Examining individual, interpersonal, and environmental influences on children’s physical activity levels

The purpose of this study was to explore individual-level socio-demographic factors and interpersonal-level factors related to social support, as well as the potential role of neighborhood and school environments that may influence the physical activity (PA) levels of children (ages 9–11). Child and parent questionnaires included individual and interpersonal factors, and PA behaviour. Home postal codes were used to determine the neighbourhood the child resides within, as well as their geographic accessibility to recreation opportunities. The models were assessed using a series of cross-classified random-intercept multi-level regression models as children’s PA may be affected by both the school they attend and the neighbourhood in which they live. In the unadjusted model, PA varied significantly across school environments (γ = 0.023; CI: 0.003–0.043), but not across neighbourhoods (γ = 0.007; CI: -0.008 to 0.021). Boys were found to be more active compared to girls (b = 0.183; CI: 0.092–0.275), while the level of PA was lower for children whose fathers achieved post-secondary education (b = - 0.197; CI: -0.376 to 0.018) than for those whose parents completed only high school. The addition of the individual-level correlates did not have a substantial effect on level 2 variances and the level 2 variance associated with school environment remained statistically significant. At the interpersonal level, children’s perception of parental support (b = 0.117; CI: 0.091–0.143) and peer support (b = 0.111; CI: 0.079–0.142) were positively related to PA. The level 2 variance for the school environment became statistically non-significant when the interpersonal factors were added to the model. At the environmental level, geographic accessibility did not have a significant association with PA and they did not significantly affect level 1 or 2 variance. As many children do not accrue sufficient levels of PA, identifying modifiable determinants is necessary to develop effective strategies to increase PA

C.H.A.M.P. Families : Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study.

Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6⁻14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research

The Social Effects of Entrepreneurship on Society and Some Potential Remedies: Four Provocations

A rapidly growing research stream examines the social effects of entrepreneurship on society. This research assesses the rise of entrepreneurship as a dominant theme in society and studies how entrepreneurship contributes to the production and acceptance of socio-economic inequality regimes, social problems, class and power struggles, and systemic inequities. In this article, scholars present new perspectives on an organizational sociology-inspired research agenda of entrepreneurial capitalism and detail the potential remedies to bound the unfettered expansion of a narrow conception of entrepreneurship. Taken together, the essays put forward four central provocations: 1) reform the study and pedagogy of entrepreneurship by bringing in the humanities; 2) examine entrepreneurship as a cultural phenomenon shaping society; 3) go beyond the dominant biases in entrepreneurship research and pedagogy; and 4) explore alternative models to entrepreneurial capitalism. More scholarly work scrutinizing the entrepreneurship–society nexus is urgently needed, and these essays provide generative arguments toward further developing this research agenda

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation

Exploring the effect of parental influence on children’s physical activity: The mediating role of children’s perceptions of parental support

The purpose of this study was to test a conceptual model linking parental support and parental physical activity (PA), with children\u27s perception of parental support and children\u27s PA. Baseline data were drawn from the Grade 5 ACT-i-Pass community-based PA intervention conducted in London, Ontario between May and October 2014. Parent and child PA were measured using the International Physical Activity Questionnaire and Physical Activity Questionnaire for Children, respectively. Questions pertaining to parental support and children\u27s perception of that parental support were obtained via questionnaires. We employed structural equation modeling techniques to test the conceptual model. In total, 467 boys and 469 girls were included in the study. The model provided an acceptable model fit. Child\u27s perception of parental support for PA had a positive effect on boys\u27 (b = 0.319) and girls\u27 (b = 0.326) PA. Parental PA was not significantly related to child\u27s perception of parental support for PA. However, parent reported support for PA had a significant, positive effect on child\u27s perception of parental support for boys (b = 0.352) and girls (b = 0.584). In terms of the indirect effects, the effect of parental PA on child\u27s PA was not statistically significant; however, as expected, parental support for PA had a statistically significant indirect effect on child PA level in both groups. The findings of this study demonstrate the importance of children\u27s perceptions of parental support in relation to their PA behaviours. Developing a better understanding of factors related to children\u27s PA and identifying determinants and mediators of activity behaviours will help inform PA interventions

Intraoperative Fraction of Inspired Oxygen is a Modifiable Risk Factor for Surgical Site Infection after Spinal Surgery. Anesthesiology

Background: Surgical site infections (SSI) after spinal surgery increase morbidity, mortality, length of hospital stay, and costs. Most previously identified risk factors for these infections, such as severity of illness and procedure duration, are not amenable to intervention. This study sought to identify modifiable risk factors associated with SSI after spinal surgery. Methods: This is a case-control study including case identification and review of medical records. A total of 104 patients with SSI after spinal surgery were compared to 104 randomly selected control patients without SSI after spinal surgery in a 926-bed tertiary care hospital in Baltimore, Maryland, between April 1, 2001 and December 31, 2004. Results: Multivariate analysis identified independent risk factors for SSI after spinal surgery including prolonged procedure duration (odds ratio [OR], 4.7; 95% confidence interval [95% CI], 1.6 -14; P &lt; 0.001), American Society of Anesthesiologists score of 3 or greater (OR, 9.7; 95% CI, 3.7-25; P &lt; 0.001), lumbar-sacral operative level (OR, 2.9; 95% CI, 1.2-7.1; P ‫؍‬ 0.02), posterior approach (OR, 3.5; 95% CI, 1.2-9.7; P ‫؍‬ 0.02), instrumentation (OR, 2.5; 95% CI, 1.1-6.0; P ‫؍‬ 0.03), obesity (OR, 4.0; 94% CI, 1.6 -10; P &lt; 0.01), razor shaving before surgery (OR, 3.6; 95% CI, 1.2-11; P ‫؍‬ 0.02), and intraoperative administered fraction of inspired oxygen of less than 50% (OR, 12; 94% CI, 4.5-33; P &lt; 0.001). Conclusions: In addition to previously reported risk factors, this study identified intraoperative administered fraction of inspired oxygen of less than 50% as an independent, modifiable risk factor for SSI after spinal surgery. Intraoperative administration of at least 50% fraction of inspired oxygen should be tested prospectively as an intervention to prevent SSI after spinal surgery

Staging Beckett: constructing histories of performance

This multi-authored essay presents some selected initial findings from the AHRC Staging Beckett research project led by the universities of Reading and Chester with the Victoria and Albert Museum, London. For example, how did changes in economic and cultural climates, such as funding structures, impact on productions of Beckett's plays in the UK and Ireland from the 1950’s to the first decade of the twenty-first century? The essay raises historiographical questions raised by the attempts to map or construct performance histories of Beckett's theatre in the UK and Ireland