Faculty Bibliography

BACKGROUND:Drug overdose deaths have increased fivefold over the last 20 years, primarily fueled by synthetic opioids, which led the Centers for Disease Control and Prevention to declare an opioid overdose epidemic. Responding to this epidemic, we designed and implemented opioid overdose prevention (OOP) training for medical students to help promote effective naloxone usage. Previously, we compared online and in-person versions of OOP training over 2 years of training. To better establish the evidence for online training, we performed a randomized controlled non-inferiority trial comparing in-person with online opioid prevention training. METHODS:Third-year medical students were randomized into groups to receive either in-person or online training in preparation for clinical rotations. Students randomized to receive online training were provided a link to the training modules. Students randomized to receive in-person training were trained in an in-person setting. We performed a non-inferiority per-protocol analysis with the primary outcome of knowledge using a non-inferiority margin of a -9.1% difference between groups. RESULTS:A total of 205 students were randomized, 103 students to in-person training and 102 to online training. Eighty-three in-person students and 104 online students were included. The online group had a higher post-training knowledge score compared to the in-person group by 0.44 points (0-11 point scale) with a 95% CI of (-0.04, 0.93) that did not cross the margin of non-inferiority. CONCLUSIONS:Online training for OOP was effective and non-inferior to in-person training. Online OOP training may be considered an alternative to in-person training.

BACKGROUND/UNASSIGNED:Moderate kidney dysfunction is independently associated with increased cardiovascular mortality. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) mortality. METHODS/UNASSIGNED:(2021 CKD-EPI formula). A population-based SCA study in Southern California was used for validation. RESULTS/UNASSIGNED:eGFR drop below 90 increased SCA risk (OR: 1.24, 95% CI: 1.18-1.31). Similar findings were observed in the validation cohort (817 SCA and 3,249 controls), where moderate CKD was associated with SCA (OR: 1.51, 95% CI: 1.16-1.97). CONCLUSION/UNASSIGNED:Moderate CKD is associated with an increased risk of SCA in the general population. Further research into the potential integration of moderate renal dysfunction into SCA risk stratification are warranted.

Myelodysplastic syndromes (MDS) are myeloid malignancies often driven by mutations in genes encoding splicing factors (SFs). How these mutations drive the clonal expansion of MDS stem/progenitor cells to outcompete normal hematopoietic stem/progenitor cells (HSPCs) remains unexplained. Although a role for inflammatory processes in promoting clonal expansion of mutant HSPCs and MDS pathogenesis has been proposed, the specific mechanisms implicated remain incompletely understood. In this study, using human isogenic induced pluripotent stem cell (iPSC)-based models of SRSF2-mutant MDS and primary MDS patient cells, we show that the SRSF2 P95L mutation downregulates basal STAT1 expression. STAT1 downregulation dampens interferon (IFN) signaling in MDS stem/progenitor cells, which, unlike normal HSPCs, show resistance to suppression of clonogenic ability by IFNs. Treatment with the proteasome inhibitor bortezomib increased STAT1 protein levels and restored sensitivity of SRSF2-mutant cells to inflammatory stimuli. These results indicate that rewiring of STAT1 signaling by SRSF2 mutations blunts responsiveness to IFNs, conferring clonal fitness to SRSF2-mutant HSPCs against normal HSPCs in the presence of inflammatory stimuli. Our study provides a novel mechanistic link between SF mutations and inflammatory dysregulation and suggests proteasome inhibition as a potential strategy to treat MDS with SRSF2 mutations.

Cassava is a vital crop for millions of farmers worldwide, but its cultivation is threatened by various destructive diseases. Current detection methods for cassava diseases are costly, time-consuming, and often limited to controlled environments, making them unsuitable for large-scale agricultural use. This study aims to develop a deep learning framework that enables early, accurate, and efficient detection of cassava diseases in real-world conditions. We propose a self-supervised object segmentation technique, combined with a progressive learning algorithm (PLA) that incorporates both triplet loss and classification loss to learn robust feature embeddings. Our approach achieves superior performance on the Cassava Leaf Disease Classification (CLDC) dataset from the Kaggle competition, with an accuracy of 91.43%, outperforming all other participants. The proposed method offers a practical and efficient solution for cassava disease detection, demonstrating the potential for large-scale, real-world application in agriculture.

BACKGROUND:Changing from standing to sitting positions requires rotation of the femur from an almost vertical plane to the horizontal plane. Osteoarthritis of the hip limits hip extension, resulting in less ability to recruit spinopelvic tilt (SPT) while standing and requiring increased SPT while sitting to compensate for the loss of hip range of motion. To date, the effect of total hip arthroplasty (THA) on spinopelvic sitting and standing mechanics has not been reported, particularly in the setting of patients with coexistent sagittal plane spinal deformity. METHODS:A retrospective review was performed of patients ≥18 years of age undergoing unilateral THA for hip osteoarthritis with sitting and standing radiographs made before and after THA. Alignment was analyzed at baseline and follow-up after THA in both standing and sitting positions in a relaxed posture with the fingers resting on top of the clavicles. Patients were grouped according to the presence or absence of sagittal plane deformity preoperatively into 3 groups: no sagittal plane deformity (normal), thoracolumbar (TL) deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10° and/or T1-pelvic angle [TPA] > 20°), or apparent deformity (PI-LL ≤ 10° and TPA ≤ 20°, but sagittal vertical axis [SVA] > 50 mm). RESULTS:In this study, 192 patients were assessed: 64 had TL deformity, 39 had apparent deformity, and 89 had normal alignment. Overall, patients demonstrated a reduction in standing SVA (45 to 34.1 mm; p < 0.001) and an increase in SPT (14.6° to 15.7°; p = 0.03) after THA. There was a greater change in standing SVA (p < 0.001) among patients with apparent deformity (-29.0 mm) compared with patients with normal alignment (0.9 mm) and patients with TL deformity (-16.3 mm). Those with apparent deformity also experienced the greatest difference (p = 0.03) in postural SPT change (moving from standing to sitting) (-10.1°) from before to after THA when compared with those with normal alignment (-3.6°) and TL deformity (-1.2°). The difference in postural SVA change from before to after THA was also greatest (p < 0.001) in those with apparent deformity (32.1 mm) compared with those with normal alignment (6.5 mm) and TL deformity (17.3 mm). CONCLUSIONS:Postural changes in spinopelvic alignment vary after THA depending on the presence of TL deformity or apparent deformity due to hip flexion contracture. Patients with apparent deformity had larger changes in standing and sitting alignment than patients with TL deformity or patients with normal alignment. The assessment of global sagittal alignment findings can be used to predict the likelihood of improvement in sagittal alignment after THA. LEVEL OF EVIDENCE/METHODS:Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

We often exert greater cognitive resources (i.e., listening effort) to understand speech under challenging acoustic conditions. This mechanism can be overwhelmed in those with hearing loss, resulting in cognitive fatigue in adults and potentially impeding language acquisition in children. However, the neural mechanisms that support listening effort are uncertain. Evidence from human studies suggests that the cingulate cortex is engaged under difficult listening conditions and may exert top-down modulation of the auditory cortex (AC). Here, we asked whether the gerbil cingulate cortex (Cg) sends anatomical projections to the AC that facilitate perceptual performance. To model challenging listening conditions, we used a sound discrimination task in which stimulus parameters were presented in either "Easy" or "Hard" blocks (i.e., long or short stimulus duration, respectively). Gerbils achieved statistically identical psychometric performance in Easy and Hard blocks. Anatomical tracing experiments revealed a strong, descending projection from layer 2/3 of the Cg1 subregion of the cingulate cortex to superficial and deep layers of the primary and dorsal AC. To determine whether Cg improves task performance under challenging conditions, we bilaterally infused muscimol to inactivate Cg1 and found that psychometric thresholds were degraded for only Hard blocks. To test whether the Cg-to-AC projection facilitates task performance, we chemogenetically inactivated these inputs and found that performance was only degraded during Hard blocks. Taken together, the results reveal a descending cortical pathway that facilitates perceptual performance during challenging listening conditions.

OBJECTIVE/UNASSIGNED:Sentinel lymph node biopsy (SLNB) for endometrial cancer staging may identify isolated tumor cells (ITCs). Although guidelines do not classify nodes with ITCs as positive, earlier papers reported that a significant proportion of gynecologic oncologists treat ITCs as they would positive nodes. The objective of this study was to examine practice patterns and determine if the presence of ITCs in endometrial cancer affects adjuvant treatment decision-making. METHODS/UNASSIGNED:test, and logistic regression were used with significance set at p < 0.05. RESULTS/UNASSIGNED:Of seven hundred thirty-four patients included, ITCs were identified in 41 patients (5.6 %). Deep myometrial invasion (61.0 % vs 20.5 %, p < 0.001) and lymphovascular invasion (58.4 % vs 17.7 %, p < 0.001) were more common in patients with ITCs than in those with negative lymph nodes. Patients with ITCs were more likely to receive adjuvant treatment (30 of 41, 73.2 % vs 289 of 693, 41.7 %, p < 0.001). When controlling for age, stage, histology, grade, and lymphovascular space invasion, ITCs were not associated with an increased likelihood of adjuvant therapy receipt. CONCLUSIONS/UNASSIGNED:Although patients with ITCs were more likely to receive adjuvant treatment, this was accounted for by other clinical and histological factors. Clinicians were likely to make decisions based on established risk factors, and more data are needed on the role of ITCs in the landscape of molecularly based decision making.

Preceptors are essential in the clinical education of prelicensure registered nursing and advanced practice registered nursing students. However, there is a growing scarcity of preceptors available to provide clinical education. Additionally, preceptors have not uniformly received professional development in the practice of teaching that is essential in delivering high quality clinical education, and clinical education in nursing is an unfunded mandate. This article reviews the current state of preceptors, the importance and challenges of preceptors in clinical education, the lack of funding for clinical education by preceptors, and proposed solutions.

BackgroundBreast conserving surgery represents the preferred surgical treatment option for patients with early-stage breast cancer. Reexcision rates are generally higher for patients undergoing lumpectomies for ductal carcinoma in situ (DCIS) compared to invasive breast cancer, as the microscopic extent of disease is difficult to assess during excision. This study investigated the clinicopathological characteristics of patients undergoing BCS for pure DCIS and reexcision rates over time, including the effect of the MarginProbe™ device.MethodsWe queried our prospectively maintained Institutional Breast Cancer Database for patients diagnosed with DCIS and treated with BCS as their primary procedure from 2010-2021. The primary endpoint was the rate of reexcision. Variables of interest included age at diagnosis, race/ethnicity, mode of diagnostic imaging, mammographic breast density, method of core biopsy, nuclear grade, size of DCIS, multifocality, DCIS subtype, and MarginProbe™ use.ResultsPapillary DCIS (P < 0.004) and larger size (P < 0.001) was associated with an increased reexcision rate. There were also differences in the method of core biopsy (P < 0.001), with stereotactic core biopsy predominating among patients who did not require reexcision (71.3% vs 49.5%). In an unadjusted estimate for the odds ratio for association, patients who had MarginProbe™ used were 81% less likely to require reexcision (OR = 0.19, 95% CI = 0.12, 0.31, P < 0.0001).ConclusionYounger age, papillary DCIS, larger DCIS size, and non-stereotactic core biopsy method were found to be associated with higher reexcision rates. Additionally, patients whose primary procedures included intraoperative margin assessment with the MarginProbe™ were significantly less likely to require reexcision.