Faculty Bibliography

BACKGROUND:Oral pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) provision via online pharmacies (henceforth online PrEP and PEP) offers promise in increasing biomedical HIV prevention coverage. In this study, we aimed to estimate the cost-effectiveness of online PrEP and PEP scale-up in western Kenya. METHODS:We adapted a network-based model, EMOD-HIV, to simulate online PrEP and PEP implementation from 2026 to 2036; costs and use of online PrEP and PEP and client characteristics were informed by the ePrEP Kenya pilot study, which evaluated online PrEP and PEP provision in Nairobi and Mombasa, Kenya. Other parameters were obtained from surveillance data and published literature. Eligible clients were aged 15-49 years reporting condomless sex with non-marital partners. We assumed online PrEP and PEP provision was implemented through public-private partnership, with the Kenya Ministry of Health providing PrEP and PEP drugs and service delivery costs paid by the online pharmacy (and charged to clients). We estimated HIV infections, HIV-related deaths, and disability-adjusted life-years (DALYs) averted compared with the baseline scenario of background oral PrEP only. We calculated incremental cost-effectiveness ratios (ICERs) assessing only costs incurred by the Kenya Ministry of Health over 35 years and used a supply-side threshold of US$500 per DALY averted. We calculated 95% uncertainty intervals (UIs) across 100 parameter sets. FINDINGS/RESULTS:Online PrEP and PEP was projected to reach population coverage of 0·7% (95% UI 0·7-0·8) for PEP and 0·3% (0·2-0·3) for PrEP and avert 13·9% (10·1-17·1) of HIV infections over 10 years. HIV-related deaths were reduced by 4·3% (95% UI 2·0-6·9) over the 35-year time horizon. The intervention was cost-effective from the Kenya Ministry of Health perspective (ICER $212 [95% UI 15-1409] per DALY averted). In a scenario assuming only online PEP availability (to isolate the effect of PEP), 11·6% (95% UI 8·6-15·2) of HIV infections were averted (ICER $210 [95% UI 41-3798] per DALY averted). The intervention remained cost-effective when varying PrEP and PEP effectiveness and assuming HIV testing and treatment disruptions. INTERPRETATION/CONCLUSIONS:Online PrEP and PEP can avert substantial HIV infections, even with low population coverage. PEP was responsible for most intervention health benefits, likely due to high observed demand for PEP compared with PrEP in the pilot study. Leveraging private retailers can be efficient for scaling up HIV prevention in an era of shrinking donor funding. FUNDING/BACKGROUND:Gates Foundation.

PURPOSE/UNASSIGNED:This study describes the patient-centered approach to hearing technology selection and fitting of the participants randomized to a best practice hearing intervention as part of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study (ClinicalTrials.gov identifier NCT03243422). We evaluated associations between hearing technology with daily hours of hearing aid use and listening and communication goal achievement. METHOD/UNASSIGNED:technology levels, and offered at least one hearing-assistive technology (HAT). The Client-Oriented Scale of Improvement (COSI) was used to identify listening needs that guided intervention delivery and was used to assess attainment of hearing-related goals following ~10-week intervention period. Hearing aid datalogging was used to measure hours of daily wear. We estimated the association between hearing aid technology level, HATs, hours of wear, and COSI goal attainment using an ordered logistic model adjusting for auditory and sociodemographic characteristics. Proportionality odds assumption was checked for all models. RESULTS/UNASSIGNED:= 9.3 hr across all participants) and did not differ between hearing technology (levels or HATs). Participant COSI goals, which included categories such as conversation in noise and in quiet or attending church and/or meetings, improved and were not dependent on technology used. Participants benefited from patient-centered hearing intervention, and there were no statistically significant associations among hearing aid technology level, HATs, hours of use, and change in COSI goals. CONCLUSIONS/UNASSIGNED:The patient-centered selection of hearing technology used in the ACHIEVE study resulted in high levels of hearing aid and HAT usage, along with positive COSI listening goal attainment for the majority of participants. Carefully assessed and selected technology is needed to meet individual auditory rehabilitation needs. SUPPLEMENTAL MATERIAL/UNASSIGNED:https://doi.org/10.23641/asha.32069253.

IntroductionBleeding and thrombosis are major causes of morbidity and mortality in pediatric extracorporeal membrane oxygenation (ECMO), yet their evolving, time-dependent risks remain poorly defined. This study evaluated clinical predictors of bleeding and thrombotic events using time-to-event analysis.MethodsA retrospective cohort study was conducted using the Pediatric ECMO Outcomes Registry (PEDECOR) from October 2011 to September 2024. Patients aged ≤18 years undergoing their first ECMO run were included. Two time-varying Cox proportional hazards models assessed associations between prior complications and time to first bleed or thrombosis, adjusting for clinical and ECMO-related variables.ResultsAmong 1444 patients, median age was 0.4 years (IQR: 0.0-4.4), and 53.6% were male. Bleeding occurred in 65% and thrombosis in 28%. Time to first bleeding events had a median of 2 days (IQR: 0-4) while time to first thrombosis had a median of 3 days (IQR: 2-6). Prior thrombosis was associated with lower early bleeding risk (HR: 0.39, 95% CI: 0.25-0.62, p < 0.001), which reversed over time (interaction HR: 1.44, 95% CI: 1.08-1.92, p = 0.013; crossover at 12.4 days). Similarly, prior bleeding was associated with reduced early thrombosis risk (HR: 0.49, 95% CI: 0.34-0.71, p < 0.001), but reversed over time (interaction HR: 1.63, 95% CI: 1.26-2.11, p < 0.001; crossover at 4.3 days). Central cannulation, cardiac surgery, and non-pulmonary indications were associated with bleeding; sepsis was associated with thrombosis. Anticoagulant type and sex were not significant.ConclusionsBleeding and thrombosis are common and time-dependent in pediatric ECMO. These findings support dynamic anticoagulation strategies tailored to evolving risk.

Saliva has emerged as a compelling liquid biopsy for the non-invasive diagnosis and monitoring of both oral and systemic diseases. Secreted by major and minor salivary glands and enriched by gingival crevicular fluid, epithelial turnover, immune mediators, microbial products, and plasma-derived constituents, saliva reflects a biologically integrated interface between local oral environments and systemic physiology. This dual origin enables detection of disease-associated signals across multiple molecular layers, including extracellular RNA, cell-free DNA, genomic and epigenetic material, proteins, metabolites, microbial signatures, and hormones. Advances in high-throughput sequencing, mass spectrometry, and ultrasensitive immunoassays have revealed that salivary analytes can capture dynamic pathological processes ranging from periodontal inflammation and dental caries to oral and head and neck cancers, as well as systemic conditions such as non-oral cancers and autoimmune, cardiometabolic, infectious, endocrine, and neurodegenerative diseases. In particular, extracellular vesicle-encapsulated RNA, cfDNA fragmentomics, and methylation patterns have expanded the diagnostic reach of saliva beyond conventional protein-based biomarkers, while integrated multi-omics approaches increasingly improve diagnostic performance. Despite this progress, clinical translation remains constrained by biological complexity, including variable glandular contributions, oral microbiome interactions, and pre-analytical variability in collection and processing. Emerging point-of-care technologies, microfluidic platforms, and artificial intelligence-driven multi-omic integration are beginning to address these limitations, enabling higher analytical sensitivity and improved disease stratification. Regulatory pathways, including in vitro diagnostic frameworks and laboratory-developed test structures, are progressively accommodating salivary assays, as demonstrated during the COVID-19 pandemic. However, widespread clinical adoption will require rigorous standardization, large-scale validation, and demonstration of clinical utility. Together, saliva-based liquid biopsy represents a rapidly evolving diagnostic paradigm with the potential to shift disease detection towards earlier, minimally invasive, and data-rich precision medicine approaches across dentistry and systemic healthcare.

OBJECTIVES/OBJECTIVE:Generative artificial intelligence (AI) holds promise for creating patient education materials (PEM). However, AI-produced content is often difficult to read. Prompts for AI to write at a lower reading level either fail to meet recommended targets (≤6th grade) or demonstrate inconsistent results. We aimed to determine whether a new AI prompt for plain language would create PEMs that are easier to read, understand, and act upon. METHODS:We analyzed PEMs from two websites (HealthyChildren.org, UpToDate) and two generative AI programs (ChatGPT, Gemini). For each AI program, we used a basic prompt and an advanced prompt to generate separate documents. From these sources, we collected six sets of PEMs about five acute pediatric conditions, evaluated them using a panel of readability indices, and used ANOVA to compare average readability scores between sources. Two pediatricians assessed understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). We calculated mean PEMAT scores, with values > 70% considered understandable/actionable. RESULTS:ChatGPT (advanced prompt) created PEM with the lowest mean grade reading level (5.8; SD 0.84) and highest PEMAT scores (91% understandable, 84% actionable). Documents from generative AI using the advanced prompt and UpToDate had mean readability scores ≤ 6th grade, with significantly better readability than AI-generated documents using the basic prompt or HealthyChildren.org. All sources except HealthyChildren.org had mean understandability > 70%; AIs using the advanced prompt and UpToDate exceeded the actionability threshold. CONCLUSIONS:A plain-language prompt for generative AI created PEMs that were readable, understandable, and actionable, with comparable results across two AI programs. PRACTICE IMPLICATIONS/CONCLUSIONS:Healthcare providers can use this new plain-language prompt for generative AI programs to quickly create free, patient-friendly PEM about acute healthcare topics. As these AI programs were not trained to provide medical guidance, medical professionals should continue to review PEM prior to sharing with patients.

OBJECTIVES/OBJECTIVE:To evaluate the effect of a proprietary motion artifact correction algorithm on CBCT spatial resolution using an in vitro phantom model. STUDY DESIGN/METHODS:Fifty CBCT scans were acquired with a ProMax 3D unit using a point spread function phantom mounted on a motorized turntable. Ten protocols were tested, including no motion and induced motion up to 9 degrees, with and without activation of the correction algorithm. Spatial resolution was assessed using full width at half maximum (FWHM), surface plots, fast Fourier transforms, pairwise comparisons, and Bland-Altman analysis. RESULTS:Motion increased FWHM values and distorted the point spread function, with greater irregularity as motion magnitude increased. The correction algorithm produced partial improvement in selected motion protocols, particularly at lower motion magnitudes, but the effect was inconsistent across all motion conditions and measurement directions. In the no-motion protocol, activation of the algorithm introduced slight unsharpness and increased heterogeneity in the high-frequency domain. CONCLUSION/CONCLUSIONS:Patient motion degrades CBCT spatial resolution. The proprietary correction algorithm may provide partial improvement under selected conditions, particularly at lower motion magnitudes, but it does not replace the need for careful patient stabilization during image acquisition and should be used cautiously when motion is unlikely.