Faculty Bibliography

We examined the characteristics of subway- and train-related electrocution deaths in New York City between January 1, 2018 and May 31, 2024. These subway and train systems utilize an electrified third rail between 600V and 750V DC. During this period, there were 61 deaths due to electrocution. Of these, 39 cases occurred in the subway or train systems (NYC subway, Long Island Rail Road, Port Authority Trans-Hudson), 27 of which were due to electrocution only, and 12 due to a combination of electrocution and blunt trauma. The manners of death among these 39 deaths were: 23 accident, 11 undetermined, 4 suicide, and 1 homicide. In 36 of 39 deaths, significant charring of the skin was present on at least one part of the body, with charring present in more than one part of the body in most cases. Many cases also demonstrated a characteristic blistering pattern of electrothermal injury at a different location on the body away from the charring that may correspond to an electrical current "exit site." Notably, in two cases, only relatively minor electrothermal injury was identified.

Aging is an important risk factor for Parkinson's disease (PD). Characterizing age-related alterations in the nigrostriatal system may help identify early vulnerability prior to overt neurodegeneration. We aimed to delineate aging trajectories of structure and hemodynamics of the nigrostriatal system and examine their associations with motor and cognitive functions. We analyzed 486 healthy adults from Human Connectome Project-Aging dataset, stratified into younger (≤ 60 years) and older (> 60 years) groups. Motor, cognitive, and motor cognition functions were assessed. Multiparametric MRI included T1- and T2-weighted, multi-delay arterial spin labeling, and multi-shell diffusion imaging. Volumes, T1/T2 ratio, arterial transit time (ATT), and cerebral blood flow (CBF) were quantified in the nigrostriatal nuclei. The nigrostriatal tract (NST) was reconstructed and segmented along the nigra-to-striatum axis. Diffusion metrics and quantitative anisotropy were derived. A composite nigrostriatal aging index (NAI) was generated using principal component analysis. Older adults exhibited reduced substantia nigra and putamen volumes, increased caudate volume, prolonged ATT, and reduced CBF across nigrostriatal nuclei. The NST showed segment-specific age trajectories, with increased diffusivity after age 60. Imaging alterations in nigrostriatal nuclei and tract segments correlated with declines in motor, cognitive, and motor-cognitive performance. The NAI increased more steeply after age 60 and predicted poorer behavioral performance exclusively in older adults. Healthy aging is characterized by coordinated structural and hemodynamic alterations within the nigrostriatal system associated with functional decline. The composite NAI provides a sensitive framework for detecting early nigrostriatal vulnerability in older adults prior to overt neurodegeneration.

INTRODUCTION/BACKGROUND:Cognitive decrements in executive function and processing speed have been found in post-9/11 Veterans who have mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD). Decision making (DM) involves the coordination of cognitive sub-processes involving different brain regions known to be impacted by mTBI and/or PTSD, and so may be expected to be compromised. The ability to incorporate context is important because it plays a role in almost every cognitive and social process. However, DM abilities, including DM that requires taking context into account, are not typically assessed or investigated in Veterans. MATERIALS AND METHODS/METHODS:We prospectively recruited Veterans deployed to Iraq or Afghanistan who had the following characteristics: (1) no TBI before deployment, (2) mTBI because of blast only, (3) current PTSD (diagnosed within 6 months), and (4) ≤49 years of age. Deployed Veterans with no mTBI or PTSD served as the comparison group. Veterans with mTBI and comorbid PTSD (mTBI + PTSD; n = 9) and Veterans without mTBI or PTSD (n = 8) performed the Cognitive Bias Task, a DM task in which participants are asked to make a decision based on preference, and the extent to which choices are influenced by contextual information is measured. To further understand any association between DM and mTBI + PTSD, participants also filled out questionnaires to measure neurobehavioral and PTSD symptoms. Because normality was violated in both groups, Fisher's Exact and Mann-Whitney tests and Spearman's rank order correlations were used. RESULTS:Although Veterans without mTBI + PTSD made context-dependent choices, Veterans with mTBI + PTSD made context-independent choices (p = .034), similar to prior research examining individuals with severe TBI and left lateralized frontal lobe brain lesions. As expected, Veterans with mTBI + PTSD also demonstrated elevated scores on the symptom measures. Symptom measure scores were correlated with Cognitive Bias Task (CBT) scores and revealed a negative correlation between somatic, and marginally cognitive and arousal symptoms, and the extent to which context was incorporated into decisions. CONCLUSIONS:Veterans an average of 4.0 years after blast injury who had active PTSD (mTBI + PTSD) did not incorporate contextual information when making their decisions. Because understanding context is required in many everyday activities, if findings replicate in studies with larger samples, clinical testing for DM difficulties and training for context incorporation may improve everyday function in Veterans with mTBI + PTSD.

BACKGROUND:The current generation of 1.3 billion adolescents (10-19-year-olds), most of whom live in low- and middle-income countries, face large and growing mental health problems. Collective action that could lead to significant improvement in adolescent mental health and well-being (AMH) remains limited. We analyse the factors shaping the global prioritization of AMH for funding and action and reflect on a way forward. METHODS:We triangulate data from interviews with key informants knowledgeable in AMH; focus group discussions with youth representatives who are mental health advocates, some with lived experience of mental ill-health; and document review. We collected the qualitative data from 2021 to 2023, followed by thematic analysis and stakeholder consultations. RESULTS:We identify four themes which shape the global prioritization of AMH. First, prevailing interpersonal and institutional stigma and discrimination directed against adolescents with mental health problems hamper attention to AMH. Second, limited data on the burden of mental health problems and evidence of what works have led to the perception among decision-makers that AMH is an intractable problem. Third, diverse ways of framing AMH are often viewed as a sign of weak alignment rather than as opportunities for coalition-building. Fourth, a wide variety and increasing number of stakeholders are involved in AMH, while the stakeholder landscape remains fragmented, inhibiting coalition-building for AMH. CONCLUSIONS:To overcome the barriers that currently impede the prioritization of AMH, we recommend that (1) stakeholders conduct an adolescent-led consultative process to develop an "umbrella framing", supported by common metrics, (2) advocates use existing global platforms to shape the political priority for AMH, (3) decision-makers, funders and research partners invest in meaningful engagement of adolescents (with lived experience), researchers and implementing partners (4) identify a leadership, governance and accountability structure for a global coalition that could transform AMH and (5) conduct context-specific analyses to inform coalition-building nationally.

BACKGROUND:Flow diversion is effective for unruptured distal anterior cerebral artery (DACA) aneurysms, yet comparative data between the Silk Vista Baby (SVB) and Pipeline Embolization Device (PED) in this challenging territory remain scarce. METHODS:We conducted a retrospective multicenter study using the CRETA Registry, including consecutive patients with unruptured DACA aneurysms treated with SVB or PED. The primary endpoint was complete angiographic occlusion (O'Kelly-Marotta grade D). Secondary outcomes included procedural characteristics, clinical outcome (modified Rankin Scale), and complications. Overlap weighting was applied to account for non-randomized treatment allocation. Predictors of occlusion were explored using penalized logistic regression. A sensitivity analysis using a reduced five-variable model was performed to assess model robustness. RESULTS:137 patients were included (79 SVB, 58 PED). Within the PED group, devices included Pipeline Flex (n = 34), Pipeline Flex with Shield Technology (n = 14), and Pipeline Vantage with Shield Technology (n = 10). After overlap weighting, baseline characteristics were balanced; the effective sample size was 100.4. SVB procedures more often used a single device; PED frequently required multiple stents. Procedure duration was shorter with SVB. Complete occlusion was achieved in 69.6% (SVB) and 70.7% (PED) of aneurysms, with no significant difference in adjusted analysis (OR 1.32, 95% CI 0.59-2.96). Favorable clinical outcomes were observed in both groups, with acceptable and comparable complication rates. No variable, including device type, independently predicted complete occlusion, a finding confirmed in a reduced five-variable sensitivity analysis (aOR 1.04, 95% CI 0.47-2.31; p = 0.915). CONCLUSIONS:SVB and PED demonstrated comparable angiographic efficacy and clinical safety for unruptured DACA aneurysms. Despite procedural differences, mid-term occlusion rates and outcomes were similar. Device selection in this distal territory may be guided primarily by anatomical considerations and operator preference rather than expectations of differential performance.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Implementation of telemedicine expanded options for outpatient neurology care. It remains uncertain which new neurology patients can be appropriately evaluated virtually. We compared subsequent health care utilization after virtual vs in-person new patient neurology visits across 3 academic medical centers. METHODS:We conducted a retrospective multicenter cohort study of adults with a new outpatient neurology visit from September 2020 through December 2021 using the Vizient Clinical Data Base and Clinical Practice Solutions Center databases. Virtual and in-person patients were matched 1:1 using propensity scores incorporating demographics, clinical characteristics, time period, and previous health care utilization. Outcomes were analyzed overall and stratified by neurologic chief complaint category and institution. We compared rates of subsequent neurologic clinic follow-up, emergency department (ED) visits, and hospitalizations after virtual and in-person encounters. Testing and all-cause ED visits/hospitalizations were also assessed. RESULTS:= 0.13, respectively). Analyses by chief complaint found that 90-day follow-up was higher after in-person visits for dementia, whereas 30- and 90-day follow-up was higher after virtual visits for Parkinson disease and multiple sclerosis, and 90-day follow-up was higher after virtual visits for headache. Testing was more frequent after in-person visits for certain chief complaints. DISCUSSION/CONCLUSIONS:In this propensity score-matched multicenter cohort, new neurology patients seen virtually had similar downstream utilization as those seen in-person, including comparable 90-day follow-up and similar neurologic and all-cause ED visits and hospitalizations. Although follow-up varied modestly by chief complaint and testing was more frequent after some in-person visits, no major differences emerged overall.

Gut microbiome dysbiosis has been implicated in the pathogenesis of systemic lupus erythematosus (SLE). However, microbiota-targeted therapeutic strategies have been lacking. Here, we report the potential of Faecalibacterium prausnitzii (strain UT1) to ameliorate gut dysbiosis and alleviate disease progression in the B6.Sle1.Yaa male mouse model of SLE. Fecal metagenomes of patients with SLE shifted carbohydrate catabolism from dietary fibers to host glycans, coinciding with depletion of F. prausnitzii. Oral administration of UT1 partially reversed lupus-associated microbiome alterations and rescued carbohydrate metabolic deficiency in lupus-prone mice. Using correlative metatranscriptomics and metabolomics, we observed restricted expression of bacterial genes related to mucin degradation, elevated pentose phosphate pathway and bile acid-modifying activities, and redirected tryptophan catabolism toward indoleacetic and indoleacrylic acids. Further host cell profiling showed that UT1 rebalanced colonic regulatory T (Treg) and T helper 17 (Th17) cell responses, suppressed systemic autoimmune activation and autoantibody production, and reduced renal pathology. Thus, our findings identify SLE-associated active microbiome signatures and provide a probiotic candidate for the treatment of lupus disease.

OBJECTIVES/OBJECTIVE:Physician burnout is associated with both intention to leave practice and turnover. However, the individual dimensions of burnout-cynicism, exhaustion, and poor personal efficacy-have not been examined as predictors of physician intent to leave practice or departure. We sought to determine whether these individual dimensions of burnout are independent predictors of physician intent to leave practice or departure. DESIGN/METHODS:In a retrospective cohort study, we merged longitudinal survey data from all actively employed physicians at the Massachusetts General Physicians Organization (MGPO) from 2017, 2019, and 2021 with physician employment status two years after survey completion. SETTING/METHODS:Survey data were gathered from all actively employed physicians at the Massachusetts General Physicians Organization (MGPO), the largest physicians organization in New England and one of the largest in the USA. PARTICIPANTS/METHODS:There were 5976 survey responses from 2651 unique physicians over the three sequential survey years, with a survey response rate of > 90%. MAIN OUTCOMES AND MEASURES/METHODS:Rates of self-reported intention to leave and actual physician departure among physicians were analyzed by general burnout scores and scores on the three individual burnout subscales. RESULTS:Burnout was independently associated with both intention to leave (OR = 3.10, 95% CI 2.55-3.77) and physician departure (OR = 1.37, 95% CI 1.15-1.64). High scores on all three individual burnout subscales were associated with increased odds of intention to leave (exhaustion OR = 1.55, 95% CI 1.25-1.92; cynicism OR = 2.49, 95% CI 1.99-3.13; personal efficacy OR = 1.45, 95% CI 1.19-1.77). However, only high cynicism scores were associated with actual departure (cynicism OR = 1.37, 95% CI 1.12-1.68). Physicians who departed were significantly more likely to have previously expressed an intention to leave than those who remained (33.6% vs. 6.7%, p < 0.001). CONCLUSIONS:Physician cynicism is the only burnout dimension associated with departure, though multiple burnout dimensions are associated with intention to leave. Organizational efforts to combat cynicism may be especially effective in promoting physician retention.