Faculty Bibliography

Vision-language models (VLMs) have demonstrated remarkable performance across a wide range of computer-vision tasks, sparking interest in their potential for digital health applications. Here, we apply VLMs to two fundamental challenges in data-driven stroke rehabilitation: automatic quantification of rehabilitation dose and impairment from videos. We formulate these problems as motion-identification tasks, which can be addressed using VLMs. We evaluate our proposed framework on 20 healthy controls and 51 stroke survivors. Our results show that current VLMs lack the fine-grained motion understanding required for precise quantification: dose estimates are comparable to a baseline that excludes visual information, and impairment scores cannot be reliably predicted. Nevertheless, several findings suggest future promise. With optimized prompting and post-processing, VLMs can classify high-level activities from a few frames, detect motion and grasp with moderate accuracy, and approximate dose counts within 30% of ground truth for mildly impaired and healthy participants, all without task-specific training or finetuning. These results highlight both the current limitations and emerging opportunities of VLMs for data-driven stroke rehabilitation and broader clinical video analysis.

The Orthobunyavirus genus of arthropod-borne segmented RNA viruses comprises important pathogens including the human-infecting Oropouche virus and ruminant-infecting Schmallenberg virus (SBV). The prototypical Bunyamwera orthobunyavirus (BUNV) possesses envelope-embedded glycoprotein Gn-Gc tripodal spikes, of which the ectodomains mediate virus entry, while endodomains interact with nucleoprotein (NP) enwrapped genome segments driving virion assembly. Interestingly, BUNV Gc head/stalk domains are redundant for virus growth in mammalian cells, consistent with isolations of SBV from ruminants bearing head/stalk deletions. However, these domains appear strictly maintained in orthobunyavirus isolations from arthropods in nature. To investigate the molecular mechanism that underlines this discrepancy, we compared the multiplication characteristics of wildtype BUNV (BUNV-WT) with a Gc head/stalk deleted BUNV (BUNV-∆7). In mammalian cells BUNV-WT and BUNV-∆7 grew to equivalent titres, whereas in insect cells BUNV-∆7 titres were 1000-fold lower and strikingly produced no virions following blood meal infection of Aedes mosquitoes. To understand this insect-specific restriction in virion production, we showed the intracellular abundance of BUNV-WT and BUNV-∆7 Gc and NP components were equivalent, suggesting the deletion impacted post-translational stages of the infection cycle. To explore this, we investigated Gc and ∆7-Gc interactions during BUNV-WT and BUNV-∆7 infections of both insect and mammalian cells by co-immunoprecipitation and multiplex mass spectrometry, revealing ∆7-Gc exhibited markedly reduced NP interactions in insect cells, potentially indicating reduced segment interactions during assembly. We hypothesise that the Gc head/stalk performs an insect cell-specific role in segment recruitment during virion formation, and that maintenance in nature of full-length Gc is due to this essential role in the insect host.

PURPOSE/UNASSIGNED:Excimer laser therapy, a 308-nm narrowband UV-B modality, has shown promise in inflammatory dermatoses, but remains understudied in scarring alopecia (SA). MATERIALS AND METHODS/UNASSIGNED:We conducted an IRB-approved retrospective study of adults with SA treated with excimer therapy to characterize clinical outcomes, response timelines, and treatment patterns. RESULTS/UNASSIGNED:. After a mean of 3.4 months, 60% of patients reported subjective improvement in hair or hairline appearance. Symptomatic improvements were observed in scalp pain (100%), burning (75%), and pruritus (50%), generally within two to six months. Signs of inflammation, including perifollicular hyperkeratosis and erythema, improved in 83% of affected patients. Trichoscopic measures of hair density and shaft caliber remained stable, suggesting disease stabilization without accelerated follicular loss. Adverse effects were common but mild, including erythema, burning, and pain, and did not lead to koebnerization. CONCLUSIONS/UNASSIGNED:Overall, excimer therapy was well-tolerated and associated with meaningful clinical and symptomatic improvement. These findings support excimer therapy as a potentially effective adjunctive treatment for inflammatory control and stabilization in SA, with response typically occurring within the first several months of therapy.

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.

BACKGROUND/UNASSIGNED:Craniopharyngiomas are rare parasellar tumors, and papillary craniopharyngiomas (PCPs) represent 8 to 20% of cases. DESIGN/UNASSIGNED:Interim analysis of retrospective data collected from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). SETTING/UNASSIGNED:Fourteen U.S.-based academic skull base centers between 2011 and 2023. PARTICIPANTS/UNASSIGNED:Patients with PCPs. MAIN OUTCOME MEASURES/UNASSIGNED:Demographic, imaging, surgical, and outcome variables. RESULTS/UNASSIGNED: CONCLUSIONS/UNASSIGNED:RAPID consortium enabled the largest real-world clinical information dataset for PCPs. Early findings support that GTR and stalk preservation are important to outcomes. Iterative analysis and discussion of data led to the generation of a framework for future studies to fully leverage the capabilities of multicenter registries.

BACKGROUND:Efforts to improve representation of diverse communities in clinical research have progressed, yet suboptimal reach due to lack of language support, mistrust, and cultural misalignment, persist. While research often prioritizes generalizability or recruiting a specific community, a tailored approach is essential to recruit and retain diverse communities. This study aims to illustrate the depth and breadth of existing community-engaged research methods that have been used to increase recruitment and retention of diverse communities. METHODS:Semi-structured interviews were conducted to identify common themes and best practices of inclusive research with 48 principal investigators and their study staff who had successfully engaged with different diverse communities from research institutions in the United States. Data were analyzed using a rapid qualitative analysis approach and organized thematically. FINDINGS/RESULTS:Six key themes related to conducting community-engaged research emerged: research team as community health advocate, community-academic partnership characteristics, best practices for conducting research with diverse communities, incurred financial costs, sustainability of inclusive research efforts, and system-related challenges. Participants emphasized the role of research teams to uplift community voices, build authentic and collaborative partnerships, prioritize cultural practices of the community, and use data to inform policy. Best practices included providing incentives, offering bilingual materials and having bilingual staff, and using multi-pronged recruitment and retention strategies. Financial costs included both tangible costs such as transportation and honoraria, while intangible costs such as time and trust-building were also highlighted. Sustainability required early planning, capacity-building, and continuous fiscal support. Challenges included insufficient institutional support, burnout, and staff turnover, stressing the need for multi-level strategies and solutions integrated into the research environment to support inclusive research practices. CONCLUSIONS:A general research approach that tailors to specific communities' preferences and fosters collaborative partnerships will better enhance representation in research. However, the research environment requires attention to multi-level strategies to minimize challenges to conducting community-engaged research.

BACKGROUND:Emerging evidence suggests endocrine disrupting chemicals, including bisphenols and phthalates, may affect behavioral development in children and adolescents. Risk behavior constitutes a potentially sex hormone sensitive behavioral construct. Here, we examined longitudinal associations of phthalate and bisphenol exposure with performance-based tasks and self-reported risk-taking behaviors. METHODS:Within a population-based birth cohort in the Netherlands, urinary bisphenols and phthalate metabolite concentrations were measured in women during pregnancy (three times, n = 1379) and in children (once at 6 years, n = 775). At 10 years, child risk-taking behavior was assessed with the computerized experimental Columbia Card Task (CCT). At 14 years, adolescents completed a computerized self-assessment of real-life risk-taking behaviors. Linear regression and hurdle models adjusted for confounders were applied in the whole sample and stratified by sex at birth. RESULTS:After multiple testing correction, no associations in all children or in boys were found for prenatal or childhood phthalate exposure with the average CCT-score. In girls, prenatal mono-isobutyl phthalate was associated with a higher average CCT-score, indicting more risk-taking (B per 10-fold increase in creatinine-adjusted average prenatal levels = 2.10, 95% CI: 0.69,3.52). No associations were observed for bisphenol exposure nor for self-reported risk-taking. CONCLUSIONS:Prenatal phthalate exposure was associated with more risk-taking in an experimental task at 10 years-of-age in girls only. The task reflects risky decision-making, which may be a hormonally sensitive construct. Risky decision making potentially precedes real-life risk-taking, which was captured by the self-reported measure and was limited in this young sample.

BackgroundPeople with subjective cognitive decline (SCD) are at increased risk of Alzheimer's disease. Prior research has suggested that amygdala volume may be more sensitive than hippocampal volume in detecting differences between SCD and age-matched controls, as well as in predicting SCD conversion to mild cognitive impairment. However, the microstructure underlying this volumetric change remains unclear.ObjectiveThis study evaluated amygdala microstructural differences in SCD versus control participants as well as associations between amygdala microstructure and volume, age, memory performance, anxiety, and depression using diffusion imaging.MethodsDiffusion tensor imaging, diffusion kurtosis imaging, and neurite orientation dispersion and density imaging were fit to diffusion MRI images. Group differences and correlations between diffusion metrics, age, memory, anxiety, and depression were assessed in 123 SCD versus 194 age-matched controls over age 55.ResultsIn the left amygdala, SCD participants had significantly lower fractional anisotropy (FA), lower kurtosis fractional anisotropy (KFA), and higher free water fraction (FWF). KFA was lower in the right amygdala in SCD. There were no significant group differences in the amygdala volume. Bilateral KFA negatively correlated with FWF, a marker of neuroinflammation and neurodegeneration. Left FA negatively correlated with orientation dispersion index, a marker of neuritic branching. Right KFA correlated with age only in SCD, while left FA correlated with anxiety only in controls.ConclusionsKFA is sensitive to group differences between SCD and controls in bilateral amygdala. KFA may reflect neuroinflammation and increased sensitivity to aging in the amygdala in SCD.

BACKGROUND:Methadone is a highly effective treatment for opioid use disorder (OUD). Yet its impact is constrained by low rates of treatment initiation and retention, driven in part by geographic inequalities in the availability of methadone-providing opioid treatment programs (OTPs) and restrictions on the types of clinical settings where methadone can be dispensed. In response, in July 2021, the Drug Enforcement Administration released a new rule allowing OTPs to dispense medications for OUD-including methadone-through mobile medication units (MMU) without the need for additional treatment waivers. METHODS:We conducted interviews with 11 participants living in a residential substance use treatment facility in NYC and receiving methadone treatment (MT) from an MMU. Interview data were coded using Dedoose software based on a combination of inductive and deductive coding strategies, and guided by a thematic approach to explore patient's treatment experiences and perceptions. RESULTS:Participants described MMU as substantially reducing the logistical burden of treatment while also allowing patients to avoid problems associated with brick-and-mortar OTPs. Some raised minor complaints (i.e., additional waiting time on medication delivery days), yet participants framed these concerns within the context of their overall preference for MMU. Participants also expressed uncertainty about how methadone treatment would continue after leaving residential care, highlighting potential challenges in transitioning from mobile services to traditional clinic settings. DISCUSSION/CONCLUSIONS:Our findings provide qualitative evidence from patients' perspectives on how mobile methadone delivery can potentially reshape the logistical demands, treatment environments, and continuity-of-care challenges associated with methadone treatment in residential settings.

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.