bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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

AbstractBackgroundThe 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.MethodsMulticenter 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.ResultsFour 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).ConclusionsThis 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 registrationRegistered 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

AbstractBackgroundIndustrial 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.MethodsCrude 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.ResultsThe 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.ConclusionsTherefore, 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

AbstractBackgroundExercise, 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).MethodsA 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.ResultsAfter 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).ConclusionsPeople 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

Abstract
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

AbstractObjectivesThe 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.MethodsThe 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.ResultsThe 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.ConclusionOur 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

AbstractBackgroundThe 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.MethodsLeg-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.ResultsAnalysis 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.ConclusionsFor 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

Abstract
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

AimsThe 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.MethodThirteen 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.ResultThere 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.ConclusionThe 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

AimsMental 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.MethodMedical 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.ResultOf 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.ConclusionThere 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

AimsRecruitment 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?BackgroundThe 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.MethodQuestionnaires 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.Result93/148 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.ConclusionThis 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.