette2 1 Medical Education, 2 Neurology. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

CLIMATE AND HEALTH EDUCATION: A CRITICAL REVIEW AT ONE MEDICAL SCHOOL.

Lucy Greenwald1 , Olivia Blanchard1 , Colleen Hayden1 , Perry Sheffield2 . 1 Medical Education on, 2 Pediatrics.

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

AEQUITAS: A DEEP LEARNING-BASED METRIC FOR DETECTING, CHARACTERIZING, AND MITIGATING DATASET BIAS.

Faris Gulamali1 , Girish Nadkarni2 . 1 Medical Education, 2 Nephrology.

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

METABOLIC PARAMETERS PREDICTIVE OF IMAGING FEATURES ASSOCIATED WITH NEOPLASTIC PROGRESSION IN A PANCREATIC CANCER SURVEILLANCE PROGRAM.

3,4 Medicine, 5 Gastroenterology.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York, 4Weill Cornell Medicine, New York, NY, 5 Catholic Health - St. Francis Hospital & Heart Center, Roslyn, NY.

AN EXPLORATORY APPROACH TO CHARACTERIZING PEDIATRIC MENTAL HEALTH SERVICES AND REFERRALS IN EAST HARLEM.

Nancy Huang1 , Ann-Gel Palermo1 , Ray Cornbill2 1 Medical Education.

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

2 East Harlem Community Health Committee, Inc., New York, New York.

LIST OF ABSTRACTS

ASSESSING VULNERABILITIES IN TRANSITIONS FOR COVID19 PATIENTS DISCHARGED ON OXYGEN.

Nnamdi Igwe1 , Anne Linker2 , Andrew Dunn2 , Jung Ha 2 , Beth Raucher2 , Vinh-tung Nguyen2 1 Medical Education, 2 Medicine.

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

PREDICTION OF IMMUNE CHECKPOINT BLOCKADE RESPONSE BASED ON BLOOD SERUM VALUES.

Sushruta Iruvanti1 , Diego Chowell2 1 Medical Education, 2 Oncological Sciences.

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

ASSESSING THE CLINICAL QUALITY OF PCP SUBMISSIONS AND SPECIALIST RESPONSES ON AN E-CONSULT PLATFORM.

Nikita Israni1 , Karen Acevedo2 , Allie Heath2 , Katie McGarry2

1 Medical Education, 2 Clinical Operations. 1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 RubiconMD, New York, NY.

EFFECT OF VOLUNTARY EXERCISE AND PSYCHOSOCIAL STRESS ON THE IMMUNE SYSTEM IN MURINE MODELS.

Vladislav Izda1 , Sumnima Singh2 , Filip Swirski2 1 Medical Education,

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

SLEEP MAINTAINS IMMUNE HOMEOSTASIS LIMITING MURINE TAUOPATHY.

Walter Jacob1 , Abi Yates2 , Pacific Huynh2 , Andrew Varga 2 , Cameron McAlpine2 .

1 Medical Education, 2 Cardiovascular Research Institute.

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

LIST OF ABSTRACTS

THE EFFECT OF KETOROLAC ON THE OUTCOME OF SELECTIVE LASER TRABECULOPLASTY.

Jason Jo1 , Jeff Huang2 , Samuel Oh2 , Jun Lin2 , Sze Wong2 . 1 Medical Education, 2 Ophthalmology. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

CAN FRAILTY INDICES PREDICT SURGICAL RISK IN OPEN REDUCTION FACIAL FRACTURE REPAIR?

Abigail Katz1 , Peter Taub2 . 1 Medical Education, 2 Surgery. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

A NATIONWIDE STUDY OF HEALTHCARE SERVICES

PROVIDED TO CANCER PATIENTS IN AMBULATORY CARE SETTINGS. Harrison Knowlton1 , Christina Wang2 , Dustin Kee1 , Suzanne Vang3 , Madhu Mazumdar3 , Parul Agarwal3 1 Medical Education, 2 Gastroenterology, 3 Population Health Science and Policy. 1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

IS PRIOR HISTORY OF SPINE SURGERY A CONTRAINDICATION FOR ILIOFEMORAL VEIN STENTING?

Nithya Krishnamurthy1 , Halbert Bai2 , Jason Storch2 , Jenny Chen2 , Annie Chang2 , Keva Li2 , Andrew Min2 , Windsor Ting2 . 1 Medical Education, 2 Surgery. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

EVALUATING SCOLIOSIS AS AN INDEPENDENT RISK FACTOR FOR CRITICAL ILLNESS IN SARS-COV-2.

Colin Lamb1 , Danielle Chaluts2 , Konstantinos Margetis2 . 1 Medical Education, 2 Neurosurgery. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

LIST OF ABSTRACTS

PERSECUTION AND MIGRATION EXPERIENCES OF LGBTQ+ ASYLUM SEEKERS.

Patrick Lasowski1 , Olivia Moscicki1 , Clifford Liu1 , Cecilia Katzenstein1 , Elizabeth Singer2 , Kim Baranowski3 . 1 Medical Education, 2 Emergency Medicine, 3 Psychiatry.

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

THE OMICRON SURGE OUTPACES PREVIOUS SURGES IN POST-COVID HOSPITALIZATION HEALTHCARE USAGE.

Jasmine Leahy1 , Rebecca Bajracharya 2 , Brian Altonen2 , Maria Ferreira-Ortiz3 , Leopolda Silvera3 , Alfred Astua3 1 Medical Education, 2 Public Health, 3 Nursing, 4 Global Health, 5 Pulmonary Critical Care. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4,5 Elmhurst Hospital.

LINGUISTIC PREDICTORS OF RESPONSE TO INTERNET-BASED WRITTEN CBT FOR PTSD IN 9/11 WORLD TRADE CENTER RESPONDERS AND SURVIVORS.

Tomasina Leska1 , Zoe Schreiber2 , Eden Astorino2 , Maya Verghese2 , Saren Seeley2 , Leah Cahn2 , Cindy Aaronson2 , Hannah Brinkman2 , Mary Kowalchyk 2 , Maria Boettche 3 , Christine Knaevelsrud3 , Robert Pietrzak4 , Adriana Feder2 . 1 Medical Education,

2,3,4 Psychiatry. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Free University of Berlin, 4Yale School of Medicine.

DEMOGRAPHICAL AND GEOGRAPHICAL DIFFERENCES IN THE PREVALENCE OF DRY EYE AND ITS ASSOCIATION WITH PSYCHIATRIC COMORBIDITY.

Yuzhe Li1 , Catalina Garzon Vargas2 , Janek Klawe2 , Esen Akpek3 , Sumayya Ahmad2

1 Medical Education, 2,3 Ophthalmology. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Johns Hopkins University.

DOES HUMERAL FIXATION TECHNIQUE AFFECT THE LONG-TERM OUTCOMES OF TOTAL SHOULDER ARTHROPLASTY?

Troy Li1 , Paul Cagle2 1 Medical Education, 2 Orthopaedics.

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

LIST OF ABSTRACTS

67*

UNILATERAL VENOUS STENTING IS ASSOCIATED WITH SIGNIFICANTLY HIGHER ODDS OF MAJOR REOPERATION AFTER ILIAC VEIN STENTING.

Keva Li1 , Halbert Bai2 , Andrew Min2 , Annie Chang2 , Jason Storch2 , Jenny Chen2 , Jinseo Kim3 , Bianca Vama4 , Justin Wang4 , Mikeely Siegel4 , Sachi Lele4 , Windsor Ting2

1 Medical Education, 2,3,4 Surgery. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Boston College, Chestnut Hill, MA, 4 University of Pennsylvania, Philadelphia, PA.

GENETICALLY SUBTYPING CORONARY ARTERY DISEASE USING A NOVEL PATHWAY POLYGENIC RISK SCORE APPROACH.

Lathan Liou1 , Judit Garcia Gonzalez2 , Beatrice Wu2 , Zhe Wang2 , Shing Wan Choi3 , Paul O’Reilly2 1 Medical Education, 2 Genetics and Genomic Sciences, 3 Statistic Genetics. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Regeneron.

*This abstract has been withdrawn from the 2023 collection.

IDENTIFYING A NOVEL JAK1 MUTATION TO CHARACTERIZE A GAIN OF FUNCTION SYNDROME.

Nikhil Maheshwari1 , Dusan Bogunovic2 . 1 Medical Education, 2 Microbiology.

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

THE IMPACT OF AN AMBULATORY SURGERY CENTER ON CANCER DIAGNOSIS AND FOLLOW-UP IN RURAL EASTERN UGANDA.

Chelsia Melendez1 , Katie Glerum2 , Linda Zhang3 1 Medical Education,

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

ASSOCIATION OF MECHANICAL POWER WITH REINTUBATION IN THE CRITICALLY ILL: MACHINE LEARNING OUTPERFORMS LOGISTIC REGRESSION.

Kartikeya Menon1 , Pranai Tandon2 , Hung-Mo Lin3 , Yuxia Ouyang3 , Matthew Levin3 1 Medical Education, 2 Medicine, 3 Anesthesiology.

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

LIST OF ABSTRACTS

MIND MATTERS ECHO: INTEGRATING PRIMARY CARE AND MENTAL HEALTH SERVICES IN NEW YORK CITY.

Rutvij Merchant1 , Anitha Iyer2 . 1 Medical Education, 2 Psychiatry.

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

IMPACT OF SARS-COV2 INFECTION ON PREGNANCY INDUCED HYPERTENSION.

Alexandra Mills1 , Bethany Dubois1 , Corina Lesseur2 , Teresa Janevic2 , Elianna Kaplowitz2 , Rebecca Jessel2 1 Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

HOW THE COVID-19 PANDEMIC CHANGED ONE COHORT OF VASCULAR SURGERY PATIENTS.

Andrew Min1 , Annie Chang2 , Halbert Bai2 , Jason Storch2 , Jenny Chen2 , Keva Li2 , Jinseo Kim2 , Justin Wang2 , Mikeely Siegel2 , Bianca Vama 2 , Sachi Lele2 , Windsor Ting2 .

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

CHARACTERIZING THE HEALTH AND SOCIAL NEEDS OF SETTLEMENT HEALTH CENTER PATIENTS IMPACTED BY INCARCERATION.

Mackenzie Mitchell1 , Clare Idehen2 , Ann-Gel Palermo1 , Joseph Truglio 3 .

1 Medical Education, 2 Pediatrics, 3 Family Medicine and Community Health.

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

LONG COVID AND IBD OUTCOMES IN PATIENTS RECEIVING VEDOLIZUMAB OR INFLIXIMAB BASED ON THEIR CYTOKINE SIGNATURE.

Juan Munoz Eusse1 , Serre-Yu Wong2 1 Medical Education, 2 Gastroenterology.

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

LIST OF ABSTRACTS

GENOMIC COMPARISON OF INVASIVE AND COLONIZING ISOLATES IN PATIENTS HOSPITALIZED WITH METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA.

Devika Nadkarni1 , Bremy Alburquerque2 , Marilyn Chung3 , Adriana van de Guchte 3 , Ana Berbel Caba4 , Erika Reategui Schwarz4 , Mitchell Sullivan3 , Harm van Bakel2 , Deena Altman3 . 1 Medical Education, 2 Genetics and Genomic Sciences, 3 Medicine, 4 Infectious Diseases. 1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, New York.

EMBRYO UTILIZATION IN YOUNG BREAST CANCER PATIENTS WHO HAVE UNDERGONE EGG HARVESTING FOR FERTILITY PRESERVATION.

Daniella Nevid1 , Elisa Port2 , Christina Weltz2 . 1 Medical Education, 2 Breast Surgery. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

IMPACT OF PREFERENCE SIGNALING ON INTERVIEW INVITES DURING THE 2021-2022 DERMATOLOGY RESIDENCY APPLICATION CYCLE.

Danielle Novack1 , Kandice Bailey2 , Fatuma-Ayaan Rinderknecht3 , Scott Worswick4 , Adena Rosenblatt5 , Dana Dunleavy6 , Bobby Naemi6 , Ilana Rosman2 , Ammar Ahmed7. 1,3 Medical Education, 2,4,5,7 Dermatology, 6Admissions. 1 Icahn School of Medicine at Mount Sinai, New York, New York, 2Washington University School of Medicine, St. Louis, MO, 3 University of California San Francisco School of Medicine, San Francisco, CA, 4 University of Southern California, Keck School of Medicine, Los Angeles, CA, 5 University of Chicago Medical Center, Chicago, Il, 6Association of American Medical Colleges, Washington DC, 7 Dell Medical School at the University of Texas at Austin, Austin, TX. 79

ARTIFICIAL INTELLIGENCE-DRIVER AUTOMATED INTRACEREBRAL HEMORRHAGE VOLUME CALCULATION IS MORE ACCURATE THAN ABC/2.

Ian Odland1 , Braxton Schuldt2 , Kayla Liu2 , Dylan Wu2 , Margaret Downes2 , Vikram Vasan2 , Christina Rossitto2 , Trevor Hardigan2 , Christopher Kellner2 . 1 Medical Education, 2 Neurosurgery. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 80

A PROSPECTIVE STUDY UTILIZING PRE-OPERATIVE RESECTABILITY SCORES TO IMPROVE COMPLETE GROSS RESECTION RATES DURING PRIMARY DEBULKING SURGERY FOR ADVANCED OVARIAN CANCER. Kaothar Oladoja1 , Ryan Kahn2 , Dennis Chi2 1 Medical Education, 2 Gynecologic Oncology. 1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Memorial Sloan Kettering Cancer Center.

LIST OF ABSTRACTS

PROFILING T CELL SIGNALING IN IL-17A–PRODUCING GAMMA DELTA T CELLS USING CD3 ZETA MUTANT MICE

Oluomachi Onyekwere1 , Xiaoyan Xu2 , Rachel Caspi2 . 1 Medical Education,

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

2 NIH National Eye Institute.

VALIDATION OF CLINICAL GUIDELINES FOR MILD TRAUMATIC BRAIN INJURY PATIENTS FOR HEAD COMPUTED TOMOGRAPHY IN ACUTE ALCOHOL INTOXICATED PATIENTS.

Gi-Jong Paik1 , Jacques Lara-Reyna 2 , Konstantinos Margetis2 . 1 Medical Education,

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

VARIATIONS IN HOSPITAL IN HOME PROGRAMS IN VETERAN AFFAIRS HEALTH SYSTEM: A NEED FOR STANDARDIZATION?

Sungja Park1 , Emily Franzosa 2 , Akanksha Samant3 , William Hung2 . 1 Medical Education,

2 Geriatrics and Palliative Medicine, 3 Geriatric Research Education and Clinical Center.

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

3 James J Peters VA Medical Center, Bronx, New York.

THE UTILIZATION AND EQUITY OF A COMMUNITY PARAMEDICINE MODEL AMONG HOMEBOUND PATIENTS.

Colby Parsons1 , Christian Escobar2 , Peter Gliatto2 , Katherine Ornstein3

1 Medical Education, 2 Geriatrics and Palliative Medicine, 3 Geriatrics.

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

3 Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, MD.

OUTCOMES OF GLAUCOMA AND OCULAR HYPERTENSION AFTER VITREORETINAL SURGERY WITH SILICONE OIL.

Naeha Pathak1 , Laura Barna 2 , Kateki Vinod2 , Meenakashi Gupta 2 .

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

LIST OF ABSTRACTS

SURVEY AND EEG-BASED PREDICTORS OF EMPLOYMENT GOAL SUCCESS IN ADULTS WITH AUTISM SPECTRUM DISORDER.

Michael Peruggia1 , Jadyn Trayvick 2 , Sarah Barkley2 , Sarah Banker2 , Faris Gulamali2 , Daniela Schiller2 , Jennifer Foss-Feig2 1 Medical Education, 2 Psychiatry.

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

ACUTE SEVERE ULCERATIVE COLITIS IS ASSOCIATED WITH AN INCREASED RISK OF ACUTE POUCHITIS.

Hannah Posner1 , Maia Kayal2 . 1 Medical Education, 2 Medicine.

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

AN EFFICIENT PEDIATRIC AFFECT AND COOPERATION SCALE FOR MASK INDUCTION OF ANESTHESIA: A CLINICAL ASSESSMENT OF HRAD±.

Daniel Qian1 , Romy Yun2 , Thomas Caruso2 . 1 Medical Education, 2 Anesthesiology.

1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Stanford University School of Medicine, Palo Alto, CA.

EQUITABLE DESIGN IN DIGITAL HEALTH: AN OVERVIEW, INCLUDING CHALLENGES AND OPPURTUNITIES.

Nasseef Quasim1 , Deonta Wortham2 . 1 Medical Education, 2 Strategy.

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

EVALUATION OF SKIN AS A PROXY TO ASTHMA.

Grace Rabinowitz1 , Emma Guttman-Yassky2 1 Medical Education, 2 Dermatology.

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

LIST OF ABSTRACTS

EVALUATION OF INTRAOPERATIVE COMPUTER-ASSISTED NAVIGATION WITH PANORAMIC FLUOROSCOPY FUNCTIONALITY FOR IMPLANT POSITIONING IN DIRECT ANTERIOR TOTAL HIP ARTHROPLASTY.

Yi Ren1 , Andrew Jordan2 , Jonathan Spaan2 , Edwin Su2 . 1 Medical Education,

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

2 Hospital for Special Surgery.

EXAMINING THE RECRUITMENT CAPABILITY AND IMPLEMENTATION FIDELITY OF A FINANCIAL WELLNESS INTERVENTION FOR INDIVIDUALS WITH SUICIDAL IDEATION OR BEHAVIOR.

Sharen Rivas1 , Shima Sadaghiyani2 , Oscar Jimenez-Solomon2 .

1 Medical Education, 2 Psychiatry. 1 Icahn School of Medicine at Mount Sinai, New York, New York, 2 New York State Psychiatric Institute, New York, NY.

A NOVEL PORT TO FACILITATE MAGNETIC HYPERTHERMIA THERAPY FOR GLIOMA.

Benjamin Rodriguez1 , Joseph Borrello2 , Benjamin Rapoport2 , Robert Ivkov 3 , Constantinos Hadjipanayis4 1 Medical Education, 2,3,4 Neurosurgery.

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

3 Johns Hopkins Medical Institute, 4 University of Pittsburgh Medical Center.

REGENERATIVE HEALING IN NEONATAL MOUSE INTERVERTEBRAL DISCS ONLY OCCURS BEFORE POSTNATAL DAY 28.

Ashley Rosenberg1 , Danielle D’Erminio2 , James Iatridis2 . Medical Education,

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

IMPROVING UNDERINVESTMENT IN UNDERREPRESENTED FOUNDERS TO ACHIEVE HEALTH EQUITY.

Edward Sarfo1 , Ann-Gel Palermo1 . 1 Medical Education.

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

LIST OF ABSTRACTS

IMMUNOCOMPETENT NEURAL ORGANOIDS RESPOND TO BLOOD STIMULATION: A NOVEL MODEL OF INTRACEREBRAL HEMORRHAGE. Braxton Schuldt1 , James Vicari2 , Connie Lebakken3 , Christopher Kellner2 . 1 Medical Education, 2 Neurosurgery, 3 Operations. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York, 3 Stem Pharm Madison, WI. 97

THAT PART OF BREASTFEEDING I DIDN’T GET FROM ANYONE. I HAD TO LEARN IT ON MY OWN: THE IMPORTANCE OF INFORMATIONAL AND INSTRUMENTAL SOCIAL SUPPORT IN PROMOTING BREASTFEEDING AMONG BLACK MOTHERS.

Lucy Schultz1 , Lina Jandorf2 , Jamilia Sly 3 . 1 Medical Education, 2 Oncological Sciences, 3 Family Medicine and Community Health.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York. 98

ASSESSING FACTORS THAT IMPACT PARENTAL WILLINGNESS TO VACCINATE THEIR CHILDREN AGAINST COVID-19 IN A PRIMARILY IMMIGRANT PATIENT POPULATION IN ELMHURST, QUEENS

Salonee Shah1 , Payal Ram2 , Tsion Tmariam1 , Pilar Gonzalez3 , Jennifer Pintiliano 3 , Sarah Nowlin4 , Teresa Janevic4 , Uday Patil5 , Sheela Maru6 . 1 Medical Education, 2,4 Population Health Science and Policy, 3,4,5 Pediatrics, 6 Obstetrics, Gynecology, and Reproductive Science. 1,4,5,6 Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4 Elmhurst Hospital, Elmhurst, NY.

100

ASSOCIATION BETWEEN METALS AND THYROID CANCER IN PUERTO RICO - A NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY AND ECOLOGICAL STUDY.

Yaelle Shaked1 , Mathilda Alsen2 , Maaike van Gerwen2 1 Medical Education, 2 Otolaryngology. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

QUANTITATIVE ASSESSMENT OF THE EFFICACY OF MENTAL HEALTH TRAINING OF PRIMARY CARE PROFESSIONALS AND PSYCHOLOGISTS IN THE DOMINICAN REPUBLIC.

Myles Solan1 , Gabriela Calcano1 , Xiomara Fernandez2 , Dhruv Gupta3 , Craig Katz3 . 1 Medical Education, 2,3 Psychiatry. 1,3 Icahn School of Medicine at Mount Sinai, New York, New York, 2 INTEP.

LIST OF ABSTRACTS

101

IMMIGRANT VERSUS U.S.-BORN DISPARITIES IN MEDICAID ENROLLMENT FOR PREGNANCY AFTER THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT.

Morgan Steelman1 , Teresa Janevic2 , Ashley Fox3 , Ellerie Weber4 .

1 Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science, 3 Rockefeller College of Public Affairs and Policy, 4 Population Health Science and Policy. 1,2,4 Icahn School of Medicine at Mount Sinai, New York, New York, 3 University at Albany, SUNY.

INVESTIGATION OF THE EFFECTS OF ER STRESS ON MITOCHONDRIAL BIOENERGETICS IN FUCHS ENDOTHELIAL CORNEAL DYSTROPHY.

102

William Steidl1 , Saba Qureshi2 , Stephanie Lee2 , Michael Parise2 , Varun Kumar2 .

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

103

OUTCOMES FOR SALVAGE ABDOMINAL STEREOTACTIC BODY RADIATION THERAPY FOR HEPATOCELLULAR CARCINOMA AFTER LIVER TRANSPLANTATION.

Christian Stephens1 , Julie Bloom2 , Eric Lehrer2 , Ren-Dih Sheu2 , Michael Buckstein2 .

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

ASSESSING IMPACT OF SOCIOECONOMIC STATUS ON LACERATION RISK IN FORCEPS-ASSISTED VAGINAL DELIVERIES.

104

Catherine Stratis1 , Elizabeth Cochrane2 , Tahera Doctor2 , Kelly Wang2 , Chelsea DeBolt2 , Angela Bianco2 1 Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

COMPUTATIONAL DESIGN OF CUSTOM THERAPEUTIC CELLS TO CORRECT FAILING HUMAN CARDIOMYOCYTES.

105

Andrew Tieu1 , Joshua Mayourian2 , Katherine Phillips 3 , Kevin Costa4

1 Medical Education 2 Pediatrics, 3 Cardiovascular Surgery, 4 Cardiovascular Research Institute. 1,4 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Boston Children’s Hospital, Boston, MA Harvard Medical School, Boston, MA Boston University, Boston, MA Boston Medical Center, Boston, MA, 3 NYU Langone Health, New York, NY.

LIST OF ABSTRACTS

THE ASSOCIATION BETWEEN UTILIZATION OF COMMUNITY BASED ORGANIZATIONS AND MOTHERS’ WILLINGNESS TO VACCINATE CHILDREN AGAINST COVID-19.

Tsion Tmariam1 , Payal Ram2 , Salonee Shah1 , Pilar Gonzalez3 , Jennifer Pintiliano 3 , Sarah Nowlin4 , Teresa Janevic4 , Uday Patil3 , Sheela Maru 5 . 1 Medical Education, 2 Global Health and Health System Design, 3 Pediatrics, 4 Population Health Science and Policy,

5 Obstetrics, Gynecology, and Reproductive Science. 1,2,4,5 Icahn School of Medicine at Mount Sinai, New York, New York, 3 NYC Health and Hospitals-Elmhurst.

TWO-CENTER STUDY OF A VIRTUAL, SIMULATION-BASED LAPAROSCOPIC TRAINING CURRICULUM IN MEXICO.

107

Rachel Todd1 , Linda Zhang2 . 1 Medical Education, 2 Surgery.

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

ASSOCIATION OF BLOOD PRESSURE WITH NEUROLOGIC OUTCOME AFTER PEDIATRIC CARDIAC ARREST.

108

Adam Ushpol1 , Sangmo Je2 , Dana Niles2 , Tanmay Majmudar3 , Matthew Kirschen2 , Jimena del Castillo4 , Corinne Buysse5 , Alexis Topjian2 , Vinay Nadkarni2 , Sandeep Gangadharan6 1,3 Medical Education, 2,4,5,6 Pediatrics, 1,6 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Children’s Hospital of Philadelphia, 3 Drexel University College of Medicine, 4 Gregorio Marañón General University Hospital, 5 Sophia Children’s Hospital. 109

COMPUTATIONAL SCREEN FOR IMMUNOTHERAPEUTIC TARGETS FOR ENDOMETRIAL CARCINOMA.

Vivian Utti1 , Avi Ma’ayan2 . 1 Medical Education 2 Pharmacology and Systems

Therapeutics. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 110

RISK FACTORS IN PITUITARY SURGERY AMONGST OCTOGENARIANS: A COMPARATIVE STUDY WITH YOUNGER PATIENTS UNDERGOING PITUITARY SURGERY.

Vikram Vasan1 , Jonathan Dullea 2 , Alex Devarajan2 , Muhammad Ali2 , Varun Subramaniam2 , Joshua Bederson2 , Katelyn Ferreira3 , Melissa Aldridge 3 , Rainier Soriano 3 , Raj Shrivastava 2 1 Medical Education 2 Neurosurgery, 3 Geriatrics and Palliative Medicine. 1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York.

106

LIST OF ABSTRACTS

111

HOME CARE CLINICIANS’ PERSPECTIVES ON ADVANCE CARE PLANNING FOR OLDER PATIENTS WHO ARE INCAPACITATED WITH NO EVIDENT ADVANCE DIRECTIVES OR SURROGATES.

Chinmayi Venkatram1 , Aviv Y. Landau2 , Bevin Cohen3 1 Medical Education 2 Social Policy and Practice, 3 Geriatrics and Palliative Medicine. 1,3 Icahn School of Medicine at Mount Sinai, New York, New York, 2 University of Pennsylvania, Philadelphia, Pennsylvania.

RISK FACTORS FOR FREE FLAP COMPLICATIONS FOR HEAD AND NECK CANCER DEFECTS IN THE ELDERLY.

112

Hannah Verma1 , Mingyang Gray2 1 Medical Education 2 Otolaryngology. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

113

“THEY NEVER THOUGHT THEY WOULD BE HERE”: A QUALITATIVE STUDY OF HIV CLINIC PROVIDERS’ FRAMEWORKS FOR THE RELATIONSHIP BETWEEN HIV AND AGING.

Madeline Villalba1 , Abigail Baim-Lance2 . 1 Medical Education, 2 Geriatrics and Palliative Medicine. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 114

RACIAL DISPARITIES IN TREATMENT PRESENTATION, MODALITY, AND COMPLICATION IN OLDER ADULTS WITH OROPHARYNGEAL SQUAMOUS CELL CARCINOMA.

Dragan Vujovic1 , Daniel Dickstein2 , Yingtong Chen3 , Richard Bakst2 . 1 Medical Education 2 Radiation Oncology, 3 Geriatrics and Palliative Medicine. 1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York. 115

RELATIONSHIPS BETWEEN BODY COMPOSITION, ANTHROPOMETRICS, AND STANDARD LIPID PANELS IN A NORMATIVE POPULATION.

Marcus Weeks1 , Andrew Delgado2 , David Putrino2 . 1 Medical Education, 2 Rehabilitation Medicine. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York.

LIST OF ABSTRACTS

IN-VIVO COMPOUND SCREEN USING DROSOPHILA MELANOGASTER TO EXAMINE POTENTIAL THERAPEUTICS FOR NOONAN SYNDROME CAUSED BY PTPN11 VARIANT Q510P.

Orli Weiss1 , Tirtha Das2 , Sereene Kurzum2 , Bruce Gelb2

1 Medical Education, 2 Genetics and Genomic Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 117

CLINICAL AND MOLECULAR ASSOCIATIONS OF DEBULKING STATUS AND PATIENT OUTCOMES IN OVARIAN CANCER.

Catherine Wu1 , Katherine Reid2 , Maria Padron Rhenals2 , Peter Dottino 3 .

1 Medical Education, 2 Genetics and Genomic Sciences,

3 Obstetrics, Gynecology, and Reproductive Science.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, New York. 118

MULTIVARIATE ANALYSIS OF DEMOGRAPHIC AND EMS SITUATION FACTORS ON NEMSQA TRAUMA QUALITY MEASURES

Sai Kaushik Yeturu1 , David Buckler2 , Michael Redlener2 . 1 Medical Education

2 Emergency Medicine. 1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 119

CAN XLNET BE USED TO GENERATE CPT CODES FROM SPINE SURGICAL OPERATIVE NOTES?

Bashar Zaidat1 , Jun Kim2 1 Medical Education, 2 Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, New York. 120

EVALUATING THE SAFETY, FEASIBILITY, AND EFFICACY OF INTRACRANIAL CONVECTION-ENHANCED DELIVERY OF LAPONITE MAGNETIC IRON-OXIDE NANOPARTICLES FOR THE POTENTIAL TREATMENT OF GLIOBLASTOMA.

Jack Zhang1 , Wilbert Mays2 , Daniel Rivera1 , Maria Anastasiadou3 , Alexandros Bouras 3 , Tori Chanenchunk3 , Constantinos Hadjipanayis 3 . 1 Medical Education, 3 Neurosurgery.

1,3 Icahn School of Medicine at Mount Sinai, New York, New York, 2 Oakwood University, Huntsville, AL.

KNOWLEDGE OF EPINEPHRINE AUTO-INJECTOR USE AMONG FAMILIES OF PEDIATRIC FOOD ALLERGY PATIENTS.

121

Evelyn Zhang1 , Amanda Agyemang2 1 Medical Education, 2 Pediatrics.

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

116

SECTION 2: Abstracts

ABSTRACT 1

SOCIODEMOGRAPHIC AND BEHAVIORAL PREDICTORS OF DEPRESSION PREVALENCE IN NORTHERN GHANA.

Dorothy Adu-Amankwah1 , Masih Babagoli1, Raymond Aborigo2, Engelbert Nonterah3, Irene Kuwolamo4, Khadija Jones5, David Heller6. 1Medical Education, 2Social Sciences, 3Clinical Science, 4Social Sciences, 5Global Health, 6Medicine. 1,5,6Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4Navrongo Research Health Centre, Navrongo, Ghana.

BACKGROUND: Depression, one of the leading causes of morbidity worldwide, is increasingly common in Sub-Saharan Africa. Studies demonstrate that multiple socio-demographic factors may be predictive of depression, but such evidence is scarce in northern Ghana.

OBJECTIVE: To investigate the prevalence of depression and its socio-demographic and behavioral correlates in northern Ghana.

METHODS: We collected cross-sectional data on participants aged 35-70 years (n=342) recruited through COMBINE, a pilot study aiming to study, treat, and prevent hypertension and depression in northern Ghana. Socio-demographic factors, including age, sex, occupation, education, religion, ethnicity, and area of residence were collected during the screening interviews, as well as usage of tobacco and alcohol and level of physical activity. We defined depression as a score of ≥ 5 on the Physician Health Questionnaire-9 (PHQ-9). Associations between sociodemographic/behavioral factors and depression prevalence were assessed using bivariate analysis and hierarchical multivariable logistic regression models.0

RESULTS: The overall prevalence of depression was 17.5% [95% CI 13.4-21.6%]. Prevalence was non-uniform across the four communities under study: Mirigu, 6.8% [95% CI 2.4-11.1%]; Navio, 27.8% [95% CI 15.4-40.1%]; Wuru, 56.9% [95% CI 42.8-70.9%]; Yua, 6.1% [95% CI 1.3-10.8%]. In multivariate analysis adjusting only for sociodemographic factors, odds of depression were highest in Navio (OR 4.80 [95% CI 1.88, 12.82] and Wuru (OR 19.09 [95% Cl 7.86, 50.60]. Additional adjustment with behavioral predictors further increased the odds of depression in both communities: Navio (OR 6.38 [95% CI 2.13, 19.74]; Wuru (OR 25.27 [95% CI 8.90, 77.76]. Although not significant, depression prevalence was higher among individuals who identified as Muslim when demographic and behavioral factors were included in multivariate analysis.

CONCLUSION: Depression is common throughout this region, with prevalence significantly greater in the relatively urban Wuru and Navio communities, but no other sociodemographic or behavioral factors significantly correlating with depression risk. Our findings align with prior data suggesting urbanization may increase odds of depression. As the global prevalence of depression increases, local surveillance data will be essential to guiding the primary care response to depression in underserved regions such as northern Ghana.

IMPACTS OF THE COVID-19 PANDEMIC ON SKIN CANCER SURGERIES.

Aneesh Agarwal1 , Shayan Owji2, Benjamin Ungar2, Nicholas Gulati2, Jonathan Ungar2 1Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: 20% of Americans will have skin cancer by age 70, and skin cancer has an 8% prevalence among geriatric populations. During the March 2020 COVID-19 pandemic peak, skin cancer biopsies and diagnoses were down up to 85%.

OBJECTIVE: To evaluate differences between pre- and post-COVID-19 cases of skin cancer at a large academic medical center to understand potential implications for providers and patients during COVID-19 spikes or other public health emergencies.

METHODS: Single center, comparative cross-sectional retrospective study (3/2019–2/2021) of patients (N=549) undergoing surgery: all encountered melanoma cases (94) and a random sample of 238 basal cell carcinomas (BCC) and 217 squamous cell carcinomas (SCC) at the Mount Sinai Department of Dermatology. By cancer type, cases were split into pre-pandemic (3/2019-2/2021) and post-pandemic start (3/11/20202/2021) groups. From medical record review, we collected lesion size, melanoma staging/depth, closure dimensions, zip code, age, biopsy/surgery dates, biopsy/surgery locations, and total departmental case volumes.

PRELIMINARY RESULTS: Average age at surgery was 67.58. Lesion and surgery closure sizes, and melanoma stage/depth, were the same in both periods. Biopsy to treatment time increased among SCC (+4.82 days, +7.87%) and BCC (+26.14 days, +34.40%, p<0.05) but decreased for melanoma (-9.80 days, -24.81%). Surgery stages increased for BCC by 0.21 (13.01%, p<0.05) and SCC by 0.15 (9.15%). SCC surgery volume decreased to 1 in 04/2020 and 5 in 05/2020; BCC volumes similarly declined to 9 and 13, representing decreases of over 74% from the respective average monthly cases prior; melanomas were not seen in 05/2020. BCC surgery delays and higher stages of surgery suggest potentially poorer wound healing or recovery. Overall cases were not more serious due to similar lesion characteristics in both pre- and postperiods, suggesting similar clinical outcomes. The more rapid treatment of melanomas, though not significant at the current level, may be a product of elective procedure postponement; impacts of treatment expediency on outcomes should be explored further. Case volume decreases in the immediate periods following public health crises may indicate a need for greater vigilance among at-risk groups, including geriatric populations, to ensure that cases are diagnosed, followed-up on, and treated, as well as backlogs cleared.

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MITOCHONDRIAL DYSFUNCTION IN STEADY STATE SICKLE CELL DISEASE (SCD) CHARACTERIZED BY FLAVOPROTEIN FLUORESCENCE (FPF) IN THE RETINA.

Sofia Ahsanuddin1 , Hernan Rios2, Jordan Bellis3, Luis Duran2, Maxime Centeno4, Jeffrey Glassberg4, Richard Rosen2. 1Medical Education, 2Ophthalmology, 3Oncological Sciences, 4Emergency Medicine.

1,3,4Icahn School of Medicine at Mount Sinai, New York, New York, 2New York Eye and Ear Infirmary of Mount Sinai, New York, NY.

BACKGROUND: Oxidative stress is implicated in the pathophysiology of sickle cell disease (SCD). Chronic hemolysis and platelet activation are correlated with decreased platelet mitochondrial complex V activity, resulting in low nitric oxide bioavailability and increased oxidant production. In SCD, the precise role of mitochondrial dysfunction in facilitating retinal oxidative stress is unknown. Prior studies have shown that retinal mitochondrial flavoproteins emit a green fluorescence (520-540 nm) when exposed to blue light (450-470 nm). The emission signal, termed flavoprotein fluorescence (FPF), is a quantifiable marker of in vivo mitochondrial dysfunction.

OBJECTIVE: FPF can be utilized as a noninvasive indicator of retinal oxidative stress in SCD.

METHODS: 25 eyes from 25 SCD (steady state 18 hemoglobin-SS, 7 hemoglobin-SC) patients and 21 eyes from 21 unaffected age-matched controls (hemoglobin-AA) were included in the present cross-sectional study. During each imaging session, the macula was imaged with the OcuMet Beacon, a fundus camera equipped with 467 nm excitation and 535 nm emission filters (OcuSciences, Ann Arbor, MI). The depth of focus enables capture of FPF from all retinal layers in a rectangular 17° x 21° region of interest centered at the fovea. Statistical tests were performed to determine differences in FPF between subjects stratified by genotype. Spearman rank correlation coefficients were used to determine if FPF is associated with clinical markers of hemolysis.

RESULTS: Mean (±SD) FPF values for SCD subjects and controls were 39.1±12.6 and 29.3±5.5, respectively. Mean (±SD) FPF values for HbSS and HbSC genotypes were 40.3±13.9 and 35.8±8.4, respectively. FPF in SCD subjects was significantly elevated compared to those in controls (Mann-Whitney U Test, p = 0.018). SCD subjects with the HbSS genotype displayed significantly elevated FPF compared to controls (Kruskal Wallis Test, p = 0.032). FPF was not significantly elevated in HbSC subjects (Kruskal Wallis Test, p = 0.448). There was a moderate correlation between FPF and urine microalbuminuria (ρ=0.437, p=0.033) and FPF and pro-BNP (ρ=0.524, p=0.009).

CONCLUSION: These preliminary findings indicate that SCD patients with the HbSS genotype display significantly elevated FPF compared to controls and patients with the HbSC genotype. This suggests that FPF can serve as a functional index of systemic disease severity. FPF can be correlated with clinical markers of hemolysis.

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PASS STUDY: RELATIONSHIP OF FOOD INSECURITY AND PARENTAL STRESS IN FAMILIES SCREENED FOR SDH AT A PEDIATRIC CLINIC IN EAST HARLEM, NYC.

1Medical Education, 2Population Health Science and Policy, 3Environmental Medicine and Public Health, 4Biology, 5Pediatrics. 1,2,3,5Icahn School of Medicine at Mount Sinai, New York, New York, 4Barnard College, New York, NY.

BACKGROUND: Food insecurity (FI) is frequently detected at Pediatric Associates, an outpatient pediatric practice in East Harlem. Our established Social Determinants of Health (SDH) screening program and onsite pantry provides families with immediate assistance via an emergency food package and referrals to community resources such as the New York Common Pantry (NYCP) for longitudinal services. As FI has been associated with increased mental health concerns, we sought to investigate a relationship between FI and parental stress (PS) to help drive potential interventions.

OBJECTIVE: To assess the relationship between PS and FI over time of participation in the program.

METHODS: Caregivers were screened for SDH over the phone prior to their children’s appointments, and families that screened positive for FI using the 2 question Hunger Vital Signs tool received an emergency food package and were offered a referral to NCYP. Enrolled caregivers completed baseline, 3-month and 12-month surveys that assessed demographics, level of food insecurity using the 18-item USDA Household Food Security Survey and parental stress as measured by the Perceived Stress Scale 4 (PSS-4). The PSS-4 is a validated 4-question scale with a range of 0-4 points for each question with higher scores reflective of higher levels of stress. A mixed-effects model adjusted for child’s race, insurance, housing assistance, caregiver education, and employment was used to explore an association between FI and PS over time.

RESULTS: 113 caregivers enrolled in the study, 61 have completed a 3-month follow-up, and 32 have completed a 12-month follow-up. At baseline, the average FI score was 4.4 (SD 3.6). The average PSS-4 scores at baseline, 3 months and 12 months were 6 (2.8), 6.6 (2.8) and 6.2 (2.8). A mixed-effects model that considered the interaction of FI by follow-up time along with child race, housing assistance, insurance, guardian education and employment showed a significant relationship between PS and FI overall (p = 0.03).

CONCLUSION: Our analysis found that decreased FI was associated with decreased PS after 12 months of participation. Taking this into consideration, interventions that decrease FI could have an impact on PS and may inform parent-directed mental health interventions. The impact of the on-site pantry and referral to NYCP on FI and PS will be further analyzed once complete 12-month data is available to see if the association between FI and PS persists.

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DOES PATIENTS’ PRIMARY SPOKEN LANGUAGE MAKE A DIFFERENCE IN REPORTED PAIN SCORES AFTER TOTAL HIP OR KNEE REPLACEMENT SURGERY?

Diego Arevalo1 , Nicole Zubizarreta2, Brett Hayden3, Darwin Chen3, Samuel DeMaria4, Calin Moucha3, Jashvant Poeran2. 1Medical Education, 2Population Health Science and Policy, 3Orthopaedics, 4Anesthesiology. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Race- and ethnicity-based differences in postoperative pain scores and pain management have been well described. Far less data exists on the impact of patients’ primary spoken language on reported pain scores.

OBJECTIVE: To investigate if there is a difference in 1) the magnitude, 2) frequency of assessment and 3) timing of pain scores between patients who do not speak English as a primary language and those who do, among total joint arthroplasty patients.

METHODS: This retrospective institutional cohort study utilized data from patients who underwent joint arthroplasty surgery from 2017 to 2021 at a large academic urban health system. Post-operative pain scores (measured at 3, 6, 12, and 24 hours after surgery) and patients’ primary spoken language (English, nonEnglish) were extracted. Pain scores, frequency and timing of assessment were described by primary spoken language. Generalized linear models were subsequently fitted.

RESULTS: Overall, 6028 and 1166 patients had English and non-English as primary spoken language, respectively. Patients with a primary spoken language other than English (compared to English) reported lower average pain scores at 6, 12 and 24 after surgery (4.44 versus 4.74 / 4.62 versus 5.08 / 4.37 versus 4.75; all p<0.05), had fewer assessments of pain scores in the 24 hours following surgery (7.45 versus 8.56; p<0.001) and had their first pain score assessment at a later time point after surgery (5.92 versus 5.39 hours; p=0.07). These findings were also reflected in our adjusted models.

CONCLUSION: These findings point towards an understudied determinant of potential disparities in postoperative pain assessments -patients’ primary spoken language- which could have important implications on subsequent differences in pain management strategies.

SOCIO-DEMOGRAPHIC AND BEHAVIORAL FACTORS ASSOCIATED

WITH HYPERTENSION PREVALENCE IN FOUR RURAL COMMUNITIES IN NORTHERN GHANA. Masih Babagoli1 , Dorothy Adu-Amankwah1, Engelbert Nonterah2, Raymond Aborigo3, Irene Kuwolamo3, Khadija Jones4, David Heller5. 1Medical Education, 2Clinical Sciences,3Social Sciences, 4Global Health, 5Medicine. 1,4,5Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4Navrongo Health Research Centre, Navrongo, Ghana.

BACKGROUND: Hypertension is associated with more deaths globally than any other health risk factor. Its burden has shifted to low- and middle-income countries in a global nutritional and epidemiological transition. A paucity of evidence regarding the hypertension distribution across different socio-demographic groups limits the design of targeted interventions to focus on vulnerable groups with hypertension.

OBJECTIVE: To analyze the socio-demographic and behavioral factors associated with hypertension prevalence in rural northern Ghana.

METHODS: This analysis was based on screening data for the COMBINE study, a pilot study that seeks to train community health officers and volunteers to provide hypertension and depression care at a community level in northern Ghana. Eligible individuals (35-70 years old) were screened for hypertension during household visits, which also collected socio-demographic and behavioral information. We defined a participant as having hypertension if he/she had an average systolic blood pressure >=140mmHg and/ or diastolic blood pressure >=90mmHg on two separate days. Socio-demographic factors included in this analysis were age, sex, occupation, education level, religion, ethnicity, and community; behavioral factors were tobacco use, alcohol use, and physical activity. We used bivariate and hierarchical multivariable logistic regression models to analyze the relationship between socio-demographic/behavioral factors and hypertension prevalence. Data from 342 individuals was used in the final analysis.

RESULTS: Overall prevalence of hypertension was 11.4% [95% CI 7.9-14.9%] and non-uniform across the four communities – Wuru 20.4%, Navio 11.5%, Yua 9.5%, and Mirigu 9.3%. Across socio-demographic characteristics, hypertension was more prevalent among individuals who were older (51-70 years old) and those who reported alcohol use. In multivariable models adjusted for all socio-demographic and behavioral variables, older age (OR 2.32 [95% CI 1.04, 5.40]) and residence in Wuru (OR 5.13 [95% CI 1.51, 17.25]) were associated with higher odds of having hypertension.

CONCLUSION: Hypertension in northern Ghana is more concentrated in older individuals but similarly affects individuals across all sexes, occupations, and other socio-demographic strata. The high prevalence in specific communities warrants further investigation into dietary habits, environmental exposures, and other possible causes that can account for this trend.

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SEVERE PREOPERATIVE VENOUS CLINICAL SEVERITY SCORES ARE NOT ASSOCIATED WITH HIGHER ODDS OF MAJOR REOPERATIONS. Halbert Bai1 , Jason Storch2, Andrew Min2, Jenny Chen2, Annie Chang2, Keva Li2, Jinseo Kim2, Bianca Vama2, Justin Wang2, Mikeely Siegel2, Sachi Lele2, Windsor Ting2. 1Medical Education, Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Venous Clinical Severity Score (VCSS) was devised to measure the severity of venous disease and quantify changes with treatment. There has been no large-scale study to date that examines whether preoperative VCSS scores could be used to predict long-term outcomes.

OBJECTIVE: To determine whether preoperative VCSS composite scores are a useful marker for predicting the likelihood of having a major reoperation.

METHODS: A single institution registry of 873 patients who underwent iliac vein stent placement for chronic proximal venous outflow obstruction from August 2011 to June 2021 was retrospectively analyzed. Symptoms were quantified using VCSS and the primary outcome was major reoperation defined as balloon angioplasty and stenting. Two groups of patients were followed for up to five years after initial vein stent placement. VCSS is comprised of 10 components scored from 0 to 3. Group 1 had VCSS composite scores < 15, and Group 2 had VCSS composite scores ≥ 15. Multivariate logistic regression was employed to determine the odds of major reoperation and controlled for the confounders of age, gender, race/ethnicity, BMI, and history of DVT. Reintervention-free survival was assessed using Kaplan-Meier analysis.

RESULTS: Those with higher VCSS composite scores were more likely to be male (54.1% vs. 42.4%; P=0.031), overweight (27.5 vs. 26.2; P=0.027) and have a history of deep vein thrombosis (26.5% vs. 13.5%; P=0.027). A higher VCSS score was not associated with a higher number of major reoperations (18.7% vs. 14.4%; P=0.362). Even after controlling for covariates, there remained no difference in the odds of major reoperation between those with and without a higher VCSS composite score (odds ratio [OR] = 0.97, 95% confidence interval [CI] = [0.48-1.84]). Additionally, there was also no difference in any reintervention-free survival (P = 0.600).

CONCLUSION: Despite its widespread use, VCSS composite scores are a poor prognosticator of long-term rates of major reoperation and is a major limitation of VCSS.

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PREDICTORS OF REINTERVENTION AFTER ILIOFEMORAL VEIN STENTING.

Halbert Bai1 , Jason Storch2, Annie Chang2, Andrew Min2, Jenny Chen2, Keva Li2, Jinseo Kim2, Bianca Vama2, Justin Wang2, Mikeely Siegel2, Sachi Lele2, Windsor Ting2 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Ten components comprise the Venous Clinical Severity Score (VCSS), a tool often used t o quantify the severity of venous disease. While each component contributes equally to the composite score, each individual component, in practice, contributes to the patient’s prognosis to varying degrees.

OBJECTIVE: This study sought to identify the most salient preoperative VCSS components that predict the likelihood of major reoperation.

METHODS: A clinical registry of 873 patients who underwent iliofemoral vein stenting for chronic proximal venous outflow obstruction (PVOO) from August 2011 to June 2021 was retrospectively analyzed. Symptoms were quantified using VCSS and major reoperation was defined as percutaneous transluminal angioplasty (PTA) and stenting. Multivariate linear regression was used to determine the most salient predictors among the ten components of VCSS for major reintervention. To enable comparison of the predictors, coefficients in the regression were standardized around a variance of 1. Standardized regression coefficients ( ) represent how many standard deviations the dependent variable would change with a one standard deviation increase in the value of the predictor variable. Multivariate logistic regression was also used to determine which of the components was most predictive, controlling for all other VCSS components.

RESULTS: Multivariate linear regression revealed that preoperative VCSS pain ( =0.09; P=0.013), varicose veins ( =-0.20; P<0.001), and pigmentation ( =0.09; P=0.042) were the most significant predictors of major reoperation. Multivariate logistic regression also showed that VCSS pain (odds ratio [OR] = 1.37, 95% confidence interval [CI] = [1.08-1.77]), varicose veins (OR = 0.57, 95% CI = 0.46-0.71), and pigmentation (OR = 1.37, 95% CI = 1.01-1.86) were significantly associated with major reoperation. All seven other components of the VCSS were non-significant predictors of major reintervention.

CONCLUSION: Only three of the ten components of VCSS were significantly associated with major reoperation, including VCSS pain, varicose veins, and pigmentation. VCSS pain and pigmentation were directly associated with major reoperation, whereas severity of varicose veins was inversely associated with major reoperation.

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DAILY VS TWICE DAILY DOSING OF NIFEDIPINE FOR BLOOD PRESSURE CONTROL IN PREGNANCY AND POSTPARTUM.

Isabelle Band1 , Jessica Peterson2, Kelly Wang2, Angela Bianco2 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) may be managed with oral anti-hypertensives, however pregnancy-induced changes in the hormonal milieu and volume of distribution make it difficult to determine optimal dosing regimens. Nifedipine is a first line therapy for treatment of HDP.

OBJECTIVE: To compare 60mg daily (QD) of extended released (XR) nifedipine to 30mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum.

METHODS: This was a retrospective chart review conducted at the Mount Sinai Health System. Patients admitted from 1/1/2015-4/30/2021, who were diagnosed with a HDP and received nifedipine XR 30 mg BID or 60mg QD for intrapartum or postpartum BP control were included. The primary outcome was need for dose adjustment of nifedipine or addition of another anti-hypertensive agent. Patients were excluded if they had preexisting renal disease or were already taking oral anti-hypertensives.

RESULTS: 237 patients were included, 139 (59%) received 30 mg BID and 98 (41%) 60 mg QD. There was no statistically significant difference in the percentage of patients who needed an increase in nifedipine dose or addition of another oral anti-hypertensive between those receiving 30 mg BID versus 60 mg QD (33.8% vs 35.7%; aOR (95% CI): 0.90 (0.50, 1.60); p=0.71). Additionally, there was no difference in need for emergency hypertensive treatment after reaching study dose (p=0.19) or readmission for BP control between the two groups (p>0.99).

CONCLUSION: These findings suggest that BID vs QD dosing of nifedipine XR does not improve blood pressure control in the antepartum or postpartum periods, thus daily dosing is reasonable and may be preferable for patient convenience and compliance.

ANTIPSYCHOTIC USE AND COVID INFECTION RISK.

Sewit Bereket1 , Rachel Litke2, Tonia Ogundipe1, Charles Mobbs2 1Medical Education, 2Neuroscience. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Currently, in vitro studies show phenothiazines (a class of antipsychotic drugs) have antiviral and anti-inflammatory properties lending support to the idea that they may be protective against COVID infection. However, existing epidemiological research shows conflicting results but does not study the ‘class’ effect of ‘all antipsychotics’, therefore there is a need to evaluate this association of specific classes of antipsychotics on incidence and severity of covid.

OBJECTIVE: To investigate this further, we have developed this study, wherein we hypothesize that schizophrenic patients living in a residential facility, receiving antipsychotic medications such as phenothiazines or tricyclic antipsychotics, are less likely to test positive for COVID.

METHODS: We conducted an observational retrospective study using de-identified data of patient records from 3 shelters in New York City. We conducted a chi-square contingency analysis with phenothiazine or tricyclic antipsychotic use as the exposure and COVID-19 infection (positive diagnosis via PCR or serology) as the outcome of interest. We also collected data on age, sex, BMI, tobacco use, medical history and antipsychotic medication use.

RESULTS: Our sample consisted of 192 patients, mean age 64 years, 63% male, 27% female, 50% current smokers, 39% BMI >/= 30. 17% of patients used only phenothiazines, 52% used tricyclic antipsychotics (a broader class including phenothiazines). 85% had received a 2-dose COVID vaccine series, and 3% of patients tested positive for COVID. 1 patient died during the study period and was excluded. Based on chisquare analysis, there was no significant difference between patients on phenothiazines and COVID infection (p=0.9772). Similarly, there was no significant difference between patients on tricyclic antipsychotics and COVID infection (p= 0.9697).

CONCLUSION: We learned that the proportion of the sample who tested positive for COVID was much lower than that of the general NYC population. However, we did not identify any differences in COVID infections between our patients on antipsychotic medications. Other protective factors could explain these unexpected results. For example, social distancing was a key strategy to mitigate infection risk during the pandemic and patients with schizophrenia are characteristically more inclined to socially isolate themselves which may have been protective and led to fewer infections.

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CLIMATE CHANGE AND MEDICAL EDUCATION: UNDERSTANDING NATIONWIDE CURRICULAR EFFORTS.

Olivia Blanchard1 , Lucy Greenwald1, Perry Sheffield2 1Medical Education, 2Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Despite increased awareness of the public and global health ramifications of climate change, there is a lack of curriculum discussing climate change within medical education. In response, calls have gone out from organizations such as the American Medical Association and the National Academy of Sciences for physicians and medical students to develop a knowledge of climate change’s medical relevance. Where greater societal awareness and improved scientific understanding have begun to grab the attention of members of the medical education community, there is the precedent, the desire, and the need to incorporate climate change-related health (CCRH) into medical education.

METHODS: We conducted a literature review to identify existing curricular efforts, potential interviewee candidates, and professional societies that could be leveraged to support CCRH curriculum development. We hosted semi-structured interviews (n=9) with faculty members at different institutions across the country who have been involved with climate change education. We pursued a qualitative approach to identify a set of consistent challenges in CCRH implementation and begin an inter-institutional conversation on how we can support our colleagues and peers in expanding climate change-related health education.

DISCUSSION: From our series of interviews with faculty members around the country involved in medical education efforts, we developed a stronger understanding of some of the key challenges in teaching medical students about the global health crisis that is climate change: Obtaining Institutional Resources, Formalizing Initiative Leadership, and Empowering Faculty Involvement. We also began to appreciate the creative strategies that programs across the country have employed to tackle these challenges. Working with interested students, developing funded faculty positions, and creatively integrating curricular materials are just a few of the approaches that have helped CCRH initiatives to succeed. A better identification of the challenges and drivers for success in curricular efforts can provide a roadmap to more efficient implementation of CCRH topics within medical education.

IMPACTFUL LIFE EVENTS, POST-TRAUMATIC STRESS, AND RESILIENCE PROMOTING BEHAVIORS

IN JAPANESE MEDICAL STUDENTS AT FUKUSHIMA MEDICAL UNIVERSITY. Anna Blech1 , Hideki Sato2, Satoshi Waguri2, Masaharu Maeda2, Craig Katz3, Robert Yanagisawa4 1Medical Education, 2Disaster Psychiatry, 3Psychiatry, 4Medicine. 1,3,4Icahn School of Medicine at Mount Sinai, New York, New York, 2Fukushima Medical University Fukushima, Japan.

BACKGROUND: 40,000 people in Japan remain displaced due to the 2011 earthquake and tsunami. Fukushima Medical University was located at the center of that disaster.

OBJECTIVE: To identify strategies used by medical students to cope with traumatic experiences, both personal and collective, and to learn about the effects of living through different kinds of traumatic events on post-traumatic growth and resilience.

METHODS: The surveys were sent via email to all 799 FMU medical students. They completed multiplechoice surveys via Google Forms about the most stressful event they had experienced, with validated instruments including the PHQ-4, PCL4, PTGI-SF, DTS, CDRS, and RBS. Students could also volunteer to participate in qualitative interviews.

RESULTS: Of the 94 FMU students who responded, 40 (42.6%) listed Fukushima as their hometown and 10 (10.6%) listed 3/11 as their most stressful life event. Other common most stressful life events listed by students included school/academic problems (26.6%), COVID-19 (13.8%), relationship problems (9.6%), and friendship problems (9.6%). Results were analyzed using t-tests, ANOVA, and Pearson correlations. Compared to students with other most stressful events, students who listed 3/11 reported significantly lower levels of post-traumatic stress, including feelings of anger and guilt, difficulty sleeping, changing in appetite, problems concentrating, and refusing sympathy. Students who listed 3/11 as their most stressful life event also reported significantly higher levels of certain measures of post-traumatic growth (appreciation for life, ability to face life and death, and sense of how wonderful people are) and resilience behaviors (facing fear with the support of family). Students who selected 3/11 as their most stressful events were also more likely to report wanting to help with the event they experienced, feeling safe at home, and feeling safe at work/school. By contrast, students who listed relationship problems or friendship problems as their most stressful events reported the highest levels of post-traumatic stress.

CONCLUSION: Students who reported 3/11 as their most traumatic event experienced significantly fewer post-traumatic stress symptoms than those who listed friendship and relationship problems as their most traumatic event. This result may speak to the protective factors of shared experiences, mutual support, and ability to help in community-wide traumatic events as compared to interpersonal traumas.

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PRINCIPLES OF BEHAVIORAL SCIENCE TO ENHANCE COMMUNITY HEALTH

MESSAGING CAMPAIGN DESIGN, IMPLEMENTATION, AND EVALUATION.

James Brooks1 , Faven Araya2, Maya Korin3, Idris Muhammed4, Kristelle Pierre2, Luz Claudio3 1Medical Education, 2Operations, 3Environmental Medicine and Public Health, 4Public Health.

1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2Arthur Ashe Institute for Urban Health, 4Morehouse School of Medicine.

The spread of health misinformation has reached epidemic proportions. This urgent public health issue requires increased effort to communicate scientifically-sound health messages. Principles of communitybased participatory research (CBPR) can be used to improve health communication campaigns by engaging community-based organizations (CBOs). Leveraging the trust that CBOs have established within their communities may facilitate more effective communication of health information. However, concerted efforts to engage CBOs in the use of behavioral science methods to counter health misinformation are lacking. The purpose of this article is to present a concise community- and outcome-focused framework for designing, implementing, and evaluating health messaging campaigns using CBPR-informed principles of behavioral science. Applying lessons from established behavioral science and successful messaging campaigns in public health and other contexts, we propose the “Lights, Facts, and Goals” model, a succinct and transparent method to plan public health messaging with individual and community health objectives at the forefront. “Lights” refers to different methods of reaching the community like online advertisements, billboards, and text messages. “Facts” refers to the key sourced scientific information that is relevant to a specific aspect of community health. “Goals” refers to the actions community members can take to improve their health in connection with the communicated health facts. This article describes how the “Lights, Facts, and Goals” model facilitates the creation of health message content informed by established behavioral science and health communication principles. Through use of “Lights, Facts, and Goals,” community leaders and their partners in science and public health will be more effective at improving community health through messaging.

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PREVALENCE OF ADVERSE PREGNANCY OUTCOMES IN WILSON’S DISEASE

DURING PREGNANCY: SYSTEMATIC REVIEW AND META-ANALYSIS. Ashley Brown1 , Sasha Kogan2, Marcia Lange1, Lily Martin3, Tatyana Kushner4 1Medical Education, 2Medicine, 3Levy Library, 4Liver Diseases. 1,3,4Icahn School of Medicine at Mount Sinai, New York, New York, 2Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.

BACKGROUND: Wilson’s disease (WD) is a rare genetic disease of copper metabolism. Due to its rarity, cases of WD in pregnancy are few and there are limited studies reporting on pregnancy outcomes in WD, with very limited data to inform preconception counseling and prenatal care.

OBJECTIVE: To report on the prevalence of adverse pregnancy outcomes in patients with WD.

METHODS: A comprehensive query of Scopus, MEDLINE, and EMBASE was performed until May 19, 2022. Outcomes of interest included: cesarean sections, spontaneous abortions, preterm births, liver disorders unique to pregnancy, hypertensive disorders of pregnancy, gestational diabetes, and any adverse neonatal outcomes.

RESULTS: The initial literature search yielded 1,482 studies, of which 790 were eligible for title/abstract screening (k=0.50). Following screening, 261 studies met eligibility criteria for full-text review (k=0.12-0.62). Ten cohort studies and three case series published from 1976-2021, comprising 396 pregnant patients with WD and 696 pregnancies were included in the review. Of the 696 reported pregnancies, 390 were on treatment for WD (56.0%), 178 pregnancies were reported off treatment (25.6%), and 128 pregnancies were not categorized (18.4%). Among the pregnancies that occurred with treatment, the pooled prevalence of any adverse pregnancy outcomes was 30.3% vs 39.9% in those untreated. The incidence of adverse outcomes was significantly lower in patients who were on treatment during pregnancy (OR 0.65, 95% CI 0.45-0.95, p=0.01). Forest plots demonstrated that the most common complication among all pregnant patients with WD was spontaneous abortion (18.9%, 95% CI 12.8%-27%). The pooled prevalences of cesarean sections, preterm birth, hypertensive disorders of pregnancy and gestational diabetes were 17.1% (95% CI 8.5%-31.2%), 7.2% (95% CI 4.7%-10.8%), 5.1% (95% CI 3.0%-8.6%), and 7.5% (95% CI 0.4%-59.3%) respectively. Pooled prevalence of liver diseases unique to pregnancy was 9% (95% CI 3.8%-19.9%). Adverse neonatal outcomes were reported in 30 pregnancies (8.7%, 95% CI 3.8%-18.5%).

CONCLUSION: We identified high rates of adverse pregnancy and neonatal outcomes in patients with WD, although there was notable heterogeneity in publication year and treatment. However, treatment of WD during pregnancy was shown to reduce the overall risk of adverse pregnancy outcomes by 35%. Future studies should explore the impact of treatment type and optimal disease control on pregnancy complications.

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FIGURATIVE LANGUAGE IN CANCER CONVERSATIONS: DIFFERENCES BY SOCIODEMOGRAPHIC CHARACTERISTICS.

Nicholas Buehler1 , Jeannys Nnemnbeng2, Laura Gelfman3, Cardinale Smith3, Julia Frydman3.1Medical Education, 2Clinical Research, 3Geriatrics and Palliative Medicine.

1,2,3Icahn

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

BACKGROUND: Figurative language, such as metaphor and analogy, is commonly used to describe complex concepts around serious illness conversations and can impact patient perceptions and decisions.

OBJECTIVE: To describe figurative language use during patient-oncologist outpatient encounters across patient sociodemographic characteristics.

METHODS: We conducted a secondary mixed-methods data analysis of transcriptions of English-speaking patient/oncologist encounters in four outpatient cancer centers in New York and Connecticut. We conducted a thematic analysis by coding for occurrences of figurative language (metaphor and analogy) and their types. We then compared figurative language use and sociodemographic characteristics.

RESULTS: A total of 53 patient-oncologist outpatient encounters were included in the analysis. Overall, subjects had a mean age 64.8 years, 47% were Female, 34% Black Non-Hispanic, 36% White Non-Hispanic, and 30% Hispanic. There were 74 figurative language uses during the 53 encounters. Patient-oncologist conversations among White Non-Hispanic patients had more figurative language use as compared to Black non-Hispanic patients (48 uses vs. 16 uses, p-value = 0.005) and Hispanic patients (48 uses vs. 10 uses, p-value = 0.002). Oncologists used figurative language more often with White non-Hispanic patients than with Black non-Hispanic patients (28 uses vs. 12 uses, p-value = 0.03) and Hispanic patients (28 uses vs. 7 uses, p-value = 0.007). We identified four main figurative language types: fight, mechanical, journey, and medical comparisons. Fight figurative language was used more often with White Non-Hispanic patients than with Black non-Hispanic patients (12 (25% of FL used) vs. 8 (50%)) and Hispanic patients (1). Oncologists used more “fight” figurative language with male patients as compared to female patients ((15 (41%) vs. 10 (27%)) and older patients (>= 65 years) as compared to younger patients (< 65 years) ((17 (41%) vs. 8 (24%)).

CONCLUSION: Figurative language use differed among patients with advanced cancer based on race, age, and gender. This mixed-methods study indicates more research needs to be done to identify specific tools in serious illness communication which can improve quality of care and minimize communication disparities across patient groups.

QUALITATIVE ASSESSMENT OF THE EFFICACY OF PSYCHIATRIC TRAINING MODULES IN PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY IN THE DOMINICAN REPUBLIC.

Gabriela Calcano Castro1 , Myles Solan1, Dhruv Gupta2, Xiomara Fernandez3, Craig Katz2

1Medical

Education,

2,3Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Instituto Terapeutico y Psicologico para la Familia, Jarabacoa, Dominican Republic.

BACKGROUND: In 2017, a mental health needs assessment survey was conducted, identifying the r egion of Jarabacoa, Dominican Republic as high-need for mental health services.with only one trained psychiatrist in the region. In partnership with the Instituto Terapeeutico y Psicoloogico para la Familia (INTEP), the Icahn School of Medicine at Mount Sinai (ISMMS) provided training to primary care professionals including general medical doctors, medical assistants, nurses, and support staff in identifying and diagnosing common mental health disorders and to psychologists in cognitive behavioral therapy.

OBJECTIVE: To assess the efficacy of the training in improving provider ability to identify, diagnose and treat common mental health disorders.

METHODS: Participants completed an interview two to three months following their training consisting of questions regarding experiences identifying, diagnosing, and treating common mental health conditions.

RESULTS: 76 primary care professionals participated in the training, and 28 were interviewed. Those interviewed indicated the training enabled them to implement changes in their medical practice, increasing the ease with which they identify and diagnose patients with mental health disorders. The training also increased the overall sense of security and comfort when managing patients with mental health concerns and their desire for further learning and consultation. 13 psychologists completed the training, and five were interviewed. Those interviewed reported an increase in knowledge on treatment options for those with mental health concerns and, on long term follow-up, improved outcomes in patients started on CBT treatment.

CONCLUSION: During interviews conducted several months following the training, both primary care professionals and psychologists described an increased sense of security, ease, and comfort in identifying and managing patients with mental health disorders but a desire to further their education on mental health conditions and collaborate with other providers in the region. Future plans include connecting local providers with psychiatric experts from ISMMS or INTEP and facilitating regular meetings to strengthen collaborative efforts and knowledge exchange among practitioners in the region.

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ESTABLISHING A POVERTY ASSESSMENT TOOL FOR USER FEES AT AN AMBULATORY SURGERY CENTER IN RURAL UGANDA.

Peter Campbell1 , Chelsia Melendez1, Makda Getachew Zewde1, Katie Glerum2, Joseph Okello-Damo3, Anna Kalumuna3, Linda Zhang2. 1Medical Education, 2,3Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Kyabirwa Surgical Center Kyabirwa, Uganda.

BACKGROUND: Out of pocket healthcare expenditures in sub-Saharan Africa, in the form of user fees, can amount to catastrophic expenditures for individuals, especially for patients living in poverty. Previous literature suggests that while free care can lead to increased utilization of curative services, it can also decrease the overall quality of care. The Kyabirwa Surgical Center (KSC), an ambulatory surgery center in rural Uganda, is sensitive to the arguments both for and against user fees. While KSC charges below market-value pricing for services, it also offers subsidized or free care for those who cannot afford its services. However, in Uganda, there is no standardized or validated tool that can be used in a healthcare setting to determine patients’ poverty level. While the Simple Poverty Scorecard (SPS) for Uganda is a validated individualized poverty survey, SPS questions are not all pertinent to healthcare and may trigger false reporting by patients if they suspect the survey is assessing their ability to pay. This study provides a statistical approach to identifying a medically-relevant poverty assessment tool that accurately determines patients’ poverty level and need for subsidized user fees.

OBJECTIVE: The User Fees Survey (UFS) created by KSC is a poverty assessment tool that can be used in a medical setting to accurately estimate an individual’s poverty level.

METHODS: The SPS was modified to establish KSC’s own UFS, where all questions were medically-relevant. Both the SPS and UFS were administered to patients during their initial visit to the center. SPS and UFS scores were compared to each other using Spearman’s correlation, to evaluate UFS’s validity in accurately assessing, in a medical setting, patients’ level of poverty.

RESULTS: Of the 425 patients who started the surveys, 218 patients (51%) completed both the UFS and SPS. Using Spearman’s correlation, SPS and UFS scores were positively correlated (R=.54, p<0.001), indicating that the UFS is an effective assessment tool to estimate a patient’s poverty level and need for subsidized user fees.

CONCLUSION: In Uganda, the UFS can be used in the medical setting as a poverty assessment tool to help determine patients’ ability to pay for healthcare services. Implementation of this survey at healthcare facilities will likely minimize patients’ catastrophic healthcare expenditures and increase healthcare

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SITE OF LUMINAL NARROWING AFFECTS LIKELIHOOD OF SUCCESSFUL DILATION WHEN ULTRA-THIN ENDOSCOPES ARE REQUIRED.

Michael Chang1 , Michael Smith2 1Medical Education, 2Gastroenterology and Hepatology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2Mount Sinai Morningside and West Hospitals.

BACKGROUND: Esophagogastroduodenosopy (EGD) is used to assess the digestive lumen and mucosa, sample tissue, and perform therapeutic maneuvers. When esophageal narrowing is present, standard endoscopes (9-10 mm diameter) may not be able to traverse the entire esophagus. Ultra-thin endoscopes (UTEs), with diameters closer to 6 mm, may allow endoscopists to complete inspection and optimize treatment plans.

OBJECTIVE: To explore UTE patterns of use and identify factors which predict successful therapeutic dilation when UTEs are used.

METHODS: All patients undergoing EGD with UTE at a single high-volume teaching hospital between 9/2018 and 5/2022 were included. Successful dilation was defined as either balloon or Savary (bougie) dilation to a luminal diameter of at least 13 mm. Stricture locations were defined as upper third (< 24 cm from incisors), middle third (24-32 cm) and lower third ( >32 cm). Demographic and endoscopic data were aggregated and deidentified prior to analysis.

RESULTS: A total of 205 EGDs with UTE were performed, with 103 of those procedures including dilation. Within this cohort, 31 patients with luminal narrowing not due to malignancy underwent 47 total dilations. Successful dilation was achieved in 14 patients, with an average of 1.86 dilations (vs. 1.24 in the unsuccessful group). There was no significant difference with respect to age or gender when comparing these groups. An ANOVA model showed a statistically significant difference between success rates for dilation of upper, middle, and lower third narrowings (p = 0.01027), with the best results for proximal lesions.

CONCLUSION: The use of UTE to traverse luminal narrowings has been studied, but rarely have therapeutic outcomes been correlated with lesion location. This study shows that proximal narrowing is associated with a greater likelihood of successful dilation. One explanation is that the more proximal narrowings often result from congenital webs and radiation-induced strictures, where the causative insult is not active during dilation. This contrasts with distal lesions, which are often reflux-induced, where ongoing inflammation and resulting scarring may impede successful dilation. These results suggest aggressive reflux management should be considered before attempting distal dilation. A potential limitation is the small number of dilations per patient, leaving open the possibility that more dilations could have evened out the success rates between groups.

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ELUCIDATION OF RISK FACTORS FOR CEAP CLASS AMONG

VASCULAR

SURGERY PATIENTS.

Annie Chang1 , Halbert Bai2, Andrew Min2, Jason Storch2, Jenny Chen2, Keva Li2, Windsor Ting2 1Medical Education, 2Vascular Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification is a classification system for venous disease created by the American Venous Forum in 1994 to aid in diagnosis and comparison of chronic venous disorders. Although CEAP classification has been adopted worldwide, little information is available on risk factors for individual CEAP class.

OBJECTIVE: To determine the most salient pre-operative risk factors for each CEAP class among vascular surgery patients.

METHODS: This retrospective analysis included 844 patients undergoing vascular surgery at a single institution from 2013 to 2020. Patients in our analysis were primarily classified as Classes 3 through 6 in the CEAP classification (“Venous Edema”, “Skin Changes”, “Healed Venous Ulcer”, “Active Venous Ulcer”, respectively). Risk factors included in our analysis were hypertension, smoking history, gender, diabetes, race, cancer, previous vein surgery, and DVT or PE history. CEAP classification scores were collected pre- and post-operatively. Multivariate logistic regressions were used to identify significant predictor variables for each CEAP class.

RESULTS: For CEAP Class 3, gender (odds ratio [OR] = 0.50, 95% confidence interval [CI] = [0.34-0.73]) and previous vein surgery (OR = 0.68, 95% CI = 0.47-0.99) are significantly associated. For CEAP Class 4, gender (odds ratio [OR] = 1.49, 95% confidence interval [CI] = [0.99-2.24]) is significantly associated. For CEAP Class 5, gender (odds ratio [OR] = 2.93, 95% confidence interval [CI] = [1.08-8.74]) and hypertension (OR = 5.68, 95% CI = 1.77-25.4) are significantly associated. For CEAP Class 6, smoking history (odds ratio [OR] = 1.96, 95% confidence interval [CI] = [0.93-4.03]) and race (OR = 0.60, 95% CI = 0.39-0.91) are significantly associated.

CONCLUSION: Gender appears to be highly associated with chronic venous outcomes, namely venous edema, skin changes, and healed venous ulcers. It is possible that venous diseases are underdiagnosed and undertreated among women due to gender-related issues on the part of both providers and patients. Furthermore, the finding that smoking history is highly associated with active venous ulcers may be due to the fact that smoking increases the risk for ongoing tissue loss and infection, exacerbating active ulcers. This work may inform risk factors for CEAP classification to provide a more complete understanding on the etiology of venous disorders.

SIGNIFICANT PREDICTORS OF PREOPERATIVE VCSS COMPOSITE SCORE FOR VASCULAR SURGERY PATIENTS AT A SINGLE INSTITUTION.

Annie Chang1 , Halbert Bai2, Andrew Min2, Jason Storch2, Jenny Chen2, Keva Li2, Windsor Ting2 1Medical Education, 2Vascular Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Venous Clinical Severity Score (VCSS) is designed to measure the severity of chronic venous disease. Pre-operative composite VCSS score is a metric that aggregates ten components, including venous pain, venous edema, skin pigmentation, inflammation, induration, and active ulcer number to represent the degree of venous disease severity prior to surgical operation.

OBJECTIVE: To determine the significant predictors of pre-operative composite VCSS score in order to inform the treatment and pre-operative care of vascular surgery patients. The predictors examined in this analysis were smoking history, gender, diabetes, race, cancer, peripheral artery disease (PAD) history, previous vein surgery, and deep vein thrombosis (DVT) or pulmonary embolism (PE) history.

METHODS: A clinical registry of 844 vascular surgery patients who were treated at a single institution from 2013 to 2020 was retrospectively analyzed. We identified eight risk factors that included the demographic and past medical history of vascular surgery patients. Multivariate linear regression was used to determine the most important predictors among these variables for pre-operative composite VCSS score. Standardized regression coefficients ( ) demonstrated how many standard deviations that pre-operative composite VCSS score would change per standard deviation increase in the predictor variable.

RESULTS: Multivariate linear regression revealed that gender ( =1.13; P<0.001) and previous vein surgery ( =0.852; P=0.0018) were the most significant predictors of pre-operative composite VCSS score (i.e., being male and having previous vein surgery were predictive of a higher pre-operative composite VCSS score). The remaining six variables – smoking history, diabetes, race, cancer, PAD history, and DVT or PE history – were non-significant predictors of pre-operative composite VCSS score.

CONCLUSION: Among the eight pre-operative variables we examined, two variables had a significant, direct association with pre-operative composite VCSS score, namely gender and previous history of vein surgery. Therefore, patients who are male and have a history of prior vein surgery are more likely to have a higher pre-operative composite VCSS score. These findings may be useful in aiding pre-operative decision making for vascular surgery patients.

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REMOTE PATIENT MONITORING OF CENTRAL RETINAL FUNCTION WITH MACUSTAT®: A MULTI-MODAL MACULAR FUNCTION SCAN.

Earnest Chen1 , Michael Mills2, Tara Gallagher3, Ranya Habash4, Ronald Gentile5, Sean Ianchulev6 1Medical Education, 2,3,4,5,6Ophthalmology. 1,6Icahn School of Medicine at Mount Sinai, New York, New York, 2Prism Eye Institute, Oakville, Ontario, Canada, 3Gentile Retina Practice, New York City, NY, 4Bascom Palmer Eye Institute, Miami, FL, 5New York Eye and Ear of Mount Sinai, New York, NY.

BACKGROUND: There is significant unmet need for remote monitoring of visual function with home-based, patient-centric technologies for chronic retinal diseases, especially during times of crisis such as the COVID-19 pandemic. The Macustat® central retinal function scan is a novel on-demand cloud-based digital health application for home monitoring that can be accessed on any smart phone, tablet, laptop or desktop.

OBJECTIVE: To assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations.

METHODS: Retina practice patients with underlying macular pathology underwent office-based retinal examination, OCT macula imaging and best-corrected visual acuity assessment using the Snellen chart test followed by remote tele-monitoring assessment with the Macustat® foveal function multi-modal scan. The self-administered home test was accessed on a cross-platform device-agnostic screen of a smart phone, tablet, laptop, desktop or other consumer peripherals with internet access. Central visual function was assessed with the multi-modal Macustat® test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing, all delivered via remote telehealth interface. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation. In the subgroup of eyes with exudative AMD, Macustat® foveal function scans were compared to OCT findings.

RESULTS: The foveal acuity potential registered with the Macustat® test showed high correlation with the office Snellen acuity potential 96% of eyes registered Macustat® acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat® foveal function scan showed a corresponding abnormality in 89% of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan.

CONCLUSION: The Macustat® demonstrates high concordance with clinical findings using traditional diagnostic devices. Home monitoring with the Macustat® may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease.

PATIENT’S PERCEIVED UTILITY OF THE MACUSTAT TEST TO ASSESS RETINAL CARE QUALITY.

Earnest Chen1 , Ronald Gentile2, Sean Ianchulev3 1Medical Education, 2,3Ophthalmology. 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2New York Eye and Ear of Mount Sinai, New York, NY.

BACKGROUND: The Macustat, a digital ophthalmic exam to assess retinal function that can be accessed by anyone with a personal electronic device, has been a solution to the need for remote monitoring, made apparent by the COVID-19 pandemic. We previously reported that the clinical findings made from the Macustat is comparable to that of in-office visual exams. However, patient satisfaction (a key marker for user compliance) remains ambiguous.

OBJECTIVE: To assess the utility of the Macustat from the patient’s perspective.

METHODS: Thirty-four patients who have been using the Macustat test for at least 60 days between July and December of 2022 were chosen to be included in this study. A survey was administered to participants to assess their perception of the utility of the remote monitoring program. Patients were asked to choose between five options (strongly agree, agree, neutral, disagree, and strongly disagree) to questions that gauged user-friendliness of the platform, patient confidence in remote monitoring, and platform impact on the patient-doctor relationship. Lastly, patients were asked to rate the remote monitoring program on a numeric basis.

RESULTS: Out of all participants, 88% agree or strongly agree that the Macustat is “easy to do.” Patients showed high confidence in remote monitoring with 76% agreeing that the tests were worth their time, 65% agreeing that it increases peace of mind, and 59% agreeing that remote monitoring provides better care than in-person visits alone. Remote monitoring also generally improves doctor-patient relationships with 53% reporting that it increases confidence in doctors and 47% agreeing that they feel more connected with their doctors. Meanwhile, only 3 individuals reported decreased confidence in doctors and 15% found they felt less connected with physicians. Overall, 76% of the participants rated the Macustat 4 out of 5 or higher for their general experience, and 71% would recommend it to other patients.

CONCLUSION: We report one of the first studies that assess patient satisfaction and outcomes of the use of a digital platform to monitor chronic disease progression for retina patients. The Macustat test for retinal function is user-friendly and increases participants’ confidence in digital remote monitoring programs without compromising the doctor-patient relationship. At home monitoring via Macustat has potential to improve both quality of care and patient experiences with medicine.

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EXAMINING HEALTHCARE NGO TRENDS THROUGH GOOGLE ANALYTICS.

Jenny Chen1 , Nicolas Douard2, Evan Afshin2, Joan LaRovere2, Ebrahim Elahi3 1Medical Education, 2Data Science, 3Ophthalmology. 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2Virtue Foundation, New York, NY.

BACKGROUND: NGOs (non-government organizations) have been critical for the development of modern civilization. We observed a rapid growth in healthcare NGO establishment throughout the 1900s, peaking in 2010 with 110 novel NGOs established worldwide. This was followed by a decline in NGOs established every year from 2010 to 2019, with only 25 NGOs established in 2019. This phenomenon exists even when the data is subdivided based on location, volunteering subtype, and medical specialty.

OBJECTIVE: To uncover potential factors behind such trends, particularly the public interest in volunteering.

METHODS: This study included data from the Virtue Foundation Actionable Data Initiative’s World Compendium, a database that comprises 2055 NGOs providing healthcare services in 72 low- and lowmiddle-income countries, as classified by the World Bank. We analyzed Google search data from 2005 to the present day, using search terms related to the public interest in volunteering, such as “how to volunteer” and “mission trips.” Pearson correlation coefficients were calculated to assess the association between trends in NGO establishment and Google search hits for various terms.

RESULTS: Three search terms showed a parallel trend to that of NGO establishments, with a peak in 2009/2010 followed by a continual decline - these were “volunteer abroad”, “mission trips”, and “NGOs abroad”. Correlation analysis shows a strong positive correlation between the number of search hits of these terms and the number of NGOs established (R = 0.8, p = 0.00035). In contrast, more general search terms “how to volunteer”, “how to help others”, and “how to donate” exhibited a continual upward trend from 2010.

CONCLUSION: The search terms which followed a decline parallel to that of NGO establishments appear to be those centered around international volunteering, including traveling to a foreign location and participating in mission trips. Nonetheless, it appears that overall interest in donations and volunteering has not subsided. These findings suggest that there has been a shift from active to passive involvement and potentially a shift to more local involvement. A possible explanation for the decreased interest in mission trips may be the widespread anti-voluntourism movement, which emphasized the harmful consequences of volunteering abroad. Future research is needed to further explore these findings.

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DELAYED TYPE HYPERSENSITIVITY REACTIONS TO VARIOUS ALLERGENS MAY

DIFFERENTLY MODEL INFLAMMATORY SKIN DISEASES.

Julia Cheng1 , Emma Guttman-Yassky2 1Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Treatment of inflammatory skin diseases, including atopic dermatitis (AD) and psoriasis is undergoing transformative changes, highlighting the need to develop experimental models of skin inflammation in humans to predict treatment responses.

OBJECTIVE: We topically or intradermally administered 4 common sensitizers (dust mite (DM), diphencyprone (DPCP), nickel (Ni), and purified protein derivative (PPD)) to the backs of 40 healthy patients and the skin hypersensitivity response was biopsied and evaluated using immunohistochemistry, RNA-seq, and RT-PCR.

RESULTS: All agents induced strong increases in cellular infiltrates (T-cells and dendritic cells) as compared to untreated skin (p<0.05), with variable T helper polarization. Overall, DPCP induced the strongest immune responses across all pathways, including innate immunity (IL- 1 , IL-8), Th1 (IFN , CXCL10), Th2 (IL-5, CCL11), and Th17 (CAMP/LL37) products, as well as the highest regulatory tone (FOXP3, IL-34, IL-37) (FDR<0.01). Nickel induced Th17 (IL- 17A), Th1 (CXCL10) and Th2 (IL-4R) immune responses to a lesser extent than DPCP (p<0.05). PPD induced predominantly Th1 (IFN , CXCL10, STAT1) and Th17 inflammation (IL-17A) (p<0.05). DM induced strong modulation of the Th2 (IL-13, CCL17, CCL18), Th22 (IL- 22), and the Th17/ Th22 (S100A7/9/12) pathways (p<0.05). Barrier defects that characterize both AD and psoriasis were best modeled by DPCP and Ni, followed by PPD, including downregulation of terminal differentiation (FLG, FLG2, LOR, LCEs), tight junction (CLDN1/CLDN8), and lipid metabolism (FA2H, FABP7)-related markers.

CONCLUSION: Our data implies that DPCP induced the strongest immune response across all pathways, and barrier defects characteristic of AD and psoriasis. DPCP may be useful as an experimental model to screen for inhibitory effects of various immune modulating treatments.

HEAD-TO-HEAD COMPARISON OF VISION TESTS INTEGRATED INTO A VIRTUAL REALITY TECHNOLOGY AGAINST THEIR CLINICAL ANALOGUES. Christopher Cheng1 , Margarita Labkovich1, Andrew Warburton2, Randal Serafini3, James Chelnis4 1Medical Education, 2Anesthesiology, 3Neuroscience, 4Ophthalmology. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Each year, the United States sees 240,000 new cases of minimal vision loss or blindness. For timely treatment of these cases, virtual reality (VR) offers a promising avenue for improving access to vision screening without sacrificing accuracy.

METHODS: A non-inferiority trial was performed at New York Eye and Ear Infirmary 102nd St clinic, where patients received a 24-2 Humphrey Visual Field Analyzer (HVFA) exam, Ishihara color blindness test, ETDRS acuity chart, Pelli-Robson contrast-sensitivity chart, and/or an Amsler Grid vision exam along with their VR analogues in a randomized fashion. Secondary outcomes were also collected, such as the time it took to complete each test and a survey for evaluating the patient experience.

RESULTS: From 86 subjects recruited, 110 eyes underwent Ishihara testing for both VR and non-VR modalities and their respective results demonstrated no significant difference (p = 0.12, U = 1253.5) in a MannWhitney U test. 98 eyes took both versions of the Amsler grid test, demonstrating no significant difference (p = 0.81, U = 4514.5). The 24-2 suprathreshold perimetry analog achieved a 78% and 76% overall agreement in the left and right eyes among samples of 41 and 43 eyes, respectively. 34 eyes took both versions of the ETRDS and Pelli-Robson tests twice and the inter/intra-test reliability results demonstrated no significant difference for either eye. Perimetry was much faster on the VR headset (p<0.0001) and patients reported significant preference (p<0.05) for the experience, comfort and speed of VR analogues.

CONCLUSION: VR vision test packages are comparable to traditional tests and can help increase access to vision screening and detect vision abnormalities earlier. VR’s impact is helped by its comparatively lower cost, faster speed, and user-friendliness.

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EVALUATING THE IMPACT OF CLIMATE-RELATED MATERIAL IN THE PRECLINICAL CURRICULUM: MOUNT SINAI CLIMATE CHANGE CURRICULUM INFUSION PROJECT (CCCIP) 2020. Lindsay Clark1 , Perry Sheffield2 1Medical Education, 2Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Medical school curricula do not yet contain sufficient content regarding health impacts of climate change. Phase I of the Climate Change Curriculum Infusion Project (CCCIP) at ISMMS began in 2018 with integration of climate change-related health materials into pre-clinical curricula. It was unclear how infused content would compete for visibility and retention in an already dense curriculum. Thus, Phase II began in 2020 with evaluation of effectiveness of existing CCCIP curriculum.

OBJECTIVE: To test visibility and retention of previously infused content through mid-stream evaluation surveys of current ISMMS students.

METHODS: Survey questions were developed and submitted for approval through the IRB, the appropriate Medical Education reviewing authority, and Student Council. The survey was sent out via listserv to current second- and third-year medical students. Participation was voluntary and anonymous. Survey questions used a Likert scale and evaluated visibility and retention of content integrated into curricula during Phase I including ASM1, Immunology, Medical Microbiology, Brain and Behavior, Pulmonary Pathophysiology, and Cardiovascular Pathophysiology. Questions were included to gauge attitudes and motivations of students opting to complete the survey. The survey also solicited qualitative feedback.

RESULTS: Total respondents = 89 (32% response rate(rr)); Second-year students = 57 (40% rr); Thirdyear students = 32 (23% rr). 57% of students endorsed some familiarity with climate-related health material coming into medical school. Students’ ability to recall exposure to climate-related content in specific courses was inconsistent. Students were most consistently able to recall CCCIP material from Medical Microbiology and ASM1. A majority of students agreed with statements assessing attitudes about the importance of climate-related material to their medical education (82%) and to their future clinical careers (77%). Trends in qualitative feedback suggested students desired a more robust climate curriculum.

CONCLUSION: 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 1) review of integrated content (ensure content is still being included and as organically as possible), and 2) incorporation of the content into course assessments to incentivize retention.

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IMPACT OF PERIPHERAL ARTERY DISEASE ON OUTCOMES IN HIGH BLEEDING RISK PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION.

Rebecca Cohen1 , Alessandro Spirito2, Samantha Sartori2, Clayton Snyder2, Birgit Vogel2, Samin Sharma2, George Dangas2, Annapoorna Kini2, Roxana Mehran2. 1Medical Education, 2Cardiovascular Research Institute. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Peripheral artery disease (PAD) is associated with worse outcomes after percutaneous coronary intervention (PCI). Little is known about the prognostic impact of PAD in patients with concomitant high bleeding risk (HBR) undergoing PCI.

OBJECTIVE: To assess ischemic and bleeding complications at 1 year after PCI in HBR and non-HBR patients with or without concomitant PAD.

METHODS: Consecutive patients undergoing PCI with drug eluting stent implantation (DES) at a large tertiary-care center (Mount Sinai Hospital, New York, USA) between 2012 and 2019 were stratified according to HBR status using the Academic Research Consortium and by presence of PAD at index PCI. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI) and stroke 1 year after PCI. The key secondary outcome was major bleeding according to a study specific definition. Clinical event rates at 1 year were obtained using the Kaplan–Meier method and compared using the log-rank test for the time-to-first-event. Unadjusted and adjusted risks were calculated using Cox proportional hazard models. The adjusted model included clinically relevant baseline characteristics.

RESULTS: Out of 16,750 patients, 7,192 (42.9%) were at HBR of whom 975 (13.6%) had concomitant PAD and 6217 (86.4%) did not have PAD. Of the non-HBR group, 549 (5.7%) had PAD and 9,009 (94.3%) did not. Within both groups, PAD compared to non-PAD patients were more likely to have cardiovascular risk factors, known or established coronary artery disease and interventions, and undergo procedural characteristics of complex PCI. Within the HBR group, MACE occurred in 93 (11.4%) patients with PAD and 382 (7.3%) without PAD (HR 1.59, 95% CI 1.27-1.99, p<0.001) due to an excess of all-cause death and MI in PAD patients. The risk of major bleeding tended to be higher in PAD than non-PAD patients (8.5% vs 6.9%, HR 1.26, 95% CI 0.99-1.60, p=0.062). PAD was associated with similar risks in the non-HBR group. After adjustment for confounders, PAD was no longer a predictor of any adverse outcomes.

CONCLUSION: Among HBR and non-HBR patients undergoing DES implantation, PAD was associated with worse outcomes at 1 year following PCI. After adjustment for confounders, PAD was no longer a predictor of adverse outcomes, suggesting that prognosis is determined by cardiovascular risk factors and comorbidities burden rather than PAD alone.

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INCREASED SEVERITY OF INFLUENZA-ASSOCIATED HOSPITALIZATIONS IN RESOURCE-LIMITED SETTINGS: RESULTS FROM THE GLOBAL INFLUENZA SURVEILLANCE NETWORK (GIHSN). Lily Cohen1 , Chelsea Hansen2, Cecile Viboud2, Sandra Chaves3 1Medical Education, 2International Epidemiology and Population Studies, 3Epidemiology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2NIH, 3Foundation for Influenza Epidemiology, Fondation de France, Paris, France.

BACKGROUND: Influenza disease data remain scarce in middle and lower-income countries.

OBJECTIVE: We used data from the Global Influenza Hospital Surveillance Network (GIHSN), a prospective multi-country surveillance system from 2012-2019, to assess differences in the epidemiology and severity of influenza hospitalizations by country income level.

METHODS: We compiled individual-level data on acute respiratory hospitalizations, with standardized clinical reporting and testing for influenza. Adjusted odds ratios (aORs) for influenza-associated intensive care unit (ICU) admission and in-hospital death were estimated with multivariable logistic regression that included country income group (World Bank designation: high-income countries: HIC; upper middle-income countries: UMIC; lower middle-income countries: LMIC), age, sex, number of comorbidities, influenza subtype and lineage, and season as covariates.

RESULTS: From 73,121 patients hospitalized with respiratory illness in 22 countries, 15,660 were laboratoryconfirmed for influenza. After adjustment for patient-level covariates, there was a two-fold increased risk of ICU admission for patients in UMIC (aOR 2.31; 95% confidence interval (CI) 1.85-2.88, p < 0.001), and a 5-fold increase in LMIC (aOR 5.35; 95% CI 3.98-7.17, p < 0.001), compared to HIC. The risk of in-hospital death in HIC and UMIC was comparable (UMIC: aOR 1.14; 95% 0.87-1.50; p > 0.05), though substantially lower than that in LMIC (aOR 5.05; 95% 3.61-7.03; p < 0.001 relative to HIC). A similar severity increase linked to country income was found in influenza-negative patients.

CONCLUSION: We found significant disparities in influenza severity among hospitalized patients in countries with limited resources, supporting global efforts to implement public health interventions.

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OX40/OX40L IS INTEGRAL TO THE PATHOGENESIS OF AA AT THE SKIN AND BLOOD LEVEL.

Dante Dahabreh1 , Daniel Lozano-ojalvo2, Ester del Duca2, Jonathan Bar2, James Krueger2, Emma GuttmanYassky2 1Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Alopecia Areata (AA) is a chronic inflammatory hair loss disorder mainly characterized as a Th1 and cytotoxic T cell mediated disease. Recent studies on elevated Th2 markers in peripheral blood and scalp biopsies show how the Th2 axis may be integral to the immune activation of AA. OX40 and OX40L act as co-stimulator molecules that have been described to contribute to Th2 cell activation.

OBJECTIVE: To identify immune cell interactions at the skin level and quantify immune cells expression of OX40 and OX40L in the peripheral blood.

METHODS: We analyzed blood and scalp tissue from 31 moderate-to-severe AA adults with 12 age matched healthy controls. PCR analysis of biopsy samples were used to broadly characterize the immunoinflammatory profile of AA. Immunohistochemistry was used to measure OX40, OX40L, and tryptase at the dermal level. Immunofluorescence characterized molecular interactions of the OX40/OX40L axis in the dermal layer. Flow cytometry was used to measure innate immunity, T cell, and APC subsets of which express OX40 and OX40L.

RESULTS: PCR analysis identified significant expression of OX40 in scalp biopsies of AA patients (P<0.05). IHC highlighted significant increase in cell counts of OX40, OX40L, and tryptase in the dermal layer compared to healthy controls. By IF analysis, we distinguished interactions with co-expressing OX40/CD8 T cells and co-expressing OX40/IgE-Fc epsilon receptor cells. Flow cytometry analysis of AA patients show OX40 expression was significantly increased in NK cells (P<0.01), monocytes (P<0.01), CD8+ CLA+ T cells (P<0.001) and CLA- Tregs (P<0.0001) compared to controls. OX40 expression was insignificant in CD4+ CLA+/- T cell frequencies when compared to controls. OX40L expression was significantly increased in CD4+ T cells (P<0.01), CD8+ T cells (P<0.0001) Tregs (P<0.001) compared to healthy controls. AA patients also had increased expression of OX40 on NK cells (P<0.01), dendritic cells (P<0.05), and non-classic monocytes (P<0.05).

CONCLUSION: The OX40/OX40L axis is highly involved at the skin level, with activation of mast cells near the hair follicle. In peripheral blood, OX40 expression is found on innate immunity, CD8+ T cells, and Treg cells, while OX40L expression is found on all T cell subsets and on innate immune cells. Our study suggests OX40/ OX40L is integral to AA pathogenesis by contributing to systemic immune activation, highlighting this axis as an important target for future treatment.

PSYCHOLOGICAL OUTCOMES AMONG MEDICAL STUDENTS THAT HAVE EXPERIENCED CHILDHOOD TRAUMA.

Candida Damian1 , Mary Rojas1 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: It is known that childhood trauma is associated with negative health outcomes. It is also known that medical students suffer from high rates of mental health difficulties. However, research on how childhood trauma impacts medical students is limited.

RESEARCH QUESTION: Among medical students, does childhood trauma impact psychological outcomes during their clinical years?

METHODS: This prospective survey-based study was conducted at Mount Sinai. Third-year medical students were given a baseline survey in June 2020 via an anonymous electronic platform (REDcap). The survey included validated instruments. For this study we use a subset of the measures that include mental health outcomes (GAD-7, PHQ-8, PCL-5), risk factors (LEC-5, CTQ-SF, SAS-SR, worries about COVID-19), coping factors (BCOPE, RCOPE), and protective factors (CD-RISC-10, LOT-R, TIPI, MSPSS), as well as questions about demographics. The childhood trauma questionnaire (CTQ-SF) was used to measure the severity of the individual subsets of childhood trauma (e.g., physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect) as well as a combined childhood trauma score.

RESULTS: Of 147 third-year medical students, 110 (74.8%) completed the baseline survey. There was a statistically significant difference in symptom severity of MDD (H= 9.36, p=0.025) and childhood trauma. No significant differences were found between GAD or PTSD and childhood trauma. A Kruskal-Wallis test also showed that there was a statistically significant difference in lower perceived social support (H= 29.32, p<0.001) or lower dispositional optimism (H= 9.20, p=0.027) and severity of childhood trauma.

CONCLUSION: These findings show that third-year medical students that experienced childhood trauma were more likely to have poorer psychological outcomes during their clinical years. This suggests the need for medical schools to develop interventions to help students with lived adversity. Future plans would be to analyze the impact of childhood trauma among all medical students so that a larger sample size can allow for a more powerful analysis in regards to the outcomes of their trauma on their medical careers.

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BENT PEDAGOGIES: CENTERING QUEER THEORIES AND VOICES IN A NOVEL APPROACH TO LGBTQ UNDERGRADUATE EDUCATION.

Christopher DeVita1 , Alli Morgan1, Beverly Forsyth2 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: In pre-clinical medical education, LGBT topics are overwhelmingly taught in a disparities model which reduces LGBT populations to singular health risks.

OBJECTIVE: To design and deliver an elective course that centered queer voices that cover topics outside of the traditional curricula and restructured the design of the course based on well-defined tenets of queer theory.

METHODS: The course design and methods of evaluation are derived from the central tenets of Queer Theory, which advocate for a multiplicity of viewpoints and constant reflexivity (Ghaziani and Brim, 2019). Rather than replicate the models of rigid benchmarks, assessments, and hierarchy that have come to define medical education, our efforts were instead motivated by tracing affect, community, and experience. Rather than seek to capture an “objective” snapshot of knowledge accumulated by class participants as is routine practice in normative curricular evaluations, we instead employed autoethnographic methods (Jones et. al, 2016) paired with narrative feedback in order to understand how course design impacts student learning experiences.

RESULTS AND CONCLUSION: The course was carried out in virtual sessions over ten consecutive weeks. 28 participants registered for the course and 41 participants attended at least one session. The participant population was composed of medical students, graduate students, faculty, residents, and staff. Participants came with a broad range of exposure to queer theory spanning from none to graduate level education. Topics included: intersex advocacy, minority stress, PrEP, extra-medical care, poly and kink care, medical advocacy, most of which are not included in traditional disparity-centered curricula. Within these sessions discussion naturally spanned and crossed scale from individual, to class, to medicine writ large, reflecting queer modes of relation. Participants remarked on how disruption of the typical lecture hierarchy allowed for them to “bring in [our] actual lived experience.” Emergent and recurrent themes shifted from how LGBT curricula might be improved to how queer insight can inform medicine more broadly. Narrative feedback highlighted the general sentiment that “[medical] curricula does not have nearly enough LGBT focus.” When participants were asked what they gained from the course they cited “community” and “opportunity to celebrate queerness from multifaceted perspectives rather than focusing only on disparities.”

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GERIATRIC RENAL TRANSPLANT CO-MANAGEMENT PROGRAM: A NEW MODEL TO OPTIMIZE PRE-TRANSPLANT CARE AND EVALUATION FOR FRAIL OLDER ADULTS.

Jared Doan1 , Stephanie Chow2, Fred Ko2 1Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Older transplant patients have higher rates of adverse post-transplant outcomes. The Renal Transplant Co-Management (RCOM) program is an interprofessional collaboration of surgeons, geriatricians, and social workers, to medically and psychosocially optimize older renal transplant candidates by providing a comprehensive geriatric-centered frailty assessment with complementing medical and psychosocial interventions prior to renal transplant listing decision. The RCOM assessment aids the surgical team in deciding whether to list a patient for transplant. Understanding how geriatric and frailty assessments factor into transplant eligibility may be clinically valuable in pre-transplant care.

HYPOTHESIS: Transplant-ineligible patients are more functionally and cognitively impaired than transplant-eligible patients.

METHODS: Fifty-five patients from a single metropolitan hospital were evaluated during the study period (1/1/22 to 6/16/22). RCOM assessment included frailty (Clinical Frailty Scale/CFS), functional status (Karnofsky score, Katz Index, Lawton-Brody) and cognition (MOCA) – factors that the renal transplant team considers in listing a patient for surgery (i.e., listed) or not (i.e., ineligible/removed from the list).

RESULTS: In this cohort, 20 patients (36.4%) were female. Of the ineligible/removed (n=10) and listed/ transplanted (n=45) patients, mean age was 74.7 (4.8) and 72.5 (3.8) respectively, with no differences in age, gender, race, education, CFS, or health insurance between groups. Patients who were listed/transplanted had a higher Lawton-Brody instrumental activities of daily living (IADL) score compared to those who were not listed (p=0.025, t-test). Karnofsky (p=0.09), Katz Index (p=0.074), and MOCA (p=0.094) scores were similar between groups but approached statistical significance despite a small sample size.

CONCLUSION: Functional status as measured by IADL may be a significant factor considered by the renal transplant team in determining the transplant eligibility of older adults. Ongoing study and a larger sample size may enable better delineation of specific measures of physical and cognitive functions that impact eligibility for transplant listing in frail older adults.

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IS OBESITY ASSOCIATED WITH INCREASED ADVERSE OUTCOMES AMONG FORCEPS ASSISTED VAGINAL DELIVERIES?

Tahera Doctor1 , Catherine Stratis1, Camila Cabrera2, Kelly Wang3, Guillaume Stoffels2, Keisha Paul3, Chloe Getrajdman2, Henri Rosenberg2, Elizabeth Cochrane2, Lauren Ferrara2, Angela Bianco2, Chelsea DeBolt2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3Biostatistics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Obstetric anal sphincter injury (OASIS) are a significant cause of perinatal morbidity and are known to be more commonly associated with forceps deliveries than with vacuum-assisted vaginal deliveries. However, the relationship between body mass index (BMI) and OASIS is unclear, with some studies showing an increased risk and other studies showing a decreased risk.

OBJECTIVE: To assess the relationship between obesity and adverse outcomes, including OASIS, among patients with forceps assisted vaginal deliveries (FAVD).

METHODS: This was a retrospective cohort study including patients at a single institution with term singleton gestations between 2017-2021 who underwent successful FAVD. The primary outcome was frequency of OASIS in patients with obesity (defined as BMI≥30) as compared to those without obesity (BMI<30). Secondary outcomes included quantitative maternal blood loss (QBL), neonatal ICU admission, and a composite adverse neonatal outcome (composite of subgaleal hematoma and cephalohematoma). Outcomes were assessed using multivariable logistic regression adjusting for clinically significant confounders.

RESULTS: 897 patients (637 (71%) with BMI<30 and 260 (29%) with BMI≥30) were included in this study. There was no significant difference in odds of OASIS between patients with BMI≥30 and patients with BMI<30 (OR 0.89 [0.56, 1.42]). When assessed as a continuous variable, higher BMI was not associated with OASIS risk (OR 0.96 [0.92, 1.01]). There was no statistically significant difference in NICU admission (OR 1.00 [0.94, 1.06]), neonatal composite score (OR 0.85 [0.54, 1.36]), or QBL (350.0cc vs 380cc, p=0.10) between the two groups.

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DOSIMETRIC COMPARISON OF IMRT VS. 3D-CRT TO SPARE ERECTILE AND OTHER SEXUAL STRUCTURES IN FEMALE RECTAL CANCER PATIENTS UNDERGOING PELVIC RADIOTHERAPY. Margaret Downes1 , Vishruta Dumane2, Kristin Hsieh2, Ayesha Ali3, Orly Morgan4, Lucy Greenwald1, Deborah Marshall2. ,4Medical Education, 2,3Radiation Oncology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, 44. Miller School of Medicine at University of Miami, Miami, Florida.

BACKGROUND: Sexual dysfunction is a distressing side effect for many female patients receiving rectal cancer radiotherapy (RT). Currently, three-dimensional conformal RT (3D-CRT) is the standard of care for rectal cancer, as intensity-modulated RT (IMRT) has not been shown to improve gastrointestinal toxicity outcomes. However, the proximity of female sexual structures to the pelvis and exclusion of female erectile tissues in prior studies warrants further investigation.

OBJECTIVE: To compare IMRT to 3D-CRT to determine the dosimetric benefits of re-optimization to avoid female sexual structures in patients receiving rectal cancer RT.

METHODS: Nine female patients [mean age: 55.6 years (SD=14.2)] with low rectal cancers treated with chemoradiation using 3D-CRT were analyzed. Doses received by sexual OARs, including bulboclitoris (BC), external genitalia (EG), and low vagina (LV), and planning target volumes (PTVs) using 3D-CRT plans were compared to IMRT plans optimized to avoid sexual structures. Dose-volume histograms for planning target volumes and other OARs were described and compared for IMRT versus 3D-CRT using Wilcoxon signedrank tests.

RESULTS: When comparing IMRT to 3D-CRT, all sexual structures received significantly lower mean doses [BC: IMRT, median 1290cGy (IQR: 572-1420) vs. 3D-CRT, 2200cGy (870-3320), p=0.004; EG: IMRT, 560cGy (509-677) vs. 3D-CRT, 1210cGy (991-1430), p=0.004; LV: IMRT, 3640cGy (2420-3780) vs. 3D-CRT, 4080cGy (3440-4330), p=0.020]. IMRT also produced large reductions in the percent volume receiving 2000cGy (V20) for all three structures compared to 3D-CRT that reached significance [BC: IMRT, 18.1% (0-26.9) vs. 3D-CRT, 55.5% (13.6-87.8), p=0.004; EG: IMRT, 0% (0-0.50) vs. 3D-CRT, 27.0% (19.4-36.1), p=0.004; LV: IMRT, 73.5% (46.1-76.2) vs. 3D-CRT, 87.1% (68.0-94.9), p=0.014]. The bulboclitoris-PTV also saw significant reductions with IMRT in mean dose [IMRT, 1200cGy (880-1360) vs. 3D-CRT, 2150 cGy (1170-3260), p=0.004] and V20 [IMRT, 16.2% (12.7-25.5) vs. 3D-CRT, 54.6% (22.0-87.5), p=0.004]. While the femoral heads and bowels did not show any significant differences, the percent of bladder receiving 5000cGy was also reduced on IMRT [IMRT, 9.3 (0-22.6) vs. 3D-CRT, 29.2 (16.7-45.2), p=0.020].

CONCLUSION: Compared with 3D-CRT, IMRT significantly reduces sexual and bladder toxicity and key dosimetric indexes while not introducing significant changes to PTV coverage or dose to other important OARs.

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THE IMPACT OF SURGERY ON MORTALITY IN ELDERLY PATIENTS WITH PROXIMAL HUMERUS FRACTURES: A RETROSPECTIVE ANALYSIS OF MEDICARE BENEFICIARIES. Akiro Duey1 , Nicole Zubizarreta2, Brocha Stern2, Jashvant Poeran2, Leesa Galatz2, Bradford Parsons2, Paul Cagle2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Proximal humerus fracture (PHF) is the third most common type of fracture in elderly patients and has been identified as a risk factor for 1-year mortality.

OBJECTIVE: To determine if surgical treatment for PHF in elderly patients is associated with higher mortality compared to nonoperative treatment.

METHODS: This was a retrospective study using the Centers for Medicare and Medicaid Services Limited Data Set (CMS-LDS) between the years 2016-2020. All patients were over the age of 65. Patients were included based on a diagnosis of PHF which was identified by the International Classification of Diseases, 10th Revision (ICD-10) diagnosis code S42.2X. The surgical cohort was defined as any patient undergoing open reduction internal fixation (ORIF), hemiarthroplasty (HA), or total shoulder arthroplasty (TSA). Patients who did not undergo surgery within 30 days of initial PHF diagnosis were placed in the nonoperative treatment group. A multivariate logistic regression model was created to compare mortality between surgical and nonoperative groups while controlling for patient demographics and comorbidities.

RESULTS: In total, 163,672 patients were included in the study. The mean age was 78.1 years, and 131,125 patients (80.1%) were female. Patients in the nonoperative group were older (78.5 years; p<0.001) and less likely to be female (79.7%; p<0.001). 142,439 patients (87.0%) were treated nonoperatively, 6.3% underwent TSA, 5.9% underwent ORIF, and 0.8% underwent HA. At one year after the initial PHF diagnosis, the nonoperative group had the highest mortality rate at 15.6% (p<0.001). The 1-year mortality rates were 6.0% for TSA, 7.0% for ORIF, and 8.6% for HA. Logistic regression analysis showed that TSA (OR: 0.43; 95% CI: [0.39, 0.47]; p<0.001), ORIF (OR: 0.55; 95% CI: [0.51, 0.60]; p<0.001), and HA (OR: 0.59; 95% CI: [0.48; 0.72]; p<0.001) remained associated with significantly lower 1-year mortality compared to nonoperative treatment.

CONCLUSION: When compared to nonoperative treatment of PHF, surgery was associated with lower 1-year mortality rates. Our findings suggest that in elderly patients, surgical treatment of PHF may reduce short-term mortality.

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PULMONARY HYPERTENSION IN CHILDREN WITH SEVERE OBSTRUCTIVE SLEEP APNEA.

Monica Feeley1 , Jason Bronstein2, Douglas Bush2 1Medical Education, 2Pediatrics.

1,2Icahn

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

BACKGROUND: Obstructive sleep apnea (OSA) is a well-documented risk factor for pulmonary hypertension (PH) in adults; however, this is a less clearly defined risk factor in children. There are varying reports of PH in children with OSA, mostly at low frequencies. Varying definitions of PH and OSA in children have made it difficult to estimate the presence of PH in this population.

OBJECTIVE: To evaluate the prevalence of PH in children with OSA screened in a pediatric PH clinic. Further, we hoped to understand additional biomarkers that might support the need for echocardiograms in children with OSA. To investigate biomarkers and prevalence of PH in children with severe OSA.

METHODS: We completed a single center retrospective chart review of pediatric patients with suspected OSA from Jan. 2018-present. Patients included were ≤ 18 years and had evidence of severe OSA (AHI > e/ hr) on polysomnography (PSG). Patients with known comorbid associations contributing to PH onset (e.g. genetic syndromes) were excluded from analysis. We then determined the prevalence of echocardiographicbased PH diagnosis within this sample, as well as potential PSG biomarkers for PH.

RESULTS: A total of 58 patients with severe OSA met the criteria for inclusion in this retrospective study. Mean age at PSG was 7.3 years (SD= 4.1). The male to female ratio was 2.6:1. A majority of the patients identified their race as other (n=35, 60.3%) and approximately a quarter identified as black (n= 15, 25.9%). The mean BMI was 27.93 kg/m2 ± 12.1 and half of the patients were either overweight or obese (n= 29, 50%). 4 of the patients with severe OSA had PH diagnosed based on echocardiographic evidence (6.9%, 95% CI [0.0191 – 0.1673]). The mean apnea hypopnea index (AHI) for OSA + PH was 17.9 ± 14.1 e/hr compared to 32.2 ± 25.3 e/hr. The lowest SpO2 average (74.8% v. 73.7%) and cumulative time SpO2 <90% (23.1 v. 22.6 minutes) for both OSA + PH and OSA groups were similar. Interestingly, n=0 of the OSA + PH patients underwent an adenotonsillectomy, whereas n=42 of the OSA patients did.

CONCLUSION: Although OSA is identified as a risk factor for PH in adults, there is neither a definitive set of biomarkers nor accepted prevalence estimate in pediatric patients. This single center cohort supports previous literature indicating that PH prevalence in pediatric patients with OSA is low. Therefore, OSA and PSG data may not be an accurate predictor of PH development in this population.

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EVALUATION OF THE REDUCTION AND ASSOCIATION OF THE SCAPHOID, CAPITATE, AND LUNATE (RASCL) PROCEDURE IN RESOLVING CARPAL INSTABILITY: A BIOMECHANICAL ANALYSIS. Pierce Ferriter1 , Christian Awah2, Matthew Gluck1, Philip Nasser2, Amanda Walsh2, Michael Hausman2 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Disruption of the scapholunate (SL) ligament leads to progressive radiocarpal arthritis and instability. While the reduction and association of the scaphoid and lunate (RASL) procedure can restore anatomic alignment of the carpus, complications are common. Previous studies have shown up to a 39% failure rate, with SL joint widening being the most common.

OBJECTIVE: To evaluate the effect of the reduction and association of the scaphoid, capitate, and lunate (RASCL) procedure, where an additional screw is placed at the scaphocapitate (SC) interval. We hypothesize the addition of the SC screw in RASCL specimens will decrease diastasis and rotation at the SL interval, conferring greater stability and a lesser likelihood of implant failure compared to RASL specimens.

METHODS: 7 RASL and 7 RASCL fresh-frozen cadaveric upper extremities were harvested via ulnohumeral disarticulation. Specimens were positioned grasping a custom bar attached to an Instron testing system, mimicking clenched-fist loading, and were subjected to transcarpal axial forces ranging from 100-200N. Infrared (IR) 3D motion capture cameras viewed IR markers embedded into the scaphoid, capitate, and lunate. Outcomes measured included Euler angle (axial rotation in three dimensions) and diastasis at the SL interval. Euler angles were collected using motion capture software and diastasis was measured radiographically using ImageJ. A Mann-Whitney U-test was used to compare RASL and RASCL diastasis.

RESULTS: 13 specimens were included in the study. Euler angle measurements were almost indistinguishable and did not increase proportionally to greater force cycles. Although RASCL diastasis values were overall more negative than RASL, there was no statistically significant difference between the two groups in terms of diastasis (p=0.07).

CONCLUSION: Despite no statistical difference between RASL and RASCL groups, this result is clinically meaningful; it suggests no benefit to an additional SC screw in terms of stabilizing the SL joint. Our conclusions are limited by a few factors, primarily a small sample size. Secondly, the testing protocol with distinct RASL and RASCL groups may have not been sensitive enough to appreciate the SC screw’s effect on SL stability. In future testing, a new protocol will measure diastasis and rotation at the SL joint but on the same specimen and in stepwise fashion with no injury, after SL injury, and finally with the addition of SL and SC screws.

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COVID-ERA CHRONIC KIDNEY DISEASE PATIENT ENGAGEMENT VARIES

DISTINCTLY BY SOCIO-DEMOGRAPHIC FACTORS.

James Fleming1 , Richa Deshpande2, Lili Chan3, Kirk Campbell3, Ellerie Weber2 1Medical Education, 2Population Health Science and Policy, 3Medicine.

1,2,3Icahn

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

BACKGROUND: Chronic Kidney Disease (CKD) requires regular outpatient follow up for management and monitoring of progression. While there are known disparities in CKD care, few studies have quantified the impact of COVID on CKD visit frequency in relation to sub-populations of racial/ethnic identity, age, sex, and insurance.

OBJECTIVE: To compare how COVID impacted the number of visits for newly established CKD patients, and to investigate whether there are significant discrepancies when considering subgroups of race, age, sex, and insurance status.

METHODS: MSHS EHR data was obtained from 1/18 – 7/21 for patients (pts) with CKD stages 3-5 (no dialysis). Variables included demographics, outpatient encounters, provider names/services, and ICD-10/ CPT codes. Patients were included if the visit was conducted by a nephrology provider and CKD was an encounter diagnosis. The pre-COVID cohort consisted of pts who had a NEW office visit by CPT code between 9/18-2/19; their data was analyzed from 3/19-2/20. The COVID cohort was established in the same manner, targeting data from 3/20-2/21.

RESULTS: The number of patients in each cohort was 530 (pre-COVID) and 759 (COVID). Established office visits per pt differed between pre-COVID (2.5) vs. COVID (1.4, p < 0.001). All racial/ethnic subgroups except for Asian displayed proportionally less established visits during COVID (Hispanic/Latinx p < 0.001, Black/African American p = 0.007, Other p < 0.001, White p = 0.005, overall p = 0.02). Pt age was younger during COVID for all racial/ethnic subgroups except for White, with significance observed in Hispanic/Latinx (70 vs. 61, p < 0.001) and Black/African American (66 vs. 64, p = 0.046). Fewer female pts attended established visits during COVID in all racial subgroups except for White [Asian 62% vs 21% (p < 0.001), Hispanic/Latinx 57% vs. 43% (p = 0.038), White 25% vs 40% (p < 0.001)]. Visits by insurance were significantly different within both cohorts (p < 0.001) and pts covered by Medicare and Medicaid had less visits compared to Commercial (p < 0.01 vs. p=ns).

CONCLUSION: These findings from a COVID-era CKD patient population reveal disparities that existed before the pandemic and demonstrate which were exacerbated thereafter. Further analysis is warranted to expand the insights as they relate to lab markers, inpatient events, and long-term outcomes. Providers who treat CKD patients can use these findings to anticipate care gaps and address them accordingly.

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HISTOLOGIC EOSINOPHILIA IN PEDIATRIC IBD.

Hannah Freid1 , Elizabeth Spencer2 1Medical Education, 2Gastroenterology.

1,2Icahn

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

BACKGROUND: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been proposed to include involvement of eosinophils, a type of inflammatory immune cell. While previous literature suggests involvement of such immune cells in IBD, the incidence of eosinophilia in IBD has not been well-documented. Predictors of eosinophilia and how presence of eosinophilia should alter treatment is not understood.

METHODS: Patients under 22 at time of colonoscopy were included from a Prospective BioBank Program, which includes clinical patient data, at the IBD Center of a tertiary care center from 2006-2022. Available colonoscopy and pathology reports were analyzed, along with disease phenotype, therapy, and history of atopy.

RESULTS: Data from 300 colonoscopy reports (202 CD, 98 UC) was recorded, representing 126 individuals (88 CD, 38 UC). 16% of reports and 30% of individuals had eosinophilia noted on pathology. Of individuals with eosinophilia, 50% of their available pathology reports noted eosinophilia. There was no significant difference in percentage of patients or reports with eosinophilia when comparing CD and UC. Of reports with complete disease remission (no active or chronic inflammation; n=38), only 5% noted eosinophilia. Endoscopic eosinophilia was significantly associated with family history of an atopic disorder for CD (p=0.02) but not for UC. Though not significant, a smaller percentage of patients on no treatment at time of endoscopy (n=86) had histologic eosinophilia (22%) than patients on an anti-TNF biologic (31%, p=.1). This trend was not observed for anti-40 or anti-integrin biologics. A paradoxical reaction to anti-TNF therapy, which includes alopecia and psoriasiform dermatitis, trended towards being more likely in patients who also had endoscopic eosinophilia while on anti-TNF therapy (p=0.0505).

CONCLUSION: These results identify the prevalence of eosinophilia in IBD, suggesting that the potential mechanism of eosinophils in IBD should be further explored. While IBD type is not predictive of eosinophilia, family history of atopy and disease remission status seem to be associated with eosinophils. Treatment with anti-TNF showed a potential trend of eosinophilia, which may warrant further exploration. Anti-TNF therapy may be associated with eosinophilia in a certain cohort–those who also experience anti-TNF paradoxical reactions.

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TACKLING FOOD INSECURITY WITH A CLINIC-BASED FOOD PANTRY AND REFERRALS

TO COMMUNITY-BASED FOOD PANTRY IN NEW YORK CITY.

Zachary Gallin1 , Leora Mogilner2, Lauren Zajac3, Sonia Khurana2, Paige Cloonan2, Jennifer Acevedo2, Eve Spear4, Haley Ottensoser3, Alexis Burgess2. 1Medical Education, 2Pediatrics, 3Preventive Medicine, 4Biology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York, 4Barnard College, New York, NY.

BACKGROUND: Pediatricians can detect and address food insecurity (FI), a significant issue affecting children’s health. As part of its socioeconomic determinants of health (SDH) screening program, the pediatric clinic at Mount Sinai provides families with FI an emergency food package, a referral to a local pantry, and information about food assistance programs (such as WIC and SNAP). Understanding the impact of the SDH program on FI can inform program design.

OBJECTIVE: To assess changes in FI over a 3-month period among families with FI that were referred by a SDH program to on-site clinic food pantry.

METHODS: Families with FI were offered an emergency food package, information about food assistance programs and an invitation to participate in the study. We collected baseline sociodemographic data, and families completed the 18-item USDA Household Food Security Survey upon enrollment and three months later. Information on participation in food assistance programs and registration in local food pantries was gathered. To explore changes in FI scores over time, we used a mixed-effects model. This model was adjusted for child’s race and sex, housing type, insurance, caregiver education, employment, and number of unmet social needs.

RESULTS: 113 families with FI enrolled in the study and 63 (56%) completed the 3-month follow-up USDA Household Food Security Survey. In a mixed-effects model, enrollment in the SDH program was associated with a decrease in the FI score at 3 months [4.4 (SD=3.6) to 3.3 (SD=3.3)] (p<0.05). This remained significant after adjusting for covariates (p<0.02). All families that enrolled accepted a food package, and 23 (20%) consented to get information about SNAP and 10 (9%) accepted information about WIC. Forty-three (68.3%) families accepted a referral to NYCP, and 24 (56%) of 43 became clients at a local pantry.

CONCLUSION: Families with FI who were referred by an SDH program to a clinic on-site food pantry where they received an emergency food package, referrals to a community pantry, and information about food assistance programs experienced a decrease in FI over a 3- month period. Future plans include analyzing changes over a 12-month period to assess if FI changes are sustained and which interventions were most impactful. This intervention, which provides immediate food assistance while linking families to more longterm assistance may be a successful model for combating food insecurity.

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INDIVIDUAL SOCIOECONOMIC FACTORS HAVE A GREATER IMPACT ON PROXY-REPORTED END-OF-LIFE OUTCOMES THAN REGIONALITY.

William Gansa1 , Hannah Kleijwegt2, Subashini Rajagopalan2, Melissa Aldridge2, Mohamed Benyamine2, Claire Ankuda2. 1Medical Education, 2Geriatrics and Palliative Medicine.

1,2Icahn

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

BACKGROUND: End-of-Life (EoL) healthcare provided to Americans in urban and rural settings is distinct in terms of both available and delivered services. But much less is still known about which geographic, demographic, and health indicators drive disparities in satisfaction with EoL care outcomes.

OBJECTIVE: To assess how regional indicators and degrees of rurality affect proxy reported Quality of Care (QoC) during the Last Month of Life (LML) across individual socioeconomic factors.

METHODS: This is a cross-sectional study of N=2778 decedents whose proxies completed the LML questionnaire distributed by the National Health and Aging Trends Study (NHATS). The NHATS is a national representative cohort study of adults over the age of 65. The data was linked at the zip code level to United States Department of Agriculture (USDA) Economic Research Service Typology Codes, USDA Urban Influence Codes, and University of Wisconsin County Health Rankings. We tested the association of individual and regional characteristics using two way frequency tables and simple logistic regressions.

RESULTS: County rurality index (p=0.70) and county health factors (p=0.75) were not correlated with proxy-reported QoC during the LML, after adjusting for age, race, and sex. The cohort that reported excellent care versus not excellent care differed significantly by race (p=0.05), education level (p=0.05), and income quartile (p=0.000) after appropriate survey weighting.

CONCLUSION: Proxy-reported satisfaction with EoL care may be more dependent on individual socioeconomic factors than a wide range of regional indicators including degrees of rurality. Clinicians in both metropolitan and rural areas should strive to more comprehensively recognize the interplay of individual characteristics and regional indicators to provide more personalized care to their patients and to achieve higher levels of patient satisfaction at this critical juncture.

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WHITE MATTER MARKERS FOR TREATMENT OUTCOMES IN MAJOR DEPRESSIVE DISORDER.

Jack Gomberg1 , Jungho Cha2, Juna Khang2, Boadie Dunlop3, Edward Craighead4, Ki Sueng Choi2, Helen Mayberg2 1Medical Education, 2,3Neurology, 4Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3,4Emory University.

BACKGROUND: First-line treatment for major depressive disorder (MDD) include cognitive behavioral therapy (CBT) and/or antidepressant medications (ADM). These treatments have heterogeneous effects in patients with similar presentations. Previous fMRI studies implicate differential connectivity in the left anterior insula in CBT/ADM remitters (Dunlop 2017). Unknown structural connectivity changes might mediate these functional connectivity (FC) patterns. Therefore, we evaluated White matter (WM) integrity in MDD patient response to CBT or ADM monotherapy.

OBJECTIVE: To determine potential markers for differentiation of MDD treatment outcomes. Similar studies in FC point to areas in the insula, left ventromedial prefrontal cortex, and periaqueductal gray. We hypothesize that we will see areas of interest within FA maps within these same areas.

METHODS: Analysis of diffusion-weighted-imaging (DWI) was performed in 110 treatment naïve MDD patients randomized to 12-weeks of CBT/ADM. Subjects were grouped into remitters (HDRS17 score <7 at 10 and 12 weeks) and nonresponders (HDRS change<30%). Whole-brain fractional-anisotropy (FA) maps were calculated using Fdt toolbox. Tract-Based-Spatial-Statistics (TBSS) generated for statistical comparison. Voxel-wise 2x2 ANOVA: treatment (CBT/ADM) by outcome (remitter/nonresponder) was performed using AFNI 3dMVM toolbox. Regional WM changes were correlated with HDRS changes within treatment.

RESULTS: A significant treatment by outcome interaction was identified affecting WM tracts adjacent to the left insula, left supplementary motor area, and left hippocampus (p<0.001 uncorrected). Post hoc analysis revealed ADM remitters and CBT nonresponders show higher FA values in the left insula (0.35, 0.41) and SMA (0.36, 0.45) compared to both ADM nonresponders and CBT remitters (0.32, 0.31 insula; 0.31, 0.31 SMA), near the location and pattern of FC. In contrast, ADM remitters (0.52) and CBT nonresponders (0.48) show lower FA in the left hippocampus compared to ADM nonresponders (0.56) and CBT remitters (0.54). Of note, only the left insula showed a significant correlation (r=0.089; p=0.001) with magnitude of clinical response, but only in the ADM treated group.

CONCLUSION: These findings identify differential WM integrity in the insula, SMA, and hippocampus in remitters and failures to CBT and ADM. As with FC findings, structural connectivity patterns may define biotypes that impact response to MDD therapies and guide treatment.

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THE EFFECT OF CAGE DIMENSIONS ON SUBSIDENCE FOLLOWING ANTERIOR CERVICAL DISCECTOMY AND FUSION.

Christopher Gonzalez1 , Akiro Duey2, Eric Geng2, Justin Tang2, Pierce Ferriter2, Ashley Rosenberg2, Ula Isleem2, Bashar Zaidat2, Paul Al-Attar2, Jonathan Markowitz2, Jonathan Gal2, Jun Kim2, Samuel Cho2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Cage subsidence is a common complication following ACDF which poses clinical complications including decrease in disc height, sagittal alignment disruption, nonunion or pseudoarthrosis formation, and foraminal stenosis.

OBJECTIVE: To determine the relationship between cage dimensions and cage-to-vertebral body ratio and subsidence in ACDF.

METHODS: We conducted a retrospective analysis of radiographs following elective ACDF performed from 2016-2021 at an urban, academic tertiary medical center. The radiographic measurements were obtained on lateral cervical radiographs at immediate postop (<6 weeks) and long-term postop (> 6 months). Posterior disc height (PDH) and anterior disc height (ADH), vertebral body length, cage length and height, and segmental lordosis were measured as indicated in Figure 1. Pearson correlation tests and multivariate logistic regression analyses were used to compare cage height, length, vertebral body length, and cage-to-body ratio with subsidence and change in segmental lordosis.

RESULTS: There were 131 patients and 244 levels fused in this study: 41 one-level, 67 two-level, and 23 threelevel fusions. The median final follow-up time was 366 (IQR: 239-566) days. Cage length (r = 0.238; p < 0.001), cage height (r = 0.329, p < 0.001), and vertebral body length (r = 0.286; p < 0.001) were positively correlated with anterior subsidence. Cage length (beta = 0.22; 95% CI: [0.11, 0.33]; p < 0.001), cage height (beta = 0.34; 95% CI: [0.20, 0.47]; p < 0.001), and vertebral body length (beta = 0.22; 95% CI: [0.15, 0.30]; p < 0.001) were all also significant predictors of anterior segmental subsidence as determined by multivariate analyses.

CONCLUSION: Cage length and height were both positively correlated with anterior subsidence. The results from this study can better inform surgeons about cage selection and its impact on postoperative recovery in ACDF to help obtain optimal outcomes for patients.

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THE

EFFECTS OF NEIGHBORHOOD CHARACTERSTICS ON PUERTO RICAN CHILD MENTAL HEALTH DURING THE COVID-19 PANDEMIC.

Brianna Gordon1 , Cristiane Duarte2 1Medical Education, 2Psychiatry. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2Columbia University, New York, New York.

BACKGROUND: There is a growing body of literature examining the neighborhood as an essential aspect of child development. Studies have linked worse neighborhood social processes with poorer child mental health outcomes. Few studies have explored the role of neighborhood processes on child mental health during the COVID-19 pandemic, as efforts to minimize virus spread increased time at home and decreased networks for support and resources.

OBJECTIVE: To examine the effect of neighborhood collective efficacy and neighborhood risk on Puerto Rican child mental health during the pandemic. This inquiry would add to the scholarship investigating structural forces on minoritized childhood.

METHODS: The New York Psychiatric Institute and University of Puerto Rico Medical School conducted parental interviews evaluating collective efficacy, which measures the degree to which residents perceive community cohesion and trust, and neighborhood risk, resident perception of safety. We utilized the Child Behavioral Checklist (CBCL), a validated parental screening tool to assess a child’s behavioral well-being. The CBCL is categorized into externalizing or internalizing behaviors and six DSM-guided dimensions, with higher scores indicating worse mental health outcomes. A Spearman’s rho 2 tailed-test was run to determine whether predictors, collective efficacy or risk, influenced CBCL score as a parameter of child mental health. A multiple linear regression was run to determine the effects of collective efficacy and risk on CBCL score with adjustments for other relevant co-factors including age and gender.

RESULTS: 412 parental interviews and child assessments were conducted, 268 from San Juan, PR, and 144 from New York, NY. Child ages ranged from 3-11 years (M=7) and 49.4% were female. We found a significant negative correlation between collective efficacy and CBCL scores, rho=-.144, p=.003. We also found a significant positive correlation between risk and CBCL score, rho=.108, p=.028. On regression analysis, collective efficacy significantly predicted CBCL score, =-.099, p=0.044. Neighborhood risk, however, did not significantly predict CBCL score =.035, p=.482.

CONCLUSION: The findings in this cohort suggest neighborhood collective efficacy is a protective factor in child mental health and may be crucial to community resilience. Future research should investigate the role of other demographics and racial dynamics to explore collective efficacy further.

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FAMILY CAREGIVERS’ CHALLENGES NAVIGATING THE INSURANCE LANDSCAPE FOR FAMILY MEMBERS WITH DEMENTIA IN A HOME-BASED PRIMARY CARE PROGRAM.

Mikayla Gordon Wexler1 , Jennifer Reckrey2 1Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: For the almost 11.3 million family and other unpaid caregivers in the United States caring for loved ones with dementia, navigating the health insurance landscape is shaded by the complex care needs of those with dementia.

OBJECTIVE: To explore how caregivers make decisions around insurance and how these choices affect the care that home-bound individuals with dementia receive.

METHODS: Semi-structured telephone interviews were conducted from June 2022 to December 2022 with family caregivers of people with dementia who are enrolled in home-based primary care and who are dually eligible for Medicaid and Medicare. After obtaining sociodemographic data, we asked a set of open-ended questions exploring caregivers’ perspectives on navigating their family member’s insurance plans. Interview data were analyzed using thematic analysis with both deductive and inductive coding.

RESULTS: Participants (N=13) described how in the initial transition to caregiving after their family members’ dementia diagnosis or decompensated medical status, the burden of insurance decision-making compounded the stress of adjusting to care responsibilities at home. Participants described medical and legal professionals, particularly the home-based primary care team, as providing necessary support when accessible; however, they saw no centralized way to identify insurance-specific supports. Attributes influencing insurance choices included: family dynamics; previous plans in which their family member was enrolled; home care and medical supply needs. After initial insurance decisions were made, participants describe maintaining existing insurance. Despite clinically significant gaps in insurance coverage, participants reported that the burden of changing to any alternative plans was too high.

CONCLUSION: This study highlights the challenges that family caregivers caring for home-bound individuals experience when seeking out information about needed insurance plans, especially when they are new to the caregiving role. These challenges may contribute to unwillingness to change plans even when gaps in insurance plans exist. Robust and centralized professional support for family members immediately after loved one’s dementia diagnosis could alleviate burden on caregivers and increase their capacity to maximize insurance plan and coverage benefits throughout their family member’s dementia progression so that their family member can continue to receive care at home.

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DISPARITIES IN HEALTH OUTCOMES IN MEDICAID PATIENTS WITH EPILEPSY BY PRACTICE SETTING: PROMOTING HEALTH EQUITY IN ACADEMIC MEDICAL CENTERS.

Evelyn Gotlieb1 , Parul Agarwal2, Leah Blank2, Nathalie Jette2 1Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Medicaid beneficiaries represent one third of all people with epilepsy. In New York City and across the country, many academic medical centers operate on a ‘two-tiered’ system in which Medicaid patients receive care in a separate setting than non-Medicaid patients. In 2018, the Neurology department at Mount Sinai Hospital adopted ‘Article 28,’ which permitted integration of care; the non-Medicaid ‘faculty practice’ could now see patients who would previously only be eligible for the Medicaid-only ‘outpatient clinic.’

OBJECTIVE: To evaluate the association between type of facility (integrated or not) and telehealth utilization.

METHODS: We performed retrospective analyses using data from the Mount Sinai Health System (MSHS) electronic medical record. We identified people of all ages with epilepsy who were followed by an epileptologist after 2018 using an ICD-10-CM coded case definition validated in our health system. We stratified patients by practice setting [(‘outpatient clinic’ (Medicaid-only) versus MSHS epilepsy faculty practice)]. Our key outcome of interest was telehealth use. Descriptive statistics stratified by facility type were estimated. Logistic regression was used to evaluate associations between groups.

RESULTS: We computed patient characteristics for three sub-groups in our sample (N=4586): (1) Medicaid patients seen in Medicaid clinic (N=387), (2) Medicaid patients seen in outpatient clinic after integration (N=723), and (3) non-Medicaid patients seen in outpatient clinic (N=3476). Patients in group 3 were significantly older than Medicaid patients, with an average age of 40 compared to 29 and 28.5 in groups 1 and 2 respectively (p<0.0001). Medicaid patients were more likely to have drug resistant epilepsy, with 51.94% of patients in group 1, 41.63% of in group 2, and 37.2% of group 3 having drug resistant epilepsy (p<0.0001). Patients seen in Medicaid clinic were less likely to have telehealth visits (phone and video); 81.65% of patients in group 1 had no telehealth visits compared to 71.78% of group 2 and 70.89% of group 3 (p<0.001).

CONCLUSION: Our study demonstrates higher telehealth utilization in those followed in the integrated faculty practice. This suggests that integrated care may be associated with better health outcomes in people with epilepsy. Future research is needed to examine the direct impact of integrated care on other epilepsy related health outcomes.

CLIMATE AND HEALTH EDUCATION: A CRITICAL REVIEW AT ONE MEDICAL SCHOOL.

Lucy Greenwald1 , Olivia Blanchard1, Colleen Hayden1, Perry Sheffield2 1Medical Education, 2Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized. To continue to grow the number of medical students who achieve competency in the effects of climate change on individual health and the health of the planet during their training, we must examine what has worked to date and continue to shift our approach as curricular changes are implemented for feasibility and relevancy.

OBJECTIVE: To assessed the “climate and health” content at one northeastern U.S. medical school that is undergoing an overhaul of their entire curriculum to explore strategies to deliver more robust climate health education in the context of the educational redesign.

METHODS: We conducted 1) a retrospective review of the now four-year-old initiative to investigate the sustainability of the original content, and 2) semi-structured interviews with lecturers, course directors, and medical education coordinators involved in implementation, and with faculty tasked with developing the upcoming curricular redesign.

RESULTS AND DISCUSSION: Of the original implementation plan, the content was still present in nine of the 14 lectures. Themes determined from our conversations with involved faculty included the need for 1) a shared vision throughout the content arc, 2) further professional development for faculty, and 3) involvement of summative assessment for students and the content itself to ensure longevity. The interviews also highlighted the importance of developing climate-specific resources that fit within the school’s new curricular priorities. This critical review can serve as a case study in curriculum to inform other schools undergoing similar changes.

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AEQUITAS: A DEEP LEARNING-BASED METRIC FOR DETECTING, CHARACTERIZING, AND MITIGATING DATASET BIAS.

Faris Gulamali1 , Girish Nadkarni2 1Medical Education, 2Nephrology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

Biased datasets can generate models that propagate sociodemographic disparities in diagnosis, prognosis, and treatment in healthcare. However, these biases are often difficult to detect and address, due to their implicit nature. Here, we introduced AEquitas (AEq), an unsupervised, scalable deep learning metric based on autoencoders, to detect different types of biases in datasets. We showed that AEq exhibits distinct characteristics when a dataset is subject to sampling bias, label bias, and complexity bias in synthetic datasets. We then used multiple medical imaging datasets to show that AEq can quantify and qualify biases by diagnosis, self-reported race, and insurance status. For example, chest X-rays from Black patients diagnosed with atelectasis and pneumothorax have a significantly larger AEq values than chest X-rays belonging to White individuals with the same diagnoses ((AEqBlack, Atelctasis = 9.12; 95% CI: (9.01, 9.22), AEqWhite, Atelctasis = 8.22; 95% CI: (8.13, 8.30); P < 0.05), (AEqBlack, Pneumothorax = 10.10; 95% CI: (10.01, 10.18), AEqWhite, Pneumothorax = 9.50; 95% CI: (9.44, 9.58); P < 0.05). A larger AEq represents a dataset biased against a given population, which aligns with past work which has shown the chest X-ray classifiers under-perform in black individuals. Next, we highlighted targeted interventions that are informed by AEq, applicable during data collection, labeling and training, to mitigate bias and improve generalizability of models. Prospectively collecting population-specific X-ray data leads to a 0.07 increase in test AUC for edema on Chest X-rays belonging to Black patients. (AUCPre = 0.72; 95% CI: (0.71, 0.73) vs. AUCPost = 0.79; 95% CI: (0.79, 0.80), P < 0.05, n=8,192). Similarly, we demonstrated a 0.06 increase in test AUC for pneumothorax on Chest X-rays belonging to individuals with Medicare when a similar intervention is performed on insurance status (AUCPre = 0.59; 95% CI: (0.59, 0.60) vs AUCPost = 0.65; 95% CI: (0.65, 0.66), P < 0.05 n = 8,192). Finally, we highlight the sample efficiency of our method compared to prospective validation, which ranges from 200-500 depending on the task. In summary, we developed and validated a novel method to investigate dataset bias and enable equity in the application of artificial intelligence to medical imaging.

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METABOLIC PARAMETERS PREDICTIVE OF IMAGING FEATURES ASSOCIATED WITH NEOPLASTIC PROGRESSION IN A PANCREATIC CANCER SURVEILLANCE PROGRAM.

Michael Hill-Oliva1 , John Doucette2, Arielle Labiner3, Marlon Brewer3, Ariel Bar-Mashiah4, Daniel Fulop1, Julie Yang3, Satish Nagula3, Christopher DiMaio5, Aimee Lucas3. 1Medical Education, 2Environmental Medicine & Public Health, 3,4Medicine, 5Gastroenterology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York, 4Weill Cornell Medicine, New York, NY, 5Catholic Health - St. Francis Hospital & Heart Center, Roslyn, NY.

BACKGROUND: Early detection of pancreatic ductal adenocarcinoma (PDAC) is critical for reducing mortality.

OBJECTIVE: To identify whether changes in metabolic parameters predicted the development of imaging features previously associated with neoplastic progression (IFNP), high-grade dysplasia (HGD), or PDAC in high-risk individuals (HRIs). IFNP includes solid lesions, high-risk cysts, duct abnormalities, lymphadenopathy.

METHODS: Of patients enrolled in a pancreatic disease registry, HRIs who were first-degree relatives of affected individuals in Familial Pancreatic Cancer (FPC) kindreds or who harbored pathogenic germline variants (PGVs) in PDAC-susceptibility genes with a family history of pancreatic cancer were included if they met criteria for surveillance and underwent imaging or resection. Clinical data including hemoglobin A1c (HbA1c), fasting blood glucose (FBG), body mass index (BMI), and imaging/pathology data were extracted from records, missing values imputed from prior observations. Rates of change were calculated. Data were censored after development of HGD or PDAC. Mixed effects logistic regression models analyzed the relationship between metabolic parameters and IFNP, PDAC or a composite endpoint of IFNP/HGD/PDAC.

RESULTS: Of 875 enrolled, 176 met inclusion criteria: 104 (59.09%) from FPC kindreds. Median age was 64 (range: 36-84), 115 (65.34%) female; 142 (80.68%) identified as White. PDAC was found in 6 (3.41%), HGD in 1 (0.57%) and IFNP in 57 (32.39%). Median surveillance was 2.72 years (IQR: 4.06).

In univariate models, HbA1c (OR: 2.81, 95% CI: 1.50-5.27), age (OR: 1.20, 95% CI: 1.13-1.27), and FPC (OR: 4.14, 95% CI: 1.31-13.10) were associated with IFNP. Only BMI (OR: 1.07, 95% CI: 1.02-1.13) was associated with PDAC. HbA1c (OR: 2.70, 95% CI: 1.46-5.02), age (OR: 1.20, 95% CI: 1.13-1.27) and FPC (OR: 4.43, 95% CI: 1.4113.90) were associated with the composite. In multivariate analysis of HbA1c, age and FPC, only HbA1c (aOR: 2.86, 95% CI: 1.46-5.58) and age (aOR: 1.22, 95% CI: 1.13-1.31) were associated with IFNP. Neither HbA1c (aOR: 1.85, 95% CI: 0.77-4.48) nor BMI (aOR; 1.05, 95% CI: 0.98-1.13) were associated with PDAC. HbA1c (aOR: 2.71, 95% CI: 1.41-5.23) and age (aOR: 1.21, 95% CI: 1.13-1.30) but not FPC predicted the composite.

CONCLUSION: Elevated HbA1c may signal precancerous abnormalities in HRIs and serve as a valuable tool in surveillance. Further research is required to understand metabolic changes prior to development of PDAC.

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AN EXPLORATORY APPROACH TO CHARACTERIZING PEDIATRIC MENTAL HEALTH SERVICES AND REFERRALS IN EAST HARLEM.

Nancy Huang1 , Ann-Gel Palermo1, Ray Cornbill2 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2East Harlem Community Health Committee, Inc., New York, New York.

BACKGROUND: The inequity in accessing youth mental health services (MHS) became even more pronounced with COVID-19, as the NYC Department of Education reports a steady rise in the number of students needing MHS. Subsequently, this project, supported by the East Harlem Community Health Committee, Inc., aims to examine specific entry, interaction, and exit points for at-risk youth while outlining service provider connections. Having detailed insight into the workflow of referral and follow up procedures for pediatric MHS could further reveal areas in the process that are successful or could be improved to provide minors equitable consistent access to adequate services.

RESEARCH QUESTION: What is the characterization of the current status of pediatric mental health services, including referral and follow-up processes, provided by School-Based Health Centers (SBHC) in East Harlem?

METHODS: A review of peer-reviewed and ‘gray’ literature, public data, and news media was conducted. This informed the compilation of public schools, SBHC, school-based mental health clinics, and their designated services in East Harlem. Semi-structured interviews with school providers, administration, and staff at a single SBHC were conducted to observe the delivery of care and develop a process flowchart, focusing on referral and follow-up procedures for their clients.

RESULTS: The inventory of EH public schools characterized the variety in governance, providers/sponsors of MHS, student population size, NYC community school status, association with a District 75 program, and designated MHS. This compilation process also revealed a gap in understanding of the operational status of the designated MHS at each school. The flowchart of the process for MHS at a single SBHC detailed the current referral and follow-up procedures. This revealed complexity and nuance of student-provider, provider-provider, provider-family, student-family relationships in an educational setting, further adding to the potential variability within pediatric MHS.

CONCLUSION: This project provides the foundation towards a comprehensive assessment of mental health services at individual schools within East Harlem. Variability and ambiguity is present within each level of examination - schools, SBHC services, individual SHBC providers and processes. The complexity of a single SBHC’s referral and follow up process exposes the potential for targeted exploration and intervention.

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ASSESSING VULNERABILITIES IN TRANSITIONS FOR COVID19 PATIENTS DISCHARGED ON OXYGEN.

Nnamdi Igwe1 , Anne Linker2, Andrew Dunn2, Jung Ha2, Beth Raucher2, Vinh-tung Nguyen2 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Hospitalized patients with COVID19 who improve clinically but have ongoing oxygen requirements are often discharged with home oxygen.

OBJECTIVE: To describe discharge planning for COVID19 patients with new home oxygen and to explore patient/caregiver experience of the care transition.

METHODS: MSH patients with COVID19 who were discharged from the Medicine service with new home oxygen from Dec. 2020-Mar. 2021 were identified. The information collected included 30-day readmission rates, discharge instruction provided, and follow-up appointments scheduled. A phone survey was used to assess explanation of home oxygen use, delivery, and patient awareness of follow-up appointments.

RESULTS: 72 patients with COVID19 required new home oxygen. The 30-day readmission rate was 11.1% in this cohort, compared to 7.8% for all COVID19 patients on the Medicine Service during the same period. Of the 72 patients, 26 agreed to participate in a phone survey. 58% of survey participants expressed satisfaction with the discharge process and 92% reported feeling at least moderately prepared to use home oxygen. 20% of patients expressed that the process was rushed and desired more education prior to discharge. Equipment problems at the home were reported by 8% of patients. Patients perceived wide variability in time to follow-up. 19% recalled follow-up within 1 week, 27% reported follow-up more than 4 weeks after discharge, and 35% reported lack of any follow-up. Chart review identified that most (79%) had been scheduled for follow-up appointment within 30 days.

CONCLUSION: Our study found that patients hospitalized with COVID19 requiring new home oxygen had a higher 30-day readmission rate compared to all patients hospitalized with COVID19, suggesting that this population is higher risk for adverse outcomes and requires careful discharge planning. Though most patients were satisfied with the discharge process, approximately 20% felt the process was rushed and 40% did not recall receiving education on the equipment while hospitalized. We also identified dissonance between patients’ perception of follow-up and the follow-up appointments in the EHR. Based on the identification of these vulnerabilities in the transition process, we plan to optimize several processes for these patients, including enhanced early patient education, standard written discharge instructions, provision of pulseoximeters, and standardization of post-discharge provider follow-up.

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PREDICTION OF IMMUNE CHECKPOINT BLOCKADE RESPONSE BASED ON BLOOD SERUM VALUES.

Sushruta Iruvanti1 , Diego Chowell2 1Medical Education, 2Oncological Sciences.

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

BACKGROUND: Immune checkpoints are vital to prevent immune responses from attacking host cells. Checkpoints play an important role in cancer immune escape. Tumor cells can present surface proteins that signal checkpoints, causing T-cells to not recognize cancerous cells. Immune checkpoint blockades (ICB) are a novel class of cancer therapies that prevent checkpoint signaling, thus allowing T cells to kill cancer cells. We propose testing supervised machine learning models, such as XGBoost and NGBoost, to predict patient responses to immune checkpoint inhibitors based on serum values. If serum data can be used to predict ICB response, clinical decision making can be potentially improved.

OBJECTIVE: To understand whether gradient boosting models can predict responses to immune checkpoint inhibitors.

METHODS: The dataset consisted of patient responses to immune checkpoint inhibitors and their blood serum values. The dataset includes patients with bladder, breast, CNS, colorectal, esophageal, gastric, head & neck, hepatobiliary, SC and NSC lung cancer, and other cancer types. Train and test sets were partitioned with equivalent cancer type stratification. I have trained XGBoost and NGBoost machine learning models on this data. Hyperparameter tuning was done using Grid Search Cross Validation on Mount Sinai’s Minerva supercomputing cluster. Parameters were optimized using area-under-curve (AUC) evaluation metric. Feature importances were calculated using the scikit-learn permutation importance function.

RESULTS: The NGBoost model had a training AUC of 0.944 and an accuracy of 82.3%. The XGBoost model had a training AUC of 0.75 and an accuracy of 75%. For the test set, the NGBoost model had an AUC of 0.709 and an accuracy of 74.9%. The XGBoost model had an AUC of 0.72 and an accuracy of 74.2%. NGBoost calculated alkaline phosphatase, lymphocytes, and age as the most important features while XGBoost identified albumin, alkaline phosphatase, and age as most important.

CONCLUSION: Both XGBoost and NGBoost perform adequately well at predicting ICB response given their AUC values above 0.7. The XGBoost model performs marginally better on test data than NGBoost given its higher AUC and similar accuracy. XGBoost presents a better framework given its larger potential parameter space. The disparity between train and test AUC values for NGBoost indicate overfitting of the training data.

ABSTRACT 53

ASSESSING THE CLINICAL QUALITY OF PCP SUBMISSIONS AND SPECIALIST RESPONSES ON AN E-CONSULT PLATFORM.

Nikita Israni1 , Karen Acevedo2, Allie Heath2, Katie McGarry2 1Medical Education, 2Clinical Operations 1Icahn School of Medicine at Mount Sinai, New York, New York, 2RubiconMD New York, NY.

BACKGROUND: RubiconMD is an educational, e-consult platform that rapidly connects primary care physicians (PCPs) with specialists who can provide insight on patient-specific questions. The company’s mission is to streamline patient care by sharing expertise and reducing unnecessary referrals, which come with their own wait times and cost burdens. This project fell under the clinical operations arm of RubiconMD, whose main purpose is to ensure appropriate and effective clinical use of the platform.

OBJECTIVE: To develop and test an internal framework for defining good clinical quality in an e-consult, which includes both the PCP question and specialist response.

METHODS: A literature review was conducted of existing methods used to assess the quality of traditional in-person consults and electronic consults. Using the previously validated eConsult Specialist Quality of Response (eSQUARE), we reviewed transcripts of e-consults on the RubiconMD platform and completed a questionnaire on the quality of each specialist response. This was followed by a test of inter-rater reliability of the eSQUARE tool. To assess the quality of PCP questions, for which no validated tool exists, a single reviewer collected all cases rated by specialists in the previous 6 months and characterized a subset of poorly rated submissions.

RESULTS: Between Jan 2022 and Jul 2022, 4,112 specialist responses received a general quality rating. Three raters reviewed a subset of 160 cases in-depth using the eSQUARE. The average rating for a specialist response was 4.65 out of 5. The most common reason for a low rating was a failure to provide educational information or anticipatory guidance in the response. Inter-rater agreement was lowest when deciding whether a response was evidence-based or not. We found a dearth of data on quality of PCP questions over a 6-month period, as only 5% of 50,118 cases on the platform were rated by specialists. Of the 2,274 cases rated by specialists, 181 were rated as poor. The most common reasons for a poor rating were no exam finding, incomplete medical history, and no question included in the consult.

CONCLUSION: These findings pinpoint areas of further education for PCPs and specialists using RubiconMD, which can be addressed by the clinical operations team. Additionally, they provide support for product changes, such as including a field for anticipatory guidance or physical exam, that would improve e-consult quality.

ABSTRACT 54

EFFECT OF VOLUNTARY EXERCISE AND PSYCHOSOCIAL STRESS ON THE IMMUNE SYSTEM IN MURINE MODELS.

Vladislav Izda1 , Sumnima Singh2, Filip Swirski2 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: In response to acute psychological stress distinct regions of the brain and skeletomuscular systems influence the immune system. As an extension of the skeletomuscular system, exercise has been known to induce anti-inflammatory factors, that target cerebrovasculature. Despite the clear benefits of exercise to human health, a direct link between exercise and psychological stress remains to be established.

OBJECTIVE: To assess whether voluntary exercise alleviates the effects of psychological stress on the immune system. We focused on whether circulating immune cells, specifically the number and functions of neutrophils are altered in voluntarily exercising mice that are exposed to acute stress.

METHODS: C57BL/6J mice (n=8-20 per group, per time point) were habituated to the running wheels for 2 days and left to voluntarily exercise. After the 2 days, mice were physically restrained for 3 minutes. The mice were bled at baseline, 15 minutes, 1, 2, and 4 hours after, and flow cytometry was performed. For flow cytometry analysis we included unpaired two-tailed Student’s t-tests (two groups), and nonparametric MannWhitney U-tests (when Gaussian distribution was not assumed). For multiple comparisons, non-parametric multiple-comparison tests comparing the mean rank of each group (when Gaussian distribution was not assumed), or one- or two-way ANOVA followed by Dunnett multiple-comparisons test for one-way ANOVA and Sidak multiple-comparisons test for two-way ANOVA were used.

RESULTS: We found that exercising mice had approximately double the number of circulating neutrophils (1.8x10^5 cells) at baseline as compared to non-exercising, stressed controls (8.5x10^4 cells). However, 1 hour after stress induction, the exercising mice had a significantly reduced number of neutrophils (6x10^5 cells) compared to non-exercising mice (1.2x10^6 cells, p=0.0270). In exercising mice exposed to stress, the neutrophils showed a loss of the activation marker CD62L, a marker known to decrease transcriptional capacity, and retain neutrophils longer in circulation. We found no differences between the groups in glucocorticoid or CXCL1 blood circulating levels.

CONCLUSION: We demonstrated that exercise successfully dampens neutrophilia induced by acute psychological stress and that CD62L low neutrophils may be involved. Further work is needed to examine the specific role of CD62L low neutrophils in exercise and their impact on the cardiovascular system.

ABSTRACT 55

SLEEP MAINTAINS IMMUNE HOMEOSTASIS LIMITING MURINE TAUOPATHY.

Walter Jacob1 , Abi Yates2, Pacific Huynh2, Andrew Varga2, Cameron McAlpine2 1Medical Education, 2Cardiovascular Research Institute. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Sleep declines in both quality and quantity with age, and inadequate sleep is associated with both cardiovascular and neurodegenerative diseases, such as atherosclerosis and Alzheimer’s disease (AD). Poor and inadequate sleep drives many disease sequalae including immune dysfunction and systemic inflammation; however, little is known about the molecular and cellular mechanisms that link sleep, the immune system, and disease. Systemic inflammation drives many disease processes, including cardiovascular disease, and may be involved in the development of AD. The contribution of circulating immune cells and their secreted factors to AD pathology remains unclear.

RESULTS: Using mice lines harboring mutations causative in AD, we show that 5xFAD mice demonstrate increased levels of bone marrow hematopoiesis and increased numbers of circulating immune cells. Additionally, we show that young PS19 mice exhibit increased leukocyte populations in the spleen compared to wild type mice well before clinical signs of AD are evident. This increase in splenic leukocytes is likely mediated by extramedullary hematopoiesis in the spleen, as we observe significant rises in myeloid and lymphoid progenitor cells in splenic tissue. Further, aged PS19 mice exhibit significantly impaired sleep compared to wild type mice, and 8 weeks of sleep fragmentation greatly exacerbates tau phosphorylation in these mice, a marker of aggregate stability and burden of disease.

CONCLUSION: Our findings suggest there is early activation of the innate immune system in AD, which is known to elicit widespread inflammation and can disrupt resident immune cell functionality in the brain. We are still exploring whether systemic inflammation due to increased immune cell activation is causative in AD. We also suggest a bi-directional relationship between tau burden and sleep fragmentation that may be mediated by the immune system. Ongoing experiments using orexin receptor antagonists, which promote sleep, are examining whether rescue of sleep impairment and the associated return to immune homeostasis can ameliorate tau burden. While orexin receptor antagonists have already been identified as treatments for insomnia, we hope to decipher possible neuroprotective roles of these compounds in mitigating tau hyperphosphorylation and disruption of microglial architecture.

ABSTRACT 56

THE EFFECT OF KETOROLAC ON THE OUTCOME OF SELECTIVE LASER TRABECULOPLASTY.

Jason Jo1 , Jeff Huang2, Samuel Oh2, Jun Lin2, Sze Wong2 1Medical Education, 2Ophthalmology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Selective laser trabeculoplasty (SLT) is a treatment used to lower intraocular pressure (IOP) in open angle glaucoma and ocular hypertension patients. The 2019 Steroids After Laser Trabeculoplasty (SALT) trial saw that use of topical steroids or non-steroidal anti-inflammatory drugs (NSAIDs) after SLT had additional IOP-lowering effects.

OBJECTIVE: To investigate whether use of NSAIDs following SLT has an additional IOP-lowering effect in a real-life setting outside of a controlled clinical trial.

METHODS: Retrospective chart review was performed on patients who received SLT in New York-based clinical practices from 2016-2021. Patients over 18-years-old with a minimum SLT energy of 70 mJ who received either post-SLT ketorolac (0.5%) 4 times/day for 4 days or no topical anti-inflammatory agent were included. Baseline, 6-, and 12-week IOP measurements (Goldman applanation) were recorded. Patients with glaucoma from traumatic, congenital, juvenile-onset, or multi-mechanism causes were excluded. The primary outcome was IOP reduction in NSAID patients vs non-NSAID patients following SLT at the 12-week follow up period. The sample size required for an 80% chance to find differences in IOP of at least 2 mmHg between groups was 29 in each ( =0.05). One-way ANOVA analyses were performed to evaluate potential differences between groups.

RESULTS: 94 patients (68.8±11.9 y/o, 52.1% female) met inclusion criteria from a total of 1901 records of SLT patients retrieved. 39(41.5%) received NSAIDs post-SLT. Mean cup-to-disc ratio was 0.74±0.15 and showed no differences between control and NSAID groups (0.71±0.15 vs. 0.77±0.14, p=0.10). 63.8% of patients had primary open angle glaucoma, 4.3% pseudoexfoliative glaucoma, 3.2% ocular hypertension, 11.7% normal tension glaucoma, and 17.0% had a diagnosis outside these classifications. One-way ANOVA showed no differences for baseline- (19.3±4.0 vs. 19.4±4.2 mmHg, p=0.99), 6-week- (-3.1±3.8 vs. -3.6±6.3 mmHg, p=0.23), or 12-week-IOP difference (-3.5±4.7 vs. -3.3±6.0 mmHg, p=0.42). No significant differences were seen in 12-week IOP difference in both baseline IOP > 21 mmHg (-6.8±4.2 vs. -8.5±5.7 mmHg, p=0.12) and IOP ≤ 21 mmHg subjects (-1.9±4.1 vs. -1.0±4.5 mmHg, p=0.42).

CONCLUSION: After controlling for SLT energy and degree, patients who received post-SLT ketorolac did not show a difference in IOP reduction at both 6- or 12-week follow ups in comparison with patients who did not receive post-SLT ketorolac.

ABSTRACT 57

CAN FRAILTY INDICES PREDICT SURGICAL RISK IN OPEN REDUCTION FACIAL FRACTURE REPAIR?

Abigail Katz1 , Peter Taub2 1Medical Education, 2Surgery.

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

BACKGROUND: Across all surgical fields, risk prediction is an essential component in postoperative management. Historically, age, BMI, comorbidities and smoking status are considered the most commonly used risk proxies. In recent years, “frailty indices” such as the modified 5-item frailty index (mFI-5) and the Charlson Comorbidity Index (mCCI) have emerged as more streamlined and accurate predictors of complication risk.

OBJECTIVE: To evaluate whether the mFI-5 and mCCI are stronger predictors of 30-day postoperative complications and complication severity after open reduction of facial fractures compared to historic risk proxies.

METHODS: A retrospective review of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted to investigate patients who underwent open reduction facial fracture surgery between 2013-2018. Risk factors including age, smoking status, BMI, comorbidities, and ASA class were extracted for each patient. The mFI-5 score and mCCI score were calculated based on this data. Univariate logistic regressions were performed (p<0.05)

RESULTS: A total of 2,667 cases were included. Of these, 2,131 (80%) were male. The strongest predictors for overall 30-day complications and complication severity were ASA class ≥3 (OR=3.60, p<0.001), comorbidities ≥2 (OR= 2.78, p<0.001), mCCl score ≥2 (OR=2.19, p<0.001) and mFI-5 ≥1 (OR=1.96, p<0.001). Smoking status and BMI were not strong predictors of total complications or complication severity. Age was found to be a statically significant, but low-impact, predictor of complications and severity (OR= 1.02, p<0.001). The only significant predictors of surgical site infections (SSI) were smoking status (OR=1.56, p=0.042) and ASA class ≥3 (OR=2.37, p=0.013). mFI-5 ≥1 was a significant predictor of hospital readmission (p<0.001). BMI was not associated with any increased risk.

CONCLUSION: The mCCI and mFI-5 are statistically significant predictors of total complications and complication severity in open reduction of facial fracture repair, and thus provide a tool to inform decision making and improve care. Smoking status may increase risk for SSIs following facial fracture repair.

ABSTRACT 58

A NATIONWIDE STUDY OF HEALTHCARE SERVICES PROVIDED TO CANCER PATIENTS IN AMBULATORY CARE SETTINGS.

Harrison Knowlton1 , Christina Wang2, Dustin Kee1, Suzanne Vang3, Madhu Mazumdar3, Parul Agarwal3.1Medical Education, 2Gastroenterology, 3Population Health Science and Policy.

1,2,3Icahn

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

BACKGROUND: Due to the often long and costly nature of their treatment, cancer patients are vulnerable to obstacles in accessing care. Additionally, work on access to ambulatory healthcare services in cancer populations is limited.

OBJECTIVE: To examine the association between having a cancer diagnosis and the types of healthcare services ordered or provided. We also hoped to assess whether insurance status affects the services offered to cancer patients as well as whether age- or race-related disparities exist in this population.

METHODS: A retrospective cross-sectional study was conducted using 2016-2018 National Ambulatory Medical Care Survey data. Descriptive statistics were used to assess baseline characteristics and services ordered or provided stratified by cancer diagnosis and insurance status in those with cancer. We performed multivariable analysis adjusting for age to examine the association between having a cancer diagnosis and types of healthcare services. More analyses are being done to examine age- and race-related differences in provision of services.

RESULTS: Of approximately 1.74 billion ambulatory care visits, 7% (125,294,620 visits) were by patients with cancer. Cancer patients were significantly older (mean age: 66 vs. 46, p<0.001), identified as non-Hispanic white (81% vs 69%, p<0.001), were mainly insured with Medicare (52% vs 24%, p<0.001), and had more comorbidities than patients without cancer (2.7 vs 1, p<0.001). A higher proportion of visits by cancer patients were to medical specialists (45% vs 24%, p<0.001), while patients without cancer were more likely to visit with primary care (55% vs 28%, p<0.001). Among cancer patients, self-pay patients were less likely to receive a skin exam than any other group (p=0.036). Cancer patients had higher odds of being provided or ordered any healthcare service (OR=1.21, 95% CI:1.06,1.38), wound care (OR=3.98, 95% CI:2.97,5.33), skin (OR=2.02, 95% CI:1.79,2.27) and breast exams (OR=1.91, 95% CI:1.41,2.60) but lower odds of receiving services such as nutrition (OR 0.74, 95% CI: 0.59,0.93), exercise (OR 0.73, 95% CI: 0.55,0.95), and mental health counseling (OR 0.35, 95% CI: 0.16,0.75).

CONCLUSION: Cancer patients use a wide range of services in ambulatory care settings. While insurance status largely did not impact cancer patients’ ability to access services, there are significant differences in the services that cancer patients are provided or ordered relative to those without cancer.

ABSTRACT 59

IS PRIOR HISTORY OF SPINE SURGERY A CONTRAINDICATION FOR ILIOFEMORAL VEIN STENTING?

Nithya Krishnamurthy1 , Halbert Bai2, Jason Storch2, Jenny Chen2, Annie Chang2, Keva Li2, Andrew Min2, Windsor Ting2. 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Spine surgery is a possible risk factor for development of symptomatic peripheral venous outflow obstructions (PVOO). There is insufficient research assessing whether spine surgery is a contraindication for venous stenting.

OBJECTIVE: To determine differences in presentation and outcomes after iliofemoral vein stenting for chronic PVOO patients with a history of spine surgery versus those without.

METHODS: We retrospectively analyzed a database of 876 patients at a single institution who underwent iliac vein stenting for PVOO from 2011 to 2020. Patients were stratified into groups based on the presence or absence of a history of spine surgery (N=31; 3.5%, N=845; 96.5%). Presenting symptoms in both cohorts were quantified using Venous Clinical Severity Score (VCSS). Multivariate logistic regression models were used to determine odds of minor and major reoperations.

RESULTS: Patients with a history of spine surgery had a greater preoperative ulcer size (0.3 vs 0.1, P=0.021) and longer ulcer duration (0.5 vs 0.2, P=0.004) than patients without a history of spine surgery. This group also presented preoperatively with a lower VCSS score for varicose veins (0.9 vs 1.3, P=0.023). Patients with a history of spine surgery were less likely to have a minor reoperation (OR = 0.26; 95% C.I. = [0.06-0.82]; P=0.038). Post-operatively, spine surgery patients had an increased VCSS pain score (1.2 vs 0.9, P=0.021). One-year post-stent, spine surgery patients continued to present with greater ulcer duration and size (0.4 vs 0.1, P=0.009 and 0.4 vs 0.1 (P=0.002). Spine surgery patients had similar clinical improvements poststent, with no significant difference in change in VCSS 1, 2, and 3 years post-venous stent (P=0.811, 0.621, 0.641). There was no significant difference in the likelihood of having a major reoperation post-stent between patients with a history of spine surgery versus those who did not (OR 2.03 (0.68-5.39, P=0.175).

CONCLUSION: Patients with a history of spine surgery had longer ulcer duration and size before and after venous stenting but had similar rates of improvement in VCSS outcomes as their nonsurgical counterparts. Spine surgery patients did not have a higher likelihood of major reoperations and were less likely to undergo minor reoperations post-stent. Spine surgery should not be a contraindication for venous stenting.

ABSTRACT 60

EVALUATING SCOLIOSIS AS AN INDEPENDENT RISK FACTOR FOR CRITICAL ILLNESS IN SARS-COV-2.

Colin Lamb1 , Danielle Chaluts2, Konstantinos Margetis2 1Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Scoliosis can reduce compliance of the chest wall leading to respiratory complications. The first strain of SARS-CoV-2 (L-variant) caused critical respiratory illness in a number of vulnerable patients.

OBJECTIVE: This study investigates the association between scoliosis and severity of disease course from SARS-CoV-2 (COVID).

METHODS: This single-center, retrospective study analyzed clinical data of 137 subjects admitted to the hospital for COVID between March 2020 to June 2021 with a positive COVID PCR result and an ICD-10 code for scoliosis (M41.0–M41.9). Subjects with COVID vaccination or CPT codes for surgical correction of scoliosis (22842–22847) were excluded. Degree of coronal plane scoliosis on CT and X-ray was confirmed by two independent measurers and grouped into no scoliosis (Cobb angle <10°), mild (10-24°), moderate (2539°), and severe scoliosis ( 40°) cohorts. Baseline characteristics were compared between cohorts and a multivariable logistic regression controlling for age, gender, and BMI examined the significance of scoliosis as an independent risk factor for ARDS, mechanical ventilation, and mortality.

RESULTS: The no (n=58), mild (n=12), moderate (n=38), and severe scoliosis (n=29) cohorts differed significantly only in BMI (p=0.02), with the no scoliosis group having the highest average BMI (28.8 kg/m2). The cohorts did not differ in age, gender, smoking status, diabetes, hypertension, other cardiopulmonary and autoimmune diseases. None of the subjects developed ARDS. The percentage of patients who had ICU stays (no scoliosis=13.8%, mild=16.7%, moderate=13.6%, severe=13.8%; p=0.99), mechanical ventilation (no scoliosis=5.2%, mild=8.3%, moderate=7.9%, severe=6.9%, p=0.95), or expired (no scoliosis=18.3%, mild=8.3%, moderate=13.2%, severe=10.3%; p=0.53) did not significantly differ between the cohorts. The mild, moderate, and severe scoliosis cohorts did not have a significantly higher likelihood of ICU admissions (1.2 [0.9-1.6] p=0.06, 0.9 [0.5-1.7] p=0.68, 0.9 [0.7-1.2] p=0.41), mechanical ventilation (2.1 [0.2-2.5] p=0.57, 1.3 [0.2-8.2] p=0.79, 1.8 (0.2-1.5) p=0.57), or death (0.4 [0.03-3.2] p=0.39, 0.4 [0.1-1.6] p=0.21, 0.5 (0.1-2.1) p=0.31) than the no scoliosis cohort.

CONCLUSION: Scoliosis was not an independent risk factor for critical illness in COVID patients. There were no trends to indicate a consistent effect of the degree of scoliosis on the likelihood of an adverse outcome, but future studies should compare patients with any scoliosis to no scoliosis.

ABSTRACT 61

PERSECUTION AND MIGRATION EXPERIENCES OF LGBTQ+ ASYLUM SEEKERS.

Patrick Lasowski1 , Olivia Moscicki1, Clifford Liu1, Cecilia Katzenstein1, Elizabeth Singer2, Kim Baranowski3 1Medical Education, 2Emergency Medicine, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

LGBTQ+ asylum seekers are exposed to high rates of persecution. The aim of this study was to identify the forms of ill treatment and impact of these experiences on the mental health of 66 self-identified LGBTQ+ asylum seekers from 24 nations through the analysis of human rights program intakes, sworn declarations, and pro bono forensic psychological evaluation affidavits. Results indicate that participants experienced physical assault (92%), harassment and intimidation (85%), and sexual assault (56%). Psychological sequelae included symptoms of posttraumatic stress disorder (PTSD) (83%), depression (73%), and anxiety (58%). LGBTQ+ asylum seekers faced additional hazards upon arrival in the U.S. Still, these asylum seekers experienced resilience as they leveraged internal and external supports. The results can serve to inform clinical professionals about the range and impact of exposures to harm experienced by LGBTQ+ asylum seekers, as well as possible strategies for support and advocacy for this diverse community.

ABSTRACT 62

THE OMICRON SURGE OUTPACES PREVIOUS SURGES IN POST-COVID HOSPITALIZATION HEALTHCARE USAGE.

Jasmine Leahy1 , Rebecca

Astua3. Bajracharya2,

Brian

Altonen2,

Maria Ferreira-Ortiz3, Leopolda Silvera3, Alfred

1Medical Education, 2Public Health, 3Nursing, 4Global Health, 5Pulmonary Critical Care.

1,2Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4,5Elmhurst Hospital.

BACKGROUND: Despite the rise of post-COVID care centers, few studies exist that quantify the burden of long COVID in terms of patient healthcare usage. In this study, we used post-discharge healthcare utilization metrics for non-intubated, medical patients admitted with COVID -19 as their primary diagnosis requiring hospitalization during the first four surges of the pandemic, ending with the Omicron variant.

OBJECTIVE: To compare how patients sought and received care in the year after hospital discharge.

METHODS: This was a retrospective cohort comparison among four groups of 50 patients (200 total) at a large public hospital in New York City. Each cohort represented a different surge, broken down as follows: 1. March 2020 – May 2020, 2. November 2020 – February 2021, 3. August 2021 – October 2021, 4. November 2021 – February 2022. Metrics were counted up to 12 months after hospital discharge. Paired t-tests were run comparing average appointment numbers between surges.

RESULTS: Average age was 57 years. One hundred-fifteen patients were Hispanic/Latino. The average length of hospital stay was 8 days. For Surge 1, 62% (n=31) of patients were scheduled for primary care, 56% scheduled for specialists, 20% went to the ED at least once, and 54% of patients missed at least one appointment. For Surge 2, 66% of patients were scheduled for primary care, 56% scheduled for specialists, 18% visited the ED, and 64% missed at least one appointment. For Surge 3, 68% of patients were scheduled for primary care, 48% scheduled for specialists, 12% went to the ED, and 60% missed at least one appointment. For Surge 4, 62% were scheduled for primary care, 72% scheduled for specialists, 22% went to the ED, and 74% missed at least one appointment. While primary care rates remained consistent across surges, patients in Surge 4 were scheduled for the most specialist visits on average (7). This was significantly higher than average specialist visits in Surge 3 (p<0.05).

CONCLUSION: Surge 4 shows more referrals to specialists, missed appointments, and ED visits than previous surges. Physicians and patients alike may be more attuned to long COVID symptoms, resulting in more referrals and/or scheduled appointments. Alternatively, long COVID may be evolving or worsening, resulting in increased demand for care. High rates of missed appointments underscore the importance of patient outreach, especially to disadvantaged communities, when designing post-COVID care models.

ABSTRACT 63

LINGUISTIC PREDICTORS OF RESPONSE TO INTERNET-BASED WRITTEN CBT FOR PTSD IN 9/11 WORLD TRADE CENTER RESPONDERS AND SURVIVORS. Tomasina Leska1 , Zoe Schreiber2, Eden Astorino2, Maya Verghese2, Saren Seeley2, Leah Cahn2, Cindy Aaronson2, Hannah Brinkman2, Mary Kowalchyk2, Maria Boettche3, Christine Knaevelsrud3, Robert Pietrzak4, Adriana Feder2. 1Medical Education, 2,3,4Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Free University of Berlin, 4Yale School of Medicine.

BACKGROUND: Research has demonstrated that automated language analyses can be used to detect PTSD and predict symptom trajectories, but scarce research exists using this approach to predict treatment response. Cognitive behavioral therapy (CBT) is a first-line treatment for PTSD, and recent research suggests that an internet-based, therapist-assisted CBT for PTSD, called integrative testimonial therapy (ITT), is also an effective treatment.

OBJECTIVE: To identify predictors of response to ITT by exploring associations between language usage and symptom improvement in 9/11 World Trade Center (WTC) responders and survivors with clinically significant WTC-related PTSD symptoms.

METHODS: Participants were provided with instructions for 11 writing assignments (“narratives”) and asynchronous written feedback. The four treatment modules included: 1) biographical reconstructions from birth-9/11 (3 narratives), 2) WTC trauma exposure (4 narratives), 3) biographical reconstruction from 9/11-present (1 narrative), and 4) cognitive reframing (3 narratives). Data from 35 participants with persistent, full or sub-threshold WTC-related PTSD were analyzed using Linguistic Inquiry and Word Count (LIWC) software and the Valence Aware Dictionary and sEntiment Reasoner (VADER) package. Treatment response was defined as pre- to post-treatment PCL-5 score change.

RESULTS: A stepwise multiple linear regression demonstrated that higher use of words relating to LIWC categories of death (e.g. passed away), causation (e.g. because), and motion (e.g. went) in biographical reconstructions was associated with more improvement, while higher use of social behavior words (e.g. said) in exposure narratives was associated with less improvement. Collectively, these categories explained 59.2% of the variance in PCL-5 score improvement (R2adjusted=0.59, F(1,30)=13.33, p<0.001). Death words explained 23.3% of this variance (R2adjusted=0.23, F(1,33) =11.33, p=0.002). Additionally, a multiple linear regression showed that higher VADER negative sentiment scores in Modules 1 and 2 predicted greater PTSD symptom improvement (R2adjusted=0.34, F(3,31)=5.28, p=0.005).

CONCLUSION: Language in biographical reconstruction narratives early in treatment emerged as the main driver of symptom improvement. Greater use of death words and negative sentiment were the strongest predictors of improvement, suggesting that describing negative early life experiences may help facilitate therapeutic response to ITT.

ABSTRACT 64

DEMOGRAPHICAL AND GEOGRAPHICAL DIFFERENCES IN THE PREVALENCE OF DRY EYE AND ITS ASSOCIATION WITH PSYCHIATRIC COMORBIDITY.

Yuzhe Li1 , Catalina Garzon Vargas2, Janek Klawe2, Esen Akpek3, Sumayya Ahmad2 1Medical Education, 2,3Ophthalmology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Johns Hopkins University.

OBJECTIVE: To elucidate the association between patient demographic characteristics and psychiatric comorbidity, including depression and anxiety, on the diagnosis of dry eye in the geriatric population.

METHODS: 1,321,000 patients residing within the lower 48 states were identified from a 5% random sample of 2011 Medicare beneficiaries. Clinically significant dry eye patients were classified as having 2 or more dry eye claims in the calendar year. Patients with a depression or anxiety disorder diagnosis were likewise identified. Demographical characteristics including age, gender, race/ethnicity, state, county code, and median income were collected. Odds ratios between dry eye and each of anxiety and depression, controlling for demographic covariates, were generated using logistic regression models.

RESULTS: A total of 21,059 clinically significant dry eye patients were identified. Women were 2.03 times more likely to be diagnosed with dry eye compared to men (p<0.01). Patients of Asian (OR 1.85, p<0.01) or native American race (OR 1.51, p<0.01) had higher odds of being diagnosed with dry eye compared to white patients, while black patients were slightly less likely to be diagnosed with dry eye (OR 0.83, p<0.01). Compared to patients residing in the Northeast, patients in the West were more likely to have dry eye (OR 1.38, p<0.01), while patients in the Northwest were less likely to have dry eye (OR 0.58, p<0.01). There was no observed pattern between income decile and dry eye diagnosis. Compared to patients aged 65-74, patients aged 75-84 (OR 1.49, p<0.01) and 85+ (OR 1.54, p<0.01) were more likely to have dry eye. Having both depression and anxiety was associated with higher odds of dry eye diagnosis (OR 2.38, p<0.01) compared to having depression (OR 1.95, p<0.01) or anxiety (OR 2.22, p<0.01) alone.

CONCLUSION: Gender, age, race, and geography influence the prevalence of dry eye. Controlling for these covariates, there still exists a significant association between dry eye and each of depression and anxiety in the geriatric population. Longitudinal studies evaluating the temporal relationship between dry eye and psychiatric disease are warranted.

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DOES HUMERAL FIXATION TECHNIQUE AFFECT THE LONG-TERM OUTCOMES OF TOTAL SHOULDER ARTHROPLASTY?

Troy Li1 , Paul Cagle2. Medical Education, 2Orthopaedics.

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

BACKGROUND: While cementation of humeral stems has long been considered the gold standard for anatomic shoulder arthroplasty (aTSA), cementless, or press-fit, fixation offers a relatively cheaper and less demanding alternative, particularly in the setting of a revision procedure.

OBJECTIVE: To evaluate the long-term radiographic, range of motion (ROM), patient-reported outcomes (PRO), and implant survival in patients receiving a cemented versus cementless humeral stem during aTSA.

METHODS: This study retrospectively analyzed 134 patients (169 shoulders) who underwent total shoulder arthroplasty between February 1990 and June 2019 with minimum 2.0 years follow-up. Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data was collected pre- and postoperatively. Primary outcome measures included range of motion (forward elevation, external rotation, internal rotation), patient reported outcomes (American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), Visual Analog Scores (VAS)), and radiographic analysis of humeral lucency. Analysis of all collected data was performed using Python version 3.8.8. Continuous variables were compared using a student’s t-test, and categorical variables were compared using a chi-square test. For all statistical testing, a p-value <0.050 was considered significant.

RESULTS: 138 cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients, with no significant differences between cohorts (FE: p=0.12, ER: p=0.59, IR: p=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (VAS: p=0.04, ASES: p<0.01, SST: p=0.03). Humeral lucency was noted in 2 cemented implants and 1 press-fit implant. No significant differences in implant survival were seen between the two cohorts (p=0.97).

CONCLUSION: We found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes when compared to the cemented stems regarding patient reported outcome scores.

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UNILATERAL VENOUS STENTING IS ASSOCIATED WITH SIGNIFICANTLY HIGHER ODDS OF MAJOR REOPERATION AFTER ILIAC VEIN STENTING.

Keva Li1 , Halbert Bai2, Andrew Min2, Annie Chang2, Jason Storch2, Jenny Chen2, Jinseo Kim3, Bianca Vama4, Justin Wang4, Mikeely Siegel4, Sachi Lele4, Windsor Ting2. 1Medical Education, 2,3,4Surgery.

1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Boston College, Chestnut Hill, MA, 4University of Pennsylvania, Philadelphia, PA.

BACKGROUND: The efficacy of unilateral compared to bilateral venous stenting for the treatment of chronic proximal venous outflow obstruction (PVOO) remains unknown. To date, there has been no large-scale study of outcomes after iliac vein stenting comparing the two deployment methods.

OBJECTIVE: To elucidate whether initial unilateral or bilateral venous stent placement showed superiority in long-term outcomes.

METHODS: A clinical registry of 840 patients who underwent iliac vein stenting for PVOO from 2011 to 2021 at a single institution was retrospectively analyzed. Whether stent(s) were deployed bilaterally or unilaterally at the initial procedure was recorded. The primary endpoint was major reoperation, which was defined as any intervention with venogram. The secondary endpoints included minor reoperation, defined as endovenous thermal ablation, and change in Venous Clinical Severity Score (VCSS). Multivariate logistic regression was employed to determine the odds of major and minor reoperation controlling for the confounders of age, gender, race/ethnicity, smoking history, and history of DVT.

RESULTS: Between the two groups, no differences were seen in preoperative and demographic characteristics except that patients receiving unilateral stent(s) were more likely to have a history of smoking (24.6% vs. 18.6%; p = 0.043). Unilateral stent placement demonstrated a longer length of follow-up (2.4 vs. 1.8 years; p < 0.001), more reoperations (1.2 vs. 0.9; p = 0.005), higher postoperative VCSS composite scores (6.2 vs. 5.5; p = 0.008), and less improvement in VCSS composite scores (4.2 vs. 4.8; p = 0.042). Multivariate analysis showed that initial unilateral stent placement was associated with a significantly higher odds of major reintervention (odds ratio [OR] = 2.34, 95% confidence interval [CI] = [1.47-3.75], p < 0.001) but no difference in odds of minor reintervention (p = 0.089).

CONCLUSION: Compared to bilateral stent placement, unilateral deployment of venous stents at the initial procedure is associated with 2.34 greater odds of major reoperation.

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GENETICALLY SUBTYPING CORONARY ARTERY DISEASE USING A NOVEL PATHWAY POLYGENIC RISK SCORE APPROACH.

Lathan Liou1 , Judit Garcia Gonzalez2, Beatrice Wu2, Zhe Wang2, Shing Wan Choi3, Paul O’Reilly2 1Medical Education, 2Genetics and Genomic Sciences, 3Statistic Genetics.

1,2Icahn

School of Medicine at Mount Sinai, New York, New York, 3Regeneron.

BACKGROUND: Coronary artery disease (CAD), characterized by reduction of blood flow to the heart, is the leading cause of morbidity and mortality in the United States and globally. Much attention has been focused on prevention of coronary artery disease earlier in life, which calls for early risk prediction. Polygenic risk scores (PRS), cumulative weighted genetic effects that estimate individual disease risk, have been proposed as a useful tool for providing risk-stratification of individuals, before traditional clinical symptoms manifest. Conventional PRS summarizes an individual’s genomic risk as a single number, and thus, does not distinguish among various contributing biological pathways. However, such distinctions may be important in generating the known heterogenous clinical presentation of CAD, and, specifically, different subtypes of CAD. Being able to link individual pathway-based genetic risk with specific subtypes of CAD may better inform treatment decisions.

OBJECTIVE: By applying a novel pathway PRS approach to identify subtypes of CAD, we aim to show that this is a statistically powerful strategy for predicting distinct clinical phenotypes of CAD, as well as elucidating biological pathway etiology for different CAD subtypes.

METHODS: Pathways are defined using six publicly available datasets (Biocarta, Pathway Interaction Database, Reactome, Mouse Genome Database, KEGG, and GO). CardiogramC4D 1000 Genomes GWAS was used for the base weights. UK Biobank was used as the study cohort, which is a well-defined research cohort.<span style=”font-size:10.8333px”> </span>CAD subtypes were defined as either angina (ICD-10 I20, I25.11, I25.7) or myocardial infarction (MI) (I21, I22, I25.2). Supervised stratification with an 80-20% train-test split, using lasso regression, was applied to build sparse models of pathway predictors.

PRELIMINARY RESULTS: The mean age of the analysis cohort (N=18,492) was 60.2 (SD=7.8). There were 12380 males (67%). There were 12,544 cases of angina, and 5948 cases of MI. In fully-adjusted models for age, sex, center, batch, 15 principal components of ancestry, total cholesterol, HDL, LDL, smoking, blood pressure meds, and systolic blood pressure, the training R2 was 6.3% (p-value < 0.001) and the test R2 was 2.3% (p-value < 0.001). These preliminary results show that the pathway PRS approach has the capacity to discriminate between angina and MI with magnitudes of explained variability consistent with the existing literature.

*This abstract has been withdrawn from the 2023 collection.

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IDENTIFYING A NOVEL JAK1 MUTATION TO CHARACTERIZE A GAIN OF FUNCTION SYNDROME.

Nikhil Maheshwari1 , Dusan Bogunovic2 1Medical Education, 2Microbiology.

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

BACKGROUND: Some rare autoimmune and autoinflammatory syndromes have been identified as creating a gain of function mutation in the JAK-STAT pathway that result in overactive signal transduction. JAK1 is activated by multiple different cytokines and is expressed in all tissues. This can lead to a variety of symptoms that can be generally described as autoinflammatory. In some patients, this presents as colonic unspecified inflammation, eosinophilic infiltration, and immunodeficiencies, among other symptoms. Additionally, some patients can have immune dysfunction restored with a JAK1 inhibitor such as tofacitinib. We have identified one patient with an N76S mutation in JAK1 who presents with atopic phenotypes such as hypogammaglobulinemia and follicular lymphoid hyperplasia.

OBJECTIVE: To date, only two such GoF mutations have been characterized and we proposed a novel mutation in the FERM domain of the JAK1 protein to result in a similar gain of function. The objective was to test cells with this JAK1 N76S mutation and we expected to see elevated levels of JAK1 signaling through pSTATs and increased expression of downstream genes.

METHODS: Experiments were conducted using U4C and 293T cell lines that were transfected with JAK1 mutant DNA and analyzed using qPCR, Western Blots, and Dual Luciferase assays to determine level of signaling expression.

RESULTS: In Western blot, the novel JAK1 N76S mutation appears to confer hyperactive signaling compared to wild type at baseline. Band densitometry of pSTAT1 showed a 298% increase in relative signaling activity at baseline compared to wild type. Additionally, there is some evidence hyperactive signaling of pSTAT1/2 when stimulated with interferon-gamma. Band densitometry of relative pSTAT1/2 showed a nonsignificant 25% and 27% increase respectively in relative signaling when stimulated compared to wild type. JAK1 N76S also exhibits increased distal signaling as shown in the Dual Luciferase assay compared to wild type JAK1. Downstream expression increased by 200% in cells at baseline with the N76S mutation compared with wild type.

CONCLUSION: This novel mutation is likely to be identified as another GoF and disease-causing mutation in the JAK1 pathway. Based on previous studies, this patient could benefit from JAK inhibitor therapy. Additionally, there may be variants yet to be identified that cause a similar activity.

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THE IMPACT OF AN AMBULATORY SURGERY CENTER ON CANCER DIAGNOSIS AND FOLLOW-UP IN RURAL EASTERN UGANDA.

Chelsia Melendez1 , Katie Glerum2, Linda Zhang3 1Medical Education, 2,3Surgery. 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2Mount Sinai Hospital System.

BACKGROUND: The WHO estimates that the global cancer burden will increase by 6 million between 2000 and 2022, and that most of this increase will be in the developing countries, especially Sub-Saharan Africa. Kyabirwa Surgical Center, an ambulatory surgical center in rural eastern Uganda, has worked to make cancer care in Uganda more accessible through biopsy and diagnosis. However, diagnosis of cancer is a small portion of making cancer a treatable disease in LMICs. Linkage to care is difficult for many patients who receive a cancer diagnosis and who are then unable to seek out treatment.

METHODS: This is a retrospective, single-center study of Kyabirwa Surgical Center patients who received a diagnosis of cancer. The primary data collection tool for this study is an in-person survey administered to patients who received a cancer-related referral from the KSC. Data collected from the survey was analyzed to determine follow-up rates, treatment offered, costs of treatment, barriers to care, and cultural and familial attitudes towards cancer and cancer treatment.

RESULTS: This study included 75 participants from eastern rural Uganda. The study found that 70% of patients attended follow-up cancer care. However, 40% of patients did not accept treatment for their cancer diagnosis after following up with the Ugandan Cancer Care Institute. The majority of patients, 75%, understood their diagnosis. Moreover, 75% of patients had family members who both supported their decision to seek treatment and assisted them with their cancer follow up. Therefore, health literacy and caregiver support were not a main barrier to care for rural located Ugandans. However, cost, transportation and housing were the main barriers to care. 76% of participants that did not accept cancer care stated cost as a barrier, 58% stated transportation and 42% stated housing as barriers. For the 54 patients that did stay overnight for cancer treatment 56% of patients slept outside on the grounds of the Cancer Institute further highlighting the lack of housing as a barrier to cancer care.

CONCLUSION: Identifying and addressing the barriers to receiving treatment is essential in providing access to cancer care post-diagnosis. By understanding the reasons for delay or lack of follow-up care, overall cancer burden in the community can be minimized. The results of this study can standardize and streamline the referral process post-biopsy and diagnosis, improving the outcomes of patients that follow up.

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ASSOCIATION OF MECHANICAL POWER WITH REINTUBATION IN THE CRITICALLY ILL: MACHINE LEARNING OUTPERFORMS LOGISTIC REGRESSION.

Kartikeya Menon1 , Pranai Tandon2, Hung-Mo Lin3, Yuxia Ouyang3, Matthew Levin3 1Medical Education, 2Medicine, 3Anesthesiology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Mechanical power (MP) estimates the energy delivered to the lung parenchyma using respiratory rate, driving pressure, tidal volume, and peak pressure. Higher MP is correlated with greater risk of postoperative respiratory failure, as well as greater mortality in the critically ill and those with ARDS.

HYPOTHESIS: A machine learning approach would demonstrate the predictive ability of higher mechanical power with reintubation in critically ill patients.

METHODS: Single-center retrospective study of medical ICU patients intubated >48 hours from 2011-2019. A random forest (RF) and logit (LR) were used to predict 72-hour reintubation. Synthetic minority oversampling was employed for class imbalance. Comorbidities included were age, BMI, RSBI, intubation length, PF ratio, and level of consciousness. Models were evaluated with sensitivity, specificity, F1 score, AUC, k-fold crossvalidation, and odds ratios (ORs). Feature saliency was assessed with mean decrease in impurity.

RESULTS: 894 patients met inclusion criteria, of which 136 (15.2%) required reintubation. Median MP was higher in the reintubation cohort (12.7 [10.0-16.2] vs 11.8 [9.5-14.9] J/min, p<0.01) than in those who were successfully extubated. In the test set, the LR had a sensitivity of 25%, specificity of 64%, AUC-ROC of 0.52, AUC-PRC of 0.46, and F1 score of 0.32. The RF achieved a sensitivity of 55%, specificity of 76%, AUC-ROC of 0.71, AUC-PRC of 0.74, F1 score of 0.61. 10-fold cross-validation accuracy was 84.71% ± 0.01%. Feature analysis found peak MP over duration of ventilation to be most important, followed by median PF and median MP. The LR found the risk of reintubation to be 25% higher for each 5 J/min increase in median MP (OR 1.25, 95% CI 1.10-1.43, p<0.001). The RF-implied average reintubation risk per 5 J/min increase in median MP between 8 J/min and 23 J/mi was 20% (odds ratio 1.20, 95% CI 1.19-1.21, p<0.005).

CONCLUSION: Machine learning outperforms LR in predicting the association of mechanical power with reintubation in the critically ill. Further, the median MP delivered to ICU patients in this cohort is lower than values previously reported in the literature, suggesting a correlation between MP and reintubation risk regardless of absolute MP value.

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MIND MATTERS ECHO: INTEGRATING PRIMARY CARE AND MENTAL HEALTH SERVICES IN NEW YORK CITY.

Rutvij Merchant1 , Anitha Iyer2 1Medical Education, 2Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: New York ranks among the bottom half of all states by some behavioral health (BH) metrics, including the proportion of adults, youth, and children with depression who did not receive treatment in 2021. To address this, Mount Sinai Health Partners aims to train primary care providers in the diagnosis and treatment of patients living with anxiety and depression. As such, the team has developed MindMatters ECHO, a BH learning collaborative, that uses a case-based didactic approach to enable providers to treat BH issues in the primary care setting.

OBJECTIVE: To: Assess the demographics of the attendees of MindMatters ECHO 2022; Assess provider learning; Assess the impact on patient care; and Assess the impact on cost savings

METHODS: A survey was disseminated to attendees before and after each ECHO session. Demographic information was collected, and provider knowledge was assessed with regards to therapy and medication management of BH conditions before and after the session. This enabled us to measure provider learning. To assess the impact on patient care, we evaluated longitudinal depression screening rates for participants who attended > 50% of the sessions. To assess the impact on cost savings, we evaluated the change in Observed to Expected cost ratios between 2022 and 2021 for participants who attended > 50% of the sessions.

RESULTS: 51% of survey respondents were internal medicine or family medicine physicians. We also found that regular attendees of MindMatters ECHO were voluntary physicians who are based in the community. They are part of the Mount Sinai Clinically Integrated Network but are not directly employed by the Mount Sinai Health System. Across 7 sessions in 2022, 261 attendees were recorded. 33 respondents across 7 sessions filled out both the pre and post session surveys. Using these responses, we found that attendees with a lower self-reported level of confidence with regards to providing behavioral health services exhibited a greater improvement in learning outcomes. Dimensions where provider learning was pronounced include how to access behavioral health referrals and the impact of sociocultural factors in whether/when/how patients present with depression. We also found that there was limited improvement in knowledge when questions focused on medication management (n=5). The process of assessing impact on patient care and cost savings is ongoing.

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IMPACT OF SARS-COV2 INFECTION ON PREGNANCY INDUCED HYPERTENSION.

Alexandra Mills1 , Bethany Dubois1, Corina Lesseur2, Teresa Janevic2, Elianna Kaplowitz2, Rebecca Jessel2 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Since March 2020, the COVID-19 pandemic has affected the entire world. Infection risk is higher for pregnant patients, as well as those with preexisting hypertensive disorders. SARS-CoV-2 infection and the resultant hyperinflammatory state may cause physiological stress during pregnancy that adversely affects maternal and fetal health. Preeclampsia is thought to be caused by endothelial dysregulation of maternal spiral arteries leading to vasoconstriction and placental insufficiency. COVID infection, too, is associated with endothelial dysfunction and placental microangiopathy.

OBJECTIVE: To examine the association of Pregnancy Induced Hypertension (PIH) and antepartum COVID infection in a large NYC hospital system.

METHODS: A large prospective cohort study of people who became pregnant between March 2020 and April 2022 and delivered at the Mount Sinai Hospital System. Clinical outcomes data was collected postpartum from electronic medical record (EMR) review, demographic information was collected by enrollment survey and EMR, and COVID infection was ascertained via survey, PCR, or antigen testing during pregnancy.

RESULTS: The incidence of any PIH, defined as gestational hypertension (gHTN), pre-eclampsia, or eclampsia, in the COVID-19 positive cohort was 13% (13/99) vs 17% (56/332) in the COVID-19 negative cohort. When adjusting for maternal age, BMI, parity, history of chronic hypertension (cHTN), history of gHTN, aspirin use during pregnancy, and socioeconomic factors (gestational age at first prenatal visit, mothers’ race and ethnicity, and NYC borough), COVID-19 was not shown to be associated with any PIH, with an odds ratio of 0.68 (95% CI 0.32, 1.37 p=0.30).

CONCLUSION: We did not observe an association between prenatal COVID-19 infection and pregnancyinduced hypertension. This may be in contrast to other studies with positive findings because we included asymptomatic or mild COVID-19 infection in our exposure group.

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HOW THE COVID-19 PANDEMIC CHANGED ONE COHORT OF VASCULAR SURGERY PATIENTS.

Andrew

OBJECTIVE: The COVID-19 pandemic has significantly affected healthcare delivery and accessibility. We conducted this study to better understand how the COVID-19 pandemic affected vein stent surgery patients.

METHODS: This retrospective analysis included 500 vein stent placements for non-thrombotic iliac vein lesion (NIVL) at a single institution from 2013 to 2022. “Pre-pandemic” patients were defined as patients whose last documented follow-up occurred prior to March 1, 2020, whereas “Post-Pandemic” patients had their last documented follow-up after March 1, 2020. Venous Clinical Severity Score (VCSS) was collected pre- and post-operatively. Major reintervention defined any reoperation with venography. Multivariate regression models calculated the odds ratio of major re-interventions and controlled for demographics and comorbidities.

RESULTS: Among 500 patients, 39.8% were identified as having their last follow-up occur post-pandemic. Post-pandemic patients had higher average preoperative VCSS pain scores (1.95 vs. 1.72, P = 0.004) and higher post-operative VCSS pain scores (0.95 vs. 0.78, P = 0.03). Post-pandemic patients also had a higher average number of reoperations (2.12 vs. 1.62, P = 0.003) and were more likely to have a major reoperation (34.1% vs. 12.6%, P < 0.001). Post-pandemic patients were more likely to undergo major reoperation compared to patients who were identified as pre-pandemic on multivariate analysis (OR = 2.31, 95% CI = [1.36 - 3.97], P = 0.002). The ethnicities of post-pandemic patients were different compared to patients seen pre-pandemic. The proportion of post-pandemic patients who were Asian was lower than the proportion of pre-pandemic patients who were Asian (85% vs. 61.3%, P = < 0.001). All patients in the analysis had their vein stent surgery before March 1, 2020. No patients in the analysis were established after March 1, 2020.

CONCLUSION: Post-pandemic patients were associated with an increased risk of major re-interventions and worse pain. The patient population seen post-pandemic differed significantly from the patient population seen pre-pandemic. A possible explanation is that the COVID-19 pandemic changed the likelihood of patients with milder venous disease from accessing healthcare during the pandemic, leaving only patients with more severe disease accessing healthcare during the pandemic. The COVID-19 pandemic may have also contributed to Asian patients being less likely to access healthcare during the pandemic.

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ABSTRACT

Min1 , Annie Chang2, Halbert Bai2, Jason Storch2, Jenny Chen2, Keva Li2, Jinseo Kim2, Justin Wang2, Mikeely Siegel2, Bianca Vama2, Sachi Lele2, Windsor Ting2 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

CHARACTERIZING THE HEALTH AND SOCIAL NEEDS OF SETTLEMENT HEALTH CENTER PATIENTS IMPACTED BY INCARCERATION.

Mackenzie Mitchell1 , Clare Idehen2, Ann-Gel Palermo1, Joseph Truglio3 1Medical Education, 2Pediatrics, 3Family Medicine and Community Health. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

Mass incarceration, including the criminalization of racialized communities, results in a high burden of disease among incarcerated and highly surveilled individuals. Health and social service related interventions directed towards individuals who are formally incarcerated are critical as this population is at high risk for recidivism, drug overdose, death from violence, lapse in management of chronic health conditions, and suicide. However, many community-based organizations that regularly interface with criminalized individuals do not have structured approaches and resources to best support these communities. Settlement Health Center, a longstanding Federally Qualified Health Center (FQHC) in East Harlem, faces barriers in meeting the social and health needs of this patient population, specifically adults and young adults who have a history of incarceration, and their children, with complex medical care issues. In this project, we look to characterize the health and social needs of Settlement Health Center (SHC) patients who have a history of incarceration and are reintegrating back into the East Harlem community, as well as family members impacted by incarceration. Using this information, we hope to identify opportunities for improvement within SHC resources and services in order to better provide holistic support and care to this population. To meet this objective, we designed and conducted semi-structured interviews with two groups 1) SHC clinic staff and community members working with this population and 2) SHC patients with a history of incarceration. Preliminary results from 10 staff and community member interviews reveal a lack of standardization of screening for history or impact of incarceration, lack of standardization of documentation after a positive screen, and lack of centralization of resources for staff to reference. The pre-existing SHC framework does however provide low-barrier access to care for patients without insurance and the ability to see entire families in one setting. We plan to hold additional interviews with eligible patients to better characterize and identify strategies to address their health and social unmet needs.

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LONG COVID AND IBD OUTCOMES IN PATIENTS RECEIVING VEDOLIZUMAB OR INFLIXIMAB BASED ON THEIR CYTOKINE SIGNATURE.

Juan Munoz Eusse1 , Serre-Yu Wong2. Medical Education, 2Gastroenterology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The differential effects of inflammatory bowel disease (IBD) therapies on immune response to COVID in patients with IBD are an area of interest. Our group has shown differences in circulating cytokine signatures in IBD patients after COVID infection treated with vedolizumab or infliximab. Whether therapies result in differences in long-term clinical outcomes after SARS-CoV-2 infection is unknown.

OBJECTIVE: To elucidate long-term outcomes of IBD patients receiving vedolizumab or infliximab with prior COVID infection. We predict that patients on vedolizumab had a higher incidence of IBD exacerbations and a higher incidence of long-COVID symptoms.

METHODS: In a screen of 235 patients with IBD, 21 patients tested positive for COVID antibodies prior to vaccination. We collected data for these 21 patients on long-COVID symptoms and duration, post-COVID IBD flares, hospitalizations, surgeries, medication changes, vaccination status/date/type, and infection severity. Data was gathered via telephone and chart review.

RESULTS: There were 18 male (86%) and 3 female (14%) patients. The average age was 45.8 years (±21.68), average BMI was 29.7 (±8.29), and 90% were vaccinated. Twelve patients had Crohn’s disease (CD) (57%), 8 with ulcerative colitis (38%), and 1 with IBD-undetermined (5%). Eleven patients were on infliximab, 7 were on vedolizumab, 1 on vedolizumab + methotrexate, and 2 on ustekinumab. The average number of COVID infections was 1.3( ±.88); 33% of patients had COVID more than once. Two patients contracted COVID at least 3 times (both receiving infliximab). One patient had severe COVID (vedolizumab), 3 of 4 patients with moderate COVID were on vedolizumab, and 9 of 14 patients had mild COVID. Five patients (24%) had long-COVID symptoms (3 with moderate or severe COVID of whom 2 were on vedolizumab). Most of the symptoms were neurological. Patients experienced long COVID from 9 to 31 months; 29% reported having IBD flares post-COVID (2 vedolizumab and 4 infliximab); 5% reported having a post-COVID IBD related hospitalization (infliximab).

CONCLUSION: IBD patients on infliximab appeared to be more susceptible to recurrent COVID infections, patients on vedolizumab had higher rates of moderate to severe COVID. Vedolizumab patients were more likely to experience long COVID. However, patients on infliximab appear to have had higher rates of IBD flares post-COVID. These results imply that IBD therapies can lead to differences in long-term clinical outcomes.

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GENOMIC COMPARISON OF INVASIVE AND COLONIZING ISOLATES IN PATIENTS HOSPITALIZED WITH METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA.

Devika Nadkarni1 , Bremy Alburquerque2, Marilyn Chung3, Adriana van de Guchte3, Ana Berbel Caba4, Erika Reategui Schwarz4, Mitchell Sullivan3, Harm van Bakel2, Deena Altman3. 1Medical Education, 2Genetics and Genomic Sciences, 3Medicine, 4Infectious Diseases. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of health-care associated infections, particularly bloodstream infections (BSI). Concomitant colonization of the anterior nares has been shown to have implications on persistence, recurrence, and transmission events. We performed genomic comparisons between paired nasal and blood MRSA isolates obtained from the same patient to elucidate the genetic differences that may contribute to within-host invasion and virulence.

METHODS: Patients hospitalized with MRSA bloodstream infection were swabbed in the bilateral nares. Paired blood and nasal isolates underwent DNA extraction and spa typing. Nasal and blood isolates from the same patients with matching spa types were sequenced by Illumina and PacBio respectively. For genomic analysis, PathoSPOT and Snippy were used to compare genomes of nasal and blood isolate pairs to evaluate single nucleotide polymorphisms, insertions and deletions.

RESULTS: Of 121 patients with MRSA BSI, 87 patients (72%) had concomitant colonization of the anterior nares with MRSA. Spa type of t002 predominated in both blood and nasal isolates. From the 76 pairs that underwent genomic analysis, several mutated genes were identified across all pairwise comparisons, 8 of which recurred in more than one patient pair. These included genes involved in conferring antibiotic resistance, increased mutability, immune evasion, and adaptive metabolism.

CONCLUSION: In patients with MRSA BSI and concomitant MRSA nasal colonization, mutations identified by genomic analysis in blood-nasal pairs are implicated in contributing to invasion and within-host adaptability.

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EMBRYO UTILIZATION IN YOUNG BREAST CANCER PATIENTS WHO HAVE UNDERGONE EGG HARVESTING FOR FERTILITY PRESERVATION.

Daniella Nevid1 , Elisa Port2, Christina Weltz2 1Medical Education, 2Breast Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Much progress has been made related to fertility preservation in women diagnosed with breast cancer. Nevertheless, there has been limited investigation of the ultimate issue in fertility preservation, namely the frequency with which women who have undergone egg harvesting actually pursue childbearing.

OBJECTIVE: To examine a single institution’s experience with egg and embryo utilization among patients diagnosed with breast cancer.

METHODS: In an IRB approved study, breast cancer patients treated in our institution between 2010 and 2020 were identified and their post-diagnosis fertility and childbearing history was reviewed. Inclusion criteria were age at presentation ≤ 45 years and diagnosis of either invasive breast cancer or ductal carcinoma in situ.

RESULTS: 316 patients were identified (average age at diagnosis = 39 years, range: 23 - 45). Of these, 168 patients (53%) were offered fertility referral and 118 (37%) saw a fertility specialist. 91 patients (29%) pursued egg harvesting followed by cryopreservation of eggs in 49 cases and embryos in 41, with 1 case unknown. Over an average of 5 years of follow-up, 29 women (32% of those who pursued egg harvesting) utilized the egg or embryo to pursue childbearing. 17 underwent embryo transfer to themselves and 11 used surrogate carriers.

Of the 55 Medicaid patients in the cohort, only 8 (15%) met with a fertility specialist, 4 harvested eggs, and none pursued childbearing. Of 260 HMO/PPO insured patients, 110 (42%) met with a fertility specialist, 87 harvested eggs, and 28 pursued embryo transfer. HMO/PPO insured patients were significantly more likely than Medicaid patients to see a fertility specialist (p = 0.0079) and pursue egg harvesting (p = 0.0131). There was also a significant difference in the rate of egg harvesting across self-identified racial groups (p = 0.047) with only 7.7% of Hispanic and 10% of Black patients in the cohort having undergone cryopreservation as compared to 34.8% of white and 40% of Asian patients.

CONCLUSION: These data demonstrate a low overall rate of cryopreserved egg and embryo utilization among women treated for breast cancer whose earlier pursuit of egg harvesting was evidence of a desire for childbearing. Furthermore, race and insurance data demonstrate disparities in the pursuit of fertility treatment and utilization of preserved eggs and embryos. Given the disparity findings reported here, finances and access will likely emerge as a significant barrier to childbearing in future qualitative research.

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IMPACT OF PREFERENCE SIGNALING ON INTERVIEW INVITES DURING THE 2021-2022 DERMATOLOGY RESIDENCY APPLICATION CYCLE.

Danielle Novack1 , Kandice Bailey2, Fatuma-Ayaan Rinderknecht3, Scott Worswick4, Adena Rosenblatt5, Dana Dunleavy6, Bobby Naemi6, Ilana Rosman2, Ammar Ahmed7. 1,3Medical Education, 2,4,5,7Dermatology, 6Admissions. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2Washington University School of Medicine, St. Louis, MO, 3University of California San Francisco School of Medicine, San Francisco, CA, 4University of Southern California, Keck School of Medicine, Los Angeles, CA, 5University of Chicago Medical Center, Chicago, Il, 6Association of American Medical Colleges, Washington DC, 7Dell Medical School at the University of Texas at Austin, Austin, TX.

BACKGROUND: During the 2021-2022 residency application process the American Academy of Medical Colleges (AAMC) instituted a supplemental Electronic Application Residency Service (ERAS) application piloted by internal medicine, general surgery, and dermatology. As part of the dermatology supplemental application, each applicant was allotted 3 preference signals (PS) that could be sent to programs of interest. 81% (117/145) of dermatology programs and 93% (950/1019) of dermatology applicants participated in the supplemental application.

OBJECTIVE: To evaluate how PS affected dermatology residency applicants’ likelihood of receiving an interview offer at a signaled program.

METHODS: A logistic regression was conducted to explore the relationship between an applicant’s signal status and interview offer. Residency programs were included based on (1) receiving at least one PS and (2) having met a 7:1 ratio of interviews per residency positions. Only applicants to programs meeting the inclusion criteria were analyzed. The data on interview offers was obtained via the “Selected for Interview” status in the ERAS Program Director’s Workstation.

RESULTS: Of 117 programs that participated in the supplemental application, 73 (62%) met the inclusion criteria. Of the 73 programs analyzed, they received a mean of 600 applications and 20 preference signals and offered a mean of 45 interviews. Sending a PS increased the likelihood of an applicant receiving an interview offer from 6% (95% CI 0.04-0.08) for those who did not signal to 38% (95% CI 0.18-0.62) for those who did. This did not vary by gender or underrepresented racial/ethnic groups.

CONCLUSION: An applicant’s median likelihood of receiving an interview invitation was over 6 times higher for programs to which they sent a PS, although there was a large range in predicted probabilities across programs (5% to 80%). Results from our study can help inform applicants, advisors, and programs approaches to preference signaling.

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ARTIFICIAL INTELLIGENCE-DRIVER AUTOMATED INTRACEREBRAL HEMORRHAGE VOLUME CALCULATION IS MORE ACCURATE THAN ABC/2. Ian Odland1 , Braxton Schuldt2, Kayla Liu2, Dylan Wu2, Margaret Downes2, Vikram Vasan2, Christina Rossitto2, Trevor Hardigan2, Christopher Kellner2. Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Treatment of spontaneous intracerebral hemorrhage (ICH) requires rapid, accurate estimation of hemorrhage volume to determine appropriate patient care and guide prognosis. ICH volume estimation on Computed Tomography (CT) imaging using the ABC/2 formula is the clinical gold standard, however this method can be inaccurate, suffers from observer scoring variability, and takes time to make the measurement on a workstation. Semi-Autonomous Segmentation (SAS) is the gold standard for hemorrhage volume estimation; however, it is not used clinically due to the increased time for analysis. Recently, artificial intelligence (AI) driven segmentation has been developed (Viz.ai, San Francisco, California) to automatically detect ICH and calculate hematoma volume.

OBJECTIVE: To validate the accuracy of the Viz.ai ICH segmentation algorithm as a tool for determining hemorrhage volume by comparing its performance to both ABC/2 and SAS.

METHODS: Seventy head CTs positive for ICH were analyzed with SAS in 3D Slicer to determine ICH volume as the standard reference volume. The same CT scans were then analyzed using the ABC/2 method. Finally, scans were uploaded to Viz.ai for ICH volume analysis.

RESULTS: Compared against standard SAS, Viz.ai ICH volumes were more accurate than ABC/2 in 77% of cases. The average difference between Viz.ai ICH volume and SAS ICH volume was 4.9±4.2 mL (R2=0.98). The average difference between ABC/2 ICH volume and SAS ICH volume was 10.6± 11.4 mL (R2=0.77).

CONCLUSION: This study indicates that Viz.ai more accurately estimates ICH volume than ABC/2 over a broad range of hematoma volumes when compared to standard SAS, which when coupled with significantly faster analysis compared to SAS justifies the use of AI in ICH triage workflow.

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A PROSPECTIVE STUDY UTILIZING PRE-OPERATIVE RESECTABILITY SCORES TO IMPROVE COMPLETE GROSS RESECTION RATES DURING PRIMARY DEBULKING SURGERY FOR ADVANCED OVARIAN CANCER.

Kaothar Oladoja1 , Ryan Kahn2, Dennis Chi2. 1Medical Education, 2Gynecologic Oncology.

1Icahn School of Medicine at Mount Sinai, New York, New York, 2Memorial Sloan Kettering Cancer Center.

BACKGROUND: Despite advances in surgical care, women undergoing debulking surgery for ovarian cancer remain at risk for suboptimal resection, with its associated morbidity without proportionate survival benefit. There is evidence supporting the association between complete gross resection during surgical debulking and improved patient outcomes. Preoperative assessment of tumor burden with clinical and radiologic data has been the goal of several predictive models to minimize the risk of a suboptimal resection.

OBJECTIVES: 1. To assess the feasibility of implementing a multimodal algorithm to triage patients with advanced epithelial ovarian cancer to primary debulking surgery (PDS) versus diagnostic laparoscopy followed by PDS or neoadjuvant chemotherapy (NACT). 2. To prospectively compare the performance of two different algorithms in predicting residual disease outcomes in patients undergoing PDS

METHODS: All patients treated at MSKCC with known or suspected advanced epithelial ovarian cancer between 8/21- 7/22 were identified. Patients underwent a prospective calculation of Respectability Score (RS) based on radiologic and clinical variables using two models. RS1 was initially developed to evaluate the risk of residual disease greater than 1cm. RS2 was later developed to predict the likelihood of achieving complete gross resection (CGR). Based on score, patients were triaged to PDS or laparoscopic evaluation of resectability followed by PDS or NACT.

RESULTS: 71 patients were identified, 16 (23%) a high-risk score using the RS1 algorithm and 12 (17%) a highrisk score using the RS2 algorithm. Of the 71 patients, 56 (80%) patients underwent PDS, 9 (13%) underwent diagnostic laparoscopy, and 5 (7%) patients underwent NACT. For patients that underwent diagnostic laparoscopy, 8 (89%) were subsequently triaged to NACT and 1 (11%) was triaged to PDS. For patients that underwent PDS, there was a CGR rate of 79% (n=44), an optimal resection rate of 18% (n=14) and a suboptimal resection rate of 4% (n=2). Implementation of the RS2 algorithm led to an overall futile laparotomy rate of <3% and a CGR rate of 79%. RS2 demonstrated no significant differences in predicting a suboptimal resection when compared to RS1.

CONCLUSION: Overall, application of a multimodal algorithm with synoptic radiology templates to triage patients with advanced ovarian cancer was successful at decreasing the rates of suboptimal resection and futile laparotomies at a high-volume cancer center.

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PROFILING T CELL SIGNALING IN IL-17A–PRODUCING GAMMA DELTA T CELLS

USING CD3 ZETA MUTANT MICE

Oluomachi Onyekwere1 , Xiaoyan Xu2, Rachel Caspi2 1Medical Education, 2Ophthalmology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2NIH National Eye Institute.

Ocular surface immunity is important to maintaining the integrity of the cornea. Previous research found that a commensal bacteria within the ocular surface protects against corneal infection by driving an interleukin 17 response from gamma delta T cells. gamma delta T cell production of IL-17 is facilitated by T cell receptor (TCR) signaling, but the downstream signaling pathway has not been extensively addressed. The TCR complex is made up of multiple signal transduction subunits (CD3 , CD3 , CD3 , and CD3zeta), each containing one or more copies of Immunoreceptor Tyrosine-based Activation Motif (ITAM) that relay downstream signaling molecules through phosphorylation of its tyrosine residues and activation of Syk and Zap70 kinases. ITAMs are not unique to T cell receptors but are also found in B cell receptors (BCR) and Fc receptors (FCR). Phosphorylation of ITAMs is traditionally viewed as an activating process, but a more complex mechanism is suggested involving a possible inhibitory function of ITAMs, coined the term ITAMi (inhibitory ITAM), as seen in B cell anergy. We were interested in whether an inhibitory function of ITAM is present in gamma delta T cells, and if the mechanism is mediated by the phosphatase SHP-1. To address the role of ITAM for TCR signaling, we used 6Y/6Y and 6Y/6F mice. 6Y/6Y mice encoded a wild-type CD3zeta chain. In the 6Y/6F heterozygous mice, half of the CD3zeta tyrosine (Y) residues were mutated to phenylalanine (F), rendering them non-functional. We examined the effects of the mutation by following the phosphorylation activity of downstream TCR signaling products: pERK, pS6, and pLAT1, which are known to be part of the IL-17A-producing gamma delta T cell signaling pathway. We then used proximity ligation assay to observe the interaction of SHP-1 with CD3zeta ITAM. We hypothesized that if there is an inhibitory function, we expect that in gamma delta T cells with mutant CD3zeta ITAMs there will be increased phosphorylation of the downstream molecules and that this increase is due to reduced phosphatase (SHP-1) activity. For IL-A–producing gamma delta T cells, the highest level of pERK, pS6, and pLAT1 occurred in the heterozygous mutant, supporting our hypothesis. It was also observed that SHP-1 interacts with CD3zeta ITAMs. The implication of our findings is that gamma delta T cell receptor signaling is a complex mechanism that may provide a point of manipulation at the CD3zeta ITAM to increase or decrease downstream production of IL-17 in ocular surface disease states and autoimmunity, respectively.

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VALIDATION OF CLINICAL GUIDELINES FOR MILD TRAUMATIC BRAIN INJURY PATIENTS FOR HEAD COMPUTED TOMOGRAPHY IN ACUTE ALCOHOL INTOXICATED PATIENTS.

Gi-Jong Paik1 , Jacques Lara-Reyna2, Konstantinos Margetis2 1Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: There is disagreement in clinical decision rules regarding the use of head computed tomography (CT) scan for patients with suspected acute alcohol intoxication (AAI) and mild traumatic brain injury (mTBI).

OBJECTIVE: To validate and compare four of the most common head CT scan guidelines in predicting the presence of clinically important intracranial lesions in the AAI patient subset.

METHODS: Retrospective review was performed on patients with suspected TBI and a head CT scan from the Mount Sinai Morningside Trauma Registry from May 2018 to December 2020. Patients were included in the analysis if they met the following criteria: blunt head trauma, initial emergency department Glasgow Coma Score (GCS) of 14-15, and a positive blood alcohol content (BAC) and/or subjective signs of intoxication. Positive CT was determined as evidence of any acute intracranial injury on head CT that required neurosurgical follow up. Validation of the four guidelines, the Canadian Head CT Rule (CCHR), New Orleans Head Criteria (NOC), American College of Emergency Physicians (ACEP), and the NEXUS II were performed by calculating instrument sensitivity, specificity, positive predictive value and negative predictive value.

RESULTS: A total of 991 patients with suspected TBI and head CT scan were reviewed. Of these, 107 patients were included in the analysis (mean age = 52.8 years, male = 83.2%, mean BAC = 193.8 mg/dL). A total of 76.6% of patients yielded a positive CT scan. The NOC and ACEP had the highest sensitivity followed by the NEXUS II and CHCR (100% vs 100% vs 91.3% vs 52.3%), but the CHCR was the most specific followed by NEXUS II, NOC and ACEP (60.0% vs 20.0% vs 0% vs 0%).

CONCLUSION: For AAI patients with mTBI, the CHCR had the lowest sensitivity, missing almost 50% of all positive CT cases. However, it had the highest specificity followed by the NEXUS II. Utilization of both the NOC and ACEP would have resulted in excessive overuse of CT with 0% specificity. This study shows that all clinical guidelines have weaknesses, and a new clinical decision rule is needed to properly identify acute intracranial injury in the AAI patient subset.

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VARIATIONS IN HOSPITAL IN HOME PROGRAMS IN VETERAN AFFAIRS HEALTH SYSTEM: A NEED FOR STANDARDIZATION?

Sungja Park1 , Emily Franzosa2, Akanksha Samant3, William Hung2 1Medical Education, 2Geriatrics and Palliative Medicine, 3Geriatric Research Education and Clinical Center. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3James J Peters VA Medical Center, Bronx, New York.

BACKGROUND: The Department of Veterans Affairs (VA’s) Hospital In Home (HIH) program is a model of care that delivers acute level hospital care at home. Since the first HIH program at a VA health facility, this model of care has spread throughout the VA health facilities across the nation. To meet the needs of its own unique patient demographics with specific geographic characteristics, each VA health facility started their own variations of the HIH program and have been modifying and maintaining them to improve patient care.

OBJECTIVE: To evaluate the necessity of federal level care model standardization to examine similarities and differences among all 11 VA’s HIH programs across the nation which ultimately may provide data to support guidelines for best practices.

METHODS: Hospital-in-home programs’ medical directors at 5 VA health facilities were interviewed for the characteristics of their HIH program care models and their clinical outcomes. Site 1 was the Southern and Site 2 was in the Northeastern United States of America. According to the self-reported data, the team mapped the implementation of Hospital-in-home model of care based on RE-AIM framework that assesses reach, staffing, effectiveness, adoption, implementation, and maintenance.

RESULTS: The HIH programs showed variations and similarities in outpatient, inpatient, and ED services in the forms of both early discharge and replacement hospitalization services. Both sites also provided 24/7 emergency contact services.

CONCLUSION: Hospital-in-home programs at Veterans Affairs hospitals have variations in how each program is implemented and operated. Also, each site collected variations of metrics for the measurement of clinical outcomes; for comparison across sites, it would be important to have common metrics across these programs. There needs to be additional work looking into what standardized metrics should be to evaluate HIH program’s clinical effectiveness. This information will be necessary to guide practices and program development for HIH programs across the nation. As non-VA HIH programs in the nation also may lack standardized care model and metrics to measure clinical outcomes, the discussion of this paper will have implications for the non-VA HIH programs across the nation as well.

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THE UTILIZATION AND EQUITY OF A COMMUNITY PARAMEDICINE MODEL AMONG HOMEBOUND PATIENTS.

Colby Parsons1 , Christian Escobar2, Peter Gliatto2, Katherine Ornstein3 1Medical Education, 2Geriatrics and Palliative Medicine, 3Geriatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, MD.

BACKGROUND: Community Paramedicine (CP) is a novel hospital diversion model. CP is designed to extend primary care provider capabilities by deploying paramedics to the home, who virtually consult with a physician to coordinate treatment and assess disposition. While evidence suggests CP programs can effectively manage many patients in their homes, few studies have described CP amongst a homebound population and fewer have explored concerns of equity.

OBJECTIVE: To characterize the use of CP amongst homebound patients at the Mount Sinai Visiting Doctors Program (MSVD) and assess deployment equity by comparing the socioeconomic demographics of CP-utilizers and non-utilizers.

METHODS: This retrospective cohort study examined 256 homebound MSVD patients, who utilized a physician-led CP service between March 2017 and May 2022. We linked datasets from CP and MSVD, which include patient demographics, health status, social history, and encounter-specific information. We reviewed each encounter to abstract additional variables of interest, such as advanced care planning status, hospice status, and chief complaint. Outcome variables abstracted from the electronic health record, such as rates of ED transport, hospital admission following transport, and 3-day ED utilization, were also manually validated. Using t-tests and chi square analyses we compared the clinical and demographic characteristics between patients who utilized CP and those who did not.

RESULTS: CP was deployed 366 times for 256 unique MSVD patients.15.4% of all MSVD patients used CP at least once during this period. Of CP-utilizers, 28.1% utilized the service repeatedly. CP-utilizers were significantly older than non-utilizers (86.2 vs. 82.4, p<0.001). CP-utilizers also tend to have higher chronic disease burden than non-utilizers as measured by mean Elixhauser score (4.7 vs. 3.8, p<0.001). There was not a significant difference between the percent of CP-utilizers enrolled in Medicaid as compared to non-utilizers (48% vs. 49%, p=0.65), nor was there a significant difference between rates of enrollment in public housing (19% vs. 15%, p=0.07).

CONCLUSION: Community paramedicine is deployed, often repeatedly, for a population of homebound patients that is older and has a high chronic disease burden. The socioeconomic demographic similarities between CP-utilizers and non-utilizers offers promising evidence that the service is being deployed equitably for patients regardless of socioeconomic status.

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OUTCOMES OF GLAUCOMA AND OCULAR HYPERTENSION AFTER VITREORETINAL SURGERY WITH SILICONE OIL.

Naeha Pathak1 , Laura Barna2, Kateki Vinod2, Meenakashi Gupta2 1Medical Education, 2Ophthalmology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Vitreoretinal surgeries, performed for conditions such as retinal detachments, often involve the injection of silicone oil (SiO) into the eye to keep the retina attached. SiO is useful because it is clear and has minimal refractive shifts. However, research suggests that SiO can potentially increase intraocular pressure (IOP) and lead to secondary glaucoma by blocking the trabecular meshwork. Topical medical therapy can be used in patients with elevated IOP. However, in more severe cases, glaucoma surgery may be necessary, which has unpredictable success rates.

METHODS: A retrospective study was performed that looked at pre- and postoperative data from 186 patients at New York Eye and Ear of Mount Sinai who had vitreoretinal surgeries with SiO injections in one eye between Jan 1, 2016 and Jan 1, 2022. Risk factors, visual acuity, IOP, and number of glaucoma medications were analyzed and compared between patients who eventually needed glaucoma surgery and those who did not.

RESULTS: Of 186 patients who had retinal detachment surgery with SiO injection, 17 (9.1%) required glaucoma surgery. At postoperative month 3, there was no significant difference in visual acuity and IOP between patients who eventually needed glaucoma surgery and those who did not; however, the former group was more likely to need glaucoma medications (p-value <0.05). At postoperative month 6 and 12, patients who required glaucoma surgery were more likely to have lower visual acuity, higher IOP, and more glaucoma medications (p-value <0.05). Lastly, at postoperative month 24, there was no significant difference in IOP, but patients who needed glaucoma surgery were more likely to have lower visual acuity and more glaucoma medications (p-value <0.001).

Risk factors for eventually requiring glaucoma surgery included a prior retinal detachment in the same eye, monocular vision, postoperative non-emulsified SiO in the anterior chamber, emulsified SiO in anterior segment, postoperative IOP elevation, and postoperative intravitreal injections (p-value <0.05). A retinectomy, or excision of the peripheral retina, during the surgery was associated with a lower risk of glaucoma surgery (p-value <0.001).

CONCLUSION: This research elucidates that SiO in vitreoretinal surgeries may increase IOP and cause secondary glaucoma. This data will help increase clinical knowledge of how to minimize postoperative complications following vitreoretinal surgeries, especially in patients at high-risk for developing elevated IOP.

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SURVEY AND EEG-BASED PREDICTORS OF EMPLOYMENT GOAL SUCCESS IN ADULTS WITH AUTISM SPECTRUM DISORDER.

Michael Peruggia1 , Jadyn Trayvick2, Sarah Barkley2, Sarah Banker2, Faris Gulamali2, Daniela Schiller2, Jennifer Foss-Feig2. 1Medical Education, 2Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Between 707,000 and 1,116,000 people in the US with Autism Spectrum Disorder (ASD) turn 21 each year, at which point they age out of their school programs. Teachers report that only 58% of students with ASD have a plan for after schooling. Employment is a goal for many autistic adults and the workplace can be a place for building friendships, finding structure, and achieving independence. Previous research has identified differences in resting frontal gamma-band power when comparing people with autism to typically developing individuals (TD), and frontal gamma-band power has been associated with expressive language skills and complex processing. However, previous research has not compared resting encephalography (EEG) differences among adults with autism who have achieved and have not achieved personal goals, such as employment.

RESEARCH QUESTION: Is there a relationship between resting state EEG and employment success?

METHODS: 29 adult participants were split into three groups: TD (4F, 1M), employed ASD individuals (5F, 12M), and individuals with ASD seeking employment (2F, 5M). Adults with autism who were not seeking employment were omitted from analyses because we investigated barriers to goals that are claimed by the individual. Participants completed a 5-minute resting electroencephalogram and the Lehman Work Questionnaire. Autism symptoms were quantified with the Social Responsiveness Scale (SRS-2).

RESULTS: Groups had significant differences in resting EEG power (F=10.75, p= 4.58*10-5). Specifically, frontal gamma power was different between the employed and seeking groups (p=0.03) and the TD and seeking groups (p<0.01). Survey data showed a significant difference in total SRS score between employed vs. seeking participants with ASD (t=-3.823, p<0.001). However, frontal gamma power and SRS were not significantly correlated with each other (p=0.679). Also, within the employed ASD group, job satisfaction was more strongly correlated with coworker relationships (n=11, r=0.88, p<0.001) than boss relationships (n=10, r=0.54, p=0.1).

CONCLUSION: Resting frontal gamma power was higher in people with ASD who are seeking employment than in people with autism who are employed and controls. SRS scores and frontal gamma power can both help us predict employment success. The job satisfaction of employed adults with autism is more related to their relationship with coworkers than their relationship with their bosses.

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ABSTRACT 87

ACUTE SEVERE ULCERATIVE COLITIS IS ASSOCIATED WITH AN INCREASED RISK OF ACUTE POUCHITIS.

Hannah Posner1 , Maia Kayal2 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Pouchitis occurs in up to 80% of patients with ulcerative colitis (UC) after total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA). Increasing data suggest a robust immune system may be associated with an increased risk of pouchitis.

OBJECTIVE: To test this hypothesis by performing a retrospective cohort analysis, comparing the incidence of acute pouchitis in patients admitted with acute severe ulcerative colitis (ASUC) at the time of colectomy to patients admitted without ASUC.

METHODS: This was a retrospective cohort analysis of all patients with UC or IBD unclassified complicated by medically refractory disease or dysplasia who underwent TPC with IPAA at MSH between 2008-2017 and at least one subsequent pouchoscopy. ASUC was defined by the Truelove and Witts criteria. Acute pouchitis was defined by the Pouchitis Disease Activity Index. Univariable cox regression was used to assess unadjusted relationships between hypothesized risk factors and acute pouchitis. Multivariable cox regression for the primary outcome of acute pouchitis was performed a priori with selection of the following clinically relevant variables: age, sex, ASUC admission, number of pre-colectomy biologics, and disease extent.

RESULTS: A total of 416 patients met inclusion criteria. The median age at colectomy was 35.4 [IQR 26.149.0] years and 224 (53.8%) patients were male. Biologics were used in 292 (70.2%) patients pre-colectomy, and disease extent was reported as extensive in 327 (78.6%). Elective colectomy was performed in 251 (60.3%) patients. Of the 165 (39.7%) patients who underwent urgent colectomy, 77 (46.7%) were admitted with ASUC. Acute pouchitis occurred in 228 (54.8%) patients had a median of 1.3 [IQR 0.6-3.1] years after the final surgical stage. On multivariable analysis, older age at colectomy (HR 0.98 95% CI (0.97-0.99)) was significantly associated with a decreased probability of acute pouchitis, while ASUC (HR 1.53 95% CI (1.062.22)) and a greater number of biologics pre-colectomy (HR 1.30 95% CI (1.05-1.62)) were associated with an increased probability of acute pouchitis. Time to pouchitis was significantly less in patients admitted with ASUC compared to those not, p=0.002.

CONCLUSION: ASUC and greater use of biologics pre-colectomy were associated with the development of acute pouchitis. Both are surrogates for severe disease and immune activation. Hence, pouchitis may be driven by the propensity to inflammation that exists with both.

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AN EFFICIENT PEDIATRIC AFFECT AND COOPERATION SCALE FOR MASK INDUCTION OF ANESTHESIA: A CLINICAL ASSESSMENT OF HRAD±.

Daniel Qian1 , Romy Yun2, Thomas Caruso2 1Medical Education, 2Anesthesiology. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2Stanford University School of Medicine, Palo Alto, CA.

BACKGROUND: Mask induction of anesthesia consistently produces high anxiety and distress for perioperative pediatric patients. The most reliable affect scales are typically used in research settings. Clinical use of these scales would be too time consuming to be routinely completed. HRAD± (Happy, Relaxed, Anxious, Distressed, Cooperativity) was developed to rapidly assess pediatric affect during mask induction. In a previous study using HRAD±, anesthesiologists and nurses scored standardized patient videos; HRAD± compared favorably to more complex affect scales.

OBJECTIVE: The primary aim was to compare HRAD± to the modified Yale Preoperative Anxiety Scale (mYPAS), Observation Scale of Behavioral Distress (OSBD), and Induction Compliance Checklist (ICC) at mask induction in real time (opposed to videos). Secondary outcomes determined correlations between HRAD± to emergence delirium using the Pediatric Anesthesia Emergency Delirium (PAED), Watcha, and Cravero scales.

METHODS: This observational study was conducted at a quaternary care center in California. Inclusion criteria included patients 1-18 years, ASA 1-3, undergoing inhalational mask induction. Exclusion criteria were intravenous induction, ASA 4+, emergent procedures and awake extubations.

At induction, two trained research assistants independently scored patients using HRAD±, mYPAS, OSBD, and ICC. On emergence, PAED, Watcha, and Cravero were assessed by the same researchers. Correlation analyses computed associations between HRAD± and reference scales. Inter-rater reliability was assessed using Fleiss’ kappa.

RESULTS: 197 patients were included. HRAD± demonstrated strong correlation with mYPAS, moderate correlation with OSBD and ICC, and weak correlation with PAED and Watcha (Table 1). No correlation was observed between HRAD± and Cravero. Inter-rater reliability was moderate for both HRAD and cooperativity respectively ( =0.595, =0.478 p<0.0001).

CONCLUSION: We demonstrated that HRAD± is a comparative tool for rapidly identifying pediatric affect during mask induction. Strong correlation to mYPAS was observed. Although mYPAS is one of the most utilized anxiety scales, it is complex, requiring trained observers. HRAD± is simpler, positioning it for routine clinical use. The development of an efficient scale to improve recognition of anxiety is important to drive quality outcomes measures. Further studies are needed to assess the scale in different hospitals and settings.

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EQUITABLE DESIGN IN DIGITAL HEALTH: AN OVERVIEW, INCLUDING CHALLENGES AND OPPURTUNITIES.

Nasseef Quasim1 , Deonta Wortham2 1Medical Education, 2Strategy.

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

OBJECTIVE: RockHealth.org is a non-profit that fosters equity and equitable design in digital health. This project was a preliminary review to develop a strategic report for digital health stakeholders. The objective was to synthesize knowledge related to equitable digital health design.

METHODS: The project included 3 approaches: a literature review, landscape review, and discovery interviews. The literature review was conducted using a search of key texts in Pubmed, Scopus, Google Scholar, and the Google Search Engine. The landscape review was a search of nonprofit and for-profit organizations using Crunchbase. Discovery interviews were 1 on 1 interviews with field actors. Pre-developed questions focused on the individual’s direct work, perspective on digital health, and recommendations for RockHealth.org.

RESULTS: 4 key themes, 42 organizations, and 5 Interviews were collected. The themes were a) equity design leaders have not directly built frameworks specifically for digital health; b) when digital health innovators adapt equity frameworks they emphasize technical solutions and deemphasize structural and political approaches; c) technical solutions may differ from immediate concerns of lay people; d) general barriers in healthcare like fragmentation of care also challenge digital health. The landscape review yielded 14 equity design non-profit and 30 for-profit organizations. Companies without a direct focus on equity or marginalized communities were excluded. 5 Interviews were conducted: 2 RockHealth staff in consulting and research, 2 design specialists, and 1 physician-innovator. These interviews revealed broad consensus on advancing equity with caveats on the intentionality the challenge requires.

CONCLUSION: The equity design field is still refining co-creation METHODS, where experts and community members work together to serve marginalized communities. Problems affecting the entire healthcare system like fragmentation of care makes this harder. However, centering on the principle of inclusion and adapting lessons from liberal democratic values offers innovators a path forward to develop strategic goals and pragmatic solutions. Some of these tenets have coalesced into training manuals by equitable designers, broadly, but can be adapted to the field of digital health, specifically, to create future solutions.

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EVALUATION OF SKIN AS A PROXY TO ASTHMA.

Grace Rabinowitz1 , Emma Guttman-Yassky2 1Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Incidence of allergic diseases has been increasing, with progression from atopic dermatitis to allergic asthma over time. This “atopic march” implicates the epithelial barrier of the skin and respiratory tract as disease modulators. Skin barrier defects and pathological lung changes have been postulated to be interwoven by the systemic inflammatory profile of the immune system. The epidermal inflammatory profile is a potential window to internal changes.

OBJECTIVE: To examine tape-stripped healthy skin in asthma to determine if sampling the skin provides understanding of internal inflammatory processes. The goal was to use tape strips to characterize the immunologic profile of asthma noninvasively and demonstrate predictive capacity of a minimally invasive technique.

HYPOTHESIS: Patients with asthma have systemic inflammation reflected in abnormalities in skin tissue.

METHODS: Study groups were: (1) 45 children (<18 years) with allergic asthma, (2) 19 healthy control children, (3) 19 adults with allergic asthma, and (4) 26 healthy control adults. Methods include a one-time evaluation of skin using tape strips taken from the upper extremities, sputum sampling, and lung function testing. RNA-seq libraries were pooled and sequenced on the Ion S5 XL System Sequencer with Ion 550 Chips (ThermoFisher, Waltham, MA). P values were adjusted using the Bejamini-Hochberg procedure, controlling for false discovery rate (FDR). Genes with an FCH > 2 and an FDR < 0.05 were DEGs. Mean expressions of all markers were summarized in a heat map, in which unsupervised clustering was performed using Euclidean distance and average agglomeration criteria.

RESULTS: We identified 641 differentially expressed genes (DEGs) in children with allergic asthma (AA) including genes related to the lung fibrotic pathway (ID1, PROS1) and airway remodeling (TGFBR1, EGFR). Significant dysregulation of epithelial cell-to-cell adhesion genes found in lungs include tight junctions (CLDN18) and adherens junctions (CDH1) (P<0.05). We also found EXOSC1 to be the best single gene classifier for AA children (AUC=0.97) and determined tape strip biomarkers show correlation with asthma severity (FEV1) while blood proteomics was not a good proxy for AA biomarkers.

CONCLUSION: Physical insults to respiratory epithelium in asthma lead to barrier dysfunction and stimulation of inflammatory cytokines such as TGF-B during lung remodeling. These barrier changes are detectable in skin via tape strips.

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EVALUATION OF INTRAOPERATIVE COMPUTER-ASSISTED NAVIGATION WITH PANORAMIC FLUOROSCOPY FUNCTIONALITY FOR IMPLANT POSITIONING IN DIRECT ANTERIOR TOTAL HIP ARTHROPLASTY.

Yi Ren1 , Andrew Jordan2, Jonathan Spaan2, Edwin Su2. 1Medical Education, 2Orthopaedics.

1Icahn School of Medicine at Mount Sinai, New York, New York, 2Hospital for Special Surgery.

BACKGROUND: Intraoperative C-arm imaging is widely used for direct anterior approach total hip arthroplasties (DAA THAs), but the parallax phenomenon and the limited field of view can compromise image quality. Computer-assisted intraoperative navigation may mitigate C-arm distortions. Little is known to what degree navigation may improve the precision and/or accuracy of intraoperative measurements, compared to measurements obtained on C-arm fluoroscopy and postoperative radiographs (PRs). Thus, we compared real-time intraoperative inclination, anteversion, and LLD obtained with RadlinkTM navigation software versus measurements obtained with the C-arm, and compared both intraoperative measurements to PR measurements.

METHODS: From 2020-2021, 148 primary DAA THAs using computer-assisted navigation was analyzed. LLD and inclination were measured manually on calibrated C-arm images. LLD, inclination, and anteversion were measured on PRs using Einzel-Bild-Röntgen-Analyse software. Univariate, correlation, and multivariate analyses considering age, sex, BMI, acetabular cup and head sizes were conducted.

RESULTS: The median difference between postoperative radiographic and navigation was significantly lower than the difference between postoperative radiographic and C-arm for LLD (0.30mm vs 2.00mm, p<.001) and inclination (1.33° vs 2.60°, p<.001). Median (IQR) C-arm LLD (3.44mm, 1.94mm-5.63mm) was significantly greater and had wider variation than navigation LLD (1.20mm, 0.30mm-2.20mm; p<0.001) and postoperative radiographic LLD (1.50mm, 1.00mm-2.50mm; p<.001). Median C-arm inclination (38.50°) was significantly lower than supine postoperative radiographs and navigation inclination (40.90°, 39.00°; p<.001). Median anteversion differed between navigation and supine PRs (19.00° vs 23.09°; p<.001).

Spearman correlation analysis found that increasing BMI was associated with lower LLD (rs = –0.221, p=.007) and lower cup anteversion measurements (rs = –0.173, p=.037) on navigation, but not PR or C-arm. However, regression analysis found no associations between BMI and LLD, inclination, or anteversion measurements obtained on all 3 imaging modalities (p>.05 for all comparisons).

CONCLUSION: Measurements on C-arm were greater and more varied than those obtained on navigation or PRs, consistent with the effects of parallax distortion. Measurements on navigation were closer to PRs than C-arm, supporting its use in providing more accurate intraoperative measurements.

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EXAMINING THE RECRUITMENT CAPABILITY AND IMPLEMENTATION FIDELITY OF A FINANCIAL WELLNESS INTERVENTION FOR INDIVIDUALS WITH SUICIDAL IDEATION OR BEHAVIOR.

Sharen Rivas1 , Shima Sadaghiyani2, Oscar Jimenez-Solomon2 1Medical Education, 2Psychiatry. 1Icahn School of Medicine at Mount Sinai, New York, New York, 2New York State Psychiatric Institute, New York, NY.

Financial wellness and peer-support interventions may improve mental health outcomes in individuals experiencing psychiatric distress. As the use of evidence-based interventions becomes increasingly common in psychiatric research, it is vital that the feasibility and potential biases of these interventions is properly investigated so that they may be executed successfully. Recruitment bias, in particular, is a significant barrier against ensuring a diverse sample. Failure to implement the intervention as originally intended may also compromise the reliability or integrity of the intervention. Our study examines the recruitment and implementation feasibility of the pilot study, From Hardship to Hope (FHTH). FHTH is a peer-led financial wellness intervention for individuals with suicidal ideation or behavior (SIB). The New York State Psychiatric Institute and Baltic Street AEH, Inc distributed an online form to recruit associated individuals for FHTH. To examine recruitment capability, the demographic and eligibility data of participants were analyzed. These include the contact information form(demographics), the phone screening check for eligibility, and the Columbia-Suicide Severity Rating Scale (C-SSRS) completed by participants. Those eligible were aged 18-64 y/o, worked or lived in NYC, and had financial hardship and recent SIB. Financial hardship was defined as having a loss of income, difficulty paying bills, repaying debt, or paying for basic necessities. Recruitment bias was also assessed by conducting a literature review to investigate if the C-SSRS evokes similar responses from individuals from diverse socio demographic backgrounds, to determine if utilizing this scale in FHTH posed a barrier to recruiting a diverse sample population. We also analyzed the limitations of the current indicators used to measure the implementation fidelity of FHTH. Overall, sixty individuals completed the initial FHTH online form but only thirty were eligible to complete the C-SSRS. Younger participants (≤30 y/o) had higher C-SSRS scores for lifetime SIB (t(28)=1.83, p < .10) compared to older participants, and financial hardship was not positively correlated with lifetime SIB, though the data are trending towards significance. The findings of the present study were used to develop recommendations for future indicators of recruitment capability and implementation fidelity that should be employed before FHTH moves on from the pilot phase.

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ABSTRACT 93

A NOVEL PORT TO FACILITATE MAGNETIC HYPERTHERMIA THERAPY FOR GLIOMA.

Benjamin Rodriguez1 , Joseph Borrello2, Benjamin Rapoport2, Robert Ivkov3, Constantinos Hadjipanayis4 1Medical Education, 2,3,4Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Johns Hopkins Medical Institute, 4University of Pittsburgh Medical Center.

BACKGROUND: Magnetic hyperthermia therapy (MHT) is an emerging technique to treat glioblastoma by leveraging the heating properties of magnetic nanoparticles (MNP) within an alternating magnetic field (AMF). MNPs must surpass 45oC to kill tumor cells, while remaining below 55oC to avoid killing healthy cells, but currently there is no modality to directly measure intratumoral temperature during MHT sessions. We developed a subcutaneous device to allow real-time intratumoral temperature measurement during an MHT session. This phantom study was designed to test the feasibility of the device (ThermOmmaya) in MHT clinical workflow.

METHODS: The device was implanted in a polyvinyl alcohol skull phantom model; 400 microliters of iron oxide MNPs were delivered into a lesion via the device. Two fiber optic probes were then localized into the lesion, one centrally located within the MNPs and one at the periphery. This phantom model was then placed in an AMF and subjected to clinical standard magnetic field ranges.

RESULTS: Using an average magnetic field of 55 Oe at 160 kHz, the temperature of the MNPs was continuously measured within the lesion. A rapid 31°C increase in temperature of the nanoparticles (13.8°C to 45°C) was observed in 53 seconds. Upon reaching a temperature of 45°C +/- .9°C an average temperature of 44.8°C was maintained for 15 minutes. There was no excessive heating observed when conducting this test in the AMF and the temperature of the nanoparticles returned to body temperature (37°C) 30.3 seconds after the magnetic field was deactivated.

CONCLUSION: The results of this trial illustrate that the device is capable of continuously and accurately measuring intratumoral MNP temperature during an MHT session. This paradigm may ultimately prove useful in clinical practice by ensuring adequate temperatures are reached to eradicate tumor cells.

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ABSTRACT 94

REGENERATIVE HEALING IN NEONATAL MOUSE INTERVERTEBRAL DISCS ONLY OCCURS BEFORE POSTNATAL DAY 28.

Ashley Rosenberg1 , Danielle D’Erminio2, James Iatridis2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The neonatal mouse is a good regeneration model to study IVD injury as it has been shown to have regenerative capabilities.

OBJECTIVE: To determine when neonatal mice lose their regenerative healing potential after IVD puncture injury and determine if healing was improved in p1 mice.

METHODS: Needle puncture injuries were performed on caudal IVDs of p1, p5, p14, and p28 mice (n=5/ group). Picrosirius Red and Alcian Blue (PRAB) and was used to assess IVD composition and polarized light evaluated structural organization of AF collagen. DAPI evaluated total cell number and ScxGFP evaluated AF phenotype. ImageJ was used to quantify total cell number in the injury site, area of the injury site, and the ratio of cells to injury site area. GraphPad Prism using 1-way ANOVA with Bonferroni’s post-hoc comparisons was used to determine significant effects.

RESULTS: Neonatal p1, p5, and p14 caudal IVDs show robust repair tissue ingrowth within the injury site while p28 IVDs healed with a fibrous cap. p28 IVDs had disorganized collagen adjacent to the injury site. Fluorescent images showed ingrowth of highly cellular tissue within the injury sites of p1, p5, and p14 mice, and many of these cells were ScxGFP positive. Meanwhile p28 mice had very little infiltration of repair tissue and very few cells within the injury sites. The injured p1, p5, and p14 mice had significantly more cells within the injury site compared to p28 mice.

CONCLUSION: Neonatal mice with IVD injury at p1, p5, and p14 exhibited regenerative healing while p28 healing was inferior. While p1, p5, and p14 healing did not fully restore AF lamellar structure in the injury site, the healing was similar to previously reported p5 healing that restored functional biomechanical properties and was considered functionally regenerated. p28 healing was similar to previously reported adult mice that also showed minimal healing response with scarring and low cellularity. IVD injury at p1 was similar to p5 and p14 suggesting full structural regeneration of the AF may not be possible from puncture injury postnatally; contrasting tendon where structure is restored after injury. The loss of regenerative healing after p14 could be related to decreased cell proliferation. We conclude that functional regeneration is possible in the AF and future studies will discern the changes occurring between p14 and p28 that may contribute to postnatal regenerative healing.

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IMPROVING UNDERINVESTMENT IN UNDERREPRESENTED FOUNDERS TO ACHIEVE HEALTH EQUITY.

Edward Sarfo1, Ann-Gel Palermo1 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Over the past decade, venture capital funds have grown steadily from $29 billion in 2006 to $329 billion in 2021, nearly doubling yearly. However, these funds are distributed disproportionately to founders from certain racial and ethnic groups and genders. This problem is further exacerbated by a lack of diversity in the entrepreneurial and venture capital ecosystem with very little representation of certain racial and ethnic groups, and genders in leadership positions. The root causes of underinvestment and lack of diversity in these spaces are as varied as the interventions available to address them.

OBJECTIVE: To explore the current state of underinvestment in startup founders, primarily black, other racial and ethnic minorities, and/or women. This involves a holistic landscape analysis of the cause of underfunding and evaluating some solutions to the inequality in funding.

METHODS: An extensive literature review and data analysis of research and surveys from private, public, and government entities about the funding among underrepresented founders were performed. Additionally, topic-focused meetings were held with some health equity venture investment stakeholders to develop platforms to bridge this gap.

RESULTS: Historical and systemic racism and bias, racial wealth gap, gender bias, lack of social and personal networks, debt and financial unsustainability, failed diversity efforts, and long-standing VC culture, among others, are some of the root causes of underfunding in certain groups. Additionally, VCs also face barriers to funding underrepresented founders such as location, oversight, idea origination, and general partner commitment. Solutions such as VCs reviewing their diversity focus, modifying the interview and pitching process, investor partnerships, and self-accountability can help increase the funding levels for underrepresented founders.

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IMMUNOCOMPETENT NEURAL ORGANOIDS RESPOND TO BLOOD STIMULATION: A NOVEL MODEL OF INTRACEREBRAL HEMORRHAGE.

Braxton Schuldt1 , James Vicari2, Connie Lebakken3, Christopher Kellner2 1Medical Education, 2Neurosurgery, 3Operations. 1,2Icahn School of Medicine at Mount Sinai, New York, New York, 3Stem Pharm Madison, WI.

BACKGROUND: Intracerebral hemorrhage (ICH) is a subtype of stroke characterized by bleeding into the brain parenchyma and subsequent neuroinflammation. Despite several existing ICH animal models, the lack of treatments for this disease suggests the need for novel preclinical approaches.

OBJECTIVE: To explore the utility of an immunocompetent ICH neural organoid model that may be used for future drug testing and discovery to treat the neuroinflammation in this disease.

METHODS: Multicellullar, microglia-containing human neural organoids were provided by Stem Pharm, Inc. On day 21 in vitro, organoids were treated with human whole blood (n=3 organoids per blood condition) for 24 hours. Blood was diluted in organoid culture medium to the desired percentages by volume previously shown to produce an inflammatory reaction in an ICH microglia model. To serve as positive and negative controls, one organoid was treated with lipopolysaccharide (LPS) for 24 hours and three remained untreated. Human IL-6 concentrations were measured in the culture media prior to and after treatments using an enzyme-linked immunosorbent assay (ELISA) and the fold-change from baseline was normalized to the negative control condition. A one-way ANOVA with Dunnett’s test was then performed to compare IL-6 secretion between the control and treatment conditions.

RESULTS: LPS and blood stimulation both induced IL-6 secretion after 24 hours. The greatest fold increase in IL-6 concentration relative to the control group was observed with 10% blood stimulation (29.76±7.91fold increase, p<0.0001) followed by LPS (23.43±11.18-fold increase, p<0.001) and 5% blood (22.56±7.91fold increase, p<0.0001). Significant fold increases in IL-6 secretion were also observed in the lower concentration conditions of 2.5% (15.75±7.91-fold increase, p<0.001), 1.25% (11.46±7.91-fold increase, p<0.01), and 0.6% blood (11.60±7.91-fold increase, p<0.01).

CONCLUSION: This preliminary study is the first to explore a neural organoid model of ICH. Comparable to LPS, the observed trends in IL-6 secretion suggest that whole blood is a potent, dose-dependent inducer of organoid inflammation. Given the blood-induced neuroinflammation that occurs during ICH, these initial RESULTS support a potential role for neural organoids in ICH modeling. From this study, future work will aim to further characterize the organoid inflammatory response and validate this ICH model system via gene expression analyses.

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THAT PART OF BREASTFEEDING I DIDN’T GET FROM ANYONE. I HAD TO LEARN IT ON MY OWN: THE IMPORTANCE OF INFORMATIONAL AND INSTRUMENTAL SOCIAL SUPPORT IN PROMOTING BREASTFEEDING AMONG BLACK MOTHERS.

Lucy Schultz1 , Lina Jandorf2, Jamilia Sly3. 1Medical Education, 2Oncological Sciences, 3Family Medicine and Community Health. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Black women are twice as likely to be diagnosed with triple-negative breast cancer (TNBC), which has fewer treatment options than other types of breast cancer. Black women are therefore 40% more likely to die of breast cancer than white women. Studies have found that breastfeeding can reduce the risk of breast cancer later in life. Though several initiatives have been put forth to promote breastfeeding, their efficacy has been inequitable, as Black women continue to have lower rates of breastfeeding compared to other racial and ethnic groups.

According to House’s model, social support plays a key role in influencing health behaviors. Relationships can yield multiple types of social support such as emotional, instrumental, and informational support. This qualitative research project aims to identify social support received by Black women, their efficacy, and shortcomings in promoting breastfeeding behavior.

RESEARCH QUESTION: Using the House Model of Social Support as a guiding framework, what are the most significant sources of social support for Black mothers when breastfeeding?

METHODS: We recruited, consented, and interviewed 15 Black women who were less than 4 months postpartum. Participants were asked questions regarding breastfeeding behaviors, support received, and unmet support needs. Interviews were transcribed using NVivo software and doubled-coded using a thematic analysis approach framed by the House Model of Social Support. Coding discrepancies were reviewed and discussed between the two coders until consensus was met.

RESULTS: The mean age of participants interviewed was 32.26 years. Participants had an average of 2.13 children. 86% of participants were still breastfeeding at the time of their interview. Emotional support was the most frequently mentioned type of support received (48 references), most often from family, friends, and partners (26 references). The most frequent type of unmet social support referenced was informational support (50 references), especially from hospital-based healthcare providers (23 references).

CONCLUSION: Our results demonstrate that Black women are receiving emotional support from family, friends and partners. However, more informational support is needed to effectively support postpartum Black women with breastfeeding, particularly from hospital-based healthcare providers. Interventions should focus on improving the delivery of this type of support to postpartum Black women while in the hospital.

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ASSESSING FACTORS THAT IMPACT PARENTAL WILLINGNESS TO VACCINATE THEIR CHILDREN AGAINST COVID-19 IN A PRIMARILY IMMIGRANT PATIENT POPULATION IN ELMHURST, QUEENS. Salonee Shah1 , Payal Ram2, Tsion Tmariam1, Pilar Gonzalez3, Jennifer Pintiliano3, Sarah Nowlin4, Teresa Janevic4, Uday Patil5, Sheela Maru6. 1Medical Education, 2,4Population Health Science and Policy, 3,4,5Pediatrics, 6Obstetrics, Gynecology, and Reproductive Science. 1,4,5,6Icahn School of Medicine at Mount Sinai, New York, New York, 2,3,4Elmhurst Hospital, Elmhurst, NY.

BACKGROUND: Parental concerns surrounding COVID-19 vaccination of their children often include fear of side effects and perceived lack of information. Specifically, immigrant parents may face additional barriers in this decision, such as language barriers or low health literacy. As COVID-19 has disproportionately affected vulnerable populations, this study focused on a largely immigrant cohort in Elmhurst, Queens to gauge factors that influence parents’ decisions to vaccinate their children against COVID-19, specifically maternal COVID-19 illness history, a variable that has been scarcely studied.

OBJECTIVE: The primary goal of this study is to assess the relationship between history of maternal COVID-19 illness, defined as having tested positive for COVID-19 at least once, and the willingness of a mother to vaccinate their child for COVID-19. Our hypothesis is that mothers who had tested positive for COVID-19 may be more likely to be comfortable vaccinating their child due to existing research that shows that past familial experience with COVID-19 may be a factor in vaccine decisions.

METHODS: A cross-sectional survey was conducted with women who had a pregnancy encounter at Elmhurst Hospital between March 1, 2020 and September 1, 2021 and whose children were between 6 months and 2 years at the time of survey completion. The survey contained questions about demographics, COVID-19 vaccination/illness history, and child development.

RESULTS: In preliminary analysis with data from 24 mothers, all of the survey respondents self-reported their race as Non-white, with 79.2% of respondents identifying as Hispanic. 66.7% reported not being born in the U.S. 70.9% of respondents’ highest level of schooling was a high school diploma or less. 50% of the respondents had tested positive for COVID-19 at some point. The rate of willingness to vaccinate their children was 59.1%. There was no significant association found between maternal COVID-19 illness status and mothers’ willingness to vaccinate their children (Fisher’s exact = 0.099).

CONCLUSION: While the results of this study show no significant association between maternal COVID-19 illness and willingness to vaccinate their children, the understudied factor of maternal COVID-19 illness history merits further study in a larger sample. Future plans for this ongoing study include increasing sample size and examining the relationship between maternal COVID-19 illness and child development.

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ABSTRACT 99

ASSOCIATION BETWEEN METALS AND THYROID CANCER IN PUERTO RICOA NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY AND ECOLOGICAL STUDY.

Yaelle Shaked1 , Mathilda Alsen2, Maaike van Gerwen2 1Medical Education, 2Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: The increasing thyroid cancer incidence rates in Puerto Rico (PR) may be associated with high concentrations of metals in the soil. Metals are known to alter thyroid function and may be associated with thyroid cancer. This study assessed the association between metals with known endocrine disrupting properties (arsenic (As), lead (Pb), cadmium (Cd) and mercury (Hg)) and thyroid-associated antibodies (thyroglobulin antibodies (ATG) and anti-thyroid-peroxidase (anti-TPO)) levels and thyroid cancer incidence in PR.

METHODS: We used National Health and Nutrition Examination Survey (NHANES) data from 2007-2012 of adults > 20 y/o without known thyroid problems (n=7,688). Separate models with log-adjusted Cd, Pb, and Hg and log-adjusted/creatinine-adjusted As as continuous variable and divided into quartiles, were assessed, using complex survey design adjusting for age, sex, race, smoking status, and BMI. An ecological study was done using the Environmental Protection Agency report on Metals from Natural & Anthropogenic Source in Puerto Rico Soils and the Puerto Rico Central Cancer Registry on age-adjusted thyroid cancer incidence rates from 2015-2019.

RESULTS: The geometric mean (standard error) for the metals was Hg:0.96 (0.03) ug/dL, Cd:0.36 (0.01) ug/dL, As:1.22 (0.02) ug/dL, and Pb:1.26 (0.02) ug/dL. There was a significant negative association between higher Hg and ATG levels in the continuous model ( adj:-0.042 (95% CI:-0.072;-0.012)) and the categorical model ( adj:-0.109 (95% CI:-0.199; -0.020)) for quartile 4 vs. quartile 1. In the adjusted linear models, no significant association was found between ATG levels and the exposure to As (p=0.81), Pb (p=0.12), and Cd (p=0.45) and anti-TPO levels and the exposure to As (p=0.88), Pb (p=0.059), and Cd (p=0.28), which was confirmed in the categorical models. High metal concentrations and age-adjusted thyroid cancer incidence rates were observed in the northern region of PR.

CONCLUSION: Although, the NHANES analysis didn’t confirm an association between the metals and ATG, high thyroid cancer incidence rates and metal levels in the soil observed in northern PR highlight the need to investigate the role of metals in thyroid carcinogenesis in this region.

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ABSTRACT 100

QUANTITATIVE

ASSESSMENT OF THE EFFICACY OF MENTAL HEALTH TRAINING OF PRIMARY CARE PROFESSIONALS AND PSYCHOLOGISTS IN THE DOMINICAN REPUBLIC. Myles Solan1 , Gabriela Calcano1, Xiomara Fernandez2, Dhruv Gupta3, Craig Katz3 1Medical

Education, 2,3Psychiatry.

1,3Icahn

School of Medicine

Mount Sinai, New York, New York, 2INTEP.

BACKGROUND: In 2017, the Icahn School of Medicine at Mount Sinai (ISMMS) conducted a survey in Jarabacoa, Dominican Republic that revealed a high rate of mental health disorders. In order to address the shortage of mental health services, ISMMS collaborated with the Instituto Terapeutico y Psicologico para la Familia to provide training sessions to primary care physicians, nurses, and medical assistants in three provinces– La Vega, Sanchez Ramirez, and Monsenor Nouel. The training sought to instruct how to identify, diagnose, and treat common mental health disorders. ISMMS also provided Cognitive Behavioral Therapy training to local psychologists.

OBJECTIVE: To evaluate the impact of the trainings on provider understanding, utilization, and comfort with diagnosing and treating mental illness disorders.

METHODS: The providers were administered a survey pre, immediate post, and three months following the training to assess their comfort diagnosing and treating psychiatric conditions.

RESULTS: 76 general practitioners underwent training and completed the pre and immediate post surveys. A group wide analysis found a significant increase in the proportion of practitioners who agreed to questions evaluating comfort in diagnosing and treating mental health disorders in their immediate post-training survey as compared to their pre-training survey (student paired t-test, p< 0.0002). A longitudinal analysis on the 21 general practitioners who responded to all three time points revealed that this increase was sustained (student paired t-test, p< 0.0005). 13 psychologists underwent CBT training and completed pre and immediate post surveys. A group wide analysis found a significant decrease in the proportion of participants with correct answers to the assessment instruments before and immediately following the training despite expressing an increase in comfort utilizing CBT techniques (student paired t-test, p< 0.0229).

CONCLUSION: General practitioners appeared to acquire sustained knowledge and comfort with diagnosing and treating mental health disorders. Conversely, although the psychologists reported more comfort with CBT following the training, their knowledge did not improve in a statistically significant fashion. Future work should focus on maintaining the knowledge acquisition of the general practitioners and helping them translate it into practice and on assessing how to better impart knowledge of CBT to the psychologists.

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ABSTRACT 101

IMMIGRANT VERSUS U.S.-BORN DISPARITIES IN MEDICAID ENROLLMENT FOR PREGNANCY AFTER THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT.

Morgan Steelman1 , Teresa Janevic2, Ashley Fox3, Ellerie Weber4 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3Rockefeller College of Public Affairs and Policy, 4Population Health Science and Policy. 1,2,4Icahn School of Medicine at Mount Sinai, New York, New York, 3University at Albany, SUNY.

BACKGROUND: In response to the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA) in March 2020. Under FFCRA, states receive increased federal Medicaid match rates if they adhere to new maintenance of eligibility (MOE) requirements that mandate continuous coverage until the public health emergency lapses. Postpartum women have been one of the largest groups of Medicaid beneficiaries affected by FFCRA; the policy has led to a de-facto extension of coverage for postpartum women beyond the typical 60-day period. However, FFCRA’s MOE may lead to disparities in postpartum coverage gains, specifically between U.S.-born versus foreign-born (FB) mothers. Unlike lowincome U.S.-born mothers who qualify for Medicaid pregnancy coverage and the FFCRA extension, many FB mothers only qualify for pregnancy coverage through CHIP’s unborn child option (UCO), which has no MOE. Thus, states are not obligated under FFCRA to maintain coverage for women with CHIP’s UCO.

OBJECTIVE: To examine whether FB mothers were less likely to retain Medicaid coverage for pregnancy than U.S.-born mothers due to FFCRA exclusions.

METHODS: We used natality data from the CDC to calculate the percentage of births to FB women in each of the 255 Texas counties every month in 2020 and linked it to Texas HHS data that contains the number of women enrolled in Medicaid for pregnancy in each county by month and year. We chose Texas because it is a large, diverse state with a significant CHIP UCO population. Using the linked data and a Difference-inDifference (DiD) design, we compared the percentage change in enrollment in counties with low rates of FB births to counties with high rates of FB births, before and after March 2020.

RESULTS: A total of 368,190 births in Texas were included, 14.6% of which were to FB-mothers. Medicaid enrollees for pregnancy grew from 136,995 pre-FFCRA to 375,920 post-FFCRA. Our preliminary analysis shows that growth in Medicaid enrollment for pregnancy after FFCRA was 5.77 percentage points (pp) lower among counties in the top quartile of FB births than those in the bottom quartile of FB births (DiD estimate = -5.77 pp, 95% CI = 0.07, 11.48). This difference persists despite controlling for education level (DiD estimate = -5.69 pp, 95% CI = 0.12, 11.26).

CONCLUSION: Our results show how FFCRA may exacerbate maternal health disadvantages in Texas and informs decision makers of the equity impacts of postpartum extension policies.

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INVESTIGATION OF THE EFFECTS OF ER STRESS ON MITOCHONDRIAL BIOENERGETICS IN FUCHS ENDOTHELIAL CORNEAL DYSTROPHY.

William Steidl1 , Saba Qureshi2, Stephanie Lee2, Michael Parise2, Varun Kumar2 1Medical Education, 2Ophthalmology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Fuchs endothelial corneal dystrophy (FECD) is an age-related degenerative disease of corneal endothelial cells (CEnCs) in which endoplasmic reticulum (ER) and mitochondrial stress play a critical pathophysiological role in disrupting corneal fluid and ion transport, leading to edema and apoptosis. The only treatment for FECD patients is corneal transplantation.

OBJECTIVE: To investigate the role of ER stress in controlling mitochondrial bioenergetics and dynamics in CEnCs.

METHODS: To investigate changes in mitochondrial bioenergetics, ER stress was induced in a human corneal endothelial cell line (HCEnT-21T) for 2 hours using tunicamycin, which inhibits ER N-linked glycosylation. 40,000 cells/well were plated for treatment (10mg/ml tunicamycin, 20 wells), vehicle (10mg/ ml DMSO, 20 wells), and untreated control (16 wells). Mitochondrial O2 consumption was measured for each group using the Seahorse XFe96 Analyzer. To investigate changes in mitochondrial dynamics, percentages of fragmented mitochondria were counted per visual field. Dynamics results were confirmed through western blotting of mitochondrial fission proteins Fis1 and pDRP1.

RESULTS: Compared to the untreated cells (M 177.89, SD 14.22), tunicamycin-treated cells displayed significantly higher O2 consumption rates (M 126.49, SD 61.68) after addition of carbonyl cyanide-ptrifluoromethoxyphenylhydrazone (FCCP) uncoupling agent (P = 0.049, n = 3). The tunicamycin group also exhibited significantly greater maximum respiratory capacity (M 126.02, SD 20.71) compared to untreated cells (M 85.99, SD 10.56), (P = 0.036, n = 3). There was a significant difference (P < 0.0001) in fragmentation at 10mg/ml tunicamycin (M 98.25, SD 2.06) versus DMSO (M 8.33, SD 1.53). Fis1 protein expression was significantly greater for tunicamycin (M 1.07, SD 0.18) than for DMSO (M 0.65, SD 0.03), (P = 0.0146, n = 3), and pDRP1 expression was significantly greater for tunicamycin (M 1.46, SD 0.33, n = 3) than for DMSO (M 0.97, SD 0.01, n = 4), (P = 0.0239).

CONCLUSION: These data suggest that ER stress alters mitochondrial bioenergetics in the human corneal endothelial cell line by increasing maximum respiratory capacity. Furthermore, these data indicate that ER stress disrupts mitochondrial dynamics by inducing processes of mitochondrial fission. These results provide insight into the complex intraorganellar crosstalk that contribute to the development of FECD.

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ABSTRACT 103

OUTCOMES FOR SALVAGE ABDOMINAL STEREOTACTIC BODY RADIATION THERAPY FOR HEPATOCELLULAR CARCINOMA AFTER LIVER TRANSPLANTATION. Christian Stephens1 , Julie Bloom2, Eric Lehrer2, Ren-Dih Sheu2, Michael Buckstein2 1Medical Education, 2Radiation Oncology. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: While orthotopic liver transplantation (OLT) is considered curative for most hepatocellular carcinoma (HCC) patients, recurrence can occur in 10-20% of these patients. Data has shown stereotactic body radiation therapy (SBRT) to be safe and effective as treatment for primary HCC, however few studies have investigated the safety and efficacy of SBRT as treatment for HCC after OLT.

OBJECTIVE: To evaluate the safety and efficacy of intra-abdominal salvage SBRT for HCC in patients who previously underwent OLT.

METHODS: A retrospective chart review of a single institution was conducted to identify patients who received intra-abdominal SBRT as treatment for recurrent HCC after OLT from 1/1/2013 to 9/1/2022. Clinical safety was measured by the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) v5.0 for grading adverse events, Child-Turcott-Pugh (CTP) score, and Albumin-Bilirubin (ALBI) grade for HCC. Dosimetric analysis was performed. Efficacy was measured by local control (LC) and objective response using modified Response Evaluation Criteria in Solid Tumors (mRECIST). The KaplanMeier method was used to evaluate overall survival (OS) and progression free survival (PFS).

RESULTS: Twenty lesions treated with SBRT for HCC recurrence after OLT were identified among 16 patients. The median age at treatment was 64 (interquartile range (IQR) 52-80), with 65% male. Most patients were diagnosed with Stage I, T1N0M0 HCC (45%) or Stage II, T2N0M0 (30%). The median time from transplant to SBRT start was 5.5 years (IQR 0.17-21). Fifteen lesions were hepatic, 3 lymph nodes, 1 diaphragm, and 1 adrenal. Median SBRT dose delivered was 5000 cGy in 5 fractions (IQR 4500-5000). During 40% (8) of the SBRT treatments, patients experienced grade 1 or 2 CTCAE toxicity with nausea, vomiting, or fatigue. There was no grade 3 or above CTCAE toxicities. The median change in CTP score from baseline was 0 at 3 months, 1 at 6 months, and 1 at 12 months. The median change in ALBI score from baseline was 0.14 at 3 months, 0.40 at 6 months, and 0.42 at 12 months. LC was achieved in 95% (19) of the lesions. After a median follow up time of 15 months, median PFS was 9.5 months; median OS was 14.5 months.

CONCLUSION: For patients with HCC after OLT, SBRT appears to be a safe and effective treatment modality, as no patients experienced significant toxicities and the majority had complete treatment response.

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ASSESSING IMPACT OF SOCIOECONOMIC STATUS ON LACERATION RISK IN FORCEPS-ASSISTED VAGINAL DELIVERIES.

Catherine Stratis1 , Elizabeth Cochrane2, Tahera Doctor2, Kelly Wang2, Chelsea DeBolt2, Angela Bianco2 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Studies evaluating adverse outcomes in forceps-assisted vaginal delivery (FAVD) have assessed maternal age and race, but not socioeconomic status (SES).

OBJECTIVE: To determine if SES is associated with rates of obstetric anal sphincter injury (OASIS) in patients undergoing FAVD.

METHODS: IRB-approved, retrospective chart review of patients undergoing FAVD between 2017-2021 was conducted. The primary outcome was OASIS. SES was based on patient home zip code. Patients were classified as low or high SES, determined by whether their home zip code’s median income level was below or above their state’s median income level, respectively. Chi-Square test and Fisher’s Exact Test were used to analyze the association between SES and categorical patient demographics. Mann-Whitney U test was used for continuous variables. Random-intercept logistic regression models were used to test for provider observation clustering.

RESULTS: Of 979 patients included, 361 (36.9%) were classified as low SES and 618 (63.1%) as high SES. Proportions of Caucasian race (71.0% vs. 39.4%, p<.0001) and private insurance (84.3% vs. 54.6%, p<.0001) were higher among patients of high SES. After adjusting for provider clustering effects, maternal age, BMI, birthweight, intraamniotic infection, episiotomy, race, ethnicity, nulliparity, forceps indication, and length of second stage of labor, patients of low SES were not at increased risk of OASIS compared to patients of high SES (aOR 1.40 [0.89, 2.22]).

CONCLUSION: Individuals of low SES undergoing FAVD were not at increased risk of OASIS. Further research is necessary to elucidate the impact of SES and identify patient vulnerabilities to reduce obstetric health disparities.

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ABSTRACT 105

COMPUTATIONAL DESIGN OF CUSTOM THERAPEUTIC CELLS TO CORRECT FAILING HUMAN CARDIOMYOCYTES.

Andrew Tieu1 , Joshua Mayourian2, Katherine Phillips3, Kevin Costa4 1Medical Education, 2Pediatrics, 3Cardiovascular Surgery, 4Cardiovascular Research Institute. 1,4Icahn School of Medicine at Mount Sinai, New York, New York, 2Boston Children’s Hospital, Boston, MA Harvard Medical School, Boston, MA Boston University, Boston, MA Boston Medical Center, Boston, MA, 3NYU Langone Health, New York, NY.

BACKGROUND: Myocardial delivery of non-excitable cells—namely human mesenchymal stem cells (hMSCs) and c-kit+ cardiac interstitial cells (hCICs)—remains a promising approach for treating the failing heart. Recent empirical studies attempt to improve such therapies by genetically engineering cells to express specific ion channels, or by creating hybrid cells with combined channel expression.

OBJECTIVE: To use a computational modeling approach to test the hypothesis that custom hypothetical cells can be designed to restore a healthy phenotype when coupled to human heart failure (HF) cardiomyocytes.

METHODS: Candidate custom cells were simulated with a combination of ion channels from non-excitable cells and healthy human cardiomyocytes (hCMs). Using a genetic algorithm-based approach, candidate cells were accepted if a root mean square error (RMSE) of less than 50% relative to hCM was achieved for both action potential and calcium transient waveforms for the cell-treated HF cardiomyocyte, normalized to the untreated HF cardiomyocyte.

RESULTS: Custom cells expressing only non-excitable ion channels were inadequate to restore a healthy cardiac phenotype when coupled to HF cardiomyocytes. In contrast, custom cells also expressing cardiac ion channels led to acceptable restoration of a healthy cardiomyocyte phenotype when coupled to fibrotic, but not non-fibrotic, HF cardiomyocytes. Incorporating the cardiomyocyte inward rectifier K+ channel was critical to accomplishing this phenotypic rescue while also improving single-cell action potential metrics associated with arrhythmias, namely resting membrane potential and action potential duration. The computational approach also provided insight into the rescue mechanisms, whereby heterocellular coupling enhanced cardiomyocyte L-type calcium channel current and promoted calcium-induced calcium release. Finally, as a therapeutically translatable strategy, we simulated delivery of hMSCs and hCICs genetically engineered to express the cardiomyocyte inward rectifier K+ channel, which decreased action potential and calcium transient RMSEs by at least 24% relative to control hMSCs and hCICs, with more favorable single-cell arrhythmia metrics.

CONCLUSION: Optimized cells expressing cardiac ion channels restored healthy action potential and calcium handling phenotypes in fibrotic HF cardiomyocytes and improved single-cell arrhythmia metrics, warranting further experimental validation studies of the proposed therapeutic cells.

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THE ASSOCIATION BETWEEN UTILIZATION OF COMMUNITY BASED ORGANIZATIONS AND MOTHERS’ WILLINGNESS TO VACCINATE CHILDREN AGAINST COVID-19.

Tsion Tmariam1 , Payal Ram2, Salonee Shah1, Pilar Gonzalez3, Jennifer Pintiliano3, Sarah Nowlin4, Teresa Janevic4, Uday Patil3, Sheela Maru5. 1Medical Education, 2Global Health and Health System Design, 3Pediatrics, 4Population Health Science and Policy, 5Obstetrics, Gynecology, and Reproductive Science.

1,2,4,5Icahn School of Medicine at Mount Sinai, New York, New York, 3NYC Health and Hospitals-Elmhurst.

BACKGROUND: Vaccines provide immunity against many deadly pathogens and protect our most vulnerable community members. The CDC reports that over 4 million deaths worldwide are prevented by childhood vaccination. In recent years the US has seen a historic drop in childhood vaccination, possibly attributed to parental vaccine hesitancy, surrounding safety and side effects, and the COVID-19 pandemic. While public health entities have tried effortlessly to increase vaccine confidence amongst communities, literature suggests it may be more effective to increase efforts in partnership with community-facing and community-based organizations.

OBJECTIVE: The primary goal of this proposal is to determine the association between parental utilization of community-facing and community-based services and parental willingness to vaccinate their child against COVID-19. We hypothesize that those who have had more contact with such organizations would be more willing to vaccinate their child.

METHODS: Our team conducted a cross-sectional survey of mothers with children between the ages of 6 months and 2 years, who received care at Elmhurst Hospital. Our preliminary analysis included responses from 24 mothers.

RESULTS: In our study population, 79% of parents had a high school degree or higher, 67% were born outside of the US, and over 70% were married or living with their significant other. 41% of the respondents demonstrated an unwillingness to vaccinate their child against COVID-19. With vaccine safety cited as the primary concern leading to vaccine hesitancy amongst parents. Around 63% of the total sample reported utilizing at least one community-based service, and 40% of those who utilized any service reported utilizing two or more community services. Our study finds no statistically significant association (Fisher’s exact: 0.561) between willingness to vaccinate children and utilization of community-based services.

CONCLUSION: Study findings demonstrate a marked parental COVID-19 vaccine hesitancy that is linked to concerns about vaccine safety. In addition, the majority of this population utilizes community-facing and/ or community-based organizations for a multitude of reasons. The connection of this largely immigrant, public hospital population to community services suggests that further partnership with community-based organizations on vaccine education has the potential to impact vaccine confidence.

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TWO-CENTER STUDY OF A VIRTUAL, SIMULATION-BASED LAPAROSCOPIC TRAINING CURRICULUM IN MEXICO.

Rachel Todd1 , Linda Zhang2 1Medical Education, 2Surgery.

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

BACKGROUND: Adult medical education is an area of interest in global health for expanding the surgical capacities of low and middle-income countries (LMICs), where the practice of laparoscopic surgery is rapidly expanding yet formal training in laparoscopy remains limited. In 2017, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. Due to the COVID-19 pandemic, GLAP was adapted to a 6-month virtual format.

OBJECTIVE: To examine the feasibility and efficacy of virtual laparoscopic simulation training in two resource-limited settings in Mexico.

METHODS: Participants from Leon and Guadalajara, Mexico enrolled in the virtual GLAP curriculum, meeting biweekly for 2- hour didactic classes and hands-on simulation practice. Participants completed pre- and post-program surveys assessing their perception of simulation-based training. Surgical residents’ laparoscopic skills were evaluated using the Fundamental of Laparoscopic Surgery (FLS) exam during initial and final weeks of the program. Of the 26 total participants (10 attendings, 16 residents), 20 completed the post-program survey, while 13 residents submitted their results of both pre- and post- evaluation of FLS skills.

RESULTS: At completion of the program, residents were 34.41% faster in completing the bimanual transfer (2:31 vs 4:27, p< 0.05), 31.82% faster on the precision cutting (4:05 vs 6:12, p<0.05), 109.21% faster on the endo-loop task (1:30 vs 2:47, p< 0.05), and 35.38% faster on the intracorporeal knot (5:39 vs 9:42, p<0.05). There was no significant difference in completing extracorporeal knot tie (4:52 vs. 6:59, p=0.115). On a Likert scale (1=worst, 5=best), participants appreciated the program’s quality (mean 4.7), effectiveness of teaching (mean 4.7), depth of content (mean 4.55), and quality of faculty (mean 4.9). Participants considered the practice sessions (50%) and friendly competition (20%) as their favorite aspects, while the theoretical sessions (15%) and scheduling (15%) were the least favorite aspects of the program.

CONCLUSION: A virtual simulation-based curriculum can be an effective training strategy for teaching laparoscopic skills to surgeons in LMICs such as Mexico. Future programs can expand on the use of a virtual platform as a low-cost, effective strategy for training laparoscopic skills in other LMICs across the globe.

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ABSTRACT 108

ASSOCIATION OF BLOOD PRESSURE WITH NEUROLOGIC OUTCOME AFTER PEDIATRIC CARDIAC ARREST.

Adam Ushpol1 , Sangmo Je2, Dana Niles2, Tanmay Majmudar3, Matthew Kirschen2, Jimena del Castillo4, Corinne Buysse5, Alexis Topjian2, Vinay Nadkarni2, Sandeep Gangadharan6. 1,3Medical Education, 2,4,5,6Pediatrics, 1,6Icahn School of Medicine at Mount Sinai, New York, New York, 2Children’s Hospital of Philadelphia, 3Drexel University College of Medicine, 4Gregorio Marañón General University Hospital, 5Sophia Children’s Hospital.

BACKGROUND: Post cardiac arrest blood pressure <5th percentile for age is associated with worse survival to discharge. There are limited data on the impact of mean arterial pressure (MAP) on favorable neurologic outcome.

HYPOTHESIS: In the first 6-hours post-return of spontaneous circulation (ROSC), that a minimum documented MAP >5th percentile is associated with better neurologic outcomes.

METHODS: Prospective, multi-center, observational study using data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC (without ECMO) following index in-hospital or out-of-hospital cardiac arrest and survived ≥6 hours were included. Minimum documented MAP within the first 6 hours of ROSC was percentile adjusted for age based on normative data and categorized into 6 groups: Group I= <5th percentile; II= 5–24th; III= 25–49th; IV= 50–74th; V= 75–94th; and VI= ≥95th. Primary outcome was favorable neurologic status at hospital discharge, defined as PCPC score ≤2 or no change from pre-arrest baseline. Multivariable logistic regression was performed to estimate the association of favorable outcome with MAP group, controlling for illness category (surgical-cardiac vs. other), shockable rhythm, weekend/night arrest, age, CPR duration, and clustering by site.

RESULTS: 787 patients were included: median [Q1,Q3] age 17.9 [4.8,90.6] months; male 58%; OHCA 21%; shockable rhythm 13%; CPR duration 7 [3,16] min; favorable neurologic outcome 54%. Median lowest documented MAP percentile for the favorable outcome group was 13 [3,43] versus 8 [1,37] for the unfavorable group. The distribution of blood pressures by MAP group was I: 37%, II: 28%, III: 13%, IV: 11%, V: 7%, and VI: 4%. Compared with patients in Group I (<5%ile), those in Groups II, III, and IV had significantly higher odds of favorable outcome (aOR, 1.84 [95% CI, 1.24, 2.73]; 2.20 [95% CI, 1.32, 3.68]; 1.90 [95% CI, 1.12, 3.25]). There was no statistically significant association between Groups V or VI and favorable outcome (aOR, 1.44 [95% CI, .75, 2.80]; 1.11 [95% CI, .47, 2.59]).

CONCLUSION: In the first 6-hours post-return of spontaneous circulation (ROSC) after pediatric cardiac arrest, a lowest documented MAP >5th percentile (specifically 5th to 74th percentile) is associated with better neurologic outcomes.

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ABSTRACT 109

COMPUTATIONAL SCREEN FOR IMMUNOTHERAPEUTIC TARGETS FOR ENDOMETRIAL CARCINOMA.

Vivian Utti1 , Avi Ma’ayan2 1Medical Education, 2Pharmacology and Systems Therapeutics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

Endometrial cancer (EC) is the most common malignant gynecological cancer in the United States and Canada, and accounts for ~7% of new cancer cases in women. Incidence rates have steadily increased worldwide due to factors such as delayed childbirth and rising obesity. EC is one of the leading causes of the leading causes of cancer death worldwide owing to limitations in screening. In most cases, solid tumors develop without specific clinical signs and, consequently, evade detection until the disease progresses. The current screening and diagnostic approaches for EC include endometrial biopsy and transvaginal ultrasonography. Both methods, however, have limited efficiency and are ineffective in early diagnosis.

Accordingly, biomarkers for early diagnosis of endometrial cancer could significantly improve the clinical management of cancer as well as its prognosis. There is no recognized serum or blood biomarker to predict the occurrence or recurrence of endometrial carcinoma (EC). We therefore focused on identifying effective biomarkers that could be detectable by noninvasive tests. We propose to use RNA-Seq data for evaluating higher accuracy gene level blood biomarkers that could help in early prognosis. In this study, we conducted computational analysis on tissue-based gene-expression data to identify possible gene signatures and blood bio markers for endometrial cancer grading and staging prediction. We obtained multi-omics data from TCGA endometrial carcinoma project of coding genes including mRNA expression and DNA copy number, that were downloaded from NCI Genomic Data Commons (GDC) database using the TCGAbiolinks package in R. By performing multiple bioinformatics and machine learning algorithms based on RNA-seq data, including differential expression genes (DEGs) analysis, dimensionality reduction, and Leiden clustering, we have obtained four gene candidate clusters that drive the disease phenotype seen in EC. We are currently prioritizing these gene candidates by significance and targetability. Our next steps are to combine the patients’ clinical metadata with the candidate gene targets, to create a biomarker-based prediction model of EC diagnosis. This will be verified in independent cohorts to provide theoretical basis for blood-based diagnosis of EC and discovering potential targets for drug therapy. In doing so, we expect to comprehensively explore the gene regulation of EC to further clarify the pathogenesis of EC.

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ABSTRACT 110

RISK FACTORS IN PITUITARY SURGERY AMONGST OCTOGENARIANS: A COMPARATIVE STUDY WITH YOUNGER PATIENTS UNDERGOING PITUITARY SURGERY. Vikram Vasan1 , Jonathan Dullea2, Alex Devarajan2, Muhammad Ali2, Varun Subramaniam2, Joshua Bederson2, Katelyn Ferreira3, Melissa Aldridge3, Rainier Soriano3, Raj Shrivastava2. 1Medical Education, 2Neurosurgery, 3Geriatrics and Palliative Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: As life expectancy has increased, the number of elderly patients has grown rapidly. Pituitary adenomas (PA) are known to occur more frequently in patients of increasing age.

OBJECTIVE: To evaluate trends in pituitary surgery and characterize differences in comorbidities, length of stay, and in-hospital mortality between octogenarians and younger patients 65-79 and <65 years old.

METHODS: The 2016-2019 National Inpatient Sample (NIS) dataset was utilized as a data-source for this analysis. Hospitalizations for PA surgery were distinguished by the appropriate diagnosis related group (drg) code. Comorbidities were classified based on the Elixhauser Comorbidity Index mapping of ICD-10 codes. Patients were stratified to age categories as follows: 80+, 65-79, <65. 1-way ANOVA tests accounting for the sampling design, were performed to determine differences in comorbidity prevalence, in-hospital mortality, and length of stay between the three groups.

RESULTS: The number of pituitary surgeries performed per year has increased over the 4 years (13,355, 14,414, 16,320, 17,015). Octogenarians had higher comorbidities compared to patients 65-79 and <65: congestive heart failure (8.0% vs. 5.3% vs. 2.0%; p<0.001), peripheral vascular disease (14.1% vs. 4.3% vs. 1.5%; p<0.001), pulmonary disease (10.3% vs. 6.3% vs. 5.8%; p<0.001), and renal disease (14.9% vs. 11.2% vs. 3.9%; p<0.001). Octogenarians also significantly experienced more in-hospital mortality (1.5% vs. 0.4% vs. 0.3%; p=0.001) in unadjusted analysis. Though not statistically significant, octogenarians experienced a longer mean length of stay, (4.37 vs. 3.84 vs. 3.97; p=0.117).

CONCLUSION: The known higher incidence of PA with older age and increase in the aging population may contribute to the trend of increased pituitary surgery per year. As expected with older age, octogenarians had significantly more comorbid conditions compared to patients 65-79 and <65. Octogenarians also experienced higher in-hospital mortality rates, calling for identification of predictive comorbidities for octogenarians and operative selectivity for these patients.

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ABSTRACT 111

HOME CARE CLINICIANS’ PERSPECTIVES ON ADVANCE CARE

PLANNING

FOR OLDER PATIENTS WHO ARE INCAPACITATED WITH NO EVIDENT ADVANCE DIRECTIVES OR SURROGATES.

Chinmayi Venkatram1 , Aviv Y. Landau2, Bevin Cohen3 1Medical Education, 2Social Policy and Practice, 3Geriatrics and Palliative Medicine. 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2University of Pennsylvania, Philadelphia, Pennsylvania.

BACKGROUND: Older patients who lack advance directives and surrogate decision makers are at risk of receiving care that is unaligned with their goals and preferences if they lose decisional capacity. This study explored barriers to advance care planning (ACP) among patients with limited family or community support who are without surrogates.

OBJECTIVE: To elicit home care clinicians’ perspectives on barriers and facilitators to completing advance directives and appointing surrogate decision makers among older adult patients at risk of becoming Incapacitated with No Evident Advance Directives or Surrogates (INEADS) who are receiving home care services following acute care hospitalization.

METHODS: From August 2021 through November 2022, we conducted 30–90-minute semi-structured interviews with 8 nurses and 7 social workers who had worked with multiple older patients who were at risk of becoming INEADS while receiving post-acute home care services in a New York based agency. The interview guide asked clinicians to recall experiences discussing ACP and end of life with patients at risk of becoming INEADS. Two coders reviewed the transcripts and conducted a thematic analysis.

RESULTS: Three central themes emerged: (1) Clinician-level personal and structural barriers to ACP conversations, (2) Patient-level barriers to understanding and completing ACP forms, and (3) Institution-level policy and procedural barriers in hospital and community settings. For example, one social worker noted that “Patients that didn’t have advance directives in the community thought that what they were signing in the hospital was going to follow them and they don’t.” The clinician emphasized this misconception among both patients and providers, highlighting the procedural complexities of ACP documents.

CONCLUSION: Our findings highlight challenges to providing ethical care for older patients who are at risk for becoming INEADS. Home care presents unique opportunities to assist these patients with ACP in a safe, comfortable, intimate environment. However, current barriers to utilizing this opportunity for ACP, such as lack of training, language barriers, fear of litigation, and procedural complexities regarding the completion and transfer of ACP documents across care settings must be addressed.

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RISK FACTORS FOR FREE FLAP COMPLICATIONS FOR HEAD AND NECK CANCER DEFECTS IN THE ELDERLY.

Hannah Verma1 , Mingyang Gray2 1Medical Education, 2Otolaryngology.

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

BACKGROUND: Free flap tissue transfer is a complicated and highly invasive procedure that is performed in patients for reconstruction of defects after resection of head and neck cancer. It is often performed in older patients given the prevalence of head and neck cancer in the elderly population.

OBJECTIVE: To define risk factors for post-operative complications of free flaps in older adults.

METHODS: Between 2016 and 2017, 40 free flaps with microvascular transfer were performed at a single institution as part of head and neck reconstruction for cancer patients aged 60 and older. Electronic medical records of these were reviewed, and demographics, medical history, and surgical history were recorded and analyzed using ANOVA and multiple linear regressions. Comorbidity status was graded using the Adult Comorbidity Evaluation-27 Index (ACE-27).

RESULTS: The average age of the cohort was 73 and the flap failure rate was 7.5%. Age was not independently associated with overall surgical site complications or flap failure, although it was significantly associated with recipient site dehiscence. High ACE-27 score was a significant risk factor for systemic infection. Recipient site infection, a history of prior head and neck cancer excision, and a history of prior head and neck radiation exposure have an additive effect on incidence of flap failure.

CONCLUSION: Older age is not a predictor of flap failure. Patients’ prior history of radiation therapy and previous cancer excision should be taken into account during post-operative monitoring of free flaps.

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ABSTRACT 113

“THEY NEVER THOUGHT THEY WOULD BE HERE”: A QUALITATIVE STUDY OF HIV CLINIC PROVIDERS’ FRAMEWORKS FOR THE RELATIONSHIP BETWEEN HIV AND AGING.

Madeline Villalba1 , Abigail Baim-Lance2 1Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: As a result of treatment advancements, people living with HIV (PLWH) are living longer: an estimated 70% of PLWH in the US will be over the age of 50 by 2030. Providers’ framings of disease may impact patient care and health, but limited research characterizes how providers caring for older PLWH conceptualize the relationships between HIV, aging, and comorbidities among this quickly growing and aging population.

OBJECTIVE: To examine HIV clinic providers’ underlying framings of these relationships.

METHODS: We conducted 11 semi-structured interviews with physicians, RN case managers, and administrators at two health systems’ HIV clinics in NYC and the Hudson Valley between November 2019 and July 2020. We coded the interviews using Dedoose, developing a codebook comprising both etic and emic codes through multiple iterations (ABL, RS, MV), and thematically analyzed the data (MV, ABL).

RESULTS: Analysis revealed a range of framings involving (patho)physiological and psychosocial dimensions of aging and HIV. To providers, the relative clinical importance of HIV depended upon whether HIV was managed and the presence of comorbidities; often, HIV was well-managed and comorbidities were positioned as the main drivers of morbidity and mortality. Additionally, providers often employed the language of “duration,” “endurance,” or “living through” when describing patients, conveying their perceptions of older patients as having longitudinal social and medical experiences over different phases of an evolving epidemic.

CONCLUSION: Providers caring for aging PLWH have moved beyond HIV exceptionalism, towards HIV conditionality: a contingent framing of aging with HIV that encompasses both management issues and the biopsychosocial dimensions of living with HIV over and through time. These findings have implications for structuring interdisciplinary care management across geriatrics, specialty care, and HIV care for aging PLWH; supporting patient engagement with comorbidity care building upon longstanding HIV care management practices; and adapting existing geriatrics frameworks, such as the Five M’s, to engage with temporality, lived experience, and the life course.

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ABSTRACT 114

RACIAL DISPARITIES IN TREATMENT PRESENTATION, MODALITY, AND COMPLICATIONSN IN OLDER ADULTS WITH OROPHARYNGEAL SQUAMOUS CELL CARCINOMA.

Dragan Vujovic1 , Daniel Dickstein2, Yingtong Chen3, Richard Bakst2 1Medical Education, 2Radiation Oncology, 3Geriatrics and Palliative Medicine.

1,2,3Icahn

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

BACKGROUND: The rise of HPV infections has caused an increase in oropharyngeal squamous cell carcinoma (OPSCC), despite the decreasing rate of tobacco usage. This cancer had been associated with the middle-aged population (45-65 years); however, as the HPV+ population ages the cancer burden will likely shift to the elderly cohort. Additionally, white patients are more likely to have HPV+ disease which had limited research studies on other racial and ethnic groups with OPSCC.

OBJECTIVE: To investigate racial and ethnic disparities in treatment presentation, type, and complications for older adults with OPSCC.

METHODS: In this retrospective cohort study, we identified 140 elderly patients, aged ≥ 65 years, from a database in the Department of Radiation Oncology. All patients were newly diagnosed and treated at Mount Sinai Hospital between 2007 and 2020 for non-metastatic, OPSCC. Patients were categorized according to race as identified in the electronic medical record (white, black, other/not specified) and ethnicity (nonHispanic, Hispanic, other/non-specified). We excluded individuals with recurrent disease, prior history of OPSCC, or previous radiation therapy to the head and neck. Time to treatment initiation respective to race was analyzed using a non-parametric test for continuous variables (Kruskal-Wallis) and Scheffé test for posthoc analysis. Treatment modality, pain levels, and PEG placement, were compared across races using the 2 test and Fisher’s exact test.

RESULTS: Patients of Hispanic ethnicity had the longest time from diagnosis to treatment (47 days) compared to patients from other races/ethnicities (white non-Hispanic= 25 days, black non-Hispanic= 32 days, other race/ethnicity= 23 days). This was statistically significant when compared to white non-Hispanic patients (p=0.037). Additionally, there was a significant association between races/ ethnicities and treatment modality used (p=0.0044). There were no significant differences between races/ ethnicities in treatment complications including levels of acute, subacute, or late pain, as well as in the frequency of PEG tube placement.

CONCLUSION: This is one of the first studies to investigate the impact of race/ethnicity on OPSCC presentation, treatment modalities, and complications in older adults with OPSCC. Preliminary analysis shows differences between racial and ethnic groups in length of time between diagnosis and treatment as well as in treatment modalities used.

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RELATIONSHIPS BETWEEN BODY COMPOSITION, ANTHROPOMETRICS, AND STANDARD LIPID PANELS IN A NORMATIVE POPULATION.

Marcus Weeks1 , Andrew Delgado2, David Putrino2 1Medical Education, 2Rehabilitation Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Evidence of body shape and size (i.e. anthropometrics and body composition) and its connection to overall health are well documented, in particular as a risk factor for components of metabolic syndrome. However, there exists limited instances in which normative populations have been assessed for associations between these now readily obtainable body measurements and routine blood tests.

RESULTS: Body Fat Percentage (BFP), Visceral Fat Level (VFL), Waist to Hip Ratio (WHR), and A Body Shape Index (ABSI) would be positively associated with rates of dyslipidemia but that negative associations would be seen when comparing Skeletal Muscle Mass (SMM) and Surface Body Shape Index (SBSI) to dyslipidemia.

METHODS: A clinical record review was conducted on data collected from 347 patients dating back to Nov. 2021. Patients were seen at Thorne Lab, formerly known as the Lab 100 medical clinic at Mount Sinai. Following exclusion of participants on lipid modulating medications and with missing data, a total of 199 were included in the study. A logistical regression approach was taken to determine both zero order associations between variables of interest as well as associations adjusted for age, sex, race, AUDIT-C total score, and current smoking status.

RESULTS: In the unadjusted zero order effects, only WHR was correlated with every laboratory value measured, while ABSI was not found to be correlated with any. VFL, BFP, SMM, and SBSI were all associated with some metrics but not others. The most significant zero order effect was seen between SMM and HDL (t = -5.91, p = 4e-07). Following adjustments however, VFL and BFP were found to be associated with every laboratory value. WHR only had some significant associations while SMM, SBSI, and ABSI had none. BFP showed the two most significant associations with VLDL (t = 4.53, p = 0.000115) and triglycerides (t = 4.51, p = 0.000118). Of the 13 total adjusted associations that were found, 11 of them had >10% change in estimated value as compared to the zero order effect and thus indicated confounding was present and the adjustments were warranted.

CONCLUSION: We conclude that certain body composition and anthropometric measurements have the potential to serve as an added screening tool however larger and more diverse sample sizes will need to be assessed in order to determine whether or not this proof of concept model is generalizable.

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ABSTRACT 115

ABSTRACT 116

IN-VIVO COMPOUND SCREEN USING DROSOPHILA MELANOGASTER TO EXAMINE POTENTIAL THERAPEUTICS FOR NOONAN SYNDROME CAUSED BY PTPN11 VARIANT Q510P. Orli Weiss1 , Tirtha Das2, Sereene Kurzum2, Bruce Gelb2 1Medical Education, 2Genetics and Genomic Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Noonan Syndrome (NS) is a genetic disease presenting with craniofacial abnormalities, short stature, and congenital cardiovascular defects occurring in 1/1000-1/2500 live births. NS is a member of the RASopathies, a group of genetic disorders caused by germline mutations in the RAS/MAPK pathway. Variants in the PTPN11 gene are responsible for approximately one-half of NS cases. This study uses Drosophila melanogaster models to screen compounds for potential therapeutic effects for RASopathies, focusing on the PTPN11 p.Q510P variant (Q510P), a gain-of-function variant associated with NS. csw is the D. melanogaster ortholog for PTPN11. Prior work generated NS models expressing transgenic PTPN11 constructs using the CRIMIC system. csw is on the X chromosome, and thus the csw CRIMIC allele is male lethal.

OBJECTIVE: This study examines the pupal and adult survival of transgenic females expressing p.Q510P and wildtype csw gene, as well as the survival of males expressing Q510P. To assess the effects of pimasertib (pima) and candidate compound 107-7 in survival of CRIMIC generated D. melanogaster expressing Q510P to identify potential compounds for translation to human therapeutics.

METHODS: CRIMIC-csw/FM7GFP females were mated to either UAS-RFP or UAS-csw-Q510P males. Mated flies were placed in individual vials of food containing either 107-7 or pima overnight. Three concentrations were tested for each pimasertib and 107-7, with DMSO as a control. CRIMIC pupae and CRIMIC adults were scored.

RESULTS: Q510P flies show trends of increased pupal survival compared to UAS-RFP flies in both pima and 107-7 trials (p=0.19). Female UAS-RFP flies receiving pima show increased survival compared to those receiving DMSO (p=0.20), and compared to Q510P females (p=0.08). Male survival in flies receiving pima appears increased in Q510P compared to UAS-RFP (p=0.19). The pupal and male survival trends may suggest a drug-variant interaction between pimaand Q510P allowing signaling sufficient for survival. Drug-variant interaction is less apparent for 107-7. UAS-RFP females receiving 107-7 show increased survival compared to Q510P females (p=0.02). Male survival trends appear similar (p=0.20) across both genotypes

These results were collected from crosses using CRIMIC-csw/FM7-GFP flies with melanocytes, indicating infection. Many vials produced no living progeny. Infection may have affected results. This experiment should be repeated with healthy lines.

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ABSTRACT 117

CLINICAL AND MOLECULAR ASSOCIATIONS OF DEBULKING STATUS AND PATIENT OUTCOMES IN OVARIAN CANCER.

Catherine Wu1 , Katherine Reid2, Maria Padron Rhenals2, Peter Dottino3 1Medical Education, 2Genetics and Genomic Sciences, 3Obstetrics, Gynecology, and Reproductive Science.

1,2,3Icahn

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

BACKGROUND: Ovarian cancer is one of the deadliest cancers in the United States. Standard treatment involves primary cytoreductive surgery, as studies have shown that macroscopically visible disease is associated with decreased survival. Current screening methods, including CT and serum CA-125 levels, lack the specificity and sensitivity to predict debulking outcomes. We believe that differences in tumor biology and/or clinical features dictates debulking status. Here, we analyze clinical and molecular data to better understand differences between optimal and suboptimal tumors and how they might confer differences in survival.

METHODS: We analyzed the clinical and molecular data of 310 ovarian cancer patients enrolled at the ISMMS according to the IRB. Patient outcomes, defined as length of progression free survival (PFS) and overall survival (OS), and debulking status were determined. We performed logistic regression, Kaplan-Meier survival analysis, and cox proportional hazard to determine association with debulking status and survival. Additionally, RNA sequencing data from high grade serous ovarian cancer patient tumors were analyzed (n = 7). DESeq2 analysis was conducted to identify differences in gene expression.

RESULTS: Only stage showed association with debulking status, with an odds ratio of 2.04 +/- 0.37 (p = 0.006). Interestingly, generation of a log-rank test stratified by ethnicity yielded significant differences in overall survival (p = 0.0046). Significant differences were also observed when stratified by histology (p = 0.00028), stage (p < 0.0001), ascites (p = 0.023), and bowel resection (p < 0.0001). However, cox proportional hazard analysis indicated that in a multivariate model, only age (p = 0.0009), stage (p = 0.02), and bowel resection (p = 0.002) were significantly associated with survival.

DESeq2 was performed using RNA-seq raw counts, resulting in 65 genes showing significance (p < 0.1). Included were genes involved in modulation of cell proliferation, such as TM4SF4, FABP2, and ANP32D. Furthermore, other genes, such as HEMGN, ANP32D, B3GALT5, and FOXR2 have been implicated in other cancers, including colorectal, prostate, pancreatic, and breast cancer.

CONCLUSION: While only stage was shown to be associated with debulking status, increasing age and stage, and presence of bowel resection were all associated with decreased survival. Furthermore, RNA-seq and DESeq2 analysis revealed 62 gene signatures of suboptimal tumors.

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ABSTRACT 118

MULTIVARIATE ANALYSIS OF DEMOGRAPHIC AND EMS SITUATION FACTORS ON NEMSQA TRAUMA QUALITY MEASURES.

Sai Kaushik Yeturu1 , David Buckler2, Michael Redlener2 1Medical Education, 2Emergency Medicine.1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Previously, evaluating Emergency Medical Services (EMS) care quality for trauma has been challenging in the United States due to the lack of standard trauma quality measures. In 2019, the National EMS Quality Alliance (NEMSQA) developed and published 11 national clinical quality measures to evaluate and benchmark. Three measures pertain to trauma: documentation of pain assessment (T1), documented improvement in patient pain (T3), and appropriate transport to a trauma center (T4). The vast majority of EMS care performed in the United States is reported to the National EMS Information System (NEMSIS) database.

OBJECTIVE: To determine if NEMSQA trauma quality outcomes are independently associated with patient race when controlling for region, urbanicity, and ALS care.

METHODS: Using the 2019 NEMSIS public dataset, we identified 4,581,134 EMS runs for possible traumatic injury. Utilizing the NEMSQA numerator and denominator definitions, multivariate logistic regression was used to evaluate the association of NEMSQA trauma care measure achievement with patient race and sex while controlling for patient age, census division, urbanicity and EMS level of care.

RESULTS: 2,766,114 patients met the NEMSQA definition for T1 and T3 while 136,854 met criteria for T4. Overall, 68.8% of patients achieved T1—had a documented pain assessment—while 10.3% achieved T3— had documented improvement in the pain score during EMS care. 21.6% of patients meeting CDC Step 1/2 criteria for trauma were transported to a Level 1 or 2 trauma center (T4). In multivariate analysis, Male, Black, Asian, and Hispanic patients were less likely to achieve T1 or T3 measures (T1:Male-aOR:0.916, p<0.001; Black-aOR:0.914, p<0.001;Asian-aOR:0.859, p<0.001; Hispanic-aOR:0.857,p<0.001; T3:Male-aOR:0.871, p<0.001; Black-aOR:0.679, p<0.001; Asian-aOR:0.779, p<0.001; Hispanic-aOR:0.797, p<0.001). However, Black, Asian, and Hispanic patients were significantly positively associated with the T4 measure (T4:BlackaOR:1.139, p<0.001; Asian-aOR:1.492, p<0.001; Hispanic-aOR:1.161, p<0.001).

CONCLUSION: These results generally show a reduced quality of pain management for male and non-White patients in EMS, nationally, even when controlling for region, urbanicity, and advanced EMS care. These findings also highlight the utility of NEMSQA quality measures in understanding disparities in trauma care and that these results may be useful to benchmark providers and agencies for equity in EMS care.

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ABSTRACT 119

CAN XLNET BE USED TO GENERATE CPT CODES FROM SPINE SURGICAL OPERATIVE NOTES?

Bashar Zaidat1 , Jun Kim2 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

OBJECTIVE: Billing and coding-related administrative tasks are a major source of healthcare expenditure in the United States. We aim to show that a second-iteration Natural Language Processing (NLP) machine learning algorithm, XLNet, can successfully automate the generation of CPT codes from operative notes in ACDF, PCDF, and CDA procedures.

METHODS: In this retrospective cohort we collected 922 operative notes from patients who underwent elective ACDF, PCDF, or CDA from 2015 to 2020 and included CPT codes generated by the billing code department. We fine-tuned XLNet, a generalized autoregressive pretraining method, on this dataset and tested its performance in four procedural combinations by calculating the area under the receiver operating curve (AUROC) and the area under the precision-recall curve (AUPRC).

RESULTS: The performance of the model approached human accuracy, with trial 1 (ACDF) achieving an AUROC score of .82, an AUPRC score of .81, a class-by-class accuracy of 77% (range: 34% – 91%); trial 2 (PCDF) achieving an AUROC score of .83, an AUPRC score of .70, and a class-by-class accuracy of 71% (range: 42% – 93%); trial 3 (ACDF and CDA) achieving an AUROC score of .95, an AUPRC score of .91, and a class-by-class accuracy of 87% (range: 63% – 99%); and trial 4 (ACDF, PCDF, and CDA) achieving a AUROC score of .95, an AUPRC score of .84, and a class-by-class accuracy of 88% (range: 70% – 99%).

CONCLUSION: We show that the XLNet model can be successfully applied to orthopedic surgeon’s operative notes to generate CPT billing codes. As NLP models as a whole continue to improve, billing can be greatly augmented with artificial intelligence assisted generation of CPT billing codes which will help minimize error and promote standardization in the process.

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ABSTRACT 120

EVALUATING THE SAFETY, FEASIBILITY, AND EFFICACY OF INTRACRANIAL CONVECTIONENHANCED DELIVERY OF LAPONITE MAGNETIC IRON-OXIDE NANOPARTICLES FOR THE POTENTIAL TREATMENT OF GLIOBLASTOMA.

Jack Zhang1 , Wilbert Mays2, Daniel Rivera1, Maria Anastasiadou3, Alexandros Bouras3, Tori Chanenchunk3, Constantinos Hadjipanayis3. 1Medical Education, 3Neurosurgery. 1,3Icahn School of Medicine at Mount Sinai, New York, New York, 2Oakwood University, Huntsville, AL.

Glioblastoma (GBM) is the most common primary brain cancer in adults and is universally lethal. Magnetic hyperthermia therapy (MHT) is a nanotechnology-based treatment consisting of local heat generation in a tumor region via direct delivery of magnetic iron-oxide nanoparticles (MIONPs), which are then activated by exposure to an external alternating magnetic field (AMF). The local hyperthermia generated can potentially enhance anti-tumor effects of radiation therapy (RT) and chemotherapy (temozolomide, TMZ), making MHT in combination with RT and TMZ a promising therapeutic approach for GBM patients. Convection-enhanced delivery (CED) is a well-established technique used to deliver therapeutic agents into the brain and bypass the blood-brain barrier (BBB). CED allows for delivery of robust MIONP concentrations directly into the tumor bulk and surrounding infiltrating tumor cells. Laponite is a synthetic clay matrix used as a MIONP delivery system. Stable dispersions of laponite are especially important as they complement the bulk flow properties of CED. In this study, we seek to evaluate the safety and feasibility of intracranial CED as a method of laponite MIONP delivery, as well as to investigate the heating efficacy of the laponite MIONPs. Our preliminary data have confirmed the safety and feasibility of intracranial laponite MIONP CED. Healthy immunocompetent C57BL/6 mice (n=5) were anesthetized and placed on a stereotactic frame, after which intracranial laponite MIONP CED was performed at a flow rate of 0.5 μL/min, delivering a total MIONP volume of 10 μL . No leakback was observed. Mice were allowed to recover and were monitored daily for short- and long-term adverse effects. No signs of toxicity were observed across 4 weeks. Additionally, MIONPs were directly visualizable in fresh brain tissue immediately post-CED, and on brain MRI 24 hours post-CED. MIONPs were also detected in frozen brain sections via Prussian Blue staining. Temperature measurements of stable laponite MIONP dispersions following exposure to an external AMF were conducted in vitro using different AMF and laponite MIONP solution parameters. Intracranial heating efficacy of laponite MIONPs after CED and AMF exposure was then determined in vivo, using healthy immunocompetent C57BL/6 mice (n=5). Results will inform further animal studies investigating the anti-tumor efficacy of combination laponite MIONP MHT with RT and TMZ.

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ABSTRACT 121

KNOWLEDGE OF EPINEPHRINE AUTO-INJECTOR USE AMONG FAMILIES OF PEDIATRIC FOOD ALLERGY PATIENTS.

Evelyn Zhang1 , Amanda Agyemang2 1Medical Education, 2Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, New York.

BACKGROUND: Around 40% of children in the US have an allergy, and about a quarter suffer from a food allergy, which can lead to life-threatening anaphylaxis. Yet, some studies show that up to two-thirds of pediatric patients presenting to the ED with anaphylaxis did not receive epinephrine prior to admission. Previous studies show that many food allergy patients don’t even carry an epinephrine auto-injector (EAI). If they did, many didn’t know how to use their EAI correctly. With three new types of EAIs approved just in the last decade, all with slightly different administration procedures, it is important to evaluate whether parents of children with food allergies know how to properly use their prescribed EAI.

OBJECTIVE: To evaluate the knowledge that the families of pediatric food allergic patients have on the use of EAIs, as well as the factors associated with correct use.

METHODS: This prospective study recruited any patient <19 years old with positive skin/IgE tests for food allergy from three pediatric allergy clinics within Mount Sinai. A survey was administered to a parent/guardian during their appointment. Descriptive statistics and chi-square tests were performed, with significance defined as p<0.05.

RESULTS: Of 136 participants, 47% carry the Auvi-Q EAI, 23% Mylan, 22% Teva, and 8% Adrenaclick. 63% of all caregivers were able to correctly demonstrate how to use their child’s EAI (defined as completing all “critical steps”), but the rate of correct usage was significantly different depending on EAI type (89% Auvi-Q, 42% Mylan, 43% Teva, 27% Adrenaclick; p<0.01). Correct EAI usage also differed significantly among categories of SES, food allergy history, and EAI teaching history. However, among Mylan users, only certain SES and allergy history were significant. For Auvi-Q and Teva users, allergy type and teaching history were significant. No factors were significantly associated with correct Adrenaclick use.

CONCLUSION: Knowledge of EAI use is relatively low among surveyed families, although Auvi-Q seems significantly easier to use. Factors associated with correct EAI use vary based on EAI type. Many factors that were significant in the total population were not within each EAI type, suggesting that type of EAI is more associated with correct use than other variables. However, factors such as allergy and teaching history were significant across EAI types, which are intervention opportunities that should be explored in future studies.

154

156

157 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Adu-Amankwah, Dorothy David Heller, MD Medicine 1 Agarwal, Aneesh Jonathan Ungar, MD Dermatology 2 Ahsanuddin, Sofia Richard Rosen, MD Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai 3 Aliano Ruiz, Katherine Lauren Zajac, MD, MPH Leora Mogilner, MD Pediatrics Pediatrics 4 Arevalo, Diego Jashvant Poeran, MD, PhD Population Health Science and Policy 5 Babagoli, Masih David Heller, MD, MPH Medicine 6 Bai, Halbert Windsor Ting, MD Surgery 7, 8 Band, Isabelle Angela Bianco, MD Obstetrics, Gynecology, and Reproductive Science 9 Bereket, Sewit Charles Mobbs, PhD Neuroscience 10 Blanchard, Olivia Perry Sheffield, MD, MPH Pediatrics 11 Blech, Anna Craig Katz, MD Robert Yanagisawa, MD Psychiatry Medicine 12 Brooks, James Maya Korin, PhD Luz Claudio, PhD Environmental Medicine and Public Health Environmental Medicine and Public Health 13 Brown, Ashley Tatyana Kushner, MD, MSCE Liver Diseases 14

STUDENT INDEX

158 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Buehler, Nicholas Julia Frydman, MD Geriatrics and Palliative Medicine 15 Calcano Castro, Gabriela Craig Katz, MD Psychiatry 16 Campbell, Peter Linda Zhang, MD Surgery 17 Chang, Michael Michael Smith, MD Gastroenterology and Hepatology, Mount Sinai Morningside and West Hospitals 18 Chang, Annie Windsor Ting, MD Vascular Surgery 19, 20 Chen, Earnest Ronald Gentile, MD Sean Ianchulev, MD, MPH Ophthalmology, New York Eye and Ear of Mount Sinai Ophthalmology 21, 22 Chen, Jenny Ebrahim Elahi, MD, FACS Ophthalmology 23 Cheng, Julia Emma Guttman-Yassky, MD, PhD Dermatology 24 Cheng, Christopher James Chelnis, MD Ophthalmology 25 Clark, Lindsay Perry Sheffield, MD, MPH Pediatrics 26 Cohen, Rebecca Roxana Mehran, MD Cardiovascular Research Institute 27

STUDENT INDEX

159 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Cohen, Lily Cecile Viboud, PhD Sandra Chaves, MD International Epidemiology and Population Studies, NIH Epidemiology Foundation for Influenza Epidemiology, Fondation de France, Paris, France 28 Dahabreh, Dante James Krueger, MD, PhD Emma Guttman-Yassky, MD, PhD Dermatology Dermatology 29 Damian, Candida Mary Rojas, PhD Medical Education 30 DeVita, Christopher Beverly Forsyth, MD Medicine 31 Doan, Jared Fred Ko, MD, MS Geriatrics and Palliative Medicine 32 Doctor, Tahera Elizabeth Cochrane, MD Chelsea DeBolt, MD Obstetrics, Gynecology, and Reproductive Science Obstetrics, Gynecology, and Reproductive Science 33 Downes, Margaret Deborah Marshall, MD Radiation Oncology 34 Duey, Akiro Paul Cagle, MD Orthopaedics 35 Feeley, Monica Douglas Bush, MD Pediatrics 36 Ferriter, Pierce Michael Hausman, MD Orthopaedics 37 Fleming, James Ellerie Weber, PhD Population Health Science and Policy 38 Freid, Hannah Elizabeth Spencer, MD Gastroenterology 39 Gallin, Zachary Leora Mogilner, MD Pediatrics 40 Gansa, William Claire Ankuda, MD Geriatrics and Palliative Medicine 41 Gomberg, Jack Helen Mayberg, MD Neurology 42

STUDENT INDEX

160 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Gonzalez, Christopher Samuel Cho, MD Orthopaedics 43 Gordon, Brianna Cristiane Duarte, PhD Psychiatry, Columbia University, New York 44 Gordon Wexler, Mikayla Jennifer Reckrey, MD Geriatrics and Palliative Medicine 45 Gotlieb, Evelyn Nathalie Jette, MSc, MD Neurology 46 Greenwald, Lucy Perry Sheffield, MD, MPH Pediatrics 47 Gulamali, Faris Girish Nadkarni, MD, MPH Nephrology 48 Hill-Oliva, Michael Aimee Lucas, MD, MS Medicine 49 Huang, Nancy Ann-Gel Palermo, DrPH Ray Cornbill, MBA, BASc Medical Education East Harlem Community Health Committee, Inc. (EHCHC), New York 50 Igwe, Nnamdi Anne Linker, MD Vinh-Tung Nguyen, MD Medicine Medicine 51 Iruvanti, Sushruta Diego Chowell, PhD Oncological Sciences 52 Israni, Nikita Katie McGarry, DNP Clinical Operations, RubiconMD, New York 53 Izda, Vladislav Sumnima Singh, MBBS Filip Swirski, PhD Medicine Medicine 54 Jacob, Walter Cameron McAlpine, PhD Cardiovascular Research Institute 55 Jo, Jason Sze Wong, MD Ophthalmology 56 Katz, Abigail Peter Taub, MD Surgery 57 Knowlton, Harrison Parul Agarwal, PhD Population Health Science and Policy 58 Krishnamurthy, Nithya Windsor Ting, MD Surgery 59

STUDENT INDEX

*This abstract has been withdrawn from the 2023 collection.

161 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Lamb, Colin Konstantinos Margetis, MD, PhD Neurosurgery 60 Lasowski, Patrick Kim Baranowski, PhD Psychiatry 61 Leahy, Jasmine Alfred Astua, MD Nursing, Elmhurst Hospital 62 Leska, Tomasina Adriana Feder, MD Psychiatry 63 Li, Yuzhe Sumayya Ahmad, MD Ophthalmology 64 Li, Troy Paul Cagle, MD Orthopaedics 65 Li, Keva Windsor Ting, MD Surgery 66 Liou, Lathan* Paul O’Reilly, PhD Genetics and Genomic Sciences 67 Maheshwari, Nikhil Dusan Bogunovic, PhD Microbiology 68 Melendez, Chelsia Linda Zhang, MD Surgery 69 Menon, Kartikeya Matthew Levin, MD Anesthesiology 70 Merchant, Rutvij Anitha Lyer, PhD Psychiatry 71 Mills, Alexandra Rebecca Jessel, MD Obstetrics, Gynecology, and Reproductive Science 72 Min, Andrew Windsor Ting, MD Surgery 73 Mitchell, Mackenzie Joseph Truglio, MD Family Medicine and Community Health 74 Munoz Eusse, Juan Serre-Yu Wong, MD, PhD Gastroenterology 75 Nadkarni, Devika Deena Altman, MD Medicine 76

162 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Nevid, Daniella Christina Weltz, MD Breast Surgery 77 Novack, Danielle Scott Worswick, MD Dermatology, University of Southern California, Keck School of Medicine, Los Angeles 78 Odland, Ian Christopher Kellner, MD Neurosurgery 79 Oladoja, Kaothar Dennis Chi, MD Gynecologic Oncology, Memorial Sloan Kettering Cancer Center 80 Onyekwere, Oluomachi Xiaoyan Xu, PhD Rachel Caspi, PhD Ophthalmology, NIH National Eye Institute Ophthalmology, NIH National Eye Institute 81 Paik, Gi-Jong Konstantinos Margetis, MD, PhD Neurosurgery 82 Park, Sungja William Hung, MD, MPH Geriatrics and Palliative Medicine 83 Parsons, Colby Christian Escobar, MD Peter Gliatto, MD Katherine Ornstein, PhD Geriatrics and Palliative Medicine Geriatrics and Palliative Medicine Geriatrics, Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore 84 Pathak, Naeha Meenakashi Gupta, MD Ophthalmology 85

STUDENT INDEX

163 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Peruggia, Michael Jennifer Foss-Feig, PhD Psychiatry 86 Posner, Hannah Maia Kayal, MD Medicine 87 Qian, Daniel Thomas Caruso, MD Anesthesiology, Stanford University School of Medicine, Palo Alto 88 Quasim, Nasseef Deonta Wortham, BA Strategy, Rock Health 89 Rabinowitz, Grace Emma Guttman-Yassky, MD, PhD Dermatology 90 Ren, Yi Edwin Su, MD Orthopaedics, Hospital for Special Surgery 91 Rivas, Sharen Oscar Jimenez-Solomon, MPH Psychiatry, New York State Psychiatric Institute 92 Rodriguez, Benjamin Constantinos Hadjipanayis, MD, PhD Neurosurgery, University of Pittsburgh Medical Center 93 Rosenberg, Ashley James Iatridis, PhD Orthopaedics 94 Sarfo, Edward Ann-Gel Palermo, DrPH Medical Education 95 Schuldt, Braxton Christopher Kellner, MD Neurosurgery 96 Schultz, Lucy Jamilia Sly, PhD Family Medicine and Community Health 97 Shah, Salonee Sheela Maru, MD, MPH Obstetrics, Gynecology, and Reproductive Science 98 STUDENT INDEX

164 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Shaked, Yaelle Maaike van Gerwen, MD, PhD Otolaryngology 99 Solan, Myles Craig Katz, PhD Psychiatry 100 Steelman, Morgan Ellerie Weber, PhD Population Health Science and Policy 101 Steidl, William Varun Kumar, PhD Ophthalmology 102 Stephens, Christian Michael Buckstein, MD, PhD Radiation Oncology 103 Stratis, Catherine Angela Bianco, MD Obstetrics, Gynecology, and Reproductive Science 104 Tieu, Andrew Kevin Costa, PhD Cardiovascular Research Institute 105 Tmariam, Tsion Sheela Maru, MD, MPH Obstetrics, Gynecology, and Reproductive Science 106 Todd, Rachel Linda Zhang, MD Surgery 107 Ushpol, Adam Sandeep Gangadharan, MD Pediatrics 108 Utti, Vivian Avi Ma’ayan, PhD Pharmacology and Systems Therapeutics 109 Vasan, Vikram Raj Shrivastava, MD Neurosurgery 110 Venkatram, Chinmayi Bevin Cohen, PhD Geriatrics and Palliative Medicine 111 Verma, Hannah Mingyang Gray, MD, MPH Otolaryngology 112 STUDENT INDEX

165 STUDENT NAME MENTOR NAME AFFILIATION POSTER NUMBER Villalba, Madeline Abigail Baim-Lance, PhD Geriatrics and Palliative Medicine 113 Vujovic, Dragan Richard Bakst, MD Radiation Oncology 114 Weeks, Marcus David Putrino, PhD Rehabilitation Medicine 115 Weiss, Orli Bruce Gelb, MD Genetics and Genomic Sciences 116 Wu, Catherine Peter Dottino, MD Obstetrics, Gynecology, and Reproductive Science 117 Yeturu, Sai Kaushik Michael Redlener, MD Emergency Medicine 118 Zaidat, Bashar Jun Kim, MD Orthopaedics 119 Zhang, Jack Constantinos Hadjipanayis, MD, PhD Neurosurgery 120 Zhang, Evelyn Amanda Agyemang, MD Pediatrics 121

STUDENT INDEX

SECTION 4: Mentor Index

168 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Agarwal Parul PhD Population Health Science and Policy 58 Agyemang Amanda MD Pediatrics 121 Ahmad Sumayya MD Ophthalmology 64 Altman Deena MD Medicine 76 Ankuda Claire MD Geriatrics and Palliative Medicine 41 Astua Alfred MD Nursing, Elmhurst Hospital 62 Baim-Lance Abigail PhD Geriatrics and Palliative Medicine 113 Bakst Richard MD Radiation Oncology 114 Baranowski Kim PhD Psychiatry 61 Bianco Angela MD Obstetrics, Gynecology, and Reproductive Science 9, 104 Bogunovic Dusan PhD Microbiology 68 Buckstein Michael MD, PhD Radiation Oncology 103 Bush Douglas MD Pediatrics 36 Cagle Paul MD Orthopaedics 35, 65 Caruso Thomas MD Anesthesiology, Stanford University School of Medicine, Palo Alto 88 Caspi Rachel PhD Ophthalmology, NIH National Eye Institute 81

MENTOR INDEX

169 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Chaves Sandra MD Epidemiology, Foundation for Influenza Epidemiology, Fondation de France, Paris, France 28 Chelnis James MD Ophthalmology 25 Chi Dennis MD Gynecologic Oncology, Memorial Sloan Kettering Cancer Center 80 Cho Samuel MD Orthopaedics 43 Chowell Diego PhD Oncological Sciences 52 Claudio Luz PhD Environmental Medicine and Public Health 13 Cochrane Elizabeth MD Obstetrics, Gynecology, and Reproductive Science 33 Cohen Bevin PhD Geriatrics and Palliative Medicine 111 Cornbill Ray MBA, BASc East Harlem Community Health Committee, Inc. (EHCHC), New York 50 Costa Kevin PhD Cardiovascular Research Institute 105 DeBolt Chelsea MD Obstetrics, Gynecology, and Reproductive Science 33 Dottino Peter MD Obstetrics, Gynecology, and Reproductive Science 117 Duarte Cristiane PhD Psychiatry, Columbia University, New York 44

MENTOR INDEX

170 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Elahi Ebrahim MD, FACS Ophthalmology 23 Escobar Christian MD Geriatrics and Palliative Medicine 84 Feder Adriana MD Psychiatry 63 Forsyth Beverly MD Medicine 31 Foss-Feig Jennifer PhD Psychiatry 86 Frydman Julia MD Geriatrics and Palliative Medicine 15 Gangadharan Sandeep MD Pediatrics 108 Gelb Bruce MD Genetics and Genomic Sciences 116 Gentile Ronald MD Ophthalmology, New York Eye and Ear of Mount Sinai 21, 22 Gliatto Peter MD Geriatrics and Palliative Medicine 84 Gray Mingyang MD, MPH Otolaryngology 112 Gupta Meenakashi MD Ophthalmology 85 Guttman-Yassky Emma MD, PhD Dermatology 24, 29, 90 Hadjipanayis Constantinos MD, PhD Neurosurgery, University of Pittsburgh Medical Center 93, 120 Hausman Michael MD Orthopaedics 37

MENTOR INDEX

171 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Heller David MD, MPH Medicine 1, 6 Hung William MD, MPH Geriatrics and Palliative Medicine 83 Ianchulev Sean MD, MPH Ophthalmology 21, 22 Iatridis James PhD Orthopaedics 94 Iyer Anitha PhD Psychiatry 71 Jessel Rebecca MD Obstetrics, Gynecology, and Reproductive Science 72 Jette Nathalie MSc, MD Neurology 46 Jimenez-Solomon Oscar MPH Psychiatry, New York State Psychiatric Institute 92 Katz Craig MD Psychiatry 12, 16, 100 Kayal Maia MD Medicine 87 Kellner Christopher MD Neurosurgery 79, 96 Kim Jun MD Orthopaedics 119 Ko Fred MD, MS Geriatrics and Palliative Medicine 32 Korin Maya PhD Environmental Medicine and Public Health 13 Krueger James MD, PhD Dermatology 29 Kumar Varun PhD Ophthalmology 102 Kushner Tatyana MD, MSCE Liver Diseases 14

MENTOR INDEX

*This abstract has been withdrawn from the 2023 collection.

172 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Levin Matthew MD Anesthesiology 70 Linker Anne MD Medicine 51 Lucas Aimee MD, MS Medicine 49 Ma’ayan Avi PhD Pharmacology and Systems Therapeutics 109 Margetis Konstantinos MD, PhD Neurosurgery 60, 82 Marshall Deborah MD Radiation Oncology 34 Maru Sheela MD, MPH Obstetrics, Gynecology, and Reproductive Science 98, 106 Mayberg Helen MD Neurology 42 McAlpine Cameron PhD Cardiovascular Research Institute 55 McGarry Katie DNP Clinical Operations, Rubicon MD 53 Mehran Roxana MD Cardiovascular Research Institute 27 Mobbs Charles PhD Neuroscience 10 Mogilner Leora MD Pediatrics 4, 40 Nadkarni Girish MD, MPH Nephrology 48 Nguyen Vinh-tung MD Medicine 51 O’Reilly* Paul PhD Genetics and Genomic Sciences 67

173 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Ornstein Katherine PhD Geriatrics, Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore 84 Palermo Ann-Gel DrPH Medical Education 50, 95 Poeran Jashvant MD, PhD Population Health Science and Policy 5 Putrino David PhD Rehabilitation Medicine 115 Reckrey Jennifer MD Geriatrics and Palliative Medicine 45 Redlener Michael MD Emergency Medicine 118 Rojas Mary PhD Medical Education 30 Rosen Richard MD Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai 3 Sheffield Perry MD, MPH Pediatrics 11, 26, 47 Shrivastava Raj MD Neurosurgery 110 Singh Sumnima MBBS Medicine 54 Sly Jamilia PhD Family Medicine and Community Health 97 Smith Michael MD Gastroenterology and Hepatology, Mount Sinai Morningside and West Hospitals 18 Spencer Elizabeth MD Gastroenterology 39 Su Edwin MD Orthopaedics, Hospital for Special Surgery 91 Swirski Filip PhD Medicine 54

MENTOR INDEX

174 MENTOR LAST NAME MENTOR FIRST NAME DEGREE AFFILIATION POSTER POSITION Taub Peter MD Surgery 57 Ting Windsor MD Surgery 7, 8, 19, 20, 59, 66, 73 Truglio Joseph MD Family Medicine and Community Health 74 Ungar Jonathan MD Dermatology 2 Viboud Cecile PhD International Epidemiology and Population Studies, NIH 28 Weber Ellerie PhD Population Health Science and Policy 38, 101 Weltz Christina MD Breast Surgery 77 Wong Sze MD Ophthalmology 56 Wong Serre-Yu MD, PhD Gastroenterology 75 Worswick Scott MD Dermatology, University of Southern California, Keck School of Medicine, Los Angeles 78 Wortham Deonta BA Strategy, Rock Health 89 Xu Xiaoyan PhD Ophthalmology, NIH National Eye Institute 81 Yanagisawa Robert MD Medicine 12 Zajac Lauren MD, MPH Pediatrics 4 Zhang Linda MD Surgery 17, 69, 107 van Gerwen Maaike MD, PhD Otolaryngology 99

SECTION 5:

Abstracts Topics Area

ABSTRACT TOPICS AREA

177 CATEGORY POSTER POSITION Allergy and Immunology 68 Anesthesiology, Perioperative, and Pain Medicine 5, 70, 88 Cardiology 27, 54, 105 Dermatology 2, 24, 29, 78, 90 Digital Health 89 Environmental Medicine & Public Health 26, 40 Family Medicine & Community Health 74 Gastroenterology 18, 39, 49, 75, 87 General Internal Medicine 48 Genetics and Genomic Sciences 67, 76, 116, 117 Geriatrics and Palliative Medicine 15, 32, 41, 45, 64, 84, 111, 112, 113 Gynecologic Oncology 80 Global Health 1, 6, 11, 12, 13, 16, 17, 23, 47, 62, 69, 98, 107 Health Policy/ Population Health 58, 71, 118 Health System Operations & Strategic Planning 53 HealthTech Innovation, Diversity Innovation 95 Hospital in Home Program 83 Hospital Medicine 51

ABSTRACT TOPICS AREA

178 CATEGORY POSTER POSITION Infectious Diseases 28 Liver Diseases 14 Medical Education 31 Nephrology 38 Neurology 42, 46, 55 Neuroscience 10 Neurosurgery 60, 79, 82, 93, 96, 110, 120 Obstetrics, Gynecology, and Reproductive Science 9, 33, 72, 97, 101, 104, 106 Oncofertility 77 Oncology 52, 109 Ophthalmology 3, 21, 22, 25, 56, 81, 85, 102 Orthopaedics 35, 37, 43, 65, 91, 94, 119 Otolaryngology-Head and Neck Surgery 99 Pediatrics 4, 108, 121 Psychiatry, Psychology, Mental Health 30, 44, 50, 61, 63, 86, 92, 100 Pulmonary, Critical Care and Sleep Medicine 36 Radiation Oncology 34, 103, 114

ABSTRACT TOPICS AREA

179 CATEGORY POSTER POSITION Rehabilitation and Human Performance 115 Surgery 57 Vascular Surgery 7, 8, 19, 20, 59, 66, 73

SECTION 6:

Acknowledgements

POSTER SESSION FACILITATORS

Francesca Cossarini, MD Medicine, Infectious Diseases

Lonnie Embleton, PhD Global Health

Stephanie Factor, MD

Medicine, Infectious Diseases Obstetrics, Gynecology and Reproductive Science

Scott Friedman, MD

Therapeutic Discovery Medicine, Pharmacologic Sciences, Liver Diseases

Darinka Gadikota-Klumpers, PhD Medical Education, Program Global Health Education

Leona Hess, PhD Medical Education

Joanne Hojsak MD Pediatrics and Medical Education

Pediatric Critical Care & Institute of Critical Care Medicine

Geoffrey Jara-Almonte, MD Emergency Medicine

Minal Kale, MD

Medicine, General Internal Medicine

Amanda Leiter, MD

Endocrine, Diabetes and Bone Diseases

Jenny Lin MD, MPH Medicine, General Internal Medicine

Peter Morgenstern, MD

Neurosurgery

Pediatrics

Jashvant Poeran MD, PhD

Population Health Science & Policy

Barbara Sampson, MD

Pathology, Molecular and Cell Based Medicine

Perry Sheffield MD, MPH

Environmental Medicine & Public Health

Pediatrics

Keith Siegel MD, PhD

Medicine, General Internal Medicine & Infectious Diseases

Otolaryngology

Maaike van Gerwen MD, PhD

Otolaryngology- Head and Neck Surgery

Institute for Translational Epidemiology

Rajwanth Veluswamy, MD

Medicine, Hematology and Medical Oncology

182

Mary Rojas, PhD

Director, Medical Student Research Office

Jenny J. Lin, MD, MPH

Associate Director of SCHOLaR

Keith Sigel, MD, PhD Director, PORTAL Program (MD/MSCR)

Associate Director of MSRO

Grace A. Oluoch, MBA Senior Program Coordinator

Yakhira Encarnacion-Patterson, MPH Senior Program Coordinator

2023 Medical Student Research Day Abstract Book

and Abstracts

TABLE OF CONTENTS

Sixth Annual Karen Zier Medical Student Research Day

STUDENT SPEAKERS

SECTION 1: List of Abstracts

LIST OF ABSTRACTS

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SECTION 2: Abstracts

ABSTRACT 1

SOCIODEMOGRAPHIC AND BEHAVIORAL PREDICTORS OF DEPRESSION PREVALENCE IN NORTHERN GHANA.

IMPACTS OF THE COVID-19 PANDEMIC ON SKIN CANCER SURGERIES.

MITOCHONDRIAL DYSFUNCTION IN STEADY STATE SICKLE CELL DISEASE (SCD) CHARACTERIZED BY FLAVOPROTEIN FLUORESCENCE (FPF) IN THE RETINA.

ABSTRACT 4

PASS STUDY: RELATIONSHIP OF FOOD INSECURITY AND PARENTAL STRESS IN FAMILIES SCREENED FOR SDH AT A PEDIATRIC CLINIC IN EAST HARLEM, NYC.

ABSTRACT 5

SOCIO-DEMOGRAPHIC AND BEHAVIORAL FACTORS ASSOCIATED

ABSTRACT 7

ABSTRACT 8

PREDICTORS OF REINTERVENTION AFTER ILIOFEMORAL VEIN STENTING.

ABSTRACT 9

DAILY VS TWICE DAILY DOSING OF NIFEDIPINE FOR BLOOD PRESSURE CONTROL IN PREGNANCY AND POSTPARTUM.

ANTIPSYCHOTIC USE AND COVID INFECTION RISK.

ABSTRACT 11

CLIMATE CHANGE AND MEDICAL EDUCATION: UNDERSTANDING NATIONWIDE CURRICULAR EFFORTS.

IMPACTFUL LIFE EVENTS, POST-TRAUMATIC STRESS, AND RESILIENCE PROMOTING BEHAVIORS

PRINCIPLES OF BEHAVIORAL SCIENCE TO ENHANCE COMMUNITY HEALTH

MESSAGING CAMPAIGN DESIGN, IMPLEMENTATION, AND EVALUATION.

PREVALENCE OF ADVERSE PREGNANCY OUTCOMES IN WILSON’S DISEASE

ABSTRACT 15

FIGURATIVE LANGUAGE IN CANCER CONVERSATIONS: DIFFERENCES BY SOCIODEMOGRAPHIC CHARACTERISTICS.

QUALITATIVE ASSESSMENT OF THE EFFICACY OF PSYCHIATRIC TRAINING MODULES IN PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY IN THE DOMINICAN REPUBLIC.

ESTABLISHING A POVERTY ASSESSMENT TOOL FOR USER FEES AT AN AMBULATORY SURGERY CENTER IN RURAL UGANDA.

ABSTRACT 18

ABSTRACT 19

ELUCIDATION OF RISK FACTORS FOR CEAP CLASS AMONG

SURGERY PATIENTS.

SIGNIFICANT PREDICTORS OF PREOPERATIVE VCSS COMPOSITE SCORE FOR VASCULAR SURGERY PATIENTS AT A SINGLE INSTITUTION.

ABSTRACT 21

REMOTE PATIENT MONITORING OF CENTRAL RETINAL FUNCTION WITH MACUSTAT®: A MULTI-MODAL MACULAR FUNCTION SCAN.

PATIENT’S PERCEIVED UTILITY OF THE MACUSTAT TEST TO ASSESS RETINAL CARE QUALITY.

ABSTRACT 23

EXAMINING HEALTHCARE NGO TRENDS THROUGH GOOGLE ANALYTICS.

ABSTRACT 24

DELAYED TYPE HYPERSENSITIVITY REACTIONS TO VARIOUS ALLERGENS MAY

ABSTRACT 27

IMPACT OF PERIPHERAL ARTERY DISEASE ON OUTCOMES IN HIGH BLEEDING RISK PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION.

ABSTRACT 28

ABSTRACT 29

PSYCHOLOGICAL OUTCOMES AMONG MEDICAL STUDENTS THAT HAVE EXPERIENCED CHILDHOOD TRAUMA.

ABSTRACT 31

ABSTRACT 32

ABSTRACT 33

IS OBESITY ASSOCIATED WITH INCREASED ADVERSE OUTCOMES AMONG FORCEPS ASSISTED VAGINAL DELIVERIES?

ABSTRACT 34

ABSTRACT 35

ABSTRACT 36

PULMONARY HYPERTENSION IN CHILDREN WITH SEVERE OBSTRUCTIVE SLEEP APNEA.