Senior Scientific Session Abstract Book - Pritzker School of Medicine
Senior Scientific Session Abstract Book - Pritzker School of Medicine
Senior Scientific Session Abstract Book - Pritzker School of Medicine
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67 th Annual<br />
<strong>Senior</strong> <strong>Scientific</strong> <strong>Session</strong><br />
<strong>Abstract</strong> <strong>Book</strong><br />
d<br />
May 16, 2013
67 th Annual<br />
<strong>Senior</strong> <strong>Scientific</strong> <strong>Session</strong><br />
<strong>Abstract</strong> <strong>Book</strong><br />
Thursday, May 16, 2013<br />
1 PM - 6:30 PM<br />
Biological Sciences Learning Center<br />
Room 115 & Lobby<br />
John Alverdy, MD<br />
Department <strong>of</strong> Surgery<br />
2013 <strong>Session</strong> Chair<br />
Vineet Arora, MD, MAPP<br />
Assistant Dean for Scholarship & Discovery<br />
Associate Pr<strong>of</strong>essor <strong>of</strong> <strong>Medicine</strong><br />
d<br />
2013 Presentation Judges<br />
Kristen Knutson, PhD<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Arshiya Baig, MD, MPH<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Matthew Brady, PhD<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Marshall Chin, MD, MPH<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Ronald Cohen, MD<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Andrew Davis, MD, MPH<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Harriet deWit, PhD<br />
Department <strong>of</strong> Psychiatry & Behavioral Neuroscience<br />
Peggy Mason, PhD<br />
Department <strong>of</strong> Neurobiology<br />
Mark Musch, PhD<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Funmi Olopade, MD<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Sola Olopade, MD, MPH<br />
Department <strong>of</strong> Family <strong>Medicine</strong><br />
Tipu Puri, MD, PhD<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Lainie Ross, MD, PhD<br />
Department <strong>of</strong> Pediatrics<br />
Elbert Huang, MD, MPH<br />
Department <strong>of</strong> <strong>Medicine</strong><br />
Scott Hunter, PhD<br />
Department <strong>of</strong> Psychiatry & Behavioral Neuroscience<br />
Department <strong>of</strong> Pediatrics<br />
Stephen Small, MD<br />
Department <strong>of</strong> Anesthesia & Critical Care<br />
1
1 PM Holly J. Humphrey, MD<br />
Dean for Medical Education<br />
Welcome & Opening Remarks<br />
Biological Sciences Learning Center Room 115<br />
Vineet Arora, MD, MAPP<br />
Assistant Dean for Scholarship & Discovery<br />
Associate Pr<strong>of</strong>essor <strong>of</strong> <strong>Medicine</strong><br />
Oral Presentations<br />
<strong>Abstract</strong>s Located on Pages 13-22<br />
1:15 PM Nikita Alexiades: Maciej Lesniak, MD, MHCM<br />
Evaluation <strong>of</strong> VEGFR2 Signaling and MMP14 Activity in Human Neural Stem<br />
Cell Glioma Tropism<br />
1:30 PM Kiran Kumar: Ralph Weichselbaum, MD<br />
Cytosolic DNA Sensors Regulate IR Induced Interferon Killing <strong>of</strong> Tumor Cells<br />
1:45 PM Marcia Faustin: Dana Suskind, MD<br />
A Randomized Controlled Pilot <strong>of</strong> a Novel Parent-Directed Language Intervention in Children <strong>of</strong> Low<br />
SES: The Thirty Million Words Project<br />
2:00 PM Gabrielle Schaefer: Vineet Arora, MD, MAPP<br />
Financial Responsibility <strong>of</strong> Hospitalized Patients Who Left Against Medical Advice:<br />
Medical Urban Legend?<br />
2:15 PM Rachel Stork: Jeffrey Frank, MD<br />
Simulation: A Novel Modality for Improving Physician Knowledge and Confidence with<br />
Recombinant Tissue-Type Plasminogen Activator for Acute Ischemic Stroke<br />
2:30 PM BREAK<br />
2:45 PM Benjamin Ferguson, PhD: Ravi Salgia, MD, PhD<br />
The EphB4 Receptor Tyrosine Kinase Promotes Lung Cancer Growth:<br />
A Potential Novel Therapeutic Target<br />
3:00 PM William Zeiger, PhD: Gopal Thinakaran, PhD<br />
Ca2+ Influx through Store-Operated Calcium Channels Reduces Alzheimer’s<br />
Disease Aβ Secretion<br />
3:15 PM Kelly Ledbetter: David H. Song, MD, MBA<br />
Thoracodorsal Artery Perforator and Muscle Sparing Latissimus Dorsi Flaps in Breast Reconstruction<br />
after Radiation Therapy<br />
3:30 PM Tarak Trivedi: Benjamin Lopman, PhD<br />
Hospitalizations and Mortality Associated with Norovirus Outbreaks in Nursing Homes, 2009-2010<br />
3:45 PM Joyce Woo: David Glick, MD<br />
Competition and Quality in Procedural Health Care<br />
2
Poster Presentations<br />
Biological Sciences Learning Center Lobby<br />
<strong>Abstract</strong>s Located on Pages 25-53<br />
4:15 PM<br />
Rajiv Agarwal<br />
Brittany Betham<br />
Clifton Brock<br />
Valerie Chen<br />
Tharian Cherian<br />
Kevin Choo<br />
Michael Combs<br />
Amanda Gawin<br />
Elizabeth Greenstein<br />
Atul Kapila<br />
Yelena Koldobskaya, PhD<br />
Samuel Lee<br />
Patrick Mann<br />
Rebecca Miller<br />
Shamsideen Musa, MS<br />
Michael Putman<br />
Katie Raffel<br />
Paul Riordan<br />
Jasmine Swaniker<br />
Sarah Todd, MAT<br />
Anne Toledo<br />
Joseph Triggs, PhD<br />
William Uffmann<br />
Joshua Williams<br />
Wenlu Xiong<br />
Babatunde Yerokun<br />
Jordan Yoder<br />
Matthew Zegarek<br />
Presentation Judging<br />
5:45 PM<br />
ORAL<br />
Catherine Dobson Prize<br />
For the best oral presentation given by a student in the area <strong>of</strong> scientific investigation<br />
in clinical or social sciences<br />
Leon O. Jacobson Basic Science Prize (MD/PhD students)<br />
Granted to the MD/PhD student whose basic science research is judged to be the most<br />
meritorious from among session participants<br />
Leon O. Jacobson Prize (non-PhD students)<br />
For the best oral presentation given by a non-PhD student in the area <strong>of</strong> the basic biological sciences<br />
Medical and Biological Sciences Alumni Association Prize<br />
For the best presentation made by a student in the area <strong>of</strong> Applied Scholarship (Global Health,<br />
Community Health, Medical Education or Quality & Safety)<br />
POSTER<br />
Award for Best Poster Describing Applied Scholarship<br />
Award for Best Poster Describing Basic <strong>Scientific</strong> Investigation<br />
Award for Best Poster Describing <strong>Scientific</strong> Investigation in Clinical or Social Sciences<br />
ORAL OR POSTER<br />
Franklin McLean Medical Student Research Award<br />
Granted to the non-PhD student who has performed the most meritorious research<br />
in the medical field<br />
6:15 PM Vineet Arora, MD, MAPP<br />
Closing Remarks & Award Presentations<br />
2013 <strong>Senior</strong> <strong>Scientific</strong> <strong>Session</strong> Organized by <strong>Pritzker</strong> <strong>School</strong> <strong>of</strong> <strong>Medicine</strong> Faculty and Staff:<br />
Vineet Arora, MD, MAPP, Assistant Dean for Scholarship and Discovery, Associate Pr<strong>of</strong>essor <strong>of</strong> <strong>Medicine</strong><br />
Kate Blythe, Director <strong>of</strong> Student Programs<br />
Candi Gard, Student Programs Administrator<br />
Jo Beaudreau, Student Programs Administrator<br />
3
Oral Presentations<br />
Numbers are Associated with <strong>Abstract</strong> Page Number. <strong>Abstract</strong>s are in Order <strong>of</strong> Presentations.<br />
13……...Nikita Alexiades: Maciej Lesniak, MD, MHCM<br />
Evaluation <strong>of</strong> VEGFR2 Signaling and MMP14 Activity in Human Neural Stem<br />
Cell Glioma Tropism<br />
14.……..Kiran Kumar: Ralph Weichselbaum, MD<br />
Cytosolic DNA Sensors Regulate IR Induced Interferon Killing <strong>of</strong> Tumor Cells<br />
15……..Marcia Faustin: Dana Suskind, MD<br />
A Randomized Controlled Pilot <strong>of</strong> a Novel Parent-Directed Language Intervention in Children <strong>of</strong> Low<br />
SES: The Thirty Million Words Project<br />
16……..Gabrielle Schaefer: Vineet Arora, MD, MAPP<br />
Financial Responsibility <strong>of</strong> Hospitalized Patients Who Left Against Medical Advice:<br />
Medical Urban Legend?<br />
17……..Rachel Stork: Jeffrey Frank, MD<br />
Simulation: A Novel Modality for Improving Physician Knowledge and Confidence with<br />
Recombinant Tissue-Type Plasminogen Activator for Acute Ischemic Stroke<br />
18……...Benjamin Ferguson, PhD: Ravi Salgia, MD, PhD<br />
The EphB4 Receptor Tyrosine Kinase Promotes Lung Cancer Growth: A Potential Novel Therapeutic Target<br />
19….…..William Zeiger, PhD: Gopal Thinakaran, PhD<br />
Ca2+ Influx through Store-Operated Calcium Channels Reduces Alzheimer’s<br />
Disease Aβ Secretion<br />
20…….. Kelly Ledbetter: David H. Song, MD, MBA<br />
Thoracodorsal Artery Perforator and Muscle Sparing Latissimus Dorsi Flaps in Breast Reconstruction<br />
after Radiation Therapy<br />
21….….Tarak Trivedi: Benjamin Lopman, PhD<br />
Hospitalizations and Mortality Associated with Norovirus Outbreaks in Nursing Homes, 2009-2010<br />
22……...Joyce Woo: David Glick, MD<br />
Competition and Quality in Procedural Health Care<br />
4 Oral Presentation <strong>Abstract</strong>s
APPLIED SCHOLARSHIP<br />
Poster Presentations<br />
Numbers are Associated with both <strong>Abstract</strong> Page Number & Poster Number<br />
25……..Kevin Choo: Jeanne M. Farnan, MD, MHPE<br />
How Do Supervising Physicians Decide to Entrust Residents with Unsupervised Tasks?<br />
26……..Amanda Gawin: Deborah Burnet, MD, MA<br />
Development <strong>of</strong> Text Message Intervention to Engage Parents in Youth After-<strong>School</strong> Nutrition and<br />
Exercise Program<br />
27……..Elizabeth Greenstein: Jeanne M. Farnan, MD, MHPE<br />
Interruptions During Resident Hand<strong>of</strong>fs on Labor and Delivery: A Mixed-Methods Multi-Site Study<br />
28……..Patrick Mann: Aliya Husain, MD<br />
Updating the Virtual Pathology <strong>of</strong> Clinical Pathophysiology and Therapeutics<br />
29……..Rebecca Miller: Debra Stulberg, MD, MA<br />
Sex(Ed) is Fun: Design, Implementation and Analysis <strong>of</strong> a Sexual Education Curriculum<br />
for Middle <strong>School</strong> Students<br />
30……..Katie Raffel: Monica Peek, MD<br />
Food Rx: Integrating Clinic and Community Resources to Improve Dietary Management <strong>of</strong> Diabetes<br />
29……..Sarah Todd, MAT: Debra Stulberg, MD, MA<br />
Sex(Ed) is Fun: Design, Implementation and Analysis <strong>of</strong> a Sexual Education Curriculum<br />
for Middle <strong>School</strong> Students<br />
31……..Anne Toledo: Brian Callender, MD<br />
Attitudes <strong>of</strong> Chilean Primary Care Providers Toward Chilean Public Primary Care<br />
32……..William Uffmann: Christopher Straus, MD<br />
Streamlining the Medical Imaging Anatomy Curriculum: Introducing Image Interpretation<br />
with ‘Core’ Images and Narrated Screencasts<br />
33……..Wenlu Xiong: Aisha Sethi, MD<br />
Global Health Experiences and Their Influence on Medical Specialty Choice and Career Path<br />
34……..Matthew Zegarek: Shalini Reddy, MD<br />
Can I Get Some Feedback?: Student Descriptions <strong>of</strong> Facilitators and Barriers to Formative Feedback<br />
BASIC SCIENTIFIC INVESTIGATION<br />
36……..Clifton Brock: Suzanne Conzen, MD<br />
Glucocorticoid Mediated Gene Expression is Associated with Decreased Insulin Sensitivity<br />
in Human Sub-Cutaneous Abdominal Fat<br />
37……..Tharian Cherian:Timothy Niewold, MD<br />
IRF5 Systemic Lupus Erythematosus Risk Haplotype is Associated with Serologic Autoimmunity and<br />
Progression to Clinical Autoimmunity in Mothers <strong>of</strong> Children with Neonatal Lupus<br />
38……..Yelena Koldobskaya, PhD: Joseph A. Piccirilli, MS, PhD<br />
A Portable RNA Sequence Whose Recognition by a Synthetic Antibody Facilitates Structural<br />
Determination<br />
Poster Presentation <strong>Abstract</strong>s<br />
5
39……..Samuel Lee: Edwin Munro, PhD<br />
Dynamic Interactions Among CDC42, PAR-6/PKC-3 and LGL Can Maintain Cell Polarity in Early<br />
Embryos <strong>of</strong> the Nematode Worm C. elegans<br />
40……..Shamsideen Musa, MS: Rick Kittles, PhD<br />
Uncovering the Mechanism <strong>of</strong> Vitamin D and NSAID Combination Therapy in Prostate Cancer<br />
41……..Joseph Triggs, PhD: Harinder Singh, PhD<br />
The Genomic Interplay <strong>of</strong> Key Lineage Determinants During B Cell Fate Determination<br />
42……..Joshua Williams: Stephen Meredith, MD, PhD<br />
Chaotic Aggregation <strong>of</strong> Truncated Amyloid Beta Peptides<br />
43……..Babatunde Yerokun: Elizabeth McNally, MD<br />
Abcc9 is Required for the Transition to Oxidative Metabolism in the Newborn Heart<br />
SCIENTIFIC INVESTIGATION IN CLINICAL OR SOCIAL SCIENCES<br />
45……..Rajiv Agarwal: Hongtao Liu, MD, PhD<br />
Predicting Allogeneic Stem Cell Transplant Outcomes in Patients with High Risk AML & MDS:<br />
A Retrospective Analysis <strong>of</strong> Pre-Transplantation Variables<br />
46……..Brittany Betham: Melissa Gilliam, MD, MPH<br />
Impact <strong>of</strong> a Revised Appointment Scheduling Script on IUD Service Delivery in<br />
Three Title X Family Planning Clinics<br />
47……..Valerie Chen: H.Barrett Fromme, MD, MHPE & Susan Ksiazek, MD<br />
Comparison <strong>of</strong> Illuminated Dilated Pinhole, Laser Inferometer, and Potential Acuity Meter in Predicting<br />
Postoperative Visual Acuity after Cataract Surgery<br />
48……..Michael Combs: Farr A. Curlin, MD<br />
Substituted Judgment in Principle and Practice: A National Physician Survey<br />
49……..Atul Kapila: Sangeeta Bhorade, MD<br />
Inter‐Observer Variability Regarding the Diagnosis <strong>of</strong> Bronchiolitis Obliterans Syndrome<br />
50……..Michael Putman: Farr A. Curlin, MD<br />
Intentional Sedation to Unconsciousness at the End <strong>of</strong> Life: Findings From a National Physician Survey<br />
51……..Paul Riordan: Gregory Ruhnke, MD, MS, MPH<br />
The Impact <strong>of</strong> Adverse Economic Conditions on Healthcare Demand<br />
52……..Jasmine Swaniker: David Glick, MD<br />
Infection Control for Anesthesia Providers: A Literature Review and Research Proposal<br />
53……..Jordan Yoder: Vineet Arora, MD, MAPP<br />
Are All Vital Signs “Vital”? A Prospective Study <strong>of</strong> Nighttime Vital Sign Frequency and<br />
Risk <strong>of</strong> Clinical Deterioration<br />
6 Poster Presentation <strong>Abstract</strong>s
Presentation Notes
LEON ORRIS JACOBSON<br />
December 16, 1911 – September 20, 1992<br />
The annual <strong>Senior</strong> <strong>Scientific</strong> <strong>Session</strong> was founded by Dr. Leon Jacobson in 1946 to showcase the caliber <strong>of</strong> <strong>Pritzker</strong><br />
graduates and the quality <strong>of</strong> their education. The <strong>Session</strong> provides fourth-year students with the opportunity to<br />
showcase their research through oral and poster presentations.<br />
As a young resident at the University <strong>of</strong> Chicago hospital in 1942, Dr. Jacobson was summoned from a patient’s bedside<br />
and told he was being put in charge <strong>of</strong> protecting the health <strong>of</strong> the staff <strong>of</strong> the secret Manhattan Project. He was<br />
later credited with laying the groundwork for bone marrow transplantation and initiating the search for the hormone<br />
erythropoietin, which regulates red blood cell production in mammals. Erythropoietin is now the basis for a drug that<br />
treats chemotherapy-induced anemia in some cancer patients.<br />
He was chosen because he had done research on the biological effects <strong>of</strong> radiation, and was one <strong>of</strong> the first doctors to<br />
treat blood disorders with radioactive phosphorus. By the conclusion <strong>of</strong> the project in 1945 Dr. Jacobson and his staff<br />
had produced several medical advances, including testing the first forms <strong>of</strong> chemotherapy to fight cancer.<br />
Pr<strong>of</strong>essor Jacobson, a native <strong>of</strong> Sims, North Dakota, received a Bachelor <strong>of</strong> Science degree from North Dakota State<br />
University in 1935 and his medical degree from the University <strong>of</strong> Chicago in 1939.<br />
He was an authority on the study and clinical use <strong>of</strong> radiation in medicine and on diseases <strong>of</strong> the blood. His pr<strong>of</strong>essional<br />
career, spent entirely at the University <strong>of</strong> Chicago, included serving as director <strong>of</strong> the Argonne Cancer Research Hospital<br />
and as dean <strong>of</strong> the division <strong>of</strong> biological sciences.<br />
Dr. Leon Jacobson passed in 1992. His first wife, Elizabeth L. Benton, died in 1983. Dr. Jacobson, who lived in Chicago,<br />
is survived by his second wife, Elise; a son, Eric P. Jacobson; a daughter, Judith A. Boniker, and six grandchildren.<br />
8 History
2012-2013 Calvin Fentress Fellowship Recipients<br />
Rajiv Agarwal<br />
Mentor: Hongtao Liu, MD, PhD<br />
Tharian Cherian<br />
Mentor: Timothy Niewold, MD<br />
Michael Combs<br />
Mentor: Farr A. Curlin, MD<br />
Kiran Kumar<br />
Mentor: Ralph Weichselbaum, MD<br />
Samuel Lee<br />
Mentor: Edwin Munro, PhD<br />
Tarak Trivedi<br />
Mentor: Benjamin Lopman, PhD<br />
Joshua Williams<br />
Mentor: Stephen Meredith, MD, PhD<br />
Joyce Woo<br />
Mentor: David Glick, MD<br />
Jordan Yoder<br />
Mentor: dVineet Arora, MD, MAPP<br />
2012-2013 John D. Arnold, MD<br />
<strong>Scientific</strong> Research Prize Recipients<br />
Nikita Alexiades<br />
Mentor: Maciej Lesniak, MD<br />
Clifton Brock<br />
Mentor: Suzanne Conzen, MD<br />
Jasmine Swaniker<br />
Mentor: David Glick, MD<br />
Awards<br />
9
2012-2013 JOHN D. ARNOLD, MD<br />
MENTOR AWARD RECIPIENTS<br />
In 2012, a grateful alumnus, Dr. Charles Pak, established the John D. Arnold, MD <strong>Scientific</strong> Research Prize in<br />
recognition <strong>of</strong> the impact his mentor had on his education and future research career. The Arnold <strong>Scientific</strong> Research<br />
Prize recognizes students whose research accomplishments as medical students are based on ongoing, sustained work<br />
with a single faculty mentor. The goal <strong>of</strong> the Arnold <strong>Scientific</strong> Research Prize is to provide support for the continuation<br />
<strong>of</strong> the mentoring relationship and collaborative research during the fourth year <strong>of</strong> medical school. As part <strong>of</strong> the<br />
application, students were asked to comment on the contributions their mentors had made on their pr<strong>of</strong>essional growth<br />
and development, and the mentors <strong>of</strong> the selected students are also honored with the 2012-2013 John D. Arnold, MD<br />
Mentor Award for sustained excellence in mentoring medical students.<br />
The inaugural John D. Arnold, MD Mentor Awards are bestowed upon:<br />
Suzanne Conzen, MD<br />
Dr. Conzen is an expert in the diagnosis and treatment <strong>of</strong> breast cancer. She has a special clinical interest in the<br />
multidisciplinary care <strong>of</strong> locally advanced breast cancers, which may require chemotherapy and radiation therapy prior<br />
to surgical resection. Dr. Conzen’s research laboratory uses a combination <strong>of</strong> molecular biology and large-scale genomic<br />
techniques to identify new targets for the effective therapy <strong>of</strong> breast cancer. Her work led to the recognition <strong>of</strong> a role for<br />
glucocorticoid receptor signaling in breast cancer biology.<br />
Dr. Conzen received the John D. Arnold MD Mentor Award for her work with fourth year student Clifton Brock. In<br />
commenting on Dr. Conzen’s contributions to his pr<strong>of</strong>essional growth and development, he wrote:<br />
“With Dr. Conzen’s help, I was able to learn cutting edge techniques in bioinformatics, attend national<br />
conferences in endocrinology, and acquire my own funding from HHMI. None <strong>of</strong> this would have<br />
been possible without her ongoing support. While a medical education obviously requires scientific<br />
literacy, the vast majority <strong>of</strong> my skill in generating scientific hypotheses and performing experiments was<br />
developed in Dr. Conzen’s laboratory. In short, she has provided a foundation for a career as a physicianscientist.”<br />
Suzanne Conzen, MD<br />
Pr<strong>of</strong>essor <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hematology-Oncology<br />
10 Awards
David Glick, MD<br />
Associate Pr<strong>of</strong>essor <strong>of</strong> Anesthesia<br />
and Critical Care<br />
David Glick, MD<br />
Dr. Glick’s academic interests include a focus on anesthesia and the<br />
autonomic nervous system, intraoperative awareness under anesthesia,<br />
and structural issues related to the practice <strong>of</strong> anesthesia, including<br />
quality metrics in anesthesia and surgery and economic optimization<br />
<strong>of</strong> the operating room. Dr. Glick is a devoted teacher, who serves as<br />
the track leader in the <strong>Scientific</strong> Investigation – Clinical Sciences track<br />
for the Scholarship and Discovery curriculum at the <strong>Pritzker</strong> <strong>School</strong> <strong>of</strong><br />
<strong>Medicine</strong>.<br />
Dr. Glick received the John D. Arnold MD Mentor Award for his work<br />
with fourth year student Jasmine Swaniker. In commenting on Dr.<br />
Glick’s sustained excellence as a mentor, she wrote:<br />
“I wanted to find a mentor with a great deal <strong>of</strong> research experience as<br />
well as a reputation for being a great teacher and source <strong>of</strong> support<br />
for medical students. In speaking with previous students who’d done<br />
research with Dr. Glick, I was struck by the overwhelmingly positive<br />
d<br />
experiences they had and knew that working with him would be a great learning experience. I was certainly not<br />
disappointed….Furthermore, it is due in no small part to the time I’ve spent in his lab that I’ve chosen to pursue<br />
Anesthesiology as my specialty.”<br />
Maciej Lesniak, MD<br />
Dr. Lesniak is director <strong>of</strong> neurosurgical oncology and neuro-oncology<br />
research in the University <strong>of</strong> Chicago Brain Tumor Center. This<br />
multidisciplinary physician team provides a comprehensive approach<br />
to brain tumor care, and <strong>of</strong>fers the newest, most innovative therapies.<br />
The Brain Tumor Center actively participates in clinical trials sponsored<br />
by the National Institutes <strong>of</strong> Health (NIH). Dr. Lesniak’s research<br />
interests include gene therapy, stem cell therapy, immunotherapy and<br />
nanotechnology.<br />
Dr. Lesniak received the John D. Arnold, MD Mentor Award for his<br />
work with fourth year student Nikita Alexiades, who described her<br />
interactions with Dr. Lesniak over the course <strong>of</strong> the last few years as<br />
follows:<br />
Maciej Lesniak, MD<br />
Pr<strong>of</strong>essor <strong>of</strong> Surgery and Neurology<br />
“Dr. Lesniak has been an amazing mentor thus far, both in guiding my development as a physician<br />
scientist and in guiding my path into the field <strong>of</strong> neurosurgery. He has been and continues to be extremely<br />
involved in my career development and has opened many doors for me into my desired field. He has been<br />
an outstanding pr<strong>of</strong>essional role model, and I am certain that his role in my career will continue well<br />
beyond my graduation from <strong>Pritzker</strong>.”<br />
Awards<br />
11
12 Oral Presentation <strong>Abstract</strong>s<br />
Oral Presentations<br />
In Presentation Order
Evaluation <strong>of</strong> VEGFR2 Signaling and MMP14 Activity in<br />
Human Neural Stem Cell Glioma Tropism<br />
Nikita Alexiades<br />
MENTOR: Maciej Lesniak, MD, MHCM, Department <strong>of</strong> Surgery, Section <strong>of</strong> Neurological Surgery<br />
CO-AUTHORS: Atique U. Ahmed, PhD, Alex Tobias, BA, Chung Kwon Kim, PhD<br />
BACKGROUND: Despite aggressive research efforts the prognosis for patients diagnosed with malignant glioma<br />
remains dismal. Optimal accepted treatment combining surgical resection, chemotherapy and radiotherapy continues<br />
to afford a median survival <strong>of</strong> little over one year. Neural stem cells possessing inherent tumor tropism <strong>of</strong>fer a platform<br />
for the targeted delivery <strong>of</strong> diverse therapeutic agents including oncolytic viruses, chemotherapeutic drugs and custom<br />
built antibodies to diffusely distributed tumor burden. Despite the effectiveness <strong>of</strong> this approach, NSC migration<br />
remains consistently incomplete with only 20‐25% <strong>of</strong> cells migrating to the tumor burden. Numerous signaling<br />
molecules and membrane bound proteins have been implicated in NSC migration. The identification <strong>of</strong> such molecules<br />
and their augmentation may serve to enhance migration and increase clinical efficacy.<br />
METHODS: Migratory and non migratory subpopulations were isolated using Transwell migration chambers and<br />
levels <strong>of</strong> VEGFR2 and Nestin expression were measured using qRTPCR and FACS. Immun<strong>of</strong>luoresence was employed<br />
to evaluate VEGFR2 protein expression and localization in both in vitro and in vivo tumor models. A custom built PCR<br />
array was conducted to identify target molecules unpregulated following NSC exposure to growth factors previously<br />
shown to enhance migration. Western blots were used to study the VEGFR2 signaling cascade and MMP14 expression<br />
following dose and time dependent exposure to VEGFA. An shRNA knockdown <strong>of</strong> MMP14 using a lentiviral vector<br />
was executed and functional assays <strong>of</strong> NSC glioma tropism were conducted.<br />
RESULTS: Migratory NSCs were found to express significantly greater levels <strong>of</strong> VEGFR2 mRNA (4x, p
Cytosolic DNA Sensors Regulate IR-Induced Interferon Killing <strong>of</strong> Tumor Cells<br />
Kiran Kumar<br />
MENTOR: Ralph Weichselbaum, MD, Department <strong>of</strong> Radiation and Cellular Oncology<br />
CO-AUTHORS: Akash Parekh, MS2, Ryan Widau, PhD, Nikolai Khodarev, PhD<br />
BACKGROUND: Ionizing radiation (IR) induces interferon (IFN) production in tumor cells both in vitro and in<br />
vivo, which play a role in IR-induced cytotoxicity. This project aims to further understand the connection between<br />
IR and IFN production. Specifically, we hypothesize that radiation-induced DNA damage is recognized by cytosolic<br />
sensors <strong>of</strong> DNA, which signal downstream through proteins like STING to activate the IFN production pathways.<br />
METHODS: Cell cultures were maintained using standard protocols. IR was delivered using a Phillips orthovoltage<br />
X-ray generator. IFN-b response was measured using qRT-PCR. shRNA was used to create stable knockdowns <strong>of</strong><br />
STING in SCC61 head and neck cancer cell line (knockdowns verified with Western blots and PCR). Clonogenic<br />
assays were done to measure cell survival and radio-resistance and –sensitivity. Immun<strong>of</strong>luorescence (IF) was used with<br />
HSV as a positive control to visualize STING relocation to Golgi after IR. C57BL/6 mice livers were treated with 20<br />
Gy IR and one day later, harvested. DNA is then extracted from the cytosolic portion <strong>of</strong> cells by using the detergent<br />
Digitonin to lyse the plasma membrane only.<br />
RESULTS: We irradiated 11 different cancer cell lines in vitro, and measured IFN-b response on Day 3 post-IR. We<br />
found that the cell lines that expressed the highest levels <strong>of</strong> STING had the highest fold induction (>50) <strong>of</strong> IFN-b.<br />
Knockdown <strong>of</strong> STING reduced IFN-b induction by 75% (p
A Randomized Controlled Pilot <strong>of</strong> a Novel Parent-Directed Language Intervention<br />
in Children <strong>of</strong> Low SES: The Thirty Million Words Project<br />
Marcia Faustin<br />
MENTOR: Dana Suskind, MD, Department <strong>of</strong> Surgery, Section <strong>of</strong> Otolaryngology<br />
CO-AUTHORS: Kristen Leffel, BS, Shannon Sapolich, BA, Elizabeth Suskind, BA<br />
BACKGROUND: The Thirty Million Words Project (TMW) is a parent‐directed intervention aimed at increasing<br />
the educational potential <strong>of</strong> children <strong>of</strong> low socioeconomic status (SES). A Hart and Risely study demonstrated that<br />
children <strong>of</strong> lower SES heard thirty million fewer words than children <strong>of</strong> greater affluence by age three. Low‐SES<br />
mothers have consistently been found to talk less, use a smaller vocabulary, be more directive, and ask fewer questions<br />
<strong>of</strong> their children than higher SES mothers. Subsequently, these low‐SES children enter school with much smaller<br />
vocabularies, become weaker readers, and set out on trajectories for lower ultimate educational attainment. However,<br />
research has found that child‐directed speech is mediated by parental knowledge <strong>of</strong> child development. Therefore, we<br />
hypothesize that parental linguistic input can be increased by increasing parental knowledge <strong>of</strong> child development and<br />
giving parents quantitative linguistic feedback, measured by adult word count and conversational turn count.<br />
METHODS: This was a randomized, controlled study trial completed on Chicago’s South side. Twenty‐six families<br />
completed the study and were randomly assigned to either the treatment or control group. Inclusion criteria included<br />
parents <strong>of</strong> children age 18‐36 months with government medical insurance and parent education level at or below a<br />
college degree. Exclusion criteria included children receiving early intervention or parents unable to commit to the<br />
length <strong>of</strong> the study.<br />
A 30‐item TMW Knowledge Questionnaire was administered pre‐ and post‐intervention to assess parental knowledge<br />
<strong>of</strong> a variety <strong>of</strong> child language development topics. The Language Environment Analysis System (LENA) was used to<br />
record and analyze the child’s language environment, focusing on: adult word count (AWC) and conversational turn<br />
counts (CTC). Fourteen LENA recordings were completed over a 24‐week period: three pre‐intervention baseline<br />
recordings, eight weekly recordings, and three monthly post‐intervention follow up recordings. The Home Visitor<br />
made home visits for the eight weekly recordings to discuss the parent’s LENA feedback reports and strategies for<br />
improving their child’s language environment.<br />
RESULTS: The treatment and control groups were comparable in regards to baseline measurements <strong>of</strong> mean AWC<br />
= 711 wordsper‐ hour, SD = 332 and mean CTC = 26 turns‐per‐hour, SD = 14. Post‐intervention, the treatment<br />
group showed statistically significant changes in all the variables tested. The TMW Knowledge Questionnaire showed a<br />
significant postintervention increase, p < .05. AWC had a significant increase, mean difference = +146 words‐per‐hour,<br />
t = 2.64, p
Financial Responsibility <strong>of</strong> Hospitalized Patients<br />
Who Left Against Medical Advice: Medical Urban Legend?<br />
Gabrielle Schaefer<br />
MENTOR: Vineet Arora, MD, MAPP, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> General Internal <strong>Medicine</strong><br />
CO-AUTHORS: John Schumann, MD, Heidi Matus, MD, Keith Sauter, Ben Vekhter, PhD,<br />
David Meltzer, MD, PhD<br />
BACKGROUND: When patients leave against medical advice (AMA) health care providers <strong>of</strong>ten tell them that<br />
insurance will not pay for the care they have received. To clarify whether or not third party payers actually deny<br />
payment to the hospital in these circumstances we studied the bills <strong>of</strong> patients who had left against medical advice. In<br />
addition, we created and educational intervention to address these myths.<br />
DESCRIPTION OF PROGRAM/INNOVATION: We audited billing records <strong>of</strong> patients who left AMA at UCMC<br />
and surveyed attending and resident physicians about their beliefs about whether insurance pays when someone leaves<br />
AMA. Review <strong>of</strong> 10 years <strong>of</strong> billing data showed that none <strong>of</strong> the patients who left AMA (N=526) were denied<br />
payment because they left AMA. Despite this 68% <strong>of</strong> residents and 45% <strong>of</strong> attendings believed that insurance would<br />
deny payment if a patient left AMA. Sources <strong>of</strong> this misconception were the AMA form, as well as rumor and other<br />
residents. Review <strong>of</strong> the AMA forms from Chicago hospitals (N=17) showed our hospital was an outlier in including<br />
this language on the form.<br />
We developed an educational video for physicians that included a scenario <strong>of</strong> a patient leaving against medical and<br />
advice about how to negotiate with patients based on literature review and the findings <strong>of</strong> our study. We housed this<br />
video on a website that contained additional information about the subject and links to reference articles. We then used<br />
social media (Facebook, Twitter) to disseminate our findings. As another part <strong>of</strong> our QI project, we worked with our<br />
hospital’s Medical Legal and Risk Management departments to update the language in the AMA form to remove any<br />
statements about financial responsibility.<br />
EVALUATION OF PROGRAM/INNOVATION: In an annual survey <strong>of</strong> internal <strong>Medicine</strong> attendings at UCMC,<br />
we examined the effect <strong>of</strong> education on the degree to which they believed insurance does not pay when a patient leaves<br />
AMA and how <strong>of</strong>ten they inform patients <strong>of</strong> this. The response rates for the attending physician survey were 56%<br />
in 2010, 60% in 2011, 54% in 2012. Initially 45% <strong>of</strong> attendings responded they agreed or strongly agreed with the<br />
statement “when a patient leaves the hospital against medical advice, insurance companies do not pay for the patient’s<br />
hospitalization”. In the two years since our intervention, there has been a sustained downward trend in that belief from<br />
45% to 28% and then 21% (trend test p value = 0.043). Before the intervention, 51% <strong>of</strong> attendings responded that<br />
they <strong>of</strong>ten or always informed patients that they may be held financially responsible if the leave AMA. In the years since<br />
that has decreased to 36% and then 33%.<br />
CONCLUSION: Despite the belief that patients are forced to pay the bill when they leave AMA, we found no<br />
evidence <strong>of</strong> this practice. With education, UCMC physicians were less likely to report patients are held financially<br />
responsible for leaving AMA. We plan to continue our efforts to make sure all our physicians are informed <strong>of</strong> the truth<br />
about this issue to prevent them from misinforming patients.<br />
IRB/IACUC: ExemptTrack: Quality and Safety<br />
Submitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: Grant Funding: AHRQ CERT Grant 1U18HS016967-01 and NIA T35 Grant 5T35AG029795-02.<br />
Disclosures: David O. Meltzer reports a consultancy position at the Congress and Budget Office and grants from the NIH, RWJ, and<br />
AHRQ. Vineet Arora reports grants from the NIA, AHRQ, ACGME, and the ABIM Foundation.<br />
16 Oral Presentation <strong>Abstract</strong>s
Simulation: A Novel Modality for Improving Physician Knowledge and Confidence<br />
with Recombinant Tissue-Type Plasminogen Activator for Acute Ischemic Stroke<br />
Rachel Stork<br />
MENTOR: Jeffrey Frank, MD, Department <strong>of</strong> Neurology, Section <strong>of</strong> Neurocritical Care<br />
CO-AUTHORS: Morris Kharasch, MD, Ernest Wang, MD, Pam Aitchison, RN, Fernando Goldenberg, MD,<br />
Cedric McKoy, APN<br />
BACKGROUND: Intravenous recombinant tissue-type plasminogen activator (Alteplase) is the only FDA approved<br />
non-invasive medical treatment for restoring brain perfusion in acute ischemic stroke (AIS) patients, however many<br />
neurology residents will graduate with little or no experience in its use. Alteplase for AIS is underutilized, in part, due<br />
to lack <strong>of</strong> physician experience and training. Inappropriate use <strong>of</strong> Alteplase leads to more frequent, potentially deadly<br />
complications. Simulation is an ideal educational modality for increasing physician knowledge, skill, and xperience<br />
with the management <strong>of</strong> AIS without risk to patients.<br />
DESCRIPTION OF PROGRAM/INNOVATION: 23 physicians (13 neurology, 10 emergency medicine) were<br />
interviewed to identify and prioritize learning objectives for AIS management with respect to intravenous rtPA use.<br />
A comprehensive curriculum consisting <strong>of</strong> case discussions, a standardized patient encounter, and both high and low<br />
fidelity simulated patient scenarios were designed around these objectives in the format <strong>of</strong> a half-day acute stroke<br />
simulation workshop (ASSW). A pilot workshop was used to refine the curriculum. Entrance and exit surveys were<br />
administered to measure changes in knowledge, skills, and attitudes. The use <strong>of</strong> Alteplase for AIS was tracked before<br />
and after the intervention.<br />
EVALUATION OF PROGRAM/INNOVATION: To date, 17 neurology and emergency medicine residents have<br />
completed the workshop. All trainees reported significantly increased confidence in AIS patient selection and management<br />
with Alteplase, including its potential complications. The percent <strong>of</strong> AIS patients who received interventions doubled<br />
after resident participation in simulation, going from 6.75% in the 26 months before the first simulation workshop<br />
to 13.82% in the 13 months following the third simulation workshop, with no complications or protocol violations.<br />
CONCLUSION: Medical simulation is an effective educational modality for the training <strong>of</strong> physicians in management<br />
<strong>of</strong> AIS and shows great promise to favorably impact physician practice and AIS patient outcome.<br />
Track: Medical EducationSubmitted for: MS1 Spring Elective, SRP, MS2 S&D Block, MS4 S&D Work<br />
Acknowledgements/Disclosures: None.<br />
Oral Presentation <strong>Abstract</strong>s<br />
17
The EphB4 Receptor Tyrosine Kinase Promotes Lung Cancer Growth:<br />
A Potential Novel Therapeutic Target<br />
Benjamin Ferguson, PhD<br />
MENTOR: Ravi Salgia, MD, PhD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hematology/Oncology<br />
CO-AUTHORS: Ren Liu, PhD, Cleo E. Rolle, PhD, Yi-Hung Carol Tan, PhD, Valery Krasnoperov, PhD,<br />
Maria S. Tretiakova, MD, PhD, Gustavo M. Cervantes, MD, Robyn D. Hseu, Theodore Karrison, PhD,<br />
Mark K. Ferguson, MD, Aliya N. Husain, MD, Leonardo Faoro, MD, Parkash S. Gill, MD<br />
BACKGROUND: Despite progress in locoregional and systemic therapies, patient survival from lung cancer remains<br />
a challenge. Receptor tyrosine kinases are frequently implicated in lung cancer pathogenesis, and some tyrosine kinase<br />
inhibition strategies have been effective clinically. The EphB4 receptor tyrosine kinase has recently emerged as a potential<br />
target in several other cancers.<br />
METHODS: We sought to systematically study the role <strong>of</strong> EphB4 in lung cancer through analysis <strong>of</strong> protein expression<br />
and gene copy number aberration in tumor tissues; modulation <strong>of</strong> protein expression and effects on cell viability,<br />
growth, and motility; and inhibition <strong>of</strong> protein function in xenograft mouse models.<br />
RESULTS: We demonstrate that EphB4 is overexpressed 3-fold in lung tumors compared to paired normal tissues and<br />
frequently exhibits gene copy number increases in lung cancer. We also show that overexpression <strong>of</strong> EphB4 promotes<br />
cellular proliferation, colony formation, and motility, while EphB4 inhibition reduces cellular viability in vitro, halts<br />
the growth <strong>of</strong> established tumors in mouse xenograft models, and causes near-complete regression <strong>of</strong> established tumors<br />
when used in combination with paclitaxel.<br />
CONCLUSION: Taken together, these data suggest an important role for EphB4 as a potential novel therapeutic<br />
target in lung cancer. Clinical trials investigating the efficacy <strong>of</strong> anti-EphB4 therapies as well as combination therapy<br />
involving EphB4 inhibition may be warranted.<br />
Acknowledgements/Disclosures: NIH/NICHD T32HD009007 (BDF), NIH/NCI (RS), Janice Lamb McArdle Cancer Research<br />
Foundation (RS). PSG is the co-founder and director <strong>of</strong> Vasgene Therapeutics, Inc. VK is an employee <strong>of</strong> Vasgene Therapeutics, Inc.<br />
18 Oral Presentation <strong>Abstract</strong>s
Ca2+ Influx through Store-Operated Calcium Channels<br />
Reduces Alzheimer’s Disease Aβ Secretion<br />
William Zeiger, PhD<br />
MENTOR: Gopal Thinakaran, PhD, Department <strong>of</strong> Neurobiology<br />
CO-AUTHORS: Kulandaivelu S. Vetrivel, PhD<br />
BACKGROUND: Alzheimer’s disease (AD), the leading cause <strong>of</strong> dementia in the United States, is characterized by the<br />
accumulation <strong>of</strong> amyloid beta (Aβ)-containing senile plaques in the brains <strong>of</strong> affected patients. While Aβ is considered to<br />
play a central role in the pathogenesis <strong>of</strong> AD, recent work has implicated other mechanisms as potentially important in<br />
the development and progression <strong>of</strong> the disease. Specifically, several lines <strong>of</strong> evidence point to the dysregulation <strong>of</strong> Ca2+<br />
homeostasis as underlying aspects <strong>of</strong> AD pathogenesis. These include studies showing alterations in expression <strong>of</strong> Ca2+<br />
handling proteins and Ca2+-dependent enzymes in the brains <strong>of</strong> affected AD patients. Other work has demonstrated<br />
direct roles for Aβ peptides and the familial-AD linked genes presenilin 1 (PS1) and amyloid precursor protein (APP)<br />
in the regulation <strong>of</strong> Ca2+ homeostasis. While these studies support the hypothesis that disruption <strong>of</strong> Ca2+ homeostasis<br />
contributes to AD, it has been difficult to disentangle the effects <strong>of</strong> FAD-linked genes on Aβ production from their<br />
effects on Ca2+ homeostasis.<br />
METHODS: To directly investigate the effects <strong>of</strong> alterations in Ca2+ homeostasis on APP processing, we developed<br />
a genetic system in which cellular Ca2+ homeostasis could be directly manipulated. Specifically, we overexpressed<br />
the molecular components <strong>of</strong> the store-operated Ca2+ entry (SOCE) pathway, STIM1 and Orai1, in cells expressing<br />
APP. We then characterized the changes in constitutive and store-depletion induced Ca2+ entry in these cells and<br />
investigated the effects <strong>of</strong> these changes on APP processing using metabolic labeling and Aβ ELISA.<br />
RESULTS: We found that overexpression <strong>of</strong> STIM1 and Orai1 produced dramatic effects on both store-operated and<br />
constitutive Ca2+ entry. These changes in Ca2+ homeostasis led to striking alterations in APP processing. Specifically,<br />
elevations in [Ca2+]i levels reduced amyloidogenic processing <strong>of</strong> APP and resulted in dramatic reductions in the<br />
secretion <strong>of</strong> Aβ.<br />
CONCLUSION: Our results suggest a reciprocal relationship between cellular Ca2+ homeostasis and Aβ production<br />
and demonstrate that disruptions in Ca2+ homeostasis may influence AD pathogenesis directly through the modulation<br />
<strong>of</strong> Aβ production.<br />
Acknowledgements/Disclosures: This work was supported, in whole or in part, by National Institutes <strong>of</strong> Health Grants AG021495 and<br />
AG019070 (to G. T.) and NRSA award NS065660 (to W.Z.). This work was also supported by grants from the Alzheimer’s Association<br />
(to G. T. and to K. S. V).<br />
Oral Presentation <strong>Abstract</strong>s<br />
19
Thoracodorsal Artery Perforator and Muscle Sparing Latissimus Dorsi<br />
Flaps in Breast Reconstruction after Radiation Therapy<br />
Kelly Ledbetter<br />
MENTOR: David H. Song, MD, MBA, Department <strong>of</strong> Surgery, Section <strong>of</strong> Plastic and Reconstructive Surgery<br />
CO-AUTHORS: Jonathan Bank, MD<br />
BACKGROUND: After mastectomy, patients <strong>of</strong>ten have breast reconstruction with tissue expanders or implants. If<br />
they had prior implant failure or radiation therapy they may also have one <strong>of</strong> three pedicle flaps to provide additional<br />
s<strong>of</strong>t tissue coverage: a thoracodorsal artery perforator (TDAP) flap, a muscle-sparing latissimus dorsi (MSLD) flap, or<br />
a latissimus dorsi (LD) flap. More technically demanding, TDAP and MSLD flaps spare most <strong>of</strong> the latissimus dorsi<br />
muscle and may have better functional outcomes and fewer donor site complications. Though studies have found that<br />
preoperative chest wall irradiation increases the complication rate <strong>of</strong> tissue expander/implant reconstruction, the effect<br />
<strong>of</strong> radiation on TDAP and MSLD flaps remains unclear. The goal <strong>of</strong> this study is to evaluate the long-term outcomes <strong>of</strong><br />
patients with and without preoperative radiotherapy who subsequently had TDAP, MSLD, or LD flap reconstruction<br />
with expanders or implants.<br />
METHODS: A retrospective analysis <strong>of</strong> a prospectively maintained database was performed to identify patients who<br />
received a TDAP, MSLD, or LD flap plus a tissue expander or implant between 2005 and 2012 by a single surgeon.<br />
During the operation an algorithm was used to determine the suitability <strong>of</strong> the TDAP, MSLD, or LD flap. If a sizable<br />
pulsatile perforator was identified, a TDAP flap or MSLD type 1 flap was selected and < 2cm <strong>of</strong> LD muscle was sacrificed.<br />
If the signal was not pulsatile and lacked large perforators, an MSLD type 2 flap was performed (< 5cm LD muscle).<br />
Lastly, a standard LD flap was performed in the event that additional muscle was needed. Information regarding the<br />
patients’ primary diagnosis, radiation history, prior breast reconstructions, and complications was collected. Statistical<br />
analysis using the student t-test or fisher’s exact test was performed using p
Hospitalizations and Mortality Associated With<br />
Norovirus Outbreaks in Nursing Homes, 2009-2010<br />
Tarak Trivedi<br />
MENTOR: Benjamin Lopman, PhD, Centers for Disease Control and Prevention<br />
CO-AUTHORS: Traci DeSalvo, MPH, Lore Lee, MPH, Aimee Palumbo, MPH<br />
BACKGROUND: Norovirus outbreaks are common among vulnerable, elderly populations in US nursing homes.<br />
To assess whether all-cause hospitalization and mortality rates are increased during norovirus outbreak vs nonoutbreak<br />
periods in nursing homes, and to identify factors associated with increased risk.<br />
METHODS: We conducted a retrospective cohort study <strong>of</strong> Medicare-certified nursing homes in Oregon, Wisconsin,<br />
and Pennsylvania that reported at least 1 confirmed or suspected norovirus outbreak to the Centers for Disease Control<br />
and Prevention’s National Outbreak Reporting System (NORS), January 2009 to December 2010. Deaths and<br />
hospitalizations occurring among residents <strong>of</strong> these nursing homes were identified through the Medicare Minimum Data<br />
Set (MDS). We measured rates <strong>of</strong> all-cause hospitalization and mortality during outbreak compared with nonoutbreak<br />
periods were estimated using a random-effects Poisson regression model controlling for background seasonality in both<br />
outcomes.<br />
RESULTS: The cohort consisted <strong>of</strong> 308 nursing homes that reported 407 norovirus outbreaks to NORS. Per MDS,<br />
67 730 hospitalizations and 26 055 deaths occurred in these homes during the 2-year study. Hospitalization rates<br />
were 124.0 (95% CI, 119.4-129.1) vs 109.5 (95% CI, 108.6-110.3) hospitalizations per nursing home−year during<br />
outbreak vs nonoutbreak periods, yielding a seasonally adjusted rate ratio (RR) <strong>of</strong> 1.09 (95% CI, 1.05-1.14). Similarly,<br />
mortality rates were 53.7 (95% CI, 50.6-57.0) vs 41.9 (95% CI, 41.4-42.4) deaths per nursing home−year in outbreak<br />
vs nonoutbreak periods (seasonally adjusted RR, 1.11; 95% CI, 1.05-1.18). The increases in hospitalizations and<br />
mortality were concentrated in the first 2 weeks (week 0 and 1) and the initial week (week 0) <strong>of</strong> the outbreak, respectively.<br />
Homes with lower daily registered nurse (RN) hours per resident (
Competition and Quality in Procedural Health Care<br />
Joyce Woo<br />
MENTOR: David Glick, MD, Department <strong>of</strong> Anesthesia and Critical Care<br />
CO-AUTHORS: Kristen Wroblewski, MS, Ben Dauber, Avery Tung, MD<br />
BACKGROUND: In light <strong>of</strong> unsustainable health care costs, there has been a great movement to focus spending from<br />
a cost‐centric to value‐centric view, and with that a better understanding <strong>of</strong> quality is essential. Proposals to increase<br />
competition among hospitals have been advocated to improve quality, especially with the implementation <strong>of</strong> publicly<br />
reported quality measures. Yet it is unclear the degree to which hospitals compete on quality, and the current literature<br />
employ different definitions <strong>of</strong> competition. We hypothesize that hospitals in more competitive environments would be<br />
more likely to compete on the basis <strong>of</strong> quality. To test our hypothesis, we studied the relationship between competition<br />
and quality in hospitals providing cardiac care, and further compared our results using the two most widely used<br />
geographic statistics used to define competition: fixed radius and Metropolitan Statistical Area (MSA).<br />
METHODS: We examined hospitals performing heart valve surgery (HVS) and delivering acute myocardial infarction<br />
care (AMI) in the Hospital Compare database. We defined competition either as (1) the number <strong>of</strong> hospitals managing<br />
the same diagnosis within a 20‐mile fixed radius, or (2) the number <strong>of</strong> hospitals managing the same diagnoses within<br />
the same MSA. For each hospital that managed the diagnosis in question, we correlated competition with performance<br />
on quality metrics as defined by the Centers for Medicare and Medicaid services (CMS), mortality, patient volume, and<br />
Medicare per‐patient costs. All statistical analyses were performed using Stata Version 11 (Stata Corp., College Station,<br />
TX).<br />
RESULTS: 653 hospitals met inclusion criteria for HVS, and 1,898 for AMI. Hospitals facing more competition did<br />
not demonstrate better performance in CMS quality metrics for either diagnosis. This was evident for both measures<br />
<strong>of</strong> competition. For both diagnoses, competition correlated positively with costs: partial correlation coefficients =<br />
0.40 (p
Poster Presentations<br />
Applied Scholarship............................25<br />
Basic <strong>Scientific</strong> Investigation...............36<br />
<strong>Scientific</strong> Investigation in<br />
Clinical or Social Sciences...................45<br />
Poster Presentation <strong>Abstract</strong>s<br />
23
24 Poster Presentation <strong>Abstract</strong>s<br />
Applied Scholarship
How Do Supervising Physicians Decide to Entrust<br />
Residents with Unsupervised Tasks?<br />
Kevin Choo<br />
MENTOR: Jeanne M. Farnan, MD, MHPE, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hospital <strong>Medicine</strong><br />
CO-AUTHORS: Vineet Arora, MD, MAPP, Paul Barach, MD, MPH, Julie K. Johnson, MSPH, PhD<br />
BACKGROUND: Medical educators struggle to find meaningful ways to evaluate trainees’ preparedness to<br />
independently perform tasks. The aim <strong>of</strong> this study was to identify factors and to develop a conceptual framework to<br />
determine how attending and resident perceptions <strong>of</strong> trust relate to clinical decision-making and patient care.<br />
METHODS: Internal medicine residents and attending physicians at an academic medical center were interviewed<br />
between January and November 2006. Participants were asked to describe, using the Critical Incident Technique,<br />
important entrustment decisions made during their clinical rotations. A deductive qualitative analysis using the<br />
Entrustable Pr<strong>of</strong>essional Activities (EPA) framework was used. Inter-rater reliability was calculated using a generalized<br />
kappa-statistic (k).<br />
RESULTS: Eighty four percent (42/50) <strong>of</strong> residents and 80% (40/50) <strong>of</strong> attending physicians participated. Analysis<br />
yielded 535 discrete mentions <strong>of</strong> trust factors. The domains <strong>of</strong> trust described included: trainee factors (e.g., confidence,<br />
specialty plans); supervisor factors (e.g., approachability, clinical expertise); task factors (e.g., situational characteristics);<br />
and systems factors (e.g., workload, duty hours). The kappa (k) between the two raters was 0.84.<br />
CONCLUSION: The development <strong>of</strong> trust is multi-factorial and consists <strong>of</strong> factors driven by the supervisor, trainee,<br />
task, and environment. Trust is <strong>of</strong>ten determined by subjective conclusions drawn from direct trainee observation.<br />
Attendings and residents reported team dynamics played a large role in influencing trust. Attendings noted trainee<br />
absences, even those to comply with regulation, had a negative effect on entrustment decisions. Future studies are<br />
needed to address correlations with patient outcomes, and tools to objectively make entrustment decisions regarding<br />
preparedness for independent practice.<br />
IRB/IACUC: TBDTrack: Medical EducationSubmitted for: MS2 S&D Block<br />
Acknowledgements/Disclosures: None.<br />
Poster Presentation <strong>Abstract</strong>s<br />
25
Development <strong>of</strong> Text Message Intervention to Engage Parents in Youth After-<strong>School</strong><br />
Nutrition and Exercise Program<br />
Amanda Gawin<br />
MENTOR: Deborah Burnet, MD, MA, Departments <strong>of</strong> <strong>Medicine</strong>, General Internal <strong>Medicine</strong> and Pediatrics<br />
CO-AUTHORS: Michael T. Quinn, PhD, Althera M. Steenes, Marla C. Solomon RD, CDE, Shantanu Nundy, MD,<br />
Lori McClinton-Powell, BA, F. Kwieku Embil, MA<br />
BACKGROUND: Obesity and its consequences are on the rise among children, especially minority youth. Power<br />
Up is a weekly healthy nutrition and exercise after‐school program for 2nd – 5th graders in south‐side Chicago Public<br />
<strong>School</strong>s. Power Up was successfully pilot tested in 2009 with promising results; however engaging the parents <strong>of</strong> the<br />
Power Up children was a challenge.<br />
Text messaging has been used effectively for a number <strong>of</strong> behavior change and health interventions. Additionally, given<br />
that cell phones have been shown to be virtually universal in American homes, text messaging potentially presents a<br />
prime delivery channel for interventions targeting traditionally hard‐to‐reach populations. Using a text message system<br />
to engage the parents <strong>of</strong> Power Up children has the potential to enhance the impact <strong>of</strong> the Power Up intervention.<br />
DESCRIPTION OF PROGRAM/INNOVATION: First, a literature review was performed to learn about previous<br />
text messaging interventions. In total, 15 studies published after 2004 were reviewed. The search engine was PubMed<br />
with search terms “SMS”/”Short Messaging Service” and “text message/messaging”. The literature review revealed that<br />
most studies reported improved outcomes with text messaging interventions, and participants were typically satisfied<br />
with the intervention. Personally tailored and interactive messages were the most effective. Text frequency was optimal<br />
when it reflected the expected frequency <strong>of</strong> the targeted behavior, and response rates tended to decrease over time.<br />
Next, a collection <strong>of</strong> messages intending to engage Power Up parents as their children participated in the Power Up<br />
curriculum was created. First, five text message categories were described using findings from the literature review:<br />
1) Informational: shared information learned in Power Up session, 2) Importance: explained importance <strong>of</strong> session<br />
content, 3) Motivational: encouraged a family activity related to session content, 4) Reminders: reminder to complete<br />
homework, 5) Monitoring/feedback: posed a question. Then, the categories were integrated with the Power Up<br />
curriculum to create text messages that corresponded with each session.<br />
EVALUATION OF PROGRAM/INNOVATION: In 2012, Power Up with the text messaging component was<br />
pilot tested for one month to assess the feasibility <strong>of</strong> such an intervention with the Power Up parent population. The<br />
study design was a Pre‐Post survey with follow‐up interviews. Study subjects were 10 Power Up parents, all <strong>of</strong> whom<br />
were African American and low‐income. At baseline, 100% <strong>of</strong> the parents used text messaging, and 100% reported<br />
feeling comfort using text messages. The mean response rate to text messages was 32% (range: 0% ‐ 73%). Follow‐up<br />
interviews showed that participants found the intervention to be “easy to use”, “helpful”, and “engaging”.<br />
CONCLUSION: AA review <strong>of</strong> the literature revealed that text messaging interventions can be effective at invoking<br />
behavior change. Text message types can be organized into five categories: informational, importance, motivational,<br />
reminders, and monitoring/feedback. Finally, the 2012 pilot demonstrated that a text message system aimed to engage<br />
parents is feasible with the Power Up population.<br />
IRB/IACUC: 16364B<br />
Track: Community HealthSubmitted for: MS2 S&D Block, MS4 S&D Work<br />
Acknowledgements/Disclosures: Supported by University <strong>of</strong> Chicago CTSA UL1 RR0244999, NIDDK Diabetes Research, and Training<br />
Center P60 DK20595.<br />
26 Poster Presentation <strong>Abstract</strong>s
Interruptions During Resident Hand<strong>of</strong>fs on Labor and Delivery:<br />
A Mixed-Methods Multi-Site Study<br />
Elizabeth Greenstein<br />
MENTOR: Jeanne M. Farnan, MD, MHPE, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hospital <strong>Medicine</strong><br />
CO-AUTHORS: Adrianne V. Dade, MD, Vineet Arora, MD, MAPP<br />
BACKGROUND: The transfer <strong>of</strong> care <strong>of</strong> patients, or hand<strong>of</strong>f, between trainees represents a potential threat to patient<br />
safety. This transfer <strong>of</strong> pr<strong>of</strong>essional responsibility has the potential for miscommunication, and published research<br />
shows frequent interruptions. There is little literature regarding hand<strong>of</strong>fs in Obstetrics and Gynecology, particularly on<br />
the interruption-prone Labor and Delivery floor.<br />
METHODS: All 27 OB/GYN residents from a single residency program rotating on all OB/GYN services at two<br />
hospitals (University <strong>of</strong> Chicago <strong>Medicine</strong> and NorthShore Evanston Hospital) from January-March 2013 consented<br />
and participated. Direct observations <strong>of</strong> AM and PM hand<strong>of</strong>fs were performed with tallies <strong>of</strong> interruptions. A paperbased<br />
survey was administered to all OB/GYN residents regarding the frequency, disruptiveness, and preventability<br />
<strong>of</strong> different interruptions. A focus group was held with 10 <strong>of</strong> 27 OB/GYN residents regarding their experience with<br />
missed information secondary to interruptions during hand<strong>of</strong>fs.<br />
Descriptive statistics were performed on the direct observation and survey data. Pairwise correlations were performed<br />
on direct observations versus time <strong>of</strong> day. Qualitative analysis was performed by two authors (EG,JF), and any<br />
disagreements were settled by consensus.<br />
RESULTS: Twenty total hand<strong>of</strong>fs were observed at both UChicago and NorthShore. People entered the hand<strong>of</strong>f area<br />
in 85% <strong>of</strong> hand<strong>of</strong>fs (mean = 6.5 times), other teams had conversations in the hand<strong>of</strong>f area in 75% <strong>of</strong> hand<strong>of</strong>fs (mean =<br />
4.2 times), two separate conversations occurred within the hand<strong>of</strong>f in 73% <strong>of</strong> hand<strong>of</strong>fs (mean = 3.1 times), phone calls<br />
among the hand<strong>of</strong>f team or other teams in the same room occurred in 55% and 45% <strong>of</strong> hand<strong>of</strong>fs, respectively (mean=<br />
2.2 times total).<br />
Pairwise correlations show a statistically significant strong correlation between evening hand<strong>of</strong>fs and all pagers in the<br />
room going <strong>of</strong>f (R= 0.7203, p=0.003) as well as other teams not involved in the hand<strong>of</strong>f having conversations amongst<br />
themselves or on the phone in the same workspace (R=0.6834, p=0.009).<br />
Qualitative analysis <strong>of</strong> the focus group elicited many themes.<br />
1) Evening hand<strong>of</strong>fs to night float are less formal. (n=5)<br />
2) The lack <strong>of</strong> defined roles contributes to missed information. (n=3)<br />
3) The contribution <strong>of</strong> physical workspace to disruptions. (e.g. phones) (n=11)<br />
4) Adverse events occur, e.g. missed or delayed tubal ligations due to inadequate hand<strong>of</strong>fs. (n=7)<br />
CONCLUSION: Structural workplace issues, particularly handing <strong>of</strong>f at the phones they work at during shift makes<br />
residents available to be contacted for non-emergent issues during hand<strong>of</strong>fs. Work should be aimed towards fixing<br />
preventable systems issues which are interrupting hand<strong>of</strong>fs.<br />
Side conversations are frequent, by both observation and resident report. Residents rated side conversations both<br />
among the most disruptive and the most preventable. Cultural changes should be enacted to allow for a less interrupted<br />
hand<strong>of</strong>f.<br />
Evening hand<strong>of</strong>fs, per the direct observations and the focus group participants, are more frequently interrupted. As<br />
night float residents do not know patients as well as the primary services, patients may be put at extra risk from both<br />
the lesser amount <strong>of</strong> knowledge <strong>of</strong> night float and a suboptimal hand<strong>of</strong>f.<br />
IRB/IACUC: 12-2300<br />
Track: Medical EducationSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: None.<br />
Poster Presentation <strong>Abstract</strong>s 27
Updating the Virtual Pathology <strong>of</strong> Clinical Pathophysiology and Therapeutics<br />
MENTOR: Aliya Husain, MD, Department <strong>of</strong> Pathology<br />
CO-AUTHORS: Scott Stern, MD, Peter Pytel, MD<br />
28 Poster Presentation <strong>Abstract</strong>s<br />
Patrick Mann<br />
BACKGROUND: For over 40 years, the <strong>Pritzker</strong> <strong>School</strong> <strong>of</strong> <strong>Medicine</strong> has <strong>of</strong>fered second year medical students an<br />
integrated clinical and pathology course spanning the breadth <strong>of</strong> medicine. Started in 1972 by Drs. Seymour Glagov<br />
(Department <strong>of</strong> Pathology) and John E. Ultmann (Department <strong>of</strong> <strong>Medicine</strong>), the course has grown from 12‐weeks,<br />
lecture only, focusing primarily on pathology with clinical correlations to a robust, 17‐week, multi‐modality lecture and<br />
lab course that introduces students to the world <strong>of</strong> clinical pathophysiology and its therapeutic interventions.<br />
Just as the length and scope <strong>of</strong> the course has not remained static, its approach to teaching has also evolved to match<br />
technological advances seen over the past 40 years. Lectures once taught with chalkboards are now projected, recorded,<br />
and disseminated to students via the internet. The sound <strong>of</strong> scratching pencils has been replaced by the clacking <strong>of</strong><br />
laptop keyboards. Lab books have migrated from paper to CDs to a static website to an interactive, multimedia enabled<br />
site that gives students a shared and universal learning experience. Most importantly to this project, students no longer<br />
review disparate glass pathology slides using microscopes; instead, they have been unchained from their microscopes<br />
and are provided high quality, uniform, virtual microscope slides accessible via the internet.<br />
METHODS: The primary goals <strong>of</strong> this project were three‐fold: 1) to update the image quality <strong>of</strong> the pathology<br />
portions <strong>of</strong> the course cases, including the virtual slides and static images (gross and microscopic); 2) to develop <strong>of</strong> a<br />
Socratic approach for training students to recognize common pathology; and 3) redesign the pathology‐based questions<br />
in the cases to better solidify students’ understanding <strong>of</strong> pathogenesis.<br />
To evaluate the success <strong>of</strong> these initiatives, a retrospective analysis <strong>of</strong> test scores and course evaluations (including the<br />
comment sections) will be used in order to address the effectiveness <strong>of</strong> the above improvements and seek to identify new<br />
directions to take this continually evolving course.<br />
RESULTS:<br />
1) Microscopic images within the cases were evaluated, with the majority <strong>of</strong> these images replaced. The replacement<br />
images now only highlight, but do not identify, the pathology discussed in the case, with answers provided to the<br />
students following the lab.<br />
2) Gross pathology images were evaluated and replaced as needed.<br />
3) Twenty-five new virtual pathology slides were added, most replacing older, poor quality slides. The addition <strong>of</strong><br />
normal histology correlations to the cases is ongoing.<br />
4) Questions related to the pathology portion <strong>of</strong> the cases are under continuous improvement, with one section<br />
(pulmonary) completely updated and others close to completion. For instance, one word answers <strong>of</strong> “yes” or “no” were<br />
augmented to provide explanations <strong>of</strong> the affirmation or negation.<br />
CONCLUSION: Anecdotal reviews <strong>of</strong> the project indicate that the new slides, images, and questions significantly<br />
improve the laboratory experience for both instructors and students. However, given those taking CPP&T in 2012‐2013<br />
only saw improvements to the Pulmonary, Obstetrics/ Gynecology, and Dermatology sections, we could not perform a<br />
more quantitative analysis comparing their evaluations to prior years’ evaluations.<br />
Current suggestions for improvement include: adding annotated images to help supplement the existing, unlabeled<br />
still images, adding extra normal histology slides for reference, and restructuring the flow <strong>of</strong> cases to put the pathology<br />
images and questions into closer context with each cases’ clinical aspects.<br />
Following these updates, a retrospective analysis <strong>of</strong> test scores and course evaluations will address the effectiveness <strong>of</strong><br />
these improvements and seek to identify new directions to take this continually evolving course.<br />
RB/IACUC: TBD - n/aTrack: Medical EducationSubmitted for: MS2 S&D Block, MS4 S&D Work<br />
Acknowledgements/Disclosures: None.
Sex(Ed) is Fun: Design, Implementation and Analysis <strong>of</strong> a Sexual Education<br />
Curriculum for Middle <strong>School</strong> Students<br />
Rebecca Miller & Sarah Todd, MAT<br />
MENTOR: Debra Stulberg, MD, MA, Department <strong>of</strong> Family <strong>Medicine</strong><br />
BACKGROUND: In the United States, 46% <strong>of</strong> students in grades 9‐12 report having had sexual intercourse with at least<br />
one person, and nearly 6% <strong>of</strong> high school students report that their sexual debut was prior to the age <strong>of</strong> 13. It is estimated<br />
that American teens between the ages <strong>of</strong> 15‐19 acquire 50% <strong>of</strong> new sexually transmitted infections, and the United States<br />
continues to have one <strong>of</strong> the highest teen pregnancy rates in the developed world. In addition, data suggests that more than<br />
one third <strong>of</strong> U.S. teens do not receive any formal education about contraception prior to their sexual debut. Despite these<br />
statistics, sexual education in schools remains a hotly debated optic. Currently, mandates about sexual health education vary<br />
widely by state: some states require an emphasis on abstinence, some require HIV education only, and few require instruction<br />
about contraception. It has been demonstrated repeatedly that effective sexual education programs educate teens about both<br />
abstinence and safer sex practices. Studies show that abstinence‐only programs may actually deter contraceptive use among<br />
sexually active teens, increasing their risk <strong>of</strong> STIs and unintended pregnancy. It is <strong>of</strong>ten argued that the most effective sexual<br />
health programs for teens are multi‐disciplinary, involving the efforts <strong>of</strong> schools, parents, community leaders, and health care<br />
providers. In this intervention, a comprehensive sexual education program for middle school students was born out <strong>of</strong> close<br />
collaboration between educators and medical students.<br />
DESCRIPTION OF PROGRAM/INNOVATION: Three fourth year medical students from the University <strong>of</strong> Chicago<br />
partnered with a local public charter school, Gary Comer College Prep Middle <strong>School</strong>. Teachers from the middle school<br />
identified the need for sexual health education lessons for their seventh grade students. The medical students agreed to<br />
research, design and implement a sexual health curriculum for their students. Goals and objectives were written based<br />
on existing sexual health curricula and teacher/administrator concerns. Six one‐hour lessons were planned, addressing the<br />
following topics: reproductive anatomy, puberty, contraception, STI prevention, hygiene, and healthy communication. The<br />
six lessons were taught at Gary Comer Middle <strong>School</strong> over the course <strong>of</strong> three months. A core group <strong>of</strong> six medical students<br />
completed the teaching, which occurred in two single‐gender classrooms, each with 25 seventh grade students. <strong>Session</strong>s were<br />
objective‐driven and interactive.<br />
EVALUATION OF PROGRAM/INNOVATION: On the first day <strong>of</strong> the intervention, students were given a pre‐test to<br />
assess their baseline knowledge. To evaluate the program’s efficacy, a post‐test was given on the last day <strong>of</strong> the intervention.<br />
The tests assessed both specific content knowledge and the students’ perception <strong>of</strong> their mastery <strong>of</strong> the material. Unique<br />
anonymous identifiers allowed preand post‐test data comparison.<br />
Initially, both groups <strong>of</strong> students demonstrated relatively low knowledge levels. Both male and female students initially<br />
overestimated their mastery <strong>of</strong> different sexual health topics. Both male and female students demonstrated improved<br />
knowledge after the intervention. Both groups <strong>of</strong> students also perceived that their knowledge <strong>of</strong> sexual health topics had<br />
improved.<br />
For the male students, pre‐test mastery <strong>of</strong> the objectives ranged from 3%‐33%, while post‐test mastery <strong>of</strong> the objectives ranged<br />
from 20%‐70%. The boys scored 8.23 (SD=5.13) points higher on the post‐test than the pre‐test, which was statistically<br />
significant according to a paired t‐test, t(21)=7.51, p
30 Poster Presentation <strong>Abstract</strong>s<br />
Food Rx: Integrating Clinic and Community<br />
Resources to Improve Dietary Management <strong>of</strong> Diabetes<br />
Katie Raffel<br />
MENTOR: Monica Peek, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> General Internal <strong>Medicine</strong><br />
CO-AUTHORS: Anne Goddu, MSc, Tonya Roberson, DT, BA, Marshall Chin, MD, MPH, Rachel Stork<br />
BACKGROUND: For low-income minorities with diabetes, barriers <strong>of</strong>ten exist to healthy eating, including limited<br />
access to healthy food in their community, lack <strong>of</strong> knowledge about dietary recommendations, and lack <strong>of</strong> physician<br />
support/recommendations. The integration <strong>of</strong> community resources into the clinic setting may be an effective way to<br />
address these barriers. Our aim was to create a program that leveraged the power <strong>of</strong> physician recommendation, reduced<br />
financial barriers to healthy food, increased patient awareness about community resources for healthy food within the<br />
city’s ‘food deserts,’ and provided patient education resources within the clinic setting.<br />
DESCRIPTION OF PROGRAM/INNOVATION: Food Rx was collaboratively designed by Improving Diabetes<br />
Care and Outcomes <strong>of</strong> the South Side <strong>of</strong> Chicago, Walgreens and the 61st Farmers Market. The Food Rx has four<br />
components: a dietary prescription, low-literacy nutrition education handout, map <strong>of</strong> participating locations, and<br />
coupon/voucher for healthy food. During visits with diabetic patients, providers screened patients for food insecurity;<br />
if a need were found, the provider could then prescribe a diet (low-carbohydrate, low-fat, low-sodium, and/or high<br />
fiber) using the Food Rx. Patients could then redeem the Food Rx coupon at the local farmers market or the nine<br />
participating Walgreens stores expanded to sell healthy food.<br />
Six sites including four federally qualified health centers, one academic primary care clinic and one academic<br />
endocrinology clinic participated in the Food Rx program; patients at each site were predominantly African-Americans<br />
with poorly-controlled diabetes.<br />
EVALUATION OF PROGRAM/INNOVATION: We are evaluating Food Rx utilization among recipients via deidentified<br />
coupon redemption data provided by our retail partners. Further, through a series <strong>of</strong> focus groups and<br />
one-on-one interviews with Food Rx recipients, we plan to qualitatively explore the impact <strong>of</strong> Food Rx on patient’s<br />
understanding <strong>of</strong> dietary recommendations, perceptions <strong>of</strong> their community’s food resources and the barriers/facilitators<br />
to Rx utilization.<br />
CONCLUSION: We have found that providers and patients are enthusiastic about the Food Rx program. Providers<br />
report feeling empowered to provide comprehensive diabetes care, and patients report that the educational handouts<br />
and coupons are helpful. However, there were both provider and patient barriers to the initial Food Rx implementation.<br />
Despite provider training, utilization <strong>of</strong> the prescriptions was impeded by time constraints and oversight. In order to<br />
adapt the Food Rx program to the clinic workflow, non-physician staff (e.g. nutritionists, medical assistants) with more<br />
time and familiarity with the community became champions <strong>of</strong> the program. Further, despite the selection <strong>of</strong> Walgreens<br />
stores near clinic sites, patients <strong>of</strong>ten preferred to shop at Walgreens stores closer to home, many <strong>of</strong> which were not<br />
participating locations. Patients also believed that the higher prices at Walgreens would <strong>of</strong>fset the value <strong>of</strong> the voucher.<br />
To address these concerns, we have included 2 new Walgreens sites frequented by clinic patients and performed a cost<br />
comparison between the Walgreens sites and local low-cost grocers. No significant difference in cost was found.<br />
Food Rx has demonstrated that it is feasible to implement a program integrating community nutrition resources into<br />
a variety <strong>of</strong> medical settings. The collaborative nature <strong>of</strong> program development allowed the intervention and study to<br />
meet the demands <strong>of</strong> all stakeholders: safety-net clinics, an academic medical center, a national corporation and a local<br />
non-pr<strong>of</strong>it.<br />
IRB/IACUC: TBD- Left BlankTrack: Community HealthSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: This research was supported by the National Institute <strong>of</strong> Diabetes and Digestive and Kidney Diseases (NIDDK) (Grant No. R18DK083946), the Chicago Center<br />
for Diabetes Translation Research (Grant No. P30 DK092949), the Diabetes Research and Training Center (Grant No. P60 DK20595), and the Alliance to Reduce Disparities in Diabetes <strong>of</strong> the<br />
Merck Company Foundation. Marshall Chin is supported by an NIDDK Midcareer Investigator Award in Patient-Oriented Research (Grant No. K24 DK071933).
Attitudes <strong>of</strong> Chilean Primary Care Providers Toward Chilean Public Primary Care<br />
Anne Toledo<br />
MENTOR: Brian Callender, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hospital <strong>Medicine</strong><br />
CO-AUTHORS: Gavin Hougham, PhD<br />
BACKGROUND: This study is a survey assessing Chilean providers’ attitudes toward recent health care reform and its<br />
effects on delivery <strong>of</strong> primary care in the public health sector.<br />
With the exception <strong>of</strong> military personnel, the Chilean population is served by a dual public and private health system<br />
(Vargas, 2008). The system is funded by an income tax <strong>of</strong> 7% on all Chilean citizens above a minimum income level.<br />
A prioritized system <strong>of</strong> public services (Guarantias Explicitas de Salud, GES; to guarantee coverage by disease type, age<br />
group) began implementation in 2005 within an already existing public system.<br />
The plan’s four guarantees are: Access, guaranteeing healthcare to the uninsured; Opportunity, guaranteeing timely<br />
access; Quality <strong>of</strong> treatment and Financial Protection from more than 20% <strong>of</strong> the cost <strong>of</strong> treatment (Borzutsky, 2008).<br />
The plan originally included 56 medical conditions which together comprised 80% <strong>of</strong> Chile’s disease burden at the time<br />
(Borzutsky, 2008). Since the implementation <strong>of</strong> GES from 2005‐2007, Chileans’ access to health care has improved<br />
and Chile is now viewed as having one <strong>of</strong> the strongest health systems in Latin America (Bitrán, 2010). Despite national<br />
surveys tracking improved treatment <strong>of</strong> illnesses, as far as we know there is comparatively less investigative information<br />
about health pr<strong>of</strong>essionals’ continued reception <strong>of</strong> the plan in their daily work (Ministerio de Salud, 2011).<br />
The goal <strong>of</strong> this research is to use our survey data to better understand the opinions <strong>of</strong> primary care providers working<br />
in the public health system as they are most directly involved in administering care within the reformed system.<br />
DESCRIPTION OF PROGRAM/INNOVATION: Anonymous, four question open‐ended survey, consented in<br />
person by research staff. Surveys transcribed, translated from Spanish to English then analyzed with standard qualitative<br />
analysis techniques. Themes sorted by larger domains and divided into more/less prevalent by number <strong>of</strong> occurrences<br />
relative to median (5< responses).<br />
EVALUATION OF PROGRAM/INNOVATION: The following domains are those represented by 5< survey<br />
responses; findings are presented in aggregate from entire survey rather than by question given limited sample size and<br />
overlapping themes: Quality, Streamlining, Expanded Access, Utilitarianism, System Overload, Work Culture, Work<br />
Challenges.<br />
CONCLUSION: Majority <strong>of</strong> respondents stated that government constructed medical guidelines did not negatively<br />
affect their clinical reasoning. They cited clear infrastructure, care goals and evidence based guides as GES‐related<br />
sources <strong>of</strong> patient access improvements. In tension with improvements in access appears an omnipresent sense <strong>of</strong><br />
utilitarianism, with prioritization focusing on most good for most people yet leaving certain illnesses and age groups<br />
vulnerable. Many providers feel motivated by leading multidisciplinary teams and sense <strong>of</strong> duty to the under‐served yet<br />
simultaneously cite frustration with a perceived lack <strong>of</strong> societal support, both economically and morally.<br />
IRB/IACUC: TBA - Left BlankTrack: Global HealthSubmitted for: MS1 Spring Elective, MS2 S&D Block, MS4 S&D Work, Innovation<br />
Award, Other (Global Health Fellowship)<br />
Acknowledgements/Disclosures: Keith Edson Fellowship, Innovation Funding, Global Health Fellowship. Additional support provided<br />
by: Eduardo Costa, Patricia Larraín, Nell Thompson, Valentina Osses, Jeanne Farnan, Jose Iriarte.<br />
Poster Presentation <strong>Abstract</strong>s<br />
31
Streamlining the Medical Imaging Anatomy Curriculum: Introducing Image<br />
Interpretation with ‘Core’ Images and Narrated Screencasts<br />
William Uffmann<br />
MENTOR: Christopher Straus, MD, Department <strong>of</strong> Radiology<br />
CO-AUTHORS: Kelly Ledbetter, BA, MS4, Andrew Phillips, MD, Steven Eilers, BA, MS3<br />
BACKGROUND: Many educators accept the value <strong>of</strong> incorporating medical imaging curriculum into first year anatomy<br />
courses. Doing so provides a key opportunity to refine, solidify, and test newly acquired anatomical knowledge. Despite the<br />
increasing popularity <strong>of</strong> medical images as anatomy teaching tools, there is no standard or ‘core’ set <strong>of</strong> images nor a tried<br />
and true means <strong>of</strong> implementation and integration into the traditionally rigorous anatomy curriculum. As the incorporation<br />
<strong>of</strong> medical imaging into medical school anatomy curriculum becomes more common, important questions arise as to how<br />
best package and deliver an integrated imaging curriculum in a successful, time-sensitive, and independent learning module<br />
preferred by today’s students. The ultimate educational goal is to provide long term retention <strong>of</strong> anatomical knowledge<br />
while simultaneously introducing the primary means in which each future physician will clinically evaluate anatomy. With<br />
anatomy being sufficiently challenging in its own right, the approach to medical imaging must be at an introductory level<br />
and every effort should be made to avoid overwhelming students with extraneous material. The key challenge is to develop<br />
a portable, digital learning platform that allows students to acquire and refine image interpretation skills on a concise set <strong>of</strong><br />
medical images carefully chosen to illustrate integrated learning objectives tested in the classroom and anatomy lab.<br />
DESCRIPTION OF PROGRAM/INNOVATION: The authors created a streamlined survey <strong>of</strong> normal radiographic<br />
anatomy by building easily accessible “core” files <strong>of</strong> hand chosen, digital medical images that demonstrate basic regional<br />
anatomy. Images from multiple modalities were chosen to illustrate key structures and clinically pertinent anatomical<br />
relationships wherever possible. Common structures were labeled with arrows and key structures were highlighted with<br />
transparent colored overlays superimposed upon the image to make them more readily identifiable. As the course progressed<br />
through regional anatomy, successive files progressed from simple plain films to more complex serial imaging requiring<br />
improved image understanding. Initial files emphasized image orientation, production, and skills needed for the later, more<br />
advanced imaging modalities. The authors then created screencast recordings <strong>of</strong> each “core” file providing powerful, selfpaced,<br />
portable, and independent teaching tools to practice image interpretation. These audio-visual files captured the<br />
narrative and mouse inputs <strong>of</strong> a course instructor discussing and deconstructing selected images within each core file.<br />
With each file representing an independent lesson in skill building, focus was placed on pivotal image information and<br />
accompanying logic required for structure identification. Serial narrative reinforcement within each module cues the learner<br />
to follow along, first developing and then solidifying their skills. Computer-displayed video formatting within each module<br />
allows the student to stop, start, replay, speed up, or slow down the modules providing individually paced learning. To<br />
evaluate the curriculum, Ninety first year medical students in the Human Body Course at the <strong>Pritzker</strong> <strong>School</strong> <strong>of</strong> <strong>Medicine</strong><br />
were given web access to the “Core” images and screencast videos as an optional educational resource. Student performance<br />
in the course was assessed using three examinations per course module: a written anatomy examination, a free response<br />
cadaver lab practical, and a twenty question free response radiology practical exam. All images used in the Radiology exam<br />
were previously unseen by students. Surveys given at three points in the course collected the students’ opinions about the<br />
effectiveness and usage <strong>of</strong> the course’s teaching tools.<br />
EVALUATION OF PROGRAM/INNOVATION: Preliminary results include data from 85 <strong>of</strong> 90 (94%) first year medical<br />
students over the first three modules <strong>of</strong> a six-module course. Students who utilized the recordings did not have significantly<br />
higher test scores. As the course progressed, more students watched the video recordings (43%, 58%, and 60% for modules<br />
1-3 respectively). Additionally, students identified using the recordings as their principle radiology material (33%, 32%, and<br />
37%) as opposed to a supplement, an equivalent radiology material, or a material not used. Preliminary qualitative survey<br />
results indicate that the videos were well liked and used as the primary means <strong>of</strong> learning radiology material. Exam data<br />
indicate this method is equivalent to other radiology education methods and is an effective independent learning tool.<br />
CONCLUSION: Our study provides evidence that a well-designed independent learning tool is preferred by students<br />
and provides a unique means <strong>of</strong> teaching image interpretation skills and key educational objectives. It is these skills that<br />
are neither inherent nor addressed in more traditional, time-compressed curricula. These streamlined materials are at least<br />
an equally effective means <strong>of</strong> medical imaging instruction and further tailor individual learning into a time-compressed<br />
curriculum addressing the needs <strong>of</strong> students.<br />
IRB/IACUC: 15817ETrack: Medical EducationSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: None.<br />
32 Poster Presentation <strong>Abstract</strong>s
Global Health Experiences and Their Influence on<br />
Medical Specialty Choice and Career Path<br />
Wenlu Xiong<br />
MENTOR: Aisha Sethi, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Dermatology<br />
BACKGROUND: Global health has become increasingly popular amongst students and trainees in colleges, medical<br />
schools, and residencies. The world has become more globally connected as technologies in travel and trade have<br />
improved, placing people in contact with all parts <strong>of</strong> the world. Tropical diseases only found abroad can be witnessed<br />
in travelers returning to the U.S., and patients <strong>of</strong> various cultural and ethnic backgrounds can be a part <strong>of</strong> any doctor’s<br />
practice. Therefore, global health should be considered in any medical training program. Currently, many colleges,<br />
medical schools, and residencies do provide students with global health opportunities. However, the future outcomes<br />
<strong>of</strong> these experiences have not been well‐studied and, therefore, are not entirely known.<br />
METHODS: A confidential, structured online survey was developed using Google Forms and distributed to 90<br />
Internal <strong>Medicine</strong>, Pediatrics, Med‐Peds, and Dermatology residency programs throughout the U.S. <strong>Senior</strong> residents<br />
were surveyed about their global health experience in the past, if any, how these experiences may have influenced<br />
their plans for the future, and reasons for not participating in global health. We obtained 142 survey respondents and<br />
analyzed the data with Stata.<br />
RESULTS: When asked why respondents did not participate in global health at each educational level, the vast majority<br />
cited lack <strong>of</strong> opportunity, opportunities that they were not interested in, or conflicts with time and/or money, and not<br />
lack <strong>of</strong> interest in global health. When asked whether institutions at each educational level should provide global health<br />
opportunities, a large percentage marked that they should regardless <strong>of</strong> the respondents’ global health experience level.<br />
Residents with global health experience were more likely to report considering a public health degree and expecting to<br />
go into global health in the future than residents with no global health experience. Residents without global health<br />
experience expected a career in private practice more <strong>of</strong>ten than those with global health experience although the groups<br />
did not significantly differ in plans to do academic medicine in the future.<br />
CONCLUSION: Therefore, institutions should provide their students with global health opportunities or increase<br />
awareness <strong>of</strong> their programs to further develop interest in the medical field and possibly influence career choices in the<br />
future.<br />
IRB/IACUC: n/a, Exempt Category 45 CFR 46.101(b)(2)Track: Global HealthSubmitted for: MS2 S&D Block, MS4 S&D Work<br />
Acknowledgements/Disclosures: None.<br />
Poster Presentation <strong>Abstract</strong>s<br />
33
Can I Get Some Feedback?:<br />
Student Descriptions <strong>of</strong> Facilitators and Barriers to Formative Feedback<br />
Matthew Zegarek<br />
MENTOR: Shalini Reddy, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hospital <strong>Medicine</strong><br />
CO-AUTHORS: H. Barrett Fromme, MD, MHPE, Michael S. Ryan, MD, Sarah-Anne Schumann, MD<br />
BACKGROUND: Quality formative feedback supports the development <strong>of</strong> medical students (MS) into competent<br />
pr<strong>of</strong>essionals. Studies demonstrate that student satisfaction with feedback frequency and quality is low. This qualitative<br />
study examines the student perspective on facilitators and barriers to feedback.<br />
METHODS: Third‐year MS and second‐year physician assistant students (PA‐S) from three geographically diverse<br />
medical schools were recruited to participate in focus groups in 2012. Open‐ended questions prompted students to<br />
describe their experiences with feedback and discuss facilitators and barriers. Focus group transcripts were analyzed for<br />
themes and sub‐themes using the constant comparative method.<br />
RESULTS: A total <strong>of</strong> 25 MS and four PA‐S participated at the three sites, with an average focus group size <strong>of</strong> ten.<br />
Barriers to feedback initiation include learner intimidation, lack <strong>of</strong> time, and teacher discomfort with giving negative<br />
feedback. Barriers to students interpreting feedback as effective include lacking a strong student‐teacher relationship,<br />
considering the feedback to be poorly timed, and having a performance rather than a learning goal orientation.<br />
Facilitators <strong>of</strong> effective feedback include teacher and learner behaviors such as specificity, purposefulness, exhibiting<br />
a positive attitude, using feedback tools, and learner self‐reflection. Based on the themes that emerged, a conceptual<br />
framework centered on a “feedback event” was created, grouping factors that affect feedback initiation, content, learner<br />
interpretation, and follow‐through.<br />
CONCLUSION: This conceptual framework can inform the development <strong>of</strong> curricular interventions to mitigate<br />
barriers and enhance facilitators to feedback. Further curricular interventions to promote a learning goal orientation <strong>of</strong><br />
students and to provide time to develop stronger student‐teacher relationships can address negative student emotions<br />
and interpretations <strong>of</strong> feedback events.<br />
IRB/IACUC: Exempt<br />
Track: Medical EducationSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: Supported by a grant from the Institute <strong>of</strong> <strong>Medicine</strong> as a Pr<strong>of</strong>ession and the Josiah Macy Jr. Foundation.<br />
34 Poster Presentation <strong>Abstract</strong>s
Basic <strong>Scientific</strong> Investigation<br />
Poster Presentation <strong>Abstract</strong>s<br />
35
Glucocorticoid Mediated Gene Expression is Associated with<br />
Decreased Insulin Sensitivity in Human Sub-Cutaneous Abdominal Fat<br />
Clifton Brock<br />
MENTOR: Suzanne Conzen, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hematology/Oncology<br />
CO-AUTHORS: Paul Volden, Julie Park, MD, Maxwell Skor<br />
BACKGROUND: The glucocorticoid receptor (GR) is ubiquitously expressed in adipose tissue and known to be<br />
involved in several normal adipocyte functions as well as the pathogenesis <strong>of</strong> metabolic syndrome, diabetes, and<br />
hypertension. Despite this, few studies have been performed in primary human adipose tissue. Based on the time<br />
course <strong>of</strong> glucocorticoid treatment required to decrease insulin sensitivity in primary adipose tissue, we hypothesized<br />
that the ligand-activated GR may alter insulin signaling through direct transcriptional regulation <strong>of</strong> key genes involved<br />
in insulin signaling.<br />
METHODS: GR activation was shown to decrease insulin-mediated activation <strong>of</strong> AKT in primary subcutaneous<br />
adipose tissue. We therefore performed anti-GR chromatin immunoprecipitation (ChIP) coupled with high throughput<br />
sequencing (ChIP-seq) in primary subcutaneous adipocytes +/- dexamethasone treatment to determine GR chromatin<br />
binding regions and compared this GR cistrome with early (four hr) glucocorticoid-mediated gene expression.<br />
RESULTS: We found that several genes encoding proteins known to regulate insulin signaling were likely direct<br />
transcriptional targets <strong>of</strong> the GR. For example, following GR activation PIK3R1 (p85) and MTORC inhibitors<br />
DEPTOR and SESN1 were upregulated, while PIK3R5 (p101) expression was repressed, consistent with glucocorticoidmediated<br />
insulin resistance occurring via decreased PI3K and MTORC2 signaling to AKT. In addition, GR activation<br />
was associated with the direct regulation <strong>of</strong> genes associated with inflammation and lipolysis.<br />
CONCLUSION: We show for the first time in human primary subcutaneous adipose tissue that the GR directly<br />
regulates a subset <strong>of</strong> genes encoding proteins that modulate insulin signaling and inflammation. Because an unwanted<br />
side-effect <strong>of</strong> currently employed glucocorticoids is insulin resistance, understanding those genes GR regulates is<br />
predicted to be useful in screening novel GR modulators that lack these unwanted side effects and yet retain antiinflammatory<br />
activity.<br />
Acknowledgements/Disclosures: Howard Hughes Medical Institute (HHMI) Medical Fellows Scholarship, The University <strong>of</strong> Chicago<br />
John D. Arnold, MD <strong>Scientific</strong> Research Prize Recipient.<br />
36 Poster Presentation <strong>Abstract</strong>s
IRF5 Systemic Lupus Erythematosus Risk Haplotype is Associated with<br />
Serologic Autoimmunity and Progression to Clinical Autoimmunity in<br />
Mothers <strong>of</strong> Children with Neonatal Lupus<br />
Tharian Cherian<br />
MENTOR: Timothy Niewold, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Rheumatology<br />
CO-AUTHORS: Silvia N. Kariuki, BA, Beverly S. Franek, BS, Jill P. Buyon, MD, Robert M. Clancy, PhD<br />
BACKGROUND: Neonatal lupus (NL) is caused by the passage <strong>of</strong> maternal antibodies across the placenta, with tissue<br />
deposition and inflammation in the fetus. Mothers <strong>of</strong> NL patients may have a variety <strong>of</strong> diagnoses such as systemic<br />
lupus erythematosus (SLE), sjogren’s syndrome (SS), undifferentiated autoimmune disease (UAS) and asymptomatic.<br />
Variation in the interferon regulatory factor 5 (IRF5) gene has been associated with risk <strong>of</strong> developing SLE, and this<br />
association is largely dependent upon the presence <strong>of</strong> anti-Ro autoantibodies. This study was undertaken to determine<br />
if the IRF5 genotype is associated with anti-Ro antibodies, maternal diagnosis, and/or progression <strong>of</strong> autoimmunity in<br />
mothers <strong>of</strong> children with NL.<br />
METHODS: Genotyping <strong>of</strong> haplotype-tagging polymorphisms in IRF5 was performed in 93 subjects <strong>of</strong> European<br />
ancestry who were recruited to the Research Registry for Neonatal Lupus. Seventeen <strong>of</strong> these subjects were healthy/<br />
asymptomatic, 30 had been diagnosed with SLE, 22 had been diagnosed with SS, and 24 had been diagnosed with<br />
UAS. All subjects had high-titer anti-Ro autoantibodies and had a child with NL. Allele frequencies in subjects were<br />
compared to those in non-autoimmune controls at the IRF5 locus.<br />
RESULTS: The SLE risk haplotype <strong>of</strong> IRF5 was enriched in all anti-Ro-positive subjects except in those with SS (odds<br />
ratio [OR] 2.55, P = 8.8 × 10(-4) ). The SLE risk haplotype was even enriched in asymptomatic individuals with anti-Ro<br />
antibodies (OR 2.69, P = 0.019). The same haplotype was more prevalent in subjects who were initially asymptomatic<br />
but developed symptomatic SLE during follow up (OR 5.83, P = 0.0024). Interestingly, SS was associated with 2 minor<br />
IRF5 haplotypes, and these same haplotypes were decreased in frequency in mothers with SLE and those with UAS.<br />
CONCLUSION: The IRF5 SLE risk haplotype was associated with anti-Ro antibody positivity in asymptomatic<br />
individuals, as well as with progression to SLE in asymptomatic anti-Ro-positive individuals. SS in mothers <strong>of</strong> children<br />
with NL was associated with different IRF5 haplotypes. These data suggest that IRF5 haplotypes are associated with<br />
both auto-antibody formation and progression to autoimmune disease in patients with serologic autoimmunity.<br />
IRB/IACUC: TBDTrack: Basic SciencesSubmitted for: MS4 S&D Work, Fentress<br />
Acknowledgements/Disclosures: Dr. Niewold’s work was supported by the NIH (grants R01-AR-060861, K08-AI-083790, and<br />
P30-DK-42086, National Institute <strong>of</strong> Allergy and Infectious Diseases Clinical Research Loan Repayment AI-071651, Clinical and<br />
Translational Science Award [CTSA] Core Subsidy Grant, and CTSA Pilot Grant UL1-RR-024999), The University <strong>of</strong> Chicago Calvin<br />
Fentress Fellowship Recipient.<br />
Poster Presentation <strong>Abstract</strong>s<br />
37
A Portable RNA Sequence Whose Recognition by a<br />
Synthetic Antibody Facilitates Structural Determination<br />
Yelena Koldobskaya, PhD<br />
MENTOR: Joseph A. Piccirilli, PhD, Department <strong>of</strong> Chemistry<br />
CO-AUTHORS: Erica M. Duguid, PhD, David M. Shechner, PhD, Nikolai B. Suslov<br />
BACKGROUND: RNA crystallization and phasing represent major bottlenecks in RNA structure determination.<br />
Seeking to exploit antibody fragments as RNA crystallization chaperones, we used an arginine-enriched synthetic<br />
antibody fragment (Fab) library displayed on phage to obtain specific Fabs that bound the class I ligase ribozyme.<br />
METHODS: Phage display was used to select synthetic Fab fragments that bound the class I ligase RNA. Crystal<br />
screening was performed using pre-formulated Hampton Research crystallization screen reagents. X-ray diffraction was<br />
performed at the Advanced Photon Source Sector 21, and initial phases for the Fab-class I ligase crystal structure at 3.1<br />
Å resolution were obtained by molecular replacement.<br />
RESULTS: We used phage display to select synthetic Fab fragments that bound the class I ligase RNA with micromolar<br />
affinities, and then used error-prone PCR to improve Fab-ligase binding 10-fold. We then used molecular replacement<br />
with Fab coordinates to solve the structure <strong>of</strong> a Fab–ligase complex at 3.1-Å resolution, revealing the ribozyme<br />
architecture and the chaperone’s role in RNA recognition and crystal contacts. The Fab-RNA epitope resides in the<br />
GAAACAC sequence that caps the P5 helix <strong>of</strong> the ligase. This sequence retains high-affinity Fab binding within the<br />
context <strong>of</strong> other structured RNAs.<br />
CONCLUSION: The Fab-GAAACAC epitope provides a new RNA crystallization chaperone system that easily can be<br />
screened in parallel to the U1A RNA-binding protein, with the advantages <strong>of</strong> a smaller loop and Fabs′ high molecular<br />
weight, large surface area and phasing power.<br />
Acknowledgements/Disclosures: This work was funded by Howard Hughes Medical Institute (J.A.P.), US National Institute <strong>of</strong> General<br />
Medical Sciences Medical Scientist National Research Service Award no. 5 T32 GM07281 (Y.K.) and US National Institutes <strong>of</strong> Health<br />
grants R01-GM72688 and U54-GM74946 (to S.K. and A.A.K.) and R01-GM61835 (to D.P.B.). Use <strong>of</strong> the Advanced Photon Source<br />
was supported by the US Department <strong>of</strong> Energy, Office <strong>of</strong> Science, Office <strong>of</strong> Basic Energy Sciences, under contract no. DEAC02-<br />
06CH11357. Use <strong>of</strong> the LS-CAT Sector 21 was supported by the Michigan Economic Development Corporation and the Michigan<br />
Technology Tri-Corridor for the support <strong>of</strong> this research program (grant 085P1000817).<br />
38 Poster Presentation <strong>Abstract</strong>s
Dynamic Interactions Among CDC42, PAR-6/PKC-3 and LGL Can Maintain Cell<br />
Polarity in Early Embryos <strong>of</strong> the Nematode Worm C. elegans.<br />
Samuel Lee<br />
MENTOR: Edwin Munro, PhD, Department <strong>of</strong> Cell Biology and Molecular Genetics<br />
BACKGROUND: Maintaining cell polarity is fundamental for cell structures and their specialized functions. Genetic<br />
and biochemical studies have defined a core set <strong>of</strong> highly conserved regulatory molecules that are asymmetrically<br />
localized in the Caenorhabditis elegans embryo cells and that interact dynamically to maintain polarity. These<br />
include the posterior cytoskeletal protein LGL, the anterior GTPase CDC42, the adaptor protein PAR-6 and the<br />
serine threonine kinase PKC-3. Previous studies suggest that a system <strong>of</strong> cross-regulatory interactions among PAR-6/<br />
PKC-3, LGL and CDC42 is essential for the maintenance <strong>of</strong> complementary domains enriched in anterior CDC42/<br />
PAR-6/PKC-3 and posterior LGL. Hoege et al. recently proposed that the binding <strong>of</strong> PAR-6/PKC-3 to LGL leads<br />
phosphorylation <strong>of</strong> LGL, resulting in destabilization <strong>of</strong> cortical binding <strong>of</strong> LGL, which in turn causes dissociation<br />
<strong>of</strong> an LGL-phosphorylated/PAR-6/PKC-3 complex from the cortex. They proposed that this interaction results in<br />
stochiometrically balanced “mutual elimination” <strong>of</strong> PAR-6/PKC-3 and LGL from the cortex, and that this could<br />
mediate the dynamic maintenance <strong>of</strong> the boundary between the anterior PAR-rich and posterior LGL-rich domains.<br />
However, while existing data support the mutual elimination model, it remains unclear whether this mechanism is in<br />
fact sufficient to dynamically sustain the polarized protein distributions.<br />
METHODS: We modeled a two-dimensional cross section <strong>of</strong> the embryo cell with a single cytoplasmic compartment<br />
and the cortex represented by a collection <strong>of</strong> discrete compartments surrounding the cytoplasm. We converted known/<br />
hypothesized molecular interactions into a system <strong>of</strong> biochemical kinetic equations that governs how the densities <strong>of</strong><br />
elements in each compartment evolve over time due to local interactions and flux between compartments. Then we<br />
asked whether and under what conditions these interactions could explain the stable maintenance <strong>of</strong> complementary<br />
anterior and posterior domains.<br />
RESULTS: We show that the mutual elimination mechanism cannot explain absolute stable maintenance <strong>of</strong> polarity<br />
under any conditions – the system always tends towards a single spatially uniform steady state. Furthermore, even<br />
the two-step mutual elimination mechanism (CDC42 initially binds to the cortex and recruits PAR-6/PKC-3. Then<br />
PAR-6/PKC-3 is transferred to LGL and phosphorylates LGL), the absolute stable polarity cannot be maintained.<br />
Here, we propose an alternative mechanism that maintains polarity for an indefinite amount <strong>of</strong> time. In addition to<br />
the two-step mutual elimination mechanism, CDC42/PAR-6/PKC-3 directly phosphorylates LGL thus dissociating<br />
LGL from the cortex, and a posterior protein (e.g. PAR-2 through CHIN-1) inhibits CDC42 from associating with the<br />
cortex. Essentially, this biologically plausible “cross-inhibition” mechanism is a variant <strong>of</strong> a simple theoretical two-step<br />
cortical recruitment <strong>of</strong> an anterior protein where the posterior protein inhibits both recruitment steps, and the anterior<br />
protein promotes the cortical dissociation <strong>of</strong> the posterior protein. These proposed mechanisms are the first systems <strong>of</strong><br />
interactions which can dynamically maintain polarity with only a set <strong>of</strong> unimolecular and bimolecular kinetic laws and<br />
without using any non-linear relationships in the system.<br />
CONCLUSION: We show that both the one-step and two-step mutual elimination mechanisms are insufficient to<br />
sustain the polarized distributions <strong>of</strong> CDC42, PAR-6/PKC-3, and LGL in the C. elegans embryo. The proposed crossinhibition<br />
mechanisms are the biologically and kinetically plausible mechanism that can sufficiently maintain cell<br />
polarity.<br />
IRB/IACUC: TBD - Left Blank<br />
Track: Basic SciencesSubmitted for: MS1 Spring Elective, SRP, MS2 S&D Block, MS4 S&D Work, Fentress<br />
Acknowledgements/Disclosures: NIH, The University <strong>of</strong> Chicago Calvin Fentress Fellowship Recipient.<br />
Poster Presentation <strong>Abstract</strong>s<br />
39
Uncovering the Mechanism <strong>of</strong> Vitamin D and<br />
NSAID Combination Therapy in Prostate Cancer<br />
Shamsideen Musa, MS<br />
MENTOR: Rick Kittles, PhD, Department <strong>of</strong> Genetics, University <strong>of</strong> Illinois at Chicago<br />
BACKGROUND: Prostate cancer arises from complex interactions <strong>of</strong> environmental and genetic factors and is the<br />
second leading cause <strong>of</strong> cancer death in American men behind lung cancer. The leading risk factors for developing<br />
prostate cancer include age, family history, and ancestry. A interesting potential environmental factor that may lead to<br />
increased risk <strong>of</strong> prostate cancer is vitamin D deficiency. Vitamin D has both anti-proliferative and anti-inflammatory<br />
effects on prostate cells and may be an important therapeutic in the treatment <strong>of</strong> prostate cancer. Recently the active<br />
metabolite <strong>of</strong> vitamin D, calcitriol (1,25(OH)2D3), has been found to influence multiple steps in the prostaglandin<br />
(PG) synthesis pathway.<br />
Furthermore, when calcitriol is combined with non-steroidal anti-inflammatory drug (NSAID) therapy, a synergistic<br />
antiproliferative effect is observed in prostate cancer cell lines. Despite this, the mechanism <strong>of</strong> vitamin D mediated antiinflammatory<br />
activity in combination with NSAIDs is poorly characterized in the prostate cancer setting. Expression<br />
pr<strong>of</strong>iling <strong>of</strong> prostate cancer cells have demonstrated that thousands <strong>of</strong> genes are differentially expressed when comparing<br />
non-selective to selective COX-2 inhibitors and low dose to high dose NSAIDs. We hypothesize that this synergistic<br />
effect occurs by targeting COX-2 independent mechanisms in addition to COX-2 mediated inflammation.<br />
METHODS: Prostate cancer cell lines MDA-Pca-2b and DU 145 will be grown in culture with manufacturer<br />
recommend media in an incubator containing 5% CO2. Cells will be obtained from current lab frozen stock. NS-398<br />
will be used as the COX-2 selective NSAID and ibupr<strong>of</strong>en will be used as the COX-1 and COX-2 nonselective NSAID.<br />
NSAIDs will be ordered from Cayman Chemical Company in Ann Arbor, MI[9]. Cells will be treated with NS-398<br />
(1-100 µM) and ibupr<strong>of</strong>en (5-100 µM) in combination with calcitriol (50nM) for 24 hours.<br />
Western Blots: Western Blots will be performed in all cell lines to confirm the COX-2 and VDR status <strong>of</strong> each cell line.<br />
RESULTS:<br />
1) High dose ibupr<strong>of</strong>en decreases AR and VDR expression in addition to COX-2 in MDA-Pca 2b cells.<br />
2) MDA-Pca-2b cells express COX-2.<br />
3) DU-145 cells do not show a similar decrease in VDR expression in response to high dose ibupr<strong>of</strong>en treatment<br />
CONCLUSION: Preliminary data indicates COX-2 pathway dependent and independent changes in expression occur<br />
after combination therapy. This can lead to the identification <strong>of</strong> new therapeutic targets for prostate cancer treatment.<br />
Acknowledgements/Disclosures: None.<br />
40 Poster Presentation <strong>Abstract</strong>s
The Genomic Interplay <strong>of</strong> Key Lineage Determinants<br />
During B Cell Fate Determination<br />
Joseph Triggs, PhD<br />
MENTOR: Harinder Singh, PhD, Department <strong>of</strong> Molecular Genetics and Cell Biology<br />
CO-AUTHORS: Chauncey J. Spooner, PhD<br />
BACKGROUND: Hematopoiesis is an ideal system to investigate the molecular underpinnings <strong>of</strong> cell fate choice due to<br />
the ease with which developmental intermediates can be isolated and analyzed both in vitro and in vivo. Hematopoietic<br />
stem cells differentiate into all the cells that constitute the blood and immune systems. This process is coordinated by<br />
the unique combinatorial set <strong>of</strong> transcriptional regulators that control gene expression, in part, by altering the proximal<br />
and distal epigenetic landscape to shape the identity <strong>of</strong> a particular cell fate. During B lymphopoiesis, the transcription<br />
factors PU.1, Ebf1 and Pax5 are all required for proper development. The loss <strong>of</strong> any one <strong>of</strong> these factors results in<br />
a failure <strong>of</strong> B cell developmental progression and mutations in these factors have been implicated in several human<br />
malignancies. However, an in depth understanding <strong>of</strong> how these transcriptional regulators coordinate the B cell fate is<br />
not fully understood.<br />
METHODS: Using mouse primary bone marrow progenitors, we performed chromatin immunoprecipitation<br />
followed by massively parallel sequencing (ChIPseq) to identify where transcriptional regulators (Ebf1, PU.1 and Pax5)<br />
and histone modifications (monomethylation <strong>of</strong> histone H3 on lysine 4 [H3K4me1]) were present throughout the<br />
genome during B cell specification and commitment. These data were integrated with microarray gene expression<br />
pr<strong>of</strong>iles <strong>of</strong> cellular states prior to and subsequent B cell commitment. All sequencing data were analyzed using the<br />
Illumina sequencing pipeline and QuEST (quantitative enrichment <strong>of</strong> sequence tags). An in-depth analysis <strong>of</strong> the<br />
spatial regulation <strong>of</strong> the immunoglobulin (Igh) locus during B cell fate commitment was carried out via fluorescence<br />
in situ hybridization (FISH).<br />
RESULTS: Ebf1 targets B-lineage genes, including the Igh locus, for activation, in part, by regulating H3K4me1, a<br />
histone mark enriched at enhancer elements. Notably, Ebf1 induces release <strong>of</strong> Igh alleles from the nuclear lamina, a<br />
process that precedes Igh recombination. Our data suggest that this regulation may be due to alterations in chromatin<br />
structure at the Igh locus induced by Ebf1 binding. Furthermore, the Ebf1 binding landscape undergoes expansion in<br />
a Pax5-dependent manner as cells transit from a specified to a committed state. De novo motif analysis <strong>of</strong> Ebf1 target<br />
sequences in Ebf1-regulated genes reveals presumptive sites for Pax5 and PU.1. ChIPseq analysis <strong>of</strong> Pax-5 and PU.1<br />
identifies a class <strong>of</strong> sequences in functionally important B cell genes that are bound by all three factors.<br />
CONCLUSION: Although PU.1, Ebf1 and Pax5 have been shown to act in a hierarchical manner in B cell fate<br />
determination, our molecular and genetic analyses demonstrate that downstream components in the gene regulatory<br />
network feedback to substantially modify the genomic targeting and functioning <strong>of</strong> upstream counterparts. Furthermore,<br />
Ebf1 targets the Igh locus and is required for release from its association with the nuclear lamina, a process necessary for<br />
proper Igh recombination. Ours is the first study to demonstrate such a function for a transcription factor.<br />
Acknowledgements/Disclosures: HHMI, NIH P50 GM081892-01A1 & Chicago Biomedical Consortium.<br />
Poster Presentation <strong>Abstract</strong>s<br />
41
Chaotic Aggregation <strong>of</strong> Truncated Amyloid Beta Peptides<br />
Joshua Williams<br />
MENTOR: Stephen Meredith, MD, PhD, Departments <strong>of</strong> Pathology and Biochemistry and Molecular Biology<br />
CO-AUTHORS: Laura Luther, MS, Andrew Hawk, PhD, Joseph Sachleben, PhD<br />
BACKGROUND: Aggregation <strong>of</strong> monomeric Amyloid Beta (Aβ) peptides (mostly Aβ1-40 and Aβ1-42) into<br />
neurotoxic soluble oligomers and insoluble fibrils is believed to be essential to the pathogenesis <strong>of</strong> Alzheimer’s Disease.<br />
Yet, the mechanism by which monomeric Aβ undergoes aggregation is poorly understood; two possibilities have been<br />
suggested. One hypothesis proposes that a central domain, possibly Aβ21-30, folds autonomously, thereby apposing<br />
hydrophobic residues within Aβ that interact to induce the formation <strong>of</strong> β-sheet, oligomers and fibrils. An alternative<br />
hypothesis suggests that an ordered folding process is unlikely; rather, hydrophobic residues within Aβ collapse upon<br />
one another in a chaotic fashion, forming polymorphic associations that favor β-sheet formation then oligomer and<br />
fibril formation.<br />
METHODS: In order to compare these hypotheses, we synthesized three internal fragments <strong>of</strong> Aβ <strong>of</strong> varying length<br />
(Aβ21-30, Aβ16-34 and Aβ13-38); the longer fragments contained more hydrophobic residues on either side <strong>of</strong> the<br />
central domain. In addition, we synthesized cyclic Aβ21-30, cyclic Aβ 16-34, and Aβ21-30 and Aβ16-34 extended<br />
at their N-termini by a Cystine residue. The Cys-containing or cyclic peptides, we hypothesized, might stabilize any<br />
interactions between side chains in Aβ21-30 through an entropic effect, making them more manifest by structural<br />
techniques, including Circular Dichroism (CD), Size Exclusion Chromatography (SEC), and two-dimensional Nuclear<br />
Magnetic Resonance (NMR) Spectroscopy.<br />
RESULTS: Aβ21-30, in addition to its Cys-modified and cyclic variants, was strictly monomeric and unstructured<br />
by CD, SEC, NMR, and analytical ultracentrifugation. Conversely, Aβ16-34 and Aβ13-38 formed oligomers, slowly<br />
fibrillized, and had strong β-turn and weak β-sheet signals (Aβ13-38 > Aβ16-34). Individual NMR spectra <strong>of</strong> Aβ16-<br />
34 were polymorphic and strongly dependent on temperature and pH. Sequential NMR spectra <strong>of</strong> fibrillizing samples<br />
<strong>of</strong> Aβ16-34 demonstrated variable signal decay and a faster rate <strong>of</strong> decay at certain hydrophobic residues near the<br />
N-terminus <strong>of</strong> the peptide. Adding a Cys residue to Aβ16-34 accelerated fibril formation, increased the rates <strong>of</strong> signal<br />
decay, and increased the consistency <strong>of</strong> decay rates within and between experiments. Finally, Cys-Aβ16-34 > Aβ13-38<br />
> Aβ16-34 were able to seed fibrillization <strong>of</strong> monomeric Aβ.<br />
CONCLUSION: We find no evidence that Aβ21-30 constitutes an autonomously folding core domain or has the<br />
ability to promote oligomerization or fibrillization <strong>of</strong> Aβ monomers. Conversely, Aβ fragments extended by hydrophobic<br />
residues possess a β-turn like structure, aggregate into soluble oligomers and fibrils, and seed fibrillization <strong>of</strong> monomeric<br />
Aβ. Furthermore, the addition <strong>of</strong> an N-terminal Cys residue favors interactions between sidechain residues known to<br />
interact in Aβ fibrils and orders the aggregation process. Lastly, differences in chemical shifts and signal decay rates for<br />
sequential NMR spectra <strong>of</strong> fibrillizing Aβ16-34 and Cys-Aβ16-34 indicate that Aβ fails to adopt a single structure<br />
during aggregation. Rather, hydrophobic effects lead to the formation <strong>of</strong> polymorphic aggregated species (i.e. oligomers<br />
and fibrils) that have greater heterogeneity than any normally folded protein. That is, the defining feature <strong>of</strong> Aβ –<br />
and perhaps <strong>of</strong> any amyloid – is its incompetence to assume a unique three-dimensional structure beyond the most<br />
rudimentary architectures, e.g. the presence <strong>of</strong> β-sheets.<br />
Acknowledgements/Disclosures: Laura Luther & Joshua Williams contributed equally to this project. We acknowledge the National<br />
Institutes <strong>of</strong> Health (NIH) Grant NS042852 to S.C.M, The University <strong>of</strong> Chicago Calvin Fentress Fellowship Recipient.<br />
42 Poster Presentation <strong>Abstract</strong>s
Abcc9 is Required for the Transition to Oxidative<br />
Metabolism in the Newborn Heart<br />
Babatunde Yerokun<br />
MENTOR: Elizabeth McNally, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Cardiology<br />
CO-AUTHORS: John P. Fahrenbach, Douglas Stoller, Gene Kim, Nitin Aggarwal, Judy U. Earley, Michele Hadhazy,<br />
Nian-Qing Shi, Jonathan Makielski<br />
BACKGROUND: At birth the newborn heart adapts by shifting from a fetal glycolytic metabolism to a mitochondrial<br />
oxidative metabolism, and the regulation <strong>of</strong> this transition is not well understood. With the shift to oxidative<br />
metabolism, the maturing heart generates more ATP. Abcc9, an ATP binding cassette family member, is highly<br />
expressed in the developing heart consistent with a role in this transition to oxidative metabolism. Abcc9 encodes a<br />
membrane-associated sulfonylurea receptor that partners with a potassium channel to become the major potassium<br />
sensitive ATP channel in the heart. Abcc9 also encodes a smaller protein enriched in the mitochondria.<br />
METHODS: We now deleted exon 5 <strong>of</strong> Abcc9 to ablate expression <strong>of</strong> both plasma membrane and mitochondriaassociated<br />
proteins.<br />
RESULTS: In the absence <strong>of</strong> Abcc9, the myocardium failed to acquire normal mature metabolism and caused neonatal<br />
cardiomyopathy. Unlike normal cardiomyocytes, mitochondria from Ex5 cardiomyocytes were unresponsive to the<br />
KATP agonist diazoxide, consistent with loss <strong>of</strong> mitochondrial KATP activity. When exposed to hydrogen peroxide to<br />
induce cell stress, Ex5 neonatal cardiomyocytes displayed a rapid collapse <strong>of</strong> mitochondria membrane potential, distinct<br />
from normal cardiomyocytes. Ex5 cardiomyocytes had reduced fatty acid oxidation and reduced oxygen consumption,<br />
and morphologically, Ex5 cardiac mitochondria exhibited an immature pattern with reduced cross sectional area and<br />
inter-mitochondrial contacts.<br />
CONCLUSION: In the absence <strong>of</strong> Abcc9 the newborn heart fails to transition normally from fetal to mature<br />
myocardial metabolism.<br />
IRB/IACUC: 70950; 70783<br />
Track: Basic ScienceSubmitted for: MS1 Spring Elective, SRP, MS2 S&D Block, MS4 S&D Work<br />
Acknowledgements/Disclosures: None.<br />
Poster Presentation <strong>Abstract</strong>s<br />
43
<strong>Scientific</strong> Investigation<br />
in<br />
Clinical or Social Sciences<br />
44 Poster Presentation <strong>Abstract</strong>s
Predicting Allogeneic Stem Cell Transplant Outcomes in Patients with<br />
High Risk AML & MDS: A Retrospective Analysis <strong>of</strong> Pre-Transplantation Variables<br />
Rajiv Agarwal<br />
MENTOR: Hongtao Liu, MD, PhD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hematology/Oncology<br />
CO-AUTHORS: Andrew Artz, MD<br />
BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HCT) is the only treatment option with the<br />
potential for long term disease remission for patients with relapsed and/or refractory AML and MDS. Response to<br />
HCT is dependent on a number <strong>of</strong> variables. Identifying pre‐transplantation variables may be used to predict clinical<br />
outcomes.<br />
METHODS: We performed a retrospective analysis to examine pre‐HCT variables for patients with high risk AML or<br />
MDS who underwent reduced intensity conditioning (RIC) for T‐cell depleted HCT from 2002‐2012. Our primary<br />
objective was to critically assess which variables may serve as prognostic factors that predispose patients to better or<br />
worse clinical outcomes. Inclusion criteria for our study included adult patients: (a) who received RIC, (b) undergoing<br />
first allogeneic HCT without previous HCT, (c) with high risk disease status, and (d) who are not in remission at time<br />
<strong>of</strong> HCT. Based on previous studies, pre‐HCT variables considered for analysis include: C‐reactive protein, number <strong>of</strong><br />
courses <strong>of</strong> induction chemotherapy, number <strong>of</strong> previous relapses, time <strong>of</strong> relapse after induction therapy, age at relapse<br />
post induction therapy, presence <strong>of</strong> molecular FLT‐ITD mutations, bone marrow blast percentage at HCT, neutrophil<br />
nadir, cytogenetic pr<strong>of</strong>iles, and ECOG performance status. Using univariate and multivariate analysis, we aim to show<br />
how different pre‐HCT variables correlate with post‐HCT outcomes: namely, incidence <strong>of</strong> graft versus host disease,<br />
progression free survival, and overall survival.<br />
RESULTS: 127 patients were evaluable based on inclusion criteria; 96 AML (disease status: 60 PIF/Refractory, 36<br />
relapse), 31 MDS (disease status: 12 RAEB‐1, 10 RAEB‐2, 5 CMML, 4 active disease/progressing); median age was<br />
56 years (range 18‐71); sex: 78 M, 49 F. 18 patients had low risk, 52 had intermediate risk, and 49 had high risk<br />
cytogenetic pr<strong>of</strong>iles at diagnosis. 8 patients had an inadequate sample or did not have cytogenetic analysis. Of the<br />
36 patients who relapsed prior to HCT, only 3 patients relapsed after > 12mo <strong>of</strong> induction and 14 patients relapsed<br />
between 6 and 12 mo, but 19 patients relapsed after < 6mo <strong>of</strong> induction; median age at first relapse was 53 years (range<br />
25‐68); 31 patients had only 1 relapse while 5 patients had multiple relapses. 9 <strong>of</strong> 60 patients evaluated showed a<br />
FLT3 ITD mutation. 32 <strong>of</strong> 45 evaluable patients had high C‐reactive protein levels at study entry (>5mg/L). Nearly all<br />
patients had ECOG performance status <strong>of</strong> 0 to 1.<br />
2 patients did not have pre‐HCT induction chemotherapy, 46 patients had one, 47 patients had two, and 32 patients<br />
had three or more courses; 79 patients had pre‐HCT BM blast percentage < 10%, 16 had between 10‐20%, 31 had<br />
> 20%; 70 patients had pre‐HCT BMcellularity < 20%, 56 had > 20%; One pt’s pre‐HCT BM was inadequate for<br />
analysis. Graft sources included: 108 PBSC (64 matched related, 44 matched unrelated), and 19 haploidentical PBSC<br />
plus a cord blood unit. We are currently in the process <strong>of</strong> examining post‐transplant outcomes: GVHD, progression<br />
free survival, and overall survival, and conducting univariate and multivariate analysis on pre‐HCT variables.<br />
CONCLUSION: We expect that with further statistical analysis <strong>of</strong> our results, we can identify which variables predict<br />
favorable or unfavorable clinical outcomes prior to HCT. This provides us with the potential to optimize therapeutic<br />
strategies and identify subgroups <strong>of</strong> high‐risk patients with AML or MDS who are more likely to benefit from HCT.<br />
By detecting the prognostic factors that correlate with post‐HCT outcomes, we advance our understanding <strong>of</strong> how<br />
patients with hematologic malignancies vary in their response to HCT.<br />
RB/IACUC: 12335BTrack: Clinical SciencesSubmitted for: MS4 S&D Work, Fentress<br />
Acknowledgements/Disclosures: The University <strong>of</strong> Chicago Calvin Fentress Fellowship Recipient.<br />
Poster Presentation <strong>Abstract</strong>s<br />
45
Impact <strong>of</strong> a Revised Appointment Scheduling Script on IUD Service<br />
Delivery in Three Title X Family Planning Clinics<br />
Brittany Betham<br />
MENTOR: Melissa Gilliam, MD, MPH, Department <strong>of</strong> Obstetrics and Gynecology, Section <strong>of</strong> Family Planning<br />
CO-AUTHORS: Stephanie Mistretta, MA, Summer Martins, MPH, Jane Holl, MD, MPH<br />
BACKGROUND: Women ages 15-25 are at high risk <strong>of</strong> unintended pregnancy yet have the lowest rates <strong>of</strong> intrauterine<br />
device (IUD) use. There is a paucity <strong>of</strong> research about how failures <strong>of</strong> in the system <strong>of</strong> IUD delivery may be contributing<br />
to this low rate <strong>of</strong> uptake. We used Failure Modes Effects and Criticality Analysis (FMECA), a well-established risk<br />
assessment and safety technique derived from industries outside <strong>of</strong> healthcare, to systematically evaluate IUD service<br />
delivery to young women in three Chicago Title X clinics. The FMECA is a multidisciplinary process, for which, in our<br />
study, the steps <strong>of</strong> obtaining an IUD were delineated and ways in which the delivery system fails (failure modes) were<br />
identified. The consequences <strong>of</strong> these failures were then identified and assessed for severity, frequency <strong>of</strong> occurrence, and<br />
potential safeguards already in place. Based on this assessment, a “criticality score” (level <strong>of</strong> risk) was assigned to each<br />
failure mode, and the highest risk failure modes were selected for possible intervention. We identified three “high risk”<br />
areas preventing IUD insertion: unprotected sex prior to the appointment, lack <strong>of</strong> understanding <strong>of</strong> clinic policies, and<br />
missed appointments.<br />
METHODS: We revised the call center’s script for IUD appointment scheduling to address the failures identified<br />
during the FMECA. We piloted the new script over a one-month period in November 2012 and assessed its impact on<br />
rates <strong>of</strong> appointment attendance, IUD eligibility (i.e. adherence to unprotected sex instructions), and completed IUD<br />
insertions using a pre/post study design with 3-week blocks <strong>of</strong> data collection before and after the intervention (n=99<br />
appointments).<br />
RESULTS: The revised script decreased no-show rates for appointments overall (40.4% vs. 23.8%, p=0.08), with<br />
significant differences for patients < age 25 (n=51; 46.9% vs. 15.8%, p=0.04). Among patients who attended their<br />
appointment, there were no pre/post differences in the proportions <strong>of</strong> IUD-eligible patients (97.1% vs. 90.3%, NS) or<br />
completed insertions (79.4% vs. 78.1%, NS).<br />
CONCLUSION: Use <strong>of</strong> a standardized scheduling script that emphasizes clinical and administrative policies for IUD<br />
visits may positively impact appointment outcomes. This simple, scalable intervention can increase the efficient use <strong>of</strong><br />
clinic resources, thereby improving IUD service delivery and administrative outcomes.<br />
IRB/IACUC: 10-508-BTrack: Clinical SciencesSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: Department <strong>of</strong> Health and Human Services: Office <strong>of</strong> Secretary, Office <strong>of</strong> Public Health and Science,<br />
Office <strong>of</strong> Population Affairs.<br />
46 Poster Presentation <strong>Abstract</strong>s
Comparison <strong>of</strong> Illuminated Dilated Pinhole, Laser Inferometer, and Potential Acuity<br />
Meter in Predicting Postoperative Visual Acuity after Cataract Surgery<br />
Valerie Chen<br />
MENTOR: H. Barrett Fromme, MD, MHPE, Department <strong>of</strong> Pediatrics &<br />
Susan Ksiazek, MD, Department <strong>of</strong> Surgery, Section <strong>of</strong> Ophthalmology and Visual Science<br />
CO-AUTHORS: Janice M. McMahon, OD, Rominder S. Momi, MD, Joshua K. Fernandes, MD<br />
BACKGROUND: The majority <strong>of</strong> people begin to develop age‐related cataracts by their 40s‐50s. At age 60, most<br />
cataracts begin to steal vision. It is difficult to determine how much <strong>of</strong> the decreased vision is due to the cataract in<br />
patients with coexisting ocular comorbidities (e.g. retinal or neural disease).<br />
Potential vision tests (e.g. Dilated Pinhole, Laser Inferometer, Potential Acuity Meter) have been developed to help<br />
predict visual acuity after uncomplicated cataract surgery. These tests <strong>of</strong>fer the patient more complete information in<br />
weighing the risks, benefits, and risks and benefits <strong>of</strong> undergoing the operation.<br />
METHODS: This prospective study evaluated 58 eyes in 48 patients undergoing cataract surgery between May 2011<br />
and January 2013. Pre‐operative measurements included pre‐operative best‐corrected visual acuity (BCVA), Illuminated<br />
Dilated Pinhole (DPH), Potential Acuity Meter (PAM), and Laser Inferometer (LI). One month post‐operative BCVA<br />
was used at the outcome measure to evaluate the accuracy <strong>of</strong> the potential vision tests. For data analysis, eyes were<br />
categorized based on pre‐operative BCVA: Group 1 ‐ LogMar 0.30 to 0.48 (equivalent to 20/40 to 20/60) (n=28),<br />
Group 2 ‐ LogMar 0.50 to 0.70 (equivalent to 20/63 to 20/100) (n=12), and Group 3 ‐ LogMar 0.72 to 1.3 (equivalent<br />
to 20/125 to 20/400) (n=18). Percent accuracy <strong>of</strong> prediction within LogMar 0.2 (equivalent to 2 lines on the Snellen<br />
chart), mean LogMar inaccuracy between predicted and post‐operative visual acuity, and paired t‐tests were then<br />
calculated.<br />
RESULTS: DPH predicted visual outcomes within LogMar 0.2 (equivalent to 2 lines on the Snellen chart) in 50%,<br />
50%, and 33% for Group 1, Group 2, and Group 3, respectively. LI predictions within LogMar 0.2 for the same groups<br />
were 39%, 33%, and 50%. Similarly, PAM predictions within LogMar 0.2 were 36%, 42%, and 28%, respectively.<br />
Mean LogMar inaccuracy with DPH was 0.22 (±0.19), 0.18 (±0.25), 0.30 (±0.43), and 0.23 (±0.30) for Group 1,<br />
Group 2, Group 3, and Overall, respectively. Mean LogMar Inaccuracy with LI was 0.29 (±0.26), 0.21 (±0.38), 0.26<br />
(±0.40), and 0.25 (±0.35) for the same groups. Mean LogMar Inaccuracy with PAM was 0.35 (±0.34), 0.32 (±0.45),<br />
0.38 (±0.31), and 0.35 (±0.37), respectively. Paired t‐tests revealed no significant statistical differences between any <strong>of</strong><br />
the 3 potential vision tests’ ability to predict visual outcomes both overall and after pre‐operative BCVA classification.<br />
CONCLUSION: The Dilated Pinhole test is a simple, inexpensive method that may be useful in predicting visual<br />
acuity after cataract surgery. It is comparable to Potential Acuity Meter and Laser Inferometer.<br />
IRB/IACUC: TBDTrack: Clinical SciencesSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: None.<br />
Poster Presentation <strong>Abstract</strong>s<br />
47
Substituted Judgment in Principle and Practice:<br />
A National Physician Survey<br />
Michael Combs<br />
MENTOR: Farr A. Curlin, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> General Internal <strong>Medicine</strong> &<br />
MacLean Center for Clinical Ethics<br />
CO-AUTHORS: Kenneth A. Rasinski, PhD, John D. Yoon, MD<br />
BACKGROUND: The conventional framework for surrogate decision‐making prioritizes substituted judgments over<br />
judgments about what is in the patient’s best interest, but it is unknown to what extent physicians endorse substituted<br />
judgments in principle or accommodate them in practice.<br />
METHODS: We surveyed a stratified, random sample <strong>of</strong> 2016 U.S. physicians by mail. Primary outcome measures<br />
were agreement with two in‐principle statements about substituted judgment and, following an experimental vignette<br />
that varied the basis used by a patient’s surrogate to refuse life‐saving treatment, responses indicating how appropriate<br />
it would be to overrule the surrogate’s decision.<br />
RESULTS: Our response rate was 62% (1156/1875). Most physicians (78%) agreed that surrogate decision makers<br />
should base their decisions on substituted judgment rather than on what they believe is in the patient’s best interest<br />
when the two values are in conflict. Yet, a significant minority <strong>of</strong> physicians (40%) agreed with a statement expressing<br />
the opposite. In the experimental vignette, physicians were much more likely to oppose overruling a surrogate’s refusal<br />
<strong>of</strong> life‐sustaining medical treatment when that refusal was based on substituted judgment, compared to when the<br />
refusal was based on the patient’s best interest (50% vs. 20%; OR 4.2, 95% CI 2.7 to 6.3). Contrary to our hypothesis,<br />
responses to the inprinciple statements about substituted judgment were not consistently associated with responses to<br />
the experimental vignette.<br />
CONCLUSION: U.S. physicians largely agree, in principle, that surrogates should prioritize what the patient would<br />
have wanted over what they believe is in the patient’s best interest, although many physicians are ambivalent in cases<br />
in which the two norms conflict. Even physicians who reject the principle <strong>of</strong> substituted judgment tend to treat<br />
substituted judgment as the preferred norm for surrogate decision‐making when responding to a clinical vignette.<br />
IRB/IACUC: TBD<br />
Track: Social SciencesSubmitted for: MS2 S&D Block, MS4 S&D Work, Fentress<br />
Acknowledgements/Disclosures: This study was supported by a grant from the John Templeton Foundation, and The University <strong>of</strong><br />
Chicago Calvin Fentress Fellowship supported my involvement.<br />
48 Poster Presentation <strong>Abstract</strong>s
Inter-Observer Variability Regarding the Diagnosis<br />
<strong>of</strong> Bronchiolitis Obliterans Syndrome<br />
Atul Kapila<br />
MENTOR: Sangeeta Bhorade, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Pulmonary and Critical Care<br />
CO-AUTHORS: Jerry Krishnan, MD, PhD<br />
BACKGROUND: Bronchiolitis obliterans syndrome (BOS), or chronic rejection, is the major limitation affecting<br />
long‐term survival in the lung transplant population. The current criteria used by clinicians in identifying BOS onset<br />
and severity is based on values <strong>of</strong> forced expiratory volume in 1 second (FEV1) obtained from pulmonary function<br />
testing. To our knowledge, no studies have formally evaluated the reliability or concordance <strong>of</strong> this definition. The<br />
purpose <strong>of</strong> this study is to determine a concordance rate among lung transplant experts, identify potential difficulties<br />
with the criteria, and discuss possible improvements.<br />
METHODS: Spirometric data from 181 patients enrolled in the AIRSAC trial were analyzed by 3 reviewers for the<br />
development <strong>of</strong> BOS. From the 35 discordant cases identified, 5 were selected, summarized with relevant clinical<br />
information, and formatted into a survey. The survey was sent to lung transplant experts around the world, and the<br />
results were analyzed for concordance.<br />
RESULTS: Eighty‐seven (47%) <strong>of</strong> the individuals who received the survey responded. Ninety‐five percent were<br />
pulmonologists with a mean <strong>of</strong> 12.2 years <strong>of</strong> experience in lung transplantation. The majority agreed with and felt<br />
confident in their ability to use the FEV1 criteria for BOS. An average discordance <strong>of</strong> almost 30% was observed over<br />
the five clinical scenarios. An average <strong>of</strong> 46% agreement regarding the time <strong>of</strong> BOS onset was noted among those who<br />
agreed upon the presence (or absence) <strong>of</strong> BOS.<br />
CONCLUSION: At least in a subset <strong>of</strong> patients, substantial discordance among clinicians exists in diagnosing BOS<br />
when using current guidelines based primarily on FEV1 values. This indicates that the definition likely needs further<br />
refinement to increase the reliability in identifying patients who have developed or are at risk for developing BOS.<br />
IRB/IACUC: 11-081Track: Clinical SciencesSubmitted for: MS2 S&D Block, MS4 S&D Work<br />
Acknowledgements/Disclosures: We would like to acknowledge the AIRSAC Investigators, The AIRSAC study was funded by Astellas<br />
Pharma, Inc.<br />
Poster Presentation <strong>Abstract</strong>s<br />
49
Intentional Sedation to Unconsciousness at the End <strong>of</strong> Life:<br />
Findings From a National Physician Survey<br />
Michael Putman<br />
MENTOR: Farr A. Curlin, MD, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> General Internal <strong>Medicine</strong> &<br />
MacLean Center for Clinical Ethics<br />
CO-AUTHORS: John D. Yoon, MD, Kenneth A. Rasinski, PhD<br />
BACKGROUND: The terms “palliative sedation’’ and “terminal sedation’’ have been used to refer to both proportionate<br />
palliative sedation, in which unconsciousness is a foreseen but an unintended side effect, and palliative sedation to<br />
unconsciousness, in which physicians aim to make their patients unconscious until death. It has not been clear to what<br />
extent palliative sedation to unconsciousness is accepted and practiced by U.S. physicians.<br />
METHODS: In 2010, a survey was mailed to 2016 practicing U.S. physicians. Criterion measures included selfreported<br />
practice <strong>of</strong> palliative sedation to unconsciousness until death and physician endorsement <strong>of</strong> such sedation for<br />
a hypothetical patient with existential suffering at the end <strong>of</strong> life.<br />
RESULTS: Of the 1880 eligible physicians, 1156 responded to the survey (62%). One in ten (141/1156) physicians<br />
had sedated a patient in the previous 12 months with the specific intention <strong>of</strong> making the patient unconscious until<br />
death, and two <strong>of</strong> three physicians opposed sedation to unconsciousness for existential suffering, both in principle<br />
(68%, n=773) and in the case <strong>of</strong> a hypothetical dying patient (72%, n 1=831). Eighty-five percent (n=973) <strong>of</strong> physicians<br />
agreed that unconsciousness is an acceptable side effect <strong>of</strong> palliative sedation but should not be directly intended.<br />
CONCLUSION: Although there is a widespread support among U.S. physicians for proportionate palliative sedation,<br />
intentionally sedating dying patients to unconsciousness until death is neither the norm in clinical practice nor broadly<br />
supported for the treatment <strong>of</strong> primarily existential suffering.<br />
IRB/IACUC: TBA - Left Blank, No Human Research conductedTrack: Social SciencesSubmitted for: MS2 S&D Block, MS4 S&D<br />
Work<br />
Acknowledgements/Disclosures: This study was supported by a grant from the John Templeton Foundation.<br />
50 Poster Presentation <strong>Abstract</strong>s
The Impact <strong>of</strong> Adverse Economic Conditions on Healthcare Demand<br />
Paul Riordan<br />
MENTOR: Gregory W. Ruhnke, MD, MS, MPH, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> Hospital <strong>Medicine</strong><br />
CO-AUTHORS: David O. Meltzer, MD, PhD, Christopher S. Lyttle<br />
BACKGROUND: Media reports have suggested that the demand for health care is resistant to market fluctuations,<br />
particularly for patients with health insurance, whose out-<strong>of</strong>-pocket payments compromise only a small proportion<br />
<strong>of</strong> total costs. To determine if the recent recession affected health care utilization, we examined the effects <strong>of</strong> variation<br />
in income and housing prices on the likelihood that patients with osteoarthritis <strong>of</strong> the knee would undergo knee<br />
replacement. We hypothesized that higher income and housing prices, before and after the recession, would be associated<br />
with an increased likelihood <strong>of</strong> knee replacement.<br />
METHODS: Claims data were extracted from the 2005-2010 MarketScan commercial claims and Medicare<br />
supplemental databases from a convenience sample <strong>of</strong> 20 metropolitan statistical areas (MSAs) for which detailed<br />
income and housing price information were available. These claims were linked to county-level percent change scores<br />
for annual per capita personal income and to MSA-level percent change scores for monthly Case-Shiller housing<br />
indices. Additionally, the claims were linked to 2008 area resource file data on the county-level density <strong>of</strong> orthopedic<br />
surgeons and total number hospital beds. The cohort was defined by patients with any claim for osteoarthritis <strong>of</strong><br />
the knee who were continuously enrolled for four years. Using the Elixhauser Comorbidity S<strong>of</strong>tware, comorbidity<br />
indicator variables for 29 conditions were defined based on all outpatient and inpatient claims one year prior to the<br />
first osteoarthritis diagnosis. A fixed effects hazard model was constructed with the economic indicators entered as<br />
time-dependent covariates and other characteristics (orthopedic surgeon density, total hospital bed density, age, sex,<br />
comorbidities) as time-independent covariates.<br />
RESULTS: The cohort consisted <strong>of</strong> 202,932 patients with osteoarthritis <strong>of</strong> the knee, <strong>of</strong> whom 23,397 (11.53%) had a<br />
knee replacement for osteoarthritis. A 1% increase in income predicted a 3.9% greater likelihood <strong>of</strong> knee replacement<br />
(Hazard Ratio [HR]: 1.039 [95% Confidence Interval [CI] 1.036-1.042]), and a 1% increase in the CaseShiller Index<br />
predicted a 3.3% greater likelihood <strong>of</strong> knee replacement (HR: 1.033 [95% CI 1.024-1.042]). Greater density <strong>of</strong><br />
orthopedic surgeons and hospital beds did not predict a greater likelihood <strong>of</strong> knee replacement, [compared to the<br />
lowest quartile; orthopedic surgeon density highest quartile 1.040 (0.965-1.121); total hospital bed density highest<br />
quartile 1.036 (0.964-1.113)].<br />
CONCLUSION: Improved macroeconomic conditions are associated with increased demand for elective health care<br />
among a cohort <strong>of</strong> insured patients. Increased housing prices and per capita income both predicted a increased likelihood<br />
<strong>of</strong> knee replacement among patients with osteoarthritis, suggesting that elective procedures may be postponed during<br />
a recession.<br />
Acknowledgements/Disclosures: None.<br />
Poster Presentation <strong>Abstract</strong>s<br />
51
Infection Control for Anesthesia Providers:<br />
A Literature Review and Research Proposal<br />
Jasmine Swaniker<br />
MENTOR: David Glick, MD, Department <strong>of</strong> Anesthesia and Critical Care<br />
BACKGROUND: Iatrogenic post‐operative infections remain a significant healthcare system and patient burden<br />
despite advances in aseptic technique. While past research has focused on surgical site infections, recent contamination<br />
outbreaks involving prop<strong>of</strong>ol and hepatitis virus transmission suggest the anesthesia provider plays a large role in<br />
maintaining intraoperative sterility. These recent breeches in aseptic technique have helped improve education about<br />
the dangerous practice <strong>of</strong> reusing a syringe or medication vial on more than one patient. However, many other sources<br />
<strong>of</strong> bacterial transmission remain overlooked.<br />
The goal <strong>of</strong> this investigation is to a. compare and contrast intraoperative infection control guidelines for anesthesia<br />
providers in order to identify gaps and/or inconsistencies in policy recommendations b. review recent literature on<br />
potential sources <strong>of</strong> intraoperative infection transmission c. propose a novel investigation <strong>of</strong> syringe contamination<br />
based on insufficiencies in current guidelines and recent data.<br />
METHODS: The injection practice guidelines for the following major administrative organizations were reviewed and<br />
compared: Center for Disease Control (CDC), American Society <strong>of</strong> Anesthesiology (ASA), United States Pharamacopeia<br />
(USP), and the American Association <strong>of</strong> Nurse Anesthetists (AANA). Additionally, a literature review was performed<br />
using PubMed and the search terms “intraoperative contamination.” Only studies from the last 10 years were included.<br />
The following studies were excluded a. those lacking microbiological confirmation <strong>of</strong> contamination b. case reports c.<br />
those involving pre‐filled syringes not prepared directly by a healthcare provider d. those regarding contamination <strong>of</strong><br />
prop<strong>of</strong>ol syringes (given its intrinsic bacterial growth‐promoting properties and distinct administration regulations) e.<br />
those involving single syringe use on multiple patients. A total <strong>of</strong> 9 studies were reviewed.<br />
RESULTS: While there was concordance among all administrative organizations regarding the re‐use <strong>of</strong> syringes on<br />
multiple patients and the preference for single‐use vials over multi‐use vials there were inconsistent findings on handwashing<br />
guidelines, re‐use <strong>of</strong> syringes for the same patient, and appropriate use <strong>of</strong> single‐use vials. A review <strong>of</strong> recent<br />
investigations on intraoperative contamination shows that the patient, the provider, and the environment are the<br />
most important contributors to IV access contamination. Noted contamination rates ranged from 13‐32%. Anesthesia<br />
workplace decontamination and provider hand hygiene improvements are the most promising avenues for reducing<br />
infectious transmission.<br />
CONCLUSION: This review suggests that intraoperative infection control guidelines for anesthesia providers should<br />
be revised to include a. intraoperative hand‐washing protocols b. directions regarding the re‐use <strong>of</strong> syringe on the same<br />
patient c. the appropriate timing and use <strong>of</strong> single‐use vials. Additionally, a review <strong>of</strong> recent literature suggests that<br />
the patient, the environment, and the provider all significantly contribute to intraoperative contamination. Improved<br />
anesthesia workspace decontamination and provider hand hygiene are promising points <strong>of</strong> intervention. These findings<br />
suggest that a novel investigation examining the correlation between syringe re‐use during extended surgical cases and<br />
internal syringe contamination is warranted to guide future infection control policies.<br />
IRB/IACUC: 12-1952Track: Clinical SciencesSubmitted for: MS4 S&D Work<br />
Acknowledgements/Disclosures: The University <strong>of</strong> Chicago John D. Arnold, MD <strong>Scientific</strong> Research Prize Recipient.<br />
52 Poster Presentation <strong>Abstract</strong>s
Are All Vital Signs “Vital”? A Prospective Study <strong>of</strong> Nighttime<br />
Vital Sign Frequency and Risk <strong>of</strong> Clinical Deterioration<br />
Jordan Yoder<br />
MENTOR: Vineet Arora, MD, MAPP, Department <strong>of</strong> <strong>Medicine</strong>, Section <strong>of</strong> General Internal <strong>Medicine</strong><br />
CO-AUTHORS: Trevor C. Yuen, Matthew M. Churpek, MD, MPH, Dana P. Edelson, MD, MS<br />
BACKGROUND: Sleep disruptions are prevalent among ward patients and are associated with a number <strong>of</strong> negative<br />
health outcomes, including elevated blood pressures and delirium. Overnight vital signs are an especially bothersome<br />
disruptor and can deplete crucial health care resources. While vital sign checks every four hours are <strong>of</strong>ten routine, there<br />
are limited data to support this level <strong>of</strong> monitoring for all ward patients. The Modified Early Warning Score (MEWS)<br />
has been used to identify high-risk patients for Rapid Response Team interventions. This study investigated whether<br />
evening MEWS could identify low risk patients who could forgo overnight vital signs.<br />
METHODS: We conducted a prospective cohort study <strong>of</strong> consecutive adult, inpatients at an academic institution<br />
between November 2008 and January 2011. All vital signs were extracted from the electronic medical record (EPIC,<br />
Verona, WI), and a MEWS was calculated for each set taken on the general floors, with median-value imputation used<br />
for incomplete sets. The MEWS most closely preceding 11pm each evening was used to stratify patients. The number <strong>of</strong><br />
nighttime (11pm - 6am) disruptions for vital signs and adverse events (AE), defined as ICU transfers or cardiac arrests<br />
in the next 24 hours (11pm - 11pm), were compared across all MEWS.<br />
RESULTS: A total <strong>of</strong> 54,096 patients were included in the study, accounting for 182,828 patient-days on the wards<br />
and 1,699 AEs. The median evening MEWS score was 2 (IQR 1-2). The AE rate increased with increasing evening<br />
MEWS from a rate <strong>of</strong> 5.0 per 1000 patient days (when the MEWS was 0 or 1) to 157.3 (when the MEWS was greater<br />
than 6), p=0.003 for trend. However, the frequency <strong>of</strong> vital sign disruptions was unchanged, with a median <strong>of</strong> 2 vital<br />
sign checks per patient per night and at least one disruption for vitals 99% <strong>of</strong> the nights, regardless <strong>of</strong> MEWS category.<br />
Almost half <strong>of</strong> all nighttime vital sign disruptions (48%) occurred in patients with a MEWS <strong>of</strong> 0 or 1.<br />
CONCLUSION: Overnight vital signs are frequently collected in ward patients regardless <strong>of</strong> the patient’s risk <strong>of</strong> clinical<br />
deterioration. The MEWS identified a subset <strong>of</strong> patients who had significantly fewer adverse events, but had overnight<br />
vital signs taken at a similar rate as high-risk patients. This suggests nighttime frequency <strong>of</strong> vital signs for low risk<br />
medical inpatients could be reduced, potentially improving patient sleep without forsaking safety. A tailored approach<br />
would also enable reallocation <strong>of</strong> resources to monitoring higher risk patients more frequently. Further prospective<br />
study <strong>of</strong> the safety and benefit <strong>of</strong> personalized vital sign collection is warranted.<br />
IRB/IACUC: TBD - Left BlankTrack: Social SciencesSubmitted for: MS4 S&D Work, Fentress<br />
Acknowledgements/Disclosures: This research was funded in part by an institutional Clinical and Translational Science Award grant<br />
(UL1 RR024999). Dr. Edelson is supported by a career development award from the National Heart, Lung, and Blood Institute (K23<br />
HL097157-01) and has received research support from Philips Healthcare (Andover, MA) and Laerdal Medical (Wappingers Falls, NY),<br />
and has ownership interest in Quant HC (Chicago, IL), which is developing products for risk stratification <strong>of</strong> hospitalized patients. Dr.<br />
Churpek is supported by a National Institutes <strong>of</strong> Health grant (T32 HL 07605). Dr. Arora is supported by the National Institutes on<br />
Aging K23AG033763-04 and Jordan Yoder is supported by the Fentress Award from the <strong>Pritzker</strong> <strong>School</strong> <strong>of</strong> <strong>Medicine</strong>. The University <strong>of</strong><br />
Chicago Calvin Fentress Fellowship Recipient.<br />
Poster Presentation <strong>Abstract</strong>s<br />
53
Presentation Notes
Scholarship d& Discovery Leadership<br />
Vineet Arora, MD, MAPP<br />
Rachel Wolfson, MD<br />
Sujata Mehta, MA<br />
Scholarship & Discovery Tracks<br />
Applied Scholarship<br />
Community Health<br />
Deborah Burnet, MD, MAPP<br />
Kohar Jones, MD<br />
Global Health<br />
Brian Callender, MD, MPH<br />
John Schneider, MD<br />
Medical Education<br />
Jeanne Farnan, MD, MHPE<br />
H. Barrett Fromme, MD, MHPE<br />
Quality & Safety<br />
Julie Oyler, MD<br />
Lisa Vinci, MD, MS<br />
Basic <strong>Scientific</strong> Investigation<br />
David Boone, PhD<br />
Erika Claud, MD<br />
<strong>Scientific</strong> Investigation in Clinical or Social Sciences<br />
David Glick, MD (Clinical Research)<br />
Gavin Hougham, PhD (Social Sciences)<br />
V. Leo Towle, PhD (Clinical Research)
The annual <strong>Senior</strong> <strong>Scientific</strong> <strong>Session</strong> was founded in 1946 by Dr. Leon Jacobson to provide fourth<br />
d<br />
year medical students with a forum to present their research. Each year over 1/3 <strong>of</strong> the graduating class<br />
participate in this event. Student presentations and posters are judged by a panel <strong>of</strong> faculty members.<br />
2013 Panel <strong>of</strong> Faculty Judges:<br />
John Alverdy, MD<br />
Arshiya Baig, MD, MPH<br />
Matthew Brady, PhD<br />
Marshall Chin, MD, MPH<br />
Ronald Cohen, MD<br />
Andrew Davis, MD, MPH<br />
Harriet deWit, PhD<br />
Elbert Huang, MD, MPH<br />
dScott Hunter, PhD<br />
Oral Presentations By:<br />
Nikita Alexiades<br />
Marcia Faustin<br />
Benjamin Ferguson, PhD<br />
Kiran Kumar<br />
Kelly Ledbetter<br />
d<br />
Kristen Knutson, PhD<br />
Peggy Mason, PhD<br />
Mark Musch, PhD<br />
Funmi Olopade, MD<br />
Sola Olopade, MD, MPH<br />
Tipu Puri, MD, PhD<br />
Lainie Ross, MD, PhD<br />
Stephen Small, MD<br />
Gabrielle Schaefer<br />
Rachel Stork<br />
Tarak Trivedi<br />
Joyce Woo<br />
William Zeiger, PhD<br />
Rajiv Agarwal<br />
Brittany Betham<br />
Clifton Brock<br />
Valerie Chen<br />
Tharian Cherian<br />
Kevin Choo<br />
Michael Combs<br />
Amanda Gawin<br />
Elizabeth Greenstein<br />
Poster Presentations By:<br />
Atul Kapila<br />
Yelena Koldobskaya, PhD<br />
Samuel Lee<br />
Patrick Mann<br />
Rebecca Miller<br />
Shamsideen Musa, MS<br />
Michael Putman<br />
Katie Raffel<br />
Paul Riordan<br />
Jasmine Swaniker<br />
Sarah Todd, MAT<br />
Anne Toledo<br />
Joseph Triggs, PhD<br />
William Uffmann<br />
Joshua Williams<br />
Wenlu Xiong<br />
Babatunde Yerokun<br />
Jordan Yoder<br />
Matthew Zegarek<br />
At the University <strong>of</strong> Chicago, in an atmosphere <strong>of</strong><br />
interdisciplinary scholarship and discovery, the <strong>Pritzker</strong><br />
<strong>School</strong> <strong>of</strong> <strong>Medicine</strong> is dedicated to inspiring diverse students<br />
<strong>of</strong> exceptional promise to become leaders and innovators in<br />
science and medicine for the betterment <strong>of</strong> humanity.<br />
Front Cover: Images from the 2012 <strong>Senior</strong> Scientic <strong>Session</strong>