bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of brushing teeth in patients with reduced oral hygiene by laypeople: a randomized, controlled study
Authors: Barbe Anna Greta , Al-Barwari Aya , Hamacher Stefanie , Deinzer Renate , Weik Ulrike , Noack Michael J. 
Published: May 2021

Abstract
Background
To evaluate the success of plaque reduction after external toothbrushing by instructed laypeople versus dental professionals using either a manual or powered toothbrush. Longitudinal, randomized, parallel-group intervention study in periodontitis patients with reduced oral hygiene quality undergoing anti-infective therapy. Patients were randomly and equally assigned to one of four groups: laypeople using a manual or powered toothbrush or dental professionals using a manual or powered toothbrush. Plaque reduction (Quigley–Hein-Index (QHI), Marginal Plaque Index (MPI)), gingivitis (papilla bleeding index), and cleaning time (seconds) were investigated.

Results
Thirty-nine patients participated in the study. Neither the choice of toothbrush (p = 0.399) nor the use of a dental professional (p = 0.790) had a significant influence on plaque levels achieved. However, multivariate modeling indicated statistically significant differences in the external cleaning time between brushing groups, with longer time required by laypeople (p = 0.002) and longer use of the powered toothbrush (p = 0.024).

Conclusion
When the ability to carry out personal oral hygiene is reduced, external brushing by dental professionals or instructed laypeople who meet previously defined criteria such as sufficient personal oral hygiene at home could help to fill the emerging dental care gap. A combination of oral hygiene approaches adapted to the individual needs of the patients in need of external help is necessary for optimum oral hygiene.

Trial registration: German Clinical Trials register (https://www.germanctr.de; number DRKS00018779; date of registration 04/11/2019).
Implicit gender-career bias in postgraduate medical training still exists, mainly in residents and in females
Authors: Kramer Maud , Heyligers Ide C. , Könings Karen D. 
Published: May 2021

Abstract
Background
More and more female residents enter postgraduate medical training (PGMT). Meanwhile, women are still underrepresented in academic medicine, in leadership positions and in most surgical specialties. This suggests that female residents’ career development may still be negatively impacted by subtle, often unconscious stereotype associations regarding gender and career-ambition, called implicit gender-career bias. This study explored the existence and strength of implicit gender-career bias in doctors who currently work in PGMT, i.e. in attending physicians who act as clinical trainers and in their residents.

Methods
We tested implicit gender-career bias in doctors working in PGMT by means of an online questionnaire and an online Implicit Association Test (IAT). We used standard IAT analysis to calculate participants’ IAT D scores, which indicate the direction and strength of bias. Linear regression analyses were used to test whether the strength of bias was related to gender, position (resident or clinical trainer) or specialty (non-surgical or surgical specialty).

Results
The mean IAT D score among 403 participants significantly differed from zero (D-score = 0.36 (SD = 0.39), indicating bias associating male with career and female with family. Stronger gender-career bias was found in women (βfemale =0 .11; CI 0.02; 0.19; p = 0.01) and in residents (βresident 0.12; CI 0.01; 0.23; p = 0.03).

Conclusions
This study may provide a solid basis for explicitly addressing implicit gender-career bias in PGMT. The general understanding in the medical field is that gender bias is strongest among male doctors’ in male-dominated surgical specialties. Contrary to this view, this study demonstrated that the strongest bias is held by females themselves and by residents, independently of their specialty. Apparently, the influx of female doctors in the medical field has not yet reduced implicit gender-career bias in the next generation of doctors, i.e. in today’s residents, and in females.
Factors affecting the performance of brain arteriovenous malformation rupture prediction models
Authors: Tao Wengui , Yan Langchao , Zeng Ming , Chen Fenghua 
Published: May 2021

Abstract
Background
In many cases, both the rupture rate of cerebral arteriovenous malformation (bAVM) in patients and the risk of endovascular or surgical treatment (when radiosurgery is not appropriate) are not low, it is important to assess the risk of rupture more cautiously before treatment. Based on the current high-risk predictors and clinical data, different sample sizes, sampling times and algorithms were used to build prediction models for the risk of hemorrhage in bAVM, and the accuracy and stability of the models were investigated. Our purpose was to remind researchers that there may be some pitfalls in developing similar prediction models.

Methods
The clinical data of 353 patients with bAVMs were collected. During the creation of prediction models for bAVM rupture, we changed the ratio of the training dataset to the test dataset, increased the number of sampling times, and built models for predicting bAVM rupture by the logistic regression (LR) algorithm and random forest (RF) algorithm. The area under the curve (AUC) was used to evaluate the predictive performances of those models.

Results
The performances of the prediction models built by both algorithms were not ideal (AUCs: 0.7 or less). The AUCs from the models built by the LR algorithm with different sample sizes were better than those built by the RF algorithm (0.70 vs 0.68, p < 0.001). The standard deviations (SDs) of the AUCs from both prediction models with different sample sizes displayed wide ranges (max range > 0.1).

Conclusions
Based on the current risk predictors, it may be difficult to build a stable and accurate prediction model for the hemorrhagic risk of bAVMs. Compared with sample size and algorithms, meaningful predictors are more important in establishing an accurate and stable prediction model.
Commissioner, clinician, and patient experiences of a pre‐surgical health optimisation programme – a qualitative study
Authors: McLaughlin Joanna , Palmer Cecily , Redwood Sabi , Kipping Ruth , Owens Lucie , Reynolds Rebecca , Scott Lauren J , Hill Elizabeth M , Donovan Jenny L , Jago Russell , Owen-Smith Amanda 
Published: May 2021

AbstractBackgroundHealth optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery. There is little evidence about their impact and the experience of their use. The aim of this study was to investigate the experiences and perspectives of commissioners, clinicians and patients involved in a locality’s health optimisation programme in the United Kingdom. The programme alters access to elective orthopaedic surgery for patients who smoke or are obese (body mass index ≥ 30 kg/m2), diverting them to a 12-week programme of behavioural change interventions prior to assessment for surgical referral.MethodsA thematic analysis of semi-structured interviews (n = 20) with National Health Service and Local Authority commissioners and planners, healthcare professionals, and patients using the pathway.ResultsHealth optimisation was broadly acceptable to professionals and patients in our sample and offered a chance to trigger both short term pre-surgical weight loss/smoking cessation and longer-term sustained changes to lifestyle intentions post-surgery. Communicating the nature and purpose of the programme to patients was challenging and consequently the quality of the explanation received and understanding gained by patients was generally low. Insight into the successful implementation of health optimisation for the hip and knee pathway, but failure in roll-out to other surgical specialities, suggests placement of health optimisation interventions into the ‘usual waiting time’ for surgical referral may be of greatest acceptability to professionals and patients.ConclusionsPatients and professionals supported the continuation of health optimisation in this context and recognised likely health and wellbeing benefits for a majority of patients. However, the clinicians’ communication to patients about health optimisation needs to improve to prepare patients and optimise their engagement.
Intrauterine midgut volvulus as a rare cause of intestinal obstruction: a case report
Authors: Gerçel Gonca , Anadolulu Ali İhsan 
Published: May 2021

Abstract
Background
Intrauterine midgut volvulus is a very rare, life-threatening condition, and prenatal diagnosis is difficult. In this article, we present a case of midgut volvulus followed by a pre-diagnosis of antenatal jejunal atresia.

Case presentation
A 1-day-old Turkish male baby, who was followed with a diagnosis of antenatal jejunal atresia, with a birth weight of 3600 g, delivered by cesarean section at 38 weeks of gestation from a 19-year-old mother in her fourth pregnancy, was taken to the newborn intensive care unit. The patient underwent surgery on the postnatal first day with a preliminary diagnosis of jejunal atresia. It was observed that the small intestine was rotated two full cycles from the mesenteric root. Bowel blood circulation was good. Volvulus was untwisted. There was malrotation. Ladd's procedure was performed. The baby was discharged on the seventh postoperative day with full oral feeding. The patient is still in the first postoperative year and follow-up has been uneventful.

Conclusion
Intrauterine midgut volvulus has been associated with high mortality in the literature. Differential diagnosis of midgut volvulus in patients with antenatal intestinal obstruction, close prenatal follow-up, appropriate delivery and timing of surgical intervention may significantly reduce morbidity and mortality.
Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the literature
Authors: Olorunsola Ifeoluwa S. , Etonyeaku Amarachukwu C. , Lekwa Blessing O. , Ojo Olusegun S. 
Published: May 2021

Abstract
Background
Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases.

Case presentation
A 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence.

Conclusion
Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.
Comparison of one versus two maxillary molars distalization with iPanda: a finite element analysis
Authors: Sujaritwanid Kamontip , Suzuki Boonsiva , Suzuki Eduardo Yugo 
Published: May 2021

Abstract
Background
The purpose of this study was to compare the stress distribution and displacement patterns of the one versus two maxillary molars distalization with iPanda and to evaluate the biomechanical effect of distalization on the iPanda using the finite element method.

Methods
The finite element models of a maxillary arch with complete dentition, periodontal ligament, palatal and alveolar bone, and an iPanda connected to a pair of midpalatal miniscrews were created. Two models were created to simulate maxillary molar distalization. In the first model, the iPanda was connected to the second molar to simulate a single molar distalization. In the second model, the iPanda was connected to the first molar to simulate “en-masse” first and second molar distalization. A varying force from 50 to 200 g was applied. The stress distribution and displacement patterns were analyzed.

Results
For one molar, the stress was concentrated at the furcation and along the distal surface in all roots with a large amount of distalization and distobuccal crown tipping. For two molars, the stress in the first molar was 10 times higher than in the second molar with a great tendency for buccal tipping and a minimal amount of distalization. Moreover, the stress concentration on the distal miniscrew was six times higher than in the mesial miniscrew with an extrusive and intrusive vector, respectively.

Conclusions
Individual molar distalization provides the most effective stress distribution and displacement patterns with reduced force levels. In contrast, the en-masse distalization of two molars results in increased force levels with undesirable effects in the transverse and vertical direction.
School-level inequality measurement based categorical data: a novel approach applied to PISA
Authors: Sempé Lucas 
Published: May 2021

AbstractThis paper introduces a new method to measure school-level inequality based on Item Response Theory (IRT) models. Categorical data collected by large-scale assessments poses diverse methodological challenges hinder measuring inequality due to data truncation and asymmetric intervals between categories. I use family possessions data from PISA 2015 to exemplify the process of computing the measurement and develop a set of country-level mixed-effects linear regression models comparing the predictive performance of the novel inequality measure with school-level Gini coefficients. I find school-level inequality is negatively associated with learning outcomes across many non-European countries.
Public and private sectors collective response to combat COVID-19 in Malaysia
Authors: Tan Ching Siang , Lokman Saim , Rao Yao , Kok Szu Hua , Ming Long Chiau 
Published: May 2021

AbstractOver the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed “private contractors” who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.
The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers
Authors:   on behalf of the AUTO Research Team, Betz Marian E. , Omeragic Faris , Meador Lauren , DiGuiseppi Carolyn G. , Fowler Nicole R. , Han S. Duke , Hill Linda , Johnson Rachel L. , Knoepke Christopher E. , Matlock Daniel D. , Moran Ryan 
Published: May 2021

Abstract
Background
Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult’s health and well-being. Decision aids can enhance the decision-making process by increasing knowledge of the risks and benefits of driving cessation and improve decision quality. The impact of decision aids regarding driving cessation for older adults is unknown.

Methods
The Advancing Understanding of Transportation Options (AUTO) study is a multi-site, two-armed randomized controlled trial that will test the impact of a decision aid on older adults’ decisions about changes in driving behaviors and cessation. AUTO will enroll 300 drivers age ≥ 70 years with a study partner (identified by each driver); the dyads will be randomized into two groups (n = 150/group). The decision aid group will view the web-based decision aid created by Healthwise at baseline and the control group will review information about driving that does not include evidence-based elements on risks and benefits and values clarification about driving decisions. The AUTO trial will compare the effect of the decision aid, versus control, on a) immediate decision quality (measured by the Decisional Conflict Scale; primary outcome); b) longitudinal psychosocial outcomes at 12 and 24 months (secondary outcomes); and c) longitudinal driving behaviors (including reduction or cessation) at 12 and 24 months (secondary outcomes). Planned stratified analyses will examine the effects in subgroups defined by cognitive function, decisional capacity, and readiness to stop driving.

Discussion
The AUTO study is the first large-scale randomized trial of a driving decision aid for older adults. Results from this study will directly inform clinical practice about how best to support older adults in decision-making about driving.

Trial registration
ClinicalTrials.gov: NCT04141891. Registered on October 28, 2019. Located at https://clinicaltrials.gov/ct2/show/NCT04141891
Effects of foraging site distances on the intestinal bacterial community compositions of the sympatric wintering Hooded Crane (Grus monacha) and Domestic Duck (Anas platyrhynchos domesticus)
Authors: Wang Wei , Zhou Lizhi , Fu Rong , Cheng Lei , Yan Shaofei , Mahtab Nazia , Song Yunwei 
Published: May 2021

AbstractBackgroundThe composition of intestinal microflora in animals is affected by cross-species transmission. In a nature reserve, the foraging sites of waterbirds are relatively fixed, but frequently close to residential areas and can also be visited by domestic fowls. It is easy to result in the trans-species-flock dispersal of gut microbes between the wild birds and domestic fowls. The effects of the variable foraging site distances on the gut microbe structures of the waterbirds and the sympatric domestic fowls are currently unclear, and further research is required to evaluate the impacts of geographic location on cross-infection.MethodsIllumina high-throughput sequencing and bioinformatics analysis software were utilized to compare and analyze the composition of gut microbes from the fecal samples of Hooded Cranes (HC;Grus monacha) and two groups of Domestic Ducks (Anas platyrhynchos domesticus) that foraged at 1 km (ducks in near areas, D-N), and 4 km (ducks in far areas, D-F) away from the habitats of the Hooded Cranes at Shengjin Lake, China.ResultsThe results showed that there were significant differences in the alpha-diversity of the gut bacteria in the HC, D-N, and D-F samples under the interspecific distance factor. The dominant bacterial phyla, Cyanobacteria and Proteobacteria, showed correlations with distance for each host. The D-N group had more diverse intestinal flora than the D-F, as they were physically closer to the HC and had more indirect contact and cross-transmission of their gut microbes. More potentially pathogenic bacterial sequences, and Operational Taxonomic Units (OTUs) were found in the D-N than in HC and D-F.ConclusionsHooded Cranes and the Domestic Duck populations at variable distances from the cranes showed significant differences in their intestinal bacteria and potentially pathogenic bacteria. The closer the foraging sites were, the easier the intestinal flora spread across species. The results provide a basis for determining the safe distance between wild birds and domestic fowls in a nature reserve.
Neurovascular unit in diabetic retinopathy: pathophysiological roles and potential therapeutical targets
Authors: Nian Shen , Lo Amy C. Y. , Mi Yajing , Ren Kai , Yang Di 
Published: May 2021

AbstractDiabetic retinopathy (DR), one of the common complications of diabetes, is the leading cause of visual loss in working-age individuals in many industrialized countries. It has been traditionally regarded as a purely microvascular disease in the retina. However, an increasing number of studies have shown that DR is a complex neurovascular disorder that affects not only vascular structure but also neural tissue of the retina. Deterioration of neural retina could precede microvascular abnormalities in the DR, leading to microvascular changes. Furthermore, disruption of interactions among neurons, vascular cells, glia and local immune cells, which collectively form the neurovascular unit, is considered to be associated with the progression of DR early on in the disease. Therefore, it makes sense to develop new therapeutic strategies to prevent or reverse retinal neurodegeneration, neuroinflammation and impaired cell-cell interactions of the neurovascular unit in early stage DR. Here, we present current perspectives on the pathophysiology of DR as a neurovascular disease, especially at the early stage. Potential novel treatments for preventing or reversing neurovascular injuries in DR are discussed as well.