bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased risk of valvular heart disease in patients with ankylosing spondylitis: a nationwide population-based longitudinal cohort study
Authors: Siao Wun-Zhih , Liu Chin-Hsiu , Wang Yu-Hsun , Wei James Cheng-Chung , Jong Gwo-Ping
Published: June 2021

Aims:

We aimed to evaluate the risk of valvular heart disease (VHD) among patients with ankylosing spondylitis (AS).

Methods:

This was a population-based cohort study utilizing the Longitudinal Health Insurance Research Database of the National Health Insurance in Taiwan. Patients with and without coding of newly diagnosed AS from 1999 to 2013 were assigned to the AS and non-AS groups, respectively. Primary outcome was the incidental risk of VHD. Multiple Cox regression was used to estimate the adjusted hazard ratio of VHD. Subgroup analysis and sensitivity tests were also conducted.

Results:

The AS group included 3780 patients, and 22,680 matched subjects without an AS diagnosis were identified as controls. The AS group had an increased risk of VHD compared with non-AS controls (adjusted hazard ratio: 1.63; 95% confidence interval: 1.43–1.86; p < 0.001). Subgroup analysis also revealed an increased risk of individual types of VHD, including aortic, mitral, and tricuspid valve disease. Patients in the AS group had a higher incidence of valve replacement surgery after the onset of VHD.

Conclusion:

Patients with AS had a significant risk of VHD compared to non-AS controls in this population-based cohort study. Screening for VHD may be needed in caring patients with AS. We suggest that echocardiography may be performed when patients are diagnosed with AS.
Lack of Surgeon Standardization on Implant Selection in Ankle Fracture Fixation May Increase Costs and Decrease Contribution Margin
Authors: Bernstein David N. , Hanna Philip , Merchan Nelson , Rodriguez Edward K. , Appleton Paul T. , Kwon John Y. , Wixted John J.
Published: June 2021

Background

Surgical standardization has been shown to decrease costs without impacting quality; however, there is limited literature on this subject regarding ankle fracture fixation. Methods. Between October 5, 2015 and September 27, 2017, a total of 168 patients with isolated ankle fractures who underwent open reduction, internal fixation (ORIF) were analyzed. Financial data were analyzed across ankle fracture classification type, implant characteristics, and surgeons. Bivariate analyses were conducted. One-way analysis of variance was used to compare hardware costs across all 5 surgeons. Linear regression analysis was used to determine if hardware cost differed by surgeon when accounting for fracture type.

Results

The mean contribution margin was $4853 (SD $6446). There was a significant difference in implant costs by surgeon (range, lowest-cost surgeon: $471 [SD $283] to $1609 [SD $819]; P < .001). There was no difference in the use of a suture button or locking plate by fracture type (P = .13); however, the cost of the implant was significantly higher if a suture button or locking plate was used ($1014 [SD $666] vs $338 [SD $176]; P < .001). There was an association between surgeon 3 (β = 200.32 [95% CI 6.18-394.47]; P = .043) and surgeon 4 (β = 1131.07 [95% CI 906.84-1355.30]; P < .001) and higher hardware costs.

Conclusions

Even for the same ankle fracture type, a wide variation in implant costs exists. The lack of standardization among surgeons accounted for a nearly 3.5-fold difference, on average, between the lowest- and highest-cost surgeons, negatively affecting contribution margin.

Levels of Evidence

Level IV
Patients With Chronic Foot and Ankle Conditions Experience Significant Improvements in Sleep Quality Following Surgical Intervention
Authors: Kunze Kyle N. , Farivar Daniel , Wu Kevin , Holmes George B. , Lee Simon , Lin Johnny , Bohl Daniel D. , Hamid Kamran S.
Published: June 2021

Background

Poor sleep quality is associated with metabolic dysregulation and impaired healing. The purpose of the current study was to quantify the prevalence of poor sleep in patients with atraumatic foot and ankle (F&A) conditions and determine whether surgical treatment is associated with sleep quality improvement.

Methods

Patients scheduled for surgical management of atraumatic F&A conditions were enrolled by 4 fellowship-trained orthopaedic F&A surgeons between May 2018 and April 2019. Patients completed the Pittsburgh Sleep Quality Index (PSQI) pre- and postoperatively. The PSQI ranges from 0 to 21, with a score ≥5 indicative of poor sleep quality. Patients also reported their perception of how their current F&A pain influenced their sleep quality on a scale of 0 to 10, where 0 indicated no influence and 10 indicated a strong influence (pain perception score [PPS]). Patients with known sleep disorders, acute surgical trauma, and infection were excluded.

Results

A total of 115 patients were enrolled. The mean preoperative PSQI and PPS were 8.1 ± 3.6 (range, 2-19) and 3.1 ± 2.7 (range, 0-10), respectively. Overall, 86.1% of patients had poor sleep quality (PSQI score ≥5). Similarly, 64.3% of patients had a PPS ≥1, indicating the belief that F&A pain contributed to sleep disturbance. A minimum of 6 months of follow-up was collected for 72 (62.6%) patients. On average, these 72 patients experienced significant improvements in sleep quality (mean PSQI decreased from 7.8 ± 3.2 to 5.4 ± 3.1, P < .001). Of these patients, 59.7% continued to experience poor sleep quality (PSQI ≥5), and 55.6% perceived that F&A pain contributed to sleep disturbance (PPS ≥1).

Conclusion

In this series, 86.1% of patients presenting for management of atraumatic F&A conditions had poor sleep quality at the time of their initial visit, with 64.3% perceiving their F&A conditions to influence their sleep quality. Improvements in sleep quality were observed at 6 months postoperatively, though over half of patients continued to experience poor sleep quality. The location of pathology and procedure performed was not associated with sleep quality.

Levels of Evidence

Level IV: Prospective case series
Common Core in Danger? Personalized Information and the Fragmentation of the Public Agenda
Authors: Magin Melanie , Geiß Stefan , Stark Birgit , Jürgens Pascal
Published: June 2021

The diversification of information sources has reignited the controversy on media-induced fragmentation endangering social integration. The media's capability to set the public agenda and create issues as a common core is a pivotal part of the public sphere and contributes fundamentally to society's cohesion. Algorithm-driven sources like social media that personalize content to the preferences of individuals and their social networks are considered agents of fragmentation of the public sphere. Politically extreme individuals relying on them may be particularly vulnerable to losing touch with society's common core. We employ an innovative operationalization of fragmentation on the individual level: “issue horizons”—comprising issue diversity, top issue focus, and issue overlap—to investigate how different information sources affect fragmentation. In a two-week daily diary, conducted 2016 in Germany, 356 participants named the two most important political issues of each day and reported the issue-specific sources of information. Results show that social media reliance neither increases nor decreases the compatibility of individuals' issue horizons, but news media reliance significantly increases the compatibility of issue horizons among the politically more extreme. Not relying on news media (but rather on social media) means that politically extreme persons are at risk of losing touch with society's mainstream. This attests to the news media's ongoing, indispensable integration function. Using multiple sources of political information—including the news media—appears to be of paramount importance in ensuring that most citizens are aware of the most important issues facing the nation.
Small saccular aneurysms in the coronary and right epigastric arteries: A case report
Authors: Yamamoto Taira , Endo Daisuke , Shimada Akie , Amano Atsushi
Published: June 2021

Small saccular aneurysm in the right gastroepiploic artery is a sporadic disease accounting for approximately 0.4% of abdominal visceral aneurysms rarely observed during routine examination of other illnesses; however, it has been reported following rupture. The right gastroepiploic artery is a common alternative to the internal thoracic artery in coronary artery bypass grafting. We report a case of small aneurysms in the left anterior descending artery, diagonal branch artery, and right gastroepiploic artery and a pseudoaneurysm in right gastroepiploic artery. Coronary artery bypass grafting was performed using the left internal thoracic artery and right gastroepiploic artery, and a 5-mm aneurysm was observed in the right gastroepiploic artery. The resected 5-mm right gastroepiploic artery aneurysm was saccular. Pathological investigation revealed media loss and adventitial thinning, indicating the possibility of an aneurysm rupture. Thus, preoperative three-dimensional computed tomography is beneficial for patients with coronary arterial aneurysms and preoperative evaluation of right gastroepiploic artery to help achieve good clinical outcomes in patients undergoing coronary artery bypass grafting with another arterial aneurysm.
Expression pattern of the autophagy related proteins Beclin1 and LC3B in tuberculous wound tissues
Authors: Zhou Keqiang , Su Yingjun , Jia Chiyu
Published: June 2021

Tuberculous wound therapy is a major challenge in clinical practice, due to the protracted disease course, high recurrence rate, and an unclear pathogenesis. We explored the expression patterns of Beclin1 and LC3B in tuberculous wound tissues in human tuberculous chronic wound and normal tissues was assayed by immunohistochemistry. Rat models of tuberculous wounding were induced by the Bacillus Calmette-Guerin (BCG) method. Beclin1 and LC3B protein expression in human tuberculous wound tissues differed from that of normal skin and non-tuberculous chronic wound tissues.In rat tuberculous wound tissues, expression of Beclin1 and LC3B mRNA time-dependently changed post-infection. Abnormal fluctuation of autophagy protein in the development of tuberculosis wound could be one of the causes for the repeated occurrence and protracted disease course of the tuberculous wound.
Healthy Lifestyle Counseling by Healthcare Practitioners: A Time to Event Analysis
Authors: Zoltick David , Scribani Melissa Brower , Krupa Nicole , Kern Megan , Vaccaro Eliza , Jenkins Paul
Published: June 2021

Introduction

Medical societies have heavily prioritized preventive care, as evidenced by numerous best practice guidelines supporting counseling patients on lifestyle factors. This report examines preventive counseling by healthcare providers in a rural healthcare system. We utilized electronic medical records to determine whether patient characteristics and chronic conditions were predictors of preventive counseling, and what the average time-interval was before a patient received this counseling.

Methods

Medical records from a cohort of 395 subjects participating in the 1999 Bassett Health Census Survey were reviewed for documented counseling with respect to smoking cessation, weight management, physical activity, and health condition-related diets (anti-hypertensive and diabetic diets).

Results

Our analyses revealed extensive delays in counseling for smoking cessation among smokers (median time to counseling = 4.2 years), for weight management among the obese (median time = 4.8 years), and for physical activity for all subjects (median time = 10.9 years). For those with diabetes, a median time of 7.5 years passed before being counseled on a diabetic diet. Hypertensive diet counseling did not occur for more than 50% of hypertensives.

Conclusion

In this population, we did not find documentation of lifestyle counseling that was in compliance with current guidelines for any of the lifestyle factors. The measurement of actual delay times provides further support for the position that preventive efforts of health care providers need to be improved.
The Experiences of Mothers in a Neonatal Unit and Their Use of the Babble App
Authors: Gibson Charlotte , Ross Kirsty , Williams Matt , de Vries Nathalie
Published: June 2021

To better understand the experiences of mothers with an infant admitted to a neonatal unit and ascertain their perspectives on an available information support app, Babble, eight mothers with an infant admitted to a Level II+ neonatal unit were interviewed. Thematic analysis was utilized and responses indicated that mothers of neonates experienced challenges around adapting to the maternal role and managing their expectations of motherhood. Relationships with staff were seen as pivotal in the development of maternal confidence and essential to the overall experience. Mothers prioritized informational support, but how mothers sought out this information depended on their individual needs. Mothers who reported using the Babble app found it to be a helpful supplementary resource, tailorable to their situation. Results suggest that greater staff awareness of parental perspectives and the development of adaptable and diverse resources, ensuring parents are provided with individualized and appropriate care, is needed.
Thrombophilia and Preoperative Deep Venous Thrombosis and Their Effect on Free Flap Survival: A Scoping Review
Authors: Hagiga Ahmed , Gultiaeva Mariia , Harry Lorraine E.
Published: June 2021

Background: A proper preoperative planning is essential to prevent flap failure. However, venous workup for flaps has not been commonly performed or utilized as a preoperative screening tool. A scoping review was conducted to explore preoperative venous system screening, including deep vein thrombosis diagnosis, and its effect on flap survival rate. This review identified existing gaps of knowledge and emphasized potential research areas for future studies. Methods: Two independent reviewers searched 3 electronic databases from inception to September 2020. Retrieved appropriate articles were selected systematically by title, abstract, and full review of the article. Studies were included if they enrolled patients who had thrombophilia or deep venous thrombosis (DVT) preoperatively and had undergone a free flap reconstruction. For eligible studies, the following information was extracted: basic demographics (sex, age, comorbidities), preoperative scans type, free flap type, clotting mode (causes), wound type, and flap survival. Results: Seventeen articles were found eligible for this review. Traumatic aetiology was found in 63 (33.6%) patients, while 124 (66.3%) patients had a non-traumatic aetiology. Preoperative screening for patients with non-traumatic aetiology was reported in 119 patients. In these patients, the flap survived in 107 (89.91%) patients. Four studies investigating patients with traumatic DVT aetiology, 60 patients (out of 63) had a preoperative computed tomography angiography or duplex. Those patients had 100% flap survival rates. Conclusion: Further investigations are required to identify venous thrombosis incidence in patients with non-traumatic thrombosis aetiology as this cohort of patients is at high risk of flap failure. Finally, the prognostic validity of available preoperative screening tools to identify high-risk patients should be assessed, such as imaging techniques, which would include venous duplex scanning, may prevent failure in free flap surgery.
“The Looming, Crazy Stalker Coronavirus”: Fear Mongering, Fake News, and the Diffusion of Distrust
Authors: Ravenelle Alexandrea J. , Newell Abigail , Kowalski Ken Cai
Published: June 2021

The authors explore media distrust among a sample of precarious and gig workers interviewed during the COVID-19 pandemic. Although these left-leaning respondents initially increased their media consumption at the outset of the pandemic, they soon complained of media sensationalism and repurposed a readily available cultural tool: claims of “fake news.” As a result, these unsettled times have resulted in a “diffusion of distrust,” in which an elite conservative discourse of skepticism toward the media has also become a popular form of compensatory control among self-identified liberals. Perceiving “fake news” and media sensationalism as “not good” for their mental health, respondents also reported experiencing media burnout and withdrawing from media consumption. As the pandemic passes its one-year anniversary, this research has implications for long-term media coverage on COVID-19 and ongoing media trust and consumption.
European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
Authors: Sandset Else Charlotte , Anderson Craig S , Bath Philip M , Christensen Hanne , Fischer Urs , Gąsecki Dariusz , Lal Avtar , Manning Lisa S , Sacco Simona , Steiner Thorsten , Tsivgoulis Georgios
Published: June 2021

The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP management in acute stroke.

The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Despite several large randomised-controlled clinical trials, quality of evidence is generally low due to inconsistent results of the effect of blood pressure lowering in AIS. We recommend early and modest blood pressure control (avoiding blood pressure levels >180/105 mm Hg) in AIS patients undergoing reperfusion therapies. There is more high-quality randomised evidence for BP lowering in acute ICH, where intensive blood pressure lowering is recommended rapidly after hospital presentation with the intent to improve recovery by reducing haematoma expansion. These guidelines provide further recommendations on blood pressure thresholds and for specific patient subgroups.

There is ongoing uncertainty regarding the most appropriate blood pressure management in AIS and ICH. Future randomised-controlled clinical trials are needed to inform decision making on thresholds, timing and strategy of blood pressure lowering in different acute stroke patient subgroups.
Infertility: A product of smoke emanating from Transfluthrin coated insecticide paper (TCIP)
Authors: Oyeniran David Anuoluwapo , Ojewale Abdulfatai Olakunle , Jewo Peter Imoni , Ashamu Ebenezer Adeola , Adeniyi Olajumoke Oluwaseun , Adelakun Sunday Aderemi
Published: June 2021

Transfluthrin is a fast-acting insecticide used in household and hygiene products, mainly against flying insects, such as mosquito and flies, and in agriculture material pests. Its uses in these areas have not been without health risk to humans and the ecosystem. Therefore, the current study was designed to investigate the effect of smoke emanating from Transfluthrin Coated Insecticide Paper (TCIP) on adult Wistar rats’ testicular functions. The rats were grouped into three. Group A was exposed to normal environmental air. Group B and C rats were exposed via whole-body inhalation to smoke emanating from 6 g and 12 g of TCIP every day for 8 weeks. The entire groups contained eight rats each. At the end of the exposure, body and organs weight, semen analysis, biochemical assay and histological examination were evaluated and determined. The results show that the exposure significantly altered the testicular cytoarchitecture, sperm quality, hormonal profile and oxidative parameters with an increase in exposure to TCIP. This study revealed that exposure to transfluthrin is detrimental to the reproductive functions of male rats.
Minimally Invasive Surgical Management of Complex Pediatric Facial Fractures
Authors: Mckenzie Jamie , Nguyen Edward
Published: June 2021

Le Fort fractures in pediatric patients are rare, and their management has increased complexity due to the development of the maxillofacial musculoskeletal complex and dentition. The authors present a case using historic circum-zygomatic wiring with 21st century surgical planning in a 18 month old, who sustained complex Le Fort II and III fractures. Treatment involved surgical planning with dental and stereolithographic models, and the fabrication of a retention modified, occlusal splint. Closed reduction with circum-zygomatic wiring retained by the occlusal splint, for a 3 week period, prior to removal. At 12 month review, the patient had good facial symmetry, cosmesis, profile, and function. The use of circum-zygomatic wiring provided a conservative operative approach, achieving excellent functional and cosmetic results without the potential morbidity of more invasive surgery.
Learning Design Thinking: A Social Innovation Jam
Authors: Pizarro Nelson , Graybeal Geoffrey M.
Published: June 2021

This learning innovation offers the framework for a three-day extracurricular “Social Innovation Jam” workshop aimed at teaching design thinking to address sustainable development. As entrepreneurship educators incorporate the United Nations Sustainable Development Goals into their programs, the Social Innovation Jam can be replicated to provide local solutions to global problems using design thinking and “learning by teaching” pedagogy both in and out of the classroom.
Characterisation of the opening behavior of multilayer films with cohesive failure mechanism by in situ peel tests in the ESEM
Authors: Heuser M , Zankel A , Mayrhofer C , Reincke K , Langer B , Grellmann W
Published: June 2021

In this work, peel tests inside the chamber of an ESEM ( in situ peel tests) are described with heat-sealed test specimens of packaging systems made of multilayer films that simulate different flexible packaging types, according to the packaging line used. The in situ peel tests provided evidence to describe the influence of three different main aspects of the packaging process in relation to the opening behavior of the sealing packages. The investigated aspects are the peel angle, the alignment angle between the orientation of the multilayer films and the seal, and the bulge formation as a consequence of inadequate sealing parameters. In situ peel tests enabled the differentiation between peel angle and local (micro) peel angle, which results from the overall stiffness of the multilayer structure film. Alignment angles of 90° and 45° were found to produce similar opening forces. Images showing the formation of various new local micro fissures on new planes during the in situ peel test explained how the opening force can be dramatically increased during the tearing of two sealed multilayer films.
Increasing the completion rate of the advance directives in primary care setting – a randomized controlled trial
Authors: Xu Cunzhi , Yan Shi , Chee Jade , Lee Emily Pui-Yan , Lim Han Wei , Lim Sarah Woon Ching , Low Lian Leng
Published: June 2021

Background

The completion rate of Advance Directives (ADs) has been low. This study aims to examine the effectiveness of two interventions 1) active counseling sessions coupled with passive patient education pamphlets, and 2) patient education pamphlets alone, compared with 3) control group (usual care), in increasing the completion rates of ADs in the primary care setting.

Methods

Multicenter randomised controlled trial in four public primary care clinics in Singapore under Singapore Health Services. Randomization was performed via block randomization with Sequential Numbered Opaque Sealed Envelopes. Participants were randomized into 1) active intervention group (both counseling by primary care physicians and patient education pamphlets) or 2) passive intervention group (only patient education pamphlets), and 3) control group (usual care) with follow-up at 6 weeks. The main outcome measure is the proportion of participants who completed / planned to complete) ADs six weeks post-intervention.

Results

Four hundred five participants were eligible to participate in the study. One hundred eighty-eight participants were recruited into the study (response rate = 46.4%), of which 158 completed the study. There was no significant difference between the control group, passive intervention group, and active intervention group, in terms of completion rates of ADs (29.4, 36.4, and 30.8% respectively).

Conclusions

This randomized controlled trial did not support the use of patient education pamphlets with or without active counseling sessions in increasing the completion of ADs in a primary care setting in Singapore. The optimal intervention strategy depends on each health system’s context and resources, taking into consideration patients’ profiles, which deserves further studies.

Trial registration

Registered on April 17, 2018 clinicaltrials.gov (NCT03499847).
Is industrial pollution detrimental to public health? Evidence from the world’s most industrialised countries
Authors: Rahman Mohammad Mafizur , Alam Khosrul , Velayutham Eswaran
Published: June 2021

Background

Industrial pollution is considered to be a detrimental factor for human health. This study, therefore, explores the link between health status and industrial pollution for the top 20 industrialised countries of the world.

Methods

Crude death rate is used to represent health status and CO2emissions from manufacturing industries and construction, and nitrous oxide emissions are considered to be indicators of industrial pollution. Using annual data of 60 years (1960–2019), an unbalanced panel data estimation method is followed where (Driscoll, J. C. et al. Rev Econ Stat, 80, 549–560, 1998) standard error technique is employed to deal with heteroscedasticity, autocorrelation and cross-sectional dependence problems.

Results

The research findings indicate that industrial pollution arising from both variables has a detrimental impact on human health and significantly increases the death rate, while an increase in economic growth, number of physicians, urbanisation, sanitation facilities and schooling decreases the death rate.

Conclusions

Therefore, minimisation of industrial pollution should be the topmost policy agenda in these countries. All the findings are consistent theoretically, and have empirical implications as well. The policy implication of this study is that the mitigation of industrial pollution, considering other pertinent factors, should be addressed appropriately by enunciating effective policies to reduce the human death rate and improve health status in the studied panel countries.
The effects of different accumulated pressure-time integral stimuli on plantar blood flow in people with diabetes mellitus
Authors: Duan Yijie , Ren Weiyan , Xu Liqiang , Ye Wenqiang , Jan Yih-Kuen , Pu Fang
Published: June 2021

Background

Exercise, especially weight-bearing exercise (e.g. walking), may affect plantar tissue viability due to prolonged repetitive high vertical and high shear pressure stimulus on the plantar tissue, and further induce development of diabetic foot ulcers (DFUs). This study aimed to investigate the effects of different accumulated pressure-time integral (APTI) stimuli induced by walking on plantar skin blood flow (SBF) responses in people with diabetes mellitus (DM).

Methods

A repeated measures design was used in this study. Two walking protocols (low APTI (73,000 kPa·s) and high APTI (73,000 × 1.5 kPa·s)) were randomly assigned to ten people with DM and twenty people without DM. The ratio of SBF measured by laser Doppler flowmetry after walking to that before (normalized SBF) was used to express the SBF responses.

Results

After low APTI, plantar SBF of people with DM showed a similar response to people without DM (P = 0.91). However, after high APTI, people with DM had a significantly lower plantar SBF compared to people without DM (P < 0.05). In people with DM, plantar SBF in the first 2 min after both APTI stimuli significantly decreased compared to plantar SBF before walking (P < 0.05).

Conclusions

People with DM had a normal SBF response after low APTI walking but had an impaired SBF response after high APTI walking, which suggests that they should avoid weight-bearing physical activity with intensity more than 73,000 kPa·s and should rest for more than 2 min after weight-bearing physical activity to allow a full vasodilatory response to reduce risk of DFUs.
Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation
Authors: Daneshvarhashjin Nazanin , Chizari Mahmoud , Mortazavi Javad , Rouhi Gholamreza
Published: June 2021

Background

Superior biomechanical performance of tapered interference screws, compared with non-tapered screws, with reference to the anterior cruciate ligament (ACL) reconstruction process, has been reported in the literature. However, the effect of tapered interference screw’s body slope on the initial stability of ACL is poorly understood. Thus, the main goal of this study was to investigate the effect of the interference screw’s body slope on the initial stability of the reconstructed ACL.

Methods

Based on the best screw-bone tunnel diameter ratios in non-tapered screws, two different tapered interference screws were designed and fabricated. The diameters of both screws were equal to bone tunnel diameter in one-third of their length from screw tip, then they were gradually increased by 1mm, in the lower slope (LSTIS), and 2 mm, in the higher slope (HSTIS) screws. To simulate the ACL reconstruction, sixteen soft tissue grafts were fixed, using HSTIS and LSTIS, in synthetic bone blocks. Through applying sub-failure cyclic incremental tensile load, graft-bone-screw construct’s stiffness and graft laxity in each cycle, also through applying subsequent step of loading graft to the failure, maximum load to failure, and graft’s mode of failure were determined. Accordingly, the performance of the fabricated interference screws was compared with each other.

Results

HSTIS provides a greater graft-bone-screw construct stiffness, and a lower graft laxity, compared to LSTIS. Moreover, transverse rupture of graft fibers for LSTIS, and necking of graft in the HSTIS group were the major types of grafts’ failure.

Conclusions

HSTIS better replicates the intact ACL’s behavior, compared to LSTIS, by causing less damage in graft’s fibers; reducing graft laxity; and increasing fixation stability. Nonetheless, finding the optimal slope remains as an unknown and can be the subject of future studies.
Estradiol regulates intestinal ABCG2 to promote urate excretion via the PI3K/Akt pathway
Authors: Liu Lei , Zhao Tianyi , Shan Lizhen , Cao Ling , Zhu Xiaoxia , Xue Yu
Published: June 2021

Objectives

The study of sex differences in hyperuricemia can provide not only a theoretical basis for this clinical phenomenon but also new therapeutic targets for urate-lowering therapy. In the current study, we aimed to confirm that estradiol can promote intestinal ATP binding cassette subfamily G member 2 (ABCG2) expression to increase urate excretion through the PI3K/Akt pathway.

Methods

The estradiol levels of hyperuricemia/gout patients and healthy controls were compared, and a hyperuricemia mouse model was used to observe the urate-lowering effect of estradiol and the changes in ABCG2 expression in the kidney and intestine. In vivo and in vitro intestinal urate transport models were established to verify the urate transport function regulated by estradiol. The molecular pathway by which estradiol regulates ABCG2 expression in intestinal cells was explored.

Results

The estradiol level of hyperuricemia/gout patients was significantly lower than that of healthy controls. Administering estradiol benzoate (EB) to both male hyperuricemic mice and female mice after removing the ovaries confirmed the urate-lowering effect of estradiol, and hyperuricemia and estradiol upregulated the expression of intestinal ABCG2. Estradiol has been confirmed to promote urate transport by upregulating ABCG2 expression in intestinal urate excretion models in vivo and in vitro. Estradiol regulates the expression of intestinal ABCG2 through the PI3K/Akt pathway.

Conclusion

Our study revealed that estradiol regulates intestinal ABCG2 through the PI3K/Akt pathway to promote urate excretion, thereby reducing serum urate levels.
Pair bonds during the annual cycle of a long-distance migrant, the Arctic Tern (Sterna paradisaea)
Authors: Redfern Chris P. F.
Published: June 2021

Background

The extent to which pairs remain together during the annual cycle is a key question in the behavioural ecology of migratory birds. While a few species migrate and winter as family units, for most the extent to which breeding partners associate in the non-breeding season is unknown. The Arctic Tern (Sterna paradisaea) has one of the longest migrations of any species, and the aim of this study was to establish whether or not partners remain together after breeding.

Methods

Leg-mounted geolocators were fitted to breeding pairs of Arctic Terns nesting on the Farne Islands, Northumberland, UK. The devices were recovered for analysis the following year.

Results

Analysis of data for the six pairs which returned the following year showed that partners departed from the colony at different times after breeding and migrated independently to different Antarctic regions. Partners also departed from the Antarctic and turned to the breeding colony independently. One third of the pairs divorced on return.

Conclusions

For long-distance migrants reliant on unpredictable foraging opportunities, it may not be viable to remain as pairs away from the breeding colony. Synchrony in arrival times at the breeding colony may maximise the chance of retaining a familiar partner, but could be affected by environmental factors in wintering areas or along migration routes.
Common computed tomography artifact: source and avoidance
Authors: Alzain Amel F. , Elhussein Nagwan , Fadulelmulla Ibtisam Abdallah , Ahmed Amna Mohamed , Elbashir M. E. , Elamin Badria Awad
Published: June 2021

Background

Artifacts have significantly degraded the quality of computed tomography (CT) images, to the extent of making them unusable for diagnosis. The types of artifact that could be used are as follows: (a) streaking, which is commonly due to a discrepancy in a single measurement, (b) shading, which is due to a group of channels deviating gradually from the true measurement, (c) rings, which are due to errors in individual detector calibration and (d) distortion, which is due to helical reconstruction. It is occasionally possible to avoid scanning of a bony area, by means of changing the postion of the patient. Thus, this study aimed to evaluate the common artifacts that affect image quality and the method of correction to improve image quality.

Results

The data were collected by distributing a questionnaire to the CT technologist at different hospitals about the most common type of artifacts in the CT images, source of artifacts and methods of correction. A total of 95 CT technologists responded to the questionnaire, which included 67% males and 33% females. Most of the participants (70%) were experienced CT technologists, and 61% of the participants had not done any subspecialty CT scan courses. The most common artifact used in the CT departments was motion artifact in brain CT (73%), and the best method to reduce motion artifact was patient preparation (87%).

Conclusions

The most common shown artifact in this study was motion artifact, and the common cause was the patient-based artifact. It is important to understand why objects occur and how they could be prevented or suppressed to improve image quality.
Completed audit of the use of seclusion in the Approved Centre in Tallaght University Hospital following the introduction of an Integrated Care Pathway
Authors: Conlan-Trant Rebecca , Corrigan Kate , Whitty Peter
Published: June 2021

Aims

The Mental Heath Commission (MHC) is an independent body in Ireland, set up in 2002, to promote, encourage and foster high standards and good practices in the delivery of mental health services and to protect the interests of patients who are involuntarily admitted. Guidelines on the rules governing the use of seclusion are published by the MHC. These guidelines must be followed and recorded in the patient's clinical file during each seclusion episode. A Seclusion Integrated Care Pathway (ICP) was devised in 2012 for use in the Approved Centre in Tallaght University Hospital. This ICP was developed in conjunction with the MHC guidelines to assist in the recording and monitoring of each seclusion episode. Since its introduction in 2012, this ICP has become an established tool used in the Approved Centre in Tallaght University Hospital.

The aim of this audit was to assess adherence to MHC guidelines on the use of seclusion in the Approved Centre in Tallaght University Hospital 8 years after the introduction of an ICP and compare it to adherence prior to its introduction and immediately after its introduction.

Method

Thirteen rules governing the use of seclusion have been published by the MHC. These include the responsibility of registered medical practitioners (RMP), nursing staff and the levels of observations and frequency of reviews that must take place during each seclusion episode. Using the seclusion register we identified a total of 50 seclusion episodes between August 2019 and July 2020. A retrospective chart review was conducted to assess documentation of each seclusion episode.

Result

There was an overall improvement in adherence with MHC guidelines compared to adherence prior to the introduction of the ICP and immediately after its introduction. Areas of improvement included medical reviews, nursing reviews, informing patient of reasons for, likely duration of and circumstances that could end seclusion, and informing next of kin. The range of compliance levels across the thirteen MHC guidelines improved from 3–100% to 69–100%. Post intervention there was 100% compliance with five of the thirteen guidelines.

Conclusion

The introduction of an ICP led to an overall improvement in compliance with MHC guidelines. The ICP has ensured that many of the rules governing seclusion are explicitly stated; however adjustments and revisions to the document and ongoing staff training are needed to ensure full adherence to MHC guidelines.
Mental health training for correctional officers: a systematic review
Authors: Darani Shaheen , Simpson Sandy , McMaster Robert , Wolff Elena , Bonato Sarah , Glancy Graham , Quinn Jason
Published: June 2021

Aims

Mental illness amongst prison inmates is a prevailing issue across the world, as mental illnesses are overrepresented in correctional facilities when compared to community populations. Despite this, correctional officers receive little to no training on how to respond to inmates with mental illness. Implementing mental health training could improve officer knowledge, skills, and attitudes toward inmates with mental illness. This could lead to improvements in risk management, humane treatment of inmates, and interprofessional collaboration with healthcare providers. There is limited research on the educational value of inmate mental health training programs for correctional officers. As far as we are aware, there have been no prior reviews of this literature. The goal of the present study is to review this literature to explore the nature and effectiveness of correctional officer mental health training programs.

Method

Medical and criminal justice databases were searched for scientific articles describing correctional officer mental health training programs. All studies that included a measurable outcome on either correctional officer knowledge or inmate mental health were included in a final analysis. The review adhered to PRISMA guidelines for systematic reviews.

Result

Of 1492 articles identified using search terms, 11 were included in the analysis. 6 articles described mental health education programs, 2 articles described skill-specific programs, and 3 articles described suicide prevention programs. Training programs reviewed content about mental illness, practical skills, and included didactic and experiential teaching modalities. The programs led to improvements in knowledge, skills, and attitudes amongst officers. Prior mental health attitudes, knowledge, and work experience did not correlate with improvements following training. Officers were more receptive to program facilitators with correctional or lived mental health experience. Experiential teaching was preferred to didactic teaching. A decline in training improvements occurred several months after training.

Conclusion

There is limited but positive literature suggesting that structured training programs, particularly involving persons with lived experience and experiential components are beneficial. The decline in training improvements suggests need for ongoing education and systems change within correctional institutions to ensure sustainability of gains. In terms of limitations of this review, it is possible articles pertaining to correctional officer mental health training were not available on the databases searched or some programs may not be published. Studies were also limited in their outcome measurement, with no consistent tools, and no control groups. This review can guide the development, delivery, and contribute toward best practice guidelines for future inmate mental health training programs and studies.
A qualitative study of foundation year two (F2) doctor's attitudes towards psychiatry carried out in Northern Ireland
Authors: Doris Michael , Mitchell Kathyrn , Hughes Damien , Parks Lorraine , Carragher Angela
Published: June 2021

Aims

Recruitment into psychiatry is a major issue nationally. Northern Ireland (NI) consistently punching above it's weight with psychiatry recruitment - in a region that only attracts 31.8% of F2s to enter into any training programme, Core psychiatry has been consistently oversubscribed. Here we look to examine the experiences of F2s in NI, including those who have had a placement in psychiatry and those who have not - what can we learn from NI?

Background

The exposure to psychiatry during the F2 year is a crucial time for recruitment to psychiatry. In NI, where there has been an 100% fill rate at core training level for many years, trainees and consultants have pointed towards a positive experience in the F2 year.

Method

Questionnaires were given out at a sample of F2 Generic Skills sessions, gathering a range of quantitative and qualitative data. A representative sample of over half of current F2s wrote about there preconceptions and experiences of psychiatry, whether they had worked in it or not. An a priori approach was taken towards generating codes as part of a framework analysis from which 4 major themes were identified.

Result

93/148 F2 doctors who were approached responded to the survey of which 36.6% had experienced a Foundation placement in psychiatry. Major qualitative themes that emerged were exposure to psychiatry, the nature of working in psychiatry, being valued and stigma. Doctors who had an F2 placement were much more likely to be willing to pursue a career in it, regardless of whether they had been allocated a placement with psychiatry by choice or not.

Conclusion

This survey adds to the literature that exposure to psychiatry in undergraduate and postgraduate level has a huge role in shaping attitudes towards the specialty of psychiatry, and indeed the likelihood of a foundation doctor going on to become a psychiatry trainee. Stigma in the medical profession towards mental illness and psychiatry remains prevalent.
Effectiveness of repetitive transcranial magnetic stimulation (rTMS) for the treatment of obsessive-compulsive disorder (OCD): a meta-analysis
Authors: Garg Kabir , Fineberg Naomi , Pellegrini Luca , Enara Arun , Cinosi Eduardo
Published: June 2021

Aims

OCD is a chronic and debilitating psychiatric illness. Current first-line treatments include serotonin reuptake inhibitors and cognitive behavioural therapy, but a substantial minority of patients fail to respond adequately, requiring further forms of intervention usually provided in a sequenced algorithm. Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetic pulses passed through a coil placed on the scalp to stimulate the underlying brain region. Clinical trials of r-TMS in OCD have produced conflicting results, possibly related to the variability in the site of stimulation, protocols used, and variability in the selection of patients. We perform an updated systematic review and meta-analysis of the effectiveness of rTMS for the treatment of OCD aimed to determine whether certain rTMS parameters (i.e. site, duration, protocol etc.) or patients’ characteristics (i.e age, duration of illness, illness severity, treatment resistance etc), are associated with effectiveness. Our overarching aim is to determine the place of rTMS in the sequenced OCD care-pathway.

Method

The meta-analysis is pre-registered in PROSPERO (ID: 241381). Potentially relevant studies will be retrieved using the MEDLINE, PsycINFO, and Cochrane Library databases using the parameters [‘obsessive compulsive disorder’ or ‘OCD’ or ‘obsessions’ or ‘compulsions’] AND [‘transcranial magnetic stimulation’ or ‘TMS’]. The reference lists of retained articles will also be scrutinized for additional relevant publications. Only full text English language articles will be included in the review. The methodological quality of the studies will be assessed using CONSORT criteria. A summary of the study's quality as a randomized clinical trial will be produced.

Result

Our preliminary analysis shows some efficacy for r-TMS in non-treatment resistant OCD than treatment resistant OCD. Detailed results will be presented in the poster at the event. Effect measure will be either categorical (e.g. relative risk (RR) or odds ratio (OR) or continuous (mean difference or standardized mean difference - Hedge's g or Cohen's d - when taking into consideration the severity of the disorder as a dimension). These outcomes will be measured through validated instruments, in the form of both self- rated scales and observer rated scales including semi-structured interviews.

Conclusion

This meta-analysis will identify the patient, illness and protocol parameters that determine clinical outcomes, as guide to optimizing the role of rTMS in the care of patients with OCD.