A.T. Still University

Artificial intelligence (AI) data centers are an underrecognized health concern because their rapid growth increases demand for water-intensive cooling and electricity. This narrative review examines AI data-center water use as an upstream determinant of health for pregnant, postpartum, and lactating people. It synthesizes evidence across infrastructure, environmental health, and maternal-child-health literatures to identify plausible pathways and policy implications. A structured search found that data centers can require water, while pregnancy and lactation heighten vulnerability to dehydration and heat, and household water insecurity is linked to poorer health outcomes. Although no direct epidemiologic studies connect AI data-center water use to maternal or infant outcomes, evidence supports pathways through water insecurity, dehydration, thermal strain, hygiene constraints, stress, and cumulative burden, especially in drought-prone settings. AI infrastructure should be included in environmental and maternal-child health surveillance using a precautionary public health approach.

Sexually transmitted infections (STIs) remain a major global public health concern, disproportionately affecting uninsured and underserved populations. Student-run free clinics (SRFCs) play a vital role in addressing disparities in STI screening and treatment; however, data describing infection patterns and symptom-based testing outcomes in these settings are limited. This IRB-approved retrospective review analyzed 296 patient records from a SRFC between October 2019 and November 2023. Patients who underwent testing for Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Human Immunodeficiency Virus (HIV), and Human Papilloma Virus (HPV) were included. Patients were categorized as symptomatic or asymptomatic at the time of testing. Demographic data were collected when available. Positivity rates were 19.6% for HPV, 7.1% for chlamydia, 7.1% for syphilis, 4.1% for gonorrhea, and 0.5% for HIV. Roughly half of gonorrhea and chlamydia infections occurred in asymptomatic patients. Symptomatic presentation was not significantly associated with positive and negative results. Assigned male at birth (AMAB) patients and younger individuals had higher odds of gonorrhea, while older AMAB patients had higher odds of syphilis. A substantial proportion of STIs, particularly gonorrhea and chlamydia, occurred in asymptomatic individuals, underscoring the limitations of symptom-based screening. Expanding access to asymptomatic STI testing in SRFCs is essential to reduce missed diagnoses, improve equity, and mitigate long-term sequelae among underserved populations.

SM is common in a tertiary headache population, affecting nearly half of specialty clinic patients with migraine over their lifetime and one in five in a single year. In this population, patients with SM tend to have chronic migraine with high rates of aura. This study highlights the need for improved diagnostic consistency and treatment.

Improving diagnostic precision in periodontology and implantology is essential for betterpatient care, scientific advancement and study consistency, while always considering the worst-case scenario for diagnosis.

Background and ObjectivesThere is a need to understand Black older adults’ perceptions and attitudes about commercial activity trackers to measure and monitor outcomes in clinical trials. We sought to identify the preferred activity tracker features of Black older adults living with memory challenges or dementia and their care partners.MethodsUtilizing a mixed-methods convergent parallel design, 9 participants were recruited from Eskenazi Health in Indianapolis, Indiana. Data were collected through 2 focus groups with participants (n = 3) and care partners (n = 4), and a group interview with 1 participant and 2 care partners. The focus groups were guided by semi-structured interviews, whereas participants interacted with 4 common consumer activity tracking devices (Fitbit Inspire 3, Apple Watch SE, Polar Watch, Oura Ring Heritage). Audio recordings were analyzed using the Rapid Identification of Themes from Audio Recordings method. Participants ranked each device based on comfort, convenience, and features (eg, tracked outcomes of activity, distance/GPS, and respiratory rate). Device rankings were summarized with descriptive statistics.ResultsParticipants with memory challenges rated Apple Watch SE highest, with mean scores in comfort (4.3), convenience (3.3), and features (4.3). Care partners rated Fitbit Inspire 3 highest in comfort and Apple Watch SE for convenience and features. Qualitative findings highlighted physical attributes and comfort (large screen size), convenience (viewing progress), and features (having an emergency button and GPS).Discussion and ImplicationsFindings can guide the selection of activity trackers in future research for this population and may increase wear time and adherence in clinical trials.

Purpose: The purpose of this study was to report the clinical outcomes of delayed speech-language pathology intervention in an individual with Alzheimer's disease and highlight implementation barriers in dementia care. Method: A 63-year-old man diagnosed with Alzheimer's disease went 4.5 years without a speech-language consultation, despite declining cognitive-linguistic abilities noted by his neurologist. Neither he nor his care partner received guidance on interventions, leading the care partner to independently seek services, self-referring to a speech-language pathology clinic where a comprehensive cognitive-communication evaluation was completed. Following the evaluation, a person-centered intervention was implemented incorporating cognitive-communication strategies and care partner training, providing specific methods to enhance communication with the goal of improving quality of care (QoL). Results: The evaluation revealed that, despite severe cognitive impairment and notable word-finding difficulties, he had relatively intact syntactic and grammatical language skills. However, the patient lacked compensatory communication strategies, which hindered his ability to convey overall message effectively, resulting in frequent communication breakdowns. Following speech-language pathology intervention, the patient demonstrated improved functional communication abilities, and both he and his care partner reported enhanced QoL, as documented through standardized outcome measures. Conclusions: This case presentation demonstrates that despite delayed speech-language pathology intervention, individuals with severe dementia and their care partners could benefit from person-centered intervention approaches targeted at communication, safety, and social connection. This case presentation is also a call to action for health care systems to develop standardized clinical pathways where speech-language pathology referrals are initiated early in the progression of the condition.

Longevity research has traditionally emphasized peripheral organ systems, metabolic optimization, and molecular aging pathways, while comparatively neglecting the central nervous system as the primary determinant of healthspan. This editorial advances the thesis that the brain functions as the rate-limiting organ of longevity. Drawing on systems neuroscience, clinical neurology, and evidence from neuropsychiatric and neurodegenerative disease, it is argued that progressive disruption of neural networks governs functional decline across multiple physiological systems, regardless of peripheral biological age. Cognitive resilience, autonomic regulation, sleep integrity, affective stability, and behavioral capacity are centrally mediated processes that determine an individual's ability to maintain homeostasis over time. When brain function deteriorates, lifespan may persist, but meaningful healthspan collapses. A Brain-First Longevity Framework (BFLF) is proposed that prioritizes preservation and restoration of neural network function as foundational to extending durable, functional longevity. BFLF has direct implications for clinical practice, therapeutic development, and the future architecture of longevity medicine.

Oral rehabilitation of the atrophic maxilla is a common clinical challenge, especially in edentulous patients, due to significant bone loss that compromises implant stability and smile esthetics. The All-on-Four protocol has emerged as an effective, minimally invasive, and predictable alternative, eliminating the need for bone grafting procedures while promoting satisfactory functional and aesthetic outcomes. This case report presents a clinical scenario of the rehabilitation of an atrophic maxilla using the All-on-Four technique. The patient, a 70-year-old female who was fully edentulous in the maxilla, reported aesthetic and functional dissatisfaction with her current prosthesis. After clinical and tomographic evaluation, the All-on-Four protocol was indicated for the placement of four Morse taper implants. Two anterior straight implants and two posterior implants angled at 45° were placed to maximize bone utilization and avoid the maxillary sinus. The surgical procedure was performed under local anesthesia, followed by relining of the provisional prosthesis. No adverse event or complications were observed on the day of the surgical procedure or in the postoperative period. After the osseointegration period, intermediate abutments were placed, and the definitive prosthesis was installed. After 6 months, the patient reported complete satisfaction with the treatment, which enhanced both the esthetic and masticatory functions. The case report demonstrates the benefits of the technique, including reduced treatment time, good primary stability, absence of significant morbidity, and excellent functional and esthetic outcomes for the patient. The All-on-Four protocol proved to be an effective and safe rehabilitative solution for cases of atrophic maxilla, contributing to improvements in the patient’s quality of life.

This study aimed to assess how the anteroposterior position of the miniscrew-assisted rapid palatal expansion (MARPE) appliance influences maxillary skeletal expansion and to propose a reference point for optimal placement. Thirty-two skeletally mature patients treated with MARPE were retrospectively assigned to an anterior group (anterior miniscrews ≥ 5 mm anterior to the centre of the maxilla (CM)) or a posterior group (≤ 2 mm from or posterior to CM). Pre- and post-expansion cone-beam computed tomography scans were used to measure skeletal, dental, and paramaxillary changes. Independent t-tests following data normality, linear regression with validated model assumptions, and Bayesian mediation analyses evaluated direct and indirect effects of appliance position and bicortical engagement. The anteroposterior appliance position significantly affected expansion outcomes. Posterior placement yielded greater skeletal expansion and a more parallel pattern (p = 0.008), especially in the posterior maxilla (p = 0.001). Anterior positioning produced reduced skeletal effects and a V-shaped expansion (p = 0.001). Molar tipping increased both directly with anterior positioning (p = 0.002) and indirectly through reduced bicortical engagements. Miniscrew movement, indicating activation loss, was likewise indirectly mediated by fewer bicortical engagements (95% highest density interval: [-0.140, -0.009]). The posterior group exhibited significantly greater paramaxillary expansion, especially in the posterior regions of the jugale and zygoma (p = 0.011). Anteroposterior MARPE position significantly impacts skeletal expansion results. Positioning near or posterior to the centre of the maxilla point enhances parallel skeletal expansion and minimizes undesirable dental effects. This reference point can serve as a practical reference to optimize MARPE placement for mature patients.