Investigation into the relationship between adolescents’ perceived and actual fundamental movement skills and physical activity

Abstract Objectives: To explore the relationship between fundamental movement skill (FMS) competence, perceived FMS competence and physical activity (PA) in adolescents. Methods: The Test of Gross Motor Development (TGMD), the TGMD-2 and the Victorian Skills manual were used to assess FMS competence (locomotor, object control and stability). The Physical Self Confidence scale was used to assess perceived FMS competence (locomotor, object control and stability). Moderate to vigorous intensity PA (MVPA) was measured via accelerometry. Multi-level modelling analyses was used to examine: (i) actual FMS as the predictor and perceived FMS as the outcome, (ii) perceived FMS as the predictor and MVPA as the outcome, and (iii) actual FMS as the predictor and MVPA as the outcome. All analyses were completed for each subtest of FMS (locomotor, object control and stability). Results: A total of 584 adolescents (boys n = 278) aged 12.82 – 15.25 years (M 13.78, SD .42) participated in this study. Actual stability was associated with perceived stability (p<.01) and MVPA (p<.05) in boys. This was not found true for girls, however actual locomotor skills were associated with MVPA (p≤.05). Boys scored significantly higher than girls for FMS proficiency, perceived FMS and MVPA (p<.05). Discussion: Gender differences may exist due to cultural gender differences in sport participation norms. Considering the magnitude of physical and psychological changes occurring during adolescence, it is recommended to track young people over time to better understand the relationship between perceived and actual FMS, as well as PA participation. Keywords: physical activity, motor competence, adolescent

The Youth-Physical Activity Towards Health (Y-PATH) intervention: Results of a 24 month cluster randomised controlled trial

Low levels of physical activity in youth are an issue internationally, with the age related decline in levels over the adolescent period of particular concern. This study evaluated a multi-component school-based intervention (Y-PATH: Youth-Physical Activity Towards Health), focused on halting the age-related decline in physical activity of youth in early adolescence. A cluster randomized controlled trial in 20 post primary schools (10 control, 10 intervention) was conducted. Data were collected from all 20 schools at baseline (2013), and 12 months (2014), and from 10 of these schools (5 intervention) at 24 months (2015). The setting was mixed gender post primary schools residing in the greater area of Dublin, Ireland. Principals from each school were asked to nominate one first year class group attending their school in September 2013 to participate in the study (N = 564). Intervention schools implemented the Y-PATH whole school intervention, comprising teacher component, parent component, and PE component; while control schools continued with usual care. The main outcome measure was accelerometer derived average minutes of daily moderate to vigorous physical activity (MVPA). Data were analysed from October 2015 -November 2017. At baseline 490 participants were assessed (mean age 12.78y ± .42). Results of the multilevel regression analysis confirmed that there was a significant time intervention effect, and this was predominantly contributed by the difference between control and intervention groups within females. Findings support the case for national dissemination of the Y-PATH intervention so that the knowledge learned can be translated to routine practice in schools

Reducing delays in the diagnosis and treatment of muscle-invasive bladder cancer using simulation modelling

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this record Objective: To develop a simulation model to identify key bottlenecks in the bladder cancer pathway at Royal Cornwall Hospital and predict the impact of potential changes to reduce these delays. Materials and methods: The diagnosis and treatment of muscle-invasive bladder cancer can suffer numerous delays, which can significantly affect patient outcomes. We developed a discrete event computer simulation model of the flow of patients through the bladder cancer pathway at the hospital, using anonymised patient records from 2014 and 2015. The changes tested in the model were for patients suspected to have muscle-invasive disease on flexible cystoscopy. Those patients were ‘fast-tracked’ to receive their transurethral resection of bladder tumour (TURBT) treatment using operating slots kept free for these patients. A staging computed tomography scan was booked in the haematuria clinic. Pathology requests were marked as 48 hour turnaround. The nurse specialist would then speak to the patient whilst they were on the ward following their TURBT to give information about their ongoing treatment and provide support. Results: The model predicted that if the changes were implemented, delays in the system could be reduced by around 5 weeks. The changes were implemented, and analysis of 3 months of the data post-implementation shows that the average time in the system was reduced by 5 weeks. The environment created by the changes in the pathway improved referral to treatment times in both muscle-invasive and non-muscle-invasive groups. Conclusion: The simulation model proved an invaluable tool for facilitating the implementation of changes. Simple changes to the pathway led to significant reductions in delays for bladder cancer patients at Royal Cornwall Hospital. Level of evidence: Not applicable for this cohort study.National Institute for Health Research (NIHR

Engaging stakeholders in research to address water-energy-food (WEF) nexus challenges

The water–energy–food (WEF) nexus has become a popular, and potentially powerful, frame through which to analyse interactions and interdependencies between these three systems. Though the case for transdisciplinary research in this space has been made, the extent of stakeholder engagement in research remains limited with stakeholders most commonly incorporated in research as end-users. Yet, stakeholders interact with nexus issues in a variety of ways, consequently there is much that collaboration might offer to develop nexus research and enhance its application. This paper outlines four aspects of nexus research and considers the value and potential challenges for transdisciplinary research in each. We focus on assessing and visualising nexus systems; understanding governance and capacity building; the importance of scale; and the implications of future change. The paper then proceeds to describe a novel mixed-method study that deeply integrates stakeholder knowledge with insights from multiple disciplines. We argue that mixed-method research designs—in this case orientated around a number of cases studies—are best suited to understanding and addressing real-world nexus challenges, with their inevitable complex, non-linear system characteristics. Moreover, integrating multiple forms of knowledge in the manner described in this paper enables research to assess the potential for, and processes of, scaling-up innovations in the nexus space, to contribute insights to policy and decision making

During a winter of storms in a small UK catchment, hydrology and water quality responses follow a clear rural-urban gradient

This paper presents the hydrological and water quality response from a series of extreme storm events that passed across the UK during the winter of 2013/2014, in an experimental catchment with a strong rural-urban gradient across four nested sub-catchment areas. The Ray catchment in the upper Thames basin, UK, was extensively monitored using in-situ, high-resolution (15 minute) flow and water quality instrumentation. Dissolved oxygen, ammonium, turbidity and specific conductivity are used to characterise the water quality dynamics. The impact of the Swindon sewage treatment works (SSTW) on water chemistry at the catchment outlet is considerable. Hydrological and water-quality response varies considerably during the events, with the rural catchments exhibiting a much slower hydrological response compared to urban areas. A simple hydrological model (TETIS) was developed to provide insight into water sources in nested subcatchments, highlighting the disparity of the hydrological dynamics across contrasting land-uses during events. The variation in stormwater runoff sources impacts water quality signals with urban sites contributing to dilution dynamics in ammonium, whereas the more rural site experiences a peak in ammonium during the same event. Dissolved oxygen concentrations vary on a rural-urban gradient and experience a notable sag at the Water Eaton outlet (4.4mg/l) during the events, that would have resulted in significant ecological harm had they occurred during the summer in warmer temperatures. The water-quality legacy of these storms in the wider context of the hydrological year is somewhat negligible, with markedly poorer water quality signals being observed during the summer months of 2014. Although ammonium concentrations during the events are elevated (above the ‘good’ status threshold under the WFD), higher values are observed during spring and summer months. The high flows actually appear to flush contaminants out of the Ray and its subcatchments, though the urban sites demonstrate a resupply dynamic during interim dry periods. Data suggest winter storms following dry spells in urban catchments cause some short-lived and spatially extensive deteriorations in water quality. More chronic effects, although prolonged, are only seen downstream of SSTW. These are indicative of capacity of infrastructure being reached, and from the data do not appear to be severe enough to cause ecological harm

Genetically Determined Uric Acid and the Risk of Cardiovascular and Neurovascular Diseases: A Mendelian Randomization Study of Outcomes Investigated in Randomized Trials.

Background Higher serum uric acid levels are associated with cardiovascular and neurovascular disease, but whether these relationships are causal is not known. We applied Mendelian randomization approaches to assess the association between genetically determined uric acid levels and outcomes under study in large clinical trials. Methods and Results We used 28 genetic variants related to serum uric acid as instruments to perform a range of 2-sample Mendelian randomization methods. Our analysis had statistical power to detect clinically relevant effects of genetically determined serum uric acid levels on the considered clinical outcomes; cognitive function, Alzheimer disease, coronary heart disease, myocardial infarction, systolic blood pressure, and stroke. There was some suggestive evidence for an association between higher genetically determined serum uric acid and cognitive function. There was also some suggestive evidence of a relationship between coronary heart disease, systolic blood pressure, and the serum uric acid genetic instruments, but likely related to genetic pleiotropy. Overall, there was no consistent evidence of a clinically relevant effect of genetically determined serum uric acid on any of the considered outcomes. Conclusions This Mendelian randomization study does not support a clinically relevant causal effect of genetically determined serum urate on a range of cardiovascular and neurovascular outcomes. The weak association of genetically determined serum urate with coronary heart disease and systolic blood pressure may be because of pleiotropic effects. If urate lowering drugs such as allopurinol are found to affect these outcomes in clinical trials, then the effects may be mediated through urate independent mechanisms

Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial

Abstract Introduction Benzodiazepines and α2 adrenoceptor agonists exert opposing effects on innate immunity and mortality in animal models of infection. We hypothesized that sedation with dexmedetomidine (an α2 adrenoceptor agonist), as compared with lorazepam (a benzodiazepine), would provide greater improvements in clinical outcomes among septic patients than among non-septic patients. Methods In this a priori-determined subgroup analysis of septic vs non-septic patients from the MENDS double-blind randomized controlled trial, adult medical/surgical mechanically ventilated patients were randomized to receive dexmedetomidine-based or lorazepam-based sedation for up to 5 days. Delirium and other clinical outcomes were analyzed comparing sedation groups, adjusting for clinically relevant covariates as well as assessing interactions between sedation group and sepsis. Results Of the 103 patients randomized, 63 (31 dexmedetomidine; 32 lorazepam) were admitted with sepsis and 40 (21 dexmedetomidine; 19 lorazepam) without sepsis. Baseline characteristics were similar between treatment groups for both septic and non-septic patients. Compared with septic patients who received lorazepam, the dexmedetomidine septic patients had 3.2 more delirium/coma-free days (DCFD) on average (95% CI for difference, 1.1 to 4.9), 1.5 (-0.1, 2.8) more delirium-free days (DFD) and 6 (0.3, 11.1) more ventilator-free days (VFD). The beneficial effects of dexmedetomidine were more pronounced in septic patients than in non-septic patients for both DCFDs and VFDs (P-value for interaction = 0.09 and 0.02 respectively). Additionally, sedation with dexmedetomidine, compared with lorazepam, reduced the daily risk of delirium [OR, CI 0.3 (0.1, 0.7)] in both septic and non-septic patients (P-value for interaction = 0.94). Risk of dying at 28 days was reduced by 70% [hazard ratio 0.3 (0.1, 0.9)] in dexmedetomidine patients with sepsis as compared to the lorazepam patients; this reduction in death was not seen in non-septic patients (P-value for interaction = 0.11). Conclusions In this subgroup analysis, septic patients receiving dexmedetomidine had more days free of brain dysfunction and mechanical ventilation and were less likely to die than those that received a lorazepam-based sedation regimen. These results were more pronounced in septic patients than in non-septic patients. Prospective clinical studies and further preclinical mechanistic studies are needed to confirm these results. Trial Registration NCT00095251