Cleft lip and palate surgery. While completing my doctorate, I began what was to become a long involvement in experimental and clinical studies of cranial morphology. Concerns about possible iatrogenic effects of cleft lip and palate repair and in particular, clinical observations suggesting that cleft palate repair inhibits growth of the maxillofacial skeleton date back to the 1940s. This unparalleled series of studies identified technique-specific variations in subsequent maxillofacial growth and form leading to the reconsideration/modification of surgical techniques. I was a co-investigator in all of these studies. I participated in the design of the studies, assisted with surgical procedures, was responsible for the execution of the studies and collection of data, performed all statistical analyses, contributed substantially to the writing of the manuscripts, and reviewed, revised and approved the final manuscripts as submitted. These publications are representative of the body of work that lead to my election in 1993 to the honorary position of Associate Member of the Plastic Surgery Research Council.
Human biogeography. My doctoral research focused on the biogeographic distribution of Oceanic populations. Haplotype arrays of gamma-immunoglobulin polymorphisms had previously been recognized as genetic markers for specific Oceanic linguistic taxa. My research found an association between the distribution of malaria and the frequency and occurrence of specific gamma-immunoglobulin allotypes posited to be mediated by an abnormal immune response to malaria. These publications extended the work of my predecessors and mentors; reframed the interpretation of gamma-immunoglobulin polymorphism distributions, extended the principles of human biogeography and compelled discussions of (pre-European) Oceanic colonization to address the role of natural selection. I was the sole investigator or co-primary investigator in all of these studies. This line of investigation and specifically the publication of the Clark & Kelly (1993) lead to my recognition as a Fellow of the American Anthropological Association in 1994. [Kelly (1990) and Clark & Kelly (1993) are cited WW Howells in Volume 2 of “History of Physical Anthropology: An Encyclopedia” (1997), Frank Spencer (Editor).]
Deformational plagiocephaly. The success of the 1992 “Back to Sleep” public health campaign was followed by an epidemic increase in the incidence of infants with deformational changes of the cranium. Although first described in 1979, in 1995, the FDA sought to regulate the orthotic cranial molding helmets devices being used to treat deformational plagiocephaly. I was the lead investigator on a pair of clinical studies submitted to the FDA, and subsequently published, that demonstrated orthotic cranial molding helmets as a safe and effective nonsurgical alternative to invasive intracranial surgical remodeling. These efforts led to the classification of cranial orthoses as a Class II neurology device and subsequently to the approval of the first regulated cranial orthosis. Follow-up studies have focused on the etiology and incidence of deformational plagiocephaly. By providing evidence of safety, effectiveness, etiology and incidence, this body of work has changed the standard of medical treatment of nonsynostotic cranial deformations. I was the primary investigator or a co-investigator in all of these studies. I participated in the conceptualization and design of these studies, performed all statistical analyses, contributed substantially to the writing of the manuscripts, and reviewed, revised and approved the final manuscripts as submitted.
Rural health. Rural populations are disproportionately affected by public health issues. The Keokuk County Rural Health Study (KCRHS) was a population based, prospective cohort study of health status and environmental exposures in a large, stratified, random sample of residents in the rural Iowa county of Keokuk. Over the span of nearly 20 years, the KCRHS and KCRHS-derived studies provided data that has documented many of the suspected health issues and identified new public health concerns. I was a data analyst/co-investigator in all of these studies. I participated in or reviewed the design of these studies, performed all statistical analyses, contributed to the writing of manuscripts, and reviewed, revised and approved the final manuscripts as submitted.
Exposure assessment. Understanding the nature and extent of environmental contaminant exposure is essential to assessing the risks posed to human health. These studies have advanced our knowledge of occupational contaminant exposure by assessing the comparability of exposure assessment methods from various labs, identifying previously undetected sources of contaminants, and ascertaining task-specific differences in contaminant exposure. I was a co-investigator in all of these studies. I reviewed the design of the studies, performed or confirmed all statistical analyses, and reviewed and approved the final manuscripts as submitted.
Total Worker Health. I was co-investigator on a pair of statewide surveys (http://RealIowans.com): 1) a survey of employed Iowans that provided employment sector estimates of health status, prevention behaviors, and productivity measures by employment status (self-employed, employed by an organization or currently unemployed, but seeking employment) and 2) a survey of Iowa employers that provided employment sector estimates of employee health and safety programs. Results of the employee survey showed that higher quality of life measures and practicing more prevention behaviors are strongly associated with lower absenteeism and higher presenteeism scores. At the same time, we found that Iowa employers are implementing less than 30% of the 12 IOM-recommended employee total health management components. Responding to this need, our team produced and evaluated a series of eight translational videos. The Total Worker Health Essentials videos uses a peer-to-peer approach to help small businesses tailor integrated health and safety programs, practices and policies into their workplaces. I participated in the conceptualization and design of the survey studies, performed all statistical analyses, contributed substantially to the writing of the manuscripts, and reviewed, revised and approved the final manuscripts as submitted. I reviewed, revised and approved content of the translational Total Worker Health videos and assisted with evaluation of the videos by community stakeholders.