Access to natural green spaces and their associations with psychological wellbeing for South Asian people in the UK: A systematic literature review.

Use of natural green spaces (NGS) is associated with improved psychological well-being (PWB). Ethnic minorities, particularly South Asian (SA) communities in the UK, face unequal access to NGS and experience a greater prevalence of health challenges than the general population. Improving access to green space can contribute to addressing current health inequalities. Following PRISMA guidelines, this systematic literature review aimed to synthesise existing research on NGS access barriers experienced by SAs and associations between NGS use and PWB. A comprehensive search was conducted through SAGE, Science Direct, and SCOPUS in August 2022; we included qualitative, quantitative and mixed-methods studies with findings on NGS access and/or associations between NGS use and PWB for SAs in the UK. We employed deductive thematic analysis to explore inhibitors and enablers of access which were then conceptualised through a multidimensional framework. Associations between NGS and PWB were coded inductively and mapped separately. This review is registered on PROSPERO: CRD42022353711. Twenty-six studies were included in the review which varied substantially in their aims, methods, context, and participants. Included studies on NGS grouped SAs within broader demographic categories such as minority ethnic communities or Muslims. Our findings indicate that SAs are disadvantaged in their access to NGS due to numerous intersecting factors including unequal distribution, inadequate transport, racialisation of NGS, and safety concerns. Whilst these findings generally aligned with broader literature on NGS access, certain access barriers and enablers are particularly significant to SA communities. We also identified several dimensions of PWB that are enhanced for SAs through interacting with NGS including overall mental health outcomes, physical wellbeing, and social relatedness. This review highlights opportunities to improve access to NGS and thereby enhance PWB outcomes for SA people. It also identifies the lack of primary research exploring NGS access and PWB associations for SA communities, specifically in rural contexts.

Animal-assisted interventions in adult hospital rehabilitation settings: A scoping review.

Animal-assisted interventions (AAIs) have the potential to enhance people's well-being and function and are increasingly being implemented across a range of settings. This scoping review explored how AAIs have been used in adult hospital rehabilitative care. Using JBI and PRISMA-ScR guidelines, a systematic search of four databases was undertaken. Inclusion criteria involved adults, aged >18 years, who had received AAIs in the hospital rehabilitation setting. Twenty-two articles met the inclusion criteria. Results identified two intervention types: visitation activities (n = 8 studies) and structured therapeutic interventions (n = 14 studies). Dogs were the most common animal species. Improvements in social and emotional well-being were reported across both types of interventions, with improvements in ambulation, motor skills, and verbal communication reported by those engaged in structured therapeutic interventions. Implementation challenges included a dependency on volunteer dog-handlers; the need for better recording of interventions in medical records to enable evaluation; and cost, safety, infection control, and animal welfare considerations. Strengthening the planning of AAIs is fundamental for the realization of potential outcomes from human-animal interactions in hospital rehabilitative care.

"They don't have the luxury of time": interviews exploring the determinants of public health research activity that contextualise embedded researcher roles in local government.

BACKGROUND: Embedded researchers are a novel intervention to improve the translation of research evidence into policy and practice settings, including public health. These roles are being implemented with increasing popularity, but they often lack clear evaluative frameworks. Understanding initial levels of research activity, including associated barriers and opportunities, is essential to developing theories of change and thus shaping the roles and defining expectations. We aimed to identify the principal determinants of research activity in public health that contextualise embedded researcher roles, including attributes of the embedded researcher themselves. METHODS: We undertook seventeen semi-structured interviews with embedded researchers in diverse public health settings in English local government. Interviews were analysed using thematic analysis. RESULTS: We identified thirteen interlinked determinants of research activity within local government public health settings. Research and interpersonal skills, as well as pre-existing connections and knowledge within local government, were highly valued individual attributes for embedded researchers. Resource deficiencies (funding, time, and infrastructure) were primary barriers to research activity, whereas a strong local appetite for evidence informed decision making presented a valuable opportunity. However, there was inconsistencies across public health teams relating to perceptions of what constituted "research" and the resources that would be required. CONCLUSIONS: Our results suggest that successful embedded researchers will have equally strong research and communication skills and should be offered mentorship and clear career progression pathways. Perceptions of research within local government are closely linked to resource deficiencies and senior endorsement. Embedded researchers could benefit from taking the time to develop locally contextualised knowledge of this research culture. Theories of change for embedded researchers should conceptualise the interconnections across individual, interpersonal, and organisational barriers and opportunities underlying local government research activity. Further research is needed to identify methods for exploring the influence of embedded researchers as well as to unpack the stages of research activity within local government and the associated behaviours.

The implementation of embedded researchers in policy, public services, and commercial settings: a systematic evidence and gap map.

BACKGROUND: Embedding researchers into policy and other settings may enhance research capacity within organisations to enable them to become more research active. We aimed to generate an evidence map on evaluations of embedded researcher interventions to (i) identify where systematic reviews and primary research are needed and (ii) develop conceptual understandings of 'embedded researchers'. We define 'embedded researchers' through a set of principles that incorporate elements such as the aim of activities, the types of relationships and learning involved, and the affiliations and identities adopted. METHODS: We included studies published across all sectors, searching fourteen databases, other web sources and two journals for evaluations published between 1991 and spring 2021. Data were extracted using a coding tool developed for this study. We identified new typologies of embedded researcher interventions through undertaking Latent Class Analysis. RESULTS: The map describes 229 evaluations spanning a variety of contexts. Our set of principles allowed us to move beyond a narrow focus on embedded researchers in name alone, towards consideration of the wide range of roles, activities, identities, and affiliations related to embedded researchers. We identified 108 different allied terms describing an embedded researcher. Embedded researcher activity spanned a continuum across lines of physical, cultural, institutional, and procedural embeddedness (from weaker to more intense forms of embeddedness) and took a range of forms that bridge or blur boundaries between academia and policy/practice. CONCLUSIONS: We developed a broad map of international embedded researcher activity in a wide range of sectors. The map suggests that embedded researcher interventions occupy a broader suite of models than previously acknowledged and our findings also offer insight on the type and nature of this literature. Given the clear policy interest in this area, a better understanding of the processes involved with becoming embedded within an organisation is needed. Further work is also necessary to address the challenges of evaluating the work of embedded researchers, including consideration for which outcome measures are most appropriate, to better understand their influence.

What are the mechanisms driving the early stages of embedded researcher interventions? A qualitative process evaluation in English local government.

Improved collaboration and communication between public health practitioners and academia could enhance the flow of research evidence into policy and practice. Embedded researchers present one type of intervention with the potential to bridge the research-implementation gap through their dual affiliations with decision makers and academia. Although embedded researcher posts are garnering increasing attention in public health, there remains a need to understand the mechanisms through which they may promote the translation of evidence into practice. To address this gap, we conducted a processes evaluation incorporating data from seventeen semi-structured interviews with embedded researchers in local government public health teams across England. We aimed to expand theoretical understandings of embedded researchers in public health through providing a detailed conceptualisation of the mechanisms shaping the early stages of their roles. Interviews with embedded researchers were conducted from late 2021 to spring 2022. Our results suggest that the initial months of embedded researcher roles are defined by a lengthy embedding phase centred on building trust and gathering contextual knowledge. This phase forms the foundation on which these interventions are built. We identified seven categories of outputs delivered by embedded researchers which primarily revolved around building research capacity and addressed many of the primary barriers limiting research activity in public health. Improvements in research awareness, interest, and involvement reflected early changes in local research cultures. However, our results align with previous work suggesting that changing an organisational research culture is a long-term process. Expectations for embedded researchers should thus be proportionate to the seniority and scale of the post and we add our voice to calls for sustained investment in these valuable interventions. Further examination of how embedded researcher roles evolve over time in public health is necessary to broaden understandings of the concept of embeddedness in these settings.

Prevalence and Patterns of Resuscitation-Associated Injury Detected by Head-to-Pelvis Computed Tomography After Successful Out-of-Hospital Cardiac Arrest Resuscitation.

Background Patients resuscitated from out-of-hospital circulatory arrest (OHCA) frequently have cardiopulmonary resuscitation injuries identifiable by computed tomography, although the prevalence, types of injury, and effects on clinical outcomes are poorly characterized. Methods and Results We assessed the prevalence of resuscitation-associated injuries in a prospective, observational study of a head-to-pelvis sudden-death computed tomography scan within 6 hours of successful OHCA resuscitation. Primary outcomes included total injuries and time-critical injuries (such as organ laceration). Exploratory outcomes were injury associations with mechanical cardiopulmonary resuscitation and survival to discharge. Among 104 patients with OHCA (age 56±15 years, 30% women), 58% had bystander cardiopulmonary resuscitation, and total cardiopulmonary resuscitation time was 15±11 minutes. The prevalence of resuscitation-associated injury was high (81%), including 15 patients (14%) with time-critical findings. Patients with resuscitation injury were older (58±15 versus 46±13 years; P<0.001), but had otherwise similar baseline characteristics and survival compared with those without. Mechanical chest compression systems (27%) had more frequent sternal fractures (36% versus 12%; P=0.009), including displaced fractures (18% versus 1%; P=0.005), but no difference in survival (46% versus 41%; P=0.66). Conclusions In patients resuscitated from OHCA, head-to-pelvis sudden-death computed tomography identified resuscitation injuries in most patients, with nearly 1 in 7 with time-critical complications, and one-half with extensive rib-cage injuries. These data suggest that sudden-death computed tomography may have additional diagnostic utility and treatment implications beyond evaluating causes of OHCA. These important findings need to also be taken in context of the certain fatal outcome without resuscitation efforts. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03111043.

Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology.

OBJECTIVES: Patients resuscitated from an out-of-hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head-to-pelvis computed tomography (CT) imaging in such patients. METHODS: From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden-death CT (SDCT) scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram-gated cardiac and thoracic CT angiogram, and a nongated venous-phase abdominopelvic CT angiogram. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared to the adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a >50% stenosis without another OHCA cause. RESULTS: SDCT scans occurred within 1.9 ± 1.0 h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentially identifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life-threatening resuscitation complications of liver or spleen laceration (n = 6); pneumothorax or thoracic organ laceration (n = 8); and mediastinal, pericardial, or vascular hemorrhage (n = 3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatments resulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis. CONCLUSIONS: This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.

Comprehensive review of pericardial diseases using different imaging modalities.

Pericardial abnormalities are common cardiovascular disease entity, which are encountered in various clinical settings. Imaging plays an integral role in evaluation of pericardial abnormalities. The appropriate use of multiple imaging modalities is crucial to initiate the diagnosis and guide the referring providers to establish a management plan. Echocardiography (echo) is the initial imaging modality of choice. Computed tomography (CT) and magnetic resonance imaging (MRI) are complementary imaging tools with better tissue characterization. Pericardial abnormalities include pericardial effusion, pericarditis, pericardial constriction, tamponade, pneumopericardium, pericardial rupture, fistulas, congenital abnormalities, and pericardial tumors. Pericardial effusion is a common clinical entity, where there is accumulation of fluid in the pericardial sac. Pericarditis can be acute, incessant, chronic, or recurrent. Pericardial thickening or enhancement are the main CT findings in acute pericarditis. Pericardial constriction results into diastolic heart failure. Differentiating constrictive pericarditis from restrictive cardiomyopathy is important, since these conditions can present with similar clinical and hemodynamic findings and both have different management. Right atrial or right ventricular compression by the pericardial sac contents should raise the suspicion for tamponade. Immediate pericardiocentesis to release the elevated intra-pericardial pressure can be lifesaving. Pericardial rupture is a serious condition that can occur after trauma and can lead to cardiac herniation. The main purpose of this article is to do a comprehensive review of the imaging appearance of pericardial diseases on different imaging modalities and establish a structured diagnostic approach for pericardial diseases to appropriately guide management.

Core curriculum illustration: blunt traumatic diaphragmatic hernia.

This is the 43rd installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.

Core curriculum illustration: pulmonary laceration.

This is the 44th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.

Accuracy of Digital Tomosynthesis of the Chest in Detection of Interstitial Lung Disease Comparison With Digital Chest Radiography.

PURPOSE: The aim of the study was to assess the ability of chest digital tomosynthesis (DTS) for detection of interstitial lung disease (ILD) compared with conventional chest radiography. MATERIALS AND METHODS: We retrospectively reviewed 78 patients (60 males, 18 females, mean age = 53.05 years, range, 19-83 years) who underwent chest DTS for a 5-year interval (January 1, 2009-December 31, 2014). Of the 78 patients, 33 (42.3%) carried a diagnosis of ILD and 45 (57.7%) were not ILD. All computed tomography reports and medical records were reviewed. The conventional chest radiography and DTS were separately reviewed by 2 radiologists for the presence of ILD and the confidence in diagnosis. RESULTS: The diagnostic accuracy of DTS for the detection of ILD was better than conventional chest radiography (P < 0.05). Digital tomosynthesis had a sensitivity of 83.3% and negative predictive value of 89.0% that were statistically significantly better than conventional chest radiography (43.9% and 70.9%, respectively). Confidence in diagnosing ILD at DTS was higher than conventional chest radiography (P < 0.001) and had higher interobserver agreement than conventional chest radiography (P < 0.01). CONCLUSIONS: Digital tomosynthesis improves diagnostic performance and confidence in diagnosing ILD compared with conventional chest radiography. Digital tomosynthesis can be suggested as the initial diagnostic technique for patients with suspected ILD.

Core curriculum illustration: supination-external rotation trimalleolar fracture.

This is the 37th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and on the use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.erad.org/page/CCIP_TOC .

Core curriculum illustration: pediatric buckle fracture of the distal radius.

This is the 38th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.

Core curriculum illustration: "Colles," dorsally angulated fracture of the distal radius.

This is the 41st installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC .

Restoring Cystic Fibrosis Transmembrane Conductance Regulator Function Reduces Airway Bacteria and Inflammation in People with Cystic Fibrosis and Chronic Lung Infections.

RATIONALE: Previous work indicates that ivacaftor improves cystic fibrosis transmembrane conductance regulator (CFTR) activity and lung function in people with cystic fibrosis and G551D-CFTR mutations but does not reduce density of bacteria or markers of inflammation in the airway. These findings raise the possibility that infection and inflammation may progress independently of CFTR activity once cystic fibrosis lung disease is established. OBJECTIVES: To better understand the relationship between CFTR activity, airway microbiology and inflammation, and lung function in subjects with cystic fibrosis and chronic airway infections. METHODS: We studied 12 subjects with G551D-CFTR mutations and chronic airway infections before and after ivacaftor. We measured lung function, sputum bacterial content, and inflammation, and obtained chest computed tomography scans. MEASUREMENTS AND MAIN RESULTS: Ivacaftor produced rapid decreases in sputum Pseudomonas aeruginosa density that began within 48 hours and continued in the first year of treatment. However, no subject eradicated their infecting P. aeruginosa strain, and after the first year P. aeruginosa densities rebounded. Sputum total bacterial concentrations also decreased, but less than P. aeruginosa. Sputum inflammatory measures decreased significantly in the first week of treatment and continued to decline over 2 years. Computed tomography scans obtained before and 1 year after ivacaftor treatment revealed that ivacaftor decreased airway mucous plugging. CONCLUSIONS: Ivacaftor caused marked reductions in sputum P. aeruginosa density and airway inflammation and produced modest improvements in radiographic lung disease in subjects with G551D-CFTR mutations. However, P. aeruginosa airway infection persisted. Thus, measures that control infection may be required to realize the full benefits of CFTR-targeting treatments.

Imaging of Occupational Lung Disease.

Occupational lung diseases span a variety of pulmonary disorders caused by inhalation of dusts or chemical antigens in a vocational setting. Included in these are the classic mineral pneumoconioses of silicosis, coal worker's pneumoconiosis, and asbestos-related diseases as well as many immune-mediated and airway-centric diseases, and new and emerging disorders. Although some of these have characteristic imaging appearances, a multidisciplinary approach with focus on occupational exposure history is essential to proper diagnosis.

The functional single ventricle: how imaging guides treatment.

Functional single ventricle (FSV) encompasses a spectrum of severe congenital heart disease. Patients with FSV are living longer than decades prior resulting in more frequent imaging both for surgical planning and functional evaluation. At each stage of surgical intervention, imaging plays a critical role in detecting postoperative complications and preprocedural planning. This article describes the unique imaging findings, including complications, that are most important to the referring physician or surgeon at each surgical stage of FSV management. A description of lesions that embody the diagnosis of FSV is also included.

A Quantitative Approach to Distinguish Pneumonia From Atelectasis Using Computed Tomography Attenuation.

OBJECTIVE: It is known that atelectasis demonstrates greater contrast enhancement than pneumonia on computed tomography (CT). However, the effectiveness of using a Hounsfield unit (HU) threshold to distinguish pneumonia from atelectasis has never been shown. The objective of the study is to demonstrate that an HU threshold can be quantitatively used to effectively distinguish pneumonia from atelectasis. METHODS: Retrospectively identified CT pulmonary angiogram examinations that did not show pulmonary embolism but contained nonaerated lungs were classified as atelectasis or pneumonia based on established clinical criteria. The HU attenuation was measured in these nonaerated lungs. Receiver operating characteristic (ROC) analysis was performed to determine the area under the ROC curve, sensitivity, and specificity of using the attenuation to distinguish pneumonia from atelectasis. RESULTS: Sixty-eight nonaerated lungs were measured in 55 patients. The mean (SD) enhancement was 62 (18) HU in pneumonia and 119 (24) HU in atelectasis (P < 0.001). A threshold of 92 HU diagnosed pneumonia with 97% sensitivity (confidence interval [CI], 80%-99%) and 85% specificity (CI, 70-93). Accuracy, measured as area under the ROC curve, was 0.97 (CI, 0.89-0.99). CONCLUSIONS: We have established that a threshold HU value can be used to confidently distinguish pneumonia from atelectasis with our standard CT pulmonary angiogram imaging protocol and patient population. This suggests that a similar threshold HU value may be determined for other scanning protocols, and application of this threshold may facilitate a more confident diagnosis of pneumonia and thus speed treatment.