How Does the University Environment Relate to Student's Physical Activity Patterns in Ireland.

BACKGROUND: Identifying factors related to physical activity in university students can aid the development of health promotion interventions, but there is limited research regarding the influence of university environments. This study examined the relationship between level of provision for university environments that aim to promote physical activity and self-reported physical activity patterns of students. METHODS: An environmental audit tool was completed by universities (n = 28) on the island of Ireland to acquire information about physical activity opportunities, resources, and supports offered. Students (N = 6951; 50.7% male; 21.51 [5.55] y) completed an online survey, providing responses about their active transport and recreational physical activity behaviors. Binary logistic regressions were used to examine the associations between environmental factors that support physical activity and clustered physical activity patterns, while controlling for gender, age, and university size. RESULTS: Universities with a high provision for organizational structures and internal partnerships, indoor facilities, and sport clubs increase the odds of their students having more active physical activity patterns. Increased provision of investment and personnel was seen to have a mixed relationship with students' physical activity engagement, highlighting the need to understand where resources are needed and not just increase them. CONCLUSIONS: It is important for universities to have adequate organizational structures with internal partnerships to understand how resources can be maximized to support physical activity engagement across the whole student population. University campuses hold the potential for increasing student engagement in physical activity, and these findings can help inform campus-wide initiatives that foster active student populations for improving overall long-term health.

Development, scoring, and reliability for the Microscale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) instrument.

BACKGROUND: Active commuting to school can be a meaningful contributor to overall physical activity in children. To inform better micro-level urban design near schools that can support active commuting to school, there is a need for measures that capture these elements. This paper describes the adaptation of an observational instrument for use in assessing micro-scale environments around urban elementary schools in the United States. METHODS: The Micro-scale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) was developed from existing audit instruments not designed for school travel environments and modifications for the MAPS-SRTS instrument include the structure of the audit tool sections, the content, the observation route, and addition of new subscales. Subscales were analyzed for inter-rater reliability in a sample of 36 schools in Austin, TX. To assess reliability for each subscale, one-way random effects single-measure intraclass correlation coefficients (ICC) were used. RESULTS: Compared to the 30 original subscales, the adapted MAPS-SRTS included 26 (86.6%) subscales with revised scoring algorithms. Most MAPS-SRTS subscales had acceptable inter-rater reliability, with an ICC of 0.97 for the revised audit tool. CONCLUSIONS: The MAPS-SRTS audit tool is a reliable instrument for measuring the school travel environment for research and evaluation purposes, such as assessing human-scale determinants of active commuting to school behavior and documenting built environment changes from infrastructure interventions.

Effects of air environmental audit on reducing air pollutant emissions: evidence from China.

In order to mitigate air pollution, governments have implemented various active measures for air pollution prevention and control, among which the air environmental audit is an essential supervision initiative of air environmental regulation policy. This study aims to focus on and investigate the role of air environmental audit in national governance systems by collecting panel data on air environmental audits and air pollutant emissions from 261 prefecture-level cities across China between 2004 and 2018. Using difference-in-differences (DID) models, we empirically analyzed the policy effects of air environmental audits on reducing air pollutant emissions. The results indicate that air environmental audits have a significant impact on reducing air pollutant emissions, which is robust under multiple scenarios, including propensity score matching and placebo tests. The effect of air environmental audits varies significantly among different air pollutants, with the most significant and rapid effect observed on PM2.5 concentration, while industrial sulfur dioxide and industrial smoke (dust) emissions exhibit a time lag. Moreover, the promotion effect of air environmental audits on air pollution control displays strong heterogeneity based on local economic levels, initial environmental quality, and government competition. Therefore, it is of great significance to intensify the implementation of air environmental audits for air pollution control and to promote and improve the audit work according to pollutant classification and local conditions, thereby fully leveraging the audit's role and further improving air quality continuously.

Street environments and crime around low-income and minority schools: Adopting an environmental audit tool to assess crime prevention through environmental design (CPTED).

Crime prevention through environmental design (CPTED) suggests an association between micro-scale environmental conditions and crime, but little empirical research exists on the detailed street-level environmental features associated with crime near low-income and minority schools. This study focuses on the neighborhoods around 14 elementary schools serving lower income populations in Seattle, WA to assess if the distribution of crime incidences (2013-2017) is linked with the street-level environmental features that reflect CPTED principles. We used a total of 40 audit variables that were included in the four domains derived from the broken windows theory and CPTED principles: natural surveillance (e.g., number of windows, balconies, and a sense of surveillance), territoriality (e.g., crime watch signs, trees), image/maintenance (e.g., graffiti and a sense of maintenance/cleanness), and geographical juxtaposition (e.g., bus stops, presence of arterial). We found that multiple crime types had significant associations with CPTED components at the street level. Among the CPTED domains, two image/maintenance features (i.e., maintenance of streets and visual quality of buildings) and two geographical juxtaposition features (i.e., being adjacent to multi-family housing and bus stops) were consistently associated with both violent and property crime. The findings suggest that local efforts to improve maintenance of streets and visual quality of buildings and broader planning efforts to control specific land uses near schools are important to improve safety in marginalized neighborhoods near schools that tend to be more vulnerable to crime. Our research on micro-scale environmental determinants of crime can also serve as promising targets for CPTED research and initiatives.

Changes in physicochemical, heavy metals and air quality linked to spot Aplocheilus panchax along Mahanadi industrial belt of India under COVID-19-induced lockdowns.

Positive effects of COVID-19-induced lockdowns on environment are well documented although pre-planned experiments for such analyses and appearance of fish species are lacking. We hypothesize that spotting the fish Aplocheilus panchax along the industrial belt of Mahanadi River near Cuttack in a never seen manner could be due to the regenerated environment. Heavy metals, water and air qualities along with spotting A. panchax in up, mid and downstream of Mahanadi River near Jagatpur industrial basins were analysed during pre-(end of March 2020) and after 60 days of lockdowns (last week of May 2020). An overall 45, 61, 79, 100, 97 and 90% reduction of Fe, Cu, Ni, Cd, Pb and Zn was recorded in the studied area after lockdowns, respectively. Similarly, dissolved oxygen and pH were elevated by 26 and 7%, respectively. Water temperature, conductivity and total dissolved solute levels were reduced by 7, 46 and 15%, respectively, which were again elevated during post-lockdowns during 2021 as observed from the Landsat-8 OLI satellite data. Air NO2, SO2, NH3, PM2.5, PM10 and CO levels were alleviated by 58.75, 80.33, 72.22, 76.28, 77.33 and 80.15%, respectively. Finally, for the first time, about 12 A. panchax fish per 100 m shore line in the area were spotted. The observed lockdown-induced environmental healing at the studied area could contribute to the appearance of A. panchax in the study site and therefore a stringent environmental audit is suggested during post-COVID-19 periods to make the regenerated environmental status long lasting in such habitats.

Exploring Knowledge Domain and Emerging Trends in Climate Change and Environmental Audit: A Scientometric Review.

Environmental audit is inevitably linked to climate change, one immediate target of the auditors is likely to be climate control, and the warming of the Earth and the consequent climatic changes affect us all. What is the link between environmental audit and climate change? What ties together some of these themes between environmental audit and climate change? The interaction between climate change and environmental audit has been one of the most challenging. In this paper, a scientometric analysis of 84 academic publications between 2013 and 2021 related to climate change and environmental audit is presented to characterize the knowledge domain by using the CiteSpace visualization software. First, we present the number of publications, the number of citations, research categories, and journals published through Web of Science database. Secondly, we analyze countries, authors, and journals with outstanding contributions through network analysis. Finally, we use keyword analysis and apply three types of knowledge mapping to our research, cluster view, timeline view, and time zone view, revealing the focus and future directions. We identify the most important topic in the field of climate change and environment audit as represented on the basis of existing literature data which include the Carbon Emissions, Social Capital, Energy Audit, Corporate Governance, Diffusion of Innovation Environmental Management System, and Audit Committee. The results show that climate change and environmental audit publications grew slowly, but the research are widely cited by scholars. Published journals are relatively scattered, but the cited journals are the world's top journals, and most research countries are developed countries. The most productive authors and institutions in this subject area are in UK, Australia, USA, Spain, and Netherlands. There are no leading figures, but the content of their research can be divided into six clusters. Future research content involving city, policy, dynamics, information, biodiversity, conservation and clustering social capital, diffusion of innovation environmental management, and audit committee are the directions for future research. It is worth noting that cities, policies, and adaptability are closely linked to public health.

Does environmental audit help to improve water quality? Evidence from the China National Environmental Monitoring Centre.

As an essential re-supervision system of the environmental regulation, the environmental audit can help improve the quality of the ecological environment by correcting the deviation of local governments' environmental regulatory behavior. This study constructed a conceptual model of environmental audit affecting water quality, and empirically examined the effects and mechanism through the difference in difference (DID) regression and the mediating analysis. The panel data were collected from 76 cities covered by the surface water quality monitored by China Environmental Monitoring Station from 2006 to 2017. The results indicated that: (1) the overall effect of the environmental audit on the water quality was positive but not significant; (2) the environmental audit mainly encouraged local governments to strengthen superficial regulations with lower cost, more immediate and perceptible effects, but failed to promote the advanced regulation to reduce the pollution sources and fundamentally improve the water quality. On this basis, the policy implications were proposed that the environmental audit should be strengthened to further promote the advanced regulation and improve water quality constantly.

Beyond Walking: An Assessment and Description of Streets as Potential Physical Activity Places in Low-Income Communities.

Low-income communities often have fewer quality community-level physical activity places (PAPs) or resources (e.g., parks, playgrounds). When present, barriers like traffic, distance, and crime often prevent access. Creative solutions and better understanding of current and potential realistic PAPs are necessary for children and families to be active. Streets are rarely considered potential PAPs despite their ubiquity and accessibility. This article describes street segments as potential PAPs in two low-income Mexican-heritage colonias communities along the Texas-Mexico border. Promotora-researchers conducted PAP assessments of all street segments (n=867) in the two communities to describe the availability and quality of their physical activity features (e.g., basketball hoops, bicycles), amenities (e.g., paved driveways, yard space), and incivilities (e.g., vandalism, loose dogs). Streets in these communities did contain features and amenities associated with physical activity promotion. On average, street segments had 6.10 (SD=7.20) physical activity-promoting features, 27.65 (SD=27.30) physical activity-promoting amenities, and both were assessed as good-to-fair quality. Future physical activity programming should consider incorporating streets as potential PAPs to enhance physical activity and active play. Further, evaluating streets as PAPs in this way may provide insight into locations for temporary place-based programs such as Play Streets. Future research should also examine residents' perceptions of their streets as PAPs for safe physical activity and active play, not just as places to walk, and which PAP characteristics matter for safe physical activity and active play to occur on streets.

Transit environments for physical activity: Relationship between micro-scale built environment features surrounding light rail stations and ridership in Houston, Texas.

INTRODUCTION: Health professionals promote transport-related physical activity because travelers oftentimes walk or bike to and from transit stops or stations. Although previous studies have examined the associations between macro-scale built environment features surrounding light rail transit (LRT) stations (e.g., density) and LRT ridership, this study examined the associations between numerous micro-scale features (e.g., street-level noise pollution) and ridership. METHODS: This analysis originated from the Houston Travel-Related Activity in Neighborhoods (TRAIN) Study, a project evaluating how an LRT extension impacted adult physical activity in Houston, Texas. In 2014, researchers used the Analytic Audit Tool to quantify 58 micro-scale built environment features within six categories: Land Use Environment, Transportation Environment, Facilities, Aesthetics, Signage, and Social Environment. Feature data were obtained from 590 street segments within 0.25 miles of 22 LRT stations. For each station, separate composite indices were created per category by averaging the computed feature scores (1-7) within each category, with higher scores signifying more physical activity-promoting features. Station-level LRT ridership data were obtained from monthly ridership reports for the 12 months following station opening. Linear mixed models were constructed to examine the associations of the six built environment categories with ridership, adjusting for season, weekday vs. weekend day, and station as a random intercept. RESULTS: Holding all other variables constant, every one-unit increase in composite index scores for Transportation Environment and Social Environment was associated with an increase in daily ridership by 425 and 488 riders, respectively (p < 0.05). Every one-unit increase in composite index score for Signage was associated with a decrease of 722 riders daily (p < 0.05). The relations of Land Use Environment, Facilities, and Aesthetics with ridership were statistically null (p > 0.05). CONCLUSIONS: Enhancements to the Transportation Environment and Social Environment may slightly increase overall LRT ridership, and consequently, utilitarian physical activity.

School Walkability Index: Application of Environmental Audit Tool and GIS.

INTRODUCTION: Active school travel is an important way to promote children's physical activity, but it requires supportive environments that can safely and comfortably accommodate children's walking and biking. Few existing indices explicitly consider school neighborhood environmental factors related to children's walking to school. In this study, we used a street audit tool and Geographic Information System (GIS) to evaluate walkability near low-income elementary schools in Seattle, WA. METHODS: The audit-based school walkability index was developed based on all street segments (n=841) within a 0.4km network buffer from each study school (n=18). The GIS-based school walkability, a combination of road connectivity, vehicular traffic exposure, and residential density, was also measured in a 2km network buffer around each school. The participants were individuals aged 8-11 years (n=315) who participated in the Walking School Bus randomized controlled trial project. Mixed-effects logistic and linear models were used to examine the association of the index's representations of the built environment with children's school travel mode (walking or biking to school 1+ times per week) and with objectively measured moderate-to-vigorous physical activity (MVPA, average weekday minutes during the 90-min before-school period). These associations were tested with the total sample as well as the subsample of children living within 1.5km from their schools. RESULTS: The audit-based school walkability index (WI) was positively associated with both active commuting to school among the subsample living within 1.5km from their schools and with children's before-school MVPA among the subsample and the total sample. The GIS-based school WI showed significant associations with children's before-school MVPA but no relationships with active school travel among the subsample and the total sample. CONCLUSION: The audit-based school walkability index can be used as a complementary tool for measuring walkability near low-income elementary schools along with existing GIS-based school walkability index.

Soil Lead Concentrations in Dareta Village, Zamfara, Nigeria.

BACKGROUND: Acute widespread lead poisoning took place in Zamfara State, Nigeria in 2010. Over 735 children were reported dead and thousands sickened by the neurotoxin. The source was traced to artisanal gold mining and processing in the villages. An immediate medical response protocol was developed to provide oral chelation therapy to the vulnerable population. In order not to compromise the efficacy of the chelation therapy, immediate remediation of the affected villages was carried out. An over 95% reduction in soil lead levels was reported immediately after the remediation exercise. OBJECTIVES: The aim of the present study was to perform a general audit of soil lead concentrations, conducted between June and July 2013 in Dareta village (one of the most affected villages), to evaluate the soil pollution status of the village three years after the remediation exercise. METHODS: Soil samples were collected from residential compounds, cultivated farmlands and other common areas. Lead contents of the samples were determined using atomic absorption spectrophotometer (Shimadzu, model AA-6800, Japan) after wet digestion. Speciation of lead in soil was done following standard analytical methods. RESULTS: Mean soil lead concentrations for residential areas were 1029.42±98.50 mg/kg, 1523.99±201.00 mg/kg, 1404.57±141.00 mg/kg and 6724.68±84.00 mg/kg for residential compounds, market square, old grinding mills and new grinding mills, respectively. The concentrations exceeded both the Dutch target and intervention values and US Environmental Protection Agency limit for soil lead levels in residential areas. Based on the index of geo-accumulation, the ranking of intensity of lead (Pb) pollution of Dareta soils ranged from strongly polluted to extremely polluted, indicating they pose a range of moderate to very high potential ecological risk to the other components of the environment. At the current rate of accumulation, by the year 2025, soil Pb levels of Dareta common areas are expected to exceed the pre-remediation levels associated with several deaths. CONCLUSIONS: Findings of this study indicate that the problem of lead poisoning is ongoing in Dareta village. Zamfara State authorities should address the challenge through sustained periodic assessment and cleanup of affected areas. Implementation of safer mining practices should be enforced immediately. COMPETING INTERESTS: The authors declare no competing financial interests.

Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites.

Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).

Foot-based audit of streets adjacent to new light rail stations in Houston, Texas: measurement of health-related characteristics of the built environment for physical activity research.

BACKGROUND: Active travel to and from a transit station may provide significant amounts of physical activity and improve health. The ease with which people can traverse the distance to the transit station may impede or support active travel. Therefore, transit stations that have features that are supportive of utilitarian physical activity would be desirable. This study aimed to characterize the built environment surrounding new light rail transit (LRT) stations in the City of Houston, Texas. METHODS: In 2014, we used a series of systematic protocols and a standardized environmental audit instrument, the Analytic Audit Tool, to collect data on segments (streets) that surround 22 LRT stations that were being newly built. Using Geographic Information System (GIS), we assembled all the segments that intersect a 0.25-mile circular buffer around each station for the audit exercise. Several 3- to 4-member teams of trained auditors completed the audit exercise on a subset of these identified segments. Our analysis were descriptive in nature. We provided the frequency distributions of audited features across the study area. We also followed an original algorithm to produce several composite index scores for our study area. The composite index score is indicative of the prevalence of physical activity friendly/unfriendly features in the study area. RESULTS: In all, we audited a total of 590 segments covering a total of 218 US Census blocks, and eight City of Houston super neighborhoods. Findings suggest the environment around the new LRT stations may not be supportive of physical activity. In general, the audited segments lacked land use integration; had abandoned buildings, had uneven sidewalks; were not bike-friendly, had minimal presence of public-recreational facilities that would support physical activity; and had significant physical disorder. Notably, certain attractive and comfort features were frequently to usually available. CONCLUSIONS: Current findings, which will be compared to follow-up audit data, can be useful for future researchers and practitioners interested in the built environment around LRT stations.

Reliability and validity of environmental audits using GigaPan® technology in parks.

Park quality and features can contribute to more engaging places for play and recreation. However, assessing park characteristics remains a challenge. This study measured the reliability of GigaPan® as a method for assessing park characteristics as well as the validity of GigaPan® compared to Google Street View (GSV) and direct observation (DO). A total of 65 target areas (16 parks total) in Pittsburgh, PA were assessed using GigaPan®, GSV, and DO from July 2015-January 2016. For reliability and validity, 14 and 28 variables were examined, respectively. Cohen's kappa was used to assess inter-rater reliability. Sensitivity and specificity were used to measure validity. Of the 14 variables included in the inter-rater reliability analysis, five variables had almost perfect reliability (kappa > 0.80) and three variables had substantial reliability (kappa > 0.60). Of the 28 variables included in the validity analysis, GigaPan® was able to correctly classify 17 of the 28 variables and GSV was able to correctly classify 15 of the 28 variables with a sensitivity >80%. There were no significant differences between sensitivity and specificity between GSV and GigaPan®. GigaPan® performed similarly to GSV with DO being used as the gold standard. Further, GigaPan overall had high reliability among the features measured. A strength of GigaPan® is the ability to be implemented quickly in the field, making it a viable alternative to GSV particularly when temporality is an important factor.

Physical and spatial assessment of school neighbourhood built environments for active transport to school in adolescents from Dunedin (New Zealand).

Adolescent active transport to school (ATS) is influenced by demographic, social, environmental and policy factors. Yet, the relationship between school neighbourhood built environment (SN-BE) and adolescents' ATS remains largely unexplored. This observational study examined associations between observed, objectively-measured and perceived SN-BE features and adolescents' ATS in Dunedin (New Zealand). Adolescents' perception of safety of walking to school was the strongest correlate of ATS among adolescents living ≤ 2.25 km of school, whereas assessed micro- and macro-scale SN-BE features were not significantly correlated with ATS. Adolescents' perceptions of walking safety should be considered as a part of comprehensive efforts to encourage ATS.

Role of National Policy in Improving Health Care Waste Management in Nigeria.

BACKGROUND: As Nigeria strives to improve health services nationwide, there is a corresponding increase in laboratory testing, care and treatment activities, producing more healthcare waste that must be safely managed. In the past, Nigeria lacked an enabling environment for healthcare waste management, as it did not have a national health care waste management policy. However, in 2013 a policy and strategic plan for healthcare waste management was developed to address this problem. OBJECTIVES: The present study performed an environmental safeguard audit to determine the level of implementation of the 2013 national policy in the 36 states and Federal Capital Territory in Nigeria. We also sought to determine whether the 2013 national policy has had an impact on healthcare waste management. METHODS: The present study was conducted in 1921 health facilities, selected using the probability proportional to size sampling method. RESULTS: The present study found that 44.8% of health facilities surveyed had healthcare waste management work plans adapted from the 2013 national policy. In addition, 89.2% of health facilities segregated waste. This is an important improvement, as previous studies reported that there was little to no waste segregation at health facilities. Furthermore, 41.4% of health facilities had designated persons or units handling healthcare waste, in contrast to previous studies which found no designated person or unit responsible for healthcare waste. However, the quality of healthcare waste management varied across states and health facilities. DISCUSSION: Following the introduction of healthcare waste management policy, health facilities in Nigeria have improved waste management practices. However, training, availability of required tools and functional governance structures are essential to the implementation of an effective healthcare waste management policy. CONCLUSIONS: The study findings show that safe healthcare waste management can be implemented if the government leads by providing policy and required resources, while health facilities put standard operating procedures in place to guide day to day healthcare waste management operations. PARTICIPANT CONSENT: Obtained. ETHICAL APPROVAL: The protocol was approved by the National Health Research Ethics Committee of Nigeria. COMPETING INTERESTS: The authors declare no competing financial interests.

Development and Validation of a Simple Convenience Store SHELF Audit.

Background This paper describes the development, reliability, and convergent validity of a practical tool-the Convenience Store Supportive Healthy Environment for Life-Promoting Food (SHELF) Audit. Methods Audit items included: a variety of fresh, processed, and frozen fruits and vegetables; low-fat dairy products; healthy staples and frozen meals; healthy food incentive programs; items sold in check-out areas; portion/cup sizes; and pricing. Each audit item was scored using a five-point semantic-differential scale (1 = provides little or no support for healthful foods to 5 = provides high support for healthful foods). Convergent validity was examined by comparing the SHELF audit to Ghirardelli et al. and Laska et al. store audits. Statistical analysis included: Factor analysis, ANOVA, and Spearman correlations. Results SHELF included three factors: a Fruits/Vegetables scale (eight items, α = 0.79; total potential points = 34); a Healthy Foods scale (four items, α = 0.72; total potential points = 16); and a Supports scale (four items, α = 0.685; total potential points = 16). Only 6% of the 124 convenience stores assessed scored in the most healthful range (46⁻66). The assessed drug stores (n = 15) scored higher than convenience stores (n = 81) on the Healthy Foods and Supports scales but not the Fruits/Vegetables scale. The SHELF sub-scores were highly correlated with other audit tools indicating convergent validity. Conclusion The SHELF convenience store audit is a valid, reliable tool for assessing the degree to which convenience stores support healthfulness regarding Fruits/Vegetables, Healthy Foods, and Supports for choosing healthy.

Validity of environmental audits using GigaPan® and Google Earth Technology.

BACKGROUND: Health behaviors are shaped by the context in which people live. However, documenting environmental context has remained a challenge. More specifically, direct observation techniques require large investments in time and resources and auditing the environment through web-based platforms has limited stability in spatio-temporal imagery. This study examined the validity of a new methodology, using GigaPan® imagery, where we took photos locally and, stitched them together using GigaPan® technology, and quantified environmental attributes from the resulting panoramic photo. For comparison, we examined validity using Google Earth imagery. METHODS: A total of 464 street segments were assessed using three methods: GigaPan® audits, Google Earth audits, and direct observation audits. Thirty-seven different attributes were captured representing three broad constructs: land use, traffic and safety, and amenities. Sensitivity (i.e. the proportion of true positives) and specificity (i.e. the proportion of true negatives) were used to estimate the validity of GigaPan® and Google Earth audits using direct observation audits as the gold standard. RESULTS: Using GigaPan®, sensitivity was 80% or higher for 6 of 37 items and specificity was 80% or higher for 31 of 37 items. Using Google Earth, sensitivity was 80% or higher for 8 of 37 items and specificity was 80% or higher for 30 of 37 items. The validity of GigaPan® and Google Earth was similar, with significant differences in sensitivity and specificity for 7 items and 2 items, respectively. CONCLUSION: GigaPan® performed well, especially when identifying features absent from the environment. A major strength of the GigaPan® technology is its ability to be implemented quickly in the field relative to direct observation. GigaPan® is a method to consider as an alternative to direct observation when temporality is prioritized or Google Earth imagery is unavailable.

Living with dementia in hospital wards: a comparative study of staff perceptions of practice and observed patient experience.

AIMS AND OBJECTIVES: To ascertain the experiences, attitudes and knowledge of staff working in two Maltese hospital wards and the observed experiences of people with dementia living there. To examine the impact of recommendations made in October 2011 for improving the psychosocial and physical environments of the wards 1 year later. BACKGROUND: There is an increasing policy recognition of the need for a better trained and educated dementia care workforce and of ensuring that the environmental design of care settings meets the needs of people with dementia. DESIGN AND METHODS: At both time points, three established and validated data-collection methods evaluated (i) staff/patient interaction and patient experience, (ii) the extent to which the wards met dementia friendly principles and (iii) staff views about their work environment and their perceptions about their practice. Sixteen (five male and 11 female) patients with dementia and 69 staff in the two wards participated in the study. RESULTS: We noted small but important changes; however, the physical and psychosocial environments of the wards did not always align to current recommendations for dementia care, with staff perceptions of care delivery not always reflecting the observed experiences of care of those living with dementia. CONCLUSIONS: Comparing staff questionnaire data with observational methods offered a unique opportunity to understand multiple perspectives in a complex hospital setting. Incorporating these perspectives into staff and management feedback allowed for recommendations that recognised both patient-centred values and staff constraints.

Community-based walking exercise for peripheral artery disease: An exploratory pilot study.

Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease (PAD), but few exercise programs in community settings have been effective. The aim of this study was to determine the efficacy of a community-based walking exercise program with training, monitoring and coaching (TMC) components to improve exercise performance and patient-reported outcomes in PAD patients. This was a randomized, controlled trial including PAD patients (n=25) who previously received peripheral endovascular therapy or presented with stable claudication. Patients randomized to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks. Patients in the control group did not receive treatment beyond standard advice to walk. The primary outcome in the intent-to-treat (ITT) analyses was peak walking time (PWT) on a graded treadmill. Secondary outcomes included claudication onset time (COT) and patient-reported outcomes assessed via the Walking Impairment Questionnaire (WIQ). Intervention group patients (n=10) did not significantly improve PWT when compared with the control group patients (n=10) (mean ± standard error: +2.1 ± 0.7 versus 0.0 ± 0.7 min, p=0.052). Changes in COT and WIQ scores were greater for intervention patients compared with control patients (COT: +1.6 ± 0.8 versus -0.6 ± 0.7 min, p=0.045; WIQ: +18.3 ± 4.2 versus -4.6 ± 4.2%, p=0.001). This pilot using a walking program with TMC and an ITT analysis did not improve the primary outcome in PAD patients. Other walking performance and patient self-reported outcomes were improved following exercise in community settings. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size.