Firefighters\u27 physical activity across multiple shifts of planned burn work

Little is currently known about the physical activity patterns of workers in physically demanding populations. The aims of this study were to (a) quantify firefighters\u27 physical activity and sedentary time within (2-h periods) and across planned burn shifts; and (b) examine whether firefighters\u27 activity levels during one shift or 2-h period was associated with their activity levels in the following shift or 2-h period. Thirty-four salaried firefighters (26 men, 8 women) wore an Actical accelerometer for 28 consecutive days. Time spent sedentary (SED) and in light- (LPA), moderate- (MPA) and vigorous-intensity physical activity (VPA) were derived using validated cut-points. Multilevel analyses (shift, participant) were conducted using generalised linear latent and mixed models. Firefighters spent the majority of a planned burn shift (average length 10.4 h) or 2-h period engaged in LPA (69% and 70%, respectively). No significant associations were observed between SED and physical activity levels between consecutive planned burned shifts or 2-h periods. The physical activity that a firefighter engaged in during one shift (or 2-h period) did not subsequently affect their physical activity levels in the subsequent shift (or 2-h period). Further research is needed to establish how workers in physically demanding populations are able to sustain their activity levels over long periods of time

Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016

BACKGROUND: In 2015, there were approximately 40,000 new HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP. METHODS AND FINDINGS: We analyzed prescription drug claims for individuals prescribed PrEP in the Integrated Dataverse (IDV) from Symphony Health for the period of September 2015 to August 2016 to describe PrEP patients, prescribers, relative uptake, and payment methods in the US. Data were available for 75,839 individuals prescribed PrEP, and findings were extrapolated to approximately 101,000 individuals, which is less than 10% of the 1.1 million adults for whom PrEP was indicated. Compared to individuals with newly diagnosed HIV infection, PrEP patients were more likely to be non-Hispanic white (45% versus 26.2%), older (25% versus 19% at ages 35-44), male (94% versus 81%), and not reside in the South (30% versus 52% reside in the South).Using a ratio of the number of PrEP patients within an MSA to the number of newly diagnosed individuals with HIV infection, we found MSAs with relatively low uptake of PrEP were concentrated in the South. Of the approximately 24,000 providers who prescribed PrEP, two-thirds reported primary care as their specialty. Compared to the types of payment methods that people living with diagnosed HIV (PLWH) used to pay for their antiretroviral treatment in 2015 to 2016 reported in the Centers for Disease Control and Prevention (CDC) HIV Surveillance Special Report, PrEP patients were more likely to have used commercial health insurance (80% versus 35%) and less likely to have used public healthcare coverage or a publicly sponsored assistance program to pay for PrEP (12% versus 45% for Medicaid). Third-party payors covered 95% of the costs of PrEP. Overall, we estimated the median annual per patient out-of-pocket spending on PrEP was approximately US$72. Limitations of this study include missing information on prescription claims of patients not included in the database, and for those included, some patients were missing information on patient diagnosis, race/ethnicity, educational attainment, and income (34%-36%). CONCLUSIONS: Our findings indicate that in 2015-2016, many individuals in the US who could benefit from being on PrEP were not receiving this HIV prevention medication, and those prescribed PrEP had a significantly different distribution of characteristics from the broader population that is at risk for acquiring HIV. PrEP patients were more likely to pay for PrEP using commercial or private insurance, whereas PLWH were more likely to pay for their antiretroviral treatment using publicly sponsored programs. Addressing the affordability of PrEP and otherwise promoting its use among those with indications for PrEP represents an important opportunity to help end the HIV epidemic

Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study

Background: There is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability.Objective: This study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children’s physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives; (2) determine use of different features and functions incorporated into the accompanying app; and (3) identify parents’ awareness of their child’s current physical activity levels.Methods: In total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25; 21 mothers and 4 fathers) completed a Web-based survey to record their child’s activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subsample of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts.Results: Parents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports.Conclusions: Most parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children’s daily activity. However, several barriers were identified, which may impact sustained use over time; both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Emergency nurses’ activity levels across rotating shifts

Chappel, SE ORCiD: 0000-0001-6559-8929Background: Emergency nurses work consecutive, rotating shift patterns. However, how their occupational physical activity levels are associated between these shifts is unknown. This study aimed to examine the associations between emergency nurses’ time spent in different activity levels across one shift and the following day's shift. Methods: Fifty emergency nurses (45 female, five male) wore an ActiGraph accelerometer and completed work and sleep diaries across four weeks in 2018. A sub-sample (n = 42) also wore an activPAL inclinometer. Time spent sedentary, physically active, and in postural positions was determined. Multi-level analyses examined associations between one shift and the following day's shift. Results: Additional time spent sedentary and in light-intensity physical activity during the first shift was associated with more time spent being physically active in the following day's shift for all rotations except back-to-back night shifts. However, additional time spent engaged in moderate- to vigorous-intensity physical activity during the first shift was associated with less time spent physically active in the following day's shift for afternoon-morning and morning-afternoon rotations. Conclusion: These findings demonstrate that shift sequences may impact emergency nurses’ physical activity across shifts. Future research should identify the strategies emergency nurses use to maintain activity levels between shifts. © 2020 College of Emergency Nursing Australasi

The accumulation of, and associations between, nurses’ activity levels within their shift in the emergency department

The aim of this study was to examine emergency nurses’ activity levels and associations between hourly activity levels within-shifts. Fifty emergency nurses (45 females, 5 males) wore ActiGraph accelerometers and completed work diaries for up to 4 weeks. A sub-group (n = 42) also wore activPALs. Multilevel analyses examined temporal associations between hourly periods. In any hourly period, increased time spent in moderate- to vigorous-intensity physical activity (MVPA) was associated with less time spent in MVPA in the following hourly period. In any afternoon hourly period, increased time spent in MVPA was associated with more time spent in light-intensity physical activity in the following hourly period. No other associations were significant. Emergency nurses maintain activity levels within-shifts, except when more time spent in MVPA was associated with less time spent in MVPA in the following hour; a potential recovery strategy. Future research should determine how emergency nurses maintain their activity levels within-shifts. Practitioner Summary: Emergency nursing is physically demanding; however, it is unknown how active they are during hourly periods within-shifts. Emergency nurses' activity levels were maintained within hourly periods of a shift. Except for an increase in MVPA in 1 h was associated with a decrease in MVPA in the following hour. Abbreviations: CPR: cardiopulmonary resusitation; LPA: light-intensity physical activity; MPA: moderate-intenisty physical activity; MVPA: moderate- to vigorous-intensity physical activity; SED: sedentary. © 2020 Informa UK Limited, trading as Taylor & Francis Group

Translatability of a wearable technology intervention to increase adolescent physical activity: mixed methods implementation evaluation

Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents&rsquo; and teachers&rsquo; perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field

Hot, tired and hungry: the snacking behaviour and food cravings of firefighters during multi-day simulated wildfire suppression

Firefighters are exposed to numerous stressors during wildfire suppression, including working in hot temperatures and sleep restricted conditions. Research has shown that when sleep restricted, individuals choose foods higher in carbohydrates, fat, and sugar, and have increased cravings for calorie dense foods. However, there is currently no research on the combined effect of heat and sleep restriction on snacking behaviour. Conducting secondary analyses from a larger study, the current study aimed to investigate the impact of heat and sleep restriction on snacking behaviour and food cravings. Sixty-six firefighters completed three days of simulated physically demanding firefighting work and were randomly allocated to either the control (n = 18, CON; 19 &deg;C, 8h sleep opportunity), sleep restricted (n = 16, SR; 19 &deg;C, 4-h sleep opportunity), hot (n = 18, HOT; 33 &deg;C, 8h sleep opportunity), or hot and sleep restricted (n = 14 HOT + SR; 33 &deg;C, 4-h sleep opportunity) condition. During rest periods firefighters were able to self-select sweet, savoury, or healthy snacks from a ration pack and were asked to rate their hunger, fullness, and cravings every two hours (eating block). Mixed model analyses revealed no difference in total energy intake between conditions, however there was a significant interaction between eating block and condition, with those in the CON, HOT, and HOT + SR condition consuming significantly more energy between 1230 and 1430 compared to the SR condition (p = 0.002). Sleep restriction and heat did not impact feelings of hunger and fullness across the day, and did not lead to greater cravings for snacks, with no differences between conditions. These findings suggest that under various simulated firefighting conditions, it is not the amount of food that differs but the timing of food intake, with those that are required to work in hot conditions while sleep restricted more likely to consume food between 1230 and 1430. This has potential implications for the time of day in which a greater amount of food should be available for firefighters