Faculty Bibliography

BACKGROUND:Depression, a debilitating mental disorder, has become the leading cause of disability worldwide. A growing body of evidence supports the feasibility and effectiveness of multicomponent lifestyle medicine programs for the treatment of depression, including the recent novel multicomponent Traditional Chinese Medicine Lifestyle Medicine (TCMLM) program (Registered at ClinicalTrials.Gov with registration number: NCT05799586). However, little is known about participants' experiences and perceptions of the program and the aspects that require improvement. This study aimed to explore the experiences and perceptions of participants attending the multicomponent TCMLM program and practicing the related lifestyle behaviors. METHODS:In this descriptive qualitative study, purposeful sampling was used to recruit Hong Kong Chinese adults who had participated in the multicomponent TCMLM program between August 2023 and January 2024. Face-to-face focus-group interviews and semi-structured interviews were conducted with audio recording, transcribed verbatim, and analyzed using conventional content analysis. All interviews were performed in classrooms in a university in Hong Kong. RESULTS:A total of 31 multicomponent TCMLM program attendees aged 20 to 65 years participated in the qualitative interviews. The content analysis identified three themes and 12 subthemes, namely, Theme 1: multicomponent TCMLM program originally being comprehensive and special (e.g., TCMLM program content originally being not unitary, increasing the number of methods for dealing with depressive symptoms); Theme 2: multicomponent TCMLM program being far more beneficial than expected (e.g., promoting diet, exercises, daily routine and sleep management based on TCMLM, improving physical functional status, improving one's personality); and Theme 3: practicing multicomponent TCMLM program having challenges (e.g., unsuitable conditions hindering some TCMLM practices in community). CONCLUSIONS:This study provides fresh in-depth insights into the perceptions and experiences of Hong Kong Chinese adults with depression who attended the multicomponent TCMLM program and engaged in the related lifestyle behaviors. Meanwhile, the challenges encountered while attending the program and practicing the related behaviors offer valuable information for further optimization of the program and expanding its application in Hong Kong or other regions.

IMPORTANCE/UNASSIGNED:Lyme disease (LD) is the most common vector-borne illness in the US. Given the increasing prevalence and expanding geographic bounds of LD, in-depth, up-to-date understanding of costs associated with an LD diagnosis, including patient out-of-pocket (OOP) costs, is needed. OBJECTIVE/UNASSIGNED:To assess health care costs in a broad US population diagnosed with LD, overall and stratified by localized disease vs disseminated disease. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This retrospective cohort study identified patients from Optum's deidentified Market Clarity Data (Optum Market Clarity) between December 2, 2014, and January 30, 2023 (study period), with an LD diagnosis between January 1, 2016, and December 31, 2022 (identification period), having at least 14 months of continuous health plan enrollment. Optum Market Clarity is an integrated, multisource medical claims, pharmacy claims, and electronic health records data set. Outpatients had a claim with an LD diagnosis plus relevant antibiotics within 30 days, and inpatients had a claim with LD as the primary diagnosis or as a secondary diagnosis with an LD-associated condition as the primary diagnosis. Data were analyzed from February 27, 2023, to October 20, 2025. EXPOSURE/UNASSIGNED:The main exposure was LD diagnosis. Case patients were classified as having disseminated, localized, or indeterminate LD based on diagnosis codes for LD and LD-associated conditions, inpatient vs outpatient services, or antibiotic treatment type. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Health care costs (reported in US dollars) for LD cases overall and stratified by localized disease vs disseminated disease were assessed 4 ways: (1) LD-specific costs per episode, (2) all-cause 6-month baseline vs follow-up costs for case patients with LD, (3) all-cause 6-month follow-up costs for case patients with LD compared with the control group, and (4) multivariable case-control analysis. Costs are reported as estimated direct (standardized) costs and patient OOP costs. Wald 95% CIs were used for means of cost measures. RESULTS/UNASSIGNED:A total of 70 531 case patients with LD were included. Their mean (SD) age was 44.8 (21.3) years; 51.3% were female. Estimated direct costs of LD were substantial across assessment methods, including episode cost (mean, $2227 [95% CI, $2111-$2342]), case patients as self-controls analysis (difference, $3304 [95% CI, $3117-$3491] in mean 6-month costs between baseline and follow-up), case-control analysis (difference, $4098 [95% CI, $3888-$4307] in mean 6-month follow-up costs), and multivariable-adjusted analysis (case-control difference, $5571 in projected mean 6-month follow-up costs; cost ratio, 1.96 [95% CI, 1.90-2.02]). OOP costs were available for 10 962 patients (15.5%) with LD. Mean OOP costs attributed to LD ranged from $188 to $399. Extrapolating to the US population in high-incidence states, annual costs of LD could range between $591 million and $1.05 billion (2022 dollars), with $411 to $771 million attributable to disseminated disease. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this retrospective cohort study, LD presented a large financial burden to the health care system and patients, especially for those with disseminated disease. These findings highlight the need for effective preventive measures to reduce costs for patients and the health care system.

Antiretroviral therapies (ARTs) have reduced mortality among people living with HIV (PLWH) in Nigeria. Nonetheless, there is limited research on the impact of perceived helplessness on the wellbeing of PLWH in Nigeria. This study examined the effect of perceived helplessness on middle-age and older PLWH using health-related quality of life (HRQoL), subjective health (SH), and subjective cognitive decline (SCD) as outcomes related to wellbeing. We invited 150 participants, all of whom completed a self-administered questionnaire assessing the variables of interest and key sociodemographic characteristics. Multiple linear regression models were fit to examine the relationship between perceived helplessness and wellbeing, accounting for relevant covariates such as age, sex, relationship status etc. Results showed that higher perceived helplessness was associated with lower physical HRQoL (B = -0.275, p < 0.001), lower mental HRQoL (B = -0.18, p < 0.001), better SH (B = 0.010, p < 0.001) and higher reports of SCD (B = 0.443, p < 0.001). PLWH in Nigeria are exposed to stressors that diminish their sense of control and increase their risk for poor wellbeing. The findings underscore the need for interventions to ameliorate perceived helplessness, thereby improving health and wellbeing among aging adult PLWH in Nigeria.

OBJECTIVE:Cervical artery dissection (CeAD) may be limited to the extracranial extradural space or extend to the intradural space. Intradural extension can potentially increase the risk of stroke and subarachnoid hemorrhage. However, the factors associated with intradural extension and its impact on clinical outcome remain unclear. METHODS:This was a secondary analysis of the STOP-CAD observational, multi-center study. Patients with CeAD and intradural extension (CeADid) were compared with those with pure CeAD extradural dissections (CeADed) using multiple regression analyses. RESULTS:Of 4,023 patients with CeAD, 534 (13.3%) had CeADid. In comparison to patients with CeADed, those with CeADid more often had clinical overt stroke or transient ischemic attack (TIA) at presentation, acute infarcts on imaging, a vertebral artery affected, and severe stenosis of the involved vessel (p < 0.001 for all). In contrast, carotid involvement and complete occlusions were more frequent in patients with CeADed (p < 0.001 for both). CeADid was associated with a shift in the distribution of scores on the modified Rankin Scale (mRS) toward worse functional outcome (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.62-0.92) but the odds for favorable outcomes (mRS = 0-2) did not differ between the groups after appropriate adjustments on multivariate analysis. CeADid was independently associated with higher mortality at 180 days on multivariate analysis (adjusted OR = 2.84, 95% CI = 1.50-5.38). INTERPRETATION/CONCLUSIONS:CeADid is associated with more severe clinical presentation, a shift toward less favorable outcomes, and higher mortality rates. These findings suggest that CeADid may represent a high-risk type of CeAD. ANN NEUROL 2026.

BACKGROUND/UNASSIGNED:The potential for impaired sleep due to pain or discomfort can be a concern for adherence to nighttime bracing when treating clubfoot. The primary aim of our study was to compare sleep efficiency in young children wearing a nighttime foot abduction orthosis (FAO) to that of a matched control group. Secondary aims included the comparison of total sleep time, number of night wakings, and number of parental interventions between groups. METHODS/UNASSIGNED:< .05. RESULTS/UNASSIGNED:There were no significant differences in sleep efficiency, total sleep time, or number of night wakings. There were slightly more nighttime interventions for parents of children with clubfeet compared to controls. CONCLUSIONS/UNASSIGNED:Sleep metrics of young children undergoing Ponseti-style FAO bracing are not significantly different from those of matched controls. KEY CONCEPTS/UNASSIGNED:(1)Autovideosomnography using the Nanit infant monitor was utilized to measure sleep/wake patterns in 25 clubfoot patients undergoing Ponseti-style boots and bar treatment and 75 matched controls.(2)Clubfoot patients undergoing Ponseti-style boots and bar treatment did not have any significant differences across sleep efficiency, total sleep time, total time awake or number of night wakings compared to controls.(3)As brace tolerance and consistent adherence to a nighttime bracing regimen are essential to prevent recurrent clubfoot, caregivers and physicians may be reassured that clubfoot bracing will not significantly impact a child's sleep. LEVEL OF EVIDENCE/UNASSIGNED:Level II.

BACKGROUND/UNASSIGNED:Outdoor navigation poses significant challenges for people with blindness or low vision, yet the role of gaze behaviour in supporting mobility remains underexplored. Fully sighted individuals typically adopt consistent scanning strategies, whereas those with visual impairments rely on heterogeneous adaptations shaped by residual vision and experience. METHODS/UNASSIGNED:We conducted a comparative eye-tracking study of fully sighted, low vision, blind, and fully blind participants navigating outdoor routes. Using a wearable eye tracker, we quantified fixation counts, fixation rate, fixation area, direction, peak fixation location, and walking speed. RESULTS/UNASSIGNED:Walking speed declined systematically with worsening vision. Fixation count increased with greater impairment, reflecting slower travel times and more frequent sampling. Fixation rate differed across groups, though between-group differences were generally not significant between most groups. Fixation spatial coverage decreased along the continuum of vision loss. Fixation patterns were most consistent in the fully sighted group. Peak fixation locations were centred in fully sighted participants but shifted outward and became more variable with impairment. CONCLUSION/UNASSIGNED:Gaze strategies during navigation form a graded continuum across vision groups, with fully sighted and fully blind participants at opposite poles and low vision and blind groups spanning the middle. Visual acuity alone does not predict functional gaze use, as rehabilitation experience and adaptive strategies strongly shape behaviour. These findings highlight the need for personalised rehabilitation and assistive technologies, with residual gaze patterns offering insight into mobility capacity and training opportunities for safer navigation.IMPLICATIONS FOR REHABILITATIONDistinct Residual Vision Patterns: This research reveals that residual vision patterns differ significantly, with fully sighted individuals exhibiting a consistent fixation pattern while low vision participants show more varied strategies during navigation.Highly Individualised Gaze Behaviours: Low vision participants demonstrate highly individualised gaze behaviours, indicating that a one-size-fits-all approach is inadequate for effective rehabilitation.Tailored Assistive Solutions: Assistive technologies and rehabilitation programs should be designed to address these unique, individualised needs, providing personalised feedback and training to enhance mobility and safety.

The ability to shift focus within three-dimensional space depends on vergence eye movements, which are impaired in ≤40% of individuals with neurodegenerative disorders. Although foundational studies in monkeys have identified neural correlates of vergence in the midbrain, a translational gap persists, leaving the neural basis of vergence dysfunction in humans poorly understood. Through voxel-wise analyses in 66 humans and 19 monkeys with midbrain lesions, we link vergence dysfunction causally to a region rostral to the superior colliculus and centred on the nucleus of the posterior commissure (NPC). Connectivity analyses across species identified a brain circuit linking the NPC to the visual pretectum and midbrain premotor hubs, regions capable of integrating the visual input and motor output necessary for vergence control. Collectively, these findings provide a neuroanatomical basis for vergence dysfunction and demonstrate how lesion mapping can bridge fundamental insights from animal models with clinical observations in humans.

BACKGROUND:Multiple sclerosis (MS) and neurosarcoidosis (NS) can present as similar neuro-radiologic syndromes. Neither disease has pathognomonic clinical or laboratory findings and differentiating between them may be challenging. We hypothesized that cerebrospinal fluid (CSF) immune cell profiles, including CD4/CD8 cell ratio and proportion of B cells, might help to distinguish NS from MS. METHODS:Patients with probable or definite NS who were evaluated at the NYU MS Comprehensive Care Center (New York) and had CSF flow cytometry done as part of diagnostic workup were matched by age, sex, and race/ethnicity to MS patients with available CSF flow cytometry. All patients who received immunomodulatory therapy within 3 months of lumbar puncture were excluded. Flow cytometry was performed using BD FACSCanto™ and FACSCanto™ II Cell Analyzers (BDBiosciences, San Jose, CA) and manually verified by a hematopathologist. Group comparisons were made with an unpaired two-tailed Student's t-test, Chi-square test, or Wilcoxon rank sum test, as appropriate; p < 0.05 was considered significant. RESULTS:, p < 0.0001) and protein levels (101.2 ± 88.9 mg/dL vs. 35.7 ± 19.6, p = 0.003), while MS patients had more CSF-restricted oligoclonal bands (7.7 ± 5.3 vs. 1.7 ± 2.4, p < 0.00042). No differences were found in CSF glucose concentrations or IgG indices. Proportions of all immune cells in CSF were similar in NS and MS, including the CD4/CD8 ratio and percentages of B cells. CONCLUSION/CONCLUSIONS:Clinically available CSF flow cytometry immune profiles do not offer added discriminatory value for differentiating NS from MS. More granular immunophenotyping may be needed to improve diagnostic precision.

BACKGROUND:Increased chronological age correlates with reduced relapse rates and increased disability in multiple sclerosis (MS). Biological age may better capture ageing's impact on MS and might accelerate due to MS itself. Establishing accelerated biological ageing in adults is complicated by normal ageing and comorbidities. Telomere length, a well-recognised biological ageing marker, is shortened in adults with MS and associated with disability. Demonstrating accelerated biological ageing in paediatric-onset MS (POMS) would strengthen the hypothesis that MS drives premature biological ageing. This study aimed to determine if telomere length differs in POMS compared to age-similar healthy controls. METHODS:We performed a cross-sectional case-control study of whole blood samples and clinical data from The US Network of Pediatric MS Centers. Real-time quantitative PCR measured telomere length, expressed as a telomere to somatic DNA ratio (T/S ratio). T/S ratio was compared between cases and age-similar healthy controls using multivariate regression analysis adjusting for chronological age, sex, race, ethnicity, tobacco exposure, socioeconomic status and body mass index. RESULTS:We analysed 300 POMS cases and 200 controls. The unadjusted mean T/S ratios were 1.66 (SD 0.32) for cases and 1.71 (SD 0.29) for controls (mean difference -0.05, 95% CI -0.10 to 0.01, p=0.08). After adjusting for key covariables with face validity, POMS participants had a mean 0.086 shorter T/S ratio than controls (95% CI 0.015 to 0.157, p=0.018). CONCLUSIONS:POMS participants demonstrated shorter telomeres than age-similar controls in a multivariable model adjusting for sociodemographic variables, suggesting that MS may contribute to accelerated biological ageing.

IMPORTANCE/UNASSIGNED:Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. OBJECTIVE/UNASSIGNED:To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. EXPOSURE/UNASSIGNED:Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. RESULTS/UNASSIGNED:The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.