Suffolk County Research Articles

The Sheriff’s Sword: Property, Democracy, and Public Order in Early Republic Massachusetts

Abstract: The rise of capitalism and democracy in the Early Republic transformed how Americans engaged county officers who served as important middlemen who shaped how communities understood value and property ownership through their processes of seizing and redistributing property. Court officers represented the legal system and governments’ right to rule, and they drew on that authority to maintain their own legitimacy. This article explores the ways that members of the Suffolk County, Massachusetts Sheriff’s Office—Deputy Sheriff Luke Baldwin and Sheriff Charles P. Sumner—did their work and how contemporaries attempted to limit their authority through the legal system, democracy, and mobocracy. As courts and creditors increasingly deferred to a private individual’s judgement than that of a public officer, sheriffs such as Sumner and Baldwin emerged in debates over who ultimately held the responsibility for maintaining law and order.

Long-Term Course of Remission and Recovery in Psychotic Disorders.

Understanding prognosis is critical to anticipating public health needs and providing care to individuals with psychotic disorders. However, the long-term course of remission and recovery remains unclear. In this study, the most common trajectories of illness course are described for a cohort of individuals followed for 25 years since first admission for psychosis. Participants are from the Suffolk County Mental Health Project, an epidemiological study of first-admission psychosis. Data for the present study was collected from six follow-ups, with 311 individuals assessed at the 25-year follow-up. Common patterns of remission and recovery were assessed in the baseline cohort of 591 individuals and the subsample from the 25-year follow up. In the baseline cohort and the 25-year subsample, the most common trajectory for individuals with schizophrenia spectrum disorders was no remission and no recovery. Among individuals with other psychotic disorders, in both the baseline and 25-year cohorts, the modal pattern was one of intermittent remission and recovery. Individuals with other psychotic disorders were more likely to experience stable remission (15.1%) and stable recovery (21.1%), outcomes that were rare among individuals with schizophrenia spectrum disorders (0% and 0.6%, respectively). The modal longitudinal pattern for individuals with other psychoses is one of multiple transitions into and out of symptomatic and functional recovery. Engagement in a long-term health care plan may help individuals detect and respond to these changes. Sustained remission and recovery are rare among people with schizophrenia spectrum disorders. Efforts should be directed toward developing more effective treatments for this population.

Exploring Barriers Toward Telehealth in an Underserved, Uninsured Patient Population.

Telehealth has untapped potential to improve health care for underserved communities. However, it remains underutilized, limiting opportunities to improve continuity of care and health care outcomes. This pilot study investigates attitudes and barriers to telehealth at Stony Brook HOME, Renaissance School of Medicine's student-run free-health clinic in Suffolk County, NY. Surveys (n = 100) were electronically administered bimonthly during clinic waiting room time from May 2022 to August 2023 in both English (40%) and Spanish (60%). Surveys collected information on patient demographics, perceived patient barriers and attitudes to telehealth, and technological comfort levels. Most patients were Hispanic/Latino (68%), female (54%), and 40-60 years old (52%). Spanish speakers often come from high social vulnerability regions. English speakers were more likely to own a smartphone, computer, or tablet than Spanish speakers (p = 0.046). English speakers reported higher levels of technological comfort using a smartphone or tablet (p = 0.0033) and using it for their health care (p = 0.03). Finally, 100% of English speakers reported reliable internet access compared to 66.7% of Spanish speakers. These results demonstrate that barriers to telehealth are being disproportionately felt by Spanish speakers, thus necessitating survey-directed interventions to address this disparity.

Monitoring of over-the-counter (OTC) and COVID-19 treatment drugs complement wastewater surveillance of SARS-CoV-2

BackgroundThe application of wastewater-based epidemiology to track the outbreak and prevalence of coronavirus disease (COVID-19) in communities has been tested and validated by several researchers across the globe. However, the RNA-based surveillance has its inherent limitations and uncertainties.ObjectiveThis study aims to complement the ongoing wastewater surveillance efforts by analyzing other chemical biomarkers in wastewater to help assess community response (hospitalization and treatment) during the pandemic (2020–2021).MethodsWastewater samples (n = 183) were collected from the largest wastewater treatment facility in Suffolk County, NY, USA and analyzed for COVID-19 treatment drugs (remdesivir, chloroquine, and hydroxychloroquine (HCQ)) and their human metabolites. We additionally monitored 26 pharmaceuticals including common over-the-counter (OTC) drugs. Lastly, we developed a Bayesian model that uses viral RNA, COVID-19 treatment drugs, and pharmaceuticals data to predict the confirmed COVID-19 cases within the catchment area.ResultsThe viral RNA levels in wastewater tracked the actual COVID-19 case numbers well as expected. COVID-19 treatment drugs were detected with varying frequency (9–100%) partly due to their instability in wastewater. We observed a significant correlation (R = 0.30, p < 0.01) between the SARS-CoV-2 genes and desethylhydroxychloroquine (DHCQ, metabolite of HCQ). Remdesivir levels peaked immediately after the Emergency Use Authorization approved by the FDA. Although, 13 out of 26 pharmaceuticals assessed were consistently detected (DF = 100%, n = 111), only acetaminophen was significantly correlated with viral loads, especially when the Omicron variant was dominant. The Bayesian models were capable of reproducing the temporal trend of the confirmed cases.ImpactIn this study, for the first time, we measured COVID-19 treatment and pharmaceutical drugs and their metabolites in wastewater to complement ongoing COVID-19 viral RNA surveillance efforts. Our results highlighted that, although the COVID-19 treatment drugs were not very stable in wastewater, their detection matched with usage trends in the community. Acetaminophen, an OTC drug, was significantly correlated with viral loads and confirmed cases, especially when the Omicron variant was dominant. A Bayesian model was developed which could predict COVID-19 cases more accurately when incorporating other drugs data along with viral RNA levels in wastewater.

Embedding psychological thinking within a local authority children and young people’s service; supporting, developing, and nurturing the workforce to work in a trauma informed way from the inside out

This article provides an overview of some of the psychologically informed practice of supporting young people, their families and the people supporting them within Children and Young People’s Services (CYPS) in Suffolk County Council (SCC). The overview outlines the approach and experiences of the Psychology Support Service (PSS; formerly known as Suffolk Family Focus Psychology Service). The PSS enables practitioners and managers across CYPS to access specialist psychological support to enable practitioners to support children, young people, and families with a range of needs. The PSS works closely with stakeholders including frontline practitioners, managers, and workforce development. The article, therefore, also includes reflections from practice management (Early Help) and workforce development management about psychological and trauma informed practice within CYPS. It is clear from the evidence, and from our own work within PSS, that working in a psychologically and trauma-informed way is important to meet the needs of vulnerable children and young people and those who are supporting them.The Psychology Support Service: Who we are, Why we do it and What we do.

Cross-sectional Ct distributions from qPCR tests can provide an early warning signal for the spread of COVID-19 in communities.

SARS-CoV-2 PCR testing data has been widely used for COVID-19 surveillance. Existing COVID-19 forecasting models mainly rely on case counts obtained from qPCR results, even though the binary PCR results provide a limited picture of the pandemic trajectory. Most forecasting models have failed to accurately predict the COVID-19 waves before they occur. Recently a model utilizing cross-sectional population cycle threshold (Ct-the number of cycles required for the fluorescent signal to cross the background threshold) values obtained from PCR tests (Ct-based model) was developed to overcome the limitations of using only binary PCR results. In this study, we aimed to improve on COVID-19 forecasting models using features derived from the Ct-based model, to detect epidemic waves earlier than case-based trajectories. PCR data was collected weekly at Northeastern University (NU) between August 2020 and January 2022. Campus and county epidemic trajectories were generated from case counts. A novel forecasting approach was developed by enhancing a recent deep learning model with Ct-based features and applied in Suffolk County and NU campus. For this, cross-sectional Ct values from PCR data were used to generate Ct-based epidemic trajectories, including effective reproductive rate (Rt) and incidence. The improvement in forecasting performance was compared using absolute errors and residual squared errors with respect to actual observed cases at the 7-day and 14-day forecasting horizons. The model was also tested prospectively over the period January 2022 to April 2022. Rt curves estimated from the Ct-based model indicated epidemic waves 12 to 14 days earlier than Rt curves from NU campus and Suffolk County cases, with a correlation of 0.57. Enhancing the forecasting models with Ct-based information significantly decreased absolute error (decrease of 49.4 and 221.5 for the 7 and 14-day forecasting horizons) and residual squared error (40.6 and 217.1 for the 7 and 14-day forecasting horizons) compared to the original model without Ct features. Ct-based epidemic trajectories can herald an earlier signal for impending epidemic waves in the community and forecast transmission peaks. Moreover, COVID-19 forecasting models can be enhanced using these Ct features to improve their forecasting accuracy. In this study, we make the case that public health agencies should publish Ct values along with the binary positive/negative PCR results. Early and accurate forecasting of epidemic waves can inform public health policies and countermeasures which can mitigate spread.

Seroprevalence of Chagas Disease among People of Latin American Descent Living in Suffolk County, Long Island, New York.

This cross-sectional study estimated a one-time point seroprevalence rate of Chagas disease among people of Latin American descent in Suffolk County, Long Island, New York. Subjects who met the inclusion criteria were screened using the Chagas Detect Plus Rapid Test (InBios, Seattle, WA) with confirmation via Trypanosoma cruzi enzyme immunoassay and T. cruzi immunoblot assay. Administration of a questionnaire regarding demographics and risk factors followed. A seroprevalence rate of 10.74% was found. Identified risk factors included prior residence in a palm leaf house (odds ratio [OR], 10.42; P = 0.003; 95% CI, 2.18-49.76), residence in a house with triatomines (OR, 9.03; P = 0.006; 95% CI, 1.90-42.88), and history of triatomine bite (OR, 9.52; P = 0.009; 95% CI, 1.75-51.77). Our findings emphasize the importance of this frequently underdiagnosed disease and help highlight the importance of early screening among high-risk populations.

Student Threats of Violence Often Signal Underlying Psychiatric Disorders

Student Threats of Violence Often Signal Underlying Psychiatric Disorders

Reduced Risk of Syphilis Reinfection in Men Interviewed by Disease Intervention Specialists: A Pilot Study

Syphilis is a highly transmissible sexually transmitted infection. Rising rates of infection and reinfection are of great concern to public health officials. In local health departments across the U.S., disease intervention specialists attempt to interview all people diagnosed with early syphilis, to elicit sexual partner information, and to trace and treat the partners. This method of interviewing and contact tracing is an evidence-based practice that reduces the spread of the disease in the community, but few studies address the relationship between the disease intervention specialists' interviews and index patient reinfections. We hypothesized that patients who were interviewed, patients who provided partner information, and patients with more treated partners would have a reduced risk of reinfection. Our sample consisted of 82 men listed in the Suffolk County Department of Health Services syphilis log who were diagnosed with primary, secondary, or early latent syphilis. We determined whether and when the patients were reinfected during a set time period, from 2016 to 2020. Kaplan-Meier analyses with log-rank statistics and Cox hazard proportional models were used to calculate time to reinfection and hazard ratios. Although none of the models produced p<0.05, notable trends were observed. In subset analyses of interviewed patients, 23.8% of patients who named partners were reinfected during the study period, whereas 50% of those who did not name partners were reinfected during that time. In addition, the hazard ratio for index patients who named partners was 0.51 (95% CI=0.225, 1.170, p=0.113). When some or all the patients' partners were treated, 20% were reinfected by the end of the study, whereas 33.3% of cases with no partners treated were reinfected by the end of the study. The hazard ratio for patients with some or all partners treated was 0.48 (95% CI=0.136, 1.711, p=0.258). Although none of the results was statistically significant, trends suggest that partner elicitation and partner treatment status could be associated with reduced risk of syphilis reinfection. Because this pilot study utilized a small convenience sample that was not tested for statistical power, we could not adequately address these trends. Future studies, with larger sample sizes, should address these relationships.

Results from an LGBTQ+ Community Health Needs Assessment in Nassau and Suffolk Counties of New York State

LGBTQ+ individuals experience health care disparities and difficulty accessing affirming care. Little is known regarding the health and experiences among subpopulations of specific sexual orientations and gender identities (SOGI). We implemented the first LGBTQ + health needs assessment survey in Nassau and Suffolk Counties, New York, to assess individuals’ health care experiences, behaviors, access to care, and health care needs. The sample (N = 1150) consisted of many SOGI subgroups. Greater than 60% of respondents reported symptoms of chronic depression; over one third reported disrespectful health care experiences; and two thirds experienced verbal harassment. Bisexual/bicurious, pansexual, queer, gender nonconforming and transgender individuals experienced highest rates of mental health concerns and difficulty accessing care. Behavioral health concerns were also high among Black, multiracial, Hispanic, Asian, young adult, and lower-income respondents. Gaining an understanding of unique differences among LGBTQ+ subgroups can guide implementation of services targeting specific subpopulations to improve access to care and reduce disparities.

Abstract WP15: Short-Term Functional Outcomes Of Patients With Large Vessel Occlusions Transported By Mobile Stroke Unit Compared To Conventional Transport.

Background: A major limiting factor of favorable outcomes among patients with emergent large vessel occlusions (ELVO) is delay in transfer to a comprehensive stroke center (CSC). Stony Brook University Hospital (SBUH) is one of two CSCs in Suffolk County, serving approximately 1.5 million patients over 912 square miles. In 2019, SBUH implemented 2 mobile stroke units in strategic locations within Suffolk County to facilitate rapid delivery of acute stroke treatments. With the capability of performing computed tomography angiography (CTA) in addition to non-contrasted head CT, SBUH MSU offers an opportunity to rapidly triage patients to necessary CSCs. We sought to compare functional outcomes of patients receiving thrombectomies following transport by MSU versus conventional EMS and hospital transfers. Methods: A retrospective study was conducted that included patients eligible to receive mechanical thrombectomy from 2017 to 2020. Patients who had pre-morbid modified Rankin scale (mRs) greater than 0, transient ischemic events, subarachnoid hemorrhage, intraparenchymal hemorrhage, or strokes post-hospital arrival were excluded. A total of 77 patients were included, 37 of whom received care by MSU and 40 by EMS or transfers. Time interval from Door-to-Needle time was measured. T-test for independent samples was used to measure differences in time among both groups. Functional outcomes were measured using mRS at discharge. Patients were trichotomized into three outcome groups, mRS 0-1, 2-4, and 5-6. Chi square was used to analyze differences among the outcome groups Results: MSU patients had a significantly shorter Door-to-Needle time than the EMS patients: (69± 64 min vs. 115 ± 65 min respectively, t=3.319, 78.155df, P&lt;0.001). At discharge in MSU group, 37.8% (14) had favorable mRS 0-1 compared to the control group 26.4% (14). The MSU group had 56.8% (21) moderate mRS 2-4 compared to the control group 47.2% (25) with mRS of 2-4. The MSU group had 5.4% (2) severe mRS 5-6 compared to the control group 26.4% (14). X 2 =7.716, 2df, p&lt;.01 Conclusions: CTA can be performed on MSUs to detect ELVOs in the field and achieve prompt triage of these patients to CSCs, thereby reducing time to thrombectomy and improving short-term functional outcomes.

Abstract WP44: Long Functional Outcomes After Acute Stroke Treatment After Implementation Of Mobile Stroke Unit Program

Background: Mobile stroke units (MSU) were developed as a tool to facilitate rapid delivery of acute stroke treatments and improving patient functional outcomes. Currently, there is limited data on the functional outcomes of patients receiving acute stroke treatments after being transported by MSU. In 2019, Stony Brook University Hospital (SBUH) implemented 2 mobile stroke units to assist with rapid delivery of acute stroke treatments. We sought to compare the long-term functional outcomes of patients who received acute stroke treatment after transport by our MSU versus conventional transportation prior to MSU implementation. Methods: This is a retrospective study of patients who received either tissue plasminogen activator (t-PA) and/or thrombectomy between the years 2017-2020 (n=316). Patients were separated into two groups; Either receiving care via MSU to SBUH (n=107) or receiving care after arrival/transfer to SBUH via conventional transportation (n=165). Time interval from door to t-PA administration and door to groin puncture were measured. T test for independent samples were used to measure differences in time among both groups. Long term functional outcomes were measured using modified Rankin Scale (mRS) at 90 days. Patients were trichotomized into three outcome groups, mRS 0-1, 2-4, and 5-6. Chi square was used to analyze differences among the outcome groups. Results: The MSU patients had a significantly shorter Door to TPA time than the control group: (28 min±22 min vs. 63 min ±40 min respectively, t=4.770, 74 df, P&lt;0.001). MSU patients had significantly shorter Door to groin puncture time than the control group (69 min ± 57 min vs 155min ± 271 min. respectively, t=2.807, 234 df, P&lt;0.001). In MSU group (44), 41% had favorable mRS 0-1 compared to control group 23% (31) with mRS of 0-1. MSU group had 36% (44) moderate mRS 2-4 compared to control group 45% (31) with mRS of 2-4. MSU group had 23% (41) severe mRS 5-6 compared to control group 33% (31). X 2 =9.770, 2df, p &lt;.01 Conclusions: MSU transported patients had shorter door to t-PA and thrombectomy times compared to patients using traditional EMS transfer system in Suffolk County. This improvement translated into more favorable long-term patient outcomes as seen with more MSU patients with lower 90 day mRS.

Misdemeanor Prosecution

Abstract Communities across the United States are reconsidering the public safety benefits of prosecuting nonviolent misdemeanor offenses, yet there is little empirical evidence to inform policy in this area. We report the first estimates of the causal effects of misdemeanor prosecution on defendants’ subsequent criminal justice involvement. We leverage the as-if random assignment of nonviolent misdemeanor cases to assistant district attorneys (ADAs) who decide whether a case should be prosecuted in the Suffolk County District Attorney’s Office in Massachusetts. These ADAs vary in the average leniency of their prosecution decisions. We find that for the marginal defendant, nonprosecution of a nonviolent misdemeanor offense leads to a 53% reduction in the likelihood of a new criminal complaint and a 60% reduction in the number of new criminal complaints over the next two years. These local average treatment effects are largest for defendants without prior criminal records, suggesting that averting criminal record acquisition is an important mechanism driving our findings. We also present evidence that a recent policy change in Suffolk County imposing a presumption of nonprosecution for nonviolent misdemeanor offenses had similar beneficial effects, decreasing the likelihood of subsequent criminal justice involvement.

Business and Local Government: Prevention of Unethical Conduct

The case describes the developments of an ethics code observed in the local government of Suffolk County, New York, USA. In Suffolk County, there is now a dedicated Board of Ethics Agency (“Board”) within the local government to ensure that business operations and government operations run as ethically compliant as possible. This Board was created in 2012 in order to follow compliance with a law that established a replacement for the Ethics Commission (previously existing within Suffolk County) because this Ethics Commission had been involved in a serious controversy. The former County Executive, Steve Levy, was found guilty of compromising the “integrity of an ethics commission”. Suffolk County government prescribed various measures in order to ensure that the citizens of Suffolk County were protected from business ethical violations. The Board also preemptively created laws that discouraged businesses from acting unethically.

Bourbon Virus Transmission, New York, USA

In July 2019, Bourbon virus RNA was detected in an Amblyomma americanum tick removed from a resident of Long Island, New York, USA. Tick infection and white-tailed deer (Odocoileus virginianus) serosurvey results demonstrate active transmission in New York, especially Suffolk County, emphasizing a need for surveillance anywhere A. americanum ticks are reported.

1409. Infectious Complications in People Who Inject Drugs (PWID): A Retrospective Review and Recommendations for Improved Care

Abstract Background Suffolk County, NY is home to 1.5. million people and has a higher drug related deaths per capita rate compared to NY state average (19.9 vs 14.9/100,000). Injection drug use (IDU) is associated with complicated infections and inadequate treatment of substance use disorder (SUD) leads to relapse of infection and treatment failure. Unfortunately, access to SUD treatment services is not optimized in Suffolk County. We aimed to characterize the incidence and outcome of admissions for PWID and identify modifiable risk factors which can contribute to suboptimal care for PWID. Methods A retrospective review of SBUH electronic medical record was conducted from Jan 1, 2015 to June 1, 2021. Length of stay, discharge disposition, 6-month hospital readmission, insurance, employment and housing status, SUD history plus infection type and antimicrobial receipt were assessed. Results Of 425 patients (pts) admitted between Jan 1, 2015 to June 1, 2021, the median age was 34 years, 93% were white, and 59% male. Most pts. (89%) reported stable housing and had government insurance. The average length of stay was 13.6 days with 1/3 of pts. requiring ICU admission. Notably, 34% of pts left prematurely against medical advice and 34% were readmitted within 6 months. Formal ID (63%) and Psychiatry (62.5%) consults were not requested on all pts. Only 18% and 25% of pts. were treated with methadone or suboxone. 60% of screened pts. had HCV but 50% were not screened for co-infections. Complicated skin and soft tissue represented 70%, sepsis/bacteremia 11%, osteomyelitis/arthritis 10% and endocarditis 12% of the cases. 14.8% of pts. with endocarditis died, 48% had recurrent endocarditis, 52% needed surgery including 12% of repeat valve replacements. Staphylococcus species caused 42% of infections. About 2/3 of pts required continued antibiotic therapy at time of discharge, leading to delayed discharge for IV catheter placement. Conclusion Managing infectious complications in PWID is a multi-faceted endeavor extending beyond inpatient care. This study highlights the need for standardized treatment plans involving specialized case managers to reduce LOS and AMA discharges, improve screening for infections and integrate SUD treatment for PWID. Disclosures All Authors: No reported disclosures.

Attitudes toward a novel breastfeeding-mediated drug and nutrient delivery system: A qualitative study

The objective of this study was to determine the attitudes and impressions of breastfeeding mothers and healthcare practitioners towards a device concept integrating breastfeeding with infant drug and nutrient administration. This was an exploratory qualitative study involving 20 breastfeeding mothers and 6 healthcare practitioners from the Suffolk and Middlesex County areas of Massachusetts, USA each individually interviewed. Interview transcription of the semi-structured interviews by an independent service began during data collection, and data coding into major themes continued until and after data saturation was reached.Repeated medication delivery with a reusable product was highlighted as a potential use case for the device concept; ease of use and cleaning as well as cost, familiarity with the method, and infant response were identified as critical considerations. Participants questioned device suitability with liquid formulations (as opposed to non-liquid), while potential advantages over alternative medication delivery technology like oral syringes were identified, including a more “natural” feeling.Most participants had prior knowledge of, or personal experience with, devices like commercially available nipple shields. Attitudes towards the NSDS were not determined by experience with nipple shields, however. The participants’ prior exposure to nipple shields is in contrast to related studies in Kenya and South Africa where commercial nipple shields were not widely known and where specific concerns surrounding potential community stigma to an unknown device were raised by participants.

A Community-Based COVID-19 Vaccine Education Initiative.

Coronavirus disease 2019 (COVID-19) has had a disparate impact on Black and Latinx communities. Even before the COVID-19 pandemic, inaccessibility and distrust of the medical community rooted in historical oppression led to hesitancy about medical interventions. In Boston, COVID-19 vaccination rates of Black and Latinx adolescents lagged behind their white and Asian peers. In response, Boston Medical Center created community vaccine clinic sites across Suffolk County. Pediatric resident physicians subsequently partnered with Boston Medical Center to establish an accompanying education program entitled "Ask-a-Doc" to help improve health literacy and address vaccine hesitancy that focused on Black and Latinx adolescents. In partnership with multidisciplinary stakeholders, including Boston Public School leaders, Ask-a-Doc pediatric resident physicians staffed 46 community vaccine events in 15 zip codes. At these events, 1521 vaccine doses were administered, with most administered to Black and Latinx community members. As of January 1, 2022, 67% of 51 first-year pediatric resident physicians had participated. Ask-A-Doc is an example of a community-based intervention that directly targets health inequities and misinformation and demonstrates that pediatric resident physicians can meaningfully engage in community outreach with sufficient protected time, resources, and institutional support. The resulting connections may lead to greater trust and credibility within systematically oppressed communities.

S1036 Cannabidiol (CBD) Use in Inflammatory Bowel Disease

Introduction: Cannabidiol (CBD) is a cannabinoid compound found in cannabis that has been gaining attention over the past few years in the medical community. Unlike tetrahydrocannabinol, also found in cannabis, it does not have psychoactive effects. It is easily obtainable, mixed in an oil or gummy form, and available in different strengths and flavors. CBD is used for pain, anxiety, depression and insomnia. While marijuana use has been widely studied in patients with Inflammatory Bowel Disease (IBD), there are few studies on the use and effects of CBD in this population. The purpose of this survey based study is to determine the number of IBD patients using CBD products, why they use them and if they perceive any benefits. Methods: 229 patients over the age of 18 with a diagnosis of IBD, from two gastroenterology outpatient clinics in Suffolk county, NY were invited to participate in an anonymous survey from June 1st to June 16th, 2022. The survey consisted of 13 questions pertaining to demographics, IBD related history, cancer history and CBD use. The surveys were completed in the office or by telephone. Data was entered into an anonymous database for interpretation. Results: Of the 229 patients, 10.5% used CBD products (n=24). Of the CBD users, more than half (66.7%, n=11) were female, 14 had Crohn’s disease while the rest had Ulcerative colitis, 37.5% (n=9) were on biologic therapy, and 9 (37.5%) had an IBD related surgery. Anxiety (62.5%, n=15), insomnia (54.2%, n=13) and pain (41.7%, n=10) were the most commonly reported reasons for use of CBD. Increase in appetite (25%, n=6) and nausea and vomiting (20.8%, n=5) were also reasons for use but were not reported as frequently. The majority of patients (87.5 %, n=21) felt that CBD helped their symptoms. Conclusion: IBD patients frequently suffer from pain, anxiety, insomnia and depression. There has been a rise in the use of CBD products in patients with various medical conditions. In our small study, we found that only 10.5% of IBD patients use CBD products, mainly for anxiety, insomnia and pain, compared with arthritis where reported use is 50% or more. Patients with IBD who have a complicated disease process often seek alternative therapies and are therefore at risk for substance use. Until there are large clinical trials to assess the role and safety profile of CBD in IBD patients, clinicians should be aware of its use in this population.Figure 1. : Cannabidiol (CBD) use in Inflammatory Bowel Disease Patients

Economic Valuation for Coastal Water Infrastructure Planning: Analysis of the Housing Market and Nutrient Pollution in Suffolk County, NY

The waters around Suffolk County, New York, are plagued by water quality concerns from nitrogen inputs, algal blooms, and eutrophication. Meanwhile, waterfront and near-water homes fuel a robust real estate market with many iconic regions, such as the Hamptons. Aging cesspools and septic systems are a paramount concern in the area. With approximately 74% of homes outside sewer systems, several jurisdictions are evaluating approaches to funding retrofits that would improve septic systems and water quality. It is therefore an ideal location to assess the impact that water quality has on home values; this paper investigates property sales near the Long Island Sound, South Shore Bays, and Peconic Estuary System. Results show that water quality has a significant impact on nearby home sales, with the largest effects generally seen nearest to the coastline. These results inform a discussion about potential benefits and costs of widespread septic tank and cesspool retrofitting, which is currently incentivized by grant and loan programs.