Medicine of the Highest Order 2019 Annual Medical Student Abstract Journal Sponsored by: Center for Advocacy, Community Health, Education and Diversity Offices for Medical Education Medical Student Research Faculty Advisory Committee Community Outreach Faculty Advisory Committee International Medicine Faculty Advisory Committee Medical Humanities Faculty Advisory Committee Table of Contents SUMMER RESEARCH ................................................................................................................................................3 Basic Science, Clinical & Translational Research ..............................................................................................5 Community Health Research ........................................................................................................................... 89 International Medicine Research ................................................................................................................... 100 Medical Humanities Research ....................................................................................................................... 120 YEAR-OUT RESEARCH ........................................................................................................................................ 127 Basic Science, Clinical & Translational Research ......................................................................................... 129 International Medicine Research ................................................................................................................... 148 i ii SUMMER RESEARCH 3 4 Basic Science, Clinical & Translational Research Alam, Ahmar Preceptor Harris Chengazi, MD University of Rochester Medical Center Department of Radiology Co-Author Michael J. Potchen, MD University of Rochester Medical Center Department of Imaging Sciences Development of Portable Radiology Training and Retaining Radiologists for Africa Objective: To develop an affordable and accessible radiology curriculum tailored to Zambian Radiologist residents in order to combat the current physician shortage. Background: Zambia has been experiencing a major radiologist shortage, exemplified by both a lack of formal training in radiology along with a limited number of practicing radiologists for the public sector. Prior research has suggested that improvements in medical education could play a role in combatting physician shortages. In 2018, a group of radiologists at the University of Rochester developed PRACTERRA, a Portable Radiology Curriculum for Training, Evaluating, and Retaining Radiologists for Africa, in the hopes to improve radiology residency training in Zambia in order to effectively reduce the current shortage. Since its inception, the PRACTERRA team has begun case collection and module development for the curriculum, and has been actively working with institutes in Zambia to facilitate curriculum integration. Methods: The primary task this summer was to continue curriculum development by collecting a set of radiology cases that covered a wide array of pathology commonly seen in Zambia. Radiology cases included MRIs, CT scans, and Ultrasound imaging. Following collection, the cases needed to be organized based on both their system pathology and integration into the overall curriculum design developed by the PRACTERRA team. Following case collection and organization, a literature review needed to be conducted for every case collected, so that residents would have access to supplementary readings and sources for each case analyzed. Along with case collection, the PRACTERRA team was also developing case modules for curriculum use. Furthermore, the team has planned to publish papers regarding the developmental process in order to contribute to the literature concerning international medical education. Results: Over 300 cases were collected and organized based on system pathology and curriculum integration. A literature review has been conducted for almost 50 cases, and is still being conducted for the remaining cases. 5 Conclusions: There has been great development regarding case collection and organization for usage in the developing curriculum. Additionally, the literature review is still underway, which will serve as great additional resources for the residents as they utilize our curriculum cases. Future plans are to continue collecting and organizing cases, and disseminating primary literature regarding the development process. PRACTERRA representatives also plan on visiting Zambia in the coming year to further assess product compatibility prior to curriculum finalization. The goal is provide the curriculum in its entirety in 2020. 6 Basic Science, Clinical & Translational Research Arora, Trisha Preceptor Lynn Fiellin, MD Yale School of Medicine Department of General Medicine Co-Authors Lindsay Duncan, PhD Tyra Pendergrass Yale School of Medicine Physical Fighting Among Adolescents: The Role of Future Orientation and Anger Rates of physical fighting differ between adolescent boys and girls, but it is not clear why. Previous studies have suggested that in boys, future orientation may predict weapon-related violence. However, this relationship has not been studied in girls. Anger has also been associated with overt aggression for both adolescent boys and girls. In this study, we analyzed secondary data collected from a two year randomized controlled trial studying a digital game intervention to understand whether adolescents’ anger and future orientation were associated with their rates of physical fighting. Adolescents were asked about their anger (defined as “I got angry very easily with someone” and “I was angry most of the day” at least one day during the past 7 days), whether they had ever been in a physical fight, and questions to measure their future orientation. Data was collected from 333 adolescents aged 11 to 14 at seven time points over 24 months. Logistic regression analyses, conducted separately for boys and girls, examined anger and future orientation as predictors of physical fighting. Of the participants, 177 (53.2%) were boys and the mean age was 12.9 years. Future orientation scores increased for boys and girls, but plateaued after 3 months. Boys reported higher rates of having been in a physical fight in the prior 24 months whereas girls reported higher rates of anger. For boys, a change in future orientation was a significant predictor of having been in a fight, whereas for girls, anger was a significant predictor of having been in a fight. These data suggest that factors associated with or predictive for being involved in physical fighting may vary by gender. Using targeted methods that address these specific differences for each gender group may improve the effectiveness of future violence prevention interventions. 7 Basic Science, Clinical & Translational Research Bai, Heidi Preceptor JiaDe (Jeff) Yu, MD Massachusetts General Hospital, Harvard Medical School Department of Dermatology Contact Allergens in Top-Selling Textile Care Products Allergic contact dermatitis (ACD) is a type IV cell-mediated delayed-type hypersensitivity reaction induced by haptens contacting the skin. ACD affects approximately 20% of both the general adult and pediatric populations, leading to impairment of one’s quality of life and ability to work due to symptoms, functioning, and appearance. Epicutaneous patch testing is the gold standard for detecting allergens responsible for ACD. Clothing can induce ACD through the addition of disperse dyes for dying synthetic fabrics and formaldehyde resins for strength enhancement and shrinking and wrinkle prevention. While allergens corresponding to the textile production process itself have been recognized, washing and care products associated with textiles have been widely understudied, and are potentially relevant sources for triggering ACD in a similar pattern to textile dermatitis. We conducted a comprehensive examination of potential allergens in commonly used laundering products, including 30 laundry detergents, 10 fabric softeners, 8 dryer sheets, and 17 stain removers. Fragrances and essential oils were the top potential allergens found in laundry detergents, fabric softeners, and stain removers, followed by preservatives benzisothiazolinone and methylisothiazolinone. Fragrance was the only potential allergen in dryer sheets. Other common potential allergens identified were emulsifiers such as propylene glycol, and surfactants such as alkyl glucosides and cocamidopropyl betaine. Many of these potential allergens were named Allergen of the Year by the American Contact Dermatitis Society. These findings are particularly concerning since residues have been shown to linger after one wash. We recommend practitioners to recognize and consider the potential allergens in textile care products when evaluating patients with diffuse ACD. 8 Basic Science, Clinical & Translational Research Bhagat, Rohun Preceptor Scott J. Swanson, MD Dana-Farber Cancer Institute, Brigham and Women’s Hospital Department of Thoracic Surgery Co-Authors Emily Polhemus Abby White, DO Brigham and Women’s Hospital Department of Surgery Suden Kucukak and Dan Lee Harvard Medical School Cardiothoracic Surgery Research Project 1: Case Report In this project, we identified a patient who was initially diagnosed with primary breast cancer and upon further workup was found to have an additional primary lung tumor. The primary lung tumor spanned much of the left thoracic cavity with involvement of the heart. We