Faculty Bibliography

BACKGROUND:According to textbook guidance, satisfying the well-defined intervention assumption is key for estimating causal effects. However, no studies have systematically evaluated how the assumption is addressed in research. Thus, we reviewed how researchers using g-methods or targeted maximum likelihood estimation (TMLE) interpreted and addressed the well-defined intervention assumption in epidemiological studies. METHODS:We reviewed observational epidemiological studies that used g-methods or TMLE, were published from 2000-21 in epidemiology journals with the six highest 2020 impact factors and met additional criteria. Among other factors, reviewers assessed if authors of included studies aimed to estimate the effects of hypothetical interventions. Then, among such studies, reviewers assessed whether authors discussed key causal-inference assumptions (e.g. consistency or treatment variation irrelevance), how they interpreted their findings and if they specified well-defined interventions. RESULTS:Just 20% (29/146) of studies aimed to estimate the effects of hypothetical interventions. Of such intervention-effect studies, almost none (1/29) stated 'how' the exposure would be intervened upon; among those that did not state a 'how', the 'how' mattered for consistency (i.e., for treatment variation irrelevance) in 64% of studies (18/28). Moreover, whereas 79% (23/29) of intervention-effect studies mentioned consistency, just 45% (13/29) interpreted findings as corresponding to the effects of hypothetical interventions. Finally, reviewers determined that just 38% (11/29) of intervention-effect studies had well-defined interventions. CONCLUSIONS:We found substantial deviations between guidelines regarding meeting the well-defined intervention assumption and researchers' application of the guidelines, with authors of intervention-effect studies rarely critically examining the assumption's validity, let alone specifying well-defined interventions.

PURPOSE/OBJECTIVE:The purpose of this analysis was to identify key difference-making conditions that distinguish oncology institutions that collect sexual orientation and gender identity (SOGI) data across a sample of American Society of Clinical Oncology (ASCO) members. METHODS:From October to November 2020, an anonymous 54-item web-based survey was distributed to ASCO members. Coincidence analysis was used to identify difference-making conditions for the collection of SOGI data. RESULTS:ASCO members' responses to just three items consistently distinguished practices that reported collecting both SO and GI data (n = 25) from those who did not (n = 20): (1)."Do you ask your patients what pronouns they want you to use for them?"; (2) "Institutional leadership supports collecting SOGI data from patients"; and (3)"Does the electronic health record (EHR) at your institution have a specific section to collect information about patients' SOGI?" The positive model exhibited both reliability (consistency = 0.87, or 20/23) and explanatory breadth (coverage = 0.80, or 20/25). The negative model for SOGI data collection consisted of different responses to the same three items and likewise showed both reliability (consistency = 0.94, or 16/17) and explanatory breadth (coverage = 0.80, or 16/20). CONCLUSIONS:Specific levels of leadership support, frequency of asking patients about pronouns, and the presence or absence of EHR record structure were difference-makers for collecting SOGI data in this sample. The study underscores the importance of leadership support, structured data fields, and attention to patient pronouns, which are aligned with the ASCO and National Institutes of Health calls to action.

OBJECTIVES/OBJECTIVE:Hearing impairment is associated with delirium among ICU patients and a lack of functional recovery among older ICU survivors. We assessed the feasibility of using otoacoustic emissions (OAEs) testing to screen for preexisting hearing loss in the ICU. DESIGN/METHODS:Pilot study. SETTING/METHODS:Medical ICU at a tertiary medical center. PATIENTS/METHODS:All adults (age ≥ 18) and admitted to the medical ICU between November 29, 2021, and December 03, 2021, were eligible for the study. INTERVENTIONS/METHODS:OAE is a noninvasive, nonparticipatory tool that is used to screen for hearing loss by detecting intracochlear motion in response to auditory stimulation. The presence or absence of OAE was tested at six frequencies (1 k, 1.5 k, 2 k, 3 k, 4 k hertz). MEASUREMENTS AND MAIN RESULTS/RESULTS:The primary outcome of feasibility was defined a priori as completion of greater than or equal to 70% of attempted tests. Average time of test completion and barriers or facilitators were also measured as outcomes. A patient passed OAE testing if at least two of six frequencies were detected in at least one ear, suggesting they did not have moderate or severe hearing impairment (that would require an amplifier). Data were also gathered on demographics, delirium, ventilation, sedation, illness severity, and ambient noise. Of 31 patients approached, 23 (74.2%) underwent testing. Eight patients (25.8%) were unable to be tested, most commonly due to elevated ambient noise. Among the 18 patients with complete data, six patients screened positive for hearing loss. The average time for OAE test completion per ear was 152.6 seconds (sd = 97.6 s). CONCLUSIONS:OAE testing is a feasible method to screen for hearing loss in the ICU, including in nonparticipatory patients. Identification of hearing loss would facilitate improved communication through interventions such as amplifiers and accommodations. Future studies should evaluate whether identification and treatment of hearing loss in the ICU may reduce delirium and improve post-ICU recovery.

BACKGROUND:Food and beverage marketing is an important influence on the health and diets of adolescents. Food and beverage companies spend billions of dollars annually on advertisements to promote their products and are increasingly focusing on social media influencers. Influencer product endorsements blur the line between entertainment and marketing. OBJECTIVE:This study aimed to quantify how often TikTok influencers promote products from food and beverage brands and document the range of ways they disclose brand relationships in their content. METHODS:We collected up to 100 videos posted on or before July 1, 2022, from each of the top 100 influencers on TikTok in the United States and recorded information about the influencer (eg, number of followers) and video (eg, number of views and likes). For each video that contained food or beverage products, we identified the main product featured. A team of research assistants then coded each video for how the product was featured (ie, in the video, audio, or caption) and, for branded products, whether the video was accompanied by any disclosures of brand relationships. Average pairwise percentage agreement among coders was 92%, and average pairwise Cohen κ was 0.82. RESULTS:Among the 8871 videos from 97 influencers that made up the final analytical sample, we identified 1360 videos (15.3%) that featured at least one food or beverage product. These 1360 videos were viewed >9 million times and received >1 million likes each. Nearly half (n=648, 47.6%) of the videos featured a branded product. Most videos featuring a branded product did not contain a brand relationship disclosure (n=449, 69.3%). Among videos that disclosed a brand relationship, influencers used 10 different types of disclosures. Tagging a brand in the video's caption was the most common disclosure method (n=182, 28.1%). Six types of caption hashtags were used to disclose brand relationships, including #[brandname] (n=63, 9.7%) and #ad (n=30, 4.6%). Only 1 video (0.2%) made use of TikTok's official disclosure label and only 1 video (0.2%) verbally mentioned a contractual agreement with a brand. CONCLUSIONS:Among the food and beverage videos with disclosures we identified, the most frequently used mechanism-tagging the brand-did not clearly differentiate between sponsored content and the influencer trying to attract a brand or followers who may like that brand. Social media users, particularly adolescents, need clearer, more robust disclosures from influencers to protect against the undue influence of food marketing. These findings may also inform calls for the Children's Food and Beverage Advertising Initiative-the largest self-regulatory pledge to reduce unhealthy food marketing-to include older adolescents, who are heavily targeted by food and beverage companies on social media.

PURPOSE/UNASSIGNED:To assess corneal resistance to enzymatic digestion after rose bengal (RB)/green light and RB/green light followed by riboflavin (RF)/ultraviolet A (UV-A) cross-linking (CXL), with or without oxygen. METHODS/UNASSIGNED:Ex vivo porcine corneal buttons (n = 144) underwent CXL with RB/green or RB/green-RF/UV-A under atmospheric 21% oxygen conditions or in a nitrogen chamber with 0.1% oxygen (hypoxic conditions) to test 10- and 15-J/cm2 fluences. After CXL, corneas were digested with 0.3% collagenase A, and mean digestion times (MDTs) were recorded. RESULTS/UNASSIGNED:For the non-irradiated control group, the MDT was 19.75 ± 1.34 hours. Under atmospheric oxygen conditions, RB/green CXL yielded MDTs of 33.69 ± 1.4 and 34.38 ± 1.31 hours with fluences of 10 and 15 J/cm2, respectively. RB/green + RF/UV-A showed MDTs of 39.56 ± 1.93 and 51.94 ± 4.2 hours for combined fluences of 10 + 10 J/cm2 and 15 + 15 J/cm2, respectively. Hypoxic RB/green MDTs were 33.88 ± 1.02 and 34.06 ± 1.57 hours, and RB/green + RF/UV-A MDTs were 39.62 ± 2.5 and 50.35 ± 1.59 hours for the same respective fluences. No significant differences were observed between the control groups and corresponding intervention groups (all P > 0.05). CONCLUSIONS/UNASSIGNED:CXL via RB/green and RB/green-RF/UV-A significantly enhanced corneal collagenase digestion resistance, irrespective of oxygen presence. These findings could help optimize infectious keratitis therapy CXL protocols. TRANSLATIONAL RELEVANCE/UNASSIGNED:Our findings aid the understanding of the molecular mechanisms underlying the therapeutic effect of CXL and may contribute to refining accelerated PACK-CXL protocols and other CXL treatment strategies.

Amyotrophic lateral sclerosis (ALS) is a complex syndrome with multiple genetic causes and wide variation in disease presentation. Despite this heterogeneity, large-scale genomics studies revealed that ALS postmortem samples can be grouped into a small number of subtypes, defined by transcriptomic signatures of mitochondrial dysfunction and oxidative stress (ALS-Ox), microglial activation and neuroinflammation (ALS-Glia), or TDP-43 pathology and associated transposable elements (ALS-TE). In this study, we present a deep ALS neural net classifier (DANCer) for ALS molecular subtypes. Applying DANCer to an expanded cohort from the NYGC ALS Consortium highlights two subtypes that strongly correlate with disease duration: ALS-TE in cortex and ALS-Glia in spinal cord. Finally, single-nucleus transcriptomes demonstrate that ALS subtypes are recapitulated in neurons and glia, with both ALS-wide and subtype-specific alterations in all cell types. In summary, ALS molecular subtypes represent a combination of cellular and pathological features that correlate with clinical features of ALS.

Growing evidence suggests exposure to high temperatures may result in increased urban crime, a known driver of health and health inequity. Theoretical explanations have been developed to describe the heat-crime relationship without consensus yet achieved among experts. This scoping review aims to summarize evidence of heat-crime associations in U.S. cities. Further examination of empirical and translational inconsistencies in this literature will ensure future studies of urban heat-crime relationships in the U.S., and their policy impacts are informed by a thorough understanding of existing evidence. We performed a comprehensive literature search of empirical studies on heat-crime relationships in U.S. cities published between January 2000 and August 2023. The included studies were qualitatively synthesized based on operationalized exposures, outcomes, covariates, methodologies, theoretical framing, and policy implications. In total, 46 studies were included in this review. Most studies (93%) reported significant, positive associations between urban heat exposure and both violent and non-violent crime outcomes. The shape and strength of these associations varied based on operational definitions of urban heat exposures, crime outcomes, and relevant covariates in employed methods. We also found inconsistencies in the theoretical explanations and policy implications reported across studies. Climate-driven extreme heat events are projected to increase in frequency and severity. Our findings underscore the urgency of refining the understanding and translation of the complex relationship between urban heat and crime. In this review, we highlight opportunities to improve the methodological quality and responsible policy translation of future research in U.S. cities, which has implications for research globally.

This article highlights the gender data gaps in clinical trial inclusion and funding, with a particular focus on gynecologic oncology. Female patients have historically been excluded from clinical trials across all medical domains. Despite recent improvements, female patients remain underrepresented in key diseases, including several cancer types, despite experiencing increased burden of disease. Lack of representation is particularly stark for patients in racial, ethnic, and gender minoritized populations, including in gynecologic cancer trials. Furthermore, female health conditions receive disproportionately small amounts of funding relative to their disease burden. Despite their high lethality, gynecologic cancers, including ovarian, cervical, and uterine malignancies, rank among the lowest funded cancer sites from the National Cancer Institute. Likewise, there is significant bias against female investigators with regard to funding, publication, and academic advancement, which affects the prioritization of women's health. In combination, gender disparities at multiple steps along the research pathway from investigator and disease funding to trial inclusion to publication and dissemination of research perpetuate a significant data gap in the diagnosis, treatment, and prevention of diseases affecting female patients, including gynecologic cancers. Strategies to improve this gender gap and prioritize women's health funding include increasing female representation in clinical trials with a specific focus on inclusion of patients from historically marginalized backgrounds, considering disease burden-based funding policies, and prioritizing female academic leadership opportunities.

After stroke, upper extremity (UE) motor recovery may be mediated in part by transcallosal projections between hemispheres. The interhemispheric competition model posits that transcallosal inhibition (TI) from the contralesional hemisphere is abnormally strengthened following stroke and interferes with motor recovery. This model has recently been questioned. In this longitudinal study, we aimed to definitively confirm or refute a maladaptive role of contralesional TI in subacute motor recovery. We assessed 30 mild-to-moderately impaired subjects over the six months following ischemic stroke. We tracked contralesional TI and motor functions in the proximal and distal segments of the paretic UE. We used transcranial magnetic stimulation to examine the ipsilateral silent period (iSP) in an arm and hand muscle. We used quantitative and clinical testing to examine deficits in muscle strength, motor control, and individuation; UE segmental impairment; and UE activity limitation. We assessed the relationships of contralesional TI to motor functions in the subacute period. Despite recovery of most motor functions in the proximal and distal UE, contralesional TI was largely static and unrelated to recovery of any motor function. There were inconsistent associations between stronger TI, less hand impairment, and less activity limitation in the subacute period overall. We found no compelling evidence to suggest a maladaptive role of contralesional TI in UE motor recovery in mild-to-moderately impaired stroke subjects. The scattered associations between stronger TI and better levels of paretic UE function suggest a potential supportive role rather than a limiting one. These findings challenge the validity of the interhemispheric competition model in the subacute recovery period, and prompt reconsideration of neuromodulatory strategies that subacutely target contralesional TI.