bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of periodontitis in obese patients in Bahrain: a cross-sectional study
Authors: Alsalihi Leena , Bain Crawford , Milosevic Alexander , Hassan Amar , Janahi Abeer , Sivaramakrishnan Gowri 
Published: July 2021

Abstract
Background
Adult obesity has been associated with various systemic diseases and is an increasing problem in Bahrain. Recent evidence indicates a correlation between adult obesity and periodontitis. Hence the aim of this study was to assess the prevalence of periodontitis in overweight/obese adults in Bahrain and to determine the factors associated with periodontitis in these obese adults.

Method
This cross-sectional study was conducted in overweight subjects attending Ministry of Health (MOH) Nutrition Clinics at primary health centers in Bahrain. After obtaining the institutional ethics approval, the demographic and anthropometric data, including Body Mass Index (BMI) and waist circumference (WC) using World Health Organization (WHO) thresholds for severity of obesity, were recorded. Periodontal status was measured using the Community Periodontal Index (CPI) and the extent and severity of periodontal disease were categorized according to the number of sextants with CPI codes 3 and 4.

Results
A total of 372 participated with a mean age 44.0 (± 10.5) years for males, and 42.5 (± 11.2) years for females. Periodontitis was present in 361 (97%) of participants. Hypertension and diabetes were the most prevalent co-morbidities at 23.4% and 16% respectively. Mean WC was significantly greater in males at 114 cm (± 15.6) compared to females 109.5 cm (± 12.5) (p < 0.001). BMI was not associated with severity or extent of periodontitis but WC was weakly correlated in males but not in females (Spearman rho =  + 0.2, p < 0.05). In the logistic regression model using overall WC to predict the severity of periodontitis, the adjusted OR was 1.02 (95% CI 1.00–1.04) and for age it was 1.05 (95% CI 1.00–1.07).

Conclusion
The prevalence of periodontitis was high in this sample of overweight Bahrainis. BMI was not correlated with periodontitis but WC had a weak positive correlation. Implementation of periodontal health screening as a routine part of a nutrition clinic program is recommended.
The effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment: systematic review of prospective randomized clinical trials
Authors: Abou ElReash Ashraf , Hamama Hamdi , Comisi John C. , Zaeneldin Ahmed , Xiaoli Xie 
Published: July 2021

Abstract
Background
Endodontic surgical procedures, when performed, require retrograde filling materials that are biocompatible, non-toxic, non-irritant, dimensionally stable, and ideally promote bone formation. Precise evaluation of retrograde filling materials in clinical trials is necessary to give holistic view for properties of material and potential outcome from its use. The purpose of this review is to evaluate the effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment.

Methods
An electronic search was performed in the time frame between 1st of January 2000 to 1st of September 2020 using database.
Sources
Web of Science, PubMed and redundant hand searches through their references. Seven inclusion–exclusion criteria were set for the selection and identification of relevant articles. Risk of bias was conducted for the included studies.

Results
Nine randomized clinical trials (RCTs) fulfilled the inclusion criteria for this systematic review. The outcome of this review revealed that none of the reviewed trials totally-fulfilled CONSORT 2010 criteria.

Conclusions
In light of the outcome of this review, there is no enough evidence to support the superiority of certain retrograde filling material or surgical technique over another in the success rate of surgical endodontics retreatment. The variety of methodologies and strategies, such as patient selection, the method of treatment and study analysis, led to doubtful credibility of the obtained clinical evidence. Further prospective randomized controlled clinical trials evaluating the specific effect of the various used materials are needed.
The future of physician advocacy: a survey of U.S. medical students
Authors: Chimonas Susan , Mamoor Maha , Kaltenboeck Anna , Korenstein Deborah 
Published: July 2021

Abstract
Background
Advocacy is a core component of medical professionalism. It is unclear how educators can best prepare trainees for this professional obligation. We sought to assess medical students’ attitudes toward advocacy, including activities and issues of interest, and to determine congruence with professional obligations.

Methods
A cross-sectional, web-based survey probed U.S. medical students’ attitudes around 7 medical issues (e.g. nutrition/obesity, addiction) and 11 determinants of health (e.g. housing, transportation). Descriptive statistics, Kruskal-Wallis tests, and regression analysis investigated associations with demographic characteristics.

Results
Of 240 students completing the survey, 53% were female; most were white (62%) or Asian (28%). Most agreed it is very important that physicians encourage medical organizations to advocate for public health (76%) and provide health-related expertise to the community (57%). More participants rated advocacy for medical issues as very important, compared to issues with indirect connections to health (p < 0.001). Generally, liberals and non-whites were likelier than others to value advocacy.

Conclusions
Medical students reported strong interest in advocacy, particularly around health issues, consistent with professional standards. Many attitudes were associated with political affiliation and race. To optimize future physician advocacy, educators should provide opportunities for learning and engagement in issues of interest.
Predicting clinical outcomes among hospitalized COVID-19 patients using both local and published models
Authors: Galanter William , Rodríguez-Fernández Jorge Mario , Chow Kevin , Harford Samuel , Kochendorfer Karl M. , Pishgar Maryam , Theis Julian , Zulueta John , Darabi Houshang 
Published: July 2021

Abstract
Background
Many models are published which predict outcomes in hospitalized COVID-19 patients. The generalizability of many is unknown. We evaluated the performance of selected models from the literature and our own models to predict outcomes in patients at our institution.

Methods
We searched the literature for models predicting outcomes in inpatients with COVID-19. We produced models of mortality or criticality (mortality or ICU admission) in a development cohort. We tested external models which provided sufficient information and our models using a test cohort of our most recent patients. The performance of models was compared using the area under the receiver operator curve (AUC).

Results
Our literature review yielded 41 papers. Of those, 8 were found to have sufficient documentation and concordance with features available in our cohort to implement in our test cohort. All models were from Chinese patients. One model predicted criticality and seven mortality. Tested against the test cohort, internal models had an AUC of 0.84 (0.74–0.94) for mortality and 0.83 (0.76–0.90) for criticality. The best external model had an AUC of 0.89 (0.82–0.96) using three variables, another an AUC of 0.84 (0.78–0.91) using ten variables. AUC’s ranged from 0.68 to 0.89. On average, models tested were unable to produce predictions in 27% of patients due to missing lab data.

Conclusion
Despite differences in pandemic timeline, race, and socio-cultural healthcare context some models derived in China performed well. For healthcare organizations considering implementation of an external model, concordance between the features used in the model and features available in their own patients may be important. Analysis of both local and external models should be done to help decide on what prediction method is used to provide clinical decision support to clinicians treating COVID-19 patients as well as what lab tests should be included in order sets.
Development and field testing of a patient decision aid for management of acute Achilles tendon rupture: a study protocol
Authors: Meulenkamp Brad , Brillinger Julia , Fergusson Dean , Stacey Dawn , Graham Ian D. 
Published: July 2021

Abstract
Background
Achilles tendon ruptures are common injuries in an otherwise healthy, active population. Several treatment options exist, with both surgical and non-surgical options. Each treatment option has a unique set of risks and harms, which may present patients with decisional conflict. The aim of the proposed study is to develop, alpha test and field test a patient decision aid for patients presenting with acute Achilles tendon ruptures.

Methods
This is a three-stage study protocol. First, we will assemble a multi-disciplinary steering group including patients, clinicians, educators, and researchers to develop the patient decision aid prototype using the Ottawa Decision Support Framework. Second, we will perform a mixed-methods alpha test of the decision aid prototype with patients and clinicians experienced in acute Achilles tendon ruptures. Outcomes measured will include acceptability and usability of the patient decision aid measured using validated outcome scales and semi-structured interviews. A minimum of three rounds of feedback will be obtained. Results will be analyzed using descriptive statistics, reviewed by the steering group, to guide revisions to decision aid prototype at each round. The third stage will be field testing the revised decision aid prototype in usual clinical care. A pre-/post-study will be performed with patients with acute Achilles tendon ruptures. Patients will be recruited from the emergency department and complete the pre-consultation decision aid prior to a one-week follow up with their surgeon. The primary outcome of field testing will be feasibility of implementing the decision aid in the clinical setting and will be measured with recruitment and completion metrics. Secondary outcomes include acceptability of the decision aid, knowledge, preparedness for decision making, and decisional conflict, measured using validated outcome measures. Statistical analysis will be performed using descriptive analysis for primary outcomes and a student t-test and Wilcoxon Rank-Sum test for secondary outcomes.

Discussion
This comprehensive study protocol outlines the development, alpha testing, and field testing of a patient decision aid for patients with acute Achilles tendon rupture. Systematic and transparent development and testing of patient decision aids is critical to improve decision aid quality.
Trial registration Not Applicable.
Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania
Authors: Mwansisya Tumbwene , Mbekenga Columba , Isangula Kahabi , Mwasha Loveluck , Pallangyo Eunice , Edwards Grace , Orwa James , Mantel Michaela , Mugerwa Micheal , Subi Leonard , Mrema Secilia , Siso David , Selestine Edna , Temmerman Marleen 
Published: July 2021

Abstract
Background
Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs.

Methods
A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ).

Results
In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1.

Conclusions
The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.
Patients’ and professionals’ perspectives on implementation of opportunistic salpingectomy: a mixed-method study
Authors: Gelderblom Malou E. , Van Lieshout Laura A. M. , Piek Jurgen M. J. , De Hullu Joanne A. , Hermens Rosella P. M. G. 
Published: July 2021

Abstract
Background
To prevent ovarian cancer, several international societies have issued guidelines which recommend to discuss opportunistic salpingectomy with women undergoing pelvic surgery after completion of childbearing. The opportunistic salpingectomy refers to the additional removal of Fallopian tubes during pelvic surgery for another indication to reduce the risk of developing ovarian cancer. These recommendations emphasize the importance of counselling on benefits and risks of opportunistic salpingectomy but offer no guidance on their implementation in daily practice. The lack of a tailored implementation strategy has resulted in a wide variation in current practice. To reduce this practice variation, we identified influencing factors on implementing opportunistic salpingectomy from patients’ and professionals’ perspectives.

Methods
We conducted a mixed-method study between 2019 and 2020 throughout the Netherlands. In a qualitative phase, we conducted interviews with gynecologic patients (N = 11) and their professionals (N = 20) to explore barriers and facilitators, using an interview guide. In the quantitative phase, we quantified these barriers and facilitators among patients who underwent a hysterectomy or sterilization and were counselled on the opportunistic salpingectomy (N = 77), and members of the Dutch Society of Obstetrics and Gynecology (N = 204), using questionnaires. For both phases, barriers and facilitators were classified into the following domains: innovation, patient, healthcare professional, social setting, organization, and economic and political context.

Results
For patients, main barriers were lack of knowledge about: the existence of the opportunistic salpingectomy (45%), size of the surgery (44%) and its associated possible disadvantages (37%). In addition, patients attributed their reluctance to concerns about the removal of healthy organs (46%). For professionals, main barriers were: patients’ lack of knowledge of the size of surgery (85%) and its associated possible disadvantages (77%), the gap in evidence on long term risks and benefits (43%), the lack of feasibility in certain patients and during vaginal surgery (66%). Both patients (41%) and professionals (67%) identified the need for counselling material as facilitator.

Conclusion
To reduce the variety in care regarding opportunistic salpingectomy, consensus and uniform counselling is needed. Including the opportunistic salpingectomy in gynecological guidelines and a decision aid for counselling could serve as tools to facilitate implementation.
Production of trans-cinnamic acid by whole-cell bioconversion from l-phenylalanine in engineered Corynebacterium glutamicum
Authors: Son Jaewoo , Jang Jun Hong , Choi In Hyeok , Lim Chang Gyu , Jeon Eun Jung , Bae Bang Hyun , Jeong Ki Jun 
Published: July 2021

AbstractBackgroundtrans-cinnamic acid (t-CA) is a phenylpropanoid with a broad spectrum of biological activities including antioxidant and antibacterial activities, and it also has high potential in food and cosmetic applications. Although significant progress has been made in the production oft-CA using microorganisms, its relatively low product titers still need to be improved. In this study, we engineeredCorynebacterium glutamicumas a whole-cell catalyst for the bioconversion ofl-phenylalanine (l-Phe) intot-CA and developed a repeated bioconversion process.ResultsAn expression module based on a phenylalanine ammonia lyase-encoding gene fromStreptomyces maritimus(SmPAL), which mediates the conversion ofl-Phe intot-CA, was constructed inC. glutamicum. Using the strong promoter PH36and ribosome binding site (RBS) (in front of gene 10 of the T7 phage), and a high-copy number plasmid, SmPAL could be expressed to levels as high as 39.1% of the total proteins inC. glutamicum. Next, to improvet-CA production at an industrial scale, reaction conditions including temperature and pH were optimized;t-CA production reached up to 6.7 mM/h in a bioreactor under optimal conditions (50 °C and pH 8.5, using NaOH as base solution). Finally, a recycling system was developed by coupling membrane filtration with the bioreactor, and the engineeredC. glutamicumsuccessfully produced 13.7 mM oft-CA (24.3 g) from 18.2 mM ofl-Phe (36 g) and thus with a yield of 75% (0.75 mol/mol) through repetitive supplementation.ConclusionsWe developed a highly efficient bioconversion process usingC. glutamicumas a biocatalyst and a micromembrane-based cell recycling system. To the best of our knowledge, this is the first report ont-CA production inC. glutamicum, and this robust platform will contribute to the development of an industrially relevant platform for the production oft-CA using microorganisms.
Cobalt-doped bioceramic scaffolds fabricated by 3D printing show enhanced osteogenic and angiogenic properties for bone repair
Authors: Li Jungang , Zhao Chaoqian , Liu Chun , Wang Zhenyu , Ling Zeming , Lin Bin , Tan Bizhi , Zhou Linquan , Chen Yan , Liu Delong , Zou Xuenong , Liu Wenge 
Published: July 2021

Abstract
Background
The bone regeneration of artificial bone grafts is still in need of a breakthrough to improve the processes of bone defect repair. Artificial bone grafts should be modified to enable angiogenesis and thus improve osteogenesis. We have previously revealed that crystalline Ca10Li(PO4)7 (CLP) possesses higher compressive strength and better biocompatibility than that of pure beta-tricalcium phosphate (β-TCP). In this work, we explored the possibility of cobalt (Co), known for mimicking hypoxia, doped into CLP to promote osteogenesis and angiogenesis.

Methods
We designed and manufactured porous scaffolds by doping CLP with various concentrations of Co (0, 0.1, 0.25, 0.5, and 1 mol%) and using 3D printing techniques. The crystal phase, surface morphology, compressive strength, in vitro degradation, and mineralization properties of Co-doped and -undoped CLP scaffolds were investigated. Next, we investigated the biocompatibility and effects of Co-doped and -undoped samples on osteogenic and angiogenic properties in vitro and on bone regeneration in rat cranium defects.

Results
With increasing Co-doping level, the compressive strength of Co-doped CLP scaffolds decreased in comparison with that of undoped CLP scaffolds, especially when the Co-doping concentration increased to 1 mol%. Co-doped CLP scaffolds possessed excellent degradation properties compared with those of undoped CLP scaffolds. The (0.1, 0.25, 0.5 mol%) Co-doped CLP scaffolds had mineralization properties similar to those of undoped CLP scaffolds, whereas the 1 mol% Co-doped CLP scaffolds shown no mineralization changes. Furthermore, compared with undoped scaffolds, Co-doped CLP scaffolds possessed excellent biocompatibility and prominent osteogenic and angiogenic properties in vitro, notably when the doping concentration was 0.25 mol%. After 8 weeks of implantation, 0.25 mol% Co-doped scaffolds had markedly enhanced bone regeneration at the defect site compared with that of the undoped scaffold.

Conclusion
In summary, CLP doped with 0.25 mol% Co2+ ions is a prospective method to enhance osteogenic and angiogenic properties, thus promoting bone regeneration in bone defect repair.
A spotlight on lime: a review about adverse reactions and clinical manifestations due to Citrus aurantiifolia
Authors: Alessandrello Clara , Gammeri Luca , Sanfilippo Serena , Cordiano Raffaele , Brunetto Silvia , Casciaro Marco , Gangemi Sebastiano 
Published: July 2021

AbstractLime (Citrus aurantiifolia) is a plant belonging to the family of Rutaceae and to the genus Citrus. The fruit is widely used in the United States, Mexico, Southeast Asia, Latin America, but is increasingly widespread all over the world. It is used as a fresh fruit, in the preparation of foods, sweets and drinks and its oils are used in the cosmetic and pharmaceutical industry. The main adverse reactions to lime seem to be represented by contact dermatitis, allergic and phototoxic type. In the context of allergic forms, several allergens have been identified in the citrus family, the main one being limonene, but no noteworthy cross-reactivity has been identified. However, a case of fruit protein contact dermatitis has been described, showing sensitization to other fruits, such as kiwi, avocado, pineapple and apple. There are several molecules responsible for phototoxic reactions and mainly belonging to the coumarin and furocoumarins families. Reactions related to ingesting the fruit or inhaling pollen from the tree appear to be rare, as there are no known cases reported in the literature. The increasing diffusion of lime in Europe must pay attention to possible adverse reactions due to contact with this fruit, which seem destined to increase in future years. Further importance must be placed on patch tests and on the possibility of using alternative extracts to classic fragrance mixes.
Standard multiple imputation of survey data didn’t perform better than simple substitution in enhancing an administrative dataset: the example of self-rated health in England
Authors: Popham Frank , Whitley Elise , Molaodi Oarabile , Gray Linsay 
Published: July 2021

Abstract
Background
Health surveys provide a rich array of information but on relatively small numbers of individuals and evidence suggests that they are becoming less representative as response levels fall. Routinely collected administrative data offer more extensive population coverage but typically comprise fewer health topics. We explore whether data combination and multiple imputation of health variables from survey data is a simple and robust way of generating these variables in the general population.

Methods
We use the UK Integrated Household Survey and the English 2011 population census both of which included self-rated general health. Setting aside the census self-rated health data we multiply imputed self-rated health responses for the census using the survey data and compared these with the actual census results in 576 unique groups defined by age, sex, housing tenure and geographic region.

Results
Compared with original census data across the groups, multiply imputed proportions of bad or very bad self-rated health were not a markedly better fit than those simply derived from the survey proportions.

Conclusion
While multiple imputation may have the potential to augment population data with information from surveys, further testing and refinement is required.