Integrating ultrasound education and resources within undergraduate medical education in order to Bring Ultrasound Internationally for Long-term Development (BUILD)

Aims: At the Ohio State University College of Medicine, medical students have the option to train in ultrasound and take part in global electives where they can utilize clinical ultrasound. This presents the opportunity for medical students to engage in bidirectional sharing of medical and ultrasound knowledge in geographic regions with limited resources. We developedBringing Ultrasound Internationally for Long-term development (BUILD), a longitudinal course, to provide standardized ultrasound education to students planning to enroll in global health electives.Material and methods: This was a pilot study of the BUILD curriculum. Third-year medical students planning to complete a global health elective were invited to participate. Enrolled students completed an online curriculum, hands-on scanning, and pathology sessions, which augmented the predeparture Global Health course work. Students received two resource assessments: one to be completed by the student, and one to be completed by the on-site preceptor. Main outcomes measured were number of enrolled students, primary indications for imaging, and number of scans per-day.Results: In total, 152 students participated in the study and traveled to 22 different global sites in Low-Income Countries (LIC’s). All enrolled students completed the curriculum. Between 3 and 25 scans were performed per day and the leading indication for ultrasound imaging was obstetric and abdominal pain evaluation.Conclusions: The BUILD curriculum is a feasible construct to prepare students for using ultrasound during global electives. Students successfully performed proctored scans in a variety of settings. This format can be adopted by other institutions to further support student and global ultrasound programs.

Identification of Putative β-Galactosidase Genes in the Genome of Lactobacillus helveticus OSU-PECh-4A

The Lactobacillus helveticus OSU-PECh-4A strain, from the Ohio State University Parker Chair collection, produces exceptional β-galactosidase activity using acid whey as a culture medium, compared with a commercial broth. The strain has a genome sequence of 1,834,843 bp, and its GC content is 36.69%. Using InterProScan v5.50-84.0 software, four genes with putative β-galactosidase function were found.

The Columbus Linguistics in High School experience: Fits and starts as a prelude to success

We report here on our efforts to incorporate linguistics into the high school curriculum in a large midwestern metropolitan area through a university-based initiative — Linguistics in High School (LxHS) — spearheaded by the Department of Linguistics at The Ohio State University. We offer a brief history of the project, and explain our strategy of targeting non-public schools and the practical nature of the reasoning behind this decision. We chronicle the ups and downs of our efforts, ultimately reporting on our success with implementing a linguistics course and a linguistics club at a small local STEM-oriented high school. This partnership between the school and the Linguistics Department has allowed, among other things, for on-site visits by the students to phonetics and sociolinguistics labs. By presenting our challenges, strategies, failures, and successes, we hope that others may be encouraged to evaluate how they can make a difference in their locale and with the resources they have.

318. Description of Patients Readmitted within 30 Days from COVID-19 Hospitalization

Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to increased hospitalizations and utilization of critical care services. There are few studies describing co-morbidities and demographics associated with patients re-admitted within 30-days of discharge. The purpose of this study is to describe this patient population. Methods This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to identify patients who were admitted secondary to SARS-CoV-2 and required readmission within 30 days due to complications that might be associated with COVID-19. Adults admitted between 3/15/2020 and 11/15/2020 were included in this study. Baseline demographics including age, gender and race in addition to select comorbidities were identified. Results 250 patients were identified who were readmitted for various reasons. Readmitted patients had a median age of 55 years, 44% were male, and 41.2% were Black/African American. 62.4% of the population was obese (BMI ≥30 kg/m2) with 21.6% with a BMI ≥ 40 kg/m2. The top three co-morbidities seen included Diabetes Mellitus (DM) (32.2%), Hyperlipidemia (48.3%) and Hypertension (51.7%). Conclusion Though this study lacked a comparator group, it is clear that patients readmitted with all cause etiologies were disproportionally Black/African-American and obese, with a high prevalence of DM, hyperlipidemia, and hypertension. We recommend close monitoring of patients in these groups to reduce COVID19 readmissions. This is the first step in identifying which patients may be more likely to develop complications and required readmission, the next step is to compare these patients to those that were not readmitted to develop a risk model for readmission. Disclosures Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member) Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069)

678 The neonatal Fc receptor is elevated in monocyte-derived immune cells in pancreatic cancer

BackgroundPancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death in the United States with 5-year survival rates below 10%. PDAC is commonly diagnosed after metastasis has occurred and treatment options are limited. Immune checkpoint inhibitor (ICI) monoclonal antibody (mAb) therapy has shown great promise in other cancers, however little efficacy has been observed in patients with PDAC. The protein responsible for recycling IgG based mAb therapeutics like ICIs in the bloodstream, as well as processing peptides for antigen presentation, is the neonatal Fc receptor (FcRn). Little is known about FcRn in cancer, and to our knowledge no characterization of host FcRn, or FcRn extrinsic to tumor cells exists in PDAC patients. We hypothesized that PDAC patients and tumor-bearing animals would have altered FcRn expression by their immune populations compared to their healthy counterparts.MethodsC57BL/6 mice were orthotopically injected with KPC-luc (KrasLSL-G12D, Trp53LSL-R270H, Pdx1-cre) pancreatic tumor cells, and FcRn expression in myeloid-derived splenocytes were analyzed by fluorescence cytometry. Time-of-flight mass cytometry (CyTOF) was utilized to immunophenotype peripheral blood mononuclear cells (PBMCs) of PDAC or non-cancer patients for expression levels of FcRn within these immune populations.ResultsPDAC tumor-bearing mice exhibit altered FcRn expression among myeloid immune cell populations. Mice with pancreatic tumors had elevated expression of FcRn on migratory cDC2 (CD8-CD11b+CD103+CD24++; p = 0.017), monocytic MDSC (CD11b+Ly6G-Ly6C+; p = 0.0023), granulocytic MDSC (CD11b+Ly6G+Ly6C±; p = 0.0542), and cDC2 (CD8-CD11b+CD103-CD24±; p=0.036) cells. PBMCs from non-cancer obese patients (healthy control samples; n=8) and PDAC patients prior to surgical resection (n=13) were subjected to CyTOF analyses. The majority of FcRn expression was concentrated to monocyte (p=0.017), DCs (p=0.017) and MDSC (p=0.012) immune populations. Overall, we observed increased expression of FcRn on myeloid-derived immune populations from patients with PDAC. FcRn expression was elevated in both monocytes and DC populations in PDAC relative to non-cancer PBMCs. Monocytic and granulocytic MDSC from patients with PDAC had significantly elevated FcRn positivity compared to healthy controls (p = 0.034, p = 0.026, respectively).ConclusionsFcRn is upregulated in monocytes, dendritic cells and MDSC immune populations in patients and mice with pancreatic tumors. Future investigations into FcRn function in preclinical models and PDAC patients will hopefully elucidate new mechanisms of ICI resistance and possible alternative approaches for improving immunotherapy efficacy in these patients.Ethics ApprovalAll patients provided voluntary written informed consent (Institutional Review Board protocol: 2010C0051) to participate. The protocols and subsequent amendments were approved by The Ohio State University Institutional Review Board. All animal protocols were approved by the Ohio State University Institutional Animal Care and Use Committee (IACUC) at The Ohio State University (Approved IACUC protocols 2009A0178-R4 and 2017A00000117-R1) and mice were treated in accordance with institutional guidelines for animal care. The Ohio State University Laboratory Animal Shared Resource is an Association for Assessment and Accreditation of Laboratory Animal Care International accredited program that follows Public Health Service policy and guidelines. All other experiments were completed under the research protocols (2014R00000086; 2013R00000056) approved by the Ohio State University Institutional Biosafety Committee.

Myxedema Coma and Acute Hepatopathy in a Dog with Severe Atherosclerosis

A 9-year-old male intact mixed-breed dog was presented to The Ohio State University Veterinary Medical Center for evaluation of two days’ duration of weakness, lethargy, inappetence, and one episode of vomiting the day of presentation. On presentation, the dog was depressed and tetraparetic. He was noted to be icteric and dehydrated. Obesity and truncal alopecia with a “rat tail” appearance were observed. Diagnostic testing revealed evidence of an acute hepatopathy and peritonitis. Given the dog’s neurologic status, physical examination abnormalities, including a “tragic facial expression”, and hyperlipidemia, there was concern for possible myxedema coma. A thyroid panel was consistent with hypothyroidism. The dog experienced respiratory arrest prior to initiation of therapy, and an autopsy confirmed the presence of subacute necrotizing cholangiohepatitis, marked atherosclerosis, and severe thyroid atrophy. These clinical and pathologic changes were supportive of myxedema coma.

Clinical Outcomes with Ertapenem for Pneumonia in Obese versus Non-obese Patients

The objective of this study was to compare the rate of pneumonia resolution in obese (BMI ≥ 30 kg/m 2 ) and non-obese (BMI < 30 kg/m 2 ) patients treated with ertapenem one gram daily. This was a retrospective cohort study evaluating patients treated at The Ohio State University Wexner Medical Center between January 1, 2015 and August 31, 2020. Patients were included if they were between 18 and 89 years old and received ertapenem for at least 48 hours for pneumonia. Patients were excluded if pregnant, incarcerated, had renal impairment, received antibiotics with gram-negative activity for a significant period prior to or in addition to ertapenem, and patients with other concomitant deep-seated infections. The primary outcome of clinical resolution was defined as meeting any of three criteria in order of evaluation: discontinuation of antibiotics by day 8 of therapy, afebrile while on ertapenem in addition to a decrease in white blood cell count, or improvement on chest radiograph at day 7 of therapy. A multivariable logistic regression analysis was performed to examine the association between obesity and clinical resolution, while adjusting for proven confounders. There were 76 non-obese and 65 obese patients included. The median patient BMI was 23.7 kg/m 2 (21.0-26.9) and 35.0 kg/m 2 (32.8-39.8) for the non-obese and obese cohorts, respectively. Clinical resolution was achieved in 78% (59/76) of non-obese and 75% (49/65) of obese patients (p=0.75) without an observed difference in the regression model. Outcomes were similar in obese and non-obese patients treated with ertapenem one gram daily for pneumonia.

The formulary process for biosimilar additions at a comprehensive cancer center

Biological products may be used to diagnose, prevent, treat, and cure diseases and medical conditions, including cancer. Biosimilar agents, approved under an abbreviated 351(k) pathway, continue to increase in number and market share for biologic agents, especially for cancer care. Although biosimilars offer the potential for improved access to care, their introduction to the marketplace has created significant disruption. It is imperative that health systems providing care to patients with cancer develop a well-defined process to address the challenges associated with biosimilars. This descriptive article outlines pharmacy considerations for biosimilars and describes the current practices at The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University. Biosimilars have and will continue to significantly impact oncology care. Organizations must understand the clinical, operational, and financial challenges associated with the use of these products.