Poster: Allergic Asthma and Anaphylaxis Induced by Different Allergens Show Distinctive IgE Dependence
Category: Biomedical
Abstract: The pathogenesis of allergic asthma is classically understood to involve allergens crosslinking Immunoglobulin E (IgE) bound to mast cells and basophils, leading to the release of inflammatory mediators. However, omalizumab, an anti-IgE antibody, reduces exacerbation rates in only about 40% of adult patients with severe asthma. These findings highlight the need for further research to fully address the role of IgE in allergic diseases like asthma. This study aims to explore which allergen induces Th2-associated airway inflammation through an IgE-dependent mechanism. Methods: We used IgE deficient mice (IgE KO) to generate asthma mouse models induced by two highly clinically relevant allergens house dust mite extract (HDM), cockroach extract (CRE) and one classic allergen ovalbumin (OVA). Hematoxylin and Eosin (HE) staining and Alcian Blue-Periodic Acid-Schiff (AB-PAS) staining was performed on lung tissue to evaluate inflammatory responses and mucus production, respectively. The count of inflammatory cells in Bronchial Alveolar Lavage Fluids (BALF) was determined using flow cytometry. Results: All mice treated with allergens exhibited significant signs of airway inflammation, as evidenced by the recruitment of inflammatory cells to the lung parenchyma and goblet cell hyperplasia. However, IgE KO mice treated with different allergens demonstrated significantly variable degrees of inflammation compared to the WT control. Of these, HDM-treated IgE KO mice showed an attenuated inflammatory profile with reduced inflammatory cells, particularly eosinophils. These mice had lower serum levels of HDM-specific IgE1 (sIgE1) and IgG1 (sIgG1) and reduced levels of Th2 cytokines IL-4 and IL-5 in BALF. While CRE-treated IgE KO mice also displayed a reduced inflammation compared to WT mice, the only statistically significant difference was found for eosinophils. No significant differences were observed between OVA-treated IgE KO and WT mice. Discussion: The results highlight the variability in IgE pathway dependence among different allergens, emphasizing the need for further research is to delineate the mechanisms and develop more effective therapeutic strategies for allergic diseases.
Meet/Contact Us:
Yingchun Shen, 26, John A. Burns School of Medicine
Contact: yingchun@hawaii.edu
Jiwoo Kim, 24, John A. Burns School of Medicine
Contact: jiwookim@hawaii.edu
Poster: Impact of Polystyrene Nanoplastics on Stress Response, Accumulation Sites, and Anxiety in Danio Rerio
Category: Biomedical
Abstract: Microplastics (MPs) and nanoplastics (NPs) have been found in the human abdomen, reproductive, and thoracic organs. However, there is insufficient research regarding the uptake and behavioral effects. This study addresses that by identifying behavioral responses and residence of MPs in zebrafish because they share 70% of the human genome. Zebrafish were treated to a 10 ppm fluorescent-polystyrene-nano plastic solution 0-5, 0-3, and 3-5 days post fertilization (dpf). Primary data was collected using ImageJ, along with anxiety and stress assays. ImageJ analysis measured the fluorescence of MPs to identify MP accumulation regions. The anxiety assay measured the time spent inside and outside an overlaid circle. The stress assay used a 0.5 cm grid overlay to record the distance traveled and stress response after a flash of white light. All data was hand-collected. Each treatment group showed an increased stress response to the white-light stimulus with 0-5 dpf exhibiting the highest response. MPs were found in all regions of the fish, predominantly in the GI and kidney. No differences in anxiety responses among treatment groups and controls. The high-stress response of the 0-5 dpf treatment group suggests that prolonged MP exposure may exacerbate stress levels. Variability within the stress assay may be due to varying microplastic uptake, locomotive, and hyperactive responses rather than stress. This was addressed by using medians for graphing. Analysis continues to determine the relative accumulation of MPs by organ system. MPs concentration was highest in the GI, an integral part of the brain-gut axis system. This study highlights the potential harms of MPs to induce stress responses and build up human organs. Future studies should investigate whether stress is the primary factor for erratic movement,explore the brain-gut axis system, and different forms of anxiety-assays such as use of caffeine and alcohol.
Meet/Contact Us:
Luke Itomura, 15, Punahou School
Contact: litomura@punahou.edu
Corina Liang, 17, University Laboratory School
Contact: liangc2025@universitylaboratoryschool.org
Tiara Harris, University of California, Los Angeles
Contact: harristta@gmail.com
Gemma Quiroz, 16, Kamehameha Schools
Contact: GQ120407@gmail.com
Poster: Association between Alzheimer's and Related Dementias Risk and Demographics among Older Adults in American Samoa
Category: Social
Abstract: Fifty-five million people including 5.8 million Americans are affected by Alzheimer’s disease and related dementias (ADRDs) worldwide. Alzheimer’s disease is a progressive and irreversible degenerative brain disease characterized by memory loss and decline in cognitive function. Decreased cognitive impairment in older people has been linked to a greater risk for developing ADRD. There is still a large gap in the information available regarding ADRD risk and its associated risk factors among Indigenous populations, especially in American Samoa. This study will aid in increasing the knowledge about ADRD risk in American Samoa. Methods: This will be a retrospective cross-sectional study using de-identified data obtained from the American Samoa Community Cancer Coalition Puipui Malu Manatu study. Data includes demographics of American Samoan adults ages 50 and above, and Montreal Cognitive Assessment, Cognivue, and Number Symbol Coding Test scores to discover correlations between the participant demographics and ADRD risk. Analysis will be done in Statistical Package for Social Sciences (SPSS) through multivariate analysis, i.e., linear regression. Results: This study shows that six variables were found to be associated with ADRD risk among older adults in American Samoa: age range, birthplace, primary language, highest degree earned, occupation type, and housing type. In addition, the demographic variables that predict ADRD risk include age, birthplace, whether they are Native Hawaiian/Pacific Islander or not, highest degree earned, and some types of occupation and housing. Discussion: The identified associated variables from this study will build a necessary foundation for further research to be done with the American Samoan population. Results may also be expanded upon in further studies aiming to test effective prevention methods for ADRD. Findings may also provide insight toward developing culturally tailored interventions for the Samoan community to address demographic-associated ADRD risks.
Meet/Contact Us:
Zoe Smith, 22, University of Hawai'i at Manoa
Contact: zoesmith@hawaii.edu
Poster: Exploring the Relationship Between Type of Contraception and Economic Situation in West Virginia: An Analysis of Survey Data
Category: Social
Abstract: Choice of contraception is accompanied by percent effectiveness. Due to factors including human error and misuse, male condoms are not the most effective form of birth control. About 15 in 100 people who rely on condoms become pregnant. Thus, it is necessary to identify patterns related to economic status because a failure of contraception weighs more heavily on lower-income households. By exploring the relationship between type of contraception and economic situation, we aim to understand if household income influences whether or not adults in West Virginia use a condom during sexual intercourse. We used secondary data from a state survey collected from a diverse group of around 4,000 respondents. I extracted data on income brackets, separated into 17 categories ranging from $10,000 to $300,000 yearly, and survey answers from sexually active adults (age 18+) to the question: “The last time you had sexual intercourse, did you or your partner use a condom?” Upon filtering the data, I completed a chi-squared test of independence on 835 valid data points to determine the relationship between my two variables. Graphing observed vs. expected values indicated a significant skew. With a calculated p-value of 0.0021, at the 5% significance level, I rejected the null hypothesis in favor of the alternative. There is enough evidence to suggest an association between using a condom during sexual intercourse and household income. The double bar graphs demonstrate higher rates of condom usage in lower-income subjects. These conclusions illuminate a larger need for research and discussion around access to more effective birth control for lower-income individuals; especially in Hawaii, it being an isolated island state. Given Hawaii’s diverse population and the financial strain from the cost of living on many residents in-state, it is imperative to address challenges related to contraception and unintended pregnancies.
Meet/Contact Us:
Sophia Kato, 16, Maui High School
Contact: sophia.linh.kato@gmail.com
Poster: Evaluating the Physical and Social Neighborhood Environment of Older American Samoan Adults and its Relation to Alzheimer’s Disease and Related Dementias
Category: Social
Abstract: Alzheimer’s and related dementias (ADRD) affect over 55 million people worldwide (National Institute of Neurological Disorders and Stroke, n.d.). ADRD are the debilitating conditions that impair memory, thought processes, and functioning, primarily among older adults. The environment can play a large role in health and can expose communities to unhealthy foods and lower access to healthcare. There is no current research done in American Samoa focusing on Alzheimer’s and related dementias. With increasing life expectancies, there is a drastic increase in people over the age of 65. ADRD typically takes effect in a person in their mid-60s, but it can also develop before the age of 65, where it is then considered early-onset Alzheimer’s (NIH, 2022). Objective: To determine any association between the Montreal Cognitive Assessment and the neighborhood questionnaire on the risk factors of Alzheimer’s disease and related dementias. Materials and Methods: De-identified data through randomized ID numbers from the American Samoa Community Cancer Coalition’s REDCap database system were collected. A data request will be made to access neighborhood questionnaire, Montreal Cognitive Assessment-Blind (MoCA-Blind), and cognitive scores. Data will be collected through a survey comprised of questions about built and social environment, cognitive abilities, and the Montreal Cognitive Assessment. Result: Logistic regression performed through SAS showed there is significance in ADRD risk to sidewalk availability, shaded areas, and exercise where all of which reported a p-value of .04. The p-value threshold is 0.05, any value below is significant. Conclusion: There is association between the social and physical village environment of American Samoan adults and ADRD risk where there is association found in exercise, sidewalk availability and shade. Little or no shade and low sidewalk accessibility has higher risks of medium and high ADRD. Moderate exercise has lower risk of moderate and high ADRD.
Meet/Contact Us:
Amanda Mass, 22, University of Hawai'i at Manoa
Contact: amandamaass221@gmail.com
Poster: Exercise Intervention and Bone Mineral Density Changes in Breast Cancer Patients and Survivors
Category: Clinical
Abstract: Breast cancer survivors are at an increased risk of various health issues including those that affect bone health. Up to 80% of breast cancer survivors have osteoporosis, likely influenced by treatment therapies. Lifestyle modifications like exercise can help combat this. In this study, breast cancer patients and survivors (n=32, group=18, individual=14) were recruited into an exercise intervention program. All participants met one-on-one with a trainer for 3 months and then were randomized to either group exercise sessions or continued individual sessions for the next 3 months. Participants were then monitored via phone or email to follow up on lifestyle changes for the following 6 months. Whole body bone mineral density (BMD) was measured at baseline, 6 months, and 1 year. For all participants, there was no significant difference in BMD from baseline to 6 months (p=0.267), and there was a significant 1.8% decrease in BMD from baseline to 1 year (p<0.001). There were no significant differences in BMD between participants in the group exercise sessions versus the individual exercise sessions at baseline (p=0.612), 6 months (p=0.815), or 1 year (p=0.722). Although this intervention did not show significant improvements or maintenance of BMD at 1 year, it maintained a rate of BMD loss similar to the 1-2% average BMD loss per year for women without breast cancer and shows a slower rate of BMD loss compared to the 2-8% average BMD loss per year for breast cancer patients.
Meet/Contact Us:
Kayla Lum, 21, University of Hawai'i at Manoa
Contact: kaylalum@hawaii.edu
Poster: Comparing the Dose-Dependent Effects of Ivermectin on SKOV-3 Ovarian Cancer and MCF-7 Breast Cancer Cells
Category: Biomedical
Abstract: Globally, in 2020, 313,959 individuals were diagnosed with ovarian cancer, and 207,252 ovarian cancer deaths were reported. That same year 2.3 million women were diagnosed with breast cancer, with 685,000 reported deaths. Native Hawaiians have among the highest incidence rates and lowest survival rates for both localized and advanced stages of breast and ovarian cancers. Chemotherapy, an efficient treatment modality for cancer, is undeniably the most expensive treatment option. Repurposing drugs, such as Ivermectin, an FDA antiparasitic reduces development time and cost, with large potential savings for healthcare. This study assessed and compared the effects of three concentrations of Ivermectin (11.5 μM, 23 μM, 46 μM) on MCF-7 breast and SKOV-3 ovarian cancer cell lines. We hypothesized that high concentrations of Ivermectin would decrease breast and ovarian cancer cell proliferation, with greater inhibition of proliferation occurring in ovarian cancer. Since Ivermectin was dissolved in dimethyl-sulfoxide (DMSO), two control groups were tested, one with cell media and the other with media and DMSO. Cell counting was performed with a hemocytometer 3 days post-treatment. Results showed that Ivermectin significantly decreased MCF-7 and SKOV-3 cell counts relative to controls, with greater effects at higher treatment concentrations. Decreases were more significant in the SKOV-3 cells. Noticeable similarities between the breast and ovarian cell counts were as concentrations of Ivermectin increased cell densities decreased. There appeared to be no significant differences in cell counts between control groups, confirming that the solvent (DMSO) did not affect cell densities. The SKOV-3 cell line demonstrated highly significant decreases in cell densities with increasing Ivermectin concentrations. However, the decreases between successive treatment groups were less striking for MCF-7 cells.
Meet/Contact Us:
Genevieve Yamaguchi, 16, Kamehameha Kapalama
Contact: genevieveyamaguchi@gmail.com
Kalei Yoshimura, 16, Kamehameha Kapalama
Contact: yoshimurakalei.26@gmail.com
Poster: The Impact of Smoking on Your Vehicle Air Quality
Category: Clinical
Abstract: Being a part of the Tobacco Coalition led me to an interest in the effects of smoking and the usage of tobacco products. As a result, I aimed my project towards the impact of smoking on air quality. I am using a Wynd Pm 2.5 Sampler and putting it in non-smokers, smokers, and vapers cars for 10 minutes. So far, my results have concluded that non-smokers' air quality has been above 95, a healthy score. In contrast, a smoker's car scores in the low-quality category at 25. In conclusion, my poster will go more in-depth into my project and research findings. While also shedding light on the harmful effects of these products that are so commonly used.
Meet/Contact Us:
Talia Farrington, 16, Kapaa High School
Contact: taliaemi123@gmail.com
Poster: Annotation of Hypothetical Genes in Kytococcus sedentarius: KSED_RS02510 and KSED_RS02515
Category: Biomedical
Abstract: This poster is an annotation of hypothetical genes KSED_RS02510 and KSED_RS02515 in Kytococcus sedentarius. This organism is a gram-positive bacterium with a genome of 2,639 protein-coded genes where 777 are designated as hypothetical. This study investigates whether these genes have been called correctly by the pipeline annotation to propose a new gene annotation if needed. Findings on these hypothetical genes can then be shared with the microbial genomics community to be used to further research on the organism and for future wet lab experiments. Regarding the methodology for this poster, seven online modules were used to investigate questions corresponding to each module using bioinformatics tools. Each module focused on a specific aspect of analysis ranging from the sequence-based similarity or the cellular localization of the genes using resources used by professors and scientists. After completing the modules, findings were compiled into the final annotation, an evaluation of data from all modules. The key findings on these genes are as follows: the final proposed gene annotations for both hypothetical genes are hypothetical membrane proteins as KSED_RS02510 contains five or six transmembrane helices and KSED_RS02515 contains seven transmembrane helices. Both genes are located in the cytoplasmic membrane and are part of an operon. KSED_RS02510 exists only in the genome Kytococcus while KSED_RS02515 has low levels of conservation scattered between its N and C terminal domain regions. These findings suggest that KSED_RS02510 is not conserved among other species and is unique to Kytococcus. KSED_RS02515 was fairly well conserved among other species of bacteria phylogenetically related to the organism supporting that though hypothetical, the gene should consider wet lab experiments to determine its function. The first step for the wet lab experiments should be to use NCBI Primer Blast to design primers for PCR experiments.
Meet/Contact Us:
Coco Kim, 15, Iolani School
Contact: ck2701@iolani.org
Poster: The Implications of Socioeconomic Status on Healthcare and Mortality Rates
Category: Social
Abstract: In the US, 11.6% of people are impoverished, with 39 million living in poverty. Poverty is associated with a 42% excess risk annually. During the COVID-19 pandemic, lower Socio-Economic Status (SES) countries had higher mortality rates. Low SES have decreased insurance rates, primarily due to cost. Conversely, access to healthcare in those with high SES is more likely preventive measures. Reductions in maternal healthcare funding can disproportionately affect those with low incomes. Methods: Data was collected from Google Scholar, PubMed, and Google search, focusing on hypotheses on SES, mortality, insurance, and pregnancy in the United States. Prompts used on Google Scholar: SES healthcare, SES and medical debt, Health Insurance America. Prompts used on PubMed: Low-income death causes, Low socioeconomic Covid, Low SES pregnancy mortality. Google was used to find definitions. Results: 73.7% of uninsured people cite unaffordability (Cha and Cohen), and the mortality ratio of uninsured to insured is 1.40 (Wilpert et al.). Discussion: Uninsured individuals find health insurance costly. Graph 2 shows a link between chronic conditions and higher medical debt. Low-income individuals are less likely to seek medical care due to high debt. Data suggests that uninsured patients are 40% more likely to die compared to insured individuals. Access to medical care and insurance is a significant challenge for those with low SES, posing a threat to their lives. In pregnancy, women and infants from low socioeconomic backgrounds face higher maternal mortality risks due to limited access to prenatal care, leading to preterm birth and low fetal growth. Low-income mothers have three times higher mortality and morbidity than wealthier mothers. Conclusion: Individuals in the lower socioeconomic bracket are significantly more likely to lack insurance coverage, which prevents them from accessing crucial preventive healthcare for chronic conditions. Additionally, their SES detrimentally affects mortality rates and maternal health survival.
Meet/Contact Us:
Maxwell Heidelberg, 17, Punahou School
Contact: mheidelberg25@punahou.org
Poster: Comprehensive Analysis of Emergency Room Visits Due to Heart Failure: A Multivariate Regression Study of Demographic Influences Among Patients in Hawaii
Category: Social
Abstract: Our study investigates the correlation between demographic factors and the frequency of emergency room (ER) visits due to heart failure (HF) among patients in Hawaii. Utilizing data from Texas A&M University, which included 454,835 HF patients identified by ICD-10 code I50.9, the analysis employed both bivariate and multivariate regression models to assess the impact of race, gender, income, and insurance status on ER visit likelihood. Key findings revealed that males, Medicare recipients, and certain racial groups (Hispanic, Asian/Pacific Islander, Native American) have higher odds of ER visits. Urban residents and those with private insurance had lower odds, highlighting potential disparities in healthcare access. The study emphasizes the importance of targeted interventions and policies to address these disparities and improve heart failure management for vulnerable populations in Hawaii.
Meet/Contact Us:
Chani Chung, Punahou School
Contact: chanichung77@gmail.com
Kristiann Miguel, University of Hawai'i at Manoa
Vincent Ooi, 24, William Carey University College of Medicine
Contact: VOoi585525@student.wmcarey.edu
Poster: Analyzing Cardiovascular Disease Patterns in Hawaii: A Zip Code-Based Correlation Study of Demographics and Cardiologist Distribution
Category: Social
Abstract: Cardiovascular disease (CVD) continues to be a major health concern as it’s the leading cause of death worldwide with 17.9 million deaths per year. There’s little information available about Native Hawaiian communities because CVD research frequently ignores rural places like Hawaii. In order to address this, I conducted a zip code-level correlation study between Hawaii's CVD rates and demographics. The study included demographic factors like gender, ethnicity, education level, poverty, and insurance status along with data on hypertension, hyperlipidemia, coronary heart disease, and stroke. Important indicators were found using statistical techniques such as regression analysis, R-squared tests, and correlation coefficients through software. I also looked at the relationship between the distribution of cardiologists by county and the rates of CVD. The regression analysis revealed that 63.8% of heart disease cases can be explained by the selected indicators. Among the significant indicators, females and obese individuals in Hawaii have a notably higher risk of CVD. Additionally, people living in poverty and those aged 65 and older also face an increased risk. The correlation analysis indicates that Native Hawaiians have a higher risk of CVD compared to other ethnic groups. It also reinforces the strong association between CVD and individuals aged 65 and older, as well as those who are uninsured. These results explain the zip codes with high prevalence of CVD and help to create focused prevention initiatives. The distribution of cardiologists can be analyzed to help allocate healthcare resources optimally, ensuring that patients in locations with higher prevalence of CVD receive adequate care. This study emphasizes how we can address health disparities and advance public health initiatives in Hawaii to improve the well-being of Hawaii residents. Disclaimer: The cardiologist analysis isn’t done yet due to Dr. Withy being on vacation. It will be done before the poster deadline.
Meet/Contact Us:
Travis Osaki, 15
Contact: travis.osaki@gmail.com
Poster: Factors Contributing to the Hawai'i Physician Workforce Shortage
Category: Social
Abstract: My research was inspired by page 10 of the 2024 Hawai’i Physician Workforce Report, where physicians were qualitatively surveyed to see what they felt was most important to reducing administrative burden. I wanted to know what physicians in Hawai’i felt were the largest issues affecting Hawaii's medical workforce retention, as well as whether any particular factors correlated with specific counties/islands, and the Physician Workforce Report showed how certain islands experience more shortages than others. The method used to get this data is a Google form, asking physicians questions about the previously mentioned topics; the survey also introduces them to some solutions being pushed by the AHEC, asking which ones they find most impactful, and if the physicians themselves have any potential solutions that have not yet been pursued. Gathering this data will allow us to understand current opinions and barriers to physician workforce recruitment and retention in Hawai’i. This understanding allows those working on solutions to know where resources should be prioritized towards, based on what people think will make the most impact on this issue.
Meet/Contact Us:
Eden Thompson, 16, The Taft School
Contact: edenkthompson@gmail.com
Poster: Factors Contributing to the Hawai'i Physician Workforce Shortage
Category: Social
Abstract: My research was inspired by page 10 of the 2024 Hawai’i Physician Workforce Report, where physicians were qualitatively surveyed to see what they felt was most important to reducing administrative burden. I wanted to know what physicians in Hawai’i felt were the largest issues affecting Hawaii's medical workforce retention, as well as whether any particular factors correlated with specific counties/islands, and the Physician Workforce Report showed how certain islands experience more shortages than others. The method used to get this data is a Google form, asking physicians questions about the previously mentioned topics; the survey also introduces them to some solutions being pushed by the AHEC, asking which ones they find most impactful, and if the physicians themselves have any potential solutions that have not yet been pursued. Gathering this data will allow us to understand current opinions and barriers to physician workforce recruitment and retention in Hawai’i. This understanding allows those working on solutions to know where resources should be prioritized towards, based on what people think will make the most impact on this issue.
Meet/Contact Us:
Eden Thompson, 16, The Taft School
Contact: edenkthompson@gmail.com
Poster: Characterizing Fall Risk in Patients with Mild Cognitive Impairment
Category: Clinical
Abstract: The title of our research poster is “Characterizing Fall Risk in Patients with Mild Cognitive Impairment”. Globally, falls incidence is the second leading cause of unintentional death. Current literature highlights how the fall risk of patients experiencing Mild Cognitive Impairment (MCI) is greater than those who do not have a MCI diagnosis despite being a cognitive disorder as opposed to physical.In this study, we aimed to determine the correlation of fall incidence with Mini Mental State Examination scores in patients with MCI and identify any racial ethnic groups that may present a higher prevalence of falling.Our research methodology included a retrospective chart review of patients diagnosed with MCI at Hawaii Pacific Neuroscience. Data collected include demographics, falls, cognitive metrics, comorbid conditions, and medications. We utilized varying biostatistical analyses for interpretation. The average MMSE score was 24.3 Scores between 20 and 25 suggest that patients need significant accommodation for daily living and constant supervision. This study found no clear relationship between the initial MMSE score and the total falls of patients with MCI. These findings differ from the literature that shows cognitive impairment results in an increase in fall risk. There was a notable disparity in age and age of diagnosis between patients who have experienced falls and those who haven’t which indicates age being protective of falls. Additionally, there was statistically significant usage of antihypertensives and anticholinergics in those who have experienced falls. These additional findings are also consistent with the literature and warrant future investigation for specificities. Demographics-wise, Asian American Native Hawaiian and Pacific Islanders (AANHPI) represented a combined 49.3% of our sample population addressing a current underrepresented demographic in the literature. These findings should help contribute to fall screening and prevention protocols for patients with MCI.
Meet/Contact Us:
Gabrielle Sarmiento, University of Hawai'i at Manoa
Contact: gsarmien@hawaii.edu
Ryan Nakamura, John A. Burns School of Medicine
Contact: rnakamura@hawaii.edu
Jill Morimoto, Santa Clarita University
Contact: jmorimoto@scu.edu
Andrew Kai, Santa Clarita University
Contact: akai@scu.edu
Anita Cehung, John A. Burns School of Medicine
Contact: anitajc@hawaii.edu
D-Dré D. Wright, John A. Burns School of Medicine
Contact: ddre@hawaii.edu
Michaela Kop, John A. Burns School of Medicine
Contact: mkop@hawaii.edu
Chris Deng, University of Hawai'i at Manoa
Contact: cdeng32@hawaii.edu
Kore Kaw Liow, MD, FACP, FAAN, John A. Burns School of Medicine
Contact: kliow@hawaii.edu
Enrique Carrazana, MD , John A. Burns School of Medicine
Contact: ecarrazana@neurelis.com
Poster: UTERUS: Utilization of a Three-D Model for Education and Research in Uterine Simulation
Category: Biomedical
Abstract: Intrauterine procedures such as IUD insertion and uterine aspiration can be challenging to teach due to limited models that simulate the sensation of instrumentation of the cervix and uterus. Effective training assets facilitating instruction of relevant intrauterine procedures remain broadly unavailable. This study aims to develop a low-cost, reusable, high-fidelity model using 3-D printing technology for learners to practice intrauterine procedures. The hypothesis to be tested is that a 3-D printed uterine model improves training outcomes compared to existing methods. Methods: The workflow to create a 3-D uterine training model consists of three steps including Model Creation, Review, and Production. For Creation, an anonymized female cadaver was MRI scanned, and the uterus was identified and segmented (Slicer), providing a mesh model that was subjected to artistic edits (Maya software). The Review step was achieved by uploading the model for visualization (Sketchfab and Z-Space platforms) and final alterations. After export as an .stl file, the final Production step comprised 3-D printing using a Bambu X1C printer and Bambu Studio for support and infill settings. Results: The model dimensions are approximately 87 mm by 177 mm by 32 mm. Printing time was 4 hours and 24 minutes with tree supports and 5% infill. 41.30 grams of Polylactic Acid filament with an estimated cost of 0.83 cents to print, assuming a cost of $20 per 1 kg of filament. A looped handle was included as a mounting point for hardness. Thermoplastic polyurethane filament was also attempted to produce a more malleable model, but will need revisions for stability during printing. Discussion: The workflow delineated here facilitates the production of a lightweight, low-cost, and ease-of-use model that can be created with an inexpensive and widely available 3-D printer. Future work focuses on assessing the instructional effectiveness of the 3-D-printed uterus.
Meet/Contact Us:
Brandi Mikami, 25, John A. Burns School of Medicine
Contact: mikamib@hawaii.edu
Poster: Determining a Definition of Brain Health through Fefaʻasoaaʻi and Soalaupule (Focus Groups) with Indigenous Samoans
Category: Social
Abstract: Increased life expectancies have made Alzheimer’s disease and related dementias (ADRD) more visible to Indigenous communities, however these healthcare systems are unprepared for the burdens associated with ADRD. There is no documented cultural understanding of brain health or ADRD within the Samoan population. This qualitative study explored the knowledge, beliefs, and experiences of Indigenous Samoans regarding brain health in American Samoa. METHODS: Three focus groups were conducted in Samoan and English, covering participants' knowledge and experiences. Each focus group lasted 90 minutes, with sessions transcribed verbatim and translated when necessary. Utilizing a decolonization research method, two coders analyzed the data by capturing complete participant stories. Coding was corroborated, with discrepancies resolved by a referee, and re-coding continued until consensus was achieved. RESULTS: Twenty participants (10 males and 10 females) aged 18-64 were interviewed, resulting in 101 stories categorized under five themes: faith-based, FaʻaSamoa, colonization, distrust in the medical system, and education/awareness. From these stories, a definition of brain health was developed: “Brain health in American Samoa..…is relational and involves guiding the community to recognize and address cognitive changes, fostering strong familial and community relationships, and integrating Fa'aSamoa values and faith-based practices. Brain health emphasizes the importance of a balanced lifestyle to support mental well being that honors the unique cultural and historical lens of the people to support generational growth and resilience.” DISCUSSION: Storytelling is a culturally appropriate method to obtain rich participation & valuable data among Samoan population. Longer time allocated for focus group discussions in Samoan community are necessary to allow for storytelling and expressiveness of the language. The next step is to share definition with broader community and stakeholders in American Samoa to gather feedback to refine the definition. Integrating faith-based & FaʻaSamoa elements in educational campaigns and building public health programs and partnerships will follow.
Meet/Contact Us:
Jena Funakoshi, University of Hawai'i at Manoa
Contact: jenaf@hawaii.edu
Poster: Effectiveness of Comprehensive Sexual Health Education in 9th Graders of Hawai’i’s DreamHouse ‘Ewa Beach Public Charter School
Category: Social
Abstract: Hawai’i has one of the lowest rates of condom use in sexually active teens, along with high rates of teen pregnancies and sexually transmitted infections (STIs)1. This issue is especially prevalent amongst Hawai’i teens in rural public schools. Board Policy 103-5, passed in 2015 by the Hawai’i Board of Education (BOE), requires public schools to offer comprehensive sexual health education programs emphasizing abstention as the surest way to prevent unintended pregnancy, STIs, and consequent emotional distress1. Despite these efforts, high-risk sexual behavior remains common among Hawai’i’s youth. To address these needs and equip students to make informed choices about their health, sexual education programs should emphasize body autonomy and awareness. Participants were 9th-grade students attending DreamHouse ‘Ewa Beach Public Charter School located in Kalaeloa, O’ahu. Lesson 1 provided baseline education on reproductive anatomy, puberty, and menstruation. Lesson 2 focused on healthy relationships, and family roles/ responsibilities. Lesson 3 addressed contraceptive methods, pregnancy, and sexual healthcare resources. To conclude the series, Lesson 4 covered STIs and their respective symptoms, prevention, and treatments. Each lesson began with a 10-minute anonymous pre-test, followed by a PowerPoint presentation and topic-specific activities. Sessions ended with a 10-minute anonymous post-test to evaluate changes in knowledge. Data showed a significant increase in student knowledge from pre- to post-test responses (p<0.05) in all 4 lesson plans. This project aimed to implement a sexual health education program that emphasized body autonomy and health literacy while ensuring the integrity of evidence-based medicine. Our goal was to help adolescents understand that, even if they don’t choose abstinence, they can maintain the power to make informed decisions about their sexual health. We hope future programs can adapt to our local youth’s needs with the ultimate goal of reducing rates of STIs and teen pregnancies.
Meet/Contact Us:
Sarah Thompson, 25, AT Still University- School of Osteopathic Medicine in Arizona
Contact: sthompson@atsu.edu
Darian Finley, 26, AT Still University- School of Osteopathic Medicine in Arizona
Contact: dfinley@atsu.edu
Brooke Chmiel, 25, AT Still University - School of Osteopathic Medicine in Arizona
Contact: bchmiel@atsu.edu
Michelle Balshin, 25, AT Still University - School of Osteopathic Medicine in Arizona
Contact: mbalshin@atsu.edu
Chakameh Akhavan, 28, AT Still University - School of Osteopathic Medicine in Arizona
Contact: cakhavan@atsu.edu
Kalena Spinola, 28, AT Still University - School of Osteopathic Medicine in Arizona
Contact: kalenaspinola@atsu.edu
Keahealailani Takushi, 25, AT Still University - School of Osteopathic Medicine in Arizona
Contact: alaitakushi@atsu.edu
Sharon Hiu, 59, AT Still University - School of Osteopathic Medicine in Arizona
Contact: sharonhiu@atsu.edu
Surekha Appikatla, 34, AT Still University - School of Osteopathic Medicine in Arizona
Contact: surekhaappikatla@atsu.edu
Joy Lewis, AT Still University - School of Osteopathic Medicine in Arizona
Contact: jhlewis@atsu.edu
Poster: A Quantitative Assessment of Orthopaedic Surgery in Palau to Support Capacity-Building
Category: Clinical
Abstract: Palau, an island nation in Micronesia, is a medically underserved area with no full-time orthopaedic surgeons. Orthopaedic diagnoses in Palau remain among the three most common reasons for costly off-island medical referral. This gap analysis assessed the prevalence of orthopaedic conditions and quantified referral rates and spending with the purpose of informing future interventions to build orthopaedic surgery capacity in Palau. Methods Data was collected from Belau National Hospital’s electronic health record (EHR) and from the Palau Medical Referral Committee (MRC) reports. All encounters with musculoskeletal diagnoses in the EHR between November 2022 and July 2023 and all orthopaedic referrals between October 2018 and June 2023 were included. Results were reported descriptively. Results The EHR data from November 2022 to July 2023 included 1,235 musculoskeletal cases, totaling 1,762 encounters. The most common regions affected were the back/spine, knee/lower leg, and foot/ankle. The most common diagnoses were pain (due to sciatica, osteophytes, etc.) (47%), osteoarthritis (15%), sprain/tear (11%), and fracture (10%). Orthopaedic referrals (n = 140) from the MRC reports costed a total of $1,546,068.50 United States dollars (USD), which equals 0.6% of Palau’s 2023 GDP. Fracture was the most common reason for referral, with 53 (38% of all referrals) totaling $510,247.20 USD. Conclusion Quality of care may be improved for the greatest number of patients in Palau through capacity-building efforts targeting pain, osteoarthritis, and sprain/tear management. Initiatives to improve fracture management, followed by osteoarthritis and spinal stenosis management, have the greatest potential to decrease referral spending. This framework of utilizing baseline needs and capacity assessments with quantitative analyses to inform capacity-building approaches that effectively improve care quality, access, and value may be applied to other resource-limited settings globally.
Meet/Contact Us:
Yujin Na, 26, John A. Burns School of Medicine
Contact: yujinna@hawaii.edu
Poster: Impact of Pre-Class Exercise on Medical Student Well-Being
Category: Social
Abstract: Exercise positively affects physiological and psychological well-being, and may improve anxiety, stress and depression.1 Further effects may include improved executive function. 2 Recent surveys revealed that medical students experience significantly increased stressors and a decline in mental/emotional wellbeing from baseline to end of year one.3 Methods: First year medical students were offered a pre-class exercise session outside of curricular hours. A survey was implemented 3 months later to the entire class to investigate the relationship between exercise and wellness. Results: Out of 77 students, 25 responded to the survey, 2 of which attended the on-campus class. 75% of respondents expressed a desire to exercise, but experienced barriers. 60% reported exercising daily, with 12% normally exercising before class. 44% had historically exercised before class, with 85% of these students agreeing or strongly agreeing that it resulted in an increased sense of well-being and a more positive attitude about learning. The percentage dropped to 77% when prompted regarding stress alleviation, with one student strongly disagreeing with “I feel less stressed when I exercise before class.” All respondents who had ever exercised before class agreed or strongly agreed it was enjoyable; however only 81% planned to do it again. All students who attended the pre-class exercise (or any other on-campus exercise) agreed or strongly agreed it improved their wellbeing, promoted stress-reduction, and they would attend a future class. Discussion: Given the positive effects of exercise, pre-class sessions may reduce stress and improve well-being for medical students.1-2 Our results demonstrate that most medical-students look favorably upon on-campus exercise, and are open to future attendance. Students who attended the pilot pre-class session agreed with their peers' analysis. The lower impact of pre-class exercise on perceived stress levels and future plans to exercise may be explained by access issues.
Meet/Contact Us:
Heather M. Zimmerman, 37, John A. Burns School of Medicine
Contact: hz862000@hawaii.edu
Richard Kasuya, 63, John A. Burns School of Medicine
Contact: kasuya@hawaii.edu
Poster: Differences in Breast Cancer Subtypes Among Racial/Ethnic Groups
Category: Clinical
Abstract: Differences in the incidence of breast cancer subtypes among racial/ethnic groups have been evaluated as a contributing factor in disparities seen in breast cancer prognosis. Prior studies have utilized aggregated Asian American and Pacific Islander data to discuss breast cancer subtype differences, limiting insight into specific minority groups. We evaluated new breast cancer cases in Hawaii to determine if there were subtype differences according to race/ethnicity that may contribute to known disparities. Methods: We reviewed 4,591 cases of women diagnosed with breast cancer from two large tumor registries between 2013 and 2020. We evaluated breast cancer cases according to age at diagnosis, self-reported race, breast cancer subtype (ER, PR, and HER2 receptor status), histology, county, and year. Results: We found both premenopausal and postmenopausal Native Hawaiian women were less likely to be diagnosed with triple-negative breast cancer (OR=0.27, P=0.002; OR=0.56, P=0.007, respectively). Premenopausal Japanese women were less likely to be diagnosed with triple-positive (ER+/PR+/HER2+) breast cancer (OR=0.37, P=0.03). Premenopausal women in the “Other” racial category were more likely to be diagnosed with HR-/HER2+ breast cancer (OR=2.69, P=0.04). Discussion: Our study highlights significant racial and ethnic differences in breast cancer subtypes among women in Hawaii, which may contribute to differences in clinical outcomes. These differences have important implications for clinical practice, public health programs, and future research. By addressing the unique characteristics of Hawaii's population, we can improve breast cancer outcomes and reduce disparities, ultimately benefiting all women in the state.
Meet/Contact Us:
Tamlyn Sasaki, 24, John A. Burns School of Medicine
Contact: tamlyn21@hawaii.edu
Akash Liyanage, 26, General Sir John Kotelawala Defense University
Contact: yohanakash16@gmail.com
Poster: Colorectal cancer screening rates in private practice in West Oahu: A root cause analysis
Category: Clinical
Abstract: Colorectal cancer (CRC) is the third most common cause for cancer-related mortality in Hawaii. Only 65% of Hawaii’s population between ages 45 and 75 has been screened for CRC, which is below the American Cancer Society National Colorectal Cancer Roundtable goal of 80%. Similarly, we found the screening rate in the population at a primary care practice in West Oahu to be low. The goal of this quality improvement (QI) project was to identify root causes for low CRC screening rates and develop possible patient outreach interventions to improve screening rates in this population. Methods: Chart review of the electronic medical records of 388 patients covered by Hawaii Medical Service Association (HMSA) at this primary care office was conducted. Patients were excluded from the study if they were found to be compliant or at high risk for CRC (Family history of CRC, past medical history of CRC, diagnosed with inflammatory bowel disease, diagnosed with FAP/Lynch syndrome, past colectomy, past radiation to pelvis). Results: Baseline screening rate was 45% (314 compliant patients out of 702 HMSA patients). After chart review, 74 additional patients were found to be compliant and 14 patients were excluded, increasing the screening rate to 57%. The most common reason for care gaps in unscreened patients was a lack of discussion about CRC screening at appointments. Patient noncompliance with screening did not contribute greatly to low screening rates. Discussion: This root cause analysis suggests that interventions that standardize the office workflow for discussing CRC screening with patients and improving patient outreach should be the focus moving forward. Current interventions being implemented include standardizing electronic orders for fecal immunochemical tests (FIT) and text messaging outreach.
Meet/Contact Us:
Aaron Yamasaki, John A. Burns School of Medicine
Contact: ajyama@hawaii.edu
Agnes Catherine Santiano, John A. Burns School of Medicine
Contact: agmescat@hawaii.edu
Marguerite Cazin, John A. Burns School of Medicine
Contact: mcazin@hawaii.edu
Natalie Kamada, John A. Burns School of Medicine
Contact: kamadan@hawaii.edu
Tyler Liu, John A. Burns School of Medicine
Contact: tylerliu@hawaii.edu
Jimmy Chen MD, John A. Burns School of Medicine
Contact: jchen808@hawaii.edu
Poster: Addressing Health & Wellness in Students from Waiʻanae High School
Category: Social
Abstract: Native Hawaiian and Pacific Islander communities exhibit elevated rates of chronic disease, with increased mental health challenges in the adolescent population. The objective of this project is to enhance Waiʻanae High School adolescents’ comprehension of health and wellness, with a focus on mental, social, and physical health, alongside health literacy promotion. Our project team designed three in-person educational sessions with students of Waiʻanae High School. Lesson one aimed to define mental and physical health, emphasizing stress management. Lesson two aimed to define social health, with a focus on intrapersonal and interpersonal relationships. Lesson 3 aimed to define osteopathic medicine and its philosophy. A pre-survey was collected to understand students’ baseline knowledge of each topic. This was followed by an educational session and post-survey, which was administered after each lesson. Response rates were at or above 97% for pre and post-surveys. Data analysis of pre and post-surveys showed a statistically significant increase in students’ perceived knowledge and understanding of the presented lessons (p < 0.05). Of the stress coping mechanisms presented in Lesson 1, Journaling, Breathing, and Meditation were the top three techniques students chose to use in the future to reduce stress. When asked to list signs of a healthy relationship as discussed in Lesson 2, Communication and Honesty were the top qualities students noted. Reflective assignments completed by students after Lesson 3 discussed that the session was useful in providing insightful information on osteopathic medical practices and other healthcare careers. Data collected from pre and post-surveys, along with student reflections provided by faculty after each lesson, yielded significant insights into the effectiveness of the educational sessions. Optimal health is crucial for students to excel academically, so having discussions encompassing health and well-being with our adolescent population serves as a preventative measure to lower chronic disease in disadvantaged communities.
Meet/Contact Us:
Keahealailani Takushi, 25, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: alaitakushi@atsu.edu
Kalena Spinola, 28, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: kalenaspinola@atsu.edu
Elise Rivera, 29, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: elise.rivera@atsu.edu
Darian Finley, 26, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: dfinley@atsu.edu
Chakameh Akhavan, 28, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: cakhavan@atsu.edu
Michelle Balshin, 25, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: mbalshin@atsu.edu
Brooke Chmiel, 25, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: mbalshin@atsu.edu
Sarah Thompson, 25, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: sthompson@hawaii.edu
Kirsten Jin, 29, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: kjin@hawaii.edu
Ms. Surekha Appikatla, 34, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: surekhaappikatla@atsu.edu
Dr. Sharon Hiu, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: sharonhiu@atsu.edu
Dr. Joy Lewis, A.T. Still University - School of Osteopathic Medicine in Arizona
Contact: jhlewis@atsu.edu
Poster: Improving Diabetic Retinopathy Screening in the Central Oahu Community: A Root Cause Analysis
Category: Clinical
Abstract: Diabetic Retinopathy (DR), a common complication of diabetes (DM), is one of the leading causes of blindness in the US. Many patients are asymptomatic until advanced stages of the disease, highlighting the importance of guideline-based screening; However, DR screening rates remain low in the US and Hawaii. This study seeks to identify the root causes of care gaps in DR screening within a group primary care practice in the Central Oahu Community. Methods: First, care team members in a Central Oahu primary care clinic were interviewed about their current workflows to develop a process map for DR screening. Second, a retrospective chart review of 316 patients categorized as being overdue for their DR screening was performed. Inclusion and exclusion criteria were defined by the Merit-based Incentive Payment System (MIPS) Clinical Quality Measures (CQM). Data collected include last clinic visit, date and location of last diabetic eye exam, DM type, and presence of diabetes complications. Of the 316 patients, 284 were included in the root-cause analysis (RCA). Using the process map, root-causes were identified for each patient and most common causes cumulatively were determined. Results: The baseline screening rate was 43%. The top three root causes for care gaps amongst unscreened diabetic patients was 1) a lack of discussion of DR screening and no referral/order placed (59%), followed by 2) documented discussion of DR screening but no referral/placed (19%), and 3) DM not on the problem list (11%). Discussion: Our findings demonstrate that 89% of patients who failed to meet annual diabetic eye screening requirements were related to clinic workflow and systemic issues. This information can be used to implement new workflows as next steps to improve DR screening rates for this large primary care group practice which serves the Central Oahu community.
Meet/Contact Us:
Sean Choi, 26, John A. Burns School of Medicine
Contact: choisean@hawaii.edu
Haylee Fujioka, 23, John A. Burns School of Medicine
Contact: hfujioka@hawaii.edu
Anna Gan, 24, John A. Burns School of Medicine
Contact: ygan@hawaii.edu
Poster: Uncovering Galectin-3/9’s Novel Role in Early Fibrotic Cardiomyopathy using CRISPANT-Generated F0 Zebrafish Mutant Lines
Category: Biomedical
Abstract: The development of the human heart progresses through complex embryological stages, regulated by key proteins such as Galectin-3 (lgals3a) and Galectin-9 (lgal9l3). These proteins, part of the beta-galactoside-binding Galectin family, play crucial roles in cardiac repair and regeneration. Knockout (KO) studies of lgals3a and lgal9l3 have linked them to cardiovascular diseases (CVDs), specifically arrhythmogenic and fibrotic cardiomyopathies. These conditions are significant in clinical cardiology due to their association with heart failure and sudden cardiac death, contributing to the global burden of disease and mortality. Despite their importance, the exact roles of Galectin-3 and Galectin-9 in cardiomyopathy and cardiac regeneration remain unclear. This study investigates the clinical anatomy and pathophysiology of arrhythmogenic and fibrotic cardiomyopathy phenotypes using Galectin-3/9 KO zebrafish mutant lines. Zebrafish are ideal for cardiac disease research due to their heart tissue regeneration abilities and transparent embryos, which allow for detailed live imaging. Through CRISPR-Cas9 technology, deletions in lgals3a and lgal9l3 were induced in zebrafish, and the resulting cardiomyopathic phenotypes were analyzed using transgenic Fli1;myl7DSRedNLS and myl7;Lifeact-GFP lines, alongside ImageJ and pyHeart4Fish software. After injecting over 400 zebrafish embryos with Cas9 mRNA and protein along with specific gRNAs, successful deletions were confirmed in lgals9l3 mutants. The study found that these deletion mutants displayed abnormal vascular morphology, including vessel constriction and irregular angiogenesis, as well as increased heart rate, contractility, arrhythmia, and conduction issues compared to wild-type controls. These findings suggest that Galectin-3/9 plays a significant role in cardiac and vascular development, providing insights into the mechanisms of arrhythmogenic and fibrotic cardiomyopathies and their potential human relevance.
Meet/Contact Us:
Vincent Ooi, 24, William Carey University College of Medicine
Contact: VOoi585525@student.wmcarey.edu
Poster: Impact of Prior Authorizations on Healthcare in Hawaiʻi
Category: Clinical
Abstract: Health plans utilize prior authorizations (PAs) to control costs, requiring that healthcare professionals obtain approval before a patient receives certain medications or treatments. Despite their intended purpose, research shows that PAs not only lead to delays in care and poor patient outcomes but also contribute to physician burnout. In Hawaiʻi, where the physician shortage is a concern, reducing the administrative burden of PAs could improve the recruitment and retention of physicians. This study elicits physicians' opinions on how PAs impact their patients and practices, and on possible legislative solutions. Methods: A survey modeling the American Medical Association’s (AMA) annual nationwide PA physician survey was developed and administered electronically to board-certified physicians practicing at least 20 hours a week and who complete PAs on a weekly basis. Results: Of the 98 physicians who responded, 10 did not meet the inclusion criteria of being a practicing physician in Hawaiʻi, providing 20+ hours of patient care a week, and completing PAs regularly. Among those who met the requirements, 84% described the burden of PAs on their practice as high or very high. Delays in necessary care due to PAs were reported by 98% of physicians. Notably, 90% indicated that PAs at least sometimes lead to abandonment of the recommended course of treatment, and 60.2% reported that it interfered with a patient’s participation in the workforce (p<0.0001). Discussion: The PA process negatively impacts the lives of both physicians and patients in Hawaiʻi, making a PA reform essential. Utilizing guidelines supported by both the AMA and physicians, PA legislation can make medical practices more sustainable, improve equity in care, and advance the health of patients and communities in Hawaiʻi.
Meet/Contact Us:
Liana Chinen, 21, Creighton University
Contact: LianaChinen@creighton.edu
Elizabeth Rooks, 24, John A. Burns School of Medicine
Contact: ear33@hawaii.edu
Dr. Kelley Withy, John A. Burns School of Medicine
Contact: withy@hawaii.edu