bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and evaluation of e‐learning materials for dental hygiene students in six schools: Using smartphones to learn dental treatment procedures
Authors: Takenouchi Akane , Otani Etsuyo , Sunaga Masayo , Toyama Takako , Uehara Hiromi , Akiyama Kyoko , Kawashima Takae , Ito Kanade , Izuno Hiromi , Kinoshita Atsuhiro
Published: June 2020

Objective

The purpose of this study was to develop and evaluate the effectiveness of using e‐learning on smartphones to provide dental hygiene education on dental treatment procedures.

Methods

This was a randomized controlled trial. Two‐hundred ninety‐three dental hygiene students in four universities, one junior college and one technical school took a preliminary examination, and based on the results, participants in each school were randomly divided into two groups, a test or control group. Both groups took pre‐ and post‐examinations at a 4‐week interval. The test groups learned dental treatment procedures and four‐handed techniques with interactive learning materials using smartphones. The learning materials allowed them to watch videos of dental treatments. The control groups were not provided any learning material.

Results

Results of all schools combined showed that the changes from pre‐ to post‐examination scores in the test groups were significantly higher than those of the control groups (p < .05). Post‐examination scores were significantly higher than pre‐examination scores in the test groups in all schools (p  < .05). Also, post‐examination scores of the test groups were significantly higher than those of the control groups (p < .05). The changes from pre‐ to post‐examination scores in the test groups of two schools were significantly higher than those of control groups (p < .05). Post‐examination scores of the control groups in two schools were significantly higher than pre‐examination scores (p < .05).

Conclusions

Learning dental treatment procedures through e‐learning on a smartphone was effective in developing participants’ understanding of dental treatment procedures and four‐handed techniques.
Assessment of caries on the first permanent molars in a group of seven‐ to thirteen‐year‐old schoolchildren: Comparison of DMF and ICDAS systems
Authors: Houchaimi Amani , El Osta Nada , Abou Chedid Jean‐Claude , El Osta Lana , Farhat Mchayleh Nada
Published: June 2020

Objectives

The objective of this study was to compare ICDAS and DMFT/S in the evaluation of caries status of the first permanent molar in 200 children aged 7 to 13 years.

Methods

This was a cross‐sectional design study. Participants were selected from two private schools in Lebanon. The examinations were performed by two trained and calibrated examiners using a dental mirror and a WHO probe. The number of decayed (D), missing (M) and filled (F) teeth was recorded in DMFT/S form, and the numbers related to D, M and F were then added to record the DMFT/S value (D1MFT/S, D2MFT/S and D3MFT/S). In the ICDAS, the assessment of caries associated with restorations and sealant was recorded. Student t tests/and Mann‐Whitney tests were used to compare the continuous variables. Chi‐square tests and Fisher exact tests were used to compare the categorical variables.

Results

The average age of the participants was 9.21 ± 1.927 (7‐13 years old). No significant difference was found between the mean time to score DMFT, DMFS and ICDAS indices (‐p‐value > 0.05). The prevalence of caries with D1MFS, D2MFS and D3MFS was 80.5%, 54% and 30.5%, respectively. However, the prevalence of caries with ICDAS II was 77.5%.

Conclusion

The DMF index is an international user‐friendly system that shows the carious history of teeth. However, the ICDAS assesses the different stages of caries and describes the restorative status of the tooth, promoting new preventive approaches and curative needs. More studies should be done to confirm these findings.
Anti‐inflammatory and immunomodulatory effects of Biodentine on human periapical lesion cells in culture
Authors: Eraković M. , Duka M. , Bekić M. , Tomić S. , Ismaili B. , Vučević D. , Čolić M.
Published: June 2020

Aim

To evaluate the effect of Biodentine eluate on cytotoxicity and production of pro‐ and anti‐inflammatory cytokines and osteodestructive/osteoprotective cytokines in cultures of human periapical lesion cells.

Methodology

Conditioned Biodentine Medium (CBM) was prepared according to ISO 10993‐12, by incubating Biodentine in RPMI medium (0.2 g mL−1) for 3 days at 37 °C. CBM contained both released microparticles and leachable soluble components. Inflammatory cells were isolated from 22 human periapical lesions after apicectomy or tooth extraction, by collagenase/DNase digestion, and cultured in several dilutions of CBM. The composition of periapical lesion cells was determined by morphological criteria, cytotoxicity was quantified by MTT and flow cytometric apoptosis/necrosis assays, whereas the levels of produced cytokines in cell culture supernatants were measured by flow cytometry and ELISA. Student t‐test and Friedman test with Dunn's post‐test were used for comparison of parametric and nonparametric variables, respectively.

Results

Undiluted (100%), 75% and 50% CBM were cytotoxic for periapical lesion cells due to induction of both necrosis (100% CBM) and apoptosis (75% and 50% CBM). Noncytotoxic concentrations of CBM (25%) inhibited the production of pro‐inflammatory cytokines: TNF‐α, (P < 0.005); IL‐1β (P < 0.01); IL‐6 (P < 0.005) and chemokines IL‐8: (P < 0.005); MCP‐1 (P < 0.005), stimulated the production of anti‐inflammatory cytokine (IL‐10; P < 0.005), Th2 cytokines: IL‐4, IL‐5 and IL‐33 (all P < 0.01), and IL‐17A (P < 0.01). The concentration of CBM (12.5%) inhibited the production of IL‐6 (P < 0.05), IL‐8 (P < 0.01) and MCP‐1 (P < 0.005) and augmented the production of IL‐10 (P < 0.05). No significant effects on Th1‐related cytokines (IFN‐γ and IL‐12) and IL‐23 were detected with 25% and 12.5% CBM concentrations. Both CBM concentrations inhibited the production of osteolytic receptor activator of nuclear factor kappa‐Β ligand (RANKL), dose dependently (P < 0.005 and P < 0.01, respectively). Higher CBM concentrations decreased RANKL/osteoprotegerin (OPG) ratio (P < 0.05), without significant influence on the levels of osteoprotective OPG.

Conclusion

Biodentine possesses immunomodulatory properties by suppressing pro‐inflammatory and augmenting anti‐inflammatory cytokines. Together with the reduction of osteodestructive mediators, this novel root‐end filling cement could be beneficial for healing and bone reparation after the surgical treatment of periapical lesions.
Pilot study: immunohistochemistry expressions of vitamin D receptor associated with severity of disease in psoriasis patients
Authors: Chandra Rudi , Roesyanto‐Mahadi Irma D. , Yosi Ariyati
Published: June 2020

Background

Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferation, differentiation abnormalities, and resistance to apoptosis. There are several factors that can affect psoriasis and vitamin D is one of the recently arisen. The role of vitamin D is mediated by vitamin D receptors (VDR) in target cells. VDR is a nuclear hormone that is involved in the antiproliferation and pro‐differentiation pathways in keratinocytes. However, until now vitamin D/VDR signaling in psoriasis has not been fully understood.

Methods

A cross‐sectional study that involved 28 skin specimens from psoriasis patients to assess the immunohistochemistry expressions of VDR as well as their association with severity and duration of psoriasis. Statistical analyses were performed using Spearman's correlation coefficients, with P <0.05 was considered statistically significant.

Results

In total, 28 specimens from psoriasis patients consisting of 60.7% women and 39.3% men, with mean age 41.28 ± 14.97 years, predominantly age group 46–55 years (25%), mean duration of disease 6.64 ± 4.26 years, and mean Psoriasis Area and Severity Index (PASI) score 19.23 ± 11.30. The immunohistochemistry expressions of VDR were predominantly strong (57.1%) and located in the basal layer (53.6%). There were a significant negative correlation between the expressions of VDR and PASI score (P <0.001, r = −0.719) and between the expressions of VDR and duration of disease in psoriasis (P = 0.020, r = −0.438).

Conclusion

VDR expressions and severity of psoriasis showed a strong significant negative correlation and also a moderate significant negative correlation between VDR expressions and duration of disease.
The dynamic change of oolong tea constitutes during enzymatic‐catalysed process of manufacturing
Authors: Huang Xujian , Cao Hongli , Guo Yaling , Liu Jianghong , Sun Yun , Liu Shengrui , Lin Jinke , Wei Shu , Wu Liangyu
Published: June 2020

To understand leaf enzyme‐modulated dynamic changes of character constitutes during withering and turning‐over steps of oolong tea manufacturing, complementary proteomic and metabolomic analyses were performed using the processed tea leaves from the two steps. A total of 778 metabolites and 6274 proteins were identified and quantified in this study. A biosynthetic pathway network of flavouring compounds was suggested in combination with the abundance of candidate enzymes. The free amino acids were necessary not only to the umami or sweet tastes of oolong tea, but also to the biosynthesis of secondary metabolites responsible for the environmental stress. As the downstream derivatives of the phenylpropanoid pathway with phenylalanine as one of the upstream metabolites, the glycosides of isoflavonoids and anthocyanins showed decreasing trends during the enzymatic‐catalysed process, potentially contributing to flavour of mellow and brisk. The formation of flavouring compounds in oolong tea production is a result of systematic responses to serious stress conditions, during which a series of defensing mechanisms in tea leaves were triggered to induce dynamic changes in various enzymes and metabolites.
Community pharmacy: a crucial enabler in creating the effectiveness study environment in the Salford Lung Studies
Authors: Leather David A , Howard Steve , Haydock Gerry , Stephens Linda
Published: June 2020

Objective

Creating an environment that supports conditions of routine clinical practice and enables an effectiveness trial design with a pre-licensed medicine is extremely challenging. Here, we summarise our experiences and achievements with engaging and mobilising community pharmacies in and around Salford, United Kingdom, in the Phase III effectiveness Salford Lung Studies (SLS).

Methods

This article provides the authors’ personal experiences and viewpoints on community pharmacy involvement in the SLS.

Key findings

More than 130 community pharmacies were enabled, and >2500 pharmacy staff trained, for involvement in the SLS. Key to community pharmacy participation in the SLS was the formation of the SLS Pharmacy Steering Group (PSG), contributing to study oversight, and the development of a pharmacy standard operating procedure document, the major principle of which was to ensure minimum disruption to the normal medicine dispensing process while ensuring compliance with regulations, guidelines, good clinical practice and requirements for pharmacovigilance. The high level of commitment and collaboration of community pharmacy in the SLS demonstrated a willingness to work together and take on additional and novel roles beyond their everyday commercial functions for the benefit of patients, despite normally competing for prescription business.

Conclusions

The involvement and integration of community pharmacy as a key partner in the SLS was pivotal in securing the delivery of these world-first clinical effectiveness studies. To our knowledge, this has not been previously achieved in a study of a pre-licensed maintenance therapy for a common disease in primary care.
Desigualdad de oportunidades laborales para los jóvenes: ¿En qué se diferencia el mundo árabe?
Authors: DIMOVA Ralitza , STEPHAN Karim
Published: June 2020

El mercado de trabajo de Oriente Medio y África del Norte se caracteriza por un desempleo juvenil generalizado y desproporcionadamente alto entre los jóvenes con estudios. Con datos de las encuestas de la OIT sobre la transición de la escuela al trabajo en Egipto, Jordania y Túnez, los autores examinan si esto está relacionado con la desigualdad de oportunidades o con un desajuste estructural entre la demanda y la oferta de competencias laborales. Se constata que la escasa disponibilidad de puestos de trabajo altamente calificados y el escaso valor otorgado a las competencias adquiridas mediante el sistema de formación profesional tienen un gran poder explicativo.
Gasdermin D‐independent release of interleukin‐1β by living macrophages in response to mycoplasmal lipoproteins and lipopeptides
Authors: Saeki Ayumi , Tsuchiya Kohsuke , Suda Takashi , Into Takeshi , Hasebe Akira , Suzuki Toshihiko , Shibata Ken‐ichiro
Published: June 2020

Interleukin‐1β (IL‐1β) plays pivotal roles in controlling bacterial infections and is produced after the processing of pro‐IL‐1β by caspase‐1, which is activated by the inflammasome. In addition, caspase‐1 cleaves the cytosolic protein, gasdermin‐D (GSDMD), whose N‐terminal fragment subsequently forms a pore in the plasma membrane, leading to the pyroptic cell‐death‐mediated release of IL‐1β. Living cells can also release IL‐1β via GSDMD pores or other unconventional secretory pathways. However, the precise mechanisms are poorly defined. Here, we show that lipoproteins from Mycoplasma salivarium (MsLP) and Mycoplasma pneumoniae (MpLP) and an M. salivarium‐derived lipopeptide (FSL‐1), which are activators of the nucleotide‐binding oligomerization domain‐like receptor family, pyrin domain containing 3 (NLRP3) inflammasome, induce IL‐1β release from mouse bone‐marrow‐derived macrophages (BMMs) without inducing cell death. The levels of IL‐1β release induced by MsLP, MpLP and FSL‐1 were more than 100 times lower than those induced by the canonical NLRP3 activator nigericin. The IL‐1β release‐inducing activities of MsLP, MpLP and FSL‐1 were not attenuated in BMMs from GSDMD‐deficient mice. Furthermore, both active caspase‐1 and cleaved GSDMD were detected in response to transfection of FSL‐1 into the cytosol of BMMs, but the release of IL‐1β was unaffected by GSDMD deficiency. Meanwhile, punicalagin, a membrane‐stabilizing agent, drastically down‐regulated the release of IL‐1β in response to FSL‐1. These results suggest that mycoplasmal lipoprotein/lipopeptide‐induced IL‐1β release by living macrophages is not mediated via GSDMD but rather through changes in membrane permeability.
How intrinsic and extrinsic regulators of plasma cell survival might intersect for durable humoral immunity
Authors: Robinson Marcus J. , Webster Rosela H. , Tarlinton David M.
Published: June 2020

Plasma cells (PC) are key to protective immunity because they secrete antibodies. Surviving for periods ranging from days to decades in mammals, PC possess varying survival times that cannot be entirely stochastic or extrinsically set, as presumed half‐lives vary with antigenic specificity. Here, we review the signals that impart survival potential to PC. These include signals provided during formation, and signals experienced once generated and embedded in the so‐called long‐lived niche. These signals all feed into survival by maintaining PC expression of MCL1, potentially synergistically with influences of other BCL2 family members. Herein, we propose that each formed PC has a capacity to respond to extrinsic cues that sets an upper maximum to its lifespan, but survival is also affected by variable availability of signals provided in BM survival niches. PC survival thus becomes a function of immunogen characteristics and niche anatomy, determined by the weighted survival benefit ascribed to each involved factor. Most factors, such as supporting cell types and secreted proteins, are predicted to influence survival times varying temporally by orders of magnitude, rather than absolute PC abundances measured at a single time, which may account for the variation in PC lifespan evident in the literature.
Mating behavior, spawning, parental care, and embryonic development of some marine pseudocerotid flatworms (Platyhelminthes: Rhabditophora: Polycladida) in Singapore
Authors: Tong Samantha Jia Wen , Ong Rene S.L.
Published: June 2020

The reproductive biology of tropical marine cotylean polyclads is presently poorly known. Reproductive aspects of 16 polyclad species from the family Pseudocerotidae in the genera Acanthozoon, Nymphozoon, Phrikoceros, Pseudobiceros, Pseudoceros, Thysanozoon, and Tytthosoceros from Singapore were documented for the first time. Penis fencing was observed to be just a mating ritual and not necessary for insemination, not always aggressive, and could also result in eventual reciprocal insemination. Results showed that all species underwent similar embryonic developmental stages and hatched as Müller's larvae. Only Pseudoceros concinnus and Pseudoceros laingensis, with mean developmental times of >20 days and mean brood sizes of <1,000 eggs, displayed long‐term parental care. Polyclads producing larger brood sizes had shorter developmental times and only covered their egg masses for about one day. Phrikoceros baibaiye and Pseudobiceros spp. produced egg capsules with pointed opercula, whereas all other species possessed smooth, rounded opercula. All genera hatched with brownish‐orange larvae, except for Pseudoceros spp., which hatched with reddish‐purple larvae regardless of the initial embryo color (either grayish‐yellow or reddish‐purple). These could potentially complement current taxonomic characters in distinguishing polyclad genera and species.
Thermophysical and mechanical properties of novel high‐entropy metal nitride‐carbides
Authors: Wen Tongqi , Ye Beilin , Nguyen Manh Cuong , Ma Mengdong , Chu Yanhui
Published: June 2020

In this work, a novel (Hf0.2Zr0.2Ta0.2Nb0.2Ti0.2)(N0.5C0.5) high‐entropy nitride‐carbide (HENC‐1) with multi‐cationic and ‐anionic sublattice structure was reported and their thermophysical and mechanical properties were studied for the first time. The results of the first‐principles calculations showed that HENC‐1 had the highest mixing entropy of 1.151R, which resulted in the lowest Gibbs free energy above 600 K among HENC‐1, (Hf0.2Zr0.2Ta0.2Nb0.2Ti0.2)N high‐entropy nitrides (HEN‐1), and (Hf0.2Zr0.2Ta0.2Nb0.2Ti0.2)C high‐entropy carbides (HEC‐1). In this case, HENC‐1 samples were successfully fabricated by hot‐pressing sintering technique at the lowest temperature (1773 K) among HENC‐1, HEN‐1 and HEC‐1 samples. The as‐fabricated HENC‐1 samples showed a single rock‐salt structure of metal nitride‐carbides and high compositional uniformity. Meanwhile, they exhibited high microhardness of 19.5 ± 0.3 GPa at an applied load of 9.8 N and nanohardness of 33.4 ± 0.5 GPa and simultaneously possessed a high bulk modulus of 258 GPa, Young's modulus of 429 GPa, shear modulus of 176 GPa, and elastic modulus of 572 ± 7 GPa. Their hardness and modulus are the highest among HENC‐1, HEN‐1 and HEC‐1 samples, which could be attributed to the presence of mass disorder and lattice distortion from the multi‐anionic sublattice structure and small grain in HENC‐1 samples. In addition, the thermal conductivity of HENC‐1 samples was significantly lower than the average value from the “rule of mixture” between HEC‐1 and HEN‐1 samples in the range of 300‐800 K, which was due to the presence of lattice distortion from the multi‐anionic sublattice structure in HENC‐1 samples.
Improved thermoelectric properties of layered Ti1−xNbxS2−ySey solid solutions
Authors: Romanenko Anatoly I. , Yakovleva Galina E. , Fedorov Vladimir E. , Artemkina Sofya B. , Yu. Ledneva Alexandra , Zhdanov Kamil R. , Kuchumov Boris M. , Kuznetsov Vitalii A. , Wang Hongchao , Singh Sanjai , Saini Shivani , Han Mi‐Kyung , Kim Sung‐Jin
Published: June 2020

The thermoelectric properties of a series of the polycrystalline samples of titanium dichalcogenides with partial substitution of Ti for Nb and S for Se were investigated. It was found that sintering of the samples improved the thermoelectric efficiency (ZT), and the maximum ZT was achieved at sintering temperature of 600°C. A further increase in the sintering temperature (850°C and 950°C) led to the recrystallization of the samples, as a result, the Seebeck coefficient sharply decreased and electrical conductivity dramatically increased. The temperature dependences of electrical conductivity σ(T) in the temperature range from 4.2 to 300 K and Seebeck coefficient S(T) in the temperature range from 77 to 300 K were investigated in order to determine the nature of the observed improvements in thermoelectric properties due to double substitutions and sintering. Two‐dimensionalization of electron transport properties of Ti1−xNbxS2−ySey solid solutions was found. The Fermi energy EF2D was estimated using the temperature dependences of Seebeck coefficient. The relationship between the Fermi energy EF2D and figure of merit ZT was established. The effect of sintering on parameters σ(T), S(T), charge carrier concentration (n2D), mobility (µ), and thermal conductivity (k) was found. The optimal value of Fermi energy EF2D in terms of figure of merit ZT = 0.31 at room temperature (T = 300 K) was found for Ti0.98Nb0.02S1.3Se0.7 sample sintered at 600°C.
Enhancement in sintering driving force derived from in situ ordered structural collapse of mesoporous powders
Authors: Zhao Yuye , Sun Sheng , Cai Xuefan , Fan Yuchi , Jiang Wan , Zhou Beiying , Gu Shijia , Shi Nian , Luo Wei , Wang Lianjun
Published: June 2020

In this study, the sintering behaviors of a series of mesoporous silica (FDU‐12, SBA‐15, MCM‐41, and mesoporous silica nanoparticles) and microporous zeolite (ZSM‐5) using spark plasma sintering (SPS) technology were investigated. Highly transparent glass was prepared at a low temperature from all the powders. In particular, FDU‐12 type of mesoporous silica could be fully densified at an ultralow sintering temperature (910°C). It is suggested that the collapse of ordered mesostructures during SPS process dependents on the large pore size/pore wall thickness ratio, appropriate pore arrangement and amorphous frameworks of mesoporous silica, which implies that the enhancement in sinterability is possibly derived from the in situ collapse of ordered mesostructures. Such present findings pave a new way toward the construction of functional dense bulk materials from mesoporous powders.
Predicting change in middle school students’ leisure‐time physical activity participation: A prospective test of the trans‐contextual model
Authors: Polet Juho , Lintunen Taru , Schneider Jekaterina , Hagger Martin S.
Published: June 2020

We applied the trans‐contextual model (TCM) to examine the effects of middle school students’ perceived autonomy support from their physical education (PE) teachers on autonomous motivation toward PE in school and, critically, autonomous motivation toward, and actual participation in, leisure‐time physical activity (PA). The research adopted a three‐wave prospective design enabling the modeling of change in the TCM constructs over time. Middle school students (N = 248) aged from 12 to 16 years reported their perceived autonomy support, autonomous motivation in PE, autonomous motivation toward leisure‐time PA, attitudes, subjective norms, perceived behavioral control (PBC), intentions for PA in leisure‐time, and leisure‐time PA participation. The psychological constructs and leisure‐time PA were measured at baseline (T0) and at a first follow‐up occasion (T1) 5 weeks later. Another measure of PA was taken at a second follow‐up occasion (T2) a further 5 weeks later. A single‐indicator structural equation model using residualized change scores revealed that perceived autonomy support predicted autonomous motivation in PE (β = .345), and autonomous motivation in PE predicted autonomous motivation for leisure‐time PA (β = .484). Autonomous motivation toward leisure‐time PA predicted attitudes (β = .425), subjective norms (β = .264), and PBC (β = .517). Autonomous motivation toward leisure‐time PA (β = .376), attitude (β = .231), and subjective norms (β = .185) predicted intentions toward leisure‐time PA, and intentions predicted PA (β = .198). Findings extend research on the TCM by demonstrating its efficacy in predicting change in middle school students’ autonomous motivation across PE and leisure‐time contexts, and accounting for change in intentions toward, and actual participation in, leisure‐time PA.
Reducing YAP expression in Pkd1 mutant mice does not improve the cystic phenotype
Authors: Formica Chiara , Kunnen Sandra , Dauwerse Johannes G. , Mullick Adam E. , Dijkstra Kyra L. , Scharpfenecker Marion , Peters Dorien J. M. ,   the DIPAK Consortium
Published: June 2020

The Hippo pathway is a highly conserved signalling route involved in organ size regulation. The final effectors of this pathway are two transcriptional coactivators, yes‐associated protein (YAP) and transcriptional coactivator with PDZ‐binding motif (WWTR1 or TAZ). Previously, we showed aberrant activation of the Hippo pathway in autosomal‐dominant polycystic kidney disease (ADPKD), suggesting that YAP/TAZ might play a role in disease progression. Using antisense oligonucleotides (ASOs) in a mouse model for ADPKD, we efficiently down‐regulated Yap levels in the kidneys. However, we did not see any effect on cyst formation or growth. Moreover, the expression of YAP/TAZ downstream targets was not changed, while WNT and TGF‐β pathways' downstream targets Myc, Acta2 and Vim were more expressed after Yap knockdown. Overall, our data indicate that reducing YAP levels is not a viable strategy to modulate PKD progression.
Self‐reported illness perception and oral health‐related quality of life predict adherence to initial periodontal treatment
Authors: Machado Vanessa , Botelho João , Proença Luís , Mendes José João
Published: June 2020

Aim

To investigate the impact of periodontal disease perception and oral health‐related quality of life (OHRQoL), towards the initial periodontal treatment adherence (IPTA).

Material and Methods

This prospective study included 571 patients (274 males and 297 females, mean age 63.1 ± 14.5) with periodontal disease, from the Study of Periodontal Health in Almada‐Seixal (SoPHiAS). We assessed the potential connections, between sociodemographic characteristics, oral hygiene behaviours, periodontal measures, the Brief Illness Perception Questionnaire (IPQ) and the Oral Health Impact Profile (OHIP‐14), through a structural equation modelling (SEM). Multivariate logistic regression assessed significant oral health‐related variables towards IPTA.

Results

Overall, 265 participants had IPTA (46.4%). The SEM had a good fit to the data on all six latent variables (χ2 = 2.221, CFI = 0.921, RMSEA = 0.0.046). Multivariate analysis for IPTA indicated Treatment Control (Odds Ratio [OR] = 1.07) and Identity domains of Brief‐IPQ (OR = 1.10) and Functional Limitation domain of OHIP‐14 (OR = 1.60) as significant predictors. The obtained tool had a satisfactory prediction of IPTA (61.1%).

Conclusions

Initial periodontal treatment adherence is influenced by patient's perception on periodontal disease treatment and identity domains and by functional impact domain of OHRQoL. Future studies shall investigate the effect of modelling these domains on therapeutic success and public health strategies.
Serum growth differentiation factor 11 is closely related to metabolic syndrome in a Chinese cohort
Authors: Xu Bo , Huang Yan , Zhang Rong , Tang Mengyang , He Zhen , Jin Li , Zong Yicen , Hu Cheng , Jia Weiping
Published: June 2020

Aims/Introduction

Despite increasing interest in growth differentiation factor 11 (GDF11) based on its involvement in age‐related disorders, clinical implications – especially for metabolic diseases – remain unclear. Therefore, we assessed the association between serum GDF11 levels and metabolic disturbance in the Chinese population.

Materials and Methods

A total of 381 individuals from the Shanghai Nicheng Cohort Study were included. In addition to anthropometry, laboratory and ultrasonography measurements, serum concentrations of GDF11 were measured by enzyme‐linked immunosorbent assay.

Results

Circulating GDF11 concentrations were unchanged with age (r = –0.064, P = 0.210), but showed an inverse relationship to body mass index, waist circumference and fat‐free mass index (all P < 0.05). Correlation analysis showed decreased GDF11 concentrations accompanied by elevated diastolic blood pressure, fasting and 2‐h plasma glucose, triglycerides, and low‐density lipoprotein cholesterol after adjusting for sex, age and body mass index, whereas variations in aspartate aminotransferase and free thyroxine were consistent with GDF11 (all P < 0.05). Furthermore, people, especially men, with abnormal glycometabolism, body mass index and/or fat accumulation in the liver had lower serum levels of GDF11 (P < 0.05); an increase in metabolic syndrome morbidity along with the circulatory decline of GDF11 was found when stratified by GDF11‐level quartiles (P‐trend <0.001). Logistic regression showed that serum GDF11 levels were independently correlated with the presence of metabolic syndrome (odds ratio 0.665, 95% confidence interval 0.510–0.867, P = 0.003).

Conclusions

We confirmed GDF11 as an endocrine factor playing a significant role in multiple metabolic processes and an indicator of metabolic syndrome in the Chinese population, particularly in males.
Multiple‐quality Cournot oligopoly and the role of market size
Authors: Long Ngo Van , Miao Zhuang
Published: June 2020

We model an oligopoly where firms are allowed to freely enter and exit the market and choose the quality level of their products by incurring different setup costs. Using this framework, we study the mix of firms in the long‐run Cournot–Nash equilibrium under different cost structures and the effects of market size on market outcomes. Specifically, we consider two alternative specifications of cost structure. In the first specification, quality upgrading requires a large increment in the setup cost or R&D investment. Under this cost structure, we show that in the Nash equilibrium, each firm specializes in a single quality level, and an increase in the market size leads to (a) an increase in the fraction of firms that specialize in the high‐quality product, (b) an increase in the market share of the high‐quality product, and (c) a reduction in firms’ markups and in markup dispersion. Under the second type of cost structure where quality upgrading only requires higher marginal cost, we find that all firms will produce both types of product, and the value share of the high‐quality product increases as the market expands, but in quantity terms, the market share of the high‐quality product does not change. Finally, we find that trade liberalization has broadly similar effects to that of a market expansion, but the supply of the high‐quality product from the smaller economy may decrease.
Bedside education in the art of medicine (BEAM): A learner's perspective on arts‐based teaching
Authors: Kim Kain
Published: June 2020

In today's culture of the medical profession, it is fairly unusual for students to actually witness physicians talking with patients about anything outside scientific explanation. That other side of medicine – the one that goes beyond explanation to understanding – goes unexplored, and the patient's personal narrative is consequently less understood. Meanwhile, though reflective writing is the most frequently used didactic method to promote introspection and deeper consolidation of new ideas for medical learners, there is robust evidence that other art forms – such as storytelling, dance, theatre, literature and the visual arts – can also help deepen reflection and understanding of the human aspect of medical practice. The overall goal of the Bedside Education in the Art of Medicine (BEAM) project is to redress these issues through early interventions within the culture of the medical profession. By creating an arts‐based humanities curriculum, we hope to broaden medical learners' understanding and shine a light on what it means – for patients and clinicians – to be human, live well, experience loss, encounter disease, and engage in a therapeutic relationship. BEAM is envisioned as a modular, online resource of “third things” that any clinician anywhere will be able to access via a smartphone application to deliver brief, focused, humanistic clinical teaching in either hospital or ambulatory care settings. This commentary foregrounds a learner's perspective to model BEAM's usage in an in‐depth manner; it examines the relation of a painting by Edward Hopper to medical education through the lens of a poem by Victoria Chang, in the context of the BEAM web‐based app educational resource. By assessing the poignancy of the painting via the poem, I demonstrate the capacity of the arts and humanities in medical education, with a specific focus on the development of interpretative skills and tolerance for ambiguity that all authentic, engaged physicians need.
Behavioural responses of female lake trout Salvelinus namaycush to male chemical stimuli and prostaglandin F2α
Authors: Buchinger Tyler J. , Li Weiming , Johnson Nicholas S.
Published: June 2020

Male olfactory cues may guide aggregation on spawning reefs, mate evaluation and synchronized gamete release in lake trout Salvelinus namaycush, but a lack of information on the source and identity of the cues precludes direct tests of their function. Using a two‐channel flume, we found ovulated female lake trout increased time spent in the channel treated with spermiated male‐conditioned water, urine and bile but not synthesized prostaglandin F2α. We suggest future efforts to characterize male olfactory cues focus on urine and postulate that bile acids contribute to its behavioural activity.
Improving storage quality of refrigerated steamed buns by mung bean starch composite coating enriched with nano‐emulsified essential oils
Authors: Li Kun , Zhang Min , Bhandari Bhesh , Xu Jicheng , Yang Chaohui
Published: June 2020

In this study, the edible antimicrobial coating was prepared from mung bean starch and soluble soybean polysaccharide (MBS‐SSPS) enriched with different concentrations (0%, 0.3%, 0.6%, 0.9%, and 1.2%) of nano‐emulsified clove and cinnamon oil (CCO). Then MBS‐SSPS incorporated CCO coating (MSC) was applied on steamed buns at 10°C, 50% RH and the microbiological attributes (total viable count and the mold and yeast counts), hardness, and organoleptic attributes were assessed. The use of CCO in MBS‐SSPS coating solution reduced viscosity of final coating and increased antimicrobial activity. Also, compared with the uncoated sample, MSC0.6 and MSC0.9 under no adverse effect on flavor quality, reduced the aerobic plate count by 38.5 and 42% and decreased mold and yeast counts by 32 and 37%, respectively. Meanwhile, the coated samples obtained acceptable sensory qualities and lower hardness than the uncoated ones.

Practical Applications

The objective of the study was to develop and characterize the MBS‐SSPS coating enriched with nano‐emulsified CCO (the mixture of cinnamon and clove essential oil), then evaluate the effectiveness of antimicrobial coating on the storage quality of steamed buns. MSC0.6 and MSC0.9 improved the storage quality without sacrificing flavor while compared with uncoated samples. Therefore, it was feasible to apply this new edible antimicrobial coating on the surface of the steamed buns.
Determination of mechanical properties of whey protein films during accelerated aging: Application of FTIR profiles and chemometric tools
Authors: Agudelo‐Cuartas Camilo , Granda‐Restrepo Diana , Sobral Paulo J. A. , Castro Wilson
Published: June 2020

Nowadays, the application of non‐destructive techniques in food engineering is arising. Fourier transform infrared spectroscopy (FTIR) combined with chemometric tools show potential in evaluation of food materials. The aim of this work was to determine the applicability of FTIR profiles and chemometric tools to predict the mechanical properties of whey protein‐based film (WPF). A WPF solution was prepared using whey protein concentrate/distilled‐water/glycerol in (10/85/5% wt/wt) respectively. Then, the films were aged at 30°C/5 days and 60% RH. Each day, 10 pieces were evaluated, obtaining their FTIR profiles (4000–650 cm−1), tensile strength (TS), elongation at break (EB), and elastic modulus (EM). Principal component analysis‐multilinear regression (PCA‐MLR) and partial least square regression (PLSR) were developed using the K‐fold cross‐validation technique. For EB and EM, the coefficient of correlation (R2) and root means squared error (RMSE) were above 0.8990 and under 0.5250 (Full PLSR) and 0.8730 and 0.1378 (Optimized PLSR), unlike to TS presented R2 and RMSE values lower than 0.2160 and 2.5247, similar to PCA‐MLR models with values lower than 0.2050 and 0.1889, respectively (for all variables). In this sense, the use of FTIR profiles coupled to chemometric tools could be adequate to predict some properties in WPFs during aging.

Practical applications

This research presents a practical way for mechanical properties evaluation in films by means of Fourier Transform Infrared Spectroscopy (FTIR) coupled to chemometric tools. This new method could be useful for rapid monitoring of textural properties and characterization of films for food packaging.
Using Healthcare Data in Embedded Pragmatic Clinical Trials among People Living with Dementia and Their Caregivers: State of the Art
Authors: Bynum Julie P.W. , Dorr David A. , Lima Julie , McCarthy Ellen P. , McCreedy Ellen , Platt Richard , Vydiswaran V.G. Vinod
Published: June 2020

Embedded pragmatic clinical trials (ePCTs) are embedded in healthcare systems as well as their data environments. For people living with dementia (PLWD), settings of care can be different from the general population and involve additional people whose information is also important. The ePCT designs have the opportunity to leverage data that becomes available through the normal delivery of care. They may be particularly valuable in Alzheimer's disease and Alzheimer's disease‐related dementia (AD/ADRD), given the complexity of case identification and the diversity of care settings. Grounded in the objectives of the Data and Technical Core of the newly established National Institute on Aging Imbedded Pragmatic Alzheimer's Disease and AD‐Related Dementias Clinical Trials Collaboratory (IMPACT Collaboratory), this article summarizes the state of the art in using existing data sources (eg, Medicare claims, electronic health records) in AD/ADRD ePCTs and approaches to integrating them in real‐world settings. J Am Geriatr Soc 68:S49–S54, 2020.
Building a National Program for Pilot Studies of Embedded Pragmatic Clinical Trials in Dementia Care
Authors: Brody Abraham A. , Barnes Deborah E. , Chodosh Joshua , Galvin James E. , Hepburn Kenneth W. , Troxel Andrea B. , Hom Kimberly , McCarthy Ellen P. , Unroe Kathleen T.
Published: June 2020

Sixteen million caregivers currently provide care to more than 5 million persons living with dementia (PLWD) in the United States. Although this population is growing and highly complex, evidence‐based management remains poorly integrated within healthcare systems. Therefore, the National Institute on Aging IMPACT Collaboratory was formed to build the nation's ability to conduct embedded pragmatic clinical trials (ePCTs) for PLWD and their caregivers. The pilot core of the IMPACT Collaboratory seeks to provide funds for upward of 40 pilots for ePCTs to accelerate the testing of nonpharmacologic interventions with the goal that these pilots lead to full‐scale ePCTs and eventually the embedding of evidence‐based care into healthcare systems. The first two challenges for the pilot core in building the pilot study program were (1) to develop a transparent, ethical, and open nationwide process for soliciting, reviewing, and selecting pilot studies; and (2) to begin the process of describing the necessary components of a pilot study for an ePCT. During our initial funding cycle, we received 35 letters of intent, of which 17 were accepted for a full proposal and 14 were submitted. From this process we learned that investigators lack knowledge in ePCTs, many interventions lack readiness for an ePCT pilot study, and many proposed studies lack key pragmatic design elements. We therefore have set three key criteria that future pilot studies must meet at a minimum to be considered viable. We additionally discuss key design decisions investigators should consider in designing a pilot study for an ePCT. J Am Geriatr Soc 68:S14–S20, 2020.
Dissemination and Implementation of Evidence‐Based Dementia Care Using Embedded Pragmatic Trials
Authors: Gitlin Laura N. , Baier Rosa R. , Jutkowitz Eric , Baker Zachary G. , Gustavson Allison M. , Sefcik Justine S. , Hodgson Nancy A. , Koeuth Sokha , Gaugler Joseph E.
Published: June 2020

There are many nonpharmacologic interventions tested in randomized clinical trials that demonstrate significant benefits for people living with Alzheimer's disease (AD) and AD‐related dementia, their care partners, or professional care providers. Nevertheless, with few exceptions, proven interventions have not been translated for delivery in real‐world settings, such as home care, primary care, hospitals, community‐based services, adult day services, assisted living, nursing homes, or other healthcare systems (HCSs). Using embedded pragmatic clinical trial (ePCT) methods is one approach that can facilitate dissemination and implementation (D&I) of dementia care interventions. The science of D&I can inform the integration of evidence‐based dementia care in HCSs by offering theoretical frameworks that capture field complexities and guiding evaluation of implementation processes. Also, D&I science can suggest evidence‐based strategies for implementing dementia care in HCSs. Although D&I considerations can inform each stage of dementia care intervention development, it is particularly critical when designing ePCTs. This article examines fundamental considerations for implementing dementia‐specific interventions in HCSs and how best to prepare for successful dissemination upstream in the context of ePCTs, thereby illustrating the critical role of the D&I Core of the National Institute on Aging Imbedded Pragmatic Alzheimer's Disease and AD‐Related Dementias Clinical Trials Collaboratory. The scientific premise of the D&I Core is that having the “end” in mind, upfront in the design and testing of dementia care programs, can lead to decision‐making that optimizes the ultimate goal of wide‐scale D&I of evidence‐based dementia care programs in HCSs. J Am Geriatr Soc 68:S28–S36, 2020.
Benefits of Intensive Care Unit Hospitalization for Patients Older than 90 Years
Authors: Hall William J.
Published: June 2020

This editorial comments on the article by Haas et al. in this issue.
A multi‐center cross‐sectional study on midwives' self‐efficacy and influencing factors
Authors: Jiang Xiu‐Min , Chen Xiao‐Qian , Zheng Jing , Zheng Qing‐Xiang , Huang Xin‐Xin , Pan Yu‐Qing
Published: June 2020

Aim

Healthcare professionals who lack self‐efficacy may fail to cope with stressful situations, which increases job burnout and turnout. Self‐efficacy of midwives with high workload may affect the quality of service. However, little is known about midwives' self‐efficacy and related factors. This study aimed to examine the level and influencing factors of self‐efficacy among midwives, and to assess the relationships between their self‐efficacy and job burnout.

Methods

This was a multi‐center cross‐sectional study involving 700 midwives from 33 hospitals in China. Data were collected by three self‐administered questionnaires, including a socio‐demographic questionnaire, General Self‐Efficacy Scale and Maslach Burnout Inventory. Pearson correlation was utilized to analyze the association of self‐efficacy with job burnout. A multiple linear regression model was performed to identify variables associated with midwives' self‐efficacy.

Results

The score of self‐efficacy among Chinese midwives was 24.34 ± 5.28. The incidence of job burnout was 52.9%. The influencing factors of self‐efficacy among midwives were low personal accomplishment, emotional exhaustion, length of service, interest in the midwifery field, marital status and whether they came from a one‐child family or not.

Conclusions

Chinese midwives had a moderate level of self‐efficacy which easily led to job burnout. Also, several personal‐related and work‐related factors would affect the self‐efficacy of midwives. Nursing managers are called on to attach importance to self‐efficacy of midwives and provide effective interventions to improve their self‐efficacy.
Intrauterine Devices in the Context of Gonococcal Infection, Chlamydial Infection, and Pelvic Inflammatory Disease: Not Mutually Exclusive
Authors: Esposito Christa Palancia
Published: June 2020

The use of long‐acting reversible contraception, namely, intrauterine device (IUDs) and the subdermal implant, has been recommended to address the high rate of the unintended pregnancy in the United States. IUDs are a safe, highly effective contraceptive method, suitable for most women. The underutilization of IUDs arises in part from the lack of translation of best practices in the clinical setting as well as fears and misperceptions about this contraceptive method held by health care providers and women. This article reviews screening and management of Neisseria gonorrhoeae and Chlamydia trachomatis infection and pelvic inflammatory disease (PID) in women who are using or want to use an IUD. An IUD may be inserted without prior screening for N gonorrhoeae or C trachomatis in women who are at low risk for sexually transmitted infections and asymptomatic. An in situ IUD may remain in the uterus during and after treatment for gonococcal infection, chlamydial infection, or PID. The risk of PID with an IUD in situ is less than 1%. Following IUD best practices, including their use in the context of sexually transmitted infections, can increase the availability of this method for suitable candidates and decrease the unintended pregnancy rate.
Calprotectin in acne vulgaris: A possible contributory role
Authors: Fouda Ibrahim , Obaid Zakaria M. , Hegazy Shimaa F. , Samir Abd Al‐Samie Hesham , Nofal Ahmad
Published: June 2020

Background

Acne vulgaris (AV) is a common inflammatory skin disease involving dysfunction of the pilosebaceous unit. Many mechanisms for the pathogenesis of acne have been postulated; however, the precise pathogenesis is still uncertain.

Aim

Evaluation of the level of serum calprotectin in patients with AV and its correlation with the different clinical variables of the disease, particularly severity.

Patients and methods

This is a case‐control study that included ninety subjects who were subdivided into two groups; group I, which included sixty patients complaining of AV with different grades of severity, and group II that included thirty apparent healthy age and sex‐matched participants as a control group. Severity of AV was determined according to the Global Acne Grading System (GAGS). Serum calprotectin level was measured in both patients and controls by the enzyme‐linked immunosorbent assay (ELISA) method.

Results

A highly statistically significant difference in the serum calprotectin level was found between patients with AV and control subjects. A highly significant positive correlation was found between the serum calprotectin levels and the severity of acne. Similarly, a significant positive correlation was found between serum calprotectin levels and the duration of the disease.

Conclusion

Serum calprotectin levels are increased in acne patients and are positively correlated with its severity.