Medical Student Research Forum Posters

Assess the efficacy of ultrasound, a more accessible point of care modality, to describe the dimensions of the epidural space. Determine the reliability of ultrasound for measuring cervical and lumbar epiduralspaces for ESIs in chronic pain patients and compares these to MRI measurement.

Purpose: Compare opioid utilization in pediatric surgical patients undergoing tonsillectomy/adenoidectomy using

• Modified preoperative oral vs IV acetaminophen

• Standard multimodal pain regimen

Hypothesis: One loading dose of PO acetaminophen given pre-operatively will provide superior opioid sparing effects compared to one standard dose of IVacetaminophen.

• Postoperative residual neuromuscular blockade is associated with post-op complications

• Current blockade reversal agents are Sugammadex and Neostigmine

• Sugammadex may decrease postoperative residual neuromuscular blockade

• Sugammadex was introduced to UC Davis Academic Center on 3/11/16

The role of supraspinal circuits in the control posture after spinal cord injury (SCI) is poorly understood. Understanding how the brain encodes such information before and after SCI can inform the design a motor brain-machine interface for restoration of motor function.

• The role of supraspinal circuits in the control posture after spinal cord injury (SCI) is poorly understood. Understanding how the brain encodes such information before and after SCI can inform the design a motor brain-machine interface for restoration of motor function.

Placental mesenchymal stem cell derived-extracellular vesicles (PMSC-EVs) triggercellular regeneration with less toxicity andimmunogenicity compared to cell-basedtherapy. Conventional monolayer cell culture has low yield of PMSC-EVs which limits currentapplications.

The CELLine bioreactor, allows for a high-density 3D cell culture within a semipermeablemembrane. It has been utilized as a large-scaletissue culture method. The objective is to explore the application of the CELLine bioreactor as a novel approach to improve the production and yield of PMSC-EVs for regenerative medicine applications.

Transcatheter mitral edge-to edge repair(mTEER) is a minimally invasive, catheter-based therapy used to treat mitralregurgitation. The gold standard for intraprocedural guidance of mTEER is transesophageal echocardiography (TEE).4-dimensional volumetric intracardiacechocardiography (vICE) is an alternativeimaging modality that provides volumetricimages with multiplanar reconstruction forguidance during structural heart procedures.

Heart failure (HF) with reduced ejection fraction (HFrEF) remains a leading cause of morbidity and mortality. Heart failure withimproved ejection fraction (HFimpEF) has better prognosis and outcomes. However, improvement only occurs in a subpopulationof HFrEF.

• ACC/AHA guidelines (GLs) recommend Ex treadmill test (ETT) without imaging as the initial test to evaluate patients with chest pain who have normal baseline ECG andadequate exercise capability.

• Stress imaging (ESE or ex-MPI) preferred by clinicians because of superior sensitivity and specificity to standard treadmill.

• Studies show ETT performs adequately vs. stress imaging for Dx and progmosis.

• ETT preferred because: relatively low cost, less labor and technician demand.

Glucocorticoids (GC) induce osteonecrosis (ON) and osteoporosis (OP); however, themechanism is complicated. While GCs may increase the risk of ON by reducing angiogenesis and vasoactivity, the reduction in bone strength that accompanies GC use is greater than can be explained by the loss of bone mass alone. To try to understand this discrepancy, we evaluated GC’s effects on novel bone quality measures, including bone bone hydration, bone blood flow, and bone angiogenesis gene expression. We performed two experiments. The first was to understand the role of GC on bone hydration, bone blood flow, and strength, and whether this is altered by anti-vascular endothelial growth factor (VEGF). In the second study we evaluated GC effects on bone vascularity by evaluating gene expression in bone, and if PTH, a known vasculoactive agent, influences this.

Neurofibromatosis type 1 (NF1) is an inherited tumor syndrome caused by heterozygous germline mutations in the NF1 gene, occurring in approximately 1/2600 individuals. A subset of patients with neurofibromatosis type 1 (NF1) develop juvenile xanthogranulomas (JXGs), a non-Langerhans cell histiocytosis, and some of these patients also develop juvenile myelomonocytic leukemia (JMML).Yet, these associations are poorly delineated.JXG is a benign proliferation of non-Langerhans cells histiocytes characterized by small yellow/brown papulonodules ranging from 1-20 mm in size. JMML is a mixed myeloproliferative-myelodysplastic disorder that affects children, most often before age 6.4. The first and only systematic review on this described therisk of developing JMML 20 to 30 times higher in patients with NF1 with JXG lesions compared to those without JXG. Since then, mostly isolated case reports have either refuted or confirmed this triple association.

• Early diagnosis of melanoma is imperative for improved survival

• The diagnosis of melanoma is based on histopathologic evaluation but lacks interobserver agreement in up to 10-25% of cases1 , showing the diagnostic difficulty in a subset of melanocytic neoplasms

• Improved molecular diagnostic markers are needed, which may impact diagnosis and treatment recommendations2

• p16, the protein product of CDKN2A, is a gene frequently mutated in melanomagenesis3,4

• p16 immunohistochemistry (IHC) is becoming a commonly used marker for evaluating challenging melanocytic neoplasms

• Prospective studies on the impact of p16 IHC on the diagnosis, diagnostic confidence, and treatment recommendations by dermatopathologists of melanocytic neoplasms are lacking

For over a century, undergraduate medical education (UME) has adhered to the “two-pillar” model focused mainly on the basic and clinical sciences. As a result, newly graduated medical students often state a lack of understanding of the structure and function of the U.S. health care delivery system. To bridge this gap, in 2016 the American Medical Association’s Accelerating Change in Medical Education Consortium introduced a new “third-pillar” of UME called Health Systems Science (HSS). HSS focuses on the broader context of health care delivery including organizational structures and processes, policy, economics and management, clinical informatics and health information technology, population health, value-based care, and health system improvement.

Pepper spray and mace are common items used for personal protection and are common “less lethal” options for law enforcement use for crowd control. These agents are irritants with symptoms of exposure ranging from mild pain to potentially permanent ocular injury.

• The recent protests have increased attention on the use of these agents and their potential toxicity.

Patient experience surveys (PES) may be used to evaluate emergency department (ED) physician performance PES quantitative scores may be subject to gender biasFew studies have evaluated PES free-text comments.

Patients with critical limb ischemia and concurrent wounds suffer higher rates of amputation. An ankle brachial index (ABI) is the standard practice for screening peripheral artery disease in patients. Our study goal was to determine if high risk patients who received an earlier ABI were less likely to receive an amputation later in life.

For patients with diabetes mellitus requiring specialty care, access to routine careis essential for maintaining a high quality of life and avoiding adverse health outcomes. Telemedicine improves access to diabetes specialists and was rapidly adopted during the COVID-19 pandemic

Background: Studies have shown that there is increased risk of intrinsic acute kidney injury (AKI) in patients with Type 1 Diabetes (T1D) following an episode of diabetic ketoacidosis (DKA). An association between episodes of DKA and greater risk for future diabetic nephropathy has not previously been studied in children. This research project aims to investigate whether DKA, with its potential ability to induce lasting renal insult, incurs an increased risk of developing diabetic nephropathy.

Methods: IRB approval was obtained at two sites, the UC Davis Medical Center and Children’s Hospital of Philadelphia, for a retrospective study of all patients with a pediatric diagnosis of T1D who had ≥ 1 measure of microalbumin to creatinine ratio (MA:Cr) and had no history of non-diabetic renal disease. Data was collected on their history of DKA, all MA:Cr values, and diagnosis of microalbuminuria which served to reflect as our early marker of diabetic nephropathy. Secondary data on sex, pH of DKA episodes, age at T1D diagnosis, and average HbA1c were collected to adjust for confounding factors. The MA:Cr values will be compared across patients with and without history of DKA.

Results: Early preliminary results do show a significant association between a history of DKA and developing microalbuminuria (Table 1). However, secondary analysis involving multivariable models are needed to adjust for possible confounding variables including age, diabetes duration, and glycemic control (HbA1c).

Conclusions: The results do not yet support nor deny if there is an increased risk of microalbuminuria following DKA. Following full statistical analysis taking into consideration confounding factors, we will be able to provide further conclusions.

Adolescents and young adults (AYAs; 12-25 years old) with cancer are at high risk for elevated distress and poorer mental health outcomes than their peers. Studies have shown that, in particular, Spanish-speaking Latinos with cancer are at risk for increased psychosocial burden, lower quality of life, and higher depressive symptoms when compared to their non-Latino counterparts. Despite this, a systemic review of the literature finds a severe lack of interventional studies being conducted among Hispanic/Latinx cancer patients and survivors. PRISM (Promoting Resilience in Stress Management) is an intervention built on the premise that promoting resilience resources will reduce distress and improve outcomes. However, its efficacy has only been tested in English-speaking populations. Studies show that translating a psychosocial intervention without considering key cultural differences will inevitably be ineffective. The aim of this study is to lay the groundwork for an adaptation of the PRISM intervention for a Spanish-speaking population with an emphasis on promoting engagement and accessibility. In the literature, this process is called cultural attunement. We will focus on the first PRISM module – “Stress Management”

Patients with CHF seen by an interdisciplinary palliative care team have shown improvements in patients' quality of life, sympton burden, and mood. The Supportive Medicine Clinic (SMC) at UC Davis Health (UCDH) is a Palliative Care Clinic that is embedded in an academic cardiology practice and sees patients one day per week for sixty minutes.

The impact of being unhoused on the likelihoodof being violently injured and reinjured (+financial burden) has become more significantas the unhoused population continues toincrease. Being unhoused is associated with an increased likelihood of being re-assaulted (recidivism) after an initial violent assault compared to the housed population.

Hepatitis B (HBV) is a major global health problem disproportionately affecting the Asian population in the United States. Past research that focused on Asian health care disparities has shown a poor understanding of HBV knowledge and screening among Asian-Americans.

Metabolomics refers to the analysis of patterns of small molecular metabolites in biological samples. Given the systemic effects of Crohn’s Disease (CD) on metabolite production, immune mediation, and microbiota growth, metabolomic studies undoubtedly provide clarity into disease course and prognosis. This is a comprehensive systematic review of human studies to identify common metabolite signatures in human CD.

US elderly population is rapidly becoming more diverse. Historically, studies of aging and dementia do not reflect this increase in diversity. Aging and cognitive health is affected by psychosocial and environmental determinants that particularly impact diverse groups. White Matter Hyperintensities (WMH) are imaging findings that have been linked to dementia and Alzheimer’s Disease processes.

To date, we are not aware of a systematic review that has investigated the extent to which white matter hyperintensities contribute to the ethno-racial disparities in dementia and cognitive impairment.

• Older adults have the highest incidence of traumatic brain injury (TBI) of any age-group.

• Patients aged 65 and older comprise 15% of the population and account for 50% of TBI deaths

• Few studies have examined risk factors of morbidity and mortality in elderly, TBI patients

Adolescents and young adults (AYAs; 12-25 years old) with cancer are at high risk for elevated distress and poorer mental health outcomes than their peers. Studies have shown that, in particular, Spanish-speaking Latinos with cancer are at risk for increased psychosocial burden, lower quality of life, and higher depressive symptoms when compared to their non-Latino counterparts. Despite this, a systemic review of the literature finds a severe lack of interventional studies being conducted among Hispanic/Latinx cancer patients and survivors. PRISM (Promoting Resilience in Stress Management) is an intervention built on the premise that promoting resilience resources will reduce distress and improve outcomes. However, its efficacy has only been tested in English-speaking populations. Studies show that translating a psychosocial intervention without considering key cultural differences will inevitably be ineffective. The aim of this study is to lay the groundwork for an adaptation of the PRISM intervention for a Spanish-speaking population with an emphasis on promoting engagement and accessibility. In the literature, this process is called cultural attunement. We will focus on the first PRISM module – “Stress Management”

Lung cancer is the leading cause of both cancer and cancer-related mortality in the United States. Targeting different receptor tyrosine kinase pathways has proven to be a potent therapeutic strategy for such cancers.

- Sickle Cell Disease (SCD) predominantly affects people of African ancestry and a multidisciplinary complex care model has been suggested to optimize care

- Young adults (YA) 18-25 years of age transition from pediatric to adult models of care and the effect of receiving care at multiple medical facilities (fragmentation) during this time on outcomes has not been well-described

- We sought to examine fragmentation of care for YA SCD patients and the potential effect of fragmentation on mortality.

A small but significant portion of UCDMS inpatients have been medically cleared discharge but are unable to be placed for weeks to months.

Extended boarding in hospital beds is harmful to patients

• Patients are at risk for falls or hospital acquired infections.

• Hospital beds lack privacy and quiet offered by lower levels of care, which is especially unhealthy for patients with psychiatric or neurocognitive comorbidities.

Extended boarding in hospital beds is expensive and wasteful

• Care at UCDMC is significantly more expensive than at lower levels of care, so weeks or months spent at a higher than necessary level of care represents a significant and unnecessary expenditure of resources.

From January to December, 2019, there were 53 adult patients with LOS>100 days. 17 of those patients were medically justified for staying that long and were discharged within a week of medical clearance. The rest, 36 patients, were discharged 13 to 732 days (mean of 218 days) after medical clearance.

The factors associated with LOS Outliers have been described, but previous studies have not focused on a populations with such large minimum LOS. This study seeks to characterize and quantify the barriers to discharge faced by LOS>100 patients who have been medically cleared but have difficulty finding placement at a lower level of care.

Atypical presentations of conditions make identifying source of Fever of Unknown Origin (FUO) challenging. Incidence of hepatic abscesses (HA) in the pediatric population in the U.S. is 25 per 100,000 admissions. Most cases occur in children with predisposing factors such as appendicitis or immunocompromised state.

• Epidemiologic investigation used to make policy changes and prevent future spread

• Timely and accurate investigation vital for staff and patient safety

SARS-CoV-2 superinfection can masquerade as COVID-19 flare or non-infectious ARDS. No method of diagnosis of bacterial pneumonia exists for non-intubated patients. Lower respiratory culture results in ~1 week and not all pathogens can be cultured. Differential diagnoses have contradictory treatments. We aimed to compare host transcriptomics of Delta variant versus other variants. We aimed to characterize microbiome of upper and lower airway in patients with COVID-19

According to the CDC, chlamydia and gonorrhea are the most reported bacterial STIs in the United States and their rates are increasing. The CDC guidelines were updated in December 2020 to suggest a single IM dose of 500mg of ceftriaxone for treatment of gonorrhea, and if chlamydial infection is not excluded, a dual therapy combined with 100mg doxycycline 2x/day for 7 days. Inappropriate antibiotic use has contributed to growing resistance. It is important for health care providers to follow evidence-based treatment guidelines to prevent further AMR and ensure the best possible outcomes for patients. But are providers away of these new guidelines and have they accepted them into their practice? This exploratory study aims to determine how providers with different levels of background and experience will treat gonorrhea and chlamydia infections.

State and national guidelines recommend that prescribing opioids for chronic pain should be based on patients’ progress towards mutually agreed on, objective treatment goals. Physicians lack practical advice on discussing goals. We lack research on how, when, and why patients with chronic pain discuss treatment goals during clinic visits.

Up to 25% of US women regret having undergone surgical sterilization. Intrauterine contraception (IUC) can be safely used for up to 20 years offering rapidly-reversible contraception that is as effective as surgical sterilization. FamilyPACT covers service for Californians living at or below 200% of the Federal Poverty Level, who do not meet criteria for Medi-Cal eligibility. Discriminatory medical practices have long-term effects on minority communities’ trust in the healthcare system. California has a problematic history of eugenics practices that spanned over 70 years, until 2010.

Long-term management strategies to preserve graft function in post-renal transplant patients have largely remained stagnant. Whole-food plant-based dietary counseling has beenshown to reduce the incidence of comorbidities(diabetes, dyslipidemia, and hypertension) that post-transplant patients are at increased risk for developing. It is not yet standard-of-care to offer post-transplant patients long-term dietary counseling. Whole-food plant-based dietary counseling is a cost-effective and safe intervention that can be widely distributed.This examines if three months of whole-food plant-based dietary counseling in post-renal transplant patients can reduce the incidence of comorbidities thus improving graft & patient outcome.

During the COVID-19 pandemic, medical education has drastically changed to a remote format, with independent and e-learning becoming more valuable. While virtual learning of ultrasound has shown to be effective, there is scant literature regarding the efficacy of independent remote learning of the Extended Focused Assessment with Sonography in Trauma exam (E-FAST).

• Nationally, students in their pre-clerkship years have been abruptly transitioned to a mostly or entirely virtual educational experience. In this research study, we explored the impacts of this radical and sudden change on medical student well-being.

• How does the COVID-19 pandemic affect this already staggeringly high burn-out rate? To our knowledge, this question has not been thoroughly explored in the literature.

• We hypothesized that the sudden changes in medical education—including the loss of many timed and anticipated traditions, such as physical exam sessions, shadowing, and preceptorships— may potentially have negative effects on the mental health of medical students.

Mentorship has been shown to play a large part in career development, program retention and workplace satisfaction. Previous studies have shed light on the importance of improving the representation of women and racial minorities among faculty mentors across several medical specialties. This is especially true in the field of surgery, where female and minority representation has been historically low. Women, for example, represent only 15% of orthopaedic surgery residents while racial/ethnic minorities account for 3% to 10% of US orthopaedic surgeons. Recognizing these continued disparities, our study aimed to describe the implication and perception of need for same-sex and same-race mentorship and role models at evolving stages of a medical career, from medical student to resident to attending physician and to explore if these differences affect specific career choices within the field of medicine.

Salmonella Typhi is the causative agent of typhoid fever, which is a lifethreatening, systemic disease, with an estimated global disease burden of 21.6 million cases annually, resulting in about 220,000 deaths. Due to the absence of convenient animals models to study S. Typhi and other typhoidal Salmonella serovars, our understanding of typhoid fever pathogenesis is still incomplete.

Tuberous Sclerosis (TS) is a genetic disorder that affects multiple organ systems and is associated with growth of non-malignant hamartomas throughout the body. The disease is highly associated with seizures, cognitive impairments, and behavioral or social deficits such as ASD or ADHD.

There have been various studies examining the association between TS and intellectual and behavioral outcomes for young patients using event related potentials (ERPs) obtained on EEG. This includes the Mismatch Negativity (MMN) ERP. The measurement of these potentials is a reliable, non-invasive method to compare brain activity patterns across subjects. Following from previous study data, we want to explore specific, altered patterns of electrical activity in TS patients with ASD that are distinct from those found in TS patients without ASD.

Long-term management strategies to preserve graft function in post-renal transplant patients have largely remained stagnant. Whole-food plant-based dietary counseling has beenshown to reduce the incidence of comorbidities(diabetes, dyslipidemia, and hypertension) that post-transplant patients are at increased risk for developing. It is not yet standard-of-care to offer post-transplant patients long-term dietary counseling. Whole-food plant-based dietary counseling is a cost-effective and safe intervention that can be widely distributed.This examines if three months of whole-food plant-based dietary counseling in post-renal transplant patients can reduce the incidence of comorbidities thus improving graft & patient outcome.

An accurate determination of Glomerular Filtration Rate (GFR) is essential in the evaluation of living kidney donors. The gold standard measurement of GFR is urinary clearance of inulin, which is a cumbersome and difficult testing process. Iohexol is a non-ionic contrast agent with low extrarenal excretion, tubular secretion or reabsorption, and protein binding affinity, and is therefore a good agent for measurement of GFR (mGFR).

Iohexol has also been found to be virtually non-toxic, with low cost and can yield mGFR with one timed blood draw.

Characterization of electrophysiological recordings during deep brain stimulation (DBS) surgery is critical for anatomical targeting and is extensively utilized to investigate physiologic markers of Parkinson’s Disease (PD). Transient improvement in clinical symptoms has been reported after microelectrode penetration, but the mechanism(s) underlying this improvement are not well understood. Thus, we sought to determine the electrophysiologic effects of microelectrode penetration in the Subthalamic Nucleus (STN).

Stereo-electroencephalography (SEEG) is a commonly used method for intracranial monitoring in patients with medically intractable epilepsy. Depth electrodes are inserted to localize seizure onset zones and map epileptic and neural networks in order to plan further therapeutic surgeries such as resection or neuromodulation.

Due to the placement of SEEG electrodes in deep brain structures, accuracy is important to ensure the intended areas are sampled and to minimize complications. Various methods exist for placement, and can be broadly classified into frameless and frame-based methods. The former includes roboticassisted insertion and frameless navigation guidance systems, and the latter most commonly includes Leksell and CRW frame-based insertion. Despite the widespread use of these techniques, a recent meta-analysis was unable to find superiority of one method over the others.

We aimed to compare the accuracy, precision, and safety of these methods. We hypothesized that frame-based insertion would be more accurate and precise as compared to frameless insertion, with equal safety profiles for the two techniques.

The Theory of Mind (ToM) refers to the ability to assign mental states to oneself and others. The development of this social cognitive ability is a major issue in people with Autism Spectrum Disorder (ASD). Although we understand what the impairment consists of on a psychological level, how and why this deficit manifests on a physiologic level remains elusive. Current treatment of the ASD remains primarily psychological with a heavy emphasis on behavioral therapy. A deeper understanding of the neurophysiologic mechanisms and neural networking in ToM cognition can bring us closer to adapting neuromodulatory advancements for the treatment of behavioral deficits in ASD.

The majority of physiologic research in ToM comes from neural imaging, namely fMRI. These fMRI studies point to the temporal parietal junction (TPJ), the medial prefrontal cortex (mPFC), and the anterior and posterior cingulate cortex (ACC/PCC) as primary components of ToM networking. The downfall of fMRI data is the poor spatial resolution. Intracranial electrocorticography (ECoG) has the ability of providing unrivalled temporal resolution of neurological data because the electrodes are recording directly from the surface of the brain. Due to the invasive nature of this approach, this is not a common way to obtain neural recordings of cognitive processes.

Several studies have shown the promise of cognitive ERP (event-related potential) as a cost-effective and non-invasive modality for monitoring forms of pathological aging such as Alzheimer’s Disease. Specifically, ERP waveforms P600 and N400 have been shown to be sensitive to pathological aging and potentially predictive for development of Alzheimer’s Disease. In collaboration with UCSD, the Olichney Cognitive Electrophysiology and Neuroimaging (CEAN) lab has been conducting a multiyear longitudinal study to better understand and characterize Alzheimer’s Disease progression through ERP biomarker analysis. This study involves recruitment of four patient groups (control, “preclinical” Alzheimer’s Disease, mild cognitive impairment, and mild Alzheimer’s Dementia) that undergo initial ERP testing with repeat testing at 12 months and 24 months. Here, we assess the preliminary changes seen in ERP waveforms P600 and N400 for enrolled patients with AD progression at baseline when compared to a normal aging cohort. By using average z-scores for each patient group, we found that P600 amplitude was reduced significantly in all three AD groups when compared to the normal control. This suggests that P600 may be a sensitive marker of AD progression prior to clinical symptoms showing. We also found that the N400 congruous effect was increased in MCI and AD patients but not preclinical AD, suggesting that N400 changes may occur later in AD progression than P600. Due to small sample size, however, further statistical analysis must be conducted to confirm these trends when enrollment restarts in Spring 2021.

Atrial fibrillation (AF) is directly associated with cognitivedecline and dementia1,2. AF can alter cerebral blood flow3, which may disrupt white matter (WM) integrity, and lead to cerebral vascular disease (CVD). Cerebral free water (FW), derived from Diffusion Tensor Imaging (DTI), can predict most subtle WM microstructuralchanges in young healthy adults4,5 and is strongly associated with WM injury in older adults6.  Fractional anisotropy (FA), also derived from DTI, is a sensitive measure of brain connectivity. Decreased FA is associated with poorer cognitive and executive function 7.  This study aimed to investigate whether AF is a risk factor for CVD in non-demented individuals using two biomarkers: cerebral FW and FA.

Major burns (burns >20% body surface area) can cause a patient’s body to enter a hypermetabolic state, in which increased calories and protein are required to meet elevated nutritional demands. Adequate nutrition can help avoid severe consequences that arise from inadequate nutrients, such as weight loss, wound healing, and infections. Normally, patients are given a rate-based feeding regimen. However, this method often falls short of meeting the patient’s nutritional demand. Recently, volume-based feeding has been introduced as a superior alternative.

• 59% of women of reproductive age (WRA) in Cameroon had inadequate folate intake in 2009. 1

• Folate deficiency increases the risk of neural tube defects (NTD), specifically spina bifida and anencephaly.

• The prevalence of NTD in Cameroon from 1997-2006 was four times that of the US, at 1.99/1000 cases per year. 2

• Wheat flour fortification with micronutrients – including folic acid – was implemented in Cameroon in 2011, showing marked improvement in micronutrient status in WRA. 1

• Food fortification programs are considered cost-effective; most cost-effectiveness estimates rely either on cost-perindividual reached or biological impact.

Numerous studies in clinical literature have explored the link between nutrition and skin. However, it remains unclear whether patients come to their dermatologists with knowledge from these studies and where they obtain their skin health information. We characterized patient perceptions surrounding nutrition and skin health, including what patients identify as aggravating and alleviating foods and their sources of information.

• About 2-10% of all pregnancies are affected by gestationaldiabetes mellitus (GDM)

• Women with GDM are 7x more likely to develop type 2 diabetes mellitus compared to those without GDM within 10years after delivery

• ADA and ACOG recommend glucose testing at 4-12 weeks after delivery to identify women with diabetes or impairedglucose metabolism

• Postpartum glucose screening rates in women with GDM remains strikingly low at 3.4%-38%

• Scheduling an earlier postpartum visit resulted in higher attendance rates; however, there is limited data on how anearlier postpartum visit may impact rates of postpartum glucose testing

To provide better support to houseless individuals’experiences with MAB.

Melanoma is one of the most common malignancy of both women of child-bearing age and during pregnancy. Modulations of the immune system that occur during pregnancy may play a role in the prognosis of melanoma in pregnancy (PAM).

Purpose: To identify clinical and anatomic factors associated vision loss in eyes with treatmentnaïve diabetic macular edema (DME) and good initial visual acuity (VA)

Methods: Retrospective cohort study following long-term natural history of eyes with untreated center-involving DME and baseline VA ≥ 20/25 seen at the University of California, Davis Eye Center between March 2007 to March 2018. We collected clinical characteristics including diabetes type, hemoglobin A1c, presence of visual symptoms, VA, and diabetic retinopathy (DR) severity; and spectral domain-optical coherence tomography (SD-OCT) biomarkers including central subfield thickness, intraretinal cyst size, intraretinal hyperreflective foci, disorganization of the retinal inner layers (DRIL), and outer retinal layer disruptions, to determine factors associated with vision loss as defined by the DRCR Protocol V study as threshold for initiating aflibercept therapy.

Results: 76 eyes (67 patients) with untreated DME and mean baseline VA of logMAR 0.05 ± 0.05 (Snellen 20/22) was followed for an average of 4.3 ± 3.2 years, with a median time to vision loss of 335.5 days (11 months). Older age (hazard ratio (HR) 1.027/year, P = 0.04) and eyes with severe non-proliferative DR (HR 2.42, P = 0.01) or proliferative DR (HR 3.79, P < 0.001) showed higher risk of vision loss, while no SD-OCT biomarker showed significant association.

Conclusions: In eyes with DME and good initial vision, older patients or those with worse DR severity should be monitored more closely for prompt treatment initiation when vision loss occurs.

Inequities in distribution of specialty ophthalmology care. Increased studies demonstrating efficacy, cost efficiency of teleophthalmology. Rising concerns of compensation, perhaps hindering adoption.

Visual impairment decreases quality of life, impacts health outcomes, and places substantial economic burden in the United States. Racial/ethnic disparities exist in the rates of eye disease and eye care utilization, with Chinese Americans having lower rates of utilization than African Americans and whites.  To meet the eye care needs of Sacramento’s large Asian community, U.C. Davis Eye Center and Paul Hom Asian Clinic (PHAC) partnered together to offer no-cost ophthalmologic services for underserved Asian Americans and immigrants. There is limited data examining patterns of eye disease prevalence and eye care utilization for high-risk populations in an Asian free healthcare clinic setting. Our study aims to understand these patterns at Paul Hom Eye Clinic and identify potential barriers related to follow-up management.

Ultrasound of the foot and ankle offers low cost, in-office real-time dynamic imaging without radiation. Given the complex and relatively smaller size of the many joints of the foot, ultrasound guidance can increase the accuracy of intra-articular aspirations and injections. Whether helping to establish a diagnosis, aid in nonoperative treatment or localize anatomy for postoperative pain control, ultrasound is an invaluable imaging technique for a foot and ankle surgeon.

The use of Bone Morphogenetic Protein clinically is supra-physiologic in concentration.

Bone Morphogenetic Protein 2 (BMP2) is used everyday in orthopaedic surgeries and bone autografts, but it is not used in normal biological amounts.

Clinical uses are 1 million times more than concentrations found physiologically.

Cartilage Oligomeric Matrix Protein (COMP) is known to bind proteins from the TGF superfamily and makes the presentation of BMP2 enhanced due to their binding interaction.

The aging population are participating in more athletic  and physically demanding activities longer and later in life.  The debate over the best graft for ACL reconstructions has been ongoing for years and there are numerous studies supporting all types, but none focus on the older population.  This study aims to report allografts are an equally viable and effective option for ACL reconstruction in patients over 40 years of age with no difference in re-rupture rates.

Frontal sinus fractures represent approximately 10-15% of maxillofacial fractures and are generally a result of high-speed motor vehicle accidents, assaults, or sporting injuries1. Historic treatment options have included: observation, open reduction and internal fixation, obliteration, and cranialization. Frontal sinus fractures often occur with involvement of the frontal sinus outflow tract (FSOT) which has been treated aggressively to prevent complications including CSF leak, sinusitis, mucocele, meningitis, or brain abscess. To avoid the possibility of these complications, immediate surgical treatment of FSOT fractures has been a standard practice. However, early surgical intervention has an intrinsic morbidity, and through technologic and endoscopic advances, conservative management (i.e. observation) of FSOT fractures has become more common as well as a more viable option to treat the described long-term complications.

The current coronavirus (COVID-19) pandemic has had a profound impact on patient care due to delays in healthcare delivery. We aim to compare wait times of definitive treatment in patients newly diagnosed with HNSCC before the pandemic versus those seen during the pandemic at a single academic institution.

Hiatal hernia (HH) involves the displacement of abdominal organs through the esophageal hiatus to above the diaphragm into the thoracic cavity. The overall prevalence of HH varies between 10-80% and increases with age, higher intrabdominal pressure (ex: obesity), genetic predisposition, congenital defect, and trauma. Sliding HH results in acid and non-acid reflux. Chronic exposure of the esophagus to refluxate can results in dysphagia, difficulty swallowing, due to impaired esophageal motility.

Neurofibromatosis type 1 (NF1) is an inherited tumor syndrome caused by heterozygous germline mutations in the NF1 gene, occurring in approximately 1/2600 individuals. A subset of patients with neurofibromatosis type 1 (NF1) develop juvenile xanthogranulomas (JXGs), a non-Langerhans cell histiocytosis, and some of these patients also develop juvenile myelomonocytic leukemia (JMML).Yet, these associations are poorly delineated.JXG is a benign proliferation of non-Langerhans cells histiocytes characterized by small yellow/brown papulonodules ranging from 1-20 mm in size. JMML is a mixed myeloproliferative-myelodysplastic disorder that affects children, most often before age 6.4. The first and only systematic review on this described therisk of developing JMML 20 to 30 times higher in patients with NF1 with JXG lesions compared to those without JXG. Since then, mostly isolated case reports have either refuted or confirmed this triple association.

Machine learning (ML) is an application of computational and statistical techniques to allow computers to learn and predict without explicit programming. In recent years, with the increasing availability of large scale and low-cost computing power, ML capacity has expanded vastly and has begun to change how many industries operate. The ability of machines to analyze large, complex datasets and to detect patterns beyond the scope of the human mind provides a powerful opportunity for application in a healthcare setting. ML has introduced new approaches to many dimensions of medicine including, but not limited to, Pathology, Radiology, drug development, enhancing existing clinical predictive tools, and the management of many diseases including cancer and autoimmune diseases. Currently, ML remains in its infancy but has already started to make an impact in various healthcare disciplines. This research project aimed to provide the foundational training and understanding of the modern approaches to ML and develop the skill set necessary to use available healthcare data to develop and deploy new ML models to assist in the delivery of future healthcare.

Introduction: In the era of molecular diagnostics and personalized medicine, it is becoming increasingly important to save tissue for downstream testing for optimal pathologic diagnosis. Unfortunately, conventional histology processing and its expenditure of tissue for H&E imaging often results in inadequate material for essential molecular tests downstream. Microscopy Using Ultraviolet Excitation (MUSE) has emerged as a promising potential answer in providing a novel tissuesparing method of generating morphologic imaging without the need to fix or cut fresh tissue. We aim to standardize protocols for imaging an array of CNS tumor samples and demonstrate equivalency to traditional FFPE H&E in terms of generating images for tumor diagnostics.

Materials and Methods: 24 CNS tumor biopsy specimens were imaged using the MUSE interface, then subsequently fixed and paraffinembedded for traditional H&E staining. Each pair of slides (MUSE and H&E) were then read by a panel of 4 neuropathologists, and the diagnosis by each reader was recorded as correct or wrong. Combined accuracy was calculated within each diagnosis category and for each pathologist.

Results: In surgical resections of 24 adult patients (mean age 54 years) with newly diagnosed brain and spinal cord tumors, 7/24 were diagnosed by conventional methodology with diffuse astrocytic/oligodendroglial tumors, 8/24 with meningiomas, 3/24 with ependymal/choroid plexus tumors, 3/24 with tumors of cranial/paraspinal nerves, and 3/24 with metastatic tumors. 97% concordance was observed among MUSE versus light microscopy diagnostics, with 94% within the pathologist panel.

Conclusions: MUSE imaging appears to have been successful in reliably generating diagnostic-quality histological images of CNS tumors. This is supported by inter-pathologist concordance on diagnoses made through both MUSE and traditional H&E images. Ongoing studies are expected to expand to assessments of grading MUSE images of more diagnostically difficult brain and spinal cord tumors.

1. Quantify stride-to-stride variability in typically developing (TD) children using three-dimensional gait analysis (3DGA) in an expanded set of 14 kinematic variables.

2. Assess the effect of laterality, age, and sex on stride-to-stride variability

Neurofibromatosis type 1 (NF1) is an inherited tumor syndrome caused by heterozygous germline mutations in the NF1 gene, occurring in approximately 1/2600 individuals. A subset of patients with neurofibromatosis type 1 (NF1) develop juvenile xanthogranulomas (JXGs), a non-Langerhans cell histiocytosis, and some of these patients also develop juvenile myelomonocytic leukemia (JMML).Yet, these associations are poorly delineated.JXG is a benign proliferation of non-Langerhans cells histiocytes characterized by small yellow/brown papulonodules ranging from 1-20 mm in size. JMML is a mixed myeloproliferative-myelodysplastic disorder that affects children, most often before age 6.4. The first and only systematic review on this described therisk of developing JMML 20 to 30 times higher in patients with NF1 with JXG lesions compared to those without JXG. Since then, mostly isolated case reports have either refuted or confirmed this triple association.

In May of 2022, parents living in the United States (U.S.) experienced a significant infant formula shortage with national out-of-stock rates of up to 74% for the week ending in May 28, 2022. Longstanding Contributing Factors:few U.S. formula producers, U.S. trade policy and high tariff rates, Infant formula rebate contracts used by the Special Supplemental Nutrition Program for Woman Infant Children(WIC).

FSHD is an autosomal-dominant disorder that asymmetrically affects the face, shoulders, and upper arms and later progresses to affecting the trunk and lower extremities. Symptoms usually begin before the age of 20 with a prevalence thought to occur around 4-10 per 100,000 people (1,2). The pathogenesis has been linked to the inappropriate expression of DUX4, a gene usually limited to the germline, that relaxes the chromatin either by a loss of macrosatellite repeats (D4Z4) or mutations in the structural maintenance of chromosome flexible hinge domain containing gene 1 (SMCHD1).

Anterior Cruciate Ligament (ACL) injuries are prevalent in the United States and are associated with poor quality of life and decreased physical activity. Use of surgical intervention for the treatment of ACL injuries carries a myriad of challenges for patients including but not limited to high cost of treatment as well as an increased risk of developing secondary osteoarthritis. Given these difficulties associated with the application of surgical intervention in the treatment of acute ACL tears, more and more patients are looking for less invasive, cost-effective treatment modalities including the application of autologous stem cell treatment. While physicians have begun to offer more autologous stem cell treatment modalities to patients who have experienced acute ACL tears, there is still a lack of quality research that demonstrates the efficacy of these therapies, thus indicating the need for more thorough studies that evaluate the effectiveness of this regenerative orthobiologic technology. Bone Marrow Aspirate Concentrate has risen as a potential viable option for patients interested in regenerative, less invasive treatment of knee pathologies

Females are at higher risk for non-contact anterior cruciate ligament (ACL) injuries compared to males, in part due to sex-based differences in neuromuscular control during high-risk tasks such as jump landing.  Strength development during puberty tends to be lower and delayed in females compared to males; this may result in compensatory neuromuscular control patterns that placefemales at higher risk for ACL injury. The relationship between strength development andneuromuscular control is not currently known.The objective is to determine the effect of sex, strength, and pubertal stage on neuromuscular control during jump landing in middle school children.

Background: Transdermal drug delivery (TDD) is a method used to deliver a therapy into systemic circulation across the skin. Transdermal therapeutic administration is common practice in response to chronic inflammatory skin disease. However, subtherapeutic outcomes are prevalent without known cause. This is largely due to inter- and intraindividual variability of drug absorption through the skin. It is known that the inherent skin membrane function poses unique challenges to effective systemic drug delivery. Diffusion, metabolism, and other skin biophysics profiles and their contributions to drug response have yet to be fully elucidated.

Problem: The use of computational and predictive modelling poses potential to assist drug developers and clinicians in determining the most effective drugs for a given patient with their unique biological profile. Given the intricacies of biological interplay, it is important to determine which biological factors are the most predictive for drug delivery efficacy.

Why this model?: This one compartment model is used to simply illustrate the relationship between varied simulated rate constants and drug concentrations of the drug donor and acceptor as it relates to time

Multiple sclerosis (MS) is an autoimmune disease effecting around 1 million people in the US. This disease in associated with physical symptoms such as fatigue, weakness, pain and psychological symptoms such as mood problems and diminished sociability. MS also has been shown to be sexually biased toward females. In this project we have used the experimental autoimmune encephalomyelitis (EAE) and relapsing remitting experimental autoimmune encephalomyelitis (RREAE), the mouse model for MS. We hypothesized that EAE progression is associated with changes in muscle strength, balance, pain, and sociability and that these variations are linked to sex and/or strain. Our results indicate that strain but not sex influenced differences in muscle strength and balance during EAE, and both sex and strain have an impact on sociability and mechanical nociception, regardless of EAE disease status. Our goal is to provide some insight about the change in social behavior of MS patients and its effect on their social and day to day activities.

Examine the number of appointments fulfilled within the past year, contrasting between the behavioral health clinic at Willow Free Clinic and the newly introduced hybrid model. Our hypothesis suggests that implementing the hybrid model at the behavioral health clinic will lead to an increase in the number of patients identified as screening positive and subsequently accessing care.

The BOT-2 is a valid and reliable tool to measure motor function in children with ASD for initial diagnostic evaluation and for therapeutic interventions.

Objectives: Latino individuals report high rates of childhood trauma, but the impact of parenting styles on childhood maltreatment (CM) in this population is unknown. This study examined the association between CM and parental bonding (PB) among adult Mexican Americans and Mexican nationals seeking services at primary care and mental health clinics on both sides of the California-Mexico border.

Methods: The Childhood Trauma Questionnaire and Parental Bonding Instrument were administered to 516 patients at one of 8 clinics in San Diego and Imperial, CA and Tijuana, Mexico between 2007 and 2008. Statistical analyses included Chi-square tests and multivariable logistic regression.

Results: Among respondents, 305 reported moderate to severe CM and 210 reported mild or no CM. PB style of mothers [N=503, χ2 (3)=115.69, p < .001] and fathers [N = 417, χ2 (3)=70.4, p < .001] was significantly associated with CM history. Patients who characterized their maternal bonding as “affectionless control” had an 8.94-fold higher odds of reporting moderate to severe CM compared to patients who characterized their maternal bonding as “optimal parenting” (95% CI, 4.51 to 17.73). Patients who characterized their paternal bonding as “affectionless control” had a 10.90-fold higher odds of reporting moderate to severe CM compared to patients who characterized their paternal bonding as “optimal parenting” (95% CI, 4.96 to 23.96). Maternal and paternal “affectionless control” were associated with higher odds of emotional, physical, and sexual abuse and of emotional and physical neglect compared to “optimal parenting.”

Conclusions: Suboptimal parenting near the California-Mexico border is associated with CM, which may negatively impact patients’ physical and mental health and socioeconomic opportunities into adulthood. These results may be used to develop and test parenting interventions in the border region to increase “optimal parenting” and decrease “affectionless control” practices.

Neurofibromatosis type 1 (NF1) is an inherited tumor syndrome caused by heterozygous germline mutations in the NF1 gene, occurring in approximately 1/2600 individuals. A subset of patients with neurofibromatosis type 1 (NF1) develop juvenile xanthogranulomas (JXGs), a non-Langerhans cell histiocytosis, and some of these patients also develop juvenile myelomonocytic leukemia (JMML).Yet, these associations are poorly delineated.JXG is a benign proliferation of non-Langerhans cells histiocytes characterized by small yellow/brown papulonodules ranging from 1-20 mm in size. JMML is a mixed myeloproliferative-myelodysplastic disorder that affects children, most often before age 6.4. The first and only systematic review on this described therisk of developing JMML 20 to 30 times higher in patients with NF1 with JXG lesions compared to those without JXG. Since then, mostly isolated case reports have either refuted or confirmed this triple association.

Racial inequities in medicine have impacted health outcomes in various communities. These inequities have been documented in journals to highlight racial inequities in health status, racial inequities in clinical algorithms, and racial identity and health. We conducted a review of literature and selected 95 articles to analyze and summarize in an annotated bibliography. The annotated bibliography was sorted into four categories: racial inequality in health status, racial inequality in clinical algorithms, racial identity and health (ex. mental health, development, schooling, etc.) including biracial and multiracial individuals, and the impact of racism on health. These articles highlight a theme of racial inequities in policy making, racial perceptions which influence clinical decision making, and the use of race as a sole indicator for diagnosis and treatment options in clinical algorithms. Racist perceptions against non-white patients were found to negatively influence clinical decision making in emergency settings.

The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 has expanded health care access in the United States by subsidizing insurance premiums, establishing marketplaces for private insurance plans, and expanding Medicaid eligibility. 1 Since the passage of the ACA, more than 20 million previously uninsured people have been able to enroll in health insurance programs. Despite these gains, more than 32 million Americans remain uninsured. 2 Uninsured patients rely heavily on safety-net services such as free clinics for medical care. There are over 1,000 student-run clinics (SRCs) and other free clinics in in the United States, serving over 1.8 million patients annually. 3 These clinics primarily provide primary care services, although some clinics offer a broader scope of care. Nevertheless, these clinics do not offer the full range of services available in other care settings to patients with insurance. 3,4 Despite the increased availability of health insurance, there are still barriers that prevent uninsured patients of free clinics from enrolling in health insurance. Several studies have examined these barriers and a few studies have examined the protocols used by clinics to enroll patients in health insurance and effectiveness of these protocols. The purpose of this review is to synthesize the findings of studies that have assessed these topics.

Radiation therapy is an integral part of treatment of early -stage breast cancer. Utilizing prone treatment plan can help minimize heart irradiation. However, prone setup is more difficult to replicate than standard supine technique

Second primary lung cancer (SPLC) occurs at a rate of 1-2% per year in nonsmall cell lung cancer (NSCLC) patients following surgical resection. Wang and colleagues examined patterns of second primary lung cancer in patients undergoing CT scans at fixed 6-month intervals during the first 2 years. All patients in their study but one had the second primary lung cancer identified at the asymptomatic stage (Y. Wang et. al). It is critical to detect SPLC when asymptomatic as presence of symptoms at diagnosis is associated with detection at later stage and worse overall survival (L. Calman et. al)( F. Lou et. al). With increasing implementation of stereotactic ablative radiotherapy (SABR) for medically inoperable, early stage NSCLC, improved understanding of SPLC in this population is important.

To determine if CT features of adrenal nodules and of the remainder of the abdomen can predict autonomous cortisol secretion (ACH) in patients with adrenal nodules, and to identify a nodule size threshold below which ACH is unlikely. Retrospective review of adult patients with adrenal nodules who underwent CT of abdomen and 1-mg Dexamethasone suppression test within one year of each other. Patients were considered to have no ACH if serum cortisol was < 1.8 µg/dL after the 1-mg dexamethasone suppression test and to have possible or definite autonomous cortisol secretion if serum cortisol was > 1.8 µg/dL. The following CT features were assessed: Adrenal nodule length, nodule width, unenhanced nodule attenuation, contralateral adrenal gland thickness, visceral and subcutaneous adipose tissue area, skeletal muscle area and density, and unenhanced liver attenuation. 29 patients had no autonomous cortisol secretion and 29 patients had possible or definite autonomous cortisol secretion. Nodule length and width were the only two variables that significantly differed between patients with nonfunctional nodules and those with possibly or definitely functional nodules. Using a threshold nodule length of 1.5 cm, the sensitivity and specificity for predicting possible or definite autonomous cortisol secretion was 93.1% and 37.9% respectively. Autonomous cortisol secretion in patients with adrenal nodules correlates with increasing nodule size. A nodule length threshold of 1.5 cm provides 93.1% sensitivity for predicting possible or definite ACH based on the 1-mg Dexamethasone suppression test.

Cholecystectomy is the gold standard treatment for patients with acute cholecystitis. Patients who are high risk for complications from cholecystectomy can be offered percutaneous cholecystostomy (PC) tube placement. PC can be done to bridge high-risk patients for subsequent, elective cholecystectomy. 129 patients were identified to have undergone PC at UC Davis. 122 patients had their initial tube placed by UC Davis. Manual chart review to evaluatecharacteristics of patient population who’vereceived a PC tube, including demographics,radiation exposure, complications, andtreatment course.

The study aim was to characterize patientswho received PC at a tertiary academichospital to evaluate the potential populationbenefitting from gallbladder thermoablation.

Shoulder MRI occasionally shows a low signal prominence at the anteroinferior glenohumeral joint (GHJ) recess resembling thickened capsular tissue which has an uncertain clinical significance.

Objectives are to examine the frequency of this finding on MR and if it is visualized on arthroscopy, and to correlate with other common shoulderpathologies seen on MR.

Catastrophic Anti-Phospholipid Syndrome (CAPS) is a rare autoimmune disorder characterized by widespread small vessel thromboembolic events in multiple organs. There are four diagnostic criteria:

1) presence of antiphospholipid antibodies

2) histopathological evidence of small vessel occlusion

3) involvement of 3 or more organ systems

4) development of manifestations in ​<1 week

A triple therapy approach of anticoagulation, corticosteroids, and therapeutic plasma exchange (TPE) or IVIG has been shown to decrease mortality. However, there are no prospective trials exist to guide chronic management, and the optimal timing and frequency of these treatments is unknown. We present the case of a patient with definitive and recurrent CAPS, and our experience with the chronic management of this rare condition.

Healthcare disparities exist in surgicalmedicine and several factors contribute tothem, including the systemic effects ofstructural racism as well as implicit biascarried by providers. Complications arisingfrom harmful institutional structures, SocialDeterminants of Health, and lack of culturalcompetency are appropriately named“Cultural Complications.” In this paper, wereview the literature for strategies surgicalresidency programs have utilized to combatboth staff and patient exposure to CulturalComplications. In addition, we introduce thenovel UC Davis Department of Surgery’sCultural Complications M&M series.

Surgical Site Complications (SSCs) may occur in up to 25% of patients undergoing bowel resection, resulting in significant morbidity and economic burden. However, the accurate prediction of SSCs remains clinically challenging. Leveraging high-content proteomic technologies to comprehensively profile patients’ immune response to surgery is a promising approach to identify predictive biological factors of SSCs.

Smoking Quit Line (QL) programs utilizing free education and telephone counseling services have been well demonstrated to effectively promote smoking cessation in outpatient primary care settings. Given that active smoking increases pulmonary complications after thoracic surgery, we sought to evaluate the efficacy of the voluntary California Smoker’s Helpline (CSH) QL program in the setting of a thoracic surgery preoperative clinic and tested the hypothesis that patients undergoing surgery would have higher durability of smoking cessation after QL intervention compared historical non-surgical figures.