January 2021

Research Day

Ross University School of Medicine hosted its 63rd Research Day Symposium on January 22nd, 2021 from 11:00a to 5:00p AST.

Plenary Speakers

Oral Presentations

Poster Presentations

Abstracts

Research Day is an opportunity for students, faculty and skilled professionals to showcase their research. Research Day will be held virtually, with e-Poster presentation and oral presentation formats. Guest speakers will highlight important topics within the theme 'Cultivating Physician-Scientists'.

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63rd RUSM Research Day Symposium

Cultivating Physician-Scientists

Oral Presentations

"COVID-19 Pandemic Impact on Geriatric Mental Health Among Diverse Seniors at a FQHC."

Presented by Brittany M. Barba, MPH ​

“Toward the development and construct validity of the 7Ps inventory of self-regulated learning to identify student academic success.”

Presented by Daria Ellis, PhD

“Anti-Racism Discussion Group Pilot Evaluation at RUSM.”

Presented by Karie Gaska, PhD

"The potential impact of dietary intervention on recurrence-free and overall survival in ovarian cancer patients: Results from an observational study.”

Presented by Alexandria Laws, MPH

 

Plenary Speakers

Dr. Elijah Paintsil, FAAP, MBCHB

The Making of a Physician-Scientist: Mitochondrion the Master of the Orchestra

 

Dr. Paintsil is a Professor of Pediatrics (Infectious Diseases), Pharmacology, Public Health, and Management at Yale University. He is the Chief of the Section of Pediatric Infectious Diseases and Global Health, Department of Pediatrics at Yale School of Medicine and the Program Director of Pediatric Infectious Diseases Fellowship Training Program, the Director of Pediatric AIDS Program at Yale-New Haven Hospital. His clinical interest is pediatric infectious diseases with special interest in prevention of mother to child transmission of HIV and the management of multidrug resistant HIV infection. His laboratory focuses on increasing the understanding of the host determinants of individual differences in response to antiretroviral therapy; biomarkers and pathogenesis of increasing incidence of cancers in HIV treatment-experienced individuals.

Dr. Juliet Daniel, PhD

Adventures of a Barbadian in Cancer Research and the Ivory Tower of Academia

Dr. Daniel is a Professor and Cancer Biologist at McMaster University, and Acting Associate Dean of Research and External Relations in the Faculty of Science. Professor Daniel’s cancer biology research led to her discovery and naming of a new gene “Kaiso”, coined from her favorite Caribbean music “calypso”. Kaiso regulates the expression of genes that control cell proliferation, cell adhesion and cell motility. Consequently Kaiso’s malfunction in cells leads to developmental disorders, and aggressive tumor growth and spread in various human cancers (e.g. breast, colon, prostate). Professor Daniel’s team is currently studying the aggressive and difficult to treat triple negative breast cancers (TNBC) that are most prevalent in young women of African ancestry and Hispanic women – groups that despite a lower incidence and lifetime risk of breast cancer than Caucasian women, have a higher mortality rate from breast cancer.

 

Poster Presentations

Medical Education/Educational Research

STEPS in Becoming Physician-Scientists

Presented by Dr. Liris Benjamin, RUSM Colleague

Multifaceted academic tool: a protocol for teaching & learning

Presented by Dr. Maureen Hall, RUSM Colleague

Capturing and analyzing targeted needs assessment of matriculating students at RUSM: Phase 1 results

Presented by Dr. Priyadarshini Dattathreya, RUSM Colleague

Review of Syphilis Through Historical Art and Fashion for Teaching

Presented by Aarthi Chezian, RUSM Student

The potential utility of an AI-powered literature review for COVID-19 questions

Presented by Amna Afreen, RUSM Student

Low Fidelity Medical Simulation to Teach Basic Science Cardiovascular Concepts

Presented by George Saboura, RUSM Student

Public Health/Infectious Disease

Comparison of Top Comorbidities, Fatality Rate of COVID-19, Their Correlation to Hospital Capacity Among the First Countries Most Affected During First 60 Days

Presented by Negar Makhsous, RUSM Student

Clinical Medicine

Disseminated Coccidioidomycosis of Chest Wall

Presented by Sandhya Dhital, RUSM Student

Curcumins effects on Ulcerative Colitis: a meta-analysis and systematic review

Presented by Yousif Slim, RUSM Student

P4 Women’s Heart Study (Personalized, Participatory, Preventive, Predictive): The Role of Family History in Vascular Disease Among African American Women Unsuspected of Cardiovascular Disease

Presented by Meldra Hall, RUSM Student

Central Line-Associated Blood Stream Infections in NICUs

Presented by Mohamad Alhamwi, RUSM Student

Case Reports

A case of sigmoid volvulus in an unexpected demographic.

Presented by Mohammad Saba, RUSM Student

Kratom induced Panic Attack

Presented by Raja Atchutuni, RUSM Student

Tension Bullae With Peripheral Pneumothorax

Presented by Bushra Malik, RUSM Student

Antiphospholipid syndrome and cholangiocarcinoma in a young male: an anomaly

Presented by Sangamithra Sathian, RUSM Student

The mysterious case of the Papillary Fibroelastoma

Presented by Shafaq Shereen, RUSM Student

Presumed conversion disorder in a patient found to have new-onset multiple sclerosis: challenges in diagnosis and treatment

Presented by Khan Sinyun Lam, RUSM Student

Peritoneal tuberculosis: a rare elevation in tumor markers

Presented by Dilek Sen, RUSM Student

Nervous & Psychiatric System/Behavioral Health

Impact of Mind-Body medicine in Diabetes, Hypertension, and COPD Management

Presented by Dominique Jenkins, RUSM Student

Psychophysiology of Self-Forgiveness

Presented by Dr. Thomas Ferrari, RUSM Colleague

Mind-Body Medicine at RUSM: Implementation review and preliminary findings from a mixed-methods study

Presented by Dr. Christina Salama, RUSM Colleague

 

 

The potential utility of an AI-powered literature review for COVID-19 questions

Author: Amna Afreen, RUSM Student

Other Authors Names: Jan Bremer, Maikel Boot, Lucas Buyon, Paul Mooney, Byron Wallace, Dylan Vance, Amna Afreen, Zachary Landau, Michael Stolz, Evan DaBreo, Rebecca Clawson, Jose Morey, Mika Tabata, Tayab Waseem

 

Affiliations: Allen Institute for AI, Chan Zuckerberg Initiative (CZI), Georgetown University’s Center for Security and Emerging Technology (CSET), Microsoft, and the National Library of Medicine (NLM) at the National Institutes of Health (NIH).

 

Abstract

Integrating automated knowledge extraction tools in the process of writing literature reviews is important, given the rapidly expanding body of COVID-19 publications. Such systems are often designed to produce tables of structured data extracted from studies, but the utility of such automatically constructed tables, even if highly accurate, has not been assessed. Given the recent influx of recourses and attention to creating tools for an AI-powered literature review, we saw it pertinent to conduct a study to determine the utility of these types of tools and if further resources should be allocated towards the creation of such tools.

 

Methods. To investigate the potential utility of an AI-powered literature tool we conducted a study with 50 researchers writing 83 literature reviews to evaluate the speed, completeness and accuracy advantages afforded by summary tables in the process of writing literature reviews. Each institute was provided with a pre-made information table for the research questions of their choice. These tables mimic the output of a highly accurate automated extraction tool. Half of the participants used the tool, while the other half served as controls and completed literature reviews traditionally.

 

Results. Supporting literature reviews with premade information tables significantly reduced the time spent searching for papers by 52%, extracting useful information from the papers by 35% and the time of the full literature review by 25%. All researchers reported that it helped them put their review together faster and 94% thought these would have yielded a more comprehensive study.

 

Conclusions. Using tables of extracted data (such as automated systems might produce) was shown to significantly decrease the time to obtain relevant research papers to write reviews. This shows the potential supportive function of machine learning and the need for accurate automated knowledge extraction tools in writing literature reviews.

Disseminated Coccidioidomycosis of Chest Wall

Author: Sandhya Dhital, RUSM Student

Other Authors Names: Dr. Nadia Raza, Dr. Arash Heidari

 

Affiliations: Kern Medical Center, RUSM

Abstract

Coccidioidomycosis is an infection caused by soil-dwelling fungi, Coccidioides, that are endemic to southwestern United States, northern Mexico, and scattered areas of Latin America.1 Pulmonary and certain extrapulmonary manifestations of coccidioidomycosis infection are well described, and typically resemble symptoms of bronchitis, pneumonia,6 and the flu,7 but disseminated coccidioidomycosis initially presenting as chest wall disease is not. Here, we present a case of a 33-year-old man with coccidioidomycosis who initially presented with chest wall swelling and eventually abscesses. We propose that consideration of disseminated coccidioidomycosis in non-resolving swelling, mass, lesions, or abscess especially in endemic areas for coccidioidomycosis and in travelers may prevent the progression and further complications of coccidioidomycosis.

 
 

Impact of Mind-body medicine in Diabetes, Hypertension, and COPD Management

Author: Dominique Jenkins, RUSM Student

Other Authors Names: Shaemion Mcbride

 

Affiliations: RUSM

Abstract

The CDC reports 6 in 10 adults in the US are living with a chronic disease. It is imperative to ensure patients have the tools to achieve their best quality of life physically, emotionally, and psychosocially. Mind-body medicine serves as a patient-centered approach to improving health outcomes by focusing on ways in which an individual’s emotional, mental, social, spiritual, and behavioral factors affect daily experience of chronic disease. Growing research suggests that incorporating mind-body practices into chronic disease management may lead to physiological improvements in health outcomes more than health education alone.

 

This review explores the effect of mind-body practices on physiological outcomes in individuals living with chronic disease, including type 2 diabetes, mild stage 1 hypertension, and chronic obstructive pulmonary disease (COPD). A review of 17 studies was conducted to assess the effect of mind-body practices across a number of chronic conditions. PubMed and Google Scholar were used to review randomized control trials and prospective cohort studies.

The review of studies that evaluated the impact of various mind-body practices in chronic disease management determined (1) improvement in reduced glycosylated hemoglobin (HbA1c) levels in type 2 diabetics, (2) improved mild stage 1 hypertensive participants’ blood pressure and (3) improved respiratory function in COPD patients. However, one study reported no difference between three comparison groups in relation to diabetes distress, psychological response to stress, glycemic control, or vascular inflammation.

Research on mindfulness-based strategies used among a chronic disease population suggest promising findings. These findings indicate that mindfulness-based strategies may serve as complementary behavioral and lifestyle approaches to chronic disease management. Several study limitations included lack of generalizability and small sample sizes. Future investigations should also consider measuring the effects of mind-body practices on stress reduction in those with chronic diseases and complete follow-up studies to monitor progress.

 

Psychophysiology of Self-Forgiveness

Author: Thomas Ferrari, Ph.D., RUSM Colleague

Affiliations: RUSM

Abstract

The psychophysiology of self-forgiveness (SF) is largely unexplored, but is of particular interest since health care workers can struggle to forgive themselves after medical error. We conducted a psychophysiology study using a short audio session designed to promote SF. As we previously reported, SF scores increased dramatically after this intervention, and both stress and anger were inversely correlated with heart rate variability (HRV); HRV changes during SF were also significant. Here, we report results from respiratory plethysmography and an EMG of the frontalis during the SF process. Respiratory measures included breaths per minute (BPM), BPM variability, amplitude, inspiration/expiration times, and sighs. Interestingly, sigh frequency was significantly correlated with SF scores, consistent with reports that sighing has been shown to occur during conditions of relief compared to conditions of stress, i.e. sighing may act to reset vagal activity. In our EMG results, we found that furrowing of the brow was positively correlated with anger and negatively correlated with SF. Changes in eye blink rate were inversely correlated with SF. Collectively, the cardiorespiratory and EMG data indicate the SF state is correlated with emotional relief and high parasympathetic tone. Our SF intervention may thus have immediate benefits as well as long-term cardioprotective consequences. For health care students and professionals, SF is a very important component of the recovery process after educational shortfalls or medical errors, so these results are highly encouraging.

 

The mysterious case of the Papillary Fibroelastoma

Author: Shafaq Shereen Khan, RUSM Student

Other Authors Names: Dr. Justin Fields

Affiliations: St Joseph Mercy Oakland hospital

Abstract

Primary cardiac tumors account for only 5% of cardiac tumors of which papillary fibroelastomas are the third most common benign cardiac neoplasm following cardiac myxomas and fibromas 1-2. Despite being a benign tumor and particularly rare, they are progressively becoming more recognized as a cause of embolic strokes in the young population 1-2. Here we present a special case of a 26-year-old female who presented with right-sided weakness and aphasia. Stroke workup was done, and CT indicated a left MCA M1 segment ischemic stroke for which the patient subsequently underwent surgical thrombectomy. Histopathology of the thrombus was composed of blood. This finding led to further investigation where coagulation work-up was negative, but a transesophageal echo indicated a mobile echodensity of 0.43cm x 0.8cm on the atrial aspect of the posterior mitral valve leaflet. Based on numerous prior cases demonstrating papillary fibroelastoma as a potential cause of CVA in a young patient, there is high suspicion for the mass being this tumor and necessitates surgical resection to prevent future recurrence. Due to the patient's critical condition, resection has been delayed to 6 weeks post admission. This case illustrates the importance of echocardiographic imaging in the workup of cardioembolic stroke in a young individual and further demonstrates the current histological, anatomicopathological, and treatment guidelines for such tumors of the mitral valve.

 

Multifaceted academic tool: a protocol for teaching & learning

Author: Maureen Hall, RUSM Colleague

Other Authors Names: Priya Dattathreya; Daria Ellis

Affiliations: RUSM

Abstract

PURPOSE. A multifaceted academic tool was designed to support faculty facilitated teachings and students’ learning through reflective and guided protocols. Using a similar approach of the learning cycle, we established seven steps as academic tools for both faculty and students.  These seven steps are referred to as the 7Ps for ease of retrieval which include – Plan, Prepare, Participate, Process, Practice, Performance and Pause.

 

METHODS. Using a qualitative approach, we conducted a focus group with faculty to discuss their experience with students reflecting on overall academic outcomes.  In addition, students took an inventory survey tool of items regarding an approach on how learning took place within the curriculum.

 

RESULTS. The results of comparative analysis of survey results revealed that students’ use of the guided protocol allowed students to organize learning of large volume of contents and thus had more favorable academic outcomes than those students who did not. Faculty were more confident teaching metacognitive strategies to students. Students established a sequence of daily study routine that aided successful self-regulated learning  in a fast-paced academic learning environment.

 

CONCLUSION. The multifaceted academic tool provided benefits to teaching and learning for both faculty and students of the curriculum. It not only takes the students’ reflection and teaching faculty guidance to support an academic learning environment but also, the institution’s curriculum design. 

 

Central Line-Associated Blood Stream Infections in NICUs

Author: Mohamad Alhamwi, RUSM Student

Affiliations: University of Central Florida Health Sciences Department

Abstract

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity, and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs.

 

Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews, and MEDLINE from January 2008 up to 2018. There were multiple search terms used and these included ""neonate OR newborn OR infant"", ""CLABSI OR central line-associated bloodstream infection"", ""intervention OR prevention"" and ""bundle"". The search solely focused on the outcome of infant patients. Therefore studies were excluded for the following criteria: being non-peer-reviewed, being published before 2008, and being a case in which CLABSI was assessed in patients outside the NICU. See Table 4 and 5 for further information.

 

Results: Eight articles were eligible for inclusion all of which CDC's guidelines were implemented in their strategy of intervention. The systematic review showed that adherence to care bundles decreases infection rates drastically. All eight articles reported a significant decrease in CLABSI rates following the implementation of the bundle set by CDC with two studies achieving a CLABSI rate of zero.

Conclusion: Implementation of care bundles showed success in reducing CLABSI rates in the NICUs; however none of the studies endorsed a specific bundle application utilized to achieve its intended goal. Some practices adopted CDC's guidelines more than others and those showed a greater decrease in infection rate. In addition, it is evident that nurses deliver the best care when preventing an infection. Further research is needed to assess the effectiveness of a specific bundle element."         

 

Capturing and analyzing targeted needs assessment of matriculating students at RUSM: Phase 1 results

Author: Priyadarshini Dattathreya, RUSM Colleague

Affiliations: RUSM

Abstract

The transitional support of new incoming medical students prepares them for the rigor of a typical medical school curriculum. Students who matriculate into Ross University School of Medicine (RUSM) have diverse prerequisite knowledge, backgrounds and life experiences that are established in our holistic admissions criteria. RUSM offers a Pre-matriculation course (PMX) and Medical Education Readiness Program (MERP) to support student transition with varied results. Regular needs assessment is important to stay abreast of the evolving learning needs of matriculating medical students.

As part of a targeted needs assessment of learners entering RUSM, qualitative data on student learning needs was collected from RUSM colleagues (n=18), peer tutors (n=30) and MERP (n=9) and PMX (n=13) students using an online survey. Data was analyzed using “The Core Competencies for Entering Medical Students” set by the American Association of Medical Colleges (AAMC) as top-level categories and the sub-categories were inductively identified. Data was also classified into perceived needs (what students perceive as their learning needs), expressed needs (needs identified through their actions) and normative needs (needs determined by experts). 518 items were coded. The competencies were cross tabulated with the types of needs. Science-related competencies was the commonest theme across all three needs (54.25%), followed by Intrapersonal (27.41%) and Thinking and Reasoning (10.62%). Study skills was the most commonly mentioned perceived (15.2%) and expressed (13.2%) need; whereas Molecular Biology knowledge was the most commonly mentioned normative need (11.3%). This data provides an insight into students’ learning needs through different perspectives. The next phase of this research will involve analyzing the students’ perceived level of competence and their relative importance in transitioning to medical school using a quantitative survey. The survey results will highlight the academic needs of matriculating students in RUSM that need to be prioritized in the pre-matriculation course.

 

Presumed conversion disorder in a patient found to have new onset multiple sclerosis: challenges in diagnosis and treatment

Author: Sinyun Lam, RUSM Student

Other Authors Names: Estefania Laboy- Gonzalez, Nicholas Kotsyubko, Saad Thara, Sara Abdijadid

Affiliations: RUSM, Kern Medical Center 

Abstract

Objective: Conversion Disorder is often a diagnosis of exclusion after primary organic/neurological causes are ruled out, and when clinical findings do not correlate with recognized disease states. The following case report highlights the diagnostic and treatment challenges in a patient initially thought to have conversion disorder but later diagnosed with severe relapsing-remitting multiple sclerosis (MS).

Design: The case presented is a 45-year-old female with history of schizoaffective disorder and mild cognitive delay who presented with inability to move her limbs or walk for a month. She underwent extensive testing including neuroimaging of the head, neck, and spine and lumbar puncture in prior hospitalizations and were unremarkable. Labs revealed low vitamin B12 levels and she was started on replacement therapy in addition to her psychiatric medications. She continues to be unresponsive to medication.

Results: T2-weighted brain MRI with and without contrast with fluid-attenuated inversion recovery showed multiple periventricular hyperintense areas. Cerebrospinal fluid analysis revealed elevated IgG, IgG synthesis rate, and oligoclonal bands.

Conclusion: Clinicians should maintain a high level of suspicion and broad differential diagnosis in patients with established psychiatric illness and new neurologic symptoms. A thorough workup should be done to rule out underlying medical conditions before considering a diagnosis of conversion disorder. This is imperative to prevent misdiagnosis or delay in timely treatment and care.

 

Curcumins effects on Ulcerative Colitis: a meta-analysis and systematic review

Author: Yousif Slim, RUSM Student

Affiliations: RUSM

Abstract

Ulcerative colitis is one of the major inflammatory bowel diseases. Ulcerative colitis’s mechanism of action in producing inflammatory cytokines is still being investigated today. Various publications suggest stressors, sustenance, and genetics play a central role in the cause of these flare-ups. Research has shown that ulcerative colitis’s inflammatory nature is localized to the large bowel producing bloody stools, key crypt abscesses with neutrophils, and mucosal/submucosal ulcers. Diagnostic through colonoscopy, ulcerative colitis is normally seen at the rectum proximally continuous to the head of the cecum. Medicinal therapy (e.g. sulfasalazine, mesalamine) has been used to treat ulcerative colitis for years; however, studies have shown that natural remedies incorporated with medicinal therapy have proven to be beneficial in treating ulcerative colitis. One natural remedy being curcumin, a southeastern Asian spice, that is derived from the rhizomes of Curcuma longa (i.e. herb belonging to the ginger family). Curcumin’s use in patients with ulcerative colitis has shown to improve anti-inflammatory effects in the colon as well as keep patients in remission for longer durations as a supplement with prescription medication. The current exploration of curcumin’s reactivity as an anti-inflammatory is that it reduces the protein complex NF-κB1 cytokine production. This production has been shown to produce inflammatory cytokines indirectly, via the interleukin family. This meta-analysis is designed to expose patients with ulcerative colitis to curcumin’s benefits as a possible supplement to their prescription medication.         

 

STEPS in Becoming Physician-Scientists

Author: Dr. Liris Benjamin, RUSM Colleague

Other Authors Names: Ezell K2, Swindle J2, Fabien J2, Bassi R2, Johnson A2, Benjamin GC3, Benjamin G3,4, Hood R1

Affiliations: 1 Dept of Clinical Foundations, Ross University School of Medicine (RUSM), Barbados; 2 Ross Academic Research Society, RUSM, Barbados; 3 Family Medical Clinic, Dominica; 4 Princess Margaret Hospital, Dominica.

Abstract

INTRODUCTION: Although all physicians receive training in medical science, physician-scientists are medical doctors trained to conduct scientific investigation as part of their medical practice. It was Dr Edward Jenner who in 1796, observed that milkmaids who previously suffered with cowpox did not catch smallpox. His testing led to development of the small-pox vaccine1. Medicine-science breakthroughs continue to positively impact us today as evidenced by the vaccines and treatments still being discovered for COVID-19. It is therefore not surprising that NIH provides funding for several physician-scientists training programs. Furthermore that the AAMC has convened an expert Committee to develop recommendations for medical schools and teaching hospitals to nurture physician-scientists2 (see Committee Charge3).

Medical curriculums are generally compact with limited or no integration of medical science research into the training program. However, research interests can be cultivated through activities to include research clubs, service learning, research mentorship and other intra or extracurricular activities.

Ross Academic Research Society (RARS) is a student club of Ross University School of Medicine (RUSM). The aim of this paper is to present some ways in which a student-led club along with its faculty advisors could cultivate research interests of students to becoming physician-scientists.

METHODS: To review activities conducted by RARS over the past 4 years (2016-present) that helped cultivate research interests of students.

RESULTS: The activities conducted by RARS include but are not limited to the following. Several research workshops; research fair; journal clubs; research mentorship through student-faculty research collaborative framework and facilitation; active participation and facilitation of Ross Research Day activities and Ross Service Learning Symposium; and our most recent development of a Research blog in collaboration with Ross communication administrative team.

CONCLUSIONS:

Ross Academic Research Society has cultivated research interests of its medical students through research activities resulting in the blossoms of several physician-scientists