Case: Dysplasia surveillance is an important aspect of management in inflammatory bowel disease (IBD). A variety of lesions can be identified on surveillance biopsies, including serrated epithelial change (SEC). In this report, we aim to raise awareness about SEC and discuss its implications in IBD patients. Case 1: A 76 -year-old female with left sided ulcerative colitis (UC) on Adalimumab underwent a colonoscopy which revealed a flat 1 cm rectal polyp. Remainder of the colon was endoscopically normal and biopsies showed quiescent colitis, however polyp returned as SEC. Case 2: A 64 -year-old male with UC on Infliximab and a history of low grade dysplasia (LGD) on 2 previous surveillance colonoscopies presented for colonoscopy with chromoendoscopy. Previous area of dysplasia was biopsied and showed SEC with LGD. Remainder of colonic biopsies showed quiescent disease. Discussion: In accordance with established guidelines, patients with IBD are recommended to have regular colonoscopies every 1 to 2 years for dysplasia surveillance. Our patient in Case 2 had LGD for several years before SEC was seen, which raised the question of the importance of SEC and its dysplastic potential. While traditional serrated adenomas (TSA) and sessile serrated polyps are commonly seen in both IBD and non-IBD patients, SEC is a distinct entity that has only been described in patients with IBD. It has also been termed hyperplastic-like change and flat serrated change. There is no standardized endoscopic appearance of SEC. Histologically, SECs have crypt distortion and loss of perpendicular orientation of crypts with no typical features of dysplasia. Review of the current literature demonstrates differing opinions on the dysplasia risk associated with SEC. Brcic et al identified mutations in KRAS and BRAF genes in several serrated lesions, that were not seen in mucosa with SEC, implying that the neoplastic potential is comparatively lower in SEC. However, a separate study of serrated lesions identified evidence of aneuploidy that was present in TSA and SEC samples suggesting that there may be an association with neoplasia on a molecular level. From a clinical perspective, in 1 study of patients with SEC, 21% developed dysplasia over the observed 8-year period, suggesting a possible association between SEC and dysplasia, albeit not a causative one. A more recent case controlled study of 196 patients showed that in UC patients with SEC, the rate of metachronous/synchronous neoplasia was 26.5% compared with 3.1% in UC patients without SEC. High grade dyplasia was also seen more commonly in patients with UC and SEC (11.2%) compared with 2% in UC patients with SEC. This study concluded that due to this association, close attention should be paid on subsequent surveillance colonoscopies to patients with SEC. Conclusion: Ultimately, further controlled studies and prospective trials are needed to assess the true impact of SEC as a risk factor for dysplasia. This is still an under-recognized entity and the associations that have been noted in the recent studies suggest that closer endoscopic follow up may be necessary when SEC is revealed on surveillance biopsies.

Introduction: Hepatic Sinusoidal Obstruction Syndrome (Veno-Occlusive Disease) is a rare life-threatening complication of hematopoietic stem cell transplant (HSCT) caused by damage to sinusoidal endothelial cells. SOS most commonly occurs within 21 days of HSCT and has a high mortality. Early identification of high-risk patients with severe disease is of utmost importance and clinicians should be aware of risk factors and management. Case Description/Methods: A 58 year-old female with history of NASH and myelodysplastic syndrome s/p pre-conditioning with busulfan/fludarabine and allogenic HSCT (CMV serostatus +/+) complicated by graft-versus-host disease (GVHD) involving the skin (biopsy confirmed) and liver (no biopsy confirmation) presented D75 post-HSCT with weight gain and anasarca. Physical exam was notable for ascites and lower extremity pitting edema without jaundice, abdominal tenderness or organomegaly. Patient’s medications included prednisone and tacrolimus. Laboratory work-up revealed ALT 31[0-35U/L], AST 25[0-35U/L], Alk Phos 111[35-105U/L], T.Bili 0.5[0-1.2mg/dL], Creatinine 1.29[0.51-0.95mg/dL] and Albumin 3.1[3.5-5.2g/dL]. CMV PCR was undetectable, Tacrolimus level 8.9ng/mL, Ferritin 111[10-120ng/mL], SMA 12[0-19U], and AMA 2.0[0-24.9U]. Patient was HAV immune, non-HBV immune without active Hepatitis B and negative for HCV antibody. Diagnostic paracentesis revealed albumin < 1.0 g/dL, protein 1.7 g/dL and 15 nucleated cells. SAAG was >1.1. A transjugular liver biopsy with pressure measurements revealed HVPG of 14mmHg and pathology findings of acute venous outflow obstruction with central hemorrhage and fibrotic terminal hepatic venules (Figure 1). Patient was started on defibrotide infusion. Discussion: SOS is a life threatening complication of HSCT occurring classically within 21 days of transplant with a high mortality rate (80%) in severe cases. Damage to the sinusoidal epithelium causes portal hypertension. Risk factors include pre-transplant factors, transplant factors, and medications. Defibrotide is the only FDA-approved treatment for SOS. Our case highlights a difficult diagnosis of late-onset (D75 post-HSCT) SOS given concurrent history of NASH and GVHD, ultimately diagnosed with a liver biopsy. Our patient lacked some common signs and symptoms, such as painful hepatomegaly, hyperbilirubinemia, and ascites with high total protein which make up the diagnostic criteria (Table 1). Understanding the risk factors and clinical manifestations can assist in diagnosis and management.Figure 1.: Sinusoidal Obstructive Syndrome (Veno-Occlusive Disease). A. Early stage with pronounced centrilobular congestion and sinusoidal dilatation consistent with acute venous outflow obstruction (normal portal tract lower right). B. With progression, the central veins become completely obliterated by fibrous tissue.Table 1.: Criteria for SOS diagnosis, adapted from European Society for Blood and Marrow Transplantation revised diagnostic criteria for classical and late-onset hepatic SOS.

We hear from Jean Filtness, headteacher of Mengham Junior School in Hampshire, and Dr Neil Saunders, an education researcher, about their year-long project to implement an action research approach to leadership learning at the school

We argue that by conducting systematic research with communities rather than on communities, community-based research (CBR) methods can both advance the study of human interaction and strengthen public understanding and appreciation of social sciences. CBR, among other methods, can also address social scientists’ ethical and social commitments. We recap the history of calls by leading sociologists for rigorous, empirical, community-engaged research. We introduce CBR methods as empirically grounded methods for conducting social research with social actors. We define terms and describe the range of methods that we include in the umbrella term, “community-based research.” After providing exemplars of community-based research, we review CBR’s advantages and challenges. We, next, summarize an intervention that we undertook as members of the Publication Committee of the URBAN Research Network’s Sociology section in which the committee developed and disseminated guidelines for peer review of community-based research. We also share initial responses from journal editors. In the conclusion, we revisit the potential of community-based research and note the consequences of neglecting community-based research traditions.

In building public support for social change, activists in communities of color routinely approach broader audiences via news media. Communities of color, however, routinely face disparities that limit their access to media including local news media outlets. This lack of access mirrors inequalities in political, social, and economic arenas and can slow public awareness campaigns to address disparities in health, environmental, and other quality-of-life issues. I describe two community-based collaborative action research studies that documented and challenged how local television newscasts underrepresented and misrepresented three communities of color in Boston. The linkage between communication rights and campaigns to address quality-of-life issues is presented, as well as unresolved challenges in the collaborative research process. The study has implications for environmental health campaigns.

Despite their documented successes, permanent supportive housing programs have not received adequate funding at federal or state levels. Building public will to fund permanent supportive housing, therefore, becomes the order of the day. Drawing on the work of the Rhode Island Coalition for the Homeless (RICH), the authors describe how RICH, housing advocates, activists representing the homeless and formerly homeless, and other allies forged an inclusive, multiconstituency network. This coalition went on to reverse state cuts in the highly effective Neighborhood Opportunities Program, which had built more than 1,000 units of well-received affordable housing including permanent supportive housing units.

SYR 2013 Accepted Poster abstracts