East Harlem Research Articles

An Innovative Consulting Group for Sharing Expertise on Launching and Sustaining Student-Run Free Clinics: A Model for Building Student-Run Endeavors.

Student-run, physician-supervised free clinics (SRFCs) provide essential healthcare services for many uninsured and underinsured patients in the USA. While SRFCs serve diverse populations and offer distinct services, they face many similar barriers to successful clinic operation. Historically, the sharing of best practices and development strategies across SRFCs has been limited and insufficient for both new and emerging free clinics. To address these challenges, in 2015, the East Harlem Health Outreach Program (EHHOP) at the Icahn School of Medicine at Mount Sinai formed the EHHOP Consulting Group (ECG), with the goal of providing client SRFCs individualized support from medical students. ECG draws from the experience of EHHOP and other veteran SRFCs to provide customized solutions to best address client SRFC needs. Here, we describe ECG's inception, structure, and consulting work with client SRFCs. We propose that this interactive, longitudinal model can be adapted to other healthcare trainee initiatives where cross-institutional collaboration could prove beneficial.

Building a Partnership at the Top: Introducing PCHP's New Co-Editor-in-Chief, Ann-Gel Palermo

Building a Partnership at the Top:Introducing PCHP's New Co-Editor-in-Chief, Ann-Gel Palermo A. Hal Strelnick, MD There is no power for change greater than a community discovering what it cares about. Margaret J. Wheatley An academic journal about partnerships, such as Progress in Community Health Partnerships (PCHP), I believe, should practice what it preaches and seek to build sustainable and mutually beneficial partnerships with organizations, such as Community Campus Partnerships for Health (CCPH). The PCHP brochure on the Johns Hopkins University Press' website still includes the CCPH subscription discount, but the Internet has altered how our readers access the articles that we publish in the journal and now earns most of its income from downloads of individual articles rather than individual and institutional subscriptions. While we are pursuing more Open Access for PCHP, we can better ensure the "community voice" in the journal by having its leadership reflect the communities of color that we seek to serve. We are taking several steps in that direction in recruiting a community activist as Co-Editor-in-Chief supported by several more community-based and -oriented associate editors. Beginning in the fall of 2019, Ann-Gel Palermo joined PCHP as my Co-Editor-in-Chief. Because she has earned both an MPH from the University of Michigan and a DrPH from the City University of New York's School of Public Health at Hunter College and holds the titles of Associate Professor of Pediatrics and Medical Education and Associate Dean for Diversity and Inclusion at the Icahn School of Medicine at Mount Sinai, I want to assure our readers that Dr. Palermo has been both a longtime community leader in East Harlem and a community advocate at the national level. Her academic career seeks to educate physicians to better serve and partner with their patients and their patients' families and communities. On the local level, Ann-Gel has been a community health activist in East Harlem for the last twenty years. Since 1999, she has been a board member for the East Harlem Community Health Committee, Inc., and since 2003 served as the Chair of its Health Policy & Legislation Subcommittee. For a 3-year term (2004–2007) she was appointed by Mayor Michael Bloomberg to the HIV Health & Human Services Planning Council of New York, where she co-chaired its annual needs assessment. Then, from 2007 to 2011 Dr. Palermo served as a member of Manhattan's Community Board #11 in East Harlem. She also served as the community member from 2005 to 2008 on the New York Academy of Medicine's Institutional Review Board. More recently, Ann-Gel co-founded two organizations focused on emergency preparedness in East Harlem. First, in 2013, she co-founded the East Harlem Emergency Preparedness Collaborative, which is comprised of a cross-section of emergency management officials focused on neighborhood-based planning, readiness, and response efforts in East Harlem. After the March 12, 2014, natural gas explosion that killed 8 and injured more than 70 people, the East Harlem Community Organizations Active in Disasters was founded in 2015, a coalition of local organizations and businesses that work to prepare for, respond to, and recover from disasters that affect the lives of East Harlem residents. And this is only a very partial listing of Ann-Gel's community and civic leadership! [End Page 7] On the national stage, Dr. Palermo has also advocated for the community's role in public health, health care, and research. From 2006 to 2010 she served on the National Institute of Health's federal advisory committee, the Council of Public Representatives, and co-chaired their Role of the Public in Research Work Group, which successfully developed definitions and frameworks on community engagement for the National Institutes of Health, published in the American Journal of Public Health.1 (Our new Associate Editor Elmer R. Freeman, MSW, Executive Director of the Center for Community Health Education Research and Service, served an over-lapping term with Ann-Gel on the National Institutes of Health's Council of Public Representatives from 2007 to 2011.) Dr. Palermo also served as a two-term member of the Board of Directors of CCPH from 2011...

The Rise of the Latino Vote: A History by Benjamin Francis-Fallon

Reviewed by: The Rise of the Latino Vote: A History by Benjamin Francis-Fallon Felipe Hinojosa The Rise of the Latino Vote: A History. By Benjamin Francis-Fallon. (Cambridge, Mass.: Harvard University Press, 2019. Pp 494. Illustrations, notes, index.) To write a history of the rise of the Latino vote in the United States is no easy task. It requires a readiness to confront the unexpected, to merge local and national politics, and to navigate how groups coalesce amidst national and political differences. I will admit to being skeptical about whether the author could pull that off. But not only does he succeed, he does so with grace and a narrative brilliance that keeps the reader engaged through twists and turns by political leaders in South Texas, East Los Angeles, and East Harlem. While the Latino community shares histories of colonialism, immigration, and racial formation, the experiences are vastly different along lines of citizenship, race, and culture. Benjamin Francis-Fallon acknowledges these differences with an impressive analysis of Mexican American, Puerto Rican, and Cuban politics even as he highlights their combined political efforts. He takes what are difficult and complex movements and organizes them so readers see the many ways that Latinos have carved political space for themselves. Chronological chapters give equal time to progressive and conservative Latinos as they struggled to become forces within the two-party system. This straightforward narrative history sticks to its main purpose: telling the story of the Latino vote. The book is big—385 pages of narrative in eleven chapters—but rather than creating a cumbersome read, the author keeps readers on the alert with his gripping narrative and [End Page 232] chapters that are precise in their purpose and clear in their arguments. Significant here is the centrality of Mexican American politics in the Southwest to the larger scene of Latino politics across the nation. Even as the "Viva Kennedy" campaign emerged in the Southwest and brought together a cadre of Mexican American politicians, the national scope of the movement helped form coalitions with New York Puerto Ricans. As the author correctly points out, "Kennedy's victory in the historically close 1960 presidential election was in no small part due to Puerto Rican and Mexican-American votes" (62). The book does have its weaknesses. The role of Latinas in forging these politics is almost absent, and the author should have focused more on the role of grassroots radical Latino politics. While the author does devote a few pages to the New York Young Lords and the Texas-based Mexican American Youth Organization (MAYO), their influence is downplayed. But aside from these criticisms, The Rise of the Latino Vote succeeds on many levels, especially in the way the author recognizes the complexities of Latino politics even as he makes a compelling case for the importance of their struggle to present a united front. This book should be required reading for students of Mexican American history, state and national politicians and anyone interested in understanding the significant role that Latinos have played, and continue to play, in Texas and national politics. Felipe Hinojosa Texas A&M University Copyright © 2020 The Texas State Historical Association

Alcoholic cardiomyopathy and liver disease in a community hospital in east Harlem in New York City

Background: Alcohol abuse can result in alcoholic cardiomyopathy (ACM). As one of the most common causes of liver disease in patients admitted to our hospital is alcohol abuse, the aim of this study was to characterize patients with ACM and compare them to those with ischemic cardiomyopathy from a group of patients with heart failure (HF). Methods: retrospective study of patients with HF defined as ejection fraction lower than 40%, identified over a period of 5 years, from 2012 to 2017. Data were analyzed by the use of T-test and Chi-square, as appropriate. Results: 117 of 333(35%) had ischemic cardiomyopathy (IC), and 216(64.8%) had non ischemic cardiomyopathy (NICM); of these, 53(25%) had ACM, which is 6.4% of patients admitted with alcoholic liver disease (ALD). The majority of patients with ACM were of the black race, and was younger than those from the IC group. Conclusion: ACM is not highly prevalent in the community of East Harlem, and cirrhosis is not commonly associated with ACM. Racial and genetic predisposition may play a role in the development of ACM.

MOBILIZING NETWORKS TO ADDRESS DEMENTIA IN A LATINO COMMUNITY

Many Latino older adults delay seeking help for symptoms of Alzheimer’s Disease or Related Dementia (ADRD) due to substantial barriers to services. Community-based Natural helpers (NHs) can increase health-related knowledge and can serve as full partners in health education and promotion. This paper presents the process and product of the first phase of a community-based participatory research study to develop a culturally-tailored intervention increasing knowledge about ADRD and services in East Harlem, NY. We describe the results of the initial survey and development of El Barrio SHARE, an intervention that recruits and trains community residents to provide information and referrals about dementia, tapping into natural community networks of people (hairdressers, bodega clerks, mail carriers) who interact with and have longstanding relationships with older adults in the course of their work. NHs are well-positioned to observe and detect problems, and can link elders to relevant, culturally-sensitive resources, accessible support, and treatment.

MOBILIZING COMMUNITY PARTNERSHIPS TO ENHANCE HEALTH AND REDUCE INEQUITIES IN MULTICULTURAL COMMUNITIES

Community-based gerontological research plays an indispensable role in identifying and addressing the strengths, intersectionalities, and socio-structural inequities that shape the lives of older adults in multicultural communities around the world. This symposium highlights the innovative, global scholarship of Silberman Aging: A Hartford Center of Excellence in Diverse Aging, as the Center begins its sixth year. Through community-based research and academic-community collaborations, Center researchers examine challenges affecting the health and wellbeing of diverse and often marginalized aging communities in North America, West Africa, and East Asia. The first paper describes and evaluates a CBPR project that trains community-based natural helping networks to identify and refer older adults with dementia in East Harlem, NY. The second study explores the perceptions and strategies of community-based primary care physicians in Ulaanbaatar, Mongolia in dealing with elder abuse and neglect. The third takes a population health approach to the relationship between social capital and health among older adults in Ghana. Fourth, preliminary results from an evaluation of a nation-wide training initiative that promotes cultural-competencies among aging services providers working with LGBT elders. Finally, we present findings from a CBPR study examining barriers to palliative care among racially and ethnically-diverse community-dwelling older adults with serious illness. Although substantively and methodologically varied, these studies all demonstrate the importance of social networks in health in later life, and underscore the value of community-based research that supports collaboration, empowers communities, and ultimately transforms practice and policy to better meet the diverse needs of older adults around the globe.

TAPPING NATURAL NETWORKS TO ADDRESS DEMENTIA IN A LATINO COMMUNITY

The need for health education regarding Alzheimer’s disease and related dementias (ADRD), specifically designed for Latinos, has been well-documented. Many Latino older adults and their families delay seeking formal help for ADRD symptoms due to lack of information and access to culturally sensitive services. This paper presents preliminary findings of community-based participatory research to develop El Barrio SHARE, a culturally-tailored intervention tapping natural helpers (NHs) to address a need identified by community members in East Harlem, NY. It trains people who often interact with elders in the course of their work (e.g., hairdressers, bodega clerks), and are well-positioned to observe and detect ADRD-related problems and potentially link elders to relevant services. Findings from a process evaluation developing the 10-module NH training suggest that (a) participants seek information that debunks myths and stigma surrounding ADRD, and (b) the need for culturally-tailored, participant-centered interventions in marginalized communities is critical.

Dietary Behavior and Urinary Gallic Acid Concentrations in Older Minority Residents of East Harlem, New York City.

In this multidisciplinary study, we explored relationships between demographic factors, dietary habits, and gallic acid, a polyphenolic biomarker that correlates with self-reported dietary behaviors and negatively correlates with the incidence of cancer. Thirty-three (33) participants were recruited from a senior center in East Harlem, New York City, a racially diverse and underserved community. A National Institute of Health (NIH)-validated survey questionnaire was used to gather dietary behavior data, alongside demographic and cancer history information. Urine samples were obtained from participants for analyzing gallic acid content level. All 33 recruited participants completed the survey and 25 of them provided urine samples for gallic acid analysis. Associations between demographic factors and intake of certain foods were observed. Specifically, age was negatively associated with French fries/fried potatoes, cooked dried beans, and tomato soup intake (p < 0.05), and Black/African American race was associated with increased consumption of fruits and vegetables in comparison to Hispanic/Latino ethnicity (p < 0.05). No associations between urinary gallic acid levels and demographic information was observed. However, French fries/fried potatoes intake was significantly associated with urinary gallic acid concentration (p < 0.01). The small sample size limited the execution of meaningful statistical analysis. However, this study provided preliminary findings about the dietary behavior of older adults in East Harlem, New York City, which will serve as a basis for a future larger study to investigate nutrition/dietary education intervention on cancer prevention among diverse elderly residents in New York City.

Leveraging NADAC to Steer Drug Formularies in Resource-Limited Clinics

Objectives: Free medical clinics provide healthcare to populations with limited options for insurance coverage and are thus key medical safety nets. Such clinics have limited operating budgets due in part to their lack of revenue streams through insurance reimbursements. Thus, pharmaceutical acquisitions can impose significant financial burdens in light of rising and volatile prices [1]. The goal of this study was to provide clinics with a real-time comparison of national retail pharmacy acquisition prices against clinic purchasing prices to determine potentially overpriced drugs. Methods: Historical ledger data from the East Harlem Health Outreach Program (EHHOP) at Mount Sinai was used to determine the clinic’s average price and volatility for specific drugs over time. Average prices were cross-referenced against the publicly available National Average Drug Acquisition Cost (NADAC) database, which outlines the average acquisition cost of drugs by retail pharmacies across the United States. Results: This analysis demonstrated that 36% (16/45) of EHHOP drug price averages were significantly different than relative NADAC values, with 9% (4/45) more expensive and 27% (12/45) cheaper. Price volatility between EHHOP and NADAC acquisition prices varied. Assuming the NADAC benchmark for significantly more expensive EHHOP purchases resulted in potential savings of $4,424 (6% of budget) over the projected period. Conclusions: Clinic drug acquisition price comparison to NADAC database prices serves as an effective benchmark for cost reduction. In order to implement change after expensive drug identification, we developed a decision-tree model that outlines several steps that can reduce drug expenditures. Using this process can potentially save financial resources for medical clinics.

The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center

Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016–2017, the NYC Health Department’s Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the first to open, and share findings from qualitative interviews with the East Harlem Action Center’s Governance Council, a group comprised of Action Center staff and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members’ expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation.

Outcomes of a Weight Loss Intervention to Prevent Diabetes Among Low-Income Residents of East Harlem, New York.

There is a need for diabetes prevention efforts targeting vulnerable populations. Our community-academic partnership, the East Harlem Partnership for Diabetes Prevention, conducted a randomized controlled trial to study the impact of peer led diabetes prevention workshops on weight and diabetes risk among an economically and racially diverse population in East Harlem, New York. We recruited overweight/obese adults from more than 50 community sites and conducted oral glucose tolerance testing and completed other clinical assessments and a health and lifestyle survey. We randomized prediabetic participants to intervention or delayed intervention groups. Intervention participants attended eight 90-minute peer-led workshop sessions at community sites. Participants in both groups returned for follow-up assessments 6 months after randomization. The main outcomes were the proportion of participants who achieved 5% weight loss, percentage weight loss, and change in the probability of developing diabetes over the next 7.5 years according to the San Antonio Diabetes Prediction Model. We enrolled 402 participants who were mainly female (85%), Latino (73%) or Black (23%), foreign born (64%), and non-English speaking (58%). At 6 months, the intervention group lost a greater percentage of their baseline weight, had significantly lower rise in HbA1c (glycated hemoglobin), decreased risk of diabetes, larger decreases in fat and fiber intake, improved confidence in nutrition label reading, and decrease in sedentary behavior as compared with the control group. Thus, in partnership with community stakeholders, we created an effective low-resource program that was less intensive than previously studied programs by incorporating strategies to engage and affect our priority population.

84. TEACHING SOCIAL DETERMINANTS VIA SERVICE LEARNING AND COMMUNITY EXPLORATION

Background Residents must be familiar with the community they serve and understand the impact of social determinants of health (SDH). Service learning is an educational approach that combines community service with reflection to achieve meaningful community engagement and understanding of SDH. We designed an intern orientation program to engage new trainees in conversations about SDH and advocacy through service learning and a team building experience. Objective Assess the impact of a community tour and volunteer experience on knowledge of local community, attitudes around SDH screening, and intern bonding. Methods The intervention included a didactic session on SDH; a walking tour of East Harlem (EH), the hospital neighborhood; and a visit to a local food pantry/community-based organization where residents engaged in a volunteer activity (packing meals). Residents completed a mixed methods survey with retrospective pre/post questions to reflect on the impact of the activity on knowledge and attitudes regarding: patient demographics, SDH (particularly food insecurity), and familiarity with co-interns. Data were analyzed using McNemar's test. RESULTS:35 residents were surveyed in 2017-2018. The program was effective in increasing interns’ understanding of the demographics and health issues affecting EH children (p=0.001) as well as increasing comfort discussing food insecurity with patients (p=0.001). All respondents reported a future plan to screen patients for food security, and 100% affirmed that program participation provided tools to help their patients. 97% agreed the activity helped them get to know their fellow interns. When asked for favorite aspects of the day, “volunteering at the pantry and giving back to the community,” “learning more about the EH community” and “getting to know our co-residents,” were identified. Conclusion A volunteer experience followed by a walking tour gave interns the opportunity to learn about EH while performing community service and bonding with their co-interns. Future research is needed to ascertain whether this hands-on experience inspires and sustains a program culture of advocacy.

Abstract 1615: Correlation between demographic factors, dietary habits and urinary micronutrient content among minority groups in New York City

Abstract Cancer is the second leading cause of death in the United States. A diet low in fruits and vegetables increases the risk of certain cancer types. Moreover, socioeconomic factors contribute to limited access to fresh and healthy foods and limited opportunities for safe physical activity, leading to poor physical health. In this multidisciplinary, IRB approved study, we explored relationships between demographic factors, self-reported dietary behaviors and gallic acid, a polyphenolic micronutrient that correlates well with fruit and vegetable intake. We recruited participants at a senior center in East Harlem, New York City, a racially diverse and underserved community. The participants completed a NIH-validated survey through which we assessed their dietary habits and collected standardized demographic data and history of cancer. Urine samples from participants were analyzed for gallic acid. So far, 33 participants completed the survey and 25 of them provided urine samples for gallic acid analysis. We found an association between demographic information (Race/ethnicity and age) and intake of certain foods. Specifically, age was negatively associated with french fries/fried potatoes, cooked dried beans and tomato soup intake (p&amp;lt;0.05) and Black/African American race was associated with increased intake of juice (p&amp;lt;0.05). A positive association between self-reported food intake and gallic acid concentration was only observed with french fries/fried potatoes (R = 0.641, p&amp;lt;0.001). Overall, the results suggest a significant association between dietary habits and demographic factors. Ongoing work include further recruitment of participants, and multivariate analysis of the data. This will be followed by an intervention consisting of active nutritional education, and urinary gallic acid analysis to assess the impact of nutritional education on dietary habits. Citation Format: Cristina Zambrano, Maayan Beeber, April Panitz, Katarzyna Wyka, Safa Ibrahim, Yin Tan, Grace Ma, Khursheed Navder, Ming-Chin Yeh, Olorunseun Ogunwobi. Correlation between demographic factors, dietary habits and urinary micronutrient content among minority groups in New York City [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1615.

Comparing Food Policies and Programs in an Urban Neighborhood – an Agent-Based Modeling Approach (P04-181-19)

ObjectivesPublic health practitioners and policymakers often need to determine which strategies are most effective prior to investing in implementation. This is particularly important in urban neighborhoods where public health initiatives may have a significant impact on the health of a large population. This study aims to use an innovative agent-based model to evaluate and compare the potential impact of three food policies and programs on the consumption of fruits and vegetables in an urban neighborhood. MethodsWe developed an agent-based model that takes into account individual and neighborhood-level factors (e.g., age, gender, education, food environment) to predict fruit and vegetable consumption at the neighborhood level. Model parameters were estimated from the Food Attitudes and Behaviors Survey, United States Census data, and previous studies. We simulated three hypothetical interventions, including implementing a mass media and nutrition education campaign to alter healthy social norms, increasing the number of fruit and vegetable vendors, and reducing the price of fruits and vegetables. We predicted the impact of these interventions on the consumption of fruits and vegetables in the East Harlem neighborhood in New York City. ResultsThe simulation results suggested that a mass media and nutrition education campaign could increase the consumption of fruits and vegetables by 5.5%. In comparison, a program that increases the number of fruit and vegetable vendors by 10% and the one that reduces the price of fruits and vegetables by 10% could increase the consumption of fruits and vegetables by 1.6% and 1.2%, respectively. ConclusionsA mass media and nutrition education campaign may be more effective than increasing the access to or reducing the price of fruits and vegetables in East Harlem. A well-designed, validated agent-based model has the potential to provide insights on the impact of food policies and programs in a complex urban environment and aid policymakers and public health officials in making informed decisions for priority setting and program implementation. Funding SourcesThis study was supported by an R01 grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Improving Student Clinicians’ Documentation of Lifestyle Modification

Background: Lifestyle modification is an important component of clinical encounters, particularly in student-run free clinics that provide care for uninsured patients with a high burden of chronic disease. This study aimed to evaluate the effect of two interventions on the rates of documentation of patient diet, exercise, and health goals at East Harlem Health Outreach Partnership (EHHOP), a student-run free clinic affiliated with the Icahn School of Medicine at Mount Sinai.Methods: A quasi-experimental study was performed at EHHOP over 12 weeks from September to November 2015. Rates of documentation of lifestyle modification and health goals discussions were assessed at baseline and following two periods of intervention. Intervention 1 used electronic medical record (EMR) templates for documenting discussions, and Intervention 2 used focused student teaching to prioritize discussion and documentation of lifestyle modification and health goals. Patient characteristics and documentation rates were compared between each of the three time periods.Results: A total of 161 patient visits were included. There were no significant differences in patient characteristics between Baseline (n=54), Intervention 1 (n=50), and Intervention 2 (n=57) time periods. Rates of documentation increased from 48% (Baseline) to 56% (Intervention 1) to 68% (Intervention 2) for diet, 25% to 42% to 53% for exercise, and 22% to 34% to 39% for health goals. EMR-based Intervention 1 was more effective in improving documentation rates for clinicians caring for patients without diabetes, and student teaching-based Intervention 2 was more effective in improving documentation rates for clinicians caring for patients with diabetes.Conclusions: Systemic efforts that incorporate targeted EMR templates and teaching can help promote documentation rates of lifestyle modification discussions in student clinicians.

Tu1539 – Prevalence of Liver Disease in Patients with Alcoholic Cardiomyopathy (ACM) is Low in a Community Hospital in East Harlem

Tu1539 – Prevalence of Liver Disease in Patients with Alcoholic Cardiomyopathy (ACM) is Low in a Community Hospital in East Harlem

Health in Action: Evaluation of a Participatory Grant-Making Project in East Harlem.

Decision-making processes that include resident input have been shown to be effective in addressing community needs. However, few examples discuss the role of a local health department in leading a participatory decision-making process. In 2016, the New York City Department of Health and Mental Hygiene implemented a participatory grant-making process to allocate grant funds to community organizations in East Harlem. Findings from the evaluation suggest that a participatory grant-making process can be an effective way to include community member as decision makers. It can also build capacity among organizations and foster meaningful community engagement with a local health department.

3310 A Community-Academic Partnership to Understand the Association Among Health Status and Senior Services Utilization to Improve Nutrition and Blood Pressure Control for Low Income Seniors Aging in Place

OBJECTIVES/SPECIFIC AIMS: The Rockefeller University Center for Clinical and Translational Science (RU-CCTS), Clinical Directors Network (CDN), and Carter Burden Network (CBN), a multi-site senior services organization serving East Harlem, NY, formed a community-academic research partnership to characterize the health of the CBN seniors (many who are racial/ethnic minorities, low-income, and suffering from multiple chronic conditions) and to explore the use and associations of a measure of overall health status and frailty in this population. A simple validated measure of health status could standardize and streamline community-based translational research to study the impact of CBN’s services on health outcomes. The CCTS-funded Pilot Project aims to: 1) Engage CBN seniors and stakeholders in priority-setting, joint protocol development, research conduct, analysis and dissemination; 2) Characterize the health status of the CBN seniors using validated measures; 3) Establish an electronic database infrastructure for current and future research; 4) Understand how health and senior activities information can be used to implement programs to improve senior health and well-being. METHODS/STUDY POPULATION: 1) We used Community Engaged Research Navigation (CEnR-Nav) methods to facilitate partnership development, and to engage CBN seniors and stakeholders in each step of the research; 2) Research staff conducted recruitment, informed consent, and physical assessments (e.g., pulse, blood pressure, BMI); and administered validated surveys to collect health status information. 3) Data were captured on a REDCap-based platform. The primary outcome, frailty, was measured by the validated Short Physical Performance Battery (SPPB). 4) Secondary outcomes include the association of use of services/activities with the primary outcome. Research participants consented to sharing of their health, demographic and services utilization data compiled by CBN staff and the NYC Department for the Aging (DFTA). DFTA provided comparison datasets of de-identified health and demographic data for clients attending other NYC DFTA-funded senior centers. RESULTS/ANTICIPATED RESULTS: 1) 43 residents and stakeholders engaged in partnership-building, study design and implementation. 2) 218 participants from two senior centers were enrolled. Mean age, 68 ± 11 years; 58% Hispanic; 33% African American, 23% White, 1% Asian, 18% Unknown, 17% Other; 69% reported &lt;$20000 annual income; 40% had not completed high school; 30% scored as moderately or severely frail; 83% were overweight or obese; and 33% reported a history of diabetes. 84% had uncontrolled high blood pressure; many participants were previously aware of their hypertension diagnosis. 3) A REDcap database was developed to store historical and prospective data. 4) Across frailty categories, there was a significant difference in utilization of non-meal (p = 0.0237) and meal services (p = 0.0127) and there was an inverse proportional relationship between the number of meal and non-meal visits, and frailty. Additional associations among health status measures (e.g., SPPB, demographics, biological measures: pulse, blood pressure, BMI; psychosocial and nutritional scales) and CBN service utilization (i.e., meals vs. non-meals activities) will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: We developed a community-academic research partnership, infrastructure and capacity, built through our Community-Engaged (CEnR-Nav) model, to conduct a pilot study characterizing the health status and services utilization of low-income minority seniors. Our pilot study identified an urgent health priority, uncontrolled hypertension in 84% of CBN’s seniors. We then leveraged the team’s expertise and CBN’s meal services program to develop a research proposal for external funding to conduct a community-based multi-component intervention study. Replacement of a typical Western diet with the Dietary Approaches to Stop Hypertension (DASH) diet has been proven to reduce blood pressure in hypertensive and normotensive individuals in as little as 14 days, yet effective implementation has been lacking, and it is relatively untested in community-living seniors who receive their meals in settings such as CBN. We are also exploring mechanistic questions that relate to blood pressure control, such as the impact of the DASH diet on inflammation, which may lead to a better understanding of the underlying mechanism of action of the DASH diet. Our community partner, CBN, was awarded the DHHS-ACL nutrition innovation grant to conduct this 2-year study with CDN and RU-CCTS. The resulting study developed out of the community engaged pilot study represents a unique combination of community-centered care, within an implementation science framework (with embedded mechanistic measures under development). This is an example of the novel, full-spectrum approach to translational research that the RU-CCTS/CDN Community Engaged Research Core has been developing over the last decade. The research to characterize CBN clients’ health status is now being extended to address cardiovascular health by way of intervening on diet quality and food insecurity, a key component of the social determinants of health, in partnership with agencies outside of the healthcare delivery system. The outcomes of the DASH Diet implementation study will also serve to inform the broader aging service provider network and the healthcare community about the impact of senior center congregate meal composition and services on health outcomes.

Case analysis and CFD numerical study on gas explosion and damage processing caused by aging urban subsurface pipeline failures

Abstract The overall targets of this study are to focus on a comprehensive summary of the East Harlem gas explosion in Manhattan, New York. To investigate how the tragedy occurs in the neighborhood of Manhattan and how it influences the probability and the scale of this accident causing corresponding damages. CFD numerical simulations were performed to study explosion characteristics of natural gas leakage and the explosion based on the realistic accident scenario. The gas dispersion, blast wave and flame propagation process were analyzed, the simulated results agreed well with actual destruction in real accident. It further verified the location and the reasons of the ignition sources in the actual event. Moreover, a series of post-accident testing and inspections were undertaken on the accident scene, followed by an in-depth analysis of the causes. This accident highlights the potential hazards of aging urban subsurface infrastructure in such historic metropolis, which especially targets at aging pipes. It is intended to prompt a serious discussion concerning the outmoded technology, overburdened lines, maintenance programs and future risk management, which must be properly managed by authorities if NYC is to remain a dominant global urban destination.

Risk Factors and Birth Outcomes of a High-Risk Cohort of Women Served by a Community-Based Prenatal Home Visiting Program

ABSTRACTOur study explored risk factors and birth outcomes of a community maternal and child outreach program for high poverty mothers in East and Central Harlem. We conducted a retrospective chart review of 75 mother–infant dyads, with singleton pregnancies, receiving antepartum and postpartum home visits. Inexperienced parenting was associated with increased odds of giving birth to an infant weighing <2,700 g compared to experienced parenting after adjustment for race/ethnicity and preeclampsia diagnosis (odds ratio (OR) 4.9, p = 0.04). Mothers had comparatively lower depression risk in the postpartum period compared to antepartum (p = 0.006).