Promoting children's health through community-led street interventions: analyzing sustained voluntarism in Canadian School Streets.

BACKGROUND: Active School Travel (AST) initiatives align with the Ottawa Charter for Health Promotion, which calls for 'creating supportive environments' and 'strengthening community action.' However, their reliance on volunteers poses sustainability challenges. The main objectives of this study were to document the motivations, satisfaction, and experiences of volunteers involved in sustaining two AST initiatives in Ontario for an entire school year. METHODS: Two volunteer-led School Street initiatives in Kingston, Ontario successfully operated during pick-up and drop-off times of each school day. The first initiative operated for the entire 2021-2022 school year, and the second operated for the entire 2022-2023 school year. These initiatives were the first of their kind in the province of Ontario, Canada. Volunteers from both sites (n = 56) participated in online surveys and their motivations, satisfaction, and experiences of their role were compared using the 2-sided Fisher's Exact Test. RESULTS: Over 80% of volunteers were highly motivated to promote safety and over 70% of volunteers were highly motivated to disrupt the status quo of unsupportive, car-centric urban environments by reimagining how streets can be used. By taking collective action to re-shape the environment around these public schools to support healthy, active living, our findings reveal that over 90% of volunteers were highly satisfied. Of the volunteers, 87% felt they contributed to child safety and 85% felt they had developed stronger community connections. They appreciated the short (i.e., 40 minute) time commitment of each shift, weekly email communications by the community organization leading the initiative, and the volunteer schedule. They also appreciated the positive social interactions during volunteer shifts, which they felt outweighed the minimal resistance they experienced. CONCLUSIONS: This research demonstrates the importance of logistical, motivational, and social factors in recruiting and retaining volunteers for community-led School Streets. Our findings support appealing to prospective volunteers' influence in achieving School Street objectives (e.g., improved safety) in recruitment efforts, as well as highlighting School Streets' innovative approach. Communicating with volunteers throughout School Street planning and implementation processes and limiting traffic in the closed street zone (i.e., by excluding the school staff parking lot and private driveways from the scope) are additional recommendations based on the findings of this study.

The IκB-protein BCL-3 controls Toll-like receptor-induced MAPK activity by promoting TPL-2 degradation in the nucleus.

Proinflammatory responses induced by Toll-like receptors (TLRs) are dependent on the activation of the NF-ĸB and mitogen-activated protein kinase (MAPK) pathways, which coordinate the transcription and synthesis of proinflammatory cytokines. We demonstrate that BCL-3, a nuclear IĸB protein that regulates NF-ĸB, also controls TLR-induced MAPK activity by regulating the stability of the TPL-2 kinase. TPL-2 is essential for MAPK activation by TLR ligands, and the rapid proteasomal degradation of active TPL-2 is a critical mechanism limiting TLR-induced MAPK activity. We reveal that TPL-2 is a nucleocytoplasmic shuttling protein and identify the nucleus as the primary site for TPL-2 degradation. BCL-3 interacts with TPL-2 and promotes its degradation by promoting its nuclear localization. As a consequence, Bcl3-/- macrophages have increased TPL-2 stability following TLR stimulation, leading to increased MAPK activity and MAPK-dependent responses. Moreover, BCL-3-mediated regulation of TPL-2 stability sets the MAPK activation threshold and determines the amount of TLR ligand required to initiate the production of inflammatory cytokines. Thus, the nucleus is a key site in the regulation of TLR-induced MAPK activity. BCL-3 links control of the MAPK and NF-ĸB pathways in the nucleus, and BCL-3-mediated TPL-2 regulation impacts on the cellular decision to initiate proinflammatory cytokine production in response to TLR activation.

Automated phantom analysis for gamma cameras and SPECT: A methodology for use in a clinical setting.

PURPOSE: We introduce an automated, quantitative image analysis package for gamma camera and single photon emission computed tomography quality control. Our focus was to produce consistent methods that are feasible in clinical settings and use standard phantoms. METHODS: Four gamma cameras were used to acquire planar images of four-quadrant bar phantoms and projection views of an American College of Radiology (ACR) phantom as part of a standard gamma camera quality control program. Images were sent to QC-Track® (Atirix Medical Systems, Inc., Minneapolis, MN, USA), which automatically placed predetermined regions of interest (ROIs) and performed analysis. For the bar phantom, a standard deviation (SD)-based modulation transfer function was calculated for a circular ROI in each quadrant. The bar widths at various MTF values were reported using linear interpolation as applicable. For the ACR phantom, the contrast-to-noise ratio (CNR) for each sphere, a modulation for each rods section, and a percent deviation for uniformity ROIs was calculated. Spheres corresponding to a CNR of 3, and the rod size at various modulations were also reported using linear interpolation. Visual analysis was performed by three medical physicists to evaluate interobserver variability and correlation to quantitative values. RESULTS: Analysis of the bar phantom showed predictable differences with changes in matrix size and bar width and showed consistency over similar acquisitions over the course of the study. Analysis of the ACR Phantom showed increasing CNR and modulation with increasing sphere and rod diameter, as expected. For both phantoms, quantitative values from linear interpolation correlated well with visual analysis. CONCLUSION: Our automated method for quantitative image analysis is consistent and shows increased precision and sensitivity when compared to standard visual methods. Thresholds correspond well with visual analysis and previous guidelines for observer visibility (e.g., Rose criterion), making our framework suitable for routine use in a nuclear medicine department.

Signal and contrast to noise ratio evaluation of fluoroscopic loops for interventional fluoroscope quality control.

Modern fluoroscopes pose a challenge for the clinical physicist for annual testing and continued upkeep. These fluoroscopes are critical to providing care to patients for complex interventions, and continue to evolve in automated image quality adjustments. Few tools in software or hardware currently exist to assist the physicist or technologist in gauging fluoroscope constancy or readiness for procedures. Many modalities such as mammography, computed tomography or even magnetic resonance imaging are much more evolved with respect to testing or quality control. In this work we sought to provide simple reproducible tools and methods for spot evaluating or continued quality testing of interventional fluoroscopes.

Residential moves, neighbourhood walkability, and physical activity: a longitudinal pilot study in Ontario Canada.

BACKGROUND: Numerous cross-sectional studies have consistently demonstrated an association between attributes of urban form or 'walkability' and individual- and population-level physical activity (PA) patterns. However, in the absence of longitudinal research, the self-selection problem undermines the claim that a walkable built form produces more physically active people. Through a longitudinal pilot study of 'imminent movers' in Ontario using a quasi-experimental approach, we sought to examine the feasibility of longitudinal methods that would produce stronger evidence for a causal relationship between the built environment and PA levels. METHODS: Participants were recruited using publicly available real estate listings. Successful recruits were sent a PA diary to track their activity for a week, and were also scheduled for a 45-min phone interview that collected demographic details, neighbourhood perceptions and self-efficacy for walking, and verified the PA diary. Following their move, participants were given the same tasks and then sorted into groups based on changes in their neighbourhood walkability (measured with Walk Score) from baseline to follow-up. RESULTS: There were challenges in recruiting a sufficient number of participants and counter-factuals to examine the relationship between changes in walkability and PA. Our limited sample showed a substantial decrease in Walk Score over the entire sample, from an average of 45.8 to 30.6, with most participants moving to less walkable areas. From baseline to follow-up, the largest declines in reported self-efficacy for walking were to grocery stores, banks, and for entertainment. For the entire sample, utilitarian PA decreased, while recreational and job-related PA increased. CONCLUSIONS: This pilot study highlighted the methodological challenges involved in collecting quasi-experimental evidence on the effect of walkable environments on PA. Additionally, the low sample size and the tendency for most participants to move to less walkable areas meant there were insufficient counter-factuals for study of the effect of walkability on PA. Despite these challenges, we saw important changes in self-efficacy for walking that were commensurate with changes to the built environment. In sum, while longitudinal research on health and the built environment is urgently needed, recruiting an adequate sample size for a quasi-experimental study such as this is extremely challenging.

Mapping the Interaction of B Cell Leukemia 3 (BCL-3) and Nuclear Factor κB (NF-κB) p50 Identifies a BCL-3-mimetic Anti-inflammatory Peptide.

The NF-κB transcriptional response is tightly regulated by a number of processes including the phosphorylation, ubiquitination, and subsequent proteasomal degradation of NF-κB subunits. The IκB family protein BCL-3 stabilizes a NF-κB p50 homodimer·DNA complex through inhibition of p50 ubiquitination. This complex inhibits the binding of the transcriptionally active NF-κB subunits p65 and c-Rel on the promoters of NF-κB target genes and functions to suppress inflammatory gene expression. We have previously shown that the direct interaction between p50 and BCL-3 is required for BCL-3-mediated inhibition of pro-inflammatory gene expression. In this study we have used immobilized peptide array technology to define regions of BCl-3 that mediate interaction with p50 homodimers. Our data show that BCL-3 makes extensive contacts with p50 homodimers and in particular with ankyrin repeats (ANK) 1, 6, and 7, and the N-terminal region of Bcl-3. Using these data we have designed a BCL-3 mimetic peptide based on a region of the ANK1 of BCL-3 that interacts with p50 and shares low sequence similarity with other IκB proteins. When fused to a cargo carrying peptide sequence this BCL-3-derived peptide, but not a mutated peptide, inhibited Toll-like receptor-induced cytokine expression in vitro. The BCL-3 mimetic peptide was also effective in preventing inflammation in vivo in the carrageenan-induced paw edema mouse model. This study demonstrates that therapeutic strategies aimed at mimicking the functional activity of BCL-3 may be effective in the treatment of inflammatory disease.

The Regulation of Endotoxin Tolerance and its Impact on Macrophage Activation.

Endotoxin tolerance in macrophages is a key regulatory mechanism to limit the innate immune response to infection or injury. Long considered a state of unresponsiveness to Toll-like receptor activation, tolerance is now recognized as a state of altered responsiveness to infection or injury. Endotoxin tolerance leads to a shift away from a pro-inflammatory response toward a response with key anti-inflammatory and pro-resolution features. Advances in our understanding of Toll-like receptor function have identified a number of molecular mechanisms that promote tolerance, but how these are integrated to achieve gene-specific regulation is an important outstanding question. The potential to harness the mechanisms of endotoxin tolerance to promote the resolution of chronic inflammation warrants the continued investigation of this fundamental feature of innate immunity. This review focuses on the endotoxin tolerant state, our understanding of the underlying molecular mechanisms, and the clinical significance of endotoxin tolerance.

Deubiquitination of NF-κB by Ubiquitin-Specific Protease-7 promotes transcription.

NF-κB is the master regulator of the immune response and is responsible for the transcription of hundreds of genes controlling inflammation and immunity. Activation of NF-κB occurs in the cytoplasm through the kinase activity of the IκB kinase complex, which leads to translocation of NF-κB to the nucleus. Once in the nucleus, NF-κB transcriptional activity is regulated by DNA binding-dependent ubiquitin-mediated proteasomal degradation. We have identified the deubiquitinase Ubiquitin Specific Protease-7 (USP7) as a regulator of NF-κB transcriptional activity. USP7 deubiquitination of NF-κB leads to increased transcription. Loss of USP7 activity results in increased ubiquitination of NF-κB, leading to reduced promoter occupancy and reduced expression of target genes in response to Toll-like- and TNF-receptor activation. These findings reveal a unique mechanism controlling NF-κB activity and demonstrate that the deubiquitination of NF-κB by USP7 is critical for target gene transcription.

Inhibition of transcription by B cell Leukemia 3 (Bcl-3) protein requires interaction with nuclear factor κB (NF-κB) p50.

B cell leukemia 3 (Bcl-3) is an essential negative regulator of NF-κB during Toll-like receptor and TNF receptor signaling. Bcl-3 also interacts with a number of transcriptional regulators, including homodimers of the NF-κB p50 subunit. Deletion of Bcl-3 results in increased NF-κB p50 ubiquitination and proteasomal degradation and increased inflammatory gene expression. We employed immobilized peptide array technology to define a region of p50 required for the formation of a Bcl-3·p50 homodimer immunosuppressor complex. Our data demonstrate that amino acids 359-361 and 363 of p50 are critical for interaction with Bcl-3 and essential for Bcl-3-mediated inhibition of inflammatory gene expression. Bcl-3 is unable to interact with p50 when these amino acids are mutated, rendering it incapable of inhibiting the transcriptional activity of NF-κB. Bcl-3 interaction-defective p50 is hyperubiquitinated and has a significantly reduced half-life relative to wild-type p50. Nfkb1(-/-) cells reconstituted with mutated p50 precursor p105 are hyperresponsive to TNFα stimulation relative to wild-type p105, as measured by inflammatory gene expression. Mutant p105 recapitulates a Bcl3(-/-) phenotype. This study demonstrates that interaction with p50 is necessary and sufficient for the anti-inflammatory properties of Bcl-3 and further highlights the importance of p50 homodimer stability in the control of NF-κB target gene expression.

Should Canadian health promoters support a food stamp-style program to address food insecurity?

Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.

A passion for gambling: a generation-specific conceptual analysis and review of gambling among older adults in Canada.

The proliferation of gambling opportunities in Canada, coupled with an aging population, has led to an increased prevalence of gambling among older adults. Encouraged by this trend, gambling industries have modified their activities to attract and market to this group. Yet, older adults are not a homogeneous group. The life experiences, values, and attitudes shared by generations make a cohort-specific analysis of gambling among older adults a worthwhile pursuit. Drawing from the Dualistic Model of Passion (Vallerand et al. in J Pers Soc Psychol 85(4):756-767, 2003), we discuss the role of passion in shaping gambling behaviours, and the implications of a harmonious or obsessive passion on the benefits and risks to two distinct generations of older adults. Based on their generational attributes, we posit that members of the Silent Generation (those born between 1925 and 1942) stand to gain more from the benefits of recreational gambling, but also stand lose more from problem gambling, than their children's generation, the Baby Boomers (those born between 1942 and 1964). Preventative strategies to assist problem gambling seniors, along with recommendations for further research, are discussed.

Framing incremental expansions to public health insurance systems: the case of Canadian pharmacare.

Canada is the only country in the world to offer universal comprehensive public health insurance that excludes outpatient prescription medicines. Few scholars have attempted to explain this policy puzzle. We study media coverage of prescription drug financing from 1990 to 2010 to elucidate how the policy problem and potential solutions have been framed in media discourse and identify the actors that have dominated media texts. We confirm previous analyses that have revealed the significant role played by policy elites in media coverage of health reform debates. We also find that proposed expansions to public coverage are presented as a financial liability that could "crowd out" the existing (and popular) public insurance program. Within the context of a predominantly public funded system, framing of incremental expansion reorients away from values and toward discourse related to costs--both of the current system and of potential reforms. This may reflect a strategic narrative used by actors to maintain "silos of values" for coverage for prescription medicines versus those for other services. This has significant implications for the motivation for reform among the electorate and politicians alike, and for the extent to which policy developments, if they occurred, would legitimately reflect societal values for health financing.

Investigating social inequalities in children's independent mobility, active transportation and outdoor free play in two Canadian cities.

Background: Active transportation (AT) and free play (FP) are the primary ways in which children engage in unstructured physical activity in cities, with independent mobility (IM) gaining increased attention as a potential precursor of AT and FP. However, current trends show that children are engaging in less FP and AT, and have less IM, than previous generations and it is not well understood how these practices, and their interrelatedness, differ by neighbourhood-level socio-economic stats (SES) and municipal contexts. Objectives: This study aims to address the gaps in knowledge by quantifying, comparing, and correlating IM, AT, and FP practices in high and low-SES neighbourhoods within and across the cities of Montreal and Kingston, Canada. Methods: 584 questionnaires were distributed among children in grades 1 to 5, living in low- and high-SES neighbourhoods of these two citiesResultsEngagement in the three practices was low in every study neighbourhood, though all three practices were higher in high-SES compared to low-SES neighbourhoods in both cities. Levels of FP were higher in Kingston compared to Montreal, while AT was higher in Montreal than in Kingston. Conclusion: This study revealed social inequalities in all three of these practices based on socioeconomic status and city. Since IM is likely a precursor to both independent FP and AT, more research is warranted into how our cities can become more conducive to IM in children, particularly in low SES neighbourhoods where children have less freedom of movement independently and otherwise.

Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities.

INTRODUCTION: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. METHODS AND ANALYSIS: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. ETHICS AND DISSEMINATION: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Children's right to the city and their independent mobility: why it matters for public health.

Automobile-centric community design, or 'motornormativity', severely restricts opportunities for children to engage in active transportation (AT) and outdoor free play (OFP). As these activities are critical to children's health and well-being, their decline has become a major public health concern. Meanwhile, independent mobility (IM) has emerged as a critical determinant of child development and well-being. Defined as 'the freedom for children to move about their neighbourhood without adult supervision', children's IM is in direct conflict with motornormativity. And yet, very few studies explore these three practices together, and very few public health interventions actively confront motornormativity to support children's IM. We hypothesise that IM is foundational to AT and OFP, and that efforts to increase AT and OFP are doomed to fail without a deep understanding of the barriers to children's IM. We conclude with ideas to study and support children's IM in public health research and practice.

How to Recognize and Correct Artifacts on Contrast-Enhanced Mammography.

Contrast-enhanced mammography (CEM) has emerged as an important new technology in breast imaging. It can demonstrate a number of imaging artifacts that have the potential to limit interpretation by either obscuring or potentially mimicking disease. Commonly encountered artifacts on CEM include patient motion artifacts (ripple and misregistration), pectoral highlighting artifact, breast implant artifact, halo artifact, corrugation artifact, cloudy fat artifact, contrast artifacts (retention and contamination), skin artifacts (skin line enhancement and skin overexposure), and skin lesions. Skin lesions may demonstrate a variety of imaging appearances and have both benign and malignant etiologies. It is important that the technologist, radiologist, and physicist be aware of potential artifacts and skin enhancement on CEM that may affect interpretation and understand their causes and potential solutions.

Do great local minds think alike? Comparing perceptions of the social determinants of health between non-profit and governmental actors in two Canadian cities.

Cities are important sites for intervention on social determinants of health (SDOH); yet, little is known about how influential local actors, namely workers in municipal governments (GOVs) and community-based organizations (CBOs), perceive the SDOH. Capturing and comparing perceptions between these groups are important for assessing how SDOH discourse has permeated local actors' thinking--a meaningful endeavour as local-level health equity action often invokes inter-institutional partnerships. This paper compares SDOH perceptions between CBO workers in Hamilton, Ontario, with politicians and senior-level staff in GOVs in Vancouver, British Columbia, based on two studies with surveys containing identical questions on SDOH perceptions. Overall, there was high comparability between the groups in their relative ratings of the SDOH. Both groups assigned high levels of 'influence' and 'priority' to 'healthy lifestyles' and 'clean air and water' and lower levels to 'strong community' and 'income'. Given the importance of a shared vision in collaborative enterprises, the comparability of perceptions between the groups found here holds promise for the prospect of inter-institutional partnerships. However, the low rating assigned to more structural health determinants suggests that more work is needed from researchers and advocates to effectively advance a health equity agenda at the local level in Canada.

A Tale of Two Cities: Unpacking the Success and Failure of School Street Interventions in Two Canadian Cities.

One innovative strategy to support child-friendly cities is street-based interventions that provide safe, vehicle-free spaces for children to play and move about freely. School streets are one such innovation involving closing streets around elementary schools to vehicular traffic to improve children's safety as they come and go from school while providing opportunities for children to play and socialize on the street. Launching these initiatives in communities dominated by automobiles is enormously challenging and little is known about why these interventions are successfully launched in some places but not others. As part of a larger research project called Levelling the Playing Fields, two School Street initiatives were planned for the 2021-2022 school year; one initiative was successfully launched in Kingston, ON, while the second initiative failed to launch in Montreal, QC. Using a critical realist evaluation methodology, this paper documents the contextual elements and key mechanisms that enabled and constrained the launch of these School Streets in these cities, through document analysis and key informant interviews. Our results suggest that municipal and school support for the initiative are both imperative to establishing legitimacy and collaborative governance, both of which were necessary for a successful launch.

Procedural pain management: a position statement with clinical practice recommendations.

The American Society for Pain Management Nursing (ASPMN) has developed a position statement and clinical practice recommendations related to procedural preparation and comfort management. Procedures potentially produce pain and anxiety, both of which should be assessed and addressed before the procedure begins. This position statement refers to "comfort management" as incorporating the management of pain, anxiety, and any other discomforts that may occur with procedures. It is the position of ASPMN that nurses and other health care professionals advocate and intervene based on the needs of the patient, setting, and situation, to provide optimal comfort management before, during, and after procedures. Furthermore, ASPMN does not condone procedures being performed without the implementation of planned comfort assessment and management. In addition to outlining this position with supporting evidence, this paper reviews the ethical considerations regarding procedural comfort management and provides recommendations for nonpharmacologic and pharmacologic management during all phases of the procedure. An appendix provides a summary of this position statement and clinical practice recommendations.

Nanometals induce stress and alter thyroid hormone action in amphibia at or below North American water quality guidelines.

Nanometals are manufactured to particle sizes with diameters in the nanometer range and are included in a variety of consumer and health products. There is a lack of information regarding potential effects of these materials on aquatic organisms. Amphibians are regarded as environmental sentinels and demonstrate an exquisite sensitivity to thyroid hormone action, a hormone that is essential for human health. This present study assessed the effect of exposure to nanometals on stress and thyroid hormone signaling in frog tissue using a cultured tail fin biopsy (C-fin) assay derived from Rana catesbeiana tadpoles. The C-fin assay maintains tissue complexity and biological replication while multiple chemical responses can be assessed from the same individual. We tested the ability of nanosilver (0.06 µg/L-5.5 mg/L), quantum dots (0.25 µg/L-22 mg/L), and nanozinc oxide (0.19-10 mg/L) to alter gene expression in the presence or absence of 3,3',5'-triiodothyronine (T(3)) using quantitative real-time polymerase chain reaction. Results were compared to exposure to micrometer-silver, silver nitrate, and micrometer-cadmium telluride. Nanosilver (≥2.75 mg/L) and quantum dots (≥0.22 mg/L) altered the expression of transcripts linked to T(3)- and stress-mediated pathways, while nanozinc oxide had no effect. Lower concentrations of nanosilver (0.6 to 550 µg/L) perturbed T(3)-mediated signaling while not inducing cell stress. The observed effects were orders of magnitude below acute toxicity levels and occurred at or below the current North American water quality guidelines for metals, underscoring the need for evaluating nanoparticles separately from their constituent chemicals.