Faculty Bibliography

BACKGROUND:Facial trauma surgeons consulted by emergency departments (EDs) for mandible fractures must decide whether hospital admission is warranted. While admission may allow for closer monitoring and expedited surgery, many patients present with clinically stable injuries for which outpatient management is feasible. PURPOSE/OBJECTIVE:This study aims to identify biological, situational, and socioeconomic predictors of admission for mandible fractures presenting to EDs across the United States. STUDY DESIGN, SETTING, AND SAMPLE/UNASSIGNED:This was a retrospective cohort study of the 2022 Nationwide Emergency Department Sample. Subjects diagnosed with mandible fractures (International Classification of Diseases, 10th Revision, Clinical Modification S02.6-) were included. Subjects who died in the ED or left against medical advice were excluded. PREDICTOR VARIABLES/METHODS:The predictor variables consisted of a heterogeneous set of demographic, hospital-related, and injury-related risk factors. MAIN OUTCOME VARIABLES/METHODS:The outcome variables were admission status and ED charges. COVARIATES/UNASSIGNED:None. ANALYSES/METHODS:tests. A multivariable logistic model was used to identify independent predictors of admission. A P value <.05 was considered statistically significant. RESULTS:The sample was composed of 12,160 subjects with a mean age of 39 years (SD = 19), and 9,117 (75%) were male. A total of 5,236 (43%) subjects were admitted. Mandibular symphysis fractures had the highest likelihood of admission (P < .001), whereas body fractures had the lowest likelihood (P < .001). In a multivariable logistic model, male sex (OR: 1.23; 95% CI: 1.11 to 1.36), number of mandible fractures (OR: 2.81; 95% CI: 2.61 to 3.02), concomitant midface fractures (OR: 3.25; 95% CI: 2.89 to 3.65), and firearm injuries (OR: 16.16; 95% CI: 11.50 to 22.71) were associated with admission, whereas uninsured patients were less likely to be admitted (OR: 0.84; 95% CI: 0.75 to 0.94). Admissions were more costly than discharges ($15,511 vs $4,899, P < .001). CONCLUSION AND RELEVANCE/CONCLUSIONS:Disposition decisions for mandible fractures are influenced by not only injury severity (eg, multiple mandible fractures, concomitant facial fractures) but also patient characteristics and socioeconomic factors. These findings support the development of standardized admission criteria to improve equity and resource utilization.

Integrated electronic health record databases provide an unprecedented opportunity to enhance knowledge of disease prediction, prevention, and management in real-world settings. The Precision Medicine (PMED) Registry is a cohort of approximately 2 million patients seen at NYU Langone Health inpatient and outpatient centers, capturing data generated during clinical care from January 1, 2010, to the present, with regular data updates. Data have been used for several research investigations, including international meta-analyses, validation of disease identification algorithms, local evaluation of risk tools, testing analytical pipelines for imaging data, and the investigation of novel correlates of established risk prediction models. Additionally, the assessment of local practice has provided insights into clinical practice patterns and aided quality improvement efforts to assess and promote the uptake of guideline-directed therapies at the system and provider level. This study illustrates how real-world integrated electronic health record data with multi-modal clinical information can be leveraged to support research in prediction, diagnosis, prevention, and treatment optimization across health systems.

Early-career hospitalists interested in research often face uncertainty when deciding whether to apply for grant funding. This article provides a practical guide to help early-career researchers navigate early decisions in the grant application process. We review key sources of grants (federal funding, foundations, professional societies, institutional, and commercial), as well as common types of grants (eg, pilot or seed grants, travel grants, career development awards, engagement or community partnership grants, independent research grants) that may be of interest to junior investigators. We take readers through the process of determining whether specific grants are the right fit, how to decide if they should apply, sources of grants, and how to find them. The article addresses the next steps after submission, including interpreting feedback, options for resubmission, or alternative approaches if funding is not secured. Overall, this guide aims to demystify the grant-writing process and support early-career hospitalist researchers in taking their first steps toward funded research. Several helpful tips are also provided. A future article will take readers through the process of writing components of individual grants.

BACKGROUND:Legalization of cannabis across several US states may increase its use by individuals on hemodialysis, particularly among those with chronic pain. Contemporary data on frequency or factors associated with cannabis use by this population are limited. METHODS:We conducted a secondary analysis of the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis, a randomized trial that tested whether a cognitive behavioral therapy intervention lowered pain interference in people with chronic pain receiving hemodialysis at 103 US dialysis facilities. We analyzed baseline demographic characteristics, social and medical history, pain intensity, pain interference, and cannabis use. Multivariable logistic regression was used to examine associations of baseline data with cannabis use. Linear regression was used to examine whether cannabis use modified the response to the intervention. RESULTS:Among 643 participants, 102 (16%) reported current cannabis use, 133 (21%) reported former use, and 408 (63%) had never used. Current users were younger than never or past users combined (median age 54 vs. 63 years) and more likely to be disabled (79% vs. 66%), to have received dialysis for >5 years (40% vs. 30%), and to self-report depression (41% vs. 31%), anxiety (28% vs. 20%), or any psychological disorder (51% vs. 38%), and less likely to be married (16% vs. 34%). Current cigarette smoking (odds ratio [OR]=3.22, 95% confidence interval (CI) 1.61-6.46) and alcohol use (OR=2.82, 95% CI 1.37-5.80) were independently associated with cannabis use, as were age, relationship status, neighborhood segregation index, and cocaine/heroin use. Cannabis use did not modify response to the intervention. CONCLUSIONS:Current cannabis use was reported by 16% of HOPE participants and was more common among younger, unmarried individuals who use other substances, but did not alter response to our intervention. More research is needed on the consequences of cannabis use among people receiving hemodialysis.

INTRODUCTION/UNASSIGNED:Acute kidney injury (AKI) is a common complication of pediatric hospitalizations. We evaluated the prevalence of AKI in children hospitalized with acute malnutrition, examined how AKI definitions influence risk stratification, and assessed the performance of the STOP AKI risk score. METHODS/UNASSIGNED:We enrolled 185 Ugandan children hospitalized with acute malnutrition. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria based on serial creatinine measurements, with the nadir creatinine during hospitalization as baseline. Because children with malnutrition have low baseline creatinine levels, we evaluated whether applying minimum absolute creatinine thresholds improved identification of clinically meaningful AKI, defined by its association with mortality. RESULTS/UNASSIGNED:The median age was 1.2 years, and 13.5% of children died. KDIGO-defined AKI without a minimum creatinine threshold was not associated with mortality. Applying a minimum absolute creatinine threshold of 0.4 mg/dl to the KDIGO criteria identified AKI in 23.2% of participants and was independently associated with mortality (adjusted odds ratio [OR, aOR]: 4.06, 95% confidence interval [CI]: 1.39-11.84). A threshold of 0.5 mg/dl identified fewer children but predominantly severe AKI. Clinical risk factors included diarrhea, vomiting, and sepsis. The ISN STOP AKI risk score did not discriminate AKI risk (area under the receiver operating characteristic curve [AUROC]: 0.50, 95% CI: 0.40-0.60). CONCLUSION/UNASSIGNED:AKI is common in children hospitalized with acute malnutrition and is strongly associated with mortality when clinically meaningful creatinine thresholds are applied. Existing AKI risk tools perform poorly in this population, thereby underscoring the need for adapted approaches to AKI identification in malnourished children.

Therapeutic cancer vaccines can generate measurable antigen-specific immune responses in humans, yet tumor regression is often incomplete, inconsistent, or short-lived. In immunologically cold tumors, this pattern may reflect not an absolute inability to prime immunity, but difficulty advancing induced immunity through the full sequence required for tumor control. Peripheral blood responses may be real and still be biologically inadequate if they contract early, fail to acquire productive trafficking programs sufficient for tissue entry, lose functional competence under chronic antigen stress, or remain constrained by the suppressive tumor microenvironment. The manuscript advances a sequential, feedback-guided adjuvant framework in which peptide vaccination remains the backbone but is preceded and followed by distinct support phases. A Phase 0 immune-readiness step, potentially using IL-7 (e.g., CYT107), is intended to improve the baseline substrate before antigen exposure. Phase 1 priming uses peptide vaccination on a commonly used adjuvant backbone such as Montanide ISA-51 or poly-ICLC (Hiltonol), while radiation and/or STING-based strategies are treated as context-dependent enhancers rather than replacements for priming. IL-15-centered consolidation is then used to support expansion and persistence. A formal trafficking assessment follows so that blood-only success is not overinterpreted. IL-21 is positioned later as a persistence- and quality-support cytokine when response quality declines. The framework also addresses why otherwise rational protocols can fail at the chemokine-trafficking step: CXCR3-dependent tumor entry is not interchangeable with generic inflammation, CCR5 biology is context dependent, and IL-12, although biologically attractive and previously tested as a vaccine adjuvant, is best viewed here as an optional, context-specific amplifier rather than a universal backbone. Although organized as sequential phases, the framework is intended as a bottleneck-guided and iterative design logic in which phases may overlap, repeat, or be entered in partial parallel depending on the dominant biologic constraint. The central hypothesis is that vaccine programs that progress beyond priming into trafficking-competent and functionally sustained states are predicted to correlate more closely with disease control than programs judged mainly by early blood immunogenicity.

Vertebral metastatic disease results from many types of cancer and can have a devastating impact on patient mobility, psychological health, quality of life, and ultimately overall patient survival. However, the development of radiotherapy and surgical techniques has rapidly surged in conjunction with ongoing advances in basic science and translational studies. In this review, we discuss the paradigm shift in our understanding of the epidemiology and treatment algorithms for spinal oncology, ranging from preoperative optimization strategies, radiation and surgical techniques, the utilization of molecular markers and targeted therapeutics in medical oncology, and prognostication tools that underscore a new multidisciplinary approach to spinal oncology care.

The extended care for deceased organ donors can be challenging for resource-constrained hospitals that do not have the staff, equipment, or expertise to manage a donor. Donor care units provide a dedicated space and team for donor management, which allows for efficient and effective care. In 2020, the transplant institute at a New York City hospital established the first hospital-based donor care unit in the city with its local organ procurement organization to help alleviate the organ crisis in the United States. Hospital-based donor care units require a trusting relationship between the organ procurement organization and donor management team to maximize every donor's gift.