Active commute to school: does distance from school or walkability of the home neighbourhood matter? A national cross-sectional study of children aged 10–11 years, Scotland, UK

Objectives: To study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10–11 years old. Design: Cross-sectional study. Setting: Data were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study. Participants: 713 children (male (n=330) and female (n=383) 10–11 years old) from Studying Physical Activity in Children’s Environments across Scotland. Primary and secondary outcome measures: Children who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (<0.5 km, 0.5 to <1 km, 1 to <1.5 km, 1.5 to <2 km, 2 km+); home neighbourhood walkability (i.e., composite measure of road/path intersection density and dwelling density) (in quintiles). Results: Distance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with ‘most’ walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2–Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys). Conclusion: Walkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children’s ATS

Children's mobility and environmental exposures in urban landscapes: a cross-sectional study of 10–11 year old Scottish children

Research into how the environment affects health and related behaviour is typically limited in at least two ways: it represents the environment to which people are exposed using fixed areal units, and, it focuses on one or two environmental characteristics only. This study developed a methodology for describing children's mobility and the complexity of their environmental exposure across a 1934 km2 study area, including urban, suburban and rural zones. It conceptualised and modelled this area as a landscape, comprised of spatially discrete amenities, infrastructure features, differing land covers/use and broader environmental contexts. The model used a 25 m2 grid system (∼3 million cells). For each cell, there was detailed built-environment information. We joined data for 100 10/11-year-old children who had worn GPS trackers to provide individual-level mobility information for one week during 2015/16 to our model. Using negative binomial regression, we explored which landscape features were associated with a child visiting that space and time spent there. We examined whether relationships between the features across our study area and children's use of the space differed by their sociodemographic characteristics. We found that children often used specific amenities outside their home neighbourhood, even if they were also available close to home. They spent more time in cells containing roads/transportation stops, food/drink retail (Incidence rate ratio (IRR):4.02, 95%CI 2.33 to 6.94), places of worship (IRR:5.98, 95%CI 3.33 to 10.72) and libraries (IRR:7.40, 95%CI 2.13 to 25.68), independently of proximity to home. This has importance for the optimal location of place-based health interventions. If we want to target children, we need to understand that using fixed neighbourhood boundaries may not be the best way to do it. The variations we found in time spent in certain areas by sex and socio-economic position also raise the possibility that interventions which ignore these differences may exacerbate inequalities

Neighbourhood natural space and the narrowing of socioeconomic inequality in children’s social, emotional, and behavioural wellbeing

Introduction: The natural environment may benefit children's social, emotional and behavioural wellbeing, whilst offering a lever to narrow socioeconomic health inequalities. We investigated whether immediate neighbourhood natural space and private gardens were related to children's wellbeing outcomes and whether these relationships were moderated by household income. Methods: A nationally representative sample of 774 children (55% female, 10/11 years old) from the Studying Physical Activity in Children's Environments across Scotland study. Social, emotional and behavioural difficulty scores (Strengths and Difficulties Questionnaire) represented wellbeing outcomes. Percentage of total natural space and private gardens within 100m of the child's residence was quantified using Ordnance Survey's MasterMap Topography Layer®. Linear regression, including interaction terms, explored the two main research questions. Results: A 10% increase in residential natural space was associated with a 0.08 reduction (-0.15, -0.01; 95%CI) in Emotional Problem scores and a 0.09 improvement (0.02, 0.16; 95%CI) in Prosocial Behaviour scores. Household income moderated the associations between % natural space and private gardens on Prosocial Behaviour scores: for natural space, there was a positive relationship for those in the lowest income quintile (0.25 (0.09, 0.41; 95%CI)) and a null relationship for those in the highest quintile (-0.07 (-0.16, 0.02; 95%CI)). For private garden space, there was a positive relationship for those in the highest quintile (0.15 (0.05, 0.26; 95%CI)) and negative relationship with those in the lowest quintile (-0.30 (-0.50, -0.07, 95%CI)). Conclusion: The natural environment could be a lever to benefit those from less advantaged backgrounds, particularly the development of prosocial behaviours

Understanding long-term opioid prescribing for non-cancer pain in primary care: A qualitative study

YesBackground: The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. Methods: We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. Results: Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs’ responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient’s wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. Conclusions: Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG- 1010–23041)

Effect of a hospital command centre on patient safety: an interrupted time series study

Background Command centres have been piloted in some hospitals across the developed world in the last few years. Their impact on patient safety, however, has not been systematically studied. Hence, we aimed to investigate this. Methods This is a retrospective population-based cohort study. Participants were patients who visited Bradford Royal Infirmary Hospital and Calderdale & Huddersfield hospitals between 1 January 2018 and 31 August 2021. A five-phase, interrupted time series, linear regression analysis was used. Results After introduction of a Command Centre, while mortality and readmissions marginally improved, there was no statistically significant impact on postoperative sepsis. In the intervention hospital, when compared with the preintervention period, mortality decreased by 1.4% (95% CI 0.8% to 1.9%), 1.5% (95% CI 0.9% to 2.1%), 1.3% (95% CI 0.7% to 1.8%) and 2.5% (95% CI 1.7% to 3.4%) during successive phases of the command centre programme, including roll-in and activation of the technology and preparatory quality improvement work. However, in the control site, compared with the baseline, the weekly mortality also decreased by 2.0% (95% CI 0.9 to 3.1), 2.3% (95% CI 1.1 to 3.5), 1.3% (95% CI 0.2 to 2.4), 3.1% (95% CI 1.4 to 4.8) for the respective intervention phases. No impact on any of the indicators was observed when only the software technology part of the Command Centre was considered. Conclusion Implementation of a hospital Command Centre may have a marginal positive impact on patient safety when implemented as part of a broader hospital-wide improvement programme including colocation of operations and clinical leads in a central location. However, improvement in patient safety indicators was also observed for a comparable period in the control site. Further evaluative research into the impact of hospital command centres on a broader range of patient safety and other outcomes is warranted

Effect of a hospital command centre on patient safety: An interrupted time series study

Background Command centres have been piloted in some hospitals across the developed world in the last few years. Their impact on patient safety, however, has not been systematically studied. Hence, we aimed to investigate this. Methods This is a retrospective population-based cohort study. Participants were patients who visited Bradford Royal Infirmary Hospital and Calderdale & Huddersfield hospitals between 1 January 2018 and 31 August 2021. A five-phase, interrupted time series, linear regression analysis was used. Results After introduction of a Command Centre, while mortality and readmissions marginally improved, there was no statistically significant impact on postoperative sepsis. In the intervention hospital, when compared with the preintervention period, mortality decreased by 1.4% (95% CI 0.8% to 1.9%), 1.5% (95% CI 0.9% to 2.1%), 1.3% (95% CI 0.7% to 1.8%) and 2.5% (95% CI 1.7% to 3.4%) during successive phases of the command centre programme, including roll-in and activation of the technology and preparatory quality improvement work. However, in the control site, compared with the baseline, the weekly mortality also decreased by 2.0% (95% CI 0.9 to 3.1), 2.3% (95% CI 1.1 to 3.5), 1.3% (95% CI 0.2 to 2.4), 3.1% (95% CI 1.4 to 4.8) for the respective intervention phases. No impact on any of the indicators was observed when only the software technology part of the Command Centre was considered. Conclusion Implementation of a hospital Command Centre may have a marginal positive impact on patient safety when implemented as part of a broader hospital-wide improvement programme including colocation of operations and clinical leads in a central location. However, improvement in patient safety indicators was also observed for a comparable period in the control site. Further evaluative research into the impact of hospital command centres on a broader range of patient safety and other outcomes is warranted

Assessment at UK medical schools varies substantially in volume, type and intensity and correlates with postgraduate attainment

BACKGROUND: In the United Kingdom (UK), medical schools are free to develop local systems and policies that govern student assessment and progression. Successful completion of an undergraduate medical degree results in the automatic award of a provisional licence to practice medicine by the General Medical Council (GMC). Such a licensing process relies heavily on the assumption that individual schools develop similarly rigorous assessment policies. Little work has evaluated variability of undergraduate medical assessment between medical schools. That absence is important in the light of the GMC's recent announcement of the introduction of the UKMLA (UK Medical Licensing Assessment) for all doctors who wish to practise in the UK. The present study aimed to quantify and compare the volume, type and intensity of summative assessment across medicine (A100) courses in the United Kingdom, and to assess whether intensity of assessment correlates with the postgraduate attainment of doctors from these schools. METHODS: Locally knowledgeable students in each school were approached to take part in guided-questionnaire interviews via telephone or Skype(TM). Their understanding of assessment at their medical school was probed, and later validated with the assessment department of the respective medical school. We gathered data for 25 of 27 A100 programmes in the UK and compared volume, type and intensity of assessment between schools. We then correlated these data with the mean first-attempt score of graduates sitting MRCGP and MRCP(UK), as well as with UKFPO selection measures. RESULTS: The median written assessment volume across all schools was 2000 min (mean = 2027, SD = 586, LQ = 1500, UQ = 2500, range = 1000-3200) and 1400 marks (mean = 1555, SD = 463, LQ = 1200, UQ = 1800, range = 1100-2800). The median practical assessment volume was 400 min (mean = 472, SD = 207, LQ = 400, UQ = 600, range = 200-1000). The median intensity (minutes per mark ratio) of summative written assessment was 1.24 min per mark (mean = 1.28, SD = 0.30, LQ = 1.11, UQ = 1.37, range = 0.85-2.08). An exploratory analysis suggested a significant correlation of total assessment time with mean first-attempt score on both the knowledge and the clinical assessments of MRCGP and of MRCP(UK). CONCLUSIONS: There are substantial differences in the volume, format and intensity of undergraduate assessment between UK medical schools. These findings suggest a potential for differences in the reliability of detecting poorly performing students, or differences in identifying and stratifying academically equivalent students for ranking in the Foundation Programme Application System (FPAS). Furthermore, these differences appear to directly correlate with performance in postgraduate examinations. Taken together, our findings highlight highly variable local assessment procedures that warrant further investigation to establish their potential impact on students

Role of Self‐Assembly Conditions and Amphiphilic Balance on Nanoparticle Formation of PEG‐PDLLA Copolymers in Aqueous Environments

The production of well-defined and reproducible poly-meric nanoparticles (NPs), in terms of size and stability in biological environments, is undoubtedly a fundamental challenge in the formulation of novel and more effective nanomedicines. The adoption of PEGylated lactide (LA) block copolymers as biodegradable and biocompatible nanocarriers at different clinical stages has rendered these materials an attractive polymeric platform to be exploited and their formulation is further understood. In the present work, we synthesized a library of linear polyethyl-ene glycol-poly(D,L-lactide) block copolymers with different lengths of LA (15, 25, 50, and 100 LA units) via simple and metal-free ring-opening polymerization, in order to alter the amphi-philic balance of the different macromolecules. The produced polymers were formulated into NPs while varying a series of key parameters in the solvent displacement process, including solvent:nonsolvent ratios and the nature of the two media, and the effect on size and stability was assessed. In addition, stability to protein-NPs interaction and aggregation was studied, highlighting the different NP final properties according to the nature of the amphiphilic balance and nanoformulation conditions. Therefore, we have illustrated a systematic and methodo-logical process to optimize a series of NPs parameters balancing particle size, size distribution, surface charge, and stability to guide future works in the nanoformulation field

How does the built environment affect teenagers (aged 13–14) physical activity and fitness? A cross-sectional analysis of the ACTIVE Project

Built environments have been cited as important facilitators of activity and research using geographic information systems (GIS) has emerged as a novel approach in exploring environmental determinants. The Active Children Through Individual Vouchers Evaluation Project used GIS to conduct a cross-sectional analysis of how teenager's (aged 13-14) environments impacted on their amount of activity and influences fitness. The ACTIVE Project recruited 270 participants aged 13-14 (year 9) from 7 secondary schools in south Wales, UK. Demographic data and objective measures of accelerometery and fitness were collected from each participant between September and December 2016. Objective data was mapped in a GIS alongside datasets relating to activity provision, active travel routes, public transport stops, main roads and natural resources. This study shows that fitness and physical activity are not correlated. Teenagers who had higher levels of activity also had higher levels of sedentary time/inactivity. Teenagers showed higher amounts of moderate-to-vigorous physical activity if their homes were closer to public transport. However, they were also more active if their schools were further away from public transport and natural resources. Teenagers were fitter if schools were closer to natural resources. Sedentary behaviour, fitness and activity do not cluster in the same teenagers. Policymakers/planning committees need to consider this when designing teenage friendly environments. Access to public transport, active travel, green space and activities that teenagers want, and need could make a significant difference to teenage health