Digital Commons Network^™

J Mich Dent Assoc November 2025

The Journal of the Michigan Dental Association

Each month, the Journal of the Michigan Dental Association delivers news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. It remains the main publication reaching Michigan dentists and is available worldwide through ADA Commons.

The November 2025 (Volume 107, No. 11) issue of the Journal is published in both hard copy and with a digital-only format to provide updates and insights for Michigan's oral health community and MDA members. Print editions will resume in November.

The November issue focuses on membership along with a reprinted clinical article on the Oral Manifestations …

Dentistry And The Law: There Will Be No Ban On Covenants Not To Compete, Daniel Schulte Jd

The Journal of the Michigan Dental Association

The Federal Trade Commission (FTC) voted on September 5, 2025, to accept a federal court ruling that it had exceeded its authority in proposing a ban on covenants not to compete (CNTCs), ending two-and-a-half years of speculation. Consequently, the enforceability of CNTCs will primarily be determined by Michigan statutory and common law. Guidelines for drafting enforceable CNTCs include setting a reasonable term, typically two years or less for employees, though purchase agreements may allow up to five years. The restricted geographic territory must be limited to what is necessary to protect the practice’s current patient population, such as a 10-mile …

Stronger Together: The Case For Mda Membership, Cheri Newman Dds

The Journal of the Michigan Dental Association

MDA President Dr. Cheri Newman makes the case for membership, arguing that while automatic membership is no longer assumed, the value is essential to the profession. The primary benefit is the collective voice; without organized dentistry (MDA/ADA), dentists would lose advocacy and support, necessitating the eventual reinvention of the system. The COVID-19 pandemic highlighted the MDA's critical role as a trusted source for guidance on mandates and safe reopening. Beyond intangible advocacy, membership offers substantial, practical advantages that can easily cover the cost of dues. These advantages include financial savings on malpractice, liability, health, disability, and life insurance, along with …

Ear Foreign Body, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Child-Taking Justice And The Federal Indian Boarding School Initiative, Diane Marie Amann

Scholarly Works

The focus of this article is the 2022–2024 Federal Indian Boarding School Initiative undertaken the U.S. Executive Branch. The article chronicles this three-year process, which included sessions with survivors and their descendants, and which resulted in a two-volume report, in an apology by President Joe Biden, and in designation of a national memorial at one of the most notorious school sites. This article examines the initiative as an example of “child-taking justice”; that is, as a process of what is called “transitional justice”, done in an effort to redress the takings of children from their community, followed by efforts to …

Attorneys And Ai: How Lawyers Use Artificial Intelligence And Analyze Its Impacts, Matthew I. Hall, Christian Turner, Eddie A. Gomez Schieber, Nathaniel Kite, Ari Schlesinger

Scholarly Works

AI systems are testing lawyers' professional ethics obligations of competence, confidentiality, and candor. In the legal profession, the widespread availability of AI systems presents opportunities, like improving the review of documents during the discovery stage of a lawsuit, and challenges, illustrated by the handful of high-profile incidents where lawyers submitted legal briefs in court citing and describing fictitious cases based on AI-generated output. We conducted interviews with 44 legal professionals in the U.S. to understand how attorneys are making sense of AI technology and the impacts these technologies are having on their profession, legal ethics, and legal institutions. We describe …

Capacity Maximization Through Production Lead Time Reduction Of Company Xyz With The Use Of Dmaic Methodology, Aaron Will G. Delmo, Julius Angelo D.J. Galang, Maria Liezel C. Eusebio

Journal Article

Company XYZ, an industrial printing company, has been declining in capacity and actual output resulting in monthly unrealized revenue. The goal of this study is to maximize the current capacity, decreasing production lead time by at least 12%, with the use of Define, Measure, Analyze, Improve and Control methodology. The focus was set on the offset machine and packaging process which are the most crucial steps based on Pareto Analysis. Fishbone diagram was then utilized to identify the root cause of the problems with the aforementioned processes. These root causes are further assessed using the CNX analysis. The main root …

Development Of A Ux Effectiveness Evaluation Tool For Mental Health Mobile Applications, Stephanie Caridad Dr. Landicho, Maria Aura Teodora C. Matias

Journal Article

This study developed and validated a comprehensive User Experience (UX) evaluation tool specifically designed for mental health mobile applications. User experience plays a critical role in sustaining engagement and effectiveness in digital mental health interventions, yet existing evaluation tools are not tailored to the unique challenges of this domain. Through a multi-phase process, the research identified 12 key domains for evaluation and developed an initial 48-item instrument, which was refined through expert panel review for face and content validity, resulting in 50 items. Pilot testing with 19 participants demonstrated strong internal consistency (Cronbach's alpha = 0.972). Full-scale testing involved 205 …

Single-Cell-Driven Design Of Logic-Gated Car Circuits For Enhanced Solid Tumor Immunotherapy, Sanna Madan, Tian-Gen Chang, Alexandra Harris, Huaitian Liu, Andrew Martinez, Saugato Dhruba, Binbin Wang, Padma Rajagopal, Sanju Sinha, Shahin Sayed

Pathology, East Africa

Background Chimeric antigen receptor (CAR) T-cell therapy has revolutionized cancer immunotherapy for hematological malignancies but faces critical barriers in solid tumors due to tumor antigen heterogeneity and on-target, off-tumor toxicities. Logic-gated multi-antigen targeting using Boolean operators (AND, OR, NOT) represents an emerging precision immunotherapy engineering approach to overcome these challenges.

Methods We developed LogiCAR designer, a genetic algorithm-based computational framework that systematically identifies optimal logic-gated antigen combinations (i.e., ‘circuits’) from single-cell transcriptomics data. The algorithm identifies CAR circuits consisting of 1-5 antigens from 2,758 cell surface proteins, optimizing tumor-targeting efficacy while maintaining stringent safety requirements in normal tissues. …

Refugee Stigma And Its Toll On Mental Health: Development And Validation Of The Refugee Stigma Scale (Rss), Hamed Abdollahpour Ranjbar, Khaled Elazab, Ibrahim Yigit, Fatema Almeamari, Ceren Acartürk, Gülşah Kurt, Janet Turan, Andrea Norcini Pala, Bulent Turan

Student Publications [Scholarly]

Background Unprecedented, forced displacement, especially from conflict and war areas, requires addressing resultant mental health issues. Aim Refugees experience mental and physical health problems due to post-displacement stressors, and the pervasive stigma associated with refugee status can exacerbate these difficulties, highlighting the need for a comprehensive assessment tool to understand various facets of refugee stigma. Method We developed the refugee stigma scale (RSS), consisting of 43 items informed by the literature, qualitative and quantitative data. The scale includes four theoretical dimensions of stigma: perceived community stigma, experienced stigma, anticipated stigma and internalised stigma. To examine convergent validity, validated self-report measures …

A Gis Method To Summarize Changes Among Classes During A Time Series With An Application To Land Cover In Western Bahia, Brazil, Robert Gilmore Pontius, Antonio Victor Galvão Da Fonseca

Geography

Petabytes of raster maps exist that show numerous classes across a series of many time points. Scientists need new methods to summarize the temporal changes so scientists can understand broad patterns and have guidance for how to look deeper into particular places, trajectories, classes, and time intervals. Our manuscript addresses this need by presenting an innovative method that summarizes the temporal changes in terms of a map of four trajectories and bar charts of five components: quantity, allocation exchange, allocation shift, alternation exchange, and alternation shift. An application illustrates the method using 16 land cover classes at 7 time points …

Identification Of Ethanol-Insensitive N-Methyl-D-Aspartate Receptor Glun2a And Glun2b Subunit Mutants With Minimal Alterations In Ion Channel Gating, Claire M. Fellbaum, John L. Mckee, Yulin Zhao, Josephy M. Harris, Danicamae Padua, Rohan Katti, Tarini Mitra, John L. Levahn, Priya Katti, Hong Ren, Robert W. Peoples

Biomedical Sciences Faculty Research and Publications

Background and Purpose

Ethanol inhibits N-methyl-d-aspartate (NMDA) receptors through actions on positions in the membrane-associated (M) domains. Ethanol-insensitive mutant NMDA receptors would be valuable molecular tools for evaluating the roles of NMDA receptors in ethanol actions. However, mutations that decrease ethanol sensitivity also usually alter ion channel gating, which would likely affect glutamatergic synaptic transmission and central nervous system (CNS) function. We selected candidate ethanol-insensitive mutations in the GluN2A and GluN2B subunits with relatively low disruption of ion channel gating: isoleucine substitution at two positions (F636/F637) in M3 of GluN2A and tryptophan substitution at G826 in M4 of GluN2B. …

Neural Network Ensemble For Computing Cross Sections Of Rotational Transitions In H2O + H2O Collisions, Bikramaditya Mandal, Dmitri Babikov, Phillip C. Stancil, Robert C. Forrey, Roman V. Krems, Naduvalath Balakrishnan

Chemistry Faculty Research and Publications

Water (H₂O) is one of the most abundant molecules in the universe and is found in a wide variety of astrophysical environments. Rotational transitions in H₂O + H₂O collisions are important for modeling environments rich in water molecules but they are computationally intractable using quantum mechanical methods. Here, we present a machine learning (ML) tool using an ensemble of neural networks (NNs) to predict cross sections to construct a database of rate coefficients for rotationally inelastic transitions in collisions of complex molecules such as water. The proposed methodology utilizes data computed with a mixed …

The Progression Of Deinstitutionalization And Its Effects On The American South: A Judicial Analysis Of 20th-Century United States Supreme Court Decisions, Eva-Marie V. Jones

Honors College Theses

This thesis explores the effects of four landmark Supreme Court cases on the deinstitutionalization movement in the American south. Previous literature frequently discusses the legislative implications of this era; however, no law is applicable without the interpretation and application of the judiciary, which so often contextualizes the greater public perspective. Rarely has an analysis of judicial decisions involving psychiatric care merged with regional focus, and certainly not in a format accessible to the average individual.

From unmarked graves to abandoned infrastructure, the legacy of historic psychiatric care in the United States has been largely obscured – yet its consequences continue …

Ethics Of Care In Rural Communities: Highlighting The Relational Nature Of Care, Stephanie Scherer

The Rural Educator

No abstract provided.

Exploring An Asset-Based Framework For The Ethics Of Care In Rural Communities, Phillip D. Grant, J. Kessa Roberts, Jamon H. Flowers

The Rural Educator

This article introduces asset-based innovation in rural education (ABIRE) as a framework for rethinking school improvement in rural communities and integrates the ethics of care as a conceptual lens to view improvement efforts. Rather than focusing on external problems or shortcomings, ABIRE centers the strengths, relationships, and resources already present in rural contexts. The framework offers a relational and locally responsive approach to educational change by drawing on principles from the ethics of care, improvement science, and asset-based community development. Through asset mapping, educators and leaders can engage in cycles of inquiry that are grounded in place and driven by …

Designing Research With Care: A Critical Race Nepantlera Methodological Approach To Rural Latinx College Access, Mayra Puente, Lupita Romo-González, Marlene López Torres, Melissa Romero

The Rural Educator

Research has widely documented the lack of educational resources and opportunities available to rural communities. Cognizant of the structural and spatial barriers facing rural communities, this study intentionally employed a critical race nepantlera methodology (CRNM) to mitigate the adverse effects of living in geographically isolated, systemically underinvested rural areas. Rather than perpetuating a false notion of objectivity in research, the research team actively supported rural Latinx students in accessing higher education through a CRNM research design, which prioritizes the well-being of research collaborators over the study. In enacting a CRNM approach, the research team demonstrated care while increasing students’ access …

Creating A Culture Of Safety: A Rural School’S Story, Melissa Rivers, Katie Ralston

The Rural Educator

Post-pandemic measures show increases in mental health concerns, chronic absenteeism, and disciplinary incidents in schools across the US. This article focuses on how a rural school district in western New York, Silver Creek Central School District, is addressing student mental health needs, working to lower absenteeism rates, and increasing student engagement through purposeful programming and support system under the leadership of their superintendent and support from the board of education.

Recovery As Relational Care: Integrating Policy, Education, And Community Resilience In Rural Appalachia, Jon Dance, Josh Thompson

The Rural Educator

Despite national media attention and significant policy investment, substance use epidemics continue to impact Central Appalachia. Inequities affecting rural communities and persistent stigma create significant barriers to well-being and recovery. Recovery, however, is more than a healthcare issue; it is a relational and community-rooted process that must involve education, policy, and care. In this article, we reframe deficit-oriented conceptions of recovery to highlight the vital role of relational care and community collaboration in promoting wellness in rural Appalachia. We offer the Community Resiliency Model (CRM) as a practical, evidence-informed strategy to foster emotional regulation, coregulation, and community resilience. We call …

Beyond Community To Collective Care: Reimagining Inclusion For Rural Students With Disabilities, Y. Radeen Yang, Katie M. Mccabe, Sarah Bubash, Carlyn Mueller

The Rural Educator

This conceptual piece examines how prevailing notions of community in rural schools influence inclusive education practices for students with disabilities. While rural communities often emphasize care and belonging, these values can mask exclusionary practices when inclusion is treated as sameness or is assumed rather than actively cultivated. We explore how disability is acknowledged or overlooked within rural community traditions and how these dynamics sustain outdated models of special education service delivery and reinforce exclusionary practices. To reframe inclusion as a collective and relational practice, we introduce a care-based framework rooted in three interrelated components: mattering, interdependence, and accountability. Informed by …

Mindful Leadership: How Rural Principals Enact School Mindfulness Through Care And Social-Emotional Learning, Jesse Wood

The Rural Educator

This qualitative research study explored how rural secondary principals in Tennessee made sense of the practice of school mindfulness and what motivated them to engage in leadership practices that enact mindfulness in this setting. This study draws from the theoretical construct of high reliability theory (HRT) and school mindfulness: focus on failure, reluctance to simplify, sensitivity to teaching and learning, commitment to resilience, and deference to expertise. Three themes emerged: situational awareness, social-emotional learning (SEL), and care. This study extends the extant literature on school mindfulness and highlights leadership practices of care and social-emotional learning that enact school mindfulness in …

Rural School Redesign: Enacting Care And Mutuality Through Responsive Professional Development, Catharine Biddle

The Rural Educator

One of the challenges that rural schools face is a lack of school change models developed from a rural standpoint that position schools and their organizational improvement as a critical component of rural community development policy. This case study of the Rural Aspirations Project draws on an evaluation of their decade of work with 18 small and rural schools in Maine to provide curriculum support and responsive professional development. Positioning their work as a revelatory case, this article explores the organization’s embodiment of a central component of care theory—mutuality—and the ways in which this principle enabled ecologies of care between …

American Period Poverty: Highlighting Inequity At Home, Julia E. Lever, Phillip D. Grant

The Rural Educator

No abstract provided.

Afterword, Kristina A. Hesbol

The Rural Educator

No abstract provided.

Basal Cell Carcinoma Risk Prediction In Survivors Of Childhood Cancer, Cindy Im, Christina Boull, Zhe Lu, Kenneth Liao, Hasibul Hasan, Linwan Xu, Yadav Sapkota, Rebecca M Howell, Michael A Arnold, Miriam R Conces, Ashley J Housten, Judith Gebauer, Thorsten Langer, Jop C Teepen, Leontien C M Kremer, Louis S Constine, Yutaka Yasui, Melissa M Hudson, Kirsten K Ness, Gregory T Armstrong, Joseph P Neglia, Yan Yuan, Lucie M Turcotte

Faculty, Staff and Student Publications

Background: Survivors of childhood cancer face excess risk of developing basal cell carcinoma. Age-specific basal cell carcinoma risk prediction models for survivors may support targeted screening recommendations.

Methods: We developed models predicting basal cell carcinoma risk by ages 40 and 50 years featuring detailed cancer treatment predictors, utilizing statistical and machine-learning algorithms and data from 23 166 five-year survivors in the Childhood Cancer Survivor Study, a multi-institutional retrospective cohort study. Selected models were externally validated in 5314 survivors in the St Jude Lifetime Cohort. Model discrimination and precision were evaluated using the area under the receiver operating characteristic curve (AUROC) …

Data-Driven Abdominal Phenotypes Of Type 2 Diabetes In Lean, Overweight, And Obese Cohorts From Computed Tomography, Lucas W Remedios, Chloe Cho, Trent M Schwartz, Dingjie Su, Gaurav Rudravaram, Chenyu Gao, Aravind R Krishnan, Adam M Saunders, Michael E Kim, Shunxing Bao, Alvin C Powers, Bennett A Landman, John Virostko

Faculty, Staff and Student Publications

Purpose: Although elevated body mass index (BMI) is a well-known risk factor for type 2 diabetes, the disease's presence in some lean adults and absence in others with obesity suggests that more detailed measurements of body composition may uncover abdominal phenotypes of type 2 diabetes. With artificial intelligence (AI) and computed tomography (CT), we can now leverage robust image segmentation to extract detailed measurements of size, shape, and tissue composition from abdominal organs, abdominal muscle, and abdominal fat depots in 3D clinical imaging at scale. This creates an opportunity to empirically define body composition signatures linked to type 2 diabetes …

Acute Kidney Injury Is Associated With Elevated Urinary Endotrophin, Amanda J Clark, Brenda Mendoza Flores, Marie Christelle Saade, Kyle Q Vu, Isaac J Pence, Ningyan Zhang, Zhiqiang An, Dawei Bu, Philipp E Scherer, Samir M Parikh

Faculty, Staff and Student Publications

Acute kidney injury (AKI) is prevalent among hospitalized patients. Novel biomarkers are needed to diagnose AKI and target therapies. Endotrophin (ETP) is a molecule released during collagen type VI formation that may promote injury and fibrosis. Although serum ETP elevation has been associated with adverse outcomes in AKI, urinary ETP has not been assessed in AKI, nor has ETP been evaluated in a pediatric population. Urine samples were collected from a tertiary children's hospital. Medical records were reviewed, and patients who met criteria were sorted into three categories:

Bilateral Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea: A Nonrandomized Clinical Trial, B. Tucker Woodson, David T. Kent, Colin Huntley, Melyssa K Hancock, Douglas J. Van Daele, Maurits S. Boon, Tod C. Huntley, Sam Mickelson, M. Boyd Gillespie, Maria V. Suurna, Ashutosh Kacker, Asim Roy, Stuart Mackay, Kirk P. Withrow, Raj C. Dedhia, Phillip Huyett, Clemens Heiser, Sylvie Di Nicola, Fatima Makori, Olivier M. Vanderveken, Tapan A. Padyha, Ulysses J. Magalang, Eugene Chio, Eric J. Kezirian, Richard Lewis

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Study Objectives: To evaluate the safety and efficacy of a novel bilateral hypoglossal nerve stimulation (HNS_BL) device for the treatment of obstructive sleep apnea.

Methods: Adult patients with moderate-to-severe obstructive sleep apnea who refused, failed, or did not tolerate positive airway pressure therapy underwent implantation and nightly use of HNS_BL. The coprimary endpoints at 12 months were (1) a minimum of 50% reduction in the 4% apnea-hypopnea index (AHI) from baseline with a final AHI of less than 20 events/h, and (2) a minimum of 25% reduction in the 4% oxygen desaturation index. Objective secondary endpoints …

Hypertension Prevention Program And Its Effects On Blood Pressure Levels Among Young Adults In A Christian Community In Southwest Michigan, Cindel Hollancid

Doctor of Nursing Practice Projects

Background

Although the majority of patients who present are adults over the age of 40 years old; with blood pressures ranging from 140/88 – 190/110 and many times higher readings, it was intriguing and important to assess whether a direct intervention, teaching young adults ages 18 – 39 years the benefits of lifestyle choices would be beneficial as a preventative measure to implement for hypertension reduction patterns as one ages. According to Hinton et al. (2019), hypertension affects 1 in 8 adults between the ages of 20 and 40 years old and is thus common among young people; with the …

An Analysis Of How Autistic Burnout Relates To Posttraumatic Stress In Autistic Adults, Antonio F Pagán, Madeline J Bruce, Juliana L Vanderburg, Grace Sattem, Katherine A Loveland, Ron Acierno

Faculty, Staff and Student Publications

This study investigated the relationship between autistic burnout and posttraumatic stress symptoms (PTSS) in trauma-exposed autistic adults without intellectual disability (n = 91). Cross-sectional relationships between autistic burnout (measured by the ABSI), PTSS (PCL-5), depression (PHQ-9), and anxiety (GAD-7) were assessed using Pearson correlations. To examine the distinctiveness of autistic burnout from posttraumatic stress, an exploratory factor analysis was conducted on ABSI and PCL-5 data. A strong correlation was found between autistic burnout and PTSS (r = .70, p < .001), an exploratory factor analysis suggested shared underlying factors. These findings indicate a close relationship between autistic burnout and …