Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation.

BACKGROUND: The Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9-10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods. This paper reports on both the quantitative and qualitative data regarding the implementation of the HeLP intervention in the definitive cluster randomised controlled trial, which was part of the wider process evaluation. METHODS: Mixed methods were used to collect data on intervention uptake, fidelity of delivery in terms of content and quality of delivery of the intervention, as well as school and child engagement with the programme. Data were collected using registers of attendance, observations and checklists, field notes, focus groups with children and semi-structured interviews with teachers. Qualitative data were analysed thematically and quantitative data were summarized using descriptive statistics. RESULTS: All 16 intervention schools received a complete or near complete programme (94-100%), which was delivered in the spirit in which it had been designed. Of the 676 children in the intervention schools, over 90% of children participated in each phase of HeLP; 92% of children across the socio-economic spectrum were deemed to be engaged with HeLP and qualitative data revealed a high level of enjoyment by all children, particularly to the interactive drama workshops. Further evidence of child engagment with the programme was demonstrated by children's clear understanding of programme messages around marketing, moderation and food labelling. Thirteen of the intervention schools were deemed to be fully engaged with HeLP and qualitative data revealed a high level of teacher 'buy in', due to the programme's compatability with the National Curriculum, level of teacher support and use of innovative and creative delivery methods by external drama practitioners. CONCLUSION: Our trial shows that it is possible to successfully scale up complex school-based interventions, engage schools and children across the socio-economic spectrum and deliver an intervention as designed. As programme integrity was maintained throughout the HeLP trial, across all intervention schools, we can be confident that the trial findings are a true reflection of the effectiveness of the intervention, enabling policy recommendations to be made. TRIAL REGISTRATION: ISRCTN15811706

Corporate philanthropy through the lens of ethical subjectivity

The dynamic organisational processes in businesses dilute the boundaries between the individual, organisational, and societal drivers of corporate philanthropy. This creates a complex framework in which charitable project selection occurs. Using the example of European tour operators, this study investigates the mechanisms through which companies invest in charitable projects in overseas destinations. Inextricably linked to this is the increasing contestation by local communities as to how they are able to engage effectively with tourism in order to realise the benefits tourism development can bring. This research furthers such debates by exploring the processes through which tour operators facilitate community development through charitable giving. Findings show, with no formal frameworks in existence, project selection depends upon emergent strategies that connect the professional with the personal, with trust being positioned as a central driver of these informal processes. Discretionary responsibilities are reworked through business leaders’ commitment to responsible business practises and the ethical subjectivity guiding these processes

Problematizing fit and survival: transforming the law of requisite variety through complexity misalignment

The law of requisite variety is widely employed in management theorizing and is linked with core strategy themes such as contingency and fit. We reflect upon requisite variety as an archetypal borrowed concept. We contrast its premises with insights from the institutional literature and commitment literature, draw propositions that set boundaries to its applicability, and review the ramifications of what we call “complexity misalignment.” In this way we contradict foundational assumptions of the law, problematize adaptation- and survival-centric views of strategizing, and theorize the role of human agency in variously complex regimes

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

An experience of implementing Professional and Community Engagement (PACE): PACE yourself with work-integrated learning (WIL)

WIL within partner organisations aligned to the career aspirations of students represents a mutually-beneficial collaboration that contributes to social impact and innovation, while supporting graduate employability through industry connections, knowledge exchange and professional experience. At Macquarie University (MQ), this is a well-established part of the core curriculum – with all undergraduate students required to complete a PACE course1. Throughout 2016-18, the Clinical Science team was engaged in the development of a PACE/Capstone course for the new B. Clinical Science. Here, we share the experience of developing PACE for learners with a clinical/ health focus. A critical step was reaching out to relevant industry contacts in the network of the academic team. Leveraging these existing relationships, particularly within the local Ryde Technology Park, yielded a wide-range of potential partners. Engagement involved a series of workshops to: clarify expectations, demonstrate support, outline benefits of participation, and, ultimately, frame ‘activity statements’ that codified the partnership projects available. Students then formalised a learning contract with the partner and university, completed a reflective report, and presented their graduate portfolio in showcase event. In the first offering, 25 students completed PACE. The range of experiences on offer were well-aligned to the interests of students, with 92% of candidates allocated their first-/second-preference. Numbers approximately doubled in each subsequent offering, but feedback from supervisors remained consistently encouraging with: these undergraduate students ‘putting MRes and PhD students to shame’, securing internships and future employment opportunities. Prize-winning students in 2018 partnered with The Australian Museum and the university library to curate an exhibition on Indigenous health, and developed an employee health/well-being program for Konica-Minolta. PACE is a tested way of embedding WIL into undergraduate programs and offers a rewarding experience that can be adapted by educators. References 1McLachlan, K., et al. (2017). The student experience of PACE at Macquarie University: Understanding motivations for learning. Asia-Pacific Journal of Cooperative Education, 18(1), 59-71

Our Experience Adapting Team Based Learning (TBL) for Online Teaching: Our New Normal

In response to COVID-19, we rapidly transitioned our three-hour sessions (comprising lecture, tutorial, and practical components) for ‘Human Body 1’ to an interactive online format from 20S2. We decided to adapt a TBL approach as it lends itself to Zoom delivery in combination with other platforms, is associated with high levels of active student participation, and incorporates many assessment touchpoints – creating new opportunities for feedback and longitudinal performance monitoring1. Our approach involved flipping and chunking lecture content, supplemented by knowledge-check activities with automated feedback as pre-work. Weekly Zoom sessions started with an individual readiness assurance test (RAT) comprising 10 multiple-choice-questions; immediately followed by the same RAT, completed by student teams in separate breakout rooms – all via Blackboard. Student performance was quickly analysed, with individual and team results presented back to the cohort in a ‘clarification’ session (that focussed on poorly answered questions with explanations of the most correct response and exploration of misconceptions). Teams returned to breakout rooms to complete focused application tasks (FAT) before debriefing as a cohort. In our approach, the FAT varied between teams – with each requiring students to work through a case scenario or interpret complex data. Student performance is enhanced following peer-teaching and learning in our TBL. Online TBL has been well-received, with internal course evaluations improved since introduction – in our student’s voice, “I really enjoyed the pre-work… it [was] really helpful in consolidating knowledge. I also really enjoyed the i[ndividual]RAT and t[eam]RAT quizzes and discussing the trickier questions afterwards in class. It encouraged us to keep on top of the large workload.” (SEC-21S1) The additional results and feedback generated through the pre-work, RAT and FAT have provided new ways to see how performance is developing from week to week. Courses interested in adopting a flipped online format may benefit from using this approach

Evaluation and use of an online data acquisition and content platform for physiology practicals and tutorials

The blended learning approach to teaching allows educators to incorporate multiple learning resources whilst making courseware available to students outside the traditional classroom setting. An online platform that interfaces easily with a range of biological and clinical equipment for real-time data acquisition was introduced for laboratory-based practicals and associated tutorials for all intermediate/second year undergraduate physiology courses. The traditional paper-based notes across the intermediate physiology curriculum were converted to custom interactive, online modules delivered using a blended approach to learning. An advantage of incorporating online elements, particularly in the practical/laboratory context, was the opportunity to collect learning analytics to gauge student engagement with practical learning. Online delivery of content also facilitated the delivery of evaluation surveys to gauge student satisfaction with converted courseware. The purpose of this study was twofold: (1) to examine the usage pattern of students during delivery of one module of the online practical courseware, 'Electrophysiology of the Nerve', over the first two years of its implementation; and (2) to gather evidence of the impact of the platform on student engagement and learning outcomes. Data analysis and positive student feedback from surveys demonstrate that the new online system improved student engagement and active participation in practical activities.11 page(s

Phenomenology and clinical correlates of family accommodation in pediatric anxiety disorders

Despite evidence documenting high prevalence of family accommodation in pediatric obsessive–compulsive disorder, examination in other pediatric anxiety disorders is limited. Preliminary evidence suggests that family accommodation is common amongst children with anxiety disorders; however, the impact on clinical presentation and functional impairment has not been addressed. This study assessed the nature and clinical correlates of family accommodation in pediatric anxiety, as well as validating a mechanistic model. Participants included 112 anxious youth and their parents who were administered a diagnostic clinical interview and measure of anxiety severity, as well as questionnaires assessing internalizing and externalizing symptoms, family accommodation and functional impairment. Some form of accommodation was present in all families. Family accommodation was associated with increased anxiety severity and externalizing behaviors, having a diagnosis of separation anxiety, and increased functional impairment. Family accommodation partially mediated the relationship between anxiety severity and functional impairment, as well as externalizing behaviors and functional impairment. Family accommodation is common in pediatric anxiety disorders, and is associated with more severe clinical presentations and functional impairment. These findings highlight the importance of parental involvement in treatment and the need to specifically target accommodation practices during interventions to mitigate negative outcomes in anxious youth. Further studies utilizing longitudinal data are needed to validate mechanistic models.7 page(s

Regional Study of No-Till Impacts on Near-Surface Aggregate Properties that Influence Soil Erodibility

The extent to which tillage systems modify the near-surface soil aggregate properties aff ecting soil’s susceptibility to erosion by water and wind is not well understood. We hypothesized that an increase in soil organic carbon (SOC) content with conservation tillage systems, particularly no-till (NT), may improve near-surface soil aggregate properties that infl uence soil erodibility. This regional study assessed changes in aggregate resistance to raindrops, dry aggregate wettability, and dry aggregate stability as well as their relationships with changes in SOC content. Four long-term (\u3e19 yr) tillage systems including moldboard plow (MP), conventional till (CT), reduced till (RT), and NT were chosen across the central Great Plains at Hays and Tribune, KS, Akron, CO, and Sidney, NE. The kinetic energy (KE) of raindrops required to disintegrate 4.75- to 8-mm aggregates from NT soils equilibrated at −0.03 and −155 MPa matric potential was between two and seven times greater than that required for MP and CT soils in the 0- to 2-cm depth in all soils. At the same depth, the water drop penetration time (WDPT) in aggregates from NT soils was four times greater at Akron and Hays and seven times greater at Sidney and Tribune compared with that in plowed soils. Aggregates from NT soils were more stable under rain and less wettable than those from plowed soils particularly in the surface 0 to 5 cm, but RT had lesser beneficial effects than NT management. The SOC content increased with NT over MP and CT and explained 35% of the variability across soils in aggregate wettability and 28% of the variability in resistance to raindrops in the 0- to 2-cm depth. Aggregate wettability explained 47% of the variability across soils in KE of raindrops required for the disintegration of aggregates. No-till management did not affect dry aggregate-size distribution and stability except at Akron where mean weight diameter (MWD) in RT and NT was 50% lower than in MP management in the 0- to 2-cm depth. Aggregates in MP and CT soils were either stronger or equally strong when dry but less stable when wet than in NT soils. Overall, NT farming enhanced near-surface aggregate properties affecting erosion by water but had small or no effects on dry aggregate stability