Search Results (17)

Background/Objectives: Community health workers (CHWs) play a critical role in advancing health equity by bridging gaps in care for underserved populations. However, limited institutional support, inconsistent training, and lack of integration contribute to high rates of burnout. The Lunch and Learn program was launched in Maryland in fall 2023 as a virtual continuing education and peer-support initiative designed to foster professional development, enhance connections among CHWs, and align with Maryland state CHW certification requirements. This article describes the program’s first year of implementation as a proof-of-concept and model for scalable CHW workforce support. Methods: The program offered twice-monthly, one-hour virtual sessions that included expert-led presentations, Q&A discussions, and dedicated peer-support time. Participant engagement was assessed using attendance metrics, post-session surveys, and annual feedback forms to identify trends in participation, learning outcomes, and evolving professional priorities. Results: Participation increased over time with the program’s listserv expanding from 29 to 118 members and average session attendance more than doubling. CHWs highlighted the program’s value in meeting both educational and emotional support needs. Conclusions: The Lunch and Learn program demonstrates a promising model for addressing burnout through education and community connection. As an adaptable, CHW-informed initiative, it supports both professional growth and well-being. Ongoing development will focus on expanding access, incorporating experiential learning assessments, and advocating for sustainable funding to ensure long-term program impact and CHW workforce stability. Full article

This study analyzes long-term deterioration patterns in 1378 Maryland steel bridges using annual Bridge Health Index (BHI) records from 1995–2021. Missing observations were addressed through linear interpolation combined with forward/backward filling, after which feature-wise z-score standardization was applied to ensure comparability across annual trajectories. Euclidean K-means clustering (k-means++ initialization, 10 restarts) was implemented to identify deterioration archetypes, with K = 6 selected using the elbow method and the silhouette coefficient. Cluster-internal stability was evaluated using bridge-level Root Mean Squared Error (RMSE), and uncertainty in median deterioration profiles was quantified using 2000-iteration percentile-based bootstrap confidence intervals. To interpret structural and contextual drivers within each group, Principal Component Analysis (PCA) was performed on screened and standardized geometric, structural, and traffic-related attributes. Results revealed strong imbalance in cluster membership (757, 503, 35, 33, 44, and 6 bridges), reflecting substantial diversity in long-term BHI behavior. Cluster-median RMSE values ranged from 2.69 to 22.66, while wide confidence bands in smaller clusters highlighted elevated uncertainty due to limited sample size. PCA indicated that span length, deck width, truck percentage, and projected future ADT were the most influential differentiators of deteriorating clusters, while stable clusters were distinguished by consistently high BHI component values and limited geometric complexity. Missing rehabilitation records prevented definitive attribution of U-shaped or recovering trajectories to specific intervention events. Overall, this study establishes a scalable, statistically supported framework for deterioration-trajectory profiling and provides actionable insight for proactive inspection scheduling, rehabilitation prioritization, and long-term asset management planning for state-level bridge networks. Full article

Objectives: The presence of gingival buccal recession is a frequent problem especially in the canine area. The cortical buccal bone may be absent in presence of health normal lingual/palatal bone and of other periodontal pockets. The present case report describes a minimally invasive approach in a 76-year-old patient with previously endodontically treated lower canine affected by root fracture and by a serious chronic buccal recession. Methods: The tooth was characterized by a deep vestibular bone defect, lack of buccal bone and acute periapical lesion. After extraction, Maryland bridge was positioned on the edentulous area. A two-piece convergent neck transmucosal implant was inserted with a flapless approach after 6 months. Maryland bridge was left in place for additional 3 months. After this time, digital impressions were taken, and a customized abutment was positioned. A provisional crown was designed according to Biologically Oriented Preparation Technique (BOPT) concept and maintained for 6 months. A zirconia definitive crown was digitally designed and cemented with a polycarboxylate-based cement. The Pink Esthetic Score (PES) was used as an index to assess peri-implant soft tissue stability over time (preoperatively, at 9 months, at 12 months and 72 months). Results: The patient was followed for 6 years under a conventional hygienic recall program. No complications occurred, and the PES improved from 4 preoperatively to 8 at 9 months, 10 at 12 months and 13 at 72 months. Conclusions: The use of Maryland bridge prevented occlusal trauma on healing tissues and appeared to support bone and soft tissue healing for transmucosal implant placement. A stable aesthetic rehabilitation was achieved up to 6 years. Full article

This paper analyzes the long-term thermal effect of newly applied fiber-reinforced concrete link slabs on an existing steel bridge for a rehabilitation project of the Maryland Transportation Authority. To enhance structural resilience, thermal movement is one of the major concerns in concrete link slab design. To accommodate the global thermal expansion of a full bridge, the existing fixed bearings were modified to expansion bearings to release the longitudinal thermal movement of the super-structure. Their movements were measured by the installed LVDT devices. In this pilot study for the Maryland Transportation Authority (MDTA), engineered cementitious composite (ECC) and ultra-high-performance concrete (UHPC) were selected as candidate materials for link slabs to replace traditional steel expansion joints. To evaluate the performances of ECC and UHPC, built-in strain gauges were implemented for long-term field monitoring to ensure the durability of link slabs. For comparison, the measured data were collected over two full years to study their thermal effects in order to evaluate their sustainability. The novelty of the study is in comparing the performance of different materials side-by-side using true sensor measurements and numerical simulation. Thermal movement performance, including thermal cracking, will be one of the major selection criteria for the link slab material. Full article

Aim: This in vitro study aimed to evaluate the adhesive performance of zirconia and lithium disilicate Maryland cantilever restorations on prepared and non-prepared anterior abutment teeth. While conventional clinical protocols involve abutment tooth preparation, no-preparation (no-prep) restorations have emerged as a viable, minimally invasive alternative. This study compared the adhesion fracture resistance (N) of zirconia restorations on non-prepared enamel surfaces with those on prepared surfaces exposing the dentin. Additionally, the zirconia restorations were compared with lithium disilicate Maryland cantilever restorations, a more common yet costly alternative. Materials and Methods: Forty extracted anterior teeth were allocated into four groups based on preparation type (prepared vs. non-prepared) and material (zirconia vs. lithium disilicate). Each group received cantilevered single-unit FPDs fabricated via CAD/CAM and adhesively cemented using Variolink^® Esthetic DC. Standardized loading was applied using a universal testing machine, and the fracture resistance was recorded. Results: The fracture resistance ranged from 190 to 447 N in the zirconia groups and from 219 to 412 N in the lithium disilicate groups. When comparing all the zirconia versus all the lithium disilicate ceramic restorations, regardless of tooth preparation, no statistically significant difference was found (p = 0.752). However, the non-prepared restorations exhibited significantly higher fracture resistance than their prepared counterparts (p = 0.004 for zirconia; p = 0.012 for lithium disilicate ceramic). All the failures were attributed to tooth fracture, except one zirconia restoration, with no debonding observed. Conclusions: Both zirconia and lithium disilicate Maryland cantilever restorations demonstrated reliable adhesive performance when bonded using appropriate surface conditioning and adhesive protocols. Interestingly, the non-prepared designs exhibited higher fracture resistance than the prepared abutments, highlighting their potential advantage in minimally invasive restorative dentistry. Zirconia Maryland bridges, in particular, represent a cost-effective and mechanically resilient option for anterior single-tooth replacement. Full article

This study advances crime analysis methodologies in Maryland by leveraging sophisticated machine learning (ML) techniques designed to cater to the state’s varied urban, suburban, and rural contexts. Our research utilized an enhanced combination of machine learning models, including random forest, gradient boosting, XGBoost, extra trees, and advanced ensemble methods like stacking regressors. These models have been meticulously optimized to address the unique dynamics and demographic variations across Maryland, enhancing our capability to capture localized crime trends with high precision. Through the integration of a comprehensive dataset comprising five years of detailed police reports and multiple crime databases, we executed a rigorous spatial and temporal analysis to identify crime hotspots. The novelty of our methodology lies in its technical sophistication and contextual sensitivity, ensuring that the models are not only accurate but also highly adaptable to local variations. Our models’ performance was extensively validated across various train–test split ratios, utilizing R-squared and RMSE metrics to confirm their efficacy and reliability for practical applications. The findings from this study contribute significantly to the field by offering new insights into localized crime patterns and demonstrating how tailored, data-driven strategies can effectively enhance public safety. This research importantly bridges the gap between general analytical techniques and the bespoke solutions required for detailed crime pattern analysis, providing a crucial resource for policymakers and law enforcement agencies dedicated to developing precise, adaptive public safety strategies. Full article

This case report focuses on applying a protocol for dental implant restoration in aesthetic zones, specifically the anterior sectors. The protocol aims to achieve optimal results with minimal complexity, reducing the number of sessions and impressions required for transferring clinical information to the laboratory. The historical development of dental implantology and the evolution of dental implant restoration workflows are discussed, highlighting the significance of osseointegration and advancements in materials, surgical techniques, and prosthetic components. The case report describes rehabilitating congenitally missing lateral incisors using fibre-reinforced composite Maryland bridges for provisional restoration and Osstem TSIII (Osstem^®, Seoul, South Korea) implants, zirconia abutments, and disilicate lithium crowns for definitive repair. The discussion covers essential aspects of aesthetic dental implant restoration, including materials, types of dental implants, surgical techniques for soft tissue enhancement, and prosthetic and impression techniques. The study emphasises the importance of selecting appropriate materials, employing advanced surgical procedures, and utilising accurate prosthetic and impression techniques to enhance the aesthetic outcomes of dental implant restorations. A multidisciplinary approach and patient-centred care are essential for successful aesthetic dental implant restorations. The methodology presented in this manuscript demonstrates its effectiveness in achieving optimal outcomes while minimising stress on soft tissues and improving patient comfort and satisfaction. This case report contributes to dental implant restoration, providing evidence-based techniques for achieving aesthetic and functional success. Full article

This study uses machine learning methods to model different stages of the calcination process in cement, with the goal of improving knowledge of the generation of CO₂ during cement manufacturing. Calcination is necessary to determine the clinker quality, energy needs, and CO₂ emissions in a cement-producing facility. Due to the intricacy of the calcination process, it has historically been challenging to precisely anticipate the CO₂ produced. The purpose of this study is to determine a direct association between CO₂ generation from the manufacture of raw materials and the process factors. In this paper, six machine learning techniques are investigated to explore two output variables: (1) the apparent degree of oxidation, and (2) the apparent degree of calcination. CO₂ molecular composition (dry basis) sensitivity analysis uses over 6000 historical manufacturing health data points as input variables, and the results are used to train the algorithms. The Root Mean Squared Error (RMSE) of various regression models is examined, and the models are then run to ascertain which independent variables in cement manufacturing had the largest impact on the dependent variables. To establish which independent variable has the biggest impact on CO₂ emissions, the significance of the other factors is also assessed. Full article

Highway agencies monitor the condition of thousands of bridge decks every year. Even though Ground Penetrating Radar (GPR) has been used in bridge-deck evaluation, Step-Frequency GPR (SF-GPR) provides advanced condition assessment yet requires extensive and complex post-processing analysis. An SF-GPR analysis system was recently developed and used for monitoring the condition of all the bridge decks in the state of Maryland. The objective of this study was to develop a bridge deck condition rating approach using fuzzy sets modeling on the SF-GPR data and analysis. The fuzzy sets membership functions needed to reflect rating score categories similar to those considered in the National Bridge Inventory (NBI) database for uniformity. Thus, the fuzzy sets modeling was built considering nine condition membership functions. The overall bridge deck condition score leading to each of the nine condition states was based on both physical and condition-related bridge deck parameters as obtained from the SF-GPR analysis. The modeling approach is presented herein, along with two bridge deck examples. The proposed novel fuzzy sets modeling can be considered for possible adoption elsewhere where similar GPR systems are used. Full article

Objective: Evaluation of the success and/or survival rates of resin-bonded fixed partial dentures (RBFPDs) reported in the scientific literature with a minimum average observation time of five years. Materials and Methods: Search conducted in Pubmed, Web of Science, and Cochrane databases in free-text format and MESH terms, until May 2021. The random-effects model was used for the estimated survival rate, percentage per year of estimated failure, and existing complications for the meta-analysis. Study heterogeneity was assessed by the inconsistency test (I²) and study quality by the Downs and Black scale. Results: Eleven articles were included, with 687 participants and 783 RBFPDs, with a mean observation time of 8.2 years, with success rates mentioned in three articles and survival rates reported in nine articles. A total of 142 failures were reported for 783 prostheses, the most frequent being debonding. The estimated failure rate was between 0.53% and 5.10% per year. The studies were of sufficient quality. In the meta-analysis, the survival rates showed a significant result (p < 0.001), with moderate heterogeneity (I₂ = 58.76%). Conclusions: Within the limitations of this research, mainly related to the heterogeneity of the studies and their quality, it seems possible to conclude that RBFPDs are a viable clinical option for the rehabilitation of patients with single edentulous spaces, mainly when using a single retainer and a zirconia-ceramic prosthesis. Full article

Aim: To evaluate the effect of the resin-bonded prosthesis (Maryland bridge) on marginal bone remodeling of implants placed at the tissue level in the posterior region. Methods: Consecutive healthy patients (n = 46) were included in this clinical study. Flapless not-submerged implants were placed with cover screws exposed and positioned approximately 0.5 mm above tissue level. Patients received the implant and a temporary resin-bonded prosthesis (RBP) (n = 22) or only the implant (n = 24). The RBPs were kept in place for 3 months and removed before impressions. The implants received a custom-made abutment and provisional resin crowns followed by definitive cemented metal–ceramic crowns after 2–3 weeks. The marginal bone level (MBL) was evaluated in a single-blind condition on scanned periapical radiographs and assessed mesially and distally (MBL-M/MBL-D). The bone levels of adjacent teeth (CEJ-M/CEJ-D) and the modification of the area between the implant and the mesial/distal teeth (Area-M/Area-D) were measured. All measurements were made at 1, 3 (pre-loading time) and 12 months (post-loading time). Linear regression models were fitted to evaluate the existence of any significant difference. Results: A total of 44 patients (20 Female, 24 Male; Mean age: 53.9 ± 10.3) completed the study. Two patients were excluded for fractured RBP or de-bonding. The drop-out was of 4.3%. After 12 months, all implants were free from complications. No peri-implantitis or mucositis were observed. The RBP group showed the most stable MBL at 12 months (−0.07 ± 0.41), statistically different from the non-RBP group (−0.67 ± 0.52). CEJ-M and CEJ-D were stable in both groups. Conclusion: The proposed approach of the use of RBP creates a more stable marginal bone level around implants placed at the tissue level, resulting in a reliable technique to protect bone tissue from mechanical and occlusal trauma during the healing period and osteointegration. Full article

Resin-bonded fixed dental prostheses (RBFDP) are minimally invasive alternatives to traditional full-coverage fixed partial dentures as they rely on resin cements for retention. This study compared and evaluated the tensile bond strength of three different resin-bonded bridge designs, namely, three-unit fixed-fixed, two-unit cantilever single abutment, and three-unit cantilever double-abutted resin-bonded bridge. Furthermore, the study attempted to compare the tensile bond strengths of the Maryland and Rochette types of resin-bonded bridges. Based on the inclusion and exclusion criteria, a total of seventy-five extracted maxillary incisors were collected and later were mounted on the acrylic blocks. Three distinct resin-bonded metal frameworks were designed: three-unit fixed-fixed (n = 30), two-unit cantilever single abutment (n = 30), and a three-unit cantilever double abutment (n = 30). The main groups were further divided into two subgroups based on the retainer design such as Rochette and Maryland. The different prosthesis designs were cemented to the prepared teeth. Later, abutment preparations were made on all specimens keeping the preparation as minimally invasive and esthetic oriented. Impression of the preparations were made using polyvinyl siloxane impression material, followed by pouring cast using die stone. A U-shaped handle of 1.5 mm diameter sprue wax with a 3 mm hole in between was attached to the occlusal surface of each pattern. The wax patterns were sprued and cast in a cobalt–chromium alloy. The castings were cleaned by sandblasting, followed by finishing and polishing. Lastly, based on the study group, specimens for Rochette bridge were perforated to provide mechanical retention between resin cement and metal, whereas the remaining 15 specimens were sandblasted on the palatal side to provide mechanical retention (Maryland bridge). In order to evaluate the tensile bond strength, the specimens were subjected to tensile forces on a universal testing machine with a uniform crosshead speed. The fixed-fixed partial prosthesis proved superior to both cantilever designs, whereas the single abutment cantilever design showed the lowest tensile bond strength. Maryland bridges uniformly showed higher bond strengths across all framework designs. Within the limitations of this study, the three-unit fixed-fixed design and Maryland bridges had greater bond strengths, implying that they may demonstrate lower clinical failure than cantilever designs and Rochette bridges. Full article

Graduate students often seek hands-on experiences in the international development field. Given that Multilateral Development Banks (MDBs) provide hundreds of billions of dollars in aid each year, we expected that reviewing the design, implementation, and outcomes of their environmental projects would provide valuable learning outcomes for students. This novel study on Nature-based Solutions (NbS) in the Global Environment Facility (GEF) gave students the opportunity to engage directly with practitioners in the review of 50 environmental projects across 45 countries. A team of professionals from the Scientific and Technical Advisory Panel (STAP) of the GEF and eight students from the University of Michigan School for Environment and Sustainability and the University of Maryland School of Public Policy developed lessons learned from reviewing the GEF portfolio over a twenty-year time span. When screening projects for enabling conditions including theory of change, climate risk screening, multi-stakeholder engagement, and adaptive management, most had stronger explanations of the environmental than the social outcomes sought, and only more recent ones incorporated climate risk screening. The process and findings associated with this educational experience contributed to students’ climate change leadership development; for example, by learning about the tradeoffs and possible co-benefits of improving both environmental conditions and livelihoods in less developed countries. Our research led to practice advice for the design of future GEF projects, as well as ideas for future coursework to further bridge the gap between theory and practice in academia, which we believe to be essential to preparing the next generation of climate leaders. Full article

Background: Medically ill youth are at increased suicide risk, necessitating early detection. This study aimed to assess the feasibility of administering the Death Implicit Association Test (Death IAT) to pediatric medical inpatients. Methods: Participants completed measures including the Ask Suicide-Screening Questions (ASQ) and the Death IAT. Results: Over 90% of participants found the Death IAT to be acceptable and more than 75% of participants were comfortable completing the task. There was a small, but statistically significant, improvement from pre-survey to post-survey reports of mood (t(174) = 3.02, p = 0.003, d = 0.15). Participants who endorsed a past suicide attempt on the ASQ had significantly higher “suicide” trial D-scores than those without a past suicide attempt (Wilcoxon W = 1312; p = 0.048; d = 0.61). Conclusions: Implementing an IAT measure among pediatric medical inpatients was feasible and acceptable. In exploratory analyses, “suicide” trial IAT D-scores were associated with past suicide attempts, suggesting future studies should examine whether implicit measures may be useful in hospital settings to augment detection of youth suicide risk. Full article

Background: Individuals with neurodevelopmental disorders (NDD) are at increased risk for suicide, yet little work has been done to address the specific needs for this population. Specifically, there are no validated suicide risk screening instruments and processes for individuals with NDD; this study aimed to assess the opinions of individuals with NDD and their therapists on suicide risk screening in order to inform best practices for screening. Method: A pilot study was launched to qualitatively evaluate processes and instruments that may be used in future studies on suicide screening risk in NDDs. Participants and their therapists were surveyed after filling out suicide risk screening instruments and provided qualitative feedback on their opinions of screening for suicide risk. Results: Most participants (9/15) reported positive experiences of being screened for suicide risk. Additionally, almost all therapists (14/15) were in support of suicide risk screening. Several themes, such as interpersonal benefits, emerged as reasons for supporting screening. Conclusions: The findings from this pilot study provide initial qualitative evidence that many individuals with NDD and their therapists would be comfortable with and are in support of suicide risk screening for this population. Screening tools to guide clinicians on how to ask about suicide risk are needed and appear to be desired by clinicians on the frontlines of mental health treatment for people with NDD. Full article