Chicago Center Research Articles

Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework.

Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults.

Clinical Validation and Comparison of Bacterial Vaginosis Detection

Abstract Introduction/Objective Bacterial vaginosis (BV) is considered a top reason for women’s gynecological visits, causing symptoms such as vaginal discharge, foul odor, itching, and burning associated with the alteration of the normal vaginal microbiome. It is often presented as a decrease in Lactobacillus spp. and an increase in anaerobic organisms such as Gardnerella vaginalis and Atopobium vaginae. In response to the demand for more automated and less subjective testing, molecular methods have recently been developed to aid in BV testing. The objectives of this study are to validate and compare the molecular Aptima® Bacterial Vaginosis Assay by Hologic® to the established BV Screen via a Gram stained vaginal smear graded through Nugent scoring at RUSH University Medical Center in Chicago, IL and perform a cost analysis between the testing methods. Methods/Case Report Samples of known BV value were tested on the Panther® instrument to validate the Aptima® Bacterial Vaginosis Assay for accuracy and precision. Clinical samples of vaginal swabs were used to make a Gram stained BV screen for Nugent scoring, then afterwards were placed into Hologic Multitest Aptima® probes for molecular testing on the Panther® instrument. Nugent scoring was performed blind by the molecular test. Molecular results of negative, positive, and invalid were then compared to the Nugent scores: scores of 0-3 for negative/normal vaginal flora, 7-10 for positive BV, and 4-6 for intermediate/altered scores were screened for discrepancy. Results (if a Case Study enter NA) The Aptima® BV Assay tested 52 known samples with 97% accuracy and 100% precision. A total of 80 clinical samples of vaginal swabs used for Gram stained BV screens were run on the Aptima® BV Assay; 61 provided conclusive data for comparative analysis. When compared to the original Nugent scores, the positive percent agreement (PPA) was 77.0% and negative percent agreement (NPA) was 92.9%. Conclusion The Aptima® BV Assay proved to be both accurate and precise in its validation testing. Clinically, it was able to screen for BV in vaginal samples with a good percent agreement to Gram stained BV screens. Further testing of additional clinical samples are to be done to continue analysis. Although the supplies needed to perform a Gram stain cost less than molecular testing, the reimbursement payment for molecular testing is much greater and overall reduces employee time costs for performing the test, making it the more cost effective choice for the laboratory.

Racial and ethnic disparities in COVID-19 hospital cost of care.

Although studies have evaluated the hospital cost of care associated with treating patients with COVID-19, there are no studies that compare the hospital cost of care among racial and ethnic groups based on detailed cost accounting data. The aims of this study were to provide a detailed description of the hospital costs of COVID-19 based on individual resources during the hospital stay and standardized costs that do not rely on inflation adjustment and evaluate the extent to which hospital total cost of care for patients with COVID-19 differs by race and ethnicity. This study used electronic medical record data from an urban academic medical center in Chicago, Illinois USA. Hospital cost of care was calculated using accounting data representing the cost of the resources used to the hospital (i.e., cost to the hospital, not payments). A multivariable generalized linear model with a log link function and inverse gaussian distribution family was used to calculate the average marginal effect (AME) for Black, White, and Hispanic patients. A second regression model further compared Hispanic patients by preferred language (English versus Spanish). In our sample of 1,853 patients, the average adjusted cost of care was significantly lower for Black compared to White patients (AME = -$5,606; 95% confidence interval (CI), -$10,711 to -$501), and Hispanic patients had higher cost of care compared to White patients (AME = $8,539, 95% CI, $3,963 to $13,115). In addition, Hispanic patients who preferred Spanish had significantly higher cost than Hispanic patients who preferred English (AME = $11,866; 95% CI $5,302 to $18,431). Total cost of care takes into account both the intensity of the treatment as well as the duration of the hospital stay. Thus, policy makers and health systems can use cost of care as a proxy for severity, especially when looking at the disparities among different race and ethnicity groups.

Real-world experience of abemaciclib for adjuvant and metastatic breast cancer.

Hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer is the most common subtype. Abemaciclib, an inhibitor of cyclin-dependent kinases 4 and 6, was approved to reduce risk of recurrence in high-risk, HR+, HER2-, early breast cancer based on the monarchE trial. The most common adverse events reported in monarchE were diarrhea, neutropenia, and fatigue. Real-world tolerability data and incidence of adverse events with abemaciclib in the adjuvant setting versus the metastatic setting is lacking. This is a retrospective analysis of HR+, HER2- breast cancer patients on abemaciclib from March 2018 to September 2021 at Robert H. Lurie Comprehensive Cancer Center in Chicago, Illinois. Incidence, grade of adverse events, dose reductions, and discontinuations were evaluated in patients taking abemaciclib in the adjuvant setting and the metastatic setting. Of the 30 patients included in this analysis, 100% experienced an adverse event of any grade. During treatment, 12.5% treated in the adjuvant setting and 35.7% in the metastatic setting experienced grade ≥3 adverse events. Adverse events leading to discontinuation of abemaciclib occurred in 18.8% of patients in the adjuvant setting and 57.1% in the metastatic setting. This data suggests abemaciclib is better tolerated in high-risk, HR+, HER2-, node-positive, early breast cancer treated in the adjuvant setting compared to the metastatic setting. Management of adverse events is crucial to help patients stay on therapy to improve clinical outcomes. Real-world tolerability of abemaciclib in both the adjuvant and metastatic settings is of importance.

The Impact of the Communities that Care Approach in Reducing Violence and Crime Within an Urban, High-Burden Community.

Community violence and crime are significant public health problems with serious and lasting effects on young people, families, and communities. This violence and crime have significant ripple effects, affecting not just those who are directly physically injured, but also those who witness violent episodes, those who have friends or loved ones killed or injured, and those who must everyday navigate streets that they know have been frequent sites of serious violence and crime. The current study presents evidence of the impact that a data-driven, collective impact approach - the Communities that Care prevention system - can have on violence and crime outcomes within a large urban, high-burden community. Established as one of the national Youth Violence Prevention Centers (YVPC) funded by the Centers for Disease Control and Prevention, the Chicago Center for Youth Violence Prevention is among the first to implement the CTC approach in a large, urban community. The current study's findings show reductions in violence (i.e., aggravated assaults and robberies) in the Bronzeville community, compared to similar communities in Chicago.

Prevalence of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Individuals With Dystrophinopathy at a Tertiary Care Center in Chicago

ObjectiveTo study the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in individuals with dystrophinopathy compared with the general population. MethodsRetrospective chart review to examine the prevalence of ADHD and ASD, diagnosed both formally and informally, in individuals with dystrophinopathy receiving care in the multidisciplinary neuromuscular clinic at the Ann and Robert H. Lurie Children's Hospital of Chicago. ResultsOur results demonstrate an ADHD prevalence of 18.40% and ASD prevalence of 12.73%, both significantly higher than those reported for the general population. Our results revealed a significant association between ADHD diagnosis and a positive family history but did not show a statistically significant association between prevalence of ADHD and the use of steroids. ConclusionBased on our current study results, we plan to further evaluate the prevalence, in a prospective cross-sectional manner, using validated screens for both ADHD and ASD.

Patient and clinician preferences for diabetes management among older adults with co-morbid HIV: A qualitative exploration.

Older adults with HIV are at increased risk of developing certain chronic health conditions including type 2 diabetes mellitus (T2DM). As the number and complexity of conditions increases, so do treatment and health care needs. We explored patient and clinician preferences for HIV+T2DM care and perceived solutions to improving care. We conducted an exploratory qualitative study comprised of individual in-depth interviews. Participants included English-speaking patients aged 50 and older living with HIV and T2DM and infectious disease (ID) and primary care (PC) clinicians from a large academic health center in Chicago. Thematic analysis drew from the Framework Method. A total of 19 patient and 10 clinician participants were interviewed. Many patients reported seeking HIV and T2DM care from the same clinician; they valued rapport and a 'one-stop-shop'. Others reported having separate clinicians; they valued perceived expertise and specialty care. Nearly all clinicians reported comfort screening for T2DM and initiating first line oral therapy; ID clinicians reported placing referrals for newer, complex therapies. Patients would like educational support for T2DM management; clinicians would like to learn more about newer therapies and easier referral processes. Patient-centered care includes managing T2DM from a variety of clinical settings for individuals with HIV, yet strategies are needed to better support clinicians. Future research should examine how best to implement these strategies.

Altered transcriptomic immune responses of maintenance hemodialysis patients to the COVID-19 mRNA vaccine.

End-stage renal disease (ESRD) patients experience immune compromise characterized by complex alterations of both innate and adaptive immunity, and results in higher susceptibility to infection and lower response to vaccination. This immune compromise, coupled with greater risk of exposure to infectious disease at hemodialysis (HD) centers, underscores the need for examination of the immune response to the COVID-19 mRNA-based vaccines. The immune response to the COVID-19 BNT162b2 mRNA vaccine was assessed in 20 HD patients and cohort-matched controls. RNA sequencing of peripheral blood mononuclear cells was performed longitudinally before and after each vaccination dose for a total of six time points per subject. Anti-spike antibody levels were quantified prior to the first vaccination dose (V1D0) and 7 d after the second dose (V2D7) using anti-spike IgG titers and antibody neutralization assays. Anti-spike IgG titers were additionally quantified 6 mo after initial vaccination. Clinical history and lab values in HD patients were obtained to identify predictors of vaccination response. Transcriptomic analyses demonstrated differing time courses of immune responses, with prolonged myeloid cell activity in HD at 1 wk after the first vaccination dose. HD also demonstrated decreased metabolic activity and decreased antigen presentation compared to controls after the second vaccination dose. Anti-spike IgG titers and neutralizing function were substantially elevated in both controls and HD at V2D7, with a small but significant reduction in titers in HD groups (p<0.05). Anti-spike IgG remained elevated above baseline at 6 mo in both subject groups. Anti-spike IgG titers at V2D7 were highly predictive of 6-month titer levels. Transcriptomic biomarkers after the second vaccination dose and clinical biomarkers including ferritin levels were found to be predictive of antibody development. Overall, we demonstrate differing time courses of immune responses to the BTN162b2 mRNA COVID-19 vaccination in maintenance HD subjects comparable to healthy controls and identify transcriptomic and clinical predictors of anti-spike IgG titers in HD. Analyzing vaccination as an in vivo perturbation, our results warrant further characterization of the immune dysregulation of ESRD. F30HD102093, F30HL151182, T32HL144909, R01HL138628. This research has been funded by the University of Illinois at Chicago Center for Clinical and Translational Science (CCTS) award UL1TR002003.

Abstract 3558: An integrated data platform to support the international alliance for cancer early detection

Abstract Cancer early detection is one of the most critical areas of cancer research, as it offers the greatest potential for improving patient outcomes. The International Alliance for Cancer Early Detection (ACED) is a global partnership of world-leading cancer research institutions in the UK and US, established in 2019 to accelerate and revolutionize research in this field. ACED brings together the expertise of the Canary Center at Stanford University, the University of Cambridge, the Knight Cancer Institute at Oregon Health and Sciences University, University College London, and the University of Manchester, together with Cancer Research UK, with the goal of catalyzing new collaborations and research in the field of early detection. One of the major challenges to enabling international collaborations across different institutions is the ability to collect, share and discover datasets between researchers and institutions. To enable collaboration on innovative data science, fundamental functions include, 1) controlled data sharing mechanisms; 2) structured metadata to enable data exploration and data discovery; and 3) enabling easy computational access to that data. To advance researchers' collaboration, ACED began development of an Integrated Data Platform (IDP). The ACED-IDP is based on the Gen3 software platform developed by the University of Chicago's Center for Translational Data Science. Based on software systems originally developed for the NCI's Genomic Data Commons, Gen3 has been used in several other data projects including The Blood Profiling Atlas in Cancer (BloodPAC), Australian BioCommons and numerous other research data platforms. The unique nature of ACED required unique innovations to be made for the development of the IDP. Each of the member institutions within the alliance has different existing computer infrastructures, separate authentication platforms and heterogeneous data types forming the basis of their research. The IDP sought a cloud-ready strategy, while still being cognizant of the extreme costs associated with cloud egress fees that hamper researchers' ability to download data. Additions were made to the Gen3 platform to allow for hybrid cloud support, allowing on-premises as well as cloud object storage systems to be linked to the platform. This innovation permits each institution to share files using the mechanisms that they see fit. To unify the various datasets, the standard Gen3 schema was replaced with one derived from the Fast Healthcare Interoperability Resources (FHIR) standard. To support import from clinical data sets, tooling to enable import and export Observational Medical Outcomes Partnership (OMOP) data has been integrated. With this platform in place, we hope to advance international collaborations and accelerate early cancer detection research. Citation Format: Brian Walsh, Liam Beckman, JD Burchett, Matthew Peterkort, Jordan Lee, Michael Fitzsimons, Peter Vassilatos, Binam Bajracharya, Craig Barnes, Jawad Qureshi, Robert Grossman, Carrie Yakura, Yaozhi Lu, Sarah Burge, Daniel Kelberman, Erin Watson, Kyle Ellrott. An integrated data platform to support the international alliance for cancer early detection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3558.

Disparities in Patient Portal Use Among Adults With Chronic Conditions

Disparities in patient access and use of health care portals have been documented. Limited research has evaluated disparities in portal use during and after the COVID-19 pandemic. To assess prevalence of health care portal use before, during, and after the most restrictive phase of the pandemic (2019-2022) among the COVID-19 & Chronic Conditions (C3) cohort and to investigate any disparities in use by sociodemographic factors. This cohort study uses data from the C3 study, an ongoing, longitudinal, telephone-based survey of participants with multiple chronic conditions. Participants were middle aged and older-adult primary care patients who had an active portal account, recruited from a single academic medical center in Chicago, Illinois, between 2019 and 2022. Data were analyzed between March and June 2022. Outcomes of portal use (ie, number of days of portal login by year) were recorded for all study participants by the electronic data warehouse. All parent studies had uniform sociodemographic data and measures of social support, self-efficacy, health literacy, and health activation. Of 536 participants (mean [SD] age, 66.7 [12.0] years; 336 [62.7%] female), 44 (8.2%) were Hispanic or Latinx, 142 (26.5%) were non-Hispanic Black, 322 (60.1%) were non-Hispanic White, and 20 individuals (3.7%) identified as other race, including Asian, Native American or Alaskan Native, and self-reported other race. In multivariable analyses, portal login activity was higher during the 3 years of the COVID-19 pandemic compared with the 2019 baseline. Higher portal login activity was associated with adequate health literacy (incidence rate ratio [IRR], 1.51; 95% CI, 1.18-1.94) and multimorbidity (IRR, 1.38; 95% CI, 1.17-1.64). Lower portal activity was associated with older age (≥70 years: IRR, 0.69; 95% CI, 0.55-0.85) and female sex (IRR, 0.77; 95% CI, 0.66-0.91). Compared with non-Hispanic White patients, lower portal activity was observed among Hispanic or Latinx patients (IRR, 0.66; 95% CI, 0.49-0.89), non-Hispanic Black patients (IRR, 0.68; 95% CI, 0.56-0.83), and patients who identified as other race (IRR, 0.42; 95% CI, 0.28-0.64). This cohort study using data from the C3 study identified changes in portal use over time and highlighted populations that had lower access to health information. The COVID-19 pandemic was associated with an increase in portal use. Sociodemographic disparities by sex and age were reduced, although disparities by health literacy widened. A brief validated health literacy measure may serve as a useful digital literacy screening tool to identify patients who need further support.

Building Students Cultural Quotient Through Urban Internships and Practica Experiences

In response to intensified globalization, the importance of Cultural Intelligence (CQ) in U.S. higher education has risen. This study introduces a framework integrating Experiential Learning Theory (ELT) and CQ within an urban, domestic context, challenging the emphasis on international experiences. Using the Chicago Center's immersive programs as a foundation, a new 35-question scale was developed to measure CQ in a domestic setting. Preliminary findings show improved performance across all CQ dimensions, highlighting the efficacy of experiential curricular interventions. This research underscores the need for robust tools in assessing students' CQ development in our globalized society.

Lithuanian Research and Studies Center

With origins that date back to the 1970s, the Lithuanian Research and Studies Center is the only Lithuanian diaspora research institution in the world. Its emergence was determined by the Lithuanian heritage accumulated in the Lithuanian diaspora and the need to disseminate it, as well as the developing scien- tific potential of Lithuanians abroad and the consequences of the Soviet occupation. Representatives of the Lithuanian American scientific and cultural elite founded this institution at the Youth Center in Chicago in early 1982, uniting 12 departments under the umbrella principle. The goal was to collect Lithuanian material, make it available to researchers, bring the latter together for scientific work, and promote research both within the Lithuanian diaspora and among non-Lithuanians. Up until 1990, the Center took shape by pooling the Lithuanian base and strengthening Lithuanian research. After 1990, in the second stage of the lrsC’s activities, extensive and resilient relations were established with Lithuanian research institutions and scholars; Lithuanian libraries were supplied with Western literature and diaspora publications; books by Lithuanian and foreign scholars were prepared and published; articles and documents were scanned and microfilmed; and exhibitions were put together. The Center also became known to foreign scholars interested in Lithuanian studies.

Sensitivity and Specificity of the Boston Criteria Version 2.0 for the Diagnosis of Cerebral Amyloid Angiopathy in a Community-Based Sample.

The Boston criteria are a set of clinical and neuroimaging features that enable accurate diagnosis of cerebral amyloid angiopathy (CAA) without invasive methods such as brain biopsies or autopsy. The last updates to the Boston criteria, named version 2.0, were recently released and incorporated new nonhemorrhagic MRI features. These criteria have been validated in symptomatic samples, with improved diagnostic yield. We set out to investigate the accuracy of the Boston criteria v2.0 for the diagnosis of CAA in a community-based sample. Participants were recruited from longitudinal clinical-pathologic studies of aging conducted at the Rush Alzheimer's Disease Center in Chicago: the Religious Orders Study and the Rush Memory and Aging Project. Deceased participants with in vivo 3T MRI and detailed pathologic data available were included in the analysis. We compared the diagnostic yield of the current and earlier versions of the Boston criteria in our sample. Among those classified as probable CAA according to the Boston criteria v2.0, we investigated the ability of each neuroimaging marker to distinguish between false-positive and true-positive cases. In total, 134 individuals were included in the study (mean age = 82.4 ± 6.0 years; 69.4% F), and 49 of them were considered pathology-proven definite cases with CAA (mean age = 82.9 ± 6.0 years; 63.3% F). The Boston criteria versions 1.0 and 1.5 yielded similar sensitivity (26.5%, both), specificity (90.6% and 89.4%, respectively), and predictive values (negative: 68.1% and 67.9%; positive: 61.9% and 59.1%, respectively). The recently released Boston criteria v2.0 offered higher sensitivity (38.8%) and slightly lower specificity (83.5%). Among those classified as probable CAA (v2.0), pathology-proven true-positive cases had higher numbers of strictly cortical lobar microbleeds compared with false-positive cases (p = 0.004). Similar to findings from symptomatic samples, the inclusion of nonhemorrhagic neuroimaging markers in the updated Boston criteria offered a 12.3% gain in sensitivity among community-dwelling individuals, at the expense of a 5.9% drop in specificity. In cases with probable CAA, the cortical location of microbleeds may represent a promising distinguishing feature between true-positive and false-positive cases. Despite its improved performance, the diagnostic sensitivity of the updated criteria in a community-based sample remains limited. This study provides Class II evidence that the Boston criteria v2.0 accurately distinguishes people with CAA from those without CAA.

Organising social care initiatives within an urban academic medical centre

Meaningfully addressing social risk factors that impact health outcomes is a complex and expensive endeavour. As healthcare systems across the USA pivot their operations to include upstream and downstream social care elements, they struggle with the operationalising screenings, intervention, staffing and sustainability. This paper shares the nearly decade-long experience of Rush Medical Center in Chicago in creating an infrastructure that identifies social needs, escalates patient cases to an interdisciplinary team intervening at different levels of intensity and simultaneously engages local community and medical entities to develop an enduring partnership to support these efforts.

Abstract A025: Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies

Abstract Purpose: Precision cancer prevention strategies are critical for addressing the complex interplay of adverse social determinants of health (SDOH) and elevated biological risks for breast cancer (BC) among Latinas and other marginalized communities. FQHC-community-academic partnerships may have particularly high potential for operationalizing these strategies and reducing population-level disparities through enhancing genetic counseling and testing (GCT) and subsequent cascade testing/personalized care. Objective: To present emerging results from a RCT comparing the effectiveness of two precision cancer prevention strategies on increasing GCT among Latinas and networks with elevated biological and adverse SDOH risks. Methods: Latinas Lideres en Salud (LaLiSa) is an ongoing RCT is situated in a 14-site federally qualified health center (FQHC) in Chicago. This unique FQHC has a comprehensive GCT program, as part of its integration with an academic medical center. Eligibility criteria for patients include: 1) identification as Latina, Hispanic, Chicana, etc.; 2) age of 18+ years old; 3) personal or family history of BC or related cancers (e.g., ovarian); 4) no previous GCT uptake; and, 5) no prior volunteerism. Patients are randomly assigned to participate in one of two 3-week phone-based interventions from a community agency. Both interventions offer personalized BC education, SDOH screening and navigation, and free/low-cost GCT services. “Educate” offers education on risk reduction (diet, exercise). “Empower” offers skills training on sharing precision cancer prevention information with family and other network members, who can also be eligible for SDOH navigation and GCT services. Data collection includes two surveys (baseline, post-intervention) for relevant covariates and use of study/navigation records for GCT uptake. Results: Of 299 patients approached, 89 participants have enrolled in the RCT (42 educate, 45 empower), with 89% retention. Approximately 55% are 50+ years old, 85% prefer Spanish, 65% have less than a high school education, and 64% have Medicaid/Medicare. For BC and SDOH risks, 17% are cancer survivors, 81% have financial stress and 42% have other competing SDOH risks (intimate partner violence, housing instability, transit instability). No significant arm differences exist. About 76% have initiated GCT referrals and 43% of participants have received GCT services, including 70% who have been identified as having elevated hereditary risk. Empower participants have been more likely to obtain GCT services than Educate participants, (51% vs. 33%, aOR = 5.44, 95%CI[1.45, 20.40], p=.01) after adjusting for age and self-reported social desirability. Discussion: Emerging data suggest the feasibility of precision cancer prevention strategies through FQHC-community-academic partnerships. Empower approaches may be more effective for enhancing at-risk Latinas’ GCT uptake than Educate approaches, when combined with SDOH navigation and free/low-cost GCT services. Limitations concern generalizability due a small, non-probability based sample. Citation Format: Paola Torres, Carolina Bujanda, Celeste Charchalac-Zapeta, Juanita Arroyo, Pamela Ganschow, Vivian Pan, Nathan Stackhouse, Sage J. Kim, Araceli Lucio, Yamilé Molina. Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A025.

Racial/Ethnic disparities in exposure to neighborhood violence and lung cancer risk in Chicago

BackgroundDespite the lower prevalence and frequency of smoking, Black adults are disproportionately affected by lung cancer. Exposure to chronic stress generates heightened immune responses, which creates a cell environment conducive to lung cancer development. Residents in poor and segregated neighborhoods are exposed to increased neighborhood violence, and chronic exposure to violence may have downstream physiological stress responses, which may explain racial disparities in lung cancer in predominantly Black urban communities. MethodsWe utilized retrospective electronic medical records of patients who underwent a screening or diagnostic test for lung cancer at an academic medical center in Chicago to examine the associations between lung cancer diagnosis and individual characteristics (age, gender, race/ethnicity, and smoking status) and neighborhood-level homicide rate. We then used a synthetic population to estimate the neighborhood-level lung cancer risk to understand spatial clusters of increased homicide rates and lung cancer risk. ResultsOlder age and former/current smoking status were associated with increased odds of lung cancer diagnosis. Hispanic patients were more likely than White patients to be diagnosed with lung cancer, but there was no statistical difference between Black and White patients in lung cancer diagnosis. The odds of being diagnosed with lung cancer were significantly higher for patients living in areas with the third and fourth quartiles of homicide rates compared to the second quartile of homicide rates. Furthermore, significant spatial clusters of increased lung cancer risk and homicide rates were observed on Chicago's South and West sides. ConclusionsNeighborhood violence was associated with an increased risk of lung cancer. Black residents in Chicago are disproportionately exposed to neighborhood violence, which may partially explain the existing racial disparity in lung cancer. Incorporating neighborhood violence exposure into lung cancer risk models may help identify high-risk individuals who could benefit from lung cancer screening.

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Mobile Health Intervention in Patients With Type 2 Diabetes

Clinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes. To determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels. This randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year. The mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients' primary care physicians, including medication reconciliation and adjustment. Outcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months. Among the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of -0.79 percentage points in the intervention group compared with -0.24 percentage points in the waiting list control group (treatment effect, -0.62; 95% CI, -1.04 to -0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, -0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes. In this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach-delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities. ClinicalTrials.gov Identifier: NCT02990299.

Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the COVID-19 Pandemic

At the beginning of the COVID-19 pandemic, whether performing CPR on patients with COVID-19 would be effective or increase COVID-19 transmission to health care workers was unclear. Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to health care workers improved? This cross-sectional study assessed DNR orders for all adult patients admitted to ICUs at two academic medical centers in Chicago, IL, between April 2020 and April 2021. DNR orders by COVID-19 status were assessed using risk-adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness. The study population of 3,070 critically ill patients were 46%Black, 53%male, with median age (interquartile range [IQR]) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27%had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30%vs29%vs23%; P= .006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in patients with COVID-19 in the nonpropensity score-matched (n= 3,070; aOR, 2.01; 95%CI, 1.64-2.38) and propensity score-matched (n= 1,118; aOR, 1.91; 95%CI, 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for patients with COVID-19 than patients without COVID-19 during all months of the study period (difference in prevalence over time, P= .751). In this multihospital study, DNR orders remained persistently higher for patients with COVID-19 vspatients without COVID-19 with similar severity of illness during the first year of the pandemic. The specific reasons why DNR orders remained persistently elevated for patients with COVID-19 should be assessed in future studies, because these changes may continue to affect COVID-19 patient care and outcomes.

Evaluation of Eye Gaze Dynamics During Physician-Patient-Computer Interaction in Federally Qualified Health Centers: Systematic Analysis.

Understanding the communication between physicians and patients can identify areas where they can improve and build stronger relationships. This led to better patient outcomes including increased engagement, enhanced adherence to treatment plan, and a boost in trust. This study investigates eye gaze directions of physicians, patients, and computers in naturalistic medical encounters at Federally Qualified Health Centers to understand communication patterns given different patients' diverse backgrounds. The aim is to support the building and designing of health information technologies, which will facilitate the improvement of patient outcomes. Data were obtained from 77 videotaped medical encounters in 2014 from 3 Federally Qualified Health Centers in Chicago, Illinois, that included 11 physicians and 77 patients. Self-reported surveys were collected from physicians and patients. A systematic analysis approach was used to thoroughly examine and analyze the data. The dynamics of eye gazes during interactions between physicians, patients, and computers were evaluated using the lag sequential analysis method. The objective of the study was to identify significant behavior patterns from the 6 predefined patterns initiated by both physicians and patients. The association between eye gaze patterns was examined using the Pearson chi-square test and the Yule Q test. The results of the lag sequential method showed that 3 out of 6 doctor-initiated gaze patterns were followed by patient-response gaze patterns. Moreover, 4 out of 6 patient-initiated patterns were significantly followed by doctor-response gaze patterns. Unlike the findings in previous studies, doctor-initiated eye gaze behavior patterns were not leading patients' eye gaze. Moreover, patient-initiated eye gaze behavior patterns were significant in certain circumstances, particularly when interacting with physicians. This study examined several physician-patient-computer interaction patterns in naturalistic settings using lag sequential analysis. The data indicated a significant influence of the patients' gazes on physicians. The findings revealed that physicians demonstrated a higher tendency to engage with patients by reciprocating the patient's eye gaze when the patient looked at them. However, the reverse pattern was not observed, suggesting a lack of reciprocal gaze from patients toward physicians and a tendency to not direct their gaze toward a specific object. Furthermore, patients exhibited a preference for the computer when physicians directed their eye gaze toward it.