Publications by Year: 2026

The Association of Chiefs and Leaders of General Internal Medicine (ACLGIM), a group of division chiefs and other division leaders within the Society for General Internal Medicine (SGIM), convened the Hess Initiative Work Group on Learner Experience in Primary Care in 2023 to (1) identify the gaps between the current state of resident continuity clinic and current standards for a high-functioning primary care setting, (2) review the evidence to identify solutions, and (3) develop a set of evidence-based recommendations. These recommendations align with the current Accreditation Council for Graduate Medical Education (ACGME) IM milestones, with the goal to improve the experience of resident continuity clinic and meet the needs of the three key stakeholders of GME: residents, patients, and the healthcare system. We recruited experts in internal medicine ambulatory training from across the country, representing a variety of US regions, membership in professional societies and organizations related to internal medicine, community and academic settings, and residency program sizes during national and regional meetings at SGIM between 2023 and 2025. Using standard frameworks of high-functioning primary care practice, we performed an extensive review of the literature to identify discrepancies between these standards and resident continuity clinics, then, using the expertise of the group, produced a set of recommendations, which were reviewed and endorsed by the SGIM Council in September 2025.

BACKGROUND: Over the past decade, emerging evidence has shed light on the role of the gut microbiota in the interface between diet and brain health. Olive oil, particularly virgin olive oil, a key component and major fat source in the Mediterranean diet, has exhibited widespread healthful benefits, including improvements in gut microbiota and cognitive health. Despite insights from preclinical studies into the relationship between virgin olive oil consumption, gut microbiota, and cognitive function, human research in this area remains limited. Therefore, our study aims to investigate the interplay between total olive oil consumption and its subtypes, gut microbiota, and changes in cognitive function in older adults who were cognitively healthy at baseline but at high risk of cognitive decline.

METHODS: In this prospective cohort study, we assessed a total of 656 participants aged 55 to 75y (mean age 65.0 ± 4.9y, 47.9% women) with overweight/obesity and metabolic syndrome who provided stool samples and completed a validated semi-quantitative food frequency questionnaire at baseline and a comprehensive battery of neuropsychological tests at baseline and at a 2-y follow-up.

RESULTS: Results from the multivariable linear regression models showed that higher consumption of virgin olive oil was associated with improved cognitive function over a 2-y follow-up, and a more diverse gut microbiota overall structure at baseline. Conversely, increased consumption of common olive oil is linked to lower alpha diversity of the microbial communities, and accelerated cognitive decline. Mediation analysis suggests that gut microbiota and particularly the Adlercreutzia, may serve as a mediator taxon in the association between virgin olive oil consumption and positive changes in general cognitive function.

CONCLUSIONS: Higher consumption of virgin olive oil was associated with cognitive preservation, possibly mediated by favorable alterations in gut microbiota composition. Our study provides novel insights into the complex interplay between different types of olive oil consumption, gut microbiota, and changes in cognitive function. These findings underscore the potential of microbiota-targeted dietary strategies to promote cognitive health in aging populations, though further high-quality and clinical cohort studies are required. Video Abstract.

PURPOSE: In the course of diffusion, water molecules encounter varying values for the relaxation-time properties of the underlying tissue. This factor, which has rarely been accounted for in diffusion MRI (dMRI), is modeled in this work, allowing for the estimation of the gradient of relaxation-time properties from the dMRI signal.

METHODS: With the aim of mining the dMRI data for information about spatial variations in tissue relaxation-time properties, a new mathematical relationship between the diffusion signal and the spatial gradient of the image is derived, enabling the estimation of the latter from the former. The hypothesis was validated on human brain dMRI images from three datasets: the public Human Connectome Project Young Adults database, 10 healthy volunteers and 1 ex vivo sample scanned in-house with stimulated-echo diffusion encoding and a long diffusion time of 1 s (which we have made publicly available), and three subjects from the public Multi-TE database. The effects of the confounding factor of "fiber continuity" were furthermore measured.

RESULTS: The spatial image gradient estimated from the diffusion signal was compared to the gold-standard spatial gradient approximated using the finite difference method. The former gradient was significantly related to the latter in all datasets (i.e., with a difference significantly smaller than chance), with an effect distinct from fiber continuity.

CONCLUSION: The results support the hypothesized relationship between within-voxel dMRI signal and image gradient, with an effect that was not explainable by the confounding factor of fiber continuity.

OBJECTIVE: Determine the lowest level of functional recovery after severe traumatic brain injury (TBI) that is perceived to be acceptable by persons with TBI and TBI caregivers.

DESIGN: Cross-sectional crowdsourcing online survey disseminated May-July 2024.

SETTING: United States.

SUBJECTS: Persons with a history of TBI requiring assistance with basic daily activities and TBI caregivers.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULT: We developed an expanded version of the Glasgow Outcome Scale-Extended to determine the acceptability of 11 TBI outcome milestones and identify the minimally acceptable outcome (MAO). The survey was completed by 252 persons with TBI (mean [ sd ] 39.8 [13.5] yr old; 67% female; 75% White; 11.9 [12.0] yr post-TBI) and 256 TBI caregivers (41.0 [12.1] yr old; 57% female; 65% White). Among the outcomes selected most frequently as the MAO by persons with TBI ("recovery of basic yes/no communication" and "conscious, but does not communicate") and TBI caregivers ("recovery of basic yes/no communication" and "alive, but permanently unconscious"), recovery of yes/no communication was rated as acceptable by more respondents (persons with TBI: 36% vs. 12%; Z = -7.1, p < 0.0001; TBI caregivers: 40% vs. 14%; Z = -7.1, p < 0.0001). Recovery of communication was therefore identified as the MAO by both cohorts. This outcome was rated as acceptable or somewhat acceptable by 65% of persons with TBI and 72% of caregivers. All outcomes ranging from "alive, but permanently unconscious" to "partially independent in the home" were selected as the MAO significantly more frequently than "completely independent in the home," a common "favorable" recovery cutoff.

CONCLUSIONS: Persons with TBI and TBI caregivers identified recovery of communication as the MAO. Persons with lived experience appear more accepting of a greater burden of disability than TBI investigators and providers. Recognizing this disparity in perspectives may influence clinical decision-making regarding goals of care and suggests the need for a more person-centered approach to TBI outcome assessment.

BACKGROUND: Effective anti-obesity interventions that preserve lean mass are of increasing clinical significance for optimizing metabolic health. This study investigated whether lorcaserin, a centrally acting weight loss agent, modifies body composition, circulating lipidomic profiles, and muscle-regulating hormones within the myostatin-activin-follistatin-IGF-1 (MAFI) axes.

METHODS: Forty-eight adults with obesity were randomized to lorcaserin (10 mg twice daily) or placebo for 6 months in a double-blind trial. Regional body composition, hormones and lipidomics were assessed. Changes were analysed using linear mixed models with fixed effects for time, treatment and interaction. Adjusted deltas and endpoints were compared by analysis of covariance controlling for baseline body mass index. Lipidomic profiles were analysed using principal component and partial least-squares discriminant analyses.

RESULTS: Lorcaserin reduced total body weight (time*treatment, p = 0.004). Adjusted delta and endpoint comparisons showed reductions in total body (p = 0.031) and abdominal fat mass (p = 0.002). Lipidomic assessments revealed primarily lower levels of triglyceride-rich lipoproteins with treatment. No significant changes in MAFI axes components were detected in linear mixed models.

CONCLUSIONS: Lorcaserin treatment was associated with greater abdominal fat mass loss, favourable lipid profile changes, while MAFI components remained largely unaffected. Lorcaserin may improve cardiometabolic health primarily through reductions in central adiposity.

Implantable bioelectronic devices, due to their prolonged contact with biological tissues, face persistent challenges including moisture permeation, mechanical deformation, and biofouling. Traditional encapsulation strategies using either inorganic or organic materials face trade-offs between moisture barrier performance and mechanical flexibility. Inorganic materials provide excellent moisture resistance but are brittle, whereas organic polymers are flexible but inherently permeable. Here, we developed a Multi-layered Organic-based Liquid Encapsulation (MOLE) specifically tailored for implantable bioelectronics. MOLE consists of a layer-by-layer assembly of amine-functionalized silicone elastomer and Parylene-C, forming chemically bonded and conformal interfaces with enhanced interfacial adhesion. The outermost silicone layer, infused with silicone oil, minimizes protein adsorption (<1%), resists biofilm formation (sliding angle <10°), and prevents adhesion of inflammatory cells and proteins, thereby reducing acute inflammation. This hybrid architecture achieves an 86-fold improvement in adhesion strength compared to conventional Parylene-C coatings and significantly enhances mechanical robustness under dynamic deformation. In addition, MOLE provides superior moisture and ion barrier properties. Accelerated aging tests at 85°C demonstrated a 160-fold increase in insulation lifetime over Parylene-C, equivalent to approximately 445 h at physiological temperature (37°C). Furthermore, in vivo studies using a degradable magnesium antenna demonstrated stable encapsulation, minimal interfacial disruption, and strong resistance to biological degradation over time.

The management of brain metastases is increasingly complex and requires multidisciplinary input from a wide array of experts, including radiation oncology, medical oncology, neurosurgery, and palliative care. Novel radiation techniques, radiosensitization, combination approaches with systemic therapy and approaches to penetrate or bypass the blood-brain barrier represent some of the more promising strategies that have the potential to improve outcomes of brain metastases patients. A better understanding of the biology and development of brain metastases may allow for greater efforts towards prevention. Rigorous, well-designed clinical trials addressing specific challenges of the brain metastasis population will be necessary to evaluate these novel approaches.

Clear cell adenocarcinoma of the urinary tract is a rare subtype of urethral/bladder cancer that is classified as a Müllerian-type tumor and is typically associated with more aggressive behavior and worse prognosis. Individuals with underlying congenital defects involving the urinary system are known to be at an increased risk for bladder cancer in general; however, it is currently unknown whether patients with aberrant Müllerian and Wolffian duct regression and/or persistence, in addition to urinary anomalies, are at an increased risk for developing Müllerian-associated urinary tumors. In this case report, we present an extremely rare and unusual diagnosis of clear cell adenocarcinoma of the urinary tract arising in a male individual with Opitz syndrome, a congenital malformation disorder affecting multiple organ systems, including urogenital development. This presentation represents the first report of a urothelial tumor of Müllerian type occurring in a male individual with a urogenital congenital disorder.

STUDY OBJECTIVE: Pediatric data on health care utilization following disasters are limited, with most studies focused on adults. This study evaluated changes in pediatric emergency department (ED) volumes, hospital admissions, and diagnoses following Major Disaster Declarations by the Federal Emergency Management Agency.

METHODS: This was a retrospective observational analysis of patients aged ≤18 years presenting to a Pediatric Health Information System-participating ED between 2010 and 2023. We paired each Pediatric Health Information System ED with any major disaster that occurred within 50 miles of the ED. For each ED-disaster pair, we analyzed changes in weekly ED visits, admissions, and diagnoses for weeks 1 to 4 after the disaster. We report mean counts (SD) and percent changes (95% confidence interval), stratified by the 5 disaster types (severe storm/flood, snow/ice storm, fire, tornado, and earthquake).

RESULTS: Across 288 Major Disaster Declarations over 14 years, there were 409 ED-disaster pairs. For all disaster types, ED visits and admissions showed modest week 1 declines followed by a return to baseline levels. Tornadoes were associated with consistent decreases in ED visits over all 4 weeks, whereas snow/ice storms, severe storms/floods, and earthquakes demonstrated early decreases followed by recovery. Fires were associated with sustained increases, particularly for respiratory diagnoses. Admissions declined after tornadoes, with smaller decreases after snow/ice storms and earthquakes, whereas remaining stable after severe storms/floods and fires.

CONCLUSION: Pediatric ED utilization generally declined modestly after most disasters but increased following fires, driven by respiratory presentations. Declines likely reflect disruptions in access and care seeking, whereas fire-related surges highlight distinct respiratory effects. Preparedness efforts should incorporate event and diagnosis-specific trends to support continuity of operations and capacity for brief surges when they occur.