United States

Background
People with disabilities (PWD) face numerous barriers to equitable healthcare, despite utilizing the healthcare system at three times the rate of people without disabilities. In 2005, the Surgeon General identified the lack of provider training as one major barrier to high-value care for PWD, citing disability awareness education for healthcare providers as a key solution. Nevertheless, a 2017 survey found that only 52% of medical schools provided a disability awareness program, with significantly fewer reporting an experiential component or the incorporation of disability community input. As the disabled population continues to grow, it is increasingly important to implement and evaluate disability curricula for medical trainees to close this gap. 

Methods
A four-week, full-time (118.5 contact hours) elective course for third- and fourth-year medical students was developed by faculty with disabilities at Washington University, in partnership with disability-centered community groups. The course simultaneously aims to: (1) increase knowledge about conceptual frameworks of disability and community support services, (2) enhance skills in accommodating patient needs and adapting clinical assessments, and (3) change attitudes through engagement with PWD sharing their lived experiences. Attitudes and perceived self-competence were assessed via completion of identical pre- and post-intervention surveys consisting of Likert-type items adapted from the validated Medical Student Attitudes toward People with Disabilities (MSA-PWD) instrument, as well as open-ended feedback questions administered at course-end. Knowledge was assessed dichotomously using students’ scores on course assessments.

Results
Across seven cohorts of students enrolled in the course from January 2023 – September 2025, 41 students completed the pre- and post-intervention surveys. Wilcoxon signed-rank tests, conducted to compare mean pre-intervention and post-intervention scores, indicated significant increases in positive attitudes towards PWD, comfort interacting with PWD, and perceived self-competence in caring for PWD (all: W=0, p&lt;0.001), regardless of whether or not students had prior personal or professional experience working with PWD. Exam scores demonstrated that all students achieved competency on course assessments. Qualitative feedback revealed themes focused on attitudinal change and appreciation of experiential coursework and non-clinical interactions with disability communities.

Conclusion
This disability elective represents a novel experiential curriculum that has demonstrated the ability to effectively educate medical students about disability-inclusive health and positively change attitudes toward PWD. Future work will develop and evaluate expanded disability-focused content for undergraduate medical education, with the goal of implementing a longitudinal curriculum to ensure that medical trainees become healthcare professionals who are equipped to provide high-value care to PWD and chronic illnesses.

AMA Research Challenge 2025 

Efficacy of a 4-week Immersive Disability Elective in Increasing Knowledge and Changing Attitudes

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Background
People with disabilities (PWD) face numerous barriers to equitable healthcare, despite utilizing the healthcare system at three times the rate of people without disabilities. In 2005, the Surgeon General identified the lack of provider training as one major barrier to high-value care for PWD, citing disability awareness education for healthcare providers as a key solution. Nevertheless, a 2017 survey found that only 52% of medical schools provided a disability awareness program, with significantly fewer reporting an experiential component or the incorporation of disability community input. As the disabled population continues to grow, it is increasingly important to implement and evaluate disability curricula for medical trainees to close this gap. 

Methods
A four-week, full-time (118.5 contact hours) elective course for third- and fourth-year medical students was developed by faculty with disabilities at Washington University, in partnership with disability-centered community groups. The course simultaneously aims to: (1) increase knowledge about conceptual frameworks of disability and community support services, (2) enhance skills in accommodating patient needs and adapting clinical assessments, and (3) change attitudes through engagement with PWD sharing their lived experiences. Attitudes and perceived self-competence were assessed via completion of identical pre- and post-intervention surveys consisting of Likert-type items adapted from the validated Medical Student Attitudes toward People with Disabilities (MSA-PWD) instrument, as well as open-ended feedback questions administered at course-end. Knowledge was assessed dichotomously using students’ scores on course assessments.

Results
Across seven cohorts of students enrolled in the course from January 2023 – September 2025, 41 students completed the pre- and post-intervention surveys. Wilcoxon signed-rank tests, conducted to compare mean pre-intervention and post-intervention scores, indicated significant increases in positive attitudes towards PWD, comfort interacting with PWD, and perceived self-competence in caring for PWD (all: W=0, p<0.001), regardless of whether or not students had prior personal or professional experience working with PWD. Exam scores demonstrated that all students achieved competency on course assessments. Qualitative feedback revealed themes focused on attitudinal change and appreciation of experiential coursework and non-clinical interactions with disability communities.

Conclusion
This disability elective represents a novel experiential curriculum that has demonstrated the ability to effectively educate medical students about disability-inclusive health and positively change attitudes toward PWD. Future work will develop and evaluate expanded disability-focused content for undergraduate medical education, with the goal of implementing a longitudinal curriculum to ensure that medical trainees become healthcare professionals who are equipped to provide high-value care to PWD and chronic illnesses.

poster

Activating mutations in the receptor tyrosine kinase c-Kit, particularly the D816V substitution, are implicated in several malignancies including systemic mastocytosis and gastrointestinal stromal tumors, and are known to confer resistance to type-II tyrosine kinase inhibitors (TKIs) such as imatinib and dasatinib. We investigated the structural and thermodynamic mechanisms underlying drug resistance and constitutive activation in c-Kit mutants, focusing on the interplay between local rigidification and intrinsic disorder.
Through in silico saturation mutagenesis and vibrational entropy analysis, we demonstrate that hydrophobic and aromatic substitutions at position D816 (e.g., V, F, W, Y, L) induce enthalpy-driven rigidification of critical regulatory elements such as the juxtamembrane latch, N-lobe wedges, and activation loop. This rigidified core pre-aligns the catalytic spine, locks the kinase in an active conformation, and prevents transition to the inactive DFG-out state required for type-II TKI binding. In contrast, substitutions at Asn819 lead to increased conformational flexibility, partial destabilization, and retention of inhibitor sensitivity.
Notably, despite increased rigidity at D816, a segment of intrinsic disorder persists within the activation loop and may serve as a dynamic interface for protein interactions. Structural modeling also reveals a shift in dimerization preference, with D816 mutants favoring heterodimer formation with wild-type receptors, further amplifying oncogenic signaling.
These findings redefine rigidification—not flexibility—as a key driver of drug resistance and constitutive activity in c-Kit, and provide a mechanistic framework for the development of next-generation inhibitors targeting rigidified active conformations or disordered regulatory interfaces.


Constitutive activation of the c-Kit oncoprotein induced by a rigidifying hydrophobic interaction between D816V and N819 in the presence of imatinib

Background
Perioperative pain management for c-sections can be supplemented by adjuvant neuraxial opioids. However, opioids are not desirable for all patients, especially those with opioid use disorder or allergy. Meanwhile, dexmedetomidine is a highly specific and selective α2 agonist that is considered a safe and effective adjuvant. Currently, there is a need for a comprehensive systematic review that compares these medications in this setting but does not limit itself to either one opioid or a preidentified dose combination.

Methods
Embase, CENTRAL, Web of Science, and MEDLINE were searched on 08/29/24.1599 studies were imported to Covidence. Only randomized controlled trials (RCTs) that compared dexmedetomidine to opioids as neuraxial adjuvants during c-sections were eligible for inclusion with no restriction on local anesthetic, time of administration of adjuvant, or dosing. Two reviewers independently evaluated each article for abstract/full text screening, data extraction, and risk of bias. Conflicts were resolved by a third reviewer or mutual consensus. Pain outcomes, sedation, onset/duration of motor/sensory block, and adverse effects were recorded. A p-value of < 0.05 represented statistical significance. Prospero number is CRD42024590544.

Results
The final analysis included 17 RCTs. 15 evaluated intrathecal administration with standard opioid dosing per SOAP guidelines while dexmedetomidine dosing was 2.5-10µg. For these intrathecal studies, the comparators were fentanyl/sufentanil in 13, morphine in 2, and meperidine in 1 (one compared fentanyl, morphine, and dexmedetomidine). Two studies compared patient-controlled epidural analgesia (PCEA) dexmedetomidine to morphine. Across dosing ranges and routes, dexmedetomidine had superior pain scores and analgesia duration in the majority of studies with these variables. None found inferiority. Dexmedetomidine prolonged motor block in the majority of studies with this variable. In a minority, it reduced shivering. It reduced pruritus vs morphine and meperidine. No adjuvant was consistently superior in onset of analgesia/motor block, hemodynamic effects, nausea/vomiting, or respiratory depression. For PCEA, dexmedetomidine produced deeper, less desirable sedation.

Conclusion
Neuraxial dexmedetomidine offers comparable-to-superior perioperative pain control vs standard dose fentanyl, sufentanil, morphine, or meperidine as c-section adjuvants. Its most common adverse effect is prolonged motor block. Therefore, intrathecal adjuvant dexmedetomidine at 2.5-10µg is a reasonable alternative in cases of contraindications to opioids or where further surgical intervention is expected such as tubal ligation.


Neuraxial Adjuvants for C-section Analgesia: A Systematic Review of Dexmedetomidine vs Opioids


Background:
FLT3-ITD mutation occurs in 25–30% of acute myeloid leukemia (AML) and is associated with a poor prognosis. FLT3 inhibitors (FLT3i), such as gilteritinib and quizartinib, improve initial response rates, but relapse is common. While on-target resistance via FLT3-TKD mutations is established, emerging evidence suggests that “collateral resistance,” characterized by the outgrowth of non-FLT3 subclones, contributes significantly to therapeutic escape. This review synthesizes current data on clonal evolution under FLT3i pressure, focusing on non-FLT3 subclonal emergence.

Methods:
We conducted a comprehensive review of published studies done up to June 2025, in PubMed, Web of Science, and Scopus. Studies were included if they involved FLT3-mutated AML patients treated with FLT3 inhibitors, reported paired genomic data at diagnosis and relapse. Data on FLT3i type, resistance mechanisms, mutation spectrum, and variant allele frequency (VAF) changes were extracted from clinical trials, retrospective cohorts, and preclinical models.

Results:
In a cohort of 41 relapsed patients treated with gilteritinib, 33% developed FLT3-TKD mutations (D835, F691L), 36.6% acquired NRAS/KRAS mutations, and 5% developed BCR-ABL1 fusions. Another study found off-target RAS/MAPK pathway mutations in 30–37% of relapses, frequently co-occurring with ASXL1, RUNX1, and PTPN11 mutations. Resistance to quizartinib was driven by FLT3-TKD mutations in 33–50% of cases, yet up to 50% of relapses lacked FLT3 mutations, suggesting alternative mechanisms such as microenvironmental signaling and off-target mutations. Three reported cases of BCR-ABL1 fusion following FLT3i failure showed partial responses to combined FLT3 and ABL1 inhibition. Single-cell DNA sequencing revealed that non-FLT3 subclones, undetectable at baseline by bulk sequencing, expanded under FLT3 inhibitor pressure, demonstrating polyclonal resistance and clonal selection as key drivers of relapse. These studies consistently demonstrate that non-FLT3 resistance, particularly involving the RAS/MAPK axis, is frequent and clinically relevant following targeted therapy.

Conclusion:
Collateral resistance to FLT3 inhibitors in AML is frequently mediated by the selection of pre-existing, low-frequency non-FLT3 mutant subclones, particularly those involving the RAS/MAPK pathway. These findings emphasize the importance of comprehensive genomic profiling for diagnosis and relapse. Future therapeutic strategies should prioritize rational drug combinations targeting FLT3 and non-FLT3 pathways to overcome resistance and improve patient outcomes.


REFERENCES
1.Smith, C. C., Levis, M. J., Perl, A. E., et al. (2022). Molecular profile of FLT3-mutated relapsed/refractory patients with AML in the phase 3 ADMIRAL study of gilteritinib. Blood Advances, 6(7), 2144–2155. https://doi.org/10.1182/bloodadvances.2021006489
2. Smith, C. C., Lin, K., Stecula, A., Sali, A., & Shah, N. P. (2015). FLT3 D835 mutations confer differential resistance to type II FLT3 inhibitors. Leukemia, 29(12), 2390–2392. https://doi.org/10.1038/leu.2015.165
3. Tarver, T. C., Hill, J. E., Rahmat, L., et al. (2020). Gilteritinib is a clinically active FLT3 inhibitor with broad activity against FLT3 kinase domain mutations. Blood Advances, 4(3), 514–524. https://doi.org/10.1182/bloodadvances.2019000919


Collateral Resistance in FLT3-Mutated AML: Unraveling Non-FLT3 Subclonal Emergence and Therapeutic Escape Under FLT3 Inhibitor Pressure - A Comprehensive Literature Review

Chinwe Ohanu, MD¹, Ana S. Rosado-Collazo, MD¹, Diane Mankin-Cruz, MD¹, Paco Diaz, MD²,
Frankie Alvarado, MD¹
¹Pavia Hospital, Internal Medicine Department, Pulmonology Section, Arecibo, Puerto Rico
²Pavia Hospital, Internal Medicine Department, Infectious Disease Section, Arecibo, Puerto Rico
Abstract title:
patient.
Trichosporon asahii induced sepsis secondary to bronchopneumonia in an immunocompromised
Background:
Opportunistic fungal infections are a significant concern in immunocompromised patients,
particularly those with hematologic malignancies. Trichosporon asahii is a rare but increasingly
recognized cause of invasive fungal infections. This yeast-like organism, commonly found in
soil, water, and normal human flora, can cause both superficial and systemic disease. Incidence
is estimated at 0.4–0.6% among immunocompromised individuals, especially those with
prolonged neutropenia or hematologic cancers. It is intrinsically resistant to echinocandins and
associated with high mortality rates up to 80% especially when diagnosis or appropriate therapy
is delayed. Diagnosis requires culture, microscopy, and molecular testing. Treatment should be
guided by susceptibility, with azoles being preferred.
Case Presentation:
A 76 year old hispanic female with chronic myelogenous leukemia on chemotherapy, coronary
artery disease, type 2 diabetes, and hypertension presented with progressive dyspnea,
hemoptysis, generalized weakness, and non-radiating chest pain. Vital signs revealed BP 120/45
mmHg, pulse 120 BPM, oxygen saturation at 88% on 3L NC, and fever of 38.1°C.
Chest X-ray showed haziness in the left lower lobe and increased perihilar markings suggestive
of bronchopneumonia. Infectious workup including testing for COVID-19, influenza, TB, PCP,
HIV , and Mycoplasma pneumoniae, was negative. She was initially treated with ceftriaxone and
azithromycin, later escalated to cefepime due to lack of clinical improvement.
Fiberoptic bronchoscopy revealed copious secretions bilaterally. Bronchoalveolar lavage was
negative for AFB and cryptococcus; however, KOH prep was positive for Trichosporon asahii.
Antibiotics were discontinued, and antifungal therapy with voriconazole was initiated. The
patient gradually improved with reduced oxygen requirements, resolution of fever and
respiratory distress.
Discussion:
Trichosporon asahii is an often overlooked fungal pathogen in immunocompromised hosts,
frequently mimicking bacterial pneumonia and delaying diagnosis. Early bronchoscopy and
fungal testing are critical in patients with non-resolving pneumonia. Prompt identification and
targeted antifungal therapy significantly improve outcomes. This case highlights the importance
of clinical vigilance and rapid escalation to fungal diagnostics in high-risk patients.

Trichosporon asahii induced sepsis secondary to bronchopneumonia in an immunocompromised patient

Neural oscillations categorized into specific frequency bands offer various cognitive functions. Gamma waves are the fastest brainwaves in the human brain, generated by synchronized electrical pulses from neurons ranging from 25 to 100 Hz. Decreased gamma oscillations have been associated with cognitive declines in neuropsychiatric diseases, such as memory loss in Alzheimer’s disease (AD). Inducing gamma oscillations using 40 Hz entrainment stimulation offers benefits in learning and memory by increasing the power of spontaneous gamma neural oscillations, modulating synaptic plasticity, and thereby reducing beta-amyloid plaques. This study aimed to investigate frequency-specific EEG responses to 40 Hz auditory stimulation using an open-source EEG study in healthy older adults and individuals with mild AD. 

This secondary analysis used an open-source EEG dataset from 26 participants (16 mild AD, 10 controls). Subjects received repeated cycles of 40-second 40 Hz auditory stimulation interleaved with 20-second rest periods. EEG was recorded from 19 channels. Power spectral density was computed across six frequency bands (delta, theta, alpha, beta, gamma, and gamma40). Linear mixed-effects models assessed stimulation-induced changes (stimulation minus rest), controlling for age and accounting for repeated measures.

Compared to its controls, AD participants demonstrated significantly greater theta power increases (β = 0.406, p = 0.008) during 40 Hz stimulation, with reduced beta, gamma, and gamma40 responses. Topographic mapping revealed widespread theta enhancement in AD, particularly over frontal, parietal, and occipital regions (e.g., AD × Occipital: β = 1.516, p < 0.001), whereas controls showed focal increases in posterior gamma. Notably, theta enhancement in AD did not significantly correlate with Mini-Mental State Examination (MMSE) scores, suggesting it was not exclusively driven by cognitive severity.

AD patients demonstrated a significant increase in theta power within the frontal, parietal, and occipital lobes. This widespread theta enhancement may reflect dysfunctional network entrainment or compensatory mechanisms in early AD. These findings underscore the importance of examining broader spectral responses beyond gamma and support the potential of theta activity as a biomarker of early AD-related neural networks.

Theta Dominance During 40 Hz Auditory Stimulation in Alzheimer’s Disease

Background: The integration of artificial intelligence (AI) into healthcare has accelerated, with an increase in its use for clinical decision support and medical education. In dermatology, large language models are often used to answer patients’ inquiries and support learning for medical professionals, which raises concerns about their reliability and clinical safety. Given the nuanced interpretation required in dermatologic assessment and the potential consequences of incorrect guidance—whether for students or patients—category-specific evaluation of these models is essential to ensure responsible and effective use in dermatologic practice and education. The objective of this study is to assess and compare the performance of 8 publicly available AI models in answering dermatology-related multiple-choice questions across 6 clinical categories.

Methods: A board-certified internal medicine physician developed 11 multiple-choice American Board of Internal Medicine Certification dermatology questions covering 6 dermatologic categories: hair disorders, skin/nail infections, acneiform eruptions, nail disorders, leg ulcers, and geriatrics. All 8 AI models were prompted with the same 11 questions. Each question had 4 – 5 answer choices with a single correct answer. A response was marked correct if the AI model selected the correct choice.

Results: Gemini and DeepSeek scored highest, each with 10/11 questions answered correctly (90.91%). Le Chat scored lowest with 8/11 questions answered correctly (72.73%). All others (ChatGPT, Perplexity, Copilot, Claude, Meta) scored 9/11 (81.82%). No statistically significant differences were found between any models. Fisher’s Exact Test found that the acneiform eruptions category had a statistically significant lower correct rate (62.5%) compared to the hair disorders category (95%) across all models (p ≈ 0.0025). No statistically significant differences between other category pairs.

Conclusion: AI models show promise in dermatology-related question answering, but their performance remains inconsistent and dependent on the question category. No single model demonstrated statistically superior performance overall, and all models struggled significantly more with questions related to acneiform eruptions compared to hair disorders. These findings highlight the need for continued refinement and rigorous evaluation of AI models in dermatology. Further research using a larger, more comprehensive question bank across a broader range of dermatologic topics is warranted to better assess model capabilities and guide their integration into clinical and educational settings.

Evaluating the Performance of Large Language Models in Answering American Board of Internal Medicine Certification Dermatology Questions Across Different Categories

Background:
With the transition of STEP 1 and pre-clinical coursework to pass/fail grading recently, research has been emphasized in residency applications. At New York Medical College (NYMC), the pre-clinical curriculum became pass/fail beginning in Fall 2020; STEP 1 became pass/fail in January 2022. Since these changes are recent, limited data exists on how they have influenced medical student behavior. This study aims to evaluate how recent curricular changes have impacted student engagement in research. 

Methods:
Since 2018, NYMC has offered student-led research seminars as part of its Biomedical Area of Concentration (AoC) to graduate with distinction in research, first implemented for the Class of 2020. Each year, approximately 16 seminars are organized by medical students. Applications to present at seminars are open to the student body, with two students selected per seminar based on themed topics. Seminars are held via Zoom, and attendance is recorded using a Turning Point code distributed mid-session. To receive AoC credit, students must attend 16 seminars during their pre-clinical years. 

To assess trends in AoC participation and seminar attendance from 2020 to 2025, a linear regression was performed using year as the independent variable and number of participants as the dependent variable. An ordinary least squares model was used, with statistical significance set at p < 0.05. 

Results:
There was a statistically significant increase in the number of students completing the AoC from 2020 to 2025 (p<0.05): 18 in 2020, 22 in 2021, 34 in 2022, 35 in 2023, 42 in 2024, and 41 in 2025. 

Average seminar attendance by academic year was as follows: 56 (2018–2019), 58 (2019–2020), 94 (2020–2021), 78 (2021–2022), 57 (2022–2023), 49 (2023–2024), and 71 (2024–2025). Attendance peaked in 2020–2021, which was significantly higher than other years (p < 0.05).

Conclusion:
The increase in number of students completing the Biomedical AoC suggests growing interest in research as a means of enhancing residency applications since pre-clinical curriculum and STEP 1 became pass/fail. However, an increase in research seminar attendance was only observed during the 2020-2021 academic year. The consistent attendance suggests students may attend for other reasons besides completing the AoC such as general research interest or supporting their peers. The increase during 2020-2021 may reflect the newly established pass/fail curriculum or increased flexibility in students’ schedule and need for a sense of connection due to remote learning during the COVID-19 pandemic. 


Student Lead Research Seminars at an LCME-accredited Medical School

Background

Chronic kidney disease (CKD) affects 15% of US adults, with a disproportionate burden among racial minorities and socioeconomically disadvantaged populations. Despite established national evidence linking social determinants of health (SDOH) to CKD outcomes, granular local level analyses remain unexplored. This knowledge gap hinders the development of targeted interventions and equitable resource allocation. We hypothesized that zip-code level SDOH metrics would demonstrate strong associations with CKD prevalence, enabling identification of modifiable upstream drivers for precision public health interventions.

Methods

We conducted a comprehensive cross-sectional analysis of 70 zip codes across the Kansas City Metropolitan area (Missouri and Kansas) using 2022-2024 data. CKD prevalence and 37 validated SDOH indicators were systematically compiled from the American Community Survey, CDC PLACES, EPA, National Center for Health Statistics, Neighborhood Atlas, and Open Data KC databases. Our analytic approach employed Pearson correlations for bivariate associations, mutual information regression for predictor selection, and variance inflation factor filtering (VIF<5) to address multicollinearity. The final ordinary least squares regression model incorporated nine predictors, optimized through ten-fold cross-validation using minimum mean squared error. Benjamini-Hochberg correction controlled the false discovery rate.

Results

Striking correlations emerged between SDOH metrics and CKD prevalence. The strongest associations included mobility impairment (r=0.95), disability (r=0.84), physical inactivity (r=0.77), obesity (r=0.70), and smoking (r=0.72). Protective factors included life expectancy (r=−0.70), median household income (r=−0.54), and college graduation rates (r=−0.47), all statistically significant (FDR-adjusted p<0.001).

Our multivariable model demonstrated exceptional explanatory power (R²=0.882, F=49.89, p<0.0001), with life expectancy (β=−0.28) and median household income (β=−0.12) as primary predictors. Notably, systemic environmental factors outweighed traditional behavioral risk factors, suggesting CKD risk is fundamentally shaped by structural determinants rather than individual choices alone.



Conclusion

This preliminary study provides the first granular evidence that CKD prevalence across Kansas City is strongly determined by community-level social and structural vulnerability indicators. Our findings challenge conventional individual-focused prevention models by demonstrating that neighborhood-level factors—particularly life expectancy, economic stability, and educational attainment—are primary drivers of kidney disease risk. Health systems can leverage these risk profiles to implement targeted screening programs, allocate resources to high-vulnerability zip codes, and develop community-level interventions addressing upstream social determinants. While this cross-sectional analysis establishes foundational associations, future longitudinal studies will determine causal pathways and validate interventions. This precision public health approach represents a paradigm shift toward addressing the root causes of health disparities, potentially transforming kidney disease prevention and management strategies nationwide.

Mapping Social Vulnerability of Chronic Kidney Disease in Urban Communities

Purpose: 
Prevalence of diabetes among women in South Carolina is growing. Uncontrolled maternal diabetes is associated with significant maternal and neonatal morbidity and mortality. The Wellness and EmpOwerment for Women (WOW) program provides primary care and diabetes management to women with or at risk for diabetes. This study examines the association of continuous glucose monitors (CGM) and FoodShare as supplements to medical diabetes management, with change in HbA1c over 12 months. 

Methods: 
Women of childbearing age (18-45 years old) with a diagnosis of diabetes mellitus (T1DM or T2DM) were referred to the WOW program. Participants were included if they had a baseline and 12-month HbA1c measurement. Additionally, clinical assessments and questionnaires also were taken at baseline and 12-month appointments to measure comorbidities, demographics, and socioeconomic factors. Patients also were offered continuous glucose monitors (CGM) and access to a food share program. The collected data was summarized using means, standard deviations, and tabulations. Multivariate regression analysis was performed to examine the association between participation in continuous glucose monitoring and Foodshare programs on changes in HbA1c, controlling for demographics, socioeconomic factors, comorbid diagnoses of hypertension and depression. 

Results: 
This study found that CGM utilization was statistically significantly associated (0.04) with a reduction in HbA1c (-1.46). Participation in a food share program was not significantly associated with a change in HbA1c. 

Conclusions: 
The study demonstrates the clinical promise of a program focusing on CGMs as a supplement to medical management for glycemic control. Future efforts should focus on expanding use of such tools with the establishment of primary care and regular follow up for women with diabetes in South Carolina. 


Analyzing the Impact of Supplemental Continuous Glucose Monitoring and Foodshare Programs on Glycemic Control Among Women With Diabetes Mellitus

Introduction:
Only 23% of musculoskeletal referrals result in surgery, highlighting the need for decision support tools that assist providers in interpreting imaging when orthopaedic input is not readily available. Primary care providers often navigate complex radiology narratives without subspecialty guidance, leading to variability in referral quality. Some patients are referred prematurely, while others face delays despite surgical need. We developed OrthoScreen, a transformer-based NLP model built to support referral prioritization using solely imaging text, for potential application in arthroplasty triage. We hypothesized that OrthoScreen would demonstrate high sensitivity in identifying patients likely to be considered for surgery within 1 year, based solely on imaging reports.

Methods:
We retrospectively analyzed patients presenting with knee pathology to an urban safety-net hospital between 2017 and 2020. Each had MRI or X-ray imaging and documented one-year surgical follow-up. Patients with missing imaging or outcome data were excluded. Text from radiology “Findings” and “Impression” sections was extracted from each initial report. OrthoScreen was developed by fine-tuning Bio_ClinicalBERT to predict whether surgery was considered within one year and evaluated using stratified 10-fold cross-validation. We compared performance to a Bag-of-Embeddings MLP model (BGE M3) using identical inputs. Metrics included AUC, sensitivity, specificity, PPV, NPV, and F1 score. No formal statistical comparisons were performed.

Results:
A total of 453 patients were included, 60% of whom underwent or were recommended surgery within one year. OrthoScreen achieved AUC 0.745, sensitivity 0.933, specificity 0.352, PPV 0.689, NPV 0.837, and F1 score 0.787. BGE M3 yielded AUC 0.713, sensitivity 0.922, specificity 0.375, PPV 0.699, NPV 0.754, and F1 score 0.787.

Conclusion:
OrthoScreen demonstrated strong performance using only imaging text and may help streamline surgical triage. Broader validation could support scalable integration into orthopaedic surgical referral workflows.

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Constitutive activation of the c-Kit oncoprotein induced by a rigidifying hydrophobic interaction between D816V and N819 in the presence of imatinib

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