Faculty Bibliography

Respiratory viruses-including SARS-CoV-2 (COVID-19), Respiratory Syncytial Virus (RSV), and Influenza-pose significant risks to immunocompromised patients, who experience attenuated vaccine responses and higher morbidity. To address evolving vaccine recommendations for the 2025-2026 season, the Infectious Diseases Society of America (IDSA), in collaboration with the Vaccine Integrity Project (VIP) and partner organizations, developed rapid guidelines for U.S.-licensed vaccines targeting these viruses. The guideline applies to adults and children with compromised immunity due to hematologic malignancy, solid organ or hematopoietic cell transplantation, autoimmune disease on immunosuppressants, HIV with severe immunosuppression, and similar conditions. Strong recommendations, supported by moderate-certainty evidence, endorse timely administration of age-appropriate COVID-19, RSV, and Influenza vaccines, with guidance on optimal timing relative to immunosuppressive therapy and transplantation. Co-administration of these vaccines is considered appropriate. Research gaps remain in immunogenicity, durability, and clinical effectiveness, particularly for patients receiving B-cell-depleting therapies or early post-transplant. Priority areas include defining correlates of protection, optimizing vaccine schedules, evaluating high-dose or adjuvanted formulations, and improving real-world effectiveness and safety data. Equity and access strategies are essential to ensure uptake among vulnerable populations. These guidelines aim to support evidence-based decision-making and highlight the need for harmonized, multi-virus research to inform tailored vaccination strategies for immunocompromised individuals.

INTRODUCTION/BACKGROUND:Hounsfield units (HU) are a validated marker of bone mineral density. This study aimed to determine whether low-energy Schatzker IV, V and VI tibial plateau fractures are associated with altered bone quality. METHODS:). Fractures were classified by injury mechanism (low- vs. high-energy) and HU thresholds were defined as poor (< 110) or normal (> 160). Clinical outcomes included major complications, reoperations, range of motion, Visual Analog Scale (VAS) pain scores, and Short Musculoskeletal Function Assessment (SMFA) scores. RESULTS:Low-energy fractures (n = 96) had significantly lower HU values (113.9 vs. 150.9, p < 0.0001) across all planes. No significant differences were found in clinical outcomes. CONCLUSION/CONCLUSIONS:Low-energy Schatzker IV-VI fractures indicate poor bone quality and may represent "fragility fractures" requiring further evaluation.

BACKGROUND/OBJECTIVE/OBJECTIVE:Arthrocentesis of the noneffusive knee is challenging. We hypothesized (1) pneumatic compression of the noneffusive knee would improve arthrocentesis, and (2) the increased synovial fluid yield would be diagnostically useful. METHODS:One hundred and thirty consecutive patients with a painful but clinically noneffusive knee underwent arthrocentesis. Arthrocentesis was performed with and without pneumatic compression and fluid volumes from each were measured. Successful arthrocentesis was defined as a fluid yield ≥1.0 mL. Synovial fluid samples were analyzed for total nucleated cell (TNC) count, TNC differential, the presence of crystals by polarized microscopy, and bacteria by culture. RESULTS:Arthrocentesis of the noneffusive joint was successful (≥1.0 mL) in 15.4% (20/130) with conventional arthrocentesis and in 53.8% (70/130) with pneumatic compression (OR: 6.4; CI: 3.6-11.6; p=0.0001). Pneumatic compression increased synovial fluid yield: conventional arthrocentesis: 0.5±1.1 mL, compression: 2.8±3.5 mL [2.3±3.0 mL increase (+460%), 95% CI: -2.9<-2.3<-1.7 mL; p=0.0001]. Synovial fluids were abnormal in 60.0% (42/70) of aspirated knees. Mean TNC was 2746±10,741 cells/mm3, including 40.0% normal fluid (TNC/mm3<200), 49.2% noninflammatory fluid (TNC/mm3 ≥200 but <2000), 10.8% inflammatory fluid (TNC/mm3 ≥2000), 1.5% hemorrhagic fluid, and 10% fluids with crystals that changed the diagnosis and subsequent therapy. CONCLUSIONS:Pneumatic compression-assisted arthrocentesis enables the successful collection of synovial fluid in the clinically noneffusive symptomatic knee. The majority of extracted synovial fluids are abnormal, indicating inflammatory arthritis, noninflammatory arthritis, or previously unrecognized crystal-associated disease. Pneumatic compression-assisted arthrocentesis is useful in the evaluation of the clinically noneffusive symptomatic knee.

Mental health conditions are a major public health concern in the African region, where women experience a high prevalence of maternal mental health conditions and limited access to adequate care. This issue is particularly severe among women living with HIV (WLHIV), who face a heightened risk of depression and anxiety. Despite the well-documented association between male partner-related factors and maternal/child health outcomes, their impact on perinatal mental health from the perspective of women is not well understood. We conducted semi-structured interviews and focus group discussions with women affected by HIV. Thematic analysis revealed common sources of mental distress they experienced. Relationship with male partners was identified as an area needing further interrogation to better understand how gender inequities exacerbate maternal mental health outcomes. Male partners emerged as the most significant source of stress for postpartum women, often due to relationship instability, inadequate financial support, and in some cases, verbal or physical abuse. Additionally, women noticed signs of mental health challenges in their male partners, such as anger and chronic stress, and observed that these men often lacked support to address these issues. Other sources of stress included pregnancy-related changes, fear of acquiring HIV among those on HIV PrEP (Pre-Exposure prophylaxis) and fear of transmitting HIV to their babies among those living with HIV. Strategies for coping with perinatal mental health challenges included praying, singing, listening to music, taking walks, social interaction, and participating in church or community-based support groups. Recognizing the significant influence men have on women's mental health and the interconnectedness of men's stress and women's mental well-being, family-oriented mental health programs could be instrumental in improving perinatal mental health.

Currently, no consensus exists regarding the definition of oligometastatic pancreatic ductal adenocarcinoma, its necessary diagnostic measures, and potential treatment approaches. To address these knowledge gaps, the OligoPanc project brought together an interdisciplinary group of experts to establish consensus using a modified Delphi process and clinical vignettes. Participants agreed that the number of metastatic lesions and the number of affected organs are key elements in defining oligometastatic pancreatic ductal adenocarcinoma. Specifically, up to three lesions in a single organ, either the liver or the lung, define oligometastatic pancreatic ductal adenocarcinoma and could be either synchronous or metachronous. Necessary diagnostics include a triple-phase contrast-enhanced CT scan of the chest and abdomen and MRI of the liver with a hepatocyte-specific contrast agent. In unclear cases, [¹⁸F]fluorodeoxyglucose-PET CT or MRI can be considered. A multidisciplinary tumour board is essential. Patient-intrinsic factors, including age, do not define oligometastatic disease but should be considered for any treatment decision. Systemic treatment before any local consolidative treatment, including surgery, stereotactic ablative radiotherapy, or other locally ablative techniques, is mandatory. The proposed definition should be incorporated into future trials to improve comparability and enable validation.

IMPORTANCE/UNASSIGNED:Asian language speakers with limited English proficiency (LEP) face significant barriers to accessing adequate mental health care. Despite worsening mental health outcomes for this population, there is limited research examining the availability of Asian language mental health treatment in the US. OBJECTIVE/UNASSIGNED:To quantify trends and analyze disparities in the geographic availability of Asian language mental health treatment from 2015 to 2024. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study of US mental health facilities from April 30, 2015, to December 9, 2024, used longitudinal data from the nationally representative Mental Health and Addiction Treatment Tracking Repository linked with county-level demographic data from the 2023 American Community Survey. Facilities were included if they completed the National Mental Health Services Survey or the National Substance Use and Mental Health Services Survey. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes included the annual proportion of mental health facilities offering Asian language services and the proportion of counties with at least 1 such facility. For 2024, facility-level characteristics associated with Asian language services were assessed and geographic mismatches between service availability and the proportion of Asian language-speaking individuals with LEP were mapped. RESULTS/UNASSIGNED:The study included 3847 mental health facilities. Of these, 214 facilities (5.6%) offered services in at least 1 Asian language in 2024 (including Arabic, Chinese, Farsi, Hindi, Hmong, Japanese, Korean, Tagolog, and Vietnamese). The proportion peaked at 265 facilities (6.9%) in 2021, then declined from 2022 to 2024. The number of counties with at least 1 facility with Asian language services was 98 (6.3%) in 2024. Facilities offering Asian language services were concentrated in metropolitan areas (208 [97.2%]), particularly in California (57 [26.6%]) and the Northeast (52 [24.3%]). Rural areas lacked such services (3 of 485 rural facilities [0.6%] in 2024), even in counties with substantial populations of Asian language-speaking individuals with LEP (0 of 5 facilities). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cross-sectional study found a persistent geographic mismatch between the mental health needs of Asian language-speaking individuals with LEP and the availability of appropriate linguistic services. The gap was pronounced in rural areas. The findings suggest that policies aimed at expanding the behavioral health workforce and increasing access to culturally and linguistically competent services to reduce ongoing disparities in mental health outcomes and access to care are urgently needed.

Combat exposure significantly increases the risk of PTSD and psychological distress among military personnel. PTSD is often associated with poorer coping with personal and interpersonal demands. This cross-sectional study examined whether functional coping efficacy mediates the relationship between combat exposure and psychological outcomes among 1076 Israeli reserve soldiers (96.5% male, mean age 30.7 years) referred to a military Combat Stress Reaction Unit for evaluation and treatment during the war following the October 7th attack. Participants completed assessments measuring combat exposure; a brief Coping Efficacy Scale evaluated task performance, emotional control, interpersonal relationships and self-worth. The PTSD Checklist for DSM-5 (PCL-5) quantified PTSD severity and inferred probable PTSD status (PCL score ≥33), and the Brief Symptoms Inventory (BSI) evaluated psychological distress (BSI score ≥40). Mediation analyses examined direct and indirect statistical pathways between combat exposure and clinical outcomes. Combat exposure showed weak correlations with symptoms severity (r = 0.11, p < .001), whereas coping efficacy domains demonstrated strong negative associations with PTSD and general psychological distress (r = -0.33 to-0.60, all p < .001). Indirect association models indicated task performance and self-worth were significantly linked to the relationship between combat exposure and PTSD symptoms (indirect effects: β = 0.03, p < .001 for both). For general psychological distress, only task performance showed significant indirect association (β = 0.04, p < .001). These findings highlight functional coping domains, particularly task performance and self-worth, as strongly associated with psychological outcomes following combat exposure and underscore their potential clinical relevance in early assessment and intervention planning.

INTRODUCTION/BACKGROUND:Losses of functional reserve across multiple physiological systems have been identified in frail patients, yet the exact aetiology of frailty remains unclear. Although strongly associated with chronological age, frailty often develops at a younger age in patients with organ failure. Frailty is prevalent in patients with kidney failure; however, individuals experience improvements in physical frailty measures following kidney transplantation. This makes younger patients with kidney failure a unique population for studying both the accelerated onset of frailty and its reversal. This research project aims to test the hypothesis that frailty secondary to organ failure and age-related frailty are associated with similar molecular and physiological measures. METHODS AND ANALYSIS/METHODS:Gbp/sample). Circulating cell-free DNA/mitochondrial DNA will be quantified through droplet digital PCR. Microcirculation will be assessed via sublingual dark field videomicroscopy with glycocalyx markers measured by ELISA. ETHICS AND DISSEMINATION/BACKGROUND:This study will be conducted with all stipulations of this protocol, and the conditions of the ethics committee approval. Ethical principles have their origin in the Declaration of Helsinki, all Australian and local regulations and in the spirit of the standard of Good Clinical Practice (as defined by the International Conference on Harmonisation). Organs/tissues will be sourced ethically and will not be sourced from executed prisoners or prisoners of conscience or other vulnerable groups.Ethics approval was received by the Metro South Health Research Ethics Committee (HREC/2023/QMS/95392) and ratified by the University of Queensland.Results will be disseminated through peer-reviewed publications, academic conferences, participant newsletters and health organisation collaboration.

We present a series of pediatric and adult cases in which intestinal ultrasound (IUS) visualized benign and malignant intestinal polyps. These cases demonstrate the potential of IUS as a rapid, noninvasive bedside modality for evaluating abdominal pain. IUS has a role in recognizing structural abnormalities and associated complications such as intraluminal masses and intussusception. Although not a diagnostic standard for polyp detection, IUS can complement endoscopy in selected cases. These findings highlight an emerging, broader application of IUS beyond inflammatory bowel disease assessment.

Imaging-based staging is a key component of renal cell carcinoma (RCC) management, yet anatomic labels alone do not fully capture tumor biology. This review highlights key aspects of RCC staging using computed tomography (CT) and magnetic resonance imaging (MRI), compares their use across major guidelines, and explores how integrating imaging-based prognostic markers can refine preoperative risk assessment. We summarize the pragmatic use of multiphase CT and MRI for T-staging, highlight pitfalls, and outline indications for chest and ancillary imaging based on American Urological Association, European Association of Urology, and National Comprehensive Cancer Network guidelines. We also discuss imaging-based prognostic biomarkers, including central non-enhancement and enhancement heterogeneity, diffusion metrics, and radiomic signatures, and we describe how they correlate with outcomes such as tumor grade, stage, molecular features, and survival. In addition, we dive into future directions, focusing on the potential integration of advanced technologies (e.g., photon counting CT, ⁸⁹Zr-Girentuximab positron emission tomography/CT), integration with liquid biopsy, and development of standardized reporting systems focusing on cancer likelihood and aggressiveness (e.g., Kidney Imaging Reporting and Data System). By bridging staging descriptors with prognostic phenotypes, we aim to standardize reports, better inform management, and improve decision-making for patients with RCC.