Early developmental environment and Olympic success: an analysis of an Australian sporting "hotspot"

Inspired by the ‘birthplace effect’ phenomenon, this study aimed to identify an Australian sporting “hotspot” and gain an understanding of factors underpinning a proportionately high number of Australian summer Olympians experiencing their early developmental environment within the area. A mixed-methods approach was utilised to identify the “hotspot” through collecting biographical data on all known (n=2160) Australian summer Olympians 1984-2012, followed by undertaking a case study analysis to examine the “hotspot” within the context of Bronfenbrenner’s (1979b; 1994a; 1998) ‘Ecological Systems Theory’ and ‘Bioecological Model’. Alongside the archival collection of demographic and climate data, Olympians’ (n=11) and community stakeholders (n=31) views regarding the “hotspot’s” occurrence and its perceived influence on athletic development were gained through semi-structured interviews. The results determined several demographic, geographic, historical, individual, social and fortuitous factors contributed to the creation of the “hotspot”. Access to built and natural facilities, climate, family influence, schools, strong community clubs, opportunity to train and compete with older athletes, access to role models, high socioeconomic status and an endemic sports culture were key contributors to effective athlete development within the “hotspot”. Although not predominantly attributable to one variable, it was evident a confluence of planned and fortuitous factors had unintentionally created a “hotspot” of Australian summer Olympians in Perth, Western Australia. Despite several factors being unique to the “hotspot”, some are potentially transferable to other athlete development environments in Australia and overseas. In a quality early developmental environment, Olympians believed factors proximal to them including family, the junior sports environment and individual psychological characteristics had the most decisive influence on their athletic development

Supporting student engagement through video in distance education: Learning in a post-pandemic world

The pandemic caused many disruptions in the teaching and learning of students worldwide. Discussions continue today about its impacts and the ways in which teachers, students, and schools responded with the movement to online learning.Although the World Health Organisation has declared that COVID-19 is no longer a public health emergency of international concern, it is paramount that we consider the lessons we gained from this time as we move into a post-pandemic world. One such important consideration is the ways in which teachers can stay connected to their students in the digital space, ensuring that students remain engaged in the learning

Building Relationships Through Learning Design as Signature Pedagogy: Re-connecting Mature-aged Online Students with Educators

The Commencing Student Success Program (CSSP) comprises 13 evidence-based strategies for online engagement underpinned by the Universal Design for Learning principles of inclusive access to improve learner retention and engagement (Sasson et al., 2021), promoting first year student engagement and retention at the tertiary level. The program's impact has led to it being adopted across the University's School of Education as its signature pedagogy. The University's unique regional context provides education to a high number of students studying by distance; often rural, mature-age, or first-in-family. Applying these strategic elements into online course design ensure a sense of support and connection is embedded, and reducing sense of isolation, throughout their studies

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

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

Using Sport to Drive Social Inclusion for Newly-Arrived Ezidi People in Regional Australia

In Australia, people from newly-arrived migrant and refugee backgrounds are less likely to be involved in regular sport and physical activity or receive their associated health benefits. This study aimed to evaluate a two-year program in regional Australia that used sport as a vehicle to assist a cohort of Ezidi people from northern Iraq settle into a new community. Youth were the focus of this program as an avenue to engage the whole family in physical activity. The Diffusion of Innovation theory for health promotion underpinned the program and a qualitative approach was used to obtain the perspectives and lived experiences of both community stakeholders and participants from the Ezidi community. Semi-structured interviews and focus groups were the main source of data collection. All interviews and focus groups were audio-recorded, transcribed and analysed thematically. Twenty people comprising 14 members of the Ezidi community and 6 community stakeholders participated in this study. The findings demonstrated that the program benefitted holistic health, intercultural understanding, community relationship building and even challenged gender stereotypes. Mental and social health experienced particular positive impact through opportunities to be social, create a sense of belonging and the psychological benefits of engaging in regular physical activity following the experience of trauma. The program has exemplified the power of interagency community networks to benefit youth and public health in geographically and culturally diverse communities. These findings have potential to inform a best practice transition model for newly-arrived migrants and refugees in regional centres around Australia through sport

Early developmental environment and Olympic success: analysis of an Australian sporting "hotspot"

This study aims to identify an Australian sporting "hotspot" and the reasons for its ability to produce a greater relative number of summer Olympic representatives 1984-2012 per head of the population. The overall study adopted a mixed-methods approach, with the first stage identifying the "hotspot" using publicly available, biographical data on all known (n = 2160) Australian summer Olympians 1984-2012. The "hotspot" was examined through utilising a case study methodology within the context of Bronfenbrenner's (1979, 2005) 'Ecological Systems Theory'. Both community and Olympian's perceptions regarding why the "hotspot" occurred and the influence it has had on the athletic development of these Olympians was investigated. The results determined that a range of demographic, geographic, historical, social and fortuitous factors contributed to the creation of this "hotspot". Access to built and natural facilities, climate, family influence, schools, strong community clubs, opportunity to train and compete with older athletes, access to role models, high socioeconomic status and an endemic sports culture were amongst key contributing factors underlying the development of this "hotspot". Although many of these features appear to be unique to the "hotspot" area in Perth, Western Australia, some have potential to be transferred to other athlete development environments