Faculty Bibliography

BACKGROUND/UNASSIGNED:We investigated racial and ethnic disparities in telehealth counseling among Medicaid-insured patients in outpatient substance use disorder (SUD) treatment clinics and assessed whether the clinic-level proportion of Medicaid-insured patients moderated these disparities. METHODS/UNASSIGNED:Using New York State (NYS) Medicaid and statewide treatment registry data, we analyzed 24,814 admission episodes across 399 outpatient SUD clinics during the first 6 months of COVID-19 (April-September 2020). Our outcome measure was the number of tele-counseling sessions within the first 90 days of treatment. Key independent variables included beneficiary race/ethnicity and the clinic-level proportion of Medicaid-insured patients, divided into four quartiles: lowest, second, third, and highest. Mixed effects negative binomial models assessed the associations between race/ethnicity, Medicaid proportions, and telehealth use, with interaction terms evaluating the moderating role of Medicaid proportions. RESULTS/UNASSIGNED:Black and Latinx patients received fewer telehealth sessions than non-Latinx White patients, with adjusted incidence rate ratios (aIRRs) of 0.86 (95% CI: 0.82, 0.91) for Black patients and 0.93 (95% CI: 0.88, 0.98) for Latinx patients. Black patients at clinics with the highest Medicaid proportions had higher telehealth usage rates compared to those at clinics with the lowest Medicaid proportions (aIRR, 1.20; 95% CI, 1.03-1.41). Patients in clinics with the highest Medicaid proportions were more likely to use individual telehealth counseling (aIRR, 1.02-1.88; 95% CI, 1.01-3.04). CONCLUSIONS/UNASSIGNED:Significant racial disparities in telehealth use exist, with variations persisting across clinics with different Medicaid proportions. Targeted interventions are needed to address these access gaps.

The mechanisms behind comorbid symptoms of depression in persons with epilepsy (PWE) remain largely unknown. Our study aimed to learn whether seizures moderate fluctuations in depressive symptoms in PWE when controlling for preictal symptoms of depression. We enrolled 57 adult PWE admitted to the New York University (NYU) Langone Epilepsy Monitoring Unit (EMU) from 2021 to 2024. Thirty-seven participants had a seizure. Twenty of the admitted patients did not have seizures during the admission period and therefore served as controls. All participants were seizure free for > 7 days prior to participation. Upon admission, all participants completed the Montgomery-Asberg Depression Rating Scale (MADRS) to evaluate baseline mood. The MADRS was repeated acutely (4-24 h post seizure or admission) and subacutely (2-7 days post seizure or discharge) for both groups. Linear regression models revealed that individuals with higher baseline MADRS scores (indicating higher depressive symptoms) experienced worse mood acutely post-seizure, while lower baseline MADRS scores were associated with acute mood improvement (R² = 0.59, p < 0.001). Experiencing a seizure was not associated with subacute mood outcomes, which were instead driven by acute mood state (R² = 0.56, p < 0.001). In conclusion, we found that seizures exacerbate pre-ictal depressive symptoms and that post-ictal depressive symptoms persist up to 7 days after seizure resolution. This study may provide evidence for a bidirectional relationship and demonstrate a vicious cycle between depression and epilepsy.

INTRODUCTION/BACKGROUND:Despite longstanding status as a public health priority, preterm birth rates continue to be higher among non-Hispanic Black women compared with other racial and ethnic groups. A growing body of literature highlights the site of care as a key factor in pregnancy outcomes. Although research shows that many individuals do not receive guideline-based prenatal care, little is known about site-level variation in the use of recommended prenatal services and its potential relationship with Black-White preterm birth disparities. METHODS:In this cross-sectional cohort study, we analyzed variation in site-level use of 4 key prenatal services: tetanus, diphtheria, and pertussis (Tdap) vaccination, [per the CDC website] and screening for bacteriuria, diabetes, and group Beta streptococcus, using administrative data from New York State Medicaid and the American Community Survey. We used multivariable logistic regressions to estimate the odds of attending a low-use site (mean <2 services per patient) by race and ethnicity, controlling for age, high-poverty residential address, and low prenatal care attendance. We performed Fairlie decomposition analyses to quantify the contribution of individual and site-level factors to the observed difference in preterm birth rates among Black and White non-Hispanic women. RESULTS:Site-level use of recommended prenatal services ranged from an average of 1 to 3.6 services per patient. Non-Hispanic Black women had more than twice the odds (adjusted odds ratio, 2.42; 95% CI, 2.32-2.52) of attending a low-use site compared with non-Hispanic White women. Among factors in the decomposition analysis, site-level screening for bacteriuria and diabetes accounted for the highest proportion of the explained variance in the observed preterm birth rates for non-Hispanic Black (10.7%) and non-Hispanic White (6.7%) women. DISCUSSION/CONCLUSIONS:Results from this research support immediate improvement in guideline-based prenatal care to narrow the gap in preterm birth for non-Hispanic Black women. Research is needed to identify and correct site-level barriers to recommended prenatal services.

OBJECTIVES/OBJECTIVE:To evaluate the yield of CT-guided biopsy of 18F-piflufolastat PET avid osseous lesions in suspected prostate metastases. METHODS:Retrospective review of computed tomography guided biopsies targeting 18F-piflufolastat avid lesions on PET/CT or PET/MR performed between 2022 and 2024. Demographics, image modality, biopsy system, number of cores, lesion location, lean body mass corrected SUV (SUL) and pathology were recorded. Biopsied lesions were compared to the PROMISE (prostate cancer molecular imaging standardized evaluation) scoring system, version 2. RESULTS:Eighteen patients were included, average age 68.7 years. Lesions were defined as: ≥ 50 % sclerotic (n = 10), <50 % sclerotic (n = 7), occult (n = 0), and lytic (n = 1). A technically successful pathologic diagnosis was made in 94 % of biopsies (n = 17). Histopathological diagnosis included: metastatic prostate adenocarcinoma (n = 12), benign with fibrotic/densely sclerotic bone or normocellular bone marrow (n = 5), and metastatic non-small cell lung carcinoma (n = 1). The median SUL on PET for all patients was 7.9 (IQR 13.3), 2.6 (0.3) for benign biopsies, and 8.8 (12.5) for malignant biopsies. Major identifiable differences between biopsies yielding a metastatic versus benign diagnosis included: higher SUL (p-value = 0.03), target lesion volume (p-value = 0.01), and higher incidence of sclerotic lesions (p value = 0.003); however, multivariate analysis did not find these to be statistically significant predictors (p-value >0.05). The prostate cancer lesion biopsy positive group had significantly higher PROMISE scores than the negative group (p = 0.03). CONCLUSION/CONCLUSIONS:CT-guided biopsy of bone lesions demonstrating avidity for 18F-piflufolastat can be performed with a high diagnostic yield.

BACKGROUND:Federal laws require healthcare organizations (HCOs) to provide patients' disability accommodations when requested. However, patients' accommodations needs are often unmet, contributing to inequities in healthcare access and outcomes. Little is known about the systems and processes HCOs use to provide accommodations in varied settings. OBJECTIVE:To understand HCOs' systems and processes to provide disability accommodations. METHODS:We conducted qualitative interviews with HCO representatives responsible for disability-related initiatives within their organizations. The interviews elicited participants' current processes for providing disability-related accommodations at their HCOs. We used a team-based approach to thematic analysis, reviewing and summarizing quotations to identify themes and categorize text that exemplified themes. RESULTS:We interviewed 17 participants representing 15 HCOs, and identified four themes related to HCOs providing disability accommodations: 1) Providing accommodations proactively begins with identifying a need, though is often disconnected from the rest of the process; 2) Clinical areas had varied and duplicative processes; 3) Different workflows were created ad hoc for different types of accommodations; and 4) Critical need to educate staff on disability accommodations. Participants drew parallels between disability accommodations and language interpreter services, and also emphasized the importance of providing disability accommodations in a proactive rather than reactive manner. CONCLUSIONS:Health systems struggle with a lack of standardized processes to provide disability accommodations in an efficient, systematic way. While processes should be adapted to local contexts, standardized guidelines for providing accommodations could improve consistency in their delivery, ultimately helping to mitigate health-related disparities in the healthcare setting.

In May 2023 the World Health Organization (WHO) declared the end of COVID-19 as a public health emergency. Seroprevalence studies performed in African countries, such as Cameroon, depicted a much higher COVID-19 burden than reported by the WHO. To better understand humoral responses kinetics following infection, we enrolled 333 participants from Yaoundé, Cameroon between March 2020 and January 2022. We measured the levels of antibodies targeting the SARS-CoV-2 receptor-binding-domain (RBD) and the Spike glycoproteins of Delta, Omicron BA.1 and BA.4/5 and the common cold coronavirus HCoV-OC43. We also evaluated plasma capacity to neutralize authentic SARS-CoV-2 virus and to mediate Antibody-Dependent Cellular Cytotoxicity (ADCC). Most individuals mounted a strong antibody response against SARS-CoV-2 Spike. Plasma neutralization waned faster than anti-Spike binding and ADCC. We observed differences in humoral responses by age and circulating variants. Altogether, we show a global overview of antibody dynamics and functionality against SARS-CoV-2 in Cameroon.

PURPOSE/OBJECTIVE: METHODS: RESULTS: CONCLUSION/CONCLUSIONS:

Minoritized groups experience interpersonal, structural, and systemic marginalization that is also perpetuated within academic institutions. This marginalization produces barriers that exclude racial/ethnic minoritized groups within academic medicine from career opportunities and advancement. Racial/ethnic minoritized faculty are often expected to take on additional labor to serve the diversity needs of the program and/or institution that are often unrecognized or undervalued in the tenure or promotion process or detract from additional responsibilities. The unique needs resulting from multiple intersecting identities must be considered when planning initiatives to support minoritized groups in academia. This is detrimental to medicine as it limits innovation, perpetuates health disparities, and prevents the recruitment of scholars/physicians that are representative of the diversity within the U.S. population. Cluster hiring is a newer initiative adopted by many institutions; recently supported by funding from the National Institutes of Health (NIH) to improve diversity and inclusion of racial/ethnic minoritized groups. Here we discuss the elements of the cluster hire process and how they might be particularly relevant to intersectional inclusion and structural change of academic institutions, while also highlighting potential limitations to broad adoption. We conclude with recommendations for the potential need for integration of more culturally informed cluster hiring practices that can be made at the departmental, institutional and national level to positively impact the hiring, retention and advancement of faculty from marginalized populations.