Faculty Bibliography

BACKGROUND:Despite widespread use of Roux-en-Y gastric bypass (RYGB), there are no standardized limb lengths in the United States. METHODS:A multi-center retrospective cohort study was conducted from 2020 to 2023. Eligible patients who had undergone RYGB were divided into subgroups based on BP limb lengths: short (50-75 cm), intermediate (80-125 cm), and long (150-175 cm). Primary outcomes were total weight loss (TWL) and % TWL at 1 and 2 years. Secondary outcomes were post-operative BMI and % BMI change at 1 and 2 years, micronutrient deficiencies, hypothyroidism, acute kidney injury (AKI) requiring treatment, and remission in associated medical problems. Subgroups were compared using multivariate analysis. RESULTS:Two hundred twenty-eight patients received a long BP limb, 194 patients received an intermediate BP limb, while 152 patients received a short BP limb. Primary outcomes TWL and % TWL were significantly different between the groups at 1 year: TWL and % TWL were greater in patients with long BP limbs. The difference between the long and short BP limb groups increased at the 2-year mark. Patients who had long BP limbs had higher rates of DM remission (12.3% vs 11.9% 6.6%), HTN (8.8% vs 5.7% vs 7.9%), GERD symptoms (14.5% vs 9.8% vs 5.3%), and OSA (8.8% vs 7.7% vs 5.3%). Vitamin A deficiency rates were higher in the long BP limb group. CONCLUSIONS:The results suggest that longer BP limb lengths are conducive to TWL and overall treatment of obesity-related problems without severe rates of complications. Additional longer longitudinal studies are needed to assess the impact of long BP limbs on nutrition and weight loss in the long term.

OBJECTIVE/UNASSIGNED: The research agenda is presented here. METHOD/UNASSIGNED:The Taskforce specifically focused on aggressive behaviors and emotions associated with outbursts. The development of a research agenda took place over 2 years of examination of the current needs in the literature, with contributions from experts in the field. This work dovetailed with the efforts from the Congress on Pediatric Irritability and Dysregulation, which had been meeting since 2015 to advance research into the measurement, pathophysiology, and treatment of emotion regulation problems in youth. We concentrated on the central questions concerning the measurement of outbursts, key questions linking outbursts to other psychopathologies, and how behavior in outbursts is separable from typical behavior. RESULTS/UNASSIGNED:A description of the qualitative data gathering process is provided here, along with the following: recommendations in the research areas of measurement; pathophysiology; delineating outbursts from other psychopathologies; exploring the cultural, social, and interpersonal aspects of outbursts; understanding the prevention and treatment of outbursts; and exploring how outbursts manifest and are treated based on setting. Specific examples of research opportunities and future directions are provided. CONCLUSION/UNASSIGNED:A call is made to funding agencies to examine the spaces within their strategic plans that will allow for engagement in critical efforts to improve the lives of children and adolescents with severe emotional outbursts-some of the most impaired individuals presenting for care in child and adolescent psychiatry.

Early antibody therapy can prevent severe SARS-CoV-2 infection (COVID-19). However, the effectiveness of COVID-19 convalescent plasma (CCP) therapy in treating severe COVID-19 remains inconclusive. To test a hypothesis that some CCP units are associated with a coagulopathy hazard in severe disease that offsets its benefits, we tracked 304 CCP units administered to 414 hospitalized COVID-19 patients to assess their association with the onset of unfavorable post-transfusion D-dimer trends. CCP recipients with increasing or persistently elevated D-dimer trajectories after transfusion experienced higher mortality than those whose D-dimer levels were persistently low or decreasing after transfusion. Within the CCP donor-recipient network, recipients with increasing or persistently high D-dimer trajectories were skewed toward association with a minority of CCP units. In in vitro assays, CCP from "higher-risk" units had higher cross-reactivity with the spike protein of human seasonal betacoronavirus OC43. "Higher-risk" CCP units also mediated greater Fcγ receptor IIa signaling against cells expressing SARS-CoV-2 spike compared with "lower-risk" units. This study finds that post-transfusion activation of coagulation pathways during severe COVID-19 is associated with specific CCP antibody profiles and supports a potential mechanism of immune complex-activated coagulopathy.

BACKGROUND:Withdrawal-of-life-sustaining-therapies (WLST) in patients with traumatic brain injury (TBI) is a complex decision-making process. The clinical factors related to WLST in older adults with TBI are currently poorly understood. The present study aims to determine the clinical predictors of WLST in older patients with TBI. METHODS:All patients ≥ 65 years old with TBI (Head Abbreviated Injury Scale Score ≥ 3) were identified from the Geriatric TBI Database, a prospective registry of patients admitted to 45 trauma centers nationwide with TBI between 2017-2019. We collected factors related to past medical history, baseline demographic data, clinical presentation, TBI sub-type, neurosurgical interventions, and do-not-attempt-resuscitation (DNAR) orders. The primary outcome measure was WLST. Binary logistic regression was subsequently performed to determine factors independently associated with WLST. RESULTS:A total of 1600 patients were identified. The median age was 80 years old and 48.6 % of patients were male. In this cohort, 120 patients (7.5 %) underwent WLST. A logistic regression model revealed that Glasgow Coma Scale (GCS) (OR 0.82; 95 %-CI 0.77--0.87), cerebral edema (3.2; 1.5-7.0), craniotomy/craniectomy (2.5; 1.4-4.4), and DNAR (8.8; 5.5-14.3) were all independently associated with WLST. This model demonstrated excellent discrimination ability with a concordance statistic of 0.935. CONCLUSIONS:This study demonstrates that patients ≥ 65 years old with poor initial GCS, cerebral edema, craniotomy/craniectomy, and DNAR were all independently associated with WLST. Pre-injury frailty was not associated with WLST. Further studies are needed to evaluate the prognostic value of frailty indices in the management of patients with TBI.

PURPOSE/OBJECTIVE:The purpose of this study is to compare the quality and clinical outcomes of patients who underwent open reduction internal fixation for a proximal humerus fracture in a "timely manner" which was defined to be within 5 days of injury compared to those with "delayed intervention" (>5 Days) to determine the effect this had. METHODS:This IRB-approved study evaluated patients who sustained a proximal humerus fracture treated with plate and screw fixation (ORIF) between January 2004 and October 2022 and had time from injury to surgery documented. Patients were grouped based on the time to surgery (TTS) - Less than 5 Days (L5) vs. More than 5 Days (M5). TTS was also evaluated as a continuous variable. Univariable and multivariable analysis compared patient demographics, injury/surgical characteristics, postoperative complications, and clinical outcomes to determine effect of TTS. Clinical outcomes included shoulder range of motion (ROM) and Disabilities of the Arm, Shoulder, and Hand (DASH) score at least 1 year following the date of injury. Standard statistical tests were used (p<0.05 considered significant). RESULTS:, p=0.03, β= -0.27, 95% CI = -41.71- -2.89) surgery was associated with less passive forward elevation. CONCLUSION/CONCLUSIONS:Timing of surgery did not impact outcomes of patients who underwent open reduction internal fixation for proximal humerus fractures. Surgical intervention after 14 days was associated with diminished passive forward elevation only.

BACKGROUND:Arthrofibrosis is a debilitating complication of total knee arthroplasty (TKA) and may benefit from arthroscopic lysis of adhesions (LOA) to improve range of motion and decrease pain. However, the rates of periprosthetic joint infection (PJI) and of the need for future revision TKA (rTKA) have only been studied in a limited capacity in the literature. In this study, we aimed to compare PJI and revision outcomes in patients who had undergone TKA between those who subsequently underwent arthroscopic LOA and those who did not undergo arthroscopic LOA. METHODS:The PearlDiver database was utilized to identify patients who had undergone primary TKA between 2016 and 2021. ICD-10 (International Classification of Diseases, Tenth Revision) and CPT (Current Procedural Terminology) codes were then used to identify patients who underwent LOA for arthrofibrosis. The rates of PJI and rTKA were compared between patients who did and did not undergo LOA. Multivariable logistic and Cox regressions, controlling for age, sex, Charlson Comorbidity Index, tobacco use, and a body mass index of >30 kg/m2, were performed to compare the rates of PJI and revision between the LOA and no-LOA groups. RESULTS:A total of 383,143 patients were identified, of whom 703 had undergone arthroscopic LOA. Patients who underwent LOA had higher overall rates of PJI (2.7% versus 1.3%; p = 0.001) and all-cause revision (9.8% versus 1.8%; p < 0.001) than those who did not. Patients who underwent LOA had significantly higher odds of PJI (odds ratio [OR], 2.00; p < 0.014), aseptic loosening-related revision (OR, 3.31; p = 0.002), and all-cause revision (OR, 5.32; p < 0.001) within 1 year after the initial TKA. There was no significant difference in 1-year PJI-related revisions between the groups (OR, 1.71; p = 0.193). In a time-to-event analysis, patients undergoing LOA had significantly higher risks of PJI (p = 0.003) and all-cause revision (p = 0.001) but not PJI-related revision (p = 0.322) or aseptic loosening-related revision (p = 0.111). CONCLUSIONS:Arthroscopic LOA after primary TKA was associated with higher rates of PJI and subsequent revision surgery. Surgeons should consider the results of these studies when counseling patients on the importance of early rehabilitation and improving modifiable risk factors after TKA. LEVEL OF EVIDENCE/METHODS:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PURPOSE/OBJECTIVE:To estimate the prevalence and geographic variation of serious mental illness (SMI) among young adults enrolled in Medicaid and to identify individual and community-level factors associated with SMI. METHODS:We used New York Medicaid data for over 1.6 million young adults aged 18-34 years with continuous Medicaid enrollment from April 2021 through March 2022. We merged 3 additional county and zip code-level datasets, including the Distressed Communities Index, Area Health Resource File, and New York homelessness data. We used descriptive analyses, data visualization methods, and multivariable logistic regression to estimate the prevalence of SMI and identify individual- (sex, race and ethnicity, age, disability aid, and homelessness) and community-level (geography, community distress, number of hospital beds, and community mental health centers per capita) factors associated with SMI. RESULTS:The 12-month prevalence of SMI was 8.3% in New York State, with wide geographic variation by zip codes, ranging from 0% to 39%. Young adults identifying as Asian, Black, and Latinx (compared to White), and those living in zip codes with the most community distress were associated with lower odds of SMI, odds ratios (OR) ranged from 0.47 (Asian) (95% confidence interval [CI] [0.46-0.49]) to 0.95 (Latinx) (CI [0.93-0.97]). Young adults identifying as female (compared to male), receiving disability, experiencing homelessness, and rural residence were associated with higher odds of SMI, ORs ranged from 1.64 (female) (95% CI [1.62-1.66]) to 5.49 (homelessness) (95% CI [5.33-5.66]). DISCUSSION/CONCLUSIONS:SMI prevalence varies by individual- and community-level factors, including homelessness and rural residence, signaling the need for specific interventions and policies.

BACKGROUND:Even in the absence of weight loss, any level of physical activity (PA) can reduce the risk of cardiovascular disease among individuals with obesity. However, these individuals face multifaceted barriers that reduce their motivation and engagement in PA. They prefer programs that are convenient, fun to engage in, and feature people who they can relate to. Yet, there is a paucity of PA interventions that are designed to incorporate these preferences. We designed the web-based PA for The Heart (PATH) intervention to address this gap. OBJECTIVE:This study aimed to describe the protocol of a study that aims to examine the acceptability and preliminary efficacy of PATH intervention among insufficiently active adults with obesity aged at least 18 years. METHODS:This is a 6-month pilot randomized controlled trial (RCT), using a parallel design with 1:1 allocation to intervention or control group. The PATH intervention group is given access to the PATH platform, but the resources each participant can access are tailored according to their baseline fitness level. Control group receives a self-help PA handout. Both groups self-monitor their PA using Fitbit (Google) and have Zoom (Zoom Video Communications) meetings twice a month with either the health coach (intervention) or study coordinator (control). The outcomes at 6-months include acceptability, changes in PA, and cardiometabolic risk from baseline to 6-months. RESULTS:We screened 763 individuals for eligibility and 89 participants were enrolled and randomized to the intervention (45/504, 50.6%) and control arms (44/504, 49.4%). The average age was 48.7 (SD 12.17) years, and most participants were female (81/504, 90.1%), Black (45/504, 50.6%), and non-Hispanic (83/504, 93.3%). No systematic differences in baseline characteristics were observed between the study arms. The 6-month intervention is currently underway, and the completion of follow-up data collection is expected in February 2025, with results to be published soon after. CONCLUSIONS:The PATH intervention offers a promising, evidence-based approach to overcoming the barriers that have hindered previous PA programs for adults with obesity. It can support new and existing programs to foster long-term maintenance of health-enhancing PA. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05803304; https://clinicaltrials.gov/study/NCT05803304. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:DERR1-10.2196/67972.