Orthopedic procedure wait times (time of consult to time of surgery) are influenced by many factors. Longer wait times are detrimental to disease progression and quality of life. Additionally, rural and urban health disparities may exist for orthopedic surgery wait times.

This study conducted a retrospective chart review of patients (n=478) who underwent hip, knee, and shoulder replacement surgeries from 2019-2024 by orthopedic surgeons employed at St. Lukes Hospital (Duluth, MN). Patients were classified as urban or rural based on home zip code (202 rural, 276 urban). Other factors investigated were type of medical insurance (commercial, Medicaid, Medicare, veteran plans, and workers’ comp), age, sex (male or female), and type of joint replacement surgery. The influence of the COVID-19 epidemic, which fell within the 5-year time frame, was also investigated as influencing wait time.

The results showed no statistical difference between urban and rural patient wait times (189 vs 203 days, p=0.484). Medicare patients had the shortest average wait time (185 days), and workers’ comp patients the longest (302 days). Age did not correlate to wait time. There was also no statistical difference between sex and wait time (p=0.877). Knee replacement patients had the longest wait time (228 days). The average wait time for patients within the Covid-impacted period (Jan. 2020 to Dec. 2021) was 243 days compared to pre-Covid wait time of 201 days and post-Covid wait time of 150 days.

Neuromuscular scoliosis (NMS) is the rapid progression of pathologic spinal curvature associated with underlying neuromuscular conditions such as cerebral palsy, muscular dystrophy, and myotonic dystrophy. Spinopelvic fixation (SPF) has been refined to address the unique challenges posed by NMS. Previous studies have reported varying rates of SPF failure from 17-74% in different patient populations, yet data specific for pediatric patients with neuromuscular scoliosis are limited. The goal of this retrospective review is to report the incidence, failure mechanisms and risk factors associated with SPFF after corrective surgery for NMS in pediatric patients. Study inclusion criteria encompassed individuals diagnosed with NMS. The primary study cohort consisted of individuals ≤21 years who underwent SPF. For each individual we collected general demographic information, mode of failure and recorded the overall rate of SPF as well as failure rate for each type and associated risk factors. Of the 82 patients eligible, 35 met inclusion who underwent NMS surgery with pelvic instrumentation. The mean SPF failure rate was 11.4% (4/35). Among the cases that experienced failure, 75% (3/4) were primary surgeries, while 25% (1/4) were revision surgeries. The two most common type of failure were screw loosening and SIJ pain 50% (2/4), respectively.

An individual's strength impacts biomechanics and force management during dynamic movements. Functional demand (FD) represents the proportion of strength used for force absorption, making it critical for movement efficiency. Understanding FD's influence on ACL injury risk is key for prevention strategies. Although an increase in FD is often linked to higher injury risk, this relationship may be more nuanced. This study investigated the relationship between quadriceps strength, knee biomechanics, and FD during single-legged drop vertical jumps (VDJ) in adolescent athletes. We hypothesized two risk groups: 1) athletes using passive alignment strategies, with lower FD and reduced shock absorption due to insufficient strength. Athletes with lower quadriceps strength, especially females, were expected to show stiffer landings and reduced knee flexion, raising ACL injury risk. 2) Athletes using active alignment strategies, with higher FD and greater shock absorption, potentially over relying on knee extensors. This framework suggests FD may be influenced by motor control strategy rather than strength alone. Athletes (13-18) underwent isokinetic strength testing and 3D motion analysis during VDJ to assess sagittal moments and FD. These findings aim to enhance injury prevention by addressing the biomechanical and strength needs of at-risk athletes through tailored interventions.

Aspartate aminotransferase (AST) is a common liver and muscle tissue enzyme that functions in amino acid metabolism. In clinical practice, AST levels are commonly measured as part of liver function tests. Elevated AST levels can lead providers to suspect liver pathology. In this case, the patient’s liver was proven healthy through an ultrasound, two MRIs, a biopsy, genetic tests, and more. From the MRIs, the patient also had focal nodular hyperplasia (FNH). FNHs are benign, regress over time, and typically do not contribute to elevated aminotransferases. AST may be elevated due to muscle tissue breakdown (e.g., exercise, heart attack, muscular dystrophy). When AST elevation is due to muscle catabolism instead of hepatopathy, creatine kinase (CK) is also elevated. The patient had rigorous workout habits, leading to elevated CK and subsequent AST. The patient’s elevated AST levels were also due to supplement overuse. The broad term “supplement” encompasses vitamins, minerals, amino acids, enzymes, and herbs that people use to fill their nutritional gaps or augment their diet. Supplements can be misused due to easy accessibility, persuading advertisements, and lack of FDA oversight. The individual in this study had a healthy liver but elevated AST levels due to strenuous exercise habits and supplement overuse. 

Non-exudative (dry) age-related macular degeneration (AMD) affects 180 million people worldwide. However, no effective treatments for this common cause of vision loss yet exist. Clusterin (CLU) is an extracellular mammalian chaperone that promotes extracellular matrix health through proteostasis, cytoprotection, and anti-inflammation. CLU accumulates within drusen, which are yellow/white retinal deposits characteristic of dry AMD. Enhancers of CLU may prevent deposition and improve clearance of drusen in the retina, thus, preventing and treating dry AMD. This study used the HiBiT protein tagging system to add a luminescent tag onto the CLU gene in an immortalized retinal pigmented epithelium (RPE) cell line (ARPE-19), thereby enabling quantification of exogenously produced clusterin protein. The edited cell line was then verified using HiBiT assays, DNA gel electrophoresis, siRNA knockdown, size-exclusion chromatography, and heat-shock trials. The assay was miniaturized to 384 well cell culture plates and verified using positive (MG132) and negative (DMSO) controls, achieving an excellent Z-Factor of 0.77. Over 3,500 small molecule compounds were dispensed across 11 plates containing the HiBiT CLU RPE cells. Twelve CLU enhancers and 47 CLU inhibitors were identified. Future studies will explore the CLU enhancing mechanisms of these compounds as well as their potential in the treatment of macular degeneration.

This research focuses on optimizing lipid nanoparticle (LNP)-based drug delivery systems for cancer therapy. Traditional chemotherapeutics face challenges, including severe side effects and drug resistance, due to non-specific targeting of cancer cells. By leveraging the self-assembling properties of lipid-based nanoparticles, such as liposomes, this study aims to enhance drug specificity, reduce systemic toxicity, and increase therapeutic efficacy. Key advancements involve optimizing components like ionizable lipids and PEGylation to improve stability, delivery efficiency, and minimize immune recognition. The research examines the mechanisms of passive and active targeting, lipid interactions, and endosomal escape for more effective therapeutic outcomes.

The University of Minnesota’s (UMN) Mobile Health Initiative (MHI) provides preventative healthcare services to underserved communities via mobile clinics. MHI-hosted events encourage community engagement and access to essential healthcare services, including cancer screening. This project focuses on improving colorectal cancer (CRC) screening rates in populations experiencing such health disparities.

MHI collaborated with UMN’s Masonic Cancer Center to secure business associate agreements with Exact Sciences for Cologuard kits and MNGI for colonoscopies. This has resulted in a workflow for CRC screening, beginning with a pilot study to assess baseline community knowledge regarding CRC administered at MHI community partnered events.

The pilot survey responses highlighted perspectives on CRC screening, guiding adjustments for further project phases. It is also through the coordination between the multi-agencies involved that the project is now at a point to be seeking IRB approval. Time was spent drafting protocols, reading literature, developing the survey, obtaining ancillary review approvals, and rectifying clarification requests.

MHI’s CRC screening initiative will assess knowledge, offer education, and provide screenings via a patient navigator. Stool testing and colonoscopies will be donated by Cologuard and MNGI. By mitigating financial and logistical barriers, the project fosters accessible care in underserved communities, supporting MHI’s commitment to health equity.

Rural communities face significant disparities in healthcare. Particularly for cancer care, there is a defined gap in the care received by rural and urban residents, with rural residents having a higher mortality rate. A few models aim to address these concerns, but little research has been dedicated to finding solutions specific to the needs and preferences of rural cancer patients. To explore this, we conducted a survey of 100 consecutive cancer patients from four rural Minnesota counties served by Lakewood Health System to gather information about the biggest barriers to their care. The counties surveyed have high poverty, limited broadband access, and high food insecurity. Of the 100 patients surveyed, 60% were 65 years or older. Our findings from the survey highlighted that in these counties, while 90% of patients under 65 classified themselves as having intermediate or higher ability to use digital devices, only 48.3% of those 65 and older identified in this category. Most patients did not frequently have issues with internet connectivity. It was concluded that older patients prefer in-person care, but are open to receiving training and education about digital platforms for healthcare. These findings revealed that older patients were opposed to digital services, such as telehealth, most likely due to lack of education on use or lack of a smart device, rather than issues with accessibility. This raises pertinent points to consider when developing future solutions.

Drug overdose continues to be a leading health concern in the United States, with different trends in rural and urban populations. MNDOSA was developed with the goal of measuring the impact of overdose on Minnesota hospitals and communities to inform prevention strategies. Data is gathered via case report forms on patients who present to the emergency department (ED) with a principal diagnosis attributed to substance misuse. For patients of special interest (those who die, are hospitalized, remain in the ED for ≥ 12 hours, have atypical clinical presentation, or are part of a suspected cluster), biological samples are tested at the state Public Health Laboratory and results are compared to substances reported by patients or suspected by physicians. MNDOSA case data from five Northeast Minnesota urban and rural hospitals was analyzed utilizing chi square tests for homogeneity in the categories of demographics (age, gender, and race), suspected substances, detected substances, discharge diagnosis, and follow-up treatment. Sites were classified as rural (<50,000 population) or urban (>50,000 population) based on location. Statistically significant differences were found in demographics, suspected substances, and follow-up treatment. Further study can help identify differential overdose prevention strategies among urban and rural populations. 

Previous research indicates that early life adversity (ELA), depressive symptoms, and exposure to cannabis during adolescence are all linked to cannabis use. However, less is known about whether these variables mediate or modify the relationship with cannabis use. An analysis of an online survey revealed that individuals exposed to cannabis before age 25, as well as those with a younger age at first exposure and higher levels of depressive symptoms, exhibited modified effects on cannabis use frequency. Specifically, younger age at first cannabis exposure and greater depressive symptoms were associated with increased cannabis use. These findings suggest a potential link between increased cannabis use frequency and early exposure to cannabis in individuals experiencing depressive symptoms. This association should be considered when developing strategies to reduce cannabis use among vulnerable populations.

Postpartum depression (PPD) is a major depressive disorder that affects mothers following childbirth, often complicating their ability to resume normal functioning. Health disparities between rural and urban communities may exacerbate PPD rates in rural areas. Common barriers in rural regions include long distances to care facilities, limited transportation options, healthcare workforce shortages, insufficient insurance coverage, restricted internet access, low health literacy, and privacy concerns. In rural Minnesota, healthcare workforce shortages pose additional challenges, as only eight percent of healthcare professionals serve the fifteen percent of the population residing in these areas. Studies have shown that delays in pregnancy and postpartum care can adversely affect maternal mental health, underscoring the potential impact of these barriers on PPD rates in rural Minnesota.

To address these gaps, this research involved developing a survey for individuals who have been pregnant within the past year, focusing on their prenatal through postpartum care experiences to better understand the specific challenges they face in accessing healthcare. Analyzing these survey responses can help fill the gaps in research around understanding PPD within rural Minnesota. Such insights could inform strategies to improve PPD prevention, detection, and treatment, helping healthcare professionals better address the unique challenges faced by mothers in rural settings.

Between 2004 and 2014, 9% of rural counties in the United States lost maternity services. 45% did not offer these services to begin with. Communities in rural, northern Minnesota have faced these difficulties, including International Falls, Deer River, and others. Many people must now travel great distances to healthcare centers like Grand Itasca Clinic and Hospital (GICH) in Grand Rapids, MN, to access obstetrical care. To provide the best care to people in these communities, this project aims to understand the impacts that community infrastructure has on rural maternity care. The overall goal of the project is to better understand the experiences of people seeking maternity care in rural, northern Minnesota. To do this, a RedCap survey was distributed to postpartum mothers at GICH. Survey questions focused on both demographics as well as experiences of the new mothers. A particular focus was placed on the community resources utilized by mothers, as well as any need they identified for aid. This study is ongoing, and data collection is still in progress. These results will be returned to the community in hopes of optimizing care by both helping people access existing resources and identifying opportunities for new resource development.

Hypertensive disorders in pregnancy (HDPs) are increasingly common and rank among the leading causes of pregnancy-related death in the United States significantly impacting maternal, fetal, and neonatal morbidity and mortality. This study aims to assess the increased incidence and prevalence of HDPs over 5 years at Aspirus St. Luke’s (ASL) in Duluth, MN. We conducted a retrospective chart review of 830 patients with HDP admitted at ASL between 5/19/19-5/31/2024. We reviewed the incidence and prevalence of HDPs, patient demographics, blood pressures recorded (at admission, highest during admission, at follow-up within the first week after delivery, 6-weeks postpartum), and prescribed interventions. We also examined some of the initiatives that are being implemented at ASL to mitigate HDP that involve raising awareness to facilitate earlier intervention in pregnancy: Blue-Band program for pregnant individuals at risk or diagnosed with HDPs who are given blue wristband to wear throughout the pregnancy and 6-weeks postpartum that indicates to healthcare professionals that they have an increased risk; Heart-to-Heart - a program that connects pregnant individuals (who have or are at risk for HDPs) with a public health nurse who provides support and education throughout pregnancy and in the postpartum period. Going forward, this research will be able to compare the rates of HPDs and their complications and the impact of earlier prevention and intervention.

During pregnancy, physiologic vascular adaptations occur in order to maintain homeostasis. Pregnancy is characterized by blunted vasoconstriction to numerous agonists and/or enhanced vasodilation, contributing to blood pressure control during a state of increased cardiac output and blood volume. In non-pregnant mice, previous studies demonstrated endothelial-dependent vasodilation in isolated aortas at low doses of acetylcholine, followed by vasoconstriction at high doses. Cholinergic vasoconstriction has not been evaluated in pregnancy and postpartum, so we hypothesized that cholinergic vasodilation would be enhanced, and acetylcholine-induced constriction would be blunted in pregnancy, with a return to normal reactivity postpartum. Thoracic aortas were isolated from pregnant, postpartum, and non-pregnant mice and mounted on wire pins in physiologic salt solution for measurement of contractile force. After constriction with the alpha-adrenergic agonist phenylephrine, aorta from pregnant mice unexpectedly showed decreased cholinergic vasodilation compared to non-pregnant, while the aorta from postpartum mice showed a return to non-pregnant cholinergic reactivity. A dose-dependent cholinergic vasoconstriction was evident in aorta from non-pregnant mice, but lacking in both pregnant and postpartum aorta. These data identify loss of cholinergic vasoconstriction as an additional vascular adaptation during and after pregnancy to maintain homeostasis in the cardiovascular system.

G protein coupled receptors are controlled by Regulators of G protein signaling (RGS) proteins. Mice globally deficient in RGS2 are more prone to a hypertensive phenotype. Studies have shown that activated T cells also contribute to hypertension. When RGS2 is knocked out of only CD4+ T cells in mice, it protects against angiotensin II-induced hypertension. We hypothesize that the antihypertensive effect is due to improved vasodilation or decreased contraction of mouse resistance arteries. Male heterozygote knockouts for RGS2, specifically in CD4+ T cells (CD4 RGS2+/-; n=5), and controls (n=6) were used. Mesenteric arteries were isolated, mounted on 40 um wires, bathed in oxygenated physiologic salt solution and challenged with a stable thromboxane analog (U46619) that vasoconstricts. Vessels were then evaluated for vasodilation using endothelial-dependent vasodilator acetylcholine and endothelin-independent vasodilator sodium nitroprusside (SNP). Results indicate that neither the vasoconstrictor response to U46619 nor the vasodilation to SNP differed in arteries isolated from CD4 RGS2+/- compared to control mice. However, endothelial-dependent dilation to low dose acetylcholine was enhanced in CD4 RGS2+/- compared to control. Our data suggests that enhanced vasodilation in resistance arteries may be mechanistic in protection against hypertension in CD4+ T cell RGS2 knockout mice, and RGS2 in T cells may be a novel therapeutic target for managing hypertension.

The objective was to describe the relationship between cardiovascular risk factors and health-related social needs (HRSN) among youth 6-17 years of age receiving care in a large, primarily rural health system. This is a cross-sectional study of patients aged 6-17 years who were eligible for a larger pragmatic cluster-randomized clinical trial who had an ambulatory clinic visit and blood pressure measurement between 8/1/2022-7/31/2023. Primary measures were the number of cardiovascular risk factors (out of five) as identified through diagnoses, problem lists and clinical data, and the number of HRSN noted (out of five) as reported in a validated questionnaire. Contingency tables and logistic regression analyses were used to quantify and test associations of cardiovascular disease risk factors and HRSN. A total of 33,192 pediatric patients (average 11.6 years, 49.6% male) were included in the analysis. Thirty-five percent of patients had one or more cardiovascular risk factors, 1,855 (11%) had only one HRSN, and 671 (4%) had two or more HRSN. Having only one HRSN was significantly associated with obesity and smoking. Having two HRSNs was associated with all cardiovascular risk factors except elevated BP/hypertension. In conclusion, this study found a high prevalence of cardiovascular risk factors, including obesity, smoking, and dyslipidemia. HRSNs were higher in patients with more cardiovascular risk factors.

Atrial Fibrillation (AF) increases stroke risk fivefold, affecting an estimated 12-16 million people in the U.S. by 2050. Many patients are asymptomatic, leading to undetected episodes and higher risks of severe events. Standard prevention uses chronic direct oral anticoagulants (DOACs), but this increases bleeding risks. Wearable technology, like smartwatches, allows for real-time AF detection, suggesting a “pill-in-pocket” approach—taking a DOAC only after AF episodes. This study evaluates if this method is as effective as continuous DOAC therapy while reducing bleeding events. A prospective, randomized, open-label, blinded endpoint trial (PROBE) will recruit adults aged 22-85 with a CHA2DS2-VASc score of 1-4 at 100 U.S. sites. Participants are randomized to smartwatch-guided DOAC therapy or continuous DOAC use, with quarterly follow-ups through the Eureka app. Recruitment at Essentia Health has screened 360 patient charts, identifying 98 eligible individuals, with 5 patients consented and 3 enrolled. The study aims to determine if a smartwatch-guided approach effectively prevents thromboembolic events and reduces bleeding risks, offering a safer, individualized strategy for AF management.

Transcatheter aortic valve replacement (TAVR) is a non-invasive percutaneous treatment for aortic stenosis. Initially, TAVR was limited to elderly patients with an increased risk of surgical aortic valve replacement. TAVR is now utilized in a broader population of low-risk patients. Given how common aortic stenosis is, with a prevalence of 29% in those older than 65 years old, it’s important to make TAVR available for all appropriate patients. This study aims to enhance TAVR utilization in an ethnically diverse population in this Northern Minnesota community. This is a retrospective review of the electronic medical records of all patients who underwent the TAVR procedure at Aspirus St. Luke's Hospital from 05/01/2019 to 4/30/2024. Of those evaluated, 383 Caucasian and 7 American Indian/Alaska Native (AI/AN) patients were identified. Data on patient demographics, risk factors (specifically smoking, diabetes, and hypertension), Society of Thoracic Surgeons operative risk score, average length of stay, and discharge status were collected. Data regarding the ethnic breakdown of Northern Minnesota was gathered at the national and state levels using national and local data. Initial analysis reveals a low number of treated AI/AN patients, consistent with the PARTNER trials, but with outcomes consistent across ethnicities. There remains room to analyze both utilization and outcomes and to raise awareness regarding TAVR—and any intervention for aortic stenosis— in the AI/AN group.

The objective of this study was to evaluate the impact of the COVID-19 pandemic on patients undergoing percutaneous coronary intervention (PCI) as treatment for coronary artery disease at St. Luke’s Hospital.

We conducted a retrospective chart review of all patients who underwent PCI at St. Luke’s Hospital between 1/1/2018 and 12/31/2021. The goal was to examine any impact associated with the COVID-19 pandemic. The population was divided into two cohorts by date of intervention, specified as the pre-COVID period (1/1/2018 to 12/31/2019) and the COVID period (1/12020 to 12/31/2021). Data was abstracted from St. Luke’s Electronic Health Record (EHR), Minnesota Immunization Information Connection (MIIC) and Wisconsin Immunization Registry (WIR). Variables analyzed include patient and PCI volumes, demographic information (gender, age, and zip code indicating rural or urban residence), length of stay from PCI to discharge, discharge status (alive or deceased), discharge destination (home, skilled nursing facility, rehabilitation center), 30-day mortality rates, and COVID-19 vaccination status.

Over the four year timeline, there were 1,681 PCI procedures performed on 1,475 patients, including 206 repeat procedures. Preliminary findings suggest decreased volume of PCI procedures during COVID compared to the pre-COVID time. Analysis of the other variables is in progress.

Patients with Lymes disease can have persisting symptoms such as cognitive difficulties, palpitations, fatigue, and musculoskeletal pain.The purpose of this study is to view the interactions between the Borrelia (Bb) and the cells in the AC16 and 3T3 cell lines using confocal microscopy. We view the interactions between Bb and the nuclei from cell lines AC16 and 3T3 by using a homogenizer to isolate the nuclei and incubate them with the Bb. We then visualize the results using GFP and DAPI. Then we use the ACD RNAscope Multiplex Fluorescent v2 Assay, which is a signal amplification system, to visualize OspC3 probes in the AC16 and 3T3 cell lines. When Bb is being transmitted to humans, it expresses the antigen OpsC3 which is a major antigen on the surface of the Bb. It is important for movement and is present in the interaction with the cells. This interaction was visualized using Cy5 which emits a color on the confocal microscope when Bb interacts with the cells. We demonstrated that the Bb do interact with the AC16 and 3T3 cell lines in addition to seeking the nuclei of those cells. The clinical relevance stems from the long-term effects of Bb and how this could exacerbate myocarditis, cardiac arrhythmias, and arthritis.

Lyme Disease is a tick-borne illness caused by Borrelia burgdorferi, a gram negative spirochete, that has been increasing in incidence over the past few decades. This disease can present acutely and lead to chronic joint, cardiac, and neurologic manifestations. Analysis of cadaveric tissue using RNA hybridization and confocal microscopy is critical to understanding the pathogen persistence in postmortem settings. This study aims to investigate the presence of B. burgdorferi within histopathologic slides from four tissue donors from the Bay Area Lyme Foundation with confirmed history of Lyme disease. Using RNA hybridization with a gene specific probe that pairs to target mRNA, we assessed FFPE tissue sections from the bladder, lymph node, liver, and spleen. This technique targets the intracellular flagellin mRNA, a key virulence factor of B. burgdorferi, to provide sensitive detection of the bacterium’s genetic material and detect its presence within the cadaveric tissue. Results are predicted to include images from confocal microscopy featuring fluorescently labeled B. burgdorferi within the slides. The proposed findings will highlight the utility of RNA-based detection methods in postmortem diagnostics of Lyme disease, hoping to offer insight into the persistence of Lyme disease infection in vivo. This study hopes to underscore the need for improved diagnostic approaches in chronic and late-stage Lyme disease and suggest RNA hybridization as a tool for future investigations.

The Seward Peninsula is a region on the western coast of Alaska that currently contains the transition zone between continuous and sporadic permafrost. This permafrost transition and other effects of climate change have already impacted local ecology, infrastructure, subsistence activities and cultural practices. Of additional concern to community members is the likely approval of two mining projects in the region, which include Graphite One, a graphite mine and IPOP, LLC., a gold dredging operation. To provide researchers with information on community context and to preliminarily investigate themes of community concern, qualitative coding analysis was applied to articles from local newspapers and Tribal corporations that discussed the mining projects. Significant axial themes of environmental disturbance, subsistence concerns, community-mining corporation relationships, and disregard for community perspectives emerged. There were also differences in the relative frequency of code application between the two mining projects. Articles related to IPOP contained more code applications related to poor community-mining project relationships, while articles related to Graphite One contained more code applications related to out-community benefit and mixed local support. These findings should not be interpreted as a true measure of community sentiment but may serve to prepare researchers with community context that could prove useful in future community-based investigations. 

Wales faces significant public health concerns due improper disposal of toxic chemicals at multiple contamination sites. Among these sites is a former military base that now houses an apartment complex. Residents there have reported an increase in skin rashes, respiratory issues, and preterm births. These complaints prompted investigation to explore the geographic extent and potential health effects of the spilled chemicals. Ultimately the aim of this project is to create a public health tool for community use to better understand and prevent symptoms of concern.

Following a literature review of chemical health effects and consultation of the Alaska Department of Environmental Contamination site database, petroleum, kerosene, and sodium hydroxide were identified as potential causes of reported skin rashes. Using GIS mapping software, a visual representation of the contamination sites was created to allow interpretation of areas of concern and interaction with local water sources. Only when a buffer zone with a 200 meter radius is applied does the chemical spill area begin to interact significantly with water bodies and community areas such as the apartment complex.

This is a positive finding for Wales however there remains the question of additional chemicals known to be present here and impact they may have. Contamination sites are extensive across Alaska and future investigations may explore similar methods to inform populations of likely health dangers.

Minnesota’s EMS systems have become increasingly stressed over the last decade, highlighting the connection to a variety of factors like an aging population and the COVID-19 pandemic driving call numbers to increase. Rural EMS agencies have become strained due to staffing shortages and limited resources. Additionally, Native American populations in rural areas face a variety of health, socioeconomic, and roadway safety factors that may complicate the quality of care Native populations receive.1 This research survey serves to evaluate and assess the intersection between rural EMS and Native American care while addressing racial disparities in EMS.2 The survey also aims to examine both assets and barriers to EMS care for rural Native populations across Minnesota. EMS workers from Grand Portage Ambulance, Mille Lacs Health System Ambulance, and Cloquet Fire Department were surveyed and their responses recorded for this project. Notable findings from the survey include the strong need for EMS funding, continuing or improving community EMS involvement, and improving cultural knowledge to help serve the needs of patients in Minnesota.

Clinical Ethics Consultations (CECs) are used to support healthcare providers approaching ethical dilemmas. The objective of this study was to detail surveyed CECs and guide the approach to future CECs at a regional healthcare system.

This was a retrospective cohort study of CECs from 4/27/22 to 4/26/24. The cases are from a Midwest regional healthcare system.

103 CECs were performed within the study period. Consultations were identified through review of the internal CEC database. Decision-making was often performed by a substitute decision-maker (N=54), occurring in 70.1% of cases with known decision makers. CECs were documented in a specific note in 37 of 82 (45.1%) patient cases. It was common for physicians to mention the ethics consultation in their patient notes, occuring in 51 of 82 (62.2%) of patient cases. Age was recorded in 92.0% (N=91) of unique cases; median age was 62 years. End-of-life care was the most common cause for consultation (N=35, 34%), and CECs were most commonly requested in general medicine departments (N=38, 45.2%). Most issues were resolved in initial consultation with the ethics call team.

Recommendations for increased frequency of policy review are given based on the results of the data presented. Interpreting the CECs in this study, we offer recommendations for use and documentation of CECs in the era of open notes, open the door towards areas of future research, and ultimately promote use of CECs for more favorable patient outcomes. 

The conditions in which people are born, live, learn, work, play, worship, and age, known as social determinants of health (SDOH), broadly affect health, function, and quality-of-life outcomes. Building a deeper understanding of individual and community perspectives about SDOH can help identify needs and inform public health policy. We surveyed a total of 198 rural and 611 urban Minnesotans at the MN State Fair and 3 rural county fairs in summer 2023, to identify community perceived importance and satisfaction related to SDOH between rural and urban communities in Minnesota. The majority of respondents indicated that affordable housing and affordable healthcare were lacking in their communities, and that available jobs do not pay enough. When queried about access to healthcare services, respondents noted that mental health and specialty care services were the least accessible, particularly in rural areas. More rural residents noted healthcare access issues, were less satisfied with healthcare service quality in their community, and expressed less trust in healthcare providers. Conversely, more urban residents reported healthcare affordability issues. A significantly greater proportion of urban residents were concerned about pollution and climate change, whereas a significantly greater proportion of rural residents were concerned about safe housing and food security. These findings clarify perspectives and can inform interventions grounded in community knowledge and wisdom.

The shortage of organ and whole body donors remains a critical issue in healthcare, with significant implications for patients awaiting life-saving transplants and advancements in medical research. Understanding an individual's motivations, attitudes and behaviors related to organ and body donation is crucial for developing strategies to address this gap, specifically in the state of Minnesota. This dataset, drawn from a sample of 1,245 respondents in both urban and rural Minnesota, captures a comprehensive range of factors that influence donor’s behaviors, including demographic data (age, gender, education level, location), donation history, and attitudes towards organ and body donation. The findings reveal that while approximately 82% of participants have considered donation, barriers such as lack of knowledge, cultural beliefs, and familial influence act as barriers that prevent individuals from choosing to donate. Insights into personal beliefs and comfort levels surrounding donation processes also became apparent, underscoring areas where targeted educational interventions could increase awareness and willingness to donate. By addressing misconceptions and emphasizing the societal and personal benefits of organ and body donation, this research can guide future efforts, by identifying key factors in the decision to donate.

Eosinophilic esophagitis(EoE) is a chronic allergic condition with esophageal inflammation. Knowledge gaps remain in the underlying mechanism of EoE. This project aims to determine the association of specific cellular phenotypes when food antigens are present in the esophageal mucosa of active EoE patients.

Six FFPE pairs from six EoE patients who responded to a six-food exclusion/elimination diet were obtained from the Tissue Registry. Tissue was subjected to Fluidigm Tissue Imaging CyTOF. The images were analyzed in Fluidigm MCD Viewer and ImageJ to calculate the sample intensity and the number of nuclei.

The density of ovalbumin (R2=.6201, P<.0001) and gliadin (R2=.6822, P<.0001) was compared to the density of EMBP in a correlation plot. Peanut, casein, and soy compared to EMBP presented R2 values of .098, .02126, and .07343, respectively, with no significant P value. Conversely, the density of peanut(R2=.5319, P<.0001), casein(R2=.2828, P=.0003), and soy(R2=.4062, P<.0001) compared to CD4 had stronger correlation than OVA(R2=.0002681, P=NS) and gliadin(R2=.01294, P=NS). Furthermore, when compared to CD8, the density of peanut(R2=.6236, P<.0001), casein(R2=.5626, P<0001), and soy(R2=.4145, P<.0001) compared to CD4 again had stronger correlation that OVA(R2=.04612, P=NS) and gliadin(R2=.01847, P=NS).

Food antigens ovalbumin and gliadin correlate strongly with EMBP and poorly with CD4 and CD8. Peanut, casein, and soy correlate strongly with CD4 and CD8 and poorly with EMBP.