Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:The contribution of late-life vascular risk factors to dementia risk remains controversial. Because low blood pressure (BP) has been associated with worse clinical outcomes in frail individuals, we hypothesized hypertension, but not diabetes or smoking, is associated with higher dementia risk in robust than in frail older adults. METHODS:We performed a prospective cohort analysis of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) over 11 years (2011-2022). We included all community-living White and Black participants aged 67-89 years without dementia at baseline visit 5 (2011-2013) from ARIC-NCS field centers (Jackson, Mississippi; Forsyth County, North Carolina; Washington County, Maryland; Minneapolis suburbs, Minnesota). The primary vascular risk factors measured at baseline included elevated BP (systolic BP 120-129 mm Hg and diastolic BP < 80 mm Hg), hypertension (systolic BP ≥ 130 mm Hg, diastolic BP ≥ 80 mm Hg, or use of medication for BP), diabetes (fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, self-reported physician's diagnosis, or use of diabetes medication), and former and current smoking (self-reported). We defined frailty status using the Fried criteria (5 components that include low energy, low physical activity, slowness, weakness, and weight loss). We estimated cause-specific hazard ratios (HRs) of incident dementia (ascertained from in-person neuropsychological assessments, semiannual participant or informant report, or surveillance of claims from hospitalizations and death certificates) with Cox proportional hazards models including a multiplicative interaction between vascular factors and frailty. HRs of dementia were then stratified by frailty (robust [no frailty components present] vs prefrail/frail [at least 1 frailty component present]). RESULTS:= 0.026). For robust participants, HRs were 1.03 (95% CI 0.65-1.64) for elevated BP and 1.39 (95% CI 1.00-1.94) for hypertension relative to normal BP. For prefrail/frail participants, HRs were 0.68 (95% CI 0.49-0.95) and 0.82 (95% CI 0.66-1.01), respectively. Diabetes and current smoking were associated with higher dementia risk in both robust and prefrail/frail individuals. DISCUSSION/CONCLUSIONS:Late-life hypertension was associated with a lower relative risk of dementia in prefrail/frail participants, but the association was positive in robust participants. BP interpretation and management to support brain health in older adults could consider age-related functional status.

PURPOSE/UNASSIGNED:The safety and effectiveness of water vapor for ablation of prostate tissue was assessed in men with intermediate-risk localized prostate cancer (PCa). MATERIALS AND METHODS/UNASSIGNED:A prospective, multi-center, single arm study (VAPOR 2) was conducted in 235 men at 26 centers across the US in men ≥50 years, with Gleason Grade Group 2 (GG2) PCa confined to a single PI-RADS 3 or 4 abnormality on multi-parametric magnetic resonance imaging (mpMRI) fusion biopsy, prostate-specific antigen (PSA) level ≤15 ng/ml, and clinical stage ≤T2c. Data presented is a pre-defined subset analysis of 110 men completing 12-month follow-up to assess only ablative efficacy and toxicity. Reported outcomes include biopsy 6-months post-treatment, PSA, prostate volume reduction, urinary/sexual function, quality-of-life questionnaires, and adverse events. The 3-year follow-up analysis will evaluate efficacy in PCa management, with 5-years total follow-up. RESULTS/UNASSIGNED:Median age was 65, with a median baseline PSA of 5.6 ng/mL and prostate volume of 40.7cc. On 6-month biopsy, targeted sampling of the treated region revealed benign tissue onlyin 75% and benign tissue or GG1 PCa in 91%. Regression analysis did not identify a significant baseline predictor of positive biopsy. PSA showed a median reduction of 58%, with a median 8cc reduction in prostate volume. Urinary and sexual function showed an initial decline followed by gradual recovery through 12 months. Perioperative adverse events were generally mild and resolved without sequelae, with no reports of rectal injury. CONCLUSIONS/UNASSIGNED:The VAPOR 2 study demonstrated effective ablation of prostate tissue in men with localized, intermediate risk PCa with low rates of procedural morbidity.

Oxytocin modulates social information processing by altering excitatory-inhibitory balance at the microcircuit level, but how such local modulation gives rise to selective processing at the level of distributed brain systems remains unclear. Here, we investigated the effects of oxytocin on large-scale neurodynamics across cortico-limbic network in the mouse brain using multisite local field potential recordings. Oxytocin selectively enhanced neural responses to infant calls in the auditory cortex (AC) and medial prefrontal cortex (mPFC). These enhancements occurred while baseline activity was reduced, indicating increased signal-to-noise ratio rather than a global increase in excitability. During auditory steady-state responses (ASSRs), oxytocin increased prefrontal phase coherence without altering ASSR power. During rest, oxytocin induced a transient, broadband reduction in spontaneous spectral power across regions. Despite this reduction in activity, analyses of interregional interactions revealed a selective increase in low-theta phase coupling and directional connectivity of AC→mPFC. Session-level analyses showed that stronger bottom-up AC→mPFC coupling was associated with lower prefrontal power, consistent with a gating or disinhibitory network regime favoring sensory-to-prefrontal information transfer. Multivariate analyses showed that oxytocin/saline conditions were reliably discriminable using supervised classification models, with specific contributions from spectral power, phase-locking, and Granger-causal connectivity features. Conversely, unsupervised dimensionality reduction did not identify a distinct low-dimensional manifold separating conditions, although a modest shift in the centroid of neural state space was observed. Together, these results indicate that oxytocin reduces background neural activity while selectively enhancing sensory-prefrontal network interactions, providing a systems-level account linking local inhibitory modulation to selective processing of socially salient infant cues.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic caused significant global harm. Seroprevalence studies detected antibody increases from SARS-CoV-2 infection, assessing transmission and risk from infection. These studies and epidemiological modeling informed public health policy and behavior. Biases in early seroprevalence analyses caused underestimation of fatality risk, including the risk posed to pediatric populations and to those in lower-income nations. The scope of the pandemic was clarified by seroprevalence studies that better assessed at-risk groups and by adjustment of seroprevalence data for known data biases. Reassessment of seroprevalence data confirms the accuracy of early modeling. Public health authorities should inform the public of this modeling success and of the limitations of early seroprevalence analyses. This will prepare the public to better assess global health risk during future pandemics.

BACKGROUND/UNASSIGNED:Comorbidities increase the risk of adverse outcomes from infections. This study aimed to assess the prevalence and outcomes of vaccine-preventable infections (VPI) in adult congenital heart disease (ACHD) patients compared to the general population. METHODS/UNASSIGNED:Using the 2016-2020 National Inpatient Sample database, we identified VPI hospitalizations and compared outcomes between ACHD patients and the general population. The primary study outcome was in-hospital mortality, with secondary outcomes including respiratory failure, acute kidney injury, acute liver failure, septic shock, cardiac arrest, length of stay, and total hospital charges. RESULTS/UNASSIGNED:Of 647,440 patients hospitalized for VPI, 2610 (0.3%) had ACHD. After adjustment for baseline characteristics, ACHD patients had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 0.64-1.98), respiratory failure (aOR 1.05, 95% CI 0.84-1.32), septic shock (aOR 1.03, 95% CI 0.66-1.60), and cardiac arrest (aOR 1.01, 95% CI 0.36-2.74), but higher odds of acute kidney injury (aOR 1.34, 95% CI 1.09-1.67) and acute liver failure (aOR 1.27, CI 1.01-1.60) compared to the general population. CONCLUSION/UNASSIGNED:ACHD patients hospitalized for VPI have similar in-hospital mortality, but higher acute kidney injury and liver failure rates compared to the general population, highlighting the importance of vaccination in this vulnerable patient group.

OBJECTIVE:ratio (TPR) imaging approach and evaluates its ability to characterize MS lesions alongside other quantitative MRI (qMRI) metrics. METHODS:and PD values were used to illustrate TPR contrast. Statistical analyses included Wilcoxon rank-sum tests and Spearman correlations (p < 0.05). RESULTS:* (92 ms) values but lower MTR (37.3%) and MTsat (1.57%) compared to hypointense lesions (1085 ms; 0.88 a.u.; 64 ms; 46%; 2.48%, respectively). QSM values varied across lesion types. INTERPRETATION/CONCLUSIONS:, PD, and MT metrics, consistent with demyelination. In contrast, hypointense lesions may reflect tissue changes associated with repair processes such as remyelination.

Apheresis medicine is a continually evolving field with numerous studies published each year. To help apheresis practitioners stay up to date with the current literature, members of the American Society for Apheresis (ASFA) Attending Physician Subcommittee identified and summarized 10 seminal articles published in 2025, from the field of apheresis medicine. PubMed was used to identify articles published in four topics including donor apheresis, therapeutic apheresis, apheresis education, and apheresis collection for cellular therapy. These articles met at least one of the following criteria: novel findings, practice-altering outcomes, international in scope, randomized-controlled trial, relevant to current clinical practice, and/or provide evidence for category III or IV indications based on the ASFA 9th Special Issue of the Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach. Full length, peer-reviewed manuscripts in English with data from human subjects were included while case reports, review articles, and meta-analyses were excluded.

BACKGROUND:Improvements in cardiovascular health (CVH), an integral component of diabetes self-management, significantly reduce the risk of cardiovascular disease. OBJECTIVE:In this study, we aimed to compare CVH scores and explore barriers and facilitators to optimal CVH among 2 populations with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS:This is a secondary analysis from 2 parent-sequential explanatory mixed-methods studies: the first examined a subsample of emerging adults living with T1D; the second included emerging to middle-aged adults living with T2D. Participants' CVH was assessed using the American Heart Association's definition of CVH (Life's Simple 7). Semistructured interviews explored participants' achievement of CVH behaviors. An inductive content analysis method guided data analysis. RESULTS:The T1D sample (n1 = 50) consisted of 90% self-identifed White adults with a mean age of22 ± 2.4 years and 70% females. The T2D sample (n2 = 60) included adults who self-identifed as Black (63%) and Hispanic (47%), with a mean age of 34.4 ± 5.0 years and 75% females. The mean CVH scores for the T1D and T2D groups were 9.4 ± 2.1 and 8.6 ± 2.2, respectively. For the T1D group, barriers included knowledge deficits, whereas self-efficacy and diabetes technology facilitated self-management. For the T2D group, barriers consisted of unhealthy food convenience and limited space for physical activity, whereas access to healthcare services facilitated CVH behaviors. Shared barriers included time constraints/competing demands and financial burdens; facilitators were social support and individualized care. CONCLUSIONS:Our analysis highlights distinct and shared barriers and facilitators to CVH in 2 emerging adult populations with diabetes, emphasizing the need to assess age-specific factors and tailor clinical interventions accordingly.

INTRODUCTION/BACKGROUND:Puberty is a key transition point in adolescents' lives that plays a foundational role in shaping health behaviors and outcomes across one's life course. This period holds significant potential to empower adolescents and support autonomy in health and well-being, but limited puberty education curricula exist for early adolescents (age 8-14), and those that do exist vary in content. There is a paucity of evaluations of puberty competencies and limited consensus on what competencies should be measured to assess effectiveness or even how to measure these competencies. OBJECTIVE:The objective of this scoping review is to systematically map and characterize the outcomes, domains, and instruments used to evaluate puberty education curricula for early adolescents aged 8-14 years. In accordance with PRISMA-ScR and JBI scoping review guidance, this review does not synthesize effect sizes or assess intervention efficacy, but maps the breadth of evidence to identify conceptual gaps and inform future framework development. METHODS:The review protocol is registered with the Open Science Framework (OSF). We will search PubMed, CINAHL, PsycInfo, ERIC, Education Source, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, and OpenAlex for relevant sources. Two reviewers will independently screen and extract studies that meet inclusion criteria using our data extraction tool. EXPECTED OUTPUTS/UNASSIGNED:Findings from the scoping review will be synthesized to create an overarching framework that can guide approaches to the development and evaluation of puberty curricula targeted to early adolescents. Focus group discussions with adolescents, parents, and school representatives will be conducted to assess the applicability and appropriateness of identified competencies and evaluation measures prior to broader dissemination. Insights from this scoping review will ultimately be used to inform the implementation and evaluation of puberty education.