bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rainfall‐induced ground deformation in southern Africa
Authors: Dauteuil Olivier , Jolivet Marc , Gaudaré Louis , Pastier Anne‐Morwenn 
Published: April 2023

AbstractWe 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.
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

AbstractUsing 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.
imageKey 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.
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

ObjectivesOur study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia.DesignSystematic review of the literature.Data sourcesOnline databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023.Eligibility criteriaEligible 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 synthesisCovidence 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.ResultsFive 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.ConclusionSeveral 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 numberCRD42020214852.
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

ObjectivesThe 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.MethodsWe 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.ResultsWe 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.ConclusionWe 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

ObjectivesIn 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.DesignSemistructured 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).SettingCommunities of the GTHA and GVA with interviews conducted virtually over Zoom or telephone.Participants25 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.ResultsAccess 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.ConclusionsUnderstanding 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

IntroductionThe 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 analysisWe 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 disseminationEthical 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 numberDRKS00025991.
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

BackgroundThe 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 resultsThe 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.Conclusions84 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 1Results of total fluid givenAbstract 002 Figure 2Further fluid resuscitation following initial fluidThis 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

BackgroundChest 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 1Siemens TNIH algorithmsThis 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 2Diagnostic accuracy of 0-3h pathwaysWith 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

BackgroundAlcohol 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.ResultsA 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.ConclusionOur 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.