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Supplemental material, sj-docx-1-wso-10.1177_17474930221120349 for Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis by Emily L Ball, Mahnoor Shah, Eilidh Ross, Rachel Sutherland, Charlotte Squires, Gillian E Mead, Joanna M Wardlaw, Terence J Quinn, Dorota Religa, Erik Lundström, Joshua Cheyne and Susan D Shenkin in International Journal of Stroke

Supplemental material, sj-docx-1-wso-10.1177_17474930221120349 for Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis by Emily L Ball, Mahnoor Shah, Eilidh Ross, Rachel Sutherland, Charlotte Squires, Gillian E Mead, Joanna M Wardlaw, Terence J Quinn, Dorota Religa, Erik Lundström, Joshua Cheyne and Susan D Shenkin in International Journal of Stroke

Supplemental Material, sj-pdf-3-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal

Supplemental Material, sj-pdf-1-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal

Supplemental Material, sj-pdf-2-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal

Supplemental Material, sj-pdf-3-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal

Supplemental material, sj-pdf-1-wso-10.1177_17474930211045836 for Predicting post-stroke cognitive impairment using acute CT neuroimaging: A systematic review and meta-analysis by Emily L Ball, Rachel Sutherland, Charlotte Squires, Gillian E Mead, Dorota Religa, Erik Lundström, Joshua Cheyne, Joanna M Wardlaw, Terence J Quinn and Susan D Shenkin in International Journal of Stroke

Supplemental Material, sj-pdf-1-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal

Supplemental Material, sj-pdf-4-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal

Background \ud Medications licensed for the treatment of dementia have limited efficacy against cognitive impairment or against the distressed behaviours (behavioural and psychological symptoms, or behaviour that challenges) which are also often the most distressing aspect of the disorder for caregivers. Complementary therapies, including aromatherapy, are attractive to patients, practitioners and families, because they are perceived as being unlikely to cause adverse effects. Therefore there is interest in whether aromatherapy might offer a safe means of alleviating distressed behaviours in dementia. \ud Objectives \ud To assess the efficacy and safety of aromatherapy for people with dementia. \ud Search methods \ud We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, on 5 May 2020 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils. In addition, we searched MEDLINE, Embase, PsycINFO (all via Ovid SP), Web of Science Core Collection (via Thompson Web of Science), LILACS (via BIREME), CENTRAL (via the Cochrane Library), ClinicalTrials.gov and the World Health Organization (WHO) trials portal (ICTRP) on 5 May 2020. \ud Selection criteria \ud We included randomised controlled trials which compared fragrance from plants in an intervention defined as aromatherapy for people with dementia with placebo aromatherapy or with treatment as usual. All doses, frequencies and fragrances of aromatherapy were considered. Participants in the included studies had a diagnosis of dementia of any subtype and severity. \ud Data collection and analysis \ud Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias in included studies, involving other authors to reach consensus decisions where necessary. We did not perform any meta-analyses because of heterogeneity between studies, but presented a narrative synthesis of results from the included trials. Because of the heterogeneity of analysis methods and inadequate or absent reporting of data from some trials, we used statistical significance (P ≤ or > 0.5) as a summary metric when synthesising results across studies. As far as possible, we used GRADE methods to assess our confidence in the results of the trials, downgrading for risk of bias and imprecision.\ud Aromatherapy for dementia (Review) Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.\ud 1\ud Cochrane Library\ud Trusted evidence. Informed decisions. Better health.\ud Cochrane Database of Systematic Reviews\ud Main results \ud We included 13 studies with 708 participants. All participants had dementia and in the 12 trials which described the setting, all were resident in institutional care facilities. Nine trials recruited participants because they had significant agitation or other behavioural and psychological symptoms in dementia (BPSD) at baseline. The fragrances used were lavender (eight studies); lemon balm (four studies); lavender and lemon balm, lavender and orange, and cedar extracts (one study each). For six trials, assessment of risk of bias and extraction of results was hampered by poor reporting. Four of the other seven trials were at low risk of bias in all domains, but all were small (range 18 to 186 participants; median 66), reducing our confidence in the results. Our primary outcomes were agitation, overall behavioural and psychological symptoms, and adverse effects. Ten trials assessed agitation using various scales. Among the five trials for which our confidence in the results was moderate or low, four trials reported no significant effect on agitation and one trial reported a significant benefit of aromatherapy. The other five trials either reported no useable data or our confidence in the results was very low. Eight trials assessed overall BPSD using the Neuropsychiatric Inventory and we had moderate or low confidence in the results of five of them. Of these, four reported significant benefit from aromatherapy and one reported no significant effect. Adverse events were poorly reported or not reported at all in most trials. No more than two trials assessed each of our secondary outcomes of quality of life, mood, sleep, activities of daily living, caregiver burden. We did not find evidence of benefit on these outcomes. Three trials assessed cognition: one did not report any data and the other two trials reported no significant effect of aromatherapy on cognition. Our confidence in the results of these studies was low. \ud Authors' conclusions \ud We have not found any convincing evidence that aromatherapy (or exposure to fragrant plant oils) is beneficial for people with dementia although there are many limitations to the data. Conduct or reporting problems in half of the included studies meant that they could not contribute to the conclusions. Results from the other studies were inconsistent. Harms were very poorly reported in the included studies. In order for clear conclusions to be drawn, better design and reporting and consistency of outcome measurement in future trials would be needed.

Background: Italy's 2015 emergency contraception (EC) policy has increased access and reduced some barriers for women to obtain EC. EC is now available over-the-counter for individuals 18 years and older; however, women living in Italy continue to face knowledge and access barriers. Conscientious objection, where providers and pharmacists refuse to prescribe or dispense EC due to personal beliefs, further complicates access and dissemination. Objective: The purpose of the current paper is to understand EC knowledge, attitudes, and behaviors among women living in Italy. Additionally, a secondary purpose is to explore the impact of the 2015 EC policy. Methods: Thirty in-person interviews were conducted among women living in or around Florence, aged 18 to 50 years, and using the Italian healthcare system at the time of study enrollment. Researchers used an expanded grounded theory approach to understand women's experiences with EC with diffusion of innovations serving as a conceptual lens for data analysis. HyperRESEARCH, a data management system, assisted with open and axial coding and theme development. Results: Women described low observability of the 2015 policy, expressing surprise regarding increased EC availability. Participants suggested increased messaging in strategic locations to overcome this barrier. Participants held both positive and negative attitudes toward EC. While some perceived the relative advantage of EC compared with unintended pregnancy, others expressed concerns about irresponsibility and EC safety. Finally, conscientious objection impacted healthcare access, despite participant desire for autonomous EC decision-making, suggesting support for increased EC access despite provider barriers. Discussion: Findings offer practical recommendations to guide EC messaging in Italy to increase women's knowledge and to empower women’s access. Additionally, opportunities for communication strategies and access campaigns to improve attitudes and increase knowledge and uptake of over-the-counter EC are discussed.

Semantic cognition is supported by two interactive components: semantic representations and mechanisms that regulate retrieval (cf. ‘semantic control’). Neuropsychological studies have revealed a clear dissociation between semantic and episodic memory. This study explores if the same dissociation holds for control processes that act on episodic and semantic memory, or whether both types of long-term memory are supported by the same executive mechanisms. We addressed this question in a case-series of semantic aphasic patients who had difficulty retrieving both verbal and non-verbal conceptual information in an appropriate fashion following infarcts to left inferior frontal gyrus (LIFG). We observed parallel deficits in semantic and episodic memory: (i) the patients’ difficulties extended beyond verbal materials to include picture tasks in both domains; (ii) both types of retrieval benefitted from cues designed to reduce the need for internal constraint; (iii) there was little impairment of both semantic and episodic tasks when control demands were minimised; (iv) there were similar effects of distractors across tasks. Episodic retrieval was highly susceptible to false memories elicited by semantically-related distractors, and confidence was inappropriately high in these circumstances. Semantic judgements were also prone to contamination from recent events. These findings demonstrate that patients with deregulated semantic cognition have comparable deficits in episodic retrieval. The results are consistent with a role for LIFG in resolving competition within both episodic and semantic memory, and also in biasing cognition towards task-relevant memory stores when episodic and semantic representations do not promote the same response.

A more inclusive labour market would offer more people across Greater Manchester the chance to take part in rewarding, well-paid work, bringing both economic and social benefits. In the context of declining union membership, limited employment regulation and a growing disconnect between pay and living costs, employment charters are one means for cities to engage employers and start a conversation about how their employment practices can enable local people to live and work well. This paper grew out of a wider conversation about ways to facilitate more inclusive growth in cities, and discussions at the Greater Manchester Fair Growth conference in November 2016. It reviews the rationale, design and impact of several local employment charter initiatives in the UK to assess the role that they can play in creating and sustaining quality jobs. The paper draws on interviews withpeople involved in the design and implementation of these schemes as well as desk research. A more detailed case study paper is available alongside this paper.

In the context of declining union membership, limited employment regulation and a growing disconnect between pay and living costs, employment charters are one means for cities to engage employers and start a conversation about how their employment practices can enable local people to live and work well. This paper contains a series of case studies of local employment charter initiatives from across the UK. It describes the rationale, design and reach of these initiatives, drawing on desk research and interviews with people involved in their design and implementation. The paper accompanies the summary briefing paper ‘Good Jobs in Greater Manchester: the role of employment charters'.

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, 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. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, 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. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research. ispartof: European Stroke Journal vol:6 issue:3 pages:1-177 ispartof: location:England status: Published online