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The Unification of Oral and Systemic Health: A Comprehensive Meta-Analysis of Integrated Electronic Health Records in Dentistry
Full text linkThe historical bifurcation of dentistry and medicine has resulted in a fragmented healthcare ecosystem characterized by isolated data repositories, disjointed clinical workflows, and compromised patient safety. This comprehensive meta-analysis evaluates the critical imperative for transitioning from disparate "best-of-breed" dental software to unified, enterprise-grade Electronic Health Record (EHR) platforms, with a specific focus on the Epic Systems ecosystem and its dental module, Wisdom. By synthesizing data from peer-reviewed literature, institutional case studies including the University of North Carolina at Chapel Hill, UT Health San Antonio, and the University of Mississippi Medical Center, and health economic analyses, this report demonstrates that unified platforms are not merely administrative enhancements but clinical necessities. The analysis reveals that integrated systems significantly reduce medication reconciliation errors, unlock substantial cost savings through the co-management of chronic conditions such as diabetes and periodontal disease, streamline complex revenue cycles, and facilitate large-scale epidemiological research. We argue that the adoption of unified EHRs is the foundational technological requirement for bridging the medical-dental divide, thereby achieving the "Triple Aim" of healthcare: improved patient experience, better population health, and reduced per capita costs
Higher Proportions of Baccalaureate-Prepared Nurses in Veterans Affairs Medical Centers Associated With Lower Surgical Mortality
Full text linkBACKGROUND: Multiple studies have linked higher levels of BSN-prepared nurses to lower odds of postsurgical mortality and failure-to-rescue (FTR; ie, death following the development of a postsurgical complication). OBJECTIVE: The purpose of this national evaluation was 2-fold: (1) to assess the proportion of direct care nurses holding a BSN or higher degree in VA Medical Centers; and (2) to examine the association between the proportion of BSN-prepared nurses in VA Medical Centers and the outcomes of hospitalized Veterans undergoing commonly performed surgical procedures. RESULTS: Across our sample of 117 VA Medical Centers nationally, the mean percentage of RNs with a BSN degree or higher in nursing was 55% (SD=16%) and ranged from 9% to 84%. Every 10-point increase in the percentage of nurses with a BSN degree or higher was associated with a 9% decrease in the odds of 30-day mortality and an 8% decrease in the odds of FTR among a cohort of Veterans undergoing commonly performed general, orthopedic, and vascular surgeries. CONCLUSION: Higher proportions of nurses with a BSN or higher in VA Medical Centers is associated with lower postsurgical mortality and FTR among Veterans receiving surgery. These findings confirm within the VA what has been shown in non-VA hospital settings for the last 20 years. Ongoing monitoring and improvements, which are both considered foundational to the tenets of learning health systems and high-reliability organizations, are needed to support staffing with higher proportions of frontline BSN-prepared nurses in VA Medical Centers
Massive Intra‐Abdominal Pseudotumor in a Patient With Hemophilia A Treated With Emicizumab: A Case Report
Full text linkHemophilic pseudotumors, a rare complication of bleeding disorders, are more common in settings with limited access to clotting factor concentrates. Subcutaneous emicizumab, a relatively novel therapy for hemophilia A, was investigated for its ability to stabilize an inoperable pseudotumor in a patient with factor VIII deficiency in an under‐resourced setting
Selective classification with machine learning uncertainty estimates improves ACS prediction: a retrospective study in the prehospital setting
Full text linkAccurate identification of acute coronary syndrome (ACS) in the prehospital setting is important for timely treatments that reduce damage to the compromised myocardium. Current machine learning approaches lack sufficient performance to safely rule-in or rule-out ACS. Our goal is to identify a method that bridges this gap. To do so, we retrospectively evaluate two promising approaches, an ensemble of gradient boosted decision trees (GBDT) and selective classification (SC) on consecutive patients transported by ambulance to the ED with chest pain and/or anginal equivalents. On the task of ACS classification with 23 prehospital covariates, we found the fusion of the two (GBDT+SC) improves the best reported sensitivity and specificity by 8% and 23% respectively. Accordingly, GBDT+SC is safer than current machine learning approaches to rule-in and rule-out of ACS in the prehospital setting
A young progenitor for the most common planetary systems in the Galaxy
Full text linkThe Galaxy’s most common known planetary systems have several Earth-to-Neptune-size planets in compact orbits. At small orbital separations, larger planets are less common than their smaller counterparts by an order of magnitude. The young star V1298 Tau hosts one such compact planetary system, albeit with four planets that are uncommonly large (5 to 10 Earth radii). The planets form a chain of near-resonances that result in transit-timing variations of several hours. Here we present a multi-year campaign to characterize this system with transit-timing variations, a method insensitive to the intense magnetic activity of the star. Through targeted observations, we first resolved the previously unknown orbital period of the outermost planet. The full 9-year baseline from these and archival data then enabled robust determination of the masses and orbital parameters for all four planets. We find the planets have low, sub-Neptune masses and nearly circular orbits, implying a dynamically tranquil history. Their low masses and large radii indicate that the inner planets underwent a period of rapid cooling immediately after dispersal of the protoplanetary disk. Still, they are much less dense than mature planets of comparable size. We predict the planets will contract to 1.5–4.0 Earth radii and join the population of super-Earths and sub-Neptunes that nature produces in abundance
Global risk pooling mitigates financial risk from drought in hydropower-dependent countries
Full text linkMore than 50 countries rely on hydropower for over 25% of their electricity generation, making them vulnerable to drought and resulting revenue losses. Governments can offset financial losses for publicly-owned hydropower generators, but this can create fiscal pressures and lead to negative consequences, such as lower bond ratings. Index-based financial instruments, used to manage weather-related risk, offer an alternative, though data collection and index design are challenging. Using remotely sensed hydrometeorological data, we develop index insurance contracts to manage drought-related financial risk for hydropower-dependent countries. Low correlations in drought across these countries allow cost reductions when risks are pooled. Pooling the contracts yields average savings of 54% compared to individual risk management via reserves. These findings indicate that pooled index insurance can strengthen financial resilience in countries dependent on hydropower and support governments in mitigating drought-related economic risks
Electrocortical Reactivity to Emotional Faces in Youth of Depressed Mothers: The Moderating Role of Emotion Regulation Styles
Full text linkChildren of depressed mothers are at significantly high risk (HR) for developing major depressive disorder (MDD) compared to their low risk (LR) counterparts. Evidence shows that HR youth exhibit a reduced late positive potential (LPP), an electroencephalogram (EEG) marker of emotional reactivity, in response to social-emotional stimuli. However, it remains unknown how emotion regulation (ER) styles may impact LPP responses in HR and LR offspring. The current study sought to examine the interplay of ER strategies (i.e., rumination, cognitive reappraisal, and suppression) and maternal history of MDD in association with LPP responses to emotional stimuli among youth. Participants included 112 mother-child dyads (child age range 9–16 years) participating in a larger study on the intergenerational transmission of depression. Mothers either had a history of MDD (n = 67) or no history of psychopathology (n = 45). Youth completed an emotional face matching task while EEG was recorded to measure the LPP. Participants completed self-report measures of ER strategies and depressive symptoms. Results revealed an interactive effect of maternal MDD history and youth rumination on child’s LPP response. Specifically, a more blunted LPP response to emotional faces and shapes was observed among HR youth who engaged in more frequent rumination. Results revealed no main or interactive effects of youth’s use of cognitive reappraisal or suppression strategies in shaping youth’s LPP response. Findings suggest that certain characteristics among HR offspring (e.g., reporting more frequent use of rumination) may place them at higher risk for exhibiting attenuated emotional reactivity at the neural level
Development of an in vitro metabolic dysfunction-associated steatohepatitis model to investigate altered drug metabolizing enzymes, transport proteins, and hepatobiliary disposition
Full text linkMetabolic dysfunction-associated steatotic liver disease (MASLD) is estimated to affect ∼30% of adults globally. The progressive form of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), is a leading cause of chronic liver disease. MASH is marked by hepatocellular fat accumulation (steatosis), ballooning, and inflammation. Although many in vitro and in vivo models replicate MASH pathophysiology, no in vitro hepatocyte MASH model has been evaluated for its ability to reflect clinically observed changes in drug metabolizing enzymes (DMEs) and transporters. In this study, we addressed this gap by developing a model using sandwich-cultured human hepatocytes (SCHH) that mimics both MASH pathophysiology and alterations in DME and transporter concentrations and function. Lipid–cytokine treatments were first optimized using differentiated HuH-7 cells based on cellular toxicity and their ability to induce a MASH-like phenotype. Three final treatments—all including TNF-α (1 ng/mL) and IL-6 (1.2 ng/mL)—were selected for SCHH evaluation: (1) oleic acid (OA):palmitic acid (PA) (1:2, 0.5 mM), (2) a lipid mix (lysophospholipids mixture + OA:PA), and (3) lipid mix + 0.01 mM cholesterol. Treatments were incubated for 72 h with SCHH from three donors. Quantitative targeted absolute proteomics (QTAP) assessed the transporter and DME concentrations, whereas B-CLEAR® technology evaluated transporter function using the probe substrates [3H]-taurocholate (TCA) and [3H]-estradiol-17β-glucuronide (E217G). All three treatments significantly increased lipid droplet formation and peroxidation in SCHH with minimal toxicity. These treatments also altered DME and transporter concentrations in a manner similar to the changes observed in liver tissue from patients with MASH. Across treatments, concentrations of the bile salt export pump (BSEP), sodium taurocholate co-transporting polypeptide (NTCP), organic anion transporting polypeptide (OATP) 1B1, OATP1B3, and multidrug resistance-associated protein (MRP) 2 were reduced by 0.66–0.57-fold, 0.71–0.52-fold, 0.74–0.63-fold, 0.82–0.80-fold, and 0.71–0.48-fold, respectively. Correspondingly, the TCA apparent uptake clearance and biliary clearance were reduced by 0.70–0.26-fold and 0.61–0.27-fold, respectively. E217G apparent uptake clearance was reduced by 0.67–0.35-fold, whereas biliary excretion index values were reduced to negligible levels. These findings demonstrate that lipid–cytokine treatments induce MASH-like changes in SCHH, including clinically relevant reductions in DME and transporter concentrations and function. This model may serve as a valuable tool for predicting altered hepatobiliary drug disposition in MASH
Onset and exacerbation of obsessive–compulsive disorder in the perinatal period
Full text linkPurpose Obsessive-compulsive disorder (OCD) can emerge during pregnancy and the postpartum and may adversely affect mother and newborn. However, little is known about potential risk factors for the onset of OCD in the perinatal period. Therefore, we investigated the onset of diagnosed DSM-5 OCD in women followed from the second trimester of pregnancy to 6-months postpartum. Methods We followed 256 women from the 20-24th week of pregnancy to 6-month postpartum. Participants had psychiatric diagnostic interviews at baseline and 6-month postpartum and completed self-report instruments. We compared women with and without incident OCD on sociodemographic characteristics and clinical features. Results Of the 143 participants without past or current OCD at baseline, 12 (8.4%) were diagnosed with DSM-5 OCD at 6-month postpartum. The incident cases had a broad range of types of obsessions and compulsions. Compared to those who did not develop OCD, the incident cases were significantly less likely to be married, to have a college degree, or have an annual household income above $50,000, and they were more likely to be receiving public assistance and to have an unplanned pregnancy. The incident cases also had significantly higher mean scores on measures of obsessional beliefs, anxiety, and perceived stress. Conclusions A considerable proportion of pregnant women have onset of OCD during pregnancy and the postpartum, with multiple types of obsessions and compulsions. Socioeconomic circumstances, and cognitive and psychological vulnerabilities, may increase the risk of developing OCD in the peripartum.Article highlights
256 women were followed from the 20-24th week of pregnancy to 6-month postpartum.
12 (8%) of the women had onset of OCD during the follow-up period.
The women with OCD-onset reported fewer socioeconomic resources.
The women with OCD-onset had more psychological vulnerabilities
Disentangling Temporal Trends of Clade Ib Monkeypox Virus Transmission in Burundi.
Full text linkUtilizing mpox case data from Burundi between August 2024 and April 2025, we calibrated a mathematical model to quantify the temporal trends of clade Ib monkeypox virus transmission. The model outputs indicated a declining overall transmission trend. Children aged 0-4 and 5-9 years were estimated to be at higher risk of infection compared to older age groups, while sexual contact was inferred to contribute up to 50% of the overall transmission