bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Pharmacist-Led Interventions on Diabetes Management at a Community Pharmacy in Pakistan: A Randomized Controlled Trial
Authors: Abubakar Muhammad , Atif Muhammad 
Published: August 2021

Purpose The study aimed to determine the impact of pharmacist-led interventions on diabetes management at a community pharmacy in Pakistan. Methods A one-month follow-up, randomized controlled trial (RCT) was carried out between December 1, 2016 and June 30, 2017. Sampling population consisted of patients diagnosed with type 2 diabetes mellitus (T2DM). The study population was randomized to a control group or an intervention group to determine the impact of a community pharmacist intervention on glycemic control fasting blood glucose (FBG) and random blood glucose (RBG), medication adherence (MMAS), and health-related quality of life (HRQoL) (EQ-5D-3L). Both non-pharmacological and pharmacological interventional tools were used that consist of array of charts and verbal communication by pharmacist. Outcomes for continuous variables were analyzed using paired sample t-test for time effect and one sample t-test to evaluate the study group effect. Independent sample t-test was used to compare each independent variable with dependent variable. A P-value of <.05 was considered statistically significant. Results The control and intervention groups showed significant improvement ( P-value < .05) in glycemic control, medication adherence, and HRQoL. However, the difference between the control and intervention groups was not statistically significant in terms of blood glucose levels and HRQoL (time trade off, TTO). There was a clinically significant association between pharmacist intervention and predefined glycemic control among the study participants (FBG: P-value < .001 and RBG: P-value = .04). A clinically significant association was also found between pharmacist intervention and medication adherence at the end of the trial compared with baseline values ( P-value < .001). Similarly, a clinically significant association was found between pharmacist intervention and predefined HRQoL [TTO: P-value = .002 and EQ-VAS: P-value = .001]. Conclusion A significant proportion of T2DM patients in the intervention group achieved predefined glycemic control, medication adherence, and health related quality of life.
Upholding the EU's Commitment to ‘Animal Testing as a Last Resort' Under REACH Requires a Paradigm Shift in How We Assess Chemical Safety to Close the Gap Between Regulatory Testing and Modern Safety Science
Authors: Fentem Julia , Malcomber Ian , Maxwell Gavin , Westmoreland Carl 
Published: August 2021

Animal use for testing chemicals under REACH continues to increase, despite advances in non-animal safety science during the past 15 years. The application of modern science and technology, and the use of ‘next generation’ weight-of-evidence assessment approaches, are embedded in EU guidance for establishing the safety of cosmetics and foods – and of the ingredients used in these products. However, this is still not the case for the regulation of chemicals. Under the new Chemicals Strategy for Sustainability, thought leaders in human health and environmental protection are calling on the European Commission to quickly embrace the benefits of modern and innovative non-animal safety science, in place of outdated animal testing, if the EU is to be a leader in safe and sustainable innovation under the European Green Deal transformational change ambitions. The European Commission also needs to enable companies to meet their legal obligation to only conduct animal testing as a last resort, by providing a more flexible, science-based and consistent regulatory framework for assuring chemical safety, which supports the integration of data from different sources. We are at a tipping point for closing the gap between regulatory chemicals testing and modern safety science. It is time to join forces, across policy makers, scientists, regulators and lawyers, to lead the paradigm shift needed to deliver what EU citizens want – namely, chemicals and products that are safe and sustainable, without resorting to animal testing.
Chest computed tomography and chest X-ray in the diagnosis of community-acquired pneumonia: a retrospective observational study
Authors: Ibrahim Dima , Bizri Abdul Rahman , El Amine Mohammad Ali , Halabi Zeina 
Published: August 2021

Objectives To compare the yield of early combined use of chest X-ray (CXR) and chest computed tomography (CT) in patients diagnosed with community-acquired pneumonia (CAP) presenting to the emergency department (ED) and assess the impact of chest CT on the initial diagnosis. Methods The medical records of 900 patients who presented to the ED and were diagnosed with CAP over a 1-year period were reviewed, and 130 patients who underwent CXR and chest CT within 48 hours were selected. CXR findings were classified as positive, negative, or inconclusive for CAP. Chest CT findings were defined as positive, negative, inconclusive, or positive with add-on to the CXR findings. CT was classified as having no benefit, large benefit, or moderate benefit based on the chest CT and CXR findings. Results Chest CT results were positive in 90.7% of patients, with 41.5% being newly diagnosed after negative or inconclusive CXR and 21.5% being diagnosed with add-on to the CXR findings. CT had large, moderate, and no benefit over CXR in diagnosing or excluding CAP in 45.3%, 21.5%, and 33.1% of patients, respectively. Conclusion Early chest CT may be used to compliment CXR in the early diagnosis of CAP among patients in the ED.
The role of nurses' professional values during the COVID-19 crisis
Authors: González-Pando David , González-Nuevo Covadonga , González-Menéndez Ana , Alonso-Pérez Fernando , Cuesta Marcelino 
Published: August 2021

Background: The COVID-19 pandemic has produced high stress in nurses, affecting their professional quality of life. Different variables affect psychological stress response and professional quality of life. In this context, the role of professional values represents an interesting object of research. Objectives: To analyze the relationship between professional values, perceived stress, and professional quality of life among nurses during the COVID-19 crisis. Research design, participants, and research context: Descriptive cross-sectional study. Participants were 439 registered nurses from the public health system. Perceived stress, professional quality of life, and professional values were evaluated by using measuring instruments adapted and validated in the geographic context of research. Data were collected online in December 2020 during the second wave of the COVID-19 pandemic in Spain. Ethical considerations: This study was approved by the Ethics Committee on Clinical Research of the Principality of Asturias. Findings: Within professional values, ethics obtained higher scores showing the primacy of ethical values among nurses. Moderate correlations between ethics, mastery, expertise, and compassion satisfaction were found. Frontline nurses informed high perceived stress. The correlations between professional values and compassion satisfaction were higher in non-frontline nurses. A moderate negative correlation between perceived stress and compassion satisfaction was found in both groups, which implies that the higher the stress, the lower the satisfaction in the helping relationship. Conclusion: Professional values positively influence compassion satisfaction during the COVID-19 pandemic. Compassion satisfaction presents a negative correlation with fatigue compassion and burnout in frontline and non-frontline nurses. Given the functionality of values both to guide clinical practice professionally and ethically, and prevent dissatisfaction with one’s professional quality of life by reinforcing compassion satisfaction, it is necessary to reinforce them with an intensive and cross-sectional learning during the university training.
Association of choroidal structure and body mass index in an adult population
Authors: Temel Emine , Aşikgarip Nazife , Örnek Kemal 
Published: August 2021

Purpose: To determine the relation of choroidal structural parameters and body mass index (BMI) in an adult population. Methods: About 144 eyes of 144 healthy individuals were incorporated. There were four groups according to BMI values: Group 1 (⩽18.5), group 2 (18.6–24.9), group 3 (25.0–29.9), and group 4 (30.0–34.9). The enhanced depth imaging optical coherence tomography images were binarized using Image-J software. Choroidal thickness (CT), circumscribed choroidal area (CCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were calculated. Results: Mean subfoveal, nasal, and temporal CT were lower in group 4 rather than group 1 ( p = 0.032, p = 0.001, and p < 0.001, respectively). Mean nasal and temporal CT also showed a decrease in group 4 as compared to group 2 ( p = 0.04 and p = 0.039). Mean CCA and LA were decreased in group 4 in comparison to group 3 ( p = 0.001 and p = 0.001), group 2 ( p < 0.001 and p < 0.001), and group 1 ( p = 0.001 and p < 0.001). Mean SA showed a decrease only in group 3 rather than group 2 ( p = 0.021) and group 1 ( p = 0.008). Mean CVI was decreased in group 3 and group 4 in comparison to group 1 ( p < 0.001 and p < 0.001) and group 2 ( p = 0.002 and p < 0.001). Conclusion: Increased BMI percentile was associated with a decrease in CT and structural parameters.
Non-Operative Management of Bronchobiliary Fistula Due to Proximal Migration of Biliary Stent in a Patient With Unresectable Klatskin Tumor
Authors: Tsema Ievgen , Slobodianyk Viktor , Rahushyn Dmytro , Myrhorodskiy Denys , Yurkiv Oleh , Dinets Andrii 
Published: August 2021

Introduction: One of the methods for the biliary tree decompression in the case of Klatskin tumor is transpapillary stenting, which could be completed by stent migration in 4% to 10% of cases. Approximately half of the stent migrations are in the proximal direction. In this study, we reported a rare case of proximal trans-diaphragmatic stent migration to the lower lobe of the right lung with the formation of a biliary-bronchial fistula (BBF). Case presentation: A 60-year-old woman was diagnosed with hilar cholangiocarcinoma (type 3B by Bismuth-Corlette) complicated by posthepatic jaundice. To relieve jaundice there were performed endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, endobiliary stent placement (10 Fr, 150 mm). A restenting (11.5 Fr, 130 mm) was performed in 2.5 months due to endobiliary tube occlusion. In the next 2 months, coughing attacks and biliptysis have appeared in the patient. A CT scan showed penetration of the liver, diaphragm, and lower lobe of the right lung with the proximal part of the stent and caused BBF formation. Anti-inflammatory and antibacterial therapy was administrated for 14 days and BBF was closed. Stent retrieval from the right hemithorax and endobiliary restenting was performed in 9 months after primary stenting. During follow-up, appropriate positioning and functioning of the stent were observed. Conclusion: BBF formation is a rare complication of endobiliary stenting, which can be successfully treated by anti-inflammatory and antibiotic therapy, followed by transpapillary stent retrieval.
The EU as multidisciplinary education podium: Fusing contextual and decisional policy analytics
Authors: Koutsoukis Nikitas-Spiros , Fakiolas Efstathios , Katsis Athanassios , Papadimitriou Pyrros 
Published: August 2021

The purpose of this article is to describe a multidisciplinary approach implemented in teaching public policy analysis at university level. The approach fuses (a) contextual policy analysis with (b) bivariate and multivariate analysis techniques and (c) data analytics skills to improve the learners’ competence to conduct “decisional” policy analysis. The teaching subject matter was based on European Union policies and Eurostat data and delivered over a period of 3 years in a semester course and summer school formats. The multidisciplinary fusion generated strong interest among learners and participants from various backgrounds and skill levels. At the end of the course, even those with little or no previous exposure in at least one of the teaching topics were able to quickly grasp the “big picture” and explore their newly acquired knowledge with their own analyses. As a whole, this is an educational design where the multidisciplinary fusion is instrumented in the scope of a single course, not as the combination of different courses in a curriculum. The outcome is a viable and contemporary way to sidestep the quantitative–qualitative analysis divide (where applicable) and help learners gain valuable insight into how seemingly different subjects eventually fuse into applicable knowledge. The multidisciplinary synergy that instigated the course design was mirrored in research effort by the authors leading to publishable work, suggesting that the approach can be adopted and adapted to foster or enhance multidisciplinary research efforts. Similar educational designs can be used in existing curricula to bridge seemingly “distant” subjects and improve the comprehension of how seemingly “distant” subjects relate to each other. As in the case described, in curricula where such subjects already exist, the “raw” expertise is already present and can be readily utilized.
Fibrous coalescence filtration in treating oily wastewater: A review
Authors: Singh Chandra Jeet , Mukhopadhyay Samrat , Rengasamy Raju Seenivasan 
Published: August 2021

Many industries discharge oil-in-water emulsion in the waste stream, often above the permissible limit causing serious environmental hazards. Porous media such as membrane and coalescence beds are employed to treat oily wastewater. A coalescence bed filter consists of either fibrous or granular packing and is used for removing larger oil droplets less than 100 μm from secondary emulsions. Fibrous media have higher porosities and specific surface areas than coarse granular media and hence give higher oil removal efficiency. To design an efficient fibrous coalescence bed filter for treating industrial discharge, understanding the mechanism of oil separation is important. This involves the surface wettability of fibers relating to surface chemistry and roughness. Further, fiber diameter, filter bed’s height, porosity, and pore size in relation to the oil droplet size and throughput and influent oil concentration are interactive parameters that affect the efficiency of coalescence. The performance of coalescence filtration is evaluated by analyzing the oil concentrations and D50 droplet sizes in the influent and effluent. In this article, the above-mentioned subjects are comprehensively reviewed from the reported research works, which highlights the complex nature of fibrous coalescence filtration.
Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis
Authors: Hajibandeh Shahin , Burton Hannah , Gleed Philippa , Hajibandeh Shahab , Wilmink Teun 
Published: August 2021

Background Controversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients. Methods We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5 years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival. Results We identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF ( n = 95,143) or AVG ( n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1 year (OR: 1.91, p < .00001), at 2 years (OR: 2.52, p < .00001) and at 5 years (OR: 2.59, p < .00001); and primary-assisted patency at 1 year (OR: 1.71, p < .00001), at 2 years (OR: 2.13, p < .00001) and 5 years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1 year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2 years (OR: 1.26, p < .00001) and 5 years (OR: 1.60, p < .00001) than AVG. Conclusions The meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5 years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.
First pass effect vs multiple passes complete reperfusion: A retrospective study
Authors: Hassan Ameer E , Dibas Mahmoud , Sarraj Amrou , Ghozy Sherief , El-Qushayri Amr Ehab , Dmytriw Adam A , Tekle Wondwossen G 
Published: August 2021

Background and purpose First pass effect (FPE) is defined as achieving modified treatment in cerebral infarction (mTICI) grade 2c/3 reperfusion from the first pass and is associated with more favorable outcomes. We aimed to compare FPE and non-FPE using a large database and further compare first-pass mTICI 2b with multiple passes mTICI 3. Methods A retrospective cohort study of acute ischemic stroke patients who received mechanical thrombectomy at a high-volume center was performed. Baseline characteristics and outcomes including rates of discharge and 90-day functional independence (modified Rankin Scale ≤2), mortality, symptomatic, and asymptomatic intracerebral hemorrhage were compared. Results Of the 637 patients included, 294 achieved FPE; 161 patients had multiple passes mTICI 3 and 36 had first pass mTICI 2b. Propensity-score matching resulted in 211 matched pairs for FPE vs non-FPE, and 30 matched pairs for multiple passes mTICI 3 vs first pass mTICI 2b. The FPE group had significantly more instances of discharge (33.6% vs 19.4%, p = 0.001) and 90-day functional independence (51.7% vs 40.8%, p = 0.032), and lower rates of mortality (18.0% vs 27.5%, p = 0.027) compared to non-FPE. There was no significant difference between first pass mTICI 2b and multiple passes mTICI 3 concerning any studied outcomes. Conclusions First pass mTICI 2c/3 is safer and is associated with higher rates of functional independence. We did not observe a significant difference between first pass mTICI 2b and multiple passes mTICI 3. The limitations of this study prevent us from drawing conclusions related to the difference between them and calls for future large-scale studies to explore that further.
Variants of the Circle of Willis as seen on magnetic resonance angiography and carotid siphon calcifications in community-dwelling older adults
Authors: Del Brutto Oscar H , Recalde Bettsy Y. , Mera Robertino M 
Published: August 2021

Background and purpose Information on the association between anatomical variants of the Circle of Willis (CoW) and intracranial atherosclerotic disease (ICAD) is limited and results are controversial. In this population-based study, we aimed to assess whether an incomplete CoW is associated with high calcium content in carotid siphons (a reliable biomarker of ICAD) in community-dwelling older adults of Amerindian ancestry. Methods Individuals aged ≥60 years enrolled in the Three Villages Study received a head computed tomography (CT) and magnetic resonance angiogram (MRA) of intracranial vessels. The CoW was classified in complete or incomplete according to the presence or absence of one A1 segment of the anterior cerebral artery or one or both P1 segments of posterior cerebral arteries. Calcium content in carotid siphons was rated as low or high. A multivariate logistic model was fitted to assess the independent association between incompleteness of the CoW and high calcium content in carotid siphons, after adjusting for demographics and cardiovascular risk factors. Results A total of 581 individuals were enrolled (mean age: 71 ± 8.4 years; 57% women). MRA revealed an incomplete CoW in 227 (39%) individuals, and high-resolution CT disclosed high calcium content in carotid siphons in 185 (32%). A risk factor logistic regression model showed no independent association between incompleteness of the CoW and high calcium content in carotid siphons (odds ratio: 0.91; 95% confidence interval: 0.62–1.34; p = 0.631). Conclusion Study results disclosed no association between anatomical variants of the CoW and the presence of high calcium content in carotid siphons.
Knowledge and attitudes of schoolteachers in the Pacific Islands to childhood hearing loss and hearing services: A national survey protocol for Samoa
Authors: Kaspar Annette , Pifeleti Sione , Driscoll Carlie 
Published: August 2021

Objectives: The Pacific Island region is estimated to have among the highest rates of childhood ear disease and hearing loss in the world. The adverse effects of childhood hearing loss include delayed speech/language development, learning difficulties, and reduced social-emotional well-being. Schoolteachers and early childhood educators are among the first professionals who may suspect hearing loss in their young students, and they are well-placed to initiate referrals to appropriate health services. Given the current efforts to implement Inclusive Education in the Pacific Islands, teachers are also uniquely positioned to positively influence, support, and advocate for a child with hearing loss in their classroom. There are no previous studies on this topic from the Pacific Island region. Methods: The study will use a national survey and convenience sampling design. Teachers attending the Annual Teachers Conference in Samoa will be invited to independently and anonymously completed a 23-item questionnaire on childhood hearing loss and hearing services. Questions are in English, with a Samoan translation provided. The participating teachers will be required to respond with “yes,” “no,” or “unsure,” and to mark their response on the questionnaire. The questions assess knowledge of biomedical etiology of hearing impairment, knowledge of the adverse impacts of hearing loss on childhood development, knowledge of hearing loss identification and intervention, and attitudes toward children with a hearing impairment. Results: Not applicable for a study protocol. Conclusion: We publish these protocols to facilitate similar studies in other low- and middle-income countries, and especially among our Pacific Island neighbors.