Faculty Bibliography

INTRODUCTION:Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback. METHODS:Medical students in Bronx, NY, USA, participated in one 90-minute session on implicit bias. The focus of analysis for this study is the post-session narrative assignment inviting them to take the race-based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de-identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology. RESULTS:Medical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced. CONCLUSION:Despite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students' acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.

Purpose: To carry out a large international validation of how dose prediction quality translates to plan quality in a radiotherapy knowledge-based planning (KBP) process.
Method(s): We collected dose predictions for head-and-neck cancer radiotherapy from 21 different research groups internationally who participated in the OpenKBP Grand Challenge. Each research group used the same training dataset (n=200) and validation dataset (n=40) to develop their methods. These methods predicted dose on a testing dataset (n=100), and those 2100 unique dose predictions were input to a previously published plan optimization method to generate 2100 treatment plans. The predictions and plans were compared to the ground truth dose via: (1)error, the mean absolute voxel-by-voxel difference in dose; and (2) quality, the mean and maximum deviation across 23 dose-volume histogram (DVH) criteria.
Result(s): The range in median prediction error among the top 20 methods was 2.3Gy to 12.0Gy, which was 6.8Gy wider than the range in median plan error of 2.1Gy to 5.0Gy. One method also achieved significantly lower prediction error (P<0.05; one-sided Wilcoxon test) than all the other methods, however, it generated plans with error that was not significantly lower than 28.6% of the other methods. Additionally, predicted dose was consistently lower quality than plan dose. Half (n=1050) of all predictions and plans had an average deviation that was 0.1Gy worse and 0.8Gy better than the ground truth dose, respectively. Similarly, half of all predictions had a maximum deviation that was 3.7Gy worse than the ground truth dose, which was 1.0Gy worse than half of all plans.
Conclusion(s): Many dose prediction methods can achieve low error, however, optimization often improves upon the predictions and eliminates significant differences between prediction methods. Thus, it is critical that we improve the optimization stage in KBP to get better utility out of the existing high-quality dose prediction methods

INTRODUCTION/BACKGROUND:Poor sleep is a pervasive problem for hospitalized patients and can contribute to adverse health outcomes. METHODS:We aimed to improve self-reported sleep for patients on a general medicine ward as measured by the Richards-Campbell Sleep Questionnaire (RCSQ) as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night. We utilized a non-pharmacologic sleep hygiene bundle composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, earplugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with implementation. RESULTS:A total of 931 patients received the intervention. In a sample of surveyed patients, we observed an increase in the RCSQ global score from 6.0 (IQR 3.0-7.0) to 6.2 (IQR 4.0-7.8) from the pre- to post- intervention periods (p = 0.041), as well as increases in three of the five individual survey components. Additionally, HCAHPS "quietness at night" score increased on the unit from 34.1% pre-intervention to 42.5% post-intervention. CONCLUSION/CONCLUSIONS:A nonpharmacologic sleep hygiene protocol paired with provider education and use of champions was associated with modest improvements in patients' perceived sleep and unit HCAHPS scores.

Carotid Doppler ultrasound is used as a measure of fluid responsiveness, however, assessing change with statistical confidence requires an adequate beat sample size. The coefficient of variation helps quantify the number of cardiac cycles needed to adequately detect change during functional hemodynamic monitoring.

AIMS/OBJECTIVE:The aim at this study was to determine the effects of unsaturated fatty acids on clinical plasmids. METHODS AND RESULTS/RESULTS:, respectively, were used to assess the effects on conjugative transfer of a mcr-1-harboring plasmid pCSZ4 (IncX4) in conjugation experiment. The inhibitory mechanisms were analyzed by molecular docking and the gene expression of virB11 was quantitated by qRT-PCR. Target plasmid diversity was carried out by TrwD/VirB11 homology protein sequence prediction analysis. Our results showed that LA and ALA inhibit plasmid pCSZ4 transfer by binding to the amino acid residues (Phe124 and Thr125) of VirB11 with dose-dependent effects. The expression levels of virB11 gene were also significantly inhibited by LA and ALA treatment. Protein homology analysis revealed a wide distribution of TrwD/VirB11-like genes among over 37 classes of plasmids originated from both Gram-negative and Gram-positive bacteria, CONCLUSIONS: This study demonstrates representing a diversity of plasmids that may be potentially inhibited by unsaturated fatty acids. SIGNIFICANCE AND IMPACT OF STUDY/CONCLUSIONS:Our work reported here provides additional support for application of curbing the spread of multiple plasmids by unsaturated fatty acids.

Evidence-based strategies addressing comorbid hypertension and diabetes are needed among minority communities. We analyzed the outcome of blood pressure (BP) control using pooled data from two community health worker interventions in New York City conducted between 2011 and 2019, focusing on participants with comorbid hypertension and diabetes. The adjusted odds of controlled BP (< 140/90 mmHg) for the treatment group were significant compared with the control group (odds ratio = 1.4; 95% confidence interval = 1.1, 1.8). The interventions demonstrated clinically meaningful reductions in BP among participants with comorbid hypertension and diabetes.

Background Lenalidomide maintenance improves progression-free survival for patients with multiple myeloma, although its optimal duration is unknown. Clearance of minimal residual disease (MRD) in the bone marrow results in superior outcomes, although its attainment or sustainment does not alter clinical decision-making. Studies that have evaluated MRD serially are limited in length. We therefore aimed to evaluate longitudinal changes in MRD-status (dynamics) and their association with progression-free survival in patients with multiple myeloma.

The COVID-19 pandemic has dramatically disrupted the educational experience of medical trainees. However, a detailed characterization of exactly how trainees' clinical experiences have been affected is lacking. Here, we profile residents' inpatient clinical experiences across the four training hospitals of NYU's Internal Medicine Residency Program during the pandemic's first wave. We mined ICD-10 principal diagnosis codes attributed to residents from February 1, 2020, to May 31, 2020. We translated these codes into discrete medical content areas using a newly developed "crosswalk tool." Residents' clinical exposure was enriched in infectious diseases (ID) and cardiovascular disease content at baseline. During the pandemic's surge, ID became the dominant content area. Exposure to other content was dramatically reduced, with clinical diversity repopulating only toward the end of the study period. Such characterization can be leveraged to provide effective practice habits feedback, guide didactic and self-directed learning, and potentially predict competency-based outcomes for trainees in the COVID era.