Faculty Bibliography

BACKGROUND:Starting a pediatric subspecialty fellowship presents numerous challenges to trainees. Virtual Symposium of Pediatric Hematology/Oncology of New York (v-SYMPHONY), an educational collaborative organized by 18 pediatric hematology-oncology (PHO) programs, initiated an annual bootcamp in 2022 aimed at easing the transition from pediatric residency to PHO fellowship. METHODS:The bootcamp consisted of virtual clinical lectures and fellow-led panels, which were created with input from diverse program leadership, educators, and past fellows using Kern's six-step module of curriculum development. It was offered to incoming fellows, first in the NY/NJ/CT region, and subsequently expanded nationally. RESULTS:Over 4 years (2022-2025), 147 pediatric residents completed this virtual bootcamp. The number of residents attending the live sessions increased from 19 in 2022 to 62 in 2025. Forty-four participants completed pre- and post-bootcamp surveys over this period, which showed significant improvement in both self-reported medical knowledge and preparedness and reported a decrease in transition to fellowship anxiety scores. CONCLUSION/CONCLUSIONS:These results highlight the need and benefits of a standardized orientation program that can be delivered virtually to ease the transition of PHO trainees from residency to fellowship. Such a standardized curriculum is feasible, adaptable, and potentially scalable to a national level.

BACKGROUND/UNASSIGNED:Early-onset colorectal cancer (EOCRC), diagnosed in adults under the age of 50 years, is a significant public health challenge in the United States (US). While traditional colorectal cancer (CRC) incidence in older populations has declined due to screening, rates among younger adults are rising, likely driven by shifting birth cohort exposures to modifiable risk factors. This study aims to quantify the longitudinal burden of EOCRC and evaluates the contribution of dietary and metabolic risks from 1990 to 2023. METHODS/UNASSIGNED:Using data from the Global Burden of Disease (GBD) 2023 study, we analyzed age-specific incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for EOCRC. Trends were evaluated using joinpoint regression to calculate annual percent changes (APCs). Risk factor attribution was performed for dietary, metabolic, and behavioral exposures. Future burdens were projected to 2050 using mixed-effects and autoregressive integrated moving average (ARIMA) models. RESULTS/UNASSIGNED:Between 1990 and 2023, the age-specific incidence rate (ASIR) of EOCRC increased by 47.1%, rising from 8.01 to 11.79 per 100,000. Age-specific mortality rose from 2.48 to 3.00, and DALYs increased from 125.41 to 150.82. Males consistently carried a higher burden, with widening sex disparities in incidence by 2023 (13.10 in males versus 10.44 in females). By 2023, diet high in processed meat (18.4%) surpassed diet low in whole grains (17.6%) as the leading modifiable contributor to EOCRC mortality, followed by high body-mass index and smoking. Under a risk-reduction scenario, projected mortality could decline by more than 50% by 2050 (1.14 per 100,000) compared to the reference trend (2.42 per 100,000). CONCLUSIONS/UNASSIGNED:The EOCRC burden in the US has intensified over three decades. The shifting dominance toward processed meat and metabolic dysfunction highlights a critical need for targeted primary prevention. Achieving significant mortality reductions by 2050 will require population-level interventions addressing dietary quality and metabolic health early in life.

BACKGROUND/UNASSIGNED:Readmission risk can be assessed with risk calculators but typically requires manual chart review. We aimed to develop an artificial intelligence (AI) large language model (LLM) to predict 30-day readmission risk by directly analyzing electronic discharge summaries of cardiac surgery patients. METHODS/UNASSIGNED:We developed a cardiac surgery-specific LLM by fine-tuning a general medical LLM to predict 30-day all-cause readmissions directly from unaltered text in discharge summaries of 5244 adult cardiac surgery patients (2014-2021). Strict temporal validation was implemented in a test cohort (2021-2024; n = 3031). Model predictions were compared with readmission length of stay. RESULTS/UNASSIGNED:< .001). CONCLUSIONS/UNASSIGNED:A cardiac surgery-specific LLM showed high sensitivity, moderate specificity, and modest ability to discriminate 30-day readmission risk. Temporal trends in documentation influenced model performance, underscoring the need for dynamic recalibration to update AI models. This study suggests that AI-automated screening to assess readmission risk at the time of discharge is possible and may help inform readmission prevention strategies.

BACKGROUND/UNASSIGNED:Myocardial infarction with nonobstructive coronary arteries (MINOCA) accounts for 6% to 15% of acute coronary syndromes and disproportionately affects women. Although coronary culprit lesions are present in 45% of patients with MINOCA, multivessel optical coherence tomography (OCT) is infrequently performed. We evaluated whether interventional cardiologists can identify coronary arteries with culprit lesions using invasive coronary angiography in women with MINOCA. METHODS/UNASSIGNED:Women with MINOCA who had a coronary culprit lesion identified by multivessel OCT were included. A core laboratory confirmed and localized OCT-defined culprit lesions using angiographic coregistration. Two interventional cardiologists blinded to OCT findings independently reviewed invasive coronary angiography, before and after review of ECG and transthoracic echocardiography, to identify the culprit artery. RESULTS/UNASSIGNED:=0.97). Culprit arteries were identified by at least 1 cardiologist in 87.5% of plaque rupture cases. Only 11% of circumflex lesions were identified. CONCLUSIONS/UNASSIGNED:Interventional cardiologists could not reliably identify culprit arteries using coronary angiography in women with MINOCA, even after ECG and transthoracic echocardiography review. Our findings suggest that invasive angiography alone should not guide vessel selection for intracoronary imaging and support multivessel imaging when evaluating MINOCA. REGISTRATION/UNASSIGNED:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02905357.

BACKGROUND:The iBox is a validated prognostication system that predicts long-term death-censored graft loss in kidney transplant recipients, but its performance in the specific population of African American recipients has not been fully studied. METHODS:We conducted a multicenter study including 3,866 kidney transplant recipients from North America, of whom 1,040 (27%) were African American, to assess the impact of race on the iBox's performance in predicting graft loss. Discrimination, calibration, overall fit and clinical utility were evaluated in the whole cohort and in African American and non-African American recipients. RESULTS:Performance metrics for the prediction of graft loss were similar in both subgroups in terms of discrimination (c-index 0.80 [95% CI: 0.77-0.83] in African American recipients and 0.83 [95% CI: 0.81-0.85] in non-African American recipients, p=0.07), and observed/expected ratios (1.08 [95% CI: 0.95-1.23] and 0.99 [95% CI: 0.88-1.10], respectively, p=0.28). No significant interaction between iBox score values and race was found in multivariable analysis stratified by transplant center (p=0.29 for the interaction term). Results were consistent between subgroups regardless of the equation used to estimate glomerular filtration rate (Kidney Recipient Specific [KRS], CKD-EPI, or MDRD), with small variations in calibration across equations. CONCLUSIONS:The iBox prognostication system showed accurate discrimination, overall fit, and clinical utility up to 7 years post-risk evaluation in African American and non-African American kidney transplant recipients, supporting its robustness in this population.

Classic models of the French flag problem depict sharp cell type boundaries emerging from threshold responses to morphogen gradients. How discrete cell type boundaries arise from morphogen signals that vary continuously across developing tissues remains incompletely understood. We use hair follicle dermal condensate (DC) formation to study a sharp developmental transition in which proliferative progenitors undergo cell cycle exit concurrent with molecular differentiation. Using genetic and genomic approaches, we show that Wnt and Hedgehog signaling coordinate separable cellular events during DC commitment. Elevated Wnt signaling promotes cell cycle exit through reduced chromatin binding of the Hedgehog mediator GLI3, while Hedgehog signaling induces differentiation genes in a Wnt-dependent manner and simultaneously elevates Wnt activity. When these responses coincide, differentiation and cell cycle exit occur together, limiting the duration and abundance of intermediate states and producing a sharp boundary. When they do not, intermediate states persist and expand, producing a graded boundary. Thus, a sharp boundary can emerge from a continuous transition that is compressed in time and space.

The COVID-19 pandemic served as a catalytic opportunity for preexisting social and political forces to gain a foothold that unleashed a serious and sweeping backlash against public health. These forces fuel ongoing public health backlash and feed a broadening politics of backlash against the authority of the protective state. In this article, we describe backlash as a historically rooted political concept that helps to reconceptualize public health's pandemic experience. We use it to systematically code and analyze a unique and rich sample of oral history interviews with 109 public health officials (PHOs) from 18 geographically and politically diverse states during the COVID-19 pandemic. In each selected state, we interviewed PHOs who led departments in the largest 1 or 2 cities, local counties or districts serving rural and suburban areas, and at the state level. This study, which demonstrates how backlash operated in the context of public health, points out specific ways PHOs and health departments remain at risk for growing and increasingly severe backlash now and in the future. (Am J Public Health. Published online ahead of print September 10, 2026:e1-e12. https://doi.org/10.2105/AJPH.2026.308614).

INTRODUCTION/UNASSIGNED:Recent federal funding cuts have created pauses in admissions, hiring, and execution of research studies at academic medical centers internationally. These monetary reductions have also impacted allowances for non-essential faculty travel. As a result, faculty may now be faced with challenges in how they obtain professional development. METHODS/UNASSIGNED:A cross-sectional, exploratory study was implemented to discover the impact of funding cuts on faculty travel for professional development opportunities, as well as strategies medical educators are using to mitigate the current landscape. RESULTS/UNASSIGNED:Findings indicate that faculty now must use alternative methods to obtain professional development and that institutional guidance is lacking in how to do so. DISCUSSION/UNASSIGNED:Authors provide concrete action steps for faculty to take amidst this challenge to remain engaged in professional development.

BACKGROUND:Despite the frequent late-stage diagnosis of gastric cancer (GC), the U.S. lacks a routine gastric cancer screening program. Liquid biopsy (LB), specifically blood-based tests, has emerged as a potential screening approach, but it is unclear whether such a strategy is cost-effective. We therefore evaluated the cost-effectiveness of liquid biopsy screening for GC in the U.S. METHODS:A Markov model was developed to compare no screening (current standard-of-care) and two liquid biopsy screening strategies. The study used a simulated cohort of 45-year-old individuals with average risk of gastric cancer. Primary model outcomes included life expectancy, quality-adjusted life-years (QALYs), total cost, and incremental cost-effectiveness ratios (ICERs). A strategy was considered cost-effective if the incremental cost-effectiveness ratio was less than the U.S. willingness-to-pay threshold of $100,000 per quality-adjusted-life-year gained. RESULTS:In the base-case analysis, LB screening strategies were not cost-effective, with an incremental cost-effectiveness ratio of $917,826 per QALY gained. Screening became cost-effective for high-risk subpopulations or when the per-test cost was approximately $89. CONCLUSIONS:This economic evaluation of LB for GC screening found that while LB strategies are effective in reducing cancer incidence and mortality, they are not cost-effective due to high test costs. Our findings could help inform the potential planning of future clinical validation studies for LB tests used for GC screening.