Let's Move with Leon-A qualitative evaluation of a UK digital intervention to improve physical activity in people with a musculoskeletal condition.

OBJECTIVE: This article presents a qualitative evaluation of a 13-week digital intervention, 'Let's Move with Leon', designed to improve physical activity in people with a musculoskeletal condition. STUDY DESIGN: A qualitative evaluation embedded within a randomised controlled trial assessing the effectiveness of the intervention at improving self-reported physical activity. METHODS: A total of 184 participants received the intervention and were asked each week for 13 weeks to provide comment on their use and the usefulness of the digital physical activity behaviour change intervention. In addition, after 13 weeks, 12 participants took part in a semistructured interview to understand their use and the usefulness of the intervention. A thematic analysis was conducted on the combined qualitative data set. RESULTS: A total of 128 of the 184 intervention participants (70.11%) provided at least one qualitative comment over the course of the evaluation (mean number of comments per participant = 5); in total, 674 comments were received. The thematic analysis identified three themes: (1) dipping in and out, (2) one size does not fit all and (3) monitoring and feedback. The qualitative data suggest that participants used the intervention sporadically, dipping in and out due to other commitments, and competing programmes, their changing physical ability, confidence and motivation. Not getting off to a good start was detrimental to use; many wanted to come back to the programme at a more appropriate time. A 'one size fits' approach catered for some but not all participants. Whilst not a predetermined intervention component the act of monitoring levels of activity as a data collection method seemed to encourage physical activity but may also result in negative social comparisons. CONCLUSION: Digital physical activity behaviour change interventions are not one-size-fits-all; personalisation is key. Monitoring of activity by a named person can create commitment. Many dip in and out. Digital physical activity behaviour change interventions could complement physiotherapy exercises for people with musculoskeletal conditions. Signposting to local activities should be considered.

A new Bihari inequality and initial value problems of first order fractional differential equations.

We prove existence of solutions, and particularly positive solutions, of initial value problems (IVPs) for nonlinear fractional differential equations involving the Caputo differential operator of order α∈(0,1). One novelty in this paper is that it is not assumed that f is continuous but that it satisfies an Lp-Carathéodory condition for some p>1α (detailed definitions are given in the paper). We prove existence on an interval [0, T] in cases where T can be arbitrarily large, called global solutions. The necessary a priori bounds are found using a new version of the Bihari inequality that we prove here. We show that global solutions exist when f(t, u) grows at most linearly in u, and also in some cases when the growth is faster than linear. We give examples of the new results for some fractional differential equations with nonlinearities related to some that occur in combustion theory. We also discuss in detail the often used alternative definition of Caputo fractional derivative and we show that it has severe disadvantages which restricts its use. In particular we prove that there is a necessary condition in order that solutions of the IVP can exist with this definition, which has often been overlooked in the literature.

Applying and Assessing Participatory Approaches in an Environmental Flows Case Study.

Environmental flows (e-flows) management takes place within a complex social-ecological system, necessitating the involvement of diverse stakeholders and an appreciation of a range of perspectives and knowledge types. It is widely accepted that incorporating participatory methods into environmental flows decision-making will allow stakeholders to become meaningfully involved, improving potential solutions, and fostering social legitimacy. However, due to substantial structural barriers, implementing participatory approaches can be difficult for water managers. This paper assesses the effectiveness of an e-flows methodology that combines elements of structured decision-making and participatory modeling, whilst constrained by project resources. Three process-based objectives were identified by the group at the start of the process: improving transparency, knowledge exchange, and community ownership. We evaluated the success of the approach according to those objectives using semi-structured interviews and thematic analysis. In evaluating how well the participatory approach achieved the process objectives, we found that at least 80% of respondents expressed positive sentiment in every category (n = 15). We demonstrate that the values-based process objectives defined by the participant group are an effective tool for evaluating participatory success. This paper highlights that participatory approaches can be effective even in resource-constrained environments when the process is adapted to fit the decision-making context.

The reach and benefits of a digital intervention to improve physical activity in people with a musculoskeletal condition delivered during the COVID-19 pandemic in the UK.

AIM: To evaluate a digital intervention to improve physical activity in people in the UK with a musculoskeletal condition delivered during movement restrictions brought about because of the COVID-19 pandemic. METHOD: Service evaluation data collected from 26,041 participants over 5 months was assessed against national datasets to understand the reach and representativeness of the digital physical activity intervention. Measures to restrict the movement and interaction of people were in place during these 5 months. Cross-sectional data from 2752 participants across different stages of the 12-week programme assessed levels of physical activity and the components of behaviour as defined by the COM-B model (Capability, Opportunity, Motivation = Behaviour). Regression analysis investigated the relationship between programme stage and physical activity and the components of behaviour. RESULTS: In comparison to the UK population of people with a musculoskeletal condition, the intervention participants were over-represented by females, White, and inactive people. A cross-sectional analysis suggested that the number of participants regularly active increased by programme stage. Scores for the behavioural components of automatic and reflective motivation, physical and psychological capability, and physical opportunity were also improved by programme stage. CONCLUSION: The service evaluation suggests that the digital intervention, designed to improve physical activity in people with a musculoskeletal condition, could be beneficial during measures to restrict movement to slow the spread of infectious disease in those who are already motivated to become or stay active.

The effect of population model choice and network topologies on extinction time patterns in dendritic ecological networks.

Models of populations in habitat networks are vital for understanding and linking processes and patterns across individuals, environments, ecological interactions, and population structures. River ecosystem models combine the physical structure of the networks with the biological processes of the organisms using structural and functional models, respectively. Previous studies on dendritic river networks have employed different functional (population) models and either directly claimed or implied that the results illustrate general properties of actual river systems. However, these studies have used different approaches and assumptions when modeling population characteristics and behavior, and it is possible that inferences regarding a system may vary based on the combination of functional model and the spatial structure of a network. This study aims to understand if different functional models in river systems produce substantially different model results and, therefore, whether conclusions are model-dependent. We compare variation in extinction time and occupancy proportion of river networks with linear, trellis, dendritic and ring-lattice topologies, using three population models (uniform, age-class and individual based) and one metapopulation-based (patch-occupancy) model. Dendritic, linear, and trellis structures did not show notable differences among extinction times for any of the four models. The difference between topologies was higher for the patch-occupancy model compared to the three population models. There were significant differences in the variations of patch-occupancy between the metapopulation and the population models, but the three population models of differing complexity produced broadly similar results. Therefore, if the occupancy data is obtained based on local subpopulations, spatial arrangement and connectivity does not appear to be the sole predictor of single-species metapopulation responses. We conclude that the outputs from functional models are robust to assumptions and varying levels of detail as long as they contain at least some detail at the level of individuals within habitat nodes. Also, if we are modeling network-scale populations, models that include at least some detailed information on individuals are a far better choice than considering populations implicitly.

Online training resources to aid therapeutic radiographers in engaging in conversations about physical activity and diet: A mixed methods study.

INTRODUCTION: This study explored changes in therapeutic radiographers' (TRs) self-reported knowledge and skills to engage in conversations about physical activity and diet with people living with and beyond cancer following completion of publicly available online courses. METHODS: Participants were randomly assigned to two of five online courses that aim to support health professionals to engage in conversations about physical activity and diet in the oncology setting. Participants rated their agreement with 18 statements related to the COM-B (capability, opportunity and motivation-behaviour) model components following completion of an online course on healthy diet (n = 16) and physical activity (n = 21). Semi-structured telephone interviews (n = 21) were also conducted. Analysis of the interviews was guided by the Theoretical Domains Framework. RESULTS: Overall, the online courses were acceptable and the TRs in this study self-reported improved COM to deliver advice on physical activity and diet. The inclusion of the evidence and scientific rationale on the benefits of diet and physical activity, and also guidance on how to start conversations with patients were highlighted as important features of the courses. Suggestions for adaptations to the nutrition courses included the need for content that accounts for the side effects cancer patients experience while undergoing treatment. To support the implementation of training and the delivery of advice on these topics, multi-disciplinary working, organisational support and guidance around professional role boundaries were highlighted as important. CONCLUSION: Current publicly available online courses on physical activity and diet for oncology health professionals can reduce some barriers among TRs to providing advice to those living with and beyond cancer. IMPLICATIONS FOR PRACTICE: Existing online training courses could be used to support TRs to deliver physical activity and dietary advice in practice. Findings show that these courses can be disseminated within radiotherapy departments. The results also highlight a number of important considerations for the implementation of brief health behaviour advice and online training interventions on physical activity and diet within cancer care.

Timing of surgery for internal fixation of intracapsular hip fractures and complications at 1 year; a 32 year clinical study of 2,366 patients at a single center.

BACKGROUND: Timing of hip fracture surgery for the internal fixation of an intracapsular fracture remains controversial and few studies to date have been able to determine the optimum time to surgery in minimizing osteonecrosis and non-union with intracapsular fractures after fixation. METHODS: Using a local hip fracture database managed by the senior author over a 32 year period, those who underwent osteosynthesis following intracapsular fractures were assessed for risk of development of non-union and osteonecrosis. Multivariate regression analysis was performed focusing on factors that were predictive of complications. Patient demographics, time from injury to surgery, fixation method, fracture pattern and complications at one year were reported. The primary outcome was whether delay to surgery contributed to risk of complications, defined as non-union or osteonecrosis. Secondary outcomes assessed the contribution of other factors to these complications. RESULTS: 2,366 patients were identified with an average age of 74.7 years and 66.5% were female. 1189 (50.3%) of fractures were displaced. 481 (20.3%) had a complication at one year following fixation. 78 (3.3%) were fixed by DHS, 6 (0.3%) by cephalomedullary nail, (1257) 53.1% by cannulated screws and 1025 (43.3%) by Targon® screw. Multivariate regression revealed no significant correlation between delay to surgery and complication rates (OR 0.99, 95% CI 0.99, 1.01, p = 0.55). Significant variables include female sex (OR 2.03, 95% CI 1.58, 2.62, p<0.0001), fracture displacement (OR 4.8, 95% CI 3.79, 6.14, p<0.0001), independent mobility (OR 0.64, 95% CI 0.47, 0.87, p = 0.004) and use of Targon® screws compared to parallel screws (OR 0.61, 95% CI 0.48, 0.76, p<0.0001). CONCLUSIONS: Our study demonstrates no relationship between timing of surgery for fixation of intracapsular fracture and complication rates. Female sex and fracture displacement increased risk of complications whereas independent mobility and use of Targon® screw device in comparison to parallel screws were protective against non-union but not avascular necrosis.

An in vitro biofilm model system to facilitate study of microbial communities of the human oral cavity.

The human oral cavity is host to a diverse microbiota. Much of what is known about the behaviour of oral microbes derives from studies of individual or several cultivated species, situations which do not totally reflect the function of organisms within more complex microbiota or multispecies biofilms. The number of validated models that allow examination of the role that biofilms play during oral cavity colonization is also limited. The CDC biofilm reactor is a standard method that has been deployed to study interactions between members of human microbiotas allowing studies to be completed during an extended period under conditions where nutrient availability, and washout of waste products are controlled. The objective of this work was to develop a robust in vitro biofilm-model system from a pooled saliva inoculum to study the development, reproducibility and stability of the oral microbiota. By employing deep sequencing of the variable regions of the 16S rRNA gene, we found that the CDC biofilm reactor could be used to efficiently cultivate microbiota containing all six major phyla previously identified as the core saliva microbiota. After an acclimatisation period, communities in each reactor stabilised. Replicate reactors were predominately populated by a shared core microbiota; variation between replicate reactors was primarily driven by shifts in abundance of shared operational taxonomic units. We conclude that the CDC biofilm reactor can be used to cultivate communities that replicate key features of the human oral cavity and is a useful tool to facilitate studies of the dynamics of these communities.

Are multiple-use bottles of chlorhexidine solutions at risk of contamination in joint replacement surgery?

INTRODUCTION: Chlorhexidine gluconate 2% w/v in isopropanol 70% solutions in multiple-use bottles is commonly used in surgery as a cost-effective method for skin disinfection. However, multiple-use bottles risk contamination. This study aims to test whether bacterial contamination of multiple-use bottles or their solutions occurs once open and on use between different patients. METHODS: Consecutive samples were taken each time a chlorhexidine bottle was used over a 7-day study period. Samples were tested using blood culture, agar plate and mass spectrometry. RESULTS: No growth was observed in 52 samples taken from 18 bottles inoculated into blood culture bottles. Four growths on agar plate culture were determined to be contaminants from the sampling process. CONCLUSIONS: This study supports the use of multiple-use bottled chlorhexidine solutions as safe and cost-effective in surgical practice.

Influence of handler relationships and experience on health parameters, glucocorticoid responses and behaviour of semi-captive Asian elephants.

Declining wild populations combined with accumulating captive populations of e.g. livestock, pets, draught and zoo animals have resulted in some threatened species with substantial proportions of their populations in captivity. The interactions animals have with humans in captivity depend on handler familiarity and relationship quality and can affect animal health, growth and reproduction with consequences for the success of conservation programmes. However, assessments of how specific human-animal relationships affect a range of physiological and behavioural outcomes are rare. Here, we studied semi-captive Asian elephants with detailed records of elephant-handler (mahout) relationships and veterinary management, allowing assessment of multiple welfare indicators in relation to specific mahout-elephant relationship lengths and mahout experience. These included measures of physiological stress (faecal glucocorticoid metabolite [FGM], heterophil:lymphocyte ratio [H:L]), muscle damage (creatine kinase [CK]), immunological health (total white blood cell count [TWBC]) and behaviour (response to mahout verbal commands). We found no evidence that FGM or H:L related to aspects of the mahout-elephant relationship. Longer overall mahout experience (i.e. years of being a mahout) was linked to increased muscle damage and inflammation, but the lengths of specific mahout-elephant relationships were inversely associated with muscle damage in working-age elephants. Elephants responded more to familiar mahouts in behavioural tasks and faster to mahouts they had known for longer. In summary, our results found little evidence that the mahout-elephant relationship affects physiological stress in this population based on FGM and H:L, but mahout experience and relationships were linked to other physiological responses (CK, TWBC), and elephants require behavioural adjustment periods following mahout changes.