Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12818
Alternative waist-to-height ratios associated with risk biomarkers in youth with diabetes: comparative models in the SEARCH for Diabetes in Youth Study
BACKGROUND/OBJECTIVES:HtR) can better predict blood pressures and lipid parameters in youth. PARTICIPANTS/METHODS:HtR. RESULTS:HtR (p = 0.003), but otherwise comparisons between alternative WHtR protocols were not significantly different. CONCLUSIONS:Among youth with recently diagnosed diabetes, measurements of WHtR by either waist circumference protocol similarly helped estimate current and prospective cardiometabolic risk biomarkers.
PMID: 30926953
ISSN: 1476-5497
CID: 4318882
The immune landscape of melanoma significantly influences survival in patients with highly mutated tumours [Meeting Abstract]
Background: Tumor-specific indicators, such as tumor mutation burden (TMB) have been shown to affect overall survival (OS) in melanoma. Recently, pan-cancer analyses from The Cancer Genome Atlas (TCGA) discovered specific tumor immune signatures predictive of overall survival (OS), yet it is unclear how these interact with other prognostic markers, independently of immunotherapy (IT). We aimed to combine the immune landscape signatures with TMB and other prognostic markers to improve melanoma OS prediction in patients, independent of IT.
Method(s): We examined the whole-exome data in conjunction with the molecular, clinical and immune features from 278 metastatic melanomas from TCGA, not treated by IT, to develop an improved prognostic model of melanoma OS. Using the discovery (N=139) and validation (N=139) design we performed multivariate Cox proportional hazards (Cox HR) models, adjusted for age and tumor stage at primary diagnosis, to identify interaction between TMB and melanoma immune features (n=59), refining the prediction of melanoma OS.
Result(s): We identified 4 immune features that were significantly associated with OS in both the discovery and validation cohorts. The multivariate Cox HR models revealed that IFN-c response (IFN-c R) and macrophage regulation (MR) signatures in combination with TMB were the most significantly associated with OS (p=8.80E-14). After further refinement, we observed that patients with high TMB, high IFN-c R and high MRhad significantly better OS compared to high TMB, low IFN-y R and low MR (HR=2.8, p=3.55E-08). This association was not observed in low TMB patients.
Conclusion(s): We show, for the first time, that TMB and tumor immune features are significantly associated with improved OS, independent of IT. Further analysis of patients revealed that high TMB associates with improved OS in patients with high IFN- c R and MR but not in low IFN- c R and MR. Hence, this data provides first evidence that patients with high TMB have distinct OS outcome depending on other tumor immune features. Beside biological link between TMB and IFN-y and MR, our data suggest that these associations may significantly improve the current melanoma prognostic models
Method(s): We examined the whole-exome data in conjunction with the molecular, clinical and immune features from 278 metastatic melanomas from TCGA, not treated by IT, to develop an improved prognostic model of melanoma OS. Using the discovery (N=139) and validation (N=139) design we performed multivariate Cox proportional hazards (Cox HR) models, adjusted for age and tumor stage at primary diagnosis, to identify interaction between TMB and melanoma immune features (n=59), refining the prediction of melanoma OS.
Result(s): We identified 4 immune features that were significantly associated with OS in both the discovery and validation cohorts. The multivariate Cox HR models revealed that IFN-c response (IFN-c R) and macrophage regulation (MR) signatures in combination with TMB were the most significantly associated with OS (p=8.80E-14). After further refinement, we observed that patients with high TMB, high IFN-c R and high MRhad significantly better OS compared to high TMB, low IFN-y R and low MR (HR=2.8, p=3.55E-08). This association was not observed in low TMB patients.
Conclusion(s): We show, for the first time, that TMB and tumor immune features are significantly associated with improved OS, independent of IT. Further analysis of patients revealed that high TMB associates with improved OS in patients with high IFN- c R and MR but not in low IFN- c R and MR. Hence, this data provides first evidence that patients with high TMB have distinct OS outcome depending on other tumor immune features. Beside biological link between TMB and IFN-y and MR, our data suggest that these associations may significantly improve the current melanoma prognostic models
EMBASE:630607219
ISSN: 1569-8041
CID: 4286052
Journal of the American Academy of Child and Adolescent Psychiatry. 2019:Conference:(66th).DOI: 10.1016/j.jaac.2019.07.652
5.6 CHILDREN'S DIGITAL MENTAL HEALTH: A DESIGN AND ETHICAL FRAMEWORK [Meeting Abstract]
Objectives: Digital innovation has the potential to transform both the science and practice of child mental health. Creation of pediatric digital health tools requires that bioethics, human-centered design, and clinical and scientific expertise are integrated with digital tool development, digital data collection, and data analytics. In this talk, we will describe the opportunities for innovations in pediatric digital mental health and the concurrent ethical and security risks. We will then present a framework and design methodology for creating ethical, human-centered, clinically informed, and evidence-based digital tools for children's mental health.
Method(s): The data presented will come from our experience founding and leading the New York University Langone Department of Child and Adolescent Psychiatry's WonderLab, which creates pediatric digital mental health tools that are evidence based, scalable, and ethical, as well as beautiful and fun so that parents and children would want to use them. The WonderLab brings clinical, scientific, digital engineering, digital design, data science, and bioethics expertise together with user engagement and a "build, measure, learn" agile development culture and methodology. We will use the WonderLab team's development and launch of our first app-based study, "When to Wonder: Picky Eating," to illustrate our framework and methodology.
Result(s): We will describe the innovation opportunities in pediatric digital mental health, including innovation in measurement, engagement, access, and collaborative methodologies. We will then present the ethical, privacy, security, and safety risks related to digital health applications and app-based data collection with children and their families. Finally, we will describe how the WonderLab team, methodology, and products innovate across multiple domains within an explicit ethical and clinically informed framework.
Conclusion(s): Digital innovation and data science have great potential to address the challenges facing our patients and our field. To build ethical and useful digital health tools for children's mental health requires multidisciplinary teams, user engagement, collaborative agile methodology, and a framework that ensures that innovations are integrated with and reflect our ethics and commitment to children. R, COMP, DAM
Copyright
Method(s): The data presented will come from our experience founding and leading the New York University Langone Department of Child and Adolescent Psychiatry's WonderLab, which creates pediatric digital mental health tools that are evidence based, scalable, and ethical, as well as beautiful and fun so that parents and children would want to use them. The WonderLab brings clinical, scientific, digital engineering, digital design, data science, and bioethics expertise together with user engagement and a "build, measure, learn" agile development culture and methodology. We will use the WonderLab team's development and launch of our first app-based study, "When to Wonder: Picky Eating," to illustrate our framework and methodology.
Result(s): We will describe the innovation opportunities in pediatric digital mental health, including innovation in measurement, engagement, access, and collaborative methodologies. We will then present the ethical, privacy, security, and safety risks related to digital health applications and app-based data collection with children and their families. Finally, we will describe how the WonderLab team, methodology, and products innovate across multiple domains within an explicit ethical and clinically informed framework.
Conclusion(s): Digital innovation and data science have great potential to address the challenges facing our patients and our field. To build ethical and useful digital health tools for children's mental health requires multidisciplinary teams, user engagement, collaborative agile methodology, and a framework that ensures that innovations are integrated with and reflect our ethics and commitment to children. R, COMP, DAM
Copyright
EMBASE:2003280285
ISSN: 1527-5418
CID: 4131232
Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods: Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter?
Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à -vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
PMID: 31321639
ISSN: 1573-3254
CID: 4014772
Postinjury Complications: Retrospective Study of Causative Factors

BACKGROUND:Injury care involves the complex interaction of patient, physician, and environment that impacts patient complications, level of harm, and failure to rescue (FTR). FTR represents the likelihood of a hospital to be unable to rescue patients from death after in-hospital complications. OBJECTIVE:This study aimed to hypothesize that error type and number of errors contribute to increased level of harm and FTR. METHODS:Patient information was abstracted from weekly trauma performance improvement (PI) records (from January 1, 2016, to July 19, 2017), where trauma surgeons determined the level of harm and identified the factors associated with complications. Level of harm was determined by definitions set forth by the Agency for Healthcare Research and Quality. Logistic regression was used to determine the impact of individual factors on FTR and level of harm, controlling for age, gender, Charlson score, injury severity score (ISS), error (in diagnosis, technique, or judgment), delay (in diagnosis or intervention), and need for surgery. RESULTS:A total of 2216 trauma patients presented during the study period. Of 2216 patients, 224 (224/2216, 10.10 %) had complications reported at PI meetings; of these, 31 patients (31/224, 13.8 %) had FTR. PI patients were more likely to be older (mean age 51.3 years, SE 1.58, vs 46.5 years, SE 0.51; P=.008) and have higher ISS (median 22 vs 8; P<.001), compared with patients without complications. Physician-attributable errors (odds ratio [OR] 2.82; P=.001), most commonly errors in technique, and nature of injury (OR 1.91; P=.01) were associated with higher levels of harm, whereas delays in diagnosis or intervention were not. Each additional factor involved increased level of harm (OR 2.09; P<.001) and nearly doubled likelihood of FTR (OR 1.95; P=.01). CONCLUSIONS:Physician-attributable errors in diagnosis, technique, or judgment are more strongly correlated with harm than delays in diagnosis and intervention. Increasing number of errors identified in patient care correlates with an increasing level of harm and FTR.
PMID: 31573897
ISSN: 2292-9495
CID: 4116192
A parametric meta-analysis
In a meta-analysis, we assemble a sample of independent, nonidentically distributed p-values. The Fisher's combination procedure provides a chi-squared test of whether the p-values were sampled from the null uniform distribution. After rejecting the null uniform hypothesis, we are faced with the problem of how to combine the assembled p-values. We first derive a distribution for the p-values. The distribution is parameterized by the standardized mean difference (SMD) and the sample size. It includes the uniform as a special case. The maximum likelihood estimate (MLE) of the SMD can then be obtained from the independent, nonidentically distributed p-values. The MLE can be interpreted as a weighted average of the study-specific estimate of the effect size with a shrinkage. The method is broadly applicable to p-values obtained in the maximum likelihood framework. Simulation studies show that our method can effectively estimate the effect size with as few as 6 p-values in the meta-analyses. We also present a Bayes estimator for SMD and a method to account for publication bias. We demonstrate our methods on several meta-analyses that assess the potential benefits of citicoline for patients with memory disorders or patients recovering from ischemic stroke.
PMCID:6688941
PMID: 31206759
ISSN: 1097-0258
CID: 5161602
Lifetime Risk of Lower-Extremity Peripheral Artery Disease Defined by Ankle-Brachial Index in the United States
Background There are no available lifetime risk estimates of lower-extremity peripheral artery disease (PAD). Methods and Results Using data from 6 US community-based cohorts and the vital statistics, we estimated the prevalence and incidence of PAD, defined as an ankle-brachial index < 0.90, at each year of age from birth to 80 years for white, black, and Hispanic men and women. Then, we used Markov Monte Carlo simulations in a simulated cohort of 100 000 individuals to estimate lifetime risk of PAD. On the basis of odds ratios of PAD for traditional atherosclerotic risk factors (eg, diabetes mellitus and smoking), we developed a calculator providing residual lifetime risk of PAD. In an 80-year horizon, lifetime risks of PAD were 30.0% in black men and 27.6% in black women, but ≈19% in white men and women and ≈22% in Hispanic men and women. From another perspective, 9% of blacks were estimated to develop PAD by 60 years of age, while the same proportion was seen at ≈70 years for whites and Hispanics. The residual lifetime risk within the same race/ethnicity varied by 3.5- to 5-fold according to risk factors (eg, residual lifetime risk in 45-year-old black men was 19.9% when current smoking, diabetes mellitus, and history of cardiovascular disease were absent versus 70.4% when all were present). Conclusions In the United States, ≈30% of blacks are estimated to develop PAD during their lifetime, whereas the corresponding estimate is ≈20% for whites and Hispanics. The residual lifetime risk within the same race/ethnicity substantially varies according to traditional risk factors.
PMCID:6818002
PMID: 31500474
ISSN: 2047-9980
CID: 5101402
Differential Risk for Drug Use by Sexual Minority Status among Electronic Dance Music Party Attendees in New York City
Background: Drug use among electronic dance music (EDM) party attendees is common; however, studies are needed to examine associations between drug use and sexual orientation as this can inform prevention and harm reduction efforts in the lesbian, gay, and bisexual (LGB) community. Methods: Data were examined from a repeated cross-sectional study of 3066 young adult EDM party attendees surveyed entering nightclubs and dance festivals in New York City between 2016 and 2018. Of these participants, 277 identified as gay/lesbian, 293 identified as bisexual, and 83 identified as other sexuality. We examined how sexual orientation relates to past-year use of various 'traditional' drugs (e.g., ecstasy/MDMA/Molly) and new psychoactive substances (NPS; e.g., "bath salts") in a bivariable and multivariable manner, stratified by sex. Results: Compared to heterosexual males, gay males were at higher odds for use of ecstasy, GHB, and methamphetamine; bisexual males were at higher odds for use of LSD and unknown powders, and males identifying as "other" sexuality were at higher odds for use of mushrooms and 2C drugs. Compared to heterosexual females, lesbians were at higher odds for use of mushrooms and GHB; bisexual females were at higher odds for use of cocaine, LSD, mushrooms, and tryptamines, and females identifying as "other" sexuality were at higher odds for use of cocaine and tryptamines. Conclusions: We determined differential risk of use of different drugs among those who attend EDM parties according to sexual orientation. Findings can be used to tailor prevention messaging to specific groups within the LGB community.
PMID: 31530057
ISSN: 1532-2491
CID: 4097982
Is high vitamin B12 status a cause of lung cancer?
Vitamin B supplementation can have side effects for human health, including cancer risk. We aimed to elucidate the role of vitamin B12 in lung cancer aetiology via direct measurements of pre-diagnostic circulating vitamin B12 concentrations in a nested case-control study, complemented with a Mendelian randomization (MR) approach in an independent case-control sample. We used pre-diagnostic biomarker data from 5,183 case-control pairs nested within 20 prospective cohorts, and genetic data from 29,266 cases and 56,450 controls. Exposures included directly measured circulating vitamin B12 in pre-diagnostic blood samples from the nested case-control study, and 8 single nucleotide polymorphisms associated with vitamin B12 concentrations in the MR study. Our main outcome of interest was increased risk for lung cancer, overall and by histological subtype, per increase in circulating vitamin B12 concentrations. We found circulating vitamin B12 to be positively associated with overall lung cancer risk in a dose response fashion (odds ratio for a doubling in B12 [ORlog2B12 ] = 1.15, 95% confidence interval (95%CI) = 1.06-1.25). The MR analysis based on 8 genetic variants also indicated that genetically determined higher vitamin B12 concentrations were positively associated with overall lung cancer risk (OR per 150 pmol/L standard deviation increase in B12 [ORSD ]= 1.08, 95%CI= 1.00-1.16). Considering the consistency of these two independent and complementary analyses, these findings support the hypothesis that high vitamin B12 status increases the risk of lung cancer.
PMID: 30499135
ISSN: 1097-0215
CID: 3500852
Genome-wide association meta-analyses and fine-mapping elucidate pathways influencing albuminuria
Increased levels of the urinary albumin-to-creatinine ratio (UACR) are associated with higher risk of kidney disease progression and cardiovascular events, but underlying mechanisms are incompletely understood. Here, we conduct trans-ethnic (n = 564,257) and European-ancestry specific meta-analyses of genome-wide association studies of UACR, including ancestry- and diabetes-specific analyses, and identify 68 UACR-associated loci. Genetic correlation analyses and risk score associations in an independent electronic medical records database (n = 192,868) reveal connections with proteinuria, hyperlipidemia, gout, and hypertension. Fine-mapping and trans-Omics analyses with gene expression in 47 tissues and plasma protein levels implicate genes potentially operating through differential expression in kidney (including TGFB1, MUC1, PRKCI, and OAF), and allow coupling of UACR associations to altered plasma OAF concentrations. Knockdown of OAF and PRKCI orthologs in Drosophila nephrocytes reduces albumin endocytosis. Silencing fly PRKCI further impairs slit diaphragm formation. These results generate a priority list of genes and pathways for translational research to reduce albuminuria.
PMCID:6739370
PMID: 31511532
ISSN: 2041-1723
CID: 4318962
