Faculty Bibliography

OBJECTIVE:Our objectives were to understand migraine-related perceptions among college students and the lived experiences of those with migraine on college campuses and to generate recommendations for supporting college students with migraine. BACKGROUND:During young adulthood, there is a sharp growth in migraine prevalence and disability-adjusted life years. Migraine prevalence is approximately 16% among university students and negatively influences several aspects of a student's college experience. METHODS:This was a qualitative study using phenomenological inquiry via virtual semistructured focus groups. Recruitment took place between April 2025 and July 2025. An initial 60-min focus group was conducted in May 2025 with an all-women's college to assess our questions' relevance and comprehensiveness. We then conducted four national focus groups in June 2025 and July 2025 with college students from across the United States. All focus groups included students with and without severe headache or migraine (self-reported). Focus groups were transcribed and independently coded twice. We developed themes for the five focus groups using content analysis. Qualitative analysis was conducted between July 2025 and September 2025. RESULTS:Three students attended the all-women's college focus group and 47 students attended one of the four national focus groups (n = 50). The following themes emerged from the five focus groups: (1) Migraine is often misunderstood and not discussed on campus, with misconceptions surrounding severity and its distinction from headache. (2) The impact of migraine on campus is significant, with students reporting various triggering environments, difficulty maintaining focus, attending class, performing academically, preserving social relationships, and participating in extracurricular activities. (3) The most commonly reported accommodations for migraine were academic, specifically exam- and attendance-related, though not always honored by professors. (4) Access to migraine care for students is challenging, with reports that student health centers are typically unapproachable, inconvenient, and unhelpful, with students seeking external providers for migraine. Students recommended more awareness and education initiatives for improved understanding of migraine as well as increased access to migraine resources and accommodations. CONCLUSION/CONCLUSIONS:The experiences captured in our study provide unique qualitative insights by highlighting how misunderstanding of migraine on campus contributes to social and academic challenges faced by students with migraine. Students described unmet needs related to widespread misunderstanding of migraine, limited academic flexibility, environmental triggers, limited access to care, and inconsistent implementation of accommodations, highlighting that greater awareness of migraine, especially by professors and student health services, is crucial on college campuses. There are opportunities for migraine education programs on college campuses to increase knowledge and awareness about migraine and create a more supportive migraine environment.

Research is needed to establish optimal cutoffs to determine cocaine use via oral fluid testing while considering the possibility of unintentional exposure. We compared detection of cocaine and its metabolites to self-reported use while considering other drug use to determine optimal cutoffs to determine intentional use. In this study, 1819 adults entering randomly selected nightclubs were surveyed about cocaine and other drug use and had their oral fluid analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry. We compared self-reported use to detected exposure. 13.6% of participants reported past 24-hour cocaine use, 43.7% tested positive for cocaine exposure (≥1 ng/mL), and 11.8% tested positive for at least one metabolite. 28.6% either tested positive for or reported past 24-hour use of other drugs, primarily ketamine. Among those testing positive for cocaine exposure (n = 794), only 29.1% reported past 24-hour use. Among positive cases, the optimal cocaine concentration cut-point for predicting self-report was ≥ 26 ng/mL. When focusing on the full sample and a subsample with data on past 48-hour reported use, optimal cut-points were ≥ 6 ng/mL and ≥ 5 ng/mL, respectively. However, detection of metabolites was the strongest predictor of self-reported use. Using self-report as the gold standard, metabolite detection most accurately classified reported use, over and above detection of cocaine or other drugs; however, relying solely on detection of metabolites or higher cocaine concentration thresholds often led to under-detection. In conclusion, relying on detection of metabolites or higher concentrations most accurately detects intentional use, but these lack sensitivity to detect a portion of use.

In the past decade, interest in studying psychedelic compounds as potential therapeutic agents has resurged. These studies carefully exclude individuals at risk for developing psychotic symptoms in response to psychedelic use. Given the potential for psychedelics to be established as treatments in psychiatry, it is important to more robustly understand their link with psychosis and schizophrenia spectrum disorders (SSDs). In this narrative review, we examine the historical and theoretical relationship between psychedelic drugs and SSDs, including the origins of the psychotomimetic hypothesis. For key psychedelic compounds, we review their phenomenological manifestations in relation to the experiential alterations characteristic of SSDs, revealing both areas of overlap and important qualitative differences that challenge the uniform psychotomimetic classification. We also review putative neural mechanisms underlying altered experiential states associated with psychedelic use and SSDs, with attention to serotonergic, dopaminergic, and glutamatergic contributions. Clinical evidence demonstrates that psychedelics can exacerbate pre-existing psychotic illness and may trigger psychosis in vulnerable individuals, though the magnitude of these risks remains inadequately quantified. However, phenomenological and mechanistic distinctions suggest that potential therapeutic applications may exist for carefully selected symptoms (negative symptoms, depression) in stable patients using low-dose, controlled approaches. Based on published work, we provide recommendations regarding psychosis-related risk and potential avenues for the treatment of SSDs as psychedelics gain traction as therapeutics.

BACKGROUND AND AIMS/OBJECTIVE:Individuals who engage in illicit or nonmedical opioid use may have elevated risk of health and social consequences, including progression to opioid use disorder (OUD). Preventive interventions to reduce this risk are lacking. This trial tested the impact of a primary care-integrated collaborative care approach for reducing risky opioid use, defined as nonmedical use of prescription opioids or any use of illicit opioids. DESIGN/METHODS:Cluster-randomized controlled trial randomized primary care providers (PCPs) and their patients into the Subthreshold Opioid Use Disorder Prevention (STOP) intervention or enhanced usual care (EUC). SETTING/METHODS:Primary care clinics at 5 U.S. sites. PARTICIPANTS/METHODS:PCPs and their patients were recruited January 2021-May 2023. A total of 119 PCP clusters (STOP = 48, EUC = 51) and 202 patients (STOP = 88, EUC = 114) enrolled. Eligible patients were adults (≥18 years) having current risky opioid use, without moderate-severe OUD. Patient participants were majority female (63.4%), white (70.8%) and non-Hispanic (96.5%), with a mean age of 55.7 [standard deviation (SD) = 12.7] years. At baseline, 63.4% of participants had moderate-severe pain (Brief Pain Inventory) and below average physical (79.2%) and mental (62.4%) health (SF-12). INTERVENTIONS/METHODS:The STOP collaborative care intervention consisted of brief advice from the PCP about reducing risky opioid use, meetings with a clinic-embedded nurse care manager over 12 months and remote health coaching (2-6 sessions). Both groups received primary care treatment as usual and overdose risk reduction materials. MEASUREMENTS/METHODS:The primary outcome was total days of risky opioid use, recorded from 6 monthly electronic surveys. A key secondary outcome was moderate-severe OUD at 6 and 12 months. FINDINGS/RESULTS:A total of 77 (87.5%) STOP and 107 (93.9%) EUC participants completed the 6-month assessment period. The primary outcome analysis used the Intention-to-Treat sample with multiple imputations of missing data. Mean days of risky opioid use at 180 days were lower in STOP than EUC [12.2 (SD = 27.73) vs. 15.5 (SD = 32.64)]; the difference between groups adjusted for baseline risky opioid use was not statistically significant (rate ratio 0.95, 95% confidence interval = 0.52-1.74). One STOP participant (1.1%) and 13 EUC participants (11.4%) developed moderate-severe OUD at 6 months, and 3 (3.4%) STOP and 6 (5.3%) EUC participants had moderate-severe OUD at 12 months (P < 0.001). CONCLUSIONS:This cluster-randomized controlled trial did not find evidence that the STOP intervention for reducing risky opioid use produced greater reductions over 6 months compared with enhanced usual care, though fewer intervention participants progressed to moderate-severe opioid use disorder. Patients had a high burden of pain and comorbidities that may present challenges to reducing opioid use.

Underdiagnosis of cardiometabolic risk factors (CMRFs) may represent an unrecognised biological pathway contributing to dementia risk; yet remains poorly characterised in African and African diaspora populations. We quantified the prevalence and determinants of underdiagnosed hypertension and abnormal glycaemia across four cohorts comprising up to 7000 adults aged ≥40 years from Nigeria, Kenya, and The United States: Indianapolis, and North Texas. Underdiagnosis was defined as absence of self-reported diagnosis despite elevated systolic blood pressure ( ≥130 mmHg) or fasting blood glucose ( ≥100 mg/dL). Cohort-stratified analyses examined demographic, socioeconomic, cognitive, Alzheimer's genetic, and blood-based biomarker correlates. Underdiagnosis was pervasive in African cohorts. Elevated fasting glucose was associated with cognitive impairment in Kenya and North Texas, while severe hypertension and diabetes were linked to Alzheimer's disease-related biomarkers [pTau217/181, NFL and Aβ42/40] in North Texas (all p ≤ 0.05). These findings identify context-specific diagnostic gaps in populations at high dementia risk and highlight cardiometabolic detection as a mechanistic target for prevention.

Repetitive head impacts sustained during American football have been associated with neuropathological changes such as white matter shear injuries. However, the impact of specific factors, such as age of first exposure and cumulative head impact burden, on white matter integrity remains unclear. This study investigated in vivo white matter microstructural changes using diffusion tensor imaging and tract-based spatial statistics in 165 male former American football players (mean age 57.3 years, range 45-74) and 52 unexposed asymptomatic male controls (mean age 59.4 years, range 45-74) in the DIAGNOSE CTE Research Project. Compared to controls, former football players exhibited significantly higher fractional anisotropy (FA) in 1.97% of the white matter skeleton (1552 voxels; Cohen's d = 0.587) and higher tissue-corrected FA (FAt) in 1.48% of the white matter skeleton (1004 voxels; Cohen's d = 0.616). No significant differences were observed for mean diffusivity, axial diffusivity, radial diffusivity, or free water between football players and controls. Among football players, there were no significant differences in the white matter microstructure between players diagnosed with traumatic encephalopathy syndrome and those without the diagnosis. Lower FA was significantly associated with older age (P < 0.00001) and an earlier age of first exposure to tackle football (P < 0.01), while lower FAt was associated with greater cumulative head impact burden, specifically higher linear acceleration (P < 0.04) and rotational force (P < 0.02). This study highlights the influential role of exposure factors on white matter microstructure in former American football players, as well as the utility of diffusion tensor imaging to aid in characterizing the long-term effects of repetitive head impacts in contact sport athletes.

BACKGROUND/UNASSIGNED:. those who proceeded directly to mTESE. METHODS/UNASSIGNED:A retrospective cohort study of 73 male patients with NOA or cryptozoospermia severe enough to qualify for mTESE at NYU Langone Fertility Center between 2018 and 2024. Patients were categorized based on their initial intervention: ESSM-first group (n=45), in which ESSM was attempted prior to surgical retrieval, and an mTESE-first group (n=28), in which patients proceeded directly to surgery. The primary outcome was overall sperm identification rate per patient. Secondary outcomes included sperm retrieval success from mTESE after failed ESSM, and among patient proceeding to in vitro fertilization (IVF) with ICSI, fertilization rate, blastocyst formation rate, euploid rate, and live birth rate. RESULTS/UNASSIGNED:. 46%, P=0.66). CONCLUSIONS/UNASSIGNED:In men with NOA or cryptozoospermia eligible for surgical sperm retrieval, an ESSM-first strategy was associated with higher overall sperm identification rates while preserving comparable reproductive outcomes among those proceeding to IVF with ICSI. These findings support consideration of ESSM as an initial, non-invasive strategy prior to mTESE in appropriately selected patients.