bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tooth mousse containing casein phosphopeptide-amorphous calcium phosphate prevents biofilm formation of Streptococcus mutans
Authors: Sionov Ronit Vogt , Tsavdaridou Danae , Aqawi Muna , Zaks Batya , Steinberg Doron , Shalish Miriam 
Published: March 2021

Abstract
Background
Streptococcus mutans is a common cariogenic bacterium in the oral cavity involved in plaque formation. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been introduced into tooth mousse to encourage remineralization of dental enamel. The aim of this research was to study the effect of tooth mousse containing CPP-ACP (GC Tooth Mousse®) or CPP-ACP with 0.2% fluoride (CPP-ACPF; GC Tooth Mousse Plus®; GCP) on S. mutans planktonic growth and biofilm formation.

Methods
S. mutans was cultivated in the presence of different dilutions of the tooth mousse containing CPP-ACP or CPP-ACPF, and the planktonic growth was determined by ATP viability assay and counting colony-forming units (CFUs). The resulting biofilms were examined by crystal violet staining, MTT metabolic assay, confocal laser scanning microscopy (CLSM), and scanning electron microscope (SEM).

Results
The CPP-ACP tooth mousse (GC) at a dilution of 5–50 mg/ml (0.5–5%) did not inhibit planktonic growth, and even increased the ATP content and the number of viable bacteria after a 24 h incubation. The same was observed for the CPP-ACPF tooth mousse (GCP), except for the higher concentrations (25 and 50 mg/ml) that led to a drop in the bacterial count. Importantly, both compounds significantly decreased S. mutans biofilm formation at dilutions as low as 1.5–3 mg/ml. 12.5 mg/ml GC and 6.25 mg/ml GCP inhibited biofilm formation by 90% after 4 h. After 24 h, the MBIC90 was 6.25 mg/ml for both. CLSM images confirmed the strong inhibitory effect GC and GCP had on biofilm formation when using 5 mg/ml tooth mousse. SEM images of those bacteria that managed to form biofilm in the presence of 5 mg/ml tooth mousse, showed alterations in the bacterial morphology, where the streptococci appear 25–30% shorter on the average than the control bacteria.

Conclusion
Our data show that the tooth mousse containing CPP-ACP reduces biofilm formation of the cariogenic bacterium S. mutans without killing the bacteria. The use of natural substances which inhibit biofilm development without killing the bacteria, has therapeutic benefits, especially in orthodontic pediatric patients.
Association between Medicare’s Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share
Authors: Banerjee Souvik , Paasche-Orlow Michael K. , McCormick Danny , Lin Meng-Yun , Hanchate Amresh D. 
Published: March 2021

Abstract
Background
Medicare’s Hospital Readmissions Reduction Program (HRRP), implemented beginning in 2013, seeks to incentivize Inpatient Prospective Payment System (IPPS) hospitals to reduce 30-day readmissions for selected inpatient cohorts including acute myocardial infarction, heart failure, and pneumonia. Performance-based penalties, which take the form of a percentage reduction in Medicare reimbursement for all inpatient care services, have a risk of unintended financial burden on hospitals that care for a larger proportion of Medicare patients. To examine the role of this unintended risk on 30-day readmissions, we estimated the association between the extent of their Medicare share of total hospital bed days and changes in 30-day readmissions.

Methods
We used publicly available nationwide hospital level data for 2009–2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. Using a quasi-experimental difference-in-differences approach, we compared pre- vs. post-HRRP changes in 30-day readmission rate in hospitals with high and moderate Medicare share of total hospital bed days (“Medicare bed share”) vs. low Medicare bed share hospitals.

Results
We grouped the 1904 study hospitals into tertiles (low, moderate and high) by Medicare bed share; the average bed share in the three tertile groups was 31.2, 47.8 and 59.9%, respectively. Compared to low Medicare bed share hospitals, high bed share hospitals were more likely to be non-profit, have smaller bed size and less likely to be a teaching hospital. High bed share hospitals were more likely to be in rural and non-large-urban areas, have fewer lower income patients and have a less complex patient case-mix profile. At baseline, the average readmissions rate in the low Medicare bed share (control) hospitals was 20.0% (AMI), 24.7% (HF) and 18.4% (pneumonia). The observed pre- to post-program change in the control hospitals was − 1.35% (AMI), − 1.02% (HF) and − 0.35% (pneumonia). Difference in differences model estimates indicated no differential change in readmissions among moderate and high Medicare bed share hospitals.

Conclusions
HRRP penalties were not associated with any change in readmissions rate. The CMS should consider alternative options – including working collaboratively with hospitals – to reduce readmissions.
Are price discounts on sugar-sweetened beverages (SSB) linked to household SSB purchases? – a cross-sectional study in a large US household and retail scanner database
Authors: Zhong Yichen , Auchincloss Amy H. , Stehr Mark F. , Langellier Brent A. 
Published: March 2021

AbstractBackgroundPrice promotions on sugar-sweetened beverages (SSBs) are commonly used by retailers to provide economic incentives for purchasing. Surprisingly, there is a lack of high-quality articles that examine the frequency and magnitude of sugary beverage discounting and consumer responses to discounts. The objective of this study is to quantify the association between exposure to price discounts and SSB purchases.MethodsThis cross-sectional study linked 2016 SSB consumption data from a U.S. household consumer panel (analytic sampleN = 11,299 households) and weekly prices at stores where they shopped. We derived percent of the time SSBs were discounted (annual promotion frequency) and the amount of the discount (annual promotion magnitude) and assessed their association with household annual per capita SSB purchase ounces. Linear regression models adjusted for household size, income per capita, age, education, presence of children, race, occupation, region, and urbanicity. We also evaluated whether the association between promotion and purchase varied by socioeconomic status and race subgroups. Data were analyzed in 2019–2020.ResultsOn average, households were exposed to SSBs price promotions 44% of the time. A 10-percentage point increase in annual SSB promotion frequency was associated with 13.7% increase in annual per capita purchasing (P < 0.0001), and a 1-percentage point increase in annual SSB promotion magnitude was associated with 15.3% increase in annual per capita purchasing (P < 0.0001). These associations did no vary significantly across socioeconomic status and race subgroups (InteractionP > 0.2).ConclusionsMore frequent and deeper price promotion was associated with higher annual per capita SSB purchases. Restricting SSB price promotions may be effective at reducing SSB consumption.
Validation of the Portuguese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS)
Authors: Maurício Sandra , Rebêlo Isabel , Madeira Catarina , Resende Filipa , Esteves Susana 
Published: March 2021

AbstractBackgroundPreoperative anxiety is common among the oncological surgical population. Due to its psychological and physiological detrimental effects, identifying and addressing it is of uttermost importance to improve anesthetic management and patient’s outcomes. The aim of this study is to validate the Portuguese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the oncological population.MethodsFollowing forward and backward translation of the original APAIS scale, further adaptation was obtained through cognitive interviewing. The resulting instrument was tested on the day before surgery on a sample of adult cancer surgical patients from a Portuguese oncology centre. Psychometric evaluation was derived from inter-item correlation, confirmatory factor analysis, Cronbach’s alpha, correlation with comparative scales, receiver operating characteristic curve and Youden index.Results109 patients (58 males, 51 females) were included. A three-dimensional model—anxiety about anesthesia, anxiety about surgery and desire for information, showed the best fit to the data. The questionnaire revealed high internal consistency (Cronbach alpha 0.81) and good inter-item correlation. Also, Portuguese APAIS correlated well with the gold standard anxiety scale. Therefore, the psychometric properties of this scale version make it a valid and reliable instrument. The optimal cutoff to maximize both sensitivity and specificity was 12 for the APAIS global anxiety score.ConclusionsPortuguese APAIS version is an accurate tool to identify preoperative anxiety among cancer patients and might impact its management, from premedication choice to provision of information and reassurance about either anesthesia or surgery.
Prevalence of caregiving and high caregiving strain among late-career medical school faculty members: workforce, policy, and faculty development implications
Authors: Skarupski Kimberly A. , Roth David L. , Durso Samuel C. 
Published: March 2021

Abstract
Background
Nearly one-third of medical school faculty members are age 55 + . As our population ages, the prevalence of family caregiving is increasing, yet we know very little about the caregiving experiences of aging faculty members in academic medicine. Faculty caregiving responsibilities coupled with projected physician shortages will likely impact the future academic medical workforce. We examined the prevalence of caregiving, concomitant caregiving strain, general well-being, and thoughts about retirement for medical school faculty members age 55 and older.

Methods
We analyzed data from a survey of 2,126 full-time medical school faculty 55 + years of age conducted in 2017. Chi-square tests of independence and independent samples t-tests were used to examine statistical differences between subgroups.

Results
Of the 5,204 faculty members invited to complete the parent survey, 40.8% participated (N = 2126). Most were male (1425; 67.2%), White (1841; 88.3%), and married/partnered (1803; 85.5%). The mean age was 62.3 years. Of this sample, 19.0% (n = 396) reported providing care on an on-going basis to a family member, friend, or neighbor with a chronic illness or disability, including 22.4% (n = 154) of the female respondents and 17.3% (n = 242) of the male respondents. Among the caregiving faculty members, 90.2% reported experiencing some or a lot of mental or emotional strain from caregiving. Caregivers gave lower ratings of health, social and emotional support, and quality of life, but greater comfort in religion or spirituality than non-caregivers. Both caregiving and non-caregiving faculty members estimated retiring from full-time employment at age 67.8, on average.

Conclusion
These data highlight caregiving responsibilities and significant concomitant mental or emotional strain of a significant proportion of U.S. medical schools’ rapidly aging workforce. Human resource and faculty development leaders in academia should strategically invest in policies, programs, and resources to meet these growing workforce needs.
Evolutionary trends in fertility among Chinese women, 1990–2015
Authors: Lan Manyu , Kuang Yaoqiu 
Published: March 2021

Abstract
Background
Under the one-child policy of birth control, total fertility rates (TFRs) declined rapidly among women in China. TFRs dropped from 2.29 in 1990 to 1.18 in 2010 and to 1.05 in 2015. However, little is known about the evolution of fertility patterns in China during 1990–2015.

Methods
We used population data from 1990 to 2015 and applied age–period–cohort (APC) models to examine temporal changes and used regression models to analyze the effect of education on fertility across periods and cohorts in China.

Results
Age effects assume an inverted U-shaped curve, which increase and then decline across ages, with a peak value in age groups 20–24 or 25–29. Period effects show a U-shaped curve, which first decline and then increase. Cohort effects show an inverted U-shaped plus V-shaped curve, which first increase, then decline and rebound with different age effects and period effects. The APC effect curves of all-order births are similar to those of first birth, but with different magnitudes.

Conclusions
We revealed the evolutionary trends in fertility patterns among Chinese women from 1990 to 2015. The one-child policy exerted a crowding out effect on education. Even if the well-educated women had an intense fertility intention, the fertility policy offset their desire for more children.
Measurement of three‐dimensional changes in lip vermilion in adult female patients after orthodontic extraction: a retrospective longitudinal study
Authors: Shen Lin-hui , Xie Tian-yi , Jiang Ruo-ping , Jiang Yi-ran , Chen Gui , Xu Tian-min , Han Bing 
Published: March 2021

Abstract
Background
3D facial scanning has changed the way facial aesthetic is evaluated and has numerous advantages for facial analysis. The specific relationship between lip vermilion morphological changes after orthodontic extraction treatment has not been fully explained. The objective of this study was to evaluate 3D morphological changes after orthodontic extraction treatment in lip vermilion of adult females with dentoalveolar protrusion using a structured light-based scanner.

Methods
Forty-two female subjects (25.2 ± 1.9 years) were recruited as the treatment group; these patients had undergone extraction treatment and achieved better sagittal profiles. Twenty female subjects (25.5 ± 2.1 years) were enrolled in the non-treatment group; these patients did not require any orthodontic treatment. The follow up time for the treatment group was more than 24 months and for the non-treatment group was more than 12 months. 3D facial scans were captured using 3D CaMega. Six landmarks (Ls, Li, R.Chp, L.Chp, R.Ch, and L.Ch), three linear measurements (mouth height, philtrum width, and mouth width), and three area measurements (upper, lower, and total vermilion area) were measured. The spatial deviations of three volumetric measurements (upper, lower, and total vermilion) were constructed for quantitative analysis. Color-coded displacement map were constructed for visualization of the soft-tissue displacement as qualitative evaluation.

Results
Mouth height and philtrum width decreased (-0.93 mm and − 1.08 mm, respectively) significantly (p = 0.008 and p = 0.027, respectively), and no significant (p = 0.488) change in mouth width was observed in the treatment group. The lower and total vermilion surface areas decreased (-51.00mm2 and − 69.82mm2, respectively) significantly (p = 0.003 and p = 0.031, respectively) in the treatment group, but no statistically significant (p = 0.752) change was detected in the upper vermilion. In the treatment group, significant retractions were observed in the color-coded displacement map, and three volumetric measurements of vermilion changed significantly (p = 0.012, p = 0.001 and p = 0.004, respectively). Significant differences were found between the treatment group and the non-treatment group in the linear, area and volumetric measurements.

Conclusions
This study established a method for qualitative and quantitative evaluation of the lip vermilion. Significant 3D retraction of the lip vermilion after the extraction treatment was found, with morphological variation between upper and lower vermilion.
New insights in phenotype and treatment of lung disease immuno-deficiency and chromosome breakage syndrome (LICS)
Authors: Willemse Brigitte W. M. , van der Crabben Saskia N. , Kerstjens-Frederikse Wilhelmina S. , Timens Wim , van Montfrans Joris M. , Lindemans Caroline A. , Boelens Jaap Jan , Hennus Marije P. , van Haaften Gijs 
Published: March 2021

AbstractWe report five patients with lung disease immuno-deficiency and chromosome breakage syndrome (LICS) but without recurrent infections and severe immunodeficiency. One patient had extended survival to 6.5 years. Hematopoietic stem-cell transplantation failed to cure another patient. Our findings suggest that the immunological abnormalities can be limited and do not fully explain the LICS phenotype.
May–Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature
Authors: Hng Joel , Su Shu , Atkinson Noel 
Published: March 2021

Abstract
Background
May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required.

Case presentation
A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis.

Conclusions
Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.
Functional characterization of Fur in iron metabolism, oxidative stress resistance and virulence of Riemerella anatipestifer
Authors: Huang Mi , Liu Mafeng , Liu Jiajun , Zhu Dekang , Tang Qianying , Jia Renyong , Chen Shun , Zhao Xinxin , Yang Qiao , Wu Ying , Zhang Shaqiu , Huang Juan , Ou Xumin , Mao Sai , Gao Qun , Sun Di , Wang Mingshu , Cheng Anchun 
Published: March 2021

AbstractIron is essential for most bacteria to survive, but excessive iron leads to damage by the Fenton reaction. Therefore, the concentration of intracellular free iron must be strictly controlled in bacteria. Riemerella anatipestifer (R. anatipestifer), a Gram-negative bacterium, encodes the iron uptake system. However, the iron homeostasis mechanism remains largely unknown. In this study, it was shown that compared with the wild type R. anatipestifer CH-1, R. anatipestifer CH-1Δfur was more sensitive to streptonigrin, and this effect was alleviated when the bacteria were cultured in iron-depleted medium, suggesting that the fur mutant led to excess iron accumulation inside cells. Similarly, compared with R. anatipestifer CH-1∆recA, R. anatipestifer CH-1∆recAΔfur was more sensitive to H2O2-induced oxidative stress when the bacteria were grown in iron-rich medium rather than iron-depleted medium. Accordingly, it was shown that R. anatipestifer CH-1∆recAΔfur produced more intracellular ROS than R. anatipestifer CH-1∆recA in iron-rich medium. Electrophoretic mobility shift assays showed that R. anatipestifer CH-1 Fur suppressed the transcription of putative iron uptake genes through binding to their promoter regions. Finally, it was shown that compared with the wild type, R. anatipestifer CH-1Δfur was significantly attenuated in ducklings and that the colonization ability of R. anatipestifer CH-1Δfur in various tissues or organs was decreased. All these results suggested that Fur is important for iron homeostasis in R. anatipestifer and its pathogenic mechanism.
Characterization of smallholder cattle production systems in South-Kivu province, eastern Democratic Republic of Congo
Authors: Mugumaarhahama Yannick , Ayagirwe Rodrigue Balthazar Basengere , Mutwedu Valence Bwana , Cirezi Nadège Cizungu , Wasso Dieudonné Shukuru , Azine Pascaline Ciza , Karume Katcho 
Published: March 2021

AbstractIn South-Kivu province, cattle farming is an integral component of farmers’ livelihoods and one of the few income-generating opportunities for smallholders. However, very few studies have been conducted to characterize smallholders’ cattle production systems. This study documents cattle production systems to better understand their current situation, constraints they face and opportunities they offer. For that purpose, an investigation was conducted based on a structured survey questionnaire and participatory interviews with 863 farmers in South-Kivu province. Collected data were analysed using factorial analysis of mixed data and clustering techniques. The results revealed three types of smallholder cattle farms differing mainly in their herds’ sizes and landholding. The first category is the most common and includes farmers raising small herds (6.3 ± 6.7 cattle) of local breeds in herding system (in this work, “herding system” refers to a rearing system for which the farmer drives and stays with his animals on pastures and fallow land during the day) and grazing fodder in community pastures, fallow lands and roadside grasses, while land constitutes a scarce resource. In the second category, some farmers have small tracts of land (< 5 ha) and others have large tracts (> 5 ha), but all have medium-size herds (45.1 ± 19.4 cattle) made up of local breeds, which they rear in herding system. They also exploit community pastures, fallow land and roadside fodder for animal feeding. The third and last category includes farmers with large cattle herds (78.1 ± 28.1 cattle) of local, crossbred and exotic breeds raised free range in the fenced paddocks on vast areas of land (> 5 ha) found in high-altitude regions. However, while being different according to the above-considered characteristics, the three categories of cattle farming remain extensive pastoral farms dominated by male farmers. Agriculture and/or animal husbandry are their main source of income while their livestock are also composed of goats and poultry, beside cattle. Still, the three farming groups require more inputs and improvement strategies for increased productivity in the challenging environment characterized by low land accessibility and high demand for milk and meat. Fodder cultivation and crop-livestock integration through agro-ecological systems as well as access to credit and extension services are the proposed strategies for the improvement of this economic sector.