Two Studies of Partnership Approaches to Comprehensive School Physical Activity Programming: A Process Evaluation and a Case Study

This dissertation consists of two studies that examine partnership approaches to comprehensive school physical activity programs (CSPAP). Both studies function in tandem to advance the knowledge base about school – university partnership approaches to CSPAP programming. Study 1 examined the first-year classroom component of the Partnerships for Active Children in Elementary Schools (PACES) intervention, and Study 2 examined the implementation of a Health Optimizing Physical Education (HOPE)- based CSPAP. Both studies utilized school-university partnerships in their design and implementation. The purpose of Study 1 was to examine the effects of different PACES treatment levels on classroom movement integration promotion during the first year of implementation, and qualitatively examine program implementation processes from the perspective of intervention classroom teachers. Four schools participated in the study. The first school received all three levels of the intervention (Community of Practice [CoP], Community-based Participatory Research, [CBPR], and Service Learning [SL]), the second school received two levels (CoP and CBPR), the third school received one level of the intervention (CoP), and the fourth school served as a waitlisted control. Three teachers from each school (N=12) participated. Process data were collected in the Fall 2014 (baseline) and Spring 2015 (~ four months of intervention) using the System for Observing Student Movement in Academic Routines and Transitions. Semi-structured interviews with the intervention teachers (n=9) were conducted after ~four months of intervention. There were no significant differences between intervention classrooms and control classroom in PA promotion, but differences in classrooms receiving two levels of the intervention (CoP+ CBPR) and three levels of the intervention (CoP+CBPR+SL) when compared to classrooms receiving one component of the intervention (CoP) and the control school were found. The difference between the classrooms receiving two or more intervention components when compared to classrooms receiving one component and the control classrooms were approaching significance (U = 5, p = 0.037, d=1.22). Quantitative and qualitative results supported the CBPR component having the most marked impact on classroom-based physical activity promotion. This study provides rich information about process variables in the context of a classroom-based physical activity intervention, and the types of support universities can offer schools for physical activity promotion. The purpose of Study 2 was to examine the enablers and barriers related to the development, implementation, and sustainability of a two-year university-supported HOPE based CSPAP implemented at a middle school. The study employed a qualitative case study design. The literature on program diffusion and school-university partnerships for CSPAP implementation and sustainability guided data collection, analysis, and interpretation of results. Semi-structured interviews were conducted with each member of the implementation team (n=5), the funding agency (n=1), each health-physical education teacher at the school (n=7), follow-up interviews with the implementation team (n=5), and a focus group interview with students (n=5). Documents were collected from the implementation team (e.g., field notes, meeting minutes) and from the teachers (e.g., lesson plans, newsletters, etc.). Next, prolonged field observations were conducted at the school during physical education, health, and before and after school programming. Data was coded using the theoretical model of program diffusion. Trustworthiness included member checking, data and researcher triangulation, researcher debriefing, and an audit trail. The findings about the implementation suggest that HOPE and CSPAP programming takes a lot of effort to implement, training should be centered on marketing, advocacy, and physical activity management, and needs assessments should be used before the start of new programming. Several components of the HOPE-based CSPAP sustained including before and after school programming and an annual 5k run. This study provides insider perspectives from health-physical educators, students, and a university intervention team about the implementation and sustainability of a HOPEbased CSPAP. The study suggests that program implementation and sustainability of a CSPAP are linked to strong external support mechanisms

Incorporating spatial information for microaneurysm detection in retinal images

The presence of microaneurysms(MAs) in retinal images is a pathognomonic sign of Diabetic Retinopathy (DR). This is one of the leading causes of blindness in the working population worldwide. This paper introduces a novel algorithm that combines information from spatial views of the retina for the purpose of MA detection. Most published research in the literature has addressed the problem of detecting MAs from single retinal images. This work proposes the incorporation of information from two spatial views during the detection process. The algorithm is evaluated using 160 images from 40 patients seen as part of a UK diabetic eye screening programme which contained 207 MAs. An improvement in performance compared to detection from an algorithm that relies on a single image is shown as an increase of 2% ROC score, hence demonstrating the potential of this method

A Spitzer IRS Spectral Atlas of Luminous 8 micron Sources in the Large Magellanic Cloud

We present an atlas of Spitzer Space Telescope Infrared Spectrograph (IRS) spectra of highly luminous, compact mid-infrared sources in the Large Magellanic Cloud. Sources were selected on the basis of infrared colors and 8 micron (MSX) fluxes indicative of highly evolved, intermediate- to high-mass stars with current or recent mass loss at large rates. We determine the chemistry of the circumstellar envelope from the mid-IR continuum and spectral features and classify the spectral types of the stars. In the sample of 60 sources, we find 21 Red Supergiants (RSGs), 16 C-rich Asymptotic Giant Branch (AGB) stars, 11 HII regions, 4 likely O-rich AGB stars, 4 Galactic O-rich AGB stars, 2 OH/IR stars, and 2 B[e] supergiants with peculiar IR spectra. We find that the overwhelming majority of the sample AGB stars (with typical IR luminosities ~1.0E4 L_sun) have C-rich envelopes, while the O-rich objects are predominantly luminous RSGs with L_IR ~ 1.0E5 L_sun. We determine mean bolometric corrections to the stellar K-band flux densities and find that for carbon stars, the bolometric corrections depend on the infrared color, whereas for RSGs, the bolometric correction is independent of IR color. Our results reveal that objects previously classified as PNe on the basis of IR colors are in fact compact HII regions with very red IRS spectra that include strong atomic recombination lines and PAH emission features. We demonstrate that the IRS spectral classes in our sample separate clearly in infrared color-color diagrams that use combinations of 2MASS data and synthetic IRAC/MIPS fluxes derived from the IRS spectra. On this basis, we suggest diagnostics to identify and classify, with high confidence levels, IR-luminous evolved stars and HII regions in nearby galaxies using Spitzer and near-infrared photometry.Comment: 46 pages, 9 figures; accepted for publication in AJ; abstract abridge

Bovine Neonatal Monocytes Display Phenotypic Differences Compared With Adults After Challenge With the Infectious Abortifacient Agent Neospora caninum

The neonatal period represents a window of susceptibility for ruminants given the abundance of infectious challenges in their environment. Maternal transfer of immunity does not occur in utero but post-parturition, however this does not compensate for potential deficits in the cellular compartment. Here we present a cellular and transcriptomic study to investigate if there is an age-related difference in the monocyte response in cattle during intra-cellular protozoan infection. We utilized Neospora caninum, an obligate intracellular protozoan parasite that causes abortion and negative economic impacts in cattle worldwide, to study these responses. We found neonatal animals had a significant greater percentage of CD14+ monocytes with higher CD80 cell surface expression. Adult monocytes harbored more parasites compared to neonatal monocytes; additionally greater secretion of IL-1β was observed in neonates. Microarray analysis revealed neonates have 535 genes significantly upregulated compared to adult with 23 upregulated genes. Biological pathways involved in immune response were evaluated and both age groups showed changes in the upregulation of tyrosine phosphorylation of STAT protein and JAK-STAT cascade pathways. However, the extent to which these pathways were upregulated in neonates was much greater. Our findings suggest that neonates are more resistant to cellular invasion with protozoan parasites and that the magnitude of the responses is related to significant changes in the JAK-STAT network

The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema

Aim: To assess the rate of ‘treatment-requiring diabetic macular oedema (DMO)’ in eyes for the two  years before and after cataract surgery. Methods: Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. Inclusion criteria: eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. Main outcome measure: rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye. Results: 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of ‘treatment-requiring DMO’ increased sharply after surgery, peaking in the 3–6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0–3, 3–6, 6–9 and 9–12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01). Conclusions: This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3–6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk

Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study

BackgroundIt is unclear what effect the pattern of health-care use before admission to hospital with COVID-19 (index admission) has on the long-term outcomes for patients. We sought to describe mortality and emergency readmission to hospital after discharge following the index admission (index discharge), and to assess associations between these outcomes and patterns of health-care use before such admissions.MethodsWe did a national, retrospective, complete cohort study by extracting data from several national databases and linking the databases for all adult patients admitted to hospital in Scotland with COVID-19. We used latent class trajectory modelling to identify distinct clusters of patients on the basis of their emergency admissions to hospital in the 2 years before the index admission. The primary outcomes were mortality and emergency readmission up to 1 year after index admission. We used multivariable regression models to explore associations between these outcomes and patient demographics, vaccination status, level of care received in hospital, and previous emergency hospital use.FindingsBetween March 1, 2020, and Oct 25, 2021, 33 580 patients were admitted to hospital with COVID-19 in Scotland. Overall, the Kaplan-Meier estimate of mortality within 1 year of index admission was 29·6% (95% CI 29·1-30·2). The cumulative incidence of emergency hospital readmission within 30 days of index discharge was 14·4% (95% CI 14·0-14·8), with the number increasing to 35·6% (34·9-36·3) patients at 1 year. Among the 33 580 patients, we identified four distinct patterns of previous emergency hospital use: no admissions (n=18 772 [55·9%]); minimal admissions (n=12 057 [35·9%]); recently high admissions (n=1931 [5·8%]), and persistently high admissions (n=820 [2·4%]). Patients with recently or persistently high admissions were older, more multimorbid, and more likely to have hospital-acquired COVID-19 than patients with no or minimal admissions. People in the minimal, recently high, and persistently high admissions groups had an increased risk of mortality and hospital readmission compared with those in the no admissions group. Compared with the no admissions group, mortality was highest in the recently high admissions group (post-hospital mortality HR 2·70 [95% CI 2·35-2·81]; pInterpretationLong-term mortality and readmission rates for patients hospitalised with COVID-19 were high; within 1 year, one in three patients had died and a third had been readmitted as an emergency. Patterns of hospital use before index admission were strongly predictive of mortality and readmission risk, independent of age, pre-existing comorbidities, and COVID-19 vaccination status. This increasingly precise identification of individuals at high risk of poor outcomes from COVID-19 will enable targeted support.FundingChief Scientist Office Scotland, UK National Institute for Health Research, and UK Research and Innovation