Virginia Commonwealth University Research Articles

Smart Little Campus Food Pantries: Addressing food insecurity at Virginia Commonwealth University

Food insecurity among college students is an emerging public health issue, affecting a considera­ble proportion of the student population nation­wide, approximately 35–45%. Research is discover­ing links between college student food insecurity and physical and mental health, as well as academic performance. Such high prevalence of student food insecurity highlights the urgency of addressing the lack of consistent access to nutritious food. This research examines a pilot intervention at an urban public university that deployed miniature food pan­tries across campus from which anyone could take food anonymously. The research team systemati­cally restocked these pantries with food on a weekly basis for nearly two school years. Sensors installed in the pantries collected instances when individuals “interacted” with the pantry’s door. The sensor system documented thousands of interac­tions with the pantries each school year. As such, the intervention can be considered a success. How­ever, the miniature pantry model was not without flaws: its decentralized nature created challenges for the research team, the sensor system was often unstable, and heavy reliance on undergraduate stu­dents proved a long-term problem. The research team believes that administrative and information technology improvements could further enhance the model’s ability to mitigate campus food insecu­rity. This intervention could be an inspiration to other campuses and other institutions considering similar strategies.

The time is now: Increasing competitive integrated employment opportunities for all Americans with disabilities

We are pleased to share with you an important written testimony submitted for Senator Bob Casey’s Hearing in the U.S. Senate on “All Means All: Empowering People with Disabilities in Careers and in the Workplace.” This testimony was provided by Dr. Lauren Avellone, Associate Professor at the Virginia Commonwealth University –Rehabilitation Research and Training Center. This testimony took place on Thursday February 29, 2024. Her testimony focused on the positive impact of competitive integrated employment on people with high support needs working within the United States, the need to eliminate 14c certificates which enable subminimum wages to be paid to people with disabilities, and solutions for achieving greater employment outcomes for all people with disabilities who would like to obtain employment. Statement from Dr. Paul Wehman, Editor-in-Chief of the Journal of Vocational Rehabilitation

'Burn and Push' technique: A novel robotic liver parenchymal transection technique.

Liver parenchymal transection during robotic liver resection (RLR) remains a significant challenge due to the limited range of specialised instruments. This study introduces our 'Burn and Push' technique as a novel approach to address these challenges. A retrospective analysis was conducted on 20 patients who underwent RLR using the 'Burn and Push' technique at Virginia Commonwealth University Health System from November 2021 to August 2023. The study evaluated peri- and post-operative outcomes. The median operation time was 241.5min (range, 90-620min), and the median blood loss was 100mL (range, 10-600mL). Major complications occurred in one case, with no instances of postoperative bleeding, bile leak, or liver failure. The 'Burn and Push' technique is a viable and efficient alternative for liver parenchymal transection in RLR. Further research with larger sample sizes and consideration of the learning curve is necessary to validate these findings.

COVID‐19‐related chemosensory changes: Findings from a prospective national database

AbstractObjectiveThe aim of this study was to review findings from a large prospective national database of chemosensory disturbances associated with coronavirus disease 2019 (COVID‐19) infection.Data SourcesThe Virginia Commonwealth University Smell and Taste Center national database of COVID‐19 chemosensory disturbances.MethodsA series of online surveys, first opened on April 10, 2020, was made accessible nationwide to any adult with sudden chemosensory dysfunction since January 2020. Participants received subsequent follow‐up surveys 14 days, 1 month, 3 months, and 6 months after enrollment. An additional survey was sent to all participants on May 28, 2022 to assess long‐term outcomes. Information pertaining to demographics, symptoms, comorbidities, treatments, and life impact was collected.ResultsOf 363 participants who reported complete smell recovery, 51.2% recovered within 1 month, 70% within 3 months, and 79% within 6 months, while 8.8% took over 1 year to completely recover. Among all participants, 7.5% had no smell recovery. Positive predictors of recovery included age <40, male gender, and the presence of nasal congestion. Negative predictors included difficulty breathing and prior head injury. Many participants reported a decrease in quality of life and the presence of potential safety hazards associated with decreased smell loss.ConclusionsMost subjects with COVID‐19‐related chemosensory dysfunction recover, with the majority noting complete recovery within weeks of infection. Those aged over 40 years and female gender were associated with lower rates of recovery. A considerable number of participants reported significant impact on quality of life and safety.

CPDD election results

The College on Problems of Drug Dependence (CPDD) has a new president‐elect: Wendy Lynch Ph.D., of the University of Virginia School of Medicine. The results of the 2024 Officers and Board of Directors election also included new board members Cecelia Bergeria Ph.D. of the Johns Hopkins University School of Medicine, Bethea “Annie” Kleykamp Ph.D. of the University of Maryland, Aron Lichtman Ph.D. of Virginia Commonwealth University, and Judith Tsui M.D. of the University of Washington.

Milk and Cookies: A model for low‐intensity intervention for children with an incarcerated parent

Recently, my niece, a graduate student in clinical psychology, sent me an article she published with her undergraduate faculty mentor. The article is cited below (Walters & Dallaire, 2024) and summarizes the outcomes of a specialized group intervention for children with an incarcerated parent called Milk and Cookies (MAC). Her mentor provides evaluative support for MAC via her research lab at William and Mary. MAC is offered through a nonprofit organization in Virginia called Assisting Families of Inmates, Inc. (AFOI). AFOI works with families with an incarcerated member to facilitate reunification both prior to and after release from incarceration. The group leaders for MAC are recruited from Virginia Commonwealth University's School of Social Work.

Spit for Science and the Limits of Applied Psychiatric Genetics

The research program Spit For Science was launched at Virginia Commonwealth University (VCU) in 2011. Since then, more than 10,000 freshmen have been enrolled in the program, filling out extensive questionnaires about their drinking, general substance use, and related behaviors, and also contributing saliva for genotyping. The goals of the program, as initially stated by the investigators, were to find the genes underlying the heritability of alcohol use and related behaviors, and in addition to put genetic knowledge to work in ways that might aid university administrators and mental health professionals in the prevention and treatment of substance abuse. We review every empirical paper involving genetic data that has emerged from the program, and reach a surprising conclusion: the study has never identified a single genetic effect of more than trivial magnitude. Although the quantitative results of the studies were reported transparently, the theoretical ramifications of the negligible results have never been acknowledged. To the contrary, most of the papers ignore the tiny effects, reaching optimistic conclusions about the prospects for future genetic explanations of alcohol use. We explore the implications of these results for the broader prospects of applied psychiatric genetics.

The Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project-A Tribal Community-Academic Partnership for Understanding the Impact of Structural Factors on Perceived Cancer Risk in Rural Virginia.

In 2022, the Virginia Chickahominy Indian Tribe partnered with Virginia Commonwealth University Massey Comprehensive Cancer Center to investigate concerns about a potential cancer cluster near a local landfill. While investigating cancer clusters is complex due to long latency and multifactorial causes, the community's concerns about structural factors driving cancer risk warrant exploration. Thus, the Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project was created as a community-academic partnership to (1) identify structural factors and barriers associated with perceived cancer risk and care; (2) assess cancer knowledge, care access gaps, and perceived risks, including testing private and community water sources; (3) develop and deploy culturally tailored cancer education and resource navigation, including groundwater safety education, policies, and remediation. We will conduct 150 in-person interviews and water tests among residents within a four-mile radius of the landfill, and deploy 1000 structured questionnaires among Charles City County residents. In this paper, we provide an overview of the ongoing project design, development, and progress in support of the project's objectives. This collaborative investigation aims to address cancer health disparities, enhance research and health policy advocacy, and honor the sacred knowledge of an underserved community, laying the groundwork for a long-term partnership to guide future research questions.

Multiple Sclerosis and Family Planning: A Survey Study of the Patient Experience.

Multiple sclerosis (MS) commonly affects women in their childbearing years, necessitating discussion between patients and their MS treatment team around the issues of family planning, pregnancy, and postpartum experiences. This study assessed the impact of a diagnosis of MS on women's reproductive decision-making and on their perception of counseling received surrounding pregnancy. It also sought to evaluate trends in pregnancy and postpartum experiences and determine whether experiences differed by race, ethnicity, and zip code. Women with an MS diagnosis seen at the University of Virginia MS Clinic or at Virginia Commonwealth University (VCU) MS Clinic were invited to participate in a survey study. MS disease and pregnancy history, and, when appropriate, reasons for pregnancy avoidance were collected. Respondents who had >1 pregnancy following MS diagnosis were asked to evaluate the counseling they received from medical professionals and to share their pregnancy experiences including complications during pregnancy, delivery outcomes, and postpartum experience including breastfeeding. Of the 280 respondents, 76.6% were currently receiving MS specialty care. Most of them (79.3%) had not been pregnant following MS diagnosis. Of them, 20.1% indicated that this decision was driven by MS-related concerns: MS worsening with pregnancy (47%); ability to care for child secondary to MS (35%); passing MS onto child (19%); stopping disease-modifying therapies to attempt pregnancy (14%); lack of knowledge about options for pregnancy and MS (9%). Women with a more recent estimated decade of pregnancy were more likely to report neurologist counseling regarding MS and pregnancy (pregnancy before 2000: 40%, 2000-2010: 64.7%, 2010- present: 83.3%; χ2 0.020). Breastfeeding initiation was reported in 71.4% of postdiagnosis pregnancies (median duration 6 months, interquartile range 1.75-11). Over the past few decades, women with MS have received a wide range of evolving guidance surrounding family planning, pregnancy, and postpartum care. Survey data suggest improvements in MS/pregnancy counseling and medical management in recent years, which may be driven by an increase in research in the field. There remains an important need and opportunity to improve counseling of women with MS who are considering pregnancy.

Providing technical assistance to inclusive postsecondary education programs on paid employment experiences of college students with intellectual and developmental disabilities: A case study

BACKGROUND: Students with intellectual and developmental disabilities lag behind their peers without disabilities when it comes to participation in college and employment. In response to this, researchers at Virginia Commonwealth University (VCU) created an online, six-week course for staff who work with students with disabilities in inclusive postsecondary education (IPSE) programs. OBJECTIVE: To create a course and technical assistance (TA) based on implementing supported employment strategies through VCU’s ACE-IT in College model, using evidence-based employment practices. The course and TA were developed to increase the skills of IPSE program staff, as well as increase the number of paid internship opportunities for the students in their programs. METHODS: VCU staff offered a six-week training program, followed by yearlong technical assistance to college and university staff who implement inclusive postsecondary education programs. The researchers conducted a case study of one program and followed them through the course and their TA activities. Data examined were: facilitated discussion board responses, needs assessment results, meeting notes and case study notes, as well as goals and strategies they developed. RESULTS: Results indicate a need for more staff and funding, as well as university buy-in. The fidelity of implementation allowed researchers to make slight adjustments for future TA participants. CONCLUSION: One participating program emerged as a case study site, and results indicate a need for more staff and funding. Detailed descriptions and technical assistant support strategies are provided, as well as implications for further research.

Overcoming Immunities to Change: The ADVANCE Immunities to Change (ITC) program at Virginia Commonwealth University

Overcoming Immunities to Change: The ADVANCE Immunities to Change (ITC) program at Virginia Commonwealth University

A Multi-Institutional Description of Processes and Outcomes of Postbaccalaureate Research Education Programs in the Mid-Atlantic Region.

Outcome data from 6 National Institutes of Health-funded Postbaccalaureate Research Education Programs (PREPs) in the Mid-Atlantic region were combined to give a multi-institutional perspective on their scholars' characteristics and progress through biomedical research training. The institutions hosting these programs were Johns Hopkins University School of Medicine, the Medical University of South Carolina, the University of Maryland School of Medicine, the University of North Carolina at Chapel Hill, Virginia Commonwealth University, and Virginia Polytechnic Institute and State University. The authors summarize the institutional pathways, demographics, undergraduate institutions, and graduate institutions for a total of 384 PREP scholars who completed the programs by June 2021. A total of 228 (59.3%) of these PREP scholars identified as Black or African American, 116 (30.2%) as Hispanic or Latinx, and 269 (70.0%) as female. The authors found that 376 of 384 scholars (97.9%) who started PREP finished their program, 319 of 376 (84.8%) who finished PREP matriculated into PhD or MD/PhD programs, and 284 of 319 (89.0%) who matriculated have obtained their PhD or are successfully making progress toward their PhD.

REPORTING MERIT-BASED INCENTIVE PAYMENT SYSTEM LIKE DATA IN A UNIQUE AGE-FRIENDLY HEALTH CARE SETTING

Abstract The Richmond Health and Wellness Program (RHWP) offers screening, education, care coordination, and resources as an enhancement to primary care for older adults in five low-income apartment buildings and in a community center. Participants may receive primary care through multiple healthcare systems in the region that do not have a common electronic medical record (EMR). To track age-friendly workflows to the Health Resources Services Administration (HRSA) in the domains of advance care planning, falls prevention, and high-risk medication use, case note documentation in a REDCap database is used to generate Merit-based Incentive Payment System (MIPS)-like data. We report on advance care plans developed, fall risk screenings and risk reduction interventions implemented, high-risk medications screened, and referrals to primary care for high-risk medication deprescribing, including risk reduction with opioid use. When reporting MIPS data to HRSA, we include a disclaimer for RHWP data defining the numerator and denominator used for the MIPS-like measure calculation. For example, when reporting advance care plan completion, we include “RHWP is a care coordination site and care is not provided at the site. The population includes adults aged 55+ or people (of any age) with disabilities in low-income congregate living facilities and all adults participating in RHWP at the Virginia Commonwealth University Health Hub.” The numerator indicates the number of clients with advanced care plans created, and the denominator indicates the total number of clients seen during the reporting period. This presentation will provide strategies to meet reporting requirements when EMR records are not available.

PUSHING BACK AGAINST AI: USING UNGRADING TO PROMOTE CRITICAL THINKING AND INTRINSIC MOTIVATION

Abstract Ungrading is an innovative pedagogical practice in which instructors give frequent, detailed feedback on students’ work and/or encourage self-evaluation rather than assigning them points or letter grades. Ungrading has been shown to increase students’ intrinsic motivation to learn, their willingness to take intellectual risks, and the quality of their thinking. Prior to the introduction of advanced artificial intelligence (AI) writing in academia, grades were shown to be a motivating factor for cheating. Ungrading removes the pressure of grades, thus making the use of AI and other services including paper writing and test answer sharing less enticing. Ungrading could be key to pushing back against the potential for the advent of artificial intelligence tools, which have many universities “alarmed.” Educators at Virginia Commonwealth University College of Health Professions, supported by their Director of e-Learning, planned and piloted ungrading in one undergraduate and two graduate gerontology courses. Twenty-five students completed pre and post-surveys asking for their reactions to ungrading, if their views had changed as a result of the ungrading pilot, as well as their perceptions of traditional grading schemes. They also completed scaffolded assignments with multiple opportunities for receiving in-depth instructor feedback, rather than grades, at various points during the semester. Faculty journaled their ungrading experience in order to recognize how it can be a disruptive, and at times, uncomfortable practice and as a result, educators can better guide themselves and students through the transition. This presentation will include an Implementation Guide for gerontology faculty who wish to implement ungrading.

Impact of C-reactive protein levels and role of anakinra in patients with ST-elevation myocardial infarction

BackgroundInterleukin-1 blockade with anakinra reduces C-reactive protein (CRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). The effectiveness of anakinra according to the degree of systemic inflammation in STEMI has not been addressed. MethodsWe analyzed 139 patients from three Virginia Commonwealth University Anakinra Response Trial randomized clinical trials to assess whether CRP levels predicted HF hospitalization or death in patients with STEMI, and if CRP levels influenced the effects of treatment with anakinra. ResultsCRP cut-off levels for prediction of the composite of death or HF hospitalization for CRP at admission, 3 and 14 days were, respectively 6.45 mg/L (100% of sensitivity and 66.1% specificity), 26 mg/L (100% of sensitivity and 78% specificity) and 9.56 mg/L (100% of sensitivity and 80% specificity). More patients with elevated CRP levels died or had a HF hospitalization (5/47 [11%] vs 0/82 [0%], p = 0.004 for CRP at admission; 5/32 [15.6%] vs 0/92 [0%], p < 0.001 for day 3 and 5/26 [19%] vs 0/89 [0%], p < 0.001 for day 14). A greater number of patients treated with anakinra had low CRP levels at 3 and 14 days compared to placebo (Odds Ratio 0.11 [95% IC 0.04–0.28], p < 0.0001 and OR 0.35 [95% CI 0.14–0.86], p = 0.02, respectively). Anakinra significantly prevented death or HF hospitalization in patients with high inflammatory burden (p = 0.04 for admission, p = 0.24 for day 3, and p = 0.05 for day 14). ConclusionPatients with elevated CRP had higher incidence of HF hospitalization or death. Anakinra reduced the number of patients with elevated CRP levels and prevented death or HF hospitalization in patients with elevated CRP levels.

Outcomes of Pharmacist-Led Treatment of Hepatitis C in the Virginia Department of Corrections.

A higher proportion of people in correctional settings have, or are at risk for, hepatitis C virus (HCV) due to socioeconomic factors, mental health concerns, substance use disorders, history of high-risk experiences, and more. Compared with the general population, the prevalence of HCV is 10 times higher among people who are incarcerated. The objective of this retrospective cohort study was to describe the HCV treatment cascade in a pharmacist-led clinic model, from referral through treatment completion and documentation of cure. Pharmacists in the Virginia Department of Corrections, in collaboration with Virginia Commonwealth University, established and led a telemedicine HCV clinic. A total of 1,040 incarcerated individuals with chronic HCV infection were treated between January 2020 and January 2022. In this study, the clinical endpoint was the number of patients achieving a 12-week sustained virological response (SVR12), which is considered cure of an HCV infection. The economic endpoint was total dollars spent per patient to achieve the SVR12. Participants were HCV treatment naïve, positive for HCV genotypes 1-6, not concurrently infected with HIV, and without decompensated liver disease. The overall cure rate was 97% with no discontinuation due to adverse effects. The cost-to-cure ratio was $23,223/person achieving SVR12.

Abstract 16312: Sex-Based Differences in Response to Interleukin-1 Blockade With Anakinra in Patients With ST-Segment Elevation Myocardial Infarction

Introduction: Interleukin-1 blockade with anakinra reduces C-reactive protein (CRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra in this setting. Methods: We analyzed sex-based differences in the systemic inflammation (CRP levels) and composite end-point of new-onset HF or death in patients with STEMI from three different Virginia Commonwealth University Anakinra Response Trial (VCU-ART) randomized clinical trials. Data are reported as median and interquartile range [IQR] or number and percentage (%). Kaplan-Meier curves for event-free survival were constructed for the time-dependent composite endpoint and compared using the log-rank analysis. Results: We analyzed 139 patients from three VCU-ART trials, 29 (21%) were women while 110 (79%) were men. Baseline CRP was higher in women compared to men (8.9 [5.2-13.5] vs 4.2 [2.1-7.7] mg/L, P&lt;0.001). Twenty-two (75%) women and 62 (56%) men were treated with anakinra. Area under the curve (AUC)-CRP at 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs 223 [119-374] mg day/L) and in women (73 [46-313] vs 242 [102-988] mg day/L) (P&lt;0.001 at ANOVA for multiple groups, P for interaction 0.22) Figure A . The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs 14 [29.1%]) and in women (3 [13.6%] vs 2 [28.5%]) (P=0.019 at ANOVA, P for interaction 0.44) Figure B . There were no statistically significant differences between women and men in AUC-CRP and HF events when comparing separately the anakinra and placebo groups (all P&gt;0.05). Conclusions: Women were underrepresented in the VCU-ART trials, they appeared to have higher CRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.

Racial disparities in ALS diagnostic delay: a single center's experience and review of potential contributing factors.

Outcomes for amyotrophic lateral sclerosis (ALS) patients are improved with prompt diagnosis, earlier initiation of disease-modifying treatments, and participation in a multidisciplinary clinic. We studied diagnostic delay and disease severity at time of clinic presentation between Black and non-Hispanic Caucasian ALS patients. We performed a retrospective analysis of non-Hispanic Caucasian and Black ALS patients seen in the Virginia Commonwealth University Health System multidisciplinary ALS clinic between 2017 and 2023. Diagnostic delay, ALS Functional Rating Scale-Revised (ALSFRS-R) and upright forced vital capacity (FVC) scores at baseline appointment were collected. Patient's distance from clinic and affluency of residential neighborhood were evaluated. We analyzed 172 non-Hispanic Caucasian and 33 Black ALS patients. Black patients had a 64% increase in diagnostic delay compared to non-Hispanic Caucasian patients. Black patients had a lower performance on ALSFRS-R (5.3 points, p < 0.001) and FVC (17.9 percentage points p < 0.001) at time of first clinic visit. Black patients lived closer to clinic, with higher proportion living in the city of Richmond, but in less affluent areas with lower median house income ($55,300 ± 22,600 vs $69,900 ± 23,700). Our findings demonstrate a large racial difference in ALS diagnostic delay, and greater disease severity and lower respiratory function at time of diagnosis for Black ALS patients. Delay in diagnosis prolongs access to disease-modifying therapies, multidisciplinary care, durable medical equipment, and respiratory and nutritional support. Potential sources of these racial disparities include providers' implicit bias and structural racism.

Response to interleukin-1 blockade with anakinra in women and men with ST-segment elevation myocardial infarction.

Interleukin-1 blockade with anakinra reduces high-sensitivity C-reactive protein (hsCRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra. We analyzed the systemic inflammation and composite end-point of new-onset HF or death in women and men with STEMI treated with anakinra from three different Virginia Commonwealth University Anakinra Response Trial (VCUART) randomized clinical trials. We analyzed 139 patients, 29 (21%) were women while 110 (79%) were men. Baseline hsCRP was higher in women compared to men (8.9 [5.2-13.5] vs. 4.2 [2.1-7.7] mg/L, P<0.001). Eighty-four patients were treated with anakinra (22 [75%] women and 62 [56%] men). The area under the curve of hsCRP (hsCRP-AUC) after 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs. 223 [119-374] mg day/L) and in women (73 [46-313] vs. 242 [102-988] mg day/L) (P<0.001 for multiple groups, P for interaction 0.22). The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs. 14 [29.1%]) and in women (3 [13.6%] vs. 2 [28.5%]) (P=0.019 for multiple groups, P for interaction 0.44). There were no statistically significant differences between women and men in hsCRP-AUC and death or HF events when comparing separately the anakinra and placebo groups (all P>0.05). Women were underrepresented in the VCUART trials, they appeared to have higher hsCRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.

Cardiovascular impact of near complete estrogen deprivation in premenopausal women with breast cancer: The CROWN study

Survival with operable breast cancer has improved markedly in recent decades, however, treatment-related cardiovascular toxicities threaten to offset these gains. Ovarian function suppression paired with aromatase inhibition, for premenopausal women with hormone receptor (HR)-positive breast cancer, is a newer widely adopted therapy with the potential for significant long-term cardiovascular toxicity. Abrupt estrogen deprivation for non-cancer reasons is associated with accelerated coronary artery disease. Women with breast cancer treated with aromatase inhibition in addition to ovarian function suppression experience a dual hit with regards to estrogen exposure. The CaRdiac Outcomes With Near-complete estrogen deprivation (CROWN) study seeks to understand the early, subclinical natural history of cardiovascular compromise in young women undergoing near-complete estrogen deprivation (NCED) therapy. It is critical to understand the early subclinical development of cardiovascular disease to identify a window for therapeutic intervention before overt cardiovascular events occur. This three-site regional study (Atrium Health Wake Forest, Duke, and Virginia Commonwealth University) uses serial stress cardiac magnetic resonance (CMR) imaging and cardiac computed tomography angiography (CCTA) obtained during the initial two years of NCED therapy to study myocardial prefusion reserve (MPR), large cardiovascular vessel changes, left ventricular function, and other cardiovascular parameters. The CROWN cohort will consist of 90 premenopausal women with breast cancer, 67 with HR-positive disease receiving NCED and 23 comparators with HR-negative disease. Participants will undergo three annual CMR scans and two CCTA scans during the two-year study period. After initial activation hurdles, accrual has been brisk, and the study is expected to complete accrual in December 2024. Efforts are in place to encourage participant retention with the study primary outcome, change in MPR between the two groups, to be reported in 2026-2027. The results of this study will enable premenopausal women with breast cancer to balance the health burdens of cancer at a young age and treatment-related cardiovascular morbidity. Finally, the tools developed here can be utilized to study cardiovascular risk across a range of cancer types and cancer therapies with the ultimate goals of both developing generalizable risk stratification tools as well as validating interventions which prevent overt cardiovascular compromise.