Sixth Annual Scholarship Day

David Geffen School of Medicine at UCLA

and

Charles R. Drew University of Medicine and Science

Friday, March 20, 2009

Covel Commons, Grand Horizon Room Sunset Village Auditorium

Conference Moderator:

Wendy Coates, MD Chair, Acute Care College

Director, Medical Education Harbor-UCLA Department of EM

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Table of Contents

Schedule...............................................................................................3

Concurrent Poster Session Schedule ....................................................4 ANESTHESIOLOGY .........................................................................................4 CARDIOLOGY ................................................................................................4 DERMATOLGY/RADIOLOGY..............................................................................4 GASTROINTESTINAL DISORDERS ....................................................................5 HEALTH POLICY.............................................................................................5 INFECTIOUS DISEASES ..................................................................................6 MEDICAL EDUCATION ....................................................................................6 MEDICINE ....................................................................................................7 NEUROSCIENCE ............................................................................................7 OBSTETRICS AND GYNECOLOGY......................................................................7 ONCOLOGY...................................................................................................8 OPHTHALMOLOGY..........................................................................................8 ORTHOPAEDICS ............................................................................................9 PEDIATRICS..................................................................................................9 POTPOURRI ..................................................................................................9 PSYCHIATRY ...............................................................................................10 SURGERY ...................................................................................................10

Oral Plenary Session Schedule............................................................12

Oral Presentation Abstracts................................................................13 John Anderson-Dam.....................................................................................13 Rajan Kulkarni ............................................................................................13 Ana Lopez-O’sullivan ....................................................................................14 Diana Nguyen .............................................................................................14 Elizabeth Videlock........................................................................................15 Victoria Vo..................................................................................................15

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Schedule

8:00 – 9:00 am Check-In South Promenade

Continental Breakfast Buffet Grand Horizon Terrace

Poster Set-Up Grand Horizon Room

9:00 – 10:30 am Concurrent Poster Sessions

10:30 – 10:45 am Students remove posters no later than 10:50 am

11:00 – 12:00 noon Concurrent Plenary Oral Sessions Sunset Village Auditorium

Noon Raffle Drawing

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Concurrent Poster Session Schedule Grand Horizon Room

ANESTHESIOLOGY Moderator: Johanna Schwarzenberger, MD

Poster Student Topic

1 Arnold, Michelle Effect of Obesity on the Rate of Perioperative Complications During General Anesthesia in Surgery Patients

2 Cyril, George Influence of Race and Gender on Back Pain Treatment Outcomes

3 Eromo, Ersne The Impact of Virtual Preoperative Evaluation on the Rate of Day-of-Surgery Case Cancellations

4 Gomez Jr., Ricardo Effects of Pre/Peri-Oprative Low/Moderate/High Dose Opiates on Length of Stay in Hospital

5 Kanouse, Sara Rett Syndrome Presenting with Abnormal Breathing.

6 Kendrick, Christina Anesthetic Managment of Patients with Anterior Mediastinal Masses: A Case Series

7 Nguyen, Tuan Quantitative Analysis of Regional Diaphragmatic Function and Mechanics in Patients with Mesothelioma and Compare to Healthy Subjects Using a Real Time Respiratory Cine MRI

8 Yamoah, Edwin Knowledge and Attitudes about General Anesthesia among Adult Patients at a Los Angeles Clinic.

9 Yaqub, Aaliya Diesel Exhaust Particles and Leukotriene Production

CARDIOLOGY Moderator: Jan Tillisch, MD

10 Amezcua, Ivy Incorporating Ethnic Differences in Cardiometabolic Risk Factors into a New Definition for the Metabolic Syndrome

11 Bhatia, Ravi Impact of Diabetes and Acute Coronary Syndrome on Survival in Patients Treated with Drug-Eluting Stents

12 Burke, Guenevere Novel Pharmacologic Strategies in the Treatment of Pulseless Electrical Activity in a Porcine Model of Cardiac Arrest

13 Dhanasopon, Andrew Tissue Engineering of Blood Vessels Using Human Adipose-Derived Stem Cells on a Gelatin-PCL Electrospun Scaffold

14 Huang, William Do Oxidized Lipids cause Atherosclerosis via a Protein Trafficking Mechanism? 15 Perecko, Stanley Fully Percutaneous Abdominal Aortic Aneurysm Repair: A Case Comparison

16 Sztain, Jacklynn Retrospective Analysis of Patients Undergoing Transesophageal Echocardiography in Conjunction with Cardiac Surgery

17 Trieu, Christine Takotsubo Cardiomyopathy

18 Wang, Judy (Shin-Chern)

Pharmacological Stimulation of NO/Cgmp Levels as a Novel Therapeutic Approach for Myocardial Infarction in a Rat Model

DERMATOLGY/RADIOLOGY Moderators: Lorraine Young, MD

19 Ahdout, Jennifer Modifiable Lifestyle Factors Associated with Metabolic Syndrome in Psoriasis Patients

20 Ahmed, Sameer The Efficacy and Safety of Ultrasonic Shears in Perforator Free Flaps

21 Constantinescu, Monica Altering Dermal Vascularity in order to Assess Vascular Effects on Keratinocyte Biology

22 Graham, Nzinga The Curious Case of Integumentary Illness 23 Kaur, Ravneet A Bruise-Like Patch to the Forehead and Scalp 24 Tam, Sandy The Reproducibility of CT Lung Weight in Measuring Emphysema 25 Tarula, Erick Does the Cerebellum Learn? A Transcranial Magnetic Stimulation Study

26 Tochen, Laura Evaluation of MRI Abnormalities in Vigabatrin-Exposed versus Vigabatrin-Non-Exposed Patients with Infantile Spasms

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Concurrent Poster Sessions - continued

GASTROINTESTINAL DISORDERS Moderator: Jonathan Hiatt, MD

Poster Student Topic 27 Deboyes, Telia Removal of an Ingested Razor Blade: A Case Report 28 Dharia, Ajay Sinistral Portal Hypertension: An Unusual Cause of UGIB

29 Gudmundsson, Mitchell Histopathologic and Radiologic Comparison of Hepatocellular Carcinoma Treated with Transarterial Chemoembolization (TACE) with Ethiodol and TACE with Drug Eluting Beads

30 Nguyen, Angie A Case of Iron Deficiency Anemia in an Otherwise Healthy Female

31 Sepulveda, Joe Low Prevalence of Submucosal Invasive Carcinoma at Esophagectomy for High-Grade Dysplasia or Intramucosal Adenocarcinoma in Barrett's Esophagus: A 20-Year Experience

32 Thaker, Ashesh Combination Therapy Of Radiofrequency Ablation And Bevacizumab In The Treatment Of Ectopic Hepatocellular Carcinoma

33 Thinda, Sumeer A Mesenteric Rheumatoid Nodule Masquerading as an Intra-abdominal Malignancy

34 Yee, Shelley Concurrent Aeromonas hydrophilia Infection and Ischemia Masquerading as Ulcerative Colitis

HEALTH POLICY Moderator: Regina Richter, MA

35 Abejuela, Harmony Health Seeking Behaviors, Health Services Utilization, and Receipt of Clinician Counseling Among Latino Patients in Public Sector Clinics

36 Dixit, Ravi Harbor-UCLA Surgery Wait Time Project

37 Farnad, Shahbaz Differences among Smoker vs. Non-Smoker Property Owners and Managers Implementing Smoke-Free Policies in Multi-Unit Housing

38 Mizrahi, Mish Street-side Rapid Assessment of the Health and Social Needs of the Homeless Population of Westwood Village

39 Scott, Maurice Health Care Disparities among Children in and out of the Los Angeles County Foster Care System

40 Sinigayan, Voltaire Mortality Trends of Surrounding Communities of the Former King/Drew Medical Center: 2004-2007

41 Skor, Anna Picture of Self-Inflicted Injury in LA County

42 Stucky, Shelese Rising Costs of Screening, Diagnosing, and Managing Hearing Loss in Los Angeles County

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Concurrent Poster Sessions - continued

INFECTIOUS DISEASES Moderator: Jodi Friedman, MD

Poster Student Topic

43 Bhasin, Meenakshi Knowledge and Awareness of Horizontal Transmission of HIV among Mauritanian Villagers Living along the Senegal River

44 Celaya, Anna The Effects of CD4 Count on Tuberculin Skin Test Response Rate for Latent Tuberculosis Infection in an Underserved, HIV Infected Population of Los Angeles

45 Dumont, Rebecca Non-Invasive Imaging of Alpha-V Beta-3 Function as a Predictor of the Anti-Migratory and Anti-Proliferative Effects of Dasatinib

46 Feng, Charles Milk-Alkali Syndrome in an HIV Positive Patient 47 Marquez, Evelyn West Nile Virus Encephalitis in an Immunocompromised Patient

48 Shurell, Elizabeth Viral Pericarditis Associated with Liver Inflammation and Scarring: A Case Report

49 Tadros, Engy Cultural Influences on the Comprehension of AIDS in Kenya

50 Vanchinathan, Veena The Influence of Toll-Like Receptor Agonists & Killed but Metabolically Active Leishmania Chagasi Vaccination on Infection Course in an Experimental Murine Visceral Leishmaniasis Model

MEDICAL EDUCATION Moderator: Sebastian Uijtdehaage, PhD

51 Akroush, Alvera Screening for Lung Cancer in the Primary Care Setting

52 Chung, Connie What Motivates University and Community Physicians to Precept Medical Students?

53 Huang, Emily Maximizing Visual Information Exchange: How the Structure of Forest Plots Affects Their Interpretation

54 Melamed, Esther Patient-Based Cultural Competency Curriculum for Pre-Health Professionals

55 Nass, Scott Assessing the Efficacy and Educational Value of a Native American Patient Wellness Case among Non-American Indian/Alaska Native (AIAN) Healthcare Providers

56 Schwartz, Samuel Acgme Compentency Based Public Mock Oral: A Useful Educational Tool for Residents, Students, and Faculty

57 Tran, Linh Waiting Room Education in a County Facility: Evaluating Effects of a Spanish-English Culturally Competent Video Presentation on Patient Knowledge of Diabetic Eye Disease in the Hispanic Adult Population

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Concurrent Poster Session - continued

MEDICINE Moderator: Art Gomez, MD

Poster Student Topic

58 Chen, Christine Effectiveness of Preoperative Embolization of Osseous Tumors (PEOT) using Microspheres versus Non-Microspheres in Reducing Intraoperative Blood Loss: A Retrospective Evaluation of PEOT in 3 Years at a Single Institution

59 Nickols, Nicholas Inhibition of Androgen Receptor Activity with a Designed Sequence-Specific Androgen Response Element Antagonist

60 Oh, Andrea Connexin-43 Hemichannels 61 Pahwa, Avita Statin and Thyroid Nodules

62 Passanante, Giovanni Advanced MRI Analysis of Case of Monozygotic Twins with Tuberous Sclerosis and Discordant Degrees of Epilepsy

63 Ruiz, Rachel A Delayed Reflex: Suspecting Hypothyroidism as a Cause of Renal Dysfunction 64 Shandilya, Ruby Elastic Vascular Sclerosis of Mesenteric Vessels in Carcinoid Tumor

65 Templeman, James Evaluation of a Quality Improvement Program for Depression in Primary Care Safety-Net Settings within Urban Minority Communities

NEUROSCIENCE Moderator: Ken Wolf, MD

66 Goel, Rakhee Use of Diffusion Tensor Imaging to Detect Extra-Hippocampal Changes in Mesial Temporal Lobe Epilepsy Patients

67 Jafarian, Neda Multiple Sclerosis Disease Expression in the Hispanic Population

68 Kazmierski, Brittany Using Diffusion Tensor Imaging to Identify Post-Hemispherectomy White Matter Tract Changes in Hemimegalencephaly Patients: A Case Report

69 Kim, Eujin Ipsilateral Temporal Pole Abnormality in the Patients with Hippocampal Sclerosis: Comparison of MRI, FDG-PET and Pathology

70 Kim, Sarah Multimodality Imaging of Rasmussen's Encephalitis

71 Kim, Won Release of Epigenetic Silencing Sensitizes Glioma to Antigen-Specific Lymphocyte Recognition and Killing

72 Mattes, Malcolm The Role of Proteasome Inhibition by NPI-0052 pn Radiation Sensitivity of Glioblastoma Cell Lines

73 Torbert, Denise Not Another Patient with Vertigo… or is it? A Case Report

OBSTETRICS AND GYNECOLOGY Moderator: Andrea Rapkin, MD

74 Cross, Cherie Intrauterine Growth Restriction and Nutrient Transporters 75 Doan, Luu Racial and Ethnic Disparities in Preconception Care Utilization 76 Hernandez, Ingrid Continuation Rates for IUDs in Family Planning Clinics Serving Indigent Women 77 Katzir , Lirona Predictors of Recurrence in Cervical and Endometrial Cancer

78 Leake, Jamila Opportunities for Improvement: Incidence and Risk Factors for Maternal Mortality from Postpartum Hemorrhage in California

79 Ross, Javay An Assessment of Participation in a Free Mammogram Program by Uninsured and Underinsured African-American Women in Los Angeles County.

80 Villasenor, Maureen Factors Affecting Intent to Vaccinate Adolescent Females against Human Papillomavirus in Underserved Communities and the Effect of Educational Intervention on Intent to Vaccinate

81 Weinberg, Aviva Trends in the Surgical Management of Stress Urinary Incontinence among Female Medicare Beneficiaries

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Concurrent Poster Session – continued

ONCOLOGY Moderator: Sally Krasne, PhD

Poster Student Topic

82 Gandara, Marla Providing Plasma Upfront along with pRBCs during Massive Transfusion Significantly Improves Mortality from Hemorrhaging

83 Hetzer, Nicole Metastatic Breast Cancer Presenting with an Infundibular Mass and Intractable Nausea and Vomiting

84 Hsu, Margaret Differentiating Papillary and Chromophobe Renal Cell Carcinoma on Computed Tomography in Four Phases of Enhancement

85 Lee, Kevin Comparison of PET Tracers for Monitoring Response of Lung Cancer to EGFR Kinase Inhibition

86 Mehdizadeh, Ali Breast Cancer and Klinefelters Syndrome 87 Pedroso, Jasmine Presentation versus Prognosis of Ovarian Cancers: Implications for Screening

88 Rasheed, Sarah Intravascular Large B-cell Lymphoma with Neurological Manifestations: A Case Report

89 Wallner, Caroline Post-Prostatectomy Biochemical Failure: Does Ultrasensitive Prostate Specific Antigen offer Lead Time in the Diagnosis of Prostate Cancer Recurrence?

OPHTHALMOLOGY Moderator: Ralph Levinson, MD

90 Krishna, Sheila The Effect of Race on the Incidence of Retinoblastoma

91 Law, Pamela Waiting Room Education in a County Facility: Evaluating Effects of a Spanish-English Culturally Competent Video Presentation on Patient Knowledge of Diabetic Eye Disease in the Hispanic Adult Population

92 Mand, Paramdeep Pillows and Tape

93 Miller, Adam Outcomes of Cataract Extraction in the Seeing Eyes of Completely versus Functionally Monocular Patients

94 Puri, Aarti The Prevalence of Patent Foramen Ovale (PFO) in Postmenopausal Women who Develop an Ischemic Stroke and the Impact of Hormone Replacement Therapy (HRT)

95 Varshney, Neeta Mechanical and Chemical Disruption of Cell Adhesions of Retinoblastoma Y79 Cells Causes Increased Apoptosis and Decreased Proliferation

96 Vo, Rosalind Prevalence, Management, and Progression of Glaucoma in Patients Undergoing Boston Type 1 Keratoprosthesis Implantation

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Concurrent Poster Session - continued

ORTHOPAEDICS Moderator: Kathy Brown, MD

Poster Student Topic 97 Dowd, Casimir Glenohumeral Cryptococcus Neoformans Septic Arthritis: A Case Report

98 Esmende, Sean The Effects of Local bFGF Release and Uniaxial Strain on Cellular Adaptation and Gene Expression in a 3D Environment: Implications for Ligament Tissue Engineering

99 Espinoza, Ruth A Case Report of Surfer’s Myelopathy - First Time Surfer’s Beware 100 Gurbani, Barkha Arthroscopic Ankle Arthrodesis: A New Gold Standard

101 Hakimi, Michael Synergistic Activation of Osteogenesis in Multi-Lineage Progenitor Cells by Oxysterols

102 Kao, Kaly Effects of Footwear on Medial Compartment Knee Osteoarthritis 103 Perez, Mario Non-surgical Treatment of Lumbar Spinal Stenosis 104 Wood, Meghan Injuries in the Collegiate Female Volleyball Player

PEDIATRICS Moderator: Kelly Young, MD

105 Barba, David The Correlation of Slipped Capital Femoral Epiphysis Presentation with BMI-for-Age Percentiles

106 Castellanos, Ruby Prolonged Central Venous Oxygen Desaturaturations are Associated with Adverse Outcomes in Pediatric Patients

107 Dawes, Candice Factors Affecting Parental Intention to Vaccinate their Adolescent Daughters against Human Papillomavirus in Underserved Communities and the effect of Educational Intervention on Intent to Vaccinate

108 Khosropour, Andrea Adolescent Smoking Cessation 109 Nguyen, Kim-Tan Amiodarone for the Emergency Care of Children

110 Swant, Emily Combination Therapy with Growth Hormone and IGF-I Improves Growth in Growth Hormone Deficient Patients who Respond Poorly to Growth Hormone Alone

111 Tong, Robert Planning and Executing a Teen to Teen Health Fair Targeting Mixteco Teens Living in the Oxnard Area

112 Zaid, Uwais Incidence of Vesicoureteral Reflux in Pediatric Patients with Idiopathic Chronic Kidney

POTPOURRI Moderator: Tony Kuo, MD

113 Bonilla, Janet Isolated Hyperextension of Knee Causing Popliteal Artery Pseduoaneurysm

114 Corey, Susan Waiting Room Education in a County Facility: Evaluating Effects of a Spanish-English Culturally Competent Video Presentation on Patient Knowledge of Diabetic Eye Disease in the Hispanic Adult Population

115 Holly, Jessica Is Ibuprofen Effective for the Prevention against Acute Mountain Sickness?: The Altitude Sickness in Climbers Efficacy of NSAIDs Trial (ASCENT)

116 Le, Elizabeth Use of Early DNR Orders Varies Widely and is Strongly Related to Intensity of Care at the End of Life

117 Muscarella, Louis Advanced MRI Analysis of Case of Monozygotic Twins with Tuberous Sclerosis and Discordant Degrees of Epilepsy

118 Rico, Claudia What Motivates University and Community Physicians to Precept Medical Students?

119 Yang, Calvin BMP-2 and Adipose-Derived Stem Cells in the Healing of Rat Alveolar Defect 120 Young, Phillip Differences in Processes Between Boarding and Nonboarding Patients

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Concurrent Poster Session - continued

PSYCHIATRY Moderator: Margi Stuber, MD

121 Correa, Eva Acculturation, Depressive Symptoms, and Access to Mental Health Services Among Adolescents in California.

122 Dielubanza, Elodi Anti-Apoptotic Mechanisms in Schizophrenia: HSP70, AKT1

123 Downing, Lisa Role of Alcohol Misuse on Depression Symptoms, Outcomes Among Male & Female Emergency Department (ED) Patients

124 Oh, Esther Internet Addiction: A General Overview and Its Associated Psychiatric Comorbidities

125 Peterson, Kimberly Racial Differences in Human Immunodeficiency Virus-Related Risk Behavior Among Youth in Los Angeles: A Comparison of Latino and Non-Latino Adolescents

126 Rojas, Arbis A Retrospective Epidemiological Study Investigating the Association of PTSD with Overactive Bladder, Irritable Bowel Syndrome and Other Disorders

127 Sun, Mary A Descriptive Study of Strangulation in Sexual Assault

SURGERY Moderator: Joe Hines, MD

128 Avanesyan, Armine Post-Orthotopic Liver Transplantation Outcomes for Chronic Hepatitis B: A Seven-Year Follow-Up Study

129 Carballo, Marilee Video-Assisted Thoracic Surgery (VATS) as a Safe Alternative for the Resection of Pulmonary Metastases: A Retrospective Cohort Study

130 Covarrubias, Carolina The Effect of Cardiopulmonary Bypass Time and Donor Organ Ischemic Time on the Need for Extracorporeal Membrane Oxygenation after Orthotopic Heart Transplantation in Children

131 El-Masry, Monica Quality of Life and Projected Post Liver Transplantation Employment Status in Patients Evaluated for Liver Transplantation

132 Faucett, Allison Risk Preferences of Women Planning Surgical Management of Pelvic Organ Prolapse

133 Gonzales, Tatiana Thoracic Outlet Syndrome Presenting as Acute Limb Ischemia: A Rare Case Report

134 Lau, Jennifer Left Heart Catheterization Coronary Artery Disease Preceding OLT: Findings, Treatment and Post-Transplant Survival

135 Tang, Christopher Post Transplant Lymphoproliferative Disorder (PTLD) is a Spectrum of Lymphoid Dysplasias that Occur after Solid Organ Transplantation

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CHARLES DREW UNIVERSITY OF MEDICINE AND SCIENCE

CDU/UCLA Medical Education Program, Medical Student Research Thesis Program,

Department of Psychiatry, College of Medicine & REACH Endowment

Presents:

Current Research in Health Disparities Medical Student Research Colloquium

Class of 2009

Wednesday, March 25, 2009 7:30 a.m. – 5:30 p.m.

Location: Charles Drew University, Keck Lecture Hall

1731 E. 120th Street, Los Angeles, CA 90059

Topics Include:

For further information contact: Griselda L. Cárdenas at 323-563-4965 or via-e-mail at: griseldacardenas@cdrewu.edu

Shahrzad Bazargan-Hejazi, PhD at 323-357-3464 or via e-mail at: shahrzadbazargan@cdrewu.edu

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Oral Plenary Session Schedule Sunset Village Auditorium

11:00 am – 12:00 noon

Student presentations are six minutes in length

followed by a three-minute question and answer period

Moderator: David Schriger, MD Time Student Mentor Presentation

11:00–11:09 Anderson-Dam, John Jaco Festekjian, MD

Prophylactic Mesh Placement to Prevent Abdominal Donor Site Morbidity in Free Flap Breast Reconstruction: A Retrospective Analysis Comparing TRAM, MSFT, and DIEP

11:10–11:19 Kulkarni, Rajan Michael Yeh, MD Clinical Pathways Improve Hospital Resource Utilization in Endocrine Surgery

11:20–11:29 Lopez-O'Sullivan, Ana

David Schriger, MD; Richelle Cooper, MD, MSHS; Jennifer Chen, MD, MPH

Assessment of Risk Tolerance for Adverse Events in VA Emergency Department Chest Pain Patients

11:30–11:39 Nguyen, Diana Lynne Smith, MD

Intrauterine Growth of Infants Exposed to Prenatal Methamphetamine: Results from the Infant Development, Environment, and Lifestyle (IDEAL) Study

11:40–11:49 Videlock, Elizabeth

Lin Chang, MD Early Adverse Life Events are Associated with Increased Responsiveness of the Hypothalamic-Pituitary-Adrenal (HPA) Axis in Individuals with and without IBS

11:50–11:59 Vo, Victoria Reza Jarrahy, MD 2D-3D Study

12:00 noon Door Prize Drawings Sunset Village Auditorium

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Oral Presentation Abstracts

John Anderson-Dam Prophylactic Mesh Placement to Prevent Abdominal Donor Site Morbidity in Free Flap Breast Reconstruction: A Retrospective Analysis Comparing TRAM, MSFT,

and DIEP Introduction: Autologous tissue reconstruction following mastectomy frequently employs the lower abdominal tissues to restore breast contour. The disturbance of the rectus fascia and the abdominal musculature can lead to hernia formation. Methods: The authors conducted a retrospective review of all free flap breast reconstructions performed at the University of California Los Angeles Medical Center between July of 2002 and June of 2006. Results: A total of 387 patients underwent reconstruction utilizing free abdominal flaps. 12.1% were free transverse rectus abdominis myocutaneous (fTRAM) flaps, 47.4% were muscle-sparing free TRAM (MSFT) flaps, and 40.5% were deep inferior epigastric perforator (DIEP) flaps. Mean follow-up was 12.6 months. A total of 51 patients (13.2%) had mesh placed at the time of initial operation. Before accounting for prophylactic mesh, complication rates for fTRAM vs. DIEP showed a statistical trend towards higher rates (14.5% v. 7.1%, p=.09). This trend became significant when comparing fTRAM without mesh vs. DIEP (18.4% v. 7.1%, p=.0.043). fTRAM flaps with mesh compared favorably to DIEP (5.9% v. 7.1%, p=.73). The increase in bulge/hernia rates is also significant when comparing unilateral fTRAM to unilateral DIEP (overall 14.9% vs. 4.1%, p=.029, without mesh 18.4% vs. 4.1%, p=.017, with mesh 7.1% vs. 4.1%, p=.5). Conclusions: The use of mesh in repairing the rectus fascia after fTRAM is not currently routine. In a single institution's experience, the use of synthetic mesh significantly lowered abdominal hernia/bulge rates. The use of prophylactic mesh in repairing the rectus fascia should be considered when choosing a traditional fTRAM reconstruction.

Rajan Kulkarni Clinical Pathways Improve Hospital Resource Utilization in Endocrine Surgery

Background: Clinical pathways are increasingly adopted to streamline care after elective surgery. However, there is little data about their overall efficacy. Here, we describe novel clinical pathways developed for endocrine operations (unilateral thyroid lobectomy, total thyroidectomy, parathyroidectomy) and evaluate their effects on economic endpoints at a major academic hospital. Methods: Average length of stay (LOS) and hospital costs for 681 patients undergoing elective endocrine surgery were compared among patients either on a specific pathway or managed non-pathway. The analysis arms were conducted concurrently to minimize institutional effects. Hospital costs were subdivided by category (bed costs, laboratory, pharmacy). Data were adjusted for comorbidities using the Charlson index. Results: Clinical pathways were observed to significantly reduce LOS and hospital costs among these procedures. Average LOS was reduced for thyroid lobectomy (pathway 1.04 vs. non-pathway 1.58 days, p<0.001), total thyroidectomy (1.05 vs. 2.77, p<0.001) and parathyroidectomy (1.07 vs. 1.63, p<0.001). Clinical pathways reduced average total charges from $24,494 to $18,144 (p<0.0001), with 44.6% of savings attributable to reduced LOS. Significant improvements were observed for laboratory utilization (73.0% reduction in tests ordered, p<0.0001) and non-routine medications administration (37.4% reduction in medications ordered, p<0.0001). Non-pathway patients were 2.84 times more likely to be admitted to the intensive care unit, chiefly for hypocalcemic events, controlling for age and comorbidity. Conclusions: Implementation of clinical pathways improves efficiency of care following elective endocrine surgery, without adversely affecting safety or quality. Because these measures optimize resource utilization, they represent an important component of high-volume subspecialty surgical services.

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Ana Lopez-O’sullivan Assessment of Risk Tolerance for Adverse Events in VA Emergency Department

Chest Pain Patients Purpose: Physicians as a whole have grown conservative about admitting patients in the Emergency Department (ED) with chest pain, largely without patient input. This study seeks to assess patients' tolerance for the possibility of adverse outcomes after an ED visit for chest pain and how this might affect their decision to choose between admission and discharge options. Eliciting patient preferences could help make the decision-making process more patient-centered, rather than physician-centered, and could help conceptualize a "reasonable risk" malpractice standard, ultimately decreasing unnecessary health care utilization. Methods: In this cross-sectional observational study, a convenience sample of stable chest pain patients from the West Los Angeles Veterans' Administration ED will be administered structured interviews. Patients will be presented a description of potential adverse cardiac outcomes they could experience but could be diminished by admission to the hospital. Patients will identify the level of risk at which they prefer admission for further evaluation for their chest pain versus discharge home. We will collect patient demographics (age, race, ethnicity, level of education) and some basic clinical information. As the understanding of risk and discussion with patients can be complicated, we will assess how variation in the presentation of risk affects responses by randomizing patients to different methods of content presentation [probability (e.g. 50%) vs. standard risk statement (e.g. 1 in 2)]. All patients will then repeat the exercise with a visual aid to determine if a graphic presentation results in a different risk threshold. To determine any anchoring effect, we will randomize patients to start with either a low level of risk and increase until their threshold is met, or start with a high level of risk and decrease until their threshold is met. The primary outcome is the patient's reported risk threshold for admission. Results/Conclusion: Data is currently being collected for this project.

Diana Nguyen Intrauterine Growth of Infants Exposed to Prenatal Methamphetamine: Results

from the Infant Development, Environment, and Lifestyle (IDEAL) Study Background: Previous studies suggest prenatal methamphetamine (MA) exposure inhibits fetal growth. However, these retrospective studies are limited by small sample sizes and inadequate controls. Objectives: Examine the neonatal growth effects of prenatal MA exposure in a prospective cohort study. Methods: 3708 subjects were enrolled [n=204 MA exposed (EXP)]. EXP were identified by self-report and/or GC/MS confirmation of amphetamine and metabolites in infant meconium. Women reporting use of opiates, LSD, PCP, or cocaine were excluded. Neonatal parameters included birth weight and gestational age in weeks, and Small for Gestational Age (SGA) was calculated using Alexander's algorithm. One way ANOVA and linear regression analysis were conducted on birth weight by exposure. The relationship of MA exposure and the incidence of SGA was analyzed using multivariate logistic regression analyses. Results: Mothers in the EXP group used more tobacco, alcohol and marijuana during pregnancy. In addition, the EXP group sought prenatal care later, had a lower socioeconomic status and gained more weight during pregnancy than the UnEXP group. Birth weight was lower in the EXP than the UnEXP (3179±609 vs. 3369±557 g; P<0.001) group. In addition, the incidence of SGA was higher in the EXP group (17 vs. 9%; P<0.001). After adjustment for covariates, the EXP group had an increased likelihood of being born SGA. Conclusions: Prenatal methamphetamine use is associated with multiple maternal socioeconomic risk factors and fetal growth restriction. Longitudinal follow-up will determine if these infants are at increased risk for future growth abnormalities or other medical problems associated with being born SGA.

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Elizabeth Videlock Early Adverse Life Events are Associated with Increased Responsiveness of the Hypothalamic-Pituitary-Adrenal (HPA) Axis in Individuals with and without IBS

Background: Early adverse life events (EAL) have been shown to be associated with a poorer outcome and higher levels of distress in adulthood in patients with functional GI disorders (Biggs et al. Gut 2004). EAL is thought to predipose individuals to chronic illness by inducing persistent changes in the corticotropin-releasing factor (CRF) and HPA axis system (Heim et al. Am J Psychiatry 2001). Aims: 1) To determine if EAL affects the cortisol response to a visceral stressor in IBS patients and healthy controls and 2) To determine if there are sex differences in the effect of EAL on cortisol response. Methods: 45 Rome + irritable bowel syndrome (IBS) patients (26F, 19M) and 41 healthy controls (22F, 19M) were studied. All subjects were assessed for GI symptoms, psychological symptoms by HAD questionnaire and structured psychiatric interview. EAL events were assessed by the validated Trauma History Questionnaire and interview and included sexual, physical and verbal abuse and traumatic life events (life-threatening illness, death of a parent) and included if occurred under the age of 14. All subjects underwent a visceral stressor (sigmoidoscopy). Serial salivary cortisol levels were collected at baseline and for 1 hr post-stressor. Results: In individuals with and without IBS, EAL was associated with higher mean cortisol levels following the stressor (p=0.04). In men, 8 IBS patients and 7 controls reported EAL. Cortisol levels were significantly higher in those with EAL than those without (p=0.001). In women, 10 IBS patients and 9 controls reported EAL. There was a trend for higher cortisol levels in those with EAL than those without. Conclusion: 1. Similar to previous reports in depression and in fibromyalgia, HPA axis responsiveness is more related to a history of EAL than to diagnosis. 2. This association of stress-induced cortisol response with EAL is most pronounced in men. Stress early in development is associated with life long sensitization of the HPA axis and this may enhance the vulnerability of affected individuals to stress and stress-related conditions such as functional GI disorders.

Victoria Vo 2D-3D Study

A multidisciplinary comparison of the evaluation of two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) imaging for maxillofacial trauma. BACKGROUND & PURPOSE: Although 2D CT scans have been the preferred imaging technique for facial fractures at many high volume trauma centers, 3D model imaging is currently offered as a newer modality. The diagnostic accuracy in comparison to its 2D counterpart has yet to be determined. In our study, we compare (1) the accuracy of diagnosing facial fractures in patients using 3D and 2D CT scans, (2) the variability between four disciplines (Plastic Surgery, Head and Neck, Oral and Maxillofacial Surgery, and Radiology), and (3) levels of expertise in each using 2D and 3D CT imaging for facial fracture diagnosis. METHODS: Thirty-two residents and attendings (8 participants per division) were selected to score a timed diagnostic sheet total of 12 CT scans (1 2D CT scan and 1 3D model image per patient) from the department of Plastic Surgery, Head and Neck, Oral and Maxillofacial Surgery, and Radiology. Scoring sheets included side of fracture, location of fracture, and operable vs. non-operable fractures. CT scans represented various facial fractures (ZMC, mandible, orbital floor/wall, Le Fort I, frontal sinus, and pan-facial). RESULTS: 2D CT scans took approximately 30% longer to read than 3D CT scan. From fastest to slowest, evaluators of the CT scans ranked as follows (in all 4 departments): Attendings > Chief residents > residents. From fastest to slowest, the departments ranked as follows: Plastic Surgery = Head and Neck > Oral and Maxillofacial Surgery > Radiology. All Evaluators on average diagnosed fractures 4 times more accurately when reviewing 2D CT scans than 3D models for operable orbital floor and medial wall fractures. All other regions were compatible. CONCLUSIONS: Although evaluating surgeons note that the multiple views offered by the 3D CT scans can be very beneficial and time efficient, our data shows that 2D CT scans provide more accurate diagnosis in assessing facial fractures in a patient. MAIN OBJECTIVES OF PRESENTATION: We attempt to ascertain the benefits of 3D imaging in comparison to 2D CT scans, and to provide an insight to the variability in diagnosing facial fractures in the different levels of training in the aforementioned departments.