Encounters with Difference and Politics of Place: Meanings of Birdwatchers and Dog Walkers at a Multiple-Use Urban Forest

With a particular interest in birdwatchers and dog walkers, this case study explored place meanings of users at Westmount Summit Woods, a multiple-use urban forest located just west of downtown Montreal, Quebec, Canada. A document analysis was conducted on the research site, followed by data collected through online questionnaire. A total of 120 users participated in the online questionnaire, of which included birdwatchers (n=44), dog walkers (n=61), and the broader community (n=15). Three themes relating to place meaning were interpreted: (1) Attachment to and Preference for; (2) (Re)connection with Self and Others; and (3) Conflict Between and Within. Findings suggest encounters played key roles in the formation of social identity, capital, and conflict. Questions regarding access to and use of public space, how humans and animals are placed vis-à-vis one another, and ways to build civic culture out of difference were addressed. Following on from these findings, recommendations for outdoor recreation management and future research were offered

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Enhancing Access to Quality Rental Housing for People with Pets as Healthy Public Policy

When pets are considered in housing studies, attention tends to be paid towards vulnerable pet owners, namely in the context of homelessness, domestic violence situations, or disaster circumstances. Targeted interventions are important since vulnerable pet owners may risk their lives if they anticipate being separated from their pets or being turned away from shelters because of them. Intervention strategies that target the whole population are also needed, however, since pets are regularly restricted, if not banned outright, from the private rental sector and in social housing. Moreover, a “no pets” policy may force homeowners, specifically condominium or strata owners, to give up their pets. This thesis is comprised of three papers linking housing, health, and pet ownership in Calgary, Alberta, Canada. As a relatively new area of study, issues surrounding housing accessibility, affordability, location, and quality among pet owners were mainly explored qualitatively. The first paper drew upon online rental listings and focused on housing recovery for tenants with pets in the aftermath of a flood. The second paper moved beyond disaster circumstances and compared perspectives towards pets in rental housing more generally. Finally, the need to address housing issues for pet owners must be considered within the context of social, economic, and demographic pressures. Millennials not only represent a majority of pet owners today, they are also disproportionately tenants and they tend to move frequently. As a result, the third paper considered what life is like for millennials with dogs once they are housed in the rental market, paying close attention to the potential influence of pet ownership on their identities, relationships, and environments. Overall, this thesis begins to answer important questions about how restrictive policies on pets in rental housing impacts human health and development. Without the proper supports in place, people with access to fewer resources may face greater challenges keeping their pets, because they cannot opt for homeownership. Improvements in access to housing for pet owners, and integrated programs and services to support pet ownership in housing and neighbourhood contexts, are essential to addressing animal relinquishment and to reducing inequities in health outcomes among pet owners

After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay : a systematic review

Question: In adults undergoing inpatient rehabilitation, does additional after-hours rehabilitation decrease length of stay and improve functional outcome, activities of daily living performance and physical activity? Design: Systematic review with meta-analysis of randomised trials. Participants: Adults participating in an inpatient rehabilitation program. Intervention: Additional rehabilitation provided after hours (evening or weekend). Outcome measures: Function was measured with tests such as the Motor Assessment Scale, 10-m walk test, the Timed Up and Go test, and Berg Balance Scale. Performance on activities of daily living was measured with the Barthel index or the Functional Independence Measure. Length of stay was measured in days. Physical activity levels were measured as number of steps or time spent upright. Standardised mean differences (SMD) or mean differences (MD) were used to combine these outcomes. Adverse events were summarised using relative risks (RR). Study quality was assessed using PEDro scores. Results: Seven trials were included in the review. All trials had strong methodological quality, scoring 8/10 on the PEDro scale. Among the measures of function, only balance showed a significant effect: the MD was 14 points better (95% CI 5 to 23) with additional after-hours rehabilitation on a 0-to-56-point scale. The improvement in activities of daily living performance with additional after-hours rehabilitation was of borderline statistical significance (SMD 0.10, 95% CI 0.00 to 0.21). Hospital length of stay did not differ significantly (MD –1.8 days, 95% CI –5.1 to 1.6). Those receiving additional rehabilitation had significantly higher step counts and spent significantly more time upright. Overall, the risk of adverse events was not increased by the provision of after-hours or weekend rehabilitation (RR 0.87, 95% CI 0.70 to 1.10). Conclusion: Additional after-hours rehabilitation can increase physical activity and may improve activities of daily living, but does not seem to affect the hospital length of stay. An errata exists for this article, and can be found at http://doi.org/10.1016/j.jphys.2015.08.0087 page(s

Dogs and the Good Life: A Cross-Sectional Study of the Association Between the Dog–Owner Relationship and Owner Mental Wellbeing

Dog ownership is believed to benefit owner wellbeing but, contrary to popular belief, there is limited evidence to suggest that simply owning a dog is associated with improved mental health. This mixed-methods study investigates whether dog owners with stronger relationships with their dogs experience better mental health. Participants (n = 1,693, adult United Kingdom dog owners) completed an online survey. Owners’ health was measured using the validated PROMIS questions regarding depression, anxiety, emotional support, and companionship. The dog–owner relationship was measured using the validated MDORS scale, which has three subscales: interaction, emotional closeness, and perceived costs. Univariable and multivariable linear regression analyses were conducted, adjusting for confounding factors. Additionally, positive and negative impacts of dog ownership on mental wellbeing were coded from open questions using thematic analysis. A stronger dog–owner relationship was associated with greater feelings of emotional support and companionship but poorer mental health in terms of anxiety or depression. However, the perceived costs (burden) subscale was consistently associated with better mental health outcomes. Direction of causality cannot be inferred as people with poor mental health may acquire dogs to help relieve symptoms, which qualitative analysis supported. Key themes included positive impacts on owner wellbeing and happiness through providing purpose, companionship and self-acceptance, pleasure and distraction, as well as lessening emotional pain and suffering and reducing risk behaviors. However, negative impacts of a strong relationship include anticipatory grief over loss of the dog, and concerns regarding the burden of responsibility and ability to meet dog’s needs. Perceived ability to adequately meet dog’s needs promoted personal growth and positive relationships with others, whereas perceived inability led to feelings of guilt, or anger/frustration, and reduced autonomy and sense of environmental mastery. Dog ownership contributes to both hedonic and eudaimonic wellbeing in multiple ways, including supporting owners through periods of poor mental health and providing purpose. However, the burden of responsibility and owner and dog characteristics can create challenges, and owners may benefit from support in caring for their dogs and reducing problematic behaviors.</jats:p

“Pets Negotiable”: How Do the Perspectives of Landlords and Property Managers Compare with Those of Younger Tenants with Dogs?

Previous research has shown that housing insecurity contributes to animal relinquishment and that tenants with dogs face disadvantages in the rental market. Still, little is known about how dog owners navigate rental markets, nor how landlords and property managers perceive dogs and other pets. This case study reports on in-depth interviews with younger tenants with dogs and on open-ended survey responses from landlords and property managers. In their housing searches, tenants with dogs reported feeling powerless in negotiations and feeling discriminated against. They described settling for substandard properties, often located in less desirable neighborhoods. Also, some said they felt obliged to stay put in these rentals, given how difficult it had been to find a place that would accommodate their dogs. Meanwhile, landlords and property managers indicated that listings advertised as “pet-friendly” tend to receive more applicants than listings in which pets are prohibited. Suggestions for improvement included meeting pets prior to signing the lease; getting everything in writing; steering clear from furnished units; charging utilities to tenants; and speeding up the pet approval process when dealing with condominium boards. These suggestions offer implications for future research, partnerships, and policy options to improve the prospects of pets and their people in rental housing

Dog Walking before and during the COVID-19 Pandemic Lockdown: Experiences of UK Dog Owners

Background: This study investigated the impacts of the first COVID-19 UK lockdown on dog walking and ownership. Methods: An online survey was circulated via social media (May–June 2020). Completed responses (n = 584) were analysed using within- and between-group comparisons, and multivariable linear and logistic regression models were created. Open-ended data were coded into key themes. Results: During lockdown, dogs were walked less frequently, yet for a similar duration per week and closer to home. Dogs whose owners lived alone, or whose owners or household members had heightened vulnerability to COVID-19 were walked less than before, as were high-energy dogs. A minority of owners continued dog walking despite exhibiting symptoms or needing to self-isolate, justifying lack of help, dog behavioural problems, living in less populated areas, and the importance of outdoor exercise for their mental health. Dog ownership had multiple benefits (companionship, purpose and motivation; break from bad; positive to focus on) as well as challenges (changes in dog behaviour, balancing dog needs with public health guidance, accessing pet food/supplies and services, and sharing crowded outdoor spaces with others). Most did not have an emergency care plan for their pet before the pandemic and only a handful developed one. Conclusions: Findings can be used to inform public health and dog welfare strategies for future lockdown situations or other disasters and emergencies likely to impact on daily routines

Changes in visitor profiles and activity patterns following dog supportive modifications to parks: A natural experiment on the health impact of an urban policy

Urban parks are important settings for physical activity, but few natural experiments have investigated the influences of park modifications on activity patterns and visitor profiles.We assessed the impact of implementing a municipal policy on off-leash dogs in city parks in Calgary (Alberta, Canada). Systematic observation undertaken in 2011 and 2012 within four parks captured patterns of use, activities, and visitors׳ characteristics. After baseline data collection, off-leash areas were created in two parks only. We compared changes in the sociodemographic and activity profiles in all parks between 2011 and 2012. Visitors with dogs participated in less intense activity relative to visitors without dogs. In both modified parks, the intensity of children׳s activities decreased, while the intensity of adults’ activities remained stable. Adjusting for visitor characteristics, the likelihood of dog-related visits, relative to other activities, significantly decreased in one of the two modified parks (odds ratio 0.55, p<.05). Accommodating off-leash dogs in parks has the potential to modify activities undertaken inside parks as well as the profile of visitors, but may not increase park visits among dog-walkers in the short term. Recreation, park, and urban planners and policy-makers need to consider the needs and preferences of the broader community in the design and redesign of public parks. Keywords: Natural experiment, Park, Dog walking, Physical activity, Built environmen