Protocol for a cluster randomised waitlist-controlled trial of a goal-based behaviour change intervention for employees in workplaces enrolled in health and wellbeing initiatives.

Many workplaces offer health and wellbeing initiatives to their staff as recommended by international and national health organisations. Despite their potential, the influence of these initiatives on health behaviour appears limited and evaluations of their effectiveness are rare. In this research, we propose evaluating the effectiveness of an established behaviour change intervention in a new workplace context. The intervention, 'mental contrasting plus implementation intentions', supports staff in achieving their health and wellbeing goals by encouraging them to compare the future with the present and to develop a plan for overcoming anticipated obstacles. We conducted a systematic review that identified only three trials of this intervention in workplaces and all of them were conducted within healthcare organisations. Our research will be the first to evaluate the effectiveness of mental contrasting outside a solely healthcare context. We propose including staff from 60 organisations, 30 in the intervention and 30 in a waitlisted control group. The findings will contribute to a better understanding of how to empower and support staff to improve their health and wellbeing. Trial registration: ISRCTN17828539

A qualitative evaluation of a novel intervention using insight into tobacco industry tactics to prevent the uptake of smoking in school-aged children

Background: Evidence from the US Truth campaign suggests that interventions focusing on tobacco industry tactics can be effective in preventing smoking uptake by children. Operation Smoke Storm is the first school-based intervention based on this premise and comprises three classroom sessions in which students act as secret agents uncovering tobacco industry tactics through videos, quizzes, discussions, and presentations. We report a qualitative evaluation of its acceptability. Methods: We conducted eight focus groups with 79 students aged 11-12 who participated in Operation Smoke Storm at two UK schools in Autumn 2013, and 20 interviews with teachers who delivered the intervention. These were digitally audio-recorded, transcribed verbatim and analysed using the framework method. Results: Students enjoyed the secret agent scenario and reported acquiring new knowledge about smoking and the tobacco industry, which seemed to strengthen their aversion to smoking. Teachers felt confident delivering the ‘off the shelf’ resource, although they would have welcomed more background information about the topic and guidance on steering discussions. Teachers highlighted a need for the resource to be flexible and not dependent on lesson length, teacher confidence, or expertise. Students and teachers endorsed the idea of developing a booster component for older students and supported the development of printed information complementing the resource to encourage parents to support their child not to smoke. Conclusions: These findings demonstrate that Operation Smoke Storm can be delivered by teachers to raise awareness about smoking-related issues. The ideas and issues raised are now being used to improve and extend the resource for further evaluation

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A metacognitive approach to teaching reading comprehension in the primary school classroom

The following thesis considers the relevance of motacognitive theory to the development of children's reading comprehension. It does so by evaluating the effects of a metacomprehension training programme on children's reading comprehension. In so doing the thesis draws together the three strands of theory, teaching practice, and educational policy (i. e., 5-14 English Language Guidelines, SOED, 1991) within the context of a Scottish primary school classroom. A pilot study was designed to investigate whether or not children were currently being taught metacomprehension strategies. The pilot study therefore, looked at children's metacomprehension development using two different teaching media: one where a novel was used as the vehicle for improving children's reading comprehension and another where a mainstream reading scheme was used for the same purpose. No differences were found between the two teaching conditions and it was inferred that children were not currently being taught metacomprehension strategies. As a consequence of the results from the pilot study, the main research programme was designed to address two main research questions: 1. Can children be taught metacomprehension strategies by teachers? 2. Are there greater benefits for poor, as compared with good, readers? To investigate these questions a four stage research programme was undertaken comprising: I. the development of a metacomprehension teaching programme (Mr. Homunculus the Reading Detective). II. the instruction of teachers in metacomprehension theory, and in Mr. Homunculus the Reading Detective Ill. the application of the intervention programme by teachers to a group of Primary 5 children (mean age 9yrs 6mths), using a randomised controlled pre/post test design. IV. the evolution and refinement of appropriate metacomprehension measures Results were encouraging, suggesting that children could be taught to self-monitor and to regulate their reading behaviour. What was not clear was whether or not the children had improved their inferential comprehension as a result. A model of metacomprehension development based on the data obtained from the study was presented. Further elucidation of metacomprehension development, the specific effects of such development on reading comprehension for readers of different ages and reading ability, and better measures which tap the process, rather than the product of metacomprehension, were considered as worthy of further research.The following thesis considers the relevance of motacognitive theory to the development of children's reading comprehension. It does so by evaluating the effects of a metacomprehension training programme on children's reading comprehension. In so doing the thesis draws together the three strands of theory, teaching practice, and educational policy (i. e., 5-14 English Language Guidelines, SOED, 1991) within the context of a Scottish primary school classroom. A pilot study was designed to investigate whether or not children were currently being taught metacomprehension strategies. The pilot study therefore, looked at children's metacomprehension development using two different teaching media: one where a novel was used as the vehicle for improving children's reading comprehension and another where a mainstream reading scheme was used for the same purpose. No differences were found between the two teaching conditions and it was inferred that children were not currently being taught metacomprehension strategies. As a consequence of the results from the pilot study, the main research programme was designed to address two main research questions: 1. Can children be taught metacomprehension strategies by teachers? 2. Are there greater benefits for poor, as compared with good, readers? To investigate these questions a four stage research programme was undertaken comprising: I. the development of a metacomprehension teaching programme (Mr. Homunculus the Reading Detective). II. the instruction of teachers in metacomprehension theory, and in Mr. Homunculus the Reading Detective Ill. the application of the intervention programme by teachers to a group of Primary 5 children (mean age 9yrs 6mths), using a randomised controlled pre/post test design. IV. the evolution and refinement of appropriate metacomprehension measures Results were encouraging, suggesting that children could be taught to self-monitor and to regulate their reading behaviour. What was not clear was whether or not the children had improved their inferential comprehension as a result. A model of metacomprehension development based on the data obtained from the study was presented. Further elucidation of metacomprehension development, the specific effects of such development on reading comprehension for readers of different ages and reading ability, and better measures which tap the process, rather than the product of metacomprehension, were considered as worthy of further research

Group behavior and tolerance of Eurasian minnow (Phoxinus phoxinus) in response to tones of differing pulse repetition rate

Behavioral guidance systems are commonly used in freshwater fish conservation. The biological relevance of sound to fish and recorded responses to human-generated noise supports the viability of the use of acoustics as an effective stimulus in such technologies. Relatively little information exists on the long-term responses and recovery of fish to repeated acoustic exposures. In a controlled laboratory study, the response and tolerance of Eurasian minnow (Phoxinus phoxinus) shoals to tonal signals (150 Hz of 1 s pulse duration) differing only in temporal characteristics (‘continuous’, ‘slow’, ‘intermediate’, or ‘fast’ pulse repetition rate) were investigated. In comparison to independent control groups, fish increased their mean group swimming speed, decreased inter-individual distance and became more aligned in response to the onset of all four acoustic treatments. The magnitude of response, and time taken to develop a tolerance to a treatment differed according to pulse repetition rate. Groups were found to have the greatest and longest lasting response to tone sequences tested in this study when they were pulsed at an intermediate rate of 0.2 s-1. This study illustrates the importance of understanding the response of fish to acoustic signals, and will assist toward the development of longer-term effective acoustic guidance systems