Faculty Bibliography

BACKGROUND/UNASSIGNED:This study investigates the association between intra-operative balance and 2-year outcomes within subgroups defined by demographics and pre-operative joint balance. Our hypothesis is that patient demographics and the pre-operative state of the joint will impact patient sensitivity to post-operative balance and laxity and subsequent impact on outcome. METHODS/UNASSIGNED:A retrospective analysis of prospectively captured data across 5 sites with 5 surgeons was performed. All cases completed pre-operative demographics surveys, 2-year post-operative Knee Injury and Osteoarthritis Outcome Score (KOOS) and had a robot assisted total knee arthroplasty with an integrated digital joint balancing tool. Differences in associations between intra-operative final joint balance and 2-year KOOS pain outcomes in demographic and pre-operative balance subgroups were characterized. Associations informed clinically relevant thresholds to optimize TKA treatment for subgroups. RESULTS/UNASSIGNED:A total of 276 patients completed 2-year KOOS scores. Subgroups were defined from Sex, Age, BMI and pre-operative extension laxity. Men prefer a tight tolerance medially in extension and mid-flexion while females prefer a tight lateral flexion gap. Patients <70 years show a strong preference for equal rectangular gaps in extension, mid-flexion, and flexion, while older patients do not show a preference. Patients with BMI ≤30 demonstrate a preference for rectangular gaps, while patients with higher BMI do not. Finally, patients with looser pre-operative extension laxity (>3 mm) preferred a TKA with increased extension laxity compared to patients with minimal preoperative laxity. CONCLUSION/UNASSIGNED:Intraoperative differences in knee balance can influence patient outcome scores among different demographic groups at two years postoperatively. This suggests further research is warranted to determine how ligament balance and laxity may be optimized based on individual patient factors.

The COVID-19 pandemic profoundly impacted global health, with disproportionate consequences for healthcare workers (HCWs). Religious beliefs and practices may improve psychological resilience by fostering community, providing purpose and giving meaning to hardships. Yet, how religiosity impacts HCWs during a time of crisis is unclear. We therefore performed a cross-sectional study to investigate how religiosity contributes to resilience among HCWs who were routinely exposed to high levels of stress during the pandemic, through a physiological measure (the Auditory Sustained Attention Test; ASAT) and psychological self-reports. Forty-two HCWs were recruited from COVID-19 units and 44 HCWs from general internal medicine units during June and July 2022. COVID-19 HCWs showed significantly elevated emotional and attentional dysregulation with the ASAT, as measured by acoustic startle and prepulse inhibition, that was undetectable with self-reports. Furthermore, after dividing the HCWs into a 'high' and 'low' religiosity group, those in the 'low' group showed higher emotional and attentional dysregulation with the ASAT. Findings suggest that the ASAT has greater sensitivity at detecting emotional and attentional dysregulations than self-reports. Moderate or high religiosity may lead to better performance on the ASAT which could suggest greater resilience to mental health problems in the face of a crisis.

Children and adolescents with autism spectrum disorder and/or an intellectual disability (ASD/ID) are psychiatrically hospitalized at disproportionately higher rates than youth without ASD/ID. Despite this, few studies have compared the clinical courses of youth with and without ASD/ID in inpatient (IP) child and adolescent psychiatry (CAP) settings. This study used a cross-sectional design of all youth (M = 14.0 years, SD = 2.6 years) admitted to an urban IP unit between 2018 and 2021 to examine differences between ASD/ID and non-ASD/ID youth across dimensions of sociodemographic and psychiatric history and clinical course. 1101 Patients were included in the study and 170 (15.4%) had a history of ASD/ID. ASD/ID youth were more likely to be younger, be male, have histories of violence, and on average have more prior hospitalizations and existing psychotropic prescriptions than their non-ASD/ID counterparts. ASD/ID youth were less likely than their non-ASD/ID peers to be admitted for suicidality and more likely to be admitted for aggression; they had longer average lengths of stay, received more IP emergency medications for agitation, and experienced greater polypharmacy at discharge. The IP psychiatric clinical course of ASD/ID youth differs from that of non-ASD/ID youth, suggesting that ASD/ID youth often present to IP settings with externalizing symptoms. Findings highlight the importance of clinical strategies tailored to the unique needs of ASD/ID youth to improve their care in general IP CAP settings.

BACKGROUND:Meningiomas represent the most common primary intracranial tumors in adults, with WHO grade 1 typically associated with favorable outcomes following gross total resection (GTR). METHODS:This retrospective study included patients with CNS WHO grade 1 meningioma and available DNA methylation profiles (n=210). Clinical tumor characteristics and treatment course (e.g., surgical resection, extent of resection, radiotherapy) were evaluated. Integrated Scores (InS) were calculated based on methylation family using the DKFZ brain tumor classifier, CNS WHO grading, and chromosomal losses, categorized as low, intermediate, or high. Survival analyses employed Kaplan-Meier and Cox regression methods, with local progression-free survival defined as primary endpoint. RESULTS:In newly diagnosed cases, GTR was associated with a 93.0% 3-year progression-free survival (PFS), compared to 69.3% following subtotal resection (STR). Stratification by IntS showed that patients in the IntS-low group had superior outcomes: 3-y PFS of 93.4 after GTR and 77.4% after STR. In contrast, patients with IntS-intermediate/high profiles showed significantly worse outcomes, with PFS of 85.9% after GTR and 40.0% after STR. Following tumor recurrence, particularly those with IntS-intermediate/high, postoperative radiotherapy (RT) after STR may improve 3-year PFS to 88.9%, compared to much lower PFS rates in newly diagnosed cases managed without adjuvant RT after STR (3-year PFS: 40.0%). CONCLUSION/CONCLUSIONS:Our findings highlight the combined impact of both the extent of resection (EoR) and molecular risk profile on prognosis in newly diagnosed cases. While conservative management is feasible in lower-risk primary cases, recurrent or higher-risk patients may benefit from early postoperative RT.

OBJECTIVES/OBJECTIVE:This study examines the association between census tract-linked social vulnerability index (SVI) and maternal-fetal triage index (MFTI), a standardized score used to classify obstetric triage visit acuity. METHODS:This retrospective cohort study included patients at 20 weeks of gestational age or greater presenting to a New York City obstetric triage unit from March 2019 to April 2021, analyzing only the first pregnancy per patient. Exclusions included missing SVI or MFTI data and MFTI-5 (scheduled services). The primary exposure was SVI, and the primary outcome was MFTI score at the first triage visit. Multinomial logistic regression modeled the odds of MFTI-1 (stat) and MFTI-2 (urgent) visits relative to prompt/non-urgent visits, adjusting for potential confounders. RESULTS:Among 11,388 pregnant patients, most triage visits were classified as prompt or non-urgent (61.5 %), while 35.1 % were urgent, and 3.4 % were stat. Patients from neighborhoods with very high SVI had increased odds of an urgent visit (aOR 1.22, 95 % CI 1.06-1.41), as did those with chronic hypertension (aOR 1.46, 95 % CI 1.18-1.81), though SVI was not associated with stat visits. Stat visits were more likely during the COVID-19 pandemic (aOR 5.42, 95 % CI 4.04-7.28) and among patients with chronic hypertension (aOR 1.84, 95 % CI 1.15-2.94), while nulliparity and term presentation were associated with lower odds of a stat visit. CONCLUSIONS:Patients living in areas with a very high SVI score had increased odds of urgent triage visits but not stat visits. No racial or ethnic disparities were observed.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Disturbances in brain catecholamine activity may be associated with symptoms after exposure to repetitive head impacts (RHIs) or related chronic traumatic encephalopathy (CTE). In this article, we studied CSF catecholamines in former professional and college American football players and examined the relationship with football proxies of RHI exposure, CTE probability, cognitive performance, neuropsychiatric symptoms, and parkinsonism. METHODS:In this observational cross-sectional study, we examined male former American football players, professional ("PRO") or college ("COL") level, and asymptomatic unexposed male ("UE") individuals from the DIAGNOSE CTE Research Project. Catecholamines-norepinephrine (NE) and its metabolite, 3,4-dihydroxyphenylglycol (DHPG), and dopamine (DA) and its precursor, 3,4-dihydroxyphenylalanine (l-DOPA), and metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC)-were measured in CSF with high-performance liquid chromatography and compared across groups with analysis of covariance. Multivariable linear regression models tested the relationship between CSF catecholamines and proxies of RHI exposure (e.g., total years of playing American football), factor scores for cognition, and neurobehavioral dysregulation (explosivity, emotional dyscontrol, impulsivity, affective lability), as well as depressive/anxiety symptoms, measured with the Beck Depression/Anxiety Inventories. CTE probability and parkinsonism were assessed using the National Institute of Neurological Disorders and Stroke consensus diagnostic criteria for traumatic encephalopathy syndrome (TES), and biomarkers were compared among different diagnostic groups. RESULTS:The cohort consisted of 120 former American football players (85 PRO players, 35 COL players) and 35 UE participants (age 45-75). Former players had significantly lower levels of NE (mean difference = -0.114, 95% CI -0.190 to -0.038), l-DOPA (-0.121, 95% CI -0.109 to -0.027), and DOPAC (-0.116, 95% CI -0.177 to -0.054) than UE participants. For NE and DOPAC, these overall group differences were primarily due to differences between the PRO and UE cohorts. No significant differences were found across TES-CTE probability subgroups or TES-parkinsonism diagnostic groups. Within the COL cohort, tested as post hoc analyses, higher CSF NE and l-DOPA were associated with higher neurobehavioral dysregulation factor scores, BAI total score, and worse executive functioning and processing speed. CSF DHPG and DOPAC were associated with impulsivity only in this subgroup. DISCUSSION/CONCLUSIONS:We observed reduced CSF catecholamine concentrations in former elite American football players, although the relationship with degree of RHI exposure and the clinical impact needs further study.

Malignancy associated with ileal neobladders or ileal conduits in postradical cystectomy patients is rare. Yet, recurrent urothelial carcinoma or new primary cancers, such as adenocarcinoma, enteric type (EA), are potential complications that pose significant clinical challenges. This study aimed to evaluate the incidence, clinical outcomes, and management strategies for malignancies in patients with ileal neobladders or ileal conduits. A retrospective review was conducted at 3 large academic institutions, identifying 10 cases of malignant tumors arising in ileal neobladders or ileal conduits over a period of 10 years. The study cohort included 9 male and 1 female patient aged 56 to 92 years (mean age = 68.2 y). Data on clinical presentation, management, pathology, and outcomes were collected, with a focus on recurrence and disease-specific survival rates. Seven of 10 patients (all males) were initially diagnosed with invasive high-grade urothelial carcinoma (IHGUC), whereas 3 patients had a history of bladder augmentation with colonic tissue (BA) for benign etiologies. Of patients with IHGUC, 2 patients received neoadjuvant chemotherapy, 1 received a combination of chemotherapy agents, and 3 patients underwent intravesical BCG therapy. All IHGUC exhibited conventional morphology without divergent differentiation. Pathologic staging of the cystectomy for IHGUC ranged from pTa to pT3a, with 4 cases showing lymph node metastasis. IHGUC recurrence was detected in 6 of 7 patients with a latency period range of 7 months to 6.7 years (mean 37 mo) and all tumors again exhibiting conventional morphology without divergent differentiation. IHGUC recurrence demonstrated a pathologic stage ranging from pT2 to pT4, and 5 died (mean = 4.2 mo), whereas 1 patient remains alive and on surveillance. EA occurred in 4 patients, including 3 BA patients and 2 foci in 1 patient with a neobladder for IHGUC. Staging of patients with EA ranged from pTis to pT2 developing 31 to 55 years postsurgery. Three of 5 EA cases were associated with a precursor lesion including 2 tubular adenoma with high-grade dysplasia, and 1 sessile serrated lesion with dysplasia. EA patients had relatively favorable outcomes compared with IHGUC patients,  with all surviving patients currently on surveillance though with one case demonstrating nodal metastasis. Although rare, malignancies in ileal neobladders or ileal conduits are a serious complication. Although IHGUC recurrence often leads to poor survival, EA patients-especially those with prior bladder augmentation-seem to be associated with better survival outcomes. The long latency period for IHGUC recurrence and the favorable prognosis for EA underscore the need for vigilant long-term surveillance.

OBJECTIVE:To compare anonymized and non-anonymized approaches for imputing race and ethnicity in descriptive studies of chronic disease burden using electronic health record (EHR)-based datasets. STUDY SETTING AND DESIGN/METHODS:In this New York City-based study, we first conducted simulation analyses under different missing data mechanisms to assess the performance of Bayesian Improved Surname Geocoding (BISG), single imputation using neighborhood majority information, random forest imputation, and multiple imputation with chained equations (MICE). Imputation performance was measured using sensitivity, precision, and overall accuracy; agreement with self-reported race and ethnicity was measured with Cohen's kappa (κ). We then applied these methods to impute race and ethnicity in two EHR-based data sources and compared chronic disease burden (95% CIs) by race and ethnicity across imputation approaches. DATA SOURCES AND ANALYTIC SAMPLE/UNASSIGNED:Our data sources included EHR data from NYU Langone Health and the INSIGHT Clinical Research Network from 3/6/2016 to 3/7/2020 extracted for a parent study on older adults in NYC with multiple chronic conditions. PRINCIPAL FINDINGS/RESULTS: = 0.33). When these methods were applied to the NYU and INSIGHT cohorts, however, racial and ethnic distributions and chronic disease burden were consistent across all imputation methods. Slight improvements in the precision of estimates were observed under all imputation approaches compared to a complete case analysis. CONCLUSIONS:BISG imputation may provide a more accurate racial and ethnic classification than single or multiple imputation using anonymized covariates, particularly if the missing data mechanism is MNAR. Descriptive studies of disease burden may not be sensitive to methods for imputing missing data.

The rapid evolution of large-language models such as ChatGPT, Claude, and Gemini is reshaping the methodological landscape of obstetrics and gynecology (OBGYN) research. This narrative review provides a comprehensive account of generative AI capabilities, key use-cases, and recommended safeguards for investigators. First, generative AI expedites hypothesis generation, enabling researchers to interrogate vast corpora and surface plausible, overlooked questions. Second, it streamlines systematic reviews by composing optimized search strings, screening titles and abstracts, and identifying full-text discrepancies. Third, AI assistants can draft reproducible analytic code, perform preliminary descriptive or inferential analyses, and create publication-ready tables and figures. Fourth, the models support scholarly writing by suggesting journal-specific headings, refining prose, harmonizing references, and translating technical content for multidisciplinary audiences. Fifth, they augment peer-review and editorial workflows by delivering evidence-focused critiques. In educational settings, these models can create adaptive curricula and interactive simulations for trainees, fostering digital literacy and evidence-based practice early in professional development among clinicians. Integration into clinical decision-support pipelines is also foreseeable, warranting proactive governance. Notwithstanding these opportunities, responsible use demands vigilant oversight. Large-language models occasionally fabricate citations or misinterpret domain-specific data ("hallucinations"), potentially propagating misinformation. Outputs are highly prompt-dependent, creating a reliance on informed prompt engineering that may disadvantage less technical clinicians. Moreover, uploading protected health information or copyrighted text raises privacy, security, and intellectual-property concerns. We outline best-practice recommendations: maintain human verification of all AI-generated content; cross-validate references with primary databases; employ privacy-preserving, on-premises deployments for sensitive data; document prompts for reproducibility; and disclose AI involvement transparently. In summary, generative AI offers a powerful adjunct for OBGYN scientists by accelerating topic formulation, evidence synthesis, data analysis, manuscript preparation, and peer review. When coupled with rigorous oversight and ethical safeguards, these tools can enhance productivity without compromising scientific integrity. Future studies should quantify accuracy, bias, and downstream patient impact.