Rationale, design and conduct of a comprehensive evaluation of a school-based peer-led anti-smoking intervention in the UK: the ASSIST cluster randomised trial [ISRCTN55572965]

BACKGROUND: To date, no school-based intervention has been proven to be effective in preventing adolescent smoking, despite continuing concern about smoking levels amongst young people in the United Kingdom. Although formal teacher-led smoking prevention interventions are considered unlikely to be effective, peer-led approaches to reducing smoking have been proposed as potentially valuable. METHODS/DESIGN: ASSIST (A Stop Smoking in Schools Trial) is a comprehensive, large-scale evaluation to rigorously test whether peer supporters in Year 8 (age 11–12) can be recruited and trained to effect a reduction in smoking uptake among their fellow students. The evaluation is employing a cluster randomised controlled trial (RCT) design with secondary school as the unit of randomisation, and is being undertaken in 59 schools in South East Wales and the West of England. Embedded within the trial are an economic evaluation of the intervention costs, a process evaluation to provide detailed information on how the intervention was delivered and received, and an analysis of social networks to consider whether such a peer group intervention could work amongst schoolchildren in this age group. Schools were randomised to either continue with normal smoking education (n = 29 schools, 5562 students), or to do so and additionally receive the ASSIST intervention (n = 30 schools, 5481 students). No schools withdrew once the trial had started, and the intervention was successfully implemented in all 30 schools, with excellent participation rates from the peer supporters. The primary outcome is regular (weekly) smoking, validated by salivary cotinine, and this outcome has been obtained for 94.4%, 91.0% and 95.6% of eligible students at baseline, immediate post-intervention, and one-year follow-up respectively. DISCUSSION: Comprehensive evaluations of complex public health interventions of this scale and nature are rare in the United Kingdom. This paper demonstrates the feasibility of conducting cluster RCTs of complex public health interventions in schools, and how the rigour of such designs can be maximised both by thorough implementation of the protocol and by broadening the scope of questions addressed in the trial by including additional evaluative components

Study protocol: can a school gardening intervention improve children's diets?

BACKGROUND: The current academic literature suggests there is a potential for using gardening as a tool to improve children's fruit and vegetable intake. This study is two parallel randomised controlled trials (RCT) devised to evaluate the school gardening programme of the Royal Horticultural Society (RHS) Campaign for School Gardening, to determine if it has an effect on children's fruit and vegetable intake. METHOD/DESIGN: Trial One will consist of 26 schools; these schools will be randomised into two groups, one to receive the intensive intervention as "Partner Schools" and the other to receive the less intensive intervention as "Associate Schools". Trial Two will consist of 32 schools; these schools will be randomised into either the less intensive intervention "Associate Schools" or a comparison group with delayed intervention. Baseline data collection will be collected using a 24-hour food diary (CADET) to collect data on dietary intake and a questionnaire exploring children's knowledge and attitudes towards fruit and vegetables. A process measures questionnaire will be used to assess each school's gardening activities. DISCUSSION: The results from these trials will provide information on the impact of the RHS Campaign for School Gardening on children's fruit and vegetable intake. The evaluation will provide valuable information for designing future research in primary school children's diets and school based interventions. TRIAL REGISTRATION: ISRCTN11396528

The predicament of primary physical education: a consequence of 'insufficient' ITT and 'ineffective' CPD?

Background: Research on primary physical education (PE) in England and other countries has shown that it is an aspect of the curriculum that has suffered from sparse initial teacher training (ITT). As a consequence of ‘insufficient’ time spent on PE in ITT (PE-ITT), primary teachers often have low levels of confidence and competence with respect to teaching the subject. Evidence also points to inadequacies in traditional forms of professional development in PE (PE-CPD), leading to calls for more effective ways of developing teachers' competence to deliver high quality PE. Purpose: To explore primary school teachers' experiences of PE during ITT and the PE context in their schools prior to them engaging in a national PE-CPD programme, and their perceptions of the immediate and longer-term effects of this programme. Setting and participants: Primary school teachers in five local education authorities in England. Research design and data collection: A combination of quantitative and qualitative methodological approaches were adopted, including: pre-course audits, course evaluations, focus groups and semi-structured interviews. The pre-course audits captured information about the teachers' experiences of PE-ITT and the PE context in their schools prior to them engaging in the CPD. The course evaluations focused on initial impressions of the PE-CPD, and the focus groups and interviews captured the teachers' perceptions of its longer-term effects. Findings: For up to half of the teachers, their PE-ITT was ‘insufficient’ in terms of the time dedicated to it and the breadth of coverage of the subject. The PE-CPD programme, which was designed in the light of ‘insufficient’ PE-ITT, demonstrated features of ‘effective’ CPD in that it was considered relevant to classroom practice and partially addressed some of their many needs (especially in relation to content ideas and inclusive practice). However, its effectiveness was undoubtedly limited due to: its short time span and minimal engagement with teachers; a heavy reliance on resources; and the absence of follow-up support. In addition, it did not adequately address known areas of development for primary PE (such as medium to long-term planning and assessment) and was challenged in meeting the diverse needs of primary teachers of 5–11 year olds. Furthermore, inadequate PE time and reduced opportunities to teach PE in some schools limited implementation of learning from the PE-CPD. Conclusions: The findings of this study confirmed that PE-ITT continues to be ‘insufficient’ for many primary teachers and that the PE-CPD in question, whilst partially ‘effective’, was not, and could never have been, the panacea for the inherent issues within and predicament of primary PE. In effect, this PE-CPD programme with its limited duration and engagement with teachers, a heavy reliance on resources, and no planned follow-up support was not sufficiently different to forms of CPD described in the literature as ‘ineffective’; consequently, it could not hope to compensate for long-term systemic weaknesses such as inadequate primary PE-ITT. These weaknesses need to be addressed through a dual approach of ‘sufficient’ PE-ITT followed by ‘effective’ PE-CPD which engages teachers and their colleagues in long-term collaborative endeavours that support transformative practice

A Comparative Analysis of Competency Frameworks for Youth Workers in the Out-of-School Time Field

Research suggests that the quality of out-of-school time (OST) programs is related to positive youth outcomes and skilled staff are a critical component of high quality programming. This descriptive case study of competency frameworks for youth workers in the OST field demonstrates how experts and practitioners characterize a skilled youth worker. A comparative analysis of 11 competency frameworks is conducted to identify a set of common core competencies. A set of 12 competency areas that are shared by existing frameworks used in the OST field are identified. The age of youth being served, descriptions of mastery for each competency area, an emphasis on developing mid-level managers, and incorporating research emerge as factors that should be addressed in future competency frameworks

Driving a decade of change: HIV/AIDS, patents and access to medicines for all

Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines

Longitudinal study of ‘retraining’ non-maths specialist teachers to become capable, confident teachers of mathematics

One of the key problems to be solved in mathematics education in England is that the demand for mathematics teachers is far in excess of the supply. Acknowledging that there are simply too few mathematics teachers, the UK government has invested significantly in retraining programmes. These programmes ‘retrain’ out-of-field teachers, that is, teachers of other subjects or from other phases, to teach secondary mathematics. The increased mathematical demand of the reformed GCSE courses coupled with the expectation that most post-16 students will engage with some mathematics (studying for A and AS levels, a Core Maths qualification or re-sitting GCSE) means many more teachers of mathematics will be needed. We consider the viability of a retraining course as an effective way of alleviating the problem of the lack of well qualified teachers for mathematics. In this four-year longitudinal study, we followed teachers during their year of ‘retraining’ and in the succeeding years. Once a participant completes their part-time one-year course, the teacher is considered ‘retrained’. However, we conclude that without ongoing professional development involving collaborative support retraining courses alone can have little impact on the problem of the lack of competent and confident teachers of mathematics in the secondary sector

Maximizing the potential of early childhood education to prevent externalizing behavior problems: A meta-analysis

Early childhood education (ECE) programs offer a promising mechanism for preventing early externalizing behavior problems and later antisocial behavior; yet, questions remain about how to best maximize ECE's potential. Using a meta-analytic database of 31 studies, we examined the overall effect of ECE on externalizing behavior problems and the differential effects of 3 levels of practice, each with increasing specificity and intensity aimed at children's social and emotional development. In short, we found that each successive level of programs did a better job than the prior level at reducing externalizing behavior problems. Level 1 programs, or those without a clear focus on social and emotional development, had no significant effects on externalizing behavior problems relative to control groups (ES=.13 SD, p<.10). On the other hand, level 2 programs, or those with a clear but broad focus on social and emotional development, were significantly associated with modest decreases in externalizing behavior problems relative to control groups (ES=-.10 SD, p<.05). Hence, level 2 programs were significantly better at reducing externalizing behavior problems than level 1 programs (ES=-.23 SD, p<.01). Level 3 programs, or those that more intensively targeted children's social and emotional development, were associated with additional significant reductions in externalizing behavior problems relative to level 2 programs (ES=-.26 SD, p<.05). The most promising effects came from level 3 child social skills training programs, which reduced externalizing behavior problems half of a standard deviation more than level 2 programs (ES=-.50 SD, p<.05)

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research