Faculty Bibliography

BACKGROUND/UNASSIGNED:Despite their efficacy, medications for opioid use disorder (MOUD) remain underutilized in patients with infections from intravenous opioid use (I-IOU). This study evaluates the impact of an Expanded MOUD Access Initiative (EMAI) on MOUD uptake and other clinical outcomes in patients hospitalized for I-IOU at an institution without addiction medicine consultation. METHODS/UNASSIGNED:We performed a retrospective pre-post study of hospital admissions for I-IOU before (January 2019-June 2021) and after (January 2022-December 2023) EMAI introduction. Data was collected via chart review. The EMAI eliminated restrictions on methadone use and established a new order set for buprenorphine inductions. The primary outcome was MOUD receipt; secondary outcomes included patient directed discharge (PDD) and 30-day re-hospitalization. RESULTS/UNASSIGNED:There were 129 hospitalizations prior to the intervention (control) and 98 after (EMAI). MOUD receipt was significantly higher in the EMAI group (75.5% vs 31.0%; OR, 6.86 [95% CI, 3.84-12.61]). In patients not receiving MOUD prior to admission (n = 176), new inductions occurred more frequently in the EMAI group (68.0% vs 11.9%; OR, 15.76 [95% CI, 7.50-35.78]). PDD was lower in the EMAI group (23.5% vs 48.8%; OR, 0.32 [95% CI, 0.10-0.57]), as was 30-day re-hospitalization (12.2% vs 22.5%; OR, 0.48 [95% CI, 0.22-0.98]). In a multivariable logistic regression model, the EMAI was the only variable to show a statistically significant association with MOUD receipt (aOR, 6.89 [95% CI, 3.75-13.11]). CONCLUSIONS/UNASSIGNED:The EMAI was associated with increased MOUD uptake, reduced PDD, and fewer 30-day re-hospitalizations despite the lack of addiction medicine consultation.

Prior studies suggest that diabetes is associated with severe outcomes following COVID-19. However, most research has focused on early phases of the COVID-19 pandemic, and less is known about changing diabetes-associated risks over time. We constructed a retrospective cohort of U.S. Veterans with documented COVID-19 between March 2020 and August 2023 (N = 426,170). We used Poisson regression models to estimate relative risks of 60-day mortality following COVID-19 among Veterans with and without diabetes, incorporating demographic and clinical covariates, as well as weights to address unequal probabilities of selection into the sample. We then incorporated interaction terms representing six-month time windows and plotted predicted mortality risks over time. To contextualize risk estimates, we repeated the analysis among a cohort of Veterans without documented COVID-19. Diabetes was associated with overall higher risk of 60-day mortality following COVID-19 (RR = 1.21, 95% CI = 1.17-1.26). Mortality risks attenuated over time and converged with risks observed among Veterans without COVID-19 by March-August 2022. Results suggest that post-COVID-19 mortality risks associated with diabetes may have attenuated over time. Mechanisms underlying the attenuation of mortality risks were beyond the scope of the paper, however, future studies can potentially shed light on the contributions of population immunity (driven by previous infection or vaccination status), changing treatment patterns, and other factors to time-varying mortality risks following COVID-19 among individuals with diabetes.

BACKGROUND:HIV status disclosure to sexual partner plays an important role in fostering transparency and reducing stigma, yet it remains a complex issue influenced by various sociodemographic, psychosocial, and experiential factors. This study investigated factors associated with HIV status disclosure to sexual partner among people living with HIV (PLHIV) in Georgia. METHODS:We conducted a secondary analysis of data from the PLHIV Stigma Index 2.0 study conducted in 2022-2023. Participants were recruited from HIV care centers and community-based organizations. Data collection utilized standardized questionnaires assessing sociodemographic factors, stigma, discrimination, and interactions with the healthcare system. Statistical analysis employed descriptive statistics, bivariate, and multivariate logistic regression to examine associations between stigma, sociodemographic factors, and status disclosure to sexual partner. RESULTS:Out of 765 participants, the mean age was 40.6 years, with a majority being male (67.4%). More than a fifth of respondents reported treatment interruptions, with 35.3% not disclosing their status to sexual partner. Disclosure was more common to close contacts than to others. Indicators of internalized stigma were common, with participants reporting feelings of guilt (40.1%), shame (36.1%), worthlessness (28.4%), and feeling 'dirty' (12.4%). Common behavioral reactions to stigma included avoiding medical visits (13.1%) and refraining from social support (10.5%). Over 40% did not disclose their status to sexual partner. Logistic regression highlighted that older age, knowing partner's HIV status, positive disclosure experiences and enacted stigma were positively associated with status disclosure. CONCLUSION/CONCLUSIONS:The complex dynamics between stigma and HIV status disclosure highlight the importance of providing decision support to PLHIV, helping them navigate disclosure process while considering potential risks and benefits. The findings emphasize the need for focused interventions that promote disclosure to sexual partner, especially among individuals with treatment interruptions, as it can significantly impact personal health and broader public health objectives, including the prevention of HIV transmission.

IMPORTANCE/UNASSIGNED:Despite evidence of clinical benefits and guidelines recommending first-line treatment intensification (TI) for metastatic castration-sensitive prostate cancer (mCSPC), the majority of patients do not receive it. OBJECTIVE/UNASSIGNED:To identify barriers to and facilitators of first-line TI. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The IMPLEMENT study (December 2022 to August 2024) comprised 3 phases and used a mixed-methods, qualitative and quantitative approach. US-based urologists and oncologists who were primary treaters for 1 or more patients with mCSPC in the past 6 months, had been practicing for 2 to 35 years, spent 50% or more of their time in direct patient care, and were able to provide informed consent were included. EXPOSURE/UNASSIGNED:Phase 1 consisted of semistructured interviews based on the Theoretical Domains Framework. Phase 2 consisted of a discrete choice experiment to identify priority barriers and helpful resources. Phase 3 consisted of cocreation sessions to ideate potential solutions to underutilization based on the findings of the previous phases. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome in phase 1 was barriers to and facilitators of first-line TI, as identified through thematic analysis. The primary outcome of phase 2 was perceived helpfulness of potential resources for first-line TI decisions, measured with a coefficient of helpfulness [CoH] for each resource. The primary outcome of phase 3 was potential solutions to increase TI uptake, as cocreated and ranked by urologists and oncologists. RESULTS/UNASSIGNED:In total, 352 participants were included in IMPLEMENT, with 36 in phase 1 (33 men [92%]; mean [range] years in practice, 19 [5-34]), 302 in phase 2 (253 men [84%]; mean [range] years in practice, 18 [4-35]), and 14 in phase 3 (12 men [86%]; mean [range], years in practice, 20 [8-35]). In each phase, one-half of participants were oncologists and one-half were urologists (18 urologists and 18 oncologists in phase 1, 151 urologists and 151 oncologists in phase 2, and 7 urologists and 7 oncologists in phase 3). In phase 1, 5 domains had the greatest perceived influence on intensification: memory, attention, and decision processes; environmental context and resources; knowledge; beliefs about consequences; and social or professional role. Urologists more commonly reported barriers to intensification, while oncologists more commonly reported facilitators. In phase 2, urologists found decision-support tools most helpful (CoH, 3.27; 95% CI, 2.90-3.65), while oncologists preferred databases of posttreatment options (CoH, 2.58; 95% CI, 2.29-2.89) and clinical trial summaries (CoH, 2.41; 95% CI, 2.14-2.69). In phase 3, cross-specialty tumor boards were ranked by both specialties as the best solution to address TI underutilization. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This study using a mixed-methods approach with quantitative and qualitative components found that the issues underlying TI underutilization were numerous and multifactorial; the barriers encountered by physicians and the resources to help address them varied by specialty. These findings offer insights into physician-supported strategies that could help improve rates of first-line TI for mCSPC in the US.

Children face an urgent threat in the form of hazards posed by plastics in the environment. Despite robust and rapidly accumulating evidence on the effects of plastic on children's health, plastic presents a paradox for child health providers: while plastic is a vehicle for so many interventions, robust evidence from laboratory and human studies show that chemicals used to produce plastics contribute to chronic conditions in multiple organ systems and disrupt hormone function, and exposure to plastic-derived toxins is associated with adverse birth outcomes, metabolic conditions, neurodevelopmental disease and disability, and reproductive conditions. Evidence-based, safe, simple, and low-cost steps exist for child health providers in primary care to help families limit children's exposure to plastic-derived toxins. Health-care providers also have a crucial opportunity to protect the health and wellbeing of future generations of children by supporting local and global campaigns for governments, industries, and the general public to reduce the accumulation of plastics in the environment and minimise the use of plastics within health-care systems.

The U.S. Drug Enforcement Administration (DEA) proposed a rule in which they intend to place the psychedelic phenethylamines 2,5-dimethoxy-4-chloroamphetamine (DOC) and 2,5-dimethoxy-4-iodoamphetamine (DOI) into Schedule I of the Controlled Substances Act. We examined the epidemiology of use and availability of these substances. We examined national trends in seizures of these compounds (which indicate availability) using DEA National Forensic Laboratory Information System (NFLIS) and High Intensity Drug Trafficking Areas (HIDTA) data. We also examined the prevalence of self-reported use on the National Survey of Drug Use and Health (NSDUH), a nationally representative sample of noninstitutionalized individuals aged ≥12 in the United States. The scientific literature was also systematically searched for reports of poisonings linked to use. Between 2005 and 2024, NFLIS received 795 submissions of drugs testing positive for DOC, with a peak of 152 in 2012. There was then a decrease through 2024, with only two submissions containing DOC in 2023-2024. Forty submissions contained DOI, with no submissions testing positive in 2019-2024. Three DOC seizures were recorded by HIDTA in 2017-2021, with none in 2022-2024. HIDTA had no recorded seizures of DOI. Between 2005 and 2023, there were 37 and 10 type-in mentions of lifetime DOC and DOI use, respectively, in NSDUH responses, suggesting a lifetime prevalence of < 0.01% among the noninstitutionalized U.S. population. We located three reports of poisonings linked to DOC use (in 2008-2024) and none linked to DOI use. Availability, recreational use, and poisoning related to the use of DOC and especially DOI appear to be rare.

Repetitive head impacts are associated with structural brain changes and an increased risk for chronic traumatic encephalopathy, a progressive neurodegenerative disease that can only be diagnosed after death. Chronic traumatic encephalopathy is defined by the abnormal accumulation of phosphorylated tau protein, particularly at the depths of the superior frontal sulci, suggesting that sulcal morphology may serve as a relevant structural biomarker. Contact sport athletes, such as former football players, are at elevated risk due to their prolonged exposure to repetitive head impacts. Cortical atrophy linked to underlying tau accumulation may result in shallower and wider sulci, potentially making sulcal morphology an imaging marker for identifying individuals at risk for this disease. This study investigated sulcal morphological differences in former football players and examined associations with age, football-related exposure, clinical diagnosis of traumatic encephalopathy syndrome, levels of certainty for chronic traumatic encephalopathy pathology, neuropsychological performance, and positron emission tomography imaging using flortaucipir. We analysed structural magnetic resonance imaging data from 169 male former football players (mean age 57.2 (8.2) years, range 45-74) and 54 age-matched, unexposed asymptomatic male controls (mean age 59.4 (8.5) years, range 45-74). Sulcal depth and width were quantified using the CalcSulc, focusing on two regions in each hemisphere commonly affected by chronic traumatic encephalopathy pathology: the superior frontal and occipitotemporal sulci. Generalized least squares models were used to assess group differences and interactions with age and football exposure variables, including age of first exposure, total years played, and cumulative head impact exposure. An analysis of covariance evaluated relationships between sulcal morphology, clinical measures, and flortaucipir uptake, adjusting for age, race, body mass index, education, imaging site, apolipoprotein E4 status, and total intracranial volume. Former football players demonstrated significantly shallower sulcal depth in the left superior frontal sulcus compared to unexposed controls. Earlier age of first exposure and longer football careers were associated with greater widening of the left occipitotemporal sulcus. Higher cumulative head impact exposure was linked to reduced sulcal depth in the left superior frontal region. However, sulcal morphology was not associated with clinical diagnosis, levels of certainty, neuropsychological test performance, or flortaucipir imaging. These findings suggest that sulcal morphology may reflect cumulative exposure to repetitive head impacts, particularly in brain regions vulnerable to chronic traumatic encephalopathy pathology. Future ante- and post-mortem validation studies are needed to determine whether sulcal morphology can serve as a reliable in vivo biomarker of risk.

BACKGROUND/UNASSIGNED:In 2024, the US Environmental Protection Agency tightened the Mercury and Air Toxics Standards (MATS) for emissions of filterable particulate matter (fPM) from coal-fired power plants to 0.010 lb/MMBtu. In April 2025, a presidential proclamation stated that 47 specific power plant companies received a 2-year exemption from the new requirements. The proclamation provided no estimates of the resulting health impacts. METHODS/UNASSIGNED:: 1.095, 95% confidence interval (CI) = 1.064, 1.127; in sensitivity analyses, we employ other CRFs); (4) aggregate results (e.g., by US state). RESULTS/UNASSIGNED:emissions to ~6,900 tons, from ~4,400 tons. We estimate that the additional ~2,500 tons emitted will lead to 32 (95% CI = 22, 43) deaths. The highest mortality is in St. Louis, Missouri, (population: 2.2 million) with an estimated 14 (95% CI = 10,19) deaths. The increased mortality is, for some states (e.g., Missouri, and Pennsylvania), caused by mostly in-state emissions; for other states (e.g., Illinois, Maryland, New Jersey, and Virginia), the cause is out-of-state emissions. DISCUSSION/UNASSIGNED:Results here quantify a portion of the health impacts but leave unquantified nonmortality impacts, impacts from hazardous air pollutant (HAP) exposures, and noninhalation pathways. The reduced computational demands of the air pollution model employed here allows for more timely investigation of government actions than would traditional air dispersion modeling. Sensitivity analyses yielded mortality results that ranged from 47% lower to 169% higher than the core findings. CONCLUSIONS/UNASSIGNED:at the exempted coal-fired power plants will lead to 32 (95% CI = 22, 43) additional deaths.