Faculty Bibliography

Clinical histories are essential for accurate radiologic interpretation but are often lengthy and time-consuming to review amid increasing radiologist workloads. Large language models (LLMs) offer a potential solution by generating concise, clinically focused summaries from existing documentation; however, the optimal presentation format for radiologists remains unclear. This retrospective reader study evaluated the readability, efficiency, and radiologist preference for a two-stage LLM-based summarization pipeline designed to identify the optimal summary format for radiologic use. Ninety imaging studies across multiple modalities and care settings were processed to generate structured timeline summaries (stage 1) and brief narrative summaries (stage 2). Text length was reduced by approximately 86.8% and 95.2% for stage 1 and stage 2, respectively. Four radiologists independently rated representative subsets of cases for clarity, relevance, usefulness, and comprehensiveness and indicated their order of preference. Stage 2 summaries were preferred in 89% of ratings and were rated significantly higher than stage 1 for perceived clarity, relevance, and usefulness (p < 0.0001), with equivalent comprehensiveness. Longer source documents and longer stage 1 summaries were associated with lower ratings for the detailed timeline format, whereas no such associations were observed for the brief narrative summaries. Manual review identified 25 total hallucinations across 90 cases, of which one was considered capable of altering image interpretation in a case with borderline radiographic features. These findings demonstrate that summary format, and particularly brevity, is critical for optimizing readability and radiologist preference. Automated summarization holds promise to reduce cognitive load and improve information accessibility in radiology practice.

A strong working relationship between nurse practitioners and registered nurses is essential for strengthening staff morale and a collaborative learning environment. Within our academic health system, leaders are expected to support collaboration while striving for exceptional quality care and sustained staff engagement in a transplant unit. In recent years, through strong nursing leadership, clear goals, and shared ownership, we have improved quality metrics and strengthened nurse practitioner-registered nurse collaboration. Upholding these principles has enabled the team to consistently deliver safe, high-quality care while enhancing outcomes for both patients and staff. This article highlights the evolution of effective team building on an acute solid organ transplant unit, emphasizing shared professional goals, engagement, accountability, and the application of high-reliability organization principles. Leadership-driven interventions centered on communication, collaboration, transparency, respect, and role clarity have positively influenced patient experience, job satisfaction, and staff wellness.

INTRODUCTION/UNASSIGNED:Older adults with chronic kidney disease (CKD) likely face higher dementia risk because of vascular injury and chronic inflammation, potentially intensified among racially minoritized groups and those in rural or deprived neighborhoods. We quantified this association and examined variation by race and ethnicity, urbanicity, and neighborhood deprivation. METHODS/UNASSIGNED:We identified 211,321 older adults with CKD stages 3 to 5 from the Medicare 5% sample (2010-2022) using International Classification of Diseases (ICD)-9 and/or ICD-10 codes. Zone Improvement Plan (ZIP)-code level urbanicity was defined using Rural-Urban Commuting Area Codes, and neighborhood deprivation was derived from the American Community Survey. We used cause-specific hazard models with time-varying CKD stage (reference = stage 3) to quantify the adjusted hazard ratio (aHR) of dementia and included interaction terms to test the differential effect of these associations by race and/or ethnicity, urbanicity, and neighborhood deprivation. RESULTS/UNASSIGNED:= 0.04). Among older Black (stage 4 aHR: 1.38, 95% CI: 1.28-1.48; stage 5 aHR: 2.01, 95% CI: 1.88-2.15) and Hispanic adults (stage 4 aHR: 1.33, 95% CI: 1.10-1.62; stage 5 aHR: 1.98, 95% CI: 1.67-2.34), stages 4 and 5 were associated with a higher risk of dementia. Among older adults in high-deprivation neighborhoods, stage 5 was associated with a higher risk of dementia (aHR: 1.89, 95% CI: 1.80-1.99). CONCLUSION/UNASSIGNED:CKD stages 4 and 5 were associated with a higher dementia risk, particularly among older Black adults and those in high-deprivation neighborhoods. These findings may inform targeted interventions for early detection and management of cognitive decline in advanced CKD.

BACKGROUND:Cognitive impairments are consistently associated with the actual number of falls and future fall risk in people with multiple sclerosis (PwMS), but their influence and predictive usefulness regarding fear of falling (FoF) are not well understood. Since FoF can greatly affect a patient's lived experience and is essential for evaluating overall fall risk in PwMS, we aimed to explore how cognitive performance relates to, and forecasts, individuals' perceptions of their fall risk, and whether disease severity impacts this relationship. METHODS:FoF (Modified Falls Efficacy Scale, MFES) and neurocognitive function (NeuroTrax computerized cognitive assessment battery) were assessed in 188 PwMS. The NeuroTrax battery provided index scores for global cognition and specific cognitive domains such as memory, executive function, attention, processing speed, visuo-spatial, verbal function, and motor skills. The predictive value of cognitive performance on FoF was examined through hierarchical regression models. RESULTS: = 9.15, p < 0.001). CONCLUSION/CONCLUSIONS:FoF in PwMS can affect day-to-day planning and quality of life but is often overlooked as a meaningful aspect of the patient's lived experience. Our findings suggest that cognitive deficits are associated with greater FoF, and that the cognitive domain related to FoF varies as a function of disability level. Deficits in executive functioning and motor skills, in particular, may indicate broader disease impact on the patient's perception of their physical capabilities.

BACKGROUND:Cigarette smoking remains the leading cause of preventable death in the United States, with high prevalence among hospitalized patients. Hospitalization presents an opportunity to initiate and engage patients in tobacco treatment, yet guidance for tobacco treatment in this setting has been limited. This clinical practice guideline provides evidence-based recommendations for tobacco treatment in the inpatient setting. STUDY DESIGN AND METHODS/METHODS:A multidisciplinary panel followed CHEST's standardized clinical practice guideline methodology, including systematic literature searches in MEDLINE, Embase, and the Cochrane Database. Key clinical questions were framed using the PICO format. Eligible studies included randomized controlled trials and cohort studies. Evidence was appraised using GRADE, and recommendations were formulated through a modified Delphi process to achieve consensus. RESULTS:We identified 9330 abstracts, assessed 252 full texts, and included 142 studies. The literature review and analysis, based on 6 PICO questions, yielded 8 recommendations. No recommendations were supported by high-certainty evidence specific to inpatient tobacco treatment settings. Of the eight recommendations, four were supported by moderate-certainty evidence, two by low-certainty evidence, and two by very low-certainty evidence, supplemented by expert consensus. INTERPRETATION/CONCLUSIONS:Hospitalization offers a critical window to initiate tobacco treatment. This guideline synthesizes the existing literature to inform key components of inpatient tobacco treatment, including an opt-out population-based approach that proactively provides counseling and pharmacotherapy to all patients who smoke unless they explicitly decline; the initiation and selection of pharmacotherapies during hospitalization; counseling approaches delivered during the inpatient stay; and post-discharge counseling approaches following hospital discharge. Implementing these approaches is likely to improve smoking-cessation outcomes and reduce hospital readmissions and costs. The guideline also evaluates the strength and limitations of the current evidence base and identifies priority areas for future research, including identifying optimal implementation strategies, equity considerations, and the evaluation of cost-effectiveness across diverse hospital settings and patient populations.

Aging is the primary risk factor for synucleinopathies, including Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), and independently contributes to motor dysfunction. This review summarizes motor system degeneration in aging and disease, focusing on the primary motor cortex (M1), its white matter tracts, and the nigrostriatal system. In healthy aging, M1 exhibits cortical thinning, myelin loss, reduced perfusion, and iron deposition. The motor cortex-derived corticospinal and corticostriatal pathways undergo microstructural decline, often linked to vascular factors. The substantia nigra (SN) demonstrates selective neuronal loss, oxidative stress, iron deposition, and synaptic reduction, contributing to motor impairment. In synucleinopathies, these age-related vulnerabilities are exacerbated by disease-specific pathology. In PD, progressive dopaminergic neuron loss in the SN is a core feature, detectable with advanced magnetic resonance imaging (MRI) markers of iron, neuromelanin, and microstructure. PD pathophysiology extends beyond the nigrostriatal system, involving M1 dysfunction and widespread white matter abnormalities linked to motor deficits and cognitive impairment. DLB is characterized by widespread involvement of cortex (especially posterior), limbic, basal ganglia, brainstem, and cholinergic system, accounting for its early cognitive impairment, neuropsychiatric, motor, and autonomic symptoms. In contrast, MSA is characterized by oligodendroglial α-synuclein inclusions, causing multi-system degeneration, with characteristic atrophy and microstructural disruption in the putamen, pons, and cerebellum that aid differential diagnosis. Multiparametric MRI offers in vivo insights into structural, microstructural, hemodynamic, metabolic, and pathological changes underlying motor dysfunction in aging and neurodegenerative disorders. Understanding the convergence of age-related motor neuron degeneration and disease-specific pathology is essential for elucidating disease mechanisms, identifying early biomarkers, and developing targeted therapies in synucleinopathies.

Chromatin-modifying complexes are critical in gene regulation, yet their proposed interactions with RNA remain poorly understood. Counter to prior models of specific recruitment, we find that WDR5, an essential subunit of the MLL1/KMT2A histone methyltransferase complex, binds RNA promiscuously. Using a stringent approach, we demonstrate that WDR5 directly engages a diverse pool of cellular RNAs, dictated primarily by RNA abundance rather than specific motifs. Equilibrium binding assays show that RNA length, rather than sequence, governs high affinity. WDR5 binds to RNA through multiple surfaces, some of which overlap with MLL1 complex subunit interfaces. Strikingly, we find that RNA binding disrupts the MLL1 complex by competitively displacing WDR5 from these critical protein-protein interactions, leading to a marked inhibition of MLL1 catalytic activity. Further experiments in human cell lines suggest that this disassembly mechanism may operate to homeostatically downregulate MLL1 complex activity, thereby integrating transcriptional activity with chromatin state.

Subjective cognitive decline (SCD) refers to cognitive concerns that may occur with or without objective impairment on standardized testing. Studies suggest that SCD may be an early clinical marker of Alzheimer's disease and related dementias, and that it can predict future objective cognitive decline and progression to dementia. However, the research that supports these conclusions is primarily based on samples with homogeneous socioeconomic and cultural backgrounds. The limited studies in samples with more diverse representations of racial, ethnic, gender, and sexual orientation characteristics show varying SCD prevalence, correlates, and outcomes. Here, we review this literature, focusing on how to apply the findings to advance our understanding of SCD. We further evaluate how our findings inform a roadmap for future research. Overall, we conclude that broader investigations across more diverse populations enhance our understanding of the factors that may differentially contribute to SCD and shape its utility as a clinical metric.

BACKGROUND/UNASSIGNED:Liver cancer poses a significant global health burden, characterized by substantial regional disparities. We analyzed liver cancer incidence and mortality across 204 countries and territories from 1990 to 2021 and projected trends from 2021 to 2041. MATERIALS AND METHODS/UNASSIGNED:Data from the Global Burden of Disease (GBD) Study 2021 were used to calculate age-standardized rate (ASR), average annual percentage change (AAPC), and estimated annual percentage change (EAPC). Risk factors, human development index (HDI), and sociodemographic index (SDI) were evaluated. The Nordpred and Bayesian Age-Period-Cohort (BAPC) models projected future trends. RESULTS/UNASSIGNED:Globally, according to the analysis of AAPC, the ASR of liver cancer incidence rose by 0.115% (95% CI: 0.07-0.159) annually, while the mortality ASR trend remains stable (-0.113%, 95% CI: -0.35-0.124). Viral hepatitis B and C remained primary causes, but non-alcoholic steatohepatitis (NASH) contributions increased. The summary exposure value (SEV) for drug use increased by 12% globally, with a dramatic increase of 308% in North America. High-HDI/SDI countries exhibited higher ASR than expected, which may be attributed to aging populations and the rising incidence of metabolic diseases. Projections indicated a rising number of cases but declining ASR for both males and females by 2041. CONCLUSIONS/UNASSIGNED:Tailored prevention strategies are needed to address region-specific risk factors and mitigate the growing burden of liver cancer.