Charles R. Drew University of Medicine and Science

Mediterranean diet (MeDi) has been linked to lower incidence of cardiovascular and neurodegenerative diseases, and overall mortality, in several prospective studies. There is limited data, however, regarding the relationship between MeDi and stroke subtypes. We hypothesized that MeDi would be associated with lower total, ischemic, and hemorrhagic stroke incidence. The California Teachers Study is a prospective cohort study that comprises 133,477 women who were educators and administrators enrolled in 1995-1996 and followed since. We identified incident strokes using linked California state hospitalization data and national death records from 1996-2020. The MeDi adherence score (range 0-9, higher score indicating better adherence) was calculated based on participants' response to the Block food frequency questionnaire at study baseline. Multivariable Cox proportional hazard models adjusted for socio-demographic, lifestyle and vascular risk variables were constructed to assess the association (hazard ratios and 95% confidence intervals, HR 95% CI) between MeDi score and risk of stroke and its subtypes. 105,614 participants were eligible and included in the final analytic cohort (mean age 52.5 ± 13.8 years). Over the follow-up period (average follow-up time was 20.5 years), there were 4,083 incident stroke events (3,358 ischemic; 725 hemorrhagic). In fully-adjusted models for all stroke, ischemic and hemorrhagic subtypes, there was a lower risk of stroke among those with MeDi scores of 6-9 compared to those with scores of 0-2 (all stroke HR 0.82, 95% CI 0.74-0.92; ischemic HR 0.84, 95% CI 0.75 - 0.95; hemorrhagic HR 0.75, 95% CI 0.58-0.97). Adherence to the MeDi is associated with lower risk of total, ischemic, and hemorrhagic stroke incidence among women. Potential study limitations include recall bias, misclassification bias, and residual confounding, which would bias our results to the null.

Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that of the overall United States (US). To address the disproportionately high rate of CKD in Puerto Rico, we created a multidisciplinary chronic disease management (CDM) program targeting CKD and diabetes mellitus (DM), the leading CKD risk factor. Over 7200 eligible enrollees in a Puerto Rico-Managed Medicare Program participated in a CDM program targeting individuals with CKD or DM as determined by administrative review. Evaluations were conducted on 4068 program participants with baseline glomerular filtration rate (eGFR) and codifying CKD stage by eGFR. A dietitian/nurse team provided dietary and lifestyle recommendations to the patient/family and a nephrologist/endocrinologist made diabetes and CKD recommendations to the primary care provider. Findings on 2095 participants with Stages 1-3 CKD with follow-up eGFR at least 6 months but less than 2 years after baseline are presented. At baseline, the mean age was 74 years (range 30-101), 59% of patients were female and mean duration of follow-up from initial evaluation to second evaluation was 407 days (±159 days SD). Most participants had Stage 2 CKD (34.8%), followed by CKD Stage 1 and 3 (33.5 and 31.7%). During the follow-up period, 55.9% of participants with Stage 1 CKD remained in Stage 1, 84.9% of patients with Stage 2 remained in Stage 2 or regressed to Stage 1, while 96.1% of patients with Stage 3 remained in Stage 3 or regressed to Stage 2. Only 15.1% of patients in Stage 2 progressed to Stage 3 and 3.9% of patients in Stage 3 progressed to Stage 4 or 5. A secondary analysis comparing all 665 CDM Stage 3 participants to 117,249 historical controls found CDM participants demonstrated a higher rate of regression (20.3% vs. 15.2%; absolute difference +5.1 percentage points; p = <0.01) and a lower rate of progression (3.9% vs. 15.3%; absolute difference -11.4 percentage points; p < 0.001). Early findings of a multidisciplinary CDM intervention indicate that 79% of participants with CKD Stages 1-3 by eGFR had stabilized or improved CKD status. Comparison to a randomized control group to better assess for causality and longer-term CDM program follow-up on CKD status and clinical outcomes is warranted.

Across the United Sates, Latino men who have sex with men (LMSM) face disproportionately high HIV risk. Although pre-exposure prophylaxis (PrEP) effectively reduces HIV risk, numerous barriers limit PrEP access among LMSM. Culturally tailored public health campaigns provide one potential strategy for increasing access, awareness, and use of PrEP, including the newest long-acting injectable PrEP (LAI PrEP) formulations. The purpose of the study was to develop community-informed recommendations for a culturally responsive LAI PrEP awareness campaign designed for LMSM. Between June 2023 to March 2024, thirty LMSM participated in four virtual focus groups conducted in Los Angeles, CA. LMSM were recruited through a larger LMSM-centered HIV prevention intervention. In the focus groups, participants shared their perspectives on campaign messaging, imagery, tone, and accessibility. Coding reliability thematic analysis was used to analyze the data. Findings suggest that a LAI PrEP campaign for LMSM should: provide basic information about the strategy; highlight its benefits; incorporate humorous and sex-positive messaging or imagery; communicate the seriousness of HIV without stigmatizing, blaming, or scaring LMSM; incorporate important Latine cultural values; and include Latine celebrities, public figures, and everyday individuals as messengers. In addition, there were mixed opinions regarding the use of a syringe in the imagery, with some participants advocating against its use to avoid fear- and pain-based associations with injections. Finally, participants believed that a LAI PrEP campaign should be made accessible to LMSM by providing materials in both English and Spanish and placing physical advertisements in neighborhoods predominately occupied by Latine people. Our findings offer several practical recommendations for developing a LAI PrEP awareness campaign for LMSM that can be used by health departments, community-based organizations, and others. Incorporating community insights is crucial to ensure that a campaign resonates with and meets the needs of the LMSM community.

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, disproportionately affecting underserved and safety-net populations. Los Angeles County Department of Health Services (LAC-DHS) Kidney Health Workgroup has developed pragmatic population health frameworks and Expected Practices for DKD co-management with primary-care providers: pragmatic definitions of low kidney function (LKF, <50% of normal) and very low kidney function (VLKF, <25%), and proteinuria severity classification as early (>150 mg/g), heavy (>1 g/g), and massive (>7 g/g) to guide referral urgency; biopsy-agnostic diagnosis of DKD when four out of five criteria are met, including diabetes history or A1c more than 6%, LKF, proteinuria, diabetic microangiopathy, and larger kidney length (>12 cm) or faster CKD progression (>25 ml/min/year); Kidney Disease Integrated Therapy (KDIT) combining four medication categories (RAAS blockade, SGLT2 inhibitors, GLP-1 agonists, nonsteroidal mineralocorticoid antagonist) and renal nutrition and lifestyle medicine (PLADO/PLAFOND diets), adequate hydration, and exercise; and eConsults to support timely detection, dialysis vascular access placement, shared decision-making, and ESRD care coordination. The DKD management model demonstrates that resource-limited systems can deliver innovative, high-quality kidney care and provide a scalable framework for equity-focused and pragmatic kidney care in municipal health systems.

As a family medicine physician working in the primary care safety net of South Los Angeles, I (Matthew Yu) serve immigrant families, many undocumented, with deep roots in this community.I live just blocks from the now iconic image of protest in Paramount, California, where a car burned near Home Depot.While national headlines fixate on scenes of unrest, the quieter story I witness is in exam rooms and in my community, where fear, not fire, is what burns most intensely.Over the past few months, I have seen a sharp rise in distress among my patients due to targeted and unjust enforcement by US Immigration and Customs Enforcement (ICE).Community members tell of roundups, abductions based on ethnic appearance, with ICE detaining even those who have legal status.They fear what will happen to their children at school, whether their families can survive if the sole financial provider is taken, and deportation to remote locations unfamiliar to them.The fear is pervasive.The trauma is real.One patient working in the flower district of downtown Los Angeles described how unmarked vans pull up with tinted windows, and masked agents jump out."La migra!" she yells, as people scatter.Those who cannot run are grouped and taken.Friends have been detained.As they were taken away, they called out to her to reassure their families, their interlocked eyes conveying they might not see each other for years.She came to the United States at age 14 and is now in her 50s, still waiting for legal status.Her family recently gathered for Sunday dinner, and as they shared carne asada tacos, they wept over the cherished family moment that could be their last.Moments like this remind me how fragile preventive care becomes when fear dictates whether a patient dares to seek help.In clinic, fear rarely arrives with sirens and armed law enforcement.Instead, it shows up in absence with canceled visits, skipped prenatal care, and postponed surgeries.One woman seeking birth control asked for an expedited visit, not for medical reasons, but because she had an immigration court hearing later that week and did not know whether she would be detained after following proper process.Every blank space in my schedule is not just a no-show; it is continuity of care disrupted by policy.While social media debates rage over protest images, the real crisis remains largely unseen-a crisis that plays out in the quiet lives of families just trying to survive.Judicial approval of ICE detaining based on visual suspicion, racial profiling, is conducted in a callous and cruel manner.My family and I live close to the more violent protests portrayed in the news, and we do not feel unsafe; what unsettles me more is our military being deployed to neighborhoods like mine, another public fire that deepens private fear.This work has changed me.My patients speak with affection when they call me their doctor, and I love them.I recently sat with an older patient who has lived in Los Angeles with her immediate family for decades and who disclosed plans to self-deport out of fear.We cried together.And as we ended the visit, she took my hand, told me she loved me and would miss me.On my drive home that day, I reflected on my own privilege to move through public spaces without fear for my family.For her, taking multiple buses for preventative care could end in detention.I must account for these forces and expand my definition of care beyond the exam room.I am resolved to do more: to hold space in visits, to organize with colleagues, and to speak when my patients cannot. 1 Her story is not unique.Our patients without legal status raise their children with the same dreams I have for mine.Yet their human rights are being stripped away.Without protected human rights for immigrants, safe and effective delivery of health care is

Peer led team learning (PLTL) has served as a successful pedagogical innovation for decades. The more recent implementation of cyber peer lead team learning (cPLTL) has shown promise in student outcomes within the online space. This study utilized the combination of social constructivism, reflective problem-solving processes, observational learning and cognitive development frameworks to underpin the interactions between the student groups. The California Critical Thinking Disposition was adapted into a qualitative analysis rubric aimed at investigating the critical thinking development of cPLTL students. The scales were graded according to how students demonstrated their problem-solving skills as they related to the levels of explanation, interpretation, and analysis. Nested within these categories, student engagement was scored on a three-unit scale according to basic, intermediate, and advanced levels of observed problem-solving skills. The recordings of two student cPLTL groups were used in this study of approximately 7 students per group, meeting once a week for five weeks. The interpretation category showed the greatest number of codable instances among the students as well as growth areas for their problem-solving skills. Analysis was the most consistent area that was maintained throughout the recorded weeks. Explanation, the lowest critical thinking level, decreased over the weeks. These differences observed from lower ordered into higher ordered thinking provides a brief snapshot suggesting student participation in cPLTL provides growth in student problem-solving skills within the social learning environment. The influence of peer leaders emerged as an essential element in facilitating cognitive development among students, supporting Bandura’s concepts of observational learning and modeling. The implications of this work provide PLTL and cPLTL practitioners with a theoretically grounded method to qualitatively evaluate the development of problem-solving skills in collaborative online environments. However, contextual differences relating to the student online environment, issues with consistent student attendance, and the small sample size limit the generalizability of the results.

This chapter gives a brief overview of asymmetric phosphine organocatalysis. First reported in the mid-1990s, this subfield of phosphine organocatalysis includes a wide range of chiral catalysts used to carry out a variety of transformations, predominantly, annulations. Mechanistically, these reactions are characterized by the addition of the nucleophilic phosphine catalyst to an electrophilic substrate which forms a zwitterionic β-phosphonium α-carbanion species. This chapter is divided into sections based on the identity of the initial substrates and delves into an array of reaction pathways and products. The chapter concludes with a brief discussion of catalytic asymmetric (aza)-Wittig reactions.

Programmatic interventions that expose students from underrepresented backgrounds to biomedical research increases enrollment and persistence in STEM college degrees and have the potential to strengthen the research workforce. Here, we report pre- and post-participation survey data from 706 students (92% in high school) identifying from underrepresented groups in science. Most (76%) did not have prior research exposure or direct connection to biomedical research. They participated at one of eight US internship sites that collaborated to provide a common training curriculum (hands-on research, supportive mentoring, enrichment activities, and student stipends), with unique research experiences. Students reported a high satisfaction with programming (95%) and gains in each of the 14 scientific skills assessed. The most significant gains occurred in students’ attitudes towards their ability to analyze data and understand the research process. Importantly, 78% of the students reported the program positively influenced their interest in future research. These findings provide further support that engagement of underrepresented students in research during formative high school years is an effective intervention. The collaborative research training model allowed participating sites to leverage their own local expertise while engaging in adaptive programming that suited both the institution and the needs of its area high school students.