On Community Health Diabetes Heart Disease Infant Mortality Obesity Opioids/Pain Management 2 0 2 0 Table of Contents

2 0 2 0

on community health diabetes heart disease infant mortality obesity opioids/pain management 2 0 2 0 Table of Contents

ART PAGE Hannah Levengood 26 LANGUAGE PAGE MATH PAGE Logan Anderson 4 Sabrina Lian 80 Sarah Carlile 77 Batsheva Miriam Altose 14 Abigail Adcock 101 Grace Liberatore 43 Hannah Duncan 66 Ethan Barker 38 Carson Bauer 30 Tina Lin 4 Madeline Foresta 55 Zachary DeRespiris 48 William Benham 102 Abigail Long 79 Olivia Galek 81 Devorah Fertel 14 Nicholas Bolger 65 Tyler Louk 109 Ariela Gettig 69 Kelly McGraw 5 Nia Bordenkircher 41 Olivia McDowell 68 Mikaili Gibson 86 Mario Misiti 5 Abigail Borris 41 Parker Miller 43 Christina Ibos 32 Nora Raicevich 5 Carys Bowen 98 Amanda Mitchell 27 Allianna Jackson 104 Benjamin Roman 48 Emma Bradley 31 Shelbee Mitchem 10 Jordan Jontz 47 Addison Schermer 57 Rachel Broihier 21 Julia Morales 83 Haydyn Kirby 106 Aaron Winters 48 Isaac Cunningham 21 Lane Murray 35 Sophia Kroto 25 Christopher Wojnar 48 Anne Christy Domingo 54 Bridget O’Reilly 70 Leah LaVerde 108 Katelyn Zitnik 57 Margaret Eibler 80 Halle Parrish 93 Laura Laws 91 Gianna Faini 22 Anya Parsons 79 Nisha Makkar 34 Jillian Fitz 22 Devan’re Presley 35 Jasmijn Plusnin 94 Brigette Fuentes 46 Sefra Protch 96 Emma Sielski 36 PAGE Katrina Ganson 24 Uriah Rhoades 90 Asha Singh 28 Journey Awards 114 Keenan Garceau 31 Audrey Sanzone 98 Gianna Somrak 19 Afterword 115 Grace Geisler 23 Shivangi Sengupta 109 Bradon Timms 111 Acknowledgements 116 Layne German 90 Nadiya Seniv 68 Saamia Wanzo 72 Cassidy Gibbons 70 Kaisal Shah 88 Kya Goodwin 42 Samira Smith 96 Zehra Gungor 102 Kaylee Smith 100 Curtis Harding 89 Grace Spehn 110 Bryan Harris 90 Eli Steinberg 100 Riley Hensley 103 David Szoke 97 Emily Heuler 98 Lana Traum 89 Claire Hofstra 98 Halle Vargo 71 Ross Howell 24 Tiffany Wang 23 Emma Januszewski 76 Kira Weber 30 Tania Jimenez 87 Azleigh Whitford 73 Zach Jones 90 Abigail Wilson 37 Taj Jones 87 Taylor Wilson 113 Kayla Keplinger 99 Kari Yanders 11 Colin Kirkpatrick 107 Emma Young 97 Aedyn Kraft 99 Carolyn Yuan 101 Sophia Kroto 42 Riley Zelazny 65 Sophie Laye 26 Maya Zym 54 Halle Leroux 88 Introduction

Dear Friends,

The Cleveland Clinic Office of Government and Community Relations’ Civic Education Department is pleased to present the 2017 edition of its eXpressions™ booklet. This publication celebrates the amazing accomplishmentsIntroduction of high school students who have participated in the eXpressions™ Art, Language, and Math programs.

SinceDear Friends, 2005, eXpressions™ has engaged more than 10,000 high school students — from across Ohio and Cleveland Clinic K–12 Education’s School Programs Department is pleased to present the 2020 edition of around the® world — in the creative exploration of science and medicine. Through project-based, peer-to-peer its eXpressions booklet. This publication provides a powerful display of what students produced through learning,this year’s program, participants as well as what theyinterpret experienced research and learned instudies the process. conducted by Cleveland Clinic summer interns, producing an extraordinarySince 2005, more than array14,000 students of science-inspired — from across Ohio and aroundprojects. the world — have participated in the program. This year, through project-based, peer-to-peer learning, participants creatively interpreted research studies, conducted by their peers and Cleveland Clinic caregivers, that focused on five important Ancommunity esteemed health issues: panel diabetes, of heart content disease, infantspecialists mortality, obesity, — artsand opioids/pain educators, management. professional writers and editors, scientific researchers,These powerful interpretations and mathematicians of science can help inform, — educate, evaluated and inspire this our community,year’s 1,500ultimately submissions on four criteria: interpretation of research,leading to improved presentation public health. of ideas, creativity, and initiative. Exceptional entries were awarded one of four levels ofAn esteemedrecognition. panel of content In descending specialists — arts ordereducators, they professional are: writers Blue and Ribbon, editors, scientific Red re- Ribbon, White Ribbon, and Honorable searchers, and mathematicians — evaluated this year’s 1,410 submissions from 60 schools on four criteria: Mention.interpretation of One research, art presentation submission, of ideas, creativity, one language and initiative. Exceptional submission, entries were and awarded one math submission were also recognized as Bestone of fourin levelsShow of recognition. for their In descending respective order they programs. are: Blue Ribbon, Red Ribbon, White Ribbon, and Honorable Mention. One art submission, one language submission, and one math submission were also selected as Best in Show for their respective categories. eXpressions™eXpressions is much more is thanmuch a mere more art, writing, than or amath mere competition, art, writing, however. Tied or to math state and competition, however. Tied to state and nationalnational academic academic standards, this standards, innovative program this gives innovative participants a deeper, line real-world of programs understanding gives participants a deeper, real-world of science, art, language, and math while promoting creativity, empathy, innovation, communication, and understandingteamwork. of science, art, language, and math while promoting creativity, innovation, communication, and teamwork. To further acknowledge this kind of transformative enrichment, we implemented an additional form of recognition this year, presenting ten Journey Awards. This award celebrates recipients’ growth through WeeXpressions thank and youtheir ability for toyour eloquently interest communicate in thesethe impact three their participation dynamic in the educational program has programs, and we hope you share in our pridehad on them. and amazement as you enjoy this year’s eXpressions™ booklet. We thank you for your interest in this dynamic educational initiative, and we hope you share in our pride and amazement as you experience the power of eXpressions in the pages ahead.

Sincerely,Sincerely,

Bryan Pflaum, MFA Christine M. DeNicola, MEd BryanSchool Programs Pflaum, Director MFA School Pr ograms Manager Kelli Jorz, MEd Director,eXpressions Founder Civic Education/ eXpressions Administrator Manager, Academic Affairs/ – – eXpressions™Cleveland Clinic K 12 Education Program Designer Cleveland Clinic K 12 Education eXpressions™ Program Administrator Office of Government and Community Relations Office of Government and Community Relations Cleveland Clinic Cleveland Clinic

Diabetes

Diabetes is a disease that prevents the body from properly using energy from the food we eat. If left untreated, it can lead to an array of complications, including heart disease, kidney failure, metabolic syndrome, blindness, and nerve damage in the extremities resulting in the need for amputation. As the seventh leading cause of death in the United States, diabetes directly claimed more than 80,000 lives and played a contributing role in a quarter million deaths in 2017. Fortunately, it is a treatable, often preventable disease, and research projects like the ones outlined below give us fresh insights and new hopes for solving one of today’s most pressing public health problems.

Association of Sleep Deprivation With Reduction in Methodology: The study pool consisted of 615 individuals Insulin Sensitivity as Assessed by the Hyperglycemic between 10 and 19.9 years old who were first measured in areas such as height, weight, uric acid level, and white blood Clamp Technique in Adolescents cell count. Additionally, candidates recorded the number of Ana Maria De Bernardi Rodrigues, et al. Authors: hours they slept per night in a self-reported survey. Individ-

Publication: JAMA Pediatrics, vol. 170, no. 5, 2016, pp. uals were then categorized as either sleep-deprived adoles- 487-494. Synopsis by Cleveland Clinic Editorial Intern Joan cents (less than eight hours per night) or adolescents with Moore, The Ohio State University adequate sleep (greater than or equal to eight hours per night). A subsample of 81 individuals also underwent the hypergly- Objectives: Insulin resistance or IR, a condition which in- cemic clamp technique, which is a method for measuring creases the risk for developing prediabetes, type 2 diabetes, whether or not an individual is sensitive to insulin. and a wide range of other health problems, is when a person’s muscle, fat, and liver cells don’t respond properly to Results: 41.8% of the individuals in the study were identified the hormone insulin, and are therefore unable to effectively as being sleep-deprived. Overall, the adolescents who got use glucose in the blood for energy. The researchers aimed inadequate amounts of sleep exhibited higher age, body to study the rates of IR in adolescents who were sleep-de- mass index (BMI), waist circumference, abdominal center, prived versus adolescents who got adequate sleep, and they neck circumference, uric acid levels, and white blood cell sought to pinpoint associations between sleep deprivation counts. Within the subsample, the data displayed an associ- and insulin sensitivity. ation between sleep deprivation and IR.

2 Retrospective View of HbA1C Levels After Attend- Subclinical Inflammation and Endothelial Dysfunc- ing Diabetic Shared Medical Appointments tion in Young Patients With Diabetes: A Study From

Authors: Cleveland Clinic Science Intern Aishwarya Nippani, United Arab Emirates Cuyahoga Falls High School; Cleveland Clinic Mentors Marie Authors: Elhadi H. Aburawi, Juma AlKaabi, Taoufik Zoubeidi, Grabenstetter and Lisa De La Cruz, Medina Hospital Abdullah Shehab, Nader Lessan, Awad Al Essa, Javed Yasin, Hussain Saadi*, and Abdul-Kader Souid Publication: 2018 Cleveland Clinic Science Internship Poster Presentation Publication: PLoS ONE, vol. 11, no. 7, 2016

Hypothesis: The authors’ hypothesis was that shared med- Objective: This study investigated sets of inflammatory and ical appointments (SMAs) that conduct diabetic education endothelial dysfunction biomarkers in young patients with and include self-care skills, peer group support with social diabetes. Its main purpose was to use some known predic- interaction, and HbA1C lab testing can reduce HbA1C levels tors of cardiovascular disease as screening tools for adverse in diabetic patients. effects of obesity and dyslipidemia, abnormally high levels of cholesterol or fats (lipids) in the blood, in individuals be- Methodology: Patients with diabetes type 1 and type 2 met with healthcare providers to ask questions and share their tween the ages of 12 and 31. concerns in a 90-minute timeframe. The patients were giv- Methodology: The study investigated sets of inflammatory, en self-management skills for diabetes and recommended endothelial, and adipocyte biomarkers in 79 patients with goals for HbA1C level improvement. An HbA1C lab test was type 1 diabetes, 55 patients with type 2 diabetes, and 47 administered and recorded for each patient. HbA1C levels patients without diabetes (who formed the control group). and patients’ lifestyle changes were re-evaluated after three Results: Results indicated that patients with diabetes had months and a secondary HbA1C lab test. Finally, the HbA1C higher levels of both cytoadhesive molecules and some pro- levels of patients who attended the first SMA visit and re- teins that play important roles in how the body functions, turned for the three-month follow-up visit were compared. especially related to regulating glucose levels. The patients’ Results: It was found that by attending SMAs, eight out of heart rate variability assessment revealed lower standard ten patients (80%) had decreased HbA1C levels, and two deviation of beat-to-beat intervals and lower total power, out of ten patients (20%) reported increases in their HbA1C which reflects autonomous nervous dysfunction. This study levels. Results indicated that through following target goals is also significant because diabetes and obesity are common and lifestyle changes that were recommended in SMAs, pain the United Arab Emirates, and it may be the first study tients’ HbA1C levels could be reduced. to examine inflammation and endothelial dysfunction in this young population.

*Denotes a current or former Cleveland Clinic caregiver

3 AWARD Red Ribbon

EXPRESSIONIST Logan Anderson

SCHOOL Cleveland Heights High School

CITY Cleveland Heights, Ohio

TEACHER Nancy Rich

RESEARCH THEME Diabetes

RESEARCH TITLE Subclinical Inflammation and Endothelial Dysfunction in Young Patients With Diabetes: A Study From United Arab Emirates

TITLE Chained Down

MEDIUM/GENRE Jewelry

STATEMENT I created a gauntlet interpretation of several ideas that I had for the connection between inflammation and diabetes. My piece incorporates several ideas; the chain not only suggests a connection of my ideas, but also represents the veins and blood flow. I used thicker chain to represent how blood flow is reduced and how the body feels weighed down/lethargic. The separate rings portray the causes/links between diabetes and inflammation: genetics, physical activity, diet, sleep, and body fat. The full piece symbolizes how people are imprisoned by their symptoms, have to follow a strict dietary lifestyle, and are chained to their medication.

AWARD Red Ribbon

EXPRESSIONIST Tina Lin

SCHOOL Brecksville-Broadview Heights High School

CITY Broadview Heights, Ohio

TEACHER Anne Jones

RESEARCH THEME Diabetes

RESEARCH TITLE Insulin Resistance in Sleep- Deprived Adolescents (Synopsis of: Association of Sleep Deprivation With Reduction in Insulin Sensitivity as Assessed by the Hyperglycemic Clamp Technique in Adolescents)

TITLE Got Insulin?

MEDIUM/GENRE 3-D/Sculpture

STATEMENT With my project, I wanted to bring more awareness to how sleep deprivation affects insulin production in the body and how it leads to health conditions like diabetes. I wanted to make a piece that people can interact with, to better understand the relationship between diabetes and sleep deprivation. My goal was to have certain parts of this piece represent the effects of sleep deprivation on the human body and the effects of diabetes on the body over time.

4 AWARD White Ribbon

EXPRESSIONISTS Mario Misiti, Kelly McGraw, and Nora Raicevich

SCHOOL Notre Dame-Cathedral Latin High School

CITY Chardon, Ohio

TEACHER Beth Ward

RESEARCH THEME Diabetes

TITLE “Correlation Between Inadequate Sleep and Risk of Diabetes”

MEDIUM/GENRE Mathematical Analysis

STATEMENT Over the years, the amount of people diagnosed with diabetes has increased. While many factors go into the cause of diabetes, one of the most prevalent factors is the incorrect amount of sleep. If one gets too much or too little sleep, it can negatively affect their body mass index, as well as their blood pressure. These negative effects pose a threat to people’s health and increase the risk of diabetes, which results in a person being unable to control his or her body’s use of glucose as energy.

5 6 7 8 9 AWARD Honorable Mention O.G. Rhythm EXPRESSIONIST Shelbee Mitchem

SCHOOL Springfield-Clark Career Technology Center (bee My vision disfigured CITY Springfield, Ohio Dodoo) * 3 My weight has dropped TEACHER Susan Hyden

RESEARCH THEME Diabetes RESEARCH TITLE Insulin Resistance in Sleep- A slow non-gesture My thirst’s increasing Deprived Adolescents (Synopsis of: Association of Sleep A feeling too swell It never stops Deprivation With Reduction in Insulin Sensitivity as Assessed My sugar is rising by the Hyperglycemic Clamp Technique in Adolescents) And I almost fell ^No one to watch me,

TITLE “O.G. Rhythm” just leave me alone—^ MEDIUM/GENRE Song I’m feeling weaker— STATEMENT Not feeling good— ^A slow non-gesture The central idea of my project was to provide a perspective on someone who has suffered and still While I’m at home > suffers from diabetes. I wanted to gain knowledge about a disease that my whole family had, which was I’m feeling disgraceful the purpose of my project and what had attracted Misunderstood (bed da do doum me to it. My goals were to display a message, understand the disease more, and then help others under- doo doo) stand. Why I chose this specific genre was because people like listening to music that has meaning. So ^ I used to be pretty I took my love and background knowledge of music I used to be thin ^ Because it always is… and combined the two. (same rhythm) ^ I used to be happy But now I’m this… > A taste too sweet An action that hurt me (bee doo Small fatigue bedded) *2 Extreme irritability A killing disease (O.G. rhythm) Yeah, I ^><>^ My doctors complaining Don’t get enough sleep have diabetes My body’s evolving Won’t make a peep And I really — want — some^—thin — to, eat!

10 AWARD Honorable Mention

EXPRESSIONIST Kari Yanders

SCHOOL New Philadelphia High School

CITY New Philadelphia, Ohio

TEACHER Heather Agar

RESEARCH THEME Diabetes

TITLE Down the Rabbit Hole

MEDIUM/GENRE Painting

STATEMENT In my project, I created a dreamlike world, with a girl in the center surrounded by many distractions that would keep a person, especially one with diabetes, awake or distracted from sleep. Other elements are more fantastic, shying away from the girl in the center. She is also surrounded by clocks to show the passage of time. Wrapped around her legs is an insulin pump, which could be seen as either helping her up or pulling her back down into the abyss. The sea of hands and shadows represent the pull of the distractions around her, keeping her awake. Her eyes are shown with clocks and bags under them, showing how she sees the situation. Many elements are drawn from the book Alice in Wonderland, for many motifs, such as the passage of time and dreams, are brought forth within the piece.

11 Heart Disease

Heart disease refers to a variety of conditions that affect the heart, including blood vessel diseases, heart rhythm problems, and congenital heart defects, among others. Although an estimated 80% of heart disease can be prevented with healthy lifestyle choices, it remains our nation’s leading cause of death, claiming more than 600,000 lives each year. And the financial costs are equally alarming. Including health care services, medications, and lost productivity, the United States spends an estimated $200 billion on heart disease every 12 months. Researchers across the country and around the world, however, continue to make new discoveries into the causes of and treatments for this pervasive killer.

Childhood Psychosocial Factors and Coronary Artery Young Finns Study. The data related to 311 individuals who Calcification in Adulthood had psychosocial factors measured at 12 to 18 years of age, and CAC measured 28 years later in adulthood. A summary Authors: Markus Juonala, et al. measure of the childhood psychosocial factors was estab- Publication: JAMA Pediatrics, vol. 170, no. 5, 2016, pp. lished, with a higher score indicating greater psychosocial 466-472. Synopsis by Cleveland Clinic Editorial Intern Joan well-being, and these scores were then compared to CAC Moore, The Ohio State University test results.

Objective: The researchers aimed to determine if positive Conclusion: The baseline presence of CAC in any of the 311 psychosocial factors (like having nurturing parents), together individuals tested was 17.7%. The childhood psychosocial with few or no negative factors (such as parents who do not score, however, was inversely associated with CAC, mean- have a history of depression), can be associated with a lower ing that as an individual’s summarized psychosocial score risk of coronary artery calcification (CAC). decreased, the prevalence of CAC increased. The study demonstrates, therefore, that favorable psychosocial factors Methodology: In 2015, the researchers analyzed data gath- in childhood lead to a lower chance of atherosclerosis during ered in 1980 and 2008 as part of the Cardiovascular Risk in adulthood.

12 Identification of New Genetic Variants Associated Waist Circumference to Height Ratio and Left With Coronary Artery Disease in African Americans Ventricular Mass in Children and Adolescents

Authors: Cleveland Clinic Science Intern Taejun Kim, Author: Sudhir Ken Mehta* Hudson High School; Cleveland Clinic Mentors Fan Wang, Publication: Cardiology in the Young, vol. 26, 2016, pp. Qiuyen Chen, and Qing Wang, Hillcrest Hospital 658-662 Publication: 2017 Cleveland Clinic Science Internship Poster Objective: Waist circumference to height ratio, a measure Presentation of central obesity, is a better predictor of cardiovascular risk Hypothesis: The researchers hypothesized that some genes than body mass index for the pediatric population. Because associated with coronary artery disease (CAD) or CAD-re- research in this area is lacking, the researcher designed this lated phenotypes (an individual’s observable characteristics) study to evaluate left ventricular mass in young patients with in European samples may contribute to the risk of CAD in central obesity, as defined by waist circumference/height. African Americans. Methodology: A total of 156 patients between the ages of Methodology: A number of chemical tests were done to two and 20 who did not show evidence of structural heart analyze the genotypes (the genetic makeups of individual disease were studied. The patients were divided into three organisms) of both the case and control systems. Running groups: 52 who had already been diagnosed with central these tests allowed the researchers to determine the signif- obesity, 52 who were at risk for central obesity, and 52 with- icance of the data. out central obesity. The left ventricular mass for each patient was measured by echocardiography, and the numbers were Results: The data showed one specific single nucleotide compared across all three groups. polymorphism (SNP) in a single gene that contributed significantly to the risk of CAD in African Americans. Results: Patients with central obesity had significantly increased scores that deviated from the mean for left ventricular mass, as compared to patients who were identified as being only at risk for central obesity and patients with no central obesity. The data gathered in this study highlight the importance of maintaining an ideal waist circumference ap- propriate for a person’s height, and the researcher believes that caregivers must prioritize the identification and case management of patients with central obesity.

*Denotes a current or former Cleveland Clinic caregiver

13 AWARD Best in Show, Math

EXPRESSIONISTS Devorah Fertel and Batsheva Miriam Altose

SCHOOL Yavne High School – Hebrew Academy of Cleveland

CITY Beachwood, Ohio

TEACHER Rachel Weinberg

RESEARCH THEME Heart Disease

RESEARCH TITLE Identification of New Genetic Variants Associated With Coronary Artery Disease in African Americans

TITLE “Variations on a Gene”

MEDIUM/GENRE Computer Programming and Digital Media

STATEMENT Our project uses technology and music because technology can reach a wide audience and music reaches people’s hearts. Our animation includes an EKG from someone with coronary artery disease (CAD) during a symptomatic episode and a color- changing DNA strand, which represents the variant of the gene associated with CAD. We created the saxophone line from the EKG values using mathematics. Our project incorporates jazz because of its African American roots, with a jazzy motif symboliz- ing the gene. We hope that “Variations on a Gene” raises awareness of the genetic component of CAD and the need for further research in this area.

14 15 16 17 18 AWARD Best in Show, Language A Broken Heart’sA Broken Story Heart’s StoryA Broken Heart’s Story EXPRESSIONIST Gianna Somrak

SCHOOL Mayfield High School

CITY Mayfield Village, Ohio Our first breakOur wasfirst breakat 12 was at 12

TEACHER Kari Beery Mom cameMom home came home

RESEARCH THEME Heart Disease a 50-cent coloringa 50-cent book coloring in hand book in hand RESEARCH TITLE Psychosocial Paths Duringinstead of ainstead buttercream of a buttercream-frosted vanilla-frosted cupcake vanilla cupcake Childhood to Heart Disease in Adulthood (Synopsis of:with a singlewith lit candlea single lit candle Childhood Psychosocialanother Factors promiseanother promise and Coronary Artery Calcification in Adulthood) br ok en br ok en

TITLE “A Broken Heart’s Story”and she weptand she wept

MEDIUM/GENRE Poetry I wept I wept

STATEMENT tears bled throughtears bled faded, through auburn faded, pages auburn pages I created this poem to show the severe effects stress I took the painI took the pain has in the lives of adolescents. I was inspired by the c r a c k c r a c k original research project summarized by Joan Moore because most people do not think about how on- so Lisa didn’tso Lisahave didn’t to. have to. going stress early in life can lead to a greater risk of heart disease in adulthood. This poem takes the point of view of a young girl’s heart, showing how 14 14 certain traumatic events and psychosocial factors Dad promisedDad promised lead to its deterioration (a heart attack).late Knowing late this, it is vital as a society to protect our children and limit their exposure to stress. “i’ll be outside“i’ll beright outside when rightyou comewhen out”you come out” later later “sorry, baby“sorry, girl… baby got stuck girl… at got the stuck office at again” the office again” “i’ll just walk“i’ll home” just walk home” trust fr actrust tur ed fr ac tur ed teardrops andteardrops raindrops and raindrops merge merge into frozen intocrystals frozen on crystals cheeks on cheeks I took the painI took again the pain again c r a c k c r a c k

15 15 Mom’s sickMom’s sick Lisa’s sick Lisa’sof her sickmom of being her mom sick being sick

sick of overduesick ofbills overdue towering bills towering like predators like predators sick of missingsick ofassignments missing assignments and F F F’ ands… F F F’s… All who threatenAll who to threaten swallow toher swallow alive. her alive. the front doorthe slamsfront door slams the housethe rocks house rocks Mom and MomDad are and fighting Dad are again fighting again a mortgagea mortgagenotice lays notice sullen lays at her sullen feet at her feet c r a c k c r a c k “Mom, where’d“Mom, Dad where’d go?” Dad go?”

17 17 the hospitalthe room hospital is cold room is cold Mom’s handMom’s even… hand c oeven… l d e r c o l d e r the crimsonthe sunlight crimson creeps sunlight in creeps in startled by startled the wet by stains the wet on Lisa’sstains cheekson Lisa’s cheeks and it caresses and it hercaresses shoulders her shoulders ghosts breathghostse down breath here downneck, herwhispering neck, whispering “you won’t“you be able won’t to be graduate able to ingraduate the spring” in the spring” c r a c k c r a c k “he won’t come“he won’t back, come baby” back, baby” c r a c k c r a c k “she won’t“she make won’t it through make itthe through night” the night” c r a c k c r a c k c r a c k c r a c k c r a c k c 19r a c k Lisa is bruisedLisa is bruised I am hurting,I am hurting, but we stillbut s twe r u still g g s l te r to u beatg g l e to beat b e a t b e a t b e a t b e a t b e a b t e a t

40 40 her husband’sher husband’s lips are gentle lips are gentle brushing herbrushing own her own like an artistlike strokes an artist a masterpiecestrokes a masterpiece her children’sher children’sarms arms feel like homefeel like home “we got your“we favorite, got your Mommy! favorite, vanilla!”Mommy! vanilla!” her irises fadeher irises fade into glassyinto pearls glassy pearls a weak grimacea weak overtakes grimace overtakesher lips her lips “happy birthday“happy to birthday you!” to you!” sweaty palmssweaty palms the house rocks Mom and Dad are fighting again a mortgage notice lays sullen at her feet c r a c k “Mom, where’d Dad go?”

17 the hospital room is cold Mom’s hand even… c o l d e r the crimson sunlight creeps in startled by the wet stains on Lisa’s cheeks and it caresses her shoulders ghosts breathe down her neck, whispering “you won’t be able to graduate in the spring” c r a c k “he won’t come back, baby” c r a c k “she won’t make it through the night” c r a c k c r a c k c r a c k Lisa is bruised I am hurting, but we still s t r u g g l e to beat b e a t b e a t b e a t

40 her husband’s lips are gentle brushing her own like an artist strokes a masterpiece her children’s arms feel like home “we got your favorite, Mommy! vanilla!” her irises fade into glassy pearls a weak grimace overtakes her lips “happy birthday to you!” sweaty palms breathlesslybreathlesslybreathlessly clutchbreathlessly clutchher chest clutch her clutch chest her her chest chest breathlessly clutch her chest b e a tb b e ea bat etb b abe e tea a bat t etb b ae e ta a bt t e b a et a t b e a t b e a t b e a t Something’sSomething’sSomething’s wrong…Something’s wrong… wrong… wrong… Something’s wrong…

“happy“happy birthday,“happy birthday,“happy dear birthday, Mommy!”birthday, dear Mommy!”dear dear Mommy!” Mommy!” “happy birthday, dear Mommy!” beat beat beat beat beat beatbeat beat beat beat beat beat beat beat beat beat beat So...tight…So...tight… So...tight…So...tight… So...tight…

the dizzinessthe dizzinessthe growsthe dizziness dizziness growsin the grows candlelightin growsthe in candlelight the in thecandlelight candlelight the dizziness grows in the candlelight

beatbeatbeatbeatbeat beatbeatbeatbeatbeat beatbeatbeatbeatbeatbeatbeatbeatbeatbeat beatbeatbeatbeatbeat ...I can’t...breathe…...I can’t...breathe…...I ...Ican’t...breathe… can’t...breathe… ...I can’t...breathe…

“happy“happy birthday“happy birthday“happy to you!”birthday birthdayto you!” to you!” to you!” “happy birthday to you!” c r a c c k r a c kr ca rc a k c k c r a c k I’m so I’msorry, soI’m sorry,Lisa… I’mso sorry,so Lisa… sorry, Lisa… Lisa… I’m so sorry, Lisa… but I... butcan’t I... takebut can’t buttheI... take can’tpain…I... can’tthe take pain… take the pain…the pain… but I... can’t take the pain… anymore...anymore... anymore... anymore... anymore...

S HS SHAS H AT H A TT A ETT T TRE T E R E SR R H A T T E R

the hospitalthe hospitalthe roomthe hospital isroomhospital cold roomis coldroom is cold is cold the hospital room is cold Lisa’s Lisa’shand Lisa’s is…handLisa’s c handis…o l handd c is… o lis… dc o cl do l d Lisa’s hand is… c o l d “Daddy,“Daddy, what’s“Daddy, “Daddy,what’s wrong what’s wrongwith what’s Mommy?”wrong with wrong Mommy?” with with Mommy?” Mommy?” “Daddy, what’s wrong with Mommy?” the fadingthe fadingsunlightthethe fading sunlight fadingattempts sunlight attemptssunlight to attemptscomfort attempts to comfort its to old comfortto itscomfortfriendthe old itsfading friend oldits oldfriend sunlight friend attempts to comfort its old friend only toonly be blockedtoonly beonly toblocked bebyto greedyblockedbe byblocked greedy storm by greedyby stormclouds greedy storm clouds storm onlyclouds clouds to be blocked by greedy storm clouds “she’s “she’ssick, “she’sbaby…” sick,“she’s baby…”sick, sick, baby…” baby…” “she’s sick, baby…” “but why?”“but why?” “but“but why?” why?” “but why?” “your Mommy“your “yourMommy just…“your Mommy Mommyjust…has a just… brokenhas just… a has broken heart, has a broken a heart,baby… broken heart, “yourbaby… heart, baby…Mommy baby… just… has a broken heart, baby… “She always “She “Shealways has.” “She always has.” always has.” has.” “She always has.”

20 AWARD Blue Ribbon

EXPRESSIONIST Rachel Broihier

SCHOOL Hathaway Brown School

CITY Shaker Heights, Ohio

TEACHER Shelly Ahern

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Moved

MEDIUM/GENRE Mixed-Media

STATEMENT I wanted to show the connection between mental health and heart health by creating a piece with progression and fluidity. The research showed that having positive psychosocial factors as a child can lead to decreased risks of heart disease, so my goal was to show this through a piece where the different components feel interconnected. My hope is that the movement and layered quality of the piece will show the viewer how many different facets of human health affect each other. breathlessly clutch her chest b e a t b e a t b e a t Something’s wrong…

“happy birthday, dear Mommy!” beat beat beat beat So...tight… AWARD Blue Ribbon

EXPRESSIONIST Isaac Cunningham the dizziness grows in the candlelight SCHOOL Hoover High School

CITY North Canton, Ohio beatbeatbeatbeatbeat TEACHER Christopher Triner ...I can’t...breathe… RESEARCH THEME Heart Disease RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in “happy birthday to you!” Adulthood (Synopsis of: Childhood Psychosocial Factors c r a c k and Coronary Artery Calcification I’m so sorry, Lisa… in Adulthood) but I... can’t take the pain… TITLE Aortic Valve Sector anymore... MEDIUM/GENRE Pen and Ink

STATEMENT In this piece, I was trying to represent the idea of negative environmental factors in childhood, like S H A T T Emalnutrition, R being around depression, alcoholism, and living around narcotics, which increases the chance of coronary artery calcification (CAC). To me, the hospital room is cold it was almost like those factors were actually dump- Lisa’s hand is… c o l d ing calcium on the aortic valve, so I made a literal “Daddy, what’s wrong with Mommy?” representation of the way I imagined it. the fading sunlight attempts to comfort its old friend only to be blocked by greedy storm clouds “she’s sick, baby…” “but why?” “your Mommy just… has a broken heart, baby… “She always has.”

21 AWARD Blue Ribbon

EXPRESSIONIST Gianna Faini

SCHOOL Twinsburg High School

CITY Twinsburg, Ohio

TEACHER Sharon Misanko

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE The Heart of It All

MEDIUM/GENRE Mixed-Media

STATEMENT The idea behind this piece is that the environment a child grows up in — their socioeconomic situation, their parents’ mental health, and their own mental health — plays a major role in their heart health in the future. A child raised under poor circumstances is more likely to develop heart disease in the future. To demonstrate this, I illustrated a drunken mother yelling at her child. Her crying son casts the shadow of a man in a hospital bed to show that this situation could lead to him developing heart disease in the future.

AWARD Blue Ribbon

EXPRESSIONIST Jillian Fitz

SCHOOL Firelands High School

CITY Oberlin, Ohio

TEACHER Laura Tawil

RESEARCH THEME Heart Disease

RESEARCH TITLE Identification of New Genetic Variants Associated With Coronary Artery Disease in African Americans

TITLE One Drop It Could Pop

MEDIUM/GENRE 3-D/Sculpture

STATEMENT The symbolism and imagery in my project stand for heart disease in African Americans. I have a red balloon to symbolize the heart, and a needle to symbolize the gene rs12646447 that has contributed significantly to the risks of coronary artery disease (CAD). I have the needle hanging above the balloon fairly close because if it were to fall, it would pop the balloon and ruin it. The gene is like a needle — it’s one little thing that can contribute to ruining something huge. A balloon is very delicate, just like a heart, and that’s why I thought it would be the perfect symbol for a heart. The wire represents the vessels leading to the heart.

22 AWARD Blue Ribbon

EXPRESSIONIST Grace Geisler

SCHOOL Kenston High School

CITY Chagrin Falls Township, Ohio

TEACHER Todd Malkus

RESEARCH THEME Heart Disease

RESEARCH TITLE Identification of New Genetic Variants Associated With Coronary Artery Disease in African Americans

TITLE At the Core

MEDIUM/GENRE Painting

STATEMENT The family line shows the heritability of coronary artery disease (CAD) through a gene in African Americans. The DNA was used to show the passage of time, similar to a timeline, between the different generations of the family shown. It also wraps around the heart, showing how that heart and the SNP rs12646447 in gene PTIX2, which contributes significantly to the risk of CAD in African Americans, is what connects the lineage. The youngest in the line, who is holding the heart, represents how he is now left with the bur- den of a risk of CAD because it was passed through his family.

AWARD Blue Ribbon

EXPRESSIONIST Tiffany Wang

SCHOOL Brecksville-Broadview Heights High School

CITY Broadview Heights, Ohio

TEACHER Anne Jones

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE CardioCasino

MEDIUM/GENRE Digital Media

STATEMENT You can’t help where, when, or how you grow up. From a stressful home life to a high-income house- hold, the factors that define our childhood are like a lottery. I created a life-simulator game to interpret these phenomena alongside the effects they have on our risk of cardiovascular disease later in life. In the game, you interact with a slot machine linked to both your childhood and heart, where slots affect your memories plus the eventual physical consequences. You discover that although your slot machine results may be fated, maybe others’ aren’t.

23 AWARD Red Ribbon

EXPRESSIONIST Katrina Ganson

SCHOOL Oberlin High School

CITY Oberlin, Ohio

TEACHER Whitney Brown

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE At Risk

MEDIUM/GENRE Painting

STATEMENT I chose this article due to the fact that so many uncon- trollable factors could influence such an extreme disease. This is disheartening and brings about feelings of anxiety, which I tried to showcase with my artwork.

AWARD Red Ribbon

EXPRESSIONIST Ross Howell

SCHOOL Hoover High School

CITY North Canton, Ohio

TEACHER Christopher Triner

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Shattered Heart

MEDIUM/GENRE Drawing

STATEMENT The central idea of my project is to show the psychosocial effects during child development that could cause stress on the heart and lead to calcification in the coronary artery. Drug abuse and unhealthy family dynamics, such as parents fighting and arguing, are represented around the child with pills and two portraits yelling and seeming angry. The child is curled within the dark, stressed heart covered with yellowed scraps encasing the child, who is unable to escape. The sharp shapes around the heart represent the shattering and stress put on the heart and the child.

24 AWARD Red Ribbon Pulse EXPRESSIONIST Sophia Kroto

SCHOOL Notre Dame-Cathedral Latin High School A crow’s flourish CITY Chardon, Ohio

TEACHER Maura McGinty-O’Hara egg is -ing on RESEARCH THEME Heart Disease softly its own RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in nestled time. But Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in the the pulse in Adulthood) wood. It grows strong TITLE “Pulse”

MEDIUM/GENRE Free Verse Poem is al -er, loud STATEMENT -one and -er, ov In my interpretation of “Psychosocial Paths During Childhood to Heart Disease in Adulthood,” I used cold, yet -erwhelm the imagery of a crow to represent those impacted by the factors suspected of leading to heart disease growing -ingly smo in the research. The bird meets its fate when it is taken over by its own “pulse,” which has been present still. A -thering. ever since it was abandoned as an egg. My poem is written so that it has only two syllables per line, pulse rings The bird similar to a heartbeat when read aloud. This is representative of both the research and the “pulse” which throughout begins is mentioned throughout the poem. the trees, to wilt, as if gradual crying -ly weak in a -ened by desperate the vice plea for of its help that own tell does not -tale heart. arrive. Feathers It hatch fall to -es, a ash, and beauti the crow -ful and crumbles estranged as the creature, pulse grows deaf -ening -ly strong -er.

25 AWARD Red Ribbon

EXPRESSIONIST Sophie Laye

SCHOOL Hathaway Brown School

CITY Shaker Heights, Ohio

TEACHER Shelly Ahern

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Bleeding Heart

MEDIUM/GENRE Mixed-Media

STATEMENT This piece focuses on the research about negative psychosocial factors in childhood and the subsequent development of coronary artery calcification as an adult. Here, negative psychosocial factors — such as depression, stress, and abuse — can be seen going into a healthy heart and turning it to stone, showing the negative effects that these factors have on a heart. Additionally, the words spread into the coronary artery down the heart. The contrast between black and white and color further illustrates a difference between healthy and unhealthy tissue.

AWARD Red Ribbon

EXPRESSIONIST Hannah Levengood

SCHOOL New Philadelphia High School

CITY New Philadelphia, Ohio

TEACHER Heather Agar

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Heartbroken

MEDIUM/GENRE Mixed-Media

STATEMENT Because heart disease can be caused by emotional stress early on in life, I represented that by portraying the people in my piece as children. I portrayed two of them in pain to represent how negative emotional effects can hurt children, and the third as serene and sad to show how it’s something children cannot control. I used the wire to represent heart disease taking hold of the children, and the papier-mâché hearts to represent the damage being caused by the negative effects inflicted on them during childhood and the calcification of their hearts in the future.

26 AWARD Red Ribbon

EXPRESSIONIST Amanda Mitchell

SCHOOL Firelands High School

CITY Oberlin, Ohio

TEACHER Laura Tawil

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Happy Life, Healthy Heart

MEDIUM/GENRE Mixed-Media

STATEMENT In my painting, Happy Life, Healthy Heart, I show that the connection between psychological factors in a person’s life affects their heart health. One side of the painting shows that depression, anxiety, stress, and non-nurturing parents lead to a higher risk of hardening of the arteries. The other side of the painting shows the reverse. Favorable psychological factors lead to a lower chance of atherosclerosis.

27 AWARD Red Ribbon the attack of a heart EXPRESSIONIST Asha Singh

SCHOOL Notre Dame-Cathedral Latin High School My heart pounds on the bones of my chest. CITY Chardon, Ohio POUND, POUND, POUND TEACHER Maura McGinty-O’Hara RESEARCH THEME Heart Disease My breath transfers from my chest to my head. RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in The head is heavy; my breath is nonexistent, Adulthood (Synopsis of: Childhood Psychosocial Factors IN. OUT. IN. OUT. IN. OUT. and Coronary Artery Calcification in Adulthood) but I cannot bring it back. TITLE “the attack of a heart””

MEDIUM/GENRE Poetry My body aches in agony as I feel my chest tighten and constrict my lungs.

STATEMENT I fall to the cold, hard ground and feel my skull smash as it makes contact. For my poem, I chose to center it around Joan Moore’s heart research synopsis. I found the research to be My brain is a mirage of colors, deep plumberries and lush forest greens, as my eyes close. quite fascinating, and it struck a personal connection to me because my family has a history of heart The vivid phosphene patterns illustrate a memory of my former childhood. conditions and problems. I thought the conclusion surrounding the connection between childhood I’m sobbing hysterically and hyperventilating while trying to remain silent trauma and heart health was interesting, and it made me want to delve into my family history. The as I hear the sound of a shattered wine bottle against the living room wall research truly connected such broad concepts by demonstrating the relationship between physical and screaming echoing throughout the house. and mental health, which is a growing concern and topic in today’s world. SMASH, SMASH, SMASH SHOUT, SHOUT, SHOUT I rock back and forth against the door in my bedroom. I feel as if the shattered glass of the wine bottle penetrated inside me. My heart, my brain, my stomach, my throat all tainted by this strange pain. SCRAPE, SCRAPE, SCRAPE My stomach growls for nourishment, but I do not dare escape the safe haven of my room and I eventually sleep with one eye open and one stomach eating itself away. I start to leave my bedroom less, to hide from the nightmare outside my four walls and wooden door. Less food, less socializing, less exercise, less water, less life for me. I open my eyes in a hospital room surrounded by the toxic brightness of the cold white lights. The bed is empty even though I’m laying right in it. I grasp the metal bars with my stiff fingers, almost as if I’m trying to reach for any kind of sensation.

28 I’m bound and trapped by wires and tubes. I’m in a prison of this hospital room. Why did this happen to me? I feel a sharpness in my chest as I hear a nurse drop a glass container. SMASH, SMASH, SMASH I gasp, but I do not lose my breath. Startled, I look in strange awe around the room. I want to run. I want to hide. I want to fall through the floor and never see anyone or anything ever again for as long as I live. The doctor in a white coat tells me, “You’ve had a heart attack.” I look at the doctor in shock. I thought I was healthy. I didn’t gorge on processed fast food and carbonated contamination. The doctor said, “Despite your moderately healthy lifestyle, you are suffering from coronary artery calcification. You’ve had a heart attack.” That phrase felt like an anchor fell on me and broke every last bone in my lifeless body. I couldn’t process this news, but then I heard a janitor cleaning up that broken glass container. SWEEP, SWEEP, SWEEP My eyes became desolate, my expression empty, my body frozen. The doctor abruptly noticed and shook my shoulder aggressively. “You’re suffering from something much worse than a heart attack. It’s obvious.” I jolted as those words went right into my soul. The doctor looked me dead in the eyes: “A little love each day keeps the heart from going astray.” My breath leaves my body as I’m buried under the traumatic hell inside my mind that rages on. I realize that this was not an act of having a heart attack but my heart being attacked by memories haunting my subconscious mind.

29 AWARD Red Ribbon

EXPRESSIONIST Kira Weber

SCHOOL Kenston High School

CITY Chagrin Falls Township, Ohio

TEACHER Todd Malkus

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE The Anxious Heart

MEDIUM/GENRE Painting

STATEMENT My project is about when a person is stressed out as a kid, and how it could lead to heart problems when they are older. In my project you can see a kid becoming overwhelmed by his parents, busy schedule, and too much work. The colors in the heart show the heart becoming affected and changing color because of this stress. Long periods of stress can lead to problems in the blood or a heart attack.

AWARD White Ribbon

EXPRESSIONIST Carson Bauer

SCHOOL Oberlin High School

CITY Oberlin, Ohio

TEACHER Whitney Brown

RESEARCH THEME Heart Disease

RESEARCH TITLE Weight Circumference to Height Ratio and Left Ventricular Mass in Children and Adolescents

TITLE Where the Heart Lies

MEDIUM/GENRE Mixed-Media

STATEMENT This piece was created to express the link between obesity and heart disease. The title, Where the Heart Lies, was chosen to show how people may place more importance on their enjoyment than their health.

30 AWARD White Ribbon

EXPRESSIONIST Emma Bradley

SCHOOL Hoover High School

CITY North Canton, Ohio

TEACHER Christopher Triner

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE The Reality of the Childhood “Toy Chest”

MEDIUM/GENRE Drawing

STATEMENT My idea behind this piece was to show that your chances of developing coronary artery calcification are greatly increased if your childhood is stressful. My goal was to show the importance of having good psychosocial encounters as a child, as they have effects on your health throughout the rest of your life.

AWARD White Ribbon

EXPRESSIONIST Keenan Garceau

SCHOOL Kenston High School

CITY Chagrin Falls Township, Ohio

TEACHER Andie Quinn

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Scarred

MEDIUM/GENRE Painting

STATEMENT My project focuses on how psychological trauma during childhood can lead to heart disease in adulthood. The piece depicts a girl at three stages of her life, connected by the trauma that she experiences over the years. Their heart is clearly visible, getting more damaged as the years go by. The project states how an individual’s socioeconomic environment, he- reditary risk of depression, stress, and social life can contribute to heart disease as an adult. This is shown through the overexaggerated blemishes that gradu- ally appear on the girl throughout the piece.

31 AWARD White Ribbon ParentParent Trap EXPRESSIONIST Christina Ibos SCHOOL Trinity High School We’re getting a divorce. CITY Garfield Heights, Ohio TEACHER Gina Ramirez Pain spikes and spazzes through “W-what…” I struggle to RESEARCH THEME Heart Disease breathe. Her words fall onto my heart,

RESEARCH TITLE Psychosocial Paths During my chest, like Dorothy’s house as it crashes to the.” Childhood to Heart Disease in ground. Adulthood (Synopsis of: down my arms, Childhood Psychosocial Factors Mom refuses to look at me from and Coronary Artery Calcification across the table and pushes her pasta in Adulthood) and out my fingertips. around her plate. She speaks. “I’m sorry, TITLE “Parent Trap” Jared, but we can’t… I can’t live here MEDIUM/GENRE Poetry anymore.” Her skin turns green and her The pain throbs in time with my STATEMENT nose grows long, she becomes the My eXpressions project is inspired by the research Wicked Witch–a strange, evil monster. topic, “Psychosocial Paths During Childhood to frantic heartbeat. Heart Disease in Adulthood.” I created a short story My thoughts flap around my mixed with a poem about a child’s life after the di- I’m alive; is that the reason for this vorce of his parents. Ozzie’s childhood distress and brain, screech and cackle, faces consume my mind. Are those monkeys? Can I fix subsequent trauma lead him to suffer a heart attack torture? as an adult. The metaphor of The Wizard of Oz is my parents? Please tell me– used as a device of comparison; the elements of the children’s film run parallel to Ozzie’s experiences. As “We don’t want to hurt you, a student with relatives who have suffered from heart Son.” My dad’s voice, the protective disease, I understand the importance of the research My memories deliver different damage, rumble of a Lion, vibrates in my chest. My and appreciate the opportunity to raise awareness. ravaging pain in my mind, breath quickens and my heart rate increases. Doesn’t he see? This is killing throws my emotions in a swirling tornado. me.

“We want this to be as easy as possible, ok?” Mom’s brown eyes meet In this moment, maybe my last, I mine for a sliver of a second, a flash of regret and sorrow, before she looks realize the reason behind the attack on down. Glinda, the good witch, had kind brown eyes. my mind, Mom’s pain confuses me more. Is my body, she changing her mind? If the divorce hurts her too, why is she doing it? Is it my heart. because...of me?

Those guardians, protectors, givers, “Ozzie, you…,” sounds jumble together as my brain lets go of the

healers, caregivers, world. My mind stops spinning– monkeys fall and shatter on the ground. parents…they weren’t like parents. Is It ecause of Me? Golden Roads branch out, lead to more proof This is why they fight and think I don’t My parents didn’t notice, why Dad drinks and thinks I don’t see, why Mom cries at night and thinks I guard, protect, give, heal, care. don’t hear, why they’re punishing me Instead they with a divorce and think it won’t hurt... won’t stop my Heart. Drank, Fought, Punished, Hurt, Hated... me. Time passes, uickly, and suddenly I’m torn. Two voices, two

faces, two homes– I’m between Kansas Selfish, frustrated, lost, and Emerald City. I can’t eat enough,

sleep enough, be enough to fill the lives they never understood, never thought about me. of two people. Is this my life? m I living in a twisted fantasy? “I’m Dr. Tinman and I’m your Over time, therapist. How are you?” She doesn’t

the alcohol, fights, hurt, hatred wait for an answer and plows on, “Your mom says you’re not sleeping well. How built up inside, has the transition to high school been for you? I know it’s a ig hange.” causing my blood to slug through my veins. My lips clamp together, set in a

frustrated frown. response fights to 32 escape My parent’s abrasive words and actions flowed Dad’s drinking, now he’s rarely from sober. Mom denies my father’s eistence, this makes her distant and

my little ears, closed off, so she sends me to the Tin Metal hrink. my innocent eyes, and straight

into my growing heart.

Those guardians, protectors, givers, “Ozzie, you…,” sounds jumble together as my brain lets go of the

faces, two homes– I’m between Kansas Selfish, frustrated, lost, and Emerald City. I can’t eat enough,

frustrated frown. response fights to escape My parent’s abrasive words and actions flowed Dad’s drinking, now he’s rarely from sober. Mom denies my father’s eistence, this makes her distant and

my little ears, closed off, so she sends me to the Tin Metal hrink. my innocent eyes, and straight

into my growing heart. I hae arried at the land oer the Rainbow, I think. ow I need to return, to

Caused my heart click my heels to erase what happened

and eer think of the past. to weaken and lose vitality, I grow up and try to forget my

to develop abnormally, damaging childhood–an irreleant smudge of ash. ut the memory remains and be incapable to in my heart residing oer the part that Give and Receive Love. still aches. I’m unable to completely believe my life is Real. I’m still lost in a twisted fairytale...

If they could see me now– I think of the cyclone again as I tumble to my ineitable death no magic ruby shoes will sae me now.

on the floor all alone– The Wizard of Oz, creator behind the entire fantasy. I’m just like him...ight?

and suffering from a Heart Attack– But...no, that’s not true. Fate finally descends, finally shows me what I’m missing. Now I know, now I know…

Mother and Father,

Would you finally realize

You

All the mistakes you made,

caused

All the hurt you gave,

this.

The problems you passed onto your Son.

I pass out, just as the door Opens…

33 AWARD White Ribbon Regards, Your Daughter EXPRESSIONIST Nisha Makkar Kirtland High School SCHOOL The melancholy droop to his lips confirmed the fear that I had CITY Kirtland, Ohio

TEACHER Meriah Duncan harbored since adolescence. Inadequate. Incapable.

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Thirty-eight years old: incapable of love, and it’s your fault. Thirty- Adulthood (Synopsis of: Childhood Psychosocial Factors eight years old: dying, and it’s your fault. The fault of your words and and Coronary Artery Calcification in Adulthood) your actions, the beliefs you engrained with such force into every last TITLE “Regards, Your Daughter” fiber of my being – into my heart of hearts. MEDIUM/GENRE Letter

STATEMENT There are many ways to damage a heart. Inspired by Holding the results in his hands, he entered the room with poise and the eXpressions heart research, my piece takes the form of a woman writing to her estranged parents indifferent eyes. Near emotionless. He didn’t care the way you should; following her diagnosis of severe atherosclerosis, or it wasn’t his fault. the “hardening of the arteries.” Expressing extreme bitterness, the woman likens her inability to emote to her literal heart condition, blaming her parents’ failure to prioritize her psychosocial health and over- I wish you didn’t fight so much. I wish you didn’t break my home. all well-being throughout her childhood for both her emotional and physical atrophy. “Regards, Your I wish you taught me how to manage myself instead of how to manage Daughter” reflects the lasting damage of negative households on adolescents and clearly illustrates the the both of you. pain, suffering, and strife that accompany such detrimental environments. The incessant fighting. The screaming. The anxiety it all caused. Forgotten. Ignored. Hurt.

You made me cold. You damaged me irreparably, twisting the innocence and anticipation and emotion of youth into a hideously empty shell. Unfeeling. Save for blistering rage, that is what I amount to, what remains; it’s who I am – who you made me become.

My heart has hardened with the grief you so inconsiderately forced upon my shoulders. Selfish. Relentless. I couldn’t set it down. You damaged me irreparably. Only now is that revealing itself physically.

He said that my heart is at great risk, that it’s weak. I’ve known that since adolescence. He said that my heart is hardening. I’ve known that since adolescence. He said that my heart is failing – that blood flow has been severely restricted. This, at last, I hadn’t known.

They say, to make their way in the world, one must harden their heart. I guess you took that a little too literally.

My heart has failed emotionally; my heart is failing physically – has hardened, is hardening. I shouldn’t be dying at thirty-eight. I shouldn’t be dying before I ever got the chance to love. You took that chance away.

It’s been years since adolescence. It’s been years since we last spoke. I would like to tell you that your priorities were amiss.

Regards, Your Daughter 34 AWARD White Ribbon

EXPRESSIONIST Lane Murray

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Karen Mehling-DeMauro

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Shards of Childhood

MEDIUM/GENRE Mixed-Media

STATEMENT My mosaic focuses on the coronary artery calcifci- ation (CAC) study, which shows that psychosocial aspects from childhood may affect one’s likeliness of developing CAC in adulthood. The fragility of the glass and the breaks between each piece represent how so many small factors can come together to increase the risk for CAC. The mirror shards aim to allow each person to reflect on how they as individuals may be affected by the psychosocial factors from their childhoods.

AWARD White Ribbon

EXPRESSIONIST Devan’re Presley

SCHOOL Cleveland School of Digital Arts

CITY Cleveland, Ohio

TEACHER Stephanie Munkachy

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE A Thin Line

MEDIUM/GENRE 3-D/Sculpture

STATEMENT My sculpture represents the thin line between good and bad mental health, and its effects on the heart. The article taught me childhood trauma can cause coronary artery calcification (CAC) as an adult. The right side shows bad mental health. The bottom right corner shows depression, with your brain in a cage, and the top right represents stress eating away at the heart. The kid by himself shows loneliness. On the left side is good mental health, where stress is melting away and depression is nowhere in sight. Here the heart, brain, and the child are standing together strong and healthy, getting rid of loneliness.

35 AWARD White Ribbon A Mourning Beat EXPRESSIONIST Emma Sielski

SCHOOL Medina High School CITY Medina, Ohio Blind now I listen to the flatline TEACHER Kelli Offenberger

RESEARCH THEME Heart Disease waiting for a new song to start RESEARCH TITLE Psychosocial Paths During moments ago we were like an army Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors a united front and Coronary Artery Calcification in Adulthood) but now I TITLE “A Mourning Beat” severed from you MEDIUM/GENRE Free Verse Poem wait for a new song to start STATEMENT My poem was based on the correlation between a heart disease called coronary artery calcification (CAC) and psychological pain experienced during I remember our song childhood. The research showed that adults who were subjected to traumatic events during child- the rushing beat of the melody hood were more likely to develop CAC as adults. My poem was written from the perspective of a heart as we ran away from home belonging to someone who has CAC. “A Mourning Beat” describes how the owner’s traumatic childhood the yelling led to a heart transplant, or as the poem states, a new song. The poem breathes life into the organ that the bruises keeps us alive and describes the heart’s emotions, rather than the owner’s feelings. away from hiding in the shadows but now I feel like I have run too far from you as I wait for a new song to start

Alone and broken I stop running away tears streaming down my face from the memories as you a pincushion wait for your new song to start

Their hands now buried inside you touching the place where I once lay cut clean and calculated While I finally hear the faint gentle echo of your new song

I was sickened by the past but you my soulmate cast me away tired of our dying tune now you live by the beat of a new song

36 AWARD White Ribbon

EXPRESSIONIST Abigail Wilson

SCHOOL Berea-Midpark High School

CITY Berea, Ohio

TEACHER Jim Bycznski

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Stonecold Heart

MEDIUM/GENRE 3-D/Sculpture

STATEMENT I chose the “Psychosocial Paths During Childhood to Heart Disease in Adulthood” project as inspiration for my research to bring awareness to how mental health can affect one’s physical health. One side shows colored photographs that represent childhood stress and a centered red, beating heart with flowing arteries around it. This side maintains the idea that while children may have low mental health, they have not developed heart disease. The other side depicts black and white photographs and how their childhood mental trauma has affected their adulthood by practically turning their hearts to stone, represented by a gray, passive heart and silver arteries.

37 AWARD Honorable Mention

EXPRESSIONIST Ethan Barker

SCHOOL Berea-Midpark High School

CITY Berea, Ohio

TEACHER Jane Darrow

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE “Differentiating Coronary Artery Calcification”

MEDIUM/GENRE Mathematical Analysis

STATEMENT I selected “Psychosocial Paths During Childhood to Heart Disease in Adulthood” because I feel that with the high prevalence of heart-related diseases in our society today, it is crucial that all possible efforts be made to address this public health issue. I hope that my research project will be able to help raise awareness about significant findings that have been discovered recently in the medical community and thus help those who may be at risk, or already have developed heart disease.

38 39 40 AWARD Honorable Mention

EXPRESSIONIST Nia Bordenkircher

SCHOOL Jackson High School

CITY Massillon, Ohio

TEACHER Sara Andes

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Mental Heart

MEDIUM/GENRE Mixed-Media

STATEMENT This piece relates to the research on how mental problems, like stress and depression, increase the risk of a heart attack. The color in the veins and arteries represents life and flow of blood. The words “stress” and “depression” block the color from reaching the heart. This increases the heart’s pressure and shows signs of a heart attack by a pressure meter attached to the heart.

AWARD Honorable Mention

EXPRESSIONIST Abigail Borris

SCHOOL Euclid High School

CITY Euclid, Ohio

TEACHER Edith Mellen

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE ME

MEDIUM/GENRE 3-D/Sculpture

STATEMENT This girl has a heart disease and she is trying to have a normal life, but her heart is stopping her from doing that. The words on her body are her obstacles that she faces. I chose to keep her black and white so that the words stand out and you focus on the figure and the tiny heart in her chest.

41 AWARD Honorable Mention

EXPRESSIONIST Kya Goodwin

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Karen Mehling-DeMauro

RESEARCH THEME Heart Disease

RESEARCH TITLE Weight Circumference to Height Ratio and Left Ventricular Mass in Children and Adolescents

TITLE Heartbreak

MEDIUM/GENRE Mixed-Media

STATEMENT Creating this piece for the Cleveland Clinic was sentimental to me because of the impact that cardiac health has had on my family. My grandmother has been in heart failure for 16 years. For years, I have observed her undergo treatments from the Cleveland Clinic that have literally saved her! I’ve recently witnessed the Clinic diagnose my grandfather with a rare disease that directly affects the heart called amyloidosis. I hope that my piece inspires someone to take better care of things that affect their heart health, and remember there is hope for a cure in every diagnosis.

AWARD Honorable Mention

EXPRESSIONIST Sophia Kroto

SCHOOL Notre Dame-Cathedral Latin High School

CITY Chardon, Ohio

TEACHER Mary Ann Sedivy

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Center of Gravity

MEDIUM/GENRE Painting

STATEMENT In my interpretation of the research synopsis, I used a bird to represent the emotions of sufferers from heart disease, and a red string, which is indicative of a blood vessel. The egg at the end of the string is representative of the childhood factors, as it weighs the bird down. My goal with this piece was to show the weight which sufferers from heart disease often carry as a result of their childhood stressors.

42 AWARD Honorable Mention

EXPRESSIONIST Grace Liberatore

SCHOOL Notre Dame-Cathedral Latin High School

CITY Chardon, Ohio

TEACHER Claire Raack

RESEARCH THEME Heart Disease

RESEARCH TITLE Identification of New Genetic Variants Associated With Coronary Artery Disease in African Americans

TITLE Nature’s Heartbeat

MEDIUM/GENRE Ceramics/Clay

STATEMENT My work is inspired by “Identification of New Genetic Variants Associated With Coronary Artery Disease in African Americans.” This piece represents the widespread effects of coronary artery disease, and also the sadness that it can bring to those affected by it. The feathers that drape over the book symbolize how widespread this devastating disease is. The feathers are also going over the “writing” in the book, which is a good EKG monitor of someone with a healthy heartbeat; after the feathers come into contact with the healthy heartbeat, the heartbeat stops. There is, however, some hope represented in this piece through the gradient of glaze that starts out dark and ends at white, at the top of the piece.

AWARD Honorable Mention

EXPRESSIONIST Parker Miller

SCHOOL Springfield-Clark Career Technology Center

CITY Springfield, Ohio

TEACHER Linda Cabaluna

RESEARCH THEME Heart Disease

RESEARCH TITLE Psychosocial Paths During Childhood to Heart Disease in Adulthood (Synopsis of: Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood)

TITLE Wilted Heart

MEDIUM/GENRE Colored Pencil

STATEMENT My artwork for the research is an image of an ana- tomical heart being stabbed by wilted rose thorns. The wilted roses represent negative words and experiences that have a direct impact on one’s heart. My hope for this piece is that when people see this, it makes them think about the way their words and actions can actually impact the health of others.

43 Infant Mortality

For decades, Cuyahoga County has had one of the highest infant mortality rates in the United States – and the numbers are particularly alarming for African Americans. In 2017, the number of infant deaths per 1,000 live births was 2.54 for Caucasians, compared to 15.6 for African Americans. Several factors, including birth defects, prematurity, and sleep-related deaths – all compounded within the African American community as a result of structural racism – have contributed to the crisis. In recent years, though, local healthcare systems, community organizations, grieving families, and government leaders have rallied together with unprecedented resolve to impact social change.

Racial Disparity in Infant Mortality borhood, regardless of race, correlates with a higher IMR. In addition, studies have also shown that increased low birth Authors: Nana Matoba and James W. Collins Jr weight and preterm birth correlate with racial segregation, Publication: Seminars in Perinatology, vol. 41, no. 6, 2017, and that neighborhoods with fewer trees and plants and high- pp. 354-359. Synopsis by Cleveland Clinic Editorial Intern er rates of violence also contribute to these adverse effects. Joan Moore, The Ohio State University Conclusion: Beyond neighborhood effects, the social and Objective: The researchers wanted to look beyond the nor- psychological effects of racism toward African American mal risk factors for the infant mortality rate (IMR) in order to mothers are linked to infant mortality. Research has shown focus specifically on race. In particular, their objective was to that the main factor that physically takes a toll on mothers understand why African American women have always been is stress, which skyrockets when a mother experiences racial at a greater disadvantage. discrimination. These behavioral effects also contribute to

Discussion: While some individual risk factors — like young “weathering,” a term that refers to the decline in reproduc- motherhood, low education and income, and poor behav- tive health as an African American woman ages. Overall, the ioral habits — lead to infant mortality, these are not strongly research illustrates the importance of observing the racial connected to the racial disparity in IMR in the United States. disparity in infant mortality rates in the United States, and One factor that does contribute is the neighborhood effect, that this disparity likely exists because of many environmen- which means that when separated from socioeconomic status, tal and social factors that are unrelated to individual-level the number of women who live in an impoverished neigh- risks in mothers.

44 Impact Infant-Driven Feeding Has on the Length of Initiative to Improve Exclusive Breastfeeding by Stay of Babies in the NICU 30–34 Weeks Gestation Delaying the Newborn Bath at Hillcrest Hospital Authors: Heather Condo DiCioccio*, Candace Ady*, James Authors: Cleveland Clinic Science Intern Ramir Martin, F. Bena*, and Nancy M. Albert* Cleveland School of Science and Medicine; Cleveland Clinic Publication: Journal of Obstetric, Gynecologic & Neonatal Mentors Tina Di Fiore and Amy Berardinelli, Hillcrest Hospital Nursing, vol. 48, no. 2, 2019, pp. 189-196 2018 Cleveland Clinic Science Internship Poster Publication: Objective: The researchers aimed to examine whether de- Presentation layed newborn bathing would increase rates of in-hospital

Hypothesis: The researchers hypothesized that with the use exclusive breastfeeding and increase the probability of a of infant-driven feeding (IDF), babies in the Neonatal Inten- mother’s plan including the use of human milk after dis- sive Care Unit (NICU) who were at 30–34 weeks’ gestation charge from the hospital. would have a shorter length of stay. Methodology: This study focused on 996 pairs of mothers

Methodology: Before the project began, nurses were trained and healthy newborns. As opposed to bathing a newborn on how to use IDF in the NICU. IDF was also added to the within two hours of its birth, the baths were delayed for at electronic medical records system to assist nurses with using least 12 hours after birth; in fact, nurses were encouraged to the program for every feeding. A retrospective chart review delay the bath for closer to 24 hours. Pre- and post-interven- was performed to determine which babies in the NICU were tion data were also retrieved from the hospital’s electronic between 30 and 34 weeks gestation, and which received medical records system, and were then analyzed. IDF. This group was compared to the infants who did not Results: In-hospital exclusive breastfeeding increased from receive IDF. 59.8% before the intervention to 68.2% after the interven-

Results: The data showed that between 2014 and 2016, the tion. Newborns in the post-intervention group were more average length of stay for babies 30 to 34 weeks’ gestation likely to be breastfed exclusively during hospitalization, and decreased by eight days. In 2014, before the IDF program mothers were more likely to have discharge feeding plans began, the length of stay averaged 25 days; that number that included human milk (whether on its own, or in addition decreased to 18 in 2015, and then to 17 in 2016. The re- to formula). Thus, the researchers concluded that delaying searchers concluded overall that by implementing the IDF the newborn bath was associated with higher rates of in-hos- program, Hillcrest Hospital was able to decrease these in- pital breastfeeding, as well as more mothers whose plans fants’ length of stay. after leaving the hospital included the use of human milk.

*Denotes a current or former Cleveland Clinic caregiver

45 AWARD Blue Ribbon

EXPRESSIONIST Brigette Fuentes

SCHOOL Hathaway Brown School

CITY Shaker Heights, Ohio

TEACHER Shelly Ahern

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE Origins

MEDIUM/GENRE Mixed-Media

STATEMENT The central idea of this project was to express the relationship between impoverished environments and infant mortality rates. The goal of the piece was to invoke a feeling of helplessness and make the viewer feel trapped, as many pregnant women in not-so- well-off neighborhoods may feel. It also serves to educate the viewer on the topic of racial disparity in infant mortality according to the research provided.

46 AWARD Blue Ribbon Empty EXPRESSIONIST Jordan Jontz

SCHOOL Kirtland High School Kirtland, Ohio CITY I didn’t know what was happening to you. TEACHER Meriah Duncan RESEARCH THEME Infant Mortality The doctor showed me pictures of you six months ago; RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality) he said you were healthy. TITLE “Empty” It’s not your fault. MEDIUM/GENRE Free Verse Poem

STATEMENT I knew I should have gone back but I couldn’t pay the rent, My poem represents the inner thoughts of a woman grieving the loss of her infant, and the response of I couldn’t face the doctor again with my skinny arms and bones the child to the mother’s guilt. This was inspired by the original research project summarized by Joan protruding around my swelling belly. Moore, which focused on the impact of living in an impoverished neighborhood and a lack of support It’s not your fault. have on the rate of infant mortality, a problem that disproportionately affects African American women. My water broke a month too early, the burning liquid streamed My intent for this piece was to draw attention to the environmental impacts affecting the rate of infant mortality, which is often incorrectly attributed out of me like the tears from my eyes, to poor choices made by the mother. I hoped it wasn’t blood. It’s not your fault. I guess I should have known you wouldn’t make it, I carried my stress and solitude inside my veins like I carried you. It’s not your fault. Your father is long gone, I have no friends, no one stayed with me in the cold hospital room, I hoped I would be enough for you. It’s not your fault. The pretty white woman holding her baby looked like an angel. Her husband squeezed her hand as he wheeled her past my room, heading home. I didn’t get to hold you. Your tiny body was too red, too frail, you didn’t cry, and they rushed you away as soon as you took your first breath. They tried to tell me that you were dead, but all I could see was the empty crib at home waiting for you, the little pink shoes, your curly hair in wild pigtails after your first day of kindergarten. It’s not your fault. Every day I wish I could talk to you, fragments of broken sentiments echo through my mind as I plead for one moment with you. All I want to know is Was it my fault?

47 AWARD Blue Ribbon

EXPRESSIONISTS Aaron Winters, Zachary DeRespiris, Christopher Wojnar, and Benjamin Roman

SCHOOL Notre Dame-Cathedral Latin High School

CITY Chardon, Ohio

TEACHER Beth Ward

RESEARCH THEME Infant Mortality

RESEARCH TITLE Initiatives to Improve Exclusive Breastfeeding by Delaying the Newborn Bath

TITLE “The Trends of Infant Mortality”

MEDIUM/GENRE Mathematical Analysis

STATEMENT We chose the topic of infant mortality because we felt that it’s important to show the differences between developed and developing countries, different parenting styles, and other factors in terms of infant mortality. We also chose this topic to bring awareness to the fact that even technologically advanced societies like America still have a higher infant mortality rate than they should. Completing this analysis opened our eyes and allowed us to see these statistics through a mathematical lens.

48 49 50 51 52 53 AWARD Blue Ribbon

EXPRESSIONIST Maya Zym

SCHOOL Garfield Heights High School

CITY Garfield Heights, Ohio

TEACHER Emily Mayausky

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE “POOR” BABY

MEDIUM/GENRE Mixed-Media

STATEMENT “POOR” BABY was inspired by infant mortality. The box is covered in death certificates, which symbolize the deaths of the babies. The baby feet in the box symbolize African American baby feet, since African American babies have 2.2 times greater chance of facing mortality than white babies. I weathered the box and placed rundown houses inside to symbolize the fact that a much higher percentage of African American women live in poverty-level neighborhoods.

AWARD Red Ribbon

EXPRESSIONIST Anne Christy Domingo

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Karen Mehling-DeMauro

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE The Sea of Bears

MEDIUM/GENRE Painting

STATEMENT My piece focuses on Joan Moore’s research synopsis, which explains how the neighborhood effect results in an infant mortality rate that is 2.2 times higher in black infants than white infants. I wanted to bring awareness to how the racial gap and the different economic status between the two races affect the well-being of the infants.

54 AWARD Red Ribbon Please Get Better EXPRESSIONIST Madeline Foresta

SCHOOL Mayfield High School

CITY Mayfield Village, Ohio With tiny hands holding her youthful face, she stares into the locker mirror. TEACHER Kari Beery Frizzy hair frames her temples and a rainbow of beads hovers above her scrawny shoulders. Infant Mortality RESEARCH THEME Water droplets trickle from her innocent eyes to the floor, RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity as she waits for the bell to ring. in Infant Mortality)

TITLE “Please Get Better” She begins to wish her dark complexion would fade… MEDIUM/GENRE Poetry Smoother curls and smaller lips STATEMENT A front row seat in every class This piece is focused on the racial gap discovered through studying trends in infant mortality. I chose Feeling loved rather than hated this topic because I found it to be devastating, yet interesting, and wanted to shed further light on the issue. By incorporating imagery and a wide variety of other literary devices, I was able to share my Please get better interpretation of how personally a mother could be Please get better impacted by the loss of her child. Please get better

With bony hands holding her tired face, she stares into the bathroom mirror. Tears stream all the way down to the brown buttons on her yellow blouse. Cold toes covered by old socks tap rapidly on the floor, as she waits for the two pink lines to slowly appear. She begins to rehearse an explanation... Tell Mama that she doesn’t remember his name Say to Daddy that she should've been more careful Beg for forgiveness and pray her parents stay

Please get better Please get better Please get better

With shaky hands holding her swollen face, she stares into the compact mirror. Thin skin on the bridge of her nose folds as her bushy brows burrow. Thick feet covered in fuzzy boots glide clumsily across the floor, as she waits for the cashing of her minimum wage paycheck. She begins to fluster at the thought of her finances... Pregnancy check-ups scheduled just to be missed Work shifts consuming all hours of the day No time for the rest a soon-to-be mother so desperately needs

Please get better Please get better Please get better

55 With clenched hands holding her sweaty face, she stares into the handheld mirror. Silence echoes through her ears and panic rushes through her mind. Doctors circle the hospital bed while wrinkled sheets tickle the floor, as she waits for a cry that can never be made. She begins to imagine the absence that is now her future… A dresser drawer dedicated to onesies that won't be worn The empty wooden crib beside her window A heartache that will forever linger

Please get better Please get better Please get better

With careless hands holding her blank face, she stares into the bedroom mirror. She wears a shirt that hangs loosely and pants that bag in the wrong places. Her stomach clings to the extra weight it can still grasp, as she waits for her grief to subside. She begins to reflect on the tragic truth... Medical bills demanding money from a nonexistent supply The loneliness that becomes unbearable when the sun leaves the sky A family with only one member instead of two

Please get better Please get better Please get better

56 AWARD Red Ribbon

EXPRESSIONISTS Addison Schermer and Katelyn Zitnik

SCHOOL Notre Dame-Cathedral Latin High School

CITY Chardon, Ohio

TEACHER Beth Ward

RESEARCH THEME Infant Mortality

RESEARCH TITLE Initiatives to Improve Exclusive Breastfeeding by Delaying the Newborn Bath

TITLE “Infant Investigation”

MEDIUM/GENRE Mathematical Analysis

STATEMENT The inspiration for researching infant mortality came from our desire to better understand the issues and complications regarding prematurely born infants. We hope to convey infant mortality’s varying presence worldwide and exhibit how different tactics can be implemented to improve infants’ health and reduce their hospital stays. Hopefully, our work can help others better understand infant mortality, so that the rate can be further reduced.

57 58 59 60 61 62 63 64 AWARD Red Ribbon

EXPRESSIONIST Riley Zelazny

SCHOOL Chardon High School

CITY Chardon, Ohio

TEACHER Christina Blaschke

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE What if something goes wrong?

MEDIUM/GENRE Painting

STATEMENT Infant mortality is 2.2 times higher in African Americans due to racial discrimination, low income, and impoverished neighborhoods. These factors can be very detrimental to an infant and cause many of these soon-to-be mothers to be overcome by the unspeakable question: What if something goes wrong? My piece visually displays two contrasting thoughts provoked by this question, the left being the mother’s hopeful dream of a sweet baby, and the right being the mother’s worst nightmare: losing their future with their infant. Combined with the chaotic splashes of color, my piece shows just how consuming this worry can be.

AWARD White Ribbon

EXPRESSIONIST Nicholas Bolger

SCHOOL Vermilion High School

CITY Vermilion, Ohio

TEACHER Christen Schneid

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE Destruction of Life

MEDIUM/GENRE Painting

STATEMENT My eXpressions project is about the racial gap in infant mortality. This artwork represents unborn babies’ living environments and the mothers’ habits leading to infant mortality. The heart symbolizes the baby. The main focus of this piece is based on surrealism and its unrealistic size relationships. The community is hurting this baby by abuse and contributing to environmental issues. The ash in the sky represents the lungs from the mother’s habit of smoking, affecting everything during pregnancy. The mother’s habits — smoking, drinking, abuse — are the roots leading into the veins of the baby’s heart. The blue ribbon stands for child abuse awareness.

65 AWARD White Ribbon Dear Baby EXPRESSIONIST Hannah Duncan

SCHOOL Kirtland High School

CITY Kirtland, Ohio (Recording clicks on—birds are chirping. Sounds as if the recording is being taken on a TEACHER Meriah Duncan sunny morning on the porch.) RESEARCH THEME Infant Mortality Hi, baby! It’s your mom! RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality) Just 9 more months until you’re here.

TITLE “Dear Baby” 9 months.

MEDIUM/GENRE Lyrics/Audio Recording

STATEMENT I CAN’T PROMISE ALL THAT MUCH TO YOU, This poem, written in libretto format, complete with italicized director’s notes and capitalized lyrics, cap- I WON’T TELL YA THAT NO STORM IS GONNA BREW. tures the audio recordings throughout a mother’s pregnancy. These vignettes are intended for her DARK CLOUDS MAY COME, daughter to listen to in the future. The nameless main character represents all the mothers who have BUT I'LL CLIMB THE HIGHEST MOUNTAIN FOR YOU ALONE. experienced the tragedy of infant mortality. This character, serving as the archetypal voice of any mother who has lost an infant, apathetically dismiss- A SOUL INSIDE ME JUST WAITING FOR LIFE, es prenatal warnings. Like others, her baby becomes another statistic and cannot be brought back. YOUR EYES WILL OPEN WITH WONDER AND DELIGHT. A MOUTH SOON TO LAUGH, EXPRESSIONS UNTOLD. TO LOVE AND BE LOVED, YOUR HAND I WILL HOLD.

OF ALL THE LOVELY WONDERS YOUR SMILE WILL BRING, I CAN’T GET MY MIND OFF THE MOMENT I’LL FIRST SEE YOU. 9 months. (Recording clicks off.)

(Recording clicks on—with family, at an outdoor party. The atmosphere is peaceful, pleasant.) Demi! That will be your name! I’m having a baby girl! Your nana wanted a boy. She’d say, “He’ll be named Devon. Ooo! No! Denzel. And he will be strong!” (chuckle). Well, you will be just as strong as any Devon or Denzel. I saw you today; they even let me take home a picture! 4 months until I can see you completely. 4 months.

OH DEMI, HOW LONG ARE YOU GONNA TAKE? I’M FEELING CRAMPS AND MY BACK HAS BEGUN TO ACHE, BUT IT'S ALRIGHT, I’LL SUFFER ALL THIS PAIN SO YOU CAN SEE THE LIGHT.

MAMA TELLS ME TO QUIT WITH ALL THE STRESS, BUT I WORK SO MUCH SO YOU CAN HAVE THE BEST. ALL I CAN HOPE, IS THAT YOU WON’T SHARE THE TROUBLES TO STAY AFLOAT.

OF ALL THE ENDLESS TRIALS THIS LIFE MAY BRING, I’M HAPPY TO KNOW THAT THESE HARD MONTHS ARE ALL FOR YOU. 4 months! (Recording clicks off.)

66 (Recording clicks on—the background noise resembles a busy hospital. Not too long after the birth of Demi.) Well, I guess I only had to wait 2 months.

DEAR DEMI, YOUR SMILE I WILL NEVER SEE ‘CAUSE THE DOCTORS TOOK YOU AWAY FROM ME ‘FORE I EVEN HAD THE CHANCE TO HOLD YOU IN MY ARMS AND TAKE A GLANCE. (The melody continues without the accompanying voice. Slowly.)

OF ALL THE AWFUL MOMENTS I’VE HAD TO LIVE THROUGH, THE WORST OF THEM ALL IS WHEN I HEARD THAT I’D LOST YOU.

The doctor came back in. He told me that black babies are twice as likely to die before the age of one than white babies.

Why? Was my socioeconomic status not good enough? Weathering?

“Institutional racism!” claimed Mama.

I don’t care the reason.

My baby is gone. (Recording clicks off.)

67 AWARD White Ribbon

EXPRESSIONIST Olivia McDowell

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Karen Mehling-DeMauro

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE Safety Blanket

MEDIUM/GENRE Mixed-Media

STATEMENT I chose the topic of infant mortality and the racial gap. As an African American young woman, the lack of respect and attention given to black women has systemic roots and is very important to me. In the painting, there is an African American mother holding a small newborn to represent the low birth rate. The baby is swaddled in a blanket that has the various causes for the racial gap embroidered into the fabric for texture. To add balance, instead of painting the hair, I chose to add faux braids.

AWARD White Ribbon

EXPRESSIONIST Nadiya Seniv

SCHOOL Normandy High School

CITY Parma, Ohio

TEACHER Dave Fogle

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE Fleeting Miracle

MEDIUM/GENRE Digital Media

STATEMENT The central idea for this project was infant mortality, and I wanted to illustrate how some children aren’t given the chance to live through the experiences we get to. The baby is trapped in the hourglass, while the background shows how beautiful the world is and how a person grows internally and externally. The baby’s time is limited, the sand is slipping onto its demise. Infant mortality should be more recognized, because nobody deserves to have life taken from them before experiencing it.

68 AWARD Honorable Mention Patient X EXPRESSIONIST Ariela Gettig

SCHOOL Kirtland High School

CITY Kirtland, Ohio

TEACHER Meriah Duncan

RESEARCH THEME Infant Mortality Infant Mortality Rate: A Racial RESEARCH TITLE : Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE “Patient X”

MEDIUM/GENRE Patient Chart and Doctor’s Notes

STATEMENT “Patient X” is inspired by research on the racial disparities in infant mortality. The presentation of a patient chart underscores the complexities of mul- : : tiple complications in infants that lead to mortality. : Since the research highlighted the environmental differences between races and infant mortality rates, the technical language in the doctor’s notes parallels these differences through Patient X’s background. Patient X, “Jane Doe,” reflects the reality that many unhealthy infants are abandoned after birth. Ending the patient chart, the doctor’s notes highlight the current critical conditions of many minority infants who struggle to survive due to underdevelopment.

69 AWARD Honorable Mention

EXPRESSIONIST Cassidy Gibbons

SCHOOL Hoover High School

CITY North Canton, Ohio

TEACHER Christopher Triner

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE The Helpless Fetus

MEDIUM/GENRE Mixed-Media

STATEMENT For this piece, I wanted to show the main factors that affect African American women and the high infant mortality rate associated with them. Living in impoverished neighborhoods and the neighborhood effect are shown in the background behind the woman. The lack of trees and greenery in neighborhoods can also lead to more stress and low birth weight. In the research it is also mentioned that bad habits like smoking and drinking while you are pregnant can cause premature birth and death to the fetus. The mother in my illustration is also supposed to be a young girl. She is also crying to show stress and pressure from the surroundings.

AWARD Honorable Mention

EXPRESSIONIST Bridget O’Reilly

SCHOOL Chardon High School

CITY Chardon, Ohio

TEACHER Christina Blaschke

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE The Weight of the World

MEDIUM/GENRE Painting

STATEMENT Infant mortality is a serious problem in the U.S., with the majority of the infant deaths being in the black community. The extended arms reach out to the viewer to express the tragedy of the rates of infant deaths. They hold a very small African American baby, who represents those who sadly lost their lives soon after birth due to low birth weight, a leading cause of infant deaths. Infant mortality is an unfortunate reality that quietly plagues babies across America.

70 AWARD Honorable Mention

EXPRESSIONIST Halle Vargo

SCHOOL Berea-Midpark High School

CITY Berea, Ohio

TEACHER Jim Bycznski

RESEARCH THEME Infant Mortality

RESEARCH TITLE Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath

TITLE Two-Faced

MEDIUM/GENRE 3-D/Sculpture

STATEMENT When choosing the topic, “Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath,” I tried to accurately demonstrate the negative effects that cause the newborn to be less likely to breastfeed, as well as those that could negatively affect their health in general. The newborn is being represented as two beings in one bath surrounded by bath toys to show a contrast in comfort. One half of the newborn represents a content child where the bath has been delayed 12 hours, as shown on the clock. The other side represents an unhappy newborn, where the bath was given in the first 2 hours.

71 AWARD Honorable Mention My Life as an Angel EXPRESSIONIST Saamia Wanzo

SCHOOL Cleveland School of Science and Medicine

CITY Cleveland, Ohio Why didn’t I get to see this? Christine Sims TEACHER I didn’t get to live my life RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity Like a normal child would in Infant Mortality) The cause of this was TITLE “My Life as an Angel” MEDIUM/GENRE Poetry Infant mortality STATEMENT I wrote this poem to help bring awareness to the num- Preterm birth ber of child deaths that are caused from negative factors that affect the infant mortality rate. I chose Genetics this topic because it is not one that is talked about in society today. I hope that my poem will bring empa- Congenital malformations thy and awareness to the subject of infant mortality around the world. Access to healthcare My life was cut short Because of Discrimination Prenatal care Income Education My life was started But not finished Like a stutter I wonder What life would Have been If I was there

72 AWARD Honorable Mention

EXPRESSIONIST Azleigh Whitford

SCHOOL Riverside High School

CITY Painesville, Ohio

TEACHER Jessica Biller

RESEARCH THEME Infant Mortality

RESEARCH TITLE Infant Mortality Rate: A Racial Gap (Synopsis of: Racial Disparity in Infant Mortality)

TITLE Reaching For Solutions

MEDIUM/GENRE Mixed-Media

STATEMENT My piece, Reaching For Solutions, reflects the infant mortality rate (IMR) in America. There are various reasons for the IMR; I’ve chosen to show how the connection between race and the environment is a contributing factor. In my piece, a woman’s hand is reaching for the baby’s hand, and scenes of the inner city in the background are highlighted with articles revealing the infant mortality rate. The articles shine a light on racial differences, social economics, and unsafe environmental conditions that all contribute to infant mortality. The clouds represent the negative influences of the environment that are hard to escape.

73 Obesity

According to the Centers for Disease Control and Prevention, obesity now affects one in four adults and one in five children and adolescents in the United States. Defined as an excess amount of body fat, obesity is much more than a cosmetic concern. It is a chronic condition that increases the risk of developing a long list of health problems, including heart disease, stroke, chronic liver disease, diabetes, osteoarthritis, sleep apnea, and cancer. We know that numerous factors – from overeating and physical inactivity to slow metabolism, psychological issues, and genetics – contribute to obesity. And thanks to ongoing research, we’re learning more about its causes and consequences each day.

Nonalcoholic Fatty Liver Disease in Children creasing number of obese children affected by NAFLD, this is extremely concerning, especially because many extrahe- Authors: Praveen Kumar Conjeevaram Selvakumar, et al. patic complications can develop: poor quality of life, cancer, Publication: Pediatric Clinics of North America, vol. 64, no. bone disease, heart disease, diabetes, vitamin D deficiency, 3, 2017, pp. 659-675. Synopsis by Cleveland Clinic Editorial dyslipidemia (a high amount of lipids, or fats, in the blood), Intern Joan Moore, The Ohio State University hypertension (high blood pressure), and even end-stage liv-

Objective: The purpose of this article is to present infor- er disease. Children with NAFLD are at a much higher risk for mation about the effects of nonalcoholic fatty liver disease heart disease and type 2 diabetes.

(NAFLD), both on the liver and on other parts of children’s Conclusions: It is clear from the points above that having bodies. NAFLD can lead to a poorer quality of life. The physical and

Discussion: NAFLD encompasses a wide range of liver is- mental effects of this disease can be extremely intense or life- sues, ranging from a less harmful buildup of fat in the liver to threatening for anyone, but especially for children. Treatment the more harmful version of this disease, called steatohep- options for NAFLD are limited; the best recommendation atitis. The most concerning aspect of NAFLD is how quickly to date is a lifestyle change, including weight loss methods it can progress to more serious liver diseases. With an in- such as increasing physical activity and eating healthier foods.

74 Obesity in the Community: Taboo Subject? Are We The Protein-Sparing Modified Fast Diet: An Effec- Addressing the Needs of the Obese Hospitalized tive and Safe Approach to Induce Rapid Weight Loss Patient? in Severely Obese Adolescents

Authors: Cleveland Clinic Science Intern Kenneth Chrulski, Authors: Marwan Bakhach*, Vaishal Shah*, Tara Harwood*, St. Ignatius High School; Cleveland Clinic Mentor Joan Licata, Sara Lappe*, Natalie Bhesania*, Sana Mansoor*, and Naim Fairview Hospital Alkhouri*

Publication: 2016 Cleveland Clinic Science Internship Poster Publication: Global Pediatric Health, vol. 3, 2016, pp. 1-6 Presentation Objective: The protein-sparing modified fast (PSMF) is a rig- Hypotheses: The first hypothesis for this study was that the orous method for rapidly losing a large amount of weight. majority of patients in the sample would be overweight or Although adult studies have shown the PSMF to be effec- obese. From there, the researchers hypothesized that the tive, the data for adolescents are scarce. The objective of majority of patients who are obese would receive care that this study was to determine how safe and effective the PSMF would positively affect their obesity through diet, exercise, could be for severely obese adolescents. or medication. Finally, the researchers hypothesized that a Methodology: The research sample included 12 subjects small number of obese patients would qualify for bariatric who were evaluated in the Obesity Management Program at surgery. Cleveland Clinic between 2011 and 2014. Other convention- Methodology: Using the electronic medical records system, al methods of weight loss had not worked for them, so they a non-experimental study was conducted from a sample of were put on the PSMF program. After reaching their goal all admitted patients between June 18 and June 29, 2016. weights, the patients transitioned to the refeeding phase, The sample included 500 patients, who were separated by which focuses on weight maintenance, and were monitored body mass index (BMI) category (underweight, normal, over- at periodic intervals. weight, or obese), race, and gender. Results: Follow-up appointments at the three- and six-month Results: Out of the 500 patients in the sample, 202 patients intervals showed mostly promising results with increased in the study were classified as obese, and 133 were noted as weight loss. The subjects reported some mild side effects, being overweight. 66 of the obese patients were men, while but nothing life-threatening. Thus, the researchers conclud- 136 were women; 94 qualified for bariatric surgery based on ed from this small study that the PSMF diet can be used as their weight and comorbidities. 100 of the obese patients an effective and safe method in the outpatient setting for either discussed their obesity with medical professionals rapid weight loss in adolescents with severe obesity. during their hospital stay or had it listed as problematic in their charts. 87 of those 100 patients were given a diet recommendation or a medication that would indirectly combat *Denotes a current or former Cleveland Clinic caregiver their obesity. Out of all 202 obese patients, 57 were not made aware of their obesity at all by hospital professionals.

75 AWARD Best in Show, Art

EXPRESSIONIST Emma Januszewski

SCHOOL Berea-Midpark High School

CITY Berea, Ohio

TEACHER Thomas Conti

RESEARCH THEME Obesity

RESEARCH TITLE Obesity in the Community: Taboo Subject? Are We Addressing the Needs of the Obese Hospitalized Patient?

TITLE Taboo

MEDIUM/GENRE Mixed-Media

STATEMENT This project allows someone who has not done research on the topic of obesity to appreciate the visual that the piece portrays. The main focus of this project is how hospitals do not properly diagnose obese patients. The piece represents obese citizens and their problems due to the lack of treatment from doctors.

76 AWARD Blue Ribbon two bodies. EXPRESSIONIST Sarah Carlile

SCHOOL Mayfield High School

CITY Mayfield Village, Ohio Samantha can’t start, TEACHER Kari Beery and Rebecca can’t stop. Obesity RESEARCH THEME they’re two bodies dying, RESEARCH TITLE Obesity in the Community: Taboo Subject? Are We Addressing the and going ‘til they drop. Needs of the Obese Hospitalized Patient? “two bodies.” TITLE one of them too small, MEDIUM/GENRE Poetry the other much too big. STATEMENT Inspired by Kenneth Chrulski and Joan Licata’s case one seen through fragile glass, study evaluating the taboo nature of patient obesity, “two bodies.” is a two-voice poem highlighting two the other viewed a distasteful pig. individuals’ experiences with their respective eating disorders (the left side represents anorexia and the right represents binge-eating; the middle contains but even through their differences, the voices’ shared perspective) over the course of an in-patient admittance. The data impacted me despite their sizes and shapes, because I am one of the many individuals who face the same struggle as my character, Samantha. I know their dangerous paths still cross, I wouldn’t be alive today if I didn’t get the help I needed, the help that every individual — thin or as they end up back in the same dark place. obese — deserves.

yet, only one of them can fit, both literally and not; accommodations are made accordingly for Sam, but it seems as though Becca was never in thought.

and though it seems to remain obscure, there’s an elephant in Becca’s room— but no one says a word, even if their eyes say it all… because the obese ticking time bomb threatens to consume.

as for Sam, help is straightforward as doctors bluntly diagnose and address she’s fixable, nutritionists say. they know what to do and plan for her to be another health story success

all is not well for Becca, however as she’s treated for side effects alone hypertension, diabetes, hyperlipidemia… surely it’d be easier if she were just skin and bone?

the list doesn’t just end there, though but rather goes on, on, on COPD, CAD, CHF, GERD… and she just wants all of it gone, gone, gone.

77 they put Sam in therapy a few days later and ask her why she starves to cope she answers with numbers, calories, and pounds and over time, fear becomes replaced by hope

a weight loss surgery, resolving lots of problems and what Becca can’t see is that she’s not the only one because almost 50% of “her kind” in that place qualify and how many get consultants? yeah, that’s right, none.

so no one asks Becca why she binges and binges and no one cares it’s really her soul that’s been craving like the others, no one tells her she qualifies for surgery, too (because maybe she’s just not even worth saving.)

the process of recovery is slow, but steady and if honest, there are relapses here and there but overall, Sam comes out happier and healthier all thanks to the right treatment and medical care

six months later, Becca’s back in the hospital only this time, she lays limp on a cool metal slate numbers are finally put down in her chart oh, what a shame, her time came too late.

two different girls: one anorexic. one obese. both with eating disorders who sought out help

but if society only helped one girl’s body type, how was the other ever supposed to help herself?

78 AWARD Blue Ribbon

EXPRESSIONIST Abigail Long

SCHOOL Brecksville-Broadview Heights High School

CITY Broadview Heights, Ohio

TEACHER Anne Jones

RESEARCH THEME Obesity

RESEARCH TITLE The Relationship Between Childhood Obesity and Liver Disease (Synopsis of: Nonalcoholic Fatty Liver Disease in Children)

TITLE Overstuffed

MEDIUM/GENRE Mixed-Media

STATEMENT The central idea of Overstuffed was to show the association with liver disease and obesity in adolescents. Many of the pieces in Overstuffed have symbolic meanings. The children affected with liver disease are represented by the teddy bear. The left side of the bear symbolizes health, and the right symbolizes obesity. The heart patch represents the fact that children with liver disease are prone to developing heart disease. The stitches on the teddy bear are where a liver biopsy would take place. On the wall, the left side shows uninfected liver cells and the right side shows infected liver cells.

AWARD Blue Ribbon

EXPRESSIONIST Anya Parsons

SCHOOL Kenston High School

CITY Chagrin Falls Township, Ohio

TEACHER Todd Malkus

RESEARCH THEME Obesity

RESEARCH TITLE The Relationship Between Childhood Obesity and Liver Disease (Synopsis of: Nonalcoholic Fatty Liver Disease in Children)

TITLE Unfortunately,

MEDIUM/GENRE 3-D/Sculpture

STATEMENT The “nonalcoholic” part of the name of nonalcoholic fatty liver disease, or NAFLD, and its symptom list implies to me that the children suffering from this condition have similar health complications to adult alcoholics. I decided to put an illustration of an obese baby trapped inside of a liquor bottle to show the children whose livers are damaged like those of an alcoholic’s. I created my own label for the bottle modeled after a recognizable liquor label, but replaced some words to relate to the disease. The bottle is filled with foam to mimic fat, showing that the harmful agent in this bottle is not alcohol, but obesity.

79 AWARD Red Ribbon

EXPRESSIONIST Margaret Eibler

SCHOOL Kenston High School

CITY Chagrin Falls Township, Ohio

TEACHER Todd Malkus

RESEARCH THEME Obesity

RESEARCH TITLE The Relationship Between Childhood Obesity and Liver Disease (Synopsis of: Nonalcoholic Fatty Liver Disease in Children)

TITLE Liver Let Die

MEDIUM/GENRE Mixed-Media

STATEMENT Obesity in children can lead to a 70% chance of developing nonalcoholic fatty liver disease (NAFLD), and can cause more problems as children grow older. NAFLD leads to extreme physical and mental side effects, which can not only impact adults, but especially children. I wanted to create a piece that will showcase the emotional moment for something slightly out of our reach. I wanted to use a child reaching for a healthier, better life but is utterly surrounded by not only bad choices, but an overpowering, unhappy life.

AWARD Red Ribbon

EXPRESSIONIST Sabrina Lian

SCHOOL Vermilion High School

CITY Vermilion, Ohio

TEACHER Christen Schneid

RESEARCH THEME Obesity

RESEARCH TITLE Obesity in the Community: Taboo Subject? Are We Addressing the Needs of the Obese Hospitalized Patient?

TITLE Chained

MEDIUM/GENRE Charcoal

STATEMENT In their original research, Kenneth Chrulski and Joan Licata conducted a study on obese patients and the diagnoses of obesity. With obesity growing in the U.S., many patients’ questions and problems still do not get properly addressed in treatment. My artwork portrays a patient who is chained to a hospital bed, trapped from lack of awareness of their obesity. Patients often struggle to deal with obesity and feel helpless, which also correlates with being chained to the hospital bed.

80 AWARD White Ribbon Time for Change EXPRESSIONIST Olivia Galek

SCHOOL Trinity High School

CITY Garfield Heights, Ohio NAME: BENJAMIN DAVIS TEACHER Gina Ramirez DATE OF BIRTH: SEPTEMBER 16, 2006 RESEARCH THEME Obesity

RESEARCH TITLE The Protein-Sparing Modified AGE: THIRTEEN Fast Diet: An Effective and Safe Approach to Induce Rapid Weight Loss in Severely Obese Adolescents BASELINE TITLE “Time for Change” I hate the doctor’s office. The bland, white walls. The dustless countertops. MEDIUM/GENRE Short Story

STATEMENT The fumes of disinfectant. The quiet, calming melodies that make me want to sleep. My eXpressions project is inspired by the research, “The Protein-Sparing Modified Fast Diet: An Effec- As I sit patiently in the waiting room, my palms start to sweat. The butterflies in my tive and Safe Approach to Induce Rapid Weight Loss in Severely Obese Adolescents.” I chose to reflect stomach flutter rapidly like a miniature tornado. on the research through a short story. My narrative gives voice to the perspective of Ben, an obese boy Ten minutes later, Nurse Kendall calls me back. Immediately, my body tenses. implementing the diet plan to lose weight. The message my work conveys is Ben’s response to his I scan her head to toe. Today, she smells of vanilla, not her usual cinnamon scent. obesity and the negative effects it has on his health, well-being, and emotional life. I was drawn to this My parents are here, too; they follow noiselessly. We commence with the normal subject because proper nutrition and physical health interest me. Additionally, the number of obese peo- procedures: weight, height, blood pressure, and vitals. I close my eyes and breathe. ple in the U.S. is rising rapidly. My goal is to raise awareness and promote lifestyle changes for those I inhale. I don’t like this part. I’m embarrassed of my weight. I exhale. My heart starts who suffer from the effects of obesity. to pound. Afterwards, my parents and I wait patiently for the doctor. My mom even holds my hand. Doctor Frey, the registered bariatrician, is nothing like I imagined her to be. I envisioned a short, bald man wearing white doctor’s garb and circular glasses. Instead, Doctor Frey is a young woman with caramel hair tied tightly in a bun and bright red lipstick. When she smiles, it feels as if the world goes still. Her presence seems to mollify my anxiety, if only for an instant. Like most doctors, Frey speaks in riddles. I sit there, silently observing and listening to my parents review previous medical records. I surpassed a BMI of 27 kg/ m2 and Frey believes my best option for weight loss is to implement the protein-sparing modified fast plan. I fidget in my seat. These are big words for me. I am confused. However, from what I can gather, the PSMF incorporates medical, nutritional, and behavioral components. Exercise is also required. I groan. But the doctor emphasizes the risk. The epidemic of childhood obesity remains on the rise. And I truly want to get better. I need to get better. I’m tired of being fat.

81 INTENSIVE PHASE I’m starving. It feels as if I have not eaten in years. Only 800 calories a day! Can you believe it? I even take supplements. Mom and Dad say I look good. God, I miss junk food. Sugary candy, cheese pizza, ice cream, cake...you name it. My stomach rumbles. It aches. And my legs are sore from running. Exercise sucks. My whole life I have been bullied and teased for my appearance. I’m ordinary. Brown hair. Brown eyes. Short for my age. Chubby. I’m always picked last in gym or sit alone at lunch. I cry to my parents daily. No one can be friends with the fat kid. I don’t fit in. I’m not normal. My classmates even nicknamed me “Piggy.” The protein-sparing modified fast diet is a lot more difficult than I thought it would be.

REFEED I’m anxious again. I get to see Doctor Frey. Mom says she has news that involves my recovery and weight loss plan. What if something is wrong...? I had a lot of blood drawn the past couple weeks. What could that mean? I take a deep breath. Inhale. Exhale. Doctor Frey starts with the bad news. She diagnoses me with prediabetes. She says my blood sugar levels are high despite all the work I’ve put into losing weight. I can’t believe it. There must be a mistake. Mom and Dad both ask how this is possible. Frey responds by saying that the lingering side effects of my obesity are apparent. However, if I continue to lose weight, possible options for surgery are open. And that’s all I’ve ever wanted.

FOLLOW-UP (TWO YEARS LATER) Through the protein-sparing modified fast diet plan, I have lost close to two hundred pounds. I want to speak about my incredible journey in hopes of inspiring other obese adolescents to seek treatment. First and foremost, the process was not easy. There were days that I felt like quitting. I had days when I cried and episodes where I screamed. However, looking back over the past two years, I realize that through my struggles, I found strength. My self-esteem has never been better. I look forward to attending school. I made new friends. I joined robotics club. I’m on the soccer team. Life is good.

82 AWARD White Ribbon

EXPRESSIONIST Julia Morales

SCHOOL Westlake High School

CITY Westlake, Ohio

TEACHER Kelly Atkinson

RESEARCH THEME Obesity

RESEARCH TITLE The Relationship Between Childhood Obesity and Liver Disease (Synopsis of: Nonalcoholic Fatty Liver Disease in Children)

TITLE Sugar Ain’t So Sweet

MEDIUM/GENRE Jewelry

STATEMENT Children love sugar. However, sugar is not the sweetest substance for children’s growing bodies. The central idea of my project is to show how sugar affects our bodies. Sugar affects your mental state, your heart, and your liver, including many more. The physical and mental effects of too much sugar can be extremely intense or life-threatening for anyone. With too much sugar comes obesity, diabetes, and even nonalcoholic fatty liver disease. My jewelry piece’s goal is to show everyone what ingesting too many added sugars does to our bodies. We should be watching what we eat and all be healthy human beings.

83 Opioids/Pain Management

Hardly a family has remained untouched by the country’s opioid epidemic. Data from the Centers for Disease Control and Prevention show that overdose deaths nationwide from opioids have increased more than 300% since 1999, killing more than 47,000 people alone in 2017; and 36% of those deaths involved opioids legally prescribed to manage pain. Use of these highly addictive painkillers can increase a person’s tolerance and dependence, often leading to the need for higher and more frequent doses and/or to the use of illegal alternatives, such as heroin. New research, however, is helping us to better understand, and hopefully to ultimately overcome, this dire public health crisis.

Association of Opioid Prescriptions From Dental if they received an opioid prescription from a dental clinician Clinicians for US Adolescents and Young Adults in 2015 and showed no record of opioid use or abuse one year before receiving the prescription. A control group was With Subsequent Opioid Use and Abuse established, and patients in this group received placebo pre- Alan R. Schroeder, et al. Authors: scriptions. There were 29,776 patients in the control group,

Publication: JAMA Internal Medicine, vol. 179, no. 2, 2018, and 14,888 in the opioid-exposed group. Patients were then pp. 145-152. Synopsis by Cleveland Clinic Editorial Intern monitored within 90–365 days of receiving their initial opioid Joan Moore, The Ohio State University or placebo prescription.

Objective: The researchers wanted to explore the relation- Results: 6.9% of the opioid-exposed patients recorded opi- ship between the number of prescriptions for opioids written oid use within 90–365 days, in contrast to 0.1% of patients by dental clinicians in 2015 and the number of adolescents in the control group. 5.8% of the opioid-exposed individuals and young adults who were diagnosed as opioid abusers were further diagnosed with opioid abuse. Analysis of the re- during that same year. sults showed that individuals between 16–18 years old were more likely than individuals 22–25 years old to abuse opi- Methodology: The study involved 44,664 people between oids. Additionally, females abused opioids in greater num- the ages of 16 and 25. Patients met the criteria for the study bers than males within the study.

84 The Impact of Increased Calorie Feeding in Infants The Use of Stem Cell Therapy to Reverse Opioid With Neonatal Abstinence Syndrome (NAS) Treated Tolerance

With Morphine Authors: Fei Li*, LiPing Liu*, Kathleen Cheng*, Zhongbo Chen, Authors: Cleveland Clinic Science Intern Jenna Karpinsky, and Jianguo Cheng* Strongsville High School; Cleveland Clinic Mentors Taylor Publication: Clinical Pharmacology & Therapeutics, vol. 103, Rice and Betsy Walters Burkey, Fairview Hospital no. 6, 2012, pp. 971-974 2018 Cleveland Clinic Science Internship Post- Publication: Hypothesis: Mesenchymal stem cells (MSCs) have very er Presentation strong anti-inflammatory properties, so the researchers hy-

Hypotheses: The authors first hypothesized that patients with pothesized that transplanted MSCs would prevent and re- neonatal abstinence syndrome (NAS) receiving morphine for verse opioid tolerance (OT) and opioid-induced hyperalge- withdrawal symptoms who were given higher calorie feedings sia (OIH), which is a condition where a person develops an (22 cal/kg) may be discharged sooner and not lose as much increased sensitivity to pain. birth weight versus those receiving standard 19–20 cal/oz Methodology: The researchers began by harvesting and sort- feedings. A second hypothesis was that these infant patients ing different MSCs from rat bone marrow. They ran various would also be more likely to exhibit better overall growth. tests on rats with researcher-induced OT for the first 12 days

Methodology: Data were collected from the electronic of the study, and then determined the best way for the stem medical records database, and patients included infants in cells to be transplanted. The same process was followed to the neonatal intensive care unit (NICU) treated for NAS with observe and record the effects of OIH, but this part of the morphine at Fairview Hospital. The patients were separated study focused on mice. into two sample groups. Sample group 1 contained infants Results: It was concluded that transplanting MSCs showed who received 19 cal/oz feedings, and sample group 2 con- powerful preventative and therapeutic effects on OT and tained infants who received 22 cal/oz feedings. There were OIH in rats and mice. Transplantation methods were effec- about 25 patients in each group. The researchers tracked tive and safe, and the researchers noted the rapid effects NAS patients’ data through their stay at the hospital, from of the transplanted MSCs. Thus, the researchers concluded birth to discharge, to collect information. The outcomes mea- that MSC transplantation is emerging as an innovative, safe, sured were morphine dosage, length of opiate treatment, and effective method of therapy for treating opioid tolerance length of stay, and growth velocity. and opioid-induced hyperalgesia. Further, they believe that

Results: Small changes were found when comparing 19 cal/oz it has the potential to profoundly impact clinical practice. feedings to 22 cal/oz. 22 cal/oz feedings were shown to decrease the average length of opiate treatments and the *Denotes a current or former Cleveland Clinic caregiver average length of stay; in addition, morphine treatments ended on an earlier day of life for infants who received the larger feeding size. Overall, the researchers concluded that the switch from 19 cal/oz to 22 cal/oz did not cause any complications, and thus may be a positive long-term solution.

85 AWARD Blue Ribbon Bliss EXPRESSIONIST Mikaili Gibson

SCHOOL Orange High School CITY Pepper Pike, Ohio walking back out of the office TEACHERS Vikas Turakhia and Kathy Frazier my mother drives me back home RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE Links Between Opioid the agony i felt is now gone Prescriptions Written by Dental Clinicians and Opioid Abuse in it has been completely replaced Young Adults (Synopsis of: Association of Opioid Prescriptions by the wonderful feeling From Dental Clinicians for US Adolescents and Young Adults of Bliss With Subsequent Opioid Use and Abuse) TITLE “Bliss” waking up in so much pain MEDIUM/GENRE Poetry the pain makes it hard to sleep STATEMENT I wrote this piece to attempt to express the expe- i take another pill riences that teens who mistakenly have become addicted to prescription opioids may have to go the calming feeling washes over through, and the effect it could have on relationships that they have. I personally have never been drifting away slowly addicted to opioids, however multiple people in pure Bliss my life have been affected by addiction or gone through it themselves. I was inspired by the research synopsis written by Joan Moore, which showed the effect that taking these prescriptions without ade- creeping into the stall quate knowledge of their effects can have on a teen, the bottle rattles in my hands and the dark path in life that it can lead them down. another one goes down the bell rings faintly covered by the feeling amazing Bliss

the pain came back i need more relief mother took them all but i need them back i can’t take the pain i need my Bliss

my fist swings she’s crying take back the bottle i need more pills no more pain more Bliss

the ground is cold no feeling take the rest to feel something anything Bliss deafening sirens my family sobbing i can hear them all but i cannot move the end of the road at last, bliss.

86 AWARD Blue Ribbon

EXPRESSIONIST Tania Jimenez

SCHOOL Advanced Technology Academy

CITY Detroit, Michigan

TEACHER Erik Mylenek

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE Links Between Opioid Prescriptions Written by Dental Clinicians and Opioid Abuse in Young Adults (Synopsis of: Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse)

TITLE Just One More Pill

MEDIUM/GENRE Digital Media

STATEMENT Drugs have taken the loved ones of countless people — a parent, a sister, a cousin, or a friend, and at times it’ll seem like no one is safe from those drugs. It’s an epidemic. Every year, more than 47,000 Amer- icans die from opioid overdose, and 1.7 million suffer from substance misuse disorders. My piece depicts a person who is chained to a painkiller at the bottom of a lake, but even though he’s already drowning, he continues to reach toward more drugs. It represents the feelings of helplessness and isolation experienced by those who are addicted to opioids. Often, victims of opioid addiction will tell themselves that they will stop after just one more pill.

AWARD Blue Ribbon

EXPRESSIONIST Taj Jones

SCHOOL Euclid High School

CITY Euclid, Ohio

TEACHER Edith Mellen

RESEARCH THEME Opioids/Pain Management

TITLE Dragon’s Den

MEDIUM/GENRE 3-D/Sculpture

STATEMENT My piece is about opioid abuse and addiction. The dragon represents the fact that opioids are so closely related to heroin. I wanted my medicine cabinet to look out of place and broken. I wanted to also show placement, depicted by the way the bottles look tossed around and discarded. The door on the right is broken off to make it look like the dragon broke out.

87 AWARD Blue Ribbon

EXPRESSIONIST Halle Leroux

SCHOOL Riverside High School

CITY Painesville, Ohio

TEACHER Drew Hartmann

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance

TITLE Maze to the Cure

MEDIUM/GENRE Painting

STATEMENT My project is based on Cleveland Clinic’s research asset, “The Use of Stem Cell Therapy to Reverse Opioid Tolerance.” Rats and mice were used to test if stem cell repair worked, making them vital for the next steps in finding a solution someday. To most, rats and mice represent rot and sickness, but in this case, they are shown for the good they are doing for humanity. In the painting, the mice are fixing and replacing the gears inside the person to represent how the therapy reverses resistance to opioids in this research.

AWARD Blue Ribbon

EXPRESSIONIST Kaisal Shah

SCHOOL Hathaway Brown School

CITY Shaker Heights, Ohio

TEACHER Shelly Ahern

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance

TITLE Stem Cells Reduce Opioid Tolerance

MEDIUM/GENRE Drawing

STATEMENT The central idea of the project was to mimic the goal of the study, which was to use stem cells to reverse opioid tolerance and opioid-induced hyperalgesia in rats and mice, by depicting a mouse made of stem cells and opioid pills. The cells are made to look like they are pushing away the pill, to represent the cells reversing opioid tolerance in the study. The cast shadow of the mouse is made up of words pulled from opioid crisis research to represent how the crisis is metaphorically in the shadow of the study.

88 AWARD Blue Ribbon

EXPRESSIONIST Lana Traum

SCHOOL Brecksville-Broadview Heights High School

CITY Broadview Heights, Ohio

TEACHER Anne Jones

RESEARCH THEME Opioids/Pain Management

TITLE Good Intentions

MEDIUM/GENRE Pen and Ink

STATEMENT Dental clinicians prescribe opioids with good intentions: relieving patients’ pain. However, young adults who are prescribed opioids have a slightly increased percentage of becoming addicted shortly after receiving their prescriptions. I portrayed these struggles of good intentions versus addiction in this graphic novel-style narrative. Opioids are symbol- ized by the poppy plant, given with a well-wishing card from a dental clinician. The plant soon grows out of control and overtakes the young woman, illustrating the devastating nature of addiction. In an ironic moment, the poppy shoves the “Get Well Soon” card toward the woman, reminding her of the clinician’s good intentions.

AWARD Red Ribbon

EXPRESSIONIST Curtis Harding

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Kathleen Fleming

RESEARCH THEME Opioids/Pain Management

TITLE Heavy Sleep

MEDIUM/GENRE Photography

STATEMENT The topic that I chose for my project was the opioid epidemic. The opioid epidemic has been a massive problem sweeping over America and especially in Ohio, where over four thousand deaths occur each year. I chose to research this because not enough is being done to prevent deaths and many people die unnoticed. The main part of the topic that I wanted to show was the facelessness of the victims. Having the victim hold the bottle with her head facing away creates a sort of anonymous feeling. The grain effect allows for a static, more restless feeling in the photo and can add an element of distress.

89 AWARD Red Ribbon

EXPRESSIONISTS Zach Jones, Bryan Harris, Layne German, and Uriah Rhoades

SCHOOL Vermilion High School

CITY Vermilion, Ohio

TEACHER Christen Schneid

RESEARCH THEME Opioids/Pain Management

TITLE Prescription

MEDIUM/GENRE Digital Media

STATEMENT Our film is a commentary on today’s opioid epidemic, which is sweeping our country. As a group, we have all witnessed or been through some form of addiction. As teenagers, we live in a time where drugs are so easily accessible, causing addiction in our lives. Our film puts the viewer in the head of an addict. After a tooth extraction, the lead character is given pills for his pain. After running out of pills, he does whatever he can to get a “fix.” After overdos- ing, he is revived. The aim of our film is to prompt you as a viewer to question your life choices. Why can’t we break addiction? When does it stop?

The songs that are used in this video are “Oh Klahoma,” by Jack Stauber, and “Non, je ne regrette rien,” by Edith Piaf.

90 AWARD Red Ribbon Mind Control EXPRESSIONIST Laura Laws

SCHOOL Mayfield High School

CITY Mayfield Village, Ohio Flashes of white and silver startle me. I can’t hear anything over my own heartbeat TEACHER Kari Beery and the beeping futuristic machines obstructing my view of the door. Opioids/Pain Management RESEARCH THEME A faceless doctor, wrapped in blue sterile cloth like a mummy, reassures me softly, RESEARCH TITLE Links Between Opioid Prescriptions Written by Dental “It’s okay, we’re going to put you under now. Can you count down from ten for me?” Clinicians and Opioid Abuse in Young Adults (Synopsis of: I close my eyes and convince myself that everything will be okay. Association of Opioid Prescriptions From Dental Clinicians for US I hear myself counting, the numbers getting softer and further away the closer I get to zero. Adolescents and Young Adults With Subsequent Opioid Use My eyes close against my will, and before I know it, I’m awake, four teeth lighter. and Abuse)

TITLE “Mind Control” My head feels stuffed end to end with cotton and I can’t shake the cloud of grogginess MEDIUM/GENRE Free Verse Poem hovering between me and reality. STATEMENT I hear fragments of conversation between my mom and the doctor, I chose this case study because my family has a history of addiction. I wanted people to understand how catching blurry glimpses of them at the foot of my bed. the addict’s mind works and how the addiction starts rather than just seeing the stereotypes. The shape “... thirty-day prescription…” of this piece is meant to symbolize how an addict becomes more close-minded and feels as if they “... such a low pain tolerance…” have no other option but to use again. Additionally, “... reevaluate as needed…” I wanted to shed light on how a doctor’s ignorance of the addictive properties of opioid medication can Pain starts to seep back into my system as a nurse wheels me to my car, change someone’s life instantly. the surgical haze lifting slightly to unveil a throbbing in my jaw and the painful drum in my head with every heartbeat. Each miniscule bump on the ride to the pharmacy plunged me deeper into excruciating pain. I was sobbing by the time my mom paid for the medicine and handed me the crisp, white paper bag, neatly folded over and stapled shut. A deafening rip echoed through the car and I fumbled for a pill, relief as I felt it inch down my throat, the instant release slowly but surely drowning out my pain and replacing it with the sensation that I was floating, being coaxed into calmness by the gift of medicine. I could hardly eat anything solid, so I settled on mashed potatoes and applesauce for dinner. I wake up the next day feeling like my head had been compressed and immediately reach for the orange bottle on my nightstand before I opened my eyes. Your mouth heals faster than any other part of your body. Yet as the days turned into weeks and then a month, I couldn’t shake the urge that I needed to keep taking the pills. I couldn’t control the habit of reaching for them first thing in the morning. So when my mom asked me, meaning well, “Do you need a refill on your pain medicine?” Yes Yes “Yes.” My doctor told me that this would probably take care of the last of my surgical pains, and he sent the final prescription I would receive from him to the pharmacy.

91 But before I knew it, that little orange bottle was empty, too. Except, only two weeks had passed, Because I started taking a second pill halfway through the day. Just one suddenly wasn’t enough anymore. I couldn’t go to my mother again. The doctor wouldn’t refill the prescription anyway. I was on my own. I was alone. Hiding behind my anxiety of getting caught with excuses I was just sweaty because I was hot. I was just throwing up because I had caught a bad stomach bug. I needed it all to stop I needed to feel comfortable In my own skin To go back to the blissful peace of mind and body That only the small capsule could give me. I started talking to the “bad” kids at school. The ones who know people Who can get drugs. The ones who stay out late on Friday nights Until it’s early on Saturday morning using whatever they can get their hands on in order to escape. I craved the euphoric feeling that I had from taking the pills. It used to be about drowning out the pain, But I’m drowning without the serenity they gave me. The absence of all negative feelings and emotions. I couldn’t live without it. I can’t go on like this. I’m sixteen, I’m a drug addict, and my first dealer was my doctor.

92 AWARD Red Ribbon

EXPRESSIONIST Halle Parrish

SCHOOL Chardon High School

CITY Chardon, Ohio

TEACHER Christina Blaschke

RESEARCH THEME Opioids/Pain Management

TITLE Just One More

MEDIUM/GENRE Painting

STATEMENT Teenagers are the most likely to become abusers of opioids, and females are more likely than men to do so. The teenage girl in my piece reflects this statistic, as she is depicted reaching for just one more pill.

93 AWARD Red Ribbon Dragonfly EXPRESSIONIST Jasmijn Plusnin

SCHOOL Brecksville-Broadview Heights Middle School “I just can't do it, I – I just can’t,” I begged, “Please don’t make me!” I was CITY Broadview Heights, Ohio getting my third surgery this month because of the inflammation in my knee. The TEACHER Todd Goodman surgery I had last week didn’t work out so they had to schedule another one for today. RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to But, I was not ready for it. I didn’t want to sleep from anesthesia. I didn’t want to feel Reverse Opioid Tolerance more pain. It was all too much for me, but I was too tired to keep fighting. TITLE “Dragonfly”

MEDIUM/GENRE Short Story I closed my eyes because they were getting really heavy, too heavy to open, but

STATEMENT I would not let myself fall asleep. The doctors’ voices started echoing through my I was deeply inspired by the time when I had to head. “You’ll be fine,” “Don’t worry,” “Go to sleep.”It’s happening, I told myself, I just be put under anesthesia and how my mom helped me get through it. Therefore, I wanted to create an have to let go and sleep... And then into my darkness flew magical dragonflies. They inspiring short story about how this affected my life. I found the new opioid research fascinating and I flew so majestically, as though there was nothing to worry about. I wished I could be wanted to join in and learn more about it! like them: strong, beautiful, wise, elegant. Then everything went black. I could hear all the things around me, but I couldn’t move. I couldn’t open my eyes, couldn’t open my mouth, nor could I move my body. I heard two doctors speaking to my mom. “The surgery was successful,” one of the doctors said. “Her knee should start to heal a lot better in the next few weeks.” “Oh, that’s wonderful!” exclaimed the voice that sounded like my mom’s. “However, since she has been having a lot of surgeries recently, we have had to increase her dosage of pain-killing medicine, and she has developed opioid tolerance, or OT. Her neurons need a greater dose to have the desired analgesia,” a doctor ex- plained. “Her body will be begging for more and more opioids, and if she just listens to these demands, her opioid tolerance can lead to an overdose.” There was silence, maybe crying, and quietly Mom asked, “So, what are you saying? Is she addicted? Does she have to stop taking the pain-killing opioids?" “There has been a recent discovery using stem cells, but we are still testing it on patients. With your permission, your daughter would be perfect for this. She is strong and brave,” the doctor said. “You want to experiment on my daughter!” my mom reacted very quickly. “What if it doesn’t work?” “The trials so far have been successful,” said the other doctor. “And her success could save millions with the same opioid intolerance plaguing the world. This could really help her.” More silence. So I’m going to be a test dummy, I thought, but I could help with a huge discovery... Why does it have to be me? Well, I have nothing to really lose, do I? I’ll do it. No one spoke for a while; you could hear my heartbeat on the monitor, steady and strong. I could feel my mom’s eyes looking at me, searching for the right answer. I tried telepathy to tell her I’ll do it, I’ll do it, I’ll do it.

94 “Ok, let’s do it,” said my mother, and I heard one of the doctors leave the room. “Alright, thank you, so this full therapeutic process will take two days. During that time we will inject the mesenchymal stem cells, we just call it the MSC, and it should stop the desperate, begging neurons with the exosomes that will be sent out from the MSC. The MSC have preventive and therapeutic effects on OT, as well as on opioid-induced hyperalgesia, modulating immune cells and glial cells.” “So the problem is that the neurons are messed up?” My mom is smart but I could tell the doctor was losing her. “That’s right. The morphine leads to increased expressions of ionized calcium- binding adapter molecule I in microglia and glial fibrillary acidic protein in astrocytes, and significant morphological changes of these cells in the spinal cord,” a doctor tried to explain. There was a long pause as my mom worried about what she could not understand. “You don’t need to worry, we are going to take good care of your little girl.” Good job, doctor, I thought, and then a rattling cart broke the reassurance. I think a young nurse gently told my mom, “I’m sorry, ma’am, but you are going to have to leave, we need to get started.” I felt a mom kiss on my forehead and a mask over my nose and mouth, and then I saw the dragonflies again. They flew around playfully, into the dark black void. I woke up for real this time. My mom was sitting next to me. I looked around. I was in a different room than I was before. I couldn’t move my knee, and it hurt so bad. My arm was full of needles with long tubes connecting to hanging bottles. I still felt exhausted! “Hey, sweetie. How are you?” my mom asked. “Eh,” I said. “But I had some pretty great dreams.” The doctor came in. “Oh, you’re awake! Good morning, how’d you sleep?” “Ok,” I replied, “with some pretty cool dragonfly dreams.” “We get a lot of that in here.” He sat on the edge of the bed and suddenly seemed more like a grandpa than a doctor. “Your trial went very smoothly and it seems to be working. You have helped millions of patients with OT. This MSC therapy will significantly restore sensitivity to morphine, which will help avoid addiction and save lives. We won’t need to up your dose to safely manage your pain. My team and I would like to thank you both.” “Oh, thank you!” my mom said to him, and then turned to me. “You were amazing, honey. You close your eyes and rest now.” As I closed my eyes, I felt Mom gently kiss my forehead. The dragonflies came back, their wings glistening like stars in the night sky; they were flying with bright power like fireworks booming into the sky. And then the colorful dragonfly wings filled the darkness with light.

95 AWARD Red Ribbon

EXPRESSIONIST Sefra Protch

SCHOOL Hoover High School

CITY North Canton, Ohio

TEACHER Christopher Triner

RESEARCH THEME Opioids/Pain Management

TITLE Trapped With Opioid Abuse

MEDIUM/GENRE Marker

STATEMENT The main idea of my piece is how young adults (18–24 years old) become addicted to opioids after getting their wisdom teeth removed. 30% of young adults get their drugs from wisdom teeth surgeries alone. I illustrated a person in a pill bottle looking as if they were trapped. I wanted to make them trapped because they are representing the young adults who took prescribed opioids and became obsessed with them. The bottle has a bunch of stickers to express the idea of youth. I didn’t want to add details to the faces so I thought it would be best if I made the doctor’s head a tooth to show he/she is a dentist. I also drew the person in the bottle with a pie chart because it ties the 30% data number into the piece. I thought it would be a good idea to add that in.

AWARD Red Ribbon

EXPRESSIONIST Samira Smith

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Karen Mehling-DeMauro

RESEARCH THEME Opioids/Pain Management

TITLE Permanent Handmade Hospital Bracelet

MEDIUM/GENRE Jewelry

STATEMENT In my piece, I try to represent the opioid crisis in a handmade hospital bracelet. I made it look like it was worn out and used all the time, as if the patient is always returning to the hospital. I named my project Permanent Handmade Hospital Bracelet. I chose not to have real names because we don’t know how many people in the world have this problem and we don’t know how many doctors are doing their jobs correctly.

96 AWARD Red Ribbon

EXPRESSIONIST David Szoke

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Karen Mehling-DeMauro

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance

TITLE Signals

MEDIUM/GENRE Jewelry

STATEMENT The central idea of my project was to recreate Figure 1 from “The Use of Stem Cell Therapy to Reverse Opioid Tolerance” using jewelry. My piece shows the cellular signaling by which stem cells inhibit other cells’ pathways that lead to opioid tolerance and opioid-induced hyperalgesia by using beads, a stone, and enameled metal to represent different cellular structures. My goal was to make a piece that is functional and fashionable, but that also has a deeper meaning that brings awareness to mesenchymal stem cell (MSC) transplantation, which has a lot of potential to improve opioid safety.

AWARD Red Ribbon

EXPRESSIONIST Emma Young

SCHOOL Hathaway Brown School

CITY Shaker Heights, Ohio

TEACHER Shelly Ahern

RESEARCH THEME Opioids/Pain Management

TITLE Deception

MEDIUM/GENRE Charcoal

STATEMENT This piece explores the issue of opioid addiction acquired from pain medication in the youth population — specifically, pain medication prescribed post- dental procedure. The betrayal of being harmed by something with the purpose to aid you is a harsh twist of events. Snapdragons line the bottom of the piece because, in the language of flowers, snapdragons symbolize deception. Even the bright smile is a lie, as opioid addiction is ugly, ungraceful, and deadly.

97 AWARD White Ribbon

EXPRESSIONISTS Emily Heuler and Audrey Sanzone

SCHOOL Midview High School

CITY Grafton, Ohio

TEACHER Tara White

RESEARCH THEME Opioids/Pain Management

TITLE Escape the Addiction

MEDIUM/GENRE 3-D/Sculpture

STATEMENT For our project, we decided to use the research on opioid abuse. Since this is an epidemic for young adults, especially those who are prescribed opioids after wisdom teeth removal, we made our project look like a jail cell for the purpose of symbolism. It shows that when you abuse drugs, it’s very hard to escape. The tallies on the walls and flooring of the cell represent the amount of people who are abusing opioids in the study. The hands represent the struggle of escaping the deadly grip of opioid abuse.

AWARD White Ribbon

EXPRESSIONISTS Claire Hofstra and Carys Bowen

SCHOOL Hathaway Brown School

CITY Shaker Heights, Ohio

TEACHER Shelly Ahern

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance

TITLE Breaking the Cycle

MEDIUM/GENRE Ceramics/Clay

STATEMENT The sculpture is of a marionette reaching for a bottle that represents opioids. The puppeteer of the marionette is opioids. The strings of the marionette complete a circle, representing the cycle that forc- es the continual increase of opioid use. The cycle is created by opioid tolerance and opioid-induced hyperalgesia. One hand of the marionette reaches for the opioids; the other, whose string is broken, tries to stop it. The broken string represents the mesenchymal stem cell transplantation, and breaking the cycle — like the treatment — is the scissors that cut the string.

98 AWARD White Ribbon

EXPRESSIONIST Kayla Keplinger

SCHOOL Normandy High School

CITY Parma, Ohio

TEACHER Dave Fogle

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance

TITLE Release the Addiction

MEDIUM/GENRE Mixed-Media

STATEMENT I wanted to dive deep into the idea of what an addiction to any substance may feel like. The notion that one is able to release and overcome, freeing themselves from the addiction no matter how long it takes, is something commendable and something very possible. I took inspiration from the stem cell research. I found it could be a reminder that there is hope for those who are suffering. It is possible to release the addiction from within.

AWARD White Ribbon

EXPRESSIONIST Aedyn Kraft

SCHOOL River High School

CITY Hannibal, Ohio

TEACHER Julia Morris

RESEARCH THEME Opioids/Pain Management

TITLE Drowning in Opioids

MEDIUM/GENRE Painting

STATEMENT In my painting, I depicted the person drowning in the water close to a bridge with openings that resemble and represent pills.

99 AWARD White Ribbon

EXPRESSIONIST Kaylee Smith

SCHOOL Brecksville-Broadview Heights High School

CITY Broadview Heights, Ohio

TEACHER Anne Jones

RESEARCH THEME Opioids/Pain Management

TITLE The Hero(in)

MEDIUM/GENRE Colored Pencil

STATEMENT My project is based on the research linking opioid abuse to dental prescriptions of opioids. As shown by my piece, youth who are prescribed opioids as painkillers by their dental providers are likely to become addicted to these harmful substances. Iron- ically, the opioids are especially damaging to the teeth, which is where the inspiration for my project came from. My drawing depicts a dentist injecting his patient with heroin and, though this looks disturbing from an outside perspective, both subjects wear a drama-esque mask of bliss. This disturbing image is meant to discourage the viewer from using opioids.

AWARD White Ribbon

EXPRESSIONIST Eli Steinberg

SCHOOL Shaker Heights High School

CITY Shaker Heights, Ohio

TEACHER Christina Stouffer

RESEARCH THEME Opioids/Pain Management

TITLE Implanting Addiction

MEDIUM/GENRE Ceramics/Clay

STATEMENT When it comes to opioids, all ages of people are at risk of becoming addicted, especially adolescents. Something most people don’t know is that dentists are responsible for over 30% of all opioid prescriptions given to adolescents. In my piece, I represented the rise in wisdom tooth extraction surgery through the missing teeth, and its effect on addiction rates in adolescents by replacing the teeth with opioid pills, hence the name Implanting Addiction. I hope my piece will educate people, make them want to take action against the excessive prescription of opioids, and help stop more adolescents from becoming addicts.

100 AWARD White Ribbon

EXPRESSIONIST Carolyn Yuan

SCHOOL Brecksville-Broadview Heights High School

CITY Broadview Heights, Ohio

TEACHER Anne Jones

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance

TITLE Nibble Away!

MEDIUM/GENRE 3-D/Sculpture

STATEMENT Nibble Away! reflects Fei Li, LiPing Liu, Kathleen Cheng, Zhongbo Chen, and Jianguo Cheng’s research, “The Use of Stem Cell Therapy to Reverse Opioid Tolerance.” Their research proved that stem cell therapy can both reverse opioid tolerance (OT) in sick mice, and prevent OT development in healthy mice. This information is helpful for finding a human treatment. A tinted blue, plaster hand is tied down by rope to resemble humans suffering from OT. The shimmering sequins on the mice represent the stem cells. Together, the piece emphasizes that mice used in research are making a difference. While the hand is still tied down, I hope to illustrate progress in freeing it.

AWARD Honorable Mention

EXPRESSIONIST Abigail Adcock

SCHOOL Orrville High School

CITY Orrville, Ohio

TEACHER Matt Ramseyer

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Impact of Increased Calorie Feeding in Infants With Neonatal Abstinence Syndrome (NAS) Treated With Morphine

TITLE Warning

MEDIUM/GENRE Drawing

STATEMENT The main idea behind this project was to demonstrate the feeling of sadness and pain when taking opioids while pregnant, while also trying to warn future mothers of the hurt that can come from this choice. (Left Bottle): The viewpoint from the mother/ father holding their child for the first time, realizing that the baby was premature. (Middle Bottle): The bottle is representing the placenta where the child develops, while also having the umbilical cord attached to the top of the pill bottle to represent the feeding source for the child (drugs). (Right Bottle): The child showing their emotions in later years while experiencing the side effects caused by the drugs. In the background, I wanted to incorporate a biblical verse. This verse says that every child is fearfully and wonderfully made.

101 AWARD Honorable Mention

EXPRESSIONIST William Benham

SCHOOL Cleveland Heights High School

CITY Cleveland Heights, Ohio

TEACHER Nancy Rich

RESEARCH THEME Opioids/Pain Management

TITLE Toothpain

MEDIUM/GENRE Jewelry

STATEMENT Opioid abuse has been an issue that has affected the country for decades. The use of opioids among younger generations has grown substantially over several years. One of the largest distributors of prescription opioids has been dental clinics, causing young adults and children to be exposed to these highly addictive painkillers. My necklace is my interpretation of this research. The teeth represent the dental clinics that prescribe opioids, while the braces represent a younger generation of people who are becoming addicted. The pill in between the teeth is a direct correlation between the youth and the opioid crisis.

AWARD Honorable Mention

EXPRESSIONIST Z e h r a G u n g o r

SCHOOL Excel TECC-Studio Art & Design

CITY Pepper Pike, Ohio

TEACHER Dan Whitely

RESEARCH THEME Opioids/Pain Management

TITLE Feeding

MEDIUM/GENRE Digital Media

STATEMENT I am raising awareness about how much dental clinicians contribute to the opioid crisis. Many people don’t realize this, but 25% of opioids that are prescribed to adolescents come from dental clinicians.

102 AWARD Honorable Mention

EXPRESSIONIST Riley Hensley

SCHOOL Riverside High School

CITY Painesville, Ohio

TEACHER Drew Hartmann

RESEARCH THEME Opioids/Pain Management

TITLE TEETH

MEDIUM/GENRE Marker

STATEMENT My project is on opioids as introduced by dental clinicians. The windup toy teeth represent opioid- naïve individuals and how one prescription can turn into an unending, winding cycle of addiction. The pill bottles lined up in the back represent the dentists who are prescribing more opioid prescriptions every day. The dental tools at the bottom represent dentists as a whole. Overall, the piece represents how dental clinicians can unknowingly be the cause of addiction.

103 AWARD Honorable Mention The Life of a Dentist Who EXPRESSIONIST Allianna Jackson

SCHOOL Springfield-Clark Career Technology Center Recently Got His Wisdom Teeth Pulled

CITY Springfield, Ohio Susan Hyden TEACHER I’m 26 years old RESEARCH THEME Opioids/Pain Management RESEARCH TITLE Links Between Opioid I’m a new dentist, Prescriptions Written by Dental Clinicians and Opioid Abuse in Young Adults (Synopsis of: I have new patients Association of Opioid Prescriptions From Dental Clinicians for US I sat in my chair Adolescents and Young Adults With Subsequent Opioid Use My mouth in pain and Abuse)

TITLE “The Life of a Dentist Who Wisdom teeth newly pulled Recently Got His Wisdom Teeth Pulled” It hurt. MEDIUM/GENRE Free Verse Poem I picked up the daily paper and saw one of my patients STATEMENT I wrote this free verse poem to show how dangerous 16, OD, Jackie Jones it is for dentists to prescribe teens and young adults opioids for their teeth because they can get addicted Just another statistic to the pills. I hope to show how important this issue can be because some people can die from overdos- I held my cheek the pain was killing me ing. Some people get addicted because they think the pills make them feel good, and even when the I took my medicine I knew I should take pain from their mouth goes away, they still take the pills because they believe it helps with their mental The pills. issues as well. I think this is a severe issue that should somehow be fixed. I looked back at the paper Did I read it right? I felt guilty I felt blamed The pain doubled One more won’t hurt. I took another pill My mind was a mess without them They made me feel relieved They made me feel calm They took all the pain away I won’t get addicted. I sent the family flowers I visited her grave But the pain kept returning I took more pills than I should Just to feel better Just one more.

104 But it was a new pain Not from my mouth But in my chest The restless nights My heart, muscles, and lungs burned and hurt My stomach felt twisted What’s one more? My cheek was fine But Jackie was gone An old patient I looked through her old files I prescribed the medicine Why won’t the pain go away? I shuffled the papers It’s been a month now I looked for the pills I took more and more and more The pain getting to me Words in my mind swirling over and over It’s my fault I was 26 years old I was a new dentist, I had new patients I sat in my chair Put down the daily paper And closed my eyes The pain finally gone My breath slowed down, and I felt relief I looked next to me and saw Jackie. Just ANOTHER statistic.

105 AWARD Honorable Mention Cells of Survival EXPRESSIONIST Haydyn Kirby

SCHOOL Brecksville-Broadview Heights Middle School Theox dragged his feet through the dusty dirt road. Since the war, the ground CITY Broadview Heights, Ohio he walked upon had grown from a rich dark brown to a crusty red. He dragged a Todd Goodman TEACHER wagon filled with the last remaining equipment from his old ruined lab. Theox was RESEARCH THEME Opioids/Pain Management the last scientist hired at Neo Tech, Inc. and he was the last to leave. RESEARCH TITLE The Use of Stem Cell Therapy to Reverse Opioid Tolerance He stopped at the rusty bunker door. They had hidden it well. Theox stretched TITLE “Cells of Survival” his fingers in his leather gloves before checking his surroundings and hastily punching Short Story MEDIUM/GENRE in the door’s code. He then heaved open the metal door, carefully lowering the wagon STATEMENT and then dropping in beside it. He had to jump to reach the edge of the door and I was inspired to write about the use of stem cell therapy to reverse opioid tolerance in a post- pull it closed, covering their hidden outpost. apocalyptic scenario because I thought that it would be interesting to see it take place within a time of Theox tugged the wagon onward to his mini lab deep within the bunker. He desperate measures. passed sickly Fawn. He always felt bad passing her because he wanted to help, but the young doctor Jaxar insisted he could take care of her and the other injured survivors. Theox found his little office-like laboratory space. In his lab he found Jaxar, sitting on one of the tall stools, swinging his legs. “I give up. I need help.” Jaxar said, staring at the floor.Finally , Theox thought. “Well, you see, the amount of opioids I’ve been prescribing has kept going up. People need greater doses as they become opioid tolerant. They need more and more to achieve desired analgesia,” he continued. The solution suddenly clicked in Theox’s head. “MSCs can inhibit opioid tolerance and opioid-induced hyperalgesia through suppression of neuroinflammation,” Theox informed Jaxar. “Wait, really?” Jaxar asked. “Indeed, you see, MSCs’ paracrine secretes a multitude of exosomes, macrovesicles, and soluble factors that are small enough to go through BBB to the spinal cord – to the neurons, astrocytes, and microglia.” “No, I don't think I do see,” Jaxar said, puzzled. “MSCs exert preventive and therapeutic effects on OT and OIH by modulating immune cells and glia cells,” Theox went on. “Uh-huh.” “The problem is, morphine leads to an increased expression of ionized calcium- binding adapter molecule I in microglia and glial fibrillary acidic protein in astrocytes, and significant morphological changes of these cells in the spinal cord.” “You know a lot more than I thought you did.” Jaxar said quietly. “Well of course you thought that. You are young and think you know everything, but I actually studied this topic for quite a few years.” Theox smiled. “If you want, you can still help, but I feel it would be best if I took on the job of trying to fix this issue.” ……………………………………… Working with half-broken materials but with the help of Marge, a stern-faced former computer scientist, they managed to scavenge a vast majority of the studies Theox and his colleagues had done before the war. Theox noted that since they were now properly helping the injured, Jaxar’s mood became rather perky. Theox was happy that at least he was enjoying the apocalypse. They worked quickly, and soon others in the bunker worked to help them as well. People such as Fawn were able to get better faster and they used up less of the very limited medicines. Once they got better, they also began helping. Their effec- tiveness kept the hospital wings of the vault rather empty. What a big group project, Theox wrote in his journal, today I will take my place in a bunker conference voting on the issues. The first issue is going outside to find other survivors and offer assistance. Jaxar and I sincerely hope we can convince the others that it would be something we should try to do. With the new MSC therapy, there is hope. He put his pen down and checked the clock. It was twelve o'clock; therefore, he decided it would be wise to head down to the conference room, and hopefully get a comfy seat.

106 AWARD Honorable Mention

EXPRESSIONIST Colin Kirkpatrick

SCHOOL Bio-Med Science Academy STEM School

CITY Rootstown, Ohio

TEACHER Keagan O’Mara

RESEARCH THEME Opioids/Pain Management

TITLE Painless

MEDIUM/GENRE 3-D/Sculpture

STATEMENT This piece is based on the connection between dentistry and opioid abuse in people between the ages of 16 and 25. Usually after major operations like wisdom tooth extraction, the dentist will prescribe opioids. My piece has a life-size, 3-D model of someone’s teeth with braces and other dental and orthodontal work. The idea for this sculpture originated from the windup teeth some offices have, though the opioids have corrupted it and turned it into a nightmare.

107 AWARD Honorable Mention The Fight EXPRESSIONIST Leah LaVerde

SCHOOL Kirtland High School

CITY Kirtland, Ohio There is discomfort in what I see in the mirror Meriah Duncan TEACHER I will never say RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE Links Between Opioid Prescriptions Written by Dental I am getting better Clinicians and Opioid Abuse in Young Adults (Synopsis of: The pain aches but Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults The drugs avail With Subsequent Opioid Use and Abuse) It is a lie that “The Fight” TITLE I can get out MEDIUM/GENRE Poetry

STATEMENT I’m stuck, but Influenced by research on opioid abuse and addiction in young adults as a result of prescriptions, my I’ll soon be free poem, “The Fight,” exposes two perspectives when battling addiction: one trapped, and the other fight- It takes more every day ing to escape. Capable of being read down and up, the poem reveals different attitudes. Reading from top to bottom condemns the doctors for addiction I fight and fight and and possesses a negative outlook, while reading from bottom to top blames the drugs that hold the I can’t escape it narrator captive and retains a positive, overcoming mindset. My poem illustrates the constant battle I am weak and oblige more those with addiction face and the struggle to recover. The doctors are helping I don’t need them They are what caused my addiction The drugs have consumed me, but I will get better

(now read bottom to top)

108 AWARD Honorable Mention

EXPRESSIONIST Tyler Louk

SCHOOL Rittman High School

CITY Rittman, Ohio

TEACHER Randall Robart

RESEARCH THEME Opioids/Pain Management

TITLE C21H23NO5

MEDIUM/GENRE Mixed-Media

STATEMENT The central idea of my project is to show how teens, as well as adults, can become addicted to medicinal drugs or pills that are given to them by doctors or other medical professionals, and how this addiction can lead to them doing harder, more intense drugs like heroin. One of my goals for this project was to show the experience of becoming addicted to prescription pills and then becoming addicted to other opioids. Another goal was to provide awareness about this topic and to show others how easy it is to become addicted to opioids if you’re not careful.

AWARD Honorable Mention

EXPRESSIONIST Shivangi Sengupta

SCHOOL Laurel School

CITY Shaker Heights, Ohio

TEACHER Jessie Sun

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Impact of Increased Calorie Feeding in Infants With Neonatal Abstinence Syndrome (NAS) Treated With Morphine

TITLE The Climb

MEDIUM/GENRE 3-D/Sculpture

STATEMENT The Climb is a 3-D composition illustrating the physiological hardships that a child with neonatal abstinence syndrome (NAS) has to bear, as well as the treatment for this affliction. The pill bottles symbolize the baby’s health, as they are locked and chained to represent the host of health complications that arise from NAS. The key to NAS treatment is morphine, which is administered to infants via a syringe. I molded a syringe out of clay and set it atop a symbolic pile of pills and keys. The baby reaches out to try and seize the key to its health.

109 AWARD Honorable Mention

EXPRESSIONIST Grace Spehn

SCHOOL Kenston High School

CITY Chagrin Falls Township, Ohio

TEACHER Andie Quinn

RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Impact of Increased Calorie Feeding in Infants With Neonatal Abstinence Syndrome (NAS) Treated With Morphine

TITLE Next Addicted Generation

MEDIUM/GENRE Colored Pencil

STATEMENT The central idea of my drawing is how opioids consumed by pregnant women have big effects on the baby in the womb. The baby looking up to the mobile is representing how instead of seeing stuffed animals and toys like a healthy baby, it instead sees drugs because that’s what the baby is addicted to after being exposed to them.

110 AWARD Honorable Mention Sweet Relief EXPRESSIONIST Bradon Timms

SCHOOL Medina High School

CITY Medina, Ohio A seed TEACHER Kelli Offenberger It moves and breathes RESEARCH THEME Opioids/Pain Management

RESEARCH TITLE The Use of Stem Cell Therapy to It trembles with possibility Reverse Opioid Tolerance

TITLE “Sweet Relief” A miniscule stem cell

MEDIUM/GENRE Free Verse Poem

STATEMENT This poem describes mesenchymal stem cell (MSC) A patient therapy to reverse opioid-induced hyperalgesia (OIH) and opioid tolerance (OT) from a patient’s perspective. Cold, white, sterile rooms A patient was prescribed opioids and developed OIH, OT, and opioid dependence. MSC therapy The odor of cleanliness wafts through the halls and leaves the tongue bitter cures him and he lives a less painful, independent life. Opioids are called a poisonous serpent because Waiting with nervous anticipation they cause the patient to develop a tolerance resulting in OIH by leaking “poison” into the brain. The bags hang from him Tolerance built by the body is compared to a wall that must be scaled with more painkillers to reach Both from his veins and his eyes relief. The quick and lasting effects of MSC therapy are referenced when the “chains of dependence” How it chained him break post-treatment. The opioids

A drug A poisonous serpent that has tormented its victim for years Seeping its venom into the brain Ravaging the nerves Inflicting intolerable pain All the while Tempting and beckoning For more Opioids

The patient waits A dark tube trails from his arm A clear liquid flowing And within A cure

They meet The cells rush into the river They are few, but they make a difference all the same Hurrying to the nerves They heal

111 As he drifts off He remembers how it all started The pain, at first a nagging As if a child had held onto your leg But quickly grew into a monster Wracking his body The only respite sleep And the drug Opioids

The first time He was skeptical He had heard about the dangers But it was the only option Little did he know, his suspicions were right It slowly built a wall Brick by brick And now to scale the wall to the golden city of relief He needs many doses

He wakes No longer is there pain Despite the lack of chemicals that once rushed through his body Satisfying that need For reprieve

Tentatively, he moves There is no ache deep in the bones The chains of dependence rust and fall from him After waiting for years He lets go of the tears And smiles

The nerves have been mended Tolerance reversed Pain dissipated Finally human again

112 AWARD Honorable Mention

EXPRESSIONIST Taylor Wilson

SCHOOL Jackson High School

CITY Massillon, Ohio

TEACHER Sara Andes

RESEARCH THEME Opioids/Pain Management

TITLE Open Wide and Be Prescribed

MEDIUM/GENRE Pastel

STATEMENT This artwork was inspired by the research summary written by Cleveland Clinic’s student intern Joan Moore, which focused on opioid addiction and its association with dentistry. This piece shows tools pouring opioids down a mouth, but the concept expressed is that the tools symbolize the dentist and the mouth, the patients. This expresses how the patients are entrusting the dentists to make the right decisions to help them heal due to the dentists’ qualifications in their work, but the patients are being misguided to addiction because the dentists are prescribing addictive opioids. I hope this piece will raise awareness about opioid addiction and cause people to be cautious when they are prescribed opioids.

113 2020 Journey Award Recipients

Teranova Ake TEACHER: Elizabeth Elia SCHOOL: Whitney M. Young High School

Anna Beck TEACHER: Jessie Sun SCHOOL: Laurel School

Anastasia Crates TEACHER: Angie Stokes SCHOOL: Wayne Trace High School

Ryan Egan TEACHER: Sharon Misanko SCHOOL: Twinsburg High School

Eliana Good TEACHER: Karen Mehling-DeMauro SCHOOL: Shaker Heights High School

Nyere Grant TEACHER: Jessalyn Boeke SCHOOL: Orange High School

Tira Heiss TEACHERS: Vikas Turakhia and Kathy Frazier SCHOOL: Orange High School

Addie Hornick TEACHER: Kelly Kriner SCHOOL: Medina High School

Morgan Lang TEACHER: Tara White SCHOOL: Midview High School

Nisha Makkar TEACHER: Brian Harvey SCHOOL: Kirtland High School

114 Afterword

The work featured in this booklet is a powerful example of what can be accom- plished when students are actively engaged in learning. Cleveland Clinic recogniz- es the importance of education to the future of our industry and community, and for that reason, K–12 Education was created.

Cleveland Clinic K–12 Education promotes health and wellness, academic achieve- ment, and career preparedness for students in kindergarten through 12th grade. Our School Programs and Internship Programs provide a wide range of authentic learning experiences in schools, through technology-mediated activities, and within Cleveland Clinic facilities. Aligned with academic content standards and centered on real-world applications, these programs leverage organizational resources and community partnerships to support student success, both inside and beyond the classroom, empowering our community’s next generation of leaders. For example:

• Built around the Rex Rules!™ storybook series, the Health Unleashed!™ program delivers fun-filled, hands-on health and literacy lessons for grades K–2.

• The Dangerous Decibels® program is an interactive presentation, delivered by the Cleveland Clinic Head and Neck Institute’s Audiology Department, that teaches 4thand 5th graders the concepts of noise-induced hearing loss prevention.

• The Adventures in Health Science and Medicine® program engages middle school students in a series of connected learning sessions designed to promote awareness and understanding of health science professions.

• The Worldwide Classroom® program offers interactive, hour-long, real-time connected learning presentations to middle and high school students on a wide range of important health topics and healthcare careers.

• The Science Internship Program, The Cleveland Clinic Louis Stokes Intern- ship Program, The Healthcare+Pathways® Experience and The NEOREMA™ (Northeast Ohio Research Education Medicine Alliance) Experience provide intensive, hands-on, paid experiences that give Northeast Ohio high school students opportunities to explore careers in science and medicine as they work with and learn from nationally renowned professionals in a variety of fields.

Thank you for taking time to read this year’s eXpressions® booklet, and for learning more about some of our other exciting programs. For additional information or to learn how you can support our efforts, please visit us online at www.clevelandclinic.org/K-12.

115 Special Thanks To:

• Our participating students, families, teachers, school Richard Crepage, EdD administrators, and Cleveland Clinic mentors Board Member, Northern Ohio Area Board American Cancer Society • The Martha Holden Jennings Foundation Jennifer Cross • The Heath Education Campus of Case Western Respiratory Therapist Reserve University and Cleveland Clinic Respiratory Institute • Marty Carrick, Jonathan Hicks, Bob Kelemen, Cleveland Clinic Tom Miller, Dan Palmer, Devin Patterson, Maria Soriano, Bob Stefanov, and the Cleveland Mary Donovan, MA, MFA Clinic Center for Medical Art and Photography School of Medicine Georgetown University • M. Gentile Studios, Inc. Anthony Ezzo, MFA • Great Lakes Integrated Assistant Professor, Graphic Design Lake Erie College • James B. Young, MD; Adam Myers, MD, FACHE; Nazleen Bharmal, MD, PhD, MPP; Christine Filmer, MAEd and Vickie Eaton Johnson Artist/Art Educator • Our Panel of Reviewers and Judges: Leigh George Tricia Ambrose eBook Account Manager Reporter Macmillan Publishers The News-Herald and Morning Journal Anita Giusto, MA Lindsay Andrews Educator, Andrew J. Rickoff Elementary School Educator, Avon Lake High School Cleveland Metropolitan School District Avon Lake City Schools Carolyn Deming Glaviano Brittany Anstrom Corporate Communications Communication Manager Cleveland Clinic Progressive Insurance Laura Greenwald, MBA William Armstrong, MS Communications Manager Professor of Mathematics Education Institute Lakeland Community College Cleveland Clinic

Shira Atik Gregory H. Grossman, PhD, BCMAS, CCRP, CEBT Freelance Writer and Literary Translator Chief Scientific Officer Research Department Kelly Boyer Sagert Advancing Sight Network Freelance Writer Alicia Hemphill, MA Rosemary Burk, MA Proposal Writer Manager, Proposal Development Philanthropy Institute Philanthropy Institute Cleveland Clinic Cleveland Clinic Amanda Hollis, MA Ginger Christ Senior Director, Foundation Relations Reporter Philanthropy Institute The Plain Dealer Cleveland Clinic

Judith Church Darrell Johnson, RRT Owner, Success Talks by Judith Church Respiratory Therapist Respiratory Institute Anne Cole, MAEd Cleveland Clinic Adjunct Lecturer Art Education and University Supervisor Bob Kelemen School of Education Associate Professor of Education Baldwin Wallace University Myers School of Art The University of Akron

116 Heather Kinsey Sara Newman, PhD Professional Writer Professor, Department of English University of San Francisco, Quito Christine Kolaczewski-Ferris, MS Director, Office of Student Academic Success Bryan Palaszewski The University of Akron Leader of Advanced Fuels, Engine Combustion Branch NASA Glenn Research Center Sharon Kubasak, PhD, MFA Associate Professor of English Dan Palmer, PhD Baldwin Wallace University Professor, Mathematics and Computer Science John Carroll University Karen Latterner, BAS, RT (R)(M) Clinical Preceptor, Radiography and Mammography Emily Perry Cuyahoga Community College Associate Director, Corporate Relations Philanthropy Institute Yvonne Lee, MA Cleveland Clinic English Department Kent State University Sarah Pflaum Student, Breen School of Nursing Jeffrey Loerch, BA Ursuline College Technical Support Manager Center for Medical Art & Photography José Ramos, BS, RRT Cleveland Clinic Manager, Respiratory Institute Cleveland Clinic Monica Lott, PhD Adjunct Professor, English Composition Rebecca Ranallo Kent State University Manager, Information & Technology Literacy Cuyahoga County Public Library Rita Lovelace, RN, CCCTM Coordinator, Chronic Care Services Lindsay Ridinger Cleveland Clinic Associate II, Corporate Communications Cleveland Clinic Pam Malkoff, ATR Registered/Board Certified Art Therapist Judith Ryder & Licensed Marriage Family Therapist Founding Manager Owner and Therapist, Hayes Art Therapy Cleveland Arts Education Consortium

Tracey Meilander, MEd, PhD Maria Soriano, MA Associate Professor, Biology Director, Writing Center Notre Dame College John Carroll University

Amy Moore, BA Bob Stefanov Staff Editor, Cleveland Clinic Journal of Medicine Producer/Director Scientific Publications Department Bob Stefanov Productions Cleveland Clinic Angela Wilson, RN, BSHA Sharon Nahra, MA, ATR, LPC Community Health Educator Art Therapist Community Relations Therapeutic Programming Cleveland Clinic Lutheran Hospital Cleveland Clinic Linda Zolten Wood Artist; Director, Collinwood Painted Rain Barrel Project Gregory Nault, MA Owner, Zolten Wood Design Instructor, English & Literature Malcolm X College, City Colleges of Chicago Chuck Zitko, MSEd Artist/Art Educator Alicia Nickels Associate Director of Development Philanthropy Institute This book and all related materials may not be reproduced without Cleveland Clinic the expressed consent of the Cleveland Clinic. Please contact the K–12 Education Department for further information at 216.448.0602. Or visit our website at www.clevelandclinic.org/K-12.

K–12 Education School Programs Department 25875 Science Park Drive/AC121 Beachwood, Ohio 44122 www.clevelandclinic.org/K-12