Faculty Bibliography

BACKGROUND AND OBJECTIVES/UNASSIGNED:Persistent racial and ethnic disparities in child COVID-19 vaccination rates in the US suggest that vaccinated racial and ethnic minoritized caregivers have hesitated to vaccinate their children. To address these disparities, we sought to understand perspectives on the COVID-19 vaccine among racial and ethnic minoritized caregivers of school-aged children. METHODS/UNASSIGNED:We recruited English, Spanish, and Haitian Creole-speaking caregivers of children ages 5-11 years-old seen for pediatric care at a safety-net hospital. We surveyed caregivers on vaccination status, demographics, and conducted semi-structured interviews regarding vaccine perception. We analyzed interviews using thematic analysis with grounded theory principles. RESULTS/UNASSIGNED:We interviewed 20 caregivers (62% Non-Hispanic Black, 29% Hispanic). Caregivers had all received at least one vaccine dose and 62% of children were vaccinated against COVID-19. Caregivers discussed five core values used to appraise the COVID-19 vaccine: Safety, Knowledge, Trust, Humanity, and Autonomy. These five core values were used in decision-making about vaccination; ongoing appraisal of the vaccine after their own vaccination; and in consideration of the vaccine for their children. CONCLUSIONS/UNASSIGNED:We conclude that public health campaigns attuned to these core values may be more accepting to families and help to reduce perpetuation of healthcare mistrust and persistent health disparities among racial and ethnic minoritized families.

Nasoalveolar molding (NAM) is an established form of presurgical infant orthopedics (PSIO), whereas presurgical lip, alveolus, and nose approximation (PLANA) is a novel approach. This study compared presurgical outcomes between infants with a unilateral cleft lip treated with PLANA and NAM using an objective method for assessment of cleft severity and PSIO outcomes. A single-institution retrospective review was conducted of all patients treated with NAM (2017-2019) and PLANA (2023-2025). Anthropometric measurements including columellar angle, nostril width ratio, and lateral subnasale displacement were collected at the initiation and completion of therapy, and predefined thresholds were used to classify patients by cleft severity (mild, moderate, severe, and very severe) and outcome (poor, good, and excellent). A total of 64 patients were identified, including 36 patients treated with NAM and 28 treated with PLANA. At baseline, the 2 cohorts exhibited similar distributions in cleft severity categories. At the completion of therapy, statistically significant differences were observed between NAM (27.8% mild, 52.8% moderate, 16.7% severe, and 2.8% very severe) and PLANA (67.9% mild, 28.6% moderate, 3.6% severe, 0.0% very severe). This translated to significant differences in PSIO outcomes between NAM (11.1% excellent, 55.6% good, and 33.3% poor) and PLANA (60.7% excellent, 35.7% good, and 3.6% poor). Numerically, the 2 cohorts were statistically similar at baseline, but after PSIO the PLANA cohort displayed more favorable anthropometrics and larger improvements in all 3 parameters. Using an objective method for evaluating cleft severity, patients treated with PLANA exhibited superior morphologic outcomes in comparison to NAM.

BACKGROUND/UNASSIGNED:The American Heart Association Predicting Risk of Cardiovascular Disease EVENT (PREVENT) equations were developed from observational research cohorts and electronic health record data and provide sex-specific risk estimates for cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), and heart failure (HF). External validation in large contemporary samples across multiple health systems in the United States is needed. METHODS/UNASSIGNED:We assembled a national electronic health record-based cohort of US adults with individual-level patient data pooled from a collective of 30 health systems (Truveta) to externally validate the outcome-specific 10-year PREVENT equations (PREVENT-CVD, PREVENT-ASCVD, and PREVENT-HF). We included patients aged 30 to 79 years without a history of prior CVD and with an ambulatory encounter in the electronic health record between 2013 and 2018. The outcomes were defined as total CVD (composite of ASCVD and HF), ASCVD, and HF through December 2024 using diagnosis codes. Model performance of the outcome-specific PREVENT base equations was assessed with the Harrell C statistic and calibration slope, stratified by sex. RESULTS/UNASSIGNED:Of the 680 864 adults included, the mean (SD) age was 55 (13) years, and 56% were female. Over a mean (SD) follow-up of 6.8 (2.3) years, there were 29 535 incident CVD events, 19 280 incident ASCVD events, and 16 824 incident HF events. The median (interquartile range) 10-year predicted risk of PREVENT-CVD among women was 3.6% (1.3%-8.8%), and among men was 5.8% (2.5%-11.7%). The C statistic (95% CI) was 0.788 (0.786-0.790), and the calibration slope (95% CI) was 0.98 (0.95-1.01) for PREVENT-CVD. PREVENT-ASCVD and PREVENT-HF demonstrated similar C statistics (0.774 [0.771-0.777] and 0.824 [0.820-0.828]) and calibration slopes (1.07 [1.04-1.10] and 1.01 [0.97-1.04]) for prediction of the 10-year risk of ASCVD and HF, respectively. CONCLUSIONS/UNASSIGNED:The PREVENT equations accurately and precisely estimate the 10-year risk of CVD, ASCVD, and HF in a large sample of US adults. These findings support the generalizability of the PREVENT equations to inform guideline-recommended risk assessment and preventive efforts.

INTRODUCTION/BACKGROUND:Prediction of cartilage structural properties through MRI could allow earlier detection of joint pathologies, such as osteoarthritis. MATERIALS & METHODS/METHODS:Bovine patellar cartilage samples (n = 12) were imaged using magnetic resonance fingerprinting, followed by histological examination of proteoglycan content and collagen fiber anisotropy. The relaxation time maps and raw signal data were then used for training Gaussian process regression (GPR) models to predict the histology results. RESULTS:Proteoglycan content was predicted by the GPR models with high accuracy (median r = 0.81, σ = 0.08 and NRMSE = 11.7%). Predictions performed using raw MRF data outperformed those done using qMRI maps. Collagen fiber anisotropy predictions found only weak correlation (median r = 0.40, σ = 0.25 & NRMSE = 26.4%) and no significant difference was seen between models trained on raw MRF or relaxation time maps. DISCUSSION/CONCLUSIONS:These findings indicate that noninvasive prediction of proteoglycan content in cartilage from MRF measurements using a 3 T clinical scanner is feasible, holding promise for future clinical applications. Collagen fiber anisotropy could not be reliably estimated with the current setup. GPR-based prediction models were found to outperform reference linear models using the same prediction data.

OBJECTIVE/UNASSIGNED:Surgical education guided by Halsted's, "see one, do one, teach one," model leans heavily on an apprenticeship structure since formalization of surgical education in the 1890s. While the sentiment holds true, surgical education must adapt with evolution of medicine, work hour restrictions, exponential increase in knowledge, and technological advances. DESIGN/UNASSIGNED:A longitudinal course grounded in adult learning theories was curated to cultivate knowledge in surgery residents on imaging-based liver anatomy and operative approaches, techniques, and decision making. PARTICIPANTS/UNASSIGNED:Junior surgical residents (PGY2-3) in dedicated research time at the Surgical Oncology and Immunotherapy Clinical Research Fellowship Programs of the NIH. RESULTS/UNASSIGNED:Nineteen participants demonstrated significant improvement in all metrics assessed. Overall pre-course knowledge scores (52.1%, 95%CI [48.2%, 56%]) significantly increased in post-course evaluations (87.7%, 95%CI [85.1%, 90%], p<0.0001), maintaining significance in individual course score comparisons. Confidence improved across all disciplines from 2.49 to 2.99 points (5-point Likert scale) (p<0.0001). Significance was maintained in subgroup analysis of individual skills (anatomic delineation (2.93 to 3.51), technical approach (2.39 to 2.83), and decision-making (2.17 to 2.65), (p<0.0001)). Participants reported positive feedback regarding content and course structure which guided real-time course augmentation. CONCLUSION/UNASSIGNED:This course represents a feasible educational model highlighting potential of a theory-based curriculum to enhance surgical education. Emphasizing adult learning theories can support deeper learning and advance critical thinking in trainees.

Since the introduction of the Vesical Imaging-Reporting and Data System (VI-RADS), MRI has become an important imaging modality in the management of patients with bladder cancer. Its excellent diagnostic performance for determining muscle invasion in bladder cancer has been supported by numerous prospective and retrospective studies. Nevertheless, there needs to be continued improvement of the diagnostic performance of VI-RADS and sustained efforts to address remaining unmet clinical needs within the field of bladder cancer. In this paper, we highlight several such areas, some of which are actively being investigated. These include (1) whether to use intravenous contrast media or not (multiparametric vs. biparametric MRI), (2) quantitative metrics to enhance assessment of muscle invasion, (3) anatomic locations that come with pitfalls in staging, (4) introduction of bladder MRI image quality, (5) neoadjuvant chemotherapy VI-RADS (nacVI-RADS) and other considerations needed in the treatment response assessment after systemic therapies, (6) need for wider adoption, training, and implementation, and (7) application of artificial intelligence.

BACKGROUND:Ureteroenteric strictures (UES) are a challenging complication after urinary diversion and may lead to infection, renal dysfunction, and the need for reintervention. Robotic repair has emerged as an effective minimally invasive option, but data remain limited, particularly in complex and heterogeneous cohorts. METHODS:We conducted a retrospective review of 40 patients who underwent robotic UES repair at a single tertiary center between July 2014 and May 2024. Seventeen patients were treated with the Xi system and 23 with the single-port (SP) platform, all by a single experienced surgeon. Patient demographics, stricture characteristics, operative details, perioperative outcomes, and follow-up data were analyzed. Surgical success was defined by symptom resolution, stent- or nephrostomy-free status, radiological patency, and stable renal function. RESULTS:A total of 40 patients representing 50 ureteral units were included. The cohort included a range of stricture characteristics and reconstructive approaches. Primary anastomosis was most commonly performed for shorter strictures, whereas flap, graft, and interposition techniques were used for longer or more complex disease. Overall, robotic repair was associated with high success rates (95%) and acceptable morbidity (12.5% major complications). Perioperative outcomes improved over time, with reductions in operative time, blood loss, and length of stay, likely reflecting increasing surgical experience and technical refinement. CONCLUSIONS:Robotic repair of UES is safe and effective across both multiport and SP platforms. This series reflects a decade of evolving technique and highlights practical refinements that facilitate reconstruction in complex postdiversion cases.