Boston Area Research Articles

BODY-Q eating-related symptoms following sleeve gastrectomy.

Recent data describing gastrointestinal (GI) symptoms experienced by patients after bariatric surgery is lacking, and previous studies in sleeve gastrectomy patients have been limited in scope of follow-up time or extent of GI symptoms examined. We sought to characterize the prevalence and time course of patient-reported eating-related symptoms in sleeve gastrectomy patients. From July 2020 to July 2021, sleeve gastrectomy patients seen at three Boston area hospitals received electronic surveys and prospectively reported GI symptoms using the BODY-Q eating-related symptoms scale. Descriptive analyses were performed for patient demographics and symptom prevalence. Chi-square tests were used to compare prevalence of eating-related symptoms between follow-up time intervals. 491 sleeve gastrectomy patients completed postoperative surveys with mean follow-up time of 1.9years. Mean age was 46.6years, and 81.3% were female. The most reported GI symptoms overall included constipation (56.6%), bloating (54.0%), heartburn when standing (41.5%), and heartburn when lying down (39.9%) while the least commonly reported symptoms were palpitations (16.3%), low blood sugar (15.7%), and emesis (15.1%). At greater than 12 months, the most reported symptoms similarly included bloating (60.3%), constipation (53.2%), and heartburn while standing (46.0%). When comparing prevalence of eating-related symptoms across follow-up time intervals from < 1 to > 12months, patients reported a significant decrease in constipation, abdominal pain, and nausea over time (p = 0.012, p < .0001, p = 0.03, respectively). Patients experience both upper and lower GI symptoms following sleeve gastrectomy, and symptoms, including bloating, constipation, and heartburn may persist through long-term follow-up. These patient-centered measures add value by guiding preoperative counseling, informing postoperative expectations, and providing real-time clinical feedback for bariatric surgery patients.

Racial and Ethnic Disparities in Postpartum Care in the Greater Boston Area During the COVID-19 Pandemic

Racial and ethnic disparities in postpartum care access have been well identified in the United States. Such disparities could be exacerbated by the COVID-19 pandemic because of amplified economic distress and compromised social capital among pregnant women who belong to racial or ethnic minority groups. To examine whether the COVID-19 pandemic is associated with an increase in the existing racial and ethnic disparity in postpartum care access. This was a retrospective cohort study using electronic health records data. Multinomial logistic regressions in an interrupted time series approach were used to assess monthly changes in postpartum care access across Asian, Hispanic, non-Hispanic Black (hereafter, Black), non-Hispanic White (hereafter, White) women, and women of other racial groups, controlling for maternal demographic and clinical characteristics. Eligible participants were women who gave live birth at 8 hospitals in the greater Boston, Massachusetts, area from January 1, 2019, to November 30, 2021, allowing for tracking 90-day postpartum access until March 1, 2022. Delivery period: prepandemic (January to December 2019), early pandemic (January to March 2020), and late pandemic (April 2020 to November 2021). Postpartum care within 90 days after childbirth was categorized into 3 groups: attended, canceled, and nonscheduled. A total of 45 588 women were included. Participants were racially and ethnically diverse (4735 [10.4%] Asian women, 3399 [7.5%] Black women, 6950 [15.2%] Hispanic women, 28 529 [62.6%] White women, and 1269 [2.8%] women of other race or ethnicity). The majority were between 25 and 34 years of age and married and had a full-term pregnancy, vaginal delivery, and no clinical conditions. In the prepandemic period, the overall postpartum care attendance rate was 75.2%, dropping to 41.7% during the early pandemic period, and rebounding back to 60.9% in the late pandemic period. During the months in the late pandemic, the probability of not scheduling postpartum care among Black (average marginal effect [AME], 1.1; 95% CI, 0.6-1.6) and Hispanic women (AME, 1.3; 95% CI, 0.9-1.6) increased more than among their White counterparts. In this cohort study of postpartum care access before and during the COVID-19 pandemic, racial and ethnic disparities in postpartum care were exacerbated following the onset of the COVID-19 pandemic, when postpartum care access recovered more slowly among Black and Hispanic women than White women. These disparities require swift attention and amelioration to address barriers for these women to obtain much needed postpartum care during this pandemic.

Short-Term Outcomes of the Boston Brace 3D Program Based on SRS and SOSORT Criteria: A Retrospective Study.

Background: Adolescent idiopathic scoliosis (AIS) is characterized by a lateral curvature of the spine with a Cobb angle greater than 10 degrees, accompanied by rotation of the vertebral body. Bracing has been shown to be effective in halting the progression of at-risk curves, and, in some cases, even improving the Cobb angle by 6° or more. The Boston Brace 3D is part of the Boston Orthotics and Prosthetics standardized scoliosis program. The orthosis is custom-fabricated from scans, computer-aided design (CAD), and computer-aided manufactured (CAM) thoracolumbosacral orthosis used in the non-operative management of AIS. Aim: To evaluate the outcomes of a scoliosis program utilizing the Boston Brace 3D orthosis for patients with AIS, based on SRS and SOSORT criteria. Design: Retrospective study. Methods: An electronic medical records search was conducted to identify first-time brace wearers fitted between 1 January 2018, and 30 June 2019, at Boston Orthotics and Prosthetics Boston area clinics that met the SRS/SOSORT research guidelines. The initial out-of-brace, in-brace, and last follow-up X-rays (taken at least 12 months after fitting) were compared. Results: 84% of patients presenting with a single curve and 69% of patients with a double curve saw their curves improve (reduced 6° or more) or remain unchanged (±5°). Thirty-one patients started with a single curve between 25° and 30°, and thirty-two presented at 30° or below. Fifty-nine patients started with a double curve between 25° and 30°, and 59 patients presented at 30° or below. In general, the patients who wore their brace for more hours per day saw improved results. Conclusion: The Boston Brace 3D program is effective in controlling (and in some cases improving) curve progression in the non-operative management of adolescent idiopathic scoliosis. The approach is a repeatable system, as shown in this cohort of thirteen clinicians across six area clinics following the Boston Brace 3D clinical guidelines.

Feasibility and lessons learned on remote trial implementation from TestBoston, a fully remote, longitudinal, large-scale COVID-19 surveillance study.

Longitudinal clinical studies traditionally require in-person study visits which are well documented to pose barriers to participation and contribute challenges to enrolling representative samples. Remote trial models may reduce barriers to research engagement, improve retention, and reach a more representative cohort. As remote trials become more common following the COVID-19 pandemic, a critical evaluation of this approach is imperative to optimize this paradigm shift in research. The TestBoston study was launched to understand prevalence and risk factors for COVID-19 infection in the greater Boston area through a fully remote home-testing model. Participants (adults, within 45 miles of Boston, MA) were recruited remotely from patient registries at Brigham and Women’s Hospital and the general public. Participants were provided with monthly and “on-demand” at-home SARS-CoV-2 RT-PCR and antibody testing using nasal swab and dried blood spot self-collection kits and electronic surveys to assess symptoms and risk factors for COVID-19 via an online dashboard. Between October 2020 and January 2021, we enrolled 10,289 participants reflective of Massachusetts census data. Mean age was 47 years (range 18–93), 5855 (56.9%) were assigned female sex at birth, 7181(69.8%) reported being White non-Hispanic, 952 (9.3%) Hispanic/Latinx, 925 (9.0%) Black, 889 (8.6%) Asian, and 342 (3.3%) other and/or more than one race. Lower initial enrollment among Black and Hispanic/Latinx individuals required an adaptive approach to recruitment, leveraging connections to the medical system, coupled with community partnerships to ensure a representative cohort. Longitudinal retention was higher among participants who were White non-Hispanic, older, working remotely, and with lower socioeconomic vulnerability. Implementation highlighted key differences in remote trial models as participants independently navigate study milestones, requiring a dedicated participant support team and robust technology platforms, to reduce barriers to enrollment, promote retention, and ensure scientific rigor and data quality. Remote clinical trial models offer tremendous potential to engage representative cohorts, scale biomedical research, and promote accessibility by reducing barriers common in traditional trial design. Barriers and burdens within remote trials may be experienced disproportionately across demographic groups. To maximize engagement and retention, researchers should prioritize intensive participant support, investment in technologic infrastructure and an adaptive approach to maximize engagement and retention.

Bowel Health, Brain Age, Brain Volume and Cognitive Function in the Boston Puerto Rican Health Study

ObjectivesThe gut-brain axis has been shown to play an important role in neurodegeneration. Bowel dysfunction, such as constipation, is a marker of gut dysbiosis, which has been associated with risk of dementia in prior studies. However, no work has been done in Puerto Ricans, who have unique dietary and lifestyle characteristics impacting both gut and brain health. We aimed to study the association between constipation and cognitive outcomes including MRI-derived brain age, brain volume and cognitive function in a cohort of Puerto Ricans. MethodsThis analysis was conducted within the Boston Puerto Rican Health Study (BPRHS), an ongoing longitudinal cohort that enrolled 1502 self-identified Puerto Rican adults residing in the Boston area, aged 45–75 y at baseline through wave-4 (mean 12.7 ± 1.2 y from baseline). Our study was comprised of 179 participants at wave-4 (12.7 y). Brain age was derived from magnetic resonance imaging (MRI) features that included cortical thickness, area, volume, cerebellar-subcortical and cortical summary, using a machine learning model. Brain age deviation score was used to represent the difference of the participants’ brain age from their biological age, with higher scores representing more advanced brain aging. Constipation was estimated from self-reported bowel health and defined as bowel frequency < 1/d. Global cognitive score (GCS) is a composite of executive function, memory and attention factors. Covariate-adjusted linear regression was used to examine the association between bowel health and brain age, brain volume and GCS at wave-4 (12.7 y). ResultsAmong 179 participants with MRI, cognitive function (GCS), and bowel health measures at wave-4 (12.7 y), 45 (25.1%) self-reported constipation, defined as bowel frequency < 1/d (age 66.5 ± 7.8 y; female 75.6%). In covariate adjusted multivariable analyses, we observed that constipation was associated with higher brain age deviation (poorer brain health) (β = 0.377, P = 0.0451). We did not observe an association between constipation and brain volume (P = 0.175) or constipation and cognitive function (P = 0.573). ConclusionsIn this study of older, Boston–Area Puerto Ricans, we observed an association between constipation and brain age, but no association between constipation and brain volume or cognitive function. Funding SourcesNIH

The Evolution of CRISPR Technology from Editing to Diagnostics

The Evolution of CRISPR Technology from Editing to Diagnostics

Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical Trial

Rationale & ObjectiveTo design and implement clinical decision support incorporating a validated risk prediction estimate of kidney failure in primary care clinics and to evaluate the impact on stage-appropriate monitoring and referral.Study DesignBlock-randomized, pragmatic clinical trial.Setting & ParticipantsTen primary care clinics in the greater Boston area. Patients with stage 3-5 chronic kidney disease (CKD) were included. Patients were randomized within each primary care physician panel through a block randomization approach. The trial occurred between December 4, 2015, and December 3, 2016.InterventionPoint-of-care noninterruptive clinical decision support that delivered the 5-year kidney failure risk equation as well as recommendations for stage-appropriate monitoring and referral to nephrology.OutcomesThe primary outcome was as follows: Urine and serum laboratory monitoring test findings measured at one timepoint 6 months after the initial primary care visit and analyzed only in patients who had not undergone the recommended monitoring test in the preceding 12 months. The secondary outcome was nephrology referral in patients with a calculated kidney failure risk equation value of >10% measured at one timepoint 6 months after the initial primary care visit.ResultsThe clinical decision support application requested and processed 569,533 Continuity of Care Documents during the study period. Of these, 41,842 (7.3%) documents led to a diagnosis of stage 3, 4, or 5 CKD by the clinical decision support application. A total of 5,590 patients with stage 3, 4, or 5 CKD were randomized and included in the study. The link to the clinical decision support application was clicked 122 times by 57 primary care physicians. There was no association between the clinical decision support intervention and the primary outcome. There was a small but statistically significant difference in nephrology referral, with a higher rate of referral in the control arm.LimitationsContamination within provider and clinic may have attenuated the impact of the intervention and may have biased the result toward null.ConclusionsThe noninterruptive design of the clinical decision support was selected to prevent cognitive overload; however, the design led to a very low rate of use and ultimately did not improve stage-appropriate monitoring.FundingResearch reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award K23DK097187.Trial RegistrationClinicalTrials.gov Identifier: NCT02990897.

Geomagnetic disturbances reduce heart rate variability in the Normative Aging Study

BackgroundSolar and geomagnetic activity (GA) have been linked to increased cardiovascular (CVD) events. We hypothesize that heart rate variability (HRV) may be the biological mechanism between increased CVD risk and intense geomagnetic disturbances (GMD). MethodsTo evaluate the impact of GA and intense GMD on HRV in 809 elderly men [age mean 74.5 (SD = 6.8)] enrolled in the Normative Aging Study (Greater Boston Area), we performed repeated-measures using mixed-effects regression models. We evaluated two HRV outcomes: the square root of the mean squared differences of successive normal-to-normal intervals (r-MSSD) and the standard deviation of normal-to-normal heartbeat intervals (SDNN) in milliseconds (ms). We also compared the associations between Kp and HRV in patients with and without comorbidities such as diabetes and coronary heart diseases (CHD). We used data on global planetary K-Index (Kp) from middle latitudes as a GA and GMD (>75th Kp) parameters from the National Oceanic and Atmospheric Agency's Space Weather Prediction Center. ResultsWe found a near immediate effect of continuous and higher Kp on reduced HRV for exposures up to 24 h prior to electrocardiogram recording. A 75th percentile increase in 15-hour Kp prior the examination was associated with a −14.7 ms change in r-MSSD (95 CI: −23.1, −6.3, p-value = 0.0007) and a −8.2 ms change in SDNN (95 CI: −13.9, −2.5, p-value = 0.006). The associations remained similar after adjusting the models for air pollutants over the exposure window prior to the event. In periods of intense GMD, the associations were stronger in patients with CHD and non-diabetes. ConclusionsThis is the first study to demonstrate the potential adverse effects of geomagnetic activity on reduced heart rate variability in a large epidemiologic cohort over an extended period, which may have important clinical implications among different populations.

Risk of SARS-CoV-2 Infection Among Essential Workers in a Community-Based Cohort in the United States.

ObjectivesThe objective of this paper is to identify the risk factors for SARS-CoV-2 infection that are related to occupation type as well as workplace conditions. Identifying such risk factors could have noteworthy implications in workplace safety enhancement and emergency preparedness planning for essential workers.MethodsWe conducted a retrospective analysis of visits at a community-based SARS-CoV-2 testing site in the greater Boston area between March 18th and June 19th, 2020, for individuals between 14 and 65 years of age. Nasopharyngeal swab specimen, medical review, and self-administered questionnaire were obtained, and SARS-CoV-2 infection was determined with real-time, reverse transcriptase-polymerase chain reaction (RT-PCR). Medical record-verified job classification, customer-facing, and work patterns were extracted from each individual's response through chart review and validated by licensed clinicians. The occupational patterns were coded by occupational medicine physicians with pre-specified criteria and were analyzed with logistic regression and inverse probability weighting.ResultsAmong the 780 individuals included in the final analysis, working in healthcare-related jobs was associated with a four-fold increase in risk of SARS-CoV-2 infection (Adjusted OR: 4.00, 95% CI: 1.45–11.02). Individuals with customer-facing jobs had a two times risk increase (Adjusted OR: 1.97, 95% CI: 1.12–3.45) in having a positive SARS-CoV-2 RT-PCR assay result compared to participants with non-customer facing positions.ConclusionsIn this U.S. community-based population during the initial wave of the pandemic, a significant increase in risk of SARS-CoV-2 infection was observed in those employed in the healthcare sector or with customer-facing positions. Further research is warranted to determine if these correlations continued with the buildup of population immunity together with the attenuation of SARS-CoV-2 virulence.

Exploring COVID-19 Vaccine Hesitancy Amongst Black Americans: Contributing Factors and Motivators.

To determine reasons for hesitancy towards COVID-19 vaccination and motivators to increase COVID-19 vaccine uptake among Black Americans. Mixed-methods. Individual interviews in March-April 2021. Black adults (20-79years) who attended a church in Boston, MA and identified as "vaccine hesitant" (n = 18). Individual in-depth Zoom interviews to elicit participant views on vaccines in general, specific reasons for COVID-19 vaccine hesitancy, and trusted sources of information. Participants were also asked about possible motivators that could increase COVID-19 vaccine uptake. Transcripts were de-identified and analyzed for major themes using an inductive approach. Analysis included 18 complete interviews. Lack of trust in the government, healthcare, or pharmaceutical companies (n = 18), rushed development (n = 14), fear of side effects (n = 12), history of medical mistreatment (n = 12), and a perception of low risk of disease (n = 9) were the top-cited reasons for COVID-19 vaccine hesitancy. Motivators likely to increase COVID-19 vaccine uptake included more data (n = 17), friends and family getting vaccinated (not celebrities) (n = 11), and increased opportunities that come along with being vaccinated (n = 8). There were many reasons for COVID-19 vaccine hesitancy, as reported by participants who were all Black Americans in the Boston area. The public health challenge of increasing vaccine uptake in the Black community is nuanced and intervention efforts may be more successful if delivered by trusted members of the community and tailored to the needs of individuals.

Examining Health Conditions, Impairments, and Quality of Life for Pediatric Feeding Disorders.

By understanding health conditions, impairments, and impact on quality of life for pediatric feeding disorders, assessment and treatment approaches can target multiple levels of health-related domains that improve child health and well-being. The purpose of this study was to characterize medical diagnoses and feeding impairments for children with feeding disorders; examine child quality of life and caregiver impact; and compare quality of life differences between children with feeding disorders and children with other conditions. A cross-sectional study was conducted in the Greater Boston Area, between October 2017 and June 2018. Fifty children with a feeding disorder diagnosis, ages 2-5years, were enrolled. Demographic and clinical data were abstracted from the electronic health record to characterize medical diagnoses and impairments. Parents completed the Pediatric Quality of Life Generic Core Scales 4.0 (PedsQL) and the Feeding/Swallowing Impact Survey (FS-IS) to understand child quality of life and caregiver impact. We calculated descriptive statistics across the medical diagnosis and impairment groups, and for the surveys. Children presented with heterogeneous medical diagnoses and feeding impairments. We found a mean (SD) total score of 72.82(19.21) on the PedsQL and 2.33(0.89) on the FS-IS demonstrating that children with feeding disorders presented with poor quality of life and their caregivers were negatively impacted by their feeding difficulties. By understanding medical diagnoses, impairments, and quality of life, assessment and treatment methods can be tailored to children's specific needs, as well as address the overall wellbeing of children and their families.

Spatial Distribution and Regional Agglomeration of High-Tech Regions and Venture Capital

In this paper, I will closely examine the Mark Granovetter’s theories related to economic sociology and embeddedness. I will then apply those theories to the study of venture capital and high technology regions. My main research question encompasses the role of networks and social relations and their impact on the formation and development of high-technology clusters. Regions such as Silicon Valley (Greater Bay Area) and Route 128 (Greater Boston Area) are known as knowledge economies and contribute to great economic growth and innovation. While AnnaLee Saxenian spent her time researching the sociology of the emergence of Silicon Valley as a high-tech cluster, I will add to this research by applying the framework she used to study the role of networks within venture capital in Silicon Valley. Venture capital is particularly fascinating to study since this funding is the main driver stimulating local entrepreneurship and the regional economy.

Domestic Violence in Urban American Muslim Women

Muslims constitute about one percent of the U.S. population. Ten percent of U.S. media stories on domestic violence (DV) focus on American Muslims, implying a higher-than-average rate of DV in the American Muslim community. Our study estimates the prevalence of DV among Muslim women in greater Boston and compares it to DV rates among American women as a whole. The study also examines the effect of education, income, and employment status on DV in both samples in comparison with each other. We anonymously surveyed 332 American Muslim women over the age of 18 at five mosques in the greater Boston area and found the DV rate among our study participants to be comparable with that among American women in general.We used data from the National Longitudinal Study of Adolescent to Adult Health (AddHealth) as a surrogate for the U.S. as a whole. Our study participants experienced less intimate partner violence and more aggression from parents and siblings than the women in AddHealth. Also, rising socioeconomic and employment status were not buffers against DV in our study as they were for the AddHealth participants. Ethnicity or country of birth had no impact on DV risk among the women in our study. These results are important because they counter the bias in U.S. media that implies DV is more prevalent among American Muslims than in the U.S. population at large. Our data also suggests measures to ameliorate DV in American Muslims need to target the whole family (i.e., parents and children of both genders).

Urination Frequency Ranges in Healthy Women.

Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts. This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake. A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake. Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies. Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.

Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults

Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown. To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms. This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach. The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care. Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores. A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms. This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms. ClinicalTrials.gov Identifier: NCT03224468.

Using Digital Arts Engagement to Combat Loneliness Amongst Older Adults Living in Long-Term Care

<h3>Introduction</h3> Around 43% of Americans aged 60 and older, report experiencing loneliness on a regular basis. The prevalence of loneliness is even higher amongst those living in long term care facilities, with approximately 61% of residents experiencing loneliness regularly. Loneliness is associated with an increased risk for developing a variety of physical and mental illnesses. Prior research has found that older adults who engage with receptive arts, such as museum trips, more frequently are less likely to report feelings of loneliness. During the COVID-19 pandemic, typical in-person art activities with long-term care residents, such as field trips to museums or visits from community members, could not take place. Therefore, the student-run Harvard ARTZ (HARTZ) organization developed the Interactive Virtual Museum (IVM), which is a diverse collection of online art exhibits curated for older adults, as an innovative method to meaningfully connect residents with community members and to combat loneliness digitally, through art. The goal of the IVM is to reduce feelings of loneliness in older residents by engaging them with art and facilitating conversations about the exhibits in a way that does not put them at risk during the ongoing pandemic. <h3>Methods</h3> The IVM was created in collaboration with the Harvard Art Museums between September and December of 2020. HARTZ volunteers worked with the Harvard Art Museums staff members to curate an online exhibit of art pieces from their digital collection. Each exhibit was also paired with a prompt to encourage discussion about the artwork. From January 2021 to November 2021, the IVM was piloted in two long term care facilities in the Greater Boston Area. For the pilot, student volunteers from the HARTZ organization would schedule virtual trips to the IVM with the residents, which consisted of an hour-long phone or video call where volunteers and residents could go through the IVM together and discuss the different exhibits. Six student volunteers and 47 residents participated in the pilot. The residents included 35 females and 12 males, all between the ages of 62 and 91. In order to participate, residents needed a device with internet access, a device to call or video chat, and the ability to operate the devices independently or with assistance from someone else. For residents unable to access the IVM on their own, volunteers could instead use screen share to show the residents the IVM and navigate it on the resident's behalf. Residents and volunteers used the artwork and prompts in the exhibits as starting points for conversation. At the conclusion of the trip, all 47 residents were asked how they liked the virtual trip to the IVM and how they would compare this trip to a traditional in-person art museum trip. Feedback was voluntary and informal. Volunteers recorded and anonymized the responses. <h3>Results</h3> All 47 residents who participated in the IVM pilot provided feedback. Four main recurring themes were identified from these reflections. First, 39 residents said the trip to the IVM was an engaging social activity and that they enjoyed spending time with the volunteer. Second, 32 residents reported a more immersive art viewing experience, because the digital format allowed them to manipulate and ‘touch' the art on their screens, which is not possible in a traditional museum. Third, 27 residents experienced a greater sense of agency over their IVM experience than a traditional art museum trip. Specifically, residents mentioned that the IVM reduced viewing restrictions and enabled them to conveniently revisit and zoom into pieces at will. Finally, conversing about the pieces in the IVM encouraged the recall of personal memories. <h3>Conclusions</h3> The IVM is an effective way to harness the benefits of in-person art activities in a virtual format during this ongoing pandemic. The IVM is also a more accessible art space for residents who have physical and other health limitations that prevent them from travelling to museums. Additionally, the IVM could play a role in reminiscence therapy since the IVM encouraged the recall of personal memories. The virtual format also opens the possibility for forging meaningful connections between community members and residents in difficult to reach regions (e.g., rural areas) to help reduce potential feelings of loneliness. Future studies should expand the IVM to long term care residents and community-dwelling older adults who live in rural regions or are unable to leave their home due to medical reasons. Also, since the pilot trips found the IVM to be a feasible activity with positive feedback overall, future studies should directly study the impact of the IVM on loneliness by administering more structured surveys which assess loneliness and mood after participating in the IVM. With internet usage amongst older adults steadily increasing, the IVM is a promising avenue for utilizing the digital world to combat loneliness amongst older adults. <h3>Secondary Rationale</h3> Not applicable. <h3>This research was funded by</h3> Not applicable.

149. Turning the Hospital Inside Out: Expanding Access to COVID-19 Vaccinations for Underserved Adolescents Using Mobile Outreach

There exist clear disparities in COVID-19 vaccination rates for adolescents and young adults in Massachusetts and across the United States. Massachusetts Department of Public Health data demonstrates that where social vulnerability is high in our communities, COVID vaccination rates for adolescents and young adults staggers. With community engagement as the backbone, we implemented a low-barrier, mobile walk-in COVID-19 vaccination unit using a community health van in the greater Boston area from May 2021 to present to help address disparities in vaccination for this vulnerable population.

Virtual Compared With In-Clinic Transvaginal Ultrasonography for Ovarian Reserve Assessment.

To evaluate noninferiority of virtual transvaginal ultrasonography compared with in-clinic ultrasonography for ovarian reserve assessment. We conducted a single-site, head-to-head crossover trial. Participants performed self-administered virtual transvaginal ultrasonography at home, guided by a remote-certified ultrasound technologist, then underwent transvaginal ultrasonography in-clinic with another ultrasound technologist. Participants were women in the greater Boston area interested in evaluating ovarian reserve and recruited through social media, health care referrals, and professional networks. The uterus and ovaries were captured in sagittal and transverse views. These randomized recordings were reviewed by two or three independent, blinded reproductive endocrinologists. The primary outcome was noninferiority of the rate of clinical quality imaging produced at home compared with in clinic. Sample size was selected for greater than 90% power, given the 18% noninferiority margin. Secondary outcomes included antral follicle count equivalency and net promoter score superiority. Fifty-six women were enrolled from December 2020 to May 2021. Participants varied in age (19-35 years), BMI (19.5-33.9), and occupation. Ninety-six percent of virtual and 98% of in-clinic images met "clinical quality." The difference of -2.4% (97.5% CI lower bound -5.5%) was within the noninferiority margin (18%). Antral follicle counts were equivalent across settings, with a difference in follicles (0.23, 95% CI -0.36 to 0.82) within the equivalence margin (2.65). Virtual examinations had superior net promoter scores (58.1 points, 97.5% CI of difference 37.3-79.0, P<.01), indicating greater satisfaction with the virtual experience. Virtual transvaginal ultrasonography remotely guided by an ultrasonography technologist is noninferior to in-clinic transvaginal ultrasonography for producing clinical quality images and is equivalent for estimating antral follicle count. Virtual transvaginal ultrasonography had superior patient satisfaction and has potential to significantly expand patient access to fertility care. This study was sponsored by Turtle Health. ClinicalTrials.gov, NCT04687189.

Adherence to Mediterranean Diet and Depressive Symptomatology Among Boston Area Puerto Ricans.

Higher Mediterranean diet (MeD) adherence has been linked with lower depressive symptomatology, but research examining this association is limited, especially among Latinos, including mainland U.S. Puerto Ricans. Hence, we examined cross-sectional and longitudinal associations between MeD adherence and self-reported depressive symptomatology in Boston area Puerto Rican adults. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depressive symptoms. Adherence to MeD was assessed at all 3 visits. We used multivariable linear regression for baseline cross-sectional analysis, and linear mixed effects modeling over 3 waves of follow-up for longitudinal analysis. We also assessed whether baseline MeD adherence affected 5y CES-D trajectory. We conducted sensitivity analyses among participants without diabetes, and among participants with complete MeD and CES-D measures at all visits. MeD adherence was significantly associated with CES-D score at baseline (β = -2.0, 95% confidence interval [CI] -4.0, -0.04 for highest vs lowest tertile, p trend = .04) and across 3 waves (β = -1.9, 95% CI = -3.0, -0.8 for highest vs lowest tertile, p trend = .0005). Results were similar in analyses restricted to participants without diabetes, as well as among participants with complete CES-D and MeD scores at all visits. While CES-D score was consistently lower in those with higher MeD adherence over 5 years of follow up, no relationship between baseline MeD adherence and 5y CES-D trajectory was observed.

Longitudinal symptom changes and association with home time in people with schizophrenia: An observational digital phenotyping study

BackgroundSmartphone assessments and sensors offer the ability to easily assess symptoms across environments in a naturalistic and longitudinal manner. However, the value of this new data to make inferences about personal vs population health and the role of environment in moderating symptoms in schizophrenia has not been fully explored in a scalable and reproducible manner. MethodsEighty-six adults with a diagnosis of schizophrenia were recruited from the Greater Boston Area between August 2019 and May 2021. Using the open-source mindLAMP app in an observational manner, smartphone surveys and sensors (GPS, accelerometer, screen on/off and call and text logs) were collected for up to six months. ResultsSixty-three participants were analyzed, who had at least completed one survey in the app. App-based self-reported symptom surveys were highly correlated with scores on gold standard clinical assessments (r = 0.80, p = 10−11 for mood and r = 0.78, p = 10−12 for anxiety). For these app-based assessments, inter-individual differences account for a larger proportion of the correlations in longitudinal symptoms as compared to intra-individual differences. Mood, sleep, and psychosis symptoms reported on app surveys were more severe when taken at home as determined by the smartphone's GPS sensor. DiscussionThe intra-individual symptom correlations and the stratification of symptoms by home-time highlight the utility of digital phenotyping methods as a diagnostic tool, as well as the potential for personalized psychiatric treatment building on this data.