To estimate the burden of road traffic injuries and deaths for all road users and among different road user groups in Africa.
We searched MEDLINE, EMBASE, Global Health, Google Scholar, websites of ...African road safety agencies and organizations for registry- and population-based studies and reports on road traffic injury and death estimates in Africa, published between 1980 and 2015. Available data for all road users and by road user group were extracted and analysed. We conducted a random-effects meta-analysis and estimated pooled rates of road traffic injuries and deaths.
We identified 39 studies from 15 African countries. The estimated pooled rate for road traffic injury was 65.2 per 100 000 population (95% confidence interval, CI: 60.8-69.5) and the death rate was 16.6 per 100 000 population (95% CI: 15.2-18.0). Road traffic injury rates increased from 40.7 per 100 000 population in the 1990s to 92.9 per 100 000 population between 2010 and 2015, while death rates decreased from 19.9 per 100 000 population in the 1990s to 9.3 per 100 000 population between 2010 and 2015. The highest road traffic death rate was among motorized four-wheeler occupants at 5.9 per 100 000 population (95% CI: 4.4-7.4), closely followed by pedestrians at 3.4 per 100 000 population (95% CI: 2.5-4.2).
The burden of road traffic injury and death is high in Africa. Since registry-based reports underestimate the burden, a systematic collation of road traffic injury and death data is needed to determine the true burden.
Mechanisms that support reduced emissions from deforestation and forest degradation (REDD/REDD+) have potential to counteract a large share of global greenhouse gas emissions if implemented ...effectively across the tropics. In 2007 the conference of parties to the United Nations Framework Convention on Climate Change called upon parties and international organizations to promote REDD through investments in capacity building and demonstration activities. This prompted many new actors to become involved in REDD activities at a variety of locations and scales. A global survey of REDD activities was undertaken in 2009 to enable better understanding of the intensity and geographic distribution of these activities. Existing compilations, literature review, web-based sources, face-to-face and telephone interviews, and e-mail questionnaires were used to compile data for the inventory. Inter alia, data were collected on the location of activities and official and unofficial factors influencing location choices. Inventory data were combined with secondary data to estimate a statistical count model (Poisson) of factors affecting the number of REDD activities undertaken in the 64 developing countries that experienced significant emissions from deforestation. The results show that there were at least 79 REDD readiness activities and 100 REDD demonstration activities as of October 2009. Of these, the largest shares of REDD readiness and demonstration activities were implemented in Indonesia (7 and 15 respectively) and Brazil (4 and 13 respectively), countries widely agreed to have the greatest potential for reducing forest-based emissions. The statistical results found no national characteristic to have a statistically-significant effect on the number of REDD readiness activities, but five national characteristics to have significant effects on the number of REDD demonstration projects. Baseline CO
2 emissions, forest carbon stock, number of threatened species, quality of governance, and region all had significant effects. The results reveal the importance of biodiversity and good governance, and the relative unimportance of human need and opportunity cost of land. The results also reveal a bias against Africa and toward Latin America. Unless this pattern is countered, REDD and REDD+ may have geographic biases that undermine its broad political support.
The continuous dissemination of coronavirus disease of 2019 (COVID-19) literature can inform decision-makers and the public. Since the widespread use of COVID-19 vaccines, more systematic reviews ...have summarized the effectiveness and reported adverse events associated with vaccination. Previous systematic and scoping reviews on COVID-19 summarized various aspects surrounding COVID-19, however, a scoping review is needed to summarize the characteristics of COVID-19 vaccines and associated adverse events reported in systematic reviews and meta-analyses to provide comprehensive evidence for informed medical decision-making. We will conduct a scoping review concerning COVID-19 vaccines and adverse events from vaccines. We will search from December 2019 to present in Epistemonikos, Campbell Library, CINAHL (Ovid), MEDLINE (Ovid), Scopus, CENTRAL (Ovid), Web of Science, WHO COVID-19 database, Joanna Briggs Institute of Excellence, and COVID-19 Evidence Reviews resource. We will include systematic reviews, meta-analyses, or both of randomized controlled trials and observational studies and exclude individual randomized controlled trials and observational studies. Abstracts and full-texts will be screened prior to selection. Investigators will independently use a calibrated quantitative and qualitative data extraction sheet and rate the quality of articles with AMSTAR, resolving disagreements to aim for good agreement (≥80%). An updated scoping review of the characteristics and safety of COVID-19 vaccines would highlight the accuracy of the evidence to inform decision-making concerning COVID-19 vaccination.
Despite increasing popularity and intensive worldwide use, few studies have assessed the validity and factorial structure of the Heartland Forgiveness Scale (HFS). However, scientific literature ...showed that the original factorial structure of the HFS was not fully replicated and-in addition-the Italian translation is still lacking. To fill this gap, this study aims to extend evidence about the original HFS factorial validity by analyzing the Italian version. The final sample was composed of 523 randomly enrolled participants 139 males (26.6%), 384 females (73.4%) aged from 18 to 82 years (mean = 42.53,
= 16.41) who completed the Italian version of the HFS. The confirmatory factor analysis showed good fit indices for the original hierarchical factor solution and a significant decrease in model fit was found for all of the competing models. Also, the Italian version of the HFS revealed good reliability and very good psychometrical properties. Findings suggest that the Italian version of the HFS can be considered a reliable and good psychometrically based instrument for the assessment of dispositional forgiveness of the Self, Other, and Situation.
The increasing number of people afflicted with diabetes throughout the world is a major health issue. Inhibitors of the sodium-dependent glucose cotransporters (SGLT) have appeared as viable ...therapeutics to control blood glucose levels in diabetic patents. Herein we report the discovery of LX2761, a locally acting SGLT1 inhibitor that is highly potent in vitro and delays intestinal glucose absorption in vivo to improve glycemic control.
Early rehabilitation and mobilisation encompass patient-tailored interventions, delivered within intensive care, but there are few studies in children and young people within paediatric intensive ...care units.
To explore how healthcare professionals currently practise early rehabilitation and mobilisation using qualitative and quantitative approaches; co-design the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual of early rehabilitation and mobilisation interventions, with primary and secondary patient-centred outcomes; explore feasibility and acceptability of implementing the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual within three paediatric intensive care units.
Mixed-methods feasibility with five interlinked studies (scoping review, survey, observational study, codesign workshops, feasibility study) in three phases.
United Kingdom paediatric intensive care units.
Children and young people aged 0-16 years remaining within paediatric intensive care on day 3, their parents/guardians and healthcare professionals.
In Phase 3, unit-wide implementation of manualised early rehabilitation and mobilisation.
Phase 1 observational study: prevalence of any early rehabilitation and mobilisation on day 3. Phase 3 feasibility study: acceptability of early rehabilitation and mobilisation intervention; adverse events; acceptability of study design; acceptability of outcome measures.
Searched Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PEDro, Open grey and Cochrane CENTRAL databases.
Narrative synthesis.
In the scoping review we identified 36 full-text reports evaluating rehabilitation initiated within 7 days of paediatric intensive care unit admission, outlining non-mobility and mobility early rehabilitation and mobilisation interventions from 24 to 72 hours and delivered twice daily. With the survey, 124/191 (65%) responded from 26/29 (90%) United Kingdom paediatric intensive care units; the majority considered early rehabilitation and mobilisation a priority. The observational study followed 169 patients from 15 units; prevalence of any early rehabilitation and mobilisation on day 3 was 95.3%. We then developed a manualised early rehabilitation and mobilisation intervention informed by current evidence, experience and theory. All three sites implemented the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual successfully, recruited to target (30 patients recruited) and followed up the patients until day 30 or discharge; 21/30 parents consented to complete additional outcome measures.
The findings represent the views of National Health Service staff but may not be generalisable. We were unable to conduct workshops and interviews with children, young people and parents to support the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual development due to pandemic restrictions.
A randomised controlled trial is recommended to assess the effectiveness of the manualised early rehabilitation and mobilisation intervention.
A definitive cluster randomised trial of early rehabilitation and mobilisation in paediatric intensive care requires selection of outcome measure and health economic evaluation.
The study is registered as PROSPERO CRD42019151050. The Phase 1 observational study is registered Clinicaltrials.gov NCT04110938 (Phase 1) (registered 1 October 2019) and the Phase 3 feasibility study is registered NCT04909762 (Phase 3) (registered 2 June 2021).
This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/21/06) and is published in full in
; Vol. 27, No. 27. See the NIHR Funding and Awards website for further award information.
The disability, mortality and costs caused by non-vertebral osteoporotic fractures are enormous. Existing osteoporosis therapies are highly effective at reducing vertebral but not non-vertebral ...fractures. Cortical bone is a major determinant of non-vertebral bone strength. To identify novel osteoporosis drug targets, we phenotyped cortical bone of 3 366 viable mouse strains with global knockouts of druggable genes. Cortical bone thickness was substantially elevated in
mice. NOTUM is a secreted WNT lipase and we observed high NOTUM expression in cortical bone and osteoblasts but not osteoclasts. Three orally active small molecules and a neutralizing antibody inhibiting NOTUM lipase activity were developed. They increased cortical bone thickness and strength at multiple skeletal sites in both gonadal intact and ovariectomized rodents by stimulating endocortical bone formation. Thus, inhibition of NOTUM activity is a potential novel anabolic therapy for strengthening cortical bone and preventing non-vertebral fractures.
A graphical screening method was previously developed by Kney and Brandes (2007) for assessing stream water quality data using electronic conductivity (EC) and alkalinity data. The method was aimed ...at providing citizen scientists involved in stream monitoring programs with a relatively simple way to interpret EC data. The method utilizes a plot of EC against concurrent alkalinity data, and is used to distinguish EC values for impacted or degraded streams from those that can be considered background values in a particular geologic setting. The method performs well in areas underlain by carbonate bedrock, as streams in those areas characteristically have EC values that are strongly correlated with alkalinity. However, in areas of low stream alkalinity (less than approximately 50 mg/L as CaCO3), the Kney and Brandes (2007) method was found to be much less effective in identifying impacted streams. This paper extends the graphical screening approach to streams with low alkalinity, specifically regions underlain by clastic sedimentary or crystalline bedrock, by using the strong correlation between EC and total hardness (TH). A baseline relationship of EC vs. TH is developed using surface water chemistry data from Hydrologic Benchmark Network streams (deemed as having minimal anthropogenic impacts) and regional groundwater quality data. The usefulness of the method is demonstrated by application to publicly available stream chemistry data and to field data collected from streams of eastern Pennsylvania under baseflow conditions. Results demonstrate that for streams with alkalinity <75 mg/L as CaCO3, the TH-based graphical screening method should be used rather than the alkalinity-based method of Kney and Brandes (2007).
► A baseline stream conductivity/hardness relationship is developed from existing data. ► The baseline relationship is used as a graphical screening method for stream quality. ► Data from high quality streams plot along the baseline relationship. ► The screening method is shown to be effective in identifying impacted streams.
Abstract
Background
Despite international guideline recommendations, low back pain (LBP) imaging rates have been increasing over the last 20 years. Previous systematic reviews report limited ...effectiveness of implementation interventions aimed at reducing unnecessary LBP imaging. No previous reviews have analysed these implementation interventions to ascertain what behaviour change techniques (BCTs) have been used in this field. Understanding what techniques have been implemented in this field is an essential first step before exploring intervention effectiveness.
Methods
We searched EMBASE, Ovid (Medline), CINAHL and Cochrane CENTRAL from inception to February 1, 2021, as well as and hand-searched 6 relevant systematic reviews and conducted citation tracking of included studies. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study and intervention characteristics. Study interventions were qualitatively analysed by three coders to identify BCTs, which were mapped to mechanisms of action from the theoretical domains framework (TDF) using the Theory and Techniques Tool.
Results
We identified 36 eligible studies from 1984 citations in our electronic search and a further 2 studies from hand-searching resulting in 38 studies that targeted physician behaviour to reduce unnecessary LBP imaging. The studies were conducted in 6 countries in primary (
n
= 31) or emergency care (
n
= 7) settings. Thirty-four studies were included in our BCT synthesis which found the most frequently used BCTs were ‘4.1 instruction on how to perform the behaviour’ (e.g. Active/passive guideline dissemination and/or educational seminars/workshops), followed by ‘9.1 credible source’, ‘2.2 feedback on behaviour’ (e.g. electronic feedback reports on physicians’ image ordering) and 7.1 prompts and cues (electronic decision support or hard-copy posters/booklets for the office). This review highlighted that the majority of studies used education and/or feedback on behaviour to target the domains of knowledge and in some cases also skills and beliefs about capabilities to bring about a change in LBP imaging behaviour. Additionally, we found there to be a growing use of electronic or hard copy reminders to target the domains of memory and environmental context and resources.
Conclusions
This is the first study to identify what BCTs have been used to target a reduction in physician image ordering behaviour. The majority of included studies lacked the use of theory to inform their intervention design and failed to target known physician-reported barriers to following LBP imaging guidelines.
Protocol Registation
PROSPERO
CRD42017072518
Abstract Objective The overall goal of this research was to develop a practical method to chemically modify the surface of high strength dental ceramics (i.e. zirconia) to facilitate viable, robust ...adhesive bonding using commercially available silanes and resin cements. Methods Investigation focused on a novel approach to surface functionalize zirconia with a Six O y “seed” layer that would promote chemical bonding with traditional silanes. ProCAD and ZirCAD blocks were bonded to a dimensionally similar composite block using standard techniques designed for silica-containing materials (silane and resin cement). ZirCAD blocks were treated with SiCl4 by vapor deposition under two different conditions prior to bonding. Microtensile bars were prepared and subjected to tensile forces at a crosshead speed of 1 mm/min scanning electron microscopy was used to analyze fracture surfaces and determine failure mode; either composite cohesive failure (partial or complete cohesive failure within composite) or adhesive failure (partial or complete adhesive failure). Results Peak stress values were analyzed using single-factor ANOVA ( p < 0.05). Microtensile testing results revealed that zirconia with a surface treatment of 2.6 nm Six O y thick “seed” layer was similar in strength to the porcelain group (control). Analysis of failure modes indicated the above groups displayed higher percentages of in-composite failures. Other groups tested had lower strength values and displayed adhesive failure characteristics. Conclusion Mechanical data support that utilizing a gas-phase chloro-silane pretreatment to deposit ultra-thin silica-like seed layers can improve adhesion to zirconia using traditional silanation and bonding techniques. This technology could have clinical impact on how high strength dental materials are used today.
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