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Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

Deborah Young-Hyman
Dec 1, 2016; 39:2126-2140
Psychosocial Research and Care in Diabetes




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Table 1-Systeme International (SI) units for plasma, serum, or blood concentrations


Aug 1, 1995; 18:1223-1224
Syst[egrave]me International (SI) Units




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Professional Practice Committee: Standards of Medical Care in Diabetes--2020


Jan 1, 2020; 43:S3-S3
Professional Practice Committee




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Effects of Gender-Affirming Hormone Therapy on Insulin Sensitivity and Incretin Responses in Transgender People

OBJECTIVE

The long-term influences of sex hormone administration on insulin sensitivity and incretin hormones are controversial. We investigated these effects in 35 transgender men (TM) and 55 transgender women (TW) from the European Network for the Investigation of Gender Incongruence (ENIGI) study.

RESEARCH DESIGN AND METHODS

Before and after 1 year of gender-affirming hormone therapy, body composition and oral glucose tolerance tests (OGTTs) were evaluated.

RESULTS

In TM, body weight (2.8 ± 1.0 kg; P < 0.01), fat-free mass (FFM) (3.1 ± 0.9 kg; P < 0.01), and waist-to-hip ratio (–0.03 ± 0.01; P < 0.01) increased. Fasting insulin (–1.4 ± 0.8 mU/L; P = 0.08) and HOMA of insulin resistance (HOMA-IR) (2.2 ± 0.3 vs. 1.8 ± 0.2; P = 0.06) tended to decrease, whereas fasting glucose (–1.6 ± 1.6 mg/dL), glucose-dependent insulinotropic polypeptide (GIP) (–1.8 ± 1.0 pmol/L), and glucagon-like peptide 1 (GLP-1) (–0.2 ± 1.1 pmol/L) were statistically unchanged. Post-OGTT areas under the curve (AUCs) for GIP (2,068 ± 1,134 vs. 2,645 ± 1,248 [pmol/L] x min; P < 0.01) and GLP-1 (2,352 ± 796 vs. 2,712 ± 1,015 [pmol/L] x min; P < 0.01) increased. In TW, body weight tended to increase (1.4 ± 0.8 kg; P = 0.07) with decreasing FFM (–2.3 ± 0.4 kg; P < 0.01) and waist-to-hip ratio (–0.03 ± 0.01; P < 0.01). Insulin (3.4 ± 0.8 mU/L; P < 0.01) and HOMA-IR (1.7 ± 0.1 vs. 2.4 ± 0.2; P < 0.01) rose, fasting GIP (–1.4 ± 0.8 pmol/L; P < 0.01) and AUC GIP dropped (2,524 ± 178 vs. 1,911 ± 162 [pmol/L] x min; P < 0.01), but fasting glucose (–0.3 ± 1.4 mg/dL), GLP-1 (1.3 ± 0.8 pmol/L), and AUC GLP-1 (2,956 ± 180 vs. 2,864 ± 93 [pmol/L] x min) remained unchanged.

CONCLUSIONS

In this cohort of transgender persons, insulin sensitivity but also post-OGTT incretin responses tend to increase with masculinization and to decrease with feminization.




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Steroid Metabolomic Signature of Insulin Resistance in Childhood Obesity

OBJECTIVE

On the basis of urinary steroidal gas chromatography-mass spectrometry (GC-MS), we previously defined a novel concept of a disease-specific "steroid metabolomic signature" and reclassified childhood obesity into five groups with distinctive signatures. The objective of the current study was to delineate the steroidal signature of insulin resistance (IR) in obese children.

RESEARCH DESIGN AND METHODS

Urinary samples of 87 children (44 girls) aged 8.5–17.9 years with obesity (BMI >97th percentile) were quantified for 31 steroid metabolites by GC-MS. Defined as HOMA-IR >95th percentile and fasting glucose-to-insulin ratio >0.3, IR was diagnosed in 20 (of 87 [23%]) of the examined patients. The steroidal fingerprints of subjects with IR were compared with those of obese children without IR (non-IR). The steroidal signature of IR was created from the product of IR – non-IR for each of the 31 steroids.

RESULTS

IR and non-IR groups of children had comparable mean age (13.7 ± 1.9 and 14.6 ± 2.4 years, respectively) and z score BMI (2.7 ± 0.5 and 2.7 ± 0.5, respectively). The steroidal signature of IR was characterized by high adrenal androgens, glucocorticoids, and mineralocorticoid metabolites; higher 5α-reductase (An/Et) (P = 0.007) and 21-hydroxylase [(THE + THF + αTHF)/PT] activity (P = 0.006); and lower 11βHSD1 [(THF + αTHF)/THE] activity (P = 0.012).

CONCLUSIONS

The steroidal metabolomic signature of IR in obese children is characterized by enhanced secretion of steroids from all three adrenal pathways. As only the fasciculata and reticularis are stimulated by ACTH, these findings suggest that IR directly affects the adrenals. We suggest a vicious cycle model, whereby glucocorticoids induce IR, which could further stimulate steroidogenesis, even directly. We do not know whether obese children with IR and the new signature may benefit from amelioration of their hyperadrenalism.




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Vasodilatory Actions of Glucagon-Like Peptide 1 Are Preserved in Skeletal and Cardiac Muscle Microvasculature but Not in Conduit Artery in Obese Humans With Vascular Insulin Resistance

OBJECTIVE

Obesity is associated with microvascular insulin resistance, which is characterized by impaired insulin-mediated microvascular recruitment. Glucagon-like peptide 1 (GLP-1) recruits skeletal and cardiac muscle microvasculature, and this action is preserved in insulin-resistant rodents. We aimed to examine whether GLP-1 recruits microvasculature and improves the action of insulin in obese humans.

RESEARCH DESIGN AND METHODS

Fifteen obese adults received intravenous infusion of either saline or GLP-1 (1.2 pmol/kg/min) for 150 min with or without a euglycemic insulin clamp (1 mU/kg/min) superimposed over the last 120 min. Skeletal and cardiac muscle microvascular blood volume (MBV), flow velocity and blood flow, brachial artery diameter and blood flow, and pulse wave velocity (PWV) were determined.

RESULTS

Insulin failed to change MBV or flow in either skeletal or cardiac muscle, confirming the presence of microvascular insulin resistance. GLP-1 infusion alone increased MBV by ~30% and ~40% in skeletal and cardiac muscle, respectively, with no change in flow velocity, leading to a significant increase in microvascular blood flow in both skeletal and cardiac muscle. Superimposition of insulin to GLP-1 infusion did not further increase MBV or flow in either skeletal or cardiac muscle but raised the steady-state glucose infusion rate by ~20%. Insulin, GLP-1, and GLP-1 + insulin infusion did not alter brachial artery diameter and blood flow or PWV. The vasodilatory actions of GLP-1 are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.

CONCLUSIONS

In obese humans with microvascular insulin resistance, GLP-1’s vasodilatory actions are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.




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Time Course of Normalization of Functional {beta}-Cell Capacity in the Diabetes Remission Clinical Trial After Weight Loss in Type 2 Diabetes

OBJECTIVE

To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss.

RESEARCH DESIGN AND METHODS

A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once.

RESULTS

During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480–811) pmol/min/m2 at baseline to 736 (542–998) pmol/min/m2 at 5 months, 942 (565–1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635–1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857–1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4–67] to 107 [59–163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59–201] and 125 [65–166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226–429] pmol/min/m2; P < 0.0001).

CONCLUSIONS

A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to that of NDC group participants by 12 months. This result was unchanged at 2 years with continuing remission of type 2 diabetes.




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Amid an Unfolding Humanitarian Crisis in Syria, the European Union Faces the Perils of Devolving Migration Management to Turkey

The high-stakes gambit taken by Turkish President Recep Tayyip Erdoğan to allow tens of thousands of asylum seekers and migrants free movement to the Greek border demonstrated the fragility of the EU-Turkey deal and the European Union's broader approach to outsource migration management to third countries. This article examines the causes for the tensions, the EU approach to external partnerships, and a hardening European attitude towards unwanted arrivals.




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International Experience Suggests Safe Third-Country Agreement Would Not Solve the U.S.-Mexico Border Crisis

While safe third-country agreements appear to hold the potential of deterring new asylum claims, experience suggests this may be a false promise. As the Trump administration explores the possibility of such agreements with Mexico and Guatemala, this commentary examines the evidence of safe third-country arrangements in Europe, finding them difficult to enforce and playing little role in deterring new claims.




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Promising Strategies for Reintegration of Migrants Returning to Mexico and Central America

This MPI webinar focuses on reception and reintegration services for returning migrants, along with the heightened pressure policymakers in Mexico and Central America are facing to design systems and programs that support both returnees and the communities in which they settle. Authors of a year-long study of reception and reintegration services in Mexico and the Northern Triangle discuss the findings of their fieldwork.




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Policy Solutions to Address Crisis at Border Exist, But Require Will and Staying Power to Execute

Closing the U.S.-Mexico border and cutting off aid to Central America would only feed the crisis unfolding at key points along the U.S.-Mexico border. This commentary outlines a range of immediate and long-term policy responses that would more effectively address the complex mix of factors fueling rising Central American migration to the United States.




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Is U.S.-Mexico Cooperation on Migration Possible?

Over recent months, the number of Central American migrants apprehended at the U.S.-Mexico border has surged, presenting a critical challenge in the relationship between the two neighboring countries. Experts from a Study Group on U.S.-Mexico Migration convened by El Colegio de México and MPI discuss current trends, policies, and politics surrounding migration from the Northern Triangle of Central America and the U.S.-Mexico relationship, ways to improve U.S. and Mexican asylum systems, possible new approaches to labor migration, ways to address smuggling networks, and modernize border management.




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Strategic Solutions for the United States and Mexico to Manage the Migration Crisis

Amid surging migration from Central America, the United States and Mexico in June 2019 agreed to a series of enforcement measures. Yet these near-term efforts will be difficult to maintain given chronic institutional weaknesses and poorly thought-out policy structures in both countries. This commentary, by the presidents of MPI and El Colegio de México, offers a set of long-term, collaborative solutions to dissuade illegal migration while ensuring fairness to those seeking protection.




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Soluciones estratégicas para afrontar la crisis migratoria en Estados Unidos y México

Dado el incremento de los flujos migratorios provenientes de Centroamérica, el pasado mes de junio de 2019, los Estados Unidos y México acordaron tomar una serie de medidas para reducir los flujos irregulares. Sin embargo, será muy difícil mantener estos esfuerzos de corto plazo, debido a una debilidad institucional crónica y a estructuras de política pública poco planificadas en ambos países. Este comentario ofrece cinco recomendaciones a ambos países considerando soluciones de mediano y largo plazo para disuadir la migración irregular y, al mismo tiempo, garantizar que aquellos que busquen protección tengan un proceso justo.




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Stony Brook University opens Center for Implant and Digital Technology

Stony Brook School of Dental Medicine opened Dec. 5 its Center for Implant and Digital Technology, which will serve as a state-of-the-art space for digital dentistry-focused education, patient care and research.




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ADA CERP collaboration focuses on dentistry’s role in interprofessional education

The ADA’s Continuing Education Recognition Program, or ADA CERP, announced in December that it is collaborating with Joint Accreditation for Interprofessional Continuing Education, in an effort to offer dentists more opportunities to participate in interprofessional education.




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Former ADA vice president dies at 87

Dr. Chauncey Cross, who served as vice president of the American Dental Association from 1997-98, died Sept. 5, 2019, on his 87th birthday.




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ADA Publishing unveils new websites

The ADA Publishing unveiled in December new webpages for four award-winning and well-respected publications — ADA News, The Journal of the American Dental Association, Dental Practice Success and the New Dentist News, giving the journal and magazines a greater presence online.




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Arizona Mission of Mercy event provides treatment to over 1,700

The Central Arizona Dental Society hosted a Mission of Mercy event Dec. 13-14 at the Arizona State Fairgrounds in Phoenix, providing treatment to 1,785 patients totaling just over $2 million in free dental service.




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ADA House rescinds The Dentist’s Prayer, amends recognition of religious diversity policy to be more inclusive

In an effort to advance the Association’s diversity and inclusion efforts, the ADA House of Delegates voted at its meeting in September to rescind the policy titled “The Dentist’s Prayer,” used by some state and local dental societies during their meetings, and amend its policy on recognition of religious diversity.




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Tufts University program provides homeless veterans with advanced dental care

Service With A Smile was among 10 programs from nine universities to receive funding this year through the ADA Foundation’s E. “Bud” Tarrson Dental School Student Community Leadership Awards.




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Addressing caries through the lens of social justice, health equity, human rights

It’s a conviction that was published in the November issue of The Journal of the American Dental Association and the basis for the October 2019 forum that Dr. Francisco Ramos-Gomez fostered, where dentists, physicians, nurses and public health and public policy experts proposed, discussed and recommended solutions for preventing early childhood caries through the lens of social justice, health equity and human rights.




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Looking back: ADA annual meeting welcomes more than 200,000 attendees since 2010

The last decade brought 236,658 attendees to the American Dental Association's annual meeting. The ADA will continue to build on that momentum with the ADA FDC Annual Meeting from Oct. 15-18 in Orlando, Florida.




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Dental service leaders visit Washington

Dental service leaders met with the ADA Council on Government Affairs Jan. 25 in Washington to discuss legislative and regulatory issues.




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Hoosiers welcome young dental patients for Give Kids A Smile national kickoff

Indianapolis -- Seven-year-old Jordan Randle made a big promise after visiting Give Kids A Smile for the first time during the national kickoff event Feb. 7 in Indianapolis.




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Dental Assistants Recognition Week set for March 1-7

The ADA Council on Dental Practice is encouraging dentists to acknowledge the dedication and contributions of their dental assistants during Dental Assistants Recognition Week.




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PBHS adds mobile chairside patient education system to ADA TV

PBHS, Inc. announced in January the launch of Consult Mode, an addition to ADA TV that enables dental providers to demonstrate 3D procedural animations, videos and tutorials chairside via tablets, iPads and other hand-held devices.




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Dr. Bettie McKaig, first female ADA vice president, dies

Dr. Bettie R. McKaig, who served as the Association’s first vice president from 1998-99, died Feb. 3. She was 70.




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Former ADA President Robert M. Anderton dies at 82

Dr. Robert M. Anderton, ADA president from 2000-01 and ADA trustee from 1995-99, died Feb. 14.




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ADA seeks appointee to Joint Commission board

The Association is calling for nominations of qualified individuals to serve as the ADA appointee to the Joint Commission Board of Commissioners.




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Study investigates cellular mechanism behind dental fluorosis

Results from a NYU College of Dentistry study suggest how excess fluoride exposure affects the cells forming tooth enamel — possibly explaining how dental fluorosis arises.




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ADA Practice Transitions offering promotional trial for dentists who sign up through March 1

ADA Practice Transitions, a service offered by the ADA focused on helping dentists make the process of joining or leaving a practice successful, is offering a free three-month trial.




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ADA technical report on age assessment by dental analysis available for review

The ADA Standards Committee on Dental Informatics has approved the technical report for circulation and comment.




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Phishing email claims to be from ADA president

At least one American Dental Association member has reported receiving a phishing email appearing to come from an address containing ADA President Chad P. Gehani's name and including a link to "view member's details."




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American Dental Board of Anesthesiology recognized as national certifying board for dental specialty

The National Commission on Recognition of Dental Specialties and Certifying Boards announced March 4 it recognizes the American Dental Board of Anesthesiology as the national certifying board for dental anesthesiology.




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Study: Dental fluorosis generally less noticeable over time

Results from a University of Iowa College of Dentistry study suggest that mild and moderate dental fluorosis is generally less noticeable over time, validating the beliefs of some supporters of community water fluoridation that there have been overestimates of fluorosis prevalence made by anti-fluoridation activists.




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Wisconsin faces wave of anti-fluoridation efforts

The ADA and the Wisconsin Dental Association are partnering up with other fluoridated water proponents to address February anti-fluoridation movements in three Wisconsin municipalities: Lake Delton, Berlin and Hayward.




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Study: Evidence does not support classifying fluoride as cognitive neurodevelopmental hazard

The National Academies of Sciences, Engineering, and Medicine announced March 5 that it does not find that the National Toxicology Program adequately supported its conclusion that fluoride is “presumed” to be a cognitive neurodevelopmental hazard to humans.




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The decision to specialize

The question surfaces at the beginning of dental school, maybe even sooner, when the dream first takes hold. What kind of dentist do I want to be? Do I want to be a general dentist? An oral surgeon? A pediatric dentist? Every student’s path to becoming a dentist is unique. Choosing whether to specialize is no different.




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ADEA cancels annual session due to coronavirus concerns

The American Dental Education Association announced March 9 it has cancelled its annual session due to the coronavirus disease, now named COVID-19.




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Connecticut Foundation for Dental Outreach postpones Mission of Mercy dental clinic amid coronavirus concerns

The Connecticut Foundation for Dental Outreach has postponed the Connecticut Mission of Mercy Free Dental Clinic scheduled for March 20-21 in Danbury, Connecticut, "out of abundant caution" amid the coronavirus disease outbreak.




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IADR, AADR cancel general session in light of coronavirus

The International Association for Dental Research and American Association for Dental Research have canceled their general session scheduled for March 18-21 in Washington, D.C., in light of the coronavirus disease outbreak.




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Free ADA webinar offering answers to pressing COVID-19 questions

The ADA is partnering with the Organization for Safety, Asepsis and Prevention in providing a free on-demand webinar on Friday, March 20, with content for the program based on questions the ADA has received from members looking for guidance while navigating the novel coronavirus pandemic.




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ADA, other dental organizations ask Labor Department to help small businesses

The ADA, along with a large group of other dental organizations, told the U.S. Department of Labor that they are concerned about provisions in HR 6201, the Families First Coronavirus Response Act as related to family and medical leave and paid sick leave.




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ADA urges Congress to increase relief for small businesses, dentist owners

As Congress works on a third legislation package in response to the coronavirus pandemic, the ADA is asking lawmakers to include provisions on how to assist dental practices and other small businesses facing economic burdens.




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ADA president thanks dentists for grassroots efforts in response to CARES Act

As the Senate works to pass a stimulus package aimed at granting relief to the millions of Americans affected by the COVID-19 pandemic, the ADA is thanking dentists across the nation for making their voices heard in Washington on that same legislation.




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EPA releases expanded list of SARS-CoV-2 disinfectants

Washington — The Environmental Protection Agency announced March 13 that it was adding nearly 200 additional products that have qualified for use against SARS-CoV-2, the novel coronavirus that causes the disease COVID-19.




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University of Minnesota dental school appoints Dr. Keith A. Mays as interim dean

The University of Minnesota School of Dentistry announced March 19 that it named Dr. Keith A. Mays, Ph.D, as its interim dean for two years beginning May 15.




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University of Washington School of Dentistry appoints Dr. Gary Chiodo as dean

The University of Washington School of Dentistry announced March 26 that Dr. Gary Chiodo, its interim dean since August 2018, will now serve a full five-year term as dean.




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Delta Dental member companies begin offering financial assistance during pandemic

The ADA is calling on third-party payers to support dental practices in the midst of the COVID-19 pandemic.