Faculty Bibliography

Remote patient monitoring (RPM) has been shown to support adults with treated but uncontrolled hypertension (HTN) outside the clinic setting, yielding significant benefits in the treatment and control of blood pressure (BP). Despite its proven efficacy and recommendation as guideline-concordant care, adoption of RPM is suboptimal, particularly among marginalized populations, who face structural barriers to HTN control. A barrier to equitable adoption among marginalized populations is the lack of digital inclusivity in the design and deployment of RPM. Digitally inclusive tools consider factors such as affordability, access, digital literacy, and skills. To address this challenge, the authors describe a digitally inclusive model of RPM for HTN management within the Family Health Centers (FHCs) at NYU Langone, a federally qualified health center (FQHC) that serves more than 110,000 patients each year. The model uses protocols from the Target: BP initiative in combination with team-based care and digitally inclusive strategies to improve HTN control. Specifically, care teams work collaboratively to identify patients with uncontrolled HTN and order RPM using electronic health record-embedded clinical decision support; provide patients with free home BP monitors and training in accurate BP measurement; deliver language-concordant health coaching and optimize the antihypertensive regimen via a virtual high-risk clinic (VHRC); and monitor patient progress through shared communications. Patients also receive support from community health workers (CHWs) to address digital barriers and unmet social needs. The authors present utilization and preliminary outcome data of their model, involving 429 patients who were enrolled in RPM and the VHRC across five FHC practices between January 1, 2022, and December 31, 2023. Enrolled patients attended a mean of 4.9 (standard deviation [SD]: 0.5) visits with a nurse practitioner for medication adjustments and counseling; 5.7 (SD: 0.5) health coaching visits with a nurse; and 1 visit (SD: 0.2) with a CHW for digital and social needs over a mean of 5.7 months (SD: 0.8). Enrolled patients sent a mean number of 65 BP readings (SD: 96.4) over their period of participation. On average, enrolled patients exhibited a -13.5/-8.0 mmHg reduction from their enrollment date to the date that they were discharged from the VHRC (approximately 5.7 months). This is in comparison to a -0.5/+0.6 mmHg change in mean BP exhibited by patients with uncontrolled HTN not enrolled in the Advancing Long-term Improvements in Hypertension Outcomes through a Team-based Care Approach (ALTA) program and receiving care at the practices during the same period (n=2,843). Across the practices, BP control had also increased from the pre-ALTA baseline period (January 1, 2021, to December 31, 2021) of 68.44%-82.99%, by the end of December 31, 2023, among all patients with uncontrolled HTN. While the implementation of this digitally inclusive RPM model has shown success in a large FQHC that cares for a diverse population of patients, there remain digital inequity barriers that must be addressed at the policy level to ensure this efficacious approach reaches all patients.

BACKGROUND AND AIMS/UNASSIGNED:In patients with achalasia treated via Heller myotomy (HM) or peroral endoscopic myotomy (POEM), incomplete myotomy can lead to a "blown-out myotomy" (BOM) diverticulum, worsening obstruction, and dysphagia. We present peroral direct diverticulotomy (PODD), a salvage technique, similar to the "ultrashort tunnel" Zenker's peroral endoscopic myotomy technique, targeting the residual sphincter at the diverticular septum. METHODS/UNASSIGNED:We performed PODD in a 49-year-old man with type I achalasia who underwent POEM with minimal relief (Eckardt score 4). At 18 months, the esophagram showed delayed emptying, incomplete myotomy, and BOM diverticulum, and endoscopy revealed a "puckered," tight lower esophageal sphincter (LES) and a BOM diverticulum. PODD achieved a 2-cm myotomy at the diverticular septum, completing the initial myotomy. RESULTS/UNASSIGNED:The 25-minute procedure was uneventful, and the patient was discharged after 23 hours. Four-week follow-up endoscopy showed patulous LES, resolution of the septum, and no reflux esophagitis. Endoluminal functional lumen imaging probe and esophagram were consistent with resolution of obstruction. At 6 months, swallowing was improved (Eckardt score 1) with no gastroesophageal reflux disease symptoms. CONCLUSIONS/UNASSIGNED:As POEM spreads to low-volume centers, BOM diverticula-once mainly seen after failed HM-are increasingly seen after POEM. PODD offers a technically simple, effective salvage technique with potential broad applicability in managing POEM and HM failure due to BOM.

The rise of artificial intelligence (AI)-driven tools like ChatGPT is transforming professional fields, including pathology. This study provides early insights into how pathology trainees and practicing pathologists are integrating AI into their training and clinical practice. To assess adoption, usage patterns, perceptions, and challenges related to AI-driven tools, including large language models and vision-language models, among pathology professionals. The study also explores future directions for AI integration. A cross-sectional, anonymous survey was distributed electronically to pathology residents, fellows, and attending pathologists through the Accreditation Council for Graduate Medical Education program director registry, professional organizations, and social media (X, Reddit, LinkedIn, and The Pathologist email listserv). The survey included multiple-choice, Likert-scale, and open-ended questions on AI familiarity, usage, perceived benefits/risks, and institutional policies. Data were analyzed using descriptive and inferential statistics, with qualitative responses categorized thematically. A total of 268 respondents participated, primarily residents (41%), attendings (39%), and fellows (7%), representing 23 countries (65% from the USA). Most were affiliated with academic medical centers (72%) and aged 25-44. Whereas 73% reported some familiarity with AI, actual use was limited, 31% reported rare use and 29% no use at all, especially among residents and attendings. ChatGPT was the most used tool (84%), applied mainly for document drafting (57%), research (54%), and administrative tasks (34%). Diagnostic use was minimal. Top concerns included accuracy (81%), over-reliance (65%), and data security (63%). Only 10% reported having clear institutional AI guidelines. Familiarity was strongly associated with usage frequency (p < 0.00001). AI is increasingly used in non-diagnostic areas of pathology but adoption remains cautious. Significant gaps in clinical application, trust, and institutional support persist. Clear guidelines, targeted education, and robust validation are essential for safe, effective AI integration into pathology practice and training.

BACKGROUND:Healthcare is responsible for 8.5% of greenhouse gas emission in the United States. Physicians are becoming increasingly concerned about the climate crisis, particularly in the field of ophthalmology where there is a growing body of literature related to sustainability. Although emissions of cataracts surgery, one of the most performed surgical procedures in the world, have been quantified, modifications to practice have yet to be made. This study aims to uplift the perspectives of a diverse set of healthcare workers on implementing environmentally sustainable practices in the cataract surgery setting. METHODS:16 semi-structured interviews were conducted with professionals working in various direct patient care or administrative roles at a large health center to gain insight on implementing a variety of sustainability initiatives. We focused on initiatives related to supply reduction, reusable supplies, multi-dosing pharmaceuticals, and health system process and policy shifts. RESULTS:Participants most frequently identified infection prevention and control (IPC) concerns as a primary barrier to implementation. Additionally, the IPC department was most often cited as a key stakeholder in implementation. However, participants from this department did not share these same concerns. Additionally, participants most often cited that these initiatives would be successfully implemented by those providing direct patient care. CONCLUSIONS:Themes generated from the collection of responses underscore a broader discussion of disconnect between policy and practice in healthcare as a barrier to implementation of these initiatives and an opportunity in harnessing clinically led change to implement sustainable practices in a growing healthcare system.

OBJECTIVE/UNASSIGNED:Cardiothoracic surgery requires mastery of a broad knowledge base and advanced skillset to manage critically ill patients. Although competency-based assessment frameworks have been developed in several specialties, there remains a paucity of resources to guide practical progression for early cardiothoracic surgical trainees. METHODS/UNASSIGNED:Members of the Thoracic Surgery Residents Association, Thoracic Surgery Medical Student Association, and attending cardiothoracic surgeons with a strong track record of surgical education were invited to share their insights and experiences. A structured, milestone-driven roadmap was developed on the basis of their contributions. RESULTS/UNASSIGNED:We developed a structured, competency-based framework for early surgical trainees, with an emphasis on progressive development of clinical knowledge, technical skills, and academic proficiency. Key milestones and applicable resources were curated to help guide independent learning and skill acquisition. CONCLUSIONS/UNASSIGNED:This structured roadmap offers early-stage cardiothoracic surgery trainees a competency-guided path toward proficiency. By providing clear guidance and granular action points, this guide may help facilitate independent learning and prepare residents for advanced cardiothoracic surgical training.

A key pathological feature of Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Dementia (FTD) is the loss of nuclear localization and accumulation of cytoplasmic inclusions of TAR-DNA binding protein 43 (TDP-43). TDP-43 is a nucleic acid-binding protein involved in transcriptional repression, mRNA splicing, and the regulation of retrotransposable elements (RTEs) and endogenous retroviruses (ERVs). RTEs/ERVs are mobile virus-like genetic elements that constitute about 45% of our genome and encode the capacity to replicate through an RNA intermediate and insert cDNA copies at de novo chromosomal locations. A causal role of RTEs/ERVs has been demonstrated in Drosophila in mediating both intracellular toxicity of TDP-43 and the intercellular spread of toxicity from glia to neurons. RTEs/ERVs are inappropriately expressed in postmortem tissues from ALS, FTD, and Alzheimer's Disease (AD) patients, but the role of RTEs/ERVs has not yet been examined in a vertebrate model of TDP-43 pathology. We utilized established transgenic mouse models that overexpress moderate levels of human wild-type TDP-43 or a mutant version with a specific ALS-causal Q331K amino acid substitution, together with a LINE-1-EGFP retrotransposon indicator line. We found that TDP-43 animals exhibit broad expression of RTEs/ERVs with LINE-1 retrotransposition in glia and neurons in the motor cortex. Expression begins with onset of neurological phenotypes, earlier in hTDP-43-Q331K animals and later in hTDP-43-WT. The LINE-1-EGFP retrotransposition reporter transiently labels spatially clustered groups of neurons and glia at the time of onset of motor symptoms, while EGFP-labeled neurons undergo cell death and are therefore lost over time. Unlabeled cells also die as a function of distance from the clusters of LINE-1-EGFP labeled neurons and glial cells. Together, these findings support the hypothesis that TDP-43 pathology triggers RTE/ERV expression in the motor cortex, that such expression marks cells for programmed cell death, with cell non-autonomous effects on nearby neurons and glial cells.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Hand-sewn (HS) microsuturing is limited by tremor and fatigue. Robotic systems may improve performance, but quantitative comparisons remain limited. This study evaluates the precision of robot-assisted vs manual suturing during end-to-side microanastomosis. METHODS:Under simulation, microsurgical robot-assisted and HS sutures for end-to-side microanastomosis were performed by a single surgeon. One thousand four hundred and ninety-four total frames were assessed within 4 videos. Each robotic clip was paired with a corresponding HS clip. Tracker software extracted 2-dimensional positional data. Motion trajectories were smoothed using Savitzky-Golay filtering for an ideal suture trajectory. Deviation from an ideal path was quantified using Euclidean distance. Mean and SD of path deviation were calculated. Group comparisons were made as fold-change reductions and standardized effect sizes (Cohen d) to quantify the magnitude of observed differences. RESULTS:Robotic-assisted sutures demonstrated significantly lower mean path deviation and variability than HS sutures, particularly for the dominant (right) hand, with consistently large effect sizes for the right hand (all = 1.2, r = 0.5) and smaller for the left hand (d = 0.36-0.71, r = 0.18-0.33). CONCLUSION/CONCLUSIONS:Robotic microsuturing with microsurgical assistant significantly improves path fidelity, particularly in dominant-hand tasks. Manual sutures showed larger deviations between the ideal suture and raw data, supporting robotic integration into cerebrovascular neurosurgery and warranting study in live models.