Faculty Bibliography

BACKGROUND AND AIMS/OBJECTIVE:Although pregnant people are a WHO priority population for hepatitis C (HCV) elimination, there is limited guidance on HCV treatment in pregnancy. Emerging data suggests direct acting antiviral (DAA) therapy is safe and effective. We performed a multinational survey among gastro-hepatologists (GI-Hep), infectious disease (ID) specialists, obstetricians-gynaecologists (ob-gyns), and general practitioners (GP) to evaluate current perspectives on HCV treatment in pregnancy. METHODS:A 39-item survey was designed by experts at The Global Liver Council, the American College of Obstetricians and Gynaecologists, and the Coalition for Global Hepatitis Elimination and distributed electronically. Survey responses were compared across medical specialties and regions. RESULTS:A total of 651 participants from all WHO regions representing 58 countries completed the survey: GI-Hep: 46%, GP-ID: 36%, ob-gyns: 18%. Only 25% would consider treating HCV during pregnancy, with significant differences by specialty. Main reasons for not considering DAAs in pregnancy were insufficient safety data (27%) and no clear guidelines for HCV treatment (32%). The highest acceptance of DAA use in pregnancy was in North America (45% vs. < 20% in other regions (p < 0.01)). Predictors of a greater willingness to treat HCV in pregnancy were having ≥ 10% of practice population with injection drug use (aOR: 2.31; 95% CI: 1.49-3.60; p = 0.0002). GI-Hep specialty was associated with a lower willingness (aOR: 0.47; 95% CI: 0.28-0.78; p = 0.004). CONCLUSIONS:Despite relatively high levels of HCV knowledge, few participants have experience with HCV treatment in pregnancy or would consider such treatment. Further availability of safety evidence and the inclusion of specific recommendations in guidelines could increase uptake of DAAs for pregnant individuals.

BACKGROUND:Reductions in blood pressure (BP) control among patients with hypertension were observed early in the COVID-19 pandemic. The degree to which BP control may have returned to prepandemic levels is unknown. METHODS:Individuals aged 18 to 85 years with hypertension from 17 health systems participating in the National Patient-Centered Clinical Research Network were identified using electronic health record data collected as part of routine care. BP control (percentage of patients whose most recent BP measurement was <140/<90 mm Hg) was estimated in a series of 12-month rolling measurement periods from 2017 through 2022 (January 1, 2017 through December 31, 2017; April 1, 2017 through March 31, 2018; … January 1, 2022 through December 31, 2022). Differences in average BP control between 2022 (January 1, 2022 through December 31, 2022) and 2019 (January 1, 2019 through December 31, 2019) were estimated overall (adjusted for age, sex, and race and ethnicity) and by race and ethnicity (adjusted for age and sex). RESULTS:Our sample included 1 193 314 persons with hypertension in 2019 (48.9% aged 65-85 years, 52.9% men, 66.2% non-Hispanic White) and 1 499 418 individuals in 2022 (50.6% aged 65-85 years, 47.1% men, 62.7% non-Hispanic White). The weighted average BP control dropped from 65.3% in 2019 to 61.8% in 2020 and then partially recovered to 62.6% in 2022 (adjusted mean difference, -2.6 percentage points [95% CI, -5.0 to -0.2]). Non-Hispanic Asian individuals experienced the largest temporal drop in BP control, declining from 68.4% in 2019 to 63.9% in 2022. CONCLUSIONS:BP control was disrupted during the COVID-19 pandemic and had not fully rebounded to prepandemic levels by the end of 2022. Continued surveillance is needed to determine whether the decline in BP control will persist and will result in future adverse cardiovascular events.

Historically hindered by a lack of access to academic, political, financial, technological, scientific, and social resources, most people living with disability have been unable to successfully merge their lived experience with the traditional research process. The lack of this community's perspective has been an ongoing missed opportunity for the broadening and relevance of research around disability. Patient-scientists, however, bridge the gap. They are individuals who act as patient research partners (PRPs) with the valuable addition of a research and/or medical degree. Their embodied expertise, combined with their academic accreditation, seamlessly positions them to work within the academic system. With a foot in both worlds, they are equipped to generate real change for themselves and others living with their condition. Patients are encouraged to participate in their own clinical care, although PRPs remain relatively uncommon. Even more scarce are patient-scientists, who serve as intellectual peers with expertise in technical and experiential domains. Their research training gives them an invaluable role: to act as both scientist and patient at once. This special communication builds on ongoing efforts to bolster patient participation in rehabilitation research by focusing on patient-scientists and highlighting their potential to enhance rehabilitation research processes.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Trimodality therapy (TMT) is an accepted bladder-preserving option for selected patients with muscle-invasive bladder cancer (MIBC). Pembrolizumab has demonstrated activity in MIBC and may enhance the effects of chemotherapy and radiation. We evaluated the safety and efficacy of adding pembrolizumab to TMT. METHODS:In this multicenter phase 2 trial, patients with MIBC received one dose of pembrolizumab followed by maximal transurethral resection, then definitive bladder radiation with concurrent low-dose gemcitabine and pembrolizumab every 3 wk for three doses. The primary end point was 2-yr bladder-intact disease-free survival (BIDFS). Secondary end points included safety, metastasis-free survival (MFS), and overall survival (OS). KEY FINDINGS AND LIMITATIONS/UNASSIGNED:Fifty-four patients were enrolled, including 48 in the efficacy cohort; 67% had clinical stage T2 disease. The 2-yr BIDFS was 60% (95% confidence interval [CI], 45-73). Two-yr MFS and OS were 81% (95% CI, 66-92) and 83% (95% CI, 69-91), respectively. Grade ≥3 treatment-related adverse events occurred in 25% of patients. Limitations include the single-arm design and modest sample size. CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:Pembrolizumab combined with gemcitabine-based chemoradiation was feasible and showed efficacy comparable to standard TMT. Ongoing phase 3 trials will further define its role in bladder preservation.

Obesity, sarcopenia, malnutrition, and cachexia all include assessment of body composition in their respective clinical guidelines, although patient evaluations frequently require hardware that may not be available. Body mass index often fills this void, but its accuracy as a body composition phenotyping method is limited. Recent advances suggest a new option for assessing patient body composition: omics-derived circulating blood biomarkers applied in combination with demographic information or alone to estimate the mass or volume of clinically relevant body components. The origin of this movement has its roots, among other factors, in two longstanding observations, that serum levels of the metabolite creatinine are associated with total body skeletal muscle mass and that serum levels of the protein leptin are associated with total body adipose tissue mass. The first section of this review demonstrates how body composition prediction models can be developed that exploit these kinds of observations by adding serum metabolite and protein measurements to conventional equations designed to estimate components that include demographic covariates such as weight, height, sex, and body circumferences. The second section of this review then broadens the number of potential circulating blood metabolites and proteins examined by reviewing advances in omics technology that offer the potential to improve conventional body composition prediction models that include demographic data or to create models solely based on blood biomarker measurements. The final section of the review presents a perspective on this rapidly advancing area of human body composition assessment.

OBJECTIVES/OBJECTIVE:Obesity is highly prevalent in psoriatic arthritis (PsA) and associates with worse disease outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used for weight loss and diabetes, but their impact on PsA outcomes remains unclear. We aimed to characterize patients with PsA initiating GLP-1RAs and assess longitudinal changes in weight, PsA activity and cardiometabolic parameters. METHODS:We conducted a retrospective analysis of patients with PsA who initiated GLP-1RAs. PsA disease activity data and cardiometabolic parameters from clinical visits within 1 year before and after GLP-1RA initiation along with demographics and comorbidities were collected. RESULTS:48 patients with a median BMI 34.9 were included. Significant weight loss was observed post-treatment (-6.43 kg (95% CI -9.5, -2.0), p< 0.0001), with 60% losing ≥5 % of their baseline bodyweight. CRP levels (-1.1 mg/L, p=0.002), pain scores (-1.0, p=0.01), and triglyceride levels (-0.35 mmol/L, p=0.02) decreased significantly. Each 1% reduction in body weight was associated with significant improvements in DAPSA [β=-0.49 (95% CI: -0.94, -0.03)], tender joint count [β=-0.18 (95% CI: -0.32, -0.05)], EQ-5D [β=0.0016 (95% CI: 0.008, 0.023)], LDL [β=-0.05 (95% CI: -0.10, -0.003)], and systolic blood pressure [β=-0.67 (95% CI: -1.18, -0.15)]. CONCLUSION/CONCLUSIONS:In this real-world study, GLP-1RA therapy in PsA was associated with clinically meaningful weight loss and improvements in systemic inflammation, pain, and cardiometabolic markers. Improvements in psoriatic outcomes were proportional to the degree of weight loss. These findings warrant further investigation in prospective controlled studies to evaluate the role of GLP-1RAs in PsA management and comorbidities.

PURPOSE/OBJECTIVE:Studies show women are underrepresented in gastroenterology (GI). Understanding representation is crucial to improving representation. This study describes the geographic distribution of women in academic GI in the United States (US). METHODS:We conducted a cross-sectional study of 224 US GI fellowship programs in 2023 by review of program websites and direct inquiry. Gender distribution of trainees and faculty across US regions was evaluated. Program characteristics were examined in univariate analyses. Logistic regression models assessed factors associated with women in leadership, adjusting for program type and region. RESULTS:Women comprised 39.3% of 1,801 fellows and 30.2% of 3,899 GI faculty. Percentage of women fellows was highest in the West (50%), Northeast (38%), South (33%), and Midwest (33%), (p = 0.014). Median percentage of senior women faculty was highest in the Northeast (27%) (p = 0.009). Programs with women GI division chiefs had more women GI fellowship program directors (60% vs 40%, p = 0.001) and higher median percentage of women faculty (33% vs 26%, p = 0.016). The presence of a woman GI division chief was independently associated with having a woman GI fellowship program director (p = 0.008) and increased percentage of women faculty (p < 0.001). CONCLUSION/CONCLUSIONS:Gender representation varied regionally, with some institutions lacking women faculty or trainees. Women in leadership are associated with greater faculty gender diversity, potentially impacting trainee recruitment, faculty retention, and patient care. The association between women GI division chiefs and increased women faculty and program directors highlights how leadership gender diversity may support recruitment and retention of women in academic GI.

AIM/OBJECTIVE:This integrative review appraises the literature on the impact of gamification on academic performance among prelicensure nursing students. BACKGROUND:Traditional classroom lectures in nursing education often rely on passive teaching strategies, limiting student engagement. Game-based learning has emerged as an innovative approach to enhance active learning and improve learning outcomes. METHOD/METHODS:Following Whittemore and Knafl's guidelines, a systematic search of the Cumulative Index to Nursing and Allied Health Literature database identified research studies published after 2000. Critical appraisal was conducted using evidence-based tools, yielding 18 quantitative studies that met the inclusion criteria. RESULTS:Four key themes were identified: enhanced academic performance, improved knowledge retention, increased student satisfaction, and strengthened clinical skills. CONCLUSION/CONCLUSIONS:Findings suggest that gamification positively influences knowledge retention in nursing didactic courses. Further research is needed to explore its impact on competency development and clinical application. Faculty development optimizing the use of gamification is needed.

The importance of rapid and accurate histologic analysis of surgical tissue in the operating room has been recognized for over a century. Our standard-of-care intraoperative pathology workflow is based on light microscopy and H&E histology, which is slow, resource-intensive, and lacks real-time digital imaging capabilities. Here, we describe an emerging and innovative method for intraoperative histologic analysis, called Intelligent Histology, that integrates artificial intelligence (AI) with stimulated Raman histology (SRH). SRH is a rapid, label-free, digital imaging method for real-time microscopic tumor tissue analysis. SRH generates high-resolution digital images of surgical specimens within seconds, enabling AI-driven tumor histologic analysis, molecular classification, and tumor infiltration detection. We review the scientific background, clinical translation, and future applications of intelligent histology in tumor neurosurgery. We focus on the major scientific and clinical studies that have demonstrated the transformative potential of intelligent histology across multiple neurosurgical specialties, including neurosurgical oncology, skull base, spine oncology, pediatric tumors, and peripheral nerve tumors. Future directions include the development of AI foundation models through multi-institutional datasets, incorporating clinical and radiologic data for multimodal learning, and predicting patient outcomes. Intelligent histology represents a transformative intraoperative workflow that can reinvent real-time tumor analysis for 21st century neurosurgery.

BACKGROUND/UNASSIGNED:Adolescent blood pressure guidelines rely on expert consensus because evidence on cardiovascular outcomes is limited. This study aimed to examine the link between adolescent blood pressure indices and early cardiovascular events. METHODS/UNASSIGNED:We conducted a cohort study among 902 741 adolescents aged 16 to 19 years who were evaluated for mandatory service from 1979 to 2019, excluding those with preexisting cardiometabolic conditions. Individuals were followed until 50 or death or insurance loss or December 31, 2021, whichever occurred first. Exposures included baseline blood pressure and American Academy of Pediatrics categories: normal (<120/<80), elevated (120/<80-129/<80), stage 1 (130/80-139/89), stage 2 (≥140/90), and hypertension (clinical diagnosis). The primary outcome was incident cardiovascular events (ischemic heart disease or cerebrovascular disease). Hazard ratios were estimated using Cox models adjusted for demographic, socioeconomic, and clinical confounders. RESULTS/UNASSIGNED:During over 18 million person-years of follow-up, 6305 cardiovascular disease events were recorded, yielding an incidence rate of 0.35 per 1000 person-years. Increased diastolic, systolic, and mean arterial blood pressure were significantly associated with increased risk. Compared with the Normal group, adjusted hazard ratios for cardiovascular disease were 1.14 (95% CI, 1.08-1.22) for stage 1, 1.31 (1.20-1.44) for stage 2, and 2.42 (1.87-3.12) for hypertension. Risk in the stage 1 category was particularly sensitive to diastolic blood pressure. CONCLUSIONS/UNASSIGNED:Higher blood pressure indices during adolescence were strongly associated with an elevated risk of early cardiovascular disease, highlighting the potential need to refine current guidelines to better reflect cardiovascular risk.