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Bowen Policy Snapshot: Indiana's Dental Hygiene Workforce 2024 Supply and Demand
No full textThis snapshot report summarizes current supply estimates and future demand projections for Indiana’s dental hygiene workforce. Drawing on data from the 2024 Oral Health Workforce Data Report and Lightcast analytics, the document outlines the number of actively practicing dental hygienists in the state and identifies anticipated workforce trends from 2025 to 2035
Can decreased femoral head enhancement differentiate between septic hip arthritis and transient synovitis?
No full textObjective: To determine whether decreased femoral head enhancement on MRI differentiates septic arthritis from transient synovitis.
Materials and methods: This retrospective study included children < 10 years old with hip effusion on post-contrast MRI for suspected musculoskeletal infection. Two pediatric radiologists independently assessed femoral head enhancement. Kocher and modified Kocher scores were calculated from clinical and lab data. Differences between septic arthritis and transient synovitis were analyzed using Student's t-tests and Fisher's exact tests. Sensitivity and specificity for diagnosing septic arthritis were calculated for Kocher scores, their individual components, decreased femoral head enhancement, and muscle edema. Interobserver agreement was assessed.
Results: Thirty-four children were included (20 transient synovitis, 14 septic arthritis). Kocher and modified Kocher scores were significantly higher in septic arthritis (p = 0.003, 0.008). Interobserver agreement for femoral head enhancement was substantial (kappa = 0.70). On consensus read, decreased femoral head enhancement was seen in 71.4% of septic arthritis and 50.0% of transient synovitis cases (p = 0.296). Bone marrow edema was present in two septic arthritis cases. Muscle edema had moderate to high sensitivity (71.4%, 92.9%) but moderate to low specificity (75.0%, 50.0%) for septic arthritis.
Conclusion: Decreased femoral head enhancement does not reliably distinguish septic arthritis from transient synovitis. Relying on this finding alone may lead to unnecessary interventions in children with transient synovitis. Muscle edema and bone marrow edema may support the diagnosis of septic arthritis. Clinical evaluation and inflammatory markers remain critical in guiding decisions for hip aspiration
Early-Life Parental Affection, Social Relationships in Adulthood, and Later-Life Cognitive Function
No full textObjective:
Although research has demonstrated the long-term health consequences of childhood adversities, less is known about the long-term impact of positive childhood experiences, such as parental affection.
Method:
Using longitudinal data (1995–2014) from the Midlife in the United States (MIDUS) study, we analyze structural equation models estimating direct and indirect pathways from early-life parental affection to changes in later-life cognitive function through relationship quality in adulthood among Black and White older adults (N = 1983).
Results:
Analyses revealed significant indirect effects of parental affection on better cognitive function through higher levels of social support (both average social support and family social support) in adulthood in the full sample and among Black respondents. Indirect pathways through relationship strain and through friend support were not significant.
Discussion:
This work elevates the importance of promoting positive parental relationships during childhood, with implications for better social relationships in adulthood and cognitive function in later life
Genotype–Specific Safety and Pharmacokinetics of Cannabidiol in Healthy Volunteers
Full text linkCannabidiol (CBD) use has increased in America due to its widespread availability. Cannabidiol is metabolized by multiple polymorphic enzymes including CYP3A, CYP2C9, and CYP2C19. We sought to evaluate the genotype-specific adverse events and pharmacokinetic profiles of cannabidiol, 7-OH cannabidiol (an active metabolite), and 7-COOH cannabidiol. We completed a secondary analysis of an open-label, fixed-sequence, single-center study of cannabidiol in 33 healthy subjects. Patients first received a single dose of cannabidiol 5 mg/kg orally with serial plasma concentrations measured. Later, patients were titrated to 5 mg/kg twice daily for 14 days to reach steady state with serial plasma concentrations measured. CYP3A, CYP2C9, and CYP2C19 genotypes were assessed. Pharmacokinetic parameters were calculated by noncompartmental analysis. Diarrhea was observed more frequently in individuals with both CYP3A5 poor metabolism and CYP2C19 intermediate/normal metabolism (39%) compared to individuals with other genotypes (7%, p = 0.0463). Individuals with both CYP3A5 poor metabolism and CYP2C19 intermediate/normal metabolism had increased 7-OH cannabidiol and 7-COOH cannabidiol exposure at steady state. Cannabidiol parent drug exposure varied by CYP2C19 metabolizer status, with lower cannabidiol exposure and parent to metabolite ratios in intermediate metabolizers after single dose (p = 0.014) and at steady state (p = 0.0033). Similar CYP2C19 genotype-specific exposure was observed in an external validation cohort. Minor differences in exposure of cannabidiol and its metabolites were observed between CYP3A5 and CYP2C9 genotype groups. Significant changes in pharmacokinetics were observed between CYP2C9, CYP2C19, and CYP3A5 genotype groups. Future studies should assess whether pharmacogenomics can predict intestinal concentrations of CBD, its metabolites, and diarrhea
Branchiootorenal Spectrum Disorder
No full textClinical characteristics: Branchiootorenal spectrum disorder (BORSD) is characterized by second branchial arch anomalies (e.g., preauricular pits and branchial cleft sinuses or cysts) and malformations of the outer, middle, and inner ear associated with conductive, sensorineural, and/or mixed hearing impairment. Congenital anomalies of the kidney and urinary tract (CAKUT) include kidney agenesis, hypoplasia, and dysplasia as well as urinary tract anomalies such as ureteropelvic junction (UPJ) obstruction, calyceal cysts and/or diverticula, and/or vesicoureteral reflux (VUR). Glomerular pathology that includes proteinuria and glomerulosclerosis has been reported. Some individuals progress to end-stage kidney disease (ESKD) depending on the severity of the kidney involvement.
Diagnosis/testing: The clinical diagnosis of BORSD is established in an individual based on the presence of three or more major criteria OR two major criteria and two minor criteria OR one major criterion and a first-degree relative with BORSD. The molecular diagnosis of BORSD is established in a proband with suggestive findings and a heterozygous pathogenic variant in either EYA1 or SIX1 identified by molecular genetic testing.
Management:
Treatment of manifestations: Otologic considerations include canaloplasty to correct an atretic canal and/or excision of branchial cleft cysts/fistulae if they are infected, symptomatic, or cosmetically concerning. Audiologic considerations include hearing aids for individuals with mild-to-moderate sensorineural or mixed hearing loss and cochlear implantation (CI) for individuals with bilateral severe-to-profound hearing loss. All individuals with hearing loss should be enrolled in an appropriate educational program for the hearing impaired. CAKUT require (1) nephrologists to assess kidney function, control hypertension, manage proteinuria, and help in delaying progression of kidney disease when possible; and (2) urologists to perform corrective surgery (e.g., pyeloplasty) for UPJ obstruction and manage use of prophylactic antibiotics and/or surgical correction for VUR.
Surveillance: Routinely scheduled follow up with the treating otolaryngologist, audiologist, speech-language pathologist, nephrologist, and urologist.
Agents/circumstances to avoid: Individuals with hearing loss should avoid environmental exposures known to cause hearing loss. Individuals with CAKUT should use appropriate caution when taking medications (i.e., antibiotics and analgesics) that can impair kidney function and/or that require normal kidney physiology for their use.
Evaluation of relatives at risk: It is appropriate to evaluate apparently asymptomatic relatives at risk for BORSD to determine if treatable and/or possibly progressive otologic and/or kidney abnormalities are present. Evaluations can include molecular genetic testing if the BORSD-related genetic alteration in the family is known or comprehensive physical examination (to include hearing evaluation and kidney imaging and function studies) if the genetic alteration in the family is not known.
Genetic counseling.
BORSD is inherited in an autosomal dominant manner. Of individuals with a molecular diagnosis of BORSD, approximately 10%-20% have the disorder as the result of de novo EYA1 or SIX1 pathogenic variant. Each child of an individual with BORSD has a 50% chance of having BORSD. If the BORSD-related genetic alteration has been identified in an affected family member, prenatal and preimplantation genetic testing are possible. Intrafamilial variability makes it impossible to accurately predict which manifestations of BORSD may occur and how mild or severe they will be in a fetus found to have a familial BORSD-related genetic alteration
Core-Periphery Principle Guided State Space Model for Functional Connectome Classification
No full textUnderstanding the organization of human brain networks has become a central focus in neuroscience, particularly in the study of functional connectivity, which plays a crucial role in diagnosing neurological disorders. Advances in functional magnetic resonance imaging and machine learning techniques have significantly improved brain network analysis. However, traditional machine learning approaches struggle to capture the complex relationships between brain regions, while deep learning methods, particularly Transformer-based models, face computational challenges due to their quadratic complexity in long-sequence modeling. To address these limitations, we propose a Core-Periphery State-Space Model (CP-SSM), an innovative framework for functional connectome classification. Specifically, we introduce Mamba, a selective state-space model with linear complexity, to effectively capture long-range dependencies in functional brain networks. Furthermore, inspired by the core-periphery (CP) organization, a fundamental characteristic of brain networks that enhances efficient information transmission, we design CP-MoE, a CP-guided Mixture-of-Experts that improves the representation learning of brain connectivity patterns. We evaluate CP-SSM on two benchmark fMRI datasets: ABIDE and ADNI. Experimental results demonstrate that CP-SSM surpasses Transformer-based models in classification performance while significantly reducing computational complexity. These findings highlight the effectiveness and efficiency of CP-SSM in modeling brain functional connectivity, offering a promising direction for neuroimaging-based neurological disease diagnosis. Our code is available at https://github.com/m1nhengChen/cpssm
Sex, hormones, and lung health
No full textSex plays an essential role as a biological variable in lung health, leading to observed differences in lung disease susceptibility. Some respiratory conditions are more common in women than men, especially after puberty, indicating the influence of ovarian hormones on disease mechanisms. Other conditions display sex disparities that begin in utero and progress throughout the life span. Preclinical and clinical studies have indicated that both sex chromosomes and hormones can influence lung disease outcomes, immune responses, susceptibility to viral and bacterial infection, and responses to environmental challenges. This review summarizes the latest research on how sex affects lung physiology and health, drawing on a wide range of studies in respiratory physiology and anatomy, genetics, molecular and cellular biology, environmental health, and immunity. We emphasize how biological sex, gonadal hormones, and occupational and environmental exposures can impact disease mechanisms and outcomes. As clinical outcomes among women have not improved at the same rate as men over the past few decades, it is crucial to understand the role played by the sex variable in designing strategies to prevent and mitigate disease. The collective research indicates that sex-induced differences in the respiratory system are essential determinants of physiological responses and clinical outcomes
The Price of Dedication: An Analysis of Wage Trajectories in State and Local Public Health From 2017 to 2024
Full text linkContext: Salary plays a crucial role in recruiting and retaining employees in public health; however, information about trends in compensation is limited.
Objective: To analyze trends in earnings among state and local governmental public health workers between 2017 and 2024.
Methods: Data used are from the Public Health Workforce Interests and Needs Survey for the years 2017, 2021, and 2024. The analytic sample comprised 34 379 full-time permanent employees with complete salary data in 2017, 32 862 in 2021, and 45 241 in 2024, representing state health agency (SHA) and local health department (LHD) public health workers in each respective year. We performed a multi-cross-sectional analysis using descriptive and bivariate analyses and interval-based regression techniques to explore relationships between annualized earnings and key individual and agency-level characteristics.
Results: Earning patterns in 2024 were largely consistent with historical patterns. Individual and agency-level characteristics continued to play a significant role in shaping salary. Higher salaries remained associated with higher supervisory status, longer tenure, higher educational attainment, salaried (versus hourly) employment, union/bargaining unit representation, and employment setting within SHAs versus LHDs. Between 2017 and 2024, annual earnings for full-time permanent employees increased from 73 299 in 2024, representing a 27% average increase of $15 482. However, when adjusted for inflation, annual wages showed no real growth, indicating that earnings remained largely stable in terms of purchasing power during this timeframe. Subgroups that experienced declines in inflation-adjusted salaries between 2017 and 2024 include executives, employees with longer tenures, employees with doctoral degrees, and employees with public health degrees versus degrees in other fields.
Conclusions: The continued decline in inflation-adjusted earnings for certain groups and persistent gender and racial pay gaps indicate that without targeted interventions, public health agencies may face challenges in retaining experienced professionals, attracting new talent, and ensuring workforce stability
Low‐grade glial neoplasms of germ cell origin may represent maturation of embryonic‐type neuroectodermal elements
No full textAims: Glial tumours of germ cell origin are relatively rare in men, occurring predominantly after chemotherapy. Many exhibit low-grade histological features within a spectrum that includes teratomas with mature glial/ganglioglial elements and pure low-grade tumours with glial/ganglioglial phenotype (LGGT) that resemble gliomas/gangliogliomas of the central nervous system. Because foci of glial differentiation are very often seen in association with embryonic-type neuroectodermal tumour (ENT), we hypothesise that LGGTs may represent differentiation of embryonic-type neuroectodermal elements of teratoma and/or ENT.
Methods and results: To address this hypothesis, we compared LGGTs, ENT, non-teratomas, and teratomas using microRNA and DNA methylation analyses. Seven LGGTs underwent microRNA-371~373 analysis and genomic methylation profiling. Evidence of a prior or concurrent germ cell tumour component containing embryonic neuroectoderm (including overt ENT) was present in 4 LGGTs. None of the tested LGGTs were positive for miR-371a-3p, with three cases demonstrating low levels of expression within the so-called "grey zone". Unsupervised clustering based on microRNA-371~373 showed two clusters, one comprising non-teratomas and another including teratomas, ENTs, and LGGTs. Clustering according to top-differentially methylated probes did not demonstrate a clear separation according to histology. Genome-wide assessment of mean methylation levels using violin plots demonstrated that LGGT show a methylation profile "intermediate" between ENT and teratoma.
Conclusions: These results suggest that LGGTs of germ cell origin result from the maturation of ENT components
A Unified Continuous Staging Framework for Alzheimer’s Disease and Lewy Body Dementia via Hierarchical Anatomical Features
Full text linkAlzheimer's Disease (AD) and Lewy Body Dementia (LBD) often exhibit overlapping pathologies, leading to common symptoms that make diagnosis challenging and protracted in clinical settings. While many studies achieve promising accuracy in identifying AD and LBD at earlier stages, they often focus on discrete classification rather than capturing the gradual nature of disease progression. Since dementia develops progressively, understanding the continuous trajectory of dementia is crucial, as it allows us to uncover hidden patterns in cognitive decline and provides critical insights into the underlying mechanisms of disease progression. To address this gap, we propose a novel multi-scale learning framework that leverages hierarchical anatomical features to model the continuous relationships across various neurodegenerative conditions, including Mild Cognitive Impairment, AD, and LBD. Our approach employs the proposed hierarchical graph embedding fusion technique, integrating anatomical features, cortical folding patterns, and structural connectivity at multiple scales. This integration captures both fine-grained and coarse anatomical details, enabling the identification of subtle patterns that enhance differentiation between dementia types. Additionally, our framework projects each subject onto continuous tree structures, providing intuitive visualizations of disease trajectories and offering a more interpretable way to track cognitive decline. To validate our approach, we conduct extensive experiments on our in-house dataset of 308 subjects spanning multiple groups. Our results demonstrate that the proposed tree-based model effectively represents dementia progression, achieves promising performance in intricate classification task of AD and LBD, and highlights discriminative brain regions that contribute to the differentiation between dementia types. Our code is available at https://github.com/tongchen2010/haff