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J Mich Dent Assoc March 2024

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association provides news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. It stands as the primary publication reaching Michigan dentists.

In the March 2024 issue, the Journal focuses on the landscape of practicing in rural settings. Original content includes:

• A cover story discussing "Market Realities for Rural and Small-Town Practices"

• A feature commentary from a new dentist in the Upper Peninsula on "Why I Chose to Practice in Rural Michigan"

• A feature article highlighting a dental education initiative, "Washington’s RIDE Program: A Model …

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The Great Resignation: Narratives Of Mid-Career Teacher Burnout And Attrition, Nicole Burton

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The COVID-19 pandemic has increased the issues of teacher attrition. According to the U.S. Bureau of Labor and Statistics, from January to November 2021, there was a 40% increase in the quit levels of teachers within the state and local education agencies (John, 2022). While prior research has examined early-career teachers leaving the profession, mid-career teachers have largely been left out of the conversation. This narrative inquiry investigates the reasons that mid-career teachers are leaving the profession. Semi-structured interviews were conducted with four mid-career teachers hailing from the Midwest region. Interviews focused on understanding how teachers have experienced stress and …

Utilization Of The System Engineering Design Process To Design And Test A Low-Cost Infectious Aerosol Control Mechanism For Patient Aeromedical Evacuation, Sara Shaghaghi

Theses and Dissertations

The aeromedical evacuation of military patients is a critical component of care for Armed Forces members. The Air Force’s ability to transport patients relies on the technology and systems available. A vital transport responsibility is keeping the patient and medical personnel safe during transport. The historical and legacy systems provide reliable transport mechanisms for the Armed Forces’ patients infected with high-level biological agents, but drawbacks must be considered. This dissertation will discuss the development, conceptual design, and initial evaluation of a new low-cost, litter-mounted patient transport system, Biological-Mitigation in Patient Transport (B-MIPT), using the “V” model of the system engineering …

Identifying Rural Health Clinics Within The Transformed Medicaid Statistical Information System (T-Msis) Analytic Files, Katherine Ahrens Mph, Phd, Zachariah Croll, Yvonne Jonk Phd, John Gale Ms, Heidi O'Connor Ms

Rural Health Clinics

Researchers at the Maine Rural Health Research Center describe a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Background: There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part this is because methods to identify RHC encounters within Medicaid claims data are outdated.

Methods: We used a 100% sample of the 2018 Medicaid Demographic and Eligibility and Other Services Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files for 20 states …

The Lymphoma Epidemiology Of Outcomes Cohort Study: Design, Baseline Characteristics, And Early Outcomes, James R Cerhan, Matthew J Maurer, Brian K Link, Andrew L Feldman, Thomas M Habermann, David L Jaye, W Richard Burack, Timothy J Mcdonnell, Francisco Vega, Jennifer R Chapman, Sergei Syrbu, Kiran R Vij, Giorgio Inghirami, John P Leonard, Leon Bernal-Mizrachi, Umar Farooq, Thomas E Witzig, George J Weiner, Yucai Wang, Juan P Alderuccio, Susan L Slager, Melissa C Larson, Shaun M Riska, Brianna J Gysbers, Julianne J Lunde, Tanner W Reicks, Amy A Ayers, Colin B O'Leary, Kathleen J Yost, Hongfang Liu, Grzegorz S Nowakowski, Jia Ruan, Dai Chihara, Jean L Koff, Carla Casulo, Carrie A Thompson, Jonathon B Cohen, Brad S Kahl, Loretta J Nastoupil, Izidore S Lossos, Jonathan W Friedberg, Peter Martin, Christopher R Flowers

Faculty, Staff and Student Publications

To address the current and long-term unmet health needs of the growing population of non-Hodgkin lymphoma (NHL) patients, we established the Lymphoma Epidemiology of Outcomes (LEO) cohort study (NCT02736357; https://leocohort.org/). A total of 7735 newly diagnosed patients aged 18 years and older with NHL were prospectively enrolled from 7/1/2015 to 5/31/2020 at 8 academic centers in the United States. The median age at diagnosis was 62 years (range, 18-99). Participants came from 49 US states and included 538 Black/African-Americans (AA), 822 Hispanics (regardless of race), 3386 women, 716 age <40 >years, and 1513 rural residents. At study baseline, we abstracted clinical, …

Analysis Of East Asia Subgroup In Study 309/Keynote-775: Lenvatinib Plus Pembrolizumab Versus Treatment Of Physician's Choice Chemotherapy In Patients With Previously Treated Advanced Or Recurrent Endometrial Cancer, Kan Yonemori, Keiichi Fujiwara, Kosei Hasegawa, Mayu Yunokawa, Kimio Ushijima, Shiro Suzuki, Ayumi Shikama, Shinichiro Minobe, Tomoka Usami, Jae-Weon Kim, Byoung-Gie Kim, Peng-Hui Wang, Ting-Chang Chang, Keiko Yamamoto, Shirong Han, Jodi Mckenzie, Robert J Orlowski, Takuma Miura, Vicky Makker, Yong Man Kim

Faculty, Staff and Student Publications

OBJECTIVE: In the global phase 3 Study 309/KEYNOTE-775 (NCT03517449) at the first interim analysis, lenvatinib+pembrolizumab significantly improved progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) versus treatment of physician's choice chemotherapy (TPC) in patients with previously treated advanced/recurrent endometrial cancer (EC). This exploratory analysis evaluated outcomes in patients enrolled in East Asia at the time of prespecified final analysis.

METHODS: Women ≥18 years with histologically confirmed advanced, recurrent, or metastatic EC with progressive disease after 1 platinum-based chemotherapy (2 if 1 given in neoadjuvant/adjuvant setting) were enrolled. Patients were randomized 1:1 to lenvatinib 20 mg orally once …

Artificial Intelligence-Based Radiotherapy Contouring And Planning To Improve Global Access To Cancer Care, Laurence E Court, Ajay Aggarwal, Anuja Jhingran, Komeela Naidoo, Tucker Netherton, Adenike Olanrewaju, Christine Peterson, Jeannette Parkes, Hannah Simonds, Christoph Trauernicht, Lifei Zhang, Beth M Beadle, Radiation Planning Assistant Consortium Collaborators, Affiliations Expand

Faculty, Staff and Student Publications

PURPOSE: Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world.

METHODS: The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale.

RESULTS: For cervical cancer, RPA plans using bony landmarks were scored as …

Identifying Environmental And Genetic Risk Factors Of Diseases In Case-Control Studies, Siting Li

Dartmouth College Ph.D Dissertations

In response to the increasing efforts in disease prevention and treatment, this thesis applies statistical methods to investigate environmental and genetic risk factors associated with two diseases: bladder cancer and amyotrophic lateral sclerosis (ALS). For bladder cancer, we investigated the association between toenail metal mixture and bladder cancer risk, along with gene expression levels associated with bladder cancer risk. For ALS, our investigation involves identifying genetic variants and gene expression levels associated with ALS risk and exploring gene-smoking interactions linked to ALS risk.

In chapter two, we developed an adaptive-mixture-categorization (AMC)-based g-computation method combining g-computation with optimized exposure categorization. We …

Tuberculosis In People Of Ukrainian Origin In The European Union And The European Economic Area, 2019 To 2022, Krista Stoycheva, Veronica Cristea, Csaba Ködmön, Senia Rosales-Klintz, Dominik Zenner, Anca Vasiliu, Marieke Van Der Werf, Christoph Lange

Faculty, Staff and Students Publications

Approximately five million Ukrainians were displaced to the EU/EEA following the Russian invasion of Ukraine. While tuberculosis (TB) notification rates per 100,000 Ukrainians in the EU/EEA remained stable, the number of notified TB cases in Ukrainians increased almost fourfold (mean 2019-2021: 201; 2022: 780). In 2022, 71% cases were notified in three countries, and almost 20% of drug-resistant TB cases were of Ukrainian origin. Targeted healthcare services for Ukrainians are vital for early diagnosis and treatment, and preventing transmission.

Voices From Grenada: An Impact Evaluation Of A Community-Academic Partnership., Sade Richardson

Doctor of Social Work Capstone Projects

The purpose of this study was to evaluate the impact of the community-academic partnership between the University of Michigan School of Public Health Office of Public Health Practice and the Grenadian community. Five key informant interviews were conducted to analyze the partnership from the perspectives of the community partners in Grenada to understand the strengths, challenges, and existing opportunities, specifically within the context of a global collaboration.

The findings highlighted the benefits of community-based collaboration, considerations for partnership design, and opportunities for education, practice, policy, research, and leadership. The organizations spoke highly of the partnership, underscoring their desire for expanded …

Waning Effectiveness Of Mrna Covid-19 Vaccines Against Inpatient And Emergency Department Encounters, Theodoros V. Giannouchos, Nicole L. Hair Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

In the United States, most real-world estimates of COVID-19 vaccine effectiveness are based on data drawn from large health systems or sentinel populations. More data is needed to understand how the benefits of vaccination may vary across US populations with disparate risk profiles and policy contexts. We aimed to provide estimates of mRNA COVID-19 vaccine effectiveness against moderate and severe outcomes of COVID-19 based on state population-level data sources. Using statewide integrated administrative and clinical data and a test-negative case-control study design, we assessed mRNA COVID-19 vaccine effectiveness against SARS-CoV-2-related hospitalizations and emergency department visits among adults in South Carolina. …

Metabolomic Association And Risk Prediction With Heart Failure In Older Adults, Guning Liu, Ngoc Quynh H Nguyen, Kari E Wong, Sunil K Agarwal, Eric Boerwinkle, Patricia P Chang, Brian L Claggett, Laura R Loehr, Jianzhong Ma, Kunihiro Matsushita, Carlos J Rodriguez, Joseph S Rossi, Stuart D Russell, R Brandon Stacey, Amil M Shah, Bing Yu

Faculty, Staff and Student Publications

Background: Older adults have markedly increased risks of heart failure (HF), specifically HF with preserved ejection fraction (HFpEF). Identifying novel biomarkers can help in understanding HF pathogenesis and improve at-risk population identification. This study aimed to identify metabolites associated with incident HF, HFpEF, and HF with reduced ejection fraction and examine risk prediction in older adults.

Methods: Untargeted metabolomic profiling was performed in Black and White adults from the ARIC study (Atherosclerosis Risk in Communities) visit 5 (n=3719; mean age, 75 years). We applied Cox regressions to identify metabolites associated with incident HF and its subtypes. The metabolite risk score …

Efficacy Of A Primary Care Ehealth Obesity Treatment Pilot Intervention Developed For Vulnerable Pediatric Patients, Joshua S Yudkin, Marlyn A Allicock, Folefac D Atem, Carol A Galeener, Sarah E Messiah, Sarah E Barlow

Faculty, Staff and Student Publications

Background:

Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI.

Methods:

In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6–12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links …

Practical Considerations For Navigating Withdrawal From The Federal Select Agent Program, Scott J Patlovich, Kristin G King, Robert J Emery, Zackary B Becker, Rebecca B Kairis

Faculty, Staff and Student Publications

INTRODUCTION: Clear guidance is provided by the Federal Select Agent Program (FSAP) to assist registered entities in nearly all facets of compliance with the Federal select agent regulations (7 CFR Part 331; 9 CFR Part 121; 42 CFR Part 73). If a registered entity chooses to discontinue its registration, detailed instructions for registration withdrawal are deeply embedded within a document entitled "eFSAP Form 1 Amendment Instructions," which is found on the FSAP website within the electronic Federal Select Agent Program (eFSAP) Resource Center.

METHODS: Using the information found within the eFSAP Form 1 Amendment Instructions, as well as extensive written …

Plasma Protein Signatures Of Adult Asthma, Gordon J Smilnak, Yura Lee, Abhijnan Chattopadhyay, Annah B Wyss, Julie D White, Sinjini Sikdar, Jianping Jin, Andrew J Grant, Alison A Motsinger-Reif, Jian-Liang Li, Mikyeong Lee, Bing Yu, Stephanie J London

Faculty, Staff and Student Publications

Background: Adult asthma is complex and incompletely understood. Plasma proteomics is an evolving technique that can both generate biomarkers and provide insights into disease mechanisms. We aimed to identify plasma proteomic signatures of adult asthma.

Methods: Protein abundance in plasma was measured in individuals from the Agricultural Lung Health Study (ALHS) (761 asthma, 1095 non-case) and the Atherosclerosis Risk in Communities study (470 asthma, 10,669 non-case) using the SOMAScan 5K array. Associations with asthma were estimated using covariate adjusted logistic regression and meta-analyzed using inverse-variance weighting. Additionally, in ALHS, we examined phenotypes based on both asthma and seroatopy (asthma with …

The Use Of Optical Coherence Tomography (Oct) And Oct Angiography In Borderline Personality Disorder Compared To Health Control Subjects, Bei Xu, Fangling Li, Zhejia Zhang, Qian Xiao

Faculty, Staff and Student Publications

BACKGROUND: Optical coherence tomography (OCT) or OCT angiography (OCTA) has been investigated in few research studies of psychiatric disorders. No research has been done using OCT or OCTA in patients with borderline personality disorder (BPD).

METHODS: OCTA measured foveal avascular zone (FAZ), macular vessel density (MVD), and peripapillary vessel density (PVD). OCT measured the peripapillary retinal fiber layer (RNFL) and central retinal thickness (CRT). The study utilized the Ottawa Self-Injury Inventory, Hamilton Anxiety Rating Scale (HAMA), and Global Assessment of Functioning (GAF) to assess the symptom characteristics of individuals with BPD.

RESULTS: Fifty-nine eyes of BPD patients and 58 eyes …

The Accuracy Of Anal Self- And Companion Exams Among Sexual Minority Men And Transgender Women: A Prospective Analysis, Alan G Nyitray, Timothy L Mcauliffe, Cameron Liebert, Michael D Swartz, Ashish A Deshmukh, Elizabeth Y Chiao, Lou Weaver, Ellen Almirol, Jared Kerman, John A Schneider, J Michael Wilkerson, Lu-Yu Hwang, Derek Smith, Aniruddha Hazra

Faculty, Staff and Student Publications

BACKGROUND: Squamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Incidence may also be higher in transgender women. Since SCCA tumours average ≥30 mm at diagnosis, we assessed the accuracy of individuals to self-detect smaller anal abnormalities.

METHODS: Using convenience sampling, the study enrolled sexual minority men and transgender women, aged 25-81 years, in Chicago, Illinois and Houston, Texas, USA, during 2020-2022. Individuals were taught the anal self-examination and anal companion examination (ASE/ACE). Then, a clinician performed …

Self-Efficacy To Refuse Sex Mediates The Relationship Between Dating Violence Victimization And Sexual Risk Behavior, Briana Edison, Shristi Bhochhibhoya, Elizabeth R Baumler, Christine M Markham, Melissa F Peskin, Ross Shegog, Susan T Emery, Robert C Addy, Jeff R Temple, Dennis E Reidy

Faculty, Staff and Student Publications

Purpose: While cross-sectional studies have shown that teen dating violence (TDV) victimization is linked to sexual risk behavior (SRB), the pathway between these variables is not well-understood. To address this knowledge gap, we explore the mediating role of self-efficacy to refuse sex in the longitudinal relationship between physical TDV victimization and subsequent SRB among adolescents.

Methods: Self-report data from three prior longitudinal studies were harmonized to create a single aggregated sample of primarily racial and ethnic minority adolescents (N = 4,620; 51.4% Hispanic, 38.5% Black, and 58% female) from 44 schools in the southwest U.S. Participants' physical TDV victimization at …

Lifetime Traumatic Brain Injury And Risk Of Post-Concussive Symptoms In The Millennium Cohort Study, Kalyn C Jannace, Lisa Pompeii, David Gimeno Ruiz De Porras, William Brett Perkison, Jose-Miguel Yamal, Daniel W Trone, Rudolph P Rull

Faculty, Staff and Student Publications

Traumatic brain injury (TBI) is prevalent among active duty military service members, with studies reporting up to 23% experiencing at least one TBI, with 10-60% of service members reporting at least one subsequent repeat TBI. A TBI has been associated with an increased risk of cumulative effects and long-term neurobehavioral symptoms, impacting operational readiness in the short-term and overall health in the long term. The association between multiple TBI and post-concussive symptoms (PCS), however, defined as symptoms that follow a concussion or TBI, in the military has not been adequately examined. Previous studies in military populations are limited by methodological …

Genome-Wide Interaction Analysis With Dash Diet Score Identified Novel Loci For Systolic Blood Pressure, Mélanie Guirette, Jessie Lan, Nicola M Mckeown, Michael R Brown, Han Chen, Paul S De Vries, Hyunju Kim, Casey M Rebholz, Alanna C Morrison, Traci M Bartz, Amanda M Fretts, Xiuqing Guo, Rozenn N Lemaitre, Ching-Ti Liu, Raymond Noordam, Renée De Mutsert, Frits R Rosendaal, Carol A Wang, Lawrence J Beilin, Trevor A Mori, Wendy H Oddy, Craig E Pennell, Jin Fang Chai, Clare Whitton, Rob M Van Dam, Jianjun Liu, E Shyong Tai, Xueling Sim, Marian L Neuhouser, Charles Kooperberg, Lesley F Tinker, Nora Franceschini, Tianxiao Huan, Thomas W Winkler, Amy R Bentley, W James Gauderman, Luc Heerkens, Toshiko Tanaka, Jeroen Van Rooij, Patricia B Munroe, Helen R Warren, Trudy Voortman, Honglei Chen, D C Rao, Daniel Levy, Jiantao Ma, Charge Gene-Lifestyle Interactions Working Group

Faculty, Staff and Student Publications

Background: The Dietary Approaches to Stop Hypertension (DASH) diet score lowers blood pressure (BP). We examined interactions between genotype and the DASH diet score in relation to systolic BP.

Methods: We analyzed up to 9 420 585 single nucleotide polymorphisms in up to 127 282 individuals of 6 population groups (91% of European population) from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (n=35 660) and UK Biobank (n=91 622) and performed European population-specific and cross-population meta-analyses.

Results: We identified 3 loci in European-specific analyses and an additional 4 loci in cross-population analyses at Pinteraction<5e-8. We observed a consistent interaction between rs117878928 at 15q25.1 (minor allele frequency, 0.03) and the DASH diet score (P …