Faculty Bibliography

Artificial intelligence (AI) and machine learning (ML) have seen remarkable growth in mental health applications over the past few decades, demonstrating significant potential to transform psychiatric care. Despite these advancements, the translation of AI systems into clinical practice remains fraught with challenges. This Perspective examines critical hurdles in psychiatric AI research, emphasizing limitations in research rigor, model reliability, interpretability, clinical utility, and ethical considerations. We argue that a human-assisted AI framework-incorporating incremental feedback, self-adaptation, and dynamic collaboration-can address biases, enhance transparency, and build trust in AI systems. Moreover, initiatives in clinical education, cultural adaptation, and data/software sharing are essential to fostering public engagement, data transparency, and research reproducibility. By focusing on these areas, we aim to bridge the gap between AI potential and its successful, ethical implementation in mental health care, guiding the development of trustworthy, effective, and culturally adaptive AI-powered psychiatric tools.

PURPOSE OF REVIEW/OBJECTIVE:Medullary sponge kidney (MSK) is a congenital disorder of the distal nephron, characterized by cystic dilatation of the papillary and medullary tubules. It commonly presents with recurrent calcium nephrolithiasis and often, severe, life-altering chronic pain syndromes, often independent of urinary obstruction and of uncertain etiology. Management focuses on stone prevention and symptomatic care, but these measures are frequently inadequate. No studies of management of this pain syndrome in these patients have been performed. There are essentially no studies evaluating renal denervation in MSK specifically, although the technique has been utilized with some benefit in other disorders, underscoring a major therapeutic gap. In this review, we describe patients with MSK and chronic pain syndrome and review the role of renal denervation as a potential therapy. RECENT FINDINGS/RESULTS:Renal denervation may represent a promising strategy for chronic kidney pain syndrome. It could provide pain relief and improve quality of life in affected patients. SUMMARY/CONCLUSIONS:The optimal management strategy for chronic pain in MSK has not been elucidated. Renal denervation has recently been utilized and approved for the management of blood pressure. It could be useful for managing chronic kidney pain in this condition as well.

PURPOSE OF REVIEW/OBJECTIVE:The 2023 CONVINCE trial demonstrated improved survival with high-dose hemodiafiltration (HDF), prompting discussions about widespread adoption. However, this clinical advancement occurs amid growing awareness of healthcare's environmental impact, particularly dialysis treatments that consume extensive water and energy resources. This review examines the environmental implications of HDF adoption, synthesizing recent evidence on resource consumption and emerging sustainability solutions in the context of the climate crisis facing nephrology. RECENT FINDINGS/RESULTS:Life cycle assessments indicate HDF has a carbon footprint 30-40% higher than conventional hemodialysis, consuming an additional 10 300 L of water per patient annually. However, recent technological innovations show promise: expanded hemodialysis (HDx) using medium cut-off membranes reduces water usage by >20% and energy consumption by >30% compared to HDF while potentially achieving similar clinical outcomes. Water conservation technologies, including reverse osmosis, reject water reuse and reduced dialysate flow protocols, can decrease environmental impact by 30-50% without any difference in patient outcomes. SUMMARY/CONCLUSIONS:The adoption of HDF represents a critical test case for sustainable healthcare innovation. While the potential benefits should not be ignored, technology is not static and, if confirmed, additional sustainability work and comprehensive policy frameworks integrating environmental impact assessments into technology evaluation are urgently needed. The nephrology community must balance clinical excellence with planetary stewardship through technological innovation, resource optimization, and evidence-based environmental guidelines that benefit, not compromise, patient care.

OBJECTIVE:We sought to apply a previously developed transimpedance (TIM) heatmap pattern classification scheme in patients with no known risk factors for cochlear anomalies, in addition to patients implanted in the revision setting, to better understand the incidence of pattern variants, and potential clinical implications. STUDY DESIGN/METHODS:Single-center retrospective review. SETTING/METHODS:Tertiary referral centre. PATIENTS/METHODS:Patients older than 6 months of age who underwent cochlear implantation between June 2020 and June 2024 with normal gross cochlear anatomy and no concern for fibrosis that had intraoperative TIM testing completed. Patients undergoing revision implantation were also included as a separate cohort. INTERVENTION/METHODS:None. MAIN OUTCOME MEASURES/METHODS:The number of patients with normal and variant TIM patterns was evaluated for each cohort. TIM patterns were subsequently compared with the electrode position found on intraoperative x-ray. RESULTS:There were 321 ears that underwent implantation and subsequent intraoperative TIM assessment meeting inclusion criteria. Of these, 310 (96.6%) were in the primary surgery setting, and 11 (3.4%) were in the revision surgical setting. In the primary surgical setting, 86.4% (n=268) of the implants demonstrated a normal TIM heatmap. Compared with the primary surgical setting, where only 45.5% (n=5) of revision surgery TIM heatmaps were interpreted as normal. One patient in the revision setting had a newly identified "double X" pattern corresponding to a normal electrode position on x-ray. CONCLUSIONS:There is a decreased incidence of previously developed TIM heatmap pattern variants in CI recipients with normal gross cochlear anatomy.

INTRODUCTION/BACKGROUND:We examined obstructive sleep apnea (OSA) severity's association with Alzheimer's disease (AD) plasma biomarkers, independent or synergistic with cerebrospinal fluid (CSF) amyloid, and as a proof of concept, whether plasma amyloid beta (Aβ)42/Aβ40 with OSA severity improves detection of amyloidosis and tau pathology. METHODS:In 120 cognitively normal older adults (70 with CSF data) from New York University sleep and aging studies (2013-2021), OSA severity was measured using apnea/hypopnea index with 4% desaturation; plasma Aβ40, Aβ42, tau, and neurofilament light chain (NfL) via single molecule array; CSF amyloid and tau via enzyme-linked immunosorbent assay. Associations evaluated adjusted correlations and generalized models; receiver operating characteristic analyses evaluated diagnostic accuracy. RESULTS:OSA severity correlated with plasma Aβ40 (r = 0.21), Aβ42 (r = 0.26), and Aβ42/Aβ40 (r = 0.20). Plasma tau and NfL associations depended on CSF-Aβ42. OSA severity with Aβ42/Aβ40 improved CSF amyloidosis (area under the curve [AUC] = 0.78) and tau pathology (AUC = 0.71) detection. DISCUSSION/CONCLUSIONS:OSA severity relates to elevated plasma Aβ and, with CSF amyloid, to tau/NfL. Combined plasma and OSA measures aid non-invasive AD associations' detection.

PURPOSE/OBJECTIVE: METHODS:Like many other MRI simulators, ours discretizes magnetic fields in space. However, we extend the MR signal simulation at each grid point from the 0th-order approximation, which assumes piecewise constant fields, to a 1st-order approximation, which assumes piecewise linear fields. We solve the signal equation by analytically integrating over each grid cube, assuming linear field variations, and then summing over all cubes. We provide analytical integrals for several pulse sequences. RESULTS:The 1st-order approximation captures strongly varying fields and associated intravoxel dephasing more accurately, avoiding severe "ringing" artifacts present in the usual 0th-order simulations. This enables simulations on a much coarser grid, facilitating computational feasibility. CONCLUSION/CONCLUSIONS:The first-order simulator enables the evaluation of unconventional scanner designs with strongly varying magnetic fields.

INTRODUCTION/BACKGROUND:Though brain fog is common in Long-coronavirus disease 2019 (Long-COVID), the incidence of mild cognitive impairment (MCI) is unknown. METHODS:In an observational cohort study, recovered COVID-positive, Long-COVID, and COVID-negative subjects underwent blinded evaluation using National Alzheimer's Coordinating Center (NACC) and National Institute on Aging (NIA) -Alzheimer's Association diagnostic criteria for dementia and MCI. The cumulative incidence of MCI was calculated for each group, and the hazard of MCI was compared between groups. RESULTS:Among 260 subjects, the cumulative incidence of MCI over 4.4 years was higher with Long-COVID (27%) versus recovered-COVID (5%) or COVID-negative status (1%). There was a higher hazard of MCI for patients with Long-COVID compared to those without (hazard ratio [HR] 3.93, 95% confidence interval [CI] 1.86-8.31, p < 0.001), and specifically for the Alzheimer's disease (AD) -related MCI subtype (HR 3.20, 95% confidence interval [CI] 1.14-9.00, p = 0.027). DISCUSSION/CONCLUSIONS:The cumulative incidence and adjusted hazard of MCI (and specifically AD-related MCI) at 4.4 years was significantly higher among Long-COVID patients compared to recovered-COVID and COVID-negative controls.

BACKGROUND:Hypercalciuria is a prominent characteristic in Dent disease type 1 (DD1) and is associated with kidney stones and nephrocalcinosis. The objectives of this study were to assess fibroblast growth factor 23 (FGF23) and 24,25-dihydroxyvitamin D (24,25(OH)2D) in DD1 patients and investigate the effects of phosphate supplementation on urinary calcium excretion. METHODS:Serum and 24-hour urine assessments from adult and pediatric DD1 patients (n=10 adults; n=9 pediatrics) were compared to adult control subjects with a history of idiopathic calcium kidney stones and hypercalciuria (n=9). Adult DD1 patients and control participants completed an oral phosphate supplementation intervention (1g/day x 14 days) with reassessment immediately following intervention. RESULTS:FGF23 was significantly lower in DD1 than in the control cohort (adults, p=0.006) and positively correlated with 24,25(OH)2D across all study cohorts. The concentrations of 24,25(OH)2D were low with conversion ratios (25-hydroxyvitamin D:24,25(OH)2D) exceeding the clinical reference limit for five of 10 adults and six of nine pediatric DD1 patients. The DD1 cohorts were then stratified by the 24,25(OH)2D ratio into "normal" and "low" 24,25(OH)2D. Adult DD1 patients with low 24,25(OH)2D (n=5) had lower FGF23, higher 1,25(OH)2D, greater urine calcium, and greater urine protein. Pediatric stratified data mirrored that in adults with the exception of no difference in serum 1,25(OH)2D. Phosphate supplementation was effective in decreasing urine calcium in both adult DD1 and control adult cohorts. CONCLUSIONS:Clinical measurement of 24,25(OH)2D is a novel and useful analysis for evaluating the severity of calcium and protein dysregulation in DD1. In addition, moderate phosphate supplementation effectively mitigates urine calcium excretion in DD1 adult patients.