Publications by Year: 2026

PURPOSE: Patient care ownership (PCO) is a critical component of medical professionalism. Although various determinants of PCO among medical residents have been investigated, the impact of workplace social capital (WSC; a social resource concerning employees' perceptions of trust, reciprocity, and network interactions within the workplace) remains unclear. Here, we aimed to examine the association of WSC and PCO.

METHODS: This nationwide cross-sectional study was conducted using an anonymous online survey from January to February 2025. The participants were residents who participated in the General Medicine In-Training Examination. The primary and secondary outcomes were PCO and its four dimensions (i.e. assertiveness, sense of ownership, diligence, and being the "go-to" person), measured using the Japanese version of the PCO Scale, respectively. We adopted WSC and its two dimensions (i.e. horizontal and vertical trust) as the primary and secondary explanatory variables, assessed using the Japanese medical resident version of the WSC Scale, respectively.

RESULTS: A total of 2811 residents were analyzed. On multivariable linear regression analysis, WSC total score was positively associated with PCO total score after adjustment for possible confounders. WSC total score was also positively associated with all PCO dimension scores. Additionally, we observed a positive association between each WSC domain score, PCO total score, and each PCO domain score.

CONCLUSIONS: Our study revealed a significant and consistent association between WSC and PCO. These findings emphasize the importance of fostering a trusting workplace environment, given that PCO constitutes a pivotal component of professionalism and is likely associated with quality patient care.

Dissociative identity disorder (DID) is a childhood-onset posttraumatic biopsychosocial syndrome characterized by identity alteration symptoms in which one loses a sense of agency and ownership over some thoughts, feelings, memories, and behaviors. There is limited investigation of sociodemographic variability related to DID prevalence. Further, there is limited assessment of symptoms in non-clinical samples that may shed light on potential dissociative phenotypes in the general population. We utilized a large citizen science online data collection platform to collect self-report symptoms of dissociative identity disorder among self-selected adults in the general population. Participants (N = 5,589) provided demographic information and completed the Multiscale Dissociation Inventory self-report assessment (MDI). We completed general linear models to investigate associations between race, gender, and geographic location with a provisional self-report DID diagnosis and MDI identity dissociation scores. In general, individuals from marginalized racial groups had higher provisional DID prevalence rates and more severe identity dissociation symptoms compared to White individuals. Genderqueer individuals reported higher rates of provisional DID compared to men and women, and men reported higher rates compared to women. We also observed significant differences in the prevalence of DID symptoms across geographic regions. These novel results suggest that race, gender, and geographic location are linked to variation in rates of provisional DID diagnosis and identity alteration symptom severity. Marginalized groups with potentially the highest rates of DID are underrepresented in current research. Future work should explore contributing factors to these sociodemographic differences to develop effective prevention and treatment strategies for specific groups.

The aim of this study was to perform a detailed clinical and pathologic analysis of biopsies from 180 BE patients with the goal of understanding the clinical significance and outcome of patients diagnosed with crypt dysplasia (CD). Biopsies from 58 progressors and 122 nonprogressors (372 biopsies) were graded by 3 gastrointestinal pathologists. A consensus biopsy diagnosis (agreement by ≥2 pathologists) was used for outcome analysis. The overall diagnostic agreement among all 3 observers was high (0.75) and was observed in 83.9% cases, with a moderate level of agreement (0.44) noted for CD. BE progressors had a significantly higher proportion of index biopsies with CD (17% vs. 2%) and LGD (9% vs. 0%; overall P <0.0001) compared with nonprogressors. Compared with an index consensus biopsy diagnosis of NDBE, a consensus biopsy diagnosis of IND, CD, and LGD had significantly increased odds of developing HGD/EAC by univariable (OR: 4.05; P <0.0001) as well as multivariable analysis (OR: 10.3; P =0.01). Furthermore, Kaplan-Meier analysis showed that patients diagnosed with CD or LGD on an index biopsy had a higher probability of developing HGD/EAC than those with NDBE ( P <0.0001), and the timeline for progression among patients with CD was found to be intermediate between those diagnosed with NDBE and LGD. BE patients with an index biopsy diagnosis of CD are more likely to develop HGD/EAC compared with those without dysplasia, and these patients may benefit from surveillance and management strategies, similar to LGD.

INTRODUCTION: We developed MedSupport, a multilevel medication adherence intervention designed to address root barriers to medication adherence. This study sought to explore the feasibility and acceptability of the MedSupport intervention strategies to support a future full-scale randomized controlled trial.

DESIGN, SETTING, PARTICIPANTS, AND MEASURES: We recruited caregivers of pediatric patients (ages 1-18) with acute lymphoblastic leukemia (ALL) receiving oral home-based chemotherapy at Roswell Park during April and May 2023. Multidisciplinary healthcare providers who were on the care teams of enrolled patients were invited to participate. Feasibility and acceptability among caregivers and healthcare providers were assessed using standardized self-report measures and objective measures of intervention fidelity.

RESULTS: We implemented a pilot study of the MedSupport intervention at Roswell Park, and successfully implemented all study procedures. Feasibility was demonstrated through: (i) Demand: When approached for participation, 100% of eligible caregivers (N = 6) and healthcare providers (N = 8) agreed to participate. (ii) Practicality: 100% of families completed the barriers screening questionnaire on the first prompt. All families endorsed adherence barriers (range: 3-14). (iii) Acceptability: Caregivers rated the intervention as acceptable, appropriate, and feasible (mean: 4.71-5.0). Healthcare providers rated the intervention as acceptable, appropriate, and feasible (mean: 4.41-4.47). Objective data on intervention fidelity were feasible to capture and demonstrated both caregiver and healthcare provider engagement with the intervention.

CONCLUSIONS AND RELEVANCE: MedSupport is an innovative, low-cost, and scalable intervention that warrants additional examination to understand efficacy in enhancing home-based medication adherence in pediatric ALL.

PURPOSE: This study examined the relationship between executive functioning (EF) and core features associated with autism in children aged 2 and 4 years. EF encompasses a set of goal-directed skills that enable organized thoughts and behavior which develop rapidly during the preschool period. To examine concurrent associations between EF and early autism expression, we analyzed whether EF performance relates to observed social communication and repetitive behaviors during parent-child interactions.

METHODS: Participants included 110 autistic children aged 24 to 60 months diagnosed with autism. Developmental and cognitive abilities were assessed using the Mullen Scales of Early Learning. Social communication and repetitive behaviors associated with autism were coded from 10-minute free play parent-child videos using the Brief Observation of Social Communication Change (BOSCC), yielding total social communication, restricted/repetitive behaviors scores, and overall total scores. An EF score was derived from a test battery that included measurements of set-shifting, working memory, inhibition, and delay. Regression analyses were conducted to assess EF's contribution to autism expression, controlling for cognitive ability.

RESULTS: For 2-year-olds, EF was not related to observed autism behaviors after controlling for cognition. Conversely, for 4-year-olds, EF related to overall behaviors associated with autism observed during parent-child interactions.

CONCLUSION: Findings of an association between EF and autism-related behaviors observed in parent-child interactions by preschool at age 4 but not in toddlerhood at age 2 highlight potential developmental differences in the relation between EF and autism-related behaviors. Longitudinal and experimental research is needed to establish directionality and malleability of EF and autism-related behaviors.

Peripheral neuropathies are common neurological disorders affecting sensory, autonomic, and motor nerves, with an estimated prevalence exceeding 2% in the general population. Typical symptoms include numbness and distal limb muscle weakness, resulting from somatosensory nerve damage. Here, we investigate the genetic architecture of mono- and polyneuropathies and their relationships with comorbid traits using data from FinnGen and the UK Biobank. Our genome-wide association study (GWAS) and meta-analysis identified 48 genome-wide significant (P < 5 × 10-8) independent loci and 66 fine-mapped credible sets. These included associations with genes involved in neurotransmitter signaling (HTR3A), immune function (HLA-DQB1, BCL11A), extracellular matrix remodeling (COL11A1, ADAMTS17, LOXL4), axon guidance and neural development (DCC, ETV1, NEGR1), and carpal tunnel syndrome (DIRC3). Public variant association data across cohorts, genetic correlation, and Mendelian randomization analyses supported shared genetic links of neuropathies with sleep problems, chronic pain, and psychiatric disorders. Together, our results highlight a strong polygenic basis for neuropathies and further confirm their genetic comorbid relationships with sleep, pain, psychiatric, and autoimmune traits.

BACKGROUND: Evans syndrome (ES) is a rare immune-mediated disorder involving two or more cytopenias, including immune thrombocytopenia (ITP), autoimmune hemolytic anemia, and/or immune neutropenia. ES may occur secondary to another condition or be idiopathic. While consensus recommendations exist for adults, there is no standardized diagnostic approach for pediatric Evans syndrome (pES). This study aimed to describe typical diagnostic evaluations conducted by clinicians caring for pES patients.

METHODS: A cross-sectional survey of the Pediatric ITP Consortium of North America (ICON) assessed typical diagnostic workup for pES, the influence of clinical features on testing, evaluation for underlying disorders, including immune defects and autoimmune disease, subspecialty involvement, and genetic testing practices.

RESULTS: Sixty percent (28/47) of respondents reported performing the same evaluation for all pES patients. There was no consensus on specific diagnostic tests. Providers consistently evaluated for autoimmune conditions, but varied in testing for inborn errors of immunity (IEI). Rheumatology and immunology were most often consulted. Most respondents (85%, n = 40) obtained genetic testing through commercial laboratories, frequently encountering insurance-related barriers.

CONCLUSIONS: Even among experts, diagnostic approaches to pES vary widely. Standardized frameworks are needed to guide comprehensive evaluation for this complex disorder.

Hospitalist-focused training (electives, rotations, pathways, and tracks) evolved to address gaps in residency training pertinent to Hospital Medicine (HM). The Immersion in Hospital Medicine Elective (IHME) at Beth Israel Deaconess Medical Center immerses residents in curricular elements fundamental to HM, particularly clinical operations and healthcare economics. We surveyed IHME participants to evaluate the curriculum and characterize its impact on participants' professional development. Throughout the IHME's 20-year course, 120 residents participated, and 76 (63%) completed our survey. The majority practice HM (45, 63%) and viewed the IHME as valuable to their career preparation (36, 63%). The IHME bridged important gaps in medical knowledge and clinical skills development, such as the business of medicine, clinical operations, and creating a clinical staffing model. Most participants (59, 78%) attained key leadership positions, especially in medical education and clinical operations. Our study bolsters evidence that hospitalist-focused training in residency effectively prepares residents for adult HM practice.

Gene-environment interactions may enhance our understanding of blood pressure (BP) biology. We conducted a meta-analysis of multi-population genome-wide association studies (GWASs) of BP traits accounting for gene-depressive symptomatology (DEPR) interactions. Our study included 564,680 adults from 67 cohorts and four population backgrounds: African (5%), Asian (7%), European (85%), and Hispanic (3%). We discovered seven previously unreported BP loci showing gene-DEPR interaction. These loci mapped to genes implicated in neurogenesis (TGFA and CASP3), lipid metabolism (ACSL1), neuronal apoptosis (CASP3), and synaptic activity (CNTN6 and DBI). We also showed evidence for gene-DEPR interaction at nine known BP loci, further suggesting links between mood disturbance and BP regulation. Of the 16 identified loci, 11 were derived from non-European populations. Post-GWAS analyses prioritized 36 genes, including genes involved in synaptic functions (DOCK4 and MAGI2) and neuronal signaling (CCK, UGDH, and SLC01A2). Integrative druggability analyses identified 11 druggable candidate gene targets linked to pathways involved in mood disorders as well as known anti-hypertensive drugs. Our findings emphasize the importance of considering gene-DEPR interactions on BP, particularly in non-European populations. Our prioritized genes and druggable targets highlight biological pathways connecting mood disorders and hypertension and suggest opportunities for BP drug repurposing and risk factor prevention, especially in individuals with DEPR.