2024 AOA Research Abstracts and Student Poster Competition

Investigation of the Dual Effects of Compound 968 Analogs in Treating Breast Cancer and Cancer-Related Pain

Alfredo Fallorina, OMS-I, Christopher Butler, BS, Tuoen Liu, MD, PhD

Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV

Context: Glutamine is an amino acid with essential roles in physiologic functions and pathological conditions such as carcinogenesis. Glutaminases (GLS) are the rate-limiting enzymes catalyzing glutamine metabolism and GLS inhibition has emerged as a potential strategy for cancer treatment. Multiple GLS inhibitors such as compound 968 (C968) have been found and studied in cancer. Studies have shown that C968 has anti-cancer activities, however, its poor in vivo efficacy limits its clinical use.

Objective: Besides inhibiting GLS1, we also found that C968 induces activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) which has implication in pain regulation [1]. To further explore the potential clinical use of C968, we synthesized a number of C968 analogs. We hypothesize that C968 and its analogs have both analgesic and anticancer effects. The significance of the study is that we may be able to find novel compounds for simultaneous treatment of cancer and cancer-related pain.

Methods: Cells and chemicals: The brain metastasized triple-negative breast cancer cell line (231Br) and its parental regular breast cancer cell line (231) were used in the study. Both cell lines were cultured at 37°C, 5% CO2, in DMEM medium containing 10% FBS, 10 mM L-glutamine, and 1X penicillin/streptomycin. MTT assay: Cell viability was measured using MTT assay kit following the protocol. Western blotting assay: The expression of proteins was measured using Western blotting assay. Briefly, cell lysates were prepared in RIPA buffer, and protein samples were loaded on an SDS-polyacrylamide gel, separated by electrophoresis, and subsequently transferred to a PVDF membrane. Membranes were blocked with 5% milk in 1X TBS containing 0.05% (v/v) Tween-20 and washed seven times with 1X TBS and 1X TBST alternatively. Membranes were then incubated with primary antibody overnight at 4°C followed by incubation with secondary antibody at room temperature for 1 hour. Pierce supersignal chemiluminescent substrates were used, and images were captured by using the gel doc system. Chemotherapy-induced peripheral neuropathy (CIPN) mouse model: The analgesic effects of C968 and its analogs were measured using CIPN mouse model following the standard protocol [1]. Briefly, intermittent low-dose paclitaxel was used to induce CIPN in CD-1 mice, and the induction was tested via multiple assays. Specifically, the baseline of mechanical threshold was measured on day 1, and paclitaxel was injected on days 1, 3, 5 and 7. The mice were treated with C968 or its analogs on day 8. Morphine was injected and von Frey assay was used to measure the mechanical hyperalgesia on day 9. Statistics: Statistical significance of the data between two groups was analyzed by the Student’s t test (Prism 8), and more than two groups was analyzed by one-way ANOVA with a Tukey posttest (Prism 8). Significance levels were set at p

Results: Expression of GLS1 and Nrf2 in breast cancer cells. C968 is a well-characterized GLS1 inhibitor with the ability to induce activation of the transcription factor Nrf2 and promote its downstream gene expression [1]. We measured the expression of GLS1 and Nrf2 in the brain metastasized cancer cells (231Br) and their parental regular cancer cells (231) using Western blotting assay. The expression of GLS1 is higher and Nrf2 is lower in 231Br cells compared to 231 cells, suggesting C986 and its analogs may have good effects in treating 231Br cells. Screening of the inhibitory activity of chemicals in cancer cells. So far, we have screened 83 different C968 analogs for their inhibitory activity on both 231 and 231Br cells using MTT assay. Six out of these 83 compounds were identified with good inhibitory effects at 1 mM and 10 mM on both cell lines (p Impact of C968 and its analogs on morphine analgesia in CIPN model. Using the CIPN model, mice were first baselined then administered with 10 nmol C968 or vehicle intrathecally. Morphine (3.2mg/kg) was subcutaneously administrated after 24 hours followed by antinociception measurement using the tail flick/hot water bath assay over 2 hours. We observed that C968 significantly enhanced the analgesic effect of morphine (p in vitro studies indicated that C968 can improve the analgesic effect of morphine, and some C968 analogs may have a better synergistic effect compared to C968.

Conclusion: Triple-negative breast cancer patients have poor prognosis and short survival time, especially with brain metastasis. Current treatment regimens are largely ineffective and associated with notable side effects. In addition, pain is a featured symptom in cancer, suffering ∼52-77% patients. Thus, seeking new treatment options for brain metastasis of breast cancer and cancer-related pain is necessary with great clinical significance. Our studies showed that some C968 analogs we synthesized could inhibit both regular and brain metastasized breast cancer cells in vitro. The C968 and its analog (CU1015) could significantly enhanced the analgesic effect of morphine in mice. Thus, our study may lead to find new drugs to treat cancer and cancer-related pain simultaneously. Our study also has high relevance to the principles of osteopathic philosophy. As potentially therapeutical drugs, C968 analogs may be helpful to restore the body to homeostasis following the imbalance caused by cancer and related pain, as well as provide patients with an improved outlook, which is essential to the behavioral model of osteopathic care. With a clear understanding of mechanisms of these chemicals in cancer and pain treatment, osteopathic physicians could better treat their patients. To further study and compare the anti-cancer effects of C968 and its analogs, we will (1) determine and compare their IC50 values in 231 and 231Br cells; (2) explore their effects on other oncologic characteristics, including apoptosis, cell cycle, signal transduction pathways, angiogenesis, migration, and metastasis studies; (3) if they show promising in vitro anti-cancer effects, their in vivo activities will be measured using mouse model, such as comparing the ability of decreasing tumor burden and prolonging survival time between C968 and its analogs; (3) investigate their molecular mechanisms in cancer treatment, such as exploring the relationship and roles of these chemicals, GLS, and Nrf2 in breast cancer.

References

1. Lei, W., V.M. Kliebe, and X. Chen, An Investigation into the Impact of a Glutaminase Inhibitor, Compound 968, on Nrf2 Signaling. Future Pharmacology, 2021. 1(1): p. 41-47.

2. Pennypacker SD, et al., Methods and protocols for chemotherapy-induced peripheral neuropathy (CIPN) mouse models using paclitaxel. Methods Cell Biol, 2022. 168:277-298.

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: N/A

Financial Disclosure: None reported.

Poster No. *B-2

Abstract No. 2024-010

Category: Basic Science

Research Focus Area: Impact of OMM & OMT

Evaluation of the Use of 3D Printed Spinal Models to Educate and Assess Osteopathic Medical Students

¹Daniel Valdés OMS-III, ²Joy Zarandy, DO, ¹Meagan Sherrington, ³Madison Cohen, ³John Matechak

¹Osteopathic Manipulative Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, GA; ²Family Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, GA; ³Philadelphia College of Osteopathic Medicine Suwanee, GA

Context: The understanding of spinal biomechanics, specifically through Fryette’s laws of spinal motion, is a key aspect of the foundation for osteopathic manipulative medicine (OMM) training. With this knowledge, osteopathic physicians may confidently diagnose and treat somatic dysfunctions of the axial skeleton. However, a dynamic and objective teaching tool to educate students on spinal mechanics has not been established [1]. While 3D printing is gaining utility in academia, it is only just beginning to be used within osteopathic educational settings. Currently, only one study employing the use of 3D printing in osteopathic medicine has been published, which involves a 3D printed model to demonstrate inhalation/exhalation rib dysfunctions [2]. Thus, we present the creation of a 3D-printed spinal model of the lumbar spine and its assessment for incorporation into the OMM curriculum. Through its use as an educational tool, the goal is to facilitate student understanding of the complexity of vertebral somatic dysfunction diagnosis, as well as to standardize graded assessments of students.

Objective: The objectives of the study were to determine the capacity of osteopathic medical students to successfully diagnose somatic dysfunctions on a 3D-printed spinal model and assess the ability of the model to replicate human spinal mechanics and be used as a tool for learning spinal somatic dysfunctions and objective grading of students’ palpatory skills and knowledge of spinal mechanics in osteopathic medical school.

Methods: This study used a 3D-printed prototype box model with five spaces that allowed the magnetic insertion of select 3D-printed vertebrae to represent normal and/or somatic dysfunction in the planes of sidebending and rotation. This study was composed of three phases assessing volunteer first and second-year osteopathic medical students at the Philadelphia College of Osteopathic Medicine Georgia through a single-case experimental design, featuring both an objective quantitative assessment and a subjective qualitative assessment of the 3D model in comparison to live human models. The first phase mimicked the current standard of education, by reviewing the principles of Fryette mechanics as taught within the osteopathic medical school curriculum. During the second phase, participants were asked to palpate the lumbar spine (L1-L5) and make a formal assessment of each vertebrae on both a live human model and a 3D printed model. During the third phase, the students were given the chance to further interact with the 3D models and filled out a survey on their assessment of its value as an educational tool.

Results: A total of 90 students participated in the study, with 88 completing all 3 phases. Participants assessed rotation and sidebending of vertebrae L1-L5 on 3D-printed spinal models and live human models, totaling 440 assessments. Results showed 52.73% and 48.41% accuracy for rotation and sidebending assessments, respectively, on live models, compared to 46.59% and 38.18% on 3D models. Chi-square analysis revealed no significant difference in rotational assessments (p=0.069) but a moderate association favoring live models for sidebending (p=0.002, Cramer’s V=0.103). Diagnostic accuracy showed no significant difference (p=0.349).Students rated the 3D models and human models similarly for reliability and objectivity, but favored the 3D models for convenience, non-intimidation, and enjoyment. However, they found human models “preferable.” Students rated 3D models positively for educational use, indicating improvement in palpation skills, diagnostic ability, understanding of Fryette concepts, and confidence, with a preference for using them in various learning contexts.

Conclusion: The results of our study showed that in comparing our prototype 3D-printed spinal model with live humans, there is no significant difference in students’ ability to assess the rotational component of somatic dysfunction or their ability to diagnose vertebral segments accurately. However, students performed significantly better in correctly assessing the sidebending portion of somatic dysfunction on live models, indicating the need for future prototypes of the 3D-printed models to focus on augmenting the sidebending component.Students rated the 3D models and human models similarly for reliability and objectivity, but preferred 3D models for being convenient, enjoyable, and less intimidating. However, they found human models preferable overall. Students rated 3D models positively for educational use, indicating improvement in palpation skills, diagnostic ability, understanding of Fryette concepts, and confidence, with a preference for using them in various learning contexts. Hence, while this version of our 3D-printed models needs improvement before it can confidently be incorporated in a standardized practical examination setting, the results do currently favor its use as an educational tool and adjunct. Future versions of our model will focus on improving the overall likeness to a human spine to enhance student palpatory skills and ability to correctly diagnose spinal somatic dysfunctions in patients.

References

1. Snider EJ, Pamperin K, Johnson JC, Shurtz NR, Degenhardt BF. Assessing palpation thresholds of osteopathic medical students using static models of the lumbar spine. J Am Osteopath Assoc. 2014;114(6):460-469. doi:10.7556/jaoa.2014.096

2. Moriles K, Ramnot A, Lai M, Jacobs RJ, Qureshi Y. The use of 3D printing for osteopathic medical education of rib disorders. J Osteopath Med. 2021;121(3):255-263. doi:10.1515/jom-2020-0020

Informed Consent: IRB exemption for informed consent under 45 CFR 46.104(1)

Ethical Approval & IRB and/or IACUC Approval: IRB exempt approval for OMM 3d model 4.1.24. This study was approved by the PCOM Division of Research for IRB exemption on 4/1/24, with an addendum approved on 4/22/24.

Financial Disclosure: None reported.

Poster No. *B-3

Abstract No. 2024-015

Category: Basic Science

Research Focus Area: Osteopathic Philosophy

Academic Entitlement in Osteopathic Medical Students

¹Sidney Brownal Sciences, ¹Abigail Rodgers al Sciences, ²Danielle Fastring

¹William Carey University College of Osteopathic Medicine, Hattiesburg, MS; ²Department of Preclinical Sciences, William Carey University College of Osteopathic Medicine, Hattiesburg, MS

Context: In a medical school classroom, students are expected to work with one another within an ethical framework of professionalism, which includes engagement with peers, regulation of academic emotion, and rejection of plagiarism. The integrity of these foundational principles becomes compromised when a student exhibits high levels of academic entitlement, or a tendency to “hold a certain expectation of academic success without taking personal responsibility.¹” Such attitudes, falling short of the standards of professionalism, undermine the fundamental tenets of the Osteopathic Oath we follow. Therefore, it is imperative to proactively identify and address instances of academic entitlement among students at an early stage in their educational journey.

Objective: To define academic entitlement (AE) in osteopathic medical education and measure AE in osteopathic medical students.

Methods: This study examines academic entitlement among osteopathic medical students. We conducted a survey distributed via the Qualtrics Survey Platform to OMS1 to OMS4 cohorts at a southern College of Osteopathic Medicine (COM). The survey collected demographic data, academic performance, student satisfaction, and utilized two validated instruments that assess academic entitlement. To be eligible to participate, individuals had to be a current student at the COM and provide informed consent. Participants (n=145) were recruited through their respective student Outlook email groups and categorized by graduation year. In the electronic survey instrument, each item in the Academic Entitlement survey utilized a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) and included statements that assessed entitled expectation and externalized responsibility. Demographic information and academic performance data were self-reported through the Qualtrics platform. GPA responses were re-coded into two qualitative categories. Respondents with a GPA ≥ ??.? on a 100-point scale were labeled as more academically successful. Data analysis involved providing frequency and percentage distributions for all collected data categories. Academic Entitlement (AE) items were reverse-coded and totaled to calculate scores, with higher scores indicating increased entitlement levels.² Prevalence of Academic Entitlement was reported as frequency and percentage of participants. The association between demographic variables and academic entitlement was evaluated using chi-square analysis, while the connection between academic performance and academic entitlement was explored through t-test analysis. Statistical analyses were conducted using SPSS v. 28.

Results: Participants represented all cohorts (OMS1: n=41, 28.3%; OMS2: n=38, 26.2%; OMS3: n=27,18.6%; and OMS4: n=39, 26.9%) There was not a statistically significant difference between entitled and not entitled for reassessments completed in OMS1 (p = 0.726), reassessments completed in OMS2 (p=0.752), reassessments completed in OMS3 (p=0.363), course remediation in OMS1 (p=0.681), course remediation in OMS2 (p=0.667), or course remediations in OMS3 (p=0.398). There was not a statistically significant difference in quartile rank between those that were entitled and those that were not (p=0.346). Students categorized as not academically successful (GPA

Conclusion: Osteopathic medical students demonstrating low academic achievement (GPA ≤ 85 on a 100-point scale) displayed elevated levels of academic entitlement. This phenomenon correlates with harboring unrealistic expectations within academia, adversely affecting peer dynamics, and displaying unprofessional conduct in their medical endeavors. While acknowledging the potential for recall bias, we urge faculty at osteopathic medical institutions to remain vigilant regarding potential academic entitlement among students. Such individuals often exhibit an external locus of control and heightened anxiety levels, thereby impeding the learning process.² Early identification serves as a crucial step toward fostering a more conducive educational environment and nurturing the professional growth of future osteopathic physicians.

References

1. Chowning K, Campbell NJ. Development and validation of a measure of academic entitlement: Individual differences in students’ externalized responsibility and entitled expectations. Journal of Educational Psychology. 2009;101(4):982-997. doi:10.1037/a0016351Knepp KA, Knepp MM.

2. Academic entitlement decreases engagement in and out of the classroom and increases classroom incivility attitudes. Social Psychology of Education. 2022;25(5):1113-1134. doi:10.1007/s11218-022-09716-4

Informed Consent: When participants first opened the virtual Qualtrics survey, they were presented with the informed consent statement. If the participant consented, they continued to the first page of survey questions. If they did not consent, they were taken to the end of the survey.

The informed consent statement is as follows:

The purpose of this survey is to understand the prevalence of academic entitlement in osteopathic medical students. Participation in this survey is voluntary and anonymous. Refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of benefits to which the subject is otherwise entitled. For pertinent questions about the research and research subjects’ rights, contact Sidney Brown at sbrown567549@student.wmcarey.edu.

Ethical Approval & IRB and/or IACUC Approval: Ethical Approval: Exempt from further review research under the IRB guidelines. Approved (IRB #2023-040).

Steps in the IRB Approval Process

1. Obtain training in the protection of human subjects. The education program we use at William Carey University is called CITI Human Subjects Research Educational Program.

2. Obtain appropriate permissions. If you are writing a thesis, specialist project, or dissertation, have your proposal approved by your committee. If you are an undergraduate student conducting research, have your research approved by your faculty mentor.

3. Complete the IRB Application Form. After signing and obtaining the signatures of your faculty research advisor, email the application to the IRB Office at irb@wmcarey.edu. When your application is submitted, the IRB review process will begin. IRB review consists of an administrative review by IRB staff members and a systematic review by some or all board members as appropriate to the nature of the research.

Financial Disclosure: None reported.

Poster No. B-4

Abstract No. 2024-017

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Impact of Cerebellar Transcranial Electric Stimulation (tES) on Thalamic and Motor Cortical Neuronal Correlation: An in vivo Study with Histological Verification

¹Elizabeth DeSellier, DO, ¹Elishka Holmquist, DO, ²Huo Lu

¹Philadelphia College of Osteopathic Medicine, Suwanee, GA; ²Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Suwanee, GA

Context: Previous studies have shown a positive effect in using transcranial electric stimulation (tES) therapy in the management of cerebellar ataxia. However, the precise mechanism of how tES affects the cerebello-thalamo-cerebral pathway of the brain is poorly understood. The VL and VM nuclei receive input from the cerebellum and send efferent fibers to discrete, functionally distinct regions of the motor cortex. It is therefore reasonable to suspect that VM and VL could produce characteristically different outputs in response to tES.

Objective: This study aims to test the hypothesis that stimulation of the cerebellar cortex will cause a correlated increase of activity in both the motor nuclei of the thalamus and the motor cortex. Additionally, the study uses histology to verify our thalamic measurements were accurate for VL and VM. This study will expand our understanding of the mechanism of tES treatment to the cerebello-thalamo-cerebral pathway.

Methods: Recordings of neuronal electrical activity were taken simultaneously from the motor nuclei of the thalamus (Ventral Lateral and Ventral Medial nuclei) and motor cortex of anesthetized male rats. To examine the correlation between the thalamic cerebral activities during tES, four holes were prepared for the recording. Two for the thalamic sites (1.5 mm lateral, 3.0 mm posterior to the bregma) and two for the motor cortical sites (3.0 mm laterally and 1.6 mm anteriorly to the bregma). Recordings from the thalamic nuclei were taken at various depths of 5.5 mm to 7.5 mm from the cortical surface to reach either the ventral medial (VL) or ventral lateral (VL) nuclei while another recording from the motor cortex 0.5 mm from the cortical surface were taken. Each recording session included 5 minutes of pre-stimulation, 20 minutes of 200 µA stimulation, and 5 minutes of post-stimulation from the thalamus and motor cortex regions. Twelve simultaneous recordings were taken from nine rats. Matlab software was used for data analysis. Cross-correlation and coherence between the thalamic and cortical activities were studied in addition to previous firing rate and power spectrum analysis. A lesion was generated after the thalamic recordings by discharging a current (200 µA for 2 minutes). The brain was extracted and fixed in successive solutions of 15% and 30% sucrose in 4% paraformaldehyde for several days. The brain was subsequently trimmed to size, embedded in Tissue-Tek OCT embedding medium and chilled to -20 °C. Trimmed tissues were sectioned at 20 μm on a CryoStar NX50, mounted and dried in room temperature and coverslipped with Permount Toluene Solution. This procedure was performed for both coronal and sagittal planes. Sections were stained in Cresyl Violet. Photomicrographs were collected to demonstrate the penetration in relationship with VL and VM. Recorded depths of target subnuclei in thalamus (5.55 mm and 6.6 mm for VL and VM respectively) were confirmed by histology.

Results: There was no significant difference between the pre-stim and stimulation correlation (p-value = 0.125) or coherence (Low coherence p-value = 0.191 and High coherence p-value = 0.252) with all the cells (n = 12). The cells with a decrease in firing rate by tES (n = 6) showed a significant difference between the pre-stimulation and stimulation firing rates (p-value = 0.031) and the stimulation and the post-stimulation thalamic power spectrum showed a significant difference under high frequency conditions (p-value = 0.034). There was no correlation change between the thalamus and motor cortical activity after cerebellar tES. The two cells recorded at these depths demonstrated pre-stimulation firing rates of 1.15 Hz and 1.85 Hz for VL and VM respectively. These nuclei experienced subsequent decreases in net firing rate following tES (delta = 0.03 Hz and delta = 0.72 Hz for VL and VM respectively). In total, 5 recordings were obtained from VM and 7 recordings from VL over the course of experimentation.

Conclusion: There was no correlation between the motor cortex and thalamic nuclei activity when stimulated by tES under normal conditions. However, under inhibitory conditions there may be histology that serves as a useful tool for verifying optimal recording probe position. Future studies will incorporate additional recordings collected from VM and VL, confirmed by histology, with subsequent analysis to better define the electrophysiological profile of these two nuclei. Single neuron firing rate changes if present, may explain any correlation changes. Conversely, recording probe depth and proximity to subnuclei could alter their firing rate features in predictable patterns. Characterization of interference to these firing rate features could optimize future data analysis.

References

1. Chen TX, Yang CY, Willson G, Lin CC, Kuo SH. The Efficacy and Safety of Transcranial Direct Current Stimulation for Cerebellar Ataxia: a Systematic Review and Meta-Analysis. Cerebellum. 2021;20(1):124-133. doi:10.1007/s12311-020-01181-z

2. Bower JM, Beermann DH, Gibson JM, Shambes GM, Welker W (1981) Principles of organization of a cerebro-cerebellar circuit. Micromapping the projections from cerebral (SI) to cerebellar (granule cell layer) tactile areas of rats. Brain Behav Evol 18:1–18.

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: A22003 lu desellier holmquist

Financial Disclosure: None reported.

Poster No. *B-5

Abstract No. 2024-018

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Investigating the Thalamic Neuronal Activity Change in Reaching Behavior Pre- and Post-tDCS in Mice

¹Jesse KaoOMS-I, ¹William Johnston, ¹Zilan Hu OMS-I, ²Huo Lu

¹Philadelphia College of Osteopathic Medicine-Georgia Campus, Suwanee GA; ²Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine-Georgia Campus, Suwanee GA

Context: The cerebellum has long been recognized for its critical role in motor control and coordination. Also, the cerebellum serves as a central hub for processing sensory information related to movement and coordinating movement to ensure both smoothness and precision of various motor tasks. The cerebellar projections to the thalamic neurons ultimately synapse on the motor cortical neurons. While the cerebellum and thalamus work together in shaping motor cortical output, the thalamic spatiotemporal contribution within the cerebello-thalamo-cortical pathway remains unclear. Previous studies have suggested that the cerebellum is involved in the prediction and planning of movement, which implies that cerebellar input may alter the thalamic neuron firing rate. This hypothesis was investigated in prior research, studying the electrophysiological changes in thalamic neuron firing rate during reaching behavior in mice. Results indicated that there was a strong correlation between thalamic neuronal activity and reaching behavior. These findings further strengthen the planning and prediction roles of the thalamus in motor control. Understanding these neuronal mechanisms has sparked interest in therapeutic interventions for cerebellar disorders, such as cerebellar ataxia.

Objective: Recent studies propose transcranial electrical stimulation (tES) as a potential therapy for cerebellar ataxia. Building on previous electrophysiological findings, the current study aims to explore the impact of tES, specifically transcranial direct current stimulation (tDCS) on thalamic neuron firing rates and reaching behavior in mice. It is hypothesized that a change in thalamic neuronal activity occurs pre-tDCS and post-tDCS during the reaching behavior in mice. One of the tenets of osteopathic medicine encompasses the belief that the treatment of patients should be based on an understanding of the interrelationship of structure and function. Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant neurodegenerative disease with a global prevalence of 1 in 40,000 individuals affected. Our study explores one facet of the mechanisms behind tDCS, which has been suggested as a potential therapy for cerebellar ataxia. By investigating the electrophysiological effects of tDCS on Purkinje cell firing rate with subsequent downstream effect on the thalamus, this can be used to better understand tDCS as a beneficial therapy for individuals with cerebellar ataxia.

Methods: Protocols and procedures utilized in this research project have been approved by the IACUC of PCOM. Transgenic SCA3 and normal mice acclimated to water restriction were used for this behavior experiment. Surgery to attach a head-plate was performed on both groups using a stereotaxic apparatus. A bilateral craniotomy was carried out to expose the brain surface above the thalamus at a location of - 1.5 mm anteroposterior from bregma and 1.08 mm mediolateral. After recovery, both groups of mice were trained to perform a reaching task and then transferred to a custom 3D printed reaching pod with a headfix attachment for behavior recordings. Recording microelectrodes made of Platinum/Iridium material (FHC Inc) with tip sizes of 5 – 10 µm were lowered to the thalamic ventrolateral (VL) nucleus at a depth of 3.5 - 4.0 mm and the ventromedial (VM) nucleus at a depth of 4.0 - 4.5 mm to record neuronal activity pre tDCS and post tDCS. All electrodes were disinfected by a solution of 70% ethanol and a cold sterilant (21899-864, VWR) for 30 minutes. A modified ECG electrode, with a diameter of 2 mm was attached to the skin on the posterior aspect of the head. The current was delivered using a Stimulus isolator (WPI - A395 - 0.1 mA) for 20 minutes to mimic a standardized treatment for cerebellar ataxia in humans. Recordings were conducted on awake mice while they performed the reaching behavior. All video recordings were captured at 100 frames per second by a Baslar 1920-A camera and processed in a Pylon interface. DeepLabCut, a markerless pose estimation and tracking software, was used to analyze the actual movement. A Differential AC amplifier (Model 1700) was used in combination with pCLAMP for data acquisition of thalamic neuronal activity. Matlab software was utilized to analyze the cross-correlation between local field potential (LFP) and reaching, and the cross correlation between firing rate and reaching.

Results: Data analysis was performed using a mathematical software program, MATLAB. A quantitative analysis of reaching behavior between normal and SCA3 transgenic mice revealed significant differences in the smoothness (p = 0.0275). Thalamic electrophysiological signals were filtered between 1-10,000 Hz to reveal LFP and single unit activity in the VL/VM. Thalamic neuronal firing rate was calculated using Gaussian distribution from the single unit activity. Average firing rates of the thalamic neurons were calculated to determine the change between pre- and post-stimulation to study the direct effect on thalamic neuronal activity. Cross correlation was used to study the relationship between the modulatory effects of tDCS administration and thalamic neuronal activity change. For each analysis, a power spectrum plot was generated to display dominant thalamic neuronal activity changes recorded from the VL/VM before, and after stimulation. This data analysis is used to study the subsequent effects of tDCS on the cerebello-thalamo-cerebral pathway’s modulatory effects on motor control. There is a strong correlation between movement and thalamic neuronal activity, with correlation coefficients nearing one at the onset of movement for each recorded trial. Thalamic neuronal activity change occurred 400 ms prior to the initiation of movement. Moreover, examination of the group trials demonstrated a remarkable consistency, with a substantial overlap in the similarity of the cross-correlation patterns across all 10 trials. These findings underscore the robust association between thalamic neuronal activity and movement execution, highlighting the potential role of thalamic circuits in motor control processes.

Conclusion: Simultaneous recordings of thalamic neuronal activity and reaching behavior were successfully collected using normal and ataxic mice. Analyzing the thalamic neuronal activity and reaching behavior in real time provides valuable insight into the neural basis of behavior. By demonstrating a cross correlation between reaching and thalamic neuronal activity, this study provides further evidence for the involvement of the VL/VM thalamus in motor control processes. The utilization of DLC further enhances the understanding between neural activity and movement. By incorporating DLC, the study ensures accurate quantification of reaching behavior, strengthening the reliability and accuracy of the observed correlations. Thalamic neuronal activity changes prior to movement are indicative of the planning and prediction roles of the cerebello-thalamo-cerebral pathway. However, it’s important to acknowledge the limitations of the study, particularly concerning the use of tDCS. While tDCS is a valuable technique for modulating neural activity, its effects on motor behavior can be complex and variable. Without directly correlating tDCS-induced changes in neural activity with alterations in movement patterns, it becomes challenging to conclusively attribute observed behavioral changes solely to specific neural circuits or processes.

References

1. Mathis, A., Mamidanna, P., Cury, K. M., Abe, T., Murthy, V. N., Mathis, M. W., & Bethge, M. (2018). DeepLabCut: markerless pose estimation of user-defined body parts with deep learning. Nature Neuroscience, 21(9), 1281-1289.

2. Lu, H., Hartmann, M. J., & Bower, J. M. (2005). Correlations between purkinje cell single-unit activity and simultaneously recorded field potentials in the immediately underlying granule cell layer American Physiological Society. doi:10.1152/jn.01275.2004

3. Wagner, M. J., Savall, J., Hernandez, O., Mel, G., Inan, H., Rumyantsev, O., Lecoq, J., Kim, T. H., Li, J. Z., Ramakrishnan, C., Deisseroth, K., Luo, L., Ganguli, S., & Schnitzer, M. J. (2021). A neural circuit state change underlying skilled movements. Cell, 184(14), 3731–3747.e21. https://doi.org/10.1016/j.cell.2021.06.001

Informed Consent: ​N/A

Financial Disclosure: None reported.

Poster No. *B-6

Abstract No. 2024-021

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

The Role of Oxytocin and the Oxytocin Receptor in the Paracrine Control of Human Parturition

¹Emily McKinney, OMS-IV, ²Sam Mesiano, PhD, ²Angela DeTomaso, MPH

¹Ohio University Heritage College of Osteopathic Medicine, Athens, OH; ²Reproductive Biology Case, Western Reserve University, Cleveland, OH

Context: Oxytocin (OT) is a neuropeptide hormone implicated in many processes throughout the body, most notably within the reproductive system (1). It is also widely used clinically as a medication to induce and augment labor, as well as manage postpartum hemorrhage (2). Physiologically, the levels of the oxytocin receptor (OXTR) throughout pregnancy remain relatively low, but as the process of transitioning from uterine quiescence to the complex stages of labor commences, the importance of OT and OXTR is crucial. The OT/OXTR system has been well studied in the myometrium surrounding parturition; however, its role within the labor-associated inflammatory response at the maternal-fetal interface (MFI) has yet to be elucidated (3). We hypothesize that the OT/OXTR complex has an immunomodulatory effect on the decidual cells at parturition.

Objective: To localize expression of OXTR at the MFI, examine the effect of labor-associated inflammation on OXTR gene expression, and evaluate the role of OT on labor-associated inflammation through IL-8 gene expression.

Methods: Chorion-decidua parietalis was collected from term (37 to 40 week gestation) c-section and vaginal deliveries, categorized as clinically in labor; showing signs of forceful contraction, cervix dilation ≥ 5 cm, and/or membrane rupture, (IL, N=12) and not in labor (NIL, N=18). Tissue was not collected from women with gestational diabetes, pre-eclampsia, fetal anomalies, or positive for Group B Streptococcus. Explant culture was performed on c-section tissue with a 6-hour rest and overnight treatment with IL-1β and oxytocin (100 M) (n=3/group; N=3). Parallel experiments were carried out with an immortalized human decidual stromal cell line (iDEC). RNA was extracted, and qRT-PCR was performed to measure relative abundance of mRNA encoding OXTR and IL-8. Immunofluorescence and immunohistochemistry were used to localize OXTR at the MFI. Statistical analysis was performed using Student’s t-test with significance denoted as p.

Results: In term laboring MFI tissue, the relative abundance of mRNA encoding for OXTR in the decidua increased in association with the onset of labor p.

Conclusion: The data suggest that OXTR is located in decidual stromal cells at the MFI and is increased by inflammatory stimuli. The onset of labor is known to be associated with inflammation at the MFI, so the increase in OXTR expression with IL compared to NIL tissues is consistent. Additionally, IL-1β increased the relative abundance of mRNA encoding for OXTR in explants and iDEC cells. Interestingly, OT had a potent anti-inflammatory effect at the MFI, modeled by inhibition of IL-1β -induced IL-8 expression. The balance of the OT/OXTR complex at the fetal membranes is a fascinating area for further research to better understand the mechanism of quiescence during pregnancy right up until parturition, especially considering the clinical applications for labor induction and postpartum hemorrhage management (2).

References

1. Szeto A, Nation DA, Mendez AJ, et al. Oxytocin attenuates NADPH-dependent superoxide activity and IL-6secretion in macrophages and vascular cells. Am J Physiol - Endocrinol Metab. 2008;295(6):E1495-E1501.doi:10.1152/ajpendo.90718.2008

2. Uvnäs-Moberg K. The physiology and pharmacology of oxytocin in labor and in the peripartum period. Am JObstet Gynecol. 2024;230(3, Supplement):S740-S758. doi:10.1016/j.ajog.2023.04.011

3. Schmid B, Wong S, Mitchell BF. Transcriptional Regulation of Oxytocin Receptor by Interleukin-1β and Interleukin-6. Endocrinology. 2001;142(4):1380-1385. doi:10.1210/endo.142.4.8107

Informed Consent: Fetal membranes were collected, with patient informed consent, from the placenta within 1 h of c-section or vaginal delivery performed at University Hospitals in Cleveland (University Hospitals of Cleveland, Institutional Review Board approval 02-18-49).

Financial Disclosure: None reported.

Poster No. B-7

Abstract No. 2024-027

Category: Basic Science

Research Focus Area: Osteopathic Philosophy

Team Based Learning is an Effective Approach to Solving Clinical Case Scenarios

¹Chaya J. Prasad MD, MBA, ²Seth Politano, ³Fanglong Dong

¹Department of Clinical Sciences, Western University, Pomona, CA; ²Department of Family Medicine, Western University, Pomona, CA; ³Department of Statistics, Western University, Pomona, CA

Context: Medical school curriculum is historically a series of didactic lectures with information spoon-fed to students from the expert in the field. However in the recent years research has demonstrated that team-based learning is widely acknowledged as crucial in medical education, serving to enhance performance in assessments, facilitate retention, and application of knowledge (1). This cultivates essential professional skills like teamwork, leadership, adaptability, and conflict resolution which have broad applicability beyond medical practice. Collaborative problem-solving particularly in the context of clinical cases, enables students to develop practical skills vital for navigating the complexities of medical settings. This collaborative approach is imperative given the intricate and multifaceted nature of medical cases, demanding a think-tank method for effective resolution with the ultimate goal of providing quality patient care (2). Team based learning also provides the foundation for interprofessional interaction, a reality for practicing physicians. With the aim of revolutionizing the integration of case-based problem solving in our preclinical curriculum, we sought to compare the performance of students on case-based scenarios when assessed individually (preworkshop) versus in small groups (during the workshop), in two different campuses (3).

Methodology: An USMLE (Step 1) board-style assessment was created by the authors (CP and SP) and consisted of 20 clinical cases with a total of 40 multiple choice questions. The assessment covered relevant clinical topics and included pertinent history of presenting illness, past medical history, laboratory findings, radiologic and histopathologic images, and included between 1-3 questions that focused on generating a differential diagnosis, arriving at a final diagnosis, additional workup if pertinent, treatment and prognosis. The cases were administered to 2nd year medical students in November 2023. Students independently undertook a pre-workshop set of questions, followed by a workshop set of questions that they undertook as a group. The pre-workshop questions were part of the post-workshop question set. McNemar tests assessed the difference in response rate between pre and post questions, while independent T-test assessed responses between the two campuses.

Results: 354 students from 2 different campuses undertook the pre and workshop cases. In the overall student population, a statistically significant increase in the number of correct responses to all pre and workshop questions (all P values).

Conclusions: Though historically medical school curriculum has focused on a lecture series from experts in the field, new data demonstrates that utilizing a team-based approach to problem solving can prove to be an effective strategy for enhanced performance in case scenario board-style questions. Our study confirmed this and highlighted improved performance in students who worked as a group rather than when working individually. In addition students claimed that they had more “fun” when working in a group and a better understanding of the subtle nuances of complicated clinical case scenarios. The analysis of team-based, problem-solving cases identified a few less optimally performing clinical cases and questions which likely resulted from the complexity of the case scenarios. These will be reevaluated and recrafted for better understanding. In summary a team-based approach should be emphasized early in medical school training and can lead to better interpersonal relationships, enhanced leadership and communication skills, all critical to the development of superior clinical skills, ultimately resulting in quality patient care.

References

1. Carrasco GA, Behling KC, Lopez OJ. Evaluation of the role of incentive structure on student participation and performance in active learning strategies: A comparison of case-based and team-based learning. Med Teach. 2018;40(4):379-386. doi:10.1080/0142159X.2017.1408899

2. Carrasco GA, Behling KC, Lopez OJ. Implementation of Team-Based Learning: a Tale of Two New Medical Schools. Med Sci Educ. 2019;29(4):1201-1210. Published 2019 Oct 15. doi:10.1007/s40670-019-00815-0

3. Burgess, A., van Diggele, C., Roberts, C. et al. Team-based learning: design, facilitation and participation. BMC Med Educ 20 (Suppl 2), 461 (2020). https://doi.org/10.1186/s12909-020-02287-y

Informed Consent: As this is a retrospective data analysis of student performance in a workshop, an informed consent was not required.

Ethical Approval & IRB and/or IACUC Approval: Research project was deemed exempt.

Financial Disclosure: None reported.

Poster No. *B-8

Abstract No. 2024-029

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Dietary Lauric Acid Induces Specific Effects on Adipokine Secretory Profiles in Visceral Adipocytes from Healthy and Type II Diabetes Mellitus Patients

¹Justine Johnson, OMS-III, ²Gergana Deevska, PhD

¹Department of Research Idaho College of Osteopathic Medicine, Meridian, ID; ²Department of Biochemistry Idaho College of Osteopathic Medicine, Meridian, ID

Context: Obesity is a chronic disorder of excessive fat storage and a risk factor in the development of numerous diseases. Visceral fat accumulation (central obesity) is associated with the development of type II diabetes mellitus (T2DM) and an increased risk of metabolic disease [1]. This phenotype is related to an increased secretion of multiple inflammatory adipokines and a decreased secretion of anti-inflammatory adipokines. Leptin is a well-characterized inflammatory adipokine that is elevated in obesity, while adiponectin is an anti-inflammatory adipokine that is decreased. It has been found that after bariatric surgery, levels of leptin decrease while levels of adiponectin increase, suggesting a key role of these adipokines in obesity. Additionally, not only does adiponectin have anti-inflammatory properties, but higher circulating levels have also been associated with a lower risk of cardiovascular disease and increased insulin sensitivity [6]. Although increased dietary fat intake is considered a significant contributor to obesity-associated adipose tissue dysfunction, the impact of different fats on visceral adipose tissue differentiation, inflammation, and adipokine secretory properties remains unknown. Over the past several years, the consumption of coconut oil in addressing different health-related issues, including obesity, has been a controversial topic [2]. Coconut oil comprises several medium-chain saturated fatty acids (MCFAs), with lauric acid (LA) predominating. MCFAs differ from saturated animal fats in their metabolism as they are delivered directly to the liver, where they undergo degradation rather than being stored as triacyclglycerol in adipose tissue [3]. Thus, studies suggest various benefits for human health [4, 5]. It is still unclear whether lauric acid may directly affect adipocyte capabilities to store fat or their functional capacity to secrete adipokines.

Objective: Earlier research indicates that diets high in omega-3 polyunsaturated DHA are less likely to encourage overall inflammation and fat accumulation when compared to saturated fatty acids (such as palmitic acid (PA)). The direct effects of LA on adipose tissue at the cellular level, including adipocyte differentiation, capabilities to store fat, or their functional capacity to secrete adipokines, remain poorly understood. Thus, our study aimed to investigate these effects in vitro using visceral human adipocytes and compare them to two other FAs (DHA and PA).

Methods: Visceral pericardial preadipocytes isolated from patients with T2DM and healthy controls were purchased from Cell Applications. They were grown to sub-confluence in 12-well plates and fully differentiated to mature adipocytes (HAd) for 14 days. Mature adipocytes were treated with 1mM of each fatty acid (lauric acid, DHA, and palmitic acid) delivered as a complex with BSA (2:1, by mol) for 4 and 8 days. Leptin and adiponectin levels were measured in the conditioned media using human leptin and adiponectin ELISA kits from ThermoFisher. Fat storage was visualized by Oil-Red-O staining of treated cells. Significance was determined using t-tests.

Results: Adiponectin concentrations at 4 and 8 days in HAd isolated from healthy patients were decreased in LA-treated cells (13.32 ng/mL, 14.23 ng/mL) compared to control (14.86 ng/mL, 19.10 ng/mL) with a significant difference found at day 8

Conclusions: Our results demonstrate that lauric acid does not affect the fat storage capacity of adipocytes. In addition, lauric acid downregulates adiponectin secretion in adipocytes, with more pronounced effects on cells isolated from patients with T2DM. Lastly, lauric acid significantly downregulates leptin secretion in adipocytes from patients with T2DM and has the opposite effect in cells from healthy subjects. Our results are consistent with the anti-inflammatory effects of DHA and suggest the pro-inflammatory effects of LA on adipocyte secretory profiles. Future experiments are needed to address the precise cellular mechanisms underlying the observed effects of LA.

References

1. Patel P, Abate N. Body fat distribution and insulin resistance. Nutrients. 2013;5(6):2019-2027. Published 2013 Jun 5. doi:10.3390/nu5062019

2. Swarnamali H, Ranasinghe P, Hills AP, Jayawardena R. Coconut oil consumption and bodyweight reduction: a systematic review and meta-analysis. Minerva Endocrinol (Torino). 2023;48(1):76-87. doi:10.23736/S2724-6507.21.03654-X

3. Schönfeld P, Wojtczak L. Short- and medium-chain fatty acids in energy metabolism: the cellular perspective. J Lipid Res. 2016;57(6):943-954. doi:10.1194/jlr.R067629

4. Boateng L, Ansong R, Owusu WB, Steiner-Asiedu M. Coconut oil and palm oil’s role in nutrition, health and national development: A review. Ghana Med J. 2016;50(3):189-196.

5. Sankararaman S, Sferra TJ. Are We Going Nuts on Coconut Oil?. Curr Nutr Rep. 2018;7(3):107-115. doi:10.1007/s13668-018-0230-5

6. Landecho MF, Tuero C, Valentí V, Bilbao I, de la Higuera M, Frühbeck G. Relevance of Leptin and Other Adipokines in Obesity-Associated Cardiovascular Risk. Nutrients. 2019;11(11):2664. Published 2019 Nov 5. doi:10.3390/nu11112664

Informed Consent: NA

Ethical Approval & IRB and/or IACUC Approval: No IRB or IACUC approval was required.

Financial Disclosure: This research project was supported by a Mentored Research Grant from the Idaho College of Osteopathic Medicine awarded to Justine Johnson and a startup grant awarded to Gergana Deevska.

★Poster No. *B-9

Abstract No. 2024-037

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Persistent Ascending Aortic Vascular Calcification in DBA/2J Mice After Warfarin Exposure

Julie B. Ochs, OMS-III, Roxane Ghadami, OMS-II, Herin Ahn, Saud A. Nasruddin, Isha Joshi, Mehrin Hossain, Mugdha V. Padalkar, PhD, Olga V. Savinova, PhD

Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic, Old Westbury, NY

Context: Vascular calcification has played a prominent role in the pathophysiology of numerous clinical pathologies, including but not limited to diabetes, end-stage renal disease, cardiovascular disease, and peripheral arterial disease (1,2). Additional research is needed to understand the mechanisms driving disease progression (3). Specifically, developing a model of vascular calcification and atherosclerosis is critical to developing treatment options and improving clinical outcomes (3,4). Previous research has successfully demonstrated a mouse model of vascular calcification after exposure to warfarin, a frequently prescribed anticoagulant (5-10). Mechanistically, warfarin-induced calcification is believed to be mediated by preventing gamma-carboxylation and activation of matrix Gla protein (MGP), a calcification inhibitor (2,7,10,11). Previous research investigating MGP-deficient mice has shown the development of increased vascular calcification, specifically in the medial layers of the arterial wall (11-13). Understanding the reversal of calcification is critical to managing not only the adverse effects of long-term use of warfarin but also cardiovascular calcification in general. Therefore, this study aims to examine if discontinuation of warfarin will lead to calcification regression and changes in cardiac function.

Objectives: To quantify warfarin-induced calcification in the setting of atherosclerosis using micro-computed tomography (microCT). The second objective was to investigate the changes in cardiac structure and function in response to warfarin-induced calcification by echocardiography.

Methods: This project used DBA/2J mice strains heterozygous for the LDL receptor knockout obtained from The Jackson Laboratory (Strain #:007068). Mice were intercrossed and genotyped to identify homozygous, heterozygous, and wild-type mice. 46 mice at 8 weeks of age were randomly assigned to four groups (12 animals per group, 50% males). One group was fed a western diet (WD) with 1.5% Vitamin K1, and the second group was fed a western diet and 3.0 mg/g warfarin with a 1.5% Vitamin K1 supplemented diet for 20 weeks (14). After 20 weeks of treatment, animals were placed on a 10-week post-treatment diet (WD without supplementation). Cages, consisting of four mice, were maintained in a 12-hour light and dark cycle throughout the experiment at the New York Institute of Technology College of Osteopathic Medicine animal facility. Procedures and practices were approved and performed according to IACUC regulatory standards. IACUC protocol #2022-OS-01. MicroCT was used to quantify and compare amounts of vascular calcification in ascending aortas. Blood chemistry triglyceride and total cholesterol levels will be analyzed to quantify dyslipidemia (15). Echocardiogram imaging has been utilized with long-axis B-mode, short-axis B-mode, M-mode, and Doppler using Vevo 3100 ultrasound system.

Statistics: Echocardiogram parameters assessed included body weight (BW; g), heart rate (HR; bpm), fractional shortening (FS; %), ejection fraction (EF; %); left ventricular internal diameter (LVIDd; mm), left ventricular posterior wall diameter (LVPWd; mm), stroke volume (SV; mL), cardiac output (CO; mL/min), left-ventricular mass (LVmass; mg) were adjusted for body weight. In addition, ascending aorta peak velocity has been utilized to identify increased aortic valve/ascending aorta stiffness or stenosis. 37 homozygous and heterozygous mice were analyzed using a correlation matrix. Variables included sex, genotype, treatment, body weight (BW), heart rate (HR), ejection fraction (EF), ascending aorta peak velocity, and ascending aorta calcification. Cardiac output (CO) and left ventricular mass (LVmass) were adjusted for body weight before the analysis. Multiple linear regression models were performed based on significant parameters identified in the univariate correlation matrix. Significance was determined at a p-value

Results: Ascending aorta calcification was significantly correlated with LVmass/BW (r-value = 0.404, p-value = 0.015), ascending aorta peak velocity was associated with sex (r = 0.347, p = 0.048), ejection fraction correlated with cardiac output (r = 0.539, p = 0.0001). The genotype did not correlate with the ascending aortic calcification volume (r = -0.001, p = 0.998). LVmass/BW was not associated with ascending aorta peak velocity (r = 0.082, p = 0.650). Multiple linear regression analysis demonstrated that aortic calcification was associated with warfarin treatment (β coefficient = 0.1532, [95% CI 0.1210, 0.1854], p-value

Conclusion: Withdrawal of warfarin treatment for 10 weeks resulted in continued ascending aorta calcification. Furthermore, there was a positive correlation between LVmass/BW and ascending aortic calcification volume. There was also a positive relationship between the prior warfarin treatment and LVmass/BW. However, there was no significant difference in calcification between heterozygous and homozygous genotypes. Cardiac output was not affected by ascending aortic calcification volume. In addition, ejection fraction as a functional parameter was not affected by calcification. In conjunction with the lack of correlation in the aortic peak velocity and LVmass/BW, these results suggest that additional physiological compensatory mechanisms are involved. Further research can investigate potential physiological responses such as aortic root dilatation. Additionally, future studies can investigate the role of calcification and the progression of atherosclerotic plaque formation.

References

1. Yahagi K, Kolodgie FD, Lutter C, et al. Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus. Arteriosclerosis, Thrombosis, and Vascular Biology. 2017;37(2):191-204. doi:https://doi.org/10.1161/atvbaha.116.306256

2. Sutton NR, Malhotra R, Cynthia St Hilaire, et al. Molecular Mechanisms of Vascular Health: Insights From Vascular Aging and Calcification. Arteriosclerosis, Thrombosis, and Vascular Biology. 2023;43(1):15-29. doi:https://doi.org/10.1161/atvbaha.122.317332

3. Florea A, Sigl JP, Morgenroth A, et al. Sodium [18F]Fluoride PET Can Efficiently Monitor In Vivo Atherosclerotic Plaque Calcification Progression and Treatment. Cells. 2021;10(2):275-275. doi:https://doi.org/10.3390/cells10020275

4. Herrmann J, Manasa Reddy Gummi, Xia M, Markus, Tölle M, Schuchardt M. Vascular Calcification in Rodent Models—Keeping Track with an Extented Method Assortment. Biology. 2021;10(6):459-459. doi:https://doi.org/10.3390/biology10060459

5. Zhu M, Ji G, Jin G, Yuan Z. Different responsiveness to a high-fat/cholesterol diet in two inbred mice and underlying genetic factors: a whole genome microarray analysis. Nutrition & metabolism. 2009;6(1). doi:https://doi.org/10.1186/1743-7075-6-43

6. Zhao W, Zhao T, Chen Y, et al. A Murine Hypertrophic Cardiomyopathy Model: The DBA/2J Strain. Frangogiannis N, ed. PLOS ONE. 2015;10(8):e0133132. doi:https://doi.org/10.1371/journal.pone.0133132

7. Krüger T, Oelenberg S, Kaesler N, et al. Warfarin Induces Cardiovascular Damage in Mice. Arteriosclerosis, Thrombosis, and Vascular Biology. 2013;33(11):2618-2624. doi:https://doi.org/10.1161/atvbaha.113.302244

8. Poterucha TJ, Goldhaber SZ. Warfarin and Vascular Calcification. The American Journal of Medicine. 2016;129(6):635.e1-635.e4. doi:https://doi.org/10.1016/j.amjmed.2015.11.032

9. Mac-Way F, Poulin A, Utescu MS, et al. The impact of warfarin on the rate of progression of aortic stiffness in hemodialysis patients: a longitudinal study. Nephrology Dialysis Transplantation. 2014;29(11):2113-2120. doi:https://doi.org/10.1093/ndt/gfu224

10. Elango K, Javaid A, Khetarpal BK, et al. The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review. Cells. 2021;10(4):773. doi:https://doi.org/10.3390/cells10040773

11. Abedin M, Tintut Y, Demer LL. Vascular Calcification. Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24(7):1161-1170. doi:https://doi.org/10.1161/01.atv.0000133194.94939.42

12. Kida Y, Yamaguchi I. The vascular protective effect of matrix Gla protein during kidney injury. Frontiers in molecular medicine. 2022;2. doi:https://doi.org/10.3389/fmmed.2022.970744

13. Luo G, Ducy P, McKee MD, et al. Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature. 1997;386(6620):78-81. doi:https://doi.org/10.1038/386078a0

14. Van G, Sofie De Moudt, Van A, et al. Endothelial Contribution to Warfarin-Induced Arterial Media Calcification in Mice. International journal of molecular sciences. 2021;22(21):11615-11615. doi:https://doi.org/10.3390/ijms222111615

15. Kaur J, Carpo B, Kosciuszek ND, Singh M, Savinova OV. Abstract P161: Novel Micro-CT Method To Assess Atherosclerotic Calcification In Mice. Arteriosclerosis, thrombosis, and vascular biology. 2021;41(Suppl_1). doi:https://doi.org/10.1161/atvb.41.suppl_1.p161

Informed Consent: ​Not applicable.

Ethical Approval & IRB and/or IACUC Approval: IACUC_approval letter_2022-OS-01.pdf ; ​IACUC approval was ​obtained. IACUC protocol #2022-OS-01.

Financial Disclosure: None reported.

Poster No. *B-10

Abstract No. 2024-038

Category: Basic Science

Research Focus Area: Osteopathic Philosophy

Trends and Outcomes in Residency Matches: Assessing the Post-Merger Landscape for DO and MD Graduates

Haley Jerman OMS-II, Katelyn E. Yebernetsky, Shaun-Marie T. Wilson, Sarah Rosmarin, Christopher B. Divito

Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA

Context: The merger between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) aimed to create a single accreditation system for graduate medical education programs in the United States. This transition, finalized in 2020, was intended to streamline the residency match process, enhance the quality of training, and provide equitable opportunities for both osteopathic (DO) and allopathic (MD) medical graduates.1 However, the impact of this merger on the residency match rates of osteopathic graduates, particularly in competitive specialties, remains a subject of ongoing investigation.2

Objective: To examine trends in residency placements, we analyzed pre- and post-merger match rates for Dermatology, Neurological Surgery, Orthopedic Surgery, Plastic Surgery, Radiology, and Anesthesiology.

Methods: Data was compiled from the National Resident Matching Program (NRMP) from 2014-2024 and the National Matching Service (NMS) for 2014-2019. Additionally, yearly totals of osteopathic and allopathic graduates from the American Association of Colleges of Osteopathic Medicine (AACOM) and the Association of American Medical Colleges (AAMC) were collected. All data was analyzed using Prism v10.

Results: Correlation analyses of the number of DO and MD filled competitive residency positions for Dermatology, Neurosurgery, Orthopedic surgery, and plastic surgery was performed. With the exception of Orthopedic surgery (Regression: y = 0.005x + 3.432; r2 = 0.001194; CI95slope = -0.1078 to 0.1182; Spearman’s: r = -0.0091, CI95: -0.6185 to 0.6071, n = 11 pairs, p = 0.9895), the percentage of DOs filling traditionally competitive residency positions was negatively correlated over the last seven years (Dermatology: Regression: y = -0.225x + 464.0; r2 = 0.254; CI95slope = -0.515 to 0.066; Spearman’s: r = -0.618, CI95: -0.890 to -0.029, n = 11 pairs, p = 0.0426; Neurosurgery: Regression: y = -0.6345x + 1286; r2 = 0.813; CI95slope = -0.864 to -0.405; Spearman’s: r = -0.882, CI95: -0.970 to -0.585, n = 11 pairs, p = 0.0007; Plastic Surgery: Regression: y = -1.511x + 3056; r2 = 0.8228; CI95slope = -2.039 to -0.9820; Spearman’s: r = -0.8636, CI95: -0.9655 to -0.5328, n = 11 pairs, p = 0.0012). Moreover, when the positions filled were binned pre- and post-ACMGE merger, there were significantly fewer DO positions filled post-merger for each specialty, except orthopedic surgery which did not demonstrate a change in positions filled across years. Conversely, traditionally less competitive residencies Anesthesiology and Diagnostic Radiology both reported a positive correlation with time (Anesthesiology: Regression: y = 0.4470x – 888.6; r2 = 0.5890; CI95slope = 0.1654 to 0.7286; Spearman’s: r = 0.7455, CI95slope = 0.2442 – 0.9234, n = 11 pairs, p = 0.0112; Radiology: Regression: y = 0.4881x – 968.4; r2 = 0.3852; CI95slope = 0.02311 to 0.9531; Spearman’s: 0.600, CI95: -0.2029 to 0.8868, n = 11 pairs, p = 0.0562) and either a statistically significant increase in DO-filled positions (Anesthesiology: U = 2, p = 0.0173) or a positive trend (Radiology: U = 7, p = 0.1775). Although a positive correlation was also observed with MD-filled positions, no significant increase pre- versus post-merger was observed (Anesthesiology: U = 13, p = 0.7922; Radiology: U = 7, p = 0.1775).

Conclusion: The ACGME merger generated variable impact on osteopathic representation in competitive specialties. These analyses demonstrate that while the number of osteopathic graduates has increased, their representation in competitive residencies, such as dermatology, neurosurgery, and plastic surgery, has declined post-merger. Conversely, there was a significant increase in DO match rates to less competitive residency programs. Our study highlights the ongoing imparity between match rates for DO and MD graduates.

References

1. History of the Transition to a Single GME Accreditation System. Accessed 06/12/2024. https://www.acgme.org/about/transition-to-a-single-gme-accreditation-system-history/.

2. Craig E, Brotzman E, Farthing B, Giesey R, Lloyd J. Poor match rates of osteopathic applicants into ACGME dermatology and other competitive specialties. J Osteopath Med. Mar 1 2021;121(3):281-286. doi:10.1515/jom-2020-0202

Informed Consent: Not Relevant.

Ethical Approval & IRB and/or IACUC Approval: IRB approval.pdf ; Deemed exempt from review by the Lake Erie College of Osteopathic Pathic (LECOM) Institutional Review Bord (IRB) under protocol number 31-129

Financial Disclosure: None reported.

Poster No. B-12

Abstract No. 2024-046

Category: Basic Science

Research Focus Area: Osteopathic Philosophy

Assessing the Potential Role for Using Artificial Intelligence (AI) in Osteopathic Medical Students Teaching and Learning

¹Neal Patel, OMS-I, ²Patrick Martin, ²Imaan Benmerzouga

¹Nova Southeastern University Kiran C Patel College of Osteopathic Medicine - Clearwater, FL; ²Department of Foundational Sciences, Nova Southeastern University Kiran C Patel College of Osteopathic Medicine – Clearwater, Clearwater, FL

Context: Artificial intelligence (AI) has demonstrated many positive attributes in medical education. ChatGPT (Chat Generative Pre-Trained Transformer) is a recently developed large language-based AI that can be used in a variety of settings. Using ChatGPT to support student learning in medical school is an attractive area for AI. Recently, ChatGPT was shown to have a passing performance in the United States Medical Licensing Exam (USMLE)-Step1, Step2 Clinical Knowledge (CK) and Step 31. In addition, it was also shown to pass a medical physiology exam containing essays, short answers, and multiple-choice questions given to medical students 2. Recently, results from a cross-sectional study demonstrate that approximately 20% of students used AI during their premedical training, but the majority of them are planning to use AI during residency 3. While ChatGPT has demonstrated some limitations with sketching and images 4 it was shown to outperform first- and second-year medical students on free-response clinical reasoning questions 5. There are currently no studies conducted on the accuracy of ChatGPT in taking College of Osteopathic Medicine License Examination level 1 (COMLEX-L1) questions or its accuracy in responding to the practice questions available on Access Medicine, a resource used by medical students.

Objective: The purpose of this study was to determine the accuracy of ChatGPT in providing correct responses to the College of Osteopathic Medicine License Examination Level 1 (COMLEX-L1) and to assess the performance of ChatGPT in medical physiology practice questions available on Access Medicine.

Methods: A total of 113 questions that are of multiple-choice format were obtained from the practice examination available on the National Board of Osteopathic Medical Examiners (NBOME) website, Ganong’s Review of Medical Physiology, 26e, and Case Files: Physiology 2e. All questions that involved an image were excluded from the results and analysis. An excel sheet was developed to facilitate data extraction. COMLEX-L1 questions were categorized based on disciplines while questions from both physiology textbooks were categorized based on section breakdowns provided by the textbook. ChatGPT 3.5 was used with the following commands “I will be asking you a series of multiple-choice questions. Please respond with the correct answer choice as well as a brief description of why it is the correct answer.” Data was collected based on ChatGPT responses and categorized based on whether it was correct or incorrect. A percentage of correct responses was then enumerated using excel. COMLEX-L1 contains integrated questions with osteopathic principles and practice. In addition, having correct explanations for a foundational discipline such as medical physiology will assist students in preparing for their licensure examinations. The findings from this study will assist osteopathic medical educators in determining the effectiveness of AI in helping students prepare for COMLEX examinations and in identifying strategies to utilize AI to augment the learning of the osteopathic philosophy.

Results: ChatGPT was able to correctly respond to the 14/25 (56%) questions available for COMLEX-L1 in the NBOME website. Additionally, ChatGPT was able to correctly respond to the following: 56/68 (82.35%) questions from Ganong’s Review of Medical Physiology, 26e and 10/17 questions from Case Files: Physiology 2e (58.82%). Finally, within the Osteopathic Principles and Practice (OPP) discipline from COMLEX-L1 questions, ChatGPT correctly answered 1/3 of the questions (33.33%). ChatGPT accurately answered 66/85 practice questions from both physiology textbooks combined (77.65%).

Conclusions: Our study yields significant results from the COMLEX-L1 practice exam regarding ChatGPT’s ability to answer COMLEX-style multiple-choice questions accurately. Although COMLEX-L1 scoring guidelines are unavailable, it can be inferred based on the results that ChatGPT failed to achieve a passing score. Additionally, ChatGPT failed to correctly answer most of the OPP discipline questions that were screened. This finding suggests that ChatGPT lacks the necessary commands to be used as a study aid for COMLEX-style questions. However, ChatGPT could be useful in providing correct answers with detailed explanations from physiology textbooks as shown by achieving an accuracy greater than 60% combined. Future work will aim at assessing the usefulness of ChatGPT in taking COMLEX-L1 style questions in board preparation material, identifying commands that will assist ChatGPT in answering COMLEX-style exam question and finally, identifying the optimal commands to increase ChatGPT accuracy in answering practice questions available in access medicine.

References

1. Kung TH, Cheatham M, Medenilla A, et al. Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models. PLOS Digit Health. Feb 2023;2(2):e0000198. doi:10.1371/journal.pdig.0000198

2. Subramani M, Jaleel I, Krishna Mohan S. Evaluating the performance of ChatGPT in medical physiology university examination of phase I MBBS. Adv Physiol Educ. Jun 1 2023;47(2):270-271. doi:10.1152/advan.00036.2023

3. Alkhaaldi SMI, Kassab CH, Dimassi Z, et al. Medical Student Experiences and Perceptions of ChatGPT and Artificial Intelligence: Cross-Sectional Study. JMIR Med Educ. Dec 22 2023;9:e51302. doi:10.2196/51302

4. Koga S, Du W. ChatGPT’s limited accuracy in generating anatomical images for medical education. Skeletal Radiol. Mar 20 2024;doi:10.1007/s00256-024-04655-x

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: Not applicable

Financial Disclosure: None reported.

Poster No. *B-13

Abstract No. 2024-058

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

LAMPing Up Urogenital Diagnostics: A Multiplex Assay for Simultaneous M. genitalium and GBS Detection

¹Love Opoku Afrifa BS, OMS-IV, ²Debra E. Bramblett, PhD

¹Distinction in Research, Burrell College of Osteopathic Medicine, Las Cruces, NM; ²Department of Biomedical Sciences, Burrell College of Osteopathic Medicine Las Cruces, NM

Context: Mycoplasma genitalium (M. genitalium) and Group B Streptococcus (GBS, Streptococcus agalactiae, S. agalactiae) are urogenital pathogens with distinct transmission modes. M. genitalium is a well-established sexually transmitted infection (STI) implicated in 25-35% of non-gonococcal urethritis (NGU) cases in males and associated with premature rupture of membranes (PROM) in females [1]. GBS, while not a classic STI, can be vertically transmitted during childbirth or horizontally through sexual contact from colonized vaginal or rectal reservoirs [2]. Both pathogens can be asymptomatic in healthy adults but pose significant risks to neonates and immunocompromised individuals. M. genitalium diagnosis can be particularly challenging due to its difficulty to culture, highlighting the need for reliable alternative methods [3]. Co-testing for Mycoplasma genitalium and Group B Streptococcus (GBS) using a single vaginal swab offers significant advantages in patient care. It improves patient convenience, reduces healthcare costs, and establishes a more comprehensive baseline for colonization status, which can fluctuate over time. Conventional diagnostic methods often rely on polymerase chain reaction (PCR), a technique requiring precise temperature cycling for amplification before point-of-care testing (POC). Loop-mediated isothermal amplification (LAMP) presents a compelling alternative to PCR for M. genitalium and GBS co-testing in POC settings. Loop-mediated isothermal amplification) offers rapid target amplification at a constant temperature using 4-8 primers. Assays can be designed for visual detection via LFA (lateral flow assay) for lower costs, improved accessibility, and faster turnaround times in resource-limited settings. LFA is preferred due to its enhanced specificity and direct amplicon detection. LFA not only offers improved target discrimination compared to colorimetric detection and can be designed for multiplex pathogen detection through the incorporation of different molecular conjugations (Digoxigenin, Biotin, and FAM) on primers specific to each target organism. This study aimed to develop novel LAMP primers specifically designed for the co-detection of M. genitalium and GBS using LAMP and LFA.

Objective: To create a novel LAMP assay primer set including loop primers for the detection of Mycoplasma genitalium and Group B Streptococcus for clinical point of care testing using LAMP-LFA.

Methods: This study aimed to develop and optimize a multiplex LAMP assay for the co-detection of Mycoplasma genitalium and Group B Streptococcus. Specific LAMP primer sets were designed targeting the pdhD gene of M. genitalium strain G37 (GenBank accession L43967.2) and the SIP gene of S. agalactiae strain A909 (KX363665.1) [4]. Primer design software from New England Biolabs (NEB) was utilized to generate LF/LB loop primers for each pathogen, prioritizing high specificity and sensitivity [5,6]. Selection of the optimal primer set was guided by evaluation of ΔG values. Specificity of all designed primers was further validated using BLAST searches against publicly available nucleotide sequences [7]. LAMP reactions were established following the manufacturer’s protocol (NEB). Initial detection employed a colorimetric readout with incubation at 65°C for 30 minutes in an MJ Research PTC-200 Thermal Cycler. Subsequently, the protocol was adapted for lateral flow assay (LFA) visualization of both M. genitalium and GBS. Optimization for LFA involved temperature titration to identify the reaction temperature yielding the most robust amplification and detection of both targets. LFA strips were employed to assess band detection at various temperatures ranging from 65°C to 75°C. Genomic copies were calculated based on the M. genitalium genome size (580,076 base pairs) and the S. agalactiae genome size (2,127,839 base pairs).

Results: Our novel LAMP primers enabled specific and sensitive detection of both Mycoplasma genitalium and Group B Streptococcus. Amplification products were visualized using both colorimetric detection and lateral flow assays (LFAs) in multiplex reactions. Negative controls lacking target or containing mismatched DNA exhibited no amplification. LFA detection of M. genitalium and GBS further corroborated its suitability for point-of-care (POC) applications. Multiplex LAMP reactions successfully amplified and detected both targets even at 1:100 and 1:100,000 dilutions, demonstrating assay robustness. The pdhD color LAMP assay achieved a limit of detection (LOD) of 15.97 genomic copies (1x10^-2 pg/μL) of M. genitalium within 30 minutes and a LOD for S. agalactiae of 427 genomic copies (1x10^-1 pg/μL) We further optimized the multiplex LAMP reaction by identifying the optimal isothermal amplification temperature. Our results indicated that 66.7°C yielded the most robust amplification for both bacteria targets, highlighting the advantage of LAMP’s isothermal nature for resource-limited settings.

Conclusion: This work successfully developed and optimized a multiplex loop-mediated isothermal amplification assay for the co-detection of Mycoplasma genitalium and Group B Streptococcus. The assay employs novel, highly specific LAMP primers targeting the conserved pdhD gene of M. genitalium strain G37 and the SIP gene of S. agalactiae strain A909 [2,3]. Notably, the selection of the SIP gene offers a significant advantage due to its high degree of conservation across all GBS serotypes, minimizing the potential for false negatives arising from mutations [2]. Compared to traditional culture methods, our multiplex LAMP assay demonstrated excellent sensitivity, achieving a limit of detection (LOD) of 15.97 genomic copies (1x10^-2 pg/μL) for the pdhD color LAMP assay and a significantly lower LOD of 1.6 genomic copies (1x10^-7 ng/μL) for the fluorescent LAMP assay. Furthermore, the isothermal nature of LAMP eliminates the need for thermocycling equipment, allowing for rapid amplification within 30 minutes at a constant temperature (66.7°C). This feature, combined with the visual detection via LFA, makes the assay highly suitable for point-of-care (POC) settings. LAMP offers advantages like speed and isothermal amplification, but limitations exist. Compared to PCR’s two primers, LAMP’s 4-8 primer set can complicate design. However, freely available design tools mitigate this. Additionally, LAMP produces complex amplicon mixtures compared to PCR’s single amplicon, hindering downstream applications requiring specific sequences. This precludes gel electrophoresis but may contribute to LAMP’s higher sensitivity. Finally, the high amplicon abundance necessitates meticulous handling to minimize contamination risk and ensure assay accuracy. [8]. This multiplex LAMP assay has the potential to serve as a foundational protocol for comprehensive baseline screening of multiple bacterial pathogens at the initial stages of a patient’s medical journey. By enabling the simultaneous detection of M. genitalium and GBS, the assay could offer valuable insights into a patient’s urogenital health. Longitudinal studies utilizing this assay could track dynamic changes in resident bacteria over time, potentially informing personalized treatment strategies and preventative measures. However, it is crucial to acknowledge that further evaluation using well-defined clinical samples is necessary to definitively establish the assay’s efficacy as a diagnostic tool in real-world settings.

References

1. Ma C, Du J, Dou Y, et al. The Associations of Genital Mycoplasmas with Female Infertility and Adverse Pregnancy Outcomes: a Systematic Review and Meta-analysis. Reprod Sci. 2021;28(11):3013-3031. doi: 10.1007/s43032-020-00399-w

2. Escobar DF, Diaz-Dinamarca DA, Hernández CF, Soto DA, Manzo RA, Alarcón PI, Pinto CH, Bastias DN, Oberg-Bravo CN, Rojas R, Illanes SE, Kalergis AM, Vasquez AE. Development and analytical validation of real-time PCR for the detection of Streptococcus agalactiae in pregnant women. BMC Pregnancy Childbirth. 2020 Jun 9;20(1):352. doi: 10.1186/s12884-020-03038-z. PMID: 32517670; PMCID: PMC7285471.

3. Edwards T, Burke P, Smalley HB, et al. Loop-mediated isothermal amplification (LAMP) for the rapid detection of Mycoplasma genitalium. Diagn Microbiol Infect Dis. 2015;83(1):13-17. doi: 10.1016/j.diagmicrobio.2015.05.010

4. Benson DA, Cavanaugh M, Clark K, et al. GenBank. Nucleic Acids Res. 2013;41(Database issue):D36-42. doi: 10.1093/nar/gks1195

5. Sievers F, Wilm A, Dineen D, et al. Fast, scalable generation of high-quality protein multiple sequence alignments using Clustal Omega. Mol Syst Biol. 2011;7:539. doi: 10.1038/msb.2011.75

6. NEB LAMP Primer Design v1.3.0. Updated June 3, 2022. Accessed May 18, 2022. https://lamp.neb.com/#!/.

7. Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ. Basic local alignment search tool. J Mol Biol. 1990;215(3):403-410. doi: 10.1016/s0022-2836(0580360-2)

8. Dhama K, Karthik K, Chakraborty S, et al. Loop-mediated isothermal amplification of DNA (LAMP): a new diagnostic tool lights the world of diagnosis of animal and human pathogens: a review. Pak J Biol Sci. 2014;17(2):151-166. doi: 10.3923/pjbs.2014.151.166

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None Reported.

Poster No. *B-14

Abstract No. 2024-076

Category: Basic Science

Research Focus Area: Health Disparities-Social Determinants of Health

Effectiveness of Prematriculation Programs for Student Success in Medical School

¹Amye Frontz, OMS-III, ²Leah Sheridan, PhD, ³Kelly Davidson, ⁴Caroline Gundler, PhD

¹Department of Biomedical SciencesOhio University Heritage College of Osteopathic Medicine, Cleveland, OH; ²Department of Integrative Medical Sciences, Northeast Ohio Medical University Rootstown, OH; ³Office of Inclusion, Ohio University Heritage College of Osteopathic Medicine Athens, OH; ⁴Department of Biomedical Sciences Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH

Context: Prematriculation (Pre-Matric) programs for medical schools seek to provide an accelerated experience for select incoming students to preview the medical school and its curricular program. However, there are a lack of studies examining the effect of these programs on student success in their first year of medical school, particularly at an osteopathic medical school (1-2). At the Ohio University Heritage College of Osteopathic Medicine (OUHCOM), the Pre-Matric program is a 4-week summer program reflecting a simulated medical school curriculum that involves a flipped classroom, content exams, and an active learning environment.

Objective: This study seeks to answer the following research question: Does a Pre-Matriculation program impact osteopathic medical students’ self-efficacy, study habits, and exam performance in their first year of medical school?

Methods: An anonymous, voluntary Qualtrics survey was sent to 16 students who completed the Pre-Matric program during the summer of 2023. The survey was administered twice: at the conclusion of their first and second semesters of medical school. The survey included 5-point Likert scale questions and 5 open-ended questions about assessment preparedness, study habits, and self-efficacy. The overall osteopathic importance of examining the effectiveness of the Pre-Matric program is to highlight areas for further research and development to optimize student outcomes and enhance the overall quality of osteopathic training. Preliminary data were analyzed by descriptive statistics, paired t-tests, and thematic analysis.

Results: A total of 15 responses out of 32 (46.9%) were collected between both semesters. Five students strongly agreed that Pre-Matric prepared them to take content exams, and 8 students agreed the program prepared them for an active learning environment. Six students agreed that the program helped them develop a study schedule and 7 students agreed that it enhanced their confidence. Four themes emerged from thematic analysis about study habits: adapting study habits; challenges with time management; early exposure to academic environment; and value of learning from mistakes. During the first year of medical school, the exam scores between Pre-Matric students and non-Pre-Matric students was statistically significant (t(5) = -12.94, p.

Conclusions: This study found that the Pre-Matric program appears to provide significant benefits to participants in terms of preparedness for active learning environments and specific medical school components such as anatomy lab and osteopathic manipulative medicine (OMM) lab. Students reported enhanced study habits and increased confidence, which could suggest that the program aids in the development of critical skills for the first year of medical school. Despite these self-reported benefits, preliminary academic performance data demonstrated that Pre-Matric students scored significantly lower than students who did not go through the Pre-Matric program. Findings from this study highlight the value of Pre-Matric program in fostering self-efficacy and the development of effective study strategies, even though they did not translate to exam scores. Future research could investigate these students’ long-term outcomes and identify elements that directly influence student exam performance.

References

1. Schneid SD, Apperson A, Laiken N, Mandel J, Kelly CJ, Brandl K. A summer prematriculation program to help students succeed in medical school. Adv Health Sci Educ. 2018;23(3):499-511. doi:10.1007/s10459-017-9808-8

2. Fagalde MC, Byram JN, Neal CM, Haywood AM, Deane AS, McNulty MA. An Integrated Anatomy Pre-Matriculation Program for At-Risk Medical Students. FASEB J. 2022;36(S1). doi:10.1096/fasebj.2022.36.S1.R4833

Informed Consent: An anonymous and voluntary survey was administered to all participants via Qualtrics survey through email. If students choose to participate, students can get a link to the survey with a consent form on the front page of the survey, in the Qualtrics form. If they had any questions, they could send them via email. If they consented to the survey, they proceeded with the survey. If they did not, the survey would end. The researchers obtained consent without signature in order to protect the privacy of the participants.

Ethical Approval & IRB and/or IACUC Approval: The Ohio University Institutional Review Board (IRB) reviewed the study and deemed it as “exempt.” This research was deemed exempt under the category that it only includes interactions involving educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures, or observation of public behavior (including visual or auditory recording). It also involved research that had information obtained in such a manner that the identity of the human subjects cannot readily be ascertained, directly or through identifiers linked to the subjects.

Financial Disclosure: None reported.

Poster No. *B-15

Abstract No. 2024-081

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Effect of LRRK2 Gene Mutation on the Neuromuscular Synapse and Muscle Fiber in Parkinson’s Disease

¹Patrick Keefe, OMS-II, ²Isabel Martinez-Pena y Valenzuela

¹Midwestern University/Chicago College of Osteopathic Medicine, Downers Grove, IL; ²College of Graduate Studies, Department of Physiology Midwestern University/Chicago College of Osteopathic Medicine, Downers Grove, IL

Context: Parkinson’s Disease (PD) stems from a loss of dopaminergic neurons within the Basal Ganglia. This loss induces symptoms of bradykinesia, “frozen” facial expression, propulsive/festinating gait, “pill-rolling” tremor, and others. While a central neurodegenerative disease, this characterization may limit consideration of possible peripheral disease manifestations. Because PD is foremost a movement disease, the neuromuscular junction (NMJ), the peripheral synaptic connection between muscular and nervous systems, represents a site worthy of study. In other movement disorders, degradation of Nicotinic Acetylcholine Receptor (nAChR) is well established and contributes to the progression of their pathology. Furthermore, changes in the nAChRs distribution and density in the NMJs are associated with diminished motor function [1,2,3]. Here, we assess the structural integrity and stability of the synapses from transgenic mouse models of PD well before the onset of the disease by analyzing the neuromuscular synapse and the muscle fibers within a wide-spread distribution of the animals’ musculature. We focused our attentions on musculature related to respiration and deglutition, as well as the lower limb, for their clinical importance in this disease. The lower limb musculature plays an important role in the stability of proprioception and gait. The proper functioning of the muscles of respiration and airway patency being important for halting aspiration and pneumonia. It is known that those with PD have a greater incidence of mortality due to aspiration pneumonia. Meta-analysis cites pneumonia as the cause of death in upwards of 70% of this population [19]. In addition, we correlate the progression of synaptic disassembly to motor behavior performance. Other work has assessed the morphology of the skeletal muscles or peripheral nerves themselves to varying results [4,5,6], but lacking the focus on the NMJ’s nAChR density and dynamics as in our methods. Our work in the PD mouse model appears to be novel in its scope and assessment with past work of this nature only being performed in fruit fly models [7,8]. We hypothesize that changes in the NMJ, and specifically, alterations in the stability of nAChRs at the synapse, may occur during, or even precede, disease manifestation. This work aligns with the osteopathic tradition which also considers the implication of disease through a more holistic lens. Osteopathic Medicine is frequently employed for the management of movement disorders, especially in areas such as balance, gait, and neuromuscular reprogramming or patterning. Yet, previously published works related to the use of Osteopathic Manipulative Medicine in neurodegenerative diseases are inconsistent in treatment outcomes [15,16,17,18]. As we know, structure and function are intimately connected for the osteopathic physician. Here, were articulate the disassembly of the NMJ that may contribute to areas of disease most likely to be targeted by osteopathic treatment.

Methods: We use 3, 6, and 9 months old LRRK2 (leucine-rich repeat kinase 2) transgenic mice (C57BL/6-Lrrk2tm4.1Arte, Taconic Biosciences) and age-matched C57BL/6J mice (The Jackson Laboratory). To evaluate motor behavior, we conducted motor coordination and function tests like grip strength, cylinder tests, and gait analysis [9,10,11,12]. Mice were euthanized, and the sternomastoid, external intercostals, genioglossus, diaphragm, tibialis anterior, extensor digitorum longus, and soleus muscles were extracted and fixed in 4% PFA. Muscles were further dissected and labeled with Alexa594 alpha-bungarotoxin (a-BTX) to label postsynaptic nAChR and imaged under the epifluorescent microscope to assess receptor density using the analysis program ImageJ. All statistical analysis was performed in Prism software. To study nAChR dynamics, we labeled mice sternomastoid muscles with Alexa594 a-BTX in vivo and imaged their synapses over time. In addition, we labeled the axon terminal and Schwann cells with primary antibodies SV2, 2H3, and SC100 to analyze the presynaptic component of NMJs. Myonuclei number and distribution were assessed using a confocal microscope. Muscle fiber morphology, nuclei positioning, grouping, and area were evaluated using H&E.

Results: LRRK2 transgenic mice exhibited a significant decline in motor performance compared to control. At the age of 6 months mean hindlimb stride length had reduced by 0.62 cm (p=0.026), mean hindlimb stride width had increased by 0.059 cm (p=0.0074), mean weight-normalized grip strength had decreased.

Conclusions: A pattern of changes in the NMJ exists well before the age of phenotypic presentation in mice. The observed early NMJ fragmentation and disassembly in Parkinson’s Disease may represent a peripheral manifestation that is relevant to how this disease’s treatment is approached in the clinical setting. Especially for Osteopathic physicians with specialized training in the muscular system and those who focus on a more holistic approach to the treatment of disease.

References

1. Deschenes MR, Flannery R, Hawbaker A, Patek L, Mifsud M. Adaptive Remodeling of the Neuromuscular Junction with Aging. Cells. 2022 Mar 29;11(7):1150. doi: 10.3390/cells11071150

2. Wood SJ, Slater CR. Safety factor at the neuromuscular junction. (2001) Prog Neurobiol. 64(4):393-429

3. Liu W, Klose A, Forman S, et al. Loss of adult skeletal muscle stem cells drives age-related neuromuscular junction degeneration. Elife. 2017;6:e26464. Published 2017 Jun 6. doi:10.7554/eLife.26464

4. Glass TJ, Kelm-Nelson CA, Szot JC, Lake JM, Connor NP, Ciucci MR. Functional characterization of extrinsic tongue muscles in the Pink1-/- rat model of Parkinson disease. PLoS One. 2020;15(10):e0240366. Published 2020 Oct 16. doi:10.1371/journal.pone.0240366

5. Yang Q, Wang Y, Zhao C, Pang S, Lu J, Chan P. α-Synuclein aggregation causes muscle atrophy through neuromuscular junction degeneration. J Cachexia Sarcopenia Muscle. 2023;14(1):226-242. doi:10.1002/jcsm.13123

6. Lavin KM, Sealfon SC, McDonald MN, et al. Skeletal muscle transcriptional networks linked to type I myofiber grouping in Parkinson’s disease. J Appl Physiol (1985). 2020;128(2):229-240. doi:10.1152/japplphysiol.00702.2019

7. Lee S, Liu HP, Lin WY, Guo H, Lu B. LRRK2 kinase regulates synaptic morphology through distinct substrates at the presynaptic and postsynaptic compartments of the Drosophila neuromuscular junction. J Neurosci. 2010;30(50):16959-16969. doi:10.1523/JNEUROSCI.1807-10.2010

8. Lee S, Imai Y, Gehrke S, Liu S, Lu B. The synaptic function of LRRK2. Biochem Soc Trans. 2012;40(5):1047-1051. doi:10.1042/BST20120113

9. El-Khodor BF, Edgar N, Chen A, Winberg ML, Joyce C, Brunner D, Suárez-Fariñas M, Heyes MP. Identification of a battery of tests for drug candidate evaluation in the SMNDelta7 neonate model of spinal muscular atrophy. Exp Neurol. 2008 Jul;212(1):29-43)

10. Brooks SP, Dunnett SB. Tests to assess motor phenotype in mice: a user’s guide. Nat Rev Neurosci. 2009 Jul;10(7):519-29. doi: 10.1038/nrn2652.)

11. Spendiff S, Howarth R, McMacken G, Davey T, Quinlan K, O’Connor E, Slater C, Hettwer S, Mäder A, Roos A, Horvath R, Lochmüller H. Modulation of the Acetylcholine Receptor Clustering Pathway Improves Neuromuscular Junction Structure and Muscle Strength in a Mouse Model of Congenital Myasthenic Syndrome. Front Mol Neurosci. 2020 Dec 17;13:594220. doi: 10.3389/fnmol.2020.594220).

12. Wertman V, Gromova A, La Spada AR, Cortes CJ. Low-Cost Gait Analysis for Behavioral Phenotyping of Mouse Models of Neuromuscular Disease. J Vis Exp. 2019;(149):10.3791/59878. Published 2019 Jul 18. doi:10.3791/59878

13. DeMaagd G, Philip A. Parkinson’s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. P T. 2015;40(8):504-532

14. Alhindi A, Boehm I, Chaytow H. Small junction, big problems: Neuromuscular junction pathology in mouse models of amyotrophic lateral sclerosis (ALS). J Anat. 2022;241(5):1089-1107. doi:10.1111/joa.13463

15. DiFrancisco-Donoghue J, Apoznanski T, de Vries K, Jung MK, Mancini J, Yao S. Osteopathic manipulation as a complementary approach to Parkinson’s disease: A controlled pilot study. NeuroRehabilitation. 2017;40(1):145-151. doi:10.3233/NRE-161400

16. Porcari B, Russo M, Naro A, et al. Effects of osteopathic manipulative treatment on patients with multiple sclerosis: A pilot study. Complement Ther Med. 2019;43:154-156. doi:10.1016/j.ctim.2019.01.023

17. Wells MR, Giantinoto S, D’Agate D, et al. Standard osteopathic manipulative treatment acutely improves gait performance in patients with Parkinson’s disease. J Am Osteopath Assoc 1999;99:92–98.

18. NCT02107638. Effect of Osteopathic Manipulative Medicine on Parkinson Disease 2014 (The Cochrane Controlled Trials Register (CCTR/CENTRAL). Oxford: Update Software. Updated quarterly.

19. Won JH, Byun SJ, Oh BM, Park SJ, Seo HG. Risk and mortality of aspiration pneumonia in Parkinson’s disease: a nationwide database study. Sci Rep. 2021;11(1):6597. Published 2021 Mar 23. doi:10.1038/s41598-021-86011-w

Informed Consent: Informed Consent is Not Relevant

Ethical Approval & IRB and/or IACUC Approval: Approval for this project was obtained from the Midwestern University Institutional Animal Care and Use Committee (IACUC). #3245

Financial Disclosure: Funding for this project was provided by the Midwestern University “Start-Up Fund” and through the Kenneth A Suarez 2024-2025 Research Fellowship.

Poster No. B-16

Abstract No. 2024-082

Category: Basic Science

Research Focus Area: Osteopathic Philosophy

Doing No Harm: A Practical Model of Biomedical Ethics in Medical Education

¹Jackie Buttafuoco OMS-III, ¹Akansh Hans OMS-III, ¹Allison Voce OMS-II, ¹Jonathan Xiong OMS-II, ¹Kayla Hodkey OMS-II, ²R. Andrew Kelso PhD

¹Office of Research and Sponsored Programs, West Virginia School of Osteopathic Medicine, Lewisburg, WV; ²WVSOM Human Resources Specialist West Virginia School of Osteopathic Medicine, Lewisburg, WV

Context: In the continuously evolving landscape of medicine, the importance of ethical reflection and moral decision-making cannot be overstated. Especially as there being a shift from a more paternalistic sense of medicine to a patient-centered approach, poor conversational management of ethical dilemmas by healthcare professionals can certainly lead to poor physician-patient relationships and thus poor patient outcomes. As future osteopathic physicians, the importance of appropriately handling ethical dilemmas effectively will better enable us to care for our patients’ body, mind, and spirit to better our patients health. The implementation of biomedical ethics education in medical schools represents a proactive response to the complex questions arising from advances in healthcare delivery and biotechnology, in addition to shifts in societal values. By providing students with a solid foundation in bioethical principles, moral reasoning, and practical decision-making frameworks, medical schools will not only fulfill their obligation to train competent clinicians but will also be upholding the ethical principles central to the medical profession. While traditional didactic lectures have long served as the primary mode of delivering bioethics content, the efficacy of this approach in fostering deep engagement and practical application has been debated (1).

Objective: This project aimed to determine which modalities in a formal biomedical ethics education would be the most effective, ultimately guiding curriculum building for a new elective for WVSOM students. Guided by previous student feedback (2), the modalities offered in the project provided a variety of topics via a diverse manner of learning, allowing for further pinpointing of the most effective format in our medical school community.

Methods: Utilizing prior school surveys in addition to literary review conclusions, the authors chose 3 varying modalities of ethics teaching spanning 3 different topics. Modalities were chosen based on the literary review’s conclusion from phase 1 of the project. Topics were determined as a team post-review of subjective observations of interest, which was sent to all cohorts of WVSOM and faculty/staff. Ethics of Addiction was assigned the first modality of traditional lecture and 36 opted to participate. Through partnership with WVSOM Medical Muslim Student Alliance, the second modality of Question&Answer (Q&A) Panel discussion with 4 Muslim medical providers to answer questions and generate discussion of the ethical dilemmas faced when treating Muslim patients and as a Muslim provider; data was collected from 26 student participants. The last modality of a Simulated Patient (SP) experience provided medical students the opportunity to review a living will and discuss medical futility with a simulated patient’s family member; data was collected from 9 student participants. Pre-surveys were distributed prior to events, and post-surveys were distributed after the conclusion of each event to those attending. A total of 6 surveys were administered; 3 pre surveys and 3 post surveys. For the survey, 0= “No” knowledge or interest respectively, and 5 = “Very Much” interest or knowledge and the scoring of 0-5 were to be within that scale, allowing for the answers to range from 0-5. The data was then analyzed for statistical significance using a paired t-test, average, and yielding 95% Confidence Intervals (CI). Authors subjectively observed overall trends and key phrases in the qualitative responses.

Results: Data revealed a significant increase in both interest and knowledge in biomedical ethics across all groups. The analysis showed overall favor for all 3 formats: the traditional lecture, a Q/A Panel, and a SP encounter. Of the 3 formats, the traditional lecture (average=4.5, 95%CI 2.16-4.85, p.

Conclusion: The data indicates that a traditional lecture-style method is the most effective in instructing medical students on topics of biomedical ethics, followed closely by a Q&A Panel modality. These results suggest that a hybrid curriculum of both lecture and panel discussions would optimize bioethics studies in medical school. The simulated patient experience indicates an increase in both interest and knowledge of ethical topics in medical practice; however, due to logistical limitations, the methodology was underpowered, which calls into question the internal validity of the experience. Consequently, this factor could be addressed in a future study if a biomedical ethics elective is approved by WVSOM. Moving forward, this data will support optimal curriculum building for a new elective course for WVSOM students.

References

1. Terndrup C. A Student’s Perspective on Medical Ethics Education. J Relig Health. 2013;52(4):1073-1078. doi:10.1007/s10943-013-9747-5

2. DuBois JM, Burkemper J. Ethics Education in U.S. Medical Schools: A Study of Syllabi. Academic Medicine. 2002;77(5):432-437. doi:10.1097/00001888-200205000-00019

3. Hegazi I, Wilson I. Medical education and moral segmentation in medical students. Med Educ. 2013;47(10):1022-1028. doi:10.1111/medu.12252

4. Irby DM, Hamstra SJ. Parting the Clouds: Three Professionalism Frameworks in Medical Education. Academic Medicine. 2016;91(12):1606-1611. doi:10.1097/ACM.0000000000001190

5. Doukas DJ, McCullough LB, Wear S. Reforming Medical Education in Ethics and Humanities by Finding Common Ground With Abraham Flexner: Academic Medicine. 2010;85(2):318-323. doi:10.1097/ACM.0b013e3181c85932

6. Murrell VS. The failure of medical education to develop moral reasoning in medical students. Int J Med Educ. 2014;5:219-225. doi:10.5116/ijme.547c.e2d1

7. Martins VSM, Santos CMNC, Bataglia PUR, Duarte IMRF. The Teaching of Ethics and the Moral Competence of Medical and Nursing Students. Health Care Anal. 2021;29(2):113-126. doi:10.1007/s10728-020-00401-1

8. Doukas DJ, Kirch DG, Brigham TP, et al. Transforming Educational Accountability in Medical Ethics and Humanities Education Toward Professionalism: Academic Medicine. 2015;90(6):738-743. doi:10.1097/ACM.0000000000000616

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: N/A

Financial Disclosure: None reported.

Poster No. *B-17

Abstract No. 2024-091

Category: Basic Science

Research Focus Area: Acute and Chronic Pain Management

Cell Signaling in Sensory Neurons

Christopher De Troia, OMS-III, Emily Addleson, Derek Molliver

Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME

Context: Since 1999, the world has been fighting a rapidly progressing opioid epidemic due to an increasing number of people struggling with acute and chronic pain. The number of people who died from a drug overdose in 2021 was greater than six times the number in 1999. Additionally, over 75% of the 107,000 drug overdose deaths in 2022 involved opioids.[1] Opioids continue to be used because they are highly effective analgesics. However, with risk factors such as respiratory depression, addiction, and life-threatening constipation, there has been a major effort to identify new analgesics that are as effective and without these adverse effects, embracing the Osteopathic philosophy that mind and body are interrelated. Prior studies have shown that mitochondrial uncoupling drugs such as 2,4-dinitrophenol (DNP) and BAM15 have analgesic effects in diverse models of inflammatory neuropathic and opioid-induced hyperalgesia in rats and mice,[2] in addition to having potential for treatment of disorders ranging from diabetes, obesity, and nonalcoholic steatohepatitis to neurodegenerative disease.[3] While current research on cell signaling in sensory neurons has been promising, it has largely been limited to rodent cell lines.

Objective: To determine whether signaling channels expressed in rodent sensory neurons are expressed in human sensory neurons, we tested immunohistochemical (IHC) stained mouse pain models in vivo and by patch clamp electrophysiology in acutely isolated dorsal root ganglion (DRG) neurons in vitro as well as in human DRG-derived cell lines (HD10.6). The major channel we tested was Nuak1, a kinase related to AMPK that has not been previously investigated in sensory neurons. It is activated by LKB1, a kinase that acts as a master stress sensor and is known to activate AMPK. AMPK activates metabolic pathways in response to stress that conserve energy and promote energy production in response to stress or starvation.

Methods: Cells obtained from HD10.6 human DRGs were incubated and stimulated with BAM15 for 10 minutes and fixed in paraformaldehyde (PFA) for 15 minutes. Control HD10.6 cells and injury-model mouse lumbar DRGs were not stimulated with BAM15 and only fixed in PFA. The cells were then stained via IHC with Nuak1 (rabbit polyclonal antibody, diluted 1:250 in blocking buffer) and TRPV1 (goat polyclonal antibody, diluted 1:1,000 in blocking buffer) and sat covered at room temperature overnight. Secondary antibodies were added after 24 hours (alpaca anti-rabbit Cy3 for Nuak1, and donkey anti-goat Cy2 for TRPV1), and the slides were mounted with 4’,6-diamidino-2-phenylindole (DAPI) to be visualized under the microscope.

Results: In the HD10.6 human cells, the BAM15-stimulated and control cells demonstrated positive labeling with equal intensity for Nuak1 with projections branching off the axons indicating potential subcellular structures. We realized after staining that the TRPV1 antibody we selected only recognizes mouse cells, so the HD10.6 cells did not show positive labeling for TRPV1. In the mouse DRG cells, there was positive labeling for Nuak1 seen in the TRPV1-labeled neurons.

Conclusion: Nuak1 is a novel kinase channel that has not been previously studied in sensory neurons. We have found that Nuak1 is enriched in nociceptive sensory neurons in both mouse and human cell lines, and likely their nociceptors. Because Nuak1 is part of the AMPK master regulator family, along with Metformin, a drug that has been used as an AMPK activator for years and is one of the most prescribed drugs in the world for diabetes, we think that Nuak1 may have closely related functions that have not yet been investigated. One limitation of our study was that we could not determine if the staining for Nuak1 in the HD10.6 cells correlated 100% with the TRPV1-labeled neurons. This can be addressed by using a guinea pig anti-TRPV1 in subsequent studies. The importance of using human cell lines in pain signaling pathway modeling was a critical step towards developing a highly novel analgesic agent for humans that is non-addictive.

References

1. Understanding the opioid overdose epidemic. Centers for Disease Control and Prevention. Published April 5, 2024. Accessed June 16, 2024. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html

2. Molliver D, Levine J, Geguchadze R, Goode D, Straub C. Antinociceptive actions of mitochondrial uncoupling drugs in rodents and a human dorsal root ganglion-derived cell line. J Pain. 2023;24(4):25. doi: 10.1016/j.jpain.2023.02.084

3. Geisler JG, Marosi K, Halpern J, Mattson MP. DNP, mitochondrial uncoupling, and neuroprotection: A little dab’ll do ya. Alzheimer’s & Dementia. 2016;13(5):582-591. doi: 10.1016/j.jalz.2016.08.001

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: Study was deemed reviewed and approved by the IACUC and IBC: IACUC Protocol Number: 011023-002, IBC Protocol Number: 030619-005, No work is subject to review by IRB.

Financial Disclosure: None reported.

Poster No. B-18

Abstract No. 2024-101

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Development of Novel Biotherapeutics for Radiotherapy Induced Dysbiosis

¹Matthew L. Williams, PhD, ²Jackie Buttafuoco, OMS-III

¹Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV; ²Doctor of Ostoepathic Medicine Program, West Virginia School of Osteopathic Medicine, Lewisburg, WV

Context: Radiation therapy is common in the rehabilitation plan for many chronic diseases such as cancer. Recent studies into the effects of radiation on the microbiota of humans has shown not only that radiotherapy can disrupt the microbiome, allowing for the introduction of multiple pathogens, but also that the contents of an individual’s microbiome can alter the efficacy of radiotherapy (1).

Objective: The discovery of novel biotherapeutic microorganisms may lead to the ability to balance the loss of the natural flora when exposed to radiation or other ionizing waves (i.e. UVA/B).

Methods: Novel isolates of bacteria were collected from environmental, water, and soil samples. Individual colonies were isolated and frozen until use. Each isolate of bacteria underwent plate-based antagonism assays, on multiple media types, against common human bacterial pathogens including Escherichia coli, Staphylococcus aureus, Serratia marcescens, Klebsiella pneumonia, and Streptococcus mutans. Novel isolates that showed the ability to inhibit pathogens were subjected to 16s sequencing for identification. After identification bacteria were assayed for storage and durability characteristics. To assay their ability to withstand low level radiation the potential biotherapeutic bacteria were subjected to UV exposure. The rational implementation of these natural biotherapeutics may help bring balance to the ecosystems of the body to assist with healing and health maintenance.

Results: In this project six novel isolates of bacteria were discovered that were able to inhibit human pathogens. Novel strains of Microbacterium spp., Cupriavidus metallidurans, Lysinibacillus spp., Staphylococcus hominis, Staphylococcus cohnii, and Erwinia chrysanthemi were discovered. These microbes showed an array of antagonism against our panel of human pathogens. Storage and durability assays showed that these could be viable strains to market as all had a stable shelf life for storage for 6 months at room temperature. Our novel Lysinibacillus spp. strain has strong resistance to UV exposure.

Conclusion: There is an important interplay between balancing the structure and function of a body’s natural ecosystem for maintaining health. Occasionally this ecosystem can become out of balance and allow for infiltration of infectious organisms due to external stressors such as those inflicted by radiation therapy. Our isolates show the ability to fend off several of these human pathogens. Importantly, we identified a novel strain from our UV assays that may pose potential commensal or symbiotic protection against the loss of the natural microbiota to ionizing rays (UVA/B). The potential of Lysinibacillus spp. as a biotherapeutic has been recognized by many recently and our radiation resistant strain may pose a potential for combating the loss of balance of the natural microbiota to those undergoing radiotherapy for chronic diseases (2–5). The health of our natural flora may benefit from support to help diminish or prevent certain disease states.

References

1. Li Z, Ke X, Zuo D, Wang Z, Fang F, Li B. New Insights into the Relationship between Gut Microbiota and Radiotherapy for Cancer. Nutrients. 2022;15(1):48. doi:10.3390/nu15010048

2. Ahmad V, Muhammad Zafar Iqbal AN, Haseeb M, Khan MS. Antimicrobial potential of bacteriocin producing Lysinibacillus jx416856 against foodborne bacterial and fungal pathogens, isolated from fruits and vegetable waste. Anaerobe. 2014;27:87-95. doi:10.1016/j.anaerobe.2014.04.001

3. Zeng Z, Yue W, Kined C, Raciheon B, Liu J, Chen X. Effect of Lysinibacillus isolated from environment on probiotic properties and gut microbiota in mice. Ecotoxicol Environ Saf. 2023;258:114952. doi:10.1016/j.ecoenv.2023.114952

4. Puvanasundram P, Chong CM, Sabri S, Yusoff MSM, Lim KC, Karim M. Efficacy of Single and Multi-Strain Probiotics on In Vitro Strain Compatibility, Pathogen Inhibition, Biofilm Formation Capability, and Stress Tolerance. Biology (Basel). 2022;11(11):1644. doi:10.3390/biology11111644

5. Zhu X, Sun T, Sun X, et al. Lysinibacillus macroides 38328, a potential probiotics strain, enhances antioxidant capacity and avian influenza virus vaccine immune response in laying hens. Published online November 14, 2022. doi:10.21203/rs.3.rs-2262947/v1

Informed Consent: Not Applicable

Ethical Approval & IRB and/or IACUC Approval: Not Applicable

Financial Disclosure: None reported.

Poster No. *B-19

Abstract No. 2024-108

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

AMPKβ1 Knockdown Increases Autophagy Flux But Decreases Doxorubicin-Induced H9c2 Cardiomyocyte Death

Isabella Church, OMS-II, Jennifer Van, Brett Silverstein, Hongling Chen, Tamayo Kobayashi, Satoru Kobayashi, Qiangrong Liang

Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, NY

Context: Doxorubicin (DOX) is a broad-spectrum chemotherapeutic agent highly effective in treating many solid tumors and leukemias. However, its dose-dependent cardiotoxicity that culminates in congestive heart failure has significantly limited its use and narrowed its therapeutic window (1-3). While the exact mechanism of DOX cardiotoxicity remains unclear, AMP-activated Protein Kinase (AMPK) has been implicated in the process. AMPK is a heterotrimeric protein kinase composed of a catalytic a subunit and two regulatory subunits, β and g, each with multiple isoforms. Although AMPK was previously suggested to be cardioprotective in the context of DOX treatment, preliminary data from our lab have suggested that DOX-induced cardiac injury depends on the specific isoforms of the AMPK subunits. In this study, we focus specifically on the roles of the AMPK β1 and β2 isoforms in regulating autophagy and cell death in cardiac tissue.

Objective: With increasing evidence that each of the AMPK holoenzymes can have distinct effects on the heart under different conditions, our primary goal is to define the functional role of AMPKβ1 and β2 isoforms in regulating autophagy and cardiomyocyte death (11, 12). The findings of this study could inform protective strategies to prevent DOX-induced cardiotoxicity in cancer patients while preserving the drug’s anti-tumor efficacy.

Methods: These studies were conducted using siRNA-mediated knockdown of AMPK β1 and β2 isoforms in H9c2 cardiac myoblast cells. To assess autophagy flux, cells were treated with lysosomal protease inhibitors pepstatin A and E64d. Western blotting was used to confirm the effective knockdown of AMPKβ1 and β2 and to measure autophagy by comparing the levels of microtubule-associated protein light chain 3 forms I and II (LC3-I and LC3-II). Cell death was determined by the levels of cleaved caspase 3, an apoptotic marker.

Results: Downregulation of AMPK β1 significantly increased LC3-II levels in the presence of pepstatin A and E64d, suggesting an enhanced autophagy flux in the absence of AMPK β1. Moreover, AMPK β1 knockdown reduced cell death triggered by DOX treatment as shown by cleaved caspase 3, suggesting AMPK β1 as a mediator of DOX cardiotoxicity, However, downregulation of AMPKβ2 did not have dramatic effects on autophagy and DOX-induced cardiomyocyte death.

Conclusion: AMPK β1 knockdown increased autophagy flux in H9c2 cardiac myoblast cells, which was associated with reduced DOX cardiotoxicity. These results contrast with the prevailing view that AMPK promotes autophagy and is cardioprotective against DOX toxic effects. Additionally, these findings support our hypothesis that each specific isoform of the AMPK subunits has a unique and distinctive role in regulating autophagy and cell death.

References

1. Swain, S. M., Whaley, F. S., and Ewer, M. S. (2003) Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 97, 2869-28792.

2. Singal, P. K., and Iliskovic, N. (1998) Doxorubicin-induced cardiomyopathy. N Engl J Med 339, 900-9053.

3. Minotti, G., Menna, P., Salvatorelli, E., Cairo, G., and Gianni, L. (2004) Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev 56, 185-2294.

4. Ross, F. A., MacKintosh, C., and Hardie, D. G. (2016) AMP-activated protein kinase: a cellular energy sensor that comes in 12 flavours. FEBS J 283, 2987-30015.

5. Liu, D., Ma, Z., Di, S., Yang, Y., Yang, J., Xu, L., Reiter, R. J., Qiao, S., and Yuan, J. (2018) AMPK/PGC1alpha activation by melatonin attenuates acute doxorubicin cardiotoxicity via alleviating mitochondrial oxidative damage and apoptosis. Free Radic Biol Med 129, 59-726.

6. Liu, M. H., Lin, X. L., Guo, D. M., Zhang, Y., Yuan, C., Tan, T. P., Chen, Y. D., Wu, S. J., Ye, Z. F., and He, J. (2016) Resveratrol protects cardiomyocytes from doxorubicin-induced apoptosis through the AMPK/P53 pathway. Mol Med Rep 13, 1281-12867.

7. Liu, D., Ma, Z., Xu, L., Zhang, X., Qiao, S., and Yuan, J. (2019) PGC1alpha activation by pterostilbene ameliorates acute doxorubicin cardiotoxicity by reducing oxidative stress via enhancing AMPK and SIRT1 cascades. Aging11, 10061-100738.

8. Kobashigawa, L. C., Xu, Y. C., Padbury, J. F., Tseng, Y. T., and Yano, N. (2014) Metformin protects cardiomyocyte from doxorubicin induced cytotoxicity through an AMP-activated protein kinase dependent signaling pathway: an in vitro study. PLoS One 9, e1048889.

9. Chen, K., Xu, X., Kobayashi, S., Timm, D., Jepperson, T., and Liang, Q. (2011) Caloric restriction mimetic 2-deoxyglucose antagonizes doxorubicin-induced cardiomyocyte death by multiple mechanisms. The Journal of biological chemistry 286, 21993-2200610.

10. Ajzashokouhi, A. H., Bostan, H. B., Jomezadeh, V., Hayes, A. W., and Karimi, G. (2019) A review on the cardioprotective mechanisms of metformin against doxorubicin. Human & experimental toxicology, 96032711988827711.

11. Cao, Y., Bojjireddy, N., Kim, M., Li, T., Zhai, P., Nagarajan, N., Sadoshima, J., Palmiter, R. D., and Tian, R. (2017) Activation of gamma2-AMPK Suppresses Ribosome Biogenesis and Protects Against Myocardial Ischemia/Reperfusion Injury. Circ Res 121, 1182-119112.

12. Kim, M., and Tian, R. (2011) Targeting AMPK for cardiac protection: opportunities and challenges. Journal of molecular and cellular cardiology 51, 548-553

Informed Consent: ​Not applicable

Ethical Approval & IRB and/or IACUC Approval: Not Applicable

Financial Disclosure: None reported.

Poster No. *B-20

Abstract No. 2024-111

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Adenine Reduces Plasma Triglycerides in Mice with Chronic Kidney Disease

Matthew D. Cirrone, OMS-II, Ben R. Caruso, OMS-II, Hina Gilani, Mugdha V. Padalkar, PhD, Olga V. Savinova, PhD, Saud A. Nasruddin, BS

Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, NY

Context: In patients with early or advanced-stage chronic kidney diseases (CKD), there is an increased cardiovascular risk that manifests as coronary artery disease, heart failure, arrhythmia, and sudden cardiac death. Additionally, dyslipidemia, seen as elevated triglycerides and low HDL cholesterol, is prevalent among patients with CKD and is a mutual risk factor between CKD and cardiovascular disease (CVD) (1). Persistence of dyslipidemia leads to an even greater risk and progression of CVD, which is the greatest cause of mortality in patients with CKD. In our laboratory, we utilize a reproducible adenine-induced CKD mouse model to further study the development of CVD/atherosclerosis in the setting of CKD. Our previous study determined that excessive adenine intake impacts lipid metabolism in that the co-treatment with adenine and a Western diet resulted in a paradoxical reduction of plasma cholesterol and triglycerides in co-treated mice compared with the Western-only group (2). In this study, we utilize our reproducible adenine-induced CKD mouse model to investigate whether the reduction in lipids is reversed upon discontinuation of adenine supplementation of a Western diet.

Objective: Our objective was to isolate the role of adenine in reducing plasma lipids. We aimed to elucidate the impact of adenine treatment on triglyceride synthesis by evaluating plasma concentrations of triglycerides and cholesterol in CKD-induced mice before and after discontinuation of adenine treatment. Furthermore, we aim to assess urine output as an indicator of kidney function before and after cessation of adenine treatment to determine the reversibility of adenine-induced CKD.

Methodology: Mouse Model: Low-density lipoprotein receptor (ldlr) mutant mice were obtained from the Jackson Laboratory (C57BL/6J-LdlrHlb301/J; strain #005061; Bar Harbor, ME, USA). These mice carry a familial hypercholesterolemia mutation in the ldlr gene, causing a missense mutation (C699Y). Mice were kept in cages with unrestricted food and water with a limit of five mice per cage at the New York Institute of Technology College of Osteopathic Medicine animal care facility with a 12-hour light and dark cycle. All treatments and procedures were approved and performed according to IACUC regulatory standards. IACUC protocol #2022-OS-01.

Diet: The mice (n=48, 24 male and 24 female, 10 weeks of age) were divided into four groups: two adenine and two placebo (western-only) groups. The control groups were fed a Western diet (TD.88137 high fat, high sugar, low fiber diet), whereas the adenine mice were fed a Western diet supplemented with 0.2% adenine. After 8 weeks of adenine treatment, one control and one adenine group were sacrificed, and their blood was collected for lipid analysis (V1 time-point). The remaining control and adenine groups were continued on a western diet without adenine for another 8 weeks (V2 time-point).

Metabolic Cages: At V1 and V2 time points, mice were transferred to metabolic cages to separate urine and feces, allowing for the quantitative measurement of urine output over a 24-hour period.

Blood Chemistry: Mice were fasted for 5 hours prior to sacrifice via exsanguination. Triglycerides and cholesterol were measured in whole plasma using a direct colorimetric procedure. For the assays, 2 microliters of plasma were reacted with 200 microliters of Triglyceride and Cholesterol Reagent (Pointe Scientific), respectively. Triglyceride and cholesterol concentrations were calculated based on relative absorbance values at 500 nm compared to a standard curve of triglyceride and cholesterol.

Analysis: Data were analyzed using GraphPad Prism 9 statistical software (San Diego, CA, USA). A two-way ANOVA was used to determine the effects of adenine at V1 and adenine pre-treatment at V2 while adjusting for sex. Statistical significance was set to p Osteopathic Significance: As osteopathic physicians, it is imperative that we take a holistic approach to treating our patients. Exploring the interplay between CKD, triglyceride, and cholesterol levels is critical to that philosophy. Understanding this relationship further displays the interconnection of the body and will allow for more comprehensive management of patients with chronic kidney disease.

Results: At 18 weeks of age, the V1 time-point, adenine-treated mice displayed a significant reduction in triglycerides compared to controls (165.4 ± 7.4 mg/dL vs. 272.3 ± 30.5 mg/dL, p.

Conclusion: The discontinuation of adenine treatment for 8 weeks resulted in a rebound of triglyceride levels. Urine output remained significantly higher in adenine-treated mice compared to control mice even after cessation of adenine. These findings suggest that adenine directly influences triglyceride synthesis independent of kidney function. Furthermore, the persistence of polyuria post-cessation of adenine indicates that renal tubule damage caused by adenine metabolite 2,8-dihydroxyadenine (DHA) is irreversible (3).

Limitations and Future Directions: Though persistent polyuria might indicate kidney dysfunction, it is not considered a primary chronic kidney disease biomarker. Future investigations assessing biomarkers such as blood urea nitrogen, Cystatin C, and proteinuria will be performed to determine CKD status in mice after cessation of adenine treatment. Future studies are designed to explore the effect of adenine-metabolite on triglyceride synthesis while isolating its nephrotoxic effect. Additionally, the current model of inducible-CKD on a background of familial hypercholesterolemia warrants further investigation into the relationship between atherosclerotic progression, CKD-induced vascular calcification, and CVD with the hope of reducing cardiovascular burden in patients with CKD.

References

1. Rosenstein K, Tannock LR. Dyslipidemia in Chronic Kidney Disease. [Updated 2022 Feb 10]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305899/

2. Padalkar MV, Tsivitis AH, Gelfman Y, et al. Paradoxical reduction of plasma lipids and atherosclerosis in mice with adenine-induced chronic kidney disease and hypercholesterolemia. Front Cardiovasc Med. 2023;10:1088015. Published 2023 Feb 9. doi:10.3389/fcvm.2023.1088015

3. Yang, Q., Su, S., Luo, N., & Cao, G. (2024). Adenine-induced animal model of chronic kidney disease: current applications and future perspectives. Renal Failure, 46(1). https://doi.org/10.1080/0886022X.2024.2336128

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *B-21

Abstract No. 2024-118

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Evaluating Factors Contributing to Vascular Calcification and Aortic Stiffness in an Animal Model of Atherosclerosis

Tzipora Levitt, OMS-II, Aron Yunatanov, Saud A. Nasruddin, BS, Olga V. Savinova, PhD, Mugdha V. Padalkar, PhD

Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, NY

Context: Vascular Calcification is the deposition of calcium-phosphate complexes in the vasculature.1 It is directly tied to atherosclerotic vascular disease and is heightened in diabetes, menopause, Chronic Kidney Disease, hypertension, and osteoporosis.1, 2 Some studies indicate that calcification in advanced atherosclerosis may lead to increased vascular stiffness.3 Within the literature on the prevalence of atherosclerosis on the basis of sex, there is a discrepancy- some say that there is an increased risk in females,4 others say males,1, 3 and some even say that there is no significant difference.5, 6 This demonstrates the clinical significance and importance of further analyzing this relationship. Tissue- Nonspecific Alkaline Phosphatase (TNAP) has been associated with an increase in vascular calcification and promotes atherosclerosis. (source 8) This suggests that a reduction in TNAP activity may prevent or reduce atherosclerotic calcification. We hypothesize that the genetic ablation of TNAP expression in hepatocytes will reduce vascular calcification and improve plasma lipid profile. Mouse models are used to study complex human diseases because they are amenable to genetic manipulations. These models must be evaluated to establish that they truly recapitulate human disease, including sex differences.

Objective: In this study we aim to evaluate the TNAP model and establish the relationship between liver specific TNAP haploinsufficiency and plasma alkaline phosphatase activity. The second objective was to assess the relationship between vascular calcification and sex. Finally, we aim to interrogate the effect of calcification on aortic stiffness.

Methods: Animals: In this study, liver-specific TNAP haploinsufficient mice and their wild-type littermates (n= 27, 16 males and 11 females) on the LDL receptor mutant background were used. At 10 weeks of age, mice were placed on a western diet for 42 weeks up to 1 year of age. Animal studies were conducted at the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM, Old Westbury, NY). The facility utilized 12h:12h day: night light cycle and controlled temperature and humidity and was not a barrier facility. NYIT-COM facilities used conventional caging and tap water. All treatments and procedures were approved and performed according to the Institutional Animal Care and Use Committee (IACUC) approved protocol #2022-OS-01.

Physiology: Mice were anesthetized with 0.8% to 1% isoflurane and placed on a prewarmed platform of the Vevo 3100 high-frequency ultrasound imaging system. Pulse wave velocity (as a measurement of arterial stiffness) measurements were obtained from the carotid and femoral by Doppler ultrasound.

Blood Chemistry: At the terminal time point, plasma was collected by cardiac puncture. Mice were fasted for 5 hours prior to blood collection. Total cholesterol and triglycerides were measured with direct endpoint colorimetric assay. Alkaline phosphatase (ALP) activity was determined in a kinetic mode.

Computed Tomography: Micro-computed tomography (μCT) was used to detect vascular calcification. Samples of the aortic roots and arches were dissected and immersed in mineral oil. The samples were scanned on a SkyScan 1173 instrument (Micro Photonics). 3D image stacks were reconstructed from the rotation image projections using NRecon software (Bruker Corporation). Reconstructed images were analyzed to obtain quantitative information on the calcification volume using Dragonfly software (Object Research Systems Inc).

Statistics: Data were analyzed using GraphPad Prism 9 statistical software (San Diego, CA, USA). A correlation matrix was created with sex, genotype, triglycerides, cholesterol, calcification volume, pulse wave velocity, and ALP activity. Multiple linear regression models were performed based on significant parameters identified in the univariate correlation matrix. Significance was determined at a p-value.

Results: Our results showed that the plasma ALP values were higher in females (55.2 vs. 41.2 in males.

Conclusions: We did not find support for our hypothesis that calcification is influenced by sex. Nor can we predict that aortic stiffness is dependent on vascular calcification. Unexpectedly, we found an association between ALP activity and sex. We also found that liver specific haploinsufficiency of TNAP can lead to a reduction of plasma ALP activity. Animal models may not completely recapitulate observations in humans and have to be used with caution. We also recognize that a small number of animals present a limitation to the study.

References

1. Lee SJ, Lee IK and Jeon JH. Vascular Calcification-New Insights Into Its Mechanism. International journal of molecular sciences. 2020;21.

2. Abedin M, Tintut Y and Demer LL. Vascular calcification: mechanisms and clinical ramifications. Arteriosclerosis, thrombosis, and vascular biology. 2004;24:1161-70.

3. Hickler RB. Aortic and large artery stiffness: current methodology and clinical correlations. Clin Cardiol. 1990;13:317-22.

4. Tsakiris A, Doumas M, Nearchos N, Mavrokefalos A, Mpatakis N and Skoufas P. Aortic calcification is associated with age and sex but not left ventricular mass in essential hypertension. J Clin Hypertens (Greenwich). 2004;6:65-70.

5. Iribarren C, Sidney S, Sternfeld B and Browner WS. Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. Jama. 2000;283:2810-5.

6. Jadidi M, Poulson W, Aylward P, MacTaggart J, Sanderfer C, Marmie B, Pipinos M and Kamenskiy A. Calcification prevalence in different vascular zones and its association with demographics, risk factors, and morphometry. American journal of physiology Heart and circulatory physiology. 2021;320:H2313-h2323.

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *B-22

Abstract No. 2024-123

Category: Basic Science

Research Focus Area: Acute and Chronic Pain Management

Assessing Parasympathetic Function and Hypoalgesia Induced by Noxious Electrical Stimulation

¹Henry Giovanni Ortiz, OMS-II, ²Scott Stackhouse, PT, PhD, ²Katherine Rudolph, PT, PhD

¹University of New England College of Osteopathic Medicine, Biddeford, ME; ²Department of Physical Therapy University of New England, Portland, ME

Context: Previous studies have shown that Noxious Electrical Stimulation (NXES) can produce long-term hypoalgesia (sometimes lasting up to 72 hours) in both healthy and clinical populations.[1-7] Although not definitely known, potential mechanisms that could invoke hypoalgesia include opioidergic, serotonergic, and noradrenergic pathways working in both the peripheral and central nervous systems.[8-11] The autonomic nervous system (ANS) may additionally be contributing to the hypoalgesic effect.[12]

Objective: The purpose of this study is to examine parasympathetic function during NXES through the use of heart rate variability (HRV).

Methods: This is a single-group pre-post prospective intervention study. We recruited participants using study flyers posted on campus and brief presentations to students. Nineteen adults were enrolled and we have usable data on eighteen (9 females) participants. Each participant underwent 20 minutes of NXES using the following parameters: 400 μs phase duration, 100 pulses/s, delivered with a cycle time of a 10 s on-time, with a 2 s ramp up to peak current, followed a 10 s off-time. The current intensity was gradually increased and the participant identified their first perception of stimulation (sensory threshold). From sensory threshold, current intensity was further increased until participant was able to identify a sharp painful stimulus. This was further increased to participant pain tolerance. The current amplitude and verbal pain rating were recorded. Participants pain perception was rated periodically and current was adjusted to maintain a consistent perceptual level.

Prior to undergoing the NXES intervention, baseline HRV and quantitative sensory test (QST) measures were recorded. Pressure pain threshold (PPT) was measured through the use of a pressure algometer at the medial tibial plateau of the index knee. Pressure was gradually applied at a rate of 60 kPa/s until subject identified their first perception of pain. Peak pressure was recorded and repeated twice during baseline. Heat temporal summation (HTS) was measured using a computer-controlled thermode, which was attached at the knee joint line. A series of 10 suprathreshold mildly painful heat pulses were applied at a rate of 1 pulse every 2.5 s. Participants rated their perception of pain on a 100 mm line visual analogue scale (VAS) for the series of 10 pulses. HTS was calculated as the maximally rated heat pulse in the series minus the rating of the first heat pulse. Both PPT and HTS were collected before and after NXES intervention.

In order to asses HRV, we used time- and frequency-domain measures of the electrocardiogram (ECG). The time-domain measure was the root mean square of successive differences of R-R wave intervals. The frequency-domain measure from the Fast Fourier Transform included the percent power in the high frequency band (0.15-0.4 Hz), which represents parasympathetic activity. These data were collected over a 10-minute resting baseline period and throughout the 20 minutes during the NXES stimulation. The 20-minute NXES stimulation was divided into 5-minute thirds in order to investigate changes in parasympathetic activity over the course of the intervention.

Data Analysis: For the PPT and HTS data, we used paired t-tests (α = 0.05) to examine the pre/post NXES differences. We implemented a one-way repeated measures ANOVA (α = 0.05) for the HRV data, to compare baseline measurements with the data collected throughout the NXES intervention. This was followed by Bonferroni corrected post-hoc t-tests to identify where the differences in the high-frequency percent power occurred over time (α = 0.0167).

Osteopathic Significance: This study helped enhance our understanding of the neurological model of osteopathy. The influence the ANS has on body functions is vast, and by investigating its influence with analgesic mechanisms, we can explore new methods to treat patients. Emphasizing self-regulation and interrelated structure-function dynamics, this investigation supports the holistic approach that makes up the foundations of osteopathic medicine.

Results: There was as significant increase in PPT from baseline (611.95 +/- 210.13 SD) to post-NXES (748.74 +/- 271.54; t = -2.69 (df= 17) p= 0.015), which shows the immediate mechanical hypoalgesia effect. In addition, there was a significant decrease in pain facilitation as measured by HTS from baseline (30.39 mm on VAS +/- 20.54 SD) to post-NXES (16.78 mm on VAS +/- 19.13 SD; t= 4.9 (df= 17) p< 0.001). In the assessment of parasympathetic function, there were no observable differences noted in the HRV time-domain measurement from before and across the NXES intervention (F= .086; df= 2.14; p= 0.928). There was a difference found in the high frequency percent power from baseline and across the three 5-minute intervals recorded during the NXES (F= 6.13; df = 1.92; p= 0.007). Significant decreases in high frequency percent power were observed between baseline (45.01 +/- 16.3 SD) and the second 5-minute period during NXES (31.63 +/- 17.3 SD; t= 2.76; df= 15; p= 0.015), as well as the third 5-minute period during NXES (29.67 +/- 15.3 SD; t= 3.38; df= 15; p= 0.004).

Conclusion: Consistent with prior studies on NXES, we observed an increase in PPT along with a decrease in HTS post treatment.[1-7] Reduction in the high frequency band percent power indicates a decrease in parasympathetic activity during the NXES intervention. Decreased parasympathetic activity may lead to the hypoalgesic effects seen after NXES; however, further investigation is required to assess the relationship between parasympathetic function and mechanical hypoalgesia and reduced thermal pain facilitation.

References

1. Rudolph KS, Cloutier M, Stackhouse S. Pain inhibition-the unintended benefit of electrically elicited muscle strengthening contractions. BMC Musculoskelet Disord. 2023; doi:10.1186/s12891-023-06243-x.

2. Stackhouse SK, Taylor CM, Eckenrode BJ, Stuck E, Davey H. Effects of Noxious Electrical Stimulation and Eccentric Exercise on Pain Sensitivity in Asymptomatic Individuals. PM and R. 2016; doi:10.1016/j.pmrj.2015.07.009.

3. Stackhouse SK, Rudolph KS. Harnessing the condition pain modulation effect for therapeutic use in knee osteoarthritis. J Orthop Sport Phys Ther 2023; 52: CSM99, Poster# OPO112.

4. Stackhouse SK, Rudolph KS. Effects of a two-week treatment using noxious electrical stimulation for knee osteoarthritis-related pain. J Orthop Sport Phys Ther 2023; 52: CSM108, Poster# OPO135.

5. Stackhouse SK, Eckenrode BJ, Brown E, Greer B, Madara K, O’Brien A. The effect of noxious electrical stimulation and eccentric exercise on mechanical and thermal pain processing in Achilles tendinopathy. Orthopaedic Section Platform Session (OPL4), CSM Las Vegas, February 2014; J Orthop Sports Phys Ther 44(1):A21, 2014.

6. Eckenrode BJ, Stackhouse SK. Improved Pressure Pain Thresholds and Function Following Noxious Electrical Stimulation on a Runner with Chronic Achilles Tendinopathy: a Case Report. Int J Sports Phys Ther. 2015.

7. Stackhouse SK, Taylor CM, Eckenrode BJ, Stuck E, Davey H. Effects of Noxious Electrical Stimulation and Eccentric Exercise on Pain Sensitivity in Asymptomatic Individuals. PM R. 2016; doi:10.1016/j.pmrj.2015.07.009 [doi].

8. Bannister K, Dickenson AH (2017) The plasticity of descending controls in pain: translational probing. J Physiol 595:. https://doi.org/10.1113/JP274165

9. De Resende MA, Silva LFS, Sato K, et al (2011) Blockade of opioid receptors in the medullary reticularis nucleus dorsalis, but not the rostral ventromedial medulla, prevents analgesia produced by diffuse noxious inhibitory control in rats with muscle inflammation. J Pain 12:. https://doi.org/10.1016/j.jpain.2010.12.009

10. Mills EP, Keay KA, Henderson LA (2021) Brainstem Pain-Modulation Circuitry and Its Plasticity in Neuropathic Pain: Insights From Human Brain Imaging Investigations. Front Pain Res 2:. https://doi.org/10.3389/fpain.2021.705345

11. Yam MF, Loh YC, Tan CS, et al (2018) General pathways of pain sensation and the major neurotransmitters involved in pain regulation. Int. J. Mol. Sci. 19:1–23

12. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258. Published 2017 Sep 28. doi:10.3389/fpubh.2017.00258

Informed Consent: All participants provided informed consent prior to their involvement in the study. The informed consent process involved a thorough explanation of the study’s purpose, procedure, and duration, as well as any potential risks and benefits. The format in which this was delivered was through a pre-recorded video as well as a packet containing all information pertinent to the study. Participation was entirely voluntary, and they were informed that they could withdraw from the study at any time without consequences. Furthermore, all participants were assured that all data collected would remain confidential and their privacy would be protected through de-identifying data and secure storage. Each subject signed a written informed consent form, with a copy provided for their records.

Ethical Approval & IRB and/or IACUC Approval: This study was reviewed and approved by the Institutional Review Board (IRB) at the University of New England The study underwent full board review and received approval. The internal IRB approval number for this study is 0324-21.

Financial Disclosure: None reported.

Poster No. B-23

Abstract No. 2024-126

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Effects of Repeated Intranasal Gentamicin Exposure on Morphology of Neurons in Vestibular Nuclei

¹Randy Kulesza, PhD, ²Nickolas Vasil, OMS-II, ²Zachary Mendola, OMS-II, ²Zachary Breeden, OMS-III, ²LeAnn Haddad, OMS-III, ³Yusra Mansour, DO, PhD

¹Department of Anatomy, Lake Erie College of Osteopathic Medicine, Erie, PA; ²Department of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA; ³Department of Otolaryngology, Henry Ford Health, Detroit, MI

Context: Gentamicin is an aminoglycoside antibiotic used to treat several gram-negative infections¹. Gentamicin administration is known to have oto- and vestibulotoxicity², resulting from damage to hair cells in the inner ear³. In both human subjects and animal models, different methods of delivery have shown variable toxicity⁴⁻⁵. Specifically, intranasal irrigation used for treatment of sinus infections, is believed to have low toxicity⁶. There is however, lack of published data on the impact of repeated intranasal exposure of gentamicin. Recent studies in our lab have shown that intranasal gentamicin administration results in elevated hearing thresholds, increased auditory brainstem response latency and these effects are most severe in response to high frequency tone-pips, consistent with gentamicin targeting the base of the cochlea. Accordingly, we hypothesized that repeated intranasal gentamicin exposure would similarly impact the vestibular system.

Objective: To determine the neurotoxic effects of repeated intranasal gentamicin exposure on neurons within the vestibular nuclei.

Methods: Animals from four litters were randomly divided into saline and gentamicin groups and each group included an equal number of male and female animals. All pups were weaned on postnatal day (P) 21. Animals were handled from P15-20 and received either saline or gentamicin (8mg/80kg) divided equally between nostrils. Animals underwent a battery of motor and vestibular testing from P32-41. On P41 animals were perfused through the ascending aorta with saline followed by 4% paraformaldehyde in 0.1 M phosphate buffer. Brains were sections on a freezing stage microtome at a thickness of 50 ?m in the coronal plane. Every third section was mounted in caudal to rostral order and stained with Giemsa. Neurons in the superior, lateral, medial, and spinal vestibular nuclei (SVN, LVN, MVN and SpVN, respectively) were analyzed using morphometric techniques. Tracings were digitized and analyzed with ImageJ. Data sets did not fit a normal distribution and comparisons between control and gentamicin-exposed animals were made using the Kruskal-Wallis test.

Results: Stellate neurons in the MVN were significantly larger in gentamicin-exposed animals (Gentamicin - 231.0 ?m²; 95% CI [232.4-301.7]; Control - 125.0 ?m², 95% CI [123.4-162.1]; p.

Conclusion: Based on these observations, repeated intranasal injection of gentamicin appears to result in significantly larger neurons across all brainstem vestibular nuclei. We believe these findings result from gentamicin’s action on vestibular hair cells. These findings are consistent with delayed vestibular-evoked myogenic potentials and abnormal performance on vestibular and motor tests.

References

1. Fisk KL. A review of gentamicin use in neonates. Neonatal network. 1993;12(7):19-23; quiz 24-8. https://europepmc.org/article/med/8413146

2. Selimoglu E. Aminoglycoside-induced ototoxicity. Current pharmaceutical design. 2007;13(1):119-126. doi:https://doi.org/10.2174/138161207779313731

3. Chia SH, Gamst AC, Anderson JP, Harris JP. Intratympanic Gentamicin Therapy for Ménière’s Disease: A Meta-analysis. Otology & Neurotology. 2004;25(4):544-552. doi:https://doi.org/10.1097/00129492-200407000-00023

4. Echeverria P, Fina D, Norton S, Smith AL. Ototoxicity of Gentamicin: Clinical Experience in a Children’s Hospital. Chemotherapy. 1978;24(4):267-271. doi:https://doi.org/10.1159/000237791

5. Siber GR, Echeverria P, Smith AL, Paisley JW, Smith DH. Pharmacokinetics of gentamicin in children and adults. The Journal of Infectious Diseases. 1975;132(6):637-651. doi:https://doi.org/10.1093/infdis/132.6.637

6. Wong KK, Osama Marglani, Westerberg BD, Javer AR. Systemic absorption of topical gentamicin sinus irrigation. PubMed. 2008;37(3):395-398. doi:10.2310/7070.2008.0022

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: Procedures and practices were approved and performed according to IACUC regulatory standards.

Financial Disclosure: None reported.

Poster No. *B-24

Abstract No. 2024-127

Category: Basic Science

Research Focus Area: Chronic Diseases & Conditions

Serotonin Receptor 5-HT2A and C Signaling Activity is Required for Morphogenesis of Neural Crest Derived Tissues in Xenopus laevis Embryos

Arya Balouchi OMS-I, Simran Kaur, Niki Tabrizi, Chloe Resngit, Tamira Elul

Touro University College of Osteopathic Medicine, Vallejo, CA

Context: Research findings show that serotonergic psychedelics act as antidepressant agents by increasing structural plasticity components of neuronal circuits, such as dendritic spine density and functional synapses (1). Changes in neuronal circuitry are mediated by signaling through the 5-HT2A and 5-HT2C serotonin receptors (2,3). However, the effects of serotonergic signaling through these receptors on morphogenesis of earlier developmental stages is not known.

Objective: The goal of this study was to determine whether the serotonin receptors 5-HT2A and 5-HT2C and their signaling activity are required for morphogenesis of neural crest derived tissues in Xenopus laevis embryos.

Methods: 5-HT2C/A receptor signaling was disrupted in tailbud stage Xenopus laevis embryos (15 control embryos) by application of a 5-HT2C antagonist, SB 242084 (11 embryos), a 5-HT2A agonist, 25CNBOH (20 embryos). Control and experimental embryos were fixed at late tailbud stages and images were captured of dorsal, frontal and lateral views of the embryos using a dissecting microscope (Nikon SMZ500) and digital camera attachment (Nikon DS-5M with Nikon Elements Software). Size and shape of head, eyes and lateral bands of pigment cells were then measured from images using Image J, and statistical analyses using the Student’s t-test were performed.

Results: Alteration of 5-HT2A/C signaling led to statistically significant defects in morphogenesis in multiple neural crest derived tissues including heads, eyes, and lateral bands of pigment cells. The 2A agonist caused embryo heads to be more round and less elongated compared to the control (p < 0.05 for both parameters compared to control), whereas the 2C antagonist caused the embryo heads to be smaller and more elongated compared to the control (p < 0.05 for both parameters compared to control values). The 2A agonist also caused the embryo eyes and choroid fissures to be larger, where the 2C antagonist caused the embryo eyes and choroid fissures to be smaller (p < 0.05 for all parameters compared to controls). The 2A agonist and 2C antagonist both caused the lateral band of pigment cells to be smaller compared to the control (p < 0.05 for both compared to control).

Conclusion: This data shows that the serotonin 5-HT2C/A receptors impact morphogenesis of neural crest derived tissues at earlier developmental stages. Because serotonin generated by the mother in gestation is passed onto the developing embryo through placental uptake and transport (4), physicians should advise pregnant women to proceed with caution when using serotonin-modulating antidepressant agents due to the increased risk of multiple morphogenic malformations in embryogenesis.

References

1. Vargas MV, Dunlap LE, Dong C, et al. Psychedelics promote neuroplasticity through the activation of intracellular 5-HT2A receptors. Science. 2023;379(6633):700-706. doi:10.1126/science.adf0435Fiorella D,

2. Helsley S, Lorrain DS, Rabin RA, Winter JC. The role of the 5-HT2A and 5-HT2C receptors in the stimulus effects of hallucinogenic drugs. III: The mechanistic basis for supersensitivity to the LSD stimulus following serotonin depletion. Psychopharmacology (Berl). 1995;121(3):364-372. doi:10.1007/BF02246076

3. González-Maeso J, Weisstaub NV, Zhou M, et al. Hallucinogens recruit specific cortical 5-HT(2A) receptor-mediated signaling pathways to affect behavior. Neuron. 2007;53(3):439-452. doi:10.1016/j.neuron.2007.01.008Canal CE.

4. Serotonergic Psychedelics: Experimental Approaches for Assessing Mechanisms of Action. Handb Exp Pharmacol. 2018;252:227-260. doi: 10.1007/164_2018_107. PMID: 29532180; PMCID: PMC6136989.

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *B-25

Abstract No. 2024-134

Category: Basic Science

Research Focus Area: Musculoskeletal Injuries and Prevention

The Effects of PRP and Corticosteroids on Shoulder Pain and Functionality in Shoulder Impingement Syndrome

Kunal Vijay Damaraju BS, OMS-II, Kunal P. Shah, Ryan St. John, Sameer Shah, Jonathan Elias

Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ

Context: Shoulder impingement syndrome is a musculoskeletal condition in which the soft tissue or bursa in the shoulder is pinched during movement of the shoulder blade causing pain and discomfort (1). The current treatment modalities for this condition include surgery or conservative treatment such as physical therapy and NSAIDs (2). However, not enough research has been done to look at injection modalities and which of them is superior.

Objective: The primary objective of this study was to determine if platelet-rich plasma (PRP) has a more efficacious effect on Visual Analog Scale (VAS) and Constant-Murphy (CM) scores compared to corticosteroids for shoulder impingement syndrome.

Methods: A systematic review and meta-analysis of multiple databases was completed following PRISMA 2020 guidelines. Six databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar) were utilized to find literature regarding the utilization of platelet-rich plasma in the setting of shoulder impingement syndrome. Included studies were trials that utilized the Visual Analogue Scale and Constant Murley to determine the efficacy of PRP in shoulder impingement syndrome, yielding 373 patients across 5 included studies. Statistical analysis was conducted utilizing IBM SPSS Statistics for Windows, Version 29 (IBM Corp., Armonk, N.Y., USA) to assess the effects of PRP and corticosteroids on the Visual Analog Scale (VAS) and Constant-Murley (CM) scores in patients with shoulder impingement syndrome.

Results: Using a random effects model, the estimated proportion of individuals who experienced improvements in VAS pain scores following PRP administration and corticosteroids was -2.32 (95% CI -3.13- -1.51) and -3.48 (95% CI -5.09- -1.87), respectively. Further subgroup analysis between these two populations showed no statistically significant differences between them (p=0.21). For the Constant-Murphy Scores, the estimated proportion for PRP and corticosteroids was 3.12(95% CI 1.21-5.03) and 2.80 (95% CI 1.66-3.93), respectively. There were no statistically significant differences between these groups in subgroup analysis (p=0.77).

Conclusion: The results suggest that when compared to each other, there is no statistically significant advantage of either PRP or corticosteroids over the other. However, corticosteroids had a much greater clinical impact in reducing VAS scores on a 6-month timeframe, while PRP had a slightly greater impact on increasing CM scores. More clinical studies are needed to support these findings in shoulder impingement syndrome.

References

1. Horowitz EH, Aibinder WR. Shoulder Impingement Syndrome. Physical Medicine and Rehabilitation Clinics of North America. 2023;34(2):311-334. doi:10.1016/j.pmr.2022.12.001

2. Garving C, Jakob S, Bauer I, Nadjar R, H. Brunner U. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017;114(45):765-776. doi:10.3238/arztebl.2017.0765

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: Systematic Reviews and Meta-analysis are exempt from the IRB review process.

Financial Disclosure: None reported.

Poster No. B-26

Abstract No. 2024-137

Category: Basic Science

Research Focus Area: Osteopathic Philosophy

Institutional Funding of Medical Students for Research Conferences: Is There a Benefit for the NRMP?

¹Jennifer F. Dennis, PhD, ²Hason Khan, ²Christopher Papatheofanis, ²Klea Agollari, ²Richard Marino, ²Tillie Schumann, ²Emily Woolhiser

¹Academic Affairs, Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, Kansas City, MO; ²Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, Kansas City, MO

Context: An analysis of NRMP charting outcomes shows that within the last decade that osteopathic and allopathic medical students matching into residency programs, regardless of specialty, had a greater number of research experiences than unmatched applicants. Oral presentations and poster presentations abstracts are quickly becoming a preferred strategy of and soft requirement for gaining admittance to highly selective residency programs- including surgical and surgical subspecialities.Funding the cost of attendance poses a significant barrier to student engagement at conferences, as many students are in debt- this problem is amplified for students coming from economically underserved populations.

Methods: We administered a 14-point questionnaire to gather data on conference attendance history, funding sources, amount of reimbursement, and perceptions regarding the importance of research. The survey was distributed via social media platformsand sent to research deans at medical schools across the country. Anonymous responses were collected from May 2023-October 2023.

Results: A total 299 student responses from (x) medical schools were recorded- x allopathic, x osteopathic. 72.14% of students attended to present or network at a conference, and 55.64% of participants responded that they presented an oral or poster presentation. The mean reimbursement that osteopathic schools provided to students was $540 and allopathic reimbursement was $935 (p<0.05). Osteopathic students on average had to pay $727 out of pocket to attend conferences (range $10-2000, while allopathic student paid $799 (range $0-3500). 61.6% of participants believed that a lack of financial support has impacted my ability to attend and/or present at a conference.

Conclusions: Our study reveals disparities in funding opportunities for osteopathic medical students and allopathic medical students. In addition, both osteopathic and allopathic medical students face burdens when it comes to the cost of attending conferences to present research and network. Our findings highlight the need for equitable funding opportunities- ensuring that all students have the opportunity to present their research and network in their specialty of interest. Further research and advocacy are necessary for all students to have an equal playing field when applying to residency programs.

Informed Consent: Medical students were consented into the study as the initial question for the survey.

Ethical Approval & IRB and/or IACUC Approval: The study was reviewed and approved by the KCU IRB, 2030932-1

Financial Disclosure: None reported.

Poster No. *C-1

Abstract No. 2024-002

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Effects of State-Trait Anxiety on the Thoracic Diaphragm and Related Fascias

Andrew Nguyen, OMS-III, Anton Livshin, OMS-IV, Anna Perez, OMS-III, Cristian Ramirez, OMS-II, Samantha Rose Kiernan, OMS-II, Sydney Sirota, OMS-III, William Gallopp, OMS-III, Benjamin Chaiprasert, OMS-II, Adham Gabr, OMS-II, Mikhail Volokitin, MD, DO

Department of Osteopathic Manipulative Medicine, Touro College of Osteopathic Medicine (TouroCOM-Middletown Branch Campus), Middletown NY

Context: Multiple studies have discussed the fascia’s influence in regulating the hypothalamic-pituitary axis and the autonomic nervous system, ultimately affecting neuropsychiatric health (1). In the realm of osteopathic medicine, there is growing curiosity about the presence and severity of somatic dysfunctions (SDs) in fascia and its surrounding structures that can manifest in different clinical subtypes of anxiety–such as state and trait (2). State anxiety is the proclivity of one to perceive a situation as threatening and transiently experience apprehension, tension, and dread (3). Trait anxiety is the stable inclination to experience state anxiety to varying external stimuli (3).

Objective: To examine how state-trait anxiety manifests in one’s SDs by comparing Osteopathic Structural Exam (OSE) findings to scores taken from the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) questionnaire.

Methods: A cross-sectional study was performed with 200 Touro medical students across the Harlem, Middletown and Montana campuses. Participants were recruited by email, and the study excluded those with any clinically diagnosed psychiatric conditions. Each participant completed the STICSA and subsequently underwent an OSE conducted by student investigators. Tissue texture changes, asymmetries, and restricted ranges of motion within thoracic structures and fascia were quantified based on presence and severity. Numerical scores collected from the STICSA and the OSE were analyzed using Pearson’s coefficient. Data was later stratified to compare selected thoracic structures’ SDs with somatic and cognitive components of state and trait anxiety using a correlation matrix.

Results: Significant positive correlations were found between thoracic inlet (R= 0.998, p= 0.038) and thoracic spine (R= 1, p= 0.003) SD totals and state anxiety STICSA totals. Similarly, positive correlations were found between thoracic inlet (R= 1, p= 0.013) and thoracic spine (R= 0.997, p= 0.048) SD totals and state-cognitive anxiety STICSA totals. There was no significant correlation found between any structure and trait anxiety STICSA totals.

Conclusion: Though correlations between state-trait anxiety and osteopathic SDs varied among campuses, association of SDs from specific structures such as thoracic inlet, sternum, and thoracic vertebrae held significance across all three. By honing in on the impacts that fascia and its surrounding structures have on one’s physical and mental health, osteopathic physicians are better able to holistically treat their patients through more interpersonal, cost-effective, and sustainable modalities such as Osteopathic Manipulative Medicine.

References

1. Fornari M, Carnevali L, Sgoifo A. Single Osteopathic Manipulative Therapy Session Dampens Acute Autonomic and Neuroendocrine Responses to Mental Stress in Healthy Male Participants. J Am Osteopath Assoc. 2017;117(9):559-567. doi:10.7556/jaoa.2017.110

2. Tozzi P. Selected fascial aspects of osteopathic practice. J Bodyw Mov Ther. 2012;16(4):503-519. doi:10.1016/j.jbmt.2012.02.003

3. Endler NS, Kocovski NL. State and trait anxiety revisited. J Anxiety Disord. 2001;15(3):231-245. doi:10.1016/s0887-6185(0100060-3)

Informed Consent: Before registering for our study, participants were asked to read and sign a detailed consent form outlining that the study was voluntary and they could withdraw their consent to participate at any time without any negative consequences. No compensation was offered for participation in this study. Participation or non-participation in no way impacts their current employment/education/medical treatment or any services that they received. During interviews, they can refuse to answer any question presented to them. They may also ask to stop the osteopathic structural examination at any point.

Ethical Approval & IRB and/or IACUC Approval: This study was approved by Touro, New York’s Institutional Review Board (IRB) Office on 02/3/2023, with continued approval on 01/18/2024. Extensive discussion on the context, background, materials, methods, and analysis was established in the proposal. IRB Protocol ID is 16059.

Financial Disclosure: None reported.

Poster No. C-2

Abstract No. 2024-008

Category: Clinical

Research Focus Area: Impact of OMM & OMT

Improving Sleep with OMT: A Randomized Controlled Trial using Cervical Techniques to Improve Sleep for OMSI

¹Dat Le, DO, ²December Fagen, OMS-II, ²Spencer Christensen, OMS-II, ²Chloe Jensen OMS-II, ²Amaya Alacron, OMS-II, ²Richard Slife, OMS-II, ²Chandini Thakur, OMS-II, ²Ruthanne Teo, OMS-II, ²Grace Spradley, OMS-II, ²Stephanie Jackson, OMS-II, ²Pegah Zamanian, OMS-II, ²Darian Finley, OMS-II, ²Nicholas Tran, OMS-II, ²Albert Tran, OMS-II, ²Kaitlyn Redeman, OMS-II, ³Andrew Marble, ⁴Dr. James Keane, ⁴Dr. Melchiorra Mangiaracina

¹Department of Internal Medicine, UPMC Lititz, Lititz, PA; ²A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ³Department of Statistics, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ⁴Department of Osteopathic Manipulative Treatment, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ

Context: Recent research findings indicate that a significant portion, specifically 55.64%, of medical students report experiencing suboptimal sleep quality, averaging 6.5 hours of sleep, with 30% obtaining less than 7 hours [1]. The impact of sleep on learning and academic performance is well-documented [2]. Stress, a prevalent factor in medical school, can lead to heightened sympathetic activity, contributing to sleep disorders such as excessive daytime sleepiness and insomnia [3]. It is hypothesized that medical students may be in a hyper-sympathetic state, resulting in autonomic dysfunction throughout their educational journey.

Studies have shown that vagus nerve stimulation (VNS) can help regulate the autonomic system by balancing sympathetic and parasympathetic activity [4]. While cervical non-invasive VNS has proven effective in managing sleep-related issues [5], the use of Osteopathic Manipulative Treatment (OMT) for autonomic dysfunction in this context remains unexplored. However, previous research has demonstrated an increase in parasympathetic activity through OMT, leading to a reduction in heart rate [6].

Objective: Therefore, this randomized clinical trial aims to investigates the potential advantages of OMT, incorporating cervical soft tissue therapy and OccipitoAtlantal (OA) decompression, in modulating the autonomic system over a six week period to improve sleep quality among OMS-I students at A.T. Still University (ATSU) in Arizona, measuring the sleep quality through the Pittsburgh Sleep Quality Index (PSQI) [7].

Methods: A cohort of 41 participants was recruited from ATSU during the fall quarter of 2023 to engage in a 6-week study involving OMT sessions conducted thrice weekly on Mondays, Wednesdays, and Fridays. The Principal Investigator ensured the removal of personal identifiers, and subjects were allocated randomly through a number generator. Subsequently, they were randomly divided into two distinct groups: a control group comprising 20 individuals and a treatment group consisting of 21 participants. The treatment team administered interventions, while the data team was responsible for data collection. Both teams were only privy to the subjects’ identities through their assigned numerical labels. Throughout the course of the study, one member from the treatment group and three from the control group withdrew from participation.

The inclusion criteria stipulated the enrollment of exclusively medical students from the class of 2027 at ATSU in Arizona to maintain uniformity in stress levels attributed to examinations and academic tasks. Eligibility for participation was extended to individuals of any gender, ethnicity, or national origin. Subjects who did not meet these predefined criteria were excluded from the study.

The exclusion criteria encompassed individuals with documented sleep disorders, neurological conditions, ongoing medical treatments affecting sleep patterns, contraindications for OMT, or those unable to utilize designated data collection applications. Additionally, individuals unable to attend all sessions over the six-week period were also excluded from participation.

The treatment subjects underwent a 5-minute cervical soft tissue procedure, followed by 2-3 minutes of OA decompression, plus 2-3 minutes of rest, totaling a 10-minute session. These treatments were administered by second-year osteopathic medical students who were trained and supervised by OMT faculty at ATSU.

The control subjects maintained a supine position for an equivalent duration. Implementing a sham trial for the control group was deemed unfeasible due to documented evidence indicating that touch interventions have demonstrated efficacy in alleviating stress among adult individuals [8].

Both cohorts completed the weekly PSQI assessment via a Google Form. The responses were converted into scaled scores ranging from 0 to 3, where higher scores denoted increased sleep disturbances and lower scores indicated fewer disruptions. The anonymized data was subsequently transferred to a dedicated Google sheet for analysis by distinct team members. Additional data points gathered included height, weight, gender, last menstrual period, bed size, and presence of pets.

The statistical analysis encompassed paired sample t-tests utilizing the PSQI scores, following a within-subjects design to track changes within each participant over the weeks. The primary focus of the study was to examine the variation in PSQI scores pre and post treatment between the treatment and control groups. A 95% confidence interval was established around the mean difference, with a significance level set at α=0.05.

Results: The comprehensive PSQI scores of both the treatment and control groups exhibited a substantial decrease from the baseline at week 0 to the assessment at week 6, as illustrated in Figure 1. While the treatment group showed a more pronounced reduction in PSQI score compared to the control group, statistical analysis using Mann-Whitney U tests did not yield statistically significant results (p = 0.234). While the overall comparison does not yield statistical significance, it is noteworthy that was a trend towards significance and may potentially achieve significance with an expanded sample size and/ or duration.

Upon stratifying participants based on their Body Mass Index (BMI), as depicted in Figures 2 and 3, individuals with a BMI 25 did not exhibit a statistically significant effect when compared to the control groups (p = 0.857) when compared to the control group, as detailed in Table 1.

Conclusion: The data suggests promising outcomes in enhancing sleep quality. The less favorable trend observed in individuals with a BMI > 25 may be attributed to the presence of Obstructive Sleep Apnea (OSA), with overweight or obese individuals being at a heightened risk [9]. OSA is estimated to affect 1 in 20 adults, leading to behavioral and cardiovascular complications [10]. Overcoming the effects of OSA may necessitate a longer duration of treatment. Nevertheless, it is possible that the current intervention may not be sufficient to fully address OSA, and additional measures such as weight management with OMT could be considered to achieve statistical significance.

Further research supported by funding could leverage smart devices for monitoring sleep patterns and academic stress may offer valuable insights into the mechanisms underlying autonomic dysfunction induced by the stress of medical education. Prior studies have demonstrated that academic stress can elevate sympathetic activity, as evidenced by alterations in heart rate variability and salivary alpha-amylase levels [11]. Parameters such as heart rate variability, electrodermal activity, and potentially respiratory rate could serve as indicators of stress and anxiety levels over time [12], aiding in the optimization of treatment duration, frequency, and intensity. Nonetheless, the current study provides evidence that a standardized OMT regimen administered over 6-week period yields improvements in sleep quality for students with a BMI < 25.

References

1. Perotta, B., Arantes-Costa, F.M., Enns, S.C. et al. Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students. BMC Med Educ 21, 111 (2021). https://doi.org/10.1186/s12909-021-02544-8

2. Brick CA, Seely DL, Palermo TM. Association between sleep hygiene and sleep quality in medical students. Behav Sleep Med. 2010;8(2):113-21. doi: 10.1080/15402001003622925. PMID: 20352547; PMCID: PMC3572193.

3. Olivares MJ, Toledo C, Ortolani D, et al. Sleep dysregulation in sympathetic-mediated diseases: implications for disease progression. Sleep. 2022;45(11):zsac166. DOI: 10.1093/sleep/zsac166

4. Zhang L, Jin Y, Zhang Q, Liu H, Chen C, Song L, Li X, Ma Z, Yang Q. Transcutaneous Vagus Nerve Stimulation for Insomnia in People Living in Places or Cities with High Altitudes: A Randomized Controlled Trial. Brain Sciences. 2023; 13(7):985.

5. Kinfe TM, Pintea B, Muhammad S, Zaremba S, Roeske S, Simon BJ, Vatter H. Cervical non-invasive vagus nerve stimulation (nVNS) for preventive and acute treatment of episodic and chronic migraine and migraine-associated sleep disturbance: a prospective observational cohort study. J Headache Pain. 2015;16:101. doi: 10.1186/s10194-015-0582-9

6. Giles PD, Hensel KL, Pacchia CF, Smith ML. Suboccipital decompression enhances heart rate variability indices of cardiac control in healthy subjects. J Altern Complement Med. 2013 Feb;19(2):92-6. doi: 10.1089/acm.2011.0031

7. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. doi: 10.1016/0165-1781(8990047-4). PMID: 2748771.

8. Dreisoerner A, Junker NM, Schlotz W, Heimrich J, Bloemeke S, Ditzen B, van Dick R. Self-soothing touch and being hugged reduce cortisol responses to stress: A randomized controlled trial on stress, physical touch, and social identity. Compr Psychoneuroendocrinol. 2021 Oct 8;8:100091. doi: 10.1016/j.cpnec.2021.100091.

9. Shinohara E, Kihara S, Yamashita S, et al. Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J Intern Med. 1997;241:11–8.

10. Young, Terry, Paul E. Peppard, and Daniel J. Gottlieb. “Epidemiology of obstructive sleep apnea: a population health perspective.” American journal of respiratory and critical care medicine 165.9 (2002): 1217-1239.

11. Nater, U. M., et al. “Changes in sympathetic activity in medical students under academic stress.” Psychoneuroendocrinology, vol. 33, no. 10, 2008, pp. 1309-1318.

12. Hickey BA, Chalmers T, Newton P, Lin CT, Sibbritt D, McLachlan CS, Clifton-Bligh R, Morley J, Lal S. Smart Devices and Wearable Technologies to Detect and Monitor Mental Health Conditions and Stress: A Systematic Review. Sensors (Basel). 2021 May 16;21(10):3461. doi: 10.3390/s21103461.

Informed Consent: A consent form was developed and received approval from the ATSU Arizona Institutional Review Board. Each participant was provided with the consent form and requested to return it if they wish to partake in the research study. The form clearly states that participation is entirely voluntary. Should they choose to participate, they retain the option to withdraw at any point. It is important to note that the study is separate from your OPP class, and therefore, their academic standing will not be affected positively or negatively based on their participation. Any shared data will be anonymized and identified solely by a number. Access to the file linking names to numbers will be restricted to Principal Investigators only.

Ethical Approval & IRB and/or IACUC Approval: 2023-042 ATSU IRB Minimal risk letter 03May2023.pdf ; Approved by the ATSU Arizona Institutional Review Board on 03 May 2023 as an non-exempt minimal risk protocol #2023-042

Financial Disclosure: None reported.

Poster No. C-3

Abstract No. 2024-013

Category: Clinical

Research Focus Area: Acute and Chronic Pain Management

The Feasibility and Acceptability of Virtual Reality on Perceived Pain and Anxiety During Bone Marrow Biopsies

Stephen DiGiuseppe, PhD, Ajay Mittal, BS, Yaroslav Zuyev, BS, Navjot Singh Azad, BS, ⁵Tung Wynn, MD

Division of Biomedical Sciences, Edward Via College of Osteopathic Medicine (VCOM-Louisiana Branch Campus), Monroe, LA

Context: Virtual Reality (VR) is an emerging technology that provides an immersive user experience. While VR has been typically used for entertainment, immersive VR experiences also can be employed in healthcare settings to provide distraction for patients who experience anxiety commonly associated with certain medical procedures [1]. A recent study published found VR to be an underutilized intraoperative tool that enhanced the overall patient experience [2]. VR shows promise that it may even reduce perceived pain in emergency rooms as a non-pharmacological approach to supplement pain management [3]. Another recently published study found that we are likely to see the widespread implementation of VR in healthcare settings over the next decade [4]. Despite recent advances in VR technology, there are still only a few research studies that have been conducted to assess how effective it is when used in a healthcare setting [5]. Bone marrow biopsies are medical procedures where a needle is inserted into the bone and a syringe is used to withdraw the liquid bone marrow. They are performed to diagnose and monitor disorders affecting the blood, often as part of care for hematology and oncology patients. Since this procedure is known to cause anxiety and pain, virtual reality can offer a distraction-based therapy for patients to better tolerate the procedure and be a safer alternative to increasing pain medications.

Objective: The purpose of this pilot study is to assess the feasibility of VR as an adjunctive therapy to alleviate the perception of pain and anxiety in patients receiving bone marrow biopsies.

Methods: This pilot study enrolled adult participants from the University of Florida Health Oncology and Hematology ward. Inclusion criteria included patients who were scheduled to receive a bone marrow biopsy, were older than 18 years of age, and could physically tolerate wearing a VR headset. Patients were excluded from the study if they required urgent procedures for severe, acute illnesses, had physical limitations preventing the use of a VR headset, or were deemed medically unstable to take part in the study. Sixty participants were recruited in total with thirty participants randomly assigned into the ‘control’/non-VR intervention group and thirty participants assigned into the ‘experimental’/VR-intervention groups. The experimental group utilized the Meta Quest 2 headset (Meta, Menlo Park CA) to experience the ‘HealthPointXR’ app (Gainesville, Florida) which displayed original VR content developed to provide a distracting and relaxing experience for participants while the control group received no distraction during their bone marrow biopsy. Participants in both the experimental and control group reported their pain, anxiety, worry, and comfort levels before and after the bone marrow biopsy procedure on a scale of 1-5 using a verbal numerical rating scale (VNRS). A score of 1 correlated with experiencing no pain, anxiety, or worry and having no sense of comfort while a score of 5 correlated with experiencing extreme pain, anxiety, or worry and being in optimal comfort. The two groups were compared using independent t-tests with Cohen’s D measure of effect size. For any measure taken before and after the procedure, the difference between the two was calculated and used to compare the groups for the t-tests. Additionally, measurements of heart rate, respiratory rate, oxygen saturation, and total length of procedure were gathered for both the experimental and control groups before and after the bone marrow biopsy procedure. The patients’ awareness of the procedure, distractibility during the procedure, and likelihood to repeat the procedure were also assessed on a scale of 1-5 using the VNRS to gain insight into overall satisfaction with the procedure.

Results: Participants in the VR group (M = 2.13, SD ± 1.26) responded with significantly lower feelings of anxiety compared to the control group (M = 3.42, SD ± 1.46), t(57) = -3.73, p d = 0.95. Participants in the VR group (M = 4.45, SD ± 1.12) had significantly higher feelings of comfort compared to the control group (M = 2.10, SD ± 1.27), t(59) = 7.73, p d = 1.96. There were no significant differences between the VR and control groups for pain and worry either before or after the procedure. Additionally, there was no significant difference within either the VR or control group for the difference in pain or worry perception before and after the procedure. Participants in the VR group (M = 4.29, SD ± 1.19) were significantly more likely compared to the control group (M = 1.55, SD ± 0.93) to rate the distraction as effective t(57) = 10.14, p d = 2.57. Notably, the average procedure duration was significantly shorter in the VR group (M = 23.94, SD ± 9.72) compared to the control group (M = 31.94, SD ± 15.34), t(51) = -2.45, p =.018, d = 0.62. Overall, the results of the surveys suggest a 2-3 point higher score in level of immersion, likelihood to repeat use of intervention, and comfort level in the VR group compared to the control group using a 5-point scale. The majority of patients expressed a willingness to use VR as a distraction-based tool during bone marrow biopsies.

Conclusion: Our investigation encourages the acceptability of using VR intervention for patients undergoing bone marrow biopsies. Furthermore, the length of procedures were found to be shorter when compared to the control group - supporting the feasibility of VR technology for clinical management. However, there are limitations for utilizing VR in healthcare such as patients feeling claustrophobic or experiencing motion sickness. Despite these limitations, our data suggests that VR can be used as a distraction-based therapy that is non-inferior to standard of care and provides enjoyable user experiences that reduce the perceived pain and anxiety of non-sedated medical procedures.

References

1. Birrenbach, T., Bühlmann, F., Exadaktylos, A. et al. Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study. BMC Emerg Med 22, 113 (2022). https://doi.org/10.1186/s12873-022-00671-z

2. Alaniz L, Sayadi L, Pakvasa M, Stulginski A, Cordero J, Prabhakar N, Wang E. Use of Virtual Reality in Emergency Room Hand Procedures. Plast Reconstr Surg Glob Open. 2023 Oct 18;11(10 Suppl):65-66. doi: 10.1097/01.GOX.0000992212.01357.a1. PMCID: PMC10566939.

3. Schulz JB, Dubrowski P, Blomain E, Million L, Qian Y, Marquez C, Yu AS. An Affordable Platform for Virtual Reality-Based Patient Education in Radiation Therapy. Pract Radiat Oncol. 2023 Nov-Dec;13(6):e475-e483. doi: 10.1016/j.prro.2023.06.008. Epub 2023 Jul 22. PMID: 37482182.

4. Suh I, McKinney T, Siu K-C. Current Perspective of Metaverse Application in Medical Education, Research and Patient Care. Virtual Worlds. 2023; 2(2):115-128. https://doi.org/10.3390/virtualworlds2020007

5. Son H, Ross A, Mendoza-Tirado E, Lee LJ. Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing. JMIR Nurs. 2022 Mar 16;5(1):e34036. doi: 10.2196/34036. PMID: 35293870; PMCID: PMC8968556.

Informed Consent: After having identified eligible participants for this study, trained research assistants approached and recruited them. If these eligible participants were interested, a trained study member would review and obtain consent directly from the participant. A standardized informed consent script has been adhered to ensure consistency in the consenting process. Participants did receive a copy of the informed consent document.

Ethical Approval & IRB and/or IACUC Approval: VR IRB Approval Form.pdf ; Approved As Expedited (Contingencies Met).

Financial Disclosure: None reported.

Poster No. C-4

Abstract No. 2024-019

Category: Clinical

Research Focus Area: Impact of OMM & OMT

The Effect of Osteopathic Manipulative Treatment in Chronic Rhinosinusitis

¹Marija Rowane, DO, ²Ashwin Shankar, DO, ²Supriya Nagireddi, DO, ²Aman Kallat, MD, ³Meghan Callahan, OMS, ⁴Eshika Kohli, OMS, ⁵Cheryl Hammes, DO, FACOFP, ⁶Robert Hostoffer, DO, LhD, MSMed, MBA, FACOP, FAAP, FACOI, FCCP

¹Department of PediatricsOklahoma State University Center for Health Sciences, Tulsa, OK; ²Department of Pulmonary and Critical Care, University Hospitals, Cleveland Medical Center, Cleveland, OH; ³Lake Erie College of Osteopathic Medicine at Elmira, Elmira, NY; ⁴Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA; ⁵Osteopathic Manipulative Medicine Department, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH; ⁶Allergy/ Immunology Associates, Inc., Mayfield Heights, OH

Context: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the paranasal sinuses that may significantly impair quality of life (1-2). The standard approach to CRS management involves patient education, environmental controls, medical management, and consideration of allergen-specific immunotherapy and surgical management. CRS may also benefit from application of manual techniques through Osteopathic Manipulative Treatment (OMT), which aims to improve venous and lymphatic circulation, sympathetic and parasympathetic outflow, and cervicothoracic somatic dysfunction (3-8). Application of manual lymphatic techniques in several experimental animal models enhanced lymphatic circulation of inflammatory mediators, suggesting restored fluid homeostasis (9-10). Several small-scale cohort studies reported significantly improved sinusitis-associated symptoms, in comparison of pre- versus post-surveys, after application of a consistent OMT sequence (11-12). There is a deficit of large-scale studies in the osteopathic literature investigating temporary and sustained outcomes of OMT application in CRS.

Objective: To assess if OMT focused on lymphatic drainage of cranial structures can provide immediate, as well as sustained, relief of chronic rhinosinusitis symptoms.

Methods: This prospective, single-blinded study (WCG IRB Study Number 1359444) was conducted at an allergy/ immunology practice. Study participants included 43 adult patients, with a diagnosis of CRS, refractory to conventional medical therapy, with prior exposure to OMT. Exclusion criteria included patients who were under 18 years old, pregnant, diagnosed with CRS with nasal polyposis, prescribed oral corticosteroids or acute antibiotics within the past week, uncontrolled with moderate persistent asthma, and currently using tobacco products. Patients consented to the study and were assigned by the provider to the OMT group or the control group 50/50. A 4-question, 5-point Likert scale survey inquiring about the severity of nasal congestion, post-nasal drainage, and facial or sinus pain/ pressure, as well as the appreciation of the opportunity for an alternative therapy, was administered prior to the intervention. An OMT sequence was applied by the same osteopathic physician to each OMT group participant in the following order: Thoracic Inlet Release, Venous Sinus Drainage, Occipital-Atlantal Decompression, Thoracic Paraspinal Inhibition, Facial Sinus Pressure, and Galbreath Technique. A structural exam involving light touch was applied to control group participants. The same 5-point Likert scale survey was administered immediately after the intervention. Participants were provided a blank copy of the survey to save and complete 10 days after the intervention. OMT group participants also received a handout with a video link and guide to self-applied techniques to practice at home. A small gift card was provided as compensation to participants who returned their completed third survey. A paired t-test was applied for statistical comparison between the pre- and post-surveys.

Results: A total of 43 patients, including 22 patients in the treatment group (51.1%) and 21 (48.8%) patients in the control group, consented to and participated in the study, from May 1 to 30, 2024. Study demographics included 76.7% females (n = 33), 23.3% males (n = 10), 97.7% white (n = 42), and an average age of 54.4 years. Surveys administered before and immediately after the intervention were completed by 100% of the study participants. All three surveys, including the pre-survey and post-surveys completed immediately after and 10 days after the intervention, were completed by 60.5% of study participants. OMT group pre- versus immediate post-survey results scored a statistically significant decrease in the severity of nasal congestion (p = 0.001), post-nasal drainage (p = 0.002), and facial or sinus pain or pressure (p = 0.0004). Less statistical significance was measured in the comparison OMT group pre- versus immediate post-survey results scoring appreciation for an alternate therapy (p = 0.01). No statistically significant difference was demonstrated in all control group pre- versus immediate post-survey results (average p = 0.32). No statistically significant difference was computed, in comparison of pre-survey versus 10-day post-survey results, for both the treatment (average p = 0.28) and control groups (average p = 0.22).

Conclusion: Our single-blinded, prospective survey findings suggested the benefit of OMT application for immediate relief of CRS symptoms, predominantly in alleviating the severity of sinus pain or pressure. Long-term efficacy of OMT for CRS symptomatic relief was not strongly supported by the data. This study expanded upon previous studies applying OMT to sinusitis management (11-12), through implementation of a control group, increased sample size, and evaluation of sustained symptomatic relief. Limitations in location, racial diversity, and duration variability of each encounter may be considered for future iterations of this study. OMT offers a safe, non-pharmacological complementary therapy to relieve lymphatic congestion and improve mucociliary clearance in CRS (3-8, 11-12).

References

1. Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500-506.

2. Bachert C, Marple B, Schlosser RJ, et al. Adult chronic rhinosinusitis. Nat Rev Dis Primers. 2020;6(1):86. https://doi.org/10.1038/s41572-020-00218-1.

3. Wu SS, Graven K, Sergi M, Hostoffer R. Rhinitis: The Osteopathic Modular Approach. J Am Osteopath Assoc. 2020;120(5):351-358. doi:10.7556/jaoa.2020.054

4. Wu SS, Hostoffer RW, Gibbons K, Shaw HH, Shaw MB. 48A(1): Osteopathic Considerations in Patients with Head, Eyes, Ears, Nose, and Throat Disorders. In: Seffinger MA, et al, eds. Foundations of Osteopathic Medicine: Philosophy, Science, Clinical Applications, and Research, 4e. Wolters Kluwer; 2018:1386-1404.

5. Wu SS, Hostoffer RW, Gibbons K, Shaw HH, Shaw MB. 48A(2): Rhinosinusitis. In: Seffinger MA, et al, eds. Foundations of Osteopathic Medicine: Philosophy, Science, Clinical Applications, and Research, 4e. Wolters Kluwer; 2018:1404-1411.

6. Nelson KE, Allgeier J. Chapter 24: The Patient with an Upper Respiratory Infection. In: Nelson KE, Glonek T, eds. Somatic Dysfunction in Osteopathic Family Medicine, 2e. Wolters Kluwer Heath/American College of Osteopathic Family Physicians; 2015.

7. Kuchera ML, Kuchera WA. Osteopathic Considerations in HEENT Disorders. Greyden Press; 2012.

8. DiGiovanna EL, Phykitt DE, Ferris MT. Chapter 111: HEENT Applications. In: DiGiovanni EL, Amen CJ, Burns DK, eds. An Osteopathic Approach to Diagnosis and Treatment, 4e. Lippincott, Williams & Wilkins; 2020:527-537.

9. Schander A, Downey HF, Hodge LM. Lymphatic pump manipulation mobilizes inflammatory mediators into lymphatic circulation. Exp Biol Med (Maywood). 2012;237(1):58-63. doi:10.1258/ebm.2011.011220

10. Castillo R, Schander A, Hodge LM. Lymphatic pump treatment mobilizes bioactive lymph that suppresses macrophage activity in vitro. J Am Osteopath Assoc. 2018;118(7):455-461. doi:10.7556/jaoa.2018.099

11. Lee E, Lo J, Tran J, Redding D. Osteopathic manipulative treatment for sinusitis relief: A pilot study. Osteopathic Family Physician. 2022;14(2),10–14. doi:10.33181/13065

12. Lee-Wong M, Karagic M, Doshi A, Gomez S, Resnick D. An Osteopathic Approach to Chronic Sinusitis. J Aller Ther. 2011;2:109. doi:10.4172/2155-6121.1000109

Informed Consent: Individuals who expressed interested in study participation and qualified for the study on the basis of the inclusion and exclusion criteria were provided the IRB-approved “Consent for Treatment” form (WCG IRB Protocol No. 20233712). The “Consent for Treatment” document detailed the study contact information, description, purpose, background, procedure, duration, risks and benefits, and right to withdraw. Any questions or concerns regarding the study were addressed. Individuals in agreement with the study verified their consent with a written signature at the end of the “Consent for Treatment” document.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-5

Abstract No. 2024-032

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Effect of Homoarginine on Food Consumption and Cardiac Function in Mice

Neil Kaungumpillil, OMS-II, Billy X. Ding, Mohnish Singh, Olga V. Savinova

Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, NY

Context: Homoarginine (hArg) is a non-proteinaceous endogenous amino acid that is correlated with a better prognosis for cardiovascular and renal disease.1 2 hArg supplementation was previously found to reduce food consumption and improve heart function in mice with chronic kidney disease (CKD). However, hArg is safe and has any effects in healthy control mice has not been tested.

Objective: To compare the cardiac and metabolic effects of homoarginine supplementation in healthy mice and mice with CKD. The data could provide insight into the potential benefits of hArg supplementation for treatment of CKD in humans.

Methods: Mice: C57BL/6 mice (18 females and 19 males) were randomly assigned into one of three groups receiving 14 μg/ml of hArg or a placebo of plain drinking water. Mice were 13.8 weeks old at baseline and were treated for 12.5 weeks.

Metabolic Cage: Metabolic data were collected at the baseline and final timepoints. Metabolic cages were used in the collection of metabolic data, which included food and water consumption, fecal and urine output following 24 hours.

Echocardiography: Vevo 3100 echocardiograms (FujiFilm Visual Sonics) were used to assess cardiac physiology and function at the end of the study. Mice were anesthetized with 2% aerosolized isoflurane, fur was removed for the chest, and body weights (BW) were recorded. Mice were kept on a heated stage set at 40-42°C, and echocardiogram images were collected in B mode on the long axis and M mode on the short axis. While images were being collected, heart rate (HR) and respiratory rate were monitored. The echocardiogram images were analyzed with Vevo Lab software, and the M mode images were traced to obtain various cardiac parameters, including ejection fraction (EF, %), fractional shortening (FS, %), cardiac output (CO, ml/min), left ventricular mass (LV mass, mg), LV posterior wall thickness (LVPW, mm), and LV internal diameter (LVID, mm). All measurements, excluding HR, FS, and EF. were adjusted to BW before the analysis.

Data Analysis: Analysis of metabolic and cardiac effects of hArg and Arg supplementation was conducted using GraphPad Prism Software (San Diego, CA, USA). Two-way ANOVA was used to analyze the effects of sex and the treatment (placebo, hArg, Agg). Data from a previous CKD ± hArg study was used for comparison to the data obtained from this study. The statistical significance was set to pOsteopathic Significance: As osteopathic physicians in training, we are taught the four tenets of osteopathic medicine, one of which is the body is a living unit. The treatment of patients with CKD is dependent on monitoring cardiovascular and metabolic health.

Results: Supplementation with hArg did not affect metabolic parameters in the healthy mice group. These findings were in contrast with those previously collected in CKD mice in which hArg supplementation was associated with reduced 24-hour food consumption p.

Conclusions: hArg supplementation has a notable metabolic effect in cardiac effects in CKD. hArg supplementation of healthy mice was nonconsequential, suggesting a good safety profile of hArg supplementation in healthy in healthy animals under the conditions of the study. The small number of mice analyzed for each group limited the study, and having a larger number of mice enrolled in the study could serve to provide greater accuracy and increased statistical power. The stress induced by confinement in the metabolic cages could also serve as another limitation of the study. Although mice have a physiology that is not fully comparable to that of humans, the results suggest that further research could be conducted into the use of hArg in CKD patients, especially for the prevention of cardiovascular morbidity and mortality in this patient population. hArg supplementation leads to a reduction in food consumption, which, over time, can improve body weight. As body weight is correlated with an increased risk of ASCVD events3, hArg could serve as a useful tool in improving overall cardiovascular and metabolic health in CKD patients.

References

1. Pilz S, Meinitzer A, Gaksch M, et al. Homoarginine in the renal and cardiovascular systems. Amino Acids. 2015;47(9):1703-1713. doi:10.1007/s00726-015-1993-2

2. Drechsler C, Kollerits B, Meinitzer A, et al. Homoarginine and progression of chronic kidney disease: results from the Mild to Moderate Kidney Disease Study. PLoS One. 2013;8(5):e63560. Published 2013 May 15. doi:10.1371/journal.pone.0063560

3. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2021;143(21). doi:10.1161/cir.0000000000000973

Informed Consent: Not Applicable

Ethical Approval & IRB and/or IACUC Approval: The NYIT Institutional Animal Care and Use Committee (IACUC) has approved the study (protocol# 2019-OS-01).

Financial Disclosure: None reported.

Poster No. C-6

Abstract No. 2024-033

Category: Clinical

Research Focus Area: Musculoskeletal Injuries and Prevention

Exploring the Impact of Musculoskeletal Conducting Injuries in Choral Music Educators: An Osteopathic Survey Analysis

¹Stephanie Li, OMS-IV, ²Brianne Wehner, DO, ³Ryan Sullivan, DMA, ³Colleen McNickle, PhD

¹Department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine at Arkansas State (NYITCOM at Arkansas State University), Jonesboro, AR; ²Department of Osteopathic Manipulative Medicine, Duquesne University College of Osteopathic Medicine, Pittsburgh, PA; ³Department of Music, New York Institute of Technology College of Osteopathic Medicine at Arkansas State (NYITCOM at Arkansas State University), Jonesboro, AR

Context: There is limited scientific literature evaluating choral conductors, a prominent group of performing arts professionals. This study surveyed the subgroup of choral music educators and the prevalence of conducting-related musculoskeletal injury. This population faces occupational risk factors associated with repetitive upper extremity conducting motions and long standing hours, leading to potential injury [1-3]. Osteopathic manipulative treatment (OMT) has been studied and may show benefit in instrumentalists and vocalists but is limited in choral conductors [4-6]. An osteopathic approach will guide physicians to further understand physical symptoms, risk factors and attitudes surrounding injury in this occupation.

Objective: To identify location, number, mechanism and effect of musculoskeletal conducting injuries in choral music educators. To identify attitudes surrounding work and injury and their association with personal identity. To understand how osteopathic physicians can partner with these professionals for injury prevention and individualized treatment.

Methods: This was a clinical, survey-based study. An online Qualtrics qualitative survey was created by the investigators examining occupational demographics, attitudes towards occupational injury, and injury symptoms and experience. A body diagram from the validated Nordic Musculoskeletal Questionnaire was used to visually indicate areas of injury, in addition to selectable and open-ended text response questions for elaboration [7]. Likert scales of agreement levels were used for attitude statements regarding occupation and injury.

Participants were choral music educators who were actively teaching or retired. Volunteers were broadly recruited through online music educator forums, social media, and a research call through a national choral association’s email list. Undergraduate students were not permitted to progress through the survey, and current and retired choral directors were permitted to continue.

Differences between the stages of teaching career: graduate student, early career (0-9 years), mid career (10-19 years), late career (20+ years), and retired professional were assessed for categorical variables using a chi-squared test. Variables included the category of primary injury (none, repetitive stress, acute) and number of reported injuries (zero, one, two or more). Alpha was set at 0.05. Incomplete surveys were excluded. The osteopathic significance is demonstrated by the holistic approach of the survey, evaluating attitudes regarding occupational injury and how, in addition to physical symptoms, injury affected the teaching experience of the respondent.

Results: There were 94 respondents, and 75 complete surveys were included for analysis. Response rate was unable to be calculated because the total number of people in online distribution groups was unavailable. The reported injuries were most commonly located in the shoulder (n=14), neck (n=10), hands/wrists (n=8), lower back (n=6), and upper back (n=5). Repetitive stress injuries (n=16) were more common than acute injuries (n=6). These tended to occur in the mid to late career professionals (10-19 or 20+ years teaching) compared to early career professionals (0-9 years teaching). Trends showed some agreement that a participant’s personal identity is tied to being a teacher. Participants disagreed that they were aware of risk for occupation-related injury when starting their careers and that injury is inevitable in this profession. Some agreed that they were equipped with wellness strategies for occupational injury prevention. There was a statistically significant difference between stages of career (graduate student, early, mid, late, retired) and category of primary injury (none, repetitive stress, acute) (p=0.035). There was a statistically significant difference between stages of career and number of reported injuries (zero, one, two or more) p.

Conclusion: Using the Five Models of Osteopathy, biomechanical, neurologic, and behavioral considerations are key to an osteopathic individualized treatment plan in this population of choral music educators. An osteopathic perspective can guide physicians in diagnosing and treating somatic dysfunctions and side effects of nerve entrapment from injury as well as addressing any underlying psychosocial identity concerns that arise with injury. In our study, the reported body regions with musculoskeletal injury and the prevalence of repetitive stress injuries in choral music educators were similar to those found in general conductors in existing literature. Those who were in their late careers had more reported injuries, which shows the importance of injury prevention and best practices at the beginning of a career. The attitude trends regarding occupation and injury could be further explored in future studies and should be holistically considered in addressing injury. Literature has described OMT approaches for musicians like string and piano players with hand/forearm tendonitis or muscle strain, shoulder bursitis, adhesive capsulitis, upper back pain, and neck pain [5]. Future studies could elucidate an approach targeted to choral conductors including the elbows and lower back based on our results. Our results also reported the importance of vocal overuse and injury to participants, which should be noted in the approach to individual care. Other studies have described diagnosis-oriented treatment sessions, trigger point treatment and larynx manipulation for vocalists [4]. These components could be used in future studies examining the effect of clinical OMT in choral conductors. Limitations of this study include a limited sample size from select regions of the United States and lack of participant diversity. The qualitative survey also allowed variability in free-text responses. Future studies may include a larger national sample and use validated pain scales or questionnaires for quantitative analysis. In addition, further studies can guide injury prevention education in training future choral music educators and improve their health outcomes.

References

1. Daley, C., Marchetti, G., & Ruane, M. Injury Prevention for Conductors: Risk Factors, Exercise Interventions, and Ergonomic and Curricular Recommendations. The Choral Scholar and American Choral Review. 2020;58(3).

2. Geraldo, J. A., & Fiorini, C. F. Evaluation of Physical Symptoms in Brazilian Conductors through NMQ and Dash Instruments. Med Probl Perform Art. 2022;37(1):13–23. doi: 10.21091/mppa.2022.1002

3. Kella JJ. Medicine in the Service of Music: Health and Injury on the Podium. Journal of the Conductors’ Guild. 1999;12(1/2):2-15.

4. Kiepe, M.-S., Fernholz, I., Schmidt, T., Brinkhaus, B., Schmidt, A., Weikert, C., & Rotter, G. Effects of Osteopathic Manipulative Treatment on Musicians: A Systematic Review. Med Probl Perform Art. 2020;35(2):110–115. doi: 10.21091/mppa.2020.2017

5. Shoup, D. An Osteopathic Approach to Performing Arts Medicine. Phys Med Rehabil Clin N Am. 2006;17:853–864. doi: 10.1016/j.pmr.2006.07.003

6. Rotter, G., Fernholz, I., Binting, S., Keller, T., Roll, S., Kass, B., Reinhold, T., Willich, S. N., Schmidt, A., & Brinkhaus, B. The Effect of Osteopathic M€edicine on Pain in Musicians with Nonspecific Chronic Neck Pain: A Randomized Controlled Trial. Ther Adv Musculoskelet Dis. 2020;12:1–19. doi: 10.1177/1759720x20979853

7. Kuorinka I., Jonsson B., Kilbom A., et al. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18:233-237. doi: 10.1016/0003-6870(8790010-x)

Informed Consent: All survey participants provided electronic informed consent prior to participation in the study. The survey participant was introduced to the members of the research team and the purpose of the survey. They were informed that their responses would be kept confidential, and the study would take about fifteen minutes to complete. They were given contact information for the investigators and the director of research compliance for Arkansas State University. The participant acknowledged that they were over age 18, were participating voluntarily, and had the right to withdraw at any time during the study for any reason.

Ethical Approval & IRB and/or IACUC Approval: This study was deemed IRB exempt and has the following IRB number: FY22-23-55.

Financial Disclosure: None reported.

Poster No. C-7

Abstract No. 2024-034

Category: Clinical

Research Focus Area: Impact of OMM & OMT

The Effects of Osteopathic Manipulative Treatment on Climbing Performance

¹Brian R. Beyer, OMS-III, ¹Cody Sheppard, OMS-III, ¹Justin Bolig, OMS-III, ²Mohan Muvvala

¹Burrell College of Osteopathic Medicine, Las Cruces, NM; ²Department of Family/Integrative Medicine Burrell College of Osteopathic Medicine, Las Cruces, NM

Context: Rock climbing has surged in popularity recently, driven by media attention and major motion pictures, resulting in increased public participation. Climbers place excessive strain on their upper extremities and fingers due to abnormal body positioning and intense finger grip use, raising the risk of injuries. Grip strength, essential for climbing performance, is also associated with various health outcomes, including better cardiovascular health, lower mortality rates, and improved functional independence in daily activities among older adults (1). However, factors such as aging, sedentary lifestyles, and certain medical conditions can compromise grip strength. Therefore, understanding ways to enhance grip strength is of significant interest both within the sporting community and in the broader context of public health. Previous studies have explored the effectiveness of manual therapies, including the pre-treatment of Osteopathic Manipulative Treatment (OMT), in enhancing musculoskeletal function and performance in athletes (2,3). Research indicates that manual therapy targeting specific anatomical structures can improve joint mobility, reduce pain, and enhance overall performance (4-6). Meta-analyses suggest that reduced grip strength is linked to a higher risk of injury in both the general population and climbers (7-9). Despite the recognized importance of grip strength and its implications for health and performance, research on interventions to enhance it, particularly in athletes, is lacking. Therefore, research on objective performance enhancement and injury prevention through pre-treatment of OMT in athletes is needed. This research aims to fill this gap by examining the efficacy of OMT in improving grip strength and endurance among climbers, contributing valuable insights to both the sporting community and the field of manual therapy.

Objective: Evaluate the immediate and long-term benefits of OMT to the upper extremities in climbing athletes, specifically assessing grip strength and endurance.

Methods: The study was a randomized, placebo-controlled, crossover study. Ten participants, aged 18-35 years with at least 3 months of climbing experience, were recruited through local climbing gyms in Albuquerque and Las Cruces, New Mexico. Inclusion criteria: generally healthy young adults, regardless of gender or biological sex. Exclusion criteria: acute injuries (e.g., ruptured finger tendons, tendonitis), chronic conditions (e.g., arthritis), contraindications to OMT, and pregnancy. Participants were randomly assigned to treatment or sham groups using a random number generator in Microsoft Excel. The OMT intervention targeted the upper extremities with 2 sessions/week over 4 weeks, followed by a 1-week washout, then a sham intervention with the same frequency and duration. The OMT included Spencer’s Technique, Radial Head Muscle Energy Technique (MET), Ulnar Olecranon High-Velocity Low-Amplitude (HVLA), Myofascial Release (MFR) of the interosseous membrane and forearm muscles, and carpal bone mobilization through MFR. The sham intervention involved holding the participant in a neutral position reflecting the OMT technique without active treatment. Grip strength and endurance were measured using a dynamometer and overall hang time on a 20mm edge, respectively, before and after the OMT and sham interventions. Results were analyzed using statistical analysis with one-way ANOVA comparing changes in performance metrics over the first, third, and sixth sessions, and paired t-tests comparing pre- and post-intervention measurements for each session. Trials ended if a participant experienced pain, and the data was excluded. The study question underscores the osteopathic significance by exploring the potential impact of targeted OMT on neurovascular and lymphatic flow. By focusing on the upper extremity, the study aims to show how previously mentioned treatments could enhance grip strength, endurance, and climbing performance, thereby emphasizing the practical applications and benefits of osteopathic principles.

Results: The study indicated no significant differences between the OMT and sham treatments for performance metrics when analyzed longitudinally: hang time (F(2,12) = 0.47, p = 0.64), right grip strength (F(2,12) = 0.13, p = 0.88), and left grip strength (F(2,12) = 0.26, p = 0.78). The OMT protocol significantly increased performance metrics post-treatment compared to pre-treatment: hang time increased by 4.06 seconds (t(31) = 3.79, p = 0.001, 95% CI [1.88, 6.24]), right grip strength by 4.51 pounds (t(28) = 2.95, p = 0.01, 95% CI [1.38, 7.64]), and left grip strength by 2.81 pounds (t(23) = 2.14, p = 0.04, 95% CI [0.10, 5.53]). The sham protocol resulted in significant decreased performance metrics post-treatment compared to pre-treatment with hang time by -3.42 seconds (t(34) = -3.14, p = 0.003, 95% CI [-5.63, -1.21]) and left grip strength by -3.86 pounds (t(33) = -2.94, p = 0.01, 95% CI [-6.53, -1.20]), with no significant change in right grip strength (mean difference = -1.47 pounds, t(33) = -1.10, p = 0.3, 95% CI [-4.17, 1.24]).

Conclusion: While OMT demonstrates significant short-term improvements in grip strength and endurance for climbing athletes compared to sham treatment, the study found that these effects did not persist over the long term. Further investigation is necessary to understand the factors contributing to this discrepancy, including intervention duration, participant compliance, and controlling for confounding variables. Despite the lack of sustained long-term effects, the observed significant improvement over sham treatment supports the efficacy of OMT as a valuable intervention for enhancing athletic performance in the short term. Future research should delve deeper into these findings, exploring potential mechanisms underlying the short-term benefits of OMT and addressing methodological limitations to enhance our understanding of its role in performance enhancement in athletes and healthcare. Moreover, the potential benefits of OMT extend beyond the realm of athletic performance. This includes its application to populations such as the elderly, where grip strength has significant implications for fall risk, hospitalizations, and all-cause mortality. By broadening the scope of OMT to encompass diverse populations, we can potentially improve overall health outcomes and quality of life.

References

1. Bohannon RW. Grip strength: an indispensable biomarker for older adults. Clin Interv Aging. 2019;14:1681-1691. doi:10.2147/CIA.S19454

2. Ofei-Dodoo S, Black JL, Kirkover MA, Lisenby CB, Porter AST, Cleland PM. Collegiate athletes’ perceptions of osteopathic manipulative treatment. Kans J Med. 2020;13:147-151. PMID: 32612747

3. Brolinson PG, McGinley SM, Kerger S. Osteopathic manipulative medicine and the athlete. Curr Sports Med Rep. 2008;7(1):49-56. doi:10.1097/01.CSMR.0000308664.13278.a7

4. Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341(19):1426-1431. doi:10.1056/NEJM199911043411903

5. Goldstein FJ, Jeck S, Nicholas AS, Berman MJ, Lerario M. Preoperative intravenous morphine sulfate with postoperative osteopathic manipulative treatment reduces patient analgesic use after total abdominal hysterectomy. J Am Osteopath Assoc. 2005;105(6):273-279. PMID: 16118354

6. Keller TS, Colloca CJ. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial. J Manipulative Physiol Ther. 2000;23(9):585-595. doi:10.1067/mmt.2000.110947

7. Quarmby A, Zhang M, Geisler M, et al. Risk factors and injury prevention strategies for overuse injuries in adult climbers: a systematic review. Front Sports Act Living. 2023;5:1269870. doi:10.3389/fspor.2023.1269870

8. Kozin S, Cretu M, Kozina Z, et al. Application of closed kinematic chain exercises with eccentric and strength exercises for the shoulder injuries prevention in student rock climbers: a randomized controlled trial. Acta Bioeng Biomech. 2021;23. doi:10.37190/ABB-01828-2021-01

9. Wu D, Gao X, Shi Y, et al. Association between handgrip strength and the systemic immune-inflammation index: a nationwide study, NHANES 2011-2014. Int J Environ Res Public Health. 2022;19(20):13616. doi:10.3390/ijerph192013616

Informed Consent: Informed consent was obtained for each participant with specific explanations for the OMT techniques, potential injuries, study length, and that it was on a volunteer basis. Each participant went through the IRB approved informed consent with a researcher and a witness and all questions were answered.

Ethical Approval & IRB and/or IACUC Approval: The study was approved by the Burrell Institutional Review Board (IRB). IRB number: Burrell IRB 0126_2024.

The Burrell Institutional Review Board (IRB) is the review board at Burrell with sole authority to review and approve human subjects research conducted by Burrell investigators and students and may serve outside entities under contractual agreement. Specifically, Burrell College assures that:

1. No investigator may involve a human being without IRB approval and informed consent.

2. The rights and welfare of human subjects are paramount in the research process.

3. Investigators are properly trained in the ethical and regulatory aspects of research with human subjects.

4. Investigators inform human subject participants fully of procedures to be followed, the risks and benefits of participating in research, and of their right to withdraw from participation at any time.

5. Burrell College conforms with applicable state, and federal laws and regulations and policies of Burrell College.

6. Financial Disclosure: None reported.

Poster No. *C-8

Abstract No. 2024-040

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

MTHFR Deficiency in Patients with Autism Spectrum Disorder

Christian Iannuzzelli, OMS-III, Andrea Iannuzzelli, DO, Brandon Cunha, OMS-III, Venkateswar Venkataraman, PhD, Wendy Aita, PhD

Rowan-Virtua Regional Integrated Special Needs Center, Rowan-Virtua School of Osteopathic Medicine (Rowan-VirtuaSOM-Sewell), Sewell, NJ

Context: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by social communication challenges and repetitive behaviors. Both genetic and environmental factors contribute to ASD’s severity. Currently knowledge on these factors are sparse. The special needs patient population is underserved, overlooked, and misunderstood in the healthcare industry. There is an extreme lack of research conducted in this population. This project focuses on evaluating the potential impact of a single gene on ASD severity with a large population.

Methylenetetrahydrofolate Reductase (MTHFR) is an enzyme that is involved in folate and homocysteine generation. MTHFR activity level is graded on a scale by Genomind, a genetics testing lab. This scale consisted of “low/absent,” “low to intermediate,” “intermediate,” and “high/normal.” People inherit two copies of MTHFR genes, one from each of their parents. MTHFR activity levels are negatively impacted by gene variations: C677T and A1298C. (1) The C677T variation appears to hold greater weight regarding relevance to MTHFR function levels. If a patient has this variation in at least one of their genes, then the patient has “intermediate” MTHFR levels or lower. If there are 2 variations, patients will have “low” MTHFR activity. The A1298C variation is slightly less impactful. If a patient has one A1298C variation, they will still have normal MTHFR activity; however, once the second gene is altered, their MTHFR activity level drops to “intermediate.” ​(2)

Objective: To analyze the association between MTHFR gene levels and the severity of ASD.

Methods: Patient data was collected from the Rowan-Virtua Regional Integrated Special Needs (RISN) Center via Genomind genetics testing lab and a retrospective chart analysis. The Genomind assigned MTHFR gene levels were assigned a numeric value from 1 to 4: 1 indicating “low/absent”, 2 indicating “low to intermediate,” 3 indicating “intermediate,” and 4 indicating “high/normal.” ASD severity levels were determined by 2 medical students, one psychologist, and one physician based off of the DSM-5 criteria. Retrospective chart analyses of past patient visits as well as psychiatric visits were performed. ASD severity levels were categorized into levels 1, 2, and 3 representing varying degrees of required support, from level 1 indicating “requires little support,” 2 indicating “requires substantial support,” and level 3 indicating “requires very substantial support.” Patients with MTHFR activity deficiencies but no ASD diagnosis were excluded from the study. Data analysis involved computing average MTHFR activity levels for each ASD severity level and conducting t-tests between ASD levels to assess significance. A p-value of 0.05 was deemed to indicate statistical significance.

Results: Once patients without an ASD diagnosis were excluded, there were 78 subjects involved in the study. The analysis revealed a negative correlation between lower MTHFR activity levels and higher ASD severity levels. T-tests demonstrated significant differences in MTHFR activity levels across ASD severity levels (p < 0.05). The t-tests between levels 1 and 2 as well as between levels 2 and 3 both had a p-value = 0.05. The t-test between levels 1 and 3 had a p-value = 0.00005. This data demonstrates statistical significance between all levels of ASD severity, as they relate to MTHFR activity deficiency.

Conclusion: The study findings suggest that lower MTHFR activity levels may predispose individuals to more severe ASD. This demonstrates the significance of genetic factors in ASD severity and supports existing research on the role for MTHFR gene variations. Further research into the broader behavioral implications of MTHFR deficiency beyond the ASD population is warranted. Understanding the relationship between MTHFR gene variations and ASD severity may inform personalized interventions and improve outcomes for individuals with ASD. This may include earlier screening for MTHFR variants at the time of ASD diagnosis, so that early treatment for MTHFR deficiency could begin.

References

1. El-Baz F, El-Aal MA, Kamal TM, Sadek AA, Othman AA. Study of the C677T and 1298AC polymorphic genotypes of MTHFR Gene in autism spectrum disorder. Electron Physician. 2017 Sep 25;9(9):5287-5293. PMID: 29038711; PMCID: PMC5633227. doi: 10.19082/5287.

2. Li Y, Qiu S, Shi J, Guo Y, Li Z, Cheng Y, Liu Y. Association between MTHFR C677T/A1298C and susceptibility to autism spectrum disorders: a meta-analysis. BMC Pediatr. 2020 Sep 24;20(1):449. PMID: 32972375; PMCID: PMC7517654. doi: 10.1186/s12887-020-02330-3.

Informed Consent: ​Not ​relevant

Ethical Approval & IRB and/or IACUC Approval: Study was deemed reviewed and approved with IRB Approval. IRB number: PRO-2022-198

Financial Disclosure: None reported.

Poster No. *C-9

Abstract No. 2024-041

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Pulses of Potential: Assessing the Efficacy of Transcranial Magnetic Stimulation Across Age Groups

¹Maggie Lai, MA, OMS-IV, ¹Christina Ed, OMS-IV, ²William J. Elliott, MD, PhD

¹Department of Medical Education, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, WA; ²Department of Biomedical Sciences, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, WA

Context: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are two of the most common mental health conditions encountered in primary care, affecting individuals of all ages. Transcranial Magnetic Stimulation (TMS) has consistently demonstrated safety and effectiveness in various meta-analyses as an adjunct to pharmacotherapy in adults, particularly for treatment-resistant depression (TRD) and its potential application in GAD (1). This non-invasive procedure uses magnetic fields to target the dorsolateral prefrontal cortex (DLPFC) in the brain to improve symptoms of various mental health conditions (2). However, in many cases, TMS is not considered an option unless the patient has failed multiple trials of medications and psychotherapy. Although the FDA-approved neuromodulation technique has been in use for over a decade, it is still not widely known among patients and healthcare professionals. Furthermore, studies of TMS efficacy in special populations, such as geriatrics and children and adolescents, have been inconclusive (3-5).

Objective: To assess the efficacy of TMS on treatment resistant depression and anxiety across different age demographics, aiming to uncover whether certain age populations exhibit a more favorable response.

Methods: The design of the study involved a retrospective data analysis using data maintained in the electronic health record at Olympia Center for TMS & Psychiatry. A total of 288 patients with TRD who completed 36 standard repetitive TMS or theta burst stimulation treatments between 2020 and 2023 were selected. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores of each patient were used to assess the severity of their depression and anxiety before and after treatments. Among the 288 patients, 204 had initial GAD-7 scores ≥10, indicating co-existing moderate to severe anxiety. The patients were then categorized into three age groups: ≤ 21 years old (pediatrics), 22–64 years old (adults), and ≥ 65 years old (geriatrics). Treatment efficacy was measured by averaging the initial and final PHQ-9 or GAD-7 scores and conducting a paired T-test for all age groups and each age population. In a clinical setting, treatment response was defined as a 50% reduction in PHQ-9 or GAD-7 scores. The percentage of all subjects and each population that responded to treatment was calculated, and a Chi-square analysis was performed on age groups. The data collected may be used to optimize minimally invasive neuromodulation to restore overall mental well-being, promoting the body’s propensity for self-healing, maintenance, and the interconnection of structure and function.

Results: Out of 288 patients with TRD, 39 were pediatrics, 192 were adults, and 57 were geriatrics. After treatment with TMS, 74% of the total participants demonstrated a 50% improvement in PHQ-9 scores. The response rates by age group were 51% for pediatrics, 77% for adults, and 81% for geriatrics. A Chi-square test among these groups yielded a p-value of 0.002, indicating a significant difference in response rates across age groups. The efficacy of TMS for TRD, as indicated by the improvement in mean PHQ-9 scores, was significant overall and within each age group (p-values).

Conclusion: TMS exhibits promising response rates and efficacy in addressing depression and anxiety symptoms. Our data analysis reveals significant improvements in symptom severity across various age groups, suggesting the potential integration of TMS alongside pharmacotherapy for managing MDD and GAD. The result is notable given the adverse effects associated with pharmacotherapy, including increased suicide risk with SSRI use in adolescents and concerns regarding polypharmacy among geriatric patients. Our results support TMS as a viable alternative, potentially even as a standalone treatment option. Limitations in this study include the absence of sham groups for comparison and relatively small sample sizes for certain age demographics, which warrant consideration. To increase TMS utilization, future investigations should delve into barriers to successful treatment outcomes, including factors contributing to low TMS treatment adherence such as the frequency of daily sessions, insurance coverage limitations, and geographical accessibility. Understanding these barriers and how they impact treatment outcomes can help inform efforts to enhance the application and accessibility of TMS therapy.

References

1. Somani, A., & Kar, S. K. (2019). Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. General Psychiatry, 32(4), e100074. https://doi.org/10.1136/gpsych-2019-100074

2. Avissar, M., Powell, F., Ilieva, I., Respino, M., Gunning, F. M., Liston, C., & Dubin, M. J. (2017). Functional connectivity of the left DLPFC to striatum predicts treatment response of depression to TMS. Brain Stimulation, 10(5), 919–925. https://doi.org/10.1016/j.brs.2017.07.002

3. Croarkin, P. E., Elmaadawi, A. Z., Aaronson, S. T., Schrodt, G. R., Holbert, R. C., Verdoliva, S., Heart, K. L., Demitrack, M. A., & Strawn, J. R. (2020). Left prefrontal transcranial magnetic stimulation for treatment-resistant depression in adolescents: a double-blind, randomized, sham-controlled trial. Neuropsychopharmacology, 46(2), 462–469. https://doi.org/10.1038/s41386-020-00829-y

4. Qiu, H., Liang, K., Lu, L., Gao, Y., Li, H., Hu, X., Xing, H., Huang, X., & Gong, Q. (2023). Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis. Journal of Affective Disorders, 320, 305–312. https://doi.org/10.1016/j.jad.2022.09.060

5. Sabesan, P., Lankappa, S., Khalifa, N., Krishnan, V., Gandhi, R., & Palaniyappan, L. (2015). Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls. World Journal of Psychiatry, 5(2), 170. https://doi.org/10.5498/wjp.v5.i2.170

Informed Consent: Not applicable to this study.

Ethical Approval & IRB and/or IACUC Approval: This study was deemed IRB exempt and has the following IRB number: #24-007.

Financial Disclosure: None reported.

Poster No. C-10

Abstract No. 2024-044

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Perspective Comparison Regarding the Importance of Social History, Empathy, and Their Role in Osteopathic Distinction

¹Eric Harp, DO, ²Ethan Wood

¹Department of Medical Education, Oklahoma State University College of Osteopathic Medicine - Cherokee Nation, Tahlequah, OK; ²Oklahoma State University College of Osteopathic Medicine - Cherokee Nation, Tahlequah, OK

Context: Social history continues to be a developing subject of discussion in medical education. Calls for improvement are driven by increased awareness of social determinants in health and wellness and focus on patient-centered care. Social history offers an opportunity to demonstrate both the osteopathic principle of whole person care and empathy. Both are essential to osteopathic distinctiveness. Empathy, however, has been shown to wane as training progresses. Improving skills in social history-taking can hope to reduce this decline. While satisfaction of the osteopathic principles and practice core competency is typically direct with osteopathic manipulative treatment, development into other curriculum areas continues to be a challenge. The social history offers such an opportunity. Studies have shown that both patient-centered social risk screening and conveyance of empathy can strengthen patient and provider relationships. Despite increased awareness of the importance of social history, challenges both to approaching and obtaining remain. Contributions to this challenge include expansion of included topics, temporal limitations, and insecurity in approaching less tangible subjects in a patient visit. In addition, potential differences in perspective regarding social history may exist between patients and providers. Studies have compared perspectives, identified challenges, and offered strategies to improve the social health integration. Few studies, however, address this from an osteopathic perspective. Recognition of challenges related to social history and its relationship to the osteopathic principle of body, mind, and spiritual unity from both student and patient perspectives can identify targets for improvement in our educational programs. Insight to improve alignment between patient and provider perspectives is additionally gained.

Objective: Assess responses to questions related to empathy, social history, and their relationship to the osteopathic approach. Questions aim to identify challenges and perspectives regarding social history, empathy, and the osteopathic philosophy. Information from both students and a patient-representing group is gathered. Potential differences between students enrolled in the Doctor of Osteopathic medicine (DO) and Master of Science of physician assistant studies (PA) are also explored. Information from student learners can provide opportunities to improve education and training and offer better alignment between patient and provider perspectives.

Methods: Surveys were created to address social history, empathy, and the triune osteopathic approach. Both multiple choice and Likert scale assessment questions were used. Multiple choice questions identify challenges to acquiring social history, where empathy is most significant in the interview process, and the medical significance of certain social health determinants. The Likert scale was used to assess responses to statements regarding the role of social history concerning the first osteopathic tenet and overall health and wellness, role of empathy, and contribution to trust in the provider-patient relationship. Assessment questions emphasize the first osteopathic tenet also articulated in the osteopathic core competencies. Chosen domains represent a combination of the primary author’s experience as an osteopathic physician educator, published goals of education in the osteopathic tradition, and current trends and challenges in social history taking. Three total groups were queried including second year DO students, second year PA students, and non-clinical staff at Oklahoma State University-Center for Health Sciences. The latter group represents the patient-perspective group. The patient-perspective survey included slight differences in question, but responses stayed the same. All students had comparable levels of medical education experience, recently completing one year of their respective curriculum. After a brief oral presentation, both student and patient groups were provided with the respective surveys to be completed anonymously and independently. Social and academic desirability was minimized by optimizing anonymity. Returned paper surveys were kept in three separate groups, results manually transcribed, aggregated, and analyzed using Excel.

Results: A total of 60 (n=60) surveys were returned completed (100% response). No consensus among students was identified as the most difficult social health determinant to discuss with patients, while the patient group felt emotional and spiritual wellness was the most challenging (45%). All three groups indicated a systematic approach at the initial visit to be the most effective method to obtain social history (58%). All three groups identified the chief complaint as the most important area of the patient visit to convey empathy (42%) followed by physical examination, the latter with more patient than student respondents (35% vs 15% PA and 0% DO). 15% of total indicated social history as the most crucial interview section to convey empathy. All three groups identified healthcare access and utilization as the most medically imperative social health determinant (50%). A higher percentage of PA over DO students indicated substance use as medically imperative (45% vs 20%). No consensus identified the social history interviewing aspect with which providers most struggle. 5-point Likert scale median and mean response to statements regarding empathy and osteopathic principles in social history was positive. The patient group showed a more favorable response than students regarding social history representing the osteopathic principle of body, mind, and spirit (mean 4.15/5 vs DO 2/5, PA 3/5). All groups agreed social history provides an opportunity to address physical, emotional, and spiritual wellbeing (means: PA 4.05/5, DO 4.05/5, patients 4.25/5) and can fortify trust in the relationship (means: PA 4.4/5, DO 4.45/5, patients 4.1/5). Both student groups showed a more favorable response than the patient group regarding social history being essential to health and wellness (means: DO 4.7/5, PA 4.5/5, patients 3.85/5). Student groups agreed that word choice during the social history interview is critical to the relationship (means: PA 4.45/5, DO 4.2) while the patient group was short of agreement (mean 3.9/5).

Conclusion: Responses support the importance of social history to health and wellness and a way to demonstrate the osteopathic principle of body, mind, and spiritual unity. Healthcare access and utilization stood out as the most medically imperative social health determinant. The chief complaint was highlighted as the most important temporal location to demonstrate empathy, with social history indicated as less significant. Patients indicated spiritual and emotional health as the most difficult to discuss indicating a need for improvement of our learners to address these foundational aspects of the osteopathic approach. The lack of agreement where providers most struggle in obtaining the social history supports continued efforts to improve all aspects of interviewing skills. Findings are limited by sample size (12% of typical DO class, 20 of 165; 80% of typical PA class, 20 of 25), inherent limitations of Likert-type scales, homogeneity of student subjects, and use of a surrogate patient group (non-clinical staff). The latter, however, provided an opportunity for controlled comparison of perspectives.

References

1. Behforouz HL, Drain PK, Rhatigan JJ. Rethinking the social history. N Engl J Med. 2014 Oct 2;371(14):1277-9. doi: 10.1056/NEJMp1404846. PMID: 25271600.

2. Kearney GP, Conn RL, Reid H. From pigeons to person: Reimagining social history. Clin Teach. 2022;19(3):257-259. doi:10.1111/tct.13486

3. Srivastava R. Complicated lives-taking the social history. N Engl J Med. 2011;365(7):587-589. doi:10.1056/NEJMp1106985

4. Bozinoff N, Kleinman RA, Sloan ME, et al. Rethinking Substance Use as Social History: Charting a Way Forward. J Gen Intern Med. 2024;39(7):1227-1232. doi:10.1007/s11606-024-08642-9

5. Gillespie H, Kelly M, Gormley G, King N, Gilliland D, Dornan T. How can tomorrow’s doctors be more caring? A Phenomenological Investigation Medical Education. 2018 Oct;52(10):1052–63

6. US Dept of Health and Human Services. Social determinants of health - Healthy People 2030. health.gov. Accessed April 20, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health

7. Byhoff E, De Marchis EH, Hessler D, et al. Part II: A Qualitative Study of Social Risk Screening Acceptability in Patients and Caregivers. Am J Prev Med. 2019;57(6 Suppl 1):S38-S46. doi:10.1016/j.amepre.2019.07.016

8. Newton BW, Vaskalis ZT. Cognitive empathy of osteopathic students: a longitudinal study with data comparisons to the Project in Osteopathic Medical Education and Empathy (POMEE). J Osteopath Med. 2023;124(1):13-20. Published 2023 Sep 13. doi:10.1515/jom-2023-0014

9. Waning empathy McTighe AJ, DiTomasso RA, Felgoise S, Hojat M. Effect of Medical Education on Empathy in Osteopathic Medical Students. J Am Osteopath Assoc. 2016;116(10):668-674. doi:10.7556/jaoa.2016.131

10. Core Competencies for Medical Students. American Association of Colleges of Osteopathic Medicine; 2012. https://www. aacom.org/docs/default-source/core-competencies/ corecompetencyreport2012.pdf?sfvrsn=179c6097_4. Accessed June 13, 2023

11. Seffinger MA, King HH, Ward RC, Jones JM III, Rogers FJ, Patterson MM. Osteopathic philosophy. In: Chila AG, ed. Foundations of Osteopathic Medicine. 3rd ed. Lippincott Williams & Wilkins; 2011:3-22.

12. Tenets of osteopathic medicine. American Osteopathic Association website.https://osteopathic.org/about/leadership/aoagovernancedocuments/tenets-of-osteopathic-medicine/. Accessed June 10, 2024

13. Steele KM, Baker HH. Clearly distinct: outcomes of initiative to increase integration of osteopathic principles and practice at West Virginia School of Osteopathic Medicine. J Am Osteopath Assoc. 2009;109(11):579-590.

14. Rudisill AC, Eicken MGA, Gupta D, et al. Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study. JAMA Netw Open. 2023;6(11):e2345444. Published 2023 Nov 1. doi:10.1001/jamanetworkopen.2023.45444

15. Yan AF, Chen Z, Wang Y, et al. . Effectiveness of social needs screening and interventions in clinical settings on utilization, cost, and clinical outcomes: a systematic review. Health Equity. 2022;6(1):454-475. doi:10.1089/heq.2022.0010

16. Savitz ST, Nyman MA, Kaduk A, Loftus C, Phelan S, Barry BA. Association of patient and system-level factors with social determinants of health screening. Med Care. 2022;60(9):700-708. doi:10.1097/MLR.0000000000001754

17. Gimpel JR, Belanger SI, Knebl JA, et al. 2019 United States Osteopathic Medical Regulatory Summit: Consensus, Recommendations, and Next Steps in Defining Osteopathic Distinctiveness. J Am Osteopath Assoc. 2020;120(1):35-44. doi:10.7556/jaoa.2020.005

18. Davis GE, Hartwig WC, Riemer RB, Char C, McTighe A, Kremelberg D. Assessing patient experience of the tenets of osteopathic medicine [published online ahead of print, 2023 May 16]. J Osteopath Med. 2023;10.1515/jom-2023-0038. doi:10.1515/jom-2023-0038

Informed Consent: Study participants were approached by the Principal Investigator directly or in groups in a classroom (DO and PA students) and asked if they were willing to participate. After a brief oral presentation, participants were provided with the survey which was preceded by a written description of the context, objective, goals, risks, benefits, and confidentiality related to the study. Participants were informed both orally and in writing that their participation was entirely voluntary and that by returning the survey as directed with no personal identifiers they were consenting that their information be used for research and internal quality improvement purposes.

Ethical Approval & IRB and/or IACUC Approval: Project was deemed exempt by Oklahoma State University-Center for Health Sciences IRB. Please see accompanying letter.

Financial Disclosure: None reported.

Poster No. *C-11

Abstract No. 2024-045

Category: Clinical

Research Focus Area: Osteopathic Philosophy

The Applications of Laser Interstitial Thermal Therapy and Machine Learning in Neurosurgery: An Osteopathic Perspective

¹Andrew Bouras, BS, OMS-I, ¹Dhruv Patel, ²Nitin Chetla, ¹Jyotsna Chawla

¹Nova Southeastern University Kiran C Patel College of Osteopathic Medicine - Clearwater (NSU-KPCOM Clearwater), Clearwater, FL; ²School of Medicine, University of Virginia, Charlottesville, VA

Context: Laser Interstitial Thermal Therapy (LITT) has emerged as a minimally invasive technique for treating deep-seated brain lesions, including tumors and epileptogenic foci. The integration of Machine Learning (ML) enhances LITT’s precision and patient-specific outcomes. However, existing literature lacks a comprehensive analysis of ML’s role in optimizing LITT, particularly from an osteopathic perspective, which emphasizes the body’s self-regulatory capabilities, the unity of body, mind, and spirit, and the interrelationship between structure and function. This study aims to fill this gap by examining the integration of ML with LITT from an osteopathic viewpoint.

Objective: To evaluate the integration of ML in enhancing LITT procedures, focusing on optimizing patient outcomes through self-regulation and holistic care principles inherent in osteopathic medicine.

Methods: This systematic review followed PRISMA guidelines and involved an exhaustive search of PubMed, IEEE Xplore, Google Scholar, and ScienceDirect databases for studies published from 2015 to 2023. Inclusion criteria targeted primary research on ML-enhanced LITT applications in neurosurgery. Studies were selected based on their focus on surgical planning, outcome prediction, and postoperative evaluation. Data extraction involved assessing study goals, methodologies, key findings, and osteopathic significance. Statistical analyses included meta-analysis and qualitative synthesis to identify trends and gaps.

Results: Out of 322 studies screened, 13 met the inclusion criteria. The studies demonstrated that ML significantly enhances LITT by improving patient-specific treatment plans, optimizing surgical trajectories, and predicting outcomes. For instance, ML algorithms improved the accuracy of laser probe trajectories, reducing the risk to surrounding healthy tissues and aligning with osteopathic principles of self-regulation and body unity. Quantitative data showed that ML-enhanced LITT resulted in a 20% increase in precision (p<0.05) and a 15% reduction in postoperative complications (p<0.01). Challenges such as standardizing ML algorithms and ensuring clinical validation were noted, highlighting the need for larger sample sizes and multi-institutional studies.

Conclusion: The integration of ML into LITT represents a promising advancement in neurosurgery, offering improvements in precision and patient outcomes consistent with osteopathic principles. The emphasis on the interrelationship between structure and function, and the body’s capacity for self-regulation, aligns with the holistic approach central to osteopathic medicine. Future research should focus on refining ML algorithms and validating their clinical applications, ensuring advancements align with patient-centered care and safety. This osteopathic perspective on LITT and ML integration underscores the potential for enhanced, minimally invasive treatment options in neurosurgery. Limitations include the need for larger, more diverse sample sizes and further validation of ML techniques in clinical settings.

References

1. Damante MA Jr, Wang JL, Elder JB. Surgical Management of Recurrent Brain Metastasis: A Systematic Review of Laser Interstitial Thermal Therapy. Cancers (Basel). 2022;14(18):4367. doi: 10.3390/cancers14184367

2. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Systematic Reviews. 2022;18. doi:10.1002/cl2.1230

3. Holste KG, Orringer DA. Laser interstitial thermal therapy. Neurooncol Adv. 2019;2(1). DOI: 10.1093/noajnl/vdz035

4. Johnson GW, Han RH, Smyth MD, et al. Laser Interstitial Thermal Therapy in Grade 2/3 IDH1/2 Mutant Gliomas: A Preliminary Report and Literature Review. Curr Oncol. 2022;29(4):2550-2563. DOI: 10.3390/curroncol29040209

5. Kolasa K, Galuba W, Zakrzewska M, et al. Systematic reviews of machine learning in healthcare: a literature review. Expert Rev Pharmacoecon Outcomes Res. 2023. DOI: 10.1080/14737167.2023.2279107

6. Li K, Kapoor A, Wong J, et al. Optimizing Trajectories for Cranial Laser Interstitial Thermal Therapy Using Computer-Assisted Planning: A Machine Learning Approach. Neurotherapeutics. 2019;16(1):182-191. doi: 10.1007/s13311-018-00693-1

7. Melnick K, Veeravagu A, Li G, Berger MS, Chang SD. Role of Laser Interstitial Thermal Therapy in the Management of Primary and Metastatic Brain Tumors. Curr Treat Options Oncol. 2021;22(12):108. DOI: 10.1007/s11864-021-00912-6

8. Sabahi M, Wardak Z, Danish SF. Laser Interstitial Thermal Therapy for Posterior Fossa Lesions: A Systematic Review and Analysis of Multi-Institutional Outcomes. Cancers (Basel). 2022;14(18):456. DOI: 10.3390/cancers14020456

9. Salem U, Lee I, Wong TT, et al. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging. 2019;19(1):65. DOI: 10.1186/s40644-019-0250-4

10. Souza CMP de, Miranda LAP, Pereira JF. A Systematic Literature Review on Machine Learning Model Evaluation on Healthcare Applications. Res Soc Dev. 2023;12(6). DOI: https://doi.org/10.33448/rsd-v12i6.42042

11. Srinivasan ES, Grabowski MM, Nahed BV, Barnett GH, Fecci PE. Laser interstitial thermal therapy for brain metastases. Neurooncol Adv. 2021;3(Suppl 5). doi: 10.1093/noajnl/vdab128

12. Thomas JG, Rao G, Asher AL, et al. Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma. Neurosurg Focus. 2016;41(4). DOI: 10.3171/2016.7.FOCUS16234

13. Viozzi I, Guberinic A, Overduin CG, et al. Laser Interstitial Thermal Therapy in Patients with Newly Diagnosed Glioblastoma: A Systematic Review. J Clin Med. 2021;10(2):355. DOI: 10.3390/jcm10020355

14. Zeller S, Salvetti DJ, Wilson DA, et al. Current applications and safety profile of laser interstitial thermal therapy in the pediatric population: a systematic review of the literature. J Neurosurg Pediatr. 2021. DOI: 10.3171/2021.2.PEDS20721

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: N/A

Financial Disclosure: None reported.

Poster No. *C-12

Abstract No. 2024-048

Category: Clinical

Research Focus Area: Impact of OMM & OMT

Impact of Suboccipital Release Osteopathic Manipulative Treatment on Cardiac Control in Healthy Adults

¹Jennifer Kachelmeyer, MMS, OMS-III, ¹Ryan Witczak, ²Kristina Cummings, DO, ³Maxim Crasta, MS, PhD

¹College of Medicine, Lake Erie College of Osteopathic Medicine at Elmira, Elmira, NY; ²Department of Family Medicine, Lake Erie College of Osteopathic Medicine at Elmira, Elmira, NY; ³Department of Physiology, Lake Erie College of Osteopathic Medicine at Elmira, Elmira, NY

Context: Suboccipital release (SOR) is a long-practiced osteopathic manipulative technique directed towards the fascia, connective tissue, and muscles of the suboccipital area. SOR targets the autonomic nervous system (ANS) via relieving compression of the vagus nerve. [1] The ANS, along with physiologic influence, affects the sinus node through neuromuscular stimulation. In particular, the ANS is responsible for modulating the QT interval, representing the time needed for the onset of electrical activity and its subsequent recovery in the myocardium. Variabilities in the QT interval have been associated with changes in ANS activity, and specifically parasympathetic nervous system tone. [2]

Objective: To examine how SOR impacts cardiac control, using QT variability as a surrogate measure.

Methods: A prospective, single-blinded, crossover study was utilized using a total of 24 healthy adults. Subjects were first and second year medical students at Lake Erie College of Osteopathic Medicine (LECOM) at Elmira, who were recruited with an approved poster. Interested students ages 21-35 years old were screened to determine if any exclusion criteria were met prior to obtaining consent, including a history of conditions or medications that may affect their cardiovascular or ANS function,. Each subject received three interventions: a control treatment with no physical contact, sham treatment, and SOR. Control treatment was utilized to establish a baseline for each subject before any potential therapeutic effects from touch were introduced. Sham treatment consisted of investigator finger placement near the subject’s occipital condyles without any tension to evaluate the effect of touch alone. [3] Data from 12-lead electrocardiograms (EKG) were taken with intervals for QRS, QT, QTcb, JT, QTa, and QTend, along with associated dispersion and index changes. Repeated measure analysis of variance (ANOVA) was employed with each subject serving as their own control. Post-hoc comparisons of the three treatment groups were adjusted using Bonferroni’s method for multiple comparisons. Bland-Altman limits of agreement were calculated to assess the agreement between the QTend values in the control and sham treatment groups.

Results: The final analysis consisted of 21 participants (11 female, 10 male), excluding 3 participants due to abnormal EKG results obtained during the baseline recording. A normality revealed no significant differences among the QTa intervals in the V2 (maximum) and aVF (minimum) leads [F(1.705, 34.11) = 1.294, P = 0.06]. The Mean ± SEM (msec) calculated QT variables for the SOR treatment (89.48 ± 4.62) were significantly lower than that of the control (96.29 ± 4.37) and sham (97.14 ± 5.85) treatments [F (1.705, 34.11) = 1.294, P = 0.05]. The variability in QTcb was significantly lower in the SOR group [F (1.410, 28.19) = 0.4429, P=0 .051]. A significant decrease in the ratio of QTend to either QT or QTc was observed in the SOR group compared to the control and sham treatments [F (2,60) = 10.35 = P=0.03]. The calculated Bias or Bland-Altman index of agreement was -0.86.

Conclusion: SOR treatment resulted in variations of QT intervals and shortening of QTend intervals. The decreased QTend/QTcb ratio observed in the SOR group is likely due to an increase in parasympathetic activity, via SOR-induced vagus nerve stimulation. This ratio provides a more accurate measurement of relative variation compared to QTend alone. The calculated Bland-Altman index of -0.86 indicates there was minimal difference between the QTend of the control and sham treatments, suggesting that the significant differences observed in the QTend of the SOR group were caused by the SOR treatment itself and not influenced by touch or other variables. Shortened QTend intervals can promote cardiac stability by preventing QT dispersion. This study, while small and preliminary, has provided initial evidence of a relationship between SOR manipulative treatment and QTend shortening in healthy adults. Further research with a larger sample size and more diverse population would help to confirm and expand our results to fully understand the observed relationship between SOR and QTend shortening, and its potential benefits on cardiac function in a clinical setting.

References

1. Rowlands E, Pozun A. Osteopathic Manipulative Treatment: Suboccipital Release. StatPearls. StatPearls Publishing; 2023.

2. Murakawa Y, Yamashita T, Ajiki K, Suzuki J, Hayami N, Fukui E, Kasaoka Y, Omata M, Nagai R. Is the QT interval an indicator of autonomic state?. Jpn Heart J. 2000;41(6):713-721. doi:10.1536/jhj.41.713

3. Edwards DJ, Young H, Cutis A, Johnston R. The Immediate Effect of Therapeutic Touch and Deep Touch Pressure on Range of Motion, Interoceptive Accuracy and Heart Rate Variability: A Randomized Controlled Trial With Moderation Analysis. Front Integr Neurosci. 2018;12:41. doi:10.3389/fnint.2018.00041

Informed Consent: Potential participants were given access to the study’s consent form and eligibility criteria prior to their study visit to confidentially pre-screen their eligibility. Prior to collecting study-specific data, a research team member confirmed a participant’s eligibility in a private research room. If they answered that they did meet an exclusion criterion, they were notified that they were unable to participate in the study and no data was collected. If they were eligible, a research team member explained the study and consent form, answered any questions they had, and instructed them to sign and date. The research team member that obtained consent also signed and dated the consent form and offered a photocopy for the participants’ records. The signed consent forms were kept in a locked cabinet in the Principal Investigator’s office away from all other study materials.

Ethical Approval & IRB and/or IACUC Approval: This study was reviewed and approved by the LECOM Institutional Review Board on June 14, 2023 (Protocol 30-097).

Financial Disclosure: None reported.

Poster No. *C-13

Abstract No. 2024-049

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Exploring Attitudes Towards Osteopathic Medicine in First and Second Year Osteopathic Medical Students Following Osteopathic Manipulative Medicine

Nicole Neiman, MPH, OMS-III, Alexandra De Jesus, MPH, OMS-II, Anne Marie Zeller, DO, MSc, CAQSM

Osteopathic Practices and Principles, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN

Context: Osteopathic manipulative treatment (OMT) and osteopathic principles and practices (OPP) are what distinguish osteopathic physicians from their allopathic colleagues, yet the practice of OMT is still declining in clinical practice [1]. It is important for osteopathic medical schools to foster an environment that encourages the usage of OMT during medical school and into clinical practice. It is well studied that increased exposure to OMT (e.g. OMM clinical rotation) is associated with greater comfort and confidence with using OMM and the intention to use OMM in the future [2–7]. There is inconclusive evidence for the support whether receiving OMT translates to more positive attitudes towards osteopathic medicine or increased usage of OMM in the future [2,8–10]. In this study, we delve deeper by analyzing the attitudes towards osteopathic medicine in DO students following OMT treatment, along with exploring the relationship between attitudes towards osteopathic medicine and utilization of osteopathic manipulative medicine (OMM).

Objective:

1. To explore attitudes towards osteopathic medicine in first- and second-year OMS after receiving OMT.

2. To examine the relationship between attitudes towards osteopathic medicine and confidence relating to utilization of OMM.

Methods: A cross-sectional prospective study was conducted with 41 first- and second-year osteopathic medical students (63% first-year students, 54% 20-24 years old, 56% female, 83% White). Participants were recruited from Lincoln Memorial University OMM Scholar Clinics between October 2023 to May 2024. All new patients to the clinic were eligible to participate in the study. Participants were evaluated and treated with OMT by one of six pre-doctoral OPP scholars under supervision of OPP faculty physician. Prior to OMM clinic, participants provided survey responses for demographics/background information, their level of confidence in their utilization of OMM (range: 0-10), and completed a pre-Attitudes Towards Osteopathic Medicine Survey (ATOMS) (range: 13-91) [11]. Following OMM clinic, participants completed a post-ATOMS. SPSS 29 was used to conduct a paired t-test to assess change in ATOMS following the OMM clinic, and a correlation analysis to examine the association between baseline ATOMS and confidence in their utilization of OMM.

Results: 16 participants completed both pre- and post-ATOMS (39% response rate). Exploratory analyses revealed no statistically significant improvements in attitudes towards osteopathic medicine following treatment in the OMM scholar clinic (75.94 ± 5.9 to 76.94 ± 7.00, p=0.38). 40 participants completed pre-ATOMS and assessed their confidence in utilization of OMM (98% response rate). Attitudes towards osteopathic medicine was significantly associated with confidence in recommending OMM as pain management option (r=0.35, p=0.03), using OMM in lab (r=0.34, p=0.03), and using OMM in future practice (r=0.33, p=0.04). Participants experiencing more positive attitudes towards osteopathic medicine reported higher confidence levels in utilization of OMM.

Conclusion: The results of this study support the literature that more positive attitudes towards osteopathic medicine is associated with increased confidence surrounding the utilization of OMM [8,9]. Study findings suggest that positive attitudes towards osteopathic medicine may be potentially important for the future practice of OMM. Although the present study is underpowered, it presents a way that osteopathic medical schools can expose students to the clinical practice of OMT to improve positive perceptions of OMM. It is imperative for osteopathic medical schools to continue to explore further avenues to increase attitudes towards osteopathic medicine. One limitation is our lack of response in the post-survey. To address this, we plan to modify the IRB protocol to allow for a reminder follow-up email. Future directions also include recruiting a larger and more diverse sample, adding a one-month follow-up for assessing confidence levels in utilization of OMM and ATOMS, and exploring how positive and negative affect may impact study outcomes.

References

1. Healy CJ, Brockway MD, Wilde BB. Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States. J Osteopath Med. 2021;121(1):57-61. doi:10.1515/jom-2020-0013

2. Vazzana KM, Yao SC, Jung MK, Terzella MJ. Perception-based effects of clinical exposure to osteopathic manipulative treatment on first- and second-year osteopathic medical students. J Am Osteopath Assoc. 2014;114(7):572-580. doi:10.7556/jaoa.2014.111

3. Teng AY, Terry RR, Blue RJ. Incorporating a Mandatory Osteopathic Manipulative Medicine (OMM) Curriculum in Clinical Clerkships: Impact on Student Attitudes Toward Using OMM. J Osteopath Med. 2011;111(4):219-224. doi:10.7556/jaoa.2011.111.4.219

4. Shapiro LN, Defoe D, Jung MK, Li TS, Yao SC. Effects of Clinical Exposure to Osteopathic Manipulative Medicine on Confidence Levels of Medical Students. J Osteopath Med. 2017;117(8):e1-e5. doi:10.7556/jaoa.2017.105

5. Heineman KL, Lewis DD, Finnerty EP, Crout SV, Canby C. Effect of a Mandatory Third-Year Osteopathic Manipulative Treatment Course on Student Attitudes. J Am Osteopath Assoc. 2016;116(4):207-213. doi:10.7556/jaoa.2016.045

6. Magnus WW, Gamber RG. Osteopathic manipulative treatment: student attitudes before and after intensive clinical exposure. J Am Osteopath Assoc. 1997;97(2):109-113. doi:10.7556/jaoa.1997.97.2.109

7. Leavitt NJ, Sundman RS, Mazzi JR, Spaan JM, Kisby GE. A pilot study to assess medical students’ perception of their osteopathic manipulative therapy (OMT) education. Int J Osteopath Med. 2024;51:100713. doi:10.1016/j.ijosm.2024.100713

8. Draper BB, Johnson JC, Fossum C, Chamberlain NR. Osteopathic medical students’ beliefs about osteopathic manipulative treatment at 4 colleges of osteopathic medicine. J Am Osteopath Assoc. 2011;111(11):615-630. doi.org/10.7556/jaoa.2011.111.11.615

9. Seffinger MA, Hurwitz E, Quiamas J, Kitch A, Mervyn-Cohen V, Lin E. Correlation of Personal Experience and Acquired Knowledge With Intent to Recommend Adjunctive Osteopathic Manipulative Treatment or Yoga for Patients With Chronic Low Back Pain. J Am Osteopath Assoc. 2018;118(11):738-745. doi:10.7556/jaoa.2018.159

10. Volokitin M, Ganapathiraju PV. Osteopathic Philosophy and Manipulation Enhancement Program: Influence on Osteopathic Medical Students’ Interest in Osteopathic Manipulative Medicine. J Osteopath Med. 2017;117(1):40-48. doi:10.7556/jaoa.2017.006

11. Hojat M, DeSantis J, Cain RA, Speicher MR, Bragan L, Calabrese LH. Attitudes toward osteopathic medicine scale: development and psychometrics. Int J Med Educ. 2021;12:222-232. doi:10.5116/ijme.615c.2cfa

Informed Consent: Consent for study participation was obtained via a Qualtrics consent form. An email, containing a link to the consent form was sent to eligible participants by the Medical Director. Alternatively, a flyer with a QR code to the study consent form was available in the clinic waiting room. Interested participants voluntarily accessed the link from the email or flyer and after reading the consent form, were able to mark their decision to consent and participate, or to not participate in the study. For participants who consented, a study survey followed ​the consent form.

Ethical Approval & IRB and/or IACUC Approval: 1175 Neiman and Zeller expedited 7 approval letter Oct 2023.pdf ; Study was reviewed and approved by Lincoln Memorial University’s IRB, #1175.

Financial Disclosure: None reported.

Poster No. *C-14

Abstract No. 2024-052

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Promoting the Understanding Of Prerequisites, Training, Career Opportunities, and Practice Philosophy of Osteopathic Physicians Amongst Students in the Southeastern U.S.

¹Hersha Iyer, OMS-III, ¹Sharnikha Saravanan, OMS-III, ¹Gabrielle Oquendo, OMS-IV, ²Joy Zarandy, DO, FAAFP, ³Michael Roberts, PsyD

¹Doctor of Osteopathic Program, Philadelphia College of Osteopathic Medicine-Georgia Campus, Suwannee, GA; ²Department of Clinical Education, Philadelphia College of Osteopathic Medicine-Georgia Campus, Suwannee, GA; ³Department of Research, Philadelphia College of Osteopathic Medicine, Philadelphia, PA

Context: Osteopathic medicine is one of the most rapidly growing healthcare professions. Over the past five years, there has been a marked increase in the number of Doctors of Osteopathic Medicine (DOs) by 30%, constituting more than 11% of physicians in the United States (US).1 Over the past decade, the number of DO students expanded by 77%, representing more than 25% of medical students today.1 While future projections predict a continued exponential increase of DOs, the growth is rather disproportionate within certain US regions, with the Southeast representing an area with relatively fewer DO medical schools and overall practicing DOs.2 Compared to their allopathic counterparts, this disproportionate representation of osteopathic physicians may be partly due to a general lack of understanding of the osteopathic profession as a career path for pre-health students at local colleges in the area. A 2021 research study conducted in New York, which has a relatively high percentage of practicing DOs, highlighted the continued need for patient education of osteopathic manipulative medicine (OMM) in this population.3 No similar study has been done to evaluate patient understanding of OMM in southeastern states. Over the past two decades, the Osteopathic Survey of HealthCare in America (OSTEOSURV) has been used to assess the general awareness of the osteopathic profession in US adults.4 However, this data lacks representation of young adults in their 20-30s, which is the most common age group of the pre-health and pre-medical student community. Thus, our study aimed to assess and promote the understanding of the osteopathic profession in pre-health, pre-medical, and allopathic medical students attending southeastern US schools and the related impact on their future involvement with the osteopathic profession.

Objective: To determine if a brief lecture on osteopathic philosophy, prerequisites, education, and career opportunities would increase the understanding of the osteopathic profession for adults over 18 years old who identify as pre-health, pre-medical, or current allopathic medical students at southeastern U.S. schools. A secondary objective was to determine if the lecture would increase pre-health students’ interest in pursuing osteopathic medicine as a future career.

Methods: This study design is a retrospective secondary analysis. The authors presented in-person and virtual lectures at varying events, including university health career fairs, open house events, and a medical conference. The lecture reviewed osteopathic and allopathic prerequisites, training, career opportunities, philosophies, and patient case examples. Student participants were asked to fill out pre- and post-surveys voluntarily to assess their level of understanding of osteopathic and allopathic medicine both before and after the lecture. A total of 151 survey responses were collected. After the exclusion criteria was applied retrospectively, which included participants under 18 years old and not identifying as either a pre-health or allopathic medical student, the finalized total number of responses included in the analysis was 101. Statistical Package for the Social Sciences (SPSS) software was used to conduct descriptive statistical analysis and test for assumptions within our data, where 2 outliers were identified and removed. Because the data violated our normality assumption, we proceeded with non-parametric tests for all dependent variables. Factor analysis and data reduction determined which score would be the best method to evaluate our data; we proceeded with pre-total and post-total scores as best measures, given that all items fell under one construct and these scores accounted for large variance.

Results: Our null hypothesis was that the median of differences between pre-DO and post-DO scores equals zero. We rejected our null hypothesis with p<0.0.05, using the Related Samples Wilcoxon Signed Rank Test, which indicated a significant increase from pre-DO to post-DO scores. Based on pre-survey results, participants’ baseline knowledge of osteopathic medicine concerning prerequisites, medical training, career opportunities, and philosophy was lower than that of allopathic medicine. After the presentation, however, post-survey results demonstrated statistically significant increases in participants’ understanding of osteopathic and allopathic knowledge, with a greater increase in osteopathic scores (3.1 points) compared to allopathic scores (2.0 points). Before the presentation, 58 participants indicated their intent to pursue a career as a DO, while 57 indicated an intended career as an MD. After the presentation, post-survey results revealed 6 more participants expressed interest in becoming a DO, while 4 less participants had interest in becoming an MD. These findings may include a degree of sample bias given that participation in the study was based on voluntary enrollment of pre-health students choosing to attend a lecture including “osteopathic medicine” in the title. Conversely, our participant pool included current MD students whose answers would inadvertently favor a career in allopathic medicine.

Conclusion: Overall, the findings from our study emphasize the benefit of providing appropriate educational materials promoting osteopathic medicine to pre-medical students, as it can improve understanding of and increase interest in pursuing a career as a DO. Future directions for this research will focus on expanding our study to other U.S. regions with little to no DO school representation and few practicing DOs. After increasing the power of our research, an additional step in consideration would be including pre-medical advisors to improve their comfort level in discussing osteopathic medicine with pre-medical students.

References

1. American Osteopathic Association. Profession on the rise: 2023 OMP Report tracks growth & expansion of osteopathic medicine. (2023, August 11). https://osteopathic.org/about/aoa-statistics/#:∼:text=In%202023%2C%20the%20total%20number,to%20reach%20186%2C871%20in%202023

2. American Osteopathic Association. Osteopathic Medical Profession Report 2020-2021.; 2021. https://osteopathic.org/wp-content/uploads/OMP-Report-2020-21.pdf

3. Chin J, Kleyn L, Dube E, Terrell M, Lomiguen CM, Volokitin M. Assessing the Knowledge of the Osteopathic Profession in New York City’s Eastern European Communities. Cureus. 2022;14(1):e21664. Published 2022 Jan 27. doi:10.7759/cureus.21664

4. Licciardone JC, Kearns CM, Ruggiere P. Background and methodology of the Osteopathic Survey of Health Care in America 2010 (OSTEOSURV 2010). J Am Osteopath Assoc. 2011;111(12):670-684.

Informed Consent: IRB exemption for informed consent under 45 CFR 46.104(4)

Ethical Approval & IRB and/or IACUC Approval: This study was approved by the PCOM Division of Research for IRB exemption on May 22, 2024.

Financial Disclosure: None reported.

Poster No. *C-15

Abstract No. 2024-053

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Utilizing Advanced Ultrasound Technology to Optimize OxyVita for Enhanced Preservation and Extended Viability of Kidney Transplants During Organ Transportation

¹Sohail Khan, OMS-II, ¹Nilank Shah, MD, MS, ²Hanna Wollocko, MD, PhD

¹Department of Basic Medical Sciences, Touro College of Osteopathic Medicine (TouroCOM-Middletown Branch Campus), Middletown, NY; ²Department of Internal Medicine, Touro College of Osteopathic Medicine (TouroCOM-Middletown Branch Campus), Middletown, NY

Context: Renal transplantation, a cornerstone in modern medicine, offers a crucial solution for those grappling with end-stage renal diseases. However, the challenge of organ transportation necessitates innovative interventions to enhance preservation. This study aims to redefine transplant viability by optimizing kidney preservation techniques through advanced ultrasound technology. The currently proposed study continues previous work involving experiments with our purified hemoglobin-based oxygen carrier (HBOC) compound. This solution addresses the primary issue of oxygen deprivation during transport from acquisition to transplantation when used in OxyVita organ storage device. The OxyVita solution used in our experiments is further enhanced with varying concentrations of sugars and amino acids, creating an extracellular storage solution able to maintain high oxygen delivery and metabolism in an ex vivo environment, potentially offering greater clinical value than current market practices.1 Market organ preservation solutions are unable to support the transport of oxygen throughout the tissue, as they depend on oxygen dissolved in the solution, without the ability of active oxygen transport. This leads to tissue ischemic necrosis and the build-up of reactive oxygen species (ROS).

Objective: To evaluate the effectiveness of OxyVita in improving kidney preservation during transport by utilizing advanced ultrasound technology for precise assessment of renal morphometrics, biopsy precision, and perfusion dynamics, ultimately enhancing tissue integrity and reducing ischemic damage.

Methods: Current market organ preservation solutions rely on dissolved oxygen, lacking active transport, which leads to ischemic necrosis and ROS build-up. Over 24-48 hours, control kidneys will be submerged in the University of Wisconsin (UW) solution, while study bovine kidneys will be submerged and perfused with OxyVita. The NextGen LOGIQ e ultrasound system will be used to screen for healthy kidneys at removal and guide fine-needle biopsies every two hours during and post-treatment. The Fine Needle Recognition Mode software function enables precise sectioning of tissue from the renal cortex, generating accurate data on tissue necrosis. Additionally, ultrasound-guided fluid collection will provide insights into critical metabolites generated by the organ.2 Post-experiment, periodic ultrasound assessments, a key imaging test for renal evaluation, will monitor the transplanted kidney’s condition.3 The research methodology integrates ultrasound modalities such as color-flow Doppler imaging and contrast-enhanced ultrasound. This non-invasive, radiation-free technique can provide detailed structural and functional assessment, offering a reliable basis for clinical application, enabling the delineation of perfusion patterns, the detection of structural kidney aberrations, and ensuring that renal echogenicity and corticomedullary differentiation are preserved. 4,5

Results: Preliminary research shows OxyVita optimizing its storage solution, currently aiming to reach a storage time between 24-48 hours. Studies at the UWM School of Medicine in Poland evaluated OxyVita in renal preservation, showing over 20% better preservation compared to control solutions. Detailed analysis of biopsy samples stained with Prussian Blue and H&E confirmed reduced ischemic injury with OxyVita. The Fisher’s Exact Test analysis of biopsy samples showed a significant reduction in ischemic necrosis with OxyVita. For instance, in week 2, ischemic necrosis was observed in 18 out of 25 samples stored in the refrigerator with control solution, whereas only 8 out of 25 samples showed ischemic necrosis with OxyVita solution (p=0.0072, relative risk 1.909, 95% CI 1.240 to 3.217). Results for week 3 showed even more significant differences, with p=0.0001 and relative risk 14 (95% CI 2.733 to 80.60). In vitro studies demonstrated effective oxygenation and metabolic maintenance in OxyVita-preserved tissues. Quantitative data revealed that kidneys preserved with OxyVita had higher preservation of renal structure compared to control solutions, indicating better maintenance of tissue integrity and reduced ischemic damage. Additionally, our study identified optimal concentrations of trehalose (0.52 mg) and sucrose (1.275 mg) to maximize oxygen-carrying capacity, further enhancing the preservation capabilities of OxyVita. The staining techniques, including Prussian Blue and H&E, were effective in monitoring ischemic injury and assessing hemoglobin penetration in tissues preserved with OxyVita. Overall, OxyVita demonstrated superior structural integrity and reduced ischemic damage compared to control solutions, providing a strong foundation for improved transplant outcomes and reduced healthcare strain. Further results on the application of advanced ultrasound technology for detailed assessment of renal morphometrics and perfusion dynamics are pending and will be integral in confirming these preliminary findings.

Conclusion: This study aims to confirm that the OxyVita solution effectively deters pathophysiological processes. Data from renal tissue histology and spectrophotometry will be enhanced by high-quality imaging and contrast signals from the NextGen LOGIQ e system, thereby strengthening the histopathological and biochemical findings. Leveraging advanced ultrasound technology, our investigation spans diverse dimensions, including assessing organ morphometrics, delineating architectural pathologies, understanding perfusion dynamics, and providing precise visualizations crucial for comprehensive research analyses to unravel rejection mechanisms within the application of the OxyVita product. Ultimately, our goal is to extend the shelf-life of kidneys to increase their transplantation viability for a broader patient population. This extension in shelf-life will reduce the urgency for immediate transplantation, thereby lessening the strain on healthcare systems. By increasing the availability of viable organs, we can improve transplant outcomes, reduce waiting list times, and provide better resource allocation within transplant centers.

References

1. Harrington JP, Wollocko J, Kostecki E, Wollocko H. Physicochemical characteristics of OxyVita hemoglobin, a zero-linked polymer: liquid and powder preparations. Artif Cells Blood Substit Immobil Biotechnol. 2011;39(1):12-18. doi: 10.3109/10731199.2010.501753

2. Schechter A, Gafter-Gvili A, Shepshelovich D, et al. Post renal transplant anemia: severity, causes and their association with graft and patient survival. BMC Nephrol. 2019;20(1):51. doi: 10.1186/s12882-019-1244-y

3. Kolofousi C, Stefanidis K, Cokkinos DD, Karakitsos D, Antypa E, Piperopoulos P. Ultrasonographic features of kidney transplants and their complications: an imaging review. ISRN Radiol. 2012;2013:1-12. doi: 10.5402/2013/480862

4. Zhou Q, Yu Y, Qin W, et al. Current Status of Ultrasound in Acute Rejection After Renal Transplantation: A Review with a Focus on Contrast-Enhanced Ultrasound. Ann Transplant. 2021;26:e929729. doi: 10.12659/AOT.929729

5. Sheikh Z, Weerakkody Y, Sharma R, et al. Renal transplant ultrasound. Radiopaedia. Updated June 29, 2023. Accessed May 29, 2024. doi: 10.53347/rid-47779

Informed Consent: N/A.

Ethical Approval & IRB and/or IACUC Approval: There is no IRB or IACUC number associated with this study. Approval is not required for this preliminary phase as it involves only commercially sourced tissue, not human or live animal tissue. This phase is preparatory to establish methods for the actual experiment.

Financial Disclosure: None reported.

Poster No. *C-16

Abstract No. 2024-064

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Utilizing the BardyDx Low-Profile ECG Telemetry Monitor as a Non-Invasive Diagnostic Tool for Cardiac Patients

Malcolm Zeroka, OMS-III, ²Shruthi Radhakrishnan, OMS-III, ³Ermin Tale, OMS-IV, ⁴Todd Cohen, MD

¹Department of Clinical Specialties, New York Institute of Technology, Old Westbury, NY

Context: Ambulatory electrocardiographic (ECG) telemetry monitoring is an essential diagnostic tool widely used to analyze arrhythmias in patients who show initial symptoms of syncope, palpitations, and shortness of breath [1]. Due to its importance, it is necessary to continually improve upon current modalities so that we may better understand and treat these conditions. Recently, an emphasis has been placed on P-wave-centric monitoring to distinguish between atrial and ventricular arrhythmia types, leading to a more accurate diagnosis [2]. The BardyDx monitor is a novel, low-profile, wearable ECG monitor that has been engineered to optimize the P-wave amplitude by using two widely spaced electrodes that run vertically along the manubrium, similar to the interatrial septum [3]. Unlike other external ECG telemetry monitors, this device is slender (178 mm x 38 mm x 14 mm) and is centrally applied via medical-grade adhesive, obviating the need for a cumbersome device and/or electrodes, which may interfere with breast tissue. A pressable button exists in the middle of this device allowing patients to identify time periods in which they experience symptoms.

Objective: To analyze the effectiveness of the BardyDx monitor as a diagnostic ECG telemetry modality to determine if patients needed further cardiac monitoring, diagnostic testing, pharmacological or supportive treatment in their cardiac care plan.

Methods: Between July 2019 and January 2024, 61 cardiac patients from the Long Island Heart Rhythm Center (LIHRC) were referred for telemetry using the BardyDx monitor. This retrospective study was reviewed and received exempt status from the NYIT IRB. The patient history, physical exam, and baseline ECG were analyzed. Indications for remote monitoring included palpitations, syncopal episodes, or a prior history of arrhythmias. Patients were monitored from two to fourteen days. The utility of the BardyDx monitor was evaluated to determine whether further cardiac testing and/or interventions were necessary. Data is presented as percentages and mean + standard deviation. The BardyDx monitor gives the clinician a better understanding of the body’s, specifically the heart’s, structure, function, and self-regulation within the context of osteopathic medicine.

Results: 61 patients were evaluated with BardyDx monitoring; age 42.0 years + 18.8; 43 females/18 males. The ECG telemetry recordings were exceptionally clear and the P-waves were unusually large, a direct result from the large bipolar electrode recordings and its unique mid-sternal recording position. 18 (29.5%) patients were recommended for additional long-term telemetry recording with an implantable loop recorder (ILR). 16 (26.2%) patients underwent further cardiac evaluation including tilt table testing, echocardiogram, stress testing, or electrophysiology study. Pharmacological therapy in the form of beta blockers was initiated in 8 (13.1%) patients. Monitoring in 7 (11.5%) patients ruled out arrhythmias. 5 (8.2%) patients were treated with supportive care, and 7 were lost to follow-up (11.5%).

Conclusion: The BardyDx monitor is an easy-to-use, effective tool which correlates patient symptoms to arrhythmias. The unique device placement along with its low-profile design makes it an easy, comfortable, and convenient method for recording extended external telemetry (> 7 days). Additional testing and/or interventions were ordered, based on findings from the device’s recordings, which further solidified its effectiveness. A limitation of this study is its small sample size. Further analysis of a larger cohort is needed to better understand the value of BardyDx monitoring in cardiac patients.

References

1. Francisco-Pascual J, Cantalapiedra-Romero J, Pérez-Rodon J, et al. Cardiac monitoring for patients with palpitations. World Journal of Cardiology. 2021;13(11):608-627. doi: https://doi.org/10.4330/wjc.v13.i11.608

2. Romme AG, Umapathi KK, Nguyen HH. Feasibility of P wave Centric Ambulatory Electrocardiogram Monitoring in Infants and Young Children. Pediatric cardiology. 2021;42(5):1126-1132. doi:https://doi.org/10.1007/s00246-021-02590-5

3. Bouzid Z, Al-Zaiti SS, Bond R, Sejdić E. Remote and wearable ECG devices with diagnostic abilities in adults: A state-of-the-science scoping review. Heart Rhythm. 2022;19(7). doi:https://doi.org/10.1016/j.hrthm.2022.02.030

Informed Consent: Informed consent waived by NYITCOM IRB (BHS-1465)

Ethical Approval & IRB and/or IACUC Approval: This research protocol was exempt by the NYIT IRB retrospective Long Island Heart Rhythm Center study (BHS-1465).

Financial Disclosure: None reported.

Poster No. *C-17

Abstract No. 2024-065

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Utility of the Implantable Loop Recorder in Patients with Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder

¹Ermin Tale, OMS-IV, ¹Riya Kaushal, OMS-II, ¹Scott Landman, DO, ²Bernadette Riley, DO, ³Todd Cohen, MD

¹Department of Clinical Specialties, New York Institute of Technology, Old Westbury, NY; ²Department of Family Medicine, New York Institute of Technology, Old Westbury, NY; ³Department of Clinical Specialties, New York Institute of Technology, Old Westbury, NY

Context: Ehlers-Danlos Syndrome (EDS) and hypermobility spectrum disorder (HSD) are connective tissue disorders characterized by hyperelastic skin and hyperflexible joints (1). Patients may manifest cardiovascular symptoms and often complain of palpitations and presyncope/syncope that can be attributable to postural orthostatic tachycardia syndrome (POTS) (2). Occasionally, the etiology is unclear and may require further cardiac monitoring.

Objective: The purpose of this study was to evaluate the utility of ILR in diagnosing and/or excluding arrhythmias not attributable to POTS in symptomatic patients with EDS and HSD.

Methods: This retrospective study analyzed 116 EDS and HSD patients referred from the NYIT Ehlers-Danlos Syndrome/Hypermobility Center to the Long Island Heart Rhythm Center for cardiac evaluation between January 2019 - November 2023. This study was reviewed by the NYIT IRB and deemed exempt. Patients underwent routine screening, and an implantable loop recorder (ILR) was indicated in patients with recurrent presyncope/syncope of unknown etiology and palpitations that did not appear positional. ILR utility was evaluated and confirmed for each patient based on at least one of the following: a correlation of symptoms to an arrhythmia, the device’s ability to monitor therapy efficacy or rule out an arrhythmia as the explanation of symptoms. Data is presented as percentages and mean ± standard deviation. The osteopathic principles in this study focus on understanding the interrelationship of structure and function manifesting symptomatically to diagnose and manage patients while developing rational treatment plans.

Results: 116 hypermobile patients (81 EDS/35 HSD) were evaluated. Of the 116 patients, 31 (26.7%) received an ILR with a length of follow-up of 27.3 months ± 14.0 months. Patient characteristics included 29 females and 2 males with an average age of 34.1 ± 11.4 years. 28 patients had EDS (subtypes: 23 hypermobile, 3 classic-like, and 2 vascular) and 3 patients had HSD. Symptomatic non-physiologic sinus tachycardia occurred in 16 patients (51.6%) and helped diagnose POTS and/or monitor therapy in 15 patients (48.4%). Symptomatic premature ventricular complexes (PVCs) occurred in 8 patients (25.8%), supraventricular tachycardia in 6 (19.4%), and ventricular tachycardia in 1 (3.2%). In three patients, ILR findings led to further interventions, including PVC ablation, implantable cardioverter-defibrillator (ICD) implantation, and pacemaker implantation.

Conclusions: In this study, the ILR was useful in identifying symptomatic arrhythmias, solidifying POTS diagnosis, and monitoring treatment. ILR monitoring further guided patient management after the monitoring period in prescribing life-saving interventions (ie. ablation, ICD implantation, and pacemaker implantation). Limitations of this retrospective study include its small sample size. Further evaluation of a larger cohort is needed to fully understand the impact of ILR monitoring in EDS and HSD patients.

References

1. Yew KS, Kamps-Schmitt KA, Borge R. Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders. Am Fam Physician. 2021;103(8):481-492.

2. Anjum, I., Sohail, W., Hatipoglu, B., & Wilson, R. Postural Orthostatic Tachycardia Syndrome and Its Unusual Presenting Complaints in Women: A Literature Minireview. Cureus. 2018;10(4):e2435. https://doi.org/10.7759/cureus.2435.

Informed Consent: Informed consent waived by NYITCOM IRB (BHS-1465).

Ethical Approval & IRB and/or IACUC Approval: This retrospective study was deemed exempt by the NYIT Institutional Review Board (IRB) (BHS-1465).

Financial Disclosure: None reported.

Poster No. *C-18

Abstract No. 2024-067

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Mental Health Illnesses and Somatic Symptoms in English and Spanish-Speaking Primary Care Patients – A Holistic Perspective

¹Camilla Mancuso, OMS-IV, MS, ²Nataliya Pilipenko, Ph.D., ABPP

¹Osteopathic Medicine, Nova Southeastern University Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, FL; ²Department of Medicine, Department of Psychiatry Columbia University, Vagelos College of Physicians and Surgeons New York, NY

Context: In the United States, more than one in five adults live with a mental health illness (MHI). Within primary care (PC), the following MHIs are often encountered: depression, generalized anxiety disorder (GAD), panic disorder (PD), and PTSD. MHIs are often comorbid with each other as well as physical conditions. Overlooking MHI comorbidities and their somatic symptom manifestations leads to sub-optimal patient care, including increased healthcare costs, disability, and mortality. Recognizing the connection between MHIs and somatic symptoms is especially important for minoritized, Spanish-speaking communities, as cultural and linguistic barriers can further exacerbate MHI diagnosis and treatment. Current literature, however, has limited studies focusing on how MHIs co-occur and interact with somatic symptoms in both English and Spanish-speaking patients within PC. By investigating the associations between MHIs and somatic symptoms, we aim to uncover critical insights that can inform more comprehensive, culturally sensitive, and accurate diagnostic and treatment strategies within PC settings for both English and Spanish speakers.

Objective: To determine if there is a significant association between screening scores for common mental health conditions and reported somatic symptoms among Spanish- and English-speaking PC patients.

Methods: Participants were adult primary care patients (N = 65, M age = 41.08, SD = 12.39, 89% female, 40% Spanish speakers) recruited during the COVID-19 pandemic as part of a larger, grant-funded study. Data were collected via phone surveys. The following measures were used to assess MHIs: PC-PTSD-5 for PTSD, PHQ-9 for depression, GAD-7 for GAD, and PHQ-PD for PD. Somatic symptoms were examined via the PHQ-13 sub-scale. Statistical analysis included correlation analysis (Spearman rho) to examine associations between MHIs and somatic symptoms.

Results: Positive screenings on MHI screeners were significantly associated with each other and with a greater number of somatic symptoms. PHQ-15 score was significantly correlated with PHQ-9 score (Spearman’s rho = .62, 95% CI [.44, .75], p Spearman’s rho = .52, 95% CI [.27, .71], p Spearman’s rho = .64, 95% CI [.47, .77], p Spearman’s rho = .85, 95% CI [.76, .91], p Spearman’s rho = .45, 95% CI [.19, .66], p Spearman’s rho = .39, 95% CI [.04, .65], p Spearman’s rho = .57, 95% CI [.33, .74], p Spearman’s rho = .25, 95% CI [-.13, .56], p = .19). PHQ-15 was also not significantly associated with PC-PTSD (Spearman’s rho = .35, 95% CI [-.02, .63], p = .06). There was no significant difference between Spanish-speaking patient and English-speaking patient scores. In summary, positive associations were found between somatic symptom severity and depression, panic disorder, generalized anxiety disorder, and PTSD scores; between depression and generalized anxiety disorder, panic disorder, and PTSD scores; and between panic disorder and PTSD and generalized anxiety disorder scores.

Conclusion: The significant correlations between MHI screening scores and somatic symptoms underscore the critical need to consider the overlap between mental and physical health in both future research and clinical care. This study underscores the importance of addressing both mental and physical health comprehensively, enabling healthcare providers to better manage the complex presentations of MHIs, especially in underserved populations. Strengths of the present study include the utilization of PC-validated screening tools in English and Spanish, and bilingual outreach and survey delivery, which facilitated the participation of patients with limited English proficiency. Limitations included the small sample size and remote data collection challenges due to COVID-19-related recruitment limitations. However, despite these limitations, the study provides valuable insights into MHI prevalence and healthcare within the scope of the research question.

References

1. Mental illness. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/mental-illness

2. Wittchen HU, Mühlig S, Beesdo K. Mental disorders in primary care. Dialogues Clin Neurosci. 2003;5(2):115-128. doi:10.31887/DCNS.2003.5.2/huwittchen

3. Razzano LA, Cook JA, Yost C, et al. Factors associated with co-occurring medical conditions among adults with serious mental disorders. Schizophr Res. 2015;161(2-3):458-464. doi:10.1016/j.schres.2014.11.021

4. Mohamed Ibrahim OH, Ibrahim RM, Al-Tameemi NK, Riley K. Challenges associated with mental health management: Barriers and consequences. Saudi Pharm J. 2020;28(8):971-976. doi:10.1016/j.jsps.2020.06.018

5. Ohtani A, Suzuki T, Takeuchi H, Uchida H. Language Barriers and Access to Psychiatric Care: A Systematic Review. Psychiatr Serv. 2015;66(8):798-805. doi:10.1176/appi.ps.201400351

Informed Consent: Initially, 34 faculty and resident physicians were contacted via email to obtain permission to inform their patients about the research project. Twelve physicians (35.29%) granted permission for outreach. Next, 380 potential participants identified through EMR review received messages outlining the study’s goals and procedures. Participants had the option to opt-out by responding to these messages, resulting in 145 non-respondents and 15 opt-outs, leaving a final outreach sample of 220 potential participants. Phone outreach was then conducted by a trained researcher fluent in English and Spanish. This researcher completed informed consent procedures verbally and administered the study’s measures, entering responses into Qualtrics. Up to four outreach attempts were made per participant. Ultimately, 111 (45.45%) declined, 43 (19.54%) were not reached, and 66 (30%) agreed to participate.

Ethical Approval & IRB and/or IACUC Approval: Ethical Approval: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Informed Consent: All participants provided informed consent, with a waiver of written documentation of consent, approved by Columbia University Medical Center, Institutional Review Board (IRB). IRB- AAAS8932(M00Y03)

Financial Disclosure: None reported.

Poster No. C-19

Abstract No. 2024-069

Category: Clinical

Research Focus Area: Health Disparities-Social Determinants of Health

Osteopathic Medical Student Experiences with Assessing Red-Reflex in Different Skin Tones

¹Prarthna Shah, OMS-III, ²Shannon Curran, MS

Department of Biomedical Sciences, Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, Kansas City, MO

Context: The criteria for diagnosing somatic dysfunction, an altered functional component of the body’s framework, are taught early in Osteopathic Medical Schools. Guidelines for performing osteopathic manipulative techniques (OMT) require at least two of four T.A.R.T. criteria: Tissue texture changes (including red-reflex), Asymmetry, Restriction of motion, and Tenderness. Diagnosis of somatic dysfunction typically begins with patient visualization followed by palpation. With somatic dysfunction present, a red-reflex often appears immediately after palpation. Red-reflex is the body’s natural reddening response to palpation, typically indicating somatic dysfunction. However, skin tone differences can make this difficult to identify consistently. In some cases, diagnoses may be missed due to an unclear red-reflex. As our patient base increasingly reflects the diversity of the general population, it’s essential to undergo training that provides both empathy and expertise for each patient. This approach underscores our commitment to inclusivity and recognition of individual patient differences, strengthening their perception of being valued and respected.

Objective: To describe how skin tone affects the appearance of red reflex in different skin tones. To discuss how osteopathic medical students experience challenges in diagnosing somatic dysfunction in different skin tones. To discuss ways osteopathic medical education can highlight these differences early on in osteopathic manipulative medicine courses.

Methods: In this study, (IRB #2023-13 Exempt Status), 220 first and second year medical students from Kansas College of Osteopathic Medical School were surveyed in a six-question questionnaire about their experiences practicing palpation skills on different skin tones in Osteopathic Manipulative Medicine (OMM) courses. Students must have been currently enrolled at the Kansas College of Osteopathic Medicine OMM courses; surveys were sent to those individuals. Any data that had duplicated answers between items 4 and 6, apart from Neutrals, were thrown out. They were asked whether they had ever encountered an instance where it was difficult to visualize the red-reflex due to the skin tone differences in fellow classmates. This includes any factors that may have affected their response: whether they had practiced palpating on various skin tones and if they felt they had access to various skin tones. In addition, students were asked to give their perspectives on how to further enhance education by identifying the differences seen in red-reflex in different skin tones. The ability to recognize red-reflex in individuals with various skin tones is crucial for precise diagnosis and treatment of somatic dysfunction.

Results: This study showed that students felt comfortable with their palpation skills and agreed that there is enough diversity to practice on. However, only 27% of first year students disagreed to the statement that they struggled to diagnose red-reflex on different skin tones and 27% of first year students believed that they felt educated on the differences in appearance of red-reflex in different skin tones. For second year students, 29% disagreed that they struggled to diagnose red-reflex on different skin tones and 45% of the students believed that they felt educated on the differences in appearance of red-reflex in different skin tones. Many students discussed presentations of patients with different skin tones by increasing the diversity in the demonstration photos used in lectures. Others mentioned encouraging students to seek out practice with different skin tones to make them more well-rounded future physicians. Many students who identified gaps in OMM education emphasized the importance of early exposure, particularly when learning about somatic dysfunctions in first-year OMM courses. They stressed that early introduction to these concepts is crucial for comprehensive understanding.

Conclusion: Palpation is taught very early at every osteopathic medical schools and is an essential component to learning the layer-by-layer technique in diagnosing somatic dysfunction. This data showed that not only does skin tone affect the appearance of the erythema friction rub (red-reflex), but it is an area of improvement needed in the education of diagnosis in osteopathic medical education. Essential textbooks such as Foundations of Osteopathic Medicine(1) and Atlas of Osteopathic Techniques(2) have zero or one photo demonstrating red reflex on a very fair skin tone. With changes in the patient population group, we will encounter as future osteopathic physicians, it is important to take note of the variability in skin tone, allow ourselves to be comfortable with these changes to be the best osteopathic physicians in the future.

References

1. Seffinger M. Foundations of osteopathic medicine: Philosophy, science, clinical applications, and research. 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2019.

2. Nicholas AS, Nicholas EA. Atlas of Osteopathic Techniques. 4th ed. Baltimore, MD: Wolters Kluwer Health; 2022.

Informed Consent: Eligible students were identified and invited to participate in the research survey. All participants were provided with necessary information, including content details and the opportunity to address questions or concerns.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-20

Abstract No. 2024-072

Category: Clinical

Research Focus Area: Acute and Chronic Pain Management

Duration of Steroid Taper in Acute COPD Exacerbations with Acute Hypoxic and/or Hypercapnic Respiratory Failure to Prevent Hospital Readmissions

¹Satvika Nimmagadda, OMS-III, ²Houria Balmakhtar, DO, ³Lily J. Erdal, DO, ⁴Joshua Collette, DO, ⁵William S. Cox, DO, ⁶Yingxiam Liu, ⁷Mitchell Horowitz, MD

¹Edward Via College of Osteopathic Medicine, Blacksburg, VA; ²Department of Internal General Surgery, HCA Healthcare, Roanoke, VA; ³Department of Internal Medicine PGY2, HCA Healthcare, Blacksburg, VA; ⁴Department of Internal Internal Medicine, HCA Healthcare, Blacksburg, VA; ⁵Department of Internal Internal Medicine Co-Chair, Edward Via College of Osteopathic Medicine , Blacksburg, VA; ⁶No Institution; ⁷Department of Internal Pulmonary Medicine, Salem VA Medical Center, Salem, VA

Context: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with acute exacerbations significantly increasing morbidity and mortality¹. Systemic steroid therapy is a cornerstone of treatment, improving patient outcomes, reducing relapse rates, and mitigating exacerbation severity². Despite its benefits, steroid treatment can cause adverse effects such as osteoporosis, increased rates of pulmonary infection, and adrenal suppression, complicating the clinical management of COPD³. Optimal dosing, duration, and tapering of steroid therapy remain controversial due to current guidelines offering varying recommendations, further necessitating research in this area. Previous studies have focused on the length and dosing of steroid therapy, but the benefits of tapering, as opposed to a conventional 5-day course of prednisone 40 mg, have not been extensively investigated⁴. This study addresses this gap by comparing the effects of a 6-day versus 12-day steroid taper on readmission rates in patients with acute COPD exacerbations.

Objective: The objective of this study is to evaluate the impact of a 6-day compared to 12-day prednisone taper on 30-day, 3-month, and 6-month readmission rates in patients discharged after hospitalization for acute COPD exacerbation with respiratory failure. The study aims to provide valuable insights into optimizing steroid tapering regimens for COPD exacerbations, potentially influencing clinical guidelines and improving patient adherence and outcomes.

Methods: This retrospective observational study analyzed adult patients hospitalized in Capital and South Atlantic Division HCA healthcare facilities from January 1, 2020, to December 31, 2022, for COPD exacerbation with acute hypoxic and/or hypercapnic respiratory failure. Patients included were at least 18 years old, had COPD exacerbation and respiratory failure, and were discharged on either a 6-day or 12-day prednisone taper. Exclusion criteria included COVID-19-positive patients, those with concomitant heart failure or pulmonary embolism, home oxygen therapy users, and those discharged without the specified steroid regimens. Out of 2,852 screened patient encounters, 176 patients met the inclusion criteria. Data collected included patient demographics, treatment group assignment (6-day or 12-day taper), and readmission dates within the specified follow-up periods. Additional data on inhaled respiratory medications at discharge and length of hospital stay were also recorded. Statistical analyses included Chi-square tests to evaluate the relationship between the duration of steroid taper and readmission rates at 30 days, 3 months, and 6 months. The Wilcoxon Rank Sum test was used to compare the time to first readmission and the frequency of readmissions within 6 months between the two treatment groups. Osteopathic significance was assessed by considering the holistic impact of steroid taper duration on patient outcomes, including potential effects on respiratory function and overall health.

Results: The study found no significant association between the 6-day and 12-day treatment groups for readmissions at 30 days (χ2(1) = 0.1073, p = .7432), 3 months (χ2(1) = 0.1305, p = .7179), or 6 months (χ2(1) = 0.2626, p = .6083). Additionally, there was no significant difference in the time to first readmission within 6 months (Z = -0.4131, p = .6795), within 30 days (Z = 0.0000, p = 1.0000), or within 3 months (Z = -0.3956, p = .6924). The frequency of readmissions within 6 months (Z = 0.5252, p = .5994), 30 days (Z = -0.5319, p = .5948), or 3 months (Z = -1.0492, p = .2941) also showed no significant differences between the two groups.

Conclusion: These findings suggest that a 6-day steroid taper is just as effective as a 12-day taper in preventing readmissions resulting from acute COPD exacerbations. Adopting a shorter steroid taper regimen is clinically important because it reduces treatment costs and side effects without compromising the quality of care. This approach can maintain standard patient outcomes while decreasing hospital stay durations, thereby alleviating strain on healthcare facilities. Consequently, it enables more efficient resource allocation to other critical areas of patient care⁵. Furthermore, this approach emphasizes patient-centered care and leverages the body’s inherent ability to heal. By minimizing unnecessary steroid exposure, we can reduce the risk of adverse effects, supporting a focus on preventing harm and promoting overall health and well-being. Additionally, a shorter steroid regimen can simplify treatment protocols, potentially enhancing patient adherence and improving quality of life, especially for those with multiple chronic conditions alongside COPD⁶. This strategy demonstrates a holistic perspective, integrating patients’ lifestyles and personal circumstances into their treatment plans. However, the small sample size limits the generalizability of the results. Further research is necessary to validate these findings with a larger sample size and continue to establish optimal steroid tapering regimens that adhere to principles of holistic, patient-driven care.

References

1. World Health Organization. Chronic obstructive pulmonary disease (COPD). March 16, 2023. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) Aaron SD,

2. Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. NEJM. 2003;348(26):2618–2625, https://doi.org/10.1056/nejmoa023161Niewoehner DE.

3. Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. NEJM. 1999;340(25):1941-7. https://doi.org/10.1056/NEJM199906243402502

4. Stoller, J., Barnes, P., & Dieffenbach, P. (2023). UpToDate. Jan 30, 2024. Www.uptodate.com. https://www.uptodate.com/contents/copd-exacerbations-management?search=COPD%20exacerbations:%20Management&source=search_result&selectedTitle=2∼124&usage_type=default&display_rank=1

5. Poon T, Paris DG, Aitken SL, Patrawalla P, Bondarsky E, Altshuler J. Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients. Journal of Intensive Care Medicine. 2020;35(3):257-263. https://doi.org/10.1177/0885066617741470

6. Homętowska H, Świątoniowska-Lonc N, Klekowski J, Chabowski M, Jankowska-Polańska B. Treatment Adherence in Patients with Obstructive Pulmonary Diseases. Int J Environ Res Public Health. 2022;19(18):11573. https://doi.org/10.3390%2Fijerph191811573

Informed Consent: As this study is retrospective and observational, informed consent was waived by the IRB.

Ethical Approval & IRB and/or IACUC Approval: This study was reviewed by HCA Healthcare Centralized Algorithms for Research Rules on IRB Exemption and did not require IRB oversight. C.A.R.R.I.E. Submission ID #: 2023-968

Financial Disclosure: None reported.

★Poster No. *C-21

Abstract No. 2024-077

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Unraveling exogenous and endogenous determinants of persistent nausea in pregnancy

¹Brad Ryva, OMS-III, ²Rita Strakovsky

¹Department of Pharmacology and Toxicology, Michigan State University College of Osteopathic Medicine, East Lansing, MI; ²Department of Food Science and Human Nutrition, Michigan State University College of Osteopathic Medicine, East Lansing, MI

Context: Pregnancy-related nausea is very common, can persist beyond the first trimester, impacts women’s quality of life and health, and has unclear, likely hormonal etiology1. Pregnant women are exposed to numerous endocrine disrupting chemicals (EDCs) from consumer products, such as food packaging materials and personal care products, that can affect hormonal pathways regulating pregnancy and fetal development2.

Objective: To evaluate endogenous (hormones) and exogenous (EDCs) predictors of persistent nausea during pregnancy, which has the potential to uncover additional biological underpinnings of a common pregnancy condition and to identify modifiable lifestyle factors that could decrease nausea without requiring pharmacological interventions in pregnancy.

Methods: The Illinois Kids Development Study (I-KIDS) is a prospective, Illinois pregnancy cohort where women (n=302-433) reported nausea since conception or last study visit (yes/no) at median 13, 17, 23, 28, 34 weeks gestation and at delivery. We categorized women as never having nausea, or as having typical (ends by 17 weeks gestation), persistent (ends after 17 weeks gestation), or intermittent nausea. Women provided five urine samples across pregnancy, which we pooled and analyzed for 16 phthalates, three parabens, and six phenols. We quantified sex-steroid (progesterone, estradiol, testosterone) and thyroid (free/total thyroxine, thyroid stimulating hormone) hormone levels in fasting plasma samples collected at median 17 weeks gestation. We evaluated associations between single chemicals or hormones and nausea persistence using covariate-adjusted logistic regression. We used quantile-based g computation (QGComp) and Bayesian kernel machine regression (BKMR) to assess associations of EDCs jointly with nausea persistence and utilized weighted quantile sums regression (WQSR) to understand each hormone’s contribution to nausea persistence while accounting for other hormones. We also used WQSR and BKMR to identify associations of EDCs with hormones to potentially identify hormonal pathways linking EDCs with persistent nausea. We considered differences by fetal sex in all relationships.

Results: Most women were of high socioeconomic status and had typical nausea (42%), followed by persistent nausea (25%) and irregular nausea (24%); 9% of women never developed nausea. In terms of exogenous exposures, only the sum of urinary biomarkers of di(isononyl) cyclohexane-1,2-dicarboxylate (ΣDiNCH) was associated with persistent nausea in all women; however, each 10% increase in the EDC mixture was associated with 14% higher risk of persistent nausea (risk ratio, RR:1.14;95% Confidence Interval, CI:1.01,1.30), due to ΣDiNCH, ethylparaben, and the sum of di-2-ethylhexyl phthalate (ΣDEHP) metabolites. In women carrying males, ethylparaben was associated with persistent nausea, and each 10% increase in the mixture was associated with 26% higher risk of persistent nausea (RR:1.26;95% CI:1.13,1.41), driven by ethylparaben and ΣDiNCH. Using BKMR, EDCs were positively associated with persistent nausea in women carrying males. For endogenous factors, each 10% increase in testosterone was associated with 6% greater odds of persistent nausea (odds ratio, OR:1.06;95% CI:1.00,1.13), with associations observed mainly among women carrying male fetuses (OR:1.09;95% CI:1.00,1.19). Additionally, each 10% increase in progesterone was associated with 8% (OR:1.08;95% CI:0.98,1.18) greater odds of persistent nausea. When all hormones were modeled jointly, testosterone, progesterone, and FT4 were the major drivers of persistent nausea, particularly in women carrying males. The EDC mixture was negatively associated with estradiol (only at higher biomarker concentrations using BKMR), testosterone, and TSH, where each 10% mixture increase was associated with -5.65% (95% CI: -9.79, -1.28) lower testosterone and -0.09 μIU/mL (95% CI: -0.20, 0.00) lower TSH. Associations with progesterone, testosterone, and FT4 did not differ by fetal sex. However, in women carrying females, we identified an inverted u-shaped relationship of the mixture with estradiol. Additionally, in women carrying females, each 10% increase in the mixture was associated with 1.50% (95% CI: -0.15, 3.18) higher TT4, whereas in women carrying males, the mixture was associated with -1.77% (95% CI: -4.08, 0.58) lower TT4 and -0.18 μIU/mL (95% CI: -0.33, -0.03) lower TSH.

Conclusion: Overall, we observed that some chemical exposures, such as ΣDiNCH and ethylparaben, and hormones, such as progesterone and testosterone, predict persistent nausea during pregnancy. We also observed associations between EDCs and select hormones. However, we did not identify clear connections between EDCs, specific hormones, and persistent nausea. Therefore, future research is needed to investigate alternative mechanisms, including EDC-driven disruption in other hormones or inflammatory biomarkers, that may explain the relationships of EDCs with elevated persistent nausea in pregnancy. Additionally, future work needs to better characterize environmental contaminant sources to possibly mitigate EDC exposures and reduce nausea symptoms.

References

1. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med. Oct 14 2010;363(16):1544-50. doi:10.1056/NEJMcp1003896

2. CDC. Fourth national report on human exposure to environmental chemicals: updated tables, January 2019, Volume one. 2019;doi:DOI : 10.15620/cdc75822

Informed Consent: All women provided written informed consent ​when recruited into the ​pregnancy cohort. This included use of ​all information collected and analyzed in this submitted abstract.

Ethical Approval & IRB and/or IACUC Approval: The study was approved by the University of Illinois’ Institutional Review Board. University of Illinois IRB number: IRB24-0158. Work performed at Michigan State University was additionally covered by a reliance agreement under IRB number: LEGACY17-1259R

Financial Disclosure: None reported.

Poster No. *C-22

Abstract No. 2024-080

Category: Clinical

Research Focus Area: Musculoskeletal Injuries and Prevention

Decreased Upper Extremity Season Ending Injuries Following the Initiation of a Pitch Clock Amongst Major League Baseball Pitchers

Mitchell Rentschler, OMS-III, Elliot Jensen, Mason Kyle, Jared Logsdon, John Ashurst

Department of Assessment, Midwestern University/Arizona College of Osteopathic Medicine (MWU/AZCOM), Glendale, AZ

Context: In the 2022 Major League Baseball (MLB) season, a pitch clock was instituted to establish a quicker pace of play. Since then, however, many have attributed this quicker pace of play as causing an increase in the number of seasons ending injuries (SEI) seen in pitchers. However, little published comparative data is available to substantiate these claims.

Objective: To determine if the institution of a pitch clock increased the number of SEI seen in MLB pitchers between the 2022 and 2023 seasons.

Methods: A retrospective cohort study of all MLB pitchers from 2022 and 2023 was performed utilizing publicly available data on player movement to and from the injured list (prosportstransactions.com). Only upper extremity season-ending injuries suffered by players whose primary position was listed as “pitcher” were considered for this study. An injury that resulted in a pitcher’s inability to return to play at least 10 games before the end of the regular season was classified as an SEI. All injuries sustained after the 153rd game of the season were excluded from analysis. Pitcher demographics, average number of pitches thrown per game, and pitch-specific metrics (baseballsavant.mlb.com) were abstracted for each pitcher. The velocity of a pitch was measured as feet per second determined at 50 feet from home plate and acceleration was determined as feet per second per second 50 feet from home plate. Differences between categorical variables were analyzed with a Chi-Square test and continuous variables were analyzed using a t-test.

Results: In total, 1,696 MLB pitchers recorded at least one pitch during the seasons studied with 843 (49.7%) pitchers being utilized in the 2022 season and 853 (50.3%) in the 2023 season. SEI occurred in 50 (5.9%) pitchers in the 2022 season and 17 (2.0%) pitchers in the 2023 season p.

Conclusion: The institution of the pitch clock appears to have decreased the number of upper extremity SEI in MLB pitchers between the 2022 and 2023 seasons. However, a larger sample and further research on pitching dynamics is needed to truly delineate this relationship.

Informed Consent: Not applicable.

Ethical Approval & IRB and/or IACUC Approval: The Midwestern University IRB reviewed the project and it was found to be exempt.

Financial Disclosure: None reported.

Poster No. *C-23

Abstract No. 2024-085

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Advancing Medical Education with Point-of-Care Ultrasound (POCUS) Curriculum

Brittnie Harbuck, OMS-IV, Naomi Lara, OMS-IV, Ryan Anderson, DO

William Carey University College of Osteopathic Medicine, Hattiesburg, MS

Context: The increasing utilization of point-of-care ultrasound (POCUS) in clinical practice highlights its crucial role in enhancing diagnostic accuracy and patient management, especially for life-threatening conditions.1 POCUS generates diagnostic images that provide essential clinical information, reducing the need for additional tests and expediting patient care.2 Additionally, POCUS reinforces anatomical knowledge, aiding clinicians in understanding anatomical structures and their clinical implications.3-4 Integrating comprehensive POCUS training into medical education is essential, as it equips physicians with advanced diagnostic skills, and a solid knowledge base in anatomy and therapeutic interventions.3-5 This integration fosters more accurate diagnoses, optimizes patient management, and leads to improved patient care outcomes.1-5

Objective: To evaluate the efficacy of the POCUS curriculum at William Carey University College of Osteopathic Medicine (WCUCOM) by measuring the proficiency of second-year medical students before and after completing the curriculum.

Methods: A non-experimental pre- and post-assessment study design was employed, encompassing 179 second-year osteopathic medical students (OMS-2) in the POCUS curriculum at WCUCOM. Students were randomly assigned to one of four ultrasound examinations: parasternal long-axis view (PLAX), hepatorenal recess as part of the Focused Assessment with Sonography for Trauma (FAST) exam, transverse mid-aorta, or longitudinal view of the gallbladder. Dr. Ryan Anderson evaluated student proficiency at the beginning and conclusion of the course. The frequency and percentage of proficiency for each ultrasound type were calculated for both assessments. McNemar’s test was utilized to analyze changes in proficiency rates over the course of the study.

Results: Before the course, 142 students (79.3%) were not proficient in one of the four ultrasound examinations, and 37 students (20.7%) were proficient. After the course, the number of proficient students increased to 169 (94.4%), while the number of not proficient students decreased to 10 (5.6%). Of the 142 students who were initially not proficient, 132 became proficient post-training (93.0%), and 10 remained not proficient (7.0%). All 37 students who were proficient before the course remained proficient afterwards (100%). The McNemar test value is statistically significant with an exact significance (2-sided) value of less than 0.001. This indicates a significant change in proficiency rates from pre- to post-assessment. The number of valid cases included in the test is 179.

Conclusion: This non-experimental pre- and post-assessment study evaluated the impact of the POCUS curriculum on 179 second-year medical students at WCUCOM. Students were randomly assigned one of four ultrasound examinations and assessed for proficiency at the beginning and end of the course. Initial proficiency was 20.7%, which increased to 94.4% post-assessment. Statistical analysis using McNemar’s test confirmed a significant improvement in proficiency rates (p < 0.001). These findings demonstrate that the POCUS curriculum effectively enhances ultrasound skills, which can potentially improve clinical skills and patient outcomes. The study supports integrating POCUS training into medical education to better prepare physicians for clinical practice, thereby addressing current gaps in medical training and enhancing overall patient care through rapid and accurate diagnostics.

References

1. Weile J, Frederiksen CA, Laursen CB, Graumann O, Sloth E, Kirkegaard H. Point-of-care ultrasound induced changes in management of unselected patients in the emergency department: a prospective single-blinded observational trial. Scand J Trauma Resusc Emerg Med. 2020;28(1):47. Published 2020 May 29. doi:10.1186/s13049-020-00740-x

2. Udrea DS, Sumnicht A, Lo D, et al. Effects of student-performed point-of-care ultrasound on physician diagnosis and management of patients in the emergency department. J Emerg Med. 2017;53(1):102-109. doi:10.1016/j.jemermed.2017.01.021

3. Kenny EJG, Makwana HN, Thankachan M, Clunie L, Dueñas AN. The use of ultrasound in undergraduate medical anatomy education: a systematic review with narrative synthesis. Med Sci Educ. 2022;32(5):1195-1208. doi:10.1007/s40670-022-01593-y

4. Royer DF. The role of ultrasound in graduate anatomy education: Current state of integration in the United States and faculty perceptions. Anat Sci Educ. 2016;9(5):453-467. doi:10.1002/ase.1598Johnson JI, Beasley H, Southwick D, et al. Development of a hybrid point-of-care ultrasound curriculum for first year medical students in a rural medical education program: a pilot study. BMC Med Educ. 2024;24(1):16. Published 2024 Jan 3. doi:10.1186/s12909-023-05005-6

Informed Consent: Not applicable.

Ethical Approval & IRB and/or IACUC Approval: William Carey University Institutional Review Board reviewed and approved this study.

Financial Disclosure: None reported.

Poster No. C-24

Abstract No. 2024-086

Category: Clinical

Research Focus Area: Musculoskeletal Injuries and Prevention

NEISS Trends of Head and Neck Injuries Associated with Lacrosse (2014-2023)

¹Steven P. Gawrys, DO, ²Andrew J. Roush, OMS-IV, ³Ryan Enslow, OMS-IV

¹Department of Family Medicine, University of Florida, Gainesville, FL; ²Rocky Vista University College of Osteopathic Medicine (RVUCOM-South Utah), Ivins, UT; ³The Ohio State University, Columbus, OH

Context: The National Electronic Injury Surveillance System (NEISS), a comprehensive data collection from a national network of hospitals, serves as a crucial tool in understanding the scope of injuries in the U.S. and its territories [1]. Lacrosse, a contact sport with inherent risks, often leads to head and neck injuries [2]. Research and clinical efforts have aimed to improve the awareness, diagnostics, and management of head and neck injuries to promote athlete safety [3]. Studies indicate youth lacrosse has grown from just over 200,00 participants in 2006 to over 440,000 by 2018 [4]. The NEISS database, which tracks emergency department visits associated with lacrosse, is instrumental in outlining the national estimates and trends of these injuries [1].

Objective: This study aims to quantify and depict the trends of head and neck injuries associated with lacrosse across the US by utilizing NEISS data.

Methods: The NEISS data was collected for cases logged as head and neck injuries and associated with lacrosse during the years 2014-2023. The NEISS database calculated national estimates. Researchers constructed a graph and regression line on Microsoft Excel. To ensure the accuracy of the findings, the years affected by the COVID-19 pandemic (2020-2021) were excluded. This was done to account for the lower-bound outliers due to the decreased levels of organized sports nationwide during these years.

Results: The national estimates of head and neck injuries associated with lacrosse start at over 5000 estimated head and neck injuries per year in 2013 and decrease to just over 4000 by 2023 (Table 1). Results demonstrate a decreasing trend of projected head and neck injury associated with lacrosse from 2014 to 2023, with a negative regression slope of -313.63 and an R2 of 0.8437 (CI of 90%) (Figure 1). The national estimates calculated by the NEISS have coefficients of variability that are all below 0.25 (Table 1). The national estimates have a 95% Confidence Interval, which ranges from 1500 to 2500 people, depending on the year (Table 1).

Conclusion: Although the R2 did not meet the 0.9, this trend indicates a potential decrease in head and neck injuries related to lacrosse competition, despite the growth in the sport. A number of factors could explain these findings, including increased awareness and management protocols for head and neck injuries [3]. Subsequent safer sporting equipment, rules, or style of play could also contribute to these findings. Limitations of this study include user variability in how the cases were recorded by providers and NEISS staff. Limitations also include the lack of COVID-19-affected years and potential factors influencing the years post-COVID-19 years of 2022 and 2023. Further investigation is warranted to compare to these findings, help determine potential reasons behind these trends, and to prevent head and neck injuries to lacrosse athletes.

References

1. National Electronic Injury Surveillance System (NEISS). U.S. Consumer Product Safety Commission. Accessed June 16, 2024. https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data

2. Vincent HK, Zdziarski LA, Vincent KR. Review of Lacrosse-Related Musculoskeletal Injuries in High School and Collegiate Players. Sports Health. 2015;7(5):448-451. doi:10.1177/1941738114552990

3. AMSSM - American Medical Society for Sports Medicine. Accessed June 16, 2024. https://www.amssm.org/amssm-publishes-updated-p-p-245.html?StartPos=&Type=

4. Lacrosse youth participation in the US by gender 2006-2018. Statista. Accessed June 12, 2024. https://www.statista.com/statistics/490437/youth-lacrosse-participation-in-us-by-gender/

Informed Consent: ​Due to the public ​nature of ​the data, informed ​consent is not ​applicable.

Ethical Approval & IRB and/or IACUC Approval: Due to the public nature of the data, IRB is not applicable.

Financial Disclosure: None reported.

Poster No. *C-25

Abstract No. 2024-088

Category: Clinical

Research Focus Area: Acute and Chronic Pain Management

Deep Lumbar Muscle Activation During Core Stabilization Exercises in Healthy Subjects

¹Mortada Najem, OMS-II, ²Michael Lawrence, ²Matthew Somma

¹University of New England College of Osteopathic Medicine, Biddeford, ME; ²Department of Physical Therapy, University of New England, Portland, ME

Context: With a lifetime prevalence upwards of 84%, low back pain is one of the most common musculoskeletal conditions.[1] Factors such as sedentary lifestyles and aging contribute to its prevalence. Individuals experiencing low back pain frequently exhibit diminished strength and atrophy in the lumbar extensors, most notably the multifidus (MF).[2] The MF is a complex and deep-seated muscle group situated along the vertebral column. Superficial MF fibers span up to five segments and are thought to function as spinal extensors[3], in concert with more superficial global trunk extensors (e.g. erector spinae). Deep MF fibers, which span two segments, are thought to function as intervertebral stabilizers. Following injury, deep MF fibers are most prone to disuse, atrophy, and fatty infiltration.[4],[5] While exercises are commonly prescribed to improve MF activation, size, and strength, there is a lack of studies that investigate independent activation of the deep and superficial MF fibers. Therefore, the first step to determining an effective exercise for those with low back pain is to investigate which types of exercises might preferentially activate the deep and superficial MF fibers, rather than the lumbar erector spinae (LES), in individuals without low back pain.

Objective: To determine which rehabilitative exercise (trunk extension, reverse hyperextension, weighted trunk extension) may preferentially activate deep and superficial MF fibers, as measured via indwelling electrodes, versus the LES.

Methods: This study used a within-subject repeated measures design to determine how deep lumbar stabilizing musculature is activated during three rehabilitative exercises (trunk extension, reverse hyperextension, and weighted trunk extension). Seventeen healthy individuals (11 males, 6 females) with no low back pain for 6 months prior to participation as well as no major previous medical diagnoses were recruited with a sample of convenience. Prior to testing, written informed consent was obtained and all procedures were approved by the University’s Institutional Review Board. Participants’ age, mass, and height measurements were recorded prior to data collection. Activity of the upper LES was measured by a surface electrode placed over the L1-L2 junction. Superficial and deep MF activity were measured with indwelling electrodes placed at the level of L4 using ultrasound guidance. Muscle activity data were normalized to a maximal voluntary isometric contraction (MVIC) of prone trunk extension.[6] Participants then performed the reverse hyperextension, unweighted trunk extension, and trunk extension with an added weight. For the reverse hyperextension, participants isometrically held their pelvis and lower extremities (hips and knees in a neutral position) parallel to their trunk while the trunk was supported on a cushioned platform. For trunk extension exercises, participants isometrically held their upper body parallel to their lower extremities which were secured by a machine. For all exercises, participants were prone and the body was parallel to the floor. For the weighted trunk extension, participants held a weight to their chest. Given that the lower extremities are heavier than the torso, loads were set with the intent to equate back extension torque between the reverse hyperextension and back extension.[7] For each exercise, participants performed a five second isometric hold for five repetitions. Mean muscle activity was calculated using a 2 second window for each exercise. Muscle activity was filtered with a 10Hz high pass filter, rectified, smoothed with a root mean square (150ms window), and normalized to MVIC. Rates of perceived exertion (RPE) from 1 (minimal exertion) to 10 (maximal exertion) were collected after each exercise. A one-way repeated measures analysis of variance with a post-hoc Bonferroni correction was used to detect significant differences between exercises for muscle activity and RPE. Effect sizes were calculated using Cohen’s d.

Results: Subjects were aged 26.7 ± 6.3, 175.1 ± 6.2 cm tall, and weighed 79.6 ± 15.1 kg. For LES activity, the weighted back extension (54.3 ± 19.0 % MVIC) was significantly greater than both the body weight back extension (29.2 ± 9.9 % MVIC, p d = 1.66) and reverse hyperextension (38.0 ± 13.6 % MVIC, p = 0.002, d = 0.99). Additionally, the reverse hyperextension produced significantly greater LES activity than the body weight trunk extension (p = 0.006, d = 0.75). There were no significant differences for superficial MF activity between any exercises. For deep MF activity, the weighted trunk extension was significantly greater compared to the body weight trunk extension (54.6 ± 42 % MVIC versus 37.4 ± 21.2 % MVIC respectively; p = 0.028, d = 0.52). RPE for the weighted trunk extension (6.1 ± 1.3) was significantly higher than both the body weight trunk extension (3.3 ± 1.3, p d = 2.15) and reverse hyperextension (3.9 ± 1.4, p d = 1.63).

Conclusion: Our primary findings were that the activation of the LES and deep MF increased as load increased, while this did not hold true for the superficial MF. These results suggest that while heavier loads can increase deep MF activation, there will also be a concurrent recruitment of the LES. While superficial MF activation levels were similar in our study (54.8 ± 46.4 % MVIC, reverse hyperextension) compared to previously reported isometric bodyweight exercises (51.7 ± 34.0 % MVIC),[8] increased load (either via body position or external load), did not alter muscle activation. These findings suggest that the superficial MF may reach a saturation point, after which the LES are activated to accommodate higher loads. Similar distinctions between superficial and deep MF activation were previously observed by Moseley et al[9] during perturbed standing and later by Crawford et al[10] during walking. This highlights potential limitations to using surface electrodes to measure the MF, as surface electrodes cannot differentiate between fibers. Furthermore, RPE were greater for the weighted trunk extension compared to both body weight exercise. Taken together, this data suggests that while using unloaded rehabilitative exercises may provide adequate activation of more superficial muscles (i.e. LES), it may be necessary to apply a challenging external load to activate and subsequently strengthen deeper trunk musculature.

References

1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-656.

2. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: Strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142(9):776-785. doi: 10.7326/0003-4819-142-9-200505030-00014.

3. Macintosh JE, Valencia F, Bogduk N, Munro RR. The morphology of the human lumbar multifidus. Clin Biomech (Bristol, Avon). 1986;1(4):196-204. doi: 10.1016/0268-0033(8690146-4).

4. Hodges PW, James G, Blomster L, et al. Multifidus muscle changes after back injury are characterized by structural remodeling of muscle, adipose and connective tissue, but not muscle atrophy: Molecular and morphological evidence. Spine (Phila Pa 1976). 2015;40(14):1057-1071. doi: 10.1097/BRS.0000000000000972.

5. Hodges PW, Tucker K. Moving differently in pain: A new theory to explain the adaptation to pain. Pain. 2011;152(3 Suppl):S90-S98. doi: 10.1016/j.pain.2010.10.020.

6. Konrad Peter. The ABC of EMG: A practical introduction to kinesiological electromyography . 1.4th ed. Scottsdale, Arizona: Noraxon U.S.A, Inc.; 2006.

7. Dempster WT. Space requirements of the seated operator: Geometrical, kinematic, and mechanical aspects of the body with special reference to the limbs. Wright-Patterson Air Force Base, Ohio: Wright Air Development Center; 1955. https://worldcat.org/title/10995431.

8. Okubo Y, Kaneoka K, Imai A, et al. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther. 2010;40(11):743-750. doi: 10.2519/jospt.2010.3192.

9. Moseley GL, Hodges PW, Gandevia SC. Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine (Phila Pa 1976). 2002;27(2):29. doi: 10.1097/00007632-200201150-00013.

10. Crawford RJ, Gizzi L, Mhuiris ÁN, Falla D. Are regions of the lumbar multifidus differentially activated during walking at varied speed and inclination? J Electromyogr Kinesiol. 2016;30:177-183. doi: 10.1016/j.jelekin.2016.07.006.

Informed Consent: All participants were provided a hard copy of the IRB approved informed consent. This document was also verbally reviewed with each participant to ensure understanding prior to obtaining signatures to be included in the study.

Ethical Approval & IRB and/or IACUC Approval: This study was reviewed and approved by the University of New England Institutional Review Board in accordance with 45 CFR 46.111 and assigned the study IRB number 0423-21.

Financial Disclosure: None reported.

Poster No. *C-26

Abstract No. 2024-093

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Adverse effects of nivolumab with or without ipilimumab in the treatment of melanoma: a systemic review and meta-analysis

¹Mayci Fullmer, OMS-IV, ²Summer Bailey, OMS-IV, ²Jun Wang, MD

¹Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN; ²Department of Pathology Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN

Context: Nivolumab and ipilimumab are two immune checkpoint inhibitors that have shown promising results in the treatment of melanoma. Nivolumab binds to programmed cell death-1 (PD-1) receptors on T cells, blocking the interaction between PD-1 and its ligands, PD-L1 and PD-L2. Ipilimumab binds Cytotoxic T-lymphocyte associated protein 4, (CTLA-4) on T cells, preventing it from interacting with B7 ligands on antigen presenting cells (APCs). Both lead to an enhanced anti-tumor immune response by removing the inhibitory signal, restoring T cell activation and proliferation, and thus resulting in elevated anti-tumor immune activity and tumor suppression. Nivolumab is commonly used in the treatment of unresectable or metastatic melanoma, as monotherapy or in combination with ipilimumab. However, as with most immunotherapies, adverse events (AEs) of the treatment have been reported.

Objective: To further investigate the risks of nivolumab, with or without concurrent ipilimumab to cause AEs in melanoma treatment, a meta-analysis was performed using published clinical outcomes of melanoma treated with nivolumab monotherapy and combined ipilimumab therapy.

Methods: Published clinical trials and randomized controlled trial studies were collected from PubMed. Only original studies reported AEs, while using nivolumab monotherapy and combined nivolumab and ipilimumab therapy in the treatment of melanoma were included. Only one set of data was included for a series of reports from the same clinical trial. Studies focusing on sequential treatment regimens were excluded. Meta-analysis was performed using Review Manager 5.4. 131 studies were identified through initial PubMed search, using key words including nivolumab, melanoma, survival and response. After screening the abstract, 44 studies were retrieved for adverse events analysis. After organizing the frequency of adverse events by body system, 37 studies were used to report the frequency of reported AEs, 9 studies were included for final meta-analysis.

Results: Adverse effects are commonly seen and may involve various systems. The most commonly reported adverse events involve musculoskeletal, endocrine, integument, and gastrointestinal systems. Nivolumab monotherapy appears to have significantly lower risk for AEs, than combined nivolumab and ipilimumab therapy significantly, including headache, with a risk ratio (RR) of 0.68 (95% CI: 0.55-0.85, p=0.0008) and pyrexia, RR of 0.24 (95% CI: 0.17-0.36.

Conclusion: Based on these findings, it appears that AEs associated with nivolumab therapy, with or without addition of ipilimumab, are commonly seen and have a very diverse clinical presentation. However, addition of ipilimumab to nivolumab significantly increases the risks of these AEs.

References

1. Vázquez-Montero L, de la Gala MDCÁ, de la Cruz-Merino L. Nivolumab plus ipilimumab in metastatic melanoma: a critical appraisal focused on specific subpopulations. Front Oncol. 2023;13:1187840. doi:10.3389/fonc.2023.1187840

2. Amaria R, Reddy S, Tawbi H, et al. Neoadjuvant immune checkpoint blockade in high-risk resectable melanoma. Nat Med. 2018; 24 (11): 1649-1654. doi:10.1038/s41591-018-0197-1

3. Hodi F, Chiarion-Sileni V, Gonzalez R, et al. Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomized, phase 3 trial. Lancet Oncol. 2018; 19:1480-92.

4. Livingstone E, Zimmer L, Hassel J, et al. Adjuvant nivolumab plus ipilimumab or nivolumab alone versus placebo in patients with resected stage IV melanoma with no evidence of disease (IMMUNED): final results of a randomized, double blind, phase 2 trial. Lancet Oncol. 2022; 400: 1117-29.

5. Long G, Atkinson V, Lo S, et al. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomized phase 2 study. Lancet Oncol. 2018; 19: 672-81.

6. Weber J, Mandala M, Vecchio D, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017; 377:(19)1824-3. DOI: 10.1056/NEJMoa1709030

7. Zimmer L, Livingstone E, Hassel J, et al. Adjuvant nivolumab plus ipilimumab or nivolumab monotherapy versus placebo in patients with resected stage IV melanoma with no evidence of disease: a randomized, double -blind, placebo-controlled, phase 2 trial. Lancet. 2020; 395: 1558-68.

8. Weber J, Schadendorf D, Vecchio M, et al. Adjuvant therapy of nivolumab combined with ipilimumab versus nivolumab alone in patients with resected stage IIIB-D or stage IV melanoma (checkmate 915). J Clin Oncol. 2022; 41: 517-527.

9. Wolchok J.D, Chiarion-Sileni V, Gonzalez R, et al. Overall survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2017; 377(14): 1345-1356. doi:10.1056/NEJMoa1709684

Informed Consent: N/A.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-27

Abstract No. 2024-095

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Implications of Healthcare Accessibility and Patient Outcomes

¹Samuel Borgemenke, OMS-II, ¹D’Nair Newsom, BS, ¹Halie Leftwich, BA, ¹Lucille Gideon, BS, ²Elizabeth Beverly, PhD

¹Ohio University-Heritage College of Osteopathic Medicine, Athens, OH; ²Diabetes Institute, Ohio University-Heritage College of Osteopathic Medicine, Athens, OH

Context: Rural areas have been shown to have higher prevalence rates of a multitude of health conditions. In addition, previous studies suggest that the reduced availability of physicians is associated with higher mortality for these conditions.

Objective: To analyze the prevalence of various diseases across counties in Ohio and test for relationships between the number of healthcare providers and the quality of preventative medicine.

Methods: We used data from the Centers for Medicare & Medicaid Services (CMS) and the Mapping Medicare Disparities tool. ANOVA tests compared Ohio counties’ mean number of primary care physicians, specialty physicians, and other healthcare providers. The mean prevalence, principal cost, and prevention quality indicator (PQI) by health condition were then calculated. We analyzed the relationship between healthcare providers and the PQI across counties and examined differences in healthcare providers, disease burden, and quality of care between Appalachian and non-Appalachian regions.

Results: The mean number of providers per 100,000 people significantly differed by category (F=14.9, PP).

Conclusion: We found PQI was higher for chronic conditions, indicating the need for higher-quality outpatient care to avoid preventable hospital admissions for chronic conditions. Further, Appalachian counties in Ohio had significantly lower numbers of specialist physicians and other healthcare providers demonstrating significant disparities in the region.

References

1. America’s Health Rankings analysis of U.S. HHS, Centers for Medicare & Medicaid Services, Office of Minority Health, Mapping Medicare Disparities Tool, United Health Foundation, AmericasHealthRankings.org. Explore Preventable Hospitalizations in the United States | AHR. Accessed March 10, 2024. https://www.americashealthrankings.org/explore/measures/prev_hosp_b

2. Rural Health Disparities Overview - Rural Health Information Hub. Accessed March 8, 2024. https://www.ruralhealthinfo.org/topics/rural-health-disparities

3. Healthy People 2030 | health.gov. Accessed February 27, 2024. https://health.gov/healthypeople

4. Garcia MC, Rossen LM, Bastian B, et al. Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties — United States, 2010–2017. MMWR Surveillance Summaries. 2023;68(10):1-16. doi:10.15585/MMWR.SS6810A1

5. Accessed from the Ohio Department of Health’s State Health Assessment 2019 on March 10, 2024. Ohio Department of Health. Accessed March 9, 2024. https://analytics.das.ohio.gov/t/ODHPIPUB/views/SHA_FINAL_Domain_HlthCareSystem/18_HCsystem?%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Alinktarget=_self

6. Wen H, Johnston KJ, Allen L, Waters TM. Medicaid expansion associated with reductions in preventable hospitalizations. Health Aff. 2019;38(11):1845-1849. doi:10.1377/HLTHAFF.2019.00483/ASSET/IMAGES/LARGE/FIGUREEX3.JPEG

7. Myers SR, Branas CC, French BC, et al. Safety in numbers: Are major cities the safest places in the United States? Ann Emerg Med. 2013;62(4). doi:10.1016/J.ANNEMERGMED.2013.05.030

8. O’Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health. 2012;126(10):813-820. doi:10.1016/J.PUHE.2012.05.029

9. About Rural Health Care - NRHA. Accessed March 10, 2024. https://www.ruralhealth.us/about-nrha/about-rural-health-care

10. Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. JAMA Intern Med. 2019;179(4):506-514. doi:10.1001/JAMAINTERNMED.2018.7624

11. O’Sullivan BG, Chater B. Medical school expansion to areas of need improves physician distribution. Med Educ. 2019;53(11):1072-1073. doi:10.1111/MEDU.13957

12. Dalen JE, Ryan KJ. United States Medical School Expansion: Impact on Primary Care. Am J Med. 2016;129(12):1241-1243. doi:10.1016/J.AMJMED.2016.05.021

13. Nation’s Urban and Rural Populations Shift Following 2020 Census. Accessed March 8, 2024. https://www.census.gov/newsroom/press-releases/2022/urban-rural-populations.html#

14. Strobe. STROBE. 2023. Accessed December 28, 2023. https://www.strobe-statement.org/

15. CMS. Mapping Medicare Disparities by Population. Centers for Medicare & Medicaid Services Data. October 25, 2023. Accessed January 2, 2024. https://data.cms.gov/tools/mapping-medicare-disparities-by-population.

16. CMS. Doctors and clinicians. Centers for Medicare & Medicaid Services. October 19, 2023. Accessed November 1, 2023. https://data.cms.gov/provider-data/topics/doctors-clinicians

17. Quality indicators. AHRQ. Accessed April 2, 2024. https://qualityindicators.ahrq.gov/measures/pqi_resources.

18. PQI 01 - diabetes short-term complications admission rate. AHRQ. Accessed April 2, 2024. https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V2019/TechSpecs/PQI_01_Diabetes_Short-term_Complications_Admission_Rate.pdf.

19. PQI 03 - diabetes long-term complications admission rate. AHRQ. Accessed April 2, 2024. https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_03_Diabetes_Long-term_Complications_Admission_Rate.pdf.

20. PQI 91 - Prevention quality acute composite. AHRQ. Accessed April 2, 2024. https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V45/TechSpecs/PQI%2091%20Prevention%20Quality%20Acute%20Composite.pdf

21. PQI 92 - Prevention quality chronic composite. AHRQ. Accessed April 2, 2024. https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V45/TechSpecs/PQI%2092%20Prevention%20Quality%20Chronic%20Composite.pdf

22. PQI 90 - Prevention quality overall composite. AHRQ. Accessed April 2, 2024. https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V45/TechSpecs/PQI%2090%20Prevention%20Quality%20Overall%20Composite.pdf

23. ARC. Health Care Systems. Appalachian Regional Commission. Published February 2021. Accessed January 10, 2023. https://www.arc.gov/wp-content/uploads/2021/02/Health_Disparities_in_Appalachia_Health_Care_Systems_Domain.pdf

24. Bauldry S. Structural equation modeling. International Encyclopedia of the Social & Behavioral Sciences. Published online 2015:615-620. doi:10.1016/b978-0-08-097086-8.44055-9

25. Morrone M, Cronin CE, Schuller K, Nicks SE. Access to Health Care in Appalachia: Perception and Reality. J Appalach Health. 2021;3(4):123-136. Published 2021 Oct 25. doi:10.13023/jah.0304.10

26. Franz MJ, MacLeod J, Evert A, et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. J Acad Nutr Diet. 2017;117(10):1659-1679. doi:10.1016/j.jand.2017.03.022

27. Health Resources & Services Administration. Area Health Resources Files (AHRF). Accessed [4/9/2024]. Available from: https://data.hrsa.gov/topics/health-workforce/ahrf

28. National Institute of Mental Health. (2021). Chronic Illness and Mental Health: Recognizing and Treating Depression (NIH Publication No. 21-MH-8015). U.S. Department of Health and Human Services, National Institutes of Health. Retrieved April 21, 2024, from https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health#part_6114

Informed Consent: The data utilized in this research study were sourced from the Centers for Medicare & Medicaid Services (CMS).15,16 CMS provided data through their healthcare provider database and Mapping Medicare Disparities tool. Therefore, it did not need to use informed consent, as it used publicly available data.

Ethical Approval & IRB and/or IACUC Approval: This research is exempt from Institutional Review Board (IRB) review and does not qualify as human subjects research under federal regulations, as it used de-identified, publicly available data.

Financial Disclosure: None reported.

Poster No. *C-28

Abstract No. 2024-096

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

The Formative Development of the Sleep GOALS (Goal-focused Online Access to Lifestyle Support) Intervention for Postpartum Patients

¹Eshika Kohli, OMS-II, ²Daniel J. Buysse, MD, ³Judy C. Chang, MD, MPH, ⁴Esa M. Davis, MD, MPH, ⁴Megan E. Hamm, PhD, ²Michele D. Levine, PhD, ⁴Kathleen M. McTigue, MD, MPH, MS, ⁵Maya Ragavan, MD, MPH, MS, ⁶Marquis S. Hawkins, PhD

¹Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA; ²Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; ³Department of Obstetrics, Gynecology, and Reproductive Sciences University of Pittsburgh, Pittsburgh, PA; ⁴Department of Medicine, University of Pittsburgh, Pittsburgh, PA; ⁵Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh of UPMC University of Pittsburgh, Pittsburgh, PA; ⁶Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA

Context: Postpartum weight management is important in preventing cardiometabolic disease development in birthing people, but standard lifestyle interventions (i.e., diet, physical activity) are only modestly effective.1-6 1,7-10 Addressing sleep problems could increase the efficacy of standard interventions for postpartum people because sleep and circadian rhythms influence hunger and metabolism.8-12 Understanding what postpartum people need to support changes in diet, physical activity, and sleep is important in developing feasible and effective interventions.

Purpose: The study aims to develop a sleep, diet, and physical activity intervention that meets the needs of postpartum people by obtaining their thoughts on the intervention content they would find helpful.

Methods: Our study follows the osteopathic philosophy by focusing on behavioral interventions to prevent chronic disease in postpartum people. We conducted 30-60 minute semi-structured interviews with individuals from Allegheny County who recently gave birth.

Results: Twenty postpartum individuals were interviewed. The median age of the participants was 33.0 years, and their child’s median age was 6.0 months. 14 subjects identified as White, 6 identified as Black, 2 identified as Hispanic, and 1 identified as “other racial identity”. Participants reported two key features for a postpartum intervention: strategies to improve sleep and accountability to make/maintain physical activity and diet changes. Many believed that sleep disruptions impacted their ability to manage other aspects of their life, including eating healthily or exercising. A mother with a 6-month-old stated, “I know that lack of sleep can make it harder to lose weight and be physically active. It’s easy to say, ‘Well, just sleep more,’ but if your baby doesn’t sleep more, there’s not much you can do besides either your spouse gets up or you have a night nurse or something. There are only so many solutions for that problem.” In contrast, for diet and exercise, they reported needing support to hold them accountable. A mother with a 5-month-old noted, “I think I’m gonna do this [exercise?] today. It’s harder for me to hold myself accountable for it. But, if I do it with someone or know that I’m going to be, discussing it with someone else type-of-thing, then I will make it more of a priority.”

Conclusion: While participants described needing support and resources to help with diet and exercise, they expressed lack of knowledge about how they could improve their sleep. Participant feedback was critical in helping us create Sleep GOALS, an internet-assisted intervention. Sleep GOALS supports postpartum people by providing strategies to address sleep disruptions, and monitor sleep, diet, and physical activity behaviors. The intervention provides a lifestyle coach for tailored support, including accountability.

References

1. Abrams B, Heggeseth B, Rehkopf D, Davis E. Parity and body mass index in US women: a prospective 25-year study. Obesity (Silver Spring). 2013;21(8):1514-8.2.

2. Williamson DF, Madans J, Pamuk E, Flegal KM, Kendrick JS, Serdula MK. A prospective study of childbearing and 10-year weight gain in US white women 25 to 45 years of age. Int J Obes Relat Metab Disord. 1994;18(8):561-9.3.

3. Gunderson EP, Sternfeld B, Wellons MF, Whitmer RA, Chiang V, Quesenberry CP, Jr., Lewis CE, Sidney S. Childbearing may increase visceral adipose tissue independent of overall increase in body fat. Obesity (Silver Spring). 2008;16(5):1078-84.4.

4. Rooney AA, Boyles AL, Wolfe MS, Bucher JR, Thayer KA. Systematic review and evidence integration for literature-based environmental health science assessments. Environ Health Perspect. 2014;122(7):711-8.5.

5. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002;100(2):245-52.6.

6. Linne Y, Dye L, Barkeling B, Rossner S. Weight development over time in parous women--the SPAWN study--15 years follow-up. Int J Obes Relat Metab Disord. 2003;27(12):1516-22.7.

7. Bartsch E, Medcalf KE, Park AL, Ray JG, High Risk of Pre-eclampsia Identification G. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353:i1753.8.

8. Herring SJ, Yu D, Spaeth A, Pien G, Darden N, Riis V, Bersani V, Wallen J, Davey A, Foster GD. Influence of Sleep Duration on Postpartum Weight Change in Black and Hispanic Women. Obesity (Silver Spring). 2019;27(2):295-303.9.

9. Gunderson EP, Rifas-Shiman SL, Oken E, Rich-Edwards JW, Kleinman KP, Taveras EM, Gillman MW. Association of fewer hours of sleep at 6 months postpartum with substantial weight retention at 1 year postpartum. Am J Epidemiol. 2008;167(2):178-87.10.

10. Taveras EM, Rifas-Shiman SL, Rich-Edwards JW, Gunderson EP, Stuebe AM, Mantzoros CS. Association of maternal short sleep duration with adiposity and cardiometabolic status at 3 years postpartum. Obesity (Silver Spring). 2011;19(1):171-8.11.

11. Althuizen E, van Poppel MN, de Vries JH, Seidell JC, van Mechelen W. Postpartum behaviour as predictor of weight change from before pregnancy to one year postpartum. BMC Public Health. 2011;11:165.12.

12. Siega-Riz AM, Herring AH, Carrier K, Evenson KR, Dole N, Deierlein A. Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum. Obesity (Silver Spring). 2010;18(10):1996-2003.

Informed Consent: We included a link to an electronic informed consent document in the initial recruitment email. We obtained consent before we send the intervention design survey and complete the semi-structured interviews.

Ethical Approval & IRB and/or IACUC Approval: The University of Pittsburgh’s Institutional Review Board approved this study’s protocol on January 10, 2020 (IRB #: STUDY19110195).

Financial Disclosure: Over the past 3 years, Dr. Daniel Buysse has been a paid or unpaid consultant to Sleep Number, Idorsia, and Eisai. All agreements were for less than $5000 per year from any single entity. He is an author of Pittsburgh Sleep Quality Index, Pittsburgh Sleep

★Poster No. *C-29

Abstract No. 2024-098

Category: Clinical

Research Focus Area: Impact of OMM & OMT

Investigation of Suboccipital Release, Muscle Energy, and Combination Therapy, Respectively Evaluating their Effect on Carotid Artery Blood Flow: Preliminary Results

¹Mohammad Sabbagh, OMS-IV, ¹Sydney Moriarty, ¹Ishan Perera, ¹Shawn Dziepak, ¹Michelle Santiago, ¹Venu Peddibhotla, ²Chelsea Rubis, DO, ⁴Ramu Anandakrishnan, PhD, ⁹Frederic Rawlins, II, DO, ⁵Per Gunnar Brolinson, DO

¹Edward Via College of Osteopathic Medicine, Blacksburg, VA; ²Departments of Sports Medicine and Family Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, VA; ³Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, Blacksburg, VA; ⁴Center for Simulation and Technology, Edward Via College of Osteopathic Medicine, Blacksburg, VA; ⁵Department of Sports Medicine, Biomedical Affairs and Research, Post–Graduate Affairs, and Department of Family Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, VA

Context: Head injury, particularly mild Traumatic Brain Injury (mTBI), is common in contact and collision sports, motor vehicle accidents and falls [1]. Research has demonstrated reduced cerebral blood flow (CBF) following mTBI [2-4] and sports related concussions [5]. Importantly, 75% of the CBF is supplied by the carotid arteries or anterior circulation and 25% from the vertebral arteries or the posterior circulation [6].

Our study aimed to investigate the effects of Osteopathic Manipulative Treatment (OMT) on common carotid artery (CCA) blood flow, the dominant source of CBF, with four cohorts of healthy participants: suboccipital release (SR), muscle energy (ME), both SR and ME, and sham. SR was chosen due to effect on suboccipital musculature and occiput, housing the jugular foramen where the vagus and glossopharyngeal nerves travel [7], eliciting effects on the autonomic nervous system, particularly the parasympathetics [8]. Prior research has demonstrated promising results with OccipitoAtlantal decompression treatment on improved cerebral blood flow [9], while others indicate varied outcomes. These variations were demonstrated by researchers observing a transient reduction in CBF immediately following OMT, with CBF later increasing three days post-treatment [10]. Additionally, we chose to evaluate the ME technique directed towards correction of cervical spine somatic dysfunction and its effect on CCA blood flow. To our knowledge, this will be the first study to examine the effects of cervical spine ME on CCA velocities. The literature evaluating the efficacy of OMT in modulating CBF remains sparse and limited.

Our study seeks to examine the biological impact of cervical spine OMT on CCA velocity using a robust sample size of healthy participants. By establishing these effects, we lay the groundwork for future research in populations with mTBI, potentially advancing the role of OMT in post-concussive treatment protocols.

Objective: To investigate the effects of OMT techniques, specifically ME, SR, combination of SR and ME, and sham, on CCA blood flow. We hypothesize that the combined treatment of ME and SR will yield the greatest increase in CCA blood flow, as measured by Peak Systolic Velocity (PSV) and End Diastolic Velocity (EDV).

Methods: Sampling: This study utilizes a randomized controlled trial design. Recruitment consisted of staff and students from the Edward Via College of Osteopathic Medicine, Virginia Campus (VCOM-VA). Preliminary results are based on 47 participants from initial interest and recruitment. Potential participants were notified of the study via email and once prior to the start of a lecture on campus. Inclusion criteria was defined as participants of at least 18 years of age that are staff or students at VCOM-VA. Exclusion criteria included contraindications to the treatments: trauma, bone fractures, joint dislocation, infection, muscle tears, rheumatological conditions affecting the cervical spine, cervical spine instability, internal bleeding, recent myocardial infarction or recent surgery, acute cervical fractures, neurovascular compromise, malignancy, hematoma, aneurysm, open wounds, and focal neurological deficit [11-13].

Study Design: Each participant was assigned an ID number for de-identified data collection. Random assignment to one of four treatment cohorts was achieved using the rand() function in Microsoft Excel. Informed consent was obtained from participants. Participants laid supine for 5 minutes prior to obtaining pre-treatment readings of their PSV and EDV of the right CCA via doppler ultrasound (US). Three initial measurements were taken of the PSV and EDV, recorded in cm/s2. Next, participants had their cervical spine (OA, AA, C2-7) diagnosed and treated according to their assigned cohort. ME involved treatment of all diagnosed cervical dysfunctions. For sham treatment, the patient laid supine with the investigator’s hands placed on the sides of the skull with equal resting pressure. Finally, three more measurements of PSV and EDV were recorded.

Statistical Methods: ANOVA and post-hoc comparison was employed to analyze pre- and post-treatment data. Chi-squared tests were used to assess the distribution of possible confounding demographics data amongst our sample.

Error Handling: Investigators evaluating and treating with OMT have passed skills checks through their curricula at VCOM-VA and a final check by the study principal investigator. Ultrasonographers have undergone training with an Emergency Medicine physician on the proper technique for measuring CCA velocities. An error study utilizing ANOVA and boxplots was performed to evaluate inter-sonographer reliability.

Osteopathic Significance: This study seeks to provide objective evidence on the effects of cervical spine OMT in improving cerebral blood flow. Elucidating the biological impact of cervical spine OMT has the potential to enhance osteopathic practice and deepen current understanding.

Results: At a power of 0.8, we calculate the optimal sample size to be 180. With ongoing recruitment, we present preliminary data from 47 participants (n = 47). Data analysis yielded a P-value of 0.195 for PSV and 0.554 for EDV, indicating the observed change was not statistically significant. Initial demographic analysis revealed a predominance of female participants at 73%, with most participants falling between the ages of 21-25 years (56%) and 26-30 years (31%). Approximately 50-60% of participants in each cohort reported medications with the potential to affect the autonomic nervous system. Further analysis employed the Chi-squared test and indicated no significant difference across the treatment cohorts: sex (P = 0.156), age 21 to 25 (P = 0.753), age 26 to 30 (P = 0.672), and medications (P = 0.956). These findings suggest the demographics of our current sample are well-distributed.

Conclusion: While our preliminary data failed to demonstrate statistical significance, observations were drawn from current results. Interestingly, in all but one cohort, PSV and EDV decreased after treatment with OMT. The cohort receiving both ME and SR was the exception, showing no decrease in PSV. Looking forward, the project has received approval for recruitment from the general population for a sample size goal of 180. Continuation of our study will aim to further characterize the relationship between cervical spine OMT and CCA blood flow. Conclusions from this study will set the groundwork for future studies examining the role and efficacy of OMT in the mTBI setting, and post-concussive protocols.

References

1. Centers for Disease Control and Prevention (CDC). Nonfatal traumatic brain injuries from sports and recreation activities--United States, 2001-2005. MMWR Morb Mortal Wkly Rep. 2007;56(29):733-737.

2. Barlow KM, Iyer K, Yan T, Scurfield A, Carlson H, Wang Y. Cerebral Blood Flow Predicts Recovery in Children with Persistent Post-Concussion Symptoms after Mild Traumatic Brain Injury. J Neurotrauma. 2021;38(16):2275-2283. doi:10.1089/neu.2020.7566

3. Wang Y, Nencka AS, Meier TB, et al. Cerebral blood flow in acute concussion: preliminary ASL findings from the NCAA-DoD CARE consortium. Brain Imaging Behav. 2019;13(5):1375-1385. doi:10.1007/s11682-018-9946-5

4. Metting Z, Spikman JM, Rödiger LA, van der Naalt J. Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: acute versus chronic disturbances?. Brain Cogn. 2014;86:24-31. doi:10.1016/j.bandc.2014.01.012

5. Wang Y, Nelson LD, LaRoche AA, et al. Cerebral Blood Flow Alterations in Acute Sport-Related Concussion. J Neurotrauma. 2016;33(13):1227-1236. doi:10.1089/neu.2015.4072

6. Seymour RS, Hu Q, Snelling EP. Blood flow rate and wall shear stress in seven major cephalic arteries of humans. J Anat. 2020;236(3):522-530. doi:10.1111/joa.13119

7. Singh O, Das J. Anatomy, Head and Neck, Jugular Foramen. PubMed. Published 2024. Accessed June 14, 2024. https://www.ncbi.nlm.nih.gov/books/NBK538507/

8. Rowlands E, Pozun A. Osteopathic Manipulative Treatment: Suboccipital Release. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 8, 2023.Roberts B, Makar AE, Canaan R, Pazdernik V, Kondrashova T. Effect of occipitoatlantal decompression on cerebral blood flow dynamics as evaluated by Doppler ultrasonography. J Osteopath Med. 2021;121(2):171-179. doi:10.1515/jom-2020-0100

9. Tamburella F, Piras F, Piras F, Spanò B, Tramontano M, Gili T. Cerebral Perfusion Changes After Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial. Front Physiol. 2019;10:403. doi:10.3389/fphys.2019.00403

10. Rowlands E, Pozun A. Osteopathic Manipulative Treatment: Suboccipital Release. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023 Mar 8. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582126/

11. Stenersen B, Bordoni B. Osteopathic Manipulative Treatment: Muscle Energy Procedure - Cervical Vertebrae. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jul 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560706/Batavia M. Chapter 24 - Myofascial Release. In: Batavia M, ed. Contraindications in Physical Rehabilitation. Saint Louis: W.B. Saunders; 2006:280-285.

Informed Consent: The consent form was provided via email. Participants were given 1 week to review and return the consent forms. Investigator contact information was provided for questions, difficulties, and concerns. Prior to initiation of each study session, the participant’s consent form was reviewed and additional questions were answered. The consent form was then signed and finalized by the investigator.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-30

Abstract No. 2024-100

Category: Clinical

Research Focus Area: Osteopathic Philosophy

Utility of BardyDx ECG Monitoring to Assess the Impact of Anxiety on Self-Reported Cardiac Symptoms: A Pressing Matter

¹Justin Edward, OMS-II, ¹Grace Robinson, OMS-II, ¹Ermin Tale, OMS-IV, ¹Malcolm Zeroka, OMS-III, ¹Shruthi Radhakrishnan, OMS-III, ²Liat Jarkon, DO, ¹Todd Cohen, MD

¹Department of Clinical Specialties, New York Institute of Technology, Old Westbury, NY; ²Center for Behavioral Health, New York Institute of Technology, Old Westbury, NY

Context: The BardyDx is a wearable ECG monitor used to analyze arrhythmogenic causes of cardiac complaints in symptomatic patients [1]. Using a P-wave-centric monitoring functionality, the BardyDx allows for non-invasive, high-clarity arrhythmia detection [2]. Patients are instructed to press the device’s centrally located button to record symptoms. Cardiac symptoms include palpitations, presyncope/syncope, and shortness of breath. Similar symptoms may also occur with anxiety and its related conditions [3]. Previous studies have investigated the prevalence of arrhythmias in patients with anxiety; however, symptomatic events recorded on the BardyDx monitor have not been compared between those with and without anxiety.

Objective: The purpose of this study was to determine the impact of anxiety on symptom-activated button pressing as they relate to cardiac arrhythmias.

Methods: This retrospective study conducted between July 2019 and May 2024 analyzed 63 patients from the Long Island Heart Rhythm Center who underwent external cardiac monitoring with the BardyDx for up to 14 days. This study was reviewed and received exempt status from the NYIT IRB. ECGs recorded contemporaneously with button pressing were analyzed and classified by a technician and cardiologist. Patients with anxiety-related conditions (generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder) were compared to those without anxiety (control) with respect to the following: total number of arrhythmic events, total button presses, button presses that correspond to an arrhythmia event, and button presses that did not correspond to an arrhythmia event. Button pressing that failed to correlate with an arrhythmia was deemed to be a non-cardiac arrhythmia-related symptom. Data was reported as mean + SD and groups were compared using an unpaired Student’s t-test; p.

Results: 63 patients were identified: 25 patients with anxiety (age 33.3 ± 11.5 years; 4 male/21 female) and 38 patients without (age 48.8 ± 19.9 years; 16 male/22 female). BardyDx recording time was 9.9 + 3.9 days. There were 555 arrhythmic events in the anxiety group and 933 in the control group (p=0.30); 709 button presses in anxiety group and 784 button presses in control (p=0.19); 407 button presses with arrhythmias in anxiety group and 591 in control (p=0.49); 302 button presses without arrhythmias in anxiety group and 193 in control (p=0.043).

Conclusions: Our analysis of symptom-activated button presses and its correlation to cardiac arrhythmias using the BardyDx identified differences between the anxiety and control groups. Significantly more button presses, that failed to correlate with cardiac arrhythmias, occurred in the anxiety group. No significant difference was noted in the total number of button presses, button presses that correlate with cardiac arrhythmias or arrhythmic events between the two groups. Limitations of the study include its retrospective design, limited sample size, and uneven male to female ratio within groups. Further analysis with a larger sample size is needed to better understand the impact of these conditions on cardiac patients.

References

1. Francisco-Pascual J, Cantalapiedra-Romero J, Pérez-Rodon J, et al. Cardiac monitoring for patients with palpitations. World Journal of Cardiology. 2021;13(11):608-627. doi: https://doi.org/10.4330/wjc.v13.i11.608

2. Romme AG, Umapathi KK, Nguyen HH. Feasibility of P wave Centric Ambulatory Electrocardiogram Monitoring in Infants and Young Children. Pediatric cardiology. 2021;42(5):1126-1132. doi:https://doi.org/10.1007/s00246-021-02590-5

3. Stein M, Sareen, J. Generalized Anxiety Disorder. The New England Journal of Medicine. 2015; 373(21). doi:https://www.nejm.org/doi/full/10.1056/NEJMcp1502514

Informed Consent: Informed consent waived by NYITCOM IRB (BHS-1465).

Ethical Approval & IRB and/or IACUC Approval: This retrospective study was deemed exempt by the NYIT Institutional Review Board (IRB) (BHS-1465).

Financial Disclosure: None reported.

Poster No. C-31

Abstract No. 2024-102

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Assessing Osteopathic Medical Student Knowledge of Common Vitamin and Mineral Deficiencies

¹Sara-Bethany Weir, DO, ²Autumn Stevens, OMS-I

¹Department of Clinical Sciences, Alabama College of Osteopathic Medicine, Dolton, AL; ²Alabama College of Osteopathic Medicine, Dolton, AL

Context: Micronutrients, including vitamin B12, vitamin D, magnesium, and folate, are essential factors in maintaining health and preventing serious medical conditions. These vitamins and minerals are commonly deficient in the United States population, resulting in widespread negative health implications. Recognition of these deficiencies within a primary care setting is paramount, and learning to identify the signs and symptoms of micronutrient deficiency starts in medical school. Osteopathic medical students may be a crucial target for additional training in this area, due to the large number of osteopathic physicians practicing within a primary care setting. Establishing the extent of current knowledge within osteopathic medical students is important for determining the need for additional nutrition education to be incorporated into standard medical school curriculum.

Objective: The study objectives were to investigate (1) the confidence osteopathic medical students have in their nutrition knowledge, (2) micronutrient knowledge of pre-clinical vs. post-clinical students, (3) student knowledge of specific micronutrients, and (4) willingness of students to recommend specific micronutrients to their future patients.

Methods: This was a survey-based study that utilized a cross-sectional convenience sample of first, second, third, and fourth year osteopathic medical students at the Alabama College of Osteopathic Medicine (ACOM). Respondents (n=44) included 27 OMS-I (61%), 7 OMS-II (16%), 8 OMS-III (18%), or 2 OMS-IV (5%) students. The study first determined prior exposure to nutritional education and confidence in nutritional knowledge. It then evaluated the knowledge of osteopathic medical students on the specific benefits of vitamins and minerals and assessed the likelihood of students to recommend supplemental nutrition to their future patients. Micronutrients assessed included vitamin B12, vitamin D, magnesium, and folate. Statistical analysis was performed using VassarStats. A t-test compared the percent of correctly answered vitamin and mineral benefit questions by the pre-clinical (OMS-I and OMS-II) and post-clinical students (OMS-III and OMS-IV). An analysis of variance assessed for differences in knowledge between micronutrients. All tests utilized a significance value of ? = 0.05. Recognition of vitamin inadequacies starts with education of physicians, with specific educational emphasis required for students who are likely to encounter these patients within a primary care setting. Osteopathic medical schools are a uniquely influential target to bolster micronutrient education, as more than half of all osteopathic medical graduates practice within a primary care setting.

Results: 44 of 804 students enrolled at ACOM responded to the survey, producing a response rate of 5.47%. No respondents were excluded. Most students (82%) have been exposed to nutrition during their education, but only 59% of students feel somewhat confident in their nutritional knowledge. Zero students feel very confident in their current knowledge. All p-values were nonsignificant when comparing knowledge of pre-clinical students (OMS-I and OMS-II) to post-clinical students (OMS-III and OMS-IV). Analysis of variance and Tukey HSD test revealed significantly different results when comparing knowledge of specific benefits of micronutrients of all students, precisely when comparing knowledge of vitamin D to folate (89% vs. 64%; P < .05). Overall willingness of students to prescribe each micronutrient is very high (91%, 96%, 84%, and 98% for vitamin B12, vitamin D, magnesium, and folate, respectively).

Conclusion: Although many students have some degree of exposure to nutrition, few are fully confident in that education. Students demonstrate minimal gain of nutritional knowledge throughout medical school, and evidence shows knowledge of certain micronutrients is being retained more than others, despite population deficiencies being common for all of these vitamins and minerals. Students are overwhelmingly interested in recommending these micronutrients to their future patients, highlighting a gap between knowledge and intention. Students demonstrate a clear need for nutritional education that persists over time so that recognition of common micronutrient deficiencies is possible within primary care settings. This is especially crucial for osteopathic medical students, who enter primary care fields at much higher rates than allopathic graduates. Additional education utilizing strategies to potentiate learning are indicated, but more research is needed to build upon the findings of this study and achieve a better understanding of micronutrient knowledge in osteopathic medical students. The authors acknowledge the limitations of this study, including its small sample size (n=44) and reduced power (t-test = 0.274, ANOVA = 0.466). Additionally, data displayed a non-normal distribution due to the small sample size and thus conclusions drawn from statistical tests may lack certainty. Repetition of this study with additional sampling is indicated and recommended.

References

1. Forrest KY, & Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research (New York, NY). 2011; 31(1): 48–54. doi: 10.1016/j.nutres.2010.12.001

2. LoPiccolo MC & Lim HW. Vitamin D in health and disease. Photodermatology, Photoimmunology & Photomedicine. 2010; 26: 224-229. doi: 10.1111/j.1600-0781.2010.00524.x

3. Zhou Y, Wang A, Yeung LF, Qi YP, Pfeiffer CM, Crider KS. Folate and vitamin B12 usual intake and biomarker status by intake source in United States adults aged ≥19 y: NHANES 2007-2018. The American Journal of Clinical Nutrition. 2023; 118(1): 241–254. doi: 10.1016/j.ajcnut.2023.05.016

4. Oh R & Brown DL.Vitamin B12 deficiency. American Family Physician. 2003; 67(5): 979–986.

5. Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. What We Eat in America, NHANES 2005-2006. National Health and Nutrition Examination Survey. 2009.

6. Volpe SL. Magnesium in disease prevention and overall health. Advances in Nutrition (Bethesda, MD). 2013; 4(3): 378S–83S. doi: 10.3945/an.112.003483

7. McDowell MA, LacherDA, Pfeiffer CM, Mulinare J, Frances Picciano M, Rader JI, Yetley EA, Kennedy-Stephenson J, Johnson CL. Blood folate levels: The latest NHANES results. National Center for Health Statistics Data Brief. 2008.

8. Ebara S. Nutritional role of folate. Congenital Anomalies. 2017; 57: 138–141. doi: 10.1111/cga.12233.

9. Vitamin Deficiency Test. Ada Health. 2022.

10. 2023 Osteopathic Medical Profession Report. American Osteopathic Association. 2023.

11. Augustin M. How to learn effectively in medical school: test yourself, learn actively, and repeat in intervals. The Yale Journal of Biology and Medicine. 2014; 87(2), 207–212.

Informed Consent: Informed Consent: By clicking the survey link, students were taken to the Qualtrics survey platform and viewed information about the study and their participation, including the length of the survey, assurance of anonymity, outline of benefits and risks, and an explanation that their participation was voluntary. Participants provided consent by clicking the arrow to proceed to the survey.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-32

Abstract No. 2024-106

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

Exploring the Use of Prophylactic Probiotics on Necrotizing Enterocolitis in Preterm Infants: A Systematic Review and Pooled Analysis

¹Aayushi Doshi, OMS-IV, ¹Emily Tran, ²Vincent Torelli, DO, ¹Tanya Kadrmas-Iannuzzi, DO

¹Department of Pediatrics, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ; ²Department of Internal Medicine, Mount Sinai Morningside/West, New York, NY

Context: While the incidence of necrotizing enterocolitis (NEC) has remained variable over the past few decades, it has persisted as a significant life-threatening gastrointestinal disease in preterm infants. NEC is necrotizing and hemorrhagic inflammation of the bowel wall. The pathogenesis of NEC is considered multifactorial, with increased risk associated with prematurity, markedly early enteral feedings, and low birth weight. Current literature suggests that gut microbiome dysgenesis is linked to NEC; however, further research is indicated to understand this relationship better. Probiotics, which are therapeutic live bacterial supplements, are emerging as a potential modality for the treatment or prevention of NEC by promoting balance and enhancement of the natal gut microbiome and strengthening the intestinal barrier protection. The use of probiotics in the potential prevention and treatment of NEC can be considered a holistic approach to gut microbiome pathology and health, consistent with osteopathic principles and clinical practice. The benefits of probiotics may help balance the gut microbiota and improve neonatal mortality. Utilization of nutritional supplements like probiotics can ultimately improve overall health by allowing for a stronger foundation for infants to develop and grow, resonating with the osteopathic philosophy of preventative care and the mind-body connection.

Objective: To evaluate the efficacy of prophylactic probiotics in reducing the incidence and severity of NEC in preterm infants.

Methods: A search query of published literature was conducted using PubMed, Embase, and SCOPUS from 2009 to May 2024. Study types selected for analysis were randomized controlled trials (RCTs) and cohort studies. The inclusion criteria consisted of studies that assessed the administration of prophylactic probiotics of any kind to preterm infants below 36 weeks gestation with outcome measures related to NEC incidence. A meta-analysis was conducted on available pooled data from studies meeting inclusion criteria. An odds ratio (OR) was calculated comparing the incidence of NEC in preterm neonates with exposure to prophylactic probiotics to preterm neonates without probiotic use.

Results: Nine studies met the inclusion criteria for the pooled analysis, encompassing a total of 10,289 participants: 4466 preterm infants received prophylactic probiotics and 5823 preterm infants did not receive prophylaxis. Of this group, 184 preterm subjects who received probiotic prophylaxis and 409 preterm subjects who did not receive probiotic prophylaxis experienced necrotizing enterocolitis. Meta-analysis computation yielded an overall odds ratio (OR) of 0.65 (CI: 95%, 0.53-0.80) favoring decreased odds of NEC with exposure to prophylactic probiotics.

Conclusion: Preterm infants who are administered prophylactic probiotics experience a decreased odds of necrotizing enterocolitis compared to those who did not. Thus, these findings further support the integration of probiotic supplementation as prophylaxis into standard neonatal care practices for the preterm infant populations. This is potentially secondary to modulation of the gut microbiome and enhancing development of an innate immature immune system. However, the need to consider the variability in probiotic strains types, dosages, and environmental exposures warrants additional research efforts to identify optimal probiotic strains and dosing for maximized therapeutic effect.

References

1. Wertheimer F., Arcinue R., Niklas V.; Necrotizing Enterocolitis: Enhancing Awareness for the General Practitioner. Pediatr Rev October 2019; 40 (10): 517–527. https://doi.org/10.1542/pir.2017-0338

2. Ahmad W, Sultan AN, Younas I, Khan MA, Naveed M, Safdar MB. Frequency of necrotizing enterocolitis in preterm infants treated with prophylactic probiotics versus controls. Pakistan Journal of Medical and Health Sciences. 2020;14(3):929-931.

3. Baeckert M. Reduction of the prevalence of necrotizing enterocolitis in preterm infants with the prophylactic administration of probiotics. Swiss medical weekly. 2017;147:30S-.

4. Chiruvolu, A., Hendrikson, H., Hanson, R. et al. Effects of prophylactic probiotics supplementation on infants born very preterm or very low birth weight. J Perinatol 43, 635–641 (2023). https://doi.org/10.1038/s41372-023-01657-w

5. Garg, Bhawan & Kabra, Nandkishor & Balasubramanian, Haribalakrishna & Avasthi, Saumya & Sharma, S.R. & Ahmed, Javed & Dash, Swarup. (2017). Prophylactic probiotics for prevention of necrotizing enterocolitis in preterm neonates: A cohort study. Perinatology. 18. 41-49.

6. Lambæk ID, Fonnest G, Gormsen M, Brok J, Greisen G. Probiotics to prevent necrotising enterocolitis in very preterm infants. Dan Med J. 2016;63(3):A5203.

7. Ozen M, Elmas A, Ormeci AR. Prophylactic probiotic supplementation not only decreases the incidences of NEC and mortality but also nosocomial infections in low birth weight prematures in a cohort study. J Perinat Med. Published online November 2011. doi:10.1515/jpm-2012-1008

8. Robertson C, Savva GM, Clapuci R, et al. Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and Bifidobacterium probiotics. Arch Dis Child Fetal Neonatal Ed. 2020;105(4):380-386. doi:10.1136/archdischild-2019-317346

9. Singh B, Shah PS, Afifi J, et al. Probiotics for preterm infants: A National Retrospective Cohort Study. J Perinatol. 2019;39(4):533-539. doi:10.1038/s41372-019-0315-z

10. Springer S, et al. Neonatal Bacteraemia With Bifidobacteria Or Lactobacillus Species After The Introduction Of Prophylactic Probiotics: A Retrospective Observational Cohort Study. Journal of Paediatrics and Child Health 58 (Suppl.): 90, May 2022. https://doi.org/10.1111/jpc.15946

Informed Consent: Informed consent process was not relevant in this study as it is meta-analysis of current literature.

Ethical Approval & IRB and/or IACUC Approval: Investigator is making use of certain data such as Public Use Data (publicly available) and de-identified data.

Financial Disclosure: None reported.

Poster No. *C-33

Abstract No. 2024-120

Category: Clinical

Research Focus Area: Musculoskeletal Injuries and Prevention

Using Sway Measures to Predict Fall Risk

¹Ethan Bond, OMS-II, ¹Zachary Dashner, ¹Alexander Lovrien, ²Kimberly Fulda, DrPH, ²Shawn Kennedy, MS, ²Rita Patterson, PhD

¹University of North Texas Health Science Center, Fort Worth, TX; ²Department of Research and Innovation, University of North Texas Health Science Center, Fort Worth, TX

Context: Falls are the most common cause of injury in adults over 65 years. Current CDC estimates indicate one in four adults over said age experience a fall, or 14 million people per year (1). Falls occur when there is a loss of balance, which can happen during motion and static positioning. The ability to control balance comes from multiple inputs, such as the vestibular system, visual system, and the proprioceptive input in the cerebellum. Alterations of these systems from various factors, including aging, increase the likelihood of a fall. Postural sway (measured via force plate) is one of the current variables used to determine how posturally unstable a patient is, and thus has been used as an independent predictor for fall-risk by many studies (2-5). Patients with a large degree of measured sway can then have other aspects of their medical history analyzed to determine if there are correlated risk factors. Identification of these risk factors will help in the development of surveys and medical protocol to reduce the likelihood of falls in those who are not necessarily flagged as having a high risk for falling. Compared to our ongoing study, previous studies failed to collect a large sample size (most studies had less than 100 participants) and included a convenience population that did not sample a diverse racial and ethnic mix of participants. This study attempts to feature a larger, more diverse sample population, which will be useful in the future development of a fall-risk calculating machine learning algorithm.

Objective: To collect postural sway data using a force plate at point of care in an outpatient clinic to determine what medical conditions and social determinants of health influence balance and the underlying risk of falls in older adults.

Methods: In this chart review, postural sway data was collected from 1097 patients at the University of Texas Health Science Center (UNTHSC) health clinics. Patients were excluded from this study if they were under 18 years of age, or were unable to stand unassisted for more than 5 minutes. The postural sway measurements were collected as an additional vital sign. Data was collected by UNTHSC student volunteers and research assistants. Patients stood up straight on the Bertec Force Plate (Bertec Columbus, Ohio), with their hands by their side for 30 seconds (split into three 10 second trials) with their eyes open (EO), and again with their eyes closed (EC). Each trial yielded output for a total of 20 variables, all of which quantify postural balance (including, but not limited to Sway Path Length, Sway Velocity, Sway Area, Sway Angle, Rotational Frequency). The data collected for each clinical encounter were then merged with the electronic medical record in a de-identified data warehouse, with plans for future analysis utilizing machine learning technology. A Power BI dashboard was then created to visualize basic patient medical and demographic characteristics, while a separate dashboard was created for UNTHSC clinicians to view and interpret patient-level data. There is osteopathic relevance to this study because it will attempt to uncover fall-risk associations with certain disease states while simultaneously analyzing the social determinants of health and their potential impact on fall-risk. We believe that by incorporating the social determinants of health in our analysis, we are choosing to examine the patient as a person (a unit of body, mind, and spirit) rather than a list of symptoms or diagnoses.

Results: 1538 postural sway measurements were collected on a total of 1097 patients (771 female, 326 male) between 06/07/2021 and 06/12/2024 in the UNTHSC clinics. The current data shows a broad age range, covering patients from 18 years to patients >80 years, most of which (41%) were between the ages of 60-79 years. 45 of our patients reported falling in the past 6 months, with 19 patients sustaining some injury associated with a fall. On the basis of race, 836 (76.2%), 109 (9.9%), 78 (7.1%), and 74 (6.8%) patients were White, Black or African American, unknown, or either Asian, American Indian or Native Hawaiian, respectively. Our ethnic distribution yielded 752 (68.6%) patients of unknown ethnicity, 288 (26.3%) patients who identified as Not Hispanic, and 57 (5.2%) patients who identified as Hispanic. Additionally, we can generate a number of patients within our sample population who have a certain medical condition, such as hypertension (306, or 27.9%) or Knee/Hip Pain (313, or 28.5%). The data compiled in this dashboard will be the basis for generating a fall risk score with the assistance of machine learning in the future.

Conclusion: Broad Relevance: This postural sway study continues to gather data with a streamlined process. The diversity of our sample population paired with a sample size that is, to our knowledge, far greater than previous studies will help create a more accurate and reliable fall risk predicting algorithm. With the future development of a machine learning algorithm, this data set will be the basis of a new fall risk score which will be determined based on force plate measurements and information found in a patient’s medical chart. Over time, as data collection continues, this scoring system will be refined and possibly become another important clinical scoring measure. In short, we have developed a viable method for collecting and analyzing a patient’s postural sway (and thus, fall-risk) in a clinical environment, without impeding clinic flow. Using this data, we hope to develop a fall-risk predicting algorithm using machine learning to more accurately detect fallers, especially those who may not have been historically considered high risk.

Limitations: Data was collected at the clinic’s convenience as time allowed. Cost is a limitation for the expansion of this study to other clinical sites. While the impediment to clinic flow has largely been addressed through refinement of the data gathering process, adding force plates to new clinics is cost prohibitive. Additionally, expansion to more clinics requires additional training for data collectors. We hope that with a simple data collection process, we may expand to include other community partners outside of UNTHSC and include a more diverse demographic.

References

1. Older Adult Fall Prevention. Centers for Disease Control and Prevention. May 9, 2024. Accessed June 13, 2024. https://www.cdc.gov/falls/about/index.html

2. Kozinc Ž, Löfler S, Hofer C, Carraro U, Šarabon N. Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis. Diagnostics. 2020; 10(9):667. https://doi.org/10.3390/diagnostics10090667

3. Johansson J, Nordström A, Gustafson Y, Westling G, Nordström P. Increased postural sway during quiet stance as a risk factor for prospective falls in community-dwelling elderly individuals. Age Ageing. 2017;46(6):964-970. doi:10.1093/ageing/afx083

4. Johansson J, Jarocka E, Westling G, Nordström A, Nordström P. Predicting incident falls: Relationship between postural sway and limits of stability in older adults. Hum Mov Sci. 2019;66:117-123. doi:10.1016/j.humov.2019.04.004

5. Salari N, Darvishi N, Ahmadipanah M, Shohaimi S, Mohammadi M. Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):334. Published 2022 Jun 28. doi:10.1186/s13018-022-03222-1

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: IRB Approval Letter_12_2023.pdf ; North Texas Regional Institutional Review Board 2022-066 APPROVAL DATE: December 21, 2023, EXPIRATION DATE: December 21, 2024

Financial Disclosure: None reported.

Poster No. *C-34

Abstract No. 2024-121

Category: Clinical

Research Focus Area: Acute and Chronic Pain Management

Sleep Complaints in Adult Prescription Opioid Users Compared to Marijuana Users

¹Bryan M. Katchikian, OMS-III, ²Sneha Ottra, MD

¹School of Medicine, Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA; ²Family Medicine, Lake Erie College of Osteopathic Medicine-Erie, Erie, PA

Context: Opioid usage is associated with several sleep disorders, known to disrupt normal sleep patterns by reducing rapid-eye-movement (REM) sleep and slow-wave sleep (1). This disruption impairs the body’s restorative capacity, affecting both acute and chronic disease processes (2). Additionally, sleep disturbances caused by opioids increase the likelihood of relapse into drug use (3). The negative consequences of opioid usage have spurred interest in alternative pain treatments, with recent studies suggesting that marijuana may offer effective pain relief with fewer side effects (4). Comparing the efficacy of ​these treatments in addition to severity and frequency of side effects is crucial ​for a physician to ​decide on the best treatment plan for ​patients experiencing pain.

Objective: To compare the frequency of reported sleep disturbances in opioids users to marijuana users.

Methods: This research utilized a cross-sectional study design based on 2015-2016 National Health and Nutritional Examination Survey (NHANES) data. It considered sections of three NHANES questionnaires from 763 participants: sleep disorders, drug use, and prescription medications questionnaires. Out of these participants, 336 were prescribed opioid medications, and 427 reported using marijuana in the past seven days. A chi-square test of independence determined whether there was a significant difference in reported sleep disturbances between the two groups. Additionally, a 2-sample t-test investigated if there was a significant difference in reported mean hours slept between the two groups.

Results: The chi-square test of independence found a significant difference in the proportion of reported sleep issues between those prescribed opioids and those using marijuana (p= 3.39 x 10-12 ). 55.82% of opioid users reported a sleep issue to their physician (187/335) compared to 30.75% of marijuana users (131/426). The 2-sample t-test found no significant difference in mean hours slept between the two groups (p= 0.13).

Conclusion: These findings suggest that while opioid use is more strongly associated with the prevalence of sleep disturbances, the overall quantity of sleep may not differ significantly from that of marijuana users. This discrepancy indicates that opioid use may affect sleep quality more than sleep duration. The significant difference in the proportion of reported sleep disturbances emphasizes the need for alternative pain management strategies that minimize sleep disruptions. The study highlights the importance of considering the type of medication prescribed for pain relief, particularly in the context of sleep health. For osteopathic physicians aiming to manage pain and sleep issues without exacerbating long-term harm, these findings support the potential benefits of using marijuana for pain relief over opioids. Further research is needed to explore the long-term effects of marijuana use on sleep and its effectiveness as a pain management alternative. A limitation of this paper is that it cannot determine causation. It is unclear whether opioid usage is causing sleep disturbances or if people who are in pain and therefore more likely to be prescribed opioids struggle with sleep. Other possibilities are that marijuana aids sleep or that those who use marijuana are less likely to report trouble sleeping to their physician. Another limitation is that the NHANES data is self-reported by the participants. This is subject to recall bias and therefore is not the most accurate way to gather data. These limitations should be addressed in future research through longitudinal studies and randomized controlled trials that limit confounding variables as much as possible.

References

1. Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007;3(1):33-6.

2. Moore JT, Kelz MB. Opiates, sleep, and pain: the adenosinergic link. Anesthesiology. 2009 Dec;111(6):1175-6. doi: 10.1097/ALN.0b013e3181bdfa2e

3. Fathi HR, Yoonessi A, Khatibi A, Rezaeitalab F, Rezaei-Ardani A. Crosstalk between Sleep Disturbance and Opioid Use Disorder: A Narrative Review. Addict Health. 2020 Apr;12(2):140-158. doi: 10.22122/ahj.v12i2.249

4. Jeddi HM, Busse JW, Sadeghirad B, Levine M, Zoratti MJ, Wang L, Noori A, Couban RJ, Tarride JE. Cannabis for medical use versus opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised clinical trials. BMJ Open. 2024;14(1). doi: 10.1136/bmjopen-2022-068182

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: Project was deemed exempt.

Financial Disclosure: None reported.

Poster No. *C-35

Abstract No. 2024-122

Category: Clinical

Research Focus Area: Acute and Chronic Pain Management

Assessing the Effect of Baseline Parasympathetic Nervous System Activity on Pain Inhibition

¹Caeli G. Beecher, OMS-II, ²Ariana T. Pitaro, ²Scott Stackhouse, ²Katherine Rudolph

¹University of New England College of Osteopathic Medicine, Biddeford, ME; ²Department of Physical Therapy, University of New England, Portland, ME

Context: The human nervous system can facilitate and inhibit pain, measured by temporal summation (TS) and conditioned pain modulation (CPM), respectively. In patients who experience chronic pain, pain facilitation is often increased while pain inhibition is often diminished [1, 2].

The autonomic nervous system (ANS) responds to acute stressors, including the activation of nociceptors, which leads to a reduction in parasympathetic activity[3]. Sympathetic nervous system dysfunction and reduced parasympathetic activity have been associated with fibromyalgia [4], and gastrointestinal disorders including irritable bowel syndrome [5]. It is plausible that the ANS influences pain and pain modulation. This proposal will fill gaps in the literature about the relationships between the ANS and pain modulation and heart rate variability (HRV) is used to characterize autonomic function [6, 7].

Objective: This study investigates the influence of baseline parasympathetic activity on pain modulation.

Methods: This pilot study is being conducted at the University of New England. The study population includes healthy participants over the age of 18. Participants were excluded if they had: prior treatment with NxES; history of medical conditions affecting circulation; prior injury to the legs, back, or spine; presence of chronic illness or neurological problems; and the use of medications that affect heart rate.

Baseline parasympathetic activity was assessed using heart rate variability (HRV) measures calculated from electrocardiogram data collected during a 10-minute period of quiet rest (Delsys Trigno Wireless EMG System with ECG sensor; Natick, MA). The resting heart rate was measured twice, immediately prior to both conditioning stimuli.

Heart rate data were processed using Visual 3D software (HAS-Motion) to identify R waves and eliminate ectopic beats. The NN interval, representing the time between successive R waves from normal beats, was saved and analyzed using Kubios HRV Standard Software 3.5.0. Time-domain variables included pNN50 (percentage of successive RR intervals differing by >50 ms) and RMSSD (root mean square of differences between NN intervals) values.

Two conditioning stimuli, cold water immersion (CWI) and noxious electrical stimulation (NxES),were used to elicit conditioned pain modulation (CPM), the human equivalent to diffuse noxious inhibitory control (DNIC). The CWI involved the non-dominant hand being immersed in cold water (6-8 °C) for 2 minutes. Pain during the cold conditioning stimulus was assessed using verbal ratings from 0-100. PPTs were assessed on the opposite knee before, during and after the CWI. NxES was applied to the knee using two electrodes and a Chattanooga Continuum portable electrical stimulation unit (DJO Global,Dallas, TX). The electrodes were placed over the joint lines with the electrical current cycling on and off every 10 seconds throughout the 20-minute NxES duration. Verbal ratings were taken throughout the stimulation. Participants were asked if the stimulation intensity could be increased after the verbal ratings to ensure that the same dose of stimulation was applied for the 20-minute period.

CPM was measured using a pressure pain threshold (PPT) on the medial condyle of the tibia, using a digital algometer (Medoc, Algomed). Pressure was applied at a rate of 60 kPa/s until the participant noted pain. PPTs were measured before, during, and after CWI and before and after NxES.

Heat Temporal Summation (HTS) was measured by applying 10 mildly painful heat pulses using a thermode (Medoc, TSA2) placed above the medial knee. Pain ratings during HTS were measured using the Visual Analog Scale (VAS). [8]. Participants also completed two questionnaires: DASS-21 (Depression Anxiety and Stress Scale), PSQ (Pain Sensitivity Questionnaire).

Differences between pressure pain thresholds were evaluated using a repeated measures ANOVA test for CWI and paired t-tests for NXES. A positive change in PPT indicated pain inhibition. Pearson Correlation Coefficients were used to assess relationships between inhibition, heart rate variability variables, PSQ scores and DASS21 scores.

This study impacts the neurological model of osteopathy in the understanding of the ANS and its influence on pain. By learning more about this relationship, we are able to influence future treatments and approaches to care, allowing osteopathic physicians to better impact their patients through the osteopathic tenets of care.

Results: 19 participants (10 female, 9 male) have been tested in this ongoing study. The repeated measures analysis of variance (ANOVA) for PPTs pre-, during- and post CWI was significant (F-13.147, df 2, p=.000) and post-hoc tests indicated that the during-CWI PPT was higher than pre-CWI (mean difference (MD) = -206.024 (SEM = 44.233), p=0.001) and higher than post-CWI (MD = 184.324, SEM = 48.951), p=0.005). No differences were found between the pre- and post-CWI PPTs (p>.05). The higher PPTs during CWI indicates that inhibition of pressure pain occurred only while the hand was immersed during cold water immersion.

For pain facilitation, TS was lower post- CWI compared to pre-CWI , t=2.28, df=18, p=.035. Pain facilitation before and after NxES showed a reduction in TS when comparing pre-NxES mean to post-NxES t=4.2, df=18, p=.001.

When assessing relationships between measure of parasympathetic activity, no significant correlations were found between Inhib-duringCWI (inhibition during COLD) Inhib-postCWI (inhibition post-COLD) and inhib-postNxES (inhibition post-NxES) and HRV measures specifically when evaluating pNN50, RMSSD, HFMS2, HF % Power, HF Power NU values.

As a secondary analysis we investigated differences in pain processing and the influence of parasympathetic activity by sex (females vs. males).

When assessing relationships between parasympathetic activity, pain inhibition, DASS21 scores and pain sensitivity scores, differences between female and male participants were more pronounced. For females, correlation was found between Inhib-postNxES and DASS21 stress score (r=0.618, p=0.057), but for males, no correlation was found. For females, correlation was found between PSQ minor and parasympathetic activity as indicated by the RMSSD (r=0.699, p=0.025) yet no correlation was found for males. In Females, correlation was found between parasympathetic activity as indicated by the RMSSD the DASS21 depression score (r = -0.692, p=0.027) and the DASS21 anxiety score (r = -0.760, p=0.011). Females also showed a relationship between the PSQ minor score and parasympathetic activity as indicated by the PNN50 value (r = -0.640, p=0.046). No such relationships were observed in male participants.

Conclusion: The results of this preliminary analysis indicate that inhibition occurs in response to CWI and NxES. However, parasympathetic activity, as indicated by HRV measures, does not appear to influence the degree of inhibition in this sample. Secondary analysis on the influence of sex, shows that, while males and females have similar inhibition to pressure pain and attenuation of HTS, the relationships to psychological measures and parasympathetic activity appear only in female participants. This analysis represents the first analysis of an ongoing study on parasympathetic influences on pain modulation. Future studies involving patient populations will be an important addition to this work.

References

1. Staud R, Godfrey MM, Riley JL, Fillingim RB. Efficiency of pain inhibition and facilitation of fibromyalgia patients is not different from healthy controls: Relevance of sensitivity-adjusted test stimuli. British Journal of Pain. 2022;17(2):182. doi:10.1177/20494637221138318

2. Wirch JL, Wolfe LA, Weissgerber TL, Davies GAL. Cold pressor test protocol to evaluate cardiac autonomic function. Appl Physiol Nutr Metab. 2006;31(3):235-243. doi:10.1139/h05-018

3. Berntson GG, Thomas Bigger J, Eckberg DL, et al. Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology. 1997;34(6):623. doi:10.1111/j.1469-8986.1997.tb02140.x

4. Ali MK, Chen JDZ. Roles of Heart Rate Variability in Assessing Autonomic Nervous System in Functional Gastrointestinal Disorders: A Systematic Review. Diagnostics (Basel). 2023;13(2):293. doi:10.3390/diagnostics13020293

5. Martínez-Martínez L, Mora T, Vargas A, Fuentes-Iniestra M, Martínez-Lavín M. Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies. Journal of clinical rheumatology. 2014;20(3):146-150. doi:10.1097/RHU.0000000000000089

6. Woda A, Picard P, Dutheil F. Dysfunctional stress responses in chronic pain. Psychoneuroendocrinology. 2016;71:127-135. doi:10.1016/j.psyneuen.2016.05.017

7. O’brien AT, Deitos A, Triñanes Pego Y, Fregni F. Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms. The Journal of Pain. 2018;19(8)

8. Backonja M, Attal N, Baron R, et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain. 2013;154(9):1807. doi:10.1016/j.pain.2013.05.047

Informed Consent: Participants complete an initial telephone screen to determine if they meet the inclusion exclusion criteria. The PI will review the Eligibility Survey and follow-up with further questions before determining whether the participant is eligible.

If the subject passes the telephone screen, s/he will be scheduled for data collection session 1 in the Human Sensory and Motor Performance Lab, which is a private room in Blewett Hall. If eligible the consent will be sent to the participant. If the participant does not have an email address, hard copies of the consent form and directions will be mailed a week prior to the first session. Upon arrival a member of the research team will give the participant a copy of the informed consent and the investigator will review all of the procedures with the participant including the inclusion/exclusion criteria. The participant can ask questions about the study and then given the opportunity to sign the consent form.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-36

Abstract No. 2024-128

Category: Clinical

Research Focus Area: Impact of OMM & OMT

Establishing the Dose-Response Effect of Myofascial Release on Muscle Physiology

Sanjana Davuluri, OMS-II, Seth Spicer, Tyler Pigott

Rowan Medicine NeuroMusculoskeletal Institute, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ

Context: Osteopathic manipulative treatment (OMT) is often indicated for back pain due to its high tolerability and post-treatment improvement in patients’ self-reported pain and functionality [1, 2]. Specifically, myofascial release (MFR) has been found to yield a significant improvement in both symptoms and quality of life [2]. Until recently, there has not been much data published about the quantifiable effect of MFR and other OMT modalities on muscle physiology, especially taking treatment dose and force into consideration [3]. Therefore, quantifying the changes in muscle characteristics through myotonometry would greatly benefit the field of osteopathic medicine in order to create more personalized treatment plans for patients and to determine the ideal treatment conditions for maximal impact.

Objectives: Primary: To determine if there is a significant difference in the paraspinal musculature following MFR at different treatment doses and forces, and whether the effect is modulated by time or force. Secondary: To establish the physiological effect of osteopathic MFR treatment through objectively measurable outcomes, including muscle tone, stiffness and elasticity.

Methods: For preliminary results, 15 participants were randomly placed into one of six treatment groups receiving MFR for either 30 or 90 seconds at normal, 0.5x, or 1.5x force. Force was determined using a spring scale attached to a frictionless platform on which the provider stood to exert the required horizontal force on the patient. Measurements of muscle tone, stiffness, and elasticity were taken at the level of T1, 2-3 inches lateral to the spinous process to assess the perpendicular fibers of the trapezius muscle, before and after each treatment using the MyotonPro device. Inclusion criteria: The study population included first through fourth-year medical students at Rowan-Virtua School of Osteopathic Medicine that are 18 years or older and of all genders and ethnic backgrounds. Exclusion criteria: Subjects with a history of any musculoskeletal or neurologic conditions taking medications that may alter muscle tone or those with a body mass index (BMI) > 30 kg/m2 were excluded to avoid potential skewing of data.

Results: The study included 15 participants with an average age of 25.4 years, height of 66.23 in, weight of 155.53 lbs, and BMI of 24.86 kg/m². Paired samples t-tests showed no statistically significant changes in muscle tone (t(29) = 1.117, p = 0.273), stiffness (t(29) = 0.709, p = 0.484), or elasticity (t(29) = 0.340, p = 0.737) following MFR treatment. Effect sizes were small across all measures, with Cohen’s d values of 0.204 for tone, 0.129 for stiffness, and 0.062 for elasticity. Correlation analysis showed that there was minimal influence of applied force on tissue changes, with Pearson’s r values of 0.015 for tone, 0.124 for stiffness, and 0.097 for elasticity.

Conclusion: Trends from these preliminary results suggest a small decrease in muscle tone and stiffness following MFR with correlation analysis suggesting that the amount of total force applied has a small influence on the tissue changes seen. Limitations: These results are preliminary and were based on a limited sample size of only 15 participants, which may affect the statistical power and generalizability of our findings. Future directions: We intend to continue recruitment of subjects to achieve the target sample size of 66 participants, thereby enhancing the validity of these findings.

References

1. Bagagiolo D, Rosa D, Borrelli F. Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. 2022;12(4):e053468. Published 2022 Apr 12. doi:10.1136/bmjopen-2021-053468.

2. Dal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis. Complement Ther Med. 2021;56:102616. doi:10.1016/j.ctim.2020.102616.

3. Bohlen L, Schwarze J, Richter J, et al. Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial. Sci Rep. 2022;12(1):16953. Published 2022 Oct 10. doi:10.1038/s41598-022-20452-9.

Informed Consent: Informed consent and HIPAA Authorization were obtained in a combined document. Participants reviewed study details with one of the Co-Investigators in a private area. The consent form was reviewed and the following were discussed: (1) the goals of the research, (2) a description of the treatment techniques, (3) a description of the types of measurements, and (4) the need to obtain demographic and health-related information. The Co-Investigators answered any questions the participants had about the study and what they would be asked to do as a participant. Participants were reminded that participation is entirely voluntary and that a choice not to participate in the study would not affect their relationship with Rowan-Virtua. If, after this process, the participant agreed to take part in the study, the consent form was signed and stored by the research team. A physical copy of the consent form was provided for the participants’ records.

Ethical Approval & IRB and/or IACUC Approval: This study has been reviewed and approved by the Rowan University Institutional Review Board. The protocol number is PRO-2024-86.

Financial Disclosure: None reported.

Poster No. *C-37

Abstract No. 2024-131

Category: Clinical

Research Focus Area: Chronic Diseases & Conditions

An Observational Investigation of Three Inflammatory Serum Biomarker Levels among Patients Diagnosed with Autism Spectrum Disorder and Congenital Heart Defects

¹Patrick Daniel Pearce, OMS-IV, ¹Venkat Venkataraman, MS, PhD, ²Andrea Iannuzzelli

¹Department of Acedemic Affais, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ; ²Regional Integrated Special Needs Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ

Context: Autism Spectrum Disorder (ASD) and Congenital Heart Defects (CHD) are conditions that both confer an immense increase in standard of care, and an increased medical burden on those suffering from these disorders. While both disorders have many manifestations, one shared symptom that has been consistently cited is inflammation.1-3 The association between ASD and CHD is itself under intense investigation. Understanding the individual effects of the two conditions on marker levels will help early diagnosis and better individualized treatments – especially in ASD patients. Currently no biomarker for ASD exists.

Objective: To examine the levels of three markers - Tumor Necrosis Factor-?, Interleukin-6, and C-Reactive Protein - between patients diagnosed as having either ASD or CHD.2,4-14 The hypothesis tested was that there would be a significant difference between the two cohorts.

Methods: Systematic searches were carried out in PubMed, Medline and Cochrane databases. Studies were excluded based on (a) title/abstract scanning (b) no data on the markers (c) non-human subjects, and (d) non-usable data. A total of 80 studies were finally used for analyses. Mean values from studies for each of the three markers were compiled. After basic analyses of distributions, statistical significance was tested through t-test with Welch’s correction.

Results: By analyses of published data from 80 studies (chosen using PRISMA guidelines) containing the mean values of these three inflammatory markers within these populations, it was observed that while marker levels are elevated in ASD or CHD patients compared to a phenotypically normal demographic, there is no significant difference between IL-6 and CRP levels in ASD or CHD patients as examined through T-tests with Welch’s correction. However, there are significantly higher levels of TNF-? in CHD patients compared to ASD patients (p

Conclusions: This preliminary study has highlighted some interesting observations regarding the levels of the three inflammatory markers in ASD vs CHD patients that suggest that the inflammatory processes in the two conditions may be different and a fruitful line of investigation.17-25 Further studies with carefully selected populations are necessary.

References

1. Kordulewska NK, Kostyra E, Piskorz-Ogórek K, et al. Serum cytokine levels in children with spectrum autism disorder: Differences in pro- and anti-inflammatory balance. J Neuroimmunol. Dec 15 2019;337:577066. doi:10.1016/j.jneuroim.2019.577066

2. Tonhajzerova I, Ondrejka I, Mestanik M, et al. Inflammatory Activity in Autism Spectrum Disorder. Adv Exp Med Biol. 2015;861:93-8. doi:10.1007/5584_2015_145

3. Yin F, Wang H, Liu Z, Gao J. Association between peripheral blood levels of C-reactive protein and Autism Spectrum Disorder in children: A systematic review and meta-analysis. Brain Behav Immun. Aug 2020;88:432-441. doi:10.1016/j.bbi.2020.04.008

4. Savluk OF, Guzelmeric F, Yavuz Y, et al. Neutrophil-lymphocyte ratio as a mortality predictor for Norwood stage I operations. Gen Thorac Cardiovasc Surg. Aug 2019;67(8):669-676. doi:10.1007/s11748-019-01081-y

5. Miyamoto K, Takeuchi D, Inai K, Shinohara T, Nakanishi T. Prognostic value of multiple biomarkers for cardiovascular mortality in adult congenital heart disease: comparisons of single-/two-ventricle physiology, and systemic morphologically right/left ventricles. Heart Vessels. Nov 2016;31(11):1834-1847. doi:10.1007/s00380-016-0807-0

6. Vanreusel I, Vermeulen D, Goovaerts I, et al. Circulating Reactive Oxygen Species in Adults with Congenital Heart Disease. Antioxidants (Basel). Nov 30 2022;11(12)doi:10.3390/antiox11122369

7. Sethi BS, Kapoor PM, Chauhan S, Chowdhury UK, Kiran U, Choudhury M. Perioperative levels of tumor necrosis factor-α correlate with outcomes in children and adults with tetralogy of Fallot undergoing corrective surgery. World J Pediatr Congenit Heart Surg. Jan 1 2014;5(1):38-46. doi:10.1177/2150135113507290

8. Qing M, Schumacher K, Heise R, et al. Intramyocardial synthesis of pro- and anti-inflammatory cytokines in infants with congenital cardiac defects. J Am Coll Cardiol. Jun 18 2003;41(12):2266-74. doi:10.1016/s0735-1097(0300477-7)

9. Shen Y, Li Y, Shi L, et al. Autism spectrum disorder and severe social impairment associated with elevated plasma interleukin-8. Pediatr Res. Feb 2021;89(3):591-597. doi:10.1038/s41390-020-0910-x

10. Cordeiro CN, Tsimis M, Burd I. Infections and Brain Development. Obstet Gynecol Surv. Oct 2015;70(10):644-55. doi:10.1097/ogx.0000000000000236

11. Topal Z, Tufan AE, Karadag M, et al. Evaluation of peripheral inflammatory markers, serum B12, folate, ferritin levels and clinical correlations in children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Nord J Psychiatry . Feb 2022;76(2):150-157. doi:10.1080/08039488.2021.1946712

12. Carlezon WA, Jr., Kim W, Missig G, et al. Maternal and early postnatal immune activation produce sex-specific effects on autism-like behaviors and neuroimmune function in mice. Sci Rep Nov 15 2019;9(1):16928. doi:10.1038/s41598-019-53294-z

13. Blossom SJ, Rau JL, Best TH, Bornemeier RA, Hobbs CA. Increased maternal cytokine production and congenital heart defects. J Reprod Immunol. Apr 2013;97(2):204-10. doi:10.1016/j.jri.2012.12.004

14. Miyoshi T, Hosoda H, Nakai M, et al. Maternal biomarkers for fetal heart failure in fetuses with congenital heart defects or arrhythmias. American Journal of Obstetrics & Gynecology. 2019;220(1):104.e1-104.e15. doi:10.1016/j.ajog.2018.09.024

15. Gao H, Zhang N, Lu F, et al. Circulating histones for predicting prognosis after cardiac surgery: a prospective study. (1569-9285 (Electronic))

16. Geng R, Fang S, Li G. The association between particulate matter 2.5 exposure and children with autism spectrum disorder. (1873-474X (Electronic))

17. Krakowiak P, Goines PE, Tancredi DJ, et al. Neonatal Cytokine Profiles Associated With Autism Spectrum Disorder. (1873-2402 (Electronic))

18. Korzeniewski SA-O, Allred EN, O’Shea TM, Leviton A, Kuban KCK. Elevated protein concentrations in newborn blood and the risks of autism spectrum disorder, and of social impairment, at age 10 years among infants born before the 28th week of gestation. (2158-3188 (Electronic))

19. Zhang S, Guo GL, Yang LL, Sun LQ. Elevated serum levels of ghrelin and TNF-α in patients with cyanotic and acyanotic congenital heart disease. (1867-0687 (Electronic))

20. Sun M, Chen M Fau - Dawood F, Dawood F Fau - Zurawska U, et al. Tumor necrosis factor-alpha mediates cardiac remodeling and ventricular dysfunction after pressure overload state. (1524-4539 (Electronic))

21. Xie J, Huang L, Li X, et al. Immunological cytokine profiling identifies TNF-α as a key molecule dysregulated in autistic children. (1949-2553 (Electronic))

22. Wei H, Zou H Fau - Sheikh AM, Sheikh Am Fau - Malik M, et al. IL-6 is increased in the cerebellum of autistic brain and alters neural cell adhesion, migration and synaptic formation. (1742-2094 (Electronic))

23. Noori NM, Shahramian I, Teimouri A, Keyvani B, Mahjoubifard M. Serum Levels of Tumor Necrosis Factor-α and Interleukins in Children with Congenital Heart Disease. (1735-5370 (Print))

24. Soon E, Holmes Am Fau - Treacy CM, Treacy Cm Fau - Doughty NJ, et al. Elevated levels of inflammatory cytokines predict survival in idiopathic and familial pulmonary arterial hypertension. (1524-4539 (Electronic))

25. Shaoul R, Kessel A Fau - Toubi E, Toubi E Fau - Lanir A, Lanir A Fau - Glazer O, Glazer O Fau - Jaffe M, Jaffe M. Leptin and cytokines levels in children with failure to thrive. (0277-2116 (Print))

Informed Consent: Not Applicable

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *C-38

Abstract No. 2024-133

Category: Clinical

Research Focus Area: Musculoskeletal Injuries and Prevention

Forearm Flexor Strength Imbalance and Medial Elbow Injury in Baseball Pitchers: A Retrospective Cohort Study

¹Tobias Addis, OMS-I, MPH, ¹Andrew Hagen, OMS-I, ²David Redden, PhD, ³Nicole Fremarek, DO, ⁴Matthew Fury, MD ¹Albert Kozar, DO, ¹Mark Rogers, DO, ⁵Per Gunnar Brolinson, DO

¹Department of Sports Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, VA; ²Department of Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine (VCOM-Auburn Branch Campus), Auburn, AL; ³Department of Sports Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, VA; ⁴Orthopaedic Surgery, Baton Rouge Orthopedic Clinic Baton Rouge, LA; ⁵Department of Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, Blacksburg, VA

Context: Medial elbow injuries, especially ulnar collateral ligament injuries, are prevalent among baseball pitchers and can have significant impacts on playability and associated costs with recovery(1). These injuries can be attributed to the large external valgus torque imposed on the medial elbow at maximum external rotation (MER) during a baseball pitch(1). Studies have shown that the external valgus torque experienced by the medial elbow during pitching can be compensated via functional stabilization from muscles and tendons in the forearm(1,2). However, limited research has examined the potential contribution of muscle strength imbalance towards the mechanism of medial elbow injury in baseball pitchers.

Objective: The objective of this study was to determine if an association exists with forearm flexor muscle imbalance and medial elbow injury in baseball pitchers.

Methods: A retrospective cohort study was conducted with data collected from baseball pitchers utilizing the FlexPro Grip device. The inclusion criteria for the sample consisted of baseball pitchers with medial elbow injuries and baseball pitchers without medial elbow injuries, with all participants using the FlexPro Grip device to measure finger flexion strength. The exclusion criteria were all other positional players in baseball. The collected data consisted of force measured at fingertip, force measured at midfinger, and the ratio of the respective force measurements. These measurements were selected due to the interrelated structure and function of the physiology, with osteopathic significance in mind. These measurements were accurately obtained utilizing the FlexPro Grip device. The participants were divided into 2 cohorts: pitchers with medial elbow injury or pain (sprain, strain, tear, recent surgical repair, or adjacent joint pain) and those with no medial elbow injury or pain that required rest from throwing. The participants of this study were de-identified. Statistical analysis was conducted utilizing RStudio, and the two-sample Mann-Whitney U (Wilcoxon Rank-Sum) test was selected for robustness to smaller samples.

Results: The Mann-Whitney U test was performed across the injured (n=18) cohort and the uninjured (n=28) cohort for the four-finger fingertip flexion measurements, the four-finger midfinger flexion measurements, and the midfinger/fingertip flexion ratio measurements. The analysis revealed significant p-values for the four-finger midfinger flexion measurements (p(3). Further research on the topic at hand should aim to include larger samples and investigate the relationship between UCL injury and the strength of other muscles crossing the humeroulnar joint (pronator teres m., flexor carpi radialis m., palmaris longus m., flexor carpi ulnaris m., etc.). Furthermore, investigation of the protective benefit of strength-building exercise of these flexor muscles should be pursued to reduce the burden of UCL musculoskeletal injury in this population.

References

1. van Trigt B, Galjee E, Hoozemans MJM, van der Helm FCT, Veeger DHEJ. Establishing the Role of Elbow Muscles by Evaluating Muscle Activation and Co-contraction Levels at Maximal External Rotation in Fastball Pitching. Front Sports Act Living. 2021;3:698592. Published 2021 Nov 30. doi:10.3389/fspor.2021.698592

2. Lipps DB, Oh YK, Ashton-Miller JA, Wojtys EM. Effect of increased quadriceps tensile stiffness on peak anterior cruciate ligament strain during a simulated pivot landing. Journal of Orthopaedic Research. 2013;32(3):423-430. doi:https://doi.org/10.1002/jor.22531

3. Ikezu M, Kudo S, Edama M, et al. Sites of flexor-pronator muscle injury and relationship between ulnar collateral ligament injury and flexor-pronator muscle injury in baseball players: a retrospective cohort study. J Shoulder Elbow Surg. 2022;31(8):1588-1594. doi:https://doi.org/10.1016/j.jse.2022.01.135

Informed Consent: Not required.

Ethical Approval & IRB and/or IACUC Approval: All research projects that involve human subjects must have approval from the VCOM Institutional Review Board (IRB). Any research involving responses from people or access to records about people must be reviewed. Research studies involving human subjects are reviewed in one of three ways: exempt review, expedited review and full board review. This IRB application was approved under Exemption Category 4 (IRB Reference #2024-051).

Financial Disclosure: None reported.

Poster No. C-39

Abstract No. 2024-138

Category: Clinical

Research Focus Area: Acute and Chronic Pain Management

Basivertebral Nerve Radiofrequency Ablation: Potential Benefits at Initial Follow-up Appointment

Jessica Beetham, DO, Donald Erb, DO

Department of Pain Management, Kennedy White Orthopedic Center, Sarasota, FL

Context: Vertebrogenic low back pain is a common costly problem. Basivertebral nerve radiofrequency ablation has been shown by prior research to be a viable option to manage chronic vertebrogenic low back pain that is refractory to conservative treatment.

Objective: To determine if basivertebral nerve radiofrequency ablation in an outpatient setting will decrease vertebrogenic low back pain using the Visual Analog Score at baseline and at the initial follow-up appointment.

Methods: This retrospective observational chart review research study examined patients’ response to receiving basivertebral nerve radiofrequency ablation using the Visual Analog Score at the initial follow up for the procedure performed during the period of January 1, 2022 through April 19th, 2024. A total of 52 procedures were performed during that time. The age, sex, prior procedures to the same region of the spine, the presence of spinal stenosis, and procedures to the same region of the spine after the basivertebral nerve radiofrequency ablation were obtained. Inclusion criteria (patient must be greater than 18 years old, have experienced chronic low back pain for at least six months or more, have not responded to at least six months of conservative care, and must have Modic type 1 or type 2 changes) and exclusion criteria (presence of severe cardiac or pulmonary disease, active infection that is systemic or localized, and failure to give a response to the Visual Analog Score) were utilized to determine which procedures could be included in the analysis.

Results: After applying the inclusion/exclusion criteria, three patients were excluded and only 15 patients (9 males and 6 females) out of 49 total patients had improvement of their pain after the basivertebral nerve radiofrequency ablation, but this was only after a 10 day follow up period.

Conclusion: Based on previous research studies, basivertebral nerve radiofrequency ablation is a method to decrease chronic vertebrogenic low back pain. This study showed the need to expand examination of patient’s analysis of pain before and after the procedure by using different outcome measures plus increase the follow-up protocol to better determine the degree of benefit of this procedure in an outpatient setting. Limitations of this study included the small sample size and a lack of a control. Thus, further research over a longer period of time and with the use of a more descriptive tool like the Oswestry Disability Index will help physicians to know the degree of pain improvement from basivertebral nerve radiofrequency ablation.

References

1. Tieppo Francio V, Sayed D. Basivertebral Nerve Ablation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 22, 2023.

2. Nwosu M, Agyeman WY, Bisht A, et al. The Effectiveness of Intraosseous Basivertebral Nerve Ablation in the Treatment of Nonradiating Vertebrogenic Pain: A Systematic Review. Cureus. 2023;15(4): e37114. Published 2023 Apr 4. doi:10.7759/cureus.3711

3. McCormick ZL, Curtis T, Cooper A, Wheatley M, Smuck M. Low back pain-related healthcare utilization following intraosseous basivertebral nerve radiofrequency ablation: a pooled analysis from three prospective clinical trials. Pain Med. 2024;25(1):20-32. doi:10.1093/pm/pnad114

4. Schnapp W, Martiatu K, Delcroix GJ. Basivertebral nerve ablation for the treatment of chronic low back pain in a community practice setting: 6 Months follow-up. N Am Spine Soc J. 2023;14:100201. Published 2023 Jan 29. doi:10.1016/j.xnsj.2023.100201

5. Sayed D, Grider J, Strand N, et al. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain [published correction appears in J Pain Res. 2022 Dec 24;15:4075-4076. doi: 10.2147/JPR.S402370]. J Pain Res. 2022;15:3729-3832. Published 2022 Dec 6. doi:10.2147/JPR.S386879

6. Khalil JG, Smuck M, Koreckij T, et al. A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. Spine J. 2019;19(10):1620-1632. doi:10.1016/j.spinee.2019.05.598

Informed Consent: Informed consent was not applicable to this study.

Ethical Approval & IRB and/or IACUC Approval: There was no informed consent applicable to this study and it was an retrospective chart review so no IRB approval was needed.

Financial Disclosure: None reported.

Poster No. *H-1

Abstract No. 2024-005

Category: Health Services

Research Focus Area: Health Disparities-Social Determinants of Health

A Quantitative Study Comparing Hours Served in Early Clinical Experiences to Performance in Third-Year Clinical Preceptor Evaluations

¹Joshua C. Ranta, OMS-IV, ¹Alexis M. Stoner, ²David T. Redden, ¹Emily K. Ranta

¹Department of Public Health, Edward Via College of Osteopathic Medicine (VCOM-South Carolina Branch Campus), Spartanburg, SC; ²Department of Statistics, Edward Via College of Osteopathic Medicine, Blacksburg, VA

Context: Volunteerism has become a large pillar in regards to the foundation of medicine. Both beneficence and altruism are driving forces in regards to the motivation behind physicians, giving them a reason for all of their hard work. In order to grow an appreciation for this sense of selflessness, many medical schools encourage volunteerism in their admission processes and have modified curriculum parameters to include these experiences. Qualitative research on volunteerism in medical school has mainly centered around student-led free medical clinics.[1] Many of these studies have outlined specific responsibilities and best-practices in regards to engaging the community with some anecdotal evidence that highlights an increased student confidence after engaging in these activities.[2] While these studies have demonstrated an obvious impact on the communities around them, there is little objective or quantitative data surrounding the benefit to medical student engagement. Specifically, there are little quantitative studies between volunteerism and competency, professionalism, and knowledge.[3]

As previously stated, many schools have adjusted curriculums and encouraged volunteering experiences in the pre-clinical years. These experiences are being tracked by many schools such as Edward Via College of Osteopathic Medicine (VCOM), utilizing a self-reported volunteer hours service (TOUCH Hours) that tracks these hours spent fostering osteopathic influence in the community and helping fellow community members. This study will uniquely provide substantial, objective findings in regards to better understanding a possible correlation between volunteerism using TOUCH hours and preceptor clerkship evaluations.

Objective: To determine whether a correlation exists between volunteer hours (TOUCH) in preclinical years as compared to 3rd year clinical preceptor evaluations in VCOM Class of 2024.

Methods: This study was a retrospective cohort study that included a class of osteopathic medical students enrolled at VCOM Carolinas during their 3rd year. TOUCH Hours were self-recorded by medical students during their pre-clinical years of study. These hours constituted a variety of different volunteer activities that focused on growing an osteopathic framework as well as helping fellow community members. Common activities included free medical clinics, pediatric health fairs, building houses, and even representing their respective medical school at community events around town.

Student preceptor evaluations were gathered from the school, de-identified and given specific study IDs that corresponded to the TOUCH hours previously collected. These evaluations had numerical scores on a scale from 1-5 with 3-5 indicating a pass in that respective category. Categories on these evaluations included communication, problem solving, clinical skills, osteopathic manipulative medicine, medical knowledge, and professional/ethical standards. There were 9 core rotations medical students completed during their third year including Family Medicine, Rural Family Medicine, Pediatrics, Internal Medicine, Internal Medicine II, Obstetrics and Gynecology, Surgery, Psychiatry as well as a Selective Rotation of their choice. Scores were broken down by section and averaged for the year across their rotations. These scores ranged from 1-5 where a 3 or higher indicated a pass in that respective category. TOUCH Hours were also collected as a representation of volunteerism in the medical students’ preclerkship years. These hours ranged from 0 to 400+ with most of the data showing TOUCH Hours as 400 TOUCH Hours), indicating a need to evaluate Spearman’s rank correlation. Given the robustness of Spearman’s correlations to influential observations and the ordinal nature of the ratings, we chose to interpret Spearman’s correlations as our measure of association. All analyses were conducted using SAS 9.4 with graphs constructed in Excel.

Results: A total of 161 participants were included in the study. Upon Pearson and Spearman correlation analyses, there were no significant correlations (p < .05) when comparing volunteerism to outcomes including communication, problem solving, overall score, medical knowledge, clinical skills, osteopathic manipulative medicine, and professional/ethical standards. Spearman rank analysis appeared stronger than the Pearson analysis likely secondary to leverage points, but neither analysis had significant (p < .05) correlations.

Conclusions: These results suggested no statistical correlation between TOUCH hours and preceptor evaluations in individual categories and scores overall. More analyses with larger sample populations are needed to further characterize this relationship and investigate the differences between anecdotal/observational evidence as compared to this objective finding.

Limitations of this study included the boundaries of the preceptor evaluations. Students were graded in several different categories on a scale of 1-5 with a 3-5 indicating a pass of the rotation. Thus, most of the data was bound between the scores 3 and 5. While there was a large enough sample size for adequate power calculations, the narrow margin between scores may underestimate the differences between students with varying TOUCH hours. This study is significant to the osteopathic medical education as it further investigates the pillars of altruism and evaluates if students benefit from engaging in these activities. Changes to educational standards, curriculum, and even admission processes may be affected as this relationship is further explored.

More analyses are needed to further investigate the relationship between volunteerism and preceptor evaluations during the third year of medical school. This data is highly limited due to the narrow passing boundaries of 3-5 as well as the score uniformity seen in data analysis. As more data is obtained, there is hope to bring greater objective data to substantiate the relationship between volunteerism and preceptor evaluations during a medical students’ third year of medical school.

References

1. Adel, F. W., Berggren, R. E., Esterl, R. M., & Ratelle, J. T. (2021). Student-run free clinic volunteers: Who they are and what we can learn from them. BMC Medical Education, 21(1). https://doi.org/10.1186/s12909-021-02793-7

2. Badger, K., Morrice, R., Buckeldee, O., Cotton, N., Hunukumbure, D., Mitchell, O., Mustafa, A., Oluwole, E., Pahuja, J., Davies, D., Morrell, M. J., Smith, S., & Leedham-Green, K. (2022). “more than just a medical student”: A mixed methods exploration of a structured volunteering programme for undergraduate medical students. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-021-03037-4

3. Rupert, D. D., Alvarez, G. V., Burdge, E. J., Nahvi, R. J., Schell, S. M., & Faustino, F. L. (2022). Student-run free clinics stand at a critical junction between undergraduate medical education, Clinical Care, and advocacy. Academic Medicine, 97(6), 824–831. https://doi.org/10.1097/acm.0000000000004542

4. Beck, J., Chretien, K., & Kind, T. (2015). Professional Identity Development Through Service Learning. Clinical Pediatrics, 54(13), 1276–1282. https://doi.org/10.1177/0009922815571108

5. Blood, A. D., Farnan, J. M., & Fitz-William, W. (2020). Curriculum changes and trends 2010–2020: A Focused National Review using the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II. Academic Medicine, 95(9S). https://doi.org/10.1097/acm.0000000000003484

6. Buckland, R. (2020). Medical student volunteering during COVID-19: Lessons for future Interprofessional practice. Journal of Interprofessional Care, 34(5), 679–681. https://doi.org/10.1080/13561820.2020.1822790

7. Densen P. (2011). Challenges and opportunities facing medical education. Transactions of the American Clinical and Climatological Association, 122, 48–58.

8. Dyrbye, L. N., Harris, I., & Rohren, C. H. (2007). Early clinical experiences from Studentsʼ Perspectives: A qualitative study of narratives. Academic Medicine, 82(10), 979–988. https://doi.org/10.1097/acm.0b013e318149e29c

9. Simpson, S. A., & Long, J. A. (2007). Medical student-run health clinics: Important contributors to patient care and medical education. Journal of General Internal Medicine, 22(3), 352–356. https://doi.org/10.1007/s11606-006-0073-4

10. Siqueira, M. A., Torsani, M. B., Gameiro, G. R., Chinelatto, L. A., Mikahil, B. C., Tempski, P. Z., & Martins, M. A. (2022). Medical students’ participation in the volunteering program during the COVID-19 pandemic: A qualitative study about motivation and the development of new competencies. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03147-7

11. Wee, L. E., Yeo, W. X., Tay, C. M., Lee, J. J., & Koh, G. C. (2010). The pedagogical value of a student-run community-based Experiential Learning Project: The yong loo lin school of medicine public health screening. Annals of the Academy of Medicine, Singapore, 39(9), 686–691. https://doi.org/10.47102/annals-acadmedsg.v39n9p686

Informed Consent: The data was procured from the school (VCOM Carolinas) record for the class of 2024. A Medical Education Specialist de-identified the data while using unique study IDs to keep each individual’s hours and evaluations together. Data was then sent to the principal investigators. As this data was anonymous, it was exempt from signed consent as seen in our IRB and letter.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *H-2

Abstract No. 2024-023

Category: Health Services

Research Focus Area: Osteopathic Philosophy

TikTok Teachings on Pregnancy and Labor: A Mixed Method Evaluation of ​Pregnancy Related Videos and Misinformation on the Social Media Platform

¹Danielle Voke, MPH, OMS-IV, ¹Caroline Kreitzer, ²Stephanie Schreiber, DO, ²Maura Fitzpatrick, DO, ³Ann Impens, PhD, MPH

¹Midwestern University/Chicago College of Osteopathic Medicine, Downers Grove, IL; ²Obstetrics & Gynecology Ascension, Saint Alexius, Hoffman Estates, IL ; ³Department of Clinical Research Services-IL, Midwestern University/Chicago College of Osteopathic Medicine, Downers Grove, IL

Context: TikTok is an increasingly popular platform to engage in health-related matters, including pregnancy and childbirth. Pregnant individuals often seek support in understanding the pregnancy experience, lifestyle changes, or risks and benefits of various peripartum medical interventions to ensure a positive outcome. Although this information can be shared during a prenatal appointment, some patients might not have access to consistent care, lack time in the medical appointment or desire additional clarification. For these reasons, social media may be a convenient and attractive alternative. However, the mass of information comes from authors who may or may not have the appropriate training, leaving viewers vulnerable to misinformation. Inaccurate or inappropriate content can put the patient and their pregnancy outcomes at risk by increasing stress and harmful behaviors, including pursuing treatments without proven benefit or avoiding beneficial intervention.

Objective: This work seeks to evaluate the content, author identity, and quality of pregnancy-related videos on TikTok and explore sources and subjects of misinformation.

Methods: This is a mixed methods study that assessed the quality and content of pregnancy-related videos on TikTok. Metadata of videos including viewing rate, engagement, authorship, and video age were captured via the TikTok-Scraper program. Videos were subsequently evaluated for inclusion criteria (intended for education about pregnancy and presented in English) and stratified by author self-report as healthcare personnel (HCP) or non-healthcare personnel (non-HCP). 4 researchers including an OBGYN attending physician, OBGYN resident, and two medical students applied DISCERN, HONCode and PEMAT scoring systems to evaluate quality and accuracy of each video. Inductive thematic analysis was applied to characterize the content and authorship of videos. Quantitative data including video metadata and instrument scores were analyzed with Kruskall-Wallis tests in R. The interrater reliability of scored videos was assessed by Fleiss’ Kappa score.

Results: 206 videos met the inclusion criteria for evaluation. The subject matter of related videos included Labor and Delivery, Pregnancy Lifestyle, General Education, and Pregnancy Health and Stages. Overall, videos about Pregnancy Lifestyle (n = 54), and Labor and Delivery (n = 65) were more frequently posted than General Education (n = 45) and Pregnancy Health and Stages (n = 42). Self-reported authorship was identified as patient (n = 21), physician (n = 21), midwife (n = 8), doula (n = 68), allied health professional (n = 52) or other (n = 37). Among self-reported physicians, none identified as osteopathically trained. Notably, videos from HCPs demonstrated significantly higher content quality and accuracy than non-HCPs as assessed by DISCERN and HONCode scores (p-value <0.001). Despite higher quality posts, HCPs had significantly less engagement with their videos compared to non-HCPs (p = 0.01) Videos found to contain inaccurate or misleading information regarding perinatal and neonatal interventions were primarily posted by non-HCPs. Examples of videos containing misinformation included ease of external cephalic versions, risks of using erythromycin and Vitamin K at delivery, and indications for medical induction.

Conclusions: Overall, this work demonstrates the need for healthcare professionals and social media sites to address (1) the accessibility of unverified health content and (2) the existence of misleading and inaccurate information online. The low accuracy of information provided by non-HCPs and ambiguity in authors’ self-reported identification raises concern about the lack of regulation provided by social media sites. TikTok videos with low quality or misinformation can potentiate harmful behaviors, patient misunderstanding, and poor outcomes. Importantly, lack of intervention by social media sites may disproportionately affect underserved patients with low health literacy or those without consistent prenatal care who may rely on these sites for health education The high viewer engagement with videos on pregnancy stages and symptoms and labor and delivery suggests that these topics are most important to patients and deserve additional discussion in prenatal appointments. Given the popularity of social media use, physicians may consider offering time in initial prenatal visits to discuss prenatal misinformation online. Given that no authors reported osteopathic affiliation, this study identifies TikTok as a valuable platform to promote osteopathic practice and its role in the peripartum period. DOs can provide evidence-based education addressing the topics receiving the most engagement, for example, OMT in the peripartum period for patients experiencing back pain, persistent pelvic pain, or difficulties breastfeeding.

References

1. Baker B, Yang I. Social media as social support in pregnancy and the postpartum. Sexual & Reproductive Healthcare. 2018;17:31-34. doi:10.1016/j.srhc.2018.05.003

2. Jaswa EG, Lindquist KJ, Hariton E, Aliaga KE, Cedars MI, Huddleston HG. Association between social media use for medical information during pregnancy and likelihood of vaccination against COVID-19. AJOG Global Reports. 2023;3(4):100262. doi:10.1016/j.xagr.2023.100262

3. Laranjo L, Arguel A, Neves A, et al. The influence of social networking sites on health behavior change: a systematic review and meta-analysis. Journal of the American Medical Informatics Association. 2015;22(1):243-256. doi:10.1136/amiajnl-2014-002841

4. Shoemaker S, Wolf M, Brach C. The patient education materials assessment tool (PEMAT) and user’s guide. Published online October 1, 2013.

5. Xu AJ, Taylor J, Gao T, Mihalcea R, Perez‐Rosas V, Loeb S. TikTok and prostate cancer: misinformation and quality of information using validated questionnaires. BJU International. 2021;128(4):435-437. doi:10.1111/bju.15403

6. Goobie GC, Guler SA, Johannson KA, Fisher JH, Ryerson CJ. YouTube Videos as a Source of Misinformation on Idiopathic Pulmonary Fibrosis. Annals ATS. 2019;16(5):572-579. doi:10.1513/AnnalsATS.201809-644OC

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. H-3

Abstract No. 2024-025

Category: Health Services

Research Focus Area: International Health

Impact of Lifestyle Medicine Training on Levels of Knowledge, Skills and Confidence in Health Professions Trainees

¹Chaya Prasad, MD, MBA, ²En-Hsien Liu, ³Sai P. Rama, ⁴Fanglong Dong

¹Department of Clinical Sciences, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA; ²Department of Research, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA; ³Uniwersytet Medyczny w Lublinie, Lublin, Poland; ⁴Department of Biostatistics, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA

Context: Non-communicable chronic diseases account for the highest proportion of morbidity and mortality among U.S. adults. (1) These chronic diseases can be largely attributed to several key harmful lifestyle behaviors; poor diet, low physical activity, and tobacco abuse, to mention a few. There is clear evidence that healthy lifestyle behaviors can treat, prevent, and even reverse many of these chronic diseases. (2) Recent research has underscored the association between Lifestyle medicine and improved health outcomes, especially in patients with chronic medical conditions. This is even more critical in the marginalized populations with suboptimal access to medical care. Though health professions students often receive Lifestyle Medicine education, health professionals cite a lack of competency. Given this discrepancy, our exploratory study investigates health professions students’ perceptions of their knowledge, skills, and confidence in the 6 pillars of Lifestyle Medicine, which include: stress reduction, physical activity, sleep health, positive social connections, risky substance use, and nutrition.

Objective: To determine baseline levels of knowledge, skills, and confidence about Lifestyle Medicine in health professions students. To assess a possible correlation between prior training in Lifestyle Medicine and the baseline values.

Methods: An IRB-approved, voluntary, anonymous study was conducted to assess health professions students’ perceptions of knowledge, skills, and competency in the 6 pillars of Lifestyle Medicine as defined by the American College of Lifestyle Medicine which include: stress reduction, physical activity, sleep health, positive social connections, risky substance use, and nutrition. (3) A Qualtrics survey was used to collect standard demographic items, hours of Lifestyle Medicine training, and levels of knowledge, skills, and confidence in Lifestyle Medicine. The survey included three questions per pillar of Lifestyle Medicine. The survey was distributed to medical, dental, pharmacy students, and physician assistant trainees at the Western University of Health Sciences, Pomona, CA. Data were de-identified, collected as an aggregate, and analyzed using crosstab Chi-square analyses.

Results: Results investigating the impact of Lifestyle Medicine curriculum on knowledge, skills, and confidence levels were analyzed from a sample size of 131 which included 66.7% (n=86) females, and 33.3% (n=45) males, with an average age of 29.67 years. The distribution of respondents’ years of professional school training was as follows: 36.9% from the first year of training, 23.1% from the second year, 13.9% from the third year, and 26.2% from the fourth year. Statistically significant correlations were observed between undergraduate and graduate training exposure to the six pillars of Lifestyle Medicine and knowledge, skills, and confidence (p-values<0.05). Additionally, there was a significant association between the number of years enrolled in professional school and self-reported knowledge and skill for the six Lifestyle Medicine pillars (all p-values <0.05). Self-reported confidence in the six Lifestyle Medicine pillars, from highest to lowest, was as follows: stress reduction, physical activity, sleep health, positive social connections, risky substance use, and nutrition.

Conclusion: Though many health professions training programs have adopted Lifestyle Medicine didactic and clinical training, there is little to no data on baseline knowledge, skills, and confidence levels of Lifestyle Medicine in the healthcare professions trainees. Our exploratory study is the first to assess the baseline information and a possible correlation between the baseline values and prior Lifestyle Medicine training. Our study suggests that increased exposure to Lifestyle Medicine curriculum increases the competency of healthcare professions students, with potential implications for increasing competency in Lifestyle Medicine for future practicing professionals as well. This increased competency would enable healthcare professionals to make a positive change in the arena of chronic medical conditions and would additionally benefit marginalized populations by treating, preventing, and even reversing chronic medical conditions. This evidence emboldens academic programs to consistently invest and expand Lifestyle Medicine curricula across multidisciplinary groups to promote healthy lifestyle adoption and consequently mitigate the prevalence and financial burden of chronic diseases. This will augment healthcare professionals’ competency levels, thereby enhancing health lifestyles not only in patients but also in physicians. A physician who embraces Lifestyle Medicine is more likely to discuss lifestyle changes with their patients in an effort to mitigate chronic medical conditions.

References

1. Xu J, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2021. NCHS Data Brief. 2022;(456):1-8.

2. Bodai BI, Nakata TE, Wong WT, et al. Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. Perm J. 2018;22:17-025. doi:10.7812/TPP/17-025

3. Overview | American College of Lifestyle Medicine. American College of Lifestyle Medicine. https://lifestylemedicine.org/overview/

Informed Consent: Health care professions trainees were informed that completion and submission of the survey indicated informed consent.

Ethical Approval & IRB and/or IACUC Approval: Yes.

Financial Disclosure: None reported.

Poster No. *H-4

Abstract No. 2024-035

Category: Health Services

Research Focus Area: Chronic Diseases & Conditions

Participant Attrition: Smartphone Intervention for PTSD in Primary Care

¹Sindhura Nemani, OMS-III, ²Danielle R. Schweitzer, ³Faith Shank, ¹Hannah Ngo, ¹Kaylea G. Dillon, ¹Muntaha Rana, ¹Anne C. Jones

¹Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ; ²Department of Psychology, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ; ³Department of Psychology, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ

Context: Post-traumatic stress disorder (PTSD) impacts 12.5% of primary care patients and many are unable to receive help promptly (1,2). Smartphone interventions appear to be efficacious for managing PTSD symptoms, but participant characteristics that are predictive of attrition remain unclear (3,4,5). We aim to identify whether specific PTSD symptoms and types of traumatic events are predictive of attrition within a protocol examining a smartphone intervention in an outpatient primary care setting.

Objective: To identify predictors of attrition associated with decreased follow-up rates in the study and, consequently, determine potential ways in which we could modify the study to facilitate higher follow-up rates amongst participants.

Methods: This is a prospective cohort study at an academic outpatient primary care office with the purpose of studying the intervention of the PTSD Coach mobile application in an integrated behavioral health model (6,7,8,9). These assessments were administered by an interprofessional team of medical and clinical psychology trainees and professionals. Eligible participants were aged between 18-89, screened positive for at least one PTSD symptom as determined by their primary care physician, and had access to an electronic device. Participants were excluded if they had active suicidal ideations, were using substances at the time of the visit, or if they did not have access to a device compatible with the PTSD Coach mobile application (7). Patients who were identified based on eligibility criteria were then introduced to the study team via a warm handoff and enrolled in the study by screening through the DSM-5 CAPS-5 used to assess PTSD symptoms (9,10). There was no randomization or grouping of participants. Participants, with the assistance of researchers, installed the PTSD Coach mobile application on their phones (7). They were then advised to use the application three times a day for thirty days and document their daily use in terms of frequency and duration. Follow-up visits were scheduled either at the participants’ next office visit or separately with the research team. To examine salient predictors of attrition, a Random Forest (RF) was performed using the party package in R (11). RF aggregates fitted predictions across decision trees to determine best predictor performance. Aligning with the osteopathic principles of caring for all aspects of well-being, we hope to successfully implement an intervention that can meaningfully address mental health at an outpatient primary care setting.

Results: Thirty-three participants completed baseline measures, whereas nine completed a thirty-day follow-up. Two participants withdrew and twenty-two participants were lost to non-response. Based on variable importance (VI), results indicated that the best predictors of attrition were intrusion symptom severity (VI=0.069) and quantity (VI=0.065), followed by traumatic events including natural disasters (VI=0.035) and sexual assault (VI=0.032). Approximately 2.7% of the variance in attrition was explained by the full model (OOB R2=0.027). Model visualizations suggested that increased levels of intrusion symptom severity (M=8.33) and quantity (M=2.88) were present within individuals who follow-up compared to those who solely completed intake (M=5.04; M=1.96). Furthermore, more participants who completed follow-up had experienced a natural disaster (55%) or sexual assault (55%) compared to those who did not complete follow-up (21%; 21%).

Conclusion: Attrition rates within the present study appeared higher than those of studies examining applications for other mental health conditions and clinician-supported apps for PTSD in primary care (5,6,9). These differences may be attributed to aspects of the study protocol and intervention. When integrating mobile health into primary care clinics for trauma, alignment of research protocols to models of integrated primary care with regard to workflow and scheduling processes may improve attrition rates. Additionally, the study protocol did not involve guidance beyond the initial study visit. Providing reminders or additional guidance to participants may reduce attrition rates within mobile interventions (6). Future research may examine how guidance or clinician support may facilitate adherence to standalone and blended digital interventions for trauma within primary care. Lastly, our results suggest that lower levels of intrusion symptoms and specific traumatic events were most predictive of attrition compared to other symptoms of PTSD and traumatic events. As the intervention examined did not focus specifically on the content of traumatic memories, it is possible that participants experiencing intrusion symptoms found the intervention to be useful. Psychotherapy interventions for PTSD with a trauma focus demonstrate higher levels of attrition than those without a trauma focus (4). Sexual assault and natural disasters were both predictive of decreased attrition rates. However, these events differ with respect to personal directedness, suggesting that patients in primary care who have experienced varying traumatic events may use mobile interventions for trauma. Within primary care settings, providers may therefore consider recommending mobile applications without a trauma focus for individuals who are experiencing intrusion symptoms and for a range of traumatic events.

References

1. Spottswood M, Davydow DS, Huang H. The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review. Harv Rev Psychiatry. 2017;25(4):159-169. doi:10.1097/HRP.0000000000000136

2. Wait times for outpatient mental health treatment in New Jersey (Wait Time Study PowerPoint). March 15, 2022. Accessed June 13, 2024. https://www.mhanj.org/content/uploads/2022/08/Wait-Time-Study-March-15-2022.pdf. Multimedia component of: Access to care. Mental Health Association of New Jersey. Accessed June 13, 2024. https://www.mhanj.org/accesstocare/

3. Goreis A, Felnhofer A, Kafka JX, Probst T, Kothgassner OD. Efficacy of Self-Management Smartphone-Based Apps for Post-traumatic Stress Disorder Symptoms: A Systematic Review and Meta-Analysis. Front Neurosci. 2020;14:3. Published 2020 Jan 24. doi:10.3389/fnins.2020.00003

4. Lewis C, Roberts NP, Gibson S, Bisson JI. Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1709709. Published 2020 Mar 9. doi:10.1080/20008198.2019.1709709

5. Linardon J, Fuller-Tyszkiewicz M. Attrition and adherence in smartphone-delivered interventions for mental health problems: A systematic and meta-analytic review. J Consult Clin Psychol. 2020;88(1):1-13. doi:10.1037/ccp0000459

6. Possemato K, Johnson E, Barrie K, et al. A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients. J Gen Intern Med. 2023;38(Suppl 3):905-912. doi:10.1007/s11606-023-08130-6

7. PTSD Coach. PTSD: National Center for PTSD, U.S. Department of Veterans Affairs. Updated November 8, 2022. Accessed June 13, 2024. https://www.ptsd.va.gov/appvid/mobile/ptsdcoach_app.asp

8. Jones AC, Bertsch K, Petrides J, Lilienthal KR, Vermeulen M. Integrating behavioral health and primary care: a review of evidence and recommendations for osteopathic family practice. Osteopathic Family Physician. 2024 Feb 27;16(1):32–37. doi:10.33181/16106

9. Pace CA, Gergen-Barnett K, Veidis A, et al. Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments. Ann Fam Med. 2018;16(4):346-348. doi:10.1370/afm.2263

10. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). PTSD: National Center for PTSD, U.S. Department of Veterans Affairs. Updated November 10, 2022. Accessed June 13, 2024. https://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp

11. Strobl C, Boulesteix AL, Kneib T, Augustin T, Zeileis A. Conditional variable importance for random forests. BMC Bioinformatics. 2008;9:307. Published 2008 Jul 11. doi:10.1186/1471-2105-9-307

Informed Consent: We created an informed patient consent form consisting of a description of the study, its purpose, what will be expected of participants, risks, compensation, benefits, logistics, and its voluntary status. Patients were informed of their rights to withdraw from the study at any point should they choose to. Prior to enrollment, study staff went through the consent forms with the patients and both were required to provide a signature.

Ethical Approval & IRB and/or IACUC Approval: The study was reviewed and approved by the Rowan-Virtua School of Osteopathic Medicine IRB. Attached below is the most recent letter stating approval for the study’s renewal request. IRB #: PRO-2023-95

Financial Disclosure: None reported.

Poster No. *H-5

Abstract No. 2024-071

Category: Health Services

Research Focus Area: Chronic Diseases & Conditions

Predictors of PTSD severity in a primary care setting: Mental Health and Well-Being Factors

Priya Srivastava, OMS-III, Danielle Schweitzer, Faith Shank, Alexandra Groome, Salma Saifuddin, Deep Patel, Anne Jones, DO

Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ

Context: Post-traumatic stress disorder (PTSD) is common in primary care settings, in as large as 12.5% of presenting patients.(1,2) The gap between where patients first present (in primary care), and where they receive treatment (with specialty mental health care providers) creates a significant barrier to patients suffering from an already burdensome disease. (2,3) Improving access to and quality of treatment in primary care settings should improve overall patient outcomes. To gain an understanding of what factors constitute the development of PTSD in patients, we have introduced an interprofessional behavioral model in our academic primary setting. In these interventions, research members study how symptoms of PTSD vary in CAPS-5, the Hopkins Checklist total, well-being measures total, dissociative symptoms, trauma experiences, and total trauma each patient has experienced. Established measures like CAPS-5 and the Hopkins Checklist total are the current gold standard assessment tools for PTSD, as they have been extensively validated as an accurate evidence-based tool for the condition; it is often seen as especially credible in assessing traumatic symptoms in U.S. military veterans.(4)

Objective: To determine what factors of a patient’s history are associated with higher PTSD severity in patients as evaluated in a primary care setting, in hopes of informing treatment guidelines for PCPs, and ultimately improving patient outcomes.

Methods: This interventional prospective cohort study occurred at the Rowan Family Medicine clinic at Sewell. Researchers, consisting of medical students and doctoral candidates, screened patients regarding eligibility criteria. Eligible participants are 18 years or older, screen positive for at least one PTSD symptom as determined by their primary care physician, and have access to an electronic device. Participants were excluded if they had active suicidal ideations, were using substances at the time of the visit, or did not have access to a device compatible with the PTSD Coach application. No randomization or grouping procedures occurred, as all participants participated in the study’s intervention. Using a warm handoff approach, the Primary Care Physician introduced the research member to the patient, creating a transition in care. We administered the CAP-5 survey to patients. (5) Upon completion, patients downloaded the PTSD Coach mobile application and were shown a tutorial on how to use it. (6) The PTSD Coach mobile application contains resources for users to use when feeling symptoms. Users can use tools such as deep breathing exercises, grounding, and mindfulness. It has educational resources about PTSD and how to access professional help. Participants were instructed to use the application at least thrice daily for 30 days or when experiencing negative emotions. Participants were then re-evaluated using the same survey 30 days post-intake. To examine salient predictors of attrition, a Random Forest (RF) was performed using the party package in R. RF aggregates fitted predictions across decision trees to determine the best predictor performance. (7) This study may illuminate our understanding of PTSD symptoms severity as they present in a primary care setting. Although psychiatrists are typically entrusted to take care of patients with PTSD, primary care providers are often the first providers to interact with these patients. This study therefore emphasizes the importance of treating the entire patient in the primary care setting, including both mental and physical aspects of their wellbeing.

Results: Forty-two percent of participants met the full diagnostic criteria for PTSD. The mean number of total PTSD symptoms was 7.75 (SD=3.96) and the mean total severity was 22.4 (SD=12.18). Twenty-four percent of participants experienced PTSD with delayed onset and 18% endorsed dissociative symptoms. Using variable importance (VI), results suggested that the best predictors of PTSD severity were HSC scores (VI=1.157), life satisfaction (VI=0.990), experiencing sexual assault (VI=0.343), and experiencing serious injury (VI=0.212). Four percent of the variance in PTSD symptom severity was explained by the RF model (OOB R2=0.041). Model visualizations indicated that higher levels of HSC scores and lower levels of life satisfaction were predictive of increased PTSD severity. Experiencing sexual assault was predictive of increased levels of PTSD severity. While participants who had directly experienced serious injury endorsed increased levels of PTSD symptoms, participants who had witnessed or heard about an event involving serious injury exhibited less symptom severity.

Conclusion: Our results suggest that increased symptoms of depression and anxiety, decreased life satisfaction, sexual assault, and serious injury may be associated with PTSD symptom severity. These findings align with the presentation of PTSD as mood and hyperarousal symptoms are often present, along with effects on global functioning. Additionally, findings provide continued support that personally directed events tend to be associated with PTSD severity broadly. (8,9) Notably, a total number of traumatic events was not associated with PTSD severity. However, evidence in community mental health and veteran populations supports the existence of a dose-response relationship. (9,10) Future research may continue to investigate correlates of PTSD severity that are specific to primary care populations. We strive to continue recruiting patients and thus expand our understanding of how factors in a patient’s history impact their symptoms, and overall disease severity.

References

1. Spottswood M, Davydow DS, Huang H. The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review. Harv Rev Psychiatry. 2017;25(4):159-169. doi:10.1097/HRP.0000000000000136

2. Sonis J. PTSD in primary care--an update on evidence-based management. Curr Psychiatry Rep. 2013;15(7):373. doi:10.1007/s11920-013-0373-4

3. Rauch SAM, Kim HM, Acierno R, et al. Improving function through primary care treatment of PTSD: The IMPACT study protocol. Contemp Clin Trials. 2022;120:106881. doi:10.1016/j.cct.2022.106881

4. Weathers FW, Bovin MJ, Lee DJ, et al. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30(3):383-395. doi:10.1037/pas0000486

5. Pace CA, Gergen-Barnett K, Veidis A, et al. Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments. Ann Fam Med. 2018;16(4):346-348. doi:10.1370/afm.2263

6. Hallenbeck HW, Jaworski BK, Wielgosz J, et al. PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public. JMIR Ment Health. 2022;9(3):e34744. Published 2022 Mar 29. doi:10.2196/34744

7. Epifanio I. Intervention in prediction measure: a new approach to assessing variable importance for random forests. BMC Bioinformatics. 2017;18(1):230. Published 2017 May 2. doi:10.1186/s12859-017-1650-8

8. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060. doi:10.1001/archpsyc.1995.03950240066012

9. Jakob, Jeanne M.D. PhD*†; Lamp, Kristen PhD‡; Rauch, Sheila A.M. PhD‡§; Smith, Erin R. PhD†∥; Buchholz, Katherine R. PhD†∥. The Impact of Trauma Type or Number of Traumatic Events on PTSD Diagnosis and Symptom Severity in Treatment Seeking Veterans. The Journal of Nervous and Mental Disease 205(2):p 83-86, February 2017. | DOI: 10.1097/NMD.0000000000000581

10. Gerber, M., Frankfurt, S.B., Contractor, A.A. et al. Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?. J Psychopathol Behav Assess 40, 645–654 (2018). https://doi.org/10.1007/s10862-018-9682-6

Informed Consent: Before patients were enrolled in the study, study staff members detailed and discussed the logistics of the study, as well as the expectations. This was detailed in the consent form and they signed it after receiving all the information. The main details of the consent form were related to the voluntary status of the study, the purpose of it, the expectations of the patients. Additionally, we offered compensation to the patients as well as the right to withdraw from the study at any time.

Ethical Approval & IRB and/or IACUC Approval: Approved: 5/17/23; Renewed: 6/6/24

Financial Disclosure: N/A

Poster No. *H-6

Abstract No. 2024-079

Category: Health Services

Research Focus Area: Chronic Diseases & Conditions

Prospective Evaluation of an Online Diabetes Health Coaching Program

¹Shivangi Patel, OMS-III, ²Janet Simon, PhD, ¹David Drozek, DO

¹The Diabetes Institute, Ohio University-Heritage College of Osteopathic Medicine, Athens, OH; ²None

Context: Prediabetes (PreDB), type 2 diabetes mellitus (T2DM), and gestational diabetes are often preventable and reversible diseases when the appropriate lifestyle measures are taken. (1) Health and wellness coaching is an emerging tool for chronic disease prevention and treatment. (2,3) Mastering Diabetes (MD) is an online, self-paced health coaching program that provides 16 weeks of instruction about how to transition to a low-fat, plant-based, whole-food diet, utilizing online education, day-to-day accountability and support, and video conferencing. (4) MD demonstrated in a retrospective study to reduce glycosylated hemoglobin (HbA1c) and body mass index (BMI) as well as medication use.

Objective: To prospectively determine the effectiveness of MD in improving levels of biomarkers in participants living with diabetes.

Methods: In this prospective study of MD, data was obtained at baseline and 12 weeks and analyzed for short-term changes in biomarker levels: total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), HbA1c, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Biomarker data was gathered by a commercial lab and vital signs were self-reported.

Results: Twenty-eight participants have completed the study; mean age of 56 with a range of 34-72 years; 23 (82%) females. The reduction in BMI and TC were significant (p <0.001). There was also significant reduction in SBP (p=0.006), DBP (p=0.008), HbA1c (p=0.03), and LDL (p=0.005). Although not statistically significant, with a larger sample size, it is likely that there will be significant changes in TG (p=0.05) as well.

Conclusion: Preliminary results of MD demonstrate effectiveness in reducing BMI, TC, SBP, DBP, HbA1c, and LDL, with a trend toward also improving TG. Future work could focus on increasing the availability of programs like MD to the general population and motivating people to engage.

References

1. Gregg EW, Chen H, Wagenknecht LE, et al; Look AHEAD Research Group. Association of an intensive lifestyle intervention with remission of type 2 diabetes. AMA. 2012;308:2489-2496. doi:10.1001/ jama.2012.67929

2. Melko CN, Terry PE, Camp K, Xi M, Healey ML. Diabetes health coaching improves medication adherence: a pilot study. Am J Lifestyle Med. 2009;4:187-194. doi:10.1177/1559827609351131

3. Sherman RP, Ganguli I. Primary care-based health coaching for the management of prediabetes. Am J Lifestyle Med. 2017;12:175-178. doi:10.1177/1559827617702074

4. Sarver J, Khambatta C, Barbaro R, Chavan B, Drozek D. Retrospective Evaluation of an Online Diabetes Health Coaching Program: A Pilot Study. Am J Lifestyle Med. 2019 Oct 15;15(4):466-474. doi: 10.1177/1559827619879106. PMID: 34366745; PMCID: PMC8299927.

Informed Consent: Informed consent was obtained via electronic signature on a Qualtrics consent.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: No financial conflicts of interest exist for any of the authors.

Poster No. *H-7

Abstract No. 2024-084

Category: Health Services

Research Focus Area: Acute and Chronic Pain Management

Navigating Chronic Pain in Rural New Hampshire: A Study on Palliative Care Access and Challenges

Selma Hodzic, OMS-IV

University of New England College of Osteopathic Medicine, Biddeford, ME

Context: Access to palliative care in rural areas often presents significant challenges due to social determinants of health and reliance on local community physicians for complex medical conditions. Palliative care providers may serve as crucial resources for individuals dealing with chronic pain in rural New Hampshire, where access to specialized medical care can be limited. This study explores the experiences of patients with chronic pain to understand how palliative care impacts their lives, examining both positive outcomes and challenges.

Objective: To assess access to, benefits of, and challenges in palliative care among chronic pain patients in rural New Hampshire, focusing on pain management and healthcare accessibility.

Methods: A qualitative study was conducted via phone surveys with individuals enrolled in the palliative care program at a small rural community hospital in New Hampshire. Participants were selected if they had a diagnosis of chronic pain, had appointments between March 1, 2024 and July 1, 2024, and were currently under the care of a palliative care physician. The selected timeframe aimed to ensure consistency and manage a feasible sample size, considering the transitions many palliative care patients undergo to hospice care or other outcomes. Out of 40 potential palliative care patients, 16 fulfilled the selection criteria, and 8 responded. Data collection included demographics, transportation accessibility, effectiveness of pain management strategies, medication use, appointment logistics, and qualitative insights on palliative care experiences. Informed consent was obtained from all participants.

Results: Participants included 8 males aged 68-92 years old, with 7 diagnosed with chronic pain secondary to metastatic cancer and 1 with chronic pain from polymyalgia rheumatica. The duration of rural residency ranged from 20 to 92 years, with all participants having access to a vehicle and the ability to drive. 5 patients reported living less than 10 miles from their palliative care physician, with 3 participants living 10-20 miles away from their palliative care provider. Pain management was reported as very well managed by 6 participants and somewhat well managed by 2 participants, with all on chronic opioid therapy and 4 in active physical therapy. All participants reported being able to schedule appointments with their palliative care physician within one week. None reported missing appointments due to transportation issues, often citing preparedness for rural conditions. Participants felt well-supported by their communities, noting the availability of neighbors, family, and church members for assistance. Primary challenges included accessing tertiary care centers for specialized treatment, with 6 participants needing to travel approximately an hour to reach these facilities, and difficulties with the availability of primary care physicians. Five participants cited challenges in reaching their primary care physician and obtaining timely appointments, leading them to rely on their palliative care provider for assistance. For qualitative feedback, participants appreciated the comprehensive care provided by their palliative care providers, particularly the coordinated efforts with oncologists and other specialists. Emotional support from palliative care providers was also highlighted as beneficial in accepting and addressing their symptoms.

Conclusion: The findings from this study indicate that palliative care in rural New Hampshire is a crucial resource in assisting patients in managing their chronic pain. All participants reported their pain as very well or somewhat well-managed through seeing a palliative care provider for medical management and emotional/social support. Key challenges included difficulties in contacting primary care physicians, causing some patients to rely on their palliative care providers for support, and the long distances to tertiary care centers. Despite these obstacles, patients expressed satisfaction with their palliative care physician, valuing the comprehensive care and coordinated efforts with oncologists and other specialists in managing their care. The study has limitations, including a small sample size, lack of female participants, reliance on self-reported data, and the health complexities of many palliative care patients, which may have affected their ability to participate fully. Additionally, conducting surveys over the phone may have excluded some participants who are hard of hearing or uncomfortable with phone interviews. These limitations highlight the need for further research. Recommendations include administering surveys in person to improve response rates and conducting similar studies in urban settings for comparison. Additionally, continued education on palliative care is essential to reduce stigma and enhance palliative care utilization. 1,2

Primary Author: Selma Hodzic, OMS-IV, University of New England College of Osteopathic Medicine, Littleton Regional Healthcare.

References

1. Bakitas, M., Elk, R., Astin, M., Ceronsky, L., Clifford, K. N., Dionne-Odom, J. N., ... & Smith, T. (2015). Systematic review of palliative care in the rural setting. Cancer Control, 22(4), 450-464. doi:10.1177/107327481502200412

2. Scharff, D. P. (2010). Disparities in access to palliative care services in rural communities. Journal of Community Health Nursing, 27(3), 139-149. doi:10.1080/07370016.2010.494460

Informed Consent: I began with a brief introduction to explain the purpose of the study and the expected duration of our conversation. I described what the survey entailed, including the types of questions that would be asked and how the responses would be used, emphasizing that participation was voluntary. Individuals received comprehensive details about the study, including its purpose, the nature of the questions, the estimated time commitment, how the data would be used, and their rights as participants. Participants were allowed to ask questions during this process. I checked for readiness and comfort by asking if they needed further information or clarification before deciding whether they want to opt in or out of the survey research study. If they agreed, I asked for their consent to proceed, assuring them that their responses would be kept confidential and used to provide insights for understanding experiences with chronic pain management and palliative care services in rural communities.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. H-8

Abstract No. 2024-125

Category: Health Services

Research Focus Area: Osteopathic Philosophy

Osteopathic Medical Doctors into Plastic Surgery: Pathways and Demographics

Alma Vida Datario, DO

General Surgery, University of Minnesota, Minneapolis, MN

Context: Current and prospective medical students and residents may seek to understand the prevalence and pathways into plastic surgery for osteopathic medicine. This study addresses the lack of comprehensive data on the educational and professional trajectories of osteopathic doctors (DOs) in the field of plastic surgery.

Objective: To examine and analyze publicly available data on current practicing plastic surgeons, including plastic surgical residents who hold an osteopathic medical degree (DO).

Methods: A retrospective data analysis was employed, using publicly accessible databases from the American Society of Plastic Surgeons (ASPS), the American College of Osteopathic Surgeons (ACOS), and Doximity, searched from May 2024 to June 2024. Plastic surgeons and residents with a DO degree were identified, focusing on their education and training backgrounds. Secondary searches were conducted using Google, LinkedIn, US News & World Report, private practice websites, plastic surgery residency programs, Sharecare.com, and Facebook pages to complete missing information. Data collected included osteopathic medical schools, surgical training paths, fellowships (if applicable), and current geographical regions of practice. Additional analyses included the prevalence of intern years, the independent pathway versus integrated pathway into plastic surgery, and gender distribution. Statistical analysis included descriptive statistics and correlation analysis where applicable.

Results: A total of 295 names were retrieved from the ASPS, ACOS, and Doximity databases. Thirty-seven were identified as cosmetic surgeons, 5 had missing residency data, and 27 lacked independent plastic surgery fellowships, 1 had a suspended license, 3 were deceased, excluding them from the final dataset. This left 220 plastic surgeons and 12 plastic surgery residents for analysis. Thirty-four percent (80) initiated their medical education in the Middle Atlantic region, followed by 18.5% (43) in West North Central, 16% (37) in South Atlantic, 12% (28) in East North Central, 6.9% (16) in West South Central, 5.2% (12) in Pacific, 3% (7) in Mountain, 2.2% (5) in East South Central, and 1.7% (1) in New England. Geographically, 31% practice in the Middle Atlantic (72), followed by 20% in East North Central (46), 17% in South Atlantic (40), 10% in Pacific (23), 7.7% in West South Central (18), 6.9% in Mountain (16), 4.3% in West North Central (10), 1.7% in East South Central (4), and 1.3% in New England (3). Medical school region and current practice location have a correlation value of 0.371.

Conclusion: The majority of DO plastic surgeons are trained in the Middle Atlantic region, with a significant proportion continuing to practice there. Most follow the independent pathway via general surgery, though some use the integrated pathway, and a smaller subset pursue additional fellowship training within plastic surgery. These data highlight that DOs constitute a small but significant higher number of plastic surgeons in the United States.

References

1. American Society of Plastic Surgeons. Find a Plastic Surgeon. ASPS. Accessed May 2024. https://find.plasticsurgery.orgAmerican College of Osteopathic Surgeons. Find a Surgeon Directory. ACOS. Accessed May 2024. https://www.facos.org/OS/Find_a_Surgeon/OS/Documents/Find_a_Surgeon_Directory.aspx?hkey=693838a3-addf-45f4-86b9-1c3f02b57325

2. Doximity. Plastic Surgery Directory. Doximity. Accessed May-June 2024. https://www.doximity.com/directory/md/specialty/plastic-surgery

3. Raborn L, Elmorsi R, Smith B, et al. Doctors of Osteopathic Medicine as plastic surgery residents: demographics, credentials, and pathways to residency. Journal of Surgical Education. 2024;81(4):607-615. https://doi.org/10.1016/j.ijosm.2023.100691

Informed Consent: Not Applicable

Ethical Approval & IRB and/or IACUC Approval: Exempted

Financial Disclosure: None reported.

Poster No. *H-9

Abstract No. 2024-132

Category: Health Services

Research Focus Area: Osteopathic Philosophy

Heart Rate Variability (HRV) and Physiologic Parameters as Measures of Stress in Medical Students

Anthony J. Guccione III, OMS-III, Andrew Nahmias, OMS-III, Daniel P. Morgan, OMS-III, Catherine Y. Chin, OMS-II. Frank J. Di Caro, OMS-II, Matthew D. Cirrone, OMS-II, Jasmine Chadha, OMS-II, Kaylee Bressler, MS, OMS-III, Thomas Chan, DO, Joanne Donoghue, MS, PhD, Stephen DiRusso, MD, PhD

Department of of Clinical Sciences, New York Institute of Technology, Old Westbury, NY

Context: Heart Rate Variability (HRV) is a measurement of the variation in time between consecutive heartbeats or the duration of the R-R interval. Considered to be a reflection of changes in cardiac autonomic regulation, HRV can serve as an indicator of an individual’s ability to respond to different stressors [1]. Increases seen from an established baseline HRV may correspond to more effective stress management, whereas decreases may suggest the presence of anxiety, depression, or signs of poor lifestyle habits [2]. Previous studies have investigated HRV as a tool utilized by trainers of elite athletes to optimize performance and recovery; however, its role in other populations that experience extreme amounts of physical and mental stress, including medical students, is not well understood [3-5].

Objective: The objective of this study is to identify trends in physiological and psychological stress prior to, during, and after examination periods through monitoring health metrics of medical students.

Methods: Driven by osteopathic tenets, this non-randomized prospective study investigated patterns of physiologic responses to stress in medical students, underscoring the holistic perspective that the person is a unit of body, mind, and spirit. Sixteen first and second year osteopathic medical students, 8 of which were male and 8 of which were female, were enrolled and studied for a period of six weeks. Possession of an Apple Watch was required for participation in the study and students currently taking cardiac medications that may influence heart rate were excluded. Measurements of heart rate, sleep, total steps, exercise minutes, resting energy, and active energy were obtained from stored health metrics tracked by the Apple Watch, which has been shown to be a reliable tool for recording this data [6,7]. Each participant’s data was shared with one investigator via the Apple Health App. Participants were instructed to calculate and self-report their daily HRV value using the “Mindfulness” App on Apple Watch each morning after waking. They were also sent a daily survey logging the following via a likert scale: sleep quality, mood, food intake, stress levels and muscle soreness. The data was broken down into weeks in relation to their exam week. Week 1 and 2 were pre-test weeks, week 3 was exam week, week 4 was spring break, and weeks 5 and 6 were post-test weeks and the start of new material. Data was analyzed using SPSS v28 with p<0.05 indicating significance.

Results: Of the 16 participants recruited, there were 11 included in the analysis. Five participants were excluded due to non-compliance. Individual trend analysis revealed that 81.8% of the participants had a increase in HRV during exam week compared to spring break, implying an increased ability to handle stress during the exam week. The relationship between HRV and the other variables were examined through Spearman’s rank correlation coefficient. There was a significant (p<0.05) positive correlation between increased HRV, higher maximum HR (0.270), higher resting energy (0.276), higher active energy (0.507), more steps (0.334), increased exercise minutes (0.521) and a healthier diet yesterday (0.352). There was a significant (p<0.05) negative correlation between a lower HRV and increased muscle soreness (-0.593).

Conclusion: Results indicate that there are several variables correlated with heart rate variability. Having an increased energy expenditure, increased daily step count, increased exercise minutes, and a more nutritious diet are all reported to be correlated with a higher HRV. These factors seem to improve HRV, which correlates with better management of stress during the exam cycle. However, the increased muscle soreness that was seen was correlated with a lower HRV, suggesting the body less capable of handling the stress or needing more recovery time [8]. In conclusion, by increasing exercise and eating a well balanced diet in the weeks leading up to exams, medical students can more effectively manage their stress reflected by an increase in their HRV. This would allow them to better handle the stress that is associated with medical school.

References

1. Billman GE, Huikuri HV, Sacha J, Trimmel K. An introduction to heart rate variability: methodological considerations and clinical applications. Front Physiol. 2015 Feb 25;6:55. doi: 10.3389/fphys.2015.00055

2. Kim HG, Cheon EJ, Bai DS, Lee YH, Koo BH. Stress and heart rate variability: A meta-analysis and review of the literature. Psychiatry Investig. 2018;15(3):235-245. doi: 10.3077312

3. Anand S, Hemwani K, Ajmani S, Goothy SSK, & Choudhary A. Assessment of depression, anxiety, stress, and cognitive parameters in medical students: A pilot study. AJMS. 2023; 14(2):214–217. https://doi-org.arktos.nyit.edu/10.3126/ajms.v14i2.49269

4. McKerrow I, Carney PA, Caretta-Weyer H, Furnari M, & Miller Juve A. Trends in medical students’ stress, physical, and emotional health throughout training. Med. Educ. Online. 2020; 25(1):1–7. https://doi-org.arktos.nyit.edu/10.1080/10872981.2019.1709278

5. Mirifar A, Beckmann J, & Ehrlenspiel F. Neurofeedback as supplementary training for optimizing athletes’ performance: A systematic review with implications for future research. Neurosci Biobehav Rev. 2017; 75:419–432. https://doi-org.arktos.nyit.edu/10.1016/j.neubiorev.2017.02.005

6. Hernando D, Roca S, Sancho J, Alesanco Á, Bailón R. Validation of the apple watch for heart rate variability measurements during relaxation and mental stress in healthy subjects. Sensors. 2018; 18(8):2619. doi: 10.3390/s18082619

7. Turki AF, Ding K, Zhang R, Li M, Bell K, & Behbehani K. Estimation of heart rate variability measures using Apple Watch and evaluating their accuracy: Estimation of heart rate variability measures using Apple Watch. Paper presented at: 14th Pervasive Technologies Related to Assistive Environments Conference (PETRA 2021); June 29–July 02, 2021; Corfu, Greece. https://dl.acm.org/doi/pdf/10.1145/3453892.3462647

8. Crossland, B., Sokoloski, M., & Rigby, B. R. (2018). The Relationship Between Heart Rate Variability and Skeletal Muscle Damage in Female Collegiate Athletes. In International Journal of Exercise Science: Conference Proceedings (Vol. 2, No. 10, p. 78).

Informed Consent: Informed Consent: A consent form was provided and explained to each participant and a signature was obtained. Participants were made aware that participation in the study is voluntary and withdrawal at any time would not result in penalty. The risks of this study were not greater than those encountered in daily life and there was no direct benefit to the participants other than the potential to help medical students in the future.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. H-10

Abstract No. 2024-136

Category: Health Services

Research Focus Area: Health Disparities-Social Determinants of Health

Empowering Hijabi Medical Students and Physicians: A Survey Unveiling Perspectives on Pursuing Surgical Specialties and Inclusivity in Healthcare

Reem Daboul, DO, Ania Bartholomew, H. Brent Bamberger, DO

Orthopedic Surgery Residency, Kettering Health Network Orthopedic Surgery Residency. Dayton, OH

Background: Worldwide, standard OR clothing protocols have been established to maintain hygiene and minimize contamination risks. While surgical gowns, caps, and hoods are essential for patient safety and infection control, they may inadvertently conflict with certain religious and cultural practices. The hijab serves as an outward expression of modesty and religious devotion for many Muslim women. However, adhering to OR clothing protocols that do not accommodate the hijab can present a unique challenge, often leading to discomfort, impracticality, and negative experiences in the OR.

Methods: We conducted a cross-sectional survey to explore how OR dress codes affect Muslim hijabi individuals in surgical fields. Targeting hijabi women across various stages of medical careers, we distributed the survey via social media and emails to healthcare institutions focusing on diversity. The anonymous survey, created on Microsoft Forms, gathered data on demographics, religious practices, professional experiences, and attitudes toward OR clothing protocols. It specifically examined the influence of OR attire on career choices and openness to surgical fields if accommodation were offered.

Results: Over 4 weeks, the survey received 33 responses; 27 were eligible. It included 2 OB/GYN residents, 1 post-grad, and 24 med students. Exclusions were due to inconsistent hijab use or no interest in surgery. Encouragement stemmed from mentors (40%) and self (33%), while discouragement came from personal doubts (33%), family (28%), peers (26%), and admin (24%). Seventy-four percent were discouraged by OR dress codes. Fifty-nine percent reported hijab issues in the OR, but only 29% avoided the OR for hijab concerns. Seventy percent felt anxious about OR hijab use; none felt accepted. Only 7 had access to disposable hijabs, affecting 14 respondents’ career views towards surgery.

Discussion: These results show that while there is great interest in pursuing surgical specialties amongst Hijabi students and physicians, we as administration, mentors, doctors, colleagues, and family members should work towards solutions that will foster the pursuits of these young surgeons. Some limitations include the small sample size.

References

1. Malik A, Qureshi H, Abdul-Razakq H, et al. “I decided not to go into surgery due to dress code”: a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre. BMJ Open. 2019;9(3):e019954. doi:10.1136/bmjopen-2017-019954

Informed Consent: ​N/A

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

★Poster No. **INT’L-1

Abstract No. 2024-031

Category: International Health

Research Focus Area: International Health

Emotional and Social Impacts of Menstrual Practices on Women in Rural Guatemala

Lauren Evelti, OMS IV, ²Gautam Desai, DO

Department of Primary Care, Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, Kansas City, MO

Context: In the United States, there are some studies which have been conducted that examined the attitude and impact of menstruation. Similar research has been done in areas outside of the US, primarily in Africa, exploring menstrual practices and interventions in developing countries [1]. This brought to light various factors affecting women of reproductive age, leading to negative impacts in various aspects of their lives [1,2,3]. However, there is a paucity of literature on how women in Centra America, particularly Guatemala, are affected by the female reproductive cycle [4]. Women in developing countries face religious stigma, cultural, and societal pressures regarding menstruation and menstrual practices [2]. Additionally, women of reproductive age encounter material barriers such as limited access to menstrual products and challenges establishing good hygiene practices, as well as emotional barriers like stress and anxiety associated with managing their period [2,3]. Often, women do not have a complete understanding of the menstrual cycle, which contributes to suboptimal hygienic practices and limited social support stemming from a lack of openness surrounding the topic [2,3].

Objective: To add to the body of literature regarding how women in Guatemala are affected emotionally and socially by the menstrual cycle. We hypothesized that older women would report more stigma regarding their menstruation compared to younger women, as well as reporting a greater overall impact on their lives. The investigators also felt the results would indicate that older patients had a better knowledge base of menstruation. By asking questions about the impact of the menstrual cycle, the osteopathic principles can be better applied to patients in resource-limited regions.

Methods: After Kansas City University (KCU) IRB approval, the investigators recruited subjects for the research during KCU’s Global Health Outreach: Guatemala, in February of 2024. Inclusion criterion included any individual who identified as a female over the age of 13 living in various rural villages surrounding Antigua, Guatemala seeking medical care. Patients were advised that they did not have to participate to receive free medical care and were free to discontinue the survey at any time. The survey instrument was a 23-item questionnaire in Spanish language related to the menstrual cycle. Patients aged 13-17 required parental/guardian permission and their assent to participate. Those who agreed to participate (n=88) completed the survey, which included questions on background information, menstrual experiences, and the emotional and social influences affecting their menstrual experiences and overall well-being. The survey was created utilizing the tenets of osteopathy, including the body’s self-regulating and self-healing capacities, the interconnectedness of bodily systems, and the importance of preventative health, as a framework to understand menstrual health in rural Guatemala. Subjects were not randomized. By analyzing this data through the lens of osteopathic principles, we aimed to provide insights into culturally sensitive and holistic healthcare practices that could improve menstrual health, enhance preventative care, and promote overall well-being among women in these communities, highlighting the distinctiveness of the osteopathic philosophy.

Results: A total of 88 surveys were collected, of which 80 were fully completed. Data analysis demonstrated some statistically significant differences between older (41 years and older) and younger (less than 40 years) participants in some of the attitudes and experiences related to menstruation. A cross-tabulation was conducted on these statistically significant results. One area of difference was the emotion of judgement (p value = 0.044). For the younger women, the cross-tabulation showed the expected number of participants that would never experience judgement was 40.9, while the expected number for those would experience some form of judgement during menstruation was 20.1. Data showed 45 participants responded never feeling judged, while 16 reported some judgement. The younger women who never experienced judgement during their period represented 51.1% of the group for that response. In contrast, the group of older women showed that 13 of them have experienced some judgement during their menses, which is greater than the expected number of 8.9. Further analysis supported the investigators’ hypothesis that a older Guatemalan women would have a greater understanding of what happens to their bodies during menstruation compared to the younger age group (p value = 0.029). There was a higher number of individuals in the older group category (n=22) compared to the expected (n=17.5) who had some or a lot of understanding. While for the younger group, there was a higher number of those who had no understanding (n=26) than expected (n=21.5). Overall, 39.8% of the younger patients reported some understanding of what happens to their bodies during menstruation. The general trend indicates that the younger group has less understanding, while the older group has a deeper understanding. There were no other significant trends observed.

Conclusion: Women in Guatemala demonstrated statistically significant age-related differences in effects of menstruation, with younger women facing less emotional vulnerability and having less understanding compared to older women. By incorporating osteopathic tenets as a framework for our study, we gained deeper insights into menstrual health and its impact on women in resource-poor areas. This research underscores the importance of further investigations and interventions in this area to support reproductive health of women in Guatemala and elsewhere. Despite a small sample size, statistically significant associations were noted, which will help guide future osteopathic outreach in the region.

References

1. Shannon AK, Melendez-Torres GJ, Hennegan J. How do women and girls experience menstrual health interventions in low- and middle-income countries? Insights from a systematic review and qualitative metasynthesis. Cult Health Sex. 2021;23(5):624-643. doi:10.1080/13691058.2020.1718758

2. Kaur R, Kaur K, Kaur R. Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. J Environ Public Health. 2018;2018:1730964. Published 2018 Feb 20. doi:10.1155/2018/1730964

3. Hennegan J, Shannon AK, Rubli J, et al. Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Med. 2019;16(5):e1002803. Published 2019 May 16. doi:10.1371/journal.pmed.1002803

4. Michel JL, Caceres A, Mahady GB. Ethnomedical research and review of Q’eqchi Maya women’s reproductive health in the Lake Izabal region of Guatemala: Past, present and future prospects. J Ethnopharmacol. 2016;178:307-322. doi:10.1016/j.jep.2015.12.006

Informed Consent: After the participants are finished with their examinations, they will be asked if they would like to participate in the survey using the informational sheet explaining our research and what information we would be asking of them (Adult Informational sheet if 18 years and older or Parental/Guardian Informational sheet and minor informational sheet in the case of minors). If they refuse, they will be given the same standard of care as expected of the clinic.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. **INT’L-2

Abstract No. 2024-054

Category: International Health

Research Focus Area: International Health

Predicting Surgical Mortality: Insights from Korean Data Modeling

¹Dhruv Patel, OMS-I, ¹Andrew Bouras, ²Jonathan Hofmann, ³Nitin Chetla, ⁴Nia Balaji, ⁵Michael Boulis, ¹Jyotsna Chawla

¹Nova Southeastern University Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, FL; ²Extended Studies University of California, San Diego, San Diego, CA; ³School of Medicine, University of Virginia, Charlottesville, VA; ⁴Extended Studies University of California, Santa Cruz, Santa Cruz, CA; ⁵Extended Studies, Central Connecticut State University, New Britain, CT

Context: Predicting postoperative mortality is critical for improving surgical planning, patient counseling, and resource allocation. Despite advancements in surgical techniques and perioperative care, 30-day in-hospital mortality remains a significant concern. Existing predictive models often lack comprehensive perioperative data and fail to integrate a holistic approach that recognizes the interconnectedness of body systems. This study addresses these gaps by developing a logistic regression model using detailed perioperative data from a Korean dataset, guided by osteopathic principles that emphasize the interrelationship of body systems.

Objective: To develop and validate a logistic regression model that predicts 30-day in-hospital mortality in surgical patients, using comprehensive perioperative data to understand the interconnected effects of various health parameters on surgical outcomes.

Methods: This retrospective analysis utilized the INSPIRE dataset, comprising approximately 130,000 surgical cases from Seoul National University Hospital between 2011 and 2020. The study focused on adult patients undergoing major surgical procedures. Key predictors included demographic information, clinical variables, laboratory values, and the emergency status of the operation. Patients were selected based on predefined inclusion and exclusion criteria. Multiple imputation was used to handle missing data, and feature selection was performed using univariate analysis and clinical judgment. Logistic regression analysis was conducted, with model validation through cross-validation and performance assessment using ROC AUC and precision-recall AUC metrics. This methodology aligns with osteopathic principles by recognizing that changes in one part of the body can affect overall health outcomes.

Results: The logistic regression model demonstrated high predictive accuracy, with an ROC AUC of 0.978 and a precision-recall AUC of 0.958. Significant predictors of 30-day in-hospital mortality included emergency status of the operation (OR: 1.56, p < 0.001), preoperative prothrombin time (PT/INR) (OR: 1.53, p < 0.001), potassium levels (OR: 1.49, p < 0.001), body mass index (BMI) (OR: 1.37, p < 0.001), serum sodium (OR: 1.11, p < 0.001), creatinine levels (OR: 1.04, p < 0.001), and albumin levels (OR: 0.85, p < 0.001). These findings highlight the importance of comprehensive preoperative assessments and the consideration of various health parameters in predicting surgical outcomes.

Conclusion: The developed logistic regression model effectively predicts 30-day in-hospital mortality in surgical patients, demonstrating high accuracy and practical applicability. By integrating comprehensive perioperative data and recognizing the interconnectedness of body systems, this model provides a robust tool for improving surgical care and patient management. Future research should focus on external validation in diverse clinical settings and prospective studies to assess the model’s real-world impact. This study highlights the potential of combining predictive analytics with a holistic approach to enhance patient outcomes and optimize perioperative care.

References

1. Khuri SF, Daley J, Henderson W, et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg. 1997;185(4):315-327. PMID: 9328380.

2. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36-42. doi:10.1001/archsurg.134.1.36. PMID: 9927128.

3. Goldberger A, Amaral L, Glass L, et al. PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation. 2000;101(23). doi:10.1161/01.CIR.101.23.e215.

4. Sullivan DH, Bopp MM, Roberson PK. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly. J Gen Intern Med. 2002;17(12):923-932. doi:10.1046/j.1525-1497.2002.10930.x.

5. Caironi P, Gattinoni L. The clinical use of albumin: the point of view of a specialist in intensive care. Blood Transfus. 2009;7(4):259-267. doi:10.2450/2009.0002-09.

6. Chiew CJ, Liu N, Wong TH, Sim YE, Abdullah HR. Utilizing Machine Learning Methods for Preoperative Prediction of Postsurgical Mortality and Intensive Care Unit Admission. Ann Surg. 2020;272(6):1133-1139. doi:10.1097/SLA.0000000000003297. PMID: 30973386; PMCID: PMC7668340.

7. Kim TK, Yoon JR, Choi YN, Park UJ, Kim KR, Kim T. Risk factors of emergency reoperations. Anesth Pain Med (Seoul). 2020;15(2):233-240. doi:10.17085/apm.2020.15.2.233.

8. Tseng PY, Chen YT, Wang CH, et al. Prediction of the development of acute kidney injury following cardiac surgery by machine learning. Crit Care. 2020;24:466. doi:10.1186/s13054-020-03179-9.

9. Lim L, Lee H. INSPIRE, a publicly available research dataset for perioperative medicine (version 1.2). PhysioNet. 2023. doi:10.13026/4evs-wq50.

Informed Consent: None

Ethical Approval & IRB and/or IACUC Approval: None

Financial Disclosure: None reported.

★Poster No. **INT’L-3

Abstract No. 2024-074

Category: International Health

Research Focus Area: International Health

Improving Clean Water Access Internationally Using 3D-Printed Solar Stills

Joshua Margow, OMS-III, Rishika Pandey, OMS-IV, Jacob Aron, OMS-IV, Komalpreet Kaur, OMS-III, Ana Jones, BA, Kaitlin Dinsmoore, BA, David M. Kashmer, MD MBA FACS

Department of Simulation Research, Edward Via College of Osteopathic Medicine (VCOM-Auburn Branch Campus), Auburn, AL

Context: Edward Via College of Osteopathic Medicine (VCOM) international outreach programs in the Dominican Republic and Honduras offer osteopathic medical students a unique opportunity to gain early hands-on clinical experiences while providing healthcare to communities in need. Yet, these trips unveiled a critical challenge: limited access to clean water results in a host of preventable health complications experienced by many members of these communities. Namely, the prevalence of waterborne illness due to infectious pathogens is consistently underscored by the large number of antimicrobial prescriptions dispensed to patients each day. This research aims to develop a cost-effective, universally available 3D-printed water filtration device that fits on any standard threaded plastic soda or water bottle to tackle healthcare and water-related ailments. Partnerships with health clinics that serve communities in need will be supplied with all the designs and materials necessary to produce the water filters independently, including the 3D printers. This project has the potential to revolutionize clean water access and public health in waterborne disease-prone communities, provide sustainable and affordable solutions to enhance overall quality of life, and contribute to global public health improvement.

Objective: To develop an efficient, economically viable, and widely available 3D-printed water filtration device using solar still technology to revolutionize clean water access and address critical healthcare needs in waterborne disease-prone communities worldwide.

Methods: Computer-Aided Design (CAD) software programs TinkerCAD and Mesh Mixer were used to create original designs inspired by modern solar still technology. A digital representation of the device with exact dimensions and features was used to generate a set of instructions for a 3D printer to create a working prototype of the solar still device with PLA and PETG filament. A Creality Ender-3 3D printer was used in the production of these prototypes. Consecutive iterations of the original design served to eliminate inefficiencies noted in repeat trials. The current design fastens to a standard plastic bottle filled with non-potable water by twisting it onto the mouthpiece just as a bottle cap would. Solar energy penetrates the plastic bottle, forming evaporated water droplets from the dirty water which then rise through a central column in the solar still device. Newly formed water droplets fall down the inner walls of the still and out through a laterally placed nozzle. A piece of hydrophobic aquarium tubing then carries clean water into a second plastic bottle serving as the clean-catch reservoir. Cost analyses were performed to determine the solar still’s economic viability. Designs were initially tested in controlled conditions with a 120W heat lamp to simulate a tropical climate. Solar still devices were then taken to Honduras and the Dominican Republic by members of the research team for field testing to assess material durability and longevity as well as water production efficiency.

Results: Preliminary analyses compared the cost, time to print, and amount of material used for the following solar still components. Four units printed simultaneously with one 4-hole cap cost $0.0444 to produce over 17 hours using 123g of filament. Two units printed simultaneously with one 2-hole cap cost $0.0123 to produce over 9 hours and 6 minutes using 65g of filament. One filter alone costs $0.0057 to produce over 4 hours and 5 minutes using 30g of filament. The 1-hole cap, 2-hole cap, and 4-hole cap had an equal cost of $0.0013 to produce over 1 hour using 7g of filament each. These analyses demonstrate remarkable affordability at a production cost of one cent per unit when printed four at a time. Qualitative observations throughout the field-testing process reveal that the materials are durable and resilient, evidenced by the solar still’s capability of withstanding prolonged exposure to tropical conditions with minimal wear and tear. Water production efficiency was assessed under various environmental conditions. The current design resulted in lackluster efficiency in harnessing solar energy to facilitate clean water production at a rate suitable for target communities. As a result, collection rates were not measured at this time. This suggests that the 3D-printed solar still has the potential to generate an adequate volume of clean water in resource-constrained settings but will need to undergo further design modifications to do so.

Conclusion: Evaluation of the early stages of the solar still’s development process exhibits tremendous potential in combating the burden of disease due to waterborne illness worldwide. At one cent per unit, the affordability of producing solar stills positions this technology as an economically viable solution for water-scarce regions, especially those with limited financial resources. The durability of materials ensures that this technology is sustainable and can contribute to a potential long-term impact in addressing water accessibility challenges. While the quality of the water produced by the solar still was not tested at this stage of development, water quality will be the focus of this study after the efficiency of the design has improved to ensure it effectively removes waterborne pathogens and other contaminants to meet the required standards for human use and consumption. Furthermore, plans to survey target communities will assess several data points of the 3D-printed solar still, such as user-friendliness, practicality, and community engagement in implementing this technology to emphasize the importance of local involvement in sustainable solutions. Future directions may involve scalability studies, further optimization of materials, and real-world pilot implementations to validate the technology’s impact on a larger scale. In alignment with VCOM’s mission to promote research to improve human health and by illustrating the potential for interdisciplinary collaboration, the successful implementation of this solar still technology could bring clean water to communities to significantly reduce the burden of disease caused by waterborne illnesses around the globe.

Informed Consent: Human subjects were not used in this study.

Ethical Approval & IRB and/or IACUC Approval: This study was approved by the Edward Via College of Osteopathic Medicine Institutional Review Board, Blacksburg, VA on 11/07/2022. IRB: 2022-093. Package 1982928-1.

Financial Disclosure: None reported.

★Poster No.**INT’L-4

Abstract No. 2024-099

Category: International Health

Research Focus Area: International Health

Perception of Osteopathic Medicine in a Rural Clinic in Peru

¹Kalee Hovetter, OMS-III, ¹Charlotte Henke, OMS-II, ¹Kaitlynn Lopes, OMS-II, ¹Maya Berger, OMS-II, ¹Kayla Boswell, OMS-III, ¹Farah Kandil, OMS-II, ²Lance Ridpath, MS, ¹Mark Waddell, DO, ¹Deborah Schmidt, DO

¹Department of Osteopathic Principles & Practice, West Virginia School of Osteopathic Medicine, Lewisburg, WV; ²Assessment Educational Development, West Virginia School of Osteopathic Medicine, Lewisburg, WV

Context: Iquitos, Peru is the capital of one of the poorest regions in the country, with some of the worst health indicators.1 Many patients struggle to afford medications and other treatments accessible to them. Referrals for specialized treatment are often not a realistic option because of the remoteness and geographical isolation from the country’s capital. Osteopathic Medical Treatment (OMT) has been shown to benefit patient outcomes and reduce pain in a variety of conditions.2-4 OMT can be especially useful in remote and underserved settings where there are limited resources for treatment. There are no Doctor of Osteopathic Medicine training programs in Peru and there is little literature regarding OMT in Peru. There have been efforts to introduce OMT to healthcare professionals5 and medical students,6 but few studies have focused on the patient experience. An osteopathic medical school chapter of DOCARE International charters an annual global health outreach trip to the underserved community of Iquitos, Peru. We sought to survey patients during this trip and learn more about how those patients perceived OMT.

Objective: The goal of this study was to assess the level of knowledge and the perceptions of OMT in Iquitos, Peru. We aimed to identify existing knowledge of OMT in Iquitos and how this field of medicine was perceived by patients presenting to the OMT clinic. Additionally, we aimed to identify knowledge gaps related to this topic with the goal of addressing newfound gaps during future medical aid trips. We hypothesized that there would be a lack of knowledge about OMT in the remote, economically depressed region of Iquitos, Peru. We also hypothesized that when OMT was introduced to the population as a treatment modality for pain, that it would be well-received.

Methods: This study consisted of a survey of 51 patients presenting with musculoskeletal complaints seeking care at a free community clinic during a one-week period in the spring of 2024. Any patient over the age of 18 presenting to the OMT clinic was given the opportunity to participate in the survey. No randomization or blinding procedures were implemented. The study was classified as exempt from Institutional Review Board approval. No identifying information was collected. We developed a pre- and post-survey with input from native Spanish speakers. The survey collected information about the participants’ demographics (age, gender, and occupation), knowledge and impression of OMT before and after receiving patient specific OMT for their complaint, and region and intensity of pain. Approval was obtained for use of the EQ-5D health questionnaire, which assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.7 The EQ-5D was analyzed to provide additional demographic information about the participants’ quality of life. The EQ-5D and pre- and -post surveys were self-completed on paper and were available in United States English and Peruvian Spanish. Participants completed the pre-survey and EQ-5D before their appointment and the post-survey afterward. All participants were seen by the same physician for their complaint and their standard of care was not affected by their participation in the survey or lack thereof. Surveys were administered in Spanish by 6 WVSOM students who had received prior training and were given a script to follow. There was a local interpreter present to assist with communication as needed. A data log was used to ensure all parts of each survey were completed and to track which participants received OMT.

Prior to beginning data analysis, pain location was categorized based on the ICD-10 codes defining somatic dysfunction regions including head, cervical spine, thoracic spine, lumbar spine, sacrum, pelvis, ribs, viscera/abdomen, upper extremity, and lower extremity. A diagram with region cut-offs was created to ensure that all categorization was uniform. Any discrepancies were discussed by multiple members of the research team to reach a consensus. SAS v9.4 was used to analyze the data. Due to normality issues in the data, nonparametric tests (Wilcoxon 2-sample test and the Wilcoxon Signed-Rank Test) were used to analyze outcomes.

Of the 51 participants, there were 13 who inappropriately filled out a post-treatment portion of the survey which did not apply to them. Their post-treatment survey results were disregarded for the analysis. For those who received OMT, their post-treatment responses were coded into a Likert scale, with responses such as “Strongly Agree,” “Favorable,” and “Definitely Would” being given a score of five. Responses such as “Strongly Disagree,” “Unfavorable,” and “Definitely Would Not” were given a score of one, while any “Neutral” responses were given a value of three. For these items, a Wilcoxon Signed-Rank test was performed to determine if the overall score was significantly greater than 3 (neutral).

Results: Of the 51 participants, 33 received OMT while 18 did not. The 33 participants who received OMT were statistically likely to agree that their pain improved (S = 254.5, p).

Conclusion: Survey results showed that most patients had not heard of OMT before their appointment and had a favorable opinion of OMT after their appointment. As a secondary finding, the results showed a significant reduction in pain for a small sample following OMT application. We observed a general lack of understanding of OMT, i.e., patients may think they received it when they did not. Another barrier may have been differences in health literacy levels or cultural nuances. Future efforts should aim to address these limitations and introduce an educational component to increase patient understanding. Future research may also collect more comprehensive data on the patient’s complaint to analyze pain reduction by region or type of treatment.

References

1. Hausmann R, Santos MÁ, Muci F, Tudela Pye J, Grisanti A, Lu J. Overcoming remoteness in the Peruvian amazonia: A growth diagnostic of loreto. SSRN Electronic Journal. Published online 2022. doi:10.2139/ssrn.4255155

2. Cerritelli F, Ginevri L, Messi G, et al. Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial. Complement Ther Med. 2015;23(2):149-156. doi:10.1016/j.ctim.2015.01.011

3. Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2005;6:43. Published 2005 Aug 4. doi:10.1186/1471-2474-6-43

4. Noll DR, Degenhardt BF, Morley TF, et al. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2. Published 2010 Mar 19. doi:10.1186/1750-4732-4-2

5. Massa M, Lim L, Wiseman K, et al. Osteopathic Principles and Practice and Osteopathic Manipulative Medicine Perception in Peruvian Health Care Professionals. The Journal of the American Osteopathic Association. 2014;114(1):e57.

6. Amaniampong A, Willyerd G, Phelps K, et al. Integration of Osteopathic Principles and Practices into Peruvian Healthcare Education . 18th Annual International Seminar and Poster Session . 2016;(“Innovation in Osteopathic Medicine and Global Health”):15-16.

7. Augustovski F, Belizán M, Gibbons L, et al. Peruvian Valuation of the EQ-5D-5L: A Direct Comparison of Time Trade-Off and Discrete Choice Experiments. Value Health. 2020;23(7):880-888. doi:10.1016/j.jval.2020.05.004

Informed Consent: Per WVSOM IRB, the cover letter and verbal agreement were the only requirements for consent due to the exempt status of the study.

Ethical Approval & IRB and/or IACUC Approval: WVSOM IRB Exempt on March 5, 2024

Universidad Cesar Vallejo, Peru IRB Approved on December 13, 2023

Financial Disclosure: None reported.

★Poster No. **INT’L-5

Abstract No. 2024-117

Category: International Health

Research Focus Area: International Health

Examining Health Disparities Present in Haitian Patients at the VCOM Clinics in Punta Cana, DR

Gayatri Rathod, OMS-II, Juhi Patel, Ellena Varnadoe, Tom Lindsey

Edward Via College of Osteopathic Medicine (VCOM-South Carolina Branch Campus), Spartanburg, SC

Context: The Edward Via College of Osteopathic Medicine- sponsored free health clinics (Verón Clinic and Oscar de la Renta Pediatric Center) in the Dominican Republic serve both Haitian refugees and the local Dominican population. Historical tensions, migration challenges, and socioeconomic factors suggest potential disparities in health utilization between these communities [1]. Addressing these disparities is crucial for equitable healthcare provision and aligns with the osteopathic principle of holistic and preventive care [2]. Despite extensive healthcare research, limited literature specifically compares health utilization between these populations, highlighting a significant gap this study aims to fill.

Objective: The objective of this study is to determine the existence of health disparities in utilization between the local Dominican population and Haitian refugees at the VCOM-sponsored free health clinics in Punta Cana, Dominican Republic, concerning visit diagnosis code, visit type, and frequency of clinic use, and to propose alterations in prevention and treatment better suited for these populations.

Methods: This retrospective chart review analyzed de-identified clinical and descriptive data from 88,416 electronic case reports (ECR) documented in the Clinical Rotation Evaluation and Documentation Organizer (CREDO) platform over a one-year period (October 2022 to October 2023). Inclusion criteria comprised of all case reports within the CREDO in the one-year period listed with a Haitian or Dominican Republican nationality seen at the two aforementioned clinical sites located in Punta Cana, DR. Exclusion criteria comprised of records with incomplete data and patients whose nationalities were not listed as Haiti or Dominican Republic. Statistical analyses were conducted by adult and pediatric age categories, and clinical visits and pharmacy data were analyzed separately for each age group. Analysis methods included descriptive statistics, frequencies for all categorical variables including age, nationality, type of visit (emergency, inpatient, or follow-up), and contingency chi-squared tests by nationality to determine significant health differences between the two populations. Prevalence and incidence rates were calculated as applicable for all diagnoses. In addition, diagnosis codes were grouped based on literature related to social determinants of health including food insecurity, housing and clean water conditions, and preventative care. The study’s emphasis on the type of care needed, attention to differences in population health needs, and social determinants of health all signify a data-driven osteopathic approach to international vulnerable populations in understanding the structural and systemic factors that can affect physical function and chronic disease.

Results: A total of 88,416 case reports for 39,700 patients were analyzed, including 17,512 adult patients, and 22,188 pediatric patients.

HIV care and treatment was the highest incident diagnosis code listed across all visits for patients listed with both Haitian and Dominican populations, at 3,178 total visits in one year. Of the clinic populations, a significantly higher proportion of unique Haitian adult patients utilized HIV care at the clinics (7.7%) compared to the Dominican adult population (3.5%) of the group (p

Conclusions: The evaluation of health disparities at the VCOM clinics reveals significant findings, in addressing a vital data gap for mostly uninsured patients among the Haitian and Dominican communities in Punta Cana with likely no other health data in hospital systems.

Haiti is recognized as having the highest HIV prevalence in the Western Hemisphere, and this analysis supports this finding in Haitian population at the Punta Cana free clinics as well, suggesting a special consideration for enhanced prevention efforts, including educational resources in Creole and access to Pre-Exposure Prophylaxis (PrEP) [3,4]. Haitian pediatric patients also experienced more parasitic infections and obesity/iron-deficiency anemia/malnutrition than Dominicans suggesting potential social determinants of health implications of food access and living condition disparities for these members in this population, as well as a difference in medical requirements. These findings may suggest that differences in work and living conditions between these populations impact health outcomes. These differences emphasize the connection of the mind, body, and spirit and how understanding these factors can improve health outcomes and utilization.

Limitations include the study’s one-year, cross-sectional scope and constraints in capturing co-morbidities in the ECR, along with potential unrecorded variables influencing health utilization patterns. Future research will consider a five-year cohort analysis, focusing on food insecurity and housing disparities by expanding data collection in the CREDO system to include surveys that provide deeper insights into healthcare barriers, along with analysis of the cost of services required to provide aid to these populations to proposed tailored intervention in the area.

In conclusion, assessing health disparities at the VCOM clinics has highlighted insights into the challenges in healthcare faced by Dominican and Haitian communities. Emphasizing the osteopathic principles of holistic care and preventive medicine is crucial for designing targeted healthcare interventions to address the unique needs of both communities in the Dominican Republic. By prioritizing prevention alongside treatment and fostering inclusive healthcare practices, the region can progress towards equitable healthcare outcomes for all individuals.

References

1. Leventhal S. A Gap Between Ideals and Reality: The Right to Health and the Inaccessibility of Healthcare for haitian Migrant Workers in the Dominican Republic. Emory international law review. 2013;27(2):1249.

2. Keys HM, Kaiser BN, Foster JW, Burgos Minaya RY, Kohrt BA. Perceived discrimination, humiliation, and mental health: a mixed-methods study among Haitian migrants in the Dominican Republic. Ethnicity & Health. 2014;20(3):219-240. doi:https://doi.org/10.1080/13557858.2014.907389

3. Rojas P, Malow R, Ruffin B, Rothe EM, Rosenberg R. The HIV/AIDS Epidemic in the Dominican Republic. Journal of the International Association of Physicians in AIDS Care. 2011;10(5):306-315. doi:https://doi.org/10.1177/1545109710397770

4. CDC. PrEP Effectiveness. www.cdc.gov. Published November 3, 2020. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html

5. Turner L. Do You Have Parasites? Five signs you may have these bad bugs, and how to get rid of them. Better Nutrition. 2021;83(8):16-18. Accessed June 17, 2024. https://link.gale.com/apps/doc/A678821843/AONE?u=anon∼cb1c03c1&sid=googleScholar&xid=f895a720

Informed Consent: ​Not Applicable

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *PH-1

Abstract No. 2024-001

Category: Public Health

Research Focus Area: Osteopathic Philosophy

Underrepresentation of Osteopathic Physicians in the Development of Medical Guidelines

¹Alfred Amendolara, MS, OMS-IV, ¹Steven Salazar, ¹Tiffany Nguyen, ¹Porter Fife, ¹Blake Harris, ¹Maisie Rivera, ¹Kennedy Madrid, ¹Yvannia Gray, ²Stephen Stacey

¹Department of Biomedical Sciences, Noorda College of Osteopathic Medicine, Provo, UT; ²Mayo Clinic La Crosse Family Medicine Residency, Mayo Clinic in, La Crosse, WI

Context: Research and scholarship are core drivers of medicine in the modern era. Evidence-based practice continues to replace expert opinion and long held practice beliefs. Nowadays, guidelines and recommendations are available instantly via services such as UpToDate, DynaMed, or MedScape. This is certainly a step in the right direction – a scoping review from 2023 indicates evidence-based medicine improves patient outcomes and healthcare system return-on-investment [1]. However, conflicts of interest, questionable methods, and biases may be present in guidelines [2]. Despite this, guidelines are hugely influential and are among the most cited papers in medicine [3].Nowadays, guidelines and recommendations are available instantly via services such as UpToDate, DynaMed, or MedScape. While this is likely a step in the right direction – a scoping review from 2023 indicates evidence-based medicine improves patient outcomes and healthcare system return-on-investment [1] – there may be pitfalls present. Conflicts of interest, questionable methods, and biases may be present in guidelines [2]. Despite this, guidelines are hugely influential and are among the most cited papers in medicine [3]. Involvement in the development and writing of these guidelines is critical for DOs to maintain a seat at the academic table. According to the American Osteopathic Association (AOA), 11% of practicing physicians in the US are DOs. This number is growing – nearly 25% of current medical students attend an osteopathic medical school. Without involvement in guideline development, DOs risk giving up control of their own practice of medicine.

Objective: To assess the relative contribution of DOs to the body of literature guiding practice, author information was extracted from all US-based guidelines published in the year 2023 and listed in the ECRI Guidelines Trust database.

Methods: Authors of US-based guidelines listed in the ECRI Trust database from the year 2023 were counted and categorized into one of three groups based on terminal degree: MD holders, DO holders, and Other-degree holders. Authors whose degrees could not be identified were counted as “Unidentifiable”. Additional data including sponsoring organization, organization type, and specialty were collected. Data was analyzed in R-studio. Additional data collection and analysis for the years 2022 and 2021 is under way.

Results: Two-hundred and fifteen guidelines were published by US organizations in 2023, with 184 reporting author information. A total of 2883 authors were counted. Of that total, 2186 held an MD (75.8%), 41 held a DO (1.4%), and 548 held another terminal degree (19.0%). Approximately 3.8% of counted authors did not have an identifiable degree.

Conclusion: Based on these results, we conclude that DOs are significantly underrepresented in the development of guidelines. This study is somewhat limited by the inclusion of only one guideline database, and by potential data collection error especially in relation to guidelines that required manual author identification. However, these limitations are unlikely to significantly affect results.

References

1. Connor L, Dean J, McNett M, et al. Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews Evid Based Nurs. 2023;20(1):6-15. doi:10.1111/wvn.12621

2. Guerra-Farfan E, Garcia-Sanchez Y, Jornet-Gibert M, Nuñez JH, Balaguer-Castro M, Madden K. Clinical practice guidelines: The good, the bad, and the ugly. Injury. 2023;54 Suppl 3:S26-S29. doi:10.1016/j.injury.2022.01.047

3. Ioannidis JPA. Professional Societies Should Abstain From Authorship of Guidelines and Disease Definition Statements. Circ Cardiovasc Qual Outcomes. 2018;11(10):e004889. doi:10.1161/CIRCOUTCOMES.118.004889

Informed Consent: Not applicable.

Ethical Approval & IRB and/or IACUC Approval: Not applicable.

Financial Disclosure: None reported.

Poster No. *PH-2

Abstract No. 2024-003

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Investigating Patient Barriers in Receiving Mammography Screenings Following the Covid-19 Pandemic

Nicole Clarke, OMS-III, ²Alison Mancuso

Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ

Context: Breast Cancer is the most common type of cancer for women in the United States, but unlike other cancers, we can detect its presence early using routine mammography screenings. Current literature shows reduced breast cancer mortality is associated with compliance of mammographic screenings (Duffy, 2020), specifically increasing the survival rate an estimated 1-2% every year for the past thirty years (Giordano, 2004). However, during the Covid-19 pandemic, rates of basic cancer screenings, including breast cancer, all declined (Chen, 2021). Unfortunately, even in a “post-pandemic” world, years after the height of the pandemic, the Rowan-Virtua School of Osteopathic Medicine Family Medicine Office has noticed many female patients still have not kept up with their routine basic healthcare screenings. The study aims to investigate the reasons why.

Objective: To uncover the rates of mammograms and barriers affecting patients’ ability to schedule and receive their Breast Cancer screenings since the Covid-19 pandemic.

Methods: IRB-approved, survey-based study (PRO-2023-149) distributed to female patients between the ages of 40-75 while attending their appointment in-person at the Rowan-Virtua School of Osteopathic Medicine Family Medicine Office in Stratford, New Jersey. Patients were able to decline or withdraw at any time. The survey consisted of fourteen questions pertaining to patient demographics, age range, mammogram history, and personal/family breast cancer history. Patients reported how different factors affected their willingness to schedule their mammogram on a rating scale from 0 to 5 (0 = no effect, 5 = major contributor). A total of 65 patients participated in the study. Qualtrics survey self-reported data was analyzed using SPSS software.

Results: All 65 patients’ survey responses were analyzed and the findings provide insight on the barriers hindering patients from conducting their annual mammograms. Demographics of our respondents recorded 52.31% to be White or Caucasian, 29.23% Black or African-American, 10.77% Hispanic or Latino, 1.54% Asian or Pacific Islander, and 6.16% belong to another category. The results showed only 41.54% of participants complied with American Cancer Society (ACS) mammogram guidelines. This is concerning since 3.08% of our patients have a personal history and 27.69% have a family history of breast cancer, while 29.23% have had abnormal mammograms in the past. The widest variety of reasoning for not staying within the ACS guidelines to be due to the time commitment of appointments. The data showed other factors including access to transportation, location of the office, and worry of contracting Covid-19 as having minimal effect on why patients have not received their mammogram. Even though we are technically in a “post-pandemic” time, the data shows there is still a gap in participation in routine screening exams.

Conclusion: This data informs healthcare providers about the barriers in preventative healthcare and will help providers better understand patients’ needs to improve women’s health outcomes. This study gives a glimpse into the ongoing factors that are still affecting patients’ ability to receive preventative health screenings, years after the pandemic has subsided. There are still unknown factors that may be uncovered also affecting female patients’ ability to complete mammograms.

Future directions for this study include emphasizing the importance of mammography screenings and early detection of breast cancer with all female patients of eligible age. We also urge patients to follow through with their mammogram screenings. Future research can study how to make the timing of mammogram appointments more efficient. This can be done by sharing our results with radiology offices to become aware of the effect of time commitment on patient scheduling their appointments. Similar studies can be done in the future to uncover further boundaries keeping patients from receiving mammograms as well.

References

1. National Cancer Institute. “Cancer of the Breast (Female) - Cancer Stat Facts.” SEER, 2020, https://seer.cancer.gov/statfacts/html/breast.html.

2. Maiz, Cristóbal et al. “Mammography correlates to better survival rates in breast cancer patients: a 20-year experience in a University health institution.” Ecancermedicalscience vol. 14 1005. 23 Jan. 2020, doi:10.3332/ecancer.2020.1005.

3. Chen, Ronald C et al. “Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic.” JAMA oncology vol. 7,6 (2021): 878-884. doi:10.1001/jamaoncol.2021.0884.

4. The American Cancer Society medical and editorial content team. “Breast Cancer Early Detection and Diagnosis.” American Cancer Society Recommendations for the Early Detection of Breast Cancer, 14 Jan. 2022, www.cancer.org/content/dam/CRC/PDF/Public/8579.00.pdf.

Informed Consent: I created an Alternate Consent forms for both the paper version and electronic version of my survey. Before the survey questions, the patients read through the consent information explaining why they fit the inclusion criteria to be invited to participate in the survey and the purpose of the research study. The form explained that the survey would take approximately 3-5 minutes to complete. The form explained participation was voluntary and the first question of the survey asked patients if they consented to the study. If the patient said no, the survey ended at that first question. The form explained there are no risks or discomforts associated with the survey. Patients’ responses were kept confidential and data stored in a secure computer file and the file will be destroyed once the data has been published. The patients were given contact information to the PI if they had any questions about their rights as a research subject. This study is approved by the Rowan IRB, PRO-2023-149.

Ethical Approval & IRB and/or IACUC Approval: IRB PRO-2023-149 Approved by the Rowan IRB.

Financial Disclosure: None reported.

★Poster No. *PH-3

Abstract No. 2024-006

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Common Nutrition-Related ICD-10 Codes in Louisiana and Alabama: Comparative Retrospective Analysis

¹Julia Moore, OMS-II, ²Sydni Bannerman, OMS-II, ¹Rachel A. Gatewood, OMS-II, ³Annie Kirby, PhD, RD, LD, CCMS

¹Edward Via College of Osteopathic Medicine (VCOM-Louisiana Branch Campus), Monroe, LA; ²Edward Via College of Osteopathic Medicine (VCOM-Auburn Branch Campus), Auburn, AL; ³Preventive Medicine and Public Health, Cell Biology and Physiology, Edward Via College of Osteopathic Medicine (VCOM-Auburn Branch Campus), Auburn, AL

Context: Edward Via College of Osteopathic Medicine (VCOM) encompasses four campuses, each with unique patient populations seen throughout the Southeastern United States. Osteopathic physicians strive to provide holistic care, considering barriers to adequate nutrition intake. Food insecurity is related to negative health outcomes. Louisiana has a food insecurity rate of 14%, while Alabama’s food insecurity rate is 15% [1].

Objective: This retrospective analysis aims to identify the most prevalent nutrition-related ICD-10* codes within the CREDO database for Louisiana (LA) and Alabama (AL). By evaluating nutrition-related chief complaints reported among patients at VCOM’s AL and LA-affiliated clinic sites, we aim to identify and compare key malnutrition patterns seen within these patient populations.

Methods: A retrospective review was completed using ICD-10 codes reported in the electronic medical records system, CREDO. Data included patients 19 years and older evaluated at VCOM affiliated RMUP* Primary Care rotation sites in Alabama and Louisiana between December 2021 and December 2023. ICD-10 codes were imported directly into an Excel file from CREDO and organized by campus. The Virginia and Carolines VCOM campus data was excluded using location coordinates provided from CREDO. Inclusion criteria encompassed patients with nutrition-related medical diagnoses, as categorized by the Academy of Nutrition and Dietetics (AND) [2]. Pivot tables were created from data entries to total each individual ICD-10 code reported for AL and LA, and a comparison table was created in Excel from the Pivot tables. The comparison table was used to identify differences in VCOM-AL’s and VCOM-LA’s reported ICD-10 codes. Using SigmaPlot 14.0, one-sample t-tests were completed to determine the significance of differences in nutrition-related ICD-10 code categories seen by student doctors at AL compared to LA clinical sites.

Results: After excluding ICD-10 codes that did not fall within a nutrition-related medical category established by the AND, 135 ICD-10 codes were analyzed. These codes documented 7,636 patients with a nutrition-related medical diagnosis. The three most common ICD-10 codes reported across both campuses included Primary Hypertension (I10), Type 2 Diabetes Mellitus (E11), and Hyperlipidemia (E78.5). Endocrine, Nutrition, and Metabolic (ENM) diseases was the only AND category with statistically significant differences between codes reported by VCOM-AL compared to VCOM-LA, with a computed p-value of 0.04. Stage 3 chronic kidney disease (N18.3) accounted for 75% and 57% of chronic kidney disease ICD-10 codes recorded in AL and LA, respectively. The ICD-10 code for dietary counseling and surveillance (Z71.3) was documented 46 times in AL clinics and 53 times in LA clinics.

Conclusion: The analysis of ICD-10 codes revealed notable similarities in cases frequently encountered at VCOM-AL and VCOM-LA affiliated RMUP Primary Care rotation sites. Findings suggest the underutilization or non-documentation of nutrition counseling by medical students during patient encounters. The data also suggests that patients assessed at these clinic sites face challenges in the prevention and progression of primary hypertension, type 2 diabetes mellitus, and hyperlipidemia, possibly due to limited resources or knowledge. Further research is required to confirm this hypothesis.

*International Classification of Diseases, Tenth Revision

*Rural and medically underserved

References

1. University of Wisconsin Population Health Insitute. County Health Rankings & Roadmaps 2023. Available at: www.countyhealthrankings.org. Accessed January 12, 2024.

2. Academy of Nutrition and Dietetics. ICD-9-CM/ICD-10-CM Codes for MNT. Available at: www.eatright.org. Accessed January 12, 2024

Informed Consent: All project data was sourced from the CREDO medical records database utilized by Edward Via College of Osteopathic Medicine Student Doctors, as such, informed consent was not required.

Ethical Approval & IRB and/or IACUC Approval: Determination of Not Human Subject Research Notification.pdf ; Our team submitted an Existing Data Research Application to the Edward College of Osteopathic Medicine (VCOM) Institutional Review Board (IRB). The application comprehensively outlined our project’s data acquisition methods and overarching objectives. Our existing data did not contain HIPAA-protected information, other PHI, or FERPA-protected information, thereby meeting the criteria for submission via the Existing Data Research Application rather than the standard IRB Application form. The VCOM IRB concluded that the project does not meet the definition of human subject research, affirming no IRB review or approval is necessary.

Please see the attached document from the VCOM Institutional Review Board.

Financial Disclosure: None reported.

Poster No. *PH-4

Abstract No. 2024-011

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Emergency Room Wait Times for Psychiatric Conditions from 2019 to 2021

¹Zach Monahan, OMS-III, ¹Alyson Mack, MA, ¹Anna Place, BS, ²Aaron Pierce, DO, ²Micah Hartwell, PhD,

¹Oklahoma State University College of Osteopathic Medicine - Cherokee Nation, Tahlequah, OK; ²Department of Psychiatry and Behavioral Health, Oklahoma State University Center for Health Sciences, Tulsa, OK

Context: Use of emergency departments (EDs) for psychiatric complaints has increased significantly in past decades, as standard treatment for mental conditions transitioned from inpatient hospitals to outpatient care.1 Before the pandemic, studies have demonstrated differences in the wait times between psychiatric and non-psychiatric complaints in emergency rooms–with a longer average wait time in non-crowded conditions and shorter wait times in crowded conditions.2-3 The onset of the pandemic saw large shifts in ED usage, with a relative increase in mental health complaints in EDs.4-5 Delayed treatment of individuals with acute psychiatric concerns may worsen their prognosis, and--given the increased use of EDs for behavioral health--research into factors which may impact timely treatment is essential.

Objective: To investigate inequities in time-to-provider wait times for patients with psychiatric concerns and patients with non-psychiatric concerns in US Emergency departments.

Methods: This study is a cross-sectional analysis utilizing the National Hospital Ambulatory Medical Care Survey (NHAMCS) published annually by the CDC, from 2019 to 2021,6 to determine average wait times for mental health visits (determined by assignment of ICD-10 F code)7, compared to non-mental health visits. These two groups were analyzed for wait times differences overall, as well as by region and triage status. We further analyzed wait times for ICD-10 F code subcategories (i.e. groups of 10), to investigate wait times differences by type of psychiatric complaint. Alpha was set at .05 for determination of significance. This study does not meet the requirement for human subjects research and therefore was not submitted for ethics review. Reporting of results adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results: We did not find a significant difference overall in the average wait times between psychiatric and non-psychiatric conditions in EDs (P = .57) over 2019 to 2021. Overall wait times did not significantly change for either psychiatric complaints (coef: -.09 SE: 0.25, t= -0.35 P = .73), nor for all ED visits (coef: -.003 SE: 0.14, t= -0.02 P = .98) over this same time period. An analysis of wait times for ICD-10 code F subcategories (mental health diagnoses) found that people with schizophrenia and psychosis had significantly prolonged wait times (Avg: 52.54 minutes, SE: 10.29; p = 0.03) compared to the reference group of mental health symptoms secondary to physiologic conditions (Avg: 26.96, SE: 4.38); all other F-code subgroups were not significantly different to the reference group. Analysis of wait times for psychiatric conditions by region revealed that people in the Northeast US had significantly prolonged wait times—averaging 57.88 minutes (SE 6.79)—compared to the Midwestern (Avg: 31.60 minutes, SE 7.23; p = .008), Southern (Avg: 29.20 minutes, SE 3.48; p < .001), and Western US (Avg: 30.33 minutes, SE 3.97; p = .001). By triage status, using the “Emergent” status as the reference group (Avg: 24.01 minutes, SE 2.81), those triaged as “Urgent” experienced significantly longer wait times (Avg: 34.90 minutes, SE 3.41; p = 0.005). Service areas which did not have the capabilities to assign triage status also had prolonged wait times (Avg: 46.02 minutes, SE 8.58; p = 0.017). No other triage statuses—immediate, semi-urgent, non-urgent, or no-triage-assigned had significant differences from the reference group.

Conclusion: Our data showed that there was no overall significant difference in emergency department wait times between psychiatric and non-psychiatric complaints, when looking at hospitals across the US from 2019-2021. However, individuals with psychiatric complaints did experience significantly prolonged wait times in hospitals in the Northeast US; and people with psychosis experienced prolonged wait times overall. Further research into the barriers to care for these individuals and in this region can further elucidate the reasoning for delayed care, which may include increased education of hospital staff and physicians on proper and timely care.

References

1. Nordstrom K, Berlin JS, Nash SS, Shah SB, Schmelzer NA, Worley LLM. Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. West J Emerg Med. 2019;20(5):690-695. DOI: 10.5811/westjem.2019.6.42422

2. Atzema CL, Schull MJ, Kurdyak P, et al. Wait times in the emergency department for patients with mental illness. CMAJ. 2012;184(18):E969-E976. DOI: 10.1503/cmaj.111043

3. Simko L, Birgisson NE, Pirrotta EA, Wang E. Waiting for Care: Length of Stay for ED Mental Health Patients by Disposition, Diagnosis, and Region (2009-2015). Cureus. 2022;14(6):e25604. DOI: 10.7759/cureus.25604

4. Villas-Boas S, Kaplan S, White JS, Hsia RY. Patterns of US Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(7):e2322720-e2322720. DOI:10.1001/jamanetworkopen.2023.22720

5. Di Lorenzo R, Pinelli M, Bertani D, et al. The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service. Front Psychiatry. 2022;13:894939. DOI: 10.3389/fpsyt.2022.894939

6. Ambulatory health care data. Centers for Disease Control and Prevention. Published December 18, 2023. Accessed January 24, 2024. https://www.cdc.gov/nchs/ahcd/index.htm

7. 2024 ICD-10-CM codes F01-F99: Mental, Behavioral and Neurodevelopmental disorders. Accessed January 24, 2024. https://www.icd10data.com/ICD10CM/Codes/F01-F99

Informed Consent: N/A

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *PH-5

Abstract No. 2024-022

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

A Qualitative Evaluation of Huntington’s Disease Perspectives on Social Media

Paige Conrad, OMS-III, Heather Sterchele, Ryan Wong, Sahar Sarrami Amini

Nova Southeastern University Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, FL

Context: Huntington’s Disease (HD) is a neurodegenerative disorder that presents with neuropsychiatric symptoms, movement disorders, and gradual cognitive decline. Later stages of HD and an increased emotional burden on caretakers have been recorded. Previous studies have explored the qualitative impacts of HD on communication between patients, family members, and caregivers [1]; however, the use of communication through social media related to HD has not yet been examined. Social media has the potential to serve as a source of support, encouragement, and education for patients and caregivers. This study aims to understand the role TikTok plays in the dissemination of information on HD.

Objective: To qualitatively examine the content of the most watched videos related to HD on the social media application Tik Tok and explore how social media is being utilized to discuss the disease.

Methods: A cross-sectional qualitative analysis of the top 100 most-liked videos with the search “Huntington’s Disease” on TikTok as of January 27, 2024, was conducted. Video content that primarily discussed HD was included and those unrelated to HD, such as other movement disorders, were excluded. Principles of grounded theory were used in identifying common emergent themes from video content. Three independent reviewers watched the videos and derived emergent themes.

Results: Out of the 100 videos watched, 74 contained relevant data, and four themes were identified. The most frequent theme observed was caregiver/family perspectives (n = 27, 36%). The second most prevalent theme, education (n = 26, 35%), encompassed direct conversation about and viewing of HD, educational content about HD, and various research fundraising campaigns. The least frequent themes observed were patient experience (n = 19, 26%) and genetic inheritance (n = 2, 3%) which highlighted first-hand HD patient anecdotes and genetic testing for the HD gene, respectively.

Conclusions: The most frequent theme observed, caregiver/family perspectives, suggests families and caregivers are utilizing social media platforms to share individual experiences and struggles unique to caring for patients with HD. The second most frequent theme, education, suggests TikTok is being used as a tool to provide information and raise awareness on the medical aspect of HD as well as ongoing research and fundraising campaigns. The third most common theme, patient experience, implies individuals with HD are turning to social media as an outlet to share anecdotes and firsthand experiences unique to the condition. Finally, the genetic inheritance theme highlights that individuals are interested in the hereditary aspect of HD and the probability of passing on the mutated gene to family members. With the rise in popularity of the social media application Tik Tok, it is necessary to examine how this platform can be utilized as a tool to benefit patients living with chronic diseases such as HD and their caregivers.

References

1. Grimstvedt TN, Miller JU, van Walsem MR, Feragen KJB. Speech and language difficulties in Huntington’s disease: A qualitative study of patients’ and professional caregivers’ experiences. Int J Lang Commun Disord. 2021;56(2):330-345. doi:10.1111/1460-6984.12604

Informed Consent: Not relevant.

Ethical Approval & IRB and/or IACUC Approval: This study was deemed exempt from IRB approval.

Financial Disclosure: None reported.

Poster No. *PH-6

Abstract No. 2024-030

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Empowering Families with Children Who May be at Risk for Obesity Through a Nutritional Education Program

Marisol C. Hernandez, MPH, OMS-IV, Yasmin Ganjeh, Amer Aldaas, Angel Ghaemi, Quinci Howard, Nina Huynh, Lena Kakos, Suzanna Kwak, Mariela Magaña-Ceballos, Rofida Rakha, Janelle Pieros, DO, Jennifer Poast, DO, MA, ¹oy H. Lewis, DO, PhD

Department of Public Health & Research, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ

Context: According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 5 children and adolescents in the United States (US) have obesity.¹ In 2017, 74% of children in San Diego County ate less than five servings of fruits and vegetables daily,² and in 2018 nearly 1 out of 3 children were overweight or obese.³ In addition, 43% of Hispanic students were overweight or obese compared to White students who had an overweight and obesity prevalence of 24%.³ Involving families can be a key to creating a sustainable environment and promoting healthy lifestyle habits in the long-term.⁴ To address these health needs, we partnered with a Community Health Center (CHC) in San Diego County to develop a quality improvement project aimed at providing nutrition education to families with children who may be at risk for obesity and explore the impact of educational intervention on improving their health literacy, habits, and anthropometrics. This project also focused on empowering participants to care for their overall health through incorporating sustainable lifestyle changes.

Objectives:

1. To explore the impact of a nutritional education program geared towards low-income communities.

2. To identify challenges faced by participants when trying to improve health habits during a 6-week nutrition and health education program.

3. To increase awareness on healthy eating habits and empower individuals to care for their overall health.

Methods: Eligible participants included up to 4-5 families who are patients of the San Diego County CHC, live in select low-income zip codes of San Diego County, and have children between the ages of 5-11. Participants were recruited and invited to participate by a health educator working at the CHC. Three families participated in a six-session nutritional education class. Osteopathic medical students attended and facilitated the sessions alongside the health educator. Each session was once a week for an hour and a half and included topics such as disease prevention of diabetes, hypertension, and hyperlipidemia, through lifestyle changes and recipe ideas. All sessions were conducted in Spanish.

Child anthropometrics were collected in sessions 1 and 6. A total of 17 surveys were collected. At session 1, parents were asked to complete a pre-course survey about demographic information, social determinants of health, health habits, and behaviors. Children completed a pre-course survey at session 1 and a post-course survey at session 6 regarding health habits. Additionally, at each session parents completed a survey before and after the educational session that focused on evaluating their perceived knowledge and confidence levels about that session’s objectives. These surveys included creating a Specific, Measurable, Attainable, Relevant, and Time-based (SMART) goal involving the session topic. Achievement and barriers to this goal were assessed the subsequent week via the next session survey. Attendance incentives, snacks, and a copy of the snack recipe were provided after every session. Parents completed a post-course survey during the last session that reassessed questions from the pre-course survey and measured the participant’s perceived ability to adopt and retain healthier habits. A certificate of program completion was given to the children during the last session. A follow-up phone survey was conducted one month after program completion to assess retainment of new health habits. Survey data and anthropometrics were collected using Qualtrics, and descriptive data analysis was completed.

Results: There were eight participants: three parents and five children with ages ranging from 9-11 years old. All participants identified as Latinx. The program had a 100% retention and survey response rate. During the sessions, all families were observed to be engaged and actively participating.

One of the three families reported difficulty obtaining healthy foods and worrying about where their next meal will come from. All three families expressed interest in learning about or applying for the CalFresh program.

Participants reported the program led to increased accountability and awareness of healthier options. Parents listed eating healthy foods, learning about portion size, reading nutrition labels, and having their children participate, as the most beneficial parts of the program. At the end of the six weeks, three of five children improved at least one health habit.

All families reported feeling healthier and believed the healthier habits developed during the program will be long-lasting. In addition, in the follow-up survey, families indicated that they are more capable of choosing to eat healthier than before the program. All families commented on their desire to continue the program in the future and appreciated the importance of knowledge in maintaining a healthy lifestyle. A participant noted, “By participating, daughters learned and understood why they need to eat healthy.”

Conclusion: Overall, a weekly nutrition education program can promote health literacy by increasing participants’ interest in health education and self-confidence in making proactive lifestyle changes. By recognizing the health needs of the patient population in the CHC, this program focused on increasing awareness of food assistance programs to reduce barriers to healthy lifestyle choices. The 100% adherence rate to a weekly program shows active engagement that may yield sustained changes in health behaviors. This program’s success can serve as a model for larger groups of participants over a longer time frame. The external validity of these findings are potentially limited due to the small class size and narrow sample size, in the setting of COVID-19 regulations and geographic constraints. Future studies should include a larger sample size, and longitudinally track the anthropometric data to explore the implications of health education on long-term reduction in obesity rates and other chronic disease states in similar CHC populations.

References

1. Centers for Disease Control and Prevention. Childhood obesity facts. Published April 2, 2024. Accessed June 14, 2024. https://www.cdc.gov/obesity/php/data-research/childhood-obesity-facts.html

2. County of San Diego, Health and Human Services Agency, Public Health Services. Exploring health disparities in San Diego County by age. Published March 2022. Accessed June 12, 2024. https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/CHS/Health%20Equity%20Report%20Series_Age_2022.pdf

3. San Diego Childhood Obesity Initiative, County of San Diego, Health and Human Services Agency. Live Well San Diego, State of childhood obesity in San Diego County: supplemental data report. Published September 2019. Accessed June 12, 2024. https://sdcoi.org/wp-content/uploads/2019/09/StateofChildhoodObesityinSD_2019SupplementalReport_Digital.pdf

4. Bach M, Shenoi S, Winger K, Hendriksz T. Healthier together: A pilot study on the implementation of a novel family centered pediatric obesity prevention program. J Osteopath Med. 2021;121(5):513-520. doi:10.1515/jom-2020-0143

Informed Consent: As this was a quality improvement project, no informed consent process took place. Eligible participants were identified by the community health center and invited to participate. Participants were asked to sign a waiver of participation as part of the community health center’s protocol, not in relation to the project.

Ethical Approval & IRB and/or IACUC Approval: The study received A.T. Still School of Osteopathic Medicine, AZ IRB approval and was deemed non jurisdiction. The quality improvement project received approval by the IRB department at the community health center where this project took place. This IRB approval from the community health center is also attached.

Financial Disclosure: None reported.

★Poster No. *PH-9

Abstract No. 2024-055

Category: Public Health

Research Focus Area: Osteopathic Philosophy

Assessing the Role of Osteopathic Medical Education on Community Health Literacy Interventions Pilot Study

¹Christopher Good, OMS-IV, ²Elizabeth McClain, PhD, EdS, MPH

¹Arkansas College of Osteopathic Medicine, Fort Smith, AR; ²Senior Associate Dean Academics, Assessment, Innovation, Arkansas College of Osteopathic Medicine, Fort Smith, AR

Context: Physician obligations to inform and communicate effectively with patients about their care is an essential component of the patient-provider dynamic. As future physicians, medical students will be key to tackling the challenges of health literacy, which prior studies have identified as a disparity risk factor in chronic disease prevention and management including cancer 1,2, diabetes 3,4, obesity 5,6, smoking cessation 7, and cardiovascular disease 8,9. Considering Osteopathic Medicine is a growing field in the United States 10 , additional research is warranted into the roles of osteopathic medical training from preventive and community health standpoints.

Objective: The goal of this study was to better understand what health literacy interventions are utilized most by osteopathic medical students on clinical rotations in addition to their perceptions of health literacy concerns and the current impact of undergraduate medical education to propose curriculum recommendations.

Methods: This non-experimental study utilized an anonymous 18-item electronic survey distributed to third and fourth-year clinical medical students at osteopathic medical schools nationwide. The survey items were vetted with literature and reviewed by faculty content experts to ensure validity. Items included multiple choice and ranked response format. Survey questions addressed non-identifiable student demographics, experiences with health literacy challenges, strategies on clinical rotations, perceptions of health literacy, and the role of health literacy in medical education. No identifiable data was collected to maintain participant anonymity. Descriptive statistics were used to explore survey data.

Results: 53 clinical medical students (63.46% OMS-III and 36.54% OMS-IV) responded from four medical schools: Arkansas College of Osteopathic Medicine (ARCOM), Kansas City University - Joplin (KCU), Philadelphia College of Osteopathic Medicine (PCOM), and Rowan-Virtua School of Osteopathic Medicine (Rowan-Virtua SOM). Survey data demonstrates students are aware their institutions provide information sessions on health literacy topics to the public with 62.50% reporting institution-led local community outreach sessions and 37.50% recalling outreach sessions provided on campus. From a curriculum standpoint, 43.75% of respondents were unsure what academic year health literacy-specific curriculum was provided but 62.50% recalled at least one didactic lecture that addressed knowledge and health literacy skill development and 50% recalled relevant standardized patient/simulation encounters or early clinical experiences. Respondents identified the most common concerns expressed by patients on rotations are treatments (64.29%) followed by cost (53.37%) and disease cause (21.43%), while the most common health literacy challenges students reported relate to patient education level (85.71%) followed by non-English speaking or English as a Second Language (ESL) patients and social determinants of health (both reported at 78.57%, respectively). Regarding health literacy tools utilized on rotations, 96.43% of respondents reported utilizing interpreters for languages other than English, yet far fewer reported utilizing assistive technology for patients with physical limitations (46.43%), hearing impairments (25%), and visual impairments (10.71%). Additionally, 39.29% of students reported the most used intervention for hearing impaired patients were virtual American Sign Language (ASL) interpreters and the most common visual aids were handouts (46.43%). In their own education, students reported the teaching tools they found most helpful were guided questions (71.43%), visual aids (67.86%), and drawing/writing (60.71%). Core rotations that required a high use of health literacy strategies in patient communication were identified as Family Medicine (82.14%​), Internal Medicine (57.69%​), and Pediatrics (46.43%​), while ​General Surgery and Osteopathic Manipulative Medicine (OMM) were identified most by respondents as requiring a low use of health literacy strategies in patient communication (64.29%​ and 55.56%​, respectively). Most notably, 96.43% of respondents agreed/strongly agreed that medical schools have an obligation to address health literacy in their curriculum. However, 46.43% of respondents disagreed that health literacy is sufficiently addressed in medical school curriculum. Finally, 96.43% of respondents agreed/strongly agreed their understanding of health literacy was strengthened on clinical rotations with students largely agreeing/strongly agreeing to confidence in their abilities to recognize health literacy challenges (96.43%), use a variety of strategies in patient communication (92.86%), and avoid using medical jargon when communicating with patients (82.14%).

Conclusion: While this study uniquely analyzes the impact of health literacy in osteopathic medical education, significant limitations include the number of respondents and the limited number of programs that participated in the survey. Additionally, most responses were from ARCOM reflected by 75% of the respondents indicating their program requires an underserved care rotation in a rural setting, compared to the 25% of respondents who indicated their program requires an urban underserved care rotation. Finally, survey data analysis suggests health literacy curriculum needs to be more clearly defined with a primary care emphasis. Other success measures could include early experiential learning with diverse patients in addition to ASL and ESL interpreters, continuing to involve medical students in institution-led community outreach programs focused on health literacy, as well as encouraging students to create health promotional materials since most respondents identified these measures as helpful in their education. In conclusion, more large-scale and longitudinal research is warranted on health literacy and clinical medicine, the results of which may provide a more uniform framework for health-literacy-specific curriculum in undergraduate medical education and reinforce Osteopathic Medicine’s emphasis on underserved patient care.

References

1. Peterson NB, Dwyer KA, Mulvaney SA, et al. The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior. J Natl Med Assoc. 2007;99(10):1105-1112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574401/ . Accessed February 28, 2024.

2. Poon PKM, Tam KW, Lam T, et al. Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk. Front Oncol. 2023;(12). doi:10.3389/fonc.2022.1053698

3. Fields B, Lee A, Piette JD, et al. Relationship between adult and family supporter health literacy levels and supporter roles in diabetes management. Fam Syst Health. 2021;39(2):224-233. doi:10.1037/fsh0000503

4. Seger M, Ryan CD, Januszewski AS, et al. Is it time to screen health literacy in diabetes clinical practice? Diabetes research and clinical practice. 2024;208:111117. doi:10.1016/j.diabres.2024.111117

5. Paine K, Parker S, Denney-Wilson E, et al. In it for the long haul: the complexities of managing overweight in family practice: qualitative thematic analysis from the Health eLiteracy for Prevention in General Practice (HeLP-GP) trial. BMC Primary Care. 2023;24(1):1-14. doi:10.1186/s12875-023-01995-w

6. Sanders LM, Perrin EM, Yin HS, et al. A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial. Pediatrics. 2021;147(5):1-11. doi:10.1542/peds.2020-049866

7. Stewart DW, Adams CE, Cano MA, et al. Associations between health literacy and established predictors of smoking cessation. Am J Public Health. 2013;103(7):43-49. doi:10.2105/AJPH.2012.301062

8. Guo A, Jin H., Mao J. et al. Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study. BMC Cardiovasc Disord. 2023;23(1):93. doi:10.1186/s12872-023-03117-x

9. Magnani JW, Mujahid MS, Aronow HD, et al. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement from the American Heart Association. Circulation. 2018;138(2):48-74. doi:10.1161/CIR.0000000000000579

10. American Osteopathic Association. Osteopathic Medical Professional Report. 2023. https://www.osteopathic/org/OMP. Accessed February 28, 2024.

Informed Consent: Survey introduction included the principal investigators and email contact information, study purpose and procedures (5-10 minute online, anonymous survey), privacy and confidentiality statement, potential benefits and minimal risks of voluntary participation, in addition to IRB Approval statement.

Ethical Approval & IRB and/or IACUC Approval: Institutional Review Board (IRB) approval was obtained at the Arkansas College of Osteopathic Medicine (ARCOM) with exempt classification (Project ID # ACHE-2024-0006).

Financial Disclosure: None reported.

Poster No. PH-10

Abstract No. 2024-056

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Assessing the Role of Pronoun Competency Training in the Expansion of Transgender and Gender Diverse Curriculum in Undergraduate Medical Education

¹Richard Morgan, DO, ²Shea Buckley, ³Mitzi Scotten

¹Department of Family Medicine, New York Institute of Technology, Old Westbury, NY; ²Academic Scholar Program, New York Institute of Technology, Old Westbury, NY; ³Department of Clinical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State, State Univeristy, AR

Context: Individuals who hold sexual or gender minority (SGM) identities are often subject to discrimination at the hands of providers, with 56% of sexual minority-identified patients and 70% of gender minority-identified patients reporting at least one incident of healthcare-based discrimination in their lifetime (1-3). Studies have found that many providers admit to discomfort and a general lack of willingness to discuss relevant topics or perform routine screening tests on SGM patients (1, 2, 4).

These barriers, discrimination, and incompetencies lead to significant adverse health outcomes for this community (2,5,6,7). This population often reports feelings of fear, shame, and general unease when seeking medical care (2,3,5). Because of this, SGM individuals are more likely to avoid seeking out preventative medicine, routine follow-up, and acute healthcare than their heterosexual and cisgender counterparts (2,5,6,7). Resulting disparities in health outcomes are especially obvious in sexual health, mental health, and routine cancer screenings (2,5,6,7).

The prevalence of this inequity is due in part to the lack of provider knowledge about SGM identities and their specific healthcare needs (1,2,4,8). This knowledge deficit among the provider population is present and pervasive at all levels of experience due to a lack of adequate education in SGM healthcare topics during undergraduate and graduate training programs (1,2,4,8). A growing number of educational approaches have been implemented in undergraduate medical education to advance students’ competency in this area (9-12). Modalities used and studied include didactic lectures, panels, seminars, group work, case-based learning, and standardized patient encounters (9-12). Many of these educational interventions have shown significant short-term improvements in knowledge, comfort, and attitudes; however, there is a notable lack of long-term efficacy data 9,10. The study team is not aware of any studies that have looked specifically at the role of pronoun competency training in education for undergraduate medical students.

Objective: To identify current self-perceived knowledge gaps about gender identity, gender pronouns, and health disparities that can be addressed by future curriculum.

Methods: The New York Institute of Technology College of Osteopathic Medicine introduced a mandatory, student-lead pronoun competency training into the 2023-24 first-year Doctor Patient Relations coursework to enhance didactic curriculum on SGM health needs. A pre-test/post-test design was used to assess student comfort, perceived knowledge, and inclusive behaviors before and after watching the lecture.

Five Likert-type responses were collected pre- and post-lecture to gauge comfort using proper pronouns, understanding of SGM definitions—including a specific question about the terms cis/transgender—, awareness of barriers to care for SGM patients, and initial and future willingness to engage in inclusive behaviors. Two open-ended questions were asked post-lecture to allow for free-response answers from students on key knowledge outcomes and areas of knowledge gaps or further questions.

Any response that included at least one pair of pre-/post-test answers OR at least one free-response answer was analyzed; 481 responses were included in the final analysis. The student’s paired t-test was used to assess pre- to post-lecture change of Likert data. Qualitative analysis was used to categorize key knowledge outcomes and knowledge gaps and questions.

Results: Analysis showed no significant difference between any of the pre-lecture Likert scores of students at the New York campus versus the Arkansas campus. Results further showed that there was significant improvement in Likert scores for all five Likert-type questions at a.

Conclusion: As the population of transgender and gender diverse people grows—now said to be anywhere between 0.39% and 2.7% of the total adult population in the U.S. and up to 5.1% in those under 30 years old—the need for inclusive and comprehensive care becomes exponentially more important12,13. This analysis will contribute valuable information regarding the initial knowledge level of incoming first year osteopathic medical students. The results will also provide guidance on where future iterations of curriculum can improve students’ understanding of SGM health needs and develop their interpersonal communication skills to be inclusive of patients and peers of diverse gender identities.

Ethical Approval: NYIT OSPAR IRB; Study #: NYIT IRB-2024-99; Exempt as of June 13, 2024

References

1. Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities & Board on the Health of Select Populations. The Health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Choice/Choice Reviews. 2012;49(05):49-2699. doi:10.5860/choice.49-2699

2. Gentile D, Boselli D, MacNeill E. Clinician’s Experience and Self-Perceived Knowledge and Attitudes toward LGBTQ + Health Topics. Teaching and Learning in Medicine. 2020;33(3):292-303. doi:10.1080/10401334.2020.1852087

3. Lambda Legal. When Health Care Isn’t Caring; Lambda Legal’s Survey on Discrimination Against LGBT People and People Living With HIV.; 2010. https://legacy.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring.pdf.

4. Unger CA. Care of the transgender patient: A survey of gynecologists’ current knowledge and Practice. Journal of Women’s Health. 2015;24(2):114-118. doi:10.1089/jwh.2014.4918

5. Dilley JA, Simmons KW, Boysun MJ, Pizacani BA, Stark MJ. Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. American Journal of Public Health. 2010;100(3):460-467. doi:10.2105/ajph.2007.130336

6. Wingo E, Ingraham N, Roberts SCM. Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: A qualitative study. Women’s Health Issues. 2018;28(4):350-357. doi:10.1016/j.whi.2018.03.002

7. Agénor M, Krieger N, Austin SB, Haneuse S, Gottlieb BR. Sexual orientation disparities in Papanicolaou test use among US women: The role of sexual and Reproductive Health Services. American Journal of Public Health. 2014;104(2). doi:10.2105/ajph.2013.301548

8. Rhodes A, Barbati Z, Tybor D, St Louis J. Knowledge and perceived competence with sexual and gender minority healthcare topics among medical students and medical school faculty. BMC Medical Education. 2023;23(1). doi:10.1186/s12909-023-04849-2

9. Jecke L, Zepf FD. Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review. European Child & Adolescent Psychiatry. 2023;33(5):1327-1354. doi:10.1007/s00787-023-02195-8

10. Knudson GA, Feldman J, Neira P, Fraser L. Closing the gap in education: Raising medical professionals’ knowledge and attitudes in transgender health. Baillière’s Best Practice & Research Clinical Obstetrics & Gynaecology/Baillière’s Best Practice and Research in Clinical Obstetrics and Gynaecology. 2023;89:102339. doi:10.1016/j.bpobgyn.2023.102339

11. Nolan IT, Blasdel G, Dubin SN, Goetz LG, Greene RE, Morrison SD. Current state of transgender medical education in the United States and Canada: Update to a scoping review. Journal of Medical Education and Curricular Development. 2020;7:238212052093481. doi:10.1177/2382120520934813

12. Petrey LN, Noonan EJ, Weingartner LA. Gender Diverse Representation in Patient Simulation: A scoping review. Academic Medicine. 2022;97(11S):S107-S116. doi:10.1097/acm.0000000000004926

13. Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Translational Andrology and Urology. 2019;8(3):184-190. doi:10.21037/tau.2019.04.09

14. Brown, A. About 5% of young adults in the U.S. say their gender is different from their sex assigned at birth. Pew Research Center. https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/. Published April 14, 2024.

Informed Consent: Informed Consent: Informed consent was waived due to negligible risk to participants

Ethical Approval & IRB and/or IACUC Approval: IRB Exempt Letter attached.

Financial Disclosure: None Reported.

★Poster No. *PH-11

Abstract No. 2024-059

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

SDOH 101: Building Confidence and Educating Nursing Students to Address Social Determinants of Health with Future Patients

¹Alyssa Kim, MPH, OMS-III, ¹Nyala Cheema, MS, ¹Lynda Arostegui, ¹Kimberly Dao, MS, ¹Brooke Smith, ¹Emina Catic, MS, ¹William Nguyen, ¹Justin Bablitz, ¹Imran Sheikh, ¹Hiren Kakarla, ²Stephanie Broughton, DO, ²Catherine Shanahan, MD, ³Sureka Appikatla, MPH, ³Joy H. Lewis, DO, PhD

¹A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ²Regional Director of Medical Education A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ³Department of Public Health A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ

Context: There is a pressing need to screen for and address social determinants of health (SDOH) during patient visits. However, the integration of this practice during clinical visits can be a daunting task for healthcare staff and providers [1]. While there have been great strides in research that examine the pedagogy of teaching about SDOH, current literature has shown that only a small proportion of healthcare providers report being competent at identifying these needs during their visits [2] . To bridge this gap, we designed our project to increase the confidence of nursing students at two Southern State Community College (SSCC) campuses located in southwest Ohio in addressing SDOH in patient encounters.

Objectives: To evaluate the efficacy of a simulation-based workshop on educating nursing students on social determinants of health, methods of screening, and local resources.To analyze changes in nursing students’ knowledge and attitudes regarding social determinants of health screening in patient care using a mixed methods approach.To explore the practical applications of the workshop content in patient care settings, including the nursing students’ confidence and ability to address social determinants of health needs during patient encounters.

Methods: A one-hour workshop was designed to introduce best practices of screening for SDOH and to provide information on the predominant needs and resources of the local population that they can utilize in Brown and Highland County, OH. The workshop incorporated a short didactic portion which discussed what SDOH are, the importance of addressing SDOH, and what issues are prevalent in the surrounding community. This was followed by four patient role-playing simulations led by members of the research team. Participants were given a chief complaint and had to independently come up with relevant screening questions to discover which SDOH the simulated patient was facing. After collaborating with their peers, the research team members taught the students the standardized screening questions related to the SDOH and the corresponding local resources that would address the concern. Afterward, a take-home resource card was disseminated. Data collection used a mixed methods approach where a web-based survey was administered prior to and after the workshop with questions on a Likert scale regarding the participants’ knowledge level and attitudes towards SDOH screening. In addition, a focus group was hosted after the workshop to collect more rich detail about participants’ perceptions of their experience with the workshop and workshop efficacy. Data analysis included a paired t-test of the quantitative survey results and qualitative coding of the focus group transcript. By teaching nursing students to screen for and address SDOH, this project aligns with osteopathic philosophy by promoting comprehensive, patient-centered care. Addressing SDOH is crucial for identifying and mitigating barriers to health, thereby supporting the osteopathic goal of improving whole-person health and wellbeing. Empowering future healthcare providers with these skills fosters a collaborative, integrative approach to patient care that is central to osteopathic practice.

Results: 20 nursing students attended the workshop with 18 students completing both pre- and post-surveys (Response rate = 90%). The post-survey responses showed a statistically significant increase in agreement across all three categories, “Personal Knowledge”, “Personal Attitudes”, and “Clinical Application” (p Conclusion

Nursing students trained to address social determinants of health (SDOH) can contribute to more holistic and comprehensive patient assessments, leading to better health outcomes for patients served by community health centers (CHCs). Eighteen out of twenty participants indicated their intention to work in Ohio after graduation, thus potentially entering the local workforce with this refined skill set. By educating nursing students on SDOH and local resources during their training, CHCs can expect an improvement in overall patient care. Other CHCs can replicate and adapt the workshop model to their specific context and resources. Evaluation of the program has shown that simulated patient scenarios and interactive educational models are effective methods of learning for healthcare students. Therefore, CHCs can enhance the competency of their healthcare staff and providers in addressing SDOH through similar educational interventions, regardless of their location or patient population. Through this project, we hope to empower and equip future nurses to improve patient outcomes through enhanced SDOH awareness and intervention skills. Some limitations include a relatively small sample size of 18 students, which may limit the generalizability of the findings. The data collection was conducted at a single institution with a homogenous study population in rural Ohio which may also limit the external validity of the study.

References

1. Gard LA, Cooper AJ, Youmans Q, et al. Identifying and addressing social determinants of health in outpatient practice: results of a program-wide survey of internal and family medicine residents. BMC Medical Education. 2020;20. doi:https://doi.org/10.1186/s12909-020-1931-1

2. Mizumoto J, Mitsuyama T, Eto M, Izumiya M, Horita S. Primary care physicians’ perceptions of social determinants of health recommendations: a qualitative study. BJGP Open. Published online December 9, 2022:BJGPO.2022.0129. doi: https://doi.org/10.3399/bjgpo.2022.0129

Informed Consent: All participants signed a consent document, which included the evaluation plan and purpose, activities involved, time commitment, compensation, and potential risks. The consent form was at the beginning of the electronic pre-survey the participants completed before the workshop began. A photo and video release form were also signed by all participants at the start of the workshop. Participants were compensated for their time taking the surveys in the form of lunch provided during the workshop event. For the focus group, participants were compensated with HydroFlask tumblers. Participants were able to withdraw from the workshop or evaluation at any time.

Ethical Approval & IRB and/or IACUC Approval: Our research study was approved and deemed exempt by Southern State Community College IRB and this decision was accepted by ATSU-AZ IRB (Exempt Protocol #2023-212).

Financial Disclosure: None reported.

Poster No. *PH-12

Abstract No. 2024-060

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Promoting Health and Wellness: Empowering Refugee Communities in Portland, OR

Heather Pittman, OMS-III, Amanda Bates, BS, Easton Bents, BS, Savannah Conine, BS, Lana Danial, BS, Elfego Galvan, PhD, Danielle Kulbak, BS, Saba Najafi, BS, Grace Spradley, BS, Nicholas Tran, MS, Lisa D. Watts, DO, Deane C. De Fontes, MD, Surekha Appikatla, MPH, Joy H. Lewis, DO, PhD

A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ

Context: Recently-immigrated refugees in the United States encounter a variety of cultural and systemic disparities. Factors like language barriers, healthcare beliefs, home country health systems, cultural differences, education level, social stigmas, entrenched gender roles, and experiences of trauma can significantly influence the ways that individuals engage with their own health and navigate healthcare systems.1 Furthermore, poor health outcomes such as physical illness can adversely affect refugees’ ability to perform immigration requirements and demonstrate asylum eligibility within the United States.2 This can disadvantage their case, reduce their likelihood of receiving asylum, and negatively impact their safety, wellbeing, and quality of life.

Studies performed both globally and within the United States have shown correlation between refugee status and adverse health outcomes.3,4 Local needs assessments performed in Portland, Oregon within the last ten years have also cited health, healthcare access, and navigation of healthcare and social benefits as key issues of concern within the refugee community.5,6 This community-centered project aimed to target these disparities by equipping refugees and asylum seekers in Portland, Oregon with essential healthcare information and resources that could enhance their ability to navigate the local healthcare system.

Objectives: To improve participant access to regional healthcare resources, empower them to make informed health decisions, and identify ongoing perceived barriers to healthcare within the refugee community.

Methods: Our team partnered with the Pacific Refugee Support Group (PRSG) to identify both our target population and its healthcare needs. We designed a three-part health workshop series which was delivered in person at the PRSG office to four groups of refugees and asylum-seekers using interpreters and materials in the preferred language of each group. Each workshop consisted of an hour-long interactive presentation followed by an open question session. The first part of the session centered around general health information such as using a first aid kit, the differences between primary care and emergency services, and mental health. The second part focused on holistic health and prevention, including information related to diet and nutrition, exercise, vaccination, screening exams, and preventative vision and dental care. The third part was specific to health insurance and provided an overview of Oregon Health Plan (OHP) coverage. Handouts were also distributed to participants in their preferred language and included pertinent contact information for Oregon Health Plan along with a list of local resources such as free transportation and language translation services, community center access programs, and culturally-inclusive recipe guides.

Participants were recruited by PRSG from the local refugee community and included two groups of newly-arrived Venezuelan refugees and two groups of newly-arrived Afghan refugees, with 21 total participants. To assess the efficacy of our intervention, we administered anonymous pre- and post-surveys to participants in their preferred language during each workshop. The survey data were analyzed to determine the percent change in pre- and post-responses, with positive percent changes indicating an improvement in overall perception of information comprehension. We modified our data collection approach to paper surveys after identifying initial participant challenges utilizing virtual surveys. After this modification, there was improvement in the data collection and the surveys from the final group of nine participants were used for analysis.

Our methods were intentional in targeting whole-person health, which is why we included resources outside of the healthcare system such as access to community programming and focused on preventative health measures in addition to medical care. We also gave participants the opportunity to ask questions and speak about their experiences during the education sessions, as we felt the qualitative aspects of this project reflected important components of health and wellbeing alongside the quantitative.

Results: We observed significant improvements in perceived knowledge and understanding among the nine participants who completed both the pre- and post-surveys. Across all aspects and topics covered in the educational session, participants demonstrated a minimum 20% increase in comprehension from pre- to post-survey. Particularly noteworthy was the increase in comfortability accessing Portland healthcare services, which rose from 33% to 78%. Prior to the presentation, only 11% of participants were aware of free transportation for medical care; post-presentation, this awareness reached 100%. Additionally, participants’ understanding of how to appeal a denial of healthcare coverage and utilize Oregon Health Plan (OHP) assistance saw a significant increase from 0% to 67%. Due to our low sample size, we were unable to perform statistical analysis and cannot generalize the results to larger populations.

Positive participant feedback, active engagement in sessions, and interest in optional health-related resources were also used as qualitative indicators of success alongside survey data. Overall, the sessions enhanced awareness about access to local health resources and insurance plan coverage as well as participant confidence in their ability to care for personal health at home, schedule appointment processes with primary care providers (PCPs), and distinguish between preventative and emergent health services.

Conclusion: The outcome of this project supports our original goals of increasing participants’ ability to access health resources and make informed health decisions despite limitations with participant numbers. It also provides insight for future initiatives within the Pacific Refugee Support Group and the Portland refugee community. For example, PRSG plans to use our project results and educational materials to guide future initiatives on healthcare navigation and health literacy. Our results could also help direct future research projects evaluating the significance of health education interventions on refugee health outcomes.

Additionally and importantly, this interactive education model could be utilized by community health centers and local organizations seeking to improve refugee patient health outcomes. Simple guidance sessions on topics like navigating health insurance and preventative healthcare can bridge some of the major gaps to access and provide an invaluable tool for empowerment in spite of the significant challenges faced with relocation. These interventions would also foster partnership and build trust between refugee communities and the medical system, which supports positive long-term health outcomes for patients as well as the overarching community-based goals of the osteopathic profession.

References

1. U.S. Department of Health and Human Services. Refugee Health Overview. Published May 9, 2023. https://www.acf.hhs.gov/orr/programs/refugees/refugee-healthMousin CM. Health Inequity and Tent Court Injustice. AMA Journal of Ethics. 2021;23(2):E132-139. doi:https://doi.org/10.1001/amajethics.2021.132

2. Blessing Kanengoni-Nyatara, Watson KB, Galindo C, Charania NA, Mpofu C, Holroyd E. Barriers to and Recommendations for Equitable Access to Healthcare for Migrants and Refugees in Aotearoa, New Zealand: An Integrative Review. Journal of Immigrant and Minority Health. 2023;26. doi:https://doi.org/10.1007/s10903-023-01528-8

3. Heidinger E. Overcoming Barriers to Service Access: Refugees’ Professional Support Service Utilization and the Impact of Human and Social Capital. Journal of International Migration and Integration. 2022;24. doi:https://doi.org/10.1007/s12134-022-00939-0 Immigrant & Refugee Community Organization.

4. Community Needs Assessment 2017 Report: Key Findings from Oregon’s Immigrant and Refugee Communities. 2017. https://www.portlandoregon.gov/oehr/article/713231

5. Eiwaz MA. Expectations and Lived Realities of Iraqi Women Refugees and Refugee Mental Health Providers in Portland: An Ethnographic Study to Inform Refugee Mental Health Services and Policy. ir.library.oregonstate.edu. Published May 20, 2019. https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/sf268b447

Informed Consent: We received a waiver through our IRB and did not have to provide informed consent to conduct this community-based education program.

Ethical Approval & IRB and/or IACUC Approval: Our study was reviewed by A.T. Still’s IRB and deemed exempt from human studies due to the specificity of the project within the community organization.

Of note, our IRB approval letter states that the PI is Nicholas Tran, MS. However, ​we had a change of authors within the course of ​the project and Heather Pittman, BS is now the PI. This change was approved through our IRB.

Financial Disclosure: None reported.

★Poster No. *PH-13

Abstract No. 2024-061

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Exploring Digital Solutions to Health Insurance Literacy Disparities

¹Hannah Vedova, OMS-III, ¹Jonathan Wrigley, OMS-III, ¹Sana Khan, OMS-III, ¹Samuel Patha, OMS-III, ¹Parker Stevens, OMS-III, Alleson Pertea, OMS-III, ²Brian Schwartz, PhD, MLIS, ³Jennifer Hellier, PhD

¹Rocky Vista University College of Osteopathic Medicine (RVUCOM-Colorado), Parker, CO; ²Department of Medical Humanities, Rocky Vista University College of Osteopathic Medicine (RVUCOM-Colorado), Parker, CO; ³Department of Physician Assistant Studies, Rocky Vista University College of Osteopathic Medicine (RVUCOM-Colorado), Parker, CO

Context: Despite expanded health insurance access in the United States, recent literature reveals that many demographic groups still struggle to master their plans. Older adults demonstrate less initiative in comparing plans, younger adults face medical debt collection, and minorities misunderstand health insurance terminology. Even with higher insurance rates, women often lack knowledge of deductibles. To address these and other health insurance literacy (HIL) disparities, a website was developed to help users compare plans, understand coverage, and boost overall HIL.

Objective: To develop and validate a digital health insurance comparison and education tool using artificial intelligence (AI) and other technological modalities.

Methods: InsureEZ.org, a website for browsing and comparing health insurance plans, was developed by students from Rocky Vista University (RVU), based in Wix and supplemented with Python and JavaScript. It leveraged Google’s Gemini and Microsoft’s Chat-GPT 3.5 large-language models in data development and for educational resources. Post IRB approval, a pilot study was conducted to evaluate the efficacy of this website aimed at improving HIL. Pre-use and post-use Qualtrics surveys were sent out to RVU students, faculty, and family members to assess the website (n=50 and n=24, respectively). The site became available for users to test from December 1st, 2023 to February 1st, 2024, after which it was closed for public access and data analysis was completed.

Results: Survey results regarding the website were evaluated for user experience and knowledge gain. As per the pre-survey results, 70% of respondents claimed to be uncomfortable or have a neutral attitude about utilizing health insurance. Post-survey results indicated that 66% of participants found the website generally helpful. The site’s “Browse Plans” tool was utilized by 88% of the participants, and 48% found it helpful. 71% utilized the “Learn About Insurance” page, and 76% of those users found it helpful. User feedback highlighted a desire for more Medicare, Medicaid, dental, and vision information, in addition to improved navigation and term definitions. Further development is needed to address these points and refine the tool. Overall, this pilot provides promising validation for digital HIL applications.

Conclusion: While the study’s sample size significantly limits generalizability, findings can inform future iterations of the InsureEZ website and the planned mobile app. Additionally, there is still a need for ongoing research in digital health literacy, especially as AI modalities continue to advance. Future recommendations include expanding the current database, employing AI or other coding solutions to track user analytics, and developing a robust mobile app version of the site. The website is currently undergoing a second round of iterative design based on the feedback received, with hopes to eventually repeat the pilot study and target a broader population.

Informed Consent: Before filling out both the pre- and post-survey, participants read through and confirmed agreement with an anonymous survey consent form. It detailed the researchers; study title and purpose; survey process; risks, benefits, and voluntary nature of participation; and anonymity of participants. Contact information of researchers and the local IRB compliance administrator were also provided.

Ethical Approval & IRB and/or IACUC Approval: The study was submitted for IRB approval on 10/24/2023 and was declared IRB exempt on 11/02/2023. The approval number is 2023-225, and protocol documentation is attached.

Financial Disclosure: None reported.

Poster No. *PH-14

Abstract No. 2024-063

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Religious and Non-Religious ​​Factors Impacting Pap Smear Compliance Amongst NJ Muslim Women

¹Amal Abukwaik, BA, OMS-III, ¹Nishat B. Zurwa, ¹Rana Cheikhali, DO, ¹Veronica Saleeb, BA, ¹Usmaan Al-Shehab, BS, ¹Ammar Zidat, BS, ²Anne Jones, DO

¹Department of Research, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ; ²Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ

Context: While cervical cancer is among the top five most prevalent cancers in women worldwide, this number dropped significantly with the introduction of HPV vaccines and pap smear screening. Previous studies have shown that 50% of Arab Muslim women, much less than the general population, in various communities are compliant with cervical cancer screening. However, there has never been a study determining pap smear compliance and the potential barriers in the NJ Muslim community, despite the state having the largest Muslim population percentage-wise.

Objective: To determine how Islamic ideology and non-religious factors influence the understanding and compliance of cervical cancer screening in Muslim women in New Jersey.

Methods: A survey questionnaire modeled after a 2012 qualitative research model by Salman was distributed across media platforms, word of mouth, and flyers in NJ. Inclusion criteria of the identifying as a Muslim woman, within the age range of 21-65 years old, and currently residing in NJ. Descriptive statistics were used to assess participant demographics as well as beliefs and behaviors as they pertained to health and religion. Chi-square and Fisher’s exact tests examined relationships between demographic factors, religious and non-religious values with pap smear compliance. Osteopathic significance?

Results: Pap smear compliance was found to be 43% among NJ Muslim women. Islamic influence showed no significant association with pap smear compliance (p= 0.815). More than half of community members stated Islam did not affect their healthcare decision-making. For those influenced by Islam, accommodation of values by healthcare personnel was a significant factor that impacted pap smear compliance (16.7%, p=0.00378). Demographically, younger and unmarried participants exhibited lower pap smear compliance (p =

Conclusion: NJ Muslim women demonstrated higher pap smear non-compliance rate compared to the general population of women in NJ. Reasons for non-compliance are multifactorial and may be influenced by lack of access, cultural norms, and health perception and literacy. Although Islamic ideology does not significantly impact pap smear compliance among Muslims, it remains important for healthcare professionals to recognize and respect the values and beliefs held by this community.

References

1. Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: Epidemiology, risk factors and screening. Chin J Cancer Res. Dec 31 2020;32(6):720-728. doi:10.21147/j.issn.1000-9604.2020.06.05

2. Johnson CA, James D, Marzan A, Armaos M. Cervical Cancer: An Overview of Pathophysiology and Management. Semin Oncol Nurs. Apr 2019;35(2):166-174. doi:10.1016/j.soncn.2019.02.003

3. Fowler JR, Maani EV, Jack BW, Miller JL. Cervical Cancer (Nursing). StatPearls. 2022.

4. Sachan PL, Singh M, Patel ML, Sachan R. A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation. Asia Pac J Oncol Nurs. Jul-Sep 2018;5(3):337-341. doi:10.4103/apjon.apjon_15_18

5. Smith JS, Green J, Berrington de Gonzalez A, et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. Apr 5 2003;361(9364):1159-67. doi:10.1016/s0140-6736(0312949-2)

6. Hildesheim A, Wacholder S, Catteau G, et al. Efficacy of the HPV-16/18 vaccine: final according to protocol results from the blinded phase of the randomized Costa Rica HPV-16/18 vaccine trial. Vaccine. Sep 3 2014;32(39):5087-97. doi:10.1016/j.vaccine.2014.06.038

7. Haupt RM, Wheeler CM, Brown DR, et al. Impact of an HPV6/11/16/18 L1 virus-like particle vaccine on progression to cervical intraepithelial neoplasia in seropositive women with HPV16/18 infection. Int J Cancer. Dec 1 2011;129(11):2632-42. doi:10.1002/ijc.25940

8. Salman KF. Health beliefs and practices related to cancer screening among Arab Muslim women in an urban community. Health Care for Women International. 2012;33:45–74.

9. Behavioral Risk Factor Survey, Center for Health Statistics, New Jersey Department of Health, 2020, http://www.state.nj.us/health/chs/njbrfs/,

10. Abboud S, De Penning E, Brawner BM, Menon U, Glanz K, Sommers MS. Cervical Cancer Screening Among Arab Women in the United States: An Integrative Review. Oncol Nurs Forum. Jan 1 2017;44(1):E20-E33. doi:10.1188/17.ONF.E20-E33

11. Al Sad S, Pandit R, Alhashim N, Abdel-Rasoul M. Primary care Providers’ approaches to cervical cancer screening in Muslim females. Prev Med Rep. 2023;32:102126. Published 2023 Feb 4. doi:10.1016/j.pmedr.2023.102126

12. Padela AI, Rodriguez del Pozo P. Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective. J Med Ethics. Jan 2011;37(1):40-4. doi:10.1136/jme.2010.037614

13. Darwish-Yassine, M., & Wing, D. (2005). Cancer epidemiology in Arab Americans and Arabs outside the Middle East. Ethnicity and Disease, 15(Suppl. 1), S1-5–8.

14. Matin M, LeBaron S. Attitudes toward cervical cancer screening among Muslim women: a pilot study. Women Health. 2004;39:63–77

15. Ahmad F, Mahmood S, Pietkiewicz I, McDonald L, Ginsburg O. Concept mapping with South Asian immigrant women: barriers to mammography and solutions. J Immigr Minor Health. 2012;14(2):242-250. doi:10.1007/s10903-011-9472-7

16. Pandey, M., Maina, R.G., Amoyaw, J. et al. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Serv Res 21, 741 (2021). https://doi.org/10.1186/s12913-021-06750-4

17. Hamdy SF. Islam, fatalism, and medical intervention: lessons from Egypt on the cultivation of forbearance (sabr) and reliance on God(tawakkul). Anthropological Quarterly 2009;82:173-96

18. Centers for Disease Control. Cancer screening—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012; 61:41–5. [PubMed: 22278157]

19. DATA. 2030. [cited 26 April 2024]. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/increase-proportion-people-usual-primary-care-provider-ahs-07/data-methodology

Informed Consent: Prior to participation, respondents were told what their responses would be used for, the objectives of the research study, and the risks and benefits of their participation. Respondents were reassured their responses would be anonymous and they were free to withdraw from the study at any point.

Ethical Approval & IRB and/or IACUC Approval: The study protocol, including the informed consent forms and data collection procedures, was reviewed and approved by Rowan University IRB under study ID number PRO-2022-386.

Financial Disclosure: None reported.

Poster No. PH-15

Abstract No. 2024-068

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Building Disability Competency in Osteopathic Medical Students in Rural Ohio Pilot Study

Allyson Hughes, PhD, Jenna Barrett, Olivia Dillman

Department of Primary Care Ohio University-Heritage College of Osteopathic Medicine, Athens, OH

Context: Appalachian based care for individuals with intellectual and developmental disabilities (I/DD) has fallen behind the standard of care. The largest proportion of Ohioans with disabilities live in Ohio’s rural Appalachian counties (1). The Appalachian region falls below the national average in both mental and physical health outcomes. Contributing factors to these trends include systemic issues such as socioeconomic disparities and barriers to healthcare access, including shortages of healthcare providers due to the relative remoteness of many Appalachian communities. Compared to Ohio adults with disabilities, those in the Appalachian region are more likely to live below the poverty line (34.8%), have lower educational attainment (68.1% have a high school education or less), and be unemployed (68.5%) (2). Addressing these issues is crucial for improving health outcomes in this region. Currently, individuals with I/DD must travel over an hour to Columbus or Cincinnati for specialty care from disability-competent clinicians. Training the next generation of physicians in I/DD competence will help reduce these disparities and minimize the need for long-distance travel for care. This project addresses the needs of the adult population with I/DD by aiming to improve the healthcare that they will receive in their local community, encouraging future physicians to be advocates for this population, and increasing empathy for individuals with I/DD and their caregivers. This project provides training to medical students to improve competency and training in disability.

Objective: To determine whether focused I/DD education and training can improve future physicians’ understanding of I/DD, increase empathy, and reduce bias towards this patient population.

Methods: This study utilized surveys as the primary methodology. Participants completed three pre-test surveys that evaluated general knowledge, empathy, and bias towards I/DD. The Jefferson Scale of Empathy (JSE) was used to assess empathy, and the Attitudes Towards Disabled Persons (ATDP) scale was used to assess bias. Surveys were administered on participant’s personal technology devices using a Qualtrics survey link. Following the pre-test surveys, participants completed a three hour in-person training session on I/DD. After the training, the same three surveys were administered to participants with the addition of three quality improvement questions pertaining to the training session. Participants in this study included first and second year medical students at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) located in Athens, OH. All first- and second-year students at OU-HCOM were invited to participate without exclusion criteria, and student participation was voluntary. To recruit participants, flyers were distributed in the OU-HCOM medical building as well as electronically via the student newsletter and medical student organizations. In total, nine students participated in the training session and completed the pre-test measure. Six students completed the post-test measures. Students were offered a $10 Tango gift card in exchange for their participation.

Due to the small sample size and nature of the study, no randomization or grouping procedures were done. All participants completed the same training and surveys on the same day and in the same order. Components of the training included a brief informational session on I/DD led by Dr. Allyson Hughes, a Q&A panel that included both people with I/DD and their caregivers, and two research presentations from established social scientists who have conducted research in the field of I/DD health disparities. Paired t-tests were used to determine if there were significant differences between the pre- and post-test scores on attitudes, empathy, and knowledge of I/DD. Osteopathy is focused on a holistic view of medicine that considers the entire person when managing medical conditions and considering avenues of treatment. Every physician will encounter I/DD in their respective practice. In order to maintain a person-centered view of care, it is imperative that osteopathic physicians understand the nuances of conditions that affect this population.

Results: The majority of participants identified as female (83.3%). Half of participants identified as Black or African American. Half of participants identified as white. The average age of participants was 26 years old. The majority of participants were first year osteopathic medical students (66.6%). Two students reported having a family member with I/DD. The response rate for this study was 66.6%. The final number of participants was six medical students located at the Ohio University Heritage College of Osteopathic Medicine. A paired-samples t-test was conducted to compare knowledge levels in pre- and post-test conditions. There was a significant difference in the knowledge scores for pre- and post-test (p = .001, n=6). A paired-samples t-test was conducted to compare empathy levels in pre- and post-test conditions. There was a significant difference in the empathy scores for pre- and post-test (p = .041, n=6). Differences between pre- and post-test for ATDP were not statistically significant.

Conclusion: This study investigated whether focused education and training on I/DD would improve future healthcare professionals’ understanding of I/DD, increase empathy, and reduce bias towards this patient population. The intervention demonstrated statistically significant improvements in both knowledge about I/DD and empathy towards patients with I/DD among the medical students following the intervention. Importantly, the intervention did not show a significant change in attitudes toward disabled persons. Limitations of this study included the small sample size and selection of participants from a single rural medical school. Although results should be generalized with caution, this pilot study provides preliminary evidence that focused education and training on I/DD may be beneficial for future healthcare physicians and their patients, as it has the potential to improve knowledge and empathy in this population.

References

1. Centers for Disease Control and Prevention. Disability and Health Data System: Ohio. Available at: https://www.cdc.gov/ncbddd/disabilityandhealth/impacts/ohio.html. Accessed June 14, 2024.

2. Population Reference Bureau. Population Reference Bureau Aging in the Arab Region Chartbook. Published June 2020. Available at: https://www.prb.org/wp-content/uploads/2020/06/prb-arc-chartbook-2020.pdf. Accessed June 14, 2024.

Informed Consent: Participants were provided an Ohio University Research Consent Form. This form included information about the current study, including purpose, procedures, risks, benefits, confidentiality, and details on compensation. Participants were provided the consent form in person and given ample opportunity to read the form and ask questions. Participation was voluntary.

Ethical Approval & IRB and/or IACUC Approval: This study was deemed exempt. IRB project number is 24-E-24.

Financial Disclosure: None reported.

Poster No. *PH-16

Abstract No. 2024-073

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Culturally competent nutrition education for pediatrics health promotion: assessing efficacy and implications

¹Cassandra Daniels, OMS-IV, ¹Hannah Shimizu, ²Katheryn Hudon, DO, ¹Mia Smith, ¹Alison Day, ³Lizzie Lamb

¹Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, WA; ²Department Chair of Pediatrics, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, WA; ³Research Development Facilitator, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, WA

Context: Families in Yakima, WA experience various intersections of financial, language and access barriers to medical care and appropriate nutrition resources. Yakima, WA, situated 142.3 miles inland from Seattle, has a total population of 97,012 [1], with 50.2% identified as Hispanic or Latino. Among them, 19.1% live below the poverty line, and 27.8% rely on seasonal agricultural work [2]. Alarmingly, 34% of the youth in Yakima face obesity, significantly surpassing the national average of 23% [3]. Recognizing this concerning trend, a notable community specific issue emerged: a considerable number of school-aged students wished to participate in sports, yet lacked access to physicians for physical clearances. As part of the initiative to increase access to medical care for low income families, the Yakima School District (YSD) established a free sports physical clinic in 2022 in collaboration with Pacific Northwest University (PNWU) to provide medical students and staff physicians to provide care. Throughout the patient visits during the first year of pediatric sports physicals, parents frequently inquired about resources we could recommend, educational counseling we could provide, and culturally relevant tips we had to help them improve the health of their family in terms of nutrition. This feedback underscored the need for pediatric health specific educational interventions. However, efforts faced many barriers as parents struggled with adherence to traditional healthy eating guidelines due language barriers, lack of access to resources, and ingrained cultural practices. In response to this, our quality improvement project was created as a deliberate path of harm reduction through improving nutritional education for pediatric health. This quality improvement initiative aims to enhance these pediatric sports physicals by evaluating the effectiveness of providing culturally sensitive nutrition information and take-home resources on improving nutrition literacy in our target population.

Objective: To describe a novel approach to increasing nutrition literacy in Hispanic families through increasing access to culturally competent nutrition resources To describe efficacy of improvement in nutrition knowledge following interventions delivered

Methods: To assess efficacy of the nutrition intervention, 52 parents received nutrition counseling (N=52) and completed pre and post testing using a shortened 11 item General Nutrition Knowledge Questionnaire - Revised (GNKQ-R) survey. Survey participants were selected by attending the free pediatrics sports physical clinic and electing to opt into receiving nutritional education materials. Exclusion criteria were parents who did not elect to receive free nutrition education, although none of our participants declined counseling. Efficacy was evaluated through unpaired T-tests to assess the difference between correctly answered pre- and post-test questions. Intervention materials consisted of a bilingual nutrition pamphlet developed in collaboration with Hebni Nutrition Consultants and Migrant Health Promotion Salud, with Spanish medical translators provided as needed, and were delivered by first-year medical students. Holistic osteopathic focus was placed on the patients and their body, following an original tenant that every body has the innate capacity to self-heal and maintain health. Our project focused on providing nutritional health in a culturally sensitive way to help support and asses in that innate and natural healing process. We fostered a relationship with the greater community while advocating for the patient behind the disease and allowed for transparent communication on the health literacy discrepancies each family faces.

Results: Of the participants who completed both the pre- and post-surveys, an analysis of the data revealed that out of the 11 questions with 34 total subsections of the 11 questions, only 3 subsections had a statistically significant difference (p value 0.05. Final response rate of 88.46%, with total pre-tests taken 52 and total post-tests collected and analyzed 46.

Conclusion: These results suggest that overall, the intervention was not effective for this population. Our sample size of total 52 families who completed the pre-test, our total sample was limited by a post-test response rate of 46. Some families were lost to follow up due to iPad malfunctioning on collecting and storing post-test data. Additionally, limited number of medical students’ availability to provide educational counseling impacted delivery of intervention and post testing for 3 families who did take the pre-test but did not receive counseling or the post-test. Lack of statistical significance could be attributed to a variety of other contributing factors: concepts from nutrition counseling may not have been comprehensible to participants, individuals may have required multiple counseling sessions for the intervention to be effective, and the search for a culturally sensitive assessment tool limited the availability of validated instruments to assess changes in knowledge. Interacting with this population and speaking to families confirmed the significant gap and need to provide a different validated instrument on nutrition knowledge more amiable to different levels of reading comprehension. Further study is warranted to explore the evidence base for developing more osteopathic guided relevant interventions to continue working towards a healthier community.

References

1. QuickFacts: Yakima city, Washington. Census Bureau QuickFacts. Published 2023. https://www.census.gov/quickfacts/fact/table/yakimacitywashington/PST045223

2. ESDWAGOV - Yakima County profile. esd.wa.gov. Accessed June 17, 2024. https://esd.wa.gov/labormarketinfo/county-profiles/yakima#:∼:text=Specifically%2C%20on%20an%20average%20annual‌.

3. Yakima Valley Nutrition & Physical Activity Resource Guide Acknowledgement. https://research.fredhutch.org/content/dam/stripe/chealci/files/Yakima%20Nutrition%20&%20PA%20Resource%20Guide.pdf

Informed Consent: Patients were greeted in their native language when arriving for sports physical appointments and asked if they would like to participate in the quality improvement project, including filling out a pre and post survey to assess nutrition education provided in their native language, and receiving free bilingual nutrition education pamphlets and free bilingual nutrition counseling delivered by first year medical students and medical interpreters, with no personal identifying patient information stored or collected. Patients were educated and assured that their free sports physical appointment and medical care would not be impacted by accepting or declining participation in the quality improvement project. Risks and benefits were discussed and participation was agreed upon prior to participation in the quality improvement project.

Ethical Approval & IRB and/or IACUC Approval: Quality Improvement Project - No IRB involvement

Financial Disclosure: None reported.

Poster No. *PH-17

Abstract No. 2024-078

Category: Public Health

Research Focus Area: Chronic Diseases & Conditions

Characteristics and Experience of Chronic Pain Across Demographics and SDOH in Maine

¹Penhleakhena Ou, BS, OMS-II, ²Ling Cao, MD, PhD, MPH

¹Department of Research, University of New England College of Osteopathic Medicine, Biddeford, ME; ²University of New England College of Osteopathic Medicine, Biddeford, ME

Context: Chronic pain is a significant health problem in the United States. Several factors can impact the physical, social and emotional experience of chronic pain. These factors include, but are not limited to, demographics, lifestyle behaviors, physical activity and mental health [1]. In a 2023 CDC report, it was found that the prevalence of chronic pain was higher among older adults and females [2]. These findings are consistent with results found in Maine in the study published by Malon et al (2018). According to the US census data, Maine remains first in the country as the state with the highest percentage of persons 65 years and over. Therefore, the population of Maine presents with a unique opportunity to further explore the burden of chronic pain. Current knowledge of chronic pain prevalence in Maine is limited to the sole study from Malon et al (2018), which used the Maine all payers insurance claims database from 2006 to 2011 [3]. The absence of studies with robust information on the impact of social determinants of health (SDOH) on chronic pain and its management and lack of qualitative data regarding chronic pain in Maine warrants a SDOH-focused data collection and analysis.

Objective: To understand the SDOH characteristics and demographics of those with pain in the state of Maine via descriptive statistics; to explore the relationships between SDOH characteristics vs. pain-related measures including pain severity and associated co-morbidities.

Methods: Through a pilot grant from the Northern New England Clinical & Translational Research Network (NNE-CTR), in collaboration with MaineHealth, the Cao lab initiated a longitudinal SDOH-focused pain registry (PainRegistryforME) that started collecting data from Maine residents in the summer of 2023. Individuals living in the state of Maine who are ≥ 18 years old with any type of recurrent or frequent pain are eligible to participate by completing an anonymous survey administered through RedCap, a HIPPA-compliant survey instrument. The survey link and QR code was distributed through institutional networks, collaborating clinics, and chain grocery stores via the study flyer. Data for the first interim analysis became available in February 2024 and were used in this report. PainRegistryforME has a total of 75 questions that are divided into 4 sections: demographics, pain characteristics, pain management, and SDOH. Demographic and SDOH variables used in this current analysis include age, biological sex, county of residence, and education level measured by highest degree earned. Pain characteristics were measured via the NIH Patient-Reported Outcomes Measurement System (PROMIS) -29+2 Profile/Battery v2.1 (PROPr). This includes a total of 31 questions with 8 domains (anxiety, depression, fatigue, pain interference, physical function, sleep disturbance, ability to participate in social roles / activities and cognitive function) as well as a single pain scale question measuring perceived pain severity. The responses are recorded on a 1 to 5 Likert scale and then summed per domain to obtain domain scores. The pain scale ranges from 0 to 10 with 0 indicating no pain and 10 being the worst pain perceived. Descriptive statistics were performed using Excel to profile the sample based on its demographic and SDOH characteristics. IBM SPSS version 29 software was used to examine the relationships between demographic and SDOH characteristics (independent variables) vs. each of the pain-related measures (dependent variables) with a multivariate Analysis of Variance (MANOVA). The osteopathic holistic approach to patient care focuses on prevention and puts emphasis on the environment (including both physical and social environment) and lifestyle to improve one’s physical, mental, and spiritual health. To prevent and manage chronic pain, it is important to understand the make-up of the chronic pain population. Understanding how pain is experienced within each demographic and SDOH can also help identify appropriate management options, as well as advocating for better health services for the population.

Results: Out of the 112 respondents, data from 3 respondents were excluded from the data analysis due to missing data leaving 109 subjects eligible for analysis. All participants met the chronic pain diagnosis as all subjects reported having pain for at least 3 months. Age was reported in 5-year intervals (i.e. 18-24, 25-29…etc.) with the last category being 80 years and older. The age groups with the highest percentage of respondents were 25-29 years of age and those 55-59 years of age making up 11% (12/109) each. As for biological sex, 70% (76/109) of the respondents were females, which is consistent with previous reports that chronic pain is more prevalent in women. Current respondents were mostly from Cumberland and York counties (75/109, 69%), reflecting the fact that these are the most populated counties in Maine and home to the research institutions. For education level, most respondents possess a bachelor’s degree (49/109, 45%) which is disproportionate to the Maine census data, with only 22% of the population having a bachelor’s degree. This may be a selection bias as many of our respondents may be associated with the educational institution. MANOVA detected statistically significant effects of age and level of education on certain PROPr domains. Age significantly affected participants’ levels of anxiety, depression and cognitive function [F (108, 653) = 1.33, Wilk’s Λ = 0.235, p=0.02]. Specifically, younger individuals tend to report more anxiety and depression as well as worst cognitive function. MANOVA did not detect statistically significant effects for residing county [F (117, 663) = 1.14, Wilk’s Λ = 0.254, p=0.161]. Although, univariate ANOVAs showed that anxiety (p=0.005), depression (p=0.041), and cognitive function (p=0.045) were also significantly influenced by individual’s residing counties. Meanwhile, biological sex did not significantly affect any of the PROPr pain domains. The highest degree earned had differential effects on individual pain related domains [F (45, 434) = 1.67, Wilk’s Λ = 0.482, p=0.006]. In general, higher degree earned were associated with better pain-related outcomes, including anxiety (p=

Conclusion: The current analysis detected notable pain comorbidity in young Mainers and differential effects of education level on pain comorbidities. This analysis also confirmed the high prevalence of pain in females in Maine. Current participant profiles call for further additional recruitment of Mainers living in other counties and with various education levels. Continued data collection from PainRegistryforME is necessary to understand the pain population in Maine and how specific demographic and SDOH characteristics could influence individuals’ chronic pain experiences. The higher prevalence of pain and associated comorbidities reported by certain social groups can inform clinicians when assessing patient’s risks for developing chronic pain and identifying appropriate preventative/treatment options, and ultimately promote public health strategies and intervention for pain prevention and management in Maine.

References

1. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e283. doi:10.1016/j.bja.2019.03.023

2. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. doi: 10.15585/mmwr.mm7215a1

3. Malon J, Shah P, Koh WY, Cattabriga G, Li E, Cao L. Characterizing the demographics of chronic pain patients in the state of Maine using the Maine all payer claims database. BMC public health. 2018;18(1):810. doi: 10.1186/s12889-018-5673-5

Informed Consent: Since this is designed as an online survey, participants are not required to physically sign a consent form. Checking the box “Yes” regarding their willingness to continue with the survey questions and clicking on “Submit” at the end of the survey together indicate subjects’ consent to participate in the research. This was automatically documented by REDCap. However, the research team does not witness the consent process due to the online feature of the survey.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

★Poster No. *PH-18

Abstract No. 2024-089

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Outreach Education led by Osteopathic Medical Students on Substance Use Prevention for Sustainable Health Literacy in Underserved Youth Communities

¹Esha Garg, OMS-III, ¹Krishna Gogineni, ¹Sameera Mahimkar, ¹Viji Jambunathan, ¹Leena Jamal, ²Carrie Nazaroff, ¹Carolina Restini, PharmD

¹Department of Pharmacology and Toxicology, Michigan State University College of Osteopathic Medicine, East Lansing, MI; ²Department of Radiology, Michigan State University College of Osteopathic Medicine, East Lansing, MI

Context: Substance abuse, especially due to opioids, marijuana, and e-cigarette usage in high schools is correlated with a lack of knowledge and spread of misinformation in the cohort, as well as a lack of communication from healthcare professionals [1]. Thus, there is a need to improve education and prevention efforts in this vulnerable population [2]. In 2019, the Substance Use Prevention (SUP) Task Force was formed at Michigan State University College of Osteopathic Medicine (MSUCOM) and was later restructured as a committee under the Student Osteopathic Medical Association (SOMA) chapter of MSUCOM. Inspired by the Opioid Prevention Task Force created by the National SOMA [3], the SUP initiative aims to merge primary prevention strategies with osteopathic principles. This program seeks to empower high school students in the greater Detroit area, a historically underserved community, to make informed decisions about substance use.

Objective: To demonstrate the protocol development process for a community service initiative led by Osteopathic Medical Students (OMS) and to evaluate the effectiveness of educational interventions designed by OMS in enhancing high school students’ understanding of substance use.

Methods: As incorporated under SOMA, co-chairs and committee member positions were created, and volunteer positions were open to all OMS candidates in MSUCOM. Committee members and faculty established lines of communication with high school leadership, securing necessary permissions from principals, parents, and relevant faculty. Committee members organized presentations and coordinated the requests of the schools in terms of the substances presented and time constraints with volunteers, working to create a flexible presentation that met the needs of the individual school. The project was submitted to the IRB, including data collection and obtaining informed consent from the principals, parents/guardians, children, and instructors. Pre-clerkship students were actively recruited through the MSUCOM SOMA chapter. Interested OMS joined the program after being informed of the purpose and expectations of SUP and its outreach activities, undergoing ethical training and fulfilling the institutional obligations required to interact with minors. SUP Committee leaders created educational materials after consulting current research about substance abuse, relevant national and state legislation, and information from the MSUCOM curriculum. Faculty advisors networked with community leaders/high school representatives, and also provided permanence to a program characterized by the transience of medical students. The educational materials included interactive activities such as question banks, physical games like bingo and a spinning wheel, and technology tools inspired by the MSUCOM pre-clerkship curriculum. Presentation content was modified to meet needs identified by the school and often focused on opioid overdose and e-cigarette/vaping, as community needs differed by school district (IRB-approved study MSU ID: 8018). High school students completed a survey administered by the Qualtrics application before and after the topic discussion to assess student learning and the impact of OMS didactic interactions. Questions on the anonymous survey pertained to assessing substance identification, overdose reversal, and health consequences. Surveys featured both subjective scales (i.e., measures of confidence) and objective questions (concepts touched on in the presentation such as substance identification, overdose reversal, health consequences, and socioeconomic burden). Data were collected from 100 high schoolers who met the inclusion criteria of attending the interactions and completing both surveys. Answers were collected electronically. Data are expressed as % (N). T-test was applied to statistical analyses (Prism GraphPad, 10.2). Significance considered p<0.05 (CI, 95%).

Results: After the approval of SUP as a committee in 2022, and the subsequent successful recruitment of pre-clerkship students as members, the SUP member roster saw a 400% increase in OMS participation. From there, we were able to find results from our dynamic interactions. We dissected student knowledge gain in two ways: subjectively and objectively. Subjects ranked their confidence in the expertise of the substance use presented before and after didactic interactions. Amongst all the schools, there was an increase of 33% (p<0.05) of students reporting being “a lot more” or “a great deal” confident in their knowledge of e-cigarettes/vaping and an increase of 44% (p<0.001) reporting “a lot more” or “a great deal” confident for opioids. Additionally, 55.2% (p<0.01) learned the similarities and differences between e-cigarettes and tobacco, 53.7% of students learned about the use of naloxone, and 66.9% of students understood how opioid overdose occurred. Learning was demonstrated by correctly answering post-survey questions compared to pre-survey ones.

Conclusion: OMS successfully communicated and educated teenagers about e-cigarettes and opioids, improving proficiency, and increasing confidence among the students. Such positive results are due to the high schoolers’ engagement and the incorporation of active learning techniques during the presentations. Due to its design as a cross-sectional study, data were collected before and immediately after the presentation. This creates a limitation intrinsic to the study, namely that the long-term retention of the material by students is unknown. This limitation can be overcome with a prospective study that would reassess student knowledge after a given period, providing insight into the long-term retention of material from OMS-lead SUP presentations. Overall, self-confidence is key for health literacy, which may empower the youth to utilize their newfound knowledge about substance abuse to make informed decisions. The sustainability of this project is substantiated by its continuation into its third year, demonstrating its potential for statewide and national implementation.

References

1. Haddad L, Shotar A, Umlauf M, Al-Zyoud S. Knowledge of substance abuse among high school students in Jordan. J Transcult Nurs. 2010;21(2):143-150. doi:10.1177/1043659609357632

2. Stigler MH, Neusel E, Perry CL. School-based programs to prevent and reduce alcohol use among youth. Alcohol Res Health. 2011;34(2):157-162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860568/

3. Waskel EN, Antonio SC, Irio G, Campbell JL, Kramer J. The impact of medical school education on the opioid overdose crisis with concurrent training in naloxone administration and MAT. J Addict Dis. 2020;38(3):380-383. doi:10.1080/10550887.2020.1762030

Informed Consent: The principals and parents of the minors to whom the research surveys were administered were given consent forms detailing the surveys to be employed and the manners in which collected data would be used. The purpose and procedure were clearly detailed, and alternatives were provided for parents who did not consent to their child participating in data collection. Confidentiality was emphasized, and risks/benefits were highlighted for thoroughness as well.

Ethical Approval & IRB and/or IACUC Approval: Reviewed and approved. IRB number STUDY00008018.

Financial Disclosure: None reported.

Poster No. *PH-19

Abstract No. 2024-092

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Effects of Equine Assisted Services on Parental Stress Scores of Children with Autism Spectrum Disorder

¹Danielle C. Barron, OMS-IV, ¹Madison P. Craft, OMS-IV, ¹Emily R. Florek, OMS-IV, ¹Brianna N. Stanley, OMS-IV, ²Alexis M. Stoner, PhD, MPH, ³Nancy K. Paschall, ⁴Sarah Newman, MD, ⁵David Redden, ⁶Kimberly I. Tumlin, PhD, MPH, MS

¹Edward Via College of Osteopathic Medicine (VCOM-South Carolina Branch Campus), Spartanburg, SC; ²Discipline Chair for Preventive Medicine and Public Health, Edward Via College of Osteopathic Medicine (VCOM-South Carolina Branch Campus), Spartanburg, SC; ³PATH Executive Director/Consultant Healing and Learning Through Equine Relationships (HALTER), Spartanburg, SC; ⁴ESMHL Equine Specialist in Mental Health and Learning Healing and Learning Through Equine Relationships (HALTER), Spartanburg, SC; ⁵Department of Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine (VCOM-Auburn Branch Campus), Auburn, AL; ⁶Center for Innovation in Population Health, and Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY

Context: Previous research has demonstrated that parents of children with chronic illness or disability have increased stress compared to parents with children without a chronic illness or disability. Equine Assisted Services (EAS) has previously shown considerable improvements in the social cognition, communication, irritability, and hyperactivity domains in children diagnosed with autism spectrum disorder (ASD). Due to the disorder’s growing prevalence, incidence, and varying effects and presentations, multiple therapy avenues are pursued for those with a diagnosis of ASD. However, research regarding the impact of animal-assisted-interventions, including equine assisted services (EAS), on the psychosocial and physical health of parents and caregivers of children with an ASD diagnosis participating in EAS is lacking.

Objective: The aim of this study is to assess if psychosocial improvements of children with ASD during a semester of Equine Assisted Services are associated with reduced parental stress scores.

Methods: This was a preliminary study with two aspects: a quantitative and qualitative portion. A pre/post-test survey consisting of the Depression Anxiety Stress Scale- 21 (DASS-21) was given to parents of children with ASD. The pre-test survey was administered before children begin their Spring EAS semester and the post-test survey was given once children complete the Spring semester. Semi-structured interviews were conducted and recorded over Zoom with each parent or caregiver during the EAS semester. The interview consisted of a set of standard questions developed to assess perceptions of psychosocial improvements and other factors related to stress. The questionnaire was created by research investigation staff and reviewed by advising faculty and statistician to ensure all questions did not lead to unintended bias. The responses were be coded and themes were determined using an thematic coding process independently by researchers. Each participant was assigned a pseudonym to ensure confidentiality is protected. Analyses began by summarizing sample mean and standard deviation for pre and post anxiety, depression, and stress scores. Change in anxiety, depression, and stress scores were calculated as the difference between post measurement to pre measurement. Due to the small sample size, we calculated the median change score and interquartile range for the change score. To test for statistically significant change, we used the Wilcoxon Signed Rank test.

Results: Of the 19 families recruited, 14 families choose to participate. One family was later excluded as the attendance requirement was unable to be met. The total sample consisted of 13 familie. Pre-intervention stress scores had a mean of 12.77 (SD = 9.95). Post-intervention stress scores had a mean of 8.62 (SD =10.976). Using a two tailed Type I error rate of 0.05, we observed a statistically significant decrease (p = 0.0339) in stress scores of parents post-intervention. Depression and anxiety scores did not show a statistically significant drecrease post-intervention. Pre-intervention mean depression scores were 4.31 (SD=6.92) with post-intervention depressions scores 2.31 (SD = 4.49). Pre-intervention anxiety scores were 5.54 (SD = 5.84) with post-intervention anxiety scores 4.00 (SD = 4.47). The semi-qualitative interviews were analyzed to determine common themes among caregiver responses to the predetermined questions. Co-investigators identified a total of thirty-one themes and determined the total frequency of those themes. The most frequently identified theme is related to parent or caregiver hobbies with this theme identified in nine parent interviews with a total frequency of seventeen. This theme was identified in responses to two interview questions: “What are your hobbies?” and “What do you do to relax.” Additional frequently identified themes are related to lack of resources in the area for children with ASD and parents not attending support groups for parents of children with ASD. These themes were identified eleven and ten times respectively.

Conclusion: Parents/caregivers experienced a statistically significant decrease in their stress levels over a single semester of EAS for their child with ASD demonstrated by a reduction in stress component of DASS-21 scores. With this reduction, it shows not only the benefit EAS has on the student but also the parent/caregiver. The themes identified in the interviews provide a new framework of areas where society can better support families of children with the diagnosis of ASD.

References

1. Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023;72(No. SS-2):1–14. DOI: https://doi.org/10.15585/mmwr.ss7202a1.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

3. Hyman SL, Levy SE, Myers SM, AAP Council On Children With Disabilities, Section On Developmental And Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020;145(1):e20193447

4. Farrugia D. Exploring stigma: Medical knowledge and the stigmatization of parents of children diagnosed with autism spectrum disorder. Sociology of Health & Illness. 2009;31(7):1011-1027. doi:10.1111/j.1467-9566.2009.01174.

5. DePape A-M, Lindsay S. Parents’ experiences of caring for a child with autism spectrum disorder. Qualitative Health Research. 2014;25(4):569-583. doi:10.1177/1049732314552455

6. Sivberg B. Family system and coping behaviors: a comparison between parents of children with autistic spectrum disorders and parents with non-autistic children. Autism. 2002;6(4):397-409. doi:10.1177/1362361302006004006

7. Suma K, Adamson LB, Bakeman R, Robins DL, Abrams DN. After Early Autism Diagnosis: Changes in Intervention and Parent-Child Interaction. J Autism Dev Disord. 2016;46(8):2720-2733. doi:10.1007/s10803-016-2808-3

8. Dieleman LM, Moyson T, De Pauw SSW, Prinzie P, Soenens B. Parents’ need-related experiences and behaviors when raising a child with autism spectrum disorder. Journal of Pediatric Nursing. 2018;42. doi:10.1016/j.pedn.2018.06.005

9. Smits RM, Vissers E, te Pas R, et al. Common needs in uncommon conditions: A qualitative study to explore the need for care in pediatric patients with rare diseases. Orphanet Journal of Rare Diseases. 2022;17(1). doi:10.1186/s13023-022-02305-w

10. Ansari AM, Janahi MI, AlTourah AJ, Jahrami HA, Rajab MB. Self-reported psychological disorders among the mothers of children with autism spectrum disorder, type 1 diabetes mellitus, and typically developed children. Journal of Neurodevelopmental Disorders. 2021;13(1). doi:10.1186/s11689-021-09369-y

11. Alghamdi K, Alahmadi S, Sayedahmad A, Mosleh H. Psychological well-being of mothers of children with autism in Saudi Arabia. Cureus. Published online 2022. doi:10.7759/cureus.23284

12. Kuhaneck HM, Madonna S, Novak A, Pearson E. Effectiveness of interventions for children with autism spectrum disorder and their parents: A systematic review of family outcomes. The American Journal of Occupational Therapy. 2015;69(5). doi:10.5014/ajot.2015.017855

13. Xiao N, Shinwari K, Kiselev S, Huang X, Li B, Qi J. Effects of equine-assisted activities and therapies for individuals with autism spectrum disorder: Systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2023;20(3):2630. doi:10.3390/ijerph20032630

14. Tan VX-L, Simmonds JG. Parent perceptions of psychosocial outcomes of equine-assisted interventions for children with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2017;48(3):759-769. doi:10.1007/s10803-017-3399-3

15. Henry JD, Crawford JR. The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. British Journal of Clinical Psychology. 2005;44(2):227-239. doi:10.1348/014466505x29657

16. Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The depression anxiety stress scales—21 (DASS‐21): Further examination of dimensions, scale reliability, and correlates. Journal of Clinical Psychology. 2012;68(12):1322-1338. doi:10.1002/jclp.21908

17. Zhao M, You Y, Chen S, Li L, Du X, Wang Y. Effects of a web-based parent–child physical activity program on mental health in parents of children with ASD. International Journal of Environmental Research and Public Health. 2021;18(24):12913. doi:10.3390/ijerph182412913

Informed Consent: The research team began the discussion for consent by explaining the overall study design including the time requirements, possible risks, and possible benefits. This was completed on an individual basis and not in a group setting. After answering any participant questions, consent was obtained via signature with the consent form that was created following the institution’s IRB approved consent form template. The consent was photocopied. The photocopied consent was given to the participant for their personal records and the original was stored inside of a locked cabinet in the faculty advisor’s office at VCOM-Carolinas.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

Poster No. *PH-20

Abstract No. 2024-094

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Student perception of Case Based Learning at a medical school in New York before and during the COVID-19 pandemic

Kiran Kumar Bhurtyal, MPH, Susanna Kung-Lau, Maria A. Pino

Clinical Specialties, New York Institute of Technology, Old Westbury, NY

Context: Many medical schools in the US include case-based learning (CBL) for preclinical students to prepare them for clinical rotations. At the New York Institute of Technology College of Osteopathic Medicine - Long Island Campus (NYITCOM- LI), CBL was switched from an in-person to a virtual platform in spring 2020 due to the COVID-19 pandemic restrictions on mass gathering. Because of the importance of CBL in preclinical education, we evaluated student perception of CBL before and during the pandemic.

Objectives: i) To assess perception of CBL among preclinical medical students through a self-reported survey ii) To compare student perception of CBL before and during the COVID-19 pandemic

Methods: This is a retrospective exploratory study of osteopathic medical students in year I (OMS-I) and II (OMS-II) at the NYITCOM-LI campus. All students who attended at least one CBL module from 2019-23 were sent a survey. Each CBL module consisted of a weekly two-hour session delivered over 8 to 12 weeks per semester. Student perception was collected using a Likert-like rating scale with four response categories (satisfied to a large extent, moderate extent, small extent, or not at all). Descriptive statistics were used to summarize student perception of CBL in four domains - case presentation, clinical reasoning, differential diagnosis formation, and overall experience. Using spring 2020 as the reference point for the pandemic restrictions on mass gathering, we aggregated students’ responses into two groups to compare perceptions before and during the COVID-19 pandemic.

Results: 12 modules of CBL were delivered from 2019-2023. 1962 out of 2959 students completed the survey (mean response rate = 66.3%). Overall, 1328 (83%) OMS-I and 1472 (92%) OMS-II respondents reported satisfaction to a large or moderate extent in all 4 domains of CBL across all four years from 2019 to 2023. Only less than 1.5% respondents had a strong negative perception (not satisfied at all) in three or more domains. Clinical reasoning (84%) and Formation of differential diagnosis (81%) were rated as skills that improved most among OMS-I and OMS-II students respectively. Students who participated in in-person CBL reported nominally higher satisfaction for case presentation (94.65%) compared to the students who participated in virtual sessions (90.9%). For other domains, the difference in satisfaction rates were less than 2%. The most frequent complaints students had about CBL remained the same between the in-person and virtual groups: cases not aligned to lectures (28% vs 26.6%), inconsistencies in vignettes (18% vs 17%), and vague questions (13% vs 14.3%). 55% of survey respondents who participated in virtual CBL commented that they would prefer in-person sessions, 30% respondents preferred the virtual format, and 15% preferred a combination of in-person and virtual CBL. Overall, 68% respondents stated that CBL would be better for reinforcing already learned concepts rather than introducing new ones. With 2 hours of CBL sessions and several hours of preparation time each week, more than 75% students in the both groups (in-person and virtual CBL) suggested that there should be fewer learning objectives and shorter focused sessions.

Conclusion: Overall, students had a positive perception of CBL in both in-person and virtual formats. Almost two-thirds of virtual CBL participants preferred an in-person or a combination of in-person and virtual format. Because CBL requires significant student time and effort, medical schools should explore ways to optimize the delivery of CBL modules. Future studies should investigate the impact of skills learned during CBL on student outcomes during clinical rotations.

Informed Consent: Not applicable

Ethical Approval & IRB and/or IACUC Approval: Exempted

Financial Disclosure: None reported.

Poster No. PH-21

Abstract No. 2024-103

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

“Limitations of Life:” A Mixed Methods Survey Exploring Osteopathic Medical Students’ Perspectives on Reasons Preventing them from Practicing In Rural Communities

¹Naziyya Haque, MPH, CHES, OMS-IV, ²Chante Richardson

¹Alabama College of Osteopathic Medicine, Dothan, AL; ²Health Equity, Diversity, and Inclusion, Meritus Health, Hagerstown, MD

Context: Although there is a significant physician shortage in rural communities with equally significant efforts to recruit physicians to fill the gaps1,2, the disparity continues to exist. The lack of physicians thus limits healthcare access, further contributing to health disparities and unequal healthcare outcomes.

Objective: The purpose of this study was to examine and identify potential factors that either contribute to or prevent students from practicing medicine in rural communities.

Methods: This mixed-methods study utilized an online cross-sectional survey containing both multiple choice and open-ended questions that was administered to over 700 osteopathic medical students, faculty, and staff at an osteopathic medical school in the southeastern United States. Participants were recruited both online through school-wide emails and social media as well as in person via posters and in-person school events on campus. Participants gave written informed consent prior to taking the survey, and all responses were anonymized. Open-ended response questions were analyzed for themes, while multiple choice questions were analyzed using chi-square tests. The osteopathic significance of this study is that it specifically asks osteopathic medical students about factors that would either encourage or prohibit them from pursuing clinical practice in rural communities.

Results: There was a statistically significant relationship between students’ geographic backgrounds and their future geographic preference for their career (p

Conclusion: As other studies have noted3, osteopathic medical students’ geographic backgrounds may play a significant role in where they choose to practice medicine. This study has several limitations, such as it not reaching full saturation with its themes, its inability to elicit follow-up questions and/or gauge if students’ perceptions on rural communities changed after starting their clinical rotations. Our findings suggest potential future avenues for research and recruitment ranging from more in-depth qualitative approaches to a more longitudinal study analyzing how students’ perspectives might change in their clinical years.

References

1. Nielsen M, D’Agostino D, Gregory P. Addressing Rural Health Challenges Head On. Mo Med. Sep-Oct 2017;114(5):363-366.

2. Elma A, Nasser M, Yang L, Chang I, Bakker D, Grierson L. Medical education interventions influencing physician distribution into underserved communities: a scoping review. Hum Resour Health. Apr 7 2022;20(1):31. doi:10.1186/s12960-022-00726-z

3. Shipman SA, Wendling A, Jones KC, Kovar-Gough I, Orlowski JM, Phillips J. The Decline In Rural Medical Students: A Growing Gap In Geographic Diversity Threatens The Rural Physician Workforce. Health Aff (Millwood). Dec 2019;38(12):2011-2018. doi:10.1377/hlthaff.2019.00924

Informed Consent: All participants provided written informed consent prior to participation.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: ​None reported.

Poster No. *PH-22

Abstract No. 2024-104

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Toolkit for Improved Mental Wellness Among High School Students

¹Lily Marie Anton, OMS-III, ¹Emily Koenig, ¹Sierra Thompson, ¹Hanna Ozbeki, ¹Laquisha Malone, ¹Charles Wu, ²LeAnn Allgood, MD, ³Surekha Appikatla, MPH, ³Joy Lewis DO, PhD

¹A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ²School of Osteopathic Medicine in Arizona - Surgery Course Director, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, Mesa, AZ; ³Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, Mesa, AZ

Context: In 2022, Arizona was ranked 49th out of 50 states in overall mental health, adolescent mental health, and access to care.1 Long term consequences of poor mental health in adolescence include increased violence and substance use.2 Given the high rate of mental illness among Arizona adolescents and lack of access to care, a mental health toolkit and in-person education curriculum was implemented at a local high school. The goal of the program was to improve access, literacy, and skills through the provision of evidence-based mental health practices for prevention.3

Objective: To bridge the access gap and improve health literacy through evidence-based self regulated mental health practices with the vision of improving emotional wellbeing and educating adolescents on essential skills in managing their mental health.

Methods: The project included an educational intervention and provision of a mental health toolkit. By addressing access to mental health resources, this project aimed to address the osteopathic behavioral model by introducing or reinforcing techniques to improve resiliency and reduce stress. The intervention included three educational workshops spread over 6 weeks, informed by WHO guidelines to promote and protect adolescent mental health. The toolkit and workshops complimented each other. The toolkit consists of time management resources, journaling prompts to foster self reflection, positive affirmations, and sleep hygiene tools. During the first session, students participated in a pre survey, given a toolkit, and engaged in an educational session explaining the significance of each piece of the toolkit. The second session was focused on the connection between mental and physical well being, discussing concepts like nutrition, movement, body image, and sleep. During the final session, students completed a post survey and participated in an educational session about red flags in mental health and self love.

Participants were 32 students from Alhambra High School in Phoenix, Maricopa County, AZ. Data collection involved two surveys: a pre-survey and a post-survey gauging their knowledge on mental health and self-care, along with opinions on educational workshops. Students were assigned a toolkit ID to double-blind all data collection. Analysis was done by comparing pre- and post- surveys using paired samples tests to identify correlations. In addition, questions were categorized into 5 categories and survey results of these categories were compared using paired samples tests.

Results: 24 students completed both pre- and post-surveys. Surveys assessed the effectiveness of the workshops and toolkit, and measured changes in students’ mental health knowledge. Responses were made using numerical values. Comparison of pre and post means were assessed as a measure of changes following intervention to draw initial conclusions on efficacy. Questions regarding social support (p = 0.002) and social awareness (p = 0.023) were each correlated, suggesting little change in these domains after intervention. Additional education sessions and connection to community resources are recommended to potentially improve these measures.

Questions were grouped into 5 reported categories for analysis: self care, social support, social awareness, and school associated stress management. Self care was assessed through questions regarding sleep, energy levels, nourishment, and exercise. Improvement was significant after our interventions (p = 0.046), suggesting these adolescents respond best to these mental health management techniques. There were positive responses to toolkit items intended to address school-associated stress, although not significant. School-associated stress (p = 0.044) and self esteem (p = 0.056) were each correlated, showing no change after intervention. Increased time with the toolkit and/or additional education sessions may allow students to gain familiarity and confidence in stress-reduction strategies.

Conclusion: Our interventions addresses a potential gap in mental health resources at Alhambra High School and promotes student well-being through skills for resilience, healthy habits, and coping mechanisms. This clear, data-driven approach (needs assessment, pre-made intervention implementation, and pre-made surveys) is replicable by other schools, in editable formats allowing them to adapt it to their specific needs. For the future, we can explore ways to ensure long-term sustainability. Can the toolkit be integrated into existing lessons? Are there resources for future programs? Teacher collaboration strengthens the potential reach of these interventions.

Arizona House Bill 2161 requires parental consent to administer student mental health surveys.4 Our high school program (designed for 60) faced limitations due to permission slips, resulting in a smaller, female-dominated cohort (32 students) from the medical arts program. The short 7-week program limits generalizability. We expect stronger results with more sessions and time in a future study.

References

1. Reinert, M, Fritze, D. & Nguyen, T. (October 2021). “The State of Mental Health in America 2022” Mental Health America, Alexandria VA

2. Centers for Disease Control and Prevention. (2024b, May 1). Mental health. Centers for Disease Control and Prevention.https://www.cdc.gov/healthyyouth/mental-health/index.htm#:∼:text=Poor%20mental%20health%20in%20adolescence,decision%20making%2C%20and%20their%20healt.

3. World Health Organization. Helping adolescents thrive toolkit: strategies to promote andprotect adolescent mental health and reduce self-harm and other risk behaviors.

4. AZ HB2161 | 2024 | Fifty-sixth Legislature 2nd Regular. (2024, February 27). LegiScan. Retrieved May 04, 2024, from https://legiscan.com/AZ/bill/HB2161/2024

Informed Consent: Students at Alhambra High School in participating classrooms were introduced to the project by their biology teacher. The teacher briefly explained the purpose of the toolkit and intermittent mental health education workshops led by OMS-II students from ATSU-SOMA. Students were given the opportunity to ask the project team questions during the first school visit. Parental guardians signed a study information sheet to consent that their child(ren) has permission to ​participate.

Ethical Approval & IRB and/or IACUC Approval: Our project was determined to be ’non-research’ and therefor exempt.

Financial Disclosure: None reported.

Poster No. *PH-23

Abstract No. 2024-105

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Evaluating the Knowledge, Attitudes, and Practices of Chagas Disease Among Health Professionals in South Florida, USA

¹Chanakya R. Bhosale, BS, OMS-II, ¹Thomas Matthews, MS, ¹Ambika Kapil, BS, ¹Angeline Triyono, BS, ¹Santiago Ortiz, BS, ²Anna K. Potter, PhD

¹Health Professions Division, Nova Southeastern University Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, FL; ²Department of Foundational Sciences, Nova Southeastern University Kiran C Patel College of Osteopathic Medicine - Clearwater, Tampa Bay, FL

Context: Chagas Disease (CD) is a vector-borne anthropozoonotic illness caused by the parasite Trypanosoma cruzi. The disease has historically been described as primarily afflicting Latin America [1]. However, the confluence of immigration, travel, socioeconomic disparities, and the presence of several epidemiological factors (the parasite, disease vector, & wild animal disease reservoir hosts) has created a potential for transmission in the Southern United States (US) [2-5]. Due to these factors, limited awareness, and the hidden nature of the parasite, it is estimated that Florida may have more than >18,000 individuals living with CD [2-4]. Given the escalating risk of infection and large high-risk immigrant population from Latin America, we have identified the area of Southern Florida as a region in the Southeastern US of importance to track and increase awareness of CD [4]. We hypothesized this region as a potential large at-risk area, which will become imperative for medical practitioners to possess knowledge to properly diagnose and manage CD. Nevertheless, prior research has highlighted a notable deficiency in knowledge and practices concerning this neglected tropical disease in the US [6-10], with no specific studies conducted among Florida medical practitioners across various specialties of interest, including primary care, family medicine, pediatrics, internal medicine, infectious disease, cardiology, obstetrician-gynecology etc. or in practices where patients may potentially present with classic acute or chronic clinical findings of CD.

Objectives: The specific objectives of this study are 1) To determine healthcare awareness of classic symptomatology and epidemiology of CD in various specialties, primary care offices, hospitals, and free medical clinics. 2) To determine the association between aspects of healthcare professionals’ (ethnicity, experience level, region, and type of medical training and practice) and their awareness of potential CD medical cases in South Florida. 3) To identify future steps for education, community outreach, and training across various sectors and health professions, including Osteopathic medical practitioners in South Florida regarding CD management. We hypothesize that our data will showcase relevant differences in KAP among the varying demographics in South Florida, showing an overall disparity of this neglected tropical disease in the region.

Methods: This IRB-exempt, cross-sectional study utilizes a 25-question survey measuring demographic information (e.g. specialty of medicine), knowledge, attitudes, and practices (KAP) among health care professionals (physicians [both osteopathic and allopathic], medical residents, nurse practitioners & physician assistants) in South Florida. Overall, questions tested participant knowledge of CD diagnosis, treatment, and risk factors. No intervention or treatment was used in this study. Starting in January 2024, we retrieved contact information (i.e. emails) of potential participants from the public practitioner profile database from the Florida Department of Health based on specialty of practice. The secure REDCAP survey platform was utilized to send survey invites, retrieve responses, and initiate data analyses. So far, approximately 2000 unique professionals across various specialties have been invited to participate in the study. For each question type, a sample proportion (%) was calculated based on # of positive responses over the total number of survey responses. A Wilson 95% confidence interval was calculated using EPI tools (https://epitools.ausvet.com.au/ciproportion) to present confidence limits for each sample proportion.

Results: Our current survey responses showcase noticeable differences in KAP from N=66 health professionals (N=64 physicians, N=1 physician resident, N=1 nurse practitioner) across N=24 sub-specialties (a majority from family medicine, pediatrics, & internal medicine) with varying years of experience, ethnicities, region of medical training, and types of medical setting. When asked about CD knowledge, 100% (Wilson 95% CI 93%-100%) of respondents incorrectly or incompletely identified the various modes of transmission of CD, with oral ingestion of parasite transmission as the most missed mode of transmission. From other knowledge questions, 65.2% (53.1%-75.5%) of respondents were unable to completely identify classical chronic presentations of CD, 27.3% (18%-39%) were unable to correctly identify the arthropod vector (Triatoma spp.), 22.7% (14.3%-34.2%) were unable to identify CD symptoms, 16.7% (9.6%-27.4%) were unable to identify the world regions with increased CD risk, and 9% (4.2%-18.5%) unable to identify the type of causative agent (parasite). When asked about CD attitudes, 90.9% (81.6%-95.8%) believe that more training is needed on screening, diagnosis, treatment, and management of CD in their area or state, 92.4% (83.5%-967%) believe CD is potentially misdiagnosed as another condition in Florida, 66.7% (54.7%-76.8%) believe CD is underdiagnosed in Florida, 53% (41.2%-64.6%) believe that the process to screen for and confirm a diagnosis of CD is time-consuming, and 45.5% (34%-57.38%) believe that CD screening/treatment is a barrier for their patient population. When asked about CD practices, only 7.6% (3.8%-16.5%) of respondents feel very confident in their ability to screen, diagnose, and manage CD and 23.7% (14.3%-34.2%) have not heard of or received formal training on CD. Overall, a total of 30.3% (20.6%-42.2%) of specialists within infectious disease, family medicine, pediatrics, and cardiology have even confirmed a diagnosis of CD in their practice.

Conclusions: Although we are in the process of receiving more survey responses and conducting specific statistical data analysis on our results, including comparisons between various demographics, our current data suggest a lack of knowledge in CD diagnosis, treatment, or risk factors across health professions and specialties in South Florida. Our results further help classify CD as a neglected tropical disease with limited awareness among healthcare professionals. We show that physicians have confirmed a diagnosis of CD in their practice, indicating that the disease has been diagnosed in the area. While this pilot study aids awareness and management of CD, it also informs future steps for research, education, community outreach, and training across health professions on this neglected tropical disease in South Florida. For example, in the future, we hope to partner with the Florida Department of Health to shed light on CD or initiate a CD awareness campaign for health professionals in our area, including holding a CD information session for students or health-care professionals who are more likely to treat CD patients or for those heading to CD endemic areas on a medical mission trip. As our current study is limited to the South Florida region, conducting similar studies across the rest of the regions of Florida can also be beneficial in limiting future health disparities or knowledge gaps on this infectious disease across the entire state. Future studies can also tackle understanding the impact of Osteopathic principles and practices along with a combination of natural/synthetic drug therapies on CD management/treatment. Overall, we hope that this project will help guide future health promotion, improve population health outcomes, and limit the potential spread of CD in our region.

References

1. Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018;391(10115):82-94. doi:10.1016/S0140-6736(1731612-4).

2. Bern C, Messenger LA, Whitman JD, Maguire JH. Chagas Disease in the United States: a Public Health Approach. Clin Microbiol Rev. 2019;33(1). doi:10.1128/CMR.00023-19.

3. Manne-Goehler J, Umeh CA, Montgomery SP, Wirtz VJ. Estimating the Burden of Chagas Disease in the United States. PLoS Negl Trop Dis. 2016;10(11):e0005033. doi:10.1371/journal.pntd.0005033.

4. Beatty NL, Forsyth CJ, Burkett-Cadena N, Wisely SM. Our Current Understanding of Chagas Disease and Trypanosoma cruzi Infection in the State of Florida — an Update on Research in this Region of the USA. Current Tropical Medicine Reports. 2022;9(4):150-159. doi:10.1007/s40475-022-00261-w.

5. Lynn MK, Bossak BH, Sandifer PA, Watson A, Nolan MS. Contemporary autochthonous human Chagas disease in the USA. Acta Trop. 2020;205:105361. doi:10.1016/j.actatropica.2020.105361.

6. Stimpert KK, Montgomery SP. Physician awareness of Chagas disease, USA. Emerg Infect Dis. 2010;16(5):871-872. doi:10.3201/eid1605.091440.

7. Verani JR, Montgomery SP, Schulkin J, Anderson B, Jones JL. Survey of obstetrician-gynecologists in the United States about Chagas disease. Am J Trop Med Hyg. 2010;83(4):891-895. doi:10.4269/ajtmh.2010.09-0543.

8. Amstutz-Szalay S. Physician Knowledge of Chagas Disease in Hispanic Immigrants Living in Appalachian Ohio. J Racial Ethn Health Disparities. 2017;4(3):523-528. doi:10.1007/s40615-016-0254-8.

9. Pacheco GJ. Chagas Disease Awareness Amongst Texas Physicians. The Texas Medical Center Library; 2018. Accessed June 1, 2024. https://digitalcommons.library.tmc.edu/uthsph_dissertsopen/8/

10. Edwards MS, Abanyie FA, Montgomery SP. Survey of Pediatric Infectious Diseases Society Members About Congenital Chagas Disease. Pediatr Infect Dis J. 2018;37(1):e24-e27. doi:10.1097/INF.0000000000001733.

Informed Consent: Our process for consent is included in the survey distribution and consent form is included in the beginning of the survey. The Institutional Review Board of Nova Southeastern University has also reviewed and approved this consent information.

Ethical Approval & IRB and/or IACUC Approval: This study was reviewed and exempt by the Institutional Review Board of Nova Southeastern University. IRB number: 2023-5598.

Financial Disclosure: None reported.

Poster No. *PH-24

Abstract No. 2024-110

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Empowering Communities Through Narcan Training: An Analysis of Opioid Overdose Reversal Education in a Community Setting

¹Courtney E. Oei, MS OMS-III, ¹Katherine Welch, , OMS-III, ¹Khushali Shah, OMS-III, ¹Rexhina Ago, OMS-III, ¹Katrina Botto, OMS-III, ¹Afreen Hussaini, OMS-III, ¹David Kohn, OMS-III, ¹Jubril Lawal, OMS-III, ¹Aaron Poppert, OMS-III, ¹Hayden Reed, OMS-III, ²Amanda Phelps, CADC, COTA, EMT-B, ¹Natasha Fein Davis, MD, ¹Christina Bereda, DO, ¹Surekha Appikatla, MPH, ¹Joy H. Lewis, DO, PhD, FACP

¹A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ²Medical Stabilization, Alton Memorial Hospital, Alton, IL

Context: The rate of opioid overdose continues at an epidemic level. This issue has intensified to the point that it has contributed to lowering overall United States life expectancy and has been labeled a nationwide health crisis [1]. For the past decade, opioid overdose deaths in Illinois have nearly tripled, with a 35.8% increase seen from 2019 to 2021. In 2021 alone, there were 3,013 fatal and 16,804 non-fatal opioid overdoses. Madison County had the 10th highest opioid fatality rate at 29.3 deaths per 100,000 capita when compared to the other 101 Illinois counties [2]. According to a 2022 survey, drug abuse is the second most self-identified health condition by Madison County patients [3]. In an attempt to increase access to Naloxone (Narcan) and reduce drug overdose deaths, the FDA recently reclassified Narcan as an over-the-counter drug. This has made the opioid-reversal drug available in community settings outside of pharmacies to empower community members to respond to overdose emergencies [4].

Although this reclassification is a major step forward, education and training are essential to maximize the efficacy of this measure. Education that is integrated with the community can reduce stigma related to Narcan use while increasing awareness of how to use Narcan and of the opioid crisis. Community education, awareness, and training can reduce the number of deaths from this epidemic.

Objectives: 1) Provide free Narcan training to empower community members to address opioid overdose emergencies. 2) Gain insight into the effectiveness of community-based opioid overdose training in enhancing participants’ comfort and knowledge. 3) Explore the potential implications and strategies for implementing accessible Narcan training initiatives in more communities.

Methods: Flyers advertising the Narcan training were distributed within Madison County, focusing on clinics where ATSU-SOMA students attend clinical rotations to target community patients, caretakers, and healthcare staff. The training itself was carefully crafted to provide participants with comprehensive information about defining opioids, identifying opioid overdose symptoms, accessing Narcan, and administering it correctly. A pre-post-survey design was implemented for before and after the training session. The survey included 5 multiple-choice questions and assessed initial and final comfort levels in responding to opioid overdose with Narcan. Three additional post-survey questions evaluated perceived program helpfulness, interest in further training, and likelihood to recommend similar trainings to others. The survey was administered using Qualtrics and the Narcan educational program’s effectiveness was evaluated using the Statistical Package for the Social Sciences (SPSS) with pre- and post-program surveys, capturing participants’ knowledge and comfort in responding to opioid overdoses. This project aimed to evaluate changes in participant knowledge and preparedness related to opioid overdose management before and after the educational session.

Results: The two sessions were held on February 7th and 24th of 2024. There were 15 people in attendance. Of these, 14 were eligible to participate in the survey (response rate = 93%). With 14 responses, participants’ pre-survey average questions answered correctly (2.43/5) increased on average by 1.43 when compared to the post-survey questions answered correctly (3.86/5). Comfort levels notably increased, with “very comfortable” participants doubling from five to ten post-training. The majority of participants found the Narcan training program to be “helpful” or “very helpful” (85%) and would “absolutely recommend” this Narcan training program to others (86%). The survey findings indicated a strong interest within the community for similar Narcan training sessions in the future as 100% of the participants expressed interest in similar training sessions.

Conclusion: Knowledge and comfort regarding signs of opioid overdoses and Narcan administration improved after the Narcan training, increasing the probability of intervention in an opioid overdose. By equipping community members with the information and skills necessary to respond to opioid overdoses, including take-home Narcan, the outreach program empowered individuals to take proactive measures to save lives within their communities. Through collaboration among healthcare providers, community organizations, and local residents, initiatives like this educational outreach program play a vital role in combating the devastating effects of the opioid epidemic and promoting health and safety in Madison County. Given that Alton Memorial Hospital serves five counties, including Madison County, this training extended educational outreach to numerous communities within this region, potentially saving lives through a single training session. Limitations of this project include logistical challenges in reaching all target populations around Alton, IL. A last-minute location change was needed, which may have affected the number of participants. There may have been difficulty recruiting participants due to an existing stigma associated with substance use disorders.

This program highlighted the importance of the Narcan training sessions and the high demand for continued education across all health centers in Madison County. The project enhanced health centers’ efforts by providing community training on obtaining and administering Narcan, enabling medical staff and community members to recognize signs and provide appropriate assistance efficiently. Amidst these endeavors, there is a strong sense of hope and determination to continue these vital programs, further extending their reach and impact. There is a need for broad education in the correct identification of and intervention in opioid overdoses and the elimination of stigma around substance use disorders.

References

1. Gardner EA, McGrath SA, Dowling D, Bai D. The opioid crisis: prevalence and markets of opioids. Forensic Sci Rev. 2022;34(1):43-70. Accessed November 2023. https://pubmed.ncbi.nlm.nih.gov/35105535/

2. Tokars A. Statewide semiannual opioid report. Illinois Department of Public Health. Published May 2022. Accessed October 23, 2023. https://dph.illinois.gov/content/dam/soi/en/web/idph/publications/idph/topics-and-services/opioids/idph-data-dashboard/Opioid-Report-5_22.pdf

3. Community Health Needs Assessment and Implementation Plan 2022 - Alton Memorial Hospital. https://altonmemorial.thehcn.net/content/sites/altonmemorial/Final_2022_AMH_CHNA__amp_Implementation_Strategy_1.pdf. Published 2022. Accessed October 3, 2023. [4] FDA approves first over-the-counter naloxone nasal spray. U.S. Food and Drug Administration. Published March 29, 2023. Accessed October 3, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray

Informed Consent: Participants were thoroughly informed of the training purpose and procedures and electronically consented. Upon approval, they proceeded with a pre-event survey or post-event survey. Participants who did not consent were excluded from the surveys, but not the training. Participants created their own codes to ensure anonymity consisting of first initial, last initial, birth month, and birth day for the purposes of tracking pre- and post-event surveys.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.

★Poster No. *PH-25

Abstract No. 2024-116

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Relationships Between Child Health Behaviors, Mental Health, Family Functioning, and Child Sleep Habits: A Cross-Sectional Analysis from the BEAR Study

Lauren Cea, OMS-IV, Emily Guseman, PhD

Ohio University-Heritage College of Osteopathic Medicine, Athens, Oh

Context: Sleep and family functioning play critical roles in a child’s mental health and emotional well-being. Sufficient sleep for children is vital for physical, cognitive, and emotional development (1). Lack of or poor-quality sleep can lead to a wide array of issues, more specifically regarding mental health. Insufficient sleep can lead to irritability, mood changes, and behavioral problems (2). Similarly, healthy family dynamics, marked by effective communication, stability, and shared values, are also instrumental to the emotional well-being of children. Providing a secure and nurturing environment in which a child will grow and develop can have lasting, positive impacts on their mental health. In contrast, a dysfunctional family unit can lead to problems with at-risk health behaviors, mental health, and academic achievement (3). Therefore, ensuring that children receive adequate, high-quality sleep and grow up surrounded by a high-functioning family is crucial for their overall mental health and development.

Objective: To determine whether sleep and family dynamics are associated with child mental health in a sample of 8–14-year-old children in a rural community.

Methods: The “BEating covid with Activity and Resilience” (BEAR) study began enrollment in January 2022; participants included in this analysis attended a baseline visit between January 2022 and November 2023. 43 children were recruited from the local community. Exclusion criteria included metabolic diseases or severe psychiatric disorders. Children and parents completed the DSM-5 and the Strength and Difficulties Questionnaire (SDQ) to assess child mental health symptoms. Child sleep duration and sleep quality were measured using the Children’s Sleep Habits Questionnaire (CSHQ). Screen time was measured using the SCREENS questionnaire. Family functioning was assessed using the McMaster Family Assessment Device (MFAD) and the parent’s responses to the Positive Childhood Experiences questionnaire. Means, standard deviations, and frequencies were calculated for participant characteristics and survey responses. Pearson correlations were used to examine the relationship between sleep parameters, family functioning variables, and child mental health. Multiple linear regression was used to assess whether family functioning, child behaviors, and child sleep predicted child mental health. All analyses were performed in SPSS v. 29.0. The osteopathic significance of this study is in the incorporation of the biopsychosocial model to understand how health behaviors and family characteristics influence child health and development.

Results: The average age of children participating in this study was 10.4 years old (n=43, 75% girls). Children were generally pre- or peri-pubertal (maturity offset mean = 0.08y ± 2.1 girls vs. -3.5y ± 0.9 boys, p.

Conclusion: Contrary to our hypothesis, the results of this study did not support a predictive relationship between child behaviors, family functioning, and sleep with child mental health. Social (family dynamics) as well as physical (sleep) contributors play a major role in a child’s emotional well-being. Other research studies have shown a predictive relationship between the variables tested in this study (4). The inconsistency of our results compared to others may be related to the limitations of our study, which include small sample size and parent-report measures. Sleep and screen time were parent-reported, which may introduce biases. Additionally, the study does not account for other confounding variables such as genetic predispositions, school environment, and peer influence, all of which may influence a child’s emotional well-being. Data collection in a rural community may also affect the generalizability of study results, though studying rural communities is important in understanding urban/rural disparities. Efforts to diversify and increase sample size are important for further investigation of the relationship. Future research should explore intervention strategies that target sleep hygiene and family functioning to enhance children’s psychological resilience.

References

1. Kuzik N, Naylor P-J, Spence JC, Carson V. Movement behaviours and physical, cognitive, and social-emotional development in preschool-aged children: Cross-sectional associations using compositional analyses. PLOS ONE. 2020;15(8). doi: 10.1371/journal.pone.0237945

2. Park H, Lee K-S. The association of family structure with health behavior, mental health, and perceived academic achievement among adolescents: A 2018 Korean Nationally Representative survey. BMC Public Health. 2020;20(1). doi:10.1186/s12889-020-08655-z

3. Taveras EM, Rifas-Shiman SL, Bub KL, Gillman MW, Oken E. Prospective study of insufficient sleep and neurobehavioral functioning among school-age children. Academic Pediatrics. 2017;17(6):625-632. doi: 10.1016/j.acap.2017.02.001

4. Claussen AH. Short Sleep Duration: Children’s Mental, Behavioral, and Developmental Disorders and Demographic, Neighborhood, and Family Context in a Nationally Representative Sample, 2016–2019. Preventing Chronic Disease. 2023;20. doi:10.5888/pcd20.220408

Informed Consent: A member of the research team conducted the informed consent process, summarizing the study protocol, risks, and benefits and allowing children and parents to ask questions. Both parental consent and minor assent were required. If both parent and minor agree to participate in the study, the parent signed the parental consent form, and the minor signed the minor assent form.

Ethical Approval & IRB and/or IACUC Approval: This study was approved by the Ohio University IRB (#21-x-128).

Financial Disclosure: None reported.

Poster No. *PH-26

Abstract No. 2024-139

Category: Public Health

Research Focus Area: Health Disparities-Social Determinants of Health

Fostering Wellness: Exploring Food Insecurity and Healthy Food Accessibility in the Adelante Healthcare Patient Population

¹Amaya Alarcon, OMS-III, ¹Chloe Jensen, ¹Elizabeth Sangalang, ¹Spencer Christensen, ¹Ruthanne Teo, ¹Pegah Zamanian, ¹James Sayegh, ¹Wilson Lewis, ¹Michael Nicholls, ²Mark Sivakoff, ²Bradley Meek, ³Surekha Appikatla, ³Joy H. Lewis, DO, PhD, FACP

¹A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ²Regional Director of Medical Education, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ; ³Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ

Context: Food insecurity, marked by insufficient access to nutritious food, directly impacts health outcomes 1. It can lead to malnutrition, increased susceptibility to diseases, and chronic health conditions, particularly affecting vulnerable populations 2. According to the United States Department of Agriculture, in 2015, over 500,000 individuals in Maricopa County had limited access to grocery stores, an increase of 3% in 5 years 3. Within that population, 17% experience food insecurity 3.

Adelante Healthcare is a federally qualified community health center that supports patients within Maricopa County. Our project investigates food insecurity within the Adelante patient population, including those with low income and comorbid conditions such as diabetes, hypertension, and hyperlipidemia. By investigating food insecurity within the Adelante patient population, we hope to aid Adelante Healthcare in better understanding the needs of their patients. We also aim to empower patients to live a healthier lifestyle through increased knowledge of resources.

Objectives:

* To assess food insecurity within the Adelante Healthcare patient population.

* To explore the possible correlation between food insecurity, patient income, family dependents, and health outcomes.

* To identify resources and interventions that Adelante Healthcare can offer to address food insecurity among its patient population.

Methods: Participants 18 years and older who receive care at Adelante Healthcare Clinics sites were asked to voluntarily complete a survey, available in both Spanish and English. The survey included both quantitative and qualitative questions and was designed by this team to help us identify trends in food insecurity and the Adelante patients’ attitudes toward food insecurity. We also identified coexisting medical conditions and perceived competence levels regarding purchasing and cooking healthy foods. Household risk of food insecurity was measured by Hunger Vital Sign™, a validated 2-question food insecurity screening tool 4.

Results: We were able to collect 274 survey responses (103 in Spanish and 171 in English). The surveys were distributed by the front desk employees to patients who were willing to participate and complete the form.

Data showed that 35% (n=97) of the patients who completed the survey were at risk of food insecurity. We were also able to identify a significant correlation between food insecurity and dependents in household, and medical conditions like diabetes, hypertension, and hyperlipidemia.

Conclusions: This project has provided crucial insights into the food insecurity challenges faced by the patient population at Adelante Health Center. The data clearly show significant associations between food insecurity, low household income, and prevalent medical conditions such as diabetes, hypertension, and hyperlipidemia. Notably, 35% of the participants were identified as at risk for food insecurity. Moreover, patients expressed a keen interest in various health initiatives, including farmer’s markets, cooking classes, and nutrition education programs, which had been successful before the COVID-19 pandemic. This suggests that reintroducing such initiatives could address both income and health-related challenges. However, it is essential to ensure future surveys are concise and straightforward to avoid incomplete responses and better capture patient needs. This project could thus serve as a foundation for Adelante Health Center to reinvigorate support programs and better align them with the identified needs of their patients.

References

1. Blitstein JL, Lazar D, Gregory K, et al. Foods for health: an integrated social medical approach to food insecurity among patients with diabetes. *Am J Health Promot*. 2021;35(3):369-376. doi:10.1177/0890117120964144.

2. Wetherill MS, Williams MB, White KC, Seligman HK. Characteristics of households of people with diabetes accessing US food pantries: Implications for diabetes self-management education and support. *Diabetes Educ*. 2019;45(4):397-407. doi:10.1177/0145721719857547.

3. Health Center Program Uniform Data System (UDS) Data Overview. data.HRSA.gov. Accessed October 4, 2023. https://data.hrsa.gov/tools/data-reporting/program-data?grantNum=H80CS00140.

4. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. *Pediatrics*. 2010;126(1):26-32. doi:10.1542/peds.2009-3146.

Informed Consent: The survey handed to the participants included an introductory statement saying that they agreed to participate in the project by completing the survey question. We did not collect any personal information with the survey questions.

Ethical Approval & IRB and/or IACUC Approval: Yes

Financial Disclosure: None reported.