Faculty Bibliography

BACKGROUND:Emerging data suggests that glyphosate, a non-selective herbicide, can influence reproductive health. We investigated associations of prenatal exposure to glyphosate and aminomethylphosphonic acid (AMPA), with preterm birth and its subtypes. METHODS:We used data from the NYU Children's Health and Environmental Study, a prospective birth cohort in New York City (2016-2019). Participants (n=1450) provided urine samples at 4 to <18 weeks and 18 to 25 weeks gestation. Exposure was adjusted for creatinine and natural log transformed. Preterm birth was defined as a birth occurring before 37 weeks of gestation. We also explored preterm birth subtypes, spontaneous preterm births and medically indicated preterm births as secondary outcomes. To examine associations between glyphosate and AMPA at both timepoints with preterm birth, we used generalized estimating equations with a logit link function. RESULTS:Overall, 7% (n=103) of births were preterm. Glyphosate concentrations at 18-25 weeks was associated with preterm birth (OR: 1.35, 95% CI: 1.04, 1.76) and spontaneous preterm birth (OR: 2.01, 95% CI: 1.40, 2.90). AMPA was not associated with preterm birth in any model. CONCLUSIONS:These results support evidence that glyphosate may act upon pathways leading to preterm birth and spontaneous preterm birth. Our study highlights pregnancy as a vulnerable period to glyphosate exposure.

Health care professionals in fluoroscopic laboratories face significant occupational hazards, including cancer, cataracts, and reproductive concerns due to prolonged exposure to iodizing radiation, and orthopedic injuries stemming from long-term use of heavy aprons as protection from radiation. Despite substantial advancements in radiation protection technology, adoption of these advancements has been slow, hindered by the high upfront costs of implementation and the lag in revising institutional and regulatory radiation exposure thresholds to reflect the capabilities of contemporary enhanced radiation protection devices (ERPDs). This multisociety statement, endorsed by the Society for Cardiovascular Angiography & Interventions, American College of Cardiology, the American Society of Echocardiography, the Heart Rhythm Society, the Society of Interventional Radiology, and the Society for Vascular Surgery, calls for mandatory implementation of ERPDs to meet as low as reasonably achievable standards. This expert consensus statement outlines the ethical and legal responsibilities of government, fluoroscopy laboratory manufacturers, and health care institutions to protect all health care professionals from avoidable workplace hazards and the urgent need to implement ERPDs. The document does not promote or recommend any single ERPD system, and the choice of protection technology is left to department preference. It also addresses the importance of training, monitoring, and continuous research to optimize radiation safety practices. The document advocates for updated regulations and standardized practices across states to ensure comprehensive protection for all fluoroscopy laboratory personnel.

BACKGROUND:The optimal number of pulsed field ablation (PFA) applications during atrial fibrillation (AF) ablation is unclear. We hypothesized that the number of PFA applications would predict atrial tachyarrhythmia (ATA) recurrence rates. OBJECTIVE:To determine whether higher numbers of PFA applications would decrease ATA recurrence rates. METHODS:We studied cases of patients with AF undergoing first-time ablation with PFA between 5/6/24 and 10/7/24. All patients underwent pulmonary vein and posterior wall isolation. The primary outcome was ATA recurrence. Additional outcomes included stroke, post-procedural acute kidney injury (AKI), total procedure time, and major periprocedural complications. Univariable and multivariable analyses were performed to determine if the number of PFA applications predicted ATA recurrence. RESULTS:In a cohort consisting of 177 patients, univariable and multivariable analysis showed that the number of PFA applications split at the smallest quartile (< 57 applications) versus the largest three quartiles (≥ 57 applications) was the strongest predictor of ATA recurrence (p = 0.03). ATA recurrence at 1 year (29% vs. 8%; p < 0.01) and AF burden on continuous monitor (4% vs. 0%; p < 0.01) was higher with the standard (< 57 applications) vs higher (≥ 57 applications) PFA dose groups. When comparing the standard versus higher PFA dose groups, there was no difference in total procedure time (106 vs. 107 min; p = 0.77), major periprocedural complications (0% vs. 2%; p = 0.33), or post-procedural AKI (2% vs. 2%; p = 0.69). CONCLUSION/CONCLUSIONS:Increasing number of PFA applications is associated with reduced ATA recurrence. A higher number of PFA applications may decrease ATA recurrence without affecting procedure times or complication rate.

PURPOSE/OBJECTIVE:To determine whether cephalomedullary nail (CMN) angle was associated with malreduction after intertrochanteric (IT) fracture fixation. Secondarily, to explore if CMN angle was associated with fixation failure (FF). METHODS:A retrospective comparative review was conducted of patients ≥ 65 years old with low energy falls and OTA/AO 31-A fractures treated with a CMN from 12/01/2016-06/30/2024 at a single academic institution (four hospitals). The primary outcome was immediate postoperative malreduction (IPM)-the absolute difference between post-fixation neck-shaft angle (NSA) and native contralateral NSA being ≥ 3°. The secondary outcome was FF. Univariate analyses compared IPM between 125° and 130° CMNs. Multivariable regression was performed to determine if CMN angle was associated with IPM, and as an exploratory analysis, FF. RESULTS:A total of 277 patients were included with follow-up of 18.2 ± 15.1 months. The 125° CMN group had significantly greater age, body mass index (BMI), and American Society of Anesthesiologists score (ASA). There was a higher incidence of IPM with 125° CMNs (p = 0.02). Among patients with native NSA ≥ 130°, those treated with a 125° nail had significantly higher IPM incidence (p = 0.01). Mean IPM did not differ by CMN angle. Logistic regression found that BMI (OR 1.06, p = 0.04) and 125° CMN angle (OR 1.82, p = 0.05) were associated with IPM. FF rates were similar between CMN angle groups, but failures had greater varus IPM than non-failures (p = 0.02). In the exploratory FF regression model, CMN angle and varus IPM were not associated with failure, while larger native NSA was associated with FF (OR 1.16, p < 0.001). CONCLUSION/CONCLUSIONS:125° and 130° nails achieved similar mean fracture alignment, yet 125° nails were more frequently associated with varus malreduction, especially with native valgus neck-shaft angles. After adjusting for confounders, higher BMI and 125° nails were associated with malreduction but not with fixation failure.

Understanding trauma-related psychopathology increasingly requires tools capable of capturing how symptoms and underlying mechanisms unfold across real-world contexts. Traditional assessments, which depend on retrospective recall and intermittent clinical contact, are limited in their ability to reflect the dynamic and context-sensitive processes that shape trauma-related mental health outcomes. Emerging digital health technologies and computational approaches address this gap by enabling the continuous measurement of behavior and physiology, whereas biological markers provide mechanistic insights into processes such as stress-related neuroendocrine, autonomic, immune, and sleep-wake functioning that reflect the biological embedding of trauma over time. This review integrates recent advances in digital and biological measurement in posttraumatic stress disorder (PTSD) and outlines principles for combining these approaches within computational frameworks. We emphasize the importance of grounding digital proxies in established biological theory; modeling intraindividual dynamics rather than relying solely on cross-sectional group differences; and integrating multimodal behavioral, physiological, and contextual data. We further highlight essential considerations for ethical, inclusive, and methodologically rigorous implementation, including privacy-by-design, data quality, and clinical interpretability. Together, these approaches support a more mechanistic, dynamic, and personalized understanding of trauma-related risk and recovery, with the potential to enhance early risk stratification and guide preventive and individualized models of care.

BACKGROUND:In this planned analysis of a study on the effects of dorsal root ganglion stimulation (DRGS) on sleep and functional outcomes, we evaluated device-related complications, with a focus on lead fracture. MATERIALS AND METHODS/METHODS:Data were extracted for adult patients treated with DRGS between January 2018 and February 2025 from a clinical registry; patients with ≥1 follow-up were included. Device-related adverse events, including lead fracture and migration, were identified and cross-checked against clinic notes, operative reports, and device interrogation data. Cumulative fracture probability was determined with Kaplan-Meier estimation; multivariable Cox regression was used to identify predictors of fracture. A standardized fascial anchoring technique was implemented in mid-2020 and its influence on events was assessed. RESULTS:; 95% CI, 0.893-0.996; p = 0.037); age, sex, lead level, laterality, number of leads, and primary diagnosis were not significant predictors. Crude incidence of fracture was 11.9% in unanchored leads versus 8.6% in anchored leads; however, time-to-event curves were similar, and anchoring was not an independent predictor. Most patients with fractured leads underwent revision (17/21); four experienced a second fracture. Lead migration occurred in four of 375 leads (1.2%) among four patients, mostly before routine anchoring was implemented at our center in June 2020. Five patients (5.4%) underwent explantation. CONCLUSION/CONCLUSIONS:Lead fracture remains a hinderance to long-term durability of DRGS therapy although events were usually manageable with restoration of therapeutic effect. Anchoring did not change fracture risk but coincided with low migration rates. BMI was the only significant predictor of fracture.

Healthcare workers (HCWs) in emergency departments face significant mental health risk due to chronic stressors and repeated trauma, yet symptom underreporting and bias in self-reports hinder accurate assessments. Expressive flexibility, the ability to dynamically modulate and recover from stressor-related changes in emotional arousal as reflected in observable behavior, has been linked to resilience. This NIH-funded study (R01HL156134) utilized digital phenotyping and computer vision to analyze dynamic facial expressivity during video-recorded interviews about work-related stressful situations with 240 HCWs (278 assessments). Participants additionally completed validated questionnaires to assess burnout, PTSD, depression, anxiety, and resilience. Latent profile analysis revealed two clinical phenotypes: At-risk (57.6%) and Resilient/Adaptive (42.4%). Machine learning models demonstrated high classification performance (accuracy = 0.83 ± 0.06, F1-score = 0.87 ± 0.05). Our findings indicate that digital biomarkers of temporal facial dynamics may serve as objective behavioral proxies of expressive flexibility, potentially capturing dynamics consistent with underlying stress-regulatory processes. These findings highlight their potential to improve identification of resilience-related phenotypes and support well-being and mental health in HCWs.

Timely linkage from HIV diagnosis to care is critical for effective treatment and epidemic control. We evaluated the effectiveness of conditional micro-incentives on linkage to HIV care in the Home-Based Intervention to Test and Start (HITS) trial, a real-world implementation trial in rural South Africa. Of 45 communities in uMkhanyakude, KwaZulu-Natal, 16 were randomized to micro-incentive arms offering food vouchers (R50 [US$3]) conditional on completing home-based HIV counseling and testing (HBHCT) and linkage to care within 6 weeks, and 29 to non-incentive arms. All individuals were eligible for HBHCT, enrolled between February and December 2018, and followed for 1 year. The primary outcome was linkage to care at 1 year among men; secondary outcomes included linkage within the 6-week voucher eligibility among men and women, and at 1 year among women. Intention-to-treat analyses were performed using Poisson regression adjusted for study arms. Among 13,894 men and 19,884 women eligible for the study (aged ≥15 years), home-based testing uptake was 21% (n=2,867) and 29% (n=5,795), yielding 122 (4.3%) and 375 (6.5%) new diagnoses, respectively. Overall, micro-incentives nearly doubled HIV-positive diagnoses. Among men, micro-incentives did not increase linkage to care within 6 weeks (risk ratio [RR]=0.78, 95% CI: 0.51-1.21) or at 1 year (RR=1.08, 95% CI: 0.86-1.35). Among women, micro-incentives increased linkage to care within 6 weeks by 51% (RR=1.51; 95% CI: 1.03-2.21), with no residual impact at 1 year (RR=1.07, 95% CI: 0.91-1.26). In a hyper-endemic rural African setting, once-off micro-incentives can substantially increase early linkage to HIV care among women during the incentive eligibility period but are inadequate to significantly improve care engagement among men.

The social environment refers to our interpersonal relations, workplaces, and neighborhoods, towns, or cities in which we live. A growing literature indicates that social environments are related to cognitive aging and risk of Alzheimer's disease and related dementias (AD/ADRD). Still, relatively little is known about how social-environmental exposures affect cognitive function over the life course and into older ages. Addressing this limitation, our paper outlines key features of the social environment and recommends priority areas of research on the social environment and cognitive aging. We divide our discussion into three subdomains: social connections, residential context, and work context. We then identify important gaps in the conceptual and empirical literature before outlining avenues for future research to strengthen our understanding of how social-environmental exposures over the life course link with cognitive function and AD/ADRD risk in late life.

Health care professionals in fluoroscopic laboratories face significant occupational hazards, including cancer, cataracts, and reproductive concerns due to prolonged exposure to iodizing radiation, and orthopedic injuries stemming from long-term use of heavy aprons as protection from radiation. Despite substantial advancements in radiation protection technology, adoption of these advancements has been slow, hindered by the high upfront costs of implementation and the lag in revising institutional and regulatory radiation exposure thresholds to reflect the capabilities of contemporary enhanced radiation protection devices (ERPDs). This multisociety statement, endorsed by the Society for Cardiovascular Angiography & Interventions, American College of Cardiology, the American Society of Echocardiography, the Heart Rhythm Society, the Society of Interventional Radiology, and the Society for Vascular Surgery, calls for mandatory implementation of ERPDs to meet as low as reasonably achievable standards. This expert consensus statement outlines the ethical and legal responsibilities of government, fluoroscopy laboratory manufacturers, and health care institutions to protect all health care professionals from avoidable workplace hazards and the urgent need to implement ERPDs. The document does not promote or recommend any single ERPD system, and the choice of protection technology is left to department preference. It also addresses the importance of training, monitoring, and continuous research to optimize radiation safety practices. The document advocates for updated regulations and standardized practices across states to ensure comprehensive protection for all fluoroscopy laboratory personnel.