Research

To combat and prevent disease, we must first understand it. With fully equipped labs at our disposal, TouroCOM faculty are hard at work, doing innovative medical and educational research. 

Research Leadership

Current Research

Current Projects

We’re working to improve the health and lives of all people and communities.

TouroCOM researchers are currently involved in a variety of projects that will help us better understand disease, add to the foundation of medical knowledge, and improve the delivery of medical care in order to provide the best possible patient care. 

In addition to advancing medical education, current laboratory research projects of the faculty include:

Kamilah Ali, PhD

Research Interest- apolipoprotein effects on atherosclerosis, lipoprotein oxidative stress and macrophage inflammation, diabetic atherosclerotic mechanistic pathways.

Project 1 –

  1. Investigate the role of apolipoprotein D in the development of atherosclerosis via lipoprotein oxidative stress and macrophage inflammation dysfunction.
  2. Determine the molecular pathway(s) for sexual dysmorphism in our atherogenic animal model.

Project 2  Collaboration with NYU Langone Medical School- Drs. Ed Fisher and Ira Goldberg

  1. Determine mechanism why diabetic females are more susceptible to cardiovascular diseases despite the use of statins with the use of a novel diabetic-atherogenic mouse model. American Heart Associate funded SFRN grant.

 

Maysa Azzeh, PhD

Research projects

Project 1 - The influence of host cellular kinases on human cytomegalovirus HCMV assembly events in the infected cell.

HCMV is an important human pathogen, particularly during pregnancy, in the newborn and in immunocompromised subjects. My investigations has demonstrated that the integrity of the viral assembly complex is dependent on several cellular kinases that play a major role in complementing activities of the viral kinase if absent, during assembly. My current research studies aim to identify the specific breakdown of those activities and the specific cellular kinases associated with them.

Project 2 - Genetic epidemiology surveys and worldwide distribution of viral genotypes.

Genotyping, analyzing mutations and drug resistance, as well as vaccine efficacy (if a vaccine is available) employing tools from epidemiology, molecular biology, and bioinformatics, are essential research studies for identifying the footprints of the microbes affecting us. Specific viral genotypes circulating in specific regions, among understudied populations, world distribution of viruses, mutations associated with drug resistance and/or severity of diseases caused by the infection, and vaccine response, are in the focus of my research, especially in regard to hepatitis viruses HBV and HCV, respiratory tract viruses such as Influenza viruses and Adenoviruses. Under the current circumstance this part of my research interest expands to SARS-CoV2.

 

Kurt Degenhardt, PhD

Potentiation of osteosarcoma by puberty related steroid hormones

The onset of osteosarcoma coincides with puberty. The steroid hormones testosterone and estradiol upsurge and stimulate bone growth during this same time frame.  It seems likely that the growth stimulation influences osteosarcoma tumor formation.  To explore the effects of puberty related steroid hormones that stimulate bone growth on osteosarcoma tumor growth and metastasis we initiated subcutaneous tumors using osteosarcoma cell lines in castrated nude mice.  The cell lines are estrogen receptor (ER) positive or androgen receptor positive (AR).  The mice were implanted with slow dissolve pellets that dose the mice with estradiol or testosterone.  Tumor growth was compared to the growth of the tumors in untreated castrated nude mice. 

We demonstrated that slow growing tumors grew faster in the presence of estradiol and in the presence of testosterone.  Next we showed that the testosterone potentiates metastasis by osteosarcoma cells that have the ability to metastasize.  The increased rate of metastasis correlated with increased morbidity.

Current Projects

Project 1 - Increased tumor growth is reversed by pharmacologic inhibition of testosterone. 

Our data suggests that enzalutamide, a direct inhibitor of testosterone, may be useful to slow tumor growth in patients diagnosed with osteosarcoma until surgical removal of the tumor.  To test the premise that enzalutamide will reverse the tumor growth accelerated by testosterone, we had custom slow release enzalutamide pellets made to co-implant with testosterone pellets.  Tumor growth rates are currently being assessed in a subcutaneous tumor growth mouse model system.   Tumor growth is assessed in mice treated with testosterone, enzalutamide, both testosterone and enzalutamide, or untreated. 

Project 2 - Increased tumor metastasis is reversed by pharmacologic inhibition of testosterone. 

Our results suggest that the puberty related hormones potentiate metastasis and that enzalutamide a direct inhibitor of testosterone may be useful to slow metastasis in patients diagnosed with osteosarcoma until surgical removal of the tumor.  Metastatic osteosarcoma has higher morbidity than localized osteosarcoma thus inhibition of metastasis will save lives. To test the premise that enzalutamide will reverse the tumor metastsasis accelerated by testosterone, we will use slow release enzalutamide pellets made to co-implant with testosterone pellets.  We use osteosarcoma cells that express luciferase, an oxidative enzyme that produce bioluminescence, to study metastasis by injecting the cells intravenously into castrated nude mice. We will use whole animal imaging to assess metastasis.  There is a direct correlation between tumor mass and the quantity of bioluminescence produced.  We are currently testing if enzalutamide will reverse the effects of testosterone by assessing metaastasis in mice treated with testosterone, enzalutamide, both testosterone and enzalutamide, or untreated. 

Data from this projects will be used to generate a grant application to be submitted to NIH NCI.

 

Michael Papetti, PhD

Research Interests - Our research primarily investigates how cells are programmed to adopt a normal state of differentiation and how this programming is disrupted in cancer, particularly at early stages when therapeutic interventions are most effective. We mostly study these processes in the colon, where changes in gene expression drive proliferative, uncommitted intestinal stem cells to mature into functional, growth arrested effector cells. For this maturation process to occur, stem cells must migrate from the crypt base toward the lumen, and disruption of this migration can contribute to tumorigenesis. Therefore, we hypothesize that aberrant expression of genes critical to cytoskeletal protein contractility and motility may be early events that can impair migration, prevent normal differentiation, and promote tumorigenesis of colon epithelial cells and that reversal of this misregulation can prevent colon cancer development.

Project 1 – Role of tropomyosin 4 gene misregualtion in colon epithelial cell premalignancy

Tropomyosin 4 (TPM4) is a protein that interacts with nonmuscle myosin and has been implicated in regulating nonmuscle cell motility. The role of TPM4 in colon epithelial cells is unknown. We have shown that tropomyosin 4 (TPM4) is upregulated at the RNA and protein levels in flat mucosa of FAP (versus non-FAP) human colon tissue in vivo as well as in proliferating, undifferentiated (relative to growth arrested, differentiating) colon epithelial cells in vitro. Therefore, we hypothesize that misregulation of TPM4 expression in colon epithelial cells may result in progression to a premalignant state, possibly by affecting cell migration. We are focused on 1) identifying a promoter region responsible for TPM4 gene regulation in order to define the transcriptional mechanisms responsible for TPM4 expression and 2) determining whether aberrant TPM4 expression in tumorigenic colon epithelial cells disrupts colon cell migration.

Project 2 - Role of calcium and vitamin D in suppression of colorectal tumor cell growth   

Colorectal cancer, the second leading cause of cancer deaths in the United States and Europe, is greatly influenced by nutrient intake. Many studies show that supplemental calcium and vitamin D can protect from colorectal tumor progression, but the mechanisms are unclear. We hypothesize that the documented ability of supplemental calcium and vitamin D to inhibit proliferation and prevent malignant progression of colon epithelial cells may be due to their ability to reverse a block to cytoskeletal contractility and cell migration induced by aberrant expression of migration-specific genes. Our experiments are aimed at 1) determining whether treatment with 1,25 dihydroxyvitamin D3 reverses an abnormal expression pattern of contractility- and migration-specific genes in tumorigenic colon epithelial cells and 2) determining whether regulation of these target genes by ligand-bound vitamin D receptor and associated nuclear proteins modulates colon epithelial cell contractility and motility. These studies will elucidate mechanisms by which calcium and vitamin D can suppress a premalignant state.

Project 3 - Time-lapse video microscopy of cultured cells

Another aspect of our research involves observing and measuring physiological processes, including migration, in live cultured cells using a simple, low-cost (<$500) time-lapse video microscopy device that we constructed. Using this device, we have observed migration of live colon epithelial cells individually in isolation as well as collectively in sheets. Ongoing efforts are aimed at observing dynamics of individual molecules in live cultured cells by modifying our existing time-lapse video device, which currently utilizes phase-contrast optics, to accommodate fluorescence microscopy.

These studies will identify novel early molecular aberrations that may contribute to adoption of a premalignant state in colon epithelial cells. Other recent efforts, which are focused on determining whether certain antigens are released from colon tumor cells into the circulation and can be used as biomarkers for colon cancer, will facilitate early stage colon cancer detection. Because therapies are more effective if they target premalignant, rather than malignant, abnormalities, our investigations will contribute to reducing the morbidity and mortality associated with colon cancer, and they will identify approaches to prevent disease and maintain normal colon homeostasis. 

 

Stacey Fanning, PhD

Research Interests: Immunotherapy and hematopoietic cell transplantation for hematopoietic malignancy; immune reconstitution; serum cytokine changes in disease states.

TouroCOM projects:

Project 1 - The Relationship Between Prenatal Stress, Microbiome Composition, and Immune Development in Offspring (2017-ongoing, paused)

The ultimate goal of this project is to determine whether prenatal stress results in a preponderance of allergic disease in offspring. Specifically, this study aims to explore the gut and vaginal microbiome as a putative pathway through which aberrant immune development occurs. Stress has been shown to alter the composition of gut and vaginal microbiomes, or “normal” bacteria which reside in the bodies of mammals. These bacteria not only help their hosts digest and absorb nutrients, but are also important for the proper development of the host immune system. A mammal’s gut is colonized by bacteria from its mother’s vaginal canal during delivery. Thus, it follows that if a mammal is stressed in pregnancy and its vaginal microbiome changes, its offspring will inherit an altered microbiome. This new microbiome may be lacking in bacterial species key to proper immune development. From here it is reasonable to conclude that offspring who inherit a maladaptive microbiome will have an improperly “trained” immune system and may thus respond inappropriately to various threats, as is the case in allergic disease. Pregnant mice will be exposed to a variety of stressors throughout the first, second, or third trimester of pregnancy. Gut and vaginal microbiomes of the mother, as well as gut microbiomes inherited by offspring will be assessed via 16S RNA sequencing. Following weaning, offspring immune functioning will be assessed via cytokine assays, flow cytometry, and antigen response following sensitization.

Project 2 -  Correlation of Non-Cognitive Skills Assessment in 1st and 2nd year Medical Students with the CASPer® SJT

While academic metrics have long been the standard for assessing admission to medical school, these metrics may fail to correlate with non-cognitive skills that also translate into successful doctor/patient relationships. For this reason, many medical schools have transitioned to a more holistic approach in the admissions process, weighing non-cognitive skills such as communication, professionalism and empathy on par with cognitive skills. However, commonly used tools to assess personal characteristics, such as recommendation letters and in-person interviews have been found to be unreliable. Situational Judgment Tests (SJTs) have more recently been incorporated into many medical school’s holistic assessment of candidates. CASPer® has recently become a popular SJT for use in medical school admissions. However, it is not yet clear if these assessments translate to student success in medical school and future clinical practice. Clinical skills courses, which include Objective Structured Clinical Exams (OSCEs) with standardized patients, and practical-based OMM exams, can be used to help assess whether SJTs at the time of admission can predict performance on these non-cognitive evaluations. The objective of this study is to determine if osteopathic medical school admissions variables, such as situational judgement test scores, correlate with clinical skills course performance outcomes in the 1st and 2nd year of medical school. The CASPer® test is an online, SJT that aims to measure personal characteristics such as ethics, empathy, humanism, communication, and professionalism through a series of short video and word-based scenarios with timed open-ended questions. The CASPer® test was added as an admissions requirement for the 2018-2019 admissions cycle. Candidates for the DO program who qualified for a secondary application were required to take the CASPer® test. Scores were submitted directly to the TouroCOM Admissions department, however invitation to interview and admissions decisions were made independent of the CASPer® score. Data regarding performance outcomes of students in their 1st and 2nd year clinical skills and OMM courses will be collected. Performance outcomes will include overall course performance, interpersonal and communication rubric scores as assessed by exam proctors during OSCEs and OMM practical exams, and evaluations completed by standardized patients following the encounters. Correlation of non-cognitive skills evaluated throughout these courses with performance on the CASPer® SJT will be assessed. 

Projects done in collaboration with Hackensack UMC:

Project 3 -  Analysis of Immune Repertoire in Patients undergoing Extracorporeal Photopheresis for the Treatment of Chronic GVHD 

Allogeneic stem cell transplantation for the treatment of hematologic malignancies continues to be plagued by complications such as chronic graft-versus-host disease (cGVHD), which can occur in upwards of 50% of patients. Standard therapy involves corticosteroid administration, which is not always effective and impedes the patient’s return to a completely competent immune system, thus increasing the risk of infectious complications. Extracorporeal photopheresis (ECP) has been successfully used to abate cGVHD symptoms in many patients. The effect this therapy has on lymphocyte subsets in the reconstituting immune compartment has yet to be ascertained. In the present study, we used flow cytometric analysis to examine lymphocyte subsets in patients undergoing ECP for the treatment of cGVHD. Peripheral blood was collected from patients prior to starting ECP and after 90 days of treatment. CD4+ T cell populations were analyzed for expression of CD45RA and CCR7 to classify naïve (RA+, CCR7+), central memory (TCM; RA-, CCR7+), effector memory (TEM; RA-, CCR7-), and terminally differentiated effector memory (TEMRA; RA+, CCR7-) T cells. Initial data supports previous studies which show that all CD4+ T cell populations analyzed are altered in cGVHD patients compared to healthy controls. In particular, CD4+ TCM and naïve cells were decreased in cGVHD patients, while CD4+ TEM and TEMRA were elevated in these patients. Analysis of the same subsets in cGVHD patients after 90 days of ECP treatment revealed an increase in CD4+ TCM, while CD4+ TEMRA were decreased during the same time frame. This data supports the role of ECP in the normalization of CD4+ T cell populations in cGVHD patients. We are currently expanding our patient population to confirm early results. In addition, we will incorporate other markers of T cell exhaustion such as CTLA-4 and PD-1.

Project 4 -  Multiplex Serum Cytokine Analysis in Patients Undergoing Autologous Stem Cell Transplantation for the Treatment of Multiple Myeloma

Autologous stem cell transplant (ASCT) following high dose chemotherapy is a common indication for hematopoietic malignancies including recurrent lymphoma, leukemia, and multiple myeloma. Engraftment syndrome (ES) is a complication of ASCT that presents with clinical similarities to graft-versus-host disease, the main complication of allogeneic SCT, and thus, ES has also been referred to as autologous GVHD. The procedure for ASCT involves the mobilization and collection of stem cells from the patient by leukapheresis and reinfusion of these cells after the administration of high dose chemotherapy. Several studies have looked for risk factors associated with the development of ES. Higher incidence is associated with certain malignancies with highest incidences reported with autotransplants for breast cancer and lymphomas other than Hodgkins lymphoma. Pretransplant conditioning has also been recently implicated with reports suggesting G-CSF treatment is associated with higher risk. Pre-collection exposure to cyclophosphamide or immunomodulatory agents has also been shown to impact the development of ES. Further elucidating the risk factors contributing to the development of ES will be crucial to decreasing ES-related deaths. This study aims to analyze the cytokine composition of the grafted cellular product as well as serum cytokine levels in patients undergoing ASCT for the treatment of Multiple Myeloma. Cytokines were analyzed in the apheresis product, as well as patient serum 1-2 days pre-transplant, 12 days post-transplant, and 2-4 months post-transplant using the Luminex xMAP multiplex cytokine platform.

Project 5 -  Immune Analysis Post-ASCT in the Presence of Checkpoint Inhibitor Double Therapy in Patients with High-Risk Multiple Myeloma

Multiple myeloma (MM) is a hematological malignancy characterized by the uncontrolled growth of clonal plasma cells. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is now standard of care for newly diagnosed MM patients with improved outcomes. However, high-risk MM patients relapse after 1 to 2 years post-ASCT. Immune checkpoint blockade using nivolumab (Nivo), an anti-PD1 monoclonal antibody or ipilimumab (Ipi), an anti-CTLA4 monoclonal antibody, as single agents have achieved durable responses in patients with advanced solid tumors. In a murine melanoma model, Nivo or Ipi monotherapy partially reduced tumor burden, whereas combined Nivo+Ipi therapy eliminated tumor burden. In patients with advanced cancers such as melanoma and non-small lung cancer, combined Nivo+Ipi resulted in superior clinical efficacy compared to patients treated with single agents. Since Nivo monotherapy did not show an objective response rate in relapsed/refractory MM patients, we hypothesized that high-risk MM patients treated with consolidation therapy consisting of Nivo+Ipi post-ASCT would achieve a more durable response and improve progression-free survival. While the primary objective of the clinical trial focused on safety and efficacy, this project focuses on the secondary objective of blood immunological characterization in patients undergoing double therapy. In particular, we focused on Regulatory (Treg), Effector Memory (EM) and Central Memory (CM) T cell compartments, as well as Myeloid-Derived Stem Cells (MDSC) by multi-parametric flow cytometry. In addition, plasma cytokine profiles for IL-10, TNF-a;, IL-6, IFN-g;, IL-12, IL-2, MCP-1, IL-4, and IL-1a were assessed by Luminex platform. 

 

Piotr B. Kozlowski, MD, PhD, FCAP

Research Interests: Dr. Kozlowski research is primarily focused on microglia and neurodegeneration in Alzheimer disease and in normal aging. Microglia are recognized as specialized resident population of macrophage-like cells with the multitude of roles and functions within the parenchyma of the brain. Microglia are quite hererogenous in terms of function, appearance, motility and mobility. Microglia colonizes the central nervous system very early in development, within the first few weeks of pregnancy, and remain in close vicinity to neurons and like neurons remain as permanent resident cells of the CNS for the rest of life of the brain. The turnover of the microglial cells is considered minimal but damaged microglial cells may be replaced from the pool of circulated monocytic blood cells. One example of such damage and replacement recruitment is HIV infection (microglia are cells where HIV replicates and eventually is destroyed by virus) where massive loss of original CNS microglial cells is followed by replacement from the blood cells. There is a clinical entity called HIV Associated Dementia (HAD) that is often present in HIV patients, even in those treated with effective antiretroviral therapy and with undetectable level of HIV in the brain. The loss of the microglial cell is also documented in the most common form of dementia, in Alzheimer disease, and in other neurodegenerative CNS disorders.

Project 1 – A Microglia in Alzheimer disease, dementias, normal aging and in brain development; and B - Immunopathology and early immunological markers of microglia and brain macrophages. .

The general research question is whether the blood borne cells replacing original resident microglial cells are equipped with the same abilities and set of functionalities as original resident microglial cells. The problem with identifying resident versus replacement blood-borne cells in the tissue is that we do not have reliable identifying markers to differentiate those cells. Our research is now focused on evaluating existing immunohistochemical markers in a variety of developmetal and neurodegenerative conditions and on search of new markers, beginning with early differentiation markers of the monocytic/macrophage cell lineage.

 

Mikhail Volokitin MD, DO.

Research Interests: Clinical OMM Research: Application of Osteopathic Principles, Philosophy and Osteopathic Manipulative Treatment in clinical situations.

Project 1 - Correlation of prolonged sitting with sacral somatic dysfunction and low back pain.

Contemporary medical students must spend most of their time in sedentary position at labs and lecture halls, libraries and study rooms, sitting in the car driving to and from the school campus, studying at home, and reading or relaxing on the couch watching TV. In this study investigators accessed through survey the total sitting time of preclinical OMS and self-reported presence of LBP; and through osteopathic examination diagnosed the existing sacral somatic dysfunction.

This research study was approved by the Touro HSIRB. First and second year Touro COM students were solicited for this study after class lectures and during biweekly student-run OMM clinic sessions on the Touro COM Harlem campus. Students voluntarily agreed to participate by completing a self-reported questionnaire on low back pain, with the additional option of having a structural sacral exam done after completion of the survey. 125 students completed the questionnaire only; 75 students completed the questionnaire in addition to having a structural exam. The questionnaire began by asking participants about their demographic information, avoiding direct participant identifiers. It was divided into a section on back pain history, present back pain, and exercise and conditioning. Participants commented on topics including provocation and palliation of their back pain if any, quantified hours seated on average in a day, and if they took breaks to get up from sitting while over the course of their study time, rated their core strength and commented on any exercises they regularly participated in.

For those participants who agreed to a sacral structural exam, after completion of the questionnaire, two student investigators screened participants for sacral somatic dysfunction. A third student investigator and/or the faculty advisor was available if needed to address any discrepancy in physical exam findings, i.e.: positive vs. negative lumbosacral spring test, in consideration of possible interexaminer unreliability with sacral somatic dysfunction diagnosis. The physical examination included quality of participants’ curvature of their spine, leg length, seated flexion test, lumbosacral spring test, and finally sacral and 5th lumbar vertebrae (L5) somatic dysfunction diagnosis - the overall focus of the physical examination was the overall sacral base motion. Statistical analysis on the collected data is in progress.

Project 2 - Evaluation of Chapman’s Reflex Points, Red Reflex, and Prevertebral Ganglia Tone Among Medical Students at Touro College of Osteopathic Medicine in Harlem.

Chapman Reflex Points (CRPs), initially described by Frank Chapman, D.O. and then published by Charles Owens, D.O. in 1937, are sites within the deep fascia that produce predictable, palpable tissue texture changes in response to specific visceral problems. Drs. Chapman and Owen proposed using these points for both diagnosis and treatment of autonomic dysfunction in a wide range of cases, from otitis media to constipation. Although CRPs were discovered almost a century ago and are currently being tested on COMLEX, little research has been published to verify or further describe the presence of CRPs. This study aimed to survey OMS of the Touro College of Osteopathic Medicine in Harlem for the presence of chapman reflexes and evaluate their correlation to self-reported pathologies, as well as other tissue texture changes. 

Subjects were asked to fill out a yes/no questionnaire about a selected range of visceral pathologies pertaining to the chapman points we will be evaluating. Afterwards, subjects were evaluated by one of the investigators listed above for the presence/absence of chapman point reflexes, red reflexes, tenderness or hypertonicity around their abdominal prevertebral ganglia, and spinal somatic dysfunction. Physical exam findings were recorded on worksheets labeled with random number identifiers matching that of the survey filled out previously by the subject. Physical exam worksheets and pre-exam surveys were transcribed into spreadsheets for statistical analysis in excel and STATA. Currently statistical analysis on the collected data is in progress.

Project 3 - Assessment of Respiratory Function in Subjects with Thoracic and Rib Somatic Dysfunction before and after application of Osteopathic Manipulative Treatment. Randomized Controlled Research Study.

Extensive research has been performed demonstrating that there is a correlation between specific respiratory conditions, such as asthma, COPD, and pneumonia, and the benefits in receiving osteopathic manipulative treatment (OMT) to alleviate associated pain. It was found that performing OMT on patients dealing with these respiratory pathologies results in a significant improvement in pulmonary function tests. However, few, if any, of these studies have demonstrated the use of OMT in the treatment of solely rib and thoracic somatic dysfunctions found in the general population. Consequently, there is a lack of evidence supporting the beneficial use of OMT in clinical settings to improve the general respiratory functions and quality of life in otherwise healthy patients presenting with thoracic and rib dysfunctions. This approach, aimed at mildly symptomatic or asymptomatic population, puts specific emphasis on prevention of respiratory problems especially in consideration of COVID-19 pandemic. Our hypothesis was that participants’ respiratory function will be improved after osteopathic treatment.

Participants first filled out an anonymous survey and an informed consent form. They had also been assigned randomly into treatment or control group. They then underwent structural osteopathic examination of the ribs and thoracic spine for presence of rib/thoracic somatic dysfunction. Subjects with thoracic and rib somatic dysfunction then went to station 1 where via pulse oximeter their oxygen saturation, heart rate and respiratory rate were measured. Participants’ weight and chest circumference was also measured. After that they went to station 2 where they had their pulmonary function assessed with spirometry.  At station 3, participants then either received an appropriate to their somatic dysfunction OMM treatment or light touch as a sham treatment and after that their respiratory function was re-assessed in the same manner as before. Assignment to the treatment or control groups were made via with random number generator application.

Statistical analysis on collected data is currently in progress. Preliminary data suggests that respiratory function improved after OMT comparing with control group.

Project 4 - The Effectiveness of Osteopathic Manipulation Under Anesthesia in a Family Practice Setting.

Patients in private FP/OMM office (“Avenue J Medical Center”) who have undergone osteopathic manipulation under anesthesia (MUA) in recent years were asked a series of survey questions to assess the effectiveness of MUA in resolving their initial complaint. All properly consented participants were assigned a participant number so that stored data in the survey will have no connection to the patients’ personal information. Nonidentifying information such as age, gender, years since MUA was performed, as well as the area of the body that was manipulated were stored securely with access to investigators of this project only to study any statistical correlations. The potential benefit will be to explore the effectiveness of MUA as a procedure to supports its future use in patients with pain based on musculoskeletal etiologies in FP/OMM clinical settings. Touro COM OMS on clinical rotation in this clinic conducted telephone surveys using patients’ phone numbers provided in their medical office files at “Avenue J Medical Center”.

Project 5 – Motivation behind patients’ reasoning not to seek medical care at the Emergency Department during COVID-19 pandemic in NYC area. Online survey.

COVID-19 is a highly infectious disease caused by the SARS-CoV2 virus, in which alveolar cells in the respiratory system are destroyed. Colloquially known as the coronavirus, COVID-19 has evolved from a local outbreak to a global pandemic, resulting in varying levels of isolation orders amid the ever-increasing number of deaths worldwide. From the closure of schools and non-essential business to the curtailment of travel and large gatherings, the impact of COVID-19 in the United States is undeniable. New York has taken the undesired center stage for COVID-19 as a hotspot for infection, hospitalization, and mortality. In this maelstrom of fear and uncertainty, emergency, and urgent care visits unrelated to COVID-19 have decreased since its pandemic designation.  Concern for the potential of contracting the virus in crowded settings, adherence to shelter in place restrictions, or other similar measures may be reasons for this decline.

This project’s purpose is to learn about patient motivations during pandemic in relation to emergency care and how to create programs to better address and serve their concerns.

The survey of individuals in the state of New York using mixed methods was aimed to learn why they considered but haven't been going to the ED. Due to the restrictions of executive order “New York State on PAUSE”, OMS from Touro COM Middletown and Harlem campuses utilized an online survey platform that solely collected demographic and survey information without any identifiers. Target population was New York state residents and recruitments were done via social media of location-specific townships.  The aim for the survey was to determine if subjects had recently decided to forego going to the ED, explain their reasons for doing so as well as the decision-making process that led to the forbearance of emergency intervention. The survey consists of 15 questions and takes 10 minutes to complete. Prior to accessing the survey, participants were directed to a consent page in which the survey, its aim, and details regarding the project has been thoroughly explained. Responses were collated on a secured, password protected Google Drive folder. No participant identifiers were collected.

Project 6 - The Impact of Height on the Prevalence of Cervical Somatic Dysfunctions.

The 2010 United States census by the U.S. Census Bureau showed that the average female height was 63.50” and the average male height was 69.00”, with 66.25” as the average height of the total population. The object of this study is to investigate if deviations from average height will lead to cervical somatic dysfunctions because of taller and shorter individuals chronically looking down and up respectively.  An observational study of a medical student population in which subjects’ heights were correlated to cervical somatic dysfunctions (SD) at the levels of the atlanto-occipital junction (OA) and C3 vertebrae (C3). Data was gathered amongst OMS at Touro COM, Harlem. Diagnosis of a flexion or extension SD was diagnosed by Touro COM OMM faculty (Dr. Volokitin) at the OA and at C3. Participants’ height, age, and gender were gathered.

A higher percentage of those shorter than average (66.25”) had restrictions in flexion (looking downwards), indicating an extension SD while a higher percentage of those taller than average had restrictions in extension (looking upwards), indicating a flexion SD. Deviations in data sorted for gender can be partially explained by the average female height of 63.50” falling below and the average male height of 69.00” falling above the combined average height. Overall, height is important when assessing potential cervical somatic dysfunctions that may cause neck or head pains. Treatment modalities should incorporate targeted OMT, exercises and behavioral modifications for those prone to chronic neck positions, whether in flexion or extension, because of being taller or shorter than the national average for height, respectively. The individual approach that OMM offers can help address these tendencies, relieve potential neck pain, and provide tailored postural head and neck changes as well as exercises to reduce future occurrences of neck pain.