Faculty Bibliography

BACKGROUND:Enhanced literacy and increased vocabulary related to Reach Out and Read (ROR) are well described. Less is known about clinicians' experience with the program. OBJECTIVE:Understand clinician experiences of implementing ROR. DESIGN/METHODS/METHODS:This study was a collaboration between ROR and the Academic Pediatric Association's Continuity Research Network. Participants completed an anonymous online survey to evaluate literacy promotion activities and training, and asked "What has been the most meaningful experience you have encountered with using ROR?" and "Is there anything else you would like to add?" Responses were evaluated by researchers and four themes were generated through discussion. All responses were then divided and coded by researchers working in pairs and then by all researchers until consensus was reached. Data were organized into themes. FINDINGS/RESULTS:Responses were provided by 592 (35%) participants. Qualitative analysis revealed benefits to participation in ROR within four themes: (1) Child/Family Impact (60%): "Seeing a child read for the first time" (2) Physician Impact (16%): "I... use the books... to connect with patients." (3) Impact on clinic practice (25%): "I... enjoy modeling for parents and use the books to assess... development" (4) Social Determinants of Health (2%): "The books... are an invaluable resource to our under-served population." CONCLUSION(S)/CONCLUSIONS:Clinicians who implement ROR report positive impact on patients, families, and their own satisfaction and methods in practice. Clinicians value that the program addresses social determinants of health and facilitates developmental surveillance. Further study is needed to understand how clinician's perspectives affect and are affected by their experiences.

OBJECTIVE:To describe attitudes, perceptions, and beliefs related to smoking and smoking cessation among survivors of genitourinary cancers using a theory-based framework. METHODS:We performed a cross-sectional analysis of Wave III of the PATH study, a prospective cohort survey study assessing tobacco-use patterns and attitudes among a representative population-based sample of US adults. All adult current smokers with a history of urologic cancer were included. Primary outcomes were mapped to components of the Theory of Planned Behavior (TPB) and included: attempts to quit, readiness to quit, plan to quit, being told to quit, peers views toward smoking, regret about smoking, the perceived relationship between smoking and cancer/overall health. Secondary outcomes include: time to first cigarette, utilization of smoking cessation aids. Population weighted percentages with 95% confidence intervals were estimated. RESULTS:Our cohort represents a population estimate of 461,182 adult current smokers with a history of genitourinary cancer. The majority of respondents (90%) perceived smoking to be harmful to one's health and 83% were regretful about having started smoking. An equal proportion of respondents indicated that they were "very ready to quit," "somewhat ready to quit," or "not ready to quit." Among all respondents, 73% had been told by a physician to quit in the past year but only 7% indicated that they had used prescription medication and only 21% had used nicotine replacement therapy to help with smoking cessation. CONCLUSION/CONCLUSIONS:There is significant variation in attitudes, behaviors, and perceptions related to smoking and smoking cessation among survivors of genitourinary malignancy. Patient-level smoking cessation interventions may need to be highly personalized for optimal success.

BACKGROUND:Sexual health (SH) is an important concern for adolescents and young adults (AYAs). This study determined current SH communication practices, barriers, and additional resources needed among pediatric oncology clinicians who treat AYAs. METHODS:A cross-sectional survey was developed by the Children's Oncology Group (COG) AYA Committee and sent to pediatric oncologists (n = 1,987; 85.9%) and advanced practice providers (APPs, n = 326; 14.1%) at 226 COG institutions. Responses were tabulated and compared using tests of proportion and trend. RESULTS:The sample comprised 602 respondents from 168 institutions and was proportionally representative (468 oncologists [77.7%], 76 APPs [12.6%], 58 unidentified [9.6%]; institutional and provider response rates 74.3% and 26.2%, respectively). Almost half of respondents (41.7%) reported no/small role in SH care. Medical topics were discussed most often, including contraception (67.2%), puberty (43.5%), and sexual activity (37.5%). Topics never/rarely discussed included gender identity (64.5%), sexual orientation (53.7%), and sexual function (50.3%). Frequently cited communication barriers included lack of time, low priority, perceived patient discomfort, and the presence of a parent/guardian. Respondents endorsed the need for further education/resources on sexual function (66.1%), gender identity/sexual orientation (59.5%), and body image (46.6%). Preferred education modalities included dissemination of published guidelines (64.7%), skills training modules (62.9%), and webinars (45.3%). By provider type, responses were similar overall but differed for perception of role, barriers identified, and resources desired. CONCLUSIONS:Many pediatric oncology clinicians play minimal roles in SH care of AYAs and most SH topics are rarely discussed. Provider-directed education/training interventions have potential for improving SH care of AYA cancer patients.

BACKGROUND:Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS:A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS/RESULTS:Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION/CONCLUSIONS:Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.

OBJECTIVES/OBJECTIVE:Gullah African Americans are descendants of formerly enslaved Africans living in the Sea Islands along the coast of the southeastern U.S., from North Carolina to Florida. Their relatively high numbers and geographic isolation were conducive to the development and preservation of a unique culture that retains deep African features. Although historical evidence supports a West-Central African ancestry for the Gullah, linguistic and cultural evidence of a connection to Sierra Leone has led to the suggestion of this country/region as their ancestral home. This study sought to elucidate the genetic structure and ancestry of the Gullah. MATERIALS AND METHODS/METHODS:We leveraged whole-genome genotype data from Gullah, African Americans from Jackson, Mississippi, African populations from Sierra Leone, and population reference panels from Africa and Europe to infer population structure, ancestry proportions, and global estimates of admixture. RESULTS:Relative to non-Gullah African Americans from the Southeast US, the Gullah exhibited higher mean African ancestry, lower European admixture, a similarly small Native American contribution, and increased male-biased European admixture. A slightly tighter bottleneck in the Gullah 13 generations ago suggests a largely shared demographic history with non-Gullah African Americans. Despite a slightly higher relatedness to populations from Sierra Leone, our data demonstrate that the Gullah are genetically related to many West African populations. DISCUSSION/CONCLUSIONS:This study confirms that subtle differences in African American population structure exist at finer regional levels. Such observations can help to inform medical genetics research in African Americans, and guide the interpretation of genetic data used by African Americans seeking to explore ancestral identities.

Buprenorphine, an effective treatment for opioid use disorder (OUD), remains underutilized in many U.S. jails and prisons. However, use of non-prescribed (i.e., diverted) buprenorphine has been reported in these settings. The current study examined non-prescribed buprenorphine use experiences in correctional and community contexts. The study conducted face-to-face interviews with 300 adults with OUD/opioid misuse and recent incarceration, recruited in Baltimore, MD, and New York, NY (n = 150 each). Illicit/non-prescribed opioid use during incarceration was reported by 63% of participants; 39% reported non-prescribed buprenorphine. Non-prescribed buprenorphine was considered the most widely available opioid in jails/prisons in both states (81% reported "very" or "somewhat" easy to get). The average price of non-prescribed buprenorphine in jail/prison was ~10× higher than in the community (p < 0.001). Participants were more likely to endorse getting high/mood alteration as reasons for using non-prescribed buprenorphine during incarceration, but tended to ascribe therapeutic motives to use in the community (e.g., self-treatment; p < 0.001). Multivariable logistic regression analyses showed that different individual-level characteristics were associated with history of non-prescribed buprenorphine use during incarceration and in the community. Use of non-prescribed buprenorphine during incarceration was associated with younger age (p = 0.006) and longer incarceration history (p < 0.001), while use of non-prescribed buprenorphine in the community was associated with MD recruitment site (p = 0.001), not being married (p < 0.001), prior buprenorphine treatment experience (p < 0.001), and housing situation (p = 0.01). These findings suggest that different dynamics and demand characteristics underlie the use of non-prescribed buprenorphine in community and incarceration contexts, with implications for efforts to expand OUD treatment in correctional settings.

The widespread availability of high-dimensional electronic healthcare record (EHR) datasets has led to significant interest in using such data to derive clinical insights and make risk predictions. More specifically, techniques from machine learning are being increasingly applied to the problem of dynamic survival analysis, where updated time-to-event risk predictions are learned as a function of the full covariate trajectory from EHR datasets. EHR data presents unique challenges in the context of dynamic survival analysis, involving a variety of decisions about data representation, modeling, interpretability, and clinically meaningful evaluation. In this paper we propose a new approach to dynamic survival analysis which addresses some of these challenges. Our modeling approach is based on learning a global parametric distribution to represent population characteristics and then dynamically locating individuals on the time-axis of this distribution conditioned on their histories. For evaluation we also propose a new version of the dynamic C-Index for clinically meaningful evaluation of dynamic survival models. To validate our approach we conduct dynamic risk prediction on three real-world datasets, involving COVID-19 severe outcomes, cardiovascular disease (CVD) onset, and primary biliary cirrhosis (PBC) time-to-transplant. We find that our proposed modeling approach is competitive with other well-known statistical and machine learning approaches for dynamic risk prediction, while offering potential advantages in terms of interepretability of predictions at the individual level.

BACKGROUND AND OBJECTIVES:Metabolomics facilitates the discovery of biomarkers and potential therapeutic targets for CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We evaluated an untargeted metabolomics quantification of stored plasma samples from 645 Chronic Kidney Disease in Children (CKiD) participants. Metabolites were standardized and logarithmically transformed. Cox proportional hazards regression examined the association between 825 nondrug metabolites and progression to the composite outcome of KRT or 50% reduction of eGFR, adjusting for age, sex, race, body mass index, hypertension, glomerular versus nonglomerular diagnosis, proteinuria, and baseline eGFR. Stratified analyses were performed within subgroups of glomerular/nonglomerular diagnosis and baseline eGFR. RESULTS:, a higher level of tetrahydrocortisol sulfate was associated with lower risk of progression (hazard ratio, 0.8; 95% confidence interval, 0.7 to 0.9). CONCLUSIONS:Untargeted plasma metabolomic profiling facilitated discovery of novel metabolite associations with CKD progression in children that were independent of established clinical predictors and highlight the role of select biologic pathways.

OBJECTIVES:This study assessed the association of diabetes duration with incident heart failure (HF). BACKGROUND:Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown. METHODS: ≥7%), with tests for interaction. RESULTS:, women, and Blacks (all P interactions <0.05). CONCLUSIONS:Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.

OBJECTIVE: The aim of this study is to model the association between gestational age at birth and early child development through 3 years of age. STUDY DESIGN/METHODS: Development of 5,868 children in Upstate KIDS (New York State; 2008-2014) was assessed at 7 time points using the Ages and Stages Questionnaire (ASQ). The ASQ was implemented using gestational age corrected dates of birth at 4, 8, 12, 18, 24, 30, and 36 months. Whether children were eligible for developmental services from the Early Intervention Program was determined through linkage. Gestational age was based on vital records. Statistical models adjusted for covariates including sociodemographic factors, maternal smoking, and plurality. RESULTS: Compared with gestational age of 39 weeks, adjusted odds ratios (aOR) and 95% confidence intervals of failing the ASQ for children delivered at <32, 32-34, 35-36, 37, 38, and 40 weeks of gestational age were 5.32 (3.42-8.28), 2.43 (1.60-3.69), 1.38 (1.00-1.90), 1.37 (0.98-1.90), 1.29 (0.99-1.67), 0.73 (0.55-0.96), and 0.51 (0.32-0.82). Similar risks of being eligible for Early Intervention Program services were observed (aOR: 4.19, 2.10, 1.29, 1.20, 1.01, 1.00 [ref], 0.92, and 0.78 respectively for <32, 32-34, 37, 38, 39 [ref], 40, and 41 weeks). CONCLUSION/CONCLUSIONS: Gestational age was inversely associated with developmental delays for all gestational ages. Evidence from our study is potentially informative for low-risk deliveries at 39 weeks, but it is notable that deliveries at 40 weeks exhibited further lower risk.