Michigan Research Articles

Daily estradiol and progesterone levels moderate genetic and environmental influences on emotional eating across 45 consecutive days in female twins.

Past studies indicate daily increases in estrogen across the menstrual cycle protect against binge-eating (BE) phenotypes (e.g. emotional eating), whereas increases in progesterone enhance risk. Two previous studies from our laboratory suggest these associations could be due to differential genomic effects of estrogen and progesterone. However, these prior studies were unable to directly model effects of daily changes in hormones on etiologic risk, instead relying on menstrual cycle phase or mean hormone levels. The current study used newly modified twin models to examine, for the first time, the effects of daily changes in estradiol and progesterone on genetic/environmental influences on emotional eating in our archival twin sample assessed across 45 consecutive days. Participants included 468 female twins from the Michigan State University Twin Registry. Daily emotional eating was assessed with the Dutch Eating Behavior Questionnaire, and daily saliva samples were assayed for ovarian hormone levels. Modified genotype × environment interaction models examined daily changes in genetic/environmental effects across hormone levels. Findings revealed differential effects of daily changes in hormones on etiologic risk, with increasing genetic influences across progesterone levels, and increasing shared environmental influences at the highest estradiol levels. Results were consistent across primary analyses examining all study days and sensitivity analyses within menstrual cycle phases. Findings are significant in being the first to identify changes in etiologic risk for BE symptoms across daily hormone levels and highlighting novel mechanisms (e.g. hormone threshold effects, regulation of conserved genes) that may contribute to the etiology of BE.

Use of Pulmonary Rehabilitation after Chronic Obstructive Pulmonary Disease Hospitalization: An Analysis of Statewide Patient and Hospital Data.

Rationale: Pulmonary rehabilitation (PR) is a clinically effective and cost-effective outpatient treatment for chronic obstructive pulmonary disease (COPD) that remains highly underused. Existing analyses of PR use patterns have been focused largely on patient characteristics, but hospital-level analysis is lacking and is needed to inform interventions aimed at improving use after COPD hospitalization. Objectives: To evaluate PR use across hospitals after COPD hospitalization in the state of Michigan, with the goal of characterizing hospital-level variation and identifying the characteristics of high-performing hospitals. Methods: This is a retrospective study of patients with COPD hospitalizations between January 1, 2018, and December 31, 2021, using claims data from the Michigan Value Collaborative and hospital data from the American Hospital Association annual survey. Our primary outcome was the initiation of PR within 30 days of discharge. Chi-square tests and analysis of variance were used to test for differences in patient and hospital covariates. Multilevel logistic regression was used to analyze associations between patient covariates and the primary outcome and to characterize hospital-level variation. Results: A total of 36,389 patients and 99 hospitals were included in the analysis. The majority of patients were older than 65 years of age, female, White, and Medicare fee-for-service insured. The rate of PR initiation within 30 days after hospitalization was 0.8%. Adjusted rates of PR initiation by hospital ranged from 0.4% to 2.0%. Compared with the set reference groups, being female, in the fifth Distressed Community Index quintile, and older than 85 years of age independently decreased the odds of initiating PR. Some variation in initiation rate was attributed to the hospital level (7%; intraclass correlation coefficient = 0.07 [95% confidence interval, 0.03-0.15]). The median odds ratio was 1.6 for PR initiation by hospital. Conclusions: Rates of PR initiation after COPD hospitalization are universally low across all hospitals, though there is some variation. Interventions targeted at patients alone are not sufficient to improve use. Hospital-based strategies to improve PR use after discharge, adapted from those being successfully used with cardiac rehabilitation, should be further explored.

An Analysis of Opioid Consumption and Patient Recovery after Hysterectomy by Surgical Approach.

Background: Minimally invasive hysterectomy is preferred to open hysterectomy due to lower morbidity, but recent data regarding the association of surgical approach with patient recovery and opioid consumption are lacking. Objective: To analyze how postoperative opioid use and return to baseline activity vary by surgical approach for hysterectomy. Study design: This was a retrospective cohort study including hysterectomy patients from the Michigan Surgical Quality Collaborative registry that was linked to the State of Michigan's prescription drug monitoring program. We analyzed two primary outcomes with respect to surgical approach: opioid consumption in the 30 days following surgery, measured in morphine milligram equivalents (MMEs), and return to baseline activity >4 weeks after surgery. Adjusting for demographics, comorbidities, preoperative opioid use, surgical indication, clinical events at 30 days postoperatively, and surgical approach, we used multivariable linear regression and logistic regression models to identify factors associated with our primary outcomes. Results: Lower opioid consumption was reported with minimally invasive hysterectomy, with mean postoperative opioid consumption (95% CI) of 32.70 (27.15-38.26) MMEs for vaginal, 39.91 (37.17-42.65) MMEs for laparoscopic, and 54.97 (48.81-61.13) MMEs for open hysterectomy. Other covariates associated with lower opioid consumption included older age and year of surgery in 2019 versus 2018. Predicted probability of return to baseline activities >4 weeks after surgery was 51% (44-57%), 43% (40-45%), and 64% (60-69%) for vaginal, laparoscopic, and open hysterectomy, respectively. Conclusion: Minimally invasive approaches to hysterectomy are associated with lower postoperative opioid consumption and a more rapid recovery relative to open hysterectomy.

Surface performance characteristics of carpet‐mat stabilized cool‐season sod over drainage cells for temporary stadium installation

AbstractCarpet‐mat systems are a diverse group of hybrid stabilizing systems that are installed during sod establishment. In this experiment, eight hybrid, carpet‐mat systems (Flexgrass, Hatko Turfgrass XL BIO 40/34/10 [Turfgrass BIO], Hatko Hybridgrass 40 DS 10 XL [Hybridgrass 40 XL], Hatko Hybridgrass 53 DS 10 XL [Hybridgrass 53 XL], HG Turf Group HERO 127.127 [HERO 127], HG Turf Group HERO 169.169 [HERO 169], Tarkett Sports PlayMaster, POWERgrass™ SP/T [POWERgrass]) were screened for their suitability as a playing surface option for FIFA tournaments. Research was conducted at Michigan State University (MSU) and the University of Tennessee (UT). In fall 2023, carpets were seeded with perennial ryegrass (Lolium perenne L.) and established over plastic. Carpets were infilled with a graded, 90:10 (sand:peat) root zone to each carpet manufacturers prescribed depth. In spring 2024 (<12 months after seeding), established sod was harvested and transplanted to a cellular drainage testing block over asphalt. Treatments were evaluated for surface hardness, rotational resistance, and soccer ball rebound. At UT, treatments had no effect on surface hardness; however, both HERO treatments registered higher rotational resistance than all other carpets. At MSU, all carpet‐mats, but HERO 169, generated a harder playing surface than the non‐stabilized control but had no effect on rotational resistance. Ball rebound was unaffected by any treatment at either location. Based on current FIFA thresholds for an excellent quality pitch, all carpet‐mat systems we evaluated following initial establishment could be considered a suitable hybrid option as a playing surface for a FIFA tournament venue.

Telehealth Research Strategies in a Post COVID-19 Era: A Roadmap for the Coming Decade.

An Agency for Healthcare Research and Quality-funded Think Tank, held at Michigan State University, brought together a wide range of subject matter experts in telemedicine, telehealth, digital health, digital access, and health care. The authors of this article represented a group focused on the research needs, constructs, and strategies in the post-COVID era. While telemedicine and telehealth grew exponentially during the pandemic, the challenges that have been with us for decades, while ameliorated to some extent, remain. To showcase the State of Michigan as a model, the authors reviewed challenges and opportunities related to telehealth and telemedicine usage and categorized them into seven areas of highest priority. Based on a review of the literature and consultation in the fields of telehealth, telemedicine, and digital access, we identified seven key categories where research would be most effective going forward. These categories include research into the impact of telehealth on clinical services, telehealth's use in administrative activities, education and training for health care providers and patients, telehealth policy implications at state and federal levels, the impact of future technology and innovation on telehealth services, patient characteristics and their experiences, and the ethical aspects of telehealth in the future. We have formulated this overview of our findings to act as a roadmap for future telehealth research. We recommend that ongoing studies should explore each of the seven categories identified above. The search for solutions to overcome the challenges within these topics must not be constrained to research that has been conducted recently; many of these challenges have faced telehealth researchers for decades, and numerous solutions have been proposed over the years. Some of these proposals should be explored once again in light of technological and societal advances. The findings from these studies should be shared in ways and through venues that can make them accessible outside the spheres of academic research, but also by practitioners, policymakers, and patients. Third, research into telehealth in all its incarnations must be prioritized, and leadership is needed to ensure these areas of study are continued to be spotlighted after the noise of the COVID-19 pandemic grows quiet.

Comparisons of 30-day outcomes after ventral hernia repair by body mass index and surgical approach: a retrospective cohort study.

Obesity is a known risk factor for postoperative complication after ventral or incisional hernia repair (VIHR). Whether minimally invasive techniques can mitigate this risk for certain patients remains unknown. This study investigates whether MIS approaches offer advantages in reducing any medical or surgical complication after VIHR across clinically meaningful BMI categories. This study analyzes data from the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR). The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan. This study includes adult patients receiving VIHR between Jan 2020 and September 2023. All elective VIHRs captured in the MSQC database were included in analysis. Univariate statistics were used for cohort summary and multivariate logistic regression was used to estimate the probability of any 30-day postoperative complication while controlling for age, sex, the interaction of BMI and surgical approach, medical comorbidities, hernia size, mesh use, use of component separation, and previous hernia repair. A total of 11,886 people met the study inclusion criteria. The median (IQR) age was 55.0 (44-65) and 5,111(43.0%) were female. The median (IQR) BMI was 31.7 (27.6-36.3). 5,260(44.3%) cases were performed with an MIS approach and 6,626(55.7%) were performed with an open approach. The adjusted relative risk of experiencing a complication after open repair when compared to MIS repair was 1.34 (95% CI [1.04-1.70], p = .02) in Obesity Class I, 1.62 (95% CI [1.23-2.14], p < .001) in Obesity Class II, and 2.31 (95% CI[1.49-3.56]) for Obesity Class III. MIS repair was associated with improved 30-day outcomes for patients with class I, II, and III obesity, but not for healthy to overweight patients. In clinical scenarios where delay for severely obese patients may be difficult, electing to use an MIS repair may be the optimal strategy to reduce risk of complications.

Postcolonial Cinema’s Pop-Culture Turn

Bannister, Matthew. Eye of the Taika: New Zealand Comedy and the Films of Taika Waititi. Wayne State UP, 2021. 304 pp. Paperback. $36.99. Carter, Erica, Bettina Malcomess, and Eileen Rositzska. Mapping the Sensible: Distribution, Inscription, Cinematic Thinking. De Gruyter, 2023. 155 pp. Paperback. $22.99. Dima, Vlad. Meaninglessness: Time, Rhythm, and the Undead in Postcolonial Cinema. Michigan State UP, 2022. 190 pp. Paperback. $49.95. Kim, Soyoung. Korean Cinema in Global Contexts: Post-Colonial Phantom, Blockbuster, and Trans-Cinema. Amsterdam UP, 2020. 212 pp. Hardcover. $131.00. Majumdar, Rochona. Art Cinema and India’s Forgotten Futures: Film and History in the Postcolony. Columbia UP, 2021. 306 pages. Paperback. $35.00. Sim, Gerald. Postcolonial Hangups in Southeast Asian Cinema: Poetics of Space, Sound, and Stability. Amsterdam UP, 2020. 254 pp. Hardcover. $138.00.

SGLT2-'eyes' on the reno-protection prize: reduction of post-PCI contrast-associated AKI in diabetic patients using SGLT2 inhibitors

Abstract Background Chronic therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with long term reno-protective benefits. There are limited data on the benefits of these agents against the risk of contrast-associated acute kidney injury (CA-AKI). Purpose The goal of our study was to assess the comparative efficacy of SGLT2i for the prevention of CA-AKI in diabetic patients undergoing PCI. Methods The study population included all diabetic patients enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Percutaneous Coronary Intervention (BMC2PCI) registry, a clinical registry of all PCI cases at non-federal hospitals in the state of Michigan, USA. Included patients underwent PCI between January 2022 and September 2023. Patients on dialysis were excluded. Predicted AKI risk was calculated using a previously validated and published machine learning BMC2 risk model. The primary outcome of CA-AKI was defined as an elevation in serum creatinine of ≥0.5 mg/dL following PCI. Risk-adjusted AKI rates were estimated by the product of event observed/expected ratio and overall collaborative AKI rate. Propensity matching on 23 covariates was used to adjust for the non-random use of SGLT2i. Results A total of 19,078 diabetic patients were included, of whom 3,087 (16.2%) were prescribed SGLT2i prior to PCI. Patients treated with SGLT2i were younger (66.1 vs 68.3 years), more likely to be men (73.3% vs 65.3%), have heart failure (50.4% vs 42.4%), have prior PCI (58.4% vs 48.8%), and have co-prescription of insulin (43.8% vs 37.3%) (p&amp;lt;0.001 for all). After propensity matching, no significant baseline difference between cohorts remained, with an absolute standardized difference less than 10% on all covariates. The pre-procedural use of SGLT2i was associated with a lower incidence of CA-AKI in unadjusted analysis (2.7% vs 3.8%, p=0.003) and after adjusting for the baseline predicted risk of CA-AKI (2.2% vs 2.8%, adjusted OR 0.69, 95% CI 0.54-0.89, p=0.0045). In a propensity-matched analysis, the use of SGLT2i was strongly associated with a reduced adjusted risk for CA-AKI (2.2 % vs 2.8%, adjusted OR 0.72, 95% CI 0.62-0.84, p=0.026). Conclusions Among patients with diabetes presenting for PCI, pre-procedural use of SGLT2i was associated with a significant reduction in the risk of CA-AKI. These results should compel further investigation into the beneficial effects of SGLT2 inhibitors in reducing the risk of CA-AKI.

Telehealth Postpandemic: A Model for Michigan and Beyond.

During the COVID-19 pandemic, telemedicine and telehealth saw a groundswell of growth, only to be shackled in the aftermath of the Public Health Emergency. A Think Tank, funded by Agency for Healthcare Research and Quality, was held at Michigan State University in August 2024. This paper serves as an introduction to a series of articles focusing on the evolution and future of telehealth in a postpandemic world. It highlights key themes including patient equity, technology, clinical opportunities, research, and education, using Michigan as a model for national adaptation. The paper aims to ignite further discussion and innovation within the telehealth community.

Postanesthetic rhabdomyolysis in 7 warmblood horses.

To describe the clinical findings, outcomes, and muscle histopathology in warmblood horses that developed severe rhabdomyolysis in the perianesthetic period despite remaining stable while under general anesthesia. 7 warmblood horses, 6 geldings and 1 mare, with a median age of 9 years (range, 4 to 18 years) and median weight of 615 kg (range, 550 to 703 kg). Records from the Valberg Neuromuscular Diagnostic Laboratory and Michigan State University were reviewed (2016 to 2023) to identify warmbloods with postanesthetic myopathy (PAM). Warmblood horses with no history of myopathy developed PAM after remaining stable while under general anesthesia. Five of 7 horses were in regular work prior to anesthesia, and activity level was unknown in 2 horses. Time to standing in recovery was prolonged, 3 horses were euthanized due to persistent recumbency, and rhabdomyolysis recurred in 4 horses 5 to 11 days after anesthesia, with 1 surviving. Horses had muscle stiffness, pain, and sweating and struggled to remain standing. As PAM developed, serum creatine kinase activity and lactate concentrations (12 ± 7 mmol/L; n = 5) were markedly increased. At necropsy, histopathology revealed complete glycogen depletion (5 of 7), acute myodegeneration (6 of 7), and chronic active myodegeneration of representative skeletal muscle samples. A semimembranosus biopsy obtained 14 days after anesthesia from the survivor had rare glycogen-depleted fibers. Warmblood horses are susceptible to fatal PAM characterized by acute myodegeneration, lactic acidosis, and muscle glycogen depletion that occurs up to 11 days after anesthesia. In horses with delayed recovery after anesthesia, monitoring for 2 weeks after anesthesia, including assessment of serum creatine kinase activity and blood lactate, could potentially improve outcomes.

Moment-Based Estimation of Linear Panel Data Models with Factor-Augmented Errors

Abstract I compare two popular methods of estimation for linear panel data models with unobserved factors: the first eliminates the factors with a parameterized quasi-long-differencing (QLD) transformation. The other, referred to as common correlated effects (CCE), uses cross-sectional averages of the data to proxy for the factor space. I show that the CCE assumptions imply unused moment conditions that can be exploited by the QLD transformation. I also derive new linear estimators that weaken identifying assumptions and have desirable theoretical properties. Unlike CCE, these estimators do not require the number of covariates to be less than the number of time periods. I provide the first proof of a fixed-T consistent mean group estimator for heterogeneous linear models with interactive fixed effects. I investigate the effects of per-student expenditure on standardized test performance using data from the state of Michigan.

Intersecting Disciplines: Should LIS Competencies Include Social Work?

Social work in librarianship is a phenomenon that has gained momentum in public libraries since the first known social worker began working at the San Francisco Public Library in 2009. Few LIS programs offer courses to address this evolving phenomenon, yet librarians and library staff nationwide have expressed the need to have training in social work to help them meet the needs of their users. To date, there are only three universities (Dominican University, University of Michigan and Middle Tennessee State University) that offer dual degree programs and even fewer universities that offer social work librarianship courses. With the concern of librarians not feeling equipped to address the social needs of library users (eg. depression, anxiety, suicide, health issues, substance abuse, poverty) this paper emphasizes the critical need for LIS programs to adapt their curriculum to adequately prepare future librarians for public librarianship.

Characteristics associated with adult non-fatal opioid and stimulant overdose and substance use disorder emergency department visits in Michigan

BackgroundUnderstanding risk factors for emergency department (ED) visits for overdose and substance use disorder (SUD) can inform prevention efforts. Few studies have considered non-fatal opioid overdoses, stimulant overdoses and SUD, and limited data exists by overdose intentionality and by sex. MethodsWe conducted a serial cross-sectional study with Healthcare Cost and Utilization Project Michigan (MI) 2019–2020 ED discharge data (n=5,716,716). Primary outcomes included non-fatal opioid overdoses, non-fatal stimulant overdoses, and SUD primary diagnoses in a single ED visit. We examined demographic and socioeconomic factors associated with study outcomes using binary and multinomial logistic regression (for overdose intentionality) models, which estimated adjusted odds ratios (AOR) and 95 % confidence intervals (CI). ResultsAmong all MI discharges, 13,908, 1,379, and 23,462 were nonfatal opioid, stimulant, or SUD overdose visits, respectively. Lower median household income (vs. higher income), male sex (vs. female), metropolitan county of residence (vs. small urban/rural), and Medicaid (vs. private insurance) were associated with increased odds of all outcomes. For example, ORs(95 % CIs) for Medicaid were 4.41(4.18,4.65), 2.25(1.95,2.60), and 2.80(2.70,2.91) for opioid overdoses, stimulant overdoses, and SUD, respectively. All outcomes had the highest increased odds in ages 28–32 years compared to 18–22 years. Stratification by sex and non-fatal overdose intentionality modified some associations, with the strongest associations observed for non-fatal opioid overdoses. ConclusionsMale sex, Medicaid, and race/ethnicity were consistently associated with all outcomes similarly, but other characteristics varied in patterns, strengths of association, and statistical significance by outcome groups, sex, and non-fatal opioid or stimulant overdose intentionality.

Corporate Social Responsibility and Consumer Choice: Lessons from the Milk Boycott

We study the impact of a boycott on one of the largest Korean dairy producers, triggered by the exposure of the firm’s unethical management practices, on sales of its own and others. We find empirical evidence that the boycott had substantial and long-lasting consequences. First, consumer utility from the boycotted products decreased significantly, reflecting consumers’ strong willingness to take part in collective action. Second, our discrete choice demand model, which addresses both price endogeneity and product substitution, estimates that sales of the boycotted firm decreased by almost 8% or, equivalently, by 8.1 million liters during the 12-month postboycott period. Third, the boycotted firm’s sales and revenue decreases would have been more severe had the firm not cut prices after the boycott outbreak. Our findings emphasize top-level managers’ role in fostering an ethical organizational culture within the firm and taking proper and timely countermeasures to curb losses incurred by a boycott. This paper was accepted by Eric Anderson, marketing. Funding: This work was supported by the Asian Studies Center of Michigan State University [Dr. Delia Koo Faculty Endowment Award] and Sogang University [New Faculty Research Funding Grant 202310031.01]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.01062 .

Analysis of Dental-related Emergency Department Utilization in Michigan

Objective: Emergency departments (ED) are critical to the United States healthcare system. However, they are known to be inefficient environments to deliver definitive care including management of dental emergencies. ED’s may also serve as an inadvertent, but important, stop gap for individuals who lack dental coverage. The nation’s healthcare system continues to struggle with inadequate resources to provide dental care for vulnerable patients who disproportionately suffer from dental-related conditions. Method: This study is an analysis on dental-related ED utilization in the state of Michigan. The authors collaborated with the Michigan Health &amp; Hospital Association who provided data from the Michigan Inpatient and Outpatient Database for dental-related hospital emergency department (ED) visits in Michigan hospitals during 2018-2019. University of Michigan Medical School’s committee on human subjects’ research reviewed the protocol and provided IRB exemption (HUM00192629). Results: State funded Medicaid (33%) and federally funded Medicare (33%) were the most common payer types for patients with dental-related conditions who reported to Michigan ED’s from 2018 to 2019. Charges per ED encounter was the highest for Medicare, $2,900-$3,200, and lowest for other payers, $1,300-$1,500. Charges for ED-inpatient per encounter were the highest for Medicare ($22,000-$24,000). The age range for which patients most frequently presented to the emergency department (ED) was 25-64. However, expenses per encounter for patients 65 and older were roughly two to three times higher than for patients in other age ranges. Conclusion: The study revealed a disproportionately higher percentage of patients who identified as Black presented to Michigan emergency departments (30%) with a dental-related emergency.

Engineering interkingdom communication for next-generation therapeutic approaches

Engineering interkingdom communication for next-generation therapeutic approaches Brian Snyder and Christopher H. Contag, from Michigan State University, discuss engineering interkingdom communication, which is not for palace intrigue, but for next-generation therapeutic approaches they argue. Our gut microbiota, once seen as ‘harmless passengers’, is now redefined as a vital symbiotic organ integral to sustaining human life. This microbiome consists of an estimated 1x1014 microbial symbionts. With an approximate 1:1 ratio of human to bacterial cells, it is the largest “organ” in the human body by cell count. Facilitating digestion, nutrient absorption, immune responses, and metabolic function, microbial symbionts are crucial for maintaining human health. Even minor changes in the composition of our microbiome have been implicated in a myriad of diseases, including cancers, metabolic diseases, autoimmune disorders, and neurological conditions (Clemente, Ursell, et al. 2012; Gomaa 2020).

8586 A Case Of Vitamin D Toxicity: From Michigan To Hawaii, Vitamin D Is Very High

Abstract Disclosure: A. Abu Limon: None. S.A. Aldasouqi: None. K. Patel: None. F. Akanbi: None. S. Khan: None. P. Kachhadia: None. We report a patient case who is a 46-year-old male, managed for Type 2 diabetes and Vitamin D deficiency (Defined by 25-hydroxy vitamin D levels less than 20ng/ml) at Michigan State University Endocrinology specialty clinic.He started taking 5000 IU daily Vitamin D supplements and on subsequent follow up his levels corrected to 88 ng/ml. His supplements were held.On a routine repeat lab check, his 25-hydroxy vitamin D level is reported to be higher than 200 ng/ml. Which meets the biochemical diagnosis of Vitamin D toxicity. His Calcium level was 9.7 mg/dL (N 8.7-10.3 mg/dL) and PTH-intact level was 38.3 pg/mL (N 14.0-72.0 pg/mL).On questioning the patient, he assured us he is still not on any Vitamin D supplements and that he just got back from a two-weeks long trip from Hawaii and spent hours daily on the beach without using sunblock.He is sure he didn't get tanning, sunburns, or any burns during that period.He was feeling fine without any symptoms or complications.While in Michigan during the winter, with limited number of sunny days, His 25-hydroxy vitamin D levels trended down slowly over the following few months, while Vitamin D supplements kept on hold.The most common cause of Vitamin D toxicity is excessive supplemental Vitamin D use. Other reasons can be related to excessive tanning or burns, that our patient didn't have. Excessive sun exposure or dietary intake is not a known reason to raise Vitamin D levels to a toxic range.Our patient lives in Mid-Michigan, an area known for low number of sunny days (150-180 sunny/ partly sunny days per year ), Which is a reason for high prevalence of vitamin D deficiency in the population. This is Compared to mostly sunny days on the Hawaiian Islands.Coming Back home for the winter season did help his Vitamin D levels to continue trending down back to a safe, non-toxic range. Presentation: 6/2/2024

Association Between Neurological Status and Outcomes in Cardiac Arrest Patients Undergoing PCI in Contemporary Practice: Insights From BMC2.

Coronary artery disease remains the largest contributor to cardiac arrests worldwide; yet, long-term outcomes are often driven by neurological status after resuscitation. We examined the association between pre-percutaneous coronary intervention (PCI) level of consciousness (LOC) and outcomes among patients with cardiac arrest who underwent PCI. The study cohort included patients undergoing PCI after cardiac arrest between April 2018 and March 2022 at 48 hospitals in the state of Michigan. Pre-PCI LOC was categorized as mentally alert, partially responsive, unresponsive, and unable to assess. In-hospital outcomes included mortality, bleeding, and acute kidney injury. Among 3021 patients who underwent PCI after cardiac arrest, 1394 (49%) were mentally alert, 132 (5%) were partially responsive, 698 (24%) were unresponsive, and 631 (22%) were unable to assess. The mentally alert cohort had lower mortality (4.59%) compared with the partially responsive (17.42%), unresponsive (50.14%), and unable to assess cohorts (38.03%; P<0.001). After adjusting for baseline differences, compared with mentally alert patients, the odds of mortality were markedly elevated in patients who were partially responsive (adjusted odds ratio, 4.63 [95% CI, 2.67-8.04]; P<0.001), unable to assess (adjusted odds ratio, 13.95 [95% CI, 9.97-19.51]; P<0.001), and unresponsive (adjusted odds ratio, 24.36 [17.34-34.23]; P<0.001). After adjustment, patients with impaired LOC also had higher risks of acute kidney injury and bleeding compared with mentally alert patients. Pre-PCI LOC is a strong predictor of in-hospital outcomes after PCI among cardiac arrest patients. A patient's pre-PCI LOC should be considered an important factor when weighing treatment options, designing clinical trials, and counseling patients and their families regarding prognosis after PCI.

Point-cloud based machine learning for classifying rare events in the Active-Target Time Projection Chamber

In this work, we assess the use of machine learning to classify fission events in the Active Target Time Projection Chamber (AT-TPC) using data from an experiment performed at the National Superconducting Cyclotron Laboratory at Michigan State University. The experiment produces an extremely large quantity of data, less than 3% of which are fission events. Therefore, separating fission events from the background beam events is critical to an efficient analysis. A heuristic method was developed to classify events as Fission or Non-Fission based on hand-tuned parameters. However, this heuristic method places 5% of all events into an Unlabeled category, including 15% of all fission events. We present a PointNet model trained on the data labeled by the heuristic method. This model is then used to generate labels for the events in the Unlabeled category. Using the heuristic and machine learning methods together, we can successfully identify 99% of fission events.

Adverse Actions and Malpractice Payments in Dentistry in the State of Michigan

Objective: Current practicing dentists in Michigan may not be well versed with the topic of adverse actions taken by the Michigan Dental Board and malpractice claims against dental practitioners. This research reviews these topics more carefully ultimately aiming to better dentistry. Method: The National Practitioner Data Bank (NPDB) provides publicly available information which assists in analysing current trends in adverse actions and malpractice payment reports in the state of Michigan. Data was extracted for the period between 1990 to 2022, and visualizations were developed to identify trends. Results: NPDB data inferred that there has been a decline in the number of malpractice payment reports over the past three decades, but adverse actions have a fluctuating trend in recent years. The loss or revoking of licensure being the most common adverse action taken. Furthermore only 32.65% cases out of these licensure loss cases were reinstated. Conclusion: There is a need for intervention with regard to the adverse action reports, which have been fluctuating but largely trending upwards since 2002, as they are detrimental to the successful growth of the dental profession as a whole. The goal of this project is to emphasize the necessity of evidence-based dentistry in practice. Dentists must understand the need to prevent the rise in malpractice trends and strive to deliver the best possible care.