Minnesota Legislature Research Articles

#22 Does Cranial Ultrasound Differentiate Asymptomatic Congenital CMV (cCMV) Infection from cCMV with Central Nervous System Disease in Infants? Results from a Universal Screening Study in Minnesota, USA

Abstract Background Congenital cytomegalovirus (cCMV) is the most common infectious cause of neurodevelopmental deficits, including sensorineural hearing loss (SNHL). With the passage of a universal cCMV screening bill by the Minnesota legislature in 2021, it is imperative to define the optimal diagnostic approach for identified cases, particularly for asymptomatic infants. Cerebral ultrasound (US) is a safe, non-invasive technique to examine neonatal brains, and has been advocated by an international consensus panel as a modality for cCMV disease classification. This analysis described clinical manifestations of cCMV in infants identified by universal screening and characterized cranial US findings obtained during diagnostic evaluation. We correlated viral load in the newborn CMV screening saliva samples with clinical and US findings. Method Newborns were screened for cCMV at six Twin Cities nurseries by PCR of dried blood spots (DBS) obtained for routine newborn screening, and saliva collected 1-2 days after birth. Screen-positive infants had a confirmatory urine PCR test within 3 weeks of birth, and clinical evaluation that included cranial US. Results Through September 1, 2021, 19,017 newborns were screened for cCMV. 76 cases were identified (prevalence of 0.4%) by saliva or DBS, confirmed by urine CMV PCR testing. 76% (58/76) had asymptomatic cCMV; the remaining 24% were infants with cCMV disease. Nine had congenital or delayed-onset SNHL, of which 7 had abnormal US; 1 had normal US, and 1 did not have US performed. Median saliva viral load differed between infants with cCMV disease (3.3×104 IU/ml) and asymptomatic infants (8.6×106 IU/ml; p< 0.05, Fig. 1). Cranial US exams were available for 68 infants (51 asymptomatic, 17 with cCMV disease). 50 (74%) infants had normal US; 18 infants had abnormal US (Table 1). Of the 17 infants with cCMV disease, 12 had abnormal US, of which 4 showed cCMV disease-defining lesions. Of 51 asymptomatic infants, 6 had abnormal, and 45 normal, cranial US. Saliva viral loads did not vary between infants with normal vs. abnormal US (p=0.7). Conclusion PCR of newborn DBS and/or saliva revealed a prevalence of 4.0 per 1000 in a universal cCMV screening study. Surprisingly, an inverse relationship was observed between saliva viral load at birth and cCMV disease classification. Among babies with cCMV, the majority had normal cranial US, and most abnormalities were not pathognomonic for cCMV disease. Clarification is needed regarding which cranial US findings require detailed follow-up, including MRI, as universal cCMV screening programs move forward in clinical practice.

The Relationship Between Institutional and Organizational Party Power: Evidence from the Minnesota House’s Experimental Setting

How parties manage capitols and constituencies in the American context is the subject of much political inquiry. This research examines whether majority parties’ institutional capability depends on their ability to organize beyond the legislative chamber. An opportunity to examine such a question presents itself in a curious historical occurrence, the Minnesota Legislature’s abrupt de jure ban on political parties. Using data compiled from the Minnesota House of Representatives, I compare partisan characteristics in roll call voting in the context of an experimental setting. The results suggest legislative leadership powers lose efficacy when party’s organizational capacity beyond the chamber diminishes.

Curtailing lead aerosols: Effects of primary lead prevention on soil lead, pediatric exposures, and community health.

Five decades after the US approval of the commercial use of leaded petrol, the US EPA began a phasedown of leaded petrol to prevent spoiling catalytic converters, mandatory on all new US cars in 1975. With prompting by citizens and the Minnesota legislature, the US Congress required the US EPA to enforce a rapid phasedown on 1 January 1986 until the final ban of leaded petrol for highway vehicles on 1 January 1996. This article reviews the outcomes of curtailing leaded petrol on the temporal and spatial changes of pediatric blood Pb and soil lead (Pb) in metropolitan New Orleans. In 2001, a soil Pb survey was completed for all census tracts of metropolitan New Orleans. In 2006, after major flooding by Hurricane Katrina, a preliminary survey of 44 census tracts showed that the median soil Pb and children’s median blood Pb decreased across flooded and unflooded communities. In June 2017 a second survey was completed in all census tracts. Evaluation of pediatric blood Pb and soil Pb in matching census tracts (N=274) confirmed that curtailing leaded petrol diminished children’s exposure and concurrently reduced soil Pb. The concurrent temporal and spatial declines of children’s exposure and soil Pb were also observed in the Detroit Tri-County Area of Michigan. Curtailing leaded petrol was gradually accepted, and on 30 August 2021, 35 years after the US EPA phasedown, leaded petrol was banned by all nations. Eliminating leaded petrol was an essential step for primary Pb prevention of pediatric exposure and improving community health. Continuing efforts are required to reduce legacy-soil Pb that persists disproportionately in traffic congested, older, inner-city, urban areas, and other communities that are subjected to large inputs of Pb aerosols.

Resident Quality of Life and Family Satisfaction: Developing Measures for Minnesota Assisted Living Report Card

The 2019 Minnesota Legislature requested the Department of Human Services (DHS) and Minnesota Board on Aging to develop and administer a report card for assisted living (AL), including conducting annual resident and family surveys in Minnesota AL settings. This presentation includes the perspectives of representatives from MN DHS and Vital Research, as well as the University of Minnesota team who worked together to develop survey items, carry out the cognitive testing, and conduct analyses. Survey items were developed from published literature and existing tools on assisted living quality and underwent testing with MN stakeholders and cognitive testing with MN AL residents. Pilot testing assessed any further changes that needed to take place for resident and family satisfaction with AL quality (n=400). Presenters will share lessons learned with implementing the new tools and different aspects of the of the report card development and implementation process as well as the survey findings.

Abstract A26: Pilot trial to examine the effect of ginger on the gut microbiome: The Minnesota Cancer Clinical Trials Network

Abstract Experimental and epidemiologic evidence shows that the use of ginger root may reduce the incidence of colorectal cancer (CRC), but the mechanism through which ginger exerts its effect is unclear. Recently, an imbalanced gut microbiome was linked to inflammation, immune response, and CRC risk. Thus, we hypothesize that ginger intake may decrease CRC risk via changing the gut microbiome. The goals of this study are (1) assess whether ginger intake shifts the distribution of the gut microbiome from proinflammatory, CRC-predisposing bacteria and towards anti-inflammatory, CRC-protective bacteria and (2) evaluate the feasibility of conducting a large randomized clinical trial (RCT) leveraging the recently established Minnesota Cancer Clinical Trials Network (MNCCTN). We will conduct a pilot double-blind RCT, called “GINGER,” of 95-100 subjects aged 50-75 years old who were diagnosed with colorectal adenoma within the last 5 years (ClinicalTrials.gov NCT03268655). The subjects will be randomized to receive either 2,000 mg of ginger extract per day or matching placebo (1:1) for 6 weeks; the treatment phase will be followed by a 6-week washout. Fecal samples to characterize the gut microbiome will be collected at baseline, midpoint (week 6), and study end. Microbiome composition will be characterized by sequencing microbial 16S ribosomal RNA genes. In addition, pre- and postexposure urine samples will be collected to examine the correlation between bacteria and urinary metabolite of prostaglandin E2, which is an inflammatory biomarker and a putative biomarker for CRC. The methodology for “GINGER” was informed by an RCT recently completed by our group that involved aspirin as the intervention. In that RCT, which included 50 subjects and 5 stool collections within 12 weeks, 49 subjects completed the entire study and all stool collections. Adherence rates for the aspirin measured by pill count was at least 90%. Thus, these pilot data support the feasibility of the GINGER study. To implement the “GINGER,” we are using the resources of the MNCCTN, established in 2017. The MNCCTN, funded by Minnesota legislature and led by Masonic Cancer Center, University of Minnesota, will bring the “GINGER” and subsequent cancer clinical trials to communities throughout Minnesota, thus reducing the patients’ burden of travel and related costs. The network partners with Minnesota’s five largest health care providers (Essentia Health, Sanford Health, Mayo Clinic Cancer Center, Metro-Minnesota Community Oncology Research Consortium, and Fairview Health System) to provide infrastructure for conducting cancer trials at 18 sites outside the Twin-Cities metro area and Rochester, Minnesota. The “GINGER”—the first study conducted within the network—will begin recruitment in 3 sites by the end of November and in 6 sites by the end of 2018. Based on our previous experience, we expect to recruit 24-25 (25%) subjects in 3 months, 50%, in 6 months and all subjects by the end of 2019. Citation Format: Anna Prizment, Timothy R. Church, Dorothy Hatsukami, Robert Madoff, Christopher Staley, Robert J. Straka, Allison Iwan, Jenn Stromberg, Ya-Feng Wen, Cheryl Stibbe, Marie Rahne. Pilot trial to examine the effect of ginger on the gut microbiome: The Minnesota Cancer Clinical Trials Network [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A26.

How the Minnesota Senate Lost Its Stagger

The Minnesota Senate is one of only 11 state senates with four-year, unstaggered terms. As a result, no senate seats are on the ballot in two out of five general elections. That practice is contrary to the constitutional framers’ intent; they thought they were providing for staggered senate terms. For more than two decades after statehood senate terms were staggered. But in 1883, Attorney General W.J. Hahn issued an opinion that senate terms were not staggered under the constitution’s language. His opinion was occasioned by an 1877 constitutional amendment intended only to lengthen senate terms from two to four years when biennial legislative sessions were adopted. The Minnesota Supreme Court confirmed Hahn’s interpretation under unusual circumstances in 1948. This quirk of history – the result of poor drafting of the constitutional language and an aggressive use of the “plain language” rule of construction by Hahn – changed the Minnesota legislature. Aside from being contrary to the founders’ intent, it has affected both partisan control of the senate and how senators carry out their duties.This article details the history of how that came about and discusses the effects on the legislature.

A Bayesian Difference-in-Difference Framework for the Impact of Primary Care Redesign on Diabetes Outcomes

Although national measures of the quality of diabetes care delivery demonstrate improvement, progress has been slow. In 2008, the Minnesota legislature endorsed the patient-centered medical home (PCMH) as the preferred model for primary care redesign. In this work, we investigate the effect of PCMH-related clinic redesign and resources on diabetes outcomes from 2008 to 2012 among Minnesota clinics certified as PCMHs by 2011 by using a Bayesian framework for a continuous difference-in-differences model. Data from the Physician Practice Connections-Research Survey were used to assess a clinic’s maturity in primary care transformation, and diabetes outcomes were obtained from the MN Community Measurement program. These data have several characteristics that must be carefully considered from a modeling perspective, including the inability to match patients over time, the potential for dynamic confounding, and the hierarchical structure of clinics. An ad-hoc analysis suggests a significant correlation between PCMH-related clinic redesign and resources on diabetes outcomes; however, this effect is not detected after properly accounting for different sources of variability and confounding. Supplementary materials for this article are available online.

Abstract TMP65: The Minnesota Stroke System, 2012-2017: Development and Impact of a Statewide System of Stroke Care

Background: The Minnesota Stroke System is comprised of hospitals able to deliver state-of-the-art stroke treatment. The system is designed to increase access to acute stroke treatment and improve outcomes for stroke patients. Between 2011 and 2013, the Minnesota Department of Health convened health care providers and stroke patient advocates to plan and create the components of a statewide stroke system for Minnesota. To launch the system, the Minnesota legislature gave MDH statutory authorization to designate Acute Stroke Ready Hospitals (ASRHs) and recognize Primary and Comprehensive Stroke Centers certified by national accreditation bodies. The ASRHs meet ten criteria corresponding to the 2013 Brain Attack Coalition recommendations. Analysis: Stroke patient data are reported to the Minnesota Stroke Registry by hospital-based abstractors. Data are combined for 2012-2013, 2014-2015, and 2016-2017. Performance metric statistics were calculated using SAS (Cary, NC). The resident population living within 30 minutes of designated hospitals was calculated from 2010 US Census Bureau data using ArcGIS 10.3 Network Analyst. Results: From 2012 to 2017, the number of designated ASRHs increased from zero to 89, out of 111 eligible hospitals. The percentage of residents living within 30 minutes of any designated facility increased from 60% to 90%. The percentage of all stroke patients whose computed tomography image was initiated within 25 minutes of arrival increased from 34.2% to 42.9%. Intravenous thrombolytic therapy increased from 8.8% to 11% of all ischemic stroke patients. Median door-to-imaging time decreased from 40 to 33 minutes. Median door-to-needle time decreased from 56 to 53 minutes. 28.7% of patients in 2012-2013 who received IV tPA were treated within 4.5 hours of time last known well, increasing to 35.6% in 2016-2017. Conclusions: The Minnesota Stroke System has successfully catalyzed and supported significant improvements in acute stroke treatment in Minnesota.

Examining the potential for racial disparity in out-of-home placement decisions: A qualitative matched-pair study

This community-based participatory research project was initiated following a charge from the Minnesota Legislature concerning the disproportionate representation of African American children in out-of-home care. The goal was to evaluate the impact of client race on child welfare worker decision-making and case outcomes and determine the potential for bias in decision-making. This report describes a detailed qualitative follow-up analysis of the data gathered for the quantitative inquiry. Cases of non-Hispanic, non-immigrant, white and African American children substantiated for child neglect in 2001 were identified from four Minnesota counties and followed until case closure or for at least 18months. Cases were matched on type of neglect, gender, age group, and county. Cases of 81 pairs of black and white children were qualitatively coded and analyzed to identify possible race-linked differences in case characteristics, and which factors, including race, were most predictive of out-of-home placement decisions. In large part, the relevant facts of the case and risk to the child were clearly the driving force behind decisions made. However, models indicated that differences existed between race and age groups in incidence of certain case characteristics and in case process and outcomes, despite similar overall rates of referral for ongoing placement between races. Implications for future research are discussed, particularly the benefits of qualitative and quantitative data used in concert to contextualize findings.

Tobacco product prices before and after a statewide tobacco tax increase

BackgroundIn 2013, the State of Minnesota Legislature passed a tobacco tax increase that increased the combined cigarette excise and sales tax by US$1.75 (from US$1.60 to US$3.35) and increased the...

The Community Oral Care Specialist©

It has been suggested that Minnesota has an underserved population that does not have access to dentists because they live in remote areas. It has been suggested that Minnesota cannot afford to treat the underserved population using licensed dentists. In 2009 the Minnesota Legislature gave the State the go ahead to train dental therapists to alleviate alleged pain and suffering in the underserved population.

Use of restorative procedures by allied dental health professionals in Minnesota

In 2003, the Minnesota legislature revised the Dental Practice Act to include restorative procedures in the scope of practice for registered dental assistants (RDAs) and registered dental hygienists (RDHs). The authors examined these practitioners' characteristics and made comparisons on the basis of their use of restorative function (RF) training and their practices' locations. They also examined practice type, models of implementation and perceived outcomes. The authors mailed a survey to all RF-certified RDAs and RDHs in Minnesota (N = 387). They used descriptive statistics to summarize the data and t tests and Fisher exact tests (P <.0001) to make comparisons between groups. The authors received 243 surveys (63 percent). Less than one-half (38 percent) of the RF-certified practitioners performed RFs. Of these, 29 percent were RDHs and 71 percent were RDAs. These practitioners performed RFs most often by working with a dentist or when time allowed. They perceived increased access to dental care and an increase in the number of patients treated to be outcomes of performing RFs. The results of this survey indicated use of restorative procedures varied greatly by practitioner type. The perceptions of those who performed RFs indicated they had a positive effect on dental practice. The addition of RF-certified personnel to the dental team has the potential to increase the number of patients seen in practice and the job satisfaction of team members.

The Decision to Run: The Stories of Women in the Minnesota Legislature

The Decision to Run: The Stories of Women in the Minnesota Legislature

The Community Oral Care Specialist

It has been suggested that Minnesota has an underserved population that does not have access to dentists because they live in remote areas. It has been suggested that Minnesota cannot afford to treat the underserved population using licensed dentists. In 2009 the Minnesota Legislature gave the State the go ahead to train dental therapists to alleviate alleged pain and suffering in the underserved population.

The Minnesota Center Against Violence and Abuse (MINCAVA)

The Minnesota Center Against Violence and Abuse (MINCAVA) was established in 1994 through an appropriation of the Minnesota Legislature. Located at the University of Minnesota, MINCAVA conducts original research, develops extensive collections of translational materials, provides higher education training on family violence prevention, and disseminates information globally. Over a dozen professional and student staff work on projects funded by federal, state, and private sources and collaborate closely with national and global advisory boards and partner agencies as well as local community-based and national advocacy organizations. The Center operates multiple project-specific and general websites that receive millions of unique visits each year from dozens of countries.

Chronicling the dental therapist movement in the United States

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.

Commentary: Minnesota's Response to Brownfield Redevelopment Issues

This article highlights the key actions implemented by Minnesota to address issues related to brownfields and focuses on a number of key legislative and state agency actions that began in the 1980s. The article acknowledges that many of the brownfield actions taken by the Minnesota legislature and state government agencies would not have taken place—as they did or when they did—if it were not for the efforts and contributions made by dozens of individuals and other public, private and non-profit organizations. The article emphasizes that the actions taken by the Minnesota legislature and the brownfield programs in the state have been very successful at encouraging private and public parties to buy, invest, sell and redevelop brownfields. However, the article further states that there are still many brownfields in Minnesota that have not yet been addressed, and that challenges still exist. It is important to recognize past contributions and accomplishments, but even more important to support and strengthen existing programs that encourage new initiatives.

Dentistry and Health Care Reform in the USA

What will the practice of dentistry look like in the United States when the health care delivery systems are changed? This question makes two likely assumptions. One assumption is that the health care systems are going to change. It is hard not to see the wave of demand for improvements in this sector. The other is that it is hard to imagine that some of the very significant changes under discussion will not impact dentistry and orthodontics. We all know that potential contentious issues are best addressed before they are encountered. We also know that orthodontics draws many of the finest minds in dentistry. It is human to lean toward favoring the status quo when we are doing well, but it is time that we begin to look at the effect some of the proposed changes can make on our discipline. The buzz I hear these days’ is about the presumed efficiency and cost savings inherent in the transfer of many patient care duties to a lesser trained person. This arises from the concept of a transfer of the medical nurse practitioner concept to dentistry. The concept is tantamount to saying that a portion of health care is technical in nature and can be properly and more economically delivered by someone with lesser education and training. The debate is largely focused on capturing the economy of such a shift with the resistance citing the need to guarantee the patients’ quality of care. While there are undoubtedly many approaches being discussed in various states, the one I hear most commonly cited is the Minnesota proposal. This is where I live and the facts are that the Minnesota legislature did address this question in 2008. The first proposal to enlarge upon dental hygiene education for certain hygienists was replaced by a second bill that is now law. This second bill provides for the creation of a new level of dental care provider, the oral health practitioner. Under the new legislation, The Board of Dentistry will license the new oral health practitioner and the oral health practitioner will work under the supervision of a dentist. The details of the final bill can

THE TRUANCY INTERVENTION PROGRAM OF THE RAMSEY COUNTY ATTORNEY'S OFFICE: A COLLABORATIVE APPROACH TO SCHOOL SUCCESS

Chronic truancy has far‐reaching effects, both for the youth who become disconnected from school and for society. Crime, unemployment, underemployment, drug abuse, alcohol abuse and risky sexual activity have all been linked to chronic truancy. In 1995, the Minnesota Legislature authorized the creation of diversion programs specifically for truants. That same year, in response to the growing truancy problem, Ramsey County Attorney Susan Gaertner directed her staff to create a program for early intervention in truancy cases. From its beginning, the goals of the Truancy Intervention Program (TIP) have been to reduce the rate of truancy, to increase school connectedness, and to improve high school graduation rates. The program has accomplished these goals and, along the way, forged strong bonds of cooperation with schools, law enforcement agencies, and service providers. Ten years after the creation of TIP, the graduation rates in the city of St. Paul, the largest school district in the county, have improved by over 50 percent; the number of students missing 15 days of school of more (excused as well as unexcused) has decreased by more than 50 percent; and a large majority of chronic truants and their families have been successfully connected to services to address underlying problems.

Defining Child Exposure to Domestic Violence as Neglect: Minnesota's Difficult Experience

Policymakers are increasingly focusing on children exposed to domestic violence. The 1999 Minnesota legislature amended the definition of child neglect to include a child's exposure to family violence. What was initially seen as a simple change to bring more attention to children exposed to domestic violence resulted in great turmoil across Minnesota's county-run child protection system. Referrals to county child protection agencies expanded rapidly in the months following the law change, and no new state funding was provided to implement the legislation. A coalition of child welfare administrators and battered women's advocates successfully lobbied for the repeal of this change in definition. Many were dissatisfied with both the impact of the legislation and the fact that exposed children and their families were left without badly needed services. This article reconstructs how Minnesota's legislature made this change, its consequences, and the lessons that may be drawn from this experience.