Faculty Bibliography

PURPOSE/UNASSIGNED:This scoping review sought to synthesize human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, incidence, risk behaviors, and risk perceptions among transmasculine (TM) individuals globally. METHODS/UNASSIGNED:Eligible articles were peer-reviewed observational and interventional studies published in English between August 2, 2014 and November 2, 2021. Four electronic databases were systematically searched: PubMed, Embase, PsycInfo, and Sociological Abstracts and reference lists hand-searched. Results are presented using numerical summary and thematic analysis. RESULTS/UNASSIGNED:=39) spanned 12 countries and 2 multi-region studies. Laboratory-confirmed HIV prevalence ranged from 0% to 4% and self-reported HIV prevalence from 0% to 8%. Laboratory-confirmed STI diagnoses ranged from 1.2% to 7.7% for chlamydia, 0% to 10.5% for gonorrhea, 0% to 6% for syphilis, 1% to 8% for hepatitis C, and 0% to 8% for hepatitis B. Self-reported lifetime diagnosis of any STI ranged from 5.8% to 53.7%. No studies assessed HIV or STI incidence. Lifetime HIV testing prevalence varied from 23% to 89%. Lifetime STI testing prevalence ranged from 31.1% to 70.8%. Pre- and post-exposure prophylaxis use and knowledge were assessed in seven studies. Qualitative studies addressed HIV vulnerabilities and protective factors, including stigma and social, medical, and legal supports. CONCLUSION/UNASSIGNED:Although TM individuals are vulnerable to HIV and STI, incidence data are lacking. There is a dearth of research on the experiences, risk factors, and sexual behaviors of TM individuals, especially those who are nonbinary or ethnoracially minoritized. The collection of gender identity data in routine HIV surveillance is recommended. Services and interventions developed by and for TM individuals are needed.

BACKGROUND/UNASSIGNED:Point of care ultrasound (POCUS) training in internal medicine (IM) training remains largely unavailable in lower-resourced health systems globally. Longitudinal inter-institutional collaboration, based in health equity principles, offers a potential mechanism for more accessible and effective IM POCUS education. METHODS/UNASSIGNED:In a partnership between two academic medical centers in Caracas, Venezuela (Luis Razetti School of Medicine at the Universidad Central de Venezuela (UCV)) and New York, USA (New York University (NYU) Grossman School of Medicine), we evaluated the impact of an IM POCUS training program on knowledge and skills of IM physicians at UCV. During 2023-2024, 18 UCV IM physicians participated in the program. The program included online tutorials and quizzes, in-person image interpretation review, and supervised practice. Participants completed a pre-course knowledge assessment, post-course knowledge, skills, and self-confidence assessments, and qualitative feedback regarding course acceptability. RESULTS/UNASSIGNED:Pre-to-post knowledge assessments demonstrated mean score improvement. Post-course knowledge scores were not significantly different between UCV and NYU cohorts (77% vs. 78%, respectively; p =0.82). Skill scores measured by a hands-on test were comparable between groups, with few significant differences. Learners self-rated increases in confidence during the course, and rated the course as locally acceptable and sustainable. CONCLUSIONS/UNASSIGNED:A standardized, longitudinal, international IM POCUS training program was successfully implemented with faculty learners in a lower-resourced health system, who demonstrated gains in knowledge and skills, and reported high educational value of the partnership. The results support expanding inter-institutional POCUS training programs founded in health equity principles.

BACKGROUND/UNASSIGNED:In May 2022, mpox (formerly monkeypox) began spreading globally through LGBTQ+ sexual networks. By August 2022, New York City (NYC) became the global epicenter of the mpox outbreak, with the highest number of cases reported in the United States. Here, we quantify the mpox vaccination effort, focusing on flexible and community-responsive mobile vaccination. METHODS/UNASSIGNED:We describe an on-site mpox vaccination strategy at commercial sex venues, nightlife venues, and pride and health centers, during August 1-November 15, 2022. Data were collected on doses, demographics, and event size to determine and evaluate vaccine uptake. RESULTS/UNASSIGNED:The on-site vaccination strategy resulted in 3358 JYNNEOS doses administered at 363 events at 58 locations, including 22 events at 2 commercial sex venues. Commercial sex venues in New York City closed at the height of the mpox epidemic. We show high uptake of the JYNNEOS vaccine at commercial sex venues, with as many as 60% of attendees of 1 event receiving a JYNNEOS vaccine dose on site. This was possible after New York City health agencies responded to community demand for second doses. Messaging about the importance and availability of vaccination at these parties was community-led. JYNNEOS vaccination via mobile clinics demonstrated less racial and geographic disparity compared with nonmobile vaccinations. We show no increase in mpox cases as commercial sex venues reopened with vaccination on site. CONCLUSIONS/UNASSIGNED:These results demonstrate the success of a community-led rapid response to an emergent mpox outbreak, including at places where people meet for sex.

BACKGROUND:Drug overdose deaths have increased fivefold over the last 20 years, primarily fueled by synthetic opioids, which led the Centers for Disease Control and Prevention to declare an opioid overdose epidemic. Responding to this epidemic, we designed and implemented opioid overdose prevention (OOP) training for medical students to help promote effective naloxone usage. Previously, we compared online and in-person versions of OOP training over 2 years of training. To better establish the evidence for online training, we performed a randomized controlled non-inferiority trial comparing in-person with online opioid prevention training. METHODS:Third-year medical students were randomized into groups to receive either in-person or online training in preparation for clinical rotations. Students randomized to receive online training were provided a link to the training modules. Students randomized to receive in-person training were trained in an in-person setting. We performed a non-inferiority per-protocol analysis with the primary outcome of knowledge using a non-inferiority margin of a -9.1% difference between groups. RESULTS:A total of 205 students were randomized, 103 students to in-person training and 102 to online training. Eighty-three in-person students and 104 online students were included. The online group had a higher post-training knowledge score compared to the in-person group by 0.44 points (0-11 point scale) with a 95% CI of (-0.04, 0.93) that did not cross the margin of non-inferiority. CONCLUSIONS:Online training for OOP was effective and non-inferior to in-person training. Online OOP training may be considered an alternative to in-person training.

OBJECTIVE:This study examined associations between access to leisure-time physical activity (LTPA) facilities and parks and repeated measures of glycated hemoglobin (A1C) over time, using follow-up tests among United States Veterans with newly diagnosed type-2 diabetes (T2D). METHODS:Data were analyzed from 274,463 patients in the Veterans Administration Diabetes Risk cohort who were newly diagnosed with T2D between 2008 and 2018 and followed through 2023. Generalized estimating equations with a logit link function and binomial logistic regression were used to examine associations. RESULTS:Patients were on average 60.5 years of age, predominantly male (95.0 %) and white (66.9 %), and had an average of 11.7 A1C tests during the study follow-up period. In high- and low-density urban communities, a one-unit higher LTPA facility density score was associated with 1 % and 3 % greater likelihood of in-range A1C tests during follow-up, respectively, but no association was observed among patients living in suburban/small town and rural communities. Across community types, closer park distance was not associated with subsequent greater odds of in-range A1C tests. Unexpectedly, in low-density urban areas, the likelihood of in-range A1C tests was 1 % lower at farther park distances. CONCLUSIONS:These results suggest that broader access to LTPA facilities, but not park proximity, may contribute in small ways to maintaining glycemic control after T2D diagnosis in urban communities. Tailored interventions may be needed to promote patients' effective use of LTPA facilities and parks.

INTRODUCTION/BACKGROUND:Black sexually minoritized men and gender-expansive people (SGM), including transgender women, have higher levels of alcohol use and experience greater negative consequences from alcohol consumption than the general population. We investigated the role of multilevel factors contributing to alcohol use among these groups. METHODS:We analyzed data collected from HIV-negative participants in the Neighborhoods and Network (N2) cohort study in Chicago, IL (N = 138). Participants completed a social network inventory (November 2018-April 2019) and reported alcohol use (frequency, quantity, and frequency of binge drinking) during a quantitative assessment. We used stepwise negative binomial regression to identify associations with social network and individual-level alcohol use while controlling for sociodemographic variables. RESULTS: = 2.7), of whom 93% were Black and 78% were friends/family. Among the confidants, 30% drank alcohol at least several times per week. Identifying as Latine (RR = 2.21; 95% CI: 1.44-3.10), having a higher Generalized Anxiety Disorder-7 score (RR = 1.03; 95%CI: 1.00-1.05), living with a problem drinker during one's childhood (RR = 1.80; 95% CI: 1.39-2.34), and having a greater proportion of regular drinkers in one's social network (RR = 1.49; 95% CI: 1.02-2.17) were positively associated with alcohol use. CONCLUSION/CONCLUSIONS:Black SGM exposed to social network alcohol use during childhood and adulthood reported increased alcohol use. Interventions targeting Black SGM should address social norms around alcohol, intersectional discrimination, and mental health.

Minimal progress has been made in narrowing disparities between patients with and without limited English proficiency (LEP). Using 2016 data from RN4CAST-US, New Jersey Discharge Data Collection System, and AHA Annual Hospital Survey, multivariable logistic regression models were employed to examine whether and to what extent the hospital nurse work environment, defined as the conditions that nurses work in, is associated with decreased disparities in 7-day hospital readmissions between patients with and without LEP. Existing literature has established associations between nurse work environments and outcomes disparities of various minoritized populations; however, no literature has examined this relationship in the context of hospitalized patients with LEP. In a sample of 424,745 hospitalized adults (n = 38,906 with LEP), patients with LEP, compared to those without LEP, were younger (63.4 vs 64 years old, p < 0.001), more likely to be insured by Medicaid (8.9% vs 5.5%) or uninsured (7.5% vs 2%, p < 0.001), and readmitted (4.5% vs 3.9%, p < 0.001). Adjusting for patient and hospital characteristics, LEP patients had 33% higher odds of a 7-day readmission, as compared to patients without LEP (OR 1.33, 95% CI [1.19-1.47]). A significant interaction was found between patients' LEP status and the nurse work environment (OR 0.83, 95% CI [0.70-0.99]), such that patients with LEP experienced lower odds of 7-day readmission in more favorable nurse work environments, compared to patients without LEP. Hospitals dedicated to providing equitable healthcare may consider enhancing nurses' working conditions as a potential way to reduce disparities in readmission rates.

OBJECTIVE:Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure. DESIGN/METHODS:We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life. SETTING/METHODS:This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center. PARTICIPANTS/METHODS:We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains. RESULTS:The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection. CONCLUSIONS:We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients' lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

BACKGROUND:Clinical reasoning (CR) is an essential skill; yet, physicians often receive limited feedback. Artificial intelligence holds promise to fill this gap. OBJECTIVE:We report the development of named entity recognition (NER), logic-based and large language model (LLM)-based assessments of CR documentation in the electronic health record across 2 institutions (New York University Grossman School of Medicine [NYU] and University of Cincinnati College of Medicine [UC]). METHODS:-scores for the NER, logic-based model and area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) for the LLMs. RESULTS:-scores 0.80, 0.74, and 0.80 for D0, D1, D2, respectively. The GatorTron LLM performed best for EA2 scores AUROC/AUPRC 0.75/ 0.69. CONCLUSIONS:This is the first multi-institutional study to apply LLMs for assessing CR documentation in the electronic health record. Such tools can enhance feedback on CR. Lessons learned by implementing these models at distinct institutions support the generalizability of this approach.

BACKGROUND/UNASSIGNED:Ecological momentary assessment (EMA) provides insight into the effectiveness and feasibility of smoking-related interventions. OBJECTIVE/UNASSIGNED:The objective of this paper was to assess adherence to an EMA protocol and compare EMA-derived responses with measures collected through multiple surveys. METHODS/UNASSIGNED:A subanalysis was conducted using data from a 12-week, open-label, and 2-arm pilot randomized clinical trial among adult smokers with chronic obstructive pulmonary disease, coronary artery disease, peripheral vascular disease, or asthma in the last 12 months (n=109). Participants were randomized to either electronic cigarette (EC) or nicotine replacement therapy (NRT) treatment arms. We compared EMA data collected through automated SMS text message prompts sent to participants 4 times daily for 12 weeks, including cigarettes smoked per day (CPD), craving, and satisfaction, to survey data collected at 12 weeks. Convergent validity between survey- and EMA-reported measures was evaluated using Pearson correlation and paired t tests. CPD was modeled using negative binomial regression. Relative rates (RRs) of reaching at least 50%, 75%, and 100% CPD reduction between two arms were calculated using both EMA and survey data. RESULTS/UNASSIGNED:The majority of participants were non-Hispanic White (63/109, 58%) and female (60/109, 55%), and had a median age of 60 (IQR 54-65) years. Among the 109 participants, 59.6% (n=65) were consistently adherent to the EMA protocol over the 12-week period. Median weekly EMA response rate remained high over the 12-week study period even though a modest decline was observed (week 1, 97.8% and week 12, 89.4%). The mean CPD declined significantly (week 1, mean 14.2, SD 9.9 and week 12, mean 4.6, SD 6.7; P<.001). EMA-derived and survey-based CPD measurements were positively correlated (r=0.73, 95% CI 0.6-0.82) as were measures of craving (r=0.38, 95% CI 0.17-0.56). No significant paired difference in CPD was observed between EMA measurements and surveys. A significant effect of time on CPD EMA data (incidence rate ratio [IRR] 1-week change 0.93; P<.01) and survey data was found (IRR 12-week change 0.36; P<.01). However, the treatment effect was not significant, which aligned with the RR results. An increase in the EC consumption was observed over time in the EC arm, with 12.1% (7/58) fully switched to EC (defined as CPD=0 and EC use>0) and 20.7% (12/58) mostly switched (defined as a reduction in CPD>75% and EC use>0) in week 12. CONCLUSIONS/UNASSIGNED:EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real time. These findings provide the feasibility of using EMA in developing smoking cessation interventions in future tobacco harm reduction research.