Medicine and Health Sciences Commons^™

The New Professional: Evaluating A Practice Purchase: Guidance For The First-Time Buyer, Amrita Patel Dds

The Journal of the Michigan Dental Association

This guidance for first-time dental practice buyers stresses that evaluating a practice involves more than just the price tag, encompassing financials, people, culture, and potential growth. Buyers must analyze at least three years of financial statements, paying close attention to collection trends, accounts receivable, overhead, net income, and the mix of insurance plans. Patient loyalty is critical; buyers must assess the number of "active" patients (seen in the last 18–24 months) and recognize that attrition may occur if loyalty was tied strongly to the selling doctor. Inheriting experienced, welcoming staff and a positive office culture is crucial for success. Practical …

What Doesn’T Kill You, Makes You Stronger, Michelle C. Dziurgot

The Journal of the Michigan Dental Association

The editorial describes the significant damage caused to a dental office in August 2025 by an "all-out power surge" resulting from a direct lightning strike, which fried equipment including dental chairs, computers, and HVAC. This forced the practice to close and reschedule patients. The experience highlighted the critical importance of having property and business interruption insurance through MDA Insurance to cover physical damages and lost scheduled procedures. Dentists are advised to install surge protectors at their fuse boxes, review their policies, document all damage with photos and receipts, and advocate aggressively for timely claim payments to ensure the practice is …

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 …

Female Genital Mutilation And Its Effects Among Women Of Reproductive Age In Kenya: Insights From Kenya Demographic And Health Survey 2022, Jovinary Adam, Joyce Jebet

School of Nursing & Midwifery, East Africa

Introduction Female genital mutilation (FGM) is a significant public health issue rooted in cultural traditions, affecting millions of women and girls. In Kenya, the practice is prevalent in various ethnic groups and is often associated with social and economic pressures.

Objective To determine the prevalence of FGM, the factors associated with FGM, and its effects among women of reproductive age in Kenya.

Methods This study used secondary data of a total 16,716 weighted women of reproductive age drawn from the 2022 Kenya Demographic and Health Survey. The study used the “svy” command in Stata to assign the sample weight. Multivariable …

Stakeholders’ Perceptions Of The Roles And Regulations Of Advanced Practice Nursing And Advanced Practice Midwifery, Constance Shumba, Benard Mutwiri, Denis Munene, Rachel Kimani, Beatrice May, Isabel Kambo, Colette Henderson, Irene Mageto, Daniela Lehwaldt, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Background Advanced practice nursing (APN) and advanced practice midwifery (APM) in Kenya are critical in healthcare system strengthening by expanding access to quality care, particularly in underserved regions. Globally, the International Council of Nurses (ICN) defines APN as a level of nursing practice that requires a minimum of a master’s degree, along with advanced clinical training and competency. Similarly, APM involves midwives with advanced training to provide specialized maternal and neonatal care. In Kenya, the APN and APM concepts were launched in 2020 and are still nascent, and their practice is determined by the context as provided by the country …

Uptake Of Covid-19 Vaccination And Associated Factors Among Patients Attending Oncology Services At The Ocean Road Cancer Institute In Dar Es Salaam, Tanzania: Insights From Mixed Design Methods’ Trajectory, David Makoko, Anthony Kapesa, Micheal Mugerwa, Mamsau Ngoma, Mark Mseti, Mary Lyimo, Lucy Kisaka, Ntuli Kapologwe, Jeremiah Seni

School of Nursing & Midwifery, East Africa

Background

COVID-19 vaccination campaigns have reduced disease severity and fatalities around the globe. Global data shows that 67.7% of the general population are vaccinated, and Tanzania has reported appealing findings of over 70% coverage among individuals over 18 years of age. However, a group-specific assessment of vaccination coverage is needed in sub-Saharan Africa. This study aimed at assessing the COVID-19 vaccination uptake and associated factors among cancer patients owing to their vulnerability.

Methods

A cross-sectional analytical study design was conducted in September 2022 at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. A multistage sampling approach was employed …

Cabotegravir And Rilpivirine For Treatment Of Hiv Infection In Africa: Week 96 Results From The Phase 3b Randomized, Open-Label, Noninferiority Cares Trial, Cissy Kityo, Ivan Mambule, Joseph Musaazi, Simiso Sokhela, Henry Mugerwa, Henry Mugerwa, Ibrahim Yawe, Fiona Cresswell, Abraham Siika, Reena Shah

Internal Medicine, East Africa

Evaluation of the durable efficacy and safety of long-acting injectable therapy for HIV is needed in African populations. In a multicenter, open-label phase 3b trial, 512 African adults with HIV-1, stable on first-line oral therapy, with screening plasma viral load (VL) < 50 copies ml−1 and without past virologic failure were randomized (1:1) to continue oral therapy or switch to cabotegravir (600 mg) and rilpivirine (900 mg) intramuscular injections every 8 weeks (optional 4-week oral lead-in). VL was monitored every 24 weeks. Here the primary outcome for our analysis up to 96 weeks was VL < 50 copies ml−1, using the Food and Drug Administration snapshot algorithm (noninferiority margin 10%) in the intention-to-treat exposed population. At 96 weeks, 247/255 (97%) in the long-acting group and 250/257 (97%) in the oral therapy group had VL < 50 copies ml−1 (difference −0.4%; 95% confidence interval −3.1% to 2.0%), demonstrating noninferiority. Adverse events of severity grade ≥3 occurred in 41/255 (16%) in the long-acting group and in 22/257 (9%) in the oral therapy group, mostly considered unrelated to the study drug; only one treatment-related adverse event in the long-acting group led to a decision to discontinue treatment (injection-site abscess). Cabotegravir and rilpivirine long-acting therapy produced durable virologic suppression, met the prespecified noninferiority endpoint compared with oral therapy and demonstrated an acceptable safety and tolerability profile. Long-acting therapy may be considered for use in African treatment programs. PACTR registration: 202104874490818.

Detection Of Left Ventricular Thrombus In Newly Diagnosed Heart Failure Patients: Diagnostic Accuracy Of 2d Transthoracic Echocardiography Compared With Cardiac Mri In A Kenyan Cohort, Barbara Karau, Nadeem Kassam, Mohamed Varwani, Jeilan Mohamed, Kevin Ombati, James Orwa, Mzee Ngunga

Internal Medicine, East Africa

Background Left ventricular thrombus (LVT) is a recognized complication of severe left ventricular (LV) systolic dysfunction. While cardiac magnetic resonance (CMR) Imaging is considered the gold standard due to its high sensitivity and specificity for detecting LVT, its availability remains limited in Sub-Saharan Africa. In contrast, 2D transthoracic echocardiography (TTE) is more accessible and commonly used in clinical practice. This study aimed to determine the incidence of LVT in patients with a left ventricular ejection fraction (LVEF) of less than 35% from any etiology, and to compare the diagnostic accuracy of TTE against CMR for its detection.

Methods This prospective, …

Implementation And Evaluation Of Infection Prevention And Control Training In Sub-Saharan Africa, David Odada, James Ndai, Ruth Thuku, Philip Adebayo

Internal Medicine, East Africa

No abstract provided.

Bridging The Gap: An Educational Intervention For The Early Introduction Of Peanut Protein In Pediatric Care, Rachel Gilson Dnp, Rnc-Ob, C-Onqs, Fnp-C, Parkview Health

Nursing Publications, Posters, & Presentations

Presented at the 6th Annual Parkview Nursing Research and Evidence-Based Practice Symposium. Theme: “From Paper to Practice: The Art of Implementation Science,” at the Parkview Mirro Center for Research and Innovation.

The primary aim of this Doctor of Nursing Practice (DNP) project was to improve provider adherence to the NIAID guidelines for the early introduction of peanut protein in infants under one year of age. The project intended to address identified knowledge and practice gaps through a targeted educational intervention at Fort Wayne Pediatrics (FWP).

Systemic Racism In Canadian Healthcare: A Policy And Equity Analysis, Kola Adegoke, Abimbola Adegoke, Deborah Dawodu, Temitope Kayode

Health & Biomedical Sciences Faculty Publications

Background: In Canadian healthcare, systemic racism subverts commitment to universal coverage by building inequities into the system of governance, regulation, and clinical practice. Although racial disparities have been documented, little attention has been paid to how institutional structures perpetuate these inequities.

Objective: This study critically examines the organizational aspects of racism in the Canadian healthcare system. It aims to identify structural obstacles faced by racialized patients and foreign-trained physicians and to provide policy recommendations grounded in evidence.

Methods: The authors employed a narrative review framework for qualitative analysis of documents. Public inquiries (eg, Truth and Reconciliation Commission and Viens Report), …

Pocus: Presence, Observation, Connection, Understanding, Story., Sanjay A Patel

Medical Education Articles

No abstract provided.

Structural-Level Stigma Within Emergency Food Assistance Programs: Perspectives From Delaware And Pennsylvania, Mckenna M Halverson, Evyn Y Appel, Valerie A Earnshaw, Raquelle Powell, Grace Sands, Nithila Chrisostam, Shreela V Sharma, Allison Karpyn

Faculty, Staff and Student Publications

To characterize the ways in which structural stigma manifests within emergency food program settings.

Methods : We conducted 30-minute semi-structured interviews with 18 emergency food program clients in Pennsylvania and Delaware between August and December of 2024. The discussion guide included open-ended questions regarding client experiences of structural stigma, with an emphasis on issues of access and quality. Demographic data and household food insecurity (Hunger Vital Sign) were also captured. A hybrid inductive and deductive coding approach was used to analyze the data.

Results : Structural stigma is a persistent issue within emergency food program environments, impacting both participant access …

Exploring The Future Of Occupational Safety Research: A Strategic Foresight Approach, Jessica M K Streit, Sarah A Felknor, Nicole T Edwards, John J Howard

Faculty, Staff and Student Publications

A team from the U.S. National Institute for Occupational Safety and Health conducted a strategic foresight project to explore the future of occupational safety research (OSR). Data collected via systematic horizon scanning and key informant interviews were synthesized into six drivers of OSR change: (1) technological advancement, (2) partnerships and public trust, (3) prioritizing research investments, (4) safety and health integration, (5) data and science quality, and (6) worker protections. These drivers served as the basis for envisioning four potential OSR futures. Analysis of the resulting scenarios identified opportunities to enhance and advance OSR methods and approaches, innovation, systems thinking, …

Mitigating Food Insecurity-Related Stigma: A Review Of Intervention Strategies, Evyn Y Appel, Mckenna M Halverson, Valerie A Earnshaw, Tania Cruz Cordero, Maya Rozin, Raquelle Powell, Grace Sands, Nithila Chrisostam, Sarah E Katz, Shreela V Sharma, Allison Karpyn

Faculty, Staff and Student Publications

Objective: To characterize intervention strategies addressing food insecurity-related stigma implemented in federal nutrition programs (e.g. SNAP, WIC) and emergency food programs (e.g. food pantries, food cupboards) within high income countries.

Methods: Six databases (PubMed, PsychINFO, Web of Science, CINAHL, Sociological Abstracts, Dissertations and Theses Global) and the Internet were searched through September 2024. Data on study characteristics and stigma intervention characteristics were extracted with a structured template. Descriptive statistics and thematic analysis were used.

Results: The review found 46 intervention strategies across 18 articles. The majority of articles were based in the United States (89.9%) with the remaining portion from …

Stomach Cancer Incidence In Asians As Compared To Other Ethnic Populations Over Time From 2000 To 2021 In Seer Areas Of The United States, Zhuoyun Li, Xianglin L Du

Faculty, Staff and Student Publications

Background: Stomach cancer is the fourth leading cause of cancer-related deaths globally, but its late-stage detection and its lack of early symptoms are still the main challenges ahead. Limited research has focused on detailed racial and ethnic disparities in stomach cancer incidence within the United States. This study aims to address these gaps by analyzing age-adjusted stomach cancer incidence rates from 2000 to 2021.

Methods: Using data from the US Surveillance, Epidemiology, and End Results (SEER) program (2000-2021), we identified a cohort of 138,628 individuals diagnosed with incident stomach cancer at age ≥ 20. Both crude and age-adjusted models were …

Estimating Daily Air Quality Exposure Of The Aging And Dementia Population, Wan-Tai Michael Au-Yeung, Moiz Usmani, Ryan Ramphul, Chao-Yi Wu, Hiroko Dodge, Joel Steele, Zachary Beattie, Jeffrey Kaye

Faculty, Staff and Student Publications

Background

To understand the effect of air quality on cognition, air quality measurements should reflect real-world exposure. Currently, air quality exposure is derived from outdoor air quality monitors despite older adults spending most of their time indoors.

Objective

To examine if there are discrepancies between indoor particulate matter 2.5 (PM2.5) at older adults’ personal residences, PM2.5 levels measured with nearest outdoor public air monitors, and remotely accessed gridded ensemble air quality data.

Methods

PM2.5 levels collected in older adults’ residences, collected from the nearest outdoor public air quality monitors and ensemble data from Hazardous Air Quality Ensemble System (HAQES) were …

Factors Associated With Cervical Cancer Screening Among Women Attending Maternal Child Health Clinics In Kenya, Loise Nthambi, Marleen Temmerman, William Macharia, Joshua Nyagol, Sophia Mogere, Jillian Neary, Edward Nyabs, Janet Itindi, Agnes Langat, Evelyn Wangari

Centre of Excellence in Women and Child Health

Background Cervical cancer is the second leading malignancy in incidence among women in sub-Saharan Africa. Early detection through screening and treatment of pre-cancerous cervical lesions is paramount in preventing cervical cancer. We sought to examine factors associated with ever being screened for cervical cancer among women attending infant immunization clinics in Kenya.

Methods We conducted secondary data analysis from a cross-sectional survey that enrolled mother-infant pairs attending 55 infant immunization clinics in Kenya between 2018 and 2019. Clinics were selected from high and medium/low HIV-burden counties using probability-proportionate-to-size sampling. The primary outcome was self-reported cervical cancer screening. To align with …

Women’S Unique Health Needs And The Sustainable Development Goals: A Meeting Report From The 79th United Nations General Assembly Science Summit, Irene Aninye, Sarah Chew, Nicole Althaus, Michele Barry, Ru-Fong Cheng, Carolyn Harris, Eleanor Nwadinobi, Beth Battaglino, Aisha Brooks, Marleen Temmerman

Centre of Excellence in Women and Child Health

Biological sex, hormones, and gender uniquely affect health and disease, often resulting in disparities for women across the lifespan and from different racial and ethnic groups, geographical locations, and socioeconomic backgrounds. Without intentional investment and infrastructure to support good health and wellbeing for women, half of the world’s population remains vulnerable to preventable morbidity and mortality. The Society for Women’s Health Research and ECHAlliance–The Global Health Connector convened a women’s health program as part of the 10th Annual Science Summit during the United Nations 79th General Assembly. This hybrid event was held in New York, NY, (USA) and virtually in …

Enhanced Recovery After Neurosurgery: A Narrative Review Comparing Clinical Outcomes, Protocols, And Challenges With Standard Postoperative Care, Tirath Patel, Hamza Yousuf Ibrahim, Rahma Naveed, Aziz Ur Rehman, Maryam Amir, Fatima Nasir, Anum Zia Khan, Nikhilesh Anand

School of Medicine Publications

Background: By integrating evidence-based pre-, intra-, and postoperative therapies, enhanced recovery after surgery (ERAS) protocols have transformed perioperative care in numerous surgical specialties. Although their use in neurosurgery aims to maximize patient recovery, minimize complications, and reduce hospital stays, the evidence remains heterogeneous, and large randomized controlled trials are scarce.

Objectives: This narrative review contrasts the clinical outcomes, advantages, and challenges of ERAS protocols with those of conventional postoperative care in neurosurgery, with a focus on cranial, spinal, pediatric, cancer, and functional procedures.

Methods: A thematic synthesis of peer-reviewed clinical evidence was conducted using PubMed, Scopus, and Google Scholar (2000-2025). …

Perceived Prejudice Or Discrimination In Medical Care Among Us Adults, Inimfon Jackson, Robert Yu, Joël Fokom Domgue, Sanjay Shete

Faculty, Staff and Student Publications

No abstract provided.

Use Of Robotic And Laparoscopic Surgery For Right Colectomies In Rural Areas: Are The Advantages Over Open Surgery Comparable To Those Reported In Urban Centers? An Analysis Using The Healthcare Cost And Utilization Project (Hcup) Michigan Inpatient Sample, Ryan T. Davis, Ibrahim B. Baida, Jacob A. Applegarth, Nathan M. Novotny

Conference Presentation Abstracts

Introduction: Surgical robotics have become more accessible in rural healthcare centers across Michigan, driving a growing demand for clinical outcomes data in these areas. National studies have shown that robotic colectomies reduce postoperative complications compared to open procedures, but data specific to rural settings remain limited. This study aims to compare postoperative complications following open, laparoscopic, and robotic right colectomies in rural Michigan.
Methods: The Healthcare Cost and Utilization Project (HCUP) Michigan inpatient database (2016-2018) was used to analyze postoperative complications after right colectomies in urban and rural hospitals. Complications analyzed included: prolonged ileus, pneumonia, surgical site infection, septicemia, hemorrhage/hematoma, …

The Genomes Of Nematode-Trapping Fungi Provide Insights Into The Origin And Diversification Of Fungal Carnivorism, Yani Fan, Minghao Du, Weiwei Zhang, Wei Deng, Ence Yang, Shunxian Wang, Luwen Yan, Liao Zhang, Seogchan Kang, Jacob L Steenwyk, Zhiqiang An, Xingzhong Liu, Meichun Xiang

The Brown Foundation: Institute of Molecular Medicine

Nematode-trapping fungi (NTF), most of which belong to a monophyletic lineage in Ascomycota, cannibalize nematodes and other microscopic animals, raising questions regarding the types and mechanisms of genomic changes that enabled carnivorism and adaptation to the carbon-rich and nitrogen-poor environment created by the Permian-Triassic extinction event. To address these questions, we conducted comparative genomic analyses of 21 NTF and 21 non-NTF. Carnivorism-associated changes include expanded genes for nematode capture, infection, and consumption (e.g., adhesive proteins, CAP superfamily, eukaryotic aspartyl proteases, and serine-type peptidases). Although the link between secondary metabolite (SM) production and carnivorism remains unclear, we found that the number …

Redefining Central Nervous System Multiple Myeloma: From Rare Phenomenon To Emerging Entity, Ian Landry, Adam F. Binder, Marc Yorker, Sarah Ramirez

Department of Medical Oncology Faculty Papers

BACKGROUND: Central nervous system involvement in multiple myeloma (CNS-MM) is considered a rare but devastating manifestation of extra-medullary disease (EMD) associated with aggressive biology and dismal outcomes. Treatment advances over the past few decades have improved survival in patients with MM, however, it has not translated into a similar survival benefit for those with CNS-MM. Early recognition and targeted management of CNS-MM remain major clinical challenges.

OBJECTIVE: This literature review summarizes the current literature on epidemiology, risk factors, clinical features, diagnostic modalities, and therapeutic approaches to CNS-MM. It focuses on emerging biomarkers and new treatment options that may affect the …

Deciphering Rna Modification And Post-Transcriptional Regulation With Netrnapan, Haodong Xu, Wankun Deng, Ruifeng Hu, Binfeng Liu, Wenchao Zhang, Lujuan Wang, Lin Qi, Xiaolei Ren, Chao Tu, Zhihong Li, Zhongming Zhao

Faculty, Staff and Student Publications

RNA modification, which is evolutionarily conserved, is crucial for modulating various biological functions and disease pathogenesis. High resolution transcriptome-wide mapping of RNA modifications has facilitated both data resources and computational prediction of RNA modification. While these prediction algorithms are promising, they are limited in interpretability or generalizability, or the capacity for discovering novel post-transcriptional regulations. Here, we present NetRNApan, a deep learning framework for RNA modification site prediction, motif discovery and trans-regulatory factor identification. Using m5U profiles generated by FICC-seq and miCLIP-seq technologies and single-base resolution m6A sites from multiple experiments as cases, we demonstrated the accuracy of NetRNApan with …

Nonsteroidal Anti-Inflammatory Drug Use And Acute Kidney Injury In Nephrectomies: A Retrospective Propensity Score-Matched Cohort Study, Chun-Yan Ye, Long-Yan Li, Min-Jing Yang, Xing-Yang Liu, Ning Luo, Jing-Han Wu, Yu-Jie Xiao, Daniel I Sessler, E Wang

Faculty, Staff and Student Publications

Introduction: Nonsteroidal anti-inflammatory drugs (NSAID) are analgesic and spare opioids, but it remains unclear whether perioperative NSAID use worsens renal function after nephrectomy. We therefore tested the hypothesis that perioperative use of NSAID is associated with acute kidney injury (AKI) after nephrectomy surgery.

Methods: This retrospective cohort study included patients ≥18 years old who had partial or radical nephrectomies. Patients who were given intravenous NSAIDs for postoperative analgesia were defined as one group, whereas reference patients did not use any NSAIDs. The primary outcome was the occurrence of postoperative acute kidney injury (AKI), as defined by the Kidney Disease: Improving …

Aligning Surgical Decisions With Older Adults' Outcome Goals, Aanand D Naik, Margaret L Schwarze, Jack Banks, Suha Soni, Salman A Arain, Parag Goyal, Daniel D Matlock, Rachel Lampert, Mary E Tinetti

Faculty, Staff and Student Publications

No abstract provided.

Evaluating Interactions Between National And Subnational Governments In The Czech Republic For Physical Activity Policy Development And Implementation, Michael Pratt, Juliana Mejía-Grueso, Eugen Resendiz, Aleš Jakubec, Zdeněk Hamřík, Deborah Salvo, Andrea Ramírez Varela, Josef Mitáš

Faculty, Staff and Student Publications

Background: Most countries now have physical activity (PA) policies but translating them into action at national and subnational levels remains poor. To better understand the disconnect, the "Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool" (INTEGRATE-PA-Pol) was developed by the Global Observatory for Physical Activity (GoPA!).

Methods: The Czech Republic was chosen as a European pilot site based on existing research capacity and relationships. The INTEGRATE-PA-Pol tool was translated and adapted for use in the country. This questionnaire-based tool has 8 components assessing government levels, political system, and sectors across the 5 …

A Longitudinal Study Of The Association Between E-Cigarette Use Contexts And Alcohol Use Problems Among College Students, Tzung-Shiang Ou, Anne Buu, James J Yang, Hsien-Chang Lin

Faculty, Staff and Student Publications

Objective: Previous studies had explored the associations between e-cigarette use and alcohol use problems, yet they did not fully consider e-cigarette use contexts. This longitudinal study conducted a prospective examination of e-cigarette use contexts and alcohol use problems among college students.

Participants: College e-cigarette users at three public universities from Fall 2019 to Fall 2020 were included (N = 377).

Methods: A linear mixed model with a random intercept and random slope was employed to examine the longitudinal associations.

Results: Higher frequencies of e-cigarette use (β = 0.38, p < 0.001), being hooked on e-cigarettes (β = 0.96, p < 0.01), using e-cigarettes for socializing purposes (β = 0.58, p < 0.05), and more occasions of co-using e-cigarettes with alcohol (β …