bluuebunny/crossref_metadata_2025_split huggingface dataset:
Balanced carbohydrate ratios are associated with improved diet quality in Australia: A nationally representative cross-sectional study
Authors: Blumfield Michelle , McConnell Andrew , Cassettari Tim , Petocz Peter , Warner Molly , Campos Vanessa , Lê Kim-Anne , Minehira Kaori , Marshall Skye , Fayet-Moore Flavia 
Published: July 2021

Background
Carbohydrate quality influences major health outcomes; however, the best criteria to assess carbohydrate quality remain unknown.

Objective
The objectives were to: i) evaluate whether a diet that meets a carbohydrate ratio (simple, modified or dual ratio) is associated with higher nutrient intakes and diet quality, and ii) model the impact of substituting carbohydrate foods that meet the proposed ratios in place of foods that do not, on nutrient intakes.

Design
A secondary analysis of cross-sectional data from the 2011–12 Australian National Nutrition and Physical Activity Survey.

Participants/Setting
National data from participants aged 2 years and older (n = 12,153).

Main outcome measures
Ratios were defined as (i) simple ratio, 10:1 (10g carbohydrate:≥1g dietary fiber); (ii) modified ratio, 10:1:2 (10g carbohydrate:≥1g dietary fiber:≤2g free sugars); and (iii) dual ratio, 10:1 & 1:2 (10g carbohydrate:≥1g dietary fiber & ≤2g free sugars per 1g dietary fiber). Ratios were compared to nutrient intakes obtained via automated multiple-pass 24-hour dietary recall and diet quality calculated using the Australian Healthy Eating Index.

Statistical analyses performed
Substitution dietary modelling was performed. Data were analyzed using paired and independent sample t-tests.

Results
Ratio adherence was highest for simple (50.2% adults; 28.6% children), followed by dual (40.6% adults; 21.7% children), then modified (32.7% adults; 18.6% children) ratios. Participants who met any ratio reported higher nutrient intake and diet quality compared to those who failed to meet the respective ratio (P < .001 for all), with the greatest nutrient intakes found for those who met modified or dual ratios. Dietary modelling improved nutrient intakes for all ratios, with the greatest improvement found for the dual ratio.

Conclusions
All carbohydrate ratios were associated with higher diet quality, with a free sugars constraint in the dual ratio providing the greatest improvements.
Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model
Authors: Li Jia , Simon Gyorgy , Castro M. Regina , Kumar Vipin , Steinbach Michael S. , Caraballo Pedro J. 
Published: July 2021

ObjectiveThe association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk.MethodsRetrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2.ResultsOf 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups.ConclusionsThere is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.
Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
Authors: Guaracha-Basáñez Guillermo A. , Contreras-Yáñez Irazú , Hernández-Molina Gabriela , González-Marín Anayanci , Pacheco-Santiago Lexli D. , Valverde-Hernández Salvador S. , Peláez-Ballestas Ingris , Pascual-Ramos Virginia 
Published: July 2021

Background
To determine the impact of health care interruption (HCI), on clinical status of the patients reincorporated to an outpatient clinic for rheumatic diseases (OCDIR), from a tertiary care level center who was temporally switched to a dedicated COVID-19 hospital, and to provide a bioethical analysis.

Methods
From March to June 2020, the OCDIR was closed; since June, it is limited to evaluate 25% of the ongoing outpatients. This cross-sectional study surveyed 670 consecutive rheumatic outpatients between June 24th and October 31th, concomitant to the assessment of the rheumatic disease clinical status by the attendant rheumatologist, according to disease activity level, clinical deterioration and adequate/inadequate control. Multiple logistic regression analysis identified factors associated to HCI and to clinical deterioration.

Results
Patients were middle-aged females (86.7%), with median disease duration of 10 years, comorbidity (38.5%) and 138 patients (20.6%) had discontinued treatment. Primary diagnoses were SLE and RA, in 285 (42.5%) and 223 (33.3%) patients, respectively.
There were 344 patients (51.3%) with HCI. Non-RA diagnosis (OR: 2.21, 95%CI: 1.5–3.13), comorbidity (OR: 1.7, 95%CI: 1.22–2.37), patient’s need for rheumatic care during HCI (OR: 3.2, 95%CI: 2.06–4.97) and adequate control of the rheumatic disease (OR: 0.64, 95%CI: 0.45–0.9) were independently associated to HCI. There were 160 patients (23.8%) with clinical deterioration and associated factors were disease duration, substantial disease activity previous HCI, patients need for rheumatic care and treatment discontinuation.

Conclusions
HCI during COVID-19 pandemic impacted course of rheumatic diseases and need to be considered in the bioethical analysis of virus containment measures.
Assessment of the effect of vacuum-formed retainers and Hawley retainers on periodontal health: A systematic review and meta-analysis
Authors: Li Bowen , Xu Yifeng , Lu Cailian , Wei Zhenheng , Li Yongyue , Zhang Jinghui 
Published: July 2021

Background
Recently, increasing attention has been paid to the periodontal health of orthodontic patients in the maintenance stage in clinical practice. The focus of this meta-analysis was to compare the effects of vacuum-formed retainers (VFR) and Hawley retainers (HR) on periodontal health, in order to provide a reference for clinical selection.

Methods
From the establishment of the database until November 2020, a large number of databases were searched to find relevant randomized control trials, including the Cochrane Library databases, Embase, PubMed, Medline via Ovi, Web of Science, Scopus, Grey Literature in Europe, Google Scholar and CNKI. Related literature was manually searched and included in the analysis. Two researchers screened the literature according to relevant criteria. The size of the effect was determined using RevMan5.3 software, and the mean difference and 95% confidence intervals (CI) were used to estimate the results using a random effects model.

Results
This meta-analysis included six randomized controlled trials involving 304 patients. The results of the meta-analysis showed that there was no statistical difference in sulcus probing depth status between the VFR group and the HR group, including at 1, 3, and 6 months. Compared with the VFR group, the HR group showed a lower gingival index at 1 month (mean difference = 0.12, 95%CI: 0.06 to 0.19) and 3 months (mean difference = 0.11, 95%CI: 0.06 to 0.17), while there was no statistically significant difference at 6 months (mean difference = 0.10, 95%CI: -0.07 to 0.27). The plaque index of the HR group also showed a good state at 1 month (mean difference = 0.06, 95%CI: 0.01 to 0.12), 3 months (mean difference = 0.12, 95%CI: 0.08 to 0.16), and 6 months (mean difference = 0.19, 95%CI: 0.09 to 0.29). Subgroup analysis of PLI showed that when all teeth were measured, PLI status was lower in the HR group at 6 months (mean difference = 0.32, 95%CI: 0.18 to 0.46). PLI status was also low for the other teeth group (mean difference = 0.15, 95%CI: 0.08 to 0.22).

Conclusion
Our meta-analysis showed that patients using the Hawley retainer had better periodontal health compared with those using vacuum-formed retainers. However, more research is needed to look at the periodontal health of patients using these two retainers.
The what, why and when of adapting interventions for new contexts: A qualitative study of researchers, funders, journal editors and practitioners’ understandings
Authors: Copeland Lauren , Littlecott Hannah , Couturiaux Danielle , Hoddinott Pat , Segrott Jeremy , Murphy Simon , Moore Graham , Evans Rhiannon 
Published: July 2021

Background
The adaptation of interventions for new contexts is a rapidly developing research area. To date there is no consensus-based guidance to support decision-making and recommend adaptation processes. The ADAPT study is developing such guidance. This aim of the qualitative component of the study was to explore stakeholders’ understandings of adaptation, as to date there has limited consideration of how different concepts and meanings shape decision-making and practice.

Methods
A case study research design was used. Participants/cases were purposefully sampled based on study outcome, study design, expertise, context and country. Semi-structured interviews were conducted with a sample of researchers (n = 23); representatives from research funding panels (n = 6); journal editors (n = 5) and practitioners (n = 3). Data were analysed using the Framework approach. Overarching themes were discussed with the ADAPT study team, with further iterative refinement of subthemes.

Results
The results generated four central themes. Four themes related to stakeholders’ understanding: 1) definitions of adaptation and related concepts; 2) rationales for undertaking adaptation; 3) the appropriate timing for adaptation; and 4) ensuring fidelity when implementing adapted interventions.

Conclusion
The findings highlight the lack of clarity around key concepts and uncertainty about central decision-making processes, notably why interventions should be adapted, when and to what extent. This has informed the ADAPT study’s guidance, shaping the scope and nature of recommendations to be included and surfacing key uncertainties that require future consideration.
Short intense psychological stress induced by skydiving does not impair intestinal barrier function
Authors: Roca Rubio Maria Fernanda , Eriksson Ulrika , Brummer Robert J. , König Julia 
Published: July 2021

Background and aim
Psychological stress has been shown to increase intestinal permeability and is associated with the development of gastrointestinal disorders. This study aimed to investigate skydiving as an alternative model to analyse the effect of acute psychological stress on intestinal barrier function.

Materials and methods
Twenty healthy subjects participated in a tandem skydive followed by a negative control visit, of which 19 (9 females and 10 males, 25.9 ± 3.7 years) were included in the study. Intestinal permeability was assessed by a multi-sugar urinary recovery test. Sucrose recovery and lactulose/rhamnose ratio in 0-5h urine indicated gastroduodenal and small intestinal permeability, respectively, and sucralose/erythritol ratio in 5-24h urine indicated colonic permeability. Blood samples were taken to assess markers associated with barrier function. This study has been registered at ClinicalTrials.gov (NCT03644979) on August 23, 2018.

Results
Skydiving resulted in a significant increase in salivary cortisol levels directly after skydiving compared to the control visit. Cortisol levels were still increased two hours after landing, while cortisol levels before skydiving were not significantly different from the baseline at the control visit. Skydiving did not induce a significant increase in gastroduodenal, small intestinal or colonic permeability. There was also no significant increase in plasma intestinal and liver fatty acid-binding proteins, suggesting no damage to the enterocytes.

Discussion
These results show that the acute intense psychological stress induced by skydiving does not affect intestinal permeability in healthy subjects. Future models aiming to investigate the effect of stress on human intestinal barrier function should consider a more sustained exposure to the psychological stressor.
Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis
Authors: Galvão Maria Helena Rodrigues , Medeiros Arthur de Almeida , Roncalli Angelo Giuseppe 
Published: July 2021

Background
This study verified the association between contextual and individual factors and public dental services utilisation in Brazil.

Methods
The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey– 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was ‘public dental service utilisation’, and Andersen’s behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level.

Results
The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care.

Conclusions
Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
Seroprevalence of antibodies against SARS-CoV-2 virus in Northern Serbia (Vojvodina): A four consecutive sentinel population-based survey study
Authors: Ristić Mioljub , Milosavljević Biljana , Vapa Slobodanka , Marković Miloš , Petrović Vladimir 
Published: July 2021

Background
Monitoring changes of seroprevalence over time is important at the beginning and during of COVID-19 outbreak to anticipate its dynamics and plan an adequate public health response.

Methods
We conducted a repeated cross-sectional investigation among asymptomatic outpatient subjects and covered 0.1% of total population of Northern Serbia (Autonomous Province of Vojvodina). Each participant was tested for anti-SARS-CoV-2 antibodies using an immunochromatographic qualitative test (point-of-care rapid test). In the last round of survey IgG antibodies targeting the S1 subunit of the spike protein and the nucleocapsid protein of SARS-CoV-2 virus were assessed.

Results
During the four rounds of survey (between the end of April and the end of September), anti-SARS-CoV-2 seropositivities based on immunochromatographic test results were 2.60% (95% CI 1.80–3.63), 3.93% (95% CI 2.85–5.28), 6.11% (95% CI 4.72–7.77) and 14.60% (95% 12.51–16.89), respectively. After adjusting with results obtained from the Line immunoassay test, the estimated overall seroprevalence increased to 16.67% (95% CI 14.45–19.08) corresponding to 322,033 infections in total by the end of September 2020 in Vojvodina’s population. Throughout the course of the study, for every RT-PCR confirmed case of COVID-19, there were 39–87 additional infections in Vojvodina. No significant difference (p>0.05) in SARS-CoV-2 seropositivity regarding gender and between age subgroups was observed over the course of the survey.

Conclusions
The population prevalence of SARS-CoV-2 antibodies implies much more widespread infection in Vojvodina than indicated by the number of confirmed cases. However, our results suggest that the population of Vojvodina has not reached a desirable level of protection from SARS-CoV-2 virus by the end of September 2020.
El quehacer docente y la educación en valores
Authors: Ochoa Cervantes Azucena , Peiró I Gregori Salvador 
Published: July 2021

Nuestro contexto social padece profundas deficiencias que tienen que relacionarse con lo ético. La educación se considera como una herramienta básica para superar estas deficiencias. Partiendo de lo anterior, se realizó una investigación con cincuenta docentes de nivel primaria de la ciudad de Querétaro (México) para conocer si realizaban actividades de educación en valores, el propósito que perseguían con éstas, los temas que trabajaban al respecto y las situaciones de evaluación generadas para tal fin. Los resultados muestran que los docentes dicen trabajar actividades de educación en valores; sin embargo, se observa cierta incongruencia entre el propósito que dicen perseguir y las actividades que realizan para lograrlo. Lo anterior implica que el hecho de implementar cambios curriculares no necesariamente impacta en la construcción de nuevas prácticas para mejorar los procesos educacionales. Consideramos que los resultados de este trabajo pueden ser de utilidad para los encargados de la gestión educativa pues es necesario que se realicen acciones de formación en el profesorado que contemplen no sólo la formación conceptual sino también la personal y valoral. Esto debería considerarse como parte del desarrollo profesional y deontológico docente.
Seven new species and seven new records of Begonia L. (Begoniaceae) in the flora of Laos
Authors: Souvannakhoummane Keooudone , Lanorsavanh Soulivanh , Averyanov Leonid V. 
Published: July 2021

New species of Begonia L. in the flora of Laos presented in this paper were mainly found in the course of botanical surveys made in Hin Nam No National Protected Area, Nam Phouy National Protected Area, Khammouane Karst Forest, and Phou Khao Khouay National Protected Area.Additionally, herbaria presently available in Laos (HNL, FOF, NUoL, FRC), living plants, and alcohol preserved material at Pha Tad Ke Botanical Garden and the data accessible online at BM, E, K, LE, NY, P, and PE Herbaria were critically studied. The study conducted during 2012–2019 reveals seven new species for science and seven species newly recorded for the flora of Lao PDR. Species described as new for science are: B. glabritepala (found in Khammouane Province; it is most close to B. pierrei but differs in glabrous outer tepals of staminate flowers, pistillate flowers, capsules, petioles, peduncles and pedicles), B. heterocantha (found in Sainyabuli Province; most close to B. depingiana but differs in reddish purple, glandular pubescent abaxial leaf surface, glandular pubescent pedicel, and outer tepals of pistillate flowers sparsely white glandular pubescent), B. lanxangensis (found in Vientiane Province; most close to B. paleacea but differs in elongate tubers, ovate-lanceolate, obscurely asymmetrical to symmetrical leaves, and glabrous pedicels), B. parviglandulosa (found in Vientiane Province; most close to B. martabanica but differs in smaller habit, reniform-cordate leaves and glandular indumentum on peduncle, pedicle and capsules), B. pseudobrandisiana (found in Khammouane Province; most close to B. brandisiana but differs in pistillate flowers with five elliptic-oblanceolate tepals), B. tripartifolia (found in Khammouane Province; most close to B. tricuspidata but differs in leaves palmate triangular-ovate, with deeply lobed lacerate margin, pistillate flower of five tepals, and ovary with unequal wing), and B. viriditenebris (found in Khammouane Province; most close to B. sinuata but differs in single leaf, indumentum of bristle hairs and reddish or bronzy green adaxial leaf surface, and three styles). The following species discovered and recorded for the flora of Laos at first are: B. hatacoa (known in Nepal, Bhutan, NE India, Myanmar, Thailand, and Vietnam), B. hemsleyana (China, Vietnam), B. labordei (NE India, Myanmar, S China, Vietnam), B. longifolia (tropical zone from NE India to Indonesia), B. minuscula (Vietnam), B. parvula (S China), and B. subperfoliata (Myanmar, Thailand, S Vietnam). Descriptions and line drawings are provided for all newly described species. Photographic illustrations, data on phenology, habitat, and notes on morphological variations and relations are given for all studied species.
Existence and uniqueness of periodic orbits in a discrete model on Wolbachia infection frequency
Authors: Zheng Bo , Yu Jianshe 
Published: July 2021

Abstract
In this paper, we study a discrete model on Wolbachia infection frequency. Assume that a periodic and impulsive release strategy is implemented, where infected males are released during the first N generations with the release ratio α, and the release is terminated from (N + 1)-th generation to T-th generation. We find a release ratio threshold denoted by α
*(N, T), and prove the existence of a T-periodic solution for the model when α ∈ (0, α
*(N, T)). For the special case when N = 1 and T = 2, we prove that the model has a unique T-periodic solution which is unstable when α ∈ (0, α
*(N, T)). While α ≥ α
*(N, T), no periodic phenomenon occurs and the Wolbachia fixation equilibrium is globally asymptotically stable. Numerical simulations are also provided to illustrate our theoretical results. One main contribution of this work is to offer a new method to determine the exact number of periodic orbits to discrete models.
On the existence of multiple solutions for a partial discrete Dirichlet boundary value problem with mean curvature operator
Authors: Du Sijia , Zhou Zhan 
Published: July 2021

Abstract
Apartial discrete Dirichlet boundary value problem involving mean curvature operator is concerned in this paper. Under proper assumptions on the nonlinear term, we obtain some feasible conditions on the existence of multiple solutions by the method of critical point theory. We further separately determine open intervals of the parameter to attain at least two positive solutions and an unbounded sequence of positive solutions with the help of the maximum principle.