Operationalising a large research programme tackling complex urban and planetary health problems: A case study approach to critical reflections

Addressing increasingly urgent global challenges requires the rapid mobilisation of new research groups that are large in scale, co-produced, and focused explicitly on investigating root causes at a systemic level. This requires new ways of operationalising and funding research programmes to better support effective interdisciplinary and transdisciplinary (ID/TD) partnerships between a wide range of academic disciplines and stakeholder groups. Understanding of the challenges and approaches that teams can follow to overcome them can come through critical reflection on experiences initiating new research programmes of this nature and sharing of these reflections. We aimed to offer a framework for critical reflection and an overview of how we developed it, and to share our reflections on operationalising a newly formed large-scale ID/TD research programme. We present a framework of 10 areas for critical reflection: Systems, Unknowns and Imperfection; ID/TD Understanding; Values; Societal Impact; Context and Stakeholder Knowledge; Project Understanding and Direction; Team Cohesion; Decision-Making; Communications; and Method Development. We reflect on our experience of operationalising the research programme in these areas. Based on this critical examination of our experiences and the processes we adopted, we make recommendations for teams seeking to tackle important and highly complex global challenges, and for those who fund or support such research groups. Our reflections point to an overarching challenge of the structural and institutional barriers for cross-disciplinary research of this nature

An Ecological Conceptualisation of Extreme Sports

Currently, there are various definitions for extreme sports and researchers in the field have been unable to advance a consensus on what exactly constitutes an ‘extreme’ sport. Traditional theory-led explanations, such as edgeworks, sensation seeking and psychoanalysis, have led to inadequate conceptions. These frameworks have failed to capture the depth and nuances of experiences of individuals who refute the notions of risk-taking, adrenaline- and thrill-seeking or death-defiance. Instead, participants are reported to describe experiences as positive, deeply meaningful and life-enhancing. The constant evolution of emerging participation styles and philosophies, expressed within and across distinguishable extreme sport niches, or forms of life, and confusingly dissimilar definitions and explanations point out that, to better understand cognitions, perceptions and actions of extreme sport participants, a different level of analysis to traditional approaches needs to be emphasized. This paper develops the claim that a more effective definition, reflecting the phenomenology, and directed by the ecological dynamics framework, can significantly advance the development of a more comprehensive and nuanced future direction for research and practice. Practical implications include study designs, representative experimental tasks or coaching practices and pedagogical approaches in extreme sports. Our analysis of the literature suggests that extreme sports are more effectively defined as activities consisting of an inimitable person-environment relationship with exquisite affordances for ultimate perception and movement experiences, leading to existential reflection and self-actualization as framed by the human form of life

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

Operationalising a large research programme tackling complex urban and planetary health problems:A case study approach to critical reflections

Addressing increasingly urgent global challenges requires the rapid mobilisation of new research groups that are large in scale, co-produced, and focused explicitly on investigating root causes at a systemic level. This requires new ways of operationalising and funding research programmes to better support effective interdisciplinary and transdisciplinary (ID/TD) partnerships between a wide range of academic disciplines and stakeholder groups. Understanding of the challenges and approaches that teams can follow to overcome them can come through critical reflection on experiences initiating new research programmes of this nature and sharing of these reflections. We aimed to offer a framework for critical reflection and an overview of how we developed it, and to share our reflections on operationalising a newly formed large-scale ID/TD research programme. We present a framework of 10 areas for critical reflection: Systems, Unknowns and Imperfection; ID/TD Understanding; Values; Societal Impact; Context and Stakeholder Knowledge; Project Understanding and Direction; Team Cohesion; Decision-Making; Communications; and Method Development. We reflect on our experience of operationalising the research programme in these areas. Based on this critical examination of our experiences and the processes we adopted, we make recommendations for teams seeking to tackle important and highly complex global challenges, and for those who fund or support such research groups. Our reflections point to an overarching challenge of the structural and institutional barriers for cross-disciplinary research of this nature