Faculty Bibliography

BACKGROUND/UNASSIGNED:Effective management of alcohol withdrawal syndrome during hospitalization is paramount to patient safety and quality care. NYC Health + Hospitals initiated a quality improvement project to pilot an electronic health record (EHR) integrated, nurse-driven CIWA-Ar symptom-triggered protocol, including recommendations for medications for alcohol use disorder (MAUD), in medical and surgical units at 3 public hospitals. OBJECTIVE/UNASSIGNED:To describe implementation processes and to report related implementation outcomes (appropriateness, feasibility, and adoption) of the updated CIWA-Ar protocol in a safety net hospital setting. METHODS/UNASSIGNED:NYC Health + Hospitals implemented a standardized CIWA-Ar symptom-triggered, nurse-driven EHR protocol on March 15, 2022. The protocol included order sets, practice advisories, task lists, and reminders for assessments and orders. We measured nursing perspectives on feasibility and appropriateness at 6 months via a survey. We measured provider adoption as the proportion of admissions with a CIWA-Ar protocol ordered among admissions that triggered a recommendation, and MAUD use as the proportion of admissions with a MAUD order during hospitalization among all patients with a protocol ordered. RESULTS/UNASSIGNED:= .249). CONCLUSIONS/UNASSIGNED:The CIWA-Ar protocol was appropriate, feasible, and adopted at NYC public hospitals. Quality improvements to ensure protocol fidelity with benzodiazepine dosing and MAUD prescribing are needed.

BACKGROUND:There is growing interest in understanding the link between early life exposures to ambient air pollution and childhood blood pressure; however, existing findings, largely from single site/cohort studies, are inconclusive. METHODS:(per 10-ppb) exposures with blood pressure outcomes were estimated using linear and Poisson regressions adjusted for sociodemographic, lifestyle, temporal, and spatial confounders. RESULTS:with both SBP (β: -2.42, 95 %CI: -4.70, -0.14) and DBP (β: -1.94, 95 %CI: -3.81, -0.08) percentiles were suggested. CONCLUSION/CONCLUSIONS:and blood pressure was counterintuitive and warrants further investigation.

Evidence is inconsistent regarding which windows of PM_2.5 exposure are critical for adverse perinatal outcomes. We investigated associations between timing of gestational PM_2.5 exposure and perinatal outcomes. Participants included 19,108 mother-infant dyads from 51 sites of the Environmental influences on Child Health Outcomes (ECHO) cohort. Repeated measures of PM_2.5 exposure were included based on high-resolution spatiotemporal models for trimesters 1-3, early first trimester (≤14 days), and late first trimester (70-92 days). We estimated associations of PM_2.5 exposure (per 5 μg/m³ increase) and continuous outcomes (gestational age at birth [GA] and birthweight for gestational age z-scores [BWZs]) using generalized estimating equation (GEE) models for linear regression. Poisson regression via GEE was used to estimate risk ratios (RRs) of PM_2.5 exposure (per 5 μg/m³ increase) with binary outcomes (preterm birth [PTB], <37 completed weeks of gestation), and term small for gestational age [SGA], <10th percentile). We explored effect modification by participants' characteristics. In fully adjusted models, early 1st trimester PM_2.5 exposure was associated with lower BWZ (β = -0.03, 95 % CI -0.06, -0.001); association with term SGA was RR = 1.06, 95 % CI 0.99, 1.13. Results were mostly null for other windows of gestational exposure. When stratified by sex, early pregnancy PM_2.5 exposure and lower BWZ associations were observed among females, but not males. Suggestive evidence indicates that associations of PM_2.5 exposure with GA, PTB risk, and term SGA risk may vary by maternal race and ethnicity. Our results suggest that policies and practices that reduce the risks of PM_2.5 exposure, particularly in pre-conception and early pregnancy, may improve perinatal outcomes.

BACKGROUND:The school environment plays a vital role in shaping children's health and well-being. Nutrition education supports health promotion and disease prevention; however, it is unclear how comprehensive curricula are in the content they cover. This study explored the content of K-12 nutrition curricula in US public schools. METHODS:We analyzed nutrition education curricula from the 2023-2024 school year across a target sample of 50 states. Materials were collected through online searches and phone calls to districts and schools. We employed content analysis to assess nutrition concepts and modes of curriculum delivery, using a codebook to systematically code the curricula. RESULTS:We obtained 110 curricula across 38 states. Common concepts included macronutrients (54.5%), micronutrients (55.4%), food groups (58%), and the benefits of good nutrition (69%). Fewer curricula addressed consequences of poor nutrition (44.5%) or behavioral changes like portion size (38.1%). Most curricula (87.2%) used didactic methods, with only 19.5% incorporating hands-on activities. Broader topics such as environmental impacts of food choices (17.2%) were less common. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY/UNASSIGNED:Nutrition education plays a critical role in shaping children's long-term health outcomes; however, challenges remain in ensuring consistent and high-quality instruction. CONCLUSIONS:Nutrition education in the US focuses on core nutrition concepts and often relies on didactic methods, with limited hands-on activities. This highlights the need for more engaging, standardized programs.

BACKGROUND:Positive psychology well-being constructs like flourishing are important predictors of health and quality of life. However, few studies have examined the association between flourishing and psychological distress (i.e., depression and anxiety). We investigated the association between flourishing and psychological distress symptoms among higher education students. METHODS:We analyzed cross-sectional survey data from 60,386 students aged 18-34 in the United States (Healthy Minds Study 2022-2023). Flourishing was measured using the Flourishing Scale, while symptoms of depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales, respectively. Associations between flourishing and psychological distress were examined using multiple logistic regression models, adjusting for age, gender identity, race/ethnicity, financial stress, and self-reported mental health treatment. RESULTS:Of the 60,386 participants included the mean age was 21.7 (SD = 3.6). Most participants were female (68.3 %) and White (55.6 %). Among individuals with significant symptoms of depression or anxiety, 13.7 % and 17.7 % were classified as flourishing (Flourishing Scale ≥48), respectively. Participants with significant symptoms of depression (OR: 0.23; CI: 0.22-0.25) or anxiety (OR: 0.56; CI: 0.54-0.59) were less likely to be classified as flourishing than those without significant symptoms. CONCLUSION/CONCLUSIONS:Flourishing is possible within psychological distress. These results suggest the importance of assessing both positive psychological well-being and psychological distress to understand student mental health. While reducing symptoms of psychological distress is crucial, enhancing positive psychological well-being should also be prioritized as part of mental health treatment.

INTRODUCTION/UNASSIGNED:This study leverages advertising industry data to quantify social media advertising expenditures and advertising impressions of the food and beverage industry on Facebook, Twitter/X, and Instagram from January 2019 to August 2021. METHODS/UNASSIGNED:=18 months). Primary outcomes were monthly trends expenditures of food/beverage advertising and the number of views and expenditures of food/beverage advertising by platform (e.g., TV, online, mobile, print). Primary outcomes was measured by monthly expenditures by (1) social media company, (2) brand, and (3) before COVID-19 versus the first year of the pandemic. RESULTS/UNASSIGNED:for interaction<0.001). CONCLUSIONS/UNASSIGNED:These data reveal that the food/beverage industry spends at least $2.8 billion on social media advertising, which generate billions of views for their products online. Determining adults' exposure to social media food advertising is critical for understanding the upstream factors that shape the risk for diet-related diseases.

INTRODUCTION/UNASSIGNED:Membranous nephropathy (MN) is a common cause of nephrotic syndrome usually diagnosed using kidney biopsy. METHODS/UNASSIGNED:= 132). RESULTS/UNASSIGNED:In BKBC, 2 proteins, testican-2 and alpha-1,6-mannosylglycoprotein 6-beta-N-acetylglucosaminyltransferase (MGT5A), were associated with MN when compared with the reference diagnosis (normal or thin basement membrane [TBM] disease) as well as when compared with all other diagnoses among individuals who had undergone kidney biopsy for the indication of proteinuria or nephrotic syndrome. In NEPTUNE, plasma levels of both proteins, as well as glomerular expression of their cognate genes, were increased in MN compared with minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). In receiver operating characteristic curve analyses, the addition of plasma testican-2 and MGT5A levels significantly improved discrimination of MN from other diagnoses in BKBC and NEPTUNE compared with models incorporating age, sex, race, estimated glomerular filtration rate (eGFR), and proteinuria. CONCLUSION/UNASSIGNED:Together, these findings motivate interest in testican-2 and MGT5A as markers and potential functional participants in MN. More work is required to understand the biological role of these proteins in the glomerular basement membrane in relation to immune complex deposition as well as to assess their performance as biomarkers alongside circulating autoantibodies in patients with MN.

RATIONALE AND OBJECTIVES/OBJECTIVE:Prostate multiparametric magnetic resonance imaging (MRI) is recommended for prostate cancer detection, staging, and surveillance. Incidental bladder lesions are encountered on these studies but remain under-characterized in the literature. The patient characteristics associated with malignancy for these lesions are not well defined. We evaluated the prevalence, histopathologic outcomes, clinical characteristics, and associations with malignancy for incidental bladder lesions on prostate MRI. MATERIALS AND METHODS/METHODS:A retrospective review included 31,241 patients undergoing prostate MRI examinations from January 2013 to January 2023. Imaging reports and medical records were analyzed for incidental bladder lesions, demographic data, clinical symptoms, urinalysis findings, and histopathologic outcomes. Lesions were categorized based on biopsy results or negative clinical follow-up for bladder tumors in chart review. Logistic regression analysis and receiver operating characteristic analyses were performed. RESULTS:Incidental bladder lesions occurred in 0.74% (230/31,241) of examinations, with biopsy-confirmed bladder cancer in 0.11% of patients (34/31,241) or 14.8% (34/230) of cases with lesions. In multivariable analysis, gross hematuria had the strongest association with biopsy-proven bladder cancer (OR 9.26, 95% CI 4.12-20.79, p<0.001). A logistic regression model incorporating age, smoking status, and gross hematuria yielded area under the curve of 0.762 for bladder cancer. CONCLUSION/CONCLUSIONS:Incidental bladder lesions on prostate MRI may represent opportunities for early detection of bladder cancer, but also have potential for harms related to unnecessary procedures. Considering the presence of gross hematuria, possibly stated as part of the MRI referral or patient questionnaire, could improve risk stratification of encountered bladder lesions and early cancer detection.

As a contingency standard of care, telemedicine use surged during the COVID-19 pandemic. The Medicare telehealth flexibilities introduced during the COVID-19 pandemic expired in September 2025. Any ongoing sustained pivot to telemedicine warrants purposeful attentiveness to ethical considerations and not just technology use as an end unto itself. Telemedicine has the potential to complement face-to-face care practices and enhance clinical interactions when its use is based on shared values. Values such as access, equity, justice, compassion, autonomy, and dignity warrant thoughtful use of telemedicine. Patients and families need to be able to trust that clinicians and health systems will place patient welfare and shared values above technical convenience. As demonstrated in this case description, upholding values fundamental to the practice of medicine in telemedicine can enhance patient connection and foster trustworthy post-pandemic practices.