Faculty Bibliography

BACKGROUND:While payers and health systems are increasingly interested in addressing health-related social needs (HRSNs) to reduce health care use and align with value-based care incentives and regulatory requirements, limited evidence enables actionable strategies to manage and address social needs across population groups. OBJECTIVES/OBJECTIVE:To understand the relationship between HRSNs and health care access and use for adults with Medicare, Medicaid, and private health insurance coverage. RESEARCH DESIGN/METHODS:Survey data from adult participants from the All of Us Research Program (2017-2023; n=126,490) and logistic regression were used to examine the association between food insecurity and housing instability and having a usual source of care, seeing a health care provider, and forgoing care due to cost-stratified by payer type. RESULTS:The prevalence of HRSNs varied substantially by insurance: food insecurity affected 49.20% of Medicaid beneficiaries 18-64 years of age, 11.89% of privately insured adults 18-64 years of age, and 5.20% of Medicare beneficiaries 65 years of age and older; housing instability affected 54.61%, 25.18%, and 14.99%, respectively. Food insecurity was associated with lower odds of having a usual source of care for Medicaid and privately insured adults, lower odds of use for privately insured adults, and higher odds of forgone care for all 3 payer types. Housing instability was associated with lower odds of having a usual source of care for all 3 papers and with higher odds of forgone care for all groups. CONCLUSIONS:HRSNs like food insecurity and housing instability vary substantially by payer type and influence health care access and utilization in different ways. This can inform the design of payer-specific health management strategies that incorporate HRSNs.

BackgroundCervical cancer is a preventable disease, and reaching populations who are under-screened and/or at highest risk is essential to the goal of disease elimination. Hispanic women in the US have a disproportionately higher incidence rate than non-Hispanic women.ObjectivePost hoc analysis of the SELF-CERV study of the unique experience and preferences among Hispanic compared to non-Hispanic participants with the goal of facilitating and improving screening and follow-up in more vulnerable populations.MethodsWomen 25 to 65 years who were enrolled performed self-collection (SC) of vaginal samples for high-risk human papillomavirus (hrHPV) testing using a unique device in a simulated at-home environment. For method comparison, a clinician-collected (CC) sample was obtained. Participants also completed usability and screening preference surveys.ResultsA total of 609 participants were consented and 603 used the SC device. Of the 603 SC users, 115 (19.1%) identified themselves as Hispanic/Latinx. Compared to non-Hispanic women, Hispanic women, had significantly lower annual income (p < .001), a lower percentage of private insurance with more uninsured (p < .001) and lower levels of education (p < .001). There was no significant difference between Hispanic and non-Hispanic women in understanding the purpose of cervical cancer screening. No difference was noted in delaying screening, although English Not Primary speaking Hispanic women were somewhat more likely to delay (p = 0.22). Financial barriers were observed to be more of an impediment to Hispanic women compared to non-Hispanic women (p = 0.016). Negative experiences with in-clinic speculum exams were similar; however, Hispanic women (78%) expressed a significantly higher endorsement of SC than non-Hispanic women (62%), (p = 0.001). Both populations reported that they would be more likely to stay up to date with cervical cancer screening with the at-home SC device, but non-Hispanic women to a significantly lesser degree (p = 0.002). In terms of assessing utility of telemedicine in screening, both populations reported similar engagement in healthcare activities, willingness to try new technology and current use of smartphones. Hispanic and non-Hispanic women were both nearly equally divided as to their preference for in-clinic visits vs telehealth.ConclusionsFacilitating screening uptake is especially critical for Hispanic women, who bear a disproportionate burden of cervical cancer diagnoses and mortality while facing more obstacles to screening than non-Hispanic women. A clinically validated and accessible at-home SC alternative holds potential for meaningful impact and improved health outcomes within this community.

APG157DS is a multi-component investigational drug which is currently the subject of multiple cancer trials. It has shown promising efficacy in patients with head and neck cancer. We report its immuno-modulatory effect in a syngeneic mouse model of glioblastoma (GBM). Long-term treatment with APG157DS led to durable tumor remission in 50% of mice, while all vehicle-treated mice reached humane endpoints within 42 days. Mechanistically, the drug induced selective repolarization of tumor-associated macrophages (TAMs) from an immunosuppressive Arg1^high/iNOS^low phenotype to a tumoricidal Arg1^low/iNOS^high state, accompanied by increased intratumoral recruitment of activated (NKp46+) natural killer cells and CD8+ cytotoxic T-cells. APG157DS also suppressed vascular endothelial growth factor (VEGF) and Hypoxia-inducible factor 1-alpha (HIF-1α) expression in tumors, further impairing tumor growth. Notably, APG157DS did not elicit off-target macrophage activation in peripheral tissues such as the spleen, highlighting its selective immune targeting. These findings provide a mechanistic rationale for further clinical development of APG157DS in GBM and potentially other immune-evasive cancers.

OBJECTIVE:Cesarean delivery (CD) remains a key obstetric quality metric, particularly among nulliparous, term, singleton, vertex (NTSV) pregnancies. In 2024, NTSV CD rate at NYU-LI was 32.9%, exceeding The Joint Commission (TJC) benchmark of ≤30% and demonstrating racial and ethnic disparities. This study aimed to reduce the institutional NTSV CD rate to ≤30% through a multidisciplinary QI initiative while prospectively monitoring safety outcomes and racial disparities. STUDY DESIGN/METHODS:A single-site QI initiative was implemented from 2024-2025 incorporating provider education, patient-centered interventions (TeamBirth and structured labor huddles), standardized labor management, and performance monitoring through monthly case review, clinician feedback, and quarterly equity-focused data review. Outcome measures included monthly overall and quarterly race- and ethnicity-stratified NTSV CD rates. Process measures assessed adherence to evidence-based labor dystocia criteria. Balancing measures included postpartum hemorrhage (PPH) and TJC PC-06 rates. Temporal trends were evaluated using multivariable Poisson regression with adjustment for maternal age, gestational age at delivery, and body mass index. RESULTS:The overall NTSV CD rate decreased from 32.9% in 2024 to 27.8% in 2025, remaining below TJC benchmark in 10 of 12 months. Across the 8-quarter study period, there was a significant decline in the outcome over time (aRR per quarter 0.97, 95% CI 0.95-0.99, p=0.003). Reductions were observed across racial and ethnic groups, including among Black non-Hispanic patients (44.0% to 40.0%) and Asian non-Hispanic patients (37.0% to 29.6%). Adherence to evidence-based labor dystocia criteria remained high, while PPH and PC-06 rates remained stable. CONCLUSIONS:A standardized, multidisciplinary QI initiative was associated with NTSV cesarean delivery rate below the Joint Commission benchmark without increases in maternal or neonatal adverse outcomes. The initiative was also associated with partial reduction in racial disparities in cesarean delivery rates, although persistent inequities remained. Future PDSA cycles will focus on sustaining standardized care and advancing equitable obstetric outcomes.

BACKGROUND/UNASSIGNED:Healthcare is a major contributor to greenhouse gases. One of the most widely used healthcare services in the USA is colorectal cancer (CRC) screening, indicated for 134 million adults. Recommended screening includes annual faecal immunochemical tests (FITs), CT colonographies every 5 years or colonoscopies every 10 years. OBJECTIVE/UNASSIGNED:To compare the environmental impacts of these tests for CRC screening. DESIGN/UNASSIGNED:We conducted a comparative life cycle assessment of three CRC screening strategies at UCSF. We performed on-site audits to document the resources used for each screening test. We estimated the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We computed 10-year impacts of each screening strategy using a Markov model. We accounted for uncertainty using hierarchical Monte Carlo simulations. RESULTS/UNASSIGNED:FITs had the lowest environmental impacts, roughly 20 percentage points superior to colonoscopies, and this was robust on sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritising FITs over colonoscopies in the USA could enhance population health by 5.2 million disability-adjusted life-years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15%-20%. CONCLUSIONS/UNASSIGNED:Given the similar efficacy and safety of these tests, payors should probably prioritise FITs for low-risk patients. Governments should decarbonise transportation and mandate environmental product declarations. We call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population.

Cefdinir is a third-generation cephalosporin with a wide variety of indications and a strong safety profile. A 24-year-old man began taking cefdinir for an uncomplicated urinary tract infection. Two days later, he began experiencing pleuritic, sharp chest pain and diarrhea and was shown to have mildly elevated troponins. Due to the pleuritic nature of his chest pain improving when leaning forward, as well as elevated troponins and a new small pericardial effusion on echocardiogram, he was diagnosed with myopericarditis thought to be secondary to cefdinir. Cefdinir was subsequently held with diarrhea and chest pain improving shortly afterwards. He was started on ibuprofen 600mg TID for two weeks, as well as colchicine 0.5mg daily for six weeks. The patient finished his treatment regimen and does not endorse recurrence of his chest pain or any symptoms of heart failure, such as orthopnea, lower extremity edema, or shortness of breath.

BACKGROUND:Parents in the United Kingdom seeking an assessment for attention-deficit/hyperactivity disorder (ADHD) for their child experience a significant wait before receiving an appointment with Child and Adolescent Mental Health Services (CAMHS), yet little has been written on how parents experience this period. Through qualitative interviews, we sought to understand how the period of waiting from being accepted onto a service waitlist and receiving a diagnostic assessment impacts parents and their children. METHOD:The study was nested within a large randomised controlled trial. We conducted semi-structured interviews with 41 parents of children aged 5-11 years. 30% of parents had waited between 18 and 24 months on a CAMHS waitlist, with 10% waiting more than 2 years. Reflexive thematic analysis was used to analyse data. RESULTS:At the point of the interview, around 50% of children were still waiting for an initial assessment. Six themes reflecting parents' uncertainty around the assessment process, lack of communication from services, the importance of receiving a diagnosis, difficulty accessing support and the negative impact of waiting on mental health and education, as well as recommendations to improve communication between services and families, emerged. CONCLUSION:Parents recognised the pressures on services to offer timely support; however, their well-being could be substantially improved by more clarity around wait times, as well as more effective signposting and support from services concerning the assessment process. This may help alleviate some of the stressors associated with their child's assessment journey, such as feeling responsible for their child's difficulties and the burden of supporting their educational needs. PATIENT AND PUBLIC CONTRIBUTION:This study was nested within the OPTIMA trial, where PPI panel members provided ongoing support in various aspects of the study, including advising on participant communication, study design and data analysis. All PPI members have lived experience of having a neurodivergent child. For this study, the PPI co-produced the interview schedule and took part in transcript analysis using a thematic framework approach. To acknowledge their contributions, members of the PPI panel are included as co-authors.

Mitochondria are critical cellular powerhouses that produce adenosine triphosphate to maintain the structure and integrity of the cell. Mitochondria generate 90% of the energy of a cell. Chronic inflammation causes damage to mitochondria. When enough mitochondria are dysfunctional, the involved organ will suffer. Mitochondria become dysfunctional in the setting of chronic inflammation. Under noninflammatory conditions, the body generates new mitochondria (mitochondrial biogenesis) and removes old and damaged mitochondria via mitophagy. When mitochondria are damaged, they "spontaneously" leak out reactive oxygen species, mitochondrial DNA, and damage-associated molecular patterns, generating erroneous innate immune responses. Autophagy is a recycling and housekeeping process that removes dysfunctional components, organelles, and proteins, promoting the recovery and maintenance of cell health. Mitophagy is a specific variant of this process that removes dysfunctional mitochondria from the cell. Mitophagy declines with age, allowing dysfunctional mitochondria to accumulate, and chronic inflammation leads to cardiovascular disease (CVD). In CVD, impairment of both autophagy and mitophagy leads to more chronic inflammation, characterized by hyperactivation of the nucleotide-binding oligomerization domain (NOD)-, leucine-rich repeat (LRR)- and pyrin domain-containing protein 3 (NLRP3) inflammasome, a key component of the immune system. Once activated, it triggers inflammation, leading to excessive cytokine activity, proinflammatory macrophage polarization, pyroptosis, and increased immune cell infiltration into cardiac and vascular tissues. Pyroptosis is a form of inflammatory cell death triggered by programmed cues; however, in autoimmunity and cancer, when overactivated, this process can become detrimental. Adequate regulation of these events reduces oxidative stress, inflammatory cascades, fibrosis, and maladaptive remodeling, thereby improving overall cardiovascular health. Targeted therapeutic enhancement of autophagy and mitophagy represents a promising strategy to modulate immune-driven pathology and improve outcomes in cardiovascular conditions. We will review the mechanisms of how this inflammation causes CVD.