Establishing the effectiveness of public health interventions using sequential meta-analysis: Case study using stair-promotion interventions

Prevention trials often generate significant health or risk factor improvements, but these improvements are limited to the selected samples of people enrolled in these studies. To make population health gains, we need to develop methods for translating evidence from these trials into practice at the broader community and population levels. One barrier to this process is researchers themselves, who conduct replications of small-scale trials, rather than conducting intervention research at scale. Our example of this is interventions to encourage short episodes of physical activity through signs promoting stair use. We pooled the evidence from these interventions from 1980 to 2014. We carried out a meta-analysis to estimate the proportion of people that changed from the elevator to the stairs following the introduction of signage. Our innovation was to use a sequential meta-analysis method, usually described in clinical settings and trials. We used this method to estimate when there was sufficient evidence of stair sign effectiveness for public health actions to be scaled up, and we found this was around 2006. Studies since then have not contributed new evidence to the field. Methods here enabled us to see when policy makers should have implemented this intervention to the community at large, and researchers then should have focused their investigations on identifying barriers and facilitators to their implementation and assessing intervention effects at scale

A Demonstration of a Systematic Item-Reduction Approach Using Structural Equation Modeling

Establishing model parsimony is an important component of structural equation modeling (SEM). Unfortunately, little attention has been given to developing systematic procedures to accomplish this goal. To this end, the current study introduces an innovative application of the jackknife approach first presented in Rensvold and Cheung (1999). Unlike the traditional application of jackknife procedures for the purpose of identifying outliers and influential cases within a dataset, this jackknife procedure is applied for the purpose of identifying and eliminating items from a structural model. Items are identified through the jackknife procedure and eliminated from the model without altering the measurement or structural integrity of the model. The goal of this application is to create the most parsimonious model by reducing the number of items in an inventory, without altering the construct represented by the model. Accessed 10,388 times on https://pareonline.net from April 23, 2012 to December 31, 2019. For downloads from January 1, 2020 forward, please click on the PlumX Metrics link to the right

Outcomes of International Service Learning (ISL): Alumni Perspectives

Service learning is an active method that combines academic knowledge and hands-on experience while serving a community. Service learning is well established within occupational therapy (OT) and allied health education, as many institutions have organized both domestic and international service learning experiences. Literature supports student benefits of participation in international service learning (ISL), but limited literature exists on the long-term impact of participation in ISL throughout allied health education. Many OT students participate in ISL during their education, but there is limited literature on the impact of an ISL experience on participants’ careers in OT. In this qualitative study, an online survey was distributed to past participants of an ISL trip of an OT program in the Midwest. Of the 100 subjects, 30 completed the survey. Researchers used conventional content analysis to extract themes from the data. Two themes were identified: (1) evolving professional self and (2) transformative personal experience. Subthemes of the evolving professional self theme included: (1) desire to work with vulnerable populations, (2) professional soft skill development, and (3) acquisition of knowledge and skills. Results indicate that benefits are maintained after graduation signifying that participation in ISL may have a sustained, lasting influence on OT practitioners. ISL supports the values of OT education by shaping professional identity through active, diverse learning and self-reflection to promote lifelong learning. Results broaden the profession’s understanding of the outcomes of ISL post-graduation and inform ISL best practice standards within OT education

Intersectoral partnership: a potential legacy success of the London 2012 Olympic and Paralympic Games

The 2008 Legacy Action Plan stated the government’s intention to make the United Kingdom (UK) a ‘world-leading sporting nation’ by using the London 2012 Olympic and Paralympic Games to inspire population changes in physical activity. It set a goal of encouraging two million more people to be active, and responsibility for achieving the target was divided between the sport and health sectors. However, data from the Active People Survey do not confirm a ‘legacy effect’ on participation as a result of the Games. Despite failure to achieve the target, the Legacy Action Plan was the first UK policy to set a shared national goal for the health and sport sectors and since its publication, the agendas of the two sectors have become increasingly aligned. This presents an unprecedented opportunity for the two sectors to work collaboratively towards the common goal of improving population health through physical activity. It is possible that this coalescence, if maintained, has the potential to create a more sustained legacy on physical activity than may have resulted from the short-lived ‘inspiration effect’ of hosting the London Olympic and Paralympic Games. Rather than dwelling on the ‘failure’ of the Olympics to achieve the legacy target, efforts should focus on the policy congruence that has developed since the Games, and how to maximise partnership working to achieve a sustained shift in population levels of physical activity

Diseño del sistema de gestión ambiental bajo los requisitos de la NTC ISO 14001:2004, en la E.S.E Hospital San Pedro y San Pablo de La Virginia Risaralda.

En este documento se plasma el desarrollo del DISEÑO DEL SISTEMA DE GESTIÓN AMBIENTAL BAJO LOS REQUISITOS DE LA NTC ISO 14001:2004, del hospital San Pedro y San Pablo ubicado en el municipio de La Virginia Risaralda. Esta organización en el área de la salud es directamente responsable de generar a través de sus procesos impactos significativos al medio ambiente, impactos que están asociados a los recursos como agua, aire, suelo y sin duda alguna de no tener un riguroso cuidado con estos impactos no alteraran solamente la naturaleza; si no que también se convertirán en un problema de salubridad pública. La metodología utilizada en el desarrollo del proyecto fue la de Planear, Hacer, Verificar y Actuar (PHVA) la cual se desarrollaron las siguientes fases. Diagnóstico: esta fase nos permitió evaluar el funcionamiento actual que la organización posee con respecto a sus prácticas y procedimientos de manejo ambiental, además nos permitió identificar requisitos legales y su grado de cumplimiento y revisión de la documentación de carácter ambiental existente. Planificación: en base a la información obtenida por la RAI, se procedió a la identificación de los aspectos significativos para la organización, se definió el alcance del Sistema de Gestión Ambiental, se identificó los requisitos legales aplicables y se definió la política ambiental. Documentación: En esta fase se diseñaron y se identificaron los documentos necesarios como soporte del Sistema de Gestión Ambiental. Enfocando así a la ESE Hospital San Pedro y San Pablo a una organización que garantiza el compromiso con el medio ambiente y con su comunidad. Palabras claves: Diseño de Sistema del Gestión Ambiental, identificación de aspectos significativos, impactos significativos, requisitos legales aplicable

Una propuesta de enseñanza para los estudiantes de grado once del I. E. D. Paulo Freire sobre la noción de límite

El siguiente documento presenta una secuencia de actividades para trabajar la noción del concepto de limite involucrado en el pensamiento variacional en grado once, donde se toma como punto de partida el trabajo con sucesiones, permitiendo desarrollar a través del uso de diferentes tipos de sucesiones y la noción de convergencia; dicho concepto, tomado desde la definición de (Steward, Redlin, & Watson, 2001). Basado en la metodología propuesta por el grupo (DECA, 1992), la cual, no solo muestra el enseñar matemáticas, como entregar algoritmos al estudiante, sino que por el contrario, un aprendizaje desde la construcción del objeto matemático, resaltando la participación activa y critica del estudiante

“WALK30X5”:A feasibility study of a physiotherapy walking programme for people with mild to moderate musculoskeletal conditions

Objectives: To explore the feasibility of delivering and evaluating a web-based walking intervention for people with long term musculoskeletal conditions (LTMCs), to determine its acceptability and the feasibility of conducting a definitive trial.  Design: Prospective randomised feasibility study, with blind outcome assessment at baseline, 3 and 6 months. Setting: Hospital based physiotherapy service. Participants: Forty one adults referred for assessment and advice for any mild/moderate LTMCs. doing <120 minutes of moderate intensity activity per week.  Interventions: Participants randomised to: 1. Usual care: one usual physiotherapy advice and assessment session, including setting a physical activity goal and one follow up session (8 weeks). 2. “Walk30 × 5”: session one, usual care plus intervention of walking programme. Participants were shown the website and podcasts and practiced how to use them. One follow up session (8 weeks). Outcome measures: Primary: timed six minute walk test (T6MWT). Secondary: step count, self-reported pain, fatigue, mood, self-efficacy, happiness, objective blood pressure, peak expiratory flow rate, and self-report and accelerometer measured physical activity.  Results: Recruitment target achieved. No adverse events occurred. Adherence was high and the intervention acceptable. Loss to follow up n = 3 (7%) at 3 months, n = 8 (20%) at 6 months. T6MWT and step count proved suitable outcomes, unlike accelerometry. Estimated sample size for a definitive trial is 216.  Conclusions: “Walk30 × 5” is ready for evaluation in a future, appropriately powered (n = 216), phase III trial. If effective, the intervention will provide a cheap, highly accessible intervention to enable people with mild/moderate LTMCs to achieve UK physical activity guidelines.  Clinical Trial Registration Number: ISRCTN78581097

The Ever Widening Gyre: Factors Affecting Change in Adult Education Graduate Programs

The purpose of this survey study was to understand the factors that have influenced recent changes in the size of adult education graduate programs. We found that integration has a significant effect on changes in student enrollment while leadership, innovation, and integration all significantly predict variance in faculty growth

A bioprinted cardiac patch composed of cardiac-specific extracellular matrix and progenitor cells for heart repair

Congenital heart defects are present in 8 of 1000 newborns and palliative surgical therapy has increased survival. Despite improved outcomes, many children develop reduced cardiac function and heart failure requiring transplantation. Human cardiac progenitor cell (hCPC) therapy has potential to repair the pediatric myocardium through release of reparative factors, but therapy suffers from limited hCPC retention and functionality. Decellularized cardiac extracellular matrix hydrogel (cECM) improves heart function in animals, and human trials are ongoing. In the present study, a 3D-bioprinted patch containing cECM for delivery of pediatric hCPCs is developed. Cardiac patches are printed with bioinks composed of cECM, hCPCs, and gelatin methacrylate (GelMA). GelMA-cECM bioinks print uniformly with a homogeneous distribution of cECM and hCPCs. hCPCs maintain &gt;75% viability and incorporation of cECM within patches results in a 30-fold increase in cardiogenic gene expression of hCPCs compared to hCPCs grown in pure GelMA patches. Conditioned media from GelMA-cECM patches show increased angiogenic potential (&gt;2-fold) over GelMA alone, as seen by improved endothelial cell tube formation. Finally, patches are retained on rat hearts and show vascularization over 14 d in vivo. This work shows the successful bioprinting and implementation of cECM-hCPC patches for potential use in repairing damaged myocardium