Faculty Bibliography

New York City (NYC) was the first epicenter of the COVID-19 pandemic in the USA. Despite the availability of COVID-19 vaccines by 2021, vaccination rates varied among racial and ethnic groups, further exacerbating COVID-19-related health disparities. This study explores the relationship between vaccination status and perspectives on COVID-19-related topics among racially and ethnically diverse NYC residents. The New York Community Engagement Alliance Against COVID-19 Disparities (NYCEAL) conducted focus groups with NYC residents to explore their perceptions about vaccine effectiveness and barriers to vaccination that may impact vaccine decision-making. We conducted seven focus groups between December 2021 and April 2022 in English and Spanish with individuals grouped based on vaccination status: (1) those vaccinated when vaccines first became available, (2) those vaccinated after mandates were announced, and (3) those who remained unvaccinated. Transcripts were initially analyzed using a priori and in vivo codes, and the team utilized framework analysis to examine similarities and differences across groups. Emerging themes centered on trust in science, perceived vaccine effectiveness, and the evolution of people's COVID-19-related perspectives, experiences, and behaviors over time. Although there were distinctions between groups on concepts like trust in science and perceived vaccine effectiveness, people's cognitive biases seemed to affect their perceptions but not necessarily their (vaccine-related) behaviors. Findings from this study may help public health professionals understand vaccine decision-making from the perspective of a diverse set of New Yorkers for use during future epidemics.

PURPOSE/OBJECTIVE:Interproximal contact loss (ICL) is considered a prevalent complication for a tooth abutting an implant restoration. While numerous potential causes for ICL have been presented, there is no consensus. A review of the current literature with a focus on possible risk factors was performed. MATERIALS AND METHODS/METHODS:A PubMed search using keywords "implant OR dental implants OR implant supported prosthesis AND proximal contact loss OR ICL OR loss of interproximal contact OR open contact OR interproximal open contact OR adjacent natural teeth" resulted in 81 citations, 9 of which were relevant to the focus question. Additional references were culled from the reference lists in the identified articles. Systematic reviews, case series, and case reports were reviewed with a focus on causation, association, or correlation. RESULTS:Eight systematic reviews and 14 case series were reviewed. The prevalence of ICL has been reported to be as low as 16% and as high as 66%. ICL was more common on the mesial side of implants and when a tooth abuts a splinted implant restoration. The absence of a uniform definition to accurately describe an interproximal (IP) contact and an open IP contact is demonstrated in the literature. A lack of standardized measurement strategies that relate to a needed consensus definition further exacerbates the broad range of reported results regarding ICL. The lack of controls for almost all the ICL literature makes it difficult to draw conclusions and comparisons to unrestored, natural tooth IP contacts and the prevalence of ICL in this patient population. As a result, the available studies are inadequate to support a causal theory and the potential risk factors associated with ICL. CONCLUSIONS:There is a large range of reported prevalence for IP contact loss. ICL is more common when a natural tooth abuts a splinted implant restoration. ICL is more common on the mesial, as opposed to the distal, of an implant retained restoration. Consensus in the definition and measurement strategies for ICL needs to be established to provide standardized terminology and methodology. Potential risk factors such as occlusion, restorative material, and tooth contact area need to be investigated.

PURPOSE/OBJECTIVE:To describe atypical fundus autofluorescence (FAF) patterns in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) with associated age-related choroidal atrophy (ARCA). METHODS:Multimodal imaging of two cases using (pseudo-)color fundus photography, optical coherence tomography (OCT), fluorescein and indocyanine green angiography, and FAF employed with blue- and green excitation wavelengths on several devices (Spectralis, Heidelberg and (ultra-)widefield [UWF] FAF [California, Optos and EIDON, iCare]). RESULTS:Two female patients, with foveal-involving GA secondary to AMD, were assessed. All eyes demonstrated concurrent features indicative of ARCA on multimodal imaging including a paucity of choroidal vasculature, reduced choroidal pigmentation, macular pigmentary changes, peripapillary atrophy, and subretinal drusenoid deposits. Clinically, progression of GA with coalescence of lobular lesions was observed. Notably, UWF FAF with green-(California) and blue excitation wavelengths (California and EIDON) revealed atypical patterns characterized by isofluorescent FAF signals (indistinguishable from surrounding tissue) or hyperautofluorescent GA lesions. In these cases, blue excitation wavelengths were more effective than green light for delineating GA, owing to increased contrast from hypoautofluorescence related to macular pigment surrounding the lesion. CONCLUSION/CONCLUSIONS:In patients with GA and concomitant ARCA, atypical FAF patterns on UWF imaging complicate the accurate delineation and monitoring of GA. Atypical FAF patterns appear due to the properties of the confocal apertures and postprocessing features of UWF imaging that allow for the detection of scleral autofluorescence in patients with reduced choroidal vasculature, pigment and thickness. In patients with concomitant ARCA, multimodal imaging plays a crucial role in precisely identifying and tracking GA progression.

INTRODUCTION/BACKGROUND:Racial and ethnic minorities experience a disproportionate burden of the type 2 diabetes (T2D) and are at a 2 to 5 times higher risk of developing macrovascular disease. The purpose of the study was to describe the perspectives of Haitian American immigrants' challenges to effective T2D self-management. METHODS:Utilizing a descriptive qualitative approach, purposive sampling was employed to recruit a subgroup of adult Haitian American immigrants from a parent cross-sectional study. Content analysis was used to identify themes describing participant perspectives. Lincoln and Guba's four criteria to assess the trustworthiness and ensure the rigor of the study were applied. RESULTS:A total of 36 participants were enrolled, with 54% being male, and age ranged from 34 to 63 years. The majority were married, and 77% reported using metformin. Three facilitators and two barriers to their T2D self-management were found. Facilitators included (1) family and social support, (2) optimism and hope, and (3) novel devices. Barriers included (1) psychosocial and (2) environmental factors. DISCUSSION/CONCLUSIONS:The facilitators underscore the pivotal role of close familial relationships, communal influence, and the potential utility of innovative devices like continuous glucose monitoring in enhancing T2D management, whereas the barriers delineate the unique challenges posed by discrimination, lack of provider/client decision-making and communication, the compounding effects of COVID-19, concerns about safety, mistrust in healthcare systems, and financial constraints, which collectively exacerbate the complexities of ineffective T2D management. Collaboration between clinicians, clients, and policymakers is imperative to emphasize the urgent necessity for a multifaceted approach in addressing the complex healthcare landscape of Haitian American immigrants managing T2D in the United States.

Neoadjuvant therapy (NAT) is the standard of care for borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). It can be used to treat resectable PDAC. This study aimed to investigate how NAT remodels the tumor immune microenvironment (TIME) and whether this remodeling translates into survival benefits. We performed spatial and digital pathology analysis of 27 upfront resection patients (naïve group) and 39 age-, gender-, and stage-matched patients who had surgery after NAT (NAT group). AI-assisted digital pathology was used to annotate cancer cells and CD8 + T lymphocytes. Spatial correlation between CD8 + T lymphocytes and cancer cells for each case was assessed using spatial point pattern analysis, followed by generalized linear modeling (GLM) of quadrat counts of CD8 + T cells, with the quadrat counts of cancer cells as the independent variable. The regression coefficient was used to quantify the strength of their spatial correlation and then further assessed for association with patient survival. The analyses showed that the NAT group, compared with the naïve group, had increased spatial correlation of CD8 + T cells with cancer cells, suggesting enhanced effector T cell-cancer cell engagement in the NAT patients. Additionally, patients with a higher degree of spatial correlation between the two cells showed improved after-surgery survival. Through a new methodological framework that takes advantage of AI-assisted digital pathology and spatial point pattern analysis, our study has successfully captured the subtle effects of NAT-induced TIME remodeling and assessed its impact on prognosis of PDAC patients.

AIM/OBJECTIVE:Heart failure is a leading cause of hospitalisation and often coexists with seven comorbid conditions on average. This study aimed to examine the gender differences in disease burden, symptom burden, and quality of life among older adults with heart failure and multimorbidity. DESIGN/METHODS:Cross-sectional study. METHODS:This study utilised a baseline survey from an ongoing cohort study in 2022-2023. Adults aged ≥ 50 years with heart failure and more than one chronic condition were recruited from a university-affiliated hospital using an electronic patient portal. Disease burden was measured using a modified Disease Burden Impact Scale. The Edmonton Symptom Assessment Scale and EuroQoL-5D-5L assessed symptom burden and quality of life. Gender differences in baseline outcomes were examined using Pearson's Chi-square tests, Welch's t-tests, and multiple linear regressions. RESULTS:Among 353 participants who completed the baseline survey, the mean (±SD) age was 70 (±9.5) years, and 50.1% were women (mean age: 67 ± 9 vs. men: 72 ± 10). In adjusted models, women had 4.9 points higher disease burden (p = 0.003) and reported higher symptom scores of pain (p = 0.018), tiredness (p = 0.021), nausea (p = 0.007), and loss of appetite compared to men (p = 0.036). Women had significantly more moderate/severe problems in usual activities and pain/discomfort and 0.07 points lower EuroQoL index than men (p = 0.010). CONCLUSIONS:There were gender differences in disease/symptom burdens and quality of life. Women living with heart failure and multimorbidity had higher burdens but lower quality of life. IMPACT/CONCLUSIONS:Identifying gender differences among people with heart failure and multimorbidity can be the first step to explaining health disparities. Research should take more inclusive and equitable approaches to address these differences. Healthcare providers, including nurses, should implement targeted strategies for effective multimorbidity management by considering these differences and disparities in clinical settings. REPORTING METHOD/UNASSIGNED:STROBE checklist, cross-sectional. PATIENT OR PUBLIC CONTRIBUTION/UNASSIGNED:No patient or public contribution.

PURPOSE/OBJECTIVE:To describe a patient with progressive visual symptoms and reduced retinal sensitivity corresponding to dark without pressure (DWP). METHODS:Retrospective chart review of a single patient. Comprehensive ophthalmic examinations and multimodal imaging techniques, including optical coherence tomography (OCT), OCT-angiography, and microperimetry, were analyzed. RESULTS:A 23-year-old male presented with progressive peripheral areas of blurred vision superiorly in his right eye and temporally in his left eye. These disturbances corresponded with dark areas of retina inferiorly in his right eye and nasally in his left eye having characteristic features of DWP on multimodal imaging. Although Humphrey visual field (HVF) 24-2 testing was normal, microperimetry showed decreased retinal sensitivity in areas of DWP relative to adjacent areas without DWP. CONCLUSION/CONCLUSIONS:Prior descriptions of DWP have described it as a benign retinal finding showing no functional deficits. We demonstrate that DWP can be associated with progressive visual complaints showing decreased retinal sensitivity on microperimetry and undetected with HVF 24-2 testing.

BACKGROUND:The widespread use of digital imaging can now be combined with additive three-dimensional (3D) printing, changing traditional clinical dentistry, especially in challenging cases. Visualizing the bone and soft tissue anatomy using computed tomography (CT) and intraoral scanning generated digital files that can be further processed for 3D printing. Among the popular 3D printing approaches, fused filament fabrication (FFF) and stereolithography (SLA) are broadly used due to their rapid production, precision, and ease of use. METHODS:The current case series outlines three challenging clinical scenarios where a combination of CT and intraoral scans were utilized for digital planning. FFF multicolor anatomical models and SLA surgical guides were produced using 3D printing technology. The first case outlines the utility of this approach to place the optimal surgical window at the lateral sinus lift with anticipated difficult access. In the second case, distinct sites for autogenous bone harvesting were identified while preserving critical adjacent structures with surgical simulation. Finally, the third case outlines this strategy for optimal surgical access to expose an impacted second premolar. RESULTS:Both clinicians and patients benefited from the educational use of FFF‒SLA 3D-printed models, and all cases were successfully treated without complications. CONCLUSIONS:These cases demonstrate the significant utility of these digital technologies and rapid prototyping for improved pre-surgical planning, patient motivation, and didactic training that contribute to improved quality of clinical care. KEY POINTS/CONCLUSIONS:To the authors' knowledge, this is the first case reports employing both fused filament fabrication (FFF) and stereolithography (SLA) printing techniques in dental surgery. This innovative approach addresses a range of clinically challenging scenarios presented in this report. Computed tomography (CT) and intraoral scanning are essential for three-dimensional (3D) reconstruction. Specialized software is required to design the guide with precise specifications, and FFF and SLA printers are necessary for fabricating the 3D model. Three-dimensional reconstruction can be time-intensive, particularly when manual segmentation is necessary. Acquiring proficiency in the software may require additional time, and multicolor 3D printing also demands extended printing durations. PLAIN LANGUAGE SUMMARY/CONCLUSIONS:This study explores how digital imaging and three-dimensional (3D) printing can improve complex dental surgeries. Using tools such as computed tomography scans and intraoral scans, dentists can create detailed 3D models of a patient's bone and soft tissues. Two popular 3D printing methods-fused-filament fabrication (FFF) and stereolithography (SLA)-were used to make these models, which help with surgical planning. The study includes three cases where 3D-printed models were used to prepare for difficult dental procedures. In the first case, the 3D model helped plan the best way to access a difficult area for sinus surgery. The second case used the model to identify the best sites for bone harvesting. The third case used the model to plan how to safely expose an impacted tooth. These helped both the dentist and the patient understand the procedure better. All surgeries were successful, demonstrating how FFF and SLA 3D printing enhance planning, making advanced dental surgeries safer and more efficient.

OBJECTIVE:The objective of this study was to determine the outcomes of robotic peritoneal flap vaginoplasty. BACKGROUND:There is a lack of long-term outcomes data for gender-affirming vaginoplasty to inform patient decision-making. METHODS:A retrospective cohort of 500 consecutive patients undergoing robotic peritoneal flap vaginoplasty from 2017-2023 were reviewed. Complications requiring procedural intervention, self-reported vaginal dimensions, and orgasm were recorded at each follow up visit and analyzed as outcomes. RESULTS:487 (97%) of patients were followed to 3 months, and 425 (85%) to 1 year or greater. Twenty patients (4%) had a complication requiring procedural intervention, and 61(12%) had elective revision surgery. Median self-reported vaginal depth and width at 1 year was 14.5 cm (14.5-14.5) and 3.8 cm (3.8-3.8 cm). There were 12 patients (4%) no longer dilating using standard dilators at this pre-scheduled 1-year appointment, and at last follow-up ≥1 year, 8% were no longer dilating. Thirty-six (8%) of patients were considered anorgasmic at last follow up. Difficulty with orgasm prior to surgery was associated with lower rates of achieving orgasm after surgery and less consistent vaginal depth at 1 year, however 80% of these patients were able to orgasm after surgery. CONCLUSIONS:Clinician-observed and patient-reported outcomes for robotic gender-affirming peritoneal flap vaginoplasty were superior to those reported in the literature for penile inversion vaginoplasty. Patients who do not achieve orgasm prior to surgery are less likely to achieve orgasm and maintain vaginal depth afterwards, however the majority of these patients have improved sexual health after surgery.