Faculty Bibliography

OBJECTIVES/UNASSIGNED:Assess time impact and provider perception of AI-generated encounter summaries. MATERIALS AND METHODS/UNASSIGNED:An artificial intelligence (AI) clinical note summarization tool was deployed in ambulatory practices for 22 providers. A 6-month pre-post analysis evaluated changes in EHR time, and survey feedback assessed tool utility. RESULTS/UNASSIGNED:= .046). The majority of providers reported high tool accuracy and time saving. DISCUSSION/UNASSIGNED:AI-generated summaries appear most beneficial for clinicians who initially spend the longest time in chart review, suggesting a targeted efficiency gain. Providers expressed optimism about the tool's potential to streamline clinical workflows. CONCLUSION/UNASSIGNED:Early experience with AI-generated summaries shows promise in improving provider workflow.

IMPORTANCE:Employing peer coaches to provide weight management counseling in primary care could address patient- and clinician-level barriers to obesity care, improve outcomes, and boost engagement in weight management programs. OBJECTIVE:To evaluate the efficacy of peer coaching to deliver a low- to moderate-intensity intervention for weight management compared with enhanced usual care (EUC). DESIGN, SETTING, AND PARTICIPANTS:This 2-arm, cluster randomized clinical trial was conducted from November 2017 to August 2021 at a single US Department of Veteran Affairs (VA) site. Primary care physicians (PCPs) and their patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of at least 25 (overweight) or 30 or more (obesity) were invited to participate. Enrollment was stopped early due to the COVID-19 pandemic, when weight management services at the VA site transitioned to primarily virtual care. PCPs were randomized to either the peer coaching (ie, Peer-Assisted Lifestyle) intervention or EUC arm, and their patients received the corresponding treatment for those arms. Data were analyzed according to the intention-to-treat principle from February 2023 and July 2024. INTERVENTIONS:Patients in the peer coaching arm completed a tablet-based, goal-setting tool and received 1 in-person and up to 12 individual peer-coaching telephone sessions over 1 year. Peer coaches were veterans with a bachelor's degree and training for a minimum of 20 hours. Patients in the EUC control arm received health education materials. MAIN OUTCOMES AND MEASURES:The primary outcome was mean (SE) change in weight (in kilograms) at 12 months. Secondary outcomes included mean (SE) weight change in percentage, proportion of patients achieving 5% or higher weight loss, and change in waist circumference in inches. RESULTS:A total of 20 PCPs (11 women [55.0%]) and 281 patients were enrolled. Patients had a mean (SD) age of 50.6 (11.5) years and included 221 men (78.6%). The mean (SD) body mass index at baseline was 33.4 (5.1). At 12 months, the adjusted mean (SE) weight change was -2.51 (0.73) kg in the peer coaching arm and -0.79 (0.48) kg in the EUC arm, but the difference was not statistically signficant (difference, -1.72 [0.88] kg; P = .05). At 6 months, the adjusted mean (SE) proportion of patients who lost at least 5% of body weight was 16.68% (0.47%) in the peer coaching arm vs 5.50% (0.32%) in the EUC arm (difference, 11.18 [5.22] percentage points; P = .03). At 6 months, the adjusted mean (SE) proportion of patients who attended a weight management program was 28.68% (5.37%) in the peer coaching arm and 13.32% (3.38%) in the EUC arm (difference, 15.37 [6.45] percentage points; P = .02). CONCLUSIONS AND RELEVANCE:In this randomized clinical trial, a low- to moderate-intensity peer-coaching intervention did not result in greater weight loss at 12 months, but it improved attendance at weight management programs. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03163264.

OBJECTIVE/UNASSIGNED:The aim is to identify surgical department chairs' perspectives on the role of Vice Chairs for Diversity, Equity, and Inclusion (DEI VCs). BACKGROUND/UNASSIGNED:The role of DEI VCs has become increasingly common in departments of surgery. However, the role remains ill-defined, and most who hold the position are the first to serve their department in this capacity. METHODS/UNASSIGNED:A 27-item online survey was administered in September 2023 to department chairs across US-based academic general surgery departments who reported having a DEI VC instated in the department. The survey assessed (1) the role, purpose, responsibilities, and value of the DEI VC, (2) resources allotted to DEI VCs, (3) demographic characteristics of both surgical chairs and DEI VCs, and (4) recommendations to increase the impact of the position within the department. RESULTS/UNASSIGNED:The survey sample consisted of 22 surgical chairs; White (73%) and men (68%). Twenty (91%) agreed that the DEI VC enhances their ability to fulfill their mission to diversity, equity, and inclusion, but only 12 (57%) said that the DEI VC was given an annual budget. Surgical chairs reported that increasing resources, integrating the position across other departments, and defining measures to evaluate success would increase the impact of DEI VCs. CONCLUSIONS/UNASSIGNED:Surgical chairs with a DEI VC find value in the position and provide a range of resources to support the role. These results should be used as evidence for establishing and funding DEI VCs across US-based academic general surgery departments.

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental chemicals that have been linked to pancreatic cancer in animal studies, but evidence in humans remains limited. We evaluated associations between pre-diagnostic circulating concentrations of 11 PFAS and pancreatic cancer risk in a nested case-control study within the New York University Women's Health Study, a prospective cohort of 14,273 women. Serum samples collected prior to diagnosis from 116 pancreatic cancer cases and 346 matched controls were analyzed for PFAS levels. Associations between individual PFAS and pancreatic cancer risk were assessed using multivariable conditional logistic regression, and mixture effects were examined using repeated holdout weighted quantile sum (WQSRH) regression and Bayesian kernel machine regression (BKMR). Ten PFAS met the inclusion criteria for analysis. In single-chemical models, N-methyl perfluorooctane sulfonamidoacetic acid (NMFOSAA) and perfluorooctanoate (PFOA) were inversely associated with pancreatic cancer risk, but associations did not remain significant after false discovery rate correction. WQSRH models with negative constraints suggested a borderline inverse association with the PFAS mixture, primarily driven by NMFOSAA, PFOA, and perfluoroundecanoate (PFUNDA), while no significant associations were observed in positively constrained WQSRH or BKMR models. Overall, these findings do not support a positive association between circulating PFAS and pancreatic cancer risk in women. Although some compounds showed suggestive inverse associations, the overall findings indicate no clear link between PFAS exposure and pancreatic cancer risk.

Reliable and valid assessment tools are crucial for measuring alcohol use expectancies (AUE) among youth living with HIV (YLHIV). In this paper, we assess the psychometric properties of the original 17-item East Africa Alcohol Expectancy Scale (AFEXS) among Ugandan YLHIV-a scale developed and validated by Woolf-King et al. for use among Uganda adults living with HIV. Specifically, we applied the measure to a sample of 100 Ugandan YLHIV enrolled in a substance use intervention. To analyze the psychometric properties, we conducted exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent validity analyses. The resulting 15-item youth AFEXS scale differed from the 11-item adult version. The 15-item Youth AFEXS demonstrated high internal consistency (α = 0.85), aligning with theoretical expectations of a three-factor structure related to sexual expectancies (7 items; α = 0.89), negative expectancies (4 items; α = 0.72), and release of inhibition expectancies (4 items; α = 0.77). The global scale and sub-scales demonstrated satisfactory convergent validity through positive correlations measures of frequency of alcohol consumption in the past 12 months: global AFEXS (r = 0.617; p = 0.000), sexual expectancies (r = 0.583; p = 0.000), negative expectancies (r = 0.618; p = 0.000), and release expectancies (r = 0.596; p = 0.000). The study confirms the youth AFEXS as a reliable and valid tool for assessing AUE among Ugandan YLHIV.

This study explores the factors that shape the savings behaviors of women engaged in sex work (WESW) in southwestern Uganda, with a particular focus on the intersection of caregiving responsibilities and economic vulnerability. Drawing on qualitative data from the Kyaterekera study-an intervention that combined economic empowerment strategies (savings, financial literacy, and mentorship) with HIV risk reduction-we examine how WESW navigate financial decision-making in the context of structural and social constraints. While participants demonstrated motivation and resilience in pursuing financial stability, they encountered significant and intersecting barriers, including fluctuating income, caregiving demands, gendered norms, and the absence of formal social support systems. Findings reveal that caregiving is not merely a personal role but a structurally marginalized identity that shapes economic behavior in profound ways as these caregiving responsibilities intersect with factors such as marital status, household composition, and urban-rural location to produce differentiated financial challenges. Despite these constraints, participants engaged in strategic saving to meet essential needs, respond to emergencies, and invest in long-term goals such as homeownership and their children's education. These insights underscore the importance of adopting an intersectional approach to economic empowerment-one that accounts for the diverse and overlapping realities of WESW. Tailored interventions that integrate financial literacy, peer mentoring, and potentially self-help groups can more effectively address both individual and structural barriers. By centering caregiving within economic empowerment strategies, programs can better support the long-term financial autonomy and well-being of WESW and their families.

BACKGROUND:Women engaged in commercial sex work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk of HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs. METHODS:Face-to-face semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within the larger Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 geographical hotspots in the Southern region of Uganda. Participants were selected based on their level of intervention attendance (high/medium/low attendance) during the 12-month follow-up (Time 2). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?" All interviews were audio-recorded, transcribed verbatim, and translated into English. Thematic analysis in Dedoose software was used to analyze the data. RESULTS:Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and staying in sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to transitioning out of sex work. Individual-level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the interpersonal level, physical and sexual violence was noted as a reason to leave sex work. At the structural level, stigma and discrimination (from community members) were identified as facilitators to leaving sex work. Income-related factors were identified mainly as barriers to leaving sex work. CONCLUSION/CONCLUSIONS:Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.

Under-five mortality remains a global health issue, especially in sub-Saharan Africa, where preventable conditions largely drive the high mortality rates. Understanding the heterogeneity in utilization of reproductive, maternal, newborn, and child health services is crucial for reducing under-five mortality. Here we show that among 9307 under-five mortality cases across 31 sub-Saharan African countries (2014-2024), maternal and child health service utilization falls into three distinct patterns-lowest, medium, and highest. Socioeconomic status strongly predicts subgroup membership: higher maternal education, employment, urban residence, and wealth are associated with lower odds of being in the lowest utilization group. Inequality indices further reveal disparities by education, wealth, residence, and employment. Our findings show a strong link between socioeconomic status and maternal and child health services utilization. To address under-five mortality in sub-Saharan Africa, targeted strategies are needed to improve access and uptake of essential health services among socioeconomically disadvantaged groups.