Implementation characteristics that may promote sustainability of a rural physical activity initiative: examination of Play Streets through the lens of community implementers.

BACKGROUND: Play Streets, which are community-based environmental initiatives where public spaces/streets are temporarily closed to create safe, low-cost physical activity opportunities, have demonstrated feasibility and physical activity benefit in rural US areas. Yet, information is needed to identify implementation characteristics that may promote sustainability. This study examined rural Play Streets implementation characteristics that could impact sustainability from local partners' perspectives. METHODS: Sixteen Play Streets implementation team members in rural Maryland, North Carolina, Oklahoma, and Texas, USA, participated in interviews. Semi-structured in-person individual and group interviews were conducted in the fall of 2018 (after Play Streets implementation in 2017 and 2018), recorded, and transcribed verbatim. Transcripts were analyzed using iterative, content analyses. Coding frameworks were based on the Public Health Program Capacity for Sustainability Framework, and emergent themes were also identified. RESULTS: Interviewees' perceived characteristics for facilitating Play Streets implementation aligned with the Public Health Program Capacity for Sustainability Framework: funding stability, political support, partnerships, organizational capacity, program adaption, and communication. Interviewees also noted the importance of cultural alignment/support and the reciprocal impact of community connectedness/engagement. CONCLUSIONS: Future research should examine the reciprocal role of public health impacts, as both outcomes and factors which may influence sustainability.

Impact of a transitional care program for heart failure patients at Baylor Scott & White Health: a pilot study.

Heart failure is a chronic health condition characterized by complex symptom management and costly hospitalizations. Hospitalization for the treatment of heart failure symptoms is common; however, many hospitalizations are thought to be preventable with effective self-management. This study describes the small, pilot implementation of a new, interventional, self-management heart failure program, "Engagement in Heart Failure Care" (EHFC), developed to assist heart failure patients with the management of disease symptoms following discharge from an inpatient hospital stay. EHFC was designed to engage patients in managing their symptoms and coaching them in skills that enable them to access medical and supportive care services across community, clinic, and hospital settings to help address both their current and future needs. The results of this pilot study suggest that EHFC's coaching model may have positive benefits on key health and well-being indicators of the patients enrolled.

Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth.

The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.

Lessons from sustainability of Play Streets in the United States.

Communities around the world lack safe places for children to play and be physically active. One solution to this issue is Play Streets, which involves the temporary closure of streets for several hours to create a safe space for active play and physical activity. While the benefits of these programs are greater when they are recurring over many years, there is a dearth of literature regarding how to successfully sustain Play Streets. To understand how Play Streets can be sustained in the long term, we conducted semi-structured interviews with 24 Play Streets organizers representing 22 Play Streets programs across the United States. Four recurring sustainability challenges were highlighted from the thematic analysis: 1) securing and sustaining funding, 2) managing community and city resistance to street closures, 3) navigating government bureaucracy, and 4) retaining interest amongst organizers and volunteers. With each challenge, we describe how Play Streets organizers navigated those challenges, with a goal of generating recommendations for those wishing to sustain Play Streets programs in the long term.

Summer Friends and Physical Activity: Social Network Effects on Child Self-Reported Physical Activity at Summer Care Programs.

Summer is a time of reduced physical activity (PA) for children; however, summer care programs (SCPs) can provide opportunities for children to be active and foster friendships. This study investigated associations between PA and friendship formation at SCPs. Children (ages 8-12 years) from two SCPs reported demographics, PA, and up to five friends at the program. Exponential random graph modeling determined significant factors associated with connections at each time point and between time points. PA was a significant factor in sending and maintaining friendship connections. A further understanding of the social dynamics which assist in the maintenance of PA behaviors during summer may improve the odds children engage in the recommended amounts of PA during this crucial time.

Implementing Play Streets in Low-Income Rural Communities in the United States.

Play streets involve the temporary closure of streets that for a specified time create a safe place for active play. Play streets have been implemented primarily in cities; it is unknown if they could be adapted and implemented in rural areas. To learn about implementation, core components of play streets and inform adaptation, we conducted systematic peer-reviewed and grey literature searches and interviews with a purposive sample of key informants. Data were analyzed by theme and used to inform implementation of play streets by four community organizations in low-income rural areas of Maryland, North Carolina, Oklahoma, and Texas from June to September 2017. Core elements of play streets in urban areas were present in rural settings-the content (e.g., activities offered), delivery of the intervention in partnership with community members and local organizations, and reoccurrence of play streets at a single location. There were three key adaptations relating to delivery and context to consider uniquely when implementing play streets in rural areas (1) using locations other than streets, (2) varying locations to account for geographic dispersion, and (3) maximizing participation and resources by coupling play streets with community events. Play streets can be successfully implemented in rural settings with these modifications, which support feasibility, reach, and access. Play streets in rural areas should include activities for active play that are age-appropriate and fun, without necessarily tailoring content for rural areas.

Real-Time Video Scan Method for Community Partner Use to Inform Play Streets Implementation.

System for Observing Play and Recreation in Communities (SOPARC) can provide accurate assessment of physical activity; however, the skills, time, and human resources necessary to collect/interpret SOPARC data can be challenging for community organizations. This article describes a more accessible adaptation of SOPARC using video recordings for community organizations to obtain physical activity feedback at Play Streets. Narrated panoramic video scans occurred every 30 minutes at each Play Street using an iPad. Videographers narrated: (1) sex, (2) age group (child, teen, adult, senior), and (3) activity level (sedentary, walking, vigorous) for everyone recorded. SOPARC video scans, in-person iSOPARC observations, and interviews were conducted with Play Streets implementors to determine validity and feasibility. Validity was examined using Lin's concordance correlation coefficient (CCC). In-person and video scans showed near perfect agreement for sedentary individuals (CCC = .95) and substantial agreement for active individuals (CCC = .72). Overall, community partners felt that they "could see how [the scans] could be useful" and "help[ed] see a bit more clearly what's happening." The method described here is a more accessible systematic observation approach to measure physical activity for communities implementing Play Streets. Further, this method can be used without research training while still providing valuable activity feedback.

The Effects of Play Streets on Social and Community Connectedness in Rural Communities.

Promoting physical activity (PA) is a long-standing public health initiative to improve overall health and wellbeing. Innovative strategies such as Play Streets, temporary activation of public spaces to provide safe places for active play, are being adopted in urban and rural communities to increase PA among children. As part of these strategies, aspects of social and community connectedness may be strengthened. This study analyzes focus groups and interviews from rural Play Street implementation team members (n = 14) as well as adults (n = 7) and children (n = 25) who attended Play Streets hosted in rural North Carolina, Maryland, Oklahoma, and Texas to better understand the added benefits of Play Streets in community connectedness. Overall, elements of social support and social cohesion are mentioned most frequently with instrumental and conditional support; however, concepts of social capital, collective-efficacy, and social identification are also presented. Participants expressed that Play Streets provided more than just PA; they provided opportunities to access and share resources, build perceptions of safety and trust in the community, and develop relationships with others. Fostering community connection through Play Streets may reduce health inequities in rural communities by building community resilience. Community-based PA programming that enhance and capitalize on community connectedness could be effective ways to improving the overall health and wellbeing of residents.

¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families.

Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers' perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas-Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children's PA.

Network Autocorrelation of Perceived Physical Activity Skill Competence Among Adolescents at a Summer Care Program: A Pilot Study.

PURPOSE: This study investigates the possible association between adolescent friendship networks and perceived physical activity skill competence in a summer care program. DESIGN: Adolescents participated in researcher-administered surveys at the start (T1) and end (T2) of summer. SETTING: Adolescents at a Boys & Girls Club were sampled. SAMPLE: Adolescents (age 8-12) completed researcher-administered surveys at T1 (n = 100; µ age = 9.9 years; 47% male; 55% Black) and T2 (n = 77; µ age = 9.8 years; 51% male; 49% Black). MEASURES: Perceived skill competence was measured by asking adolescents to rate how good they felt they were at physical activity at the club. Adolescents were also asked to provide names of up to 5 peers whom they hung around with, talked to, and did things with the most while at the club. ANALYSIS: Linear network autocorrelation models were used to determine network effects or clustering of perceived physical activity skill competence within the club. RESULTS: There were significant network effects for adolescent perceived skill competency scores at T1 (ß = 0.05, p < 0.01) and T2 (ß = 0.05, p = 0.02), indicating adolescent perceived skill competence scores were associated with those of their friends. CONCLUSIONS: Practitioners may wish to encourage the use of group or collaborative skill competency improvement activities as well as possibly pairing adolescents with differing skill competencies to foster improvement and possible diffusion of perceived skill competency.

Differences in Child Physical Activity Levels at Rural Play Streets Due to Activity Type and Sex.

Children are significantly less active during summer months, and rural children may face unique barriers to engaging in physical activity. Play Streets is a low-cost way communities can provide safe play opportunities by activating public spaces. Four low-income rural communities received mini-grants to implement four three-hour Play Streets throughout summer 2017 for a total of 16 Play Streets. System for Observing Play and Recreation in Communities (SOPARC) and iSOPARC were used to assess physical activity. Chi-square tests of homogeneity determined significant differences in the proportion of children observed as active based on sex and target area type. Binomial logistic regression was used to determine if target area characteristics (i.e., type, equipped, supervised, organized) and presence of other active children or adults increased the odds of observing a child as active. In total, 1,750 children were observed across all 16 Play Streets; roughly half of all children (48.6% of boys, 48.7% of girls) were observed as active. There was no significant difference in proportion of children observed as active based on sex of the child (OR = 0.99, 95% CI:0.82-1.20). Significant differences in the proportion of active children were found between target area categories. Boys were significantly more likely to be observed as active in areas which were equipped or organized. All children were significantly more likely to be active if there was another active child present in the same area. These results add to the growing literature surrounding successful implementation of Play Streets in rural settings, social influence, and active play.

Come together, play, be active: Physical activity engagement of school-age children at Play Streets in four diverse rural communities in the U.S.

Across the U.S., Play Streets - temporary street closures creating safe places for play for a few hours- are being implemented in urban areas during summer. Play Streets have never been implemented or evaluated in rural communities but have the potential to address challenges residents face accessing safe physical activity opportunities in these areas. Community organizations in four diverse low-income rural communities (selected to represent African American, American Indian, Latino, or White, non-Hispanic populations) received mini-grants in 2017 to implement four, three-hour Play Streets during the summer focusing on school-aged children in elementary-to-middle school. Physical activity was measured using Digi-walker (Yamax-SW200) pedometers and the System for Observing Play and Recreation in Communities (SOPARC/iSOPARC). Sixteen Play Streets were implemented in rural Maryland, North Carolina, Oklahoma, and Texas communities during June-September 2017. A total of 370 children (mean age = 8.81 years [SD = 2.75]; 55.0% female) wore pedometers across all 16 Play Streets (µâ€¯= 23.13 [SD = 8.59] children/Play Street). School-aged children with complete data (n = 353) wore pedometers for an average of 92.97 min (SD = 60.12) and accrued a mean of 42.08 steps/min (SD = 17.27), with no significant differences between boys (µâ€¯= 43.82, SD = 15.76) and girls (µâ€¯= 40.66, SD = 18.34). iSOPARC observations revealed no significant differences in child activity by sex; however, male teens were more active than female teens. Most adults were sedentary during Play Streets according to pedometer and iSOPARC data. Children in diverse rural communities are physically active at Play Streets. Play Streets are a promising intervention for promoting active play among children that lack safe opportunities to be active.

Transforming City Streets To Promote Physical Activity And Health Equity.

Most US cities lack built environments that support physical activity, which is a key determinant of health. Making permanent changes to the physical environment to promote physical activity is not always feasible. Play Streets is a place-based intervention that is typically organized by local governments or community organizations and involves temporarily closing streets to create safe places and free opportunities for physical activity. In this descriptive study we examined 162 of Chicago's PlayStreets, held in the summer of 2018, to assess the volume and type of physical activity among youth participants and the variety of services provided to residents. We analyzed implementation data and forms completed after PlayStreets, and we conducted systematic observations at a purposeful sample of PlayStreets. We found that PlayStreets provides opportunities for youth physical activity in areas where opportunities do not otherwise always exist. PlayStreets also provides an avenue for residents to access community resources. This research on Chicago's experience with PlayStreets showed how one city is temporarily turning streets into places for youth physical activity to advance health equity. Local policies that facilitate temporarily closing streets and that provide resources to support opportunities for physical activity and access to community resources can advance health equity in cities nationwide.

Functional atlas of the awake rat brain: A neuroimaging study of rat brain specialization and integration.

Connectivity-based parcellation approaches present an innovative method to segregate the brain into functionally specialized regions. These approaches have significantly advanced our understanding of the human brain organization. However, parallel progress in animal research is sparse. Using resting-state fMRI data and a novel, data-driven parcellation method, we have obtained robust functional parcellations of the rat brain. These functional parcellations reveal the regional specialization of the rat brain, which exhibited high within-parcel homogeneity and high reproducibility across animals. Graph analysis of the whole-brain network constructed based on these functional parcels indicates that the rat brain has a topological organization similar to humans, characterized by both segregation and integration. Our study also provides compelling evidence that the cingulate cortex is a functional hub region conserved from rodents to humans. Together, this study has characterized the rat brain specialization and integration, and has significantly advanced our understanding of the rat brain organization. In addition, it is valuable for studies of comparative functional neuroanatomy in mammalian brains.

Acute effects of vortioxetine and duloxetine on resting-state functional connectivity in the awake rat.

The antidepressant vortioxetine exerts its effects via modulation of several serotonin (5-HT) receptors and inhibition of the 5-HT transporter (SERT). Additionally, vortioxetine has beneficial effects on aspects of cognitive dysfunction in depressed patients. However, a global examination of the drug effect on brain network connectivity is still missing. Here we compared the effects of vortioxetine and a serotonin norepinephrine reuptake inhibitor, duloxetine, on resting-state functional connectivity (RSFC) across the whole brain in awake rats using a combination of pharmacological and awake animal resting-state functional magnetic resonance imaging (rsfMRI) techniques. Our data showed that vortioxetine and duloxetine affected different inter-areal connections with limited overlap, indicating that in addition to different primary target profiles, these two antidepressants have distinct mechanisms of action at the systems level. Further, our data suggest that vortioxetine can affect specific brain areas with distinct 5-HT receptor expression profiles. Taken together, this study demonstrates that the awake animal fMRI approach provides a powerful tool to elucidate the effects of drugs on the brain with high spatial specificity and a global field of view. This capability is valuable to understand how different drugs affect the systems-level brain function, and provides important guidance to dissect specific brain regions and connections for further detailed mechanistic studies. This study also highlights the translational opportunity of the awake animal fMRI approach between preclinical results and human studies.

Global reduction of information exchange during anesthetic-induced unconsciousness.

During anesthetic-induced unconsciousness (AIU), the brain undergoes a dramatic change in its capacity to exchange information between regions. However, the spatial distribution of information exchange loss/gain across the entire brain remains elusive. In the present study, we acquired and analyzed resting-state functional magnetic resonance imaging (rsfMRI) data in rats during wakefulness and graded levels of consciousness induced by incrementally increasing the concentration of isoflurane. We found that, regardless of spatial scale, the functional connectivity (FC) change (i.e., ∆FC) was proportionally dependent on the FC strength at the awake state across all connections. This dependency became stronger at higher doses of isoflurane. In addition, the relative FC change at each anesthetized condition (i.e., ∆FC normalized to the corresponding FC strength at the awake state) was exclusively negative across the whole brain, indicating a global loss of meaningful information exchange between brain regions during AIU. To further support this notion, we showed that during unconsciousness, the entropy of rsfMRI signal increased to a value comparable to random noise while the mutual information decreased appreciably. Importantly, consistent results were obtained when unconsciousness was induced by dexmedetomidine, an anesthetic agent with a distinct molecular action than isoflurane. This result indicates that the observed global reduction in information exchange may be agent invariant. Taken together, these findings provide compelling neuroimaging evidence suggesting that the brain undergoes a widespread disruption in the exchange of meaningful information during AIU and that this phenomenon may represent a common system-level neural mechanism of AIU.

Dynamic Connectivity Patterns in Conscious and Unconscious Brain.

Brain functional connectivity undergoes dynamic changes from the awake to unconscious states. However, how the dynamics of functional connectivity patterns are linked to consciousness at the behavioral level remains elusive. In this study, we acquired resting-state functional magnetic resonance imaging data during wakefulness and graded levels of consciousness in rats. Data were analyzed using a dynamic approach combining the sliding window method and k-means clustering. Our results demonstrate that whole-brain networks contained several quasi-stable patterns that dynamically recurred from the awake state into anesthetized states. Remarkably, two brain connectivity states with distinct spatial similarity to the structure of anatomical connectivity were strongly biased toward high and low consciousness levels, respectively. These results provide compelling neuroimaging evidence linking the dynamics of whole-brain functional connectivity patterns and states of consciousness at the behavioral level.

Genetic influences on resting-state functional networks: A twin study.

Alterations in resting-state networks (RSNs) are often associated with psychiatric and neurologic disorders. Given this critical linkage, it has been hypothesized that RSNs can potentially be used as endophenotypes for brain diseases. To validate this notion, a critical step is to show that RSNs exhibit heritability. However, the investigation of the genetic basis of RSNs has only been attempted in the default-mode network at the region-of-interest level, while the genetic control on other RSNs has not been determined yet. Here, we examined the genetic and environmental influences on eight well-characterized RSNs using a twin design. Resting-state functional magnetic resonance imaging data in 56 pairs of twins were collected. The genetic and environmental effects on each RSN were estimated by fitting the functional connectivity covariance of each voxel in the RSN to the classic ACE twin model. The data showed that although environmental effects accounted for the majority of variance in wide-spread areas, there were specific brain sites that showed significant genetic control for individual RSNs. These results suggest that part of the human brain functional connectome is shaped by genomic constraints. Importantly, this information can be useful for bridging genetic analysis and network-level assessment of brain disorders.

Coherence of visual representations: attention and integration of contour shape information.

Change blindness demonstrations illustrate the limited detail of visual representations. These demonstrations typically require disruption to the visual input when the change occurs or changes that occur very slowly. With sustained viewing or faster changes to the scenes, changes are more easily detected because attention can be effectively allocated to the part of the scene that is changing. Here, we investigate the interaction of visual attention and memory in the domain of 2-D contour shapes. We show, using a novel combination of established change blindness paradigms, that changes can go unnoticed even when they occur on isolated 2-D contour shapes. The effect appears to be due to involuntary updating of stored shape information. This involuntary updating process, however, is constrained so that previously attended shape information is updated only when attention is reallocated to qualitatively similar shape information.

The differences in self-esteem, function, and participation between adults with low cervical motor tetraplegia who use power or manual wheelchairs.

OBJECTIVE: To explore the differences between manual and power wheelchair users in terms of self-esteem, function, and participation in persons with a similar motor level of spinal cord injury (SCI). DESIGN: Descriptive cross-sectional study with a single data collection. SETTING: General community. PARTICIPANTS: Participants (N=30) were a convenience sample of adults with self-reported C6 and C7 tetraplegia caused by SCI who are 1 or more years postinjury. Eighteen were manual chair users, and 12 were power chair users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rosenberg Self-Esteem Scale, Spinal Cord Independence Measure III (SCIM III) as a measure of function, and the Craig Handicap Assessment and Reporting Technique (CHART) as a measure of participation. RESULTS: There were no significant differences between manual and power chair users regarding age, time since injury, or length of initial rehabilitation stay. A significant difference was seen between wheelchair groups (F=2.677, P=.038). Multivariate analysis showed the differences to be in the SCIM III (F=11.088, P=.003) and the CHART subcategories Physical (F=7.402, P=.011), Mobility (F=12.894, P=.001), and Occupation (F=5.174, P=.031). CONCLUSIONS: Manual wheelchair users demonstrated better physical function, mobility, and had a higher employment rate than power wheelchair users based on the SCIM III and CHART in this sample of adults with C6 or C7 motor level tetraplegia.