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Latino Medical Student Association Annual journal Volume 4 Founded to represent, support, educate and unify Latino(a) Medical Students Table of Contents • • • • • • • • • Page 2: 2014 National Conference Welcome Page 3: Art Corner Page 4: National Coordinator Report and Bio’s Page 7: N.H.M.A.- History and Greetings Page 10: Chapter Spotlight Page 12: 2013 Mentor of the Year Page 14: Policy Editorial Page 16: Student Abstracts Page 31: Health Professionals Abstracts • Page 37: Journal Articles • Page 45: About the Editors L.M.S.A. Mission To unify all Latino medical students into one organization to provide a voice for underrepresented medical students with the goal of actively promoting recruitment and retention of Latino students of all educational and professional levels, to educate medical students on Latino health issues, to advocate for the rights of Latinos in health care, and to provide leadership opportunities for Latinos. www.lmsa.net L.M.S.A. Journal Pg 1 Welcome to Houston fo the 9th Annual LMSA National Conference! About the Artist: Kathy Amortegui is a Latino Artist based out of Las Vegas, Nevada. Born and raised in Bogota, Colombia, she currently works in the Economics Department at the University of Las Vegas, Nevada Lee Bussiness School. She has been an artist most of her life studying at several arts schools in Latin America such as the Guerrero schools of Arts ,the Chico school of art, and the David Manzour art school as well as collaborating with multiple private art professors from the Latin and European Community for six years. In addition, she is involved in the latino communiy by paticipating in several charity events as well as teaching English to underserved hispanic immigrants through several programs in the Las Vegas and Clark County area. For further information, please email the artist at [email protected] On behalf of the Southwest Region, it is our pleasure to welcome you to our home! Although it is the first time Houston has the honor of hosting this conference, it is actually the second time that the National Conference has been held in the Southwest Region (back in 2007 when our organization was known as the National Network of Latin American Medical Students or NNLAMS). From that time, our region has seen a veritable revival of LMSA culminating in the conference you see today. When our regional board sat down to plan the theme of the 9th annual conference, we began with a discussion of LMSA itself; its mission, goals, and ideals. Now more than ever we see the landscape of healthcare changing before our eyes, affecting our entire community from the youngest patient to the oldest doctor. Our hope lies in each other as we grow, learn from each other, and together build a better future for our patients and communities. As you listen to the speakers and participate in the workshops, please take time to reach out to your fellow LMSA members from within your region, or another region entirely. Make contacts, exchange emails, and network. We are only as strong as we are united, and it is through our combined efforts that we can truly realize our potential. Lastly, we would like to recognize and thank our two hosting institutions, Baylor College of Medicine and the University of Texas Health and Science Center at Houston whose support made this conference possible! Kathy Amortegui. Bolivian Girl. Oil in Canvas ¡Bienvenidos! The LMSA Southwest 2014 Conference Committee About the Artist: Eduardo Torres is a design and art professor born in Mexico city who studied plubic relations, art and graphic design. In the 80’s, Mr Torres immigrated to Los Angeles through a publication company and studied Radio and Television broadcasting. He was named department head of art and publishing in the Los Angeles college. Mr. Torres has been in several art expos specialising in the the real of art realisim. Currently he resides in Las Vegas, NV and teaches classes in Oil, Acrylic, Pastel and Muralistic theory while being heavily involved in the latin community through art classes for autistic youth. He may be reached at : [email protected] www.lmsa.net L.M.S.A. Journal Pg 2 www.lmsa.net L.M.S.A. Journal Pg 3 National Cordinator’s Bio Dr. Galvis is currently serving his second term as National from Alvaro E. Galvis, Ph.D. , MS4 2013-2014 National Coordinator Dear LMSA membership. The 2013-2014 leadership has taken LMSA into new and exciting avenues that we could have not dreamt of five years ago. When the regions decided to unify under the LMSA name in 2009, our hope was to become the leading voice of Latino medical students throughout the nation. Today, we have seen tremendous expansion through our younger regions of the Southeast and Southwest, we are continuing to develop our pre-medical societies (LMSA-PLUS) and we have established out first LMSA Student Policy Section that has allowed any LMSA member to help influence the direction of organization (Please visit http://lmsa.net/policy/) . This year we are also celebrating the 5th independent National Conference in our newest region of the Southwest from April 25th-27th. Currently, we are working hard in developing further the infrastructure of LMSA and a closer collaboration with NHMA Council of Residents (COR) , Young Physicians (YP) and Executive Board (EB). To highlight a few key aspects of these new developments: 1) LMSA and all groups of NHMA (COR, YP and EB) will create one master database of its leadership and form working groups President of the Latino Medical Student Association. He is a fourth year medical student at the University of California, Irvine School of Medicine (UCI SOM). He has been involved with the LMSA since his first year of medical school in 2005, holding various positions including three terms as Southern CEO of the LMSA-West region. He received a BA in Religious Studies and a BS in Biology in 2002 from Santa Clara University. He is a member of both the Medical Scientist Training Program (MSTP) and Program in Medical Education for the Latino Community (PRIME-LC) at UCI SOM. He successfully defended his PhD dissertation entitled “An RNA Lariat Intermediate in HIV-1 cDNA Synthesis” with the Department of Molecular Biology and Biochemistry in February 2014. Dr. Galvis has also been involved in the UCI SOM Admissions Committee since 2007. He has always been a strong advocate of health for all underserved communities and increasing the number of minorities in medicine. He wants to devote his career to the well-being of others and upholding the mission of LMSA. within across the board equivalent positions (e.g. publication chairs of all the organizations will have their own committee to collaborate on newsletter/ publications). 2) LMSA will be expanding its Alumni Board into the LMSA Physician Advisory Board. Dr. Elizabeth Homan-Sandoval has ac- Amanda Lynn Hernandez is an MD/PhD candidate at Yale University pursuing her doctoral research in neuroscience and immunology and planning to complete a medical residency in neurology. Her doctoral thesis aims to characterize putative environmental factors mediating Multiple Sclerosis, work for which she was recently awarded the prestigious National Institute of Health Ruth L. Kirschstein National Research Service Award. Born and raised in the Bronx, NY, Amanda is of Puerto Rican decent and was the first in her family to complete college. She attended Columbia University in the City of New York and graduated in 2008 with BA in Neuroscience and Psychology. Following completion of her degree Amanda pursued research full-time for one year prior to matriculating at Yale. Upon arriving at Yale’s Medical Scientist Training Program, Amanda became intimately involved within the Latino community. Currently the LMSA National Vice-President, Amanda has held numerous executive board positions within LMSA National and has served as the Northeast-LMSA Regional Co-Chair for the past 4 years. Outside of her LMSA involvement, Amanda has been passionately engaged in the Yale Latino community as a Graduate Assistant at La Casa, Yale’s Latino Cultural Center, where she mentors over 50 undergraduate students. Outside of her academic and community pursuits, Amanda is an avid Crossfitter and actively competes within the state of Connecticut. cepted being LMSA’s co-executive director alongside Dr. Rueben Font. 3) In the upcoming summer LMSA will be launching its new website and membership database. 4) LMSA and NHMA have signed a new MOU that includes $1000 for each regional conference and an additional $2000 for the National Conference. NHMA will support the travel of the two regional presidents alongside the president and vice-president to the NHMA conference. At this time I would like to take a moment to thank a few key leaders in LMSA: Orlando Sola and Ankeeta Mehta for their leadership in the development of the Policy Section, Dr. Emma Olivera for her contributions to the Board, Jose Cruz for his work in developing the programing for GLAS 2013, Dr. Rueben Font in hos first year as executive director and Amanda Hernandez our 2014-2015 National President. I hope you are excited about the new developments as LMSA continues to grow and expand into new avenues. I look forward to seeing many of you at our annual conference in Houston, TX. Sincerely, Alvaro E. Galvis, Ph.D. , MS4 UCI School of Medicine M.D. candidate Class of 2015 Medical Scientist Training Program Program in Medical Education for the Latino Community Vice-President, LMSA National President, Latino Medical Student Association www.lmsa.net L.M.S.A. Journal Pg 4 www.lmsa.net L.M.S.A. Journal Pg 5 N.H.M.A. Spotlight Medical School A Brief History of the National Hispanic Medical Association Office of Diversity and Inclusion The University of Texas Medical School at Houston is committed to diversity and inclusion of each member of the Medical School family – be they students, faculty, staff or patients. Headed by LaTanya Love, M.D., assistant professor of pediatrics, and Pedro Mancias, associate professor of pediatric neurology, the goal is to serve Houston’s populace through medical education, patient care, and research that is inclusive. Specific goals of the office include increasing scholarships, improving recruitment and retention of minority faculty, enhancing the cultural competence curriculum and providing institutional support for diversity and inclusion. 713-500-5040 Main 713-500-0604 Fax 6431 Fannin Street, G.300 Houston, TX 77030 www.med.uth.tmc.edu/diversity www.lmsa.net L.M.S.A. Journal Pg 6 www.lmsa.net dent Scholarship Fund. In 2006, N.H.M.A. contracted with firms to conduct feasibility studies to develop the strategy for sustainable growth. A first step in this strategy was the establishment of an association of State Medical Societies which N.H.M.A. would develop through its Childhood Obesity Education Projects and new portal (HispanicHealth.info). In 2008, N.H.M.A. completed a National Hispanics and Health Disparities Summit Series in NY, CA and TX with H.H.S. O.M.H. that brought together 300 stakeholders from public and private sectors to provide consensus recommendations for Federal policy for public health prevention, access to care, and diversity in the health professions for the next 5 years. These recommendations were presented to Senator Kennedy led Senate health care reform committee, Congress and with President Obama’s Transition team. In 2009, N.H.M.A. Board of Directors worked more formally with L.M.S.A. as it signed an agreement and invited L.M.S.A. to serve on its Board. In 2010, NHMA developed its Council of Residents and next plans to develop the Council of Young Physicians. health research. The following year, N.H.M.A. convened its First Annual National Conference honoring regional pioneer Hispanic physicians who had been advocates for their communities. In October 1998, Dr. Rios became the Executive Director of N.H.M.A. after receiving Federal funding through a Cooperative Agreement with the H.H.S. Office of Minority Health, followed by support from foundations and the private sector for a variety of programs, including launching the Hispanic-Serving Health Professional Schools student internship program, the N.H.M.A. Leadership Fellowship, the N.H.M.A. Resident Leadership Fellowship, the N.H.M.A. Medical Student Mentorship, the N.H.M.A. Public Health Fellowship, the N.H.M.A. Research Network, the Cultural Competence Graduate Medical Education Curriculum Project, the National Hispanic Health Leadership Summit, and the Congressional Hispanic Health Briefing Series. In 2005, N.H.M.A. completed a strategic review and expanded its Board of Directors to include nationally recognized leaders in the health sector; established its foundation’s, National Hispanic Health Foundation (N.H.H.F.) affiliation and office with NYU’s Wagner Graduate School of Public Service, Corporate Advisory Council and its Hispanic Health Professional Stu- The National Hispanic Medical Association (N.H.M.A.), a 501c6 association, was developed in 1994 in Washington, DC as a result of a meeting of Presidents of Hispanic medical societies. During the meeting it was decided an organization was needed to fill a void in Washington, DC – the need for a voice for Hispanic/Latino physicians as advocates for Hispanic health with the Federal government. This decision grew from a history of organizing efforts dating back to the 1960s when Hispanic medical students formed regional associations and local societies focused on social and charitable activities. As a young medical student, Elena Rios established the California Chicano/Latino Medical Student Association in 1983, its Supernetwork Program to link with 25 premed clubs, and in 1987, the National Latin American Medical Student Network. Beginning in 1995, the Department of Health and Human Services (H.H.S.) Health Resources and Services Administration supported N.H.M.A. to convene 5 regional meetings with Hispanic health leaders around the country with recommendations that shaped the initial policy priorities of the N.H.M.A. Board of Directors: increasing access for Hispanics to quality health care, pipeline diversity in medical education, and Hispanic L.M.S.A. Journal By Elena V. Rios, MD/M.S.P.H. Pg 7 N.H.M.A. Mission: NHMA COUNCIL OF RESIDENTS MISSION: To empower Hispanic physicians to improve the health of Hispanic populations with Hispanic medical societies, resident and medical student organizations, and public and private partners. The mission of the NHMA is to empower Hispanic physicians to lead efforts to improve the health of Hispanic and other underserved populations in collaboration with the state, regional and local level Hispanic medical societies, resident and medical student organizations, and other public and private sector partners. Dr. Elena V. Rios, M.D./M.S.P.H. Dr. Rios is the President/CEO of N.H.M.A., whose mission is to represent Latino physicians in the United States and work towards improvement of Latino health. NHMA COR Spotlight-by Dr Lopez-Mena MD The goal of the National Hispanic Medical Association Council of Residents is to build the foundation of residents in NHMA, with support and opportunities for professional development, mentorship, leadership, and networking. One of our other core missions however, is to build a strong pipeline from LMSA to NHMA COR. We believe that we have strengthened this pipeline tremendously this past year through dedicated mentorship of medical students. Once again NHMA COR has collaborated with LMSA to have residents present on panels regarding mentoring, achieving the residency of your choice and community engagement and empowerment at every LMSA Regional conference. The strong collaboration this past year culminated with the first annual Student Policy Section at this year’s National NHMA Conference March 28-30th in Washington D.C. In an effort to extend LMSA’s tradition of leadership within the Latino community the Policy Section aimed to teach participants about advocacy through health policy. The Student Policy Section featured workshops for students and residents, structured and informal mentoring opportunities and experience in developing and legislating initiatives in health policy. The policy secwww.lmsa.net terested in a workshop at your institution please contact us. We will also be holding a membership drive throughout the nation to increase resident participation and voice in NHMA. tion adapted a resolution-based policy referendum. Resolutions were collected from LMSA members and shared on an online forum open to comments and suggestions from the general LMSA membership and associated organizations. The policy development process culminated in the 2014 Congress of Delegates, where a regionally elected policy committee presented submitted resolutions to be debated and voted on by LMSA Delegates. It has been an honor to serve as the NHMA Council of Residents National Chair this year. I look forward to continuing to build strong relationships with LMSA students throughout the country in my future role as LMSA Physician Advisory Board member. We sincerely hope that you will continue on in your organizational participation and join us in NHMA in our shared goals of decreasing health disparities in the Latino community and promoting Latino participation in medicine. Felicitaciones on your outstanding National Conference! In addition, this year’s National NHMA conference titled “Affordable Care Act & Best Practices for Hispanics” also gave medical students and residents to become up to date with the current happenings regarding the Affordable Care Act. Amongst many things we learned how health care innovations and the Affordable Care Act are influencing health care reform’s prevention and public health strategies; we reviewed community-based research that focuses on knowledge and policy strategies that show promise of eliminating health disparities; and identified cultural competence, literacy, and language services programs for medical education and health care delivery. L.M.S.A. Journal COR was created in 1994 to serve as an interest group of NHMA The NHMA COR seeks to increase mentorship through the Resident Mentorship Program. Objectives include: *Reaching out to graduating medical students, current residents and fellows to become registered members and join our committees. *Offering mentorship workshops, facilitating mentorship matches between physicians and trainees. *Networking COR also offers professional development through training and leadership fellowship to promote leadership development. *Emphasizes knowledge and skills necessary to take a leadership role in health policy development and advocacy at local, state, and national levels on issues of importance to the health of the Hispanic community. REGISTER NOW: Early Birds Ends March 1 www.nhmamd.org Members of COR may become leaders at multiple levels: *Executive Board Officer * Regional Representative * State Representative * Member of committee NATIONAL HISPANIC MEDICAL ASSOCIATION 1920 L ST NW, Suite 725 Washington, DC 20036 To become a COR member, visit www.nhmamd.org Phone: 202 628 5895 Fax: 202 628 5898 Email: [email protected] www.facebook.com/NHMACOR Lastly, in the fall NHMA COR will be hosting workshops at local institutions throughout the five regions, in order to further promote networking, mentoring, and professional development. If you are in NHMA 18TH Annual Conference March 28-30, 2014 Marriott Wardman Park Hotel, Washington, DC “The Affordable Care Act & Best Practices in Health Care for Hispanics” Capitol Hill Visit, Poster Presentations, & Resident Workshops Pg 8 www.lmsa.net L.M.S.A. Journal Pg 9 quarter of the Latino population, most medical schools in our region do not even know that LMSA exists. Although students in this region are highly motivated, they often lack the connection and support that a national network provides. Despite the lack of a unifying force however, individual chapters of LMSA survived, growing in number and eventually reaching out to the national organization. Chapter spotlight The story of the LMSA Southwest region cannot be told without including Ray Méndez, the acting LMSA President from 2006-2008. He contacted the Latino student groups at the major medical schools in the Southwest region, calling for a face-to-face House of Delegate meeting to help “re-establish” centralized communication within the region. He personally flew down from Illinois to meet with us on November 5, 2011 at the University of Texas –Southwestern. With his guidance, we “re-formed” the LMSA SW Regional Board, started the process of drafting our constitution, and most importantly, reconnected with students from different medical schools in our region! LMSA From the beginning, the story of LMSA has been a story familiar to anyone of Hispanic or Latino origins. Many people, many cultures, yet with a kinship few others share. Our foods are different, our music is different, and our accents are different. We all come from different countries, cultures, and backgrounds both from our family history and from our current lives, yet we are all united our goals and ideals. The last time the Southwest Region held a national conference was in 2007, and we were known as NNLAMS. Above you can see a pamphlet from that very conference, with our current website juxtaposed. While many things have changed, you will notice that the mission of our organization has remained the same: To unify all Latino medical students into one organization To provide a voice for underrepresented medical students To actively promote recruitment and retention of Latino students at all levels To educate medical students on Latino health issues To advocate for the rights of Latinos in health care To provide leadership opportunities for Latinos To promote volunteerism in the Latino community Later than year, several of us met up at the National LMSA Conference in Boston – a true inspiration and vision for the future of our fledgling SW Regional Chapter. Several members of the 2011-2012 SW Regional Board reunited for GLAS 2012 in September – a wonderful learning experience as well as the final push for organizing our 1st LMSA SW Regional Conference! he first LMSA-Southwest Regional Conference was held on October 13, 2012 at Doctors Hospital Renaissance. Our theme “Salud En La Frontera”: Inspiring Future Leaders Through Mentorship and Education reflected the culmination of many months of hard work from the conference organizers and the potential for growth in our region. We were thrilled to have over 75 medical students representing 7 medical schools and 30 undergraduates from University of Texas – Pan American in attendance! With one year under our belt, we continued to refresh our organization by electing the new officers for the LMSA-Southwest Executive Board. Between October 2012 and April 2014 we have been quite busy! The first LMSA-SW Networking event in May 2013 brought together students from UT-Houston, UTMB, UT-SW and Baylor College of Medicine as well as residents and faculty members from the Houston area. As you can see, we are growing not just in size (numbers), but in strength (the connections among different institutions). We are very excited to host the 2014 National LMSA Conference in our region and hope that the theme “Creciendo Juntos!” serves as an inspiration for all LMSA Regions and LMSA National organization to look forward to the future together. In this very way, LMSA has overcome myriad hurdles in communication, continuity, name changes, and logo changes spanning groups from around the country. Despite the hurdles, we can be proud that over the years our mission has remained unchanged as the unifying force of our various chapters. By persevering over several years, in 2008 from the alphabet soup of NNLAMS/LMSA/NBLHO emerged the unifying and overarching title, Latino Medical Student Association (LMSA). Best, Giselle Dutcher Co-President, LMSA-Southwest LMSA Southwest On the regional level – the Southwest region of LMSA has historically suffered significantly from a lack of communication and high student officer turnover. These factors among many led to the fragmentation of the Southwest region shortly after the 2007 National Conference and resulted in a loss of communication with the national organization. Though the Southwest contains roughly a Members of LMSA-Southwest at the 2013 GLAS Conference, pictured with keynote speaker Dr. Raul Ruiz. www.lmsa.net L.M.S.A. Journal Caption: 1st LMSA-SW HoD Meeting, November 5, 2011 – Representatives from UT Attendees at “Salud en la Frontera” - the 2012 LMSA Southwest SW, UT San Antonio, Baylor College of Medicine, UTMB, LSU-Shreveport, Texas Regional Conference – proudly wearing LMSA-SW T-shirts! The 2011-2012 A&M, TCOM Executive Board Members are wearing gray LMSA-SW fleeces. Pg 10 www.lmsa.net L.M.S.A. Journal Pg 11 Mentor of the year 2013 Biography of a Great Leader Dr. Phil DeChavez. “ Philip M. DeChavez M.D. M.P.H. was born of humble beginnings. His experience growing up on the west side of San Antonio, Texas was a driving factor in his life, as he both experienced and bore witness to the hardships Latinos face in education and the everyday. After graduating from high school, he enlisted in the Army and served as a combat medic in Operation Desert Storm. The first in his family to attend college, he received his Bachelor’s of Science degree from Morgan State University, graduating Summa Cum Laude as valedictorian. Dr. DeChavez then went on to pursue his medical degree and complete his internship at the University of Pennsylvania. After completing his residency in Family Medicine, he received his Masters of Public Health at Harvard University as a Commonwealth Fund Fellow in Minority Health Policy. Throughout his career, Dr. DeChavez maintained a dedication to helping Latinos in both higher education and the world at large. His commitment to social justice drove him to research and develop educational programs aimed at increasing the number of underrepresented minorities in higher education and grants such as an National Institute of Health study of minority drug use. During his time at Penn, he was influential in the development of the Center for Hispanic Excellence: La Casa Latina, and for his service to the minority community he was awarded the Helen O. Dickens prize. At Harvard, he acted as an Executive Committee Member and Graduate Student Advisor for Concilio Latino, an umbrella organization for Latino associations at the university that provided a forum for these groups to come together and discuss issues critical to Latino students. Dr. www.lmsa.net DeChavez also worked at the Boston Public Health Commission, focusing on the Mayor’s effort to reduce racial and ethnic disparities throughout the city. While serving as Medical Director at MCIFramingham, a medium-security correctional facility for female offenders, he volunteered his time as the primary medical care doctor at the Justice Resource Institute Swansea Wood School, a specialized school serving adolescents who have struggled with significant medical and mental illnesses. Dr. DeChavez is remembered as a champion of the underdog, always rooting for the successes of those who had the world against them and advocating for the voiceless. For more than a decade, he played an active role in LMSA, joining as a medical student and serving as its National Executive Director until his death in 2012. His legacy lives on in those he mentored throughout his life, including middle schoolers, high school students, undergraduates, medical students, and his own brothers and sister. L.M.S.A. Journal Pg 12 www.lmsa.net L.M.S.A. Journal Pg 13 Cultivating Latino Policymakers to Ensure Health Care for By Bryce Spitze, MPH & Orlando Sola, MPH quarter of uninsured Latinos will fall in the dreaded Medicaid Gap, left without access to public or private sources of insurance. How did Latino health advocates allow this to happen? While most contend that politics is politics and compromises must be made, some argue that our representatives merely lack the political fortitude to negotiate the complex issues that affect our patients and their families. Thus, as Latino health advocates, physicians, and concerned citizens, we must promote our patients’ interests by finding brave new leaders. Great potential exists in the thousands of aspiring Latino health professionals rising through America’s schools right now. These are the intelligent, powerful, yet compassionate individuals that have witnessed with their own eyes the effects that poorly conceived policies have on their families. They should be the ones sitting at the negotiation tables. For who could better articulate the injustice of a state rejecting the Medicaid expansion than the daughter of parents who fall into the Medicaid Gap? In light of the recent failures in the ACA, the need for passionate and informed Latino health advocates has never been more apparent. The Latino Medical Student Association is taking this message to With over 53 million in the United States, and more than 50,000 gaining the right to vote each month, Latinos are becoming increasingly influential in the American political sphere. Democrats’ promises of reform in areas ranging from immigration to health care have led to consistent political support from the Latino community. President Barak Obama rode this wave of support through two general elections, signing the Affordable Care Act into law to answer calls for equity in medicine. Yet the minority groups that supported President Obama throughout his political career, Latinos amongst them, have not had their needs met. Even when the law was first signed, the ACA was fraught with exclusions for millions of Latinos. For instance, the issue of undocumented immigrants was so politically charged that they were intentionally left out of the bill. Because of this, even those who earn enough money will not be allowed to purchase a plan in the insurance exchanges. Millions more fully documented Latinos lost their chance at coverage when the Supreme Court decided that the Medicaid expansion was an unlawful coercion of the states. Now, with 21 states rejecting the Medicaid expansion, nearly a www.lmsa.net L.M.S.A. Journal heart and will debut its new Student Policy Section this March in Washington, DC. Students and medical professionals of all ethnicities will meet to provide the networking, mentoring and academic resources necessary to train the future physician leaders of the Latino community. By preparing our youth, Latinos and other marginalized groups can ensure that future health reform in our country will address the still-growing disparities in medicine. Pg 14 www.lmsa.net L.M.S.A. Journal Pg 15 Student Abstracts Prenatal Care for Farmworkers in South Florida J. Mazzurco, OMS-III, M.P.H.(1) S. Zhang, OMS-III(1) M.I. Fernandez, PhD(1) (1) Nova Southeastern University College of Osteopathic Medicine Introduction: In the US, there is an estimated 3 million farmworkers; 22% of which are female, and the majority is of childbearing age (NCFH, 2012). In the Southeast, the greatest number of farmworkers resides in the state of Florida. Due to their working and living conditions, farmworkers are at increased risk of injury and illness. However, numerous barriers lead them to have among the lowest levels of healthcare access and utilization. Lack of accessible health care can be particularly problematic for farmworkers who have increased need for care, such as pregnant women. Lack of adequate and timely prenatal care has been associated with negative maternal and newborn health outcomes. Understanding farmworkers’ experiences in accessing and engaging in prenatal care will advance efforts to promote prenatal care services for this at-risk, understudied population. Celebrate Methodology: A bilingual researcher from the study population recruited 100 farmworker women in community venues. One hundred percent of the eligible women agreed to participate. After obtaining written informed consent, the researcher administered an interview survey consisting of 53 items. The interviewer read each question and answer choices out loud and the participant selected her response, which the interviewer recorded on a paper form. The interview survey explored the experience of female farmworkers with prenatal care during their pregnancy in the past two years. We used past literature to design the interview, which we then pilot tested on farmworker women. Our analysis focused on analyzing timely and adequate prenatal care, and maternal and newborn outcomes. All statistical analyses were done using SPSS version 20. The research protocol was approved by NSU IRB. Results: The majority (97%), of participants entered prenatal care during the first trimester of their pregnancy, and (90%) received 5-10 or 5-15 prenatal care visits. Support for prenatal care was provided by emergency Medicaid. Only 3% of women paid out-ofpocket for their prenatal care. Only 7% of women had problems during delivery, including anemia, and excessive hemorrhage. In addition, 94% of participants delivered their babies vaginally. None of the babies were of low birth weight and none died during childbirth . Conclusion: Overall, the majority of our participants received adequate and timely prenatal care. Furthermore, the majority of participants experienced positive maternal and newborn outcomes. Our results differed from previous studies that found a lack of adequate prenatal care for farmworker women, and high percentages of negative health outcomes. Our positive outcomes may be in a large part attributed to the availability of emergency Medicaid that allowed participants to access prenatal care services. These results point to the importance of maintaining and enhancing these programs to help ensure that all pregnant women have access to prenatal care. National Center for Farmworker Health [NCFH]. (2012). Farmerworker Health FactSheet. Retrieved October 28, 2012, from http:// www.ncfh.org/docs/fs-Migrant%20Demographics.pdf At Johns Hopkins Bayview, we believe that diversity creates strength. By fostering a diverse and inclusive culture “The heart of Bayview throughout the program and will remain in every the medical center, we attract resident who has the best and brightest trained here.” students from all walks of life, and help them become healers - Linda Mobula, M.D. Class of 2011 and leaders in medicine. Along the way, they build relationships with faculty, staff, and other residents that last a lifetime. We hope you’ll take the opportunity to talk to our residents and learn more for yourself. Please visit our website at http:/www.hopkinsmedicine.org/jhbmc/imresidency or call 410-550-0526 for more information. Training Healers and Leaders in Medicine www.lmsa.net L.M.S.A. Journal Pg 16 www.lmsa.net L.M.S.A. Journal Pg 17 HIV/AIDS Care Delivery in Dominican Republic – The Need for Capacity-building Felipe Cameroamortegui1, Pamela Castro1, Altagracia Nolascoc3, James R. Hillard124., Reza Nassiri12 College of Osteopathic Medicinea1 , Institute of International Health2, Michigan State University, East Lansing, Michigan, USA; Municipal Hospital of Boca Chica – Centro Atencion Integral de VIH/SIDA, Boca Chicac, Dominican Republic3; College of Human Medicine4, Michigan State University Introduction: The United Nations estimates the HIV /AIDS prevalence in the Caribbean is the second highest in the world after SubSaharan Africa. 75% of these cases reside in Dominican Republic and Haiti. The epidemic seen in the country reflects a complex interplay of factors such as socioeconomic, health disparities, unsafe sexual practices, lack of health education and geographic proximity to Haiti. The prevalence of HIV/AIDS in Haiti is almost three times that of the Dominican Republic. HYPOTHESIS: Identification implementation. of gaps and organizational capacity building would contribute to the impact of HIV care delivery Methods: In this study, we designed questionnaires which were used for 52 HIV outpatients and 15 healthcare providers. The objectives of such questionnaires were to identify barriers and obstacles perceived by various healthcare professionals in the delivery of HIV/AIDS medical care. The study was conducted at the Boca Chica Clinic located in Dominican Republic. Boca Chica is known in the country for having the highest prevalence of HIV/AIDS in the Dominican Republic primarily through sex workers and drug abuse. Results: Our results indicate that lack of transportation, the number of clinic service hours, and long waiting time were some of the urgent issues that patients were confronted with. Conversely, our data shows that in the same clinic, only 43% of providers were aware of national HIV programs aimed at collecting HIV data and 14 % were not aware of the existence of these programs at all. Even though the resting 43 % were aware, they lacked knowledge of how these programs worked and the services they provided. Conclusion: We concluded that geographical distances, lack of resources, and limited amount of hours of operation offered by the clinic were some of the key capacity-building issues. Furthermore, our observation indicates lack of effective implementation programs add to the complexity of HIV care services in the community of Boca Chica. Our study warrants a more robust national policy and implementation in the Dominican Republic to enhance capacity-building in HIV/AIDS care delivery. Role of Inflammasome Components in Innate Immune Response Against T. cruzi Infection in Chagasic Cardiomyopathy Patients Effectiveness of Using Non-Clinicians in Delivering a Brief Smoking Cessation Intervention in the Emergency Department Maria Dueñas BS, Ashley Colucci BS, Renee Fruchter BS, Ellie Grossman MD MPH Primary Author Status: 4th year Medical Student Background: Tobacco remains the leading preventable cause of morbidity and mortality. Prior studies have shown that Emergency Department (ED) patients typically smoke at rates exceeding that of the general population, are interested in quitting and often have limited access to primary care. However, a busy ED can be a difficult setting to implement preventive-health interventions. In this study, we describe a pilot initiative using non-clinician volunteers to deliver a brief smoking cessation intervention to ED patients who smoke. Methods: We trained a cohort of college-aged volunteers to assess adult patients for use of tobacco products in the Bellevue Hospital ED and proactively refer interested smokers to the NYS Quitline. All patients were offered printed information about resources to help them quit smoking. We collected information about the number of patients approached, the number who reported using tobacco and nicotine products, and acceptance of referral to the Quitline. We collected follow-up reports from the NYS Quitline and also attempted to contact all smokers at least once via phone approximately one month after ED visit. These follow-up reports provided information about use of smoking cessation pharmacotherapy, quit attempts, and smoking status. Results: During the two-month intervention period in summer 2013, we screened 1550 adult patients for tobacco use. Of those screened, 414 (26.7%) had used tobacco in the past 30 days. 353 smokers filled out an intake form; of these, 69.9% were male, 29.8% female and 0.3% transgender. Mean (±SD) age was 42.8 years (±13.1). Among these smokers, English (84.3%) and Spanish (8.5%) were the preferred languages. Nicotine product use included cigarettes (94%), electronic cigarettes (8.5%), cigars (6.9%), and pipes (1.9%). Among cigarette users, 40.3% reported smoking <5 cigarettes/day, 31.8% 5-10 cigarettes/day, 20.3% 11-20 cigarettes/day, 4.9% 21-30 cigarettes/day and 2.6% >30 cigarettes/day. 133 (32.1%) completed a fax-to-quit referral form for the NYS Quitline. The NYS Quitline reported follow-up data for 101 patients, and of these, 26 (24.8%) had completed a Quitline telephone encounter. The Quitline reported that 15 (57.7%) had already quit smoking, 9 (34.6%) wanted to quit smoking and 2 (7.7%) were not ready to quit yet. Our program reached a total of 86 patients for 1-month follow-up, and 51 (59.3%) reported tobacco use within last 7 days while 31 (36%) claimed abstinence. Fifty patients reported a quit attempt lasting longer than 24 hours since their ED visit. Conclusions: Trained volunteers are able to deliver a brief smoking cessation intervention in the ED and can feasibly refer patients to the NYS Quitline. This brief intervention, consistent with evidence-based guidelines for tobacco dependence treatment, is acceptable to patients undergoing treatment in a busy urban safety-net hospital ED. HG Mendoza1, N Dey1, MP Zago2, S Nunez3, X Wan1, NJ Garg1, 4 1Department of Microbiology and Immunology,2IPE- CONICET-UNSa,3Servicio de Cardiología, Hospital San Bernardo, Salta, Argentina,4Faculty of the Institute for Human Infections and Immunity, Center for Tropical Diseases and Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston TX. (956) 371-5252 [email protected] Chagas disease caused by T. cruzi is endemic in Latin America and an emerging disease in the US and other developed countries. The clinical course of the disease can be broadly categorized into three stages— Initial, Intermediate, and Chronic. Chagas disease pathogenesis has previously been shown to be associated with inflammatory responses including ROS production. In this study, we exam- ined key events related to innate immune responses in Chagasic patients. Previously, RNA isolated from T. cruzi infected macrophages was used to profile the expression of 84 key genes involved in innate immunity as well as in toll-like and NOD-like receptor signaling by RT-PCR arrays (QIAGEN Inc., CA).Twelve genes expressing inflammasome components (AIM2, NLRP3, NLRC5), toll-like receptors (TLR2,TLR9), adaptor molecules (MYD88), cytokines or chemokines (TNF-α, IL1-β, CCL2, CXCL1, CXCL2), and cellular transcription factors (NFκB-1A) were selected based on the results of the RT-PCR arrays for further analysis in Chagasic patients. Real Time PCR was performed to quantify differential expression of these selected genes in peripheral blood mononuclear cells (PBMCs) isolated from patients in various stages of Chaga’s disease along with PBMCs isolated from normal healthy individuals. We saw an upregulation of gene expression of various receptors, transcription factors and inflammasome components during the later stages of Chagas disease. However, due to the small pool of patients used in this project, it is difficult to generate a definite statement regarding differential gene expression in specific stages of Chagas disease. www.lmsa.net L.M.S.A. Journal Pg 18 Localization of the Virulence Regulator AtxA in Bacillus anthracis Cells Joaquin A. Villegas Inurrigarro, Theresa M. Koehler, PhD Department of Microbiology and Molecular Genetics, UTHSC at Houston Bacillus anthracis is a spore-forming Gram-positive bacterium that resides in soil but can cause anthrax disease upon entry into mammal hosts. The anthrax toxin proteins are critical virulence factors of the bacterium. Transcription of the toxin genes requires the trans-acting regulator AtxA (anthrax toxin activator). Ongoing studies of AtxA function suggest that protein activity is controlled by the phosphoenolpyruvate: carbohydrate phosphotransferase system (PTS), a system used by many bacteria for sugar uptake. The central amino acid sequence of AtxA is comprised of putative PTS-regulatory domains that are thought to be phosphorylated by the PTS. The carboxy-terminal region of AtxA shows amino acid sequence similarity to protein EIIB. EIIB is a component of the PTS that is well-studied in the non-pathogen B. subtilis. EIIB in B. subtilis and other bacteria is membrane-associated, and part of the sugar permease complex. I hypothesized that AtxA associates with the membrane via its EIIB domain. I investigated the localization of AtxA using direct fluorescence microscopy and immunofluorescence microscopy. To asses AtxA localization, I constructed a B. anthracis strain carrying a recombinant gene encoding a green fluorescent protein (GFP)-tagged AtxA. Unfortunately, AtxA activity assays showed that the GFP-AtxA protein was inactive. Also the recombinant protein formed inclusion bodies within cells. I also attempted to detect His- and Flag-tagged AtxA proteins using immunofluorescence microscopy. However, the fluorescence of cells expressing these proteins was indistinguishable from background fluorescence. In future studies, we will use anti-AtxA antibody and/or try an alternative imaging protocol. www.lmsa.net L.M.S.A. Journal Pg 19 Cost analysis of retrospectively identified cohort of patients Melissa Esparza; Daniel Beckerman (UC Berkeley); S. Samuel Bederman, MD PhD FRCSC (UC Irvine); Matt Callahan, MSBA; Serena S. Hu, MD; Shane Burch, MD; Vedat Deviren, MD; Bobby Tay, MD; Praveen V. Mummaneni, MD; Dean Chou, MD; Christopher P. Ames, MD; Sigurd H. Berven, MD University of California, San Francisco Objective: The purpose of this paper is to analyze the determinants of direct costs for single-level lumbar fusions and to identify potential areas for cost reduction. Background: Health care expenditures for the diagnosis and treatment of spine conditions are increasing more rapidly than other areas of health expenditures. There is high variability in the cost and surgical management of spine pathologies. Methods: Adult patients who underwent primary single-level lumbar fusion between fiscal years 2008-2012 met inclusion criteria. Patients were excluded if they underwent multiple surgeries, corpectomy, kyphectomy, disc replacement, surgery for tumor or infection, or had incomplete cost data. Demographic data, clinical data, and direct cost data in the categories of supplies, services, room and care, and pharmacy, were collected for each patient. Analysis of variance was performed to compare differences in costs between the five surgical approaches utilized. The Tukey Honest Significant Difference method was used to perform pairwise comparisons between approach types. Results: The cohort included 532 patients. Direct costs ranged from $8,286-$73,727 (median=$21,781; mean=$22,890 ± $6,323). Surgical approach was an important determinant of cost. The mean direct cost was highest for circumferential fusions and lowest for cage-less posterior spinal fusions. The difference in mean direct cost between transforaminal lumbar interbody fusions, anterior lumbar interbody fusions, and lateral transpsoas fusions was not statistically significant. Surgical supplies were the highest category of spending, accounting for 44% of direct costs. Spinal implants were the primary component of supply costs. Comorbidities were an important contributor to variability in cost. Conclusion: The costs of spinal surgery are highly variable. Important cost-drivers in our analysis included surgical approach, implants, operating room time, and length of hospital stay. Areas of high cost and high variability offer potential targets for cost savings and quality improvements. Literature review of cost-effectiveness analyses of new technologies in spine surgery Melissa Esparza, BA; Serena S. Hu, MD; Shane Burch, MD; Todd Lansford, MD; Sigurd H. Berven, MD University of California, San Francisco Objective: The purpose of this article is to present the concept of economic evaluation of new technologies in spine surgery as a factor to guide an evidence-based approach for their consideration for adoption into clinical practice. Summary of Background Data: The adoption and implementation of new technologies is a primary driver of the increasing rates of spending in spinal care. New technologies should be assessed by their ability to optimize value by improving outcomes or reducing costs over time. Methods: The literature was reviewed for economic evaluations of new technologies in spinal care. Four areas were chosen for further review: 1) circumferential versus posterolateral spinal fusions; 2) total disc replacement versus arthrodesis for degenerative disc disease; 3) bone morphogenic protein versus autograft in spinal fusions; and 4) vertebroplasty for osteoporotic vertebral compression fractures. Results: Cost-utility analysis shows circumferential fusion to be dominant over a posterolateral approach in that it was more effective and less costly over time. The value of bone morphogenic protein compared to iliac crest bone graft, and of lumbar and cervical total disc replacement compared to fusion, remains inconclusive and may vary with respect to patient demographics and cost calculations. A lack of sustainable outcomes with the use of vertebroplasty indicates that it is not a value-adding intervention for the treatment of osteoporotic vertebral compression fractures. Conclusions: The adoption of new technologies in spine surgery should be guided by evidence showing that the technology adds value to our health care system by significantly improving outcomes or decreasing costs over time. www.lmsa.net L.M.S.A. Journal Pg 20 TTUHSC at El Paso is seeking Board Certified Physicians in the area of Emergency Medicine to become part of its team of professionals. The Department of Emergency Medicine staffs the Emergency Room of University Medical Center El Paso, a level one-trauma center with approximately 60,000 visits annually. The department also assists in training medical students from the TTUHSC Paul L. Foster SOM. Appointments will be at the Instructor level, or above, as deemed appropriate. Please contact Christine Carbajal at 915-215-4609 or [email protected] for more information. www.lmsa.net L.M.S.A. Journal Pg 21 Evaluation of Risk Factors related to Non-communicable Diseases in Adult Community of Escondido, Bani Municipality in November 2011-January 2012. Iván Ramírez De Oleo , David Vargas Mena Dr. López Emilton Escuela De Medicina, Instituto Technologico de Santo Domingo Introduciton: The profile of the disease throughout the world is changing at an amazingly fast pace, especially in low and middle income. The old notions about the nature of chronic disease, its incidence, risk factors and underlying risk populations are no longer valid. The spread of non-communicable chronic diseases (NCD) is a global crisis. In almost all countries and in all income groups, men, women and children are at risk of these diseases. Methodology: The study was descriptive, prospective and cross-sectional, population is adults between 45-64 years of age. A protocol for data collection, which was applied to 100 persons who met the inclusion criteria, which were chosen at random was used. Results and conclusions: There was a 71% physical inactivity in the community. 59% of people had a body mass index above normal values , of which 30% were overweight. 34 % had a medical history of hypertension, and 10% of diabetes. 14% of the sample smoked. 88% of men had not have a rectal exam for the diagnosis of prostate cancer, 67 % of women had not have mammogram and 47% had not have a Pap test. Daily consumption of fruits and vegetables was 25 %. Students for a Better Healthcare System (SBHS): Educating the general public on the Affordable Care Act. Matt Meizlish, Priscilla Wang, Lorenzo Sewanan, Sean Maroongroge, Kyle Ragins, Giulio Rottaro Yale School of Medicine BACKGROUND / SPECIFIC AIMS: The success of current health care reform depends upon quality information reaching those who can benefit most. Students for a Better Healthcare System (SBHS) is a campaign started by Yale medical students, mobilizing students around the country to engage their communities on issues of health care reform. We have three major goals: (1) to explain the context and content of the Affordable Care Act (ACA) and connect community members with opportunities to enroll in health insurance, (2) to begin a broader dialogue about health care reform, and (3) to develop a nationally replicable campaign model. METHODS: (1) Developing 25-minute, visually appealing, accessible presentations, one tailored to community members and one to health care providers, and accompanying English/Spanish informational flyers. (2) Forming community partnerships and delivering interactive presentations in settings like community colleges, churches, and hospital staff meetings. (3) Working with health officials and providers to connect patients with enrollment opportunities. (4) Expanding this campaign to other universities. COLLAGENOUS GASTRITIS: AN UNUSUAL PRESENTATION Anup Shah B.S., Gilad Birnbaum BA, F. Lyone Hochman M.D. – Baylor College of Medicine Case Report: A 67 year old African American female with history of GERD, COPD, diabetes, hypertension, hyperlipidemia and anemia complains of one month nausea and vomiting with meals, dark stools, weakness and mild weight loss. She denied fever, night sweats, abdominal pain, or change in bowel movements. Her symptoms improved with Prilosec and vomiting. Patient has a history of gastric ulcers and cholecystectomy eight years prior. Recent colonoscopy was negative. Family history is significant for father with colon and lung cancer and mother with breast cancer. Examination was significant for epigastric tenderness. CT was unremarkable and EGD showed diffuse inflammation but unlike the typical antral gastirits, the fundus was most severely affected demonstrating severe hemorrhage and nodularity. Biopsies showed thick collagenous bands within the subepithelium as well as significant inflammatory infiltrate in the lamina propria consistent with the rare diagnosis of collagenous gastritis. Biopsies were negative for H.pylori, intestinal metaplasia, or malignancy. Patient was initially started on prednisone and was switched to oral budesonide. Patient reported weight gain and significant improvement of her symptoms. Discussion: Collagenous gastritis was first described in 1989 and since then there have been less than 40 reported cases in the literature, with a majority in the pediatric population. (1) Collagenous gastritis is a histological diagnosis characterized by thick subepithelial collagen bands (>10 µm) and infiltration of inflammatory cells in the lamina propria. (2) There are two phenotypes of collagenous gastritis described in the literature. The pediatric phenotype is localized to the gastric mucosa and presents with anemia, abdominal pain and gastric mucosal nodularity; The adult phenotype is complicated by collagenous colitis and therefore presents as chronic watery diarrhea. (3) Our patient appears to be the first case describing an adult patient presenting with the pediatric phenotype. The patient had a history significant for anemia and epigastric tenderness but no evidence of collagenous colitis. Our patient’s weight loss and symptoms improved with steroid therapy. (4) The long term course and prognosis of collagenous gastritis is still unknown and it may be of great interest for these patients to undergo regular follow up and testing. References: Clinical outcome of pediatric collagenous gastritis: case series and review of literature. Hijaz NM, Septer SS, Degaetano J, Attard TM. World J Gastroenterol. 2013 Mar 7;19(9):1478-84. Matsumoto Y, Kurahara K, Ooshiro Y et al. Collagenous gastritis in a young Japanese woman, report of a case. Stom. Intest. 2011; 46 (9): 1389-96 Lagorce-Pages C, Fabiani B, Bouvier R, Scoazec J-Y, Durand L, Flejou J-F. Collagenous gastritis: a report of six cases. Am J Surg Pathol. 2001;25:1174-1179 Wang HL, Shah AG, Yerian LM, Cohen RD, Hart J., Collagenous gastritis: an unusual association with profound weight loss., Arch Pathol Lab Med. 2004 Feb;128(2):229-32. RESULTS / CONCLUSIONS: We have delivered presentations to over 500 people in New Haven, receiving excellent feedback (98% of 52 post-presentation survey participants felt the ACA would benefit them). We have developed systems to connect uninsured patients in local clinics with trained enrollment “Assisters”. We’ve also begun expanding our campaign to student groups nationwide interested in using our resources and model to mobilize their communities. We look forward to working with our new partners toward a better American health care system, one community and one conversation at a time. www.lmsa.net L.M.S.A. Journal Pg 22 www.lmsa.net L.M.S.A. Journal Pg 23 IDENTIFYING NOVEL COMPLEXIN INTERACTIONS THROUGH FORWARD GENETICS. Francesco E. Michelassi and Jeremy Dittman. Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Graduate School of Medical Sciences, New York, NY, 10021. Tightly regulated neurotransmitter release is crucial for a functioning nervous system. Release occurs when vesicles filled with neurotransmitter fuse to the presynaptic plasma membrane, a process that is driven by the SNARE proteins. The small protein complexin (CPX-1) regulates vesicle fusion by binding to the SNARE proteins to inhibit spontaneous neurotransmitter release. Biochemical methods have identified the ternary SNARE bundle as the only binding partner of CPX-1, while genetic and physiological evidence suggests that CPX-1 may have interactions with other proteins. In order to find transient, low affinity binding that may not be apparent by traditional biochemical methods, this study uses a forward genetics screening approach in Caenorhabditis elegans to identify novel CPX-1 interactions in vivo. CPX-1 knockout worms (cpx-1) paralyze rapidly in the presence of acetyl cholinesterase inhibitors. cpx-1 worms are mutagenized with either EMS or ENU, and their F2 progeny are immersed in aldicarb, an acetyl cholinesterase inhibitor. F2 worms that continue to move in the presence of aldicarb, demonstrating the acquisition of mutations counteracting the cpx-1 phenotype, are selected and cultured. Selected worms are exposed to levamisole, an agonist of the worm acetyl choline receptor to identify and exclude worms with mutations in the post-synapse. Mutations in the genome resulting in pre-synaptic changes are located with Snip-SNP mapping, and implicated genes are sequenced. One of the hits from our screen, tau1, appears to be a mutation in UNC-13, a synaptic protein that is known to interact with many partners, including one of the SNARE proteins, syntaxin. These results suggest that CPX-1 and UNC-13 function in the same pathway at the synapse, though more research is required to determine if they interact with each other. New Jersey Personal Responsibility Education Program (NJ PREP): Decreasing Pregnancy and Sexually Transmitted Infections (STIs) in Teens Karen Grisales Omara Cardoza Kean University, Department of Physical Education, Recreation and Health OBJECTIVE: This study evaluated the longitudinal effectiveness of the program “Reducing the Risk - Building Skills to Prevent Pregnancy, STD and HIV”, an evidence based program designed to decrease adolescent pregnancy and sexually transmitted infections in two New Jersey State identified, high risk municipalities. METHODS: During the 2012- 2013 academic year, the curriculum was implemented in health classes with ethnic minority college research assistants co-facilitating the lessons with the health teachers. A cohort of 283 predominantly ninth grade students participated in the program. Participants completed baseline, post- and 3- month follow-up surveys. The study used randomized control and intervention groups of students in the two high schools in New Jersey. RESULTS: By the end of the 2012-13 academic year, 130 participants completed the Reducing the Risk Knowledge Survey before and after the program. The average score prior to the program was 61.2. After the program, the average score was 71.3. This change indicated that the participants knowledge significantly increase at a .001 level. 91% percent of program participants who reported being sexually inexperienced at baseline reported they’ve continued to delay initiation of sexual intercourse after program completion. 95% percent of our program participants who reported being sexually inexperienced at baseline reported they’ve continued to delay initiation of sexual intercourse 3 months after program completion. 39% percent of our program participants who reported being sexually active at baseline reported abstaining from sexual activity during the 3 months following program participation. CONCLUSION: Overall, the Reducing the Risk program was effective in presenting a strong and active approach in reducing the risk to teenage pregnancy and protecting against HIV and other STDs. The program was more effective in delaying sexual debut with 9th graders than with 11th graders. Further research is needed to determine what strategies are successful in delaying sexual debut with upper classmen. www.lmsa.net L.M.S.A. Journal Pg 24 High occurrence of gastrointestinal problems in Puerto Rican male patients with Hermansky-Pudlak Syndrome Oscar Alejandro García1; Stephanie Bermúdez1; Edwin P. Campoverde1; Paloma R. Sánchez1; Verόnica Santiago1; Leslie Seijo1; Karen R. Velarde1; Enid Rivera, MD2; Mόnica Santiago, MD3; Donna Appell4; Irvin Maldonado1. Department of Biomedical Sciences and Research, San Juan Bautista School of Medicine, Caguas, Puerto Rico1; Professor and Director of Hematology and Oncology, Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, Puerto Rico2; Hematology and Medical Oncology Department, San Juan City Hospital, San Juan, Puerto Rico3; Founder and President of Hermansky-Pudlak Syndrome Network, New York, New York.4 Introduction: Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disorder that results in oculocutaneous albinism, platelet abnormalities, as well as ceroid accumulation in different organs. HPS occurs globally at an estimated prevalence of 1:500,000 to 1:1,000,000 in the non-Puerto Rican population. In Puerto Rico, HPS is notably more frequent with approximately 1 of every 22 people carrying the gene and a prevalence of 1:1,800 in the Northwestern region. Methodology: In this pilot study, we conducted a survey in the Northwestern area of Puerto Rico to investigate the different initial symptoms experienced among HPS patients. A total of 47 patients were surveyed: 26 females, 21 males. Results: Our study shows that HPS patients may experience several gastrointestinal (GI) symptoms such as inflammatory bowel disease, irritable bowel syndrome and gastroesophageal disease. Approximately 38% (n=17) of the patients from this population presented with gastrointestinal symptoms as an initial symptom. The data demonstrated that 48% of males (n=10) experienced GI problems as an initial symptom as opposed to 19% of females (n=5). Males were 2.5 times more likely to present with GI symptoms than females. Additionally, males presented a higher recurrence of GI symptoms as opposed to females (52% vs. 27%). Conclusion: Our results suggest that males with HPS in the Northwestern region of Puerto Rico have a higher tendency to present and persist with GI complications than females. In the future, we plan to expand our survey to a larger number of HPS patients in order to obtain statistically significant results. Similarly, it would be helpful to identify why some HPS patients do not present with GI complications. Continuous Renal Replacement in Pediatric Patients with Acute and Acute-on-chronic Liver Failure Keila De La Garza, Alyssa Riley, Poyyapakkam Srivaths, Carolyn Smith, Mary N Watson, Amelia Allstead, Helen Currier, Ayse Akcan Arikan Baylor College of Medicine Acute and acute-on-chronic liver failure (LF) can lead to multiple organ failure and associated acute kidney injury (AKI) requiring renal replacement (CRRT) therapy in the pediatric population. AKI in LF is multifactorial; common etiologies are hepatorenal syndrome, nephrotoxic medications, abdominal compartment physiology, and intrinsic renal dysfunction. The natural progression of this disease process is detrimental with high mortality despite maximum support. We retrospectively reviewed charts of patients with LF who received CRRT for primary or secondary LF-related complications from 2011-2013 at our institution. There were 45 patients, 31 % were male; mean age was 6.7 ± 7.2 years. 19 of 45 patients (42%) were less than 2 years old. All patients were mechanically ventilated and mean length of ventilation was 19.2 ± 14.5 days. The mean length of hospital stay was 52.8 ± 44.5 days. 64% received at least one vasoactive amine. CRRT was provided as continuous venovenous hemodiafiltration (CVVHDF). Blood-primed circuits were used in all patients weighing less than 15 kg. Regional anticoagulation with citrate was used for all stand-alone CRRT. Median length of CVVHDF was 9 days (IQR 5, 20). 28 patients died (62%). Eleven patients received intermittent hemodialysis as well as CRRT, 6 of these were converted to IHD at PICU discharge, three patients liberated from IHD and one patient remained IHD dependent at hospital discharge. The two other patients who are IHD dependent are still in-house. All of the patients who required IHD at PICU discharge were less than 2 years old. The average percent fluid overload (FO%= total fluid in-total fluid out/PICU admission weight) was 21.3 ± 19% at CRRT initiation. Nine patients had a FO %> 25%, 6 of these died and the other three remained IHD dependent at PICU discharge. Only 19 patients had complete information available regarding citrate toxicity, of these, seven were noted to have “citrate lock” by nephrologists in the charts. Common interventions were decreasing citrate dose, increasing diffusive clearance, and transiently stopping citrate (2 patients). No treatments were interrupted because of citrate toxicity. LF-related AKI requiring CRRT has a very high mortality and high morbidity. Younger cohort of patients makes CRRT treatment technically challenging and may necessitate further IHD at PICU discharge. Long term close follow-up of these patients is essential. Regional citrate anticoagulation seems safe in this population although further studies are needed. www.lmsa.net L.M.S.A. Journal Pg 25 Discovering Regulators of Tumor Antigen Presentation on Major Histocompatability Complex I Elliott Brea12, Eusebio Manchando Robles1, Qing Xiang1, Ron Gejman12, Ralph Garippa1, Scott Lowe1, David A. Scheinberg12 1, Sloan Kettering Institute, New York, NY 10065 2 Weill Cornell Medical College, New York, NY 10065 together we build a brighter future. Specific immunotherapies for cancer continue to gain interest as effective therapeutic strategies. A number of intracellular T cell epitopes have been identified as potential therapeutic targets in cancer. However, the mechanisms underlying the presentation of tumor antigens are poorly understood and difficult to regulate. Another limitation of targeting these tumor antigens with therapies such as adoptive T-cell therapies, CAR therapy, tumor vaccines, or TCR-like antibodies is the limited cell surface presentation of tumor antigens on major histocompatibility complex molecules (MHC-I,) which may limit their clinical efficacy. We propose that genes involved in epitope presentation can be discovered in a loss of function screen using specific antibodies to MHC-I and a TCR-like antibody targeting a model tumor antigen (the intracellular oncoprotein WT1). ESK1 is a new monoclonal antibody that detects a nine amino acid peptide derived from WT1 that is presented in the context of HLA-A02 on the cellular surface. Utilizing a pooled RNAi knockdown screen, genes leading to alterations in HLA-A02 expression in a WT1 positive/HLA-A02 positive human mesothelioma cell line have been identified. Preliminary hits have been validated to confirm previously published data on regulators of MHC-I; novel gene products were also discovered. Using a TCR-like antibody can be a powerful tool for identifying regulators of antigen presentation, which can have broad implications in multiple diseases with pathophysiology related to antigen presentation, including cancer, autoimmune disease, and infectious disease. Our vision is an ambitious one… to end disparities, help everyone get the care they need, Clinica Tepati: Establishing A Preventive Care Model in Diabetes Care and Management and make better health a reality for all. Alberto F, Mayorquin MD P, Orozco M, Fancher MD MPH TL UC Davis School of Medicine Background: Though national policies have increased access to insurance, student-run free clinics remain integral in providing care for the poor and uninsured. Today there are over 110 clinics that currently operate across the United States; yet, little data exists on the quality of care being delivered at such sites. Since 1979, Clinica Tepati in Sacramento has been offering primary care to the uninsured Latino community. Staffed with UC Davis Medical students, undergraduate volunteers and physician-volunteers, Clinica focus includes diabetes management. Objective: The aim of this study to assess the extent to which Clinica Tepati meets national 2012 Health Effectiveness Data and Information Set (HEDIS) standards for outpatient diabetic care. Method: In a retrospective chart review, diabetes management was assessed by comparing quality-of-care indicators such as Blood Pressure, HBAIC Screening and control, LDL Screening and control nephropathy screening, retinopathy referrals and foot exams. Results: Clinic rates of such diabetes quality-of-care indicators ranged from 30% to 99%, Areas of strength include Clinica’s screening in HBAIC, LDL, Retinopathy, Nephropathy, and Foot Exams. Areas for improvement include management of HBA1C, LDL, and smoking cessation. Conclusion: Challenges to improving these areas include the yearly turnover of medical volunteer positions, and increase training of future physicians in managing obesity and chronic disease. To overcome these challenges, strategies to introduce new diabetesspecific checklist into Clinica’s Electronic Medical Records may strengthen weaknesses at Clinica. Kaiser Permanente Residency & Fellowship Programs ALLERGY, CARDIOLOGY, COMMUNITY MEDICINE, DIAGNOSTIC RADIOLOGY, ELECTROPHYSIOLOGY, EMERGENCY MEDICINE, FAMILY MEDICINE, GASTROENTEROLOGY, GERIATRICS, GLOBAL HEALTH PROGRAM, HOSPICE PALLIATIVE CARE, INTERNAL MEDICINE, INTERNAL MEDICINE/MPH, INTERNAL MEDICINE/PREVENTATIVE MEDICINE, NEPHROLOGY, NEUROLOGY, OB/GYN, OTOLARYNGOLOGY, ORTHO SPORTS MEDICINE, PEDIATRICS, PODIATRY, PSYCHIATRY, RADIATION ONCOLOGY, SPORTS MEDICINE, SURGERY, UROLOGY Clerkships are available in various specialties and locations. Learn more at residency.kp.org Follow us on Twitter www.lmsa.net L.M.S.A. Journal Pg 26 www.lmsa.net 2 Find us on Facebook L.M.S.A. Journal Pg 27 Toxicity in the City of Angels: Environmental Health Disparities in South Los Angeles Progression of Vasculopathy in Children with Sickle Cell Disease and Abnormal Transcranial Doppler Ultrasonography: Rates and Predictors Ernesto Villaseñor, Jr., Abby Kinchy , Kim Fortun Science and Technology Studies Department, Rensselaer Polytechnic Institute Exposure to toxic pollution has been exacerbated throughout many communities in the US as a result of development, but garner less attention in low-income, inner-city communities. Research suggest that exposure to a polluted environment results in poor health outcomes. Research also suggest that poor health outcomes are a result of lack of education in addition to not having sufficient access to health resources. As we can see, it is not a single issue that contributes to poor health outcomes, but the intersections among them. Los Angeles County is not immune to these issues: numerous cases have indicated a disproportionate burden on already disadvantaged minority populations who are affected by other psychosocial stressors in the South and Eastern part of LA County. This study looked at the intersectional root causes behind environmental health disparities as caused by industry development and presence in South and East LA County. The Exide Technologies Battery Plant case that is ongoing in LA County was used as a case study to understand environmental health, justice, and pollution by the affected members of the community. This study included, but was not limited to, the following: a literature review of environmental health disparities in South LA; developing a new definition of environmental justice and health, in addition to how members of the affected communities understood environmental health inequalities; looking at the failures to include important markers of toxic pollution/environmental inequalities in the findings/policy development of asthma/respiratory illnesses and other chronic diseases by government agencies in LA County; and the history of the environmental justice movement among vulnerable communities in LA County. High occurrence of gastrointestinal problems in Puerto Rican male patients with Hermansky-Pudlak Syndrome Oscar Alejandro García1; Stephanie Bermúdez1; Edwin P. Campoverde1; Paloma R. Sánchez1; Verόnica Santiago1; Leslie Seijo1; Karen R. Velarde1; Enid Rivera, MD2; Mόnica Santiago, MD3; Donna Appell4; Irvin Maldonado1. Department of Biomedical Sciences and Research, San Juan Bautista School of Medicine, Caguas, Puerto Rico1; Professor and Director of Hematology and Oncology, Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, Puerto Rico2; Hematology and Medical Oncology Department, San Juan City Hospital, San Juan, Puerto Rico3; Founder and President of Hermansky-Pudlak Syndrome Network, New York, New York.4 Introduction: Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disorder that results in oculocutaneous albinism, platelet abnormalities, as well as ceroid accumulation in different organs. HPS occurs globally at an estimated prevalence of 1:500,000 to 1:1,000,000 in the non-Puerto Rican population. In Puerto Rico, HPS is notably more frequent with approximately 1 of every 22 people carrying the gene and a prevalence of 1:1,800 in the Northwestern region. Methodology: In this pilot study, we conducted a survey in the Northwestern area of Puerto Rico to investigate the different initial symptoms experienced among HPS patients. A total of 47 patients were surveyed: 26 females, 21 males. Tatiana M. Villatoro1, Janet Kwiatkowski2, Deirdra Terrell3 San Juan Bautista School of Medicine1, The Children’s Hospital of Philadelphia2, The University of Oklahoma Health Sciences Center 3 Background: Children with sickle cell disease (SCD) and an abnormal transcranial Doppler (TCD) ultrasound have a high risk of stroke. Chronic transfusion therapy decreases the risk of stroke; however, some children have continued progression of cerebral blood vessel narrowing and/or silent cerebral infarcts despite treatment. Objective(s): To study the rate of progression of silent infarcts (by magnetic resonance imaging- MRI) and cerebral vessel stenosis (by magnetic resonance angiography- MRA) in children with SCD and abnormal TCD and to identify potential risk factors for progression of cerebral blood vessel stenosis and/or silent infarcts. Data and Methods/Skills Learned: A cohort study with both retrospective and prospective components of subjects with SCD-SS or Sbeta0 thalassemia and abnormal TCD from the Children’s Hospital of Philadelphia Sickle Cell Center was performed. Medical and laboratory information was obtained from patient charts and all magnetic resonance imaging (MRIs) and angiography (MRAs) reports were reviewed. MRI was classified as abnormal if silent infarct(s) were present and MRA as abnormal if stenosis or occlusion of any vessels was present. Presence or absence of progressive changes and time to progression were recorded. T-tests and chi-square analyses were used to explore potential factors associated with progression. Results: Twenty-seven children with mean age 7.82 years (range 2.86 to 16.90 y) at diagnosis of abnormal TCD were studied. The mean highest qualifying abnormal TCD velocity was 213 cm/s, (median 208 cm/s, range 200 to 241 cm/s). Of 27 patients, 4 (15%) had an abnormal baseline MRI, 3 (11%) had an abnormal baseline MRA, 13 (48%) had both abnormal baseline MRI and MRAs, and 7 (26%) had normal baseline MRI and MRAs. Of 26 subjects with follow-up studies, the average follow-up time was 7.78 years (median 7.61 y, range 3.54 to 12.99 years). The mean number of follow-up MRI/A per subject was 5 (range 0 to 9). 17 participants (65%) showed progression of cerebral vasculopathy or infarcts at a mean time of 4.49 years (median 4.02 y, range of 0.35 to 9.29 years) after starting transfusion treatment. Of the 17 who showed progression, 8 had abnormal baseline MRI/As and 4 had normal baseline MRI/As (p=NS). Of the 17 that showed an initial progression, 5 (29%) continued to progress. In addition, 1 child developed an intracranial hemorrhage 8.92 years after starting transfusions; this subject had progression of vasculopathy prior to the event. We found no association of baseline TCD velocity or baseline MRI/A results with risk of progression; however, there was a trend towards higher risk of progression in children who were younger at initial diagnosis (7.05 vs. 9.73y, p=0.07). Conclusion: Silent infarcts and/or cerebral vessel stenosis/occlusion were found commonly in this cohort of children with abnormal TCD. Progression of cerebral disease also was common, even with transfusion therapy. We are currently assessing risk of progression based on the extent of MRI/A abnormalities at baseline and associated factors including method of transfusion and average hemoglobin and hemoglobin S levels. Results: Our study shows that HPS patients may experience several gastrointestinal (GI) symptoms such as inflammatory bowel disease, irritable bowel syndrome and gastroesophageal disease. Approximately 38% (n=17) of the patients from this population presented with gastrointestinal symptoms as an initial symptom. The data demonstrated that 48% of males (n=10) experienced GI problems as an initial symptom as opposed to 19% of females (n=5). Males were 2.5 times more likely to present with GI symptoms than females. Additionally, males presented a higher recurrence of GI symptoms as opposed to females (52% vs. 27%). Conclusion: Our results suggest that males with HPS in the Northwestern region of Puerto Rico have a higher tendency to present and persist with GI complications than females. In the future, we plan to expand our survey to a larger number of HPS patients in order to obtain statistically significant results. Similarly, it would be helpful to identify why some HPS patients do not present with GI complications. www.lmsa.net L.M.S.A. Journal Pg 28 www.lmsa.net L.M.S.A. Journal Pg 29 Determining the role of G-protein signaling in Drosophila midgut peristalsis Total Ileocolic Intussusception Causing Rectal Perforation - A Case Report Camilo Doig Acuña, Columbia University Medical Center Genetics & Development Dept. Ohlstein Laboratory Miel Sundararajan, Bryan M. Pham, Patricio Lau, MD, Erik P. Askenasy, MD Baylor College of Medicine, Department of Surgery Introduction: Intussusception is rare outside the pediatric population, with only 5% of cases occurring in adults. While in children intussusception often benign and responsive to radiologic reduction, in adults intussusception is frequently associated with a lead point, often malignancy. We present a case of total ileocolic intussusception causing rectal perforation secondary to a cecal mass. Case History: A 61 year old male initially presented with abdominal pain, reflux, and irregular bowel movements. An obstructive colonic adenocarcinoma was seen on colonoscopy. He refused treatment at that time and represented 10 months later with similar symptoms at which time a CT scan revealed interval development of colocolonic intussusception secondary to the cecal cancer. The patient again refused treatment. Shortly thereafter, the patient presented to the emergency department with symptoms of intestinal obstruction. He consented to surgery and was taken to the operating room where rectal perforation secondary to an intussuscepted cecal mass was appreciated. Also appreciated was a very floppy and hyper-mobile colon. Because it could not be reduced, a total abdominal colectomy with end ileostomy was performed. Discussion: Total ileocolic intussusception has been reported only a handful of times in the literature. It is believed that a lack of retroperitoneal fixation as well as highly mobile flexures may lead to this condition. Our patient displayed these findings supporting this hypothesis. Adult intussusception often presents as acute obstruction and necessitates prompt surgical intervention. If it can be reduced, then a hemicolectomy can be performed; if not, total abdominal colectomy is warranted. CADASIL – A disease of young Little is known about the mechanisms controlling digestive motility, the failure of which underlies a variety of conditions such as irritable bowel syndrome, chronic intestinal pseudo-obstruction and gastroparesis. D. Melanogaster is an excellent model for study due to its short generational time and elegant genetics. Based on previously published data, enteroendocrine cells play a role in intestinal peristalsis in Drosophila. Neuropeptides secreted by enteroendocrine cells may act via associated G-protein coupled receptors (GPCRs) to influence intestinal muscle movement. Given the significant homology between GPCRs in Drosophila and humans, identification of the role of these receptors in flies may lead to an increased understanding of human mechanisms. This could open the door to the eventual development of drugs targeting GPCR mechanisms in digestive disease. In this experiment, the technique of RNA interference (RNAi) was used to block the expression of G-protein subunits in intestinal muscle of Drosophila using the Mef2 muscle-specific driver. Fly stocks carrying Mef2 and a temperature-sensitive gal80 repressor (gal80ts) were crossed to stocks carrying RNAi against specific genes for the common G-protein subunits α, β and γ. Wild-type yellow-white flies and flies carrying Mef2 alone were used as controls. Digestion time and midgut contractility were compared across these mutant lines and against control groups using stool assays and observational dissections. Stool assays were performed using dyed food to measure time between ingestion and defecation. Flies with RNAi were compared to wild-type and Mef2 strains. Preliminary results are inconclusive, as RNAi flies had rapid intestinal transit, but there were not significant differences from the control group. Possible confounders may include influences by temperature, a weak RNAi construct or an insufficiently robust driver. Alternative protocols are being explored to overcome these barriers. Hematology/Oncology Suneel Kumar, MD; Brian Contreras, MS1 University of Illinois at Urbana-Champaign College of Medicine Boston Children’s Hospital/Dana-Farber Cancer Institute Introduction: Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the most common heritable cause of stroke and vascular dementia in adults. It is caused by mutations of the NOTCH3 gene on the short arm of chromosome 19. An MRI is able to detect signs of the disease years prior to clinical manifestation of disease. Case Presentation: A 64-year-old Caucasian female with history of diabetes, COPD and multiple TIAs (on Warfarin for stroke prophylaxis) presented with altered mental status. The family had noticed unusual behaviors in recent months including erratic driving, sexual promiscuity, undressing in public places, urinating on floor, memory loss. Her husband had died 8 months back and son died 3 months back. Recently she overdosed on Coumadin and got admitted with GI bleed and she set her house on fire accidentally. The MRI brain showed acute small focal infarctions in the bifrontal periventricular deep white matter and old infarcts in both hemispheres. A transesophageal Echocardiogram showed a small PFO. The workup for other causes of strokes such as prothrombin gene mutation, factor V Leiden, antithrombin III levels were all negative. Neuropsychological evaluation revealed significant cognitive impairment consistent with vascular dementia. Genetic testing for CADASIL was performed since the patient had a nephew with this disorder. This revealed NOTCH3 gene mutation. A repeat MRI brain after 6 months showed deep parenchymal chronic ischemic changes within cerebral hemispheres bilaterally, pons and right cerebellar hemisphere with evidence of interval progression. Patient has been continued on Warfarin for stroke prophylaxis, admitted in an assisted living for a supervised living. The family members were referred for genetic counseling. Discussion: The prevalence of CADASIL in the U.S. is about 2 per 100,000. This may be an underestimate as the disorder is misdiagnosed, particularly in areas where cardiovascular disease and multiple sclerosis are highly prevalent. Mutations in the Notch 3 gene cause and abnormal accumulation of Notch 3 at the cytoplasmic membrane of vascular smooth muscle cells in cerebral vessels. The patients usually present with ischemic episodes TIAs/CVAs, cognitive deficits, migraine with aura, psychiatric disturbances. No specific treatment is available, however; anti-platelet agents such as aspirin might slow down the disease and help prevent strokes. Conclusion: CADSIL should be considered in deferential in young patients with multiple TIAs/CVAs and early age dementia when other common causes for such events are absent. The family members should be referred for genetic counseling. Pediatric Hematology/Oncology Fellowship Program Harvard Medical School Boston, MA The Division of Hematology/Oncology at the Boston Children’s Hospital/Dana-Farber Cancer Institute seeks qualifies applicants for fellowship training in Hematology/Oncology. The fellowship program is designed to train academic hematologists and oncologists, and provides broad clinical experience and extensive research training in basic science and/or clinical investigation. Contact: David A. Williams, MD Chief, Division of Hematology/Oncology and Boston Children's Hospital 300 Longwood Ave, Karp 08125.3 Boston, MA 02115 Phone - 617.919.2697 Fax - 617-730-0868 Email: [email protected] For more information, please visit our website: http://www.danafarberbostonchildrens.org/For-Physicians/Fellowship-Overview.aspx www.lmsa.net L.M.S.A. Journal Pg 30 www.lmsa.net L.M.S.A. Journal Pg 31 Health status and stigmatization level of individuals living with a mental illness in the community of Las Tablas, Matanzas, in the Province of Peravia, Dominican Republic: a descriptive study November 2011–January 2012. Health Professional Abstracts Improvement of District-Level Maternal Mortality Reporting with Reproductive Age Mortality Survey (RAMOS) Elisa Warner, Rachael Ward, Bradley Iott, Judy Idrovo, Frank Anderson, and Joseph Adomako Minorities in Health Disparities International Research Training, Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, 48104 Objective: To investigate maternal deaths in the Kuntanase region using the reproductive age mortality survey (RAMOS) in all community households in which a woman of reproductive age (WRA) has died and identify the most commonly reported causes of the pregnancy-related deaths. Methods: A 6-question RAMOS survey was piloted with the relatives of 357 deceased WRA who died between January 2008 and July 2013 and compared to the number of recorded deaths confirmed by the maternal mortality review committee to assess current maternal mortality surveillance systems. The maternal mortality ratio was calculated to make this comparison. Results: Of the 357 interviews conducted, 132 of the deaths were identified to have been due to pregnancy-associated reasons that will be further investigated via a verbal autopsy. Utilizing the 6 question RAMOS the maternal mortality ratio was found to have increased from 128.4 to 206.5 per 100,000 live births supporting the hypothesis that there is large underreporting of maternal deaths in the region. Conclusion: The 6 questions RAMOS appears to be a practical method for monitoring maternal deaths. With the help of community health workers a better understanding of maternal mortality in rural Ghana can help improve maternal mortality surveillance systems in this region. Future work should include pilot testing in other under-resourced areas and parts of the world. AGE AND EDUCATION ANALYSIS ON ALCOHOL CONSUMPTION AMONGST LATINA AND NON-LATINA WOMEN IN SOUTHERN CALIFORNIA Kristen Brañes, 4th year Biological Sciences Major, Helena Do, 4th year Biological Sciences Major, Kenneth Huynh, 3rd year Biological Sciences Major, Shahram Lotfipour, MD, MPH, Craig Anderson, PhD, Wirachin Ying Hoonpongsimanont, MD University of California, Irvine, Department of Emergency Medicine Background: Recent studies have confirmed that white women report the highest prevalence of alcohol use and binge drinking compared to women of any other race/ethnicity group, consisting of Latinas, Asians, and African-Americans. In this study we analyze the quantity of alcohol consumed depending on age and education-level of the Latina and non-Latina subjects in Southern California. Through analysis we can determine which specific female population is more at-risk to alcohol dependency. The findings will provide us with aid to foresee, prevent, and manage alcohol dependency. MethodsThis study uses data from a Computerized Screening and Brief Intervention tablet consisting of questions relevant to the data findings found in this study. The data findings include; Age, education-level, Race/Ethnicity, and many questions concerning the subject’s alcohol consumption. The Brief Intervention takes place in the Emergency Department of UC Irvine. Although not a population sample, Emergency Department patients come from a large range in economic background, sex, education level, and age. Results Highest percent of non-drinkers are amongst Asians, followed by Hispanics. The majority of White females drink within the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommendations. There were fewer non-drinkers, but fewer drinks per day among drinkers with females who received a high-school degree or at-least an associate’s degree compared to females who did not complete high school. After age 40 the amount of drinks consumed per day decreases significantly. Lastly, Spanish-speaking Latina subjects were found to have considerably less quantity of consumption compared to English-speaking Latina subjects. Cynthia Ángeles, Robert Pantaleón, Cristina Rivera. ** Dr. Rafael Johnson.* *Medical Psychiatrist. ** Medical students from escuela de medicina, instituto technologico de Santo Domingo INTRODUCTION: A mental illness is a psychological or behavioral pattern that is generally associated with distress or disability, and which is not considered part of a person’s normal development or part of that person’s culture. Important aspects like the living conditions of those suffering from a mental illness, their physical and psychological health status, socioeconomic level and knowledge about their condition were studied in this investigation; likewise, it was also determined the percentage of these patients that felt stigmatized by others due to their condition. Las Tablas is a small community, located in the municipality of Matanzas, Province of Peravia, Dominican Republic. OBJECTIVES: 1) Determine the stigmatization level towards individuals with a chronic mental illness residing in Las Tablas. 2) Evaluate the general health situation of patients with a chronic mental illness living in Las Tablas. 3) Assess the knowledge about chronic mental illnesses of the general population in Las Tablas. MATERIAL AND METHODS: Two surveys were used, one was applied to 100 randomly selected residents of the community of Las Tablas over the age of 18; another survey was applied to individuals suffering from a chronic mental illness or to a close family member. RESULTS: 52% of respondents considered people with mental disease to be dangerous to others. Most interviewees were aware that alcohol use (81%) and illicit drug use (89%) could increase the risk of manifesting a mental illness and 65% of the population consulted believed witchcraft as a cause of mental illness. 88% considered people with mental disease not to be blamed for their condition. Only 1 out of the 7 patients with a mental illness to reside in the community had medical insurance (14.3%). All individuals with a mental illness (100%) had been victims of some kind of offensive conduct. 43% agreed to feeling generally discriminated against by society. CONCLUSIONS: There’s a great lack of knowledge of mentally ill individuals concerning their condition. Having a family member with a mental illness affects negatively the way people see and treat people with a mental illness in the community. Regardless of educational level, most people understand that individuals with a mental illness can study and work as others. Most patients with a mental illness say the way their family treats them had changed since the disease manifested. Education of the population and individuals with a mental disease is advised, looking to reduce stigma against mental disease and getting people with a mental illness to know more about their condition and how to live with it and overcome it. Knowledge, Attitudes and Practices about danger signs in mothers of children under five years in the community of Boca Canasta, Peravia province in the period November 2011 January 2012. Br. Sheila M. Collado Marmolejos , Br. Indhira De la cruz Alcántara, Dr. Emilton Lopez Instituto Tecnologico de Santo Domingo Children under 5 years who have one or more danger signs in general are in a serious situation. Despite knowing that mothers do not turn immediately to health centers we cannot state if they are able to identify the danger signs when these arise. Determine what knowledge, beliefs, practices and attitudes about danger signs have the mothers of children younger than 5 years in the community of Boca Canasta, Peravia. The study was prospective, descriptive and analytical type of cross section. We used a data collection protocol, which was applied to a sample of 101 women who met the inclusion criteria, these mothers were chosen randomly. 62% of mothers admitted not knowing the danger signs, while the 38% that said knew the danger signs actually had a misconception. 75% of mothers go to health centers for other signs that are not classified by IMCI danger signs, fever being the most frequent with 25%; of those classified by IMCI the sign vomits everything occupy 22%. 62% of mothers incorrectly handles diarrhea putting their children on a diet, further more this percentage of mothers believes that the administration of intravenous serum is better than the administration of oral serum, another mistaken belief. Mothers do not have knowledge of danger signs and this conditions their attitudes and practices in the presence of disease in their children. We recommend carrying out information, education and communication campaigns on the subject, use of materials to educate mothers so they develop the skills to identify their seriously ill children on time. Conclusion-This study provides data proving that English-Speaking Latina, White, and African-American women are most at risk to alcohol dependence. Additional studies on Asian and Spanish-Speaking Latina women can help reason why they can control and limit their alcohol consumption. The analysis and comparison of both groups can help provide methods in helping the female group that is at most risk of alcohol dependency. Alcohol education programs that target this population will prove to be most effective. www.lmsa.net L.M.S.A. Journal Pg 32 www.lmsa.net L.M.S.A. Journal Pg 33 Pediatric Hospitalists Assessing Postpartum Depression during Infant Inpatient Admissions M. Trost1, MD, K. Torreblanca1, DO, H. Avila2, and J. DeSena2 Assistant Professor of Clinical Pediatrics, Department of Hospital Medicine, Children’s Hospital Los Angeles (CHLA)1, Year II Medical Student Keck School of Medicine, Los Angeles California2 Goal: The American Academy of Pediatrics recommends that pediatricians screen mothers for symptoms of postpartum depression at their infant’s clinic visits. This often does not occur due to time constraints, lack of physician comfort, or chronically ill children unable to make outpatient appointments. The primary goal of our study is to show screening for postpartum depression can be effective when infants are hospitalized. We hypothesize this will capture moms who missed screening; and that an intervention we provide for those at risk will result in reduced depressive symptoms and increased maternal-child bonding. Methods: Women with a child age >2 weeks and <1 year of age admitted to CHLA are eligible for our study. Enrolled mothers complete questionnaires including the validated Edinburgh Postpartum Depression Scale (EPDS). If the score is greater than or equal to 10, they are at risk for postpartum depression and we provide education and mental health referral. We follow up with phone calls in 3 and 6 months. Moms are asked if they pursued further evaluation with either their doctor, one of the resources given, or another method. We also re-administer the EPDS and maternal-infant bonding screens to compare with original scores. Based on previously reported incidence rates we calculated our sample size to be 310. We need to complete phone follow up with 55 mothers screening positive on the EPDS to show an effect of our intervention. Results: This study is ongoing and my role has been participating in the hospital screening process, entering data, and conducting follow up calls. To date we have enrolled 217 subjects with 63 (29%) screening at risk for postpartum depression. Only 28 (13%) report they had been previously screened for depression in the outpatient setting. Conclusion: Postpartum depression impacts both the child’s development and mother’s health. Demographic data we are collecting may show factors such as decreased rates of breastfeeding, or certain medical problems in the child, associated with risk for postpartum depression. Further data analysis is needed to determine if our intervention has long-term benefit. THE WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY VALUES DIVERSITY 459 total students • 23% underrepresented in medicine • 54% women • 101 undergraduate institutions • 41 states, 5 countries represented 776 residents and fellows 2,172 campus and hospital-based faculty Visit the Office of Diversity and Multicultural Affairs at http://brown.edu/academics/ medical/diversity www.lmsa.net L.M.S.A. Journal Pg 34 www.lmsa.net L.M.S.A. Journal Pg 35 Rural Medicina Academy: A Multidisciplinary Rural Health Professions Pipeline Program at the University of Illinois College of Medicine at Rockford Journal Articles Natalia Suarez, National Center for Rural Health Professions Introduction/Background: The lack of underrepresented minorities (URMs) in the healthcare workforce is a major cause of health disparities among ethnic and racial minorities in the US. This workforce gap is the result of obstructions in the K-12 educational system such as unequal educational resources, disparities in learning outcomes, disparities in high school completion rates, low aspirations among URM youth, and lack of positive role models and parental support. Innovative and nontraditional paths such as K-16 pipeline programs targeting URMs have shown to be an effective way to address this health professions shortage. Objective: The purpose of this paper is to describe the programmatic components of The Rural Medicina Academy (RMA), a health career awareness pipeline program targeting underrepresented minority (URM) youth. We highlight its partnership with the University of Illinois College of Medicine at Rockford (UI COM-R) Latino Medical Student Association Rockford chapter (LMSA Rockford). We find that our LMSA Rockford/RMA partnership not only aims to enhance health career awareness among RMA’s young participants, but also fosters mentorship roles and community engagement, and ultimately healthcare delivery for the Latino community. Methods: The RMA incorporates a core curriculum comprised of four tracks: 1) Exploring Health Professions; 2) Understanding Health Disparities; 3) Professional Skills Development; and 4) Cultural Competency. The RMA’s programmatic components are: 1) K-16 Workshops, 2) Summer Scholars Internship Program, 3) Native American Pathways Program, and 4) Early-Bird and After-School Sessions. In addition, the RMA is involved in outreach efforts, such as K-12 career fairs and community-led health fairs. Results: At large, the RMA has reached over 600 participants between spring 2013 and spring 2014 by means of RMA programmatic components, including nine workshops, one pilot Summer Scholars program, three early-bird/after-school programs, one Native American Pathways Program, and 14 community outreach initiatives in two urban counties, two rural counties, and two out-of-state Native American/American Indian reservations. The Summer Scholars program evaluation found that the program increased students’ health career awareness and interest, as well as their understanding on different health topics. Pre- and post-assessments found that all (100%) participants indicated that helping people is a key reason why they want to pursue a health career, followed by job prestige (33.34% increase) and work environment (22.23% increase). Our preliminary findings indicate that the Summer Scholars pilot program has succesfully given participants a candid portray of health careers, as well as shown its influence on a community’s health and well-being. Conclusion: Future studies should further explore URMs educational journeys by looking into matters such as what and who inspired URMs to pursue their education track, barriers encountered, and availability of support systems. Examining these issues will help researchers, educators, and institutional agents better understand the perspectives and experiences of URM students, identify their unique needs and challenges, as well as provide information for culturally competent institutional programming initiatives. Band cupping: report of two cases Tim Soeken,1MS, Angelina Espino Barros Palau,23 MD, Michael Morgan23MD, PhD, Andrew G Lee,12345MD. 1. Baylor College of Medicine, Houston, TX (Department of Ophthalmology, AGL: Adjunct Professor) 2. Department of Ophthalmology, Houston Methodist Hospital, Houston, TX 3. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX (AGL: Clinical Professor) 4. Department of Ophthalmology; The University of Iowa Hospitals and Clinics, Iowa City, IA (Adjunct Professor) 5. Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX. (Adjunct Professor) Abstract Importance: The concept of optic nerve “band atrophy” associated with bi-temporal hemianopsia was first described in 1980. Bilateral band or “bow-tie” atrophy has since then been described in association to optic chiasm compression, usually secondary to pituitary adenoma, craniopharyngioma, or meningioma. Given that these cases are scarce in the current literature, we add two new cases of band cupping associated with anterior visual pathway (AVP) compressive lesions. Observations: The first patient presented with a 7 year history of painless progressive bilateral vision loss, worse in the left eye. On fundoscopy, the patient had band cupping OD and diffuse optic cupping OS. Subsequent MRI showed a large mass consistent with a pituitary macroadenoma. The second patient presented complaining of bilateral vision loss. Fundoscopy showed disc cupping more prominent nasally and temporally in both eyes. MRI revealed a mass lesion involving the optic chiasm with extension to the right optic tract and bilateral optic nerves consistent with an optic pathway glioma. Conclusions and Relevance: Band cupping is clearly distinct from glaucoma cupping. The presence of band cupping should alert the clinician of the possibility of an underlying compressive lesion. Introduction www.lmsa.net L.M.S.A. Journal Pg 36 The concept of optic nerve “band atrophy” associated with bi-temporal hemianopsia was first described by Unsold and Hoyt in 1980. The authors examined a cross-section of the distal optic nerve and found a distinct pattern of band atrophy. They conwww.lmsa.net cluded that a lesion affecting nerve fiber bundles at the nasal side of the optic nerve would affect exclusively the temporal field of vision.1 Bilateral band or “bow-tie” atrophy has since then been amply described in association to optic chiasm compression, usually secondary to pituitary adenoma, craniopharyngioma, or meningioma. Unilateral band atrophy has been seen in optic tract syndrome (OTS) where a contralateral optic tract compressive, traumatic, demyelinating, or vascular lesion damages the crossing nasal fibers as well as the unilateral non-crossing temporal fibers.2 Although band atrophy is a commonly described finding in chiasmal compressive lesions, the presence of band cupping has not been widely reported. We present two new cases of band cupping associated with anterior visual pathway (AVP) compressive lesions. Case 1 A 60 year old woman presented complaining of painless progressive bilateral vision loss, worse in the left eye. At symptom onset 7 years prior, she was seen by an optometrist, but was only correctable to 20/50. Visual field testing was undertaken 4 years later by her optometrist. It showed nonspecific scatter in the right eye, and the left eye was judged unreliable. She sought care with another optometrist who referred her immediately for evaluation by neuro-ophthalmology. visual field testing showed a temporal hemianopia OD and only a relatively preserved nasal island OS. On fundoscopy, the patient had band cupping OD and diffuse optic cupping OS. The remainder of the examination was unremarkable (Figure 1). The junctional scotoma raised concern for a suprasellar mass, and subsequent MRI showed a mass consistent with a pituitary macroadenoma (Figure 2). The patient was referred to neurosurgery and subsequently underwent resection. Pathology showed staining for FSH and LH consistent with a gonadotropin secreting pituitary macroadenoma. The patient’s post-operative course was remarkable for panhypopituitarism with diabetes insipidus managed medically and a cerebrospinal fluid leak that resolved with conservative management. Case 2 An 18 year old healthy Hispanic female presented to the neuro-ophthalmology clinic complaining of bilateral vision loss. She was seen by an optometrist who noticed optic disc cupping and an anomalous automated visual field. She was told she was a glaucoma suspect, but should seek neuroophthalmologic examination. Examination revealed a best corrected visual acuity of 20/20– OU. Color vision was preserved in both eyes. Pupils were symmetric and briskly reactive to light and accommodation. She did, however, have a trace RAPD OS. Automated visual field testing suggested a left homonymous hemiExamination revealed visual acuity 20/30 anopsia, denser in the left eye, as well as a OD and, with eccentric fixation, 20/80 OS. possible OD temporal defect. Fundoscopy Color vision in the right eye was preserved, showed disc cupping bilaterally. Cupping 14/14 Ishihara plates, but left eye testing was more prominent nasally and temporalrevealed severe dyschromatopsia with 0/14 ly in both eyes although a clearly preserved plates correct. She had a relative afferent superior-inferior rim was more evident in pupillary defect (RAPD) OS. Automated the left eye. OCT was consistent with pre L.M.S.A. Journal Pg 37 dominant band atrophy and cupping OS, but showed a more diffuse atrophy OD (Figure 1). The remainder of the examination was unremarkable. The atypical disc cupping as well as the non-glaucomatous visual field raised concern for a chiasmal compressive lesion. MRI brain and orbit with and without contrast was ordered and revealed a mass lesion involving the optic chiasm with extension to the right optic tract and bilateral optic nerves (Figure 2). Its appearance was consistent with an optic pathway glioma. The patient was referred to neuro-surgery for further discussion of treatment options. The patient opted for close observation and is being followed with repeat brain imaging. Comment Optic disc cupping has been reported to occur in less than 10% of compressive lesions. It has been sometimes described as “glaucoma type cupping” with cases being misdiagnosed and treated as normal tension glaucoma.3 Proposed criteria to help differentiate between compressive lesions and glaucoma include a younger age at presentation, worse visual acuity, vertically aligned visual field defects, neuroretinal rim pallor, mismatch between the degree of disc cupping and visual or visual field loss, the presence of an RAPD, and rapid progression.4 Band atrophy is a specific type of optic disc atrophy that is typically observed in patients with intracranial mass lesions which compress on the optic nerve, optic chiasm, or optic tract.1,2 When the mass lesion compresses the AVP, there is eventually retrograde degeneration of axonal nerve fibers. Due to the established pathways of retinal ganglion cell fibers from the retina to the lateral geniculate nucleus, observed atrophy and cupping patterns can be correlated to compressive lesions in these locations. Band atrophy is not a feature of glaucoma and should always prompt further evaluation. ping in the contralateral eye. She had been complaining of vision loss for seven years before being diagnosed with a pituitary macroadenoma. In retrospect, the presence of this atypical cupping pattern might have alerted the clinician to the possibility of an underlying compressive lesion. The second patient presented with visual fields and ON cupping atypical for glaucoma. Bilateral band cupping was consistent with the underlying chiasmal optic glioma. To our knowledge, these would be only the second and third cases describing band cupping in compressive AVP lesions.5 THese Hands will cure diseases noT yeT known In summary, band cupping, in addition to band atrophy, is another differentiating sign of chiasmal compression and OTS. It is clearly distinct from glaucoma cupping where the superior and inferior RNFL are more affected. The presence of band cupping should therefore alert the clinician of the possibility of an underlying compressive lesion. These hands belong to a student at Baylor College of Medicine. Every day they ask questions. Explore facts. Master new skills. These are the hands of the future. Eager to analyze, solve and cure. Like all at Baylor College of Medicine, these hands are giving life to possible. References 1. Unsöld R, Hoyt WF. Band atrophy of the optic nerve. The histology of temporal hemianopsia. Arch Ophthalmol. 1980;98:1637-8. 2. Newman SA, Miller NR. Optic tract syndrome: neuroophthalmologic considerations. Arch Ophthalmol 1983; 101:1241– 1250. 3. Ahmed II, Feldman F, Kucharczyk W, Trope GE. Neuroradiologic screening in normal-pressure glaucoma: Study results and literature review. J Glaucoma 2002;11:279-86. 4. Greenfield DS, Siatkowski RM, Glaser JS, Schatz NJ, Parrish RK II. Cupped disc. Who needs neuroimaging? Ophthalmology 1998;105:1866-74. 5. Hildebrand GD, Russell-Eggitt I, Saunders D, Hoyt WF, Taylor DS. Bow-tie cupping: a new sign of chiasmal compression. Arch Ophthalmol. 2010;128:1625-6. We present two cases of band cupping associated with compressive lesions of the crossing nasal axonal fibers at the optic chiasm and optic tract. In addition to the expected band atrophy, nasal and temporal pathologic cupping was clearly observed in both cases. The first patient had band cupping in one eye but a more diffuse cupwww.lmsa.net Proud sponsor of the Latino Medical Student Association. Visit bcm.edu/possible to see all that’s possible. L.M.S.A. Journal Pg 38 www.lmsa.net L.M.S.A. Journal Pg 39 ANALYSIS ON ALCOHOL CONSUMPTION AMONGST LATINA AND NON-LATINA WOMEN IN SOUTHERN CALIFORNIA Brañes, Kristen, Shahram Lotfipour, MD, MPH, Wirachin Ying Hoonpongsimanont, MD University of California, Irvine, Department of Emergency Medicine The purpose of this study is to analyze alcohol consumption trends amongst Latina and non-Latina women in Southern California. Previous studies analyzing trends between different ethnicities show that Latinos (males and females) have a higher consumption rate of alcohol. However this does not stand correct when analyzing only the female population. Recent studies have confirmed that white women report the highest prevalence of alcohol use and binge drinking compared to women of any other race/ethnicity group, consisting of Latinas, Asians, and African-Americans. In this study we analyze the quantity of alcohol consumed per day, AUDIT score, and language spoken depending on age and education-level of the Latina and non-Latina subjects in Southern California. Research associates approached the patients involved in this study in the Emergency Department. Through analysis we can determine which specific female population is more at-risk to alcohol dependency. These findings will provide us with findings that aid to foresee, prevent, and manage alcohol dependency. Identifying the specific population vulnerable to alcohol dependency is the first step to knowing where to improve assistance. Interest in alcohol consumption amongst women has increased throughout the years due to cultural adjustments. Men and women may have similar consumption quantity but studies have proven that there are twice as many alcohol dependent men than there are women (Alvanzo 2011). Despite this drastic difference there continues to be an increase in alcohol dependent females. For example, females born from 1944 to 1953 drink more than females that were born from 1934 to 1943, especially amongst 48 and 57 year olds. Studies have shown that this may be explained by the shock of World-War II, affecting White and Hispanic women the most (Grucza, 2008). Female alcoholics are under-identified in primary care settings. Women deal with stigma that place barriers to their treatment and are under-represented in specialized treatment settings (Grucza, 2008). Due to this barrier, females with alcohol related problems are more vulnerable to www.lmsa.net severe health issues than males. For example, birth defects and developmental disabilities of newborns to mothers who consumed alcohol during pregnancy (Marchetta 2012). Due to abundant social and cultural changes, the stigma of drinking behavior amongst women has reduced within the past few years. However, reduction to the barriers alcoholic women face has not been focused on (Grucza, 2008). The purpose of this study is to identify which specific female population is most vulnerable and provide aid in identifying and aiding the female population to abolish this barrier. It was hypothesized that, in general, Latina females (from Mexico and other Latino countries) would contain the least non-drinkers amongst women, followed by black females due to economic class. MATERIALS AND METHODS All experiments were carried out in accordance with the Institutional Review Board at the University of California, Irvine, and were consistent with Federal guidelines. Computerized Alcohol and Brief Intervention (CASI) study was approved by the Institutional Review Board (IRB) on August 4th, 2011. Screening started January 15, 2012. The data collection takes place in the Emergency Department (ED) of the University of California, Irvine Medical Center (UCIMC). The Emergency Medicine Research Associates Program (EMRAP) contributes to the data collection for this study. Undergraduate research associates screen all patients entering the ED everyday of the week from 8am to 12am. CASI began collecting data on January 15th 2012. Questions including the patient’s age, education-level, race/ethnicity, and few questions concerning the patient’s alcohol consumption were gradually added by 2012. Data collection for this study began November 5th, 2012 and ended December 31st 2014. The research associates screened a total of 791 females, from which, 21 subjects are Spanish-speaking. Of the three categories, percent drinkers, drink per day an audit score was observed to conduct a statistical analysis. This aided in demonstrating a trend of alcohol consumption amongst Latinas, and non-Latinas/Hispanics (including Native Americans, Black, Asians, more than one race, and those who did not state their race). Inclusion/Exclusion Criteria All Spanish and English-Speaking patients who are cognitive, able to provide written consent and over the age of 18 are eligible to be enrolled into the study. If patients do not fit the above requirements they are excluded from our study and not approached by the research associate. All patients are required to sign a consent and a Health Insurance Portability and Accountability Act (HIPAA) form prior to starting the questions provided in the computerized tablet. Data collection The computerized tablet provides the patient with questions concerning their race/ethnicity, gender, education level, and their alcohol consumption. Since the questions are computerized this facilitates data collection and provides the CASI research team with accurate statistics for every question asked. The data collection for this study occurred from November 5th 2012 to December 31, 2014. During this time period 791 females, including 21 Spanish-Speaking females were screened and enrolled into our study. When data was collected for this study, we noticed that for some categories, such as the quantity of drinks-per day, were not normally distributed. To resolve this complication, we used a Kruskal-Wallis rank test to compare groups with one another. After completing the questions provided by CASI, patients are given a score generated by the Alcohol Use Disorders Identification Test (AUDIT). This score is used to determine if a patient does not drink, is at-risk, or a dependent alcohol consumer. From the 791 females, we analyzed data according to three categories; the subject’s race/ethnicity, education-level, and age. L.M.S.A. Journal Pg 40 Alcohol Use Disorders Identification Test (AUDIT) The World Health Organization uses AUDIT as an assessment tool to identify hazardous drinking habits and dependency symptoms. AUDIT is time efficient and takes approximately six minutes. After taking CASI, the AUDIT score is provided to both the patient and the research associate. This score ranges from 0-30, and categorizes all patients into three different groups. Patients who score from 0-10 are non-dependent and not hazardous; 8-19 are classified as hazardous drinkers; with a score of 20 or more are considered dependent drinkers and suggested to attend programs that can help them control their drinking habits. Only patients with an AUDIT score from 8-19 are eligible to be enrolled in the study. Enrolled patients are then asked to complete follow-up questions. Follow-up questions There are a total of 3 follow-up questionnaires given one week, 3 months and 6 months from the date they were enrolled into the study. The questions are completed via phone or email. The follow-up includes the same questions patients completed during their stay at the ED. The one-week follow-up demonstrates short-term improvement and both the 3-month and 6-month demonstrates long-term improvement of all patients enrolled in the study. (43.96%). Sixty-seven percent of NonHispanic Whites and 64.29% other NonHispanics admit to drinking, although they were not identified as dependent or at-risk to alcohol dependency. Non-Hispanic Whites and Non-Hispanic others rank the highest amongst female drinkers. Despite the high percentage of drinking amongst whites, further analysis demonstrates that the majority of White females (48%) drink within the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommendations, which is one drink or less per day. Drinks-per-day among drinking women by education It was determined that 53% nondrinkers are women who did not complete high school, while only 32% women who completed at least a associates degree were nondrinkers. Amongst drinking women, 68% women have completed their associate’s degree, 58% have completed their highschool degree, and 46% have not completed high school. The goal is to create behavioral change within the community regarding alcohol use by performing screening and brief intervention using CASI. Currently, CASI is considered a standard of care at UC Irvine Medical Center. RESULTS From November 2012 to December 2014, 791 females were enrolled into CASI. The 791 females include 21 Spanish-speakers. All patients were provided with the same questions and categorized depending on the language they spoke, education level, race/ethnicity, and AUDIT score. Of the total 791 female patients enrolled in the study, 311 were non-drinkers and 480 were drinkers. There was a significant difference when drinkers and non-drinkers were compared. The highest percentages of non-drinkers are amongst Asians (52%), followed by Latinas, which includes women from Mexican (44.76%) and other Latin countries www.lmsa.net Drinks per day by language among drinking Latinas Figure 2. Drinks per day and language spoken. (n=188, p=0.0031) Among Latinas, Spanish-speakers drank fewer drinks per day. Analyzing the amount of drinks consumed per day amongst all race/ethnicities was difficult because of the uneven distribution. In order to compare groups we needed to use the Kruskal-Wallis rank test and determined that the Asians, again, drank the least (2.13 drinks per day) while the Latinas drank second most (2.68 drinks per day). Whites show that their average drink per day is 2.18, which is very close to the Asians’ alcohol consumption per day. Therefore, among female drinkers, the two Latina groups drank more than non-Hispanic White, Asian, and non-Hispanic other women. Figure 1. Drinks-per-day among women by education. (n=480, p-value=0.0317) Among drinking women, the number of drinks per day was higher for women who did not complete high school and lowest for women who completed at least an associates degree. L.M.S.A. Journal Pg 41 Audit score by language among drinking Latinas Figure 3. Language spoken and AUDIT Score. (n=188, p=0.0148) Among drinking Latinas, the audit score was lower (2.5) for Spanish-speakers than English-speakers (4.7). Figure 4. Language spoken and AUDIT score (n=188, p=0.0148) Among drinking Latinas, the audit score was lower for Spanish-speakers than English-speakers. DISCUSSION The results found from this study clarifies that non-Latino/Hispanic white females admit to consuming more alcohol than Latino, or other non-Latino/Hispanic females (Asians and/or Blacks). Although it was originally believed that Latinas drink more www.lmsa.net than non-Latinas, it can be understood that cultural change is influencing their health and health behaviors. Spanish-speaking Latina’s seems to be more strongly attached to the Latino/Hispanic culture and tend not to drink as much as the non-Latina white females. There are studies that encourage public health programs that are aimed at Hispanic to consider the importance of cultural change and diversity within and across Hispanic subpopulations (Black 1993). Clinical practices that advise women about the dangers associated with drinking while pregnant, coupled with communitylevel interventions that reduce alcoholrelated harms, are necessary to mitigate Alcohol-exposed pregnancies (AEP) risk among women of childbearing age and to achieve the Healthy People 202 objectives (Marchetta 2012) liaison in the Adult CASI team thanks too the past coordinators, Armaan Rowther and Lynne Le. I am grateful for the present liaison, Chris Gilani and Anum Iqbal who continue to encourage me and make me feel welcomed in EMRAP. I’d also like to thank all research associates in EMRAP and faculty that work in the ED, they have contributed a lot throughout my learning experience while in EMRAP. I would lastly like to thank my family for constantly supporting me with surpassing my endeavors throughout my life. One limitation we encountered was the small sample size. There were only 188 Latinas enrolled into the study. We are continuing to enroll Spanish-speaking patients but have a lower success rate due to the language barrier between the patient and the research associates. Research associates do not feel comfortable approaching the patients incase further questions about the study are asked but are unable to respond. The process of overcoming this barrier is difficult. We now have Spanish scripts and audio; despite this research associates continue to have difficulty approaching Spanish-speaking patients. Grucza RA, Bucholz KK, John PR, Bierut LJ, Secular Trends in the Lifetime Prevalence of Alcohol Dependence in the United States: A Re-Evaluation. Alcohol Clin Exp Res. May 2008. Pages 763-770. This study provides data proving that English-Speaking Latina, White, and AfricanAmerican women are most at risk to Alcohol dependence. Additional studies on Asian and Spanish-Speaking Latina women can help understand reasons why they can control and limit their alcohol consumption. The analysis and comparison of both groups can help provide methods in helping the female group that is at most risk of alcohol dependency. Alcohol education programs that target this population will prove to be most effective. LITERATURE CITED Black SA, Markides KS, Acculturation and alcohol consumption in Puerto Rican, Cuban-American, and MexicanAmerican women in the United States. Am J Public Health. 1993 Pages 890–893. Alvanzo AAH, Storr CL, Flair LL, Green KM, Wagner FA, Crum RM, Race/Ethnicity and sex differences in progression from drinking initiation to the development of alcohol dependence. Drug Alcohol Depend. November 1, 2011. Pages 375-382. Marchetta CM, Denny CH, Floyd L, Cheal NE, Sniezek JE, Alcohol use and binge drinking among women of childbearing age—United States, 2006-2010. MMWR Morb Mortal Weekly Report. July 20, 2012. Pages 534-538. L.M.S.A. Journal Sarah Carlson, MS2 and Michael Henry, MS2 Loyola University Chicago, Stritch School of Medicine Background With an increasingly diverse patient population in the United States, the need for language proficiency in languages other than English is greater than it has ever been in the past. With limited time and resources, medical students may find that learning a second language amidst the rigorous medical school curriculum is seemingly impossible. In addition to this challenge, organizing official courses, finding the budget to pay teachers, and writing a curriculum that is worthy of elective credit is difficult for administrative faculty in medical schools. Keeping these challenges in mind, Loyola University Chicago Stritch School of Medicine has implemented a Peer-Led Medical Spanish Program in which first and second year medical students organize curriculum and teach classes focused on Medical Spanish to their peers. Teachers earn elective credit for their efforts, and students receive the benefit of courses tailored specifically to their needs without paying any extra tuition. Methods The following “Eight Step Sequence” has been used at Stritch for over five years. The success and maintenance of our Peer-Led Medical Spanish Program supports the effectiveness of these methods: 1. Recognize the need According to a report issued by the US Census Bureau in April of 2010, 55.4 million or 20% of the US population 5 years old and older spoke a language other than English at home. Of this 20%, 62% or 34.5 million people spoke Spanish. If these 34.5 million individuals speaking Spanish at home also speak English fluently, the need for bi-lingual health care providers would be minimal. However, 47.4% spoke English less than “very well” with respondents between the ages of 41 and 64 and those 65 and older reporting the lowest English speaking abilities.1 Due to the sensitive nature of personal medical information, family members— particularly young family members—are not suitable medical interpreters. Further, the use of trained medical interpreters can ACKNOWLEDGEMENTS I would like to thank Dr. Wirachin Hoonpongsimanont (MD), and Dr. Shahram Lotfipour for continuously supporting me for the past two years in the Emergency Medicine Research Associates Program (EMRAP). My learning experience has vastly accelerated thanks to my position as Peer-Led Medical Spanish: An Instructional Guide Pg 42 www.lmsa.net add time and cost to already rushed patient encounters. Therefore, a Spanish speaking physician can save time and money while maintaining the doctor-patient relationship. Starting a peer-led Medical Spanish program provides students the opportunity to improve their medical Spanish and gain realistic expectations of the care they can and cannot provide in the Spanish language. 2. Establish a certification program When students pass all three phases of certification, they are given a special “Hablo Español” name badge, priority at predominantly Spanish speaking clinical sites, a notation on the transcript, and recognition of competency in the Dean’s letter. More detailed information about our certification process can be found at http://www.stritch.luc.edu/medspanish/ content/certification. Perhaps the worst potential outcome of a Medical Spanish program would be giving students a false confidence in their Spanish speaking abilities leading to dangerous patient care. Indeed, ad hoc interpreters such as health care providers have been shown to commit significantly more potentially clinically significant errors when compared to trained hospital interpreters2 underscoring the importance of a rigorous certification process. The certification process used by Stritch medical students not only tests a student’s knowledge of medical vocabulary and ability to give directions and medical advice, but it also evaluates the student’s fluency, pronunciation, customer service, and interpretation skills as well as the student’s ability to adjust his or her language based on the age, gender, and educational status of the patient. There are 3 testing components to certification: 1. Clinician Cultural and Linguistic Assessment – Spanish (CCLA): A one-hour phone exam developed by Kaiser Permanente and administered by ALTA Language Services simulating primary care encounters. 2. Qualified Bilingual Staff Assessment – Spanish (QBS): A one-hour phone exam developed by Kaiser Permanente and administered by ALTA Language Services that directly measures medical vocabulary as well as sight translation, medical diagnosis and instructions, customer service, and social conversation. 3. Spanish Objective Structured Clinical Exam (OSCE): An unprompted complete history and physical with a standardized patient in Spanish developed and administered by Stritch School of Medicine Faculty. 3. Incentivize medical student teachers L.M.S.A. Journal Establishing a teaching elective to earn credit has been an essential part of the success that Medical Spanish has seen at Stritch. As it stands today, medical students who complete the teaching elective requirements earn two weeks of elective credit toward fourth year. This is a recognized teaching elective that also earns mention in students’ Dean’s letters as they apply to residency programs. With the establishment of the elective, we secured administrative support while also providing a tangible benefit for students that commit to teaching Medical Spanish. The following requirements must be met to earn the teaching credit: Teachers must plan and teach at least 20 lesson plans during their first and second year of medical school. Teachers must create a portfolio of their lesson plans, including a reflection that is to be completed at the conclusion of each class reflecting upon what activities or teaching methods worked well, which didn’t, and how they could improve this lesson in the future. Teachers must attend at least one Medical Spanish workshop each semester. (These workshops are developed by the Medical Spanish Coordinators in conjunction with faculty input. In the past, topics have included strategies to engage adult learners, teaching methods for foreign language instruction, and many others.) Teachers must attend Spanish teachers’ meetings, usually one per semester. Teachers must evaluate at least two other peer teachers and fill out the required evaluation form. Pg 43 Teachers must be evaluated by at least two different Medical Spanish teachers and that evaluator must complete the required form. As long as the medical student Spanish instructor completes the above requirements, he or she will earn the elective credit, in addition to including the teaching elective on his or her Dean’s letter and resume. 4. Develop a curriculum Developing a curriculum has been an ongoing project at Stritch since the initiation of the Medical Spanish Program. In the past few years, teachers have worked to create a set of Learning Objectives for each week and each level. Learning Objectives clearly identify the goals of that week’s class, and teachers plan their lesson focusing on these goals. Establishing clear goals has helped classes to remain organized and proceed in a logical manner throughout the course of the year. Furthermore, if a student must miss a class, the teacher can easily provide the Learning Objectives and lesson plan for the week so the student does not fall behind. In the past years, Medical Spanish teachers have found that following a textbook is not always the best option for the class, although it can be a helpful resource. The Medical Spanish program has used the texts listed at the bottom in the past. These texts can help teachers to develop ideas and focus their teaching strategy, but the Learning Objectives that have been specifically created for the Medical Spanish program are designed to directly target medical student’s needs for communicating with patients. Textbooks Level 1 Fraser-Molina, Maria and Constanza Gomez-Joines. ¿Qué le duele? 2nd edition. Level 2: Kechikian, Claudia. Quick and Easy Medical Spanish. McGraw-Hill. New York, 2006. Levels 3: Ortega, Pilar. Spanish and The Medical Interview. 5. Incentivize student attendance Every year, maintaining attendance in the Medical Spanish courses is a challenge. Early in the year, medical students are eager to join many activities and get involved as much as possible. However, as the year progresses, it is inevitable that students stop attending classes due to other commitments, exam studying, shadowing, and a variety of other reasons. Currently, students do not www.lmsa.net earn elective credit for attending Medical Spanish classes at Stritch, so it can be difficult for students to maintain motivation for weekly attendance throughout the school year. To solve this problem, Medical Spanish has worked with our Center for Community and Global Health (CCGH) to develop one type of incentive. Every summer, upwards of 50 first year medical students travel to developing countries on International Service Immersion trips (ISI). Many of the ISI sites are in Spanish-speaking countries, and therefore, CCGH has recognized the importance of Spanish language skills for traveling to these locations. For the past couple of years, CCGH has helped to subsidize some of the costs of the trip if the student attended 90% of Medical Spanish courses throughout the year. As one example, thirteen students traveled to Bolivia in the summer of 2013, and all thirteen students on this particular trip attended 90% of Medical Spanish classes throughout the course of the year; therefore, all thirteen students received additional funding. Nearly all of these students cited the ISI incentive as a significant motivating factor for continued attendance. While monetary incentives may not be possible in all situations, developing some type of incentive for students to continually attend class is essential for a successful program—without students, there is no class! 6. Collaborate within the school Piggybacking off of existing programs will allow your school’s peer-led Medical Spanish program to do more than it could on its own. In the past, our program has used the expertise of our Academic Center for Excellence to help our student teachers address the needs of adult learners in the classroom. Our Clinical Skills Center has also provided our program with transcripts of standardized patient encounters in Spanish and opened up the Center for Clinical Skills for students to practice patient histories and exams in Spanish. Recently, our program has expanded to incorporate Marcella Niehoff School of Nursing students into the existing Medical Spanish classes. We have seen our attendance numbers increase and project to have higher retention rates as well. The Medical Spanish program at Stritch is constantly seeking ways to provide new opportunities for students to practice their language skills. One opportunity that is currently offered to teachers and advanced students is translating at Loyola’s Access to Care Clinic. This clinic is run by Loyola medicine residents and attending medicine physicians, and they are constantly in need of help translating for Spanish-speaking patients. Interested students are able to sign up for 1-2 three hour shifts per month. During that shift, students are given the opportunity to translate for patients, while also practicing their history taking and physical exam skills. We are fortunate to work with excellent residents and physicians who are eager to assist students with their skills. Not only is this an excellent opportunity to practice Spanish communication skills, but it offers another atmosphere in which students can hone the necessary skills for taking a thorough history and developing proper physical exam techniques. Physicians and patients are grateful for the help that Medical Spanish students offer to their clinic, and students are excited to utilize this opportunity! For a program to continue, it must transition well. From year to year, student leadership positions change. The one constant is our Medical Spanish Advisory Board which consists of our Senior Associate and Assistant Deans of Medical Education, Director of the Center for Community and Global Health (CCGH), as well as other members of the Office of Medical Education and CCGH. Every year, the advisory board meets with the outgoing Program Director(s) for a report on how the year went. The board also meets with the incoming program leader(s) to discuss goals for the upcoming year. Applications for positions are submitted every spring and interviews are conducted by the program leader(s). Past teachers make up the majority of applicants. Discussion: Establishing a Peer-Led Medical Spanish Program is not without its challenges. Maintaining student attendance throughout the year, incentivizing teachers, and L.M.S.A. Journal hard-earned skills into practice. If there is not an additional elective credit or monetary incentive for students, perhaps there can be recognition on their Dean’s letter for completion of the courses. There are a variety of ways in which these goals can be met, but these challenges should be anticipated and addressed when beginning a Peer-Led Medical Spanish Program. Overcoming these challenges and starting a Peer-Led Medical Spanish Program provides a tangible and valuable skill to medical students in the clinical years and beyond. This program should be considered for implementation in medical schools across the country. pretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111:6–14. References: 1. Shin, H. B. and Kominski, R. A.. “Language Use in the United States: 2007.” April 2010. ACS-12. 2. Flores G, et al. Errors in medical inter- About the Editors 8. Structured transition 7. Provide opportunities for practice and service creating a certification program were some of the most significant problems faced when our program began, and many of these continue to be ongoing challenges. Establishing a certification program recognized by your institution’s hospitals and clerkship sites is essential for the program. Without a way to qualify students’ Spanishspeaking abilities, there is a risk of putting patient safety in jeopardy if the student interpreter is not qualified. Establishing objective benefits is key to recruiting and keeping teachers as well. Whether it’s elective credit, Honors in Global Health, or some other type of distinction, the work that Medical Spanish teachers put into the program needs to be recognized. Additionally, there needs to be an objective benefit to medical students if they are to add another commitment on top of their first and second year curriculum. For these reasons, it is essential that earning the Medical Spanish certification is recognized by clerkship sites so that students are able to put their Pg 44 Felipe Camero, OMSII Michigan State University, DO/MPH Candidate-Publication Co-Chair LMSA and main editor of journal. Born and raised in Bogota Colombia, I came to the US when I was 16 years old. Upon graduating from high school, I enlisted in the US Navy as a hospital corpsman which exposed me to medicine worldwide. After my military service, I did my undergrad at the University of South Florida were I was a spanish interpreted at the Universities free clinic as well as worked with veteran patients at the veterans hospital. Upon my acceptance to MSU, I continue my commitment to Latino Community by being a spanish coordinator in the medical missions to Peru and Guatemala, participating in an elective to Costa Rica and became a healthfair coordinator for MSU’s community integrative medicine group as well as served as a lead researcher in an HIV project to the Dominican Republic. www.lmsa.net L.M.S.A. Journal Pg 45 Pamela Castro, OMS II Michigan State University, DO/MPH Candidate-Public Relations Committee Chair LMSA and co-editor of journal. Born and raised in Lima, Peru, I came to the US to attend college. I graduated from the Florida State University with a business degree and did my premedical education at the University of South Florida. During my undergraduate studies, I became heavily involved with Latino Healthcare by managing a free healthcare clinic for the underserved. Upon my acceptance to medical school, I continued my passion to help the Hispanic communities by serving as a Spanish coordinator in medical missions to Peru and Guatemala, the main student coordinator to a Costa Rica medical elective, an executive board member of the Lansing Latino Health Alliance, participated n a public health project in Huaraz, Peru and acted as lead researcher in an HIV Project to the Dominican Republic. Abner Antonio Murray, MSTP III Case Western Reserve University School of Medicine MD/ Ph. D. Candidate-Publication Co-Chair LMSA journal contributor I was born in Santo Domingo, Dominican Republic and raised in Miami, Florida. I graduated from Florida International University (FIU) with a Bachelor of Science in Biology. As a MARC U-STAR and Ronald E. McNair Fellow at FIU, I conducted research on the translational initiation strategies of mammalian Orthoreoviruses. In addition, I functioned as the outreach and events coordinator, at Missionary Ministry “Anchor of Salvation” International, a nonprofit organization based in Miami, Florida. I was involved in organizing over 30 medical mission trips to Central, South America, and the Caribbean where medical and counseling services were provided free of cost to the most indigent Latin American communities. In 2011, I enrolled in the Medical Scientist Training Program at Case Western Reserve University in Cleveland, Ohio. Currently, I am beginning my Ph. D. in molecular virology at the Case Western Reserve University Center for AIDS Research El Poder de la Diferencia The Power of Difference Diversity is central to our core values. As a world-class academic medical and research center, OHSU educates, employs and cares for people from many cultural and linguistic backgrounds, belief systems and experiences. Dr Ruben Font MD LMSA Executive Officer -Peer Review Coordinator Current plans for LMSA: Work on organizing logistical opeartions, membership development, continue to develop the southwest region Future plans: Solidify the pipeline from highschool level to graduate level; continue working with NHMA to help with this pipeline and create more physicians to be part of the NHMA membership core. Continue to promote NHMA events, internship, opportunities for medical student; continue to raise funding for LMSA scholarship fund; eventually would like to see an LMSA leadership summer internship/retreat of some sort. www.ohsu.edu/diversity www.lmsa.net L.M.S.A. Journal Pg 46 www.lmsa.net L.M.S.A. Journal Pg 47 P R O G R A M Find the Concept or Clue . . . Click N Move # 1 USMLE & COMLEX Prep Program Do More Than JusT Pass unDersTanD anD reMeMber for a LifeTiMe Offering: • USMLE Steps 1, 2(CK and CS), and 3 • 8 Week Guarantee Program • COMLEX Levels 1, 2(CK and CS), and 3 • On Campus Housing Accommodations • Online Courses and Webinars • Standard 6 Week Program Register Today: www.PASSprogram.net | 217.378.8018 | [email protected] www.lmsa.net L.M.S.A. Journal Pg 48 www.lmsa.net L.M.S.A. Journal Pg 49 LMSA follows in the tradition of numerous minority group associations made to create a forum for networking, exchange of ideas and support between Latino Medical Students across the United States. In this spirit the LMSA annual journal supplies a forum for members and non-members to write about their experiences in school and life in general. In one unified voice we all shout the mantra: “Adelante!”