Geisel Medical Student Annual Poster Presentation

Monday, January 31, 2022 through Thursday, February 3, 2022, students will present, daily, from 12:30pm to 1:00pm

Presenter and Date of Presentation	Title and Summary of Poster	Poster
Ahmed, Maha 3-Feb	Predictors of Long Term Left Ventricular (LV) Function Following Surgical Correction of Mitral Regurgitation. Impairment of mitral valve function causes chronic volume overload that is often masked by the favorable loading conditions in mitral regurgitation (MR) and unmasked by mitral valve surgery. Chronic volume overload leads to compensatory ventricular remodeling and myocardial dysfunction which may become irreversible over time, increasing morbidity and mortality. Left ventricle systolic function and size have been shown to be strong predictors of long-term cardiac function after surgery. In this study, we noticed a postoperative decrease in left ventricular ejection fraction, left ventricular end-diastolic dimension, and left atrial volume index in some patients after mitral valve repair and replacement. The mean decrease in left ventricular ejection fraction in patients who had mitral valve repair was different from the mean decrease in patients who had a mitral valve replacement. We have also noticed other independent predictors of a lower postoperative ejection fraction including, preoperative atrial fibrillation, NYHA class, preoperative ejection fraction, and larger preoperative left heart dimensions. Identifying comorbid conditions, preoperative echocardiographic measurements, and postoperative management strategies predictive of subsequent left ventricle performance is of extreme significance as it could be used to improve the quality of care provided to patients with MR.	Predictors of Long Term Left Ventricular (LV) Function Following Surgical Correction of Mitral Regurgitation.
Barthold, Laura 1-Feb	Mortality and Operative Complexity in Rural Geriatric Emergency General Surgery Patients With the aging population in the United States, the number of geriatric adults (age ≥65) requiring Emergency General Surgery (EGS) care is increasing. Specific predictors of poor EGS outcomes include increased age, rural presentation, and transfer from other hospitals. We performed a retrospective chart review of 674 rural geriatric patients presenting to DHMC for an EGS operation to better characterize the pattern of care for this at-risk population, particularly focusing on patients transferred to our institution. We found that transferred patients had higher operative complexity, longer length of stay, higher mortality, and higher rates of non-home discharge. However, transfer status was not independently associated with mortality or non-home discharge.	Mortality and Operative Complexity in Rural Geriatric Emergency General Surgery Patients
Bello, Feranmi 2-Feb	Redling and Cancer Related Outcomes - A Scoping Review Structural racism has been cited as a key driver of health inequities, including for cancer care. Racial residential segregation, a form of structural racism, has been studied for a variety of health conditions but influence on cancer outcomes is less well delineated. The primary objective of this study was to evaluate the current data on the association of residential segregation with cancer outcomes. Further, we sought to evaluate how often studies explicitly named “structural racism” and specifically discussed the legacy of residential redlining, government-sponsored segregation, and systemic devaluation of neighborhoods largely along racial and ethnic lines.	Redling and Cancer Related Outcomes - A Scoping Review
Bennett, Raven 31-Jan	A single institutional review of the impact of geographic location and socioeconomic status on the outcomes of adults with Acute Myeloid Leukemia This project is a quality improvement study I conducted in collaboration with Dr. Odeth Barrett-Campbell and Dr. Erick Lansigan from the Section of Hematology & Oncology at DHMC and Liying Pan, a graduate student in the Quantitative Biomedical Sciences Master’s Program at Dartmouth. The aim of our project was to identify if socioeconomic factors such as travel distance to DHMC, income, and education play a role in survival disparities in AML patients in our predominantly rural population. We performed a retrospective review of 500 charts and included adult AML patients who received chemotherapy at DHMC from 2010 to 2020 in the study. In our preliminary analysis, a one-way ANOVA was conducted to compare the effect of distance in minutes from the hospital on whether patients received remission, relapsed, or did not achieve remission. There was no significant effect of distance on patient outcomes, F (2,86) = 0.483, p = 0.619. In future analysis, we intend to compare outcomes based on other factors, including education level and income.	A single institutional review of the impact of geographic location and socioeconomic status on the outcomes of adults with Acute Myeloid Leukemia
Bergman, Drew 3-Feb	Genome-scale DNA methylation analysis identifies repeat element alterations that modulate the genomic stability of melanocytic nevi The majority of acquired melanocytic nevi (AMN) grow and persist in a stable form into adulthood, yet share many phenotypic and molecular characteristics (such as BRAF mutation) of early cutaneous melanoma and may be excised and analyzed as a precautionary measure. Histopathological classification of nevi is based on the location and proliferation of melanocytic nests (junctional, intradermal, compound) and generally consists of ‘benign’ or ‘dysplastic’ classes. Dermoscopic classification is used for clinical decision-making, and consists of phenotypic description of lesions (globular, reticular, non-specific). Evidence for which of these combinations of classes and descriptions of AMNs carry higher risk for transformation is lacking, and mechanisms driving nevogenesis and either stability or transformation of AMNs are yet unclear. To investigate these questions, we evaluated the genome-scale DNA methylation profiles of 32 histopathologically and dermoscopically characterized nevi in comparison to adjacent normal skin. Benign and dysplastic AMNs were very dissimilar, sharing virtually no differentially-methylated loci in comparison to adjacent normal skin. Benign AMNs had increases in both global methylation and methylation of specific markers of genomic stability in comparison to dysplastic AMNs. While AMNs described as globular showed no differences in methylation compared with normal skin, reticular/non-specific AMNs showed stark changes in methylation, especially in areas important for gene regulation such as open chromatin and active gene promoters, such as the promoter of PTEN, an important tumor suppressor gene in melanoma.	Genome-scale DNA methylation analysis identifies repeat element alterations that modulate the genomic stability of melanocytic nevi
Blythe, Madeleine 2-Feb	Opioid Misuse Risk Screening in the Palliative Care Setting The opioid epidemic is a serious public health problem affecting millions of people around the world. There are tools designed to identify risks for opioid misuse and improve appropriate opioid prescribing, such as the Opioid Risk Tool, Prescription Drug Monitoring Program, urine drug screens, and opioid treatment agreements. Palliative care has particular indications for using opioids in the care of patients with chronic and terminal illnesses, rendering some of these tools less necessary than in patients without terminal diseases. This project set out to find out more about how the DHMC palliative care inpatient consult service uses these tools.	Opioid Misuse Risk Screening in the Palliative Care Setting
Bradley, Katherine 31-Jan	Point of Care Diagnostics for Cutaneous Fungal Infections Given the rising costs of care for dermatophytosis, paired with the limitation of low sensitivity and time-intensive clinical tests, there is a demand for rapid, cost-efficient, and accurate diagnostic alternatives. In this study, we developed a clustered regularly interspaced short palindromic repeats (CRISPR) Cas12a-based test using the highly conserved dermatophyte gene, Topoisomerase II (TOP II), which has been used to identify dermatophytes at the species level. The results of Cas12a cutting of species-specific TOPII target DNA were visualized by the naked eye with lateral flow strips (LFA). We also introduced an additional rapid dermatophyte identification method using colorimetric loop-mediated isothermal (LAMP) detection. In the presence of a specific dermatophyte species, this assay amplified a target region of the TOP II gene, yielding a pH-induced color change indicative of a positive test. The question of scaling these identification methods to a pan-dermatophyte test was also explored, culminating in the creation of a pan-dermatophyte TOP II consensus sequence from which CRISPR crRNA guides and LAMP primers can be derived for streamlining future point of care testing and research applications.	Point of Care Diagnostics for Cutaneous Fungal Infections
Braz, Armando 1-Feb	Expand your mind: evidence for psychedelic enhanced brain stimulation Psychedelics have recently enjoyed a resurgence in neuroscience and psychiatry with promising success in psychedelic-assisted therapy for the treatment of anxiety, depression, and addiction. At the cellular level, psychedelics have been shown to increase neuritogenesis, spinogenesis, and synaptogenesis (observed 24 hours after acute administration), priming neural circuits for neuroplastic changes—perhaps explaining the sustained efficacy of psychedelic-assisted therapy. The acute effects of psychedelics have been described with functional imaging and neural oscillations showing an increase in the entropy of spontaneous cortical activity. However, the strongest and most reliable therapeutic effects of psychedelics manifest when the drugs are paired with a targeted intervention (e.g., psychotherapy). In order to better understand this synergistic interaction without human bias, we recorded local field potential (LFP) oscillations from rats following lysergic acid diethylamide (LSD) or saline administration and determined if exposure to these treatments altered the effect of a targeted intervention, brain stimulation, applied 24 hours later.	Expand your mind: evidence for psychedelic enhanced brain stimulation
Burdon Dasbach, India 3-Feb	Lung Protective Ventilation in a Rural Level I Trauma Center Prior studies demonstrated that lung protective ventilation (< 8 mL/kg ideal body weight) reduces associated lung injuries and improves clinical outcomes. Our research is to investigate the use of lung protective ventilation for adult trauma patients arriving at a rural trauma center, and the impact of emergency department (ED) ventilator settings on subsequent intensive care unit (ICU) ventilator management. This was a retrospective review of trauma databases of mechanically ventilated adult patients arriving to Dartmouth-Hitchcock Medical Center between January 2018 and December 2020. Three hundred twelve patients were identified; 125 (40%) received tidal volumes > 8 mL/kg ideal body weight). We found that tidal volumes of patients in the ED are positively correlated with ICU tidal volumes. Our team has identified opportunities for standardization and improvement in lung protective ventilation practices of trauma patients in the ED.	Lung Protective Ventilation in a Rural Level I Trauma Center
Burdon Dasbach, India 3-Feb	Understanding the Birthing Experiences of People with Substance Use Disorder at Dartmouth Hitchcock Medical Center The incidence of SUD and OUD among pregnant people is rising in parallel with our nation’s opioid epidemic. In New Hampshire, opioid overdose is the leading cause of maternal mortality in the year following delivery. Prior research suggests that pregnant patients who represent historically marginalized communities often have negative experiences during birth in the United States. In order to properly care for this patient population and improve the relationship between patients with SUD and their providers, more research is needed to specifically elucidate the factors that contribute to negative labor and delivery experiences for this patient population. Our study is a mixed methods exploratory study, utilizing validated surveys and patient and provider interviews to explore both the positive and negative factors contributing to patients’ experiences giving birth at DHMC. By better understanding these factors, we hope to inform future initiatives at DHMC that will improve the quality of care for pregnant patients with SUD.	Understanding the Birthing Experiences of People with Substance Use Disorder at Dartmouth Hitchcock Medical Center
Callif, Charles 2-Feb	Indications for Nuclear Imaging in Epithelioid Sarcoma – An Analysis of the SEER Registry Nuclear imaging, specifically positron emission tomography (PET), is widely used for the staging and surveillance of various tumor types. Epithelioid Sarcoma (ES) is a high-grade rare mesenchymal cancer that commonly metastasizes to regional lymph nodes, lung, bone, brain, and scalp. These metastases can be difficult to detect using established sarcoma staging protocols, and the role of PET in the workup of ES remains largely undefined. Thus, this study sought to elucidate potential indications for the use of nuclear imaging in cases of ES, by evaluating the association between patient characteristics and risk of metastases at presentation.	Indications for Nuclear Imaging in Epithelioid Sarcoma – An Analysis of the SEER Registry
Denson, Daniel 3-Feb	Lung Protective Ventilation in a Rural Level I Trauma Center Prior studies demonstrated that lung protective ventilation (< 8 mL/kg ideal body weight) reduces associated lung injuries and improves clinical outcomes. Our research is to investigate the use of lung protective ventilation for adult trauma patients arriving at a rural trauma center, and the impact of emergency department (ED) ventilator settings on subsequent intensive care unit (ICU) ventilator management. This was a retrospective review of trauma databases of mechanically ventilated adult patients arriving to Dartmouth-Hitchcock Medical Center between January 2018 and December 2020. Three hundred twelve patients were identified; 125 (40%) received tidal volumes > 8 mL/kg ideal body weight). We found that tidal volumes of patients in the ED are positively correlated with ICU tidal volumes. Our team has identified opportunities for standardization and improvement in lung protective ventilation practices of trauma patients in the ED.	Lung Protective Ventilation in a Rural Level I Trauma Center
Diaz, Ariana 31-Jan	The Incidence of Acne Vulgaris Associated with Progestin-Releasing Intrauterine Devices (IUDs) As the use of hormonal birth control becomes increasingly more popular, it is crucial that we understand the role that these hormones play in the various processes in our bodies and the side effects they can produce. One of these side effects is acne vulgaris, which is the most common skin condition in the world and can negatively affect one’s life. Making the right choice when it comes to birth control is a difficult decision and determining whether there is a relationship between different classes of birth control and the incidence of acne will better inform these decisions. As such, our literature review looked at the relationship between different birth control types and incidence of acne and found that while there seems to be an increase in acne following IUD insertion, these findings are less dependable due to self-report bias. Anecdotal evidence seen by the DHMC Dermatology Clinic supports the idea that there is an increase in acne vulgaris diagnosis after IUD placement. Our future study will investigate the association between progesterone only intrauterine device (IUD) and acne vulgaris using hospital ICD-10 codes for acne as an objective measure.	The Incidence of Acne Vulgaris Associated with Progestin-Releasing Intrauterine Devices (IUDs)
Dickinson, Micaela 31-Jan	Prevalence of Rectal Examinations Prior to Magnetic Resonance Defecography Studies Magnetic resonance defecography (MRD) is among the adjunct tests utilized in evaluation of pelvic floor dysfunction. To assess indications and referral patterns for MRD, we conducted a retrospective cohort review of MRDs performed at DHMC from 2016 to 2020. This poster shows the frequency of digital rectal exam (DRE) performance prior to MRD based on referring provider specialty. While we expected to find that DRE was performed universally before MRD, this was not the case. Moreover, performance of DRE was less common within gastroenterology than with other referring providers.	Prevalence of Rectal Examinations Prior to Magnetic Resonance Defecography Studies
English, Jada 2-Feb	Investigating the Dynamic and Static Criteria in the Diagnosis of Sepsis Sepsis is a life-threatening illness that occurs due to a dysregulated immune response to an infection. In order to reduce the mortality of sepsis, early recognition and diagnosis are imperative. Currently, diagnostic tools such as the Quick Sequential Organ Failure Assessment (qSOFA) and the Systemic Inflammatory Response Syndrome (SIRS) have been used to identify the early signs of sepsis in patients. However, each scoring system has its own limitations and has not been analyzed in a dynamic approach. Our research focuses on a retrospective analysis of admitted patients within Dartmouth-Hitchcock Medical Center sepsis registry. We aim to investigate various factors including: hemodynamic, physiologic, and lab data that will allow earlier detection of sepsis. Results show that an amendment of current SIRS criteria to include additional clinical data allows greater differentiation between those with or without sepsis. Dynamic analysis of patients’ lab values revealed timepoints that will allow for earlier therapeutic interventions for septic patients.	Investigating the Dynamic and Static Criteria in the Diagnosis of Sepsis
Fasman, Adam 3-Feb	Training a Deep Convolutional Neural Network to Diagnose Pneumothorax on Lung Ultrasound The objective of this project was to create a graduated machine learned algorithm (MLA) that could detect pneumothorax (PTX) on ultrasound videos, with the aim of incorporating this artificial intelligence (AI) into an Automated Needle Decompression Device (ANEED) to assist clinicians in the evaluation and needle decompression of trauma patients. Through the DH Data Analytics Institute, all patients with diagnosis of PTX in the ED were identified and their ultrasound data collected. These positive and negative images were independently evaluated by two experts to validate results prior to transfer and use by computer scientists at Creare LLC to create the MLA. A preliminary algorithm has been trained and tested on two human videos to successfully identify pleura, ribs, and lung sliding (no PTX) and no lung sliding (+PTX). In addition, a preliminary ANEED Device effortlessly deployed three catheters in deceased pig with functional operation of all basic commands. After determining safety and efficacy in animal trials human trials will be pursued.	Training a Deep Convolutional Neural Network to Diagnose Pneumothorax on Lung Ultrasound
Fontaine, Dominique 2-Feb	ER-β Agonist as a Cure for High-Grade Gliomas High-grade gliomas are the most aggressive CNS malignancy; maintaining the worst prognosis of all intracranial tumors with a mean survival of 15 months and 5-year survival rate of <5%.The Guar Lab explores the utility, efficacy, and toxicity of a novel drug in the context of treatment-resistant, high-grade gliomas (Grade III, IV). Despite therapeutic efficacy in various malignancies, SOC estrogen therapies increase the risk of the development of other diseases overtime and non-specifically bind and agonize ERα, causing additional adverse side effects. ERβ is understood to have tumor-suppressive effects in glioblastoma, as increased expression correlates with better prognosis and less-aggressive tumor growth. We recently published that a novel, potent and selective ERβ agonist, ent-28, reduces cell proliferation at a 50-fold lower concentration and induces apoptosis at a 7-fold lower concentration when compared to TMZ in GBM cell lines. We have demonstrated that ent-28 has anti-tumor activity in patient-derived glioma cells in vitro and in vivo regardless of tumor grade and mutation status. Additionally, ent-28 crosses the blood brain barrier with 85% penetrance in vivo.Ent-28 promotes survival and attenuates tumor growth five patient cell line-derived orthotopic xenografts. Furthermore, irrespective of tumor grade, mutational status, sex, cellular and/or molecular heterogeneity, Ent-28 attenuates glioma patient-derived tumor cells. Thus, the specificity of ent-28 for ERb over ERa may allow us to minimize side-effects of non-selective ER-targeted therapy and maximize therapeutic benefit.	ER-β Agonist as a Cure for High-Grade Gliomas
Gardner, Cooper 31-Jan	Clinical Clerkship Grade Distributions This poster is a summary of project that is still currently in progress at this time. We are preforming a retrospective study investigating grade distributions among allopathic medical schools in the US. Residency applications received by the Dartmouth Orthopaedics residency program were used to extract de-identified MSPE data pertaining to the distribution of grades awarded at medical schools across the country for each academic year between 2015 and 2021. Medical schools were divided into cohorts based upon the grading methodology employed by the school. The primary research question is if the percentage of students receiving the highest grade during core clerkships is statistically different in grading scales that utilize more than 3 grade categories (i.e. H/HP/P/LP/F, or H/HP/P/F, etc.) compared to schools using only 3 grade categories (H/P/F), and has the distribution of grades awarded during clinical clerkships changed over time? With decreasing amounts of objective data points available, particularly with the USMLE announcing that STEP 1 will become pass/fail beginning in 2021, review of residency applications and applicant matching is an increasingly complicated task.	Clinical Clerkship Grade Distributions
Goff, Matthew 1-Feb	Identifying Needs for Acute Mental Health Crisis Response in the Upper Valley This poster details the work Sirey Zhang and Matthew Goff undertook this summer in partnership with West Central Behavior Health (WCBH). In July of 2021, WCBH launched a mobile mental health crisis response program to provide 24/7 mobile mental health services to individuals in the Upper Valley experiencing mental health crises. The goal of our work was to support WCBH in the development, launch, and delivery of this program. We conducted a series of interviews with community stakeholders and similar mobile mental health crisis organizations (such as STAR in Denver, CO) to best understand the needs of the local community, as well as best practices of similar organizations nationally. We were able to synthesize our findings into three key principles, which we shared with WCBH to facilitate the effective and efficient roll out of their mobile crisis response program.	Identifying Needs for Acute Mental Health Crisis Response in the Upper Valley
Greene, Lily 31-Jan	Identifying Drug Targets to Radiosensitize Medulloblastoma Fanconi Anemia (FA) is an inherited condition characterized by bone marrow failure and predisposition to malignancy, including medulloblastoma (MB) brain tumors. FA occurs due to genetic mutations in the FA/BRCA DNA damage repair pathway which leads to genomic instability and increased toxicity to cancer treatments like radiation. MB is the most common pediatric brain tumor. The MB subtype commonly found in FA patients contain mutations in the Sonic Hedgehog (SHH) pathway leading to its constitutive activation. Treatment of SHH-MB tumors includes surgery, chemotherapy and radiation. PARP (poly adp-ribose polymerase) is a DNA damage repair protein involved in base excision repair. We aimed to investigate whether inhibiting PARP and the SHH pathway can sensitize MB cells to radiation, with the hope of reducing the amount of radiation needed to induce tumor cell death. Using MTT colorimetric assays, we identified the IC50 of Veliparib (PARP inhibitor) and Sonidegib (SHH pathway inhibitor) in two human MB cell lines as a 1uM dose. This dose of drug will be utilized in future radiation pretreatment experiments. Going forward, we plan to complete radiation dose-response curves in both cell lines, validate the drugs inhibitory effect in proof of concept experiments, and measure colony formation in response to radiation with and without drug pretreatment.	Identifying Drug Targets to Radiosensitize Medulloblastoma
Harri, Adina 2-Feb	Who is Teaching Our Preclinical Medical Students? Historically, preclinical medical faculty have not represented their student body or the population at large. However, the Association of American Medical Colleges (AAMC) Faculty Roster demonstrates that over the past 20 years there are increasing numbers of basic science female faculty teaching medical students than there have been in the past. However, the AAMC Faculty Roster does not demonstrate whether this current population of faculty members teach in small-group courses that offer high contact and mentorship opportunities with preclinical medical students. To answer this question, we distributed a qualitative survey to the Senior Associate Deans of Medical Education (SADMEs) at a representative sample of medical schools that gathered demographic data on small group clinical skills faculty and conducted semi-structured interviews with two SADMEs. Our findings demonstrated that female faculty are predominantly represented in these “high-contact” small group courses, while procedural specialists are often underrepresented, and most faculty hold assistant or associate professor roles. While the culture of medical education and compensatory structures might be responsible for these observations, more national-scale efforts are needed to gather this data and better understand the nuances of who is truly teaching our preclinical medical students.	Who is Teaching Our Preclinical Medical Students?
Kersbergen, Gary 1-Feb	Point of Care Ultrasound Use in Graduates of the Maine-Dartmouth Family Medicine Residency This project aims to address the increasing utility and need for point of care ultrasound (POCUS) training in family medicine residencies by conducting a POCUS-based survey in order to better understand current utilization and barriers for POCUS use among graduates of the Maine-Dartmouth Family Medicine Residency (MDFMR). We wanted to determine the ways in which providers use POCUS in their clinical practice, frequency of use, and which specific POCUS studies would be most useful for them for their patients. Additionally, we wanted to identify current barriers that prevent MDFMR graduates from using POCUS in their practice in order to determine how best to overcome those barriers. In our study, we paid particular attention to the usefulness of POCUS in outpatient settings for rural and medically underserved communities, as POCUS has shown to have particular utility to physicians working in such settings.	Point of Care Ultrasound Use in Graduates of the Maine-Dartmouth Family Medicine Residency
Kim, Stephanie 1-Feb	Biased Relaxin-RXFP1 Agonist ML290 Attenuates the Development of Pulmonary Hypertension RXFP1 is a G-coupled protein receptor for the hormone Relaxin-2. Relaxin-2 has antifibrotic and vasodilatory properties that have long been investigated as potential therapies for cardiovascular disease. More specifically, there is increased RXFP1 receptor expression in the vascular media of lungs from patients with pulmonary arterial hypertension suggesting a potential role in disease modulation. Administration of Relaxin-2 in-vivo however shows little success in attenuating pulmonary fibrotic disease potentially due to its short half-life and immunogenicity. This study investigates the therapeutic potential of RXFP1 signaling using a small-molecule allosteric RXFP1 receptor agonist, ML290. Similar to Relaxin-2, ML290 demonstrates in-vitro attenuation of TGF-B induced fibrotic phenotype in pulmonary arterial smooth muscle cells. Furthermore, ML290 is able to attenuate SU541-hypoxia induced pulmonary arterial hypertension in mice models with knock-in humanized RXFP1, thus demonstrating a promising strategy for RXFP1 modulation.	Biased Relaxin-RXFP1 Agonist ML290 Attenuates the Development of Pulmonary Hypertension
Koo, Michael 2-Feb	Bayes EM - Real Time Bayesian Analysis at the Bedside Bayes EM is an app that will provide an easy-to-interface tool that provides an evidence-based algorithm for doing real-time Bayesian analysis for the most emergent and acute conditions in emergency medicine. The app is based on the concepts of evidence based medicine (EBM), utilizing the literature on how medical history, presenting symptoms, and diagnostic test results affect the likelihood that a patient has a certain condition. While primarily focused on becoming a real-time tool to assist in medical diagnosis, the app can also be used to help train medical students and residents on the concepts of Bayesian analysis as it shows numerically how different histories, symptoms, and diagnostic test results can affect the likelihood of a specific diagnosis.	Bayes EM - Real Time Bayesian Analysis at the Bedside
Kouassi-Brou, Marilyn 31-Jan	The Incidence of Acne Vulgaris Associated with Progestin-Releasing Intrauterine Devices (IUDs) As the use of hormonal birth control becomes increasingly more popular, it is crucial that we understand the role that these hormones play in the various processes in our bodies and the side effects they can produce. One of these side effects is acne vulgaris, which is the most common skin condition in the world and can negatively affect one’s life. Making the right choice when it comes to birth control is a difficult decision and determining whether there is a relationship between different classes of birth control and the incidence of acne will better inform these decisions. As such, our literature review looked at the relationship between different birth control types and incidence of acne and found that while there seems to be an increase in acne following IUD insertion, these findings are less dependable due to self-report bias. Anecdotal evidence seen by the DHMC Dermatology Clinic supports the idea that there is an increase in acne vulgaris diagnosis after IUD placement. Our future study will investigate the association between progesterone only intrauterine device (IUD) and acne vulgaris using hospital ICD-10 codes for acne as an objective measure.	The Incidence of Acne Vulgaris Associated with Progestin-Releasing Intrauterine Devices (IUDs)
Kroll, Elizabeth 3-Feb	Shared Decision-Making in Total Hip/Knee Arthroplasty: Understanding Surgeon and Patient Differences about When it is Time for Operation Deciding whether a patient is a good candidate for Total Hip/Knee Arthroplasty to treat arthritis is a complex decision with variable outcomes. Recent years have emphasized shared decision-making between the patient and surgeon regarding candidacy for TKA/THA. However, successful shared decision-making requires clear communication of symptoms and mutual understanding of expectations. Understanding a patient’s perspective and recognizing where communication gaps may occur can be helpful in facilitating productive shared decision-making. The OPTION (Objective Performance Threshold Indicating Operative Need) Survey is currently being studied to guide the conversation between patient and surgeon. The pilot data from this study can be analyzed for insights into the patient and surgeon perspectives during this shared decision-making conversation: specifically, how surgeons perceive the patient’s experience, how the priorities of different groups of patients differ in treating their arthritis, and how radiographic data align with the patient experience of arthritis. The major takeaways from analysis of the pilot data are that when patient and surgeon disagree, surgeons tend to underestimate the patient’s subjective experience of arthritis; patient’s priorities in treating their arthritis vary depending on certain factors describing their experience; and radiographic joint space data does not give the full picture of a patient’s experience with arthritis.	Shared Decision-Making in Total Hip/Knee Arthroplasty: Understanding Surgeon and Patient Differences about When it is Time for Operation
Kuck, Christa 1-Feb	Creating an Integrative and Mind-Body Medicine Elective for Medical Students Although almost a third of U.S. adults engage in non-allopathic care and therapies, there is little attention devoted to this in medical school curricula, both in understanding the practices and communicating about them with our patients. The goal of this summer project - Creating an Integrative and Mind-Body Medicine Elective for Medical Students - was to create an elective course that includes both a basic introduction to the most-commonly encountered non-allopathic practices and a discussion on how best to talk with our patients about these practices.	Creating an Integrative and Mind-Body Medicine Elective for Medical Students
Lee, Andrew 31-Jan	Antibiotic Concentration After Delivery to Middle Ear for Chronic Suppurative Otitis Media Chronis suppurative otitis media (CSOM) is characterized by long term middle ear infection with perforation and purulent drainage of the tympanic membrane. A critical assumption in using local antibiotic delivery by ototopical droplets is that the high bactericidal concentrations would overcome any minimum inhibitory concentration (MIC) of the bacteria, regardless of its resistance to antibiotics or not. Nonetheless, we observe in the literature that resistant bacteria demonstrate higher MICs and that those infected with resistant bacteria have poorer outcomes. Our primary objective is to describe the antibiotic concentration at the tissue level to elucidate the role of antibiotic delivery in this paradox. Due to the on-going nature of the study, this poster aims to share and characterize the question we are answering.	Antibiotic Concentration After Delivery to Middle Ear for Chronic Suppurative Otitis Media
Lee, Hong M. 1-Feb	Characterizing AAVrg Infection in Peripheral Nervous Tissue Following Injection of Constructs to Mouse Sciatic Nerve Peripheral nerve injuries afflict more than 20 million Americans today [1] and can significantly disrupt quality of life, causing pain and impairing motor and sensory function. Improvement upon these outcomes are limited by the slow and inadequate rate at which damaged nerves to regenerate axons after injury. Adeno-associated viruses (AAV) represent a powerful vehicle for gene therapies to treat peripheral nerve injury as past studies have demonstrated tropism to nervous tissue [2]. We aimed to characterize and compare the distribution and delivery efficiency of this vehicle when directly injected into the peripheral nerves. Two AAV recombinant viruses were investigated: AAVrg hSyn eGFP and AAVrg CAG TdTomato. These recombinant AAVs were designed with retrograde capsid (AAVrg) conferring ability for retrograde transport. AAVrg hSyn eGFP encodes a human synapsin 1 gene promotor driving expression of a green fluorescent protein reporter while the AAVrg CAG tdTomato encodes a CAG promotor driving expression of a red fluorescent protein. We found that AAVrg hSyn eGFP had a significantly higher rate of Schwann cell specific expression than AAVrg CAG tdTomato in the mouse sciatic nerve. There was minimal to no co-expression with axons. By characterizing the transduction efficiency of these viruses in peripheral nerve tissue, we can test the feasibility of using AAV vector- based gene therapy in peripheral nerve injuries.	Characterizing AAVrg Infection in Peripheral Nervous Tissue Following Injection of Constructs to Mouse Sciatic Nerve
Lee, Torri 2-Feb	Tablet-Based Central Auditory Processing This study aims to determine the feasibility of administering portable, self-led central auditory hearing tests to English and Spanish-speaking children using a novel, tablet-based system developed for this project. In this pilot study, all children were able to successfully complete the battery of tests for central auditory processing using the tablet-based training videos. This verifies its use for future clinical investigation. Upon validation with a larger cohort, these hearing tests will be used in Nicaragua to investigate the prevalence of hearing loss in children exposed to heavy metals living in mining communities.	Tablet-Based Central Auditory Processing
Liu, Alice 31-Jan	Characterizing the cellular phenotype of AAV-mediated Pten knockout in the peripheral nervous system	Characterizing the cellular phenotype of AAV-mediated Pten knockout in the peripheral nervous system
Marwood, Jacob 3-Feb	Lung Protective Ventilation in a Rural Level I Trauma Center Prior studies demonstrated that lung protective ventilation (< 8 mL/kg ideal body weight) reduces associated lung injuries and improves clinical outcomes. Our research is to investigate the use of lung protective ventilation for adult trauma patients arriving at a rural trauma center, and the impact of emergency department (ED) ventilator settings on subsequent intensive care unit (ICU) ventilator management. This was a retrospective review of trauma databases of mechanically ventilated adult patients arriving to Dartmouth-Hitchcock Medical Center between January 2018 and December 2020. Three hundred twelve patients were identified; 125 (40%) received tidal volumes > 8 mL/kg ideal body weight). We found that tidal volumes of patients in the ED are positively correlated with ICU tidal volumes. Our team has identified opportunities for standardization and improvement in lung protective ventilation practices of trauma patients in the ED.	Lung Protective Ventilation in a Rural Level I Trauma Center
Matsunaga, Sarah 3-Feb	Does This Still Bother You Today?" Addressing Adverse Childhood Experiences (ACEs) In Adult Primary Care Patients Childhood Adverse Experiences (ACEs) have been shown to be linked to adult health behaviors, and increased morbidity and mortality. 238 adult outpatients seen in primary care clinics across New England completed an ACE screening form on whether they had experienced ACEs, whether they were still bothered by them, and whether they would like to discuss them today, in addition to a 10-item validated measure of coping skills/resilience, and self-reported information on chronic disease. Providers completed logs of visit type, and if discussion or referral occurred.	Does This Still Bother You Today?" Addressing Adverse Childhood Experiences (ACEs) In Adult Primary Care Patients
Nelton, Emmalin 2-Feb	Effectiveness of written instruction for completing the Focused Assessment with Sonography for Trauma (FAST) in a wilderness setting Point of Care Ultrasound (PoCUS) has gained traction in its application in under-resourced and remote settings due to ease of use, portability, and ability to integrate with telemedicine modalities. Previous research has shown that an eighth grade education is adequate to obtain PoCUS images with some training. The Focused Assessment with Sonography for Trauma (FAST) is a common PoCUS exam which can be performed in an out-of-hospital setting to evaluate the need for further medical care. We hypothesize that a layperson with no advanced medical training in a wilderness setting can obtain adequate ultrasound images while performing a with a handheld ultrasound device, using only pre-written instructions. Participants will follow a typed set of instructions and an accompanying set of representative ultrasound images to obtain the four views used most commonly in FAST. While no results have been collected as of yet, the possibility of deploying PoCUS technology for layperson use in the wilderness setting presents a promising avenue for the expansion of medical access and care in remote and under-resourced settings.	Effectiveness of written instruction for completing the Focused Assessment with Sonography for Trauma (FAST) in a wilderness setting
Nevil, Grace 31-Jan	Neuromodulation to Enhance Spatial Learning Deficits After Shockwave-Induced Traumatic Brain Injury Traumatic brain injury (TBI) is a significant problem worldwide, affecting around 69 million individuals yearly. Due to their regular proximity to improvised explosive devices, combat military personnel are at heightened risk for shockwave-induced, blast TBIs. Sequelae include, but are not limited to, significant cognitive impairment, reduced executive functioning, and neuropsychiatric conditions, all of which significantly impact the quality of life of those affected and their families. Neuromodulation techniques, including deep brain stimulation (DBS) and vagus nerve stimulation (VNS), are currently under investigation in the treatment of neurotrauma and neuropsychiatric illness. Our lab is focused on defining effective stimulation targets and parameters to enhance functional recovery following bTBI in mice. We have shown that repeated bTBI can be conducted in mice with minimal mortality and functional status can be assessed with various neurobehavioral assays, such as the Morris Water Maze (MWM). Mice with more severe bTBI injuries exhibit worse spatial learning memory deficits (MWM) compared to animals with milder injuries. Ongoing work is focused on advanced neurobehavioral assays, including operant conditioning and hyperarousal, to investigate the therapeutic implications of DBS and VNS in an animal model of PTSD.	Neuromodulation to Enhance Spatial Learning Deficits After Shockwave-Induced Traumatic Brain Injury
Nguyen, Phuong 2-Feb	Investigating the Dynamic and Static Criteria in the Diagnosis of Sepsis Sepsis is a life-threatening illness that occurs due to a dysregulated immune response to an infection. In order to reduce the mortality of sepsis, early recognition and diagnosis are imperative. Currently, diagnostic tools such as the Quick Sequential Organ Failure Assessment (qSOFA) and the Systemic Inflammatory Response Syndrome (SIRS) have been used to identify the early signs of sepsis in patients. However, each scoring system has its own limitations and has not been analyzed in a dynamic approach. Our research focuses on a retrospective analysis of admitted patients within Dartmouth-Hitchcock Medical Center sepsis registry. We aim to investigate various factors including: hemodynamic, physiologic, and lab data that will allow earlier detection of sepsis. Results show that an amendment of current SIRS criteria to include additional clinical data allows greater differentiation between those with or without sepsis. Dynamic analysis of patients’ lab values revealed timepoints that will allow for earlier therapeutic interventions for septic patients.	Investigating the Dynamic and Static Criteria in the Diagnosis of Sepsis
O'Brien, Casey 1-Feb	Head and Neck Cancer in Fanconi Anemia Creating models to study FA mutated solid tumors, such as HNSCC, will give more insight into the disease and improve treatment options. We sought to understand the role of some FA mutations in HNSCC by creating a model in JHU011 cell lines by knocking out FANCA and FANCD2. After creating and validating these cell lines, we analyzed the effect of the mutations on growth rate, finding that it was increased in both edited lines compared to the WT. Further exploration will be done to understand the increased growth rate. After WES, we found that there was an increase in somatic mutations after introduction of the knockdown, which also may have contributed to increased growth. We used these models to test the efficacy of a PARPi, olaparib, and an EGFRi, gefitinib and found an increased effect in the edited HNSCC cells. With the WES data, we plan to measure the TMB as well as the EGFR pathway to understand the increased effectiveness of these targeted agents. Hopefully this can be used to further expand the study of targeted agents for FA HNSCC.	Head and Neck Cancer in Fanconi Anemia
Orozco Rendon, Daniela 1-Feb	Fascia attachment optimization during pelvic organ prolapse surgery; an animal model Pelvic Organ Prolapse is a female pelvic floor disorder that is common and increases in frequency with age. One option foe repair is surgical repair using autologous fascia; however, this comes with the risk of suture pull though and no current studies demonstrate the optimal suture configuration in order to avoid this. Our goal was to determine the ideal method of suture placement through fascia and vaginal tissue using an animal model. We hypothesized that the best configuration to avoid suture pull through was the use of either triple knot or barbed suture with a vicryl mesh overlay. To conduct our research, we used strips of bovine fascia sutured together in an overlapping fashion as our animal model and used either single knot, triple knot, or barbed suture configurations and tested their tensile strength using the Instron 5544. A one-way ANOVA test and t-test was used to determine the difference between the means of the different groups. In the end, the use of barbed suture for fresh fascial attachment results in greater tensile strength when compared with two methods of single interrupted sutures in this study. This data may be used to support attachment of fascia during pelvic organ prolapse surgery. In vivo studies are recommended to further evaluate anatomical outcomes.	Fascia attachment optimization during pelvic organ prolapse surgery; an animal model
Partin, Lindsay 3-Feb	Storytelling: Collaborating with Patients and Parents to Create a Children's Book Representative of Their Experiences Children experiencing disease or disability are rarely depicted in children's literature and are often overlooked or presented inaccurately in children's books. This project aims to write and illustrate a children’s book about, by, and for those living with a chronic and/or serious medical condition to promote its normalization, provide a sense of comfort and community, and to help similarly impacted children and their families feel less alone. To accomplish this, in-depth interviews were conducted with pediatric patient and family participants within the Type 1 Diabetes community at CHaD to learn about their experiences and how they navigate living with a chronic medical condition. To further develop the book, the participants continue to participate in the project through "feedback sessions" to collaboratively create the plot, illustrations, and additional information for the story.	Storytelling: Collaborating with Patients and Parents to Create a Children's Book Representative of Their Experiences
Pawelczyk, Brayson 2-Feb	Nationwide Analysis of Ophthalmologists' Online Profiles Comparing Patient Outcomes with Different Materials in Calvarial Reconstruction and Cranioplasties Social media in the United States has become a widespread method of communication and continues to grow in popularity among adults. The utility of social media to serve as an online resource for patients to educate themselves, interact virtually with their providers, and receive additional practice-specific information has only recently undergone investigation in medicine. Therefore, we sought to understand social media usage in patient care of board-certified U.S. ophthalmologists. By using the American Academy of Ophthalmology’s “Find an Ophthalmologist” directory, we randomly selected 20 ophthalmologists from each state except Alaska (N=18) and Wyoming (N=9). Practice websites and online profiles were evaluated for degree of social media utilization and quality of self-education material based on a four-point scoring system. Notably, we identified a total of 1007 ophthalmologists. 851 (84.5%) of all ophthalmologists were found to have ≥1 online profile with more than half of all website profiles (57.0%) displaying a moderate quality of educational content (score 1-2). However, 33.5% of these profiles provided no educational content. Ultimately, the utilization of social media and other online platforms by providers for patient interaction and education warrants additional research to understand both the breadth of use and effectiveness in patient care.	Nationwide Analysis of Ophthalmologists' Online Profiles Comparing Patient Outcomes with Different Materials in Calvarial Reconstruction and Cranioplasties

Geisel Medical Student Annual Poster Presentation

Monday, January 31, 2022 through Thursday, February 3, 2022, students will present, daily, from 12:30pm to 1:00pm

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