Improved GNSS-R bi-static altimetry and independent DEMs of Greenland and Antarctica from TechDemoSat-1

Improved Digital Elevation Models (DEMs) of the Antarctic and Greenland Ice Sheets are presented, derived from Global Navigation Satellite Systems-Reflectometry (GNSS-R). This builds on a previous study (Cartwright et al., 2018) using GNSS-R to derive an Antarctic DEM but uses improved processing and an additional 13 months of measurements, totalling 46 months of data from the UK TechDemoSat-1 satellite. A median bias of under 10 m and root-mean-square (RMS) errors of under 53 m for the Antarctic and 166 m for Greenland are obtained, as compared to existing DEMs. The results represent, compared to the earlier study, a halving of the median bias to 9 m, an improvement in coverage of 18 %, and a four times higher spatial resolution (now gridded at 25 km). In addition, these are the first published satellite altimetry measurements of the region surrounding the South Pole. Comparisons south of 88° S yield RMS errors of less than 33 m when compared to NASA’s Operation IceBridge measurements. Differences between DEMs are explored and the future potential for ice sheet monitoring by this technique is noted

Monitoring the environmental impact of mining in remote locations through remotely sensed data

Mining is an integral part of the development of many countries in the Asia-Pacific region and is associated with adverse environmental and social impacts. The monitoring of mining in remote locations is problematic due to difficulties of access. Satellite remote sensing is able to provide information on landscape transformation in a cost-effective way around large-scale mines. The PT Freeport Indonesia mine in Papua (Indonesia) is the world's largest copper-gold mine and previous studies have documented a range of impacts. A multi-temporal analysis of Landsat 5 imagery of the Freeport area was undertaken for the years between 1988 and 2004. Anthropogenic land cover changes were quantified by screen digitising polygons from three false colour composite images over this period to determine the area of forested land that had been cleared and the area that had been affected by mine-derived sediment transported by the Ajkwa River system. The results show that both settlement and sediment had radically altered land cover and together had led to a sixfold increase in the area of ultra-diverse lowland tropical rainforest cleared in the study area. The study highlights the utility of this method to monitor elements of the impact of large-scale mining and other extensive forms of resource exploitation such as deforestation in developing countries

Continuous, risk-based, consultation peer review in out-of-hours general practice:a qualitative interview study of the benefits and limitations

Background: Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practice to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Aim: To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK. Design and setting: A qualitative interview study in South-West England. Method: Semi-structured interviews with intervention users (clinicians, peer-reviewers and clinical management), analysed by inductive thematic analysis and integrated into a programme theory. Results: 20 clinicians were interviewed between September 2018 - January 2019. Interviewees indicated the intervention supported clinician learning through improved peer-feedback; highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence; supporting standardisation of supervision, clinical governance and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation and organisational learning culture influenced the perception of the intervention as a support or stressor. Conclusion: Our findings demonstrate the potential of this methodology to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practice to their full potential. Our programme theory provides a theoretical basis to maximise its benefits and accommodate its potential limitations

Novel Energy Drink Improves Mood and Raises Blood Pressure, but has No Effect on Cardiac QTc Interval or Rate-Pressure Product in Young Adult Gamers

Novel energy drink formulations have been introduced to the market that are purported to have nootropic effects – including improving mood. Despite their rapidly growing popularity, especially among video gamers, there is minimal evidence supporting their efficacy or establishing their cardiovascular safety profiles. PURPOSE: We conducted a randomized, double-blind, placebo-controlled, crossover trial to investigate the effects of acute consumption of a non-caloric, novel energy drink (NED) containing 200 mg caffeine, citicoline, tyrosine, B-vitamins, and carboxylic acids on mood and cardiovascular safety outcomes. We hypothesized that NED would improve mood without significant adverse cardiovascular effects when compared to placebo. METHODS: Forty-five healthy young adults who routinely play video games (37M, 8F; mean ± SD, age = 25 ± 6 y) each completed two experimental study visits in randomized order where they consumed either NED or a placebo matched for volume, calories, taste, appearance, and mouthfeel. Resting systolic and diastolic blood pressure (SBP and DBP) and an electrocardiogram (ECG) were obtained from each participant after a 10-min quiescent period prior to and 45 minutes after consumption of NED or placebo. Resting heart rate (RHR) and corrected QT interval length (QTc) were derived from the ECG. Rate-pressure product (RPP) was determined as the product of HR and SBP. Mood was assessed using the Profile of Mood States at post-consumption after BP and ECG assessments. Paired t-tests or signed ranked tests (for non- normally distributed data) were used to examine between-condition differences in mood states, whereas 2 (condition) × 2 (time) ANOVAs were used to examine SBP, DBP, QTc, and RPP. RESULTS: Change scores are presented as mean absolute change ± 95% confidence interval. Relative changes are provided for mood data. Acute NED consumption improved fatigue-inertia (-1.4 ± 1.0 a.u. [+36%]; p = 0.004), vigor-activity (+2.4 ± 1.2 a.u. [+33%]; p \u3c 0.001), and friendliness (+0.7 ± 0.7 a.u. [+7%]; p = 0.04), without adverse effects on tension-anxiety, confusion-bewilderment, or depression-dejection (all p ≥ 0.27). RHR decreased from pre- to post-beverage consumption, and this decrease was greater following NED than placebo consumption (-6.0 ± 2.8 vs. -2.6 ± 1.4 bpm, p = 0.017). SBP (+3.7 ± 2.0 vs. -0.4 ± 2.0 mmHg; p = 0.002) and DBP (+3.7 ± 1.7 vs. -0.04 ± 1.4 mmHg; p = 0.003) increased following NED vs. placebo; however, RPP decreased independent of condition (-386.0 ± 229.0; p = 0.03), and there was no effect of beverage consumption on QTc (p = 0.44). CONCLUSION: Acute NED consumption improved mood states related to vigor, fatigue, and friendliness without affecting tension-anxiety, depression, or confusion in young adult gamers. While NED consumption produced mild increases in SBP and DBP, there were no effects on either QTc or RPP. Thus, overall, NED consumption produces mood-enhancing effects without markedly influencing cardiovascular safety outcomes

Blood tests in primary care:a qualitative study of communication and decision making between doctors and patients

OBJECTIVE: Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results, these aims may not be fulfilled. Shared decision‐making is widely advocated; yet, most research focusses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore communication and decision‐making around diagnostic blood tests in primary care. METHODS: Qualitative interviews were undertaken with patients and clinicians in UK primary care. Patients were interviewed at the time of blood testing, with a follow‐up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians' and patients' expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding. RESULTS: A total of 80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision‐making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing that they were protecting patients from anxiety. CONCLUSION: Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not have sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision‐making led to downstream consequences when test results did not fulfil patients' expectations. Although shared decision‐making is recommended as best practice, it does not reflect the reality of doctors' and patients' accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis. PATIENT OR PUBLIC CONTRIBUTION: A patient and public involvement group comprising five participants with lived experience of blood testing in primary care met regularly during the study. They contributed to the development of the research objectives, planning recruitment methods, reviewing patient information leaflets and topic guides and also contributed to discussion of emerging themes at an early stage in the analysis process

Correction to: Childhood disability in Malawi: a population based assessment using the key informant method.

Following the publication of this article [1] it was brought to our attention that inadvertently the COSECSA Oxford Orthopaedic Link (COOL) programme was not acknowledged for funding this study