Faculty Bibliography

OBJECTIVES/OBJECTIVE:Adults with hearing loss experience poorer health outcomes than their hearing counterparts. As hearing loss becomes more prevalent in the United States, research examining how to reduce health disparities among this population is needed. This study aimed to estimate the associations between hearing loss and each of poor physical and mental health, evaluate health literacy as a mediator of these relationships, and estimate the proportion of cases of poor physical and mental health that are attributable to having lower health literacy among adults with hearing loss. DESIGN/METHODS:The 2016 Behavioral Risk Factor Surveillance System survey included cross-sectional data on self-reported hearing difficulty, health literacy, and number of days of poor physical and mental health in the past 30 days in a subpopulation of adults aged 18 and over among 17 US states and territories (N = 104,792). The number of days of poor physical and mental health was split into 5 categories (0, 1 to 10, 11 to 20, 21 to 29, and all 30 days). Age-stratified weighted complex survey logistic regression models estimated the total and direct effects of hearing difficulty on poor physical and mental health, and the indirect effects mediated by health literacy. Outcomes for poor physical and mental health were modeled separately as 1+ days versus 0 days, 11+ days versus ≤10 days, 21+ days versus ≤20 days, and all 30 days versus <30 days. Models were adjusted for age, sex, race/ethnicity, education, income, marital status, and health insurance coverage. Population attributable fractions were used to estimate the proportion of adults with hearing difficulties who experienced poor physical and mental health due to having lower health literacy. RESULTS:Compared with those without hearing difficulties, those with hearing difficulties had a higher prevalence of lower health literacy (70.3% versus 56.2%), 30 days of poor physical health (16% versus 6.4%), and 30 days of poor mental health (10.7% versus 5.3%). Odds ratios for the total effect of hearing difficulty ranged from 1.68 (95% confidence interval [CI]: 1.44 to 1.92) to 1.87 (95% CI: 1.66 to 2.08) for poor physical health and 1.68 (95% CI: 1.51 to 1.85) to 2.20 (95% CI: 1.81 to 2.59) for poor mental health. The indirect effect of hearing difficulty mediated through health literacy explained between 3.8 and 4.8% of the total effect for poor physical health and 2.3 and 6.6% for poor mental health. When stratified by age, the total effect generally declined as age increased, while the indirect effect stayed relatively consistent. Over 218,000 cases of poor physical health lasting 30 days and over 115,000 cases of poor mental health lasting 30 days were attributable to having lower health literacy. CONCLUSIONS:The results show that those with hearing difficulties experience significantly poorer physical health, poorer mental health, and lower health literacy. Health literacy was determined to be a significant mediator between hearing difficulty and both poor physical and mental health. Findings suggest that improving health literacy among this population would reduce the number of days of poor physical and mental health in the past month experienced by adults with hearing difficulty in the United States.

BACKGROUND:The impact of body mass index (BMI) extremes on the outcomes after head and neck cancer (HNC) reconstruction remains uncertain. Herein, we investigate the influence of low and high BMI on the intraoperative and postoperative outcomes of oncologic head and neck microvascular reconstruction. METHODS:We analyzed a prospective institutional database (09/2019-12/2024). Patients were stratified into underweight, normal weight, overweight, and obesity I, II, and III. Flaps were categorized by donor site (thigh, back, fibula, or forearm). Demographics, intraoperative events, and donor, recipient, and systemic postoperative complications were assessed. RESULTS:BMI extremes relate to perioperative risk in HNC microvascular reconstruction. Underweight status is associated with higher perioperative complications across flaps, while obesity-related risk concentrates in class II/III patients undergoing thigh-based flaps. Findings support BMI-informed preoperative optimization and flap selection strategies.

Endoscopy training traditionally relies on patient-based apprenticeship, which can limit exposure, feedback, and patient safety. Simulation offers a safe, reproducible environment for skill development, with mechanical, virtual reality, and hybrid systems providing increasing realism, procedural variety, and objective metrics. Evidence shows simulation enhances early skill acquisition, structured learning, and trainee confidence, though its superiority over patient-based training and predictive value for real-world outcomes remains under study. Barriers include cost, faculty expertise, and integration into curricula. Future work should focus on long-term skill retention, linking simulation performance to patient outcomes, and expanding accessible, cost-effective platforms.

From 2014 to 2025, accelerated 3-year MD programs (A3YP) have expanded significantly, such that 20% of allopathic medical schools offer a program to earn the MD degree in three years. While maintaining rigorous and comparable educational standards as traditional 4-year programs, A3YPs aim to address physician workforce shortages, reduce student debt, and provide individualized education pathways into specific specialties. Among the thirty-two A3YPs in existence, twenty-two medical schools have graduated 1141 students to date, with numbers increasing annually. Nineteen programs are linked to a residency program, though six of these programs consistently match students outside their linked program. As more medical schools implement A3YPs and an increasing number of graduates enter the National Residency Matching Program (NRMP), residency program directors will encounter A3YP applicants more frequently. The proliferation of A3YPs presents both challenges and opportunities for residency program directors in evaluating applicants. Despite the differences in their applications, including limited extracurricular activities and time for visiting rotations, these applicants have been found to perform similarly in standardized testing and residency milestones, and have similar well-being and satisfaction as traditional students. This perspective outlines key considerations for PDs and provides a foundation for contextually evaluating the increasing numbers of these applicants graduating from A3YPs.

OBJECTIVE:To describe the use of peripheral nerve stimulation targeting the sacral lateral branches as a treatment for sacroiliac joint mediated low back pain refractory to conventional therapies. METHODS:A 67-year-old female with chronic sacroiliac joint (SIJ)-mediated low back pain, refractory to conservative management and sacral lateral branch radiofrequency ablation, subsequently underwent a trial and implantation of peripheral nerve stimulation (PNS) targeting the sacral lateral branches. RESULTS:The PNS trial achieved 60% pain reduction without adverse events. After permanent implantation, 12-month follow-up showed 70% sustained pain relief and ODI improvement from 68% to 28%. CONCLUSION/CONCLUSIONS:PNS of the sacral lateral branches, performed using a novel technique, appears to be a safe and effective treatment for SIJ-mediated low back pain refractory to standard therapies. Further studies are warranted to validate these findings.

Concentrated bone marrow aspirate (cBMA) is an autologous biologic increasingly used in orthopaedic surgery for its regenerative potential. It contains mesenchymal stem cells (MSCs), growth factors, and cytokines that contribute to tissue repair and immunomodulation. Mesenchymal stem cells primarily exert their effects through paracrine signaling and macrophage reprogramming, promoting a shift from a pro-inflammatory (M1) to a reparative (M2) phenotype. Emerging evidence also suggests a role for mitochondrial transfer in this process. In foot and ankle surgery, cBMA has been investigated in the management of osteochondral lesions of the talus, fracture healing, and tendon disorders. Early clinical studies suggest potential improvements in functional outcomes, healing rates, and revision rates; however, the available evidence remains heterogeneous and is largely limited to small, non-randomized studies. Variability in cBMA preparation and reporting further limits comparability across studies. As such, while cBMA represents a promising adjunct in foot and ankle surgery, its clinical role is not yet fully defined. Future research should focus on prospective, controlled studies with standardized methodologies and explore emerging cell-free approaches, including MSC-derived extracellular vesicles, to optimize regenerative strategies.

INTRODUCTION AND PROBLEM STATEMENT/UNASSIGNED:Competency in brain death/death by neurologic criteria (BD/DNC) determination is an Accreditation Council for Graduate Medical Education (ACGME) milestone in neurology residency and neurocritical care fellowship; however, trainees have limited clinical exposure and receive inconsistent training across institutions. Simulation offers a standardized, safe environment to teach and assess BD/DNC, but multi-institutional implementation remains unstudied. The aim of this study was to evaluate the feasibility of implementing a consensus-based BD/DNC curriculum and to assess its impact on trainee confidence. LEARNING OBJECTIVES/UNASSIGNED:By the end of the curriculum, trainees will be confident in assessing BD/DNC prerequisites, performing a complete neurologic examination, safely conducting and interpreting apnea testing, and accurately declaring BD/DNC. METHODS AND CURRICULUM DESCRIPTION/UNASSIGNED:test. RESULTS/UNASSIGNED:Nineteen participants (9 female [47%]; predominantly PGY-4 trainees) were enrolled. Median [IQR] pre-post composite confidence scores improved significantly across all domains: "Setup and Family Counseling," 4 [3.5-4] to 4.5 [4-5]; "Prerequisites," 4 [4-5] to 4.5 [4-5]; "Neurologic Examination," 4 [4-4] to 4.5 [4-5]; and "Apnea Test and Declaration of BD/DNC," 3 [3-4] to 5 [4-5]. The effect sizes (Wilcoxon r) ranged from 0.79 to 0.88 across domains. There were no significant differences in the magnitude of improvement between high-fidelity and low-fidelity groups. After curriculum implementation, 13 of 19 participants (68%) self-assessed their ACGME BD/DNC milestone competency to be level 4 or 5. DISCUSSION AND LESSONS LEARNED/UNASSIGNED:This multi-institutional pilot demonstrated that a consensus-based BD/DNC simulation curriculum is feasible and improves trainee confidence despite limited previous clinical exposure. Key lessons include the feasibility of multicenter collaboration, standardizing core practices while accommodating local variability, and designing adaptable curricula that achieve similar outcomes across resource-diverse settings.

The upper extremity is a structure of incredible complexity able to perform unique tasks that span from the most delicate and intricate to highly strenuous and forceful. Fully functional and aesthetic replacement of the upper extremity after loss remains a medical and technological aspiration. Meaningful advancements continue to be made in all areas of upper extremity limb loss, specifically in traditional surgical reconstruction and prosthetics. This has generated a new field of treatment that is most accurately titled Bionic Reconstruction. Essentially, successful bionic reconstruction allows for the human body to effectively communicate and work in concert with the man-made technology.

BACKGROUND:Heart failure accounts for more than one million US hospitalizations annually, with 30-day all-cause readmission approaching 25% and triggering CMS Hospital Readmissions Reduction Program penalties. The 2022 ACC/AHA/HFSA guideline and the 2023 ESC focused update elevated SGLT2 inhibitors to Class I therapy for heart failure with reduced ejection fraction (HFrEF) [1, 2]. The DAPA ACT HF-TIMI 68 prespecified meta-analysis demonstrated reductions in cardiovascular death or worsening heart failure (HR 0.71) and all-cause mortality (HR 0.57). Real-world prescribing patterns and 30-day readmission outcomes in the post-guideline US era are not well characterized. The relative contribution of clinical stability variables versus co-prescribed guideline-directed medical therapy (GDMT) to confounding has not been directly quantified in this setting. METHODS:We conducted a retrospective cohort study at four NYU Langone Health hospitals from January 2023 to January 2026. Adults with a primary heart failure discharge diagnosis were included. The prespecified primary analysis was in the HFrEF subgroup (LVEF ≤ 40%). The primary outcome was 30-day all-cause readmission. Stabilized inverse probability of treatment weighting (IPTW) was the primary adjustment, with overlap weighting (ATO) as sensitivity analysis. Hierarchical logistic regression decomposed the confounding contribution of clinical stability parameters relative to GDMT. The E-value assessed robustness to unmeasured confounding. RESULTS:Among 438 patients, 122 (27.9%) received in-hospital SGLT2 inhibitor initiation. The HFrEF rate was 41.6%, a sixfold increase from 6.6% reported in INSIGHT-HF (2020-2021). Patients with prior heart failure hospitalization received SGLT2 inhibitors at 11.4% versus 29.7% in those without (p < 0.001). In HFrEF (n = 221), 30-day readmission was 12.1% versus 31.8% (crude OR 0.29, 95% CI 0.14-0.61). The primary IPTW estimate was OR 0.34 (95% CI 0.13-0.91, p = 0.032). Sensitivity analyses were directionally consistent. Clinical stability parameters contributed only 9.3% confounding attenuation; GDMT was the dominant confounder. CONCLUSIONS:In a contemporary US post-guideline cohort, in-hospital SGLT2 inhibitor initiation reached 41.6% in HFrEF but remained low in patients with recent heart failure hospitalization. In-hospital SGLT2 inhibitor initiation was associated with lower 30-day all-cause readmission, though initiation was strongly bundled with discharge GDMT optimization and cannot be distinguished from a GDMT optimization effect with this study design. These findings should be considered hypothesis-generating. Because short-term safety events and post-discharge persistence were not systematically captured, these findings should not be interpreted as establishing the benefit-risk profile of inpatient SGLT2 inhibitor initiation. The prescribing gap in high-risk patients is an actionable quality-improvement target.

INTRODUCTION/BACKGROUND:More than half of older adults with Alzheimer's Disease and Related Dementias (ADRD) are undiagnosed, limiting timely access to person-centered care. Therefore, clinicians, researchers, and population health managers need scalable, reproducible approaches to monitor both prevalence and diagnostic gaps. We evaluated whether a decision-analytic modeling framework can translate a limited number of clinician-adjudicated cases of ADRD into a probabilistic computational phenotype for accurate, population-level assignments of probable ADRD in the emergency department (ED) setting using routinely collected electronic health record (EHR) data. METHODS:Retrospective cohort study of 5000 adults aged ≥ 65 years from nine EDs within a large integrated health system (2014-2022). We randomly selected 500 individuals for clinician adjudication of dementia status (reference cohort), reserving the remaining 4500 as a phenotyping cohort. We developed the phenotype as a logistic regression model trained on adjudicated cases, embedding pattern-mixture multiple imputation to address information bias. We applied decision-curve analysis to evaluate clinical utility across probabilistic thresholds. We applied the phenotype to assign dementia status to 4500 unadjudicated patients and compared clinical characteristics to adjudicated cases. RESULTS:The mean (SD) age was 77.4 (9.0) years; 55.4% were women; 102 individuals (20.4%) had clinician-adjudicated ADRD. The model demonstrated good discrimination (AUROC 0.87; 95% CI 0.82-0.91). Decision-curve analysis revealed net clinical benefit across examined thresholds (predicted probabilities 12%-32%), identifying an additional 16-18 probable ADRD cases per 100 older adults. Among those without ADRD-related diagnosis codes, net benefit ranged from 8 to 13 additional correct identifications per 100. Phenotype-assigned cases closely resembled clinician-adjudicated cases (standardized mean differences ≤ 0.20). CONCLUSIONS:A probabilistic computational phenotype derived from routinely collected EHR data accurately reproduced clinician-adjudicated ADRD status and demonstrated net clinical benefit, including among ED patients whose ADRD was not captured by diagnosis codes. Adoption of this replicable framework may enable healthcare organizations to strengthen ADRD surveillance and reduce underdiagnosis.