Faculty Bibliography

BACKGROUND:Health literacy-informed and language-concordant written materials can promote caregiver understanding of care plans although are not commonly used in inpatient rounds. OBJECTIVES/OBJECTIVE:We sought to develop and evaluate a health literacy-informed, multilingual electronic real-time summary of rounds for hospitalized patients (the Rounds eSummary). METHODS:A multidisciplinary team developed the Rounds eSummary using health literacy, communication, and language equity best practices and multiple rounds of piloting. To generate the eSummary, clinicians completed a link with closed-ended options for various rounds components (e.g., illness severity, plan), caregiver's preferred language, and contact information. This generated an electronic PDF rounds summary (15 possible languages) emailed or texted to the family. We used descriptive statistics to analyze eSummaries (n = 437) created from October 25, 2024 to February 1, 2025. Separately, for a purposive sample of English eSummaries (n = 12) that represented different diagnoses and plans, two independent raters examined reading grade level (average of five formulas), understandability, and actionability (Patient Education Materials Assessment Tool for Printable Materials). RESULTS:Rounds eSummaries were generated in eight languages across three sites; the most common languages were English (89%), Spanish (6.2%), and Portuguese (1.8%). Plans commonly included medicines (42%), nutrition (30%), and oxygen (24%). More than half (61%) were accessed at least once by the patient/caregiver; of the eSummaries accessed, the average engagement time was 29.1 s (standard deviation 25.2). The average reading grade level was 6.8 (standard deviation 0.6, range 5.8-7.8). Overall understandability and actionability scores were 87% and 60%, respectively. CONCLUSION/CONCLUSIONS:We designed a usable Rounds eSummary that addressed language and health literacy barriers. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier: NCT05591066.

Characterizing the relationship between DNA methylation and circulating proteins is critical to understanding the epigenetic regulation of the human plasma proteome. Here, we performed an epigenome-wide association study (EWAS) of 5,032 circulating proteins in 1,449 White and 315 Black participants from the Atherosclerosis Risk in Communities (ARIC) cohort. We identified 12,500 significant protein quantitative trait methylation (pQTM)-protein associations involving 1,647 proteins. Among 7,796 unique pQTMs, 14.7% were classified as cis-pQTMs, which were enriched for fundamental cellular processes, whereas trans-pQTMs were predominantly linked to immune-related functions. Trans-pQTMs also exhibited stronger associations with demographic, lifestyle, and clinical traits compared with cis-pQTMs. We identified proteins such as GM2A and EPHB6 whose expression appears to be strongly associated with DNA methylation, suggesting potential as targets for epigenetic-based therapeutic interventions. Together, these findings demonstrate the extensive impact of DNA methylation on the circulating proteome through cis- and trans-regulatory mechanisms and underscore the influence of population-level traits on epigenetic regulation. These findings highlight a broad impact of DNA methylation on circulating proteins through both cis- and trans-regulatory mechanisms and the roles of population-level phenotypes.

BACKGROUND:Age-related hearing loss is highly prevalent, underrecognized, and consequently, undertreated. Hearing loss can have a substantial negative impact on communication and biopsychosocial health. We hypothesize that offering validated hearing assessments and a point-of-care counseling program in an older, underserved population will be more accessible and acceptable than the traditional pathway for audiology care, particularly in marginalized communities. METHODS:This convergent mixed methods feasibility study will assess the implementation of a hearing program embedded in a quality improvement initiative within the Geriatric Clinic of New York City Health and Hospital's Bellevue Hospital Center and the feasibility of recruiting for a future efficacy trial to test the intervention. Adult patients ≥ 60 years who are proficient in English or Spanish and not currently using hearing rehabilitation are eligible for initial screening. Hearing level, including individual ear severity, is identified using a validated tablet-based measure of pure tone audiometry and a self-report measure of hearing disability. We define hearing loss subjectively based on a score of 8 or greater on the Hearing Handicap Inventory-Screen (HHI-S) or using a four-frequency pure tone average > 25 dB hearing level in the better ear, representing at least a mild hearing loss. Patients who are determined to have measurable hearing loss and provide informed consent will be invited to participate in a pilot study and randomized to one of two approaches: (1) a counseling on alternative rehabilitation strategies intervention arm or (2) usual care with referral to the audiology pathway. Primary feasibility outcomes include recruitment and retention rates, intervention adherence, acceptability, and the ability to collect outcome measurements. We will also explore changes in HHI-S scores over 3 months and assess subsequent audiology service utilization in both groups. In addition to the quantitative data, we will include key participant interviews with staff and patients to assess feasibility from participant attitudes. DISCUSSION/CONCLUSIONS:This study will provide insights into the feasibility of offering hearing screening/assessments and counseling in primary care and its potential to improve access to hearing care for underserved older adults. Findings will inform the design of future trials evaluating the impact of primary care-based tailored hearing interventions on patient health and quality of life. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05943509, Trial registration date: July 13, 2023, Protocol Version: 1.

BACKGROUND:The respiratory microbiome, including that of the nasal cavity, is involved in host defense and airway pathophysiology. Interactions of the microbiome with the host immune system may impact health and disease susceptibility through changes in the epigenome. In this study, we aimed to analyze cross-sectional associations of nasal microbiome composition and the nasal epigenome among adolescents in the Project Viva cohort (N = 372, mean age: 13.0 years). We collected nasal swabs from anterior nares, profiled the microbiome by 16 S rRNA gene sequencing, and grouped samples into 6 clusters using partitioning around medoids. Nasal cell DNA methylation was measured with the Illumina MethylationEPIC BeadChip. In an epigenome-wide association study, we tested for associations of microbiome cluster assignment and DNA methylation using robust linear models adjusting sociodemographics, season, batch, and surrogates of cell type composition. Among significant loci, we conducted differential abundance analysis to identify individual bacterial genera associated with DNA methylation levels. RESULTS:< 0.05). Methylation differences between clusters ranged from 0.20 to 12.45% (median = 0.95%). Differentially methylated loci were near genes related to asthma (ITPR2, MAPK1), lung function (FKBP11), mitochondrial function (MRPL20, SPTBN1), inflammation (C3), and immune function (N4BP3, EIF5). The abundance of individual taxa, particularly Propionibacterium, was associated with methylation at 15 of these loci (FDR < 0.05). In addition, we found greater Corynebacterium abundance was associated with lower nasal epigenetic aging (FDR < 0.05). CONCLUSIONS:Our findings support the hypothesis that the nasal microbiome is associated with small-to-modest variation in the nasal epigenome. Future research is needed to investigate how the relationship between the nasal microbiome and epigenome is impacted by environmental exposures, as well as the health effects of microbial and epigenetic variation in early life and across the life course.

Current guidelines for clinically localized prostate cancer offer a wide range of management options, from active surveillance to surgery and radiation therapy (RT). Treatment selection depends on tumor characteristics, overall health, and patient goals. Advances in surgical and radiation techniques have improved survival and functional outcomes, yet treatment continues to have significant impacts on quality of life. Sexual, urinary, and bowel dysfunction are common, and psychological distress, including anxiety, depression, and decisional regret, frequently accompany survivorship. Patients must navigate complex trade-offs between disease control and functional or personal outcomes. This review explores the interplay between treatment options, functional outcomes, and psychosocial considerations in localized prostate cancer care. Key topics include patient priorities, surgical strategies to optimize functional outcomes of radical prostatectomy, advances in RT which improve precision and reduce toxicity, and the role of mental health and lifestyle in survivorship. Integrating these approaches into multidisciplinary care can support overall quality of life. Aligning treatment decisions with patient values and goals is essential for reducing decisional regret and supporting patients through the complex and deeply personal decisions inherent in localized prostate cancer management.

Childhood adversity is increasingly recognized as a critical modifier of neurologic disorder development and disease severity, including in the neuroimmune disorder multiple sclerosis (MS). While previous studies have linked early-life adversity to increased MS susceptibility and more severe disease, the underlying biological mechanisms remain poorly understood. This study investigated associations between childhood adversity and MS clinical features, with a focus on two potential pathogenic mechanisms: allostatic load and epigenetic modifications. We evaluated 60 consecutively enrolled young adults with MS; 30 with paediatric-onset MS (POMS) and 30 with adult-onset MS (AOMS). At time of enrolment in this cross-sectional study, participants had MS disease duration of 6 years on average. POMS participants were mean 22.09 (2.66) years and AOMS participants were mean 32.41 (2.19) years old. 62% of participants were female. Childhood adversity was defined using a composite index of individual, family and socioeconomic measures captured by the adverse childhood experiences questionnaire, parental education level and estimated household income during childhood. Clinical outcomes included patient-reported SymptoMScreen questionnaire regarding MS symptom burden and MS neurologist-assessed disability using the Expanded Disability Status Scale (EDSS) of the participant's neurologic exam at the time of enrolment. Circulating biomarkers of allostatic load and genome-wide epigenetic profiles (DNA methylation via RRBS; reduced representation bisulfite sequencing) were also assessed. A history of high childhood adversity was associated with significantly greater patient-reported MS symptom burden (P = 0.001) and higher neurologist-reported EDSS disability scores (P = 0.028), independent of disease duration or timing of treatment initiation. There were no differences between childhood adversity and circulating biomarkers of allostatic load. While childhood adversity was not associated with global epigenetic changes across the entire cohort, stratified analysis revealed divergent methylation patterns by age of MS onset: POMS participants with childhood adversity had increased DNA methylation, whereas AOMS participants with childhood adversity showed decreased methylation compared to individuals without childhood adversity. None of the observed clinical and biologic differences were explained by differences in disease duration or the interval between symptom onset and treatment initiation. Our findings suggest that childhood adversity is associated with increased MS symptom burden and neurologic disability in young adults with MS. Childhood adversity may differentially shape the epigenome, depending on the age of MS onset, with potential implications for disease trajectory and therapeutic vulnerability. These results support the biological embedding of childhood adversity in MS and highlight the need for age- and exposure-sensitive approaches to understanding MS pathogenesis across the lifespan.

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.

OBJECTIVE:Pediatric primary care (PPC) offers an ideal platform for integrating evidence-based programs (EBPs) to enhance early relational health (ERH). However, implementing such integration faces several challenges. This study uses quantitative and qualitative data to identify the barriers, facilitators, and strategies for implementing ERH-focused EBPs in PPC. METHODS:Using the Consolidated Framework for Implementation Research framework, we conducted a survey and focus groups with PPC personnel recruited through nationwide networks. The survey measured clinic readiness (i.e., challenges, resources, and needs) for integration and examined its associations with personnel roles and clinic characteristics using nested ANOVAs and multilevel regressions. Focus groups further probed potential strategies and were coded using thematic analysis. RESULTS:126 PPC personnel from 44 clinics completed the survey, and 18 participated in five focus groups. Clinics had strong leadership support for integrated services and high utilization of program resources and implementation practices, yet notable challenges in structural and human resources existed. Clinic staff perceived higher readiness for integration than other personnel roles. Lower-percent Medicaid eligible patients and urbanicity were associated with higher readiness, while academic affiliation showed both positive and negative associations. Promoting culturally responsive care, fostering team cohesion, utilizing standardized implementation processes, adopting flexible delivery and collaborative models, and partnering with local communities were key strategies for integrating EBPs. CONCLUSIONS:The findings can help PPC clinics more effectively integrate one or multiple EBPs into routine care and can inform ways to sustain such integrated services to optimize population-level reach and positive impacts on child and family well-being.

BACKGROUND:This cross-sectional study aimed to develop and validate measures of perceptions, attitudes, and practices to support physical activity among older adults. METHOD/METHODS:We enrolled online 310 community-dwelling U.S. older adults and 11 content experts. Using the Knowledge, Attitudes, and Practices framework, we developed 14, seven, and nine items for the Perceived Physical Activity Benefits Scale (PBAS), Attitudes toward Physical Activity Scale (APAS), and Physical Activity Practice Scale (PAPS), respectively. We generated derivation and replication samples using a 30:70 simple random split. Content validity and item analyses were performed on the full sample, followed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for derivation and replication samples, respectively. RESULTS:Item-level content validity indices for the PBAS, APAS, and PAPS were 0.96, 0.94, and 0.95, respectively. Also, the internal consistencies for the PBAS, APAS, and PAPS were 0.92, 0.77, and 0.91, respectively. Our EFA identified two subscale constructs for each measure, with good subscale reliability. CFA fit index ranges for the PBAS, APAS, and PAPS were 0.90-0.94, 0.97-0.99, and 0.95-0.97. CONCLUSIONS:The PBAS, APAS, and PAPS are reliable and valid instruments for assessing perceptions, attitudes, and practices related to physical activity among older adults.

BACKGROUND/UNASSIGNED:Weight bias is pervasive, occurs in a variety of contexts, and is associated with a range of suboptimal outcomes, including delays or avoidance in seeking health care, misdiagnosis, and denial of services. The aim of this study was to quantitatively describe the relationship between experiences of weight bias and eating behaviors of patients in a lifestyle medicine program and qualitatively describe healthcare providers' insights about weight bias. METHODS/UNASSIGNED:This study utilized an explanatory sequential design that drew on one-time survey data collected from 109 patients of a Plant-Based Lifestyle Medicine (PBLM) Program in New York City in 2019. Ordinary Least Squares and logistic regression models examined the association between weight bias and healthful plant-based eating and emotional eating after adjusting for sociodemographic characteristics. Qualitative data come from asynchronous interviews with five healthcare providers from the PBLM program completed in 2024 which were analyzed using rapid coding. RESULTS/UNASSIGNED:Survey participants were on average 53 years old, 67.0% female, 68.6% Black, Indigenous, and other people of color (BIPOC), and 56.2% reported experiencing weight bias. Weight bias was associated with 4.07 fewer points on the healthful plant-based eating measure (95%CI: 6.86, -1.27), and participants had 5.06 times the odds (95%CI: 1.76, 14.59) of emotional eating compared to those not reporting weight bias. Interview themes were: (1) Weight bias negatively influences patient lives, (2) Weight bias is negatively associated with patients' mental health, (3) Promising weight-inclusive approaches, and (4) Recommendations for providers to address weight bias. CONCLUSION/UNASSIGNED:Experiences of weight bias were associated with suboptimal eating behaviors and poor mental health. Providers observed their patients experience harm in connection with weight bias, suggested weight-inclusive approaches, and identified recommendations that would mitigate weight bias in healthcare environments including routinely screening for weight bias, training providers on weight inclusive care, incorporating mental health services into care teams, and creating size inclusive spaces. This study demonstrates that weight bias is linked to deleterious outcomes and the importance of weight-inclusive care delivery and environments.