Seven master’s graduates at Mount Sinai’s Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai discuss their educational journeys and how they are using their master’s degrees to explore new paths and careers in the following Q & A.
Award-Winning Research With a Top Mentor—How Denise Iliff Excelled in the Master of Science in Biomedical Science Program
“Mount Sinai is such a strong research institution, which was very important to me. The diversity of labs is really what attracted me. Also, Mount Sinai has an incredible array of faculty from virtually all areas of science that a student would want to pursue.”
How Analyzing Genetic Variants to Predict Alzheimer’s Disease Risk Put Raj Vaza on a Path to a Career as a Physician-Scientist
“… The classes are exceptional. The Machine Learning for Biomedical Data Science course I just finished was the most informative and tied together everything I’ve been learning throughout the years.”
Adina Singh Earned a Master of Public Health (MPH) Degree as a First Step Toward Addressing Health Care Disparities in Her Community
“Once I realized the health disparities among New Yorkers, particularly for minorities and immigrants, I knew I wanted to be part of the solution. That’s why I chose public health. By focusing specifically on health care management, I will be able to initiate and implement programs that people can access and also learn how to practice self-advocacy confidently when seeking care.”
Justine Marcinek Explores Occupational and Environmental Health Issues as She Gets a Master of Public Health (MPH) Degree
“I think it’s important that scientific research outcomes are translated into actionable information that people can understand, and use, to make well-informed health decisions.”
Alumna Spotlight: Erica Palladino, MPH, Is Making an Impact on Maternal Health With her Master of Public Health Degree
“I’m thankful to Mount Sinai for highlighting the importance of health literacy within maternal health and making me realize that this is one of those areas where we can really make a difference.”
A Desire to Gain New Skills in Strategy, Policy, and Patient Advocacy Led Susan Khalil, MD, to the Master of Science in Health Care Delivery Leadership Program
“I thought a master’s degree would help me develop leadership skills. The program has taught me to think in different ways, to think not just about clinical outcomes, but also about health care on a population level and about ways to innovate change in health care.”
Belle Herman Weiss, retired nurse and oldest-known alum of Mount Sinai Phillips School of Nursing (formerly Beth Israel School of Nursing)
At 106 years old, Belle Herman Weiss, RN, is thought to be the oldest living alum from the Beth Israel School of Nursing, now the Mount Sinai Phillips School of Nursing (founded in 1902), and one of the oldest living nurses in New York. Belle, who retired years ago and lives in Westchester County, fondly recalls her time in nursing school, which she began at just 16 years old—during a time when harmful diseases were widespread and difficult to treat.
“I enjoyed all the experiences I had to go through in nursing school,” says Belle, who graduated in 1936. “I loved being with a lot of other young women and having a goal to achieve.”
A good student who loved studying medicine, Belle was fascinated with figuring out patients’ diagnoses, which she compares to being a detective solving medical mysteries. “My favorite subjects were anatomy and physiology. I had a good memory and I was able to remember all the bones and their function. I enjoyed being able to recite the different parts of the body and what they did,” she says.
However, the lack of penicillin and treatments for infectious diseases in the 1930s and 1940s made nursing a challenging—and potentially dangerous—career path. She remembers contracting a skin lesion from tuberculosis at a hospital she worked in, noting she was “very lucky” it did not spread to her chest.
“It was a very difficult time, and [we were] studying at a bad time,” says Belle of being a nursing student. But she says many nurses managed to avoid infections by donning the cloth masks, rubber gloves, and gowns available at the time, and especially, routinely washing their hands. “Luckily, most of us stayed pretty healthy,” she says.
After graduating from the Beth Israel School of Nursing, Belle received a public health degree from New York University, which she says aided her when she later worked for The Willard Parker Hospital in Manhattan, where many patients had polio and were cared for in iron lungs (large horizontal machines that patients would lie in, which stimulated breathing). Medical technology in those days, she explains, was far more rudimentary and cumbersome to work with. For example, intravenous (IV) therapy—a routine therapy administered by nurses today using prepackaged components and fluids—was rarely ordered in the 1930s and 1940s. When it was, nurses had to prepare all the separate components—a glass bottle of saline, a separate rubber stopper and tubing, and a metal needle—and it was quite a process.
How were IVs given in the 1940s and 1950s? 106-year-old nurse Belle Herman Weiss explains:
First you got the IV pole. Then you went into the utility room and you got a sterilized package that contained the container that you were going to put the saline in. Then you got the connection of tubing, and then you got the needle that went with it. Then you got the saline that you had to pour into it. You had to get this glass container connected to the rubber tubing and put a stopper on the tubing so it wouldn’t leak out. Then you filled the container with the saline from a big bottle and hung it on the pole. Then you let the air run out, and then you connected the needle. Before you called a physician to get them to put the IV in, you had to wrap two hot water bottles around the container to warm the fluid to room temperature. That’s how an IV was given.
She says hospitals also lacked antibiotics. In their absence, she says doctors would order “bodily irrigations”—treatments that involved washing out the nose, eyes, ears, throat, and other orifices, in the hope it would wash away disease.
“We used to have a saying, ‘If in doubt, wash it out,’” Belle says, adding that nurses also kept patients healthy by routinely bathing them “head to toe.”
After retiring from nursing at age 70, Belle worked in a doctor’s office as an administrator until she was 92. She put her nursing degree and training to good use over her long career—working at hospitals throughout New York City, Long Island, and Westchester County, as well as on an ambulance, where she helped transport patients with communicable diseases. She says she enjoyed taking care of people, and particularly loved her pediatric patients. One little girl who died from kidney disease stands out to her the most.
“I can still picture her sometimes, walking around her little crib, and reaching out her arms for me to pick her up,” she says. “Those memories stick with me.”
While Belle enjoyed a storied nursing career—in addition to getting married in 1943 and having three children, including a daughter who is an advanced practice nurse in Westchester County—the two-and-a-half years she spent training at the Beth Israel School of Nursing are still fresh in her memory. She remembers the intensive 12-hour work schedules, and still recalls the names of many fellow students and head nurses she trained with. The nursing program was very disciplined, she says, and helped her acquire valuable experience for her nursing career.
“I did get a very good training,” remembers Belle of the Beth Israel School of Nursing. “We treated the patients with elite nursing care.”
Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.
The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.
Psychiatric and Reproductive System Disorders: Increased Odds
Nina Zaks, MS
The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.
The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.
Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”
Looking for Links in Mental Health and the Reproductive System
What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.
Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.
Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”
Polycystic Ovary Syndrome: PCOS and Depression
Magdalena Janecka, PhD
Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.
PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.
The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.
Chronic Pelvic Pain
Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.
Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”
Psychiatric Research at Mount Sinai and Beyond
Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.
The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.
The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.
“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”
Pride Month, which fell on June, was a time for celebration, reflection, and remembrance of LGBTQ+ struggles and achievements. Throughout the United States’ history, the LGBTQ+ community has faced various health challenges and inequities, from the HIV/AIDS epidemic in the 1980s to the mpox outbreak last year.
Although LGBTQ+ individuals’ access to health care has improved compared to decades prior, various health concerns and disparities remain pertinent, says Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square.
During Pride Month, Dr. Eiting and Antonio Urbina, MD, Medical Director of the Institute of Advanced Medicine, discussed health topics LGBTQ+ individuals should keep in mind, even as they celebrate the progress that has been made.
STI Testing: What’s Important?
Who should be thinking about getting tested for sexually transmitted infections (STIs)? Anyone who is sexually active should be considered for sexual health screening, although some groups may be more at risk, says Dr. Urbina.
While there is no hard rule for how often one should get tested, health providers at Mount Sinai offer screening every three months. These should include not only testing at genital sites, but also others including the throat and anal/rectal regions.
“That’s especially important because oftentimes, someone can have an STI in those compartments and they don’t have any symptoms at all,” says Dr. Urbina, “so the only way that you’re going to be able to detect them is if you actually swab or screen those areas as well.”
Common tests for gonorrhea, chlamydia, and syphilis help detect infection and initiate treatment if needed. But other important tests include those for HIV, meningococcal meningitis, and human papillomavirus for vaccination and preventive purposes, Dr. Urbina adds.
HIV: Counseling, Testing, Treatment, Management
As it is hard to know, through initial conversations, which patients might be at risk for HIV, it is incredibly important for health providers to make sure they are not using judgmental language or biases during their interactions, says Dr. Eiting.
“It’s really important for everybody to know their status,” notes Dr. Eiting.
Telling someone that they are HIV-positive when they don’t already know is probably one of the most difficult conversations to have, he adds.
It is really important for people to know that having HIV is considered by the medical community these days as a chronic disease that is oftentimes well-managed with medication, Dr. Eiting says. It is also important for them to have a support system in place so that they may transition into living their lives with the condition, since HIV isn’t the same kind of disease that it was decades ago.
It is important for people who test negative for HIV to consider the possibility of being on pre-exposure prophylaxis, or PrEP. In addition to a daily pill that can be taken, there is now a long-acting injectable PrEP that is given every two months by intramuscular injection into the buttocks.
“I think it’s all about empowering patients to taking steps that best fit their lifestyles for prevention,” says Dr. Urbina.
As a result of advancements in modern medicine, there are now people with HIV living into their 90s, and more attention needs to be placed on this elderly group. They tend to exhibit a little more physical vulnerability and frailty due to having lived with the virus for so long, says Dr. Urbina. More aggressive screening for malignancies or bone density loss are recommended too.
Mental Health and Substance-Use Disorders
LGBTQ+ people have been observed to have higher rates of psychosocial issues, including depression and substance-use disorder, and health institutions need to reach out to serve these communities better, says Dr. Urbina.
What is PrEP?
Pre-exposure prophylaxis, or PrEP, is a pill or injection that lowers the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention. Using PrEP, however, does not prevent other sexually transmitted infections (STIs).
“I think it’s important for us to sometimes take pause and take stock and remember that even though Pride Month is a month of celebration, and to acknowledge how far we’ve come, we have to remind ourselves that it can often be a time when it really enhances isolation for patients who are feeling that as well,” says Dr. Eiting.
Seeking help for mental health or addiction can be daunting for patients due to stigma. But health providers at clinics across the city, including at Mount Sinai, are being trained to make access comfortable and judgment-free, and so patients should not hesitate to tap those resources when needed, Dr. Eiting says.
Affirming Across the Entire Spectrum
Even though the L in LGBTQ+ comes first, the lesbian community can sometimes be forgotten with respect to health care, notes Dr. Eiting. It is important for health providers to be aware of things like breast cancer or cervical cancer screening for this population.
Studies suggest that some lesbian and bisexual women get less routine health screenings than their heterosexual counterparts due to various factors, including fear of discrimination or low rates of health insurance.
Transgender health care encompasses not just gender-affirming surgeries, but also primary care. For transgender patients, sometimes seeking health care can be stressful because if the conversations are not conducted in a respectful way, they can cause dysphoria.
But stigma should not get in the way of having people live their fullest lives, and transgender individuals should take stock of what their health needs are and have conversations with their doctors, says Dr. Urbina.
Given the current climate of anti-transgender sentiment and legislation across the country, health providers should acknowledge that these developments do leave an impact on their transgender patients. “It’s just important for us to acknowledge that that’s out there… and to make sure that we’re using principles of trauma-informed care whenever we’re talking to our patients about their health care,” says Dr. Eiting.
Read more about how Mount Sinai is empowering health care for LGBTQ+ communities
How to Find an LGBTQ+ Experienced Medical Provider and Why That’s Important
Clearing Misconceptions About Gender-Affirming Care for Transgender and Gender-Diverse People
Akhil Vaid, MD, left, and Girish Nadkarni, MD, MPH, right, are working to make artificial intelligence models more feasible for reading electrocardiograms, using a novel transformer neural network approach.
Electrocardiograms (ECGs) are often used by health providers to diagnose heart disease. At times, irregularities in the recordings are too subtle to be detected by human eyes but can be identified by artificial intelligence (AI).
However, most AI models for ECG analysis use a particular deep learning method called convolutional neural networks (CNNs). CNNs require large training datasets to make diagnoses, which spell limitations when it comes to rare heart diseases that do not have a wealth of data.
Researchers at the Icahn School of Medicine at Mount Sinai have developed an AI model, called HeartBEiT, for ECG analysis, which works by interpreting ECGs as language.
The model uses a transformer-based neural network, a class of network that is unlike conventional networks but does serve as a basis for popular generative language models, such as ChatGPT.
Here’s how HeartBEiT works as an artificial intelligence deep-learning model, and how it compares to CNNs.
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HeartBEiT outperformed conventional approaches in terms of diagnostic accuracy, especially at lower sample sizes. Study findings were published in npj Digital Medicine on June 6. Akhil Vaid, MD, Instructor of Data-Driven and Digital Medicine, was lead author, and Girish Nadkarni, MD, MPH, Irene and Dr. Arthur Fishberg Professor of Medicine, was senior author.
In this Q&A, Dr. Vaid discusses the impact of this new AI model on reading ECGs.
What was the motivation for your study?
Deep learning as applied to ECGs has had much success, but most deep learning studies for ECGs use convolutional neural networks, which have limitations.
Recently, the transformer class of models has assumed a position of importance. These models function by establishing relationships between parts of the data they see. Generative transformer models such as the popular ChatGPT utilize this understanding to generate plain-language text.
By using another generative image model, HeartBEiT creates representations of the ECG that may be considered “words,” and the whole ECG may be considered a single “document.” HeartBEiT understands the relationship between these words within the context of the document, and uses this understanding to perform diagnostic tasks better.
What are the implications?
Our model forms a universal starting point for any ECG-based study. When comparing our model to popular CNN architectures on diagnostic tasks, HeartBEiT ended up with equivalent performance and better explanations for the model’s thinking and choices using as little as a tenth of the data required by other approaches.
Additionally, HeartBEiT generates very specific explanations of which parts of an ECG were most responsible for pushing a model towards making a diagnosis.
What are the limitations of the study?
Pre-training the model takes a fair amount of time. However, fine-tuning it for a specific diagnosis is a very quick process that can be accomplished in a few minutes.
HeartBEiT was compared against other conventional AI methods on diagnostic measures, including left ventricular ejection fraction ≤40%, hypertrophic myopathy, and ST-elevation myocardial infarction, and was found to perform better.
How might these findings be put to use?
Deployment of this model and its derivatives into clinical practice can greatly enhance the manner in which clinicians interact with ECGs. We are no longer limited to models for commonly seen conditions, since the paradigm can be extended to nearly any pathology.
What is your plan for following up on this study?
We intend to scale up the model so that it can capture even more detail. We also intend to validate this approach externally, in places outside Mount Sinai.
Learn more about how Mount Sinai researchers and clinicians are leveraging machine learning to improve patient lives
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The annual Dubin Breast Center Fact vs. Fiction symposium provides a forum for Mount Sinai’s nationally recognized physician-researchers to share the latest breakthroughs in breast cancer care and to answer questions related to cutting-edge topics in adolescent and women’s health.
More than 160 guests attended the event on Monday, May 22, raising more than $180,000 in support of the Center. Held at the Harmonie Club in New York, the event was the most attended ever and sold out for the first time.
Leading the event were Mount Sinai Health System Trustee Eva Andersson-Dubin, MD, who founded the Center, which is part of The Tisch Cancer Institute, and Elisa Port, MD, FACS, Chief of Breast Surgery and Director of the Center.
In her opening remarks, Dr. Port emphasized the Center’s continued commitment to providing the most advanced treatment options to all patients.
“The Dubin Breast Center has become a destination in breast cancer care, not only in the city, but in the country and the world. We’re getting patients coming from all over, knowing that the care we deliver is exceptional,” she said. “It’s important to note that what really distinguishes our Center is that we don’t treat patients with breast cancer. We treat people, and we treat people regardless of the ability to pay—that’s always been part of our mission.”
Panelists from left: Amy Tiersten, MD; Christina Weltz, MD; Gylynthia E. Trotman, MD, MPH; Laurie Margolies, MD, FSBI, FACR; and Jeffrey Mechanick, MD.
Dr. Port served as moderator for the discussion with a panel of Mount Sinai experts, which included Amy Tiersten, MD; Christina Weltz, MD; Gylynthia E. Trotman, MD, MPH; Laurie Margolies, MD, FSBI, FACR; and Jeffrey Mechanick, MD. Watch the recording of the event here.
Dr. Tiersten, a renowned medical oncologist, addressed the challenges faced by women of child-bearing years with breast cancer. She pointed to exciting results of a recent clinical trial that studied 500 women aged 42 and under with Stage 1-3 breast cancer, who had been taking certain cancer-fighting medications for 18 to 30 months; these women paused their drug regimen for two years while they attempted to conceive, carry a pregnancy, and breastfeed. About 75 percent of the women in the trial had at least one pregnancy during that time, with no negative effects on their babies. Importantly, the study also found that none of the women appeared to have a higher risk of breast cancer recurrence.
That information was life-changing for Suzanne Foote, a Dubin Breast Center patient who shared her inspirational story at the event. She began regular screenings in her 20s, after learning that she has an inherited PALB2 gene mutation that carries an increased risk for developing the disease. Her mother died from breast cancer when she was only 43. Suzanne Foote was diagnosed in 2019, less than a year after marrying her husband, Mark.
“It was a tremendous shock,” she said, “which reverberated further when we realized cancer would be a hurdle in our quest to start a family.”
Thankfully, her cancer was caught early. Even so, she had a bilateral mastectomy to reduce the chance of the disease returning. Drs. Port and Tiersten also recommended that she undergo in vitro fertilization since some treatments for breast cancer, such as certain types of chemotherapy, can cause infertility. Later on, after consulting with Dr. Tiersten, she decided to take a break from therapy to get pregnant. Her twins, Peter and Josephine, were born at Mount Sinai in September of 2022.
“I was lucky to spend time with the amazing doctors at the Dubin Center. As a result of the time that they spent, here I am, enjoying the best time of my life,” she said. “JoJo and Pete are turning eight months, and I’m still healthy and cancer free.”
The Dubin Breast Center was created in 2011 to provide comprehensive, personalized care for every aspect of breast health, from prevention of disease through survivorship. It offers a full range of services—including the most advanced diagnostics and leading-edge treatments—in one convenient, state-of-the-art location. The Center is also unique for its emphasis on holistic therapies, such as massage, yoga, and meditation, which can promote healing and improve one’s overall well-being.
