T.H. Chan School of Medicine Student Publications

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The T.H. Chan School of Medicine at UMass Chan Medical School was founded in 1962 with the mission to advance the health and well-being of the people of the Commonwealth and beyond through pioneering education, research, and health care delivery. This collection showcases journal articles, posters, presentations and other publications authored by medical students at UMass Chan. See also the collections for specific programs listed on the T.H. Chan School of Medicine community page.

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Encouragement vs. liability: How prompt engineering influences ChatGPT-4's radiology exam performance
(2024-09-06) Nguyen, Daniel; MacKenzie, Allison; Kim, Young H; Radiology; T.H. Chan School of Medicine; Allison MacKenzie
Large Language Models (LLM) like ChatGPT-4 hold significant promise in medical application, especially in the field of radiology. While previous studies have shown the promise of ChatGTP-4 in textual-based scenarios, its performance on image-based response remains suboptimal. This study investigates the impact of prompt engineering on ChatGPT-4's accuracy on the 2022 American College of Radiology In Training Test Questions for Diagnostic Radiology Residents that include textual and visual-based questions. Four personas were created, each with unique prompts, and evaluated using ChatGPT-4. Results indicate that encouraging prompts and those disclaiming responsibility led to higher overall accuracy (number of questions answered correctly) compared to other personas. Personas that threaten the LLM with legal action or mounting clinical responsibility were not only found to score less, but also refrain of answering questions at a higher rate. These findings highlight the importance of prompt context in optimizing LLM responses and the need for further research to integrate AI responsibly into medical practice.
Targeted proteomics of cerebrospinal fluid in treatment naïve multiple sclerosis patients identifies immune biomarkers of clinical phenotypes
(2024-09-18) Rabin, Alexandra; Bello, Elisa; Kumar, Saurabh; Zeki, Dalia Abou; Afshari, Khashayar; Deshpande, Mugdha; Francis, Nimmy; Khalighinejad, Farnaz; Umeton, Raffaella; Radu, Irina; Qutab, Fatima; Kwong, Danny; Kurban, Mariana; Hemond, Christopher C; Richmond, Jillian M; Ionete, Carolina; Dermatology; Neurology; T.H. Chan School of Medicine; Elisa Bello; Alexandra Rabin
Multiple sclerosis (MS) is an inflammatory demyelinating disease with heterogeneous clinical presentations and variable long-term disability accumulation. There are currently no standard criteria to accurately predict disease outcomes. In this study we investigated the cross-sectional relationship between disease phenotype and immune-modulating cytokines and chemokines in cerebrospinal fluid (CSF). We analyzed CSF from 20 DMT-naïve MS patients using Olink Proteomics' Target 96 Inflammation panel and correlated the resulting analytes with respect to (1) disease subtype, (2) patient age and sex, (3) extent of clinical disability, and (4) MRI segmental brain volumes. We found that intrathecal IL-4 correlated with higher Expanded Disability Status Scale (EDSS) scores and longer 25-foot walk times, and CD8A correlated with decreased thalamic volumes and longer 9-hole peg test times. Male sex was associated with higher FGF-19 expression, and Tumefactive MS with elevated CCL4. Several inflammatory markers were correlated with older age at the time of LP. Finally, higher intrathecal IL-33 correlated with increased MS lesion burden and multi-compartment brain atrophy. This study confirms immune heterogeneity underlying CSF profiles in MS, but also identifies several inflammatory protein biomarkers that may be of use for predicting clinical outcomes in future algorithms.
Implementation and Preliminary Evaluation of an Entrepreneurship, Biomedical Innovation, and Design Pathway in a School of Medicine Curriculum [preprint]
(2024-09-11) Hafer, Nathaniel; Keenan, Christian; Deb, Anindita; Center for Clinical and Translational Science; Neurology; Program in Molecular Medicine; T.H. Chan School of Medicine; Christian Keenan
Background: New educational curricula are emerging to train physicians to practice healthcare in the 21st century. The University of Massachusetts Chan Medical School T.H. Chan School of Medicine (UMass Chan) implemented an MD curriculum redesign in the fall of 2022 that included seven educational pathways, including Entrepreneurship, Biomedical Innovation and Design. This pathway is modeled after the I-Corps curriculum with added material regarding engineering design. This manuscript describes this pathway curriculum and provides preliminary evaluation data and learning outcomes. Methods: First-year (Class of 2027) and second-year (Class of 2026) pathway students were invited to participate in online surveys evaluating course material and their knowledge of course content. Course evaluations and self-assessments were performed on a 4 or 5 point Likert scale. The material assessment comprised of multiple-choice questions; some had four options while others had five. Simple means were calculated for each question of the self-assessment, and as an aggregate. A two-sample t-test was performed using those means to assess statistical significance. A distribution of correct and incorrect answers was generated between the pre and post survey results, and a chi-squared analysis was used to determine whether the two correct/incorrect distributions were significantly different. Results: Initial results show that the program was well received, with 15/20 (75%) of first year students rating the experience as good or excellent and 8/10 (80%) of second year students rating the experience as good or excellent. Three lectures were provided during the Fall 2023 semester to 11 second-year students. Results of self-assessment of student comfort and understanding of engineering content significantly improved after delivery of these lectures. Objective student knowledge also significantly improved. Conclusions: This new pathway curriculum at UMass Chan is designed to introduce students to the principles of innovation, entrepreneurship, and technology commercialization. An element of this pathway focused on basic engineering principles provided students with baseline understandings of biomedical design, human factors, and risk/hazard analysis. Despite small sample sizes, the results show improvements in student comfort with the material and knowledge. Novel curricula have the potential to transform medical education and prepare future physicians to practice healthcare in the 21st Century.
Increasing magic number and other trends in diagnostic radiology NRMP match data
(2024-07-09) Taros, Trenton; Zoppo, Christopher T; Camargo, Anthony M; DeBenedectis, Carolynn M; Radiology; T.H. Chan School of Medicine; Trenton Taros; Christopher T Zoppo; Anthony M Camargo
The magic number, or number of ranks needed to achieve a greater than 90 % chance of matching, has not been investigated for diagnostic radiology (DR). Somewhat reflective of a field's changing competitiveness, this individual metric can be useful for reassuring applicants or identifying a need to reach out to mentors. The NRMP's Charting Outcomes in the Match was accessed over the previous 10 cycles to assess changes to magic number and other match-related metrics. Over the last 10 cycles, there has been an increase in magic number for prospective radiologists. Based on the most 2022 recent report, the magic number was 14 compared to 5 and 2 in 2014 and 2016 respectively. Compared to the average US MD senior, those applying into DR were significantly more likely to match in 2014, 2016 and 2020 (p < 0.01 for all), and significantly less likely to match in 2018 and 2022 (p = 0.03 and p < 0.01, respectively). This trend has had important consequences for applicants and programs as the incentive to apply more widely grows. The increasing magic number demonstrates increasing competitiveness in the field, which might be due to a positive job market, changing medical student preferences, or increased access to radiology electives and mentors. The 2024 Charting Outcomes document will be the first to include data from a class almost entirely affected by the change to a pass/fail Step1 and the new preference signaling supplement. It is currently unclear how either change will affect the overall competitiveness of the field and the magic number.
Preventing diabetes: What overweight and obese adults with prediabetes in the United States report about their providers' communication and attempted weight loss
(2024-08-11) Demosthenes, Emmanuella J; Freedman, Jason; Hernandez, Camila; Shennette, Lisa; Frisard, Christine; Lemon, Stephenie C; Gerber, Ben S; Amante, Daniel J; Morningside Graduate School of Biomedical Sciences; Population and Quantitative Health Sciences; Prevention Research Center; T.H. Chan School of Medicine; Jason Freedman; Camila Hernandez
Objective: To investigate what overweight or obese adults with prediabetes in the United States report being told by providers about 1) having prediabetes, 2) diabetes risk, and 3) losing weight and the associations of these communications with attempted weight loss. Methods: Data from 2015 to 2018 National Health and Nutrition Examination Surveys (NHANES) for adults with a body mass index in the overweight or obesity ranges and HbA1c in the prediabetes range were examined (n = 2085). Patient reported data on what providers told them about having prediabetes, being at risk for diabetes, and losing weight were compared with attempted weight loss. Results: Most participants (66.4%) reported never being told they had prediabetes nor being at risk for diabetes, 13.0% reported being told they had prediabetes, 10.6% at risk for diabetes, and 8.0% both messages. 18.3% of participants reported being told to lose weight. Participants who reported being told they had prediabetes and at increased diabetes risk were more likely to report attempted weight loss (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-3.2). Reporting that they were told to lose weight was not significantly associated with an increase in reported weight loss attempts. Conclusions: In this cohort of individuals with overweight/obesity and prediabetic HbA1c values, low rates communications with providers about prediabetes and diabetes risk were reported. When both were discussed, patients reported greater attempted weight loss. These findings draw attention to the potential impact that provider communications about prediabetes and diabetes risk may have on lifestyle behavior change.
Conquering hypertension in Vietnam: 12- month follow up results from a cluster-randomised controlled trial
(2024-07-01) Nguyen, Hoa L; Ha, Duc A; Tran, Oanh T; Phan, Van H; Nguyen, Cuc T; Nguyen, Giang H; Nguyen, Thang T; Le, Thanh T; Goldberg, Robert J.; Wang, Bo; Tang, Elena T; Chiriboga, Germán; Budhwani, Henna; Carroll, Allison J.; Biostatistics and Health Services Research; Population and Quantitative Health Sciences; T.H. Chan School of Medicine; Elena T Tang
Background: Approximately 20% of adults in Vietnam have hypertension, and management of this chronic condition remains challenging. This study aimed to assess the effectiveness of a multicomponent intervention in reducing blood pressure (BP) in adults with uncontrolled hypertension. Methods: This cluster randomised controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) in a rural setting in Vietnam (2017-2022). Consenting adults (aged ≥ 18 years) with uncontrolled hypertension were enrolled. Sixteen communities were equally randomised to an intervention or comparison group stratified by district. Consenting adults were assigned to study groups by community. The comparison arm received training sessions about hypertension prevention and management for health workers, and patient education materials. The intervention arm received training sessions about hypertension prevention and management for health workers, and patient education materials and three enhancement components including a storytelling intervention, home BP self-monitoring, and expanded community health worker services. The primary outcome was the difference in changes in patient's levels of systolic BP between the study groups over a 12-month follow-up period. Patients and outcome assessors were masked. Findings: A total of 671 patients (340: intervention, 331: comparison) were enrolled in the trial. The mean age was 66 years and 45% were men. At the 12-month follow-up, the mean systolic BP declined by 18.4 mmHg in the intervention group and 3.7 mmHg in the comparison group (differential decline of 14.7 mmHg [95% CI: 11.8-17.6]). The intervention group also achieved better BP control and medication adherence than the comparison group. There were no serious adverse events related to study participation. Interpretation: The results of this trial demonstrate that a multicomponent intervention can effectively reduce elevated BP in individuals with uncontrolled hypertension in Vietnam. Trial registration: This trial was registered at ClinicalTrials.gov, NCT03590691. Funding: National Heart, Lung, and Blood Institute.
Lung cancer screening in the Philippines: the need for guidelines based on the local context and the imperative for improved access to screening
(2023-02-16) Suanes, Patricia N; Alberto, Nicole Rose I; Alberto, Isabelle Rose I; Swami, Nishwant; Eala, Michelle Ann B; Tangco, Enrico D; Dee, Edward Christopher; T.H. Chan School of Medicine; Nishwant Swami
Cancer is the second leading cause of mortality in the Philippines, a lower-middle-income country (LMIC) in Southeast Asia with a population of more than 110 million people. Lung cancer tops the list for cancer-attributable mortality in the nation. Of the world's 1.3 billion people who smoke, eighty percent come from LMICs such as the Philippines. Almost a quarter of Filipinos aged 15 years and older smoke tobacco, placing millions of people at significant risk for developing lung cancer. Despite the burden of disease attributable to lung cancer and the prevalence of risk factors such as smoking, no context-specific national screening guidelines and nationwide screening programs currently exist in the Philippines.
Labyrinthitis Ossificans in a Post-Splenectomy Patient With Meningitis: A Case Report and Review of Literature
(2023-02-02) Kamkari, Nick; Chari, Divya A; Otolaryngology; T.H. Chan School of Medicine; Nick Kamkari
This report describes a case of cochlear implantation to treat profound deafness three months after a diagnosis of bacterial meningitis in a patient with a remote history of splenectomy. A 71-year-old woman with a remote history of a splenectomy over 20 years before presented with bilateral profound deafness that occurred as sequela from pneumococcal meningitis three months prior. The patient had been vaccinated against the 23-valent polysaccharide pneumococcal vaccine (PPV-23). The audiometric evaluation revealed no response in either ear. Imaging was suggestive of complete ossification of the right cochlea with partial ossification of the basal turn of the left cochlea. She underwent successful left-sided cochlear implantation. Standard post-implantation speech outcomes include consonant-nucleus-consonant (CNC) word and phoneme scores and Az-Bio in quiet and noise. The patient noted subjective improvement in her hearing. Performance measures markedly improved when compared to her pre-operative evaluation, which showed no aided sound detection. This case report highlights the possibility of meningitis many years after splenectomy that can result in profound deafness with labyrinthitis ossificans and the potential for hearing rehabilitation for cochlear implantation.
Three-dimensional virtual reality in surgical planning for breast cancer with reconstruction
(2023-06-07) De la Cruz-Ku, Gabriel; Mallouh, Michael P; Torres Roman, Jr Smith; Linshaw, David; Surgery; T.H. Chan School of Medicine; Michael P Mallouh
Breast surgery is performed to achieve local control in patients with breast cancer. Visualization of the anatomy with a virtual reality software platform reconstructed from magnetic resonance imaging data improves surgical planning with regards to volume and localization of the tumor, lymph nodes, blood vessels, and surrounding tissue to perform oncoplastic tissue rearrangement. We report the use and advantages of virtual reality added to the magnetic resonance imaging assessment in a 36-year-old woman with breast cancer who underwent nipple sparing mastectomy with tissue expander reconstruction.
A Research Protocol to Study the Priming Effects of Breathing Low Oxygen on Enhancing Training-Related Gains in Walking Function for Persons With Spinal Cord Injury: The BO2ST Trial
(2023-11-06) Muter, William M; Mansson, Linda; Tuthill, Christopher; Aalla, Shreya; Barth, Stella; Evans, Emily; McKenzie, Kelly; Prokup, Sara; Yang, Chen; Sandhu, Milap; Rymer, W Zev; Edgerton, Victor R; Gad, Parag; Mitchell, Gordon S; Wu, Samuel S; Shan, Guogen; Jayaraman, Arun; Trumbower, Randy D; T.H. Chan School of Medicine; Stella Barth
Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia; tAIH) may serve as an effective plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-enhanced walking therapy (WALKtSTIM) in persons with chronic (>1 year) spinal cord injury (SCI). Pre-clinical studies in rodents with SCI show that tAIH and WALKtSTIM therapies harness complementary mechanisms of plasticity to maximize walking recovery. Here, we present a multi-site clinical trial protocol designed to examine the influence of tAIH + WALKtSTIM on walking recovery in persons with chronic SCI. We hypothesize that daily (eight sessions, 2 weeks) tAIH + WALKtSTIM will elicit faster, more persistent improvements in walking recovery than either treatment alone. To test our hypothesis, we are conducting a placebo-controlled clinical trial on 60 SCI participants who randomly receive one of three interventions: tAIH + WALKtSTIM; Placebo + WALKtSTIM; and tAIH + WALKtSHAM. Participants receive daily tAIH (fifteen 90-sec episodes at 10% O2 with 60-sec intervals at 21% O2) or daily placebo (fifteen 90-sec episodes at 21% O2 with 60-sec intervals at 21% O2) before a 45-min session of WALKtSTIM or WALKtSHAM. Our primary outcome measures assess walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up and Go Test). For safety, we also measure pain levels, spasticity, sleep behavior, cognition, and rates of systemic hypertension and autonomic dysreflexia. Assessments occur before, during, and after sessions, as well as at 1, 4, and 8 weeks post-intervention. Results from this study extend our understanding of the functional benefits of tAIH priming by investigating its capacity to boost the neuromodulatory effects of transcutaneous spinal stimulation on restoring walking after SCI. Given that there is no known cure for SCI and no single treatment is sufficient to overcome walking deficits, there is a critical need for combinatorial treatments that accelerate and anchor walking gains in persons with lifelong SCI.
Closing the Digital Divide in Interventions for Substance Use Disorder
(2024-03-26) Hampton, Jazmin; Mugambi, Purity; Caggiano, Emily; Eugene, Reynalde; Valente, Alycia; Taylor, Melissa; Carreiro, Stephanie; Emergency Medicine; T.H. Chan School of Medicine; Emily Caggiano
Digital health interventions are exploding in today's medical practice and have tremendous potential to support the treatment of substance use disorders (SUD). Developers and healthcare providers alike must be cognizant of the potential for digital interventions to exacerbate existing inequities in SUD treatment, particularly as they relate to Social Determinants of Health (SDoH). To explore this evolving area of study, this manuscript will review the existing concepts of the digital divide and digital inequities, and the role SDoH play as drivers of digital inequities. We will then explore how the data used and modeling strategies can create bias in digital health tools for SUD. Finally, we will discuss potential solutions and future directions to bridge these gaps including smartphone ownership, Wi-Fi access, digital literacy, and mitigation of historical, algorithmic, and measurement bias. Thoughtful design of digital interventions is quintessential to reduce the risk of bias, decrease the digital divide, and create equitable health outcomes for individuals with SUD.
Dual engagement of the nucleosomal acidic patches is essential for deposition of histone H2A.Z by SWR1C
(2024-05-29) Baier, Alexander S; Gioacchini, Nathan; Eek, Priit; Leith, Erik M; Tan, Song; Peterson, Craig L; Morningside Graduate School of Biomedical Sciences; Program in Molecular Medicine; T.H. Chan School of Medicine; Alexander S Baier; Nathan Gioacchini
The yeast SWR1C chromatin remodeling enzyme catalyzes the ATP-dependent exchange of nucleosomal histone H2A for the histone variant H2A.Z, a key variant involved in a multitude of nuclear functions. How the 14-subunit SWR1C engages the nucleosomal substrate remains largely unknown. Studies on the ISWI, CHD1, and SWI/SNF families of chromatin remodeling enzymes have demonstrated key roles for the nucleosomal acidic patch for remodeling activity, however a role for this nucleosomal epitope in nucleosome editing by SWR1C has not been tested. Here, we employ a variety of biochemical assays to demonstrate an essential role for the acidic patch in the H2A.Z exchange reaction. Utilizing asymmetrically assembled nucleosomes, we demonstrate that the acidic patches on each face of the nucleosome are required for SWR1C-mediated dimer exchange, suggesting SWR1C engages the nucleosome in a 'pincer-like' conformation, engaging both patches simultaneously. Loss of a single acidic patch results in loss of high affinity nucleosome binding and nucleosomal stimulation of ATPase activity. We identify a conserved arginine-rich motif within the Swc5 subunit that binds the acidic patch and is key for dimer exchange activity. In addition, our cryoEM structure of a Swc5-nucleosome complex suggests that promoter proximal, histone H2B ubiquitylation may regulate H2A.Z deposition. Together these findings provide new insights into how SWR1C engages its nucleosomal substrate to promote efficient H2A.Z deposition.
I saw the 'puff of smoke' sign before it vanished into thin air
(2024-05-10) Suh, Lyle; Puri, Ajit S; Singh, Jasmeet; Kuhn, Anna Luisa; Radiology; Lyle Suh
Moyamoya is characterized as a non-atherosclerotic and non-inflammatory vasculopathy that leads to progressive stenosis of the intracranial internal carotid arteries as well as the Circle of Willis. While it can be idiopathic (Moyamoya disease) or associated with another condition (Moyamoya syndrome), there is a characteristic 'puff of smoke' sign that can be appreciated on cerebral angiography.
Pausing before verb production is associated with mild cognitive impairment in Parkinson's disease
(2023-04-11) Nascimento Andrade, Eduardo Inacio; Manxhari, Christina; Smith, Kara M; Neurology; NeuroNexus Institute; T.H. Chan School of Medicine; Christina Manxhari
Background: Cognitive dysfunction and communication impairment are common and disabling symptoms in Parkinson's Disease (PD). Action verb deficits occur in PD, but it remains unclear if these impairments are related to motor system dysfunction and/or cognitive decline. The objective of our study was to evaluate relative contributions of cognitive and motor dysfunction to action verb production in naturalistic speech of patients with PD. We proposed that pausing before action-related language is associated with cognitive dysfunction and may serve as a marker of mild cognitive impairment in PD. Method: Participants with PD (n = 92) were asked to describe the Cookie Theft picture. Speech files were transcribed, segmented into utterances, and verbs classified as action or non-action (auxiliary). We measured silent pauses before verbs and before utterances containing verbs of different classes. Cognitive assessment included Montreal Cognitive Assessment (MoCA) and neuropsychological tests to categorize PD participants as normal cognition (PD-NC) or mild cognitive impairment (PD-MCI) based on Movement Disorders Society (MDS) Task Force Tier II criteria. Motor symptoms were assessed using MDS-UPDRS. We performed Wilcoxon rank sum tests to identify differences in pausing between PD-NC and PD-MCI. Logistic regression models using PD-MCI as dependent variables were used to evaluate the association between pause variables and cognitive status. Results: Participants with PD-MCI demonstrated more pausing before and within utterances compared to PD-NC, and the duration of these pauses were correlated with MoCA but not motor severity (MDS-UPDRS). Logistic regression models demonstrated that pauses before action utterances were associated with PD-MCI status, whereas pauses before non-action utterances were not significantly associated with cognitive diagnosis. Conclusion: We characterized pausing patterns in spontaneous speech in PD-MCI, including analysis of pause location with respect to verb class. We identified associations between cognitive status and pausing before utterances containing action verbs. Evaluation of verb-related pauses may be developed into a potentially powerful speech marker tool to detect early cognitive decline in PD and better understand linguistic dysfunction in PD.
Annulus Reversus Caused by Transmural Scar in a Patient With Myopericarditis
(2023-01-03) Botros, Mina B; Narvaez-Guerra, Offdan; Harrington, Colleen M; Aurigemma, Gerard P; Medicine; T.H. Chan School of Medicine; Mina B Botros
Pericarditis, an inflammation of the pericardial sac, can be caused by infectious, autoimmune, metabolic, traumatic, iatrogenic, and drug-related entities. Not infrequently, the inflammatory process also involves the contiguous myocardium, with associated elevation in cardiac enzymes. In some instances, pericarditis is associated with constrictive pericarditis, the diagnosis of which can be challenging. Cardiac ultrasound is critical to the diagnosis of constrictive pericarditis. The finding of annulus reversus––the medial early diastolic tissue Doppler velocity exceeding the lateral velocity—can be of particular diagnostic value. It is hypothesized that this finding is due to a reduction in the longitudinal motion of the lateral annulus by the constrictive diathesis.4 In the case we are presenting herein, we demonstrate an example of annulus reversus whose origin may be related more to myocardial scar than to the inflammatory changes in the pericardium.
Validating cuffless continuous blood pressure monitoring devices
(2023-01-16) Hu, Jiun-Ruey; Martin, Gabrielle; Iyengar, Sanjna; Kovell, Lara C; Plante, Timothy B; Helmond, Noud van; Dart, Richard A; Brady, Tammy M; Turkson-Ocran, Ruth-Alma N; Juraschek, Stephen P; Medicine; T.H. Chan School of Medicine; Gabrielle Martin; Sanjna Iyengar
Cuff-based home blood pressure (BP) devices, which have been the standard for BP monitoring for decades, are limited by physical discomfort, convenience, and their ability to capture BP variability and patterns between intermittent readings. In recent years, cuffless BP devices, which do not require cuff inflation around a limb, have entered the market, offering the promise of continuous beat-to-beat measurement of BP. These devices take advantage of a variety of principles to determine BP, including (1) pulse arrival time, (2) pulse transit time, (3) pulse wave analysis, (4) volume clamping, and (5) applanation tonometry. Because BP is calculated indirectly, these devices require calibration with cuff-based devices at regular intervals. Unfortunately, the pace of regulation of these devices has failed to match the speed of innovation and direct availability to patient consumers. There is an urgent need to develop a consensus on standards by which cuffless BP devices can be tested for accuracy. In this narrative review, we describe the landscape of cuffless BP devices, summarize the current status of validation protocols, and provide recommendations for an ideal validation process for these devices.
Mixed methods evaluation of Asthma Link implementation: A community-clinical linkage intervention of school supervised asthma therapy
(UMass Chan Medical School, 2023-12-12) Ryan, Grace W; Nanavati, Janvi; Mendoza Martinez, Daniel; Pereira, Kali; Almeida, John; Spano, Michelle; Gerald, Lynn; Lemon, Stephenie C; Pbert, Lori; Trivedi, Michelle; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center; T.H. Chan School of Medicine; Janvi Nanavati; Daniel Mendoza Martinez; Kali Pereira; John Almeida
Background: Asthma Link is a community-clinical linkage intervention wherein children with poorly controlled asthma receive school-supervised asthma therapy. This intervention supports collaboration between medical providers who identify and enroll children, families who consent and bring medications to their child’s school, and school nurses who supervise daily preventive medication administration. This intervention has shown promise in reducing asthma exacerbations, however implementation outcomes (adoption and acceptability), have not previously been assessed. Methods: Using mixed-methods, we assessed adoption (defined as uptake of multiple process steps leading to children receiving supervised preventive asthma medication at school) and acceptability of Asthma Link. We generated descriptive statistics from surveys with practice staff(n=8), parents of enrolled children(n=29), and school nurses(n=14), as well as data tracking logs. We also interviewed medical providers and staff(n=8) and used rapid qualitative analysis. Finally, we triangulated qualitative and quantitative findings. Findings: Regarding adoption, first, 100% of trained providers offered the program. Providers identified 66 eligible children and enrolled 47%(n=31). The preventive asthma medication was brought into school an average of 2.6 (SD=2.9) weeks after enrollment and medication was available to students for 95% of the time they were in school over twelve months of enrollment. One medical provider reflected on adoption: “It’s not for lack of trying...but the family is not willing to.” Acceptability was high in surveys and interviews: 77% of providers, 78% of parents, and 79% of school nurses strongly agreed that the program was acceptable. One provider reported “It was an excellent, excellent program.” Implications for D&I Research: We found excellent adoption of Asthma Link once children were enrolled and high acceptability of the intervention. Qualitative interviews provided important context to quantitative implementation data and will inform future adaptations to promote intervention uptake. For example, we will develop implementation strategies to better support parents, who are identified by providers as “not willing” to participate, which could increase adoption. The use of mixed-methods to assess implementation outcomes at the level of intervention deliverers (medical providers, practice staff, school nurses) and end-users (parents) provided nuanced, actionable information on implementation. This approach should be considered in future implementation evaluations.
Vestibular damage affects the precision and accuracy of navigation in a virtual visual environment
(2023-12-08) Chari, Divya A; Ahmad, Maimuna; King, Susan; Boutabla, Anissa; Fattahi, Cameron; Panic, Alexander S; Karmali, Faisal; Lewis, Richard F; Otolaryngology; T.H. Chan School of Medicine; Cameron Fattahi
Vestibular information is available to the brain during navigation, as are the other self-generated (idiothetic) and external (allothetic) sensorimotor cues that contribute to central estimates of position and motion. Rodent studies provide strong evidence that vestibular information contributes to navigation but human studies have been less conclusive. Furthermore, sex-based differences have been described in human navigation studies performed with the head stationary, a situation where dynamic vestibular (and other idiothetic) information is absent, but sex differences in the utilization of vestibular information have not been described. Here, we studied men and women with severe bilateral vestibular damage as they navigated through a visually barren virtual reality environment and compared their performance to normal men and women. Two navigation protocols were employed, which either activated dynamic idiothetic cues ('dynamic task', navigate by turning, walking in place) or eliminated them ('static task', navigate with key presses, head stationary). For both protocols, we employed a standard 'triangle completion task' in which subjects moved to two visual targets in series and then were required to return to their perceived starting position without localizing visual information. The angular and linear 'accuracy' (derived from response error) and 'precision' (derived from response variability) were calculated. Comparing performance 'within tasks', navigation on the dynamic paradigm was worse in male vestibular-deficient patients than in normal men but vestibular-deficient and normal women were equivalent; on the static paradigm, vestibular-deficient men (but not women) performed better than normal subjects. Comparing performance 'between tasks', normal men performed better on the dynamic than the static paradigm while vestibular-deficient men and both normal and vestibular-deficient women were equivalent on both tasks. Statistical analysis demonstrated that for the angular precision metric, sex had a significant effect on the interaction between vestibular status and the test paradigm. These results provide evidence that humans use vestibular information when they navigate in a virtual visual environment and that men and women may utilize vestibular (and visual) information differently. On our navigation paradigm, men used vestibular information to improve navigation performance, and in the presence of severe vestibular damage, they utilized visual information more effectively. In contrast, we did not find evidence that women used vestibular information while navigating on our virtual task, nor did we find evidence that they improved their utilization of visual information in the presence of severe vestibular damage.
Exploring the relationship between school-supervised asthma therapy and social determinants of health in pediatric asthma care
(2024-05-16) Al-Halbouni, Layana; Ryan, Grace W; Radu, Sonia; Spano, Michelle; Sabnani, Reshma; Phipatanakul, Wanda; Gerald, Lynn B; Garg, Arvin; Pbert, Lori; Trivedi, Michelle; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center; Sonia Radu
Background: Social determinants of health (SDoH), including access to care, economic stability, neighborhood factors, and social context, strongly influence pediatric asthma outcomes. School-supervised asthma therapy (SST) is an evidence-based strategy that improves asthma outcomes, particularly for historically marginalized children, by providing support for daily medication adherence in school. However, little is known about the relationship between these programs and the adverse SDoH commonly affecting underrepresented minority and marginalized children with asthma. Methods: We examined qualitative data from interviews (n = 52) conducted between 2017 and 2020 with diverse multi-level partners involved in Asthma Link, a SST intervention. Participants included end-users (children and their parents), deliverers (school nurses and pediatric providers), and systems-level partners (e.g., insurers, legislators, and state officials). We used inductive coding to determine themes and subthemes and deductive coding using the Healthy People 2030 SDoH framework. Results: Three themes emerged: (1) SST mitigates adverse SDoH (improves access to preventive healthcare and asthma health literacy), (2) SST benefits children experiencing specific adverse SDoH (provides a consistent medication routine to children with unstable family/housing situations) and (3) specific adverse SDoH impede SST implementation (economic instability, culture and language barriers). Conclusion: This study suggests an important relationship between SDoH and SST that warrants further evaluation in our future work on this community-based asthma intervention. Moreover, our findings underscore the importance of measuring SDoH in the implementation and evaluation of pediatric asthma interventions, particularly given the strong influence of these social factors on child health outcomes.
Dietary Intake of Pregnant Women with and without Inflammatory Bowel Disease in the United States
(2023-05-25) Olendzki, Barbara C; Hsiao, Bi-Sek; Weinstein, Kaitlyn; Chen, Rosemary; Frisard, Christine; Madziar, Camilla; Picker, Mellissa; Pauplis, Connor; Maldonado-Contreras, Ana; Peter, Inga; Microbiology and Physiological Systems; Population and Quantitative Health Sciences; Prevention Research Center; T.H. Chan School of Medicine; Connor Pauplis
Background: Pregnancy is a vulnerable time where the lives of mother and baby are affected by diet, especially high-risk pregnancies in women with inflammatory bowel disease (IBD). Limited research has examined diet during pregnancy with IBD. Aims: Describe and compare the diet quality of pregnant women with and without IBD, and examine associations between dietary intake and guidelines during pregnancy. Methods: Three 24 h recalls were utilized to assess the diets of pregnant women with IBD (n = 88) and without IBD (n = 82) during 27-29 weeks of gestation. A customized frequency questionnaire was also administered to measure pre- and probiotic foods. Results: Zinc intake (p = 0.02), animal protein (g) (p = 0.03), and ounce equivalents of whole grains (p = 0.03) were significantly higher in the healthy control (HC) group than the IBD group. Nutrients of concern with no significant differences between groups included iron (3% IBD and 2% HC met the goals), saturated fat (only 1% of both groups met the goals), choline (23% IBD and 21% HC met the goals), magnesium (38% IBD and 35% HC met the goals), calcium (48% IBD and 60% HC met the goals), and water intake (49% IBD and 48% HC met the goals). Conclusions: Most pregnant women in this cohort fell short of the dietary nutrients recommended in pregnancy, especially concerning for women with IBD.

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