Faculty Bibliography

State sequence analysis of longitudinal categorical data seeks to synthesize pathways through different dimensions of the life course for descriptive, associative and predictive purposes. Given the number and variety of patterns in such data, measures of the dynamic features of sequences are used to characterize them. One, based on the information-theoretic notion of entropy, measures the uncertainty in the state that will be active at a given time. We customize its use to establish the extent to which we are ignorant, or unsure, of what happens next in a dynamic process, conditional on its past. Relying on different Markov chain models for nominal state sequences, we establish multiple measures of uncertainty that allow us to adjust expectations to reflect individual-specific differences and historical information. We establish complementary measures to assess the predictive power of the models in the context of this uncertainty. In so doing, we can summarize and contrast the change in uncertainty associated with different models. As is common in this field, we consider ways in which data can be stratified through demographics and clustering, and how this additional level of partitioning builds a more complete narrative of the social process.

Artificial Intelligence (AI) is rapidly being incorporated within healthcare, including medical education. Hematology-oncology (HO) is a complex field and AI is of great value in education and practice. We explored HO fellow's confidence and concerns with use of AI, AI training that HO fellows currently receive, and interest in future AI training. Multi-institutional survey administered to fellows in six adult HO programs. The survey was distributed electronically over one month with weekly reminders. Results were collected in RedCap and analyzed using R. 36 of 153 potential participants responded (23.5% response rate). Almost all (35, 97%) reported using AI. Fellows who reported using AI for work used it primarily for patient care (28, 82%) and/or research (29, 85%). Most were "somewhat confident" in the accuracy of AI-generated clinical information (25, 74%) and found AI "somewhat reliable" for clinical decision support (25, 74%). Respondents cited concerns about the use of AI in clinical practice, most often reliability of clinical data (32, 94%). Only one respondent (2.8%) received formal education on AI during fellowship and over who received informal training only reported its quality as "fair" or "poor" with 29 of these remaining 35 (83%) respondents interested in formal training. 31 fellows (86%) reported thinking AI would be important in their future career plans and 17 (49%) felt AI training should be required for HO fellows. While almost all HO fellows use AI, formal education in AI is rare in HO fellowship. Most fellows expressed interested in such training and believe that AI will be important in their careers, but also expressed concerns about use of AI, especially reliability of AI-generated clinical data. We plan to create formal curricula specific to HO training.

Youth in northern Ghana experience high rates of unintended pregnancy due to limited access to and use of sexual and reproductive healthcare (SRH) services. Peer-led interventions are effective in increasing the youth uptake of SRH services, but limited peer-led interventions have been developed for Ghana. This study explores youth (ages 15-24 years) and clinical provider perspectives on youth SRH to inform the co-design of a peer-led SRH counseling program in northern Ghana. We conducted a qualitative study using semi-structured interviews with 22 SRH providers and 27 youth. We then conducted an inductive thematic analysis and mapped themes onto the COM-B (Capability-Opportunity-Motivation-Behavior) model. Results revealed that youth capability to make informed and confident SRH decisions is constrained by a fragmented information environment. Although access to SRH services is increasing in the region, logistical and privacy barriers limit adolescents' opportunities to engage in care. Religious and cultural norms stigmatize youth SRH care, though support for contraceptive use is growing among more educated sectors. Youth motivation to use SRH services is driven by a desire for autonomy but undermined by concerns about contraceptive side effects and anticipated stigma. This study supports the co-development of a contextually grounded peer counseling SRH intervention in northern Ghana.

IMPORTANCE/UNASSIGNED:The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure. OBJECTIVES/UNASSIGNED:To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026. INTERVENTION/UNASSIGNED:The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority. RESULTS/UNASSIGNED:The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients' values and clinician risk assessment, a liberal transfusion strategy may be reasonable. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT02981407.

PURPOSE/OBJECTIVE:Optical coherence tomography angiography (OCTA) has enabled detailed in vivo imaging of macular neovascularization (MNV) in neovascular age-related macular degeneration (nAMD), leading to a proliferation of morphological descriptive terms. This scoping review aimed to systematically map the existing literature on OCTA-based MNV morphology and evaluate its correlation with disease activity. METHODS:A systematic literature search covering publications through 2025 was performed. After screening 2,445 titles and obtaining 60 full texts, 43 studies were included. Data on morphological terminology, study design, and correlation with disease activity were extracted and synthesized. RESULTS:The included studies, encompassing a total of 2,712 eyes, identified a vast and heterogeneous lexicon of qualitative descriptors, including terms such as "medusa," "sea-fan," and "glomerulus", characterized by significant terminological overlap and inconsistent definitions across studies. Inconsistent, low-certainty associations between specific OCTA morphologies and MNV activity were identified across studies, with findings limited by significant methodological heterogeneity. The evidence for these patterns as reliable biomarkers of disease activity is weak and often contradictory, and several studies were found to use OCTA features to define activity, creating circular arguments that undermine their conclusions. CONCLUSION/CONCLUSIONS:The current terminology for OCTA morphology in nAMD is fragmented and inconsistently applied. The link between these patterns and disease activity is poorly established, severely limiting their clinical utility. These findings highlight a need for a standardized, consensus-based framework for describing and interpreting OCTA findings in nAMD.

BACKGROUND/UNASSIGNED:Many overhead athletes, both amateur and professional, experience an increasing number of injuries to the ulnar collateral ligament (UCL) as a result of overuse or trauma. As a result of this increasing frequency, multiple techniques have been developed to reconstruct or repair the UCL with success and faster return to sports (RTS) for athletes who are ideal candidates for a repair. However, a large proportion of UCL tear patients cannot undergo repair due to chronic injury, leading to poor tissue quality, midsubstance tears, or older age, which predispose them to slower healing and a more difficult path to total rehabilitation. The senior author's "hybrid" reconstruction combines a palmaris longus autograft for reconstruction with a repair-style suture brace augmentation that allows for increased load-to-failure strength that parallels the native UCL, while allowing for native anatomic motion of the ligament when ranging the elbow. INDICATIONS/UNASSIGNED:This technique is indicated for patients with a UCL tear confirmed by magnetic resonance imaging, poor to moderate UCL tissue quality, midsubstance tears, and older patients who have a palmaris longus tendon to harvest and persistent ulnar nerve paresthesias. TECHNIQUE DESCRIPTION/UNASSIGNED:This video demonstrates the senior author's technique of harvesting a palmaris autograft, drilling proximal and distal UCL graft passage tunnels, augmenting the graft with an internal suture brace, fixation of the graft, and finally an ulnar nerve transposition to alleviate ulnar nerve paresthesia. RESULTS/UNASSIGNED:Outcomes of retrospective studies demonstrate good to excellent outcomes of UCL hybrid reconstructions with suture brace augmentation and RTS rates of at least 85%. Complication rates are low, with the most common complication being graft failure (14%) and the next most common being temporary ulnar nerve paresthesia. DISCUSSION/CONCLUSION/UNASSIGNED:Overall, this video demonstrates a highly effective technique at restoring native-like biomechanics and function for patients with UCL tears that are too complex to repair. Patients have good to excellent outcomes and RTS rates, although time to RTS may take 12 months or longer. PATIENT CONSENT DISCLOSURE STATEMENT/UNASSIGNED:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

BACKGROUND:Magnetic resonance (MR) imaging-linear accelerator-based real-time adaptive planning for delivering ultra-hypofractionated stereotactic body radiotherapy (SBRT) has advanced clinical accuracy yet added complexity to the radiotherapy workflow. We retrospectively evaluated whether the addition of a Parallel Automated Contouring module with Enhancement of AI (PACE-AI) reduced contouring time and overall SBRT duration, and its impact on intra-fractional target motion. METHODS:This study included 250 fractions from 90 prostate cancer patients from which fraction time were tracked. All patients received definitive SBRT to the prostate on the 1.5-Tesla Unity (Elekta©) system, through the Adapt-To-Shape (ATS) workflow, which required real-time re-contouring of the normal tissues by the dosimetrists and target contouring by the physician for each of the fractions. We compared the fraction durations for 125 consecutive fractions treated with the incorporation of PACE-AI with 125 fractions previously treated without PACE-AI to determine whether PACE-AI improved efficiency and reduced treatment session duration. RESULTS:For the cohort treated without PACE-AI, the overall median duration was 67.6 min, including 23.9 min contouring time. With the incorporation of PACE-AI, the overall median duration was 51.2 min, representing a 24.3% reduction. The average contouring time was reduced by 55% to 10.8 min. In addition, the extent of positional shifts prior to beam delivery was significantly reduced from an average of 1.8 mm to 1.3 mm (p < 0.001) in both superior/inferior (range reduced from 0 to 6.3 mm to 0-4.2 mm) and anterior/posterior directions (range reduced from 0 to 6.6 mm to 0-5.0 mm). CONCLUSIONS:The incorporation of PACE-AI improved workflow efficiency during SBRT. The reduction in treatment duration also helped reduce organ motion during real-time adaptive planning.