Faculty Bibliography

IMPORTANCE/UNASSIGNED:The 2026 American College of Cardiology/American Heart Association/Multisociety Dyslipidemia Guideline newly recommends selective use of coronary artery calcium (CAC) scoring based on a 10-year risk of 3% to less than 10% estimated with the Predicting Risk of Cardiovascular Disease EVENTS (PREVENT) atherosclerotic cardiovascular disease (ASCVD) equations. However, the utility of CAC scoring alongside the PREVENT equations for ASCVD risk estimation is not known. OBJECTIVE/UNASSIGNED:To determine the change in predictive utility when adding CAC scores to the PREVENT-ASCVD equations. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:Longitudinal observational cohort study conducted at 6 sites in the United States and enrolling adult participants aged 45 to 79 years without ASCVD at baseline in the Multi-Ethnic Study of Atherosclerosis. EXPOSURES/UNASSIGNED:Ten-year ASCVD risk with the PREVENT-ASCVD equations before and after adding CAC scores. MAIN OUTCOMES/UNASSIGNED:Performance metrics for estimation of risk of fatal and nonfatal ASCVD, assessed using the Harrell C statistic, calibration, and net reclassification improvement (NRI) for newly defined ASCVD risk categories: low (<3%); borderline (3% to <5%); intermediate (5% to <10%); and high (≥10%). RESULTS/UNASSIGNED:A total of 6098 participants were included. At baseline, participant mean age was 61.4 (SD, 9.6) years, 52% were female, mean estimated 10-year ASCVD risk was 6.4% (SD, 4.8%) with the PREVENT-ASCVD base equations, and 49% had a CAC score greater than 0. During 10 years of follow-up, 366 (6%) experienced an ASCVD event. The Harrell C statistic for the PREVENT-ASCVD base equations was 0.73 (95% CI, 0.70-0.75). After adding CAC to the PREVENT-ASCVD base equations, the change in Harrell C statistic was 0.02 (95% CI, 0.01-0.03), and the categorical NRI was 0.095 (95% CI, 0.053-0.137). The calibration slope for the PREVENT-ASCVD base equations was 1.09 (95% CI, 0.93-1.25), and for the PREVENT-ASCVD base plus CAC equations was 0.92 (95% CI, 0.81-1.03). Among those at borderline risk, incident ASCVD occurred in 1.9% of those with CAC score of 0, 3.9% with CAC greater than 0 and less than 100, 7.4% with CAC 100 or greater and less than 300, and 14.3% with CAC 300 or greater. CONCLUSIONS AND RELEVANCE/UNASSIGNED:Among US adults aged 45 to 79 years, addition of CAC score to the PREVENT-ASCVD equations across all risk groups overall only modestly improved and, in some groups, did not change model discrimination and reclassification. Reclassification results support selective use of CAC in those with borderline to intermediate risk estimated by the PREVENT-ASCVD equations.

INTRODUCTION/BACKGROUND:Functional brain network alterations associated with Alzheimer's disease (AD) pathology, including amyloid beta (Aβ) and phosphorylated tau (p-tau), are difficult to interpret due to overlapping aging-associated and non-amyloid biological processes. METHODS:-specific network dimensions and predict individual Aβ and p-tau levels. RESULTS:individuals involved language-related regions and aging-associated molecular pathways. CONCLUSION/CONCLUSIONS:These findings suggest that contrastive graph learning may help separate amyloid-associated functional network variation from broader background biological variability, providing insight into the heterogeneity of AD-related biomarkers and cognitive dysfunction.

Multimodal large language models are increasingly used for dermatologic queries, but whether Fitzpatrick skin type (FST) labels affect diagnostic accuracy is unknown. We evaluated 656 biopsy-confirmed photographs from the Diverse Dermatology Images (DDI) dataset under no-FST, DDI-concordant FST, and two DDI-discordant FST conditions using ChatGPT 5.2 Edu and Gemini 3.1 Pro browser configurations (5248 evaluations). Confirmed malignant diagnosis omission from the top three differential diagnoses ("lethal miss") was a prespecified exploratory outcome. Gemini had higher ordinal accuracy than ChatGPT (odds ratio 2.32; 95% confidence interval 2.01-2.67; false discovery rate-adjusted p < 0.001). No FST prompt condition significantly improved accuracy over no-FST prompting; an equal-image-weighted sensitivity analysis yielded similar results. Among malignant images eligible for extreme discordance, extreme DDI-discordant prompting was associated with more ChatGPT lethal misses than no-FST prompting (paired odds ratio 5.0; p = 0.043); Gemini showed no significant paired shift (p = 1.00). Post hoc binary malignancy detection showed low no-FST specificity for ChatGPT (42.5%) and Gemini (22.9%), indicating frequent overcalling. Gemini showed lower no-FST accuracy for malignant FST V-VI images than for FST I-II and III-IV images. FST prompting provided no measurable diagnostic benefit. Neither configuration supports autonomous dermatologic use.

STUDY DESIGN/UNASSIGNED:Retrospective cohort study. OBJECTIVES/UNASSIGNED:Given its high and increasing prevalence in the United States, rheumatoid arthritis (RA) has been a growing area of focus for spine surgeons. The literature regarding the long-term outcomes of RA patients undergoing adult spinal deformity (ASD) surgery is limited. Thus, the purpose of this study was to compare the postoperative complications and revisions through 2 years postoperatively between patients with and without RA undergoing ASD surgery. METHODS/UNASSIGNED:A retrospective analysis of the New York Statewide Planning and Research Cooperative System database was performed. Patients undergoing spinal fusion for ASD were selected for and divided into two cohorts based on RA status. Univariate analysis compared demographics, complications, length of stay, and revisions between cohorts. Multivariate logistic regression models, adjusted for age, gender, number of levels fused, and Deyo score. RESULTS/UNASSIGNED:= 0.03). CONCLUSION/UNASSIGNED:This study found RA to be an independent risk factor for increased complications and subsequent revision surgery after fusion surgery for ASD. Surgeons can use this data when counselling patients with RA regarding their operative risk.

Myelofibrosis (MF) is a chronic, progressive myeloproliferative neoplasm characterized by bone marrow fibrosis, ineffective blood cell production, and neoplastic extramedullary hematopoiesis (EMH) occurring primarily within the spleen. To explore the molecular mechanisms underlying splenic EMH, we performed single-cell transcriptional and chromatin profiling of cells from MF spleens that had been surgically removed. We demonstrate significant expansion of hematopoietic stem and progenitor cells, coupled with aberrant differentiation toward the erythroid and megakaryocytic lineages, associated with a significant enrichment of inflammatory pathways with enhanced NF-κB signaling and IFN responses, as well as dysregulation of the inferred function of differentiation-defining transcription factors. Finally, we report a significant remodeling of the immune microenvironment in MF spleens, characterized by emergence of dysfunctional T cell subsets and inflammatory memory B cells, suggesting the concomitant establishment of a pro-inflammatory and immune-tolerant tumor microenvironment within the spleen that influences hematopoietic cell differentiation and impairs tumor immune surveillance.

BACKGROUND/UNASSIGNED:Asbestosis is a progressive interstitial lung disease caused by inhalation of asbestos fibres. Although asbestos use was banned in the Netherlands in 1993, new cases continue to be diagnosed. Since 2014, a national compensation system has enabled systematic assessment of asbestosis incidence and outcomes. This population-based study examined national trends in asbestosis incidence from 2014-2024 and evaluated survival and prognostic factors. METHODS/UNASSIGNED:We conducted a retrospective national cohort study including all adults (≥18 years) diagnosed with asbestosis between 2014-2024 according to Dutch Health Council criteria used for compensation. Diagnoses were established by consensus of three independent pulmonologists based on radiological evidence of diffuse pulmonary fibrosis, ≥5 fibre-years of exposure, and lung function impairment according to American Medical Association (AMA) criteria. Demographic data, lung function, work history and overall survival were collected. Incidence per 100 000 persons per year was calculated. RESULTS/UNASSIGNED:Of 1004 applicants, 476 (47.4%) met criteria for asbestosis. Median age at diagnosis was 77 years, and 98.9% were male. Annual incidence ranged from 0.115 to 0.347 per 100 000, with no significant temporal trend (Spearman rho 0.41; p=0.214). AMA class 4 was most common (44.5%) and strongly associated with mortality (hazard ratio 2.52, 95% CI 1.81-3.49). Older age also predicted poorer survival. Median survival ranged from 25.5 months (AMA 4) to 83.4 months (AMA 0-2). Time-dependent modelling showed increasing hazard over time for AMA class 4. CONCLUSIONS/UNASSIGNED:More than two decades after the asbestos ban, asbestosis incidence remains stable. AMA class and age are key predictors of survival.

We have identified glomerulotubular neck stenoses as a novel feature of kidney histopathology that is associated with chronic kidney disease, independently of interstitial fibrosis and tubular atrophy. Herein we review the occurrence, morphology, and consequences of stenotic glomerulotubular necks, and propose future investigations.

BACKGROUND:Overdose is a large concern in permanent supportive housing (PSH), yet has been sparsely addressed in research or practice. We previously developed a technical assistance intervention to empower PSH buildings to implement evidence-based overdose prevention practices. We now describe delivery of and participation in this novel intervention. METHODS:Intervention delivery occurred over four six-month periods from November 2023-January 2026. The six-month intervention included a written implementation Toolkit, individually-tailored practice facilitation sessions, and monthly learning collaboratives. Tenant implementation champions participated alongside staff champions and other key building leaders. Trained practice facilitators recorded the attendance and content of all intervention sessions in REDCap logs. Analysis used quantitative descriptive methods. RESULTS:Twenty buildings received the intervention; they were located in New York City and upstate New York and served over 1200 PSH tenants. One building discontinued the intervention due to lack of staff time. The remaining 19 buildings participated in 95% of planned practice facilitation sessions. Additionally, 17 buildings attended over half of the monthly learning collaboratives. Most practice facilitation sessions and learning collaboratives (94%; 211 of 225 sessions) included the full content as planned in the intervention guide. CONCLUSION/CONCLUSIONS:We implemented a novel, place-based intervention to address the leading cause of death among PSH tenants, a population that faces outsized overdose risks. The intervention was feasible to deliver, designed to be sustainable and scalable, and may be a model for other communities seeking to reduce overdose risk in PSH and similar housing settings.

OBJECTIVE:Belting is a vocal quality commonly used across contemporary singing genres. Despite its ubiquity, belting production and perception are highly debated. Variable methodologies and terminology used to discuss, teach, and study belting limit our understanding of underlying mechanisms and restrict the development of science-informed voice pedagogy. We systematically examined the published literature on belting to identify commonalities, disagreements, and directions for future research. METHODS:We conducted a scoping review surveying English-language peer-reviewed scientific studies and pedagogical publications on belting in adult singers that were published between January 1978 and November 2025. Data were extracted and grouped into the following categories: perception, acoustics, physiology, and pedagogy. RESULTS:In total, 2018 publications were reviewed. 472 underwent full-text review, and 112 met inclusion criteria, comprising 58 scientific studies and 54 pedagogical publications. Most scientific studies were cross-sectional comparing the same group or population across variable tasks (n = 25), and pedagogical publications were largely expert commentary (n = 32). Perceptually, belting was characterized as having "bright" or "forward" resonance and increased loudness. Acoustic findings included higher first and second formant frequencies, with the first formant tuned to the second harmonic. Physiologically, belting was associated with an elevated laryngeal position, pharyngeal narrowing, closed quotient >50%, high subglottal pressure, and "megaphone" mouth shape. High individual variability was a hallmark of all findings. Terminology was highly variable, with over 100 words and phrases used to describe belting. CONCLUSIONS:High variability of findings suggests that belting is better understood as a family of related vocal behaviors than as a single, homogeneous phenomenon. We propose three tenets for future work: (1) use of objective acoustic and physiological terminology to define belting, (2) inclusion of multiple terminologies where appropriate to reflect the diversity of learning styles and individual physicality, and (3) use of auditory anchors to supplement written definitions and reduce perceptual ambiguity.