Faculty Bibliography

OBJECTIVES/OBJECTIVE:This review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception. METHODS:Electronic databases PubMed, Embase, Web of Science, and Scopus were searched using 'medical tourism' AND 'assisted reproductive technology' from 1978 to 2020. RESULTS:Predominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce. CONCLUSIONS:While patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient's safety. CLINICAL PRACTICE IMPLICATIONS/UNASSIGNED:This review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.

INTRODUCTION/BACKGROUND:The dramatic reduction of clinical and research activities within medical and surgical departments during COVID-19, coupled with the inability of medical students to engage in research, away rotations and academic meetings, have all posed important implications on residency match. METHODS:Using Twitter application programming interface available data, 83,000 program-specific and 28,500 candidate-specific tweets were extracted for the analysis. Applicants to urology residency were identified as matched vs unmatched based on 3-level identification and verification. All elements of microblogging were captured through Anaconda Navigator. The primary endpoint was residency match, assessed as correlation to Twitter analytics (ie retweets, tweets). The final list of matched/unmatched applicants through this process was cross-referenced with internal validation of information obtained from the American Urological Association. RESULTS:A total of 28,500 English language posts from 250 matched and 45 unmatched applicants were included in the analysis. Matched applicants generally showed higher number of followers (median 171 [IQR 88-317.5] vs 83 [42-192], p=0.001), tweet likes (2.57 [1.53-4.52] vs 1.5 [0.35-3.03], p=0.048), and recent and total manuscripts (1 [0-2] vs 0 [0-1], p=0.006); 1 [0-3] vs 0 [0-1], p=0.016) in comparison to the unmatched cohort. On multivariable analysis, after adjusting for location, total number of citations and manuscripts, being a female (OR 4.95), having more followers (OR 1.01), individual tweet likes (OR 1.011) and total number of tweets (OR 1.02) increased overall odds of matching into a urology residency. CONCLUSIONS:Our study of the 2021 urology residency application cycle and use of Twitter highlighted distinct differences among matched and unmatched applicants and their respective Twitter analytics, highlighting a potential professional development opportunity offered by social media in underscoring applicants' profiles.

BACKGROUND/OBJECTIVES/OBJECTIVE:Excessive gestational weight gain (GWG) and pre-pregnancy obesity affect a significant portion of the US pregnant population and are linked with negative maternal and child health outcomes. The objective of this study was to explore associations of pre-pregnancy body mass index (pBMI) and GWG with longitudinally measured maternal urinary metabolites throughout pregnancy. SUBJECTS/METHODS/METHODS:Among 652 participants in the New York University Children's Health and Environment Study, a longitudinal pregnancy cohort, targeted metabolomics were measured in serially collected urine samples throughout pregnancy. Metabolites were measured at median 10 (T1), 21 (T2), and 29 (T3) weeks gestation using the Biocrates AbsoluteIDQ® p180 Urine Extension kit. Acylcarnitine, amino acid, biogenic amine, phosphatidylcholine, lysophosphatidylcholine, sphingolipid, and sugar levels were quantified. Pregnant people 18 years or older, without type 1 or 2 diabetes and with singleton live births and valid pBMI and metabolomics data were included. GWG and pBMI were calculated using weight and height data obtained from electronic health records. Linear mixed effects models with interactions with time were fit to determine the gestational age-specific associations of categorical pBMI and continuous interval-specific GWG with urinary metabolites. All analyses were corrected for false discovery rate. RESULTS:Participants with obesity had lower long-chain acylcarnitine levels throughout pregnancy and lower phosphatidylcholine and glucogenic amino acids and higher phenylethylamine concentrations in T2 and T3 compared with participants with normal/underweight pBMI. GWG was associated with taurine in T2 and T3 and C5 acylcarnitine species, C5:1, C5-DC, and C5-M-DC, in T2. CONCLUSIONS:pBMI and GWG were associated with the metabolic environment of pregnant individuals, particularly in relation to mid-pregnancy. These results highlight the importance of both preconception and prenatal maternal health.

BACKGROUND:Morbidity and death due to coronavirus disease 2019 (COVID-19) experienced by older adults in nursing homes have been well described, but COVID-19's impact on community-living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID-19 risks and outcomes. METHODS:To investigate the relationship of advanced age (65+), on risk factors associated with COVID-19 outcomes in community-living elders, we identified an electronic health records cohort of older patients aged 65+ with laboratory-confirmed COVID-19 with and without an ambulatory care visit in the past 24 months (n = 47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID-19 hospitalization; severe outcomes/Intensive care unit (ICU), intubation, dialysis, stroke, in-hospital death), and in-hospital death. The exposures include demographic characteristics, and those with ambulatory records, comorbidities, frailty, and laboratory results. RESULTS:The 31,770 patients with an ambulatory history had a median age of 74 years; were 47.4% male, 24.3% non-Hispanic white, 23.3% non-Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race-ethnicity, comorbidities, and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID-19 hospitalization and severe outcomes, with strongest effect in the oldest group. CONCLUSIONS:In this cohort of community-dwelling older adults, we provided evidence of age-specific risk factors for COVID-19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID-19 outcomes in community-living older adults, and the role of engagement in ambulatory care in mitigating severe disease.

OBJECTIVE:There is growing recognition that health care professionals (HCPs) and policy makers are insufficiently equipped to provide culturally competent care to lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients and their families. We examined HCP attitudes, knowledge, and practices regarding LGBTQI cancer care using a mixed-methods research design. METHOD/METHODS:Surveys were completed by 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%), and clinical leadership roles (11%); 48 of the surveyed HCPs were interviewed. RESULTS:Most HCPs reported being comfortable treating LGBTQI patients, but reported low levels of confidence and knowledge and systemic barriers to LGBTQI cancer care. Most wanted more education and training, particularly on trans and gender-diverse people (TGD) and those born with intersex variations. CONCLUSION/CONCLUSIONS:Education of HCPs and health system changes are required to overcome barriers to the provision of culturally competent cancer care for LGBTQI patients. PRACTICE IMPLICATIONS/CONCLUSIONS:These findings reinforce the need for inclusion of LGBTQI content in HCP education and professional training curricula, and institutional support for LGBTQI-inclusive practice behaviours. This includes administrative and visual cues to signal safety of LGBTQI patients within cancer care, facilitating inclusive environments, and the provision of tailored patient-centred care.

BACKGROUND:Glycated albumin is cleared by the Food and Drug Administration (FDA) for clinical use in diabetes care. To understand its performance in the general US population, we conducted measurements in >19 000 samples from the National Health and Nutrition Examination Survey (NHANES). Of these samples, 5.7% had previously undergone at least 2 freeze-thaw cycles and were considered "non-pristine." METHODS:We measured glycated albumin and albumin using the Lucica GA-L (Asahi Kasei) assay in stored serum samples from NHANES 1999-2004. Serum albumin (Roche/Beckman) was previously measured. We examined the correlations of percent glycated albumin with hemoglobin A1C (HbA1c)and fasting glucose in the pristine and non-pristine samples. We also measured cystatin C (Siemens) and compared these to cystatin C (Dade Behring) previously obtained in a subsample. RESULTS:Glycated albumin (%) was significantly lower in pristine vs non-pristine samples (13.8% vs 23.4%, P < 0.0001). The results from the Asahi Kasei albumin assay (g/dL) were highly correlated with albumin originally measured in NHANES (Pearson's correlation coefficient, r = 0.76) but values were systematically higher (+0.25 g/dL, P < 0.0001). Cystatin C (Siemens) was similar to previous cystatin C measurements (r = 0.98) and did not differ by pristine status (P = 0.119). Glycated albumin (%) was highly correlated with HbA1c and fasting glucose in pristine samples (r = 0.78 and r = 0.71, respectively) but not in non-pristine samples (r = 0.11 and r = 0.12, respectively). CONCLUSIONS:The performance of the glycated albumin assay in the pristine samples was excellent. Performance in non-pristine samples was highly problematic. Analyses of glycated albumin in NHANES 1999-2004 should be limited to pristine samples only. These results have major implications for the use of these public data.

BACKGROUND:Glycated albumin may provide complementary information to hemoglobin A1c (HbA1c). We compared cross-sectional associations of HbA1c and glycated albumin with chronic kidney disease (CKD) in US adults. METHODS:We included 10 923 adults (9955 without diagnosed diabetes, 968 with a diabetes diagnosis) from the National Health and Nutrition Examination Survey 1999-2004. We examined continuous associations and clinical cut points for HbA1c among those without diabetes (<5.0%, 5.0%-5.6% (reference), 5.7%-6.4%, ≥6.5%) and among those with diagnosed diabetes (<7.0%, 7.0%-8.9%, ≥9.0%) and percentile equivalents for glycated albumin. We used logistic regression to compare associations with prevalent CKD, adjusting for traditional risk factors. We used likelihood ratio tests to assess whether adding glycated albumin improved the model with HbA1c. RESULTS:There were J-shaped associations for both glycated albumin and HbA1c with CKD. Persons without a history of diabetes and very low glycated albumin or HbA1c were more likely to have CKD compared to those without diabetes and normoglycemia. The odds ratios (ORs) for CKD were 1.32 (95% CI, 1.12-1.55) for HbA1c 5.7% to 6.4% and 2.04 (95% CI, 1.28-3.25) for HbA1c ≥6.5%. The ORs for glycated albumin were 1.27 (95% CI, 1.06-1.51) and 2.48 (95% CI, 1.50-4.08) for glycated albumin 14.4% to 17.8% and ≥17.9%, respectively. The inclusion of glycated albumin in the model with HbA1c and traditional risk factors modestly but significantly improved the model fit (P value = 0.006). CONCLUSIONS:Glycated albumin and HbA1c were similarly associated with prevalent CKD. Glycated albumin provides complementary information to HbA1c for prevalent CKD.