Clinical Research

From Smoke to Signaling: Linking Tobacco Exposure to Tumor Immunogenicity in Black Patients with Non Small Cell Lung Cancer (NSCLC)

Hashim Aslam, B.S.¹, Said Hafez Khayyata, M.D.², Mohammad Muhsin Chisti, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Pathology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
³ Department of Hematology and Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Tobacco use remains the leading cause of preventable mortality in the United States, with Michigan maintaining one of the highest smoking rates nationally. Smoking induces distinct genomic alterations in non-small cell lung cancer (NSCLC), influencing tumor biology and response to immune checkpoint inhibitors. Tumor mutational burden (TMB) and programmed death-ligand 1 (PD-L1) expression are key biomarkers guiding immunotherapy selection; however, their relationship with smoking exposure remains underexplored in Black NSCLC patients, an underrepresented population in molecular oncology research.

METHODS
We conducted a retrospective cohort study of Black patients with confirmed NSCLC evaluated at Corewell Royal Oak Hospital between June 2019 and June 2023. Clinical, pathologic, and molecular data were extracted via EMR. Variables included smoking status and pack-years, tumor histology, stage, PD-L1 expression, TMB (mutations/Mb), microsatellite instability (MSI), and next-generation sequencing results. Correlations between smoking exposure and molecular biomarkers were assessed using Spearman correlation and linear regression.

RESULTS
Thirty three patients met inclusion criteria (51.5% female; mean smoking exposure ~31 pack-years). Adenocarcinoma was the predominant histology (90%), and 50% of cases were Stage IV. Among Stage IV patients, smoking exposure demonstrated a moderate positive association with TMB (Spearman ρ = 0.58, p = 0.02). Linear regression showed a non-significant increase in TMB per 10 pack-years (β = 2.15, p = 0.44), suggesting a threshold driven relationship. No significant association was observed between smoking exposure and PD-L1 expression. An inverse relationship between smoking exposure and MSI was identified, most pronounced in males.

CONCLUSIONS
In advanced NSCLC, smoking exposure is associated with increased tumor mutational burden but not PD-L1 expression, highlighting distinct tobacco driven mutational processes. Smoking history may contextualize tumor immunogenicity when genomic testing is delayed or unavailable. These findings underscore the importance of multimodal biomarker assessment and expanded molecular testing access in underserved populations, supporting prospective studies of dynamic biomarkers in advanced NSCLC.

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Comparing SARS-CoV-2 Vaccination Rates

Hannah Rose Ayar, B.S.¹, Andrea Carolina Hernandez Troya, M.D.², Jonathan Norton Lauter, M.D.^1,3

_{1Oakland University William Beaumont School of Medicine, Rochester, MI
2Department of Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI
Corewell Health East Children’s, Corewell Health William Beaumont University Hospital, Royal Oak, MI
3Child Health Associates, Troy Michigan}

INTRODUCTION
Vaccine hesitancy is a significant public health concern, highlighted during the COVID-19 pandemic. Identifying factors linked to lower vaccination rates is essential in addressing disparities and developing targeted strategies. SARS-CoV-2 vaccination rates are low nationwide.

METHODS
The study consisted of patients between the ages of six months and five years of age who visited the private pediatric clinic and the pediatric residency clinic between July 1, 2022, and October 31, 2022.  Data collected included patients’ age, sex assigned at birth, insurance type (Medicaid or Private), SARS-CoV-2 vaccination status, and brand of SARS-CoV-2 vaccine received (Pfizer-BioNTech or Moderna). Vaccination rates were analyzed and compared between clinics, and results were stratified by other collected variables.

RESULTS
At the residency clinic, 33 patients (5.2%) received the first dose of the Pfizer-BioNTech vaccine. Of these, 23 patients (69.7%) received the second dose, but none (0%) received the third, resulting in a 0 (0%) series completion rate.

At the private clinic, 514 patients (35.6%) received an initial SARS-CoV-2 vaccine dose. Among these, 72 (14%) received Moderna, while the remaining 442 (86%) received the Pfizer-BioNTech vaccine. Of those who received a first dose, 351 (68.3%) received a second dose. For Moderna recipients, this completed the series. Among the Pfizer-BioNTech vaccine group, 40 (11%) received a third dose. In total, 131 (25.5%) of the private clinic patients completed the full vaccine series.

CONCLUSIONS
SARS-CoV-2 vaccination rates differed significantly between the two clinics. The private clinic had higher rates of vaccine initiation and series completion. These findings may help inform future efforts to understand and reduce vaccine hesitancy in pediatric populations with different insurance and demographic profiles. Future studies should explore whether these differences stem from resident training gaps or from the populations they serve.

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Micronutrient Deficiencies in Integrative Medicine Patients with Anxiety and Depression

Corinne Bowditch, B.S.¹, Maureen Anderson, M.D.², Virginia Uhley, Ph.D., RDN^2,3

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Family Medicine and Community Health, Corewell Health William Beaumont University Hospital, Royal Oak, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Anxiety and depression have been correlated with micronutrient deficiencies, presenting opportunities for improved pathophysiological understanding of mental illness and adjunctive treatment avenues. This retrospective chart review was conducted to quantify the prevalence of micronutrient deficiencies in individuals with anxiety and/or depression at Corewell Health Integrative Medicine Clinic (CHIMC) and to identify micronutrient deficiencies that were associated with anxiety and/or depression in the study population. 

METHODS
The study used SpectraCell micronutrient laboratory testing (SMNT), which includes 31 micronutrients and has not been employed in prior publications or in this study population.  Participants were included based on Epic chart review using the following criteria: at least one visit at Corewell Health Royal Oak Integrative Medicine Clinic between 01/01/2012 and 12/31/2023, aged 18 and older, diagnoses of anxiety and/or depressive disorders, and available SMNT data. SMNT data was manually extracted and analyzed. 

RESULTS
There were 112 participants, 50.0% with an anxiety disorder, 49.1% with both anxiety and depressive disorders, and 0.9% with a depressive disorder, included in the study. The most common micronutrient deficiencies among all participants were vitamin B12 (62.5%), vitamin B5 (59.9%), chromium (43.7%), vitamin D3 (39.3%), and zinc (34.8%). This same pattern was observed in patients with anxiety disorders only, while patients who had both anxiety and depressive disorders more commonly demonstrated zinc deficiency (41.8%) versus chromium (35.4%). 

CONCLUSIONS
This study demonstrated that the majority of patients reviewed at CHIMC had at least one micronutrient deficiency with vitamin B12 deficiency being the most common. Further, vitamin B12, chromium, zinc, and vitamin D3 deficiencies have previously been associated with anxiety and depression; however, vitamin B5 deficiency has not been isolated and associated with these mental illnesses, providing direction for future research. Addressing these deficiencies through diet or supplementation may be an important intervention to improve mental health outcomes. 

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Component-Level Analysis of the SEP-1 3-Hour Bundle and its Association With 30-day Mortality after Sepsis

Riya Chhabra, B.S.¹, Joel Karsten, B.S.¹, Paul Bozyk, Ph.D.², Ramin Homayouni, Ph.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
² Department of Internal Medicine, Corewell Health East William Beaumont University Hospital, Royal Oak, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
In 2015, CMS released the “SEP-1” core measures which are a multicomponent 3-hour and 6-hour resuscitation treatment bundles for patients with the diagnosis of either severe sepsis or septic shock. The 3-hour treatment bundle includes administration of appropriate IV fluid and antibiotics, order of blood culture before and after antibiotic administration, and two blood lactate measurements.  The purpose of this study was to understand the most commonly missed steps or “fallouts'' in the CMS-directed 3-hour bundle and their effects on patient mortality.

METHODS
A retrospective chart analysis was performed on 1561 patients (18 years and older) with sepsis onset up to 24 hours of arrival to the emergency department between January and December 2023. An algorithm was developed to establish sepsis “time zero” and to determine the timing of the various components of  the 3-hour SEP-1 bundle. Multivariable linear regression was used to determine the association between each SEP-1 component and 30-day mortality, while adjusting for age, race and gender.

RESULTS
Each year in age was significantly (adj OR: 1.04, 95% CI: 1.02-1.05) associated with 30-day mortality after sepsis. Among the six components of the 3-hour SEP-1 bundle, failure to administer antibiotics (adj OR: 1.78, 95% CI: 1.24-2.54) and appropriate volume of IV fluids (adj OR: 2.40, 95% CI: 1.74-3.31) were significantly associated with 30-day mortality.

CONCLUSIONS
It is essential to have a comprehensive treatment plan for sepsis given it is the leading cause of death in hospitalized patients worldwide. While previous studies have demonstrated an association between the lack of antibiotics and patient mortality, the research on fluids and patient mortality is still unclear. This study emphasizes the need for appropriate volume of fluids as part of sepsis treatment in addition to antibiotics. 

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The Role of Subcutaneous Fat and BMI in Predicting Surgical Outcomes and Patient Reported Outcomes in Robotic-assisted Total Hip Arthroplasty

Jacob Coleman, B.S.^1, Madeline DeClercq, M.D.², Michael Sacchetti, B.S.³, Mazen Zamzam, B.S.¹, Ehab Saleh, M.D.⁴, Abdullah Omari, M.D.⁴

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health West, Grand Rapids
³Central Michigan University College of Medicine, Saginaw, MI, USA
⁴Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
To assess if subcutaneous fat (SCF) or BMI may serve as a predictor of surgical complications and patient reported outcomes in patients undergoing robotic-assisted total hip arthroplasty (THA).

METHODS
Patients who underwent robotic-assisted primary THAs at one institution between 2018 to 2020 were included in this retrospective cohort study. 175 patients met inclusion criteria. Prior to surgery, SCF was measured in the posterolateral quadrant on three axial cuts on CT. Two obesity measures were also obtained, SCF and BMI. The CT measured SCF were distributed and divided evenly into quintiles based on distribution around the mean, and BMI was separated into five groups. Furthermore, patient reported outcomes in the form of PROMIS (Patient-Reported Outcomes Measurement Information System) scores were acquired from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) Database preoperatively, at 14-112 days post-operatively, and at the latest-follow-up.

RESULTS
SCF analysis at the hip resulted in an interclass correlation coefficient (ICC) of >0.98 at all measured variables. Analysis of Variance (ANOVA) results yielded a p-value of 0.573 when comparing the BMI vs SCF groups for length of stay (LOS). ANOVA results yielded a p-value of 0.181 when comparing the SCF groups and LOS. One-Way ANOVA of PROMIS Scores in between groups for BMI or SCF groups yielded p-values of 0.95 and 0.38, respectively.

CONCLUSIONS
The described method of measuring hip SCF on axial CT images can reliably measure local SCF. Although not significant, differences were detected between SCF and BMI groups in predicting patient outcomes such as LOS and PROMIS scores. The relatively small sample size is likely a strong contributor to these findings. As prevalence of robot-assisted THA increases, it is likely that this method of SCF measurement will provide a more reliable prediction of patient risk profiles and outcomes in THA. 

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The Impact of Caffeine Citrate Therapy on Brain Growth on Head Ultrasound in Preterm Neonates

Kaithlyn Duong, B.S.^1, Jacob Keeley, M.S.², Rawad Obeid, M.D. ³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Research, Oakland University William Beaumont School of Medicine, Rochester, MI
³Department of Pediatrics, Corewell Health Children’s Hospital, Royal Oak, MI}

INTRODUCTION
Extremely preterm infants are at risk for impaired neurodevelopment because of vulnerability of the developing brain. Caffeine citrate is the standard therapy for apnea of prematurity and has been associated with potential neuroprotective effects. However, the relationship between cumulative caffeine exposure and structural brain development is unclear. This study aimed to evaluate the association between total caffeine citrate exposure and brain growth in extremely preterm infants using cranial ultrasound measurements.

METHODS
We conducted a retrospective cohort study of infants born at <32 weeks gestational age and admitted to the neonatal intensive care unit at Corewell Health Children’s Hospital between January 2020 and December 2024, with follow-up in a neurodevelopmental clinic. Infants with intrauterine growth restriction, genetic syndromes, grade 3–4 intraventricular hemorrhage, out-born status, or unavailable cranial ultrasound data were excluded. Total cumulative caffeine citrate dose administered during hospitalization was calculated. Brain growth at term-equivalent age was assessed using cranial ultrasound measurements, including anterior horn width, ventricular index, biparietal diameter, interhemispheric space, subarachnoid space, and corpus callosum length and thickness. Statistical analyses included Pearson correlation, unequal variance t-tests, and univariable and multivariable regression models adjusting for gestational age, length of stay, bronchopulmonary dysplasia, and postnatal steroid use.

RESULTS
A total of 190 infants met inclusion criteria, of whom 184 (96.8%) received caffeine citrate. The median cumulative caffeine dose was 342 mg/kg (range 20–831 mg/kg). In multivariable analysis, a significant positive association was observed between cumulative caffeine dose and left anterior horn width (p = 0.036) and corpus callosum length (p = 0.02). Other cranial ultrasound measurements demonstrated no strong associations with caffeine exposure.

CONCLUSIONS
Cumulative caffeine exposure was associated with limited changes in brain structure in extremely preterm infants. These findings suggest that caffeine citrate has minimal impact on early brain growth, emphasizing confounders and the need for further neurodevelopmental studies. 

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Oral Feeding Patterns of Prematurely Born Infants and their Relationship to Expressive Language Outcome

Ava Harvey, B.S.¹, Rawad Obeid, M.D.², Michelle Jankowski, M.A.S.³, Nicole Rikard, M.S., OTRL⁴, Laura Bashir, M.S.⁴

¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Pediatrics, Corewell Health Children’s Hospital, Royal Oak, MI
³Department of Research, Oakland University William Beaumont School of Medicine, Rochester, MI
4Corewell Health Children’s Hospital, Royal Oak, MI

INTRODUCTION
Preterm birth is associated with significant developmental challenges, including an increased risk of expressive language delay. While oral feeding issues are well-documented at hospital discharge, their long-term impact on neurodevelopment is less understood. This study aims to evaluate the association between oral feeding patterns of premature infants at around 12 months corrected age (CA) and expressive language outcomes in their second year of life.

METHODS
A retrospective study was conducted using data from premature infants (< 37 weeks’ gestation) who presented to the neurodevelopment clinic at Corewell Health Children’s Hospital between February 2020 and February 2024. Feeding patterns (liquid, pureed, or solid diets) were assessed between 7-12 months CA by an occupational therapist. Expressive language outcomes were determined at 13-20 months CA via pediatric neurologist assessments. Growth parameters, including weight-for-age Z-scores, were also evaluated. Infants with genetic conditions or those missing required visits were excluded. Statistical analyses included regression and chi-square tests (significance set at p < 0.05).

RESULTS
Of 337 infants who presented to the clinic during the study period, 136 met inclusion criteria; 66 (48.5%) had expressive language delay at 13-20 months CA. Among those with delay, 30.3% consumed mostly solid foods at 7-12 months CA, compared to 69.7% in the no-delay group (p < 0.001). After adjusting for gestational age, birth weight, mother age at delivery, length of stay in NICU, bronchopulmonary dysplasia, and periventricular leukomalacia, infants on pureed diets had 8.91 times higher odds of language delay (p = 0.002), and those on liquid diets had 3.95 times higher odds (p = 0.05). Pureed diets at 7-12 months CA were significantly associated with lower growth trajectories after adjustment.

CONCLUSIONS
Early transition to age-appropriate food textures and timely identification of feeding delays may support oral motor development and reduce risk of expressive language delay in this population. 

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Are The Dietary Intake Patterns Of Patients Seen In A Geriatric Clinic Associated With Their Cognitive Function Status?

Anna Heath, B.S.¹, Stacey Ruff, D.O.², Virginia Uhley, Ph.D., RDN³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health Geriatric Center, Berkely, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
The Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) dietary pattern has recently been developed and implicated for use as a prevention for cognitive decline. This study provides further insight as to the relationship between the consumption of foods featured in the MIND dietary pattern and current cognitive functional status in individuals seen at a geriatric clinic. By expanding on the current data available, we continue the discussion regarding both this practice and the search for the prevention and treatment of cognitive decline. 

METHODS
Participants 65 years and older were recruited from a geriatric clinic. Cognitive function was assessed with the Mini Mental Status Exam (MMSE). Participants completed a Food Frequency Questionnaire (FFQ) to record their dietary intake and this was scored with MIND dietary pattern criteria. We collected health data including diagnosis of dementia, age, as well as history of smoking, cardiovascular disease, exercise, stroke, brain cancer, drug use, diabetes, and family history of dementia.

RESULTS
Data analysis demonstrated that for a 1-point increase in the Food Frequency Score, there was a 0.3 point increase in the MMSE score while holding all other variables constant. This was supported with a p-value of 0.0524. While technically just above the traditional 0.05 cutoff, in a sample of only 13 people, this is a strong trend. Exercise was the strongest positive factor and smoking was a notable negative factor in how they impacted the MMSE scores. 

CONCLUSIONS
This study showed an association between adherence to the MIND dietary pattern and greater cognitive function. This study was limited due to a small sample size. However, the fact that exercise and dietary patterns show such strong trends even in this group suggests these are powerful influencers of cognitive health and indicate the need for continued research in this area.

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Combined Resistance Training and Dietary Protein Supplementation Interventions in Type 2 Diabetes: A Scoping Review

Matthew Helou, B.S.¹, Dylan Moran, B.S.¹, Christina Johnson, Ph.D.², Nicholas Sculthorpe, Ph.D.³, Elise Brown, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²School of Health Sciences, Oakland University, Rochester, MI
³University of the West of Scotland, School of Science and Sport}

INTRODUCTION
Type 2 diabetes mellitus (T2D) is a chronic condition marked by impaired glucose
metabolism and insulin resistance. Resistance training (RT) and dietary protein (DP)
independently improve glycemic control, yet their combined effects remain incompletely
characterized. This study aimed to systematically explore the literature on the combined effects
of RT and DP on glycemic control, physical fitness, and cardiometabolic risk factors in
individuals with T2D to identify key gaps in the existing research.

METHODS
This review followed the Joanna Briggs Institute (JBI) framework for scoping reviews
and PRISMA-ScR guidelines. A comprehensive search of PubMed, Embase,
CINAHL/SportDiscus, and Scopus (from inception to February 2026) identified randomized
controlled trials (RCTs) evaluating RT + DP interventions in adults living with T2D. Eligible
studies included an RT-only group and reported outcomes related to glycemic control,
cardiometabolic markers, body composition, renal function, or muscular fitness. Two reviewers
independently screened records and disagreements were resolved by a third reviewer.

RESULTS
Ultimately, 5 RCTs involving 229 participants met inclusion criteria. Across studies, RT
+ DP interventions were 12–48 weeks in duration and used whey protein, leucine-enriched
supplements, or high-protein diets alongside structured RT programs. Evidence suggested that
RT + DP improved muscular strength and lean mass, but these improvements were comparable
to RT alone. Glycemic outcomes such as glycated hemoglobin and fasting glucose generally
showed no beyond improvements from RT. Body composition changes were modest across all
groups and no studies reported adverse renal effects associated with DP supplementation.

CONCLUSIONS
The current evidence suggests that RT + DP does not enhance glycemic control,
anthropometric, strength, or cardiometabolic outcomes beyond the effect of RT alone in adults
living with T2D. Both interventions appear safe and well-tolerated. Given the limited number of
trials and heterogeneity in protocols, additional high-quality studies are needed to clarify
potential RT + DP synergy.

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5-Year Retrospective Study: Relationship Between Cervical Spine Whiplash Injuries and Demyelinating Diseases in the Pediatric Population

Maya S. Kardouh, B.S.¹, Colin Van Wagoner, B.S.¹, Jacob Coleman, M.S.¹, Jacob Keeley, M.S.², Ehab Saleh, M.D.³ 

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Research, Oakland University William Beaumont School of Medicine, Rochester, MI
³Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Whiplash injuries are among the most common cervical spine injuries in the pediatric population. Limited literature demonstrates a potential link between cervical spine trauma and demyelinating disease, such as multiple sclerosis. These associations have primarily been reported from case-controlled studies, while cohort studies have not supported these findings. In this study, we aimed to evaluate whether a relationship exists between cervical spine trauma and the short-term development of demyelinating disease in pediatric patients. We hypothesized patients experiencing cervical spine whiplash injuries would demonstrate subsequent demyelinating disease.

METHODS
This was a single-center retrospective chart review. Charts for patients aged 10-16 with a suspected history of cervical spine whiplash injury were electronically reviewed for any post-traumatic symptoms of demyelinating disease. Patient’s past medical history and family history were also reviewed to evaluate for any predisposing risk factors for demyelinating disease. Statistical analysis was descriptive in nature. Collected data was summarized using counts and percentages. No inferential statistical testing was performed.

RESULTS
Of the 63 patients included for evaluation, 0 were found to have evidence or symptoms of demyelinating disease following cervical spine whiplash. The median age was 13 years, and 52% of the patients were female. 

CONCLUSIONS
The descriptive findings of this pilot study demonstrated no cases of demyelinating disease in pediatric patients experiencing cervical spine whiplash injuries within a five-year period. Further research involving larger cohorts and extended follow-up time is recommended to provide further insight regarding this potential association. 

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Association Between Neighborhood Socioeconomics and Mortality in Community Acquired Sepsis

Joel Karsten, B.S.¹, Riya Chhabra, B.S.¹, Paul Bozyk, Ph.D.³, Ramin Homayouni, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
³Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Sepsis is a significant driver of mortality, with many patients presenting to emergency departments with widespread infections already acquired from outside the hospital. While sepsis-related mortality is multifactorial, the role of social determinants and socioeconomic status remains less explored. This study aimed to investigate the association between community-level socioeconomic status, as measured by the Area Deprivation Index (ADI), on sepsis-related mortality.

METHODS
A retrospective chart analysis was conducted for 1,561 patients aged 18 years or older with sepsis onset within 24 hours of emergency department arrival between January and December 2023. Sepsis “time zero” was determined using an algorithm developed by our team to process structured clinical data as well as unstructured data with a rule-based natural language processing (NLP) approach. Multivariate linear regression including age, gender, race, ADI and 27 chronic conditions was performed using backward selection to determine variables that were significantly associated with overall mortality. 

RESULTS
Of the 1561 individuals with community acquired sepsis, 300 went on to expire, with a median age of 75 (IQR 65-83). Of those who expired, the majority were white (68%) and women (51%). In multivariate regression, acute myocardial infarction, atrial fibrillation, lung cancer, and chronic kidney disease (OR 1.66, 1.57, 1.81, and 1.58) were significantly associated with increased risk of mortality, whereas hyperplasia, hyperlipidemia, and rheumatoid arthritis (OR 0.65, 0.66, and 0.71) were significantly associated with decreased risk. In addition, there was a significant association between 30-day mortality and age (OR 1.04) and ADI quintile (OR 1.07), but not race or gender.

CONCLUSIONS
The ADI is significantly associated with 30-day mortality in community acquired sepsis after adjusting for age, chronic conditions, race, and gender. Future work will focus on understanding the specific socioeconomic factors that contribute to sepsis mortality. 

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Impact of Cholinesterase Inhibitor Therapy on Metabolomic Biomarkers of Alzheimer’s Disease

Claire Kopachik, B.A.¹, Ali Yilmaz, Ph.D.², Sangeetha Vishweswaraiah, Ph.D.², Juozas Gordevicius, Ph.D.⁴, Michael E. Maddens, M.D.⁴, Stewart F. Graham, Ph.D.⁵

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
² Metabolomics Department, Corewell Health Research Institute, Royal Oak, MI
³VUGENE, Vilnius, Lithuania
⁴Department of Geriatric Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI
⁵Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
As the global population ages, the rising prevalence of Alzheimer’s disease (AD) presents substantial personal, societal, and economic challenges. To meet the need for improved diagnostic strategies, metabolomics-based approaches have emerged as noninvasive and cost-effective alternatives to conventional methods. Prior studies have identified significant differences in salivary and urinary metabolite concentrations between individuals with AD and cognitively normal controls. However, whether these alterations reflect disease-specific changes or are influenced by medication use remains unclear. In particular, cholinesterase inhibitors are commonly prescribed for symptomatic treatment of AD, yet their impact on the AD metabolome has not been well characterized. The objective of this study was to determine whether previously identified metabolomic biomarkers of AD are confounded by cholinesterase inhibitor use.

METHODS
We conducted a retrospective analysis of existing urinary and salivary metabolomics datasets. Data were preprocessed and normalized to reduce technical variability, followed by log transformation and autoscaling. Differential metabolite abundance was assessed using linear regression models among individuals with AD to evaluate associations between cholinesterase inhibitor use and metabolite concentrations.

RESULTS
Linear regression models demonstrated that cholinesterase inhibitors did not significantly affect the urinary and salivary metabolites previously identified as candidate biomarkers for AD. However, among individuals with AD, cholinesterase inhibitor use was associated with significant changes in urinary metabolite concentrations, including increased isovaleric acid and L-leucine and decreased formate and L-histidine (q = 0.027 for all). 

CONCLUSIONS
These findings support the persistence of disease-specific metabolomic signatures in AD, independent of treatment with cholinesterase inhibitors. This work strengthens the potential clinical utility of metabolomics-based diagnostic tools and provides a foundation for future research into biomarker validation and therapeutic development. 

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Barriers to Residents’ Pre-Meal Hand Hygiene: A Survey of Nursing Facility Staff

Jacqueline A. Kraft, B.S.¹, Khaled A. Imam, M.D.², Trini A. Mathew, M.D.,M.P.H², Michael E. Maddens, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Hand hygiene is emphasized among medical professionals as a key component of infection control, but far less emphasis has been placed on encouraging patients or residents to perform hand hygiene, particularly in skilled nursing facilities (SNFs). To address this gap, this study aimed to identify barriers to residents’ pre-meal hand hygiene from the perspective of SNF staff through surveying. Understanding these perceived barriers may help inform focused interventions to improve adherence and reduce infection risk in this vulnerable population. 

METHODS
An anonymous 25-item paper survey assessed perceived barriers to residents’ pre-meal hand hygiene on a 0–5 scale. Responses were grouped into low (0–2) versus high (3–5) ratings. Exploratory post hoc comparisons were conducted using chi-square tests to evaluate differences in the proportion of high ratings between certified nursing assistants (CNAs), who directly support residents at mealtime, and other nursing staff.

RESULTS
Participants included staff (n=62) from two SNFs. Most barriers were rated as low in significance by the majority of respondents, indicating few perceived major barriers to resident pre-meal hand hygiene. Job burnout was the most frequently endorsed barrier. In exploratory post hoc analyses, other nursing staff were more likely than CNAs to rate insufficient time and activities with high risk of cross contamination as major barriers (p < 0.05).

CONCLUSIONS
Although most SNF staff did not identify major barriers, greater emphasis on education, communication, and organizational support, alongside attention to role-specific perspectives, may be warranted. Future studies using larger samples and incorporating direct observational approaches are needed to better understand how perceived barriers translate into real-world resident hand hygiene practices. 

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Lifetime PTSD and Acute COVID Severity are Independently Associated with Long COVID

Nandita Krishna, B.A.¹, Jacob Keeley, M.S.², Dwayne Baxa, Ph.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Research, Oakland University William Beaumont School of Medicine, Rochester, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
To explain the association between Post-Traumatic Stress Disorder (PTSD) and Long COVID, several theoretical models have incorporated acute COVID severity. Hypothesis 1 suggests that severe COVID infection is a mutual risk factor for Long COVID and subsequent PTSD. Hypothesis 2 presents pre-existing PTSD as risk factor for Severe COVID and Long COVID via altered stress response. Hypothesis 3 presents a multidirectional relationship involving stress response, psychosocial factors, and comorbidities. This study will investigate if accounting for acute COVID severity weakens the association between PTSD and long COVID.

METHODS
We used data from the 2023 National Wellness Survey (NWS), a cross-sectional, online survey of US adults aged 18 to 65. Our sample was respondents who ever tested positive for COVID-19. We used nested regression models to predict the odds of Long COVID based on Lifetime PTSD Diagnosis (Models 1, 2, & 3) and Severity of Acute COVID Infection (Models 2 & 3), with adjustment for demographics, socioeconomic status, and health (Model 3).

RESULTS
The PTSD group was more likely to have Long COVID, comorbidities, & low income. The non-PTSD group was more likely to be male, married, and never smokers. Regression was significant for increased odds of Long COVID with PTSD (ORs: 4.2, 3.9, 3.0) and severe COVID (2.4, 2.7), as well as decreased odds of Long COVID with older age (0.97) and higher income (0.72).

CONCLUSIONS
The association between lifetime PTSD and Long COVID was demonstrated across all 3 regression models, indicating that it is not solely dependent on COVID severity, as Hypothesis 1 predicts. Although literature shows that PTSD can develop after severe COVID, the results of this study support a more complex link between PTSD and long COVID that could be multidirectional and involve pathophysiological changes and psychosocial risk factors. 

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Responsive Neurostimulator (RNS) Implantation Outcomes in Idiopathic Generalized Epilepsy

Grace Li, B.S.¹, Atheel Yako, D.O.², Christopher M. Parres, M.D, D.O.², Andrew J. Zillgitt, D.O.², Michael D. Staudt, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Neurology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 
³Department of Neurosurgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine}

INTRODUCTION
Idiopathic generalized epilepsy (IGE) accounts for nearly 20% of epilepsy cases, and up to 30% remain drug-resistant despite appropriate medications. Because seizures arise from widespread networks, most patients are not candidates for resective surgery. Neuromodulation has emerged as a potential option, but evidence remains limited. This study evaluates seizure outcomes in adults with drug-resistant IGE treated with responsive neurostimulation (RNS) of the bilateral centromedian thalamic nucleus (CMN).

METHODS
We conducted a retrospective review of adults with drug-resistant IGE who were implanted with a RNS device between 2020–2023 at a single center. Extracted variables included demographics, epilepsy history, diagnostics, device settings, and follow-up duration. Outcomes included percent reduction in generalized tonic-clonic seizures, responder rate (≥50% reduction), and Engel classification at 6 months and last follow-up. Analysis was descriptive.

RESULTS
Ten patients with IGE were followed for an average of 34.8 months after RNS implantation.  Mean GTC frequency decreased from 11.7 to 2.4 seizures/year, representing a 79.5% average reduction, with 80% achieving ≥50% reduction and 40% GTC-free at last follow-up. Average charge density was 1.5 uC/cm2. No complications or SUDEP occurred, and 7/10 patients were able to reduce ASM burden. No device complications were encountered.

CONCLUSIONS
RNS may modulate epileptic networks through both acute interruption and longer-term neuromodulatory effects. In this cohort, lower-frequency CMN stimulation produced a 79.5% average reduction in GTCs, with 80% of patients achieving ≥50% improvement. Low-frequency settings appeared especially favorable, and the therapy was well tolerated with no complications. Conclusion: Bilateral CMN RNS is a safe, potentially effective option for drug-resistant IGE.

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Classifications and Treatment Outcomes of Composite Lymphomas: A Systematic Review 

Batoul Mazraani, B.S.¹, Mohammad Muhsin Chisti, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Hematology and Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Composite lymphoma (CL) is an uncommon entity characterized by the simultaneous occurrence of two or more distinct lymphomas in the same patient. The heterogeneity and rarity of CL pose diagnostic and therapeutic challenges, and current knowledge relies heavily on case reports. The aim of this review was to evaluate clinical presentations, treatment strategies, and outcomes of CL cases reported over the past decade to identify patterns that may guide management.

METHODS
A systematic search of PubMed (2015–2025) was conducted using terms including “composite lymphoma,” and “Hodgkin and Non-Hodgkin.” Inclusion criteria were adult case reports describing simultaneous histologically confirmed composite lymphomas with extractable data on presentation, imaging, treatment, and outcomes. Cases were categorized by composite type: B-cell + B-cell, B-cell + T-cell, B-cell + Hodgkin, and B-cell + other hematologic malignancy.

RESULTS
Thirteen articles (14 cases) were included. Patients ranged from 34 to 85 years, with a male predominance, and most presented with lymphadenopathy, though extranodal disease was common. B-cell + B-cell composites (n=8) achieved the most favorable outcomes, with 50% attaining remission, particularly when treated with R-CHOP–based regimens. B-cell + T-cell composites (n=4) demonstrated aggressive disease with poor survival; only one patient achieved durable remission beyond 4 years. The single B-cell + Hodgkin case showed partial regression with ABVD followed by R-CHOP but no durable response. The B-cell + other hematologic case (CLL + hairy cell leukemia-variant) reflected clonal evolution, with transient responses to sequential therapies but no sustained remission.

CONCLUSIONS
Composite lymphomas are rare and heterogeneous, with outcomes dependent on the subtypes involved. Standard regimens for aggressive B-cell lymphomas, particularly R-CHOP, appear most effective in B-cell + B-cell composites, whereas B-cell + T-cell composites confer the poorest prognosis. These findings underscore the importance of tailoring therapy to the most aggressive component and highlight the need for collaborative studies to establish management guidelines. 

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Association Between Chest Tube Size and Complication Rates in Trauma Patients

Negin Mohtashemian, B.S.¹, Antonela Muca, M.D.², Katelyn Ward, M.D.², Kimberly Aung, M.D.², Anthony Iacco, M.D.², Jacob Keeley, M.S.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health William Beaumont University Hospital, Royal Oak, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Tube thoracostomy is a common procedure to evacuate pleural air or fluid, prevent tension pneumothorax, and manage hemothorax. While generally safe, complications such as organ injury, infection, and ventilator dependence can occur. The relationship between tube size, patient characteristics, and outcomes remains incompletely defined.

METHODS
We conducted a retrospective review of adult trauma patients (≥18 years) admitted to Corewell Health Medical Center, Royal Oak, MI, from January 2011 to December 2022. 1,000 patients were identified using the trauma database and electronic medical records and 481 were included in the study. Data collected included Revised Trauma Score, co-morbidities, mechanism of injury, physician training level, length of stay, and complications. Patients were divided into single-tube (n=422) and multiple-tube (n=25) groups. The single-tube group was further stratified by tube size, including pigtails, to analyze outcomes and complications.

RESULTS
Smallest tubes (8.3-17 Fr) were placed primarily in older patients with more co-morbidities, lower trauma severity, and elective or semi-urgent indications. Medium tubes (18-28 Fr) were used most often for rib fractures and moderate trauma severity. Largest tubes (28Fr+) were placed in younger patients with higher trauma severity, hemothorax, and emergent indications, often associated with longer hospital stays and increased ventilator dependence. Complications were rare across all tube sizes, though larger tubes showed a slightly higher need for additional tubes and ventilator support.

CONCLUSIONS
Chest tube size selection appears influenced by both patient characteristics and injury severity and larger tubes may carry increased risks. These findings may influence chest tube size selection and inform future prospective studies.

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Opioid Use in Opioid Naive Patients After Minimally Invasive Spine Surgery

Dylan Moran, B.S.¹, Phillip Zakko, M.D.², Kedar Roderick, M.D.³, Daniel Park, M.D.⁴

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health West Orthopedic Department of Orthopedic Surgery
³Ross University School of Medicine
⁴Health West Orthopedic Department of Orthopedic Surgery
Rush Department of Orthopedic Surgery}

INTRODUCTION
The opioid epidemic continues to highlight the need for responsible postoperative prescribing. Spine surgery is often associated with significant pain and opioid reliance, yet standardized guidelines remain limited. This study evaluates opioid use in opioid-naive patients and examines whether minimally invasive techniques and procedure complexity influence postoperative opioid requirements.

METHODS
A prospective cohort of 217 opioid-naive patients undergoing outpatient lumbar laminectomy/discectomy, anterior cervical discectomy and fusion (ACDF), or total disc replacement (TDR) between August 2023 and December 2024 was analyzed. Patients were stratified by surgical approach (open, tubular, endoscopic) and by single- versus multilevel procedures. Opioid consumption was recorded in total morphine milligram equivalents (MME) using patient-reported pill counts at 2 weeks and follow-up interviews at 3 months. Refill requests were documented. Statistical comparisons were performed using t-tests and ANOVA. Demographics, comorbidities, and surgical setting (ambulatory center vs. tertiary hospital) were recorded.

RESULTS
Single-level procedures required significantly fewer opioids than multilevel procedures (75.1 ± 97.0 vs. 167.3 ± 239.6 MME; p=0.0068). Among lumbar surgeries, endoscopic approaches had the lowest opioid use (48.6 ± 57.8 MME), significantly less than open procedures (164.7 ± 223.7 MME; p=0.0021). Overall, 17.5% of patients required no postoperative opioids, with the highest rate in single-level endoscopic cases (36.3%). Refill rates were lowest in endoscopic (2.2%) and tubular (0%) groups and highest in multilevel open lumbar (35.3%) and ACDF (33.3%) procedures. Opioid use was greater at ambulatory centers than tertiary hospitals (109.6 vs. 72.9 MME; p=0.0287).

CONCLUSIONS
Minimally invasive spine surgery, particularly endoscopic techniques, is associated with reduced postoperative opioid use and fewer refills compared to open procedures. Multilevel surgery predicts higher opioid consumption. Procedure-specific prescribing protocols may help reduce overprescription while maintaining adequate pain control.

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Metaplastic Breast Cancer: Clinical and Prognostic Features

Nidhi Navaratna, B.A.^1, Lihua Qu, Ph.D.², Mariam Aoun, M.D.³, Nitya Batra, M.D.³, Mohammad Chisti, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health Research Institute, Royal Oak, MI
³Corewell Health William Beaumont University Hospital, Royal Oak, MI6}

INTRODUCTION
Metaplastic breast cancer (MpBC) is a rare malignancy characterized by differentiation of neoplastic epithelium into epithelial and mesenchymal components. Compared to invasive ductal carcinoma, MpBC is associated with worse outcomes, likely due to molecular and histologic heterogeneity and the lack of standardized treatment approaches. Further investigation of MpBC is needed to improve risk stratification and management.

METHODS
A retrospective chart review was conducted of 186 patients with MpBC and 76 patients with non-metaplastic triple-negative breast cancer diagnosed between January 2000 and August 2023. Demographics, tumor characteristics, staging, metastatic status, hormone receptor status, molecular data, and survival outcomes were collected from the EMR. Overall survival (OS) was the primary endpoint. Kaplan–Meier analysis estimated time-to-event outcomes, with log-rank tests and univariate Cox regression used to evaluate associations between clinical variables and OS.

RESULTS
Median age at MpBC diagnosis was 62; most patients presented with stage I or IV disease. The cohort was 70% White and 26.1% Black. Metastases were more frequent in MpBC than non-metaplastic cases (83.9% vs. 61.8%). Squamous differentiation was most common, followed by spindle and chondroid subtypes, with frequent BRCA, KIT, c-MYC, and p53 mutations.Triple-negative status (24%) was associated with worse OS (p=0.0009), higher mortality (p=0.0003), and a hazard ratio of 3.54 (95% CI: 1.78–7.05). Two-, five-, and ten-year OS rates were 66%, 66%, and 57% vs. 91%, 89%, and 84% in patients with ER, PR, or HER2 expression. PD-L1–negative patients had 7.4-fold higher mortality (p=0.0309) and lower two-year OS (33% vs. 84%) than PD-L1–positive patients.

CONCLUSIONS
Hormone receptor status and PD-L1 expression appear to have prognostic value in MpBC and non-metaplastic triple-negative breast cancer. Triple-negative status and lack of PD-L1 expression were associated with poorer survival. Further studies are warranted to validate these findings and inform therapeutic strategies.

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Infectious Disease Consultation in Postoperative Septic Patients: Impact on Outcomes

Cloe Nazeer, B.S.¹, Marisa Stratelak, M.D.², Bhavinkumar Dalal, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
² Department of Anesthesiology, University of Illinois, Chicago, IL
³Department of Critical Care and Pulmonology, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Postoperative sepsis is a progressive, life-threatening condition marked by organ dysfunction following surgery and is associated with significant morbidity and mortality. While infectious disease (ID) consultation has been shown to improve outcomes in general sepsis populations, its role in the surgical intensive care unit (SICU), specifically among postoperative patients, remains understudied. This retrospective study investigates the association between ID consultation and outcomes in postoperative SICU patients who developed sepsis.

METHODS
A chart review was conducted of patients admitted to the SICU at Corewell Health Royal Oak Hospital between January 1 and December 31, 2019. Patients with a documented diagnosis of sepsis in the postoperative period were included and stratified based on whether they received a formal ID consultation. Primary outcomes included SICU length of stay (LOS), mortality, and development of septic shock. 

RESULTS
A total of 320 SICU patient encounters were analyzed; 217 (67.8%) received a formal ID consult. Patients who received ID consultation were significantly younger (mean age 64.1 vs 70.1 years, p=0.0012) and had longer SICU LOS (mean 307.3 vs 214.6 hours, p=0.0451). No statistically significant differences were observed in mortality rates (p=0.2110) or rates of septic shock (p=0.6736) between the groups.

CONCLUSIONS
While ID consultation was associated with increased SICU length of stay, no significant differences in mortality or septic shock were observed. These findings suggest that ID consultations may be more commonly obtained in complex or prolonged cases. While not formally measured, it was observed during chart review that older patients often declined rapidly, leading to hospice referral without infectious disease consultation. This may have contributed to the lower ID consult rate in this population. Further research is needed to evaluate causality and to explore whether earlier or more targeted ID involvement could influence outcomes in this population. 

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Clinical Outcomes and Socio-demographic Disparities among COVID-19 Patients with Autoimmune Diseases

Jessica Ngo, B.S.¹, Dwayne Baxa, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
COVID-19, caused by SARS-CoV-2, has disproportionately affected racial/ethnic minorities and immunocompromised individuals. Black, Hispanic, and Asian Americans face greater risks of COVID-19 positivity and ICU admission. COVID-19 shares immunologic features with autoimmune diseases. This study examines differences in COVID-19 outcomes between hospitalized patients with and without autoimmune diseases. 

METHODS
We conducted a retrospective study of data from a Metro Detroit multi-center health system from Dec 2019 - Nov 2021. Demographic data, length of stay (LOS), ICU admission, diagnosis, and mortality were analyzed. Patients were stratified by autoimmune status. Chi-square, t-tests, and linear regression models were used for statistical analyses. 

RESULTS
Of 11,600 hospitalized COVID patients, 408 had preexisting autoimmune diseases. The non-autoimmune cohort was predominantly female (67.7% vs. 50.3%, p<0.001) and had a greater proportion of Black patients (26.5% vs. 24.1%) than Asians (0.7% vs. 2.9%) and Arab/Middle Easter patients (5.4% vs. 10.1%) compared with the non-autoimmune group. In univariate analysis, patients with autoimmune disease had significantly longer LOS (mean difference = +1.38 days; p = 0.0042). In multivariate models, the association between autoimmune disease and LOS was no longer significant (p = 0.2452). Arrhythmia and CKD remained significant predictors of increased LOS (+0.98 days, p = 0.0020; +1.43 days, p < 0.0001). 

CONCLUSIONS
The relationship between autoimmune disease and length of stay was not independently significant after adjusting for comorbidities, suggesting that multimorbidity, rather than autoimmunity alone, drives prolonged hospitalization. Demographic disparities were also evident, with a higher prevalence of autoimmune disease among women and Black patients, underscoring potential inequities in healthcare burden. No significant difference in mortality was observed between groups. Future studies incorporating vaccination status, outpatient outcomes, and treatment regimens are warranted to better characterize risks and optimize care for patients with autoimmune disease and COVID-19. 

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Effect of Background Music on Pulmonary Nodule Evaluation on Chest Computed Tomography

Joud Obri, B.S.¹, Adela Pouzar, M.D.², Braeden Estes, M.D.², Kiran Nandalur, M.D.², Sayf Al-Katib, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Diagnostic Radiology, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Listening to Mozart’s Sonata (MS) for 10 minutes has been associated with short-term improvement in spatial reasoning, but its relevance to diagnostic radiology (DR) has not been established. This study examined whether brief music exposure affects accuracy or interpretation time during chest computed tomography (CT) evaluation of pulmonary nodules.

METHODS
We conducted a randomized two-period crossover study among 24 DR residents interpreting chest CT scans containing multiple pulmonary nodules. Each participant read three studies: one practice case (no intervention) and two test cases presented under either silence (noise-cancelling headphones) or music (MS for two pianos). Assignment of music versus silence to the second and third cases was randomized and balanced. The primary outcomes were diagnostic accuracy (percentage of correctly identified nodules) and interpretation time (seconds). Paired t-tests compared music and silence conditions (α = 0.05). Sensitivity analyses assessed the effect of case assignment.

RESULTS
All 24 residents completed both conditions (n = 24). Mean accuracy was 54.17% ± 16.28 with music and 56.21% ± 19.80 with silence (mean difference = −2.04 percentage points; 95% CI [−9.36, 5.28]; p = 0.57). Mean interpretation time was 424.0 ± 160.2 s with music and 440.6 ± 146.7 s with silence (mean difference = −16.6 s; 95% CI [−76.0, 42.8]; p = 0.57). Sensitivity analyses showed that within-participant differences varied by which case had music, consistent with case-specific difficulty, but no overall condition effect was observed. No adverse events occurred.

CONCLUSIONS
Among radiology residents interpreting chest CT, brief background music did not significantly alter diagnostic accuracy or interpretation time compared with silence. The findings suggest that background music neither improves nor impairs core performance metrics in this setting. Further research with additional cases and attending radiologists may clarify task-specific influences of music on diagnostic performance.

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Investigating the Effect of Antihypertensives on Biomarker Patterns in Alzheimer’s Disease and Mild Cognitive Impairment

Kaitlyn Paez, B.A.¹, Claire Kopachik¹, Ali Yilmaz, Ph.D.³, Sangeetha Vishweswaraiah, Ph.D.², Michael E. Maddens, M.D.³, Stewart F. Graham, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Obstetrics & Gynecology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
³Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
As the global population ages, the increasing prevalence of Alzheimer’s disease (AD) poses significant personal, societal, and economic challenges. Addressing the demand for improved diagnostic techniques, metabolomics-based methods have emerged as non-invasive, cost-effective alternatives to conventional approaches. Researchers have identified significant concentration variations in salivary and urinary metabolites, distinguishing AD individuals from cognitively normal controls. However, the source of these differences, whether disease-related or medication-induced, remains unclear. Notably, it is unknown whether angiotensin II receptor blockers (ARBs), commonly prescribed for hypertension, significantly impact the AD patient metabolome.

METHODS
Through a retrospective analysis of existing salivary metabolomics data, we aimed to discern whether observed alterations were attributed to the disease or the prescribed polypharmacy.

RESULTS
Employing linear modeling, our study reveals that among individuals with Alzheimer’s disease, those taking ARBs had significantly lower urinary tryptophan levels (q = 0.001). Our study also reveals that ARB administration had a significant impact on the levels of acetone and isopropyl alcohol across all groups. Additionally, identified saliva metabolite ratios demonstrated significant differences in asymmetric arginine methylation between the AD group and the control group on ARBs (q=0.021), as well as variations in citrate synthesis between the MCI group and the control group on ARBs (q=0.024).

CONCLUSIONS
Remarkably, our findings substantiate the persistence of unique biomarker patterns indicative of AD, independent of ARB use. These results bolster the potential of metabolomics-based tools in AD diagnosis, thereby providing vital support for future clinical research and therapeutic interventions.

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Outcomes of Brachytherapy Comparing Coronary Bypass Grafts vs Native Vessels

Nicholas Petrykowski, B.S.¹, Matthew Hanna, M.D.², Nicholas Kondoleon, M.D.², Karan Chhabra, M.D.², Kuei Lee, M.D.³, Ivan Hanson, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Cardiology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
³Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Coronary artery in-stent restenosis (ISR) is a common challenge after treating coronary artery disease with a bare metal or drug-eluting stent (DES). Intravascular brachytherapy (IVBT) using radioactive isotopes is an effective treatment option for patients with recurrent ISR to avoid further luminal narrowing. There is limited data in the modern era comparing long term outcomes of IVBT used in native coronary arteries vs coronary artery bypass grafts in those experiencing recurrent ISR.

METHODS
This is a single institution retrospective study of 282 patients that underwent coronary brachytherapy following ISR of a previous DES between September 2014 and May 2023. Kaplan Meier analysis was used to assess the clinical endpoints of freedom from target vessel reintervention (TVR), death, and major adverse cardiac events (MACE), defined as myocardial infarction, TVR, or death.

RESULTS
A total of 248 patients were included in the study which compared the outcomes of 49 bypass grafts and 199 native arteries that underwent IVBT for recurrent ISR. There was no statistically significant difference in TVR at 1, 3 and 5 year follow up (p = 0.93, 0.77, and 0.34 respectfully). Additionally, no statistically significant difference in death was found at 1, 3 and 5 year follow up (p = 0.27, 0.11, and 0.48 respectfully). Lastly, there was no statistically significant difference in MACE at 1, 3 and 5 year follow up (p = 0.45, 0.3, and 0.12 respectfully).

CONCLUSIONS
Our data suggests that the long-term clinical outcomes of patients with bypass graft vessels are similar to those with native coronary arteries when treated with IVBT for recurrent ISR. This data further supports the safety and efficacy of coronary brachytherapy for treating complex coronary artery disease with recurrent ISR. 

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The Effects of Caffeine Use in NICU on the Neurodevelopmental Outcome of Premature Infants: A Prospective Review

Lauren Phung, B.S.¹, Rawad Obeid, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Dept. Of Pediatric Neurology, Corewell Health William Beaumon University Hospital, Royal Oak, MI}

INTRODUCTION
Prematurity-related brain vulnerability to hypoxia and inflammation remains a significant cause of neonatal morbidity. Caffeine citrate has been one of the primary therapies in the neonatal intensive care unit for apnea of prematurity due to its neuroprotective benefits via anti-inflammatory pathways. This study evaluates the caffeine citrate administration protocol at the Corewell Health system (2020–2024) and investigates the impact of cumulative caffeine dosing on long-term neurodevelopmental outcomes.

METHODS
This retrospective chart review included preterm infants who were born in the Corewell Health system and being followed in the neurodevelopmental clinic. Late preterm infants (born > 34 weeks of gestational age), those with congenital defects, and outside of system births were excluded. Clinical demographics and cumulative caffeine citrate doses were collected and analyzed against neurodevelopmental scores, including the Bayley-III, Alberta Infant Motor Scale (AIMS), and Peabody Fine Motor Scales, at multiple follow-up intervals.

RESULTS
Protocol adherence was high, as the majority of preterm infants received caffeine citrate within 24 hours of birth. Notably, reduced AIMS scores at short-term follow-up were significantly associated with clinical comorbidities, including periventricular leukomalacia, small gestrational age, patent dutus arterious, bronchopulmonary dysplasia, necrotizing enterocolitis, low birth weight, and low Apgar scores. Higher cumulative caffeine citrate doses were found not to be significantly associated with improved neurodevelopmental scores in this cohort.

CONCLUSIONS
While caffeine citrate administration was highly consistent, cumulative dosing did not correlate with significant improvements in neurodevelopment. This may be due to extreme dosing ranges or unmeasured confounding factors. Future research with a larger sample size and multivariable adjustments is required to further evaluate the impact of average daily caffeine dosage on long-term outcomes.

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Impact of CMS “Time Zero” Criteria on SEP-1 Compliance and Sepsis Outcomes in the ED

Morgan Porter, B.S.¹, Ramin Homayouni, Ph.D.², Paul Bozyk, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
³Department of Pulmonology & Critical Care Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Sepsis is a life-threatening complication of severe infection with significant morbidity and mortality. Continuous updates to sepsis protocols have been effective in reducing mortality, however it remains a leading cause of in-hospital deaths. The Centers for Medicare and Medicaid Services (CMS) SEP-1 Sepsis bundle is a widely implemented quality measure for sepsis management and establishes strict timing requirements for early sepsis recognition and treatment within defined time intervals beginning at “time zero.” However, variation in “time zero” and the initiation of sepsis treatment may influence bundle compliance and patient outcomes. The relationship between timing of sepsis recognition, SEP-1 bundle completion, and mortality remains incompletely understood.

METHODS
We performed a retrospective chart review of adult patients (≥18 years) with sepsis who presented to Corewell Health William Beaumont University Hospital ED between January and December 2022. An institutional algorithm identified patients and extracted timing of sepsis recognition, bundle compliance, and thirty-day mortality. Multivariable logistic regression was used to identify factors associated with SEP-1 bundle compliance and thirty-day mortality.

RESULTS
A total of 1,561 patients were diagnosed with sepsis based on the SEP-1 criteria with 850 (54.5%) meeting the SEP-1 bundle requirements. Patient age, sex, and race had no significant impact on SEP-1 pass/fail rates. Thirty-day mortality occurred in 290 patients (18.6%). Increasing patient age was associated with higher mortality (p<0.001) and earlier recognition was associated with improved survival (p<0.0001). Cardiovascular disease, malignancy, and major injury were also associated with increased mortality. Earlier identification of infection or organ dysfunction was associated with improved SEP-1 bundle compliance (p<0.001).

CONCLUSIONS
Baseline demographics (age, sex, race) did not explain variation in SEP-1 performance. Earlier recognition and treatment initiation were associated with higher SEP-1 bundle completion rates and improved thirty-day mortality. Mortality was driven primarily by patient age, cardiovascular disease, malignancy, and major injury. 

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Short-Term Implications of Anti-Hypertensive Treatment in the Emergency Department

Frosilda Pushani, B.S.¹, Wilfredo Escala, M.D.², Brett Todd, M.D.^1,2

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
² Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
There exists a differential in treatment of patients who present with hypertension in the Emergency Department (ED). The American College of Emergency Physicians (ACEP) makes Level C recommendations that initiation of antihypertensive therapy by EPs (Emergency Physicians) is not required, but may be considered. The objective of our study was to analyze short-term outcomes of hypertensive ED patients treated with antihypertensives before discharge. 

METHODS
We conducted a retrospective cohort study analyzing 2 and 7-day risk of AEs and revisit rates of hypertensive ED patients treated with or without antihypertensives before discharge. AEs were defined as myocardial infarction, acute heart failure, hypertensive encephalopathy, aortic catastrophe, hemorrhagic stroke, ischemic stroke, or death. Descriptive analysis was used to summarize patient characteristics; continuous variables were compared using the Kruskal–Wallis test, and categorical variables using the Chi-square test. Logistic regression adjusted for age, sex, race, hypertension stage, Elixhauser comorbidity index, and history of heart failure within 18 months. Odds ratio (OR) was reported with 95% confidence interval (CI) and p-value. 

RESULTS
A total of 93,512 of all adult patients who met inclusion criteria were included in our study; 9,442 (10.1%) patients received anti-hypertensive medication pre-discharge. There were increased odds of 2-day (OR: 1.27, p < 0.05) and 7-day(OR: 1.10, p = 0.05) revisits in the treatment group, with IV treatment (2-day OR: 1.67, p-value < 0.05 and 7-day OR: 1.32, p-value < 0.05) associated with an increased risk compared to oral treatment. The odds of a revisit at 2 days were significantly higher compared to 7 days for both treatment groups. IV antihypertensives conferred the highest 7-day AE risk (OR: 5.37, p-value < 0.05).

CONCLUSIONS
ED antihypertensive treatment for acutely elevated BP was associated with increased short-term rates of AEs and revisits, especially with the IV antihypertensive treatment group. 

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Impact of Personalized Visual Medication Charts in Patients with Cardiovascular Disease

Kaitlyn Quach, B.S.¹, Amanda Henderson, B.S.¹, Richard Bloomingdale, M.D.², Simon Dixon, Other², Elvis Cami, M.D.², Nishaki Mehta, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Polypharmacy in patients with cardiovascular disease can lead to less adherence, possibly from lower understanding of the different medications. Patients often describe pills by color and size while healthcare providers identify pills by dosage and name. To bridge this gap, a personalized visual medication chart (PVMC) was created to display a pictographic table of pills with its corresponding information. This study sought to evaluate if PVMCs increased medication knowledge in patients presenting to ambulatory cardiology clinics over a 3-6 month period.

METHODS
Patients taking 2 or more cardiac medications were enrolled into the control or intervention group. Baseline medication knowledge was assessed by a 4-point scale for each cardiac medication (name, dosage, frequency, indication). Patients in the intervention group received a PVMC at their index visit. All patients were called 3-6 months later to reassess medication knowledge and evaluate for changes in medications. Statistical analyses included descriptive analysis for baseline characteristics and paired two-tailed t-test for follow up data. 

RESULTS
From 6/2023 to 12/2024, 114 patients in the intervention group and 110 patients in the control group completed follow-up. Mean age was 69 and 68 years old for control and intervention group respectively. Mean cardiac medications were 4 and 5 for control and intervention group respectively. Mean medication knowledge in the control group did not significantly increase from baseline (79%) to reassessment (79%) (p=0.912). Mean medication knowledge in the intervention group significantly increased from baseline (76%) to reassessment (85%) (p<0.001). Overall, medication changes occurred in 43% of patients and dosage changes occurred in 16% of patients.

CONCLUSIONS
PVMCs represent a promising tool for increasing medication knowledge in patients with cardiovascular disease. There was a significant amount of medication and dosage changes over a short follow-up period, emphasizing the need for dynamic and easily implementable medication insight tools.

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Patient and caregiver experience with the use of telemedicine post-concussion in a pediatric physical medicine and rehabilitation population

Meaghan Race, M.S.¹, Neal Alpiner, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Physical Medicine & Rehabilitation, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Telemedicine is an overarching term encompassing any health care service delivered at a distance. Previous studies have reported benefits in delivering pediatric services via telemedicine with reports of fast assessment and improved quality of life for both patients and caregivers. Currently, there is limited information about the use of telemedicine for pediatric patients seeking physical medicine and rehabilitation (PM&R) care and there is a need for the assessment of patient and caregiver experience to optimize the effectiveness of telemedicine care in this patient population. The study aimed to investigate the efficacy of online care (telemedicine) for concussion compared to standard office visits from the patient and caregiver perspective. Additionally, the study aimed to explore the impact of telemedicine on patients and caregiver experience and identify factors that optimize visit satisfaction.

METHODS
We conducted a cross-sectional, web- and phone-based survey to investigate the use of telemedicine for the treatment of concussions. 

RESULTS
A total of 75 patients and caregivers completed the survey. The majority of responders reported that their medical needs were addressed using the telemedicine platform (87.8%). Additionally, 68% reported that the ability to be seen early via telemedicine resulted in less of a need to go to (or return to) the emergency room. 

CONCLUSIONS
Results suggest that telemedicine is a beneficial tool and supplemental option for concussion care in a pediatric physical medicine and rehabilitation setting. 

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Prevalence and Associated Injuries in Patients with Knee Cysts: An Epidemiological Study

Noopur Ranganathan, B.S.¹, Elijah Auch, M.D.², Avianna Arapovic, B.S.², Matthew Cederman, B.S.¹, Ehab Saleh, M.D.¹, Betina Hinckel, M.D. / Ph.D.¹

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
With the growing utilization of magnetic resonance imaging (MRI) for assessing the knee joint, there is also an increased number of incidental cystic/cyst-like lesion findings, with Baker’s cysts being the most prevalent. The purpose of this study is to assess the epidemiolocal distribution of various cysts in the knee and evaluate its presence with any associated injuries.

METHODS
A retrospective review of patients who underwent magnetic resonance imaging (MRI) of the knee for any reason between January 1, 2022, and January 1, 2023, at a single academic institution was conducted. It included patients that are greater than 18 years of age, and excluded patients without cystic knee lesions, less than 18 years old, prior knee surgery or no MRI was available. Collected variables from each patient included demographic information, cyst type, cyst location, and associated injuries.

RESULTS
Of the 4764 MRIs reviewed, 1208 (25.4%) patients had a knee cyst found on imaging. 923 (76.4%) patients had a Baker’s cyst, and was associated with older patients (p<0.001), females (p=0.042), bursitis (p=0.027), cartilage defect (p=0.017), effusion (p=0.006), MCL pathology (p=0.021), medial meniscus tear (p=0.032), PCL pathology (p=0.002), and subchondral fracture (p=0.004). Ganglion cysts were present in 257 patients (21.3%) and were associated with ACL injuries (p=0.002), osteoarthritis (p=0.009), PCL injuries (p<0.001), synovitis (p=0.002), and tendinopathy (p<0.001). Parameniscal cysts were present in 172 (14.2%) patients and were associated with younger age (p=0.039), males (p<0.001), bursitis (p=0.001), effusion (p<0.001), lateral meniscus tear (p<0.001), medial meniscus tear (p<0.001), and osteoarthritis (p=0.008).

CONCLUSIONS
Though knee cysts are often an incidental finding upon imaging, there are some key populations and associated injuries that are correlated with the presence of specific types of knee cysts. 

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Long Term Visual Outcomes of Pars Plana Vitrectomy for Infectious Endophthalmitis

Revati Rashingkar, B.S.¹, Viren K Govindaraju, M.D.², Chi Phan, B.S.^1, Adam J Weiner, M.D.², Sandeep Randhawa, M.D.², Lisa J. Faia, M.D. ², George Williams, M.D. ², Tarek S Hassan, M.D., FARS²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Associated Retinal Consultants, Royal Oak, MI
³Beaumont Eye Institue, Corewell Health, Royal Oak, MI}

INTRODUCTION
There is limited data on the role of timely surgical intervention for eyes presenting with no light perception (NLP) vision in the setting of infectious endophthalmitis. We aimed to determine whether pars plana vitrectomy (PPV) combined with intravitreal antibiotics can achieve meaningful visual recovery in NLP eyes.

METHODS
This was a retrospective study of eyes with infectious endophthalmitis treated with PPV at Associated Retinal Consultants between January 2015 and January 2024. Inclusion criteria were a confirmed diagnosis of infectious endophthalmitis, receipt of PPV, follow-up exceeding 6 months, and recorded visual acuities (VA). Exclusion criteria included follow-up under 6 months, non-infectious uveitis, and concurrent retinal detachments. The primary outcome was 12-month VA. Secondary outcomes included VA at 1, 3, and 6 months, and total VA change. Continuous variables were analyzed using T-tests and Mann-Whitney U-Tests and categorical variables with Fisher Exact Tests. All tests were two-sided with significance set at p<0.05

RESULTS
111 eyes with light perception or better (LPB) and 13 NLP eyes were included. Mean VA prior to endophthalmitis onset was similar between groups (p=0.6). Mean presenting VA at the time of diagnosis was logMAR 2.0 (LPB) versus 4.0 (NLP) (p<0.001). At 12 months, mean VA was 1.0 (LPB) and 1.6 (NLP) (p=0.04). The NLP group improved by a mean of 2.1 logMAR units (p=0.008) and the LPB group by 1.1 logMAR (p<0.001), both statistically significant. There were no differences in long-term sequelae, PPV gauge, etiology, or causative organisms between groups. No eyes progressed to phthisis.

CONCLUSIONS
Current endophthalmitis treatment guidelines are largely extrapolated from the Endophthalmitis Vitrectomy Study (EVS), which excluded NLP patients. We demonstrate that PPV with intravitreal antibiotics can yield clinically meaningful visual recovery in NLP eyes and may prevent progression to ocular atrophy. Larger prospective studies are needed to establish evidence-based practice guidelines for this underrepresented patient population.

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The Outcomes of EMS-Placed Intravenous Catheters in Patients Beyond the Prehospital Setting

Christine Roskowski, B.S.¹, Robert Swor, D.O.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Emergency Medical Services (EMS) frequently place peripheral intravenous catheters (PIVCs) in the prehospital setting; however, the downstream outcomes of EMS-placed IVs and their impact on patient care efficiency within the emergency department (ED) are not well characterized, particularly among lower acuity patients.

METHODS
This retrospective investigation analyzed the outcomes of PIVCs placed by EMS at four suburban EDs in Southeastern Michigan using data retrieved from the electronic medical record. Patient demographics, characteristics of the PIVCs, Emergency Severity Index (ESI), ED length of stay, IV dwell time, and IV failure rates were recorded.

RESULTS
From 1/1/21 to 7/27/23, among 26,920 patients transported by EMS, 19.9% had PIVCs placed by EMS, while 81.1% received PIVCs in the ED. Mean ESI was 2.66 for patients with EMS-placed IVs and 2.72 for ED-placed IVs. Mean length of stay was 6.03 hours for EMS-placed IVs and 10.03 hours for ED-placed IVs. Mean dwell time was 5.22 hours for EMS-placed IVs and 7.32 hours for ED-placed IVs. The failure rate was 2.9% for EMS-placed IVs and 3.4% for ED-placed IVs.

CONCLUSIONS
Patients with EMS-placed PIVCs had shorter ED stays than patients with ED-placed PIVCs. IV failure rates were low in both groups. These findings suggest prehospital IV placement may improve ED efficiency. Further investigation is warranted to better analyze the value proposition of EMS IVs, which could potentially guide improvements in EMS IV placement through training, equipment, and technology.

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Mirtazapine is Sedating at Low Doses and Stimulating at High Doses: Fact or Myth? 

Inderjeet Sahota, B.S.¹, Sara Dadashzadeh, M.D.², Liza Zimmerman-Slayton, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Psychiatry, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Mirtazapine is a U.S. Food and Drug Administration (FDA) approved antidepressant for major depressive disorder and is frequently used off-label for insomnia due to its sedating properties. A commonly cited clinical teaching suggests that mirtazapine is more sedating at lower doses and less sedating, or more activating, at higher doses because of increased noradrenergic transmission. Despite widespread acceptance of this concept, the degree to which it is supported by randomized controlled trial (RCT) evidence remains unclear. This study aimed to evaluate whether RCT data support a dose-dependent reduction in sedation at higher doses of mirtazapine.

METHODS
A systematic review of electronic databases identified RCTs evaluating mirtazapine and reporting sedation or sleep-related outcomes. Eighty-six RCTs were initially identified; after duplicate removal and application of secondary inclusion criteria, 13 independent, non-overlapping studies were included. These trials, conducted between 1985 and 2022, encompassed 1,005 participants and examined mirtazapine doses ranging from 7.5 mg to 45 mg compared with placebo and/or other antidepressants. Sedation outcomes were assessed using validated measures, including the Jenkins Sleep Scale, Stanford Sleepiness Scale, and Pittsburgh Sleep Quality Index. Study results were reviewed to determine the effect of dose on sedation and statistical significance.

RESULTS
Across the 13 included RCTs, there was no statistically significant reduction in sedation at doses above 15 mg. Two studies reported increased sedation at higher doses. No consistent evidence demonstrated a dose-dependent activating effect. Adverse events were consistent with known side effect profiles.

CONCLUSIONS
RCT evidence does not support the commonly held belief that mirtazapine is less sedating at higher doses. These findings challenge a frequently cited clinical teaching and highlight the need for evidence-based prescribing and further dose-comparison trials. 

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Identification of Mental Health Disparities in Pediatric Oncology Patients

Christian Santiago, M.S.¹, Kaydee Kaiser, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Pediatric cancer significantly impacts not only a child's physical health but also their mental and emotional well-being. These patients often face uncertainty, isolation, and distress throughout diagnosis and treatment, which increases their risk of developing mental health conditions such as anxiety and depression. Despite the high prevalence of mental health issues, not much is known as to how providers are identifying such issues for management. This study explores how mental health issues are identified by healthcare providers involved in the care of pediatric cancer patients to identify gaps and opportunities for improvement.

METHODS
 A survey was developed to examine the identification of mental health disparities in pediatric cancer patients, which included questions about screening timelines, methods, provider/institutional demographics, and confidence in managing mental health concerns. Eligible participants included healthcare professionals involved in the care of pediatric cancer patients, such as pediatric hematology-oncology physicians, nurses, and social workers. The survey was distributed through listservs and research boards of the Children’s Oncology Group, the American Society of Pediatric Hematology/Oncology, and pediatric hematology-oncology programs listed in the AAMC 2024 ERAS Fellowship Directory.

RESULTS
A total of 54 healthcare providers responded to the survey. 35.2% of respondents reported that they "always" screen for mental health issues, while 44.4% screen "sometimes" and 16.7% screen "rarely." Screening was most frequently initiated at diagnosis and during treatment. Nursing concerns were the most common trigger for initiating mental health evaluations. Smaller practices were more likely to screen at diagnosis. 

CONCLUSIONS
Variability in mental health screening practices for pediatric cancer patients was demonstrated, with many providers relying on inconsistent protocols and a lack of validated tools. Furthermore, the need for standardized mental health screening guidelines and improved access to psychosocial resources. Addressing these gaps will ensure early identification and intervention, ultimately improving the quality of life for pediatric cancer patients and survivors.

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The Impact of Post-Discharge Diet on Growth and Neurodevelopmental Outcomes in Preterm Infants

Christine Simon, B.S.¹, Laura Bashir, M.S.², Amanda Froling, M.P.T.², Nicole Rickard, M.S., OTRL², Jacob Keeley, M.S. ³, Michelle Jankowski, M.S.³, Rawad Obeid, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Pediatric Neurology Department, Corewell Health Children’s Hospital, Royal Oak, MI
³Department of Research, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Premature infants are at increased risk for growth failure and neurodevelopmental delay. Human milk is commonly used in the NICU to address these risks, but data on post-discharge dietary practices and long-term outcomes remain limited. This study aims to evaluate the impact of  post- discharge dietary practices on growth and neurodevelopmental outcomes in preterm 

METHODS
This is a retrospective study of premature infants followed at the Corewell Health East Neurodevelopment Clinic between February 2020 and February 2024. Eligible infants were admitted to the Corewell Health East NICU within the first week of life and had at least one follow-up between 2–6 months corrected age. Infants with genetic syndromes were excluded. Participants were categorized into three groups: 1- human milk only, 2- synthetic formula only, and 3- human milk with synthetic formula and 4- human milk with human milk fortifier. Growth metrics and neurodevelopmental assessments, including the Alberta Infant Motor Scale and Peabody fine motor scores at 8– 10.99 months corrected age, and the Bayley-III scores at 24 months, were analyzed by dietary group.

RESULTS
Of 193 infants, 21 received human milk only, 123 received synthetic formula only, and 49 received human milk fortified with formula at their first neurodevelopment follow up visit. No significant differences in early growth or developmental scores were observed at 8–10.99 months corrected age. Although, a trend toward higher head circumference was noted in the human milk only group. By 24 months corrected age, no significant differences in Bayley scores were observed. However, cognitive and language scores in the human milk only group trended towards statistical significance.

CONCLUSIONS
Exclusive human milk feeding may offer cognitive benefits at 24 months corrected age, supporting the need for greater breastfeeding support after discharge. 

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Establishing the threshold for total delivered platelets concentrated in platelet rich plasma sufficient for a therapeutic tendon, cartilage, and ligament regrowth.

Joseph Solomon, B.S.¹, Thomas Nabity, Jr., M.D.², Leah Braddell ³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Michigan Center for Regenerative Medicine, Rochester Hills, Michigan
³DataBiologics, Mesa, Arizona}

INTRODUCTION
Platelet-rich plasma (PRP) is widely used for orthopedic conditions, yet dosing standards remain undefined. We evaluated whether total delivered platelets (TDP) – product of PRP concentration and volume – influence patient-reported function and pain after PRP.

METHODS
We performed a retrospective analysis of de-identified registry data from a single procedure center captured in DataBiologics. Patients treated for orthopedic indications were included if baseline and follow-up surveys were available. Mixed-effects models with repeated measures (baseline to 24 months) estimated effects of time, TDP, and their interaction overall and by region. Procedures spanned shoulder (27.5%), knee (24.4%), hip (15.4%), spine (14.5%), upper extremity (12.0%), and lower extremity (6.2%). Marginal means were derived at mean TDP and ±1 SD.

RESULTS
We analyzed 324 procedures. Function improved significantly over time (p<0.0001). TDP alone was not associated with average function (p=0.61), but TDP significantly modified change over time (p=0.009), consistent with dose-dependent acceleration of early recovery. By region, hip function improved over time (p=0.007) and was higher with greater TDP (p=0.03), whereas spine (p=0.03) and lower extremity (p=0.004) improved without dose effects (p > 0.05); upper extremity fixed effects were not significant. Pain decreased over time (p<0.0001); neither TDP (p=0.31) nor time×TDP (p=0.50) was significant overall. Regionally, hip pain showed a significant time×TDP effect (p=0.01) despite a non-significant main effect of TDP (p=0.48). Marginal means showed larger early functional gains at higher TDP that converged by 12–24 months, with steadily declining pain.

CONCLUSIONS
In this cohort, PRP was associated with sustained improvements in function and pain over two years. Higher dose shaped recovery timing—especially accelerating early function—and influenced hip pain, but no universal TDP threshold emerged. Indication-specific, minimum clinically important difference-anchored analyses and prospective studies incorporating broader cellular composition are needed to define minimum effective dosing and optimize guidance.

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Association of Race and Ethnicity with Antibiotic Resistance

Deepali Tailor, B.S.¹, Matthew Sims, M.D. / Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Dept of Medicine, Section of Infectious Disease, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Antibiotic resistance is a major global health concern that complicates the effective treatment of bacterial infections. The development of antibiotic resistance in gut flora is multifactorial and influenced by antibiotic use in food production, food preparation practices, and ethnic dietary traditions. Antibiotics used in livestock create selective pressure that favors resistant bacteria, which may be introduced into the human gut through food consumption. Prior research by our group demonstrated associations between Asian race and Arab/Middle Eastern ethnicity and ESBL-producing Gram-negative urinary infections. Other than that study, there has been little research examining broader associations between race, ethnicity, and Gram-negative antibiotic resistance. Our objective was to determine whether a more generalized association exists beyond ESBLs in urine.

METHODS
We performed a retrospective analysis of adult patients (≥18 years) with unique positive Gram-negative isolates from blood, urine, wound, and respiratory cultures in inpatient and outpatient settings in 2019. Demographic data (age, gender, race, ethnicity, encounter type) and culture data (organism identification and sensitivities) were extracted from the EMR. Patients with missing data were excluded; those who preferred not to answer were included in totals but not analyzed as a separate category. Fisher’s exact test was used to assess differences in resistance and non-sensitivity (resistant + intermediate). 

RESULTS
We identified 36,544 unique organisms from 29,836 patients; 35,599 had ethnicity data available. Black patients had significantly higher non-sensitivity to all six antibiotics tested. Asian patients had lower resistance to beta-lactams but the highest ciprofloxacin resistance. Latinx ethnicity was associated with higher aminoglycoside non-sensitivity and higher ciprofloxacin resistance. Arab ethnicity demonstrated higher resistance rates across all six antibiotics analyzed.

CONCLUSIONS
There are clear associations between race, ethnicity, and Gram-negative antibiotic resistance. These differences likely reflect cultural and environmental factors rather than biological ones. Additional studies are needed to determine generalizability.

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Association of Dementia with Mortality and Sepsis Quality Measures Among Patients Hospitalized with Sepsis

Jaclyn Talbot, B.S.¹, Ramin Homayouni, Ph.D.², Paul Bozyk, M.D. ³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
³Department of Pulmonary and Critical Care Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Older adults hospitalized with sepsis experience substantial morbidity and mortality. Dementia is common in this population and may complicate infection recognition and management. The impact of pre-existing dementia on sepsis-related outcomes remains incompletely characterized. The objective of this study was to compare demographic characteristics and clinical outcomes among older adults hospitalized with sepsis with and without pre-existing dementia and to determine whether dementia is independently associated with 30-day mortality and adherence to sepsis quality measures.

METHODS
We conducted a retrospective chart review of patients aged ≥65 years hospitalized with sepsis within a large Metro Detroit health system from January 1 to December 31, 2023. Of 2,235 eligible patients, 674 were excluded due to incomplete data, yielding a final cohort of 1,561 patients (Alzheimer’s disease, n = 58; non-Alzheimer’s dementia, n = 312; no dementia, n = 1,191). Outcomes included 30-day mortality and adherence to sepsis quality measures (timely lactate measurement, fluid resuscitation, blood culture collection, and antibiotic administration). Multivariable logistic regression evaluated independent predictors of mortality.

RESULTS
Patients with Alzheimer’s disease were older (median 82.5 years) than those with non-Alzheimer’s dementia (79 years) and no dementia (69 years). Unadjusted 30-day mortality was highest in Alzheimer’s disease (25.86%) compared with non-Alzheimer’s dementia (17.21%) and no dementia (16.30%). In multivariable analysis, dementia was not independently associated with mortality; increasing age remained the strongest predictor of death. Alzheimer’s disease was associated with higher rates of fluid resuscitation (p = 0.0085) and blood culture (p = 0.0487) fallouts.

CONCLUSIONS
Alzheimer’s disease was associated with higher unadjusted mortality and greater sepsis quality measure fallouts. Although dementia was not independently associated with mortality after adjustment, differences in care processes may contribute to observed disparities. Targeted quality improvement efforts may improve sepsis management in cognitively impaired patients.

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Multifactorial Issues Associated with Sexual Dysfunction in Men

James Um, B.S.¹, Shivam Patel, M.D.², Michael Lutz, M.D. ³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health William Beaumont University Hospital, Royal Oak, MI
³Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Sexual dysfunction, including erectile dysfunction, premature ejaculation, and low libido, significantly affects men’s quality of life and mental health. Its multifactorial nature involves psychological stress, aging, and comorbidities such as diabetes and hypertension. While prevalence is established in older men, less is known about lifestyle contributors in younger populations. This study examines behavioral and health factors associated with sexual dysfunction in men.

METHODS
We conducted a cross-sectional study using survey data from the 2023 MI Institute of Urology Men’s Health Event in Detroit, MI. Male participants aged 18 years and older completed structured health questionnaires assessing sexual function, lifestyle behaviors, and medical comorbidities. Respondents with incomplete survey data were excluded. Descriptive statistics characterized prevalence, and multivariable logistic regression was used to identify associations between sexual dysfunction and demographic, behavioral, and health-related factors.

RESULTS
Analyses with exclusions demonstrated that men reporting higher libido were more likely to use e-cigarettes (p = 0.036), engage in cardiovascular exercise (p = 0.0445), and consume fast food more frequently (p = 0.049). Higher red meat intake was negatively associated with sexual activity (p = 0.0126). In analyses without exclusions, alcohol use correlated with greater sexual activity frequency (p = 0.0157). Libido status remained strongly linked to lifestyle factors, including e-cigarette/vaping, marijuana, weightlifting, cardiovascular activity, adequate sleep, and red meat intake, whereas fast food intake, spirituality, and meditation were not significantly associated.

CONCLUSIONS
Lifestyle behaviors, including cardiovascular exercise, red meat consumption, and e-cigarette use, demonstrated consistent associations with sexual function irrespective of exclusion criteria. While exclusion criteria address potential confounding variables that impact sexual health, the broader set of associations observed without exclusions highlights the relevance of lifestyle behaviors in the general population. This suggests that modifiable lifestyle factors may play a meaningful role in sexual function across a wider patient base, beyond those without comorbidities.

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Associated Urogenital Injuries Following Pelvic Trauma in Pediatrics, a 15-year Single-Center Retrospective Study

Colin Van Wagoner, B.S.¹, Talon Shumway, B.S.¹, Arthur Saroyan, M.D.¹, Sazid Hasan, M.D.², Alexandria Chrumka, M.D.³, Ehab Saleh, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²University of Toledo - Department of Orthopaedic Surgery, Toledo, OH
³Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
The association between pelvic trauma and urogenital injuries in adult patients is well-established, whereas literature concerning pediatric patients is sparse. The purpose of this study was to determine the association between pelvic trauma and urogenital injuries in the pediatric population, including incidence, injury patterns, diagnosis, and treatment.

METHODS
This was a single-center, retrospective chart review. Patients aged 0-16 years admitted for pelvic fracture, pelvic dislocation, proximal femur fracture, and injury of urinary and pelvic organs over 15 years were included. Primary variables included fracture diagnosis, urogenital injury, treatment modalities, and mechanism of injury. Secondary outcomes included patient demographics, length of hospital and intensive care unit (ICU) stay, imaging, and foley catheter placement. ANOVA and Chi-Square analysis were used.

RESULTS
371 patients were identified for chart review. Following additional exclusion criteria, 303 patients were compared for analysis. Patients were divided into three groups based on primary fracture diagnosis: pelvic ring fracture n = 149 (49.2%), femur fracture n = 128 (42.2%), and acetabular fracture/hip dislocation n = 26 (8.6%). Associated urogenital injuries were classified in the following groups, with injury rates listed in order of pelvic ring fracture, femur fracture, and acetabular fracture/hip dislocation: no associated injury n = 122, 116, 26, hematuria n = 10, 1, 0, superficial injury n = 5, 1, 0, urethral or bladder injury n = 3, 0, 0, urinary retention or incontinence n = 8, 8, 0, and other n = 1, 2, 0 (p = 0.0690). All results are presented in Tables 1-11 and Figure 1.

CONCLUSIONS
Pelvic trauma with associated urogenital injury is less likely to occur in pediatric patients than adults. When present, it is more commonly associated with male gender, increased severity of pelvic fracture, and treated differently depending on pelvic fracture and urogenital injury types.  

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Unveiling Physiological Impact of Active vs. Passive Cycling on Salivary Cortisol and Testosterone Levels in Healthy Adults

Claire Wang, B.S.¹, Kathryn Rougeau, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Oakland University, Rochester, MI}

INTRODUCTION
Limited research exists on how active and passive cycling affects salivary cortisol and testosterone in a healthy population. As new evidence has shown that an increase in cortisol and testosterone levels is associated with increased cardiovascular risk, our findings may provide valuable evidence to help validate the benefits of passive cycling as a therapeutic measure.

METHODS
Fifty-five (M(age) = 19.8; n = 19 males) participants underwent two randomized and counterbalanced, acute bouts of cycling (active/traditional, passive/motor-driven) for 35 minutes. Salivary samples were collected immediately before (pre-0), immediately after (post-0), and 30 minutes post-cycling (post-30), and were analyzed to quantify cortisol and testosterone levels at those time points. 

RESULTS
Paired t-tests revealed no significant difference in salivary cortisol and testosterone levels between the active and passive conditions (p > 0.10). The changes in hormones in response to active physical activity were not significantly different from those in passive physical activity, making passive physical activity a potential therapeutic intervention that yields similar physiological effects as active physical activity. 

CONCLUSIONS
If passive cycling reduces cortisol and testosterone levels post-cycling, then health professionals may prescribe passive/low-intensity cycling exercise for individuals who can not physically perform a moderate/high-intensity cycling exercise, such as those with mobility impairments or debilitating mental health concerns.

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Can Frailty Index Factors Predict Postoperative Dispositional Outcomes After Cardiac Surgery?

Mark Whitton, B.S.¹, Jose Navas, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Anesthesiology, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
With the aging population of the United States, increased pressure has been placed on research to determine the impact of patient frailty on healthcare outcomes. While standardized frailty indexes have been published, no gold standard exists for the field of cardiac surgery. This study aims to provide the groundwork for the development of a preoperative frailty metric that improves patient-centered outcome prediction to reduce preoperative stressors for frail patients and their families. 

METHODS
The authors utilized programmed retrospective chart review and a multivariable logistic regression model with backwards variable selection to determine significant frailty-associated variable relationships with desired patient-centered postoperative outcomes. Data was collected from two tertiary hospitals for patients who underwent surgical aortic valve replacement (SAVR) or coronary artery bypass grafting (CABG) between 2021 and 2023. 

RESULTS
Results depict significant utility in using serum albumin and hemoglobin to predict patient-centered dispositional outcomes as increasingly elevated values of both, increase patient odds to be discharged home postoperatively and to have below median hospital stays. Higher albumin levels were individually associated with increased odds of patients being prescribed home therapy regimens. Older age at admission and increasing numbers of comorbidities provide less clinical utility albeit both have significant negative individual associations with desired measured outcomes. Female sex additionally resulted in patients having nearly 0.5 times the odds to receive home therapy prescriptions as their male counterparts despite no impact on discharge disposition or postoperative length of stay. 

CONCLUSIONS
With model predictability, results suggest feasibility in generating a frailty index tool capable of providing predictions for patient-centered outcomes in cardiac surgery in efforts to benefit patient education and reduce patient stressors. Further studies need to be conducted to identify valuable scales, mean values and critical values for determination of each variable's optimal clinical usage in predicting patient-centered outcomes.

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The Impact of Bone Frailty vs. BMI on In-Hospital Outcomes Following Primary Total Hip and Knee Arthroplasties

Mazen Zamzam, B.S.¹, Fong Nham, M.D.², Avianna Arapovic, M.D.¹, Abdul Zalikha, M.D.², Inaya Hajj Hussein, Ph.D.³, Mohannad Othmani, M.D.⁴

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Detroit Medical Center, Detroit, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
⁴Brown University, Providence, RI}

INTRODUCTION
The United States has the highest incidence rate for Total Joint Arthroplasty (TJA), with projections showing continued growth for the next few decades. TJA remains a frequently performed procedure with consistently positive outcomes, thanks to advancements in implant longevity across generations. However, postoperative complications pose a significant financial and logistical challenge for healthcare system stakeholders. Therefore, optimizing comorbidities, situational variables, and patient demographics before surgery guides interventions aimed at improving care quality. Frailty is linked to a higher risk of postoperative complications and adverse economic impacts on hospitals.

METHODS
Discharge data from National Inpatient Sample registry was used to identify all patients 50 or older who underwent TJA in the period between 2006 and 2015. Patients were stratified into frail-nonobese, nonfrail-obese, frail-obese groupings, based on presence of specific ICD-9 diagnostic coding. An analysis comparing the two groups epidemiology, medical comorbidities, and propensity score weighted postoperative clinical and economic outcomes was performed.

RESULTS
In the time period from 2006 to the third quarter of 2015, a total of 1,738,224 (9,554 frail-nonobese, 1,725,402 nonfrail-obese, 3,268 frail-obese) patients who underwent TJA were included in this study. The average age within this study’s population was 63.0 years old, with a female distribution of 65.85%. Frail-nonobese patients were more likely to exhibit significantly higher rates of the majority Modified Elixhauser Comorbities, than other cohorts. Additionally, frail-nonobese patients displayed increased likelihood of experiencing CNS, Cardiac, GI, GU, and infection postoperatively when compared to patients who are nonfrail-obese. 

CONCLUSIONS
Patients exhibiting the defining characteristics of frailty undergoing TJA procedures are at significantly higher risk for inpatient postoperative complications compared to those who are obese. This emphasizes that understanding the implications of frailty is also more vital than obesity for clinical risk assessment, preoperative optimization, and perioperative planning for this expanding population. 

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