Faculty Bibliography

BACKGROUND:School-based caries prevention programs are clinically and cost-effective public health approaches to increase access to essential oral healthcare for high-risk children. However, approximately 1 in 4 children participating in school caries prevention fail to respond to care, remaining at risk for dental caries and related sequela. METHODS:The Building Adaptive School-based Interventions for Caries study (BASICS) will develop and test adaptive preventive interventions using a Sequential, Multiple Assignment, Randomized Trial (SMART) design, reducing treatment nonresponse by incorporating personalized medicine into school caries prevention. Children will receive a first-stage treatment of either silver diamine fluoride or glass ionomer dental sealants and atraumatic restorations. At subsequent observations, the primary outcome of reoccurrence or new presentation of dental caries will be used as a tailoring variable for treatment nonresponse. Nonresponsive participants in either first-stage pathway will subsequently receive either (1) reapplication of initial treatment plus fluoride varnish and receipt of an electronic toothbrush or (2) an intensified Silver Modified Atraumatic Restorative Technique. The targeted enrollment is 1200 children from primarily low-income rural families enrolled in kindergarten through third grades in public primary schools. DISCUSSION/CONCLUSIONS:Primary study objectives of BASICS include determining the most effective initial treatment for caries prevention and sequence of treatments to reduce nonresponse, identifying the optimal dynamic treatment regime given patient attributes, and estimating the most cost-efficient allocation of resources for adaptive school-based caries prevention. If successful, BASICS will result in a resource-efficient approach to school dental care that optimizes resources matched to patient needs. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov #NCT07265830, Registered on 12/4/25. https://www. CLINICALTRIALS/RESULTS:gov/study/NCT07265830.

INTRODUCTION/BACKGROUND:Within the kidney transplant community, there is growing recognition of the importance of treating obesity to improve access to and outcomes of kidney transplant. We sought to assess kidney transplant professionals' attitudes and practices regarding obesity management. METHODS:The American Society of Transplantation Kidney Pancreas Community of Practice Obesity Workgroup developed and administered a web-based survey to a broad audience of healthcare professionals working with potential kidney transplant candidates and recipients. RESULTS:With 275 respondents from 113 kidney transplant programs representing >70% of US kidney transplant volume, we found that only 68% of kidney transplant programs with a weight management program reported access to an obesity medicine specialist. Among programs that prescribe anti-obesity medications, the majority prescribe nutrient-stimulated hormones, while few utilize other agents. Most kidney transplant professionals prefer that obesity medicine physicians lead obesity management in their patients; however, 74% reported that access to weight management programs was extremely or somewhat difficult, with 64% citing long wait times for an appointment as the main barrier to care. CONCLUSIONS:Kidney transplant professionals believe that obesity medicine physicians are best suited to lead obesity treatment for their patients, though access to this care appears to be a major barrier.

INTRODUCTION/BACKGROUND:Inflammatory bowel disease (IBD) is a chronic inflammatory condition affecting approximately 2.39 million individuals in the USA. IBD is associated with extraintestinal manifestations (EIMs), among which pericarditis is prominent, comprising 70% of cardiac EIMs. The onset of pericarditis in these patients is primarily attributed to IBD medication-related adverse effects and is predominantly documented through case reports. This highlights the need for an epidemiological study in a large, propensity-matched cohort, given the significant morbidity and mortality of pericarditis. METHODS:Using the National Institutes of Health's (NIH) All of Us Research Program, we conducted a cross-sectional study and propensity-matched 5,178 IBD cases to 15,534 controls (1:3). We compared demographics, clinical characteristics, prevalence of autoimmune diseases, and rates of pericarditis. Logistic regressions assessed the association between IBD and pericarditis, adjusting for confounders (p < 0.15), and a sensitivity analysis confirmed the association (p < 0.001). A Kaplan-Meier analysis compared the incidence of pericarditis in various IBD severity cohorts, including mild (n = 620) and moderate/severe (n = 1,908), stratified by IBD medication exposure. RESULTS:Pericarditis was significantly more prevalent in IBD cases (1.3% vs. 0.6%; absolute risk difference 0.7%, 95% confidence interval [CI]: 0.37%-1.03%), with significant associations in univariable (odds ratio [OR] 2.2, 95% CI: 1.6-3.0, p < 0.001) and multivariable (OR 1.9, 95% CI: 1.3-2.6, p < 0.001) analyses. IBD preceded pericarditis in 65% of cases. There was no difference in pericarditis-free survival between mild and moderate/severe cohorts (p = 0.90). CONCLUSION/CONCLUSIONS:This study uniquely provides evidence of a significant association between IBD and pericarditis, establishing pericarditis as a clinically significant EIM in a large, diverse US cohort, independent of disease severity. This highlights the need for heightened screening to enhance pericarditis management and patient outcomes.

OBJECTIVES/OBJECTIVE:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN/METHODS:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.

IMPORTANCE/UNASSIGNED:There is an urgent need for algorithm trials that address treatment steps in schizophrenia sequentially. Moreover, there is a debate about whether clozapine should be used after 1 failed antipsychotic drug trial. OBJECTIVE/UNASSIGNED:To investigate whether switching to clozapine is effective in patients with first-episode psychosis (FEP) who have not responded to 1 previous antipsychotic drug. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This was a sequential, assessor-blind trial with 2 randomizations conducted across 7 centers in China from February 2019 to October 2022. Included were individuals aged 16 to 45 years and with FEP (schizophrenia, schizophreniform disorder, or schizoaffective disorder). In phase 1, patients with FEP were randomized to receive oral olanzapine, risperidone, amisulpride, aripiprazole, or perphenazine for 8 weeks. In phase 2, nonresponders were rerandomized to receive olanzapine, amisulpride, or clozapine for another 8 weeks. Responders entered a 1-year naturalistic follow-up. Study data were analyzed from February to August 2025. INTERVENTIONS/UNASSIGNED:Specific antipsychotic drugs. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcomes were as follows (1) symptomatic response, defined as the proportion of patients achieving a greater than or equal to 40% reduction in Positive and Negative Syndrome Scale (PANSS) total score and (2) time to all-cause discontinuation, defined as discontinuation of antipsychotic drugs for any reason. RESULTS/UNASSIGNED:A total of 762 participants were randomized, and 654 (mean [SD] age, 26.9 [7.5] years; 328 male [50.2%]) were eligible for the study. Of the eligible participants, 556 (85.4%) completed phase 1, and 359 (55.1%) responded to treatment. Response rates were 60.5% (78 of 129) for olanzapine, 63.4% (83 of 131) for risperidone, 61.8% (81 of 131) for amisulpride, 44.3% (58 of 131) for aripiprazole, and 45.7% (59 of 129) for perphenazine (χ2 = 18.3; P = .001). In phase 2, 111 nonresponders were rerandomized (41 taking olanzapine, 38 taking amisulpride, and 32 taking clozapine). A total of 92 patients (82.9%) completed phase 2, and the following achieved a response: 13 (31.7%) taking olanzapine vs 17 (44.7%) taking amisulpride and 20 (62.5%) taking clozapine (χ2 = 6.9; P = .03). CONCLUSIONS AND RELEVANCE/UNASSIGNED:The majority of patients with FEP responded to an initial antipsychotic drug trial, with risperidone and amisulpride being superior to aripiprazole and perphenazine. In those who initially did not respond to antipsychotic treatment, clozapine was more efficacious than olanzapine and amisulpride based on the PANSS ratings criteria outcome. This study provides some evidence for clinicians to consider regarding use of clozapine as the next sequential treatment after patients have failed an adequate trial with 1 of the more traditional antipsychotics. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03510325.

INTRODUCTION/BACKGROUND:The rapid integration of generative artificial intelligence (GenAI) into academic research has prompted ethical and regulatory concerns, particularly regarding its responsible use in scholarly publishing. Despite emerging recommendations from international organizations such as the Committee on Publication Ethics (COPE) and the International Committee of Medical Journal Editors (ICMJE), journal-specific guidance remains inconsistent. METHODS:This study evaluated the presence and characteristics of GenAI-related policies across 92 dermatology journals indexed in the 2024 Journal Citation Reports. Four reviewers independently assessed author instructions and publisher policies, collecting journal metrics, and applying logistic regression to explore associations with guideline adoption. RESULTS:GenAI-specific guidance was found in 82.6% of journals, with 60.5% linking to publisher-level policies. Most journals (90.8%) prohibited GenAI authorship and required author accountability, yet only 2.6% referenced ICMJE guidance. Disclosure of GenAI use was mandated by 98.7%, although only a minority required specification of tool version (28.0%) or manufacturer (17.3%). GenAI image generation was addressed in 55.3% of policies, with ChatGPT mentioned by 46.1% of journals. COPE membership and use of COPE AI guidance were significantly associated with the presence of journal-level GenAI policies. While journals with GenAI guidance exhibited higher impact and citation metrics in univariable analysis, no predictors remained significant in multivariable models. CONCLUSION/CONCLUSIONS:These findings highlight broad yet uneven adoption of GenAI policies in dermatology publishing. Gaps in specificity, transparency, and alignment with international standards may pose risks to research integrity, emphasizing the need for clearer, standardized, and field-specific editorial guidance on GenAI use.

OBJECTIVES/OBJECTIVE:Fentanyl test strips (FTS) have the potential to moderate drug use behavior amidst an unregulated drug supply, yet are underutilized in medical settings. We aimed to describe emergency department (ED) FTS distribution across a large NYC health system and examine characteristics associated with clinicians' ordering FTS compared with the current standard-of-care, take-home naloxone (THN), to identify opportunities to optimize FTS distribution. METHODS:We conducted a retrospective review of THN and FTS provision across a large urban health system in its first year of FTS distribution. We evaluated the demographic and clinical characteristics of visits in which clinicians ordered FTS, compared with THN only. RESULTS:From July 20, 2022 to July 20, 2023, 237 (of 423) clinicians ordered THN for 1279 unique individuals in 1376 eligible visits (436 with FTS, 940 without). In pairwise analysis, FTS receipt was associated with being male, younger, non-White, lacking commercial insurance; substance-related or overdose-related visit chief complaint or diagnosis, attending physician, and patient-directed discharge ( P <0.05 for each). In multivariable regression, higher odds of FTS receipt were associated with male gender (OR=2.4; 95% CI=1.8-3.5), a substance-related chief complaint (OR=2.0; 95% CI=1.2-3.2) or visit diagnosis (OR=5.5; 95% CI=3.8-8.0), and overdose visit diagnosis (OR=1.7; 95% CI=1.1-2.8). Lower odds of FTS receipt were associated with older age (OR=0.98; 95% CI=0.97-0.99), noncommunity hospital sites (OR=0.71; 95% CI=0.60-0.83), and non-attending clinicians (OR=0.83; 95% CI=0.69-0.98). CONCLUSIONS:Integrating FTS into an existing ED THN program was feasible without disrupting clinical workflow. ED encounters where FTS were dispensed differed significantly from THN-only, revealing opportunities to optimize FTS ordering.