Faculty Bibliography

OBJECTIVE/UNASSIGNED:Families or loved ones of adolescents and young adults (AYA) with a poor cancer prognosis who preserved fertility and did not survive treatment may choose to pursue posthumous assisted reproduction (PAR; i.e., use of preserved reproductive material for future family-building attempts). Decisions about PAR may be occurring in the context of grief and bereavement, which is associated with ethical and psychological considerations because grief can complicate a person's capacity for informed decision-making. METHODS/UNASSIGNED:Through the use of a five-step ethical decision-making model, the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct, and a blended case example, the ethical and psychological considerations for families of AYA with poor prognosis who pursue PAR is discussed with an ethical analysis. RESULTS/UNASSIGNED:Ethical and psychological considerations included assessing the potential for harm to involved parties, navigating PAR decision-making with responsibility and honesty, examining the accessibility of PAR, and considering informed consent/assent and autonomy. CONCLUSIONS/UNASSIGNED:Clinical recommendations for supporting families and loved ones exploring PAR in the context of grief were discussed, with considerations for improving clinicians' comfort and competence with PAR, incorporating grief into informed consent conversations, standardizing conversations about PAR, and promoting an interdisciplinary approach to PAR-related decisions.

BACKGROUND/UNASSIGNED:Chronic pain is highly prevalent in US military Veterans, and pain interdisciplinary teams (IDTs) are the gold standard in pain care. There is no standard or guidance for how best to develop and implement pain interdisciplinary teams within complex health care systems. OBJECTIVES/UNASSIGNED:The purpose of this quality improvement project was to evaluate the effectiveness of the standard 9-step Lean 6 Sigma (LSS) methodology in redesigning a pre-existing VA outpatient pain clinic solely offering interventional pain services into an efficient, sustainable pain IDT program. METHODS/UNASSIGNED:The initial evaluation process at a VA Medical Center that primarily serves rural Veterans was redesigned with the a priori goal of developing an efficient, sustainable IDT program that decreased driving days (ie, in-person appointments) required for a comprehensive initial pain evaluation, decreased number of consults required for initial pain evaluations, increased the number of consults to Whole Health services, and increased compliance with policies and standards. Feedback from administrators, clinicians, and Veterans was used to identify inefficiencies then iteratively design, test, and finalize a redesigned service called the PREVAIL Interdisciplinary Team Track (PREVAIL IDT Track). Baseline data was collected for 1 year followed by sustainment data for 14 months. Results were analyzed using descriptive statistics. RESULTS/UNASSIGNED:PREVAIL IDT Track decreased the number of in-person appointments from 5 to 2, decreased consults required for evaluations from 5 to 1, increased the number of unique consults to Whole Health education classes, and made the VA fully compliant with policies and standards. To date, 486 Veterans have participated in the redesigned program, including 167 graduates and 212 current enrollees in this sustained clinical program. CONCLUSION/UNASSIGNED:The success of PREVAIL IDT Track suggests that LSS may be a promising method for redesigning sustainable pain IDTs in VA that improve efficiency.

BACKGROUND:While the benefits of sonication for improving periprosthetic joint infection (PJI) are well-documented, its potential therapeutic effect against bacterial biofilm remains unstudied. This study aimed to investigate the safety and efficacy of a novel nanoparticle ultrasonication process on methicillin-resistant Staphylococcus aureus (MRSA) bacterial biofilm formation in a PJI rat model. METHODS:This novel ultrasonication process was designed to remove attached bacterial biofilm from implant and peri-articular tissues, without damaging native tissues or compromising implant integrity. Twenty-five adult Sprague-Dawley rats underwent a surgical procedure and were colonized with intra-articular MRSA, followed by the insertion of a titanium screw. Three weeks after the index surgery, the animals received a second procedure during which the screws were explanted, and soft tissue was sampled. The intraoperative use of the nanoparticle sonication treatment was employed to assess the device's safety, while ex vivo treatment on the retrieved tissue and implants was used to evaluate its efficacy. RESULTS: CFU/gram of tissue. Compared to the standard-of-care group (n = 10), implants treated with sonication (n = 15) had significantly lower remaining bacteria, as indicated by crystal violet absorbance measurements (P = 0.012). CONCLUSIONS:This study suggests that nanoparticle sonication technology can successfully remove attached bacterial biofilms from explanted orthopedic hardware and the joint capsule, without negatively affecting native tissue. The study provides initial results supporting the potential of nanoparticle sonication as an adjuvant treatment option during a DAIR (debridement, antibiotics, and implant retention) procedure for PJI, paving the way for future clinical trials.

BACKGROUND:In response to the COVID-19 pandemic, the US Congress authorized the US Department of Agriculture to waive a variety of school meal regulations and funded school meals daily for all students at no charge regardless of family income. Because federal Universal Free School Meals (UFSM) ended with the 2021-2022 school year, several states, including California and Maine, adopted state-level UFSM policies. OBJECTIVE:This study aimed to understand parent perceptions of school meals and the federal and new state UFSM policies in California and Maine, including potential challenges and benefits to students and households. DESIGN/METHODS:A mixed methods study design was used. A quantitative cross-sectional survey was administered, and semi-structured interviews were conducted in English and Spanish during the 2021-2022 school year. PARTICIPANTS/SETTING/METHODS:The quantitative survey was administered to parents of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n = 1110) and Maine (n = 80). Qualitative interviews were then conducted with a subset of these parents in California (n = 46) and Maine (n = 20) using Zoom (Zoom Video Communications). Most survey participants (708 of 1190 [59.5%]) and interviewees (40 of 66 [60.6%]) were parents of students who were eligible for free or reduced-price meals. MAIN OUTCOME MEASURES/METHODS:Parents' perceptions of UFSM, school meal quality, and experiences applying for free or reduced-price meals were examined. ANALYSES PERFORMED/UNASSIGNED:Tests of proportions were used to analyze survey data. Using grounded theory, interview transcripts were analyzed qualitatively by 2 trained research assistants, applying principles of content analysis to identify themes and domains. Inter-rater reliability was conducted. RESULTS:Parents perceived that school meals and UFSM saved families money and time, as parents had fewer meals to purchase and prepare for their children. In addition, UFSM reduced parents' stress and reduced stigma for children and for parents, who described feelings of embarrassment when they previously filled out paperwork for free or reduced-price meals. Although parent perceptions of school meal quality and healthfulness were mixed, most parents reported feeling grateful for school meals. CONCLUSIONS:Parents had mixed opinions on the quality and healthfulness of school meals, but believed UFSM saved them money and time and reduced their stress. Parents also felt UFSM reduced stigma for families.

INTRODUCTION/BACKGROUND:To assess whether a diagnosis of preexisting anemia impacts outcomes of geriatric hip fractures. METHODS:This is a retrospective comparative study conducted at a single, urban hospital system consisting of an orthopaedic specialty hospital, two level 1 trauma centers, and one university-based tertiary care hospital. Data of patients aged 55 years or older with a femoral neck, intertrochanteric, or subtrochanteric hip fracture (AO/OA 31A, 31B, and 32A-C) at a single hospital center treated from October 2014 to October 2023 were retrieved from an institutional review board-approved database. Patients were included if they had a hemoglobin measurement recorded between 6 and 12 months before hospitalization for their hip fracture. Patients were cohorted based on whether their hemoglobin values recorded anemic or not. Comparative analysis was conducted to analyze 1-year mortality, 30-day mortality, 30-day readmission, 90-day readmission, and inpatient major complications. RESULTS:Four hundred ninety-eight patients had hemoglobin values recorded at 6 to 12 months before their surgery in the electronic medical record. Two hundred seventy-three patients (54.8%) were considered anemic at that time, whereas 225 patients (45.2%) were not. Cohorts were markedly different regarding sex, Charlson Comorbidity Index, preinjury ambulatory status, and Score for Trauma Triage in Geriatric and Middle-Aged Patients (STTGMA) score (P < 0.05 for all). Multivariable analysis revealed that chronic preinjury anemia patients had a higher likelihood of 1-year mortality and a higher risk of major inpatient complication and 30- and 90-day readmission (P < 0.05 for all). CONCLUSION/CONCLUSIONS:Chronic preinjury anemia within 6 to 12 months before a hip fracture is associated with an increased risk of 1-year mortality, inpatient major complications, and 30- and 90-day readmission after hip fracture fixation. LEVEL OF EVIDENCE/METHODS:Level III.

Technological advancements in liquid chromatography (LC) electrospray ionization (ESI) high-resolution mass spectrometry (HRMS) have made it an increasingly popular analytical technique in non-targeted analysis (NTA) of environmental and biological samples. One critical limitation of current methods in NTA is the lack of available analytical standards for many of the compounds detected in biological and environmental samples. Computational approaches can provide estimates of concentrations by modeling the relative response factor of a compound (RRF) expressed as the peak area of a given peak divided by its concentration. In this paper, we explore the application of molecular dynamics (MD) in the development of a computational workflow for predicting RRF. We obtained measurements of RRF for 48 compounds with LC - quadrupole time-of-flight (QTOF) MS and calculated their RRF. We used the CGenFF force field to generate the topologies and GROMACS to conduct the (MD) simulations. We calculated the Lennard-Jones and Coulomb interactions between the analytes and all other molecules in the ESI droplet, which were then sampled to construct a multilinear regression model for predicting RRF using Monte Carlo simulations. The best performing model showed a coefficient of determination (R ²) of 0.82 and a mean absolute error (MAE) of 0.13 log units. This performance is comparable to other predictive models including machine learning models. While there is a need for further evaluation of diverse chemical structures, our approach showed promise in predictions of RRF.

PURPOSE/UNASSIGNED:The recent SENZA-PDN study showed that high-frequency (10kHz) spinal cord stimulation (SCS) provided significant, durable pain relief for individuals with painful diabetic neuropathy (PDN), along with secondary benefits, including improved sleep quality and HRQoL. Given that metabolic factors and chronic neuropathic pain are related, we evaluated potential secondary effects of 10kHz SCS on hemoglobin A1c (HbA1c) and weight in SENZA-PDN participants with type 2 diabetes (T2D). PATIENTS AND METHODS/UNASSIGNED:). RESULTS/UNASSIGNED:= 0.005), respectively. These reductions were accompanied by a mean pain reduction of 79.8% and a mean decrease in pain interference with sleep of 65.2% at 24 months across all cohorts. CONCLUSION/UNASSIGNED:This is the first study of SCS to demonstrate long-term, significant, and clinically meaningful reductions in HbA1c and weight in study participants with PDN and T2D, particularly among those with elevated preimplantation HbA1c and BMI. Although the mechanism for these improvements has yet to be established, the results suggest possible direct and indirect metabolic benefits with 10kHz SCS in addition to durable pain relief. TRIAL REGISTRATION/UNASSIGNED:ClincalTrials.gov Identifier, NCT03228420.

BACKGROUND AND AIMS/UNASSIGNED:In 2013, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) steering group published recommendations to standardize reporting quality in randomized controlled trials (RCTs). We aim to assess adherence to SPIRIT reporting guidelines in RCTs on endoscopic colorectal cancer (CRC) screening and participants' adherence to trial protocols. METHODS/UNASSIGNED:We searched databases for RCTs evaluating flexible sigmoidoscopy or colonoscopy for CRC screening published in English language through September 2023. Each eligible study was evaluated using the 8 core SPIRIT statement areas, totaling 51 points. Each item received 1 point if it met the criteria and 0 points if it did not. Adherence to SPIRIT items was calculated, and participant adherence to RCT protocols was assessed as the proportion of participants screened compared to those invited. RESULTS/UNASSIGNED:Five RCTs, including 4 on flexible sigmoidoscopy and 1 on colonoscopy, were analyzed. Adherence to SPIRIT guidance ranged from 82.4% to 92.2%. The most missed recommendation was item 2b (trial registrations), scored 0 across all studies. Additionally, item 32 (informed consent materials) scored 20%, and items 17a & b (blinding) scored 40% each. In total, 587,572 participants were randomized across the 5 RCTs. Of these, 37% (200,610) underwent CRC screening, with 69.8% (139,983/200,610) adhering to the protocol. The Nordic-European Initiative on Colorectal Cancer (NordICC) trial, employing a unique invitation method, had a lower adherence rate of 42%. Excluding this trial would raise the adherence rate to 74.3% (128,050/172,390). CONCLUSION/UNASSIGNED:The published CRC screening trials have acceptable adherence to the SPIRIT reporting guidelines. However, reporting appended consent form materials and disclosing all WHO trial registration data can be improved.