Faculty Bibliography

BACKGROUND:Online ordering in food pantries may support food security among adults with low socioeconomic status. PURPOSE/OBJECTIVE:Determine the impact of a transition from in-person ordering to online ordering on the food security status of food pantry clients. METHODS:For this quasi-experimental study, we recruited participants from Met Council's Kosher Food Network in New York City, including one pantry in Staten Island (intervention) and three pantries in the Bronx, Queens, and Brooklyn (comparison). The final sample included 114 and 90 adults in the intervention and comparison groups, respectively, at baseline (April-July 2023); and 77 and 58 adults in those groups during follow-up (October-December 2023). Using a six-item survey, we assessed food security status, where scores range from zero to six points and higher points indicate lower food security. Secondary outcomes included nutrition security status, fruit and vegetable intake, and pantry wait time. We used a difference-in-differences approach to assess differences in outcomes between conditions, including testing for differences by age (18-64 vs. ≥65 years). RESULTS:Food security scores decreased in the intervention and comparison groups over time, with no difference in the decrease between groups (P = .87). Yet, among younger adults in the intervention group, wait time decreased during follow-up, and increased in the comparison group (difference-in-differences = -12.1 minutes (95% CI: -21.9, -2.4); P = .02). We did not observe similar differences among older adults (P = .83), nor significant changes in other outcomes. CONCLUSIONS:The transition to online ordering did not influence food security status among food pantry clients but may help to save time, especially among younger adults. CLINICAL TRIALS REGISTRATION/BACKGROUND:NCT05752721.

OBJECTIVE:This study examined racial and ethnic differences in percent total weight loss (%TWL) and glycemic improvement following sleeve gastrectomy (SG) and explored the role of socioeconomic and psychosocial factors in postsurgical outcomes. METHODS:This longitudinal study included patients who underwent SG between 2017 and 2020, with follow-up visits over 24 months. RESULTS:Non-Hispanic Black (NHB) participants had lower %TWL at 3, 12, and 24 months compared with Hispanic (H) and non-Hispanic White (NHW) participants. Fat mass index was initially lower in NHB, with smaller reductions over time and significant group differences persisting at 24 months. NHB participants had higher baseline fat-free mass index values; by 24 months, fat-free mass index values were lower in H participants. Hemoglobin A1c decreased across all groups but remained consistently higher in NHB and H compared with NHW at 24 months. NHB participants reported higher perceived discrimination, sleep disturbance, and perceived stress than H and NHW participants at all time points. Employment status predicted %TWL at 12 months. There was a significant interaction between race and ethnicity and employment status observed at 12 and 24 months, suggesting that employment-related disparities could impact surgical outcomes. CONCLUSIONS:NHB participants experienced less favorable outcomes following SG, emphasizing the need for tailored interventions addressing socioeconomic and psychosocial disparities.

BACKGROUND:The design and integration of technology within inpatient hospital rooms has a critical role in supporting nursing workflows, enhancing provider experience, and improving patient care. As health care technology evolves, there is a need to design "future-proofed" physical environments that integrate technology in ways that support workflows and maintain clinical performance. Assessing how current technologies affect nursing workflows can help inform the development of these future environments. OBJECTIVE:We assessed the current challenges nursing staff face in inpatient rooms, gather insights on technology, and build environment interactions to envision the design of a technology-integrated "Inpatient Room of the Future." METHODS:A qualitative study was conducted involving semistructured interviews, shadowing, and focus groups among nursing staff in the inpatient setting. Methods including horizon scanning, scenario analysis, technology assessment, and backcasting facilitated a comprehensive qualitative analysis of current technology use and needs in inpatient nursing workflows to inform exploratory design considerations for technology-integrated envisioned futures solutions. RESULTS:In total, 26 nursing staff across 4 inpatient hospital units participated in this study. Analysis identified four major themes considered central to designing a technology-integrated inpatient room that enhances nursing workflow and experience: (1) the need for seamless integration of technologies advocating for a unified system that minimizes fragmented technology use and enhances efficiency; (2) the potential for technology to reduce cognitive load, alleviate mental strain, and streamline complex workflows; (3) a focus on enhancing interpersonal communication with specific emphasis on tools that facilitate clear and efficient communication among clinicians and with patients; and (4) the importance of improved staff well-being with design considerations aimed at promoting both physical and mental health for health care workers in the inpatient setting. Envisioned future solutions included enhanced patient monitoring with automated measurements and actions through computer vision and data triangulation, a smart electronic health record-integrated supply management system using computer vision to detect supply shortages and auto-delivery of needed supplies, and a personal tech smart assistant capable of real-time patient monitoring and escalation, task prioritization, and hands-free clinical documentation and communication. CONCLUSIONS:While current technologies address specific tasks, there are significant opportunities for better technology integration, reducing cognitive load, enhancing communication, and promoting the physical and mental well-being of nursing staff. Future research should focus on seamless technology integration aligned with clinical workflows and implementing supportive technologies that do not interfere with clinician judgment and critical thinking. Policy recommendations include oversight mechanisms for evaluating artificial intelligence-enabled devices, safeguarding patient information, and ensuring nurses are actively involved at every stage of technology development and implementation. Future inpatient unit designs should actively engage input from both nursing professionals and technologists in developing future-proofed clinical spaces to ensure the creation of integrated systems that foster a cohesive and harmonious user experience.

Altered fetal brain function is proposed as a mechanism underlying the relationship between prenatal maternal depression (PMD) and neurodevelopmental outcomes in offspring. This study investigated the association between PMD symptoms and fetal brain functional connectivity (FC) using graph theory. A total of 123 pregnant women participated in the study, completed the Center for Epidemiologic Studies Depression Scale (CES-D), and underwent fetal MRI scans. Results revealed a significant relationship between elevated PMD symptoms and reduced global efficiency in the right insular region of the fetal brain. However, because fetal age was not associated with local or global efficiency in the insular brain region, we cannot determine if the PMD-related reduction in insula global efficiency is indicative of an accelerated or delayed developmental pattern. This study is one of the few to examine fetal brain connectivity in relation to prenatal maternal depression, providing valuable insights into early neurodevelopmental risks and potential targets for early intervention.

The underlying drivers and outcomes of social determinants of health are dynamically complex, making it difficult to design effective responses. This complexity has inspired a growing number of calls to move beyond mechanistic thinking and use systems science to engage directly with complexity and highlight opportunities for methodological innovation to enhance translation of insight into real world action. This case study describes a methodological innovation combining community-based system dynamics and design thinking to understand multi-level complexity of a public health challenge: optimizing the design of a community-clinical linkage in Brooklyn, New York. In-depth description of the case illustrates methods integration and resulting insights and recommendations. Results from the case demonstrate that integrating methods generates insight at multiple levels, including connecting holistic system understanding to individual experiences of system structure and operationalizing and translating insights into action. Combining community-based system dynamics and design thinking holds value for intervention planning, strategic implementation, and sustaining change.

INTRODUCTION/UNASSIGNED:The SARS-CoV-2 virus resulted in significant disability and diagnostic challenges among patients with Post-Acute Sequelae of COVID-19 (PASC). Here, we assessed microvascular perfusion, clotting, and autoimmune responses to lung targets in PASC patients compared to healthy controls with the aim of explaining the persistent respiratory symptoms of patients with PASC. METHODS/UNASSIGNED:We performed a blinded case-control study of 20 PASC patients with persistent respiratory symptoms versus 20 healthy controls previously infected with SARS-CoV-2 virus. We assessed lung perfusion using Technetium-99m macroaggregated albumin (MAA) SPECT-CT scans, clotting using coagulation and thromboelastrogram (TEG) tests, and autoimmunity to vascular and lung antigens using ELISA assays. RESULTS/UNASSIGNED:Subjective respiratory symptoms and quality-of-life measures were significantly worse among the PASC patients compared with healthy controls (p<0.001). Clinical symptoms among PASC patients were inversely correlated with plasma total IgA levels (coefficient: -0.61, p=0.004) and with autoimmune IgA recognizing pulmonary microvascular endothelial cell antigens (coefficient: -0.51, p=0.02). Additionally, levels of total IgA were directly correlated with fibrinogen and fibrin-related clot strength (coefficient: +0.52, p=0.02; coefficient: +0.63, p=0.003). SPECT-CT scans were positive only among 25% of PASC cases versus 10% of healthy controls (p=0.41). TEG tests showed no differences between the groups. CONCLUSIONS/UNASSIGNED:Our small study of PASC patients identified that circulating IgA antibodies may correlate inversely with clinical symptoms and directly with clotting parameters, suggesting a possible link between autoimmunity and coagulation. However, many of the study's findings were null, which may mean that tissue-level studies or alternative explanations of PASC need to be explored.

Text communication between newborns' caregivers and healthcare workers allows for real-time decisional guidance; however, its impact on neonatal health outcomes is unknown. Mobile WACh NEO (MWACh NEO) was a parallel, unblinded and individually randomized controlled trial at six health facilities across Kenya. Pregnant women at 28-36 weeks gestation were randomized (1:1) to the MWACh NEO intervention or standard of care. MWACh NEO delivered automated maternal and neonatal health text messages to participants up to 6 weeks postpartum and allowed free text communication with a nurse. This trial sought to determine if text communication decreased neonatal mortality. The analysis was intention to treat. From September 2020 until June 2022, 5,020 participants were enrolled and randomized. One hundred and thirty-six participants were excluded because of incomplete mortality data, leaving 2,442 participants in each group for the analysis. Eighty-three neonatal deaths occurred for a neonatal mortality rate of 18.8 per 1,000 live births in the intervention group and 15.2 per 1,000 live births in the control group, with a risk ratio of 1.25 (0.81, 1.91), P = 0.31. No adverse events related to the intervention were reported. Text communication did not decrease neonatal mortality compared to standard of care. Most neonates died before discharge from the facility. ClinicalTrials.gov registration: NCT04598165 .

BACKGROUND:As individuals age, the immune system undergoes complex changes, including an increase in the number of CD8 T cells relative to CD4 T cells, a decline in naïve cell production (including T and B cells), and an accumulation of terminally differentiated cells with diminished functionality. These age-related immune alterations collectively contribute to immunosenescence, a phenotype associated with aging-related declines and diseases such as dementia, Alzheimer's disease, osteoporosis, and diabetes. Premature mortality at older ages often results from cumulative health deterioration initiated by physiological dysregulation over the life course. Mortality risk, therefore, provides a meaningful measure of the long-term impact of physiological changes, including those related to the immune system. Examining the link between mortality risk and immune aging in older adults could illuminate the underlying pathology of aging-related health decline. This study uses data from the Health and Retirement Study (HRS), a national, population-based sample of middle-aged and older Americans, to explore the relationship between specific immune aging ratios and six-year mortality, stratified by race/ethnicity and sex. RESULTS:Using a sample of 8,259 individuals from the HRS, we found that overall, the presence, magnitude, and direction of the association differed by the specific immune ratio measure, sex, and race/ethnicity. We found particularly robust associations among Hispanic and non-Hispanic Black females. Among Hispanic females, for example, a one-unit increase in the log CD4 EMRA: Naïve ratio was associated with a nearly 50% increase in mortality for Hispanic females and a 25% increase in mortality for non-Hispanic Black females which was robust to adjustment for additional covariates. While we found little evidence of an association between immune function and mortality among non-Hispanic White and Hispanic males, we found associations in the opposite direction as what we would expect among non-Hispanic Black males. For example, a one-unit increase in the CD4, EMRA: Naïve ratio was associated with a 15% decrease in mortality among non-Hispanic Black males. CONCLUSIONS:Our findings demonstrate that associations between immune aging and mortality are not uniform but instead vary in magnitude and direction across sex and racial/ethnic subgroups. The strongest and most consistent associations were observed among Hispanic and non-Hispanic Black females-groups experiencing multiple forms of marginalization-suggesting that these populations may face heightened vulnerability to the downstream consequences of immune aging. However, the absence or reversal of expected associations in some subgroups-particularly non-Hispanic Black males-underscores the complexity of immune aging processes and their interaction with social and biological contexts. These results highlight the importance of disaggregated analyses and suggest that immune aging may manifest and impact mortality risk differently across populations.

IMPORTANCE/UNASSIGNED:In the context of the US opioid crisis, factors associated with the prevalence of opioid use disorder (OUD) must be identified to aid prevention and treatment. State medical cannabis laws (MCL) and recreational cannabis laws (RCL) are potential factors associated with OUD prevalence. OBJECTIVE/UNASSIGNED:To examine changes in OUD prevalence associated with MCL and RCL enactment among veterans treated at the Veterans Health Administration (VHA) and whether associations differed by age or chronic pain. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:Using VHA electronic health records from January 2005 to December 2022, adjusted yearly prevalences of OUD were calculated, controlling for sociodemographic characteristics, receipt of prescription opioids, other substance use disorders, and time-varying state covariates. Staggered-adoption difference-in-difference analyses were used for estimates and 95% CIs for the relationship between MCL and RCL enactment and OUD prevalence. The study included VHA patients aged 18 to 75 years. The data were analyzed in December 2023. MAIN OUTCOME AND MEASURES/UNASSIGNED:International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) OUD diagnoses. RESULTS/UNASSIGNED:From 2005 to 2022, most patients were male (86.7.%-95.0%) and non-Hispanic White (70.3%-78.7%); the yearly mean age was 61.9 to 63.6 years (approximately 3.2 to 4.5 million patients per year). During the study period, OUD decreased from 1.12% to 1.06% in states without cannabis laws, increased from 1.13% to 1.19% in states that enacted MCL, and remained stable in states that also enacted RCL. OUD prevalence increased significantly by 0.06% (95% CI, 0.05%-0.06%) following MCL enactment and 0.07% (95% CI, 0.06%-0.08%) after RCL enactment. In patients aged 35 to 64 years and 65 to 75 years, MCL and RCL enactment was associated with increased OUD, with the greatest increase after RCL enactment among older adults (0.12%; 95% CI, 0.11%-0.13%). Patients with chronic pain had even larger increases in OUD following MCL (0.08%; 95% CI, 0.07%-0.09%) and RCL enactment (0.13%; 95% CI, 0.12%-0.15%). Consistent with overall findings, the largest increases in OUD occurred among patients with chronic pain aged 35 to 64 years following the enactment of MCL and RCL (0.09%; 95% CI, 0.07%-0.11%) and adults aged 65 to 75 years following RCL enactment (0.23%; 95% CI, 0.21%-0.25%). CONCLUSIONS AND RELEVANCE/UNASSIGNED:The results of this cohort study suggest that MCL and RCL enactment was associated with greater OUD prevalence in VHA patients over time, with the greatest increases among middle-aged and older patients and those with chronic pain. The findings did not support state cannabis legalization as a means of reducing the burden of OUD during the ongoing opioid epidemic.