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.

Liver transplant (LT) recipients experience a wide range of comorbidities, leading to frequent healthcare encounters. Until now, national registries, which have limited exposures and outcomes, and laborious small cohort studies have been the main data sources for LT research. Cosmos database offers electronic health record (EHR)-based insights into LT recipients at the national level with granular data. We evaluated if Cosmos data is representative of the entire US LT recipient population. Using Cosmos (N=20,235) and the national Scientific Registry of Transplant Recipients (SRTR) (N=51,281), we identified adult, first-time LT recipients between 7/2016-12/2022. We compared demographics, clinical data, and mortality across datasets, calculating Kaplan-Meier survival estimates and multi-variable Cox regressions. Recipient characteristics were highly comparable (e.g., female: Cosmos=36.5% vs. SRTR=36.4%, Black: 6.8% vs. 7.2%; BMI: 28.5 kg/m2 [24.8-32.9] vs. 28.2 [24.6-32.4]). Lab values were similar across cohorts, including MELD (24 [17-30] vs. 23 [16-30]). Transplant indications, donor characteristics, and 5-year survival (Cosmos 83.1% [82.3-83.8) vs. SRTR 80.9% [80.4-81.3]) were similar. The associations of clinical factors with survival were similar across both groups. Cosmos database demonstrated acceptable generalizability to the general US LT recipient population, which may advance LT research through a better understanding about LT recipients' experiences and outcomes.

Everyday discrimination is a social determinant of health linked to disease and mortality, with one potential mechanism of this link involving stress-related signaling that "weathers" immune health. Previous research has examined links between discrimination and inflammatory processes derived from innate immune cells, but little is known about the associations of everyday discrimination with lymphoid lineage cells (T cells and B cells) that mediate adaptive immunity. To better understand the potential immunological impact of everyday discrimination, we analyzed the relationship between Everyday Discrimination Scale scores and flow cytometry data from the Health and Retirement Study (n = 6337; mean age = 70 years, SD = 9 years; 58 % female; 71 % White). Primary analyses adjusted for sociodemographic factors and secondary analyses additionally controlled for health behaviors. Weighted results showed that higher levels of discrimination were significantly associated with higher total CD4⁺ T, CD8⁺ T, and B cell counts. Follow-up analyses of T and B cell maturity indicated a potential link between higher discrimination levels and mature "terminally differentiated" cells, including CD4⁺ TEMRA (7.8 % elevation, 95 % CI: 3.8 %-12.0 % elevation, p < 0.001), CD8⁺ TEMRA (2.9 % elevation, 95 CI: 0.1 %-5.9 % elevation, p = 0.040), and IgD^- memory B cells (3.4 % elevation, 95 CI: 0.7 %-6.0 % elevation, p = 0.012), but no significant associations with the immature "naïve" T or B cell subpopulations. Overall, these results suggest that everyday discrimination may contribute to immune aging by promoting the accumulation of terminally differentiated T and B cells, a profile consistent with accelerated immunosenescence in the adaptive immune system.

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.

Maternal psychological distress during pregnancy and the early postpartum period is a risk factor for dysregulated affective and regulatory function in young infants. Animal models suggest that perinatal stress may alter offspring development via allopregnanolone (ALLO) exposure. For example, variations in placentally derived ALLO in preterm infants have been linked with altered fetal neurodevelopment. However, no studies have investigated naturalistic variations in ALLO concentrations in maternal milk as a potential moderator of associations between maternal distress and infant temperament during the postnatal period. The current study assesses associations among ALLO concentrations in human milk, maternal psychological distress, and infant temperament in 81 mother-infant dyads (31 females) measured at approximately 6.5 months postpartum (M = 6.55 months, range = 5.5-8 months). Results indicated that human milk ALLO concentration moderated effects of maternal psychological distress on infant regulatory capacity. Specifically, there was a negative association between maternal psychological distress and regulatory capacity in infants of mothers with below-mean ALLO concentrations, but not in infants of mothers with above-mean ALLO concentrations. However, there were no effects of ALLO on infant negative affect or surgency/positive affect. This study provides some of the first preliminary evidence that ALLO concentrations in human milk may moderate associations between maternal psychological distress and infant regulatory capacity.

Autism spectrum disorder (ASD) is a neurodevelopmental condition, with ex vivo studies suggesting its neurobiological origin as early as the first and second trimester of pregnancy. Functional MRI studies using graph-theoretical approaches have isolated features in the global connectome architecture that distinguish toddlers with ASD from their typically developing peers. Additionally, functional connectivity patterns in the infant brain have shown to be predictive of later ASD diagnosis. An important yet unexplored question in the literature is whether graph-theoretical differences are evident prior to infancy, in the brain of fetuses who will later exhibit ASD traits in early childhood. In this study, we address this question using a sample of 88 children with both quality-assured fetal brain resting-state functional MRI data and standardized parent assessment of ASD traits including social-emotional and social communication skills and repetitive and restricted behaviors at age 3. Multiple regression analyses revealed no significant associations between fetal global graph features (e.g., network segregation, integration, and small-world architecture) and ASD traits at age 3 (p's > 0.1). Therefore, our findings do not provide support for prenatal emergence of global topographical differences of brain functional organization in fetuses who later develop ASD traits. However, this does not rule out the possibility of other neural signatures in the fetal functional connectome that may predict autistic traits and future ASD diagnosis.

BACKGROUND:The expansion of treatment options for prostate cancer (PC) has improved disease-specific and overall survival outcomes but has also raised questions about the optimal level of treatment needed for patients based on their individual prognosis and accounting for potential toxicity, incorporating quality of life considerations. METHODS:A panel of experts met to discuss current controversies in the care of patients with PC across the disease continuum. Multidisciplinary experts review advances and persistent uncertainties in biomarker-guided assessment, imaging, and systemic therapy for prostate cancer. The discussion outlines priority gaps in evidence that must be addressed to optimize individualized patient care. RESULTS:Workshop topics included use of genomic biomarkers and artificial intelligence-guided tools to identify and manage high-risk and very-high risk localized disease, management of biochemical recurrence, identification of patients with metastatic hormone-sensitive PC who warrant treatment escalation, radiopharmaceutical therapy for metastatic castration-resistant PC including optimal sequencing of approved therapies, role of imaging in identification and management of extraprostatic disease, and lifestyle interventions to optimize survivorship. CONCLUSIONS:Many questions remain about management of PC related to biomarker-based risk stratification to guide treatment selection, use of prostate-specific membrane antigen-positron emission tomography, and balancing the risk for PC-related death with risks for treatment-related toxicity. Ongoing research efforts are needed to optimize risk-based treatment, sequence of therapies throughout the disease continuum, and survivorship care.

ObjectiveWe designed a survey to determine the prevalence of sexual dysfunction among cancer patients and to understand the gaps in provider-patient communication.MethodsAn IRB-approved 36-item survey was distributed through the Jefferson Recruitment Enhancement Service team and social media. Questions assessed the impact of cancer treatment on sexual health, provider communication, how sexual health was assessed, and possible interventions. Chi-square test or Fisher's exact test were used to compare the group differences with a P-value threshold (α) of 0.05 for statistical significance.Results916 patients responded to the survey, with most being diagnosed with breast (n = 271, 29.6%) and prostate cancer (n = 358, 39.1%). 71.8% of patients experienced an impact on sexual function by cancer treatment. Most experienced issues with their sexual desire, body image, arousal, comfort during intercourse, and ability to achieve orgasm (α < 0.001). Only 35.5% reported being asked about their sexual health by an oncologist and only 22.2% were given a questionnaire to assess their sexual health (α < 0.001). 49.8% of breast patients and 15.4% of prostate patients were never told their sexual health could be affected by their cancer treatment (α < 0.001). 60.3% of prostate patients were formally asked about their sexual health by an oncologist compared to 21.4% of breast patients (α < 0.001). 74% of respondents stated it is essential for oncologists to speak to patients about sexual health.ConclusionCancer survivors believe it is important for providers to discuss sexual health. However, providers are more inclined to address sexual health concerns with male patients than with female counterparts.