Danielle Katz (Funding: Bertha Dagan Berman)
(faculty mentor: Joshua Dunaief, MD, PHD [Ophthalmology])
Fellowship term, 6 months: November 2023 - April 2024

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Project: Effect of Low Inflammatory Foods Everyday (LIFE) Smoothie vs. Average American Diet on Inflammatory Markers in Patients with Wet Age Related Macular Degeneration (AMD)

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Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in the developed world (Handa et al. 2019). AMD is defined by the presence of subretinal drusen deposits, which can ultimately cause death of the overlying photoreceptors and lead to vision loss. Subretinal soft drusen deposits contain many mediators of chronic inflammation, including C-reactive protein (CRP). Currently, the only effective treatment option for this condition is intraocular injections of VEGF inhibitors, which can be painful and costly.  Our proposed study aims to identify a novel dietary intervention that could significantly dampen the inflammation-mediated processes that lead to vision loss in AMD. The Low Inflammatory Foods Everyday (LIFE) diet has been shown to reduce systemic inflammation in numerous chronic conditions but has not yet been studied in the AMD population. We will therefore enroll approximately 15-20 patients with wet AMD to participate in this study. Patients will be randomly assigned to either the LIFE diet smoothie arm or the regular American diet arm. All patients will continue to consume their normal diet during the study period as well as continue to receive VEGF injections, but those in the LIFE diet smoothie arm will also consume one smoothie during each day of the study. Changes in the serum inflammatory markers CRP and IL-6, as well as beta carotene, a nutrient with anti-inflammatory properties, will be assessed at the initial visit and at a return visit four to six weeks later. All outcome measures will be compared between biologically male and female participants. We hope to demonstrate a significant decrease in CRP and IL-6 levels in the intervention group as compared to the control group. If this finding is borne out, it may suggest a new potential preventative strategy for inflammation-mediated vision loss in AMD.

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Sarah Rowley (Funding: Bertha Dagan Berman)
(faculty mentor: Renee Betancourt, MD [Family Medicine and Community Health])
Fellowship term, 6 months: October 2023 - April 2024

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Project: Assessing an Academic-Community Clinical Partnership’s effect on access to perinatal care and maternal and infant outcomes

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Maternal and infant morbidity and mortality is a public health crisis that has been recognized for over two decades, but despite this recognition the crisis continues to worsen within the United States. This crisis also disparately impacts Black and Hispanic communities, which make up over 41% and 16% of the Philadelphia population, respectively. This issue has made it evident that medicine must rethink how we provide perinatal care to better address this issue and to improve the health and well-being of moms and infants. This project is examining the impact of an academic-community partnership program between Penn Family Medicine and Greater Philadelphia Health Alliance (GPHA), a community health center, on obstetric care and subsequent maternal and infant outcomes. The study will compare the outcomes for patients at GPHA who delivered at Hospital of the University of Pennsylvania (HUP) in the 5 years prior to the partnership with the outcomes for patients 1 year after the partnership of Penn physicians providing care within the community at GPHA, with a preliminary analysis at 6 months. Many demographic factors and outcomes will be analyzed with my main focus on geographic analyses as well as one specific outcome of the proportion of growth scans in infants with low birth weight.

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Rebecca (Becca) Schapiro (Funding: Bertha Dagan Berman)

(faculty mentor: Nia Madhura Bhadra-Heintz, MD, MS [Obstetrics and Gynecology])
Fellowship term, 6 months: August 2023 - April 2024.

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Project: Silent Struggles: Unveiling Stigma in Healthcare with Perinatal Opioid Use Disorder

This project seeks to explore the experiences of pregnant patients with opioid use disorder in relation to their experience with healthcare providers and non-provider healthcare team members such as social workers throughout the peripartum time with a focus on the impact of perceived discrimination on their care-seeking behaviors and barriers and facilitators to receiving care. This study will use qualitative methods via in-dept. interviews. The study population will include pregnant and postpartum patients with opioid use disorder seen at the Perinatal Resources for Opioid Use Disorder (PROUD) Clinic for prenatal care who are at least 18 years old.

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Yun Ke (Tracy) Du (Funding: The Edna G. Kynett Memorial Foundation)

(faculty mentors: Julia D. Glaser, MD [Surgery/Vascular Surgery] 
Fellowship term, 6 months: August  2023 - February 2024

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Project : Gender-based Disparities in Follow-up after Diagnosis of Peripheral Arterial Disease

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Prior research has elucidated that compared to their male counterparts, women with peripheral arterial disease (PAD) tend to be underdiagnosed, present later in the disease course, are less likely to be offered surgical options for revascularization, and experience greater psychosocial impacts such as loss o findependent mobility and comorbid depression. Further disparities in outcomes and treatment offerings have been identified in patients o f color. However, follow-up after an initial diagnosis of PAD has not been thoroughly explored in recent literature. Prompt and periodic follow-up with a trained specialist is critical in the treatment o f PAD and preservation o f mobility and limb salvage. Disease progression into tissue loss and critical ischemia can Progress quickly and requires frequent vascular monitoring. Therefore, this project aims to identify factors that contribute to differences in time to follow-up for future community-level interventions and to improve treatment o f patients with PAD. Througha single-institution chart review o f all patients with a laboratory diagnosis o f PAD (ankle-brachial index measurement o f < 0.90), we will: 1. Compare length o f time to follow-up with a trained provider in the treatment o f PAD by gender 2. Stratify this data by race, zip-code income, and other demographic factors to identify trends contributing to disparities in follow-up time.

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Thilan Tudor  (Funding: The Edna G. Kynett Memorial Foundation)

(faculty mentor: Visish M. Srinivasan, MD [Neurosurgery])
Fellowship term, 6 months: October 2023 - March 2024

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Project:  Sex disparities in stroke recurrence among diabetic patients: a case-control and propensity score matching analysis of clinical and biochemical markers of recurrent stroke risk

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Diabetes and aberrant fasting blood glucose levels have been associated with increased risk of recurrent stroke. The INTERSTROKE case-control study demonstrated that specific markers of cardiovascular health, including pre-existing cardiac disease and waist-to-hip ratio were stronger markers of stroke risk in women compared to men. However, the sex-specific disparities underlying recurrent stroke risk differentials between male and female Type 2 diabetes patients in observational studies have not been clarified. A case-control approach will be utilized to compare diabetic patients with a single stroke event with a matched sample of recurrent stroke patients to identify laboratory, chemical, and functional biomarkers associated with recurrent stroke risk. Cases will be collected from a comprehensive stroke center at a large academic health system between September 2013 to August 2023. Propensity score matching and subsequent univariate and multivariate logistic regression analysis will identify estimators of recurrent stroke risk in diabetic patients and clinically-relevant sex associations. Receiver operating characteristic curve analysis will characterize any sex-specific biomarker thresholds that may explain observed differences in recurrent stroke. The findings from the analysis will inform sex-associated differences in recurrent stroke risk and may identify underlying differences in cerebrovascular and glycemic control risk factors.