• Effect of phospholipid transfer protein and apolipoprotein M in sphingosine-1-phosphate and chylomicron metabolism

  Jones, Quiana

  Phospholipid transfer protein (PLTP) is a monomeric protein primarily responsible for the transfer of hydrophobic molecules, including phospholipids, cholesterol, triglycerides from apolipoprotein B containing particles to high-density lipoprotein (HDL). Shingosine-1-phoshate is a lipid mediator which acts on five unique receptors expressed in various tissues. Both PLTP and S1P have been implicated in cardio-related disease. Germline PLTP KO studies reveal plasma S1P decreases without affected apoM, a major carrier of S1P which is bound to HDL particles. From this data, we hypothesize that PLTP could be a carrier for S1P in circulation and that its carrier function is independent of the apoM-S1P axis. We, therefore, developed single apoM and inducible PLTP KO lines as well as a double PLTP/apoM KO mice model and compared plasma changes for S1P. Our theory was that if our hypothesis was correct, double PLTP/apoM KO should decrease plasma S1P more than single KO models suggesting an additive or synergetic effect. We observed that single apoM KO reduced plasma S1P roughly 50% and single PLTP KO reduced plasma S1P roughly 40%; however, double KO did not reduce plasma S1P more than 50%. In addition, we found that PLTP KO also reduced plasma HDL, suggesting that the S1P reduction observed in this inducible KO model was due to HDL reduction in circulation. Further, we found that KO of albumin, which has long been thought to be a non-apoM-related S1P carrier, had no effect on S1P levels suggesting that although PLTP may not be an independent carrier of S1P, neither is albumin. Our focus on HDL in this set of experiments also lead us to studying apoM more closely. A previous report detailed that apoM deficiency led to decreased circulating triglyceride (TG) levels. In the liver, very low-density lipoproteins (VLDL) are produced; however, in the small intestine chylomicron (CM) are produced. CM production only happens postprandially or after 26 fat loading. These two particles are mostly responsible for the circulation of TG and both contain apolipoprotein B (apoB) – VLDL has apoB-100 and CM has apoB-48 as their main structural proteins. After confirming the previously observed apoM deficiency phenotype, we measured small intestinal as well as liver proteins related to the formation and secretion of apoB-containing particles. Although the liver and the small intestine have a similar set of proteins responsible for apoB-containing particle secretion, we found that in the small intestine but not the liver of apoM KO mice, levels of microsomal triglyceride transfer protein (MTP) and Sar1B are decreased. Both these proteins are necessary components in the formation and secretion. In addition to this, we found accumulation of lipids confirmed by Oil Red O Staining in small intestinal cells of apoM KO mice. To confirm this observation, we conducted electron microscopy of the intestinal cells using apoM KO mice which showed increased ER lipid accumulation as well as increased cytosolic lipid droplet accumulation as compared to WT mice. We also observed dysfunction in the transport of vesicles from the ER to the Golgi in apoM KO mice as compared to WT mice. Coat protein complex II are the group of proteins responsible for this transfer, one of which is Sar1B. Other proteins in this complex include Sec12, 23, 24, 13, and 31. We measured protein levels of Sec 12, 23, and 24 and found they were significantly decreased in the small intestine of apoM KO mice but not in the liver. In addition to this, we measure the mRNA levels of Sar1B and MTP in both the liver and small intestines of WT and apoM KO mice. There was no difference between the two tissues in terms of mRNA for these proteins which indicates that the effect of apoM deficiency is at the protein level. Together, our data suggests a novel role of apoM in postprandial TG metabolism. Using apoM as a target may give a method to explore the role of dietary fat intake in lipid metabolism.
• microRNAs in Retinal Development and Müller glia Reprogramming

  Kang, Seoyoung (2025)

  "Retinal diseases lead to visual impairments with loss of neurons and often cause blindness. Since the mammalian retina has no regenerative capability, one of attractive strategies is cell replacement, achieved by reprogramming endogenous mature cells. There are attractive molecules that regulate gene expression and are elementary during retinal development (retinogenesis), and also can induce reprogramming in mouse Müller glia (MG). MG, predominant glia in the retina, are known to have regenerative capacity naturally in fish, unlike mammalian. Recent studies demonstrated that microRNAs (miRNAs) play an important role in the embryonic phase of retinogenesis, and the set of miRNAs can induce mouse MG reprogramming into neuronal-like cells that express neuronal markers and have neuronal morphologies. The miRNAs were, however, poorly understood in the postnatal processes of retinogenesis. Furthermore, the questions include which cell types can be generated and, most importantly whether these neuronal cells are mature and functional were not answered yet. Therefore, the aims of this study were to 1) analyze the effects of loss of miRNAs in the late retinal progenitor cells (RPCs) during postnatal retinal development, to 2) evaluate the reprogramming efficiency of the RPC-miRNA miR-25 with regard to the generation of functional neurons. Aim 2 included the establishment of an improved cell culture protocol together with calcium imaging in order to investigate the functionality and maturation state of these newly generated neuronal-like cells. Aims one and two included the establishment of luciferase reporter assays to identify a possible underlying mechanism. Loss of miRNAs in late RPCs is caused by a genetic knock-out of the enzyme Dicer, required for the formation of mature, functional miRNA and Ascl1CreER:tdTomato strain (RPC reporter mouse). The tissue was examined at different timepoints and evaluated histologically. For MG reprogramming, RPC-miRNA miR-25 was overexpressed using artificially made miRNAs called mimics, in mouse primary MG. Cells were monitored and evaluated over the time course of three weeks. miRNA target gene analyses were performed to identify potential underlying mechanisms. Our data showed that loss of miRNAs in late RPC reduced populations of bipolar cells, rod photoreceptors, MG and increased an amacrine cell population. We found that miR-25 directly target amacrine cell mRNAs, Elavl3, a gene that encodes for HuC, a protein expressed in amacrine cells. Using the RPC-miRNA miR-25 to reprogram young primary MG led to a conversion of the cells to more immature cells. We show for the first time that one miRNA alone, namely miR-25, was sufficient to successfully reprogram primary MG into progenitor cells that subsequently differentiate into functional neurons. This cell conversion might be partly due to the inhibition of the neuronal repressor Rest, a direct target of miR-25. Furthermore, we found that miRNA molecules were taken up efficiently by all glia, however, not all glia were reprogrammed. This suggests that the competence state of the glia might play a role in reprogramming. Taken together, late RPC-miRNAs are essential for the proper development of late-born cells and miRNA loss leads to reduced bipolar cells, photoreceptors, and MG populations but an increase in amacrine cells. The reduced bipolar cell number might be partly due to a competent shift of the progenitors towards amacrine cell generation. Furthermore, the RPC-miRNA miR-25 alone is sufficient to successfully reprogram primary MG into progenitor cells that subsequently differentiate into functional neurons. The neuronal repressor Rest might be one of the primary key players in this process. Since miRNA molecules were taken up efficiently, remained at least 4 weeks after transfection, and no toxicity was detected, miR-25 might be a promising tool for in vivo MG reprogramming. "
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  The influence of video prompting with embedded safety checks to teach child passenger safety restraint skills

  Zonneveld, Kimberley L. M.; Rasuratnam, Niruba; Vladescu, Jason C. (Wiley, 2025-04-08)

  Motor vehicle collisions are among the leading causes of unintended injury-related deaths among children under the age of 14. The primary cause of these deaths is the improper use of child passenger safety restraints (CPSRs). Correctly installed CPSRs can decrease the risk of fatal injury by 45% to 95%. To date, no studies have used video prompting with embedded safety checks to teach correct CPSR installation and harnessing in the absence of researcher-delivered instruction and feedback. We used a concurrent multiple-baseline-across-participants design to evaluate the efficacy of a video-prompting procedure with embedded safety checks to teach four prospective parents and caregivers CPSR installation and harnessing skills. All participants learned to perform these skills, and these effects maintained for 4 weeks. Furthermore, this training improved all participants' performance of an untrained installation position, vehicle, and harnessing skill, and these effects were largely maintained for 4 weeks.
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  Investigating a Link Between Visual Function and Menstruation

  Goodwin, Emma (2025)

  "Throughout the course of a normal menstrual cycle, a woman’s hormone levels vary greatly and these changes cause the body to react in a multitude of ways. However, there is little previous research remarking on the link between visual function and the menstrual hormones. The objective of this study was to determine how visual function is impacted at different stages in the menstrual cycle. Specifically, tests of high and low contrast visual acuity, lag of accommodation, color vision, and critical flicker fusion frequency were recorded in order to examine changes in visual function over a normal menstrual cycle. This study recruited all subjects from the SUNY College of Optometry as well as the areas surrounding the school between the ages of 18-30 years old. 12 female subjects not currently pregnant or on birth control medication as well as 3 male control subjects will participate. Subjects performed the required clinical measurements 5 days a week for 5 weeks (25 total days) to encompass the entire menstrual cycle. In addition, female subjects also reported the day of their last menstrual cycle and any other perceived changes in visual function throughout the month. No significant difference was found between the female and male groups or within the female group throughout the month for any parameter tested. Further parameters should be measured in the future in order to gain a clear image of how menstruation impacts the whole ocular system."
• Examining the Role of Serum Ferritin Levels and the Risk of Adverse Cardiac Events Among Postmenopausal Women: Insights from the Women's Health Initiative Study

  Dasgupta, Shabitri

  Background: Postmenopausal women have a heightened risk of cardiovascular diseases (CVD), the primary cause of mortality among women in the United States. While premenopausal women are believed to have relative protection against heart disease compared to men, these benefits diminish after menopause, leading to increased cardiovascular risk. The mechanisms behind this progression are unclear, underscoring the need to evaluate additional sex-specific risk factors and biomarkers for accurate prediction of women's risk for adverse cardiovascular events (ACE). Ferritin, an acute-phase protein involved in iron storage and linked to CVD, may serve as a potential biomarker, but its role in the cardiovascular health of postmenopausal women has been understudied. Objective: This study investigates the association between serum ferritin levels and ACE in postmenopausal women using data from the Women's Health Initiative (WHI) study. Methods: A case-control study was conducted using data from the WHI, which consists of 161,808 postmenopausal women aged 50-79 from 40 U.S. clinical centers. This analysis included 313 incident cases of ACE and 1,069 controls from an ancillary study of 2,855 women with and without sarcopenia. Propensity score matching combined with inverse probability weighting was used to control for potential confounding factors and selection bias. Multivariate logistic regression analyses were conducted to examine the association between serum ferritin levels and ACE, adjusting for established cardiovascular risk factors. 6 Results: Low ferritin levels were associated with an increased odds of cardiovascular events in postmenopausal women, compared to higher levels. Women in the three highest ferritin quartiles (50-85 ng/mL, 86-146 ng/mL, and ≥147 ng/mL) had 48% (OR:0.52, 95% CI: 0.35-0.77), 48% (OR:0.52, 95% CI: 0.35-0.79), and 42% (OR:0.58, 95% CI: 0.40-0.85) lower odds of experiencing ACE compared to women in the lowest quartile (≤49 ng/mL), respectively. This suggests a threshold effect for serum ferritin, where the odds of ACE increase below a certain level and plateau at 42-48% lower in women within the three higher quartiles compared to those in the lowest quartile. Conclusion: In our study, low ferritin levels (<50 ng/mL) were associated with increased odds of experiencing ACE among postmenopausal women, while higher levels above this threshold were associated with 42-48% lower odds indicating a threshold effect. Whether targeted treatments to increase ferritin levels among those with low levels will reduce CVD risk remains unknown and warrants further study
• ON-Pathway Visual Acuity Deficits in 8-12 Years Old Children with Unilateral Amblyopia

  Li, Jerry (2025)

  "Purpose: Conventional recognition visual acuity (VA) tests, using black optotypes on white background, do not detect ON-pathway amblyopia deficits. This pilot study tests the hypothesis that VA testing with white optotypes on black background is more sensitive in detecting amblyopia than with black optotypes on white background. Methods: Two groups of children aged 8-12 were enrolled. The amblyopic group (N=13) had a best-corrected VA of 20/32 or worse in the amblyopic eye and an interocular VA difference of ≥0.2 logMAR. The control group (N=16) had best-corrected VA equal to or better than 20/25 and had an interocular VA difference of ≤0.1 logMAR. Participants’ VA were tested monocularly with an ETDRS program using the Amblyopia Treatment Study protocol and reported as a Score. Two optotype polarities were randomized, and tests were repeated after 30 minutes. VA in Scores were compared between amblyopic, fellow, and control eyes for both polarities. Results: For amblyopic eyes, the mean VA Score was significantly lower for white than for black optotypes (57.85±10.72 vs 61.46±10.10, p<0.001), indicating that amblyopic eyes had more difficulty seeing white than black optotypes. For fellow eyes, the mean Score was marginally significantly lower for white than for black optotypes (85.77±3.23 vs 87.73±4.61, p=0.03). No significant differences were found in control eyes (87.70±3.38 vs 88.02±4.03, p=0.63). Conclusions: VA in amblyopic eyes is 3.6 letters (~0.07 logMAR) worse when measured with white optotypes than black optotypes, indicating that white optotypes have higher sensitivity in detecting amblyopia ON-pathway deficit."
• The effects of glare, luminance and contrast on visual acuity (VA)

  Arun, Geerdhana (2025)

  "Purpose: Clinical measurements of VA are typically obtained under optimal conditions using high contrast optotypes. However, these conditions are not representative of real-life environments where observers are frequently faced with low contrast, low luminance targets accompanied by significant degrees of glare. Accordingly, the aim of the present study was to measure VA under both optimal and suboptimal conditions in younger and older adults. Method: The study was performed on 30 older (ages 50-71 years) and 30 younger (21-28 years) subjects. High (0.0 log unit) and low (1.05 log unit) contrast VAs were tested using the Adhikari Carter Feigl Zele logMAR chart. VA was measured both with and without a 0.3 neutral density (ND) filter to create low luminance conditions, as well as both with and without an LED glare source being directed into the eye. Results: The average change in VA under the low contrast and low luminance conditions were 1.22 logMAR (p < 0.001) and 0.94 (p < 0.001), respectively. Average VA changed by -0.77 in the presence of glare (p < 0.001). There were no significant age effects noted between the two groups (p=0.25). Interaction effects were significant between luminance and contrast (p < 0.001) as well as between luminance, contrast and the presence of glare (p < 0.001) in both age groups. Conclusions: The results demonstrate that reducing contrast and luminance produced a significant decline in VA in younger and older adults. This finding has considerable clinical significance, for example when driving at night, where a subject with excellent VA in the examination room might exhibit very poor VA under degraded conditions. Clinical measurements should include assessment of visual performance under sub-optimal conditions. "
• Smoking History Intensity and Permanent Tooth Removal: Findings from a National United States Sample

  Wei, Yu; Debick, Nadia Alexandra; Wong, Roger (MDPI, 2025-05-06)

  The role of smoking in the development of periodontal disease has been well explored. However, this study aims to explore the relationship between intensity of smoking history and permanent tooth removal. We utilized the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative sample of 107,859 US adults, to explore this association. Smoking history intensity was a BRFSS-derived measure of pack-year smoking history. Permanent tooth removal was binarized as the presence or absence of a history of permanent tooth removal. A binary logistic regression was conducted to analyze this association after adjusting for a variety of sociodemographic, health, and substance-use covariates. There was a dose-dependent relationship in which increasing smoking history intensity was associated with increased odds for removal of one or more permanent teeth. For example, those who reported a pack-year history of 30 or more years had a 6.4 times significantly higher odds of reporting a history of permanent tooth removal when compared to those with a 0 pack-year history (adjusted odds ratio = 6.37, 95% CI = 3.80–10.69, p < 0.001). These findings can be used to promote smoking reduction or cessation as a means of decreasing risk of permanent tooth removal due to tooth decay or gum disease.
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  The Bok-IP3R interaction and the impact it has on apoptosis, Bok stability, and IP3R-mediated calcium mobilization

  Bonzerato, Caden (2025-04-21)

  Bcl-2-related ovarian killer, Bok, is often considered a pro-apoptotic Bcl-2 family member due to its ability to induce mitochondrial outer membrane permeabilization (MOMP) when over-expressed. However, there are many conflicting reports regarding endogenous Bok's apoptotic function and stability. Some studies claim that endogenous Bok is constitutively a MOMP-mediator but is very unstable and kept at very low levels via ubiquitin proteasome pathway (UPP)-mediated degradation. On the other hand, many studies, including those from the Wojcikiewicz Lab, indicate that endogenous Bok is a stable protein constitutively bound to inositol 1,4,5-trisphosphate receptors (IP3Rs), a calcium (Ca2+) release channel in the endoplasmic reticulum (ER) membrane, where it would be unable to induce MOMP. In fact, Bok KO mice have no developmental of phenotypical abnormalities, further suggesting that Bok's "killer" characterization needs to be reconsidered. Since endogenous Bok is an ER protein, studying its MOMP-like properties seems futile. Therefore, focusing on the significance of the Bok-IP3R interaction has been the priority of the Wojcikiewicz Lab since we discovered the complex. Over the years, we found that Bok protects IP3Rs from proteolytic cleavage and that Bok stability is dependent on its ability to bind to IP3Rs. However, surprisingly, there is no clear evidence to date that Bok influences the Ca2+ mobilizing activity of IP3Rs. Here, I study in detail the Bok-IP3R interaction and the impact it has on apoptosis, Bok stability, and IP3R-mediated Ca2+ mobilization. I resolve the controversy surrounding the apoptotic function of exogenous and endogenous Bok and hypothesize why there is a discrepancy between the two. Also, I show that IP3R binding in the ER membrane is essential for Bok stability, and without them Bok is rapidly degraded by the UPP. This demonstrates that the Bok-IP3R interaction is critical to Bok function, likely including its newly emerged non-apoptotic roles, such as regulating mitochondrial dynamics and mitochondria associated-ER membranes. Finally, for the first time, I reveal that Bok has suppressive effects on IP3R-mediated Ca2+ mobilization and describe how these effects are reversed when Bok is phosphorylated at serine-8. Overall, this thesis demonstrates the importance of the Bok-IP3R interaction on both Bok and IP3R function.
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  Diverging cognitive benefits from education between rural and urban middle-aged and older adults in the USA.

  Wong, Roger; Mansour, Amer (Cambridge University Press, 2025-04-17)

  Subjective cognitive decline (SCD) is defined as self-reported increase in confusion or memory loss. There is limited research on the interplay between rural-urban residence and education on SCD.
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  Evidence based review of type 2 diabetes prevention and management in low and middle income countries

  Afable, Aimee; Karingula, Nidhi Shree (Baishideng Publishing Group Inc., 2016)

  Aim: To identify the newest approaches to type 2 diabetes (T2DM) prevention and control in the developing world context. Methods: We conducted a systematic review of published studies of diabetes prevention and control programs in low and middle-income countries, as defined by the World Bank. We searched PubMed using Medical Subject Headings terms. Studies needed to satisfy four criteria: (1) Must be experimental; (2) Must include patients with T2DM or focusing on prevention of T2DM; (3) Must have a lifestyle intervention component; (4) Must be written in English; and (5) Must have measurable outcomes related to diabetes. Results: A total of 66 studies from 20 developing countries were gathered with publication dates through September 2014. India contributed the largest number of trials (11/66). Of the total 66 studies reviewed, all but 3 studies reported evidence of favorable outcomes in the prevention and control of type 2 diabetes. The overwhelming majority of studies reported on diabetes management (56/66), and among these more than half were structured lifestyle education programs. The evidence suggests that lifestyle education led by allied health professionals (nurses, pharmacists) were as effective as those led by physicians or a team of clinicians. The remaining diabetes management interventions focused on diet or exercise, but the evidence to recommend one approach over another was weak. Conclusion: Large experimental diabetes prevention/control studies of dietary and exercise interventions are lacking particularly those that consider quality rather than quantity of carbohydrates and alternative exercise.
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  A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population

  Bayoumi, Nagla S.; Helzner, Elizabeth; Afable, Aimee; Joseph, Michael A.; Dhuper, Sarita (Springer Science and Business Media LLC, 2019-10-24)

  Background: Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents. Methods: The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2-19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score. Results: The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was - 3.0 (95% CI: - 5.0, - 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was - 0.15 (95% CI: - 0.2, - 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of - 15.3 mmHg (p < 0.0001) and - 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and - 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043).
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  Implementation of a Case Investigation and Contact Tracing Program at an Academic Medical Center in New York City

  Bruno, Denise M.; Afable, Aimee; Pervil-Ulysse, Mona; Putman, Jeffrey S.; Demissie, Kitaw (Ovid Technologies (Wolters Kluwer Health), 2022-02-08)

  Problem: In the spring of 2020, New York City was an epicenter of COVID-19 infections, hospitalizations, and mortality. One of the hardest hit areas in New York City was central Brooklyn, where State University of New York (SUNY) Downstate is located. As the severity of the initial wave of the COVID-19 pandemic waned in New York City, SUNY Downstate Health Sciences University planned to institute COVID-19 surveillance on campus to limit its spread among employees and students. Approach: In collaboration with university leadership and students across schools, the SUNY Downstate Contact Tracing Corps was established in July 2020. Using guidance from the Centers for Disease Control and Prevention and the New York State Department of Health, protocols for case and contact investigations, including scripts, were developed. Students were recruited and trained in remote and confidential case and contact investigations. Outcomes: From August 1, 2020, to March 23, 2021, there were 185 COVID-19 cases referred to the contact tracing program; of these, 180 were successfully investigated and isolated (97%). Case investigations identified 111 Downstate close contacts; 105 were investigated and quarantined (94.5%). There were 122 exposure-only investigations referred to the program, and 121 were successfully investigated and quarantined (99%). Next steps: The SUNY Downstate Contact Tracing Corps transitioned to a core group of tracers in January 2021 and has been maintained at 4 to 6 tracers since that time. With the emergence of COVID-19 variants, the threat of new variants, and variable COVID-19 vaccination rates across Brooklyn, Downstate employees and students remain vulnerable to COVID-19 transmission. Given this, the SUNY Downstate Contact Tracing Corps will continue to conduct case and contact investigations.
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  Insights into the challenges and facilitators to physical activity among brooklyn teens enroled in a weight management programme

  Browne, Viola R.; Bruno, Denise M.; Dhuper, Sarita; Afable, Aimee (Wiley, 2022-05-27)

  Purpose: A qualitative study was carried out to explore obese adolescents' understanding of physical activity, perceptions of the ideal body type and to identify facilitators of and barriers to physical activity. Methods: Twenty-two adolescents 12-18 years of age and 14 of their parents were recruited from an obesity intervention programme in Brooklyn, New York, from June to November 2017. Data were collected using focus groups and individual semi-structured interviews, followed by interpretative phenomenological analysis of the transcripts. Results: The adolescents wanted to 'lose some weight', but not to be 'thin' or 'look hungry'. Most females desired a 'slim-thick' figure, which was 'a flat stomach with big thighs, and curvy'. Fun and support from parents, peers and programme staff facilitated achieving their physical activity goals. Barriers included low self-efficacy, inactive families, fear of neighbourhood gangs and crime and perceptions that the parks were small and overcrowded, with limited physical activity options for adolescents. Conclusion: These findings highlight the need to consider local norms concerning body image when designing obesity interventions. To effectively reduce childhood obesity in New York City, policy should prioritize the promotion of public safety, improvement of neighbourhood parks and increase options for physical activity. Patient or public contribution: The voices and narratives of patients and their families informed this study.
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  Evaluation of a Childhood Obesity Program Serving a High-Need Population in Brooklyn, New York Using Survival Analysis

  James, Alecia; Afable, Aimee; Bayoumi, Nagla; Dhuper, Sarita (MDPI AG, 2023-05-04)

  In this study, we used survival analysis to evaluate whether contact hours intensity was associated with a reduction in time to improvement of various BMI metrics over a 5-year follow-up period at the Live Light Live Right pediatric obesity program in Brooklyn, New York. This was a single-center retrospective longitudinal study of 406 patients during 2010-2016. Participants were categorized based on hours of exposure to Live Light Live Right's interventions; high contact hours (≥50 h) vs. low contact hours (<50 h). At baseline, 88% of patients in the high contact hour group had severe obesity and the mean age for this group was 10.0 ± 2.66. High contact hours were independently associated with a shorter time to BMI improvement in the sample. There was also a significant association between high contact hours and a longer duration in the improved state. Survival analysis was successful in evaluating the efficacy of the Live Light Live Right Program and demonstrated a positive association between greater intervention intensity and a healthier metabolic profile. Patients' active engagement in a robust treatment model exemplified by Live Light Live Right is recommended to address the childhood obesity crisis in central Brooklyn.
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  Community Perceptions of Health Equity: A Qualitative Study

  Salisu, Margaret; Blackwell, Tenya; Lewis, Gwendolyn; Hoglund, Mark W; DiVittis, Anthony; Chahal, Kunika; Samuels, Chellandra; Boutin-Foster, Carla; Montgomery, Douglas; Afable, Aimee (SAGE Publications, 2023-11-18)

  Introduction: Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients' experiences of care is paramount for reducing health inequities. Methods: In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn. Results: The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants' interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive. Conclusions: Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare.
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  Do digital health interventions hold promise for stroke prevention and care in Black and Latinx populations in the United States? A scoping review

  Rivera, Bianca D.; Nurse, Claire; Shah, Vivek; Roldan, Chastidy; Jumbo, Adiebonye E.; Faysel, Mohammad; Levine, Steven R.; Kaufman, David; Afable, Aimee (Springer Science and Business Media LLC, 2023-12-21)

  Background: Black and Latinx populations are disproportionately affected by stroke and are likely to experience gaps in health care. Within fragmented care systems, remote digital solutions hold promise in reversing this pattern. However, there is a digital divide that follows historical disparities in health. Without deliberate attempts to address this digital divide, rapid advances in digital health will only perpetuate systemic biases. This study aimed to characterize the range of digital health interventions for stroke care, summarize their efficacy, and examine the inclusion of Black and Latinx populations in the evidence base. Methods: We searched PubMed, the Web of Science, and EMBASE for publications between 2015 and 2021. Inclusion criteria include peer-reviewed systematic reviews or meta-analyses of experimental studies focusing on the impact of digital health interventions on stroke risk factors and outcomes in adults. Detailed information was extracted on intervention modality and functionality, clinical/behavioral outcome, study location, sample demographics, and intervention results. Results: Thirty-eight systematic reviews met inclusion criteria and yielded 519 individual studies. We identified six functional categories and eight digital health modalities. Case management (63%) and health monitoring (50%) were the most common intervention functionalities. Mobile apps and web-based interventions were the two most commonly studied modalities. Evidence of efficacy was strongest for web-based, text-messaging, and phone-based approaches. Although mobile applications have been widely studied, the evidence on efficacy is mixed. Blood pressure and medication adherence were the most commonly studied outcomes. However, evidence on the efficacy of the various intervention modalities on these outcomes was variable. Among all individual studies, only 38.0% were conducted in the United States (n = 197). Of these U.S. studies, 54.8% adequately reported racial or ethnic group distribution. On average, samples were 27.0% Black, 17.1% Latinx, and 63.4% White. Conclusion: While evidence of the efficacy of selected digital health interventions, particularly those designed to improve blood pressure management and medication adherence, show promise, evidence of how these interventions can be generalized to historically underrepresented groups is insufficient. Including these underrepresented populations in both digital health experimental and feasibility studies is critical to advancing digital health science and achieving health equity.
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  Community design of the Brooklyn Health Equity Index

  Afable, Aimee; Salisu, Margaret; Blackwell, Tenya; Divittis, Anthony; Hoglund, Mark; Lewis, Gwendolyn; Boutin-Foster, Carla; Douglas, Montgomery (Oxford University Press (OUP), 2024-09-09)

  Health equity drives quality care. Few reliable metrics that capture patients' perceptions of health equity exist. We report on the development of a patient-centered metric for health systems change in central Brooklyn, which stands out as an outlier in New York City with a disproportionate burden of poverty, disease, and death. A community-engaged, sequential, mixed-methods research design was used. Qualitative interviews were conducted with 80 community and health care stakeholders across central Brooklyn. Candidate items were derived from qualitative themes and examined for face, interpretive validity, and language. Interitem reliability and confirmatory factor analysis was assessed using data collected via text and automated discharge calls among 368 patients from a local hospital. Qualitative data analysis informed the content of 11 draft questions covering 3 broad domains: trust-building, provider appreciation of social determinants of health, and experiences of discrimination. Psychometric testing resulted in a Cronbach's alpha of 0.774 and led to deletion of 1 item, resulting in a 10-item Brooklyn Health Equity Index (BKHI). The 10-item BKHI is a novel, brief, and reliable measure that captures patients' perceptions of inequities and offers a real-time measure for health systems and payors to monitor progress toward advancing health equity.
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  Diabetes and Hypertension Risk Across Acculturation and Education Levels in Hispanic/Latino Adults

  Pérez-Stable, Eliseo J.; Panigrahi, Asmi; Coreas, Saida I.; Rodriquez, Erik J.; Afable, Aimee; Elfassy, Tali; Isasi, Carmen R.; Gonzalez, Jeffrey S.; Daviglus, Martha L.; Hinerman, Amanda; et al. (American Medical Association (AMA), 2025-03-28)

  Importance: Acculturation among Hispanic/Latino populations, defined as adaptation to US lifestyle and culture, is often assumed to lead to adverse health outcomes that will reduce the immigrant health advantage. Objective: To evaluate the risks for incident diabetes and hypertension by levels of acculturation and educational attainment. Design, setting, and participants: This study used data from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of men and women aged 18 to 74 years who identified as Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American living in 4 urban locales in the US. Visit 1 spanned March 2008 to June 2011; visit 2 spanned October 2014 to December 2017. Main outcomes and measures: Multivariable logistic regression was used to evaluate the association between language acculturation level defined by the Short Acculturation Scale for Hispanics (SASH) and educational attainment (less than high school graduate vs more than high school) and incident diabetes and hypertension by heritage group. Results: Of 11 623 adult participants, 1207 (10.4%) were of Central American heritage, 1645 (14.2%) of Cuban heritage, 1021 (8.8%) of Dominican heritage, 11 623 (41.3%) of Mexican heritage, 1801 (15.5%) of Puerto Rican heritage, and 795 (6.8%) of South American heritage. The mean (SE) age of all participants was 43.1 (0.3) years, and 7345 (56.3%) were female. A total of 8697 (71.4%) were born outside the US, 4358 (32.5%) had less than a high school education, and 7475 (58.3%) were less acculturated (SASH score less than 2). Incident rates of diabetes (total cohort, 14.6% [95% CI, 13.6%-15.6%]) and hypertension (total cohort, 20.4% [95% CI, 19.0%-21.9%]) varied across heritages; Mexican individuals (17.2% [95% CI, 15.5%-19.0%]) had the highest diabetes incidence and Dominican individuals the highest hypertension incidence (27.1% [95% CI, 22.7%-31.4%]). Persons with more educational attainment were at lower risk for diabetes and hypertension independent of acculturation, and more acculturated participants had a lower risk for incident diabetes. Less acculturated with lower socioeconomic status (SES) were more likely to have incident diabetes (weighted predicted probability [WPP], 0.17 [95% CI, 0.14-0.19]), and more acculturated with lower SES had the highest predicted probability of hypertension (WPP, 0.19 [95% CI, 0.15-0.23]). More acculturated with higher SES were at lower risk of diabetes (WPP, 0.11 [95% CI, 0.09-0.13]) and had a lower predicted probability of hypertension (WPP, 0.10 [95% CI, 0.08-0.12]). Conclusions and relevance: In this cohort study, the association of acculturation with health outcomes is not unidirectional and interacts with educational attainment in determining incident diabetes and hypertension. The Hispanic and Latino paradox, in which immigrants have a health advantage, is influenced by more factors than acculturation and may persist with higher educational attainment. These observations may inform prevention and treatment strategies associated with cardiometabolic health in Hispanic/Latino populations.
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  Efficacy of a Novel BCL-xL Degrader, DT2216, in Preclinical Models of JAK2-mutated Post-MPN AML

  Wang, Zhe; Skwarska, Anna; Poigaialwar, Gowri; Chaudhry, Sovira; Rodriguez-Meira, Alba; Sui, Pinpin; Olivier, Emmanuel; Jia, Yannan; Gupta, Varun; Fiskus, Warren; et al. (American Society of Hematology, 2025-03-31)

  Acute myeloid leukemia (AML) that evolves from myeloproliferative neoplasm (MPN) is known as post-MPN AML. Current treatments don't significantly extend survival beyond 12 months. BCL-xL has been found to be overexpressed in leucocytes from MPN patients, making it a potential therapeutic target. We investigated the role of BCL-xL in post-MPN AML and tested the efficacy of DT2216, a platelet-sparing BCL-xL proteolysis-targeting chimera (PROTAC), in preclinical models of post-MPN AML. We found that BCL2L1, the gene encoding BCL-xL, is expressed at higher levels in post-MPN AML patients compared to those with de novo AML. Single-cell multi-omics analysis revealed that leukemia cells harboring both MPN-driver and TP53 mutations exhibited higher BCL2L1 expression, elevated scores for leukemia stem cell, megakaryocyte development, and erythroid progenitor than wild-type cells. BH3 profiling confirmed a strong dependence on BCL-xL in post-MPN AML cells. DT2216 alone, or in combination with standard AML/MPN therapies, effectively degraded BCL-xL, reduced the apoptotic threshold, and induced apoptosis in post-MPN AML cells. DT2216 effectively eliminated viable cells in JAK2-mutant AML cell lines, induced pluripotent stem cell-derived hematopoietic progenitor cells (iPSC-HPCs), primary samples, and reduced tumor burden in cell line-derived xenograft model in vivo by degrading BCL-xL. DT2216, either as a single agent or in combination with azacytidine, effectively inhibited the clonogenic potential of CD34+ leukemia cells from post-MPN AML patients. In summary, our data indicate that the survival of post-MPN AML is BCL-xL dependent, and DT2216 may offer therapeutic advantage in this high-risk leukemia subset with limited treatment options.

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