Scale-up of the Internet-based Professional Learning to help teachers promote Activity in Youth (iPLAY) intervention: a hybrid type 3 implementation-effectiveness trial

BACKGROUND

Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the 'Internet-based Professional Learning to help teachers promote Activity in Youth' (iPLAY) intervention in primary schools using the RE-AIM framework.

METHODS

We conducted a type 3 hybrid implementation-effectiveness study and collected data between April 2016 and June 2021, in New South Wales (NSW), Australia. RE-AIM was operationalised as: (i) Reach: Number and representativeness of students exposed to iPLAY; (ii) Effectiveness: Impact of iPLAY in a sub-sample of students (n = 5,959); (iii) Adoption: Number and representativeness of schools that received iPLAY; (iv) Implementation: Extent to which the three curricular and three non-curricular components of iPLAY were delivered as intended; (v) Maintenance: Extent to which iPLAY was sustained in schools. We conducted 43 semi-structured interviews with teachers (n = 14), leaders (n = 19), and principals (n = 10) from 18 schools (11 from urban and 7 from rural locations) to determine program maintenance.

RESULTS

Reach: iPLAY reached ~ 31,000 students from a variety of socio-economic strata (35% of students were in the bottom quartile, almost half in the middle two quartiles, and 20% in the top quartile).

EFFECTIVENESS

We observed small positive intervention effects for enjoyment of PE/sport (0.12 units, 95% CI: 0.05 to 0.20, d = 0.17), perceptions of need support from teachers (0.26 units, 95% CI: 0.16 to 0.53, d = 0.40), physical activity participation (0.28 units, 95% CI: 0.10 to 0.47, d = 0.14), and subjective well-being (0.82 units, 95% CI: 0.32 to 1.32, d = 0.12) at 24-months. Adoption: 115 schools received iPLAY.

IMPLEMENTATION

Most schools implemented the curricular (59%) and non-curricular (55%) strategies as intended. Maintenance: Based on our qualitative data, changes in teacher practices and school culture resulting from iPLAY were sustained.

CONCLUSIONS

iPLAY had extensive reach and adoption in NSW primary schools. Most of the schools implemented iPLAY as intended and effectiveness data suggest the positive effects observed in our cluster RCT were sustained when the intervention was delivered at-scale.

TRIAL REGISTRATION

ACTRN12621001132831.

A42 HETEROGENEITY IN EFFICACY AND SAFETY ENDPOINTS FOR PEDIATRIC CLINICAL TRIALS IN INFLAMMATORY BOWEL DISEASE: A NEED FOR HARMONIZATION

NOT PUBLISHED AT AUTHOR’S REQUEST

Funding Agencies: None

Operator variability in scan positioning is a major component of HR-pQCT precision error and is reduced by standardized training

In this study, we determined that operator positioning precision contributes significant measurement error in high-resolution peripheral quantitative computed tomography (HR-pQCT). Moreover, we developed software to quantify intra- and inter-operator variability and demonstrated that standard positioning training (now available as a web-based application) can significantly reduce inter-operator variability.

INTRODUCTION

HR-pQCT is increasingly used to assess bone quality, fracture risk, and anti-fracture interventions. The contribution of the operator has not been adequately accounted in measurement precision. Operators acquire a 2D projection ("scout view image") and define the region to be scanned by positioning a "reference line" on a standard anatomical landmark. In this study, we (i) evaluated the contribution of positioning variability to in vivo measurement precision, (ii) measured intra- and inter-operator positioning variability, and (iii) tested if custom training software led to superior reproducibility in new operators compared to experienced operators.

METHODS

To evaluate the operator in vivo measurement precision, we compared precision errors calculated in 64 co-registered and non-co-registered scan-rescan images. To quantify operator variability, we developed software that simulates the positioning process of the scanner's software. Eight experienced operators positioned reference lines on scout view images designed to test intra- and inter-operator reproducibility. Finally, we developed modules for training and evaluation of reference line positioning. We enrolled six new operators to participate in a common training, followed by the same reproducibility experiments performed by the experienced group.

RESULTS

In vivo precision errors were up to threefold greater (Tt.BMD and Ct.Th) when variability in scan positioning was included. The inter-operator precision errors were significantly greater than the short-term intra-operator precision (p < 0.001). New trained operators achieved comparable intra-operator reproducibility to experienced operators and lower inter-operator reproducibility (p < 0.001). Precision errors were significantly greater for the radius than for the tibia.

CONCLUSION

Operator reference line positioning contributes significantly to in vivo measurement precision and is significantly greater for multi-operator datasets. Inter-operator variability can be significantly reduced using a systematic training platform, now available online ( http://webapps.radiology.ucsf.edu/refline/ ).

Older adults' outdoor walking and the built environment: does income matter?

Background

Our aim was to examine the association between Street Smart Walk Score® and self-reported outdoor walking among older Canadians, and to determine whether socioeconomic status modifies this association.

Methods

We linked objective walkability data with cross-sectional survey data from the Canadian Community Health Survey Healthy-Aging 2008–2009 Cycle for a sample of 1309 British Columbians aged ≥ 65 years. We examined associations between Street Smart Walk Score and meeting physical activity guidelines (≥150 min of moderate to vigorous activity/week) through self-reported outdoor walking using multivariable logistic regression, and tested for significant interactions with household income.

Results

A ten point higher Street Smart Walk Score was associated with a 17 % higher odds of meeting physical activity guidelines through walking outside (95 % CI: 1.07,1.27). In addition, older adults living in neighbourhoods categorised as Walker’s Paradise were over three times more likely to meet guidelines than those living in Car-dependent/Very car dependent neighbourhoods. We found no evidence that household income moderated the effect of Walk Score on walking outside.

Conclusions

Neighbourhood design may be one avenue whereby physical activity levels of older people can be enhanced through outdoor walking, with benefit across socioeconomic strata.

High-resolution peripheral QCT imaging of bone micro-structure in adolescents

SUMMARY

We examined the feasibility of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microstructure in adolescents. Low radiation doses and clear images were produced using a region of interest (ROI) at 8% of tibial length. Active growth plates were observed in 33 participants. HR-pQCT safely assessed important elements of bone microstructure in adolescents.

INTRODUCTION

We examined the feasibility and safety of HR-pQCT to assess tibial bone microstructure in adolescents.

METHODS

We used XtremeCT (Scanco Medical) to assess bone microstructure at the distal tibia in 278 participants (15-20 years old).

RESULTS

The 2.8-min scan resulted in a relatively low radiation dose (<3 microSv) while producing artifact clear images in all participants. An 8% scan site was equivalent to 33 +/- 2 mm of total tibial length (400 +/- 30 mm). We observed active growth plates in 33 participants. The growth plate was located at 13 +/- 2 mm of total tibial length and was not included in the ROI for any participant.

CONCLUSIONS

HR-pQCT safely assessed important elements of bone microstructure in adolescents. Given the important contribution of bone geometry and structure to bone strength, it is essential to better understand the development and adaptation of these parameters in cortical and trabecular bone compartments.

Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis

Histological dysplasia is the cornerstone of colorectal cancer surveillance in ulcerative colitis (UC). Recently, pathologists have received unfavourable media attention concerning other cancer screening programmes. The aim of this study was to determine whether colonic biopsy specimens should be examined by gastrointestinal pathologists as opposed to generalists, by examining inter-observer variation between the two groups. Fifty-one coded slides showing varying degrees of dysplasia were mailed to seven gastrointestinal and six general histopathologists. Pathologists allocated each biopsy into one of four categories without the benefit of a clinical history or an opportunity to use the 'indefinite' category that is included in the Riddell classification. The responses were analysed using kappa statistics. The overall kappa statistic for gastrointestinal pathologists was 0.30 [95% confidence interval (CI)=0.26-0.34] and for general pathologists 0.28 (95% CI=0.23-0.32). Agreement was best for high-grade dysplasia (kappa of 0.54 and 0.61 for GI and general pathologists, respectively). There was total concordance of the 13 pathologists in only four of the 51 slides (7.8%) (95% CI=0.4-15.2%). It is concluded from these results that gastrointestinal pathologists are no better than generalists when grading dysplasia in UC and that agreement is poor in both groups. There is therefore no evidence that there would be any benefit in having specialist histopathology centres concentrating specifically on the interpretation of all surveillance colonoscopy biopsies from around the UK. It must be made clear to the public that surveillance and screening programmes carry a significant rate of histological error and that perfection cannot be expected or achieved with present methods.

The role of physiotherapy in the prevention and treatment of osteoporosis

Osteoporosis is an increasing public health problem that causes loss of life and reduced quality of life in sufferers. Strategies to improve bone density and reduce the likelihood of falls are important in the prevention of osteoporosis. Physiotherapists have a role to play in this condition through exercise prescription, therapeutic modalities, specific techniques and education. Appropriate treatment goals can be established following a thorough assessment of signs and symptoms, risk factors for osteoporosis and functional status. Levels of bone density measured from dual energy X-ray absorptiometry can help guide patient management. Since the aim is to maximize peak bone mass in children and adolescents, participation in a variety of high-impact activities should be encouraged. In the middle adult years, small increases in bone mass may be achieved by structured weight-training and weight-bearing exercise. In the older adult years, particularly if osteopenia or osteoporosis is present, the aim is to conserve bone mass, reduce the risk of falls, promote extended posture, reduce pain, and improve mobility and function.

Targeted intraparenchymal delivery of human NGF by gene transfer to the primate basal forebrain for 3 months does not accelerate beta-amyloid plaque deposition

Nerve growth factor therapy has been proposed as a potential means of preventing degeneration of basal forebrain cholinergic neurons in Alzheimer's disease and thereby improving cognition. However, NGF has been reported to upregulate expression of the beta-amyloid precursor protein, which in turn could accelerate deposition of "mature" beta-amyloid in the brain. To address this possibility, the brains of 16 adult and aged rhesus monkeys were examined for beta-amyloid plaque deposition in the presence or absence of NGF treatment. Six aged monkeys received intraparenchymal grafts into the cholinergic basal forebrain of autologous cells genetically modified to secrete NGF, six aged monkeys received intraparenchymal grafts of autologous control cells expressing the reporter gene beta-galactosidase, and four adult nonoperated monkeys served as additional controls. All brains were examined for expression of mature beta-amyloid using an antibody recognizing amino acids 1-40 of the beta-amyloid peptide. Amyloid plaques were systematically quantified in representative sections of the temporal, frontal, cingulate, insular, and parietal cortices and in the amygdala and hippocampus. Results disclosed that aging resulted in an increase in amyloid plaque formation: no plaques at all were detected in nonaged monkeys, whereas a mean of 20 +/- 13 plaques per section were present in control-aged monkeys. Aged subjects with intraparenchymal NGF-secreting grafts for 3 months contained a mean of 29 +/- 14 plaques per section, an amount that did not differ significantly from control-aged monkeys (P = 0.66). Thus, 3 months of intraparenchymal NGF delivery did not significantly increase beta-amyloid deposition.

Sonohysterographic screening before in vitro fertilization

OBJECTIVE

To evaluate the use of sonohysterography for uterine screening before IVF.

DESIGN

Prospective screening with sonohysterography and comparison with available hysterosalpingographic and hysteroscopic evaluations.

SETTING

Private practice.

PATIENT(S)

Seventy-two women undergoing IVF-ET using their own or donor eggs.

INTERVENTION(S)

Sonohysterography was performed by instilling saline into the uterine cavity through an intracervical balloon catheter; there was concurrent vaginal sonographic visualization in all cases.

MAIN OUTCOME MEASURE(S)

Sonohysterographic findings and pregnancy rates.

RESULT(S)

Cavitary lesions were detected in 8 (11.1%) of 72 sonohysterographic examinations. Six of 8 cases were confirmed and treated by hysteroscopy. After sonohysterographic evaluation, 35 (48.6%) of 72 patients conceived, resulting in 25 ongoing or delivered pregnancies, 5 chemical pregnancies, and 5 spontaneous abortions. No statistically significant difference was observed in the pregnancy outcome for patients undergoing IVF who had sonohysterography compared with that for patients undergoing IVF during the same period who previously had a uterine evaluation by a different method. The estimated cost savings per patient undergoing sonohysterography instead of in-office hysteroscopy was $275.

CONCLUSION(S)

Sonohysterography offers advantages over in-office hysteroscopy and hysterosalpingography for evaluation of the uterus before IVF.

Increased N-glycosylation and reduced transferrin-binding capacity of transferrin receptor isolated from placentae of diabetic women

Infants of diabetic mothers are frequently born iron deficient because their fetal iron demand exceeds placental iron transport capacity. Although transferrin receptor (TfR) expression is increased, binding to diferric transferrin is decreased proportionately to the severity of maternal disease. It is hypothesized that TfR isolated from diabetic placentae has altered N-glycosylation since proper glycosylation of N-linked oligosaccharides is important for normal TfR binding kinetics to diferric transferrin. TfR was obtained from syncytiotrophoblastic membranes of six diabetic and six non-diabetic human placentae. Competitive binding to 125I-transferrin demonstrated a higher Kd in the diabetic TfR (P = 0.04), directly correlated to cord serum C-peptide concentration (r = 0.81, P < 0.001). The molecular weight of the monomeric form of TfR prior to treatment with glycopeptidase F (PNG-F) was greater in the diabetic group (P < 0.001) was directly related to the Kd (r = 0.77, P = 0.002). Treatment with PNG-F eliminated the molecular weight difference between the two groups. Increased glycosylation of the N-linked oligosaccharides of TfR isolated from diabetic placentae may alter the three-dimensional structure or charge of the receptor, thus reducing its binding affinity for transferrin.

Placental transferrin receptor in diabetic pregnancies with increased fetal iron demand

Augmented fetal hemoglobin synthesis during diabetic pregnancy increases fetal iron demand. To study the effect of increased fetal iron demand on placental transferrin receptor (TR), we utilized a monoclonal antibody to localize placental TR immunoreactivity and 125I-labeled transferrin to study TR binding characteristics in 10 placentas from poorly controlled diabetic mothers with increased fetal iron demand and 10 placentas from nondiabetic mothers. The infants born to the diabetics had higher cord serum C-peptide, erythropoietin, and hemoglobin concentrations, indicating fetal hyperinsulinemia and hypoxia, with augmented erythropoiesis and iron demand. TR immunoreactivity was localized to the syncytiotrophoblast in both groups, was greater in the diabetic group, and was inversely correlated with fetal storage iron (r = -0.75; P < 0.001). Scatchard analysis of 125I transferrin binding data confirmed greater receptor number (Bmax 17.9 +/- 2.2 vs. 12.6 +/- 1.3 pM/mg protein, P = 0.05), but reduced binding affinity [dissociation constant (Kd) 7.6 +/- 0.9 vs. 5.4 +/- 0.4 nM/l, P = 0.03] in the diabetic group. The TR staining intensity, Bmax, and Kd were each correlated with cord C-peptide, suggesting either a primary or secondary role for fetal hyperinsulinemia in TR expression. This study provides in vivo evidence that fetal factors, such as iron demand or hyperinsulinemia, influence regulation of placental TR in humans. The increase in placental syncytiotrophoblastic TR expression associated with reduced cord serum ferritin concentration suggests that the fetus utilizes both increased placental iron transport and mobilization of fetal iron stores to support augmented fetal erythropoiesis.

Exercise-induced stress injuries to the femur

Seventy-one athletes with 74 stress injuries to the femur were studied using a case-controlled design. Forty-three were females (26.6 yrs) and 28 were males (31.2 yrs). Each patient had exercise-induced pain in the hip, groin or thigh and a Tec-99m-MDP bone scan showing focal uptake of radionuclide in the femur. Running was the most common activity at the time of injury (89.2%) followed by triathlon (4.6%) and aerobic dance (4.6%). Thirty per cent of the runners had increased their training duration immediately prior to their first symptom. Anterior thigh pain was the most frequent site of exercise-induced pain (45.9%) followed by hip pain (27%) and groin pain (8.1%). During the clinical examination, when asked to hop on the affected limb, 70.3% of the patients had pain reproduced in the hip, groin or anterior thigh. There were 39 cases (53%) involving focal uptake of radionuclide in the femoral shaft, 15 (20%) in the lesser trochanter, 11 (15%) in the intertrochanteric region between the femoral neck and the greater trochanter, 8 (11%) in the femoral neck and 1 (1%) in the greater trochanter. Two patients suffered displaced fractures, one at the femoral neck and the other in the shaft of the femur. Neither patient had previously sought medical attention for their leg pain. Of 46 plain radiographs taken, only 11 (24%) were abnormal. The mean time to diagnosis and recovery were 6.6 and 10.4 weeks respectively. Substitution of cycling and water exercise for running were the most common therapeutic interventions.

Infant-feeding practices and adiposity in 4-y-old Anglo- and Mexican-Americans

A longer duration of breast-feeding and later introduction to solids may protect against excessive adiposity in infancy. This study investigated infant feeding practices and their relationship to two measures of adiposity--body mass index (BMI) and sum of skinfold thicknesses (SUMSF)--in 331 4-y-old Anglo- (43%) and Mexican-American (57%) children. No associations were detected between any of the infant feeding variables of duration of breast-feeding and introduction to solids and formula and measures of the child's adiposity. Mother's physical measures of BMI and SUMSF explained the largest portion of variance for both measures of childhood adiposity, BMI (9.5%), and SUMSF (8.3%). Genetic and environmental factors other than infant feeding practices appear to have a greater influence on a 4-y-olds' adiposity.

Anthropometric status and body composition in aboriginal women of the Kimberley region

A detailed cross-sectional anthropometric study in which weight, height, three circumferences and four skinfolds were measured in 114 Aboriginal women aged 15-79 years was undertaken in the Kimberley region of Western Australia. Highly significant increases with age were observed for all measurements except height. Subcutaneous fat distribution in Aboriginal women was found to be more central than in white women, and the use of triceps skinfold to predict body fat in Aboriginal women gave lower estimates of body fat in this group than did the use of multiple skinfolds. Further work is needed to determine the accuracy of applying prediction equations that are based on skinfold measurements in white women, to assess total body fat in Aboriginal women. However, the data from this study do suggest that for a given body mass index Aboriginal women have more subcutaneous fat (as assessed from four skinfold measurements) and, consequently, a higher percentage of body fat than have white women.

Improving cognitive ability in chronically deprived children

Beginning at different ages in their preschool years, groups of chronically undernourished children from Colombian families of low socioeconomic status participated in a program of treatment combining nutritional, health care, and educational features. By school age the gap in cognitive ability between the treated children and a group of privileged children in the same city had narrowed, the effect being greater the younger the children were when they entered the treatment program. The gains were still evident at the end of the first grade in primary school, a year after the experiment had ended.