Comparison of image quality and diagnostic efficacy of routine clinical lumbar spine imaging at 0.55T and 1.5/3T.

PURPOSE: To compare image quality, assess inter-reader variability, and evaluate the diagnostic efficacy of routine clinical lumbar spine sequences at 0.55T compared with those collected at 1.5/3T to assess common spine pathology. METHODS: 665 image series across 70 studies, collected at 0.55T and 1.5/3T, were assessed by two neuroradiology fellows for overall imaging quality (OIQ), artifacts, and accurate visualization of anatomical features (intervertebral discs, neural foramina, spinal cord, bone marrow, and conus / cauda equina nerve roots) using a 4-point Likert scale (1 = non-diagnostic to 4 = excellent). For the 0.55T scans, the most appropriate diagnosis(es) from a picklist of common spine pathologies was selected. The mean ± SD of all scores for all features for each sequence and reader at 0.55T and 1.5/3T were calculated. Paired t-tests (p ≤ 0.05) were used to compare ratings between field strengths. The inter-reader agreement was calculated using linear-weighted Cohen's Kappa coefficient (p ≤ 0.05). Unpaired VCG analysis for OIQ was additionally employed to represent differences between 0.55T and 1.5/3T (95 % CI). RESULTS: All sequences at 0.55T were rated as acceptable (≥2) for diagnostic use by both readers despite significantly lower scores for some compared to those at 1.5/3T. While there was low inter-reader agreement on individual scores, the agreement on the diagnosis was high, demonstrating the potential of this system for detecting routine spine pathology. CONCLUSIONS: Clinical lumbar spine imaging at 0.55T produces diagnostic-quality images demonstrating the feasibility of its use in diagnosing spinal pathology, including osteomyelitis/discitis, post-surgical changes with complications, and metastatic disease.

Maternal exercise preserves offspring cardiovascular health via oxidative regulation of the ryanodine receptor.

OBJECTIVE: The intrauterine environment during pregnancy is a critical factor in the development of obesity, diabetes, and cardiovascular disease in offspring. Maternal exercise prevents the detrimental effects of a maternal high fat diet on the metabolic health in adult offspring, but the effects of maternal exercise on offspring cardiovascular health have not been thoroughly investigated. METHODS: To determine the effects of maternal exercise on offspring cardiovascular health, female mice were fed a chow (C; 21% kcal from fat) or high-fat (H; 60% kcal from fat) diet and further subdivided into sedentary (CS, HS) or wheel exercised (CW, HW) prior to pregnancy and throughout gestation. Offspring were maintained in a sedentary state and chow-fed throughout 52 weeks of age and subjected to serial echocardiography and cardiomyocyte isolation for functional and mechanistic studies. RESULTS: High-fat fed sedentary dams (HS) produced female offspring with reduced ejection fraction (EF) compared to offspring from chow-fed dams (CS), but EF was preserved in offspring from high-fat fed exercised dams (HW) throughout 52 weeks of age. Cardiomyocytes from HW female offspring had increased kinetics, calcium cycling, and respiration compared to CS and HS offspring. HS offspring had increased oxidation of the RyR2 in cardiomyocytes coupled with increased baseline sarcomere length, resulting in RyR2 overactivity, which was negated in female HW offspring. CONCLUSIONS: These data suggest a role for maternal exercise to protect against the detrimental effects of a maternal high-fat diet on female offspring cardiac health. Maternal exercise improved female offspring cardiomyocyte contraction, calcium cycling, respiration, RyR2 oxidation, and RyR2 activity. These data present an important, translatable role for maternal exercise to preserve cardiac health of female offspring and provide insight on mechanisms to prevent the transmission of cardiovascular diseases to subsequent generations.

Abdominal MRI on a Commercial 0.55T System: Initial Evaluation and Comparison to Higher Field Strengths.

RATIONALE AND OBJECTIVES: This study aims to assess the quality of abdominal MR images acquired on a commercial 0.55T scanner and compare these images with those acquired on conventional 1.5T/3T scanners in both healthy subjects and patients. MATERIALS AND METHODS: Fifteen healthy subjects and 52 patients underwent abdominal Magnetic Resonance Imaging at 0.55T. Images were also collected in healthy subjects at 1.5T, and comparison 1.5/3T images identified for 28 of the 52 patients. Image quality was rated by two radiologists on a 4-point Likert scale. Readers were asked whether they could answer the clinical question for patient studies. Wilcoxon signed-rank test was used to test for significant differences in image ratings and acquisition times, and inter-reader reliability was computed. RESULTS: The overall image quality of all sequences at 0.55T were rated as acceptable in healthy subjects. Sequences were modified to improve signal-to-noise ratio and reduce artifacts and deployed for clinical use; 52 patients were enrolled in this study. Radiologists were able to answer the clinical question in 52 (reader 1) and 46 (reader 2) of the patient cases. Average image quality was considered to be diagnostic (>3) for all sequences except arterial phase FS 3D T1w gradient echo (GRE) and 3D magnetic resonance cholangiopancreatography for one reader. In comparison to higher field images, significantly lower scores were given to 0.55T IP 2D GRE and arterial phase FS 3D T1w GRE, and significantly higher scores to diffusion-weighted echo planar imaging at 0.55T; other sequences were equivalent. The average scan time at 0.55T was 54 ± 10 minutes vs 36 ± 11 minutes at higher field strengths (P < .001). CONCLUSION: Diagnostic-quality abdominal MR images can be obtained on a commercial 0.55T scanner at a longer overall acquisition time compared to higher field systems, although some sequences may benefit from additional optimization.

Evaluation of Family Medicine Residency Programs for Diversity, Equity, and Inclusion Milestones.

BACKGROUND AND OBJECTIVES: In 2020, the Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed and piloted a framework to measure diversity, equity, and inclusion (DEI) initiatives in medical residencies across five domains: curriculum, evaluation, institution, resident pathway, and faculty pathway. The objectives were (1) to measure DEI initiatives across multiple domains in family medicine residencies using the DEI milestones and (2) to obtain current national baseline data providing criteria against which to measure effectiveness of initiatives and create tailored benchmarks. METHODS: We developed a cross-sectional survey of 12 quantitative residency characteristic items and the five DEI milestone ratings, and distributed the survey to program directors of family medicine residencies accredited by the Accreditation Council for Graduate Medical Education in the spring of 2022. We generated descriptive statistics, including item frequencies and cross-tabulations, and completed subgroup comparisons with analysis of variance. RESULTS: We collected aggregate milestone data for 194 family medicine residencies of 588 eligible programs (33% response rate). Respondents represented 48 states and US territories: 107 community-based, university-affiliated; 48 community-based; 34 university-based; and 5 military/other programs. Overall, the curriculum milestone was rated the highest (mean=2.54, SD=1.03), whereas the faculty pathway (mean=1.94, SD=1.04) and resident pathway (mean=2.02, SD=1.06) milestones were rated lowest. CONCLUSIONS: DEI milestone data may support residency programs as they assess their institution's developmental progress across five key domains. Additionally, aggregate data may shed light on collective strengths and areas for improvement.

Social Determinants of Health in Family Medicine Residency: A National Survey of Program Directors.

BACKGROUND AND OBJECTIVES: Social factors account for most health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. Our objectives are (1) to describe the scope of formal SDH curricula in family medicine residency, (2) to identify residency program characteristics associated with integrated core curriculum components to teach SDH, and (3) to identify barriers to addressing SDH in residency. METHODS: We distributed a cross-sectional survey to all family medicine residency program directors (PDs) accredited by the Accreditation Council for Graduate Medical Education as identified by the Association of Family Medicine Residency Directors. RESULTS: Of 624 eligible program directors, 279 completed the survey (45% response rate). Overall, 41.2% of respondents reported significant formal SDH training in their program. Though a majority (93.9%) agreed that screening for social needs should be a standard of care, most (58.9%) did not use standardized screening tools. The most common barriers to addressing SDH were lack of clinical resources (eg, social workers, legal advocates), lack of community resources (eg, food banks, substance use disorder treatment), and inadequate screening instruments or integration into the electronic medical record system. Availability of referral resources was associated with PDs' increased perception of resident SDH competency. CONCLUSIONS: Nearly all respondents agreed that screening for social needs should be a standard part of care; however, this vision is not yet realized. To better train the next generation of physicians to identify and meaningfully address social needs, additional research is needed. This research might include mixed-methods approaches that incorporate qualitative assessments to define best practices and patient-centered outcomes related to identifying and responding to SDH.

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries.

The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.

Primary health care in practice: usual source of care and health system performance across 14 countries.

Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.

An Analysis of Written and Numeric Scores in End-of-Rotation Forms from Three Residency Programs.

Introduction: End-of-Rotation Forms (EORFs) assess resident progress in graduate medical education and are a major component of Clinical Competency Committee (CCC) discussion. Single-institution studies suggest EORFs can detect deficiencies, but both grades and comments skew positive. In this study, we sought to determine whether the EORFs from three programs, including multiple specialties and institutions, produced useful information for residents, program directors, and CCCs. Methods: Evaluations from three programs were included (Program 1, Institution A, Internal Medicine: n = 38; Program 2, Institution A, Anesthesia: n = 9; Program 3, Institution B, Anesthesia: n = 11). Two independent researchers coded each written comment for relevance (specificity and actionability) and orientation (praise or critical) using a standardized rubric. Numeric scores were analyzed using descriptive statistics. Results: 4869 evaluations were collected from the programs. Of the 77,434 discrete numeric scores, 691 (0.89%) were considered "below expected level." 71.2% (2683/3767) of the total written comments were scored as irrelevant, while 3217 (85.4%) of total comments were scored positive and 550 (14.6%) were critical. When combined, 63.2% (n = 2379) of comments were scored positive and irrelevant while 6.5% (n = 246) were scored critical and relevant. Discussion: <1% of comments indicated below average performance; >70% of comments scored irrelevant. Critical, relevant comments were least frequently observed, consistent across all 3 programs. The low rate of constructive feedback and the high rate of irrelevant comments are inadequate for a CCC to make informed decisions. The consistency of these findings across programs, specialties, and institutions suggests both local and systemic changes should be considered.

Reduced Accuracy of Intake Screening Questionnaires Tied to Quality Metrics.

Clinical workflows that prioritize repetitive patient intake screening to meet performance metrics may have unintended consequences. This retrospective analysis of electronic health record data from 24 Federally Qualified Health Centers assessed effectiveness and accuracy of the 2-item Patient Health Questionnaire (PHQ-2) for depression screening and Generalized Anxiety Disorder 2 (GAD-2) for anxiety screening from 2019 to 2021. Scores of over 91% of PHQ-2 and GAD-2 tests indicated low likelihood of depression or anxiety, which diverged markedly from published literature on screening outcomes. Visit-based screenings linked to performance metrics may not be delivering the intended value in a real-world setting and risk distracting clinical effort from other high value activities.

Quality assessment of routine brain imaging at 0.55 T: initial experience in a clinical workflow.

The purpose of this study was to assess the quality of clinical brain imaging in healthy subjects and patients on an FDA-approved commercial 0.55 T MRI scanner, and to provide information about the feasibility of using this scanner in a clinical workflow. In this IRB-approved study, brain examinations on the scanner were prospectively performed in 10 healthy subjects (February-April 2022) and retrospectively derived from 44 patients (February-July 2022). Images collected using the following pulse sequences were available for assessment: axial DWI (diffusion-weighted imaging), apparent diffusion coefficient maps, 2D axial fluid-attenuated inversion recovery images, axial susceptibility-weighted images (both magnitude and phase), sagittal T1 -weighted (T1w) Sampling Perfection with Application Optimized Contrast images, sagittal T1w MPRAGE (magnetization prepared rapid gradient echo) with contrast enhancement, axial T1w turbo spin echo (TSE) with and without contrast enhancement, and axial T2 -weighted TSE. Two readers retrospectively and independently evaluated image quality and specific anatomical features in a blinded fashion on a four-point Likert scale, with a score of 1 being unacceptable and 4 being excellent, and determined the ability to answer the clinical question in patients. For each category of image sequences, the mean, standard deviation, and percentage of unacceptable quality images (<2) were calculated. Acceptable (rating ≥ 2) image quality was achieved at 0.55 T in all sequences for patients and 85% of the sequences for healthy subjects. Radiologists were able to answer the clinical question in all patients scanned. In total, 50% of the sequences used in patients and about 60% of the sequences used in healthy subjects exhibited good (rating ≥ 3) image quality. Based on these findings, we conclude that diagnostic quality clinical brain images can be successfully collected on this commercial 0.55 T scanner, indicating that the routine brain imaging protocol may be deployed on this system in the clinical workflow.

Features of Effective Clinical Competency Committees.

Background: The Clinical Competency Committee (CCC) provides accountability to the general public that physicians completing a training program have achieved competence. CCC processes and features that best identify resident outcomes along a developmental spectrum are not well described. Objective: This study sought to describe CCC features associated with effective and efficient CCC performance. Methods: The study was conducted as part of the 2022 Council of Academic Family Medicine Educational Research Alliance survey of family medicine residency program directors. The survey assessed CCC methods, policies, faculty development, structure, and overall CCC time required. The outcomes were identification of residents along a spectrum of development, from failing to exceeding expectations. Ordinal logistic regressions were used to explore the relationship between CCC characteristics and CCC outcomes. Results: The response rate was 43.3% (291 of 672). Eighty-nine percent (258 of 291) of program directors reported their CCC is successful in identifying residents not meeting expectations; 69.3% (201 of 290) agree their CCC identifies residents who are exceeding expectations. Programs with written policies for synthesizing data (OR=2.53; 95% CI 1.22-5.22; P=.012) and written policies for resident feedback (OR=19.91; 95% CI 3.72-106.44; P<.001) were more likely to report successfully identifying residents below expectations. Programs whose members spent fewer than 3 hours per 6-month interval on CCC meetings were less likely to report being able to identify failing residents (OR=0.37; 95% CI 0.19-0.72; P=.004). Conclusions: This survey of family medicine program directors suggests that formal policies, faculty development, and adequate time for CCC faculty are associated with an effective CCC, especially if goals beyond "identifying failure" are desired.

A Case Study of Hypnosis Enhanced Cognitive Therapy for Pain in a Ventilator Dependent Patient during Inpatient Rehabilitation for Spinal Cord Injury.

Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation.

Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, telemedicine was adopted to ensure continuity of HIV care. We examined how introducing televisits affected technical quality of care for people with HIV (PWH) during this time. METHODS: PWH receiving HIV care at Howard Brown Health Centers and Northwestern University in Chicago, Illinois were included. HIV care quality indicators were calculated using data extracted from electronic medical records during 4 timepoints every 6 months from March, March 1, 2020 to September 1, 2021. Generalized linear mixed models estimated differences in indicators across timepoints within each site while controlling for multiple observations of individuals. Generalized linear mixed models were also used to compare differences in outcomes among PWH who attended all versus a combination of in-person and televisits versus no televisits across the study time periods. RESULTS: 6447 PWH were included in the analysis. Compared with prepandemic levels, there were significant declines in care utilization and processes of care measures. Measures of HIV virologic suppression, blood pressure control, and HbA1C <7% (in both people with and without diabetes) were stable with no significant differences noted across the study timepoints. Similar trends were observed across all age, race, and sex subgroups. In multivariable models, televisits were not associated with decreased HIV viral suppression. CONCLUSIONS: During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and processes of care decreased compared with prepandemic levels. Among PWH who remained in care, televisits were not associated with worse virologic, blood pressure, and glycemic control in PWH.

An Analysis of a Family Medicine Residency Program's Social Media Engagement During the 2021-2022 Match Cycle.

Introduction: The COVID-19 pandemic affected the 2021 and 2022 residency recruitment cycles. Many programs rapidly shifted their recruitment efforts to include a greater presence on social media (SoMe), assuming that applicants would use these avenues as supplemental sources of information. As this represents a deviation from traditional recruitment efforts, our research team sought to analyze social media trends during the 2021-2022 family medicine virtual Match. Methods: We obtained social media analytics from our program's Facebook, Instagram, and Twitter accounts to trend user engagement as well as sources of traffic to our program's website. Results: Our study shows the ratio of users reached per post correlated with Instagram and Twitter more than Facebook. The most users reached per post were in June, October, and February, corresponding to when Electronic Residency Application Service (ERAS) application opened, when interview invitations were mostly extended, and rank order list submission. GME website traffic sources revealed that Google was the greatest driver to our website, more than the three SoMe platforms combined. Discussion: Our findings suggest Instagram and Twitter engage more users per post compared to Facebook, and user engagement appeared more aligned with the Match cycle timeline than the number of posts generated. It is important to continue to explore effective ways for applicants and programs to engage with one another in the ongoing uncertainty of virtual interviewing.

Examining How Social Risk Factors Are Integrated Into Clinical Settings Using Existing Data: A Scoping Review.

PURPOSE: Integrating social care into clinical care requires substantial resources. Use of existing data through a geographic information system (GIS) has the potential to support efficient and effective integration of social care into clinical settings. We conducted a scoping literature review characterizing its use in primary care settings to identify and address social risk factors. METHODS: In December 2018, we searched 2 databases and extracted structured data for eligible articles that (1) described the use of GIS in clinical settings to identify and/or intervene on social risks, (2) were published between December 2013 and December 2018, and (3) were based in the United States. Additional studies were identified by examining references. RESULTS: Of the 5,574 articles included for review, 18 met study eligibility criteria: 14 (78%) were descriptive studies, 3 (17%) tested an intervention, and 1 (6%) was a theoretical report. All studies used GIS to identify social risks (increase awareness); 3 studies (17%) described interventions to address social risks, primarily by identifying relevant community resources and aligning clinical services to patients' needs. CONCLUSIONS: Most studies describe associations between GIS and population health outcomes; however, there is a paucity of literature regarding GIS use to identify and address social risk factors in clinical settings. GIS technology may assist health systems seeking to address population health outcomes through alignment and advocacy; its current application in clinical care delivery is infrequent and largely limited to referring patients to local community resources.

Traumatic abdominal wall hernia and Morel-Lavallee lesion in a pediatric patient.

Traumatic abdominal wall hernias and abdominal Morel-Lavallee lesions rarely occur in blunt abdominal trauma. There are only a few documented cases of these occurring simultaneously, especially in the pediatric population. We report a case of a 15-year-old boy with a concomitant traumatic abdominal wall hernia and Morel-Lavallee lesions. Abdominal wall reconstruction was performed successfully via the collaboration of trauma, minimally invasive surgery, and plastic surgery teams.

Exploring the Great Divide: Comparing Professional Development Satisfaction and Opportunities of Program Coordinators at Academic Medical Centers and Community-Based Programs.

INTRODUCTION: Program coordinators (PCs) need to maintain flexibility and evolve professionally with rapid changes in accreditation, specialty requirements, and policies. The Accreditation Council for Graduate Medical Education recommends professional development for PCs. This mixed-methods study explored professional development opportunities and current practices of PCs at community and academic programs. METHODS: A survey was administered to the Chicago Area Medical Education Group members to elicit attitudes and opinions regarding professional development availability. RESULTS: A total of 109 participants (eligible = 178) completed surveys. 97.2% (n = 105, N = 108) of respondents indicated that development is necessary for being a great coordinator. PCs at community-based programs report lower attendance at national conferences and less satisfaction with professional development opportunities than their academic-based institution counterparts. 28.5% of the community-based coordinators are dissatisfied with opportunities compared with 7% of the academic-based coordinators. 37.7% of the community coordinators (compared with 2.9% academic) report a lack of development activities by their program or graduate medical education. Only half of the PCs report discussing professional development with their program director. However, institutional supports were regarded as facilitators to satisfaction. CONCLUSIONS: Despite recommendations for regular professional development, this study finds only half of the PCs regularly discuss professional development and finds disparities in opportunities between those in community versus academic settings.

Differential Responses to Sigma-1 or Sigma-2 Receptor Ablation in Adiposity, Fat Oxidation, and Sexual Dimorphism.

Obesity is increasing at epidemic rates across the US and worldwide, as are its co-morbidities, including type-2 diabetes and cardiovascular disease. Thus, targeted interventions to reduce the prevalence of obesity are of the utmost importance. The sigma-1 receptor (S1R) and sigma-2 receptor (S2R; encoded by Tmem97) belong to the same class of drug-binding sites, yet they are genetically distinct. There are multiple ongoing clinical trials focused on sigma receptors, targeting diseases ranging from Alzheimer's disease through chronic pain to COVID-19. However, little is known regarding their gene-specific role in obesity. In this study, we measured body composition, used a comprehensive laboratory-animal monitoring system, and determined the glucose and insulin tolerance in mice fed a high-fat diet. Compared to Sigmar1+/+ mice of the same sex, the male and female Sigmar1-/- mice had lower fat mass (17% and 12% lower, respectively), and elevated lean mass (16% and 10% higher, respectively), but S1R ablation had no effect on their metabolism. The male Tmem97-/- mice exhibited 7% lower fat mass, 8% higher lean mass, increased volumes of O2 and CO2, a decreased respiratory exchange ratio indicating elevated fatty-acid oxidation, and improved insulin tolerance, compared to the male Tmem97+/+ mice. There were no changes in any of these parameters in the female Tmem97-/- mice. Together, these data indicate that the S1R ablation in male and female mice or the S2R ablation in male mice protects against diet-induced adiposity, and that S2R ablation, but not S1R deletion, improves insulin tolerance and enhances fatty-acid oxidation in male mice. Further mechanistic investigations may lead to translational strategies to target differential S1R/S2R regulations and sexual dimorphism for precision treatments of obesity.

Mucosal plasma cells are required to protect the upper airway and brain from infection.

While blood antibodies mediate protective immunity in most organs, whether they protect nasal surfaces in the upper airway is unclear. Using multiple viral infection models in mice, we found that blood-borne antibodies could not defend the olfactory epithelium. Despite high serum antibody titers, pathogens infected nasal turbinates, and neurotropic microbes invaded the brain. Using passive antibody transfers and parabiosis, we identified a restrictive blood-endothelial barrier that excluded circulating antibodies from the olfactory mucosa. Plasma cell depletions demonstrated that plasma cells must reside within olfactory tissue to achieve sterilizing immunity. Antibody blockade and genetically deficient models revealed that this local immunity required CD4+ T cells and CXCR3. Many vaccine adjuvants failed to generate olfactory plasma cells, but mucosal immunizations established humoral protection of the olfactory surface. Our identification of a blood-olfactory barrier and the requirement for tissue-derived antibody has implications for vaccinology, respiratory and CNS pathogen transmission, and B cell fate decisions.