Faculty Bibliography

OBJECTIVE:This analysis evaluated the validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) tool for older adults. METHODS:We performed a subgroup analysis of older adults aged ≥65 (n = 184) from the TAPS tool validation study conducted in 5 primary care clinics. We compared the interviewer and self-administered versions of the TAPS tool at a cutoff of ≥1 for identifying problem use with a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview. RESULTS:The mean age was 70.6 ± 5.9 years, 52.7% were female, and 49.5% were non-Hispanic Black. For identifying problem use, the self-administered TAPS tool had sensitivity of 0.91 (95% CI: 0.75-0.98) and specificity of 0.91 (95% CI: 0.85-0.95) for tobacco; sensitivity of 0.68 (95% CI: 0.45-0.86) and specificity of 0.88 (95% CI: 0.82-0.93) for alcohol; and sensitivity 0.86 (95% CI: 0.42-1.00) and specificity 0.94 (95% CI: 0.90-0.97) for cannabis. The interviewer-administered TAPS tool had similar results. We were unable to evaluate its performance for identifying problem use of individual classes of drugs other than cannabis in this population due to small sample sizes. CONCLUSIONS:While the TAPS had excellent sensitivity and specificity for identifying tobacco use among older adults, the results for other substances lack precision, and we were unable to evaluate its performance for prescription medications and individual illicit drugs in this sample. This analysis underlines the critical need to adapt and validate screening tools for unhealthy substance use, specifically for older populations who have unique risks.

BACKGROUND:Needlestick exposures commonly occur with non-disposable metal syringes during the assembly and disassembly of needles due to the manual handling of needles. Disposable syringes are designed to reduce these exposures by using a protective sheath thus eliminating the need to handle needles while uncapping and recapping them. PURPOSE/OBJECTIVE:This pilot study compared the two syringes with two alternating groups of third-year (D3) students during clinical practice under faculty supervision to administer local anesthesia to live patients. METHODS:In 2023, two groups of Year 3 (D3) Doctor of Dental Surgery (DDS) students supervised by faculty in each group alternated over two 4-week sessions using disposable (N = 67) and non-disposable (N = 66) syringes to administer local anesthesia injections to live patients. At the end of each session, each group and supervising faculty completed a survey to capture their experience. RESULTS:While two participants reported needlestick injuries using non-disposable syringes and no injuries incurred using disposable syringes, we found neither a statistically significant increase nor decrease in exposures related to needlesticks using either syringe. Statistically significant outcomes showed that the participants found the non-disposable easier to use and they were more likely to use it going forward than the disposable syringe. Participants preferred using the non-disposable syringe mainly because of the stability and familiarity aspects of prior education. The disposable syringe, while easier and safer to assemble and disassemble, felt less stable to use during the injection procedure, especially during aspiration. CONCLUSION/CONCLUSIONS:While safety continues to be a concern, students and faculty prefer non-disposable metal syringes over disposable syringes. Most dissatisfaction with using the disposable syringe came from the aspiration system. But prior experience and comfort using non-disposable metal syringes, a lack of experience and confidence with local anesthesia procedures and a lack of experience with disposable syringes, may have contributed to these outcomes. Despite usability issues with the disposable syringe, performance was more impacted by lack of experience than the type of syringe used. Introducing both syringes early into the curriculum may help overcome usability factors, further reduce needlestick exposures, and prepare students for different workplace environments. Providing adequate training for faculty, especially on the differences between the two syringes, such as aspiration, will help alleviate discomfort and better promote the use of both.

BACKGROUND/UNASSIGNED:Disease outbreaks significantly affect maternal and neonatal health. Variability in reporting health outcomes hinder evidence generation. We aimed to develop a core outcome set (COS) for maternal and neonatal health research and surveillance during emerging and ongoing epidemic threats and to agree on outcomes' definitions. METHODS/UNASSIGNED:We conducted a systematic review of observational and experimental studies related to epidemics to identify outcomes, and a four-stage modified-Delphi consensus. 150 international stakeholders participated in online surveys, and 24 representatives in consensus meetings. The panels were diverse, with balanced representation of professional background, gender, and geography, including civil society representatives. Outcome were included if ≥ 80% of participants scored them as critically important and ≤10% rated them as not important. FINDINGS/UNASSIGNED:The final COS includes seven main maternal outcomes-pregnancy outcome, maternal death, suspected symptomatic infection, confirmed infection, severe disease, preterm delivery, mode of birth; seven complementary maternal outcomes-antepartum haemorrhage, postpartum haemorrhage, hypertensive disorders of pregnancy, maternal sepsis, admission to intensive care unit/special units, respiratory support, depression and anxiety; 11 main neonatal outcomes-neonatal death, neonatal suspected symptomatic infection, confirmed infection, severe disease, vertical transmission, low birth weight, prematurity, congenital disorder, respiratory support, skin-to-skin contact, breastfeeding; and, four complementary neonatal outcomes-admission to neonatal intensive care unit/special units, respiratory failure, birth asphyxia, sepsis. INTERPRETATION/UNASSIGNED:This COS could contribute to standardize maternal and neonatal outcomes selection and reporting in observational and experimental studies, facilitating efficient data comparison and timely evidence-based decision-making in the context of ongoing and emerging epidemic threats. FUNDING/UNASSIGNED:Bill & Melinda Gates Foundation (grant INV-041181) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (HQHRP2422779).

This article provides an overview of the FireVoxel software for quantitative analysis of medical images and its applications in the field. We describe FireVoxel's user interface, multi-layer design, dynamic parametric models, and several turn-key workflows. Additionally, we discuss its application in recent imaging projects. We outline basic image analysis tools such as segmentation, non-uniformity correction, and coregistration through a pictorial overview, with a focus on deformable coregistration and motion correction. Several example workflows and image-based dynamic modeling are also highlighted. Furthermore, we analyze peer-reviewed studies that utilized FireVoxel for image processing, categorizing published papers based on body structures/organs, image processing methods, and imaging modalities. For comparison, we searched the Ovid MEDLINE database to assess the general use of medical image analysis software. FireVoxel is used by over 3000 users worldwide, with 528 articles, including 413 in English, published in the past 15 years. MRI is the most commonly used imaging modality (78.2%), followed by CT (14.5%) and PET (7.3%). The most frequently used methods are dynamic modeling, segmentation, texture analysis, and coregistration. FireVoxel is commonly used in abdominal and genitourinary imaging studies, where it appears to fill a niche due to the lack of alternative software. The search of the Ovid MEDLINE suggests that quantitative medical imaging studies, on the other hand, focus on the brain and cardiovascular system. FireVoxel offers an effective set of quantitative tools, particularly for abdominal and genitourinary imaging, likely due to its ability to manage patient motion and correct for MR artifacts. The software is especially valuable for processing dynamic studies. The steady increase in publications utilizing FireVoxel reflects growing interest in this software and its relevance for image-based research.

BACKGROUND:Ultrasound (US) is increasingly used as the first-line imaging modality for the diagnosis of midgut volvulus, but may be non-diagnostic in some cases. OBJECTIVE:To determine the frequency and factors associated with non-diagnostic US for each midgut volvulus and malrotation in a multi-institutional sample. MATERIALS AND METHODS/METHODS:We conducted a retrospective multi-institutional study of children (age 0-18 years) who underwent US to evaluate for midgut volvulus and malrotation between January 1, 2018, and June 30, 2021, and had an available reference standard of one of the following: upper GI series, CT/MRI, surgery, or, for volvulus, clinical follow-up at 30 days or greater. Blinded review of US images was performed by a single radiologist at each institution. When available, radiographs acquired ≤3 h from the US were reviewed for bowel gas pattern. After blinded review, original ultrasound reports were classified as diagnostic or non-diagnostic for midgut volvulus and malrotation. Stepwise logistic regression identified the most important predictors of non-diagnostic US. RESULTS:In total, 637 patients were imaged for midgut volvulus and 311 for malrotation. Based on original report review, non-diagnostic proportions of examinations for volvulus and malrotation were 13.5% (86/637) and 25.7% (80/311), respectively. Based on blinded review, non-diagnostic proportions of examinations for volvulus and malrotation were 17.3% (110/637) and 37.6% (117/311), respectively. Of the patients with US considered non-diagnostic for volvulus by original reports, 2.3% (2/86) were subsequently found to have volvulus. Among patients with non-diagnostic US for volvulus by blinded review (n=110), none was found to have volvulus. Gaseous dilation with elongation of bowel on radiography was the single best predictor of a non-diagnostic US in blinded interpretation for volvulus and malrotation (OR=8.2 and 9.2; 95%CI 3.7-19.8 and 1.7-89.4, respectively) and in original radiology reports for volvulus (OR=4.5; 95%CI 2.2-9.5). CONCLUSION/CONCLUSIONS:A small fraction of a multi-institutional sample of US for midgut volvulus was non-diagnostic; however, assessment of malrotation without volvulus is associated with a higher frequency of non-diagnostic examinations. Dilated bowel gas pattern on radiography is the strongest predictor for a non-diagnostic US, although it does not necessarily preclude a diagnostic exam.

OBJECTIVES/OBJECTIVE:We explored medications for opioid use disorder treatment (MOUD) utilization in six New York City public hospitals that implemented the "Consultation for Addiction Care and Treatment in Hospitals (CATCH)" program. METHODS:CATCH rolled out between October 2018 and February 2020. Data from the electronic health record were analyzed for the first year post-implementation. Eligible cases included adults with an opioid-related diagnosis admitted to inpatient departments served by CATCH, with a stay of ≥1 night. Patients were classified as receiving an MOUD order if there was at least 1 order of buprenorphine, methadone, or naltrexone. Logistic regression modeled the impact of CATCH consults on MOUD orders, controlling for demographic and clinical characteristics with hospital as a random effect. RESULT/RESULTS:Among 2117 eligible patients, 71.4% were male, with a mean age of 51.2 years, and 27.2% identified as Black, 21.2% as White, and 34.5% as Hispanic. MOUD was ordered in 60.9% of admissions, and 41.5% had a completed CATCH consult. Patients identified as Black had lower odds of receiving a MOUD order than those identified as White (OR: 0.52, 95% CI: 0.38-0.71; P < 0.001). Patients with a CATCH consult had higher odds of receiving a MOUD order (OR: 3.22, 95% CI: 2.54-4.07; P < 0.001). CONCLUSION/CONCLUSIONS:Majority of patients in our sample received a MOUD order, with higher odds among those with a CATCH consult. Further research is needed on the drivers of racial disparities in MOUD, and other contextual, organizational, and population-specific barriers and facilitators contributing to receipt of hospital-based addiction consult services and MOUD.

Necroptosis triggers an inflammatory cascade associated with antimicrobial defense. No prospective human study has yet explored the role of necroptosis in colorectal cancer development. We conducted quantitative analysis of biomarkers for necroptosis [transient receptor potential cation channel subfamily M member 7 (TRPM7) and phosphorylated mixed lineage kinase domain-like protein], inflammation [cyclooxygenase-2 (COX-2)], apoptosis [BCL2-associated X (BAX) and terminal deoxynucleotidyl transferase dUTP nick end labeling], and cell proliferation (Ki67). This was done using tissue microarray biospecimens from the Cooperative Human Tissue Network and rectal biopsies from a longitudinal study within the Personalized Prevention of Colorectal Cancer Trial. In the human colorectal adenoma-carcinoma sequence, we observed an inverse expression trend between BAX and TRPM7; TRPM7 decreased from normal mucosa to small and large adenomas but significantly increased in early colorectal cancer stages (Ptrend = 0.004). It maintained high levels through all cancer stages. An increased COX-2 intensity in the epithelium was noted during tumorigenesis (Ptrend = 0.02) and was significantly associated with an elevated risk of metachronous polyps (odds ratio = 3.04; 95% confidence interval, 1.07-8.61; Ptrend = 0.02). The combined composite index scores of TRPM7 and COX-2 were strongly linked to 6- to 47-fold increased risks for metachronous adenoma/serrated polyps, whereas combined scores of phosphorylated mixed lineage kinase domain-like protein or TRPM7 with BAX were associated with an 11.5- or 13.3-fold elevated risk for metachronous serrated polyps. In conclusion, our findings suggest that COX-2 expression within normal-looking colorectal mucosa is significantly associated with an increased risk of metachronous colorectal polyp. Furthermore, our results propose the hypothesis that synergistic interactions among necroptosis, inflammation, and apoptosis could play a pivotal role in human colorectal tumorigenesis. Prevention Relevance: Our findings suggest that COX-2 expression and combined scores of COX-2, TRPM7, and BAX hold promise for predicting the risk of metachronous polyps and could potentially serve as a tool for assessing the effectiveness of chemopreventive agents in preventing colorectal cancer during intervention trials.

While there is agreement on the indications for intracranial pressure monitoring (ICPm) in patients with sTBI, there continues to be controversy concerning the ideal timing of its implementation. It is within this context that we decided to investigate whether a protocolization approach could optimize the timeliness of ICPm implementation. Neurosurgical and SICU providers agreed to a 3-tier protocol to identify patients with sTBI who could benefit from timelier ICPm implementation. The monthly compliance was monitored for a 9-month period. The study included a pre-protocolization group of 11 patients (2022) and a post-protocolization group of 9 patients (2023-2024). There was a trend toward earlier use of ICPm but the difference did not achieve statistical significance; there was no difference in the mortality rates between groups. A protocolization approach to the treatment of patients with sTBI developed with a consensus strategy may lead to earlier implementation of ICPm and possibly improved functional outcome.