bluuebunny/crossref_metadata_2025 huggingface dataset:
Human papillomavirus and Epstein‐Barr virus co‐infection in oral and oropharyngeal squamous cell carcinomas: A systematic review and meta‐analysis
Authors: Rahman Rifat , Shaikh Mushfiq H. , Gopinath Divya , Idris Adi , Johnson Newell W.
Published: April 2023

Squamous cell carcinoma of the oral cavity (OSCC) is the most common head‐and‐neck malignancy. Importantly, we are experiencing an alarming rise in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) globally. Oncogenic viruses, human papillomavirus (HPV) and Epstein‐Barr virus (EBV), are known to be co‐associated with OSCC and OPSCC cases. However, the reported incidence of HPV and EBV co‐infection in OSCCs and OPSCCs globally is unknown. To address this, we performed a formal meta‐analysis and systematic review on published studies that report the detection of both EBV and HPV in OSCCs and OPSCCs. Our analysis revealed 18 relevant studies out of a total of 1820 cases (1181 from the oral cavity and 639 from the oropharynx). Overall, HPV and EBV co‐infection was found in 11.9% of OSCC and OPSCC cases combined (95% CI: 8%–14.1%). Based on anatomical subsite, dual positivity estimates were 10.5% (95% CI: 6.7%–15.1%) for OSCC and 14.2% (95% CI: 9.1%–21.3%) for OPSCC. The highest dual positivity rates described were in European countries: for OSCC 34.7% (95% CI: 25.9%–44.6%) in Sweden and for OPSCC, 23.4% (95% CI: 16.9%–31.5%) in Poland. Given these substantive prevalence rates, the value of detecting dual infection in the diagnosis and prognosis of these cancers deserves careful longitudinal studies, as do implications for cancer prevention and therapy. We further proposed molecular mechanisms that could explain how HPV and EBV could co‐contribute to the aetiology of OSCCs and OPSCCs.
Lost expression of AT‐rich interaction domain 1A in the gastric mucosa—A constituent of field cancerization in the stomach
Authors: Abe Hiroyuki , Rokutan Hirofumi , Totoki Yasushi , Nakamura Hiromi , Shibata Tatsuhiro , Ushiku Tetsuo , Fukayama Masashi
Published: April 2023

Abnormalities of the AT‐rich interaction domain 1A (ARID1A) occur in cancer tissues and precursors or premalignant lesions in various organs. To investigate the significance of ARID1A abnormalities in the early phase of cancer development in the stomach, we screened for ARID1A loss and p53 overexpression in glands in non‐neoplastic gastric mucosa using immunohistochemistry. We tested 230 tissue blocks of 77 patients with gastric carcinoma, and in 10% of non‐neoplastic mucosa we detected ARID1A‐lost and in 3.7% p53‐overexpressed foci. Loss of ARID1A expression occurred in the scales of several glands, which were morphologically characterized as authentic, pseudo‐pyloric, or intestinal metaplastic glands devoid of dysplastic changes. In contrast, p53‐overexpressed foci were detected in dysplastic intestinal metaplasia. In early gastric cancer cases (n = 46), ARID1A‐lost foci were frequent in samples of patients with Epstein–Barr virus‐associated gastric carcinoma (p = 0.037). Ultra‐deep DNA sequencing of ARID1A‐lost foci revealed frameshift and nonsense mutations in ARID1A. Mapping abnormal glands in the entire resected stomach of the three selected patients demonstrated that ARID1A‐lost foci clustered with p53 abnormal glands. ARID1A‐lost epithelial cells may develop clonal growth through the pathway, different from p53‐abnormal intestinal metaplasia, and require one or more events to develop into an overt carcinoma, such as EBV infection.
“Modest doubt is called the beacon of the wise”—Incorporating uncertainty in risk analysis from Shakespeare to today
Authors: Wu Felicia , Trump Benjamin D.
Published: April 2023

“Modest doubt is call'd the beacon of the wise.”—William Shakespeare, Troilus and Cressida. Although the character Hector warns his fellow Trojans with this line not to engage in war against the Greeks, Shakespeare's works are replete with characters who do not incorporate modest doubt, or any consideration of uncertainty, in their risk decisions. Perhaps Shakespeare was simply a keen observer of human nature. Although risk science has developed tremendously over the last five decades (and scientific inquiry over five centuries), the human mind still frequently defaults to conviction about certain beliefs, absent sufficient scientific evidence—which has effects not just on individual lives, but on policy decisions that affect many. This perspective provides background on the Shakespearean quote in its literary and historical context. Then, as this quote is the theme of the 2023 Society for Risk Analysis Annual Meeting, we describe how “modest doubt”—incorporating the notion of uncertainty into risk analysis for individual and policy decisions—is still the “beacon of the wise” today.
Rainfall‐induced ground deformation in southern Africa
Authors: Dauteuil Olivier , Jolivet Marc , Gaudaré Louis , Pastier Anne‐Morwenn
Published: April 2023

We present an analysis of ground deformation induced by large‐scale seasonal rainfall in Southern Africa, based on GPS and GRACE time series and on simulations of elastic flexural response to hydrological loading. This large‐scale study including South Zambia, South Angola, North Namibia and North Botswana displays a latitudinal precipitation gradient between tropical to semi‐arid conditions. GRACE data display annual variations in water mass decreasing drastically southwards. GPS time series of three permanent stations located in Zambia, Namibia and Botswana show seasonal synchronous vertical displacements with amplitude decreasing southwards from 4 to 2 cm, with a shift of 2–3 months from the main rainfall season. Flexure simulations integrating rainfall, evapotranspiration, water storage, flood migration and river output produce a ground flexure up to 6 cm with timing in agreement with the GPS time series. It highlights the hydrological buffering of surface aquifer located in the Kalahari sands.
Changes of an endangered population of Iris dichotoma after conservation translocation in Taeanhaean National Park, Korea
Authors: ROH Dakyum , GANG Geun-Hye , CHOI Dae Hun , KIM Byung Bu , JUNG Hyun-Jin , SHIN Dae Seob , RYU Hyeon Seon , CHOI Chang Ho , KANG Heehyeok , SON Yowhan , SO Soonku
Published: April 2023

Sustainable habitats play a significant role in determining the survival and habitat preservation of endangered species. To conserve the endangered species Iris dichotoma Pall. and its habitat in Taeanhaean National Park, we collected seeds from a natural population and germinated and propagated them in a greenhouse. In 2019, the propagated individuals of I. dichotoma were transplanted at two study sites in Taeanhaean National Park. After conservation translocation, annual monitoring was conducted from 2020 to 2022, and factors related to the survival and growth of I. dichotoma (clonal propagation rate [%], the flowering rate [%], the population density [individual/m2], the maximum leaf bundle length [height; cm], the maximum leaf bundle width [cm], and the pedicel length [cm]) were measured. According to the results of the monitoring of the flowering and fruiting periods for three years after transplantation, 82.4% of individuals in total were found to have survived. During 2020 to 2022, the mean population density (individual/m2) increased from 0.36 to 0.42 and the size of the leaf bundle length and the width both decreased compared to the corresponding figures in 2019 (p < 0.05). According to the findings here, the transplanted population of I. dichotoma is considered to have adapted successfully to its new site in Taeanhaean National Park.
The complete chloroplast genome of Erigeron canadensis isolated in Korea (Asteraceae): Insight into the genetic diversity of the invasive species
Authors: OH Sang-Hun , PARK Jongsun
Published: April 2023

We have determined the complete chloroplast genome of Erigeron canadensis isolated in Korea. The circular chloroplast genome of E. canadensis is 152,767 bp long and has four subregions: 84,317 bp of large single-copy and 18,446 bp of small single-copy regions are separated by 25,004 bp of inverted repeat regions including 133 genes (88 protein-coding genes, eight rRNAs, and 37 tRNAs). The chloroplast genome isolated in Korea differs from the Chinese isolate by 103 single-nucleotide polymorphisms (SNPs) and 47 insertions and deletion (INDEL) regions, suggesting different invasion sources of E. canadensis in Korea and China. A nucleotide diversity analysis revealed that the trend of the nucleotide diversity of E. canadensis followed that of 11 Erigeron chloroplasts, except for three peaks. The phylogenetic tree showed that our E. canadensis chloroplast is clustered with E. canadensis reported from China. Erigeron canadensis can be a good target when attempting to understand genetic diversity of invasive species.
New records and distribution of three taxa in Korea: Leuzea chinensis (Asteraceae), Symplocos nakaharae (Symplocaceae), and Epilobium parviflorum (Onagraceae)
Authors: HYUN Jin-Oh , JUNG Jongduk , NA Hye Ryun , HAN Byungwoo , KANG Kyoungsuk , LEE Man Kyu , CHOI Yeongmin , CHO Woongrae
Published: April 2023

Leuzea chinensis (S. Moore) Susanna (Asteraceae), a previously unrecorded species in Korea, was found in Yeongdeok-gun, Gyeongsangbuk-do. Symplocos nakaharae (Hayata) Masam. (Symplocaceae), which had been recorded in the literature but whose native habitat was yet to be identified, was found in Geojedo Island, Gyeongsangnam-do. It was confirmed that Epilobium parviflorum Schreb. (Onagraceae) grew naturally on the islands of Jeollanam-do. Detailed morphological descriptions and geographical distribution of the three taxa are provided.
Heterostyly and pollen dimorphism of Menyanthes trifoliata
Authors: KIM Hye-Rin , HEO Kweon
Published: April 2023

Menyanthes trifoliata L., a heterostyly plant, is an endangered species in Korea. Floral morphology has been published for M. trifoliata, but few works have concentrated on pollen dimorphism differences accompanied by floral dimorphism. Here, we conducted a comparative morphological study of two morphs to investigate a dimorphism system with Korean populations. Pollen morphological characteristics were observed with a light microscope and a scanning electron microscope. For the pin type, pollen size is 36.01 ± 2.01 µm, whereas for the thrum type it is 41.28 ± 2.58 µm in terms of the equatorial diameter. The two morphs have a small apocolpium field at 5.62 ± 0.30 for the pin type and 6.24 ± 0.70 for the thrum type. The configuration of the aperture was tricolpate with a striate ridge in the two morphs. However, they have different pollen shapes and sizes, stigma shapes, and apocolpium sizes. M. trifoliata only has different pollen sizes and shapes between European populations and Korean populations. Nevertheless, Korean populations also show pollen dimorphism correlated with their floral dimorphism.
Design Model for Team-Based Projects Based on Digital Litigation in Learning Speaking
Authors: Cahyani Isah , Wahyuni Sri , Solissa Everhard Markiano , Santi Ai , Yuniarsih Yuniarsih , Munirah Munirah , Sujono Hartin Rizky , Saputra Nanda
Published: April 2023

The Team Based Project learning style aims to mold students' conceptual and procedural knowledge together with their mindset. Through the use of this paradigm, learning activities involve people actively debating and working together to solve issues. To create a learning model that can enhance students' understanding and proficiency in speaking, the team-based project learning model was created. The goal of this research was to develop a set of syntax for the Team Based Project learning model, which was implemented in spoken learning courses in the Indonesian Language and Literature Education Study Program, FPBS UPI. This model is based on digital literacy. Research and development using the Dick and Carey model is the methodology employed. Ten stages were involved in the research process. The research process for the development of the Dick and Carey pattern are (1) identifying the need to formulate goals, (2) analyzing the subject matter, (3) analyzing the learner and the context of using the learning model, (4) describing ability goals, (5) developing assessment instruments, (6) developing learning models, (7) developing and selecting teaching materials, (8) compiling and conducting formative evaluations, (9) revising learning programs, and (10) compiling and conducting summative evaluations. Based on the research results, learning to speak using the Team Based Learning model based on digital literacy is declared effective. Students have a positive response to learning and students actively interact, discuss, ask questions, and work together in solving problems.
Effects of uphill and downhill walking on post‐traumatic osteoarthritis development in mice
Authors: Li Changxin , Inoue Shota , Hatakeyama Junpei , Jiang Hanlin , Takamura Daisuke , Shirado Osamu , Moriyama Hideki
Published: April 2023

Using destabilization of the medial meniscus (DMM) to induce models of osteoarthritis (OA), we sought to clarify how flat, uphill and downhill walking affects OA‐related inflammation and articular cartilage degeneration. Thirty‐two male C57BL/6J mice 7 weeks old underwent DMM surgery in their right knee and sham surgery in their left knee, and were then assigned to either the no walking after DMM group or the flat, uphill or downhill walking after DMM group (n = 8/group). After creating the knee OA model, the mice in the walking groups were subjected to treadmill walking 1 day after surgery, which included walking at 12 m/min for 30 min/day, 7 days/week, at inclines of 0, 20, or −20 degrees. Knee joints were harvested at the end of the intervention period. Non‐demineralized frozen sections were prepared and samples were examined histologically. Osteoarthritis Research Society International scores were significantly decreased in both the uphill and flat‐walking groups, compared with the no‐walking group. Immunohistochemical staining showed increased levels of aggrecan and Sry‐related high‐mobility group box9; conversely, decreased levels of matrix metalloproteinase‐13 and A disintegrin and metalloproteinase with thrombospondin motifs‐5 in both the uphill and flat‐walking groups. Micro‐CT results showed a higher bone‐volume fraction in the uphill and flat‐walking groups than that in the no‐walking group. Our findings indicate that flat and uphill walking may prevent the progression of OA.

image

Key points

Flat and uphill treadmill walking can prevent the development of post‐traumatic osteoarthritis in mice.

Flat and uphill walking increases anabolic proteins and decreases catabolic proteins and inflammatory cytokines in articular cartilage, resulting in protection against cartilage degeneration.

Downhill walking increases catabolic proteins and inflammatory cytokines in cartilage, which has negative effects on articular cartilage.
Migration mediated by the oxysterol receptor GPR183 depends on arrestin coupling but not receptor internalization
Authors: Kjær Viktoria M. S. , Daugvilaite Viktorija , Stepniewski Tomasz M. , Madsen Christian M. , Jørgensen Astrid S. , Bhuskute Kaustubh R. , Inoue Asuka , Ulven Trond , Benned-Jensen Tau , Hjorth Siv A. , Hjortø Gertrud M. , Moo Ee Von , Selent Jana , Rosenkilde Mette M.
Published: April 2023

The chemotactic G protein–coupled receptor GPR183 and its most potent endogenous oxysterol ligand 7α,25-dihydroxycholesterol (7α,25-OHC) are important for immune cell positioning in secondary lymphoid tissues. This receptor-ligand pair is associated with various diseases, in some cases contributing favorably and in other cases adversely, making GPR183 an attractive target for therapeutic intervention. We investigated the mechanisms underlying GPR183 internalization and the role of internalization in the main biological function of the receptor, chemotaxis. We found that the C terminus of the receptor was important for ligand-induced internalization but less so for constitutive (ligand-independent) internalization. β-arrestin potentiated ligand-induced internalization but was not required for ligand-induced or constitutive internalization. Caveolin and dynamin were the main mediators of both constitutive and ligand-induced receptor internalization in a mechanism independent of G protein activation. Clathrin-mediated endocytosis also contributed to constitutive GPR183 internalization in a β-arrestin–independent manner, suggesting the existence of different pools of surface-localized GPR183. Chemotaxis mediated by GPR183 depended on receptor desensitization by β-arrestins but could be uncoupled from internalization, highlighting an important biological role for the recruitment of β-arrestin to GPR183. The role of distinct pathways in internalization and chemotaxis may aid in the development of GPR183-targeting drugs for specific disease contexts.
RNF123 Mediates Ubiquitination and Degradation of SOCS1 To Regulate Type I Interferon Production during Duck Tembusu Virus Infection
Authors: Huang Shanzhi , Cui Min , Huang Juan , Wu Ziyu , Cheng Anchun , Wang Mingshu , Zhu Dekang , Chen Shun , Liu Mafeng , Zhao Xinxin , Wu Ying , Yang Qiao , Zhang Shaqiu , Ou Xumin , Mao Sai , Gao Qun , Tian Bin , Sun Di , Yin Zhongqiong , Jing Bo , Jia Renyong
Published: April 2023

In recent years, posttranslational modification (PTM) has gradually become a research hot spot in the field of innate immunity regulation, and ubiquitination is one of the critical PTMs. DTMUV has seriously endangered the development of the waterfowl industry in Southeast Asian countries since its outbreak in 2009.
A New Phenotype in
Candida
-Epithelial Cell Interaction Distinguishes Colonization- versus Vulvovaginal Candidiasis-Associated Strains
Authors: Sala Arianna , Ardizzoni Andrea , Spaggiari Luca , Vaidya Nikhil , van der Schaaf Jane , Rizzato Cosmeri , Cermelli Claudio , Mogavero Selene , Krüger Thomas , Himmel Maximilian , Kniemeyer Olaf , Brakhage Axel A. , King Benjamin L. , Lupetti Antonella , Comar Manola , de Seta Francesco , Tavanti Arianna , Blasi Elisabetta , Wheeler Robert T. , Pericolini Eva
Published: April 2023

Despite a high incidence of VVC, we still have a poor understanding of this female-specific disease whose negative impact on women’s quality of life has become a public health issue. It is not yet possible to determine by genotype or laboratory phenotype if a given
Candida albicans
strain is more or less likely to cause VVC.
Associations of the built environment with type 2 diabetes in Asia: a systematic review
Authors: Aarthi Garudam Raveendiran , Mehreen Begum Thaharullah Shah , Moosawi Suzana Al , Kusuma Dian , Ranjani Harish , Paradeepa Rajendra , Padma Venkatasubramanian , Mohan Viswanathan , Anjana Ranjit Mohan , Fecht Daniela
Published: April 2023

Objectives

Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia.

Design

Systematic review of the literature.

Data sources

Online databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023.

Eligibility criteria

Eligible studies included cohort, cross-sectional and case–control studies that explored associations of built environment characteristics with T2D among adults 18 years and older in Asia.

Data extraction and synthesis

Covidence online was used to remove duplicates and perform title, abstract and full-text screening. Data extraction was carried out by two independent reviewers using the OVID database and data were imported into MS Excel. Out of 5208 identified studies, 28 studies were included in this systematic review. Due to heterogeneity in study design, built environment and outcome definitions, a semiqualitative analysis was conducted, which synthesised results using weighted z-scores.

Results

Five broad categories of built environment characteristics were associated with T2D in Asia. These included urban green space, walkability, food environment, availability and accessibility of services such as recreational and healthcare facilities and air pollution. We found very strong evidence of a positive association of particulate matter (PM2.5, PM10), nitrogen dioxide and sulfur dioxide (p<0.001) with T2D risk.

Conclusion

Several built environment attributes were significantly related to T2D in Asia. When compared with Western countries, very few studies have been conducted in Asia. Further research is, therefore, warranted to establish the importance of the built environment on T2D. Such evidence is essential for public health and planning policies to (re)design neighbourhoods and help improve public health across Asian countries.

PROSPERO registration number

CRD42020214852.
Health inequalities in infectious diseases: a systematic overview of reviews
Authors: Ayorinde Abimbola , Ghosh Iman , Ali Ifra , Zahair Iram , Olarewaju Olajumoke , Singh Megha , Meehan Edward , Anjorin Seun Stephen , Rotheram Suzanne , Barr Ben , McCarthy Noel , Oyebode Oyinlola
Published: April 2023

Objectives

The aim of this systematic overview of reviews was to synthesise available evidence on inequalities in infectious disease based on three dimensions of inequalities; inclusion health groups, protected characteristics and socioeconomic inequalities.

Methods

We searched MEDLINE, Embase, Web of Science and OpenGrey databases in November 2021. We included reviews published from the year 2000 which examined inequalities in the incidence, prevalence or consequences of infectious diseases based on the dimensions of interest. Our search focused on tuberculosis, HIV, sexually transmitted infections, hepatitis C, vaccination and antimicrobial resistance. However, we also included eligible reviews of any other infectious diseases. We appraised the quality of reviews using the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) checklist. We conducted a narrative data synthesis.

Results

We included 108 reviews in our synthesis covering all the dimensions of inequalities for most of the infectious disease topics of interest, however the quality and volume of review evidence and consistency of their findings varied. The existing literature reviews provide strong evidence that people in inclusion health groups and lower socioeconomic status are consistently at higher risk of infectious diseases, antimicrobial resistance and incomplete/delayed vaccination. In the protected characteristics dimension, ethnicity, and sexual orientation are important factors contributing to inequalities across the various infectious disease topics included in this overview of reviews.

Conclusion

We identified many reviews that provide evidence of various types of health inequalities in different infectious diseases, vaccination, and antimicrobial resistance. We also highlight areas where reviews may be lacking. The commonalities in the associations and their directions suggest it might be worth targeting interventions for some high risk-groups that may have benefits across multiple infectious disease outcomes rather than operating purely in infectious disease siloes.
Perceptions of COVID-19 risk, vaccine access and confidence: a qualitative description of South Asians in Canada
Authors: Kandasamy Sujane , Manoharan Baanu , Khan Zainab , Stennett Rosain , Desai Dipika , Nocos Rochelle , Wahi Gita , Banner Davina , de Souza Russell J , Lear Scott A , Anand Sonia S
Published: April 2023

Objectives

In the first full year of the COVID-19 pandemic (2020), South Asians living in the Greater Toronto and Hamilton Area (GTHA) and Greater Vancouver area (GVA) experienced specific barriers to accessing SARS-CoV-2 testing and reliable health information. However, between June 2021 and February 2022, the proportion of people having received at least one COVID-19 vaccine dose was higher among this group (96%) than among individuals who were not visible minorities (93%). A better understanding of successful approaches and the challenges experienced by those who remain unvaccinated among this highly vaccinated group may improve public health outreach in subsequent waves of the current pandemic or for future pandemic planning. Using qualitative methods, we sought to explore the perceptions of COVID-19 risk, vaccine access, uptake and confidence among South Asians living in Canada.

Design

Semistructured interviews conducted with 25 participants analysed using thematic analysis. Throughout this process, we held frequent discussions with members of the study’s advisory group to guide data collection (community engagement, recruitment and data analysis).

Setting

Communities of the GTHA and GVA with interviews conducted virtually over Zoom or telephone.

Participants

25 participants (15 from Ontario and 10 from British Columbia) were interviewed between July 2021 and January 2022. 10 individuals were community members, 9 were advocacy group leaders and 6 were public health staff.

Results

Access to and confidence in the COVID-19 vaccine was impacted by individual risk perceptions; sources of trusted information (ethnic and non-ethnic); impact of COVID-19 and the pandemic on individuals, families and society; and experiences with COVID-19 mandates and policies (including temporal and generational differences). Approaches that include community-level awareness and tailored outreach (language and cultural context) were considered successful.

Conclusions

Understanding factors and developing strategies that build vaccine confidence and improve access can guide approaches that increase vaccine acceptance in the current and future pandemics.

Visual abstract can be found athttps://drive.google.com/file/d/1iXdnJj9ssc3hXCllZxP0QA9DhHH-7uwB/view
Sustainable dietary weight loss intervention and its effects on cardiometabolic parameters and greenhouse gas emissions: study protocol of a randomised controlled trial with overweight and obese adults in Ouagadougou, Burkina Faso
Authors: Herrmann Alina , Gonnet Anais , Millogo Roche Modeste , d'Arc Kabré Wendmintiri Jeanne , Beremwidougou Tenin Rosine , Coulibaly Issa , Ouili Idrissa , Zoromé Souleymane , Weil Konstantin , Fuelbert Hannah , Soura Abdramane , Danquah Ina
Published: April 2023

Introduction

The global obesity epidemic and its adverse health effects have reached sub-Saharan Africa. In some urban settings, like Burkina Faso’s capital Ouagadougou, up to 43% of the adult population are overweight or obese. At the same time, modernised food systems are responsible for 26% of global greenhouse gas emissions, 50% of land use and 70% of freshwater use. International guidelines on the treatment of overweight and obesity recommend dietary intervention programmes that promote reduced calorie intake and increased physical activity. So far, weight loss interventions rarely consider sustainable dietary concepts, including healthfulness, affordability, cultural appropriateness and environmental friendliness. Therefore, we present a study protocol of a novel randomised controlled trial that aims to establish the effects of a sustainable weight loss intervention on cardiometabolic and environmental outcomes in urban Burkina Faso.

Methods and analysis

We conduct a non-blinded randomised controlled trial, comparing a 6-month sustainable diet weight loss intervention programme (n=125) with a standard weight loss information material and 5 min oral counselling at baseline (n=125). Primary outcome is a reduction in fasting plasma glucose of ≥0.1 mmol/L. Outcome measures are assessed at baseline, after 6 months and after 12 months.

Ethics and dissemination

Ethical approval for the study has been obtained from the Medical Faculty of Heidelberg University (S-376/2019) and from the Ministry of Health and the Ministry of Higher Education, Scientific Research and Innovation in Ouagadougou, Burkina Faso (No 2021-01-001). The results of the study will be disseminated to local stakeholders at a final project meeting and to the wider research community through peer-reviewed publications and conferences.

Trial registration number

DRKS00025991.
Abstracts from international Emergency Medicine journals
Authors: Weber Ellen J
Published: April 2023

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicinesocieties to share from each a highlighted research study, as selected by their editors. This editionwill feature an abstract from each publication.
017 Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients
Authors: Prosser Callum , Edwards David , Lecky Fiona , Bouamra Omar
Published: April 2023

Background

The recent introduction of major trauma networks throughout England in 2012 has changed how patients with suspected traumatic brain injury (TBI) are managed at the scene of injury. Selecting certain head trauma patients with suspected TBI for bypass to a more distant specialist neurological centre (SNC) is the networks function but may delay resuscitation whilst expediting neurosurgical/critical care. This comparative effectiveness research study analysed the impact of this strategy on the risk adjusted survival rates of patients confirmed to have a TBI on brain CT scan.

Method and results

The study employed data from the Trauma Audit and Research Network. Adult patients with a TBI on CT scan were included if they presented between June 2015 to February 2016 to SNCs or non-specialist acute hospitals (NSAH) in the North of England (South Cumbria, Lancashire and the North East Region). Patients were identified as having bypassed a nearer NSAH emergency department (ED) to a SNC using google maps enabling exclusion of patients whose nearest ED was within a SNC. Their risk adjusted survival was compared to TBI patients who received primary treatment at a NSAH with subsequent secondary transfer to a SNC or who remained at the NSAH until discharge or death. A multivariate logistic regression model predicting survival after TBI (Ps14n) was utilised to adjust for variation in casemix between the cohorts.

Conclusions

84 of 339 (25%) of TBI patients bypassed a nearer NSAH to a SNC, whilst 75% received primary treatment at an NSAH (n=255). There was no significant difference in the standardised excess survival rate between the two cohorts; shown as +2.55% for bypass (−5.09% to +10.20%) versus −1.49% for non-bypass (−5.34% to +2.36%).

No significant survival benefit was identified for TBI patients who bypassed the nearest ED compared to those receiving treatment at the nearest NSAH.
002 Current fluid resuscitation practice in a tertiary paediatric emergency department in infants with a working diagnosis of sepsis: a retrospective study
Authors: Ryan Elizabeth , Cantle Fleur
Published: April 2023

Sepsis is a leading cause of mortality among children worldwide (Kawasaki, 2017). Variability in treatment strategies is one of many factors complicating practice. Current UK guidelines recommend bolus fluid resuscitation with 20 ml/kg within ten minutes. However, the seminal study of the Fluid Expansion as Supportive Therapy trial (Maitlandet al., 2011) may have influenced current practice, and potentially a more restrictive approach is now being taken. This study was performed in a low-income setting, raising questions as to its applicability in a high-income setting. The FiSh study (Inwaldet al., 2019) highlights the challenges of conducting a similar study in high-income settings. The complexity of the altering physiology at different ages complicates this further, and therefore a review of current local practice was indicated.

This is a retrospective study involving 50 infants, with a working diagnosis of sepsis, treated in a tertiary paediatric emergency department resuscitation room, from November 2015 – March 2018. Data was collected regarding the volume, type, aliquots and timing of fluid, together with lactate levels. The acuity and length of admission were the measurable outcomes.

50% of infants were under fluid resuscitated against the currently recommended guidelines (figure 1). Of the infants that were under fluid resuscitated, 60% required no further fluid resuscitation (figure 2). There was no correlation between fluid resuscitation practice and admission length, although the majority of patients (84%) had admissions of less than one week. 2% of infants had positive blood cultures.

Abstract 002 Figure 1

Results of total fluid given

Abstract 002 Figure 2

Further fluid resuscitation following initial fluid

This study adds value to clinicians working in paediatrics by demonstrating that fluid resuscitation of infants specifically needs careful consideration and further investigation. Discussion surrounding the aetiology and prevalence of sepsis in high-income settings is indicated. A theory that infants should be considered a unique entity within the general field of paediatrics is proposed.
020 Diagnostic accuracy of the Siemens TNIH assay with 0/3 hour rule out algorithms
Authors: Berg Patricia van den , Collinson Paul , Morris Niall , Body Richard
Published: April 2023

Background

Chest pain accounts for approximately 6% of all Emergency Department (ED) attendances. We evaluated the diagnostic accuracy of a high-sensitivity cardiac troponin I assay (Siemens TNIH) on serial sampling for patients presenting to the ED with suspected cardiac chest pain. Specifically, we evaluated the accuracy of three previously reported accelerated diagnostic algorithms (figure 1), the 99th percentile upper reference limit and absolute and relative changes in TNIH over 3 hours.

Abstract 020 Figure 1

Siemens TNIH algorithms

This is a secondary analysis from a multi-centre prospective diagnostic accuracy study across 14 UK sites. Patients presenting to the ED with chest pain of suspected cardiac nature warranting investigation were included. The target diagnosis was acute myocardial infarction (AMI), which was adjudicated by two independent investigators. Serum blood samples were taken on ED arrival and 3 hours later. Stored frozen samples were subsequently analysed with the Siemens TNIH assay (ADVIA Centaur, 99th percentile upper reference limit: female 39.6 ng/L, male 58.0 ng/L; coefficient of variation 10% at 4.50 ng/L) and absolute (AΔ=|‘3h-TNIH’-‘0h-TNIH’|) and relative (RΔ%=(AΔ*100)/’0h-TNIH’) changes calculated.

Of 802 included patients, 13.8% had AMI. Absolute delta had superior accuracy to relative delta (C-statistic 0.94 vs 0.76, p<0.001). However, used alone no optimised delta could achieve sensitivity >95.5% for AMI. Simply ruling out AMI in patients with TNIH below the 99th percentile at 3h had only 88.3% (95% CI 80.8–93.6) sensitivity. The Basel algorithm had higher sensitivity (98.2%) than both High-STEACS (93.7%, p=0.03) and the ESC 0/3h algorithm (88.3%, p<0.001) (see figure 1). The algorithms ruled out 63%, 74% and 84% patients respectively.

Abstract 020 Figure 2

Diagnostic accuracy of 0-3h pathways

With serial sampling over 3h, the Siemens TNIH assay should be used with a validated algorithm incorporating bespoke cut-offs and absolute delta changes. In our analysis, the Basel algorithm had greatest sensitivity. ‘Ruling out’ AMI using the 99th percentile upper reference limit of the assay cannot be recommended.
022 Evaluating diversion of alcohol related attendances: the EDARA study
Authors: Goodacre Steve , Irving Andy , Young Tracey , O’Cathain Alicia , Buykx Penny , Moore Simon
Published: April 2023

Background

Alcohol Intoxication Management Services (AIMS), commonly known as ‘drunk tanks’, provide an alternative to emergency department (ED) attendance for intoxicated adults at times of high incidence. The EDARA study evaluated the role of AIMS in the emergency care system and night time economy. Here we present findings describing AIMS activity and running costs, and estimating the effect of AIMS on ED attendance rates and ED user experience.

We identified six cities with AIMS and collected data relating to attendances and costs of running the service. We matched these cities with six cities without AIMS and used routine NHS data to estimate the effect of AIMS operation upon ED attendances during hours of AIMS activity. We also surveyed ED user experience over matched time periods of AIMS activity in cities with and without AIMS.

Mean attendance rates at the AIMS ranged from 2.7 to 11.8 per night. The mean running cost for an AIMS was £1635 per night (range £1075 to £2265) and the mean cost per attendance was £222.50 (range £132.27 to £583.8). Overall AIMS were associated with reduced ED attendances (−5.30 per night, p<0.05, 95% CI −9.62 to −0.62). However, the effect varied markedly between individual AIMS, ranging from 4.93 fewer attendances to 3.32 additional attendances per night. There was no significant effect from AIMS on ED user aggregate service rating score (coefficient 0.060, p=0.372), perception of feeling threatened (−0.037, p=132), aggregate negative experience score (−0.147, p=0.196), and overall service rating score (0.25, p=0.440).

AIMS vary markedly in activity, running costs and effect on ED attendances, so estimating overall effects is probably inappropriate. The most active and expensive AIMS appeared to be associated with the greatest effect on ED attendances. We identified no effect on ED user experience.
024 Handheld electronic device use in patient care; the emergency department patient perspective
Authors: Tilbury Nicholas , Johnson Graham , Byrne Carol , Churchman Adam , Shergill Maleasha , Rusk Zoe , Tabner Andrew
Published: April 2023

What is already known?

Smartphones have an increasingly important role to play in the delivery of healthcare, especially in the acute setting. Little is known regarding patient perceptions of this development.

Why is this study important?

Staff are concerned that patients have a negative perception of their use; this concern may present a barrier to optimal use despite the existing evidence of their benefits.

What does this study add?

Our study describes patient, carer and relative attitudes towards staff use of smartphones within an emergency department. The majority of respondents trust staff to use their devices appropriately and are supportive of the use of this evolving technology in a healthcare setting.

A cross-sectional survey of emergency department service users in a single department at all times of day and on all days of the week.

Surveys were administered by medical students; all eligible individuals in the department during a data collection period were approached.

Results

A total of 438 participants successfully completed the survey with a response rate of 98%. Only 2% of those who observed staff using HEDs during their emergency department visit thought that they were being used for non-clinical purposes. 340 (72%) agreed that staff should be allowed to use HEDs in the workplace. Concerns expressed by participants included devices being used for non-clinical purposes and data security. The main suggestion by participants was that the purpose of the HEDs should be explained to patients to avoid misinterpretation.

Conclusion

Our study suggests that the majority of individuals attending the emergency department have no concerns regarding the use of HEDs by clinical staff, and that many of the concerns raised could be addressed with adequate patient information and clear governance.
027 The utilisation of urgent emergency care services by older care home residents in the UK and the subsequent impact on emergency departments
Authors: Brewster Molly , O’Keeffe Colin , Mason Suzanne
Published: April 2023

Background

Urgent and Emergency Care Services (UECS) in the UK are under increasing pressure. Although accounting for a small proportion of Emergency Department (ED) attendances, there is a continually rising demand for the care of older people. Currently, there is limited data surrounding older care home (CH) residents and their use of UECS, thus this study aims to investigate the characteristics of older CH resident UECS utilisation and factors that influence ED transfer.

Method and results

Interviews were undertaken with healthcare and CH staff to elicit views around: the characteristics of ED attendances; demand placed upon UECS; alternative services; and interventions to reduce demand. Routine administrative data was collected for 21583 patients aged ≥75 from one large, urban type 1 ED in Yorkshire and Humber (Y&H) between April 2016 and March 2017. CH residents were identified to characterise attendances.

Conclusions

CH residents were more likely to arrive by ambulance, OR of 3.810 (95% CI: 3.316–4.378, p<0.001); breach the four-hour target, OR of 1.321 (95% CI: 1.223–1.427, p<0.001); have an investigation, OR of 1.196 (95% CI: 1.035–1.381, p=0.015); receive resuscitation treatment, OR of 1.559 (95% CI: 1.409–1.725, p<0.001); and have a long inpatient admission (>2 days), OR of 2.083 (95% CI: 1.933–2.245, p<0.001) compared with non-care home residents (NCH) reflecting greater demand upon UECS. Interviews revealed ED transfer decisions were complex and reliant upon communication with the wider healthcare system and the risk averse attitudes of CH staff. Increased training of CH staff, advanced care planning and integrating healthcare services into the CH were suggestions to reduce the demands CH residents place upon UECS.

This study reflects the demand CH residents place on UECS compared with NCH residents and highlights the importance of investigating factors influencing ED transfer. This will help to create targeted interventions to improve resident care and reduce UECS demand.
031 Bed block – a game to help understand patient flow
Authors: Edwards Sarah , Parkinson Leesa
Published: April 2023

Background

Patient flow is crucial for patient safety, and for health services and the emergency departments(ED) within them to function. Poor patient flow is associated with increased mortality and morbidity. However, the concept of patient flow was not previously formally taught to all health care professionals (HCP) in our organisation. We developed a fun educational resource to be used with multidisciplinary groups to demonstrate the principles and pitfalls of patient flow in a hospital system.

Method and results

Our board game is a collaborative team game for 2–10 players and consists of a hospital with an ED, medical ward, surgical ward and intensive care. The game lasts around 45 minutes, during which the team aims to play through 24 hours in the hospital. The aim is to end the game with fewer patients in the hospital than at the start, without generating too many patient flow safety incidents. Pressure is added to the system by events such as bank holidays, norovirus outbreaks or failure of equipment. During play testing of the game, 90 different HCPs have provided written feedback.

Abstract 031 Figure 1Abstract 031 Figure 2Abstract 031 Figure 3

Conclusions

95% of people found that they were more confident, and understood the importance of patient flow following the game. Common themes learnt from the game include the importance of team work, understanding the bigger picture and understanding the pressures in other parts of the hospital. Specific quotes include ‘would like to have played for longer’, ‘this game should be made available for the public, as it might help reduce ED attendances’, ‘great way of demonstrating the importance of team work’. This early testing of the game has shown how Bed Block can educate around patient flow. Further work is needed to explore the other educational opportunities from this work and if it impacts clinical practice.
032 Clinical frailty score as a decision-making tool in the emergency department – a step towards better outcomes for older patients
Authors: Mitchell Aine , Tahir Qurrat-Ul-Ain , Banerjee Jay
Published: April 2023

Background

The ≥65 year age group don’t always receive appropriate emergency care, occasionally due to ageism and as the ‘medical’ model of emergency care often does not benefit frail older patients.

Over a six month period from December ’18 - June ’19, as part of a LeicGEM initiative, we aimed to:

1. Improve accurate calculation and documentation of the CFS for patients ≥65 years.

2. Increase utilisation of the CFS in providing individualised and holistic care for patients with frailty i.e. CFS ≥5.

3. Improve consideration of end-of-life care (EOLC) if CFS ≥7.

Through monthly PDSA cycles, our frailty QI team introduced interventions including: info-posters disseminated through email, handover sessions, ‘Champions’ on the shop-floor, targeted educational sessions and leaflets. We utilised rapid-cycle audit information and staff perceptions survey to measure improvements and focus initiatives. In the last 6 weeks, we looked for sustainability of improvements.

CFS documentation improved and remained accurate, which was sustained. Discussions with patients and families, and ‘thought’ given to offer holistic, individualised care both showed improvement, though this was not definitely sustained. EOLC discussions did not show any definite improvement.

Frailty is a clinically important entity that is recognisable and accurately measurable by emergency physicians. If appropriately used, the CFS can help guide clinical care plans for patients.

Simple interventions in a local ED setting were able to improve documentation and utilisation of the CFS to provide patient-centred care for older patients.

Changing to a culture more open to EOLC discussions in the emergency setting was noted to be difficult both from our staff survey and audit data. This will need a more focused approach to improve departmental culture to have, and staff comfort to start an EOLC conversation.

We will continue to advocate for use of CFS, and for better care for all our older patients.

Abstract 032 Figure 1

CFS completion runchart

Abstract 032 Figure 2

EOLC runchart

Abstract 032 Figure 3

Individualised care runchart
035 Ensuring data adequacy in development of a major trauma clinical decision app
Authors: Mather Alexandra , Lowe David , Thomson Kevin , Whitelaw Alan , Beaumont Ben , Tulloch James
Published: April 2023

Background

Emergency medicine clinicians from the QEUH research team EMQUIRE are working alongside design agency, Daysix, and the Scottish Trauma Network to develop a pioneering clinical decision support app to be used in major trauma.

The development of the major trauma app will support clinicians to achieve three key aims:

Robust data collection

Cognitive aids to support and prompt clinicians

Provision of a reliable framework

When creating a innovate, digital tool to be used in the medical setting, it is essential that it satisfies CE marking and MHRA regulations.

Method and results

A variety of methods have been used to ensure the trauma app provides reliable, valid and adequate data;

A systematic review of existing paper trauma proformas within Scotland was performed and data points recorded. A review of 10 major trauma cases and documentation from each region was then taken place. This information was used to establish a minimum data set

TARN and STAG data standards were reviewed, and the app data fields reflect this

Cognitive aids and prompts within the app have a strong evidence base – literature from the ATLS manual and case–based evidence

The Delphi method was used to establish clear data fields for the trauma app. This involved expert clinicians from MTCs and MTUs within Scotland

High fidelity trauma simulation was performed

Abstract 035 Figure 1Abstract 035 Figure 2

Trauma

Abstract 035 Figure 3

Trauma App-20_1

Conclusions

The comparison of current standards of paper documentation and data fields of the app has ensured granularity of data is increased.

Clinicians have provided feedback throughout the design process which has led to further development and refinement. This expert input has ensured that the data fields within the app are adequate and valid.

The overall result is an app that mirrors and supports the established clinical framework for trauma management and enables enhanced data visualisation of episodes of care.