Faculty Bibliography

There has been increasing interest in the human anaerobic colonic bacterium Oxalobacter formigenes because of its ability to metabolize oxalate, and its potential contribution to protection from calcium oxalate kidney stones. Prior studies examining the prevalence of this organism have focused on subjects in developed countries and on adults. Now using O. formigenes-specific PCR, we have compared the prevalence of these organisms among subjects in two remote areas in which modern medical practices have hardly been present with a USA group of mothers and their infants for the first three years of life. Among the Amerindians of the Yanomami-Sanema and Yekwana ethnic groups in Venezuela and the Hadza in Tanzania, O. formigenes was detected in 60-80% of the adult subjects, higher than found in adults from USA in this and prior studies. In young children, the prevalence was much lower in USA than in either tribal village. These data extend our understanding of the epidemiology of O. formigenes carriage, and are consistent with the hypothesis that the rising incidence of kidney stones is associated with the progressive loss of O. formigenes colonization in populations that have been highly impacted by modern medical practices.

Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults with Multimorbidity using a systematic review of the literature and consensus (Table 1). The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision-making for clinicians who provide both primary and specialty care to older people with MCCs. A workgroup of geriatricians, cardiologists, and generalists: 1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; 2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: 3) performed a scoping review to identify evidence-based, validated tools for carrying out the MCC Actions and Action Steps; and 4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: 1) Identify and communicate patients' health priorities and health trajectory; 2) Stop, start, or continue care based on health priorities, potential benefit versus harm and burden, and health trajectory; and 3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (www.GeriatricsCareOnline.org).

Air quality conditions in the U.S. are reported to the general public via the regulatory-based Air Quality Index (AQI). The accuracy of AQI as a risk communication tool is dependent, in part, on an assumption of equivalent health risks for each of the index pollutants. Time-series analyses of 858,030 emergency department visits from 2005–2010 for respiratory diseases in two New York counties (Bronx and Queens) were completed using a Poisson generalized linear model in order to assess the equivalency of respiratory morbidity risk for four index pollutants. Excess respiratory risk per 1-AQI unit was approximately twice as high for ozone (0.16%, 95% confidence interval [CI] [0.08, 0.24]) as compared with sulfur dioxide (0.09%, 95% CI [0.01, 0.16], nitrogen dioxide (0.07%, 95% CI [0.01, 0.15]), and fine particulate matter (0.07%, 95% CI [0.02, 0.12]). Unequal respiratory risks on a per-AQI-unit basis resulted in inconsistencies between reported AQI values and public health risks, especially during the ozone season. While still useful in reporting general air quality conditions to the public, AQI may be insufficiently precise to inform optimal daily behavior modification decisions

Purpose: In 2016 there were roughly 77,000 PrEP users in the United States, while over 1.2 million Americans were identified as "high-risk" for HIV infection. The reasons for this discrepancy are vast; however, potential reasons that have been identified are stigma, ineffective or poorly targeted marketing, access, and cost, amongst other factors. This pilot project seeks to understand the ways in which people and companies talk about PrEP on social media to glean deeper insights on methods to increase PrEP use. The increased use of social media gives researchers, clinicians, policymakers, and health organizations the opportunity to have access to real time data and potentially influence awareness of PrEP. This inductive exploratory study uses natural language processing (NLP) and content analysis to examine the ways in which people are using social media to talk about PrEP. Method(s): An R script was utilized to crawl Twitter the Twitter API based on keywords related to PrEP and HIV, plus all lemmatized variations related to the word pair. Data cleaning was then performed to remove tweets that were not in English, tweets that had been retweeted, as well as removing any identifying information. The resulting data frame was then used both qualitatively and quantitatively for analysis. Qualitative analysis involved a comprehensive reading of tweets, development of a category dictionary, and identification of themes that would help to train an algorithm to automatically process and count tweets based on its category. The quantitative process involved further cleaning and removing of stop-words to develop a Ngram frequency cloud as well as development of a process to automatically categorize the different types of tweets based on the type of tweet (advertisement, question about PrEP, comment on cost or availability, criticism of manufacturer, etc.). Result(s): This processes resulted in identification of 587 unique HIV related PrEP tweets. Qualitative insights from this reduced dataset indicated that there are preventative concerns related to access and cost which may be preventing high-risk individuals from getting PrEP. Algorithmic sorting and categorization processes also identified concerns about targeted marketing, specifically the lack of campaigns focusing on transgender, female, and minority communities. Our bootstrap method of training and testing resulted in a process that had an 80% likelihood of identifying, analyzing, and classifying HIV related PrEP tweets. Once classified, 40% of tweets were advertising and messaging, the rest were concerns about cost (31%), requests for info/ways to pay for PrEP (20%), as well as other non-classified comments. Conclusion(s): There are a number of different conversations about HIV/PrEP awareness happening on Twitter. However, access and cost were consistently the most common themes being discussed. Currently, a 30-day supply of PrEP costs between 0-$1600, in the US, which may be creating a substantial barrier to further reducing HIV rates. Additionally, Improving online marketing strategies of PrEP could increase awareness and use by offering targeted information as well as identification of local resources to those interested or in need. Sources of Support: NYU CAMS Undergradaute Internship

Purpose: There are an ever increasing number of social media platforms available for people to connect and build online communities. Pro-eating disorder communities, notably anorexia nervosa (AN), have developed a steady presence on Twitter. While these communities can be beneficial for individuals who are not yet ready or able to seek professional help, multiple studies have revealed the detrimental side effects these communities can have on users, such as normalization of maladaptive behaviors, encouragement of behaviors and sharing new ways to perpetuate behaviors. To date, few studies have investigated the ways in which available social media data from self-identified anorexic individuals could be used to better inform screening, treatment, and follow-up with these individuals. This study evaluated the ways in which natural language processing (NLP) and machine learning algorithms, coupled with qualitative methods, could collect, categorize, and inform clinician insights about pro-eating disorder communities. Method(s): Twitter crawling algorithms were developed and deployed through the Twitter API to find tweets based on key words such as: "ana" "proana" "thinspo" and "meanspo." This initial corpus of tweets containing the identified keywords was then qualitatively assessed to further refine the algorithmic process of identifying appropriate tweets and removing irrelevant tweets. This process resulted in a cleaned corpus of 970 unique tweets over a ten-day period. This cleaned dataset was then utilized for NLP to identify common words, phrases, and topics. Concurrently, data was hand coded in a thematic analysis process to identify deeper themes within the dataset. These themes could inform qualitative lines of inquiry as well as machine learning systems. Qualitative insights were utilized to improve sentiment analysis as well as classification of unstructured data though a semi-supervised machine learning process. Result(s): Analysis revealed that emotional restraint was not present and judgement of one's self on external standards was present within these Twitter communities. Additionally, users' frequently requested "meanspo," an extension of thinspo that serves as an inspiration for thinness by using aggressive and abrasive rhetoric to encourage users to aspire for thinness. Additionally, posts asking for an "ana buddy," a partner to help users hold each other accountable to their AN behaviors, were extremely common. Additional information about caloric restrictions, weekly weight loss goals, and a large number of individuals tweeting from residential treatment for ED about lying about wanting to get better as a means to be released, as well as genuine statements about wanting to change. Conclusion(s): AN is a complicated disease with multiple causes, side effects and comorbid illnesses. This pilot study offers a promising 'first-step' approach towards understanding the mindset, experiences, and potential gaps within current ED treatment approaches from a patient perspective. NLP and ML processes are now developed to scan, collect, and analyze this data in an ongoing way to develop new AI processes with the ultimate goal of identifying individuals with a higher likelihood of wanting to enter treatment. Overall, the present study highlights the benefits of using new available data streams to develop patient-informed comprehensive care models. Sources of Support: NYU CAMS Undergaduate Internship

Purpose: Instagram has grown over the years to become one of the most popular social media platforms, and three quarters of teens who use social media use Instagram. In recent years, "Finstas", or "fake" Instagrams have grown in popularity among US teenagers. Finsta accounts are subsidiary Instagram accounts with highly selected audiences where owners can post material that is not associated with their main account. Public Twitter posts (tweets) can provide insight into communication about these clandestine accounts not available through Instagram due to the inherent private nature of these accounts. This exploratory study uses natural language processing (NLP) techniques on tweets about Finsta accounts to gain insight into this phenomenon. Method(s): An R-script was developed to pull data from the Twitter API to capture tweets longitudinally that were in English, from North America, and specifically mention some form of the stem and lemmatized word "Finsta." As there are no current studies on Finsta accounts, a comprehensive thematic analysis was then performed on the corpus of tweets to develop qualitative insights on this phenomenon. A quantitative process involved further cleaning and removing of stop-words to develop a Ngram frequency chart of the lemmatized words in the corpus of tweets to better understand the ways in which people were communicating about Finsta accounts. Result(s): 10,000 tweets containing the word "Finsta" were pulled from the Twitter API. After a comprehensive cleaning process, 5,159 tweets were then analyzed qualitatively to identify themes as a preliminary inquiry into this relatively new phenomenon. Themes identified within the corpus were: a desire for privacy compared to their main account, a place to share information that may be politically incorrect or would get users in trouble if shared on accounts with wider viewership, and a place to showcase real life. Ngram frequency words highlight similar words common to social media, "follow," "like," and "post" being amongst the most popular; however, within this corpus there are high frequencies of the words, "private," "sad," "nudes," "spam," "rant," "exposed," "emotional," and "outlet," tied to contextual themes indicating that Finstas may be an outlet for emotional catharsis in a "safe space." A Finsta user may have twenty followers (as opposed to 1000 on their main account) that include their closest friends. They may post blurry pictures without filters, with long captions detailing their negative emotional state. This sensitive content is posted with the underlying assumption that their friends will keep this information private. Conclusion(s): Preliminary analyses indicate that Finstas are a new way for teens to connect with peers in a controlled space online, where they can truly express themselves. Additionally, there is also a great deal of gossip, exhibitionism, risk-taking, and other attention-seeking behaviors typical of adolescence that manifest in ways not seen on users' primary accounts. Finsta accounts fulfill a vital role in the lives of adolescents looking for ways to authentically connect, share, and create community that is not offered through traditional uses of social media. Sources of Support: NYU CAMS Undergraduate Internship

BACKGROUND:and diffusion-weighted imaging (DWI) can be utilized as a screening exam. PURPOSE/OBJECTIVE:To review the accuracy and feasibility of an interdisciplinary prospective contrast-enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection. STUDY TYPE/METHODS:Retrospective cohort study. POPULATION/METHODS:In all, 1960 adult female patients aged 18-87 undergoing screening MRI pelvis prior to uterine fibroid resection. FIELD STRENGTH/SEQUENCE/UNASSIGNED:-weighted imaging, DWI, and contrast-enhanced images were acquired at 1.5 T and 3.0 T. ASSESSMENT/RESULTS:signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost-effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI. STATISTICAL TESTS/UNASSIGNED:Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t-tests were used to compare demographics and apparent diffusion coefficient values between LMS and false-positive results. RESULTS:We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life-year gained. DATA CONCLUSION/UNASSIGNED:MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians. LEVEL OF EVIDENCE/METHODS:3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019.

OBJECTIVE:Despite substantial LGBT cancer health disparities, there are no LGBT cultural competency trainings tailored for oncologists. Here we describe the systematic development of a web-based, oncology-focused LGBT cultural competency training. METHODS:A literature review regarding LGBT cancer outcomes and competency training was conducted to identify potential training content. An expert panel meeting, including LGBT cancer survivors, cultural competency experts, oncologists, a web designer, and an instructional designer, was held to solidify the training content focus. Following the panel, the training was developed in collaboration with an instructional designer, a web designer, and LGBT community members. RESULTS:The training modules include: 1) LGBT Basics; 2) Inclusive Environments; 3) Initiating Oncology Care with LGBT Patients; and 4) Issues in Cancer Survivorship among LGBT Patients. Module content is interactive, and models effective communication. CONCLUSION/CONCLUSIONS:The process of collaboration with a diverse group of stakeholders and three cancer centers in Florida has resulted in a practical and efficient web-based resource for LGBT cultural competency training for oncologists. PRACTICE IMPLICATIONS/CONCLUSIONS:Feedback from stakeholders indicates that training in this area is needed and will be well-received by oncologists. We are currently conducting an evaluation of this training among oncologists and LGBT community members.