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Aim: Bacterial vaginosis (BV) is a common vaginal dysbiosis associated with adverse clinical sequelae, most notably, increased risk of sexually transmitted infections (STIs). The aims of this study were to estimate the frequency of BV recurrence, treatment patterns, other gynecological (GYN) conditions, and the associated healthcare resource utilization (HCRU) and costs among commercially insured patients in the USA. Patients & methods: Female patients aged 12–49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication (fungal treatment only excluded) were selected from the Merative™ MarketScan commercial database (2017–2020). During a minimum 12-month follow-up, additional treatment courses, treatment patterns, frequency of other GYN conditions, and HCRU and costs were assessed. Generalized linear models were used to identify baseline predictors of total all-cause healthcare costs and number of treatment courses. Results: The study population included 140,826 patients (mean age: 31.5 years) with an incident vaginitis diagnosis and ≥1 BV medication claim. During the follow-up, 64.2% had 1 treatment course, 22.0% had 2, 8.1% had 3, and 5.8% had ≥4; 35.8% had a BV recurrence (≥2 BV medication claims). The most commonly prescribed BV medication was oral metronidazole (73.6%). Approximately 12% (n = 16,619) of patients had a new diagnosis of another GYN condition in the follow-up; 8.2% had a new STI, which were more common among patients with ≥4 treatment courses (12.9%). During follow up, total all-cause healthcare costs averaged $8987 per patient per year (PPPY) of which $470 was BV related. BV-related healthcare costs increased from $403 PPPY among those with 1 treatment course to $806 PPPY among thosewith≥4with nearly half the costs attributed to outpatient office visits. Conclusion: BV recurrence among this population represented a substantial clinical and healthcare economic burden warranting improvements in women’s healthcare.

Objectives: This study sought to evaluate the remineralization of ex vivo human teeth using commercially available artificial saliva, SalivaMAX®, a supersaturated calcium phosphate rinse (SSCPR). Methods: early enamel lesions were artificially induced on ex vivo human teeth by chemical means. The teeth were exposed to the SSCPR for two minutes (experimental) or dH2O (control) four times per day for a total of 35 days. At time points of 0, 2.5, 21, and 35 days, micro-CT was utilized to determine the mineral density profile across the lesion and evaluate lesion depth. The relative percent remineralization was calculated from the initial lesion depth (Time 0) at each evaluation time. Student’s t-test was used to compare the extent of remineralization between the SSCPR and control groups for statistical significance at each time. To evaluate the changes in percent remineralization over time, a two-way ANOVA was used. Results: At Time 0 and 2.5 days, there was no difference in the percent remineralization between the SSCPR and control groups (p > 0.05). After 21 days, the teeth exposed to the SSCPR remineralized 56.7 ± 3.7%, while the control only remineralized 10.7 ± 11.0% (p < 0.0001). At day 35, the remineralization was 73.7 ± 5.4% and 18.2 ± 10.8% (p < 0.0001) for the SSCPR and control groups, respectively. Conclusions: A marked increase in remineralization occurred with the use of the SSCPR. Notably, the remineralization of the SSCPR occurred deep within the tooth and progressed toward the surface over time.

Introduction: Natural color of dentin is affected by many variables, including anatomical variations, age, how much dentin is exposed, or how much enamel is covering the dentin. Chlorhexidine gluconate (CHX) has been observed to cause tooth staining, especially of exposed dentin. Risk factors for CHX staining include the amount of time for CHX utilization amongst others. Interestingly, the temperature of the rinse when used has been identified as a risk factor. However, no evidence of the effect of temperature is available in the literature. The purpose of this study was to determine the effect of temperature on dentin staining due to CHX exposure.Methods: Two studies were done. The first a pilot study at room temperature to determine the time needed to establish staining solutions, a method to evaluate stain intensity, and establish the time needed to stain dentin samples in vitro. The second study exposed dentin samples on a twice daily basis to a 1 min soak in CHX at different temperatures, followed by a period in an unstimulated saliva mixed with black tea mixture. Temperatures tested were 4, 23, 37 and 50°C. Control samples were exposed to only black tea and saliva (no CHX) and tested at 23°C.Results: The pilot study found that the combination of CHX and black tea causes dentin staining. From this data the sample size needed for the second experiment was calculated, requiring 12 samples per group. Sixty dentin samples were divided amongst 5 groups. The data from this study showed significant darkening of the dentin samples over 18 days. The 4 and 23°C CHX rinses resulted in significant staining compared to the control samples. The 37 and 50°C CHX rinses did not stain significantly more than the control samples.Conclusions: Chlorhexidine has the ability to cause tooth staining in the presence of chromogens such as those in black tea. Significant darkening was observed at lower temperatures (4 and 23°C) over 18 days, therefore dental professionals may wish to advise gently warming the CHX rinse toward 37°C prior to use to reduce the risk of staining.

The U.S. with only 4% of the world’s population, bears a disproportionate share of infections in the COVID-19 pandemic. To understand this puzzle, we investigate how mitigation strategies and compliance can work together (or in opposition) to reduce (or increase) the spread of COVID-19 infection. Building on the Oxford index, we create state-specific stringency indices tailored to U.S. conditions, to measure the degree of strictness of public mitigation measures. A modified time-varying SEIRD model, incorporating this Stringency Index as well as a Compliance Indicator is then estimated with daily data for a sample of 6 U.S. states: New York, New Hampshire, New Mexico, Colorado, Texas, and Arizona. We provide a simple visual policy tool to evaluate the various combinations of mitigation policies and compliance that can reduce the basic reproduction number to less than one, the acknowledged threshold in the epidemiological literature to control the pandemic. Understanding of this relationship by both the public and policy makers is key to controlling the pandemic. This tool has the potential to be used in a real-time, dynamic fashion for flexible policy options. Our methodology can be applied to other countries and has the potential to be extended to other epidemiological models as well. With this first step in attempting to quantify the factors that go into the “black box” of the transmission factor β, we hope that our work will stimulate further research in the dual role of mitigation policies and compliance.

IntroductionOrthodontic treatment is reimbursed by Medicaid based on orthodontic and financial need with qualifiers determined by individual states. Changes in Medicaid-funded orthodontic treatment following the “Great Recession” in 2007 and the enactment of the Affordable Care Act in 2010 were compared for the 50 United States and the District of Columbia to better understand disparities in access to care. The results from this 2015 survey were compared to data gathered in 2006 (1).Materials and methodsMedicaid officials were contacted by email, telephone, or postal mail regarding the age limit for treatment, practitioner type who can determine eligibility and provide treatment, records required for case review, and rate and frequency of reimbursement. When not attained by direct contact, the information was gleaned from online websites, provider manuals, and state orthodontists.ResultsInformation gathered from 50 states and the District of Columbia documents that Medicaid program characteristics and expenditures continue to vary by state. Expenditures and reimbursement rates have decreased since 2006 and vary widely by geographic region. Some states have tightened restrictions on qualifiers and increased submission requirements by providers.ConclusionThe variation and lack of uniformity that still exists among Medicaid orthodontic programs in different states creates disparities in orthodontic care for US citizens. Barriers to care for Medicaid-funded orthodontic treatment have increased since 2006.

IntroductionIn 2014, the state of Colorado initiated new dental coverage benefits for adults in the Colorado Medicaid program. The goal of this study was to investigate the utilization and impact of this new dental coverage at the University of Colorado School of Dental Medicine. The utilization of dental services delivered and the numbers of patients in this program were compared before and after the implementation of the benefit.Materials and methodsThis retrospective study compared the utilization of services provided 2 years prior and 2 years after the Medicaid adult benefit was made available. Through the University of Colorado School of Dental Medicine (CU-SODM) electronic dental record, all adult Medicaid dental patients’ (ages 21+) charts were extracted for zip code, CDT dental procedure codes, with a focus on tooth extraction compared to tooth saving procedures. Graphical analysis and Pearson’s chi-squared tests were applied to assess the statistical significance of procedure utilization changes over time.ResultsAfter implementation of the Medicaid adult benefit, the number of patients seen at the school under this program increased by a factor of 4.5. The geographic range (zip code) increased with some patients coming from further distances to receive dental care. The number of patients from local zip codes increased by as much as 235%. There was a 51% increase in tooth saving procedures, which was statistically significant (P = 0.0013). Additionally, there was a 22% decrease in extractions, while not statistically significant (P = 0.0992), a downward trend was clear.DiscussionThe focus was on the utilization of Medicaid adult benefits at the dental school, which was only a small proportion of the state-wide Medicaid population. Therefore, these data are not generalizable for statewide assessments of the program. However, based on the findings at the school clinics, more adult patients utilized the benefits; and chose to receive more tooth saving procedures and less extractions after implementation of the Medicaid adult benefit. This Medicaid study conducted at the CU-SODM 2 years after the adult dental coverage can be used as a baseline for future studies.

The aging population experiences more gingival recession and root exposure which increases the opportunity for dentin erosion. This study tested the use of transverse microradiography (TMR) methods to assess dentin erosion and the interaction between fluoride and citric acid on the amount of erosion in the dentin samples. In a 4 × 3 interaction experimental design, four fluoride concentrations (0.00, 25.0, 50.0, and 100.0 mg/L) and three citric acid concentrations (0.0, 0.25, and 1.00%) were combined to form 12 experimental solutions. Forty-eight dentin samples were placed in the experimental solutions for 1 and 4 h and the amount of surface lost was determined by TMR methods. The resolution of the TMR method was 0.9 μm per pixel with a 0.1% and a 5% confidence interval of ±4.2 μm. Dentin erosion increased with the concentration of citric acid and time, the erosion decreased when concentration of fluoride was increased. Effects due to fluoride and citric acid concentrations individually, and their interaction on the amount of erosion observed was statistically significant (p < 0.0001). This study found that TMR methods are appropriate and that 25.0 mg/L was the optimal fluoride concentration to protect dentin from a 1.00% citric acid challenge.

Background: Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. Methods: A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. Results: Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32–0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42–0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47–2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02–1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. Conclusion: Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions. [ABSTRACT FROM AUTHOR]

Abstract Seed purchasing enables farmers to respond to adverse events that may cause chronic and temporary seed insecurity by allowing them to exploit opportunities associated with accessing new seeds. However, as with other inputs, seed purchasing is complicated by pervasive market imperfections and climate risk common in Sub-Sahara Africa. This study uses balanced household panel data for Malawi (2010–2018) and Ethiopia (2012–2016) and applies dynamic random effects Probit and Tobit models to assess how seed purchase decisions are affected by earlier participation in the market, lagged rainfall shocks, and historical climate variables. Our findings show that there are nonlinear effects of lagged seed purchase decisions on subsequent decisions with strong initial effects (weakening over time). For instance, initial maize seed purchase decisions are associated with about 11 and 22% higher probability of purchase and 1 and 2% higher shares of seed volumes purchased in later rounds in Malawi and Ethiopia, respectively. Seed purchase decisions also respond to climate variability and shocks. For instance, lagged drought shocks enhance subsequent maize purchase decisions in both countries. Historical average rainfall and temperature enhance maize seed purchase decisions in both countries. Overall, results point to state dependency on the demand side of the seed market, leading to selective access to purchased seeds. Also, seed purchase in smallholder farming is a liquidity and risk-dependent input choice. Policy efforts need to continue targeting reducing transaction costs and other barriers to entry into seed markets to enhance access to off-farm seed and support adaptation to rainfall shocks.

Objectives: This study sought to evaluate the remineralization of ex vivo human teeth using commercially available artificial saliva, SalivaMAX®, a supersaturated calcium phosphate rinse (SSCPR). Methods: early enamel lesions were artificially induced on ex vivo human teeth by chemical means. The teeth were exposed to the SSCPR for two minutes (experimental) or dH2O (control) four times per day for a total of 35 days. At time points of 0, 2.5, 21, and 35 days, micro-CT was utilized to determine the mineral density profile across the lesion and evaluate lesion depth. The relative percent remineralization was calculated from the initial lesion depth (Time 0) at each evaluation time. Student's t-test was used to compare the extent of remineralization between the SSCPR and control groups for statistical significance at each time. To evaluate the changes in percent remineralization over time, a two-way ANOVA was used. Results: At Time 0 and 2.5 days, there was no difference in the percent remineralization between the SSCPR and control groups (p > 0.05). After 21 days, the teeth exposed to the SSCPR remineralized 56.7 ± 3.7%, while the control only remineralized 10.7 ± 11.0% (p < 0.0001). At day 35, the remineralization was 73.7 ± 5.4% and 18.2 ± 10.8% (p < 0.0001) for the SSCPR and control groups, respectively. Conclusions: A marked increase in remineralization occurred with the use of the SSCPR. Notably, the remineralization of the SSCPR occurred deep within the tooth and progressed toward the surface over time. [ABSTRACT FROM AUTHOR]

1. Introduction Fluoride-containing dentifrices have been in common usage since the 1960s when it was shown that dentifrices containing sodium fluoride (NaF), disodium monofluorophosphate (MFP), stannous fluoride (SnF2), acidulated phosphate [...]

AbstractThe study was carried out in Murehwa, Mutoko, and Goromonzi district in Mashonaland East Province, Zimbabwe guided by the objective of analyzing factors that determine commercialization of African indigenous vegetables (AIVs) by smallholder farmers with different characterization. Quantitative techniques were used to collect data from three purposively sampled districts and 250 randomly sampled smallholder farmers using a questionnaire. The fractional regression model (FRM) was used to regress the explanatory variables. The paper revealed that the bulk of the households who participated were male-headed, married households and unemployed. Having a bulk of participants as male-headed households has a possible negative effect on commercialization. About 54.8% of households of the sampled population participated in the selling of African indigenous vegetables. Commercialization was significantly affected by the age of the household head, the quantity of AIVs sold, estimated income, employment status and distance to the main market which in this case is Mbare Musika. Mutoko has many households participating in the African indigenous vegetables commercialization. However, their index is low compared to Goromonzi which had few farmers but with a higher commercialization index, reflecting the volume per farmer that reaches the market. Commercialization of AIVs was found to be viable at 60 kg and above of quantities sold to the market. Household income had an inverse relationship with the commercialization index. Capacitating the younger generation in line with benefits of AIVs can enhance their participation in production and marketing and propel commercialization.

The COVID-19 pandemic led to an unprecedented demand for projections of disease burden and healthcare utilization under scenarios ranging from unmitigated spread to strict social distancing policies. In response, members of the Johns Hopkins Infectious Disease Dynamics Group developed flepiMoP (formerly called the COVID Scenario Modeling Pipeline), a comprehensive open-source software pipeline designed for creating and simulating compartmental models of infectious disease transmission and inferring parameters through these models. The framework has been used extensively to produce short-term forecasts and longer-term scenario projections of COVID-19 at the state and county level in the US, for COVID-19 in other countries at various geographic scales, and more recently for seasonal influenza. In this paper, we highlight how the flepiMoP has evolved throughout the COVID-19 pandemic to address changing epidemiological dynamics, new interventions, and shifts in policy-relevant model outputs. As the framework has reached a mature state, we provide a detailed overview of flepiMoP’s key features and remaining limitations, thereby distributing flepiMoP and its documentation as a flexible and powerful tool for researchers and public health professionals to rapidly build and deploy large-scale complex infectious disease models for any pathogen and demographic setup.

The objective of this work was to determine bonding characteristics of a hydrophilic monomer formulation containing polymerizable cyclodextrin derivatives. The hypothesis was that a formulation containing hydrophilic cross-linking diluent comonomcrs […]