Faculty Bibliography

OBJECTIVES/HYPOTHESIS/OBJECTIVE:This study sought to characterize the attitudes of performers regarding factors commonly believed to influence the voice. The primary goal was to describe the vocal health habits of singers to provide a framework for clinical counseling and a potential schema for future investigation. Secondary objectives included examining changes in these attitudes over time and identifying differences between professional and amateur vocalists. STUDY DESIGN/METHODS:Prospective, longitudinal analysis. METHODS:A longitudinal assessment was performed across ten years at two time points (2013 and 2023) to investigate potential changes in attitudes and practices over time. Participants were recruited by word of mouth and social media. RESULTS:One hundred nine participants completed the 2013 survey, approximately half of whom were professional vocalists (52.3% professionals vs 47.7% amateurs), defined by those who either considered themselves a professional performer or had at some point obtained their primary source of income from singing or performing. The 2023 cohort included 155 participants who completed the survey, 61.3% of whom were classified as professional vocalists, with the remaining 38.7% classified as amateurs. In both the 2013 and 2023 cohorts, professional vocalists were more likely than amateurs to report factors that affected their voice. Using 2013 survey results, five vocal habits showed statistically significant differences in how amateurs and professionals judged their effects: warming up for 20-60 minutes prior to singing, decongestants, holding breath, cough drops (menthol), and one glass of wine. Using 2023 survey results, eight vocal habits showed statistically significant differences in how amateurs and professionals judged their effects: belting, cough drops (menthol), decongestants, holding breath, menthol spray, spicy foods, steroids, and Throat Coat. CONCLUSION/CONCLUSIONS:This study provides a rich characterization of factors vocalists report as influencing vocal health to varying degrees. Singers' beliefs about vocal health practices at times diverged from available scientific evidence.

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.

Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, which elevates the risks of hospitalization, disease progression, and death. Despite advances in treating each condition independently, many challenges remain in diagnosing and managing them in combination. In March 2024, Kidney Disease: Improving Global Outcomes (KDIGO) held the Controversies Conference on Kidney Disease and Heart Failure: Recent Advances and Current Challenges. Discussions highlighted the complex, bidirectional relationship between HF and CKD, including shared risk factors and overlapping pathophysiology as well as nuances in interpreting biomarkers such as natriuretic peptides and serum creatinine. Sodium-glucose cotransporter-2 inhibitors, renin-angiotensin-aldosterone system inhibitors, and emerging agents such as finerenone and glucagon-like peptide-1 receptor agonists can have benefits in both populations of patients with HF and CKD, though evidence in advanced CKD remains limited. Importantly, small declines in kidney function after initiating guideline-directed HF therapies generally do not require discontinuation, as these declines are often hemodynamic in nature and not associated with poor outcomes. The group highlighted the need for CKD-specific HF diagnostic thresholds and refined acute kidney injury definitions in HF. It is important for future cardiovascular and kidney trials to include relevant end points, such as kidney function trajectories, symptom burden, and quality of life. To improve care for individuals with HF and CKD, a more integrated approach to management, rooted in individualization, clinical context, and shared therapeutic goals, is needed.

BACKGROUND AND AIMS/OBJECTIVE:Nitazenes are a novel subclass of synthetic opioids that have been increasingly implicated in the United States (US) overdose crisis. Despite their growing presence in the illicit drug supply, national trends have not been systematically evaluated. This study aimed to describe temporal and geographic patterns in nitazene detections and assess substances co-involved in nitazene-positive biospecimens. DESIGN/METHODS:Cross-sectional study using forensic data from two national sources: the US Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) and the Center for Forensic Science Research & Education's (CFSRE) NPS Discovery Program. SETTING AND CASES/METHODS:Nitazene detections in all 50 US states and the District of Columbia between 2019 and 2024. MEASUREMENTS/METHODS:We quantified annual nitazene detections overall and by individual nitazene analog, US Census region and state. Temporal trends were modeled using piecewise linear regression with a Poisson distribution and log link, nationally and by region. NPS Discovery data were used to characterize substances co-involved with nitazene-positive biospecimens. FINDINGS/RESULTS:Between 2019 and 2024, 7117 nitazene analog reports were submitted to NFLIS, increasing from 43 in 2019 to 1905 in 2024. Counts rose sharply from 2019 to 2021 [count ratio = 7.32; 95% confidence interval (CI) = 2.22-24.20] but did not increase statistically significantly from 2021 to 2024 (count ratio = 1.08; 95% CI = 1.00-1.17). Early detections were predominated by isotonitazene (97.7% of NFLIS nitazene reports in 2019) but later shifted toward metonitazene and protonitazene (29.5% and 30.1%, respectively, in 2024). NPS Discovery identified 361 nitazene-positive biospecimens, increasing from 11 in 2019 to 113 in 2024, with counts increasing by approximately 45% per year (count ratio = 1.45; 95% CI = 1.23-1.71). Nearly all nitazene-positive biospecimens (98.3%) had at least one co-detected substance, most commonly fentanyl (54.6%). CONCLUSIONS:Nitazene detections increased sharply across the United States between 2019 and 2024, with shifting patterns in the prevalence of individual nitazenes and extensive polysubstance involvement. These findings highlight the need to strengthen drug testing capacity, expand epidemiological surveillance and implement targeted public health interventions to mitigate harms associated with this emerging class of synthetic opioids.

Therapeutic resistance remains the principal barrier to durable clinical benefit in oncology, particularly in oncogene-driven malignancies and immune-refractory tumors. This meeting brought together leading experts to dissect the multifaceted biological mechanisms underlying drug tolerance, adaptive resistance, and immune escape across diverse cancer types. Presentations highlighted how cancer cell-intrinsic plasticity, chromatin reprogramming, and stress-responsive transcriptional networks intersect with tumor microenvironment-derived cues, including inflammatory signaling, stromal heterogeneity, mechanotransduction, and paracrine crosstalk, to sustain drug-tolerant persister states. Novel insights into cancer-associated fibroblast plasticity, spatially organized immunosuppressive niches, secretory autophagy, and senescence-associated programs underscored the dynamic and adaptive nature of resistance. Cutting-edge approaches, including single-cell and spatial transcriptomics, chromatin accessibility profiling, organoid-based co-culture platforms, and artificial intelligence-driven spatial inference, revealed actionable vulnerabilities and predictive biomarkers. Collectively, these studies emphasize that resistance is not a binary phenomenon but a continuum shaped by evolutionary adaptation and ecological interactions within the TME. This report synthesizes the conceptual advances and translational implications emerging from the meeting, outlining new therapeutic strategies aimed at disrupting adaptive tolerance states, reprogramming immunosuppressive niches, and enabling fast, accessible precision oncology.

Combined oral contraceptives (COC) decrease androgen levels by inhibiting androgen production and increasing sex hormone binding globulin. COC can therefore be used in the treatment of androgen-mediated dermatologic conditions. Hormonal contraceptives may also contribute to some dermatologic diseases through interactions with estrogen and/or progesterone receptors. In part two of this continuing medical education article, we discuss evidence regarding the mechanism and efficacy of hormonal contraceptives as therapeutics for acne, hirsutism, and hair loss, and review potential dermatologic SE of hormonal contraceptives to guide dermatologists in utilizing this therapy in their practices.