Faculty Bibliography

Unauthorized immigrants and permanent residents may experience challenges in accessing kidney transplantation due to limited healthcare access, socioeconomic and cultural barriers. Understanding the United States (US) national landscape of kidney transplantation for non-citizens may inform policy changes. To evaluate this, we utilized two cohorts from the US national registry (2013-2023): 287,481 adult candidates for first transplant listing and 190,176 adult first transplant recipients. Citizenship was categorized as US citizen (reference), permanent resident, and presumed unauthorized immigrant. Negative binomial regression was used to quantify the incidence rate ratio over time by citizenship status. Cause-specific hazards models, with clustering at the state of listing/transplant, were used to calculate the adjusted hazard ratio of waitlist mortality, kidney transplant, and post-transplant outcomes (mortality/death-censored graft failure) by citizenship category. The crude proportion of presumed unauthorized immigrants listed increased over time (2013: 0.9%, 2023:1.9%). However, after accounting for case mix and waitlist size, there was no change in listing over time. Presumed unauthorized immigrants were less likely to experience waitlist mortality (adjusted Hazard Ratio 0.54, 95% Confidence Interval: 0.46-0.62), were more likely to obtain deceased donor kidney transplant (1.11: 1.05-1.18), but less likely to receive live donor (0.80: 0.71-0.90) or preemptive kidney transplant (0.52: 0.43- 0.62). When stratified by insurance status, presumed unauthorized immigrants on Medicaid were less likely to receive deceased donor kidney transplants compared to their citizen counterparts; however, presumed unauthorized immigrants with Private insurance or Medicare were more likely to receive deceased donor kidney transplants. Presumed unauthorized immigrants were less likely to experience post-transplant death (0.56: 0.43-0.69) and graft failure (0.69: 0.57-0.84). Residents had similar pre- and post-transplant outcomes. Despite the barriers to kidney transplantation faced by presumed unauthorized immigrants and residents in the US, better post-transplant outcomes for presumed unauthorized immigrants compared to citizens persisted, even after accounting for differences in patient characteristics.

A COMMENTARY ON/UNASSIGNED:Zhao Z, Attanasio C, Zong C, Pedano M S, Cadenas de Llano-Pérula M. How does orthodontic tooth movement influence the dental pulp? RNA-sequencing on human premolars. Int Endod J 2024; 57: 1783-1801. DESIGN-CROSS-SECTIONAL DESIGN/UNASSIGNED:Sample selection - The study sample consisted of healthy individuals requiring extraction of maxillary or mandibular premolars for fixed appliance orthodontic treatment. Exclusion criteria included systemic diseases, a history of smoking, antibiotic or analgesic use within the past three months, periodontal probing depths greater than 3 mm, alveolar bone resorption, and premolars with prior endodontic treatment. Participants were randomly divided into 3 groups: control, 7-day, and 28-day groups. Extractions were performed prior to orthodontic treatment, and 7 days and 28 days after application of orthodontic forces (OF) in the control, 7-day and 28-day group respectively. The applied orthodontic forces were in the range of 50-150 g. RNA extraction from pulp tissues was performed using the RNeasy mini kit. After total RNA extraction, a library was prepared, and RNA sequencing was conducted to examine and compare the genetic data among the groups within each jaw. DATA ANALYSIS/METHODS:Differentially expressed genes (DEGs) were identified in the 7-day and 28-day groups, followed by functional enrichment analysis to understand their biological significance. Furthermore, protein-protein interaction network analysis was conducted to investigate the complex network of protein interactions and locate key genes involved in orthodontic tooth movement. RESULTS:Immune response, hypoxia, DNA damage, and epigenetic regulation were the pulpal reactions reflected after 7 days of OF. Whereas, at 28 days, processes such as cell adhesion, migration, organization, and tissue repair became prominent. Pulp tissues in the maxilla and mandible responded differently to orthodontic force. The maxilla showed minimal changes, primarily involving immune response at 7 days and tissue repair at 28 days. In contrast, the mandible exhibited significant DNA damage and epigenetic regulation at 7 days, with a return to its baseline condition by 28 days. CONCLUSIONS:Dental pulp demonstrated different reactions at 7 and 28 days, with maxillary and mandibular pulp tissues presenting distinct responses. The study provided knowledge about gene regulatory mechanisms modulating pulp tissue response to OF.

Laboratory communication in dentistry involves the exchange of detailed information between clinicians and technicians for fabricating restorations, ensuring optimal patient outcomes. Effective communication includes written narratives, photographs, digital scans, and physical materials. Clinicians must understand laboratory processes, while technicians need to interpret and execute requests accurately. Certification and adherence to legal standards are essential. Effective communication impacts patient care by ensuring proper case planning, patient education, and setting realistic expectations. Clear, precise exchanges between clinicians and technicians are crucial for quality and compliance, fostering a collaborative and respectful relationship that ultimately benefits patient care outcomes.

The conventional denture fabrication process normally requires at least five visits, taking up considerable chairtime, encompassing multiple laboratory steps, and demanding that patients return to the office every time for treatment. Furthermore, if the denture breaks or gets lost, the fabrication process to make a new one will likely need to be started from the beginning. Today, providers can incorporate digital technology into many of the clinical steps to minimize the number of visits and procedure time needed to fabricate a complete denture. In addition, the materials are more patient friendly as there is less residual monomer in CAD/CAM milled resins. This article presents case studies that exemplify the combination of traditional clinical practices and digital methodologies to maximize efficiency in the denture fabrication process. Intraoral scanning was used to produce a denture prototype, and a traditional myofunctional impression technique was employed with the generated prototype, which was then scanned before a new, properly fitted denture was milled using 3D technology. This process is expedited in a predictable workflow that minimizes laboratory steps and chairtime, offers improved infection control, and leads to higher patient satisfaction.

PURPOSE/UNASSIGNED:The long scan times of quantitative MRI techniques make motion artifacts more likely. For MR-Fingerprinting-like approaches, this problem can be addressed with self-navigated retrospective motion correction based on reconstructions in a singular value decomposition (SVD) subspace. However, the SVD promotes high signal intensity in all tissues, which limits the contrast between tissue types and ultimately reduces the accuracy of registration. The purpose of this paper is to rotate the subspace for maximum contrast between two types of tissue and improve the accuracy of motion estimates. METHODS/UNASSIGNED:A subspace is derived that promotes contrasts between brain parenchyma and CSF, achieved through the generalized eigendecomposition of mean autocorrelation matrices, followed by a Gram-Schmidt process to maintain orthogonality.We tested our motion correction method on 85 scans with varying motion levels, acquired with a 3D hybrid-state sequence optimized for quantitative magnetization transfer imaging. RESULTS/UNASSIGNED:A comparative analysis shows that the contrast-optimized basis significantly improve the parenchyma-CSF contrast, leading to smoother motion estimates and reduced artifacts in the quantitative maps. CONCLUSION/UNASSIGNED:The proposed contrast-optimized subspace improves the accuracy of the motion estimation.

OBJECTIVES/OBJECTIVE:The escalating overdose crisis in the United States points to the urgent need for new and novel data tools. Overdose data tools are growing in popularity but still face timely delays in surveillance data availability, lack of completeness, and wide variability in quality by region. As such, we need innovative tools to identify and prioritize emerging and high-need areas. Forecasting offers one such solution. Machine learning methods leverage numerous datasets that could be used to predict future vulnerability to overdose at the regional, town, and even neighborhood levels. This study aimed to understand the multi-level factors affecting the early stages of implementation for an overdose forecasting dashboard. This dashboard was developed with and for statewide harm reduction providers to increase data-driven response and resource distribution at the neighborhood level. METHODS:As part of PROVIDENT (Preventing OVerdose using Information and Data from the EnvironmeNT), a randomized, statewide community trial, we conducted an implementation study where we facilitated three focus groups with harm reduction organizations enrolled in the larger trial. Focus group participants held titles such as peer outreach workers, case managers, and program coordinators/managers. We employed the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to guide our analysis. This framework offers a multi-level, four-phase analysis unique to implementation within a human services environment to assess the exploration and preparation phases that influenced the early launch of the intervention. RESULTS:Multiple themes centering on organizational culture and resources emerged, including limited staff capacity for new interventions and repeated exposure to stress and trauma, which could limit intervention uptake. Community-level themes included the burden of data collection for program funding and statewide efforts to build stronger networks for data collection and dashboarding and data-driven resource allocation. DISCUSSION/CONCLUSIONS:Using an implementation framework within the larger study allowed us to identify multi-level and contextual factors affecting the early implementation of a forecasting dashboard within the PROVIDENT community trial. Additional investments to build organizational and community capacity may be required to create the optimal implementation setting and integration of forecasting tools.

Preclinical testing of tissue engineering modalities are commonly performed in a healthy wound bed. These conditions do not represent clinically relevant compromised oral wound environments due to radiation treatments seen clinically. This study aimed to characterize the bone regeneration outcomes in critical-sized mandibular defects using particulate grafting in an irradiated preclinical model of compromised wound healing. Sixteen New Zealand white rabbits were divided into two groups (n = 8/group), namely (i) irradiated (experimental) and (ii) non-irradiated (control). The rabbits in the experimental group received a total of 36 Gy radiation, followed by surgical intervention to create critical-sized (10 mm), full-thickness mandibular defects. The control group was subjected to the same surgical intervention. All defects were filled with bovine bone grafting material (Bio-Oss, Geistlich, Princeton, NJ, USA) and allowed to heal for 8 weeks. At the study endpoint, rabbits were euthanized, and their mandibles were harvested for micro-computed tomographic, histological, and histomorphometric processing and analysis. Qualitative histological analysis revealed increased levels of bone formation and bridging in the control group relative to the experimental group. This was accompanied by increased levels of soft tissue presence in the experimental group. Volumetric reconstruction showed a significantly higher degree of bone in the control group (27.59% ± 2.71), relative to the experimental group (22.02% ± 2.71) (p = 0.001). The irradiated rabbit model exhibited decreased bone regeneration capacity relative to the healthy subjects, highlighting its suitability as a robust compromised wound healing environment for further preclinical testing involving growth factors or customized, high-fidelity 3D printed tissue engineering scaffolds.

Advancements in digital technologies over the past decade have revolutionized dentistry, particularly with the integration of digital workflows in removable partial dentures (RPDs). Key innovations include digital data capture and computer-aided design and manufacturing, which enhance patient comfort, streamline workflows, and reduce treatment time and costs. Initially embraced by fixed restorations, these technologies are now transforming RPDs, previously reliant on analog methods. The collaboration between dentists, laboratory technologists, and patients is essential for selecting optimal materials and achieving successful RPD treatments.