Faculty Bibliography

BACKGROUND/UNASSIGNED:Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide, yet current prediction tools do not fully capture sex differences in risk. Menopause further modifies women's risk of CHD, but underlying molecular mechanisms are not well understood. Proteomic profiling may provide new insights into these mechanisms. METHODS/UNASSIGNED:We analyzed 4,877 SomaScan™-based plasma proteins in 10,034 Atherosclerosis Risk in Communities (ARIC) participants. Using linear regression, we identified sex- and menopause-related differences in circulating protein concentrations. We performed pathway enrichment analyses to capture underlying biological mechanisms. To evaluate the associations between proteins and incident CHD and differences by sex or menopause status, we applied Cox regression. Finally, we used LASSO regression to identify proteins that improve CHD risk prediction beyond an established clinical model. RESULTS/UNASSIGNED:We observed significant differences in circulating proteins by sex and menopausal status, including early changes during the menopausal transition. We found protein associations with incident CHD differed markedly by sex and menopausal stage: eight proteins were associated with CHD in men, compared with 54 in women, and six and 17 proteins in peri‑ and postmenopausal women, respectively. In risk prediction analyses, adding sex-specific protein panels improved CHD prediction (ΔC-statistic=0.05 in men and 0.03 in women), with similar improvement across menopausal stages. CONCLUSIONS/UNASSIGNED:Proteomic profiles underlying CHD risk differ substantially by sex and menopausal stage. These findings suggest potential biological heterogeneity in CHD and support the study of sex- and menopause-related differences in underlying mechanisms.

Generative artificial intelligence (Gen-AI) has rapidly entered clinical environments, posing a risk of "cognitive offloading" that may impede the development of independent clinical judgment. This study conducted a cross-sectional survey of residents, fellows, and faculty at a large academic medical center in January 2026 to quantify Gen-AI utilization and perceptions in physical medicine and rehabilitation (PM&R) to inform curriculum development. Thirty-six trainees (95% response rate) and 11 faculty members (30% response rate) completed the survey; 43 (91.5%) reported any Gen-AI use and formed the analytic sample. Among users, 72.1% used Gen-AI daily for clinical learning and 51.2% during patient encounters, yet 67.4% were self-taught and only 7.0% always requested citations. Trainees requested citations more often than faculty (P=.048), while faculty more often relied on clinical judgment without additional verification (62.5% vs. 25.7%, P=.089). Gen-AI-derived evidence was rarely surfaced in teaching: 60.5% discussed it during case presentations rarely or never, and only 16.2% always disclosed its origin. Residents are integrating Gen-AI into clinical workflows at rates that outpace faculty familiarity, while verification remains largely undiscussed and untaught. These gaps highlight an urgent need for structured Gen-AI curricula in PM&R residency.

Normotensive patients with pulmonary embolism (PE) experience highly variable outcomes. Despite advances in clinical prediction tools, echocardiography, and computed tomographic imaging, there is no universally agreed upon strategy to identify which normotensive patients with PE are at risk of decompensation. This article reviews the current state of evidence and recent advances in risk prediction tools, echocardiography, and imaging to predict clinical deterioration.

BACKGROUND:Daratumumab has improved survival outcomes for patients with multiple myeloma (MM), but the effect of administration route on rwOS remains unclear. METHODS:Data from Medicare fee-for-service (January 2005-December 2024) and Medicare Advantage (January 2015-December 2022) were used. Eligible patients enrolled in Medicare aged ≥ 65 years were continuously enrolled in Parts A, B, and D for ≥ 12 months before daratumumab initiation. Patients were propensity-score matched with residual covariate adjustment. The primary end point was rwOS (time from index to death from any cause), assessed using Kaplan-Meier analyses, log-rank tests, and Cox models. Exploratory competing-risk analyses evaluated non-fatal events. RESULTS:Among 14,618 eligible patients (8324 SC; 6294 IV), 1191 patients per arm were well matched after propensity-score matching. Dara PH20 SC was associated with reduced all-cause mortality versus Dara IV (hazard ratio [HR]: 0.76, 95% confidence interval [CI], 0.67-0.86, P < .001) and lower risks of serious infections (HR: 0.87, 95% CI, 0.78-0.97, P < .01) and treatment discontinuation (HR: 0.72, 95% CI, 0.66-0.79, P < .01). CONCLUSION/CONCLUSIONS:Overall, Dara PH20 SC was associated with improved rwOS versus Dara IV in Medicare beneficiaries with MM, which appears to be driven by lower risk of serious infections and longer treatment duration with Dara PH20 SC.

PURPOSE OF REVIEW/OBJECTIVE:Elevated lipoprotein(a) [Lp(a)] is a common, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Clinicians continue to face questions regarding how overall risk should be refined once Lp(a) is identified. RECENT FINDINGS/RESULTS:International guidelines are beginning to universally recommend Lp(a) measurement at least once in adulthood, which will make the discovery of elevated Lp(a) a more common finding in routine practice. Despite this, Lp(a) remains absent from conventional risk equations. Additional stratification tools including assessment of subclinical atherosclerosis can be further applied to help distinguish inherited susceptibility from expressed disease. All of this together should support a more informed shared decision regarding the intensity of preventive therapy in these cases. We aim to provide a flexible framework that integrates Lp(a), contemporary risk equations, imaging, and selective genetics to produce actionable risk phenotypes which can guide the intensity of preventive decisions today.

BACKGROUND/UNASSIGNED:Long COVID (LC) is widespread; however, limited information has been reported on the likelihood that symptoms remit over time. OBJECTIVE/UNASSIGNED:To evaluate the likelihood of improvement among persons with likely LC. DESIGN/UNASSIGNED:Prospective, multisite cohort study (RECOVER-Adult [Researching COVID to Enhance Recovery]). SETTING/UNASSIGNED:83 U.S.-based sites across 33 states; Washington, DC; and Puerto Rico. PARTICIPANTS/UNASSIGNED:1019 persons in RECOVER-Adult with likely LC (LC Research Index [LCRI] ≥11) 12 months after first SARS-CoV-2 infection. MEASUREMENTS/UNASSIGNED:The primary outcome was time until 2 consecutive study visits with LCRI less than 11. Secondary outcomes were time until LCRI measure reduced 50% or more and quality of life was good or better, and LCRI decreased to 0. Unadjusted estimates of cumulative incidence and adjusted marginal cumulative incidence by age, sex, SARS-CoV-2 wave, and LC subtype were reported across all follow-up time points. RESULTS/UNASSIGNED:An estimated 36.2% (95% CI, 33.0% to 39.5%) met the primary outcome by 24 months after infection, and 50.1% (CI, 46.1% to 54.0%) met the primary outcome by 36 months. An estimated 56.4% (CI, 52.2% to 60.4%) and 26.9% (CI, 23.3% to 30.5%), respectively, met the 2 secondary outcomes by 36 months. Among persons who still reported likely LC at 18 months and 24 months after first infection, relative timing of subsequent symptom improvement was similar. LIMITATION/UNASSIGNED:Findings in this observational cohort are interpretable in a population with prevalent likely LC and do not address causal relationships between individual characteristics and symptom improvement. CONCLUSION/UNASSIGNED:Among persons with likely LC 12 months after initial SARS-CoV-2 infection, one half experience meaningful reductions in symptoms by 36 months, whereas a quarter experience complete remission of symptoms. These findings underscore both the potential for natural recovery and the urgent need for placebo-controlled therapeutic intervention trials. PRIMARY FUNDING SOURCE/UNASSIGNED:National Institutes of Health.

Pulmonary embolism is a life-threatening condition requiring prompt anticoagulation to prevent clot propagation and recurrence. Risk stratification guides therapy, with systemic thrombolysis reserved for high-risk patients and selected intermediate-high risk cases due to significant bleeding risk. Direct oral anticoagulants are preferred for most low and intermediate-low risk patients, while low-molecular-weight heparin and unfractionated heparin remain critical for higher- risk or procedurally complex cases. Emerging strategies including low-dose thrombolysis, catheter-directed therapies, and the future use of Factor XI inhibitors may improve safety without compromising efficacy. Management of bleeding complications necessitates rapid intervention, reversal when available, and coordinated multidisciplinary care.

OBJECTIVES/OBJECTIVE:F]FES) positron emission tomography/computed tomography (PET/CT) in patients with estrogen receptor (ER)-positive breast cancer. MATERIALS AND METHODS/METHODS:F]FES PET/CT compared with conventional workup. Pooled proportions of management changes were calculated across the included studies, including subgroup and sensitivity analyses. RESULTS:F]FES PET/CT was beneficial in 39% (95% CI: 24-58%) by improving diagnostic certainty and supporting current treatment options. CONCLUSION/CONCLUSIONS:F]FES PET/CT impacted management in 38% of patients with ER-positive breast cancer. KEY POINTS/CONCLUSIONS:F]fluoroestradiol PET/CT had a substantial impact on the management of patients with ER-positive breast cancer.

INTRODUCTION:The Harambee randomised trial tested the extent to which integrating community-based care with microfinance improves viral suppression and retention in care among people with HIV in Kenya. METHODS:Using a two-arm parallel-cluster randomised controlled trial, we randomised 57 microfinance groups (29 to intervention, 28 to usual (facility-based) care) with 855 members living with HIV (407 in intervention, 448 in usual care). We enrolled n=300 frequency-matched, prospectively followed usual HIV care patients without microfinance. Delivered quarterly during community-based microfinance meetings, the intervention included clinical consultations, diabetes and/or hypertension management, distribution of antiretroviral therapy and non-communicable diseases medications, health education and facility referrals. The primary outcome was viral suppression (<400 HIV-RNA/mL before 1 January 2023; <200 HIV-RNA/mL on or after 1 January 2023) at 18 months. The secondary outcome was retention-in-care (attending >1 scheduled HIV care visit/quarter over 18 months). Between-arm comparisons were done using doubly-robust generalised estimating equations accounting for dropout and confounding (for comparisons to the non-randomised arm). RESULTS:At enrolment, 94% of participants were virally suppressed. Viral suppression at 18 months was not significantly different between microfinance group members receiving community care versus facility care (OR 1.23, 95% CI 0.51 to 2.95, p=0.64). Viral suppression at 18 months was higher among community-care microfinance members (OR 2.16, 1.48 to 3.19, p<0.001) and facility-care microfinance members (OR 1.42, 1.05 to 1.92, p=0.023), compared with matched facility-care patients not engaged in microfinance. There was evidence of better quarterly retention comparing microfinance group members receiving community care versus facility care (OR 3.79, 2.96 to 4.86, p<0.001). Retention was higher among community-care microfinance members (OR 9.13, 7.13 to 11.70, p<0.001) and facility-care microfinance members (OR 2.40, 2.03 to 2.85, p<0.001), compared with matched facility-care patients. CONCLUSION:More convenient services can improve retention in HIV care, while economic strengthening likely helps improve clinical HIV outcomes. Research to identify impact mechanisms and scale-up potential is needed. TRIAL REGISTRATION NUMBER:NCT04417127.

INTRODUCTION/BACKGROUND:Enrollment into clinical trials is challenging and has a major effect on the feasibility and the generalizability of a study. We used data from a previously completed hospital-based smoking cessation study to determine if enrollment rates varied by hospital admitting service, specifically comparing Medicine and Psychiatry departments. METHODS:We examined enrollment in the Financial Incentives for Smoking Cessation (FIESTA) study, which was conducted at the Veterans Affairs New York Harbor Healthcare System. FIESTA tested the effectiveness of financial incentives on smoking cessation among hospitalized patients. A total of 268 patients were eligible, with 182 enrolled in the original FIESTA study. In our secondary analysis, a LASSO approach was applied to the data set to create a model examining admitting service, age, sex, race and ethnicity, education, and number of cigarettes per day and their association with enrollment. RESULTS:The enrollment rates were higher for patients admitted to the Psychiatry service (80.2%) than to the Medicine and other services (59.9%). Patients with a high school education or less also had a higher enrollment rate (87.2%) than those with higher education (57.7%). Increasing age was associated with lower odds of enrollment (aOR = 0.97, 95% CI: 0.94, 0.99). Hispanic ethnicity appeared to associate with a higher odds of enrollment compared to non-Hispanic White (aOR = 2.52, 95% CI 1.11, 5.75). Higher odds of enrollment were observed among patients admitted to the Psychiatry service (aOR = 2.51, 95% CI: 1.23-5.12), while lower odds were observed among those with higher education (aOR = 0.17, 95% CI: 0.06-0.49). CONCLUSIONS:This research suggests that smoking cessation programs can effectively enroll a diverse patient population, including typically underrepresented groups such as those with lower education status and those with mental health diagnoses. Such enrollment efforts would enable studies to be more generalizable to the smoking population. Findings also emphasize the potential of urban hospital settings to support equitable enrollment efforts. The present work is a secondary analysis of the FIESTA RCT (NCT02506829). Future research should explore additional demographic factors, such as comorbidities and confidence in quitting, to better understand motivations for participation.