Faculty Bibliography

INTRODUCTION/BACKGROUND:Minimally invasive surgery (MIS) is widely considered to be the standard of care for paraesophageal hernia (PEH) repairs, yet a subset of cases still require unplanned conversion to open surgery due to factors such as poor visualization and intraoperative complications. Although both laparoscopic and robotic approaches are routinely used, few studies have compared conversion rates as a primary outcome. This study aims to evaluate conversion to open surgery and associated short-term outcomes between surgical approaches for PEH repairs. METHODS:This retrospective cohort study used the 2022-2023 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) registry to identify elective laparoscopic and robotic PEH repairs in patients aged 18-90 years. Concomitant procedures were excluded and 1:1 propensity score matching was performed to control for baseline characteristics and comorbidities. The primary outcome was unplanned conversion to open surgery. Secondary outcomes included 30-day postoperative complications, return to OR, readmission, and hospital length of stay. RESULTS:A total of 8325 patients met inclusion criteria, of which 40% (n=3364) underwent robotic repair. After matching, 3335 patients were included in each group with balanced covariates (standardized mean difference < 0.05). The robotic group had zero conversions to open, while the laparoscopic group had a conversion rate of 0.2% (p = 0.031). Operative times were longer in the robotic group (133 vs 115 minutes, p < 0.001). No differences were observed in 30-day postoperative complications, readmission, return to OR, or median length of stay. Rates of specific complications including infections, thromboembolic events, and cardiopulmonary issues were comparable between groups. CONCLUSION/CONCLUSIONS:In this large national cohort, there was a growing trend of robot usage for elective PEH repair. Additionally, robotic repairs were associated with fewer conversions to open but longer operative time. Further studies are needed.

PURPOSE/OBJECTIVE:To improve access to fertility care at the largest safety net hospital in New York City, fellows and residents run a reproductive endocrinology and infertility clinic that supports an ovulation induction (OI) program under attending physician supervision. Our objective was to evaluate OI pregnancy outcomes to describe the program's efficacy and guide quality improvement. METHODS:We performed a descriptive study of patients who completed at least one OI cycle from 6/1/2019 to 4/1/2023. Fellows and residents managed patient care, including the prescription of an OI agent (clomiphene citrate or letrozole), ultrasound monitoring, and trigger (human chorionic gonadotropin) followed by timed intercourse (TIC) or intrauterine insemination (IUI). Primary outcomes included the overall pregnancy rate (PR) and live birth rate (LBR). RESULTS:Two hundred twenty-eight patients were prescribed OI agents during the study period. Of these, 161 patients (70.6%) completed at least one OI cycle and were not lost to follow up. The PR and LBR per patient were 21.1% (34/161) and 11.2% (18/161). The PR and LBR per cycle were 9.0% (34/379) and 4.7% (18/379). Patients who achieved a pregnancy were younger (median 32.5 years vs. 36 years, p < 0.002), had a higher AMH (median 3.2 vs. 2.1 ng/mL, p < 0.03), and were more likely to have PCOS (35.3% vs. 18.9%, p < 0.04). Among the 228 patients ever-prescribed an OI agent, there were 22 (9.6%) patients with pregnancies that occurred without OI treatment. CONCLUSIONS:PRs from this low-resource OI program are comparable to published data, demonstrating that fellow and resident-run initiatives can be successful in bridging the gap in fertility care.

Study DesignLiterature review with clinical recommendations.ObjectiveProviding a clear and concise overview based on the of key literature and consensus expert opinion on spinal fusion following stabilization for spine metastases and offer actionable recommendations on when to fuse and not fuse in this patient population.MethodsKey articles from the published literature on spinal metastases treated with stabilization followed by fusion were reviewed, and clinical recommendations were formulated. The recommendations are categorized as either strong or conditional based on an assessment of methodological quality and expert opinion. This assessment considers factors such as experience, risks, burdens, costs, patient values, and circumstances.ResultsFour articles were selected by practicing spinal oncology surgeons and each was evaluated for its methodological strength and its scientific evidence.ConclusionFusion rarely influences clinical outcomes in metastatic spine surgery. Treatment should prioritize mechanical stability, pain control, functional preservation, and timely continuation of oncologic therapy rather than pursuing bony arthrodesis. Fusion should be considered exclusively in select long-surviving patients, however routine attempts to enhance fusion or delay adjuvant therapy are not justified.[Formula: see text].

Personality, as a stable and coherent set of behavioral and cognitive patterns, significantly influences linguistic expression, emotional regulation, and cognitive functioning. The Big Five personality traits-neuroticism, extraversion, openness, agreeableness, and conscientiousness- are especially relevant for understanding to language use and social interaction, making them foundational for developing of personality-informed natural language processing (NLP) systems. Despite this, existing personality lexicons often lacks rigorous validation, show weak alignment with linguistic features and personality traits, and fail to adapt to dynamic language environments such as social media. This study presents the construction and empirical validation of a personality lexicon derived from established psychological scales, dictionaries, and literature. Validation using real-world participant data yielded high hit rates across all Big Five dimensions (all > 0.70; mean = 0.787) and their 30 corresponding facets (all > 0.60; mean = 0.768). This lexicon provides a robust foundation for advancing computational personality assessment and supports applications in personalized NLP, large language models, and mental health prediction.

INTRODUCTION/UNASSIGNED:The I-PASS handoff tool guides provider handoffs and reduces adverse events in the inpatient setting. Transitions of care occur frequently in the emergency department (ED), and the unpredictable environment can lead to less structured handoffs. Our goal was to increase the percentage of handoff notes that include all 4 I-PASS components by 20% within 6 months. METHODS/UNASSIGNED:We developed a handoff note template for the pediatric ED that included 4 key I-PASS elements: illness severity, patient care summary, action list, and situational awareness/contingency planning. Our primary outcome measure was the percentage of handoff notes that contained all 4 I-PASS elements. Our process measure was the percentage of handoff notes that used the template. Our balancing measure was the percentage of handoffs with no note. We analyzed a random sample of 20 charts monthly during our preimplementation (August 2021-July 2022) and postimplementation (August 2022-January 2024) phases. We completed monthly Plan-Do-Study-Act cycles to review note usage and identify obstacles to use. Process improvements included modifying the note template, enhancing accessibility within the electronic medical record, and designating computer workstations for completing handoff notes. RESULTS/UNASSIGNED:We assessed 240 handoff notes to determine the preimplementation baseline and evaluated 360 handoff notes postimplementation. Following implementation, 63.0% of handoff notes contained 4 I-PASS elements, compared with 0% before our intervention. Similarly, use of handoff templates increased to 82.0% from 0%. There was no change in handoffs without documentation. CONCLUSIONS/UNASSIGNED:Using a standardized note template for provider handoff improved adherence with the I-PASS handoff tool in the pediatric ED.

IMPORTANCE/UNASSIGNED:Spending benchmarks in the Medicare Shared Savings Program previously only considered an accountable care organization's (ACO) historical spending, potentially disadvantaging efficient organizations in favor of inefficient ones. To more sustainably reward efficient ACOs, benchmark calculation has evolved, such as the incorporation of average regional spending in 2017, but how benchmarking policy, and its changes, have affected the financial performance of ACOs across the efficiency spectrum remains unclear. OBJECTIVE/UNASSIGNED:To measure the association between ACO efficiency on entry (ie, the ratio of observed to expected spending) with earning a shared savings bonus. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study used a 20% national sample of Medicare claims to identify ACOs that participated in the Shared Savings Program for a minimum of 4 years between January 2013 and December 2020. ACOs were sorted in quartiles based on their observed to expected spending ratio in their first year of participants. Data analysis was conducted from July 2024 to May 2025. EXPOSURE/UNASSIGNED:Quartiles of ACO efficiency with a higher spending ratio denoting lower efficiency. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was receipt of a shared savings bonus in the second, third, and fourth agreement years. Multivariable logistic regression was used to estimate the association between ACO efficiency quartiles and earning a bonus and how the regional benchmark adjustment in 2017 affected this association across measured agreement years. RESULTS/UNASSIGNED:Across 402 ACOs, the median (IQR) spending ratio was 1.000 (0.993- 1.005). After adjustment, the most efficient ACOs (ie, lowest quartile of the spending ratio) had an increased probability of earning a bonus from 24.4% (95% CI, 15.3%-33.4%) to 45.2% (95% CI, 35.4%-55.0%) after the 2017 introduction of the regional benchmark adjustment. However, the least efficient ACOs (ie, top quartile of the spending ratio) were significantly more likely to earn bonuses prior to (43.8%; 95% CI, 33.7%-53.9%) and after (60.7%; 95% CI, 51.3%-70.1%) the benchmarking change, without evidence that this gap narrowed. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cross-sectional study, ACOs across the range of efficiency on entry had greater odds of earning bonuses after the introduction of the regional benchmark adjustment in 2017. However, less efficient ACOs had significantly greater odds of earning bonuses compared with more efficient ACOs, before and after the policy change.

PURPOSE/OBJECTIVE:This study aimed to quantitatively assess relative arterial contributions to the quadriceps tendon (QT) using 7-Tesla quantitative magnetic resonance imaging (7T-qMRI), histology and high-resolution computed tomography (micro-CT) in a fresh-frozen human cadaveric model. METHODS:Six human cadaveric knee pairs were obtained (mean age: 43 years; range: 23-61 years). Pre- and post-contrast 7T-qMRI scans were performed to quantify tendonous vascularity. Subsequent algorithm-based quantitative histologic analysis was performed using hematoxylin and eosin staining, with validation by CD31 immunohistochemistry. Qualitative analysis was performed on two additional knee specimens using 98 μm micro-CT imaging. RESULTS:The distal QT demonstrated higher median arterial contributions versus central and proximal regions (distal, 47.4% [interquartile range: 30.8%-64.1%]; central, 28.6% [20.4%-41.5%]; proximal, 11.6% [8.7%-18.4%]), with significantly greater contributions distally versus proximally (Cohen's d = 1.58; p = 0.021). These findings aligned with the sagittal sub-analysis (deep-proximal 17.2 ± 19.3% vs. deep-distal 43.4 ± 20.3%; Cohen's d = 1.32; p = 0.050). Histologic analysis (interobserver-reliability: r = 0.95) corroborated the MRI results (distal QT, 43.5 ± 7.9%; central, 30.7 ± 6.4%; proximal, 25.8 ± 4.1%), with significant differences between distal and both proximal (Cohen's d = 2.81; p < 0.001) and central (Cohen's d = 1.78; p = 0.012) regions. The deep layer was found to have significantly higher arterial contributions (61.6 ± 14.2%) versus the superficial layer (38.4 ± 14.2%) (Cohen's d = 1.64; p = 0.018). The medial and lateral QT demonstrated lower arterial contributions versus middle QT (Cohen's d = 0.96-1.26; p > 0.050). CONCLUSION/CONCLUSIONS:7T-qMRI and algorithm-based histological analysis of arterial QT contributions revealed significantly greater arterial contributions in the distal compared to the proximal as well as in the deep compared to the superficial region. While the central region demonstrated higher arterial contributions than the medial and lateral aspects, these differences were not statistically significant. Given that the majority of injuries affect the distal and central portions of the QT, these findings reinforce the rationale for direct tendon-to-bone repair; however, clinical studies are necessary to confirm these findings. LEVEL OF EVIDENCE/METHODS:Level V, cadaveric study.

INTRODUCTION/UNASSIGNED:Effective clinical research training is crucial for advancing medical science and improving patient care. However, current evaluation systems in China often focus on theoretical knowledge, neglecting practical skills and innovation. This study aimed to develop a comprehensive evaluation framework for clinical research training programs using the Delphi consensus method. METHOD/UNASSIGNED:A 2-round Delphi method was employed, involving healthcare professionals and educators from top tertiary hospitals and leading academic institutions in China. The first round included 15 participants, and the second round included 19 participants. The evaluation framework was based on the Kirkpatrick model, covering Reaction, Learning, Behavior, and Results dimensions. Indicators were evaluated using a 5-point Likert scale, with consensus defined as a mean significance score ≥3.50 and a coefficient of variation ≤0.25. RESULTS/UNASSIGNED:In the first round, 9 indicators were excluded and 5 added. In the second round, 26 indicators met consensus criteria. Key indicators included "Relevance of training content" (mean = 4.89, CoV = 0.06), "Degree of knowledge mastery" (mean = 4.58, CoV = 0.13), and "Impact on career development" (mean = 4.53, CoV = 0.15). Other significant indicators were "Timeliness of training information" (mean = 4.84, CoV = 0.08) and "Success rate of applying for scientific research funds" (mean = 4.05, CoV = 0.21). DISCUSSION/UNASSIGNED:This study developed a comprehensive evaluation framework for clinical research training in China, emphasizing the importance of relevant training content, strong learning outcomes, and long-term professional impact. This framework provides a robust tool to assess and enhance clinical research training programs, ultimately contributing to improved healthcare and medical research. Future work should focus on validating this framework through empirical studies and refining it based on ongoing feedback.